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Post by mydogskip on Jun 18, 2016 18:33:43 GMT -5
There is no doubt Afrezza is a good drug. But sometimes good drugs don't sell and are taken off the market. Here's one case of that happening. finance.yahoo.com/news/non-hodgkin-lymphoma-zevalin-120931920.htmlThis is certainly a possibility with Afrezza if Mannkind fails to get effective insurance coverage, doctors to prescribe it and patients to have the patience to learn how to use it. |
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Post by Deleted on Jun 18, 2016 18:54:04 GMT -5
I sure hope not .. Time will tell... Can't get 150k patients to get the company running in a target of 30 million patients?
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Post by nylefty on Jun 18, 2016 19:11:04 GMT -5
Despite all the moaning and groaning, MNKD is up 9.7 percent in the past 30 days and up 57 percent from its low point of 64 cents.
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Post by mbseeking on Jun 18, 2016 19:57:49 GMT -5
I hate to say it but I think nylefty is right.. not anything against nylefty.. but most of us are here are with the perspective of trashed portfolios from having invested early in MNKD. Another perspective? Possibly our MNKD "Anno Domini" event was hitting the Goldman Sachs $1. Let's call it the beginning of MNKDS common era (CE) to be PC.
Maybe we are really at 0.1 CE (month 1sih) for MNKD 2.0. With that lens the price is up 9.7 percent in 30 days or 57% since the nadir.
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Post by sweedee79 on Jun 18, 2016 23:54:49 GMT -5
Yes... we are all aware of this possibility... this is a speculative investment.. also an investment where much profit can be made.. by the looks of Mike C.. and this team and what I have seen Ive placed my bet on the market accepting Afrezza .. MNKD has stated that they are going to seek label change with the recent studies.. that was great news as this has been one of my main concerns. Honestly I don't think it is the markets acceptance of Afrezza we need to be worried about... it is whether or not the medical community will accept and prescribe it and if we have the funds to continue marketing it. If the price is right insurance companies will cover it. Once it is established as superior they will have to cover it and it is by far superior. Al knew this and that is why he invested so much of his own money in it. I know because Ive seen how it works. I like Mike C.. his enthusiasm will go a long way toward getting Afrezza in the docs office and to market.. SNY FAILED ... and it was so bad it almost looks like they did it on purpose. This is a new day... with people who actually care. I doubled my investment at .90 .. and I'm happy I did.. do I realize I could lose.??.. of course I do..
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Post by matt on Jun 19, 2016 7:35:39 GMT -5
Once it is established as superior they will have to cover it and it is by far superior. Managed care will never "have to cover it" in the next 5 to 10 years. There are many drugs known to be superior for a subset of patients that are not covered, or only covered in extreme circumstances.
Despite your assertion that Afrezza is "far superior" the data simply does not exist to support that today. You might be right, but proving that assertion is what will take 5 to 10 years. Managed care is focused on getting paid insurance premiums and then providing an acceptable level of care, not the best level of care just acceptable, for less than the premium charge. If MNKD can show an insurance company that their total cost of providing care will go down within the typical time horizon of the insured patient being on their program, then you will see Tier 1 reimbursement.
The challenge here, and with any insulin, is that controlled glucose levels lead to reduced costs for expensive care events like heart attack, stroke, amputations, etc. but MNKD will have to prove that the extra cost of Afrezza translates into lower costs for the managed care company. That is a large and long trial, certainly not something that will happen this decade. The other challenge, and this is a defect in our reimbursement system, is that MNKD is asking insurance company A to pay for Afrezza today but if the patient switches insurers the long-term cost incurred by company A today will accrue to the benefit of insurance company B in future years. Since the typical insured switches their plan on average once every three years this is not a trivial concern for the insurance industry.
If all companies covered every drug the same, it wouldn't matter because the long term cost and benefits would equalize over the entire population of insureds. However, that is not how the market works and some insurers (United Healthcare for example) will do anything to make an incremental dollar today while other insurers (Aetna, many of the Blue Cross affiliates) are a bit more forward thinking. So long as different parts of the payor market have different financial incentives, coverage for a more expensive alternative will be difficult in the absence of long-term studies proving its cost effectiveness within the time horizon the patient will remain with the insurance plan. For that there is no easy answer.
