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Post by lennymnkd on May 27, 2017 14:41:01 GMT -5
No ! This is one drops plan straight from the horses mouth !!!!!
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Post by dreamboatcruise on May 27, 2017 14:50:39 GMT -5
I'd assume you'd need an initial consolation with a doc, and follow ups could be made with a teledoc, otherwise insurance coverage would be problematic. It's an interesting idea, and perhaps a bridge to Afrezza OTC. I don't see Afrezza OTC happening anytime soon... A teledoc would be very useful for updating/changing prescriptions... it would certainly save everyone a lot of time and money. If it takes off, it might be worth looking into as an alternative investment. The problem is the big boys: ExpressScripts, CVS, etc. could jump in with very little barriers to entry... though, a company offering teledoc services could be an acquisition target.. One Drop / Amazon would have huge potential as a platform for teledocs. Amazon Cloud already has the tools for videoconferencing, etc. Your comment made me curious about how many companies are already in the telemed business... which led me to the following on the telemedicine wikipedia page with some info on regulatory restrictions and existing players. I know my insurance uses Teladoc. Any company getting into telemed would need to strike deals individually with insurance companies, some such as BlueShield CA have exclusive deal whereas others such as UnitedHealth mentioned below seem to partner with multiple telemed providers. Does Medicare/Medicaid cover any/all of these? From Wikipedia "Telemedicine" page (https://en.wikipedia.org/wiki/Telemedicine#U.S._licensing_and_regulatory_issues) U.S. licensing and regulatory issues[edit] Restrictive licensure laws in the United States require a practitioner to obtain a full license to deliver telemedicine care across state lines. Typically, states with restrictive licensure laws also have several exceptions (varying from state to state) that may release an out-of-state practitioner from the additional burden of obtaining such a license. A number of states require practitioners who seek compensation to frequently deliver interstate care to acquire a full license. If a practitioner serves several states, obtaining this license in each state could be an expensive and time-consuming proposition. Even if the practitioner never practices medicine face-to-face with a patient in another state, he/she still must meet a variety of other individual state requirements, including paying substantial licensure fees, passing additional oral and written examinations, and traveling for interviews. In 2008, the U.S. passed the Ryan Haight Act which required face-to-face or valid telemedicine consultations prior to receiving a prescription.[65] State medical licensing boards have sometimes opposed telemedicine; for example, in 2012 electronic consultations were illegal in Idaho, and an Idaho-licensed general practitioner was punished by the board for prescribing an antibiotic, triggering reviews of her licensure and board certifications across the country.[66] Subsequently, in 2015 the state legislature legalized electronic consultations.[66] In 2015, Teladoc filed suit against the Texas Medical Board over a rule that required in-person consultations initially; the judge refused to dismiss the case, noting that antitrust laws apply to state medical boards.[67] Companies[edit] In the United States, the major companies offering tele-primary care are Teladoc, American Well, and Doctor on Demand.[68] Companies like Grand Rounds offer remote access to specialty care.[69] Additionally, telemedicine companies are collaborating with health insurers and other telemedicine providers to expand marketshare and patient access to telemedicine consultations. For example, In 2015, UnitedHealthcare announced that it would cover a range of video visits from Doctor On Demand, American Well’s AmWell, and its own Optum’s NowClinic, which is a white-labeled American Well offering.[70][71]
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Post by seanismorris on May 27, 2017 14:53:27 GMT -5
What is Amazon's end plan? I assure you they want to be a full online (legal) pharmacy. It may not be currently part of One Drop, but getting insurance coverage would be the logical next step.
If you look at the services offered by Amazon it goes far beyond selling things, streaming movies/music, etc. they're becoming a services juggernaut. They offer TV installation, computer repair, maid services, etc. who's to say they wouldn't offer teledocs + onsite spirometry tests. Add that to same day drug delivery... Who needs pharmacys?
At some point we might all be Shorting CVS, they may soon be as irrelevant as Sears.
---- Medical orgs may hate the idea of teledocs, etc. and they're going to fight tooth and nail against it. But it is the future.
If you want to talk about ever rising healthcare costs, this is probably the best way to reduce efficiencies from the system...
