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Post by compound26 on Aug 15, 2016 18:42:20 GMT -5
michaelcastagna Not sure if someone at Mannkind can arrange for a new interview done at Tudiabetes.org. A few happy users of Afrezza post there from time to time. But apparently, the vast majority of the users there have little or no knowledge of the existence or benefits of Afrezza. Sam (Afrezzauser) did one last year. But that was over a year ago. Sam Finta, “AfrezzaUser” Talks About Inhalable Insuline
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Post by compound26 on Aug 15, 2016 16:39:01 GMT -5
spiro michaelcastagna I am taking the liberty copying Spiro’s posts below to create a new thread to see if we can have some discussions on improving the refill rate. "Spiro believes that in order for MNKD's share price to make significant advancement, barring some unexpected positive development not related to Afrezza, it will be necessary for MNKD to meet certain Afrezza sales levels. After studying Sanofi's early launch numbers, Spiro has decided that he would like to see some progress in sales by week 12 of MNKD's launch. At week 12, SNY only had 210 NRX and 257 TRx. It appears that Sanofi was only achieving about a 20% refill rate. S piro's definition of progress is focused not only only on NRx numbers but mostly on the need to reach 50- 75% or higher refill rates. Spiro believes that Afrezza's new packaging will be likely the key to MNKD reaching and easily beating Sanofi's refill rates. Spiro is very confident that Mike and Matt have the pieces in place and the proper strategy to make Afrezza a successful alternative to injecting. Spiro here, just talking to himself out loud and hoping that he is somewhat correct?" Read more: mnkd.proboards.com/user/44/recent#ixzz4HR2DGewZ "Spiro's focus is mostly on refills and retention of adapters. If Sanofi had retained 75% of tit's users, they would still be selling the drug now. The only way Afrezza doesn't work great in most people is improper dosage. The new packaging should keep the costs down for the user and provide the ability to increase dosage with larger meals. Clearly Spiro hopes that NRx will be higher than 212. Spiro wants the TRX to be over 500, which would indicate retention of users. Sanofi only had a TRx of 257 which indicated a poor refill rate. If by week 12, the NRx were 1000 and the TRx were 1100, that would be very troubling for Spiro. Spiro here, it's all about refills and satisfied new users." Read more: mnkd.proboards.com/user/44/recent#ixzz4HR2G3t6KI share with Spiro in that I agree the key for Mannkind's success is to improve the refills rate (retention rate). So it appears to me, right now, we have a great product but a less than satisfactory retention rate. I believe Sanofi has stated about a drop-out rate of 65% sometime at the beginning of 2016. They also referenced about 20,000 people tried out Afrezza. Additionally, at one point, we were told 45,000 samples of Afrezza were distributed by Sanofi. All of these were pretty good numbers, except for the drop-out rate (or retention rate). And in Mike's presentation in the ASM, he said that it won't work when you lose 6 or 7 out of 10 patients every month. Mike also said that, had we had good renewal rate, Afrezza's first year sales would have been in the range of $20-40 million (instead of $7 million). Here is the link to the Mannkind ASM video. vimeo.com/167332167 (Mike's presentation starts at around 22' and ends at around 35'.) So Mike’s numbers match up with Sanofi’s number in that the drop-out rate is about 65% (or higher, if it the drop-out is 6 or 7 out of 10 every month). If we look at our scripts count chart, we have reached to around 250-300 weekly refills at round 1/1/2016. Had we had better retention rate, conservatively speaking, our weekly refills probably would be 400/500 right now and we would we have a TRx of around 500/600 (i.e., matching the Sanofi high water Trx with basically zero promotion and minimal NRx). Besides insurance coverage, prior authorization and reimbursement hurdles (which hurts retention rate), I believe Mannkind (and Sanofi) so far probably have under-estimated the challenges of titrating Afrezza. My impression is that Al and his team may have thought it would be easier for Afrezza users to titrate Afrezza than the with the RAAs. That probably would be true if new users of Afrezza have had no knowledge of insulin generally and RAAs in particular and how to use them. The reality is that Afrezza is more difficult to titrate than RAA because it is a paradigm shifting product and, to proper titrate, a user really needs to first de-learn all his/her knowledge about the usage of RAAs. I am really glad that Mike and his team are taking the right steps and measures to address the retention issue: Mannkind Cares, titration package, the dosing guide, new sample programs are good examples. My main purpose of this post is to initiate a discussion in this board to see if, in addition to the above measures that Mannkind is taking, whether we have some other ideas