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Post by mannmade on May 8, 2019 13:22:33 GMT -5
I think because it is in addition to the production of Afrezza. So technically they are now producing a second molecule within their facility and hence expanding their capabilities.
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Post by harryx1 on May 8, 2019 13:30:05 GMT -5
Is Treprostinil a high-potency molecule???
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Post by ktim on May 8, 2019 13:36:25 GMT -5
If you get Doctors become part owners of a clinic and if the Doctors create a Corporation which can partner with Mannkind, could this help solve the Medicare and Medicaid issues? "partnering" is not a well defined term. MNKD could certainly give them all the support they are trying to give doctors: training, hand holding with getting insurance authorization, etc. MNKD could not invest any capital into such a venture (at least my understanding). MNKD, just as all BP, could pay certain key doctors inflated "speaking fees". That seems to be the one remaining loop hole in regulations, but there does have to be some modicum of legitimacy to this. If a doctor is wanting to set up a clinic, he couldn't be funded by paying him $1M to speak to a room consisting of a couple of MNKD employees. If you've been here long enough you might remember discussion from early on about requirement for lung test. Turns out apparently MNKD can't even give a clinic a free $200 spirometry device without running afoul of regulations, much less paying to set up the entire clinic.
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Post by ktim on May 8, 2019 13:53:43 GMT -5
Then why state a new capability within Mannkind I believe it is apparent from the call that the new capability is aimed at TrepT. Backed by the fact they've previously spoken about higher dosing than is well tolerated with nebulizer being needed. That was discussed concretely in the trial results. Why are they are highlighting as a new capability on a quarterly call? Perhaps because they need something to highlight as positive in light of other things such as TV spend that they can't highlight. Perhaps it is broader capability that is applicable to other APIs, but to my recollection the lack of ability to load enough API onto TS was never mentioned as something they considered as problem. They always portrayed that they'd tested loading 40 some odd APIs and they were successful in almost all of them. It's hard to sell something as a great benefit, if it is solving a problem that seemingly was never considered a big problem. Though some investors will greet it as a great advance simply because they want to believe it is. A lot of APIs have no problem with bulkiness of delivery and in fact need fillers, such as when in pill form since a therapeutic amount is really small. Without some further indication of how many APIs they are considering where this would have therapeutical benefit, it seems all we really know is this is necessary for TrepT. Would be interesting if they think we'd benefit from having cartridges larger than 12u Afrezza, and does this new capability address that or could they have gone higher even with the older manufacturing technology. They never indicated manufacturing limitations were holding them back with regard to insulin dose size.
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Post by stevil on May 8, 2019 14:25:45 GMT -5
Wait, you were the super glucose fighting powder guy, right? So never mind on the authority part. I'm just curious why you continue to bang the Endos aren't our friends and PCP's don't know how to treat PWD's drum. What has given you that impression since you're not in the healthcare field? Seyhey is quite knowledgeable about. What is going on.. many of us here are.. you don't have to be in the healthcare field to see what is going on. I don't mean to be rude, but just because you are in the healthcare field doesn't make you an authority on what is going on with Afrezza. There are many healthcare professionals that obviously don't understand Afrezza and don't want to. I've been around the block with that. Docs who do understand Afrezza are having remarkable results. What Seyhey says is true.. he isn't beating any drum anymore than you are... Sweedee, I never said one had to work in healthcare to have knowledge of Afrezza. I do think, though, that in order to tell other people how to dose it, one should be a medical provider or be intimately involved with clinical research. I wasn't trying to be condescending to sayhey. I can see why it came across that way. Message boards are horrible means of communication, especially for me- I routinely am misunderstood because I'm a very direct communicator. I simply asked sayhey what his stance is since he is always talking as though he has authority. Personally, I don't agree with much of what he says, so I was wondering if I was in error or if he was. Since I remembered he was the glucose super powder guy, it's clear he has no experience in healthcare, so I will continue to trust my opinion over his. And yes, when it comes to the judgement of people's character, experience is required. I would imagine I have had far more encounters with medical providers than a great majority of people on this board since I have basically been living daily in hospitals and clinics for the greater part of 2 years and even a little exposure before that. So to make