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Post by nylefty on Mar 24, 2016 21:42:17 GMT -5
I just checked some of the largest states on forumularylookup.com and see that more than half of "commercial lives" have "unrestricted access" to Afrezza in Massachusetts, Maryland and Tennessee, three states where the average diabetic is much better off than in Virginia or California.
Maybe Vdex should open some clinics in MA or MD.
"Commercial lives" with unrestricted access to Afrezza:
Massachusetts: 59 percent
Maryland: 58 percent
Tennessee: 55 percent
Pennsylvania: 48 percent
Florida: 43 percent
Washington: 38 percent
New York: 37 percent
Arizona: 36 percent
Ohio: 36 percent
North Carolina: 33 percent
Georgia: 33 percent
New Jersey: 31 percent
Texas: 31 percent
Indiana: 29 percent
Illinois: 28 percent
Wisconsin: 27 percent
Michigan: 24 percent
Missouri: 24 percent
California: 23 percent
Virginia: 22 percent
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Post by nylefty on Mar 25, 2016 14:21:44 GMT -5
I should have added that, although Afrezza is on the unrestricted list on many insurance plans, it's usually on
Tier 3, which means that its co-pay is higher than competitive drugs on Tier 2. So MannKind needs to convince many more plans to move Afrezza to Tier 2. The most obvious way to do that is to reduce its price.
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Post by mnholdem on Mar 25, 2016 14:23:47 GMT -5
Please note that the full list is displayed in Formulary Tracker - Plan Coverage for Afrezza
...and is updated monthly by state. |
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Post by matt on Mar 25, 2016 15:10:40 GMT -5
Getting Afrezza on the formulary is one trick, getting the VDEX doctors enrolled onto each insurer's open panels is another. It doesn't help to have the drug covered if the physician is out of network. It would be interesting to compare both formularies and networks for overlap.
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Post by dreamboatcruise on Mar 25, 2016 15:48:44 GMT -5
I should have added that, although Afrezza is on the unrestricted list on many insurance plans, it's usually on Tier 3, which means that its co-pay is higher than competitive drugs on Tier 2. So MannKind needs to convince many more plans to move Afrezza to Tier 2. The most obvious way to do that is to reduce its price. Tier 3 shouldn't pose much of a problem since the discount card would cover the difference for the patient. We can live with Tier three, just not all the authorization hoops that need be jumped through. |
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Post by nylefty on Mar 25, 2016 19:34:14 GMT -5
I should have added that, although Afrezza is on the unrestricted list on many insurance plans, it's usually on Tier 3, which means that its co-pay is higher than competitive drugs on Tier 2. So MannKind needs to convince many more plans to move Afrezza to Tier 2. The most obvious way to do that is to reduce its price. Tier 3 shouldn't pose much of a problem since the discount card would cover the difference for the patient. We can live with Tier three, just not all the authorization hoops that need be jumped through. Of course there are no authorization hoops to jump through if Afrezza is on an unrestricted list. |
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Post by traderdennis on Mar 28, 2016 11:15:06 GMT -5
Tier 3 shouldn't pose much of a problem since the discount card would cover the difference for the patient. We can live with Tier three, just not all the authorization hoops that need be jumped through. Of course there are no authorization hoops to jump through if Afrezza is on an unrestricted list. Being on Tier 3 does not equal unrestricted access. I have ED and switched insurance. The number of hoops to get a RX for generic viagra are insane with this company. Insurance compaines are always going to be a financial gatekeeper. I have said it before, Mannkind needs to run an internal study with a large enough insurer to prove that type 1's average costs of emergency room lows will make up for the extra cost of Afrezza. Mannkind should provide the drug to the insurance company at cost in exchange for the data in the study to sell to other providers. This will put Afrezza at an equal or better net cost versus regular insulins. This is the key to then sell, I have this insulin that in the long run is cheaper than generics due to less emergency room visits, now look at the advanced pharmacological advantage of this product and it would be a no brainer, hell it would be the insurance company's fiduciary duty to provide Afrezza at tier 2/1. Unfortunately it is a long road to hoe, and should of been done with Sanofi in early 2015. |
