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Post by surplusvalue on Nov 4, 2016 12:42:02 GMT -5
While the total number of scripts and revenue is below what is needed to demonstrate Afrezza is a going concern, the "nonexistent" label oversimplifies and distracts from more quantitative analysis that is available. Perhaps now that the coverage situation is improving, Mannkind will be able to justify more reps in the field. Assuming the new reps work at same efficiency, doubling the number of reps will double the number of new scripts and revenue at double the cost. If production costs remain fixed per volume, this will more than double the profit(or reduce time to profitability). Increase reps according to the profitability prediction curve. At some point the reps can be let go = cost savings etc etc. Of course the forgoing assumes you have a superior product and virtuous market. More salesmen doesn't address the other part of the equation and that is loss of refills. If you look at the data that Liane updates weekly, the refills this week were less than 50% of the total scripts 13 weeks ago (roughly a 90 day fill). Adding resources to increase new scripts only makes sense if Mannkind can hold onto them. When Sanofi dropped the partnership they cited the loss of 65% of patients between the original prescription and the refill date, and if Mannkind is somewhere above 50% loss of patients that implies there is a lot of work to be done with patient satisfaction. The problem of retention and many of the issues that cause users to drop out have been discussed in many threads both regarding Sanofi and post Sanofi. One factor that may be affecting retention, and I must sound like broken record here, is the prospect of MNKD going under and the complete silence on this issue by MNKD for so long. If you were an endo or patient using Afrezza and you began to realize the prospect of Afrezza disappearing with MNKD's possible bankruptcy would you stay on it? Would be nice to see some financing to put these concerns to bed and rule out this as a factor contributing to poor retention. Then MNKD could better assess what work needs to be done with patient satisfaction. MNKD Cares seems to be doing a good job so far as far as we know. |
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Post by mannmade on Nov 4, 2016 12:50:56 GMT -5
To answer your question (and I am not a diabetic) I would definitely stay on AFREZZA if I was already on it and especially if I was getting superior results.
I would however likely hold off at this point trying it if I thought they might not be around much longer until the dust settled.
So I see it more as an issue for new scripts and as a non issue for retention imho...
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Post by zuegirdor on Nov 4, 2016 12:54:10 GMT -5
While the total number of scripts and revenue is below what is needed to demonstrate Afrezza is a going concern, the "nonexistent" label oversimplifies and distracts from more quantitative analysis that is available. Perhaps now that the coverage situation is improving, Mannkind will be able to justify more reps in the field. Assuming the new reps work at same efficiency, doubling the number of reps will double the number of new scripts and revenue at double the cost. If production costs remain fixed per volume, this will more than double the profit(or reduce time to profitability). Increase reps according to the profitability prediction curve. At some point the reps can be let go = cost savings etc etc. Of course the forgoing assumes you have a superior product and virtuous market. More salesmen doesn't address the other part of the equation and that is loss of refills. If you look at the data that Liane updates weekly, the refills this week were less than 50% of the total scripts 13 weeks ago (roughly a 90 day fill). Adding resources to increase new scripts only makes sense if Mannkind can hold onto them. When Sanofi dropped the partnership they cited the loss of 65% of patients between the original prescription and the refill date, and if Mannkind is somewhere above 50% loss of patients that implies there is a lot of work to be done with patient satisfaction. What you say is plausible and suggests money might be better spent on learning why some customers rave and others lapse. I am not sure if it is a reason not to hire more reps though. Drop offs merely halve the "efficiency" rate of the reps. Assuming constant drop off rate of dissatisfied customers, including Sanofi effort, means the new script number and "MNKD rep efficiency" are already accounted for in the scenario I presented. Though the improved rate of retention, small though it is, that you imply may get at some actual increase in satisfaction related to  ? I wonder it it would be possible for Mannkind to include with all new prescriptions a link to its website that seeks feedback on the new user experience. I realize that with 130 new scripts a month the number of respondents, particularly those less than satisfied with Afrezza, might be too low to signify possible solutions. IT should not cost too much to put such a system in place. But this patch would assume there is time to implement the link, collect and analyze the data. And time is money....and we have ?? |
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Post by figglebird on Nov 4, 2016 13:09:40 GMT -5
Not entirely sure if that's the significant point - patient retention has been THE MOST OVERBLOWN and misunderstood issues, disguised to appear more meaningful than it actually is to those with credibility - you have to look at both historical and current prandial retention to understand context, then simply identify the norm or mean of the systemic culture - that said it is the proportion of passionate users amongst any refill population within the diabetic culture that is important - what Sanofi nor mannkind has not shared but it glaringly apparent according to widely known data, what stands out among T2 user population is that diabetic adherence/refills and adheremce across all prandials is averaged at 30 pct so 35 pct is actually above the norm - this shifts a bit on basals - for example, you can track Tresiba's growth and retention through patient recognition of hourly increase/permittance between shots - Ask yourself this how many t2's have ever been psyched about humalog or novolog? Do you know how many unused dosed needles lay in cabinets for years?
