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Post by agedhippie on May 11, 2016 20:39:44 GMT -5
I can see your point, but I can't help thinking that if the CEO that actually signed the deal with MNKD would've still been there, things would've played out completely different. Brandicourt has single handedly destroyed sanofis diabetes franchise in my opinion, when the FDA does the post approval safety profile on Toujeo, Sanofi could be hit with tougher label restrictions for Toujeo. I have read numerous testimonials from PWD using Toujeo claiming it doesn't last 24 hours, and due to the concentration, some are building up a resistance to it quickly. Sorry for the rant, this is just the way I see it. I agree completely. It the original CEO was still in place I think this would have played out differently and Afrezza would have had a different profile within the company. Yes Toujeo would have remained the priority because basal is the cash cow, but I think they would have promoted Afrezza over Apidra. I would be quite surprised if Toujeo really does last 24 hours since Lanutus doesn't quite manage it and Toujeo is just Lantus but less diluted. It has a role for people who need big doses but for the most part Lantus is just as good. The occasional rant is good!
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Post by buyitonsale on May 11, 2016 23:04:13 GMT -5
I don't know if it has been suggested before, but I think that MNKD should give the drug away for free (or almost for free) until they build up at least 15K TRx per week volume for at least 6 consecutive months. Once the patients, doctors and insurance companies see the benefits of Afrezza, they will have much easier time negotiating the coverage and eventually get paid. There is no more margin for error (i.e. failure) at this point. They need 12K to 15K Trx per week to stay afloat. All the grand estimates I keep reading about here are nonsense and not realistic based on how difficult and expensive is for patients to get it. Script counts is what will put this company back in business, even if they give it away at first. The alternative is not pretty. Just my opinion.
P.S. I want to clarify that the discount card is not going to cut it IMO, because it only works when insurance covers Afrezza. That is my understanding. So, covered or not, give the drug to patients for free.
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Post by tripoley on May 12, 2016 6:26:56 GMT -5
I'm going to say something that will be fairly unpopular at this point. I seriously doubt any of the big pharmas saw Afrezza as any sort of risk at all. The trial data said it was equivalent to analogs in which case the USP was that it was inhaled and the big pharmas did not see that as a huge benefit (I think rightly). Sanofi knew going into this that the label was bad and so getting it broadly accepted by insurers was going to be a stretch without having to drop the price. To mitigate that they bumped the price up to compensate (the price to the Sanofi is set by Mannkind in the Supply Agreement) to try and make it a low volume/high value product. By now it was becoming clear that the doctors were also a problem because the label was worse than for the insulin analogs together with the lung test requirement. Enter the new CEO who wants to review everything the diabetes division is doing to find cost savings because they are his most dysfunctional division. With costs probably running an order of magnitude higher than revenue Afrezza must have stood out like a sore thumb - high expense/low revenue. On the other hand they were tied into a contract until January so they adhered to the letter of the contract and did the bare minimum required to meet the contract. In the short term, and maybe medium term Afrezza did not threaten the established insulins, in the longer term it did but nobody looks that far out as to much can change. The only insulin at risk was Apidra which was the runt of the analog litter, Sanofi would have happily killed that if Afrezza took off. There was no serious threat to Lantus/Toujeo as they have different roles. Afrezza may have reduced the Lantus use by patients, but that is because they were using to much Lantus all along. Simple basal testing would have given substantially the same result - you see the same thing when people move to pumps, their basal requirement drops because their meal time insulin is properly covered (basal is partially used to cover meals which is bad practice) This is all 20:20 hindsight, I never saw any of this at the time and was caught completely flat-footed when Sanofi exited! I would like to think it was all a massive conspiracy but I seriously doubt it was - the truth is usually mundane. I can see your point, but I can't help thinking that if the CEO that actually signed the deal with MNKD would've still been there, things would've played out completely different. Brandicourt has single handedly destroyed sanofis diabetes franchise in my opinion, when the FDA does the post approval safety profile on Toujeo, Sanofi could be hit with tougher label restrictions for Toujeo. I have read numerous testimonials from PWD using Toujeo claiming it doesn't last 24 hours, and