2. In-Office Pharmacy: Should Every Practice Have One? Jeff Patton, M.D., Chief Executive Officer Tennessee Oncology, Chief Medical Officer Rain Tree Oncology Services

3. Oncology Paradigm Shift Migration from intravenous to oral oncolytics 20-30% community oncology practice pharmaceutical revenue is oral today 35-40% current oncology pipeline is oral Caring for Cancer Patients is a PRIVILEGE

4. Closed door retail pharmacies within community oncology practices are critical for patients, practices and manufacturers Caring for Cancer Patients is a PRIVILEGE

5. Why are these oncology pharmacies critical for patients? Faster access ◦Full inventory ◦Access to EMR makes PA faster Improved patient experience ◦Multiple studies confirm patients want outreach from their providers not third parties Potential for Improved patient adherence ◦Studies show better patient engagement when information comes from their providers Pharmacists and technicians have full EMR access ◦Closed door system for refills Caring for Cancer Patients is a PRIVILEGE

6. Why are these oncology pharmacies critical for patients? Financial Assistance ◦Dedicated patient advocates familiar with all various manufacturer support programs ◦Fully versed in foundation support Tennessee Oncology Experience ◦2013 provided over $ 5 million in copay, foundation and provided drug (oral, injectable and IV) Caring for Cancer Patients is a PRIVILEGE

7. Why are these pharmacies critical to practices? Financial ◦Severe margin pressures ◦Evolution to orals decreases IV retail and infusion code revenue ◦Pharmacies add an additional diversified revenue stream Caring for Cancer Patients is a PRIVILEGE

10. Why are these pharmacies critical to practices? Operational ◦Provide full continuum of care ◦Chain pharmacies and specialty pharmacies lead to fragmentation of care delivery ◦Patients can receive mixed messaging ◦Providers don’t often receive feedback from those entities Caring for Cancer Patients is a PRIVILEGE

11. Why are these pharmacies critical to pharmaceutical manufacturers? Adherence ◦Compete like crazy for the Rx ◦Then script is not filled or doses are missed Access ◦Community oncology is your premier customer ◦340B threat Caring for Cancer Patients is a PRIVILEGE

13. RainTree Oncology and the Oral Channel Summer 2011 zero oral oncolytic GPO contracts Summer 2014 80% of oral revenue going through Tennessee Oncology’s pharmacy is under GPO contract Caring for Cancer Patients is a PRIVILEGE

14. RainTree Oncology Oral GPO Summer 2014 launching IV and injectable GPO Data and Analytics Company ◦Business Intelligence for practices ◦Data analytics for pharmaceutical manufacturers through Caring for Cancer Patients is a PRIVILEGE

15. Community Oncology Pharmacy Challenges Extremely skinny gross margins Cannibalizes more financially attractive infusion business Benefit design ◦Many patients have better infusion benefits than oral benefits ◦Many patients financial burden with oral therapy is problematic Caring for Cancer Patients is a PRIVILEGE

16. In-Office Pharmacy: Should Every Practice Have One? Barry Russo, MBA, Chief Executive Officer, The Center for Cancer and Blood Disorders

17. Lessons Learned

18.  19 Physicians  9 Locations  Med Onc, Rad Onc, Gyn Onc, Breast Surgery  Imaging  Complimentary Medicine  Retail Pharmacy Established 2006) – Currently average 70 Rx per day

19.  Open Door vs. Closed Door  Pricing  Licensure  Medications to Dispense  Oncology Drugs only  Supportive Drugs  Schedule Drugs  Other related Drugs – Cardiac, GI  Compounding  Oral Chemo Education  Medication Therapy Management (MTM)

20.  Flu Clinics  340B Contract Pharmacy  Nutritional Supplements  Mail order

21.  Point of Sale (POS) System  Accounting Issues  Reporting  Support  RX Tracking in relation to Satellite clinics  Payer and Pharma Audits  Contracting in the Specialty Network Space  Prior Authorization – Integrating with the Clinic Flow  Foundation and CoPay Support – Unique and a large volume

22.  Location, Location, Location  Consider the potential for other retail sales  OTC Medicine  Nutraceuticals  Gifts  Logo clothing  Assume Growth

23.  Internal  Getting the Physicians engaged  Promethazine Gel  Selling the MA’s, Nursing and Support Staff  Nutritional Supplements  Pre Chemo Meds  “In Network” for employees  Agenda item for every Board Meeting

