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Post by ktim on Oct 21, 2019 18:13:56 GMT -5
I think companies now have 2020 formularies available... at least for Medicare. I looked up a few for my state and sadly Afrezza was still not included.
I don't know how quickly sites like formularlookup.com get updated (when formulary released or when it goes into effect). Was starting a thread hoping anyone that has time to lookup up there own formulary or others and finds Afrezza newly added are changing to better placement could post their find here. Heck I guess post even if you find Afrezza removed or at worse placement (fingers crossed that is rare to non-existent).
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Post by mnholdem on Oct 21, 2019 19:11:15 GMT -5
I’ve been so swamped that I haven’t updated the Afrezza formulary charts in months. Sorry.
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Post by ktim on Oct 21, 2019 20:58:07 GMT -5
It was really an exercise in watching paint dry. I'm assuming someone would catch it if there were dramatic changes in coverage.
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Post by shawnonafrezza on Oct 21, 2019 21:09:40 GMT -5
I'm switching to Cigna this year and Afrezza isn't even listed. That'll be fun.
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Post by brotherm1 on Oct 21, 2019 21:29:06 GMT -5
My guess is insurance companies won’t move it much on the formularies until sales increase enough for MNKD to be able to afford to lower the cost of Afrezza. And at the current snails pace of increasing sales, I’m afraid Afrezza might be replaced by then with a new insulin therapy we don’t even know is being studied. I would think once Afrezza’s price comes down sufficiently, insurance companies will move on it and the so called point of inflection will have been struck and we’ll see sales increase in multiples. MNKD needs to get the ball rolling faster now and not a tad bit later.
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Post by ktim on Oct 22, 2019 2:02:49 GMT -5
My guess is insurance companies won’t move it much on the formularies until sales increase enough for MNKD to be able to afford to lower the cost of Afrezza. And at the current snails pace of increasing sales, I’m afraid Afrezza might be replaced by then with a new insulin therapy we don’t even know is being studied. I would think once Afrezza’s price comes down sufficiently, insurance companies will move on it and the so called point of inflection will have been struck and we’ll see sales increase in multiples. MNKD needs to get the ball rolling faster now and not a tad bit later. Insurers and PBMs actually want high drug list prices. But the current system is built to reinforce monopolies. Mannkind I'm sure could offer the same rebate levels if they were given similar access on formularies, but it's a winner take all system with formularies and Afrezza isn't yet a winner. You're putting the cart before the horse. Low drug prices don't win support from insurers. |
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Post by brotherm1 on Oct 22, 2019 11:38:47 GMT -5
My guess is insurance companies won’t move it much on the formularies until sales increase enough for MNKD to be able to afford to lower the cost of Afrezza. And at the current snails pace of increasing sales, I’m afraid Afrezza might be replaced by then with a new insulin therapy we don’t even know is being studied. I would think once Afrezza’s price comes down sufficiently, insurance companies will move on it and the so called point of inflection will have been struck and we’ll see sales increase in multiples. MNKD needs to get the ball rolling faster now and not a tad bit later. Insurers and PBMs actually want high drug list prices. But the current system is built to reinforce monopolies. Mannkind I'm sure could offer the same rebate levels if they were given similar access on formularies, but it's a winner take all system with formularies and Afrezza isn't yet a winner. You're putting the cart before the horse. Low drug prices don't win support from insurers. Wholesale prices of Afrezza are higher than others and need to be because of higher manufacturing costs. How are rebates from MNKD - at an amount to keep the sales profitable - going to be able to offset the higher costs for insurance companies? Why on earth would insurance companies want to pay higher amounts ? |
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Post by ktim on Oct 22, 2019 15:11:32 GMT -5
