|
Post by babaoriley on Nov 28, 2017 2:05:41 GMT -5
ezmit, users also have to be educated to using it correctly, otherwise, the benefits are lost or at least muted. Insurance continues to be the biggest problem - the power of free (or very cheap) is immense!!
|
|
|
Post by babaoriley on Nov 28, 2017 2:30:58 GMT -5
You're forgetting that continuing users have to get an NRx every 3 months (for a 1-month script with 2 refills) or every 9 months (for a 3-month script with 2 refills). In a steady state scenario, refills can only be twice as large as NRx. Put another way, with 100% retention but no new prescriptions, you will still have 33% NRx and 66% refill. Aside from that, people changing their perscription due to figuring out dosage needs can account for more NRx's. Which is a lot like more NRx's due to SKU changes. We don't have the data to evaluate retention just from Symphony scripts. Mannkind does, and that's probably where VDEX is getting their <50% number Based on the analysis our sales reps are pulling in 2-3 scripts a week? No matter how you look at it, it is dismal at this point. If the current trend continues we may break even 12-18 months down the road. Hence the 140mil shares. Jonny, you seem to very negative on MNKD, yet, if what you wrote that I bolded above obtains, we be rich! By the way, I do share your concern with refills, as I thought MNKD did some dancing around the issue at the earnings cc, and I didn't change my mind when it was re-posted on this thread. Very hocus pocus (to me, anyway - perhaps not to the intelligentsia of this forum).
|
|
|
Post by matt on Nov 28, 2017 9:04:47 GMT -5
Mannkind 2.0 relaunch has been going on long enough refills should be much better. Yes the Titration Kits extend refills. Yes many patients didn’t titrate. Yes insurance coverage sucks. However there are a scary amount of patients that try Afrezza and just don’t like it. Another confounding factor is the new packaging. As MNKD phases out certain product options and phases in new package sizes, the patients will be unable to obtain refills for the old product codes. This is not a big deal as the physician can just write a new script for the new product options, but it does artificially increase the number of new scripts and decrease the number of refills until the switch over to the new product packaging is complete. That said, there is no denying that if refill rates need some major improvement.
|
|
|
Post by morfu on Nov 28, 2017 9:17:49 GMT -5
Mannkind 2.0 relaunch has been going on long enough refills should be much better. Yes the Titration Kits extend refills. Yes many patients didn’t titrate. Yes insurance coverage sucks. However there are a scary amount of patients that try Afrezza and just don’t like it. Another confounding factor is the new packaging. As MNKD phases out certain product options and phases in new package sizes, the patients will be unable to obtain refills for the old product codes. This is not a big deal as the physician can just write a new script for the new product options, but it does artificially increase the number of new scripts and decrease the number of refills until the switch over to the new product packaging is complete. That said, there is no denying that if refill rates need some major improvement. Well, even with all that and maybe a poor conversion factor between new and refilled scripts, there should be a direct mathematical link between the new script growth in the last 3 months and the expected refilled script growth in the next 3 months, if we can assume that other factors dont change much.
|
|
|
Post by straightly on Nov 28, 2017 9:30:05 GMT -5
At this point refills should be greatly outnumbering new scripts.... at a magnitude of 5-20 or more. 270 new scripts now should be 270 refills a few months down the road. Why haven't refills gone parabolic??? Why is no one asking this question at the quarterly calls? The only thing that makes sense is that people are not using afrezza as their primary insulin. Instead they are using it for out of control correction dosing. We had a dosing problem. That means few refills till this problem is fixed. And it is. Was it just me, or did anybody else ALSO notice our refill number is growing faster AND more steadily than new RX? For one, we have just broke 200 refills latest week since the relaunch. If we keep the trend, we will break 500 total no later than Friday next week. I am patient enough, MNKD has enough patients for that.
|
|
|
Post by sophie on Nov 28, 2017 9:38:27 GMT -5
At this point refills should be greatly outnumbering new scripts.... at a magnitude of 5-20 or more. 270 new scripts now should be 270 refills a few months down the road. Why haven't refills gone parabolic??? Why is no one asking this question at the quarterly calls? The only thing that makes sense is that people are not using afrezza as their primary insulin. Instead they are using it for out of control correction dosing. We had a dosing problem. That means few refills till this problem is fixed. And it is. Was it just me, or did anybody else ALSO notice our refill number is growing faster AND more steadily than new RX? For one, we have just broke 200 refills latest week since the relaunch. If we keep the trend, we will break 500 total no later than Friday next week. I am patient enough, MNKD has enough patients for that. I’m not sure I’d say the problem is yet fixed. I’m actually curious to see how the rollout happens with advertising. My fear is that a lot of new exposure will recreate several of the old problems, resulting in a new learning curve. With a limited sales force, there isn’t going to be anyone providing instruction for new adopting physicians. New prescribers may not know how to properly titrate. If refills continue to improve that will obviously be a good sign. There is such thing as poor timing and turning off would be prescribers because they don’t know how to use Afrezza if they initially see poor results.
