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Post by kc on Nov 29, 2014 21:16:43 GMT -5
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Post by babaoriley on Nov 29, 2014 21:27:31 GMT -5
The capital health site indicates Tier 3, that's not what we want.
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Post by Deleted on Nov 29, 2014 21:44:24 GMT -5
Exclusion is not what we want.
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Post by kc on Nov 29, 2014 21:48:05 GMT -5
Other sites the same but that might be a place holder until Sanofi announces pricing or schedules for Afrezza. They just needed to get it in the system. It's early in the game.
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Post by Deleted on Nov 29, 2014 21:54:18 GMT -5
Tier 3 is covered. Better than excluded. It's likely to cost a $25 copay. Next bear thesis, I can see it now.
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Post by kc on Nov 29, 2014 22:05:50 GMT -5
$25.00 co-pay seems pretty inexpensive to me . Especially if it's a 30 day prescription.
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Post by deeznuts on Nov 29, 2014 23:42:22 GMT -5
$25.00 co-pay seems pretty inexpensive to me . Especially if it's a 30 day prescription. 25 co-pay may not be a lot but what will it show as the actual cost of the drug. Going into the doughnut hole will be the issue for Medicare folks. It shouldn't be an issue for non Medicare people.
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Post by mnkdfan on Nov 30, 2014 1:11:45 GMT -5
It's possible that the final pricing from Sanofi could move Afrezza to Tier 2 but it looked as if many other new diabetic drugs are also in tier 3:
Victoza, Bydureon, Byetta, Farxiga, Invokana, .....Billions were made with Victoza, so even if we are a tier3 classification, I think people do not mind a little more co-pay and we would be fine. After all, I think people take Victoza to avoid insulin injections so I think we could also see some sales from Victoza patients switching over to Afrezza. I trust Sanofi to know the diabetes market space to set the best pricing for both maximum margin and acceptable cost to patients.
It would seem much work is in place for an early 1st quarter roll out as oppose to a late 1st quarter based on MNKD production start in early November. My hope and guess would be for 1/15/15 launch. This would give MNKD a good 2 months time to produce and stock pile the 4 & 8 insulin cartridges.
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Post by jpg on Nov 30, 2014 3:01:47 GMT -5
It's possible that the final pricing from Sanofi could move Afrezza to Tier 2 but it looked as if many other new diabetic drugs are also in tier 3: Victoza, Bydureon, Byetta, Farxiga, Invokana, .....Billions were made with Victoza, so even if we are a tier3 classification, I think people do not mind a little more co-pay and we would be fine. After all, I think people take Victoza to avoid insulin injections so I think we could also see some sales from Victoza patients switching over to Afrezza. I trust Sanofi to know the diabetes market space to set the best pricing for both maximum margin and acceptable cost to patients. It would seem much work is in place for an early 1st quarter roll out as oppose to a late 1st quarter based on MNKD production start in early November. My hope and guess would be for 1/15/15 launch. This would give MNKD a good 2 months time to produce and stock pile the 4 & 8 insulin cartridges. Agreed and especially: I trust Sanofi to know the diabetes market space to set the best pricing for both maximum margin and acceptable cost to patients. JPG
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Post by mnholdem on Nov 30, 2014 9:05:53 GMT -5
From Express Scripts (Largest PBM in the US):
"Drug Formulary Management. Formularies are lists of drugs to which benefit design is applied under the applicable plan. Formulary management enables patients and physicians to choose clinically appropriate and cost-effective drugs for a given condition. Our foremost consideration in the formulary development process is the clinical appropriateness of the particular drugs. In developing formularies, we first perform a rigorous assessment of the available evidence regarding each drug’s safety and clinical effectiveness. No new drug is added to the formulary until it meets standards of quality established by our National Pharmacy & Therapeutics (“P&T”) Committee, a panel composed of 16 independent physicians and pharmacists in active clinical practice, representing a variety of specialties and practice settings, typically with major academic affiliations. We fully comply with the P&T Committee’s clinical recommendations. In making its clinical recommendation, the P&T Committee has no information regarding the discount or rebate arrangement we might negotiate with the manufacturer. This is designed to ensure the clinical recommendation is not affected by our financial arrangements. After the clinical recommendation is made, the drugs are evaluated on an economic basis to determine optimal cost effectiveness. We administer a number of different formularies for our clients. A majority of our clients select formularies that are designed to be used with various financial or other incentives, such as three-tier co-payments, which drive the selection of formulary drugs over their non-formulary alternatives. Some clients select closed formularies, in which benefits are available only for drugs listed on the formulary. We also provide formulary compliance services to our clients. For example, if a doctor has prescribed a drug that is not on a client’s formulary, we notify the pharmacist through our claims processing system. The pharmacist may then contact the doctor to attempt to obtain the doctor’s consent to change the prescription to the appropriate formulary product. The doctor has the final decision-making authority in prescribing the medication."
