|
|
Post by lakon on Apr 2, 2016 3:43:30 GMT -5
I was hoping to read what others on this board had proffered as "reasonable" conjecture for Mannkind's next moves after getting back Afrezza rights. I have my own ideas about RLS and don't intend to reiterate now. Back to the subject title of the thread: So what can they do, and what should they do, on April 5th? If there isn't any solid, significant source of revenue in "line of sight" as Matt says, e.g. $200m, then I think a Hail Mary is necessary. Announce free Afrezza insulin for seniors on Medicaid. Set the price of Afrezza to be newsworthy. I have been banging this drum so someone tell me why this approach is foolhardy... I wrote an email welcoming Dr. Castagna in his new position as Mannkind's CCO, wishing him luck, and voicing these suggestions about pricing Afrezza: "I would be very excited to see Mannkind announce that they are: - pricing Afrezza to make it cheaper than ALL other prandial insulins. - making Afrezza available for ALL diabetics to try for 6 mos - 1 yr through deep discounts (basically the cost of a copay). - creating a special Medicaid program for seniors who require insulin but cannot afford it." I asked, "Are you really going to try to fight PBM's and insurance companies to get Rx numbers going? I assume they will always counter with the same reasoning for denial of coverage. By selling Afrezza at an undercutting price, PBM's and insurance cos. would not be involved initially. Also the other holdups of PA / ST would be removed. If patients never hear about (and try) Afrezza, they won't know what they are missing. I believe you can get millions to try it (and fall in love with it). After 6 months, assuming better QOL and lower A1c's, patients will demand it from their docs." I realize this is probably way too simplistic. But trying to restart Afrezza, again as a niche product, means the company might not survive (I'm being generous). I also said that I think the "lowest price in the US for insulin" story would mean free advertising - a David v. Goliath story in the New York Times, the anti-Martin Shkreli approach. This might lead to national recognition (e.g. speeches from Hillary and Bernie) of Mannkind / Al Mann's contributions to Diabetes...and of course, national awareness of Afrezza. Current pricing of the competition:
"Apidra vial 10ml = $177.59
Humalog vial 10ml = $217.45
Novolog vial 10ml = $210.49
Average cost per month: $201.84
Average cost per year: $2,422.08"
It appears from the comments of users that afrezza may require significantly larger and/or more frequent dosing -- roughly 3-4 times as much as their old lispro dose. So just to stay even with the lispro prices Mannkind could charge only around 60-70 dollars. That would mean only around 700-800 bucks in revenues per year. Could Mannkind generate significant profit from that?
Maybe this is just sour grapes, but I'd like to price Afrezza at 35% of $177.59 per empirically equivalent dose requirements by way of a discount card for 12 months. Let's just see how hard Sanofi tried. Let the evidence show for all the BUT-YOU-CANNOT-SUE crowd. Oh, and to answer your question, YES, MNKD can generate significant profit from that. When and how are the questions that must be considered? |
|
|
|
Post by agedhippie on Apr 2, 2016 11:39:16 GMT -5
Maybe this is just sour grapes, but I'd like to price Afrezza at 35% of $177.59 per empirically equivalent dose requirements by way of a discount card for 12 months. Let's just see how hard Sanofi tried. Let the evidence show for all the BUT-YOU-CANNOT-SUE crowd. Oh, and to answer your question, YES, MNKD can generate significant profit from that. When and how are the questions that must be considered? I'm sure the insurers and PBMs would like that, but shouldn't we be helping the users? The current discount card is already better than that. |
|
|
|
Post by peppy on Apr 2, 2016 14:50:40 GMT -5
|
|
|
|
Post by sportsrancho on Apr 2, 2016 16:57:12 GMT -5
There is a reason for everything! You are connecting all the dots on both sides of the fence:-) Very impressive! IMO |
|
|
|
Post by peppy on Apr 2, 2016 17:34:40 GMT -5
There is a reason for everything! You are connecting all the dots on both sides of the fence:-) Very impressive! IMO it has been a pleasure knowing you, and thank you for everything. you taught me about afrezza dosing, through the kids. Cathode Nailed it for us. proof. Matt is going to launch Afrezza. screencast.com/t/rEjoecso
www.youtube.com/watch?v=CRG6R6uxMHw Graham Nash & David Crosby - Right Between The Eyes (1971)
|
|
|
|
Post by sportsrancho on Apr 2, 2016 18:15:11 GMT -5
There is a reason for everything! You are connecting all the dots on both sides of the fence:-) Very impressive! IMO it has been a pleasure knowing you, and thank you for everything. you taught me about afrezza dosing, through the kids. Cathode Nailed it for us. proof. Matt is going to launch Afrezza. screencast.com/t/rEjoecso
www.youtube.com/watch?v=CRG6R6uxMHw Graham Nash & David Crosby - Right Between The Eyes (1971)
peppy, you can think circles around most people! I remember the day I finally got it. That never would have happened, but you never gave up. Cathode nailed it.... The exact words I said to myself:-))) |
|
|
|
Post by lakon on Apr 3, 2016 4:05:21 GMT -5
