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Comment & Response
April 2018

Uses of H.P. Acthar Gel in the Clinical Setting—Reply

Author Affiliations
  • 1College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland
  • 2Department of Neurology, Oregon Health & Science University, Portland
  • 3MS Center of Excellence - West, VA Portland Health Care System, Portland, Oregon
  • 4Division of Nephrology and Hypertension, Department of Medicine, Oregon Health & Science University, Portland
JAMA Intern Med. 2018;178(4):583-584. doi:10.1001/jamainternmed.2017.8545

In Reply We thank Dr Otulana for his interest and response to our Research Letter.1 We agree that repository corticotropin (Acthar) may have a place in therapy for a small number of patients who cannot tolerate or do not respond to synthetic corticosteroids. While Acthar use in the Medicare program is attributable to a relatively small number of specialists, costs to the program are substantial. In 2015, Medicare spent nearly twice as much approximately $504 million) on Acthar for 3104 patients than it did on lisinopril prescriptions (approximately $253 million) for 7.8 million patients.2

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    1 Comment for this article
    Tom Kaye, Pharm D MBA | Research consultant
    The sales of this product seem related to  financial advancement, not clinical need. In modern medicine, this medication should be restricted in the market for any diagnosis other than stimulating the adrenal glands. This diagnosis remains important , but adrenal stimulation can be met with better value products.