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Post by liane on Jun 21, 2021 18:42:22 GMT -5
CCI - this is not the Tyvaso thread - it is the out take from Tyvaso discussing the old MNKD sales rep and why afrezza is not selling. Ok. So this thread is to talk about Afrezza sales. The title of the thread is confusing then. My bad. Well, that's what folks get when I have to create a title for the posts I need to move. |
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Post by sayhey24 on Jun 21, 2021 19:14:21 GMT -5
What I think we have here is a $4B marketing failure but I also think we have a product years ahead of its time. The good news is UTHR has provided a life line to correct things and now we have a little time. On an annual basis there are about 800k heart attacks in the U.S. and about 600k deaths from heart disease. The 600k deaths are clearly on par with Covid but I doubt Covid will have 600k deaths next year. I don't know how many of the 600k also had diabetes but they say if you have diabetes you have twice the likelihood of having a heart attack. Of the non-diabetics having a heart attack how many where averaging above 140mg/dl for 2+ hours per day? Who knows but after Apple's BG sensor we may have a better clue. Al saw afrezza as a T2 med. The fact is few expected to get T1 approval, at least initially. After 6+ years, its still not being marketed to the T2s. Can afrezza reduce heart disease by getting people under 140 when they are having 2+ hour excursions? I am pretty sure the answer is yes. Every time I see the SGLT2 commercials promoting heart healthy I cringe but I appreciate the basis of their claim. Abbott is actively marketing the Libre with their new TV commercials to start the time in range discussion. Their current answer is don't eat the food you are about to eat. Why MNKD can't jump on that is a head scratcher but we do know Mike said that in 2021 T2s were not going to be a MNKD focus. Now that we are nearly 3Q2021 I sure hope Mike is starting his 2022 planning for the T2s. If afrezza can be marketed as a heart disease slayer for the T2s then I think sales are off to the moon. I think Kendall had the nuggets of gold to show this through a combination of studies. If when the BG sensors hit the market in a couple of years can afrezza be positioned to be the solution to time out of range which leads to vascular degeneration leading to heart disease? I think it can as SGLT2s have already paved the way but in the mean time Mike needs to start working some deals with Sens, or Abbott or Sayer and he needs to start proving out such a strategy. I see Sens has popped a bit over the last few weeks but I have no idea what their patient base is. With the CGM and the remote monitoring - Sports issue of under dosing should be easily solved. If we think Covid was a frenzy, what is going to happen when all these people start seeing their BG 180+ with the Apple watch? With the right marketing/knowledge they are going to lose their minds. There is only one solution to bringing down high BG in real time and that is human insulin. There is only one human insulin delivery system which mimics the pancreas and thats afrezza. I know this was discussed at the time and I don't want to dwell on it but there had to be a reason Kendall left. Was it because he had the very data that you mention but Castagna wouldn't listen to him? I lack confidence in Mike so we'll see what happens. I don't think why he left was ever disclosed. If it was I don't remember it. When you look at his LinkedIn, he never left / It doesn't seem he took another job. Maybe he retired or maybe he got paid off. The last thing BP would have wanted was him actually getting afrezza favorable changes to the SoC. One "theory" at the time was MNKD was going in a different direction than afrezza and diabetes with the UTHR partnership and Kendall was a misfit for their new direction. If he is just hanging around doing nothing maybe Mike can give him a call and ask him to start re-mining those nuggets of gold. If he could make a gold bar or two from the nuggets that would be awesome. I would think after sitting around for 6 months or so, he is probably looking for something to do. |
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Post by sportsrancho on Jun 21, 2021 21:34:34 GMT -5
Kendall came from a strong company (Lilly) where he had funding to do the studies he needed to do. Then he came to MNKD at a time when it was barely solvent and no money to do anything -- no studies, no trials, nothing. Just sit and wait was the MC strategy, and still is, except for the UTHR deal. Maybe Kendall became disillusioned after a couple of years of not being able to use his talents because MNKD couldn't and wouldn't pay to get anything done. I heard he got tired spinning his wheels so I tend to agree with that. |
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Post by joeypotsandpans on Jun 21, 2021 21:56:35 GMT -5
Kendall came from a strong company (Lilly) where he had funding to do the studies he needed to do. Then he came to MNKD at a time when it was barely solvent and no money to do anything -- no studies, no trials, nothing. Just sit and wait was the MC strategy, and still is, except for the UTHR deal. Maybe Kendall became disillusioned after a couple of years of not being able to use his talents because MNKD couldn't and wouldn't pay to get anything done. I heard he got tired spinning his wheels so I tend to agree with that. I was curious to what Dr.Kendall did after resigning and the timeframe, maybe it's just my browsing history but I cannot see anything updated on his LinkedIn, it still shows Mannkind as last position. I think the odds of him just retiring during a pandemic and being with his family are a safe bet. Also while researching it I came across this thread and pages 5-7 when Guerrero and I had a pretty civil exchange, especially regarding the poster in my endo's office...not sure where the assessment of vitriol and cruelty comes into play 🤷♂️ mnkd.proboards.com/thread/11790/cco?page=5Lastly, Casper had a great post in the thread giving the opinion of grabbing as much shares as possible under $1.50...looking pretty smart right now 😉 |
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Post by mytakeonit on Jun 21, 2021 23:50:25 GMT -5
Hmmm ... did Casper send me $20  If not, then he isn't a friendly ghost. But, that's mytakeonit |
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Post by sportsrancho on Jun 22, 2021 7:08:52 GMT -5
Hmmm ... did Casper send me $20 If not, then he isn't a friendly ghost. But, that's mytakeonit I’ll agree with that! |
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Post by olderteampt on Jun 22, 2021 8:39:27 GMT -5
The percentages I listed refer to Diabetes being the specific/sole cause of death. So one can assume the percentages are even lower then I listed if you think about how many death certificates list it as a comorbidity.
