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Despite its exorbitant price tag and paucity of supportive clinical evidence, ACTH (corticotropin) sales have increased in the United States. A recent JAMA article examined its use by specialists and found that those who prescribe ACTH (including rheumatologists, nephrologists, neurologists) received corticotropin-related payments from the products sole manufacturer, Mallinckrod.
Researchers from Oregon State and Oregon Health Science University performed a cross-sectional analysis of data from the Centers for Medicare & Medicaid Services 2015 Part D prescribing data that was further linked to 2015 Open Payments data.
The data set include 2015 nephrologists, neurologists, and rheumatologists who had more than 10 corticotropin prescriptions. This included a total of 235 included physicians; 65 were nephrologists; 59 neurologists; and 111 rheumatologists.
Of these 235 specialists, 207 (88%) received a monetary payment from the drug’s maker, Mallinckrodt. Physician payments ranged from $11-$138 321 in 2015. More 20% of frequent prescribers receiving more than $10 000. Maximum total payments were highest for rheumatology ($138 321) compared to nephrology ($56 549) and neurology ($120 387).
There was a significant association between higher dollar amounts paid to these prescribers and greater Medicare spending on their corticotropin prescriptions.
For every $10 000 in physician payments, there was an associated 7.9% increase (approximately $53 000) in Medicare spending on corticotropin. There was no association between corticotropin-related payments and spending on prescriptions for synthetic corticosteroids.
It appears there are significant financial conflicts of interest among physicians who treat Medicare patients with corticotropin therapy.