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November 2017

New (Very High) Prices on Old Drugs

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Editorial Fellow, JAMA Internal Medicine
  • 3Editor, JAMA Internal Medicine
JAMA Intern Med. 2017;177(11):1568. doi:10.1001/jamainternmed.2017.3775

H. P. Acthar gel, or repository corticotropin (rACTH), was approved by the US Food and Drug Administration (FDA) in 1952 and currently is indicated for the treatment of infantile spasms, exacerbations of multiple sclerosis, and, nebulously, “rheumatic; collagen; dermatologic; allergic states; ophthalmic; respiratory; and edematous state.”1 The unremarkable history of this little-known drug is in contrast to its astounding rise in price, detailed in this issue of JAMA Internal Medicine, by Hartung and colleagues.2 The authors found that the price of the drug to Medicare increased almost overnight from $1650 to over $24 000 per 5-mL vial when it was acquired by Questcor in 2001 and continued to rise. It was acquired by Mallinckrodt in 2014, who increased the price yet again. It is currently $34 034 per 5 mL vial. Remarkably, Medicare spent $1.3 billion dollars on Acthar gel between 2011 and 2015.2