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Post by sayhey24 on Nov 17, 2022 15:57:27 GMT -5
OK mystery solved. What Mike said was a little misleading. It sounded like it "should" be covered but it seems it is covered and there are so many plans its hard to figure out one which does not cover it but I would say they all have they cover it as "Inhaled Insulin".
I went to medicare.gov and did a search for my zip code for afrezza and got a zillion plans covering afrezza. For 2022 the cost through Aetna would be about $30k for the year. For 2023 I got this notice
Important! Starting January 1, 2023, the cost of a one-month supply of each Part D-covered insulin will be capped at $35. If you get a 60- or 90-day supply of insulin, your costs can’t be more than $35 for each month’s supply of each covered insulin.
This new $35 cap may not be reflected when you compare 2023 plans. You should talk to someone for help comparing plans.
Who gets the credit for this? Mike? Kevin Sayer? someone else? It looks like a big win.
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Post by peppy on Nov 17, 2022 16:23:37 GMT -5
OK mystery solved. What Mike said was a little misleading. It sounded like it "should" be covered but it seems it is covered and there are so many plans its hard to figure out one which does not cover it but I would say they all have they cover it as "Inhaled Insulin". I went to medicare.gov and did a search for my zip code for afrezza and got a zillion plans covering afrezza. For 2022 the cost through Aetna would be about $30k for the year. For 2023 I got this notice Important! Starting January 1, 2023, the cost of a one-month supply of each Part D-covered insulin will be capped at $35. If you get a 60- or 90-day supply of insulin, your costs can’t be more than $35 for each month’s supply of each covered insulin.This new $35 cap may not be reflected when you compare 2023 plans. You should talk to someone for help comparing plans.Who gets the credit for this? Mike? Kevin Sayer? someone else? It looks like a big win. send an email to Investor relations and check. This seems too good to be true. I bet Afrezza isn't on my Part D covered insulin. I'll look. 2023 Aetnea silverscript formulary is too difficult to access. Catch 66. |
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Post by sayhey24 on Nov 17, 2022 16:26:54 GMT -5
Look it up - go to medicare.gov search for part d and put in your zip and see what you get.
I bet it is. It may not be on your current 2022 plan.
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Post by peppy on Nov 17, 2022 16:35:14 GMT -5
Look it up - go to medicare.gov search for part d and put in your zip and see what you get. I bet it is. It may not be on your current 2022 plan. easier said than done, I put in my zip code, it wanted to sell me an advantage plan. too darn funny. Catch 88. |
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Post by sayhey24 on Nov 17, 2022 16:45:17 GMT -5
enter your zip code and next to that select plan type "part D". They won't sell you anything.
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Post by prcgorman2 on Nov 17, 2022 17:02:03 GMT -5
OMG, I'm sitting on the edge of my seat. This won't solve all the insurance challenges, but it could be huge, especially if (when?) underwriters figure out there could be a big drop in comorbidity costs. I get agedhippie's point about short-term view for actuaries but I've been bouncing around between 4 or 5 providers for most of 30 years. This year is the first time ever I've not had one of the giants for my medical insurance provider. Point being, the big guys share a pool of customers who become repeat customers during their careers and lifetime, and actuaries have conferences and there's money to be had in taking longer-term views on paying to manage chronic ailments. (Somebody go tell them I said so.)
