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Post by agedhippie on Aug 10, 2023 22:14:36 GMT -5
Lilly has trial data for people on Mounjaro with 91.2% TIR, and 72% between 80-140 from the SURPASS-3 trial. Against that getting Afrezza to preempt GLP-1 in the Type 2 SoC is a very hard sell. Add in the cardiovascular study results from Novo Nordisk and I really cannot see it happening, it simply offers much better value. OK, so? In the Medicare market GLP1s can not compete against $35 afrezza. Do you really think these seniors are going to pay $1k+ a month when they can pay $35, get better control and not get sick in the process? Oh. and they get a CGM for a few bucks. Lets see what the India results are and if they are as Mike said they might be maybe Mike can get CMS and CGM vendors to sponsor SOC T2 changes. BTW - have one of these seniors take the "Coke Challenge" and lets see that GLP1 stop the spike. Heck. 91% it should be 100% when these people are hardly eating and what they do does not get digested. ... I don't know about "in the medicare market GLP1s can not compete against $35 afrezza" because GLP-1 is competing today and seems to be doing pretty well. And I guess that gives you your answer on whether seniors will pay for GLP1s - looks like they will. The idea that Mounjaro can hit 91% because people are not eating or digesting food is silly, they hit that number because GLP-1 works. As I said, the Mounjaro low end average was a 2.0 reduction so that's what the India trial needs to beat. Actually I think it's possible to land around there with decent dosing, but the 175 Type 2 trial had an average reduction of 0.82. There are a lot of reasons why GLP-1 get discontinued. In the UK the protocol is to use it for 2 years and then discontinue it because the bodyweight loss means the person is usually in remission. Some insurers are following the same pattern. This is the reason why the GLP-1 makers have been running trials looking for other benefits - they want to stop protocols like that. |
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Post by stevil on Aug 10, 2023 23:38:08 GMT -5
From my experience, seniors prefer once-weekly, mindless injections versus technology and “complicated” dosing adjustments. Even choosing between 1/3 colors can be overwhelming to many of them, especially when they’re faced with making that decision 3 times a day. I have put a handful of seniors on Afrezza. Every one of them decided to stop using it on their own. Every one of them chose GLP-1s
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Post by sportsrancho on Aug 11, 2023 5:46:22 GMT -5
I agree, Afrezza appeals to the up and comers, the first adapters, sports minded people on the go. And definitely teenagers.
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Post by sayhey24 on Aug 11, 2023 6:53:55 GMT -5
From my experience, seniors prefer once-weekly, mindless injections versus technology and “complicated” dosing adjustments. Even choosing between 1/3 colors can be overwhelming to many of them, especially when they’re faced with making that decision 3 times a day. I have put a handful of seniors on Afrezza. Every one of them decided to stop using it on their own. Every one of them chose GLP-1s I am assuming your seniors were on Medicare, correct? Did you do the pre auth for $35 afrezza for these T2 seniors? What did they end up paying for the GLP1, $1200+ I know a lot of seniors and not many of my friends would choose to pay $1k+ more per month and not get the CGM paid for. Your seniors must be in a very wealthy area. Maybe your seniors have cataracts and can't see the colors well. Since their liver will prevent the hypo having them use the yellow at meals would probably be ok. They may need a couple of yellows but the CGM will know. BTW do you have some AGPs of the afrezza use vs the GLP1 use. That would be interesting to see. |
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Post by hellodolly on Aug 11, 2023 7:13:17 GMT -5
From my experience, seniors prefer once-weekly, mindless injections versus technology and “complicated” dosing adjustments. Even choosing between 1/3 colors can be overwhelming to many of them, especially when they’re faced with making that decision 3 times a day. I have put a handful of seniors on Afrezza. Every one of them decided to stop using it on their own. Every one of them chose GLP-1s What is your experience with the younger generation. Us old dogs don't want new tricks. |
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Post by prcgorman2 on Aug 11, 2023 7:15:50 GMT -5
LOL, arguing both for and against GLP-1s. For if it’s on TS, against if it’s not. sayhey24, you are to be cherished. You’re a powerhouse.
