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Post by rfogel on Jan 3, 2020 12:43:44 GMT -5
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Post by neil36 on Jan 3, 2020 13:16:55 GMT -5
Has there been a previous discussion on how to interpret these entries, and the meaning of the columns IMCS 0% up to IMCS 20%
The most expensive line at IMCS 20% appears to be for 4U and 8U for “90+90+2INAL” which ranges from IMCS 20% PMC of 3909R ($967US) to IMCS 0% PF of 2278R ($563US)
Does anyone have their head around the definitions of IMCS and their associated percentages and the two numbers coded as PF and PMC?
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Post by Clement on Jan 3, 2020 14:53:10 GMT -5
Maybe Matt's post in the Brazil thread will answer some of your questions?
Brazil
Oct 4, 2019 at 10:20am
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Post by neil36 on Jan 3, 2020 15:02:31 GMT -5
Maybe Matt's post in the Brazil thread will answer some of your questions? Brazil Oct 4, 2019 at 10:20am Thanks. Here is part of one of his posts from that thread. —————— Realize that government pricing in South America is about regulating the price of healthcare and it is about controlling the use of dollars and other hard currencies. Since these countries have to import certain critical materials from the US and Europe and they have limited amounts of hard currency, it doesn't matter what a rich person is willing to pay if the government won't let them use their money to import high priced drugs. There are three prices set by the government as follows: PF: This is the factory price or in other words the maximum amount that the importer (BIOMM) can charge to pharmacies. PMC: This is the maximum retail price that a pharmacy can charge a consumer. PMVG: This is the price that can be charged to certain government owned hospitals and government entities, and it is always lower than the PMC. Each of the prices is different depending on the state where the buyer lives since the sales tax is included and ranges from 12% to 20%. Most states are 18% or 20%. The one that is important for MNKD is the PF price because MNKD will get a portion of the PF. Since Biomm has to cover their costs and can charge pharmacies no more than PF, the PF must be split between the manufacturer (MNKD) and the importer (Biomm). The government sets the PF price and all the other prices are derived from there depending on allowed markups. Brazil, in principal, will not import any new drug at a higher price that treats the same condition already served by another licensed drug. However, the government does allow a modest premium for certain innovations such as a premium for pre-filled injector pens and improved formulations. What are the market prices for competitive products (updated from the August 1st, 2019 official price list and today's Real / dollar exchange rate)?: Humulin R (100U/ml, 10ml vial) 37.63 Reals (US$9.57) Humulin Kwikpens (100U/ml, 3ml pen, 5 pens) 136.10 Reals (US$34.62) Novolin R (100U/ml, 10ml vial) 37.36 Reals (US$9.50) Novolin Pens (100U/ml, 3ml pen, 5 pens) 93.39 Reals (US$23.76) NovoRapid (100U/ml, 10ml vial) 77.25 Reals (US$19.65) <<< Novorapid is the name used in Brazil for FIASP NovoRapid Pens (100U/ml, 3ml pen, 5 pens) 147.34 Reals (US$37.48) <<< Novorapid is the name used in Brazil for FIASP Again these are the maximum prices that the importer (competitors of Biomm) can charge the pharmacies. The PF price is split between the manufacturer and the importer and must cover the product, freight to Brazil, any marketing by the importer, and distribution costs within Brazil. My guess is that Biomm will want at least a 30% discount from the PF price to cover their costs, so MNKD will get a around 70% of the PF. All things considered, I don't think it is realistic to expect a PF for Afrezza that is significantly more than the other products in the market. Obviously there is some art in the negotiation of the price, Biomm get 220 Reals for a 10 ml vial of their insulin glargine versus 167 Reals for Sanofi Lantus, but overall CMED is going to follow the rules pretty closely. If you are wondering, the maximum prices to consumers are roughly 65% higher than the PF prices in places like Rio de Janeiro where the sale tax rate is 20% (PMC price includes the sales tax). Read more: mnkd.proboards.com/thread/11417/brazil#ixzz6A029XtZR |
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Post by Clement on Jan 3, 2020 15:34:32 GMT -5
ICMS - " One of the main problems for the pharmaceutical sector is the tax called Imposto sobre Circulação de Mercadorias e Serviços (ICMS), which is the responsibility of each state and is part of the maximum sale price to the consumer. The values paid by the pharmaceutical sector to the ICMS tax reach 18%, while the values paid for cars and food, for example, do not exceed 12% and 8%, respectively [18]." www.ncbi.nlm.nih.gov/pmc/articles/PMC3511298/It appears that the max ICMS for pharmaceuticals has increased since this article was written. |
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Post by matt on Jan 3, 2020 15:36:36 GMT -5
Has there been a previous discussion on how to interpret these entries, and the meaning of the columns IMCS 0% up to IMCS 20% The most expensive line at IMCS 20% appears to be for 4U and 8U for “90+90+2INAL” which ranges from IMCS 20% PMC of 3909R ($967US) to IMCS 0% PF of 2278R ($563US) Does anyone have their head around the definitions of IMCS and their associated percentages and the two numbers coded as PF and PMC? Yes, I did a comprehensive explanation in an earlier posting around early November (or there about). The condensed version: PF = Factory Price. This is the maximum wholesale price that Biomm/MNKD can charge a pharmacy for the drug. Since they have to split the PF price, some goes to Biomm to support sales and marketing and some goes to MNKD to pay for the manufacturing costs. PF with a % = Factory Price plus sales taxes. Note that PF and PF 0% are different because imported drugs carry and extra tax that domestically-produced drugs do not. Brazil is on a VAT t wype system so some of the sales tax is collected from the pharmacy when they buy from Biomm, and the rest from the patient when the drug is purchased at retail. In practice, the patient pays all sales taxes since the pharmacy gets a rebate for what they paid when reporting retail sales. PMC with a % = Factory price, plus