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Post by trenddiver on Dec 5, 2015 1:56:53 GMT -5
Here is what my father, a retired orthopedic surgeon and very heavily invested MNKD long, discovered from speaking with his friend, a local pharmacist: The relative wholesale cost of pen injected Humalog vs. Afrezza (which the pharmacist had never even heard of) was $1.12 for Humalog and $2.50 for Afrezza, comparing 4 units of each. Has anyone on this board investigated this issue? If the reported information is correct, is there any wonder why Afrezza is not being covered by insurance and why it isn't selling as we expected? We were told by MNKD's management that Afrezza was to be priced competitively with insulin pens. Why would they say that if they knew that Sanofi was intending to make it more than twice as expensive? Is Sanofi breaching its contractual obligation with MNKD by pricing Afrezza so high? I'm not looking for any speculation here, but if someone knows something relevant to this issue, I'd love to hear it. Someone can correct me if I am wrong, but statements I am aware of from MNKD saying that were before the SNY deal was inked. No, I would highly doubt there is a minimum pricing in the agreement that SNY is ignoring. I would assume the pricing was set by the committee... of course SNY would win if there was a disagreement because the agreement does give them that power. From MNKD's prior statements we can presume that SNY either convinced MNKD of this strategy or simply used their override vote. I do agree that it would be nice if MNKD were to at least acknowledge that the pricing has turned out to be different even if they couldn't give the reasoning... but whose kidding whom, that ain't going to happen. Back in summer I thought the high price was because they felt they were in a strong enough position to quickly prove that they deserved a premium price. Of course now I tend to think everything I think must be wrong... but it's hard to figure out when to stop that circular reasoning. Though one note: The pens also require needle which are supposed to only be used once. Further, Afrezza price is not based on units so a 12u is not 3x a 4u. The overall cost for difference for payers is thus not likely to be as high as the original data for this thread would imply... but Afrezza is still meaningfully more. I suspect what happened with the pricing was that Mannkind deferred to Sanofi's on the pricing because they believed that Sanofi's had the expertise and theoretically knew what they were doing. We won't know for a few months whether in the long run it was the best strategy. Hopefully it will be thoroughly discussed at the next JAC meeting. Trend
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Post by dreamboatcruise on Dec 5, 2015 4:50:57 GMT -5
trenddiver ... I don't think we'll ever ever know whether it was the best strategy... I just hope a workable strategy regarding MNKD shareholders.
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Post by afrizzle on Dec 5, 2015 6:35:34 GMT -5
I don't think SNY will run any advertising before the end of the year. I'm guessing they'd not want individuals starting Afrezza during the heavy holiday eating season - too much variability to blur results. Better to start after the New Year as individuals are getting a fresh start with their health. Also, ad budgets for 2016 will have been approved and ready to be enacted. The latter just my opinion based on my own corporate experience with ad spends. Well, you have to factor in how long it will take patients to GET a Rx once they WANT an Rx. Ads could start right now and most new patients wouldn't start until January anyway jmho Kball my friend, your Avatar looks like it's on chemo and your sig has gone from concerned to fatalistic. Hang in there. We only lose if we sell.
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Post by kball on Dec 5, 2015 8:52:09 GMT -5
Well, you have to factor in how long it will take patients to GET a Rx once they WANT an Rx. Ads could start right now and most new patients wouldn't start until January anyway jmho Kball my friend, your Avatar looks like it's on chemo and your sig has gone from concerned to fatalistic. Hang in there. We only lose if we sell. Have you been following events the past 10 months? Its getting harder to believe any optimistic assessments or perspectives, though not yet impossible. But i swear there are some believers here (though not a large contingent) that might as well be on the Titanic and think "Yeah, but look...no waiting in the buffet line"
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Post by vissertrades on Dec 5, 2015 9:06:16 GMT -5
Kball my friend, your Avatar looks like it's on chemo and your sig has gone from concerned to fatalistic. Hang in there. We only lose if we sell. Have you been following events the past 10 months? Its getting harder to believe any optimistic assessments or perspectives, though not yet impossible. But i swear there are some believers here (though not a large contingent) that might as well be on the Titanic and think "Yeah, but look...no waiting in the buffet line" Ok, I'll admit, that would be me. Got a filling late yesterday without being numbed so I could eat dinner w/o issue.. Started out fine BUT went through enamel and zing! Wife said I'm a idiot.
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Post by vestful on Dec 5, 2015 10:40:02 GMT -5
I do that too because I don't like the numbing feeling. More difficult if replacing an old filling (drill longer). Kball - I think there are a lot of board members here that are still optimistic but are exhausted and tired of responding to the negative posters.
