1. ©2007 Walgreen Co. All rights reserved. 1 Patient Focused ADAP Programs Glen Pietrandoni, R.Ph December 4, 2008 ©2007 Walgreen Co. All rights reserved.

2. 2 ADAP Benefits ADAP Benefits Compassionate…Coordinated HIV Care Physicians Physicians Community/ASOs Community/ASOs Retail Stores & Pharmacists Public Health/Gov’t Public Health/Gov’t Medical Centers Patients Patients

3. ©2007 Walgreen Co. All rights reserved. 3 Today’s Issues Many different ADAP models Access to services varies Providing drugs vs pharmaceutical care Public Health systems are complicated Quality of life issues Respect, privacy, cultural competency Changing health care models Reporting/Outcomes

4. ©2007 Walgreen Co. All rights reserved. 4 HIV/AIDS in the U.S., 2009 Growing number of people living with HIV/AIDS Changing the demographics: ▪Women and minorities ▪Younger and older ▪Rural More people on therapy ▪Treatment guidelines suggest starting drugs earlier ▪Drug therapy options increasing ADAP funding has been flat Human resources are exhausted

5. ©2007 Walgreen Co. All rights reserved. 5 Estimated Prevalence Rates for Adults and Adolescents Living with HIV/AIDS Total Rate=168.8* Rate (per 100,000 population) 2004—USA 150 Alaska 57.0 99.5 84.7 24.5 22.312.1 48.4 42.0 30.1 147.8 104.8 44.1 17.2 23.7 60.9 139.5 196.0 88.0 74.4 99.7 50.9 66.7 166.3 201.7 89.2 129.2 88.9 307.8 198.7 187.8 116.9 103.0 68.0 72.9 70.4 42.5 145.6 68.1 44.2 43.2 NH48.7 MA152.8 RI126.9 CT221.2 NJ241.7 DE234.9 MD283.7 DC1,960.0 Note: Data adjusted for reporting delays. *Includes persons whose state of residence is unknown or missing. Hawaii 120.9 Puerto Rico 324.3 127.5 43.7

6. ©2007 Walgreen Co. All rights reserved. 6 HIV Communities: Population needs vary within a given state’s boundaries MSM Ethnic Women Religion/Churches IDU Sex workers Transgender Socioeconomic groups

7. ©2007 Walgreen Co. All rights reserved. 7 HIV Payors Medicaid/Medicare ▪Medicaid ▪Managed Medicaid ▪Formularies ▪Rx limits Rx benefit ▪Employer plans ▪Mail benefits ▪Specialty Carve outs (United) ▪Major Medical

8. ©2007 Walgreen Co. All rights reserved. 8 HIV Payors Ryan White Care Act ▪Title I ▪Title II ADAP (AIDS Drug Assistance Programs) ▪340b closed network ▪Open network ▪SPAPs, Medicare wrap arounds, etc Local resources (county, city, charity) Compassionate Care Programs

9. ©2007 Walgreen Co. All rights reserved. 9 Patient Choice Required Humanistic approached Respectful services Remove stigmas Convenience Quality of life improved HIV is a manageable health condition

10. ©2007 Walgreen Co. All rights reserved. 10 Patient Centric Care ADAP today in many states ▪HIV drugs from one pharmacy ▪All other drugs from many different pharmacies What could be: All patient’s Rxs filled together ▪Drug Interaction review ▪Missing or duplicate therapies, regimen reviews ▪Adherence monitoring ▪Monitor side effects ▪Better pharmaceutical care ▪Better clinical outcomes ▪Convenience ▪Face to face care if desired ▪Co morbidities evaluated

11. ©2007 Walgreen Co. All rights reserved. 11 Patient Pickup or delivery ADAP Administration and Pharmacy Patient Rxs Example of many ADAP programs today

12. ©2007 Walgreen Co. All rights reserved. 12 HIV Focused Pharmacies: Pros and Cons  Individualized service  Strong Physician communication  Specialized Inventory  Compassion  Educated staff  Provide delivery  Locations inconvenient to some  Limited hours of operation

13. ©2007 Walgreen Co. All rights reserved. 13 Today’s technology allows for more options

14. ©2007 Walgreen Co. All rights reserved. 14 Pickup anywhere or delivered Data Check & Drug Review Clinical review ADAP Rx sent to pharmacy via fax, phone, e-scribe Rx sent to pharmacy via fax, phone, e-scribe Eligability Check & Formulary Review

15. ©2007 Walgreen Co. All rights reserved. 15

16. ©2007 Walgreen Co. All rights reserved. 16 NATIONAL HIV OPT-IN PROGRAM Physicians Patients Nurses Pharmacists Patient Support Groups AIDS service organizations Church groups

17. ©2007 Walgreen Co. All rights reserved. 17

18. ©2007 Walgreen Co. All rights reserved. 18