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Post by nylefty on Jun 28, 2021 17:04:06 GMT -5
Tsunami=25,000,000 million patients now will have access to Afrezza... Making friends of CGM makers..which can now..co-promote...hmm No, the policy change doesn't give any more Medicare patients access to Afrezza. It does give Medicare Part B coverage for CGMs to patients who use Afrezza. It doesn't change the fact that almost all Part C and Part D plans do not cover Afrezza. |
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Post by nylefty on Jun 28, 2021 17:18:04 GMT -5
My understanding was those on medicare and insulin dependent could get a CGM covered but the insulin had to be an injectable. Now they can partner the CGM with afrezza and as VDex has demonstrated the CGM is a near requirement for learning initial dosing. I am sticking with my opinion this is huge news. Maybe I am wrong but I hope not. It's true that Medicare patients will be able to "partner" a CGM with Afrezza and have the CGM covered by Medicare Part B. But Afrezza still won't be covered by almost all of the Medicare Part C and Part D prescription plans. |
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Post by sayhey24 on Jun 28, 2021 17:50:21 GMT -5
Baby steps, its forward progress. It can start all kinds of interesting discussions for Mike with the CGM community.
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Post by uvula on Jun 28, 2021 18:39:52 GMT -5
Before today I did not know Medicare patients on afrezza could not get a cgm. This was a huge impediment. We discuss everything on this board but I don't recall this particular problem ever being mentioned. Did I miss it or was this a surprise to everyone here?
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Post by nylefty on Jun 28, 2021 18:51:01 GMT -5
Before today I did not know Medicare patients on afrezza could not get a cgm. This was a huge impediment. We discuss everything on this board but I don't recall this particular problem ever being mentioned. Did I miss it or was this a surprise to everyone here? They could get a CGM just like they could get Afrezza: by paying out of pocket. There are very few Medicare patients on Afrezza because almost none of the Medicare prescription plans cover it. That's a much bigger problem than the non-coverage of CGMs was, althogh the policy change is a much-needed step in the right direction. |
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Post by sportsrancho on Jun 28, 2021 18:51:18 GMT -5
Neither did I
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Post by bones1026 on Jun 28, 2021 21:21:00 GMT -5
Do you now agree that insurance continues to be a huge problem? I think it’s hard to argue that. Not the only thing..but we did t even know these Afrezza users couldn’t get a CGM covered by insurance no matter what..that seems crazy to be honest..use a ultra rapid insulin, but not the device to show you how it works best, and changes how you manage your diabetes much more effectively |
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Post by sportsrancho on Jun 28, 2021 21:32:45 GMT -5
Do you now agree that insurance continues to be a huge problem? I think it’s hard to argue that. Not the only thing..but we did t even know these Afrezza users couldn’t get a CGM covered by insurance no matter what..that seems crazy to be honest..use a ultra rapid insulin, but not the device to show you how it works best, and changes how you manage your diabetes much more effectively Do I now agree? Insurance IS a big problem ..but we get most of our patients CGM’s covered by insurance. If not we absorb the expense. |
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Post by bones1026 on Jun 28, 2021 21:57:30 GMT -5
Do you now agree that insurance continues to be a huge problem? I think it’s hard to argue that. Not the only thing..but we did t even know these Afrezza users couldn’t get a CGM covered by insurance no matter what..that seems crazy to be honest..use a ultra rapid insulin, but not the device to show you how it works best, and changes how you manage your diabetes much more effectively Do I now agree? Insurance IS a big problem ..but we get most of our patients CGM’s covered by insurance. If not we absorb the expense. In your opinion, why is preventing Vdex from writing a few 100 scripts each week with their 4-5 clinics? You mention Vdex doesn’t have a problem getting insurance coverage for Afrezza. |
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Post by porkini on Jun 28, 2021 22:59:07 GMT -5
Do I now agree? Insurance IS a big problem ..but we get most of our patients CGM’s covered by insurance. If not we absorb the expense. In your opinion, why is preventing Vdex from writing a few 100 scripts each week with their 4-5 clinics? You mention Vdex doesn’t have a problem getting insurance coverage for Afrezza. Here we go [again]. bones1026, respectfully, I am not trying to pick a fight with you, but are you willing to identify your employer and allow us to ask questions about their practices and expect an answer from you while you are currently employed? I mean c'mon, really? |
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Post by sportsrancho on Jun 29, 2021 6:01:27 GMT -5
In the first place I never said we didn’t have a problem with insurance, it’s difficult, but we have people that write appeals once we get the patients numbers down. It’s easier to prove necessity that way if they don’t get it right away. We try and make it seamless for the patient.
That’s where the samples come in handy.
There is a process…CGM training, samples, dosing protocols, numbers , script. There’s diet, there’s emotional well-being. There’s someone that cares and is with you every step of the way.
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Post by hellodolly on Jun 29, 2021 6:29:52 GMT -5
Tsunami=25,000,000 million patients now will have access to Afrezza... Making friends of CGM makers..which can now..co-promote...hmm Could be the external "opportunity" MC and team have matched with internal "strengths". They know what they have. |
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Post by peppy on Jun 29, 2021 6:44:34 GMT -5
Tsunami=25,000,000 million patients now will have access to Afrezza... Making friends of CGM makers..which can now..co-promote...hmm Could be the external "opportunity" MC and team have matched with internal "strengths". They know what they have. What they have. Medicare patients will be able to "partner" a CGM with Afrezza and have the CGM covered by Medicare Part B. But Afrezza still won't be covered by almost all of the Medicare Part C and Part D prescription plans. - the policy change doesn't give any more Medicare patients access to Afrezza. - It does give Medicare Part B coverage for CGMs to patients who use Afrezza. - almost all Part C and Part D plans do not cover Afrezza. Prior to this change, patients on Medicare could use Afrezza, but coverage was excluded for CGM because the language did not include inhaled insulin in the definition. From the press release: "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." |
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Post by sportsrancho on Jun 29, 2021 9:57:22 GMT -5
In your opinion, why is preventing Vdex from writing a few 100 scripts each week with their 4-5 clinics? You mention Vdex doesn’t have a problem getting insurance coverage for Afrezza. Here we go [again]. bones1026, respectfully, I am not trying to pick a fight with you, but are you willing to identify your employer and allow us to ask questions about their practices and expect an answer from you while you are currently employed? I mean c'mon, really? Exactly, and by the way bones, you might want to check the new Vdex thread because the patient that Bill talked about helping from the Afrezza private Facebook group (The one that didn’t think Afrezza was working) just gave us a testimonial …he had a telehealth session with Claudia. By the way if anybody is a member of that group you can go in and see the testimonial for yourself, it’s under the Vdex Father’s Day post. |
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Post by sayhey24 on Jun 29, 2021 10:44:43 GMT -5
I missed VDex now being down "below the fold". I am not sure I like that. VDex is a crucial player in the unfolding afrezza story.
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