I recall that Sanofi mentioned at their recent new drug event that insurance companies have been exerting pressure to lower presciption prices, and there is competitive pressure as well. However, on the first issue, pharmas are not required to meet insurance company demands. On the second point, I don't think that big pharmas are too eager to get into a price war over diabetes drugs. That would be a no-win scenario.
The smart thing for Sanofi to do is to price Afrezza to compete but not trigger a pricing war. Generics is the big problem, but one that all the major players face. The fact that Afrezza is unique does give Sanofi a competitive advantage IMHO.
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Post by dreamboatcruise on Nov 30, 2014 14:08:39 GMT -5
I guess there are two issues. Will Afrezza be at same tier as other prandials. It would seem that since there is as yet no generic prandial, that they would all be at tier 2. It is a bit disconcerting that Capital Health, as cited above, has Afrezza listed as tier 3, but perhaps it is simply that any new drug is made tier 3 before it goes through the process to have it better classified. It seems the statements from the company (Mannkind not so much SNY) have always seemed to indicate they would do what was necessary with regard to pricing to have it become tier 2 so that for most patients it would be priced equivalent to existing prandials.
But the other issue is whether there are oral anti-diabetes drugs that are tier 1 that might push people away from a tier 2 Afrezza.
Do most/all 3 tier formularies have all brand name at tier 2 or is there a possibility that a brand name can be tier 1 if it is deemed to have clinical benefits and long term cost benefits?
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Post by EveningOfTheDay on Nov 30, 2014 14:21:49 GMT -5
I remember reading, just as MNKDFAN is pointing out, that new drugs for covered conditions are automatically placed in Tier 3. I did a quick search and found confirmation here, www.firstcare.com/en/Group-Health-Plans/Pharmacy-DrugsWhat is a Change in Benefit Coverage? If there is a change in your prescription drug benefit coverage from drugs being added or removed from our formulary, you will be notified in advance of any such change(s). The following situations do not constitute a change in benefit coverage, rather are normal occurrences in the pharmaceutical market: Changes in prior authorization clinical criteria approved by the Pharmacy & Therapeutics Committee Generic drugs whose classification status changes to Brand Name during the contract period Brand name drugs that have new generic-equivalent products available during the contract period automatically move to non-covered status with a corresponding higher out-of-pocket cost. The generic equivalent drug is automatically covered at the generic drug copayment. OTHER NEWLY APPROVED FDA DRUGS ARE AUTOMATICALLY PLACED ON THE TIER 3 DRUG COPAYMENT LEVEL IF USED TO TREAT A COVERED MEDICAL CONDITION Self-injectable and other high technology drugs which are newly approved by the Food and Drug Administration (FDA) are automatically placed on the Tier 4 drug copayment level. I have to recognize I do not know enough about the Healthcare System to confirm if this is true or not, but it would make sense to me that new drugs are placed initially in Tier 3 with the possibility of a status change to Tier 2 later on.
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Post by EveningOfTheDay on Nov 30, 2014 14:28:52 GMT -5
But the other issue is whether there are oral anti-diabetes drugs that are tier 1 that might push people away from a tier 2 Afrezza. Do most/all 3 tier formularies have all brand name at tier 2 or is there a possibility that a brand name can be tier 1 if it is deemed to have clinical benefits and long term cost benefits? This from the same site. The Tier System All FirstCare plans include a tiered structure for our prescription drug benefits. A brief explanation of these tiers is below: Tier 1 – Lowest out-of-pocket cost for your generic drugs Tier 2 – Higher out-of-pocket cost for a limited list of brand name drugs Tier 3 – Higher out-of-pocket cost than tier 2 for other brand name drugs Tier 4 - Immunosuppressive medications, chemotherapy and associated agents, injectable drugs, medically infused medication, and high technology drugs. It would seem as if Tier 1 is for generic drugs, but I don't know if there are exceptions to the rule.
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Post by ashiwi on Nov 30, 2014 14:32:29 GMT -5
I would not worry about Afrezza being a tier 3. Advair for asthma is tier 3 and had sales of over $5 billion this year. It just has a higher co-pay.
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Post by brentie on Nov 30, 2014 14:35:38 GMT -5
Hakan: "In general, AFREZZA's clinical date and drug attributes were viewed very favorably. Payers told us that they believe the elimination of injection would be an important compliance advantage and due to the chronic nature of the diabetes there would welcome a product of increased compliance within the diabetic population. Now the message from the payers if that they see our AA as the value and price compare for AFREZZA based on the current safety and efficacy profile as well as their precede advantages of convenience and even increased compliance associated with our mode of delivery. This is important because, pens already carry a price premium due to their convenient and compliance benefit compared to needle injections, and based on this research, we have a clear understanding of how we can drive the placement of AFREZZA on Tier 2 formulary status which is important to drive volume and revenue and of course the most important value of AFREZZA is the far better kinetic profile leading to improved medical care and better outcomes. Since completing studies 171 and 175, we have also updated our market research into physician interest in prescribing AFREZZA which could be the first ultra rapid acting insulin in the market." seekingalpha.com/article/1803692-mannkinds-ceo-discusses-q3-2013-results-earnings-call-transcript?find=tier&all=false
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