MannKind (MNKD) has been my Top Pick for several years; the shares rose 38% in 2021 and the stock is once again my Top Pick for the coming year, asserts Nate Pile, editor of Nate's Notes.

The company's lead product, Afrezza, is an FDA-approved form of inhalable mealtime insulin that is much faster-acting than injectable insulin and has shown itself to be superior in virtually every way to all the other mealtime insulins currently on the market for people with type 1 and type 2 diabetes. 

More and more diabetics are starting to use continuous glucose monitors (CGMs) to monitor their blood sugar levels in real time these days, and, not surprisingly, once they have this ability to track their numbers in real time, they are naturally starting to want an insulin that also works in real time.

For those not familiar with the diabetes space, the "old school" injectable insulins that Afrezza is on its way to replacing can take 45 minutes or longer to start working, whereas Afrezza starts to control blood sugar levels within just a few minutes of entering the body.

And as those of you who do have some experience with the space can relate, it can be quite frustrating (as well as unhealthy) to watch blood sugar levels continue rising long after the uptrend has been detected and an attempt has been made to control it with any of the slower acting insulins.

In addition (and perhaps even more importantly as a product differentiator), Afrezza also leaves the body more quickly than the traditional injectables. Patients using Afrezza have been reporting fewer incidents of hypoglycemia (low blood sugar), a condition that can be fatal if not addressed quickly enough, while using the product.

Of course, the "magic" behind Afrezza's superiority is the fact that the insulin is delivered to the body using a proprietary drug delivery system called Technosphere.

Though MannKind has retained full rights to Afrezza, it has started licensing this technology to other companies as well, with Tyvaso DPI (an inhalable version of treprostinil used to treat pulmonary arterial hypertension and pulmonary hypertension associated with interstitial lung disease) likely to be approved and on the market sometime later this year.

If approved, Tyvaso DPI will be sold by MannKind's partner on the project, United Therapeutics (UTHR), and in addition to doing the manufacturing for United Therapeutics in the same facility that is currently producing Afrezza, MannKind will also receive royalties on sales of the product.

Along with Tyvaso DPI, MannKind has also licensed the platform to a private company, Receptor Life Sciences, which is developing pharmaceutical grade cannabinoid products for the treatment of a number of different conditions.

Provided these products continue to progress though the clinical process and eventually hit the market, MannKind will be receiving milestone payments along the way, as well as royalties on sales once they start. MNKD is considered a strong buy under $5 and a buy under $10.

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