Subject: RE: CNN Request: Acthar Date: Friday, June 22, 2018 at 12:57:42 PM Eastern Daylight Time From: Jaslow, Ryan To: Drash, Wayne Wayne. l'm reaching out from Nw's press othee. We wanted to pass along this statement from Dr. Dr. Efthimiou loined NYU in 11/2017, after the time period mentioned in your questions. Thank you, Ryan From Dr. Petrns Elthimiou: I consulted with previous and current manufacturers medication, from 201372016, on rheumatological diseases where repository corticotropin is indicated and FDA approved My efforts led to the development oftwo Institutional Revtew Board (IRB) approved research studies (at a prevtous institution) on the safety and efficacy ofthis medication, which has been in use since 1952 Rheumatology conditions not on1y affect seniors, many patients are younger individuals who suffer from autoimmune conditions like systemic lupus erythematosus, dermatomyositis, polymyositis, and others Unfortunately, both younger and older patients sometimes do not respond to tirste, seconds or, even, [htt'drlme treatments, including conicosteroids In these situations, vte consider repository corticotropin, based on published data that it may Vtork differently than corticosteroids (Benko, 2018, Lt, 2015, Aggarwal, 2012, While medication costs remain a global public health issue, my principai responsibility as a physician is to my patents 1n Rheumatology, just as in other disciplines, we constder very expensive biologic medications for treatment, especially for rare and hardrtortreat diseases None of my patients have suffered serious side effects from repository corticotropin All patients on this medication in my practice are carefully monitored for any adverse reactions ifi had a serious, refractory, immunermedtated disease, 1 would take this medication under physician supervision Begin forwarded message From: "Brash. Wayne" Dat June 1 2018 Subject. CNN Reque . Acthar Dear Dr Efihtmlou CNN is vtorking on a story about Medicare spending on HP Acthar and payments to physicians by Acthars manufacturer. and Questcor A CNN analysis found that more than 80% ofthe doctors who filed publicly available Acthar claims with Medicare in 2016 also received money or other perks from or Questcor between 2013 and 2016 I've copied my colleague, Steve Goldberg, on this email CNN's analysis showed that ofthose 288 doctors, eight received an unusually high amount of money .. more than $220,000 .. from the drugmakers Records show you are among those etght, haying received 399 payments worth $243,234 04 0fthat, more than a third was for honorarta, nearly anotherthird was compensation for serytces, more than a fifih was for travel and lodging, and the rest was for consulting, educatton and food and beverage Records also show you filed 13 Medicare Part claims for Acthar in 2010 resulting tn $093,725 34 in Medicare coverage Can you tn more detatl specifically what the payments from the dmgmaker were for and what serytces you providedl Did the payments Influence your 2016 Medicare prescriptions for Acthar'7 Have the payments influenced your protesstonal capacity as a doctor tn any way" How would you respond to critics who say has paid doctors ltke yourself tn an effort to widen the use ofActhar beyond intanttle spasms tnto conditions affecting sentors such as rheutnatology, so the company can increase revenue from Medtcare reimbursements" Why would you choose to prescribe Acthar at a cost oflnore than $35000 per vial when corticosteroids are available for a fractton ofthe cost and are considered equally etl'ecttye tn adult conditions" purchase of Acthar and its marketing push tnto the adult market has been a rise ln deaths where Acthar is the only suspected cause The FDA received one report ofsuch deaths in 20 l2, no reports in 20l3, then the number sptked to [2 in 2014, 24 ln 2015, 21m 2016 and 27 in 2017 At an FDA heanng ln 2010, Dr Philltp Pearl warned that lfdoctors outside the world oflnfantlle spastns began usmg AclhaL "We are going to have more adverse eflects than we ever dreamed of" What are your thoughts on this matter" Have any ofyour patients died from an adverse effect due to Acthar" Would you use Acthar suffered from any ofthe l9 FDAsappmved l'd apprectate a response by Thursday, June 2l Wayne Drash CNN Digital Health Enterprise Repnner This email message, including any attachments, ts for the sole use ofthe tntended recipient(s) and may contatn tnformatton that ts proprietary, contidenttal, and exempt from disclosure under applicable law Any unauthorized review, use, disclosure, or distribution is lfyou have received this ematl tn error please nottfy the sender by return email and delete the original message Please note, the recipient should check email and any attachments forthe presence ofviruses The organization accepts no liability for any damage caused by any virus transmitted by this email. ================================= -----------------------------------------------------------This email message, including any attachments, is for the sole use of the intended recipient(s) and may contain information that is proprietary, confidential, and exempt from disclosure under applicable law. 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