|
|
Post by hopingandwilling on Jan 18, 2024 12:03:54 GMT -5
Goldman Sachs Today: Stock is down by $4.00+
"Buy United Therapeutics Corp. (UTHR) May 24 $210 puts offered at $9.30 ahead of earnings. Analyst Chris Shibutani sees near-term challenges for the company due to rising competition for its key product, Tyvaso medication. “In the longer-term, he also sees challenges in modeling the steep step-up in growth required to meet the company’s $4B revenue run rate by mid-decade or $8B long-term run rate,” the report said."
Just for the record, I don't recommend anyone invest in the options market. Market makers always win!
|
|
|
|
Post by sayhey24 on Jan 18, 2024 18:28:28 GMT -5
For years MNKD had no money and little afrezza sales. When you sell no product you make no money. While MNKD may not have made money at $35 at least they had the chance to grow the base. By now it could have been substantial, maybe the 50k Bill from Vdex wants. UTHR saved MNKD. The 2 biggest GLP1s are from Novo Nordisk and Lilly. Merck and Pfizer makes a lot with the SGLT2. Those four plus their friends would have figured out something to deep six afrezza. Exubera is still approved and so would afrezza with the same sales as Exubera. ... The problem with trying to grow the base by subsidizing the cost (MNKD's involuntary strategy until recently) is that people worry about the day after. The insurers will not change coverage so the only option for people after the subsidy ends is to pay the full price. That leaves the same problem as you have now - endos reluctant to prescribe Afrezza because of the lack of insurance cover. Worse, in doing this the insurers that do cover Afrezza will immediately invoke the "most favored nation" clause in their contract to get Afrezza at the discounted price rather than the old price which will kill the existing revenue stream. I believe you are right. The insurers will not change coverage. Bill from VDex thinks if the base is 50k maybe insurance changes. I think the only way to change coverage is to disrupt the industry and that will take about 2 years. Mike has to put his big boy pants on and fess up the insurance industry is not our friend. Back in the days prior to approval Al Mann thought afrezza was so great that everyone would want it so it deserved premium pricing. That has clearly not worked out. Discounts, favored nation and all this other crap needs to stop. Its time to cut the price to $35 and lets see what happens in two years. Maybe we will have Bill's 50k. Maybe disruption can happen and Mike can announce the next product which will get BP really upset - Saxenda DPI. Step one is cut afrezza to $35. |
|
|
|
Post by agedhippie on Jan 18, 2024 19:03:27 GMT -5
The problem with trying to grow the base by subsidizing the cost (MNKD's involuntary strategy until recently) is that people worry about the day after. The insurers will not change coverage so the only option for people after the subsidy ends is to pay the full price. That leaves the same problem as you have now - endos reluctant to prescribe Afrezza because of the lack of insurance cover. Worse, in doing this the insurers that do cover Afrezza will immediately invoke the "most favored nation" clause in their contract to get Afrezza at the discounted price rather than the old price which will kill the existing revenue stream. ... I think the only way to change coverage is to disrupt the industry and that will take about 2 years... I am curious what you mean by disrupting the industry. |
|
|
|
Post by cretin11 on Jan 18, 2024 19:17:33 GMT -5
aged I think that’s been explained at length by sayhey. But it’s been rather slow around here lately so we can have a few more pages on it!
sayhey my question is, how quickly would MNKD run out of money if we tried the $35 pricing? I suppose that would depend how fast we were selling it. The conundrum with your proposal.
|
|
|
|
Post by agedhippie on Jan 18, 2024 19:46:19 GMT -5
aged I think that’s been explained at length by sayhey. But it’s been rather slow around here lately so we can have a few more pages on it! sayhey my question is, how quickly would MNKD run out of money if we tried the $35 pricing? I suppose that would depend how fast we were selling it. The conundrum with your proposal. I'm curious. It's not clear to me why the insurers would care if MNKD wanted to sell Afrezza for $35. The insurance companies that do cover Afrezza would be very happy because the price to them would drop through the floor. The others would just stand back and let MNKD sell it because there is no real margin in it for them. Then in two years MNKD stop subsidizing Afrezza and what? |
|
|
|
Post by stevil on Jan 18, 2024 22:51:04 GMT -5
I’m no engineer but I have been waiting for someone to use simple math to shut this conversation down. I guess I have to post after all.
