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Post by agedhippie on Mar 4, 2017 20:19:26 GMT -5
This requires a complete change to the [broken] way the US health system works. Today the incentive is for the insurers to have at most a three year horizon. If a treatment doesn't pay for itself in that time it doesn't get their interest. This is because the majority of insurance is through the workplace and when you change jobs the odds are you are off their books and on average people change jobs every three years. This introduces moral hazard. The insurer does not bear the cost of their actions, another insurer, or more likely, the government does. Most Type 2 diabetics get it later in life and the probability is that by the time the expensive complications turn up you will be on Medicare and the insurer gets away free and clear. Effectively the government subsidizes the insurance industry. The fix is portable insurance (Obamacare?) or a national heath system like Medicare. So the health insurance people pay $6000 a year for doesn't want to pay to, " 50%+ can be taken off all medication for years ." Interesting gig.
That's correct. There is another dirty little secret and that is insurance can be split in two - administration of the scheme, and the actual insurance. Most large companies assume the risk themselves because it is cheaper than having a health insurer assume the risk (the percentage probability of a pay out remains the same but you get rid of the health insurers margin). Now as soon as you no longer work there nobody has any interest at all. More to the point they would like to keep the costs as low as possible while you do work there. There is an active disincentive to be proactive since all you are doing is reducing costs for someone else (quite likely a competitor).
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Post by peppy on Mar 4, 2017 20:24:39 GMT -5
So the health insurance people pay $6000 a year for doesn't want to pay to, " 50%+ can be taken off all medication for years ." Interesting gig.
That's correct. There is another dirty little secret and that is insurance can be split in two - administration of the scheme, and the actual insurance. Most large companies assume the risk themselves because it is cheaper than having a health insurer assume the risk (the percentage probability of a pay out remains the same but you get rid of the health insurers margin). Now as soon as you no longer work there nobody has any interest at all. More to the point they would like to keep the costs as low as possible while you do work there. There is an active disincentive to be proactive since all you are doing is reducing costs for someone else (quite likely a competitor). So in essence this country has an expensive health care system that does not want to pay to get people well. I do not read that in the news paper. This internet thingy we have going is interesting. Spread the word. (Do not be surprised if people to not believe you.) I believe you.
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Post by sayhey24 on Mar 5, 2017 9:02:43 GMT -5
That's correct. There is another dirty little secret and that is insurance can be split in two - administration of the scheme, and the actual insurance. Most large companies assume the risk themselves because it is cheaper than having a health insurer assume the risk (the percentage probability of a pay out remains the same but you get rid of the health insurers margin). Now as soon as you no longer work there nobody has any interest at all. More to the point they would like to keep the costs as low as possible while you do work there. There is an active disincentive to be proactive since all you are doing is reducing costs for someone else (quite likely a competitor). So in essence this country has an expensive health care system that does not want to pay to get people well. I do not read that in the news paper. This internet thingy we have going is interesting. Spread the word. (Do not be surprised if people to not believe you.) I believe you.
How this is going to play out will be interesting. Onduo is clearly approaching this from a insurance perspective by putting Josh Riff in charge. Between, the sensors(CGMs), the cloud and databases, etc., the technology now exists which transforms diabetes from a "flying-blind" check back in 90 days medical issue to an engineering opportunity to measure in real time and adjust in real-time. Diabetes is the perfect fit for an engineering approach and with an insulin which works like the pancreas its easy to model. Al knew this with the pump but always said the insulin was not good enough at meal time. I would think we can all agree Dexcom will be part of the Onduo offering. Steve Edelman has been identified as a main contributor to the protocol and uses afrezza himself. Stefan Schwarz, the Sanofi Afrezza rep sold the idea to Sanofi and got them to front $250M in the partnership. How important is afrezza in what they are doing is the question and what valuation does this give afrezza? If Onduo can flip the insurance model which they have the resources to do and if, afrezza is a key component of the treatment protocol then I would say, game on. Maybe the 1-5 split makes sense then. Lots of ifs but not on the technology and not with afrezza. Neither has risk, both are proven. This is a business problem in changing how diabetics are handled with insurance. Its a huge opportunity. As someone would say Biglig. I guess some would say tin foil hat-ish but with Googles resources maybe not and I am sure Oscar would like to be a huge player in the insurance market. How big is this internationally with Google? In the mean time, since the target Endo market is not the Onduo market have MNKD hire a bunch of sales guys and have them target the endos, go door-to-door and get the word out. Maybe they sell some product, maybe there is too much resistance. However, Steve Edelman told them how to initially sell, have the Endo's prescribe initially for corrections. Once Onduo is announced the Endo's will come on board. I hope Matt knows whats going on.
