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At $28K a vial, Questcor's (QCOR) Acthar has propelled shares to huge gains. QCOR bought the...

  • Sunday, December 30, 2012, 11:35 AM ET
    At $28K a vial, Questcor's (QCOR) Acthar has propelled shares to huge gains. QCOR bought the drug for $100K in 2001, planning to produce it only to treat infantile spasms. But thanks to aggressive marketing, it's now being prescribed for MS, arthritis, and kidney disease. Aetna's (AET) decision to limit off-label treatments has hit shares, but it's not clear any viable alternatives are on the horizon. (NYT)
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This news story has 32 comments:

  • The whole story is fascinating. Considering all the hype and news, none of which is new, the shares just seem to be a punching bag despite a very low P/E and now a dividend which is equal to BMY and other mega cap drug stocks. Along with significant insider ownership and a large buyback in place I would think a short squeeze is coming. I have no stock but am certainly thinking about it
    30 Dec 2012, 12:27 PM Reply Like
  • If the whole story would be told reactions might be different. If a stockholder (I am one) does due diligence it would be very apparent that Acthar has FDA approval for some 19 immune disorders. Also, in spite of the innuendos and misinformation being bandied about by many organized shorts (Citron/Andrew Left) the insurance companies, including Aetna and BC/BS Mich. will consider coverage of NON-RESPONSIVE to CORTICOSTEROIDS as a specialty drug with the filing of a Medication Authorization Request Form which is usually required of all specialty drugs (check your Rx insurance plan). The cost is not much different than many specialty drugs for cancer and other auto immune disorders.
    30 Dec 2012, 12:45 PM Reply Like
  • Drdon, the problem is that they are charging Medicare 1 million times more than they should for their drug. Steroids cost less than 200$ and Archar cost 28k$ per injection. If they didn't get reimbursed by the insurance companies they would have maybe 1% of the sales they have now cause no one in their right mind would pay 28k$ dollars for 1 vile that used to cost 50 dollars prior to Questcor being the drug and redoing the pricing on it. To me, I sight with Citron. Seems a real shame that people are being duped into believing this company can justify this high price for this drug that isn't worth it.
    30 Dec 2012, 01:48 PM Reply Like
  • $28K per injection? Surely not. How about $28K per vail, that provides for say, 30 injections (I don't know the real number). That would equate to $933 per shot or $467 per shot under a 60 injection assumption. Then it all depends on how many shots, say, an MS patient needs a year. If, say, 4 shots a year improves my mobility, etc., I'd gladly pay $2,000 to $4,000 a year, but I'm not an MS sufferer and I don't know how many shots are required a year - just looking for answers, but $28K per injection seems incredulous.
    30 Dec 2012, 02:27 PM Reply Like
  • I don't know the cost for MS, but according to http://1.usa.gov/xpEr2s the cost for a course of treatment for infantile spasm with acthar could approach $80,000 to $100,000.

    According to http://bit.ly/R0hK7R the cost often goes to $150K per course for two courses.
    30 Dec 2012, 03:20 PM Reply Like
  • Where do you get the 1% sale projection? I believe that this drug is absolutely necessary for some
    30 Dec 2012, 03:35 PM Reply Like
  • wise words Albert wise words
    30 Dec 2012, 03:36 PM Reply Like
  • Albert, please read the NYT story linked above where the steroids cost $200 vs $125K (of Acthar) per baby and how they were saving $2 million. Indeed, our fears of how expensive Acthar (some Viking name I guess?) has gotten are realized.
    30 Dec 2012, 04:38 PM Reply Like
  • Recommended dose for MS relapse is 80 - 120 U daily for two weeks for an MS exacerbation. One vial is 5 mL at 80 U/mL, so around five days' worth. The cost is definitely in the tens of thousands which really is a tough sell for treating an MS relapse, since generally therapy during relapses has been found to offer symptomatic relief but to have no long term effects on disease progression (i.e. people feel better in the short term but they still have MS).
    30 Dec 2012, 04:40 PM Reply Like
  • Thought there was, up until a few weeks/months ago, a 100% reimbursement policy with Medicare/Medicaid? The number came down some and I can't remember who instigated that - the company or gov't, but something does not sound right about your statement....
    30 Dec 2012, 09:18 PM Reply Like
  • Correction: a vial of Acthar gel contains enough for five injections, not one. Still expensive, but the results justify the $$$$'s.
    31 Dec 2012, 09:13 AM Reply Like
  • Your numbers are so far off as to be completely made up. You've done no research.

    Acthar is approximately 9 times the price of steroids, requires more expensive manufacturing, and was a money loser for decades. Previous company was losing 15 million per year when they sold it. So now you blame a company for buying the rights to it, and making an actual profit.

    It was such a money loser, that before QCOR bought it, it was on the FDA shortage list twice in the late 1990s. No one could produce it at a profit but was a needed drug according to the FDA.

    Not to mention your many spelling errors that show you not only made all that info up, but probably before you even had a cup of coffee that day.
    31 Dec 2012, 10:07 AM Reply Like
  • A Viking term? Posting on something you don't know anything about, eh?

