Why isn't the script count growing?

[end2war]

More doctors and more patients are have tried Afrezza and now are exposed to its potential; and, more patients have tried Afrezza. What is keeping the script count down in a market with such large potential demand? One would expect gradual increases in adoption as those that like the results spread the word. 

[sportsrancho]

Dec 30, 2016 15:24:43 GMT -5 end2war said:

More doctors and more patients are have tried Afrezza and now are exposed to its potential; and, more patients have tried Afrezza. What is keeping the script count down in a market with such large potential demand? One would expect gradual increases in adoption as those that like the results spread the word. 

That would be a good question for the early adapters who are also shareholders to ask their Endo's. They see the great results. The time it takes to get the hang of dosing. The word of mouth. The problems.
From reading on Twitter it seems like people stop because their insurance drops them or won't cover Afrezza. I know Mike is working very hard on this.

[dreamboatcruise]

Due to still weak payer coverage and very conservative nature of the Endo profession and prescribing guidelines that specify putting patients on injectable basal before considering prandial.

[agedhippie]

Dec 30, 2016 16:56:34 GMT -5 dreamboatcruise said:

Due to still weak payer coverage and very conservative nature of the Endo profession and prescribing guidelines that specify putting patients on injectable basal before considering prandial.

For Type 1 basal and prandial are started together. The real killer is weak payer coverage as even when you get someone to try it they cannot remain on it.

Endos are conservative but will change if there is a good reason. There is a reluctance to move patients wholesale because it means changing peoples routines and retraining, this is a big operation and reasonably high risk for the less engaged (for want of a better description) diabetics. Where the endo is trying it I would bet that most only prescribe for one or two patients and are waiting to see how those do. A lot are also going to wait for the outcome of the lung trials.

[mango]

In the JP Morgan Conference slides MannKind mentions the diabetes care clinics multiple times and I get the sense that it will be THEM that actually spearhead physician awareness and increase the script counts. The slides state that the clinics will be centered around Afrezza and this would be a more personalized/hands on approach for helping patients with diabetes manage their condition. Correct me if I am wrong, but even The Endo Society does not even advocate diabetes drug innovation. How many studies on Afrezza or peer reviewed papers on Afrezza have they published in their journals and/or provide the literature to Endos and actually encourage new approaches and innovations for diabetics? Bottom line is, a lot of doctors just don't want to fool with it, but they have no problem prescribing inhalers that don't even work and or outdated for COPD and asthma patients. I see diabetics in the hospital all the time because they are non-compliant, regimen is too comllicated, med is too expensive, all of it is too much to keep up with etc. Patients are for the most part lazy across the board. Afrezza and Technosphere was designed to solve non-compliance and laziness and the hurdles of carb counting etc. Put your insulin in your pocket and use when needed. Face it, the current standard is a failure and simply does not work and I see it for myself as validation that it doesnt.

[lennymnkd]

Speaking of the JP Morgan conference, comeing up jan11 /17 Hmmmm : any thoughts )

[falconquest]

Dec 30, 2016 15:24:43 GMT -5 end2war said:

More doctors and more patients are have tried Afrezza and now are exposed to its potential; and, more patients have tried Afrezza. What is keeping the script count down in a market with such large potential demand? One would expect gradual increases in adoption as those that like the results spread the word. 

BINGO! The $64,000.00 question. Congratulations! ( I know, I'm being cynical but this really is the bottom line)

[dreamboatcruise]

Dec 30, 2016 18:19:51 GMT -5 mango said:

In the JP Morgan Conference slides MannKind mentions the diabetes care clinics multiple times and I get the sense that it will be THEM that actually spearhead physician awareness and increase the script counts. The slides state that the clinics will be centered around Afrezza and this would be a more personalized/hands on approach for helping patients with diabetes manage their condition. Correct me if I am wrong, but even The Endo Society does not even advocate diabetes drug innovation. How many studies on Afrezza or peer reviewed papers on Afrezza have they published in their journals and/or provide the literature to Endos and actually encourage new approaches and innovations for diabetics? Bottom line is, a lot of doctors just don't want to fool with it, but they have no problem prescribing inhalers that don't even work and or outdated for COPD and asthma patients. I see diabetics in the hospital all the time because they are non-compliant, regimen is too comllicated, med is too expensive, all of it is too much to keep up with etc. Patients are for the most part lazy across the board. Afrezza and Technosphere was designed to solve non-compliance and laziness and the hurdles of carb counting etc. Put your insulin in your pocket and use when needed. Face it, the current standard is a failure and simply does not work and I see it for myself as validation that it doesnt.

