vdex

[nylefty]

Oct 16, 2016 15:11:45 GMT -5 audiomr said:

Oct 16, 2016 7:51:55 GMT -5 falconquest said:

.....and we most likely won't know the impact on script numbers from Vdex will we? Not that it's necessary because overall script count is most important but it would be interesting to know what impact they have on the count.

It could be pretty significant, at least statistically. One clinic seeing 50 patients a week and prescribing Afrezza for half of them would pump the NRx numbers by about 16% from current levels. And if VDEX did a good job of keeping them on Afrezza, the TRx would snowball. Have to hope for quick success leading to rapid expansion of locations.

Of course the script numbers we see are just estimates, based on a limited number of reporting pharmacies. I hope the pharmacies that the Vdex patients use are among those who report to Symphony and/or
IMS.

On the other hand, Mannkind would get the actual revenue from Rx sales no matter what numbers were projected by the reporting companies, but perception is important to the stock price in the short term. 

[mpg54]

Oct 16, 2016 15:11:45 GMT -5 audiomr said:

Oct 16, 2016 7:51:55 GMT -5 falconquest said:

.....and we most likely won't know the impact on script numbers from Vdex will we? Not that it's necessary because overall script count is most important but it would be interesting to know what impact they have on the count.

It could be pretty significant, at least statistically. One clinic seeing 50 patients a week and prescribing Afrezza for half of them would pump the NRx numbers by about 16% from current levels. And if VDEX did a good job of keeping them on Afrezza, the TRx would snowball. Have to hope for quick success leading to rapid expansion of locations.

Not sure if a diabetic clinic would get that many patients a weeks. It's not a normal clinic. For MNKD I certainly hope so.

[benh]

Oct 16, 2016 15:44:28 GMT -5 nylefty said:

Oct 16, 2016 15:11:45 GMT -5 audiomr said:

It could be pretty significant, at least statistically. One clinic seeing 50 patients a week and prescribing Afrezza for half of them would pump the NRx numbers by about 16% from current levels. And if VDEX did a good job of keeping them on Afrezza, the TRx would snowball. Have to hope for quick success leading to rapid expansion of locations.

Of course the script numbers we see are just estimates, based on a limited number of reporting pharmacies. I hope the pharmacies that the Vdex patients use are among those who report to Symphony and/or
IMS.

On the other hand, Mannkind would get the actual revenue from Rx sales no matter what numbers were projected by the reporting companies, but perception is important to the stock price in the short term. 

Same rationale was used in MNKD 1.0 for low script #'s.

The myth:
''What if the RX being reported was in a pharmacy that was calculated by algo and not reporting directly? The #'s could be huge and likely because Goldman are fiddling the figures - evil Goldman

Turned out that IMS had nailed it. Symphony were, normally, slightly over IMS.

[nylefty]

Oct 16, 2016 19:18:14 GMT -5 benh said:

Oct 16, 2016 15:44:28 GMT -5 nylefty said:

Of course the script numbers we see are just estimates, based on a limited number of reporting pharmacies. I hope the pharmacies that the Vdex patients use are among those who report to Symphony and/or
IMS.

On the other hand, Mannkind would get the actual revenue from Rx sales no matter what numbers were projected by the reporting companies, but perception is important to the stock price in the short term. 

Same rationale was used in MNKD 1.0 for low script #'s.

The myth:
''What if the RX being reported was in a pharmacy that was calculated by algo and not reporting directly? The #'s could be huge and likely because Goldman are fiddling the figures - evil Goldman

Turned out that IMS had nailed it. Symphony were, normally, slightly over IMS.

There was a clinic during 1.0 where the protocol called for Afrezza as the mealtime insulin?  Really?  I must have missed that. 

[audiomr]

Oct 16, 2016 17:17:25 GMT -5 mpg54 said:

Oct 16, 2016 15:11:45 GMT -5 audiomr said:

It could be pretty significant, at least statistically. One clinic seeing 50 patients a week and prescribing Afrezza for half of them would pump the NRx numbers by about 16% from current levels. And if VDEX did a good job of keeping them on Afrezza, the TRx would snowball. Have to hope for quick success leading to rapid expansion of locations.

Not sure if a diabetic clinic would get that many patients a weeks. It's not a normal clinic. For MNKD I certainly hope so.

I don't see how it would stay open if it didn't get that many per week. Maybe not the first week, but pretty soon.

[buyitonsale]

Was in the area this afternoon and stopped by the address that was mentioned. It's a nicely maintained 2 story office building. The gate to enter the building was closed, so the unit is inside and will not be visible from the street. This is a good location in a busy residential / shopping and business area. I took a picture of the building but do not know how to post here.

[nylefty]

Oct 16, 2016 23:27:58 GMT -5 audiomr said:

Oct 16, 2016 17:17:25 GMT -5 mpg54 said:

Not sure if a diabetic clinic would get that many patients a weeks. It's not a normal clinic. For MNKD I certainly hope so.

I don't see how it would stay open if it didn't get that many per week. Maybe not the first week, but pretty soon.

Doesn't it stand to reason that Vdex will prescribe Afrezza for all or almost all of its patients, who, by definition will be diabetic? It's part of the Vdex protocol.

[benh]

Oct 16, 2016 21:20:35 GMT -5 nylefty said:

Oct 16, 2016 19:18:14 GMT -5 benh said:

Same rationale was used in MNKD 1.0 for low script #'s.

