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Post by compound26 on Aug 17, 2016 12:32:57 GMT -5
The titration and insurance issues are kind of a chicken and egg problem. Did patients stop using Afrezza because they couldn't titrate with limited packs and then discover insurance wouldn't cover Afrezza anyway? Or did they try Afrezza knowing they would have to fight for coverage and then find out they couldn't titrate and just gave up? I'll bet both scenarios played out multiple times. Maybe what Mike and the team are trying to overcome is just plain frustration. Regarding agedhippie's post (earlier in this thread) about Sanofi probably having stats as to why people stopped using and your post, MNKD at the CC's made it clear that it was a combination of factors including those who used sample packs and didnt go any farther. As I recall factors involved were titration/initial dosing problems (including but not limited to running out), coverage(insurance), preauthorization hurdles, and pricing and a combination thereof. prvs michaelcastagna yes, apparently, it is a combination of factors. However, for Mannkind to succeed, it needs to address each of these issues. Since Sanofi drops its efforts in marketing Afrezza, the Afrezza NRx and TRx has steadily declined since Sept./Oct. 2015. To me, that is not surprising or a big concern. However, the weekly refills has also declined from 250/300 level reached at the start of 2016 to around 160/170 level right now. That is a bigger concern to me. Yes, insurance and reimbursement is an issue. However, since for those users who are already on Afrezza, these should be less an issue. Plus, even though NRx are relatively low in the first half of 2016 and retention rate is not satisfactory, a part of the NRx is nevertheless being turned into refills each and every week, therefore, ideally, our total refills should still steadily increase despite these factors. To me, the steadily dropping of weekly refills suggest that some users are dropping out after one or two refills and that the numbers dropping out of the refills exceeds the numbers being added via NRx. That is worrisome. To me, most likely, those who drop out of the refills did not titrate Afrezza well to give them the good control they wanted. To me, a steady rise of refills is even more important than a steady rise of NRx. As long as we can retain a great majority of the existing users, refills will keep rising, no matter how small the NRx is. On the other hand, even if the NRx is high, if we keep loosing users (even after one or two refills), our TRx will not rise significantly. I would think it is important from now on that Mannkind makes every effort to make sure that each new user is followed up in the initial 7-10 days. Do not know whether it is doable or not. But perhaps Mannkind gets the patient's contact information through their enrollment of the Afrezza co-pay card? Maybe some of the nurse educators can follow up on these new users and to the extent a new patient has any titration issue refer the patient to a titration specialist/doctor engaged by Mannkind?
In terms man power, since we are probably talking about 1,000 new patients every month at most at this moment, that will be 250 per week or 50 per day. I would think Mannkind does have the resource to follow up with these new patients. However, I do not know whether the current medical practices allow them to do so. Also, is it possible for Mannkind to create some type of Afrezza community site like the Amazon Q&A service? In Amazon, for every popular product, there is a section called "Customer Questions & Answers". Where a user can post any question and other users can answer the question. All the questions and answers are archived and searchable. A user can get lots of useful information about a product by looking through these Q&As. The keys is that all the questions are answers by Amazon's customers and no Amazon representative is involved. Additionally, based on my experience, if you post a question, someone will very timely answer the question. This an excellent example of cloud sourcing. Based on how well Afrezza has worked for some of the early adopters, perhaps a similar Afrezza Q&A community can be supported and monitored (but without actual involvement by any Mannkind employee) by Mannkind? Any Afrezza user will share their experience solely as a share of their personal experience (not as a medical advice). I think in such a site, initially, we can probably have 20-30 successful Afrezza early adopters to volunteer to each write a few paragraphs about their best tips on Afrezza titration, with several themes, like their typical dosage, timing, how many follow-up doses they will need, how many units and boxes they use every week and month, improvement in their quality of life (weight loss, sleep quality, less diabetic complications (neuropathy, Cholesterol level, etc.), freedom in dining out and exercise, etc.), how to dose for fatty and slow digesting foods (pizza, etc.), how to address dry cough issue (if any), their experience deal with prior authorization and insurance, which insurance they are using, etc. Those information will then get categorized (like dosage related, gender, age, type 1 and type 2, different food type, etc.), archived and made searchable. This will serve as a good starting point for an Afrezza community.Above are some of my random thoughts that I throw out for your consideration. They may not be practical, but just in case any of them is helpful in stimulating your creative discussions.
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Post by babaoriley on Aug 17, 2016 13:10:16 GMT -5
One thing I clearly do not understand, Compound, and that is how you got only 14 "likes" so far on your initial post. Lots of work and well done!! As far as taking the dose 10-15 minutes after the start of the meal, I'd be washing dishes by then! And the three nursettes that frequent this board (Lynn, Dolly and Coco), we've gone to several lunches, coinciding with the quarterly reports; heck, those girls are served and five minutes later, the table is cleared!