    Acthar's name comes from the main active ingredient ACTH, which your body produces in your pituitary and sends to you adrenal glands.

    It is a precursor to your own body's steroids. Steroids that you need if you have an allergic reaction or other contraindication to steroids that were manufactured.
    31 Dec 2012, 10:10 AM Reply Like
  • If steroids cost $200, wouldn't a million times more be $200,000,000 per vial of Acthar? Just askin.
    31 Dec 2012, 05:08 PM Reply Like
  • Albert, the injections are for MS flare ups not to treat MS thus the timing of the injections is not regularly. Scott - QCOR has not been charging Medicare patients for Achtar. They have been refunding 100% of these prescriptions. They just recently announced that the Government had approved a much lower rebate and this hasn't gone through yet, but they should only have to refund 23% of these prescriptions in the future, instead of 100%. Also, the person who wrote this comment should edit their comment. None of these indications are off-label. That needs to be removed as it is completely untrue.
    30 Dec 2012, 04:26 PM Reply Like
  • Nobody in the correct frame of thought would pay $28K for a vial of drug that used to cost $50 - until you're the 2% of MS sufferers that don't respond to convention therapies with corticosteroids. Or you're at the end stage of nephrotic syndrome and kidney failure is looming. These patient populations are what QCOR is targeting.

    The NY Times article states that QCOR helps process 30 prescriptions a day. That works out to be about 650 or a month or less than 8000 a year. That's a tiny number in a grand scheme of things. How much should QCOR lower the price of the Acthar to stay profitable? I am sure if it's so lucrative and easy money, the big pharmas will be knocking on their doors by now.

    Citron and StreetSweepers are short selling entities that are in it to make a quick bucks. Some of their arguments are valid, but when the stock started to recover from their attacks, they resorted back to their playbook of spreading misinformation - to create fear, uncertainty and doubts.
    30 Dec 2012, 04:35 PM Reply Like
  • Here's the deal with Acthar.... perhaps besides for infantile spasms, the drug is used as a last line of defense in dealing with inflammatory indications. There are literally dozens of corticosteriods that could be used to treat these conditions-- and Medicare and managed care make well sure they are used first in therapy.

    When these don't work, then there is little available in the market that can address these flares. Questcor is pricing based on supply/demand factors-- when there is a viable product that can compete after corticosteriods, then the price will go down.

    Questcor tried at one time to use Acthar as a first line of defense in several inflammatory diseases-- and almost went bankrupt because they couldn't compete directly against corticosteriod alternatives.

    The pricing keeps the company viable. The risk is that there's another viable alternative in 3rd line therapy-- or if someone else figures out the biologic makeup of the drug and start making generic Achthar vials. This is literally a one-hit wonder for the company... which should really make one think.

    Managed care providers have every right to make the case for Acthar therapy a bigger uphill battle... and they are doing it. Interestingly enough, it isn't stopping patients who are really needing the therapy from getting it.
    30 Dec 2012, 04:56 PM Reply Like
  • The answer is as I have previously stated...NON RESPONSIVE to corticosteroids. Also you should all realize, especially if you read the NYT article and saw the picture of the packaging, that the vial is 5ml. and a multiple dose. So it is incorrect to say that a single dose costs $28,000. because it is a multiple dose. Familiarize yourselves with the cost and pricing structure of specialty drugs for immune, inflammatory diseases and you will see that they are exceedingly expensive and that's the reasoning behind pre-authorization for these upper tier drugs.
    30 Dec 2012, 07:57 PM Reply Like
  • Just to be clear... if Medicare is reimbusing a drug, despite what you consider is "too expensive", they are doing so under no legal challenge whatsoever. Your opinions on the cost of the drug should be directed at the parties that are willing to pay the price for it.

    If managed care is reimbursing the drug, which they are under increasingly higher hurdles, they are also doing so under their own guidelines. Perhaps your arguments should be direct there as well.

    If one wants to take a moral stance on drug pricing for Acthar-- that is fine (I think there are literally dozens of other drugs that meet that criteria). But the legal and economic arguments have all fallen short of the mark.

    I think there are a whole lot of interested parties hoping that there is either a valid legal challenge on the horizon, or something on the R&D front that will force some competiton in these niche markets (whether its a generic equivalent or a branded drug). But until one gets to that point, QCOR will be a very profitable company-- with a whole lot of short sellers pumping and then dumping the stock.
    31 Dec 2012, 10:10 AM Reply Like
  • sorry for the errors in my posting. and i am not short, but i know when i see a scam going on and to me QCOR is a total scam. i think with all the heat they are getting you will see another drop sometime soon. i think other insurance carriers are going to drop it other than infantile spasms. if i was holding long i would be holding scared. that is just me. if you guys are totally confident in this investment that is great, but i am just saying it has a long way to fall if these short sellers keep up this attack. if i was long i would feel a lot more comfortable if i was long at say 10bucks than 25.
    30 Dec 2012, 08:09 PM Reply Like
  • An even more laughable post. You 'know' when you see a scam? If that were true, then you wouldn't be posting on SA as you'd be the richest man on the face of the earth.

