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Post by dreamboatcruise on Apr 6, 2017 11:58:14 GMT -5
This raises an important question. Do you think MNKD also has set its sights predominantly on this group limiting the field of potential scripts as a result without the potential to tap the wider diabetic population that are not so well off. I get the sense from a majority of the posts here that many here assume that MNKD's approach is to be revolutionary and transformative to the PWD community as a whole. That may not be what they initially at least have in mind. Perhaps this is why they are reluctant to move on lowering the price. Thus maybe part of the problem is that MNKD has not cast its net wide enough so to speak. Perhaps the way to break into a market already dominated by big pharma would be to tap all those whose needs are largely unmet. Then the group you refer to above would follow alongside or get on board after. Now that would be revolutionary and call for significant thinking outside the box; probably too much to expect since it would require challenging the existing structure of the health care system. Nevertheless perhaps until they take this transformative turn or some approximation to it they will increase scripts in an almost tortuously slow manner but remain largely insignificant. Having good drug coverage doesn't require people be financially "well off". I know CA Medicaid (Medi-Cal) covers drugs 100% for the poorest. Those on Medicare can opt for Advantage plans that are fixed co-pay rather than deductible. Anyone with a co-pay based plan, even if the co-pay is high, could use the MNKD card to bring cost down to $15 per month. It would seem the availability of the discount card would indicate Mannkind is trying to address patients without cream of the crop drug coverage. Quite frankly, as complicated as our health care payer system is, I wouldn't have much of a sense of what percentage of people have fixed co-pay plans, vs percent co-pay, no coverage until deductible met, or no insurance at all. So when you say "the wider population", I'm assuming you have some sense that those who would not be able to have the cost of $15 per month using the card is larger than the group that would be at $15 per month? I would have assumed a majority would have access to Afrezza at $15 per month. I'm sure MNKD would want to think of Afrezza as revolutionary... but I don't think they have much leverage to be revolutionary in the business aspect of healthcare. The only thing they have hinted at would potentially pertain to a new model of drug payment that has been tossed around for some time but to my knowledge only used in EU... pay for results. That would be very interesting, if not totally revolutionary. Unfortunately it seems U.S. healthcare players are being slow to try this out. I get the gut level notion that being "revolutionary" might somehow be a solution... but the devil is in the details. It might be a valiant crusade to try to provide good diabetes care to those lacking any type of insurance in the U.S (under 10% now)... but that would require basically giving away Afrezza and still doesn't address how that population gets the needed prescription. Based on the bolded above it seems you believe that there is something fundamentally different about Afrezza that it cannot have robust script growth without something "transformative" in the way healthcare is provided or paid for? Why does Afrezza not have the same path to success that many other branded drugs have used... negotiating pricing with payers to get coverage and offering discount cards to patients? If there is something unique about Afrezza that prevents it from succeeding in the ecosystem that exists, that certainly would have been good to know, since that would have made MNKD almost untouchable as an investment in my opinion. Getting doctors to consider a new clinical tool is tough enough... but "transforming" the business of healthcare is not something I'd ever think a small startup is going to do, not even for a single disease.
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Post by lakers on Apr 6, 2017 12:08:17 GMT -5
Good point dbc. Keep in mind, Mnkd can't lower A price so much so that it can preserve decent GM for potential international partners. This is one of the main negotiation points. COGS will be lowered with much higher volume. I hope the partners will provide some immediate relief.
Investors complained about A price w/o thinking about ex-US ramifications.
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Post by fanz8967 on Apr 6, 2017 12:24:31 GMT -5
Maybe they can just do more low cost advertising, like in the MoneyMailer, or get one of those car wraps that you can put around your car with a picture of Damon Dash smoking Afrezza, and drive it around the hood.
