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Post by peppy on Aug 10, 2017 15:40:37 GMT -5
We know sweedee's dad can not get afrezza coverage. I believe he is on Medicare and sweedee could not find a supplement to help. Reportedly, United Health does not cover afrezza unless disability. MN, I am not sure I am understanding the Medicaid information. 100% not covered?
From the conference call: insurance coverage: Mike C
We continued with commercial improvement in our insurance coverage. As I previously announced, we had Anthem on April 1, we renewed the VA contract and we’re now working on reducing high authorization burdens.
For example, we know contract that continue to have Novolog as preferred exclusive agent. Those contracts and the terms within those prior authorizations typically will say something to the nature of in order to get Afrezza you must fail insulin and have physical and invisible disabilities. And we don't believe it's fair that healthy patients who desire better health should have to fail every aspect of your life before they get access to Afrezza.
We continue to work with places like United and CBS to reduce the burden of the prior authorizations. We’re okay if patients have to fail insulin to get to our product, but we don't think it's fair that patients have to go potentially be visually impaired and physically disabled. So we will continue to open up those opportunities. We had some success already in that nature.
Can you all explain to me what does 70% of lives mean?
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Post by dreamboatcruise on Aug 10, 2017 16:37:22 GMT -5
We know sweedee's dad can not get afrezza coverage. I believe he is on Medicare and sweedee could not find a supplement to help. Reportedly, United Health does not cover afrezza unless disability. MN, I am not sure I am understanding the Medicaid information. 100% not covered?
From the conference call: insurance coverage: Mike C
We continued with commercial improvement in our insurance coverage. As I previously announced, we had Anthem on April 1, we renewed the VA contract and we’re now working on reducing high authorization burdens.
For example, we know contract that continue to have Novolog as preferred exclusive agent. Those contracts and the terms within those prior authorizations typically will say something to the nature of in order to get Afrezza you must fail insulin and have physical and invisible disabilities. And we don't believe it's fair that healthy patients who desire better health should have to fail every aspect of your life before they get access to Afrezza.
We continue to work with places like United and CBS to reduce the burden of the prior authorizations. We’re okay if patients have to fail insulin to get to our product, but we don't think it's fair that patients have to go potentially be visually impaired and physically disabled. So we will continue to open up those opportunities. We had some success already in that nature.
Can you all explain to me what does 70% of lives mean?
It means 70% of all the people covered by the types of insurance he is talking about. However, I've been unclear as to which insurance is included when he says "commercial"... does that include Medicare advantage? does it include health exchange? It may be everyone not on straight Medicare or Medicaid, or uninsured.
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Post by peppy on Aug 10, 2017 16:48:16 GMT -5
yep. MN can help me understand what we are looking at, even though he has tired. So this story, that afrezza is failing, could it be just no insurance coverage? how has sam, eric and laura k gotten coverage? Although I do think I understand Laura K insurance coverage. I used to joke in my youth, to marry well. I wonder what insurance policies they have.
So on reversed, the man with out a leg get lows from his meds. Lisa I saw a seen where she goes low, and a mention she is wearing a pump. I do not believe these people have the insurance coverage for afrezza. The disability would allow it.
Man, I am a bitch.
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Post by peppy on Aug 10, 2017 17:26:03 GMT -5
Thank you oldfishtowner, I read it. I see you decided to let it be gone.
