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Post by stevil on Jul 7, 2015 14:49:39 GMT -5
Ha, I'm just reporting the facts. Whether you want to believe me or not is up to you. It's really not that hard to understand. If people have a regimen that works well for them, or what they think is the best available option because "it's always been that way", and don't know that the inhaled insulin works faster and doesn't cause hypos with as much regularity, they're not very keen on change. She only heard about the inhaled insulin because of the artificial pancreas. She went to a conference, and from the sound of it, the presenters may have been from the same company who made this video. www.youtube.com/watch?v=GGgGjtM5ipgShe was more excited about the artificial pancreas and not having to measure dosages but having the machine adjust in real time. Or, maybe it's because Afrezza isn't approved yet for kids so she didn't even waste more time researching it. I don't know what to tell you... I'm not making this up ha.
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Post by peppy on Jul 8, 2015 8:37:06 GMT -5
QUOTE: It's really not that hard to understand. If people have a regimen that works well for them, or what they think is the best available option because "it's always been that way", and don't know that the inhaled insulin works faster and doesn't cause hypos with as much regularity, they're not very keen on change.
Reply: The older regimen does not work that well. Have you seen the GCOM's?
Attachment DeletedAttachment Deleted
What makes you think the present regimes work well?
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Post by ezrasfund on Jul 8, 2015 9:07:12 GMT -5
There are many advantages to Afrezza over RAA's including no needles, better HbA1c's, less risk of severe hypoglycemia and less weight gain. But the most surprising advantage is the change in lifestyle that all of this creates. Because Afrezza is much faster acting with less risk of hypos Afrezza users do not spend as much time (all of their time) managing their diabetes. And because they can now eat more like non-diabetics their lifestyles are more relaxed. (I just saw an old Seinfeld episode where an obnoxious guy is freaking out in the restaurant because the waitress is so slow and he is "starting to feel hypoglycemic.") This quality of life improvement is why diabetics will want Afrezza.
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Post by stevil on Jul 8, 2015 9:18:06 GMT -5
I give up. You guys nitpick every little thing I say.
I address the question about how many people know about Afrezza and you start getting super critical about the smallest details. I'm just reporting the facts from my small world.
Without insulin, people would probably die in a matter of a couple years. With insulin, they can live 60+. I have an uncle who has been diabetic for nearly 60 years. I'd say that's pretty effective, regardless of whether his blood sugar is optimal and his life is "normal" by non diabetic standards. He's had some toes amputated over the years and has to wear a brace for drop foot, but he's just glad modern medicine has allowed him to watch his grandchildren grow up.
Believe me, I'm probably the biggest believer of Afrezza on the board. I'm a biochem major and I understand much of the science behind it. It's phenomenal what MNKD accomplished. But you guys act like it's doing something other drugs can't. While that's true to an extent because it works faster, mimics a healthy pancreas, will save the body damage over many years, etc, diabetics can "get by" with injections for the most part. Most of them have accepted that they'll need shots the rest of their lives and don't seek out something better because they just think this is the way it is. Without someone telling them a better alternative is out there, they're unlikely to become aware of it. Not everyone is actively pursuing a cure to their disease like you think. I really don't understand what's so hard to understand about that.
Forgive me, but I'll be bowing out from here and just lurking on the board. It doesn't appear I'm adding anything to the discussion anyway.
Cheers.
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Post by BD on Jul 8, 2015 9:26:33 GMT -5
stevil, this is a discussion board, and from what I see, all anyone has been doing here is duscussing. You'll need a bit thicker of a skin if you want the benefit of picking the brains of the regulars--recently we've had some unscrupulous FUDsters sneaking in and wreaking havoc, so you'll have to forgive the gang if some seem a bit on the nit-picky side.
FWIW, I think you've been adding to the discussion, and I encourage you to stick with it.