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Post by morfu on Jun 22, 2021 10:38:17 GMT -5
What I think we have here is a $4B marketing failure but I also think we have a product years ahead of its time. The good news is UTHR has provided a life line to correct things and now we have a little time. On an annual basis there are about 800k heart attacks in the U.S. and about 600k deaths from heart disease. The 600k deaths are clearly on par with Covid but I doubt Covid will have 600k deaths next year. I don't know how many of the 600k also had diabetes but they say if you have diabetes you have twice the likelihood of having a heart attack. Of the non-diabetics having a heart attack how many where averaging above 140mg/dl for 2+ hours per day? Who knows but after Apple's BG sensor we may have a better clue. Al saw afrezza as a T2 med. The fact is few expected to get T1 approval, at least initially. After 6+ years, its still not being marketed to the T2s. Can afrezza reduce heart disease by getting people under 140 when they are having 2+ hour excursions? I am pretty sure the answer is yes. Every time I see the SGLT2 commercials promoting heart healthy I cringe but I appreciate the basis of their claim. Abbott is actively marketing the Libre with their new TV commercials to start the time in range discussion. Their current answer is don't eat the food you are about to eat. Why MNKD can't jump on that is a head scratcher but we do know Mike said that in 2021 T2s were not going to be a MNKD focus. Now that we are nearly 3Q2021 I sure hope Mike is starting his 2022 planning for the T2s. If afrezza can be marketed as a heart disease slayer for the T2s then I think sales are off to the moon. I think Kendall had the nuggets of gold to show this through a combination of studies. If when the BG sensors hit the market in a couple of years can afrezza be positioned to be the solution to time out of range which leads to vascular degeneration leading to heart disease? I think it can as SGLT2s have already paved the way but in the mean time Mike needs to start working some deals with Sens, or Abbott or Sayer and he needs to start proving out such a strategy. I see Sens has popped a bit over the last few weeks but I have no idea what their patient base is. With the CGM and the remote monitoring - Sports issue of under dosing should be easily solved. If we think Covid was a frenzy, what is going to happen when all these people start seeing their BG 180+ with the Apple watch? With the right marketing/knowledge they are going to lose their minds. There is only one solution to bringing down high BG in real time and that is human insulin. There is only one human insulin delivery system which mimics the pancreas and thats afrezza.
>> here is a $4B marketing failure Ah well, people repeat this again and again . . half of that would be a tax write-off anyhow!
Reality of course is, that Afrezza sale numbers were raising double digits since 2017 and would have taken us to green numbers with US-adult sales alone by about 2023. Obviously you can always dream bigger and criticize management (like I hold them responsible for that 20% dilution in 2018 without any need or explanation, which costs all shareholders a lot of money.. 20%  ). I think no one here really knows if Afrezza sales still climb at that 2017-2020 rate (I would be happy to read an analysis about that) or if you can really blame sales management for the trend changes over the last 15 moths, I for one can imagine a fast recovery to the old trend once Corona gets under control or even a consistent ongoing trend hidden outside Symphony numbers and getting green in 2023 seems still very possible.. failures look very different.
Second guessing the past or smart-assing the business model as an outsider (possibly with an own agenda) is just poor form IMHO.