Insurers and PBMs actually want high drug list prices. But the current system is built to reinforce monopolies. Mannkind I'm sure could offer the same rebate levels if they were given similar access on formularies, but it's a winner take all system with formularies and Afrezza isn't yet a winner. You're putting the cart before the horse. Low drug prices don't win support from insurers. Wholesale prices of Afrezza are higher than others and need to be because of higher manufacturing costs. How are rebates from MNKD - at an amount to keep the sales profitable - going to be able to offset the higher costs for insurance companies? Why on earth would insurance companies want to pay higher amounts ? I could try to dig up articles over the past years arguing that point. It's not one I've made up. Though the workings of the "value chain" for pharma industry seems quite opaque. But I'd point to one macro issue. Under ACA, and I think some state regulations, insurance companies profits are limited to certain percentage. With ACA they actually have to rebate money at the end of the year if the premiums they collected were too high compared to the expenses (profit was too high). I administered plans at a company and every year we got rebate... I'm assuming this is norm that companies max out profit. So the only way to make more money is to either increase the number of covered patients or to increase the average expenses per patient. The insurance industry as a whole makes more money every year that overall medical expenses rise. When PBMs took over the market many years ago the line feed to consumers was that they were intended to help insurers save money on drugs. Look at drug costs over the time period PBMs have been around and tell me if you think the PBM industry has truly been about reducing prices. I do realize there are counter arguments to be made. It seems like the entire industry is rather convoluted. On the one hand a desire to push up the amount of overall health spending in the US, but a need to strategically be competitive in the regional markets against whomever is the competition. |
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Post by matt on Oct 22, 2019 15:15:59 GMT -5
Wholesale prices of Afrezza are higher than others and need to be because of higher manufacturing costs. How are rebates from MNKD - at an amount to keep the sales profitable - going to be able to offset the higher costs for insurance companies? Why on earth would insurance companies want to pay higher amounts ? Insurance wants to pay higher amounts because they keep a major portion of the rebates received by the PBM. When the insurance plan has a high deductible and high out-of-pocket limit, as with the "Bronze" Obamacare plans, higher drug costs at the pharmacy counter actually reduce the cost of providing insurance because the patient pays more in co-pays. In some cases, patients are better off paying cash via a discount pharmacy then they are paying the co-pay at the pharmacy (i.e. the co-pay is more than 100% of the true cost of the drug). This is especially true for generics; it is almost always better paying 100% in cash at a discounter (like Wal-Mart or Costco) than it is using your normal pharmacy that knows about your insurance coverage. However, what holds true for most drugs does not apply to Afrezza due to the large price difference between Afrezza and the best selling injectable insulins. If a diabetic is on Afrezza they are in danger of reaching the out-of-pocket maximum for the year and that is the point at which the insurance company actually starts to pay the true cost of care. |
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Post by harryx1 on Oct 28, 2019 14:08:24 GMT -5
Afrezza under class review in insulins... www.health.mil/About-MHS/OASDHA/Defense-Health-Agency/Operations/Pharmacy-Division/DoD-Pharmacy-and-Therapeutics-Committeewww.fbo.gov/utils/view?id=9978dc64f4de55fc2e4941ad07814437ATTENDEES DHA - Lt. Col. Ronald Khoury; Yvette Dluhos; Melanie Richardson; Richard Schoenemann; Alexia Ray Bayer - Barry Goldberg; Eli Easterbrook; Laura Magalhaes GSK – Tracy Miller; Katie Walton Sanofi – Steve Boekenoogen; Trevor Mikel; Laura Horn; Adrian Mimini; Azim Ejaz; Peter Garibaldi Eli Lilly – Charlie Wilson Merck – Kathleen Blum MannKind Corp – Andrea Hoogwerf Pfizer - Francis Asper; Kasey Cullen; Lynne Kuhn Novo Nordisk – Elisa Persi; Corissa Prevete; Charles Slonsky; Jerry Vuocolo; Mike McFadden; David Jahnke; Charlotte Veazie UCB – Nick Quintana Allergan – Dominic Cuccaro Elizabeth Nowak Murray, Corissa Prevete, Charles Slonsky, David Jahnke, Greg Ford, Keith Lavan Sharma Gaurav, Andrea Hoogwerf, Paula Davis |
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