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Post by boomboom on Apr 14, 2016 9:47:15 GMT -5
I hope once VDEX grounds itself it starts moving to the South. Looks like the bulk of the diabetic population resides there. Looks like Texas (probably Houston) would be a great choice. Have they mentioned why New Jersey was chosen, first? Nice heat map provided by CDC below.... www.cdc.gov/diabetes/atlas/obesityrisk/atlas.html |
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Post by peppy on Apr 14, 2016 9:50:12 GMT -5
I hope once VDEX grounds itself it starts moving to the South. Looks like the bulk of the diabetic population resides there. Looks like Texas (probably Houston) would be a great choice. Have they mentioned why New Jersey was chosen, first? Nice heat map provided by CDC below.... www.cdc.gov/diabetes/atlas/obesityrisk/atlas.htmlThe east coast is population dense. Manhattan, right next door.
(most of the people do not eat at home.)
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Post by nylefty on Apr 14, 2016 10:14:49 GMT -5
I hope once VDEX grounds itself it starts moving to the South. Looks like the bulk of the diabetic population resides there. Looks like Texas (probably Houston) would be a great choice. Have they mentioned why New Jersey was chosen, first? - Might it be as simple as the people behind VDEX live in New Jersey? I started a business in New York because I lived in New York. Steve Jobs and Steve Wozniak started Apple in California because they lived in California, etc. |
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Post by boomboom on Apr 14, 2016 10:28:46 GMT -5
I hope once VDEX grounds itself it starts moving to the South. Looks like the bulk of the diabetic population resides there. Looks like Texas (probably Houston) would be a great choice. Have they mentioned why New Jersey was chosen, first? - Might it be as simple as the people behind VDEX live in New Jersey? I started a business in New York because I lived in New York. I did think of that, as well. But if I was going into a business without a product thats already flying off the shelves I would think I would want it at a location that would have the most demand density. I think I also have to keep in mind this is not just for Afrezza which is something I am finding hard for myself to decouple. I am sure there are a lot of factors I am overlooking. Would just love to hear it from the source |
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Post by nylefty on Apr 14, 2016 10:43:11 GMT -5
Vdex has all the markings of a shoestring operation with limited funds. At this point (if I was behind it) I wouldn't pull up roots, leaving behind my home, my friends and relatives, and (possibly) my day job to move to Texas, where I knew no one.
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Post by factspls88 on Apr 14, 2016 13:17:00 GMT -5
Nice chart - thanks for posting. It could be that in NJ there is a high concentration of diabetics in a small area who could easily access the facility. It could be for other reasons as others have surmised, but I'd like to think they put some thought into their site selection.
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Post by dreamboatcruise on Apr 14, 2016 15:28:52 GMT -5
States vary a lot in what percentage of population has unrestricted access to Afrezza on insurance plans. It might be wise for them to focus on that as part of their criteria. If in a particular state more than half of patients had access without the hassle of paperwork, doctors would probably be more open to start utilizing it as a regular part of their practice.
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Post by mnholdem on Apr 14, 2016 17:06:38 GMT -5
Perhaps the number of healthcare plans that provide unrestricted access to Afrezza was considered...
NEW JERSEY
Payer/PBM | # of Commercial Plans ● Status
Express Scripts PBM |128 plans ● 100% Covered
Catamaran | 5 plans ● 100% Covered
EmblemHealth, Inc. | 1 plan ● 100% Covered
State of New Jersey | 1 plan ● 100% Covered
Open Formulary PBM | 1 plan ● Covered
General Prescription Programs PBM | 1 plan ● Covered
In addition to 31% of commercial plans having unrestricted access to Afrezza, New Jersey also has unrestricted access for:
● 21% of Medicare lives ● 100% of State Medicaid lives (1 plan)
0% Health Exchange lives 0% Managed Medicaid lives
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Post by LosingMyBullishness on Apr 14, 2016 17:34:51 GMT -5
Perhaps the number of healthcare plans that provide unrestricted access to Afrezza was considered...
NEW JERSEY
Payer/PBM | # of Commercial Plans ● Status
Express Scripts PBM |128 plans ● 100% Covered
Catamaran | 5 plans ● 100% Covered
EmblemHealth, Inc. | 1 plan ● 100% Covered
State of New Jersey | 1 plan ● 100% Covered
Open Formulary PBM | 1 plan ● Covered
General Prescription Programs PBM | 1 plan ● Covered
In addition to 31% of commercial plans having unrestricted access to Afrezza, New Jersey also has unrestricted access for:
● 21% of Medicare lives ● 100% of State Medicaid lives (1 plan)
0% Health Exchange lives 0% Managed Medicaid lives
Sorry for my ignorance as a European. What is a commercial plan? |
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Post by mnholdem on Apr 14, 2016 20:05:03 GMT -5
Commercial health insurance is a type of health insurance that covers medical expenses and disability income for the insured. Commercial health insurance can be categorized according to its renewal provisions and type of medical benefits provided. Commercial policies can be sold individually or as part of a group plan. Commercial health insurance policies are sold by for-profit carriers. They are usually sold by agents and brokers, but can also be purchased directly from the carrier in many instances. These policies vary widely in the amount and types of specific coverage that they provide.
Most businesses (large or small) in United States enroll their employees in commercial health insurance plans. Federal/state employees are typically enrolled in other plans.
Because of the aging population within the U.S., Medicare & Medicaid (government-run plans) are huge and, because these formularies are determined by government agencies, these plans often require the steepest price discounts.
