Its no wonder everyone refers to Alnylam as the Asylum-WTF

I was just told that Andy Orth actually held a meeting wtih the National Account teams eralier this year where he admitted that this place was a mess and that he inteded to "give it a year". This is our leader of US Business saying this shit out loud to a group of people in his own division. Was also told that no matter how much we talk about those Value Based Agreements, they are not worth the paper they are written on. The nominal discount payors "could" receive will not even cover the cost incurred by the organization to monitor, collect the data, and submit the forms. Its no wonder they are not being signed. What a joke.

 

Is it really suprising? He is in charge of our taregting Pfizer. They are focused on cardiology and wild-type where we are not indicated. Everthing screams that the DOJ will be making a call here eventually.

 

Pfizer is focused on their FDA indication. Wild type and hattr-cm. Actively looking out for Alnylam reps talking off Label to turn in to FDA I'm not kidding

 

Lets simplify - Shit Show

 

Asylum is dead on. In fact, I always assumed Cafepharma was idiotic, but the posts here are so dead on I'm beginning to wonder. The post talking about the DOJ coming around is real and warranted. Management is so blinded by their 16 years trying to bring a product to market that they think everyone else will just fall in love with our products regarless of cost, indication, or serious side-effects. Lets not forget one of our earlier products appears to have killed a few people and givo will be a disaster with no patients and serious side-effects. Its why our stock tanked when the announced the "positive" results. This company IS asking its sales team to promote in a specialty for which we do not have an indication, cardiology. My mouth was agape when on our recent conference call they announced that at least 50% of our time should be in cardiology and that they would pay $2,000 for each start form regardless of if it ships or not. If that is not a sideways way to tell a team to promote off-label and you will be paid hansomely, I dont know what is. I'm trying to get out, but our reputation in a little over a year is so tarnished no one wants to touch us. What a disaster, what a mistake.

 

Your post is spot on...I’ve never seen anything like it

 

Time to call it a day and go home. I just left a cardiologists office and got totally reamed out for bringing Onpattro into her office when it is not indicated for her patients. "I treat cardiomyopathy, can your drug treat that? I don't care about neuropathy, why are you here?"

So tired of this happening and no one in home office or management wants to listen and I don't want to be targeted for having an issue. I can't believe this company does not acknowledge, or recognize that they are inappropriately promoting a product in this specialty. Is that why they hired second rate managers with no experience in rare disease, poor ethics, were lackys to the home office, or had been fired multiple times for ineffective leadership at other companies? They either don't know what they are directing is wrong, or have poor ethics. Either way, this is not going to end well.

Advice to everyone on the commercial team....document everything.

#AlnylamtheAsylum

 

Having spent a large portion of my career in ultra rare disease it is very common to call on multiple specialties for patient finding purposes. Since hATTR amyloidosis patients have issues associated with the heart, I don’t find it egregious to call on cardiologists to see if they have treatment appropriate patients. That’s the whole reason rare disease is not for everyone. It’s about finding appropriate patients that are often time misdiagnosed or undiagnosed. No one is claiming onpattro treats cardiomyopathy. It’s entirely appropriate to describe an appropriate patient and ask if they have a patient that fits the bill.

 

Being directed to focus on cardiology 2-3 times more than neurology while we have an indication for polyneuropathy only is a huge problem.

Having a speakers board that has significantly more cardiologists than neurologists is a problem.

Telling a sales team to call on a specialty outside of indication then simultaneously holding a start form contest that pays regardless of shipment creates an environment where the team is rewarded for doing the wrong thing.

V122I is associated with cardiomyopathy. I’m willing to believe in some cases there can be a neuropathic component, but that is not what cardiologist are treating. They are treating CARDIOMYOPATHY. There is no data stating Onpattro and Tafamidis have an additive effect and managed care won’t approve that anyway. So if cardiologists are treating cardiomyopathy, the two products can’t or will not be used together, we are paying the sales team on ALL start forms, and we are trying to cloud the waters by insinuating the autonomic symptoms of polyneuropathy give us a cardiac play then I believe it’s just a matter of time before the DOJ come calling. They will look at this as a pattern designed to induce prescribing for cardiomyopathy.

Just because our executives are in love with their first product launch doesn’t mean authorities feel the same and will look the other way.

 

It's obvious that you have never spent any significant time in rare disease. No one is telling you to sell for cardiomyopathy. It sounds like you decided that is the intent. Patient finding takes place wherever a potential patient may be treated! How is that lost on you? Sounds like you would be much happier in a therapeutic space that is clearly defined, where you are given a list of targets with decile ratings and told to call on your decile 8-10's 3x a quarter, your 4-7's 2x a quarter. Where you are told what to say, how often to say it and to whom to say it to. Save yourself the hassle and go there. Leave the heavy lifting to the rest of us who KNOW that patient finding is the only way to succeed.
And yes, I agree that paying for a start form is just a game that new companies play so when they can have their earnings call they can tell Wall Street that "we had X new start forms this quarter". Garbage in, garbage out. All this does is clog up the hub and delay real patient starts. I've dealt with this at other startups and their first product launch. Eventually clearer heads prevail and we will only pay on start forms that correlate to product shipment. Seriously, everyone wants to be in rare disease and a part of a start up until they actually are. If you can hang in through the rough spots, you will reap the benefits. If you can't, get out. Life is too short to be miserable everyday.

