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Post by compound26 on Aug 18, 2017 17:20:29 GMT -5
I decided to create a separate thread to discuss the afrezza pricing issue.
I think the price issue is much more complicated than some members here argued. And I recall Mike has expressed a similar view in previous conference calls.
1. Will a significant decrease of price lead to increase of overall sales (in terms of dollars)?
I think the answer is probably no, as I think the main bottleneck of Afrezza's sales growth has been the doctors' general reluctance to prescribe it, with poor coverage of insurance probably being a second factor. So, if we reduce the price by 50%, will we see sales volume pick up 100%? I doubt it.
Ultimately, the sales volume may pick up as we lowered the price significantly. However, what if sales volume does not increase much for quite some time (say several quarters) after we cut the price by half (which is a very likely scenario)? Our PPS will probably be cut in half again in no time.
2. The retail price we see at GoodRX and other places is different from the price that insurance companies and other major payors. I would think they are paying a much lower price than the retail price we see at GoodRX.
3. I think Mike and others at Mannkind do see the price issue. However, it is a complicated issue and can not be solved by a simple reduction of price across the board.
I think, however, the high price of Afrezza to the cash paying market probably will be resolved once Mannkind and One Drop finalize their afrezza subscription service. At that point, I think consumers who are willing to pay a reasonable price for subscription Afrezza with out-of-pocket cash will be able to get Afrezza (without going through the hassle of dealing with prior authorizations with insurance companies).
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Post by traderdennis on Aug 18, 2017 18:53:43 GMT -5
I decided to create a separate thread to discuss the afrezza pricing issue. I think the price issue is much more complicated than some members here argued. And I recall Mike has expressed a similar view in previous conference calls. 1. Will a significant decrease of price lead to increase of overall sales (in terms of dollars)?
I think the answer is probably no, as I think the main bottleneck of Afrezza's sales growth has been the doctors' general reluctance to prescribe it, with poor coverage of insurance probably being a second factor. So, if we reduce the price by 50%, will we see sales volume pick up 100%? I doubt it. Ultimately, the sales volume may pick up as we lowered the price significantly. However, what if sales volume does not increase much for quite some time (say several quarters) after we cut the price by half (which is a very likely scenario)? Our PPS will probably be cut in half again in no time. 2. The retail price we see at GoodRX and other places is different from the price that insurance companies and other major payors. I would think they are paying a much lower price than the retail price we see at GoodRX. 3. I think Mike and others at Mannkind do see the price issue. However, it is a complicated issue and can not be solved by a simple reduction of price across the board. I think, however, the high price of Afrezza to the cash paying market probably will be resolved once Mannkind and One Drop finalize their afrezza subscription service. At that point, I think consumers who are willing to pay a reasonable price for subscription Afrezza with out-of-pocket cash will be able to get Afrezza (without going through the hassle of dealing with prior authorizations with insurance companies). I agree with most of what you are saying but the pricing train has left the station. The mistake was made in Jan/July 2016 when MNKD took over Afrezza not to be more aggressive with pricing. It would of also put more pressure on BP to either match with their franchises or loose market share. We would of had 12 months of better insurance coverage which may of translated to better scripts today. And since we tossed out 1.5 million dollars in expired insulin, selling more would not of effected COGS much. |
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Post by sayhey24 on Aug 18, 2017 19:04:26 GMT -5
Here is what GoodRX says about afrezza www.goodrx.com/afrezza?drug-name=afrezzaAfrezza (insulin) is an expensive drug used to treat diabetes mellitus, including diabetes type 1 and diabetes type 2. This drug is less popular than comparable drugs. There are currently no generic options for any insulin brand, but less expensive biosimilar versions may be available in the future. It is not covered by most Medicare and insurance plans, but manufacturer and pharmacy coupons can help offset the cost. Compare insulins. They list Costco at $358.65 with the coupon. It use to be $278 at Costco with no coupon. Bottom line its damn expensive. It would also be nice if Mike could get the description cleaned up. Maybe they need the follow the Tresiba lead and sell it for $15 for the next 24 months. The AOL model gave their disks away for free until everyone was using AOL email - got mail? got afrezza? |
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Post by peppy on Aug 18, 2017 22:00:28 GMT -5
Here is what GoodRX says about afrezza www.goodrx.com/afrezza?drug-name=afrezzaAfrezza (insulin) is an expensive drug used to treat diabetes mellitus, including diabetes type 1 and diabetes type 2. This drug is less popular than comparable drugs. There are currently no generic options for any insulin brand, but less expensive biosimilar versions may be available in the future. It is not covered by most Medicare and insurance plans, but manufacturer and pharmacy coupons can help offset the cost. Compare insulins. They list Costco at $358.65 with the coupon. It use to be $278 at Costco with no coupon. Bottom line its damn expensive. It would also be nice if Mike could get the description cleaned up. Maybe they need the follow the Tresiba lead and sell it for $15 for the next 24 months. The AOL model gave their disks away for free until everyone was using AOL email - got mail? got afrezza? quote: They list Costco at $358.65 with the coupon. It use to be $278 at Costco with no coupon. Bottom line its damn expensive. It would also be nice if Mike could get the description cleaned up.