the claim that an entire profession of people is malicious and self-serving absolutely needs to be justified with evidence if it is to be taken seriously. Ultimately, that evidence will probably have to come in the form of personal testimony, since other evidence will be hard to find. The issue with this board is it is full of disgruntled investors who didn't understand before they placed their bets how difficult it would be for Afrezza to break into the market. This unfairly puts prescribers unfairly in the crosshairs of their frustration. I'm here to call those people out and tell them they're wrong and are unfairly judging doctors. I have heard numerous horror stories of doctors prescribing FDA approved medications, even according to the label, and have been sued (and lost) because of deleterious side effects. Money aside, doctors do have hearts (despite public opinion on here) and don't want to bring harm to their patients. To them, the devil they know (current insulin therapy) is safer than the one they don't (Afrezza), so they continue to go with the devil they know until they are given a reason not to. Mannkind hasn't given them a reason not to yet. They haven't shown them that the theoretical risk (in their mind) outweighs the benefit of current insulin therapy. That is how a doctor thinks- does the risk outweigh the benefit. Just so I'm clear and state my own beliefs, I do think the medical community thus far has gotten it wrong on Afrezza. That doesn't mean that I think they're stupid or self-serving assholes that are afraid of losing business. I have never heard a doctor tell me they feel threatened by innovation and advances in science. At the end of the day, someone needs to critically analyze the data and AI is many, many decades away, if ever from being a legitimate threat. Going back to disagreeing but understanding why adoption has been so slow... I saw this many years ago when I joined the site but I have an even greater appreciation for it now that my time is right around the corner to have people's lives in my hands. It's not as easy as you all think. Decisions matter. Consequences are real. I fully intend to practice medicine conservatively. It's an admission of my own limitations. I don't have all the answers and I don't know everything, so I will tread lightly when I'm limited in my understanding. That's the biggest issue I have with Mannkind. They're stuck between a rock and a hard place because they need money to prove to doctors that Afrezza is safe and works, but they can't get it until they convince doctors to prescribe without this evidence. Knowing all this, I used to get criticized for trying to caution people from buying this stock, but got tarred and feathered on my way out the last time I was here. This was never going to be a quick process, and I think it's still at least a couple years out for Afrezza to really gain traction, based on the time required for CGMs to break into the market and change current perceptions on insulin therapy. So to wrap up an incredibly long post, I do take issue and will call people out when they do not know of what they speak and I will continue to defend the wonderful profession I am entering into, especially since no one else will. Doctors are not the enemies. Not all of them anyway. It's just an unfortunate situation where Mannkind is trying to reinvent the wheel when one already exists. It's not an easy sell. It takes hours of time to explain the differences and that amount of time is not easy to ask for from a physician. I sure hope that Mannkind has a huge budget for dinners because that's probably going to be their best bet for capturing the attention they need. Drive by reps aren't going to work... I have seen enough interactions to be convinced of this.
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Post by stevil on May 8, 2019 14:33:49 GMT -5
Seyhey is quite knowledgeable about. What is going on.. many of us here are.. you don't have to be in the healthcare field to see what is going on. I don't mean to be rude, but just because you are in the healthcare field doesn't make you an authority on what is going on with Afrezza. There are many healthcare professionals that obviously don't understand Afrezza and don't want to. I've been around the block with that. Docs who do understand Afrezza are having remarkable results. What Seyhey says is true.. he isn't beating any drum anymore than you are... I second that! I think someone has taken over stevil’s ID🤣 this is not how I remember him. Sayhey knows of what he speaks I’m just gonna leave it at that. Are you still a physical trainer, Sports? Do you ever get frustrated with people who think they know your job better than you because they have a gym membership and can lift a few weights but don't know what they're talking about? Now that you have experience, you can pretty easily spot the pretenders from the ones who know what they're talking about? That's pretty much where I'm at now. I think if I went into the gym, bad mouthed all the trainers and said they're all idiots and are horrible at their job that you'd get extremely annoyed at them and you'd try to set them straight. Am I right? I don't usually engage with those kinds of people because ignorance is hard to cure, especially when you're unable or unwilling to admit it, but when the board keeps getting littered with this kind of dialogue, again, no one else will defend it except me, so I have to engage it.