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Post by sportsrancho on Aug 17, 2016 15:38:28 GMT -5
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Post by daduke38 on Aug 17, 2016 17:00:01 GMT -5
Thanks and great to read the tweet!
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Post by peppy on Aug 17, 2016 17:29:50 GMT -5
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Post by sayhey24 on Aug 17, 2016 19:08:33 GMT -5
The Cnogacare link has a really interesting FAQ on the issues around optical glucose measurement. They are available for sale but not in the U.S. yet - Cnoga Medical devices are approved for marketing in the following countries: Brazil – ANVISA Certification Israel – AMAR Certification China – CFDA certification Europe – CE certification They also have a cloud monitoring service and would be ideal in titrating the T2s "IF" these devices really worked. The T2 does not need the CGM. I have not personally tried one but I did read the review by the Chief Engineer at Texas Instrument who at first did not believe it would work. TI is now providing Cnoga with funding.
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Post by agedhippie on Aug 17, 2016 19:39:13 GMT -5
The Cnogacare link has a really interesting FAQ on the issues around optical glucose measurement. They are available for sale but not in the U.S. yet - Cnoga Medical devices are approved for marketing in the following countries: Brazil – ANVISA Certification Israel – AMAR Certification China – CFDA certification Europe – CE certification They also have a cloud monitoring service and would be ideal in titrating the T2s "IF" these devices really worked. The T2 does not need the CGM. I have not personally tried one but I did read the review by the Chief Engineer at Texas Instrument who at first did not believe it would work. TI is now providing Cnoga with funding. It's biggest problem is that it cannot be used by Type 1 and probably not by insulin using Type 2 diabetics either. It cannot manage rapid changes or numbers below 70.
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Post by sayhey24 on Aug 17, 2016 19:58:33 GMT -5
They are available for sale but not in the U.S. yet - Cnoga Medical devices are approved for marketing in the following countries: Brazil – ANVISA Certification Israel – AMAR Certification China – CFDA certification Europe – CE certification They also have a cloud monitoring service and would be ideal in titrating the T2s "IF" these devices really worked. The T2 does not need the CGM. I have not personally tried one but I did read the review by the Chief Engineer at Texas Instrument who at first did not believe it would work. TI is now providing Cnoga with funding. It's biggest problem is that it cannot be used by Type 1 and probably not by insulin using Type 2 diabetics either. It cannot manage rapid changes or numbers below 70. Maybe it won't fit the bill. For the T1 San Meditech at a $50-$100 price point would be the best, but again not U.S. approved, yet. For the T2 I think Cnoga could just work. You only need a readings about 90 minutes apart. I think its worth a try. With that said I wish Verily and IBM would announce their services tomorrow, but I will probably be disappointed again.
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Post by surplusvalue on Aug 17, 2016 20:52:41 GMT -5
Regarding agedhippie's post (earlier in this thread) about Sanofi probably having stats as to why people stopped using and your post, MNKD at the CC's made it clear that it was a combination of factors including those who used sample packs and didnt go any farther. As I recall factors involved were titration/initial dosing problems (including but not limited to running out), coverage(insurance), preauthorization hurdles, and pricing and a combination thereof. prvs michaelcastagna yes, apparently, it is a combination of factors. However, for Mannkind to succeed, it needs to address each of these issues. Since Sanofi drops its efforts in marketing Afrezza, the Afrezza NRx and TRx has steadily declined since Sept./Oct. 2015. To me, that is not surprising or a big concern. However, the weekly refills has also declined from 250/300 level reached at the start of 2016 to around 160/170 level right now. That is a bigger concern to me. Yes, insurance and reimbursement is an issue. However, since for those users who are already on Afrezza, these should be less an issue. Plus, even though NRx are relatively low in the first half of 2016 and retention rate is not satisfactory, a part of the NRx is nevertheless being turned into refills each and every week, therefore, ideally, our total refills should still steadily increase despite these factors. To me, the steadily dropping of weekly refills suggest that some users are dropping out after one or two refills and that the numbers dropping out of the refills exceeds the numbers being added via NRx. That is worrisome. To me, most likely, those who drop out of the refills did not titrate Afrezza well to give them the good control they wanted. To me, a steady rise of refills is even more important than a steady rise of NRx. As long as we can retain a great majority of the existing users, refills will keep rising, no matter how small the NRx is. On the other hand, even if the NRx is high, if we keep loosing users (even after one or two refills), our TRx will not rise significantly. I would think it is important from now on that Mannkind makes every effort to make sure that each new user is followed up in the initial 7-10 days. Do not know whether it is doable or not. But perhaps Mannkind gets the patient's contact information through their enrollment of the Afrezza co-pay card? Maybe some of the nurse educators can follow up on these new users and to the extent a new patient has any titration issue refer the patient to a titration specialist/doctor engaged by Mannkind?
