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Post by agedhippie on Apr 27, 2016 19:10:50 GMT -5
Even though Endos prescribed 40% of the TXs, they were a "secondary" focus to primary care physicians who treated T2 diabetics, by the SNY sales force. Endos are 2X more likely to be early adopters of new medications, have more experience working through prior authorization, and have a staff available to teach dose titration My conclusion: SNY blew off T1s and concentrated their sales efforts on primary care physicians who were less willing to adopt new medications, teach titration, or conduct spirometry tests. Even the Mannkind thought that the market was Type 2 as the USP was seen to be that it was inhaled (no needles!) and since Type 1s have been using pumps and needles for years it was unlikely they would be impressed by no needles. Type 2 diabetics who were just moving to insulin were seen as the target audience since they were thought to be squeamish about needles and would flock to an inhaled insulin. That and the fact that Type 2 make up 80% of the diabetics. My feeling is that endos will be a hard sell. They have definite ideas and are not easily swayed. At the moment there is not the study data to persuade them that Afrezza with a lung risk is superior to injected insulin that they are familiar with. I think they will take it but very slowly while they see how patients cope and if any lung issues materialize. |
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Post by peppy on Apr 27, 2016 19:16:28 GMT -5
I listened to the call, replaying it until I got the information as presented. Here are some items I thought were very important in the short term: Even though Endos prescribed 40% of the TXs, they were a "secondary" focus to primary care physicians who treated T2 diabetics, by the SNY sales force. Endos are 2X more likely to be early adopters of new medications, have more experience working through prior authorization, and have a staff available to teach dose titration My conclusion: SNY blew off T1s and concentrated their sales efforts on primary care physicians who were less willing to adopt new medications, teach titration, or conduct spirometry tests. Yes, this was said. Even though Endos prescribed 40% of the TXs, they were a "secondary" focus to primary care physicians who treated T2 diabetics, by the SNY sales force.
Endos are 2X more likely to be early adopters of new medications, have more experience working through prior authorization, and have a staff available to teach dose titration.
I do not doubt what has been said. I called every endo office in Minneapolis MN. None of them were writing for Afrezza. There is at least one primary care physician writing in Minnesota as reported in a post. Additionally, primary care physicians have spirometry.
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Post by sweedee79 on Apr 27, 2016 19:26:26 GMT -5
I listened to the call, replaying it until I got the information as presented. Here are some items I thought were very important in the short term: Even though Endos prescribed 40% of the TXs, they were a "secondary" focus to primary care physicians who treated T2 diabetics, by the SNY sales force. Endos are 2X more likely to be early adopters of new medications, have more experience working through prior authorization, and have a staff available to teach dose titration My conclusion: SNY blew off T1s and concentrated their sales efforts on primary care physicians who were less willing to adopt new medications, teach titration, or conduct spirometry tests. From personal experiences... SNY didn't concentrate their efforts on primary care physicians in the Dakotas.. the endos were the only ones who had been approached by SNY .. Primary physicians hadn't even heard of it, and would not prescribe without patient seeing an endo first. I'm not sure who they were targeting.. My dad is a T1 .. he was on Afrezza for 5 months until his insurance removed it from the formulary.. I believe it is wise to target the endos first because Afrezza is so different and requires a change from the typical standard of care which primary care physicians wont be so likely to do.. they will send their patient to an endo for this..
I didn't hear this part in the CC yesterday... it surprises me .. since for the past year all I have heard is that endos were the focus... IMO the entire diabetes population should be the target market..
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Post by peppy on Apr 27, 2016 19:50:17 GMT -5
I don't think I am clear on what you said. Are you saying after hearing the conference call that you are thinking the market for Afrezza is smaller than what you thought prior to the call? Would you be able to estimate what proportion of the insulin market Afrezza could possibly capture? Approximately 1.25 million American children and adults have type 1 diabetes. I figure half of them may consider changing.
Type 2 market is: people already on basal and are adding insulin intensification. no clue as to the number of type two's that fit that bill, although there are a couple on the board.
In 2012, 29.1 million Americans, or 9.3% of the population, had diabetes. 318 million people times .09 = 28.6 million - 1.25 million = 27.35 million type 2's how many are up to insulin intensification?
the guidelines www.ndei.org/AACE-guidelines-diabetes-treatment-algorithm.aspx 
regarding type two. A better algorithm. Insulin intensification shown to be added and why.
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Post by Deleted on Apr 27, 2016 20:06:37 GMT -5
My buddy who works at Hedge fund brother in laws mother (i know yahoo message board material) was on Afrezza last year,and her Dr pulled it on her for no reason. She loved it, and went back to the injections and lost control, and finally the Dr offered it back to her. Hes trying to find out more as to why the Dr pulled and then offered back again. What changed? There firm is very short but love how mnkd is trading right now. Everyone should be taking advantage of these swings.
