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Post by stevil on Dec 3, 2018 15:56:51 GMT -5
The problem is that there are no quantified results of the impact of Afrezza in the long term. Afrezza returns you to the baseline in two hours taken properly. The question is in the real world will it be taken properly, and if so by how many and for how long. This is complicated by the use of HbA1c as a proxy for the likelihood of complications, one day it will be TIR but the data is not there yet. Without a pivotal trial it is going to be a game of inches. GLP-1 is the perfect drug for the patient population that Stevil is talking about. This is a group that struggles to take drugs daily and you are asking them to take a changing dose of Afrezza every time they eat and to test and possibly follow up an hour later. That is to much of a load, they will not be able to deal with that. Taking a GLP-1 dose every Sunday is far more achievable. It doesn't matter how wonderful a drug is if people do not take it. , For the most part, I agree with everything above. Also, I meant what I said back then and I still do believe that Afrezza will be the gold standard for glucose control. We know that insulin is designed specifically to allow for the uptake of glucose into muscle and fat cells so it would logically follow that the insulin that does its job the quickest, most predictably, and safely would lend to the best control. All that to say, just because something is the gold standard in medicine does not mean that it is the go-to first step. Often times, the gold standard is actually the last step. Well, by definition it should be because it's pointless to continue past the gold standard, but in instances where other modalities are cheaper than the gold standard, there is a step process before getting to the gold standard. Other things are usually tried first. This is where pricing becomes an issue. If Afrezza were the cheapest AND the gold standard for insulins, it would undoubtedly be the go to first-line insulin therapy. As we know, this is not the case. It is my fear that unless/until profoundly convincing trials emerge, Afrezza is going to be stuck on the shelf and saved only for those who cannot control their disease with other insulin. I'm not going to say that it never happens because I don't have enough experience, but from the experience I have had, the only people I have seen who cannot get their A1c below 7 are ones that are 1. noncompliant 2. not properly dosing (amount or frequency) or 3. eating too much of/ or the wrong food. Supposedly Afrezza can knock out #3, but they still have to follow #1 and #2 to the T in order for Afrezza to have any real benefit over other insulins. If I had to put a number on it, from my limited experience mind you, #1 and #2 have made up over 75+% of the problem. I want to believe that Afrezza will solve #1 and #2 being that it is pain free, easy to do, and comes in pre-packaged doses that don't require much thinking, but I have not seen trials show that Afrezza has greater compliance and fewer dosing issues. There is still not a whole lot known about it that should be known by now. I'm really hoping that these studies will start to emerge. Peppy, as to the second part of your question regarding the first phase response- I'll be honest and say that we very briefly covered this topic in my first year. It is too specific since the only time it matters is when discussing Afrezza. Looking back, I'm actually surprised it got covered at all, but it did get mentioned, probably because my professor was trying to prepare us for anything we would encounter. All I can say to it is what is seen in the graphic. Beyond that, I couldn't really offer more information. It is kind of insignificant, though, since that is not a deal maker or breaker. That alone will not be a reason doctors choose to prescribe, at least as far as things have been studied. It is significant only in better controlling post prandial glucose, but that benefit in and of itself- as far as I know- has not been studied or shown to be significant. Hopefully you'll understand what I mean after reading this post in its entirety. If I need to further clarify, please let me know. |
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Post by stevil on Dec 3, 2018 16:19:00 GMT -5
What's the stats on GLP-1s keeping people from developing chronic diabetes-related conditions? What's the stats for people on GLP-1s having to require increasing step therapy? These people have a problem with regulating their glucose. Afrezza takes care of that. Argue all day about this or that, but what are you doing by negatively reinforcing by giving the medically incorrect treatment? Someone complained about a person not understanding after a 30 minute glucose explaination, well take more time to help them understand. Days, weeks, months—does it really matter? That's not an excuse that works for me. You either want the best for people or don't. The choice is yours. That's my opinion. You don't have to like it, and I'm not looking for a reply full of excuses and reasons why you don't. Mango, You're an intelligent person, so I'm not sure why you're completely missing my message. I'll try again, for your sake, to try to help you understand. My wife and I just welcomed our first little one so I took an early Christmas break, so I'm a little more cheery than usual and have the time to reply while my wife and little one nap. I don't have the stats in front of me that you're seeking. However, I can tell you that whatever those stats are, they're a lot better than no therapy at all. Which is exactly what will