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Post by agedhippie on May 7, 2016 15:18:40 GMT -5
Dear Mr. Hippie - You say you don't believe scripts will increase significantly with MannKind's new sales force because of the black label that is still attached to Afrezza. Reading through your posts it appears you inject yourself with insulin. Did you have any personal experience with Afrezza you could share here? TIA I have not used it. I did ask my endo for a sample but they (there are 12 endos and 6 CDEs in the practice) are not prescribing it so they didn't have any samples. The pharma sales people never get to talk to the doctors, the closest they get is a CDE. Turns out even if I had got a prescription my insurance would not have covered it. I think Afrezza will take off, I just don't think it will be as quick as people expect and probably not as big. What do I know though, my other big holdings are DVAX and RLYP - I really out to avoid this whole area! |
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Post by kc on May 7, 2016 15:48:16 GMT -5
Dear Mr. Hippie - You say you don't believe scripts will increase significantly with MannKind's new sales force because of the black label that is still attached to Afrezza. Reading through your posts it appears you inject yourself with insulin. Did you have any personal experience with Afrezza you could share here? TIA I have not used it. I did ask my endo for a sample but they (there are 12 endos and 6 CDEs in the practice) are not prescribing it so they didn't have any samples. The pharma sales people never get to talk to the doctors, the closest they get is a CDE. Turns out even if I had got a prescription my insurance would not have covered it. I think Afrezza will take off, I just don't think it will be as quick as people expect and probably not as big. What do I know though, my other big holdings are DVAX and RLYP - I really out to avoid this whole area! Need to send us the name of your Endo And I will see that gets passed along to MannKind. They need to get out and see them to educate them about Afrezza. What city and state was this in? |
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Post by matt on May 7, 2016 17:08:26 GMT -5
The reason script counts are declining is a well-known marketing response. A product gets to a point where no amount of extra advertising and promotion will increase sales, but a decrease in advertising and promotion will decrease sales. There is no magic method to finding the equilibrium level of advertising required to maintain a market.
I am not saying the Sanofi effort was optimal, but by now they have taken their foot off the gas and the Afrezza car is coasting to a stop. That will change when MNKD gets a sales force knocking on doors, but until then scripts will decline. There are lots of salespeople trying to sell lots of drugs to physician offices and until the MNKD sales presence is felt a few loyal prescribers will continue to write but the most will forget about Afrezza. It is true what they say about out of sight, out of mind.
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Post by agedhippie on May 7, 2016 21:49:10 GMT -5
Need to send us the name of your Endo And I will see that gets passed along to MannKind. They need to get out and see them to educate them about Afrezza. What city and state was this in? New York is one of the targeted areas for Mannkind so that group will definitely already be on the hit list for when the sales force start up. They were aware of Afrezza, but also of the trials data and label as well as having some concerns of their own. |
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Post by kc on May 7, 2016 21:54:09 GMT -5
Need to send us the name of your Endo And I will see that gets passed along to MannKind. They need to get out and see them to educate them about Afrezza. What city and state was this in? New York is one of the targeted areas for Mannkind so that group will definitely already be on the hit list for when the sales force start up. They were aware of Afrezza, but also of the trials data and label as well as having some concerns of their own. Send me the group name and I will forward to Matt or Mike C. |
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Post by morfu on May 8, 2016 10:46:45 GMT -5
The script count has only represented a very small part of this uncaptured market.. SNY hardly scratched the surface with their so called marketing... We now have the opportunity to capture this untapped market and show the medical community what Afrezza really is.. The scripts so far I would say mostly account for docs and patients who never understood the drug in the first place or were not that interested.. throw in the fact that insurance companies have been resistant due to the high price, unproven status .. and noninferior label. My dads insurance removed it from the formulary after he had been on it for 5 months which was effective Jan. 1 and could account for some loss of scripts.
I am very happy with what Matt P and Mike Castagna are doing so far.. The lowered price will count substantially toward insurance coverage. Some of the comments Mike has made have stood out to me as a man who "gets" what is going on and what needs to change. So while the loss of scripts does concern me very much,( the SNY debacle was bad for business) it doesnt mean things will remain this way. Well, there is a mismatch between the quoted 15k user and script numbers of 200per week 15k users would need 60k refills per year of the 90 supply or about 1200 per week. We see about half of that (including new presciptions). Also, each week about 20% of the presciptions are new users. One explanation for the mismatch certainly could be a huge dropout rate (which has to be more or less continuous otherwise the trend would look different); another one could be in my opinion, that the counting is off (too low).. It seems to me, that we might have users, which are only counted the first time and their refills are not counted by Symphony. |
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Post by capnbob on May 8, 2016 11:09:39 GMT -5
The script count has only represented a very small part of this uncaptured market.. SNY hardly scratched the surface with their so called marketing... We now have the opportunity to capture this untapped market and show the medical community what Afrezza really is.. The scripts so far I would say mostly account for docs and patients who never understood the drug in the first place or were not that interested.. throw in the fact that insurance companies have been resistant due to the high price, unproven status .. and noninferior label. My dads insurance removed it from the formulary after he had been on it for 5 months which was effective Jan. 1 and could account for some loss of scripts.
