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Post by agedhippie on Mar 2, 2023 8:20:46 GMT -5
Another angle to the current chaos in the diabetes and insulin market is that more eyes from industry thought leaders will be focused on solution options and opportunities for change. Lilly's move forces BPs to take a new and hard look at the near future. IMO, the timing is good and should work to Mannkind and Afrezza's advantage. I think this is absolutely correct. Lilly have basically decided that the insane price for insulin in this country isn't worth the political damage and bad publicity it attracts. They split the RAA market with NVO and the market is stable. What they have done is drop the price to where it is the same as in the rest of the world so they are still making money. Having done that they can focus marketing on GLP-1 and SGLT2 which already make far more money than insulin. Does this benefit Mannkind? I think it's a double edged sword. I can see the insulin market being neglected by BP now the margins are where they should be which should make it easier for the Mannkind reps (not as aggressive competition). The flip side is that Mannkind may well need to match this or be priced out of the market and that will hurt revenue. I think a lot depends on what NVO does.
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Post by agedhippie on Mar 2, 2023 8:08:09 GMT -5
... What I am not clear on is did Lilly cut the price for insulin forms "vial and pen" or just "vial"? Everything I see only mentions "vial". For basal and rapid acting under Medicare the answer is going to be Lilly for form "vial". For form "pen" that will depend on if they cut the price there. For form "inhaled", thats afrezza. The thing is when we talk afrezza everyone thinks of it as insulin. Its is nothing like subq insulin and that is the marketing challenge Mike has. He needs to get doctors to think of it as a totally new type of treatment which may contain insulin but is nothing like insulin. ... It's both, but initially it's only their generic lispro product which is really Humalog (the packaging is the only difference). Towards the end of the year they will apply this to Humalog as well. I suspect that they have supply agreements for Humalog that need to time out. Mike's problem isn't getting doctors to think of Afrezza as a new type of treatment, it's getting the FDA to do that which I think is impossible. It's insulin and the FDA won't move off that. Remember the reps are constrained in what they can say by the FDA rules.
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Post by agedhippie on Mar 1, 2023 22:18:38 GMT -5
Lilly are making money even with the $35 cap. To put this in perspective the UK NHS pays $35 for a box of 5 pens. That would last me for a couple of months. Outside the US nobody pays anywhere near what we pay here. All they have done really is bring the price closer to where it is in every other country.
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Post by agedhippie on Mar 1, 2023 22:13:10 GMT -5
"Not a PWDs so, tell me, if you're on this $25 insulin, how much do you need per day/week/month to control your diabetes and how does that stack up with what you get from MNKD, each month? What are the dollars and cents here?" I read what peppy said but still am unclear [read clueless] was to how the $35 cap for insulin compares for what an ave Afrezza would use in $ and cents. I am just a long invested and luckily not diabetic. Thanks in advance for your help and kindness to this clueless person. Have a look at the "Wondering what the monthly cost breakdown is for a Type 1" a bit further down the page. There are some breakdowns in that thread.
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Post by agedhippie on Mar 1, 2023 18:50:40 GMT -5
.. Aged - have you ever gone to a T2 educational seminar? If so have you asked how many T2s are checking their BG with a meter? Unless they are on insulin they are told it is not necessary not even once a day to check with a meter. ... You need to go to better T2 educational seminars then. Around the hospital groups NYC that is no-longer the case and hasn't been for a couple of years. I can believe that there are parts of the country where they are not as current, but I would question in that case if they are going to promote CGMs either.
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Post by agedhippie on Mar 1, 2023 18:42:37 GMT -5
I guess he saw the ABC trial results and knows the future for mealtime control is afrezza and NVO is getting icodec approved. He is really excited about Mounjaro - lets hope CGMs get approved for 1 daily insulin on Medicare and we can get more people seeing their post meal numbers. Lets also hope Mike gets the study going he mentioned last week for the GLP1s, asap. LLY has it's own weekly basal going through approval as well so Icodec is unlikely to scare them. I think we are going to have to disagree how much CGMs will change the T2 landscape. For years now people there has been the "eat to your meter" mantra in the T2 world for exactly that - seeing the spike after you eat. You will see it as standard advice to T2s on diabetes forums. If you have reached the point of basal insulin you will already know that you spike after a meal. As to the ABC trial results; nobody knows what those are at the moment, it certainly isn't the results they published at ATTD. The ABC trial didn't include any mealtime challenge anywhere so it can't even be part of the trial, check the protocol if you don't believe me - clinicaltrials.gov/ct2/show/NCT05243628. TBH it doesn't really matter (it's not new so the endos won't care) - it's the big follow on trial that will matter.
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Post by agedhippie on Mar 1, 2023 18:30:32 GMT -5
Not a PWDs so, tell me, if you're on this $25 insulin, how much do you need per day/week/month to control your diabetes and how does that stack up with what you get from MNKD, each month? What are the dollars and cents here? agedhippie , pipe up and I know you use pens. ... I use a couple of pens a month. If I was a Type 2 I would expect to be using between three and four times as much so 6 to 8 pens. The key thing here though is that $35 per month cap. If I was a Type 2 that would save me a lot of money. If was on a pump it would be a complete no-brainer financially as I could probably get by on one vial and that would be both my basal and bolus covered.
