" please explain how this debt for equity swap is different than the last. both involved no exchange of cash for the shares. "

In the prior debt for equity swaps, the line of credit was reduced by the dollar amount of shares purchased, thus no new net source of funds. Under this most recent debt for equity swap, the amount that can be borrowed under the line was not reduced. The net result was approximately $107 million of net new sources of funds.

You are correct that there was no "immediate" exchange of cash for the shares, but the critical difference from prior transactions is MNKD can draw down the line of credit in the future for the $107 million of debt retirement used to purchase shares. After the line is fully used, Al will have put an additional $107 of new cash in MNKD.