$35 x 50,000 scripts nets you $1.75 million.
It’s been a while since ripano/kippy posted the weekly script numbers… I guess it’s been too long and everyone has forgotten this is about $250,000 short of what they were routinely getting with the current plan.
A better plan is to pay $250,000 (plus whatever expenses are incurred from all the extra manufacturing and labor) to give 49,000 scripts away?
Just poking fun. Carry on and on and on 😁
|
|
|
|
Post by sayhey24 on Jan 19, 2024 14:25:42 GMT -5
I’m no engineer but I have been waiting for someone to use simple math to shut this conversation down. I guess I have to post after all. $35 x 50,000 scripts nets you $1.75 million. It’s been a while since ripano/kippy posted the weekly script numbers… I guess it’s been too long and everyone has forgotten this is about $250,000 short of what they were routinely getting with the current plan. A better plan is to pay $250,000 (plus whatever expenses are incurred from all the extra manufacturing and labor) to give 49,000 scripts away? Just poking fun. Carry on and on and on 😁 You are missing the point - its not about making money. Its about breaking the insurance blockade and establishing the base. The $35 campaign only makes sense if the Cipla and kids trial data is a good as Mike has signaled. If they are then we have solved the multi-year Proboards discussion that afrezza does not have the "data" for doctors to prescribe. You also never give anything away for free which has value and afrezza has value. Even if you have people pay $1 that is significantly different than "free". Even in the days of AOL you got the CD for free but then you had to pay the $5 per month. Is $35 the right number IDK. Maybe its a little more or less but $35 is the current Medicare price for insulin. Its also the number Mark Cuban promised for CostPlusDrugs. From an ongoing business perspective, as long as BP has afrezza at 1k scripts afrezza is really not worth perusing. If it were not for Tyvaso DPI paying for the factory afrezza at 1k scripts a week even at the current $1000 a box pricing is a money loser. Even a bigger question for you is do you agree with Bill from VDex and think afrezza should be prescribed first or do you think the current T2 SoC is the right way to go? |
|
|
|
Post by agedhippie on Jan 19, 2024 19:24:23 GMT -5
... Is $35 the right number IDK. Maybe its a little more or less but $35 is the current Medicare price for insulin. Its also the number Mark Cuban promised for CostPlusDrugs. From an ongoing business perspective, as long as BP has afrezza at 1k scripts afrezza is really not worth perusing. If it were not for Tyvaso DPI paying for the factory afrezza at 1k scripts a week even at the current $1000 a box pricing is a money loser. ... Why do you think insurers will rush to cover Afrezza? They know MNKD can only subsidize the price for a short while and is then going to put the price back up and the price increase is going to land on them. They will stand back and let MNKD throw money at the problem. The share price would go off a cliff. The Medicare price MNKD has to match isn't $35 per box, it's $35 per prescription which is several boxes. The same mantra applies; if you want to change the SoC do large trials and get the data. |
|
|
|
Post by stevil on Jan 19, 2024 22:55:01 GMT -5
You are missing the point - its not about making money. Its about breaking the insurance blockade and establishing the base. The $35 campaign only makes sense if the Cipla and kids trial data is a good as Mike has signaled. If they are then we have solved the multi-year Proboards discussion that afrezza does not have the "data" for doctors to prescribe. You also never give anything away for free which has value and afrezza has value. Even if you have people pay $1 that is significantly different than "free". Even in the days of AOL you got the CD for free but then you had to pay the $5 per month. Is $35 the right number IDK. Maybe its a little more or less but $35 is the current Medicare price for insulin. Its also the number Mark Cuban promised for CostPlusDrugs. From an ongoing business perspective, as long as BP has afrezza at 1k scripts afrezza is really not worth perusing. If it were not for Tyvaso DPI paying for the factory