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Post by mannmade on Aug 10, 2016 12:07:49 GMT -5
I think the one note of caution here is as was referenced above already, sales is about relationships no matter how good the product is (for the most part). And as good as AFREZZA is, it is not an easy product to explain and as such AFREZZA is very misunderstood. Having said that, it will take more than 5 mins and one visit with a doctor to discuss (with the goal of getting a doc to write scripts) and to get this time with a doctor the reps will need to have solid relationships with the various docs in their territory.
Having said the above this is a new sales force, so really how many of the sales reps already know the docs in their territory? And how long will it take for them to be able to establish the kind of relationships that will allow for the reps to get the kind of time and multiple meets it may take to have a doc finally understand the real value of AFREZZA?
I am thinking that if we get past 627 scripts per week by end of October and 1,000 per week by end of the year it will show enough to get the stock up past $1.50 a bit, just my personal opinion. If this happens the warrants will kick in and that will add another $50m or so to Mnkd and extend the runway a bit longer to allow the trend to continue and complete one more financing deal that is not so onerous compared to what it would look like if made at today's pps.
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Post by akemp3000 on Aug 10, 2016 12:13:38 GMT -5
Outstanding and encouraging thread at a critical time in the life of Afrezza. Thanks!
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Post by od on Aug 10, 2016 12:16:37 GMT -5
What can Mike Castagna and his Afrezza sales team accomplish in 2016?
Market Penetration 2016 Worksheet - Afrezza
Providers – visits in 2016 to endocrinologists and similar high-prescribing physicians to detail Afrezza.
- 60 Territorial/Regional Sales Managers (100% focus on detailing of Afrezza)
- 500 visits/week (1-2 per day x 5 days x 60 Sales Mgrs)
- 9,000 endos and h/p physicians detailed in 2016 (500 visits x 18 weeks*)
* NOTE: 2 weeks dropped for holidays/vacations
Patients with Diabetes (PWD) - visits to physicians detailed in 2016 by Afrezza Sales Mgrs
- 9,000 physicians detailed on Afrezza by end of CY-2016 (see Providers)
- 450,000 PWD per week will be visiting Afrezza-detailed physicians by EOY-2016 (9,000 docs x 10 patients/day average x 5 days/week)
Results – Weekly TRx* for Afrezza by EOY 2016
- Afrezza market = potential patient awareness by EOY 2016 = 450,000 PWD per week (see Patient with Diabetes)
- 1% patient penetration = 4,500 Afrezza TRx per week
- 5% patient penetration = 22,500 Afrezza TRx per week
- 10% patient penetration = 45,000 Afrezza TRx per week
* Total U.S. prandial market (all brands) = 300,000 TRx per week reported by IMS (2015) + 100,000-150,000 unreported TRx per week
Results – Weekly TRx for Afrezza by EOY 2017
- Stay tuned...
---
National Center for Health Statistics
Source: www.cdc.gov/nchs/fastats/diabetes.htm
Data are for the U.S.
Morbidity
• Percent of adults 20 years and older with diabetes (physician-diagnosed or undiagnosed): 12.6% (2011-2014)
• Percent of adults 20 years and older with physician-diagnosed diabetes: 9.6% (2011-2014)
• Percent of adults 20 years and older with undiagnosed diabetes: 3.0% (2011-2014)
Source: www.cdc.gov/nchs/data/hus/hus15.pdf#040
Ambulatory care visits
• Number of visits (to physician offices, hospital outpatient and emergency departments) with diabetes as primary diagnosis: 37.3 million
Source: www.cdc.gov/nchs/data/ahcd/combined_tables/AMC_2009-2010_combined_web_table01.pdf
Hospital inpatient care
• Number of discharges with diabetes as first-listed diagnosis: 635,000
• Average length of stay: 4.6 days
Source: www.cdc.gov/nchs/data/nhds/2average/2010ave2_firstlist.pdf#x2013
Mortality
• Number of deaths: 75,578
• Deaths per 100,000 population: 23.9
• Cause of death rank: 7
Source: www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf
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These statistics demonstrate that our current healthcare environment in the U.S. for the treatment of diabetes is inadequate. It's time for a paradigm change. It's time for Afrezza.