 

Until yesterday I was on the side that said we are doing nothing wrong. Now that we are almost doubling our sales team to "focus on cardiology" when we are at least 2 years out from a possible indication, it's clear management does not care of how it looks or what happens.

The prevalence for our indication is "ATTR‐FAP prevalence in core countries, extrapolated countries, and globally was 3,762" and "cumulative estimated number of persons with ATTR‐FAP across the 42 countries considered was 10,186 persons." This is a from a source on the NIH website. This is the population we are approved to treat and it is a GLOBAL number. The U.S. has mostly V122I which is associated with cardiomyopathy so at the very best, the US would account for half of this number. In fact the article being referenced below has the highest possible prevalence at 2,488 patients. It's clear Alnylam is hoping to secure patients outside of this indication. Management can say what they want, the actions are clear.

Country General population, M Prevalence low Prevalence mid Prevalence high
USA 321.4M 104 476 2,488

Estimating the global prevalence of transthyretin familial amyloid polyneuropathy

 

2400 patients. How many do we have on therapy today?!?? Doesn’t it make sense If we have more reps “hunting” we will get more patients on drug, our revenues will increase, our stock price will increase and guess what, WE WILL HELP PATIENTS! WTF? It’s obvious we aren’t getting it done and packing it in isn’t an option. My God go back to BMS or Shire or Novartis or Biogen or wherever you came from. Get on board or get out.

 

Why would I go back to Shire? They all came here after they were fired?

It will be really hard to help polyneuropathy patients without a plan that includes neurologists. Expanding/nearly doubling a salesforce and making zero mention of neurology as a call point clearly demonstrates intent. The home office continues to say we need to compete with Pfizer, but last I heard their drug was for cardiomyopathy. I knew things were seriously circling the toilet during the call that announced the start form contest that pays regardless of shipping. After the announcement, someone made a comment that Pfizer should be afraid and the home office was ecstatic about it. That was an opportunity to separate indications and the opportunity wasn't taken. DOJ doesn't care if you openly say to do the wrong thing, they care if you actually do the wrong thing.

Cambridge can say whatever they like in response to all of this, the actions are very clear and your intent is known.

As you read all of this, keep in mind that Barry and John originally didn't think they needed a sales force because RNAi would sell itself. Now they are approving anything to try to make money. This expansion will have no impact on sales and will add over $5M in just salary and benefit expenses for the BAEs alone per annum. This is not including other expenses like car, travel, etc. Might want to up price of Onpattro from $450K to $900K.

 

I’ve never heard such sanctimonious bullshit in my life. Please spare us all and GET THE F OUT! Jesus Christ you are on Cafepharma at 3:30 on a work day! If you spent as much time doing your GD job as you do wringing your hands on this site you’d actually find some patients. You are the epitome of what is wrong with our industry.

 

Take a close look. Whether you support the inappropriate promotion or are against, the typical Cafepharma post is written during the workday. Seems like there is a lot of down time all around. Main difference? We are willing to look at both sides and try to actually do the right thing overall.

ONPATTRO contains a transthyretin-directed small interfering RNA and is indicated for the treatment of the polyneuropathy of hereditary transthyretin-mediated amyloidosis in adults.

These patients are not being treated in cardiology. It's just a fact.

 

ONPATTRO contains a transthyretin-directed small interfering RNA and is indicated for the treatment of the polyneuropathy of hereditary transthyretin-mediated amyloidosis in adults. (1)

Take a look at all the entries on this thread. Regardless of whether you are ok with inappropriate promotion or against, the typical response is during the workday. You just made our argument that we have too much fat and an expansion is ridiculous. Thank you. Adding a $5-10M expansion expansion expense to promote off-label in an unprofitable company is the epitome of what is wrong with our industry.

The patients we are indicated for are not being treated in cardiology. Cardiologists treat cardiomyopathy. Maybe there are some co-morbid neuropathic symptoms, but cardiologists treat cardiomyopathy. Facts are facts.

 

Your retorts and responses to his curse-riddled posts are going to make JG go apoplectic around here, and will wake up sleepy JM. But we love it! Keep 'em coming!

 

No one could wake up JM - that guy is a dinosaur! The mere fact that they went from JJ to JM says all we need to know - I bet you a million bucks that he brings in yet another Flexion loser like DM - how do these fired idiots keep getting recycled?

 

That is soooooooooooooo spot on - DM "interviewed" me - spent 30 minutes talking about him - WTF???

 

It really is a cast of characters we have, isn't it?
"Hey, I have an idea! Why not hire some senior level managers let go or passed over at their last job, and then allow them to bring in whomever they want from their former company?"-says no one from an ELT whos product exceeds Wall Street expectations.

The "sales contest" is another funny idea from a so-called leadership team better suited to working on some blood pressure blockbuster in 2008.