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Post by jonny80s on Sept 28, 2016 9:35:39 GMT -5
One of my colleagues just got back from vacation and had the chance to speak with a couple of pharmacist friends. They said that Afrezza is simply to expensive.
To back up this information: one of my other colleagues is a T2 and is on metformin. Between diet and excercise he keeps everything under control. His cost after insurance for metformin is $0.27 per month. And they never bill him the $0.27 because it costs more to do so then eating the $0.27.
I'm still in for the long haul because I've always believed that technosphere was a much bigger game then Afrezza itself. But it doesn't look good. Hopefully Mnkd can find a way to access the T1 market with broader use of CGM type monitoring and portions of the T2 market in which Afrezza would benefit patients more than the other pharmacy offerings.
It takes time..... and money.
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Post by matt on Sept 28, 2016 9:45:45 GMT -5
Your really can't compare metformin to insulin, they are two different beasts. Metformin does work for many Type II patients, but small molecule drugs are dirt cheap to produce and generics are really cheap at this point. I am on one generic small molecule and I can buy a year's supply for about $35 without any insurance contribution.
The valid comparison point is rapid acting insulin vs Afrezza, but even there Afrezza is expensive. Nobody really know how much the big PBMs pay for insulin because those sold source deals are confidential, but suffice it to say that Lilly and Novo are deeply discounting their product to get tier 1 coverage. MNKD can help fight that war with the discount card, but that is economically the same as cutting the price, and for a company that has yet to breakeven it is not clear if that is a sustainable strategy or not. However, if a patient compares full price insulin with full price Afrezza, that is an invalid comparison since most drugs covered by insurance are actually price much lower than that after rebates and other discounts. It is roughly comparable to Hertz and Avis buying new cars for their fleet; they don't pay anything close to the sticker price.
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Post by cjm18 on Sept 28, 2016 9:48:15 GMT -5
2.0 launch is targeting people on insulin. 1.0 was going after people on any meds including metaformin.
Afrezza is competitively priced compared to other insulins If there is decent insurance coverage.
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Post by slugworth008 on Sept 28, 2016 9:49:59 GMT -5
One of my colleagues just got back from vacation and had the chance to speak with a couple of pharmacist friends. They said that Afrezza is simply to expensive. To back up this information: one of my other colleagues is a T2 and is on metformin. Between diet and excercise he keeps everything under control. His cost after insurance for metformin is $0.27 per month. And they never bill him the $0.27 because it costs more to do so then eating the $0.27. I'm still in for the long haul because I've always believed that technosphere was a much bigger game then Afrezza itself. But it doesn't look good. Hopefully Mnkd can find a way to access the T1 market with broader use of CGM type monitoring and portions of the T2 market in which Afrezza would benefit patients more than the other pharmacy offerings. It takes time..... and money. We only need a certain percentage of the market to make bank here. IMO, there is plenty of market to go after.
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Post by mnholdem on Sept 28, 2016 9:56:16 GMT -5
"He keeps everything under control" and yet the beta cells in his pancreas will likely continue to deteriorate to the point where metformin will not be enough. Then he'll need insulin.
I agree that it will take time, but perhaps not for what you are referring to. IMHO, it will take time and more evidence (which takes money, of course) to convince the ADA and the rest of the medical community that early Short-Term Intensive Insulin therapy can result in a remission of the disease. Resistance to injections is no longer an excuse with an inhaled prandial insulin on the market.
Physicians who prescribe metformin do so because it is the current Standard of Care published by the ADA. But the medical institutes like ADA are fooling themselves. With metformin, the short-term cost of treatment is extremely low, but in the long-term the patients are being condemned to a lifetime of diabetes treatment which will become more expensive as the disease progresses.
The exception are those patients who are motivated to enact lifestyle changes when they are first prescribed to an oral med. In those cases, it's the patient who helps remedy the situation, not the medication. For the rest, metformin is a cheap delay tactic that does little to stem an epidemic disease that costs our nation multiple $billions. In the long haul, metformin is WAY more expensive.
That matters little to payers whose only concern is the quarterly income report, but it should matter to the ADA. In fairness to them, however, the Standard of Care may be based more on ensuring compliance among patients. Oral = easy (1st choice of drug); 1 daily injection (basal) = tolerable (2nd choice of drug); 1 basal + multiple prandial injections = intolerable, but no choice (3rd choice).
Inhaled insulin could result in compliance levels that are similar to orals, if it were endorsed by the ADA as a first choice for treatment of early T2. Alfred Mann died believing that Afrezza would change the standards for treatment of diabetes. Time (& money) will tell if he was correct.
