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Post by Clement on Jan 30, 2023 8:58:57 GMT -5
Development partners reduce risk of failure to bring a product to market by absorbing some of the cost of development. And has been mentioned UTHR has proven sales and marketing for pulmonary medications. If I remember, the $3B market for clofazimine is about 50% larger than the market for Tyvaso DPI. A $100M to $200M development partnership with UTHR and maybe a 15% to 20% royalty looks possible. Knowing what we do about royalties from Tyvaso DPI, the prospect of 50% to 100% greater royalties per unit on a 50% larger market seems very appealing to me. slide 20 of 3Q 2022 EC investors.mannkindcorp.com/static-files/92d4a5eb-72b6-4527-9951-6e613d4edac8$3.7B WW 2030 I guess that means WorldWide in 2030. |
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Post by stevil on Jan 30, 2023 9:57:42 GMT -5
You didn’t read my post carefully.
It’s not the fault of the sales team.
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Post by peppy on Jan 30, 2023 10:08:54 GMT -5
The other issue that people aren’t (fully) taking into account, ar least as it pertains to MNKDs failed efforts with Afrezza is the access to physicians to sell as well as a convincing argument to prescribe. A lot of reps are having trouble breaking through offices to get a face to face with a physician. A lot of offices have stopped seeing reps after COVID- for reasons I can’t imagine other than just wanting an excuse to say no. On top of that, and I should probably verify with my rep because I haven’t asked explicitly, but I don’t think they buy lunch for office staffs because that gets really expensive really quickly. My rep said he’ll get his foot in the door and talk to staff, they’ll be kind to him, act like they like the product, and then never prescribe it. Happens often with reps because people are either too “polite” or cowardly to be honest. I’ve lived in 2 densely populated areas now that have been key targets for MNKDs sales team. Both times, you can sense the discouragement and almost lack of confidence in the reps. By that, I mean you can see they get rejected so many times and have so much difficulty selling the product that it weighs on them. It’s like they expect things to go wrong… probably because everything does. Outside of sayhey, I don’t know of a single human being that can run into a brick wall countless times and get back up for more. It’s hard to find those types, and even if we had them, I don’t think they’d be anymore successful- the barriers aren’t at their level to overcome. It’s a really hard sell to walk into a doctors office with a novel product (and one that carries baggage from a botched Exubera) and change minds. It’s different because you inhale it. That was ultimately the angle the first rep I worked with used. It was almost embarrassing the data they bring with them from the stat study to show superiority with an n of 24 for study participants. Then, if they do get a few prescriptions written, prescribers will give up once they inevitably run into countless prior authorizations and appeals in an office already inundated by frivolous paperwork. No one wants the hassle. To be honest, there’s no way I’d think twice about prescribing Afrezza based on what the reps have said and shown to me. If I didn’t do all the research myself, I wouldnt believe in the product enough to waste my time. Food for thought. I’m on the fence regarding if I want MNKD to go it alone or have a sales team. It depends on how good the results are. Anyone and their grandmother could sell Viagra. Doesn’t take talent to sell something with exceptional data and coverage. It’s more just a matter of getting boots on the ground and bringing food. "Anyone and their grandmother could sell Viagra." "Doesn’t take talent to sell something with exceptional data and coverage." Really? You think it was the exceptional data and coverage that sold Viagra? |
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Post by stevil on Jan 30, 2023 10:41:05 GMT -5
Side effects fall under exceptional data 😁
Very, very few non responders.
