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Post by spiro on Apr 8, 2015 18:06:43 GMT -5
Spiro got a call from his Health Insurance Company today and a guy told Spiro that because of Afrezza and Dexilant, he was going to fall into the doughnut hole by the end of the year. Thinking that it was some kind of trick insurance question, Spiro immediately told the guy, that he hasn't eaten a doughnut since he started using Afrezza. He then told Spiro that he needed to immediately have his doctor change all of his scripts into 90 day scripts, which could reduce the cost of the Donut hole later in the year. Spiro was now in donuts mode and asked the insurance guy, if this applied to both glazed donuts and chocolate donuts. He said that Spiro would reach the donut hole when he reached $4000. Let's see, that could buy around 500 dozen boxes of donuts. At this point in the conversation, it finally became apparent to Spiro, that donut holes could have an impact on TRx counts for Afrezza. These damn insurance companies sure know how to ruin a perfectly good snack.
Spiro here
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Post by sportsrancho on Apr 8, 2015 18:34:10 GMT -5
I know! My friend with the two kids on Afrezza script is good for a year. But dad will get re-fill every 3 months. They are taking their inhaler to school now and the other kids think it's cool. They are both type 1. And very happy campers now! They are eating more carbs and have more energy for sports. Good luck to you and keep up all that walking!
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Post by mnkdd on Apr 8, 2015 18:42:57 GMT -5
I know! My friend with the two kids on Afrezza script is good for a year. But dad will get re-fill every 3 months. They are taking their inhaler to school now and the other kids think it's cool. They are both type 1. And very happy campers now! They are eating more carbs and have more energy for sports. Good luck to you and keep up all that walking! How old are the kids? |
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Post by sportsrancho on Apr 8, 2015 18:58:04 GMT -5
The kids are 14 and 17. Off label script. Dad says a 2 and 12 unit would be great. The daughter has been type I all her life and the son just got over his honeymoon. Was devastated when he found out because he had seen what his sister had gone through! So many trips to the ER in the middle of the night! Well now everything is different. So much stress off the parents too! God bless Al Mann and Afrezza!
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Post by notamnkdmillionaire on Apr 8, 2015 19:03:46 GMT -5
The kids are 14 and 17. Off label script. Dad says a 2 and 12 unit would be great. The daughter has been type I all her life and the son just got over his honeymoon. Was devastated when he found out because he had seen what his sister had gone through! So many trips to the ER in the middle of the night! Well now everything is different. So much stress off the parents too! God bless Al Mann and Afrezza! Was this an endo or GP that Rx'd this off label? Pretty gutsy call on the doc's part and must mean s/he did research on Afrezza, or at least I hope s/he did. |
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Post by Deleted on Apr 8, 2015 19:11:18 GMT -5
Spiro got a call from his Health Insurance Company today and a guy told Spiro that because of Afrezza and Dexilant, he was going to fall into the doughnut hole by the end of the year. Thinking that it was some kind of trick insurance question, Spiro immediately told the guy, that he hasn't eaten a doughnut since he started using Afrezza. He then told Spiro that he needed to immediately have his doctor change all of his scripts into 90 day scripts, which could reduce the cost of the Donut hole later in the year. Spiro was now in donuts mode and asked the insurance guy, if this applied to both glazed donuts and chocolate donuts. He said that Spiro would reach the donut hole when he reached $4000. Let's see, that could buy around 500 dozen boxes of donuts. At this point in the conversation, it finally became apparent to Spiro, that donut holes could have an impact on TRx counts for Afrezza. These damn insurance companies sure know how to ruin a perfectly good snack. Spiro here so cryptic for me...is $4000 your deductible or limit? |
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Post by thekindaguyiyam on Apr 8, 2015 19:47:21 GMT -5
Spiro got a call from his Health Insurance Company today and a guy told Spiro that because of Afrezza and Dexilant, he was going to fall into the doughnut hole by the end of the year. Thinking that it was some kind of trick insurance question, Spiro immediately told the guy, that he hasn't eaten a doughnut since he started using Afrezza. He then told Spiro that he needed to immediately have his doctor change all of his scripts into 90 day scripts, which could reduce the cost of the Donut hole later in the year. Spiro was now in donuts mode and asked the insurance guy, if this applied to both glazed donuts and chocolate donuts. He said that Spiro would reach the donut hole when he reached $4000. Let's see, that could buy around 500 dozen boxes of donuts. At this point in the conversation, it finally became apparent to Spiro, that donut holes could have an impact on TRx counts for Afrezza. These damn insurance companies sure know how to ruin a perfectly good snack. Spiro here You are being cited of using 2 meds Dexilant which is expensive, but I thought the price of Afrezza was comparable to existing meds within reason. If it's not the cost of Afrezza then it's your insurance company's attitude about this new med because it's fresh to the market, and not about the price? Sorry to hear this. Keep up the good work. |
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Post by sportsrancho on Apr 8, 2015 19:57:22 GMT -5
mnkd, I'm a personal trainer. The dad is my client. We live in CA. My clients Endo would not give him a script. So he got one from a GP in NYC that's friends with his mom who lives there. The whole family is very long MNKD because of me. I told them about the company years ago. I'm sure the doc knows all about Afrezza. He may even be a shareholder but I was not in on that conversation. I do know that the doc that runs the wellness center that I work at is very excited about it and thinks it will be huge! But again I had to tell him too:-)
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Post by spiro on Apr 8, 2015 20:06:37 GMT -5
After the doughnut hole is reached, the participant pays 45% of the plans cost for brand name and 65% for generic until your costs total $4700, which is the end of the coverage gap. Spiro has no clue what all this means. He thinks the insurance companies are more like a black hole, sucking up all of his money. it's so nice of them to call this a puny doughnut hole.
