This document summarizes highlights from ExLPharma's 2nd Pharmaceutical Managed Markets Insight and Marketing conference held in February 2010 in Philadelphia. It discusses concerns from healthcare providers around quality of care, patient access to drugs, and costs. It also outlines strategies pharmaceutical companies can take to address these concerns, including keeping providers informed, convincing health plan medical directors, and streamlining charity care guidelines. The document emphasizes that with the right strategies, patients, insurers, hospitals, and pharmaceutical companies can all benefit through improved patient access and care, reduced costs, and increased sales.

1. Highlights from ExLPharma’s 2nd Pharmaceutical Managed Markets Insight and Marketing February 9-10, 2010 Philadelphia, PA

2. The Providers Perspective

3. Provider’s Concerns Quality of Care Patients Access to Drugs Compliance/Costs of Readmits or unnecessary ER visits Free up Capacity Reduce Denials Getting Paid

4. What can you do? Keep us informed of expensive drugs and how do we get paid.

5. ExampleCoverage for Drug X in Local Market

6. Convince the Medical Directors of Health Plans Instead of just paying for one drug among a whole class of drugs, focus on patient-centered care Help to finance for “Off-label” use if justified Streamline Charity Care Guidelines

7. Bottom-line: Everyone Wins Patients – gain access to drugs for individualized treatment Insurers - May pay more for drugs which will more than off-set by avoiding unnecessary ER visits, readmits and patient compliance. Hospitals – Provide quality care to patients & actually get paid

8. And YOU? More Sales

9. Keys to Developing a Medical/Value Managed Care Strategy to Achieve Competitive Advantage

10. 10 The Evidence Continuum APPLICATION OF EVIDENCE-BASED MEDICINE Population Based Local & Customized EVIDENCE GENERATION EVIDENCE TRANSLATION EVIDENCE APPLICATION Safety Efficacy Effectiveness Efficiency Proof of Concept Tolerability Best Value ? Risk /Benefit ? Real World Benefits ? CONTROLLED CLINICAL STUDIES REAL WORLD STUDIES Process Improvement & Quality of Care Initiatives Practical Clinical Trials Quasi Experimental Studies Observational Studies Economic / Cost / Utility Studies Systematic Reviews Population Management Programs Quality of Care Initiatives Point of Care Decision Support Consumer-Centric / Directed Care Placebo Comparator Agent Comparators Rigor Generalizability

12. Market & Customer Insights

13. Coverage & Reimbursement Decision MakingEvidence Generation: Safety, Efficacy & Real World Effectiveness Research to support product value proposition Evidence Translation: Development of Customer Centric “Toolbox” to support Access , Coverage & Process of Care Activities Evidence Application: Customized Solutions to support Preferred & Appropriate Utilization of Portfolio

14. Evolving Customer Needs Evolving Customer Needs Traditional Customer Needs Evidence-Based Medicine Broad Business Acumen Ability to Lead Transformation Clinically Effective, Safe, and Tolerable 1.Cost Effective 2.Improves Quality 3.Easy to Adopt 1. Clinically Effective, Safe, and Tolerable 2. Cost Effective 3. Improves Quality 4. Easy to Adopt Adapting to an Evolving Customer Environment

15. Customized Solutions Approach A P P L Y Population- Based Evidence- Based Local and Plan Level- Based Measurement-Based T O Identify and treat appropriate patients Promote evidence-based best practices Improve patient outcome and quality of life Manage total cost of care D E L I V E R V A L U E

17. Historically underutilized

20. Monographs

21. Slide Presentations

22. Dossiers

23. Compendia

24. EB Synthesis

25. CME programs

26. Advocacy Meetings

27. Product Information

28. Budget Impact Models

29. Cost Effect. Models

30. Formulary Mgmt Tools

31. Benefit Design Tools

32. Risk Prediction Tools

33. Pt Identification Tools

34. Population Profiling

35. Predictive Models

36. Benchmarking Data

37. Guideline Translations

38. Discharge Protocols

39. Transition of Care Tools

40. Pt Compliance Support

41. Self Care Tools

42. Case Mgmt Tools

43. ePrescribing Support

44. Pt Education Support

45. Medical Home

47. Health Care Challenges—Are there solutions we can trust?

48. The Ever Changing Landscape Increased price pressures Fewer new unique Chemical entities being brought to the FDA Fewer new Pharmaceutical products being approved Risk Evaluation Mitigation Programs (REMs) Increased pressures to demonstrate health outcomes Medication Adherence and Persistency Patient non-adherence causing costs to rise Politicians desiring to practice medicine Patient satisfaction/Customer service growing more uneasy

49. Stake Holders searching For solutions Government Healthcare Reform Non-Government Collaborations The California Pay For Performance Program The California Healthcare Foundation (CHCF) The National Committee for Quality Assurance (NCQA) The Pacific Business Group on Health (PBGH) The California Association of Physician Groups (CAPG) Managed Care Organizations Pharmaceutical Manufacturers National Organizations Evidence-based clinical practice guidelines Value-based Benefit Designs Employers Patients Health Care Providers

50. Searching for Solutions California’s Pay-For-Performance Program Non-governmental physician incentive program Improve quality of care and health outcomes 8 Health Plans 200 Medical Groups 35,000 Physicians caring for 11.5 Million HMO Members Single performance-based set of measures Public report card Aggregation of data from multiple payers for calculating scores Source: The California Pay for Performance Program, The Second Chapter, Measurement Years 2006-2009

51. Searching for Solutions Patient-Centered Medical Homes Goal: “Relieve the looming crisis in primary care, improve clinical quality and patient experience, and moderate cost increases.” Coalition Major Employers Consumer Groups Patient Quality Organizations Health Plans Labor Unions Hospitals Physicians Source: www.pcpcc.net/content/pcmh-vision-reality

52. Searching for Solutions PCMH continued Pilots in 44 States & District of Columbia Commercial Medicare Medicaid VA/DOD LTC

53. Searching for Solutions Education Health Coaches Electronic Health Records Patient phone calls Automated Telephone Self Management Support Programs Stakeholder Alignments Health Insurance for everyone Removing soda pop from schools Make healthy foods available at a cheaper price Single Payer Health Care Government/Elected Officials Taxes on Soda Pop

54. Searching for Solutions Put the healthcare dollar in the consumers hands Allow market forces to drive the delivery of Healthcare Real incentives to the consumer of healthcare Strategic Legislation Malpractice Insurance Reform Worker’s Compensation*** Reform Welfare System***

55. Searching for Solutions Things to Consider: Government’s track record of Program implementation & sustainability “If you put the federal government in charge of the Sahara Desert, in 5 years there would be a shortage of sand.” Morgan Friedman The best of America comes when “These are that tries men’s souls” Thomas Paine “What we obtain too cheap, we esteem too lightly” Thomas Paine The Wizard is Fraud!! The entrepreneurial spirit is alive and well in America When incentives are appropriately aligned America’s citizens will rally and find ways to succeed ‘Rome was not built in a day and it did not fall in a day’

56. There is no magic quick fix solution When we are sick we take sick days to heal ourselves or we go to the appropriate Physician—the Government doesn’t treat fevers

57. Still have any questions? For additional information on ExLPharma’s Pharmaceutical Managed Markets Insight and Marketing Conferences, please visitwww.exlpharma.com