Questions for Diabetics

[PorscheGAL]

Hey guys.

Hoping for some feedback:

I am interviewing for a position with a company who has developed an inhaled insulin to replace short action insulins at meals. I'm trying to do a little research from a patient perspective so I am going into the interview and potential job with eyes open.

In my short time with nursing, I have met quite a few patients who were non compliant because they didn't like the multiple injections per day. The bruising is terrible and I can't imagine how that can impact their daily treatment.

Best I can tell the data looks good as a replacement but the down side is the cost (though a lot of insurance pays for it, not sure how many).

My questions are how much does an average month of injected meal time insulin cost? Does insurance cover most of it? Is an inhaled version something you would be wiling to try?

What questions or concerns would you have?

[jhynesrockmtn]

Type 1 here. Late onset diagnosed 5+ years ago at 54. I've heard of Afrezza but it has never been discussed as an alternative for whatever reason by my endo and diabetic educator. I've also never seen a post in the few forums/FB groups I sometimes peruse. It has been either a pump or injections. So far I'm MDI. Dealing with insurance has been one of the most frustrating parts of this whole journey. I've avoided pumps as they just seem more complex, more to fail and trying to figure out if insurance will cover has been a mess. I don't mind the needles too much but sometimes my abdomen looks like I've been in a fight and lost. My insurance is supposed to cover 90 days but will only do 60 after they decided they won't break apart the 5 packs that injection pens are packed in. I pay a $40 deductible for mail order prescriptions, so It's roughly $120 to $160 every two months for supplies and my CGM. Probably more information than you wanted/needed. Happy to answer any questions you have. Best of luck!

[PorscheGAL]

Thank you for the response. This is exactly the kind of info I need to research the opportunity. My understanding is: that although Afrezza was FDA approved several years ago, they are just now in the position to create a sales and education team. That may be why it has never come up with your care team?

[Mahler9th]

I may have some perspective for you. I worked in the space on the device side. Launched a product that was approved by FDA. That day my work was on evening news and in newspapers in every major US market.

The Secretary of Health and Human Services even issued a press release.

One thing I learned right away... we say people with diabetes on the commercial and HCP side. We don't say diabetics.

Feel free to send me a PM -- happy to help if I can.

[PorscheGAL]

Originally Posted by Mahler9th

I may have some perspective for you. I worked in the space on the device side. Launched a product that was approved by FDA. That day my work was on evening news and in newspapers in every major US market.

The Secretary of Health and Human Services even issued a press release.

One thing I learned right away... we say people with diabetes on the commercial and HCP side. We don't say diabetics.

Feel free to send me a PM -- happy to help if I can.

Thanks for the verbiage correction. I will adjust myself in the future.

[masraum]

Originally Posted by Mahler9th

One thing I learned right away... we say people with diabetes on the commercial and HCP side. We don't say diabetics.

Why is that.

[Tobra]

Because it is no different than everything else.

[jhynesrockmtn]

Originally Posted by PorscheGAL

Thank you for the response. This is exactly the kind of info I need to research the opportunity. My understanding is: that although Afrezza was FDA approved several years ago, they are just now in the position to create a sales and education team. That may be why it has never come up with your care team?

I just read a piece on diabetes strong about Afrezza vs Humalog, which is what I use. I guess I would approach this with caution from a potential employment standpoint. If the delivery mechanism is still the same as in set units of 4,8, 12, I can't see using it. I am active and try and maintain a tight control. I am regularly dosing 1-4 units. The lowest dose of Afrezza is the equivalent of 1.5 of Humalog and it acts much quicker. I read it can also cause a cough in over 20% of users.

If I were to use it, it would likely be rarely, and a 3rd product I have to keep track of. No thanks. Given how long it has been approved by the FDA and the limited number of users vs. MDI or pump, I am making an educated guess that the potential market is very limited.

[Mahler9th]

The diabetes commercial and HCP space is a little different from many others in the pharma and med device arenas.

When I was involved, DTC activity in the space was evolving.

I will never forget how highly anticipated our product was... I remember going to lunch at a famous Silicon Valley restaurant and while waiting in the foyer I had a draft copy of some of our patient marketing material.

It was created by our ad agency in NYC and I was marking it up with edits.

Three different people asked me about it, and asked me when the product was going to get approved by FDA.

During that period the company was contacted by a Hollywood production team working on the film "The Panic Room." The product concept had been written into the script and they requested a prototype.

On the day of approval, FDA contacted our VP regulatory, that person contacted the COO, and the COO called me. Then I called NYC and told them to launch our PR campaign.

We got a calls from reps of Tommy Lasorda and Halle Berry.

The company stock shot up big time that day, and we had people coming to HQ trying to get the product, even though we weren't yet manufacturing.

Right around that time there was a lot of activity in the inhaled insulin arena and some famous players were going hard at it.

A company called Therasense had recently commercialized a new type of BGM-- they were later acquired and folks made plenty of money.

One of the areas in this category is the pediatric area-- lots of advocacy and activity.

Certified diabetes educators were amongst the key audiences with which we needed to communicate. They were advocates of the term people with diabetes.

Never used the term diabetics in any advertising or marketing materials.

On the insurance side I am sure that this chronic condition is large cost pie slice for companies like UHC and Anthem. One of my college classmates used to run the former and now runs the latter, and I am sure she can recite numbers related to this condition.

My experiences in that category were very interesting.

Insurance reimbursement... complex topic.

[scott540]

Type 1 since I was 13. I'm 54 now. I'm on a pump and have been about 20 yrs. Never really understood the inhaled insulin. I don't see how you could get the precise dosages we need. Or say you're eating a meal. You inhale the amount if insulin you think you need and then 2 hours later realize you need a little more because you miscalculated the carbohydrates. Can you sniff a 1/2 unit?
Maybe for the total non compliant who refuse needles, better than nothing?

For now, anyone that wants good control and has an active lifestyle, can't see anything better than a pump especially paired with a continuos glucose monitor

To answer your question, I use about 1 vial of humalag per month. $300 until my deductible is met then I only have a copay