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Post by dh4mizzou on Jan 25, 2018 9:45:08 GMT -5
Interesting question dreamboat. I've discussed this with some docs and they feel Afrezza has the added element of rapid on-off that RAAs paradoxically don't have, and that that makes it more difficult to learn. I don't have a strong opinion. I do think because docs fear injected insulin so much, they put a lot of time into teaching after trying to stave off the use of insulin for years. Sorry but rapid one-off makes Afrezza harder to learn? Seriously? Help me understand how the speed at which a medication acts confounds the users. |
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Post by agedhippie on Jan 25, 2018 9:45:56 GMT -5
Amazon continues to increase headcount for a potential entry into the retail pharmacy business. Would be mail order of course and there is no longer a question, they are coming and it will be disruptive. Diabetes remains the 500 lb gorilla in healthcare in terms of prevalence and cost. BTW - Toys R Us closing another 180 stores. 9 West getting ready to file. More retail carnage in 2018 followed by weakening mall debt. Amazon can run their PBM on much smaller margins and be happy with the $$ they will make. From what I have read, it will be on an outsourced platform. I will lay you money that Amazon does not enter the prescription drug business in 2018. They already sell OTC items so there is little to gain from their being involved in the heavily regulated end of the market. To the second point, Amazon creating a PBM, that isn't going to happen either. If it was happening then Amazon would be piloting it internally and they are not - they use Express Scripts. |
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Post by mango on Jan 25, 2018 9:51:03 GMT -5
The CEO of Humana was just on CNBC (8:45am EST) talking about the new approach to health care. He gave diabetes as an example and talked about the old silo approach to medical care. He said we need to treat the underlying disease better instead of spending so much on the complications such as neuropathy, amputations, and loss of eye sight. He also stressed how important it was to keep customers with the same insurer for multiple years and gave that as the reason why they pulled out of the ACA. When more people with T2D start to realize that the Standards of Care is medically incorrect and only insulin can address their condition the correct way then I would suspect providers will be forced to explain why they are prescribing them medication(s) that do not address the underlying issue. Only insulin can do that and only Afrezza can restore first-phase insulin response. |
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Post by Deleted on Jan 25, 2018 9:51:39 GMT -5
Amazon continues to increase headcount for a potential entry into the retail pharmacy business. Would be mail order of course and there is no longer a question, they are coming and it will be disruptive. Diabetes remains the 500 lb gorilla in healthcare in terms of prevalence and cost. BTW - Toys R Us closing another 180 stores. 9 West getting ready to file. More retail carnage in 2018 followed by weakening mall debt. Amazon can run their PBM on much smaller margins and be happy with the $$ they will make. From what I have read, it will be on an outsourced platform. I will lay you money that Amazon does not enter the prescription drug business in 2018. They already sell OTC items so there is little to gain from their being involved in the heavily regulated end of the market. To the second point, Amazon creating a PBM, that isn't going to happen either. If it was happening then Amazon would be piloting it internally and they are not - they use Express Scripts. I can't speak to when they will enter the market but they continue to add headcount. There is an inordinate amount of costs to be taken out of Rx distribution to the end consumer. Big bucks to set up the platform but the variable costs become miniscule. As I indicated in my post, the PBM will be on an outsourced platform. Not sure who they currently use for PBM but I thought it was a smaller company. ES would likely want no part of Amazon as Amazon will kill them. Here is an interesting article. www.statnews.com/2017/11/15/pharmacy-benefit-manager-amazon/ |
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Post by boca1girl on Jan 25, 2018 9:53:02 GMT -5
The CEO of Humana was just on CNBC (8:45am EST) talking about the new approach to health care. He gave diabetes as an example and talked about the old silo approach to medical care. He said we need to treat the underlying disease better instead of spending so much on the complications such as neuropathy, amputations, and loss of eye sight. He also stressed how important it was to keep customers with the same insurer for multiple years and gave that as the reason why they pulled out of the ACA. The problem is that the option to remain with the same insurer is in the hands of the employer in most cases. Counter to his argument ACA is one of the few cases where it is possible to remain with the same insurer since it's not the employers call. His point with the ACA is that people came into the system when they needed something taken care of and then dropped out ASAP. |
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Post by brentie on Jan 25, 2018 10:07:01 GMT -5
The CEO of Humana was just on CNBC (8:45am EST) talking about the new approach to health care. He gave diabetes as an example and talked about the old silo approach to medical care. He said we need to treat the underlying disease better instead of spending so much on the complications such as neuropathy, amputations, and loss of eye sight. He also stressed how important it was to keep customers with the same insurer for multiple years and gave that as the reason why they pulled out of the ACA. When more people with T2D start to realize that the Standards of Care is medically incorrect and only insulin can address their condition the correct way then I would suspect providers will be forced to explain why they are prescribing them medication(s) that do not address the underlying issue. Only insulin can do that and only Afrezza can restore first-phase insulin response. Remember when Al said this? Does anybody know if they still think that's a possibility. "Key opinion leaders are becoming increasingly positive and enthusiastic about the potential of AFREZZA. Some are suggesting that by reducing pancreatic stress, AFREZZA may slow and perhaps stop and even reverse progression of type 2 disease. Moreover, delivery of AFREZZA by the inhalation with a tiny, whistle-size inhaler is so simple, so convenient and will be so very cost effective. I truly believe many patients will prefer this therapy modality." seekingalpha.com/article/1173611-mannkind-management-discusses-q4-2012-results-earnings-call-transcript |
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Post by hellodolly on Jan 25, 2018 10:14:44 GMT -5
So, during the gas crisis of the 70's a Japanese owned automobile manufacturing company saw an opportunity to get a foothold in the American dominated new car market. The market, dominated for decades existed essentially since the invention of the automobile, by American manufacturers. Sure there were the high end luxury cars like Ferrari, Rolls Royce and a few others but, not a car for the masses.
