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Post by stevil on Feb 6, 2016 16:10:24 GMT -5
I wonder if they can start negotiating with the insurance companies, based on a future price. That would put them ahead of the game. Insurance companies may not be able to offer coverage until the price changes, but the paperwork would be in place so that they could initiate coverage at the lower price when the time comes (April 5 or later). Anyone know someone who works for an insurance company that offers drug coverage? I don't think mannkind can do anything until Sanofi deal is over. If I am wrong someone correct me. That is what Matt said, however, I wonder how strictly this is enforced. For instance, I wonder if Matt could be in talks with insurance companies and simply ask "what would happen if we lowered the cost to this". Nothing official is being done, but there's still progress. I can't imagine he can't even throw feelers out to get the ball rolling. If so, that's pretty awful.
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Post by lorcan458 on Feb 7, 2016 14:13:50 GMT -5
I've emailed Matt twice requesting that he ask Sanofi, in writitng, for an immediate price reduction and renegotiation with insurance companies. If Sanofi complies, that's great. If they don't, the expose themselves as actively working against the success of Afrezza and further damages in a future lawsuit. Asking in writing is a win-win.
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Post by xoxoxoxo on Feb 7, 2016 14:56:45 GMT -5
I'm sure we'll get the price reduction eventually, but how low are we going to go is going to be the big question? We need to go low enough to convince insurers we're cost effective compared to existing RAAs. Do we have to go lower than what humalog/novolog costs? If we did undercut the big guys, will they just lower their prices? Part of me wants to see a nice insulin price war because that'd be great for diabetics. My belief is they won't drop the price on novolog/humalog at first since they see us as a failed product anyways. But if scripts picked up, then they'd lower their prices to try and hold their market share. For those of you who know I sold, nothing like having 20 years of capital losses to carry forward I'm still sitting on the sidelines until bankruptcy is off the table and then I'll probably jump back in.
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Post by Deleted on Feb 7, 2016 15:14:03 GMT -5
Wrong thread
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Post by stevil on Feb 7, 2016 15:22:23 GMT -5
I'm sure we'll get the price reduction eventually, but how low are we going to go is going to be the big question? We need to go low enough to convince insurers we're cost effective compared to existing RAAs. Do we have to go lower than what humalog/novolog costs? If we did undercut the big guys, will they just lower their prices? Part of me wants to see a nice insulin price war because that'd be great for diabetics. My belief is they won't drop the price on novolog/humalog at first since they see us as a failed product anyways. But if scripts picked up, then they'd lower their prices to try and hold their market share. For those of you who know I sold, nothing like having 20 years of capital losses to carry forward I'm still sitting on the sidelines until bankruptcy is off the table and then I'll probably jump back in. Ya, they likely won't lower their prices until it hurts. Because lowering their prices too soon only means less revenue for them anyway. There's a point where it becomes beneficial for them to do that and that wouldn't be for a while. Now, that's not to say they wouldn't be proactive and just lower their prices for 3-6 months as that would be all it would take for them to screw us over. It all depends on how serious of a threat they perceive us to be. 3-6 months of lowered pricing is better than many years or permanent lost market share. I'm sure they've got someone in an office somewhere crunching those numbers....
