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Author: JiminyBillyBob Three stars, 500 posts Old School Fool SC1 Red Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 100  
Subject: Re: Blue Cross Blue Shield Michigan Date: 12/27/2012 7:44 PM
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Whoops, I published information from August 2012, not the most recent study update. Here is the link:

http://www.bcbsm.com/mprApp/MedicalPolicyDocument?fileId=204...

Here is the relevant paragraph:


Acthar is not covered for the following indications:
a. Diagnostic testing of adrenocortical function, as it does not have higher efficacy than cosyntropin for this indication
b. Corticosteroid-responsive conditions, as it does not have higher efficacy than corticosteroids for these indications
c. Any other indications, as efficacy has not been established.
4 of 4
d. Medical contraindications or intolerance to corticosteroids expected to occur with Acthar gel (e.g., fluid retention, altered glucose tolerance, elevated blood pressure, behavioral and mood changes, increased appetite, and weight gain)


This appears to be a little more restrictive because while Acthar coverage for Corticosteroid-responsive conditions (MS) would be covered provided that patients don't respond to steroids (which is normal business for Questcor), Blue Cross Blue Shield Michigan is basically putting a blanket stop to all other indications since efficacy has not been established.

However, I'd have to research how many of the indications in addition to MS that are approved for Acthar are steroid-related...meaning that if steroids are used for treatment, and if those steroids fail, then Acthar would be a covered option according to the policy above. Autoimmune disorders in general would seem to be covered. I hope this can be addressed on the next conference call, but my educated guess is that while this appears to be a more restrictive policy, it is actually not going to affect coverage because Acthar is supposed to be used only when steroids fail as a first-line treatment.

For example, the three indications that Acthar is generally used for are infantile spasms, MS, and nephrotic syndrome. If you research treatment for nephrotic syndrome, one of the first things that pop up is use of Corticosteroids. If that is prescribed to the patient and it fails, Acthar would be a covered option according to the policy.

Questcor is pursuing Acthar as treatment for rheumatology patients, and one of the normal treatments for patients with severe rheumatologic diseases is steroids. Thus, one would think that after all other first-line treatments fail for rheumatology patients, Acthar is a covered option according to the policy above.

Carl
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