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Post by rtmd on Jun 19, 2019 21:07:46 GMT -5
This provides the "Best Wholesale Price for Afrezza": www.drugpatentwatch.com/p/drug-price/drugname/index.php?query=AFREZZAThe interesting part was the sentence at the top: "These are wholesale prices available to the US Federal Government which, by law, must be the best prices available to any customer under comparable terms and conditions." I never knew there was such a law. So if Mannkind negotiates a lower price deal with a PBM, are they stuck not only lowering the price to the government, but to revealing the price to the world as well? It seems like that is somehow anti-competitive.
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Post by matt on Jun 20, 2019 7:34:26 GMT -5
It seems like that is somehow anti-competitive. Yes, it is. What is your point? Welcome to the world where governments can set drug prices. To be fair, the Centers for Medicare and Medicaid services probably pays more than any other single provider in the US and thus they should be entitled to the largest discount. There are very few competitive industries where the biggest customer doesn't get the best price. If a company doesn't like this arrangement they don't have to sell to the government at all, the government cannot compel a company to do business with it, but if the company chooses to take government money then there are price strings attached. At least in the US the price only applies if the reference customer has comparable terms and conditions, which means time for payment, quantities ordered and other factors. If the government does not order as much as a PBM or does not pay as promptly, then the PBM can get a better price than the government. That is fair. However, it is much worse in other countries. Many countries have implemented pricing methods that limit drug prices to the prevailing market price in a basket of named countries and the manufacturer must disclose those prices. Japan does it, several European countries do it, and most developing countries have started doing this. The problem is that a price discount in one country has a ripple effect across the world that causes the price in all countries to drop. Some pricing formulas are reasonable, while some are stacked against the company. Brazil looks for the lowest price based on the active ingredient in nine specific countries, but one of those named countries is Greece where the drug market is a pricing disaster. Humulin R and Novolin R which both have a retail price of about $150 / 1000 unit vial in the US have a government enforced import price into Brazil that is about $9.60 at current exchange rates. Injector pens are priced about double that amount, which is no where near the $500 retail price in the US. In turn, the government set import price of $9.60 is used to set the maximum price charged to pharmacies (about $12.00) and the maximum consumer price pharmacies can charge (about $16.60 including a 20% sales tax), and government entities in Brazil pay 20% than the permitted import price (about $7.70). It remains to be seen how Brazil will price Afrezza, but the company preaches that Afrezza is "just insulin" so expect the authorities to start with the prevailing prices for recombinant human insulins and add a small premium for the convenience of the delivery method they way they do for pens. Increasingly, government across the world exchange price information to insure that they are getting the best possible price. Then there are place like Spain where it is illegal not to fill a purchase order that comes from a government entity. That is fine if the entity is the local government in Madrid that tends to pay their invoices in about 180 days, but not such a great deal if the order comes from one of the poor provinces that take 18-24 months to pay. No matter how bad you think the market prices and formulary access is for Afrezza in the US, remember that every other country in the world is worse and the growing number with government price controls are much worse.