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Post by mssciguy on Dec 5, 2015 10:49:28 GMT -5
Kball my friend, your Avatar looks like it's on chemo and your sig has gone from concerned to fatalistic. Hang in there. We only lose if we sell. Have you been following events the past 10 months? Its getting harder to believe any optimistic assessments or perspectives, though not yet impossible. But i swear there are some believers here (though not a large contingent) that might as well be on the Titanic and think "Yeah, but look...no waiting in the buffet line" When is the next shareholder's meeting? Are you going? Seriously, mgmt has been playing very reckless here, isn't part of their job to defend shareholder value? All the patents in the world aren't worth anything without execution. Good example is the electronic cigarette. It was invented in the 1970s by the tobacco companies and was killed for reasons unknown. Over twenty years later, all the patents were expired and the Chinese started producing these by the millions. Now you can find them everywhere. Allowing the competition to beat MNKD to the inhaled triptan... come on guys.
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Post by Deleted on Dec 5, 2015 10:55:49 GMT -5
While I have been critical of Sanofi, one thing I think they bring to the table vs Mannkind is better knowledge on how to price Afrezza from a global perspective. I think another thread on this board had indicated that pricing in the US serves as a proxy for the rest of the world - not dollar for dollar but as a benchmark to discount off of.
Since Afrezza is so different and Sanofi's time to develop a launch plan was limited, I think they took the conservative route, threw Afrezza into the market and observed what happened. Now with some information / data under their belt, they will try to determine how much the market will pay for Afrezza. Some good information obtained from the San Francisco meetings as well and perhaps they put together a full go launch for 2016 and with additional information, it may need to be tweaked. Don't be shocked if advertising and promotion does not ramp until Q2. Marketing collateral has to make its way through legal / regulatory and then go into production and that is not an overnight process even if done at warp speed.
DBC - you make some interesting comments on dose to dose pricing but the RAAs have been around so long, insurance companies have a pretty good idea how much patients will use. With Afrezza, not enough data to get to the same level of certainty (even though Afrezza is more consistent than RAAs) and I suspect patients using more than anticipated. It could be pricing needs to be adjusted a bit or something as simple as increasing certain box configurations by XX% cartridges to get to a more consistent rate of utilization per Rx filled.
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Post by blu2waz on Dec 5, 2015 11:02:44 GMT -5
If they advertise in December they might be able to start taking Afrezza by mid January, but based on past performance they'll drag their heels as long as possible and maybe start advertising by April...I don't care, I'm not selling.
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Post by Deleted on Dec 5, 2015 11:08:28 GMT -5
If they advertise in December they might be able to start taking Afrezza by mid January, but based on past performance they'll drag their heels as long as possible and maybe start advertising by April...I don't care, I'm not selling. Even with formulary improvement, by the time the sales reps speak to the doctors (and it will take 3-4 sales calls just to get docs to start to remember) NRx uptick would still be 4-6 weeks out. Any big label change means the managed care folks first have to go to the payors and negotiate and this takes months too. If all the above came to fruition in the next 2-3 months, NRx growth curve would not get steep until likely H2 of 16. Nothing happens quickly in the world of big pharma. Just the way it is.
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Post by mssciguy on Dec 5, 2015 11:12:05 GMT -5
While I have been critical of Sanofi, one thing I think they bring to the table vs Mannkind is better knowledge on how to price Afrezza from a global perspective. I think another thread on this board had indicated that pricing in the US serves as a proxy for the rest of the world - not dollar for dollar but as a benchmark to discount off of. Since Afrezza is so different and Sanofi's time to develop a launch plan was limited, I think they took the conservative route, threw Afrezza into the market and observed what happened. Now with some information / data under their belt, they will try to determine how much the market will pay for Afrezza. Some good information obtained from the San Francisco meetings as well and perhaps they put together a full go launch for 2016 and with additional information, it may need to be tweaked. Don't be shocked if advertising and promotion does not ramp until Q2. Marketing collateral has to make its way through legal / regulatory and then go into production and that is not an overnight process even if done at warp speed. DBC - you make some interesting comments on dose to dose pricing but the RAAs have been around so long, insurance companies have a pretty good idea how much patients will use. With Afrezza, not enough data to get to the same level of certainty (even though Afrezza is more consistent than RAAs) and I suspect patients using more than anticipated. It could be pricing needs to be adjusted a bit or something as simple as increasing certain box configurations by XX% cartridges to get to a more consistent rate of utilization per Rx filled. Apparently Novo is going for the rapid acting market now www.fiercebiotech.com/press-releases/novo-nordisk-files-regulatory-approval-faster-acting-insulin-aspart-eu-treaAll the things you say make sense, but the logical method is not necessarily the best method. This is an extremely competitive space with a lot of brand recognition and loyalty. Sanofi can and must move much faster. Likewise, MNKD must land a Technosphere deal to regain a little "Street cred" -- The wolf is at the door. No, I take that back, there is a whole pack of them, GSCO, Renaissance, AF, Shrek, Karp, not to mention possibly smarter and faster companies that also have particle inhalation technologies. Knock down the share price further, and it gets harder and harder to get financing and we're dead in the water or on the auction block. Let's hope that Sanofi decides as you suggest that Afrezza is cool and even sexy, and should have price parity with the injectables. We have the capacity to produce and distribute, just meet with the insurers and get it done, give them what they want. You can always raise the price later. THAT is how it works. Is Brandicourt asleep at the wheel?
