Highlights from ExL Pharma's 2nd Pharmaceutical Managed Markets

HIGHLIGHTS FROM EXL PHARMA’S 2ND PHARMACEUTICAL MANAGED

MARKETS INSIGHT AND MARKETING

February 9-10, 2010Philadelphia, PA

The Providers Perspective

Provider’s Concerns

Quality of Care Patients Access to Drugs Compliance/Costs of Readmits or

unnecessary ER visits Free up Capacity Reduce Denials Getting Paid

What can you do?

Keep us informed of expensive drugs and how do we get paid.

ExampleCoverage for Drug X in Local Market

Hospital Physician  

Inpatient Clinic OfficeBilling

Codes

Emblem        

HMO Yes No Yes J1234

PPO Yes No Yes J1234

Medicaid Yes No Yes J1234

Medicare Yes No Yes J1234

Convince the Medical Directors of Health Plans

Instead of just paying for one drug among a whole class of drugs, focus on patient-centered care

Help to finance for “Off-label” use if justified

Streamline Charity Care Guidelines

Bottom-line: Everyone Wins

Patients – gain access to drugs for individualized treatment

Insurers - May pay more for drugs which will more than off-set by avoiding unnecessary ER visits, readmits and patient compliance.

Hospitals – Provide quality care to patients & actually get paid

And YOU?

More Sales

KEYS TO DEVELOPING A MEDICAL/VALUE MANAGED CARE

STRATEGY TO ACHIEVE COMPETITIVE ADVANTAGE

10

The Evidence Continuum

APPLICATION OF EVIDENCE-BASED MEDICINE

Population Based Local & CustomizedEVIDENCE GENERATION EVIDENCE TRANSLATION EVIDENCE APPLICATION

Safety EfficacyTolerability

Proof of Concept

CONTROLLED CLINICAL STUDIES

Effectiveness

REAL WORLD STUDIES

Efficiency

Best Value ? Process

Improvement & Quality of Care

Initiatives

Risk / Benefit ? Real World Benefits ?

Practical Clinical TrialsQuasi Experimental StudiesObservational StudiesEconomic / Cost / Utility Studies Systematic Reviews

Population Management ProgramsQuality of Care InitiativesPoint of Care Decision SupportConsumer-Centric / Directed Care

Placebo ComparatorAgent Comparators

Rigor Generalizability

Supporting the Evidence Continuum

Evidence Application:

Customized Solutions to support

Preferred & AppropriateUtilization of

Portfolio

Evidence Generation:

Safety, Efficacy & Real World

Effectiveness Research to support

product value proposition

Evidence Translation:

Development of Customer Centric “Toolbox” to support

Access , Coverage & Process

of Care Activities

Evidence Gap:• Unmet Medical Needs / Value Perception • Market & Customer Insights • Coverage & Reimbursement Decision Making

Adapting to an Evolving Customer Environment

Evolving Customer

NeedsClinically Effective, Safe, and Tolerable

1. Cost Effective2. Improves Quality

3. Easy to Adopt

Evolving Customer

Needs

Traditional Customer

Needs1. Clinically Effective, Safe,

and Tolerable2. Cost Effective

3. Improves Quality4. Easy to Adopt

Ability to Lead

Transformation

Broad Business Acumen

Evidence-Based

Medicine

Evidence-Based

Medicine

Customized Solutions Approach

Population- Based

Evidence- Based

Local and Plan Level-

Based

Measurement-Based

A P P L Y

Identify and treat

appropriate patients

Promote evidence-

based best practices

Improve patient

outcome and quality

of life

Manage total cost of

care

T O

D E L I V E R V A L U E

Redefining the Value Equation

What is it? • Efficacy • Safety • Tolerability • Clinical trials

Who else thinks it’s valuable?• Thought leader support• Patient organization support• Healthcare provider advocacy• Quality organization support

What’s in it for me? • Outcomes • Cost effectiveness • Cost offsets • Quality improvement

