Rebecca M. Shanahan, CEO of Avella Specialty Pharmacy presents on Specialty Pharmacy at Retail Pharmacy at the 2014 Armada Summit. Learn more about Avella and connect with your local rep if you have any questions. http://www.avella.com/

2. SPECIALTY AT RETAILRebecca M. Shanahan, CEO
Avella Specialty Pharmacy

3. Agenda
• Specialty Pharmacy Market Drivers
• Specialty at Retail Program Highlights
• Patient Engagement
• Integrated, Real-time Data Sharing
• Opportunities for Growth

4. State of Retail Pharmacy
• 93% of Americans live within 5 miles of a retail
pharmacy
• Pharmacists ranked as the second most trusted
profession for the third consecutive year (Gallup Poll,
2013)
• Pharmacists may soon to be given “provider status’
• Retail pharmacies becoming a healthcare destination
(screenings, immunizations, first injections, flu shots,
clinic)

6. • 1,256,250 patients per year
• Assumes conservative $2,000 per
month, 8 scripts per year
• Data & Other FFS opportunities
• Shared/Aligned Risk Upside

8. Specialty at Retail - Options
Traditional SRx
Investigate Benefits
Hub & Spoke Triage
Limited Distribution
Drugs
Dispensed by XX on
Behalf of Retail YY
Specialized SRx
Lower $$; Higher
Volume Drugs
Compounds,
Infusions &
Nutriceuticals
Brand Extensions
Co-Pay & Discount
Cards
Persistence &
Compliance
Payor Centric
SRx
Disease Specific
“Center of
Excellence”
Geographically
Dense Relationships
Clinical Program &
Data
Orphan SRx
3PL Competencies
REMS Competencies
Roll Out Experience
Informatics
Competencies
Clinical & Program
Data
IDN/ACO SRx
Medical Home
Medications @
Discharge
340(b) Programs
IPA Relationships
Shared Risk

9. The Path of a Specialty Prescription
Retail Rx
Specialty Rx

10. Location, Location,
Location - Patient Access
and Empowerment
• Patient Assistance Programs
• Drug/Disease Education
• Persistence & Compliance
What Specialty Stakeholders Want
Payer Hotbox - Predictable
Costs
• Value based health care
• Bending the cost curve
• Documented Comparative
Outcomes
Actionable Information is
the Special Sauce - Quality
Clinical Programs
• Best Practices Clinical &
Formulary Management
• Patient & Provider Network
Satisfaction
Not Your Grandmother’s
Soda Fountain – Access to
Clinical Pharmacist
• Pharmacy & Medical Benefit
• Engagement with Patients
• Engagement with Physicians &
Offices
• Real Time visibility to
Drug/Disease/Patient Variables

11. Food For Thought
• Is Specialty Pharmacy a set of activities that drive patient access &
compliance, a “bricks and mortar” profile or both?
• Are there discernable factors that drive Pharmaceutical Manufacturers to
select certain profiles of Pharmacy Providers?
• Hep C, HIV, Infertility, RA have broad Retail dispensing presence
• Oral Oncology, Injected and Infused Drugs have more Limited Distribution
Specialty Presence
• How are site of service changes, e.g. Hospital acquired Medical Oncology
Practices, Physician Networks, etc. driving Class of Trade and Pharmacy
network differences?
• Are there different factors driving Payer Network Selection
• National/Affiliated Pharmacies
• Fulfillment Pharmacies
• Regional Retail &/or SRx Pharmacies
• Provider Based Pharmacies

12. Specialty at Retail Program Highlights

13. HIV at Retail
Chronic Condition No Limited Distribution
Financial Assistance AAHIVM Credentials Adherence Tools
Community Focus

14. HIV at Retail
• HIV – A Chronic Condition requiring individual regimens, treatment plans and Pharmacist/Patient
interactions
– 90 to 95 % adherence to HAART achieves Optimal efficacy.
– Viral load increases after only 2 days of missed dosing.
– Some patients acquire drug-resistant mutations, requiring changes in medication regimen.
• Key Compliance Driver – Hands-on Coordinated Care
• No increased level of adherence/virologic improvement with intensive telephone counseling as the only approach to
adherence (Collier and the ACTG Team, 2002 – HIV patients)
• Patient is an active participant in therapy management with MD/RPh professional guidance and regular intervals of review
• Adherence is monitored through regular face-to-face interactions with Pharmacists who reach out to Physicians when
Patient encounters barriers to adherence
Patient
Questionnaire
Build Meds
Schedule
Teach Patient
• Score Patient
Adherence Likelihood
• Set Cadence of In
person Follow ups
• Review of Meds
Tracking
Measure MPR Review & Report
• Collect &
Analyze Data
• Patient Compliance
• Patient Safety
• Comparative Outcomes
• Share with MDs & RPhD
RPh Disease &
Drug Education
• Standard Content &
Scripts
• Standard
Information &
Intervals
• One Platform
• Sleep pattern
• Work schedule
• Eating schedule
• Travel & weekend
schedule
• Standardized Meds
Adherence Tracking
• Build Contingency
Plans
• Build Pt. Coping Skills
• Patient Adherence
• Side Effects
• Patient Well-Being
• Discharge Reasons
90% Compliance

