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Post by stevil on Nov 23, 2015 19:15:14 GMT -5
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Post by stevil on Nov 23, 2015 18:59:26 GMT -5
You were right regarding your comment pertaining to nasal steroids. It was common for intranasal steroids to be excluded, but that's only because Flonase was generic. Nasonex, Omnaris, Rhinocort, and others, would typically be denied coverage because fluticasone (generic flonase) was available for 25% of the cost of those different brands. On most plans, those other drugs would have needed a PA from the doc, with an explanation that fluticasone didn't work and they needed to try X because _____.
I can't say with 100% certainty, but pretty close- I don't think insurance companies make those kinds of deals with pharmas to only accept their drugs and not their competitors. Drugs are excluded from formularies based solely on cost. I can't imagine the FDA would allow certain pharmas to monopolize an insurance carrier (generics can be manufactured by anyone), nor would it be in the insurer's best interest to do so- they would surely piss off their customers. It's why you see a drug get added to the formulary if enough people complain about it...
Excluded drugs are denied coverage at the choice of the insurance company because they couldn't agree on the value of a drug with the pharmaceutical company. If SNY wanted to lower their price, insurance companies would cover Afrezza. I don't believe Novo or Lilly are strong-arming insurance companies, at least not in broad daylight.
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Post by stevil on Nov 23, 2015 18:27:45 GMT -5
Very interesting article, SO why isn't SNY offering Afrezza at a steep discount as opposed to an absurd 3-4x price tag with a "non-inferior" label to boot. Has it not been on market long enough for them to discount (even though it's not selling)? It's still a bit of a "chicken or egg" scenario [insurance, advertising, doctor education etc.] but SNY doesn't seem to be willing to supply either the chicken or the egg, so the process cannot begin. Bottomline: No Omelettes for anyone [shareholders, diabetics, SNY, MNKD]. Maybe there are exclusivity deals already in place for Novo and Huma that must run their course before they can add Afrezza at any price. Maybe SNY is willing to heavily discount. I know I don't have the answers... just throwing out possibilities. DBC, Where did you get your exclusivity theory from? SNY already has a prandial that is well-covered- Apidra. There have been very few true exclusivity coverages that I saw, and even if they did exist, it would only be with one specific insurance carrier, not across the board. And the only one that I can really think of off the top of my head is ProAir/Ventolin HFA inhalers. And the only reason one would be exclusive is because it's the exact same medication (albuterol), just branded differently. So, of course the insurance company would want to protect exclusivity if they could provide the same medication to their client at a cheaper price. I've never heard of exclusivity being tied to drugs with a different molecular composition. People respond differently to different chemicals. It wouldn't be in the client's best interest to limit their options...
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Post by stevil on Nov 23, 2015 17:17:55 GMT -5
Nice to know everyone is writing eulogies to to the dearly departed. I suspect there are many more chapters to the MNKD story, and Wall St. corruption is not the thing keeping MNKD down. Execute on the sales and marketing initiative for Afrezza and everything else becomes minor. No eulogies, yet. But dismal for sure. We're in the hospital, at the moment, needing to be nursed back to health. My argument is that there are barriers that should not be there that could likely be the cause for not increasing marketing and, thus, sales. Let me explain just one point. It's possible that Afrezza isn't selling because docs don't want to go through the hassle of spirometry. That's not really what I meant by WS corruption. But it's a restriction that shouldn't exist. People have been inhaling medications for years, and far worse chemicals than an inert substance that has shown near 100% clearance. In other words, it's as though that particle never entered your system. Coal plants and pollution from our automobiles are infinitely more harmful to our lungs than these particles. Yet no one cares about restricting those because there is big money behind both. So no, I'm not talking about hedge funds or market manipulators when I talk about corruption. Maybe I shouldn't have stated it being WS. My point is that there seem to be unnecessary roadblocks prohibiting the success of Afrezza. I'm now concerned those same roadblocks may apply to all future TS applications. Those roadblocks are farther "upstream" in the marketing process. Meaning, if doctors don't want to bother with the hassles of prescribing, why advertise for it? It'd be a waste of money. To DBC's point, I do not know anything specifically about that scenario as it pertains to Afrezza. I do know that it is true- there are drugs with "preferred" status, but that would not limit the complete coverage of Afrezza. It would just be in a different tier. Whether that is happening or not to us, I do not know. But like I said, it would not stop Afrezza from being covered altogether.
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Post by stevil on Nov 23, 2015 17:03:33 GMT -5
I have seen a couple of medical bills in my life. one for $204,000......settled by the insurance companies for $67,000. $3000 of that the co-pay. one for $159,000 .....settled by the insurance company for $57,000. $4000 of that copay.
Do the drug insurance policies work the same way? what I m asking, does the $4,374.12 no insurance annual cost of afrezza go down for the insurance companies to 1/2-1/3 the price, like the hospital and physicians bills do? Is that why the no insurance cost is so high?
Ditto, the question; $1,406.28 annually apidra?
