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Post by sophie on Oct 10, 2016 0:24:50 GMT -5
Wouldn't this mean that Afrezza is quite a bit more expensive considering that it takes 2-3 more units/dose (from what I've read) than injected? I'm not understanding the graphic that got posted... Fuzzy math. A different graphic from last year. Towards the bottom it says that 4 units translates laterally, 6 goes to 8 with Afrezza and 9 goes to 12. secure.medicalletter.org/w1463cLooks similar to me - from the dosing guide as approved by the FDA and MNKD, unless you don't believe them.  Unless someone is on the low end of the dose. 9 units of injected insulin is equivalent to 12 Afrezza units. It may or may not cost more, depending on how often they dose. It comes down to needing an extra box of Afrezza vs an extra pen to satisfy the 30/90 day regimen. |
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Post by wgreystone on Oct 10, 2016 1:13:22 GMT -5
Mannkind was an obvious winner due to supriority of Afrezza. Unfortunately, the company was ruinned by over-pride management team. It refused to raise money while the stock price was $10 (while most small bio/pharma companies were doing that). It refuses to low Afrezza price when it's obvious that insurance companies won't put Afrezza on tier 1/2 and remove prior-auth unless MNKD does something. Mannkind management team needs to get into the paranoid mode now. And it would appear that you've refused to do any real research on MNKD nor do you know the history of the CO - Like many of us longtime longs have and know. So I'll briefly enlighten you. At 10 a share and a partnership with SNY - MNKD entered into what should have been a lucrative partnership agreement...Then Vienbacher, who signed off on the deal, was sacked by SNY and his replacement - Oliver Brandicourt - Had no taste for Afrezza....What has been done since by Matt and Mike is nothing short of remarkable IMO. That is the seriously abbreviated version - If you want to know more spend some time reading older threads on this board. I have owned MNKD stock for many years. So I know all the history. At the time MNKD signed partnership with SNY, MNKD owed hundreds of millions to debt holders and Al Mann foundation. In addition, the partnership deal with SNY was profit sharing (which is very unusual). That meant MNKD had to share the initial launching cost. Wouldn't a prudent management team raise some money while the market was still very friendly to the bio/pharma markets? I owned several small cap biotech companies (some with newly approved drugs) at that time. All of them raised good money during 2014 and 2015. |
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Post by wgreystone on Oct 10, 2016 1:20:02 GMT -5
Any idea if this accounts for Afrezza's higher units/dose needed for therapeutic effect? I know that vials contain 1000 units, but depending on which box of Afrezza one buys, the unit count varies. Each individual also responds differently to Afrezza from what I've gathered from testimonials. It seems they've accounted for this somehow, since one vial of humalog/novolog does not cost >$450, so I'm wondering if they've simply averaged the normal cost per prescription. This would seem to be unreliable (either high or low) since titration packs aren't needed for injected insulin. Most Rx's have been new, which could mean that we're either seeing a greater number of patients trying Afrezza, or it's taking awhile to dial the patients in on the correct dosage. With the low refill count, I would suspect this is what's happening. However, being >$100 cheaper than competitors, even if the numbers are skewed slightly downward, it looks like it will still be cheaper, even after patients get dialed in. There's that, but injected insulin has either the cost of tips + "air shot" wastage for injector pens or the cost for syringes for vial-based. I posted a head-to-head here a while back showing that Afrezza and modern prandial RAAs are about equal in cost. It shocked me - I thought Afrezza would be far more expensive. "GoodRx lists (30 (4 unit) and 60 (8 unit) cartridges) of Afrezza 4 units and 8 units) cheapest at Kroger = $272 for 600 Units, equivalent to 600 IU as per dosing instructions. GoodRx lists Novolog at Kroger (not the cheapest option, but I want to compare apples to apples) at $491 for 5 * 3ml pens = 1500 units. Now, remove 50 units from each pen for air shots (wastage) = 1250 IU for $491. add on 3 boxes of tips for $50 = $541 for 1250 units usable Novolog: $541 for 1500 units (1250 usable) = $.43 per unit Afrezza: $272 for 600 units = $.45 per unit I could have priced out the Novolog for $373 at price club and 300 tips for $30 for off-brand, but I wanted to make the comparison fair, sourcing from the same pharmacy." I suspect one Afrezza prescription (90 cartridges) won't last for one month. From the tweet posts, Afrezza users quite often use more than one cartridge during a meal. Insurance companies are not stupid. If Afrezza is cheaper and performs better, they would put it on better coverage now. If MNKD really doesn't want to lower Afrezza price, the other option is to add more cartridges to the box. For example, makes one box 120 cartridges. |
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Post by cjm18 on Oct 10, 2016 8:04:29 GMT -5
The per unit price varies by which packs you get.