An American, W. Ed Deming, worked with this Japanese company who adopted and applied many of his "14 Points" of Total Quality Management, and he was considered a hero by Japanese corporations post WWII. He convinced them that they made the highest quality products anywhere in the world. In this example, the Japanese company built cheap, small, economical, fuel efficient cars and started selling them here. The moment in history of long gas lines, gas shortages, OPEC bringing this country to our knees opened the door for Datsun. They offered their cars so cheap, had competitive new car warranty's that consumers couldn't resist. Once a foothold was established, Datsun began introducing another line of cars, more expensive but who cared? Datsun was proving to be a reliable manufacturer of cars. You know the rest of the history, as Datsun became Nissan and now they sell their luxury line, known as Infiniti. Toyota adopted the same model and thus...Deming's influence had profound implications in the Japanese business culture (plus it helped that the Japanese are hard driving individuals).
So, where is the link to MNKD? While I believe that most of Deming's TQM principles (now replaced by Quality Management Principles) are hard at work at MNKD, I see this as the "exact right moment" to offer Afrezza so cheap, that it can't be ignored. Everything is in place, with insurers not too far behind. Once the Afrezza foothold and growth trajectories are attained, Rx prices can increase over time. Just as Datsun introduced cheap cars and later became a household name in America, consideration by MNKD for this strategy has a proven place in American history. There is only a very small issue of your thesis and it is called cash. Like Chineses say: Money may not accomplish everything, but no money is surely not to accomplish anything. IF there is a way for MNKD to cash flow positive, we are talking about a blockbuster stock. Only IF! Not an issue if you have means to raise it, right? So, let's put that out as being equal on both sides of the thesis. Besides, I've addressed this in a previous post by suggesting that "overstating the obvious" is not necessary. I'm reminded of the kids who I taught to play baseball. Dads would sit behind the fence and yell, "Hit the ball", "Catch the ball", "Make that throw", well, duh? Little Johnny isn't out there dropping the ball on purpose. In fact, it took years of explaining to parents that physical errors and striking out occur in the game...it's the mental mistakes that cost you. Mike and his executive staff are like the coaches of the team. They have the strategy of getting this game into the ninth inning. If money is home plate and Afrezza the ball, you have to hit the ball and put it in play before you can get to home plate. One more baseball analogy I've learned from coaching for 25 years...at all age levels, base hits win more games, not home runs. |
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Post by lennymnkd on Jan 25, 2018 10:17:58 GMT -5
Not to mention there has been talk about them AMAZON ...looking at rite aid # and their PBM ...all plugged in and ready to go ...stores would be a nice fit foe Vdex.