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Post by surplusvalue on Apr 6, 2017 14:55:56 GMT -5
This raises an important question. Do you think MNKD also has set its sights predominantly on this group limiting the field of potential scripts as a result without the potential to tap the wider diabetic population that are not so well off. I get the sense from a majority of the posts here that many here assume that MNKD's approach is to be revolutionary and transformative to the PWD community as a whole. That may not be what they initially at least have in mind. Perhaps this is why they are reluctant to move on lowering the price. Thus maybe part of the problem is that MNKD has not cast its net wide enough so to speak. Perhaps the way to break into a market already dominated by big pharma would be to tap all those whose needs are largely unmet. Then the group you refer to above would follow alongside or get on board after. Now that would be revolutionary and call for significant thinking outside the box; probably too much to expect since it would require challenging the existing structure of the health care system. Nevertheless perhaps until they take this transformative turn or some approximation to it they will increase scripts in an almost tortuously slow manner but remain largely insignificant. Having good drug coverage doesn't require people be financially "well off". I know CA Medicaid (Medi-Cal) covers drugs 100% for the poorest. Those on Medicare can opt for Advantage plans that are fixed co-pay rather than deductible. Anyone with a co-pay based plan, even if the co-pay is high, could use the MNKD card to bring cost down to $15 per month. It would seem the availability of the discount card would indicate Mannkind is trying to address patients without cream of the crop drug coverage. Quite frankly, as complicated as our health care payer system is, I wouldn't have much of a sense of what percentage of people have fixed co-pay plans, vs percent co-pay, no coverage until deductible met, or no insurance at all. So when you say "the wider population", I'm assuming you have some sense that those who would not be able to have the cost of $15 per month using the card is larger than the group that would be at $15 per month? I would have assumed a majority would have access to Afrezza at $15 per month. I'm sure MNKD would want to think of Afrezza as revolutionary... but I don't think they have much leverage to be revolutionary in the business aspect of healthcare. The only thing they have hinted at would potentially pertain to a new model of drug payment that has been tossed around for some time but to my knowledge only used in EU... pay for results. That would be very interesting, if not totally revolutionary. Unfortunately it seems U.S. healthcare players are being slow to try this out. I get the gut level notion that being "revolutionary" might somehow be a solution... but the devil is in the details. It might be a valiant crusade to try to provide good diabetes care to those lacking any type of insurance in the U.S (under 10% now)... but that would require basically giving away Afrezza and still doesn't address how that population gets the needed prescription. Based on the bolded above it seems you believe that there is something fundamentally different about Afrezza that it cannot have robust script growth without something "transformative" in the way healthcare is provided or paid for? Why does Afrezza not have the same path to success that many other branded drugs have used... negotiating pricing with payers to get coverage and offering discount cards to patients? If there is something unique about Afrezza that prevents it from succeeding in the ecosystem that exists, that certainly would have been good to know, since that would have made MNKD almost untouchable as an investment in my opinion. Getting doctors to consider a new clinical tool is tough enough... but "transforming" the business of healthcare is not something I'd ever think a small startup is going to do, not even for a single disease. Just responding to your previous post where you indicated that you didnt think price/affordability was the issue. I suggested that given what even many on this board have experienced or heard and communicated that affordability is an issue, that you are underestimating, given what you have in terms of coverage and terms, what others can or cannot afford. I suggested that perhaps MNKD had the same view and that the net might have been cast wider. I myself even indicated that MNKD wouldnt be able to challenge or transform the health care system so the thinking outside the box in these terms wouldnt be pragmatic. So the last sentence should have read "Nevertheless since they cant take this transformative turn" (quite late when I wrote the post and didnt follow my own conclusion there so thanks for directing my attention to the inconsistency). Well, it may not be Afrezza per se but rather the strategy and the management attached to it that makes it plausible that it cannot have robust script growth. That certainly seems to be the evidence after 3 different launches. Endos arent prescribing and they dont seem to understand Afrezza very well either despite all the effort and funds that have gone into "educating" them. From what I can gather price among many other things seems to be a factor; it may not be the most significant one as I have indicated elsewhere in criticisms of the launch and advertising etc. but I wouldnt suggest that it isnt a problem. There is no doubt that there is a combination of problems as is clearly evident despite the cheerleading by some on this board taking every opportunity to defend management almost unconditionally. I already pointed out that the chance of recovery of our investments from the RS without management having provided something to support it would be highly unlikely. We hit a low of $1.16 post split today which I think confirms my view of the RS and its effects.You recently indicated that further dilution would make our investment recovery unlikely. I think we are already there and further dilution will just put the last nail in the coffin of our investment. Even if management ever figures out what the problems are its pretty much too late for us; perhaps not for those who only got in recently.