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Post by dreamboatcruise on Aug 10, 2017 18:52:17 GMT -5
yep. MN can help me understand what we are looking at, even though he has tired. So this story, that afrezza is failing, could it be just no insurance coverage? how has sam, eric and laura k gotten coverage? Although I do think I understand Laura K insurance coverage. I used to joke in my youth, to marry well. I wonder what insurance policies they have. So on reversed, the man with out a leg get lows from his meds. Lisa I saw a seen where she goes low, and a mention she is wearing a pump. I do not believe these people have the insurance coverage for afrezza. The disability would allow it. Man, I am a bitch. Different insurers have very different levels of coverage. Here is data for entire U.S. for what is considered "Commercial" by formularylookup.com (not Medicare, Medicaid or health exchange). This list is ordered from the largest (by "lives" covered) and I only copied and pasted the top dozen or so. Unfortunately it merely shows the category (covered, NOT covered, covered with PA) that makes up the largest portion for a particular insurer... but many of them are above 90% for a given insurer, which probably means that a given insurer decides on a particular coverage (or lack thereof) as their default and only deviates from that if a particular large employer (like GE) tells them they want a deviation from that default. So good news is that 98% of people covered by the largest on the list, Express Scripts, are covered for Afrezza and apparently with no prior authorization. But then the number 2 is CVS Caremark and they are exactly the opposite... 91% of their "lives" have no coverage for Afrezza. To get it with them wouldn't be a prior authorization, it would be a much more onerous applying for an "exception". I'm hereby dubbing them NoCareMark. You can see that UnitedHealth is 97% Not Covered... which is NOT GOOD. Shame on you UnitedAgainstHealth. Express Scripts PBM 1427 plans 98% Covered CVS Caremark RX 1315 plans 91% Not Covered Anthem, Inc. 297 plans 99% Covered (PA/ST) UnitedHealth Group, Inc. 92 plans 97% Not Covered OptumRx 99 plans 53% Covered Aetna, Inc. 178 plans 64% Covered (PA/ST) CIGNA Health Plans, Inc. 43 plans 92% Not Covered Kaiser Foundation Health Plans, Inc. 30 plans 91% Not Covered Department of Defense - TRICARE 6 plans 100% Covered (PA/ST) Blue Cross Blue Shield Association Corporation 5 plans 100% Covered (PA/ST) Health Care Service Corporation 84 plans 96% Covered (PA/ST) Envision Pharmaceutical Services 22 plans 100% Not Covered Department of Veterans Affairs (VHA) 2 plans 100% Covered (PA/ST) Indian Health Service (IHS) 1 plan 100% Covered (PA/ST) Blue Shield of California 8 plans 100% Covered (PA/ST)
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Post by peppy on Aug 10, 2017 20:20:04 GMT -5
Thank you.
prior authorization/step therapy. so you have to flunk the steps?
The flunk is the HgA1c.
(Inappropriate me. Do I see it? Survival of the fittest. Decreasing the population decreases the social security pay out.)
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Post by sellhighdrinklow on Aug 10, 2017 20:34:25 GMT -5
Thank you.
prior authorization/step therapy. so you have to flunk the steps?
The flunk is the HgA1c.
(Inappropriate me. Do I see it? Survival of the fittest. Decreasing the population decreases the social security pay out.)
Many years back, Dexcom had barriers to getting approved through insurance. I had to fill out a 30-day history of logging blood sugars and my hypoglycemia episodes. I filled it out without the real numbers BUT my hypos were everyday so it was not a fib. My point is, these things take time and Afrezza will succeed and be fully covered. Btw, DXCM was trading at 4.50$ at the time. Probably 5++ years ago
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Post by dreamboatcruise on Aug 10, 2017 20:35:13 GMT -5
Thank you.
prior authorization/step therapy. so you have to flunk the steps?
The flunk is the HgA1c.
(Inappropriate me. Do I see it? Survival of the fittest. Decreasing the population decreases the social security pay out.)
Yes, hard to ascertain the real impact of PA/ST in the formularylookup list because that can mean a wide range of things from simply that they need to have gone through normal steps... metformin, orals and basal and still have high A1c before adding mealtime insulin, but where a doc can prescribe Afrezza just as easily as Novolog, or it could mean that a patient would have to have a documented needle phobia or injection site problems to justify Afrezza over injectable RAA. Management seems to be saying that they are improving the situation such that even if an insurer is PA/ST, the restrictions are not as onerous... but MNKD would really be the only ones with much insight into where we stand currently and how quickly its changing.
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Post by derek2 on Aug 10, 2017 20:56:00 GMT -5
HbA1c, not HgA1c. I think "mercury" every time I see that mis-spelling. "A1c" is perfectly fine to use as an abbreviation.
Rules for using A1c in relation to Afrezza:
1: Afrezza was inferior or barely non-inferior to other therapies in lowering A1c in well-controlled trials. Conclusion: A1c is BS. 2. Someone tweets 5.8 A1c after using Afrezza. Conclusion: A1c is the best.
Why the insurance woes? Afrezza is more expensive than SC insulin. Plain and simple.
Here's hoping for an Rx mini-leap above 500 tomorrow.
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Post by peppy on Aug 10, 2017 21:22:16 GMT -5
HbA1c, not HgA1c. I think "mercury" every time I see that mis-spelling. "A1c" is perfectly fine to use as an abbreviation. Rules for using A1c in relation to Afrezza: 1: Afrezza was inferior or barely non-inferior to other therapies in lowering A1c in well-controlled trials. Conclusion: A1c is BS. 2. Someone tweets 5.8 A1c after using Afrezza. Conclusion: A1c is the best. Why the insurance woes? Afrezza is more expensive than SC insulin. Plain and simple. Here's hoping for an Rx mini-leap above 500 tomorrow. oh gezze, my bad. thank you for telling me. I was watching mcdougall. he showed me. the reading is what % the hemoglobin is saturated with glucose. What mcdougall pointed out to me is the glucose distorts the hemoglobin molecule. I promise I will try to improve my spelling errors. Mercury, heh. good one.
