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Post by sweedee79 on Mar 2, 2020 12:59:17 GMT -5
charlie .. Saying that our sales reps are doing a bad job is a blanket statement.. Bottom line is Afrezza is so different from anything out there and misunderstood, that we needed large trial data to prove what we claim... we don't have that and probably wont have that under the circumstances... Marketing Afrezza in the typical BP manner will never work... Matt P knew this... He had been with the company for years right alongside of Al... unfortunately Mike has never known this...
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Post by mytakeonit on Mar 2, 2020 13:22:27 GMT -5
I eat once a day, so if I were a PWD I would try and take 24 units with no follow up. sports - And which meal is that? Not dinner is it? The most expensive meal that probably includes wine. If yes, then you better hope NVAX goes back up so I can pay for the meal. But, that's mytakeonit |
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Post by sportsrancho on Mar 2, 2020 16:28:27 GMT -5
charlie .. Saying that our sales reps are doing a bad job is a blanket statement.. Bottom line is Afrezza is so different from anything out there and misunderstood, that we needed large trial data to prove what we claim... we don't have that and probably wont have that under the circumstances... Marketing Afrezza in the typical BP manner will never work... Matt P knew this... He had been with the company for years right alongside of Al... unfortunately Mike has never known this... Mike to Bill, “Because it’s all I’ve got”. |
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Post by joeypotsandpans on Mar 2, 2020 23:51:21 GMT -5
Thanks for that Mannmade. 6 doses is an interesting thing as in what is a dose. Given that the medicine is of equal strength and I take 4 3 unit cartridges; I'd guess that this is a "dose". But, if the glucose # is too high in 90 minutes because I miscalculated then I would take another cartridge as a corrective measure. Would you consider this a 2nd dose? I think that Mannkind is yielding information on the conservative side. Someone else mention why there isn't the retention that we would like to see. My answer to this is that is a learning curve which requires confidence and the chance to personally confirm Afrezza's positive affects. For me, there was an adjustment (described by others as a tickle in the back of the throat). I got use to it. The real challenge for me which made me feel like a moron was that I was under dosing for too long trying to associate certain foods with how much insulin I needed to neutralize the blood sugar. So now I'm not just taking a 12 unit for a bagel. Yes, I shouldn't be eating bagels; however I like them and consider the carb content in them so I now adjust with 16 units for just the bread. It's all individual based on the Body Mass Index. Bloggers have posted that they eat up to 5 or 6 times a day with smaller portions and asking that 2 unit cartridges be made available. @ 6 times a day that would be more than 6 doses a day which is the guideline. Lastly, because food is no longer just categorized as "what is delicious"; my new interpretation is seeing food much differently broken into Carbs, Fat, Protein, & Sugar. I can't say that Afrezza has made me lose weight; but I can say that for 10 years I weighed 220 lbs. This morning I am at 190. I think the weight loss is do to thinking about and motivated by controlling my diabetes. thank you for your contribution. Bagels are my kryptonite....I wish my buddy who makes them didn't because they are the best...for those that remember...he's the same as my pizza guy lol...still has his shares btw.  |
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Post by mnholdem on Mar 3, 2020 5:41:51 GMT -5
Oh yeah! Who can forget your pizza guy?
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Post by peppy on Mar 3, 2020 5:48:51 GMT -5
Thanks for that Mannmade. 6 doses is an interesting thing as in what is a dose. Given that the medicine is of equal strength and I take 4 3 unit cartridges; I'd guess that this is a "dose". But, if the glucose # is too high in 90 minutes because I miscalculated then I would take another cartridge as a corrective measure. Would you consider this a 2nd dose? I think that Mannkind is yielding information on the conservative side. Someone else mention why there isn't the retention that we would like to see. My answer to this is that is a learning curve which requires confidence and the chance to personally confirm Afrezza's positive affects. For me, there was an adjustment (described by others as a tickle in the back of the throat). I got use to it. The real challenge for me which made me feel like a moron was that I was under dosing for too long trying to associate certain foods with how much insulin I needed to neutralize the blood sugar. So now I'm not just taking a 12 unit for a bagel. Yes, I shouldn't be eating bagels; however I like them and consider the carb content in them so I now adjust with 16 units for just the bread. It's all individual based on the Body Mass Index. Bloggers have posted that they eat up to 5 or 6 times a day with smaller portions and asking that 2 unit cartridges be made available. @ 6 times a day that would be more than 6 doses a day which is the guideline. Lastly, because food is no longer just categorized as "what is delicious"; my new interpretation is seeing food much differently broken into Carbs, Fat, Protein, & Sugar. I can't say that Afrezza has made me lose weight; but I can say that for 10 years I weighed 220 lbs. This morning I am at 190. I think the weight loss is do to thinking about and motivated by controlling my diabetes. thank you for your contribution. Quote: I can say that for 10 years I weighed 220 lbs. This morning I am at 190. I have heard this before with type two's. My secret untested theory is the phase one. Even though you are type two and make insulin, I think the phase one would help.  Quote; high in 90 minutes because I miscalculated then I would take another cartridge as a corrective measure. Would you consider this a 2nd dose? Reply, yes that is the definition of a second dose. www.screencast.com/t/QSyjoEdUyL |