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Deleted
Deleted Member
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Afrezza
Mar 5, 2017 10:03:20 GMT -5
sky likes this
Post by Deleted on Mar 5, 2017 10:03:20 GMT -5
So in essence this country has an expensive health care system that does not want to pay to get people well. I do not read that in the news paper. This internet thingy we have going is interesting. Spread the word. (Do not be surprised if people to not believe you.) I believe you.
How this is going to play out will be interesting. Onduo is clearly approaching this from a insurance perspective by putting Josh Riff in charge. Between, the sensors(CGMs), the cloud and databases, etc., the technology now exists which transforms diabetes from a "flying-blind" check back in 90 days medical issue to an engineering opportunity to measure in real time and adjust in real-time. Diabetes is the perfect fit for an engineering approach and with an insulin which works like the pancreas its easy to model. Al knew this with the pump but always said the insulin was not good enough at meal time. I would think we can all agree Dexcom will be part of the Onduo offering. Steve Edelman has been identified as a main contributor to the protocol and uses afrezza himself. Stefan Schwarz, the Sanofi Afrezza rep sold the idea to Sanofi and got them to front $250M in the partnership. How important is afrezza in what they are doing is the question and what valuation does this give afrezza? If Onduo can flip the insurance model which they have the resources to do and if, afrezza is a key component of the treatment protocol then I would say, game on. Maybe the 1-5 split makes sense then. Lots of ifs but not on the technology and not with afrezza. Neither has risk, both are proven. This is a business problem in changing how diabetics are handled with insurance. Its a huge opportunity. As someone would say Biglig. I guess some would say tin foil hat-ish but with Googles resources maybe not and I am sure Oscar would like to be a huge player in the insurance market. How big is this internationally with Google? In the mean time, since the target Endo market is not the Onduo market have MNKD hire a bunch of sales guys and have them target the endos, go door-to-door and get the word out. Maybe they sell some product, maybe there is too much resistance. However, Steve Edelman told them how to initially sell, have the Endo's prescribe initially for corrections. Once Onduo is announced the Endo's will come on board. I hope Matt knows whats going on. you can tell Stefan , to tell Onduo, he can buy the whole enchilada now for around $200 million. When you are dreaming, atleast dream big. Mannkind will be bought by Sanofi, Google partering with Apple with 200 billion. And I feel sorry myself for keep reading BS and even worse replying. I hope atleast some of the investors dont believe your BS which is similar to Kevin's stuff.
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Afrezza
Mar 5, 2017 10:06:43 GMT -5
Post by lennymnkd on Mar 5, 2017 10:06:43 GMT -5
Well said seyhey 24 / your not speculating, it's what's being had . Just needs to come to fuition , and I think it will.. 🤞
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Post by peppy on Mar 5, 2017 10:13:07 GMT -5
quote: have the Endo's prescribe initially for corrections. Once Onduo is announced the Endo's will come on board. I hope Matt knows whats going on. reply: Insurance coverage will not cover that.
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Post by lennymnkd on Mar 5, 2017 10:30:44 GMT -5
Peppy ; will not cover ,hope matt knows what's going on or working well for endos as far as corrections are concerned !