due to the concentration, some are building up a resistance to it quickly. Then I keep reflecting on the testimonies from the many Healthcare Professionals that spoke at the afrezza FDA ADCOM, unanimously they all agreed that afrezza, in combination with current therapies, would positively enhance the treatment programs for at least some PWD. So yes, I agree, afrezza was no threat to the basal insulin market and should've been viewed as a tool that would enhance insulin therapy, and as an alternative option to those who don't like injections at mealtime. I guess the thing that bothers me the most, is there are people using afrezza that claim they are no longer held hostage from their diabetes, and if afrezza had been aggressively marketed, how many more would experience this new found freedom ?? What a complete shame it would be if they now, because of Sanofi, lost it. How long until somebody has the funds and tenacity of Al Mann to bring inhaled insulin back to the market ?? All the "big boys" tapped out after Exhubra, they aren't willing to risk the possibility of failing even though they know current therapies, as good as they are, still aren't good enough, they're on cruise control. Nearly every advancement in Diabetes care in the last 20 years has Al Manns hard earned money and his time deeply invested in it, he cared, he was trying to make life better for these people. You would think a leader in Diabetes therapy like Sanofi would've put a little more effort into it, 3 or 4 months of doing just enough to satisfy their obligation, then pull the plug. Disgusting in my opinion, Sanofi doesn't care about PWD, they care about capitolizing on their disease. I hope they sink to the bottom, they disgust me. Sorry for the rant, this is just the way I see it. Good Luck In a T2, Afrezza is a threat to every other diabetes med. SNY couldn't have Afrezza cannibalizing all their other diabetes sales, especially Toujeo.
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Post by agedhippie on May 12, 2016 7:28:49 GMT -5
In a T2, Afrezza is a threat to every other diabetes med. SNY couldn't have Afrezza cannibalizing all their other diabetes sales, especially Toujeo. Properly priced Afrezza is a threat to the newer Type 2 diabetes drugs - absolutely. It's impact on Toujeo (and other basal insulins) would not be noticeable since they have different roles and the standard of care says basal insulin should be used first. Once basal fails then the next step is to add prandial insulin, not discontinue basal insulin. The reason it would not wipe out the other drugs (other than metformin I would be happy if it did) is compliance. A weekly shot is an easier sell than a 3+ times a day inhaler. Even daily dosing is better. It would be interesting to see what sort of impact you could get taking Afrezza once a day just for the biggest meal rather than taking other drugs - that would combine convenience with effect.
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Post by tripoley on May 12, 2016 8:21:38 GMT -5
In a T2, Afrezza is a threat to every other diabetes med. SNY couldn't have Afrezza cannibalizing all their other diabetes sales, especially Toujeo. Properly priced Afrezza is a threat to the newer Type 2 diabetes drugs - absolutely. It's impact on Toujeo (and other basal insulins) would not be noticeable since they have different roles and the standard of care says basal insulin should be used first. Once basal fails then the next step is to add prandial insulin, not discontinue basal insulin. The reason it would not wipe out the other drugs (other than metformin I would be happy if it did) is compliance. A weekly shot is an easier sell than a 3+ times a day inhaler. Even daily dosing is better. It would be interesting to see what sort of impact you could get taking Afrezza once a day just for the biggest meal rather than taking other drugs - that would combine convenience with effect. The standard of care is based on convenience. Starting a once or twice a day basal is a much easier sell than 3+ shots per day that have to be titrated, taken at a precise time and risk hypoglycemia, etc. in reality the deficit in a T2 is first phase insulin which Afrezza replaces exactly. If you can remember to eat then you can remember to take Afrezza. And trust me, T2s remember to eat.
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Post by tripoley on May 12, 2016 8:31:04 GMT -5
In a T2, Afrezza is a threat to every other diabetes med. SNY couldn't have Afrezza cannibalizing all their other diabetes sales, especially Toujeo. It would be interesting to see what sort of impact you could get taking Afrezza once a day just for the biggest meal rather than taking other drugs - that would combine convenience with effect. Ive actually had this thought. Take Afrezza with the biggest meal of the day and see the effect on HgbA1cs three months down the road. This might work wonders in a prediabetic or newly diagnosed T2 whose pancreas isn't quite shot yet. The T2s going on insulin have failed every other and multiple diabetes meds and their pancreas has lost first phase, probably second phase and basal secretion isn't so hot either. At this point all meals need to be covered.