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Post by me on Apr 6, 2017 15:11:23 GMT -5
This raises an important question. Do you think MNKD also has set its sights predominantly on this group limiting the field of potential scripts as a result without the potential to tap the wider diabetic population that are not so well off. I get the sense from a majority of the posts here that many here assume that MNKD's approach is to be revolutionary and transformative to the PWD community as a whole. That may not be what they initially at least have in mind. Perhaps this is why they are reluctant to move on lowering the price. Thus maybe part of the problem is that MNKD has not cast its net wide enough so to speak. Perhaps the way to break into a market already dominated by big pharma would be to tap all those whose needs are largely unmet. Then the group you refer to above would follow alongside or get on board after. Now that would be revolutionary and call for significant thinking outside the box; probably too much to expect since it would require challenging the existing structure of the health care system. Nevertheless perhaps until they take this transformative turn or some approximation to it they will increase scripts in an almost tortuously slow manner but remain largely insignificant. Having good drug coverage doesn't require people be financially "well off". I know CA Medicaid (Medi-Cal) covers drugs 100% for the poorest. Those on Medicare can opt for Advantage plans that are fixed co-pay rather than deductible. Anyone with a co-pay based plan, even if the co-pay is high, could use the MNKD card to bring cost down to $15 per month. It would seem the availability of the discount card would indicate Mannkind is trying to address patients without cream of the crop drug coverage. Quite frankly, as complicated as our health care payer system is, I wouldn't have much of a sense of what percentage of people have fixed co-pay plans, vs percent co-pay, no coverage until deductible met, or no insurance at all. So when you say "the wider population", I'm assuming you have some sense that those who would not be able to have the cost of $15 per month using the card is larger than the group that would be at $15 per month? I would have assumed a majority would have access to Afrezza at $15 per month. DBC, your comments regarding the breadth of access to copay Rx plans and whether one needs to be financially "well off" to have good drug coverage, are generally correct. I don't believe you are drawing conclusions from, "an elevated and privileged position," an ever so subtle ad hominem logical fallacy! Your conclusions appear to come from reality. This is my business, so I see it every day. Over 99% of employer health plans offer prescription benefits, covering approximately 147 million non-Medicare eligible individuals. Medicare covers another 55+ million, Medicaid and CHIP another 74+ million and ACA exchanges about 12 million. That means there are nearly 290 million Americans with Rx benefits. Far and away, the ACA exchanges offer the very lowest benefit Rx plan designs with the most restrictions, but that represents only 4% of those with prescription coverage. (BTW, employer-offered Rx plans offer copay plan designs to almost 90% of those covered, with the average three tier copays being 10-30-55.)
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Post by surplusvalue on Apr 6, 2017 15:41:55 GMT -5
Having good drug coverage doesn't require people be financially "well off". I know CA Medicaid (Medi-Cal) covers drugs 100% for the poorest. Those on Medicare can opt for Advantage plans that are fixed co-pay rather than deductible. Anyone with a co-pay based plan, even if the co-pay is high, could use the MNKD card to bring cost down to $15 per month. It would seem the availability of the discount card would indicate Mannkind is trying to address patients without cream of the crop drug coverage. Quite frankly, as complicated as our health care payer system is, I wouldn't have much of a sense of what percentage of people have fixed co-pay plans, vs percent co-pay, no coverage until deductible met, or no insurance at all. So when you say "the wider population", I'm assuming you have some sense that those who would not be able to have the cost of $15 per month using the card is larger than the group that would be at $15 per month? I would have assumed a majority would have access to Afrezza at $15 per month. DBC, your comments regarding the breadth of access to copay Rx plans and whether one needs to be financially "well off" to have good drug coverage, are generally correct. I don't believe you are drawing conclusions from, "an elevated and privileged position," an ever so subtle ad hominem logical fallacy! Your conclusions appear to come from