Tracking Unrestricted Access to Afrezza in USA

[eddiemoy]

I found the iPhone App is not accurate when compared to the website (https://formularylookup.com/)

Going forward, I will be using the above site to track the progress of getting Afrezza on the Preferred and Covered (Unrestricted Access) plans.

To start, the following is a snapshot of how it looks like today:  NOT AT ALL BAD!!  40% Unrestricted Access on average USA wide!

Commercial	Preferred	Covered	Restricted	Not Covered	# of Plans	% Unrestricted Access
Alabama	4	44	77	36	161	30%
Alaska	3	26	23	12	64	45%
Arizona	3	49	59	54	165	32%
Arkansas	3	38	32	29	102	40%
California	9	145	87	125	366	42%
Colorado	3	42	61	62	168	27%
Connecticut	3	58	48	44	153	40%
Delaware	4	33	41	15	93	40%
Florida	3	74	73	83	233	33%
Georgia	3	73	64	72	212	36%
Guam	2	17	8	9	36	53%
Hawaii	3	33	12	18	66	55%
Idaho	5	31	17	17	70	51%
Illinois	6	107	83	137	333	34%
Indiana	3	56	56	83	198	30%
Iowa	3	38	31	33	105	39%
Kansas	4	38	64	42	148	28%
Kentucky	3	56	51	50	160	37%
Louisiana	3	49	50	39	141	37%
Maine	4	20	48	16	88	27%
Maryland	4	91	45	44	184	52%
Massachusetts	4	50	33	56	143	38%
Michigan	5	127	57	93	282	47%
Minnesota	4	52	21	54	131	43%
Mississippi	3	30	29	22	84	39%
Missouri	4	72	67	46	189	40%
Montana	3	26	20	18	67	43%
Nebraska	3	29	36	26	94	34%
Nevada	3	43	53	36	135	34%
New Hampshire	3	29	41	23	96	33%
New Jersey	5	141	60	52	258	57%
New Mexico	3	29	24	18	74	43%
New York	8	199	78	100	385	54%
North Carolina	5	71	69	54	199	38%
North Dakota	3	20	19	13	55	42%
Ohio	9	156	67	223	455	36%
Oklahoma	3	40	48	32	123	35%
Oregon	4	49	24	23	100	53%
Pennsylvania	10	172	61	98	341	53%
Puerto Rico	3	20	15	14	52	44%
Rhode Island	3	28	14	23	68	46%
South Carolina	3	56	39	42	140	42%
South Dakota	3	28	24	18	73	42%
Tennessee	5	62	53	63	183	37%
Texas	5	145	69	151	370	41%
Utah	4	38	47	30	119	35%
Vermont	3	22	19	12	56	45%
Virginia	3	75	58	57	193	40%
Washington	5	70	33	36	144	52%
Washington DC	3	35	41	39	118	32%
West Virginia	3	31	43	26	103	33%
Wisconsin	6	83	60	72	221	40%
Wyoming	3	25	34	13	75	37%
USA Total	212	3,171	2,386	2,603	8,372	40%

[Deleted]

More importantly how are the subscribers distributed in those plans? It can be unrestricted access for 90% of the plans but where do the 90% of patients fall into?

[dreamboatcruise]

Jun 25, 2015 19:30:08 GMT -5 @iam2sekc4u2002 said:

More importantly how are the subscribers distributed in those plans? It can be unrestricted access for 90% of the plans but where do the 90% of patients fall into?

The site lists % of patients not % of plans

(Edit) ^^^^ this should have said "insured people" rather than "patients".

[eddiemoy]

Jun 25, 2015 19:30:08 GMT -5 @iam2sekc4u2002 said:

More importantly how are the subscribers distributed in those plans? It can be unrestricted access for 90% of the plans but where do the 90% of patients fall into?

If you don't know by now, diabetes is the biggest disease in the world!  In just the USA, there are 29.1M diabetics, 1 out of 4 of them are undiagnosed...

The scarier number is 86M people in the USA are prediabetic!  86 MILLION!!!  That is 1 out of out every 3 adults!

There isn't a way to figure out where those who have diabetes are in which plan!  I'm guessing if the access in general is progressing well, people who need it will have access.

[dreamboatcruise]

I go to the site right now and only see 25% as covered and preferred. How did you get those numbers? Are you calculating % of plans vs patients? I would still get only 34% of plans based on what I see.