or suggestions to help Mannkind/users to make the titration process easier and more like a sure success process. Here are a few thoughts of mine just to initiate the discussion: 1. If possible, some type of video or animation guide on titration will be great. Not sure how restrictive FDA is on this or how difficult it will be Mannkind to produce some type of video or animation titration guide, but I would think if it is possible it would really helpful. Mike B. at Austrialia produced a few impressive videos ( afrezzadownunder.com/afrezza-insulin/) and are really informative. I do not how many Afrezza users have benefited from it, but here is one comment from them: My son has more stable blood sugars with Afrezza and Tresiba than he did with OmniPod and Humalog. It reduces highs more quickly and eliminates lows. His A1C had been running 7.0-7.2 and declined to 6.6 after two months on Afrezza. It requires a different mindset, but we learned a lot by watching videos at AfrezzaDownUnder.com. The learning curve was a tough week to two, but was greatly aided by our CGM (Mike is right that CGMs are an idea partner to frezza). Son's quality of life much improved. I can be more specific on any particular aspect if you are more curious. We absolutely love Afrezza. www.tudiabetes.org/forum/t/exciting-news-since-switching-to-tresiba/54986/42?u=charles52. If there a way for pull the expertise of the really successful Afrezza uers together and put them to use (like setting up an Afrezza user community)?
Even among our most successful Afrezza users, I noticed that there are a few of them who basically mastered the timing and dosage of Afrezza to a higher level than the others (as evidenced by their CGM graphs with smooth and flat lines). Afrezza Guy is one of them (see his CGM graph below). I would think Matt B. is another one due to the knowledge he demonstrated in his writings on Afrezza on his blog. Duck Fiabetes NorCal probably is another one (see his CGM graph below. But some may think he may have allowed his BG level to go down too much sometimes). Gustavo Basualdo may be another user that has excellent controls of his blood sugar level.
To this end, we will look at purely how well an Afrezza user is able to use Afrezza to control his blood sugar level regardless whether he/she is well known to the others in the diabetic community. We really need to pool these users and compile their most helpful tips and find ways to share the tips to the new users. I try to the extent I can to compile the useful tips in afrezzajustbreathe.com. However, I do not think the site generates a large traffic to be helpful to a lot Afrezza users. www.afrezzajustbreathe.com/tips-from-afrezza-users/I think to a large extent, as a community, we already have a good amount of helpful information (as evidenced by Matt B's site, my above blog post, Afrezzauser's blog ( afrezzauser.com/afrezza-journey/), many posts on Twitter and tudiabetes.org). However, most new Afrezza users do not know that such information is out there or, if they do, where to get such information. I recall Matt mentioned something about Afrezza Advocate Counsel earlier this year. Not sure if Mannkind is still working on this idea. 3. Timing of taking Afrezza
I believe it is now pretty clearly demonstrated that Afrezza is most effective for most meals to be taken 10-15 minutes after the start of the meal. However, I understand that Afrezza’s label is still limiting the manual to say that Afrezza is to be taken “at the beginning of” each meal. There needs to be ways to let users know that, in this case, “at the beginning of” each meal actually should be translated as 10-15 minutes after the start of the meal. afrezzadownunder.com/2015/10/afrezza-timing-is-everything/www.afrezzajustbreathe.com/tips-from-afrezza-users/4. Dosage of AfrezzaMatt B. has demonstrated that it is best to think Afrezza dosage as small, medium and large rather than 4, 8 or 12 units as he think it is a bit misleading to covert the units between Afrezza and RAAs. Also, he demonstrated it needs more Afrezza to bring blood sugar levels down (once it is up there) than to keep the blood sugar level from rising in the first place. I understand that Afrezza’s label is still limiting the manual to say these things, but finding a way to bring such information to the users will definitely help users to titrate (so that they will pay more attention to the timing of the Afrezza, not afraid of taking large dosage of Afrezza and remember to take follow-up dosage). afrezzadownunder.com/2015/09/afrezza-units-insulincarb-ratios/5. Follow up dosage(s)
I understand for users of RAAs, you generally do not take any follow-up dosage as that will have an insulin stacking issue. However, contrary to that of RAA, due to its short tail, not only it is much much safer to take follow-up dosage of Afrezza (with little risk of insulin stacking), it actually is often necessary to take follow-up dosage of Afrezza in order to obtain optimum control of one’s blood sugar level. How do we best bring this information to the new users of Afrezza.