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Post by hellodolly on Jun 20, 2019 7:40:40 GMT -5
It seems like that is somehow anti-competitive. Yes, it is. What is your point? Welcome to the world where governments can set drug prices. To be fair, the Centers for Medicare and Medicaid services probably pays more than any other single provider in the US and thus they should be entitled to the largest discount. There are very few competitive industries where the biggest customer doesn't get the best price. If a company doesn't like this arrangement they don't have to sell to the government at all, the government cannot compel a company to do business with it, but if the company chooses to take government money then there are price strings attached. At least in the US the price only applies if the reference customer has comparable terms and conditions, which means time for payment, quantities ordered and other factors. If the government does not order as much as a PBM or does not pay as promptly, then the PBM can get a better price than the government. That is fair. However, it is much worse in other countries. Many countries have implemented pricing methods that limit drug prices to the prevailing market price in a basket of named countries and the manufacturer must disclose those prices. Japan does it, several European countries do it, and most developing countries have started doing this. The problem is that a price discount in one country has a ripple effect across the world that causes the price in all countries to drop. Some pricing formulas are reasonable, while some are stacked against the company. Brazil looks for the lowest price based on the active ingredient in nine specific countries, but one of those named countries is Greece where the drug market is a pricing disaster. Humulin R and Novolin R which both have a retail price of about $150 / 1000 unit vial in the US have a government enforced import price into Brazil that is about $9.60 at current exchange rates. Injector pens are priced about double that amount, which is no where near the $500 retail price in the US. In turn, the government set import price of $9.60 is used to set the maximum price charged to pharmacies (about $12.00) and the maximum consumer price pharmacies can charge (about $16.60 including a 20% sales tax), and government entities in Brazil pay 20% than the permitted import price (about $7.70). It remains to be seen how Brazil will price Afrezza, but the company preaches that Afrezza is "just insulin" so expect the authorities to start with the prevailing prices for recombinant human insulins and add a small premium for the convenience of the delivery method they way they do for pens. Increasingly, government across the world exchange price information to insure that they are getting the best possible price. Then there are place like Spain where it is illegal not to fill a purchase order that comes from a government entity. That is fine if the entity is the local government in Madrid that tends to pay their invoices in about 180 days, but not such a great deal if the order comes from one of the poor provinces that take 18-24 months to pay. No matter how bad you think the market prices and formulary access is for Afrezza in the US, remember that every other country in the world is worse and the growing number with government price controls are much worse. Matt, you're wealth of information. Thanks for always taking some time, when time permits, for you to participate here with those who have no background in the field. There is a lot of speculation on your true ID, I really don't personally care myself. It's what you post here that makes the value of your online ID worth five stars! - HD
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Post by rtmd on Jun 20, 2019 9:08:06 GMT -5
Yes, it is. What is your point? Welcome to the world where governments can set drug prices. To be fair, the Centers for Medicare and Medicaid services probably pays more than any other single provider in the US and thus they should be entitled to the largest discount. There are very few competitive industries where the biggest customer doesn't get the best price. If a company doesn't like this arrangement they don't have to sell to the government at all, the government cannot compel a company to do business with it, but if the company chooses to take government money then there are price strings attached. At least in the US the price only applies if the reference customer has comparable terms and conditions, which means time for payment, quantities ordered and other factors. If the government does not order as much as a PBM or does not pay as promptly, then the PBM can get a better price than the government. That is fair. However, it is much worse in other countries. Many countries have implemented pricing methods that limit drug prices to the prevailing market price in a basket of named countries and the manufacturer must disclose those prices. Japan does it, several European countries do it, and most developing countries have started doing this. The problem is that a price discount in one country has a ripple effect across the world that causes the price in all countries to drop. Some pricing formulas are reasonable, while some are stacked against the company. Brazil looks for the lowest price based on the active ingredient in nine specific countries, but one of those named countries is Greece where the drug market is a pricing disaster. Humulin R and Novolin R which both have a retail price of about $150 / 1000 unit vial in the US have a government enforced import price into Brazil that is about $9.60 at current exchange rates. Injector pens are priced about double that amount, which is no where near the $500 retail price in the US. In turn, the government set import price of $9.60 is used to set the maximum price charged to pharmacies (about $12.00) and the maximum consumer price pharmacies can charge (about $16.60 including a 20% sales tax), and government entities in Brazil pay 20% than the permitted import price (about $7.70). It remains to be seen how Brazil will price Afrezza, but the company preaches that Afrezza is "just insulin" so expect the authorities to start with the prevailing prices for recombinant human insulins and add a small premium for the convenience of the delivery method they way they do for pens. Increasingly, government across the world exchange price information to insure that they are getting the best possible price. Then there are place like Spain where it is illegal not to fill a purchase order that comes from a government entity. That is fine if the entity is the local government in Madrid that tends to pay their invoices in about 180 days, but not such a great deal if the order comes from one of the poor provinces that take 18-24 months to pay. No matter how bad you think the market prices and formulary access is for Afrezza in the US, remember that every other country in the world is worse and the growing number with government price controls are much worse. Matt, you're wealth of information. Thanks for always taking some time, when time permits, for you to participate here with those who have no background in the field. There is a lot of speculation on your true ID, I really don't personally care myself. It's what you post here that makes the value of your online ID worth five stars! - HD Well, I guess the underlying point was that the law appears to rob Mannkind of pricing flexibility. People gripe about the high price of afrezza and wonder why Mannkind can't lower it in order to compete with big pharma. Evidently though, they really can't lower it since if they lowered it, they would then be stuck not only lowering it to the government but would also be stuck with having the lowered price advertised to the world. Does the law's requirement include what Mannkind charges foreign distributors?
