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Post by markado on Nov 17, 2024 19:24:36 GMT -5
I think, in part, this is a weaning of lesser productive former Vgo reps that came via acquisition. And, since there's a reduced focus on Vgo, inefficient, former Vgo reps are potentially less valuable to the enterprise. I'm actually surprised it took this long. I hope they aimed to keep the 50 best, most productive and invested reps! That said, I look forward to the day we turn our sales focus toward pediatric endocrinologists and pediatricians. That'll be the long game and most valuable in terms of patient LTV to Afrezza/MNKD.
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Post by cretin11 on Nov 17, 2024 21:58:30 GMT -5
You may be right, but I kinda hope not because I’d rather we had gotten rid of that VGo sales staff dead weight long ago. It’s not a new development that VGo is a bust. But if your theory is correct, then better late than never 👍🏼
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Post by parrerob on Nov 18, 2024 3:50:05 GMT -5
What is a little bit concerning is that seems there is no a real plan... Strange that in June We present, at ADA event, Inhale 3 results coming from a very expensive study and having good results and echoes.... Then, just after the event, We reduced sales force from 80 to 50...
Understand there is a reason behind... But the timing is strange... Isn't it ?
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Post by Clement on Nov 18, 2024 7:43:19 GMT -5
I think MNKD is setting the stage for 2025.
2023 had dramatic rev growth of almost 100% over previous year.
2024 will have about 40% rev growth over previous year.
2025? We are looking at maybe 20% rev growth mostly due to TDPI royalties. Big growth comes back in 2026 with TDPI for IPF and maybe Peds. So, for 2025, the Mannkind story will be earnings growth, rather than revenue growth.
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Post by prcgorman2 on Nov 18, 2024 8:45:17 GMT -5
What is a little bit concerning is that seems there is no a real plan... Strange that in June We present, at ADA event, Inhale 3 results coming from a very expensive study and having good results and echoes.... Then, just after the event, We reduced sales force from 80 to 50... Understand there is a reason behind... But the timing is strange... Isn't it ? That’s about the same time the share price started climbing too. |
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Post by parrerob on Nov 18, 2024 9:01:24 GMT -5
Yes but since when it was announced (last recent ER) pps stopped growing...
At least We still have to see now what is future direction
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Post by prcgorman2 on Nov 18, 2024 9:26:51 GMT -5
I agree but while Afrezza is important, it's a very minor source of earnings. MannKind's main source is Tyvaso DPI and that will remain the driver for fundamentals until sales of MannKind products begin in 2026(?).
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Post by parrerob on Nov 18, 2024 10:15:19 GMT -5
Tyvaso DPI is Property of UTHR.... Managed by UTHR..... Sold by UTHR.... FDA relations by UTHR and Marketing strategy by UTHR.
We know that MNKD part of Tyvaso DPI is worth $1.5 B.... So the market today evaluate the whole MNKD pipeline including Afrezza and going studies only few hundreds million euro (considering more or minus cash cover the debt).
It is a shame..... and I am sure this is because the market does not like MNKD strategy... MNKD has yet to demostrated that it can successfully bring a product to the market... that it can successfully manage a sale force....
The fact that after Inhale 3 presentation at ADA, Afrezza didn't bat an eyelid, in fact there were fewer prescriptions than the previous quarter, is very significant.
- Avertising does not affect sales....
- Years and years of restructuring sale force
- Reducing sale force just after the good news presented at ADA
Does not seem our management has a clear strategy and path......
This is why I believe Afrezza is the most important driver of our PPS, and it will be till next partnership..... If MC insist on his go solo plan then they have to demonstrate first they are able to do it.
Afrezza is so important and now it is on the market since 10 years and no strategy.... Likely it is already sustainable....
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Post by prcgorman2 on Nov 18, 2024 11:42:37 GMT -5
Tyvaso DPI is Property of UTHR.... Managed by UTHR..... Sold by UTHR.... FDA relations by UTHR and Marketing strategy by UTHR. We know that MNKD part of Tyvaso DPI is worth $1.5 B.... So the market today evaluate the whole MNKD pipeline including Afrezza and going studies only few hundreds million euro (considering more or minus cash cover the debt). It is a shame..... and I am sure this is because the market does not like MNKD strategy... MNKD has yet to demostrated that it can successfully bring a product to the market... that it can successfully manage a sale force.... The fact that after Inhale 3 presentation at ADA, Afrezza didn't bat an eyelid, in fact there were fewer prescriptions than the previous quarter, is very significant. - Avertising does not affect sales.... - Years and years of restructuring sale force - Reducing sale force just after the good news presented at ADA Does not seem our management has a clear strategy and path...... This is why I believe Afrezza is the most important driver of our PPS, and it will be till next partnership..... If MC insist on his go solo plan then they have to demonstrate first they are able to do it. Afrezza is so important and now it is on the market since 10 years and no strategy.... Likely it is already sustainable.... The two biggest hurdles to success of Afrezza sales have been getting doctors to prescribe Afrezza and insurers to place Afrezza in a favorable position on their formularies. The latter problem contributes to the former problem in a material way. Afrezza prescriptions often require Prior Authorization. Insurers also often have Afrezza behind other possible choices as part of a STEP program. That means a prescriber is supposed to try other insured products first and if those other products (e.g., humalog, etc.) don't meet the need, then the insurer may pay for the prescription. An insured person may move to another insurance provider and have to start the Prior Auth process all over again. As stevil mentioned, the Prior Auths require a lot of labor from the doctor's office staff which makes them unappealing as a cost to the doctor and frustrating for trying to provide care to a patient who may in the end have to pay out-of-pocket. One of the other things Mike mentioned in the last EC was OptumRx(?) dropped support for specialty pharmacies. He didn't quantify the impact but he did mention it. Doctors have to be convinced they should want to prescribe Afrezza, and insurers have to be convinced they should want to pay for Afrezza. Solve those two problems and Afrezza sales will increase in a material way. The INHALE and gestational trials are trying to solve the first problem. To your point, what is the plan for the 2nd problem? I think specialty pharmacies were the plan to avoid having to bribe Pharmacy Branch Managers (PBMs) for insurance coverage because MannKind frankly couldn't afford it. But specialty pharmacies is not a broadscale solution (and apparently now harder to use). So, if we can assume the trials will continue to make progress solving prescriber reluctance, the question is, what is the solution for resolving the lack of insurance coverage? |
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Post by parrerob on Nov 18, 2024 13:46:30 GMT -5
Board and specially CEO are well payd to answer Your question.