www.afrezzajustbreathe.com/tips-from-afrezza-users/
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Post by compound26 on Aug 15, 2016 13:28:57 GMT -5
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Post by compound26 on Aug 15, 2016 13:16:19 GMT -5
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Post by compound26 on Aug 11, 2016 10:05:01 GMT -5
He needs to come back. Matt is a nice guy but NEVER allow a CFO to run a company, recipe for disaster.
How did CFOs become the new heirs apparent to CEOs?www.chicagobusiness.com/article/20140927/ISSUE02/309279997/how-did-cfos-become-the-new-heirs-apparent-to-ceos................ As more companies decide not to replace their COO, many CFOs are picking up those duties, expanding their purview beyond finance. CFOs are overseeing operations, IT, supply chain, risk management, HR and even PR. And increasingly, observers say, this knowledge of every facet of the business is making them the heirs apparent to their bosses. ................ The most notable example from the past decade: PepsiCo Inc. CEO Indra Nooyi, who was CFO before she took the top spot in 2006. In the Chicago area, Crate & Barrel's Adrian Mitchell served as both chief operating officer and chief financial officer until August, when CEO Sascha Bopp suddenly resigned, and he took on the top job on an interim basis. |
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Post by compound26 on Aug 10, 2016 13:44:59 GMT -5
i can read your sarcasm, but arent we talking about Mannkind and Afrezza? I honestly wasn't being sarcastic. I was making a point. My reps physically visit existing accounts quarterly at most (less than 10% of our customer base get monthly visits), so weekly visits just seemed absurd to me for a single product. However, my playing field is in the medical devices arena, not drugs.
I also assumed that, in the case of MannKind, Mike hired the nurse educators to handle clinical training so that the sales force could concentrate on adding Afrezza accounts.
500 visits/week equated to 1-2 visits each day (1.67 new physicians detailed each day was the number I used). You guys really think that is too many?
Again, I really didn't mean to sound sarcastic.
, what you stated above sounds reasonable to me and probably is generally the case.  However, for Mannkind, I believe Afrezza reps are indeed making a lot of repeat visits in a short period of time, at least on their top prescribers. Here is what Mike C. said at the 2nd quarter CC: "So when you look at the decline in prescriptions from January through June, a lot of that was the result of people not believing we were going to be around in July and they thought once the Sanofi inventory ran out that was it, the product will no longer be available. So as a result of that, they stopped initiating new patients back in Q1 and Q2. Now that we’ve been out there for almost a month creating our second and third visits, doctors are remaining confident, they’re starting to see our samples and copays. We expect this trend to change quickly around the feedback and availability of Afrezza amongst our top prescribers. And then finally, the social media coverage as well as press coverage from ADA continue to be positive and Ray will speak to that in a moment." |
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Post by compound26 on Aug 10, 2016 11:01:03 GMT -5
Compound26, I agree with all the positives you mention and believe they will have a benefit over time. Maybe the end of September is early but I have to think some impact should be visible by then. If the studies presented at ADA, better marketing and having reps on the street for two months don't have a positive effect on NRx, maybe we really are delusional. Even two new prescriptions per week per rep would float my boat. BTW, it would be great if you could develop your list into an article for SA. We could use something positive to balance the naysayers. thanks. I am not a good writer and plus I have had difficulties in the past in trying to get any article published by SA. So I just posted this simple summary as an instablog in SA (see the link below). You are welcome to share it anywhere you want to. Thanks! seekingalpha.com/instablog/6595801-6595801/4907225-mannkind-s-future-will-bright |
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Post by compound26 on Aug 10, 2016 10:52:08 GMT -5
Market Penetration 2016 Worksheet - Afrezza
Providers – visits in 2016 to endocrinologists and similar high-prescribing physicians to detail Afrezza.