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Post by sayhey24 on Nov 17, 2022 17:58:20 GMT -5
OMG, I'm sitting on the edge of my seat. This won't solve all the insurance challenges, but it could be huge, especially if (when?) underwriters figure out there could be a big drop in comorbidity costs. I get agedhippie's point about short-term view for actuaries but I've been bouncing around between 4 or 5 providers for most of 30 years. This year is the first time ever I've not had one of the giants for my medical insurance provider. Point being, the big guys share a pool of customers who become repeat customers during their careers and lifetime, and actuaries have conferences and there's money to be had in taking longer-term views on paying to manage chronic ailments. (Somebody go tell them I said so.) Right, its pretty crazy. Its now $420 per year for afrezza and about $2600 for Ozempic and about $3200 for Mounjaro and about $4000 for Januva on the same Plan D plans. Lets see what Mike can do with this. Its cheaper, it has significantly fewer side effects and it just might stop the progression or even reverse it. This could as Mike said - change the game. |
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Post by sr71 on Nov 17, 2022 20:01:48 GMT -5
OK mystery solved. What Mike said was a little misleading. It sounded like it "should" be covered but it seems it is covered and there are so many plans its hard to figure out one which does not cover it but I would say they all have they cover it as "Inhaled Insulin". I went to medicare.gov and did a search for my zip code for afrezza and got a zillion plans covering afrezza. For 2022 the cost through Aetna would be about $30k for the year. For 2023 I got this notice Important! Starting January 1, 2023, the cost of a one-month supply of each Part D-covered insulin will be capped at $35. If you get a 60- or 90-day supply of insulin, your costs can’t be more than $35 for each month’s supply of each covered insulin.This new $35 cap may not be reflected when you compare 2023 plans. You should talk to someone for help comparing plans.Who gets the credit for this? Mike? Kevin Sayer? someone else? It looks like a big win. sayhey - I used the search on medicare.gov you suggested, but ALL the Part D plans for my zip code listed Afrezza 8 unit cartridges (90 count) as costing over $1,000 per month. But I noticed a Medicare Chat feature, so I tried it out hoping to get a definitive answer for if Afrezza is included for the $35 copay. Here's the Chat transcript: ------------------- Medicare.gov Live Chat Transcript --------------------- Live chat Date:11/17/2022 Start Time:2:25:53 pm End Time:2:33:01 pm ----------------------------------------------------------------------------- [2:25:53 pm]: Thank you for contacting Medicare.gov Live Chat. [2:25:56 pm]: James I'm using the Part D Plan Comparator tool to find coverage for the insulin drug Afrezza 90 8 unit cartridges, and at the top of the screen it says that it is covered with a 35 Dollar copay per month. But when I enter any 5 of the pharmacies, ALL Part D plans come up with an annual cost of Afrezza in excess of 12,000 Dollars. How do I get the 35 Dollar copay only price? [2:25:58 pm]: Please wait while you are connected to an agent. [2:26:05 pm]: You are now connected with Medicare.gov Live Chat. Thank you for contacting Medicare.gov Live Chat. My name is Jessica. For privacy purposes, please do not disclose any personal information such as your Social Security Number, Medicare ID, or any other sensitive medical or personal information. [2:26:25 pm]: James OK. [2:27:05 pm]: Jessica I'll be happy to assist you. [2:27:14 pm]: Jessica Please allow a few moments while I review your questions. [2:28:31 pm]: Jessica The Inflation Reduction Act sets a maximum copayment of $35 for a month’s supply of insulin covered by a plan. You won’t have to pay a deductible, if your plan has one, for your covered insulin. [2:28:40 pm]: Jessica Because this act was passed close to the start of Medicare’s open enrollment period, the plans didn't have a chance to submit updated prices for insulin drugs that appear in the Medicare Plan Finder. [2:28:56 pm]: Jessica If you join a stand-alone prescription drug plan or Medicare Advantage plan with drug coverage, you will pay up to $35 a month for insulin covered by the plan during all phases of coverage. [2:30:47 pm]: James Can you confirm if Afrezza is in fact an insulin that is covered and subject to only the 35 Dollars per month copay for 2023? [2:31:53 pm]: Jessica You would need to call the plan, the information we have been provided is all insulin qualifies. [2:32:44 pm]: James Thank you very much for your response. Not sure that is a definitive answer, though, so I also called my Part D provider (Aetna), who stated that Afrezza is not on their formulary for 2023, is not covered, and therefore is not subject to the $35 monthly copay amount. If Mike Castagna is serious about Afrezza being covered by any Part D providers for 2023, he should issue a press release listing the Medicare Part D plans that are actually offering this coverage for Afrezza. This issue is pivotal for Mannkind since the Afrezza price barrier could be coming down. And imagine what VDEX could/would be able to do to help many, many more people effectively gain control their diabetes! |
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Post by sayhey24 on Nov 17, 2022 20:41:30 GMT -5
I agree - Mike should issue a press release and square this away but that will probably be January 1, 2023. Right now I think this has happened and Mike was correct when he said this will change the game.
