|
Post by charlespk on Mar 29, 2017 15:10:05 GMT -5
This is not FUD , as those who know me on this board can attest .
Here is what i see , the science and the drug works beautifully ;
But -
When I ask pharmacists about Afrezza , only one said he heard about it and he had not dispensed any .
I have asked in different pharmacies the same question .
Diabetics , that are on oral agents , and failing Hb Aic anywhere between 7 to 10 , have not heard about it .
Doctors that i have asked , ( not endo's ) , some specialists , some GP's do not know about it
and finally it seems like the endo's are not Prescribing it , and that is what we we need to find out , why are they not ,
Too conservative ? , don't like change or the need to adjust pts to this medication , they still remember Exubera failure ? In my opinion , there are ways to find out this info from the Endocrinologists ( I know because I have participated in similar activities to get the answers from them
This last one is key to being successful or not
Insurance companies only care about , how much will it cost them now , therefore lack of coverage being available easily without prior auth .
So the way i see it;
1) Find out from the endo's ( see above)
2) Lower the price so its slightly less than other mealtime insulin .
3 ) advertise - you have to spend money to make money but unfortunately that what MNKD lacks right now .
4) ) Educate , educate , do webinars
5) I am not selling , I have lost so much that it would not make a difference and I am getting close to retire): , I want it to succeed for the pts , imagine if it was taken off the market for all those pts who know how good it works with a CGM 6 ) Finally do it for the kids , imagine your child being a type 1 and needing to be poked several times a day
I hope someone can pass this on to management ,
|
|
|
Post by careful2invest on Mar 29, 2017 15:18:20 GMT -5
This is not FUD , as those who know me on this board can attest . Here is what i see , the science and the drug works beautifully ; But - When I ask pharmacists about Afrezza , only one said he heard about it and he had not dispensed any . I have asked in different pharmacies the same question . Diabetics , that are on oral agents , and failing Hb Aic anywhere between 7 to 10 , have not heard about it . Doctors that i have asked , ( not endo's ) , some specialists , some GP's do not know about it and finally it seems like the endo's are not Prescribing it , and that is what we we need to find out , why are they not , Too conservative ? , don't like change or the need to adjust pts to this medication , they still remember Exubera failure ? In my opinion , there are ways to find out this info from the Endocrinologists ( I know because I have participated in similar activities to get the answers from them This last one is key to being successful or not Insurance companies only care about , how much will it cost them now , therefore lack of coverage being available easily without prior auth . So the way i see it; 1) Find out from the endo's ( see above) 2) Lower the price so its slightly less than other mealtime insulin . 3 ) advertise - you have to spend money to make money but unfortunately that what MNKD lacks right now . 4) ) Educate , educate , do webinars 5) I am not selling , I have lost so much that it would not make a difference and I am getting close to retire): , I want it to succeed for the pts , imagine if it was taken off the market for all those pts who know how good it works with a CGM 6 ) Finally do it for the kids , imagine your child being a type 1 and needing to be poked several times a day I hope someone can pass this on to management , What you wrote makes perfect sense and trust that many of us on this board have already said what you are saying to many others, including MNKD Management. Why they have not acted on and are not all over these issues remains the 2 billion dollar mystery.
|
|
|
Post by derek2 on Mar 29, 2017 15:55:36 GMT -5
6 ) Finally do it for the kids , imagine your child being a type 1 and needing to be poked several times a day I hope someone can pass this on to management , Do it for the kids? MNKD didn't, to the extent of getting permission to have pediatric trials delayed until a finish date of 2021 instead of being part of the initial application. This drug should have been aimed at children and primarily studied on them. They're a sensible, humane, and sizable target market. MNKD did the exact opposite.
|
|
|
Post by sportsrancho on Mar 29, 2017 16:10:20 GMT -5
I'm not sure if they had any idea it would take off with kids the way it has. At first I think they were thinking it would be excepted by the T2's that were just about to need meal time shots. ( But I could be way off on that).
