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Post by cjm18 on Apr 14, 2018 19:08:59 GMT -5
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Post by boca1girl on Apr 14, 2018 19:49:52 GMT -5
How can I like your post cjm? I don’t like it but I agree. The biggest problem we have is insurance coverage.
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Post by cjm18 on Apr 14, 2018 20:28:13 GMT -5
Did the other prandials have insurance coverage issues until they gained market share? One of mikes interviews alluded to needing to have market share to gain acceptance by the pbms.
I actually think the doctors are a bigger issue. They are afraid of change and don’t believe afrezza to be any better.
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Post by brotherm1 on Apr 14, 2018 21:06:00 GMT -5
I think most docs of all practices are stuck in the mud; perhaps too busy to learn
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Post by digger on Apr 14, 2018 21:06:46 GMT -5
Did the other prandials have insurance coverage issues until they gained market share? One of mikes interviews alluded to needing to have market share to gain acceptance by the pbms. I actually think the doctors are a bigger issue. They are afraid of change and don’t believe afrezza to be any better. I don't agree. To gain acceptance by PBMs, Mannkind needs to either be cost competitive or demonstrate that covering afrezza will save the PBM money in the long term. The latter likely will require another extended trial with a better dosing protocol. Also, I suspect that if insurers were were more accepting of the product, doctors would also be as well. |
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Post by bill on Apr 14, 2018 21:11:16 GMT -5
Did the other prandials have insurance coverage issues until they gained market share? One of mikes interviews alluded to needing to have market share to gain acceptance by the pbms. I actually think the doctors are a bigger issue. They are afraid of change and don’t believe afrezza to be any better. I've always been puzzled by the argument that insurers want to see market share before providing coverage. If a product has little market share, it costs the insurer very little to cover it at a level consistent with competing products. If it then gains market share, the insurer breaks even and their patients may become more healthy and make fewer claims. If it doesn't gain market share once covered, then the insurer loses very little by having covered it. Essentially, the insurers either win or break even if they cover a product, don't they? Why would they not cover Afrezza? |
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Post by cjm18 on Apr 14, 2018 21:20:57 GMT -5
The pbm isn’t an insurance company. They don’t care about long run health outcomes. www.fool.com/investing/2017/11/21/mannkind-ceo-michael-castagna-on-whats-ahead-for-t.aspx“So that's what happens. Novo Nordisk (NYSE:NVO) basically blocks patient access to our product. And so, if you're CVS, and you want those rebates, and you want that admin fee, and you don't want to do any work, the easier thing to do is just to say, "Sorry, I'm doing good cost of care, because Novo is giving me all these rebates for blocking everybody." And then if you say, "Well, add us to the formulary," they say, "You don't have any market share." Then we say, "We don't have any market share, because you block everything!" So how can I get market share? It's a circular argument. This is how they protect their monopoly“ |
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Post by digger on Apr 14, 2018 21:38:44 GMT -5
The pbm isn’t an insurance company. They don’t care about long run health outcomes. www.fool.com/investing/2017/11/21/mannkind-ceo-michael-castagna-on-whats-ahead-for-t.aspx“So that's what happens. Novo Nordisk (NYSE:NVO) basically blocks patient access to our product. And so, if you're CVS, and you want those rebates, and you want that admin fee, and you don't want to do any work, the easier thing to do is just to say, "Sorry, I'm doing good cost of care, because Novo is giving me all these rebates for blocking everybody." And then if you say, "Well, add us to the formulary," they say, "You don't have any market share." Then we say, "We don't have any market share, because you block everything!" So how can I get market share? It's a circular argument. This is how they protect their monopoly“ The objective of the pharmacy benefit management is to reduce the cost of healthcare to both the insurer and employer -- www.truveris.com/resources/what-is-a-pbm-and-how-does-a-pbm-impact-the-pharmacy-benefits-ecosystem. Towards that end they must look at everything that impacts that cost -- "A formulary is a list of drugs, both brand and generic, that are covered within a certain plan. The list is determined by PBMs with the assistance of physicians and other clinical experts to include the drugs that will be most effective and affordable." "Most effective and affordable" no doubt includes consideration of long term outcomes. |