reply: 30 4 unit 60 8 unit cartridges. 600 units total www.screencast.com/t/ByP84qolYQrX hmmmmm I do not see the titration packs listed on good rx. Ray said something on the conference call about packaging configurations. I got tired trying to find it. seekingalpha.com/article/4096149-mannkinds-mnkd-ceo-michael-castagna-q2-2017-results-earnings-call-transcript?part=single
dosing:
www.seventhform.com/vdexdownloads/vdex-whitepaper-072817.pdf
page 22.
Comments
Afrezza’s speed of action is both a blessing and a curse. Clearly, it is a large factor in the safety of the
product, but for longer meals, you may need more Afrezza to keep the post prandial levels in check. We
recommend follow-on doses. For example, we advise with a standard meal to dose Afrezza 15-20
minutes after the start of the meal, and then another dose of the same size about 45 minutes later.
With very long meals, we have even advised patients to administer two follow-on doses, for very tight
control.
Read more: mnkd.proboards.com/thread/7878/afrezza-starting-titrating#ixzz4qANKinml
When it comes to the speed of onset saying we work within five minutes the reason that's important as we’re running these trials right now with DexCom and what you can see is within three dots on the DexCom you can see whether you got your appropriate dose we need to follow up the dose. hmmmm
seekingalpha.com/article/4096149-mannkinds-mnkd-ceo-michael-castagna-q2-2017-results-earnings-call-transcript?part=single
These people are screwed. They have to be able to eat.
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Post by thekid2499 on Aug 19, 2017 9:31:21 GMT -5
Compound - There are a lot of "thinks" in that statement  . And I "think" that is part of the problem. No one seems to have a good handle on pricing, how it affects groups of patients, and what it is costing our patients and, more importantly, prospective patients. I realize pricing is different depending on insurance coverage and various different situations, but we need to be able to determine what percentage of potential patients it is too expensive for based on how it is priced right now. Based on what I'm seeing and hearing (I know, small sample and not scientific), it appears that Afrezza is too expensive for many potential patients based on current price points. |
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Post by babaoriley on Aug 19, 2017 11:35:40 GMT -5
Well, if any one group of people should know the issues behind poor sales, they would be MNKD employees, starting with Mike and on down to the sales reps. Many here feel they have a grasp on the issues, and perhaps they do, but I believe management is in the best position of anyone to figure this out and to address it as well as possible. Doesn't mean that whatever they come up with will work, but they are in the best position to determine what has the best chance of succeeding.
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Post by agedhippie on Aug 19, 2017 11:42:34 GMT -5
I wonder if insurance is the issue. Insurers look for a discount or rebate relative to the retail price. If Mannkind drops the price to something affordable then the insurers will rebase their price to the new lower number with a knock-on to the cashflow.
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Post by seanismorris on Aug 19, 2017 12:16:57 GMT -5
What I think the dialogue between the Afrezza Rep. and the Docs looks like:
Rep:
And... here's what the charts and graphs look like... here's the PK ... and there you see how Afrezza works.
Doc:
Cut the BS. What's the bottom line?
Rep:
Well...
I can't tell you it's SUPERIOR to the other treatments available... because we didn't do a Superiority trial.
I can't tell much about long term safety... because we haven't even started that trial yet.
I can tell you we will be starting the Pediatric Study soon, and we expect excellent results!
Doc:
Hmm... Didn't you tell me that you were starting the Ped. Trial the last two times we met? Never mind...
Doc:
How about price and coverage?
Rep:
The issues in the past, with regards to approval, are mostly gone. And we set up a rebate (etc.) system to make Afrezza more affordable...
Doc:
Well. Maybe if I find a patient that is interested we'll give it a try...
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Post by sportsrancho on Aug 19, 2017 12:32:07 GMT -5
What I think is the last one is true. Many will wait till the patient asks. But much better than where we were before when the doc's just said no.