reality. This is my business, so I see it every day. Over 99% of employer health plans offer prescription benefits, covering approximately 147 million non-Medicare eligible individuals. Medicare covers another 55+ million, Medicaid and CHIP another 74+ million and ACA exchanges about 12 million. That means there are nearly 290 million Americans with Rx benefits. Far and away, the ACA exchanges offer the very lowest benefit Rx plan designs with the most restrictions, but that represents only 4% of those with prescription coverage. (BTW, employer-offered Rx plans offer copay plan designs to almost 90% of those covered, with the average three tier copays being 10-30-55.) Well, if you are not aware that the US health care system is significantly stratified by class divisions, despite or because of the work you do, then either the work you do insulates you from that reality or you're living in a bubble (or perhaps both). Thus the comment isnt an ad hominem fallacy and DBC didnt seem to take it that way anyways. In fact he acknowledged his position when he stated in direct response ."I certainly do appreciate that I have a very nice insurance plan with low deductible, and many people do not." So he's a big boy and doesnt seem to need your defense. If the US health care system and coverage is so great whats everyone so concerned about; seems the only one promoting a fallacy, that everything is ok, is you. Seems you are the one who took offense, and took the opportunity to tell us you know because its your business. That leaves only about 35-40 million without coverage and some, by your own account, with low restrictive coverage ... good thing youre not one of them.
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Post by me on Apr 6, 2017 16:35:25 GMT -5
DBC, your comments regarding the breadth of access to copay Rx plans and whether one needs to be financially "well off" to have good drug coverage, are generally correct. I don't believe you are drawing conclusions from, "an elevated and privileged position," an ever so subtle ad hominem logical fallacy! Your conclusions appear to come from reality. This is my business, so I see it every day. Over 99% of employer health plans offer prescription benefits, covering approximately 147 million non-Medicare eligible individuals. Medicare covers another 55+ million, Medicaid and CHIP another 74+ million and ACA exchanges about 12 million. That means there are nearly 290 million Americans with Rx benefits. Far and away, the ACA exchanges offer the very lowest benefit Rx plan designs with the most restrictions, but that represents only 4% of those with prescription coverage. (BTW, employer-offered Rx plans offer copay plan designs to almost 90% of those covered, with the average three tier copays being 10-30-55.) Well, if you are not aware that the US health care system is significantly stratified by class divisions, despite or because of the work you do, then either the work you do insulates you from that reality or you're living in a bubble (or perhaps both). Thus the comment isnt an ad hominem fallacy and DBC didnt seem to take it that way anyways. In fact he acknowledged his position when he stated in direct response ."I certainly do appreciate that I have a very nice insurance plan with low deductible, and many people do not." So he's a big boy and doesnt seem to need your defense. If the US health care system and coverage is so great whats everyone so concerned about; seems the only one promoting a fallacy, that everything is ok, is you. Seems you are the one who took offense, and took the opportunity to tell us you know because its your business. That leaves only about 35-40 million without coverage and some, by your own account, with low restrictive coverage ... good thing youre not one of them. Where in my post did I state that the US healthcare system is NOT "significantly stratified by class divisions?!" I wasn't commenting on the healthcare system, but rather Rx plan designs across America. I can assure you, I'm not living in a bubble. In fact, the work I do exposes me quite liberally to reality. And what is it with all these straw men thrown up when someone pushes back on a post?! No where in my prior post (or in any of my posts for that matter) have I ever said or hinted that "the US health care system and coverage is...great." In fact, the healthcare system needs to be significantly reformed (the ACA didn't reform healthcare, but rather focused on healthcare financing), and healthcare financing needs to be restructured (the ACA did indeed focus here...and screwed it up). If you have a sincere interest in what true health care and healthcare financing should probably look like, I'd be happy to engage you (or anyone else interested) here. I will not, however, accept your straw model "arguments."