|
|
|
Post by pantaloons on Nov 28, 2017 10:01:44 GMT -5
We had a dosing problem. That means few refills till this problem is fixed. And it is. Was it just me, or did anybody else ALSO notice our refill number is growing faster AND more steadily than new RX? For one, we have just broke 200 refills latest week since the relaunch. If we keep the trend, we will break 500 total no later than Friday next week. I am patient enough, MNKD has enough patients for that. I’m not sure I’d say the problem is yet fixed. I’m actually curious to see how the rollout happens with advertising. My fear is that a lot of new exposure will recreate several of the old problems, resulting in a new learning curve. With a limited sales force, there isn’t going to be anyone providing instruction for new adopting physicians. New prescribers may not know how to properly titrate. If refills continue to improve that will obviously be a good sign. There is such thing as poor timing and turning off would be prescribers because they don’t know how to use Afrezza if they initially see poor results. Can we assume that the regions targeted by the new TV ads have already been or are currently occupied by sales reps who are educating Afrezza-prescribing physicians? That seems to be the most logical strategy to ensure patients are able to titration properly, otherwise the titration issue would most definitely be a reoccurring issue.
|
|
|
Post by me on Nov 28, 2017 10:06:10 GMT -5
That's not even a hypothetical. Refills aren't counted that way. When someone gets a new Rx, it has a specific number of refills, but the days supply are never greater than one year. That means that for someone on Afrezza who regularly refills a 90 DS, they would have 1 x NRx in Month 1, and a Refill in Months 4, 7 and 10, with another NRx in the following Month 1. This last script is counted as a NRx, not a refill. While not exact, a good estimation of a retention range would be to divide Refills in Week X by NRx in Week X-12. Do this for each of the most recent Y weeks and look at the average. Additionally, to get an estimate of the other end of the range of retention, divide Refills in Week X by NRx in Week X-4. Do this for each of the most recent Y weeks and look at the average. These two results (assuming you haven't gone back to prior to the new sales force) should give you a reasonable upper and lower limit on retention. Of course, as has been pointed out here in numerous posts, you can't calculate retention exactly because there is still a lot of noise in these numbers with regard to actual DS splits, samples, individual titration adjustments (which will result in a NRx and not a Refill) and changes in the DS of a script, among others. using the above model, can someone on the board make a calculation? Refill rate compared to NRx set-back 4 weeks is 82% (181/220). Refill rate compared to 12-week set-back doesn't make much sense (>96%), so we probably haven't seen 90 DS scripts for the past four months. Please see caveats above and elsewhere regarding noise and other confounding factors.
|
|
|
Post by derek2 on Nov 28, 2017 10:09:45 GMT -5
|
|
|
Post by InvesterSam on Nov 28, 2017 10:12:08 GMT -5
That's not even a hypothetical. Refills aren't counted that way. When someone gets a new Rx, it has a specific number of refills, but the days supply are never greater than one year. That means that for someone on Afrezza who regularly refills a 90 DS, they would have 1 x NRx in Month 1, and a Refill in Months 4, 7 and 10, with another NRx in the following Month 1. This last script is counted as a NRx, not a refill. While not exact, a good estimation of a retention range would be to divide Refills in Week X by NRx in Week X-12. Do this for each of the most recent Y weeks and look at the average. Additionally, to get an estimate of the other end of the range of retention, divide Refills in Week X by NRx in Week X-4. Do this for each of the most recent Y weeks and look at the average. These two results (assuming you haven't gone back to prior to the new sales force) should give you a reasonable upper and lower limit on retention. Of course, as has been pointed out here in numerous posts, you can't calculate retention exactly because there is still a lot of noise in these numbers with regard to actual DS splits, samples, individual titration adjustments (which will result in a NRx and not a Refill) and changes in the DS of a script, among others. using the above model, can someone on the board make a calculation? I tried the calculation in little different way with following assumptions. 1. Once a patient decided to refill, he/she will continue to refill. He/she will get new script one year later (subtracted that count from NRx and added to Refill). 2. Until Nov 2016, refill occurs every 4 weeks. 3. Three months (Dec 2016, Jan & Feb 2017) are transition from 4 week to 12 week refill interval. 4. From Mar 2017, refill occurs every 12 weeks. 5. To determine weekly NRx increase and retention rate (refill), the rates were adjusted to fit the adjusted NRx & Refill Symphony data. I was able to have a good fit with the following rate.
| NRx Weekly Increase Rate | Retention Rate (Refill %) | Nov-Dec 2016 | 0% | 0% | Jan-Feb 2017 | 1% | -8% | Mar-Jun 2017 | 1% | 5% | Jul-Nov 2017 | 2.5% | 15% |
The retention rate of -8% for Jan-Feb 2017 suggests that the actual transition (4 week to 12 week refill interval) may have happened earlier. The current 15% retention means 15% of true new patients 12 weeks ago (adjusted NRx) refilled and 100% of previous week refills continue refill. For SNY data, the highest rates were for March - May 2015 where weekly NRx increase and retention rate (4 week refill) were 6% and 15%, respectively. If the current rates continue, the expected scripts numbers are
| NRx | Refill | TRx | 12/31/2017 | 307 | 211 | 518 | 12/31/2018 | 1108 | 546 | 1654 |
With new label change, TV ad, and patient education, I guess the script numbers can be much higher quickly.