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Post by sayhey24 on Aug 11, 2023 7:17:40 GMT -5
OK, so? In the Medicare market GLP1s can not compete against $35 afrezza. Do you really think these seniors are going to pay $1k+ a month when they can pay $35, get better control and not get sick in the process? Oh. and they get a CGM for a few bucks. Lets see what the India results are and if they are as Mike said they might be maybe Mike can get CMS and CGM vendors to sponsor SOC T2 changes. BTW - have one of these seniors take the "Coke Challenge" and lets see that GLP1 stop the spike. Heck. 91% it should be 100% when these people are hardly eating and what they do does not get digested. ... I don't know about "in the medicare market GLP1s can not compete against $35 afrezza" because GLP-1 is competing today and seems to be doing pretty well. And I guess that gives you your answer on whether seniors will pay for GLP1s - looks like they will. The idea that Mounjaro can hit 91% because people are not eating or digesting food is silly, they hit that number because GLP-1 works. As I said, the Mounjaro low end average was a 2.0 reduction so that's what the India trial needs to beat. Actually I think it's possible to land around there with decent dosing, but the 175 Type 2 trial had an average reduction of 0.82. There are a lot of reasons why GLP-1 get discontinued. In the UK the protocol is to use it for 2 years and then discontinue it because the bodyweight loss means the person is usually in remission. Some insurers are following the same pattern. This is the reason why the GLP-1 makers have been running trials looking for other benefits - they want to stop protocols like that. What? GLP1s are not competing against afrezza today in the Medicare market. Nearly all pre auths for afrezza are for T1s. It will not be until afrezza is available without pre auths does the game begin. This is why I sound like a broken record about Mike needing to get pre auths removed for 2024. Once that is accomplished afrezza is in a brand new world. Here is a news article which kind of sums it up. They see their weight plateau and it costs too much long term. "Wendy Tell, a retired teacher in Yorktown, Virginia, said she’s not sure she can afford to stay on Ozempic, which she takes primarily for Type 2 diabetes. Even though she’s on Medicare, she said, she currently pays more than $700 for a 90-day supply because of coverage limits in her prescription plan. Tell said she dreads gaining back the 25 pounds she has lost. “I’m at a dilemma,” she said. “Am I going to get it again? Because who has that much money?" Aside from Stevils patients few will pay $1k+ unless they are looking for weight loss and then once they plateau most stop. www.nbcnews.com/health/health-news/ozempic-what-its-like-to-take-for-years-rcna93921Mike just needs to make Victoza DPI and sell it for $99. The seniors can use it as an adder to their $35 afrezza. |
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Post by peppy on Aug 11, 2023 7:20:24 GMT -5
From my experience, seniors prefer once-weekly, mindless injections versus technology and “complicated” dosing adjustments. Even choosing between 1/3 colors can be overwhelming to many of them, especially when they’re faced with making that decision 3 times a day. I have put a handful of seniors on Afrezza. Every one of them decided to stop using it on their own. Every one of them chose GLP-1s What are the senior TYPE ONE's doing when you put them on Afrezza? |
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Post by sayhey24 on Aug 11, 2023 7:28:42 GMT -5
LOL, arguing both for and against GLP-1s. For if it’s on TS, against if it’s not. sayhey24, you are to be cherished. You’re a powerhouse. Of course I am because I am looking at it for 2 different markets. When we are talking A1c control they are both about equal short term. For post prandial control afrezza wins hands down. Longer term afrezza will win as GLP1s plateau and afrezza users may see improved beta cell development. Of course Mike needs to do the study to show that. For Medicare with pre auth afrezza is $35 and GLP1s can not compete with that. The problem is few T2s are getting pre auths for afrezza. Until Mike gets the pre auth removed Medicare T2s remain an unrealized growth opportunity. The growth Mike talked about on Monday with Medicare was for the T1s but at least he is now seeing the potential. Lets hope for 2024 but he was hedging to 2025. We will know in October. For weight loss its GLP1s all the way. Afrezza is not in this market but a Victoza DPI could be and why I started this thread. |
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Post by stevil on Aug 11, 2023 8:05:34 GMT -5
Ozempic, Rybelsus, and trulicity all have very good Medicare coverage. I do practice in a more affluent area and only have about 15-20% Medicaid. I don’t pay too close of attention to the MAPs… they change every year so I don’t bother myself with trying to keep up.
Most of my patients don’t pay more than $25-50 for their GLP-1s per month. There’s usually one that’s covered. I throw in Soliqua from time to time as well if there’s an issue with coverage on the other ones and they’re already on a basal. It’s extremely rare for a Medicare plan not to have very good coverage… I’m pretty sure it’s only the really crappy commercial plans that don’t cover them very well. I don’t think I ever run into the issue with my seniors unless they don’t have Medicare
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Post by agedhippie on Aug 11, 2023 9:50:55 GMT -5
LOL, arguing both for and against GLP-1s. For if it’s on TS, against if it’s not. sayhey24, you are to be cherished. You’re a powerhouse. Of course I am because I am looking at it for 2 different markets. When we are talking A1c control they are both about equal short term. For post prandial control afrezza wins hands down. Longer term afrezza will win as GLP1s plateau and afrezza users may see improved beta cell development. Of course Mike needs to do the study to show that. ... Afrezza providing better meal time control is currently unsupported. I have tried to find charts comparing the two and failed so far. Right now the idea goes that Afrezza has a fast action therefore it must hit the spike faster. This overlooks that part of the action of GLP-1 is to make the body's own insulin more effective and therefore you can kill the spike without external insulin. This is a case where YMMV applies heavily. Mike needs to do a study to support that because currently there is no evidence that this scenario plays out. Certainly the idea that Afrezza cause beta cell development is pretty radical. |