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Post by sayhey24 on Jun 22, 2021 11:51:23 GMT -5
Well - my personal agenda is pretty straight forward. I would like to see MNKD realize Al Mann's vision. Many years ago Al convinced me afrezza would be one of the greatest selling drugs of all time because it was the greatest advance in diabetes care in 100 years and could be a near cure for some T2s.
Al also told me afrezza was much bigger than MiniMed. As I learned more and more about afrezza and diabetes I became a true believer. That would put the pps much much higher than it is now but not with year over year double digit growth of 700 script per week. If you think the 2018 dilution was a big hit, you clearly where not around for the 1:5 reverse split after watching the pps go from over $20pps to sub $1.
I wish I could say I was smart-assing the T2 business model. Then there would be a business model. However, the reality is there is no current T2 business model and Mike told us during one of his presentations maybe 4Q 2019 that T2s were being put on hold for 2021.
When it comes to afrezza I really don't want to dream about huge sales. I would like it to become reality. Part of the process is understanding why it is not living up to Al's vision. I think we have a couple of the reason, maybe most.
1. Dosing - most initial users are under-dosing and their reaction is afrezza doesn't work for me or as one ex-MNKD sale rep thought - they can't inhale. There are several reasons for this including the dosing instructions, lack of experience by the doctors and even Al's decision to package afrezza as 4/8/12 units instead of calling them small medium and large. The current packaging leads current T1's who are counting every carb to try and do a comparision to the current RAA dosing.
2. No coordinated approach to the T2 market - Most T2s have little idea what is going on with their BG. Since diabetes progresses slowly they put finding out what is happening until tomorrow until tomorrow is too late. Many PCPs do not even have T2s take daily BG readings let alone before and after meals. IMO the new Libre TV commercial is ground breaking, maybe not for this forum but for the rest of the world.
3. Insurance coverage and cost - Getting T1 coverage with some work is usually doable but it takes work. Getting it for a new T2 with the current SoC is just not going to happen. At the same time $100-$200 through Eagle when some are willing to pay GoLo $400 is not too crazy.
4. A drug ahead of its time - Continuous Glucose Sensors are coming. Unlike CGMs, companies like Apple are not going to seek FDA approval for the sensors - at least not initially. The big unknown is what impact will they have on the general population all of a sudden caring about BG levels and things like TIR. I think with the proper marketing it could be huge, especially if its tied to heart disease.
So, I am not focused on the past but its important to understand the past to develop a successful path forward. Exactly what that is I hope Mike figures out. We do know on a small scale with limited resource Bill from VDex has provided some insight. Maybe Dachis with Sano can provide more.
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Post by backwash on Jun 23, 2021 8:27:16 GMT -5
Pguererro vs Newsletter Nate vs mytakeonit & clan? To date, Pguererro hands down for accuracy vs fluff. I am unable to find anything wrong with taking the time to understand both the short & long thesis and subsequently coming up with my own investment decisions. Right or wrong--I own it. Going forward the analysts covering UTHR must factor in the MNKD relationship-expecting some good reads and likely new analyst coverage & upgrades for mnkd. We'll see? buenas suerte (sorry for the typos English is my third language)
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Post by morfu on Jun 23, 2021 8:29:04 GMT -5
Well - my personal agenda is pretty straight forward. I would like to see MNKD realize Al Mann's vision. Many years ago Al convinced me afrezza would be one of the greatest selling drugs of all time because it was the greatest advance in diabetes care in 100 years and could be a near cure for some T2s. Al also told me afrezza was much bigger than MiniMed. As I learned more and more about afrezza and diabetes I became a true believer. That would put the pps much much higher than it is now but not with year over year double digit growth of 700 script per week. If you think the 2018 dilution was a big hit, you clearly where not around for the 1:5 reverse split after watching the pps go from over $20pps to sub $1. I wish I could say I was smart-assing the T2 business model. Then there would be a business model. However, the reality is there is no current T2 business model and Mike told us during one of his presentations maybe 4Q 2019 that T2s were being put on hold for 2021. When it comes to afrezza I really don't want to dream about huge sales. I would like it to become reality. Part of the process is understanding why it is not living up to Al's vision. I think we have a couple of the reason, maybe most. 1. Dosing - most initial users are under-dosing and their reaction is afrezza doesn't work for me or as one ex-MNKD sale rep thought - they can't inhale. There are several reasons for this including the dosing instructions, lack of experience by the doctors and even Al's decision to package afrezza as 4/8/12 units instead of calling them small medium and large. The current packaging leads current T1's who are counting every carb to try and do a comparision to the current RAA dosing. 