1. Access to Treatment: Asia Abd Razak Muhammad Malaysia CML Horizons, May 2012

2. Difference in Culture Food Languages Healthcare systems The Region: Asia Pacific Just over 4.2 billion people live in the Asia-Pacific region in 2010, constituting 61% of the world’s population. Source: United Nations Population Division. World Population Prospects: The 2010 Revision.

3. Challenges in Access to Treatments No reimbursement Health authority says “too expensive” – economic point Patient burden in co-pay in long term treatment Capped in budget for drug – waiting list ? Corruption ? Inefficient in being referred for reimbursement Drug is not approved Logistic challenge Generic version

4. Paths to Access to Treatment Government funded - full, partial Insurance coverage - with limitation Employer support - full, partial Industry program Self funded Clinical trial Named patient donation - compassionate No access ?

5. Imatinib Access - Case Example: Malaysia GIPAP, 2002 Patient - Industry All hospitals Financial status MYPAP, 2007 Government – Industry MOH & MOE hospitals Fixed access scheme NOA, 2012 Patient – Industry Private hospitals Fixed access scheme Employer coverage Insurance coverage Full self funded Clinical trial A Malaysian patient will have access to Imatinib.

6. MOH Malaysian Society of Haematology The Max Foundation Max Family Society Malaysia Novartis Excellence in Patient Care, including treatment access Malaysia: Successful Model

7. Network of CML Advocate Groups In Asia Pacific

8. Our dream comes true – Rising Sun 2010, 1 st RS Hong Kong Novartis organized 35 delegates 2011, 2 nd RS Singapore Novartis organized 42 delegates 2012, 3 rd RS Malaysia Community-driven Multi-sponsors (Novartis, Ariad, Pfizer, Stem Molecular Diagnostics, printing companies) 54 delegates

9. India – Friends of Max Indonesia – ELGEKA Malaysia – Max Family Thailand – Thai CML Patient Group & MaxSmiles Philippines – Touched by Max Vietnam – Max’s Vie Pakistan – KIRAN Japan - IZUMI China – New Sunshine Known CML Patient Groups in AP

10. Rising Sun 2012 – Meeting at A Glance 30 March 2012 – 1 April 2012, Kuala Lumpur > 50 delegates 2 sessions - CML related, with survey among participated countries 1 session - Clinical trial 3 Capacity building & Advocacy 1 Country Best Practices Show & Tell Posters display 6 SCs : Anna Williamson, Zhengchen Liu, Rod Padua, Dr Razak, Viji Venkatesh, Mei Ching Ong

11. Survey The Existing Standards of Treatment, Monitoring and Other Support Systems For CML Patients in the Asia Pacific Region SC: Try to know more about what we do not know

12. Aims: Collect background information on current status of CML care and support system available to patients challenges, experiences could be shared and learned and some issues could possibly be improved  Based on the best knowledge of participants  May not reflect accurate information  No statistical significance could be inferred  Findings only for basis of discussion  Based on the best knowledge of participants  May not reflect accurate information  No statistical significance could be inferred  Findings only for basis of discussion

13. Countries participate – 13 Australia China India Indonesia Japan Malaysia Pakistan Philippines Singapore Sri Lanka Taiwan Thailand Vietnam

14. SECTION A: TREATMENT AVAILABILITY AND ACCESSIBILITY

15. Results  Hydroxyurea, Interferon and TKI (at least one) are available in ALL countries  Stem cell transplant is NOT AVAILABLE in Indonesia and Sri Lanka  Only Japan & Australia have all TKIs as first line

16. How is CML oral therapy (TKI) made available in your country? Majority access through partially-funded program Some patients in Thailand, Malaysia and Singapore self-funded their TKIs

17. Which fully-funded drug access program exists in your country? Most countries has GIPAP/NOA Sri Lanka and Vietnam has full funded government program Malaysia has corporate-government shared program Singapore has non government full funded program Singapore and Taiwan have full insurance reimbursement

18. Which partially-funded program exists in your country? Almost all countries has a program that patient need to share with either corporate, government, non government or insurance company

19. Is 2 nd generation TKI (other than Imatinib) available in your country?  2 nd generation TKI is available in all countries EXCEPT Sri Lanka

20. How do CML patients have access to 2 nd generation TKI? Majority access through clinical trial government sponsored in Japan, Thailand, Vietnam and Australia *corporate sponsored in China # non government sponsored in Singapore * # end of Sec A

21. Key Learning from Survey TKIs are available in most of the countries, however access remains a big challenge o financially (partial reimbursement) o logistic difficulties (China, Indonesia, India) Thai CML Group managed to lobby government to include “social security” patients in imatinib reimbursement letter writing group of patients made appointment with authority, work with media Support from key physicians in getting government funding for treatment access is equally as important as lobbying from patient groups.

22. Thank You