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Post by nylefty on Mar 28, 2016 12:25:08 GMT -5
Of course there are no authorization hoops to jump through if Afrezza is on an unrestricted list. Being on Tier 3 does not equal unrestricted access. I have ED and switched insurance. The number of hoops to get a RX for generic viagra are insane with this company. Insurance compaines are always going to be a financial gatekeeper. I have said it before, Mannkind needs to run an internal study with a large enough insurer to prove that type 1's average costs of emergency room lows will make up for the extra cost of Afrezza. Mannkind should provide the drug to the insurance company at cost in exchange for the data in the study to sell to other providers. This will put Afrezza at an equal or better net cost versus regular insulins. This is the key to then sell, I have this insulin that in the long run is cheaper than generics due to less emergency room visits, now look at the advanced pharmacological advantage of this product and it would be a no brainer, hell it would be the insurance company's fiduciary duty to provide Afrezza at tier 2/1. Unfortunately it is a long road to hoe, and should of been done with Sanofi in early 2015. Express Scripts has 100% unrestricted coverage for Afrezza in every state I checked, but in every state Afrezza is on Tier 3. Express Scripts covers prescription drugs, not emergency room visits. Why would it care if Afrezza cut down on ER visits? |
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Post by traderdennis on Mar 28, 2016 12:36:46 GMT -5
Being on Tier 3 does not equal unrestricted access. I have ED and switched insurance. The number of hoops to get a RX for generic viagra are insane with this company. Insurance compaines are always going to be a financial gatekeeper. I have said it before, Mannkind needs to run an internal study with a large enough insurer to prove that type 1's average costs of emergency room lows will make up for the extra cost of Afrezza. Mannkind should provide the drug to the insurance company at cost in exchange for the data in the study to sell to other providers. This will put Afrezza at an equal or better net cost versus regular insulins. This is the key to then sell, I have this insulin that in the long run is cheaper than generics due to less emergency room visits, now look at the advanced pharmacological advantage of this product and it would be a no brainer, hell it would be the insurance company's fiduciary duty to provide Afrezza at tier 2/1. Unfortunately it is a long road to hoe, and should of been done with Sanofi in early 2015. Express Scripts has 100% unrestricted coverage for Afrezza in every state I checked, but in every state Afrezza is on Tier 3. Express Scripts covers prescription drugs, not emergency room visits. Why would it care if Afrezza cut down on ER visits?
Express scripts could care less. BC/BS, Aetna, or other health insurance provider writes their RX plan based on their cost of doing business. If they can net out $3 for ever $1 spent on Afrezza, you bet the tier level will change. Even though it is on Tier 3 now, in almost all cases it will take a pre authorization. Pre Authorizations are the norm in the insurance industry in the US now. If you think just because we are on Tier 3 right now on most policies, that alone will not generate more sales. |
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Post by nylefty on Mar 28, 2016 13:13:15 GMT -5
"Even though it is on Tier 3 now, in almost all cases it will take a pre authorization."
Wrong. When formularylookup.com lists a drug as having "unrestricted" coverage it means that NO pre-authorization is required. Express Scripts lists Afrezza as requiring NO pre-authorization, but it does require a higher co-payment than it does for competitive drugs on Tier 2.
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Post by traderdennis on Mar 28, 2016 15:17:23 GMT -5
"Even though it is on Tier 3 now, in almost all cases it will take a pre authorization." Wrong. When formularylookup.com lists a drug as having "unrestricted" coverage it means that NO pre-authorization is required. Express Scripts lists Afrezza as requiring NO pre-authorization, but it does require a higher co-payment than it does for competitive drugs on Tier 2. I wish you luck, do your DD. I am a sample of one and am suprised how much pre authorization it is taking on my current plan for drugs that are more benign than Afreezra. I wish I had followed what I had said a year ago. |
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