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Post by kball on Dec 5, 2015 11:13:25 GMT -5
-snip- DBC - you make some interesting comments on dose to dose pricing but the RAAs have been around so long, insurance companies have a pretty good idea how much patients will use. With Afrezza, not enough data to get to the same level of certainty (even though Afrezza is more consistent than RAAs) and I suspect patients using more than anticipated. It could be pricing needs to be adjusted a bit or something as simple as increasing certain box configurations by XX% cartridges to get to a more consistent rate of utilization per Rx filled. I wonder how much the 'using more than anticipated' can be mitigated by better timing of doses? (which the label doesn't help and actually may contribute to).
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Post by stevil on Dec 5, 2015 12:43:33 GMT -5
While I have been critical of Sanofi, one thing I think they bring to the table vs Mannkind is better knowledge on how to price Afrezza from a global perspective. I think another thread on this board had indicated that pricing in the US serves as a proxy for the rest of the world - not dollar for dollar but as a benchmark to discount off of. Since Afrezza is so different and Sanofi's time to develop a launch plan was limited, I think they took the conservative route, threw Afrezza into the market and observed what happened. Now with some information / data under their belt, they will try to determine how much the market will pay for Afrezza. Some good information obtained from the San Francisco meetings as well and perhaps they put together a full go launch for 2016 and with additional information, it may need to be tweaked. Don't be shocked if advertising and promotion does not ramp until Q2. Marketing collateral has to make its way through legal / regulatory and then go into production and that is not an overnight process even if done at warp speed. DBC - you make some interesting comments on dose to dose pricing but the RAAs have been around so long, insurance companies have a pretty good idea how much patients will use. With Afrezza, not enough data to get to the same level of certainty (even though Afrezza is more consistent than RAAs) and I suspect patients using more than anticipated. It could be pricing needs to be adjusted a bit or something as simple as increasing certain box configurations by XX% cartridges to get to a more consistent rate of utilization per Rx filled. Apparently Novo is going for the rapid acting market now www.fiercebiotech.com/press-releases/novo-nordisk-files-regulatory-approval-faster-acting-insulin-aspart-eu-treaAll the things you say make sense, but the logical method is not necessarily the best method. This is an extremely competitive space with a lot of brand recognition and loyalty. Sanofi can and must move much faster. Likewise, MNKD must land a Technosphere deal to regain a little "Street cred" -- The wolf is at the door. No, I take that back, there is a whole pack of them, GSCO, Renaissance, AF, Shrek, Karp, not to mention possibly smarter and faster companies that also have particle inhalation technologies. Knock down the share price further, and it gets harder and harder to get financing and we're dead in the water or on the auction block. Let's hope that Sanofi decides as you suggest that Afrezza is cool and even sexy, and should have price parity with the injectables. We have the capacity to produce and distribute, just meet with the insurers and get it done, give them what they want. You can always raise the price later. THAT is how it works. Is Brandicourt asleep at the wheel? I think if MNKD were setting prices, you'd see them much more willing to budge. They're a new company in terms of brand recognition and I'm sure they'd gladly take a small hit on their first drug to gain popularity. Look at Toyota/Honda/Hyundai. They used to be the cheapest cars on the road. Still are the best bargain, but they gained their reputation by outperforming their competition at a smaller price. Al is a smart businessman and he knows that there is "an embarrassment of riches" waiting to be developed. The first one doesn't need to be a blockbuster, even if it should be. It'll likely be one if it deserves it, but there is even more potential sitting in the lab, just waiting to be developed and marketed. It doesn't do any good sitting there. I have to believe that SNY is the one holding things up. Again, I'll be really concerned if they choose to pass on Afrezza, because that will mean they don't see the potential that we think there is in it. But Al needs to do whatever he can to at least get the pipeline open so we can release blockbuster after blockbuster.