333 dollars for 60 8u and 30 12u. Still cheaper than competitors.
"If it was cheaper insurance companies would cover it". Wow. Same logic shorts use when they say Afrezza would be selling if it was a better drug.
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Post by mnholdem on Oct 10, 2016 8:53:16 GMT -5
I think that some here who are attempting to dissect the "cost per/unit of insulin" are missing a very important point. With injected insulin, the number of units injected is EXTREMELY important, largely because it hangs around so long. Patients with diabetes who use Continuous Glucose Monitors are less likely to be surprised by a hypoglycemic event caused by having too much insulin in the blood stream for too long, but for the 90%+ of patients with diabetes who do not have or use a CGM, the units of Afrezza insulin administered via inhalation clears the system so fast that insulin stacking is virtually impossible unless one is extremely careless. This benefit is also why Afrezza cartridge can be considered "small, medium, large or x-large (multiple cartridges). The patient does not need to dial in a dose of Afrezza inhaled insulin as precisely as they must with injected rapid-acting analog insulin because Afrezza clears the system to virtually eliminate insulin "stacking".
The hidden cost savings of using Afrezza, of which the 3rd party payers may ultimately take notice and which has not been broached yet in the discussion in this thread, will also be the significantly lower number of trips to the emergency room of patients with diabetes who do not have a CGM to warn them that immediate corrective action is needed. Even patients who do use a CGM still report out of control blood glucose levels with RAA injected insulin and are posting the screen shots as proof of the "Before" and "After" effects of using Afrezza for their daily prandial insulin.
The additional cost of syringes, needles (including those consumable pen tips) and the biological hazards associated with them really amount to a tiny fraction of the "hidden costs" associated with the complications from extremely high and/or extremely low blood glucose levels, which include loss of limb, sight and life by patients with diabetes who are not able to control their "time in zone" using injected insulin or oral medications.
Some argue that payers are only concerned with short-term profits and perhaps so. But the empirical evidence of how well Afrezza can help a patient control his/her blood glucose levels is mounting. The costs - both biologically and economically - of being "out-of-zone" are increasingly being recognized by the medical community. This is why we're seeing a push for wider use of CGMs. Eventually, this awareness will also create demand for Afrezza.
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Post by derek2 on Oct 10, 2016 9:00:46 GMT -5
Looks similar to me - from the dosing guide as approved by the FDA and MNKD, unless you don't believe them. Unless someone is on the low end of the dose. 9 units of injected insulin is equivalent to 12 Afrezza units. It may or may not cost more, depending on how often they dose. It comes down to needing an extra box of Afrezza vs an extra pen to satisfy the 30/90 day regimen. Thank you sophie for a nuanced response, as opposed to some who decide to cherry pick an edge case. |
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Post by fiddler on Oct 10, 2016 9:28:02 GMT -5
Any idea if this accounts for Afrezza's higher units/dose needed for therapeutic effect? I know that vials contain 1000 units, but depending on which box of Afrezza one buys, the unit count varies. Each individual also responds differently to Afrezza from what I've gathered from testimonials. It seems they've accounted for this somehow, since one vial of humalog/novolog does not cost >$450, so I'm wondering if they've simply averaged the normal cost per prescription. This would seem to be unreliable (either high or low) since titration packs aren't needed for injected insulin. Most Rx's have been new, which could mean that we're either seeing a greater number of patients trying Afrezza, or it's taking awhile to dial the patients in on the correct dosage. With the low refill count, I would suspect this is what's happening. However, being >$100 cheaper than competitors, even if the numbers are skewed slightly downward, it looks like it will still be cheaper, even after patients get dialed in. There's that, but injected insulin has either the cost of tips + "air shot" wastage for injector pens or the cost for syringes for vial-based. I