Time will tell but the clock is ticking

Time will tell but the clock is ticking

One of the more interesting debates going on in the wacky world of diabetes is just how Afrezza will perform in the market. A debate that is supposed to begin sometime this quarter as that’s when our friends in France said Afrezza would be in the market. Now we know we’re only halfway through January and the company has all the way until the end of March to get Afrezza to market but one has to wonder whether they will hit this first milestone.

Listening to both sides of the debate Diabetic Investor comes away feeling slightly disappointed. Afrezza supporters continue to harp on the drugs delivery system, rarely if ever is it mentioned that this is a “better” short-acting insulin. Generally Afrezza supporters talk about how patients “fear the needle”, the “pain” of daily injections. That patients who should be on insulin but aren’t due to this fear will magically switch to Afrezza once it’s on the market.

Now we hate to burst any bubbles but if this is the argument these people are going to make when asking physicians to prescribe Afrezza then Sanofi (NYSE:SNY) has already lost the debate. Something we witnessed at the J P Morgan Healthcare Conference when they kept comparing Afrezza to the way dead $4 billion blunder known as Exubera. Yes the Afrezza supporters consistently point out that the delivery device is far superior to the Exubera bong, really ya think. This is like saying John Fox the newly hired head coach of the Chicago Bears is going to do a better job than Mark Trestman who got fired after a disastrous stint as head coach. While Bears fan are praying this comes true the fact is it would be hard for Fox to do any worse than Trestman.

Afrezza supporters seem to forget that when it comes to which therapy option a physician prescribes delivery systems don’t trump formulary position. They seem to believe that patients will actually pay more, out of their own pockets so they won’t have to endure the “pain” of injections. They seem to believe that patients who have been avoiding insulin therapy will all of sudden have a change of heart because they won’t have to suffer the “pain” of daily injections. Never mind these same patients are not afraid of injections and are actually afraid of insulin no matter how it’s delivered. A fact that gets lost in almost every debate as to why more patients are not using insulin. If patients were truly afraid of injections why then are sales of GLP-1’s increasing and why is the insulin current insulin market worth over $15 billion.

Just so we’re clear here it would foolish to state that there are not patients who are afraid of injections. It would be equally foolish however to state that insulin injections are overly painful events. Typically the people who believe injections are so painful have either never injected or done so once. While we would not call injections pleasant the truth is with new needle technology they really aren’t all that painful. Quite honestly it’s more painful to prick a finger for a glucose test than it is easy to administer an insulin injection.

Yet the debate over Afrezza isn’t about pain or even if it is a better insulin, which it isn’t. The debate over Afrezza is about money. Should Sanofi accept a third trier formulary position the party is over before it gets started. Even with a second trier formulary position this is no cakewalk. The simple fact is when it comes to diabetes drugs formulary position can mean the difference between being a million dollar drug or a billion dollar one. And just in case anyone thinks payors will provide Afrezza with premium reimbursement think again. These are the same payors who are squeezing drug companies when it comes to price, something that was mentioned by every diabetes drug company that presented at JP Morgan.

Oh and did we mention that Afrezza is supposed to be sold by the same sales force that was thrown under the bus by acting CEO and foot in mouth specialist Serge Weinberg. Yep that’s the way to motivate sales professionals throw them under the bus and then make it even harder to sell an unproven new drug with poor formulary position. Other than that Mrs. Lincoln how was the play?

Diabetic Investor actually thinks the debate shouldn’t be whether Afrezza is successful or not, rather the debate should be when will Sanofi admit they made a mistake by partnering with MannKind (NASDAQ:MNKD). The clock is ticking and we’re putting the over/under at 18 months.