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Post by Cowgirl on Apr 28, 2017 9:37:33 GMT -5
What are they doing all day? What are they telling Mike C. the reason for lack of sales? Why aren't they fired! And BTW...you know there are a few reps out there doing fine with 10-20 scripts a week, so really the others have 0 sales. Have many reps have 0 sales?
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Post by ssiegel on Apr 28, 2017 9:43:13 GMT -5
I would be curious as to how they monitor rep activity and how they evaluate performance. You can't necessarily blame someone who gets stuck in a difficult area, but how does MNKD decide whether a spot is difficult or whether the rep just isn't performing?
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Post by cjm18 on Apr 28, 2017 9:43:35 GMT -5
If all the reps are failing then it's not the reps.
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Post by markado on Apr 28, 2017 9:48:26 GMT -5
Hire'em to fire'em. The excuse is that Dr.S don't seem to want to write the scripts. It's time to go through or around the Doctor's to the patients to inspire demand. When patients literally demand the product, Dr.S will capitulate/cooperate. The question is, at that point, does one really need a sales force? Demonstrate the benefits to the insurance co.s and hospitals, and let them "sell" it in to Dr.S as standard of care. Rededicate spending on sales to DTC ads and skip dilutive stock options in the process. No, this is not easy, but it certainly appears MNKD leadership and management are making it harder than it needs to be! And, the only thing that is transparent is that it's BS! Chief People Officer - big expense, bigger fail.
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Post by straightly on Apr 28, 2017 9:49:21 GMT -5
What are they doing all day? What are they telling Mike C. the reason for lack of sales? Why aren't they fired! And BTW...you know there are a few reps out there doing fine with 10-20 scripts a week, so really the others have 0 sales. Have many reps have 0 sales? In Mike's own words, they were telling Mike that the doctors they visited were exicited. They were selling sizzle because we know that they are definitely not selling any steaks. My thesis is that they are not selling sizzle to the right audience. The right audience should be the patients, especially those reachable ONLY by social media. For example, college students. |
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Post by agedhippie on Apr 28, 2017 10:10:30 GMT -5
Hire'em to fire'em. The excuse is that Dr.S don't seem to want to write the scripts. It's time to go through or around the Doctor's to the patients to inspire demand. When patients literally demand the product, Dr.S will capitulate/cooperate. The question is, at that point, does one really need a sales force? Demonstrate the benefits to the insurance co.s and hospitals, and let them "sell" it in to Dr.S as standard of care. Rededicate spending on sales to DTC ads and skip dilutive stock options in the process. No, this is not easy, but it certainly appears MNKD leadership and management are making it harder than it needs to be! And, the only thing that is transparent is that it's BS! Chief People Officer - big expense, bigger fail. This isn't like selling most drugs. If you are insulin dependent you need it to literally stay alive for the next 24 hours. That risk makes change a hard sell because once people are in a routine they are very reluctant to change. There are no benefits to insurers, only down side. Because the US has an employer based health system and most people change jobs every few years the patient will be off their books before complications show so why spend money on preventative medicine? On the down side the insurers drug price will rise because they can no longer offer insulin as part of a bigger deal. |
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Post by markado on Apr 28, 2017 10:20:36 GMT -5
Hire'em to fire'em. The excuse is that Dr.S don't seem to want to write the scripts. It's time to go through or around the Doctor's to the patients to inspire demand. When patients literally demand the product, Dr.S will capitulate/cooperate. The question is, at that point, does one really need a sales force? Demonstrate the benefits to the insurance co.s and hospitals, and let them "sell" it in to Dr.S as standard of care. Rededicate spending on sales to DTC ads and skip dilutive stock options in the process. No, this is not easy, but it certainly appears MNKD leadership and management are making it harder than it needs to be! And, the only thing that is transparent is that it's BS! Chief People Officer - big expense, bigger fail. This isn't like selling most drugs. If you are insulin dependent you need it to literally stay alive for the next 24 hours. That risk makes change a hard sell because once people are in a routine they are very reluctant to change. There are no benefits to insurers, only down side. Because the US has an employer based health system and most people change jobs every few years the patient will be off their books before complications show so why spend money on preventative medicine? On the down side the insurers drug price will rise because they can no longer offer insulin as part of a bigger deal. With all due respect, I don't buy your argument. If one were to look at the impact of Afrezza or inhaled insulin vs injected insulin over the next 10,20,50, years, I think the potential savings due to redux in adverse events would prove staggering. In the short term, no change ever seems worth it. |
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Post by matt on Apr 28, 2017 10:24:44 GMT -5