In terms man power, since we are probably talking about 1,000 new patients every month at most at this moment, that will be 250 per week or 50 per day. I would think Mannkind does have the resource to follow up with these new patients. However, I do not know whether the current medical practices allow them to do so. Also, is it possible for Mannkind to create some type of Afrezza community site like the Amazon Q&A service? In Amazon, for every popular product, there is a section called "Customer Questions & Answers". Where a user can post any question and other users can answer the question. All the questions and answers are archived and searchable. A user can get lots of useful information about a product by looking through these Q&As. The keys is that all the questions are answers by Amazon's customers and no Amazon representative is involved. Additionally, based on my experience, if you post a question, someone will very timely answer the question. This an excellent example of cloud sourcing. Based on how well Afrezza has worked for some of the early adopters, perhaps a similar Afrezza Q&A community can be supported and monitored (but without actual involvement by any Mannkind employee) by Mannkind? Any Afrezza user will share their experience solely as a share of their personal experience (not as a medical advice). I think in such a site, initially, we can probably have 20-30 successful Afrezza early adopters to volunteer to each write a few paragraphs about their best tips on Afrezza titration, with several themes, like their typical dosage, timing, how many follow-up doses they will need, how many units and boxes they use every week and month, improvement in their quality of life (weight loss, sleep quality, less diabetic complications (neuropathy, Cholesterol level, etc.), freedom in dining out and exercise, etc.), how to dose for fatty and slow digesting foods (pizza, etc.), how to address dry cough issue (if any), their experience deal with prior authorization and insurance, which insurance they are using, etc. Those information will then get categorized (like dosage related, gender, age, type 1 and type 2, different food type, etc.), archived and made searchable. This will serve as a good starting point for an Afrezza community.Above are some of my random thoughts that I throw out for your consideration. They may not be practical, but just in case any of them is helpful in stimulating your creative discussions. I think your concern over the the rate of decline in refills in the first half of 2016 has to be put in the context of almost total lack of support by Sanofi before MNKD got back control. Hence in my mind, this decline is to be expected, and not a huge concern. Remember Sanofi not only told everyone that it was not sellable but also was so unsupportive that everyone at the ADA thought Afrezza was off or going off the market. The period to begin to evaluate the rate of refills should correctly begin in the second half of 2016 and even now its a bit early. Given that there will hopefully be a lag in the rate of refills compared to the rate of new users, you are correct that if we see the rate of dropout exceed the rate of new users MNKD is in big trouble. I think its too early to make an assessment but I concur with your emphasis on MNKD needing to make sure retention takes place and they seem to be aware of the issues mentioned (titration, coverage, price etc.) Also I believe that the increase in new users will be biphasic: the first phase in the targeting of doctors (endos) for education and presence and the second phase involving the diabetic "consumer". I think that most endos, like most doctors, are conservative and reluctant to embark on modifying their habitual practice and relations so that an increase of scripts will be less than most here expect or desire. Once MNKD chips away at public awareness (which is probably the biggest problem) the demand side should help pressure the endos so that we begin to see a steady increase in scripts. So from this perspective it's not only to early to evaluate the retention rate but also the rate of increase. I'm prepared to suspend judgment until early December although I'd like nothing more than to get some more immediate gratification.
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Post by therealisaching on Aug 22, 2016 10:20:04 GMT -5
prvs michaelcastagna yes, apparently, it is a combination of factors. However, for Mannkind to succeed, it needs to address each of these issues. Since Sanofi drops its efforts in marketing Afrezza, the Afrezza NRx and TRx has steadily declined since Sept./Oct. 2015. To me, that is not surprising or a big concern. However, the weekly refills has also declined from 250/300 level reached at the start of 2016 to around 160/170 level right now. That is a bigger concern to me. Yes, insurance and reimbursement is an issue. However, since for those users who are already on Afrezza, these should be less an issue. Plus, even though NRx are relatively low in the first half of 2016 and retention rate is not satisfactory, a part of the NRx is nevertheless being turned into refills each and every week, therefore, ideally, our total refills should still steadily increase despite these factors. To me, the steadily dropping of weekly refills suggest that some users are dropping out after one or two refills and that the numbers dropping out of the refills exceeds the numbers being added via NRx. That is worrisome. To me, most likely, those who drop out of the refills did not titrate Afrezza well to give them the good control they wanted. To me, a steady rise of refills is even more important than a steady rise of NRx. As long as we can retain a great majority of the existing users, refills will keep rising, no matter how small the NRx is. On the other hand, even if the NRx is high, if we keep loosing users (even after one or two refills), our TRx will not rise significantly. I would think it is important from now on that Mannkind makes every effort to make sure that each new user is followed up in the initial 7-10 days. Do not know whether it is doable or not. But perhaps Mannkind gets the patient's contact information through their enrollment of the Afrezza co-pay card? Maybe some of the nurse educators can follow up on these new users and to the extent a new patient has any titration issue refer the patient to a titration specialist/doctor engaged by Mannkind?
