H.P. Acthar Gel

9. H.P. Acthar Gel
Questcor Pharmaceuticals
2013 Revenue:
$250 million

H.P. Acthar Gel is a hormone-based drug derived from pig pituitary glands that has been on the market for more than 60 years. Multiple sclerosis is only one of 19 conditions it is approved to treat, but the condition for which it derived about a third of its $761.3 million in sales last year, sales that were up 50%. The drug is often prescribed in older patients with relapsing MS.

The drug ran about $40 per vial when Questcor ($QCOR) bought it in 2001, but since then its cost--and questions regarding its effectiveness--have soared, particularly in the past year. In 2007, the company jacked the price up to $23,000 per vial and by 2012, the Medicare Part D drug program paid an average of $41,763 per prescription, according to recent reports by the ProPublica investigative journalism group. It found that the top 15 prescribers of Acthar accounted for 10% of Medicare prescriptions, and the top four were paid promotional speakers and/or researchers for the company.

But there has been more. In July, shortly after the New York Times found that the drug was associated with 20 deaths and 6 disabilities since 2012, Questcor conceded in an SEC filing that the drug actually prompted 1,022 patients to report 3,100 adverse events between January 2011 and December 2013. In 2012, federal authorities launched an investigation into the company's marketing of the product, but if anything comes of all of these questions, it will be a problem for Mallinckrodt ($MNK) to sort out. The Ireland-based company completed its $5.8 billion buyout of Questcor in August. -- Eric Palmer (email | Twitter)

For more:
Is Medicare wasting $220M a year on Questcor's controversial Acthar?
Questcor comes clean on adverse effects of beleaguered drug Acthar
With $135M rights deal, Questcor locks up rival to its pricey Acthar drug
Questcor stock reels as feds eye Acthar marketing
Aetna all but drops Questcor's Acthar drug; shares plummet

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