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Post by mbseeking on Oct 13, 2015 8:03:51 GMT -5
In the past month ( 7th month after launch ):
Formulary Status (Afrezza) | Sept 12, 2015 | Oct 12, 2015 | +/- Change | Total Plans | 6,950 | 6,963 | +13 | Preferred | 90 | 95 | + 5 | Covered | 2,242 | 2,261 | +19 | Restricted | 1,412 | 1,446 | +34 | Not Covered | 3,206 | 3,161 | - 45 |
Of the 45 plans that picked up coverage of Afrezza in September, Restricted coverage outnumbered Preferred+Covered placement in formularies.
It seems like a trickle right now but, according to Hakan, we should started seeing increasing coverage throughout months 7-12 post launch.
Source: FormularyLookup.com
Overnight, two plans moved Afrezza from Restricted (now @ 1,444 plans) to Preferred (now @ 97 plans). I thought this site was updated weekly, but apparently there are daily updates. I'm considering starting a table, similar to what Liane does with script counts, only this one would track Formulary Status from the free site FormularyLookup.
What does everyone think of that idea? Board members would able to track changes in formulary coverage for Afrezza (I'm thinking of updating by week).
Mnholdem , , congratulations you may have just captured the real launch of Afrezza! We will know for sure almost immediately, if there is a big short attack this week then we will know they are running scared.
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Post by compound26 on Oct 13, 2015 8:12:21 GMT -5
In the past month ( 7th month after launch ):
Formulary Status (Afrezza) | Sept 12, 2015 | Oct 12, 2015 | +/- Change | Total Plans | 6,950 | 6,963 | +13 | Preferred | 90 | 95 | + 5 | Covered | 2,242 | 2,261 | +19 | Restricted | 1,412 | 1,446 | +34 | Not Covered | 3,206 | 3,161 | - 45 |
Of the 45 plans that picked up coverage of Afrezza in September, Restricted coverage outnumbered Preferred+Covered placement in formularies.
It seems like a trickle right now but, according to Hakan, we should started seeing increasing coverage throughout months 7-12 post launch.
Source: FormularyLookup.com
Overnight, two plans moved Afrezza from Restricted (now @ 1,444 plans) to Preferred (now @ 97 plans). I thought this site was updated weekly, but apparently there are daily updates. I'm considering starting a table, similar to what Liane does with script counts, only this one would track Formulary Status from the free site FormularyLookup.
What does everyone think of that idea? Board members would able to track changes in formulary coverage for Afrezza (I'm thinking of updating by week).
mnholdem, that's a great idea!
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Post by centralcoastinvestor on Oct 13, 2015 8:26:35 GMT -5
In the past month ( 7th month after launch ):
Formulary Status (Afrezza) | Sept 12, 2015 | Oct 12, 2015 | +/- Change | Total Plans | 6,950 | 6,963 | +13 | Preferred | 90 | 95 | + 5 | Covered | 2,242 | 2,261 | +19 | Restricted | 1,412 | 1,446 | +34 | Not Covered | 3,206 | 3,161 | - 45 |
Of the 45 plans that picked up coverage of Afrezza in September, Restricted coverage outnumbered Preferred+Covered placement in formularies.
It seems like a trickle right now but, according to Hakan, we should started seeing increasing coverage throughout months 7-12 post launch.
Source: FormularyLookup.com
Overnight, two plans moved Afrezza from Restricted (now @ 1,444 plans) to Preferred (now @ 97 plans). I thought this site was updated weekly, but apparently there are daily updates. I'm considering starting a table, similar to what Liane does with script counts, only this one would track Formulary Status from the free site FormularyLookup.
What does everyone think of that idea? Board members would able to track changes in formulary coverage for Afrezza (I'm thinking of updating by week).
I think it's a great idea. Following the script numbers is only part of the story. I am also following the doctors that are prescribing number as well.
