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Post by lennymnkd on Feb 3, 2024 8:58:51 GMT -5
This why I advocate for having the annual shareholder meeting in DANBURY..because we would absolutely have these questions
Answered in the question and answer segment.. and even more in the breakout afterwards.
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Post by lennymnkd on Feb 3, 2024 9:08:44 GMT -5
I’m all for public awareness 👍however it’s achieved but let me ask ! How are the scripts that are being written now 700-800
Being paid for / demographic and all.
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Post by agedhippie on Feb 3, 2024 10:18:20 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 That's close. Lets use bigger numbers since it's clearer then taking GoodRx list price for a titration pack. 1) wholesale is $1200 (a random number, but I suspect it's close) 2) list is $2100 3) co-pay is $450 The pharmacy can be taken out of the equation because they are paid a fee to dispense rather than a margin via reimbursement. That's a can of worms on it's own but not relevant at the moment. So we have: a) The PBM get a commission for negotiating the $2100 list down to $1200. This is why list prices are simultaneously so high and largely a fantasy as the pharma has to raise the list price so the PBM can make a bigger commission on the difference between the list price and the actual price. The Symphony data includes the average actual price (WAC). This is also why Lilly could drop their insulin price from hundreds to tens of dollars and still make the same profit. b) The PBM has just paid $1200 for the drug and will get $450 back as co-pay leaving them $750 out of pocket. c) The patient arrives with their $35 co-pay card reducing their cost from $450 to $35 with Mannkind picking up the $415 difference. d) MNKD have just sold Afrezza at $1200 - $415 = $785 which is a lot more than it cost them to make, and more to the point it made a sale they otherwise may well not have got because of co-pay cost. The PBM would rather supply RAA at $30, get a $35 co-pay and make a profit (it's not quite that simple since the co-pay almost certainly covers more than one box so there will likely be a small cost to the PBM.) The cost to the patient is the same in both cases, the cost to the provider definitely is not. By subsidizing the more expensive drug the pharma is inducing (bribing in CMS terms) the patient to ignore the drug cost to the pharma's benefit. This is why you cannot use these cards with Medicare, it's a kickback and that's illegal under the Anti-Kickback Statue (AKS) for Federal health care, but that doesn't apply to commercial plans. There is jail time attached to AKS so pharmas tend to tread very carefully around that area. |
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rebby
Researcher
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Post by rebby on Feb 3, 2024 13:22:47 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 That's close. Lets use bigger numbers since it's clearer then taking GoodRx list price for a titration pack. 1) wholesale is $1200 (a random number, but I suspect it's close) 2) list is $2100 3) co-pay is $450 The pharmacy can be taken out of the equation because they are paid a fee to dispense rather than a margin via reimbursement. That's a can of worms on it's own but not relevant at the moment. So we have: a) The PBM get a commission for negotiating the $2100 list down to $1200. This is why list prices are simultaneously so high and largely a fantasy as the pharma has to raise the list price so the PBM can make a bigger commission on the difference between the list price and the actual price. The Symphony data includes the average actual price (WAC). This is also why Lilly could drop their insulin price from hundreds to tens of dollars and still make the same profit. b) The PBM has just paid $1200 for the drug and will get $450 back as co-pay leaving them $750 out of pocket. c) The patient arrives with their $35 co-pay card reducing their cost from $450 to $35 with Mannkind picking up the $415 difference. d) MNKD have just sold Afrezza at $1200 - $415 = $785 which is a lot more than it cost them to make, and more to the point it made a sale they otherwise may well not have got because of co-pay cost. The PBM would rather supply RAA at $30, get a $35 co-pay and make a profit (it's not quite that simple since the co-pay almost certainly covers more than one box so there will likely be a small cost to the PBM.) The cost to the patient is the same in both cases, the cost to the provider definitely is not. By subsidizing the more expensive drug the pharma is inducing (bribing in CMS terms) the patient to ignore the drug cost to the pharma's benefit. This is why you cannot use these cards with Medicare, it's a kickback and that's illegal under the Anti-Kickback Statue (AKS) for Federal health care, but that doesn't apply to commercial plans. There is jail time attached to AKS so pharmas tend to tread very carefully around that area. Great summary, Aged…thank you |
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Post by hopingandwilling on Feb 3, 2024 18:17:48 GMT -5
Instead of using hypothetical examples, let me share personal examples of how screwed-up our healthcare system and insurance-related issues distort the reality of how it works.