15. Rheumatoid Arthritis at Retail
“Specialty Light” Program Patient Education Injection Training
Intervention Step Therapy CDAI Scores

16. Outcomes: Patient Counseling and
Education

17. Infertility at Retail
STAT Medications Disease Management Hub and Spoke
Centers of Excellence Trained Pharmacist Provider Relations
Compounding Services Passion Patient Education

18. Hepatitis at Retail
High Revenue Growth Opportunity Not Limited Distribution
Short Duration CDC Testing Guidelines
Provider Relations National Testing Day Manage Viral Load
Patient Education

19. Patient Access & Empowerment

21. Bi-Directional Text Messaging Program
• Text messaging program
– Daily reminders to take medication
– Reminders for lab work
– Educational tips, e.g. blood pressure
monitoring
– Motivational messaging
– Patient surveys
• Gather lab values
• Pharmacist intervention for any indication of
non-compliance
– Clinician notified
– Weekly emails to clinical staff
• Refill Reminders

22. Bi-Directional Text Messaging Program
Increase in Refill Rates After Adoption
69.4%
89.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Pre-adoption
rate
29%
Growth in refill rate
after adoption of text
messaging program
Post-adoption
rate

24. Study Results
The intervention group showed a 12.6%
improvement in adherence rate (MPR)
over the course of the study.

25. Study Results
Intervention group was 78% more likely
not to be hospitalized: Saving $27,852
per month in healthcare costs.

26. Integrated, Real-time Data Sharing

27. Integrated Real-time Close-Looped Solutions
Will Drive the Future of Healthcare
© Copyright 2014, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health.
Shared
HIT
Solutions
Patient
Specialty
PharmacyPhysician
Physician:
Increasing complexity of
precision therapeutics requires
decision support, virtual Clinical
Pharmacist Partner
Patient:
Just-In-Time, 3 minute mobile health
solutions to empower the patient &
maximize adherence and compliance
Specialty Pharmacy:
Rapidly expanding arsenal of high-cost,
low-volume therapeutics demands
personalized approach
Ongoing Benefits Management
Complexities
Patient:
Get the right information
Get the right drug & dose
Get it at the right time

28. Avella Frameworks SRx Integrator Platform
The New Specialty
Pharmacy:
Highly configurable
Pushing/Pulling Data Across
dispersed yet shared
healthcare continuum.
Connecting Patients, Payors,
Providers, Drug Manufactures,
Specialty Pharmacy for better
outcomes (Health/Financial)
Specialty Pharmacy
Management
Patient & Payor
Physician/Hospital
Management

29. Single Repository – User Specific Insights
Transactional
• Scripts
• Authorizations
• Fills
• Claim Filing
• POS/Medical
Data Capture
• Providers
• Pharmacy
• Patient
• Payor
Central Data
Repository and
Analytics
• Contract
• Patient Management
• Claims Management
• Audit Risk Mitigation
• Better Outcomes
Patients
• Better Compliance
• Better Management
• Lower Cost
• Predictable
• Better Outcomes

31. Opportunities for Growth

32. SRx Implemented Pathways Programs
• 96% cost savings between Payor-sponsored Formulary/Pathways Program vs. oncologists
not utilizing pathways for breast, colon and lung cancers (1)
• Variance includes only the use of clinically equivalent, evidenced based protocols. Additional
savings can be generated from anti-emetics, dose modulation, off-protocol prescribing,
management of late stage metastatic disease, and care management
(1) Study included practice data for all Medicare HMO patients with a breast, colon, or lung
cancer diagnosis at 3 non pathway practices and 1 pathway practice for 12 months.
Oncology Spend Comparison
Pathway Physician Non-Pathway Physician
Avg. Drug Cost Per Person $5,160.6 $10,115.2
Patient Sample Size 15 49
# of Practices 1 3
Avg # of Infusion's Per Month 3.00 3.23
Cost Differential 96%

33. Medications at Discharge
CMS Star Rating
Re-Admission rates a Key Driver of CSM Star Ratings MPR/Adherence is a Key Driver of CSM Star Ratings
Coordinated Discharge and Prescription Follow up
Hospital & Pharmacy jointly participate
at the Discharge point
Patients leave with Rx, and a
Follow-up plan from the Pharmacy
Numerous Studies Demonstrate poor Rx management at Discharge
Poor Patient management of Discharge Rx leads to Re-Admission

34. Movement from Volume to Value
Fee for
Service

35. Thank You

36. Stay Connected
Rebecca M. Shanahan, Esq.
CEO of Avella
linkedin.com/pub/rebecca-shanahan/7/100/262
rebecca.shanahan@avella.com