Maybe this is just sour grapes, but I'd like to price Afrezza at 35% of $177.59 per empirically equivalent dose requirements by way of a discount card for 12 months. Let's just see how hard Sanofi tried. Let the evidence show for all the BUT-YOU-CANNOT-SUE crowd. Oh, and to answer your question, YES, MNKD can generate significant profit from that. When and how are the questions that must be considered? I'm sure the insurers and PBMs would like that, but shouldn't we be helping the users? The current discount card is already better than that. We should be helping users. I dispute your assessment of the current discount card; however, I never said to stop other offerings. I also never said to charge the end user a dime. I basically said to price Afrezza at parity with the lowest priced competitor [SNY], but subtract out what Sanofi would have cost Mannkind at 65%. Assume the price is all profit since the marginal cost of manufacturing at volume is negligible compared to all of the expensed insulin on hand at MannKind. All MNKD needs is to remain cash flow neutral to take market share. How low do you think the price of Afrezza can go? Here's a hint: my suggestion should still be profitable at volume albeit a bit mean spirited towards the competition. My buddy and I recently did the math again, and Sanofi marked up the price of Afrezza to basically turn their 65% into the same return as 100% on Apidra -- bunch of greedy clowns or smart like foxes, if one wanted to slow roll it off the table. Just to make you think, my whole argument is based on logic and a few back of a napkin calculations. The best part is while the competition is seeing revenues collapse, MNKD is growing revenues. Priceless. If one wanted to play like a hedge fund and had the money, heavily short KBIOQ, RTRX, VRX, SNY, LLY, NVO and leverage into MNKD/AMPH with the proceeds to cause buying/interest pressure on the shorts. That's another way a big player [GS] could cause a real short squeeze. This turnaround is going to be EPIC! How can this be splashy? In light of recent events regarding Shkreli and Valeant pricing models, the press and politicians might find the splash of MannKind LOWERING PRICES a bit intriguing after another big pharma had them priced out of the market. Splish Splash just a thought... |
|
|
|
Post by agedhippie on Apr 3, 2016 8:53:52 GMT -5
I'm sure the insurers and PBMs would like that, but shouldn't we be helping the users? The current discount card is already better than that. We should be helping users. I dispute your assessment of the current discount card; however, I never said to stop other offerings. I also never said to charge the end user a dime. I basically said to price Afrezza at parity with the lowest priced competitor [SNY], but subtract out what Sanofi would have cost Mannkind at 65%. So, to be clear. The card caps the cost for a prescription at $30. Your solution has it at $41 and uncapped. Therefore reducing the cost only benefits the PBMs and insurers since they are the ones who pick up the difference. Sell them Afrezza at $41 or $141 it still costs the user $30 with a card so all you are doing is giving away margin (to the PBMs). |
|
|
|
Post by lakon on Apr 3, 2016 12:54:42 GMT -5
We should be helping users. I dispute your assessment of the current discount card; however, I never said to stop other offerings. I also never said to charge the end user a dime. I basically said to price Afrezza at parity with the lowest priced competitor [SNY], but subtract out what Sanofi would have cost Mannkind at 65%. So, to be clear. The card caps the cost for a prescription at $30. Your solution has it at $41 and uncapped. Therefore reducing the cost only benefits the PBMs and insurers since they are the ones who pick up the difference. Sell them Afrezza at $41 or $141 it still costs the user $30 with a card so all you are doing is giving away margin (to the PBMs). Okay, this is my last try for your benefit hippie. You made a whole lot of assumptions about what I was saying. I never gave a complete solution or proposal for how to negotiate with insurers or setup a new discount card. I was simply stating, tongue in cheek, that MNKD could lower the price to 35% of Apidra because Al always said it would be priced on par with other prandials. Since SNY would have taken 65%, that's obvious wiggle room. I was not bothering to split hairs about the details of which other costs, such as marketing, play a role. I could have said 25%, but I think fewer would have gotten the connection. In any event, I was proposing a PRICE WAR with the unstated assumption that insurers would cover Afrezza at the deep discount of about $62.16/mo. You could still have your first month free and cap at $30 for refills blah blah blah... Don't forget the clause, "depending on your insurance coverage." That's the point. It actually DOES MATTER what the insurance companies have to pay, or they simply won't cover it. Get all the insurance companies on board while being generally affordable! Take market share. Worry about fair pricing later after statistically relevant numbers of HbA1C improvements become the norm for Afrezza users. The details I leave to MannKind executives because I am an investor, and I don't have time to do their jobs too. Hope that clears things up. Enjoy.  |
|
|
|
Post by stevil on Apr 3, 2016 16:03:09 GMT -5
Either I'm not understanding what you're saying or you don't understand how insurance coverage works...
