Specialty Pharmacy Sales, Otezla, Humira, Sovaldi, Harvoni, Cinryze,Daklinza,HP Acthar, Olysio, Orkambi, Cuprimine, Firazyr, Viekira Pak, Stelara, Cosentyx, Enbreland 300 more. Visit www.maximedrx.com

1. Specialty Pharmacy Sales
Connecting the Healthcare Industry
800-848-7240www.maximedrx.com

2. “A lot of people in our industry haven't had very
diverse experiences. So they don't have
enough dots to connect, and they end up with
very linear solutions without a broad
perspective on the problem. The broader
one's understanding of the human
experience, the better design we will have.”
- Steve Jobs

3. Current Forces in Healthcare
“Minute clinics” Primary care office Specialist office
Hospital Outpatient Home health
Hospice Retail pharmacy Specialty pharmacy

4. Explosive Growth in Healthcare Data
The healthcare industry is experiencing explosive
growth in data: from 500 petabytes in 2013 to
25,000 petabytes by 2020.
= 500 Petabytes
2013 2020
Source: http://hin.com/blog/2013/12/24/infographic-storing-healthcare-data/

5. Physicians are Going Mobile
66% of doctors use a tablet for
medical purposes
More than 50% of doctors
using a mobile device report
that they aid in decision-making
40% report decreases in
administration time due to
mobile device usage
Doctors are 250% more
likely to own a tablet
than other consumers Source: http://www.totalassist.com/infographic-healthcare-mobility-doctors-250-likely-tablet/

6. Silo Innovation May not Work
#1 Innovation: Checklists
Hospitals will require health care
providers to follow strict protocols for
procedures that benefit from
routinization—from preparing a patient for
surgery to inserting a central line.
“Ten Innovations That Will Transform Medicine”
“Researchers found no significant drop in complication or mortality rates
in the three months after the adoption of checklists.”

8. What Watson is Doing Now

9. By 2016, 8 out of the top 10 branded
pharmaceuticals in the U.S. will be
specialty medications.

10. =+
Cashless & Convenient:
You don't need cash when you ride with Uber.
Once you arrive at your destination, your fare is
automatically charged to your credit card on file
– no need to tip. We’ll also e-mail you a receipt.
One Tap to Ride:
Uber uses your phone's GPS to detect your
location and connects you with the nearest
available driver. Get picked up anywhere —
even if you don't know the exact address.

11. Patient Access and
Empowerment
• Physicians, nurses, medical assistants,
practice managers and other staff that
influence what specialty pharmacy is
used by the patient.
What Specialty Stakeholders Want
Predictable Costs
• Value based health care
• Bending the cost curve
Documented Quality
• Best Practices Clinical & Formulary
Management
• Patient & Provider Network Satisfaction
• Documented Comparative Outcomes
Integrated Care
• Pharmacy & Medical Benefit
• Administrative efficiencies
• Web based technology interfaces with
protected PHI

12. Connecting a
Disconnected Industry

13. Specialty Pharmacy: Linking the Silos
Specialty Pharmacy Healthcare Silos
• Which patients have experienced (1)
ER visit / hospitalization or (2) new
medical condition?
• Which patients need refills?
• QOL Issues/Opportunities
• Correlate outcomes differences to
prescriber, patient therapy, outcomes
Safety & OutcomesCompliance & Benefits
• What Step Therapy, PA & CPBs
• How often is patient missing
doses? Why?
• Has patient discontinued
therapy? Why?
• Has patient been referred to MD
or manufacturer patient support?
• What disposition?
Patient Data
• Lab Values
• Patient-specific Data
• Skills of Daily Living and
Physical Info
• Compliance Rate
• Discontinuation & Reasons
Why
• Drug-Specific Outcomes at
Targeted Levels
Physician Payor Pharma
RESULTS:
• Communication
• Safety
• Adherence
• Improved
Outcomes

14. Integrated Care

15. Conflicting Trends
New Approach Needed:
‘Specialty’ Specialty Pharmacy to focus on high-cost, low-population needs
Reining-in the high
cost of healthcare
Industry consolidation
leveraging volume throughput
Higher-cost specialty
drugs for smaller
populations of patients
Precision therapy with highly refined
patient populations
Economic Clinical

16. Drug Development: Rapidly Advancing Arsenal of
Very Costly, High Precision Tools
Ref: Robert Mancini et al. Oral Oncolytics: Part 1—Financial, Adherence, and Management Challenges; August 15, 2013, Cancer Network, Oncology Vol. 27, No. 8
© Copyright 2014, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health.

