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Post by sportsrancho on Jan 16, 2018 13:06:56 GMT -5
I remember vaguely Mike making some remark regarding lowering the price and how rebates to the Pharmacy Benefit Management Companies have a lot to do with covering drugs and the tier levels. Don’t quote me but I got the impression that a higher price would provide a larger profit for the middle men and therefore more favorable treatment with coverage. Sounds bassackwards, but the for profit medical system drives unexpected results. You have a great memory. I knew he told us the reason, but that I didn’t really understand it.
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Post by Deleted on Jan 16, 2018 13:17:28 GMT -5
If I recall correctly, Michael said during an earnings call lower pricing would not help until insurance coverage improved.
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Post by peppy on Jan 16, 2018 13:21:10 GMT -5
If I recall correctly, Michael said during an earnings call lower pricing would not help until insurance coverage improved. something about the higher cost of the medications, the more money the pharmacy purchasing managers make. the health insurance companies run a profit of @ 30% of revenue.
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Post by boca1girl on Jan 16, 2018 13:28:22 GMT -5
I also would like to see a price drop so that every PWD could afford to get Afrezza with or without insurance (gov’t assistance for those who need it).
My dream scenario would be a recognition from the medical and insurance comunities that Afrezza is the best treatment for mealtime insulin needs, barring a cure. Then Mike makes a commitment to the world that MNKD will sell Afrezza at “cost” plus a reasonable profit margin of 20% (??). We (or our partners) build manufacturing plants around the world and sell millions of scripts (or OTC) per week. We will make our profits in the huge volume. (I know, wild dream, but from the little I know about Al Mann, he might agree to that approach.)
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Post by alethea on Jan 16, 2018 13:44:28 GMT -5
Peppy, I love you BUT why do you think Insurance Companies want to or will pay $1,600 per month when injected insulin is much cheaper? ? They don't. They won't. Afrezza is so far overpriced it's ridiculous. Cut the price of Afrezza SIGNIFICANTLY BELOW injected insulin and increase its Sales by three, four, five times or more! Make insurance companies our friends... by making Afrezza CHEAPER than Humalog and Novalog. Althea, you have much more experience with buying Afrezza than I do, but why is $1600/month being talked about? Earlier in this thread, we were talking about a price of $1600/script, and the high price of the script being from more people moving to 3-month scriptswww.goodrx.com/afrezza shows the "large" pack of 60 8u and 30 12u under $700 with coupon, and the "smaller pack" of 60 4u and 30 8u at ~$350 www.goodrx.com/novolog with 5 flexpens at about $550. I'm not sure which is a good comparison Insurance companies probably pay less. I took $1,600 from suegirdor's (zue??) post. Her son uses Afrezza I think. I'm not sure but her young son is a Type 1 if I recall correctly? And he's probably eating like "normal" people his age which means lots and lots of carbs. The more carbs you eat, the more insulin you need. I PERSONALLY paid $485 for my last box which contained only 90 cartridges. 30 4's and 60 8's. And I use Afrezza only sporadically because of its high cost. I am a quite insulin resistant T2. I would need three boxes per month to even begin to even try to eat the carbs a nondiabetic does. Hence 3 boxes at $485 each would be $1,455 for me at that level of use. $1,455 is pretty close to Sue's figure of $1,600. Type 2's generally require much, much more insulin than Type 1's. Even our most famous T1, Sam AfrezzaUser Finta uses a whole bunch of insulin, AT LEAST two boxes per month and maybe more I think. Each diabetic is different, especially T2's. Spiro seems to be getting wonderful results using Afrezza but keep in mind he is a relatively recently developed diabetic. Me, I've had it for nearly 20 years. I am a typical older, "stale" diabetic who requires big, big amounts of insulin to counter carbs. I can't prove it nor am I inclined to try, but I believe strongly that Afrezza is priced way too high to ever catch on "en masse" with Type 2's at its current price. Ironically and coincidentally I am waiting to get my first Afrezza since my new Obamacare insurance effective this month, January. I called MannKindCares and they helped with Prior Authorization which is terrific. My new insurance covers Afrezza, not sure what Tier, but my first order (which is TWO boxes, 180 cartridges) is supposed to be FREE. Hip, hip Hooray. Kudos MNKD. Thank you! BUT, after that, until my deductible is achieved, my new cost will be $418 per box if I've got it correctly. So even with my new insurance, two boxes per month would/will cost me over $900. And even two boxes monthly is not enough for me to eat carbs like a nondiabetic. Anyway, don't want to get too verbose and make this post way too long. I hope that somewhat answers your question.