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Post by esstan2001 on Jul 8, 2015 9:35:20 GMT -5
...Most of them have accepted that they'll need shots the rest of their lives and don't seek out something better because they just think this is the way it is. Without someone telling them a better alternative is out there, they're unlikely to become aware of it. ... Cheers. In retrospect, I believe many here have concluded that SNY really needed to execute a slow roll intro- it would do no good to overwhelm the 'system' with patients clamoring at Dr's offices before they are on board, or before there was enough inventory stockpiled to address demand; getting Physicians on board to me is the long pull here, and it is this step that is seemingly being tackled at this moment. The telling of Afrezza to the patients is coming- SNY just has to get all the support infrastructure in place and solidified otherwise there is the potential for bad associations with this drug. Reputation is important to the brand.
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Post by Chris-C on Jul 8, 2015 9:51:45 GMT -5
Esstan - well said. I totally agree! I'm not an expert in the science of networks or how innovations gain awareness and change behavior, particularly when it comes to health care. I do have a feeling, however, that the enthusiasm from the investors on this board may create expectations that go beyond what might be realistic when it comes to targeted marketing success. This campaign will take time. We know that awareness does not equate with behavior change, even in a perfect system. There are so many variables involved, it's a complex undertaking.
That said, Sanofi is not sharing their game plan with us, so we are left to speculate. We know it is important for SNY to target and educate certain providers and they are doing that. On the patient related side, I suspect they also have a well considered plan for targeting early adopters as well. Marketing is too expensive not to have well defined target populations and a focused game plan. We know SNY is doing a controlled launch, and the script numbers reflect this. Personally, I think it might be premature and possibly damaging to do a huge television blitz, only because it might generate actions that overwhelm the system, exceed production capabilities, and create more harm than good.
Personally, I like the way things are going. Over time, they will produce results. I say again, in real estate, the three magic words are location, location, and location. In investing, the three magic words are patience, patience, and patience.
GLTAL
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Post by ezrasfund on Jul 8, 2015 10:16:19 GMT -5
What percentage of endos, PCPs or phrmacists know about Afrezza? And what percentage of what they know is incorrect or incomplete?
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Post by stevil on Jul 8, 2015 10:49:01 GMT -5
Thanks BD. Thicker skin it is then. I'll write for those who care to learn from my opinions and block out the ones that don't, I suppose.
Like I stated earlier, I was a pharm tech during my undergrad. That doesn't amount to a hill of beans, but I did gain some experience talking to drug reps while I was there.
My guess is that SNY is waiting to do commercials until they have their label changed to allow them to boast all of its best qualities. I think they're waiting for the latest trials to finish so they can claim superiority. That way it's not just another drug flooding the market. Exubera showed inhaled insulin isn't gimmicky enough to be successful. They need the science and results to show why it is better than every other drug that's available.
The reps can tell the doctors what they're finding in the studies- all they have to do is point them to the data points. The FDA won't allow them to market the drug the way they want until they can change the label.
I am not concerned at all with how SNY is rolling Afrezza out. Like many others have stated, the market is saturated with drugs- with more coming. Let's let SNY and MNKD show others why theirs is a head above the rest. If Afrezza is as remarkable as it's showing to be, time only allows more data points to be gathered and further prove its superiority. The only thing I think we need to worry about is the next "big thing" when technology improves. I've been researching and from what I've gathered, there isn't anything showing as much promise as Afrezza that will be approved in the next several years. I think nanotechnology is the only thing that can take us down at this point and that is still in its infancy.
