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Post by mnholdem on Aug 22, 2016 19:52:54 GMT -5
You're still missing the point. Let's say the patient's insurer pays MannKind the wholesale price (i.e. $225 discounted from $287 retail price) and wants the patient to pay a $50 copay. Then MannKind would cover $35 of the $50 copay so that the patient only pays $15. The result is that MannKind receives $225 for the prescription.
If the patient isn't insured or has no coverage for Afrezza, the maximum assistance they can receive through the assistance plan is $150. Therefore, a patient with no coverage would have to pay retail minus $150. In the example above, if the retail price for the prescription was $285, so MannKind discounts $150 from the retail and the patient pays $135.
Both scenarios ensure that a profit margin is realized for MannKind.
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Post by mnkdnewb on Aug 22, 2016 20:01:41 GMT -5
There isn't much profit margin in $15 a month. Lol $15 is copayment that the patients pay to pharmacy.. Insurance pays the rest . Have you had ever filled an RX and looked into your prescription plan? At $15 cost, even the target of 6.5 million diabetics wouldn't even pay for a Mannkind. They better close the shop and stop the agony What insurance? Isn't it a Mannkind assistance program? The whole problem is a lot of insurance doesn't cover it. IMHO, Mnkd is trying to get scripts up as much as they can (and I don't blame them for that), but for now the more afrezza they sell the more they lose until more insurance plans cover it.
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Post by mnholdem on Aug 22, 2016 20:33:50 GMT -5
There is a big difference between making less profit and losing money. MannKind may be giving samples away, but not prescriptions. Also, Mike Castagna confirmed that 70% of health plans are covering Afrezza, although too many still require prior authorization. The assistance program "MannKind Cares" is there to help the patient/physician expedite the authorization process required by several health plans. Repeat. MannKind is NOT selling Afrezza at a loss. Go to the website and read.
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Post by flatrock on Aug 22, 2016 20:39:01 GMT -5
You're still missing the point. Let's say the patient's insurer pays MannKind the wholesale price (i.e. $225 discounted from $287 retail price) and wants the patient to pay a $50 copay. Then MannKind would cover $35 of the $50 copay so that the patient only pays $15. The result is that MannKind receives $225 for the prescription. If the patient isn't insured or has no coverage for Afrezza, the maximum assistance they can receive through the assistance plan is $150. Therefore, a patient with no coverage would have to pay retail minus $150. In the example above, if the retail price for the prescription was $285, so MannKind discounts $150 from the retail and the patient pays $135. Both scenarios ensure that a profit margin is realized for MannKind. I see, but then the patient is still out the $135 which is still a lot more than what they would pay for humalog or novolog if they were insured. That has to put afrezza in a weaker competitive position, doesn't it?
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Post by mnholdem on Aug 22, 2016 21:13:07 GMT -5
Look at what just happened to Sanofi. The largest PBM in the U.S. just announced that they will no longer cover Lantus and Toujeo. Does that put Sanofi at a competitive disadvantage? Of course it does.
Afrezza may not be covered by 100% of the formularies in the U.S., but it will still be available to millions of patients with diabetes mellitus. The new guy on the block always faces an uphill battle. Patient/physician awareness of the benefits of Afrezza will make the difference. The endocrinologists are currently being educated with new materials on proper titration of Afrezza for their patients and the DTC marketing will begin with print and digital media coupled with direct mailings to build patient awareness, starting in September.
Less coverage is a disadvantage, but so what? Every new drug starts out having to prove itself to the medical community and 3rd party payers.
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Post by anderson on Aug 23, 2016 4:24:13 GMT -5
Uh that isnt a pricing issue if they cost nearly the same whole sale that is an insurance coverage issue. Just like obamacare(health insurance) isnt health care. Apples are not oranges but people keep trying to say they are...... Anderson, help me understand "Just like obamacare (health insurance) isn't health care". Thanks. Just because you have insurance doesnt mean someone has to take it and give you health care.....take all that money spent on the websites and use it to pay back the student loans of nurses and doctors with the stipulation they have to work in the US for a couple of years or have clinics where they are required to work day a week etc....more supply of doctors and nurses would help more people have access to health care. Also you need tort reform. With those two things you could have affordable health care. Insurance on the other hand is "Insurance is a means of protection from financial loss. It is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss". I never have seen how that is equal to health care. If you want poor people to have health care you provide it to them by providing doctors. Could you image doctors without borders being a health insurance plan?
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Post by peppy on Aug 23, 2016 8:18:26 GMT -5
From the FAQ, "we are investigating our ability to post prescription data on our web site or similar accessible portal under the terms of our subscription agreement with the provider of this data."
Reply: That would be nice.
Other comments. The speculation about pricing now is moot. With insulin price increases, and discounts, the Board, has determined the price and that it can be done. 70% insurance coverage after prior authorizations. Additionally the 2016 abstracts that will make label changes possible. www.mannkindcorp.com/Collateral/Documents/English-US/Baughman%20poster%20100-LB%20FINAL%20X2.pdf This is the information physicians needed to get on board.
One other thing. For those of you that think, with the discount cards, the amount of money Mannkind will get reimbursed from insurance will not be enough, you are "el wrongo." Mannkind gets the script, works with discount cards, and retains users; their is enough profit margin.
Interesting on the mankind slide Mannkind shows afrezza and tresiba
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Post by flatrock on Aug 23, 2016 8:30:03 GMT -5
From the FAQ, "we are investigating our ability to post prescription data on our web site or similar accessible portal under the terms of our subscription agreement with the provider of this data."
