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Post by oldfishtowner on May 31, 2016 9:49:36 GMT -5
Will they wait till MNKD has the titration pack ready to distributed before they push for prescriptions? Also it would seem they need the new sample packs as well before they get the ball rolling. I may be wrong, but I thought they said at the share holders meeting these were ready to roll with our name on the package. Please correct me if I am wrong. Ty. I thought that MNKD couldn't sell its own product until 6 months after the notification date and this is why the 3Q target. If so, sales of MNKD product should begin in early July. I would hope, though, that this limitation does not apply to the distribution of samples. As for actual scripts, my early measure of success is beating Sanofi's numbers. As soon as MNKD proves that Sanofi was not doing its best, all those who jumped to the conclusion that Afrezza is a failure because even Sanofi couldn't sell it, have to think again about their assumption that Sanofi was making an honest effort to market the drug. |
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Post by saxcmann on May 31, 2016 9:51:47 GMT -5
Realistic numbers Patton....
1 full time endo, supports afrezza. regular business hours, 30 mins visits, 4 days per week...
16 patients per day
12 diabetes
3 type-1
2 pass asthma, smoke, lung test
2 per day, best case.
1 realistic (current insulin in control)
1 x 4 days = 4 per week realistic.
2 x for high frequency providers. (See more patients per hour than above)
2500 full time endos, fyi.
Best promotion, imo...
Hire afrezza endo activists to speak with doctors. Sanofi never asked for afrezza only speakers and mnkd hasn't yet either. Last chance for mnkd management to get it right with 2nd launch. Mike C just might do it. Go mnkd!
*hope the above helps board with real numbers to project and speculate with.
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Post by agedhippie on May 31, 2016 10:03:55 GMT -5
I may be wrong, but I thought they said at the share holders meeting these were ready to roll with our name on the package. Please correct me if I am wrong. Ty. I thought that MNKD couldn't sell its own product until 6 months after the notification date and this is why the 3Q target. If so, sales of MNKD product should begin in early July. I would hope, though, that this limitation does not apply to the distribution of samples. As for actual scripts, my early measure of success is beating Sanofi's numbers. As soon as MNKD proves that Sanofi was not doing its best, all those who jumped to the conclusion that Afrezza is a failure because even Sanofi couldn't sell it, have to think again about their assumption that Sanofi was making an honest effort to market the drug. Mannkind could have started to sell on day one, they just need to release Sanofi. There is no 6 month limit in the contract other than that is the period Sanofi must sell for to maintain continuity if Mannkind does not start selling. The delay is because Mannkind has to build a salesforce and the support infrastructure to market Afrezza. Since the new target is Type 1s I don't think 20 patients per endo is realistic for a short term target. I think it is going to be one or two patients per endo. This is a new treatment and endos are not going to be in a hurry to move people off established routines (nor are people going to be in a hurry to be moved). Endos will want to have a test patient or two for a while to see how it goes. |
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Post by BlueCat on May 31, 2016 10:04:05 GMT -5
My hope (and wild guess) is that the sales team begins with the low hanging fruit - check in and strengthen relationships with those initial prescribing drs during the SNY period. And I think that's already been happening. Then, with the strongest leads out of ADA .... we'll get back pretty quickly to that bare minimum we had from SNY at its height.
That's when the real work will begin on growing that doctor and patient base.
The good news is that this won't be happening sequentially. It'll be in parallel - and one will feed the other. And hopefully with Mike's efforts, it will be somewhat accelerated from before.
IMHO tho, I think if MNKD only does US, this is going to be a very long road to get to the numbers we'll really need for SOS (save our stock) - for those of us not able to sit on it for another decade. I really do hope that once they get it rolling here (and can show proof-of-concept and company stability), we see either large direct sale and/or regional partnerships so we get a multiplier effect.
Essentially, for a drug that will take a while to build on adoption, multiple channels are likely the most effective way to show more hockey-stick like performance for investors, and to capitalize on the way Matt represented the margins WRT to sales volume.
