Refills

[bthomas55ep]

The momentum in the price and company events is great. Very excited about the potential. The one question I continue to think about that I'd love to hear some thoughts. With thousands upon thousands of new prescriptions since the beginning of the year, why are refills still under 200 each week? Shouldn't the refills be climbing by now and the new scripts just putting new users into the queue? Maybe I don't understand how the numbers should work and was hoping for some thoughts. Thx

[peppy]

Oct 9, 2017 7:01:48 GMT -5 bthomas55ep said:

The momentum in the price and company events is great. Very excited about the potential. The one question I continue to think about that I'd love to hear some thoughts. With thousands upon thousands of new prescriptions since the beginning of the year, why are refills still under 200 each week? Shouldn't the refills be climbing by now and the new scripts just putting new users into the queue? Maybe I don't understand how the numbers should work and was hoping for some thoughts. Thx

They should.

report after report, users turned down by insurance.

sweedee's dad can not get coverage.

refills is insurance,

dosing figured out now.

insurance should pick up.

mike said a new insurer is coming on board January of 2018.

insurance, the trick here is the label. and we have table four now.

table four, can be seen in better light along side table 5.

www.screencast.com/t/Q8CeRZDM8

look for refills to go up now

dosing; 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#ixzz4v0oEYRau

[Deleted]

bthomas55ep you created a similar thread months ago, why are you repeating?

[babaoriley]

Oct 9, 2017 7:11:33 GMT -5 @kastanes said:

bthomas55ep you created a similar thread months ago, why are you repeating?

Glad he did, it's something most either overlooked (negligently or intentionally) during the Sanofi era.

[therealisaching]

Oct 9, 2017 7:01:48 GMT -5 bthomas55ep said:

The momentum in the price and company events is great. Very excited about the potential. The one question I continue to think about that I'd love to hear some thoughts. With thousands upon thousands of new prescriptions since the beginning of the year, why are refills still under 200 each week? Shouldn't the refills be climbing by now and the new scripts just putting new users into the queue? Maybe I don't understand how the numbers should work and was hoping for some thoughts. Thx

Something to keep in mind is that when a doc writes a script it will have a certain number of refills.  When those refills are up it requires a new authorization.  That new authorization now falls in the new prescription bucket not the refill.  You can be a long time afrezza user by now and have several "new" prescriptions.

[Deleted]

Castagna addressed that issue : some NRx are renewed prescriptions, new pharmacy, and new doctor.

[madog365]

IMO the problems with refill rate can be broken down into 3 categories:

1. People who do not titrate correctly, and therefore afrezza does not work for them.
2. People who like afrezza but cannot continue using it due to insurance problems and cannot afford out of pocket costs.
3. People who use afrezza sparingly ONLY for as needed corrections, they would not need refills for many months.

All three categories are very popular in user testimonials i've seen on online message boards so let's break them down and how Mannkind is solving all three since Mike Castagna joined the team.

Number 1. One of the first things Mike did was create the titration pack, a combination pack of units designed to let patients experiment with what works best for them. Diabetes is not a one size fits all disease and therefore a one size fits all dosing doesn't always work for patients. The titration pack worked but patients still are struggling with changing their old school mindset that decades of injectables insulin usage has created. If you follow the comments you will see patients commonly calling it out that when they first try Afrezza they sometimes think it does not work for them. This is due to not taking enough units most of the time, something that is quite common and will be fixed with the new label and additional prescriber education. The other big issue is that what works for the first few weeks of Afrezza may not continue to work within those first few months which is likely why Mike expanded the titration pack to be an up to 90 day prescription. Titration is a key period but so is getting HELP along the way. When patients are getting support from Afrezza advocates with experience, they almost always get it right and i've seen how powerful that is. I think that is one of the cornerstones of the One Drop collaboration and the reason they are doing this new study, there is going to be some really good refill results for patients who titrate with help from a one drop expert.

