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Post by dreamboatcruise on Dec 5, 2015 14:19:35 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. This may well be a big issue with insurers. Based on the PK profile, someone eating a somewhat typical American diet might use quite a bit more Afrezza than SQ RAA. We've learned in our physiology tutorials here that a certain amount of insulin doesn't remove a fixed quantity of glucose, it enables cells to gobble up glucose for a relatively fixed amount of time... and in the case of Afrezza, a shorter amount of time. So slow digesting meals such fried foods and pizza need an extra dose of Afrezza that would not be needed with SQ RAA. I'm not sure RAA's are inconsistent, it's just that they are consistent/persistent in a way that doesn't match one's digestion after meals. The speed of Afrezza doesn't always match digestion either, but the beauty of too short is that you can always take a supplemental dose whereas there is no solution to too long other than taking counteracting sugar. I guess I'm less hopeful that a meeting with a relatively small number of users would be an enabler in itself for a significant change in marketing effort. I would assume it would be a step in the process of designing a trial that would be what is needed to change marketing effort... and unfortunately, that would imply a longer process than you suggest.
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Post by trenddiver on Dec 6, 2015 1:44:06 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. DBC, Sanofi's strategy re pricing has been well discussed and explained in many excellent posts on this board. We will know at some point whether it was the best strategy because worldwide pricing (and Afrezza revenue) to a large extent, is based on the U.S. pricing. Mannkind entrusted Afrezza to Sanofi, because Sanofi was arguably the leader in the diabetes genre to launch the product. I remember when the Sanofi deal was announced how ecstatic most on this board were to have such an outstanding partner. Now, many of those same posters (most of whom have launched nothing) question or disagree with the pricing and launch strategy and Sanofi's commitment. Of course we worry about the effect on MNKD, the share price and the current lack of revenue, hence cash burn. However, Mannkind should have prepared for the launch strategy by creating sufficient capital to weather the launch. Unfortunately our management was drinking the Kool-Aid and did not plan for the headwinds by raising additional capital at higher prices. As a long term shareholder of MNKD, I want Sanofi to continue proceeding in a way that will best exploit the potential of Mannkind over the longterm for that is the best way to create long term shareholder value. At this point in time all we long shareholders can do is buy at these depressed prices if we believe that the future will be better, or do nothing or even sell if we have no confidence in the plan. But whining and complaining on this board will do nothing (I direct this comment to no one specifically.) Like I said in other posts, I'm buying. Trend
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Post by doodyfree on Dec 6, 2015 2:04:59 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. DBC, Sanofi's strategy re pricing has been well discussed and explained in many excellent posts on this board. We will know at some point whether it was the best strategy because worldwide pricing (and Afrezza revenue) to a large extent, is based on the U.S. pricing. Mannkind entrusted Afrezza to Sanofi, because Sanofi was arguably the leader in the diabetes genre to launch the product. I remember when the Sanofi deal was announced how ecstatic most on this board were to have such an outstanding partner. Now, many of those same posters (most of whom have launched nothing) question or disagree with the pricing and launch strategy and Sanofi's commitment. Of course we worry about the effect on MNKD, the share price and the current lack of revenue, hence cash burn. However, Mannkind should have prepared for the launch strategy by creating sufficient capital to weather the launch. Unfortunately our management was drinking the Kool-Aid and did not plan for the headwinds by raising additional capital at higher prices. As a long term shareholder of MNKD, I want Sanofi to continue proceeding in a way that will best exploit the potential of Mannkind over the longterm for that is the best way to create long term shareholder value. At this point in time all we long shareholders can do is buy at these depressed prices if we believe that the future will be better, or do nothing or even sell if we have no confidence in the plan. But whining and complaining on this board will do nothing (I direct this comment to no one specifically.) Like I said in other posts, I'm buying. Trend Buying also. I missed the 1.85 low Friday. Hope I get another chance next week.
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Post by trenddiver on Dec 6, 2015 2:12:30 GMT -5
I think anything under $2.00 is a great value.