Considering that in 2011 there were less than 6000 Board Certified Endocrinologists in clinical practice in the United States and the current MNKD salesforce has limited geographic reach, I think your estimate of visited providers in high. Yes, other high prescribers are targeted, but to me 9000 is a reach. |
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Post by dcassidy1618a on Aug 10, 2016 12:35:32 GMT -5
And then we have identified several direct mail opportunities that we compile and see targeting patients directly in the mail. As you know, the average age of a Type 2 or Type 1 patient could be in the 45 to 55 range and sometimes direct mails are better way to go as opposed to digital for younger audience. Either way, we will have lots of data coming out in Q3 that would continue to fine tune our direct to patient efforts.
So we have several initiatives on track to launch starting in September which will be our first consumer print ad you will start to see out there in mid to late September pop up in some journals.
To me DTC is basically useless since the company is stuck publishing the black box and and all the warnings about adverse effects while having little that they can claim on the postive side except that the patient can avoid injections. As I recall, SNY had some ads in big magazines like "Time" and in some of the smaller diabetes magazines, but those aparently didn't produce much results. A quote that I have seen many times in many places: "Physicians are the most important component in sales." Actually, I think insurers are probably ahead of physicians. Either way, I think money is best spent working the physicians and insurers. |
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Post by babaoriley on Aug 10, 2016 12:46:46 GMT -5
I think the one note of caution here is as was referenced above already, sales is about relationships no matter how good the product is (for the most part). And as good as AFREZZA is, it is not an easy product to explain and as such AFREZZA is very misunderstood. Having said that it will take more than 5 mins and one visit with a doctor to discuss (with the goal of getting a doc to write scripts) and to get this time with a doctor the reps will need to have solid relationships with the various docs in their territory. Having said the above this is a new sales force, so really how many of the sales reps already know the docs in their territory? And how long will it take for them to be able to establish the kind of relationship that will allow for the reps to get the kind of time and multiple meets it may take to have a doc finally understand the real value of AFREZZA? I am thinking that if we get past 627 scripts per week by end of October and 1,000 per week by end of year it will show enough to get the stock up past $1.50 a bit, just my personal opinion. If this happens the warrant will kick in and that will add another $50m or so to Mnkd and extend the runway a bit longer to allow the trend to continue and complete one ore financing deal that is not so onerous compared to what it would look like if made at today's pps. When the hell did you become so reasonable?  |
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Post by dcassidy1618a on Aug 10, 2016 12:49:55 GMT -5
What can Mike Castagna and his Afrezza sales team accomplish in 2016?
Market Penetration 2016 Worksheet - Afrezza
Providers – visits in 2016 to endocrinologists and similar high-prescribing physicians to detail Afrezza.
- 60 Territorial/Regional Sales Managers (100% focus on detailing of Afrezza)
- 500 visits/week (1-2 per day x 5 days x 60 Sales Mgrs)
- 9,000 endos and h/p physicians detailed in 2016 (500 visits x 18 weeks*)
* NOTE: 2 weeks dropped for holidays/vacations
Patients with Diabetes (PWD) - visits to physicians detailed in 2016 by Afrezza Sales Mgrs
- 9,000 physicians detailed on Afrezza by end of CY-2016 (see Providers)
- 450,000 PWD per week will be visiting Afrezza-detailed physicians by EOY-2016 (9,000 docs x 10 patients/day average x 5 days/week)
Results – Weekly TRx* for Afrezza by EOY 2016
- Afrezza market = potential patient awareness by EOY 2016 = 450,000 PWD per week (see Patient with Diabetes)
- 1% patient penetration = 4,500 Afrezza TRx per week
- 5% patient penetration = 22,500 Afrezza TRx per week
- 10% patient penetration = 45,000 Afrezza TRx per week
* Total U.S. prandial market (all brands) = 300,000 TRx per week reported by IMS (2015) + 100,000-150,000 unreported TRx per week
Results – Weekly TRx for Afrezza by EOY 2017
- Stay tuned...
---
National Center for Health Statistics
Source: www.cdc.gov/nchs/fastats/diabetes.htm
Data are for the U.S.
