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  • pharmaman58 pharmaman58 Mar 23, 2013 11:32 AM Flag

    Focus on a Mikey statement, big, big news

    Mikey informed us that many insurance companies have added Acthar to Part D coverage in 2013. This is great news--from a financial standpoint and perhaps even more so, from a insurance reimbursement standpoint.

    Also stated by mikey, coverage by CMS puts considerably more pressure on private insurers to reimburse. Insurers are reluctant to fly too hard against CMS for many reasons and perhaps mikey will elucidate when he has time, as the resident expert.

    My advice? Pay no attention to short seller noise regarding reimbursement. QCOR is getting no different treatment than other expensive biological drugs--which is: lots of questioning, scrutiny, conditions, pre-auth-- then reimbursement for appropriate patients--for both on and off label use.

    For those not in the biotech industry--let me define off label. Biotechs can not sell or promote off label use--go directly to jail--do not pass go. But...prescribers can write a script for any drug on the market where they believe patients will benefit, especially desperate patients who have failed first line therapies. Prescribers can and do initiate dialogs with drug companies about off label scripts--in which case, the medical affairs department of the drug company is allowed to answer specific questions and point to literature, without promoting use.

    Hence, for example, we saw Acthar scripts for gout coming out of the LifeSci survey of rheumatologists. This is not surprising, and not surprising to anticipate low volume, incremental growth in off label scripts as more rheumatologists become educated about Acthar's potential effects on autoimmune and inflammatory disorders.

    Lastly, put the short seller and Jefferies thesis about potentially declining MS sales into perspective. First, I expect those revenues to grow slowly, with seasonal ups and downs--warmer weather, more MS flares, more scripts. Second, this thesis "accidentally" fails to mention the offset revenue in NS and rheumatology indications. Oops.

    Sentiment: Strong Buy

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