Insulin pricing and exposure

[mango]

Feb 23, 2017 10:45:28 GMT -5 matt said:

Feb 23, 2017 9:47:26 GMT -5 agedhippie said:

It's not a coincidence at all.

If you are an endo doing research you will be getting grants from diabetes drug companies. That doesn't mean they are in anyones pocket, just that a pharma is funding a project.

Exactly correct.  I have funded lots of investigators that were working on projects of interest to my companies, but in my experience academics (especially) are in nobody's pocket.  I have cringed more than once when an investigator that we had funded generously tactfully suggested to a room full of his colleagues that he would not use our product in particular circumstances.  He was right of course, but it was not fun hearing him say it.  I am not saying that some people cannot be bought off, but it doesn't happen for the amounts discussed here and in many cases, those funds are tracked and controlled by the hospital or university.  Many of the checks are payable to the institution, not the physician directly.

The physicians you have to worry about are not those who are disclosing.  The ones you need to worry about are those who are getting envelopes full of cash via a quasi-related party (like an "independent" distributor) out in the parking lot after dark.  Pay to play is alive and well, but not for those participating in highly public panel discussions.

Like this qui tam involving Eli Lilly, right? Were those doctors receiving the money from Eli Lilly or these "quasi-related parties"? The doctors were receiving the money from Eli Lilly, matt. You are wrong. 

• Joe Faltaous worked as a Neuroscience Sales Specialist for Eli Lilly for two years before resigning after expressing concerns about Eli Lilly’s practices. Joe complained of Lilly’s illegal marketing, promotion and sale of Zyprexa to children and in higher-than-recommended dosages to adults. Joe also complained that, as part of the marketing and promotional schemes, Lilly encouraged physicians by means of monetary payments. In 2009, Faltaous and 9 other whistleblowers won a settlement with Eli Lilly in a civil qui tam action in U.S. District Court.[19]

en.m.wikipedia.org/wiki/Qui_tam

www.bafirm.com/result/joel-androphy-and-sarah-frazier-represented-one-of-the-nine-whistleblowers-and-won-a-settlement-with-eli-lilly/




DISCLOSURES

Dr. Jeffrey R. Garber reports that he does not have any relevant financial relationships with any commercial interests.

Dr. Alan J. Garber reports that he is a consultant for Novo Nordisk and Intarcia

Dr. W. Timothy Garvey reports that he is a consultant for AstraZeneca, Janssen, Eisai, Takeda, Novo Nordisk, Alexion, and Merck. He has also received research grants from Merck, Weight Watchers, Sanofi, Eisai, AstraZeneca, Lexicon, Pfizer, Novo Nordisk, and Elcelyx. Dr. Garvey is a shareholder in ISIS Pharmaceuticals, Novartis, Bristol Myers Squibb, Pfizer, Merck, and Eli Lilly.

Dr. Martin Julian Abrahamson reports that he is a consultant for Novo Nordisk, WebMD Health Services, and Health IQ.

Dr. Joshua I. Barzilay reports that he does not have any relevant financial relationships with any commercial interests.

Dr. Lawrence Blonde reports that he is a consultant for AstraZeneca, GlaxoSmithKline, Intarcia, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk, and Sanofi. He is also a speaker for AstraZeneca, Janssen Pharmacueticals, Inc., Merck & Co., Inc., Novo Nordisk, and Sanofi. Dr. Blonde has received research grant support from AstraZeneca, Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck & Co., Novo Nordisk, and Sanofi.

Dr. George Grunberger reports that he has received speaker honoraria from Eli Lilly, BI-Lilly, Novo Nordisk, Sanofi, Janssen, and AstraZeneca. He has received research funding from AstraZeneca, Eli Lilly, Lexicon, and Medtronic.

Dr. Zachary Bloomgarden reports that he is a consultant for AstraZeneca, Johnson & Johnson, Merck, Intarcia, and Novartis. He is also a speaker for Merck, AstraZeneca, and Johnson & Johnson. He is a stock shareholder for Allergan, Pfizer, Zimmer Biomet, and Novartis.

