ronw77077
Researcher
Posts: 84
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Post by ronw77077 on Sept 12, 2024 21:37:40 GMT -5
MNKD has said and shown in the Q2 results presentation that the peds population is 300,00. So, 10% is 30,000.
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Post by Clement on Sept 13, 2024 6:23:12 GMT -5
I am not an expert on insurance. Following is how I see afrezza for kids will be purchased along with the associated profit. Please tell me what I have wrong.
For Peds, payers will be:
1) Medicaid. $35. MNKD makes no profit.
2) Commercial insurance. $35. MNKD pays down the deductible and then makes money after deductible is met.
3) Parents, ie, no insurance. $99. MNKD makes a little bit of money.
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Post by sayhey24 on Sept 13, 2024 6:38:41 GMT -5
I am not an expert on insurance. Following is how I see afrezza for kids will be purchased along with the associated profit. Please tell me what I have wrong. For Peds, payers will be: 1) Medicaid. $35. MNKD makes no profit. 2) Commercial insurance. $35. MNKD pays down the deductible and then makes money after deductible is met. 3) Parents, ie, no insurance. $99. MNKD makes a little bit of money. It would be nice if Mike could give us a slide on this. The question is how are the kid's Moms going to be able to afford afrezza. Medicaid does not qualify for the $35 pre auth pricing. That is Medicare which the kids do not qualify for. I am guessing but I would think the negotiated PBM payment on afrezza to MNKD is around $300 a box. To get the MNKD $99 pricing you currently have to be turned down by your commercial insurance. I am pretty sure they did aware with the Sterling $99 for anyone pricing probably because the PBMs complained. |
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Post by Clement on Sept 13, 2024 8:05:17 GMT -5
"If your insurance doesn’t cover Afrezza®, options may exist to help offset the cost. MannKind also offers a direct purchase program. You may be eligible to get Afrezza® for as little as $99/month. For more information, please contact our patient support team at Afrezza Assist 1-844-323-7399, Monday-Friday 8am-8pm ET." afrezza.com/paying-for-afrezza/It's still not clear what happens if you have no insurance. |
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Post by sayhey24 on Sept 13, 2024 9:17:55 GMT -5
"If your insurance doesn’t cover Afrezza®, options may exist to help offset the cost. MannKind also offers a direct purchase program. You may be eligible to get Afrezza® for as little as $99/month. For more information, please contact our patient support team at Afrezza Assist 1-844-323-7399, Monday-Friday 8am-8pm ET." afrezza.com/paying-for-afrezza/It's still not clear what happens if you have no insurance. There use to be a direct purchase plan through Sterling for $99. If you had no insurance you could purchase direct. The PBMs complained so MNKD got rid of it. If you have no insurance or if you wanted to bypass the insurance hassle and just buy direct for $99 you can't. Right now its too bad so sad. You can buy from amazon. If you are a T2 and your doctor wants to give you metformin and you say no, no no your PCP is not going to file for pre auths, etc. They might write you a script after you twist their arm which you can take to amazon but thats about it. BTW both the Stelo and Lingo are now available for purchase. |
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Post by Clement on Sept 13, 2024 10:49:05 GMT -5
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Post by ktim on Sept 13, 2024 14:37:50 GMT -5
You hope what you imagine he's thinking is what he really is and hope that he's then right about it?  I hope I'm imagining right about your thinking about Mike's thinking and that you're right and what you think Mike is thinking is right  On a more serious note, I do hope he has some plan to monetize peds beyond $35 per patient-month. How many kids with diabetes are there? What would $35/month on 30% market share mean for revenue... and profit margin? Fix cost of afrezza is already covered. The variable cost is pretty low. Even at $35 there is great margin. Of course at $1200 its a lot better than at $99 ($35 is the Medicare price) but zero scripts at $1200 is not going to bring in much money. However, I think what I mentioned above is spot on. The kids numbers are going to be great. Its then up to Mike and team and I think Mike mentioned they have a new dedicated pediatric team now in place. Hopefully they will earn their salary and get things done so I can stop complaining about price, SoC and label. Based on current numbers I find that rather implausible. What are you basing that assertion on? |
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Post by sayhey24 on Sept 13, 2024 17:14:51 GMT -5
Fix cost of afrezza is already covered. The variable cost is pretty low. Even at $35 there is great margin. Of course at $1200 its a lot better than at $99 ($35 is the Medicare price) but zero scripts at $1200 is not going to bring in much money. However, I think what I mentioned above is spot on. The kids numbers are going to be great. Its then up to Mike and team and I think Mike mentioned they have a new dedicated pediatric team now in place. Hopefully they will earn their salary and get things done so I can stop complaining about price, SoC and label. Based on current numbers I find that rather implausible. What are you basing that assertion on? Variable cost - whats the cost of an inhaler - 5cents? cost of the insulin and TS to fill a cartridge; the box; cost to put the cartridges in the box. Whats the total cost of a box? What are they running now 600 cartridges per minute on the filling line? Mike has told us the script increase in afrezza has been primally due to medicare scripts and I will add at $35 per script. Based on the current numbers you have been looking at is MNKD making more money on afrezza than they did last year? If so thats mostly at $35 script if we are to believe Mike. I will ask if the Medicare patient is paying $35 per script is that what MNKD is getting paid by the PBM? If the negotiated price between the PBM and MNKD is $300 does MNKD actually get $300 and Uncle Sam pays the PBM $265 plus fees? Mike needs to provide a slide on this. |
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Post by ktim on Sept 13, 2024 17:26:26 GMT -5
It wasn't all that long ago we had Symphony numbers. The average price had been going up quite steadily. To believe it has now reversed and dropped from thousands down to anywhere near $35 seems far fetched, IMO
Edit:
This is from the most recent earnings filing.
