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Post by peppy on Oct 8, 2015 20:59:02 GMT -5
First of all, to whoever changed the word world in the subject of this post, thank you (I incorrectly put in "worl"). I will try and answer questions as best as I can without revealing who I am. Many of you know me from YMB. I am a primary care practitioner, not an endocrinologist. At this point in time I do not want to reveal my identity. Thus far I have prescribed Afrezza more that 10 times, less than 20 times. I have no idea as to how many scripts I will write in the next year. The best A1c I have seen thus far, and there have been 2 of these, was a drop from over 12 to below 7. The amazing thing is that none of my patients have had hypoglycemia. None. That reflects the PK profile many of you are aware of. It is one thing to see a slide in a presentation or an article describing the PK profile. It is something else to see it in practice, in the real world. I talk to any practitioners that I can about Afrezza. I know of 2 that began prescribing Afrezza as a result of our conversation. The biggest pushback is either the PFT issue or their stubbornness in learning something new. Patients are typically given the 10 day sample and a script. They have all started on the prescription as the sample ran out. I have now had one patient stop Afrezza. Not because of a side effect but because of extended work travel and the bulk of Afrezza he would have to pack as a result of this travel. I want to thank those of you who research and post about Mannkind and Afrezza. This is a paradigm changing product which I certainly hope to prescribe for years to come. I will continue to answer questions but as stated previously do not want to reveal my identity and will certainly give no patient specific information. quote; The best A1c I have seen thus far, and there have been 2 of these, was a drop from over 12 to below 7. The amazing thing is that none of my patients have had hypoglycemia. None.
Reply: my eyeballs are popping out of my head. With results like that Afrezza, will be huge.
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Post by jimo on Oct 8, 2015 21:01:13 GMT -5
I hope docfrezza's note of being visited by two representatives will help put to rest the notion that SNY is not stepping up to the plate. Two reps visiting a Primary Care Physician - nice. That doesn't qualify as SNY stepping up to the plate. Look at the script count over the summer and count the success stories out of NYC - I don't see one yet. SNY clearly deviated from the plan MNKD thought they jointly established prior to launch. We'll see if they can deliver this fall as Hakan stated.
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Post by od on Oct 8, 2015 21:15:45 GMT -5
I hope docfrezza's note of being visited by two representatives will help put to rest the notion that SNY is not stepping up to the plate. Two reps visiting a Primary Care Physician - nice. That doesn't qualify as SNY stepping up to the plate. Look at the script count over the summer and count the success stories out of NYC - I don't see one yet. SNY clearly deviated from the plan MNKD thought they jointly established prior to launch. We'll see if they can deliver this fall as Hakan stated. What plan are you speaking of? I don't recall it being shared. I will not be an apologist for SNY; I have been candid about my belief that mistakes have been made. Too many posters, who I suspect have never introduced a new therapeutic modality for patients who have many proven effective therapeutic options, are quick to demonize SNY. Embedded prescribing inertia, limited data, labeling that hampers claims - a high bar to overcome.
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Post by kball on Oct 8, 2015 22:03:16 GMT -5
Thanks Doc. Always hoped youd show up here after following some of your informative threads "over there"
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Post by Deleted on Oct 9, 2015 5:03:18 GMT -5
That doesn't qualify as SNY stepping up to the plate. Look at the script count over the summer and count the success stories out of NYC - I don't see one yet. SNY clearly deviated from the plan MNKD thought they jointly established prior to launch. We'll see if they can deliver this fall as Hakan stated. What plan are you speaking of? I don't recall it being shared. I will not be an apologist for SNY; I have been candid about my belief that mistakes have been made. Too many posters, who I suspect have never introduced a new therapeutic modality for patients who have many proven effective therapeutic options, are quick to demonize SNY. Embedded prescribing inertia, limited data, labeling that hampers claims - a high bar to overcome. You are right OD, it is a very high bar to overcome. Up to this point, we can give SNY a pass on results and chalk it up to learning, testing and then modifying the go to market plan based on all key learnings since launch. On the other side of the ledger is Afrezza. A product that is beyond remarkable in its ease of use, consistency and predictability of results, unsurpassed speed of action, ability to lower blood glucose levels in a manner not seen by ANY other product (injected or oral), reduction in A1c, reduction in long term health complications and improvement in quality of life for the patient. Yes indeed, Sanofi's marketing team has a very big challenge ahead of them. Fortunately, they have one of the best Rx products ever created. In my book, not being able to sell Afrezza successfully in the US is equal to not being able to sell the services of a prostitute in a maximum security prison.