In the future, when you need in-home healthcare you might be scheduling it on Amazon.
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Post by dreamboatcruise on May 27, 2017 15:05:25 GMT -5
No ! This is one drops plan straight from the horses mouth !!!!! One Drop actually has not said what the business model will be for a subscription model offering of Afrezza. People are assuming it will be the same as for the test strips which does have a no reimbursement model catering to those willing to pay... but they also have One Drop Professional where they are trying to partner with insurance companies. (It is their One Drop Professional offering that was selected for the UAE national health insurance provider Daman. I don't believe they've done any deals yet with US insurance.) The one PR release on Afrezza and One Drop did not go into details about which of these models would apply to Afrezza. The price of Afrezza is currently an order of magnitude more than the monthly test strip price, so assuming that their is a viable business model to cut insurance out of the loop is questionable. I know many here are speculating about that, but at this point it is merely that... speculation. Sorry, just wanting to keep the facts straight.
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Post by sportsrancho on May 27, 2017 15:08:15 GMT -5
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Post by dreamboatcruise on May 27, 2017 15:13:31 GMT -5
What is Amazon's end plan? I assure you they want to be a full online (legal) pharmacy. It may not be currently part of One Drop, but getting insurance coverage would be the logical next step. If you look at the services offered by Amazon it goes far beyond selling things, streaming movies/music, etc. they're becoming a services juggernaut. They offer TV installation, computer repair, maid services, etc. who's to say they wouldn't offer teledocs + onsite spirometry tests. Add that to same day drug delivery... Who needs pharmacys? At some point we might all be Shorting CVS, they may soon be as irrelevant as Sears. ---- Medical orgs may hate the idea of teledocs, etc. and they're going to fight tooth and nail against it. But it is the future.If you want to talk about ever rising healthcare costs, this is probably the best way to reduce efficiencies from the system... In the future, when you need in-home healthcare you might be scheduling it on Amazon. Years ago I proposed to a pretty well connected pathologist that we should start a business to automate/offshore pathology and radiology... think India, Thailand, etc. I figured one could even build redundancy into the system having multiple reviewers, so perhaps getting better results... and that could have been a way of then also introducing AI review into the process. He basically laughed at me and said it would be a cold day in H before doctors would allow that to happen. So agree... tooth and nail. Doctors have far better grip on their business than did the cabbies that fought against Uber.
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Post by lennymnkd on May 27, 2017 15:24:54 GMT -5
Don't worry have my facts straight ! After breakout period at meeting " private company " lets just leave it at that : whether its implemented and maximized to its full potential that's a whole other story ... remember I think Matt s got it right medicine is going 2.0 / and we are in the game ... if it's becoming all to opaque, an you don't have the vision for this sort of thing .. might not be the proper investment for you.
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Post by dreamboatcruise on May 27, 2017 15:35:59 GMT -5
Interesting find. It appears Teladoc (according to wikipedia page on them) is now operating in 48 states whereas Plush (according to their website) is operating in 9 states. I wonder if they get all doctors approved for all of the states they cover or if it's a matter of building up enough volume to have doctors licensed in each of the states. Plush claims it is accepted by most insurance but my insurance BlueShield CA only lists Teladoc on their site. Maybe the next time I need something I'll call Plush to see if they do or do not accept my insurance. Seems the telemed companies would want exclusive deals and the insurers would not... and to me, being the new entrants in the equation, the telemed companies would have a tough battle to get exclusive deals despite it appearing that Teladoc is exclusive with BlueShield CA. Teladoc is publicly traded... I think I'll look into possibility of investing in one or more telemed companies. Would love any thoughts on this if someone has investigated the landscape... though I guess that discussion needs to be put in a different thread.
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Post by lennymnkd on May 27, 2017 15:39:41 GMT -5
I spoke to soon DBC.. your looking to invest ! Sorry
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Post by agedhippie on May 27, 2017 15:57:49 GMT -5
I wonder what the standard of care is in other countries and perhaps those with a single payer system? UAE for example? For the UK standard of care ('pathway' in their terminology) you have to fail three oral drugs before they will talk about insulin. The UAE uses the ADA standard of care I believe which makes sense give their position on FDA approvals.
