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Post by cretin11 on Jan 30, 2024 18:11:23 GMT -5
No the safelight add ! Above Safelight add? I feel sure you are making some point here… but what it is I have no idea!! 🤷🏽♂️ |
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Post by lennymnkd on Jan 30, 2024 18:12:56 GMT -5
An example of name brand recognition thur advertising…
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Post by daisyz on Feb 1, 2024 17:46:19 GMT -5
I'm finally getting around to order more Afrezza and was going through the steps on Mannkind website to contact them on how to get my Afrezza at a lower cost. I went back into the app of my pharmacy to confirm my co-pay and, surprise surprise, the co-pay is now $0. I placed my order and will keep you updated. The copay @ $0 was a glitch w the pharmacy's app. The co-pay is now showing, $538.57. Unfortunate. Update: The $538.57 "copay" was because I hadn't hit my prescription deductible for $2024 yet. After the $300 is met, the copay reduced to $250. However, the pharmacy I was using didn't use the Afrezza discount card because they "don't have an agreement with the manufacturer". Bottom line, I didn't realize I was overpaying at $250 per. I'm now w Amazon Pharmcy and my cost is $35 per refill for the titration pack, 4s and 8s. |
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Post by sr71 on Feb 1, 2024 18:51:08 GMT -5
Thats great news, daisyz!
Did you have to get any Pre-Authorization to get Afrezza coverage through Blue Cross, or did they cover it regardless?
I'm not being nosey, but I feel the answer to that question may help other PWD's obtain Afrezza for an affordable price.
And I think VDEX would be very interested in finding ways for their patients to ride that train as well. (:>
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Post by sayhey24 on Feb 1, 2024 19:10:49 GMT -5
The copay @ $0 was a glitch w the pharmacy's app. The co-pay is now showing, $538.57. Unfortunate. Update: The $538.57 "copay" was because I hadn't hit my prescription deductible for $2024 yet. After the $300 is met, the copay reduced to $250. However, the pharmacy I was using didn't use the Afrezza discount card because they "don't have an agreement with the manufacturer". Bottom line, I didn't realize I was overpaying at $250 per. I'm now w Amazon Pharmcy and my cost is $35 per refill for the titration pack, 4s and 8s. Just so I understand - you are not Medicare age and have a regular Blue Cross plan. After you pay $300 yearly you can use the $35 "Afrezza Discount Card" with Amazon Pharmacy since they have an agreement signed with MNKD and your cost will be $35 per box. Can someone explain to me why this is so convoluted? Why can't MNKD just set the price to $35 and stop all this nonsense? In the end DaisyZ is paying $35 but few are going to pay $538 a box. I keep hearing margins blah blah blah but they are already selling it for $35. This just seems crazy. In this scheme what is the insurance company covering? I am assuming this is what is being used and it covers 12 boxes a year - afrezza.com/savings-program/ |
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Post by daisyz on Feb 1, 2024 19:35:09 GMT -5
It's Blueshield of CA. Yes, I had a prior authorization from years ago that carries forward every year. No reauthorization. I'm 58, w a PPO. My premium is over $1500 monthly(!) which is an increase of $300+ from last year. The Savings Card w a $35 rate is before I hit the $300 deductible.
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Post by sayhey24 on Feb 1, 2024 19:38:28 GMT -5
It's Blueshield of CA. Yes, I had a prior authorization from years ago that carries forward every year. No reauthorization. I'm 58, w a PPO. My premium is over $1500 monthly(!) which is an increase of $300+ from last year. The Savings Card w a $35 rate is before I hit the $300 deductible. How many boxes can you get before the $300 deductible - 8? The program says you can get up to 12 boxes a year. Here is what it says The Copay Offer applies to patient out-of-pocket costs, including deductible, co-insurance, and copayments for Afrezza. Patient is responsible for the first $35 and any costs above the maximum benefit limit. Would you be better off if your deductible was $450 so you could get 12 boxes? |
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Post by daisyz on Feb 1, 2024 19:59:24 GMT -5
It seems that w the Afrezza Savings Card, the deductible is not part of the equation. My $300 deductible has not been met.