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Post by dreamboatcruise on Dec 6, 2015 3:48:53 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. DBC, Sanofi's strategy re pricing has been well discussed and explained in many excellent posts on this board. We will know at some point whether it was the best strategy because worldwide pricing (and Afrezza revenue) to a large extent, is based on the U.S. pricing. Mannkind entrusted Afrezza to Sanofi, because Sanofi was arguably the leader in the diabetes genre to launch the product. I remember when the Sanofi deal was announced how ecstatic most on this board were to have such an outstanding partner. Now, many of those same posters (most of whom have launched nothing) question or disagree with the pricing and launch strategy and Sanofi's commitment. Of course we worry about the effect on MNKD, the share price and the current lack of revenue, hence cash burn. However, Mannkind should have prepared for the launch strategy by creating sufficient capital to weather the launch. Unfortunately our management was drinking the Kool-Aid and did not plan for the headwinds by raising additional capital at higher prices. As a long term shareholder of MNKD, I want Sanofi to continue proceeding in a way that will best exploit the potential of Mannkind over the longterm for that is the best way to create long term shareholder value. At this point in time all we long shareholders can do is buy at these depressed prices if we believe that the future will be better, or do nothing or even sell if we have no confidence in the plan. But whining and complaining on this board will do nothing (I direct this comment to no one specifically.) Like I said in other posts, I'm buying. Trend I think rather than explained, you meant speculated on. None of us know why SNY has made the decisions they have made. I tend to believe that SNY has a strategy that will maximize long term benefit to them, if not me... but that is speculation. We have no way of knowing what goes on behind the curtain... what was expected vs what has happened and what is still to come.
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Post by afrizzle on Dec 6, 2015 8:50:09 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" I've got 10% of net worth invested at an average of $5. So yeah I don't like where we are now. I do follow events pretty closely. However I'm at peace because I decided from jump street that I'd stay in until zero or when Al sold. I've been investing for a while and know I'm the type that can continually second guess myself if I don't decide and stick with the thesis (subject to change only when clear and significant change to thesis is required) I'm more distressed that I didn't do a better job at deciding when to buy to have a lower basis but that's spilled milk. This play is still in the second act
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Post by kball on Dec 6, 2015 8:56:59 GMT -5
Similar numbers here too ^ (nowhere near at peace though)
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Post by trenddiver on Dec 6, 2015 14:00:19 GMT -5
DBC, Sanofi's strategy re pricing has been well discussed and explained in many excellent posts on this board. We will know at some point whether it was the best strategy because worldwide pricing (and Afrezza revenue) to a large extent, is based on the U.S. pricing. Mannkind entrusted Afrezza to Sanofi, because Sanofi was arguably the leader in the diabetes genre to launch the product. I remember when the Sanofi deal was announced how ecstatic most on this board were to have such an outstanding partner. Now, many of those same posters (most of whom have launched nothing) question or disagree with the pricing and launch strategy and Sanofi's commitment. Of course we worry about the effect on MNKD, the share price and the current lack of revenue, hence cash burn. However, Mannkind should have prepared for the launch strategy by creating sufficient capital to weather the launch. Unfortunately our management was drinking the Kool-Aid and did not plan for the headwinds by raising additional capital at higher prices. As a long term shareholder of MNKD, I want Sanofi to continue proceeding in a way that will best exploit the potential of Mannkind over the longterm for that is the best way to create long term shareholder value. At this point in time all we long shareholders can do is buy at these depressed prices if we believe that the future will be better, or do nothing or even sell if we have no confidence in the plan. But whining and complaining on this board will do nothing (I direct this comment to no one specifically.) Like I said in other posts, I'm buying. Trend I think rather than explained, you meant speculated on. None of us know why SNY has made the decisions they have made. I tend to believe that SNY has a strategy that will maximize long term benefit to them, if not me... but that is speculation. We have no way of knowing what goes on behind the curtain... what was expected vs what has happened and what is still to come. Seriously speaking, do you think Sanofi and/or Mannkind should be discussing its pricing and other business strategies especially when ongoing sensitive insurance negotiations are ongoing? I think not.
