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Post by cedafuntennis on Apr 26, 2019 20:01:41 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........ ? Please, not BMW. VW had the emission scandal.
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Post by mango on Apr 26, 2019 20:18:08 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. I haven't read ur entire reply yet, but the part in bold I was referring to percentages of time spent in TIR. No non-diabetic is 100% of the time 100% TIR. So, who is gonna establish the Standard for the acceptable TIR %??
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Post by mango on Apr 26, 2019 20:27:17 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. Is that data from controlled trials that involve micro-regulation by physicians & other healthcare professionals in order to achieve the endpoints or is a combination of that and real-world evidence, or what? And, I have yet to see RAAs w/ CGMs create a similar, consistent synergy of that in RCT & real-life. However, I have always seen this with Afrezza.
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Post by mytakeonit on Apr 26, 2019 20:39:05 GMT -5
Off topic ... but ... peppy - Netflix is showing a documentary on the Mayo Clinic. Now I understand a lot more about the Mayo Clinic and why the doctors on this board speak so highly of it.
Thanks for leading me to view it ...
But, that's ourtakeonit
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Post by agedhippie on Apr 26, 2019 21:57:04 GMT -5
... - 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. ... I haven't read ur entire reply yet, but the part in bold I was referring to percentages of time spent in TIR. No non-diabetic is 100% of the time 100% TIR. So, who is gonna establish the Standard for the acceptable TIR %?? Good point! I confused range with TIR itself. As you say, the target is 100%. I don't think I have ever seen an acceptable TIR defined, but as a marker 50% will typically gives an HbA1c of 7.0 so you would want to do better than that.
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Post by agedhippie on Apr 26, 2019 22:16:43 GMT -5
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. Is that data from controlled trials that involve micro-regulation by physicians & other healthcare professionals in order to achieve the endpoints or is a combination of that and real-world evidence, or what? And, I have yet to see RAAs w/ CGMs create a similar, consistent synergy of that in RCT & real-life. However, I have always seen this with Afrezza. I don't actually find it that hard to do with decent CGM software (xDrip courtesy of the Nightscout group). My 90 day TIR is 68% with MDI which is better than the compliant users achieved in STAT, and includes a couple of rocky patches. I can safely say I do not get that sort of result when I use a meter and not a CGM. Definitely no micro-regulation to achieve that CGM result Really it doesn't matter what I get, any more than it matters what any individual gets. What doctors want to know is not what is achieved by any individual, it's what is achieve across large groups and trials are currently the best way to do that (one day in a connected world that will change, but we are not there yet).
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Post by bones1026 on Apr 26, 2019 22:53:10 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. Matt- Honest question... remind me, you are a current shareholder or were and currently on sidelines waiting to get back in? Just observing
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Post by ktim on Apr 27, 2019 0:05:11 GMT -5
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........ ? Please, not BMW. VW had the emission scandal. And Audi (part of VW).
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Post by ktim on Apr 27, 2019 0:40:22 GMT -5
Is that data from controlled trials that involve micro-regulation by physicians & other healthcare professionals in order to achieve the endpoints or is a combination of that and real-world evidence, or what? And, I have yet to see RAAs w/ CGMs create a similar, consistent synergy of that in RCT & real-life. However, I have always seen this with Afrezza. I don't actually find it that hard to do with decent CGM software (xDrip courtesy of the Nightscout group). My 90 day TIR is 68% with MDI which is better than the compliant users achieved in STAT, and includes a couple of rocky patches. I can safely say I do not get that sort of result when I use a meter and not a CGM. Definitely no micro-regulation to achieve that CGM result Really it doesn't matter what I get, any more than it matters what any individual gets. What doctors want to know is not what is achieved by any individual, it's what is achieve across large groups and trials are currently the best way to do that (one day in a connected world that will change, but we are not there yet). Do you avoid super carby things? We all should, and I try to. I assume RAAs are problematic, regardless of CGM, if one indulges in a lot of sweet/starchy stuff. I'd be glad both as a human being and as an investor (often not the same as being human) if either Afrezza or CGMs took off. Long been Mannkind and Dexcom investor and recently Senseonics (after the major correction).