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Post by cretin11 on Jan 30, 2023 13:17:56 GMT -5
So you're suggesting that we quit trying to develop and sell our own product and leave the selling to others? While I don't disagree with the theory especially in light of previous results, shouldn't look forward to breaking away from that? I won't beat the lack of sales to death, it's been discussed at nauseum, but it's tough to sell when you have no money. I'd like to see how sales improve this year before throwing this opportunity to someone else. Point being, wouldn't we want to go alone and keep all the revenue, rather than look for partners once again? Lets face it, so far MNKDs sales efforts are pretty much a failure. Yes, there are lots of reasons with the biggest being not understanding the market and what its going to take to sell into it. With UTHR they are already selling to the pulmonologists who know UTHR and MNKD as a team and if Tyvaso DPI is great so should their new product. You are correct that our team doesn't understand what it takes to sell into this market. If we had a partner effective at sales/marketing, our cut of Afrezza revenue (even at a modest royalty) would dwarf our current 100% share. Let's not repeat this broken model and throw good money at bad. Partner with UTHR as much as possible, we have the relationship, they are trustworthy and they KNOW how to sell product. Replicate this model as many times as we can. |
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Post by sayhey24 on Jan 30, 2023 13:32:04 GMT -5
You didn’t read my post carefully. It’s not the fault of the sales team. What did I not read carefully??? Here is what you said "I’ve lived in 2 densely populated areas now that have been key targets for MNKDs sales team. Both times, you can sense the discouragement and almost lack of confidence in the reps. By that, I mean you can see they get rejected so many times and have so much difficulty selling the product that it weighs on them. It’s like they expect things to go wrong… probably because everything does. Outside of sayhey, I don’t know of a single human being that can run into a brick wall countless times and get back up for more. It’s hard to find those types, and even if we had them, I don’t think they’d be anymore successful- the barriers aren’t at their level to overcome. It’s a really hard sell to walk into a doctors office with a novel product (and one that carries baggage from a botched Exubera[Really???]) and change minds. It’s different because you inhale it. That was ultimately the angle the first rep I worked with used. It was almost embarrassing the data they bring with them from the stat study to show superiority with an n of 24 for study participants. Then, if they do get a few prescriptions written, prescribers will give up once they inevitably run into countless prior authorizations and appeals in an office already inundated by frivolous paperwork. No one wants the hassle." ---------------------------------------------------------------- To which I replied it sounds like a leadership problem. These guys should never lack confidence with the greatest advance in diabetes care since Banting and Best. If they need better sales packets and slides again that's on leadership. If these guy are leading with "its inhaled" good grief, they need to read some of Mango's posts and thats a leadership issue. Bill from VDex raised the same issue as its being seen as just another prandial insulin. It is night and day from Exubera. And yes, in many things I have done I was often told "You can't do that". Man, when ever I hear that now they just get the look and I know they are not going to lead or follow so they better just get out of the way. |
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Post by runner on Jan 30, 2023 13:44:28 GMT -5
Lets face it, so far MNKDs sales efforts are pretty much a failure. Yes, there are lots of reasons with the biggest being not understanding the market and what it’s going to take to sell into it. With UTHR they are already selling to the pulmonologists who know UTHR and MNKD as a team and if Tyvaso DPI is great so should their new product. You are correct that mnkd doesn't understand what it takes to sell into this market. If we had a partner effective at sales/marketing, our cut of Afrezza revenue (even at a modest royalty) would dwarf our current 100% share. Let's not repeat this broken model and throw good money at bad. Partner with UTHR as much as possible, we have the relationship, they are trustworthy and they KNOW how to sell product. Replicate this model as many times as we can. Steve, I agree with you. It’s not a criticism of MannKind that they don’t know how to sell their product. The company is first and foremost a dynamic medical company developing products that change people’s lives. They need another entity to collaborate with them to market their products. The problem going back to the beginning with the Sanofi deal was that the then mnkd management just handed over Afrezza without having any say in how it was marketed. I brought this up at the 2015 shareholder meeting is a lot of agreement in the room. I believe Mike would demand much more say in the marketing. |
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Post by sayhey24 on Jan 30, 2023 13:44:36 GMT -5
"Anyone and their grandmother could sell Viagra." "Doesn’t take talent to sell something with exceptional data and coverage." Really? You think it was the exceptional data and coverage that sold Viagra? Peppy - if afrezza did what Viagra does and lowered BG at the same time I would be shocked if it was not selling like hot cakes and we won't need any sales reps. If afrezza did what Ozempic does for weight loss all we would need are some TikTok videos. If MNKD would start getting the work out about how important getting under 140 is and everyone had a non-invasive CGMs who knows. What I do know is nothing is stopping MNKD from spreading the word on post meal glucose spikes and the dangers they bring. How about marketing the dangers of post meal spikes and getting on the morning and evening shows and even the View? No one likes BP and MNKD has a great story for these shows. |
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Post by stevil on Jan 30, 2023 13:54:58 GMT -5
@sayhey
I was initially talking to prc who said we need a more persistent and better sales team. Doctors aren’t unlike anyone else. Who likes having door to door salespeople show up at their house all the time? Or telemarketers blowing up your phone? The only reason we tolerate them at all (the vast majority of the time, if not completely) is because of the quid pro quo food they bring. They take care of our office staff with goodies, I give you an ear for a few minutes. We’re too busy during the daytime to entertain company. I barely talk to my wife during the day. Why would I spend that time with a stranger?