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Post by MnkdWASmyRtrmntPlan on May 8, 2019 14:52:52 GMT -5
Just for reference, We also continued to grow Afrezza net revenue by 49% compared to 1Q 2018 and we released new clinical data at scientific meetings that continue to differentiate Afrezza from other rapid acting insulins,” said Michael Castagna. The MNKD cup is half full ... not half empty. It's great there's some cup that's half full. My retirement account cup keeps on going down from the dilution and reverse splits. Ha, that's good, ktim. Well when you put it that way, even with all the averaging down I have done, my cup is still only about 35% full ... but it's not 65% empty. My "outlook" cup is still as full as the first day I invested. This stock is way undervalued. It will still probably take a couple years, but it's coming sometime and hopefully sooner than later. ASM next week. The magic word for Mike to mention is breakeven.
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Post by ktim on May 8, 2019 15:05:51 GMT -5
It's great there's some cup that's half full. My retirement account cup keeps on going down from the dilution and reverse splits. Ha, that's good, ktim. Well when you put it that way, even with all the averaging down I have done, my cup is still only about 35% full ... but it's not 65% empty. My "outlook" cup is still as full as the first day I invested. This stock is way undervalued. It will still probably take a couple years, but it's coming sometime and hopefully sooner than later. ASM next week. The magic word for Mike to mention is breakeven. Mike backed away from giving revenue guidance. The ability to guide revenue comes before giving guidance of break even. From the script projections we're still many years (6+) from break even. Given that you seem to think it is "magic" phrase, and others may agree, he may throw that phrase in for you. "We are very confident as we move towards break even". It does seem like he occasionally picks up on things said by investors here and works it into his presentations in positive sounding but non committal sort of ways. If he actually talks about WHEN we will reach break even, I'll be so shocked I'll probably need cardiac resuscitation.
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Post by sweedee79 on May 8, 2019 17:42:12 GMT -5
stevil ... My dad was on Afrezza.. it wasn't that time consuming to get him on it and the doc didn't do most of the educating.. they actually had an RN that spent the time with him. Also if a patient comes in requesting Afrezza I believe it's the docs job to find out about it. It's not that hard. I don't think docs are in the crosshairs unfairly. I also don't ever remember someone accusing them of being malicious. And Sayhey isn't prescribing to anyone that I know of.. I'm not a disgruntled investor.. I saw years ago what the problems were. For some reason I stayed the course.. that's on me..
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Post by MnkdWASmyRtrmntPlan on May 8, 2019 17:45:11 GMT -5
Ha, that's good, ktim. Well when you put it that way, even with all the averaging down I have done, my cup is still only about 35% full ... but it's not 65% empty. My "outlook" cup is still as full as the first day I invested. This stock is way undervalued. It will still probably take a couple years, but it's coming sometime and hopefully sooner than later. ASM next week. The magic word for Mike to mention is breakeven. Mike backed away from giving revenue guidance. The ability to guide revenue comes before giving guidance of break even. From the script projections we're still many years (6+) from break even. Given that you seem to think it is "magic" phrase, and others may agree, he may throw that phrase in for you. "We are very confident as we move towards break even". It does seem like he occasionally picks up on things said by investors here and works it into his presentations in positive sounding but non committal sort of ways. If he actually talks about WHEN we will reach break even, I'll be so shocked I'll probably need cardiac resuscitation. ktim, I have been enjoying your posts. I think you are correct about Mike throwing that particular phrase around and how and why he did it. 6+ years? That's the longest estimate I have seen posted for breakeven. So, is that projection just looking at scripts for revenue, and no other pipelines? How did you calculate that, ktim? btw, the "couple years" I referred to was the maximum that I am hoping for the stock to stop being diluted and start turning around ... not for breakeven (although I have not made any formal calculations, I expect (probably hope is a better word) for breakeven to be closer to 2 years than 6). I do believe that there may be news at anytime (partners, pipelines, etc.) that can initiate that elusive inflection point. And even just considering Afrezza sales, I don't expect it to follow a linear progression in the future, which may also expedite that two years. And our sales graphs have had a much nicer trajectory than the script growth graph (although I am not quite sure why that disparity between sales and scripts graphs is as drastic and ongoing as it is). Anyway, ktim, I'm interested to know how you did your calculations. I don't recall anyone here ever posting any calculations any more than as has been described as "back of napkin" calculations, but even those are always interesting. It's the ideas that are interesting, not necessarily formal financial bookwork. I'm thinking maybe this would be a good new thread to start, so I'm going to challenge you to start a new thread with your response to this. C'mon, ktim, I'll egg you on because I think this will be a great new thread and I would love to see it.