|
|
|
Post by dreamboatcruise on Mar 29, 2017 16:25:22 GMT -5
This is not FUD , as those who know me on this board can attest . Here is what i see , the science and the drug works beautifully ; But - When I ask pharmacists about Afrezza , only one said he heard about it and he had not dispensed any . I have asked in different pharmacies the same question . Diabetics , that are on oral agents , and failing Hb Aic anywhere between 7 to 10 , have not heard about it . Doctors that i have asked , ( not endo's ) , some specialists , some GP's do not know about it and finally it seems like the endo's are not Prescribing it , and that is what we we need to find out , why are they not , Too conservative ? , don't like change or the need to adjust pts to this medication , they still remember Exubera failure ? In my opinion , there are ways to find out this info from the Endocrinologists ( I know because I have participated in similar activities to get the answers from them This last one is key to being successful or not Insurance companies only care about , how much will it cost them now , therefore lack of coverage being available easily without prior auth . So the way i see it; 1) Find out from the endo's ( see above) 2) Lower the price so its slightly less than other mealtime insulin . 3 ) advertise - you have to spend money to make money but unfortunately that what MNKD lacks right now . 4) ) Educate , educate , do webinars 5) I am not selling , I have lost so much that it would not make a difference and I am getting close to retire): , I want it to succeed for the pts , imagine if it was taken off the market for all those pts who know how good it works with a CGM 6 ) Finally do it for the kids , imagine your child being a type 1 and needing to be poked several times a day I hope someone can pass this on to management , They are doing #1, and they have talked about some of the things they've learned including that some doctors have avoided using Afrezza because they perceive it may not remain on the market. We also know it had to do with coverage and with problems with onboarding/titration. As for pricing, we really don't know what prices Mannkind has negotiated with insurance. We do know that they have made progress in getting on commercial insurance formularies and in getting PAs approved... I'm guessing they didn't achieve that at a higher price than subq pens. I really don't know, but given the lack of doctor support and lack of large numbers of patients demanding Afrezza... why else would insurance companies be improving coverage of Afrezza other than extracting a bargain from Mannkind? Lots of us agree advertising is needed now, whether targeted or more widespread. We've had one claim here today of someone seeing an ad at a doctors office. I'm very keen to see evidence this has really been rolled out.
|
|
Deleted
Deleted Member
Posts: 0
|
Post by Deleted on Mar 29, 2017 19:44:51 GMT -5
"and finally it seems like the endo's are not Prescribing it , and that is what we we need to find out , why are they not" Is it possible Endocrinologists and other doctors are not prescribing in order to maintain their patient population? Of the 6 diabetics I know that inquired about Afrezza, all 6 doctors knew of it but refused to prescribe it. Let's face it, a diabetic on analogues, orals or both will have complications and their conditions worsen over time. If Afrezza would reduce or eliminate those issues is it possible these patients would require fewer appointments and lab work? Read more: mnkd.proboards.com/thread/7519/problem-knows-doctors-pre#ixzz4clSSuQmv
|
|
|
Post by sportsrancho on Mar 29, 2017 19:51:36 GMT -5
"and finally it seems like the endo's are not Prescribing it , and that is what we we need to find out , why are they not" Is it possible Endocrinologists and other doctors are not prescribing in order to maintain their patient population? Of the 6 diabetics I know that inquired about Afrezza, all 6 doctors knew of it but refused to prescribe it. Let's face it, a diabetic on analogues, orals or both will have complications and their conditions worsen over time. If Afrezza would reduce or eliminate those issues is it possible these patients would require fewer appointments and lab work? Read more: mnkd.proboards.com/thread/7519/problem-knows-doctors-pre#ixzz4clSSuQmv Would be good to contract the local rep in their area so they can find a prescribing doctor.
|
|
|
Post by dreamboatcruise on Mar 29, 2017 19:56:09 GMT -5
"and finally it seems like the endo's are not Prescribing it , and that is what we we need to find out , why are they not" Is it possible Endocrinologists and other doctors are not prescribing in order to maintain their patient population? Of the 6 diabetics I know that inquired about Afrezza, all 6 doctors knew of it but refused to prescribe it. Let's face it, a diabetic on analogues, orals or both will have complications and their conditions worsen over time. If Afrezza would reduce or eliminate those issues is it possible these patients would require fewer appointments and lab work? Read more: mnkd.proboards.com/thread/7519/problem-knows-doctors-pre#ixzz4clSSuQmvIf one insists on rejecting the things that we've heard doctors tell patients, and the things MNKD management has told us about what they've learned of doctor reluctance... I suppose this is as good as any "conspiracy" sort of idea. There are some medical groups such as Kaiser where doctors are paid salary rather than fee for service. And other doctors are part of medical groups where they share in profits but are getting paid capitated rates for patients from insurance... i.e. they lose money if more visits and lab tests are required. If you really think your idea is correct, it should clearly show up as a difference in prescribing with these different medical payment models.
