MannKind’s Big Question

There’s no question that MannKind Corp. came up with an innovative product – insulin that you inhale instead of inject. There’s also no question that it could represent a big improvement in the lives of diabetics. The only remaining question is this: Will doctors actually prescribe it? That question apparently was answered with a loud “No” six months ago when Sanofi, the pharma giant contracted to market the product, walked away, saying doctors weren’t much interested in the inhalable insulin. Only a paltry amount had been sold in the previous nine months. But now, MannKind is ready to try again. The Valencia company regained the rights to sell the drug, called Afrezza, a few months ago and in the coming days it is set to launch 60 to 70 of its own sales people charged with once again asking the question: Will you prescribe Afrezza for your patients? So what’s different this time? First, here’s what is not different: The new sales force will again market to doctors and not to consumers. In the past, I opined that decision may be an error. After all, doctors are resistant to prescribing anything new and unknown and therefore legally risky for them, especially since there is a perfectly well-established and effective insulin-delivery system in place. Instead of pitching the product to doctors, it may be better to market to the diabetics since they’re the ones who have to live with needle sticks and insulin packs attached to their bodies. They may be quite interested in breathing powdered insulin from a pocket inhaler instead. But marketing to consumers has its own problems. For one thing, it is very expensive and takes time – think of all those Cialis commercials with the twin bathtubs – and MannKind doesn’t have much money. Or time. So again, what is different this time? For one thing, a new study from the American Diabetes Association should help. It shows Afrezza is much faster acting, which differentiates the product from other meal-time insulins. Afrezza can now be pitched to those concerned about hypoglycemia, and that’s no small thing since there are reportedly about 100,000 trips to the hospital each year because of it. For another thing, the new sales force will be far more focused. In fact, the new sales associates have one product to sell – Afrezza – and their livelihoods depend on the product’s success. Compare that to the previous effort to sell Afrezza by Sanofi. That company had a far larger sales force, true, but the sales people had many products to sell. And there was the lingering question of how dedicated the company really was, since the Sanofi chief executive who championed the deal to market Afrezza was fired before the marketing got underway. In other words, it wasn’t the new CEO’s baby. MannKind has trudged a years-long and tortured path with Afrezza, it’s only product. In 2007, a similar product from Pfizer was killed, throwing the whole idea of inhalable insulin into serious doubt. At other points, the Food and Drug Administration sent MannKind back to the proverbial drawing board, some think unjustly, forcing the company to spend oodles more money on testing, without revenue coming in, just to stay afloat. The new sales effort may well be MannKind’s last frantic gasp. The company has blown through ungodly amounts of money. Its stock, already depressed, tanked 30 percent in May because, in an effort to raise more money, it made a new stock offering that was highly dilutive. One analyst wrote “the offering reeks of desperation.” The company’s founder, Alfred E. Mann, a remarkable entrepreneur, reportedly spent nearly $1 billion of his personal fortune to keep the company going. He died in February at age 90, not knowing whether Afrezza – which he believed in deeply – would be a success in the marketplace. If it is a success, it would be, first, a posthumous victory for Mann. It would be an improvement for diabetics. But it would also be a nice economic boost for the Valley. A successful Afrezza likely would transform MannKind into a vibrant company. It’s not hard to imagine that MannKind could become one of the Valley’s biggest public companies. We know all of that. The only remaining question is whether doctors will actually prescribe it. As the sales people go out in the coming days and weeks, they will ask that question. And after years of effort and a fortune spent, we finally will get the answer. Charles Crumpley is editor and publisher of the San Fernando Valley Business Journal. He can be reached at [email protected].