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Post by markado on Nov 29, 2018 21:42:06 GMT -5
As stated, many times - by many here, that is the stumbling block to higher sales. And, that is not a sales task. Achieving improved coverage comes from the senior levels and leadership suite. So, where is that milestone path. Who is specifically responsible for this MNKD, and are they being held responsible/accountable?
Somewhat rhetorical, but ultimately practical. When a major plan or two offers Afrezza more freely as an option, others will come on board, to avoid being perceived as laggards.
Where is our big insurance plan win?!
KP, BCBS, Aetna, UHP, Anthem, etc.,etc.
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Post by brotherm1 on Nov 29, 2018 22:02:36 GMT -5
My gut feeling is that insurance companies don’t want to pay for the costs of Afrezza. Not sure, but I think they mostly look at short term costs of a malady and not as much long term. I think MNKD would like to lower the price of Aftezza but at this time the economic benefits would not outweigh the costs, and so for now MNKD targets those who can afford it much out of pocket. Perhaps wihen foreign sales are implemented, foreign distributors will also initially target those who can afford to pay much out of pocket.
I think MNKD is working every which way to increaae sales in order to bring down manufacturing costs which will in turn enable the price to be lowered. At some point insurance companies will better buy into it.
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Post by brotherm1 on Nov 29, 2018 22:09:32 GMT -5
And in the mean time, Mike, Dr. Kendall and others are working with the insurance companies the best they can, for now and for the future
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Post by mytakeonit on Nov 30, 2018 0:27:46 GMT -5
I think the key is patience ... wait for 2019 to start. Well, at least till I return from VEGAS BABY !!!
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Post by sayhey24 on Nov 30, 2018 7:50:37 GMT -5
This is not rocket science. Get the updates to the standards of care and insurance coverage follows.
When considered a niche drug by the standards you get niche coverage by insurance.
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Post by agedhippie on Nov 30, 2018 9:21:52 GMT -5
This is not rocket science. Get the updates to the standards of care and insurance coverage follows. When considered a niche drug by the standards you get niche coverage by insurance. The 2019 Standard of Care should be released in December so we get to see what Dr Kendall has achieved on that side. |
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Post by goyocafe on Nov 30, 2018 11:19:55 GMT -5
This is not rocket science. Get the updates to the standards of care and insurance coverage follows. When considered a niche drug by the standards you get niche coverage by insurance. The 2019 Standard of Care should be released in December so we get to see what Dr Kendall has achieved on that side. I was under the impression that the ADA has adopted a living SOC and changes would be more fluid/dynamic? |
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Post by peppy on Nov 30, 2018 11:26:42 GMT -5
The 2019 Standard of Care should be released in December so we get to see what Dr Kendall has achieved on that side. I was under the impression that the ADA has adopted a living SOC and changes would be more fluid/dynamic? That is what the Standards of Care indicated. We need to consider it may be lip service for these reasons. From Matt: It is not the PBM you have an issue with; they find it tough to make windfall profits because the insurance plans are experts at squeezing every last penny out of their drug program. PBMs may go along with these practices but I assure you that it is primarily the pharma companies and the insurers that drive the behaviors, but that is not something you can remedy with financial reporting. The rebates can be a huge percentage of the list price and companies with a deep product portfolio can bundle purchases and rebates while a single drug company like Mannkind cannot. If Afrezza makes too much headway into the prandial insulin market, Lilly and Novo can increase rebates on prandial insulins and squeeze the rebates on other products. The insurer gets the same gross rebate, albeit one that is calculated differently, and the rebates provided by the large manufacturers don't change, but it makes it economically impossible for Afrezza to get to tier 2. In the beginning (late 1980's) PBMs didn't get involved in the rebate game so much; they simply filled a script for a fixed price that was cheaper than the neighborhood pharmacist. They truly were a mail order pharmacy filling whatever the patient ordered. The fixed costs were cheaper due to use of automation and lack of a retail storefront, but the PBM didn't really care what drug was n the bottle. As soon as the pharmas figured out that rebates could be used to influence the choice of drug, the rebate system evolved quickly and the insurers made sure that they were the one getting the rebate and not the order filling pharmacy. The system is far from perfect but trying to change healthcare law is about as attractive as walking into a running wood chipper. That is why nobody tries very often. |
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Post by brotherm1 on Nov 30, 2018 11:28:56 GMT -5