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Post by lennymnkd on Apr 27, 2019 4:51:32 GMT -5
Ktim ,the Eversense cgm with its 90/180 day implantable moniter would seem to be a nice fit for AFREZZA ... makeing for an easier routine ! How’s their accuracy rated...every little bit helps patients incentive.
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Post by porkini on Apr 27, 2019 7:14:28 GMT -5
Off topic ... but ... peppy - Netflix is showing a documentary on the Mayo Clinic. Now I understand a lot more about the Mayo Clinic and why the doctors on this board speak so highly of it. Thanks for leading me to view it ... But, that's ourtakeonit I don't do that subscribtion, but looking at their site, it appears this may be the same PBS ( www.pbs.org/show/the-mayo-clinic/) documentary that premiered last September ( mnkd.proboards.com/post/159272/thread). Just thought it might be worth posting alternate sources for those who don't subscribe to a particular service.
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Post by ktim on Apr 27, 2019 7:59:28 GMT -5
Ktim ,the Eversense cgm with its 90/180 day implantable moniter would seem to be a nice fit for AFREZZA ... makeing for an easier routine ! How’s their accuracy rated...every little bit helps patients incentive. The 90 day accuracy is very good. Not sure about when it is extended to 180. I know they are also working to get approved for a full year. If they do pull off reasonable accuracy with a yearly replacement cycle I think that would start looking extremely attractive to people. They would need to have sufficient accuracy to meet the FDA requirement to be considered something that could be used for insulin dosing.
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Post by sayhey24 on Apr 27, 2019 12:40:25 GMT -5
Is that data from controlled trials that involve micro-regulation by physicians & other healthcare professionals in order to achieve the endpoints or is a combination of that and real-world evidence, or what? And, I have yet to see RAAs w/ CGMs create a similar, consistent synergy of that in RCT & real-life. However, I have always seen this with Afrezza. I don't actually find it that hard to do with decent CGM software (xDrip courtesy of the Nightscout group). My 90 day TIR is 68% with MDI which is better than the compliant users achieved in STAT, and includes a couple of rocky patches. I can safely say I do not get that sort of result when I use a meter and not a CGM. Definitely no micro-regulation to achieve that CGM result Really it doesn't matter what I get, any more than it matters what any individual gets. What doctors want to know is not what is achieved by any individual, it's what is achieve across large groups and trials are currently the best way to do that (one day in a connected world that will change, but we are not there yet). Aged - compliant afrezza users in STAT achieved 100% TIR during its field of use basically 8am to 8pm. Being out of range during fasting periods is out of scope for afrezza. You can't do much better than 100%.
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Post by agedhippie on Apr 27, 2019 14:22:11 GMT -5
I don't actually find it that hard to do with decent CGM software (xDrip courtesy of the Nightscout group). My 90 day TIR is 68% with MDI which is better than the compliant users achieved in STAT, and includes a couple of rocky patches. I can safely say I do not get that sort of result when I use a meter and not a CGM. Definitely no micro-regulation to achieve that CGM result Really it doesn't matter what I get, any more than it matters what any individual gets. What doctors want to know is not what is achieved by any individual, it's what is achieve across large groups and trials are currently the best way to do that (one day in a connected world that will change, but we are not there yet). Aged - compliant afrezza users in STAT achieved 100% TIR during its field of use basically 8am to 8pm. Being out of range during fasting periods is out of scope for afrezza. You can't do much better than 100%. Afrezza is dragged down by the basal, but you have to have a basal - it's a package. A doctor is going to say Afrezza + basal gives 59% and the alternative gives X, which has the better TIR? It's this simple. STAT says if you use MDI with RAA then Afrezza + basal wins, if you use a hybrid loop then Afrezza + basal loses.
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Post by mytakeonit on Apr 27, 2019 16:59:44 GMT -5
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