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Post by Deleted on May 31, 2016 10:22:26 GMT -5
My hope (and wild guess) is that the sales team begins with the low hanging fruit - check in and strengthen relationships with those initial prescribing drs during the SNY period. And I think that's already been happening. Then, with the strongest leads out of ADA .... we'll get back pretty quickly to that bare minimum we had from SNY at its height. That's when the real work will begin on growing that doctor and patient base. The good news is that this won't be happening sequentially. It'll be in parallel - and one will feed the other. And hopefully with Mike's efforts, it will be somewhat accelerated from before. IMHO tho, I think if MNKD only does US, this is going to be a very long road to get to the numbers we'll really need for SOS (save our stock) - for those of us not able to sit on it for another decade. I really do hope that once they get it rolling here (and can show proof-of-concept and company stability), we see either large direct sale and/or regional partnerships so we get a multiplier effect. Essentially, for a drug that will take a while to build on adoption, multiple channels are likely the most effective way to show more hockey-stick like performance for investors, and to capitalize on the way Matt represented the margins WRT to sales volume. Core group of endos writing Rxs during the Sanofi era. Mike should have the diabetes educators calling on them immediately and maybe Mike himself and his key mgt team in the field walking in with the nurse educators to demonstrate the importance of these key docs. Other than NRx from existing endos, don't expect a big pop in the prescription numbers in June, July or even August. September we should start to see it roll. In house Spirometry and the expedited prior authorization will help reduce these barriers. Patients first month supply will be sample product so from time doc wants patient on Afrezza until they get their first Rx at drugstore likely 4-6 weeks. While NRx & TRx are the canary and quarterly earnings reports are a big metric, don't discount hope as a driver of a portion of share price. If this thing gets to 800 NRx by end of year and starts to grow 14% week over week, we could have NRx by last reporting period of April 2017 of 6400 NRx. Lots of noise on social media from a small core group. Add a few thousand to this and big mo could take over. PS - the 800 NRx by end of year assumes the group of docs writing Afrezza while Sanofi was selling it all jump back on board and support it vigorously. |
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Post by BlueCat on May 31, 2016 10:30:11 GMT -5
Core group of endos writing Rxs during the Sanofi era. Mike should have the diabetes educators calling on them immediately and maybe Mike himself and his key mgt team in the field walking in with the nurse educators to demonstrate the importance of these key docs. Other than NRx from existing endos, don't expect a big pop in the prescription numbers in June, July or even August. September we should start to see it roll. In house Spirometry and the expedited prior authorization will help reduce these barriers. Patients first month supply will be sample product so from time doc wants patient on Afrezza until they get their first Rx at drugstore likely 4-6 weeks. While NRx & TRx are the canary and quarterly earnings reports are a big metric, don't discount hope as a driver of a portion of share price. If this thing gets to 800 NRx by end of year and starts to grow 14% week over week, we could have NRx by last reporting period of April 2017 of 6400 NRx. Lots of noise on social media from a small core group. Add a few thousand to this and big mo could take over. PS - the 800 NRx by end of year assumes the group of docs writing Afrezza while Sanofi was selling it all jump back on board and support it vigorously. Overall, Yes. This is where I was headed. I think one key inflection point will be when NRx exceeds the SNY number and the trend continues to grow. That's where hope will ignite - including if not already concluded - argument for settlement with SNY on breach. I think the pain points (for stock price) will be every time we hit plateaus or slower weeks (even if holiday weeks). Short side will continuously point to those stalls as indicators of a ceiling for the product (e.g. screaming micro-niche). PS> I do half-expect tho a 'micro-pop' during Q3 taking us back to where things were using the 'yes, we're here to stay' combined with the few 'i can't wait' doctors from ADA. Then it will flatten for a bit while MNKD 2.0 starts to really roll. |
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Post by BlueCat on May 31, 2016 10:33:08 GMT -5
But for major hockey stick in stock price (I don't mean getting us back into 3-4 range), I think multi-channel will be required.