24.  External  Flyers  Posted in all your clinic sites  New Patient Packets  Direct Patient Contact  Education  Location  Satellite Visits  Personal Delivery to Chemo Suites

25.  Why is it important?  Specialty Pharmacy Competition  Win – Win  Need a Process/System  Support Outcome Measurement  Provide Pharma Support  Patient Portal Opportunity

26.  As Dr. Patton mentions, oral volume will continue to grow – 35-40% of Oncology pipeline – As a result, establishing successful strategies for Retail Pharmacy is essential.  It is important to ensure the Retail Pharmacy is seen as an integral component of the Practice – a treatment modality – not just a business unit.  Competing in the Specialty Pharmacy space is an important strategy for community oncology – remember this in all interactions with Pharma and your GPO

27. In-Office Pharmacy: Should Every Practice Have One? Gitesh Patel, Chief Executive Officer, Sargas Pharmaceutical Adherence and Compliance International

28. Transforming Patient Care through Data Transparency and Analytics www.spacinternational.com

29. No matter what the circumstances, we will help you take your prescribed drugs on time www.spacinternational.com

30. Automation delivers Adherence & Compliance Current Model

31. www.spacinternational.com Automation delivers Adherence & Compliance SPAC Model

32. WHY SPAC? SPAC provides the compliance, adherence, chronic care management and 24/7 medication monitoring by hand holding the patients. SPAC captures revenue, visits, scripts and provides better patient care. SPAC delivers better outcomes and survival SPAC keeps the physicians informed through the entire treatment cycle in real time. www.spacinternational.com Automation delivers Adherence & Compliance SPAC Model

33. WHY SPAC? SPAC program activates in the exam room when the script is written and then it tracks the delivery of that entire treatment. SPAC is a conduit that connects patients, physicians, insurance companies, co pay programs, authorization programs and other patient services. SPAC’s vision is to provide the patient with the drug in the most efficient manner by working with the providers. www.spacinternational.com Automation delivers Adherence & Compliance SPAC Model

34. WHY SPAC? SPAC provides administrative support via a personal phone contact or mobile applications like Apple or Android SPAC helps schedule the follow up and captures patient reluctance (e.g. mouth sores, fatigue) to treatment in real time. SPAC cloud application works with patient, primary care, oncologists, other specialists, and dispensing pharmacies, specialty pharmacies, infusion centers, hospitals, patient centered medical homes, Accountable Care Organizations. SPAC follows up on the patient on a daily, weekly and monthly basis www.spacinternational.com Automation delivers Adherence & Compliance SPAC Model

35. Delivering better patient outcomes while having fun!! www.spacinternational.com

36. Partnership with the Physicians mHealth applications that engage the patient with their physicians. Immediate feedback on patient symptoms and performance status. Patient health information exchange portal for the multispecialty. www.spacinternational.com

37. A day in the life of a Cancer Patient. Chemo Radiation Biopsy Lab Tests Infusion Transfusions Imaging studies Holistic therapy Family Stress Clinical Trials Financial Stress Psychological stress www.spacinternational.com

38. Providing any patient services that do not begin with their physician leads to confusion for the patient and all other service providers. Sargas has developed its patient centered solutions with the oncologist and their staff such that they are aware and have control over their patient's experiences www.spacinternational.com Automation delivers Adherence & Compliance SPAC Model

39. Partnership with Patients Minimizing the barriers that prevent patients from quickly accessing their treatments. Utilizing all possible means including mHealth to communicate with patients and their caregivers or family members in the way that works best for them. Text messages, phone follow-up and email messages regarding treatment compliance. Care teams comprising of nurses and certified health professionals to assist the patients 24/7 with their treatment needs. www.spacinternational.com

40. Physicians would bill Medicare for chronic-care management using a new G code. It would apply to at least 20 minutes of management services over 30 days for a patient whose multiple chronic conditions are expected to last at least 12 months, or until death, and that represent a significant risk for death, functional decline, or acute exacerbation or decompensation. Chronic-care services must be available on a 24/7 basis, but a clinical staff member can provide them at the midnight hour on an "incident-to" billing basis without direct supervision. www.spacinternational.com Automation delivers Chronic Care Management SPAC Model