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Post by dreamboatcruise on Jul 8, 2015 13:29:15 GMT -5
Thanks BD. Thicker skin it is then. I'll write for those who care to learn from my opinions and block out the ones that don't, I suppose. Like I stated earlier, I was a pharm tech during my undergrad. That doesn't amount to a hill of beans, but I did gain some experience talking to drug reps while I was there. My guess is that SNY is waiting to do commercials until they have their label changed to allow them to boast all of its best qualities. I think they're waiting for the latest trials to finish so they can claim superiority. That way it's not just another drug flooding the market. Exubera showed inhaled insulin isn't gimmicky enough to be successful. They need the science and results to show why it is better than every other drug that's available. The reps can tell the doctors what they're finding in the studies- all they have to do is point them to the data points. The FDA won't allow them to market the drug the way they want until they can change the label. I am not concerned at all with how SNY is rolling Afrezza out. Like many others have stated, the market is saturated with drugs- with more coming. Let's let SNY and MNKD show others why theirs is a head above the rest. If Afrezza is as remarkable as it's showing to be, time only allows more data points to be gathered and further prove its superiority. The only thing I think we need to worry about is the next "big thing" when technology improves. I've been researching and from what I've gathered, there isn't anything showing as much promise as Afrezza that will be approved in the next several years. I think nanotechnology is the only thing that can take us down at this point and that is still in its infancy. I suspect they may do TV before the label is changed. I think they would want to let the doctor seminars play out and have somewhat improved formulary access before TV, however. The label change is likely still pretty far out. I don't think the trials we've heard about are anything that will get a better label. The PK profile is already in the prescribing material. These clamp trials aren't going to show better A1c's or less hypos. I think the label change will come with trials specifically designed to show A1c's can be lowered without increasing risk of hypos. Matt has seemed to indicate, according to one contributor here, that these label improvement trials will not be started until after the all FDA mandatory trials have begun (which they haven't).
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Post by Chris-C on Jul 8, 2015 20:17:53 GMT -5
Thanks BD. Thicker skin it is then. I'll write for those who care to learn from my opinions and block out the ones that don't, I suppose. Like I stated earlier, I was a pharm tech during my undergrad. That doesn't amount to a hill of beans, but I did gain some experience talking to drug reps while I was there. My guess is that SNY is waiting to do commercials until they have their label changed to allow them to boast all of its best qualities. I think they're waiting for the latest trials to finish so they can claim superiority. That way it's not just another drug flooding the market. Exubera showed inhaled insulin isn't gimmicky enough to be successful. They need the science and results to show why it is better than every other drug that's available. The reps can tell the doctors what they're finding in the studies- all they have to do is point them to the data points. The FDA won't allow them to market the drug the way they want until they can change the label. I am not concerned at all with how SNY is rolling Afrezza out. Like many others have stated, the market is saturated with drugs- with more coming. Let's let SNY and MNKD show others why theirs is a head above the rest. If Afrezza is as remarkable as it's showing to be, time only allows more data points to be gathered and further prove its superiority. The only thing I think we need to worry about is the next "big thing" when technology improves. I've been researching and from what I've gathered, there isn't anything showing as much promise as Afrezza that will be approved in the next several years. I think nanotechnology is the only thing that can take us down at this point and that is still in its infancy. I suspect they may do TV before the label is changed. I think they would want to let the doctor seminars play out and have somewhat improved formulary access before TV, however. The label change is likely still pretty far out. I don't think the trials we've heard about are anything that will get a better label. The PK profile is already in the prescribing material. These clamp trials aren't going to show better A1c's or less hypos. I think the label change will come with trials specifically designed to show A1c's can be lowered without increasing risk of hypos. Matt has seemed to indicate, according to one contributor here, that these label improvement trials will not be started until after the all FDA mandatory trials have begun (which they haven't). I agree dream. Given the above: (1) Taking care of provider education and awareness (2) Targeting specific groups of providers and diabetics, (3) advocating for more favorable formulary inclusion, and (4) Doing required FDA studies followed by superiority studies, leads me to believe that the high return profitability horizon SNY has in mind is longer than the investment return horizon many on this board envision. From a pure investment standpoint, as long as short sellers can knock the price down on no news and slow growth, of course they are going to take advantage of the situation. What irritates is the brazen misinformation campaign being waged by short shills like AF and others, and of course, the trading of phantom shares. None of this changes the ultimate outcome, it just makes the journey a little more stressful than most long investors would prefer. I'm now changing my ROI timeline (target price $30/sh) to early or mid 2017. This could change with partnership announcements.
