|
|
Post by compound26 on Jan 11, 2016 13:12:47 GMT -5
Let's hope Matt has some concrete plans laid out for Mannkind. For all it is worth, Matt does seem to be an upgrade from Hakan in that: 1. Matt is more outspoken. At least he did a good job at the BofA presentation last May and sounded more confident and forceful than Hakan in the last several conference calls. 2. Matt has some connections to the shareholders. Note that Hakan made many automated sales of his shares in 2014-2015. Matt has very few of them compared with Hakan and some other directors/officers. Hakan had to be educated by the shareholders to cancel his automatic sales. 3. Matt probably has closer relation to Al than Hakan and therefore he probably will have a better chance to execute his plans (than Hakan did with his plans). In this interview in 2013, Al Mann brought Matt (not Hakan) with him. While I certainly hoped Duane DeSisto was able to take the job as CEO for Mannkind. Matt is all we have at this moment. Matt does have all the knowledge and information on Afrezza and Mannkind. (Whereas it may take Duane DeSisto a fews weeks to get himself educated on these things.) And based on the statements Matt made on Jan. 5, Mannkind has had independent market research on Afrezza, it appears Mannkind has had some preparation for revamping the market strategy of Afrezza. And what Matt stated in terms of the revised strategy does make senses to me (i.e., different pricing, educating the doctors and patients on how to get the most benefits from Afrezza, etc.). Again, hope Matt has some concrete plans laid out for Mannkind and is able to execute such plans. Additionally, based on this post, if the source is reliable, it appears that, had Duane DeSisto been able to take the CEO job, it would take some time for Duane DeSisto and Matt to establish an efficient working relationship. |
|
|
|
Post by compound26 on Jan 11, 2016 12:21:52 GMT -5
Wow. How time changes everything. No, I am not being sarcastic. Almost everyone on this board praised Matt for doing a great job at the BofA presentation last May. mnkd.proboards.com/post/25494/thread |
|
|
|
Post by compound26 on Jan 10, 2016 17:36:11 GMT -5
As for Pfeffer’s assertion that patients who do use Afrezza love the product, there is plenty of supporting evidence available from online anecdotes. At least 3 Twitter users — Afrezzauser, Afrezza Army and Afrezza Guy — have attracted communities of enthusiastic supporters. That said, Sanofi’s figures indicate that such enthusiasm is far from universal. Brooks wrote in her email that only 35% of the 6000 patients who have ever started on Afrezza are still using it. I recall seeing somewhere on the web stating that before Exubera was dropped, 24,000 patients have ever started on Exubera. Sorry can't find the source right now, but that was the number I recall seeing. That seems to be a reasonable number giving that Exubera's TRx at some point was close to 1800/1900 weekly. Given that Afrezza is hands-down a better product than Exubera, it wouldn't be a high bar for Sanofi to reach similar number of patients Exubera reached. If Sanofi was able to have 24,000 patients starting on Afrezza by now and even if we assume this 35% retention rate as quoted above applies, the current patients on Afrezza would be 8,200 and our weekly TRx will be four times of current number, i.e., around 2,400-2,800, with an annual run rate of close around $64-80 million. |
|
|
|
Post by compound26 on Jan 10, 2016 12:31:12 GMT -5
My thoughts on the reasons for 35% renewal:
1. confusing dosage and timing instruction. I do not believe that in most cases Sanofi reps provided good training to the doctors and nurses on these issues.
As Matt B's videos demonstrate, Afrezza's dosage and timing is so different, one probably will get a suboptimal result if he/she does not understand how it works and does not try to figure it out (dial in).
Once dialed in, it appears the retention rate is very high. This is supported by most of the early adopters we hear from in the social media. Amy, who had some issues with Afrezza earlier, is still using it.
2. high cost, rozale and others gave up on cost. I believe many others did that. The latest LA times piece supports that.
3. some people only use Afrezza for correcting high BGs and therefore their refills occur with long gaps.