|
|
Deleted
Deleted Member
Posts: 0
|
Post by Deleted on Mar 29, 2017 20:00:19 GMT -5
"and finally it seems like the endo's are not Prescribing it , and that is what we we need to find out , why are they not" Is it possible Endocrinologists and other doctors are not prescribing in order to maintain their patient population? Of the 6 diabetics I know that inquired about Afrezza, all 6 doctors knew of it but refused to prescribe it. Let's face it, a diabetic on analogues, orals or both will have complications and their conditions worsen over time. If Afrezza would reduce or eliminate those issues is it possible these patients would require fewer appointments and lab work? Read more: mnkd.proboards.com/thread/7519/problem-knows-doctors-pre#ixzz4clSSuQmv Would be good to contract the local rep in their area so they can find a prescribing doctor. Easier said than done. We looked into that but each time the doctor would have to refer the patient to another doctor which would mean losing that patient and they never did.
|
|
|
Post by sayhey24 on Mar 29, 2017 20:01:22 GMT -5
"and finally it seems like the endo's are not Prescribing it , and that is what we we need to find out , why are they not" Is it possible Endocrinologists and other doctors are not prescribing in order to maintain their patient population? Of the 6 diabetics I know that inquired about Afrezza, all 6 doctors knew of it but refused to prescribe it. Let's face it, a diabetic on analogues, orals or both will have complications and their conditions worsen over time. If Afrezza would reduce or eliminate those issues is it possible these patients would require fewer appointments and lab work? Read more: mnkd.proboards.com/thread/7519/problem-knows-doctors-pre#ixzz4clSSuQmvI could be wrong but I firmly believe your theory. I also think Big Pharma is pressuring them not to. I think Stefan Schwarz knew the Endo's would be a tough sell and that was a big reason he never thought the Endo's were a target market. Now, what would happen if you could get those newly diagnosed T2 and put them on afrezza immediately for 3 to 6 months? I bet 60+% could be put into remission. Some of the early intervention studies included patients up to 7 years and still got 50%. Whats wrong with this picture? Whats the pps a $buck and change and a $150M market cap? Thats round-off for a company who wants to get into diabetes in a big way and fundamentally change how diabetes it treated.
|
|
|
Post by jpg on Mar 29, 2017 20:31:49 GMT -5
I could be wrong but I firmly believe your theory. I also think Big Pharma is pressuring them not to. I think Stefan Schwarz knew the Endo's would be a tough sell and that was a big reason he never thought the Endo's were a target market. Now, what would happen if you could get those newly diagnosed T2 and put them on afrezza immediately for 3 to 6 months? I bet 60+% could be put into remission. Some of the early intervention studies included patients up to 7 years and still got 50%. Whats wrong with this picture? Whats the pps a $buck and change and a $150M market cap? Thats round-off for a company who wants to get into diabetes in a big way and fundamentally change how diabetes it treated. Completely agree. This is a study that I suggested MNKD set up. I mentioned it verbally and by email to MKND management just after the Sanofi partnership. Their verbal answer was that they would look into it and bring it up at their joint committee with Sanofi. Nothing obviously was done. Sanofi just didn't want to fund any studies. Second to the lack of sales the lack of commitment from Sanofi to doing any significant studies (other than their PCSK9 study using Afrezza which they later abandoned before starting) was probably my biggest red flag for thinking Sanofi would walk at the first possible opportunity. You are right that Sanofi doing this kind of study would have been financially illogical. Sanofi is a diabetes management company... If Mannkind had done this study or partnered with a group of endocrinologists interested in doing this study (probably an Asian group as a lot of this literature comes from Asia) they would probably be in a very different position right now (if the studies proved that intensive early inhaled insulin delays or reverses the onset of diabetes obviously). The odds of a BP going out on a limb and doing this now? Close enough to nil in my mind.