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Post by agedhippie on Mar 1, 2023 18:10:15 GMT -5
Was it really Toujeo or was it really Adlyxin? At the time that was what they were saying but it never made any sense. They licensed afrezza for the T2 market and they were 100% focused on Toujeo for the T1s. What I have been told is they thought they thought they were getting Adlyxin approved much quicker than it did and GLP-1s were the new hot thing. At the same time Brandicourt did not want to be one upped after Al stuck it to him on Exubera. I would take a Sanofi again if they did what they were suppose to do. They bet the farm on Adlyxin and lost in the T2 market. NVO is next up. They are losing market share to Mounjaro and if CGMs gets approved for once daily insulin, the post meal spikes are going to need a solution as they will be exposed. ... Definitely Toujeo. Adlyxin had already been on sale for a year everywhere in the world except the US (the FDA hates diabetics). Lantus was coming up to end of patent and there were biosiliars just waiting for the expiry. Sanofi dominated the basal insulin market, NVO was a distant second and Lilly didn't have a basal, and Sanofi wanted to keep it that way. That meant they needed to get as many people as possible off Lantus and onto Toujeo. That's where the effort went and why Afrezza didn't get what it needed. Sanofi wanted Afrezza as an RAA replacement so it would be wrong to say they licensed Afrezza for the T2 market. It was the RAA users in general regardless of diabetes Type. You are pinning a lot of faith in peoples reaction to the CGM. Right now they can see the spike by simply taking a meter reading an hour or two after the meal. This is what you see described as "eat to the meter". People are told to note what they ate, the size, and how they reacted then modify accordingly. You will find that advice on most diabetes forums when people ask for advice. The only difference will be a CGM instead of a meter.
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Post by agedhippie on Feb 28, 2023 18:48:56 GMT -5
It sure seems from the many recent posts following the Q4 report, Afrezza might just be on a good path to possibly break the cartel firewall. Going it alone hasn't worked after many various attempts. The countless reasons are now known in hindsight. IMO, attaching Afrezza and its use to existing entities in the diabetes space (BPs and basals) may turn out to be a brilliant strategy to finally achieve acceptance. Let's hope. The problem is that the only company of the cartel with basal but no new RAA is Sanofi None of the big three insulin makers is going to pick up Afrezza, and that cartel has the RAA market sewn up. Right now NVO and LLY are both focused on getting their weekly basal insulins past the FDA and to market so that's where their focus is. Do we want a replay of Sanofi and Afrezza where they focused on bring Toujeo to market over Afrezza? Afrezza has to do this alone which is why it need a big trial.
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Post by agedhippie on Feb 28, 2023 18:37:50 GMT -5
My takeaways from that video; - you have to pick solutions patients want (3:00) - Bluhale will be here in the next couple of months. It will tell the dose from the color of the cartridge. Records timestamp and dose. (Missed my timestamp!) - Nice comment about the endo asking how can they not be completely focused on their insulin and dosing, but people are busy and this stuff takes second place. Hence need for timestamps to see how dosing really happened. (7:40)
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Post by agedhippie on Feb 28, 2023 18:21:18 GMT -5
...
Omnipod, does it really have the life span of a fruit fly (3 days) as the article says and must be replaced? Yes, it's designed to be disposable. You wear it for three days, toss it and slap on another one. No maintenance, and no other parts. It's why it's available from pharmacies and other pumps are not.
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Post by agedhippie on Feb 26, 2023 23:04:36 GMT -5
Aged- Since you’re not an investor, I’ve always been curious why you share your incredible knowledge about diabetes, on a stock MB? Because I have been here for eight years now and I still enjoy it. I am glad you find my knowledge useful.
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Post by agedhippie on Feb 26, 2023 15:44:01 GMT -5
... It can be a great tool, although PWDs will still need to inhale a minimum of 3X daily, if eating three meals plus more if they snack or decide to have a "me day" and treat themselves to a little something-something extra. ...
I also believe I hear you saying that "less is more" doesn't always equate to "less is best"...because of the dynamics I described in my post, at play. ...
As a new PWD...it may very well be those words that encourage someone to take this seriously. As you said, by the way new to me and funny as all get out...You don't want to wind up being the pig. The pump can deal with small quantities of carbs (20g or so) without being told about them so a certain amount of snacking is free. I probably would only use Afrezza at a meal and not for snacks. I would fall back on a bolus from the pump for that. It's not a reflection on Afrezza, but more that I wouldn't carry the inhaler and cartridges around with me just as I don't carry around my pen today (which is not good practice I know!) What makes a new type 1 take it seriously the ambulance ride to hospital where they hook you up to various drips, and the doctor telling you the bad news. I remember saying I didn't think I could inject myself and the doctor saying in that case I would be dead before the next day. At which point I discovered I could inject myself quite happily! Oddly the idea of injecting is considerably worse than the reality - this is also why I think that Afrezza should focus on new Type 1s rather than the existing. I never presume to tell a diabetic how to manage their diabetes unless they very explicitly ask. My view is that we all reach our peace with this disease in our own way and it's not for me to tell them that they are wrong (not least because they may not be). That peace can be via always under 120 (the flatline group), the LCHF diet people trying for minimal carbs, or the minimal involvement group, and hundreds of other approaches. It's about finding a way to feel you have some control, this is mental and not physical. I wasn't quite clear with my breakfast analogy; breakfast is diabetes, the chicken is everyone (especially endos) telling you how to manage it, and the pig is the diabetic.