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Post by compound26 on Jan 16, 2018 14:16:23 GMT -5
Althea, you have much more experience with buying Afrezza than I do, but why is $1600/month being talked about? Earlier in this thread, we were talking about a price of $1600/script, and the high price of the script being from more people moving to 3-month scriptswww.goodrx.com/afrezza shows the "large" pack of 60 8u and 30 12u under $700 with coupon, and the "smaller pack" of 60 4u and 30 8u at ~$350 www.goodrx.com/novolog with 5 flexpens at about $550. I'm not sure which is a good comparison Insurance companies probably pay less. I took $1,600 from suegirdor's (zue??) post. Her son uses Afrezza I think. I'm not sure but her young son is a Type 1 if I recall correctly? And he's probably eating like "normal" people his age which means lots and lots of carbs. The more carbs you eat, the more insulin you need. I PERSONALLY paid $485 for my last box which contained only 90 cartridges. 30 4's and 60 8's. And I use Afrezza only sporadically because of its high cost. I am a quite insulin resistant T2. I would need three boxes per month to even begin to even try to eat the carbs a nondiabetic does. Hence 3 boxes at $485 each would be $1,455 for me at that level of use. $1,455 is pretty close to Sue's figure of $1,600. Type 2's generally require much, much more insulin than Type 1's. Even our most famous T1, Sam AfrezzaUser Finta uses a whole bunch of insulin, AT LEAST two boxes per month and maybe more I think. Each diabetic is different, especially T2's. Spiro seems to be getting wonderful results using Afrezza but keep in mind he is a relatively recently developed diabetic. Me, I've had it for nearly 20 years. I am a typical older, "stale" diabetic who requires big, big amounts of insulin to counter carbs. I can't prove it nor am I inclined to try, but I believe strongly that Afrezza is priced way too high to ever catch on "en masse" with Type 2's at its current price. Ironically and coincidentally I am waiting to get my first Afrezza since my new Obamacare insurance effective this month, January. I called MannKindCares and they helped with Prior Authorization which is terrific. My new insurance covers Afrezza, not sure what Tier, but my first order (which is TWO boxes, 180 cartridges) is supposed to be FREE. Hip, hip Hooray. Kudos MNKD. Thank you! BUT, after that, until my deductible is achieved, my new cost will be $418 per box if I've got it correctly. So even with my new insurance, two boxes per month would/will cost me over $900. And even two boxes monthly is not enough for me to eat carbs like a nondiabetic. Anyway, don't want to get too verbose and make this post way too long. I hope that somewhat answers your question. alethea I think Mike is taking the pricing issue with a two-prong approach as outlined below. As you can see, it is not that Mike is not aware of the pricing issue, it is just that it is not easy to fix the pricing issue. If Mike just cut the retail price by 50% or even 75%, it may not be the best approach. (What if Mike cuts Afrezza price by 75% and the overall insurance coverage and prescription only increased modestly? Say if our TRx increased to 750 within three months due to lower Afrezza retail price (that's a 50% increase, not bad at all). However, because Afrezza price is reduced by 75%, our per script sales will be only 25% of current level. Therefore our total weekly sales will be around $225,000. If this will be the case, where our PPS will be?) For anyone with (relatively acceptable) insurance coverage, retail price of Afrezza is not an issue to the consumer as the consumer is paying the co-pay. For insurance companies, lower price of a drug does not necessarily translate into better coverage. Here is what Mike stated on this subject: On the PBM side, with CVS and Express Scripts, you've got to remember two things about them. They make money off the higher-volume drugs. And they make money off drugs that increase prices frequently. Because as a PBM, they get an administration fee. If you're making 5% off of a $100 versus 5% off $500, which drug would you rather have on formulary -- the one that's going to give $25, not $5, right? So then if you're getting $25 a year, and the price is going to go up, you're going to get a raise of 20% a year, that gives you a $5 raise every single year. You don't have to do anything, other than block competition. So today, our competition says in order to get our discount, you need to block every drug in the class, including Afrezza, and every patient must fail our drug to get to Afrezza, in order to get our rebates. So that's what happens. Novo Nordisk (NYSE:NVO) basically blocks patient access to our product. And so, if you're CVS, and you want those rebates, and you want that admin fee, and you don't want to do any work, the easier thing to do is just to say, "Sorry, I'm doing good cost of care, because