Cigna updates its coverage guidelines for $30,000-a-vial Acthar Gel

June 07--Cigna, one of the nation's biggest health insurers, has issued new medical coverage guidelines, saying that Acthar Gel, a $30,000-a-vial drug manufactured by Anaheim-based Questcor Pharmaceuticals, is "significantly more expensive than" but "not clinically superior to" alternative treatments for a number of autoimmune and inflammatory diseases such as rheumatoid arthritis, lupus erythematosus and multiple sclerosis.

Cigna's new policy, effective June 16, stops short of saying it will not approve Acthar Gel for those conditions. But, if followed by other insurers, it could cast doubt on the rationale behind more than 90 percent of Acthar sales. Cigna said it will still cover Acthar "as medically necessary" for infantile spasms in children under 2 years old. But that accounts for less than 10 percent of sales.

Acthar's $799 million in 2013 sales accounted for virtually the entirety of Questcor's revenues. The drug's alleged impurity is being investigated by the U.S. Food and Drug Administration, and the company is also under scrutiny by the Department of Justice and the Securities and Exchange Commission.

Questcor said in April that it had agreed to be acquired for $5.6 billion by Dublin-based Malinckrodt.

Contact the writer: 714-796-2440 or bwolfson@ocregister.com

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