That type of clinic model may well be a better standard of care.  Unfortunately, attempts at that in the past have run into financial hurdles trying to operate within our insurance system.  There was an article on this subject just a couple of years ago.

Would be very encouraging news if a clinic could negotiate a performance based reimbursement scheme with payers.

[mango]

Dec 30, 2016 18:49:39 GMT -5 dreamboatcruise said:

Dec 30, 2016 18:19:51 GMT -5 mango said:

In the JP Morgan Conference slides MannKind mentions the diabetes care clinics multiple times and I get the sense that it will be THEM that actually spearhead physician awareness and increase the script counts. The slides state that the clinics will be centered around Afrezza and this would be a more personalized/hands on approach for helping patients with diabetes manage their condition. Correct me if I am wrong, but even The Endo Society does not even advocate diabetes drug innovation. How many studies on Afrezza or peer reviewed papers on Afrezza have they published in their journals and/or provide the literature to Endos and actually encourage new approaches and innovations for diabetics? Bottom line is, a lot of doctors just don't want to fool with it, but they have no problem prescribing inhalers that don't even work and or outdated for COPD and asthma patients. I see diabetics in the hospital all the time because they are non-compliant, regimen is too comllicated, med is too expensive, all of it is too much to keep up with etc. Patients are for the most part lazy across the board. Afrezza and Technosphere was designed to solve non-compliance and laziness and the hurdles of carb counting etc. Put your insulin in your pocket and use when needed. Face it, the current standard is a failure and simply does not work and I see it for myself as validation that it doesnt.

That type of clinic model may well be a better standard of care.  Unfortunately, attempts at that in the past have run into financial hurdles trying to operate within our insurance system.  There was an article on this subject just a couple of years ago.

Would be very encouraging news if a clinic could negotiate a performance based reimbursement scheme with payers.

The slides also state the business model the clinics have position them in a way to be able to produce hundreds, yes hundreds, of clinics during 2017-2018. Majority of skeptics fail to realize exactly how much money William McCullough generates through being the owner of SHR which is also affiliated with a very large and renowned elite Beverley Hills practice and has numerous connections around Silicone Valley etc. 

Few have paid attention or even read the SHR website. It is kind of a foundation and a prelude to what is to come and what to expect. William McCullough actually adheres to the same kind of philosophy as Al Mann. He truly wants to help people and only have the best and always strive for innovation. SHR does not do any TV advertising, they are strictly a word of mouth multi-million (prob billion nearly) business that became this way just through word of mouth. Usually top quality products/services are those you hear about from your best friend or acquaintances. If someone truly likes and benefits from something and has a great experience, they will talk about it. Top quality sells itself. All of this is just IMO of course. Therebisbno telling how many wealthy millionaires McCullough has helping with Vdex. It could be a national prong approach for all we know. We do know that they definitely have the funds and the connections.  

[mango]

I see a theme amongst closed minded providers and that is that nothing could ever actually be better than the way they have been doing things for "30" years. Generally, these same people are usually the ones that end up harming patients because of their flat out refusal to acknowledge scientific evidence that supports something else over their norm. These are the same people that also copy and paste their entire notes, spend no time with patients, don't read up on current innovations and medicines, just go along doing the same thing everyday and expecting different results is the epitome of ignorant. When providers acknowledge that their current standards and medicines are a failure for the most part in managing a disease that often leads to people having their toes and feet cut off, maybe, just maybe, they will ask themselves why this just continues to happen and what can be done about it.