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Post by agedhippie on Aug 11, 2023 10:04:12 GMT -5
What? GLP1s are not competing against afrezza today in the Medicare market. Nearly all pre auths for afrezza are for T1s. It will not be until afrezza is available without pre auths does the game begin. This is why I sound like a broken record about Mike needing to get pre auths removed for 2024. Once that is accomplished afrezza is in a brand new world. ... As I said earlier, insurers decide where pre-auth applies, not Medicare, so there is nothing Mike can do here. The largest two Medicare insurer in the US, UHC and Humana, do not even have Afrezza in their formulary so pre-auth is irrelevant in that case for over 50% of the US Medicare patients. |
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Post by sayhey24 on Aug 11, 2023 10:32:15 GMT -5
Of course I am because I am looking at it for 2 different markets. When we are talking A1c control they are both about equal short term. For post prandial control afrezza wins hands down. Longer term afrezza will win as GLP1s plateau and afrezza users may see improved beta cell development. Of course Mike needs to do the study to show that. ... Afrezza providing better meal time control is currently unsupported. I have tried to find charts comparing the two and failed so far. Right now the idea goes that Afrezza has a fast action therefore it must hit the spike faster. This overlooks that part of the action of GLP-1 is to make the body's own insulin more effective and therefore you can kill the spike without external insulin. This is a case where YMMV applies heavily. Mike needs to do a study to support that because currently there is no evidence that this scenario plays out. Certainly the idea that Afrezza cause beta cell development is pretty radical. Why do you think you failed finding AGPs for GLP1 users? I sound like a broken record on this. Mike needs to do the study and then you will be able to find them. He said a few calls back they were going to start the pilot. One arm is suppose to be adding afrezza to the GLP1. The thing is, it doesn't really matter short term which one wins. Long term the PWDs stop using the GLP1s. My point is Mike needs to be positioned to fill that gap. If he can show adding afrezza to the Medicare GLP1 users they can also get an almost free CGM. He also needs to do the Victoza DPI pilot and prove this will never work for the diet market. But then again, maybe it will. On Monday he did say they have bandwidth to run some pilot studies. |
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Post by sayhey24 on Aug 11, 2023 13:07:54 GMT -5
What? GLP1s are not competing against afrezza today in the Medicare market. Nearly all pre auths for afrezza are for T1s. It will not be until afrezza is available without pre auths does the game begin. This is why I sound like a broken record about Mike needing to get pre auths removed for 2024. Once that is accomplished afrezza is in a brand new world. ... As I said earlier, insurers decide where pre-auth applies, not Medicare, so there is nothing Mike can do here. The largest two Medicare insurer in the US, UHC and Humana, do not even have Afrezza in their formulary so pre-auth is irrelevant in that case for over 50% of the US Medicare patients. Aged - for 2023 afrezza is not on any formulary. It was not included in the 2023 bid package. Are you talking 2023 or 2024? From what I reviewed it looked to me various afrezza "products" were included in the 2024 bid package. Whether afrezza makes the cut we will find out in October. If it does Mike should throw a Proboards Party in Danbury. I just did this - For 2023 here is one example when I select Humana when I go to Medicare.gov For this one example plan for this one type "product" of afrezza for my zip code I would pay the following Afrezza 180 inhalation cartridge pack - 90 (8 unt), 90 (12 unt) 90 x 8 UNIT &90x12 unit powder $10,823.56 Thats the yearly cost. However, at the top of the page it tells me about the $35 insulin cap. Now, once I go through the pre auth process and get approved I would pay $35. On Monday Mike said 90%+ are getting approved. CMS originally said about 80% were going to be approved after we put some pressure on them. I think CMS sent something out to the insurers after the IRA became law and told the insurers to approve the pre auths. |
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Post by agedhippie on Aug 11, 2023 13:44:32 GMT -5
Why do you think you failed finding AGPs for GLP1 users? I sound like a broken record on this. Mike needs to do the study and then you will be able to find them. He said a few calls back they were going to start the pilot. One arm is suppose to be adding afrezza to the GLP1. The thing is, it doesn't really matter short term which one wins. Long term the PWDs stop using the GLP1s. My point is Mike needs to be positioned to fill that gap. If he can show adding afrezza to the Medicare GLP1 users they can also get an almost free CGM. He also needs to do the Victoza DPI pilot and prove this will never work for the diet market. But then again, maybe it will. On Monday he did say they have bandwidth to run some pilot studies. Because an APG is meaningless in a clinical trial - they are individually tailored. Notice that there are no Afrezza APGs either? You keep saying that diabetics quit GLP-1 in the long term, but you are failing to account for that being by design (protocol). Once their HbA1c is in range they can stop and go back on it a year or two later if necessary - that a cycle that is being used in Europe and probably in the US. The idea that on top of everything else you have to worry about a CGM is not a great sales pitch. People want a magic bullet which is why Ozempic is such a huge seller for weight loss and diabetes. Mike is not going to seriously follow up on GLP-1 because the science says it is very unlikely that you get a different result from injected GLP-1 analogs at which point a daily Victoza loses to a weekly Ozempic. He knows that so other than PR he isn't going down that path. |
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