Morbidity
• Percent of adults 20 years and older with diabetes (physician-diagnosed or undiagnosed): 12.6% (2011-2014)
• Percent of adults 20 years and older with physician-diagnosed diabetes: 9.6% (2011-2014)
• Percent of adults 20 years and older with undiagnosed diabetes: 3.0% (2011-2014)
Source: www.cdc.gov/nchs/data/hus/hus15.pdf#040
Ambulatory care visits
• Number of visits (to physician offices, hospital outpatient and emergency departments) with diabetes as primary diagnosis: 37.3 million
Source: www.cdc.gov/nchs/data/ahcd/combined_tables/AMC_2009-2010_combined_web_table01.pdf
Hospital inpatient care
• Number of discharges with diabetes as first-listed diagnosis: 635,000
• Average length of stay: 4.6 days
Source: www.cdc.gov/nchs/data/nhds/2average/2010ave2_firstlist.pdf#x2013
Mortality
• Number of deaths: 75,578
• Deaths per 100,000 population: 23.9
• Cause of death rank: 7
Source: www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf
---
These statistics demonstrate that our current healthcare environment in the U.S. for the treatment of diabetes is inadequate. It's time for a paradigm change. It's time for Afrezza.
Considering that in 2011 there were less than 6000 Board Certified Endocrinologists in clinical practice in the United States and the current MNKD salesforce has limited geographic reach, I think your estimate of visited providers in high. Yes, other high prescribers are targeted, but to me 9000 is a reach. I agree. Of those, maybe only about 50% are available to sales reps: www.zsassociates.com/-/media/files/publications/public/ph-mar-wp-access-monitor-es-f.pdf?la=en |
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Post by babaoriley on Aug 10, 2016 12:54:35 GMT -5
Here's another way we can help the cause. If, after a few more weeks and scripts aren't increasing the way they should, you happen to be out and about and see a someone living out of his/her car, ask him or her if they're an Afrezza rep, and if so, offer a hot meal, some shaving equipment (for either gender), toothpaste and deodorant, and other items of personal appearance and hygiene. We want our reps looking sharp! Sports, perhaps you can offer use of the locker room for showering.
Just funin'.
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Post by peppy on Aug 10, 2016 12:58:13 GMT -5
And then we have identified several direct mail opportunities that we compile and see targeting patients directly in the mail. As you know, the average age of a Type 2 or Type 1 patient could be in the 45 to 55 range and sometimes direct mails are better way to go as opposed to digital for younger audience. Either way, we will have lots of data coming out in Q3 that would continue to fine tune our direct to patient efforts.
So we have several initiatives on track to launch starting in September which will be our first consumer print ad you will start to see out there in mid to late September pop up in some journals.
about adverse effects while having little that they can claim on the postive side except that the patient can avoid injections. As I recall, SNY had some ads in big magazines like "Time" and in some of the smaller diabetes magazines, but those aparently didn't produce much results. A quote that I have seen many times in many places: "Physicians are the most important component in sales." Actually, I think insurers are probably ahead of physicians. Either way, I think money is best spent working the physicians and insurers. To me it is like finding out their is a cordless telephone. More over, there are people like Mattb, that couldn't eat out. Their lives so much improved, Mattb can eat out and more importantly he can eat. As twisted a I am with the supreme court decision that has made every national news broadcast, what we have left of them a drug sales platform, to your point, perhaps I have been looking at it wrong. The supreme court has managed to desensitize us from the warnings. If I could I truly would mention that afrezza is insulin delivered as a monomer.
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Post by mnholdem on Aug 10, 2016 13:22:04 GMT -5
Are the reps visiting every week for the same drug or does the sales visit more frequently because the pharmaceutical company the rep is working for has many, many drugs to discuss? Afrezza reps only have one product to sell. i can read your sarcasm, but arent we talking about Mannkind and Afrezza? I honestly wasn't being sarcastic. I was making a point. My reps physically visit existing accounts quarterly at most (less than 10% of our customer base get monthly visits), so weekly visits just seemed absurd to me for a single product. However, my playing field is in the medical devices arena, not drugs.
I also assumed that, in the case of MannKind, Mike hired the nurse educators to handle clinical training that may be requested for Afrezza, so that the sales force could concentrate on adding more customer accounts.
500 visits/week equated to 1-2 visits each day (1.67 new physicians detailed each day was the number I used). You guys really think that is too many?
Again, I really didn't mean to sound sarcastic.
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Post by compound26 on Aug 10, 2016 13:44:59 GMT -5
i can read your sarcasm, but arent we talking about Mannkind and Afrezza? I honestly wasn't being sarcastic. I was making a point. My reps physically visit existing accounts quarterly at most (less than 10% of our customer base get monthly visits), so weekly visits just seemed absurd to me for a single product. However, my playing field is in the medical devices arena, not drugs.
