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Post by digger on Apr 15, 2018 19:38:09 GMT -5
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Post by mnholdem on Apr 15, 2018 19:50:21 GMT -5
Non-Preferred is NOT EVEN CLOSE to "Not Covered" so your link is irrelevant. Perhaps the time will come when Afrezza will be the preferred insulin. In the meantime, coverage is as expected, maybe even better than expected nationally for a relatively new insulin.
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Post by sweedee79 on Apr 15, 2018 20:54:00 GMT -5
Thank you mnholdem.. I really needed your positivity .. this has been one heck of a ride.. still hanging in there... if anyone can pull this off it's Mike.. And Dr. Kendall..
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Post by digger on Apr 16, 2018 0:02:13 GMT -5
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Post by mnholdem on Apr 16, 2018 3:21:00 GMT -5
Medicare coverage for Afrezza is poor and this forum covered that topic back in January when new 2018 Medicare formularies showed no significant improvement over 2017. Coverage in the commercial channel is considerably better and continues to improve. No disrespect intended but you are providing links for formularies in Vermont and at a few universities that are low population areas which barely register in comparison to national numbers.
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Post by digger on Apr 16, 2018 9:54:18 GMT -5
Medicare coverage for Afrezza is poor and this forum covered that topic back in January when new 2018 Medicare formularies showed no significant improvement over 2017. Coverage in the commercial channel is considerably better and continues to improve. No disrespect intended but you are providing links for formularies in Vermont and at a few universities that are low population areas which barely register in comparison to national numbers. I searched for "express scripts 2018 formulary." The links all represent Express Scripts customers who use the company's pharmacy benefit management. The lists are all the same regardless whether they were from a large corporation like Symantec or a branch of state government or a large university. I couldn't find one that had afrezza listed. Do you have reason to believe a different list exists somewhere that does show afrezza as covered by Express Scripts? Can you find anyplace whose PBM is Express Scripts that provides afrezza coverage? Furthermore, formularylookup claims that afrezza is "preferred" under New jersey Medicaid. Well, here's their formulary -- fm.formularynavigator.com/FBO/4/New_Jersey_PDL_English.pdf. Humalog, novolog, and apidra are all there but not afrezza.
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Post by tlundy on Apr 16, 2018 10:41:59 GMT -5
The Formulary tracker shows 65% of commercial lives covered (with 25% unrestricted) and that number was corroborated by the latest materials from management stating that 70% of commercial are covered. investors.mannkindcorp.com/static-files/68a15775-613a-4bd1-b839-08bf5543dcb7However, even assuming for the sake of argument that the number is actually much lower (e.g., 25%), a 25% market penetration would produce close to $2 billion in revenue according to managements' projection of $70-100 million per 1% market share. This is is why I don't understand the argument of those who say they Mnkd cannot succeed until better insurance coverage is achieved.
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Post by brotherm1 on Apr 16, 2018 11:01:03 GMT -5
Don’t know how little we have of these, but I’m certain we don’t have near enough tier I or even tier II coverage.
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Post by casualinvestor on Apr 16, 2018 12:07:45 GMT -5
It's hard to believe that access to Afrezza is a major problem for total script sales. It's a *significant* problem for individual people who have the wrong coverage, but overall (from OOG's posts): 15 Mar 2018 Afrezza----452 $589k 245 $323k Apidra----6687 $5.0m 2367 $1.89m Novalog--136k $132m 57.4k $59.2m Humalog-155k $146m 67.7k $62.2m Humalin--38.8k $21.2m 15.9k $8.6m Getting 1% market share would be the equivalent of $3M/week in Symphony sales. The the difference between 25% coverage and 70% coverage seems moot when you just want 1% of the overall market (to start anyway )
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Post by ilovekauai on Apr 16, 2018 12:14:45 GMT -5
I'm encouraged by reviewing these posts that MNKD is now on the right track to rope in the insurance coverage component of this wonderful life changing drug, Afrezza. I feel more at ease now on this front. Thank you all for the digging.
