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