I would be curious as to how they monitor rep activity and how they evaluate performance. You can't necessarily blame someone who gets stuck in a difficult area, but how does MNKD decide whether a spot is difficult or whether the rep just isn't performing? Most pharma companies know which territories are difficult. In some parts of the country nearly all the private practices are affiliated with a large local hospital system that has a firm "no see" policy, meaning that pharma salesmen are not allowed to visit those doctors in the hospital or office (most have periodic product fairs where the companies can present). If you get stuck into a no see region, you are not going to sell much product. Similarly, if a particular insurance company covers 80-90% of the insured lives, and that insurance is partnered with ExpressScripts or CVS as a pharmacy benefit manager, then most of the patients aren't going to have access to Afrezza. Those are the rules of the game in pharma in 2017. One product companies with a disruptive technology are not going to do well in many geographies, and no amount of DTC or social media advertising is going to change that. Many large pharma companies have a sales quota of 8 physician visits a day, but even when the salesman reps multiple products and can walk around a medical office building stuffed with 50 or more physicians with whom they have long-standing relationships, they still have a hard time having 8 conversations. Now, imagine being an Afrezza salesman with one product that you can detail only to endos and PCPs with large diabetic populations. It is tough out there. |
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Post by ezmit on Apr 28, 2017 10:27:12 GMT -5
Were only reaching out to about 10% of the us diabetic population..if that. We really need to start some dtc and drive the patients to the doctors.
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Post by Cowgirl on Apr 28, 2017 10:28:47 GMT -5
All the things above (try to work ins. co's. , go directly to people, educate) take time...and with that money. Mannkind does not have the money to do this as this is not an overnight thing. So, they were incredibly arrogant thinking they had a Sanofi buyout early on (and probably drove away many other interested parties) ...and that changed to partnership for profits...which didn't work. Then they try to "go it alone" and that isn't working obviously. That bravado and arrogance is great for the ego but look at where they are today.
It's embarrassing - earnings call with be absolutely great to hear Matt quiver and shake and then simply say scripts are building as fast as planned. Shareholder meeting will be bizarre. They will all look and act as things are going to plan all is good. The BOD should be embarrassed.
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Post by dreamboatcruise on Apr 28, 2017 10:43:30 GMT -5
This isn't like selling most drugs. If you are insulin dependent you need it to literally stay alive for the next 24 hours. That risk makes change a hard sell because once people are in a routine they are very reluctant to change. There are no benefits to insurers, only down side. Because the US has an employer based health system and most people change jobs every few years the patient will be off their books before complications show so why spend money on preventative medicine? On the down side the insurers drug price will rise because they can no longer offer insulin as part of a bigger deal. With all due respect, I don't buy your argument. If one were to look at the impact of Afrezza or inhaled insulin vs injected insulin over the next 10,20,50, years, I think the potential savings due to redux in adverse events would prove staggering. In the short term, no change ever seems worth it. I can vouch from discussions with financial people in health insurance industry that they indeed do not think out as far as decades. An organization like Kaiser where insurance and care falls under the same umbrella may provide some opportunity for clinical concerns to steer decisions about thing like drug coverage, but even there the dollar and cent people have shorter term views. And Kaiser doesn't yet cover Afrezza. You have an overly optimistic view if you think health insurance companies aren't as quarter by quarter driven as any other... and with compensation packages for management aligned with that. With all due respect, do you really think United Health has a bonus structure for their management based on 10 year goals? Or do you think management would jeopardize the bonuses they actually have in order to chase a noble goal to benefit patients decades down the road? Sad fact, for the most part insurance companies won't even lose money due to the complications, they will simply charge higher premiums and make even more money since they are doing more volume. The process to get change would be through an organization like the ADA where people are actually tasked with looking at patient outcomes and formulating treatment guidelines. Of course for that, we need clinical trials. |
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Post by markado on Apr 28, 2017 11:11:39 GMT -5
Trust me, DBC, nothing about my views or alternative strategy suggestions - when it comes to MNKD - is overly optimistic. What I do know, is that to succeed in any business, one must recognize and eliminate or otherwise work around obstacles and limitations. Otherwise, the entrenched and static sI tuition does not change. "An object at rest tends to remain at rest unless acted upon by an outside force." At this point, it appears that the outside force needs to apply itself to MNKD, because, potential energy has not yet unleashed itself to prove kinetic.