|
|
|
|
Post by compound26 on Jan 10, 2016 12:19:19 GMT -5
Did this nugget jump out at anyone else? 65% drop out??? It did jump out, in a number of ways. First being if there are 35% of the 6,000 still on it (that makes 2,100 patients) why is this not showing up in Symphony? Script numbers have never been remotely close to 2,100 Trx. If we had 2,100 scripts the board would be screaming with joy - that is a very respectable number after 11 months. Do they include patients who were given samples as "starting on Afrezza"? Starting then having the insurance issues thus dropping out due to affordability? It is way too vague to make any real assessment. It is almost impossible to believe there would be a 65% dropout rate due to patient dissatisfaction when it it is extremely rare to find any sort of negative references to Afrezza anywhere. If it was viewed 65% negatively that is all you would read about. The statement just makes no sense to me for all these reasons. , not every patient has a NRx or refill every week. If they can get a NRx or refill for a 90 day supply, they will have a NRx or refill every 90 days. If they get a NRx or refill for one month's supply, they will have a NRx or refill every four weeks. |
|
|
|
Post by compound26 on Jan 8, 2016 18:37:55 GMT -5
Google and Mannkind is a perfect match. Here are my thoughts on this: 1. Afrezza improves the quality of life of PWDs dramatically. This is now very well documented in the social media. As Sam noted on Tudiabetes.org: “ in my opinion this is the biggest breakthrough in medicine that has occurred in my lifetime…”. For proof on this, one can just read the latest comments on Tudiabetes.org. www.tudiabetes.org/forum/t/sanofi-ending-its-afrezza-partnership-with-mannkind/50253/79www.tudiabetes.org/forum/t/sanofi-ends-marketing-agreement-with-mannkind/50293/24This fits well with Google’s philosophy of doing no evil (and in other words, making the world a better place).
2. Afrezza is a great innovation in the treatment of diabetics. Afrezza mimics the action of the pancreas. No other insulin in the market can do that. This fits well with Google as an innovative company in general.
3. One thing Google has plenty is cash. This will support a long runway for Afrezza, no matter how long. Five years, no problem. And in all likelihood, what Mannkind need is a few hundred millions to push it to success. That is no problem for an owner like Google. That will make Afrezza’s success a near guarantee. 4. One thing Google does not lack is patience. You can see this from the growth of its Android business. So if Afrezza needs five years to take off, no problem (I think this is mainly because Google’s search engine generates so much income that there is much less pressure on other units to generate profit as early as possible). Again, that will make Afrezza’s success a near guarantee. 5. Google knows how to advertise on the web and has huge resources in that respect (i.e., it does not cost much for Google to run Afrezza ads on Google’s search engine if the advertiser is Google itself). If Google is the owner of Afrezza and with Google taking off its gloves on advertising of Afrezza, I would guarantee that the awareness of Afrezza will grow exponentially, worldwide.6. Another thing Google is good at is data collection and analysis. Afrezza fits well with what Google and Dexcom are working at---Real time monitoring. Afrezza will be able to offer real time correction of high blood sugar. Real time monitoring + real time correction => happier users. With the vast amount data collected, Google will be able to generate huge amount of useful information to help it to come up with optimal dosage and time recommendations and other marketing decision information (like which group of population uses Afrezza the most and which group has best results, etc.). 7. Google’s high awareness (the brand effect) will bring much greater awareness of Afrezza to PWDs and most likely better acceptance of Afrezza by doctors and insurance companies.
On the other hand, the overwhelming positive reviews Afrezza users will enhance the image of Google.
8. Afrezza and TS does not conflict with any other existing business of Google. Unlike any other BP, Afrezza and TS will not negatively affect any other business of Google. On the other hand, the vast amount of information Google can collect from Afrezza users will contribute to the existing data collection, analysis and advertising business of Google. 9. Afrezza and TS applications have huge potential and therefore this fits well with Google diversification efforts. If Afrezza reaches its full potential (if Google is the owner, that probably will be a guarantee, see discussion in points 3 through 8 above), Afrezza can obtain an annual sales comparable to that of Lantus today (or even greater). Give it a 50% margin and 20 times PE, you can estimate the value the market would be giving to such a business. I would guess that will put the value of the Afrezza business to be $50+ billion. At that time, Google will truly have a diversified business (i.e., not only the monopoly business on search engine)! And it will be less likely targeted for antitrust charges by the US government (a big concern for Google if you know Microsoft’s history). And shareholders of Google will be happy!
10. Al Mann and the founders of Google share many similarities (great innovators, visionaries, entrepreneurs, and philanthropists). I do not know whether they know each other well, but I would guess that they respect each other. There is no big pharma vs. small biotech division here.
In short, it will be a true win-win situation if Google picks up Mannkind/Afrezza. Google will be able to pick up a diamond in the rough that it has the skills and resources to bring out its true value. Al Mann and Mannkind will be rewarded for their decade long fight to bring Afrezza to market and will be glad that Afrezza is in good hand. PWDs will be able to enjoy Aferzza for decades to come.
P.S., to a lesser degree, the above analysis is also applicable to a combination of Dexcom (producer of CGMs) + Afrezza/Mannkind and Abbott (producer of Freestyle Lite) + Afrezza/Mannking. Al Mann and Matthew J. Pfeffer, give Larry Page, Sergey Brin and Sundar Pichai a call!