Formulary Status % of Lives # of Plans
Preferred 3% 121
Covered 22% 2306
Restricted 42% 1456
Not Covered 32% 3231

[eddiemoy]

Jun 25, 2015 19:45:29 GMT -5 dreamboatcruise said:

I go to the site right now and only see 25% as covered and preferred. How did you get those numbers? Are you calculating % of plans vs patients? I would still get only 34% of plans based on what I see.

Formulary Status % of Lives # of Plans
Preferred 3% 121
Covered 22% 2306
Restricted 42% 1456
Not Covered 32% 3231

Yes, I'm looking at % of plans.  not sure what the "% of Lives" represents.  Do you know what that number represents?

[dreamboatcruise]

I would assume they take the total number of insured in all the plans that they cover and then figure out the percentage of those covered people that are in the various categories of plans... preferred, covered, etc. That would seem far more meaningful than % of plans. I still wonder where the disconnect is on number of plans between what I see on the site and what you list. I don't know of any way of listing a complete table by state. How did you get that?

[eddiemoy]

Jun 25, 2015 20:35:25 GMT -5 dreamboatcruise said:

I would assume they take the total number of insured in all the plans that they cover and then figure out the percentage of those covered people that are in the various categories of plans... preferred, covered, etc. That would seem far more meaningful than % of plans. I still wonder where the disconnect is on number of plans between what I see on the site and what you list. I don't know of any way of listing a complete table by state. How did you get that?

Did state by state, will include the "% of lives" number.  The numbers don't add up when i do total USA.  Unless there are lots of duplicates!

[dreamboatcruise]

I've figured out the source of this discrepancy. You are double counting plans. Some plans are offered in multiple states, so you're picking them up more than once. So the real numbers are that 34% of plans in the U.S. are preferred or covered but they represent only 25% of the people covered by all these plans. And that is assuming that the data on this site is good. I've seen some flaky behavior where the numbers mysteriously jump one way or the other and then revert. I have a couple of snapshots during past couple of months but no meaningful movement over that period.

Not horrible numbers, but still a long way to go. We know that Afrezza isn't a typical new drug. It is a bit disappointing to see Toujeo so far out ahead. It's "covered" plus "preferred" is now over 50% of covered people.

[1 percenter]

FWIW, I asked a Pharma worker at my local Costco to check and see if they had Rxed Afrezza and their system showed that they had not yet. And I believe her system shows all Costco pharmacies.

[eddiemoy]

Jun 25, 2015 21:34:46 GMT -5 dreamboatcruise said:

I've figured out the source of this discrepancy. You are double counting plans. Some plans are offered in multiple states, so you're picking them up more than once. So the real numbers are that 34% of plans in the U.S. are preferred or covered but they represent only 25% of the people covered by all these plans. And that is assuming that the data on this site is good. I've seen some flaky behavior where the numbers mysteriously jump one way or the other and then revert. I have a couple of snapshots during past couple of months but no meaningful movement over that period.

Not horrible numbers, but still a long way to go. We know that Afrezza isn't a typical new drug. It is a bit disappointing to see Toujeo so far out ahead. It's "covered" plus "preferred" is now over 50% of covered people.

Yeh I figured that I might be double counting, but when you click into the details, I only see a few multi state plans.   Doesn't account for the descrepency that I got by going state by state.  Agree that the numbers seemed flaky.   Will track anyway to see what it looks like two weeks and a month from now.  

[eddiemoy]

Jun 25, 2015 23:01:06 GMT -5 1 percenter said:

FWIW, I asked a Pharma worker at my local Costco to check and see if they had Rxed Afrezza and their system showed that they had not yet. And I believe her system shows all Costco pharmacies.

Yeh, I had someone check prices for me in the CVS system and they didnt carry their own inventory yet a few weeks ago.  Will check with them to see if anything has changed.  

[rmgillis]

I saw a news story that mentioned that Alabama is the least competitive insurance state with 90% of covered individuals insured by Blue Cross. So, at least here in Alabama, the percentages are hard to reconcile.
BCBS's 90% should all be in one bin, shouldn't it?  Not covered means the drug is not covered, not the % of residents not covered by insurance (my assumption).

If there is any accuracy, I have to think it must include Medicaid and Medicare patients, but I don't have those percentages handy.  I think it
will be difficult to pin much of this down based solely on this site- not without a lot of additional data to work with.

[abovemyraising]

Horizon BC/BS has afrezza covered as tier 3:

www.myprime.com/content/myprime/en/find-medicine/find-medicine-results.html

It lists the cost as $237 for each 90 unit box per month. I presume that's what the patient would pay.