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Post by prcgorman2 on Mar 3, 2020 7:11:09 GMT -5
charlie .. Saying that our sales reps are doing a bad job is a blanket statement.. Bottom line is Afrezza is so different from anything out there and misunderstood, that we needed large trial data to prove what we claim... we don't have that and probably wont have that under the circumstances... Marketing Afrezza in the typical BP manner will never work... Matt P knew this... He had been with the company for years right alongside of Al... unfortunately Mike has never known this... Never is a long time. And how do we know it will never work? It works for typical BPs so it seems reasonable it can work for Afrezza too. You yourself said “we needed large trial data”. I agree. We needed it, and we need it. Large trial data takes time and money of which the latter is the more scarce resource and I assume is the limiting factor. As Mannkind approaches cash flow break even, the cost of capital is going to decrease significantly. Bankers make money on loans, not sitting on their cash reserves. Profitable companies have less need of loans and therefore get better terms. It feels ironic that the folks who need cash the least get the best terms. The point is, the resources needed for the large trial data appear to be becoming a reasonable expection in about 18 months to 2 years. That is my expectation for CFBE on the current trajectory. I don’t know how long the trials take to conduct but that will be an exciting time because we all know what the data will show. And then, the money needed to “market Afrezza in the typical BP manner” with advertising, a larger sales force with diabetes educators and a better label and better data and with better discounts for the PBMs, all of the things associated with “the typical BP manner” can be brought to bear for Mannkind. Dr. Castagna is not stupid. He knows all of this as do many here. It may not feel like this can work but I personally am very confident it can and will. |
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Post by Deleted on Mar 3, 2020 9:45:10 GMT -5
charlie .. Saying that our sales reps are doing a bad job is a blanket statement.. Bottom line is Afrezza is so different from anything out there and misunderstood, that we needed large trial data to prove what we claim... we don't have that and probably wont have that under the circumstances... Marketing Afrezza in the typical BP manner will never work... Matt P knew this... He had been with the company for years right alongside of Al... unfortunately Mike has never known this... I believe this is the path for the larger trials and better penetration. Once the Pediatric trials are completed and approved MNKD will partner with a larger pharma company to market Afrezza. The larger company have the resources to design and commence a large scale trial to prove the superiority of Afrezza. This will probably happen in late 2021 or 2022. In the meantime they will continue with their business plan by educating the doctors and getting their existing DATA Published. Also in that same timeframe royalties will start with UTHR and MNKD will have breathing room and more flexibility in the molecules they pursue. Also I believe UTHR will sign on for another molecule or two which will give MNKD additional resources. |
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Post by agedhippie on Mar 3, 2020 10:51:52 GMT -5
I believe this is the path for the larger trials and better penetration. Once the Pediatric trials are completed and approved MNKD will partner with a larger pharma company to market Afrezza. The larger company have the resources to design and commence a large scale trial to prove the superiority of Afrezza. This will probably happen in late 2021 or 2022.... It's difficult to see who would want to partner. Lilly and Novo Nordisk both have their new insulins which they need to recover the development costs on, and Sanofi has their Humalog clone. Sanofi don't seem to have heard that it takes years to launch an insulin - Admelog has been on the market for two years and last year's net revenue was $278M which was 155% up on the previous year. I don't know what people's expectation of the pediatric trials is, but the insurance barrier remains. Then there is the whole question on how you get endos to prescribe it because if you are having a 75% drop out rate with adults then they are going to expect at least that with kids. |
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Post by Deleted on Mar 3, 2020 11:28:37 GMT -5
