Senator Jeff Merkley says that he will cosponsor Sen. Bernie Sanders’s Medicare for All legislation, which is expected to be introduced later this week.
As Sen. Merkley has talked with Oregonians and Americans while Congress debated health care this year, he has heard from many about the importance of not only solidifying the gains we have made, but also simplifying our fragmented health care system to ensure that no Americans fall through the cracks.
“Health care should be a right for every single American, not a privilege reserved for the healthy and the wealthy.
“Right now, our health care system is incredibly complex, fragmented, and stressful. It would be terrific to have a simple, seamless system where, solely by virtue of living in America, you know that you will get the care you need.
“We’ve made tremendous strides in expanding access to health care across our nation, but many Americans still are rightfully frustrated by the cost and complexity of our current system. It’s time to simplify health care and lower patients’ costs, and embrace Medicare for All.”
OHSU, Oregon’s premier medical facility, released a statement that typifies some of the root causes of ever and ever higher costs for medical care.
Medicare spent more than $1 billion over a five-year period on a high-priced drug that has not been proven more effective for a collection of inflammatory conditions than much less expensive corticosteroids, research by the OSU/OHSU College of Pharmacy shows.
The analysis also indicates that a comparatively small group of “frequent prescribers” combine to write prescriptions that lead to the bulk of Medicare’s expenditures on the drug, repository adrenocorticotropin, or ACTH.
In 2015 alone, Medicare spending topped $500 million on the drug, the cost of which has soared to $36,000 per course of therapy.
Known by the trade name Acthar, the drug’s primary use is to treat rare epileptic spasms in children under age 2.
“The drug has an interesting back story,” said Dan Hartung, lead author on a research letter that was published today in JAMA Internal Medicine. “It’s a fairly old drug, first approved in 1952, prior to many of the FDA rules about clinical effectiveness of various drugs.
The drug, classified as a “biologic,” was initially approved for a broad range of corticosteroid-responsive inflammatory conditions. “It’s a hormone produced in the human body that signals the release of steroids,” Hartung said. “It does the same job as low-cost corticosteroids.”
Questcor Pharmaceuticals purchased the rights to Acthar in 2001 for $100,000 and began steadily raising Acthar’s price. In 2007 Questcor increased the price of the drug, which once sold for $40 for a vial, or course of therapy, from $1,650 to $23,000 overnight.
Questcor markets the drug aggressively for relatively common conditions such as rheumatoid arthritis, multiple sclerosis and nephrotic syndrome, Hartung said. The Food and Drug Administration approved Acthar for those types of conditions decades ago when requirements were less strict; no clinical trials were required.
“There are a variety of FDA-approved indications that lack a lot of evidence that Acthar is even effective, let alone better than inexpensive corticosteroids,” Hartung said. “And what allows for this kind of pricing is that it’s a fairly complex molecule and no competitors can exactly duplicate it; they have a monopoly on this particular molecule.”
In 2015, Acthar generated gross revenue of about $1 billion – more than half of which came from Medicare, and much of the rest coming from Medicaid, Hartung said, meaning public expenditures likely accounted for almost all of the sales.
Hartung and the other collaborators found Medicare spending on the drug increased tenfold and totaled $1.3 billion from 2011 to 2015.
In 2014, a total of 1,621 prescribers were responsible for $391.2 million in Acthar spending; among those, 203 frequent prescribers – 94 rheumatologists, 55 neurologists and 54 nephrologists, each with more than 10 prescriptions – accounted for $165 million of the total.
“And in general these physicians are prescribing about the same number of other drugs compared to their peer specialty groups, so we suspect they are not treating more severely ill patients,” Hartung said. “Mallinckrodt is really aggressively marketing in ways that possibly subject prescribers to conflicts of interest. From the payer side, there is really little that little justifies this drug and its exorbitant cost over much cheaper alternatives. If Medicare were to take a firm stand on reimbursements, this wouldn’t be happening.”
Joining Hartrung on the study were Kirbee Johnston, Shelby Van Leuven, Atul Deodhar, David Cohen and Dennis Bourdette.