If you price it at 35% of $161, or x amount of dollars... as long as the cost of the medication is more expensive than the copay, the patient will not enjoy any savings. The drug could cost $83,457,048 and if their copay is $30, they'd still pay $30. If the drug cost $30.01 and the copay was $30, the patient would still pay $30.
What agedhippie has been saying is that you're not saving the patients money by reducing the cost of the drug. You'd only be saving the patients without insurance, of which there aren't many (or weren't when I was in the pharmacy). Most importantly, you'd mostly only be saving the insurance companies money by reducing the cost of the medication- to the detriment of MNKD.
I'd suspect with Obamacare having no exclusions for previous conditions, the vast majority of diabetics would have insurance. So you'd only be helping the cash paying patients as well as those trying to hit their deductible, or those lucky enough to be in the doughnut-hole- the gap in coverage between hitting your first tier of coverage and then hitting the maximum out of pocket portion. These are generally only found in medicare coverages.
So if you're saying to reduce the cost of the medication to gain better insurance coverage, I think that's what Matt has been stating he'd be doing. Lowering the cost even one cent below what would be necessary to gain coverage likely wouldn't be very advantageous for us as a company.
I'll admit that the landscape may have changed since I was last in the pharmacy. Medicare didn't use to allow discount cards to be applied to their customers. Also, the way insurance plans are structured now, it's possible that the deductible is so high that reducing the price of the drug might be better for those trying to reach it. But according to when I was last in the pharmacy- a couple years ago, the majority of our customers had tiered copays. Discount cards are better for the company (and most patients) than lowering the cost of the medication for better tier placement. We just need to be really good about supplying docs with stacks of discount cards so that everyone who gets prescribed Afrezza gets a discount card.
|
|
|
|
Post by victoria on Apr 3, 2016 16:45:35 GMT -5
I think this is new today 3 April, at least it shows as new within 24 hours on google. At www.findacode.com/ndc/drugs/Afrezza Afrezza is listed as having National Drug Codes which state Mannkind as the Labeller, with separate codes for the Sanofi labelled product. I assume thats expected with the imminent handover back to Mannkind. However Im not sure of the signifcance, if any, of Mannkind having 5 listed drug codes while Sanofi have only 4 for afrezza. Curious whether that might mean eg a new dose cartridge capacity or pack size? Without a subscription to that site no way to tell. NB the official FDA database which ought to show these codes does not give hits for these, at www.accessdata.fda.gov/scripts/cder/ndc/default.cfm but there is a nitice on their site saying "FDA IT has discovered a processing error affecting the NDC Directory. We have reverted back to the version of the Directory dated 3/18/2016 until the issue is resolved.". Using that site I dont get any hits at all for Afrezza or Mannkind so presumably technical issue. |
|
|
|
Post by spiro on Apr 3, 2016 16:53:10 GMT -5
Spiro thinks if MNKD makes Afrezza $125 or so per month, that it will start flying off the shelves and who cares about insurance. There are millions of diabetics who will try it out of pocket at that cost. Just ask joeypotsandpans about that. At $125/month, insurance coverage will expand dramatically within 12 months. MNKD needs to just drop the price and get the word out and forget about a discount card.
