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Post by brotherm1 on Feb 27, 2020 22:30:24 GMT -5
I would think it’s not for UTHR then. If it was I would think they would not disclose the data publicly
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Post by brotherm1 on Feb 28, 2020 6:26:05 GMT -5
In addition to tret-t UTHR royalties, MNkD will be the manufacturer of tret-t for UTHR. How much could we expect MNkD to make from the manufacturing ?
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Post by rfogel on Feb 28, 2020 8:24:41 GMT -5
In addition to tret-t UTHR royalties, MNkD will be the manufacturer of tret-t for UTHR. How much could we expect MNkD to make from the manufacturing ? As I understand the deal, Mannkind will only be the manufacturer for the quantities needed to complete the trials. Once the drug is approved, United will assume manufacturing responsibility. |
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Post by brotherm1 on Feb 28, 2020 9:13:59 GMT -5
I’ll listen again to Leerlink presentation from yesterday, but I’m 99.999% certain MC said they need to look into expanding their manufacturing plant again because of the now expected UTHR sales of tret-t to include who group 3. Though I believe he said the recent expansion they did for tret-t only took five months and he expects further expansion to not be a problem as they’ll have up to around 24 months from now to do it.
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Post by boca1girl on Feb 28, 2020 9:23:12 GMT -5
In addition to tret-t UTHR royalties, MNkD will be the manufacturer of tret-t for UTHR. How much could we expect MNkD to make from the manufacturing ? As I understand the deal, Mannkind will only be the manufacturer for the quantities needed to complete the trials. Once the drug is approved, United will assume manufacturing responsibility. United has the right to manufacture their own supply does not necessarily mean that they will. I bet MNKD will produce their products on a long term basis. |
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Post by ktim on Feb 28, 2020 9:38:44 GMT -5
In addition to tret-t UTHR royalties, MNkD will be the manufacturer of tret-t for UTHR. How much could we expect MNkD to make from the manufacturing ? I would suspect at or near cost. Though there could be some beneficial effect to Afrezza COGS if some higher paid personnel, such as quality control, serve the function for both drugs. |
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Post by mnholdem on Feb 28, 2020 9:58:12 GMT -5
One comment from CEO Castagna did bother me. When asked about payer coverage, he stated that ~80% of commercial payers cover Afrezza but then, when asked about possible future plans to improve payer coverage, Castagna's response included the remark "we're okay with the P.A." (Reminder: PA = prior authorization and approval is required for patient to be covered for Afrezza). This indicates one of two obstacles to unrestricted coverage are still being faced: - Payers give preferred status to other brands of rapid-acting insulin that compete against Afrezza, or;
- Payers consider insulin to be dangerous and therefore require ALL brands of rapid-acting insulin to be burdened with the PA requirement.
Slide 6 illustrates that one of the MannKind's 2020 Strategies to "Focus on Placing Key Bets to Drive Wider Afrezza Adoption" is the creation of a Specialty Pharmacy Network that is hoped will provide:
- Reimbursement support
- Pharmacy fulfillment support
- Patient persistency tactics (e.g. texts, emails, phone calls)
This is troublesome to me as MannKind apparently has capitulated and has decided a good option is to basically put the burden of dealing with the payer onto the patient. Reading through all the hype, what this CEO seems to be implying here is that patient is likely to be denied coverage and the physician doesn't have time or won't make the time to become a patient advocate with payers. It seems that the CEO believes that it will be beneficial to teach the patients communication tactics to use against the payer. Does Castagna really think that the majority of patients are going to suddenly become assertive when denied coverage for Afrezza by their plan managers? IMO, only a fraction of the patients will be persistent. The same applies for physicians. The 2020 Strategy relies heavily on organic growth rather than tactics associated with disrupting the diabetes market. IMO, if this is the strategy, then stockholders can expect slow adoption of Afrezza to continue. 
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Post by lennymnkd on Feb 28, 2020 10:16:39 GMT -5
90% for type one
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Post by mango on Feb 28, 2020 10:21:47 GMT -5
Prior Authorization is a burden on not just the patient but the physician. Mike should be slapped for saying that.
Just say NO to Prior Authorization.