happen if you prescribe something that your patient doesn't want to take and/or cannot afford. I have never made the assertion that Afrezza was inferior. I know this is not an issue of my communication skills because Aged already responded earlier in this thread fully understanding exactly what I was saying, not what I wasn't. Medically incorrect treatment? LOL. LOL. Sorry, had to do that one twice. By whose standards is it medically incorrect? Yours? Dude, you totally have a God complex! Get over yourself already! Days, weeks, months, does it really matter- actually, yes. This is another one of those things that you won't understand because you're not a doctor. It's not that doctors are any better than anyone else, it's that everyone has their own role to play. It would be foolish for me to spend that much time educating my patient. There are diabetes educators whose sole purpose is to do that. It would be a waste of my time in the sense that I need to take care of other patients and allow my support staff to take care of those kinds of issues. Education does not require medical decision making. Anyone can educate (although it's mostly done by nurses). Only doctors and practitioners can make medical decisions. Again, doesn't make me any better than my staff, it's just the most efficient way for a system to run. I need to do my job and only my job, otherwise my job doesn't get done. It's not my job to educate my patience. To a point, yes, but if it takes longer than 30 minutes, I need to be more creative and use my resources to my benefit to help my patients more effectively. If I spent that much time with one patient, I would be neglecting my other patients and not giving them the care THEY deserve. So, mango, I'll leave you with this... what are YOU doing for people with diabetes? |
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Post by peppy on Dec 3, 2018 16:43:37 GMT -5
The problem is that there are no quantified results of the impact of Afrezza in the long term. Afrezza returns you to the baseline in two hours taken properly. The question is in the real world will it be taken properly, and if so by how many and for how long. This is complicated by the use of HbA1c as a proxy for the likelihood of complications, one day it will be TIR but the data is not there yet. Without a pivotal trial it is going to be a game of inches. GLP-1 is the perfect drug for the patient population that Stevil is talking about. This is a group that struggles to take drugs daily and you are asking them to take a changing dose of Afrezza every time they eat and to test and possibly follow up an hour later. That is to much of a load, they will not be able to deal with that. Taking a GLP-1 dose every Sunday is far more achievable. It doesn't matter how wonderful a drug is if people do not take it. , For the most part, I agree with everything above.Also, I meant what I said back then and I still do believe that Afrezza will be the gold standard for glucose control. We know that insulin is designed specifically to allow for the uptake of glucose into muscle and fat cells so it would logically follow that the insulin that does its job the quickest, most predictably, and safely would lend to the best control. All that to say, just because something is the gold standard in medicine does not mean that it is the go-to first step. Often times, the gold standard is actually the last step. Well, by definition it should be because it's pointless to continue past the gold standard, but in instances where other modalities are cheaper than the gold standard, there is a step process before getting to the gold standard. Other things are usually tried first. This is where pricing becomes an issue. If Afrezza were the cheapest AND the gold standard for insulins, it would undoubtedly be the go to first-line insulin therapy. As we know, this is not the case. It is my fear that unless/until profoundly convincing trials emerge, Afrezza is going to be stuck on the shelf and saved only for those who cannot control their disease with other insulin. I'm not going to say that it never happens because I don't have enough experience, but from the experience I have had, the only people I have seen who cannot get their A1c below 7 are ones that are 1. noncompliant 2. not properly dosing (amount or frequency) or 3. eating too much of/ or the wrong food. Supposedly Afrezza can knock out #3, but they still have to follow #1 and #2 to the T in order for Afrezza to have any real benefit over other insulins. If I had to put a number on it, from my limited experience mind you, #1 and #2 have made up over 75+% of the problem. I want to believe that Afrezza will solve #1 and #2 being that it is pain free, easy to do, and comes in pre-packaged doses that don't require much thinking, but I have not seen trials show that Afrezza has greater compliance and fewer dosing issues. There is still not a whole lot known about it that should be known by now. I'm really hoping that these studies will start to emerge. Peppy, as to the second part of your question regarding the first phase response- I'll be honest and say that we very briefly covered this topic in my first year. It is too specific since the only time it matters is when discussing Afrezza. Looking back, I'm actually surprised it got covered at all, but it did get mentioned, probably because my professor was trying to prepare us for anything we would encounter. All I can say to it is what is seen in the graphic. Beyond that, I couldn't really offer more information. It is kind of insignificant, though, since that is not a deal maker or breaker. That alone will not be a reason doctors choose to prescribe, at least as far as things have been studied. It is significant only in better controlling post prandial glucose, but that benefit in and of itself- as far as I know- has not been studied or shown to be significant. Hopefully you'll understand what I mean after reading this post in its entirety. If I need to further clarify, please let me know. Aged likes every other diabetes drug on the market, and would put the type two on a 800 calorie diet for his fun and pleasure. that is aged gig. What aged really wants is a cure. I would want that as well. So aged said, gap-1 is perfect for the population you are talking about, type twos. There are type ones. 1.5 million of them in the USA. Stevil, we are just talking. Congratulations on your infant! Love, Love, Love. it is amazing isn't it! |