Spiro here, one of the lucky Type 2 diabetics using Afrezza, or should he say, one of the self proclaimed smart enough diabetic to use Afrezza.
|
|
|
|
Post by stevil on Apr 3, 2016 17:05:56 GMT -5
I think this is new today 3 April, at least it shows as new within 24 hours on google. At www.findacode.com/ndc/drugs/Afrezza Afrezza is listed as having National Drug Codes which state Mannkind as the Labeller, with separate codes for the Sanofi labelled product. I assume thats expected with the imminent handover back to Mannkind. However Im not sure of the signifcance, if any, of Mannkind having 5 listed drug codes while Sanofi have only 4 for afrezza. Curious whether that might mean eg a new dose cartridge capacity or pack size? Without a subscription to that site no way to tell. NB the official FDA database which ought to show these codes does not give hits for these, at www.accessdata.fda.gov/scripts/cder/ndc/default.cfm but there is a nitice on their site saying "FDA IT has discovered a processing error affecting the NDC Directory. We have reverted back to the version of the Directory dated 3/18/2016 until the issue is resolved.". Using that site I dont get any hits at all for Afrezza or Mannkind so presumably technical issue. here's a tool to help explain NDC codes. It looks like it's probably a new strength. The last 2 digits (left off from the info you provided), the "package code" is the quantity. So it's not a different quantity, as that would not change the first 2 groups of numbers. It's either a different formulation (unlikely) or a different strength (most likely). Edit: I don't know the legitimacy of the link you provided with the 5 NDC codes, but it could maybe be the oral tab someone was talking about earlier on here... That would be interesting... It seems like that would have to be FDA approved first though and we'd have heard about that by now... |
|
|
|
Post by stevil on Apr 3, 2016 17:32:49 GMT -5
Spiro thinks if MNKD makes Afrezza $125 or so per month, that it will start flying off the shelves and who cares about insurance. There are millions of diabetics who will try it out of pocket at that cost. Just ask joeypotsandpans about that. At $125/month, insurance coverage will expand dramatically within 12 months. MNKD needs to just drop the price and get the word out and forget about a discount card. Spiro here, one of the lucky Type 2 diabetics using Afrezza, or should he say, one of the self proclaimed smart enough diabetic to use Afrezza. I'm not sure what the angst is against using discount cards? If MNKD were really smart, they'd dispense pre-filled scripts to the docs with just the sig missing that had a discount card attached to the script, or maybe even printed on the back. This is a tactic used by Suprep- a bowel prep compound used for colonoscopies. The active ingredient is basically the same thing as what's in Miralax, only with added Magnesium. But the cost for it is probably at least 5x as much, simply because instead of drinking a gallon of the nasty stuff, you only have to drink either 1-2 liters, 2-4 times less (my memory is failing me at the moment). They get around the increased cost by giving docs pre-filled scripts and discount cards. If people can pay the same price and drink 2-4 times less of the nasty solution, they'll choose the better option. It's not hard for a patient to hand the pharmacy either a stapled piece of paper or 2 separate pieces of paper. They have to hand something to the pharmacy anyway. Might as well lower the cost for the patients to free and then $30 thereafter (and keep the extra money from the insurance) rather than charging their patients more and recouping less... I don't think people would mind saving $95/month (using the $30/month max copay as an example) just by handing in an extra piece of paper. I'd do that all day long if I could. I'm sure you know just as well or better than anyone that dosing varies. You shouldn't have flat rates. Some people will need more than one pack and a combination of 2-3 strengths. Insurance is our friend in this instance. MNKD just needs to make more contracts to get added to the formularies. Discount cards are good for MNKD and better for the patients. |
|
|
|
Post by victoria on Apr 3, 2016 17:54:12 GMT -5
For what its worth, the Sanofi NDC codes appear to mean the following (I have not yet found a free access site which is up to date so as to give the details for the Mannkind labelling) however this list will enable later comparison with the mannkind data when the FDA site is back up to date so we can see what new dose or format the fifth code is in the Mannkind portfolio. Data from www.hipaaspace.com/Medical_Billing/Coding/National_Drug_Code/NDC_Number_Lookup.aspxSanofi code 00024-5874-90 unit strength 4, 90 doses 00024-5882-36 unit strength not stated (seems to be a mixed pack of 30 plus 60 doses) 00024-5884-63 unit strength not stated (seems to be a different mixed pack of 30 plus 60 doses) 00024-5894-63 unit strength not stated (but again seems to be a different mixed pack of 30 plus 60 doses) Perhaps someone who has an afrezza prescription can see on the packaging what codes from Sanofi relate to what permutations of cartridge size? Then we will in due course be able to spot what the new Mannkind 'fifth' label relates to more easily. Perhaps its a bulk pack of 12 unit or 8 unit cartridges, which I think is something some users would welcome? So maybe something very slightly splashy willl be announced in terms of a new pack size or strength, soon. |
|
