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Post by trenddiver on Oct 30, 2015 16:49:44 GMT -5
No, I am not calling any one stupid. First let me say, "I know very little about this topic". Next to getting FDA approval, there is NO more important task that must be accomplished than getting on these insurance formularies. Why, because most sick or diseased patients don't pay for their prescriptions, its the insurance company or health care provider that pay. So I took a look at the detailed formulary list at FormularyLookup.com and was almost flabbergasted to see how many insurance problems DO NOT cover Afrezza. And I think its not a slam dunk getting on these formularies and achieving a Tier level which makes Afrezza affordable to diabetics. From what I am learning, there are all kinds of games being played by these drug companies to get preferred or exclusive placement of their drugs including big discounts and who knows what other trade-offs.
Mannkind is a one drug company. Sanofy has many many drugs. I wonder how hard Sanofy is pushing to get formulary coverage. Is Sanofy in a conflict of interest situation with respect to Afrezza considering they don't want to piss off these drug plans with respect to their other more important drugs. Are these exclusive placement agreements freezing out Afrezza and Sanofy doesn't want to push hard to undo these because maybe they have their own exclusive arrangements? Are these kind of agreements anti-trust violations or restraints of trade because consumers are the ones who are unable to get freedom of choice?
I'm sure there is a lot more to say on this topic and a lot of nuances, but like I said, "I know very little". But I do know this, it is a big daunting task that needs to be accomplished right now.
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Post by mssciguy on Oct 30, 2015 16:53:05 GMT -5
trenddiver please see mnholdem 's posts earlier today and please stop calling us stupid. Insurance takes time. Insurance companies in the US consume at least 25% of the health care budget, the proverbial "blood from a turnip"  sometimes to meet the special needs of many diabetics who have been human pincushions for many years.... Afrezza is a superior medication though the labeling does not yet reflect the superiority. Happy halloween and don't give any candy to the Fauerstein monsta .... please!
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Post by trenddiver on Oct 30, 2015 16:56:59 GMT -5
trenddiver please see mnholdem 's posts earlier today and please stop calling us stupid. Insurance takes time. Insurance companies in the US consume at least 25% of the health care budget, the proverbial "blood from a turnip" sometimes to meet the special needs of many diabetics who have been human pincushions for many years.... Afrezza is a superior medication though the labeling does not yet reflect the superiority. Happy halloween and don't give any candy to the Fauerstein monsta .... please! I was just kinda quoting Bill Clinton. Not directed to anyone, except maybe me.
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Post by mnholdem on Oct 30, 2015 17:12:46 GMT -5
Your premise is that insurers may offer tit-for-tat in negotiating each drug, but I really don't think it works that way. The way I see it, with the current label, Sanofi will score an initial victory if they get the same Tier as the competitors' RAA insulin. Later, when studies result in label improvements, then we should expect separation from the rest of the pack. Bring on the studies, Sanofi!
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Post by dreamboatcruise on Oct 30, 2015 17:35:36 GMT -5
No, I am not calling any one stupid. First let me say, "I know very little about this topic". Next to getting FDA approval, there is NO more important task that must be accomplished than getting on these insurance formularies. Why, because most sick or diseased patients don't pay for their prescriptions, its the insurance company or health care provider that pay. So I took a look at the detailed formulary list at FormularyLookup.com and was almost flabbergasted to see how many insurance problems DO NOT cover Afrezza. And I think its not a slam dunk getting on these formularies and achieving a Tier level which makes Afrezza affordable to diabetics. From what I am learning, there are all kinds of games being played by these drug companies to get preferred or exclusive placement of their drugs including big discounts and who knows what other trade-offs.
Mannkind is a one drug company. Sanofy has many many drugs. I wonder how hard Sanofy is pushing to get formulary coverage. Is Sanofy in a conflict of interest situation with respect to Afrezza considering they don't want to piss off these drug plans with respect to their other more important drugs. Are these exclusive placement agreements freezing out Afrezza and Sanofy doesn't want to push hard to undo these because maybe they have their own exclusive arrangements? Are these kind of agreements anti-trust violations or restraints of trade because consumers are the ones who are unable to get freedom of choice?
I'm sure there is a lot more to say on this topic and a lot of nuances, but like I said, "I know very little". But I do know this, it is a big daunting task that needs to be accomplished right now.
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Today is the day we took our first big step forward. It seems likely some rather large plan, covering about 10% of patients in the U.S., just decided to cover Afrezza without restriction or pre-auth. Afrezza may need greater preferred to truly be the blockbuster we know it can be, but even getting in unrestricted tier 3 would be a sea change with regard to patient access. At that point the discount card really means something and the doctors would no longer consider it a waste of time sending people with a prescription for something that they likely aren't going to get. Then over time SNY can arm twist insurers into making it preferred when doctors are singing Afrezza's praises... and then profit will shoot through the roof when the card discounts are no longer needed. I'm about to do another happy dance... but I already did that on the formulary thread. (and not to worry, I'm often accused of being both stupid and cold blooded) |
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Post by suebeeee1 on Oct 30, 2015 17:51:22 GMT -5
I'm about to do another happy dance... but I already did that on the formulary thread. (and not to worry, I'm often accused of being both stupid and cold blooded) I was under the impression that Lizards did happy dances for just about any occassion. Can you shed some truth on this? |
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Post by dreamboatcruise on Oct 30, 2015 17:53:13 GMT -5
Sorry to keep harping on this, but I think this is a big accomplishment. My confidence has shot up in SNY. I think it would be a monumental task to convince formularies to give good placement to Afrezza... here's why... Afrezza is unique in that patients that use it and like will be far less willing to be forced onto injectable RAA's later. In contrast, if a formulary gives preferred status to Novolog and then pricing is increased too much, they can always switch and put Humalog on the next year... or not too long from now perhaps a biosimilar generic. Patient's might not like having to switch but it would be far less onerous than switching from Afrezza to an injectable RAA. If I'm smart enough to figure out getting on tier 3 now with Afrezza is going to put HUGE pressure on the formularies to have it preferred later, they must be smart enough to figure that out also. SNY can build up a huge number of prescribing doctors and patients using the discount card to make tier 3 equivalent to tier 2, then they go in at some point and say... "Mr. Pharmacy Benefit Manager, we just wanted to give you friendly warning we're going to be discontinuing our discount card program 6 months from now, you might want to think about moving this to preferred status or you could end up with a lot of very angry patients not able to afford their medication and maybe looking to switch plans." What's a PBM to do at that point. However SNY has done it, today they proved that it is possible.
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Post by dreamboatcruise on Oct 30, 2015 17:54:26 GMT -5
suebeeee1... the sun has to be shining, otherwise the cold blooded are too lethargic.
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Post by suebeeee1 on Oct 30, 2015 18:12:38 GMT -5
Dreamboatcruise, the sun is indeed shining somewhere in the world. We just have to wait till the sun rotates to our side!
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sometimes to meet the special needs of many diabetics who have been human pincushions for many years.... Afrezza is a superior medication though the labeling does not yet reflect the superiority.
