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Post by compound26 on Aug 25, 2015 18:07:34 GMT -5
It appears there are unfulfilled needs by patients to find pro-Afrezza physicians. Can the members of this board collect available public information to create a useful list for the public? I have been able to collect a little bit of information on this in this post: www.afrezzajustbreathe.com/afrezza-prescribing-physicians/If you can, please kindly provide your input so that we can collectively create a useful list for the public.
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Post by compound26 on Aug 24, 2015 10:13:45 GMT -5
Here is an update on the insurance coverage based on Formularylookup.
Formularylookup on 08.07.2015.
Insurance Status Toujeo Afrezza
Preferred 28% 4%
Covered 23% 21%
Restricted 28% 43%
Not Covered 22% 32%
Formularylookup on 08.24.2015.
Insurance Status Toujeo Afrezza Lantus Novolog Levemir
Preferred 32% 4% 89% 66% 86%
Covered 19% 22% 6% 5% 2%
Restricted 27% 42% 4% 15% 9%
Not Covered 22% 32% 1% 13% 3%
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Post by compound26 on Aug 19, 2015 23:00:53 GMT -5
Has anyone used the service of CoverMyMeds? Will it help the Afrezza prior authorization process (make it easier)? Will it work with Sanofi's patient connect?
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Post by compound26 on Aug 19, 2015 13:41:09 GMT -5
Nate copyrights his $289 a year newsletter and you're giving it away for free? Not good. Not me giving it away. Nate is giving this away as a sample issue.
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Post by compound26 on Aug 19, 2015 12:24:46 GMT -5
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Post by compound26 on Aug 18, 2015 17:29:27 GMT -5
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Post by compound26 on Aug 17, 2015 11:08:07 GMT -5
Knowing who this guy is, I would not invest in him (or his company) even if I know for sure my money will double.
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Post by compound26 on Aug 12, 2015 13:44:09 GMT -5
Eric's tweet once again shows the importance of insurance coverage for Afrezza.
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Post by compound26 on Aug 8, 2015 12:56:56 GMT -5
Rozale, many thanks for the update! Very helpful. Based on the information your provided below on the tiered treatment of prescription drugs, it appears for Afrezza to be competitive, it has to be in Tier 2, together with a reduced retail price. That will take time. But I have confidence it will happen eventually.
P.S. Rozale, I noticed that I mis-spelled in your ID in my previous posts. My apology. I have corrected that.
Aug 8, 2015 0:09:29 GMT -5 rozale said:
Hello Everyone,
I am glad my post helped some people out. In regards to the questions asked, I think compound pretty much hit the nail on the head for some of the questions. The cartridges were 4 units. I typically take about 70-100 units of novolog/humalog daily, so the conversion from novolog/humalog to Afrezza is not 1 for 1, not for me anyway. Each person's body chemistry is different so the conversion rate may actually be 1:1 for others, just not for me. The prescription I have for novolog is for 33 days, which equates to basically 2 months supply. I remember looking at the Walmart retail price for 2 boxes of novolog (10 pens) at the beginning of the year, and it was about $900. My out of pocket for a 30 day supply of novolog is $45, for my prescription of 33 day supply is thus $90. I do not know if the price Target gave me was for 30 days or for 33 days. And I do not know what mix of 4u's and 8u's was used by target. I was a bit in shock at the $$$ amount.
I hope the additional info does not confuse people, but I thought it could help the community builds a sample size and extrapolate.
I have not rechecked about tier status, but I did just resend an e-mail to check on the status, I will update you all if they have changed Tiers. My insurance company (BCBS) uses CVS Caremark as it's prescription benefit plan supplier. BCBS had Afrezza.
Below is an excerpt I received:
Basic Option
Tier 1 (generic drug): $10 copayment for each purchase up to a 30-day supply ($30 copayment for up to a 90-day supply)
Tier 2 (preferred brand-name drug): $45 copayment for each purchase up to a 30-day supply ($135 copayment for up to a 90-day supply)
Tier 3 (non-preferred brand-name drug): 50% of Plan allowance ($55 minimum for each purchase up to a 30-day supply, or $165 minimum for up to a 90-day supply)
Tier 4 (preferred specialty drug): $60 copayment for up to a 30-day supply only
Tier 5 (non-preferred specialty drug): $80 for up to a 30-day supply only
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Post by compound26 on Aug 7, 2015 14:42:02 GMT -5
Here are comments from LeMarJackson to the article: MannKind's Afrezza: One Investor's User Experience, Practical Insights And Perspective Of A Diabetic Pharmacologist [http://seekingalpha.com/article/3390555-mannkinds-afrezza-one-investors-user-experience-practical-insights-and-perspective-of-a-diabetic-pharmacologist]
LeMarJackson: Thanks for your write up. It added to my decision to continue holding MNKD. BTW my doctor had also never heard of Afrezza when I sought to learn how it was doing in his practice. And no one had ever contacted him to provide samples etc. In his opinion, insurance companies are the deciding factor for any new drug's success because most patients simply will not pay out of pocket if there is a cheaper alternative. He seemed pretty happy with the status quo, meaning no hassle in him getting paid, the patient is happy the insurance company covers insulin, and the insurance company approves. MNKD really needs to work on this.
