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Post by sayhey24 on Apr 28, 2017 18:21:53 GMT -5
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. Treating diabetes used to be a very hard problem. Growing up in a house of diabetics it seemed like a black art. Thanks to Dr. Bernstein's effort anyone can now go to any pharmacy and by a meter for $20. That was a great start. As CGMs continue to gain traction BG can be easily monitored and addressed. Diabetes is actually a simple problem when you know what your numbers are. Keep them between 80 - 120 give or take and things are pretty great. To be able to do this you need to be able to address mealtime spikes like a natural pancreas and get back to baseline asap. The problem up until now is doing that was near impossible. Now that problem is solved. For T2s metformin nor any of the other T2 product can address the mealtime spike. Only one thing lowers mealtime BG spikes and thats insulin and only one insulin works like the natural pancreas. Once PCPs start using CGMs and prescribing afrezza immediately upon diagnosis everyone except the Endos business and the specialists will be better off. The question on deck is who is big enough to change current treatment protocol? There are lots of big name players who seem to want to monitor. Who wants to dominate? A few billion is round off if they can do $10B or more per year in sales between the monitoring, remote teledoc and direct drug fulfillment.
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Post by dreamboatcruise on Apr 28, 2017 19:13:40 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? 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!? Why would you assume that? Few doctors know what each insurer covers, what copays are, what retail prices are, etc? Most patients don't find out until they show up at the pharmacy to pick up a prescription and the pharmacist says "that'll be $15" or "that's not covered, that'll be $315".
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Post by nylefty on Apr 28, 2017 19:59:55 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!? (snip) A lot of the "new" Afrezza prescriptions are new only in the sense that the doc has written a new Rx for the same patient in order to change (or confirm) the dosage or because an earlier prescription has expired. This happens far more often with Afrezza than with many other drugs which have standard dosages or longer patient histories. This also partially explains the low renewal rate for Afrezza since every time a doc writes a new prescription for the same patient it goes in the NRx column, not under Renewals. At the risk of belaboring my point, consider this example: Joe hears about Afrezza and asks his doc about it. The doc says, "Let's try it for a month." Joe comes back in a month and expresses some concerns, so he and the doc agree on a different dosage and the doc writes a new prescription for three months. Three months later Joe comes back and either reports success or they agree on another dosage change. In either case the doc writes another new prescription. And so on. None of these new prescriptions are counted as renewals.
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Post by dreamboatcruise on Apr 28, 2017 20:14:38 GMT -5
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!? A lot of the "new" Afrezza prescriptions are new only in the sense that the doc has written a new Rx for the same patient in order to change (or confirm) the dosage or because an earlier prescription has expired. This happens far more often with Afrezza than with many other drugs which have standard dosages or longer patient histories. This also partially explains the low renewal rate for Afrezza since every time a doc writes a new prescription for the same patient it goes in the NRx column, not under Renewals. Hard to estimate the impact of that, but would certainly agree that is likely a factor. It would seem that with the titration pack it is likely that most new patient may start with a NRx that is never refilled, followed by a NRx for whatever is determined to be correct mix/quantity.
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Post by peppy on Apr 28, 2017 20:35:44 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!? quote: I have a hard time to buy a high dropout rate for money/insurance reason.. reply: the case of sweedee's dad: first sweedee's dad fought tooth and nail to get on Afrezza. Then his insurance coverage changed. A fixed income at this age. Sweedee reported that her dad reprimanded the physician when put back on rapid acting subq.
People on Twitter complaining to Mike C that insurance coverage had been refused.
Additionally, an initial problem, the 90 count 4 unit 360 total units, was not enough afrezza. So Dosing.
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Post by morfu on Apr 30, 2017 11:53:42 GMT -5
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!? quote: I have a hard time to buy a high dropout rate for money/insurance reason.. reply: the case of sweedee's dad: first sweedee's dad fought tooth and nail to get on Afrezza. Then his insurance coverage changed. A fixed income at this age. Sweedee reported that her dad reprimanded the physician when put back on rapid acting subq.
People on Twitter complaining to Mike C that insurance coverage had been refused.
Additionally, an initial problem, the 90 count 4 unit 360 total units, was not enough afrezza. So Dosing.
I am not sure what to make of this post, for most of it, it does not contain full sentences and tells a story of "sweedee" and her dad. That is just a single case and not very relevant to ohters. dreamboatcruise makes a similar point: "Why would you assume that? Few doctors know what each insurer covers, what copays are, what retail prices are, etc? Most patients don't find out until they show up at the pharmacy to pick up a prescription and the pharmacist says "that'll be $15" or "that's not covered, that'll be $315"." Well, beside changes in coverage, which are as far as I understand the situation, should become less and less or even better for the patients as Afrezza is eventually bumped up in the tiers, I assume that there are enough cases out there, that each Afrezza patient can find a user with similar coverage and get the costs, also the doctor should have the situation. But perhaps I am wrong and that is the whole problem.. Back to the numbers... I seems that is it possible that each new patient is counted as several NRx .. as nylefty suggested 4x!? (sample pack, titration pack, first dosage and change in dosage) To me that leaves more questions than answers.. First of all: What are the sales people doing!? That amounts to less than 1 new patient per sales person every two weeks (not taking into account, that we should by now have some doctors prescribing Afrezza without relying on sales represantatives)!? => Anyone has any insights into this!? Its most puzzling! Yet, even if we assume a adjusted NRx of only 30 per week or so, still the TRx is growing way too slow! (I am looking for other possible explanations beside changing costs)
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Post by nylefty on Apr 30, 2017 13:18:28 GMT -5
quote: I have a hard time to buy a high dropout rate for money/insurance reason.. (snip) Back to the numbers... I seems that is it possible that each new patient is counted as several NRx .. as nylefty suggested 4x!? (sample pack, titration pack, first dosage and change in dosage) Samples are not counted as new prescriptions. The docs just hand them out and since they aren't filled by a pharmacy they never show up in Symphony's numbers.
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Post by cjm18 on Apr 30, 2017 15:39:24 GMT -5
what happened to the 200 mannkind cares referrals that mike mentioned a long time ago?
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Post by matt on May 1, 2017 7:34:42 GMT -5
Why would you assume that? Few doctors know what each insurer covers, what copays are, what retail prices are, etc? I am not sure I agree with that. My physician knows exactly which drugs are on or off formulary for each of the health plans, and can see which drug he should be writing before he ever sends the script. I takes him no more than five seconds to pull it up on his computer, and I presume most offices are computerized at this point.
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Post by derek2 on May 1, 2017 8:25:11 GMT -5
A lot of the "new" Afrezza prescriptions are new only in the sense that the doc has written a new Rx for the same patient in order to change (or confirm) the dosage or because an earlier prescription has expired. This happens far more often with Afrezza than with many other drugs which have standard dosages or longer patient histories. This also partially explains the low renewal rate for Afrezza since every time a doc writes a new prescription for the same patient it goes in the NRx column, not under Renewals. Hard to estimate the impact of that, but would certainly agree that is likely a factor. It would seem that with the titration pack it is likely that most new patient may start with a NRx that is never refilled, followed by a NRx for whatever is determined to be correct mix/quantity. In NYLefty's scenario, I think we would see very high NRx and some TRx growth, since these patients would be retained and other new customers would be piling in as well. Instead we see flat NRx and TRx, indicating that for every new user, one drops out. The only way you have flat TRx for a year is if no new patients start Afrezza or if you have an equilibrium of patients starting and patients discontinuing.
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