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Post by yossarian on Aug 27, 2015 13:45:35 GMT -5
restrictions. Attachments:
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Post by rozale on Aug 27, 2015 15:24:35 GMT -5
Yes but the tier level still makes it non acquirable for most people. I think the target tier for BCBS is tier 2, tier 3 still puts roughly 50% of cost onto the user.
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Post by bioexec25 on Aug 27, 2015 21:48:20 GMT -5
Yes but the tier level still makes it non acquirable for most people. I think the target tier for BCBS is tier 2, tier 3 still puts roughly 50% of cost onto the user. Not sure exactly but definitely agree the elephants in the room are out of pocket costs and the associated non-interest by docs. With a chronic disease most average folks will choose the free or a near free option. The giveaways and promotions help but are a rounding error of volume needed to succeed. Many people believe that success stories and demand will bring payors around. I hope so cause right now competitors also are busy lobbying and advertising. So far Afrezza in the overall market is not even a rounding error of over segment scripts.
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Post by longstocking on Aug 27, 2015 21:58:58 GMT -5
Yes but the tier level still makes it non acquirable for most people. I think the target tier for BCBS is tier 2, tier 3 still puts roughly 50% of cost onto the user. Not sure exactly but definitely agree the elephants in the room are out of pocket costs and the associated non-interest by docs. With a chronic disease most average folks will choose the free or a near free option. The giveaways and promotions help but are a rounding error of volume needed to succeed. Many people believe that success stories and demand will bring payors around. I hope so cause right now competitors also are busy lobbying and advertising. So far Afrezza in the overall market is not even a rounding error of over segment scripts. They might not be so quick to chose the "free" option when they realize that the long term effects of the chronic disease can be largely mitigated, i.e. vision, limbs, organ damage, etc. How much would you pay to extend the years of your life if there was a way? $3k/year? I would, with or without insurance. Ultimately it won't matter though, because insurance will cover. It just might be a bit yet.
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Post by bioexec25 on Aug 27, 2015 22:36:00 GMT -5
Hope so Longstocking. Historically absent of corruption the payors and docs do come around especially when the ground swell of positive patient results become pervasive. Like many Longs though beginning to inject more critical thinking about this especially if we see a ho-hum Q4. Everybody has diff tipping points. But even the longest term thinkers question holding 1.5-2 yr post launch without significant indicators. That's coming between now and mid-2016.
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Post by nylefty on Aug 27, 2015 22:48:26 GMT -5
I'm looking for good news after the one year anniversary of the launch in February. From what I hear many docs wait a year before prescribing new drugs and many insurance plans also wait a full year before adding drugs to their Tier 2s.
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Post by kball on Aug 28, 2015 6:48:30 GMT -5
I'm looking for good news after the one year anniversary of the launch in February. From what I hear many docs wait a year before prescribing new drugs and many insurance plans also wait a full year before adding drugs to their Tier 2s. This is my leanings as well. Also, i never hop on the latest medication (and i would guess other patients may also be reluctant) as its always more expensive and many people are fine with being somewhat controlled of their disease rather than perfectly controlled at the risk of or the fear of dealing with a few new side effects. Many many examples of new meds given FDA approval only to be yanked due to unforeseen problems that weren't observed in trials--or quietly fudged during them (it was even the backstory of THE FUGITIVE w Harrison Ford). Not saying that is the case with Afrezza. But overcoming that "fear" from patients and doctors i think is a real issue. Let alone the insurance issue for now. My guess is if scripts right now were quadruple what they are, the stock price would be north of here too. So i accumulate under 4 and feel like an idiot and will continue to feel like an idiot...until one day hopefully i'm smiling and feeling like a genius. But thats how all of my investments seem to go. Except the one where i feel like a bigger idiot--and there have been those too.
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Post by longstocking on Aug 28, 2015 11:48:01 GMT -5
I'm looking for good news after the one year anniversary of the launch in February. From what I hear many docs wait a year before prescribing new drugs and many insurance plans also wait a full year before adding drugs to their Tier 2s. This is my leanings as well. Also, i never hop on the latest medication (and i would guess other patients may also be reluctant) as its always more expensive and many people are fine with being somewhat controlled of their disease rather than perfectly controlled at the risk of or the fear of dealing with a few new side effects. Many many examples of new meds given FDA approval only to be yanked due to unforeseen problems that weren't observed in trials--or quietly fudged during them (it was even the backstory of THE FUGITIVE w Harrison Ford). Not saying that is the case with Afrezza. But overcoming that "fear" from patients and doctors i think is a real issue. Let alone the insurance issue for now. My guess is if scripts right now were quadruple what they are, the stock price would be north of here too. So i accumulate under 4 and feel like an idiot and will continue to feel like an idiot...until one day hopefully i'm smiling and feeling like a genius. But thats how all of my investments seem to go. Except the one where i feel like a bigger idiot--and there have been those too. I'm happy to be hanging out with the "idiots". Hope to be in the genius camp in a year or so.