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Post by dreamboatcruise on Dec 6, 2015 14:14:43 GMT -5
trenddiver... no I wouldn't expect them to, which is why we don't have any explanation for pricing that seems to contradict what MNKD had stated before partnering. I am surprised no analyst has asked that question, however. They don't seem to shy away from asking questions they should know likely won't be answered. I would be curious how MNKD management would have responded to "why the higher price than previously suggested?" Maybe there would have been some hint in the choice of words to indicate something... maybe not.
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Post by jeremg on Dec 6, 2015 14:24:29 GMT -5
trenddiver... no I wouldn't expect them to, which is why we don't have any explanation for pricing that seems to contradict what MNKD had stated before partnering. I am surprised no analyst has asked that question, however. They don't seem to shy away from asking questions they should know likely won't be answered. I would be curious how MNKD management would have responded to "why the higher price than previously suggested?" Maybe there would have been some hint in the choice of words to indicate something... maybe not. Matt: "We'll have to refer you to SNY on pricing" or Hakan: "No hablo Inglés [llámame]."
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Post by peppy on Dec 7, 2015 11:59:04 GMT -5
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Post by compound26 on Dec 7, 2015 12:20:13 GMT -5
Note that Sam (Sam on Tudiabetes.org, not Sam Finta) uses less than one box in one month (he says one box will last 1.5 months for him). That is atypical. Most Afrezza users use more than that. Sam Finta uses about two boxes a month and I think at some time Laureen indicated that she uses 9 boxes for three months. In another tweet she mentioned she got a refill for 90 days for 7 boxes. I would roughly estimate that generally a user will probably need two boxes of Afrezza per months. That would reasonable as a 90 cartridge only gives you one cartridge for each meal. Since you will naturally need additional units for snacks and follow-up doses, two boxes per month would seem to be the right (average) number. In that case, the average cost will be much higher (than $159 as indicated by Sam on Tudiabetes.org), if not covered by insurance. This is because the Sanofi savings card is limited to one box per prescription/refill. So if you need two boxes per month, without insurance, the cost will be $380+ (say if you get two boxes of 90 x 4Us at Costco without insurance) or somewhere around $400.
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Post by Deleted on Dec 7, 2015 20:02:05 GMT -5
Note that Sam (Sam on Tudiabetes.org, not Sam Finta) uses less than one box in one month (he says one box will last 1.5 months for him). That is atypical. Most Afrezza users use more than that. Sam Finta uses about two boxes a month and I think at some time Laureen indicated that she uses 9 boxes for three months. In another tweet she mentioned she got a refill for 90 days for 7 boxes. I would roughly estimate that generally a user will probably need two boxes of Afrezza per months. That would reasonable as a 90 cartridge only gives you one cartridge for each meal. Since you will naturally need additional units for snacks and follow-up doses, two boxes per month would seem to be the right (average) number. In that case, the average cost will be much higher (than $159 as indicated by Sam on Tudiabetes.org), if not covered by insurance. This is because the Sanofi savings card is limited to one box per prescription/refill. So if you need two boxes per month, without insurance, the cost will be $380+ (say if you get two boxes of 90 x 4Us at Costco without insurance) or somewhere around $400. Note that you do NOT need to be a member at Costco to purchase Rx products at their stores or via their online (mail order) pharmacy. The only issue with online (mail order) is if your Rx plan has a mandated mail order pharmacy. For those that do not have insurance, Costco and the Sanofi discount card is a great idea and even more important as we all wait for formulary coverage to improve. Compound, any chance you can put some type of streaming banner ad on your blog about the above?