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Post by mytakeonit on Jun 20, 2019 13:34:50 GMT -5
If you think that is bad getting paid 6 months down the road ... think about how I felt when I found out that the office manager was giving a customer like this a "cash discount" if they paid the current invoices within 20 days. !!!! I looked at account receivable files and noticed ... why is current monthly receivables so much lower for this customer??? I checked and ... AAaaarrrggghhhh !!!
But, that's mytakeonit
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Post by seanismorris on Jun 20, 2019 13:52:14 GMT -5
Matt, you're wealth of information. Thanks for always taking some time, when time permits, for you to participate here with those who have no background in the field. There is a lot of speculation on your true ID, I really don't personally care myself. It's what you post here that makes the value of your online ID worth five stars! - HD Well, I guess the underlying point was that the law appears to rob Mannkind of pricing flexibility. People gripe about the high price of afrezza and wonder why Mannkind can't lower it in order to compete with big pharma. Evidently though, they really can't lower it since if they lowered it, they would then be stuck not only lowering it to the government but would also be stuck with having the lowered price advertised to the world. Does the law's requirement include what Mannkind charges foreign distributors? I’m not on board with your reasoning for not lowing Afrezza’s price (to achieve price parity). I can pretty much guarantee you Americans will be paying the highest price on the planet, for any drug. (sold through a legitimate source/volume) You might have also noticed drug companies raise prices indiscriminately. If MannKind lowered the price today, they’re not locked in that price indefinitely. I’d have Afrezza's price track the main competitor, maybe even 5% less... the “premium” price isn’t working.
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Post by rtmd on Jun 20, 2019 13:56:58 GMT -5
Well, I guess the underlying point was that the law appears to rob Mannkind of pricing flexibility. People gripe about the high price of afrezza and wonder why Mannkind can't lower it in order to compete with big pharma. Evidently though, they really can't lower it since if they lowered it, they would then be stuck not only lowering it to the government but would also be stuck with having the lowered price advertised to the world. Does the law's requirement include what Mannkind charges foreign distributors? I’m not on board with your reasoning for not lowing Afrezza’s price (to achieve price parity). I can pretty much guarantee you Americans will be paying the highest price on the planet, for any drug. (sold through a legitimate source/volume) You might have also noticed drug companies raise prices indiscriminately. If MannKind lowered the price today, they’re not locked in that price indefinitely. I’d have Afrezza's price track the main competitor, maybe even 5% less... the “premium” price isn’t working. True, but even though they are not stuck indefinitely, contracts are usually for a certain number of months. During that period the wholesale price goes up on that website where everyone can see it. That allows the big pharmas to lower their prices accordingly and always stay ahead of whatever price Mannkind chooses.