2. Pretty common issue that comes up is insurance problems, and not just getting the first fill but especially when refilling a prescription. Not only that but this even happens for the patients who have been on afrezza for years now, who all of a sudden get declined and must go through the appeals process year after year. One of the big wins with the label change is the idea that it will help Mannkind renegotiate it's contracts with these insurance companies. Getting afrezza out of tier 3 and into tier 2, no prior authorization across the board will be a huge boost to refill rate. This was a big focus for Mannkind and one that i expect improves significantly for next year. We've also all also heard "Uber of Diabetes", Mike's ideas about cutting out the middle man and going direct to consumer, while it's a novel idea i don't see it impacting us in the short term but potentially could be a revolutionary idea for long term Afrezza sales.

3. This group is interesting, I've read about many who keep Afrezza as a tool in the toolkit but don't use it daily only once in a while for serious highs or a cheat meal. Hospitals too which keep Afrezza stocked but may not need consistent orders. I'm actually hoping Mannkind has some ideas to get more of these types of use cases as they could make Afrezza the must have tool out there - One thing i have seen is the "Monopack" language being trademarked and i'm hoping this will be a new packaging available for these types of one off use cases. Keep in mind these users are already Afrezza approved and although they use it sparingly now they are much likelier to become full time users then somebody who still has to go through the education process.

-M

[nadathing]

This claim that people don't refill due to insurance is nonsense. To get an Afrezza script most insurance companies require preauthorization. Patients are aware of the coverage and price before filling a script. Who would fill a script once and then not refill it because of the cost?

[sportsrancho]

Oct 9, 2017 11:28:35 GMT -5 nadathing said:

This claim that people don't refill due to insurance is nonsense. To get an Afrezza script most insurance companies require preauthorization. Patients are aware of the coverage and price before filling a script. Who would fill a script once and then not refill it because of the cost?

NO that is not correct. We have been over this before! It is the insurance. I deal with people every week that this happens to.

[nylefty]

Oct 9, 2017 11:28:35 GMT -5 nadathing said:

This claim that people don't refill due to insurance is nonsense. To get an Afrezza script most insurance companies require preauthorization. Patients are aware of the coverage and price before filling a script. Who would fill a script once and then not refill it because of the cost?

Who?  A patient who gets a voucher for his or her first RX which costs the patient nothing.  A patient who has no way of knowing whether his or her insurance will pay for a refill. A patient who then gets turned down by the insurer and then decides not to pay for a refill out of his or her pocket. 

[sportsrancho]

Who has to write a letter to the insurance company after they get the script. At last gets excepted and then in 6 months gets denied again and has to do it all over again!

[joeypotsandpans]

Oct 9, 2017 11:28:35 GMT -5 nadathing said:

This claim that people don't refill due to insurance is nonsense. To get an Afrezza script most insurance companies require preauthorization. Patients are aware of the coverage and price before filling a script. Who would fill a script once and then not refill it because of the cost?

Have you not been reading, I personally received a script and it never got filled even after two prior authorizations, your post is nonsense as you make a statement with no direct knowledge of what patients have had to deal with regarding the insurance and prices. Think about others like myself that got a script that never got filled, I am sure there are more than most realize yet that gets twisted as users that don't like the product, couldn't be further from the truth. These are users that want the product and can't get it due to malevolent insurance carriers which hopefully will get their due.

[madog365]

Oct 9, 2017 11:28:35 GMT -5 nadathing said:

This claim that people don't refill due to insurance is nonsense. To get an Afrezza script most insurance companies require preauthorization. Patients are aware of the coverage and price before filling a script. Who would fill a script once and then not refill it because of the cost?

Even the slightest bit of research reading real user experience testimonials online would show you this is happening to a significant subset of users, and they are not happy about it. 

[compound26]

Oct 9, 2017 12:06:08 GMT -5 joeypotsandpans said:

Oct 9, 2017 11:28:35 GMT -5 nadathing said:

This claim that people don't refill due to insurance is nonsense. To get an Afrezza script most insurance companies require preauthorization. Patients are aware of the coverage and price before filling a script. Who would fill a script once and then not refill it because of the cost?

