|
Post by agedhippie on Apr 26, 2019 11:45:31 GMT -5
If this "pay for time not in range" is widespread this would be a huge reason for all cgm companies to promote afrezza without it costing mnkd anything. Of course medtronic would probably promote their automatic pancreas thing instead. Medtronics have already done that just that with Aetna and UHC.
|
|
|
Post by peppy on Apr 26, 2019 11:48:00 GMT -5
If this "pay for time not in range" is widespread this would be a huge reason for all cgm companies to promote afrezza without it costing mnkd anything. Of course medtronic would probably promote their automatic pancreas thing instead. Medtronics have already done that just that with Aetna and UHC. Hey, pay? Can we characterize this correctly?
|
|
|
Post by ktim on Apr 26, 2019 11:54:30 GMT -5
What do you see? An insulin that is ineffective or do you blame the CGM software for the blood sugars? What do you see when you look at the Afrezza users blood sugars recorded by their CGMs? Do you see an insulin that works or does everyone just have decent CGM software? Everyone having software that works is a good start since you can get hypos with Afrezza as well. Also far more people use insulins other than Afrezza and they need this technology. I know the argument says they should all move to Afrezza, but realistically that's not happening any time soon or it would already have happened and it's going to be a slow steady growth. Medtronic and Blue Cross and Blue Shield of Minnesota (BCBSM) have just done a rebate deal for the Medtronics CGM where Medtronics pays BCBSM a rebate for time spent outside range.That's quite encouraging news. That's actually pay for performance that would benefit Afrezza. Unfortunately, some pay for performance, such as Medicare incarnation of it, would actually disincentivize doctors from prescribing something that is costlier in the short term even if it saves money in the long term. Their diabetes pay for performance is based on total cost spent in the year on a patient. Hopefully MNKD has got someone high level all over BCBSM trying to get a pay for performance program of their own. Great news actually, that an insurer is actually implementing a program based on TIR. That's the first I've heard of it. This should have had a thread of it's own. www.bluecrossmn.com/value-based-agreement
|
|
|
Post by peppy on Apr 26, 2019 12:00:30 GMT -5
Fee for outcomes. What a novel idea. Wait till they start wiring up patients for head to head evaluation and Afrezza is part of it. BTW, what does a MDT pump cost these days, over $10K? They used to ship the patient two so a backup was always in hand. The real price is around $4,000 to the insurer based on the retail price outside the US. Typically it costs the user $1,000 one off. MDT also do rebate deals on the 670G pumps with Aetna and UHC. At the moment the 670G has a 72% TIR range which is why they can do these deals. More to the point, for MDT it locks their competitors out of the market because they cannot afford to fund these programs (DEXCOM's CEO spoke about this). Certainly for the last ten years at least they have just shipped a single pump, and ship a next day replacement if necessary (you use pens in the interval). At the moment the 670G has a 72% TIR range which is why they can do these deals. the BMW emissions sandal, where the computer was........ ?
|
|
|
Post by agedhippie on Apr 26, 2019 12:01:46 GMT -5
Medtronics have already done that just that with Aetna and UHC. Hey, pay? Can we characterize this correctly? The BCBSM, UHC, and Aetna deals are all separate. The BCBSM deal is interesting because up to now you had to take the whole 670G pump and couldn't take just the CGM component.
|
|
|
Post by ktim on Apr 26, 2019 12:03:49 GMT -5
Hey, pay? Can we characterize this correctly? The BCBSM, UHC, and Aetna deals are all separate. The BCBSM deal is interesting because up to now you had to take the whole 670G pump and couldn't take just the CGM component. Are they making these CGMs available to T2 or primarily only for T1?
|
|
|
Post by agedhippie on Apr 26, 2019 12:04:17 GMT -5
The real price is around $4,000 to the insurer based on the retail price outside the US. Typically it costs the user $1,000 one off. MDT also do rebate deals on the 670G pumps with Aetna and UHC. At the moment the 670G has a 72% TIR range which is why they can do these deals. More to the point, for MDT it locks their competitors out of the market because they cannot afford to fund these programs (DEXCOM's CEO spoke about this). Certainly for the last ten years at least they have just shipped a single pump, and ship a next day replacement if necessary (you use pens in the interval). At the moment the 670G has a 72% TIR range which is why they can do these deals. the BMW emissions sandal, where the computer was........ ? Lol. Well that will impact Afrezza as well since the current advice I see given is to look at your CGM after an hour to decide if you need a second dose.
|
|
|
Post by agedhippie on Apr 26, 2019 12:05:08 GMT -5
The BCBSM, UHC, and Aetna deals are all separate. The BCBSM deal is interesting because up to now you had to take the whole 670G pump and couldn't take just the CGM component. Are they making these CGMs available to T2 or primarily only for T1? No idea, but I expect only Type 1 based on their current policy.