Spiro here
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Post by liane on Apr 8, 2015 20:18:58 GMT -5
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Post by spiro on Apr 8, 2015 20:20:50 GMT -5
thekindaguyiyam,
The Dexilant costs the insurance company $205/month x 12 or $2460. Afrezza will be $235 x12 or $2820. So without counting my other 3 generic drugs, Spiro is already $1280 into the doughnut hole. Spiro wants to know if they sell glazed donuts in Siberia?
Spiro here
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Post by mnkdd on Apr 8, 2015 20:35:30 GMT -5
mnkd, I'm a personal trainer. The dad is my client. We live in CA. My clients Endo would not give him a script. So he got one from a GP in NYC that's friends with his mom who lives there. The whole family is very long MNKD because of me. I told them about the company years ago. I'm sure the doc knows all about Afrezza. He may even be a shareholder but I was not in on that conversation. I do know that the doc that runs the wellness center that I work at is very excited about it and thinks it will be huge! But again I had to tell him too:-) This is pretty big news, I think. Opens up a whole new target demo, one that is not set in their ways and resistant to change. |
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Post by jpg on Apr 8, 2015 20:55:43 GMT -5
Those are the types of stories that, when made public, make a huge difference.
Any chance of them going public with their story?
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Post by jpg on Apr 8, 2015 21:04:40 GMT -5
The kids are 14 and 17. Off label script. Dad says a 2 and 12 unit would be great. The daughter has been type I all her life and the son just got over his honeymoon. Was devastated when he found out because he had seen what his sister had gone through! So many trips to the ER in the middle of the night! Well now everything is different. So much stress off the parents too! God bless Al Mann and Afrezza! Was this an endo or GP that Rx'd this off label? Pretty gutsy call on the doc's part and must mean s/he did research on Afrezza, or at least I hope s/he did. Not that gutsy really. We prescribe off label all the time. It is even routine for many parts of what doctors do. For paediatrics doubly so. Nothing or almost nothing is studied for kids. There is no financial incentive to do so for most big pharma as there is barely a market. I doubt even the Mannkind trial for kids will get done quickly. If the endos don't want to prescribe Afrezza to adults what company would risk doing a study for kids? I think the only paediatric access for Afrezza will be off label for a very long time... A lot of endos don't want change or innovation (unless it comes with a needle!). |
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Post by thekindaguyiyam on Apr 8, 2015 22:40:58 GMT -5
thekindaguyiyam, The Dexilant costs the insurance company $205/month x 12 or $2460. Afrezza will be $235 x12 or $2820. So without counting my other 3 generic drugs, Spiro is already $1280 into the doughnut hole. Spiro wants to know if they sell glazed donuts in Siberia? Spiro here Spiro. Hard to believe.... you know I do. But the insurance companies are outrageous. They will have to find their own learning curve. Short term some minds will have to be pried open. Siberia and glazed donuts of course. You'd want to get them from the source. btw. my health insurance is going from $4400. copayment to 11,600.00 this year when the wife retires... per person. I take Dexilant. Had 96,000.00 in blood tests and take a daily pharmacy too... My guess is that it's going to take some time for real reform.... just expensive and damn inconvenient to get the care and prescriptions we need. Thanks for your reply. |
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