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Post by hellodolly on Dec 20, 2017 10:23:35 GMT -5
So, during the gas crisis of the 70's a Japanese owned automobile manufacturing company saw an opportunity to get a foothold in the American dominated new car market. The market, dominated for decades existed essentially since the invention of the automobile, by American manufacturers. Sure there were the high end luxury cars like Ferrari, Rolls Royce and a few others but, not a car for the masses.
An American, W. Ed Deming, worked with this Japanese company who adopted and applied many of his "14 Points" of Total Quality Management, and he was considered a hero by Japanese corporations post WWII. He convinced them that they made the highest quality products anywhere in the world. In this example, the Japanese company built cheap, small, economical, fuel efficient cars and started selling them here. The moment in history of long gas lines, gas shortages, OPEC bringing this country to our knees opened the door for Datsun. They offered their cars so cheap, had competitive new car warranty's that consumers couldn't resist. Once a foothold was established, Datsun began introducing another line of cars, more expensive but who cared? Datsun was proving to be a reliable manufacturer of cars. You know the rest of the history, as Datsun became Nissan and now they sell their luxury line, known as Infiniti. Toyota adopted the same model and thus...Deming's influence had profound implications in the Japanese business culture (plus it helped that the Japanese are hard driving individuals).
So, where is the link to MNKD? While I believe that most of Deming's TQM principles (now replaced by Quality Management Principles) are hard at work at MNKD, I see this as the "exact right moment" to offer Afrezza so cheap, that it can't be ignored. Everything is in place, with insurers not too far behind. Once the Afrezza foothold and growth trajectories are attained, Rx prices can increase over time. Just as Datsun introduced cheap cars and later became a household name in America, consideration by MNKD for this strategy has a proven place in American history. |
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Post by alethea on Dec 20, 2017 12:06:54 GMT -5
Amen brother.
Lower the price below injectables, SELL the damn insulin for Goodness sakes.
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Post by tiberious on Dec 20, 2017 13:54:50 GMT -5
Amen brother. Lower the price below injectables, SELL the damn insulin for Goodness sakes. Agreed ..... I personally would love it if they (MIKE) thought outside the box at this point and did what SayHey suggests (below). Circumvent the bloody insurance company BS already...its a weight hanging off Mannkind's neck screw them and sell the product. Patients first right. Oh and one more thing... don't wait for the ADA to release latest study results if they are great. The establishment has done NOTHING for Mannkind. Mike needs to set the price for the next 2 years at $50 and flood the market. After 3 years we are doing 500 scripts a week with a paradigm shifting super blockbuster product. MNKD can not compete against BP on a playing field titled against them. Its time to tilt it in their favor. Unless Mike has some deals going we can't keep doing the same thing which means adding a few scripts every week.
Technology is now in place to support the launch. VDex type coaching programs need to spring up like dandelions to link the PWD to the online services like Onduo and One Drop and insurance is standing in their way.
Set the price, do the TV commercials and stand out of the way. 70+% of T2 are not at an A1c of 7. More important nearly 100% of newly diagnosed PWDs are scared and have no idea what they are facing and are looking for help. Send the message that the #1 killer is heart disease and PWDs are 3x more likely to get it and the way to stop it is to stop the spike and keep non-diabetic BG, Maybe there are other ways to stop the spike but the easiest and short of a highly carb restricted diet "safest" is afrezza. It seems like a no-brainer to me.
