Legal But Immoral Medicare Ripoff?

According to a CNN report, By Wayne Drash, Sergio Hernandez and Aaron Kessler, CNN, published June 29, 2018, entitled,

"Medicare spent $2 billion for one drug as the manufacturer paid doctors millions"

 Ref. https://www.cnn.com/2018/06/29/health/acthar-mallinckrodt-medicare-claims-doctor-payments/index.html

Quotes shown below are from the above referenced article.

While the vast majority of doctors consider the needs of their patients first, and, in general, try to use generic drugs when writing their prescriptions, there are a significant number, who, apparently, consider their financial needs first.  I can attest to that because myself I have experienced where proprietary drugs were ordered, when compatible generic drugs were available, which were ultimately successfully used, upon my insistence.

"(CNN)More than 80% of doctors who filed Medicare claims in 2016 for H.P. Acthar Gel -- a drug best known for treating a rare infant seizure disorder -- received money or other perks from the drugmakers, according to a CNN analysis of publicly identified prescribers."

CNN shows the following quotes:

"The evidence that this drug is any better than synthetic steroids is either weak or does not exist. Daniel Hartung, Oregon State College of Pharmacy"

"We clearly found that as you ratchet up the payments to doctors, there were more prescriptions generated and more spending in the Medicare program on this drug," said Daniel Hartung, the study's lead author."

"Acthar is best known for treating babies with infantile spasms, a rare and catastrophic form of epilepsy. Hartung, an associate professor at Oregon State's College of Pharmacy, said he found it troubling the drug is being marketed in adult medicine, with taxpayers footing the bill for hundreds of millions of dollars." 

It appears, an infant drug is now prescribed for seniors, for a variety of reasons, at a staggering cost to Medicare.

"A steroid like prednisone can cost as little as $2.50 for a bottle of pills -- less than a venti coffee from Starbucks -- compared to Acthar at nearly $39,000 a vial of injectable liquid. Over a course of treatment, those figures get even more dramatic: $7.50 for three bottles of prednisone vs. $117,000 for three vials of Acthar."

Year	Claim Count	Total Spending
2011	1,471	$49,456,911
2012	3,387	$141,451,608
2013	6,752	$262,581,602
2014	9,611	$391,189,653
2015	11,209	$503,999,371
2016	12,867	$636,174,840
Total:	45,297	$1,984,853,985

The meteoric rise in claims is surely the result of massive payoffs to the doctors involved.  The CNN article, shows some amounts spent on doctors, and even names a few of them.

"Since Mallinckrodt purchased the drug from Questcor in 2014, the price of Acthar has gone from $32,000 a vial to nearly $39,000. In 2000, before Questcor purchased it, it was $40. Questcor shocked the medical community when, on August 27, 2007, it raised the price overnight from $1,600 to $23,000 a vial."

CNN shows this quote:

  

"Medicare having to spend almost $2 billion on a drug that is of questionable benefit is very disturbing.  Rita Redberg, cardiologist and professor at the University of California, San Francisco, School of Medicin" 

"Multiple doctors familiar with Acthar told CNN that the drug shows little benefit in adults over steroid treatments, which they said could range anywhere from $2.50 for prednisone to $5,000 for a high IV dose of methylprednisolone. Even at the high end, these doctors said, prescribing steroids over Acthar could have saved Medicare nearly $1.8 billion."

"Why would Medicare pay nearly $2 billion over five years when there was a far cheaper alternative?

Stephen Schondelmeyer says you can thank lawmakers for that: Medicare is not allowed to negotiate drug prices or tell doctors what drugs to prescribe.

"Our Congress has told the Medicare program, you cannot control drug prices," says Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota. He directs the College of Pharmacy's PRIME Institute, which studies economic and policy issues related to pharmaceuticals. "We don't have any government process for evaluating, regulating and managing drug prices." 

 

It is this pervasive behavior, bordering on fraud, by the Pharmaceutical industry, and by some doctors that add to the high cost of medicine in the US, when compared to other industrialized countries.

 

This $1.8 Billion fraud connected to this one drug, is surely just the tip of the iceberg.

 

For more details, I suggest one reads the article/report, referenced above.