WTAF: Company Raises the Price of a Drug That Fights Infant Epilepsy by 85,000%

I worked for a medicare and medicaid company. This drug is approved for a few other companies. We approved it once for infantile spasms. Acthar gel is approved for a few other conditions that are usually treated by a few other medications, like prednisone. Anyway we had one nurse that liked prescribe this drug, and she wouldn't change it, even if the patient hadn't tried first line therapies for their condition. The thing about medicare is you can keep appealing a decision, if you appeal it twice there is an independent review board that reviews it after the second denial. They overturn nearly ever decision made by a plan, and an overturned decision creates a mark against the plan that can impede their availability to advertise and cost them millions of dollars. So if a plan doesn't pay for it they can lose millions, if they do lose $60,000 (most people need to injections) a month. Anyway that was the companies PPO plan, they members could go to any doctor. The plan pulled out of the area, and I still wonder how many medicare plans still offer coverage in that area.

/r/news Thread Parent Link - futurism.com