Read more: mnkd.proboards.com/thread/9238/heck-on?page=3#ixzz51pQdJ0oe |
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Post by hellodolly on Dec 20, 2017 14:19:11 GMT -5
Amen brother. Lower the price below injectables, SELL the damn insulin for Goodness sakes. It does come at a cost: debt if he so chooses to take that path. However, this can buy more time and there are many ways "debt" can be managed. Even so, the "Perfect Storm" is here and now, and the stage is set. |
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Post by sellhighdrinklow on Dec 20, 2017 15:03:33 GMT -5
A low price point could imply Afrezza is an inferior product. Doctors are already hesitant to prescribe A based on ignorance and pricing it at the bottom of the rung implies inferiority, and is unnecessary. It is superior and the price should reflect that. When the STAT study results come out, the insurance companies will have no choice but to move it up to the top tier, IMHO. Mannkind just needs to get those results out sooner rather than later. Lowering the price is shooting themselves in the foot and everywhere else. STAT STUDY RESULTS ASAP!
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Post by tiberious on Dec 20, 2017 16:00:33 GMT -5
A low price point could imply Afrezza is an inferior product. Doctors are already hesitant to prescribe A based on ignorance and pricing it at the bottom of the rung implies inferiority, and is unnecessary. It is superior and the price should reflect that. When the STAT study results come out, the insurance companies will have no choice but to move it up to the top tier, IMHO. Mannkind just needs to get those results out sooner rather than later. Lowering the price is shooting themselves in the foot and everywhere else. STAT STUDY RESULTS ASAP! Unfortunately the insurance companies have plenty of choice and will do what is in their (or their pals) best interest given superior STAT study results...not the patients best interest and certainly not the shareholders. I say remove the gatekeeper with its boot on the neck of Mannkind and use blowout pricing to achieve sales volume. Drug companies can and do raise prices down the road (EPI, injectables) so why not open up the floodgates now and get patients on board with a better product? Let word of mouth and low pricing drive the push toward Afrezza adoption and worry about pricing later. BTW, "SELLHIGH" is not really working out for Mannkind is it? How about we kill two birds with one stone, word of mouth and low cost access will circumvent the resistance of doctors and insurance IMHO. We cant wait for them to wake up or warm to Afrezza. |
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Post by nadathing on Dec 20, 2017 16:17:33 GMT -5
A low price point could imply Afrezza is an inferior product. Doctors are already hesitant to prescribe A based on ignorance and pricing it at the bottom of the rung implies inferiority, and is unnecessary. It is superior and the price should reflect that. When the STAT study results come out, the insurance companies will have no choice but to move it up to the top tier, IMHO. Mannkind just needs to get those results out sooner rather than later. Lowering the price is shooting themselves in the foot and everywhere else. STAT STUDY RESULTS ASAP! Afrezza 4unit(90) Cart Inhal = $8,000/year Afrezza 8unit(60) Cart Inhal = $10,000/year Afrezza 4-8unit Cart Inhal = $15,000/year This is what my plan pays. Does not include $600/year in copays. If I use Afrezza 3 times daily (meal time use) I would still need to inject. Anyone know what a years worth of insulin costs? How about the cost without mealtime dosing? I can't imagine I'd be saving 8 to 15 grand a year by using Afrezza instead of injecting. |
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Post by wgreystone on Dec 20, 2017 18:55:46 GMT -5
So, during the gas crisis of the 70's a Japanese owned automobile manufacturing company saw an opportunity to get a foothold in the American dominated new car market. The market, dominated for decades existed essentially since the invention of the automobile, by American manufacturers. Sure there were the high end luxury cars like Ferrari, Rolls Royce and a few others but, not a car for the masses.
An American, W. Ed Deming, worked with this Japanese company who adopted and applied many of his "14 Points" of Total Quality Management, and he was considered a hero by Japanese corporations post WWII. He convinced them that they made the highest quality products anywhere in the world. In this example, the Japanese company built cheap, small, economical, fuel efficient cars and started selling them here. The moment in history of long gas lines, gas shortages, OPEC bringing this country to our knees opened the door for Datsun. They offered their cars so cheap, had competitive new car warranty's that consumers couldn't resist. Once a foothold was established, Datsun began introducing another line of cars, more expensive but who cared? Datsun was proving to be a reliable manufacturer of cars. You know the rest of the history, as Datsun became Nissan and now they sell their luxury line, known as Infiniti. Toyota adopted the same model and thus...Deming's influence had profound implications in the Japanese business culture (plus it helped that the Japanese are hard driving individuals).