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Post by kball on Oct 13, 2015 8:37:22 GMT -5
Overnight, two plans moved Afrezza from Restricted (now @ 1,444 plans) to Preferred (now @ 97 plans). I thought this site was updated weekly, but apparently there are daily updates. I'm considering starting a table, similar to what Liane does with script counts, only this one would track Formulary Status from the free site FormularyLookup.
What does everyone think of that idea? Board members would able to track changes in formulary coverage for Afrezza (I'm thinking of updating by week).
I think it's a great idea. Following the script numbers is only part of the story. I am also following the doctors that are prescribing number as well.1. Insurance companies 2. Prescribing doctors 3. Script counts 4. Advertising 5. Social media patient testimonials (cgms, a1c's, etc) Quarter to Quarter growth for the clearest picture
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Post by centralcoastinvestor on Oct 13, 2015 8:51:35 GMT -5
I think it's a great idea. Following the script numbers is only part of the story. I am also following the doctors that are prescribing number as well.1. Insurance companies 2. Prescribing doctors 3. Script counts 4. Advertising 5. Social media patient testimonials (cgms, a1c's, etc) Quarter to Quarter growth for the clearest picture I think we may be onto to something important here. What you describe above is a set of metrics that moves beyond just script numbers for judging the progress of Afrezza traction. What would be really amazing is if we could develop a dashboard type view that gives us a weekly snap shot of numbers for these metrics. We could call it the Proboards Afrezza Dashboard. Something else that these metrics show us in a round about way is Sanofi's implied commitment to Afrezza.
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Post by kball on Oct 13, 2015 8:58:28 GMT -5
^ I might also add available countries column but thats probably about a year off based on some reports
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Post by me on Oct 13, 2015 9:11:34 GMT -5
Can someone articulate simply what will change the insurance situation? I've seen many times the 6-12 months review period (post launch) mentioned (which we are now in), but then what happens at the healthcare companies? It seems the smoking gun we are missing is the authoritative proof that Afrezza lowers A1Cs better than anything else. But other than blogs, such as Finta's, I cant see that proof anywhere else. If I was an insurance company I'm not sure how else I could justify it. There was some reference to a clamp study as providing this , but I believe this has largely been dismissed now. Is that correct? Is there another study underway that might provide this proof? The only other thing that might lead to more coverage I've seen on this board is a case (or two) where the individual has harassed their healthcare provider and then succeeded in coverage. Insurance coverage is clearly the problem (search on the new drug Teojeo and it already has far far better coverage), but I'm lacking the knowledge of how Afrezza's improves. Is it simply time, a long time? The only thing that can change the insurance situation is high quality data demonstrating that afrezza is superior to lispro for treating diabetes. Currently, to move toujeo up the tier ladder, Sanofi is conducting a 3,000 subject "real life" study. Unless Sanofi comes up with something similar that results in demonstrating that afrezza is worth its added expense, it will remain a reimbursed only when "medically necessary" item. I'm in the industry. Your example is not the only thing that can change the insurance situation (although it definitely would). Regardless of what you read of P&T Committees' activities and responsibilities, tiering decisions are ALWAYS made with financial impacts in mind, and not only related to the reduced cost of outcomes. In other words, the combination of the cost of the product, its associated rebate, the relationship between the manufacturer and the PBM (read, the level of rebates received by the PBM for the manufacturer's other drugs), and the PBM's expectation of the manufacturer's intent to drive market share, are all considered on a par with the therapeutic impact of a drug. Also, when prescribed to a diabetic, Afrezza is always "medically necessary."
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Post by jbe on Oct 13, 2015 9:14:51 GMT -5
Does anyone know if Exubera ever got "Preferred status" insurance coverage?
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Post by suebeeee1 on Oct 13, 2015 9:31:59 GMT -5
In the past month ( 7th month after launch ):
Formulary Status (Afrezza) | Sept 12, 2015 | Oct 12, 2015 | +/- Change | Total Plans | 6,950 | 6,963 | +13 | Preferred | 90 | 95 | + 5 | Covered | 2,242 | 2,261 | +19 | Restricted | 1,412 | 1,446 | +34 | Not Covered | 3,206 | 3,161 | - 45 |
Of the 45 plans that picked up coverage of Afrezza in September, Restricted coverage outnumbered Preferred+Covered placement in formularies.