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Post by sluggobear on Feb 7, 2016 17:41:13 GMT -5
The poster named "Me" / "Ranger" wrote a long informative post about the importance of the PBM relationship with drug companies. mnkd.proboards.com/thread/5120/price-afrezza(Wikipedia: "In the United States, a pharmacy benefit manager (PBM) is most often a third party administrator (TPA) of prescription drug programs but sometimes can be a service inside of an integrated healthcare system (e.g.: Kaiser or VA). They are primarily responsible for processing and paying prescription drug claims.") It's a good description of PBM negotiations and how drug pricing is set. It seems the rebates are collusion between pharmas and insurance companies and diminish competition in drug pricing. IMO the status quo will start to change this year and next. Drug prices are out of whack and the country cannot afford the current pricing scheme. We know the well-publicized examples (GILD, Shkreli) but all of us are paying huge amounts of extra money for MOST drugs in the US - the price gets passed through in our insurance premiums and copays. GILD would never get $85K from individual cash pay patients who need Hep C drugs. Why so much? The answers to that, even if decent and plausible, aren't relevant to the public's perception because the entire biotechnology sector faces scrutiny over high drug prices now. If Shkreli was shorting IBB when he jacked up the price ridiculously for Daraprim - well, hats off to his sociopathic greed. If you haven't noticed, biotech is getting killed right now, probably for a lot of reasons but one is that Hillary and Bernie keep talking about extremely high drug prices. This may be the time when a convergence of factors could lead to a paradigm shift in how drugs are priced and Afrezza could generate a lot of good will by undercutting ALL of the competition. Insulin is one of these very touchy drugs, like other life-saving and life-giving drugs. If Al Mann/Mannkind management are looking at possible BK for Mannkind and the death knell for Afrezza - why not go after the insulin market using 19th century monopoly tactics. The COGS for Afrezza are still important but basically give it away! You can raise the price later when you're selling 10K TRx/week. Get patients to try it and then let them have enough to get hooked on the convenience and the great results. Afrezza could lead the way in providing cheaper, much easier to use insulin to diabetic seniors on Medicare. For cheap! That would steal the headlines - the reverse of a Shkreli story. In April when MNKD gets Afrezza back from SNY, how will they jump out of the starting gate? Afrezza must spike in Rx immediately. Mannkind's 2.0 Afrezza Launch: 1. Communicate the Afrezza Promise to all patients, endos and PCP's that MNKD will ensure supply of Afrezza through 2017 at least.2. Send out a massive number of samples to Endos and PCP's in a FEW STATES (California, New York, Washington, Hawaii?) where: a. Afrezza insurance coverage is highest (or where all RAA insulin is expensive and coverage is poor?) b. Diabetic patient numbers are concentrated, and c. Diabetes / medical treatment of the population is good. 3. Price must be VERY CHEAP for Afrezza. Provide steep year-long discounts. Undercut prices of all other RAA insulins. 4. Focus on Type 1 D's? 5. Education and support: provide very easy path to FEV1 testing, hold the patient's and doc's hands, provide REAL education on how to optimize Afrezza dosing. Get T1D's to use it...if the results are truly going to speak for themselves, the T1D's are the right patients to do the speaking. Here's the problem: Mannkind has NO SALES FORCE. If Al Mann (and some billionaire friends?) want to help on the ground they could finance contracting with a private sales and distribution team (25-50 reps) that would make hundreds of directed calls/month on the biggest insulin prescribing PCP's and Endo's in only a few states. Maybe some expert in the Sales world would speak to this basic issue.
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Post by agedhippie on Feb 7, 2016 20:30:35 GMT -5
Mannkind's 2.0 Afrezza Launch: 1. Communicate the Afrezza Promise to all patients, endos and PCP's that MNKD will ensure supply of Afrezza through 2017 at least.2. Send out a massive number of samples to Endos and PCP's in a FEW STATES (California, New York, Washington, Hawaii?) where: a. Afrezza insurance coverage is highest (or where all RAA insulin is expensive and coverage is poor?) b. Diabetic patient numbers are concentrated, and c. Diabetes / medical treatment of the population is good. 3. Price must be VERY CHEAP for Afrezza. Provide steep year-long discounts. Undercut prices of all other RAA insulins. 4. Focus on Type 1 D's? 5. Education and support: provide very easy path to FEV1 testing, hold the patient's and doc's hands, provide REAL education on how to optimize Afrezza dosing. Get T1D's to use it...if the results are truly going to speak for themselves, the T1D's are the right patients to do the speaking. I agree with one part of this, and I disagree with another. I think focusing on a limited number of states is definitely the way to do this. We have limited resources for the near future so get good marketing in limited areas. I would chose Florida and California among others as I think you want Type 2 diabetics who are arriving at the insulin point and they are older. I am not sure focusing on Type 1 diabetics is a good idea. Insulin dependent diabetics (people for who insulin is the only option, not the favored option) are extremely conservative with major changes because that insulin is keeping them alive. This often translates into an unwillingness to try new insulins and delivery methods. There are still a lot of people using Mix insulins, these are horrible for control, who will not move off them. If I was trying to sell this to them I would focus on a consistent uptake as the key benefit. Fast onset and clearance are nice but not a big deal and needles are a non-event.