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Post by peppy on Jun 20, 2019 17:23:09 GMT -5
It seems like that is somehow anti-competitive. Yes, it is. What is your point? Welcome to the world where governments can set drug prices. To be fair, the Centers for Medicare and Medicaid services probably pays more than any other single provider in the US and thus they should be entitled to the largest discount. There are very few competitive industries where the biggest customer doesn't get the best price. If a company doesn't like this arrangement they don't have to sell to the government at all, the government cannot compel a company to do business with it, but if the company chooses to take government money then there are price strings attached. At least in the US the price only applies if the reference customer has comparable terms and conditions, which means time for payment, quantities ordered and other factors. If the government does not order as much as a PBM or does not pay as promptly, then the PBM can get a better price than the government. That is fair. However, it is much worse in other countries. Many countries have implemented pricing methods that limit drug prices to the prevailing market price in a basket of named countries and the manufacturer must disclose those prices. Japan does it, several European countries do it, and most developing countries have started doing this. The problem is that a price discount in one country has a ripple effect across the world that causes the price in all countries to drop. Some pricing formulas are reasonable, while some are stacked against the company. Brazil looks for the lowest price based on the active ingredient in nine specific countries, but one of those named countries is Greece where the drug market is a pricing disaster. Humulin R and Novolin R which both have a retail price of about $150 / 1000 unit vial in the US have a government enforced import price into Brazil that is about $9.60 at current exchange rates. Injector pens are priced about double that amount, which is no where near the $500 retail price in the US. In turn, the government set import price of $9.60 is used to set the maximum price charged to pharmacies (about $12.00) and the maximum consumer price pharmacies can charge (about $16.60 including a 20% sales tax), and government entities in Brazil pay 20% than the permitted import price (about $7.70). It remains to be seen how Brazil will price Afrezza, but the company preaches that Afrezza is "just insulin" so expect the authorities to start with the prevailing prices for recombinant human insulins and add a small premium for the convenience of the delivery method they way they do for pens. Increasingly, government across the world exchange price information to insure that they are getting the best possible price. Then there are place like Spain where it is illegal not to fill a purchase order that comes from a government entity. That is fine if the entity is the local government in Madrid that tends to pay their invoices in about 180 days, but not such a great deal if the order comes from one of the poor provinces that take 18-24 months to pay. No matter how bad you think the market prices and formulary access is for Afrezza in the US, remember that every other country in the world is worse and the growing number with government price controls are much worse. Quote: "the Centers for Medicare and Medicaid services probably pays more than any other single provider in the US and thus they should be entitled to the largest discount." Reply: it is my understanding by law in USA, the only agency that can negotiate drug prices is medicare. Something about some law put on the books to this regard. Hence, the rebate/kickback system is used the "for profit health insurance companies" in the USA. quote: Humulin R and Novolin R which both have a retail price of about $150 / 1000 unit vial in the US have a government enforced import price into Brazil that is about $9.60 at current exchange rates. Injector pens are priced about double that amount, which is no where near the $500 retail price in the US. In turn, the government set import price of $9.60 is used to set the maximum price charged to pharmacies (about $12.00) and the maximum consumer price pharmacies can charge (about $16.60 including a 20% sales tax), and government entities in Brazil pay 20% than the permitted import price (about $7.70). It remains to be seen how Brazil will price Afrezza, but the company preaches that Afrezza is "just insulin" so expect the authorities to start with the prevailing prices for recombinant human insulins and add a small premium for the convenience of the delivery method they way they do for pens. reply: subq regular insulin is chit. Additionally Countries other than the USA in general do not have pumps available to diabetes. Afrezza is looking good to them.
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Post by rtmd on Jun 20, 2019 18:45:35 GMT -5
I think Matt's point is that since afrezza contains just Humulin R, then likely it will be priced on par with humulin R.
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Post by liane on Jun 20, 2019 18:50:03 GMT -5
I think Matt's point is that since afrezza contains just Humulin R, then likely it will be priced on par with humulin R. Afrezza is not Humulin R!
Humulin R (insulin human recombinant) U-100 is a sterile, clear, aqueous, and colorless solution that contains human insulin (rDNA origin) 100 units/mL, glycerin 16 mg/mL and metacresol 2.5 mg/mL, endogenous zinc (approximately 0.015 mg/100 units) and water for injection. The pH is 7.0 to 7.8. Sodiumhydroxide and/or hydrochloric acid may be added during manufacture to adjust the pH.