Readers: if the above analysis makes sense to you and you happen to have some connections to Google (Dexcom/Abbott), give it a shot and forward the above analysis to Google (Dexcom/Abbott). WIth Afrezza being such a wonderful product, it's really worth five minutes of Larry Page, Sergey Brin and Sundar Pichai to read information related to it and give the above ideas some thought. Who knows what wonders a company like Google can do with such a wonderful product?
|
|
|
|
Post by compound26 on Jan 8, 2016 14:06:05 GMT -5
Latest comment: www.tudiabetes.org/forum/t/sanofi-ending-its-afrezza-partnership-with-mannkind/50253/70?u=charles5Hi Sam19. This is my first post although I've been reading this forum for quite a while. I REALLY appreciate your posts. I am a significantly insulin resistant Type 2 and have been using Afrezza since last July. It is the ONLY mealtime insulin I have ever used that has worked for me. It is a superior, fantastically effective prandial insulin. I am PRAYING that Afrezza survives even if MNKD the company fails. MNKD the Company is in great danger of bankruptcy. Again, I PRAY its insulin survives no matter what happens to MNKD. About the only you ever said that I disagree with is about insurance coverage. Very, very few plans cover Afrezza in an affordable, accessible way. Personally, I have little money, almost "poor". After my mortgage payment and the cost of food and groceries, just one box per month of Afrezza at $300.99 is my biggest expense. Entirely out of pocket for me. Two years ago I got my insurance via Obamacare, a godsend for me. I only had three or choices of insurance companies and NONE of them covere Afrezza at all. Not on the formulary of any of them. Last year my income dropped and I was forced into State Medicaid. My doctor submitted an application for me but it was denied since Humalog was cheaper. Injected prandial insulin does not work for me, too slow (several hours). Although I have little money, I am still spending $300 per month because I realize I am talking about my very life!!!! In my eyes Afrezza is my most important expense.
Sadly I really need at least two boxes of Afrezza per month but that is out of the question for me financially. I am two years away from Medicare and hoping it will be covered by then...... but I doubt it will be. I try to make do by eating as low carb as I can possibly stand. MNKD could quintuple its volume of scripts sold by cutting the price in half. They need to do that. Please keep up your good work of helping to educate diabetics about Afrezza. I believe for all you Type 1's it really is almost miraculous. And even for us highly insulin resistant Type 2's, it is an extremely effective mealtime insulin. I appeal to all diabetics to consider trying it and doing what they can to help ensure the survival of this fantastic insulin. It IS life changing and will be a crime if it is shelved by corrupted, big money financial interests. |
|
|
|
Post by compound26 on Jan 8, 2016 10:00:41 GMT -5
Lantus and Toujeo in trouble?
www.tudiabetes.org/forum/t/tresiba-basal-insulin/50202/14?u=charles5" Had a chance to talk to doc in more detail about this and he is absolutely ecstatic about tresiba--- he said he's not even prescribing lantus and levemir anymore unless the patient has been using it for a long time and insist on sticking with them. He insists tresiba is vastly superior. I questioned him about the dosing as I was concerned I might be effectively stacking doses if they actually last two days and I am taking the same dose as I took of lantus every day-- he explained that's not really how it works because you're still just taking the same dose of U100 insulin every day and how long it lasts really won't change the dosing-- he did caution me to not adjust doses more often than every 3-4 days as that will confuse the whole issue with a basal that lasts so long.... He was actually really excited about it and now I am too." "So, as you might have seen in my other discussion, i was prescribed Tresiba yesterday, and started it last night. i had been on levemir for a month before that, and my doctor told me i might have better results with it: 1. it is way more stable than levemir, which, at low doses of 10-15 units, like i need it, doesnt even work 12 hrs sometimes. 2. it works up to 48hrs or longer, so i dont have to take my basal shot at the exact time every day, he told me i'd be able to vary up to 2 hrs. He also told me that i might need somewhat less insulin than with levemir (24 units daily, i started with 22 units of tresiba yesterday). @sam19 you might wanna be cautious on correcting your dose too soon, as it takes also up to 48 hrs or more for tresiba to enter your body, so dont wait the first 24 hrs and then already change dosage. the only problem with it seems that it is very dull, so when you change your doses afterwards, it takes a few days to see the full effect. but my doctor was also very positive about the insulin, working in europe he has already seen patients using it for at least 2 years, and says he puts patients only on that basal insulin if possible." "Sam - very nice. Please keep us in the loop. As mentioned before, I'm still (LOL) thinking of ditching my Omnipod and going with long acting basal to use in conjunction with Afrezza." |
|
|
|
Post by compound26 on Jan 7, 2016 13:19:14 GMT -5