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Post by Deleted on Feb 7, 2016 20:43:46 GMT -5
I agree with one part of this, and I disagree with another. I think focusing on a limited number of states is definitely the way to do this. We have limited resources for the near future so get good marketing in limited areas. I would chose Florida and California among others as I think you want Type 2 diabetics who are arriving at the insulin point and they are older. I am not sure focusing on Type 1 diabetics is a good idea. Insulin dependent diabetics (people for who insulin is the only option, not the favored option) are extremely conservative with major changes because that insulin is keeping them alive. This often translates into an unwillingness to try new insulins and delivery methods. There are still a lot of people using Mix insulins, these are horrible for control, who will not move off them. If I was trying to sell this to them I would focus on a consistent uptake as the key benefit. Fast onset and clearance are nice but not a big deal and needles are a non-event. Do you think they are lot of people using mix Insulins because they are extremely conserative with major changes ? ( even though they are horrible for control? ) . Any other reasons?
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Post by suebeeee1 on Feb 7, 2016 20:50:25 GMT -5
I agree with one part of this, and I disagree with another. I think focusing on a limited number of states is definitely the way to do this. We have limited resources for the near future so get good marketing in limited areas. I would chose Florida and California among others as I think you want Type 2 diabetics who are arriving at the insulin point and they are older. I am not sure focusing on Type 1 diabetics is a good idea. Insulin dependent diabetics (people for who insulin is the only option, not the favored option) are extremely conservative with major changes because that insulin is keeping them alive. This often translates into an unwillingness to try new insulins and delivery methods. There are still a lot of people using Mix insulins, these are horrible for control, who will not move off them. If I was trying to sell this to them I would focus on a consistent uptake as the key benefit. Fast onset and clearance are nice but not a big deal and needles are a non-event. There are thousands, if not tens of thousans of type 2 diabetics who are being badly maintained on oral insulins because they do not want to go on injectable insulin. They don't want the hastle of testing their blood 10x/day. They don't want to worry about dying of a hypo in the middle of the night. THIS is the population we should be targeting! They get only Afrezza first and get wonderful results with minimal efforts and then all the Type 1s will see these results and want the same. Snowball begins. Add to that each and every child that is diagnosed with Type 1 and you know there isn't a parent alive that won't choose inhalable insulin over injecting their kids. We just need to get that snowball moving!
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Post by suebeeee1 on Feb 7, 2016 20:53:33 GMT -5
Here's the problem: Mannkind has NO SALES FORCE. If Al Mann (and some billionaire friends?) want to help on the ground they could finance contracting with a private sales and distribution team (25-50 reps) that would make hundreds of directed calls/month on the biggest insulin prescribing PCP's and Endo's in only a few states. Maybe some expert in the Sales world would speak to this basic issue. There are a whole bunch of us who are true believers. Some of us have lots of time on our hands. Perhaps we should alll get together and offer to be the salesforce. MNKD will happily train us and we can work for stock in lieu of commission!
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Post by sportsrancho on Feb 7, 2016 21:41:44 GMT -5
Here's the problem: Mannkind has NO SALES FORCE. If Al Mann (and some billionaire friends?) want to help on the ground they could finance contracting with a private sales and distribution team (25-50 reps) that would make hundreds of directed calls/month on the biggest insulin prescribing PCP's and Endo's in only a few states. Maybe some expert in the Sales world would speak to this basic issue. There are a whole bunch of us who are true believers. Some of us have lots of time on our hands. Perhaps we should alll get together and offer to be the salesforce. MNKD will happily train us and we can work for stock in lieu of commission! Sue, I'm tired of talking! Let's start doing! Sign me up. Let's get a list going and send to Matt. I need to be trained but I'll give it my all!
