SPECIALTY AT RETAILRebecca M. Shanahan, CEO

Avella Specialty Pharmacy

Agenda• Specialty Pharmacy Market Drivers

• Specialty at Retail Program Highlights

• Patient Engagement

• Integrated, Real-time Data Sharing

• Opportunities for Growth

State of Retail Pharmacy• 93% of Americans live within 5 miles of a

retail pharmacy

• Pharmacists ranked as the second most trusted profession for the third consecutive year (Gallup Poll, 2013)

• Pharmacists may soon to be given “provider status’

• Retail pharmacies becoming a healthcare destination (screenings, immunizations, first injections, flu shots, clinic)

• BUT the growth is in Specialty Rx

• 1,256,250 patients per year• Assumes conservative $2,000

per month, 8 scripts per year• Data & Other FFS

opportunities• Shared/Aligned Risk Upside

Specialty at Retail - OptionsTraditional SRx

Investigate Benefits

Hub & Spoke Triage

Limited Distribution Drugs

Dispensed by XX on Behalf of Retail YY

Specialized SRx

Lower $$; Higher Volume Drugs

Compounds, Infusions & Nutriceuticals Brand ExtensionsCo-Pay & Discount Cards

Persistence & Compliance

Payor Centric SRx

Disease Specific “Center of Excellence”

Geographically Dense Relationships

Clinical Program & Data

Orphan SRx

3PL Competencies

REMS Competencies

Roll Out Experience

Informatics Competencies

Clinical & Program Data

IDN/ACO SRx

Medical Home

Medications @ Discharge

340(b) Programs

IPA Relationships

Shared Risk

The Path of a Specialty Prescription

Retail Rx

Specialty Rx

Location, Location, Location - Patient Access and Empowerment• Patient Assistance Programs• Drug/Disease Education• Persistence & Compliance

What Specialty Stakeholders Want

Payer Hotbox - Predictable Costs• Value based health care• Bending the cost curve• Documented Comparative

Outcomes

Actionable Information is the Special Sauce - Quality Clinical Programs• Best Practices Clinical &

Formulary Management• Patient & Provider Network

Satisfaction

Not Your Grandmother’s Soda Fountain – Access to Clinical Pharmacist• Pharmacy & Medical Benefit• Engagement with Patients• Engagement with Physicians &

Offices• Real Time visibility to

Drug/Disease/Patient Variables

Food For Thought• Is Specialty Pharmacy a set of activities that drive patient access &

compliance, a “bricks and mortar” profile or both?• Are there discernable factors that drive Pharmaceutical Manufacturers to

select certain profiles of Pharmacy Providers?• Hep C, HIV, Infertility, RA have broad Retail dispensing presence• Oral Oncology, Injected and Infused Drugs have more Limited Distribution

Specialty Presence• How are site of service changes, e.g. Hospital acquired Medical Oncology

Practices, Physician Networks, etc. driving Class of Trade and Pharmacy network differences?

• Are there different factors driving Payer Network Selection• National/Affiliated Pharmacies• Fulfillment Pharmacies• Regional Retail &/or SRx Pharmacies• Provider Based Pharmacies

Specialty at Retail Program Highlights

HIV at Retail

Chronic Condition No Limited Distribution

Financial Assistance AAHIVM Credentials Adherence Tools

Community Focus

HIV at Retail• HIV – A Chronic Condition requiring individual regimens, treatment

plans and Pharmacist/Patient interactions– 90 to 95 % adherence to HAART achieves Optimal efficacy.– Viral load increases after only 2 days of missed dosing.– Some patients acquire drug-resistant mutations, requiring changes in medication regimen.

• Key Compliance Driver – Hands-on Coordinated Care• No increased level of adherence/virologic improvement with intensive telephone counseling as

the only approach to adherence (Collier and the ACTG Team, 2002 – HIV patients)• Patient is an active participant in therapy management with MD/RPh professional guidance

and regular intervals of review • Adherence is monitored through regular face-to-face interactions with Pharmacists who reach

out to Physicians when Patient encounters barriers to adherencePatientQuestionnaire

Build Meds Schedule Teach Patient

• Score Patient Adherence Likelihood

• Set Cadence of In person Follow ups

• Review of Meds Tracking

Measure MPR Review & Report

• Collect & Analyze Data

• Patient Compliance• Patient Safety• Comparative Outcomes• Share with MDs & RPhD

RPh Disease & Drug Education

• Standard Content & Scripts

• Standard Information & Intervals

• One Platform

• Sleep pattern• Work schedule• Eating schedule• Travel & weekend

schedule

• Standardized Meds Adherence Tracking

• Build Contingency Plans

• Build Pt. Coping Skills

• Patient Adherence • Side Effects• Patient Well-Being• Discharge Reasons

90% Compliance

Rheumatoid Arthritis at Retail

“Specialty Light” Program Patient Education Injection Training

Intervention Step Therapy CDAI Scores

Outcomes: Patient Counseling and Education

Infertility at Retail

STAT Medications Disease Management Hub and Spoke

Centers of Excellence Trained Pharmacist Provider Relations

Compounding Services Passion Patient Education

Hepatitis at Retail

High Revenue Growth Opportunity Not Limited Distribution

Short Duration CDC Testing Guidelines

Provider Relations National Testing Day Manage Viral Load

Patient Education

Patient Access & Empowerment

Mobile App

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

Bi-Directional Text Messaging ProgramIncrease in Refill Rates After Adoption

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

69.4%

89.4%

Pre-adoption rate

29%Growth in refill rate after adoption of text messaging program

Post-adoption rate

Study Results

The intervention group showed a 12.6% improvement in adherence rate (MPR)

over the course of the study.

Study Results

Intervention group was 78% more likely not to be hospitalized: Saving $27,852

per month in healthcare costs.

Integrated, Real-time Data Sharing

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.

SharedHIT

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 informationGet the right drug & dose

Get it at the right time

Avella Frameworks SRx Integrator Platform

The New Specialty Pharmacy:Highly configurablePushing/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

Single Repository – User Specific Insights

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

Provider Portal

Opportunities for Growth

SRx Implemented Pathways Programs

• 96% cost savings between Payor-sponsored Formulary/Pathways Program vs. oncologists not utilizing pathways for breast, colon and lung cancers (1)

• Variance includes only the use of clinically equivalent, evidenced based protocols. Additional savings can be generated from anti-emetics, dose modulation, off-protocol prescribing, management of late stage metastatic disease, and care management

(1) Study included practice data for all Medicare HMO patients with a breast, colon, or lung cancer diagnosis at 3 non pathway practices and 1 pathway practice for 12 months.

Oncology Spend Comparison Pathway Physician Non-Pathway Physician

Avg. Drug Cost Per Person $5,160.6 $10,115.2Patient Sample Size 15 49# of Practices 1 3Avg # of Infusion's Per Month 3.00 3.23Cost Differential 96%

Medications at Discharge

CMS Star Rating

Re-Admission rates a Key Driver of CSM Star Ratings MPR/Adherence is a Key Driver of CSM Star Ratings

Coordinated Discharge and Prescription Follow upHospital & Pharmacy jointly participate

at the Discharge pointPatients leave with Rx, and a

Follow-up plan from the Pharmacy

Numerous Studies Demonstrate poor Rx management at DischargePoor Patient management of Discharge Rx leads to Re-Admission

Movement from Volume to Value

Fee for Service

Thank You

Stay Connected

Rebecca M. Shanahan, Esq.CEO of Avella

linkedin.com/pub/rebecca-shanahan/7/100/262

rebecca.shanahan@avella.com