Every drug, surgical procedure, physician consultant, anesthesia for access to central vein has been assigned a billing code number.
Let me use the latter example to show you how it is billed, what the provider bills, the total cost allowed, what the plan(Insurance) paid, and your Share of the original "billed" amount.
Anesthesia for access to central vein Billing Code--00532-QK, P3
Provider billed plan $1,188.00
Total Cost(allowed amount) $94.94
Plan Paid $93.05
Your Share $0.00
Another Example:
Detection of infectious agent antibody, quantitative billing code 86317
Provider billed plan $984.93
Total Cost(allowed amount) $13.37
Plan Paid $13.37
Your Share $0.00
Now Let Me Share the Shocker About Our Healthcare System. The following is the hospital's latest monthly statement:
Prior Balance $111,064.67
New Charges $58,952.15
Adjustments $-76,115.22
Insurance Payments $-28,245.35
Insurance Pending $63,521.40
Patient Payments $0.00
Guarantor Balance $1,416.85
The point of this information is that we, the general public, have no idea what goes on with the cost of drugs, doctor's care, or hospital charges IF we have health insurance. In my real-world example, those without health insurance would be obligated to pay the reflected $170,016.00.
Our system has the above-reflected PBM, the middleman for obtaining the amount insurance companies will pay for a drug or medical service. In the case of MannKind, because of the cost of manufacturing, their price for Afrezza is so out of price range for what other insulin products cost initially, MannKind could not find a PBM to handle Afrezza because of the price; they knew they couldn't get an insurance company willing to pay this wide discrepancy that other drug companies would be willing to accept as shown in my real examples. When Pfizer attempted to market the original inhaled insulin product, the lack of insurance coverage doomed it to fail. Al Mann knew this but ignored the fact that insurance companies are in business to make money. All the clinical trial data shows that Afrezza is comparable to the results of injectable insulin but never better with lowering A1c levels--the SOC metric for treating diabetes. The current fallacy of insulin users paying only $35.00 for insulin applies to injectable insulin unless Mannkind wants to accept $35.00 for Afrezza. The solution for MannKind is to lower their price to match injectable prices. Insurance companies are the gatekeepers for our healthcare ---MannKind's management needs to accept this reality, and shareholders should understand why their stock is priced at $3.00 a share.
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Post by mymann on Feb 3, 2024 18:54:29 GMT -5
Instead of using hypothetical examples, let me share personal examples of how screwed-up our healthcare system and insurance-related issues distort the reality of how it works. Every drug, surgical procedure, physician consultant, anesthesia for access to central vein has been assigned a billing code number. Let me use the latter example to show you how it is billed, what the provider bills, the total cost allowed, what the plan(Insurance) paid, and your Share of the original "billed" amount. Anesthesia for access to central vein Billing Code--00532-QK, P3 Provider billed plan $1,188.00 Total Cost(allowed amount) $94.94 Plan Paid $93.05 Your Share $0.00 Another Example: Detection of infectious agent antibody, quantitative billing code 86317 Provider billed plan $984.93 Total Cost(allowed amount) $13.37 Plan Paid $13.37 Your Share $0.00 Now Let Me Share the Shocker About Our Healthcare System. The following is the hospital's latest monthly statement: Prior Balance $111,064.67 New Charges $58,952.15 Adjustments $-76,115.22 Insurance Payments $-28,245.35 Insurance Pending $63,521.40 Patient Payments $0.00 Guarantor Balance $1,416.85 The point of this information is that we, the general public, have no idea what goes on with the cost of drugs, doctor's care, or hospital charges IF we have health insurance. In my real-world example, those without health insurance would be obligated to pay the reflected $170,016.00. Our system has the above-reflected PBM, the middleman for obtaining the amount insurance companies will pay for a drug or medical service. In the case of MannKind, because of the cost of manufacturing, their price for Afrezza is so out of price range for what other insulin products cost initially, MannKind could not find a PBM to handle Afrezza because of the price; they knew they couldn't get an insurance company willing to pay this wide discrepancy that other drug companies would be willing to accept as shown in my real examples. When Pfizer attempted to market the original inhaled insulin product, the lack of insurance coverage doomed it to fail. Al Mann knew this but ignored the fact that insurance companies are in business to make money. All the clinical trial data shows that Afrezza is comparable to the results of injectable insulin but never better with lowering A1c levels--the SOC metric for treating diabetes. The current fallacy of insulin users paying only $35.00 for insulin applies to injectable insulin unless Mannkind wants to accept $35.00 for Afrezza. The solution for MannKind is to lower their price to match injectable prices. Insurance companies are the gatekeepers for our healthcare ---MannKind's management needs to accept this reality, and shareholders should understand why their stock is priced at $3.00 a share. 15 [br I said it before and I will say it again. Afrezza is a failed experiment. Billionaires dream about making the best insulin mimicking the human pancreas. |
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Post by prcgorman2 on Feb 3, 2024 20:34:13 GMT -5
Afrezza is the best prandial insulin on the planet, bar none. It cost a billionaire over $1B to bring it to market. There was a profit motive, but Dr. Al Mann's philanthropy is also unquestionable. I would never "dream" of insulting the memory of such a great humanitarian.