This is not rocket science. Get the updates to the standards of care and insurance coverage follows. When considered a niche drug by the standards you get niche coverage by insurance. I would hope money would not be a factor, though seeing that the ADA has been after congress for the past couple of years to find ways to lower or keep insulin costs from rising, I would think costs would would be a factor they consider when determining the standard of care. |
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Post by peppy on Nov 30, 2018 13:52:35 GMT -5
This is not rocket science. Get the updates to the standards of care and insurance coverage follows. When considered a niche drug by the standards you get niche coverage by insurance. I would hope money would not be a factor, though seeing that the ADA has been after congress for the past couple of years to find ways to lower or keep insulin costs from rising, I would think costs would would be a factor they consider when determining the standard of care. Kendall used to be president of the ADA. he knows all the policies and procedures. |
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Post by agedhippie on Nov 30, 2018 14:00:40 GMT -5
I would hope money would not be a factor, though seeing that the ADA has been after congress for the past couple of years to find ways to lower or keep insulin costs from rising, I would think costs would would be a factor they consider when determining the standard of care. Kendall used to be president of the ADA. he knows all the policies and procedures. Chief Scientific and Medical Officer, but he should definitely know all the policies and procedures. |
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Post by peppy on Nov 30, 2018 14:07:55 GMT -5
Kendall used to be president of the ADA. he knows all the policies and procedures. but he should definitely know all the policies and procedures. Even better. |
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Post by matt on Nov 30, 2018 15:41:00 GMT -5
I would hope money would not be a factor . . . Money is a factor in any healthcare decision these days; don't kid yourself about that. Mannkind never did the kind of studies it needed to do in order to be considered superior to the existing standard of care so instead it is left arguing with insurers why they should pay more money for no incremental therapeutic benefit. You can argue until you are blue in the face that Afrezza has benefits that other prandial insulins don't have, and you may even be correct, but the data from a large, randomized, controlled trial is lacking and that is what standards of care are based upon. We know Mannkind cannot make a compelling economic proposition to any insurance company. The cost of producing Afrezza is an order of magnitude more expensive than producing Humalog or Novolog. Likewise, we know the company is not earning any gross profit on the sales they do have because the production costs are higher than the net selling price, and even those costs are artificially low because Danbury and the raw insulin supplies were written down below their original cost and thus are not reflective of the replacement value. On the other hand, we know that Lilly and Novo have increased insulin prices by around 200% in the past ten years. While there may have been some component cost increases in those decisions, mostly the increased prices for Humalog and Novolog are pure profit. The flip side to that coin is that Lilly and Novo could revert to their 2008 pricing, which is roughly a third of today's price, and still be making money selling insulin. That is a price trap that MNKD cannot escape from. If MNKD matched the prices and rebates of Lilly and Novo, the company would hemorrhage even more cash than it is already losing. If MNKD did match them on price, thus absorbing the loss of sales dollars, Lilly and Novo have enough excess gross margin to reduce price and move the goal posts. It is not that Afrezza is not a good product, it is that it is a good product that cannot be manufactured at an economic price relative to the competition AND it lacks the clinical data to prove that the extra cost can be justified by superior patient benefits. This is a simple cost accounting problem; MNKD can never gain enough manufacturing efficiency to play the game according to Lilly's rules; they need to change the rules. The only way for Afrezza to be a success if for MNKD to change the game by changing the standard of care. Dr. Kendall jawboning his friends and medical contacts is not going to get it done. Rehashing the same studies that are already out there is not going to get it done either. Either MNKD steps up and funds a large and extremely compelling study that proves the economic benefits of Afrezza to the healthcare system, or else to quote the great Yogi Bera, it will be deja vu all over again. If MNKD doesn't want to fund that kind of study, which is admittedly a risky proposition, then they should consider pulling the plug on the continual cash drain that the marketing effort has become and plow those dollars into the research pipeline. Rock meet hard place. |
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Post by goyocafe on Nov 30, 2018 16:15:18 GMT -5
Geez! I wish I’d waited til Monday to read Matt’s post. fml
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Post by timri on Nov 30, 2018 16:28:32 GMT -5
Geez! I wish I’d waited til Monday to read Matt’s post. fml He’s unfortunately spot on. That’s why I feel a partner is a must. Share cost, triple your reps, use rebates, prior Doctor relationships. It’s a no brainer. |
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