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Post by agedhippie on Feb 26, 2023 11:02:26 GMT -5
... The thing is its during meals when BG goes whacky. If the PWD never ate and just sat still all day their BG would be pretty flat. That is not reality. If so Tresiba would easily win over the Aid. The advantage of the AID over Tresiba is at mealtime but we see afrezza kicks butt here over the AID. Aged's argument is with afrezza you have to check you BG 60minutes after eating and maybe 90minutes and even 2 hrs. What PWD on a CGM is not going to check? I would say very few. Come on - how hard is it to look at your phone? ... In this part of the study they did not second dose afrezza. They let the AID handle the BG after 2 hrs when afrezza is gone. If they second dosed afrezza with Tresiba there is little doubt it will win. As a diabetic I can tell you that while sitting in a room doing nothing you body is quite capable of messing with your BG. This is the approach that endos take and the over-simplification drives the diabetics I know wild. You end up with the endo saying you must have done something because they cannot comprehend in a tidy universe how it could happen. What diabetic with a CGM isn't going to check? Almost all the ones I know. You check when something feels wrong, or on impulse, you don't check according to a timetable - that's letting diabetes run your life. I can delegate all that checking to the AID, and hey it can do the correction as well! Now I can get on with my life and not think about diabetes. That second dose model is the one that interests me. I have zero interest in the Afrezza plus Tresiba because it's increasing my diabetes workload.
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Post by agedhippie on Feb 26, 2023 10:53:00 GMT -5
... Does an AID dose only at the peak level to begin the correction or does it dose smaller incremental amounts as it catches the excursion gaining traction during that messy day? Also, is there a need to still use a CGM if you utilize an AID?... Does it dose and track your BG? Keeping track of the BG levels seems to be the central piece to managing the disease. Moving on...I would believe when managing the disease, during those "messy moments" you illustrated, why Afrezza should also be included in that management tool kit and here's why. The old adage, "One size fits all does" cannot apply to this disease, period ... This is why it's not as simple as, "Wear this it will save your life" or "Inhale at mealtime"...there's just too many variables, options, lifestyles that require each set of circumstances to define what suits and fits the individual best, given what I've stated. ... It's just me letting it out that I cannot subscribe to the notion that Afrezza can be defeated at every turn, without feeling the same way about other therapies. There are too many unique moving parts with managing diabetes ... IMHO, experienced PWD will choose for themselves what works best for them and they will not be pigeon holed into one therapy or another by their physicians anymore. That was a great post and put a lot of my points better than I have! To the first section; the CGM is part of the AID along with the physical pump and whatever computer (usually a phone) is running the algorithm. The computer checks BG readings every five minutes or so, looks up how much insulin it has given you, and makes sure you are still within the margin of error. If you have strayed outside that for whatever reason, you drank a coffee or your body just decided to mess with you, then it will do a partial correction - rinse repeat. You set a target for where you want your BG to land when you first get the AID, usually around 100 or 120 and it's always aiming for that. The AID works by increments rather than large jump - the tradition analogy is it's like steering a car with large swings being generally a bad idea. The second section is more philosophical. People seem to think I am anti-Afrezza and I am not. I absolutely want Afrezza to continue to be available, but there is an idea that it's a magic bullet. For some people that may well be the case, diabetes is sufficiently diverse, but more generally it seems to be used as part of the toolkit. This is one of the reasons I am so interested in the Single Afrezza dose plus AID approach. I can use Afrezza to kneecap that initial spike, but I don't need to be accurate because the AID will clean up. If I took to much then the AID will reduce my basal to give me room, if I took to little I am dealling with a smaller spike so it's easier on the algorithm. My theory is that by using Afrezza with an AID system I can effectively use the AID as a closed loop system and need not tell it about events at all. Anyway - that's just a theory right now:) I only know a few Type 2 diabetics so this is pretty much about Type 1; The group I know are very engaged in their treatment because it's literally your life, and not amputations or CKD or eyesight or other complications, but dead in less than a day if you get it wrong. That makes it hard to always do what the endo asks, and makes you check everything. There is the old adage about making breakfast - the chicken is involved, but the pig is committed. The two great lies Type 1 diabetics are always told are: there will be a cure in the next 5 years, and this treatment is the magic bullet. Any time someone says that their credibility automatically drops. There have been to many disappointments in the past.
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