INSIGHT | STRATEGY | EXECUTION
The Aequitas Group Advantage
Capabilities Presentation
INSIGHT | STRATEGY | EXECUTION
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The Aequitas Group Who We Are
The Aequitas Group Specializes in the Development of Solutions Used to Define and Communicate a Product’s Value. We Deliver These Offerings in a Disciplined, Evidence-Driven Environment.
Boutique strategic healthcareadvisory firm
Established December 1999
Venture backed
Corporate office in San Diego, California
Analysis that helps maximize product value for stakeholders Manufacturers Patients Providers Third-party payors Third-party vendors Investors
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The Aequitas GroupWhat Makes Us Unique
Industry experts Brand, Marketing, and Sales Operations Directors Centers for Medicare and Medicaid National Administrator Hospital Administrators Commercial Payor Medical Directors and Reimbursement Specialists Health Economists Global Government Affairs Specialists Regulatory Affairs Specialists Medical Affairs Specialists Patient Educators
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The Aequitas GroupWhat Differentiates Our Approach
Evaluation of Complex Commercialization Factors
Clinical Assessment
Payor Assessment
Marketing Assessment
Health Policy Assessment
Analysis and strategy for each aspect of the commercialization process Focus on ALL customers and service providers
Company
Investors
Patients Providers Payors
Specialty Pharmacy &
PBMCall CentersHospital
Administrators
ROI
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Clinical Study Design Review
Competitive Intelligence
Coverage, Coding, and Payment Plan
Pharmaco-economic Studies
Payor Mix Analysis Formulary Analysis
Physician and Sales Force Education Reimbursement Billing Guides Reimbursement Call Center Training Patient Assistance Program Design and
OIG Guidance HCPCS Code Applications Payor Messaging and Presentation
Development Payor Market Research Competitive Intelligence
Formulary Kit and AMCP Dossier Development Payor Information Tracking Formal Policy Response Pharmacoeconomic Studies Formulary Placement Appeals Reimbursement Training Ad hoc Reimbursement Commercialization
Consulting Competitive Intelligence
The Aequitas Group Maximizing Patient Access By…
Pre-Launch Post-LaunchMarket Launch
Clinical Trials Product Filings (NDA, BLA, 510K, PMA)
Launch Phase IV New Indication
Obtaining optimal coverage and reimbursement Translating product attributes to multiple stakeholders (patients, doctors, HMOs) Educating management, field force, and call center staff on product attributes and challenges Navigating the increasingly complex competitive landscape and regulatory environment
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The Aequitas Group Complementary Specialties
Managed Markets Consulting
Reimbursement, distribution, and access plan development Payor plan data collection and analysis Named patient programs Ad hoc consulting support Comparative effectiveness and health economic assessments
Reimbursement Training and Patient Educators Programs
Competitive Intelligence
Call CenterDesign and Compliance Auditing
Customized and certified reimbursement training programs Certified patient educator program
Scenario planning Competitor review and disruptive technology analysis
Compliance audit of patient assistance and reimbursement hotlines Process optimization based on patient access, channel design, and budget
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Managed Markets ConsultingActivities To Match Perspectives
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Out-of-Pocket Analysis to Inform Patient Assistance Programs and Foundation Development
Facilitating the Client’s Patient Experience through the Reimbursement and Patient Assistance Process
Enhance Prescriber Access Through Coverage Review and Coding Applications
Collateral Material Development and Website Content Population
Product Analog Analysis Payor Landscape Review Payor Marketing Plans and
Message Development Product Dossiers Competitor Product Review
Provider Perspective Payor PerspectivePatient Perspective1 2 3
Provider Perspective
Patient Perspective Payor Perspective
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0 100 200 300
Managed Markets Consulting Aequitas Reimbursement Likelihood Ratio™
Lowest Highest
Clinical Value
Reimbursement Likelihood
Econ
omic
Val
ue
INSIGHT | STRATEGY | EXECUTION
Managed Markets ConsultingCoverage Dashboards and Payor Tracking Systems
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INSIGHT | STRATEGY | EXECUTION
Managed Markets ConsultingNamed Patient Program Support
Send PhysicianProduct NamedPatient letter
LOA PI Forms Price
Are received
documents complete
Review Requestby Patient Access
Committee
Pass Request to Trade forDelivery of Product to Physician
Ship Product to Physician Using Import Vendor
Receive Confirmation of Delivery ofDrug and Receipt by Physician
Re-label Product as Required Get Import License
Send Polite “Reject” Letter. Can not Provide Drug
Send polite letter Can not provide
drug
Send Letter to Physician asking for Missing Info
Refer to Partner
No Yes
Yes No
No
Yes
Is Product Covered
by Partner
Authorized Country
Time Frame for Planning a Named Patient Program
6 Months 12 Months
Prepared Documents and Contracts
Information for physicians and pharmacists
Dose and administration of drug
Patient treatment criteria
Named Patient Program Established
Marketing Authorization Anticipated
10
No
Yes
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Post-Graduate Institute of Medicine Certification
Wholesalers Group
Purchase Organizations
Wholesalers Specialty
Pharmacies Specialty
Distributors Pharmacy
Benefit Managers
Physician Offices