|
|
|
Post by sayhey24 on Mar 30, 2017 5:28:48 GMT -5
I could be wrong but I firmly believe your theory. I also think Big Pharma is pressuring them not to. I think Stefan Schwarz knew the Endo's would be a tough sell and that was a big reason he never thought the Endo's were a target market. Now, what would happen if you could get those newly diagnosed T2 and put them on afrezza immediately for 3 to 6 months? I bet 60+% could be put into remission. Some of the early intervention studies included patients up to 7 years and still got 50%. Whats wrong with this picture? Whats the pps a $buck and change and a $150M market cap? Thats round-off for a company who wants to get into diabetes in a big way and fundamentally change how diabetes it treated. Completely agree. This is a study that I suggested MNKD set up. I mentioned it verbally and by email to MKND management just after the Sanofi partnership. Their verbal answer was that they would look into it and bring it up at their joint committee with Sanofi. Nothing obviously was done. Sanofi just didn't want to fund any studies. Second to the lack of sales the lack of commitment from Sanofi to doing any significant studies (other than their PCSK9 study using Afrezza which they later abandoned before starting) was probably my biggest red flag for thinking Sanofi would walk at the first possible opportunity. You are right that Sanofi doing this kind of study would have been financially illogical. Sanofi is a diabetes management company... If Mannkind had done this study or partnered with a group of endocrinologists interested in doing this study (probably an Asian group as a lot of this literature comes from Asia) they would probably be in a very different position right now (if the studies proved that intensive early inhaled insulin delays or reverses the onset of diabetes obviously). The odds of a BP going out on a limb and doing this now? Close enough to nil in my mind. Does MNKD need its own study? There are a zillion of them all saying the same thing to one degree or another? We already know the answer although afrezza with a CGM would probably do even better. Their own would be nice as every study says we need another study. But, I guess the bigger problem is they have no money to jump start this. They would need a big company who wants to setup diabetic clinics with a focus on early intervention who would partner with area PCPs and do DTC advertising. I am not sure the ADA would like this let alone the Endos or the SGLT-2 developers.
|
|
Deleted
Deleted Member
Posts: 0
|
Post by Deleted on Mar 30, 2017 6:01:36 GMT -5
The point I tried to express was: of the 6 diabetics that inquired about Afrezza to their doctors, all 6 knew of it. Therefore, the supposition that Endocrinologists and doctors are unaware of Afrezza is false. Getting them to prescribe it is THE challenge.
|
|
|
Post by golfeveryday on Mar 30, 2017 6:58:49 GMT -5
I'm not sure if they had any idea it would take off with kids the way it has. At first I think they were thinking it would be excepted by the T2's that were just about to need meal time shots. ( But I could be way off on that). This product, quite frankly, is good for everyone because it acts like a healthy pancreas, but no one knows about it for the most part. The ideal target is kids, others taking multiple injections daily, and likely brittle diabetics. Get traction there and it will flow to the Type 2 market. Just an opinion.
|
|
|
Post by peppy on Mar 30, 2017 7:16:15 GMT -5
"and finally it seems like the endo's are not Prescribing it , and that is what we we need to find out , why are they not" Is it possible Endocrinologists and other doctors are not prescribing in order to maintain their patient population? Of the 6 diabetics I know that inquired about Afrezza, all 6 doctors knew of it but refused to prescribe it. Let's face it, a diabetic on analogues, orals or both will have complications and their conditions worsen over time. If Afrezza would reduce or eliminate those issues is it possible these patients would require fewer appointments and lab work? Read more: mnkd.proboards.com/thread/7519/problem-knows-doctors-pre#ixzz4clSSuQmvKastanes and all. kastances, all these people were type 2? The cost of an Afrezza titration pack is $619. a month. cost for metformin, a month? 10 dollars. cost for a SGLT 2 inhibitor (besides your kidneys and bladder) is what per month? SGLT2 inhibitors. Invokamet canagliflozin on good rx $443 us dollars. This how ever is on the standards of care for type two. www.screencast.com/t/nOwBa4aaA Farxiga dapagliflozin Xigduo XR dapagliflozin Jardiance empagliflozin
This is getting interesting. Then basal insulin is added, or another pill. The money gap starts to get narrower. I should look at the manufactures of the SGLT2 inhibitors. I watch the news. SGLT2 inhibitor advertisements hit the news hour.
metformin, basal and mealtime insulin on the list at the bottom. Best if we work in the established criteria.
Type Ones should be able to get Afrezza per the standards of care. The Afrezza failure there prescription, titration and cost. We hear about it every conference call.
Rapid acting shown below, do not fear. these people have to work blind and hidden behind these HgA1c is this nightmare.
|
|