17. Courtesy Mark Schoenebaum, ISI Group

18. p70 S6K
p70 S6K
mTOR
AKT
P13K
GSK3 a/b
BCR-
AB1
Src
Src
P
Predominant in
endothelia
Bevacizumab
Bevacizumab
VEGFR3
VEGFR2
VEGFR1
bFGR
IGF-1R
P P
P
HER-2
ErbB3PDGFRa/b Cetuximab
c-Kit
AZD2171
Sunitinib
Dasatinib
Imatinib
AZD2171
Sunitinib
Dasatinib
Imatinib PF-0299804
BIBW 2992
PPI/DasatinibBEZ235
Dasatinib
PDF184352
Sorafenib
RAD001
P
P
P
RAS
P
B-RAF
MEK
ERK1/2
P
P
p38MAPK
P
ERK1/2
p38MAPK
P
P
Chemotherapeutic agents
(cisplatin/paclitaxel
docetaxel/docetaxel + cisplatin)
Bortezomib
Proteosome
SUBSTRATE
CELLCYCLE
G1
R
S
MG2 17-AAG
STAT1,2,3,5,6
P
STAT1,2,3,5,6
P
AG490
AZD2171
Sunitinib
STAT
Jak
P
P
P
P
P
P
AG1024 /
PP1
SU5402
AZD2171
Sunitinib
Sorafenib
AZD2171
ZD6474
Sunitinib
Sorafenib
Tumor cell
VEGFs,
bFGF
HIF-1a
bFGFR VEGFR1 VEGFR1 VEGFR3
Endothelial cell
Bevacizumab Bevacizumab
Blood vessel
AZD2171
sunitinib
AZD2171
ZD6474
sorafenib
sunitinib
AZD2171
sorafenib
sunitinib
SU5402
Waste
Proteins
LBH589
Aggresome
LBH589
ASA404
HDAC
HDAC
Figitumuma
b
P
EGFR/HER-1
Gefitinib
Erlotinib
PF-0299804
BIBW 2992
ALK
Crizotinib
c-Met
Crizotinib
PF-04217903
Drug Specialization:
Increasing with Understanding of Biology
© Copyright 2014, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health.

19. Integrated Real-time Close-Looped Solutions Will
Drive the Future of Healthcare
© Copyright 2014, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health.
Shared
HIT
Solutions
Patient
Specialty
PharmacyPhysician
Physician:
Increasing complexity of
precision therapeutics requires
decision support, virtual Clinical
Pharmacist Partner
Patient:
Just-In-Time, 3 minute mobile health
solutions to empower the patient &
maximize adherence and compliance
Specialty Pharmacy:
Rapidly expanding arsenal of high-cost,
low-volume therapeutics demands
personalized approach
Ongoing Benefits Management
Complexities
Patient:
Get the right information
Get the right drug & dose
Get it at the right time

20. Specialty Pharmacy: POS & Medical
Benefits, Processing World Collide
Considerations
Two billing
methodologies
converge
Specialty Drug Spend
2014 and beyond
Specialty Pharmacy
Medication Fulfillment
Point of Service
Drug Claims Processing
Drug Benefit
NCPDP/PBM
One system, non siloes
claims data
Strong Integration
Billing requirement
differences,
NCPDP/Universal Claim vs.
Procedural Coding,
HC15010, EDI vs. snail mail
or 837
Traditional
Medical Claims Processing
Medical Benefit
UB/1500 -837(p)or(i)/Payors
Reimbursement
“Rules of Engagement”
Managed Care/Payor
Contracting

21. PathWare™ Decision Support for Clinical
Pathways
Get the Right Drug to the Right Patient at the Right Time
© Copyright 2014, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health.

22. AIM Provider Portal
Source: https://wellpoint.aimoncology.com/CancerTreatmentPathways.html

23. Frameworks SRx Integrator Platform
The New Specialty
Pharmacy:
Highly configurable
Pushing/Pulling Data Across
dispersed yet shared
healthcare continuum.
Connecting Patients, Payors,
Providers, Drug Manufactures,
Specialty Pharmacy for better
outcomes (Health/Financial)
Specialty Pharmacy
Management
Patient & Payor
Physician/Hospital
Management