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Post by peppy on Sept 28, 2016 9:59:33 GMT -5
your t2 friend controlled on metformin; it is a mild glucose resistance. not all type 2 is created equal.
Prednisone, or betamethasone, some prescription drugs elevate blood glucose levels.
Money wise, yes. the public being sold the problem is being solved for 49 cents. Everyone is happy.
(why are monthly healthcare premiums so high? Did you see bariatric surgery on the list of t2 treatment options for the overweight? I have always thought that is extreme. Everyone is different. Those people feel the right thing being done.)
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Post by nadathing on Sept 28, 2016 10:03:47 GMT -5
As with any drug, one size does nor fit all and not everyone will need Afrezza. I am not insulin dependent. I use metformin and Trulicity. My A1c is 5.7. There are advantages to using Afrezza for some T2's, but my doctor is not going to prescribe it unless I cannot control my diabetes through diet, exercise and non-insulin treatment. As for the cost, my copay for Trulicity is $50 a month. My copay for a month (60 8 unit) would be $50.
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Post by gonetotown on Sept 28, 2016 10:10:15 GMT -5
"He keeps everything under control" and yet the beta cells in his pancreas will likely continue to deteriorate to the point where metformin will not be enough. Then he'll need insulin.
I agree that it will take time, but perhaps not for what you are referring to. IMHO, it will take time and more evidence (which takes money, of course) to convince the ADA and the rest of the medical community that early Short-Term Intensive Insulin therapy can result in a remission of the disease. Resistance to injections is no longer an excuse with an inhaled prandial insulin on the market.
Physicians who prescribe metformin do so because it is the current Standard of Care published by the ADA. But the medical institutes like ADA are fooling themselves. With metformin, the short-term cost of treatment is extremely low, but in the long-term the patients are being condemned to a lifetime of diabetes treatment which will become more expensive as the disease progresses.
The exception are those patients who are motivated to enact lifestyle changes when they are first prescribed to an oral med. In those cases, it's the patient who helps remedy the situation, not the medication. For the rest, metformin is a cheap delay tactic that does little to stem an epidemic disease that costs our nation multiple $billions. In the long haul, metformin is WAY more expensive.
That matters little to payers whose only concern is the quarterly income report, but it should matter to the ADA. In fairness to them, however, the Standard of Care may be based more on ensuring compliance among patients. Oral = easy (1st choice of drug); 1 daily injection (basal) = tolerable (2nd choice of drug); 1 basal + multiple prandial injections = intolerable, but no choice (3rd choice).
Inhaled insulin could result in compliance levels that are similar to orals, if it were endorsed by the ADA as a first choice for treatment of early T2. Alfred Mann died believing that Afrezza would change the standards for treatment of diabetes. Time (& money) will tell if he was correct. Canadians seem to think metformin has advantages: www.rxfiles.ca/rxfiles/uploads/documents/diabetes-agents-outcomes-comparison-summary-table.pdf
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Post by mnholdem on Sept 28, 2016 11:25:29 GMT -5
Yessir-you-betcha! What is going to be the most difficult part of updating standards is separating Afrezza inhaled monomer insulin from RAA/injected hexamer insulin, with their higher risk of hypoglycemic excursions.
IMO, this is a valid argument behind the need for FDA to create a separate class of insulin for Afrezza. Technosphere insulin belongs in a completely different spot on these standards charts rather than being lumped in with injected insulin (human and/or analog).
NOTE: This is another reason why new post-market superiority trials are essential.
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Post by madog365 on Sept 28, 2016 11:55:06 GMT -5
Untrue that Afrezza is expensive compared to other fast acting meal time insulins. It is true that the competitive set has better coverage and therefore may be cheaper on certain plans but definately not all. I urge you to do your own comparison here. www.blinkhealth.com/Afrezza is the cheapest when not factoring in insurance. Blink is available to anyone to use.
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Post by gonetotown on Sept 28, 2016 20:33:03 GMT -5
Untrue that Afrezza is expensive compared to other fast acting meal time insulins. It is true that the competitive set has better coverage and therefore may be cheaper on certain plans but definately not all. I urge you to do your own comparison here. www.blinkhealth.com/Afrezza is the cheapest when not factoring in insurance. Blink is available to anyone to use. As I read it, 30 cartridges cost almost $100, so that's about $300 for a month's supply at the minimum for a type 1. Humalog pen is $500 for 1,500 units, which would be up to five months supply for a type 1. So afrezza is still roughly three times as expensive as a humalog pen.
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