I know I have two close family members and have seen first hand the data alligned with the apathy of the diabetic culture...
Every condition is different and treated differently... think about who is spreading valuable info and why?... I do not fault this posters views but they are consistently misinformed and lack context.
Diabetes is a dark listless ocean of massive profits based on the systemic failure of those in charge of combatting...
let there be light.
There was and will be.
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Post by sportsrancho on Nov 4, 2016 13:14:47 GMT -5
Nate has a lot to say about the CC...
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Post by mnholdem on Nov 4, 2016 13:23:44 GMT -5
While the total number of scripts and revenue is below what is needed to demonstrate Afrezza is a going concern, the "nonexistent" label oversimplifies and distracts from more quantitative analysis that is available. More salesmen doesn't address the other part of the equation and that is loss of refills. If you look at the data that Liane updates weekly, the refills this week were less than 50% of the total scripts 13 weeks ago (roughly a 90 day fill). Adding resources to increase new scripts only makes sense if Mannkind can hold onto them. When Sanofi dropped the partnership they cited the loss of 65% of patients between the original prescription and the refill date, and if Mannkind is somewhere above 50% loss of patients that implies there is a lot of work to be done with patient satisfaction. matt, shouldn't refills this week be compared to new scripts rather than total scripts from xx weeks ago? I keep track of this data, even though I don't post it with the graph.
For example, this week the refills are:
89.0% of NRx from 4 weeks ago (1M) 89.0% of NRx from 8 weeks ago (2M) 96.3% of NRx from 12 weeks ago (3M)
91.5% of NRx (mean of all the above)
Using the formulae above, I can tell you that Sanofi's % were considerably lower than what MannKind is currently doing with the scripts counts. For example, from May-2015 through July-2015 the mean (average) of the 1M/2M/3M refill numbers came in at 48% - 62%.
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I understand that IMS/Symphony collects and provides refill rate data to a subscriber company, but I don't know if they publish that data to other subscribers or to the public. With so many refill variables it's difficult to model accurately.
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Post by ilovekauai on Nov 4, 2016 13:30:38 GMT -5
Call me a true believer because I am. I like what Michael C is doing out there, like the slow progress since the soft relaunch, don't expect too much news in the CC next Wednesday, and added more shares today to my holding, as I've been doing all year long. Have a great weekend all. Aloha.
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Post by Deleted on Nov 4, 2016 14:08:12 GMT -5
Call me a true believer because I am. I like what Michael C is doing out there, like the slow progress since the soft relaunch, don't expect too much news in the CC next Wednesday, and added more shares today to my holding, as I've been doing all year long. Have a great weekend all. Aloha. please dont say - soft launch. They are working as much as they can with their available resources. So its an aggressive launch with limits by their budget. If they have $$$ to put 1000 reps in the field, and they only use 70 reps - that is called soft launch. And good that you have such deep pockets. Good fortune. Aloha. |
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Post by me on Nov 4, 2016 15:16:13 GMT -5
More salesmen doesn't address the other part of the equation and that is loss of refills. If you look at the data that Liane updates weekly, the refills this week were less than 50% of the total scripts 13 weeks ago (roughly a 90 day fill). Adding resources to increase new scripts only makes sense if Mannkind can hold onto them. When Sanofi dropped the partnership they cited the loss of 65% of patients between the original prescription and the refill date, and if Mannkind is somewhere above 50% loss of patients that implies there is a lot of work to be done with patient satisfaction. matt, shouldn't refills this week be compared to new scripts rather than total scripts from xx weeks ago? I keep track of this data, even though I don't post it with the graph.