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Post by agedhippie on Feb 7, 2016 22:12:22 GMT -5
I agree with one part of this, and I disagree with another. I think focusing on a limited number of states is definitely the way to do this. We have limited resources for the near future so get good marketing in limited areas. I would chose Florida and California among others as I think you want Type 2 diabetics who are arriving at the insulin point and they are older. I am not sure focusing on Type 1 diabetics is a good idea. Insulin dependent diabetics (people for who insulin is the only option, not the favored option) are extremely conservative with major changes because that insulin is keeping them alive. This often translates into an unwillingness to try new insulins and delivery methods. There are still a lot of people using Mix insulins, these are horrible for control, who will not move off them. If I was trying to sell this to them I would focus on a consistent uptake as the key benefit. Fast onset and clearance are nice but not a big deal and needles are a non-event. Do you think they are lot of people using mix Insulins because they are extremely conserative with major changes ? ( even though they are horrible for control? ) . Any other reasons? The convenience of a combining the basal and prandial insulin in one shot. Mainly though on the patient side it is a concern that they may get better control but they are not confident they achieve it. Better not to take the risk. Also the doctor not feeling they or the patient can handle MDI and carb counting. Doctors are far more comfortable about people running high levels than low levels because it avoids hypos. That is stupid really because DKA is far more lethal than a severe hypo if you are insulin dependent.
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Post by benh on Feb 8, 2016 10:03:36 GMT -5
Anyone looking for price reductions and/or foreign approval needs to read the collaboration agreement.
There is a Joint Committee. Made up of 4 SNY and 4 MNKD representatives. This Q's strategy, be it, how much to allocate to print/ online ads, foreign approval, studies etc etc. will have been decided at the last meeting. Matt does not need to ask for response to price reduction - it's already been decided and already in writing. Whatever SNY will do between now and April has already been decided.
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Post by biffn on Feb 8, 2016 11:21:59 GMT -5
SNY is maintaining it's strategy even in the end game to prevent Afrezza from competing with its other products. Big Pharma may still step in, but they probably don't want to deal with SNY as well as MNKD. This is becoming a high risk-reward game of legal cat and mouse.
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Post by mnholdem on Feb 8, 2016 11:39:31 GMT -5
(c) Transition. The Parties shall negotiate in good faith a written transition agreement pursuant to which the Parties would effectuate this Section 13.3 to coordinate the transition of relevant obligations and rights to MannKind as necessary to Develop and Commercialize Product in the Field in the Territory to ensure no interruption of therapy or coverage for patients, including promptly submitting all necessary filings with Governmental Authorities. Sanofi shall use diligent efforts to cooperate with MannKind or its designee to effect a smooth and orderly transition in the Development and Commercialization of Product in the Territory during the notice and the Wind-down Period. (d) Rights Become Non-Exclusive. Notwithstanding any other provision of this Agreement, following the effective date of termination and during the Wind-down Period, Sanofi’s and its Affiliates’ rights with respect to Product in the Field in the Territory shall be non-exclusive, and, without limiting the foregoing, MannKind shall have the right to engage one or more other distributors and/or licensees of Product in the Field in the Territory.
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A number of corporate lawyers may argue that the Agreement stipulates that Sanofi is required to cooperate with MannKind Corporation, not the other way around. The term "diligent efforts" carries with it a more stringent standard than "reasonable efforts" and it would be an interesting case to consider whether Sanofi could be forced to lower pricing as part of the transition from Sanofi to MannKind. Regardless, Sanofi's rights become non-exclusive following the effective date of termination. At that date, MannKind or an Agent of MannKind may immediately assume negotiations with the major 3rd party payers related to price discounts needed for preferred or similar tier assignment to RAA insulin brands.
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