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Post by sportsrancho on Apr 28, 2017 13:30:15 GMT -5
The Endo's aren't buying it. GP's will prescribe. It's been that way since day one. Two years ago Tom kids Endo said no and they had to get a script from a GP mailed to them from NY. Tell the patients Target the GP's Send the patients to the GP's. They will find a way to resolve the issues because they are aware of them:-)
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Post by peppy on Apr 28, 2017 13:46:34 GMT -5
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. "What obstacles need to be removed"? The standards of care have to be changed. Biggest obstacle. www.screencast.com/t/nOwBa4aaA presently type 2 have to flunk three different therapies before insulin. Then if afrezza was added to the mealtime insulin for type one and two's we would have it made?
Practical time frame. MNKD needs to wait for the FDA decisions on their latest label change submission?
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Post by rombic33 on Apr 28, 2017 14:09:27 GMT -5
Does anyone know if scripts prescribed week by week are done by same doctors? If so sale force is stalled. If new scripts every week written by new doctors, then what happened to doctors who wrote scripts week(s) before?
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Post by agedhippie on Apr 28, 2017 14:25:44 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. The point is that the insurer you have today is probably not going to be the one you have when you change jobs. There is no incentive for your insurer today to worry about costs in twenty years time (which is where the gain would be) when on on average you are going to be off their books in less than five years. All that does is save a competitor money. It's worse with Type 2 because of the late onset, by delaying they can push the expenses off to Medicare so the government subsidizes their bad behavior. Your problem is that the US health system is based on the short term costs making it good for acute conditions and awful for chronic conditions.
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Post by dreamboatcruise on Apr 28, 2017 15:08:58 GMT -5
zuegirdor... even though without saying it, you must be in the camp that believes MNKD management is lacking... i.e. that they are missing something obvious that could remove barriers... something that a bunch of people, mostly with no experience in healthcare industry, could come up with. In my opinion it's unrealistic that the process of evaluating new treatments (based on clinical trials rather than anecdotal social media posts) and financial incentives of the healthcare industry are obstacles that can "be removed" by Mannkind by some idea that has yet occurred to them. Those are impediments that Mannkind will have to continue the hard and slow process of pushing through. Of course, the one obstacle that theoretically could be removed is the lack of funding. The economic justification why that hasn't happened is sadly that those with the available resources do not regard MNKD as a good risk/reward ratio. The steps that we know MNKD has been working on, though with insufficient funding are: 1) get payer coverage 2) get doctors on board 3) generate patient awareness (largely neglected to date because of waiting for 1&2 and/or lack of money)
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Post by phantomfj on Apr 28, 2017 15:09:53 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. The point is that the insurer you have today is probably not going to be the one you have when you change jobs. There is no incentive for your insurer today to worry about costs in twenty years time (which is where the gain would be) when on on average you are going to be off their books in less than five years. All that does is save a competitor money. It's worse with Type 2 because of the late onset, by delaying they can push the expenses off to Medicare so the government subsidizes their bad behavior. Your problem is that the US health system is based on the short term costs making it good for acute conditions and awful for chronic conditions. As are most businesses that are not run by the owner.....seems like every executive at every company has their snout in that trough digging for that last good turnip............whatever your opinion of the execs at Mannkind, no doubt their personal concerns come first, whereas Al Mann would have done whatever it took to make it work, it is HIS company
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Post by dreamboatcruise on Apr 28, 2017 15:19:40 GMT -5
Does anyone know if scripts prescribed week by week are done by same doctors? If so sale force is stalled. If new scripts every week written by new doctors, then what happened to doctors who wrote scripts week(s) before? I would presume that MNKD has some insight into this. We do not. But some anecdotal reports might suggest a couple of things: - If a doctor prescribes Afrezza because a patient has gone in and demanded it (as we know some have to), that doesn't mean the doctor plans to recommend it to others. - A doctor that is intrigued by Afrezza may pick one or two patients to try it on and then wait for quite some time to see results before gradually expanding their use of Afrezza. We do know that some patients in the past haven't had good results (hopefully fewer now with better education). It would be interesting if MNKD tracked the number of doctors regularly prescribing (whatever definition of regularly would make sense).