- 60 Territorial/Regional Sales Managers (100% focus on detailing of Afrezza)
- 500 visits/week (1-2 per day x 5 days x 60 Sales Mgrs)
- 9,000 endos and h/p physicians detailed in 2016 (500 visits x 18 weeks*)
* NOTE: 2 weeks dropped for holidays/vacations
Patients with Diabetes (PWD) - visits to physicians detailed in 2016 by Afrezza Sales Mgrs
- 9,000 physicians detailed on Afrezza by end of CY-2016 (see Providers)
- 450,000 PWD per week will be visiting Afrezza-detailed physicians by EOY-2016 (9,000 docs x 10 patients/day average x 5 days/week)
Corrections:
500 visits/week (1-2 per day x 5 days x 60 Sales Mgrs)
9,000 endos and h/p physicians detailed in 2016 (500 visits x 18 weeks*)The 500 physicians ( high prescribers - possibly part of the 3000 who had written atleast 1 rx ) will be visited over and over again. in your scenario - every one looks like touch and go which should not be the case. 1 doc can be visited once every week of the month atleast for 3 months , before reducing the frequency.
450,000 PWD per week will be visiting Afrezza-detailed physicians by EOY-2016 (9,000 docs x 10 patients/day average x 5 days/week)Based on my correction factor, this math needs to be changed. further all the 10 patients are not target and what would prompt the doc to bring up Afrezza? ( compliance, needle phobia,a1c > 7 very subjective as some docs are ok with as much as 9? ) A few points for discussion: " 9,000 endos and h/p physicians detailed in 2016 (500 visits x 18 weeks*)" In the annual shareholder meeting, Mike C. has clearly stated that their target is around 7,000 physicians initially, with endos mostly the focus right now. They will expand to PCPs only after they have penetrated the endos market. So, most likely, we will unlikely to hit 9,000 doctors in 2016. "The 500 physicians ( high prescribers - possibly part of the 3000 who had written atleast 1 rx ) will be visited over and over again."Agree. Not sure where you get the 500 number (I do not have the impression of seeing this number mentioned by Mannkind anywhere), the actual top prescriber group might be even smaller (i.e., could be 200-300 physicians). But 500 sounds right to me. In the second quarter CC, after only 3-4 weeks of relaunch, Mike is saying that some of the doctors will be having 2nd and 3rd visits from Mannkind representatives at this point of time. "450,000 PWD per week will be visiting Afrezza-detailed physicians by EOY-2016 (9,000 docs x 10 patients/day average x 5 days/week)"We need to change that 9,000 to 7,000, that will result in 350,000 (rather than 450,000) PWDs per week. Plus, after a few weeks, a higher percentage of the visitors will be repeat visitors as time goes by (i.e., not all the visitors will be new patients). Additionally, some of the visitors may already have Afrezza prescriptions and some of them may not get a insulin prescription at all for a particular visit. |
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Post by compound26 on Aug 9, 2016 20:38:23 GMT -5
Approximately 20k-30k scripts were written for the Sanofi-branded Afrezza with about 70% of PWDs choosing not to renew due either to poor instruction of how to titrate or because of no reimbursement / high co-pays. Those PWDs are being invited to try Afrezza again with much better titration instructions, a new 180-cartridge titration pack, a MannKind Cares program to streamline and expedite the prior authorization process required by some plans and a simplified $15 co-pay plan. A consumer website for Afrezza and a DTC printed, digital and direct mailing marketing campaign will begin in 3-6 weeks by an advertising agency which specializes in marketing disruptive drugs / devices. It didn't escape me the context in which Castagna used the phrase "new paradigm" to describe Afrezza when he was talking about marketing plans. I stand by my earlier analysis, confident that Afrezza sales will attain 3,000 scripts per week by EOY 2016.  , that will great! My expectation of TRx growth rate is (much)  lower than yours. I will be satisfied if we grow the TRx to somewhere higher than the high water we achieved under Sanofi (i.e., some where around 600 weekly) by EOY 2016 and 3,000 weekly by EOY 2017. And from there, I then expect us to double the weekly TRx every year. |
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Post by compound26 on Aug 9, 2016 16:00:20 GMT -5