It seems like a trickle right now but, according to Hakan, we should started seeing increasing coverage throughout months 7-12 post launch.
Source: FormularyLookup.com
Overnight, two plans moved Afrezza from Restricted (now @ 1,444 plans) to Preferred (now @ 97 plans). I thought this site was updated weekly, but apparently there are daily updates. I'm considering starting a table, similar to what Liane does with script counts, only this one would track Formulary Status from the free site FormularyLookup.
What does everyone think of that idea? Board members would able to track changes in formulary coverage for Afrezza (I'm thinking of updating by week).
Providing us weekly updates would give a good indication of where the script counts should be as well. It would certainly let us know if insurance IS the issue! In fact, it might even be fun to overlay the two numbers (increase in formulary acceptance and weekly script counts) in a chart to see if they move in conjunction. ..............anything to keep us occupied while we wait
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Post by rrtzmd on Oct 13, 2015 10:30:39 GMT -5
The only thing that can change the insurance situation is high quality data demonstrating that afrezza is superior to lispro for treating diabetes. Currently, to move toujeo up the tier ladder, Sanofi is conducting a 3,000 subject "real life" study. Unless Sanofi comes up with something similar that results in demonstrating that afrezza is worth its added expense, it will remain a reimbursed only when "medically necessary" item. I'm in the industry. Your example is not the only thing that can change the insurance situation (although it definitely would). Regardless of what you read of P&T Committees' activities and responsibilities, tiering decisions are ALWAYS made with financial impacts in mind, and not only related to the reduced cost of outcomes. In other words, the combination of the cost of the product, its associated rebate, the relationship between the manufacturer and the PBM (read, the level of rebates received by the PBM for the manufacturer's other drugs), and the PBM's expectation of the manufacturer's intent to drive market share, are all considered on a par with the therapeutic impact of a drug. Also, when prescribed to a diabetic, Afrezza is always "medically necessary." I agree absolutely that "tiering decisions are ALWAYS made with financial impacts in mind..." And with that in mind, SNY would have to cut its prices on afrezza to match the level of lispro, given afrezza's "non-inferior" label. However, I presume you'd prefer SNY and MNKD make some serious money off afrezza -- correct? To reach THAT goal will require a study analogous to the 3,000 patient "real life" study SNY is doing for toujeo. Unfortunately, insurance companies won't agree with your assessment that "when prescribed to a diabetic, Afrezza is always "medically necessary."
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Post by rrtzmd on Oct 13, 2015 10:35:30 GMT -5
Does anyone know if Exubera ever got "Preferred status" insurance coverage? I don't believe exubera was around long enough to achieve "preferred status": example of exubera assessment
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Post by tayl5 on Oct 13, 2015 11:38:29 GMT -5
Anyone else amazed that we need almost 7000 separate plans to deliver healthcare in this country? Think of how much of the 30% of the healthcare spend that the Institute of Medicine estimates does not involve actual healthcare could be recovered if this was a more rational number.
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Post by kball on Oct 13, 2015 12:52:18 GMT -5
In looking over afrezzausers list of prescribing docs currently numbering 87, a full 1/3 are in 1 state...California. Very populous state but not 1/3 of US diabetic population i would imagine.
Also only about 1/2 the states accounted for and many big cities missing (Houston, Phoenix to name 2)
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Post by irrationalexubera on Oct 13, 2015 13:00:23 GMT -5
great idea, please do. as it's now generally accepted that insurance is the biggest hurdle, it will be nice to see trendlines with WOW improvements.
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Post by Deleted on Oct 13, 2015 13:21:01 GMT -5
In looking over afrezzausers list of prescribing docs currently numbering 87, a full 1/3 are in 1 state...California. Very populous state but not 1/3 of US diabetic population i would imagine. Also only about 1/2 the states accounted for and many big cities missing (Houston, Phoenix to name 2) patient awareness too... Californians are more tech savvy and live on twitter/facebook?
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