Have you not been reading, I personally received a script and it never got filled even after two prior authorizations, your post is nonsense as you make a statement with no direct knowledge of what patients have had to deal with regarding the insurance and prices. Think about others like myself that got a script that never got filled, I am sure there are more than most realize yet that gets twisted as users that don't like the product, couldn't be further from the truth. These are users that want the product and can't get it due to malevolent insurance carriers which hopefully will get their due.

[straightly]

Oct 9, 2017 8:00:44 GMT -5 madog365 said:

IMO the problems with refill rate can be broken down into 3 categories:

1. People who do not titrate correctly, and therefore afrezza does not work for them.
2. People who like afrezza but cannot continue using it due to insurance problems and cannot afford out of pocket costs.
3. People who use afrezza sparingly ONLY for as needed corrections, they would not need refills for many months.

All three categories are very popular in user testimonials i've seen on online message boards so let's break them down and how Mannkind is solving all three since Mike Castagna joined the team.

Number 1. One of the first things Mike did was create the titration pack, a combination pack of units designed to let patients experiment with what works best for them. Diabetes is not a one size fits all disease and therefore a one size fits all dosing doesn't always work for patients. The titration pack worked but patients still are struggling with changing their old school mindset that decades of injectables insulin usage has created. If you follow the comments you will see patients commonly calling it out that when they first try Afrezza they sometimes think it does not work for them. This is due to not taking enough units most of the time, something that is quite common and will be fixed with the new label and additional prescriber education. The other big issue is that what works for the first few weeks of Afrezza may not continue to work within those first few months which is likely why Mike expanded the titration pack to be an up to 90 day prescription. Titration is a key period but so is getting HELP along the way. When patients are getting support from Afrezza advocates with experience, they almost always get it right and i've seen how powerful that is. I think that is one of the cornerstones of the One Drop collaboration and the reason they are doing this new study, there is going to be some really good refill results for patients who titrate with help from a one drop expert.

2. Pretty common issue that comes up is insurance problems, and not just getting the first fill but especially when refilling a prescription. Not only that but this even happens for the patients who have been on afrezza for years now, who all of a sudden get declined and must go through the appeals process year after year. One of the big wins with the label change is the idea that it will help Mannkind renegotiate it's contracts with these insurance companies. Getting afrezza out of tier 3 and into tier 2, no prior authorization across the board will be a huge boost to refill rate. This was a big focus for Mannkind and one that i expect improves significantly for next year. We've also all also heard "Uber of Diabetes", Mike's ideas about cutting out the middle man and going direct to consumer, while it's a novel idea i don't see it impacting us in the short term but potentially could be a revolutionary idea for long term Afrezza sales.

3. This group is interesting, I've read about many who keep Afrezza as a tool in the toolkit but don't use it daily only once in a while for serious highs or a cheat meal. Hospitals too which keep Afrezza stocked but may not need consistent orders. I'm actually hoping Mannkind has some ideas to get more of these types of use cases as they could make Afrezza the must have tool out there - One thing i have seen is the "Monopack" language being trademarked and i'm hoping this will be a new packaging available for these types of one off use cases. Keep in mind these users are already Afrezza approved and although they use it sparingly now they are much likelier to become full time users then somebody who still has to go through the education process.

-M

I knew a disbetes patient who has been on insulin for decades. He told me how very hard it was for him to get into his current routine. He can afford Afrezza but 1. Refuse to believe the results: too good to be true, there got to be such got you people not saying. 2. Even if the results were true, he is not sure he would switch. It was PAINFUL for him to get his routine and it is very rigid and fragile and Afrezza can be a disturbance.

We are pushing for disturbance, as we are convinced the results will be so much better.

So this is another way our suffers turned out to a blessing in disguise. After two years, we can say that there was no got you. We also accumulated success stories and honed on how Afrezza should be dosed and used. These will one day convince these people to try.