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Post by almannlives on Dec 31, 2016 13:08:44 GMT -5
Derek excellent post any thoughts on how Mike and Matt should address that?
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Post by mango on Dec 31, 2016 14:28:56 GMT -5
It has been so obvious that MNKD's success with Afrezza will be thru clinics = Vdex. We are lead to believe that the one clinic in CA. is the status but I believe when they make their announcements they will include a long list of clinic openings and the primary investor is not "Bill". This is why there is no concern about script count, delisting, cash flow, etc. MNKD is keeping Afrezza on life support until this launch takes place in 2017. The same applies to RLS....there is much more to RLS than "inhalable grass" (which is a part but not THE part). All this has taken lots of time...that 65/35 partnership was dissolved but not due to Afrezza's slow sales but due to a total change in direction. There is a ton of $$ on the table and Al Mann stated that he once left the table way too soon and he would NEVER, EVER do that again. Well, Al is gone but I would wager that his plan of attack for Afrezza is still alive and about ready to rock the pharma world. Bubble buster pessimist reporting in. Didn't VDEX open its doors sometime in October? For sure by November if not. How much has the script count gone up in those nearly 2 months when it has been apparent that prescribing afrezza was the #1 priority? It's most likely due to low volume at the clinic, but we don't have unlimited time for this to take off. Additional financing at this point will be difficult to get, although reducing debt was helpful. I don't think we have several years to rely on clinics to be our savior. They started taking appointments on October 22nd. Their mission is not to prescribe as much Afrezza as humanly possible. It is to engage in a new approach, protocol, and more personalized one-on-one care so diabetics can take control over their disease. This involves everything from utilizing the latest and best therapies and treatment options and making sure patients understand that lifestyle choices are equally as important. Volume is probably low like you said, but understand they literally just opened their doors and it is a diabetic clinic so expect volume to be low, they aren't advertised as an acute care clinic. Also, I suspect sample packs will be given out first, and so you will not see script counts from them for a little while don't you think? And I think there will most definitely be a lot more of these clinics opening in 2017. • At Vdex, we will increase access to medical care by having more convenient locations, longer office hours more non-physician caregivers, and technological innovations. Patients need regular care and monitoring for life. As a result, diabetics have far better control of blood glucose levels and reduced hypoglycemia as compared to the current, best therapies available today. • Control of diabetes is essentially control of blood glucose levels. To control any variable such as blood glucose, requires two things: the practical ability to measure that variable in real-time and the ability to affect it. Together, we will provide “Real-Time Diabetes Management” and it is the cornerstone of our therapy.
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Post by sayhey24 on Dec 31, 2016 15:18:51 GMT -5
Bubble buster pessimist reporting in. Didn't VDEX open its doors sometime in October? For sure by November if not. How much has the script count gone up in those nearly 2 months when it has been apparent that prescribing afrezza was the #1 priority? It's most likely due to low volume at the clinic, but we don't have unlimited time for this to take off. Additional financing at this point will be difficult to get, although reducing debt was helpful. I don't think we have several years to rely on clinics to be our savior. They started taking appointments on October 22nd. Their mission is not to prescribe as much Afrezza as humanly possible. It is to engage in a new approach, protocol, and more personalized one-on-one care so diabetics can take control over their disease. This involves everything from utilizing the latest and best therapies and treatment options and making sure patients understand that lifestyle choices are equally as important. Volume is probably low like you said, but understand they literally just opened their doors and it is a diabetic clinic so expect volume to be low, they aren't advertised as an acute care clinic. Also, I suspect sample packs will be given out first, and so you will not see script counts from them for a little while don't you think? And I think there will most definitely be a lot more of these clinics opening in 2017. • At Vdex, we will increase access to medical care by having more convenient locations, longer office hours more non-physician caregivers, and technological innovations. Patients need regular care and monitoring for life. As a result, diabetics have far better control of blood glucose levels and reduced hypoglycemia as compared to the current, best therapies available today. • Control of diabetes is essentially control of blood glucose levels. To control any variable such as blood glucose, requires two things: the practical ability to measure that variable in real-time and the ability to affect it. Together, we will provide “Real-Time Diabetes Management” and it is the cornerstone of our therapy. While I wish Vdex all the best in the new year I sure hope we see many of these diabetic clinics opening in 2017 looking to follow the San Diego protocol and Vdex has lots of competition. The more clinics prescribing afrezza the better.