I believe this is the path for the larger trials and better penetration. Once the Pediatric trials are completed and approved MNKD will partner with a larger pharma company to market Afrezza. The larger company have the resources to design and commence a large scale trial to prove the superiority of Afrezza. This will probably happen in late 2021 or 2022.... It's difficult to see who would want to partner. Lilly and Novo Nordisk both have their new insulins which they need to recover the development costs on, and Sanofi has their Humalog clone. Sanofi don't seem to have heard that it takes years to launch an insulin - Admelog has been on the market for two years and last year's net revenue was $278M which was 155% up on the previous year. I don't know what people's expectation of the pediatric trials is, but the insurance barrier remains. Then there is the whole question on how you get endos to prescribe it because if you are having a 75% drop out rate with adults then they are going to expect at least that with kids. Sanofi would be a prime candidate....yes I know about the history but I think their old CEO saw the potential in Afrezza. We all know Afrezza is far superior to the existing prandials. At the time of the deal Sanofi needed GROWTH and Afrezza would have given them that growth. Apidra is sucking wind and to write off that product line would not hurt their bottom line when you have Afrezza. MNKD's main issue per Mike is DOSING. They have to develop dosing protocols. IMO the reason why people drop Afrezza is bc they have been programmed on the hazards of Insulin. Whenever you hear someone is on INSULIN they cringed. You feel sorry for them bc everyone know that people can die if they take too much. Well that has to changed. MNKD needs to DEPROGRAM and REPROGRAM patients on how Afrezza works. That's not going to be easy. Patients are under dosing and see little benefit. Once they proper dose and fully understand how it works more PWD will embrace. Pediatrics is the holy grail for MNKD. Like Mike said if you can get the kids on it you have a customer for life. Insurance will get onboard especially if MNKD can get Afrezza into their own class. Mike has been throwing out ULTRA RAPID ACTING a lot lately so maybe they are working with the FDA? If that happens all bets are off and we skyrocket. |
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Post by agedhippie on Mar 3, 2020 12:33:29 GMT -5
Sanofi would be a prime candidate....yes I know about the history but I think their old CEO saw the potential in Afrezza. We all know Afrezza is far superior to the existing prandials. At the time of the deal Sanofi needed GROWTH and Afrezza would have given them that growth. Apidra is sucking wind and to write off that product line would not hurt their bottom line when you have Afrezza. MNKD's main issue per Mike is DOSING. They have to develop dosing protocols. IMO the reason why people drop Afrezza is bc they have been programmed on the hazards of Insulin. Whenever you hear someone is on INSULIN they cringed. You feel sorry for them bc everyone know that people can die if they take too much. Well that has to changed. MNKD needs to DEPROGRAM and REPROGRAM patients on how Afrezza works. That's not going to be easy. Patients are under dosing and see little benefit. Once they proper dose and fully understand how it works more PWD will embrace. Pediatrics is the holy grail for MNKD. Like Mike said if you can get the kids on it you have a customer for life. Insurance will get onboard especially if MNKD can get Afrezza into their own class. Mike has been throwing out ULTRA RAPID ACTING a lot lately so maybe they are working with the FDA? If that happens all bets are off and we skyrocket. Let's split that into three parts... Sanofi has two RAA insulins; Apidra and Admelog. Apidra has static sales, but the net revenue is still 10x Afrezza and losing that revenue would definitely impact the bottom line. Admelog also had 10x Afrezza's net revenue but is growing at 155% which is considerably faster than Afrezza so they are not going to scrap that. Back in 2015 I would have (actually I did!) agree with you - having Afrezza cannibalizing Apidra's revenue was not an issue because it was expected to grow so fast. The problem right now is that Sanofi has failed to sell Afrezza once, and five years on Afrezza' net revenue is still only 10% of Apidra's net revenue. Sanofi is not going to take back Afrezza. I think dosing is an issue, but what STAT showed was that the fast clearance meant that patients often had to take two doses per meal. Contrary to what is often said here that is a very real problem for compliance. My bet would be that most people only take a single dose because typically that's what you do (the tail takes care of the excess), and then are going high because there are uncovered carbs on the tail of the meal. At that point they tink it doesn't work. Very long winded, but yes I agree there needs to be a better protocol identified and communicated. That may well mean a label change though and so the need for trial data (STAT-2 please!) Pediatrics. Why will insurers get onboard? They still have the same short term incentives as they do with adults. Children's insurance is hooked to their parents' insurance so it rolls over every five or so years. I predict that the insurers will remain with their sweetheart RAA deals. Mike has been throwing around ultra-rapid acting, as have Novo Nordisk for Fiasp, and Lilly. They are not going to create a new class. |
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Post by sweedee79 on Mar 3, 2020 12:42:25 GMT -5
I don't know how Peds will go... I pray that Mnkd markets it in a way that the kids will want it.. However, we do NOT have Endos on board.. nor do we have a lot of money to advertise so we are always at a disadvantage..
It is possible BP will want to partner for the peds population... But I don't know enough about it to say.. how large is that population? It's all about $$$$$!!!!
Regarding our current marketing plan.. it isn't working.. it's been how many years now? Time is money.. our retention rate is dismal.. I for one don't want to be diluted into Oblivion.. or wake up one morning and find our company has filed BK.. sticking our heads into the sand isn't a good investment strategy IMO..
All of the problems have been spelled out to us and it's obvious our management has no plan to address any of it. My money is on Vdex.. and because I know how good Afrezza is. Mnkd needs to team up with Vdex.. and work together.. that is how we will see hockey stick growth!!!!
