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Post by agedhippie on Aug 2, 2024 13:30:23 GMT -5
Perhaps missing that companies that sell CGMs aren't going to set sales goals for another company's product ?? Granted I only have one career's worth of experience, but I've never encountered that arrangement. And there is also the thing that lack of sales reps has never been the problem with Afrezza. If all we needed was "rep"ing, MNKD could just hire them... especially now that we are profitable. What is the measure CGM manufacturers use to set sales goals? Is it a simple trend of what they've been able to sell? Or do they look for strategies that help them expand how many CGMs are in use?
The CGM sales people have never had a tool to be able to show anyone in as much time as it takes to do a sales call, the wonder of their product.
I'm not sure how practical it would be, but I would want to start the sales call by chugging a coke, wait 15 minutes, and then inhale a cartridge of Afrezza. You might be able to accomplish a visible spike, and reduction, in less than 30 minutes. Certainly within 1 hour. (Hopefully I wouldn't have more than 2 sales calls in a day. The issue is that the CGM salesman is there to sell a tool, not change diabetes treatments (that's the endos' job). The endo is going to prescribe that CGM regardless if the patient is on insulin. There is no up side for the CGM vendor in presenting Afrezza.
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Post by agedhippie on Aug 2, 2024 9:58:24 GMT -5
... Look, there is nothing better to demonstrate the power of a CGM than afrezza. Inhale-3 proved that. With the CGM and afrezza the PWD can make real-time corrections. They are not looking in the rear-view mirror. They have forward looking radar with afrezza. This is irrelevant to the CGM manufacturers. They have demonstrated the benefit of CGMs for insulin users in clinical trials to the satisfaction of the insurers and Medicare. At this point they have made the sale as anyone on insulin can have a CGM covered by insurance or Medicare. They have moved on to non-insulin users and are build their case there, so revisiting insulin has no value to them.
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Post by agedhippie on Aug 2, 2024 8:41:16 GMT -5
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Post by agedhippie on Aug 2, 2024 8:10:32 GMT -5
Can a CGM manufacturer “rep” an insulin? In principle you could, and there are freelance agents who do that. The problem is that there is zero incentive for Abbott or Dexcom to play ball. They don't care how effective the insulin is, in fact CGMs are more important with more unpredictable insulins, they are selling CGMs and not a diabetes drug.
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Post by agedhippie on Aug 2, 2024 8:00:29 GMT -5
Refresh my memory. Is PH-ILD the market that is “10x” the size of the current PAH market? If so, can it not sustain multiple competitors whose stock prices benefit from the revenue? I don't know about the size, but BoA reckons that it's big enough for UTHR and LQDA not to be able to fill it between them. The PAH market on the other hand is rather crowded, and sotatercept is threatening that market.
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Post by agedhippie on Aug 1, 2024 20:17:07 GMT -5
U.S. RESEARCH ROUNDUP- 08:57:41 AM ET, 08/01/2024 - Reuters United Therapeutics Corp : Leerink Partners raises PT to $350 from $344 * United Therapeutics Corp : Morgan Stanley raises PT to $337 from $321 BofA Global Research cuts PT to $280 from $303 Scratches head looking at "BofA Global Research cuts PT to $280 from $303" What is BofA looking at that the others are not, or, what are they missing? Pretty big ($57-70) difference between the PT's. I am guessing here, but.... given the Tyvaso revenue estimate miss I suspect that they think with PAH competitors coming on line, sotatercept in particular, that Tyvaso sales get impacted and it is by far UTHR's best seller. Personally I think it depends how fast the uptake is in the PH-ILD market since that is where BoA sees most of the opportunity for LQDA and UTHR. Label this as speculation - I don't know the reason for the BoA downgrade and that ^ is partly based of a JPMC article on UTHR earning.
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Post by agedhippie on Aug 1, 2024 19:59:47 GMT -5
Where did Robert Ford say he was planning on Icodec getting approved to boost Libre sales? Icodec would have been a replacement for a patients' existing basal insulin, not be a net new patient so I find it hard to believe. ...He said he was very confident they could get the SoC changed to have icodec added to T2 treatment in an early stage before GLP1 as it would reduce A1c and be a lot cheaper than the GLP1 and only 1 shot a week. That was his plan. Now he needs a new plan. ... Where did he say Icodec would get the SOC changed which seems very hard to believe since it is just basal insulin (and I am still waiting for where he said Icodec would boost Libre sales)? I can understand that you think if he was you he would do this. But that's not the same as him doing this.
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Post by agedhippie on Aug 1, 2024 17:04:49 GMT -5
I can't speak for Kevin Sayer but I know Robert Ford predicted his Libre would hit $4B but he was expecting icodec to get approved and he was planning on this. Afrezza without pre-auths solves his problem without fighting for CGM coverage with GLP1s.... Where did Robert Ford say he was planning on Icodec getting approved to boost Libre sales? Icodec would have been a replacement for a patients's existing basal insulin, not be a net new patient so I find it hard to believe. Basal is where he see's the biggest opportunity - this line from the last earnings call talking about growth potential for Libre: "Obviously, the basal opportunity is the biggest one, and we're doing -- having great progress over there." So as you can see, no concerns on the basal market (or the failure of Iodec to get approved).