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Post by sportsrancho on Dec 31, 2016 15:42:23 GMT -5
Bubble buster pessimist reporting in. Didn't VDEX open its doors sometime in October? For sure by November if not. How much has the script count gone up in those nearly 2 months when it has been apparent that prescribing afrezza was the #1 priority? It's most likely due to low volume at the clinic, but we don't have unlimited time for this to take off. Additional financing at this point will be difficult to get, although reducing debt was helpful. I don't think we have several years to rely on clinics to be our savior. They started taking appointments on October 22nd. Their mission is not to prescribe as much Afrezza as humanly possible. It is to engage in a new approach, protocol, and more personalized one-on-one care so diabetics can take control over their disease. This involves everything from utilizing the latest and best therapies and treatment options and making sure patients understand that lifestyle choices are equally as important. Volume is probably low like you said, but understand they literally just opened their doors and it is a diabetic clinic so expect volume to be low, they aren't advertised as an acute care clinic. Also, I suspect sample packs will be given out first, and so you will not see script counts from them for a little while don't you think? And I think there will most definitely be a lot more of these clinics opening in 2017. • At Vdex, we will increase access to medical care by having more convenient locations, longer office hours more non-physician caregivers, and technological innovations. Patients need regular care and monitoring for life. As a result, diabetics have far better control of blood glucose levels and reduced hypoglycemia as compared to the current, best therapies available today. • Control of diabetes is essentially control of blood glucose levels. To control any variable such as blood glucose, requires two things: the practical ability to measure that variable in real-time and the ability to affect it. Together, we will provide “Real-Time Diabetes Management” and it is the cornerstone of our therapy. Mango, they opened Dec 1st. In LA. Other than that great post:-)
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Post by derek2 on Dec 31, 2016 17:20:00 GMT -5
Derek excellent post any thoughts on how Mike and Matt should address that? Well, they did mention retention as a large issue on the last quarterly call, which is encouraging. If they know it's a problem, at least there's a chance of addressing it. They really need to get a handle on what motivates people to stick with Afrezza and what motivates people to stop. MNKD may have some amount of data that they could mine already. Certainly, clinical study data could be looked at with an eye to categorizing reasons for drop-out, but post-marketing data is also crucial for identifying factors such as cost and availability, which would not have been a factor in the trials. So: 1. Acquire data on patients who have discontinued Afrezza. Not easy with a drug that doesn't have a huge patient base. From what I've read, this is best collected from physicians and could be as part of sales rep visits or as part of a more organized campaign. 2. Set up focus groups with users who have discontinued use or those having trouble with their therapy. Get a non-MNKD organization to conduct the focus groups to avoid defensiveness or bias. 3. Prioritize and do a little hill charging. Actually put more energy into execution than into planning. There's power in committing to a course of action and doing it. MNKD doesn't seem like that kind of company, unfortunately, but Mike C seems to be an exception, so you never know. That said, I bet others on the board could have better ideas. I'm just hoping to focus the discussion on what I think is the crucial factor - retention first, growth later.
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Post by cjm18 on Dec 31, 2016 17:45:00 GMT -5
Derek excellent post any thoughts on how Mike and Matt should address that? Well, they did mention retention as a large issue on the last quarterly call, which is encouraging. If they know it's a problem, at least there's a chance of addressing it. They really need to get a handle on what motivates people to stick with Afrezza and what motivates people to stop. MNKD may have some amount of data that they could mine already. Certainly, clinical study data could be looked at with an eye to categorizing reasons for drop-out, but post-marketing data is also crucial for identifying factors such as cost and availability, which would not have been a factor in the trials. So: 1. Acquire data on patients who have discontinued Afrezza. Not easy with a drug that doesn't have a huge patient base. From what I've read, this is best collected from physicians and could be as part of sales rep visits or as part of a more organized campaign. 2. Set up focus groups with users who have discontinued use or those having trouble with their therapy. Get a non-MNKD organization to conduct the focus groups to avoid defensiveness or bias. 3. Prioritize and do a little hill charging. Actually put more energy into execution than into planning. There's power in committing to a course of action and doing it. MNKD doesn't seem like that kind of company, unfortunately, but Mike C seems to be an exception, so you never know. That said, I bet others on the board could have better ideas. I'm just hoping to focus the discussion on what I think is the crucial factor - retention first, growth later. The saying goes it's easier to retain than get a new.
