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Post by madog365 on Oct 9, 2017 12:18:25 GMT -5
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. Keep in mind my post was in regards to why people don't refill afrezza, not why they don't start with it in the first place. The list of reasons there would be very different.
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Post by babaoriley on Oct 9, 2017 16:29:23 GMT -5
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. At this point, gotta throw a penalty flag for piling on to nadathing, who's been reduced to nadathing.
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Post by peppy on Oct 9, 2017 16:50:46 GMT -5
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Post by babaoriley on Oct 9, 2017 16:54:27 GMT -5
Well, that last line, "Time for effect to return to baseline" - it's in hours for FIASP and in minutes for MannKind, do they thinks we're all imbeciles?
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Refills
Oct 9, 2017 17:39:09 GMT -5
Post by nadathing on Oct 9, 2017 17:39:09 GMT -5
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. Not correct. Tell us again that you would fill a script you can't afford. I've been through the process several times with my doctor and insurance company. I am told the cost of the drug before I go to the pharmacy. I even had a pharmacist not fill a script for my daughter once until he told me the cost. You really think someone would fill a script they can't afford to refill? Not on your life.
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Refills
Oct 9, 2017 17:40:33 GMT -5
Post by nadathing on Oct 9, 2017 17:40:33 GMT -5
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. Been through this more than you or others on this board apparently.
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Refills
Oct 9, 2017 18:06:06 GMT -5
Post by babaoriley on Oct 9, 2017 18:06:06 GMT -5
Okay, there appears to be a violation of the first rule of holes...
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Post by joeypotsandpans on Oct 9, 2017 18:10:36 GMT -5
Okay, there appears to be a violation of the first rule of holes... It wasn't worthy of a response so I took the higher road called ignore
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Post by nylefty on Oct 9, 2017 18:54:37 GMT -5
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. Not correct. Tell us again that you would fill a script you can't afford. I've been through the process several times with my doctor and insurance company. I am told the cost of the drug before I go to the pharmacy. I even had a pharmacist not fill a script for my daughter once until he told me the cost. You really think someone would fill a script they can't afford to refill? Not on your life. What was it about my explanation that you didn't understand? You keep saying no one would fill a script they can't afford to refill, but ignore the very likely possibility that they hope their insurance will cover a good part of the cost. Let me try again: 1. Patient uses a voucher to get a free Rx. Starts using Afrezza. 2. Patient is told Prior Authorization is required by Insurance Company in order to get a refill. 3. Patient's doctor appeals to Insurance Company. 4. Insurance company denies appeal. 5. Patient decides he can't pay for refill out of his own pocket. Doesn't get refill because of Insurance Problem.
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Refills
Oct 9, 2017 20:27:01 GMT -5
via mobile
Post by brewguy on Oct 9, 2017 20:27:01 GMT -5
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. This is false. A prior authorization is only need once every calendar year. Call your insurance if you don't believe me.
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Post by sportsrancho on Oct 9, 2017 20:34:06 GMT -5
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. This is false. A prior authorization is only need once every calendar year. Call your insurance if you don't believe me. “ 6 months”
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Post by compound26 on Oct 9, 2017 20:35:18 GMT -5
I feel like there are a few former longs who sold out their MNKD holdings at some points, feeling MNKD totally had no future, are still hanging around here.
And now that MNKD PPS rebounded strongly, to the extent they did not jump back in, but are still hanging around on this board from time to time, they have a strong urge to convince others (and more importantly themselves) that they made a right and great decision in getting out. So as the PPS continues to climb, many of them will have a stronger and stronger belief that the rising PPS is irrational as MNKD should really have no future.
Of course, I know there are many longs who have sold out simply take it with total peace or never looked back. But I feel like there are are few of those are still trying to convince themselves that they made a great decision.
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Post by sportsrancho on Oct 9, 2017 20:37:25 GMT -5
Yep:-)
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Post by od on Oct 9, 2017 21:07:10 GMT -5
Re: prior authorization -- Unfortunately/fortunately my wife and I endure a complicated daily medication regimen. Many of our prescriptions require prior authorizations; some need to be renewed semi-annually, others annually. (I had promised myself to stay away from this thread's rabbit hole, but prior authorizations hit close to home.)
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Refills
Oct 9, 2017 22:04:54 GMT -5
Post by applogic on Oct 9, 2017 22:04:54 GMT -5
I still have 4 boxes I think. Originally script was 2x4, 1x8 and the 4's were useless. As such, I learned to save it to double up and use it only when i had to and that habit continues to this day. If i had originally received larger doses, I probably would have used it more but fast forward a year and I've skipped 2 refills even though my insurance covers it since i have only used 2 out 6 boxes. In the meantime I dropped my A1C to 5.5 for 3 months using keto alone which got me too comfortable and now my mornings are in the 200's again although this time i'm not sure what has change diet wise. Since afrezza is meal time, it doesn't do me much good for overnight levels which i am finding is the biggest issue. If blood sugar is 120 in the morning it's 100 by night but if it's 270 in the morning it's 190 by bedtime so Afrezza isn't of much use to me until the numbers drop - then i can use it for the 2 or 3 times during the month I fall off keto.
At the start my endo never received samples and I got the left over sample packs (4's only). Mannkind dropped the ball there. It took a 2 hour drive to get a doctor to prescribe afrezza and my current doc thinks I'm doing fine without it although she let me keep the script since I was using it sparingly. I *really* wanted Afrezza to succeed - I suffered through this and went all in at 100k shares in July of 2014 and held it up until the other day - converting it to ROTH and paying the taxes along the way. For T1's with a monitor perhaps this is great but for T2's, the weekly insulins now seem to be the way to go. My sibling uses that and her numbers are better and she's eating fries while I'm living on lettuce and avocados so objectively, that looks like the more convenient option.
If Mannkind's going to recover, they'll need juvenile studies completed, bring the epipen alternative to market and a cash infusion from RLS but I don't know if they'll survive that long so I'll take my 7 cents on the dollar.
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