For example, this week the refills are:
89.0% of NRx from 4 weeks ago (1M) 89.0% of NRx from 8 weeks ago (2M) 96.3% of NRx from 12 weeks ago (3M)
91.5% of NRx (mean of all the above)
^^^ This The refill ratio is (TRx'-NRx')/NRx", with TRx' and NRx' being current numbers, and NRx" being NRx set back 30, 60 or 90 days, pick 'em |
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Post by tingtongtung on Nov 4, 2016 15:54:33 GMT -5
matt, shouldn't refills this week be compared to new scripts rather than total scripts from xx weeks ago? I keep track of this data, even though I don't post it with the graph.
For example, this week the refills are:
89.0% of NRx from 4 weeks ago (1M) 89.0% of NRx from 8 weeks ago (2M) 96.3% of NRx from 12 weeks ago (3M)
91.5% of NRx (mean of all the above)
^^^ This The refill ratio is (TRx'-NRx')/NRx", with TRx' and NRx' being current numbers, and NRx" being NRx set back 30, 60 or 90 days, pick 'em So, the new ones are always 30/60/90 day? Is their a price diff betwen 30/60/90 day prescriptions? Or, is it mainly new patients start with 30, and go to 90? Also, from teh scripts table, the running ave cost has steadily increased to $54x now.. What exactly does it include/mean? Thanks! |
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Post by mnholdem on Nov 4, 2016 16:10:40 GMT -5
That is the formula I used. Thank you, me, for verifying it. |
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Post by rayskum on Nov 4, 2016 16:27:44 GMT -5
I think 80-90% is overstated because this percent is off NRx 1-3mo ago. Shouldn't we include RRx from 1-3 mo ago? I think we should. If we do that, the percents will surely come down.
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Post by agedhippie on Nov 4, 2016 16:50:01 GMT -5
I think 80-90% is overstated because this percent is off NRx 1-3mo ago. Shouldn't we include RRx from 1-3 mo ago? I think we should. If we do that, the percents will surely come down. That's correct unless everyone does one refill and immediately stops You cannot really tell what is happening because if someone doesn't renew you cannot tell if it was an existing user or a new user. The probability is that it's a new user that drops out but you don't know the real ratio old to new. |
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Post by mnholdem on Nov 4, 2016 17:00:03 GMT -5
What I'm tracking is a KPI for observing trends. It's not an actual Refill Rate but a comparison. The percentage could be 200% compared to NRx from 3 months ago because today's numbers could include refills from NRx's that were also written 1 month & 2 months ago. It's impossible to know the what percentage of refills were 30, 60 and 90 day refills. It's the trend I'm watching. I'm pretty sure that the company gets the actual refill rate from IMS/Symphony. Overall the numbers have been pretty steady, with a slight % drop over the past four weeks. The KPI is still much higher than when Sanofi was running with the ball. |
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Post by matt on Nov 4, 2016 17:05:59 GMT -5
There are a number of ways to estimate refills, and I don't know that one is particularly more or less correct than another because I don't have the data to validate it either way. Of the few plans that do cover Afrezza, most are quantity limited. While 90 day fills from mail order pharmacies are almost always the most economical not all patients can or should be on 90 day scripts. It should also be cumulative so some of the patients exhausting their available refills each period were placed on Afrezza back when Sanofi was handling the marketing, and most people don't count those either even though Sanofi does deserve some credit.
Bottom line, the drug has been on the market since February 2015 and now it is November 2016. Regardless of how you choose to estimate refill rates, the TRx number should be substantially higher than it is. Far more patients have tried Afrezza and dropped it than there are patients who tried the drug and remain active users. When you have an elephant in the room it is best to acknowledge that there is a large gray mammal stomping about, not to worry about exactly how much the beast weighs. Regardless, you are going to get squished unless the elephant is brought under control.
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