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Post by digger on Apr 16, 2018 12:38:52 GMT -5
The Formulary tracker shows 65% of commercial lives covered (with 25% unrestricted) and that number was corroborated by the latest materials from management stating that 70% of commercial are covered. investors.mannkindcorp.com/static-files/68a15775-613a-4bd1-b839-08bf5543dcb7However, even assuming for the sake of argument that the number is actually much lower (e.g., 25%), a 25% market penetration would produce close to $2 billion in revenue according to managements' projection of $70-100 million per 1% market share. This is is why I don't understand the argument of those who say they Mnkd cannot succeed until better insurance coverage is achieved. My main argument is that formularytracker may be wrong. Like I note with those links, they make claims about Express Scripts coverage and Medicaid coverage, but when you go and actually look at the formularies of the companies and the states listed as having coverage, you can't even find afrezza. Mannkind might be saying afrezza is 70% covered, but have they ever specified who, where, and how -- PA, ST, etc requirements? Prior authorization is difficult. You can tell how difficult by the demands made by the form that MannkindCares requests doctors fill out. Consequently, PA, ST, and other requirements become major hurdles. Has Mannkind ever mentioned the number of prior authorizations they have attempted and how many have actually succeeded?
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Post by tlundy on Apr 16, 2018 12:56:09 GMT -5
Assuming you are right that some of the numbers are off, are you suggesting that there isn't enough insurance available for even a 1% market penetration?
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Post by traderdennis on Apr 16, 2018 18:52:28 GMT -5
The Formulary tracker shows 65% of commercial lives covered (with 25% unrestricted) and that number was corroborated by the latest materials from management stating that 70% of commercial are covered. investors.mannkindcorp.com/static-files/68a15775-613a-4bd1-b839-08bf5543dcb7However, even assuming for the sake of argument that the number is actually much lower (e.g., 25%), a 25% market penetration would produce close to $2 billion in revenue according to managements' projection of $70-100 million per 1% market share. This is is why I don't understand the argument of those who say they Mnkd cannot succeed until better insurance coverage is achieved. Just because a commerical life is covered, does not mean it is easy to acquire a drug, even on Tier 2. For example most ED drugs require that a user be over 50 years of age, or they have to fill out pre authorization forms for each prescription, even if they use the preferred drug on tier 2. As a former member of Kaiser, typically tier II drugs are only prescribed by specialists and the users need to of failed a treatment using the generic tier one protocols. And then, their is incentive for the doctors to use the cheapest (to KP) tier 2 protocol before advancing to more expensive alternatives. Earlier in the thread they mention Afrezra on Tier 2, but it still does not make it easy to get at KP, especially the KP socal group. By the way each KP region is independent of each other so if KP Tennesse has a drug on tier II, it does not equate to KP Socal or any other KP having equal treatment of the drug.
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Post by nadathing on Apr 16, 2018 22:16:48 GMT -5
If I were on Afrezza my copay would be $75 for 3 months. That is down 50% from 2017.
Afrezza: You pay 2% of the cost. Your Plan pays $2,931.36 / 3 months
I pay the same for Trulicity.
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Post by digger on Apr 16, 2018 22:18:53 GMT -5
Assuming you are right that some of the numbers are off, are you suggesting that there isn't enough insurance available for even a 1% market penetration? No, I'm just suggesting that you can't rely on formularytracker to assess the current insurance situation. You can tell the significance of insurance by looking at otherottawaguy's posts of competitors sales -- Apidra 6,693 $5.16m/Novalog 137,000 $133m/Humalog 155,000 $144m. Despite being cheaper retail than either humalog or novolog, Apidra coverage is almost as bad as afrezza. Even if afrezza caught up with apidra, would it be enough to for Mannkind to break even? Regardless, based on my googling, ignoring the difficulty of the illness itself, the expense of managing it is far above any other concern. I do think that with humalog and novolog invariably tier 1 or 2 in every insurance company, the cost differential to the diabetic them at a large competitive advantage.
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