Not me.... I am an investor and I would like to hear what is the strategy...
These problems are in place since at least 8 years ( 8 years of MNKD directly managing Afrezza sales).
So 80 salesman were too much? Oki.....
Could make sense not to pay 30 guys if they cannot bring home enough prescriptions....
What is disappointing is that it does not seem a strategy but just an event to report.
We could have waited a year to present fully inhale3 results during ADA 2025, if a strategy was in place.
Isn't it?
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Post by prcgorman2 on Nov 18, 2024 15:49:49 GMT -5
Board and specially CEO are well payd to answer Your question. Not me.... I am an investor and I would like to hear what is the strategy... These problems are in place since at least 8 years ( 8 years of MNKD directly managing Afrezza sales). So 80 salesman were too much? Oki..... Could make sense not to pay 30 guys if they cannot bring home enough prescriptions.... What is disappointing is that it does not seem a strategy but just an event to report. We could have waited a year to present fully inhale3 results during ADA 2025, if a strategy was in place. Isn't it? I think the strategy is first aimed at resolving the prescriber reluctance problem.
I don't know if there is a strategy for tackling the insurance coverage problem. I personally don't think relying on a specialty pharmacy for patients that cannot get coverage otherwise qualifies as a "strategy". |
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Post by markado on Nov 18, 2024 20:52:45 GMT -5
Positive/superior PEDs results will eventually help answer the insurance question. Not just because the study is in children, but because positive results equates to lower lifetime payouts from insurcos due to better diabetes management and fewer expensive hospitalization events. I've said it before, Mike and team need to estimate the average reduction in healthcare cost for a patient on Afrezza vs current SOC. It's a detailed but not overly complicated actuarial exercise. It should be done for T1's and T2's, at an individual patient level, then multiplied by those respective populations. I'm sure hoping we see positive Inhale-1 results, soon!
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Post by Thundersnow on Nov 19, 2024 9:54:17 GMT -5
They said in the EC last week that they reduced the sales force. I don’t remember the numbers but they mentioned some. They did not say they eliminated the salesforce. I do wonder what the Board of Directors thinks of the EBU. Being self-sufficient seems to be of paramount importance. The INHALE trials and the gestational diabetes trial may be the end of the road for Afrezza if they don’t “move the needle”. I’m very uncomfortable with that. Partly because I may someday need Afrezza. There must be cost components that make it challenging to compete with $35 RAAs. If not, it would seem there’s nothing stopping MNKD from playing the same discount game with the PBMs and insurers as the other BPs. There’s always been some mystery around this and I’m tired of it. Sales force cut to 50 reps from 80. "Michael E. Castagna -- Chief Executive Officer and Director Thank you, Brandon. Nice to hear from you. There's a few questions wrapped up in there. And so, I would say, the unaided awareness of Afrezza among doctors is what we'd expect given the investment in our narrow target, meaning we target probably about 4,000 to 5,000 docs in any given quarter. And the number that actually write on a consistent basis is, obviously, much less. And so, that gets you to our focus, which is not broadening prescribers right now. It's actually going deeper with the current prescribers who've used the product because we got to a point this year where we really reduced our sales force from roughly 80 people down to 50. And so, with that 40% cut, we had to go narrow and deep. And that strategy seems to be working. We're seeing growth within our targets that we're really on top of. And we've seen that we've lost a little bit of scripts in the non-targets, I'll say, or in some of those docs that we had to leave with the reduction in the sales force. But the hope was we would make up that drop on those that we are targeting. www.fool.com/earnings/call-transcripts/2024/11/07/mannkind-mnkd-q3-2024-earnings-call-transcript/IMHO - I believe MNKD will find a partner to market Afrezza when PEDS is approved. It's easier to transition 50 sales people than 80+. Also the 50 salespeople will be MNKD's BEST so the new company/JV will be comfortable in their performance. The partner will be one of the Big 3 which means they have an established salesforce. Once the Top Line Data is released this will give MNKD strategic leverage to negotiate a good deal (THIS TIME AROUND). Now the question will be.....will this be a GLOBAL partner or US ONLY and ROW? I'm sure they are going to maximize the alliance and have safe guards in this deal so that another Sanofi debacle will not happen again. This will truly be AFREZZA 2.0. |
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Post by cretin11 on Nov 19, 2024 13:00:38 GMT -5
I hope you're right about the plan being to partner. If that happens, the number of our sales force might be irrelevant because the partner hopefully has far more capable sales people already. 50 sales people servicing/generating such a paltry number of scripts doesn't seem to be a good value.
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