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Post by mango on Jan 25, 2018 11:10:03 GMT -5
When more people with T2D start to realize that the Standards of Care is medically incorrect and only insulin can address their condition the correct way then I would suspect providers will be forced to explain why they are prescribing them medication(s) that do not address the underlying issue. Only insulin can do that and only Afrezza can restore first-phase insulin response. Remember when Al said this? Does anybody know if they still think that's a possibility. "Key opinion leaders are becoming increasingly positive and enthusiastic about the potential of AFREZZA. Some are suggesting that by reducing pancreatic stress, AFREZZA may slow and perhaps stop and even reverse progression of type 2 disease. Moreover, delivery of AFREZZA by the inhalation with a tiny, whistle-size inhaler is so simple, so convenient and will be so very cost effective. I truly believe many patients will prefer this therapy modality." seekingalpha.com/article/1173611-mannkind-management-discusses-q4-2012-results-earnings-call-transcriptOf course it is a possibility. Afrezza restores the first-phase insulin response which is loss in people with type 2 diabetes. So when they have it restored this is restoring post-prandial glucose homeostasis which was dysregulated because of the loss of the FPIR. Most definitely if people with "prediabetes" especially were put on Afrezza we would see this IMO. |
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Post by peppy on Jan 25, 2018 11:53:42 GMT -5
Remember when Al said this? Does anybody know if they still think that's a possibility. "Key opinion leaders are becoming increasingly positive and enthusiastic about the potential of AFREZZA. Some are suggesting that by reducing pancreatic stress, AFREZZA may slow and perhaps stop and even reverse progression of type 2 disease. Moreover, delivery of AFREZZA by the inhalation with a tiny, whistle-size inhaler is so simple, so convenient and will be so very cost effective. I truly believe many patients will prefer this therapy modality." seekingalpha.com/article/1173611-mannkind-management-discusses-q4-2012-results-earnings-call-transcriptOf course it is a possibility. Afrezza restores the first-phase insulin response which is loss in people with type 2 diabetes. So when they have it restored this is restoring post-prandial glucose homeostasis which was dysregulated because of the loss of the FPIR. Most definitely if people with "prediabetes" especially were put on Afrezza we would see this IMO. if I am a type two requiring 20 units of mealtime insulin.... that is pretty close to 25 dollars U.S. a meal. Do you see American insurance companies paying 25 dollars a meal for blood glucose control on a chronic basis? It is difficult for me to see that. |
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Post by bill on Jan 25, 2018 12:33:55 GMT -5
Of course it is a possibility. Afrezza restores the first-phase insulin response which is loss in people with type 2 diabetes. So when they have it restored this is restoring post-prandial glucose homeostasis which was dysregulated because of the loss of the FPIR. Most definitely if people with "prediabetes" especially were put on Afrezza we would see this IMO. if I am a type two requiring 20 units of mealtime insulin.... that is pretty close to 25 dollars U.S. a meal. Do you see American insurance companies paying 25 dollars a meal for blood glucose control on a chronic basis? It is difficult for me to see that. If it allowed enough Type 2's to recover their insulin producing capabilities and no longer requirement treatment, it would be profitable for the insurance companies. The idea would be to help Type 2's avoid becoming Type 1's over time while offsetting some or all of the Afrezza costs via avoidance of other medical expenses that result from less effective treatment options. |
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Post by peppy on Jan 25, 2018 12:38:38 GMT -5
if I am a type two requiring 20 units of mealtime insulin.... that is pretty close to 25 dollars U.S. a meal. Do you see American insurance companies paying 25 dollars a meal for blood glucose control on a chronic basis? It is difficult for me to see that. If it allowed enough Type 2's to recover their insulin producing capabilities and no longer requirement treatment, it would be profitable for the insurance companies. The idea would be to help Type 2's avoid becoming Type 1's over time while offsetting some or all of the Afrezza costs via avoidance of other medical expenses that result from less effective treatment options. understood bill. "On May 20, 2017, Smith turned 26, aging out of his parents’ insurance. Because he was a single man with a decent job, Smith didn’t qualify for subsidies under the Affordable Care Act. The most inexpensive plan Smith and his mother could find on the Minnesota exchange was around $450 per month with a $7600 deductible. Smith could have afforded the monthly premiums, but the deductible made the plan too expensive. On June 25, Smith went to dinner with his girlfriend, where he complained about stomach pains. It was the last time anyone saw him alive. He called in sick to work the next day. On June 27, Smith was found dead in his apartment." "Mick Mulvaney, the Trump administration’s director of the Office of Management and Budget, said last year that the government should “provide that safety net so that if you get cancer you don’t end up broke,” but later added, “That doesn’t mean we should take care of the person who sits at home, eats poorly, and gets diabetes.” This narrative is one of the main reasons why diabetes advocacy cannot get off the ground, while price increases for drugs like the EpiPen were met with wide public outrage." harvardpolitics.com/united-states/how-insulin-became-unaffordable/ |
