COMMUNITY ONCOLOGY CONFERENCE The In-Practice Pharmacy Value Proposition & Need for a National Association Ricky Newton, CPA Orlando, Florida April 24, 2015

▪ Do you have one of the following within your practice currently? Retail Pharmacy In-house dispensing (only allowed to dispenses drugs that your physicians prescribe within the practice) We do not currently dispense oral drugs within our practice Lumi Question #1 2 © 2015 Community Oncology Alliance

▪ For those that do not dispense drugs in their clinics We are very interested in setting up an in-house or retail pharmacy within our clinic We do not have the physical space to set up in-house dispensing but if we did we would be interested Our state laws do not allow our practice to dispense oral drugs within our clinic We have no interest of dispensing oral drugs from within our clinic Lumi Question #2 3 © 2015 Community Oncology Alliance

▪ Community oncology practices expressed interest based on current existing pharmacy facilities (dispensing or retail pharmacy) or on planned facilities 59 practices (from CAN) originally expressed interest 72 practices currently part of COPA 82 practices weighed in on priorities for COPA ▪ Pharmacy issues becoming more important USP chapters 797 and 800 Oral cancer drugs an increasing percentage of pharma pipelines ▪ Need for standards and information sharing on “best practices” ▪ Threat of specialty pharmacy disjointing Why a National Pharmacy Organization? 4 © 2015 Community Oncology Alliance

70 Oncology Oral Drugs 5 © 2015 Community Oncology Alliance

Oral Drugs Classified by Indication 6 © 2015 Community Oncology Alliance

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▪ Foster oral cancer therapy tightly integrated into cancer patient treatment at the site of care. Specifically, COPA will: Help practices enhance outcomes of cancer patients treated with oral medications ▸ Focus on quality, efficiency, and financial viability Establish quality standards, best practice benchmarks, operating procedures, and other clinical/operating processes Provide a forum for practices to share best practices and information, especially relating to state pharmacy issues Develop the quality/value proposition of “integrated oral cancer treatment” for payers (Medicare, private, self insured) Educate pharmaceutical companies on the clinical/value proposition of “integrated oral cancer treatment” COPA Mission 9 © 2015 Community Oncology Alliance

▪ Please rank the following five items in order of importance to you (1 being the most important and 5 being the least) Guides, tips and templates for contracting with insurance companies White paper that tells the story of why payers should choose practices dispensing oral drugs to their patients verses specialty pharmacies Library of patient assistance programs for all oral chemo and supportive care drugs Develop and benchmark quality measures and standards for operating a dispensing pharmacy in a practice Patient & Payer focused educational material highlighting a practice’s dispensing program Lumi Question #3 10 © 2015 Community Oncology Alliance

▪ Most important hurdle that we have is insurance companies allowing physician dispensing. Please work on getting major commercial insurances to allow us to dispense. ▪ I think the biggest issue we face is competition from specialty pharmacy. Community oncology dispensing/pharmacy programs needs to find a way to be recognized by the pharmacy benefit manager's as a "specialty dispenser/pharmacy". I think that oral adherence & toxicity management, having the ability to dispense all oral oncolytics, and having dialogue on what is happening in the oral oncolytic market space with the high price increases (6 to 10% increases) are important topics as well. ▪ Information on how to combat insurance carriers who will not let you dispense or only let you do first fill ▪ How to battle with payers requiring orals be dispensed only by their selected specialty pharmacies ▪ Any assistance with helping contract and combating insurance and specialty pharmacies would be a great help. ▪ A major concern is dealing with payers who require oral drugs to be ordered thru PBMs, and how this would influences the viability of an oral chemo and support drug dispensing program. ▪ I feel the most important tool is one that will document compliance, quality and safety measures so that we can utilize that to show payers the importance of maintaining physician dispensing. If there was a way for us to track the over fill, delays in dispensing and other issues for Rx's issues with specialty pharmacies, we can provide comparative information that indicates in office dispensing is better for patients and payers. ▪ Contracting for orals, period - with payers - perhaps as a group?! Comments from COPA Survey from Practices 11 © 2015 Community Oncology Alliance

▪ Create standard national quality measures ▪ Establish a way to measure quality in a tangible way Similar to the oncology medical home initiative ▪ Publish an independent report/analysis documenting patient experience of receiving oral cancer drugs in practice versus specialty pharmacy ▪ Develop the COPA website ▪ Create information sharing on the closed COPA list serve Immediate Priorities 12 © 2015 Community Oncology Alliance

Web Site Content for Patients ▪ Library of patient assistant programs for all oral chemotherapy and supportive care drugs ▪ Library of patient focused educational materials on each oral drug ▪ Patient focused educational material highlighting a practice’s dispensing program ▪ Blog for patients to be able to ask questions of other patients on oral drugs or the ability to write their stories and experiences to share with other 13

▪ Does your pharmacy satisfy the requirements for USP 797 USP 800 (Which means you also qualify for USP 797) Neither of the above Lumi Question #4 14 © 2015 Community Oncology Alliance

▪ Link to all state laws for in-house and retail pharmacies ▪ Listing of what each state allows in regards to in-house and retail pharmacies ▪ Resources and project plan to assist in complying with USP 797 & USP 800 Website Content on State Pharmacy Laws and USP 797 & © 2015 Community Oncology Alliance

▪ Links to pharmaceutical & GPO contracts on oral drugs ▪ Links to pharmaceutical patient assistance programs ▪ Listing of each drug and indication along with the links to each pharmaceutical company websites for each drug ▪ Links to companies that provide in-house/retail pharmacy software Website Content on Pharmaceutical, GPO & Pharmacy Software Vendors 16 © 2015 Community Oncology Alliance

▪ Policies and procedures for operating in-house and retail pharmacies ▪ Historical information from the list serve on all questions and answers ▪ Benchmarking and other financial data ▪ Infrastructure needs for setting up and maintaining pharmacies inside a practice ▪ Quality Measures ▪ Staffing Models ▪ Resources to assist in state pharmacy board audits ▪ Stories of Success and Failures Tool Box for Managing Pharmacies Website Content 17 © 2015 Community Oncology Alliance

▪ Non Participating payers by state ▪ Medicare Part D ▪ Medicaid programs ▪ Payer focused educational material ▪ Guides, tips and templates for contracting with payers Website Content on Payers 18 © 2015 Community Oncology Alliance

▪ Josh Cox, Pharm.D., BCPS, Chairperson Dayton Physicians Network ▪ Tommy Harwood, CPT, Chairperson NSHOA ▪ Steve D’Amato, BS Pharm, BCOP New England Cancer Specialists ▪ John Clagg, RPh The Center for Cancer and Blood Disorders ▪ Bob Phelan Cancer Specialists of North Florida ▪ Maryann Roefaro, M.S., FACMPE Hematology-Oncology Associates of CNY ▪ Stacey McCullough, PharmD Tennessee Oncology ▪ Michelle Moore, RPh Michiana Hematology Oncology COPA Board 19 © 2015 Community Oncology Alliance

▪ COPA List Serve ▪ COPA Registration ▪ Questions Ricky Newton ( or COPA Listserv and Involvement 20 © 2015 Community Oncology Alliance