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Quest Diagnostics Fighting Opioid Abuse with Objective Information Presented by: Michael E. Prevoznik Senior Vice President and General Counsel July 31, 2017

Quest Diagnostics World’s leading diagnostic information services provider $7.5 billion in revenues; 43,000 employees Operates 2,300 patient service centers Employs over 650 MDs and PhDs Serves 50% of U.S. physicians and hospitals annually and 500k + patients per day Maintains the largest private laboratory database with 40 billion de-identified test results and growing at the rate of 3 billion new results per year Advocates for clinically and fiscally appropriate drug testing as part of any response to the opioid crisis Drug testing generates objective information to help: Health care providers better treat and monitor their patients All levels of government monitor and address the epidemic of prescription drug misuse and abuse

Robust Opioid Solutions Must Include Drug Testing Value of drug testing in treatment and monitoring of patients: Provides objective information for health care providers to assess patient drug use and misuse Alerts providers if patient is not taking prescribed medication and possible diversion risk Augments existing subjective tools (e.g. patient medical history, risk assessment, etc.) that providers use to determine patient risk for drug misuse Self report of drug use has limited validity Monitoring behavior alone can fail to detect problems revealed by drug testing Assists providers to make appropriate evidence-based decisions prior to and throughout treatment Non-opioid therapy Opioid therapy Referral for Substance Use Disorder treatment Helps maintain the provider-patient relationship Creating mandatory testing guidelines for all patients on opioids may help de- stigmatize the testing and help the provider maintain trust with her patients

Guidelines for Opioid Patient Treatment and Surveillance Must Include a Role for Drug Testing CDC’s opioid guideline calls for baseline and periodic drug testing (2016) Federation of State Medical Boards guidelines are similar to CDC’s (2017) U.S. Depts. of Defense and Veterans Affairs: baseline and ongoing random drug testing (2017) Some States have adopted drug testing guidelines, but have taken different approaches. For example: Oregon: adopted CDC guidelines (2016) Washington: baseline and periodic drug testing (frequency based on patient risk assessment) (2015) Virginia: baseline testing and retesting for chronic pain or addiction patients every three months in the first year and six months thereafter (2017) But many states have not yet included a role for drug testing as part of the solution in fighting the opioid crisis

Drug Testing is a Trusted Source of Objective Information that can be Part of an Effective Health Surveillance Program U.S. Department of HHS identified a national priority to strengthen its understanding of the opioid epidemic through better health surveillance Quest Diagnostics Drug Testing Index: Published annually for 29 years Relied upon as a public service by government, employers and policymakers Quest Diagnostics Prescription Drug Monitoring Report Published annually for 5 years Next report will be published in September 2017

Results of >3,000,000 2015 Patient Drug Tests Quest Diagnostics 2016 Prescription Drug Monitoring Report: Prescription Drug Misuse in the U.S. is Pervasive Results of >3,000,000 2015 Patient Drug Tests

Quest Diagnostics 2016 Prescription Drug Monitoring Report California

How Quest Diagnostics Can Partner With You State Prescription Drug Monitoring Programs (PDMPs): Help prescribers identify patients who are “doctor-shopping” or who might need substance use disorder treatment Help government agencies and medical licensure boards monitor prescribing practices and identify unusual prescribing patterns Inform community-based prevention strategies Drug testing provides objective information that complements state PDMPs: PDMPs cannot tell if the patient adhered to the drug regimen or misused or diverted the drugs

How Quest Diagnostics Can Partner With You Quest Diagnostics can partner to provide tailored reports at the local, state and federal government level Quest data can assist in identifying trends of drug use and misuse and in turn can better inform decisions about training and healthcare resource allocations Quest’s medical and scientific experts can assist in developing and refining policy and surveillance Explore expanding scope and use of court-ordered drug testing Quest Diagnostics is a Reliable Partner: Per CMS data, for the typical prescription drug monitoring patient, certain competitor labs billed for on average 8x more services per patient than Quest, receiving 4x higher Medicare payment per patient than Quest Quest Diagnostics thanks the Attorneys Generals for their efforts in routing out fraud and inappropriate testing in the lab industry

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