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Post by nylefty on Jul 7, 2021 18:25:32 GMT -5
I do not see it that way. True about Part A & B, that is nothing new. As stated on ST’s, in 2020 alone, 46M of more than 60M covered by Medicare are enrolled in Part D Plans. If I recall correctly, MNKD has a rebate deal with Aetna. the only deal we have/had. That is for people paying an insurance premium. nylefty All? I have an Aetna Medicare Advanage plan and it doesn't cover Afrezza at all, much less offer a rebate. Maybe there are Aetna non-Medicare plans that do but I'm not familiar with them.
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Post by nylefty on Jul 7, 2021 18:39:54 GMT -5
I do not see it that way. True about Part A & B, that is nothing new. As stated on ST’s, in 2020 alone, 46M of more than 60M covered by Medicare are enrolled in Part D Plans. I think the change is a great one and MNKD Afrezza will do just fine. As far as Part D - it is the part of Medicare that provides outpatient drug coverage. Part D is provided only through private insurance companies that have contracts with the Federal Government. Folks pay the extra amount and the plans premium each month to keep Medicare Prescription Drug (Part D). Medicare, Part D - helps pay brand name and prescription drugs. I'm on Medicare and have never seen a Part D plan that I could subscribe to that covers Afrezza. There are a tiny number of such plans that are offered by employers and unions to their retirees, but not to other Medicare patients. I pay for an Aetna Medicare Advantage plan, but it does not cover Afrezza. So you're right that most Medicare recipients subscribe to Part D plans, but hardly any of them get coverage for Afrezza. I'm not a diabetic so I don't need Afrezza, but as a MannKind stockholder I check the Medicare plans that are available to me and always look to see if they cover Afrezza. I've never found one that does!
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Post by stockwhisperer on Jul 7, 2021 18:57:39 GMT -5
Can not speak to all the plans as there are many - so, maybe now - as of the 18th, they or more of them will cover Afrezza. The announcement states… MannKind requested that the Durable Medical Equipment (DME) MACs reconsider the existing language in the LCD: Glucose Monitors (L33822) to include use of inhaled insulin. Previously, the criteria defined patients as taking insulin either with multiple daily injections or an insulin pump. The amended definition now includes a patient that takes insulin with inhalation as an alternative.
"This is a win-win for Medicare patients and providers that serve those patients," said Stella Ilyayeva, MD, FACE, an Endocrinology, Diabetes and Metabolism specialist. "In 2020, almost 2/3 of T1D Afrezza patients were utilizing a CGM concomitantly. I anticipate this change will open up more doors for the population of Afrezza users."
So, I would think that since the wording - definition has been revised to include patients selecting insulin w/inhalation - Afrezza - the plans would now, need to consider approving it - even if they didn’t before. We will see.
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Post by sweedee79 on Jul 7, 2021 20:13:00 GMT -5
In looking at all part D plans a few years back only Express Scripts covered Afrezza and I don't believe they do anymore. So I am in agreement with Nylefty.. most part d plans don't cover Afrezza.. however it's a step in the right direction.
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Post by stockwhisperer on Jul 7, 2021 20:24:09 GMT -5
But isn’t that the point of the wording - definition change to cover inhaled insulin? If the wording has been revised to do just that, won’t the Part D Medicare Providers have to now - as of July 18, consider covering it? I must be missing something here. It makes no sense to change the wording if nothing changes about Part D Medicare coverage for Afrezza as of July18th.
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Post by sweedee79 on Jul 7, 2021 20:38:45 GMT -5
It seems to me they don't want to cover it... And they probably won't unless they are made to.. for one thing Afrezza is way more expensive..
But I think if you can get a doctor to help you, and you can prove your need for being on Afrezza , you can appeal the non coverage..
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Post by stockwhisperer on Jul 7, 2021 20:45:46 GMT -5
I would think so too. If the wording has specifically been revised to include inhaled insulin, yet the Part D providers, at large - continue to not cover Afrezza, I would think appeals would be in order.