To go into a little more detail than jeremg's post... agree with everything he said, but wanted to add a little more to maybe help clarify. Hospitals and pharmacies set their (out of pocket) prices fully expecting to not receive that amount from insurance companies. Hospitals and pharmacies make contracts with each insurance payer to receive a certain amount of reimbursement. For instance, the OOP cost for one of the drugs I took was over $100. But once I ran that medication through my insurance plan, I got the contracted rate of $4 and change. (Isn't that insane!). My insurance did not pay the difference as I had not hit a deductible yet. That was just the difference between contracted rate and the "cash" price. So, with the same insurance, you may find the same medication cheaper at a grocery store chain rather than a Walgreen's or CVS, which typically have higher contracted rates because they actually count on their pharmacies to make them money. Local grocery stores/Walmart/Costco, on the other hand, are consistently selling their drugs below cost of dispensing in order to draw customers into their store to buy other products with a higher profit margin. So yes, each plan and each pharmacy has its own contract. If you have a flat copay, you'll pay the same price at each pharmacy. Some plans, though, pay a certain percentage of the contracted price between pharmacy and insurance company, so you may find the same medication is cheaper, depending on where you have it filled.
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Post by stevil on Nov 23, 2015 16:51:57 GMT -5
Given that Warren famously only invests in things he understands... I think I can't possibly qualify my investment in MNKD within the Buffet investing sphere. I think I understand Afrezza, but I don't understand the pharma business. I suspect there are others here in similar situation. I can't imagine there are too many out there with the kind of experience I've had. I've worked with docs, know the science (biochem major, med school student), worked in a pharmacy, worked with insurance companies... All this to say, the only experience I lacked was WS corruption. And that's not really something you can predict. You're basically at the mercy of someone else that has more ability to assert their will than you do yours. I still contend that this SHOULD be a good investment. For whatever corrupt reason, it is not at this moment. You can't tell me that COPD patients that have been taking inhaled steroids for years (steroids have much more potential for harm than FDKP that has nearly 100% clearance in urine) shouldn't prove the safety and efficacy of inhaled medications. Spirometry should not be required. It makes sense to list asthma and other breathing complications as contraindications for Afrezza, but people with no prior lung issues should not have to restricted at all. There are far worse drugs out there. Birth control pills have been linked to a higher incidence of sterility and breast cancers. People who smoke while taking them can suffer fatal blood clots. I have family members on bowel anti-inflammatory meds that have been shown to cause lymphoma. There are very few drugs without risks. That's what the black box warning is for. Those working behind the scenes have an agenda to push to do as much as they can to make sure this drug does not succeed. There's no way we could have been aware of those without time exposing those evil intentions. That's why it's always crucial not to invest more than you can afford to lose. Wall street has become a casino. Unless you're going to stick with mutual funds or invest in stable companies that pay a dividend, you're going to be at risk of losing your money. Even though I am not pleased with the way my investment turned out, I do not regret my mistake. I played by my rules. I did the things I was supposed to do. The results just didn't turn out in my favor. Sometimes that happens. So I've been trying to learn as much as I can about this experience and apply it to the next one...
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Post by stevil on Nov 22, 2015 20:17:38 GMT -5
Pardon me, Jewish. That's what I meant... Hate citing wiki as a source, but I hope you'll accept. Let me know if you need DNA evidence to confirm. Lab is on standby. Thanks in advance. en.wikipedia.org/wiki/Alfred_E._Mannstevil, I am quite sure jpg, is aware of Mann's religion. Could you simply have acknowledged your error, without the tail comment Just because we share a sandbox, must we act like children? You're right. I threw mud back instead of just wiping it off my face. I usually ignore the haters, but there are a couple who still get me to engage them. Personally, I enjoy the banter but I can see how it's distracting for others. My apologies to you, od, and anyone else whose experience gets ruined by me and the jpg's of this board. I can't control them, but I'll do my best to do my part to keep this board free from our squabbles.
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Post by stevil on Nov 22, 2015 15:24:08 GMT -5
I've been saying this for a while.
Something>>>>nothing. SNY has sunk a lot of money into Afrezza. You'd think they'd rather recoup something rather than nothing. Afrezza is currently sitting at the 2 yard line. It's a viable, FDA-approved drug. The expensive, heavy lifting has been done. Just need someone to take it the rest of the way in.
More speculation, but I can't imagine this isn't malicious*. While I don't have the authority to say this, they shouldn't have a problem recouping any marketing costs if they just got Afrezza covered. Especially if it's as great as those here and in social media have described.
edit: malicious unless there are studies being done that we aren't aware of that will increase the value of Afrezza to what SNY is asking. Then yes, don't budge on the price. But, as it stands now, they will never get Afrezza covered for that price.