    You need to do research on what Acthar is and what it does. In depth research, not short articles. Pick up an A&P textbook and go to the endocrinology section. Even a dental hygienist has to pass a test on what ACTH is, so this isn't rocket science and you can understand that chapter.
    31 Dec 2012, 10:13 AM Reply Like
  • I don't think there are any uncertainties in any investment, Scott.

    But the mere suggesstion that what QCOR is doing in the marketplace is a "scam" is just ridiculous. QCOR is providing a therapy for a very narrow segment of the patient population, and they are pricing it in a relatively free market. Government and private insurers are paying for it. If you happen to find the "scam", I'm sure those entities are more than willing to listen.

    I think the real risks behind QCOR are not really what people are focusing on today. If you are getting massive profits from a one drug wonder where the patents have already expired-- you better start making the upfront investments in R&D to significantly broaden your product pipeline.

    To that end, it appears that QCOR management is content on milking the Achthar golden goose as much as they possibly can in the near term. And i think that ultimately becomes a big mistake.

    In the meantime, QCOR will continue to be a very profitable company that will remain a favorite targets for shorts. This stock can be pumped higher on fundamentals alone-- and it will continue to be exposed to short sellers willing to find a nugget or two that can challenge the business model.
    31 Dec 2012, 10:27 AM Reply Like
  • if we see a step up by more government agencies looking into their marketing practices i think the longs are totally screwed. all i can say is watch out below.
    30 Dec 2012, 08:10 PM Reply Like
  • But you're not short, right? ;-)
    30 Dec 2012, 09:14 PM Reply Like
  • Scott,
    Sure, and by the way can you enlighten us more about Qcor. I was really impressed by your suggestions on Qcor. You should be hired by Citron as your insights into biotech stocks might help them more. You are a smart man indeed??
    30 Dec 2012, 10:40 PM Reply Like
  • If pigs could fly, would they be birds?

    If MSFT CEO Bill didn't sign a fantastic contract with IBM for the first DOS, which IBM considered to be a fantastic deal for them... well, I don't need to finish that do I?

    If investigation results in no action, then QCOR skyrockets, watch out shorts?

    See how that works? Not helpful is it? Neither are your comments.
    31 Dec 2012, 10:34 AM Reply Like
  • As far as I know, (QCOR)'s drug is a biotech drug. The FDA has no guidelines on generic biotech drugs, so none exists in the U.S. Europe has guidelines on generic biotech drugs, so Citron's statement of a generic version of Achtar is probably true. But that won't affect the U.S. market.

    As for the price, $28k is nothing. Cancer drugs can cost $100k to prolong life for 3 months.
    30 Dec 2012, 08:14 PM Reply Like
  • Michael, that is so true. If you look at studies performed for new drugs much of the study is mathematical because they look for endpoints particularly in a Phase 3 trial. For cancer drugs, in particular, just an additional few months can be the difference between halting a trial or going on to obtain approval. A single IV infusion of Immunoglobulin, used for some MS patients and neuropathy patients can cost thousands for a single dose. You are not dealing with a common statin drug or aspirin for that matter. Specialty drugs that have orphan status are generally used for treating rare and esoteric disease entities. No one is putting a gun to a patient's head and gouging.
    30 Dec 2012, 08:41 PM Reply Like
  • The implication in the article is that while it may be fair for a company to recoup large R&D and manufacturing costs (which is what you see with many cancer drugs). QCOR expended almost nothing on R&D and it costs around $280 per vial to manufacture. The article didn't mention the capital costs for the manufacturing equipment. But there's a clear insinuation that they're price gouging.
    31 Dec 2012, 08:38 AM Reply Like
  • Millions went into the manufacturing process. The fact that it isn't expensive to operate the plant, doesn't mean those millions don't need to be recouped.

    Previous company lost 15 million a year trying to manufacture this drug and had a lot of problems with purification. Mad cow disease kept creeping in.

    Research people, most of the comments here show zero research except in reading short articles.
    31 Dec 2012, 10:16 AM Reply Like
  • Michael... to be sure, there are guidelines the FDA uses for generic biologics. In many cases, full fledged studies are required to prove bioequivalence. That's one of the primary reasons why Acthar has been such a challenge, despite it being "off patent". Proving bioequivalnece for Acthar has been very difficult... and with such a narrow market, potential competitors are reluctant to enter.

    As for the issue with price gouging, there are literally dozens and dozens of drug therapies out there that serve very small patient populations and priced in a similar way. One drug that comes to mind in Cinryze, a drug used to treat heriditary angiodema attacks (produced by ViroPharma). A few weeks use of that drug usually runs in the range of $75k to $125k.

    I think the problematic issue with QCOR is what they are doing with the profits. While they could easily acquire an emerging R&D pipeline, or invest internally in their own, they prefer to harvest Acthar for all it can. And I don't think that will serve their best interests in the long run, for a number of reasons.
    31 Dec 2012, 10:44 AM Reply Like
  • Longing $QCOR will never hurt you with such big negativity on this stock.
    31 Dec 2012, 02:10 AM Reply Like
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