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Post by peppy on Jul 7, 2021 21:06:54 GMT -5
I would think so too. If the wording has specifically been revised to include inhaled insulin, yet the Part D providers, at large - continue to not cover Afrezza, I would think appeals would be in order. Off topic. I read this remark on a video about construction and concrete. You know what is sad my uncle who passed on was a civil engineer in south Florida from 79 to 90 his specialty was concrete and I know for a fact he saw so much bad concrete go in to these condos When he tried to reject it he was threatened with death. He had a few concrete blocks dropped next to him To send a massage. it got so bad he had to go hide out camping in the Fl woods because he could not be bought the man had integrity But the payoffs went all the way up
Ps he worked up and down the west coast of Florida he saw concrete plants mixing beach sand into the concrete just think about that He worked inspecting for condos,bridges ect there are bridge abutments in Sarasota county that are made with beach sand So you have salt and other impurities in that He had his tires slashed his windows broken vehicles wrecked then he had enough and left the state ===========================================================================================================There may be an analogy. However I have become bent.
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Post by boca1girl on Jul 7, 2021 21:13:18 GMT -5
I would think so too. If the wording has specifically been revised to include inhaled insulin, yet the Part D providers, at large - continue to not cover Afrezza, I would think appeals would be in order. Maybe the current Afrezza users on Medicare buy their insulin cash via Eagle or the assistance card offered by MNKD. Now they can qualify for a CGM through Medicare if they use Afrezza. Hopefully it does encourage more to try Afrezza.
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Post by nylefty on Jul 7, 2021 21:41:30 GMT -5
But isn’t that the point of the wording - definition change to cover inhaled insulin? If the wording has been revised to do just that, won’t the Part D Medicare Providers have to now - as of July 18, consider covering it? I must be missing something here. It makes no sense to change the wording if nothing changes about Part D Medicare coverage for Afrezza as of July18th. The government can't force insurance companies to cover Afrezza. It can offer to cover CGMs for Medicare patients who get Afrezza by paying out of pocket or the relatively few who get Afrezza through employer or union retiree plans. We used to have access to a site that covered drug insurance coverage and I remember a graphic showing that the percentage of Medicare coverage of Afrezza was "0." That wasn't strictly true, but because the percentage was below half a percent the site rounded it off to zero. The insurance companies don't want to cover Afrezza because it's so expensive. They save money by covering its cheaper competitors. Sad but true.
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Post by stockwhisperer on Jul 7, 2021 22:45:38 GMT -5
Not sure why you do not appear to be thinking there will be any major positives in this for MNKD - Afrezza but I think there will be. More to follow as this moves forward, GL
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Post by nylefty on Jul 7, 2021 23:17:34 GMT -5
I would think so too. If the wording has specifically been revised to include inhaled insulin, yet the Part D providers, at large - continue to not cover Afrezza, I would think appeals would be in order. Maybe the current Afrezza users on Medicare buy their insulin cash via Eagle or the assistance card offered by MNKD. Now they can qualify for a CGM through Medicare if they use Afrezza. Hopefully it does encourage more to try Afrezza. Absolutely. Thanks for contributing your realistic viewpoint.
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Post by mnkdfann on Jul 8, 2021 0:58:06 GMT -5
Not sure why you do not appear to be thinking there will be any major positives in this for MNKD - Afrezza but I think there will be. More to follow as this moves forward, GL Isn't factual reality better than hopium? While it is a positive, the facts seem to suggest it will amount to weak sauce rather than anything 'major'.
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Post by stockwhisperer on Jul 8, 2021 2:04:18 GMT -5
Yes, factual reality is always better but there is no factual reality yet, as far as to what will actually happen for MNKD - Afrezza with the new wording definition so - if you look at it that way - maybe those that have the opinion - speculation, that there will be only weak sauce, are living on hopium, too. So, as I said before, more to follow as this moves forward.
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Post by uvula on Jul 8, 2021 3:27:15 GMT -5
What does a Cgm cost? I'm guessing (with no facts) that anyone who can afford to pay for afrezza without assistance can also afford a cgm. But I don't have any numbers to support this.
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