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Post by peppy on Dec 31, 2016 18:33:24 GMT -5
The replies in this thread do not answer the posted question "Why isn't the script count growing?" They address a secondary question: "Why are there not more new patients being added?" The answer to the posted question is this: Script count is not growing because patients are not sticking with Afrezza. For every new user, one discontinues. Until MNKD addresses THAT question, no amount of new users will be helpful if they just discontinue. Once somebody is using Afrezza (after going through the spirometry and possibly pre-authorization) does the black box warning make them stop? No Would coughing fits make them stop? Maybe Would trial design that showed non-inferiority and showed 37% got to treatment goal make them stop? No Would not getting to treatment goal make them stop? Maybe Add in the cost associated if 1: Copay is high, 2: Coverage is denied or 3: Patient requires more doses than are covered by insurance and you have a few reasons why patients may discontinue use. If MNKD had retained even 70% of new patients, we would be seeing thousands of weekly prescriptions even at these low weekly new Rx numbers. Pouring water into a sieve is not effective no matter how wide open you set the tap. MNKD needs to properly address retention regardless of past mistakes, past trials or current label. It is the priority. Oh, and : Happy new year! Quote: "The answer to the posted question is this: Script count is not growing because patients are not sticking with Afrezza. For every new user, one discontinues." Reply: Thank you for the work. Quote: Why: Add in the cost associated if 1: Copay is high, 2: Coverage is denied or 3: Patient requires more doses than are covered by insurance and you have a few reasons why patients may discontinue use. additionally, They can not wrap their heads around afrezza with out a CGM? They are using sub q insulin and afrezza, afrezza for corrections? Titration too low initially and waiting too long to correct?
From Matt down under
As a general rule, I dose about 10 minutes after I start eating, which is before my glucose levels start to rise from the meal. As I mention in the video, the best time to dose seems to depend on the fat content of the meal. And for some high fat meals, a follow up dose of Afrezza is neccesary.
I have found the same rule also applies if a follow-up dose is required. It is important to have the follow-up dose before the levels begin to rise out of range. If I had a CGM with alerts, I would use this to notify me as soon as it levels began to increase. That way I wouldn’t miss the optimum time for the follow-up.
It is worth remembering that much, much more Afrezza is needed to correct high glucose levels than to cover meals. As the video details, if I wait too long to dose, the dose required may be four times higher!
– Matt afrezzadownunder.com/
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Post by lb on Dec 31, 2016 18:40:17 GMT -5
They need to start selling in China already! Did you see their air? Inhaling Afrezza would actually be better than inhaling their air! Combined with the cultural needle-phobia, it should do fine there!
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Post by nylefty on Dec 31, 2016 19:37:00 GMT -5
Posted on Facebook today:
Jim Balkwill
December 31 at 1:02pm
63 job postings on MannKind's site this morning - another area business manager's position added for Beverley Hills, CA yesterday. Certainly doesn't appear to be a company with financial worries. Happy New Year to all, and let's hope for better things for MannKind in 2017.
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Post by derek2 on Dec 31, 2016 19:38:16 GMT -5
The replies in this thread do not answer the posted question "Why isn't the script count growing?" They address a secondary question: "Why are there not more new patients being added?" The answer to the posted question is this: Script count is not growing because patients are not sticking with Afrezza. For every new user, one discontinues. Until MNKD addresses THAT question, no amount of new users will be helpful if they just discontinue. Once somebody is using Afrezza (after going through the spirometry and possibly pre-authorization) does the black box warning make them stop? No Would coughing fits make them stop? Maybe Would trial design that showed non-inferiority and showed 37% got to treatment goal make them stop? No Would not getting to treatment goal make them stop? Maybe Add in the cost associated if 1: Copay is high, 2: Coverage is denied or 3: Patient requires more doses than are covered by insurance and you have a few reasons why patients may discontinue use. If MNKD had retained even 70% of new patients, we would be seeing thousands of weekly prescriptions even at these low weekly new Rx numbers. Pouring water into a sieve is not effective no matter how wide open you set the tap. MNKD needs to properly address retention regardless of past mistakes, past trials or current label. It is the priority. Oh, and : Happy new year! Quote: "The answer to the posted question is this: Script count is not growing because patients are not sticking with Afrezza. For every new user, one discontinues." Reply: Thank you for the work. Quote: Why: Add in the cost associated if 1: Copay is high, 2: Coverage is denied or 3: Patient requires more doses than are covered by insurance and you have a few reasons why patients may discontinue use. additionally, They can not wrap their heads around afrezza with out a CGM? They are using sub q insulin and afrezza, afrezza for corrections? Titration too low initially and waiting too long to correct?
From Matt down under
As a general rule, I dose about 10 minutes after I start eating, which is before my glucose levels start to rise from the meal. As I mention in the video, the best time to dose seems to depend on the fat content of the meal. And for some high fat meals, a follow up dose of Afrezza is neccesary.