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Post by peppy on Jun 19, 2016 9:30:32 GMT -5
Once it is established as superior they will have to cover it and it is by far superior. Managed care will never "have to cover it" in the next 5 to 10 years. There are many drugs known to be superior for a subset of patients that are not covered, or only covered in extreme circumstances.
Despite your assertion that Afrezza is "far superior" the data simply does not exist to support that today. You might be right, but proving that assertion is what will take 5 to 10 years. Managed care is focused on getting paid insurance premiums and then providing an acceptable level of care, not the best level of care just acceptable, for less than the premium charge. If MNKD can show an insurance company that their total cost of providing care will go down within the typical time horizon of the insured patient being on their program, then you will see Tier 1 reimbursement.
The challenge here, and with any insulin, is that controlled glucose levels lead to reduced costs for expensive care events like heart attack, stroke, amputations, etc. but MNKD will have to prove that the extra cost of Afrezza translates into lower costs for the managed care company. That is a large and long trial, certainly not something that will happen this decade. The other challenge, and this is a defect in our reimbursement system, is that MNKD is asking insurance company A to pay for Afrezza today but if the patient switches insurers the long-term cost incurred by company A today will accrue to the benefit of insurance company B in future years. Since the typical insured switches their plan on average once every three years this is not a trivial concern for the insurance industry.
If all companies covered every drug the same, it wouldn't matter because the long term cost and benefits would equalize over the entire population of insureds. However, that is not how the market works and some insurers (United Healthcare for example) will do anything to make an incremental dollar today while other insurers (Aetna, many of the Blue Cross affiliates) are a bit more forward thinking. So long as different parts of the payor market have different financial incentives, coverage for a more expensive alternative will be difficult in the absence of long-term studies proving its cost effectiveness within the time horizon the patient will remain with the insurance plan. For that there is no easy answer.
Matt, is it true insurance companies health care plan pricing is their costs plus 20%?
Regarding superiority, subjective? the abstracts... 
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Post by Deleted on Jun 19, 2016 9:35:21 GMT -5
Once it is established as superior they will have to cover it and it is by far superior. Managed care will never "have to cover it" in the next 5 to 10 years. There are many drugs known to be superior for a subset of patients that are not covered, or only covered in extreme circumstances.
Despite your assertion that Afrezza is "far superior" the data simply does not exist to support that today. You might be right, but proving that assertion is what will take 5 to 10 years. Managed care is focused on getting paid insurance premiums and then providing an acceptable level of care, not the best level of care just acceptable, for less than the premium charge. If MNKD can show an insurance company that their total cost of providing care will go down within the typical time horizon of the insured patient being on their program, then you will see Tier 1 reimbursement.
The challenge here, and with any insulin, is that controlled glucose levels lead to reduced costs for expensive care events like heart attack, stroke, amputations, etc. but MNKD will have to prove that the extra cost of Afrezza translates into lower costs for the managed care company. That is a large and long trial, certainly not something that will happen this decade. The other challenge, and this is a defect in our reimbursement system, is that MNKD is asking insurance company A to pay for Afrezza today but if the patient switches insurers the long-term cost incurred by company A today will accrue to the benefit of insurance company B in future years. Since the typical insured switches their plan on average once every three years this is not a trivial concern for the insurance industry.
If all companies covered every drug the same, it wouldn't matter because the long term cost and benefits would equalize over the entire population of insureds. However, that is not how the market works and some insurers (United Healthcare for example) will do anything to make an incremental dollar today while other insurers (Aetna, many of the Blue Cross affiliates) are a bit more forward thinking. So long as different parts of the payor market have different financial incentives, coverage for a more expensive alternative will be difficult in the absence of long-term studies proving its cost effectiveness within the time horizon the patient will remain with the insurance plan. For that there is no easy answer.
If Afrezza is priced at or below rapid acting insulins, would that be sufficient to gain tier 1 status given the non-inferiority? |
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Post by nylefty on Jun 19, 2016 9:56:15 GMT -5
Once it is established as superior they will have to cover it and it is by far superior. Managed care will never "have to cover it" in the next 5 to 10 years. There are many drugs known to be superior for a subset of patients that are not covered, or only covered in extreme circumstances.
Despite your assertion that Afrezza is "far superior" the data simply does not exist to support that today. You might be right, but proving that assertion is what will take 5 to 10 years. Managed care is focused on getting paid insurance premiums and then providing an acceptable level of care, not the best level of care just acceptable, for less than the premium charge. If MNKD can show an insurance company that their total cost of providing care will go down within the typical time horizon of the insured patient being on their program, then you will see Tier 1 reimbursement.