I am very happy with what Matt P and Mike Castagna are doing so far.. The lowered price will count substantially toward insurance coverage. Some of the comments Mike has made have stood out to me as a man who "gets" what is going on and what needs to change. So while the loss of scripts does concern me very much,( the SNY debacle was bad for business) it doesnt mean things will remain this way. Well, there is a mismatch between the quoted 15k user and script numbers of 200per week 15k users would need 60k refills per year of the 90 supply or about 1200 per week. We see about half of that (including new presciptions). Also, each week about 20% of the presciptions are new users. One explanation for the mismatch certainly could be a huge dropout rate (which has to be more or less continuous otherwise the trend would look different); another one could be in my opinion, that the counting is off (too low).. It seems to me, that we might have users, which are only counted the first time and their refills are not counted by Symphony. Something else to consider is that when starting new meds, especially something like insulin, the dose will need to be adjusted. That usually means the quantity and the dosing must be changed which, in turn, necessitates writing a new prescription. In other words, a significant number of "new" scripts could be just rewritten "old" scripts. Symphony does have the means to monitor those numbers and does report them to subcscribers who want them. As I recall, Sanofi routinely provides the number when it discusses how toujeo is doing. I don't believe they ever did that for Afrezza, however. |
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Post by agedhippie on May 8, 2016 14:30:42 GMT -5
Something else to consider is that when starting new meds, especially something like insulin, the dose will need to be adjusted. That usually means the quantity and the dosing must be changed which, in turn, necessitates writing a new prescription. In other words, a significant number of "new" scripts could be just rewritten "old" scripts. Symphony does have the means to monitor those numbers and does report them to subcscribers who want them. As I recall, Sanofi routinely provides the number when it discusses how toujeo is doing. I don't believe they ever did that for Afrezza, however. Every doctor is different and I deal mostly with endos but that's not the way it works. You get a prescription based on a low dose dose pattern and then it is adjusted up or down on a daily basis (or every two days for basal insulin) until you are getting the desired results. This whole process should be easier to do with Afrezza because it allows far more room for error so giving someone a mix of 4u and 8u doses and saying take 4u for a small meal and 8u for a big meal may well do it! Either way they will have the numbers set before the first prescription expires. The other factor is that my insulin prescriptions get written for a year (made up of several refills) so I guess that every year there is a new prescription. |
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Post by capnbob on May 8, 2016 19:26:48 GMT -5
Something else to consider is that when starting new meds, especially something like insulin, the dose will need to be adjusted. That usually means the quantity and the dosing must be changed which, in turn, necessitates writing a new prescription. In other words, a significant number of "new" scripts could be just rewritten "old" scripts. Symphony does have the means to monitor those numbers and does report them to subcscribers who want them. As I recall, Sanofi routinely provides the number when it discusses how toujeo is doing. I don't believe they ever did that for Afrezza, however. Every doctor is different and I deal mostly with endos but that's not the way it works. You get a prescription based on a low dose dose pattern and then it is adjusted up or down on a daily basis (or every two days for basal insulin) until you are getting the desired results. This whole process should be easier to do with Afrezza because it allows far more room for error so giving someone a mix of 4u and 8u doses and saying take 4u for a small meal and 8u for a big meal may well do it! Either way they will have the numbers set before the first prescription expires. The other factor is that my insulin prescriptions get written for a year (made up of several refills) so I guess that every year there is a new prescription. A patient starting on a new drug will likely not get a script for a year -- ninety days at best. The logic there is simple enough -- new drug, new dosing, can't tell how patient will respond, need follow up, A1c, etc. Perhaps more importantly, insurance companies have their own sets of rules. Say a script for "x" doses is written with two refills. The patient determines they are needing 2x instead and uses up the refills. Insurance says that a new script must be rewritten for the new "2x" dose if the patient is to get reimbursed. Insurance companies require that for the obvious reason that they need the data for actuarial purposes to predict future demand on their resources from that patient. Regardless, as I pointed out, the numbers that assess the revision of old scripts versus true new scripts are available to MNKD if they want them. |
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Post by sweedee79 on May 9, 2016 12:21:07 GMT -5
Regardless of what the script count is now... it is a new day... I know from personal experience that Afrezza is an amazing drug and I believe in Al Mann's vision as I believe Matt P does as well.. will just have to wait til the rest of the world( yes the world) knows this too...
