CONTROLLING THE COSTS OF HEMOPHILIA HEMOPHILIA TREATMENT CENTERS: CONTROLLING THE COSTS OF HEMOPHILIA (INSERT YOUR LOGO HERE)

INSERT YOUR HTC: WHO WE ARE • One of 140 non-profit, federally recognized Hemophilia Treatment Center of Excellence •HTC specialty pharmacy with access to the Public Health Service Federal Drug Discount Program registered with the OPA as a Hemophilia (HM) designated covered entity. •Recognized best in-class care for the bleeding and clotting disorder community by NHF and the CDC. •Comprehensive medical home to patients in (LOCATION) promoting collaboration across medical and pharmacy services. •Stat delivery of on hand drug inventory reducing ER visits and time to treatment. • Specialized in disease, utilization, and assay management. • A Hemophilia Alliance Member sharing innovative ideas and best practices to promote cost effective high quality service to bleeding disorder patients. Insert Your Logo Here

HEMOPHILIA: A RARE, EXPENSIVE DISORDER The CDC estimates there to be 20,000 people living with hemophilia in the United States. Average cost of treatment for a person with severe hemophilia is approximately $300,000 per year and can surpass $1,000,000 if complications occur. Hemophilia affects 1 in 5000 male births Insert Your Logo Here Sources: The Center for Disease Control and Prevention – http//www.cdc.gov/ncbddd/hemophilia/data.html National Hemophilia Foundation – www.hemophilia.org

THE HTC COMPREHENSIVE MODEL OF CARE The National Hemophilia Foundation Medical and Scientific Advisory Council (MASAC) recognizes the HTC’s emphasis on early diagnosis and intervention as the optimal health care delivery model for this complex chronic disease. CDC recognizes hemophilia as a complex disorder requiring good quality medical care from HTC doctors, nurses, social workers, physical therapists, and other health care professionals specialized in caring for people with bleeding disorders. Insert Your Logo Here *The National Hemophilia Foundation’s (NHF) Medical and Scientific Advisory Council (MASAC) Standard 132- http://www.hemophilia.org

THE HTC COMPREHENSIVE MODEL OF CARE REFERRAL CLINICAL ASSESSMENT TEAM INTERDISCIPLINARY CARE PLAN IMPLEMENTATION / INTERVENTIONS Assessment includes: • Patient/Caregiver • Physician • Nurse • Psychosocial Professional • Physical Therapist • Pharmacist • Genetics Counselor • Other HTC Team Members Components include: • Clinical Care • Pharmacy • Nursing Coordination of Care • Psychosocial Support • Physical Therapy Interventions • Pain Management • Clinical and Patient Goals Coordination of Care: • Medication/Supplies • Lifestyle/Service Items • Home Treatment Training • School In-service • Education & Support • Adherence Monitoring • In Home Coordination of Care EVALUATION / REASSESSMENT / OUTCOMES OUTCOMES ANALYSIS & REPORTING Targeted education, adherence coaching, and side effect management improve clinical outcomes Continuous monitoring of outcomes with goal of improving overall health. Ongoing communication between the HTC care team and patient is critical. Desired vs. Actual • Clinical • Humanistic • Economic Insert Your Logo Here

COST MANAGEMENT THE HTC COMMITMENT: Effectively manage the complications of hemophilia while monitoring adherence to drug treatment and decreasing total cost of care. -Hot Buttons Insert Your Logo Here

CASE STUDY: COST SAVINGS ANALYSIS Quoted charges obtained from insurance company as of April 10, 2014. HTC provides clinical care to patient with hemophilia but patient’s insurance requires patient to utilize a national PBM or specialty pharmacy provider listed in their network to obtain drug. Xyntha Solofuse: 30 day supply, total dose ANNUAL SAVINGS recognized by insurance company by contracting with HTC specialty pharmacy versus national PBM $193,668 $45,980 ($1.51/unit) $36,845 ($1.21/unit) $29,841 ($0.98/unit) NATIONAL PBM LOCAL SPECIALTY PHARMACY HTC SPECIALTY PHARMACY Insert Your Logo Here

CASE STUDY: INHIBITOR PATIENT 15-20% of all hemophilia patients will develop an inhibitor in their lifetime Quoted charges obtained from PBM benefit notification to patient as of August 30, 2013. HTC provides clinical care to patient with an inhibitor but patient’s employer requires patient to utilize a national PBM they have contracted with to obtain drug. Novoseven: Cost Per Dose Hemofil M: Cost Per Dose $16,960 $11,600 $8,960 $6,960 NATIONAL PBM HTC SPECIALTY PHARMACY NATIONAL PBM HTC SPECIALTY PHARMACY SAVINGS recognized by employer by contracting with HTC specialty pharmacy vs. National PBM: 8mg dose times 2, infused every two hours or 192mg per day 8,000 iu dose infused twice daily or 16,000 iu per day SAVINGS PER DAY: $192,000 SAVINGS PER DAY: $9,280 SAVINGS PER WEEK: $1,344,000 SAVINGS PER MONTH: $278,400 Insert Your Logo Here

CASE STUDY: COST SAVINGS THROUGH ASSAY MANAGEMENT Service Provider Disease Severity Average IU/Kg/Year No. of Patients Avg. of Units Dispensed Avg. Cost per Unit HTC Severe 4,448 125 300,553 $0.98 Commercial Specialty Pharmacies and PBMs 5,395 31 352,716 $1.21 Data collected reflects the additional cost savings per patient when utilizing the HTC specialty pharmacy. PER PATIENT ANNUAL SAVINGS: Average decrease in units dispensed: $63,117.23 Ask about this • All patients included in the comparison receive clinical care through HTC. • Patients with inhibitors are excluded from this study. • Commercial pharmacies include 9 entities including Accredo and Caremark. Average commercial cost per unit of product is $1.21 and 340B cost per unit of product based on the federal discount is $0.98. Actual savings will vary based on cost and insurance reimbursement. Average per unit cost reduction: $69,127.19 TOTAL AVERAGE SAVINGS: $132,244.42 Insert Your Logo Here

LET’S WORK TOGETHER. YOU see a direct impact to your bottom line. PATIENTS receive the best possible care and an enhanced quality of life. YOU see a direct impact to your bottom line. Insert Your Logo Here

THANK YOU FOR YOUR TIME. QUESTIONS? Insert Your Logo Here