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Post by sayhey24 on Mar 5, 2017 11:18:10 GMT -5
How this is going to play out will be interesting. Onduo is clearly approaching this from a insurance perspective by putting Josh Riff in charge. Between, the sensors(CGMs), the cloud and databases, etc., the technology now exists which transforms diabetes from a "flying-blind" check back in 90 days medical issue to an engineering opportunity to measure in real time and adjust in real-time. Diabetes is the perfect fit for an engineering approach and with an insulin which works like the pancreas its easy to model. Al knew this with the pump but always said the insulin was not good enough at meal time. I would think we can all agree Dexcom will be part of the Onduo offering. Steve Edelman has been identified as a main contributor to the protocol and uses afrezza himself. Stefan Schwarz, the Sanofi Afrezza rep sold the idea to Sanofi and got them to front $250M in the partnership. How important is afrezza in what they are doing is the question and what valuation does this give afrezza? If Onduo can flip the insurance model which they have the resources to do and if, afrezza is a key component of the treatment protocol then I would say, game on. Maybe the 1-5 split makes sense then. Lots of ifs but not on the technology and not with afrezza. Neither has risk, both are proven. This is a business problem in changing how diabetics are handled with insurance. Its a huge opportunity. As someone would say Biglig. I guess some would say tin foil hat-ish but with Googles resources maybe not and I am sure Oscar would like to be a huge player in the insurance market. How big is this internationally with Google? In the mean time, since the target Endo market is not the Onduo market have MNKD hire a bunch of sales guys and have them target the endos, go door-to-door and get the word out. Maybe they sell some product, maybe there is too much resistance. However, Steve Edelman told them how to initially sell, have the Endo's prescribe initially for corrections. Once Onduo is announced the Endo's will come on board. I hope Matt knows whats going on. you can tell Stefan , to tell Onduo, he can buy the whole enchilada now for around $200 million. When you are dreaming, atleast dream big. Mannkind will be bought by Sanofi, Google partering with Apple with 200 billion. And I feel sorry myself for keep reading BS and even worse replying. I hope atleast some of the investors dont believe your BS which is similar to Kevin's stuff. Nothing I said is BS but if you can point to it I will review. The only unknown is if and to what degree afrezza may or may not be involved with Ondou's protocol. Stefan's new title is Ondou Alliance manager. This is all on him and he was the guy in May '15 that started selling the Onduo idea. With the Mann estate and Mann foundation ownership, I don't think $200M will buy MNKD. If Ondou is serious about changing the insurance market through diabetes care and if afrezza is part of this, the question is what is the real value of afrezza? Its not $200M. If Mike can get his sales guys to get each of the 2000 endo's to prescribe 1 script a week, in no time afrezza will hit the magical 12,000 scripts per week. If it were $200M to even get 51% control, Mannkind would have already been gone. The one thing Al Mann always did was make sure he was always part of the dilution to keep control. If Ondou makes it and afrezza is part of it, could you imagine selling for $200M.
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Afrezza
Mar 5, 2017 11:20:58 GMT -5
Post by sayhey24 on Mar 5, 2017 11:20:58 GMT -5
quote: have the Endo's prescribe initially for corrections. Once Onduo is announced the Endo's will come on board. I hope Matt knows whats going on. reply: Insurance coverage will not cover that. Give it away for $30 a box for now on a manufacturer's rebate for correction prescriptions. I would send Bernie Sander's some of the coupons while they are at it.
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Post by goyocafe on Mar 5, 2017 11:40:32 GMT -5
Peppy ; will not cover ,hope matt knows what's going on or working well for endos as far as corrections are concerned ! From all the bits and pieces I've picked up about dosing, correction dosing is only going to work if they catch it early enough, otherwise they'll all be complaining about how much Afrezza they have to take in order to correct. Correct me if I'm wrong.
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Afrezza
Mar 5, 2017 12:01:19 GMT -5
Post by agedhippie on Mar 5, 2017 12:01:19 GMT -5
Peppy ; will not cover ,hope matt knows what's going on or working well for endos as far as corrections are concerned ! From all the bits and pieces I've picked up about dosing, correction dosing is only going to work if they catch it early enough, otherwise they'll all be complaining about how much Afrezza they have to take in order to correct. Correct me if I'm wrong. It depends It varies from person to person. Once I get above mid 300s I start to need a lot more insulin to correct. The other problem, and this is wild speculation, that glucose binds to your hemoglobin and doesn't want to let go so you get less oxygen - you feel breathless. I wonder if that makes inhaled insulin a less viable route at those times.