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Post by mango on Dec 3, 2018 16:47:00 GMT -5
What's the stats on GLP-1s keeping people from developing chronic diabetes-related conditions? What's the stats for people on GLP-1s having to require increasing step therapy? These people have a problem with regulating their glucose. Afrezza takes care of that. Argue all day about this or that, but what are you doing by negatively reinforcing by giving the medically incorrect treatment? Someone complained about a person not understanding after a 30 minute glucose explaination, well take more time to help them understand. Days, weeks, months—does it really matter? That's not an excuse that works for me. You either want the best for people or don't. The choice is yours. That's my opinion. You don't have to like it, and I'm not looking for a reply full of excuses and reasons why you don't. Mango, You're an intelligent person, so I'm not sure why you're completely missing my message. I'll try again, for your sake, to try to help you understand. My wife and I just welcomed our first little one so I took an early Christmas break, so I'm a little more cheery than usual and have the time to reply while my wife and little one nap. I don't have the stats in front of me that you're seeking. However, I can tell you that whatever those stats are, they're a lot better than no therapy at all. Which is exactly what will happen if you prescribe something that your patient doesn't want to take and/or cannot afford. I have never made the assertion that Afrezza was inferior. I know this is not an issue of my communication skills because Aged already responded earlier in this thread fully understanding exactly what I was saying, not what I wasn't. Medically incorrect treatment? LOL. LOL. Sorry, had to do that one twice. By whose standards is it medically incorrect? Yours? Dude, you totally have a God complex! Get over yourself already! Days, weeks, months, does it really matter- actually, yes. This is another one of those things that you won't understand because you're not a doctor. It's not that doctors are any better than anyone else, it's that everyone has their own role to play. It would be foolish for me to spend that much time educating my patient. There are diabetes educators whose sole purpose is to do that. It would be a waste of my time in the sense that I need to take care of other patients and allow my support staff to take care of those kinds of issues. Education does not require medical decision making. Anyone can educate (although it's mostly done by nurses). Only doctors and practitioners can make medical decisions. Again, doesn't make me any better than my staff, it's just the most efficient way for a system to run. I need to do my job and only my job, otherwise my job doesn't get done. It's not my job to educate my patience. To a point, yes, but if it takes longer than 30 minutes, I need to be more creative and use my resources to my benefit to help my patients more effectively. If I spent that much time with one patient, I would be neglecting my other patients and not giving them the care THEY deserve. So, mango, I'll leave you with this... what are YOU doing for people with diabetes? "Believe me, I'm probably the biggest believer of Afrezza on the board." — stevil July 8, 2015 at 9:18AM Stevil, you are a hypocrite or a liar. Take your pick.  |
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Post by stevil on Dec 3, 2018 16:58:25 GMT -5
peppy , For the most part, I agree with everything above.Also, I meant what I said back then and I still do believe that Afrezza will be the gold standard for glucose control. We know that insulin is designed specifically to allow for the uptake of glucose into muscle and fat cells so it would logically follow that the insulin that does its job the quickest, most predictably, and safely would lend to the best control. All that to say, just because something is the gold standard in medicine does not mean that it is the go-to first step. Often times, the gold standard is actually the last step. Well, by definition it should be because it's pointless to continue past the gold standard, but in instances where other modalities are cheaper than the gold standard, there is a step process before getting to the gold standard. Other things are usually tried first. This is where pricing becomes an issue. If Afrezza were the cheapest AND the gold standard for insulins, it would undoubtedly be the go to first-line insulin therapy. As we know, this is not the case. It is my fear that unless/until profoundly convincing trials emerge, Afrezza is going to be stuck on the shelf and saved only for those who cannot control their disease with other insulin. I'm not going to say that it never happens because I don't have enough