Brazil

[lakers]

Thanks Matt, aka Matt_PK:
“The official CMED price lists are updated monthly. The most recent update on October 1st did not contain pricing for Afrezza. There may be another way that CMED can communicate a final decision to Biomm itself during the month, but I am not aware of any other method that is publicly viewable.”

MannKind: Q3 Afrezza Sales In The Books - Brazil Launch Pending $MNKD seekingalpha.com/article/4295537

Wed Oct 9, 2019, 10:44A

[shawnonafrezza]

Oct 10, 2019 15:24:34 GMT -5 harryx1 said:

When we look back, the invention of inhaled insulin (monomer insulin which happened in 2015) will be bigger than automated insulin delivery that still uses liquid insulin (hexamer)... but, that's mytakeonit.

I don't get this post. One post praising closed loops and afrezza and one bashing on close loops (one that was in trial no less). I still don't know what AP she was in but there have been no true AP trials to date. There have been hybrid closed loops but anything outside of the control-iq and medtronics latest were complete disasters IMO.

[mango]

Oct 10, 2019 22:33:33 GMT -5 agedhippie said:

Oct 10, 2019 19:38:33 GMT -5 mytakeonit said:

I believe that mango was pointing you to "intended as an alternative to the high production of hospital waste"

But, that's mytakeonit

I get that, but my experience is that there is a minimal amount of waste generated. If they dispense an insulin pen then you get to keep it when you are discharged, otherwise at my usage rate I get through a pen every two weeks or so. The hospital has to deal with the needles used, but that is tiny and shrinks to nothing when it's incinerated which is what happens.

If they are using an IV then that's drawn from a vial.

In the end, provided they are not using syringes (and the article specifically mentions pens) there is very little waste generated.

This Brazilian Pharmacist, Ciro Massari, knows the situation in Brazilian hospitals better than anyone of us, and as such, really nulls your argument.

This Brazilian Pharmacist is telling you there is a high production of hospital waste CAUSED BY disposable insulin pens:

“The arrival of inhalable insulin is also intended as an alternative to the high production of hospital waste caused by the disposable pen method. In Brazil, only Uberlândia has a collection focused on this specific type, alarming the need for greater environmental concern.”


www2.ufjf.br/noticias/2019/10/04/palestra-aborda-aplicacao-de-insulina-inalavel/

[harryx1]

shawnonafrezza They are 2 different people but I think you can get the idea that even with AP there still requires more work than Afrezza + basal (once a pwd understands how to use it) for most pwd. AP is great but for many people that have a hard time with technology, it might not be a good match. Also, you still have the problem with using liquid insulin (although the algorithms most likely take this into account) & site failures. I know Afrezza may not be for everyone but you can't argue with the formulation & route of delivery making it the fastest & closest insulin to mimic the physiologic profile of insulin the body releases.

Maybe she meant "study" instead of trial but I'm not sure.

medicalxpress.com/news/2017-10-artificial-pancreas-clinical-trial.html

[shawnonafrezza]

Oct 11, 2019 10:17:18 GMT -5 harryx1 said:

shawnonafrezza They are 2 different people but I think you can get the idea that even with AP there still requires more work than Afrezza + basal (once a pwd understands how to use it) for most pwd. AP is great but for many people that have a hard time with technology, it might not be a good match. Also, you still have the problem with using liquid insulin (although the algorithms most likely take this into account) & site failures. I know Afrezza may not be for everyone but you can't argue with the formulation & route of delivery making it the fastest & closest insulin to mimic the physiologic profile of insulin the body releases.

Maybe she meant "study" instead of trial but I'm not sure.

medicalxpress.com/news/2017-10-artificial-pancreas-clinical-trial.html

But the first person wasn't on basal, they were on an diy AP.

[mytakeonit]

Going back to the Brazil shipment - I'm not sure that Afrezza will need to be listed on a price book since the total shipment is going into their hospital system. If anyone needs to lists prices it will probably come from the hospitals.

But, that's mytakeonit

[agedhippie]

Oct 11, 2019 10:08:37 GMT -5 mango said:

This Brazilian Pharmacist, Ciro Massari, knows the situation in Brazilian hospitals better than anyone of us, and as such, really nulls your argument.

This Brazilian Pharmacist is telling you there is a high production of hospital waste CAUSED BY disposable insulin pens:

...

Except he is not a pharmacist, he is BIOMM's Commercial Director with no medical qualifications. Previously he worked for Sanofi in marketing.

So what we have is the Commercial Director of BIOMM who are selling saying this solves a problem that I am unconvinced exists. My feeling is that he is trying to create an operational rationale and good luck to him, but it's pure marketing which is after all his job. I was curious though so I talked to a couple of people I know in the UK who work in hospital operations and their view is that it's so low volume that it doesn't even rate on their list. They incinerate pens so there is no residual waste, which is what they care about because that's the problem part.