24. Transactional
• Scripts
• Authorizations
• Fills
• Claim Filing
• POS/Medical
Data Capture
• Providers
• Pharmacy
• Patient
• Payor
Central Data
Repository
and Analytics
• Contract
• Patient Management
• Claims Management
• Audit Risk Mitigation
• Better Outcomes
Patients
• Better Compliance
• Better Management
• Lower Cost
• Predictable
• Better Outcomes
Single Repository – User Specific Insights
Making data user defined and easily obtainable

25. Page: 25 | Confidential and Proprietary
Patient Access and Empowerment

26. Bi-Directional Text Messaging Program
• Text messaging program
• Daily reminders to take
medication
• Reminders for lab work
• Educational tips, e.g. blood
pressure monitoring
• Motivational messaging
• Patient surveys
• Gather lab values
• Pharmacist intervention for any
indication of non-compliance
• Clinician notified
• Weekly emails to clinical staff
• Refill Reminders

27. Bi-Directional Text Messaging Program
Increase in Refill Rates After Adoption
69.4%
89.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Pre-adoption
rate
29%
Growth in refill rate
after adoption of text
messaging program
Post-adoption
rate

28. Patient Education & Adherence
Personalized education appended
to patient’s personal health record

29. Patient Empowerment
Leading provider of oncology patient
portals provides personal health record
for connected patient participation
68% visit
greater than 4+ times
per month
50% of invited
patients join portal

30. Our pilot program demonstrated a 50% increase in
medication adherence at month 4 of therapy for Tasigna®
patients using GlowCap (vs. control group).

31. Page: 31 | Confidential and Proprietary
Patient Adherence Comparison
GlowCap Users vs. Non-Users
• Early data show patients
with GlowCap had better
adherence in their first 4
months of therapy.
• The gap between the
groups seems to grow
overtime, especially for
Tasigna patients.

32. Page: 32 | Confidential and Proprietary
Documented Quality &
Predictable Costs

33. Dispensing Scorecard Example – Q4, 2013
Pharmacy A
Other specialty pharmacies
33%
34%
23%
9%
3%
45%
23%
22%
9%
1%0%
10%
20%
30%
40%
50%
0-3 4-7 8-14 15-28 29+
45%

35. Study Results
The intervention group showed a 12.6%
improvement in adherence rate (MPR)
over the course of the study.

36. Study Results
Intervention group was 78% more likely
not to be hospitalized: Saving $27,852
per month in healthcare costs.

37. Pathway Results Speak
for Themselves…
“This analysis affirms that savings on aggregated breast,
colon, and lung cancer spending as high as 15% can be
achieved in the first year of our pathways program concurrent
with as much as a 7% reduction in hospital admissions.”
© Copyright 2014, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health.

38. Page: 38 | Confidential and Proprietary
Program Validation: Open-Ended Questions
Drug Response Type Response Count
Xeloda YES 56
Xeloda NO 60
Side Effects — Was the patient aware of [Xeloda] side effects?
Drug Response Type Response Count
Xeloda YES 76
Xeloda NO 40
Monitoring Parameters — Did your doctor tell you about the importance of [Xeloda] lab work?
Drug Response Type Response Count
Xeloda YES 64
Xeloda NO 52
Indications — Does the patient know what the [Xeloda] indication is?

39. Page: 39 | Confidential and Proprietary
Program Validation: Counsel opt-out

40. Page: 40 | Confidential and Proprietary
Prior Authorization Edit for Telaprevir
(Formulary Management)
Goals:
• Clinical evaluation of each fill
– RGT
• Prevent wastage
– 4th fills denied
Pharmacy Intervention
Clinical Pharmacist
Review
325 internal PA’s submitted
6 claims denied due to
inappropriate request
• 4 requested for 4th fill
• 2 requested for patients with VL
>1,000u/ml at week 4
Total Savings of $158,772.90

41. Page: 41 |
Plan A
50%Plan B
47%
Cost Savings
3%
Votrient for 60 Patients Over 30 Days
Monthly cost of Votrient:
$9,240* per patient
• Plan A: Total cost for 30 day
supply
• Plan B: Total cost for 15 day
increments in 30 days
• Anticipated 10% attrition within
30 days
• $27,720 potential savings in one
month for one drug if utilizing
Plan B
• 5% savings per month utilizing
Plan B
* Based on current AWP

42. Page: 42 |
In Summary
• Explosive growth in SRx pipeline
and costs create a demand for
industry collaboration.
• Communication, collaboration and
technology drive adherence,
improve outcomes, and reduce
healthcare costs.
• Specialty pharmacies are uniquely
positioned to serve as the
“healthcare industry connecter”
• Watershed moments in SRx
continue – Sovaldi,
Imbruvica…more to come