Reply: That would be nice.
Other comments. The speculation about pricing now is moot. With insulin price increases, and discounts, the Board, has determined the price and that it can be done. 70% insurance coverage after prior authorizations. Additionally the 2016 abstracts that will make label changes possible. www.mannkindcorp.com/Collateral/Documents/English-US/Baughman%20poster%20100-LB%20FINAL%20X2.pdf This is the information physicians needed to get on board.
One other thing. For those of you that think, with the discount cards, the amount of money Mannkind will get reimbursed from insurance will not be enough, you are "el wrongo." Mannkind gets the script, works with discount cards, and retains users; their is enough profit margin.
The "speculation about pricing" isn't moot quite yet:
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Post by peppy on Aug 23, 2016 8:36:29 GMT -5
yeah, she may have to change from blue cross blue shield. or change to a blue cross blue shield plan that covers afrezza.
We human beings do have the power to change things. She needs to work with mannkind cares to get authorized. They have a system I would think. I would hit blue cross blue shield with hypoglycemia reduction information and have the physician write, for reduction in hypoglycemia risk and better glycemic control secondary to less hypoglycemic fear.
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Post by flatrock on Aug 23, 2016 9:03:28 GMT -5
yeah, she may have to change from blue cross blue shield. or change to a blue cross blue shield plan that covers afrezza. We human beings do have the power to change things. She needs to work with mannkind cares to get authorized. They have a system I would think. I would hit blue cross blue shield with hypoglycemia reduction information and have the physician write, for reduction in hypoglycemia risk and better glycemic control secondary to less hypoglycemic fear. I'm not sure if this means the endo was involved or not: "Peer to peer" makes it sound like the endo was involved in the decision.
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Post by peppy on Aug 23, 2016 9:25:56 GMT -5
yeah, she may have to change from blue cross blue shield. or change to a blue cross blue shield plan that covers afrezza. We human beings do have the power to change things. She needs to work with mannkind cares to get authorized. They have a system I would think. I would hit blue cross blue shield with hypoglycemia reduction information and have the physician write, for reduction in hypoglycemia risk and better glycemic control secondary to less hypoglycemic fear. I'm not sure if this means the endo was involved or not: "Peer to peer" makes it sound like the endo was involved in the decision. I am sure there is a process. This individual a squeaky wheel , hopefully get insurance coverage. so flat rock, are you worried? or just like to point things out? Where do you stand on the American military complex?
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Post by derek2 on Aug 23, 2016 9:47:49 GMT -5
You're still missing the point. Let's say the patient's insurer pays MannKind the wholesale price (i.e. $225 discounted from $287 retail price) and wants the patient to pay a $50 copay. Then MannKind would cover $35 of the $50 copay so that the patient only pays $15. The result is that MannKind receives $225 for the prescription. If the patient isn't insured or has no coverage for Afrezza, the maximum assistance they can receive through the assistance plan is $150. Therefore, a patient with no coverage would have to pay retail minus $150. In the example above, if the retail price for the prescription was $285, so MannKind discounts $150 from the retail and the patient pays $135. Both scenarios ensure that a profit margin is realized for MannKind. In the second example, a profit margin is realized only if the cost of goods sold (COGS) is less than $135 for the prescription. MNKD has never disclosed their COGS, so it's tough to say if both scenarios ensure a parofit margin. Both scenarios do ensure some amount of revenue from each sale, though.
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Post by lakon on Aug 23, 2016 9:51:11 GMT -5
You're still missing the point. Let's say the patient's insurer pays MannKind the wholesale price (i.e. $225 discounted from $287 retail price) and wants the patient to pay a $50 copay. Then MannKind would cover $35 of the $50 copay so that the patient only pays $15. The result is that MannKind receives $225 for the prescription. If the patient isn't insured or has no coverage for Afrezza, the maximum assistance they can receive through the assistance plan is $150. Therefore, a patient with no coverage would have to pay retail minus $150. In the example above, if the retail price for the prescription was $285, so MannKind discounts $150 from the retail and the patient pays $135. Both scenarios ensure that a profit margin is realized for MannKind. In the second example, a profit margin is realized only if the cost of goods sold (COGS) is less than $135 for the prescription. MNKD has never disclosed their COGS, so it's tough to say if both scenarios ensure a parofit margin. Both scenarios do ensure some amount of revenue from each sale, though. Simple arithmetic based on the old partnership and price reveals the answer that you *should* seek.
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Post by mnholdem on Aug 23, 2016 10:02:20 GMT -5
Actually, the COGS was inadvertently disclosed quite some time ago by Matt in a sort of backdoor manner. Some folks figured it out based on Pfeffer's remark about the deal being equivalent to a mid-20% royalty deal. Some shareholders who were accountants were able to take that information and a COGS was calculated and posted. However, two years later, I'm not certain that I could even find those posts anymore. As I recall, the profit margin for MannKind was over 85% profit margin AFTER Sanofi's 65% piece of the pie.
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Post by flatrock on Aug 23, 2016 10:09:34 GMT -5
I'm not sure if this means the endo was involved or not: "Peer to peer" makes it sound like the endo was involved in the decision. I am sure there is a process. This individual a squeaky wheel , hopefully get insurance coverage. so flat rock, are you worried? or just like to point things out? Where do you stand on the American military complex?
Well, worried about cost and insurance coverage. I happened to note a tweet from Adam Lasher: Is that typical? I could see that insurance might push back if users routinely need 5 boxes a month. That would use up the $150 coupon pretty quick.
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