I agree the issue is with leadership. You also can’t legally say anything that’s not in the literature. You can point to individual studies, but again, this stuff takes a long time, which is why we’re handed printed materials. To keep things concise and highlight the key memorable points when the salespeople are gone.
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Post by sayhey24 on Jan 30, 2023 13:56:14 GMT -5
You are correct that mnkd doesn't understand what it takes to sell into this market. If we had a partner effective at sales/marketing, our cut of Afrezza revenue (even at a modest royalty) would dwarf our current 100% share. Let's not repeat this broken model and throw good money at bad. Partner with UTHR as much as possible, we have the relationship, they are trustworthy and they KNOW how to sell product. Replicate this model as many times as we can. Steve, I agree with you. It’s not a criticism of MannKind that they don’t know how to sell their product. The company is first and foremost a dynamic medical company developing products that change people’s lives. They need another entity to collaborate with them to market their products. The problem going back to the beginning with the Sanofi deal was that the then mnkd management just handed over Afrezza without having any say in how it was marketed. I brought this up at the 2015 shareholder meeting is a lot of agreement in the room. I believe Mike would demand much more say in the marketing. Lets say I was Robert Frost and some lunatic contacted me and convinced me the way to really break into the T2 market with the Libre was with afrezza. Do you think Robert Frost would want Mike's say??? I am sure he and his team would like to understand why they failed and their lessons learned and any suggestions they may have but letting Mike in the middle of things? Do you think Martine is letting Mike have much say with how Tyvaso DPI is being marketed and sold? |
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Post by sayhey24 on Jan 30, 2023 14:07:19 GMT -5
@sayhey I was initially talking to prc who said we need a more persistent and better sales team. Doctors aren’t unlike anyone else. Who likes having door to door salespeople show up at their house all the time? Or telemarketers blowing up your phone? The only reason we tolerate them at all (the vast majority of the time, if not completely) is because of the quid pro quo food they bring. They take care of our office staff with goodies, I give you an ear for a few minutes. We’re too busy during the daytime to entertain company. I barely talk to my wife during the day. Why would I spend that time with a stranger? I agree the issue is with leadership. You also can’t legally say anything that’s not in the literature. You can point to individual studies, but again, this stuff takes a long time, which is why we’re handed printed materials. To keep things concise and highlight the key memorable points when the salespeople are gone. I agree with the food. If they are not leading with food thats the first issue and thats a leadership issue. Damn as part of the food they could be doing a "Seeing is Believing" demo. In Kendall's "Veins of Gold" there is plenty of study data and there are plenty of published studies show the benefits of early insulin interventions and the dangers of post meal BG over 140. I have got to believe Kendall had already been well on his way to putting this data together. I think someone at MNKD needs to go back and figure out what they are doing. When I asked about TS GLP1 last year no one seemed to know what I was talking about so I would not be surprised they have not looked at Kendall's "Veins of Gold". BTW - Kendal said "Veins" and there is a lot of gold in just one vein. |
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Post by lennymnkd on Jan 30, 2023 14:13:07 GMT -5
At the end of the day , doctors are making money off these drugs.
Isn’t in their best interest too at least screen visits or phone call ?
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Post by prcgorman2 on Jan 30, 2023 14:13:50 GMT -5
Lets face it, so far MNKDs sales efforts are pretty much a failure. Yes, there are lots of reasons with the biggest being not understanding the market and what its going to take to sell into it. With UTHR they are already selling to the pulmonologists who know UTHR and MNKD as a team and if Tyvaso DPI is great so should their new product. You are correct that our team doesn't understand what it takes to sell into this market. If we had a partner effective at sales/marketing, our cut of Afrezza revenue (even at a modest royalty) would dwarf our current 100% share. Let's not repeat this broken model and throw good money at bad. Partner with UTHR as much as possible, we have the relationship, they are trustworthy and they KNOW how to sell product. Replicate this model as many times as we can. Wrong again.