Prescribing Afrezza because of lung issues or "want to wait and see" crap is simply not true at all. Docs prescribe BS meds all the time if they get a free lunch or have a hot girl flirt with them every other week. It is laziness on the providors side that prevents change. Also, it is fear. Lots of people will lose a lot of money because Technosphere is so absolutely a destructive drug delivery platform. Those ridiculous things called a MDI that comes in a pressurized cannister couldn't help someone if their life depended on it. For some reason majority of providors have no problem prescribing them and consequently seeing them in the hospital later on.

[radgray68]

When I try to sum it all up, I keep getting the FDA + Sanofi.

Restrictions on use forced by the FDA and Diabetic guidelines for standard practice are too limiting, causing endos to hesitate and Insurers to balk. The really smart investors started selling the minute we got approval because they saw the hatchet job the FDA did to our product's chances. I didn't see it because it was my first product launch. Many here didn't either. But, I believe the GS types saw the writing on the wall.

And then, there's Sanofi. I'm looking at the 3 year chart now. Some people knew something was off with the Sanofi partnership because they started selling right off the bat. The only valuable info they had received during that few month period at the top of our price climb were the FDA restrictions and the Sanofi partnership. JMHO but I believe it starts and ends with those two factors.  

[mango]

Restrictions ultimately mean crap. I see tons of physicians say, "I was reading a study/a new study came out let's give it a try and see what happens." Part of the job of a physician is being able to evaluate data and studies, use common sense, and practice medicine. You aren't practicing medicine if you are doing an outdated procedure/technique or utilizing the same harmful and ineffective drugs and regimens if there is significant evidence to suggest your methods fail and are unsuccessful majoirty of the time. Practicing medicine is the ones reading studies, asking questions, seeking answers, and utilizing and trying the newest things they read and hear about when the right time arrises, which will arise, because a true care providor isn't aftaid to try and fix the problem and make mistakes or successes and thus learn and contribute to advancing medicine instead of being a robot.

[mango]

Most up to date and open minded physicians kinda make their own best practices while their counterparts are still doing what has always been done and has nothing to show for the decades of repetition and copying and pasting. Most all docs do things their own way. Prescribing Afrezza is not a malpractice liability concern and it is absolutely disinformation to suggest it is. It is an FDA approved medicine and device. If benefit outweighs the risk is an acceptable ideology for physicians to utilize daily, prescribing a new innovative diabetic drug with a new ROA that is FDA approved should be a no brainer. It is providor laziness and their lack of interest in utilizing something new vs what doesn't work but everyone does it anyway. This goes for every field not just endo. Seems like EM docs are an exception from my experience though. Why do so many anaphylactic cases present in the ED? Because the patient either waited til the last minute to stab themselves, refused to stab themselves, or never had an epipen with them. A pocket sized inhaler that doesn't harm you would fix that.

How many patients have been admitted for something directly insulin therapy related that were on Afrezza vs injections? Facts don't lie.

[MnkdWASmyRtrmntPlan]

This is a very good thread. Thank you Mango for your research and reporting it. Thank everyone here for your contributions. Keep up the good work.

[falconquest]

Dec 30, 2016 19:33:56 GMT -5 radgray68 said:

When I try to sum it all up, I keep getting the FDA + Sanofi.

Restrictions on use forced by the FDA and Diabetic guidelines for standard practice are too limiting, causing endos to hesitate and Insurers to balk. The really smart investors started selling the minute we got approval because they saw the hatchet job the FDA did to our product's chances. I didn't see it because it was my first product launch. Many here didn't either. But, I believe the GS types saw the writing on the wall.

And then, there's Sanofi. I'm looking at the 3 year chart now. Some people knew something was off with the Sanofi partnership because they started selling right off the bat. The only valuable info they had received during that few month period at the top of our price climb were the FDA restrictions and the Sanofi partnership. JMHO but I believe it starts and ends with those two factors.  

See Sanofi change in CEO.