Friday, 19 Oct 2018

You are here

Company Payments to Rheumatologists, Specialists Linked to Increased ACTH Prescriptions

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.



The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

Jack It is unfortunate and sad that obvious and subtle conflicts of interest with regard to drug choice are so common in rheumatology and medicine in general. I am surprised however that insurance companies are not limiting the use of Acthar, since they seem to do so with many highly effective and appropriate therapies. Art

More Like This

NEJM Debate on Medical Marijuana for Chronic Pain

This week’s NEJM features a case discussion and debate over whether medical marijuana should be used to treat chronic pain. The debate focuses on a 31-year-old woman with long-standing complex regional pain syndrome in her leg and foot. CRPS followed a sports related hairline fracture in the right fibula. Her pain has been intractable since.

Hip and Knee Replacements Monitored by Smart Watch

Reuters reports that patients with hip or knee replacements will now be followed for progress using their Apple watches.

A multi-site study involving medical facilities from Massachusetts, California, Colorado and Michigan will receive stats including heart rate, steps taken and standing hours from patients waiting for or recovering from hip and knee replacement surgery.

NSAIDs OK for Certain High-Risk Groups?

Some patients typically contraindicated for prescription nonsteroidal anti-inflammatory drug (NSAID) use may be able to take them with no increased risk of harm, according to a large observational study.

Physical Therapy Equals Arthroscopic Surgery in Meniscal Tears

Several new trials suggest that conservative management may be as efficacious as arthroscopic surgery in patients with meniscal tears, thus contributing to the trend of fewer arthroscopic surgeries. A new trial of patients with nonobstructive meniscal tears shows no significant difference in 2 year outcomes between physical therapy and early arthroscopic partial meniscectomy.

Activity Trackers May be Helpful in Arthritis Patients

Use of wearable activity trackers was associated with increases in the number of daily steps among individuals with rheumatic and musculoskeletal disorders, a meta-analysis found.