MNKD spent $10M for 10,000 customers

[peppy]

Mike C today said V-go is for the type two market.

The V-Go series of Wearable Insulin Delivery Devices are indicated for continuous subcutaneous infusion of either 20 Units of Insulin (0.83 U/hr), 30 Units of insulin (1.25 U/hr) or 40 Units of insulin (1.67 U/hr) in one 24-hour time period and on-demand bolus dosing in 2 Unit increments (up to 36 Units per one 24-hour time period) in adults requiring insulin

Question, sayhey24, agedhippie, all.

Any chance .83 u/hr the lowest dose, any chance the intention is just to keep the insulin running continuously for a type 2 with this pump?

Thoughts, effectiveness?

[porkini]

May 23, 2022 20:26:01 GMT -5 peppy said:

Mike C today said V-go is for the type two market.

The V-Go series of Wearable Insulin Delivery Devices are indicated for continuous subcutaneous infusion of either 20 Units of Insulin (0.83 U/hr), 30 Units of insulin (1.25 U/hr) or 40 Units of insulin (1.67 U/hr) in one 24-hour time period and on-demand bolus dosing in 2 Unit increments (up to 36 Units per one 24-hour time period) in adults requiring insulin

Question, sayhey24 , agedhippie , all.

Any chance .83 u/hr the lowest dose, any chance the intention is just to keep the insulin running continuously for a type 2 with this pump?

Thoughts, effectiveness?

I'm a dim bulb tonight, maybe. Are you suggesting this could be a transition device (like training wheels) for someone moving to Afrezza use?

[Deleted]

May 23, 2022 20:26:01 GMT -5 peppy said:

Mike C today said V-go is for the type two market.

The V-Go series of Wearable Insulin Delivery Devices are indicated for continuous subcutaneous infusion of either 20 Units of Insulin (0.83 U/hr), 30 Units of insulin (1.25 U/hr) or 40 Units of insulin (1.67 U/hr) in one 24-hour time period and on-demand bolus dosing in 2 Unit increments (up to 36 Units per one 24-hour time period) in adults requiring insulin

Question, sayhey24 , agedhippie , all.

Any chance .83 u/hr the lowest dose, any chance the intention is just to keep the insulin running continuously for a type 2 with this pump?

Thoughts, effectiveness?

I don't think the V-GO works on a continuous flow.  I think it's mechanical so the patient has to initiate the bolus.  The patient checks their CGM before a meal (at least 45 minutes BEFORE the meal) and gives a bolus.   

[Deleted]

May 23, 2022 17:41:55 GMT -5 sayhey24 said:

May 23, 2022 17:07:42 GMT -5 @chuckbass said:

Guys you're missing the point.  MNKD bought V-GO to get access to the 10,000 customers.  I would make a bet that V-GO goes BYE BYE in 18 months.  MNKD will have a strategy to educate and convert the Type 2 Patient and the Doctor on Afrezza.  In the meantime MNKD will get good Revenues from V-GO.   WIN WIN  

OK - so please explain what getting access means.  Are the sales reps going door to door like the Fuller Brush man to the PWDs and then what?  Are they trying to convert them to afrezza without their doctor there?

Are the sales reps going office to office to convince the doctors to prescribe afrezza and not V-Go?  We have sent sales reps out like this before at least 2x and both times its been an epic fail.  Then we laid off the sales reps.  Why will it work now?  Couldn't we just buy the prescribing doctor list for a lot less than $10M if that is the plan?

If you could explain how this is going to work given the fact that they are currently losing money on each pump sold.  Now the 8-k they filed today says we could be hiring up to 40 people.

Mike said during the fireside chat they have a lot of doctors who only prescribe one or two scripts and they have to improve.  The doctors who write 30-40 scripts are not the problem.   One easy way to target the customers is through mailers.  I would send several mailers over the next 6 months introducing Afrezza and giving them a COUPON to try it.   So there is no cost to them.  It's an easy way to get patients interested and trying Afrezza.   If they like it I would give them a discount for the next 6 months.  Remember they are getting 77% Margins so there's room for a discount.   And most of them are on Medicare and the last time I checked Afrezza is covered under Medicare. 

Are you getting REVENUE from buying the Doctor's list???  NO.......
 

 

[porkini]

May 23, 2022 21:25:11 GMT -5 @chuckbass said:

May 23, 2022 20:26:01 GMT -5 peppy said:

Mike C today said V-go is for the type two market.

The V-Go series of Wearable Insulin Delivery Devices are indicated for continuous subcutaneous infusion of either 20 Units of Insulin (0.83 U/hr), 30 Units of insulin (1.25 U/hr) or 40 Units of insulin (1.67 U/hr) in one 24-hour time period and on-demand bolus dosing in 2 Unit increments (up to 36 Units per one 24-hour time period) in adults requiring insulin

Question, sayhey24 , agedhippie , all.

Any chance .83 u/hr the lowest dose, any chance the intention is just to keep the insulin running continuously for a type 2 with this pump?

Thoughts, effectiveness?

I don't think the V-GO works on a continuous flow.  I think it's mechanical so the patient has to initiate the bolus.  The patient checks their CGM before a meal (at least 45 minutes BEFORE the meal) and gives a bolus.   