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Post by zuegirdor on Apr 28, 2017 16:26:16 GMT -5
Peppy, that is a mind blowing flow diagram. No room for a cure let alone an alternate flow path in that abomination. It truly tests ones faith in the FUTURE of medicine.
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Post by zuegirdor on Apr 28, 2017 16:48:27 GMT -5
zuegirdor ... even though without saying it, you must be in the camp that believes MNKD management is lacking... i.e. that they are missing something obvious that could remove barriers... something that a bunch of people, mostly with no experience in healthcare industry, could come up with. In my opinion it's unrealistic that the process of evaluating new treatments (based on clinical trials rather than anecdotal social media posts) and financial incentives of the healthcare industry are obstacles that can "be removed" by Mannkind by some idea that has yet occurred to them. Those are impediments that Mannkind will have to continue the hard and slow process of pushing through. Of course, the one obstacle that theoretically could be removed is the lack of funding. The economic justification why that hasn't happened is sadly that those with the available resources do not regard MNKD as a good risk/reward ratio. The steps that we know MNKD has been working on, though with insufficient funding are: 1) get payer coverage 2) get doctors on board 3) generate patient awareness (largely neglected to date because of waiting for 1&2 and/or lack of money) I don't have enough information to judge MNKDs performance in any but the most flip and summary treatments. I agree with your assessment of the obstacles that overwhelm all of us tiny interests including MNKD. What is a $10million monthly budget against the Titans of the 21st Century- the Pharmacuetical Industry, FDA, Health Insurers and Wall Street? The information on treatment of diabetes with Afrezza and its superior qualities as an insulin for meals and blood sugar corrections is not in the doctor's office, the insurance co boardroom or brokerages. It resides almost entirely in a small group of diabetic early adopters and an equally small group of investors and medical practitioners who have compiled enough scientific information and self-experimental evidence to challenge the orthodox view of how diabetes must be treated. That orthodoxy will give way eventually if only Afrezza can be made available long enough until a critical population of diabetics has been reached. I would like that to be sooner than later but much depends upon MNKD or a successor simply showing up to work to make Afrezza every day for free (or for a loss?) until someday everyone goes "duh! why are we still using this other stuff?" Whether there is a payday for investors, I don't have enough information...don't think anybody does.
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Post by agedhippie on Apr 28, 2017 16:55:31 GMT -5
Peppy, that is a mind blowing flow diagram. No room for a cure let alone an alternate flow path in that abomination. It truly tests ones faith in the FUTURE of medicine. The lack of an alternate path is the whole point of a standard of care. It lets doctors who are not experts in a field follow a consensus among the doctors who are experts based on the evidence. This only works if it is prescriptive. Consultancies use this approach to let unskilled staff undertake tasks above their pay grade.
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Post by zuegirdor on Apr 28, 2017 16:58:07 GMT -5
Peppy, that is a mind blowing flow diagram. No room for a cure let alone an alternate flow path in that abomination. It truly tests ones faith in the FUTURE of medicine. The lack of an alternate path is the whole point of a standard of care. It lets doctors who are not experts in a field follow a consensus among the doctors who are experts based on the evidence. This only works if it is prescriptive. Consultancies use this approach to let unskilled staff undertake tasks above their pay grade. I see what you did there...the docs that need to use this flowchart are working above their competence, right?
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Post by agedhippie on Apr 28, 2017 17:10:50 GMT -5
The lack of an alternate path is the whole point of a standard of care. It lets doctors who are not experts in a field follow a consensus among the doctors who are experts based on the evidence. This only works if it is prescriptive. Consultancies use this approach to let unskilled staff undertake tasks above their pay grade. I see what you did there...the docs that need to use this flowchart are working above their competence, right? Yes, but it's understandable. I am not sure I would want my PCP who is not board certified in endocrinology winging it in treating my diabetes (full disclosure - my PCP refuses to have anything to do with my diabetes that isn't directly related to his areas for exactly that reason). Now I live in NYC so the place is littered with specialists but I can imagine in areas less well served it's a real problem and a standard of care is the only way.