Today's price action (down to 91 cents) is discouraging but I have to think the curve would be inverted if last Friday's script count was up. Those of us who have followed the MannKind story for years know that good things are happening and the company is better positioned for success now than ever before. It would be a mistake to put too much weight on weekly numbers from this hinge period. On the other hand, if the end of September comes and there is no sign of the door swinging open, then maybe we should panic. sharing with your sentiment. But personally I will give Matt, Mike and their team more time. IMHO, September will not be live/death time, neither November or December will be. As long as Matt, Mike and their team keep their noses down, putting up new plans/programs (like what they are doing right now), executing these plans/programs, and adjusting/fine tuning them based on feedbacks as necessary, I believe we will see a sustained growth of TRx. As long as the growth is sustained, even though it may be slow, I think we will be fine. Based on the latest conference call, I would think Matt, Mike and their team have one year's time from now on to turn the trend around and show sustained growth. Personally, I think by this time next year we will know whether Matt, Mike and their team are successful or not in turning around the ship. Yes, they may need another round of financing, whether through ATM or otherwise, but that is OK. There are a lot of things that the team is implementing to right the ship. Any of the following should, to some degree, help the company in achieving its goal:
Things that are happening or will most likely happen in the near future:
1. Rebranding (instead of focusing on the fact that Afrezza is inhaled—i.e., the “Surprise, its insulin” campaign under Sanofi, the new marketing campaign will focus on the unique PK/PD profile of Afrezza): appears to be the right strategy as the “Surprise, its insulin” campaign does not distinguish Afrezza at all. 2. Adjusting target patient group (from Tpye 2s (under Sanofi) to Type 1s): appears to be the right strategy as Type 1s will have better incentive to get Affrezza and better knowledge to get the best results. They will also be more successful in getting insurance coverage (than Type 2s) as it will be easier for them to prove the medical necessity (to get Afrezza). Additionally, CGMs are more commonly used by Type 1s and we know CGMs are a big help in demonstrating the effectiveness of Afrezza. 3. Mannkind care (now up): will help streamline reimbursement for patients and therefore help retention of patients. 4. Direct to patients marketing via journal ads (will be up Sept./Oct.): will improve awareness of Afrezza 5. Direct to patients marketing via digital marketing (will be up Sept./Oct.): will improve awareness of Afrezza 6. Direct to patients marketing via direct mail (will be up Sept./Oct.): will improve awareness of Afrezza 7. Presence of Mannkind in community events and patient conferences (occurring right now and from now on): will improve awareness of Afrezza 8. Voucher for one-month supply of titration pack (occurring right now): supplement the current sample program and will help retention of patients. 9. New titration packs (being shipped right now): will help retention of patients. 10. New sample packs (will be up Sept./Oct.): will help retention of patients. 11. Afrezza CoPay card program (up since end of July): simple and consistent $15 co-pay reimbursement program help reduce confusion of different (past programs). 12. A doc-finder (will be up sometime this year): increase access of Afrezza for patrients. 13. Potential milestone payment from RLS (first milestone expected sometime this year): help extend the cash runway. 14. Further payments from Sanofi via insulin put (additional payments later this year and next year): reduce Mannkind’s expenditure on insulin purchase from Amphastar by 65% and therefore help extend the cash runway. 15. 100% revenue of Afrezza (starting from now): anything earned will help extend the cash runway. 16. $50 million ATM and $30 million line from Mann Foundation (available right now): can be used if necessary and appropriate and therefore will help extend the cash runway. Things that will take some time to happen:
17. Potential label change (may be submitted to FDA in Sept./Oct.): improve competitive advantage of Afrezza. 18. Potential dosage titration study: will improve competitive advantage of Afrezza if lead to improved label 19. Potential pediatric trial (details being finalized): will increase access of Afrezza and potentially improve competitive advantage of Afrezza. 20. Other TS applications: will help the market cap of Mannkind and therefore capital-raising capability assuming good progress. Things that may or may not happen:
