|
Post by cjm18 on Apr 15, 2018 13:42:10 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? Yes!!! 70% of people are covered according to mannkind.
|
|
|
Post by plumber7474 on Apr 15, 2018 14:03:57 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? There has to be more to the story. Something there not telling us, or it doesn’t sell..
|
|
|
Post by sellhighdrinklow on Apr 15, 2018 14:10:35 GMT -5
I spoke w a friend, this AM, who has a friend in Tennessee, Kaiser insurance, previously used and loved Afrezza but Kaiser won't cover. I'm unclear how she was previously getting her Afrezza.
Kaiser doesn't cover Afrezza anywhere?
|
|
|
Post by careful2invest on Apr 15, 2018 14:17:35 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.. I agree sweedee! That is what it's going to take to make Afrezza a success! Bottom line! GLTA!
|
|
|
Post by sportsrancho on Apr 15, 2018 14:20:29 GMT -5
|
|
|
Post by centralcoastinvestor on Apr 15, 2018 14:28:13 GMT -5
On this list, Afrezza is listed as a Tier 2 which is great. Am I missing something?
|
|
|
Post by sportsrancho on Apr 15, 2018 14:33:39 GMT -5
On this list, Afrezza is listed as a Tier 2 which is great. Am I missing something? Thats what I see: PROGLYCEM INSULINS AFREZZA APIDRA APIDRA SOLOSTAR HUMALOG HUMALOG HUMALOG HUMALOG HUMALOG HUMALOG HUMULIN 70/30 KWIKPEN HUMULIN 70-30 HUMULIN N HUMULIN N KWIKPEN HUMULIN R HUMULIN R U-500 LANTUS LANTUS SOLOSTAR LEVEMIR LEVEMIR FLEXTOUCH NOVOLIN 70-30 NOVOLIN N NOVOLIN R NOVOLOG Page 36, sorry I’m having a real hard time getting it copied. Although it does say: POS Formulary with Specialty Tier – Last revised 12/22/2015, 36
|
|
|
Post by mytakeonit on Apr 15, 2018 15:05:51 GMT -5
Probably not covered by Kaiser because they are too lazy to scroll down below page 30. Oh, did I mention that I hate Kaiser?
|
|
|
Post by agedhippie on Apr 15, 2018 15:08:10 GMT -5
This might be a stupid question, but is Kaiser Permanente coverage available in Tennessee? Their site doesn't seem to think so. Is this person insured in a different state?
|
|
|
Post by mnholdem on Apr 15, 2018 15:24:39 GMT -5
The obstacle is NOT insurance. I post the formulary coverages every month and there is sufficient coverage nationwide. The #1 issue is awareness/education that is needed before Endos and PCPs will begin prescribing. Docs aren't going to prescribe any drug until they understand it and see a clear benefit over existing treatments, IMO. Patient demand may incite them to learn, but more is needed than what is currently available on the Afrezza HCP website.
|
|
|
Post by straightly on Apr 15, 2018 16:01:57 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. Given that MNKD does not have cash for 5 years,if what you said were true, then MNKD's only hope is somebody with a sh*t load of money to make a big bet on MNKD. As that is not a manageable event, MNKD, according to your theory, is doomed. In practice, thank goodness, there are other ways.
|
|
|
Post by cjm18 on Apr 15, 2018 16:12:37 GMT -5
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. Given that MNKD does not have cash for 5 years,if what you said were true, then MNKD's only hope is somebody with a sh*t load of money to make a big bet on MNKD. As that is not a manageable event, MNKD, according to your theory, is doomed. In practice, thank goodness, there are other ways. Did the two raa’s thet have a majority share of the prandial market have such a study?
|
|
|
Post by matt on Apr 15, 2018 16:29:39 GMT -5
Given that MNKD does not have cash for 5 years,if what you said were true, then MNKD's only hope is somebody with a sh*t load of money to make a big bet on MNKD. As that is not a manageable event, MNKD, according to your theory, is doomed. In practice, thank goodness, there are other ways. Did the two raa’s thet have a majority share of the prandial market have such a study? Those came to market at a different time. Prior to Medicare imposing DRGs for hospital costs, any new product at almost any cost would be reimbursed. After DRGs, hospitals tried to shift cost to private insurance which started the whole managed care movement. Prescriptions were still not a big cost back then; I was involved in setting up one of the first mail order pharmacies and uptake at the time was tepid because there was not that much money to be saved. That was 1990 and the money to be made running a PBM was not what it is now. Now you do have established products that have a foothold and they have killer market share that drives rebates for the PBMs. Back when PBMs started, the insurance companies were no so concerned by what was, or was not, on formulary. Now if you want to add anything to a formulary you had better bring a good economic argument especially if your product is premium priced. Amgen and Sanofi are battling it out in the segment for PCSK9 inhibitors, and both are losing (although Amgen is doing better than Sanofi). The main reason is that these are $14K/year drugs that control cholesterol better than now generic Lipitor for a small segment of patients, but they really don't have the data to avoid pre-authorization and other barriers. It is just the way it is now. It was not like that ten years ago.
|
|
|
Post by agedhippie on Apr 15, 2018 17:55:18 GMT -5
Given that MNKD does not have cash for 5 years,if what you said were true, then MNKD's only hope is somebody with a sh*t load of money to make a big bet on MNKD. As that is not a manageable event, MNKD, according to your theory, is doomed. In practice, thank goodness, there are other ways. Did the two raa’s thet have a majority share of the prandial market have such a study? It's hard to understand now how revolutionary the analogs, both bolus and basal were when they first arrived. When analogs arrived you could actually eat when you wanted to for the first time and not when your insulin dictated. NPH insulin, contrary to most of the idealized curves you see for it was like a switchback with certain times where you could and could not eat (interestingly NPH is used in small doses sometimes used to treat dawn phenomenon because one of it's spikes coincides with the start of the dawn glucose spike). Regular insulin, while a lot better than animal insulin was dose and hope in that it had to be taken so early it was hard to make it work well. Analogs made MDI and intensive treatment a realistic possibility, even(ish) basals, and prandial insulin that let you match the result to what you were going to eat. It is hard to explain how revolutionary this was, endos jumped on it. One of the tangible results is the increased life expectancy of Type 1s.
|
|
|
Post by digger on Apr 15, 2018 18:45:00 GMT -5
Under that plan, all FDA approved drugs are either tier 1 or 2. It appears to be some sort of special plan involving "MedImpact" -- a PBM -- pharmacies: "The Kaiser Permanente POS Formulary with Specialty Drug Tier is an open formulary of unrestricted drugs that are covered under your POS health insurance plan’s Tier 2 benefit. The formulary consists of generic, brand, and specialty drugs when you use a MedImpact pharmacy. Unless specifically excluded under your plan, all FDA-approved drugs are part of your plan’s open formulary." "A point-of-service plan (POS) is a type of managed care plan that is a hybrid of HMO and PPO plans."
|
|