Novo is giving me all these rebates for blocking everybody." And then if you say, "Well, add us to the formulary," they say, "You don't have any market share." Then we say, "We don't have any market share, because you block everything!" So how can I get market share? It's a circular argument. This is how they protect their monopoly. This is why you have all these lawsuits going on with insulin. www.fool.com/investing/2017/11/21/mannkind-ceo-michael-castagna-on-whats-ahead-for-t.aspxFor anyone without (or with poor) insurance coverage, retail price is probably too high at this moment. However, I believe Mike is working on this and his plan to solve this will be the membership subscription service through One Drop. And I believe, once this model is kicked off, a few of the people with relatively acceptable insurance coverage may elect to pay cash if their insurance coverage is not ideal or too cumbersome to get Afrezza through their insurance. Here is what Mike stated on this: One Drop partnership Castagna: We look to One Drop -- they've done a phenomenal job of building a patient-focused platform around self-directed care. So one of the things they have is an unlimited test strip membership model for $30 a month. And so we're looking to bolt on to their platform an insulin membership model. There's around $300 million in cash sales in this country where people are paying three to five hundred dollars a month for insulin. And so we look at that as a significant opportunity to help some of the people offset some of the high costs of insulin. S o it's very different business model and taking a little bit longer to get off the ground, because no one's ever done this in the pharmaceutical industry for a prescription-based product. So a lot more lawyers and pharmacy things we have to work through, but we're coming very close to getting that together and that'll be exciting to see. But that collaboration remains strong, and the people there are great. And so we'll continue to see how we integrate technology into coaching as well as getting better customer service to your doorstep on your prescription drugs. Speights: Any idea how far in the future it will be before you get benefits? Castagna: This is one where we don't know if it will take off right away. We know there's a large need. We don't know how price-sensitive people are going to be. So we're going to get it out the door, and we'll be prepared for a really good success. We'll be prepared for really low. But I think it's something that's scalable, so if it takes off faster than we think we can easily add more customer service people and things like that. So we watch this in a couple of categories like weight loss and others and we think, you know, it could be very interesting. So we'll continue to watch it. But this one has a very self-directed aspect to it. www.fool.com/investing/2017/11/21/mannkind-ceo-michael-castagna-on-whats-ahead-for-t.aspx
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Post by casualinvestor on Jan 16, 2018 14:21:42 GMT -5
Thank you, that is good information. If I'm understanding right:
1) The average T2 is using more than 1 box/month. The average may be 2 boxes/month for most users? That will definitely impact an estimate for $$/script 2) Because of the $418/box until you hit your deductible, and the fact that Afrezza is probably in one of the worst tiers, I'm guessing the cost to the insurance company is somewhere around $418-$500 per box.
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Post by peppy on Jan 16, 2018 14:26:05 GMT -5
Thank you, that is good information. If I'm understanding right: 1) The average T2 is using more than 1 box/month. The average may be 2 boxes/month for most users? That will definitely impact an estimate for $$/script 2) Because of the $418/box until you hit your deductible, and the fact that Afrezza is probably in one of the worst tiers, I'm guessing the cost to the insurance company is somewhere around $418-$500 per box. is the the way it works? a $240,000 dollar hospital bill received in the mail, insurance pays $77,000 to the hospital, hospital paid in full. insurance pays the hospital 33 cents on the dollar here. good thing she had health insurance.
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Post by alethea on Jan 16, 2018 14:33:38 GMT -5
Thanks Compound. That's a great post. I am not so arrogant to think I know better than Mike C. but I sure am tired of waiting. I think he's doing a good job, especially given the situation.
I guess I just HOPE (there's that word again) he has carefully considered, researched and consulted regarding the Sales Volume response to a significant price cut.
And I am again very disappointed that it's January 15th and not a freakin word about the Deerfield payment. That angers me a lot and I think that's not unreasonable.
My spider sense says we all are going to take in the shorts again with regard to Deerfield.