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Post by Deleted on May 31, 2016 10:37:23 GMT -5
But for major hockey stick in stock price (I don't mean getting us back into 3-4 range), I think multi-channel will be required. or IND filing for epinephrine + RLS mile stone ( only if its 30 mil and not 600k ) to extend the runway outside of Afrezza |
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Post by capnbob on May 31, 2016 10:45:10 GMT -5
Being a 1099 in my past I have a understanding of medical sales. According to Mike from meeting, team should be hitting the streets mid June. I will give a scenario then a question. 60 sales reps hit the street hypothetically June 16 let's say. Let's call them reps 1 thru 60. Rep 1 signs up 1 office week 1. Let's say the Endo wants to start 20 new patients on Afrezza. How long will it take us to see those scripts? Now for a thought of what may happen with sales. Reps one thru 60 each sign up 1 office a week with 20 new patients a week. 1st month this is only 160 doctors out of 7000 target endo's. This works out to 3600 new scripts first month. Imho this is a low ball number. So for July and August we could see 7200 new scripts. My question to this is what would this do to the stock price? Also it would show the world Sanofi screwed us and may help with the settlement case if there is one. Would love your thoughts on this. I'm afraid I don't share your optimism. The FDA continues to set stricter and stricter limits on what reps can do and/or say to promote a drug. Practically anything beyond the information already on the insert is taboo. All of the warnings and adverse effects have to be presented up front. Tack onto that the effect of the "Sunshine Act" which practically requires a report when a rep gives even a pack of gum to a doc. Then there's the hurdles imposed by managed care providers on access to docs by reps. The map on page 8 of this paper -- "Determinants of pharmaceutical sales representative access limits to physicians" -- gives some idea: mmj.sagepub.com/content/early/2015/04/29/1745790415583866.full.pdfAstra Zeneca's laying off 1,600 reps from their diabetes sales force is likely a reflection of the situation overall. I'd say Mannkind's reps are facing climbing a mountain...at night...barefoot...in the rain. |
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Post by mnholdem on May 31, 2016 11:22:45 GMT -5
I suggest that you take a look at the script data that liane has been gathering for 53 weeks and then consider the following:
MannKind management has repeatedly told shareholders that Sanofi’s effort involved targeting a SMALL group of endocrinologists in order to test Afrezza within the market. Even with this small target group, it only took Sanofi a few weeks to establish a baseline of script numbers. After Sanofi canned Vehrbacher and hired Brandecourt, any MAJOR target expansion that may have been planned came to an abrupt halt and Sanofi's effort remained limited to a minimum level that was contractually required, the extent of which appears to have been to release some magazine ads and maintain the Afrezza website.
Did Sanofi initially target 20 endos? 50? 100? We may never be told, but we do know what number of endos that Castagna has targeted and I expect to see immediate script growth by weeks rather than by quarters.
This is just my opinion, of course, and there are certainly many interconnected pieces to consider, not least of which is the marketing material to be generated by our new ad agency Precision Effect and new hire Joe Saldanha, Vice President of Marketing, as well as "encouraging progress" with payer negotiations, led by Tino Quintero, VP of Market Value, Access & Trade:
"I am excited to have Joe and Tino join my team to help us transition into a commercial organization with dedicated capabilities," said Michael Castagna. "Each brings a wealth of experience in commercialization, diabetes and pharmaceutical product launches, and their skills will be critical as MannKind moves forward with our commercial plans."
Matthew Pfeffer, Chief Executive Officer of MannKind added, "The expansion of Mike's organization with these two key roles supports MannKind's business objectives for 2016 and beyond. Under Joe and Tino's leadership, MannKind can develop strong relationships with payors that benefit patients, and produce innovative and focused marketing and sales programs that establish MannKind's market presence with Technosphere®-based products."
