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  • mikeylikesit33_99 mikeylikesit33_99 Feb 11, 2013 7:03 PM Flag

    Acthar, Medicare, Medicare Plan D, Rebates, indications, and YOU

    In an effort to stave off more fake news by Lafferty, let's talk about a few subjects. He literally called the blue sky blue and got away with it as a short thesis today. Not to forget his past trespasses of lies.

    Acthar's current main indications are IS (Infants), MS (patients have a lower life expectancy by 10 to 15 years), and NS.

    Medicare does not cover high tier drugs. This isn't restricted to just Acthar, it's all high tier drugs. Back in the middle 2000s, the Bush administration helped pass GAP insurance. This was known as the donut hole filler for expensive meds for seniors. It's formal name is Plan D.

    The Medicare rebates announced last year effectively pay Questcor 72% of retail pricing.

    Acthar's first 2 main indications do not affect many seniors. Infantile Spasms is an obvious statement. Multiple Sclerosis is less obvious unless you know about the disease. Life expectancy is 10 to 15 years less, and that means many MS sufferers just don't make it to be on Medicare. In fact, generationally, our current seniors are still under old life expectancy tables and so few MS sufferers made it. Our current generation 60 or younger, will have more MS sufferers making it to get their social security and medicare benefits.

    With that in mind, Plan D plans generally have small formularies, but they all have links to 'request' additions. Check for yourself on a bunch of insurer's Plan D websites... I helped set some of them up.

    These 'requests' are basically pre-auths, but with more polite terminology.

    Every year the insurers with Plan D plans run reports and add frequently 'requested' drugs to the agenda for the annual meeting of the decision making body.

    So it isn't surprising that not many Plan Ds have Acthar (or other high tier drugs) yet.

    Here's a game changer though... NEPHROTIC SYNDROME!

    NS can occur at any age and many older folks develop it after years of drug abuse, drinking, dealing with other kidney disease, etc.

    Do you think we will start seeing more requests for Acthar to be added to formularies for Plan D in the future? Especially with all the new studies proving efficacy?

    If anyone has any questions, I'll do my best to answer...

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