From the article (www.healthline.com/diabetesmine/v-go-dissecting-a-new-breed-of-patch-pump-for-type-2s#By-DMine-Columnist-/-Correspondent-Wil-Dubois):

Like an NTSB crash investigator, this time, I was able to piece it all back together. The V-Go features an industrial-strength 6-inch dual spring that is forced into a one-and-a-half inch cavity in the pod. This creates pressure on a reservoir of liquid silicone-like fluid. The plunger that drives the insulin is pushed, not by a traditional push rod, but by this fluid. The flow of basal insulin seems to be controlled by the diameter of the delivery needle itself, which pierces the top of the insulin cartridge at the same moment it’s inserted into the skin.



In a nutshell, the system is more hydraulic than mechanical. It functions on fluid dynamics. It’s simple. Somewhat elegant. And for many type 2s, it may prove to be just what the doctor ordered. Literally and figuratively.

[Deleted]

May 23, 2022 23:10:16 GMT -5 porkini said:

May 23, 2022 21:25:11 GMT -5 @chuckbass said:

I don't think the V-GO works on a continuous flow.  I think it's mechanical so the patient has to initiate the bolus.  The patient checks their CGM before a meal (at least 45 minutes BEFORE the meal) and gives a bolus.   

From the article (www.healthline.com/diabetesmine/v-go-dissecting-a-new-breed-of-patch-pump-for-type-2s#By-DMine-Columnist-/-Correspondent-Wil-Dubois):

Like an NTSB crash investigator, this time, I was able to piece it all back together. The V-Go features an industrial-strength 6-inch dual spring that is forced into a one-and-a-half inch cavity in the pod. This creates pressure on a reservoir of liquid silicone-like fluid. The plunger that drives the insulin is pushed, not by a traditional push rod, but by this fluid. The flow of basal insulin seems to be controlled by the diameter of the delivery needle itself, which pierces the top of the insulin cartridge at the same moment it’s inserted into the skin.



In a nutshell, the system is more hydraulic than mechanical. It functions on fluid dynamics. It’s simple. Somewhat elegant. And for many type 2s, it may prove to be just what the doctor ordered. Literally and figuratively.

Thanks for the find and explanation. I was basically saying the user has to physically enact the pump versus electronic.    

[agedhippie]

May 23, 2022 21:25:11 GMT -5 @chuckbass said:

May 23, 2022 20:26:01 GMT -5 peppy said:

Mike C today said V-go is for the type two market.

The V-Go series of Wearable Insulin Delivery Devices are indicated for continuous subcutaneous infusion of either 20 Units of Insulin (0.83 U/hr), 30 Units of insulin (1.25 U/hr) or 40 Units of insulin (1.67 U/hr) in one 24-hour time period and on-demand bolus dosing in 2 Unit increments (up to 36 Units per one 24-hour time period) in adults requiring insulin

Question, sayhey24 , agedhippie , all.

Any chance .83 u/hr the lowest dose, any chance the intention is just to keep the insulin running continuously for a type 2 with this pump?

Thoughts, effectiveness?

I don't think the V-GO works on a continuous flow.  I think it's mechanical so the patient has to initiate the bolus.  The patient checks their CGM before a meal (at least 45 minutes BEFORE the meal) and gives a bolus.   

The V-Go has two function; basal, and bolus. For basal the V-Go provides a continuous flow of RAA insulin driven by the spring throughout the life of the device, this is the 0.83u/hr for the 20u version. On a normal pump that rate would be varied according to the time of day (you need less at night for example) but the V-Go cannot do that. The bolus side is more or less separate from the basal side and bypasses the mechanism to deliver a 2u dose per click.

The basal side is really there as a convenience since a basal injection is less fuss and safer. The USP of the V-Go is the bolus side - you are carrying your insulin with you rather than leaving it somewhere so you don't have it when you want it and so delay the dose until later. The device is purely mechanical, there are no electronics in it at all.

[sayhey24]

May 24, 2022 7:29:35 GMT -5 agedhippie said:

May 23, 2022 21:25:11 GMT -5 @chuckbass said:

I don't think the V-GO works on a continuous flow.  I think it's mechanical so the patient has to initiate the bolus.  The patient checks their CGM before a meal (at least 45 minutes BEFORE the meal) and gives a bolus.   

The V-Go has two function; basal, and bolus. For basal the V-Go provides a continuous flow of RAA insulin driven by the spring throughout the life of the device, this is the 0.83u/hr for the 20u version. On a normal pump that rate would be varied according to the time of day (you need less at night for example) but the V-Go cannot do that. The bolus side is more or less separate from the basal side and bypasses the mechanism to deliver a 2u dose per click.

The basal side is really there as a convenience since a basal injection is less fuss and safer. The USP of the V-Go is the bolus side - you are carrying your insulin with you rather than leaving it somewhere so you don't have it when you want it and so delay the dose until later. The device is purely mechanical, there are no electronics in it at all.

Peppy - I don't have much to add to what Aged said.  If you believe the big advantage of this over taking a shot of Tresiba is its ability to allow for additional insulin at mealtime then you have to ask, how does this fit with afrezza? 

I am still hoping either I am missing something with this acquisition or Mike is figuring out a way to get out of this deal.  A better deal I think would be with DXCM for the T2s.  The DXCM sales reps would be motivated to get early use of afrezza replacing the GLP1s since Medicare will pick up the cost of the CGM if they are on afrezza.  If DXCM had the ability to get the T2s early in their diagnosis they could significantly increase their sales.