Dr. Yehuda Handelsman reports that he is a consultant for Amarin, Amgen, AstraZeneca, Boehringer Ingelheim (BI), Janssen, Eli Lilly, Eisai, Intarcia, Merck, Novo Nordisk, Sanofi, and Regeneron. He is a speaker for Amarin, Amgen, AstraZeneca, BI-Lilly, Janssen, Novo Nordisk, Sanofi, and Regeneron. Dr. Handelsman has also received grant support from Amgen, AstraZeneca, BI, Esperion, Grifols, Hamni, GlaxoSmithKline, Lexicon, Merck, Novo Nordisk, and Sanofi.

Dr. Michael A. Bush reports that he is an Advisory Board Consultant for Janssen and Eli Lilly. He is on the speaker’s bureau for Takeda, Eli Lilly, Novo Nordisk, AstraZeneca, and Boehringer Ingelheim.

Dr. Irl B. Hirsch reports that he is a consultant for Abbott Diabetes Care, Roche, Intarcia, and Valeritas.

Dr. Samuel Dagogo-Jack reports that he is a consultant for Merck, Novo Nordisk, Janssen, and Boehringer Ingelheim. He has received research grants from Amgen. Additionally, AstraZeneca, Novo Nordisk, and Boehringer Ingelheim have clinical trial contracts with the University of Tennessee for studies in which Dr. Dagogo-Jack serves as the Principal Investigator or Co-Investigator.

Dr. Paul S. Jellinger reports that he has received speaker honoraria from BI-Lilly, AstraZeneca, Novo Nordisk, Merck, and Amgen.

Dr. Ralph Anthony DeFronzo reports that he is on the Advisory Board for AstraZeneca, Novo Nordisk, Janssen, Boehringer Ingelheim, Intarcia, and Ecelyx. He is also a speaker for Novo Nordisk and AstraZeneca. Dr. DeFronzo has received research grant support from Boehringer Ingelheim, Takeda, Janssen, and AstraZeneca.

Dr. Janet B. McGill reports that she is a consultant for Boehringer Ingelheim, Janssen, Merck, Novo Nordisk, Calibra, Dynavax, Valertias, and Intarcia. She is also a speaker for Janssen. Dr. McGill has received research grant support from Novartis, Dexcom, Bristol Myers Squibb, and Lexicon.

Dr. Daniel Einhorn reports that he is a consultant for Eli Lilly, Takeda, Novo Nordisk, Adocia, Sanofi, Epitracker, Janssen, Intarcia, Glysens, and Freedom-Meditech and has received research grant support from Novo Nordisk, Eli Lilly, AstraZeneca, Eisai, Janssen, and Sanofi. He is also a shareholder of Halozyme.

Dr. Paul D. Rosenblit reports that he is a consultant for AstraZeneca and a speaker for AstraZeneca (Bristol Myers Squibb), Boehringer Ingelheim, GlaxoSmithKline, Janssen, Merck, Novo Nordisk, and Takeda. He has also received research grant support from Amgen, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, GlaxoSmithKline, Ionis, Eli Lilly, Lexicon, Merck, Novo Nordisk, Orexigen, Pfizer, and Sanofi.

Dr. Vivian A. Fonseca reports that he is a consultant for Takeda, Novo Nordisk, Sanofi, Eli Lily, Pamlabs, AstraZeneca, Abbott, Boehringer Ingelheim, Janssen and Intarcia. He is a speaker for Takeda, AstraZeneca, and Sanofi. Dr. Fonseca has also received research grants from Novo Nordisk, Asahi, Eli Lilly, Abbott, Endo Barrier, Bayer, and Gilead.

Dr. Guillermo E. Umpierrez reports that he is a consultant for Sanofi and Glytec. He also received research grant support from Merck, Sanofi, Boehringer Ingelheim, AstraZeneca, and Novo Nordisk.

Dr. Jeffrey I. Mechanick reports that he is a consultant for Abbott Nutrition International.