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Post by Deleted on Dec 5, 2015 13:33:52 GMT -5
While I have been critical of Sanofi, one thing I think they bring to the table vs Mannkind is better knowledge on how to price Afrezza from a global perspective. I think another thread on this board had indicated that pricing in the US serves as a proxy for the rest of the world - not dollar for dollar but as a benchmark to discount off of. Since Afrezza is so different and Sanofi's time to develop a launch plan was limited, I think they took the conservative route, threw Afrezza into the market and observed what happened. Now with some information / data under their belt, they will try to determine how much the market will pay for Afrezza. Some good information obtained from the San Francisco meetings as well and perhaps they put together a full go launch for 2016 and with additional information, it may need to be tweaked. Don't be shocked if advertising and promotion does not ramp until Q2. Marketing collateral has to make its way through legal / regulatory and then go into production and that is not an overnight process even if done at warp speed. DBC - you make some interesting comments on dose to dose pricing but the RAAs have been around so long, insurance companies have a pretty good idea how much patients will use. With Afrezza, not enough data to get to the same level of certainty (even though Afrezza is more consistent than RAAs) and I suspect patients using more than anticipated. It could be pricing needs to be adjusted a bit or something as simple as increasing certain box configurations by XX% cartridges to get to a more consistent rate of utilization per Rx filled. Apparently Novo is going for the rapid acting market now www.fiercebiotech.com/press-releases/novo-nordisk-files-regulatory-approval-faster-acting-insulin-aspart-eu-treaAll the things you say make sense, but the logical method is not necessarily the best method. This is an extremely competitive space with a lot of brand recognition and loyalty. Sanofi can and must move much faster. Likewise, MNKD must land a Technosphere deal to regain a little "Street cred" -- The wolf is at the door. No, I take that back, there is a whole pack of them, GSCO, Renaissance, AF, Shrek, Karp, not to mention possibly smarter and faster companies that also have particle inhalation technologies. Knock down the share price further, and it gets harder and harder to get financing and we're dead in the water or on the auction block. Let's hope that Sanofi decides as you suggest that Afrezza is cool and even sexy, and should have price parity with the injectables. We have the capacity to produce and distribute, just meet with the insurers and get it done, give them what they want. You can always raise the price later. THAT is how it works. Is Brandicourt asleep at the wheel? I get your point about more competition, innovation. As great of a scientist / businessman that Al is, and make no bones about it, he is extraordinary, the pace of change and competitive forces have never been greater. Time to your point is one of Mannkind's enemies. The Novo product your referred to at a quick glance appears NOT to be a quantum improvement. Many of the "new" products big pharma produces provide modest incremental benefits. Somewhere out there though is another Afrezza and to think, all it will take is someone just like Al Mann with a cool $1B available to invest and a similar determination. Intarcia comes to mind as an innovative delivery system. Still not sure how the Oramed product does not get destroyed in the gut but time will tell if their IP is that good. Remember Smart Cells got picked off by Merck for $500mm www.fiercebiotech.com/story/wsj-merck-buy-smartcells-500m-deal/2010-12-02 has Merck commercialized it? Thermalin has also been trying to create innovative product. Mannkind however, today, right now has the best product the world has ever seen. FDA approved, world class manufacturing and a slew of patients saying it is a miracle drug.
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Post by mssciguy on Dec 5, 2015 13:45:51 GMT -5
@scotta I agree. Just looked up US and EU clinical studies done by Mannkind. They are first class and have some experience with the TS that nobody else has. Regarding Afrezza prntscr.com/9ap1b3 via docgreenback ymb Endo Launch vs PCP Launch Bloomberg 8/11/14 (This is the original publicly stated strategy) “It is not going to be in competition” with existing products, “it’s going to be a nice complement and upgrade to our portfolio,” said Pierre Chancel, senior vice president of Sanofi’s diabetes division, in a call with analysts today. The inhaled product will be marketed to patients “struggling to start insulin because of the injections,” he said. SNY was going target Type2s on orals whose reluctance to inject has worsened their disease. This is the easiest prior auth and the fastest growing segment of users. As millions of early phase diabetics are gradually losing control of their sugars/a1cs. The simple beauty of this approach is that THERE IS NO COMPETITOR that doesn't involve shots other than to add more orals onto the metformin. Are we looking at Feb 2016 pcp launch with 1 year of real world data under our belts? SNY could target high volume prescribers with the Afrezza/Apidra combo......Is your patient willing to go on insulin?...Apidra Is your patient reluctant to inject?....Afrezza
They can turn on the jets anytime with the pcps. ...............................my daily dose of hope-ium.....................................
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