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Post by od on Oct 9, 2015 11:29:25 GMT -5
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. scotta, we are probably telling each other the sky is blue (or in Afrezza's case today, gray). NRxs are a disappointment. No matter how many representatives are presenting Afrezza, the messages/claims are still constrained by labeling and lack of data. The blocking and tackling that would have been addressed during a pre-launch multi-year commercialization plan and hopefully is ongoing - more data, better labeling, publication plan, peer meeting plan sharing science PLUS real patient experiences, payor acceptance - should result in lofty sales.
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Post by suebeeee1 on Oct 9, 2015 12:30:07 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. How are you dealing with the lack of insurance coverage?
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Post by Deleted on Oct 9, 2015 14:08:12 GMT -5
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. scotta, we are probably telling each other the sky is blue (or in Afrezza's case today, gray). NRxs are a disappointment. No matter how many representatives are presenting Afrezza, the messages/claims are still constrained by labeling and lack of data. The blocking and tackling that would have been addressed during a pre-launch multi-year commercialization plan and hopefully is ongoing - more data, better labeling, publication plan, peer meeting plan sharing science PLUS real patient experiences, payor acceptance - should result in lofty sales. It would help me to know on a quarterly basis how many lives move from Tier 3 to Tier 2. Probably not information I will get but of all the impediments to trial / adherence, the insurance is at the top of the list.
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Post by sweedee79 on Oct 9, 2015 21:04:25 GMT -5
thank you ... I did get his docs to raise one of his doses by 4 units.... I would like to see all of his doses raised by this much... when he goes from a 12 unit dose to a 16 unit dose he does NOT go hypo on Afrezza... He is 74 years old so I assume that is why they are so fearful...... I don't expect that his A1C will go below 6 with the way these docs are treating him... and he still has to watch closely what he eats... He has however changed into a much more energetic person.. I haven't seen him behaving this way in 20 years since his pancreas quit working... so in that regard I'm very very happy... Though, I cant wait until docs across the board understand the paradigm shift in treatment that I believe Afrezza is... We live in an area that is sparsely populated so I suspect we are one of the first patients on Afrezza in the state... And since it is my dad.... I guess I'm happy they are being careful with him...
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Post by kdaddyfresh2000 on Oct 9, 2015 21:12:51 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. Doc, great to hear your input. It is encouraging for me and and I am sure many others to hear about real-world results. Please keep us in the loop since your insight is particularly valuable.
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Post by docfrezza on Oct 11, 2015 19:47:25 GMT -5
The insurance issue is real but Sanofi is helping. Sanofi is obviously working to improve coverage for all patients but that takes time, especially in today's practice environment. They have provided us with a form regarding the patient's history, lab findings, current meds, etc which is then faxed to Sanofi after which they help us with the approval process. I have one Medicare patient who can afford Afrezza so insurance is not an issue for this patient. Another Medicare patient could not afford Afrezza. The discount card (free for first month, $30/month for rest of first year) has been used by most if not all of my non-Medicare patients (Uncle Sam will not let Medicare patients use the discount cards). My nurse handles most of these details. Nothing like a good nurse and mine is one of the best.
I had a typical Afrezza patient come in this past week. On 2 orals and a GLP-1 (injectable) with elevated A1c. Fasting blood sugars less than 120. Patient was told by me to check glucose after meals and see me in 2 weeks. My bet is that the glucose log will show elevated glucose levels after meals with near normal fasting blood sugars. Now that is a perfect Afrezza patient. Not sure exactly what I will do with the current treatment, will make that decision when the patient returns. I guarantee you that primary care practitioners see similar patients all the time. They just need to be more aware of where Afrezza fits in their practice. Like I have said before, Afrezza is a new paradigm. And changing to a new paradigm takes time.
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Post by savzak on Oct 11, 2015 19:51:55 GMT -5
The discount card (free for first month, $30/month for rest of first year) has been used by most if not all of my non-Medicare patients (Uncle Sam will not let Medicare patients use the discount cards).
