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Post by peppy on Nov 23, 2015 15:26:16 GMT -5
I have seen a couple of medical bills in my life. one for $204,000......settled by the insurance companies for $67,000. $3000 of that the co-pay. one for $159,000 .....settled by the insurance company for $57,000. $4000 of that copay.
Do the drug insurance policies work the same way? what I m asking, does the $4,374.12 no insurance annual cost of afrezza go down for the insurance companies to 1/2-1/3 the price, like the hospital and physicians bills do? Is that why the no insurance cost is so high?
Ditto, the question; $1,406.28 annually apidra?
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Post by jeremg on Nov 23, 2015 15:54:39 GMT -5
I have seen a couple of medical bills in my life. one for $204,000......settled by the insurance companies for $67,000. $3000 of that the co-pay. one for $159,000 .....settled by the insurance company for $57,000. $4000 of that copay.
Do the drug insurance policies work the same way? what I m asking, does the $4,374.12 no insurance annual cost of afrezza go down for the insurance companies to 1/2-1/3 the price, like the hospital and physicians bills do? Is that why the no insurance cost is so high?
Ditto, the question; $1,406.28 annually apidra?
Yes, the system is not designed for those who do not have insurance, it is designed with negotiation with insurance companies in mind. Some insurance plans also have an out of pocket maximum for covered drugs which may lessen that figure for those who are partially covered. Still WAYYYYY too high for Afrezza to sell with broad appeal, the question stands, why SNY?! |
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Post by stevil on Nov 23, 2015 17:03:33 GMT -5
I have seen a couple of medical bills in my life. one for $204,000......settled by the insurance companies for $67,000. $3000 of that the co-pay. one for $159,000 .....settled by the insurance company for $57,000. $4000 of that copay.
Do the drug insurance policies work the same way? what I m asking, does the $4,374.12 no insurance annual cost of afrezza go down for the insurance companies to 1/2-1/3 the price, like the hospital and physicians bills do? Is that why the no insurance cost is so high?
Ditto, the question; $1,406.28 annually apidra?
To go into a little more detail than jeremg's post... agree with everything he said, but wanted to add a little more to maybe help clarify. Hospitals and pharmacies set their (out of pocket) prices fully expecting to not receive that amount from insurance companies. Hospitals and pharmacies make contracts with each insurance payer to receive a certain amount of reimbursement. For instance, the OOP cost for one of the drugs I took was over $100. But once I ran that medication through my insurance plan, I got the contracted rate of $4 and change. (Isn't that insane!). My insurance did not pay the difference as I had not hit a deductible yet. That was just the difference between contracted rate and the "cash" price. So, with the same insurance, you may find the same medication cheaper at a grocery store chain rather than a Walgreen's or CVS, which typically have higher contracted rates because they actually count on their pharmacies to make them money. Local grocery stores/Walmart/Costco, on the other hand, are consistently selling their drugs below cost of dispensing in order to draw customers into their store to buy other products with a higher profit margin. So yes, each plan and each pharmacy has its own contract. If you have a flat copay, you'll pay the same price at each pharmacy. Some plans, though, pay a certain percentage of the contracted price between pharmacy and insurance company, so you may find the same medication is cheaper, depending on where you have it filled. |
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Post by dreamboatcruise on Nov 23, 2015 17:08:18 GMT -5
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Post by jeremg on Nov 23, 2015 17:32:13 GMT -5
Very interesting article, SO why isn't SNY offering Afrezza at a steep discount as opposed to an absurd 3-4x price tag with a "non-inferior" label to boot. Has it not been on market long enough for them to discount (even though it's not selling)? It's still a bit of a "chicken or egg" scenario [insurance, advertising, doctor education etc.] but SNY doesn't seem to be willing to supply either the chicken or the egg, so the process cannot begin. Bottomline: No Omelettes for anyone [shareholders, diabetics, SNY, MNKD]. |
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Post by peppy on Nov 23, 2015 17:43:34 GMT -5
Very interesting article, SO why isn't SNY offering Afrezza at a steep discount as opposed to an absurd 3-4x price tag with a "non-inferior" label to boot. Has it not been on market long enough for them to discount (even though it's not selling)? It's still a bit of a "chicken or egg" scenario [insurance, advertising, doctor education etc.] but SNY doesn't seem to be willing to supply either the chicken or the egg, so the process cannot begin. Bottomline: No Omelettes for anyone [shareholders, diabetics, SNY, MNKD]. as I remember the story, it takes about 1 year to get on formularies. I believe the story went, 6 months to a year typical before formulary consideration and adoption. You people that know, tell us.
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Post by jeremg on Nov 23, 2015 17:46:47 GMT -5
peppy, yes paging anyone who may know the answer to that. When did the clock officially start ticking for Afrezza though? So much has happened, ADCOM seems like it could have been a week ago looking at the [lack of] results. What date did it first come to market?
