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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Hartung DM, Bourdette DN, Cohen DM. Uses of H.P. Acthar Gel in the Clinical Setting—Reply. JAMA Intern Med. 2018;178(4):583–584. doi:10.1001/jamainternmed.2017.8545
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