In terms man power, since we are probably talking about 1,000 new patients every month at most at this moment, that will be 250 per week or 50 per day. I would think Mannkind does have the resource to follow up with these new patients. However, I do not know whether the current medical practices allow them to do so. Also, is it possible for Mannkind to create some type of Afrezza community site like the Amazon Q&A service? In Amazon, for every popular product, there is a section called "Customer Questions & Answers". Where a user can post any question and other users can answer the question. All the questions and answers are archived and searchable. A user can get lots of useful information about a product by looking through these Q&As. The keys is that all the questions are answers by Amazon's customers and no Amazon representative is involved. Additionally, based on my experience, if you post a question, someone will very timely answer the question. This an excellent example of cloud sourcing. Based on how well Afrezza has worked for some of the early adopters, perhaps a similar Afrezza Q&A community can be supported and monitored (but without actual involvement by any Mannkind employee) by Mannkind? Any Afrezza user will share their experience solely as a share of their personal experience (not as a medical advice). I think in such a site, initially, we can probably have 20-30 successful Afrezza early adopters to volunteer to each write a few paragraphs about their best tips on Afrezza titration, with several themes, like their typical dosage, timing, how many follow-up doses they will need, how many units and boxes they use every week and month, improvement in their quality of life (weight loss, sleep quality, less diabetic complications (neuropathy, Cholesterol level, etc.), freedom in dining out and exercise, etc.), how to dose for fatty and slow digesting foods (pizza, etc.), how to address dry cough issue (if any), their experience deal with prior authorization and insurance, which insurance they are using, etc. Those information will then get categorized (like dosage related, gender, age, type 1 and type 2, different food type, etc.), archived and made searchable. This will serve as a good starting point for an Afrezza community.Above are some of my random thoughts that I throw out for your consideration. They may not be practical, but just in case any of them is helpful in stimulating your creative discussions. I think your concern over the the rate of decline in refills in the first half of 2016 has to be put in the context of almost total lack of support by Sanofi before MNKD got back control. Hence in my mind, this decline is to be expected, and not a huge concern. Remember Sanofi not only told everyone that it was not sellable but also was so unsupportive that everyone at the ADA thought Afrezza was off or going off the market. The period to begin to evaluate the rate of refills should correctly begin in the second half of 2016 and even now its a bit early. Given that there will hopefully be a lag in the rate of refills compared to the rate of new users, you are correct that if we see the rate of dropout exceed the rate of new users MNKD is in big trouble. I think its too early to make an assessment but I concur with your emphasis on MNKD needing to make sure retention takes place and they seem to be aware of the issues mentioned (titration, coverage, price etc.) Also I believe that the increase in new users will be biphasic: the first phase in the targeting of doctors (endos) for education and presence and the second phase involving the diabetic "consumer". I think that most endos, like most doctors, are conservative and reluctant to embark on modifying their habitual practice and relations so that an increase of scripts will be less than most here expect or desire. Once MNKD chips away at public awareness (which is probably the biggest problem) the demand side should help pressure the endos so that we begin to see a steady increase in scripts. So from this perspective it's not only to early to evaluate the retention rate but also the rate of increase. I'm prepared to suspend judgment until early December although I'd like nothing more than to get some more immediate gratification. The lack of refills is very concerning. I dont know the answer. Despite SNY's termination, lack of support & maybe even misinformation that the product would no longer be available there have been over 4400 new & renewed scripts ytd. The last 13 weeks there have been 1300+ refills.
I'm suspending judgement as well solely because I've been impressed with Mike C. They've delievered thus far on their promises of MNKD 2.0. I hope he has the nurse educators reaching out to each & every new patient and gets the retention issue turned around.
Would welcome any thoughts on the issue.
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Post by als57 on Aug 22, 2016 11:33:05 GMT -5
I see we were "slammed" in a SA article today on the very issue of refills going negative while new Rx's saw an increase. According to the author of the article WS is more interested in refills.
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Post by anderson on Aug 22, 2016 11:37:33 GMT -5
12 weeks ago there was a dip in the Nrx would refills follow 12 weeks later for most people? If so refills will bounce around the same amount for a while(ie old users who know what they need) till the new people get through their Nrx'es(I assume the titration pack will be a 30 day perscription so NRx and then they will start on their actual dosage another 90 day NRx, so lag time for increasing refills somewhere after 13 weeks from mid july? Could be longer if the doc wants to check after the first 90 days to alter dosage again.) But that is just me rambling nothing to see here.
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