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Afrezza
Mar 5, 2017 12:13:17 GMT -5
Post by peppy on Mar 5, 2017 12:13:17 GMT -5
From all the bits and pieces I've picked up about dosing, correction dosing is only going to work if they catch it early enough, otherwise they'll all be complaining about how much Afrezza they have to take in order to correct. Correct me if I'm wrong. It depends It varies from person to person. Once I get above mid 300s I start to need a lot more insulin to correct. The other problem, and this is wild speculation, that glucose binds to your hemoglobin and doesn't want to let go so you get less oxygen - you feel breathless. I wonder if that makes inhaled insulin a less viable route at those times. quote: that glucose binds to your hemoglobin and doesn't want to let go so you get less oxygen - you feel breathless. reply: glycation. the bonding of a sugar molecule to a protein or lipid molecule without enzymatic regulation as you will know aged, that is what your hgA1c is measuring. (like spilling regular 7up on the floor.)
regarding 300 mg/dl...... and your endo refused. and he knows you. Hmmmmm........
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Post by agedhippie on Mar 5, 2017 12:14:46 GMT -5
That's correct. There is another dirty little secret and that is insurance can be split in two - administration of the scheme, and the actual insurance. Most large companies assume the risk themselves because it is cheaper than having a health insurer assume the risk (the percentage probability of a pay out remains the same but you get rid of the health insurers margin). Now as soon as you no longer work there nobody has any interest at all. More to the point they would like to keep the costs as low as possible while you do work there. There is an active disincentive to be proactive since all you are doing is reducing costs for someone else (quite likely a competitor). So in essence this country has an expensive health care system that does not want to pay to get people well. I do not read that in the news paper. This internet thingy we have going is interesting. Spread the word. (Do not be surprised if people to not believe you.) I believe you.
Last year my insurer paid $8500 for my insurance (yes, I'm doing my taxes) on top of which I paid another $2000 as my contribution. I am not sure how much co-pays, deductables, etc added up to but I know I blew through my FSA so at least another $2500. So my contribution to the medical system was over $13,000 last year. Compare that to the NHS which is tax based and costs £2,057 (roughly $3,000) per head in 2014/15. That's a $10,000+ delta!!!!
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Afrezza
Mar 5, 2017 12:17:26 GMT -5
Post by agedhippie on Mar 5, 2017 12:17:26 GMT -5
It depends It varies from person to person. Once I get above mid 300s I start to need a lot more insulin to correct. The other problem, and this is wild speculation, that glucose binds to your hemoglobin and doesn't want to let go so you get less oxygen - you feel breathless. I wonder if that makes inhaled insulin a less viable route at those times. quote: that glucose binds to your hemoglobin and doesn't want to let go so you get less oxygen - you feel breathless. reply: glycation. the bonding of a sugar molecule to a protein or lipid molecule without enzymatic regulation as you will know aged, that is what your hgA1c is measuring. (like spilling regular 7up on the floor.)
regarding 300 mg/dl...... and your endo refused. and he knows you. Hmmmmm........
He did ask about that one rather sharply [cue tuneless whistling] As it happens I had forgotten to bolus for a meal and only caught it at bed time. That's usually the cause, that or cupcakes.
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Post by jonny80s on Mar 5, 2017 12:24:53 GMT -5
This is what I think happened: Mannkind as a company did whatever it could to get approval... they didn't care what the label stated and agreed to whatever the FDA/board suggested. Mannkind was hoping that social media from 2 or 3 of the drugs biggest stars would then steer users into proper dosing/usage (off label).
This didn't happen, didn't even come close. The social media aspect is floundering on twitter. Now we are stuck with management scrambling with no real direction. Stuck, forced to adhere to the labeling that they agreed to rather than pushing for the labeling that should have been granted.... unfortunately the first epic f-up was agreeing to the trials that were created in the image of subq insulin.
In the end what you have is a great product squandered by mismanagement.
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