Doc, can you or anyone else on the board explain why the government would not permit Medicare patients to use the discount cards? Thanks.
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Post by liane on Oct 11, 2015 19:56:56 GMT -5
savzak, The government negotiates their own discount price with the pharma companies, so they don't allow a further discount on top of that. This is not just for Afrezza.
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Post by savzak on Oct 11, 2015 20:08:09 GMT -5
savzak, The government negotiates their own discount price with the pharma companies, so they don't allow a further discount on top of that. This is not just for Afrezza. Liane, please help me understand...what does the government care if the patient gets an additional discount so long as the government doesn't have to pay for it? I'm assuming that it's actually Sanofi who won't provide the discount if the patient has other coverage. That would make sense. But the government refusing additional discounts SNY is offering doesn't make sense.
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Post by od on Oct 11, 2015 20:13:44 GMT -5
savzak, The government negotiates their own discount price with the pharma companies, so they don't allow a further discount on top of that. This is not just for Afrezza. Liane, please help me understand...what does the government care if the patient gets an additional discount so long as the government doesn't have to pay for it? I'm assuming that it's actually Sanofi who won't provide the discount if the patient has other coverage. That would make sense. But the government refusing additional discounts SNY is offering doesn't make sense. If I recall correctly, if government support of a patient is involved, the final price to patient cannot be more than price government pays for medication. Government does not want to 'overpay'.
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Post by savzak on Oct 11, 2015 20:21:26 GMT -5
Liane, please help me understand...what does the government care if the patient gets an additional discount so long as the government doesn't have to pay for it? I'm assuming that it's actually Sanofi who won't provide the discount if the patient has other coverage. That would make sense. But the government refusing additional discounts SNY is offering doesn't make sense. If I recall correctly, if government support of a patient is involved, the final price to patient cannot be more than price government pays for medication. Government does not want to 'overpay'. How could the final price to the patient be more than the government pays if the patient is paying less than he/she would be paying, even with medicare coverage, due to SNY eating an additional discount? The patients price would, by definition, be lower than he/she would have paid employing only the medicare coverage.
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Post by od on Oct 11, 2015 20:24:33 GMT -5
If I recall correctly, if government support of a patient is involved, the final price to patient cannot be more than price government pays for medication. Government does not want to 'overpay'. How could the final price to the patient be more than the government pays if the patient is paying less than he/she would be paying, even with medicare coverage, due to SNY eating an additional discount? The patients price would, by definition, be lower than he/she would have paid employing only the medicare coverage. Apologies savzak, my mistake. Should be "...the final price to patient cannot me LESS than price government pays...".
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Post by rrtzmd on Oct 11, 2015 20:42:05 GMT -5
"Offer is not valid for patients if their prescriptions are paid in part or in full by any state or federally funded programs, including, but not limited to, Medicare or Medicaid, Medigap, VA, DOD or TriCare." That comes from the Afrezza coupon site: afrezza coupon
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Post by savzak on Oct 11, 2015 20:52:38 GMT -5
"Offer is not valid for patients if their prescriptions are paid in part or in full by any state or federally funded programs, including, but not limited to, Medicare or Medicaid, Medigap, VA, DOD or TriCare." That comes from the Afrezza coupon site: afrezza couponOk. That's SNY placing restrictions on its discount, not the government. But thanks for the information.
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Post by savzak on Oct 11, 2015 20:53:59 GMT -5
How could the final price to the patient be more than the government pays if the patient is paying less than he/she would be paying, even with medicare coverage, due to SNY eating an additional discount? The patients price would, by definition, be lower than he/she would have paid employing only the medicare coverage. Apologies savzak, my mistake. Should be "...the final price to patient cannot me LESS than price government pays...". Ok...back to my original question...why would the government refuse patients the ability to take advantage of such discounts when the government does not have to pay for it?
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