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Post by dreamboatcruise on Dec 5, 2017 13:55:52 GMT -5
Comments from management much earlier in the year had led me to believe that starting Jan 2018 there would be significant new Medicare coverage coming online.
I just went through a bit of a spot exercise looking at the largest 4 Medicare insurers based on number of lives covered as listed by formularylookup.com. Here is what they are currently listed as, which I believe is for 2017 plans.
UnitedHealth Group, Inc. 82 plans 100% Not Covered
Humana, Inc. 59 plans 95% Not Covered
CVS Caremark RX 5 plans 91% Not Covered
Aetna, Inc. 90 plans 100% Not Covered
I did a search for 2018 formularies for these four. From what I found it appears that their main Medicare formularies starting January still do not cover Afrezza at all.
I'm beginning to think that we really don't have any significant change to Medicare coverage that will start in January. I'd be very happy if someone has some evidence to the contrary.
It does seem that more recent comments from management have been about discussions occurring in 2018, and not so much implying there are any done deals waiting to kick in.
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Post by seanismorris on Dec 5, 2017 14:08:37 GMT -5
While I appreciate you looking into this dreamboatcruise, no LIKE for you.
Getting coverage in January would have been nice...
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Post by dreamboatcruise on Dec 5, 2017 14:26:55 GMT -5
I merely report what I find. I was wishing it would have been something different. I was beginning to assume the reason people are not discussing Medicare formulary additions isn't because others haven't looked, but probably because what they found they didn't think would be well received on PB. So I figured it might as well be me to be the bearer of bad news... that way anyone that wants to ignore it can simply chalk it up to me being evil.  It would be great if this thread turned into a list of people pointing out 2018 Medicare formularies where Afrezza has been added... I don't have the time to check hundreds of them myself. Does anyone know how to get 2018 formulary info from formularylookup.com or some similar database? |
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Post by seanismorris on Dec 5, 2017 14:38:03 GMT -5
I merely report what I find. I was wishing it would have been something different. I was beginning to assume the reason people are not discussing Medicare formulary additions isn't because others haven't looked, but probably because what they found they didn't think would be well received on PB. So I figured it might as well be me to be the bearer of bad news... that way anyone that wants to ignore it can simply chalk it up to me being evil. It would be great if this thread turned into a list of people pointing out 2018 Medicare formularies where Afrezza has been added... I don't have the time to check hundreds of them myself. Does anyone know how to get 2018 formulary info from formularylookup.com or some similar database? My humor didn’t come across in my post. Oops. Getting better coverage has been sloooow... Any idea when the next “formulary additions” occur? Is that a twice a year, quarterly, etc. update? It’s not something I’ve been researching. I figure MannKind knows how important it is, and are banging on their door daily. I suppose someone could research other companies that have had Label improvements, and the time it took to get covered... |
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Post by dreamboatcruise on Dec 5, 2017 14:50:46 GMT -5
Well, I seem to remember that back in the first half of the year when they spoke about January 2018 Medicare coverage, part of the context for that statement was that many Medicare plans are only updated once a year (this is from memory, not looking up a transcript, so grain of salt). Countering that I did find one Medicare formulary in my short investigation that had an effective date of July 2017, so there appear to be some that update mid year. It may also be possible that some make exceptions and add drugs even when there isn't a complete new formulary release.
I too am working with the assumption that MNKD management is all over this. Just trying to set my expectations right with regard to when we might actually see results.
An open question in my mind is how much of a problem deals with competing prandials plays into whether Afrezza would be added. Management stated that a different category/bucket would have made a difference, though I've heard some arguments that even a different "category" (adjective) wouldn't have really assured coverage. As we know, we didn't get a different "category" (adjective) from FDA.
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Post by cjm18 on Dec 5, 2017 15:07:59 GMT -5
Maybe (hopefully) the one time update is July and not January?