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Post by mytakeonit on Aug 10, 2017 21:35:35 GMT -5
Well obviously on the left is a normal male protein ... and on the right we add a little sugar and it becomes distorted.
#Nasty Men
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Post by mytakeonit on Aug 11, 2017 1:17:56 GMT -5
derek ... peppy probably got that HgA1c from McDougall's video. He actually calls it HgBA1c ... like hemoglobin blood A1c.
So, peppy isn't losing it yet from sucking the mercury out of thermometers. Ha!
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Post by brotherm1 on Aug 11, 2017 4:59:44 GMT -5
HbA1c, not HgA1c. I think "mercury" every time I see that mis-spelling. "A1c" is perfectly fine to use as an abbreviation. Rules for using A1c in relation to Afrezza: 1: Afrezza was inferior or barely non-inferior to other therapies in lowering A1c in well-controlled trials. Conclusion: A1c is BS. 2. Someone tweets 5.8 A1c after using Afrezza. Conclusion: A1c is the best. Why the insurance woes? Afrezza is more expensive than SC insulin. Plain and simple. Here's hoping for an Rx mini-leap above 500 tomorrow. "Why the insurance woes? Afrezza is more expensive than SC insulin. Plain and simple." Quite the quagmire, or asperity, bad news, bind, circumstance, clutch, condition, corner, crisis, deadlock, deep water, dilemma, drag, emergency, exigency, fix, hang-up, hardship, hole, hot water, imbroglio, impasse, jam, juncture, large order, lot, mess, muddle, pass, perplexity, pickle, pinch, plight, position, posture, puzzle, quandary, rigor, rough go, scrape, soup, spot, state, strait, tall order ticklish spot tight situation trouble, vicissitude
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Post by dreamboatcruise on Aug 11, 2017 13:56:42 GMT -5
HbA1c, not HgA1c. I think "mercury" every time I see that mis-spelling. "A1c" is perfectly fine to use as an abbreviation. Rules for using A1c in relation to Afrezza: 1: Afrezza was inferior or barely non-inferior to other therapies in lowering A1c in well-controlled trials. Conclusion: A1c is BS. 2. Someone tweets 5.8 A1c after using Afrezza. Conclusion: A1c is the best. Why the insurance woes? Afrezza is more expensive than SC insulin. Plain and simple. Here's hoping for an Rx mini-leap above 500 tomorrow. The first gen RAAs are getting generic (biosimilar) versions now and Afrezza is unlikely to have that for the foreseeable future. Though that manifests itself through the price. Additionally, the big pharma use their portfolios as leverage to tie insurers into preferential treatment. So with some insurers, even if Mannkind were willing to price match or beat, they might not get the tier they seek. Management seemed to indicate getting the new class on label would change this situation.
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Post by matt on Aug 11, 2017 14:34:09 GMT -5
So with some insurers, even if Mannkind were willing to price match or beat, they might not get the tier they seek. That is the way the rebate game is played, and why ExpressScripts and CVS both have brand exclusivity on their top tier formularies. Manufacturers cannot offer a price contingent on excluding other products, so instead they bundle a group of products and set a rebate contingent on the insurer or PBM reaching a certain penetration rate for their products. Example: We will charge $100 per script if fewer than 95% of your diabetic patients use our brand, but you get a rebate of $30 per script if 95% or more are on our product. Usually the rebates are all or nothing deals; the insurer hits the target or they lose the rebate entirely for that year. If the insurer covers 1 million diabetics loss of $30 million in rebates, which are pure profit, is very significant to their bottom line. The leading PBMs make 100% of their profit from the rebates (which they share with the insurers). The money is all in the rebates which is why formulary placement is so critical. If you can supply a wide range of insulin products, like Lilly or Novo does, then you can use rebates based on portfolio penetration instead of product penetration. That is why Lilly owns the ExpressScripts business and Novo owns CVS/Caremark. If Afrezza were free it might put enough of a dent in the penetration rate that an insurer would risk losing the rebate and winding up would be worse off economically. By building the rebate arithmetic around a portfolio of drugs Mannkind cannot duplicate, the competitors can ensure that Afrezza will never make economic sense for some formularies regardless of the price MNKD charges.
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