Post by stocker on Jun 1, 2019 12:38:17 GMT -5
IMO...
Why is it that anyone thinks MNKD will succeed marketing Afrezza in any market, foreign or domestic? MNKD fails here where Afrezza should be known and used the best.
Afrezza will be used to replace RAAs rarely (1 of 20 PWD on RAA) and that is ONLY when a Dr KNOWS THE DRUG WELL ENOUGH to feel confident enough to move them to Afrezza.
How many Drs is that in the US ?
Outside of the US ?
And if / when that happens,...
The Dr will not titrate Afrezza rapidly or thoroughly enough which will result in the patient’s and Dr’s dissatisfaction due to a poor outcome.
Drs won’t venture far enough into the titration process where the T2 would be taking 20u-36u per meal.
Too many…. UNITS! Measuring Afrezza in “UNITS” doesn’t help the cause.
If…it was 1 to 1 ok but now Insulin users have to self-administer WAY MORE “UNITS” of Afrezza and it causes trepidation and is another reason they fail.
They’ll instead, bail on it somewhere between 12u-20u and call it a failure.
Though Dr/patient won’t be able to explain why the morning BSs were so much better ... but back to what the Dr KNOWS and once again,
MNKD has burned one more Dr and one more patient.
Why would that be MNKD’s fault?
BECAUSE THEY ALREADY KNOW. They know they have a 75% (or worse) drop rate.
Correction... that Dr will tell two friends and that patient will tell two friends and so on and so on and so on.
No, it’s not Herbal Essence but the first to try new things are often the bold, the curious, the frustrated and they are often talkers.
Just like those self-motivated PWDs that ran out to request Afrezza after seeing the DTC add.
They are the low hanging fruit that were ripe to try Afrezza, have a great experience and share it with everyone they know!
Instead, they were driven (thankfully, in shameful numbers) into the same dysfunctional affair where Drs don’t know how to use Afrezza, SO THEY DON’T.
They don’t want to take the time to learn because the label says it’s not worth the effort.
Should they take the time to...
● Learn a new Drug that isn’t anything special(label)?
● Will be an uphill Insurance battle to get the med covered ?
● Spend real time/effort needed teaching, titrating a patient who’s insurance will never adequately reimburse the Dr for time spent?
Probably Not ? ... OBVIOUSLY NOT.
or
Their hearts are in it.
They prescribe…
but it’s just so different they inevitably mismanage Afrezza/patient, PA process, letter of Medical Necessity, ETC Etc etc.
Then there are the Drs who simply do not prescribe drugs that require the time to complete a Prior Auth or Letter of Medical Necessity.
Afrezza is a VERY different insulin.
AFREZZA - gets all the bad rap of Insulin without any of the real problems (beer commercial vibe)
Hypos ? No
Needles ? No
Weight gain ? No
Controls blood sugar ? Well...yeah
SEE!!! it’s Insulin.
Show me a Dr. that has heard the fact that Afrezza is an insulin that both lowers A1c AND hypo risk and I’ll show you a Dr. that doesn’t want to hear any more from a fool that wants him to sail off the edge of the earth (he/she actually stopped listening when you said “insulin”).
Time in / to affect / peak / out has to be understood and BELEIVED to use this bio identical hormone anywhere near it’s potential. And that takes Drs a long time.
For T2s
Drs/Endos will hear ...INSULIN.
Drs/Endos will think...INSULIN that kills the self-managed patient.
Avoid INSULIN that kills.
Prescribe something SAFE(R)
I don’t have to prescribe INSULIN yet, so WHY WOULD I?
Why would I prescribe a drug that is easily mismanaged resulting in hypo/coma/death when I can use other safe stuff.
For the Dr. it is often a simple
prescribing decision between.....
a very possible hypo/coma/death (Insulin)
and
Nasty side effects but no hypo/coma/death(all the other stuff)
The ease, efficacy and safety of Afrezza is lost to the fear of traditional INSULIN action.
Consider this.
In the environment described above…
MNKD has spent millions on a DTC knowing that they would be driving 3 of every 4 patients off a cliff.
They know the drop rate.
They’ve known the drop rate.
They won’t disclose the drop rate.
They say “Lots of drug companies go through a phase of high drop rate”.