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Post by dreamboatcruise on Dec 5, 2017 15:11:14 GMT -5
Maybe (hopefully) the one time update is July and not January? All of those 4 big ones that I looked up have new formularies for January. At least one of the 4 did seem to have some mid year update. |
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Post by dh4mizzou on Dec 5, 2017 16:00:39 GMT -5
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Post by straightly on Dec 5, 2017 16:00:46 GMT -5
Comments from management much earlier in the year had led me to believe that starting Jan 2018 there would be significant new Medicare coverage coming online. I just went through a bit of a spot exercise looking at the largest 4 Medicare insurers based on number of lives covered as listed by formularylookup.com. Here is what they are currently listed as, which I believe is for 2017 plans. UnitedHealth Group, Inc. 82 plans 100% Not Covered Humana, Inc. 59 plans 95% Not Covered CVS Caremark RX 5 plans 91% Not Covered Aetna, Inc. 90 plans 100% Not Covered I did a search for 2018 formularies for these four. From what I found it appears that their main Medicare formularies starting January still do not cover Afrezza at all. I'm beginning to think that we really don't have any significant change to Medicare coverage that will start in January. I'd be very happy if someone has some evidence to the contrary. It does seem that more recent comments from management have been about discussions occurring in 2018, and not so much implying there are any done deals waiting to kick in. Mike did say major improvements on coverage but I did not remember he ever mention Medicare. |
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Post by mnholdem on Dec 5, 2017 18:24:57 GMT -5
Actually, it was former CEO Matt Pfeffer who made comments about Sanofi not having set up Medicare coverage and that MannKind was working on getting Afrezza coverage in January 2018.
With the hustle and bustle of transforming MannKind into a commercial entity I hope nobody dropped the ball on this important issue.
Time permitting, I'll fire off an inquiry to the IR Department.
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Post by boca1girl on Dec 5, 2017 22:46:38 GMT -5
I merely report what I find. I was wishing it would have been something different. I was beginning to assume the reason people are not discussing Medicare formulary additions isn't because others haven't looked, but probably because what they found they didn't think would be well received on PB. So I figured it might as well be me to be the bearer of bad news... that way anyone that wants to ignore it can simply chalk it up to me being evil. It would be great if this thread turned into a list of people pointing out 2018 Medicare formularies where Afrezza has been added... I don't have the time to check hundreds of them myself. Does anyone know how to get 2018 formulary info from formularylookup.com or some similar database? I reported last week that I also did a search of Medicare plans using my zip code and only found one plan that covered Afrezza and the estimated cost for the plan was over $12K. |
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Post by brotherm1 on Dec 5, 2017 22:48:37 GMT -5
“In 2011, about 25 percent of the Medicare fee-for-service population had diabetes. Among Medicarebeneficiaries with diabetes, approximately 14 percent had type 1, 85 percent had type 2 but did not use insulin, and less than 1 percent had type 2 diabetes and used insulin to manage their condition.Jan 29, 2014 www.ncbi.nlm.nih.gov › books And “Currently, 44 million beneficiaries—some 15 percent of the U.S. population—are enrolled in the Medicare program. Enrollment is expected to rise to 79 million by 2030. Only one in 10 beneficiaries relies solely on the Medicare program for health care coverage.” The Medicare Beneficiary Population - AA With only 15% of the US population with Medicare, 15% of those with T1, 85% with T2 and not using insulin - and I would guess - unless they are well off enough to have a supplemental plan, many would not be able to afford it. Many are also set it their ways. Perhaps this group has not been a priority near as much as the younger on the go such as upscale college population and population sectors with good insurance and income - just for example. |
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Post by pantaloons on Dec 5, 2017 23:43:27 GMT -5
How much certainty is there that the new clinical results demonstrating superiority will improve insurance coverage? And how quickly would we be able to see the effects of such results?
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Post by kimi on Dec 6, 2017 6:40:56 GMT -5
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Post by promann on Dec 6, 2017 7:14:14 GMT -5
This is great Kimi. Thank you  |
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