[mango]

Oct 11, 2019 13:00:34 GMT -5 agedhippie said:

Oct 11, 2019 10:08:37 GMT -5 mango said:

This Brazilian Pharmacist, Ciro Massari, knows the situation in Brazilian hospitals better than anyone of us, and as such, really nulls your argument.

This Brazilian Pharmacist is telling you there is a high production of hospital waste CAUSED BY disposable insulin pens:

...

Except he is not a pharmacist, he is BIOMM's Commercial Director with no medical qualifications. Previously he worked for Sanofi in marketing.

So what we have is the Commercial Director of BIOMM who are selling saying this solves a problem that I am unconvinced exists. My feeling is that he is trying to create an operational rationale and good luck to him, but it's pure marketing which is after all his job. I was curious though so I talked to a couple of people I know in the UK who work in hospital operations and their view is that it's so low volume that it doesn't even rate on their list. They incinerate pens so there is no residual waste, which is what they care about because that's the problem part.

It says in the article he is the company’s pharmacist.

The proposal was the subject of debate this Friday, the 4th, at the Faculty of Pharmacy of the University of Juiz de Fora (UFJF), composing the program of the First Congress of Pharmaceutical Sciences - which also commemorates the 115th anniversary of the Faculty of Pharmacy - which began on Thursday, 3, and runs until Saturday, 5. With the theme “Inhalable Insulin: An Alternative to Treating Diabetes”, the lecture was given by the company pharmacist, Ciro Massari, addressing what are the new technologies for the treatment of the disease, specifically Afrezza, the name chosen for inhalable insulin.

Read more: mnkd.proboards.com/thread/11417/brazil?page=7#ixzz624QiqTnw

———————

Regardless, you should argue with him and not me—seeing as he obviously knows more than both of us and you disagree with him so passionately.

[agedhippie]

Oct 11, 2019 13:11:23 GMT -5 mango said:

It says in the article he is the company’s pharmacist.

...

Read more: mnkd.proboards.com/thread/11417/brazil?page=7#ixzz624QiqTnw

———————

Regardless, you should argue with him and not me—seeing as he obviously knows more than both of us and you disagree with him so passionately.

You are probably right

I was wrong though, he has a pharmacy qualification. I found two LinkedIn pages (in Portuguese).

This is the current BIOMM LinkedIn page with no mention of medical qualifications: br.linkedin.com/in/ciro-massari-378190b2
This is his earlier Sanofi LinkedIn page, now abandoned (I wish people wouldn't do that), that does mention his qualification: br.linkedin.com/in/ciro-massari-506b851a

In my defence it looks like he has been in the sales and marketing world for the last ten years at least.

[mango]

Ciro Massari

[agedhippie]

Oct 11, 2019 13:34:48 GMT -5 mango said:

Ciro Massari

<IMG>

Yes, that's what I said.

[mytakeonit]

Seems about time for another container of Afrezza to be headed to Brazil.

But, that's mytakeonit

[ktim]

Oct 16, 2019 14:11:18 GMT -5 mytakeonit said:

Seems about time for another container of Afrezza to be headed to Brazil.

But, that's mytakeonit

As I remember it has a much longer shelf life than a month and a half.

[Deleted]

Oct 16, 2019 14:11:18 GMT -5 mytakeonit said:

Seems about time for another container of Afrezza to be headed to Brazil.

But, that's mytakeonit

That's not gonna happen. They haven't officially launched Afrezza.  BIOMM will wait to order more until they get 50% worth of orders from doctors.  I don't think this will roll out as fast as some think.  

[matt]

Oct 11, 2019 11:55:47 GMT -5 mytakeonit said:

Going back to the Brazil shipment - I'm not sure that Afrezza will need to be listed on a price book since the total shipment is going into their hospital system. If anyone needs to lists prices it will probably come from the hospitals.

But, that's mytakeonit

I don't think anybody has said that the Afrezza is going into the hospital system.  Public healthcare is a shared expense between the national government and the various state governments, and hospitals are not in the business of dispensing drugs except for inpatients (that is the role of the Farmacia Popular).  Even if it were the government purchasing the entire shipment, the price is still regulated by CMED and the government buys at roughly a 20% discount to the permitted PF price.  Regardless of the buyer, Brazilian law requires CMED to set the PF and in most states even the hospitals are subject to ICMP and PIS taxes on the sale so Biomm must know the PF in order to properly charge for ICMP and PIS.

The PF is the important price as all the others can be computed from that, and the importer cannot charge more than the PF (plus taxes) at the wholesale level.