- See more at: investors.mannkindcorp.com/releasedetail.cfm?ReleaseID=965732#sthash.CGR46bww.dpuf
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Post by LosingMyBullishness on May 31, 2016 11:24:53 GMT -5
Realistic numbers Patton.... 1 full time endo, supports afrezza. regular business hours, 30 mins visits, 4 days per week... 16 patients per day 12 diabetes 3 type-1 2 pass asthma, smoke, lung test 2 per day, best case. 1 realistic (current insulin in control) 1 x 4 days = 4 per week realistic. 2 x for high frequency providers. (See more patients per hour than above) 2500 full time endos, fyi. Best promotion, imo... Hire afrezza endo activists to speak with doctors. Sanofi never asked for afrezza only speakers and mnkd hasn't yet either. Last chance for mnkd management to get it right with 2nd launch. Mike C just might do it. Go mnkd! *hope the above helps board with real numbers to project and speculate with. Please help me with the numbers: 2 per day, best case. -> I do not understand how you get to 2. you said: 3 type-1 -> 3 out of 12 are T1, 9 are T2 ? Why do you differentiate between T1 and T2. Both are targets for Afrezza. 2 pass asthma, smoke, lung test -> 2 of 3 or 2 of 12 ? 1 realistic (current insulin in control) -> So 50% of all diabetics have their insulin not under control? Why would the endo only advice Afrezza to diabetics who are under control ? Isnt it one of the value proposals of Afrezza that patients comply better to the required insulin dosing? |
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Post by Deleted on May 31, 2016 11:40:06 GMT -5
I suggest that you take a look at the script data that liane has been gathering for 53 weeks and then consider the following:
MannKind management has repeatedly told shareholders that Sanofi’s effort involved targeting a SMALL group of endocrinologists in order to test Afrezza within the market. Even with this small target group, it only took Sanofi a few weeks to establish a baseline of script numbers. After Sanofi canned Vehrbacher and hired Brandecourt, any MAJOR target expansion that may have been planned came to an abrupt halt and Sanofi's effort remained limited to a minimum level that was contractually required, the extent of which appears to have been to release some magazine ads and maintain the Afrezza website.
Did Sanofi initially target 20 endos? 50? 100? We may never be told, but we do know what number of endos that Castagna has targeted and I expect to see immediate script growth by weeks rather than by quarters.
This is just my opinion, of course, and there are certainly many interconnected pieces to consider, not least of which is the marketing material to be generated by our new ad agency Precision Effect.
I am under the impression that the bulk of the Rx volume for Afrezza came from a core group of 5-10 endos. If so, Mannkind goes back to this group with a simpler Spirometry solution, a platform for quicker turnaround of prior authorizations (to include e-prescribing so patient does not have to go back to doc for Rx), lower price for Afrezza and better support from the payors and compared to Sanofi, NRx should be better. If my assumptions on the number of endos who supported Afrezza is correct, add 30 - 40 more endos and we have a nice book of business. Get a few hundred more with a smaller level of support and there is a nice base and a boatload of de-identified patient data waiting to be mined by health insurers. In a world where payors want to pay for outcomes vs service... |
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Post by patten1962 on May 31, 2016 12:07:32 GMT -5
And remember, physicians will make money on spirometry testing. About $70 per test. You may not think this is important but it is!. If a endo does 4 tests per day that is $280 per day he/she makes.
As far as lunch dates with Dr's, you guys have no idea how many lunches happen every day! And I mean every day in physician offices!
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Post by mydogskip on May 31, 2016 12:58:04 GMT -5
And remember, physicians will make money on spirometry testing. About $70 per test. You may not think this is important but it is!. If a endo does 4 tests per day that is $280 per day he/she makes. As far as lunch dates with Dr's, you guys have no idea how many lunches happen every day! And I mean every day in physician offices! Won't matter what a physician will make on spirometery testing if they aren't interested in prescribing Afrezza because they won't be buying the Spirometer. What we do not know is if that was a road block Sanofi faced assuming they also tried to sell docs a spirometer. |
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Post by patten1962 on May 31, 2016 13:40:27 GMT -5
And remember, physicians will make money on spirometry testing. About $70 per test. You may not think this is important but it is!. If a endo does 4 tests per day that is $280 per day he/she makes. As far as lunch dates with Dr's, you guys have no idea how many lunches happen every day! And I mean every day in physician offices! Won't matter what a physician will make on spirometery testing if they aren't interested in prescribing Afrezza because they won't be buying the Spirometer. What we do not know is if that was a road block Sanofi faced assuming they also tried to sell docs a spirometer. I disagree. A endo will make 72k a year doing spirometry. That is if they do 4 tests a day! I talked to a sanofi rep. They did nothing with afrezza. |
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