posted a head-to-head here a while back showing that Afrezza and modern prandial RAAs are about equal in cost. It shocked me - I thought Afrezza would be far more expensive. "GoodRx lists (30 (4 unit) and 60 (8 unit) cartridges) of Afrezza 4 units and 8 units) cheapest at Kroger = $272 for 600 Units, equivalent to 600 IU as per dosing instructions. GoodRx lists Novolog at Kroger (not the cheapest option, but I want to compare apples to apples) at $491 for 5 * 3ml pens = 1500 units. Now, remove 50 units from each pen for air shots (wastage) = 1250 IU for $491. add on 3 boxes of tips for $50 = $541 for 1250 units usable Novolog: $541 for 1500 units (1250 usable) = $.43 per unit Afrezza: $272 for 600 units = $.45 per unit I could have priced out the Novolog for $373 at price club and 300 tips for $30 for off-brand, but I wanted to make the comparison fair, sourcing from the same pharmacy." You're still comparing apples and oranges since the diabetic has to use the afrezza units in 4, 8, or 12 unit segments, which can't be broken down like humalog into 0.1 cc or 0.1 units as needed. Here's how I figure it: 5 pens are supposed to last a typical user 4-5 months. $500 1 box of afrezza is supposed to last about 1 month. $300 So 4-5 months of afrezza is about $1,200-1,500 versus $500 for humalog pen. Seems like a pretty big difference to me. |
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Post by Deleted on Oct 10, 2016 9:33:44 GMT -5
Unless someone is on the low end of the dose. 9 units of injected insulin is equivalent to 12 Afrezza units. It may or may not cost more, depending on how often they dose. It comes down to needing an extra box of Afrezza vs an extra pen to satisfy the 30/90 day regimen. Thank you sophie for a nuanced response, as opposed to some who decide to cherry pick an edge case. I did pick an equivalent case too 4 unit injectables vs 4 unit Afrezza catridges. Perhaps you missed it? And 9 unit 💉 12 unit catridge is the same s the calculation I did for 5 unit injectables vs 8 unit catridges |
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Post by Deleted on Oct 10, 2016 9:46:10 GMT -5
I think that some here who are attempting to dissect the "cost per/unit of insulin" are missing a very important point. With injected insulin, the number of units injected is EXTREMELY important, largely because it hangs around so long. Patients with diabetes who use Continuous Glucose Monitors are less likely to be surprised by a hypoglycemic event caused by having too much insulin in the blood stream for too long, but for the 90%+ of patients with diabetes who do not have or use a CGM, the units of Afrezza insulin administered via inhalation clears the system so fast that insulin stacking is virtually impossible unless one is extremely careless. This benefit is also why Afrezza cartridge can be considered "small, medium, large or x-large (multiple cartridges). The patient does not need to dial in a dose of Afrezza inhaled insulin as precisely as they must with injected rapid-acting analog insulin because Afrezza clears the system to virtually eliminate insulin "stacking".
The hidden cost savings of using Afrezza, of which the 3rd party payers may ultimately take notice and which has not been broached yet in the discussion in this thread, will also be the significantly lower number of trips to the emergency room of patients with diabetes who do not have a CGM to warn them that immediate corrective action is needed. Even patients who do use a CGM still report out of control blood glucose levels with RAA injected insulin and are posting the screen shots as proof of the "Before" and "After" effects of using Afrezza for their daily prandial insulin.
The additional cost of syringes, needles (including those consumable pen tips) and the biological hazards associated with them really amount to a tiny fraction of the "hidden costs" associated with the complications from extremely high and/or extremely low blood glucose levels, which include loss of limb, sight and life by patients with diabetes who are not able to control their "time in zone" using injected insulin or oral medications.
Some argue that payers are only concerned with short-term profits and perhaps so. But the empirical evidence of how well Afrezza can help a patient control his/her blood glucose levels is mounting. The costs - both biologically and economically - of being "out-of-zone" are increasingly being recognized by the medical community. This is why we're seeing a push for wider use of CGMs. Eventually, this awareness will also create demand for Afrezza.