21. Potential international partnership (if happens): help extend the cash runway. 22. Termination settlement with (and payment from) Sanofi (if happens): help extend the cash runway. |
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Post by compound26 on Aug 9, 2016 10:55:51 GMT -5
You're out of your tree. Who do you think you're fooling??? 5000 scripts per week before November would not only bring us close to cash flow even, the share price would skyrocket and fincaning would thus not be any issue if needed. Like davinci said, you need to do the numbers. Scripts drive revenue, which is a single line on a set of financial statements. I said that 10,000 would be cash flow break-even, and I stand by that number. Why? If we take the trending price per Rx of 533 (off the chart that Liane updates weekly) 10,000 scripts would yield $21 million a month in revenue. What does that $21 million need to cover? 1. The contract sales force, which we know costs around $10 million / month.2. R&D. Everyone talks about how great Technosphere will be, but it will be worthless without further research. R&D has been averaging $2 million / month. 3. General & Administrative expenses averaged $3.3 million a month in 2015, $2.5 million for the first quarter. Call it $3 million / month. 4. Production cost averaged $5.6 million a month in 2015, and $2.5 million in the first quarter. That was to support very limited sales volumes; if the company is successful with relaunch the cost per month will scale up accordingly. It will not be linear, due to production economies of scale, but the number will substantially larger. 5. Working capital, like accounts receivable, was Sanofi's problem. Now that has to be financed by Mannkind's balance sheet and that is a use of cash that doesn't hit the income statement. 6. The company booked $5.5 million in losses per month on the Amphastar contract in 2015. That contract has not gone away and the current year exposure based on the last 10Q was $13 million. So add all of that up, and you will see that it might take substantially more than 10,000 scripts to reach cash flow break even. In the meantime, the company will burn cash, the balance sheet will deteriorate, and that is what Wall Street will be looking at. Any decent financial analyst would do the same calculation I just outlined and come to a similar conclusion on the revenue needed to support the organization as it is today, and 5,000 scripts per week just isn't enough. Many on this forum advocate dropping the unit selling price to drive penetration, but that would require even more scripts to make up the shortfall in revenue so that really isn't a feasible solution either. With 5,000 scripts the share price would move up, no doubt about that, but the financing terms will still be tough until the company can prove that it can generate enough cash to meet its maturing commitments and that will cost dearly in dilution. That level of sales buys time and loosens up the financial markets, but it is still not enough to fix the overall financial situation. , could you kindly elaborate a bit on the source of your following statement: "The contract sales force, which we know costs around $10 million / month."Why do you say " we know"? Is this a known fact or is there some specific statement in Mannkind's filings or presentation that points to this number? At least I do not know this as a fact and I am really curious about the source of your statement. If indeed the contract sales force costs $10 million / month, then they are really expensive. $10 million a month will result in $120 million in a year. Since we understand there are about 70 contact sales people (this 70 number has been mentioned quite a few times by Mike. So let's assume it is the case). Let's divide $120 million by 70, which results in $1.71 million per contract sales person per year. So, based on your statement above, it will cost about $1.71 million per year to hire one contact sales person. Wow, if that is the case, it appears, for Mannkind, the cost of hiring a contract sales person is comparable to the cost of hiring hire its CEO (Matt P.) or COO (Mike C.). If that is the case, I am seriously considering quitting my job and applying for the position of a contact sales person for Mannkind. |
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Post by compound26 on Aug 8, 2016 16:22:57 GMT -5
Was i that far off? Did Matt say we had enough cash till 2016 ? or did he say we had enough money for 2017 , he was going to fast , Will someone clarify ? Thanks As far into 2017 as possible. |
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Post by compound26 on Aug 8, 2016 15:57:18 GMT -5