For my zip Aetna has 4, 8 and 12 units cartridge boxes under Plan D. I did not check their advantage plans.
As your Jessica said "all insulin qualifies" and I will add which your plan covers. As with all medicare plans you have to shop for what you need.
When I select the 4 and 8 unit box from Aetna I get the below option and I also get the banner
This new $35 cap may not be reflected when you compare 2023 plans
SilverScript SmartSaver (PDP)
Aetna Medicare | Plan ID: S5601-181-0
Star rating:
3.5 stars
MONTHLY PREMIUM
$5.20
Includes: Only drug coverage
YEARLY DRUG & PREMIUM COST
$18,442.08
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Post by sr71 on Nov 17, 2022 23:06:50 GMT -5
Yes, and the Aetna rep even looked up the other Aetna plans offered in my area, none with Afrezza on their formularies.
Since Medicare says their Plan Finder is not updated to show actual coverages for $35 copay insulin, one would have to call every Part D provider for a given zip code to try to find any that may list Afrezza. I doubt that any senior citizens would go to that much effort.
I’m not diabetic, but as a MNKD investor believe this trip down the Part D rabbit hole was worth it to share with y’all.
Almost forgot to mention, January 1, 2023 for a press release is WAY to late - 2023 Part D signup ends December 7, 2022!
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Post by sayhey24 on Nov 18, 2022 7:20:22 GMT -5
I too think it was well worth the effort going through Medicare offering. I think I now understand what has magically happened through the Inflation Reduction Act legislation. There is a nice article which was updated in September. www.ncoa.org/article/diabetes-and-insulin-a-guide-to-paying-with-medicareI think Mike can now develop a sales strategy around this. From a cost and wellness perspective it would make more sense for the GP to put the medicare patient on afrezza and get them the free CGM than Ozempic which would cost them $3000+ and they get no CGM. In my zip code we have some 5 star rated plans and they too include afrezza. This is the banner I just got IMPORTANT! New insulin benefit: Starts January 1, 2023 $35 cap for a one-month supply of each Medicare Part D-covered insulin - it then lists afrezza under it. For Aetna this is the advantage plan which I could sign up for which is 4.5 stars but does not include drug coverage. I would need to add a separate part D plan Aetna Medicare Advantra Eagle (HMO) Aetna Medicare | Plan ID: H3959-057-0 Star rating: 4.5 stars MONTHLY PREMIUM $0.00 Includes: Only health coverage Doesn't include: $164.90 Standard Part B premium YEARLY DRUG & PREMIUM COST $18,379.68 Retail pharmacy: Estimated total drug + premium cost |
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Post by sayhey24 on Nov 18, 2022 7:51:52 GMT -5
SR71 - The enrollment time to switch advantage plans runs to March 31 if you are already on an advantage plan. For me if I had the Aetna plan above I could switch to the IBX plan or another which would then cover afrezza at $35 a month. Of course if someone is just turning 65 and going on Medicare it could be anytime during the year. "Medicare Advantage Open Enrollment Period. From January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Note: You can only switch plans once during this period." www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan |
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Post by harryx1 on Nov 18, 2022 11:47:16 GMT -5
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Post by sayhey24 on Nov 18, 2022 12:43:22 GMT -5
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Post by harryx1 on Nov 18, 2022 12:49:35 GMT -5
I just briefly scrolled through it but it has a lot of info that may or may not be of interest. I think the difference is that the 4M is from their own database they use to track.
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