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Post by MnkdWASmyRtrmntPlan on May 8, 2019 18:31:50 GMT -5
While I am on the subject of complimenting other posters, as a side-note to Stevil's threads above, I want to add to the others in saying that I also continue to enjoy sayhey's posts and I highly regard his opinions. But, Stevil, I don't mean that to contrast your posts - thanks for explaining your stance and writing about your background - it sounds interesting.
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Post by stevil on May 8, 2019 18:37:56 GMT -5
stevil ... My dad was on Afrezza.. it wasn't that time consuming to get him on it and the doc didn't do most of the educating.. they actually had an RN that spent the time with him. Also if a patient comes in requesting Afrezza I believe it's the docs job to find out about it. It's not that hard. I don't think docs are in the crosshairs unfairly. I also don't ever remember someone accusing them of being malicious. And Sayhey isn't prescribing to anyone that I know of.. I'm not a disgruntled investor.. I saw years ago what the problems were. For some reason I stayed the course.. that's on me.. I understand that and I'm sorry this has been such a stressful time for you. I don't know the particular doctor your dad saw, so I can't really say I know exactly what I'm talking about. However, as a generality, the PCPs (assuming your dad saw a primary care) that I have spoken to said that greater than half of their day is spent just covering overhead. They don't start making money until they hit midday. So what does this translate into? Cramming more patients into a smaller time frame. Also, what does this mean for the doc? He's got less time to look into new medications. He/She sees insulin, looks at the data, sees more units/$ and that it's inhaled. Pretty much stops there because we're trained that insulin is insulin. There is no importance to pharmacokinetic time-action profile for insulin... cause until Afrezza, none of that was really revolutionary or mattered. Honestly, there is nothing in the published literature that distinguishes Afrezza from other RAAs other than it's inhaled. RAAs are still the standard of care. Doctors are compliant with their duties, according to their medical boards, simply by sticking to RAAs. The answers to the questions doctors may have about Afrezza are not readily accessible or do not exist at all because it has not been properly tested. It is still an unknown quantity. RAAs on the other hand, are well known. You know what you have and what you'll get out of them. There have been millions of people on them over the past couple decades compared to the thousands over the past few years with Afrezza. This is where experience comes into play. You see a busy doctor and assume he/she is lazy and/or doesn't care about his/her patients, when in reality, due to the system they're practicing in, they have to be extremely efficient with their time if they want to make money and get home at a reasonable time. The cost of medical education has been rising like college education, so it's not uncommon for your doctor to be 200,000-500,000 by the time they start residency. Then, depending on repayment, that converts to about 400,000-1,000,000 during the lifetime of the loan due to interest. It's easy for specialists to make this money up because procedures like surgeries, endoscopies, colonoscopies, percutaneous coronary intervention, laser therapy, allergy testing, etc, etc, makes a bunch of money. Primary care doesn't typically do that many well-paying procedures. So what do doctors do? They outsource and delegate the remedial stuff to their support staff... If an RN can do the job, there's no need for the doctor to do it. In essence, it's a waste of their time because there are other jobs they can be doing that only they can do. That's why you hire staff- so you can focus on the things you need to do. If I can make $100/patient, I'm not going to spend an extra 15 minutes counseling you because that extra 15 minutes would then cost me $100. If I pay an RN $10 for 15 min ($40/hr), I keep an extra $90 by moving onto the next patient. I am not condoning this behavior, but I do not fault doctors either. I can tell you I don't want to practice medicine this way, but then again, I'm just starting out and we'll see what happens. Debt sucks. Sayhey implied malicious intent to endos because they wouldn't prescribe it out of fear of being out of a job. That sounds pretty malicious to me... "I'm not going to give you the best treatment because I don't want to heal you so you won't need me anymore". In any case, look at the scenario above to see that doctors aren't afraid of being out of a job. There is a huge shortage of physicians and there are plenty of patients to go around, especially in endocrinology and primary care.