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Post by timri on Aug 19, 2017 19:57:55 GMT -5
I wonder if insurance is the issue. Insurers look for a discount or rebate relative to the retail price. If Mannkind drops the price to something affordable then the insurers will rebase their price to the new lower number with a knock-on to the cashflow. The recent tweets on twitter are a bit concerning to me. Adam lasher and others are getting cut off by insurance. I'm in the medical field and this insulin is a no brainer. I mri people all day that have gangernous feet it's terrible bc they are non compliant diabetics. I also have a profound hatred for insurance companies that dictate patient care due to bottom lines. I hope we can somehow fix our pricing so that it will be accepted with out all these hoops to jump through. |
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Post by agedhippie on Aug 19, 2017 22:01:25 GMT -5
Lets assume that in the rest of the world Afrezza is going to sell for the same price as Humalog/Novorapid. I get through two boxes of pens every 3 months which in the UK costs the NHS the equivalent of $75, or $25 per month. At that level you don't need insurance to buy Afrezza.
There is an objection that this kills the cashflow which is true to a point. There are two issues with this argument; the cashflow is already at least an order of magnitude below where it needs to be, and that everywhere other than the US Afrezza will have to be sold at that price anyway. At this point market traction matters far more than revenue so cut the price and let people buy it.
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Post by peppy on Aug 19, 2017 22:27:13 GMT -5
Lets assume that in the rest of the world Afrezza is going to sell for the same price as Humalog/Novorapid. I get through two boxes of pens every 3 months which in the UK costs the NHS the equivalent of $75, or $25 per month. At that level you don't need insurance to buy Afrezza. There is an objection that this kills the cashflow which is true to a point. There are two issues with this argument; the cashflow is already at least an order of magnitude below where it needs to be, and that everywhere other than the US Afrezza will have to be sold at that price anyway. At this point market traction matters far more than revenue so cut the price and let people buy it. British Pound 1.2876
www.marketwatch.com/investing/currency/gbpusd
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Post by agedhippie on Aug 19, 2017 22:36:30 GMT -5
Lets assume that in the rest of the world Afrezza is going to sell for the same price as Humalog/Novorapid. I get through two boxes of pens every 3 months which in the UK costs the NHS the equivalent of $75, or $25 per month. At that level you don't need insurance to buy Afrezza. There is an objection that this kills the cashflow which is true to a point. There are two issues with this argument; the cashflow is already at least an order of magnitude below where it needs to be, and that everywhere other than the US Afrezza will have to be sold at that price anyway. At this point market traction matters far more than revenue so cut the price and let people buy it. British Pound 1.2876
www.marketwatch.com/investing/currency/gbpusd
Thanks for the rate, I was using an old one. A box of 5 pens is £32.13. I uses about 8 pens over three months so call it two boxes. The pound has strengthened (or the dollar weakened) so that is now $82.74, or $27.58 per month. |
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Post by peppy on Aug 19, 2017 23:10:54 GMT -5
Thanks for the rate, I was using an old one. A box of 5 pens is £32.13. I uses about 8 pens over three months so call it two boxes. The pound has strengthened (or the dollar weakened) so that is now $82.74, or $27.58 per month. Costco Humalog 1 carton (five 3ml cartridges) 100 units/ml Coupon Price $529.81
www.goodrx.com/humalog?form=carton&dosage=five%203ml%20cartridges%20of%20100%20units/ml&quantity=1&label_override=
Aged I do not understand. Your endocrinologist is NY state. (USA) Your rapid acting from England. (united kingdom) How are you working this system?
(inappropriately, because of your nick is aged hippie, I wonder where you are getting your pot.)
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Post by agedhippie on Aug 20, 2017 9:25:09 GMT -5
Thanks for the rate, I was using an old one. A box of 5 pens is £32.13. I uses about 8 pens over three months so call it two boxes. The pound has strengthened (or the dollar weakened) so that is now $82.74, or $27.58 per month. Costco Humalog 1 carton (five 3ml cartridges) 100 units/ml Coupon Price $529.81
www.goodrx.com/humalog?form=carton&dosage=five%203ml%20cartridges%20of%20100%20units/ml&quantity=1&label_override=
Aged I do not understand. Your endocrinologist is NY state. (USA) Your rapid acting from England. (united kingdom) How are you working this system?
(inappropriately, because of your nick is aged hippie, I wonder where you are getting your pot.)
I get my insulin in the US via insurance unfortunately. If I was in the UK it would be free. I am still in the NHS system in the UK though however other that annual pictures of my eyes (my UK doctor gets a bonus if a certain percentage of his diabetics get this done) everything is done in the US there days. Pot supplies? I live in NYC!  |
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. And I "think" that is part of the problem. No one seems to have a good handle on pricing, how it affects groups of patients, and what it is costing our patients and, more importantly, prospective patients. I realize pricing is different depending on insurance coverage and various different situations, but we need to be able to determine what percentage of potential patients it is too expensive for based on how it is priced right now. Based on what I'm seeing and hearing (I know, small sample and not scientific), it appears that Afrezza is too expensive for many potential patients based on current price points. 