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Post by kc on Feb 28, 2020 10:24:24 GMT -5
Sadly I don’t think that MannKind will be sustainable unless the BOD takeS some drastic action and make a big paradigm shift in pricing of Afrezza. BOD Needs to give payers a reaso to prescribe Afrezza. Payers will only pay for the cheapest most compliant drug. We now have five years proof that players are shunning Mannkind One comment from CEO Castagna did bother me. When asked about payer coverage, he stated that ~80% of commercial payers cover Afrezza but then, when asked about possible future plans to improve payer coverage, Castagna's response included the remark "we're okay with the P.A." (Reminder: PA = prior authorization and approval is required for patient to be covered for Afrezza). This indicates one of two obstacles to unrestricted coverage are still being faced: - Payers give preferred status to other brands of rapid-acting insulin that compete against Afrezza, or;
- Payers consider insulin to be dangerous and therefore require ALL brands of rapid-acting insulin to be burdened with the PA requirement.
Slide 6 illustrates that one of the MannKind's 2020 Strategies is to "Focus on Placing Key Bets to Drive Wider Afrezza Adoption" is the creation of a Specialty Pharmacy Network that is hoped will provide:
- Reimbursement support
- Pharmacy fulfillment support
- Patient persistency tactics (e.g. texts, emails, phone calls)
This is troublesome to me as MannKind apparently has capitulated and has decided a good option is to basically put the burden of dealing with the payer onto the patient. Reading through all the hype, what's this CEO is saying here is that patient is likely to be denied coverage and the physician doesn't have time or won't make the time to become a patient advocate with payers. It seems that the CEO believes that it will be beneficial to teach the patients communication tactics to use against the payer. Does Castagna really think that the majority of patients are going to suddenly become assertive when denied coverage for Afrezza by their plan managers? IMO, only a fraction of the patients will be persistent. The same applies for physicians. The 2020 Strategy relies heavily on organic growth rather than tactics associated with disrupting the diabetes market. IMO, if this is the strategy, then stockholders can expect slow adoption of Afrezza to continue.
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Post by agedhippie on Feb 28, 2020 10:42:55 GMT -5
...This indicates one of two obstacles to unrestricted coverage are still being faced: - Payers give preferred status to other brands of rapid-acting insulin that compete against Afrezza, or;
- Payers consider insulin to be dangerous and therefore require ALL brands of rapid-acting insulin to be burdened with the PA requirement.
Slide 6 illustrates that one of the MannKind's 2020 Strategies is to "Focus on Placing Key Bets to Drive Wider Afrezza Adoption" is the creation of a Specialty Pharmacy Network that is hoped will provide:
- Reimbursement support
- Pharmacy fulfillment support
- Patient persistency tactics (e.g. texts, emails, phone calls)
...
Does Castagna really think that the majority of patients are going to suddenly become assertive when denied coverage for Afrezza by their plan managers? IMO, only a fraction of the patients will be persistent. The same applies for physicians. The 2020 Strategy relies heavily on organic growth rather than tactics associated with disrupting the diabetes market.
I think of the two obstacles being faced it has to be the former. Certainly I have never had to get PA for insulin unless I wanted the non-preferred brand. On the specialty pharmacy practice; isn't that already done via a 3rd party specialist company? I seem to remember that being set up a while back. Does this mean it's being bought in house which I would be dubious about doing? If the existing company cannot achieve results then, given that this is all they do, I would look at the material used because if it's bad today simply bringing it in house means the material is still bad. Trying to move the Type 1 market is going to be very hard. People get set in their ways (as has been observed by some posters this is something I am guilty of!) and you are asking them to essentially make a lifestyle change which has a notoriously high failure rate (look at diets). I definitely think that there is a Type 1 market there, but I do wonder how much of that has already been met as the people most likely to move have already done so. The benefit of the Type 2 market has a large number of new insulin users every year, that is less so in the Type 1 market. |
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Post by ktim on Feb 28, 2020 11:00:32 GMT -5
Sadly I don’t think that MannKind will be sustainable unless the BOD takeS some drastic action and make a big paradigm shift in pricing of Afrezza. BOD Needs to give payers a reaso to prescribe Afrezza. Payers will only pay for the cheapest most compliant drug. We now have five years proof that players are shunning Mannkind One comment from CEO Castagna did bother me. When asked about payer coverage, he stated that ~80% of commercial payers cover Afrezza but then, when asked about possible future plans to improve payer coverage, Castagna's response included the remark "we're okay with the P.A." (Reminder: PA = prior authorization and approval is required for patient to be covered for Afrezza). This indicates one of two obstacles to unrestricted coverage are still being faced: - Payers give preferred status to other brands of rapid-acting insulin that compete against Afrezza, or;
- Payers consider insulin to be dangerous and therefore require ALL brands of rapid-acting insulin to be burdened with the PA requirement.