2. No coordinated approach to the T2 market - Most T2s have little idea what is going on with their BG. Since diabetes progresses slowly they put finding out what is happening until tomorrow until tomorrow is too late. Many PCPs do not even have T2s take daily BG readings let alone before and after meals. IMO the new Libre TV commercial is ground breaking, maybe not for this forum but for the rest of the world. 3. Insurance coverage and cost - Getting T1 coverage with some work is usually doable but it takes work. Getting it for a new T2 with the current SoC is just not going to happen. At the same time $100-$200 through Eagle when some are willing to pay GoLo $400 is not too crazy. 4. A drug ahead of its time - Continuous Glucose Sensors are coming. Unlike CGMs, companies like Apple are not going to seek FDA approval for the sensors - at least not initially. The big unknown is what impact will they have on the general population all of a sudden caring about BG levels and things like TIR. I think with the proper marketing it could be huge, especially if its tied to heart disease. So, I am not focused on the past but its important to understand the past to develop a successful path forward. Exactly what that is I hope Mike figures out. We do know on a small scale with limited resource Bill from VDex has provided some insight. Maybe Dachis with Sano can provide more. >> If you think the 2018 dilution was a big hit, you clearly where not around for the 1:5 reverse split after watching the pps go from over $20pps to sub $1. that was just a numbers trick to get the share price above 1$, no one lost any part of the company (well not quite, since the resulting devaluation meant that managements get more bonus shares) This can (to a large extent) be undone, but the 20% shares are gone, you see the difference?
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Post by sayhey24 on Jun 23, 2021 9:28:19 GMT -5
On the trip from $20 to sub $1, there were many times the stock was diluted but dilution is not a big hitter as long as the company's future looks bright. The diluted price will always recover as it did pre-2015. However, once I have 1 share instead of my 5, while the share price will recover if the company's future is still bright I won't at the same rate. Do you see the difference?
The 1 for 5 was not a numbers trick. It was a total recapitalization of the company. Do you see the difference?
I will say while many were beating Mike up over the 2018 dilution, I thanked him. He seemed to be taking the criticism pretty hard as he was trying to do the right thing. At that point in time MNKD needed money and needed it bad. I supported that dilution as I did Al's pre-2015 numerous dilutions. I did not support the 1 for 5 which was a move to keep it on the national board.
At this point it does not much matter. It is what it is. What we need now is an executable plan for T2s which marries afrezza/cgms/dosing/TIR/24-7 monitoring and maybe weight loss. The Libre commercials are starting to tee things up with just the concept of a T2 even checking their mealtime BG.
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Post by mango on Jun 23, 2021 11:54:13 GMT -5
Afrezza is poised to be the Absolute Gold Standard in Time in Range. This essentially means Afrezza is the standard for correcting blood glucose levels and restoring post-prandial glucose homeostasis.
Diabetes Partnerships with key players in the TIR market would not only be ideal for helping showcase Afrezza as the GOAT for TIR, but key to driving the new TIR Hypothesis and replacing the now debunked and dangerous HbA1c hypothesis.
Afrezza should become synonymous with the phase Time in Range. To know one should be to know the other. Just like when everyone is wearing smart sensors and more PWD are wearing them and/or CGMs, we will see rise to a heath revolution where daily meal eating is monitored by the average person to the most elite athletes—foods with low GE will become more sought after and discussed and become synonymous with the phase Time in Range. Likewise, Afrezza should become meshed with that culture and phase and we need to be really driving home the differences between Afrezza and all the other mealtime insulins and why there is only one that truly matches physiologic insulin and is capable of achieving TIR with incredible ease and unmatched safety (significantly less hypos and hypers, no insulin amyloid masses, no lipohypertropthy, no weight gain, no carb counting required, no pain from needle sticks, and so on).
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Post by sportsrancho on Jun 23, 2021 12:11:56 GMT -5
The reason MC got a lot of criticism over the Christmas massacre was because of what he told shareholders personally in emails. Right or soon before the dilution. I was not one of them but I saw proof that those emails were sent to David Thompson.
These were very large shareholders out of the New York and Illinois area.
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Post by mango on Jun 23, 2021 12:33:41 GMT -5
The reason MC got a lot of criticism over the Christmas massacre was because of what he told shareholders personally in emails. Right or soon before the dilution. I was not one of them but I saw proof that those emails were sent to David Thompson. These were very large shareholders out of the New York and Illinois area. I may be wrong, but didn’t MC say in a CC just days before the Christmas Massacre that there was no need for dilution or there would be no dilution? Something to that effect? |
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If not, then he isn't a friendly ghost.
).