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Post by rockstarrick on May 12, 2016 8:58:33 GMT -5
I can see your point, but I can't help thinking that if the CEO that actually signed the deal with MNKD would've still been there, things would've played out completely different. Brandicourt has single handedly destroyed sanofis diabetes franchise in my opinion, when the FDA does the post approval safety profile on Toujeo, Sanofi could be hit with tougher label restrictions for Toujeo. I have read numerous testimonials from PWD using Toujeo claiming it doesn't last 24 hours, and due to the concentration, some are building up a resistance to it quickly. Then I keep reflecting on the testimonies from the many Healthcare Professionals that spoke at the afrezza FDA ADCOM, unanimously they all agreed that afrezza, in combination with current therapies, would positively enhance the treatment programs for at least some PWD. So yes, I agree, afrezza was no threat to the basal insulin market and should've been viewed as a tool that would enhance insulin therapy, and as an alternative option to those who don't like injections at mealtime. I guess the thing that bothers me the most, is there are people using afrezza that claim they are no longer held hostage from their diabetes, and if afrezza had been aggressively marketed, how many more would experience this new found freedom ?? What a complete shame it would be if they now, because of Sanofi, lost it. How long until somebody has the funds and tenacity of Al Mann to bring inhaled insulin back to the market ?? All the "big boys" tapped out after Exhubra, they aren't willing to risk the possibility of failing even though they know current therapies, as good as they are, still aren't good enough, they're on cruise control. Nearly every advancement in Diabetes care in the last 20 years has Al Manns hard earned money and his time deeply invested in it, he cared, he was trying to make life better for these people. You would think a leader in Diabetes therapy like Sanofi would've put a little more effort into it, 3 or 4 months of doing just enough to satisfy their obligation, then pull the plug. Disgusting in my opinion, Sanofi doesn't care about PWD, they care about capitolizing on their disease. I hope they sink to the bottom, they disgust me. Sorry for the rant, this is just the way I see it. Good Luck In a T2, Afrezza is a threat to every other diabetes med. SNY couldn't have Afrezza cannibalizing all their other diabetes sales, especially Toujeo. As it should be, t2 drugs are tough drugs IMO, my father is on metformin, he hates it.
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ben
Newbie
Posts: 12
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Post by ben on May 13, 2016 9:10:34 GMT -5
www.activatethecard.com/7055/#
It's been mentioned on the board a few times now. MNKD has issued an Afrezza patient savings card. First fill $0, refills no more than $30 I have this card and it is somewhat misleading. There is a max discount of $150. So, most people end up paying more like $100 out of pocket than $0 or $30. At least that was my experience. They really need insurance to start covering it.
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Deleted
Deleted Member
Posts: 0
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Post by Deleted on May 13, 2016 9:30:42 GMT -5
www.activatethecard.com/7055/#
It's been mentioned on the board a few times now. MNKD has issued an Afrezza patient savings card. First fill $0, refills no more than $30 I have this card and it is somewhat misleading. There is a max discount of $150. So, most people end up paying more like $100 out of pocket than $0 or $30. At least that was my experience. They really need insurance to start covering it. What would it be if you get a prescription refill for each month? I guess all chronic ones are for 3 month?
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ben
Newbie
Posts: 12
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Post by ben on May 13, 2016 9:44:18 GMT -5
I have this card and it is somewhat misleading. There is a max discount of $150. So, most people end up paying more like $100 out of pocket than $0 or $30. At least that was my experience. They really need insurance to start covering it. What would it be if you get a prescription refill for each month? I guess all chronic ones are for 3 month? It's been a couple months since I last filled an RX. But, if I remember correctly, my RX is for 90-4u cartridges which is a 1 month RX but lasts longer. Every time I fill it, it's about $100. I'm not sure if a 3month RX is available, but I have to imagine it is. If that's the case, though, the card only knocks $150 off the price. So, I believe it would be cheaper to fill 3 RXs getting the $150 discount each time than filling it one time every 3 months and getting the $150 savings only once?
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