I also assumed that, in the case of MannKind, Mike hired the nurse educators to handle clinical training so that the sales force could concentrate on adding Afrezza accounts.
500 visits/week equated to 1-2 visits each day (1.67 new physicians detailed each day was the number I used). You guys really think that is too many?
Again, I really didn't mean to sound sarcastic.
, what you stated above sounds reasonable to me and probably is generally the case.  However, for Mannkind, I believe Afrezza reps are indeed making a lot of repeat visits in a short period of time, at least on their top prescribers. Here is what Mike C. said at the 2nd quarter CC: "So when you look at the decline in prescriptions from January through June, a lot of that was the result of people not believing we were going to be around in July and they thought once the Sanofi inventory ran out that was it, the product will no longer be available. So as a result of that, they stopped initiating new patients back in Q1 and Q2. Now that we’ve been out there for almost a month creating our second and third visits, doctors are remaining confident, they’re starting to see our samples and copays. We expect this trend to change quickly around the feedback and availability of Afrezza amongst our top prescribers. And then finally, the social media coverage as well as press coverage from ADA continue to be positive and Ray will speak to that in a moment." |
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Post by Deleted on Aug 10, 2016 14:26:17 GMT -5
i can read your sarcasm, but arent we talking about Mannkind and Afrezza? I honestly wasn't being sarcastic. I was making a point. My reps physically visit existing accounts quarterly at most (less than 10% of our customer base get monthly visits), so weekly visits just seemed absurd to me for a single product. However, my playing field is in the medical devices arena, not drugs.
I also assumed that, in the case of MannKind, Mike hired the nurse educators to handle clinical training that may be requested for Afrezza, so that the sales force could concentrate on adding more customer accounts.
500 visits/week equated to 1-2 visits each day (1.67 new physicians detailed each day was the number I used). You guys really think that is too many?
Again, I really didn't mean to sound sarcastic.
cos they are well established accounts and on auto drive? once Afrezza sails on its own, I bet the docs will be visited once a month to thank them |
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Post by mnholdem on Aug 10, 2016 16:14:40 GMT -5
I must sound like a slave driver. That's probably because I am...to a degree.
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Post by matt on Aug 10, 2016 16:36:32 GMT -5
One difference is that a lot of pharmas are still living in the "share of voice" mindset where they have multiple sales forces selling the same drugs into the same offices, where the device world does not. Part of that is the life cycle and margins for medical devices, and part of it is stupidity (if annoying the physicians one a week is bad, they will love to see us three times a week). The other consideration is that in a lot of areas the reps won't get to speak to the physicians at all. Some areas have a very strict "no visit" policy from pharma reps, and there is no amount of sweet-talking that will get you past the receptionist. Mike must know this well and will have calibrated his expectations accordingly.
The other thing I hope everyone remembers is that sales growth like this is not going to be a straight line. It will look much more like a mountain road, with lots of ups and lots of downs. The important thing is the average slope of the road, not the slope of last week's segment. Tracking weekly scripts is interesting if you are a trader, but don't read too much into any given week. This is a marathon, not a sprint.
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Post by oldfishtowner on Aug 10, 2016 16:42:27 GMT -5
What can Mike Castagna and his Afrezza sales team accomplish in 2016?
Market Penetration 2016 Worksheet - Afrezza
Providers – visits in 2016 to endocrinologists and similar high-prescribing physicians to detail Afrezza.
- 60 Territorial/Regional Sales Managers (100% focus on detailing of Afrezza)
- 500 visits/week (1-2 per day x 5 days x 60 Sales Mgrs)
- 9,000 endos and h/p physicians detailed in 2016 (500 visits x 18 weeks*)
* NOTE: 2 weeks dropped for holidays/vacations
Patients with Diabetes (PWD) - visits to physicians detailed in 2016 by Afrezza Sales Mgrs
- 9,000 physicians detailed on Afrezza by end of CY-2016 (see Providers)
- 450,000 PWD per week will be visiting Afrezza-detailed physicians by EOY-2016 (9,000 docs x 10 patients/day average x 5 days/week)
Results – Weekly TRx* for Afrezza by EOY 2016
- Afrezza market = potential patient awareness by EOY 2016 = 450,000 PWD per week (see Patient with Diabetes)
- 1% patient penetration = 4,500 Afrezza TRx per week
- 5% patient penetration = 22,500 Afrezza TRx per week
- 10% patient penetration = 45,000 Afrezza TRx per week
* Total U.S. prandial market (all brands) = 300,000 TRx per week reported by IMS (2015) + 100,000-150,000 unreported TRx per week
Results – Weekly TRx for Afrezza by EOY 2017
- Stay tuned...
