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Post by sayhey24 on Jul 8, 2021 19:37:59 GMT -5
I thought most people thought this was huge news but not because afrezza was covered by medicare but rather because it now opens up a new huge market for CGM vendors in the T2 space if the CGM vendors can leverage the safety and health benefits of afrezza and get the PCP to prescribe. Now the reality is they need to show that the SoC is a treat to fail standard and afrezza solves that problem. Only time will tell if they can do this. We know Kendall failed with the ADA but MNKD has a brand new sales force.
At the same time the CGM vendors need to figure out a way to either get afrezza covered by insurance or cheap enough nearly everyone can afford to remove yet another hurdle. I actually think my idea about CGM vendors buying direct from MNKD and selling a combo sensor/afrezza package may be a good one and the CGM vendors might be able to get medicare coverage for it.
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Post by nylefty on Jul 8, 2021 20:10:15 GMT -5
I thought most people thought this was huge news but not because afrezza was covered by medicare but rather because it now opens up a new huge market for CGM vendors in the T2 space if the CGM vendors can leverage the safety and health benefits of afrezza and get the PCP to prescribe. I was thinking of posts such as this: "Tsunami=25,000,000 million patients now will have access to Afrezza.."Talk about misinformation. |
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Post by lazyb767 on Jul 8, 2021 20:39:41 GMT -5
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Post by mnkdfann on Jul 8, 2021 21:55:50 GMT -5
That data appears to be current as of 2016. Lots has changed. For one, Sanofi bailed. You can see on the site that the number of Afrezza claims was decreasing, and the average patient cost was increasing from 2015 to 2016. I suspect the data is not remotely accurate or relevant for 2020 / 2021. |
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Post by peppy on Jul 8, 2021 22:04:30 GMT -5
Here is the interesting one - The beneficiary is insulin-treated with multiple (three or more) daily administrations of insulin or a continuous subcutaneous insulin infusion (CSII) pump; The current SoC for the T2 going on insulin would be once a day basal. This sure does not help the CGM vendors like Dexcom. If however the CGM vendors push PCPs to instead subscribe afrezza by demonstrating better control and better long term out comes, afrezza meets the 3x daily requirement. It sure seems this opens up a new huge market for the CGM vendors and a whole new huge sales force for afrezza who might actually be able to sell at the corporate headquarters who are now controlling many of the PCPs. The CGM vendors just need to figure out a way to either get afrezza covered by insurance or cheap enough nearly everyone can afford. Maybe they can buy direct from MNKD and sell a combo sensor/afrezza package. I wonder if medicare would cover that? quote, " The beneficiary is insulin-treated with multiple (three or more) daily administrations of insulin or a continuous subcutaneous insulin infusion (CSII) pump;" "The current SoC for the T2 going on insulin would be once a day basal. " Reply; Catch 22. "a dilemma or difficult circumstance from which there is no escape because of mutually conflicting or dependent conditions. "a catch-22 situation"" |
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Post by sayhey24 on Jul 9, 2021 17:41:59 GMT -5
I thought most people thought this was huge news but not because afrezza was covered by medicare but rather because it now opens up a new huge market for CGM vendors in the T2 space if the CGM vendors can leverage the safety and health benefits of afrezza and get the PCP to prescribe. I was thinking of posts such as this: "Tsunami=25,000,000 million patients now will have access to Afrezza.."Talk about misinformation. I am not sure where they got their numbers. If 44m are on medicare and 1/3 are diabetic the number would be more like 14,520,000. Thats still not a bad number for our CGM friends to go after and if they can figure out how to bundle afrezza with their sensors as a combo package these 14.5m will get afrezza covered for little to no cost. It really depends on the CGM vendors and how bad they want that market. |
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Post by nylefty on Jul 9, 2021 18:17:34 GMT -5
I was thinking of posts such as this: "Tsunami=25,000,000 million patients now will have access to Afrezza.."Talk about misinformation. I am not sure where they got their numbers. If 44m are on medicare and 1/3 are diabetic the number would be more like 14,520,000. Thats still not a bad number for our CGM friends to go after and if they can figure out how to bundle afrezza with their sensors as a combo package these 14.5m will get afrezza covered for little to no cost. It really depends on the CGM vendors and how bad they want that market. That person misinterpreted the MannKind PR to mean that Medicare will now cover Afrezza for all Medicare patients, which is flatly not true. Today another Stocktwits poster claimed that Medicare will cover Afrezza, but only in combination with CGMs, which is also not true. The PR was badly worded, causing much confusion. |
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Post by sportsrancho on Jul 9, 2021 18:28:22 GMT -5
I am not sure where they got their numbers. If 44m are on medicare and 1/3 are diabetic the number would be more like 14,520,000. Thats still not a bad number for our CGM friends to go after and if they can figure out how to bundle afrezza with their sensors as a combo package these 14.5m will get afrezza covered for little to no cost. It really depends on the CGM vendors and how bad they want that market. That person misinterpreted the MannKind PR to mean that Medicare will now cover Afrezza for all Medicare patients, which is flatly not true. Today another Stocktwits poster claimed that Medicare will cover Afrezza, but only in combination with CGMs, which is also not true. The PR was badly worded, causing much confusion. That will help us/Vdex not have to internally cover the cost of the CGM’s for our patients. |
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Post by sellhighdrinklow on Jul 9, 2021 20:53:29 GMT -5
That person misinterpreted the MannKind PR to mean that Medicare will now cover Afrezza for all Medicare patients, which is flatly not true. Today another Stocktwits poster claimed that Medicare will cover Afrezza, but only in combination with CGMs, which is also not true. The PR was badly worded, causing much confusion. That will help us/Vdex not have to internally cover the cost of the CGM’s for our patients. I'm curious how Vdex could afford to cover the cost of CGMs for patients while trying to make their business plan work. . A Dexcom system w transmitters and sensors is very costly. |
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Post by sportsrancho on Jul 9, 2021 20:58:39 GMT -5
That will help us/Vdex not have to internally cover the cost of the CGM’s for our patients. I'm curious how Vdex could afford to cover the cost of CGMs for patients while trying to make their business plan work. . A Dexcom system w transmitters and sensors is very costly. Sure… because insurance covers their care with us. We are profitable. We use the Libra. But obviously this will help. Like I have said before…time in range is the most important thing, so we start them out on a CGM before we put them on Afrezza. |
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Post by nylefty on Jul 9, 2021 22:22:30 GMT -5
Investor #1: Any idea why MannKind has been going down recently?