|
|
|
Post by mango on Apr 26, 2019 13:34:06 GMT -5
What do you see? An insulin that is ineffective or do you blame the CGM software for the blood sugars? What do you see when you look at the Afrezza users blood sugars recorded by their CGMs? Do you see an insulin that works or does everyone just have decent CGM software? Everyone having software that works is a good start since you can get hypos with Afrezza as well. Also far more people use insulins other than Afrezza and they need this technology. I know the argument says they should all move to Afrezza, but realistically that's not happening any time soon or it would already have happened and it's going to be a slow steady growth. Medtronic and Blue Cross and Blue Shield of Minnesota (BCBSM) have just done a rebate deal for the Medtronics CGM where Medtronics pays BCBSM a rebate for time spent outside range. I'm not gonna disagree with you that people using a CGM should be able to have confidence in its ability to properly function and be reliable. But, the primary defect is the prandial insulin. ADA, The Insulin Cartel, and many of the Endo thought leaders have been suppressing and diverting CGMs and everything that it gives rise to (TIR and other measurements which, taken altogether, is a significantly more accurate reflection of a person's state of glucose homeostasis). ADA, The Insulin Cartel, and many of the Endo thought leaders are not going to push for using CGMs in clinical trials and studies because the Truth will be their downfall. We know that PWD, both T1 and T2, can achieve excellent results safely without a CGM. We also know that if an Afrezza user puts a CGM into the equation they will quickly learn and understand Afrezza, and will be able to "master the art" so to speak—and this includes people like Eric who doesn't rely on the CGM software because he doesn't want to waste his time worrying about whether or not the CGM software is gonna save his ass because he knows Afrezza has his back every time. Then there's AfrezzaUser who totally flipped the meaning of TIR upside down and blasted it into outspace. The guy is in no way a diabetic in my mind, just a dude who has to take exogenous insulin. When a CGM is combined with Afrezza synergy is created. There is absolutely no synergy created with RAAs and CGMs. Don't believe me? Just look.
|
|
|
Post by mytakeonit on Apr 26, 2019 13:44:06 GMT -5
Medtronic and Blue Cross and Blue Shield of Minnesota (BCBSM) have just done a rebate deal for the Medtronics CGM where Medtronics pays BCBSM a rebate for time spent outside range. And to celebrate this ... Hawaii will have it's 17th annual SPAM Jam Festival tomorrow !!! Yes kite ... I said tomorrow !!! April 27th from 4pm - 10pm. with live entertainment, delicious SPAM dishes ... on Kalakaua Avenue in Waikiki. The street will be closed and jammed or spammed with people. This is where you will hear blond haired tourist from the mainland USA say ... "This is good ... and it is SPAM? Why is it different? ... Ahhh, because in Hawaii we cook it." And this event is all to benefit the Hawaii Foodbank. Great Cause ... Great Fun ... so be there or be square. And for you facebook fans ... visit www.facebook.com/fbcameraeffects/tryit/440084403398314And after the event closes ... if you can find my tent ... wine will be served till I pass out. BTW, The Merrie Monarch competition is on till Saturday. (Not a paid public service announcement ... unless you send me $20) But, that's mytakeonit
|
|
|
Post by mango on Apr 26, 2019 14:15:51 GMT -5
Everyone having software that works is a good start since you can get hypos with Afrezza as well. Also far more people use insulins other than Afrezza and they need this technology. I know the argument says they should all move to Afrezza, but realistically that's not happening any time soon or it would already have happened and it's going to be a slow steady growth. Medtronic and Blue Cross and Blue Shield of Minnesota (BCBSM) have just done a rebate deal for the Medtronics CGM where Medtronics pays BCBSM a rebate for time spent outside range.That's quite encouraging news. That's actually pay for performance that would benefit Afrezza. Unfortunately, some pay for performance, such as Medicare incarnation of it, would actually disincentivize doctors from prescribing something that is costlier in the short term even if it saves money in the long term. Their diabetes pay for performance is based on total cost spent in the year on a patient. Hopefully MNKD has got someone high level all over BCBSM trying to get a pay for performance program of their own. Great news actually, that an insurer is actually implementing a program based on TIR. That's the first I've heard of it. This should have had a thread of it's own. www.bluecrossmn.com/value-based-agreementIs there any scenarios down the road that may lead to insurance coverage problems for the patients if/when Medtronic is dishing out larger and larger and more and more rebates as their CGM adoption base grows? Will insulins just continue to have immunity here because the way I am seeing this is the CGM is saying it is responsible and does all the work and the insulins are taking a seat in the back. Will patients be burdened at any point in time with having to maintain certain TIRs etc? Who is going to establish the Standard for TIR %? As things currently stand, Afrezza achieves significantly better TIR with CGMs compared to the Standard of Care. Are insurers going to ignore this or will they put Afrezza in the #1 stop and require prior authorizations for the inferior insulins that cannot consistently and reliably reproduce acceptable TIR%? Insulins would lose their immunity if that happened. An acceptable TIR in my mind is Afrezza user Eric Fenar who also has a CGM but rarely relies on it/looks at it in this way to achieve the TIRs that he does because of the Afrezza. He is consistently getting exactly what he wants and is comfortable/acceptable to him, but it's also a TIR that any Endo with 2 brain cells would agree with. I would hate to see him take a hit by some insurer etc for not maintaining a certain % because then he would have to carry a needless burden around. He openly admits that he could easily have higher TIR% but Afrezza gives him the freedom to have to worry about it because he has great TIR already.
