Brazil

[letitride]

2009 JAZZ at $2, SIRI at 10 cent who would have ever expected what those two would look like 10 years later. My best trades are the ones I never made. Let it Ride

[mytakeonit]

I believe that the container to Brazil will get there next Friday. I hope my influx of $$$ shows up by Thursday.

But, that's mytakeonit

[ktim]

Sept 27, 2019 15:24:44 GMT -5 mytakeonit said:

I believe that the container to Brazil will get there next Friday. I hope my influx of $$$ shows up by Thursday.

But, that's mytakeonit

I believe the shipment of Afrezza has likely been in Brazil for 3 weeks now.  Regardless, the difficult thing isn't accomplishing an international shipment (a vast majority of which happen without incident), it is establishing a market for Afrezza in Brazil.

[Deleted]

Sept 27, 2019 17:31:41 GMT -5 ktim said:

Sept 27, 2019 15:24:44 GMT -5 mytakeonit said:

I believe that the container to Brazil will get there next Friday. I hope my influx of $$$ shows up by Thursday.

But, that's mytakeonit

I believe the shipment of Afrezza has likely been in Brazil for 3 weeks now.  Regardless, the difficult thing isn't accomplishing an international shipment (a vast majority of which happen without incident), it is establishing a market for Afrezza in Brazil.

I don't see that as an obstacle. From recent posts via Twitter or Youtube - the Medical (Endo) community seem to be very excited and have been talking about Afrezza.  My concern is the price point.  What will the Gov't allow for a price?  Will it be for the MASSES or the PRIVILEGE?  Time will tell.... 

[georgethenight2]

I would be curious to know the contract details. Specifically, a minimum purchase requirement, would it even exist?

[mytakeonit]

We will all have to wait to see if there are any contract deals. Right now I'm waiting for news that the container has reached port. I remember that it left on Sept. 2nd, so a normal trip would be 32 days meaning it arrives on October 4th. Lot of unknowns arriving at an international port, but I'm sure things and information should be out a couple of days later. We'll know more about how this all works VERY SOON !!!

But, that's mytakeonit

[matt]

Sept 27, 2019 20:26:57 GMT -5 @chuckbass said:

Sept 27, 2019 17:31:41 GMT -5 ktim said:

I believe the shipment of Afrezza has likely been in Brazil for 3 weeks now.  Regardless, the difficult thing isn't accomplishing an international shipment (a vast majority of which happen without incident), it is establishing a market for Afrezza in Brazil.

I don't see that as an obstacle. From recent posts via Twitter or Youtube - the Medical (Endo) community seem to be very excited and have been talking about Afrezza.  My concern is the price point.  What will the Gov't allow for a price?  Will it be for the MASSES or the PRIVILEGE?  Time will tell.... 

The pricing will be such that only the well-off can afford it.  The maximum price is controlled for everybody, but imported drugs carry an extra 15% sales tax and locally produced insulins are very cheap by US standards and are produced in government owned manufacturing facilities.  A 100 ml vial of recombinant insulin sells for around $6 in Brazil versus a US price of around $35 after recent manufacturer price reductions.  Any Brazilian can get free drugs from the government subsidized pharmacies, but the formularies are limited to locally produced drugs and the list of approved drugs is short with just 6 products listed for diabetics (a three versions of metformin, glyburide, one NPH insulin and one recombinant insulin).  Other insulin varieties are not covered by the government so, for example, long-acting glargine insulin would be self-pay.

For imported drugs there are no issues with formulary restrictions since most private health plans only cover drugs administered while the patient is in the hospital while outpatient prescriptions are almost always self-pay.  When drugs are cheap enough at the pharmacy the cost of administering an insurance plan outweighs the savings from bulk purchasing so that levels the playing field between importers.  The government controlled price is the maximum price the importer can charge and there is nothing preventing Biomm from pricing the drug lower, but since competitive insulins are priced aggressively in Brazil the manufacturing cost of Afrezza may ultimately be the barrier to being cost competitive in the private market.  

[mytakeonit]

When the production line gets cranking, the manufacturing cost will be minuscule per unit. The news articles and TV spots that will hit the airways will be free international advertising. If the world loves Afrezza, then it'll be hard for people in the U.S. to not try it. It's kinda like the caveman discovering fire ... "ouch ... fire bad !" ... later and animal falls into the fire ... caveman tastes it and ... "YUM ... fire good !!!" Too bad that the U.S. in this scenario is the caveman.