experience, but from the experience I have had, the only people I have seen who cannot get their A1c below 7 are ones that are 1. noncompliant 2. not properly dosing (amount or frequency) or 3. eating too much of/ or the wrong food. Supposedly Afrezza can knock out #3, but they still have to follow #1 and #2 to the T in order for Afrezza to have any real benefit over other insulins. If I had to put a number on it, from my limited experience mind you, #1 and #2 have made up over 75+% of the problem. I want to believe that Afrezza will solve #1 and #2 being that it is pain free, easy to do, and comes in pre-packaged doses that don't require much thinking, but I have not seen trials show that Afrezza has greater compliance and fewer dosing issues. There is still not a whole lot known about it that should be known by now. I'm really hoping that these studies will start to emerge. Peppy, as to the second part of your question regarding the first phase response- I'll be honest and say that we very briefly covered this topic in my first year. It is too specific since the only time it matters is when discussing Afrezza. Looking back, I'm actually surprised it got covered at all, but it did get mentioned, probably because my professor was trying to prepare us for anything we would encounter. All I can say to it is what is seen in the graphic. Beyond that, I couldn't really offer more information. It is kind of insignificant, though, since that is not a deal maker or breaker. That alone will not be a reason doctors choose to prescribe, at least as far as things have been studied. It is significant only in better controlling post prandial glucose, but that benefit in and of itself- as far as I know- has not been studied or shown to be significant. Hopefully you'll understand what I mean after reading this post in its entirety. If I need to further clarify, please let me know. Aged likes every other diabetes drug on the market, and would put the type two on a 800 calorie diet for his fun and pleasure. that is aged gig. What aged really wants is a cure. I would want that as well. So aged said gap-1 is perfect for the population you are talking about, type twos. There are type ones. 1.5 million of them in the USA. The closest thing to a cure outside of major lifestyle changes- although some modifications need to be made following surgery- is with bariatric surgery. The surgeon I rotated with did 10+/ week. I was pretty opposed to it prior to my rotation with him, but once you see people have success and lose weight they'd been struggling to lose for years, it really changed my heart. The gastric sleeve procedure is actually pretty low risk and can "cure" people of both diabetes and hypertension in the short time after surgery. It does require some adherence to a strict pre-op and post-op diet, but following that, most people resume their normal lives. The mechanism is believed to be tied to neurotransmitters in the lining of the stomach that communicate with the brain. In obese people, their stomachs distend and grow, to the normal "I'm full" receptors get thrown out of rhythm. So you keep eating because your brain never realizes it has taken up an adequate amount of food. By shrinking the stomach, it limits how much food people can eat so they avoid overeating. The byproduct of the surgery is decreased caloric intake, which leads to decreased adipokines, which leads to decreased insulin resistance, helping to increase weight loss. The lost body mass decreases angiogenesis, so there is less vasculature for the heart to have to perfuse, so it lowers blood pressure. If given the option between potentially taking insulin the rest of your life vs having a minor surgery that removes a part of your stomach that you won't miss, which would you choose? Oh, and the surgery also helps you lose those stubborn pounds you maybe have tried to lose for several years. If it were my family, I would do everything I could to avoid surgery, but if I didn't have the discipline or the genetics to avoid it, it's actually a pretty great option to have. |
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Post by peppy on Dec 3, 2018 17:01:58 GMT -5
Aged likes every other diabetes drug on the market, and would put the type two on a 800 calorie diet for his fun and pleasure. that is aged gig. What aged really wants is a cure. I would want that as well. So aged said gap-1 is perfect for the population you are talking about, type twos. There are type ones. 1.5 million of them in the USA. The closest thing to a cure outside of major lifestyle changes- although some modifications need to be made following surgery- is with bariatric surgery. The surgeon I rotated with did 10+/ week. I was pretty opposed to it prior to my rotation with him, but once you see people have success and lose weight they'd been struggling to lose for years, it really changed my heart. The gastric sleeve procedure is actually pretty low risk and can "cure" people of both diabetes and hypertension in the short time after surgery. It does require some adherence to a strict pre-op and post-op diet, but following that, most people resume their normal lives. The mechanism is believed to be tied to neurotransmitters in the lining of the stomach that communicate with the brain. In obese people, their stomachs distend and grow, to the normal "I'm full" receptors get thrown out of rhythm. So you keep eating because your brain never realizes it has taken up an adequate amount of food. By shrinking the stomach, it limits how much food people can eat so they avoid overeating. The byproduct of the surgery is decreased caloric intake, which