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Post by dreamboatcruise on Apr 6, 2017 17:08:20 GMT -5
surplusvalue... there can be things wrong with healthcare making it "not great" that wouldn't directly apply to decisions of pricing for Afrezza. For instance, in many markets premiums have been rising. If your premium is skyrocketing but you still have a co-pay plan then the discount card means you pay $15 per month for Afrezza... until you can no longer afford your premium and lose coverage. I know some Afrezza users have expressed concerns on cost, though I believe some have been ones where it was primarily a coverage issue... the cost would be acceptable if there insurance hadn't rejected coverage. I would find it hard to weigh in on whether MNKD now has pricing right or needs to make further adjustments. I simply don't have enough insight into all the different plans and how they would interact with the discount card. To get good formulary treatment I would assume MNKD must be offering deals to insurance where Afrezza doesn't end up costing more than subq pens. When it comes to those paying cash from lack of coverage or having to meet a deductible, it would seem that Afrezza needs to be no worse than similar in price to subq pens. It seems they may have misjudged initially because of what appears to be a mismatch in translating Afrezza cartridge size to "units". If we're still more expensive for the amount of Afrezza people really need to use including follow up doses, and after taking in applicable discount cards, then I'd agree that price, or quantity supplied, needs further adjustment. Seems like management has been addressing this issue.
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Post by surplusvalue on Apr 6, 2017 17:29:50 GMT -5
Well, if you are not aware that the US health care system is significantly stratified by class divisions, despite or because of the work you do, then either the work you do insulates you from that reality or you're living in a bubble (or perhaps both). Thus the comment isnt an ad hominem fallacy and DBC didnt seem to take it that way anyways. In fact he acknowledged his position when he stated in direct response ."I certainly do appreciate that I have a very nice insurance plan with low deductible, and many people do not." So he's a big boy and doesnt seem to need your defense. If the US health care system and coverage is so great whats everyone so concerned about; seems the only one promoting a fallacy, that everything is ok, is you. Seems you are the one who took offense, and took the opportunity to tell us you know because its your business. That leaves only about 35-40 million without coverage and some, by your own account, with low restrictive coverage ... good thing youre not one of them. Where in my post did I state that the US healthcare system is NOT "significantly stratified by class divisions?!" I wasn't commenting on the healthcare system, but rather Rx plan designs across America. I can assure you, I'm not living in a bubble. In fact, the work I do exposes me quite liberally to reality. And what is it with all these straw men thrown up when someone pushes back on a post?! No where in my prior post (or in any of my posts for that matter) have I ever said or hinted that "the US health care system and coverage is...great." In fact, the healthcare system needs to be significantly reformed (the ACA didn't reform healthcare, but rather focused on healthcare financing), and healthcare financing needs to be restructured (the ACA did indeed focus here...and screwed it up). If you have a sincere interest in what true health care and healthcare financing should probably look like, I'd be happy to engage you (or anyone else interested) here. I will not, however, accept your straw model "arguments." You accused me of offering up an an ad hominem fallacy about affordability and coverage in my comment that ones perspective may be influenced by the tiered level that one occupies in RX plan coverage when the restrictions and thus affordability for some is an issue; even more so if one has no coverage.Hence the stratification which I suggested is probably class based. DBC responded seeing exactly what the comment explicitly stated and implied and that we were talking about RX coverage/pricing. You're calling it an ad hominem attack, led me to consider that your accusation ("push back" you call it) perhaps had an underlying assumption about a lack of stratification which what my comment was about in the first place specifically in RX (and generally in the health care system as well since the two are related so I was including RX plan stratification within that as well). So, no straw men actually;if you think that the health care system is stratified and that its not in such good shape then we agree but back to the initial discussion. Do you think the RX coverage (which was the specific parameters of the discussion) is not stratified as well leading to conditions and concerns for some regarding affordability. If yes, then why accuse me of an ad hominem fallacy in the first place? And interestingly you didnt address the more central point I made that "that leaves only about 35-40 million without coverage and some, by your own account, with low restrictive coverage " which supports what I was saying in the first place. I am certainly aware that the stratification of the health care system in general doesnt have a one to one or directly mapped correlation to the stratification in RX coverage. Nevertheless the problem in the latter I have suggested does have a material effect. If DBC or you do not think so then youre certainly free to think so but I am not convinced it doesnt. And I do think that the various degrees of "being well off" does have some impact on what kind of plan/coverage (which includes RX coverage) you have access to or the ability to enrol in. DBC mentioned CA Medicaid (Medi-Cal) covers 100% RX for the poor; but does it cover !00% for every diabetic drug in CA and is this the case in every other state?