Dr. Stephanie Adams reports that she does not have any relevant financial relationships with any commercial interests.


www.aace.com/sites/all/files/diabetes-algorithm-executive-summary.pdf

[agedhippie]

Feb 23, 2017 15:30:07 GMT -5 mango said:

• Joe Faltaous worked as a Neuroscience Sales Specialist for Eli Lilly for two years before resigning after expressing concerns about Eli Lilly’s practices. Joe complained of Lilly’s illegal marketing, promotion and sale of Zyprexa to children and in higher-than-recommended dosages to adults. Joe also complained that, as part of the marketing and promotional schemes, Lilly encouraged physicians by means of monetary payments. In 2009, Faltaous and 9 other whistleblowers won a settlement with Eli Lilly in a civil qui tam action in U.S. District Court.[19]

Wait, isn't the section you highlighted in red what people are suggesting we do by issuing warrants for Mannkind to doctors?

[sayhey24]

Feb 23, 2017 15:45:48 GMT -5 agedhippie said:

Feb 23, 2017 15:30:07 GMT -5 mango said:

• Joe Faltaous worked as a Neuroscience Sales Specialist for Eli Lilly for two years before resigning after expressing concerns about Eli Lilly’s practices. Joe complained of Lilly’s illegal marketing, promotion and sale of Zyprexa to children and in higher-than-recommended dosages to adults. Joe also complained that, as part of the marketing and promotional schemes, Lilly encouraged physicians by means of monetary payments. In 2009, Faltaous and 9 other whistleblowers won a settlement with Eli Lilly in a civil qui tam action in U.S. District Court.[19]

Wait, isn't the section you highlighted in red what people are suggesting we do by issuing warrants for Mannkind to doctors?

The best way to get the doctors invested in understanding the benefits of afrezza so they start helping their patients is to get the doctors invested.  Warrants are not a cash payment, they are an option for the doctor to put up their own money and buy in the future at a certain price.  Paying doctors bags of cash to push some of these very questionable drugs is a real problem and a reality.  IMO, the more doctors who get invested in MNKD and understand the benefits of afrezza the better.  Bernie Sanders is having these same BPs investigated in the Justice Dept for price fixing.  If Bernie really wants to get BP to cut their price he would invite Matt Pfieffer on 60 minutes with him and during the show Matt would announce a 50% price cut to the best insulin out there and an insulin Mike C. thinks is already aggressively priced.

[agedhippie]

Feb 23, 2017 20:54:58 GMT -5 sayhey24 said:

Feb 23, 2017 15:45:48 GMT -5 agedhippie said:

Wait, isn't the section you highlighted in red what people are suggesting we do by issuing warrants for Mannkind to doctors?

The best way to get the doctors invested in understanding the benefits of afrezza so they start helping their patients is to get the doctors invested.  Warrants are not a cash payment, they are an option for the doctor to put up their own money and buy in the future at a certain price.  Paying doctors bags of cash to push some of these very questionable drugs is a real problem and a reality.  IMO, the more doctors who get invested in MNKD and understand the benefits of afrezza the better.  Bernie Sanders is having these same BPs investigated in the Justice Dept for price fixing.  If Bernie really wants to get BP to cut their price he would invite Matt Pfieffer on 60 minutes with him and during the show Matt would announce a 50% price cut to the best insulin out there and an insulin Mike C. thinks is already aggressively priced.

That's a cash inducement - if you push Afrezza the price rises and you can sell your warrants for a profit.

A 50% price cut still leaves it at 300% of the EU price (assuming they match RAA in the EU).

[mango]

Feb 23, 2017 15:45:48 GMT -5 agedhippie said:

Feb 23, 2017 15:30:07 GMT -5 mango said:

• Joe Faltaous worked as a Neuroscience Sales Specialist for Eli Lilly for two years before resigning after expressing concerns about Eli Lilly’s practices. Joe complained of Lilly’s illegal marketing, promotion and sale of Zyprexa to children and in higher-than-recommended dosages to adults. Joe also complained that, as part of the marketing and promotional schemes, Lilly encouraged physicians by means of monetary payments. In 2009, Faltaous and 9 other whistleblowers won a settlement with Eli Lilly in a civil qui tam action in U.S. District Court.[19]

Wait, isn't the section you highlighted in red what people are suggesting we do by issuing warrants for Mannkind to doctors?

I have never suggested such. And the twitter post by Michael about being ethical more than likely suggests the company's POV.  

