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Post by lakon on Feb 25, 2016 13:51:29 GMT -5
Baba, I have to disagree with you! There is no insurance coverage. I'm a Type 2 and have been on the drug since last April. Paid for it myself for 5 months, then won an appeal with my insurance company and got coverage for 6 months. Now I'm going on Medicare and I can find no supplemental coverage for Afrezza so I'll be back to paying out of pocket. Therefore, I do think the price is a critical issue, you would not understand unless the money comes directly out of your own pocket! Hopefully self funding is not going to be a big segment of the market or we will never become profitable. This has to be taken up by insurers for that to happen in which case the price paid by the user is no longer dependent on the price Mannkind charges. The last time Al Mann spoke to shareholders, he joked about reaching 400 million diabetics and pre-diabetics as being the difficult problem remaining. While tongue in cheek, I think he wants to reach them, and a solution is needed. I believe the only realistic path is heading for a showdown with regulators. At some point after long-term safety is established, a vastly cheaper OTC version of Afrezza would be a path to take over prandial insulin worldwide. The profits will come from VOLUME, governments, NGO's, and philanthropists at that point. For the first 5-10 years, insurers will be a bigger factor. On the other hand, I am interested in figuring out ways to streamline how Matt B. gets Afrezza. Of the entire diabetic population, how many can and would pay out of pocket if it was easy to do? Would it be enough to juice MNKD's cash flow for survival without dilution? Just a thought... |
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Post by mnholdem on Feb 25, 2016 14:23:50 GMT -5
Ordinarily, I'd put this in the articles folder, but since the report indicates that the new FDA head may be pharma-friendly, I'll put the link here:
www.vox.com/2015/9/21/9364847/califf-fda
Why critics are worried about the new FDA boss
Dr. Robert Califf has close ties with the pharmaceutical industry.
Updated by Julia Belluz on February 25, 2016, 11:05 a.m. ET
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Post by nylefty on Feb 25, 2016 15:24:01 GMT -5
Baba, I have to disagree with you! There is no insurance coverage. I'm a Type 2 and have been on the drug since last April. Paid for it myself for 5 months, then won an appeal with my insurance company and got coverage for 6 months. Now I'm going on Medicare and I can find no supplemental coverage for Afrezza so I'll be back to paying out of pocket. Therefore, I do think the price is a critical issue, you would not understand unless the money comes directly out of your own pocket! Which state are you in? I'm in New York and according to formularylookup.com, when it comes to Medicare coverage for Afrezza: Payer/PBM # of Plans Status
New York State Catholic Health Plan, Inc. 5 plans 100% Covered
Express Scripts PBM 4 plans 66% Covered
United American Insurance Company 6 plans 60% Covered
EmblemHealth, Inc. 8 plans 52% Covered
Mt. Carmel Health Plan, Inc. 1 plan Covered
University of Maryland Medical System 1 plan Covered
HealthSpan, Inc. 1 plan CoveredAfrezza has unrestricted access for 14% of Medicare lives in New York, NY
Maybe you need to do some more shopping. By the way, the New York State Catholic Health Plan is advertised as Fidelis Care and you don't have to be Catholic to use it. |
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Post by jurystillout on Feb 25, 2016 16:02:56 GMT -5
Baba, I have to disagree with you! There is no insurance coverage. I'm a Type 2 and have been on the drug since last April. Paid for it myself for 5 months, then won an appeal with my insurance company and got coverage for 6 months. Now I'm going on Medicare and I can find no supplemental coverage for Afrezza so I'll be back to paying out of pocket. Therefore, I do think the price is a critical issue, you would not understand unless the money comes directly out of your own pocket! Which state are you in? I'm in New York and according to formularylookup.com, when it comes to Medicare coverage for Afrezza: Payer/PBM # of Plans Status
New York State Catholic Health Plan, Inc. 5 plans 100% Covered
Express Scripts PBM 4 plans 66% Covered
United American Insurance Company 6 plans 60% Covered
EmblemHealth, Inc. 8 plans 52% Covered
Mt. Carmel Health Plan, Inc. 1 plan Covered
University of Maryland Medical System 1 plan Covered
HealthSpan, Inc. 1 plan CoveredAfrezza has unrestricted access for 14% of Medicare lives in New York, NY
Maybe you need to do some more shopping. By the way, the New York State Catholic Health Plan is advertised as Fidelis Care and you don't have to be Catholic to use it. But will it cover contraceptives?? OH No, I feel a lock coming on....  |
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Post by nylefty on Feb 25, 2016 16:26:20 GMT -5
Those of us on Medicare don't have much need for The Pill.
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