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Post by jimo on Oct 9, 2015 6:44:45 GMT -5
That doesn't qualify as SNY stepping up to the plate. Look at the script count over the summer and count the success stories out of NYC - I don't see one yet. SNY clearly deviated from the plan MNKD thought they jointly established prior to launch. We'll see if they can deliver this fall as Hakan stated. What plan are you speaking of? I don't recall it being shared. I will not be an apologist for SNY; I have been candid about my belief that mistakes have been made. Too many posters, who I suspect have never introduced a new therapeutic modality for patients who have many proven effective therapeutic options, are quick to demonize SNY. Embedded prescribing inertia, limited data, labeling that hampers claims - a high bar to overcome. Quarterly call in May, Matt said MNKD was 4 weeks behind on their sales plan which was only 3-4 months into the launch. Matt has never provided a status on that figure since and it can only be much worse looking at the flat numbers over the summer. He responded personally a few weeks ago saying he couldn't comment on that and I've read he recently acknowledged to another poster they are behind plan. Clearly a disconnect between MNKD and SNY.
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Post by slugworth008 on Oct 9, 2015 7:21:43 GMT -5
Doc, great post and great to see you here. I have abandoned the YMB altogether. Thank you for the real world perspective.
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Post by od on Oct 9, 2015 8:38:42 GMT -5
What plan are you speaking of? I don't recall it being shared. I will not be an apologist for SNY; I have been candid about my belief that mistakes have been made. Too many posters, who I suspect have never introduced a new therapeutic modality for patients who have many proven effective therapeutic options, are quick to demonize SNY. Embedded prescribing inertia, limited data, labeling that hampers claims - a high bar to overcome. You are right OD, it is a very high bar to overcome. Up to this point, we can give SNY a pass on results and chalk it up to learning, testing and then modifying the go to market plan based on all key learnings since launch. On the other side of the ledger is Afrezza. A product that is beyond remarkable in its ease of use, consistency and predictability of results, unsurpassed speed of action, ability to lower blood glucose levels in a manner not seen by ANY other product (injected or oral), reduction in A1c, reduction in long term health complications and improvement in quality of life for the patient. Yes indeed, Sanofi's marketing team has a very big challenge ahead of them. Fortunately, they have one of the best Rx products ever created. In my book, not being able to sell Afrezza successfully in the US is equal to not being able to sell the services of a prostitute in a maximum security prison. On the same page. If Afrezza was a SNY home-grown product, a commercialization team would have been working on it for years ahead of launch. Had that been the case, no doubt in my mind that we would be enjoying a much different NRx trajectory (as opposed to begrudgingly tolerating the real one.)
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Post by od on Oct 9, 2015 8:49:14 GMT -5
What plan are you speaking of? I don't recall it being shared. I will not be an apologist for SNY; I have been candid about my belief that mistakes have been made. Too many posters, who I suspect have never introduced a new therapeutic modality for patients who have many proven effective therapeutic options, are quick to demonize SNY. Embedded prescribing inertia, limited data, labeling that hampers claims - a high bar to overcome. Quarterly call in May, Matt said MNKD was 4 weeks behind on their sales plan which was only 3-4 months into the launch. Matt has never provided a status on that figure since and it can only be much worse looking at the flat numbers over the summer. He responded personally a few weeks ago saying he couldn't comment on that and I've read he recently acknowledged to another poster they are behind plan. Clearly a disconnect between MNKD and SNY. ...or a plan that was too aggressive or not working. Pfizer's Zithromax launch - that launch too was a disappointment - it happens to the most successful products. I agree, shareholders are not being unreasonable expecting an update on revised expectations.
