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Post by irrationalexubera on Oct 13, 2015 13:30:32 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? hey! i resemble that remark!
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Post by compound26 on Oct 13, 2015 13:37:01 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) Yes, the same feeling here. See my comment regarding this about one month ago: Looking at the Afrezza-prescribing physician list maintained by Sam, one will notice that California and Florida physicians now constitute around 50% of all the physicians listed there. Assuming Sam's list catches a good percentage of all the prescribing physicians (which I believe is the case as the total number in Sam's list is around 60-70 already), do the doctors or residents of California and Florida have an out-sized interest in Afrezza compared with doctors or residents of the other states? I do not think so. So I think, naturally, and, over time, the penetration rate of Afrezza in the other states will improve to catch up with that of California and Florida. If that occurs tomorrow (hypothetically) and everything else remains unchanged, by a rough estimate, with just that simple improvement in penetration rate, the TRx would be around 2.5 times that of the status quo. That will translate to a weekly TRx of 1,500 and an annual sales of $40 million.
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Post by me on Oct 13, 2015 13:51:53 GMT -5
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."One might think that SNY would have to cut its price on Afrezza, but the drug distribution structure doesn't work like that. Do not ever kid yourself that PBMs are in business to make money for their insurance company and large standalone clients - they are in business to make money for themselves. How else could Nexium ever have been Tier 2 when Prilosec was coming off patent and when omeprazole became available?! Nexium was selling at $300 per script (round numbers) versus omeprazole $7. And omeprazole is non-inferior to Nexium. The reason why Nexium was Tier 2 and selling like gangbusters was not because it was a cost-match to other drugs in its therapeutic category, but because of the loads of money that Astra put into its rebates and other manufacturer-to-PBM goodies (and well supported by DTC, which the PBMs knew would also increase the volume of scripts upon which they would be paid rebates and incentives). As I mentioned above, a study that shows superiority over RAAs would change the insurance situation, but only if it's supplemented with financial incentives. I'm not being overly cynical here, that's just the way the industry works. There are a lot of moving parts in this industry. It's not just price or distribution or efficacy or advertising or science or finance - it's all of these in a convoluted puzzle. The best pharmas figure it out. As a long, I'm happy to have SNY as the pharma tasked with figuring this out after having been handed the science and efficacy pieces by MNKD. As for medical necessity, please note that just because a drug is medically necessary, does not make it a covered drug (or one where there are not burdensome STEP therapies, PAs or other edits applied to it). The prescribing of insulin to a diabetic is always medically necessary. You'll not find an insurance company that would deny an Afrezza prescription based upon their "medically necessary" requirement.
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Post by kball on Oct 13, 2015 13:58:20 GMT -5
^ Enjoy your posts Me. Always educational
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Post by Deleted on Oct 13, 2015 14:09:36 GMT -5
patient awareness too... Californians are more tech savvy and live on twitter/facebook? hey! i resemble that remark! lol and probably more logical too to slice and dice something
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Post by compound26 on Oct 13, 2015 14:17:51 GMT -5
hey! i resemble that remark! lol and probably more logical too to slice and dice something Personally, I think this concentration of prescribing doctors in Florida and California probably may have resulted from the fact that more clinical trials of Afrezza in the past were carried out in sites located in these two states. Therefore, there are more readily accessible markets in terms of both doctors and patients who have a better awareness of Afrezza than those in other states. Of course, the above is just my hypothesis.
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