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Post by seanismorris on May 9, 2016 12:58:00 GMT -5
Al was alway more bullish on Afrezza than Matt...
Matt would frequently have to rain in All projections and enthusiasm when talking with investors. I think everyone agrees that Afrezza addresses an unmet medical need, but getting doctors on board remains an issue (also Afrezzas relatively expensive to make). I'd be happy with Afrezza just paying the bills over at MannKind...
(while funding the other TS opportunities)
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Post by sweedee79 on May 9, 2016 13:57:50 GMT -5
I will be thrilled with getting the bills paid for as well.... Once docs, patients and insurance companies find out what Afrezza really is we can raise the price cuz people and insurance companies will be willing to pay for it.. as well as the other TS drugs in our future pipeline.. we need to establish ourselves.. after that it will be easy compared to what we have been through already.. I am bullish on Afrezza as well.. more neutral on the obstacles we have yet to face..
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Post by peppy on May 9, 2016 14:25:47 GMT -5
Dear Mr. Hippie - You say you don't believe scripts will increase significantly with MannKind's new sales force because of the black label that is still attached to Afrezza. Reading through your posts it appears you inject yourself with insulin. Did you have any personal experience with Afrezza you could share here? TIA I have not used it. I did ask my endo for a sample but they (there are 12 endos and 6 CDEs in the practice) are not prescribing it so they didn't have any samples. The pharma sales people never get to talk to the doctors, the closest they get is a CDE. Turns out even if I had got a prescription my insurance would not have covered it. I think Afrezza will take off, I just don't think it will be as quick as people expect and probably not as big. What do I know though, my other big holdings are DVAX and RLYP - I really out to avoid this whole area! Aged; what do you think about this? your personal take? Pep
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Post by agedhippie on May 9, 2016 15:56:33 GMT -5
I have not used it. I did ask my endo for a sample but they (there are 12 endos and 6 CDEs in the practice) are not prescribing it so they didn't have any samples. The pharma sales people never get to talk to the doctors, the closest they get is a CDE. Turns out even if I had got a prescription my insurance would not have covered it. I think Afrezza will take off, I just don't think it will be as quick as people expect and probably not as big. What do I know though, my other big holdings are DVAX and RLYP - I really out to avoid this whole area! Aged; what do you think about this? your personal take? Pep
On reflection I think it was predictable from the hospital group. The hospital group itself is very cautious but my endo isn't and has happily gone off-label with me in the past. This time he didn't want to do it though which I found concerning. His concern was lung issues and that the trial data said it was equivalent, mostly the risk of lung issues though. I would have liked to have at least tried a sample pack though. |
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Post by peppy on May 10, 2016 6:47:55 GMT -5
Aged; what do you think about this? your personal take? Pep
On reflection I think it was predictable from the hospital group. The hospital group itself is very cautious but my endo isn't and has happily gone off-label with me in the past. This time he didn't want to do it though which I found concerning. His concern was lung issues and that the trial data said it was equivalent, mostly the risk of lung issues though. I would have liked to have at least tried a sample pack though. Thank you for the response aged, I wanted to know what you thought. Here is what I think. I think the American medical association/American diabetes Association are willing to put people on every POS medication there is. Medication that will take out livers and kidneys. Hearts. They seem to be drawing the line at lung delivery, the medication effective. www.idf.org/treatment-algorithm-people-type-2-diabetes
When I was a child, before personal computers and internet, physicians did not have algorithm resources as far as I know, at least not at their finger tips. Medicine has changed. Physicians selling their souls to pharma and routine radioactive imaging sold to the uneducated public as preventative. (Ever ask imaging recipient's about the radioactive agent?)
Amazing to me diabetics accepting some of these medications. Although, the nation has been schooled, have a problem see a doctor, take a pill. Don't ask questions.
Insulin has 256 proteins? Molecular Formula: C257H383N65O77S6 A chain consists of 21 amino acids and the B chain of 30 amino acids. Proteins tell cells what to do.
(One of my personal favorite dumb downs is proteins. Meat is now called protein. Meat is not protein, meat is protein and fat. Ask people, friends and neighbors, that talk about "protein"; what is a protein? a blank stare. Scary, that seems to be the way we like it. What do ingested animal proteins and by consumption ingested animal hormones tell our cells to do? Shoot up your proteins, injection. Put your proteins down the feeding/absorption tube in the center of your body. Talk about proteins ad nauseam as far as genes and genetic bull carp, but do not inhale a protein. Cautious my assets. More like monkey see monkey do. )
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