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Post by Deleted on Oct 9, 2015 8:57:09 GMT -5
You are right OD, it is a very high bar to overcome. Up to this point, we can give SNY a pass on results and chalk it up to learning, testing and then modifying the go to market plan based on all key learnings since launch. On the other side of the ledger is Afrezza. A product that is beyond remarkable in its ease of use, consistency and predictability of results, unsurpassed speed of action, ability to lower blood glucose levels in a manner not seen by ANY other product (injected or oral), reduction in A1c, reduction in long term health complications and improvement in quality of life for the patient. Yes indeed, Sanofi's marketing team has a very big challenge ahead of them. Fortunately, they have one of the best Rx products ever created. In my book, not being able to sell Afrezza successfully in the US is equal to not being able to sell the services of a prostitute in a maximum security prison. On the same page. If Afrezza was a SNY home-grown product, a commercialization team would have been working on it for years ahead of launch. Had that been the case, no doubt in my mind that we would be enjoying a much different NRx trajectory (as opposed to begrudgingly tolerating the real one.) Fair point. But given we are 8 months into the launch and Sanofi had a meeting with their sales team a few weeks ago (to share key learnings, tweak how they market / sell Afrezza and likely boost morale a bit) is it not fair to think that we should start to see some steady NRx growth week over week? I am not critical of Sanofi's DTC efforts so far and have gone on record saying TV ads now would be a complete waste of money. They are slowly ramping up print ads in a manner that appears to me to be rational. As far as their online efforts, I have no idea as I am not privy to their analytics but my guess is that are proceeding in a reasonable and prudent manner. This is my long winded ramp to say enough docs know about Afrezza and there is enough positive noise coming from social media that combined with reasonable sales efforts, and the small base of existing customers that is our denominator in this equation, Rx growth is not acceptable. I do not believe that excessive sampling is artificially suppressing reported Rx data. Perhaps sometime this quarter we see a big pop in Rx numbers. Without that, Sanofi will need to be willing to put more money into Afrezza in 2016 than originally anticipated and perhaps they will. If getting Afrezza revenue to $500+ million dollars per quarter takes and extra year, probably not a big deal but understand that Sanofi has 25 drug launches slated for the next 5 years which is more than 1 launch per quarter.
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Post by harryx1 on Oct 9, 2015 8:57:54 GMT -5
Real world advocates should start increasing as well...
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Post by ezrasfund on Oct 9, 2015 9:06:17 GMT -5
BTW Erin Weidner works as a wealth manager for Morgan Stanley. Maybe some of her enthusiasm will trickle up the chain of command. "Own what you know?"
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Post by curiousdoc on Oct 9, 2015 9:07:44 GMT -5
Doc,
Have you had any discussions with local Endos in private practice that you may refer to? What are their thoughts? I work in a large academic institution and have been brushed off by the few endos I have talked to with the typical "too new/too expensive/not enough data" excuses, none of which have even though of prescribing it yet.
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Post by kball on Oct 9, 2015 9:30:15 GMT -5
BTW Erin Weidner works as a wealth manager for Morgan Stanley. Maybe some of her enthusiasm will trickle up the chain of command. "Own what you know?" Coulda used her briefly back in the 7's! Now...back to the real world
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Post by newmnkdinvestor on Oct 9, 2015 9:38:07 GMT -5
Real world advocates should start increasing as well... To be honest she is probably one of the few I believe is a 100% telling the truth. I am too cynical to believe everything L read on the internet. However I researched her and she is real as per linkedin. Good post Harry!
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