Investor #2: It had gone up because of a misleading MannKind press release that investors wrongly interpreted as saying that Medicare was going to cover Afrezza. But of course Medicare doesn't cover prescription drugs and none of the insurance plans that offer drug benefits to Medicare patients cover Afrezza either. Investors finally got wise that they'd been misled.
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Post by longliner on Jul 10, 2021 2:15:23 GMT -5
Investor #1: Any idea why MannKind has been going down recently?Investor #2: It had gone up because of a misleading MannKind press release that investors wrongly interpreted as saying that Medicare was going to cover Afrezza. But of course Medicare doesn't cover prescription drugs and none of the insurance plans that offer drug benefits to Medicare patients cover Afrezza either. Investors finally got wise that they'd been misled. I welcome a response from Mannkind management regarding your post. I don't have a great level of understanding regarding our Government ran health care system and how this news affects Afrezza sales. |
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Post by sayhey24 on Jul 10, 2021 7:55:08 GMT -5
I am not sure where they got their numbers. If 44m are on medicare and 1/3 are diabetic the number would be more like 14,520,000. Thats still not a bad number for our CGM friends to go after and if they can figure out how to bundle afrezza with their sensors as a combo package these 14.5m will get afrezza covered for little to no cost. It really depends on the CGM vendors and how bad they want that market. That person misinterpreted the MannKind PR to mean that Medicare will now cover Afrezza for all Medicare patients, which is flatly not true. Today another Stocktwits poster claimed that Medicare will cover Afrezza, but only in combination with CGMs, which is also not true. The PR was badly worded, causing much confusion. You raise a good point which had me re-read the PR. I am not sure it is badly worded, maybe carefully worded. I have not talked with Mike in a long time but it seems they are up to something as the PR says Mannkind requested the change. What this does is it gives a reason for CGM vendors to promote afrezza which they never had before. Prior they had reason not to promote afrezza if the PWD was going to get denied in the T1 space let alone trying to do anything with T2s. "Prior to this change, Medicare denials were occurring for patients using CGMs and inhaled insulin as an alternative to injected mealtime insulin," explained Michael Castagna, PharmD, Chief Executive Officer of MannKind Corporation. "MannKind is committed to providing convenience for patients, and believes that patients should have the choice to use any of today's tools to help manage their diabetes." 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 Jul 10, 2021 9:08:16 GMT -5
"Prior to this change, Medicare denials were occurring for patients using CGMs and inhaled insulin as an alternative to injected mealtime insulin," explained Michael Castagna, PharmD, Chief Executive Officer of MannKind Corporation. "MannKind is committed to providing convenience for patients, and believes that patients should have the choice to use any of today's tools to help manage their diabetes."
Exactly ..this helps on the amount of appeal letters.
I believe Bill told me we were able to get about half the people covered before this. We ate the cost on the others. We have to have them on a CGM.
But now more people on Afrezza will be able to have real time/ Time in range diabetic management.. therefore it should help them stay on the drug. And it will help Mannkind’s retention rate.
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Post by mnkdfann on Jul 10, 2021 13:15:30 GMT -5
That person misinterpreted the MannKind PR to mean that Medicare will now cover Afrezza for all Medicare patients, which is flatly not true. Today another Stocktwits poster claimed that Medicare will cover Afrezza, but only in combination with CGMs, which is also not true. The PR was badly worded, causing much confusion. You raise a good point which had me re-read the PR. I am not sure it is badly worded, maybe carefully worded. I have not talked with Mike in a long time but it seems they are up to something as the PR says Mannkind requested the change. What this does is it gives a reason for CGM vendors to promote afrezza which they never had before. Prior they had reason not to promote afrezza if the PWD was going to get denied in the T1 space let alone trying to do anything with T2s. "Prior to this change, Medicare denials were occurring for patients using CGMs and inhaled insulin as an alternative to injected mealtime insulin," explained Michael Castagna, PharmD, Chief Executive Officer of MannKind Corporation. "MannKind is committed to providing convenience for patients, and believes that patients should have the choice to use any of today's tools to help manage their diabetes." 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. I don't know what you are thinking of when you wrote 'they are up to something'. I don't think they are being sneaky or that this foretells some big move or change in strategy. The CMS LCD says the same thing about Mannkind requesting the change: "The DME MACs received a reconsideration request on 7/24/2020 from MannKind Corporation, manufacturer of Afrezza inhaled insulin, to change the language in the LCD: Glucose Monitors (L33822) to include use of inhaled insulin. MannKind stated that Medicare denials are occurring for patients using CGMs and inhaled insulin as an alternative to injected mealtime insulin. They requested a change in the criteria for CGM to include ..." I think the CMS is merely indicating that the change came about because the manufacturer made a request, nothing more or less. www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?lcdid=33822My guess is that Mannkind is simply emphasising the point because from a PR viewpoint it is good to display how proactive they are being (which is still subject to debate, maybe). |
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