How much will it cost? • Discounts • Rebates

• Proves real-world, customer- and patient-centric value

• Historically underutilized• Changes the value

equation

Optimizing the New Customer Engagement Model

Align internal resources and customer needs with

real-world field experience and feedback

Outcomes Data+

Customer Solutions

Payers

Patients

Providers

EBM

Evidence Translation Toolbox

Knowledge TransferPopulation Health

Support Point of Care

Support

•Publications•Monographs•Slide Presentations•Dossiers•Compendia•EB Synthesis•CME programs•Advocacy Meetings•Product Information

•Budget Impact Models•Cost Effect. Models•Formulary Mgmt Tools•Benefit Design Tools•Risk Prediction Tools•Pt Identification Tools•Population Profiling•Predictive Models•Benchmarking Data

• Guideline Translations• Discharge Protocols• Transition of Care Tools• Pt Compliance Support• Self Care Tools• Case Mgmt Tools• ePrescribing Support• Pt Education Support• Medical Home • Information Portals

SummaryGenerate

evidence that is RELEVANT

Translate and provide solutions

that are VALUABLE

Communicate in ways that are

MEANINGFUL and ACTIONABLE

HEALTH CARE CHALLENGES—ARE THERE SOLUTIONS

WE CAN TRUST?

The Ever Changing Landscape

Increased price pressures Fewer new unique Chemical entities being

brought to the FDA Fewer new Pharmaceutical products being

approved Risk Evaluation Mitigation Programs (REMs) Increased pressures to demonstrate health

outcomes Medication Adherence and Persistency Patient non-adherence causing costs to rise Politicians desiring to practice medicine Patient satisfaction/Customer service growing

more uneasy

Stake Holders searching For solutions

Government Healthcare Reform

Non-Government Collaborations The California Pay For Performance Program

The California Healthcare Foundation (CHCF) The National Committee for Quality Assurance (NCQA) The Pacific Business Group on Health (PBGH) The California Association of Physician Groups (CAPG)

Managed Care Organizations Pharmaceutical Manufacturers National Organizations

Evidence-based clinical practice guidelines Value-based Benefit Designs

Employers Patients Health Care Providers

Searching for Solutions

California’s Pay-For-Performance Program Non-governmental physician incentive

program Improve quality of care and health outcomes 8 Health Plans 200 Medical Groups 35,000 Physicians caring for 11.5 Million HMO

Members Single performance-based set of measures Public report card Aggregation of data from multiple payers for

calculating scores

Source: The California Pay for Performance Program, The Second Chapter, Measurement Years 2006-2009

Searching for Solutions

Patient-Centered Medical Homes Goal: “Relieve the looming crisis in primary care,

improve clinical quality and patient experience, and moderate cost increases.”

Coalition Major Employers Consumer Groups Patient Quality Organizations Health Plans Labor Unions Hospitals Physicians

Source: www.pcpcc.net/content/pcmh-vision-reality

Searching for Solutions

PCMH continued Pilots in 44 States & District of Columbia

Commercial Medicare Medicaid VA/DOD LTC

Searching for Solutions Education Health Coaches Electronic Health Records Patient phone calls Automated Telephone Self Management Support Programs Stakeholder Alignments Health Insurance for everyone Removing soda pop from schools Make healthy foods available at a cheaper price Single Payer Health Care Government/Elected Officials Taxes on Soda Pop

Searching for Solutions

Put the healthcare dollar in the consumers hands

Allow market forces to drive the delivery of Healthcare

Real incentives to the consumer of healthcare

Strategic Legislation Malpractice Insurance Reform Worker’s Compensation*** Reform Welfare System***

Searching for Solutions Things to Consider:

Government’s track record of Program implementation & sustainability

“If you put the federal government in charge of the Sahara Desert, in 5 years there would be a shortage of sand.” Morgan Friedman

The best of America comes when “These are that tries men’s souls” Thomas Paine

“What we obtain too cheap, we esteem too lightly” Thomas Paine

The Wizard is Fraud!! The entrepreneurial spirit is alive and well in America When incentives are appropriately aligned America’s

citizens will rally and find ways to succeed ‘Rome was not built in a day and it did not fall in a day’

There is no magic quick fix solution When we are sick we take sick days to

heal ourselves or we go to the appropriate Physician—the Government doesn’t treat fevers

Still have any questions? For additional information on ExL Pharma’s Pharmaceutical

Managed Markets Insight and Marketing Conferences, please visit www.exlpharma.com