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Post by sweedee79 on Mar 3, 2020 12:45:03 GMT -5
I think we are off topic.. sorry Charlie!!!!
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Post by Charlie on Mar 3, 2020 13:01:03 GMT -5
charlie .. Saying that our sales reps are doing a bad job is a blanket statement.. Bottom line is Afrezza is so different from anything out there and misunderstood, that we needed large trial data to prove what we claim... we don't have that and probably wont have that under the circumstances... Marketing Afrezza in the typical BP manner will never work... Matt P knew this... He had been with the company for years right alongside of Al... unfortunately Mike has never known this... thanks sweedee RE: The reps doing a bad job. As someone in an earlier life representing my own business I did a lot of cold calls. The one thing I had to adjust to was rejection. Early on I got nothing but rejections until I broke through to prove my product and service worthy. Once that happened, acceptance happened more often and doors opened more quickly which eventually made my business successful. Someone (and more) are getting in the door. It's like a war. First to hit the beach are killed as is there enthusiasm because they are not making a living (if rewarded by success) as well as the constant rejection affecting one's attitude. These front liners must be recognized for the hard efforts that they are making. Many of them get disabled in the process thinking like new investors "what a GREAT Drug this is and enter with the expectation that they have the evidence to prove to a doctor the superiority of the Afrezza compared to injectables". If they can't get in the door because of the individual doctors system of screening, one can hardly blame them for failure of sales. Some have gotten past that and once they accumulate receptive physician clients it becomes easier. At this point they can say "I showed this to Doctor "Fletcher" who now has 4 Afrezza patients and then again a month later tells the same physican who may have 1 or 2 patients using Afrezza that Dr. Fletcher now has a dozen patients and then talk about how much lower and how his collective group of patients A1C have come down dramatically. As I said earlier about the sales representatives being bad as a blanket statement was meant to convey that Not all of them are failing even if most are hitting a brick wall. I hope that it is part of the paradigm of MNKD for the successful sales people taking along a newbie on a few days of calls to show by example what it takes to get in the door. Likewise I mentioned that the sales staff HAVE TO HAVE Dynamic information along with the brilliant charts that Peppy consistently presents this board. Visual stimulation as mentioned earlier like the little girl with a million needles in her. A couple short but strong youtube affirmations from Afrezza Users who make it PERSONAL. Doctors are humans with extreme time constraints and one's sales impact must be made dynamically in short time to wake the doctor up to the possibility to investigating something revolutionary. Once that threshold is made, getting invited in the door becomes easier and easier. As for retention. Again, the doctor has to hold the patients hand for a while know with Confidence that Afrezza is a very effective medication and worth further exploration before the patient gives up. However, the doctor has to have that confidence. I am giving my doctor that confidence and hopefully he has a few other patients that are doing that too. When I first met him I asked why he has so few patients? His reply "it takes much longer to order the drug than refill a traditional Vile order. 3 meeting later after I said no to metformin 4 times he opened up a book which shows the package combination of various doses. (30 4's, 30 8's, 30 12's) or (60 8's & 60 12's) or.... etc. This made it easier for my ENT to realize that that his bias on how long it takes to order a regiment is not that time consuming. But it took a couple of years for him to arrive at that.
So in conclusion on behalf of the share holders the slow escalation of increase of new orders and reorders are not coming fast enough. And, on behalf of the Sales Reps. it's still a very hard sell to not receptive physicians reluctant to change, and those who are selling are our hero's just as are the soldiers who hit the front line first and getting slaughtered in the continued effort to win the war on diabetes.
I appreciate your thoughtful replies. |
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Post by bill on Mar 3, 2020 13:01:41 GMT -5
I don't know how Peds will go... I pray that Mnkd markets it in a way that the kids will want it.. However, we do NOT have Endos on board.. nor do we have a lot of money to advertise so we are always at a disadvantage.. It is possible BP will want to partner for the peds population... But I don't know enough about it to say.. how large is that population? It's all about $$$$$!!!! Regarding our current marketing plan.. it isn't working.. it's been how many years now? Time is money.. our retention rate is dismal.. I for one don't want to be diluted into Oblivion.. or wake up one morning and find our company has filed BK.. sticking our heads into the sand isn't a good investment strategy IMO.. All of the problems have been spelled out to us and it's obvious our management has no plan to address any of it. My money is on Vdex.. and because I know how good Afrezza is. Mnkd needs to team up with Vdex.. and work together.. that is how we will see hockey stick growth!!!! Seems to me that Afrezza's marketing plan may lack balance. It needs to be directed to a combination of PWD, endos, and insurance companies. If MNKD is spending too little effort, or is accomplishing too little in any one of these areas, you see almost no progress since all three are required for sales and retention. |
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