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Top Acthar Prescribers in Medicare Have Ties to Its Maker

The top four prescribers of the drug were promotional speakers, researchers or consultants.

Many of Medicare's top prescribers of the expensive specialty drug H.P. Acthar Gel have financial ties to the drug's maker.

Only 18 practitioners wrote 15 or more prescriptions for the drug in 2012. At least nine — and all of the top four — were promotional speakers, researchers or consultants for Questcor Pharmaceuticals, a ProPublica analysis shows.

We identified the top prescribers of Acthar by using data from Medicare's prescription drug program, known as Part D. We determined if physicians had financial relationships with Questcor by checking their names against ads for speaking events sponsored by the company, and against clinical trial databases, research articles and conference disclosures.

The amounts paid to practitioners have not been disclosed, but beginning this fall, all such payments by pharmaceutical and medical device companies will be public under the Physician Payment Sunshine Act.

The No. 1 prescriber of Acthar in Medicare in 2012, Dr. William Shaffer, said he gives speeches that draw on his experiences as both a neurologist and a patient with multiple sclerosis, a condition that Acthar treats.

"I was and still am an M.S. patient and have seen not only my personal results but other patients that have responded amazingly," Shaffer said.

The Los Angeles neurologist Regina Berkovich, the No. 2 prescriber, with 38 prescriptions in 2012 in Medicare, has received research funds from Questcor and has spoken on behalf of the company. She did not return phone calls and emails seeking comment.

Several of Medicare's other top prescribers of Acthar have blemishes on their records. For example, the Michigan neurologist Gavin Awerbuch, the most frequent prescriber of the drug in 2011, was charged in May with health care fraud and distributing a controlled substance. He has not yet entered a plea. He could not be reached, and his lawyer did not return phone calls and emails.

The neurologist Sean Orr, who has given promotional talks for the drug but was not a top prescriber, had his medical license suspended last year by Florida, which determined that he had sex with a patient. A civil whistle-blower lawsuit filed in 2012 in United States District Court in Jacksonville, Fla., also accuses Orr of misdiagnosing healthy patients with neurological diseases, including multiple sclerosis, so he could bill for their treatment and prescribe expensive medications. That lawsuit is pending. He could not be reached for comment.

Questcor declined to answer questions for this article. Its public relations firm issued a statement saying that Questcor's promotional activities were "in line with industry best practices" and that it adhered to federal standards.

ProPublica has reported previously on ties between Medicare's top prescribers of expensive drugs and the makers of those drugs. A 2007 report in The New York Times examined the relationship between drug company payments to psychiatrists in Minnesota and prescriptions of antipsychotic drugs for children in the Medicaid program.

Last year, ProPublica reporters identified the drugs that were most actively promoted to doctors in 2010 and 2011 using rankings from Cegedim Strategic Data, a company that tracks marketing expenses. Seventeen of the top 20 Medicare prescribers of the blood pressure drug Bystolic in 2010 received speaking payments from Forest Laboratories, the company that makes it.

Nine of the top 10 prescribers of the Alzheimer's drug Exelon received money from Novartis, the drug's maker. And eight of the top 10 for Johnson & Johnson painkiller Nucynta were paid speakers.

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