This thread has done a pretty good job of describing how dysfunctional and difficult the current drug sales (and health care) regime is within the United States. Some say a single-payer system and socialized medicine will fix it. I can't help thinking better, common-sense, regulation could fix it too. Sometimes it seems common-sense is uncommon to say the least.
I remain hopeful that the measured efforts MannKind have made to improve the marketing of Afrezza will yield measurable gains (but perhaps not via Symphony). And perhaps in the long-run (very long run) Afrezza will be recognized for what it is and be a common tool in the toolbox of insulin-taking persons with diabetes.
Hope springs eternal. The horizon I'm keeping in mind is 2026. I think we should know in 2026 or 2027 whether Afrezza can ever be on par with other prandial insulins and the reason for that outlook is it takes time, money, and labor to perform full-scale multi-arm clinical trials designed to persuade, unequivocally, Afrezza is superior as much because it is safer as it is faster than other prandial insulins.
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Post by lennymnkd on Feb 3, 2024 22:58:17 GMT -5
And patient effort….
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Post by sayhey24 on Feb 4, 2024 5:40:40 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 That's close. Lets use bigger numbers since it's clearer then taking GoodRx list price for a titration pack. 1) wholesale is $1200 (a random number, but I suspect it's close) 2) list is $2100 3) co-pay is $450 The pharmacy can be taken out of the equation because they are paid a fee to dispense rather than a margin via reimbursement. That's a can of worms on it's own but not relevant at the moment. So we have: a) The PBM get a commission for negotiating the $2100 list down to $1200. This is why list prices are simultaneously so high and largely a fantasy as the pharma has to raise the list price so the PBM can make a bigger commission on the difference between the list price and the actual price. The Symphony data includes the average actual price (WAC). This is also why Lilly could drop their insulin price from hundreds to tens of dollars and still make the same profit. b) The PBM has just paid $1200 for the drug and will get $450 back as co-pay leaving them $750 out of pocket. c) The patient arrives with their $35 co-pay card reducing their cost from $450 to $35 with Mannkind picking up the $415 difference. d) MNKD have just sold Afrezza at $1200 - $415 = $785 which is a lot more than it cost them to make, and more to the point it made a sale they otherwise may well not have got because of co-pay cost. The PBM would rather supply RAA at $30, get a $35 co-pay and make a profit (it's not quite that simple since the co-pay almost certainly covers more than one box so there will likely be a small cost to the PBM.) The cost to the patient is the same in both cases, the cost to the provider definitely is not. By subsidizing the more expensive drug the pharma is inducing (bribing in CMS terms) the patient to ignore the drug cost to the pharma's benefit. This is why you cannot use these cards with Medicare, it's a kickback and that's illegal under the Anti-Kickback Statue (AKS) for Federal health care, but that doesn't apply to commercial plans. There is jail time attached to AKS so pharmas tend to tread very carefully around that area. Where is the insurance company in all of this and what are they paying and to who? Who is paying the fee to the pharmacy? In the above the pharmacy is paying the PBM $35 and MNKD $415? Without the card is the Pharmacy paying $450 to the PBM? Is there any good reason MNKD can not sell direct like Lilly is doing? I got the feeling something happened which spooked Mike when he was selling for $99. I am not sure what it is but I would like to know. |
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Post by sayhey24 on Feb 4, 2024 5:57:02 GMT -5