afrezza at 1k scripts a week even at the current $1000 a box pricing is a money loser. Even a bigger question for you is do you agree with Bill from VDex and think afrezza should be prescribed first or do you think the current T2 SoC is the right way to go? It has to be about making money when you're a publicly traded company not named Amazon. Let's say you build up the base for 50,000 people to get on Afrezza. What makes you think insurance is going to want to turn around and increase reimbursement from $35 to $1000 if they even decide to cover the patient going forward? I'd much rather they spend that minimum of $25 million of losses over a couple years designing a bomb ass study so they can actually continue getting the $1000 they're currently asking and then quickly turn 1000 weekly scripts into 50,000 once they become standard of care- if we're so sure the data will undeniably suggest that. To answer the last question- I honestly don't know. I don't really do any of my own research. I have to trust that the ones that do have done a good job. I can tell you I want to think like Bill does. I have some pretty amazing stories from diet/exercise, metformin, and Mounjaro all as monotherapy. Every one of those modalities got my patient from an A1c greater than 11 to putting their diabetes in remission. It's really hard to develop an informed decision when there isn't more than anecdotal evidence on Afrezza. I have just as many anecdotes with other medications. Do they stop the PPGE as well as Afrezza? No. But they also last longer and reduce the basal sugar better. The true SOC should be diet and exercise first, but no one really does that, so we throw medications at them. |
|
|
|
Post by prcgorman2 on Jan 20, 2024 9:03:04 GMT -5
^ good comments Stevil. Thank you.
Do you have experience with patients using both Mounjaro and Afrezza (either together or in sequence)? We can all be doxed so answer however you wish including declining to answer. I was just curious because of sayhey24’s comments assuming studies will likely show the two to be complimentary or instead that Afrezza alone is better.
|
|
|
|
Post by stevil on Jan 20, 2024 15:01:51 GMT -5
I think that would be my preference in an ideal world- Mounjaro +Afrezza. However, you’re now talking around $3500/month for treatment. That’s not going to work if everyone does it.
|
|
|
|
Post by lennymnkd on Jan 20, 2024 15:59:49 GMT -5
I think that would be my preference in an ideal world- Mounjaro +Afrezza. However, you’re now talking around $3500/month for treatment. That’s not going to work if everyone does it. Yes / and if time in range really matters to the well being of the patient. |
|
|
|
Post by lennymnkd on Jan 20, 2024 17:29:35 GMT -5
Being sarcastic, can’t believe what’s best is being denied !
|
|
|
|
Post by agedhippie on Jan 20, 2024 18:29:15 GMT -5
Being sarcastic, can’t believe what’s best is being denied ! It's not the best if you cannot afford to pay for it. |
|
|
|
Post by sportsrancho on Jan 20, 2024 21:15:11 GMT -5
Two thoughts from Bill pertaining to different parts of this overall conversation.
“1) I don’t think insurers will ever voluntarily cover Afrezza bc that’s not how those businesses function. But great data showing the superiority of Afrezza will FORCE the insurers to cover, especially for people who have prolonged lack of BG control.
2) regarding the use of Afrezza as first AND SOLO therapy, I start from the premise that the best therapy is one that manages BG as close as possible to the way the body does naturally. Intuitively it makes sense that such a strategy will lead to better control and fewer side effects. Afrezza is as close as one can get to what the body does naturally in managing glucose levels. One good example: the body doesn’t make basal insulin. Basal insulins are synthetic. They have value but they have side effects. Afrezza is essentially identical to pancreatic insulin and therefore works the same with no major side effects. In fact with Afrezza we see true disease reversal something we don’t see with other therapies. That’s why it should be used first: catch diabetes at the early stage with Afrezza and you can eliminate the disease. At least that is my belief and one I intend to prove with data in time.”
|
|