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Post by sportsrancho on Apr 27, 2016 22:15:52 GMT -5
My buddy who works at Hedge fund brother in laws mother (i know yahoo message board material) was on Afrezza last year,and her Dr pulled it on her for no reason. She loved it, and went back to the injections and lost control, and finally the Dr offered it back to her. Hes trying to find out more as to why the Dr pulled and then offered back again. What changed? There firm is very short but love how mnkd is trading right now. Everyone should be taking advantage of these swings. Thanks for the post:-) I believe you, following my instincts. Lol I find it all very interesting. Why he could pull her from something that was working? Why she would let him? And why now he's back into it? Also I wonder when the fund will go long? Lucky you, you'll have a heads up:-) Keep us posted! |
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Post by rockstarrick on Apr 28, 2016 3:52:28 GMT -5
They actually did a good job with the call. Unfortunately the theme was that it will take a while. I've already been here a while. I'm done waiting a while. I'm out and will get back in when the slope on the chart is moving in an upward direction. When the tide turns, trying to get back in will be like trying to get a drink of water from a fire hydrant flowing @ 500gallons/minute. I don't blame you, and wish you the best of luck. My shares are locked up tight, no selling here. |
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Post by anderson on Apr 28, 2016 5:50:45 GMT -5
They actually did a good job with the call. Unfortunately the theme was that it will take a while. I've already been here a while. I'm done waiting a while. I'm out and will get back in when the slope on the chart is moving in an upward direction. When the tide turns, trying to get back in will be like trying to get a drink of water from a fire hydrant flowing @ 500gallons/minute. I don't blame you, and wish you the best of luck. My shares are locked up tight, no selling here. Anyone remember the comedy UHF www.youtube.com/watch?v=OXc5ltzKq3Y |
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Post by prvs on Apr 28, 2016 7:21:19 GMT -5
See Quote
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Post by prvs on Apr 28, 2016 7:23:03 GMT -5
Even though Endos prescribed 40% of the TXs, they were a "secondary" focus to primary care physicians who treated T2 diabetics, by the SNY sales force. Endos are 2X more likely to be early adopters of new medications, have more experience working through prior authorization, and have a staff available to teach dose titration My conclusion: SNY blew off T1s and concentrated their sales efforts on primary care physicians who were less willing to adopt new medications, teach titration, or conduct spirometry tests. Even the Mannkind thought that the market was Type 2 as the USP was seen to be that it was inhaled (no needles!) and since Type 1s have been using pumps and needles for years it was unlikely they would be impressed by no needles. Type 2 diabetics who were just moving to insulin were seen as the target audience since they were thought to be squeamish about needles and would flock to an inhaled insulin. That and the fact that Type 2 make up 80% of the diabetics. My feeling is that endos will be a hard sell. They have definite ideas and are not easily swayed. At the moment there is not the study data to persuade them that Afrezza with a lung risk is superior to injected insulin that they are familiar with. I think they will take it but very slowly while they see how patients cope and if any lung issues materialize. But your feeling contradicts what Mike C said. And Mike C's statement was based on interviewing endos prior to accepting the position at MNKD. If Mike C came to the same conclusions as you did, after interviewing the endos, he probably wouldn't have taken the job Read more: mnkd.proboards.com/post/67915/quote/5496#ixzz477hsWxs5 |
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Post by prvs on Apr 28, 2016 7:34:40 GMT -5
I listened to the call, replaying it until I got the information as presented. Here are some items I thought were very important in the short term: Even though Endos prescribed 40% of the TXs, they were a "secondary" focus to primary care physicians who treated T2 diabetics, by the SNY sales force. Endos are 2X more likely to be early adopters of new medications, have more experience working through prior authorization, and have a staff available to teach dose titration My conclusion: SNY blew off T1s and concentrated their sales efforts on primary care physicians who were less willing to adopt new medications, teach titration, or conduct spirometry tests. Yes, this was said. Even though Endos prescribed 40% of the TXs, they were a "secondary" focus to primary care physicians who treated T2 diabetics, by the SNY sales force.
Endos are 2X more likely to be early adopters of new medications, have more experience working through prior authorization, and have a staff available to teach dose titration.
I do not doubt what has been said. I called every endo office in Minneapolis MN. None of them were writing for Afrezza. There is at least one primary care physician writing in Minnesota as reported in a post. Additionally, primary care physicians have spirometry.
How many of the Endo offices that you called had even heard of Afrezza? It's possible that SNY reps never visited any or most of the endos located in Minneapolis MN. I remember reading a post from a medical worker in N. Dakota who said SNY reps dropped off pamphlets and left, never even talking to the Dr. |
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Post by mnholdem on Apr 28, 2016 7:43:19 GMT -5
I believe that Al Mann would have supported the idea of introducing Afrezza to early diabetics who are reluctant to begin insulin injections but might choose an inhaled insulin. However, Sanofi stabbed Al in the back when they tacked on their 30% premium over the price of RAA insulin pens. That virtually guaranteed that no 3rd Party Payer would cover the cost of Afrezza as a transition from orals to insulin. RAA insulins Novolog and Humalog have a tough enough time getting better tier rating over regular (and cheap) human insulins such as Novalin and Humalin. Afrezza didn't stand a chance.