FormularyLookup.com categorizes healthcare plans into what it calls "channels":
• Commercial
• Medicare
• State Medicaid
• Health Exchange (e.g. Plan options set up in each state under the Affordable Care Act)
• Managed Medicaid
This is just a thumbnail sketch, but I hopefully answered your question.
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Post by LosingMyBullishness on Apr 15, 2016 7:55:11 GMT -5
Commercial health insurance is a type of health insurance that covers medical expenses and disability income for the insured. Commercial health insurance can be categorized according to its renewal provisions and type of medical benefits provided. Commercial policies can be sold individually or as part of a group plan. Commercial health insurance policies are sold by for-profit carriers. They are usually sold by agents and brokers, but can also be purchased directly from the carrier in many instances. These policies vary widely in the amount and types of specific coverage that they provide.
Most businesses (large or small) in United States enroll their employees in commercial health insurance plans. Federal/state employees are typically enrolled in other plans.
Because of the aging population within the U.S., Medicare & Medicaid (government-run plans) are huge and, because these formularies are determined by government agencies, these plans often require the steepest price discounts.
FormularyLookup.com categorizes healthcare plans into what it calls "channels":
• Commercial
• Medicare
• State Medicaid
• Health Exchange (e.g. Plan options set up in each state under the Affordable Care Act)
• Managed Medicaid
This is just a thumbnail sketch, but I hopefully answered your question.
Thanks. So Express Script offers 128 different commercial plans to business es and in each one Afrezza is covered? Is this how to read it? |
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Post by mnholdem on Apr 15, 2016 9:27:51 GMT -5
Correct. Covered with no restrictions. That description, by itself, does not detail what tier level and accompanying co-pay each plan has assigned to Afrezza, so the treatment can still be quite expensive out-of-pocket for the patient.
The best designation for any channel would be the Preferred tier. In New Jersey, according to FormularyLookup.com, commercial plans have assigned Preferred status to Afrezza for only 1% of commercial lives.
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Post by jerrys on Apr 15, 2016 10:09:49 GMT -5
Correct. Covered with no restrictions. That description, by itself, does not detail what tier level and accompanying co-pay each plan has assigned to Afrezza, so the treatment can still be quite expensive out-of-pocket for the patient. The best designation for any channel would be the Preferred tier. In New Jersey, according to FormularyLookup.com, commercial plans have assigned Preferred status to Afrezza for only 1% of commercial lives. This link takes you to the Express Scripts Federal Pharmacy Services/Tricare formulary search page. I presume this would be their "best" coverage. Searched for 4U ninety day supply; it says:
www.express-scripts.com/static/formularySearch/2.2/#/formularySearch/drugSearch?accessLink=FSTResults
I presume this would be their "best" coverage. Searched for 4U ninety day supply; it says:
"AfrezzaBrand View other alternatives
4 Unit Cartridge, With Inhalation Device
Note:Your doctor must fill out a form for you to take this medication.
Pharmacy
Is this drug covered?
[Your plan provides coverage for this medication in certain situations. To determine if coverage is available, your doctor may request a coverage review by calling the toll-free number, 1-866-684-4488.
This medication is covered for the member/cardholder only.
Please note that the coverage terms of this prescription benefit are subject to change.
You Pay
Military Pharmacy (MTF) Is this drug covered? Yes, with limitations Check Local Formulary These drugs may or may not be available at your local MTF pharmacy so check with your specific location to be sure. Additionally note that Generic products are preferred and their brand counterparts may not be stocked.
Home Delivery Pharmacy Up to 90 days supply YES, with limitations Coverage notes active duty $0.00 non-active $20.00
Retail Network Pharmacy Up to 30 days supply YES with limitations Coverage notes active duty $0.00 non-active $24.00
$0.00 $24.00
Are there forms my doctor may need to fill out?
Yes
Prior Authorization form:
www.express-scripts.com/api/formularySearch/1/formularySearch/drug/forms/EIS_P8_DC:esiCPS/%7BC5F697B0-FB57-4686-8181-0ED7FFCDA643%7D
Applies to the above limitations."
The PA form is interesting in that it allows the individual filling it out to pretty much determine for themselves whether they will get approval -- for example:
"Is Afrezza being added to current basal insulin therapy?
Yes
SKIP to question 9 on page 2
No
STOP
Coverage not approved"
I would be inclined to presume that similar restrictions exist for other plans where it's covered. I couldn't find afrezza in any of the other plans -- e..g. "2016 Express Scripts National Preferred Formulary":
www.express-scripts.com/art/open_enrollment/Formulary_PRDEUNVSTY.pdf
...nor in their most recent (March, 2016) Medicare formulary:
www.express-scripts.com/art/medicare16/pdf/16pdp_formulary_choice.pdf
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Post by Deleted on Apr 15, 2016 10:56:37 GMT -5
Vdex has all the markings of a shoestring operation with limited funds. At this point (if I was behind it) I wouldn't pull up roots, leaving behind my home, my friends and relatives, and (possibly) my day job to move to Texas, where I knew no one. Hell has frozen over. I actually agree with something you said. |
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Post by mnholdem on Apr 15, 2016 11:26:05 GMT -5
Vdex has all the markings of a shoestring operation with limited funds. At this point (if I was behind it) I wouldn't pull up roots, leaving behind my home, my friends and relatives, and (possibly) my day job to move to Texas, where I knew no one. Hell has frozen over. I actually agree with something you said. Hell has frozen over? Wow! That means the Vikings will win the Superbowl this year!  |
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