Yes we all know and agree with you but numbers are numbers when some one tries to compare insulin costs and not bring the comparison to the same scale rather just put wrong calculations |
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Post by comnkd on Oct 10, 2016 9:51:19 GMT -5
There's that, but injected insulin has either the cost of tips + "air shot" wastage for injector pens or the cost for syringes for vial-based. I posted a head-to-head here a while back showing that Afrezza and modern prandial RAAs are about equal in cost. It shocked me - I thought Afrezza would be far more expensive. "GoodRx lists (30 (4 unit) and 60 (8 unit) cartridges) of Afrezza 4 units and 8 units) cheapest at Kroger = $272 for 600 Units, equivalent to 600 IU as per dosing instructions. GoodRx lists Novolog at Kroger (not the cheapest option, but I want to compare apples to apples) at $491 for 5 * 3ml pens = 1500 units. Now, remove 50 units from each pen for air shots (wastage) = 1250 IU for $491. add on 3 boxes of tips for $50 = $541 for 1250 units usable Novolog: $541 for 1500 units (1250 usable) = $.43 per unit Afrezza: $272 for 600 units = $.45 per unit I could have priced out the Novolog for $373 at price club and 300 tips for $30 for off-brand, but I wanted to make the comparison fair, sourcing from the same pharmacy." You're still comparing apples and oranges since the diabetic has to use the afrezza units in 4, 8, or 12 unit segments, which can't be broken down like humalog into 0.1 cc or 0.1 units as needed. Here's how I figure it: 5 pens are supposed to last a typical user 4-5 months. $500 1 box of afrezza is supposed to last about 1 month. $300 So 4-5 months of afrezza is about $1,200-1,500 versus $500 for humalog pen. Seems like a pretty big difference to me. This is a "not seeing the forest from the trees" discussion. Using your numbers above, the annual cost basis for pens is $1,500 vs $3,600 for Afrezza. Is it worth an additional $2,100 annually to avoid major organ damage, loss of sight, amputation, etc.? What is the cost to our healthcare system for treating long term complications that arise from diabetes? Certainly more than an added $2,100 annually... No? |
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Post by mnholdem on Oct 10, 2016 9:52:42 GMT -5
It seems unfair to compare Afrezza cartridges to the competition by using doses that don't exist. MannKind doesn't make an adjustable-dose cartridge, after all. Why the cost of a 12-unit Afrezza cartridge is being compared to a 9-unit RAA insulin injection escapes me.
To argue that the RAA insulin prescription will last longer is valid, but to argue a per-insulin unit cost comparison is flawed logic.
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Post by saxcmann on Oct 10, 2016 9:58:12 GMT -5
My endo friend says Afrezza and Humalog are about the same after you figure in all the cost.
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Post by Deleted on Oct 10, 2016 10:09:04 GMT -5
It seems unfair to compare Afrezza cartridges to the competition by using doses that don't exist. MannKind doesn't make an adjustable-dose cartridge, after all. Why the cost of a 12-unit Afrezza cartridge is being compared to a 9-unit RAA insulin injection escapes me. To argue that the RAA insulin prescription will last longer is valid, but to argue a per-insulin unit cost comparison is flawed logic. here .. you too must have missed it.
So to keep it simple and an equivalent case, a user taking 4 units - 3 times a day
1250 units translates to 104 days of insulin ( using your post for $ - Novolog: $541 for 1500 units (1250 usable) = $.43 per unit )
in case of afrezza that would be ..
user would need 3.46 boxes of 4 unit 90 pack cartridge and to match novolog price of $541 - each box should be priced --> $156.Read more: mnkd.proboards.com/thread/6427/nate-on-mnkd?page=3#ixzz4MhACfRmr |
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Post by fiddler on Oct 10, 2016 10:09:14 GMT -5
You're still comparing apples and oranges since the diabetic has to use the afrezza units in 4, 8, or 12 unit segments, which can't be broken down like humalog into 0.1 cc or 0.1 units as needed. Here's how I figure it: 5 pens are supposed to last a typical user 4-5 months. $500 1 box of afrezza is supposed to last about 1 month. $300 So 4-5 months of afrezza is about $1,200-1,500 versus $500 for humalog pen. Seems like a pretty big difference to me. This is a "not seeing the forest from the trees" discussion. Using your numbers above, the annual cost basis for pens is $1,500 vs $3,600 for Afrezza. Is it worth an additional $2,100 annually to avoid major organ damage, loss of sight, amputation, etc.? What is the cost to our healthcare system for treating long term complications that arise from diabetes? Certainly more than an added $2,100 annually... No? If the diabetic can't afford it, what does it matter? And the pens are covered by most insurers so comparatively they cost next to nothing. |
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Post by Deleted on Oct 10, 2016 10:10:56 GMT -5
My endo friend says Afrezza and Humalog are about the same after you figure in all the cost. Agreed .. who cares about $ when it comes to convenience and health.. I am just correcting the logic of the numbers not to skew either way.. |
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