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Post by me on Apr 6, 2017 18:13:38 GMT -5
Where in my post did I state that the US healthcare system is NOT "significantly stratified by class divisions?!" I wasn't commenting on the healthcare system, but rather Rx plan designs across America. I can assure you, I'm not living in a bubble. In fact, the work I do exposes me quite liberally to reality. And what is it with all these straw men thrown up when someone pushes back on a post?! No where in my prior post (or in any of my posts for that matter) have I ever said or hinted that "the US health care system and coverage is...great." In fact, the healthcare system needs to be significantly reformed (the ACA didn't reform healthcare, but rather focused on healthcare financing), and healthcare financing needs to be restructured (the ACA did indeed focus here...and screwed it up). If you have a sincere interest in what true health care and healthcare financing should probably look like, I'd be happy to engage you (or anyone else interested) here. I will not, however, accept your straw model "arguments." You accused me of offering up an an ad hominem fallacy about affordability and coverage in my comment that ones perspective may be influenced by the tiered level that one occupies in RX plan coverage when the restrictions and thus affordability for some is an issue; even more so if one has no coverage.Hence the stratification which I suggested is probably class based. DBC responded seeing exactly what the comment explicitly stated and implied and that we were talking about RX coverage/pricing. You're calling it an ad hominem attack, led me to consider that your accusation ("push back" you call it) perhaps had an underlying assumption about a lack of stratification which what my comment was about in the first place specifically in RX (and generally in the health care system as well since the two are related ). So, no straw men actually;if you think that the health care system is stratified and that its not in such good shape then we agree but back to the initial discussion. Do you think the RX coverage (which was the specific parameters of the discussion) is not stratified as well leading to conditions and concerns for some regarding affordability. If yes, then why accuse me of an ad hominem fallacy in the first place? And interestingly you didnt address the more central point I made that "that leaves only about 35-40 million without coverage and some, by your own account, with low restrictive coverage " which supports what I was saying in the first place. I will attempt to address as many of your points as I can in the next few minutes: 1. When you suggest to someone they are drawing a conclusion from "an elevated and privileged position," then you are NOT addressing the specific position, but rather a characteristic of the individual making the argument. In most debates, this is known as an ad hominem attack. The "attack" is not necessarily (in fact, almost never is in civil debates) vitriolic nor antagonistic, but is simply an attempted bit of sophistry, usually delivered in a subtle fashion. It is a technique to dodge addressing the crux of the argument. The highlighted area in your comment above is in fact the issue...the comment was related to the (assumed) characteristic of DBC and not "affordability and coverage" as you indicated above. 2. I generally find it helpful to state exactly what I mean when engaged in discussions. If I had meant to say that the US healthcare system is NOT "significantly stratified by class divisions," I would have stated that. There was no need for your assumption. 3. Rx benefits, among those who have coverage, do vary, and sometimes substantially. If you were to map out the number of individuals covered under the actuarial value of each of their Rx plans, however, you would find a fairly steep bell curve, i.e., a very small standard deviation, especially when compared to other medical benefits. I would generally not describe this as stratified coverage. I am here referring to the group of covered individuals, and not addressing any single individual circumstance. 4. I suggested you used an ad hominem fallacy because, well, see #1 above. 5. The issue of the number of uninsureds, like the whole healthcare debate, is not straightforward. One key question is, "How many uninsureds choose to be uninsured when they can afford a basic health plan that would cover their needs (for 97% of this specific population)? Of the 29 million non-Medicare eligibles who are uninsured, I would guess (because I don't have the hard numbers at my fingertips) a substantial number are young, healthy individuals who'd rather pay the ACA penalty than pay for expensive coverage, with bloated benefits they don't want/need and with extremely high deductibles. What does this say about our self-flogging about the number of uninsureds we have in this country? If you wish to debate/discuss our healthcare system and financing in a broader context, especially with regard to what policy might ought to be, I'm all in. (I'm fairly certain, however, that our legislative bodies would never vote for a solution that increases access, decreases costs and increases the quality of healthcare. I can write a healthcare and healthcare financing reform policy that would do just that, but there would be too many sacred cows that would be gored.)