Reimbursement & Patient Educators ProgramsTraining Customized by Product and by Need
Physician Office
Hospital Outpatient
Hospital Inpatient
Home Long Term Care Dialysis Center Infusion / Shot
Clinic Ambulatory
Surgical Center
Medicare Part A Medicare Part B Medicare Part C Medicare Part D Medicaid FFS Managed
Medicaid Private Pay Medical
Benefits Pharmacy
Benefits Specialty
Benefits Durable Medical
NCPDP NDC CPT ICD-9 and ICD-
10 DRG HCPCS
Active Listening Probing for
Information Fluency with
FAQs Working all
Four (4) Sides of a Case (i.e., Patient, Provider, Payor, Distributor)
Policies Bulletins Articles Contracting Rebates Utilization
Controls Formulary Preferred Drug
Lists Generic
Positioning
AWP ASP WAC Best Price FUL AMP Samples Coupons
Medicare Managed Care Medicaid Veterans Affairs Department of
Defense Indian Health
Service
Initiation Completion
Payor Introduction
Purchasers and
Distributors
Sites of Service Plan Types Coverage and
Payment Billing and
Coding
Payment and Alternative
Funding
Objection Handling
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Reimbursement & Patient Educators ProgramsA Way to Support Your Providers and Your Patients
The Institute of Medicine estimates that health literacy generates an annual cost of 73 billion dollars per year in healthcare
Seventy-five percent of chronically ill Americans have low literacy skills
Poor literacy yields a longer length of stay in healthcare entities, and it’s been estimated that poor “health literate” patients cost four times more than a “health-literate” patient to treat
There is evidence to conclude that teaching tools, i.e., “videos, brochures, etc., help with teaching patients, but a healthcare provider who is trained on how to educate, yields the best outcomes in the progression patient knowledge
Patient Education Hierarchy
Safety
Disease- Patho-Physiology
Treatment: General & Specific
Problem Solve
Unifywith
Personal Life
Informed Decision
Self Actualization
As patients attain greater knowledge, they move
up the hierarchy which allows greater control & autonomy
in their personal healthcare
INSIGHT | STRATEGY | EXECUTION
Competitive IntelligenceAcross the Commercial Lifecycle
Actionable Intelligence Informs Critical, Key Decisions
May focus on Regulatory, Global Markets, Direct Competitors, Payors, Disruptive Technologies
Informed by primary and secondary research The Aequitas Group experts filter and interpret data Anticipate issues for proactive management
Environmental
Scan
What factors will Influence the success or failure of my product or service?
What trends may derail my opportunity?
Review potential competitors by modality, target, or therapeutic area Identify opportunities and threats Data may inform clinical trials, publication schedules, launch plans
PipelineAnalysis
What other entities have fallen out of development and why?
Who will be competing for my clinical trial patients?
What endpoints do I need to hit for differentiation?
Review best-in-class strategies to develop yours Test your plan prior to launch Strengthen your team and develop tactics for strong execution
ScenarioPlanning
Is my strategy informed by the most up-to-date, reliable market information?
Am I looking at the right competitors?
What are the real issues my plan will face in the marketplace?
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Call Center Design and Compliance AuditingIs the Fox Guarding the Hen House?
Performance gaps: The gaps may cover specific teams, the entire operation, and even identify individual contributors
Compliance: Review of how well the organization observes the various laws and regulations that guide the operations and responses
Organizational Risks: Listing of various factors that constitute an internal or an external risk
Reporting: The audit may cover metrics and other information used by managers to guide their decisions
Opportunities: Internal and external situations that present improvement or cost minimization opportunities
Weaknesses: Any areas that are clearly not at par and that must be addressed in order to improve the overall functioning of the call center
Technology: An in depth look at the technology used by the call center to handle call routing, staffing, forecasting, etc.
Quality: Call center QA scores, approach to scoring and coaching, feedback loop
Management: Support staff competency, career paths, management philosophy and approach
Call center audits are normally delivered by specialized firms who possess expertise regarding the industry and who are trained to identify gaps and propose methods of correction.
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Call Center Design and Compliance AuditingKnow the Rules to Design a Sophisticated Program
Pharmacy Switch Only?
Legal Interpretation of Programs Allowed for Government Covered Patients
InsuranceVerification Documentation Co-Pay
AssistanceHardship Exception
Language & Literacy
Alternative Funding
Formal SignatureRequirement
Alternative Communication
Collateral Pre-Populated
Website Advocate Letters Attestation/Form
4506-T
Drug Expense Service Expense Foundation Design SPAP Utilization LIS Review
Inclusion of Total Medical Costs
Income Variable or Sliding Scales
FPL or Straight Line Income
Foreign Language Lines
Collateral at Appropriate Language Arts Level
Transportation Costs
Utility Bills Quality of Life Items
(e.g., wig for cancer patients)
Electronic Signatures
Verbal Authorization
Text Messages Email Based
Communication Web Portals
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The Aequitas Value Proposition
Insight
Strategy Execution
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Insight. Strategy. Execution.
12680 High Bluff RoadSuite 110San Diego, CA 92130
T: 858.847.9126F: 858.509.4739
www.theaequitasgroup.com