1. Then disclose the rate to investors if it’s all so normal. Will it be too telling?
2. Don’t spend money we don’t have on an ill timed DTC that will drive patients into that black hole!
Don’t fill the pool until you’ve patched the cracks.
Especially if the water that leaks out (3 out of 4 patients and their 3 prescribing Drs) isn’t just lost to the water table but also bad mouths Afrezza and refuses to prescribe.
We can’t afford bitter water.
We should be spending the precious little $ we have on ensuring that every new patient succeeds and STAYS.
Yes, we need more PWD staying on Afrezza but certainly, we should not be spending millions(or $1) on an effort to bring more patients to a difunctional environment that is currently known to drop 75%(at least) of its highly self-motivated participants. Not without addressing the issue!
Will a Dr. start prescribing after being exposed to successful happy users of Afrezza? Very unlikely - They will stay with what they KNOW.
Will a PWD AVOID/fight less for Afrezza after being exposed to unsuccessful unhappy users? Very likely - It’s an uphill battle to begin with so a slight nudge is all it takes.
It seems to me that we (as a Co.) have to avoid mismanagement of Afrezza 10 times more than others.
Afrezza doesn’t have the same support($) to counteract and persevere.
We’re not Pfizer who can make a lousy drug a success, let alone a paradigm shifter like Afrezza.
Because MNKD knows their drop rate is 75%, then they also know...
$ 0.25 of every $1.00 spent on the DTC
was spent expecting/knowing that 1-NEW patient would start Afrezza and STAY on it and (possibly) 1-NEW Dr. would prescribe once and likely would continue to do so.
&
$ 0.75 of every $1.00 spent on the DTC
was spent expecting/knowing that 3-NEW patients would start Afrezza and FAIL and (possibly) 3-NEW Drs would prescribe once and likely not again.
The more the DTC campaign succeeds...
THE MORE IT FAILS.
Prior to the DTC -75% drop rate with X amount of Patients involved.
WITHOUT ANY SIGNIFICANT CHANGE TO THE LANDSCAPE,
MNKD throws down $9.3M to entice more patients to join the sh*t show. 5M? I’ll raise you 4.3M
MNKD throws down…field in a fit of desperation. The Hail-Mary that ignores (but clearly does not defy) all logic.
If I were trying to defend the DTC, the least cynical thing I could offer as a possible motive on MNKDs part is… HOPE.
HOPE that SOOOOOMMMMMMETHING happens. What? I don’t know. Maybe one of those dreams we talk about here all the time. You know, where Tom Hanks sees our add, gets on Afrezza and tells everyone to go out and get it and Drs nation wide prescribe Afrezza (and titrate successfully) and Insurance Cos adoringly pick up the tab.
Close your eyes, walk into the street and HOPE that you not only avoid getting hit but that someone notices, stops, picks you up, gives you the job of your dreams and becomes your soul mate.
It’s seems about the same for MNKD. SPOILER ALERT! --- We got hit
DTC add is looking less and less like a sincere play for genuine growth and more and more like an attempt to distract, stall and/or _________________.
Can you imagine deciding to roll out the DTC if there were other viable options for MNKD? Even one?
Austrailia? How about Alhambra?
Brazil? How about Boise?
They’re window dressing for now and it’s a good thing they are (not the misleading part) but because if they were soon to get there hands on the drug they would fail as well.
Or is it Global Drop-Rate Domination we’re after?
And that cliff…
Pissed/disappointed people complain.
And when they feel toyed with because one more diabetic medication that carried the promise/excitement of better control/ease of use has failed them, they may have something to say about it.
It’s a cliff with a lot of Drs and patients with something negative to say about their personal experience with AFREZZA.
That’s AFREZZA with an A.
A-F-R-E-Z-Z-A-AFREZZA
MNKD didn’t just burn those 3-NEW patients. MNKD didn’t just burn those 3-Drs.
If MNKD were more transparent we’d know if it was more like 300 patients and 300 Drs.
Transparent - allowing light to pass through so that objects behind can be distinctly seen.
There is a time for such a campaign. This was / is not it. STOP the SCRIPT YOYO. Build em up and tear em down. Build em up and tear em down.
DTC add was FAR worse than doing nothing. As much worse as $9.3M can buy you.
Why do it in the first place?
