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Please share the articles if you can. As others in this board have pointed out, these articles are easily among the best that have ever been written by the medical world regarding Afrezza. They are a big step forward compared with the typical medical journal articles regarding Afrezza that we have seen in the past.

Per Mike, there are over 3,000 doctors who wrote one or more prescriptions. With our cumulative prescription at around 30,000 (per Symphony). On average, each prescriber wrote about 10 prescriptions. Excluding some top prescribers, most of the prescribers on average probably have wrote 5 or less prescriptions.

cathode, I clicked on the "find a doctor" link and it does not work.

Here is my cash projection for Mannkind. It appears we do have sufficient cash to last through March 2017, assuming:

(a)    Matt and Mike tries everything to keep the cash burn flat (10 million per month), which I believe they do intend to;

(b)    Mannkind gets another 10 million under insulin put (while still maintaining the 10 million cash burn, i.e., with increase expenditure on insulin purchase) in the third and fourth quarters combined; and

(c)     Mannkind gets a 10 million milestone from RLS by year end of 2016.


Based on the above projection, Mannkind will have 28.7 million cash and 50 million under ATM at the end of March 2017, with an expected TRx around 1,000.  If during any time from now and through March 2017, SP goes above 2, I would think Mannkind will probably use some of the ATM and therefore preserve some of its cash.  

Based on such progress, I think each of the following events will be likely to occur within a few months (i.e., second quarter of 2017), which will further extend Mannkind's runway much longer:

1.    Settlement payment from Sanofi (even if just forgiveness of existing debt + release of Sanofi's lien on the Mannkind headquarter building, which is worth 20 million+ if sold, will be helpful);

2.    an international deal with some upfront fee;

3.    a label change (beneficial for SP and further increase of TRx);

4.    a partnership for epinephrine;

5.    Use of ATM on better SP (with a renewal of ATM registration for future use).   

mnholdem  Totally agree.  Mike C has stated that despite Sanofi's one year marketing efforts, 90% of the PWDs is not aware of Afrezza. But as Mike said, that's a positive right now.  Sanofi reached 627 TRx weekly with "little or no efforts", with 90% of the PWDs not aware of Afrezza. So what happens when 90% of the PWDs is made aware of Afrezza? 

prvs  michaelcastagna yes, apparently, it is a combination of factors. However, for Mannkind to succeed, it needs to address each of these issues.

Since Sanofi drops its efforts in marketing Afrezza, the Afrezza NRx and TRx has steadily declined since Sept./Oct. 2015. To me, that is not surprising or a big concern.

However, the weekly refills has also declined from 250/300 level reached at the start of 2016 to around 160/170 level right now. That is a bigger concern to me. Yes, insurance and reimbursement is an issue. However, since for those users who are already on Afrezza, these should be less an issue. Plus, even though NRx are relatively low in the first half of 2016 and retention rate is not satisfactory, a part of the NRx is nevertheless being turned into refills each and every week, therefore, ideally, our total refills should still steadily increase despite these factors. To me, the steadily dropping of weekly refills suggest that some users are dropping out after one or two refills and that the numbers dropping out of the refills exceeds the numbers being added via NRx.  That is worrisome. To me, most likely, those who drop out of the refills did not titrate Afrezza well to give them the good control they wanted. 

To me, a steady rise of refills is even more important than a steady rise of NRx. As long as we can retain a great majority of the existing users, refills will keep rising, no matter how small the NRx is. On the other hand, even if the NRx is high, if we keep loosing users (even after one or two refills), our TRx will not rise significantly. 

I would think it is important from now on that Mannkind makes every effort to make sure that each new user is followed up in the initial 7-10 days. Do not know whether it is doable or not. But perhaps Mannkind gets the patient's contact information through their enrollment of the Afrezza co-pay card? Maybe some of the nurse educators can follow up on these new users and to the extent a new patient has any titration issue refer the patient to a titration specialist/doctor engaged by Mannkind?

In terms man power, since we are probably talking about 1,000 new patients every month at most at this moment, that will be 250 per week or 50 per day. I would think Mannkind does have the resource to follow up with these new patients. However, I do not know whether the current medical practices allow them to do so. 

Also, is it possible for Mannkind to create some type of Afrezza community site like the Amazon Q&A service? In Amazon, for every popular product, there is a section called "Customer Questions & Answers". Where a user can post any question and other users can answer the question. All the questions and answers are archived and searchable. A user can get lots of useful information about a product by looking through these Q&As. The keys is that all the questions are answers by Amazon's customers and no Amazon representative is involved.  Additionally, based on my experience, if you post a question, someone will very timely answer the question. This an excellent example of cloud sourcing.

Based on how well Afrezza has worked for some of the early adopters, perhaps a similar Afrezza Q&A community can be supported and monitored (but without actual involvement by any Mannkind employee) by Mannkind?  Any Afrezza user will share their experience solely as a share of their personal experience (not as a medical advice).  

I think in such a site, initially, we can probably have 20-30 successful Afrezza early adopters to volunteer to each write a few paragraphs about their best tips on Afrezza titration, with several themes, like their typical dosage, timing, how many follow-up doses they will need, how many units and boxes they use every week and month, improvement in their quality of life (weight loss, sleep quality, less diabetic complications (neuropathy, Cholesterol level, etc.), freedom in dining out and exercise, etc.), how to dose for fatty and slow digesting foods (pizza, etc.), how to address dry cough issue (if any), their experience deal with prior authorization and insurance, which insurance they are using, etc.  Those information will then get categorized (like dosage related, gender, age, type 1 and type 2, different food type, etc.), archived and made searchable. This will serve as a good starting point for an Afrezza community.

Above are some of my random thoughts that I throw out for your consideration. They may not be practical, but just in case any of them is helpful in stimulating your creative discussions.