Why are you assuming that Afrezza will continue to be priced higher than injectables? Matt and Mike have indicated just the opposite. |
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Post by Deleted on Jun 19, 2016 10:02:39 GMT -5
Does anyone know when MannKind can reduce Afrezza's price?
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Post by peppy on Jun 19, 2016 10:21:55 GMT -5
Does anyone know when MannKind can reduce Afrezza's price? July 1 (I think) |
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Post by agedhippie on Jun 19, 2016 12:09:49 GMT -5
Managed care will never "have to cover it" in the next 5 to 10 years. There are many drugs known to be superior for a subset of patients that are not covered, or only covered in extreme circumstances.
Despite your assertion that Afrezza is "far superior" the data simply does not exist to support that today. You might be right, but proving that assertion is what will take 5 to 10 years. Managed care is focused on getting paid insurance premiums and then providing an acceptable level of care, not the best level of care just acceptable, for less than the premium charge. If MNKD can show an insurance company that their total cost of providing care will go down within the typical time horizon of the insured patient being on their program, then you will see Tier 1 reimbursement.
Why are you assuming that Afrezza will continue to be priced higher than injectables? Matt and Mike have indicated just the opposite. I read that as the insurance premium rather than a price premium. The insurers are focused on providing an acceptable level of care within the insurance premium the customer pays. The problem Matt points out is that complications turn up on a far longer timescale than the average policy life (three years). Mannkind needs to show that Afrezza can reduce costs over that three year timescale or the insurer is not going to care what it does. |
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Post by Deleted on Jun 19, 2016 12:57:23 GMT -5
Why are you assuming that Afrezza will continue to be priced higher than injectables? Matt and Mike have indicated just the opposite. I read that as the insurance premium rather than a price premium. The insurers are focused on providing an acceptable level of care within the insurance premium the customer pays. The problem Matt points out is that complications turn up on a far longer timescale than the average policy life (three years). Mannkind needs to show that Afrezza can reduce costs over that three year timescale or the insurer is not going to care what it does. depends on what needs to be showed. An uncontrolled population of 1000 with A1c above 8 , can be put on Afrezza and lower A1c to below 6.. its already documented how much difference that would be in long term.. would some thing like that be ok? |
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Post by nylefty on Jun 19, 2016 13:05:37 GMT -5
Why are you assuming that Afrezza will continue to be priced higher than injectables? Matt and Mike have indicated just the opposite. I read that as the insurance premium rather than a price premium. The insurers are focused on providing an acceptable level of care within the insurance premium the customer pays. The problem Matt points out is that complications turn up on a far longer timescale than the average policy life (three years). Mannkind needs to show that Afrezza can reduce costs over that three year timescale or the insurer is not going to care what it does. Huh? Matt said "So long as different parts of the payor market have different financial incentives, coverage for a more expensive alternative will be difficult in the absence of long-term studies proving its cost effectiveness within the time horizon the patient will remain with the insurance plan. For that there is no easy answer.
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He's calling Afrezza "a more expensive alternative." But it won't be "more expensive" after MannKind reduces its price to compete with or undercut the price of injectibles. |
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Post by peppy on Jun 19, 2016 13:24:37 GMT -5
I read that as the insurance premium rather than a price premium. The insurers are focused on providing an acceptable level of care within the insurance premium the customer pays. The problem Matt points out is that complications turn up on a far longer timescale than the average policy life (three years). Mannkind needs to show that Afrezza can reduce costs over that three year timescale or the insurer is not going to care what it does. Huh? Matt said "So long as different parts of the payor market have different financial incentives, coverage for a more expensive alternative will be difficult in the absence of long-term studies proving its cost effectiveness within the time horizon the patient will remain with the insurance plan. For that there is no easy answer.
"
He's calling Afrezza "a more expensive alternative." But it won't be "more expensive" after MannKind reduces its price to compete with or undercut the price of injectibles. Seeker or other knowledgeable person, what did you tell us the cost for fast acting insulin pens are a month? A vial of apidra by memory, with discount card in US $125/vial. www.tudiabetes.org/forum/t/costs-of-apidra-vial-insulin-canada-vs-usa/14341
I know what Matt on the proboards has said. I still think insurance coverage is a cost issue.
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