So, where is the link to MNKD? While I believe that most of Deming's TQM principles (now replaced by Quality Management Principles) are hard at work at MNKD, I see this as the "exact right moment" to offer Afrezza so cheap, that it can't be ignored. Everything is in place, with insurers not too far behind. Once the Afrezza foothold and growth trajectories are attained, Rx prices can increase over time. Just as Datsun introduced cheap cars and later became a household name in America, consideration by MNKD for this strategy has a proven place in American history. I believe MNKD just did the opposite. Per-script dollar amount was going up over the last few months if I remember correctly. |
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Post by hellodolly on Dec 21, 2017 6:03:55 GMT -5
A low price point could imply Afrezza is an inferior product. Doctors are already hesitant to prescribe A based on ignorance and pricing it at the bottom of the rung implies inferiority, and is unnecessary. It is superior and the price should reflect that. When the STAT study results come out, the insurance companies will have no choice but to move it up to the top tier, IMHO. Mannkind just needs to get those results out sooner rather than later. Lowering the price is shooting themselves in the foot and everywhere else. STAT STUDY RESULTS ASAP! "A low price point could imply Afrezza is an inferior product. Doctors are already hesitant to prescribe A based on ignorance and pricing it at the bottom of the rung implies inferiority, and is unnecessary." Sorry, I can't buy that theory just because something costs less, it must therefore be inferior. I'd rather just read that it's totally unnecessary, as you alluded to in your comment. That's a lot more plausible. I do agree that the STAT study can improve Afrezza's tier ratings and thus result in more coverage. But, until then and until insurance companies do move them up, there is no need to wait. We can penetrate the market at the same price point that a patient can expect to pay when the new coverage goes into effect.
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Post by vdexdiabetes on Dec 21, 2017 13:09:39 GMT -5
I think the idea of lowering the price of Afrezza is good on one level: it'll get the attention of the payers. Clearly, these people look at the short term issues such as price. Afrezza's long term advantages are unknown to most payers and providers since they think it is comparable to injected prandial insulins. The label certainly doesn't help in this regard either. So, not a bad idea IMO.
But, from my perspective, the big issue here is physician interest. If docs like and use a product, it'll get covered in time, I'd expect, even if more expensive. I think the incentives for physician acceptance and use of Afrezza are all aligned in the wrong direction. We at Vdex see this daily. Docs don't want to use it even when they think it would be advantageous to their patients. They say almost unanimously "I don't have the time." That may seem odd since most would expect docs to use the best therapy available for their patients, and most docs would say they are in fact doing that. But the issue is more complicated than that.
Afrezza is such a different product that it's going to take time for the docs to come around. As more data gets published, the advantages will become clearer. Docs will consider Afrezza more. Then they'll learn how to prescribe and keep patients on (no small task). I think it'll happen.
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Post by uvula on Dec 21, 2017 13:15:44 GMT -5
My guess is that Datsun made money on each car it sold even if they were relatively inexpensive cars. And they also were probably profitable in Japan so they could afford to lose money for a period of time in the USA until they got established.