---
National Center for Health Statistics
Source: www.cdc.gov/nchs/fastats/diabetes.htm
Data are for the U.S.
Morbidity
• Percent of adults 20 years and older with diabetes (physician-diagnosed or undiagnosed): 12.6% (2011-2014)
• Percent of adults 20 years and older with physician-diagnosed diabetes: 9.6% (2011-2014)
• Percent of adults 20 years and older with undiagnosed diabetes: 3.0% (2011-2014)
Source: www.cdc.gov/nchs/data/hus/hus15.pdf#040
Ambulatory care visits
• Number of visits (to physician offices, hospital outpatient and emergency departments) with diabetes as primary diagnosis: 37.3 million
Source: www.cdc.gov/nchs/data/ahcd/combined_tables/AMC_2009-2010_combined_web_table01.pdf
Hospital inpatient care
• Number of discharges with diabetes as first-listed diagnosis: 635,000
• Average length of stay: 4.6 days
Source: www.cdc.gov/nchs/data/nhds/2average/2010ave2_firstlist.pdf#x2013
Mortality
• Number of deaths: 75,578
• Deaths per 100,000 population: 23.9
• Cause of death rank: 7
Source: www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf
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These statistics demonstrate that our current healthcare environment in the U.S. for the treatment of diabetes is inadequate. It's time for a paradigm change. It's time for Afrezza.
Mike stated that in the first 2 weeks the reps received 300 requests for samples and left the impression that most of these were docs who had prescribed Afrezza before but stopped because they thought it would not be available after the breakup with SNY. Assume that 200 were returning docs and 100 were new. I will be generous and take your 500 visits a week to new docs (not currently prescribing)- a larger number would lower the success rate - giving us 1000 visits in the 2 weeks. Assuming as well that all previous prescribers requested samples the success rate for visits to new docs is 100/800= 12.5% Aug through Dec= 22 weeks. 500x22=11000 visits to new docs. 11000 x 0.125 = 1375 new prescribers, including the 200 prescribers who reenlisted, that is 1575. My recollection is that among doctors prescribing Afrezza, having 30 patients on Afrezza was a large number. According to your statistics, 50 diabetics are seen per week by each doctor, or 2,500 per year. 30/2500 = 1.2%. At the end of the year, then, the most we should expect is that 1575 doctors will be writing 1575 x 50 x 0.012 = 945 new prescriptions per week. Added to last week's TRX of 268 that gives us 1,213. So projections for the remainder of the year, based on the early results out of the gate, even if you add say a hundred refills from prescriptions started in September, don't even get us close to 2000 scripts per week. There are many factors that could add to the upside, including physician education activities and DTC, but the effectiveness of these is not yet known. It will be difficult to generate momentum in a few short months, and the effects of DTC won't be seen for months. So while I am somewhat optimistic for the future, I don't expect too much by the end of the year. Still, >1000 scripts/week might be enough to push the stock to $2 or more and allow MNKD to use the ATM without too much pain for shareholders. Raising $30-50 million buys at least another quarter. With potential payee concessions expected in the new year and a possible label change, it may be a different ball game come January, when we will also have a better idea of whether or not Mike has been able to improve the patient retention rate - which would also be a boost for the stock. |
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Post by anderson on Aug 10, 2016 19:53:45 GMT -5
My question is how fast will NRx build. If an endo prescribes Afrezza for a test case how long will he wait to prescribe to another? So if sales rep can convince a certain number of endos a week the NRx will plateau at current + average number of endos convinced per week.(note TRx will keep going up due to refills, but NRx would plateau). If TRx's just keep increasing then people believe in the product and are not just prescribing for test cases. But since everything else with MNKD is a challenge I have a feeling we will see NRx plateau at a certain number for several weeks and then slowly rise after that. If we could get the average number of visits a week, that number from current to the plataeu should give a nice metric of how successful the sales staff is.
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However, for Mannkind, I believe Afrezza reps are indeed making a lot of repeat visits in a short period of time, at least on their top prescribers. Here is what Mike C. said at the 2nd quarter CC: