1. Prescription Drug Monitoring Presented by: Len Abbott, Ph.D. Director Science and Technology Kathleen Valentine, General Manager PDM & Toxicology May 14, 2015

2. 2 CONFIDENTIAL – For internal circulation only Why Quest Diagnostics? Drug Testing Expertise Health Plan Access Connectivity Solutions Complete Diagnostic Menu Total Quest Offering Over 60 Patient Service Centers in VA Resources

3. 3 CONFIDENTIAL – For internal circulation only Why Prescription Drug Monitoring?

4. 4 CONFIDENTIAL – For internal circulation only Misuse of Prescription Drugs Source: CDC www.cdc.gov/vitalsigns/PainkillerOverdoses/index.html and www.cdc.gov/HomeandRecreationalSafety/pdf/PolicyImpact-PrescriptionPainkillerOD.pdf www.cdc.gov/HomeandRecreationalSafety/pdf/PolicyImpact-PrescriptionPainkillerOD.pdf www.cdc.gov/vitalsigns/ Prescription Drug Misuse Statistics 1.4 million emergency department visits involved nonmedical use of pharmaceuticals 30% opioid analgesics 36% anti-anxiety or insomnia medications Drug overdose deaths tripled since 1990 Each day, 46 people die from an overdose of prescription opioid or narcotic pain relievers

5. 5 CONFIDENTIAL – For internal circulation only Where and how are the drugs obtained? Source of Prescription Pain Relievers The household medicine cabinet is the primary source of misuse Nearly 70% of people who misuse prescription pain medications are taking drugs that were prescribed for someone else http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.pdf |5 |5 Other 6.9% One Doctor 19.7% Drug Dealer 3.9% Internet 0.2% Friend/Relative 68.9%

6. 6 CONFIDENTIAL – For internal circulation only Prescription Drug Monitoring Results Distribution Patients do not follow provider instructions… Quest Diagnostics January 2013 – December 2013

7. 7 CONFIDENTIAL – For internal circulation only What is the role of urine drug testing? Urine Drug Testing is a part of a comprehensive drug monitoring process: Objective laboratory testing can help to: Identify prescription noncompliance, drug substitution or supplementation Detect use of illegal substances Identify potential drug interaction Maintain patient access to beneficial prescription therapies

8. 8 CONFIDENTIAL – For internal circulation only Quest Diagnostics Prescription Drug Monitoring

9. 9 CONFIDENTIAL – For internal circulation only Prescription Drug Monitoring Program Quest Has Extensive Experience in Drug Testing * Sample listing Quest Diagnostics performs more than 10 million drug tests annually Quest Diagnostics performs more than 10 million drug tests annually State of the art testing equipment Industry-leading technical expertise in LC- MSMS technology Broad menu of testing for drugs and their metabolites* – Alcohol Metabolites Amphetamines Barbiturates Benzodiazepines Buprenorphine Cocaine Metabolite Fentanyl Gabapentin Heroin Metabolite Marijuana Metabolite MDMA/MDA Meperidine Methadone Metabolite Methylphenidate Opiates Oxycodone Phenocyclidine Pregabalin Propoxyphene Synthetic Drugs Tapentadol Tramadol Tricyclic Antidepressants

10. 10 CONFIDENTIAL – For internal circulation only Drug Testing Process Laboratory Testing Chemistry Instrumentation Testing at drug class level Presumptive results reported (Positive/Negative) Positives Reflexed for confirmation testing Uses alternate method Confirmation performed using Mass Spectrometry Metabolites identified Definitive results reported Immunoassay Qualitative Screen Positive Drug Classes Reflex to Confirmation if Ordered Mass Spectrometry Results 2 3 1

11. 11 CONFIDENTIAL – For internal circulation only Prescription Drug Monitoring PDM Product Offering Menu includes Chronic pain medications Companion controlled medications Substances of abuse Performance – Highly sensitive, low cut off levels designed to detect drugs at typical dosage levels Reporting − medMATCH ® Result Interpretation: “Consistent” when results match prescriptions provided by physician “Inconsistent” when results do not match prescriptions provided by physician

12. 12 CONFIDENTIAL – For internal circulation only medMATCH® Report Non-prescribed medication(s) X Indicates inconsistent Prescribed Medication(s) Indicates Consistent medMATCH Interpretation Identifies Inconsistent Results Specimen Validity → ←

13. 13 CONFIDENTIAL – For internal circulation only Prescription Drug Monitoring Requisition – with medMATCH® Patient Demographics Prescriptions Additional Tests Individual Tests Profiles (Base, 1, 5, 6) ICD Codes → ←

14. 14 CONFIDENTIAL – For internal circulation only Prescription Drug Monitoring Requisition – without medMATCH® Patient Demographics Additional Tests Individual Tests All Profiles ICD Codes → ←

15. 15 CONFIDENTIAL – For internal circulation only Q & A