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Post by agedhippie on Aug 1, 2024 7:48:35 GMT -5
...Once afrezza has insurance without pre-auths Abbott and DXCM can sell afrezza into the Medicare market so they can sell their CGMs. Why would that help? The first step in the SoC is basal insulin and that already qualifies the person for a CGM. They don't need to go the extra mile because they already have the sale. Besides, right now Dexcom and Abbott are focused on getting CGM cover for non-insulin users and are running trials to build that case.
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Post by agedhippie on Jul 31, 2024 16:23:42 GMT -5
Someone doesn't seem to like what's being said. The current $17 drop in UTHR share price is a very interesting reaction to what I would have thought was a very good financial report based on Michael Benkowitz, President and COO reporting their, "...fifth straight quarter of record revenue...". Did they have unusual expenses and report a poor EPS? The revenue was way over estimate, $7145M vs. $692M estimated. However the EPS was $5.85 vs. $6.50 estimated. Most of that gap was down to increased R&D spend, $140M vs. $114M. Combined with a miss on estimated Tyvaso sales, $398M vs. $400M with nebulized Tyvaso sales missing $139M vs. $151M estimate (t-DPI beat at $258M vs. $257M estimate) this was why the share price dropped like it did. For MNKD the result with T-DPI was good, but it looks like that was at the expense of nebulized Tyvaso so UTHR got penalized because Tyvaso sales are seen as a big deal for UTHR as they are over half the revenue.
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Post by agedhippie on Jul 29, 2024 19:42:41 GMT -5
Aged, it seems out of character for you to quote Hirsh and Stevil as for your reasons not to try Afrezza based on such small sample sizes. Example: "some of Hirsh's patients" and "one of Stevil's". Seems like you would want larger sample sizes to support your hesitancy. I would love larger sample sets (as you noticed), can we have them please! But I have to take what I can get. As to the Hirsch quote, I simply repeated what he said, and he is probably the most influential of the KOLs advocating for Afrezza IMHO.
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Post by agedhippie on Jul 29, 2024 18:33:10 GMT -5
Again, this is a true statement - The Standard Of Care does usefully (usually) influence writing of prescriptions. However this is not - all that is needed is to convince the consortium of folks that determine the SoC that Afrezza should be first in line for use at mealtime. To "convince" is not an easy task. This "convincing" not only takes trial data but it also takes political sway. It requires MNKD to overcome the lobbying of Big Pharm and BP does not want afrezza disrupting their $100M market. Bill from VDex suggested a 50k user base is the number needed to overcome their lobbying.Does Bill actually have experience working with the ADA SOC setting process, or is that merely his speculation? Seems they have spelled out criteria based on trial results and no indication that number of patients using a therapy is taken into account. ... I don't know how Bill arrived at that number, but it is pretty close to 10% of Type 1 diabetics using RAA. The ADA is data driven when it comes to the SOC. They are crystal clear on how they reach their decisions: Methodology and Procedure. The approach is exclusively evidence approach except for the lowest grade which is KOL members of it's Professional Practice Committee ( Expert opinion E is a separate category for recommendations in which there is no evidence from clinical trials, clinical trials may be impractical, or there is conflicting evidence). In other words clear clinical trials trump KOL views. The relevant evidence classification table from the earlier link is here: ADA evidence-grading system for Standards of Care in Diabetes
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Post by agedhippie on Jul 29, 2024 8:15:36 GMT -5
It's easy to say "be 100% focused on insurance", but without an action plan it's just wasting resources. What do you suggest he does that will get traction with the insurers and avoid this? What I propose is Mike earns his salary. Thats what he is getting paid for. My job with MNKD is to invest and let my voice be heard. ... So, no idea at all how he can achieve it, that's what I expected. I think it's far more productive for Mike to follow things where he can actually move the needle rather than chase rainbows.
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Post by agedhippie on Jul 29, 2024 8:10:48 GMT -5
You say "If the results were not good, aren't you going to say he is purposefully using it incorrectly" - How would that be possible? We have ... This is an extended ramble that beautifully illustrates why I would not come within a million miles of this idea. Insulin is a drug that keeps me alive, it's not entertainment (food logs??? daily charts??? WTF )
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Post by agedhippie on Jul 28, 2024 16:25:23 GMT -5
Because the kids trial is going to be outstanding and its the right thing to do for the kids. Mike needs 100% focus on insurance. It's easy to say "be 100% focused on insurance", but without an action plan it's just wasting resources. What do you suggest he does that will get traction with the insurers and avoid this?
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