I have found the same rule also applies if a follow-up dose is required. It is important to have the follow-up dose before the levels begin to rise out of range. If I had a CGM with alerts, I would use this to notify me as soon as it levels began to increase. That way I wouldn’t miss the optimum time for the follow-up.
It is worth remembering that much, much more Afrezza is needed to correct high glucose levels than to cover meals. As the video details, if I wait too long to dose, the dose required may be four times higher!
– Matt afrezzadownunder.com/
Yes! That's an excellent point about pairing with a CGM! Thanks, Peppy
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Post by mango on Dec 31, 2016 20:43:52 GMT -5
They started taking appointments on October 22nd. Their mission is not to prescribe as much Afrezza as humanly possible. It is to engage in a new approach, protocol, and more personalized one-on-one care so diabetics can take control over their disease. This involves everything from utilizing the latest and best therapies and treatment options and making sure patients understand that lifestyle choices are equally as important. Volume is probably low like you said, but understand they literally just opened their doors and it is a diabetic clinic so expect volume to be low, they aren't advertised as an acute care clinic. Also, I suspect sample packs will be given out first, and so you will not see script counts from them for a little while don't you think? And I think there will most definitely be a lot more of these clinics opening in 2017. • At Vdex, we will increase access to medical care by having more convenient locations, longer office hours more non-physician caregivers, and technological innovations. Patients need regular care and monitoring for life. As a result, diabetics have far better control of blood glucose levels and reduced hypoglycemia as compared to the current, best therapies available today. • Control of diabetes is essentially control of blood glucose levels. To control any variable such as blood glucose, requires two things: the practical ability to measure that variable in real-time and the ability to affect it. Together, we will provide “Real-Time Diabetes Management” and it is the cornerstone of our therapy. Mango, they opened Dec 1st. In LA. Other than that great post:-) Their facebook has a post from Oct. 17 that says they will be taking their first appointments on Oct. 22? m.facebook.com/story.php?story_fbid=1184678734952602&id=1007872209299923
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Post by sportsrancho on Dec 31, 2016 21:05:29 GMT -5
Mango.. I know. They had a little hold up. It happens:-) I'm not trying to be difficult, I just think it's maybe important to know that it's only been 4 weeks. ( as far as scripts go:-)
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Post by promann on Dec 31, 2016 22:02:53 GMT -5
It has been so obvious that MNKD's success with Afrezza will be thru clinics = Vdex. We are lead to believe that the one clinic in CA. is the status but I believe when they make their announcements they will include a long list of clinic openings and the primary investor is not "Bill". This is why there is no concern about script count, delisting, cash flow, etc. MNKD is keeping Afrezza on life support until this launch takes place in 2017. The same applies to RLS....there is much more to RLS than "inhalable grass" (which is a part but not THE part). All this has taken lots of time...that 65/35 partnership was dissolved but not due to Afrezza's slow sales but due to a total change in direction. There is a ton of $$ on the table and Al Mann stated that he once left the table way too soon and he would NEVER, EVER do that again. Well, Al is gone but I would wager that his plan of attack for Afrezza is still alive and about ready to rock the pharma world. Bubble buster pessimist reporting in. Didn't VDEX open its doors sometime in October? For sure by November if not. How much has the script count gone up in those nearly 2 months when it has been apparent that prescribing afrezza was the #1 priority? It's most likely due to low volume at the clinic, but we don't have unlimited time for this to take off. Additional financing at this point will be difficult to get, although reducing debt was helpful. I don't think we have several years to rely on clinics to be our savior. You are not busting any bubble in my opinion! VDEX has only been open since Dec 1 and I'm sure they are handing out plenty of sample packs for the first time users we need more time to see results from VDEX
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Post by mango on Dec 31, 2016 23:35:07 GMT -5
Mango.. I know. They had a little hold up. It happens:-) I'm not trying to be difficult, I just think it's maybe important to know that it's only been 4 weeks. ( as far as scripts go:-) I gotcha, got confused w/ their FB post. I remember now you mentioning this before. Interesting fact: The street I live off of is called McCullough Blvd, the house I live in used to be the house of a family friend who's last name is (and I kid you not) McCullough. I wonder if he has any relatives here in the South?
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Post by agedhippie on Jan 1, 2017 4:20:03 GMT -5
You are not busting any bubble in my opinion! VDEX has only been open since Dec 1 and I'm sure they are handing out plenty of sample packs for the first time users we need more time to see results from VDEX I know this has been asked before but I cannot remember the answer. Is the titration pack now used as the sample packs? And if so is the titration pack free?
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