Aug 7, 2015. 12:20 PM
Every general practitioner must have some diabetic patients. I was surprised when he said no salespeople had ever approached him and he had never heard about it. That shows poor marketing IMO.
Aug 7, 2015. 01:15 PM
My contact was last week. Am in a major city where I would hope they would target as important to build momentum.
Aug 7, 2015. 01:57 PM
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Post by compound26 on Aug 7, 2015 13:47:53 GMT -5
Here is a comment by Greg Johnstone, who recently wrote the "MannKind's Afrezza: One Investor's User Experience, Practical Insights And Perspective Of A Diabetic Pharmacologist" article. (http://seekingalpha.com/article/3390555-mannkinds-afrezza-one-investors-user-experience-practical-insights-and-perspective-of-a-diabetic-pharmacologist) Greg Johnstone in replying to a comment by Duago: "The cost, even after adding on the US$ to CD$ exchange was quite comparable, to my surprise. I paid for it without an expectation of reimbursement, as I wanted to try it and gain some experience and insight. I would not want to continue using it by paying out of my pocket without reimbursement. That is why I am waiting for access to Afrezza in a way that my health plan will cover it." Aug 7, 2015. 12:54 PM seekingalpha.com/author/greg-johnstone/commentsSo very similar comment to Rozale's comment regarding pricing (and insurance coverage) of Afrezza.
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Post by compound26 on Aug 7, 2015 10:30:20 GMT -5
An excellent post, compound. There will still be some patience required of MNKD investors and shorter-term traders ;-) because the expiration of the 6-month new drug restrictions isn't like the start of the Kentucky Derby. The gates to all these 3rd Party Payers aren't going to fly open all at once. However, I would be disappointed if Sanofi has not been aggressively negotiating and has already reached some agreements with at least some of the biggest payers, which should result in a sharp uptick in prescription sales. Also, Sanofi will not get them all, as evidenced by some formularies I have located that have ONLY Novo-Nordisk insulin products NovoLog and Levemir at Tier 2, while Eli-Lilly and Sanofi products are Tier 3, including Lantus, or are not covered by that payer at all. I am not suggesting any illegal, but the formularies of some insurers does cause me to raise my eyebrows. I am of the opinion that the price Sanofi has set for Afrezza was set intentionally high in preparation for these negotiations and that comments made by MNKD management at numerous 2014-2015 conferences that Afrezza will be competitively-priced against popular RAA prandials was forward-speaking about where Afrezza pricing will fall in after initial Sanofi-Payer negotiations are done. We'll see in this 2nd half - or should we all be using Matt's phrase of "stay tuned"? mnholdem, agree with your analysis. Regarding your comment "the price Sanofi has set for Afrezza was set intentionally high in preparation for these negotiations and that comments made by MNKD management at numerous 2014-2015 conferences that Afrezza will be competitively-priced against popular RAA prandials was forward-speaking about where Afrezza pricing will fall in after initial Sanofi-Payer negotiations are done", I also agree it is a reasonable assumption and hopefully that is the case. Based on the information Rozale provided, even assuming we get better insurance coverage soon, it appears Sanofi does need to lower the price to make Afrezza competitive in terms of pricing.
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Post by compound26 on Aug 7, 2015 10:13:26 GMT -5
Compound you get it! I PM'd Rozale to see if I could help, maybe get him in touch with SNY rep in his region. They are working diligently with these types of patients and their practitioners and SPC (Sanofi Patient Connection) team in addressing these issues. So based on Rozale's statement, you could add him to the "backlog" number behind the dam so to speak...now you get the picture of what pent up demand growth will translate to when the flood gates open Thanks, Joey. As Afrezza has been launched for a full 6 months period now, hopefully the insurance companies is starting to lift their blocks on Afrezza. Per the latest quarterly report of Sanofi, for Toujeo, it is now 45% tier 2, 28% tier 3 for commercial insurances, and 91% tier 2 for Medicare (see page 8 of the attached Sanofi presentation). I have confidence in Sanofi in addressing the insurance issues. Granted, it will take time. Attachment Deleted
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Post by compound26 on Aug 7, 2015 9:39:05 GMT -5
I think this post, along with joeypotsandpans's post quoted below, confirms that insurance coverage is the biggest roadblock that Afrezza has to overcome for now. See coverage of Afrezza vs Toujeo in formularylookup.com Attachment DeletedAttachment DeletedJul 31, 2015 14:51:10 GMT -5 joeypotsandpans said: Insurance, insurance, insurance....what did everyone expect Olivier to say..."as for Afrezza, we have two thousand patients that are being held back due to their healthcare providers not covering...btw, the same providers that we negotiated great coverage for with Toujeo and continue to need for our new cholesterol drug, etc. etc." Did you think he would get into an alienating pissing match with the insurance companies while he is launching the successor to Lantus? No it continues to be a diplomatic process. As I've stated in the past, when you're stepping on sleeping giants toes you need to be careful so as to not wake them up....I think their eyes are open and