Afrezza is the best prandial insulin on the planet, bar none. It cost a billionaire over $1B to bring it to market. There was a profit motive, but Dr. Al Mann's philanthropy is also unquestionable. I would never "dream" of insulting the memory of such a great humanitarian. This thread has done a pretty good job of describing how dysfunctional and difficult the current drug sales (and health care) regime is within the United States. Some say a single-payer system and socialized medicine will fix it. I can't help thinking better, common-sense, regulation could fix it too. Sometimes it seems common-sense is uncommon to say the least. I remain hopeful that the measured efforts MannKind have made to improve the marketing of Afrezza will yield measurable gains (but perhaps not via Symphony). And perhaps in the long-run (very long run) Afrezza will be recognized for what it is and be a common tool in the toolbox of insulin-taking persons with diabetes. Hope springs eternal. The horizon I'm keeping in mind is 2026. I think we should know in 2026 or 2027 whether Afrezza can ever be on par with other prandial insulins and the reason for that outlook is it takes time, money, and labor to perform full-scale multi-arm clinical trials designed to persuade, unequivocally, Afrezza is superior as much because it is safer as it is faster than other prandial insulins. A couple of points. Al Mann invested about $1B of his money in MNKD. However, to date MNKD in total has about $3.5B invested. I don't know what the actual manufacturing cost is for afrezza. What I do know is what Al Mann said which was the actual cost for the insulin, ftkp and plastic cartridges was not very much. Taking out the factory fixed cost I would guess a box of 180 is less than $10 for the variable cost. We also know Tyvaso DPI is now paying for the factory fixed cost. With only selling 800 boxes per week and wasting all this time with PBMs and pre auths and the other nonsense, MNKD should just sell direct at this point until the label and SoC are squared away. |
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Post by lennymnkd on Feb 4, 2024 6:08:50 GMT -5
And direct requires marketing and I’ll say that bad word again
ADVERTISING.. volume will make the difference..
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Post by agedhippie on Feb 4, 2024 9:54:18 GMT -5
... b) The PBM has just paid $1200 for the drug and will get $450 back as co-pay leaving them $750 out of pocket. c) The patient arrives with their $35 co-pay card reducing their cost from $450 to $35 with Mannkind picking up the $415 difference. d) MNKD have just sold Afrezza at $1200 - $415 = $785 which is a lot more than it cost them to make, and more to the point it made a sale they otherwise may well not have got because of co-pay cost. ... Where is the insurance company in all of this and what are they paying and to who? Who is paying the fee to the pharmacy? In the above the pharmacy is paying the PBM $35 and MNKD $415? Without the card is the Pharmacy paying $450 to the PBM? Is there any good reason MNKD can not sell direct like Lilly is doing? I got the feeling something happened which spooked Mike when he was selling for $99. I am not sure what it is but I would like to know. The insurance company has subcontracted managing the pharmacy benefits to the PBM who will invoice them for the cost of drugs supplied amongst other things. The pharmacy is only a conduit so while it accepts the co-pay from the person it passes that straight through to the PBM. In the example here the card co-pay is $35, but the PBM wants $450 so MNKD pays the $415 difference to the pharmacy who passes the $450 co-pay to the PBM. MNKD does sell direct just like Lilly does. They both use 3rd party pharmacy service companies to handle this. These service companies have the necessary pharmacy licenses in all the states and handle the paperwork and logistics. |
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Post by lennymnkd on Feb 4, 2024 10:04:09 GMT -5
Buy a boat and cut out the middle man
someone suggested mark cuban / cost plus drugs . Com are they any better?
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Post by agedhippie on Feb 4, 2024 10:17:47 GMT -5
Buy a boat and cut out the middle man On the supply side that's what is happening. For example CVS Health owns the insurer, Aetna, the PBM, Caremark, and the pharmacy, CVS pharmacy. The big insurers have concluded that they can buy back the PBM for efficiency (plus make money as a PBM to smaller insurers) and so we see Cigna and Express Scripts, and United Health Care and Optum Rx. The problem with selling direct is the pharmacy licenses needed to dispense drugs, and all the paper processing overhead. It's why programs like LillyDirect say they are DTC, but really they are DTC with Lilly paying EVERSANA to handle the prescriptions, and TruePill to provide the logistics. |
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Post by lennymnkd on Feb 4, 2024 10:20:59 GMT -5
someone suggested mark cuban / cost plus drugs . Com are they any better?
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