|
|
|
Post by sophie on Nov 28, 2017 10:21:34 GMT -5
Can we assume that the regions targeted by the new TV ads have already been or are currently occupied by sales reps who are educating Afrezza-prescribing physicians? That seems to be the most logical strategy to ensure patients are able to titration properly, otherwise the titration issue would most definitely be a reoccurring issue. I would say that’s a safe assumption. However, there are a lot of offices in those densely populated areas. I’m sure they know who to target, but it’s not likely with their sales force that they’re getting complete coverage.
|
|
|
Post by me on Nov 28, 2017 10:26:27 GMT -5
using the above model, can someone on the board make a calculation? I tried the calculation in little different way with following assumptions. 1. Once a patient decided to refill, he/she will continue to refill. He/she will get new script one year later (subtracted that count from NRx and added to Refill). 2. Until Nov 2016, refill occurs every 4 weeks. 3. Three months (Dec 2016, Jan & Feb 2017) are transition from 4 week to 12 week refill interval. 4. From Mar 2017, refill occurs every 12 weeks. 5. To determine weekly NRx increase and retention rate (refill), the rates were adjusted to fit the adjusted NRx & Refill Symphony data. I was able to have a good fit with the following rate.
| NRx Weekly Increase Rate | Retention Rate (Refill %) | Nov-Dec 2016 | 0% | 0% | Jan-Feb 2017 | 1% | -8% | Mar-Jun 2017 | 1% | 5% | Jul-Nov 2017 | 2.5% | 15% |
The retention rate of -8% for Jan-Feb 2017 suggests that the actual transition (4 week to 12 week refill interval) may have happened earlier. The current 15% retention means 15% of true new patients 12 weeks ago (adjusted NRx) refilled and 100% of previous week refills continue refill. For SNY data, the highest rates were for March - May 2015 where weekly NRx increase and retention rate (4 week refill) were 6% and 15%, respectively. If the current rates continue, the expected scripts numbers are
| NRx | Refill | TRx | 12/31/2017 | 307 | 211 | 518 | 12/31/2018 | 1108 | 546 | 1654 |
With new label change, TV ad, and patient education, I guess the script numbers can be much higher quickly. We can't assume that if a patient refills once, they'll continue to refill...and even if they do, we don't know whether they are refilling at the end of their prescribed DS or whether they were able to extend their supply. Additionally, refills could not have been every 12 weeks beginning March 2017. If that were the case, then the refills 12 weeks after the NRx would have exceeded the NRx being refilled, resulting in an impossible >100% retention. Basically, each refill will be associated with a NRx filled as few as 10 days (the early titration packs) or as many as 13 weeks (a 90 DS script refilled on the last day) before the refill. You can run a number of scenarios to get the best fit curve between refills and NRx by sliding the refills back, first, 10 days, then 2 weeks through 13 weeks. This will give you a good eyeball approximation of the weighted DS of scripts (again, all of this should be considered with the caveats previously mentioned).
|
|
|
Post by jred on Nov 28, 2017 10:41:28 GMT -5
To support casualinvestor 's conclusion that 100% retention with no new patients results in roughly a max of 33% refill and 66% new, here is the Symphony script data for the week of Nov 17 Novolin R 8990 total, 3770 new 42%, 5220 refills 58% Humulin R 7800 total, 3320 new 42.6%, 4480 refills 57.4% Humulin U500 3630 total, 1240 new 34.2%, 2390 refills 65.8% Humulin pen 3270 total, 1190 new 36.4%, 2080 refills 63.6% Afrezza 486 total, 270 new 55.6%, 216 refills 44.4%
While you can't draw precise conclusions from the data (as explained by others in this thread ) it's clear there is progress that needs to be made. Hopefully as Mike and his team make additional progress and all patients are moved to the new sku's , we will see the scripts continue to trend towards the healthier ratio.
|
|
|
Post by timri on Nov 28, 2017 10:46:06 GMT -5
Is vdex saying they have a 95% rentention rate
|
|
|
Post by jred on Nov 28, 2017 11:44:39 GMT -5
To support casualinvestor 's conclusion that 100% retention with no new patients results in roughly a max of 33% refill and 66% new, here is the Symphony script data for the week of Nov 17 Novolin R 8990 total, 3770 new 42%, 5220 refills 58% Humulin R 7800 total, 3320 new 42.6%, 4480 refills 57.4% Humulin U500 3630 total, 1240 new 34.2%, 2390 refills 65.8% Humulin pen 3270 total, 1190 new 36.4%, 2080 refills 63.6% Afrezza 486 total, 270 new 55.6%, 216 refills 44.4%
While you can't draw precise conclusions from the data (as explained by others in this thread ) it's clear there is progress that needs to be made. Hopefully as Mike and his team make additional progress and all patients are moved to the new sku's , we will see the scripts continue to trend towards the healthier ratio.
*should read max of 33% new and 66% refill - not other way around. Sorry for typo.
|
|