"It is probably not appropriate to use the JV expense of $175M- this predominantly factors in Sanofi's bureaucracy and cost structure; which targets support to many different drugs, devices, etc. The true estimate is going to be somewhere in between, and my WAG is about 1/2 to 2/3 of this. Certainly not the full amount. " estan2001, Deciding which SNY expense to allocate to the Afrezza joint venture was always going to be a little tricky, but if MNKD allowed Sanofi to charge the venture 1/3 to 1/2 of costs that are attributable to its own products, I would be extremely upset. Sanofi probably did not charge expenses for marketing other drugs. However, giving how ineffective their efforts have been, their claimed expenses probably are very stated compared to the efforts their employees made. |
|
|
|
Post by compound26 on Jan 6, 2016 20:16:44 GMT -5
From what I have read the last date for Sanofi is July 4th which fits the 6 month notice period and the "any reason" clause so there is not going to be a lawsuit. If you read Article 13.3 you can see why Mannkind would want shorten that period. The sooner that period ends the sooner revenue sharing ends. I think you are correct. However, there may be another scenario to consider...Genzyme bringing in the Mannkind launch as evidence of a pattern. I personally saw at least 7 Truejo commercials this year. I'm sure the number of commercials and when they aired is discoverable information. Also, the number and experience level of the sales team, the number of sales calls, etc. are all legally discoverable in the case of a lawsuit. With Sanofi already being sued, Mannkind may get brought into the fray whether they initiate it or not. Genzyme is almost certainly going to use Sanofi's behavior with Mannkind as further evidence of Sanofi's culpability as a pattern of behavior in their own lawsuit. Yes, I saw toujeo ads popping up in Youtube a few times very recently. |
|
|
|
Post by compound26 on Jan 6, 2016 19:55:58 GMT -5
Tier 2 with low pricing for out of pocket paying patients ( domestic and international ) - international being like Matt from Australia and Brendan from UK -individual buyers will alone cross 60k by a mile I agree. If the price is low enough, say $100 per month out of pocket. I think we could certainly cross a threshold. A lot of people (patients and doctors) would be glad not to deal with insurance, prior authorization and step therapy requirement. |
|
|
|
Post by compound26 on Jan 6, 2016 19:03:05 GMT -5
Now that Sanofi has terminated the license agreement, Mannkind is probably looking for another BP partner, but even if it has to do it by itself, I still think it is doable. Al Mann did it with insulin pump (MiniMed) before and Duane DeSisto did it with OmniPod. Pursuant to this podcast, at one point, Insulet had only 5 sales representatives. And when Duane DeSisto stepped down, it is stated in this article that: "OmniPod has given the freedom and simplicity of tubeless pumping to more than 60,000 people living with diabetes..... Insulet reiterated its revenue guidance, saying it still expects to pull down $73 million to $77 million for the 3rd quarter and $290 million to $300 million for the year. ...." If Mannkind can reach 60,000 patients, we will have a weekly refills of 5,000. Current average sales per script is around $500. Let's cut it by 50% to account for any anticipated price cut of Afrezza. That will lead to an average sales per script of $250. That will translates to a weekly sales of $1.25 million and an annual sales of $65 million, equal to $16.25 million a quarter. If Insulet, starting with 5 sales rep can sell OmniPod to 60,000 patients, Mannkind should be able to sell Afrezza to 60,000 people. |
|
|
|
Post by compound26 on Jan 6, 2016 17:44:55 GMT -5
Griffin Securities analyst Keith Markey is going against the grain this morning, upgrading MannKind (NASDAQ: MNKD) from Neutral to Buy with a price target of $4. www.streetinsider.com/Analyst+Comments/Griffin+Securities+Goes+Against+the+Grain...+Upgrades+MannKind+%28MNKD%29+to+Buy%3B+%244+PT/11196215.htmlNews come after Sanofi opted to exit the Afrezza partnership. Markey commented: " We think it’s probably the best outcome, since the multinational drug company devoted considerably less resources to Afrezza than to its new long-acting insulin, Toujeo®. Feedback we’ve received from various sources has indicated that physicians have continued to have difficulties getting accustomed to Afrezza and converting diabetics from an injected insulin to MannKind’s inhalable drug. Moreover, direct-to-consumer advertising has been virtually non-existent." |
|
|
|
Post by compound26 on Jan 6, 2016 13:45:17 GMT -5
I would cut Afrezza price by 50% (i.e., from $285 to $140/150 per box), considering that average Afrezza users probably use more Afrezza unit wise because: (a) Afrezza will be less likely to cause hypo; (b) one can use larger doses and follow-up doses to get tighter control of BG levels: and (c) Matt B has noted that Afrezza will need larger doses for correction of high BG (but not for stopping BG from rising in the first place).
|
|
|
|
Post by compound26 on Jan 6, 2016 13:25:01 GMT -5
I'd join MannKind in a heartbeat. In fact, I think I may dust off and forward my resume to MannKind's new CEO. mnholdem, I look forward to your joining. Mannkind needs people like you, who have passion in Afrezza and its future. |
|