The myth:
''What if the RX being reported was in a pharmacy that was calculated by algo and not reporting directly? The #'s could be huge and likely because Goldman are fiddling the figures - evil Goldman

Turned out that IMS had nailed it. Symphony were, normally, slightly over IMS.

There was a clinic during 1.0 where the protocol called for Afrezza as the mealtime insulin?  Really?  I must have missed that. 

You stated : "Of course the script numbers we see are just estimates, based on a limited number of reporting pharmacies. I hope the pharmacies that the Vdex patients use are among those who report to Symphony and/or
IMS."

This is the scaffold by which excuses are built to dismiss/alter/accept the numbers released by IMS/Symphony based on a selected narrative/bias

This was already tried during 1.0 as a reason to why Rx was low. Reasonable questions on sampling were raised and discussed. (Some unreasonable questions over the perceived nefarious motives of IMS were also raised). But, it turned out that IMS success is wholly dependant upon the accuracy of their reporting (and fiddling a few figures for Afrezza was not a good risk/reward.)

There is a political example of this strategy playing out right now. It's not a strategy that ends well. Focus on the attributes leading to low #'s not the proven method of counting and reporting.

[audiomr]

Oct 16, 2016 23:52:21 GMT -5 nylefty said:

Oct 16, 2016 23:27:58 GMT -5 audiomr said:

I don't see how it would stay open if it didn't get that many per week. Maybe not the first week, but pretty soon.

Doesn't it stand to reason that Vdex will prescribe Afrezza for all or almost all of its patients, who, by definition will be diabetic? It's part of the Vdex protocol.

We don't really know exactly what their protocol is, and they have said that they will prescribe whatever treatments are appropriate for the particular patient. That said, I think the percentage will actually be higher than 50 -- just thought it better to be conservative.

[Deleted]

Oct 16, 2016 23:52:21 GMT -5 nylefty said:

Oct 16, 2016 23:27:58 GMT -5 audiomr said:

I don't see how it would stay open if it didn't get that many per week. Maybe not the first week, but pretty soon.

Doesn't it stand to reason that Vdex will prescribe Afrezza for all or almost all of its patients, who, by definition will be diabetic? It's part of the Vdex protocol.

In my industry that would be considered steering. I have to imagine in medicine there are laws against this. Maybe Liane can clarify.

[Deleted]

Oct 17, 2016 12:21:12 GMT -5 @reverselo said:

Oct 16, 2016 23:52:21 GMT -5 nylefty said:

Doesn't it stand to reason that Vdex will prescribe Afrezza for all or almost all of its patients, who, by definition will be diabetic? It's part of the Vdex protocol.

In my industry that would be considered steering. I have to imagine in medicine there are laws against this. Maybe Liane can clarify.

Hard to prove.. not like they are selling snake oil.
so most diabetics now get rx'ed novolog and humalog.
Can that be said in novo/huma log case too?

[Deleted]

Oct 17, 2016 12:26:08 GMT -5 @iam2sekc4u2002 said:

Oct 17, 2016 12:21:12 GMT -5 @reverselo said:

In my industry that would be considered steering. I have to imagine in medicine there are laws against this. Maybe Liane can clarify.

Hard to prove.. not like they are selling snake oil.
so most diabetics now get rx'ed novolog and humalog.
Can that be said in novo/huma log case too?

I am applying my industry so I could totally be incorrect. I work in banking so I imagine medicine is just as strict or probably more strict. If they are major shareholders (in my industry) we would have to disclose a service we are pushing especially if it helps the companies bottom line. So maybe someone with better knowledge can let us know if its a conflict of interest. If MNKD cannot provide a spirometry device I have to imagine then I would say Vdex could not steer anyone.

[orlon]

This is great news indeed...tongue in cheek....especially as the stock price is now at .46. Any more good news and I'll hardly be able to contain myself!

[agedhippie]

Oct 17, 2016 12:26:08 GMT -5 @iam2sekc4u2002 said:

Oct 17, 2016 12:21:12 GMT -5 @reverselo said:

In my industry that would be considered steering. I have to imagine in medicine there are laws against this. Maybe Liane can clarify.

Hard to prove.. not like they are selling snake oil.
so most diabetics now get rx'ed novolog and humalog.
Can that be said in novo/huma log case too?

No because there is a requirement for RAA and the exact RAA used is determined by insurance cover since they are all considered non-inferior. The suggestion seems to be that VDex will say "the answer is Afrezza, now what was the question?" My suspicion is that VDex could get into trouble if they prescribe Afrezza out of line with the standard of care if for example a patient suffered a severe hypo when the SoC said that they should be on metformin alone. Obviously if the patient gave an informed consent it would be different.

[dreamboatcruise]

Oct 17, 2016 12:21:12 GMT -5 @reverselo said:

Oct 16, 2016 23:52:21 GMT -5 nylefty said:

Doesn't it stand to reason that Vdex will prescribe Afrezza for all or almost all of its patients, who, by definition will be diabetic? It's part of the Vdex protocol.

In my industry that would be considered steering. I have to imagine in medicine there are laws against this. Maybe Liane can clarify.

It seems as if there is little if any restrictions.  There certainly have been many stories of doctors invested in, or receiving money from, companies that make drugs/devices, where the doctor is heavily using the products with their patient base.  It might be something valid to address as we try to control health costs, but lobbyist would certainly scream about government meddling in medical decisions if any controls were to be proposed.