A bit of info on Costco Rx home delivery. www.costco.com/Pharmacy/home-delivery?storeId=10301&catalogId=10701We should get Stockton to make up flyers and get them to all the early adopters so they can in turn give each of their docs 100 copies. Anyone got a database of high prescribing insulin docs? We can start our own grass roots marketing campaign: Afrezza Ultra rapid acting insulin:
LESS Hypos
Much better control of blood glucose levels
No stacking or latent / late night incidences of hypoglycemia
Lowest A1c ever
NEEDLE FREE (Inhaled) Afrezza Ultra Rapid Acting Insulin at a Costco pharmacy near you
No, you do NOT need to be a memeber of Costco to get your Rx filled there
Looking for more convenience, try Costco mail order pharmacy to get Afrezza delivered right to your front door
Like Jack Welch used to say, control your destiny or someone else will.
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Post by mssciguy on Dec 7, 2015 20:06:00 GMT -5
Note that Sam (Sam on Tudiabetes.org, not Sam Finta) uses less than one box in one month (he says one box will last 1.5 months for him). That is atypical. Most Afrezza users use more than that. Sam Finta uses about two boxes a month and I think at some time Laureen indicated that she uses 9 boxes for three months. In another tweet she mentioned she got a refill for 90 days for 7 boxes. I would roughly estimate that generally a user will probably need two boxes of Afrezza per months. That would reasonable as a 90 cartridge only gives you one cartridge for each meal. Since you will naturally need additional units for snacks and follow-up doses, two boxes per month would seem to be the right (average) number. In that case, the average cost will be much higher (than $159 as indicated by Sam on Tudiabetes.org), if not covered by insurance. This is because the Sanofi savings card is limited to one box per prescription/refill. So if you need two boxes per month, without insurance, the cost will be $380+ (say if you get two boxes of 90 x 4Us at Costco without insurance) or somewhere around $400. Note that you do NOT need to be a member at Costco to purchase Rx products at their stores or via their online (mail order) pharmacy. The only issue with online (mail order) is if your Rx plan has a mandated mail order pharmacy. For those that do not have insurance, Costco and the Sanofi discount card is a great idea and even more important as we all wait for formulary coverage to improve. Sanofi is using the card as a bridge as the time it takes to negotiate to a better tier and pricing drags on. Compound, any chance you can put some type of streaming banner ad on your blog about the above?
A bit of info on Costco Rx home delivery. www.costco.com/Pharmacy/home-delivery?storeId=10301&catalogId=10701We should get Stockton to make up flyers and get them to all the early adopters so they can in turn give each of their docs 100 copies. Anyone got a database of high prescribing insulin docs? We can start our own grass roots marketing campaign: Afrezza Ultra rapid acting insulin:
LESS Hypos
Much better control of blood glucose levels
No stacking or latent / late night incidences of hypoglycemia
Lowest A1c ever
NEEDLE FREE (Inhaled) Afrezza Ultra Rapid Acting Insulin at a Costco pharmacy near you
No, you do NOT need to be a memeber of Costco to get your Rx filled there
Looking for more convenience, try Costco mail order pharmacy to get Afrezza delivered right to your front door
Like Jack Welch used to say, control your destiny or someone else will.
Isn't this something Sanofi should do? There need to be some boundaries here. All of this bubbly enthusiasm has done no good here, nothing. It would be far more legitimate to allow the PWDs and endos continue on their merry way to better health. We put up our money and are down big, almost exclusively. Let investors put their money up and suffer the pain, and let the diabetics and endos and pcps do what they do best, heal.
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Post by sweedee79 on Dec 7, 2015 20:20:51 GMT -5
It depends on the box you get. The higher doses are more expensive but around 400$ a box before insurance coverage. Each box contains 90 cartridges. My dad had been paying 240.$ a month after insurance for 2 boxes(120$ per box). That is tier 4 coverage on his Medica part D.. however after the 1st of the year it has been removed from the formulary all together in favor of injectable insulin. My dad has been using 2 boxes per month. He is near 100 miles from Costco... also the dose he is on isnt high enough so it would cost him more if he was able to continue on Afrezza. As you know he will be going off the first of the new year due to lack of insurance coverage and knowledgeable docs ..
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