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Post by ktim on Feb 2, 2024 16:55:34 GMT -5
Update: The $538.57 "copay" was because I hadn't hit my prescription deductible for $2024 yet. After the $300 is met, the copay reduced to $250. However, the pharmacy I was using didn't use the Afrezza discount card because they "don't have an agreement with the manufacturer". Bottom line, I didn't realize I was overpaying at $250 per. I'm now w Amazon Pharmcy and my cost is $35 per refill for the titration pack, 4s and 8s. Can someone explain to me why this is so convoluted? Why can't MNKD just set the price to $35 and stop all this nonsense? In the end DaisyZ is paying $35 but few are going to pay $538 a box. I keep hearing margins blah blah blah but they are already selling it for $35. This just seems crazy. MNKD is getting paid much more than $35. Insurance is paying a significant amount. MNKD is just subsidizing part of the patients co-pay. |
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Post by agedhippie on Feb 2, 2024 17:58:33 GMT -5
Can someone explain to me why this is so convoluted? Why can't MNKD just set the price to $35 and stop all this nonsense? In the end DaisyZ is paying $35 but few are going to pay $538 a box. I keep hearing margins blah blah blah but they are already selling it for $35. This just seems crazy. MNKD is getting paid much more than $35. Insurance is paying a significant amount. MNKD is just subsidizing part of the patients co-pay. ^This. MNKD (and lots of other pharmas) subsidize the patient because they can make up a lot of the difference by charging the insurer more. It's one reason these plans are not available on government programs like Medicare as I understand it since the anti-kickback provision makes the discount card a bribe since as the insurer is giving you a kickback if you buy the drug you otherwise would not buy. The insurers have mechanics to limit the impact of these cards (co-pay maximizers and accumulators) |
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Post by sayhey24 on Feb 2, 2024 18:33:43 GMT -5
Can someone explain to me why this is so convoluted? Why can't MNKD just set the price to $35 and stop all this nonsense? In the end DaisyZ is paying $35 but few are going to pay $538 a box. I keep hearing margins blah blah blah but they are already selling it for $35. This just seems crazy. MNKD is getting paid much more than $35. Insurance is paying a significant amount. MNKD is just subsidizing part of the patients co-pay. OK - insurance is paying a significant amount, how much do you think? If insurance is paying why does the pharmacy have to have the $35 deal signed directly with MNKD? The $35 did not reduce the yearly insurance deductible. Why is that? It's almost like this pharmacy/MNKD deal is between the two. |
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Post by sayhey24 on Feb 2, 2024 18:54:58 GMT -5
MNKD is getting paid much more than $35. Insurance is paying a significant amount. MNKD is just subsidizing part of the patients co-pay. ^This. MNKD (and lots of other pharmas) subsidize the patient because they can make up a lot of the difference by charging the insurer more. It's one reason these plans are not available on government programs like Medicare as I understand it since the anti-kickback provision makes the discount card a bribe since as the insurer is giving you a kickback if you buy the drug you otherwise would not buy. The insurers have mechanics to limit the impact of these cards (co-pay maximizers and accumulators) Can you explain how this works? The box lists for $538. The pharmacy signs a deal direct with MNKD for $35. The customer pays $35 and their insurance deduction does not change. The insurance copay is $250 which is not collected. Who is paying MNKD - and how much? Who is buying from MNKD. I would assume a distributor who could also be a large pharmacy with a distributor agreement? I am assuming the distributor is the buyer from MNKD and the seller to the pharmacy. I would also think the pharmacy is billing the insurance company for payment but in this case it seems like a direct deal between the pharmacy and MNKD. The insurance company wanted a $250 copay which was not collected. In the case of Medicare with the Senior Savings Model that deal was similar as the deal was signed between Medicare and MNKD. Who paid what I would like to understand. |
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Post by sayhey24 on Feb 2, 2024 19:07:10 GMT -5
Let me give this a shot and its probably totally wrong
1. lets say the wholesale price is $300
2. list is $538
3. co-pay is $250
4. pharmacy would normally bill the insurer $288 ($538 - $250)
in this case
1. co-pay is $35
2. pharmacy bills the insurer $288
3. pharmacy bills MNKD $215 ($250 - $35)
4. MNKD clears $85 vs $300
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Post by lennymnkd on Feb 3, 2024 1:07:54 GMT -5
Who on first, what’s on second … couldn’t a call to Ms. Rosabel Realica Alinaya clear this up . ( investor relations)
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Post by sayhey24 on Feb 3, 2024 8:55:08 GMT -5
Who on first, what’s on second … couldn’t a call to Ms. Rosabel Realica Alinaya clear this up . ( investor relations) What I do know is for awhile you could go to insulinsavings.com and buy a box for $99. Now you have to jump through all kinds of hoops and prove your insurance has denied you with the help of the fine people at afrezza.com If you are on Medicare you have to go through the pre auth process and probably get denied 3 times and then maybe get approved if you have a doctor willing to keep doing the paper work. If you are a new T2 on Medicare and you have been told to follow Bill's SoC and you try and get afrezza whats your option? I guess I could pay $1257 from Amazon. Most probably can't or wouldn't. I know I can't use that $35 Saving Card because thats only for commercial insurance. And as a new T2 who has never taken metfromin or any of the other junk there is close to zero chance I would get approved and pay the $35 insulin price. pharmacy.amazon.com/Afrezza-Titration-Pack-Insulin-Regular/dp/B084BQQY59?ref_=sr_1_1&s=amazon-pharmacy&keywords=afrezza+titration+medication&qid=1706967308&sr=1-1 The question to Mike is do you want to sell this stuff? If so until afrezza is on the Medicare without pre auths and commercial insurance plans not requiring a $250 co-pay and $35 card scheme - you need to fix the price. At $1257 is it any surprise no one is buying and no doctor is prescribing this stuff while the manufacturing cost is probably $5. Maybe its time to do a deal with Mark Cuban and sell direct on costplusdrugs.com Its going to be at least 2 years before the label is squared away and we have better wording in the SoC. How about a 3 year deal with costplusdrugs.com and let Mark go on some TV shows to sell it. |
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