From Results : The net loss for the second quarter of 2016 was $30.0 million , So is it safe to assume our cash burn rate is 30 million per quarter , At 10 million / per month we have 6 months of cash , although it might be higher given reps ( higher labor costs) . I suspect cash burn rate will be more like 15 - to 20 million/per month At the same time , will have revenue coming to Mannkind 100 % as opposed to the split ( when partnering with Sanofi) . We do still have the ATM and the Al Mann group , so can we say we have 6 months , before having to dilute . If sales pick /up , we could get a runway extension . Comments ? Read more: mnkd.proboards.com/thread/5936/conference-call#ixzz4Gm7YbtTcMatt and Mike have reiterated several times that the cash burn will be around $10 million a month and the total commercialization cost will be around $20 million for the year of 2016. To the extent there is increase in commercialization, they will try their best to reduce the other costs to balance it out. |
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Post by compound26 on Aug 1, 2016 11:52:03 GMT -5
The planned sample pack is 60-unit package, and is scheduled to be released in late August, according to Castagna at the last investors conference call.
There are two titration packs, one is 180 units (90 each of 4- and 8-unit) that has now been released.
The other 180-unit titration pack will also be released in late August and will include 60 each of 4-, 8- and 12-unit cartridges.
So, as I understand it, there are no sample packs currently being disseminated. Perhaps MannKind is focusing on those patients who've already been prescribed Afrezza but were improperly titrated (due largely to Sanofi's negligence in updating physician education) and who likely discontinued using Afrezza when they didn't see meaningful results. agree with all of your statements above. Except, with respect to your following statement: "So, as I understand it, there are no sample packs currently being disseminated." I do not know whether that will be the case. Agree that the new sample packs are not out yet (I recall Mike mentioned something about late August for the introduction of the updated sample packs). However, could Mannkind just instruct the doctors to provide 2-3 (instead of 1) existing sample packs to potential users of Afrezza before the new sample packs come out? |
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Post by compound26 on Aug 1, 2016 11:38:37 GMT -5
Given the number of docs prescribing Afrezza (pretty small), if there were half dozen reps who were Afrezza go-getters in VA (or maybe even 1), it would skew things such that a statistic like the above could be correct. Not sure why there are so many doctors from Virginia on Sam's list. Maybe a pure coincidence? babaoriley I think some of us here underestimated the number of doctors that have prescribed Afrezza. At one point, some of us here thought that maybe 100-200 doctors had ever wrote a prescription of Afrezza. However, according to Mike C's presentation at ASM, Sanofi targeted at 50,000 physicians and among those 50,000 physicians, 3,000 of them wrote one or more prescriptions of Afrezza. So, there are 3,000 physicians who wrote Afrezza prescriptions and Sam's list, as of today, has 123 physicians listed. So Sam's list captures 4% of all the physicians who wrote Afrezza prescriptions. However, since Sam presumably got this list mainly through input from satisfactory Afrezza users, hopefully, most of the physicians on his list are among the top prescribers. I recall that Mannkind will have a docfinder on the web (probably in third quarter, if I recall correctly). I would guess its doctor finder will have a much larger number of doctors than those we can find on Sam's list. I recall Mike's goal is to provide each potential user of Afrezza with a few choices of prescribers on the docfinder. I would guess we would need to have at least 10-20 (or more for bigger states like CA, NY and TX) doctors for each state to achieve such a goal. |
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However, for Mannkind, I believe Afrezza reps are indeed making a lot of repeat visits in a short period of time, at least on their top prescribers. Here is what Mike C. said at the 2nd quarter CC:
lower than yours. I will be satisfied if we grow the TRx to somewhere higher than the high water we achieved under Sanofi (i.e., some where around 600 weekly) by EOY 2016 and 3,000 weekly by EOY 2017. And from there, I then expect us to double the weekly TRx every year. 