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Post by compound26 on Jan 16, 2018 14:41:09 GMT -5
Thanks Compound. That's a great post. I am not so arrogant to think I know better than Mike C. but I sure am tired of waiting. I think he's doing a good job, especially given the situation. I guess I just HOPE (there's that word again) he has carefully considered, researched and consulted regarding the Sales Volume response to a significant price cut. And I am again very disappointed that it's January 15th and not a freakin word about the Deerfield payment. That angers me a lot and I think that's not unreasonable. My spider sense says we all are going to take in the shorts again with regard to Deerfield. alethea Thanks. I share with your frustration. It has been tough road to travel for Mannkind (and its shareholders ) over the last several years. With respect to the $10 million due to Deerfield on Jan. 15, I think the $10 million has been paid by Mannkind. Since it is not a news (just a payment of debt based on previously negotated and agreed upon timeline), no PR is needed. And if that is the case, I am totally fine with that. See my previous post on this. mnkd.proboards.com/post/135630
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Post by alethea on Jan 16, 2018 14:56:49 GMT -5
Thanks Compound. That's a great post. I am not so arrogant to think I know better than Mike C. but I sure am tired of waiting. I think he's doing a good job, especially given the situation. I guess I just HOPE (there's that word again) he has carefully considered, researched and consulted regarding the Sales Volume response to a significant price cut. And I am again very disappointed that it's January 15th and not a freakin word about the Deerfield payment. That angers me a lot and I think that's not unreasonable. My spider sense says we all are going to take in the shorts again with regard to Deerfield. alethea Thanks. I share with your frustration. It has been tough road to travel for Mannkind (and its shareholders ) over the last several years. With respect to the $10 million due to Deerfield on Jan. 15, I think the $10 million has been paid by Mannkind. Since it is not a news (just a payment of debt based on previously negotated and agreed upon timeline), no PR is needed. And if that is the case, I am totally fine with that. See my previous post on this. mnkd.proboards.com/post/135630While it may not be LEGALLY required to disclose the payment of the $10M, I think us long suffering shareholders DESERVE to be told NOW. And really, should we have to be Sherlock Holmes to detect whether or not such payment has been made? Do you think we have to now wait until this newly developed January 29 Investors' conference to hear the answer from MNKD? Two more weeks? And to Matt and anyone else with his wisdom, experience and insight..... how about some thoughts as to what is coming Before it happens?
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Post by casualinvestor on Jan 16, 2018 15:23:56 GMT -5
Thank you, that is good information. If I'm understanding right: 1) The average T2 is using more than 1 box/month. The average may be 2 boxes/month for most users? That will definitely impact an estimate for $$/script 2) Because of the $418/box until you hit your deductible, and the fact that Afrezza is probably in one of the worst tiers, I'm guessing the cost to the insurance company is somewhere around $418-$500 per box. is the the way it works? a $240,000 dollar hospital bill received in the mail, insurance pays $77,000 to the hospital, hospital paid in full. insurance pays the hospital 33 cents on the dollar here. good thing she had health insurance. I get what you are saying, but that's for covered services. Prescriptions/deductibles work a bit differently. I'm going on what I've observed for prescriptions where you are paying until your deductible is filled, you are usually paying 80-100% of the cost for a drug in a "bad" tier. It varies a lot from plan to plan.
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Post by kball on Jan 16, 2018 16:12:47 GMT -5
alethea Thanks. I share with your frustration. It has been tough road to travel for Mannkind (and its shareholders ) over the last several years. With respect to the $10 million due to Deerfield on Jan. 15, I think the $10 million has been paid by Mannkind. Since it is not a news (just a payment of debt based on previously negotated and agreed upon timeline), no PR is needed. And if that is the case, I am totally fine with that. See my previous post on this. mnkd.proboards.com/post/135630 While it may not be LEGALLY required to disclose the payment of the $10M, I think us long suffering shareholders DESERVE to be told NOW.And really, should we have to be Sherlock Holmes to detect whether or not such payment has been made? Do you think we have to now wait until this newly developed January 29 Investors' conference to hear the answer from MNKD? Two more weeks? And to Matt and anyone else with his wisdom, experience and insight..... how about some thoughts as to what is coming Before it happens? MANNKIND-Not helping too many diabetics. And even fewer shareholders.
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Post by tz on Jan 16, 2018 16:20:11 GMT -5
Curious, why the shorts come to longs’ forum?
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Post by kite on Jan 16, 2018 16:22:58 GMT -5
While it may not be LEGALLY required to disclose the payment of the $10M, I think us long suffering shareholders DESERVE to be told NOW.And really, should we have to be Sherlock Holmes to detect whether or not such payment has been made? Do you think we have to now wait until this newly developed January 29 Investors' conference to hear the answer from MNKD? Two more weeks? And to Matt and anyone else with his wisdom, experience and insight..... how about some thoughts as to what is coming Before it happens? MANNKIND-Not helping too many diabetics. And even fewer shareholders. Why does it make a difference if the debt has already been paid for or not... and whether it should be made news or be kept on the down low? We do not need to know every single action that the board is making in detail. The important thing is that every single point is hit. Overall, the lights are still on and marketing continues, whether its an Instagram post from the company or an official PR from the company website. There is no need to stress
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