the battle will continue to be unprecedented. They call this a battleground stock for good reason, there is so much at stake it is mind boggling and understandable why formidable forces continue to be at work. When you have Sam's and Eric's and now Laura's among others stating "why isn't every diabetic on this?" believe me those giants are hearing those screams! On a side note, SNY reported much better than expected numbers beating both top and bottom line, they were hammered at the open too and have since been climbing...I would rather have a healthy partner that continues to want to be aggressive in the space we're in than one struggling. Again, just sayin Maybe this helps drive the point home...my exchange yesterday (for the purposes of protecting any identity will omit certain specifics regarding the actual health plan connected to the conversation): Me: Is medicare (plan xxxxx) good to go with Afrezza? At lunch with a T2 who sees Dr.xxxxxxx...he's got her on Levemir and Metformin...she wants to get on it!! (Afrezza) Response: plan xxxxxx for one of our doctor's patients now, the PA (prior authorization) was denied so the doctor wrote a letter of medical necessity....plan xxxxxx advised SPC (Sanofi Patient Connection) that the letter probably wouldn't work, but SPC sent it anyway. I'll let you know if we get any positive results. plan xxxxxx is XYZ's (local provider) medicare so unfortunately they follow XYZ's restriction to new products. Our SPC team is trying to push. Me: K....need to get her on Toujeo also (said in jest due to the Levemir part of the conversation) Response: That should be a lot easier for her. There are less formulary issues on that bc it's the same molecule as Lantus, so many insurance plans lift the new to market block! So two takeaway's here: 1. For those that have been watching the weekly scripts and get disappointed please know that there is a great deal of pent up demand that is bottle necked in the system due to the insurance issues...I didn't get into how many patients since the 24 they previously mentioned but if you multiply that by 100 (don't know specific number of reps across the US that are designated solely for Afrezza sales but taking an average of 2 per state as a conservative number others may have dual or more products they are responsible for) that projects to 2400 scripts let alone renewals that are being held up. 2. For those that have been claiming their (Sanofi's) efforts have been geared more towards Toujeo, the latter part of their statement regarding the "new product restriction" block being removed should help you understand why Toujeo sales have been as strong from launch as they have on a relative basis (among other reasons ie., getting ahead of the Lantus attrition etc.). The point continues to be that they are doing what they can on both fronts simultaneously, educating the caregivers and working with patients to get their insurance issues resolved but it is and continues to be a block by block process. In the interim it is creating a growing pent up demand IMO. Enjoy the weekend all mnkd.proboards.com/post/33332/quote/3070?page=2
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Post by compound26 on Aug 6, 2015 23:17:21 GMT -5
Rozale, Thank You ! & welcome to the board I appreciate you sharing your insight & first hand experience with Afrezza . I wonder how many others have had similar experiences . I was fortunate to recently have a phone conversation w/ an Afrezzauser ( I respect their privacy and for that I haven't mentioned it here before ) . One thing he did point out to me that seems appropriate to share now is he said that one box of 90 cartridges is not enough for a type 1 , as a correction dose is often needed . I'm wondering if that's why your script cost was so high ... There are definitely some Big kinks that need to be worked out & I hope Sanofi & Mannkind are paying attention . Thanks again for sharing your story Lynn Edit : question ? You said you went thru your sample packs in 3/4 days , I forgot how many doses are in the sample packs & am wondering if you were given 4u 8u or a mix ? I'll reread your post in case I missed that part . Lynn, if I recall, a sample pack is generally supposed to last 10 days. I would guess it contains about 120-200 units. Two boxes would contain around 240-400 units. I guess Rozale needed around 90-130 units (in other words, roughly 100 units) per day. That would translate to 3,000 units per months. As the 12 units is currently unavailable, if a one-month prescription for Rozale is filled with 30 (4 unit) and 60 (8 unit) cartridges, totally 600 units, such a prescription will need 5 boxes, costs $290.59 x 5 = $1,450. Which is in line with Rozale's statement that, without insurance, the prescription would have been about $1400-1500. If we have 12 units available, and the same prescription is filled with 90 (12 unit) cartridges, totally 1080 units, a one-month prescription will need 3 boxes, costs $360 [my guess] x 3 = $1,080. I would guess it would cost about $500-600 with insurance (using the same discount provided by Rozale). If we further apply the $125 discount by Sanofi the way described by Rozale, the price will come out at $375-475. That sill sounds expensive, but much better and acceptable than the $715 price Rozale currently has to pay. Based on this, we can see that: 1. Better insurance coverage of Afrezza is absolutely necessary. 2. 12 units is indeed necessary for diabetics with high insulin resistance level. P.S. Rozale, do you know under what category (preferred, covered, or restricted) your insurance covers Afrezza?
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