a regulated retail mark-up for the pharmacy (around cost plus 32%), plus the import tax (12% of Factory Price) , plus sales tax (varies by area). This is the maximum amount the pharmacy can charge a consumer. The sales tax rate varies with the various states in Brazil so if a consumer lives in Rio de Janeirio they will pay PMC 20% while if they live in Sao Paulo the rate is lower and they pay PMC 18%. Most states have an 18% ICMP rate, and some have a lower tax rate for generic medicines. PMVG = Price for selling to state entities like government hospitals, the military and so forth which is essentially a legally mandated 25% discount for the government. Importantly, note that the numbers published this month are about 20 times higher than the numbers posted originally in December. Why the big change? I have no idea. Will there be another change in the future? I have no idea. The good news is that the permitted wholesale price is now high enough that MNKD might be able to make a modest profit over its manufacturing cost, but the bad news is that most Brazilians won't be able to afford the new prices. The old factory price for a 12U x 90 cartridge Afrezza package was 105.95 while the new factory price is 2042.42 (prices are in Brazilian Reals). The most expensive comparator product is FIASP which has a factory price in 100U X 10ML vials for 95.10 and FIASP supplied in a carton of 10 units of 3 ml pens is 285.30. Typical recombinant human insulin from local producers has a factory price of 29.76 per vial (100U x 10ml) and is available to diabetics via the Farmacia Popular for free. Imported insulins are not available at the Farmacia Popular and must be paid for at full retail prices. |
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Post by matt on Jan 3, 2020 15:38:35 GMT -5
It appears that the max ICMS for pharmaceuticals has increased since this article was written. The ICMS varies by state government. Most are at 18%, Rio de Janeiro is at 20%, some states give a lower rate for some items (like generic drugs). It gets complicated! |
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Post by peppy on Jan 3, 2020 15:43:31 GMT -5
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Post by matt on Jan 3, 2020 15:53:17 GMT -5
I also notice that the Afrezza price, which was previously priced under the "Regulado" regime is now listed as "Monitorado". Under the monitored regime the company can price the drug as they like subject to the price being lower than in the various reference countries listed by local law, but the price is flexible for now. Once a regulated price is announced the numbers could change back to what was posted in early December. Just a warning; I don't understand this particular nuance of Brazil pricing so this is a guess.
Note that the US dollar equivalent of these latest prices are about 10% lower than the comparable price from GoodRx for the similar units.
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Post by ryster505 on Jan 3, 2020 16:12:47 GMT -5
I also notice that the Afrezza price, which was previously priced under the "Regulado" regime is now listed as "Monitorado". Under the monitored regime the company can price the drug as they like subject to the price being lower than in the various reference countries listed by local law, but the price is flexible for now. Once a regulated price is announced the numbers could change back to what was posted in early December. Just a warning; I don't understand this particular nuance of Brazil pricing so this is a guess. Note that the US dollar equivalent of these latest prices are about 10% lower than the comparable price from GoodRx for the similar units. This is positive news for the company none the less. I like it. |
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Post by peppy on Jan 3, 2020 16:27:43 GMT -5
I also notice that the Afrezza price, which was previously priced under the "Regulado" regime is now listed as "Monitorado". Under the monitored regime the company can price the drug as they like subject to the price being lower than in the various reference countries listed by local law, but the price is flexible for now. Once a regulated price is announced the numbers could change back to what was posted in early December. Just a warning; I don't understand this particular nuance of Brazil pricing so this is a guess. Note that the US dollar equivalent of these latest prices are about 10% lower than the comparable price from GoodRx for the similar units. 1 Brazilian Real equals 0.25 United States Dollar A $2,172 dollar pack of 30 4u and 60 8u cartridges would bring in a little over $500? US. No sales team. www.screencast.com/t/6wuFzyBPPThe current population estimate for 2019 is 211.05 million. we need 130,000 rich type ones to use afrezza. |
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Post by brotherm1 on Jan 3, 2020 16:39:51 GMT -5
211 million that unfortunately on the average make less than $10K per year
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Post by peppy on Jan 3, 2020 16:52:07 GMT -5
211 million that unfortunately on the average make less than $10K per year if Brazil follows old style Spanish medicine, it is a pay to play system. You pay to see a physician. The physician gives you what you want if you can pay. of that 211 million, all we need is a small % of rich type ones who will pay to play. that is the game. .01 of 1% = 21,000 people. these are the Brazilians that can afford it. |
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Post by neil36 on Jan 3, 2020 16:59:44 GMT -5
The top 5% of Brazilians make as much as the bottom 95% combined.
The six richest men in Brazil make the equivalent of the bottom 50% combined.
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Post by figglebird on Jan 3, 2020 18:39:15 GMT -5
It is imperative that the company and its partners utilize any advantage available in order to succeed - how else would we compete?
The product at this point MUST CONTINUE TO OUTPRICE any competitor by as many multiples as possible - until pediatric is determined we are not equipped on practically every front to go after 1pct - this initial thought approach was flawed, except in its ability to elicit retail interest - those who can pay very much may - in which case - game on...
Price the advantage accordingly and let capitalism works its magic
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