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Post by dreamboatcruise on Dec 21, 2017 13:36:38 GMT -5
My guess is that Datsun made money on each car it sold even if they were relatively inexpensive cars. And they also were probably profitable in Japan so they could afford to lose money for a period of time in the USA until they got established. Nissan was part of a keiretsu conglomerate which included a large bank, so credit would have flowed freely if needed as well. |
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Post by hellodolly on Dec 21, 2017 13:50:40 GMT -5
My guess is that Datsun made money on each car it sold even if they were relatively inexpensive cars. And they also were probably profitable in Japan so they could afford to lose money for a period of time in the USA until they got established. Probably right. I'll have to do more research. This came to me as an old case study I did in college, along with Jack Welch at GE and David Farragut of the USN. Deming was also on the list of assignments that I had to do for each. My point was more about all of the metrics being aligned at the right time for the Japanese to break into the American market and obtain their initial foothold. I used those metrics to point to the same potential external opportunities at MNKD, aligned with their internal strengths as an alternative course of action to consider. Of course they also have the external threats right now, primarily insurance and Dr acceptance (two big ones I might add). That being said, a partner who was large enough to carry Afrezza over the goal line with MNKD, would be ideal given your thoughts on the bottom line. say an AMGN, or PFE or JNJ or some other BP could help absorb that impact. |
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Post by wgreystone on Dec 21, 2017 14:33:25 GMT -5
I think the idea of lowering the price of Afrezza is good on one level: it'll get the attention of the payers. Clearly, these people look at the short term issues such as price. Afrezza's long term advantages are unknown to most payers and providers since they think it is comparable to injected prandial insulins. The label certainly doesn't help in this regard either. So, not a bad idea IMO. But, from my perspective, the big issue here is physician interest. If docs like and use a product, it'll get covered in time, I'd expect, even if more expensive. I think the incentives for physician acceptance and use of Afrezza are all aligned in the wrong direction. We at Vdex see this daily. Docs don't want to use it even when they think it would be advantageous to their patients. They say almost unanimously "I don't have the time." That may seem odd since most would expect docs to use the best therapy available for their patients, and most docs would say they are in fact doing that. But the issue is more complicated than that. Afrezza is such a different product that it's going to take time for the docs to come around. As more data gets published, the advantages will become clearer. Docs will consider Afrezza more. Then they'll learn how to prescribe and keep patients on (no small task). I think it'll happen. I think insurance coverage is one reason that holds doctors back from prescribing Afrezza. Most doctors just don't want to spend too much time on dealing with insurance. I had such a experience. My doctor once prescribed a new medicine for me. When I went to the pharmacy to fill up the prescription, the pharmacy told me they needed to call the doctor to fillup some authorization form. Days later, the pharmacy told me that the doctor switched my prescription to another drug. When there is alternative, it's easier for the doctor to switch back than spending time filling up some forms. |
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Post by tiberious on Dec 21, 2017 14:56:01 GMT -5
I think the idea of lowering the price of Afrezza is good on one level: it'll get the attention of the payers. Clearly, these people look at the short term issues such as price. Afrezza's long term advantages are unknown to most payers and providers since they think it is comparable to injected prandial insulins. The label certainly doesn't help in this regard either. So, not a bad idea IMO. But, from my perspective, the big issue here is physician interest. If docs like and use a product, it'll get covered in time, I'd expect, even if more expensive. I think the incentives for physician acceptance and use of Afrezza are all aligned in the wrong direction. We at Vdex see this daily. Docs don't want to use it even when they think it would be advantageous to their patients. They say almost unanimously "I don't have the time." That may seem odd since most would expect docs to use the best therapy available for their patients, and most docs would say they are in fact doing that. But the issue is more complicated than that.
Afrezza is such a different product that it's going to take time for the docs to come around. As more data gets published, the advantages will become clearer. Docs will consider Afrezza more. Then they'll learn how to prescribe and keep patients on (no small task). I think it'll happen. Thanks for the perspective Vdex. Given all the things Mannkind cannot control (payers, insurance, doctors) combined with the fact that Afrezza is such a unique product, I think the only way doctors will "find the time" is when more and more of their patients start going to other docs who are writing scripts for increasingly healthier and happier patients. The only way this will happen IMHO is if Mannkind lowers the price drastically thereby taking back control of the one thing that it can actually control... pricing. Why not use pricing as a means to penetrate the market and take back control of Mannkind's destiny in doing so? Without the constant bombardment of FREE AOL and Compuserve CD's in the mail ~24 years ago would these companies even be recognizable today? |
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