|
|
|
Post by Clement on Apr 26, 2019 14:54:24 GMT -5
from www.bluecrossmn.com/value-based-agreementMINNEAPOLIS AND DUBLIN – April 8, 2019 – Blue Cross and Blue Shield of Minnesota and Medtronic plc (NYSE:MDT), the global leader in medical technology, services and solutions, announce a new outcomes-based agreement that provides members of the Blue Cross and Blue Shield of Minnesota plan who live with diabetes improved access to the Guardian™ Connect smart Continuous Glucose Monitoring (CGM) system. The system will also now be made available through a member’s pharmacy benefit, improving speed of delivery and may lower costs for members who use the device. Using the amount of time spent in a healthy glucose range as a key metric, value-based payments will be tied to the percentage of Time in Range achieved using the Guardian Connect system. . . . The Guardian Connect system is the first smart3 standalone CGM system to help people on multiple daily injection (MDI) therapy improve their management of high and low glucose events. People using the Guardian Connect system also have exclusive access to the groundbreaking Sugar.IQ™ smart diabetes assistant, an app that continually analyzes how an individual’s glucose levels respond to their food intake, insulin dosages, daily routines, and other factors, and shares insights with personalized, timely notifications. The new IQCast™ feature from the Sugar.IQ app provides a personalized trend forecast for potential low glucose events in the next 1-4 hour window, empowering people to help them manage their diabetes.
|
|
|
Post by agedhippie on Apr 26, 2019 15:40:10 GMT -5
... When a CGM is combined with Afrezza synergy is created. There is absolutely no synergy created with RAAs and CGMs. Don't believe me? Just look. Both the trial data and I would disagree with you on that There is definitely a synergy between a CGM and RAA - 39% fewer highs, and 60% fewer hypos according to Medtronics.
|
|
|
Post by matt on Apr 26, 2019 16:14:06 GMT -5
It's a poster session at a conference. It's good for mnkd but hardly a big event for a big bio company. Posters don't get that much attention at most conferences. I have been to several conferences where there were 10,000 posters presented over the course of 4 days, and the poster sessions are usually held in the afternoon and they usually compete with multiple podium presentations. Your feet and your eyeballs wear out long before you run out of poster content to view so you have to target the ones you want to see. Bottom line, if somebody knows about Afrezza and is interested in the topic they might make an effort to visit the poster but there is not much "drive-by" traffic. Booths on the exhibit floor are much more effective for educating new prescribers but that is expensive.
|
|
|
Post by agedhippie on Apr 26, 2019 16:18:42 GMT -5
Is there any scenarios down the road that may lead to insurance coverage problems for the patients if/when Medtronic is dishing out larger and larger and more and more rebates as their CGM adoption base grows? Will insulins just continue to have immunity here because the way I am seeing this is the CGM is saying it is responsible and does all the work and the insulins are taking a seat in the back. Will patients be burdened at any point in time with having to maintain certain TIRs etc? Who is going to establish the Standard for TIR %? As things currently stand, Afrezza achieves significantly better TIR with CGMs compared to the Standard of Care. Are insurers going to ignore this or will they put Afrezza in the #1 stop and require prior authorizations for the inferior insulins that cannot consistently and reliably reproduce acceptable TIR%? Insulins would lose their immunity if that happened. ... That's a lot of questions: - Is there any scenarios down the road that may lead to insurance coverage problems for the patients if/when Medtronic is dishing out larger and larger and more and more rebates as their CGM adoption base grows? + Medtronics has the data to be able to take this bet with a high level of certainty. Their rebates are calculated to be a percentage of sales so while a bigger adoption base will increase the cash payments in absolute terms it will also increase the profits in absolute terms. They will happily pay 10x the rebates if they are making 10x the profits. - Will insulins just continue to have immunity here because the way I am seeing this is the CGM is saying it is responsible and does all the work and the insulins are taking a seat in the back? + Everything is a tool in the bigger fight. If the CGM in combination with RAA will deliver a better result nobody cares whether it was the insulin or the CGM that did the heavy lifting. - Will patients be burdened at any point in time with having to maintain certain TIRs etc? + No. Unless I missed something medical treatment is never withdraw on those grounds. - Who is going to establish the Standard for TIR %? + Already done. The consensus is 180 - 70. Altering that would require the ADA and EASD to agree most likely. - Are insurers going to ignore this or will they put Afrezza in the #1 spot and require prior authorizations for the inferior insulins that cannot consistently and reliably reproduce acceptable TIR%? + No, because with the current generation of hybrid loop pumps like the 670G RAA returns better TIR results (72% - 670G Phase 3 trial - all users) than Afrezza (62% - STAT-1 complaint, or 58% STAT-1 all users). At this point basal insulin gets bought up as the culprit for the Afrezza results but that is utterly irrelevant because the medical world only cares about the holistic result. If your insulin requires you to take another insulin that is problematic then you get penalized.
|
|