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Post by morfu on Apr 28, 2017 17:26:03 GMT -5
Does anyone know if scripts prescribed week by week are done by same doctors? If so sale force is stalled. If new scripts every week written by new doctors, then what happened to doctors who wrote scripts week(s) before? Well on par with that.. each week there are more than 100 NRx, if we could keep most of them we would be in the green in no time.. What is happening!? I have a hard time to buy a high dropout rate for money/insurance reason.. my guess is, that anyone starting newly with Afrezza these days knows how much he will have to pay.. If it is not that, I wonder is most of the new user drop out because they are unhappy with the drug!?
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Post by bioexec25 on Apr 28, 2017 17:35:50 GMT -5
Does anyone know if scripts prescribed week by week are done by same doctors? If so sale force is stalled. If new scripts every week written by new doctors, then what happened to doctors who wrote scripts week(s) before? Well on par with that.. each week there are more than 100 NRx, if we could keep most of them we would be in the green in no time.. What is happening!? I have a hard time to buy a high dropout rate for money/insurance reason.. my guess is, that anyone starting newly with Afrezza these days knows how much he will have to pay.. If it is not that, I wonder is most of the new user drop out because they are unhappy with the drug!? Would be ironic if the flat numbers all along were made up of both the same docs & original patients. All other sales is just a process of slowly mowing through the pwd population adding and dropping similar numbers until all of the early adopter or willing population pool is finally exhausted.
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Post by falconquest on Apr 28, 2017 18:11:45 GMT -5
zuegirdor ... even though without saying it, you must be in the camp that believes MNKD management is lacking... i.e. that they are missing something obvious that could remove barriers... something that a bunch of people, mostly with no experience in healthcare industry, could come up with. In my opinion it's unrealistic that the process of evaluating new treatments (based on clinical trials rather than anecdotal social media posts) and financial incentives of the healthcare industry are obstacles that can "be removed" by Mannkind by some idea that has yet occurred to them. Those are impediments that Mannkind will have to continue the hard and slow process of pushing through. Of course, the one obstacle that theoretically could be removed is the lack of funding. The economic justification why that hasn't happened is sadly that those with the available resources do not regard MNKD as a good risk/reward ratio. The steps that we know MNKD has been working on, though with insufficient funding are: 1) get payer coverage 2) get doctors on board 3) generate patient awareness (largely neglected to date because of waiting for 1&2 and/or lack of money) I don't have enough information to judge MNKDs performance in any but the most flip and summary treatments. I agree with your assessment of the obstacles that overwhelm all of us tiny interests including MNKD. What is a $10million monthly budget against the Titans of the 21st Century- the Pharmacuetical Industry, FDA, Health Insurers and Wall Street? The information on treatment of diabetes with Afrezza and its superior qualities as an insulin for meals and blood sugar corrections is not in the doctor's office, the insurance co boardroom or brokerages. It resides almost entirely in a small group of diabetic early adopters and an equally small group of investors and medical practitioners who have compiled enough scientific information and self-experimental evidence to challenge the orthodox view of how diabetes must be treated. That orthodoxy will give way eventually if only Afrezza can be made available long enough until a critical population of diabetics has been reached. I would like that to be sooner than later but much depends upon MNKD or a successor simply showing up to work to make Afrezza every day for free (or for a loss?) until someday everyone goes "duh! why are we still using this other stuff?" Whether there is a payday for investors, I don't have enough information...don't think anybody does. This is perhaps the most intelligent summation of the Mannkind situation that I have read. You hit the nail on the head zuegirdor. I'm going to go out on a limb here and predict that Afrezza will become a household name in the future. At least for those who suffer from diabetes. I firmly believe in the science of this product. Whether it will be Mannkind or another company that takes this forward remains to be seen but I really think this will make it........somehow.
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