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Post by mnkdfann on Jun 20, 2019 18:50:58 GMT -5
Yes, it is. What is your point? Welcome to the world where governments can set drug prices. To be fair, the Centers for Medicare and Medicaid services probably pays more than any other single provider in the US and thus they should be entitled to the largest discount. There are very few competitive industries where the biggest customer doesn't get the best price. If a company doesn't like this arrangement they don't have to sell to the government at all, the government cannot compel a company to do business with it, but if the company chooses to take government money then there are price strings attached. At least in the US the price only applies if the reference customer has comparable terms and conditions, which means time for payment, quantities ordered and other factors. If the government does not order as much as a PBM or does not pay as promptly, then the PBM can get a better price than the government. That is fair. However, it is much worse in other countries. Many countries have implemented pricing methods that limit drug prices to the prevailing market price in a basket of named countries and the manufacturer must disclose those prices. Japan does it, several European countries do it, and most developing countries have started doing this. The problem is that a price discount in one country has a ripple effect across the world that causes the price in all countries to drop. Some pricing formulas are reasonable, while some are stacked against the company. Brazil looks for the lowest price based on the active ingredient in nine specific countries, but one of those named countries is Greece where the drug market is a pricing disaster. Humulin R and Novolin R which both have a retail price of about $150 / 1000 unit vial in the US have a government enforced import price into Brazil that is about $9.60 at current exchange rates. Injector pens are priced about double that amount, which is no where near the $500 retail price in the US. In turn, the government set import price of $9.60 is used to set the maximum price charged to pharmacies (about $12.00) and the maximum consumer price pharmacies can charge (about $16.60 including a 20% sales tax), and government entities in Brazil pay 20% than the permitted import price (about $7.70). It remains to be seen how Brazil will price Afrezza, but the company preaches that Afrezza is "just insulin" so expect the authorities to start with the prevailing prices for recombinant human insulins and add a small premium for the convenience of the delivery method they way they do for pens. Increasingly, government across the world exchange price information to insure that they are getting the best possible price. Then there are place like Spain where it is illegal not to fill a purchase order that comes from a government entity. That is fine if the entity is the local government in Madrid that tends to pay their invoices in about 180 days, but not such a great deal if the order comes from one of the poor provinces that take 18-24 months to pay. No matter how bad you think the market prices and formulary access is for Afrezza in the US, remember that every other country in the world is worse and the growing number with government price controls are much worse. Quote: "the Centers for Medicare and Medicaid services probably pays more than any other single provider in the US and thus they should be entitled to the largest discount." Reply: it is my understanding by law in USA, the only agency that can negotiate drug prices is medicare. Something about some law put on the books to this regard. Hence, the rebate/kickback system is used the "for profit health insurance companies" in the USA.I do not believe your conclusion is correct, as the private sector (typically PBMs and Health Insurers) is free to negotiate drug prices. The government IS restricted from negotiating (for a large part) for a number of reasons.
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Post by robbmo on Jun 20, 2019 18:54:44 GMT -5
I think Matt's point is that since afrezza contains just Humulin R, then likely it will be priced on par with humulin R. I am not familiar with the nuances of differentiation, but isn't Humulin a hexameric compound while Afrezza is monomeric? Is that enough to differentiate them?
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Post by rtmd on Jun 20, 2019 19:02:30 GMT -5
I think Matt's point is that since afrezza contains just Humulin R, then likely it will be priced on par with humulin R. Afrezza is not Humulin R!
Humulin R (insulin human recombinant) U-100 is a sterile, clear, aqueous, and colorless solution that contains human insulin (rDNA origin) 100 units/mL, glycerin 16 mg/mL and metacresol 2.5 mg/mL, endogenous zinc (approximately 0.015 mg/100 units) and water for injection. The pH is 7.0 to 7.8. Sodiumhydroxide and/or hydrochloric acid may be added during manufacture to adjust the pH.
Yes, I know, but the active ingredient is basically just humulin R: "AFREZZA cartridges contain human insulin produced by recombinant DNA technology utilizing a non-pathogenic laboratory strain of Escherichia coli (K12)." Consequently, it would be no surprise if the Brazilian authorities priced it similarly.
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Post by rtmd on Jun 20, 2019 19:07:47 GMT -5
I think Matt's point is that since afrezza contains just Humulin R, then likely it will be priced on par with humulin R. I am not familiar with the nuances of differentiation, but isn't Humulin a hexameric compound while Afrezza is monomeric? Is that enough to differentiate them? I don't see anything on the afrezza label about it being monomeric, so I'm inclined to doubt it be significant for differentiating them. Also, the patent describes it as "monomeric or dimeric insulin." I also did a quick google to see if I could find any papers that made a point of it being monomeric and came up empty handed.
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Post by liane on Jun 20, 2019 19:15:08 GMT -5
Afrezza is monomeric human insulin. It is stabilized in that form by the Technosphere matrix. As such, it doesn't need zinc and meta-cresol to stabilize and preserve. These are two very different beasts even though both are derived from the human insulin protein.
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