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Post by mango on Jan 25, 2018 13:16:26 GMT -5
Of course it is a possibility. Afrezza restores the first-phase insulin response which is loss in people with type 2 diabetes. So when they have it restored this is restoring post-prandial glucose homeostasis which was dysregulated because of the loss of the FPIR. Most definitely if people with "prediabetes" especially were put on Afrezza we would see this IMO. if I am a type two requiring 20 units of mealtime insulin.... that is pretty close to 25 dollars U.S. a meal. Do you see American insurance companies paying 25 dollars a meal for blood glucose control on a chronic basis? It is difficult for me to see that. If it kept the person with T2D from ER visits because they are hallucinating and falling asleep mid sentence because they have a blood sugar level over 800, if it kept them from developing diabetic complications because of chronic out-of-range blood sugar levels, if it kept them from having to take additional medications due to developing conditions related to their chronic out-of-range blood sugar levels, if it kept them from having to have procedures done, if it kept them from having to make numerous visits to the clinic, etc etc then... yes, I think it would be ridiculous to not want people with diabetes to be able to avoid all those complications by keeping their blood sugar in range long-term thus hopefully living a long healthy life, essentially with non-diabetic BS levels all day, with significantly less probability of developing additional chronic conditions and significantly less likelihood of developing acute conditions, such as severe hyperglycemia and thinking the South Carolina fair is taking place in your living room and so you're brought to the ER and now falling asleep mid sentence. I think it is obvious that time-in-range is key and maintaining non-diabetic blood sugar levels is most definitely worth it short and long term. I see all the time via Twitter PWD that maintain non-diabetic BS continuously using Afrezza as their prandial insulin. People are restoring their health. They are essentially not a diabetic, just a person taking an exogenous insulin to maintain glucose homeostasis. So alright yeah, I think health insurance companies need to wake up and see the bigger picture and realize what this insulin is capable of doing for people with diabetes. |
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Post by thekindaguyiyam on Jan 25, 2018 14:59:22 GMT -5
Beyond the diet is digestive care. My a1c climbed to 6.8 while my blood glucose average was at 160.
I took myself off Metformin which was creating havoc with my liver enzymes. I take no meds.. but trying to change the diagnostic from Pre-diabetic to Diabetic.
The insurance company wants to pay for ONE test strip a day. What can you learn from that? I pay out of pocket to get 3 test strips a day for biofeedback. With this many strips I can judge if my Pancreas is creating insulin. Going back to the endocrinologist in a couple of weeks. For the last 5 months I have been able to maintain my daily blood sugar average @ 128 . 100% within range. Couldn't have done it without test strips. I asked for a larger quantity from my doctor who contacted Blue Shield of California PPO 90% . who Declined the request because I am now in a healthy range.
The Insurance companies are extremely short sighted especially with consideration as to how Diabetes affects other health abnormalities like Heart, Memory & Depression. I guess the Insurance companies don't consider or won't consider the idea that one medication or disease affects another. With my success of reversing diabetes; what does the insurance company want to do?: eliminate the tools I used to reverse the disease at an early stage. I know for sure that had I let things go further down the line I wouldn't have been able to get to the point when my pancreas started functioning again.
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Post by dreamboatcruise on Jan 25, 2018 15:18:16 GMT -5
Beyond the diet is digestive care. My a1c climbed to 6.8 while my blood glucose average was at 160. I took myself off Metformin which was creating havoc with my liver enzymes. I take no meds.. but trying to change the diagnostic from Pre-diabetic to Diabetic. The insurance company wants to pay for ONE test strip a day. What can you learn from that? I pay out of pocket to get 3 test strips a day for biofeedback. With this many strips I can judge if my Pancreas is creating insulin. Going back to the endocrinologist in a couple of weeks. For the last 5 months I have been able to maintain my daily blood sugar average @ 128 . 100% within range. Couldn't have done it without test strips. I asked for a larger quantity from my doctor who contacted Blue Shield of California PPO 90% . who Declined the request because I am now in a healthy range. The Insurance companies are extremely short sighted especially with consideration as to how Diabetes affects other health abnormalities like Heart, Memory & Depression. I guess the Insurance companies don't consider or won't consider the idea that one medication or disease affects another. With my success of reversing diabetes; what does the insurance company want to do?: eliminate the tools I used to reverse the disease at an early stage. I know for sure that had I let things go further down the line I wouldn't have been able to get to the point when my pancreas started functioning again. Sadly, insurance company execs are judged and compensated the way almost every other corporate exec is... on short term quarterly results. Sometimes you get insurance companies doing things geared towards long term health, but it's not surprising that is the exception rather than the norm. Our health system is a for-profit enterprise. Patient/consumer advocacy will always be needed to push/shame the companies into doing the right thing. |
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