— Gross revenue from sales of Afrezza increased by $3.8 million, or 17%, for the three months ended June 30, 2024 compared to the same period
in the prior year. The increase was driven primarily by price and higher demand.
What is stated means that over the past year the average price has gone up. We know where it was back when we got Symphony numbers and it continues to go up.
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Post by Thundersnow on Sept 13, 2024 18:25:33 GMT -5
Ronw7707 - Thanks for the detailed post. I listened to the 9/10 presentation and I believe Mike said when we purchased the drug 5 years ago not. "Clofazimine should be launched in the next 5 years.". I would expect the drug to be launched in the next 2-3 years. Hopefully by the end of 2026. I agree. 5 years seems a bit long. Mike said R&D started 5 years before they bought it and have been working on it the last 4. That's 9 years of development. Mike is hoping a 6-12 Month trial is appropriate. It's up to the FDA. Hopefully the benefits will reduce the trial time. |
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Post by Thundersnow on Sept 13, 2024 18:27:30 GMT -5
With such an optimistic outlook on pediatric adoption, did Mike address how they are going to overcome the lack of formulary coverage. The market for people able, and willing, to pay out of pocket would seem smaller than the market share he is predicting. Which of the conferences did he make that projection of adoption rate and was insurance coverage addressed? Great question! What Mike did say is the afrezza prescription growth has been through targeted key accounts who know how to get insurance coverage. One approach is playing the lipohypertrophy card. What's the plan for the kids? Paying $1200 a box out of pocket is not going to fly. Well then parents will pay $99 a month directly from MNKD. EASY FIX! |
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Post by agedhippie on Sept 14, 2024 13:04:36 GMT -5
... I will ask if the Medicare patient is paying $35 per script is that what MNKD is getting paid by the PBM? If the negotiated price between the PBM and MNKD is $300 does MNKD actually get $300 and Uncle Sam pays the PBM $265 plus fees? Mike needs to provide a slide on this. I have a certain sympathy for this question and would love a definitive answer. In the interval this chart from KFF shows how costs are split at each point (deductible, co-pay, gap, catastrophe). The original paper ( here) was looking at the impact of the Inflation Reduction Act and how cost shares were shifting.  Looking at this you can understand why insurers are fussing about price. Essentially more of the cost is moving to them and away from the manufacturer and the government. This will heavily impact formularies. |
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Post by sayhey24 on Sept 14, 2024 14:23:05 GMT -5
Wow - this is kind of mind blowing. I thought Kamala just told us the other night how she fixed the cost of insulin for seniors and how the Inflation Reduction Act was so great. Does this chart even relate to the $35 insulin or is it just for other brand name drugs?
I guess if more of the cost is moving to the insurers they will just bake it into their plan costs and Uncle Sam will have to pay more for things like Medicare Advantage Plan administration.
I would sure like that slide from Mike and for Mike to tell us his plan on how the Mom's are going to afford afrezza for their kids when its approved. They are not paying $1200 a box.
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Post by porkini on Sept 14, 2024 19:26:34 GMT -5
Wow - this is kind of mind blowing. I thought Kamala just told us the other night how she fixed the cost of insulin for seniors and how the Inflation Reduction Act was so great. Does this chart even relate to the $35 insulin or is it just for other brand name drugs? I guess if more of the cost is moving to the insurers they will just bake it into their plan costs and Uncle Sam will have to pay more for things like Medicare Advantage Plan administration. I would sure like that slide from Mike and for Mike to tell us his plan on how the Mom's are going to afford afrezza for their kids when its approved. They are not paying $1200 a box. You told us your mind was "blown" already, why the redundancy? |
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Post by agedhippie on Sept 15, 2024 6:58:44 GMT -5
Wow - this is kind of mind blowing. I thought Kamala just told us the other night how she fixed the cost of insulin for seniors and how the Inflation Reduction Act was so great. Does this chart even relate to the $35 insulin or is it just for other brand name drugs? Yes, the price has been fixed for seniors, and everyone else on Medicare, it is $35. The chart relates to all brand name drugs, there is no special carve out for insulin. This is not a problem for the insulin manufacturers who already sell for less than that in the rest of the world, and according to you it shouldn't be a problem for Mannkind either since you say that even at $35 there is great margin. There is no reason why the government plan administration costs will increase since the work, the tracking of prescriptions, remains the same. Insurers can raise their plan prices, it's a free market, but they are risking the creation of a universal insurer if they do. |
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