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Post by sayhey24 on May 27, 2017 16:07:11 GMT -5
No ! This is one drops plan straight from the horses mouth !!!!! One Drop actually has not said what the business model will be for a subscription model offering of Afrezza. People are assuming it will be the same as for the test strips which does have a no reimbursement model catering to those willing to pay... but they also have One Drop Professional where they are trying to partner with insurance companies. (It is their One Drop Professional offering that was selected for the UAE national health insurance provider Daman. I don't believe they've done any deals yet with US insurance.) The one PR release on Afrezza and One Drop did not go into details about which of these models would apply to Afrezza. The price of Afrezza is currently an order of magnitude more than the monthly test strip price, so assuming that their is a viable business model to cut insurance out of the loop is questionable. I know many here are speculating about that, but at this point it is merely that... speculation. Sorry, just wanting to keep the facts straight. Jeff Dachis at the ASM spoke directly to the model he is envisioning for afrezza which is a pay one price model similar to what he currently has in place for the test strips. He is hoping to by-pass the need for insurance companies with a price point which would make it affordable without insurance. The question is at lets say $99 a month is there enough margin left to make money. Onduo is approaching things from the other angle by building the insurance relationships up-front prior to them launching their yet to be announced "product". In fact their CEO is an insurance guy. IMO, assuming MNKD can keep the lights on for the next year they are sitting in the sweet-spot for all these companies looking to leverage real-time cloud based sensor technology. VDex, Ondou, One-Drop and maybe a few more on the near horizon. Stefan Schwarz from SNY, IMO had it right. The real market for afrezza is that 70+% T2s not meeting goal. He also knew going door to door to the PCPs was not going to do it. Now, most T2s would benefit even more if given afrezza day1 and not waiting until things get bad. With CGMs once the T2s start seeing their post meal BG spikes into the 180s and 200+ their doctors are not going to be able to hide behind the pills. Maybe just maybe Nate Pile has it right, just saying.
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Post by MnkdWASmyRtrmntPlan on May 27, 2017 16:13:28 GMT -5
I had my first Skype doctor visit about 4 years ago, and I have had a few since then. I don't recall the doctor ever being late (although I was asked once to push my appointment a half-hour later). Doctors who are either more of a specialist or who are really sought-after doctors (ex. doctors who write self-help books) would tend to have more of a demand for Skype calls. It's really convenient, and you can get to see doctors from anywhere in the country (or, world) without even getting in your car. Rite-aid (and probably others) have the "Chat with a Pharmacist" facility. I'm sure that remote types of appointments will continue to be a growing field in the near future. I just found an interesting little quick-read article entitled "Skype Success: Videoconference Good for Diabetes Care in Teens". It says there was a recent study that concluded there is "no significant differences between the face-to-face and Skype groups before, during, and after the therapy and at 3-month follow-up in terms of adherence or glycemic control (P = .77)." Here' some other highlights from that article: Obstacles in the Way of Videoconferencing/Telemedicine for TherapySeveral obstacles might lie in the way of using videoconferencing technology to deliver BFST-D to adolescents with type 1 diabetes, not least of which is obtaining insurance reimbursements for it, Dr Harris pointed out. What you just said, DBC.Most states, (with the exception of five), have telehealth laws requiring Medicaid and/or commercial insurance coverage for videoconferencing. The problem is that most telehealth laws do not specifically include delivery of behavioral health programs. "More pediatric psychologists trained in BFST-D need to request coverage for BFST-D from insurance companies using the research suggesting that outcomes are just as effective using videoconferencing vs face to face in the clinic," Dr Harris urged. Another problem concerns internet security. Medical centers may not trust the security of free videoconferencing platforms like Skype and FaceTime. These institutions will need to have their own secure videoconferencing platforms that patients and their families can access free of charge, he said. Here's the article: www.medscape.com/viewarticle/846537
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Post by dreamboatcruise on May 27, 2017 16:16:34 GMT -5
Don't worry have my facts straight ! After breakout period at meeting " private company " lets just leave it at that : whether its implemented and maximized to its full potential that's a whole other story ... remember I think Matt s got it right medicine is going 2.0 / and we are in the game ... if it's becoming all to opaque, an you don't have the vision for this sort of thing .. might not be the proper investment for you. LOL... so by straight from horses mouth you meant in a supposed private conversation with Matt? I guess there is no reason to question the voracity of Matt revealing details of a business negotiation between Mannkind and One Drop that is yet to be signed. It's not as if there are regulations about selective disclosure of material information. (eyes rolling) I'm pretty confident in my level of vision and investing choices. I've been at it a long time. And a long time investor in MNKD. I know someone that was exec with Minimed working for Al that first told me about MNKD at its IPO.