It’s all you got and you don’t want to admit it.
imo
Why is it that anyone thinks MNKD will succeed marketing Afrezza in any market, foreign or domestic? MNKD fails here where Afrezza should be known and used the best.
Afrezza will be used to replace RAAs rarely (1 of 20 PWD on RAA) and that is ONLY when a Dr KNOWS THE DRUG WELL ENOUGH to feel confident enough to move them to Afrezza.
How many Drs is that in the US ?
Outside of the US ?
And if / when that happens,...
The Dr will not titrate Afrezza rapidly or thoroughly enough which will result in the patient’s and Dr’s dissatisfaction due to a poor outcome.
Drs won’t venture far enough into the titration process where the T2 would be taking 20u-36u per meal.
Too many…. UNITS! Measuring Afrezza in “UNITS” doesn’t help the cause.
If…it was 1 to 1 ok but now Insulin users have to self-administer WAY MORE “UNITS” of Afrezza and it causes trepidation and is another reason they fail.
They’ll instead, bail on it somewhere between 12u-20u and call it a failure.
Though Dr/patient won’t be able to explain why the morning BSs were so much better ... but back to what the Dr KNOWS and once again,
MNKD has burned one more Dr and one more patient.
Why would that be MNKD’s fault?
BECAUSE THEY ALREADY KNOW. They know they have a 75% (or worse) drop rate.
Correction... that Dr will tell two friends and that patient will tell two friends and so on and so on and so on.
No, it’s not Herbal Essence but the first to try new things are often the bold, the curious, the frustrated and they are often talkers.
Just like those self-motivated PWDs that ran out to request Afrezza after seeing the DTC add.
They are the low hanging fruit that were ripe to try Afrezza, have a great experience and share it with everyone they know!
Instead, they were driven (thankfully, in shameful numbers) into the same dysfunctional affair where Drs don’t know how to use Afrezza, SO THEY DON’T.
They don’t want to take the time to learn because the label says it’s not worth the effort.
Should they take the time to...
● Learn a new Drug that isn’t anything special(label)?
● Will be an uphill Insurance battle to get the med covered ?
● Spend real time/effort needed teaching, titrating a patient who’s insurance will never adequately reimburse the Dr for time spent?
Probably Not ? ... OBVIOUSLY NOT.
or
Their hearts are in it.
They prescribe…
but it’s just so different they inevitably mismanage Afrezza/patient, PA process, letter of Medical Necessity, ETC Etc etc.
Then there are the Drs who simply do not prescribe drugs that require the time to complete a Prior Auth or Letter of Medical Necessity.
Afrezza is a VERY different insulin.
AFREZZA - gets all the bad rap of Insulin without any of the real problems (beer commercial vibe)
Hypos ? No
Needles ? No
Weight gain ? No
Controls blood sugar ? Well...yeah
SEE!!! it’s Insulin.
Show me a Dr. that has heard the fact that Afrezza is an insulin that both lowers A1c AND hypo risk and I’ll show you a Dr. that doesn’t want to hear any more from a fool that wants him to sail off the edge of the earth (he/she actually stopped listening when you said “insulin”).
Time in / to affect / peak / out has to be understood and BELEIVED to use this bio identical hormone anywhere near it’s potential. And that takes Drs a long time.
For T2s
Drs/Endos will hear ...INSULIN.
Drs/Endos will think...INSULIN that kills the self-managed patient.
Avoid INSULIN that kills.
Prescribe something SAFE(R)
I don’t have to prescribe INSULIN yet, so WHY WOULD I?
Why would I prescribe a drug that is easily mismanaged resulting in hypo/coma/death when I can use other safe stuff.
For the Dr. it is often a simple
prescribing decision between.....
a very possible hypo/coma/death (Insulin)
and
Nasty side effects but no hypo/coma/death(all the other stuff)
The ease, efficacy and safety of Afrezza is lost to the fear of traditional INSULIN action.
Consider this.
In the environment described above…
MNKD has spent millions on a DTC knowing that they would be driving 3 of every 4 patients off a cliff.
They know the drop rate.
They’ve known the drop rate.
They won’t disclose the drop rate.
They say “Lots of drug companies go through a phase of high drop rate”.