[mango]

Feb 23, 2017 9:47:26 GMT -5 agedhippie said:

Feb 22, 2017 22:53:06 GMT -5 mango said:

Seems like just about everyone, with the except of a few, on the consensus committee are associated with one of the insulin cartels involved in the alleged insulin price fixing. I am sure it is rather coincidence. 🙄

It's not a coincidence at all.

If you are an endo doing research you will be getting grants from diabetes drug companies. That doesn't mean they are in anyones pocket, just that a pharma is funding a project. It is also why the disclosures change from year to year - for example in 2015 Dr Irl Hirsch (since you are picking on him) took no money from insulin companies.

From April 2015:

Dr. Irl B. Hirsch reports that he has received research grant support for his role as principal investigator from Halozyme, Inc and sanofi-aventis U.S. LLC; and consultant honoraria from Abbott Laboratories, BD, and F. Hoffman-La Roche Ltd.

www.aace.com/files/dm-guidelines-ccp.pdf

[sayhey24]

Feb 24, 2017 16:00:16 GMT -5 mango said:

Feb 23, 2017 15:45:48 GMT -5 agedhippie said:

Wait, isn't the section you highlighted in red what people are suggesting we do by issuing warrants for Mannkind to doctors?

I have never suggested such. And the twitter post by Michael about being ethical more than likely suggests the company's POV.  

I said it.  I see nothing wrong with having doctors invest their own money in MNKD.  In fact what better endorsement than the doctor putting their own money into a life changing diabetic treatment.  There is a big difference between investing in something you believe in which has real value and getting a kickback as Mike C. was referring to.  I could go down the list of very questionable "new" treatments.  I probably see as many commercials to join a law suit against Invokana as commercials telling people how they can reduce their BG and loose weight too by pissing out sugar.  I would highly recommend a MNKD private placement to the Endos.  I would also put a standard package together to offer warrants instead of cash for paid speaking engagements.  If its all done above board it would be a win for the doctors; a win for MNKD; and a big win for the PWDs who are now getting afrezza.  If Mike is sneaking around in parking lots with bags of cash, we have a big issue and I think he knows that.

[mango]

Feb 24, 2017 18:49:33 GMT -5 sayhey24 said:

Feb 24, 2017 16:00:16 GMT -5 mango said:

I have never suggested such. And the twitter post by Michael about being ethical more than likely suggests the company's POV.  

I said it.  I see nothing wrong with having doctors invest their own money in MNKD.  In fact what better endorsement than the doctor putting their own money into a life changing diabetic treatment.  There is a big difference between investing in something you believe in which has real value and getting a kickback as Mike C. was referring to.  I could go down the list of very questionable "new" treatments.  I probably see as many commercials to join a law suit against Invokana as commercials telling people how they can reduce their BG and loose weight too by pissing out sugar.  I would highly recommend a MNKD private placement to the Endos.  I would also put a standard package together to offer warrants instead of cash for paid speaking engagements.  If its all done above board it would be a win for the doctors; a win for MNKD; and a big win for the PWDs who are now getting afrezza.  If Mike is sneaking around in parking lots with bags of cash, we have a big issue and I think he knows that.

Obviously, physicians can invest their money wherever they choose, but conflicts of interests have to always be realized. What you are suggesting seems highly unethical to me. That is just my opinion.

[agedhippie]

Feb 24, 2017 18:20:53 GMT -5 mango said:

Feb 23, 2017 9:47:26 GMT -5 agedhippie said:

It's not a coincidence at all.

If you are an endo doing research you will be getting grants from diabetes drug companies. That doesn't mean they are in anyones pocket, just that a pharma is funding a project. It is also why the disclosures change from year to year - for example in 2015 Dr Irl Hirsch (since you are picking on him) took no money from insulin companies.

From April 2015:

Dr. Irl B. Hirsch reports that he has received research grant support for his role as principal investigator from Halozyme, Inc and sanofi-aventis U.S. LLC; and consultant honoraria from Abbott Laboratories, BD, and F. Hoffman-La Roche Ltd.

www.aace.com/files/dm-guidelines-ccp.pdf

An excellent example. Those were grants to the University of Washington and are marked against him because he was the principal investigator appointed by the university for the work. I think he is being over-zealous declaring them since they are not a benefit to him but there you go.