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Post by agedhippie on Apr 14, 2018 21:55:48 GMT -5
Did the other prandials have insurance coverage issues until they gained market share? One of mikes interviews alluded to needing to have market share to gain acceptance by the pbms. I actually think the doctors are a bigger issue. They are afraid of change and don’t believe afrezza to be any better. The short answer is that the insulin insulin market didn't used to be this bad. Until 2013 I could get whatever insulin I wanted and then Express Scripts dropped all Novo Nordisk diabetes products to get a better price from Eli Lilly and their diabetes products. Overnight all us Novolog users got swapped to Humalog - everyone was furious but there was nothing that could be done. All the other PBMs followed suit rather than give Express Scripts an advantage and that's where we are today. |
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Post by agedhippie on Apr 14, 2018 22:05:37 GMT -5
I think most docs of all practices are stuck in the mud; perhaps too busy to learn Insulin changes are tricky. I remember the change from porcine insulin to Regular. There was a lot of resistance from people and doctors saying that Regular wasn't real insulin because it was manufactured with people less hypo aware, and feeling worse. It dragged out so long that a lot of people jumped from animal insulins straight to RAA and never used Regular. |
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Post by sweedee79 on Apr 15, 2018 5:37:26 GMT -5
Insurance companies only care about their bottom line not the patients they serve.
Afrezza improves the health of PWD which would result in fewer claims.. But would fewer claims save the insurance company money in the long run considering Afrezza treatment is so much more expensive.
We have to prove superiority and force doctors to prescribe and insurers to pay.
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Post by mnholdem on Apr 15, 2018 6:07:08 GMT -5
Superiority studies are needed. I think it also would help if a new ultra-fasting insulin classfication were added by the ADA/AACE/FDA.
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Post by matt on Apr 15, 2018 12:07:27 GMT -5
I don't agree. To gain acceptance by PBMs, Mannkind needs to either be cost competitive or demonstrate that covering afrezza will save the PBM money in the long term. The latter likely will require another extended trial with a better dosing protocol. Also, I suspect that if insurers were were more accepting of the product, doctors would also be as well. You are mostly right, but you do need to change PBM to insurance company in the sentence. If insurers can save money then the PBMs will put a drug on formulary; it is that simple. PBMs make their money by filling scripts efficiently and via the rebates they get, but ultimately their customer is the insurance fund writing the checks. Most of the MNKD advocates assume a fairly logical progression: rapid acting insulin --> fewer excursions from desired glucose ranges --> overall reduction in HbA1c --> rapid elimination --> fewer hypoglycemic events --> improved control of diabetes --> fewer adverse health consequences --> reduced cost for payors. While that sequence is completely logical, it is entirely theoretical. There have been many drug and medical device innovations which should have reduced long-term cost but didn't do so by a sufficient amount to make it cost justified, and the insurance industry has become skeptical of any claim that is not backed up by long-term economic analysis. The right way to do a clinical trial would have been to track Afrezza against lispro, not just on clinical parameters, but on patient adherence and overall cost burden as well. There are still relatively few examples where pharma companies do the economic modeling up front, but it is necessary just the same to drive acceptance. Shareholders asserting that the faster the insulin works the better the economic outcomes is not going to get the job done. Pharmacoeconomic studies are not quick, cheap, or easy to conduct, but that is the only thing that is going to move the needle in the right direction. It is probably at least a five year study once underway. |
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Post by sweedee79 on Apr 15, 2018 13:30:31 GMT -5
Unless I'm missing something.. It's sounding and looking more and more like Mnkd needs a partner to get this all done..
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Post by tlundy on Apr 15, 2018 13:35:52 GMT -5
I don't understand why insurance coverage is perceived as such a big obstacle. Of course the more coverage the better but current unrestricted coverage is 25% of lives and restricted is 40%. Isn't that enough coverage to support a significantly greater market penetration than we currently have?
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