I assume they understand better than any of us and that nobody could do any better. They've already eclipsed the results of Sanofi which had a salesforce 5x the size of Mannkind's. The problem is not a lack of understanding. The problem has been (and may still be) a lack of money and labor resources.
The Sanofi world-wide marketing agreement for Afrezza had a potential value of $1B+ for MannKind in milestones and manufacturing, et cetera, let alone royalties. $1B without even touching the time and cost of the clinical studies needed to put Afrezza on equal footing with (if not superior to) Humalog and Novolog in the ADA's Standard of Care and in the prandial insulin marketplace.
Oliver Brandicoot was the executive at Pfizer in charge of their failed Exubera inhalable RAA product. It is blindingly obvious why one of Brandicoot's first official actions when taking over as CEO at Sanofi from Chris Viehbacher (who signed the Afrezza marketing deal with Al Mann) was to abrogate the Affreza marketing deal. He had already failed to market one inhalable insulin. He couldn't have been enthusiastic about trying again. I assume he knew Afrezza could be successful but recoiled from the time and cost of getting it there and not having had a personal relationship with Al Mann he (and the Sanofi board of directors) could have cared less how backing out of the deal would affect Mannkind. The Sanofi board had already proven adept at stabbing business partners in the back which is why they were embroiled in a class-action lawsuit with the shareholders of Genzyme for backing out of a deal to the tune of $750 million dollars, which interestingly was the same amount left outstanding on the Mannkind deal.
The result of that marketing partner fiasco was a hamstrung Mannkind with a single FDA-approved TechnoSphere product, a large pile of debt, and little money for pipeline development or to create a marketing and sales force all of which led to the 1:5 reverse split and horrible refinance with "toxic debt". Its a miracle MannKind is still here and on the verge of thriving, and a huge part of that has been the work done by MannKind management the last 6 years of which a couple of those years have been during the depths of the worst global pandemic in 100 years.
I assume the "team" understands very well what is needed to effectively market Afrezza, but they still have that same hill to finish climbing and lots more on their plate to consider and they're not completely ignoring the need for studies as the Cipla India trial and the pediatric trials prove. I am hopeful and very much desire that they take on doing more in terms of studies for Afrezza, but I have to rely on management to continue to negotiate their way forward as best as they can manage. They've been doing great so I trust them even while I am eager to see more.
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Post by peppy on Jan 30, 2023 14:14:01 GMT -5
@sayhey I was initially talking to prc who said we need a more persistent and better sales team. Doctors aren’t unlike anyone else. Who likes having door to door salespeople show up at their house all the time? Or telemarketers blowing up your phone? The only reason we tolerate them at all (the vast majority of the time, if not completely) is because of the quid pro quo food they bring. They take care of our office staff with goodies, I give you an ear for a few minutes. We’re too busy during the daytime to entertain company. I barely talk to my wife during the day. Why would I spend that time with a stranger? I agree the issue is with leadership. You also can’t legally say anything that’s not in the literature. You can point to individual studies, but again, this stuff takes a long time, which is why we’re handed printed materials. To keep things concise and highlight the key memorable points when the salespeople are gone. I have always thought the way to sell Afrezza is to show the physicians the continuous glucose monitors of people who use afrezza. That is not in the literature. When surfactant was trialed, the physicians could see the arterial blood gases. Amazing when a drug can save the medical community so much money, all of the sudden eyes can see. They could see the children weaning off the 02 and the ventilator rate and pressures being able to be reduced. Continuous glucose monitor, you can see afrezza 4 unit peak at 30 mins and baseline at 90 mins. Blood glucose can be controlled. |
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Post by peppy on Jan 30, 2023 14:16:38 GMT -5
At the end of the day , doctors are making money off these drugs. Isn’t in their best interest too at least screen visits or phone call ? At the end of the day physicians offices need to make money, pay staff. It takes office staff to write and send pre-authorization request. It seems more efficient for the office to prescribe what is covered by health insurance coverage. |
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