leads to decreased adipokines, which leads to decreased insulin resistance, helping to increase weight loss. The lost body mass decreases angiogenesis, so there is less vasculature for the heart to have to perfuse, so it lowers blood pressure. If given the option between potentially taking insulin the rest of your life vs having a minor surgery that removes a part of your stomach that you won't miss, which would you choose? Oh, and the surgery also helps you lose those stubborn pounds you maybe have tried to lose for several years. If it were my family, I would do everything I could to avoid surgery, but if I didn't have the discipline or the genetics to avoid it, it's actually a pretty great option to have. I know you are correct about bariatric surgery. Aged is a type one. I ran into this information looking at food and dieting, pertains a bit to mechanism you typed about. ( not talking about bariatric Surgery in this sentence) Obese people/people tend to eat the same weight of food per day. If I eat three pounds of food, supposedly, I would eat that every day. Interesting huh. |
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Post by stevil on Dec 3, 2018 17:07:16 GMT -5
"Believe me, I'm probably the biggest believer of Afrezza on the board." — stevil July 8, 2015 at 9:18AM Stevil, you are a hypocrite or a liar. Take your pick. I really don't enjoy getting into arguments with people that just make asses of themselves. It brings me no joy. This will be my last response for the sake of the board, moderators, and you. 1. I have not said anything contrary to that statement. You cannot make a claim without any evidence, i.e. pointing me to the post that gave you that impression. Although I think it would be necessary to dive into semantics and define believer because I will admit, you are far more radical than I am. But this was also before you joined the site (I think). 2. You pulled a quote from 3 and a half years ago. Really? Even IF I said anything contrary to that, am I not allowed to change my mind after 3 and a half years of medical school and time in general? Have you never changed your mind, ever, in your entire life? Would that not also then make you a hypocrite or liar? |
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Post by mango on Dec 3, 2018 17:12:43 GMT -5
"Believe me, I'm probably the biggest believer of Afrezza on the board." — stevil July 8, 2015 at 9:18AM Stevil, you are a hypocrite or a liar. Take your pick. I really don't enjoy getting into arguments with people that just make asses of themselves. It brings me no joy. This will be my last response for the sake of the board, moderators, and you. 1. I have not said anything contrary to that statement. You cannot make a claim without any evidence, i.e. pointing me to the post that gave you that impression. Although I think it would be necessary to dive into semantics and define believer because I will admit, you are far more radical than I am. But this was also before you joined the site (I think). 2. You pulled a quote from 3 and a half years ago. Really? Even IF I said anything contrary to that, am I not allowed to change my mind after 3 and a half years of medical school and time in general? Have you never changed your mind, ever, in your entire life? Would that not also then make you a hypocrite or liar? Not sure what your motif is here, but doesn't matter now. This is board dedicated to MannKind and obviously Afrezza. Goodbye! |
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Post by agedhippie on Dec 3, 2018 17:45:25 GMT -5
Aged likes every other diabetes drug on the market, and would put the type two on a 800 calorie diet for his fun and pleasure. that is aged gig. What aged really wants is a cure. I would want that as well. So aged said, gap-1 is perfect for the population you are talking about, type twos. There are type ones. 1.5 million of them in the USA. I think all Type 2s should be put on an 800 calorie diet because I am in fact Catbert (my favorite Dilbert character).  Moving Type 1 diabetics is incredibly difficult because we are naturally extremely conservative about change. If it was me I would largely ignore the current Type 1 diabetics (they will change if they want) and focus on new Type 1 diabetics. Part of the diagnosis is making you start injecting yourself as soon as possible to get you used to the idea. Now insert Afrezza there so it's one injection a day rather than half a dozen... |
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Post by agedhippie on Dec 3, 2018 17:50:55 GMT -5
Not sure what your motif is here, but doesn't matter now. This is board dedicated to MannKind and obviously Afrezza. Goodbye! I think you misread that. I think he means it was his last response to you and not the board (at least I hope that's what he meant) |
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Post by falconquest on Dec 3, 2018 18:20:16 GMT -5
I really don't enjoy getting into arguments with people that just make asses of themselves. It brings me no joy. This will be my last response for the sake of the board, moderators, and you. 1. I have not said anything contrary to that statement. You cannot make a claim without any evidence, i.e. pointing me to the post that gave you that impression. Although I think it would be necessary to dive into semantics and define believer because I will admit, you are far more radical than I am. But this was also before you joined the site (I think). 2. You pulled a quote from 3 and a half years ago. Really? Even IF I said anything contrary to that, am I not allowed to change my mind after 3 and a half years of medical school and time in general? Have you never changed your mind, ever, in your entire life? Would that not also then make you a hypocrite or liar? Not sure what your motif is here, but doesn't matter now. This is board dedicated to MannKind and obviously Afrezza. Goodbye! In my opinion mango these are really stupid comments......but I defend your right to say them! |