IMO, once Afrezza is established and generating enough cash flow to support it, a trial specifically design to re-write early diabetes treatment protocols is warranted. Peppy's graphic of the ADA 2016 Guidelines illustrates how diabetes treatment is dominated by powerful pharmaceutical companies with their ultimately ineffective (and often dangerous) initial treatments.
It amazes me how the ADA has turned its back on the multitude of trial results showing 40%-60% drug-free remission of diabetes mellitus following early intensive insulin therapy. In my opinion, the FDA isn't the only organization that may be influenced by a multi-$billion drug industry.
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Post by brentie on Apr 28, 2016 8:23:12 GMT -5
Aren't most Type 2s currently treated with a basal insulin only, instead of mealtime dosing? Al: Yes, but that's the wrong way around. The correct therapy should be a good prandial insulin and not long-term insulin — Afrezza in particular because it turns off glucose production and delivery from the liver. Our latest trials of 600 patients are showing even more significant benefits from the product than our original trials; the most recent trial appears to show that this should replace frontline treatment for all Type 2 patients.
www.healthline.com/diabetesmine/the-truth-about-afresa-inhalable-insulin-a-chat-with-al-mann#3
SF: Some studies or most of the studies have shown that type 2 diabetes starts as a post prandial disease. Would it make more sense to start a type 2 on a post prandial insulin or on a prandial insulin, rather than even a basal insulin?
AM: The first loss in type 2 is really the early phase 1 pancreatic spike and that is then followed by loss of the phase 2 prandial insulin. Almost all postprandial issues are from use of current prandial insulins. What is needed first in type 2 should be a very fast acting prandial insulin, not a basal insulin. Afrezza provides insulin kinetics close to the kinetics of pancreatic insulin in response to a glucose spike. Afrezza should be the first insulin employed and that should actually be prescribed in early type 2.
www.diabetesincontrol.com/an-exclusive-interview-with-al-mann-founder-and-ceo-mannkind-corp/ |
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Post by peppy on Apr 28, 2016 8:49:18 GMT -5
Aren't most Type 2s currently treated with a basal insulin only, instead of mealtime dosing?Al: Yes, but that's the wrong way around. The correct therapy should be a good prandial insulin and not long-term insulin — Afrezza in particular because it turns off glucose production and delivery from the liver. Our latest trials of 600 patients are showing even more significant benefits from the product than our original trials; the most recent trial appears to show that this should replace frontline treatment for all Type 2 patients. www.healthline.com/diabetesmine/the-truth-about-afresa-inhalable-insulin-a-chat-with-al-mann#3SF: Some studies or most of the studies have shown that type 2 diabetes starts as a post prandial disease. Would it make more sense to start a type 2 on a post prandial insulin or on a prandial insulin, rather than even a basal insulin? AM: The first loss in type 2 is really the early phase 1 pancreatic spike and that is then followed by loss of the phase 2 prandial insulin. Almost all postprandial issues are from use of current prandial insulins. What is needed first in type 2 should be a very fast acting prandial insulin, not a basal insulin. Afrezza provides insulin kinetics close to the kinetics of pancreatic insulin in response to a glucose spike. Afrezza should be the first insulin employed and that should actually be prescribed in early type 2. www.diabetesincontrol.com/an-exclusive-interview-with-al-mann-founder-and-ceo-mannkind-corp/ Here is the problem, physicians have guidelines. The guidelines need to be changed for mealtime insulin and type 2 diabetes in order for that to happen. screencast.com/t/w4oza32Gc The guidelines are to use a lot of my mouth medications before insulin. The world did not have this type of fast acting insulin prior to 2015. Only the USA has it now.
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Post by Deleted on Apr 28, 2016 8:54:23 GMT -5
I believe that Al Mann would have supported the idea of introducing Afrezza to early diabetics who are reluctant to begin insulin injections but might choose an inhaled insulin. However, Sanofi stabbed Al in the back when they tacked on their 30% premium over the price of RAA insulin pens. That virtually guaranteed that no 3rd Party Payer would cover the cost of Afrezza as a transition from orals to insulin. RAA insulins Novolog and Humalog have a tough enough time getting better tier rating over regular (and cheap) human insulins such as Novalin and Humalin. Afrezza didn't stand a chance. IMO, once Afrezza is established and generating enough cash flow to support it, a trial specifically design to re-write early diabetes treatment protocols is warranted. Peppy's graphic of the ADA 2016 Guidelines illustrates how diabetes treatment is dominated by powerful pharmaceutical companies with their ultimately ineffective (and often dangerous) initial treatments. It amazes me how the ADA has turned its back on the multitude of trial results showing 40%-60% drug-free remission of diabetes mellitus following early intensive insulin therapy. In my opinion, the FDA isn't the only organization that may be influenced by a multi-$billion drug industry.
The Heroin epidemic going on in the US today has all started from big Pharma and prescription drugs. People are dying all over the country (good young kids that dont know better)because they get hooked on pain killers from a Dr's prescription and eventually cannot afford them and climb up the ladder to Heroin. It goes so far beyond a better diabetes medication....... |
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