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Post by stevil on May 8, 2019 18:58:44 GMT -5
While I am on the subject of complimenting other posters, as a side-note to Stevil's threads above, I want to add to the others in saying that I also continue to enjoy sayhey's posts and I highly regard his opinions. But, Stevil, I don't mean that to contrast your posts - thanks for explaining your stance and writing about your background - it sounds interesting. I don't want to play the role of message board guard dog. It's annoying when others do that to me. However, one thing that bothers me is when people act the authority when they have no leg to stand on. Despite this, I do not wish to silence anyone on this board. I'm a huge advocate of free speech. Everyone is entitled to their own opinion. This is probably going to sound bad, but it's not meant to be belittling or demeaning to anyone on here. People just don't know what they don't know. It's hard for people to spot the people who know what they're talking about and those who don't because they don't know any better to distinguish between the two. To be fair, there is a lot of good info shared on here... But there's equally, if not more so, bad info that gets a lot of likes. It gets a lot of likes not because it's good info, but because it usually sounds good and is what people want to hear. Look no further than just about every post by matt. He shares his experience with people and the board hates him for it because a lot of the stuff he tells them is hard to swallow at times. I'm glad he sticks around in spite of all the mocking others do of him. Sometimes he's wrong or gets his facts incorrect, but everyone makes mistakes. I wouldn't say that he's here to be sneaky or divisive. Just shares his experience and interpretations through his lens. As for me, I usually try to stay quiet. I sometimes chime in from time to time when I see new posters or feel like I have something of value to add. I post less and less because I feel like my posts are valued less and less the longer this goes on. So why waste my time? Especially when almost every post I make I have to justify or argue my position. Arguing with people on here is usually an exercise in futility. Neither side is going to relent and neither side thinks they're wrong. I try to force myself to take the great Mark Twain's advice on this board when he said, "Never argue with a fool. Onlookers may not be able to tell the difference."
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Post by sayhey24 on May 8, 2019 19:18:57 GMT -5
Sports - we have been saying for a long time until significant changes are made to the SOC afrezza scripts will grow but they will grow very slowly. TV ads are not going to sell afrezza but I think the TV ads worked out better than I expected as a lot of people saw them and afrezza is no longer a total unknown. When Mike gets serious about selling afrezza he will partner to open dedicated health and wellness clinics which specialize in diabetes and leverage CGM and connected care technology and afrezza. I would expect each clinic to do a minimum of 100 scripts per week which is a lot more than our current sales staff is doing. and the clinics would be profitable.Endos are not our friend and PCPs just don't have the focus to properly treat PWDs. Medicare and Medicaid would not cover clinics that are owned by a pharma to push their own products. I doubt commercial health insurance would either. Does Medicare and Medicaid pay for Cigarettes? The average pack is over $6 per day more than the daily cost of afrezza insulinsavings.com Now commercial health insurance pays for health and wellness clinics such as Weight Watchers www.weightwatchers.ca/util/art/index_art.aspx?tabnum=1&art_id=134541&sc=3046Its not a question of can Mannkind partner with someone to do this, yes they can. Its a question of structuring the deal properly and doing it. It can not be "Diabetes" clinic. They need to be health and wellness centers dealing in weight loss and fitness. There is a huge untapped market in the weightloss business for CGM technology and connected care and guess what - about 25% of these people are PWDs and many don't even know it.
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Post by sweedee79 on May 8, 2019 19:20:06 GMT -5
stevilI don't hate Matt, in fact I admire a lot of what he writes and I read it. I find that I'm a pretty good judge of charachter. Primary Docs are busy. That's why they sent my dad to a specialist. There are ways to find the time to serve patients as they want to be served. Sayhey wasn't trying to be malicious..
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