Slide 6 illustrates that one of the MannKind's 2020 Strategies is to "Focus on Placing Key Bets to Drive Wider Afrezza Adoption" is the creation of a Specialty Pharmacy Network that is hoped will provide:
- Reimbursement support
- Pharmacy fulfillment support
- Patient persistency tactics (e.g. texts, emails, phone calls)
This is troublesome to me as MannKind apparently has capitulated and has decided a good option is to basically put the burden of dealing with the payer onto the patient. Reading through all the hype, what's this CEO is saying here is that patient is likely to be denied coverage and the physician doesn't have time or won't make the time to become a patient advocate with payers. It seems that the CEO believes that it will be beneficial to teach the patients communication tactics to use against the payer. Does Castagna really think that the majority of patients are going to suddenly become assertive when denied coverage for Afrezza by their plan managers? IMO, only a fraction of the patients will be persistent. The same applies for physicians. The 2020 Strategy relies heavily on organic growth rather than tactics associated with disrupting the diabetes market. IMO, if this is the strategy, then stockholders can expect slow adoption of Afrezza to continue.
Why is there a presumption that MNKD isn't already offering discounts/rebates? If a PBM has Novo as preferred and has a deal whereby they get a 50% rebate as long as they meet the goal of having 95% of prandial insulin bought be Novo, it's hard for MNKD to win the preferred slot since at this point they could give a 99% rebate so unless the PBM could force everyone on Novo to switch to Afrezza they'd lose huge amount of money if they allow the preferred to slip under the rebate threshold. In that way Afrezza's uniqueness is double edge sword, because doctors would not put up with trying to force a novel delivery mechanism onto a patient base comfortable with using their SQ. I've only learned about this convoluted PBM rebate system since investing in MNKD. If I'm wrong about this, I certainly would welcome correction... but for now I'm skeptical of those without pharma marketing experience simplifying as if this is an ordinary market with price elasticity. |
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Post by Deleted on Feb 28, 2020 11:08:49 GMT -5
In addition to tret-t UTHR royalties, MNkD will be the manufacturer of tret-t for UTHR. How much could we expect MNkD to make from the manufacturing ? As I understand the deal, Mannkind will only be the manufacturer for the quantities needed to complete the trials. Once the drug is approved, United will assume manufacturing responsibility. That was the original deal. MNKD was to make enough for the trials and initial production but now it seems like MNKD will be the contract manufacturer of TreT. UTHR realized they didn't want to make the investment in a new facility and necessary resources. MNKD has the expertise and facility space for the near future. Like Mike said.....We're going to need a BIG BOAT. I'm sure MNKD will earn some margin. IMO once TreT is approved or leading up to approval MNKD will have discussions on a new deal. |
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Post by Deleted on Feb 28, 2020 11:14:09 GMT -5
I’ll listen again to Leerlink presentation from yesterday, but I’m 99.999% certain MC said they need to look into expanding their manufacturing plant again because of the now expected UTHR sales of tret-t to include who group 3. Though I believe he said the recent expansion they did for tret-t only took five months and he expects further expansion to not be a problem as they’ll have up to around 24 months from now to do it. As a side note this is where Al Mann & Company screwed up. I call it the DNDN EFFECT. Al anticipated HUGE VOLUME of Afrezza so he built a facility to handle the volume but it never materialize. MNKD would have been in a much better shape if they phased in the production of Afrezza. If they started with 3 lines and then grow as demand increased it would have been less strain on their resources and margins would have been great. Hindsight is 20/20. |
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Post by lennymnkd on Feb 28, 2020 11:28:33 GMT -5
Type ones and pediatrics are going to be the plan going forward , mike said something to the effect that type one are covered automatically by default is that correct ? Type two compliance is even more difficult to develop than I could ever imagined.. type two’s the biggest market is Going to take some creative marketing and we do not have the funds for
that at the moment... partner needed. All I can say is good thing : as they say “we are not a one trick pony “
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