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Post by surplusvalue on Apr 6, 2017 18:32:49 GMT -5
surplusvalue ... there can be things wrong with healthcare making it "not great" that wouldn't directly apply to decisions of pricing for Afrezza. For instance, in many markets premiums have been rising. If your premium is skyrocketing but you still have a co-pay plan then the discount card means you pay $15 per month for Afrezza... until you can no longer afford your premium and lose coverage. I know some Afrezza users have expressed concerns on cost, though I believe some have been ones where it was primarily a coverage issue... the cost would be acceptable if there insurance hadn't rejected coverage.
I would find it hard to weigh in on whether MNKD now has pricing right or needs to make further adjustments. I simply don't have enough insight into all the different plans and how they would interact with the discount card. To get good formulary treatment I would assume MNKD must be offering deals to insurance where Afrezza doesn't end up costing more than subq pens. When it comes to those paying cash from lack of coverage or having to meet a deductible, it would seem that Afrezza needs to be no worse than similar in price to subq pens. It seems they may have misjudged initially because of what appears to be a mismatch in translating Afrezza cartridge size to "units". If we're still more expensive for the amount of Afrezza people really need to use including follow up doses, and after taking in applicable discount cards, then I'd agree that price, or quantity supplied, needs further adjustment. Seems like management has been addressing this issue. I dont have enough insight into all the different plans either nor the end result of how the card fits into each specific one but was suggesting price is still an issue for some despite the general state of RX plans and coverage etc in the US. Its in the specifics that would reveal the affordability issue even if it was the extent of coverage and not the inability to get coverage. From what I gather those voicing concerns over cost include both. Even more so given the dosing issue, which has been the subject of alot of discussion lately, the cost given how much RX is covered in a given time period seems exactly to be a problem given the "running out" and the "follow up " dosage costs. This is included in what can be considered issues of affordability. My comments were against this background as a whole. And as I stated pricing/affordability may not be the most significant or only problem but its definitely an issue.
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Post by surplusvalue on Apr 6, 2017 21:23:12 GMT -5
You accused me of offering up an an ad hominem fallacy about affordability and coverage in my comment that ones perspective may be influenced by the tiered level that one occupies in RX plan coverage when the restrictions and thus affordability for some is an issue; even more so if one has no coverage.Hence the stratification which I suggested is probably class based. DBC responded seeing exactly what the comment explicitly stated and implied and that we were talking about RX coverage/pricing. You're calling it an ad hominem attack, led me to consider that your accusation ("push back" you call it) perhaps had an underlying assumption about a lack of stratification which what my comment was about in the first place specifically in RX (and generally in the health care system as well since the two are related ). So, no straw men actually;if you think that the health care system is stratified and that its not in such good shape then we agree but back to the initial discussion. Do you think the RX coverage (which was the specific parameters of the discussion) is not stratified as well leading to conditions and concerns for some regarding affordability. If yes, then why accuse me of an ad hominem fallacy in the first place? And interestingly you didnt address the more central point I made that "that leaves only about 35-40 million without coverage and some, by your own account, with low restrictive coverage " which supports what I was saying in the first place. I will attempt to address as many of your points as I can in the next few minutes: 1. When you suggest to someone they are drawing a conclusion from "an elevated and privileged position," then you are NOT addressing the specific position, but rather a characteristic of the individual making the argument. In most debates, this is known as an ad hominem attack. The "attack" is not necessarily (in fact, almost never is in civil debates) vitriolic nor antagonistic, but is simply an attempted bit of sophistry, usually delivered in a subtle fashion. It is a technique to dodge addressing the crux of the argument. The highlighted area in your comment above is in fact the issue...the comment was related to the (assumed) characteristic of DBC and not "affordability and coverage" as you indicated above. 2. I generally find it helpful to state exactly what I mean when engaged in discussions. If I had meant to say that the US healthcare system is NOT "significantly stratified by class divisions," I would have stated that. There was no need for your assumption. 