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Post by anthony7 on Apr 28, 2017 11:17:48 GMT -5
One word. Advertise
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Post by markado on Apr 28, 2017 12:17:56 GMT -5
Amen
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Post by zuegirdor on Apr 28, 2017 12:46:18 GMT -5
With all due respect, I don't buy your argument. If one were to look at the impact of Afrezza or inhaled insulin vs injected insulin over the next 10,20,50, years, I think the potential savings due to redux in adverse events would prove staggering. In the short term, no change ever seems worth it. I can vouch from discussions with financial people in health insurance industry that they indeed do not think out as far as decades. An organization like Kaiser where insurance and care falls under the same umbrella may provide some opportunity for clinical concerns to steer decisions about thing like drug coverage, but even there the dollar and cent people have shorter term views. And Kaiser doesn't yet cover Afrezza. You have an overly optimistic view if you think health insurance companies aren't as quarter by quarter driven as any other... and with compensation packages for management aligned with that. With all due respect, do you really think United Health has a bonus structure for their management based on 10 year goals? Or do you think management would jeopardize the bonuses they actually have in order to chase a noble goal to benefit patients decades down the road? Sad fact, for the most part insurance companies won't even lose money due to the complications, they will simply charge higher premiums and make even more money since they are doing more volume. The process to get change would be through an organization like the ADA where people are actually tasked with looking at patient outcomes and formulating treatment guidelines. Of course for that, we need clinical trials. In my most cynical moments I reflect that our culture is so given over to instant gratification that we no longer have the spiritual and mental capacity for logical arbitration. And that means markets for drugs and health care too! Pills for ills born of lifestyle and digital thrills replacing actual physical engagement with this marvelous playground God has given us-if we don't completely destroy it! To validate Afrezza's full worth/risk/benefits through clinical trials would cost billions and take 10 years using sample sizes equivalent to the population of a mid size city. Indications by the early adopter community are CLEAR- this Drug can do things the others cannot! I want it to be profitable ONLY becuase I want it to be available to patients and provide all of the systemic as well as individual benefits which we know are possible. Seems like a straight line from where we are to a better future is obvious. Instead of adding something to the process, we need to think more about what OBSTACLES to Afrezza use must be removed. I dare say, the needs of those most threatened by a failure to launch have been subordinated to various other interests. Many of these other interests have valid concerns and offer narratives for the importance of some of the obstacles. I know that these things take time. Yes I would like the instant gratification of Afrezza being sold on the shelves of all drug stores at $100 for a month supply, starting tomorrow. So I just need to ask the right people: "What obstacles need to be removed"? "What is a practical timeframe for doing so?" "What ethical, political and economic justifications dare stand in the way of making this happen" In my most optimistic moments, I think such a perspective is right and proper and should inspire a plan that might just be executed if patient needs were superior to other interests. |
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