But, that's mytakeonit

[mymann]

you are right about US being a caveman. When the smart phones first hit the market, Asian Countries were buying up like kimchi fried rice and decade later US caveman jumped on the band wagon.

[mytakeonit]

Okay, I'm guilty there. I never wanted a cell phone, but my family forced me to get one. AND, I still have the same flip phone that they bought me. Same one that Warren Buffett has ... or had. He did mention that since he owns Apple that "maybe" he should upgrade. Ha! Why I didn't want a cell phone? Whenever I receive a call ... it's only another job for me to do for FREE !!!

But, that's mytakeonit

 My phone number you ask?  It's 808 911-5678 ...

[mymann]

Hey, I called that number and all got was leave message for Governor Ige's personal stress therapist.

[babaoriley]

"For imported drugs there are no issues with formulary restrictions since most private health plans only cover drugs administered while the patient is in the hospital while outpatient prescriptions are almost always self-pay. When drugs are cheap enough at the pharmacy the cost of administering an insurance plan outweighs the savings from bulk purchasing so that levels the playing field between importers. The government controlled price is the maximum price the importer can charge and there is nothing preventing Biomm from pricing the drug lower, but since competitive insulins are priced aggressively in Brazil the manufacturing cost of Afrezza may ultimately be the barrier to being cost competitive in the private market."

Matt, are you suggesting our management did not correctly analyze the above?

[matt]

Sept 29, 2019 0:36:28 GMT -5 babaoriley said:

"For imported drugs there are no issues with formulary restrictions since most private health plans only cover drugs administered while the patient is in the hospital while outpatient prescriptions are almost always self-pay. When drugs are cheap enough at the pharmacy the cost of administering an insurance plan outweighs the savings from bulk purchasing so that levels the playing field between importers. The government controlled price is the maximum price the importer can charge and there is nothing preventing Biomm from pricing the drug lower, but since competitive insulins are priced aggressively in Brazil the manufacturing cost of Afrezza may ultimately be the barrier to being cost competitive in the private market."

Matt, are you suggesting our management did not correctly analyze the above?

I am not implying anything; I am just stating the facts.  Those who cannot afford drugs, and those who have certain chronic conditions (including diabetics, hypertensives, and asthmatics) can get free drugs from the Farmacia Popular.  Most such pharmacies are run by the government, and there are also some hybrid pharmacies that will dispense free drugs to the indigent and also sell not-free drugs for cash.  Essentially all the drugs available for free come from government owned manufacturing plants that compete with private drug companies.

Brazil has two motives to reduce drug prices.  One is to limit healthcare costs, and the second is to conserve precious foreign exchange reserves that can be used to import critical items not available on the local market.  Brazil traditionally had hyperinflation and exchange controls that made it very difficult to get dollars or Euros, and there is no desire to return to those days.  When drugs are cheap, the cost to administer insurance is as much or more than the drug (which is why there was no drug benefit for Medicare when it was created in the 1960's).  In Brazil today there are limits to prices on all drugs, imported or not, and all the usual suspects (Sanofi, Lilly, Novo) do business there.  MNKD will have to price Afrezza to be competitive with whatever price the competition has accepted as a cost of doing business in Brazil.  I am sure management knew the system when they signed up with Biomm, but it may partially an experiment to see how much consumers are really willing to pay in a market unencumbered by restricted formularies.  Afrezza can never compete with recombinant insulin that is given away free, but it can possibly compete with injector pens, fast acting analogs, and similar innovations.

[Clement]

How many rich diabetics in Brazil can pay for an inhaled mealtime insulin that works better than anything else?
WAG : less than 1% of 10% of 200 million? .... so, less than 200,000.
Wait a minute ... that's still a lot.

[awesomo]

Sept 29, 2019 8:07:40 GMT -5 Clement said:

How many rich diabetics in Brazil can pay for an inhaled mealtime insulin that works better than anything else?
WAG : less than 1% of 10% of 200 million? .... so, less than 200,000.
Wait a minute ... that's still a lot.

Whats the market penetration in the U.S. again?  These broad stroke market sizing are meaningless.