3. Rx benefits, among those who have coverage, do vary, and sometimes substantially. If you were to map out the number of individuals covered under the actuarial value of each of their Rx plans, however, you would find a fairly steep bell curve, i.e., a very small standard deviation, especially when compared to other medical benefits. I would generally not describe this as stratified coverage. I am here referring to the group of covered individuals, and not addressing any single individual circumstance. 4. I suggested you used an ad hominem fallacy because, well, see #1 above. 5. The issue of the number of uninsureds, like the whole healthcare debate, is not straightforward. One key question is, "How many uninsureds choose to be uninsured when they can afford a basic health plan that would cover their needs (for 97% of this specific population)? Of the 29 million non-Medicare eligibles who are uninsured, I would guess (because I don't have the hard numbers at my fingertips) a substantial number are young, healthy individuals who'd rather pay the ACA penalty than pay for expensive coverage, with bloated benefits they don't want/need and with extremely high deductibles. What does this say about our self-flogging about the number of uninsureds we have in this country? If you wish to debate/discuss our healthcare system and financing in a broader context, especially with regard to what policy might ought to be, I'm all in. (I'm fairly certain, however, that our legislative bodies would never vote for a solution that increases access, decreases costs and increases the quality of healthcare. I can write a healthcare and healthcare financing reform policy that would do just that, but there would be too many sacred cows that would be gored.) re 1 &4 :First of all the remark that DBC's statements and perspective was being influenced with respect to his position vis a vis the level of plan coverage was not fallacious. DBC was not presenting an argument but rather making a statement of fact about pricing. His position (not his character, intelligence,etc ) influences the underestimation calling into to question the credibility of the statement he made and essential to understanding why the statement might be incorrect.Hence statements of fact about DBC (which he himself confirmed in his response) bear a relation to the substance and credibility of his statement. Hence my remarks were not fallacious. Not all ad hominem remarks are fallacious and the presence of an ad hominem element doesnt invalidate the substance of the criticism. In fact its often necessary to point out the attribute of the author in order to see what is essentially mistaken about his statements/perspectives especially when they are not beyond doubt. Not all ad hominem statements are equally dubious nor lacking in merit. 3) "Not addressing any single individual circumstance" Of course when you analyze the issue across individuals (in statistical groupings) the differences look less variable or dire than when you consider cases individually and assess coverage from the individual standpoint. Its the individuals that fall through the cracks in the coverage not the wider group wherein variations appear less pronounced. 5) By selecting this group as representative of the uninsured you pretty well draw the conclusion before the argument is made or evidence is presented even granting that you admit its a guess. Even if you are correct that this cohort represent the majority of uninsured it still leaves out all those who are uninsured who dont choose to be so. Not surprised you then make the remark about self flogging. I wouldnt diminish even a smaller cohort just as I wouldnt diminish the 35 or so million without coverage in comparing them to those who are. My sense of how well we are all doing as a whole is to consider those in the least favorable circumstances. In this case the moral criterion has more weight, at least for me, than the statistical one. Your last statement in brackets I would concur with.
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Post by dreamboatcruise on Apr 6, 2017 21:30:42 GMT -5
surplusvalue... for what it's worth, my intelligence is obviously lacking as can be seen from my brokerage statements from the past two years, and as could be expected from the size of a lizard's brain. Lizards do have outstanding character, however.
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Post by surplusvalue on Apr 6, 2017 22:01:45 GMT -5
surplusvalue ... for what it's worth, my intelligence is obviously lacking as can be seen from my brokerage statements from the past two years, and as could be expected from the size of a lizard's brain. Lizards do have outstanding character, however. If the measure of intelligence were reduced to how much we have lost investing in this stock then its probably reasonable to say that we are all in the same boat and all lizards or relatives thereof and hence one big happy family. (Although from looking at the other thread there seems to greater or lesser degrees of it). As for character, far be it from me to judge anyones character from postings on a stock board so I believe you and have no reason to suspect otherwise. It appears the poster "me" might have a long unfulfilled desire to be a defense attorney but what do I know.
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Post by sportsrancho on Apr 8, 2017 6:43:07 GMT -5
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