1. Then disclose the rate to investors if it’s all so normal. Will it be too telling?
2. Don’t spend money we don’t have on an ill timed DTC that will drive patients into that black hole!
Don’t fill the pool until you’ve patched the cracks.
Especially if the water that leaks out (3 out of 4 patients and their 3 prescribing Drs) isn’t just lost to the water table but also bad mouths Afrezza and refuses to prescribe.
We can’t afford bitter water.
We should be spending the precious little $ we have on ensuring that every new patient succeeds and STAYS.
Yes, we need more PWD staying on Afrezza but certainly, we should not be spending millions(or $1) on an effort to bring more patients to a difunctional environment that is currently known to drop 75%(at least) of its highly self-motivated participants. Not without addressing the issue!
Will a Dr. start prescribing after being exposed to successful happy users of Afrezza? Very unlikely - They will stay with what they KNOW.
Will a PWD AVOID/fight less for Afrezza after being exposed to unsuccessful unhappy users? Very likely - It’s an uphill battle to begin with so a slight nudge is all it takes.
It seems to me that we (as a Co.) have to avoid mismanagement of Afrezza 10 times more than others.
Afrezza doesn’t have the same support($) to counteract and persevere.
We’re not Pfizer who can make a lousy drug a success, let alone a paradigm shifter like Afrezza.
Because MNKD knows their drop rate is 75%, then they also know...
$ 0.25 of every $1.00 spent on the DTC
was spent expecting/knowing that 1-NEW patient would start Afrezza and STAY on it and (possibly) 1-NEW Dr. would prescribe once and likely would continue to do so.
&
$ 0.75 of every $1.00 spent on the DTC
was spent expecting/knowing that 3-NEW patients would start Afrezza and FAIL and (possibly) 3-NEW Drs would prescribe once and likely not again.
The more the DTC campaign succeeds...
THE MORE IT FAILS.
Prior to the DTC -75% drop rate with X amount of Patients involved.
WITHOUT ANY SIGNIFICANT CHANGE TO THE LANDSCAPE,
MNKD throws down $9.3M to entice more patients to join the sh*t show. 5M? I’ll raise you 4.3M
MNKD throws down…field in a fit of desperation. The Hail-Mary that ignores (but clearly does not defy) all logic.
If I were trying to defend the DTC, the least cynical thing I could offer as a possible motive on MNKDs part is… HOPE.
HOPE that SOOOOOMMMMMMETHING happens. What? I don’t know. Maybe one of those dreams we talk about here all the time. You know, where Tom Hanks sees our add, gets on Afrezza and tells everyone to go out and get it and Drs nation wide prescribe Afrezza (and titrate successfully) and Insurance Cos adoringly pick up the tab.
Close your eyes, walk into the street and HOPE that you not only avoid getting hit but that someone notices, stops, picks you up, gives you the job of your dreams and becomes your soul mate.
It’s seems about the same for MNKD. SPOILER ALERT! --- We got hit
DTC add is looking less and less like a sincere play for genuine growth and more and more like an attempt to distract, stall and/or _________________.
Can you imagine deciding to roll out the DTC if there were other viable options for MNKD? Even one?
Austrailia? How about Alhambra?
Brazil? How about Boise?
They’re window dressing for now and it’s a good thing they are (not the misleading part) but because if they were soon to get there hands on the drug they would fail as well.
Or is it Global Drop-Rate Domination we’re after?
And that cliff…
Pissed/disappointed people complain.
And when they feel toyed with because one more diabetic medication that carried the promise/excitement of better control/ease of use has failed them, they may have something to say about it.
It’s a cliff with a lot of Drs and patients with something negative to say about their personal experience with AFREZZA.
That’s AFREZZA with an A.
A-F-R-E-Z-Z-A-AFREZZA
MNKD didn’t just burn those 3-NEW patients. MNKD didn’t just burn those 3-Drs.
If MNKD were more transparent we’d know if it was more like 300 patients and 300 Drs.
Transparent - allowing light to pass through so that objects behind can be distinctly seen.
There is a time for such a campaign. This was / is not it. STOP the SCRIPT YOYO. Build em up and tear em down. Build em up and tear em down.
DTC add was FAR worse than doing nothing. As much worse as $9.3M can buy you.
Why do it in the first place?
It’s all you got and you don’t want to admit it.
imo