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Post by porkini on Dec 3, 2018 18:30:57 GMT -5
Yes. These unrealistic and unbridled posts by shorts on this board do affect the share price. Posting stuff like the company is going bankrupt and even messaging others of the same is damaging. :Some even sold at the time because of that. Posting things like “The Market” looks at mnkd in the light of other insulin companies that make over $50 million per week to put mnkd in a dim light is not realistic. He throws the negative slanted hyperbole in there in almost every post. I’ll never forget the nonsensical post matt posted saying 10,000 scripts per week would not bring mnkd to profitability. From a guy that says he was a ceo of a nasdaq listed pharma, that nonsense unfortunately carries a lot of weight to many and unecessarily unerves those here who have a large investment in mnkd. MNKD shareholders are mostly retail. Where do potential new investors learn about MNKD? They google and find a few sights such as this one, stock twits, yahoo and from friends who found it in these places. Not much else out there. quote: I’ll never forget the nonsensical post matt posted saying 10,000 scripts per week would not bring mnkd to profitability. reply: In all fairness (and we know the way I feel) I do not remember this post. Just sayin. My guess would be that it references this post: mnkd.proboards.com/post/75017/thread |
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Post by mango on Dec 3, 2018 18:43:21 GMT -5
quote: I’ll never forget the nonsensical post matt posted saying 10,000 scripts per week would not bring mnkd to profitability. reply: In all fairness (and we know the way I feel) I do not remember this post. Just sayin. My guess would be that it references this post: mnkd.proboards.com/post/75017/threadYep, he definitely said it. "Like davinci said, you need to do the numbers." "So add all of that up, and you will see that it might take substantially more than 10,000 scripts to reach cash flow break even. In the meantime, the company will burn cash, the balance sheet will deteriorate, and that is what Wall Street will be looking at. Any decent financial analyst would do the same calculation I just outlined and come to a similar conclusion..." — matt August 7, 2016 at 9:01AM Observation: I'm sure it doesn't count anymore though because he said it so long ago. |
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Post by nylefty on Dec 3, 2018 18:50:07 GMT -5
quote: I’ll never forget the nonsensical post matt posted saying 10,000 scripts per week would not bring mnkd to profitability. reply: In all fairness (and we know the way I feel) I do not remember this post. Just sayin. My guess would be that it references this post: mnkd.proboards.com/post/75017/threadHere's the absurd post by Matt in that thread, including his ludicrous claim that 70 contract sales reps were costing the company $10 million a month ($142,857 per rep per month).
Like davinci said, you need to do the numbers. Scripts drive revenue, which is a single line on a set of financial statements. I said that 10,000 would be cash flow break-even, and I stand by that number. Why? If we take the trending price per Rx of 533 (off the chart that Liane updates weekly) 10,000 scripts would yield $21 million a month in revenue. What does that $21 million need to cover?
1. The contract sales force, which we know costs around $10 million / month.
2. R&D. Everyone talks about how great Technosphere will be, but it will be worthless without further research. R&D has been averaging $2 million / month.
3. General & Administrative expenses averaged $3.3 million a month in 2015, $2.5 million for the first quarter. Call it $3 million / month.
4. Production cost averaged $5.6 million a month in 2015, and $2.5 million in the first quarter. That was to support very limited sales volumes; if the company is successful with relaunch the cost per month will scale up accordingly. It will not be linear, due to production economies of scale, but the number will substantially larger.
5. Working capital, like accounts receivable, was Sanofi's problem. Now that has to be financed by Mannkind's balance sheet and that is a use of cash that doesn't hit the income statement.
6. The company booked $5.5 million in losses per month on the Amphastar contract in 2015. That contract has not gone away and the current year exposure based on the last 10Q was $13 million.
So add all of that up, and you will see that it might take substantially more than 10,000 scripts to reach cash flow break even
mnkd.proboards.com/post/75017 |
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Post by slugworth008 on Dec 3, 2018 19:11:59 GMT -5
Oh that's easy - Two well dressed guys named Bruno and Pablo, or smartly dressed attractive ladies named Dallas and Annika - who make "sales calls" telling payor's execs it's in their best interests to cover afrezza with preferred tier rates and Endos they should prescribe more - or you know things could happen...like a horse head in your bed...a tragic slip or car accident...you know these things happen. And then let the real benefits take over.
Keep your friends close - Keep your enemies closer.
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