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Post by dreamboatcruise on May 27, 2017 16:38:51 GMT -5
One Drop actually has not said what the business model will be for a subscription model offering of Afrezza. People are assuming it will be the same as for the test strips which does have a no reimbursement model catering to those willing to pay... but they also have One Drop Professional where they are trying to partner with insurance companies. (It is their One Drop Professional offering that was selected for the UAE national health insurance provider Daman. I don't believe they've done any deals yet with US insurance.) The one PR release on Afrezza and One Drop did not go into details about which of these models would apply to Afrezza. The price of Afrezza is currently an order of magnitude more than the monthly test strip price, so assuming that their is a viable business model to cut insurance out of the loop is questionable. I know many here are speculating about that, but at this point it is merely that... speculation. Sorry, just wanting to keep the facts straight. Jeff Dachis at the ASM spoke directly to the model he is envisioning for afrezza which is a pay one price model similar to what he currently has in place for the test strips. He is hoping to by-pass the need for insurance companies with a price point which would make it affordable without insurance. The question is at lets say $99 a month is there enough margin left to make money.Onduo is approaching things from the other angle by building the insurance relationships up-front prior to them launching their yet to be announced "product". In fact their CEO is an insurance guy. IMO, assuming MNKD can keep the lights on for the next year they are sitting in the sweet-spot for all these companies looking to leverage real-time cloud based sensor technology. VDex, Ondou, One-Drop and maybe a few more on the near horizon. Stefan Schwarz from SNY, IMO had it right. The real market for afrezza is that 70+% T2s not meeting goal. He also knew going door to door to the PCPs was not going to do it. Now, most T2s would benefit even more if given afrezza day1 and not waiting until things get bad. With CGMs once the T2s start seeing their post meal BG spikes into the 180s and 200+ their doctors are not going to be able to hide behind the pills. Maybe just maybe Nate Pile has it right, just saying. And further questions would be... how many people with insurance would pay $99 per month if they would normally only have to pay $10 (or sometimes less if on mail order 90 day refill... for me a 90 day supply of preferred is $25) to $30? and how many people without insurance could afford $99 per month? I'm not saying there isn't some pricing point that would be feasible as a business model whether it is $99 or even higher, as there may be some number of people that would be willing to pay an additional $1000 a year to have Afrezza vs settling for subq paid for by their insurance... but I think there isn't a price that would address a majority of patient needs as out of pocket expense that wouldn't also wreck the business of Afrezza. It wouldn't have a multibillion dollar market cap potential if they sell Afrezza at the same price as One Drop is currently selling test strips. Even $99 is a drastic cut from current pricing... and can MNKD maintain pricing with PBMs that they have now if they are offering at a steeper discount through One Drop? Negotiations on pricing with PBMs are shrouded in secrecy partly because the drug companies don't want to negotiate based on openly available info about how low they are willing to go. Also, would Medicare/Medicaid pay a higher price than what One Drop is offering it at? As an investor there would be some price threshold that I would view as negative... and it is certainly no lower than $99, and likely higher. If they take that route I'd be interested in getting the opinion of one of our board members that actually has experience in pharma industry (such as Proboards Matt) as to how they would view it impacting future profit prospects and deals with PBMs.
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Post by lennymnkd on May 27, 2017 17:13:59 GMT -5
For the RECORD not Matt and I made that clear by mentioning private company in parentheses... what is your motive
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