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Post by mnkdnut on Jul 8, 2015 22:35:29 GMT -5
I suspect they may do TV before the label is changed. I think they would want to let the doctor seminars play out and have somewhat improved formulary access before TV, however. The label change is likely still pretty far out. I don't think the trials we've heard about are anything that will get a better label. The PK profile is already in the prescribing material. These clamp trials aren't going to show better A1c's or less hypos. I think the label change will come with trials specifically designed to show A1c's can be lowered without increasing risk of hypos. Matt has seemed to indicate, according to one contributor here, that these label improvement trials will not be started until after the all FDA mandatory trials have begun (which they haven't). I agree dream. Given the above: (1) Taking care of provider education and awareness (2) Targeting specific groups of providers and diabetics, (3) advocating for more favorable formulary inclusion, and (4) Doing required FDA studies followed by superiority studies, leads me to believe that the high return profitability horizon SNY has in mind is longer than the investment return horizon many on this board envision. From a pure investment standpoint, as long as short sellers can knock the price down on no news and slow growth, of course they are going to take advantage of the situation. What irritates is the brazen misinformation campaign being waged by short shills like AF and others, and of course, the trading of phantom shares. None of this changes the ultimate outcome, it just makes the journey a little more stressful than most long investors would prefer. I'm now changing my ROI timeline (target price $30/sh) to early or mid 2017. This could change with partnership announcements. Well summarized! Insurance companies are likely going to continue to resist paying up for Afrezza until they see clear scientific clinical trial data (with appropriate statistical power and done under Good Clinical Practices) that Afrezza provides the clinical benefits over status quo that we see in the early adopters. Needle-free is self-evident, but the key benefits of HbA1C reduction, hypo incidence reduction, favorable weight reduction, etc. require well designed and executed studies that will take a few years to produce, especially with the prioritized FDA-mandated studies that need to be started first. Still, the more prescriptions the insurance companies get bombarded with, the more pressure on them to loosen their grip - so physician education and DTC efforts will continue to be needed and justified. Prescription reimbursement will still happen, but it will just continue to be a struggle and require persistence and creativity by patient and doctor. Note: Sanofi may be able to do further analysis on the FDA Trial data to show some aspects of these benefits, but I'm not close enough to the data to know. What I do know is that Insurance companies base their new coverage decisions on high quality outcomes data that their in-house physician experts can't readily pick apart. Gone are the days when Insurance companies took FDA approval as a stamp of approval for private reimbursement. We investors just have to take a double dose of patience.
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Post by dreamboatcruise on Jul 8, 2015 22:54:16 GMT -5
mnkdnut... though if formularylookup.com is to be believed (not sure if that is something one should do), there are already 138 formulary plans that cover 4% of patients (under all the plans they cover) that have Afrezza at preferred status. I wonder if the ones that have already put it on preferred are simply Cadillac plans that put everything on preferred immediately, or whether there are some that have committee that actually understood the unique clinical value of Afrezza immediately.
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Post by mnkdnut on Jul 8, 2015 23:43:55 GMT -5
mnkdnut... though if formularylookup.com is to be believed (not sure if that is something one should do), there are already 138 formulary plans that cover 4% of patients (under all the plans they cover) that have Afrezza at preferred status. I wonder if the ones that have already put it on preferred are simply Cadillac plans that put everything on preferred immediately, or whether there are some that have committee that actually understood the unique clinical value of Afrezza immediately. My guess would be: some plans will give it preferred status but with restrictions that the patient cannot tolerate or handle insulin injections (?) Or, your Cadillac guess may be a factor too. There's always outliers.
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Post by sam221 on Jul 9, 2015 0:22:38 GMT -5
Would love to see separate options for T1 & T2 about knowledge of afrezza. I would guess higher percentage of T1's being aware of afrezza.
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