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Post by stevil on Nov 22, 2015 15:17:32 GMT -5
Teva is one of the most brutal and cheap partners. A last chance choice. Yes they are capable but mostly of stripping most of the value out of their partners. nd you want a lawsuit friendly partner? Again the king of lawsuits: Teva. As long as pumping a partnerhip (based on nothing) we should use Novartis (Sandoz also). Now that is pumping I could actually see as good pumping while to me the Tevs pumping is almost bashing... so sorry jpg. more like no way out I will stop the thought.
peppy, I appreciate people like you who enjoy research and lay out evidence for others to dissect. jpg, Not trying to come at you in spite of you trying to chase me off. Do what you think you must. but back to peppy, don't let people scare you off or make you feel small for having an opinion and sharing your thoughts. Some people on here value your contributions. It's up to the mods to decide if they want to revoke posting privileges. Don't let any of the others on here who want to play board police deter you from sharing. Because like I said, some of us appreciate it. The way I use this board is a strategy room. Throw up an idea and keep dissecting it until you can throw it out. Then move onto the next one. Others would prefer this be a facts only forum. To each their own. But be who you are, peppy until the people who run this site tell you it's not allowed.
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Post by stevil on Nov 22, 2015 14:59:41 GMT -5
This tells me it's clearly SNY that doesn't want to get Afrezza covered. They think it's worth likely twice the amount insurance companies will want to pay for it.
Insurance companies have the leverage right now. They don't need Afrezza. Afrezza needs them...
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Post by stevil on Nov 22, 2015 14:42:23 GMT -5
Thanks for your input, benyiju. This board would cease to exist without opinions and speculation because there is no news to report.
Sometimes throwing out stuff until it sticks isn't a bad plan. Because at least you can narrow down what is plausible vs what isn't.
Maybe it's just the scientist in me that enjoys making hypotheses and then testing the validity of it before throwing it out...
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Post by stevil on Nov 22, 2015 14:38:06 GMT -5
Speculation over the TASE listing. Why list on an Israeli market? Sure, Al is Israeli, but are you going to chalk up the TASE listing to charity from Al's pals to keep MNKD afloat? If not, there's clearly more here (or should be... ha maybe there isn't) than meets the eye. The link? TEVA is based in Israel and we just opened up a listing on an Israeli stock exchange. Could be something, could be nothing. But I'd consider that to be just a fraction above miniscule. It fits, and honestly, doesn't make much sense otherwise. What else is in Israel that's relevant to a biopharm to prompt this listing? Serious question as I don't know... Mann is Israeli? Really? Do you have a reference for that 'fact'? Pardon me, Jewish. That's what I meant... Hate citing wiki as a source, but I hope you'll accept. Let me know if you need DNA evidence to confirm. Lab is on standby. Thanks in advance. en.wikipedia.org/wiki/Alfred_E._Mann
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Post by stevil on Nov 22, 2015 14:22:04 GMT -5
quote; Could you give me one small miniscule clue to why so many seem to repeat this Teva thing so often? reply; yes. For months I have been reading, looking up chit... I really had no clue why we were going down the laundry shoot. Then I found out, sanofi has priced us ridiculously for the market. If it is obvious to me now finally, it is obvious to the board and Al. So they have to scramble is my guess. al mann wants this marketed. it has to be priced about 1/2 the present price to succeed. If Al sold afrezza to teva, they could sell it as a successful price point? the goal? Then the exchange listing, all the patents filed... money... I am looking for you all to tell ME. is it possible? would it be a win for AL. would he have afrezza viable? could it be done? I do not know enough to know. said because I would like to see afrezza make it too after learning so much.
Thank you for your response but my questioni is there a small miniscule piece of evidence that there is a link between Mannkind and Tevs? Laker seems to think so but has never provided anything to back that up. Why do we drone on about Teva? Desperation? Simply a vacuum needs to be filled? Speculation over the TASE listing. Why list on an Israeli market? Sure, Al is Israeli, but are you going to chalk up the TASE listing to charity from Al's pals to keep MNKD afloat? If not, there's clearly more here (or should be... ha maybe there isn't) than meets the eye. The link? TEVA is based in Israel and we just opened up a listing on an Israeli stock exchange. Could be something, could be nothing. But I'd consider that to be just a fraction above miniscule. It fits, and honestly, doesn't make much sense otherwise. What else is in Israel that's relevant to a biopharm to prompt this listing? Serious question as I don't know...
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Post by stevil on Nov 22, 2015 2:14:27 GMT -5
I'm sure you're aware of HIPAA laws, so just be careful if you go digging for information. No PHI of course, just general numbers. True, but even looking for Afrezza may pull up PHI on your screen, especially if you're being specific enough in your search to find co-pays. Sorry if I'm coming across as being babysitter but we had people get fired at the hospital for digging around without justification. Every key stroke on a computer is recorded nowadays so just be careful when you dig...
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Post by stevil on Nov 22, 2015 1:11:26 GMT -5
FYI - I work for a mail order pharmacy that does business with all 50 states and Puerto Rico/Virgin Islands. If any one would ever like to know numbers related to AWP, AAC, etc or copays or number of Rx's dispensed over specific time period versus another product, let me know. Some times I get bored at work and start doing random searches on products that interest me; that it is, when I am not day-dreaming about how awesome it would be if Afrezza had the numbers Lantus has had. Also, my gf who is also a pharmacist at a retail pharmacy, was just visited by a Afrezza drug rep! THEY DO EXIST!!! I'm sure you're aware of HIPAA laws, so just be careful if you go digging for information.
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