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Insurance
Nov 23, 2015 17:50:23 GMT -5
via mobile
Post by jpg on Nov 23, 2015 17:50:23 GMT -5
Very interesting article, SO why isn't SNY offering Afrezza at a steep discount as opposed to an absurd 3-4x price tag with a "non-inferior" label to boot. Has it not been on market long enough for them to discount (even though it's not selling)? It's still a bit of a "chicken or egg" scenario [insurance, advertising, doctor education etc.] but SNY doesn't seem to be willing to supply either the chicken or the egg, so the process cannot begin. Bottomline: No Omelettes for anyone [shareholders, diabetics, SNY, MNKD]. I think they were focusing on Toujeo and the rest was not that significant. |
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Post by peppy on Nov 23, 2015 17:51:22 GMT -5
peppy , yes paging anyone who may know the answer to that. When did the clock officially start ticking for Afrezza though? So much has happened, ADCOM seems like it could have been a week ago looking at the [lack of] results. What date did it first come to market? feb. 2015
dream boat cruise could tell us I his sleep. 
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Post by jeremg on Nov 23, 2015 17:54:46 GMT -5
peppy , yes paging anyone who may know the answer to that. When did the clock officially start ticking for Afrezza though? So much has happened, ADCOM seems like it could have been a week ago looking at the [lack of] results. What date did it first come to market? feb. 2015 Thanks, so if we can hold out another 3-3.5months we can reassess this 1yr figure. I hope for the sake of our PPS a lot happens between now and then though, waiting for the 1yr mark for insurance to magically grant Afrezza access to the promised land is not exactly the path I would hope SNY and Management plan on taking. |
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Post by dreamboatcruise on Nov 23, 2015 18:00:04 GMT -5
Very interesting article, SO why isn't SNY offering Afrezza at a steep discount as opposed to an absurd 3-4x price tag with a "non-inferior" label to boot. Has it not been on market long enough for them to discount (even though it's not selling)? It's still a bit of a "chicken or egg" scenario [insurance, advertising, doctor education etc.] but SNY doesn't seem to be willing to supply either the chicken or the egg, so the process cannot begin. Bottomline: No Omelettes for anyone [shareholders, diabetics, SNY, MNKD]. Maybe there are exclusivity deals already in place for Novo and Huma that must run their course before they can add Afrezza at any price. Maybe SNY is willing to heavily discount. I know I don't have the answers... just throwing out possibilities. |
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Post by peppy on Nov 23, 2015 18:00:00 GMT -5
well, then there was he fabulous thread and Goldman Sacs question....
Will sanofi drop afrezza in January?
speculation on that thread abounded. (I think I was a non-participant)
so to recap, potential for increased formulary placement and possible trouble ahead speculation co-inside.
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Post by jeremg on Nov 23, 2015 18:13:32 GMT -5
"Maybe there are exclusivity deals already in place for Novo and Huma that must run their course before they can add Afrezza at any price. Maybe SNY is willing to heavily discount."dreamboatcruise - Could be, unfortunately end result is the same if this is the case. Begs the question, why wouldn't SNY and MNKD have anticipated this if its truly the reason and their hands are tied; exclusivity could be it but I don't think the nuances we've seen from what little information we have to assess would indicate this is the case. They have feigned surprise, both SNY and MNKD.
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Post by kball on Nov 23, 2015 18:16:16 GMT -5
peppy , yes paging anyone who may know the answer to that. When did the clock officially start ticking for Afrezza though? So much has happened, ADCOM seems like it could have been a week ago looking at the [lack of] results. What date did it first come to market? feb. 2015
dream boat cruise could tell us I his sleep.
Day after superbowl iirc (feb 2nd or 3rd). Some lucky patients, Sam for instance got it a week earlier. |
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Post by dreamboatcruise on Nov 23, 2015 18:24:13 GMT -5
"Maybe there are exclusivity deals already in place for Novo and Huma that must run their course before they can add Afrezza at any price. Maybe SNY is willing to heavily discount."dreamboatcruise - Could be, unfortunately end result is the same if this is the case. Begs the question, why wouldn't SNY and MNKD have anticipated this if its truly the reason and their hands are tied; exclusivity could be it but I don't think the nuances we've seen from what little information we have to assess would indicate this is the case. They have feigned surprise, both SNY and MNKD. Maybe it was unclear whether the exclusivity would apply to an inhaled prandial. It all leaves me scratching my head and realizing the best I can do is come up with guesses as to what might be happening. I've done my fair share of licensing/marketing deals and defining what is and isn't an excluded "competitive" product isn't always straight forward. It also usually isn't public information. So the specific terms Novolog has with a PBM may well not be known to SNY. This issue is obviously a huge gap in my due diligence, that I have only recently painfully come to appreciate. |
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