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Post by patryn on Aug 28, 2015 12:18:36 GMT -5
This is my leanings as well. Also, i never hop on the latest medication (and i would guess other patients may also be reluctant) as its always more expensive and many people are fine with being somewhat controlled of their disease rather than perfectly controlled at the risk of or the fear of dealing with a few new side effects. Many many examples of new meds given FDA approval only to be yanked due to unforeseen problems that weren't observed in trials--or quietly fudged during them (it was even the backstory of THE FUGITIVE w Harrison Ford). Not saying that is the case with Afrezza. But overcoming that "fear" from patients and doctors i think is a real issue. Let alone the insurance issue for now. My guess is if scripts right now were quadruple what they are, the stock price would be north of here too. So i accumulate under 4 and feel like an idiot and will continue to feel like an idiot...until one day hopefully i'm smiling and feeling like a genius. But thats how all of my investments seem to go. Except the one where i feel like a bigger idiot--and there have been those too. I'm happy to be hanging out with the "idiots". Hope to be in the genius camp in a year or so. Please do temper our expectations. The stock price may well be higher than it is today in a year, but the genius camp will not be readily apparent for probably closer to 5 years. We need to have time to see where Afrezza reaches at peak sales, and to see the pipeline for Technosphere fill out to more than just one approved drug.
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Post by cyn on Aug 28, 2015 16:29:38 GMT -5
Just checked our BCBS (Federal Employee Plan) "Basic Plan" for coverage of Afrezza. BCBS (FEP) contracts with CVS/Caremark for pharmacy benefits. Per the Caremark formulary list, it is covered as a Tier 3 which requires preapproval (PA). Benefit for Tier 3 (non-preferred brand name): 50% coinsurance with a $55 minimum...Tiers 1, 2 and 3 cover up to a 30-day supply, or up to 90-day supply for additional copayments.
For AFREZZA 4UNIT(30) CART W/DEVICE (30 days/quantity 90) Best price via local retail pharmacy search was an out of pocket cost of $141.06 Annual:$1716.23 ($4.70/day)
Under the "Basic" BCBS (FEP) benefit plan the mail order option is "not" a benefit. However, I do know that Afrezza is available via mail order under the enhanced "Standard" BCBS (FEP) plan. Unfortunately, since I'm no longer enrolled in "Standard," I can't access online mail order pricing information. But, when I was enrolled in this premium plan a few months back (around launch time) I did look up mail order pricing for Afrezza, and I recall it being much cheaper at around $90 per month supply (even as a Tier 3).
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Post by pmikeks on Sept 2, 2015 14:50:35 GMT -5
Blue Cross of Tennessee "S" started covering affrezza September first. My out of pocket cost for future prescriptions wil be about $35 according to my pharmacist who I've gotten excited about affrezza. Coverage doesn't require prequalifiing or any of that BS. Hopefully many other insurance companies will follow suit.
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Post by peppy on Sept 2, 2015 15:24:27 GMT -5
Blue Cross of Tennessee "S" started covering affrezza September first. My out of pocket cost for future prescriptions wil be about $35 according to my pharmacist who I've gotten excited about affrezza. Coverage doesn't require prequalifiing or any of that BS. Hopefully many other insurance companies will follow suit. thanks for the information pmike. I looked up your post. Attachment Deleted
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Post by centralcoastinvestor on Sept 2, 2015 15:45:42 GMT -5
This is my leanings as well. Also, i never hop on the latest medication (and i would guess other patients may also be reluctant) as its always more expensive and many people are fine with being somewhat controlled of their disease rather than perfectly controlled at the risk of or the fear of dealing with a few new side effects. Many many examples of new meds given FDA approval only to be yanked due to unforeseen problems that weren't observed in trials--or quietly fudged during them (it was even the backstory of THE FUGITIVE w Harrison Ford). Not saying that is the case with Afrezza. But overcoming that "fear" from patients and doctors i think is a real issue. Let alone the insurance issue for now. My guess is if scripts right now were quadruple what they are, the stock price would be north of here too. So i accumulate under 4 and feel like an idiot and will continue to feel like an idiot...until one day hopefully i'm smiling and feeling like a genius. But thats how all of my investments seem to go. Except the one where i feel like a bigger idiot--and there have been those too. I'm happy to be hanging out with the "idiots". Hope to be in the genius camp in a year or so. Right there with you. I so want to be a genius but thus far it eludes me.
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Post by rozale on Sept 2, 2015 17:38:23 GMT -5
Blue Cross of Tennessee "S" started covering affrezza September first. My out of pocket cost for future prescriptions wil be about $35 according to my pharmacist who I've gotten excited about affrezza. Coverage doesn't require prequalifiing or any of that BS. Hopefully many other insurance companies will follow suit. Awesome news pmike! Hopefully my bcbs starts to cover soon . If BCBS is starting to cover , then I am pretty sure a few of the other big providers will start covering as well. We might be seeing that spike in new RXs a few months after insurance companies start to cover.
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Post by dreamboatcruise on Sept 3, 2015 12:12:12 GMT -5
Blue Cross of Tennessee "S" started covering affrezza September first. My out of pocket cost for future prescriptions wil be about $35 according to my pharmacist who I've gotten excited about affrezza. Coverage doesn't require prequalifiing or any of that BS. Hopefully many other insurance companies will follow suit. I check formularylookup.com fairly often. Have you tried finding your plan on there to see if it is accurately reflected? It would be interesting to use this as a test case to see how long it takes for it to be reflected correctly on that site. If you don't want to check yourself, can you provide the complete name of the drug plan you fall under? What is "S"? Sorry if that is obvious to most.
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