1. INSIGHT | STRATEGY | EXECUTION
The Aequitas Group Advantage
Capabilities Presentation

2. The Aequitas Group
Who We Are
 Boutique strategic healthcare  Analysis that helps maximize
advisory firm product value for stakeholders
 Manufacturers
 Established December 1999  Patients
 Venture backed  Providers
 Third-party payors
 Corporate office in  Third-party vendors
San Diego, California  Investors
The Aequitas Group Specializes in the Development of Solutions Used to Define and Communicate a
Product’s Value. We Deliver These Offerings in a Disciplined, Evidence-Driven Environment.
INSIGHT | STRATEGY | EXECUTION
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3. The Aequitas Group
What Makes Us Unique
 Industry experts
 Brand, Marketing and Sales Operations Directors
 Centers for Medicare and Medicaid National Administrator
 Hospital Administrators
 Commercial Payor Medical Directors and Reimbursement Specialists
 Health Economists
 Global Government Affairs Specialists
 Regulatory Affairs Specialists
 Medical Affairs Specialists
 Patient Educators
INSIGHT | STRATEGY | EXECUTION
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4. The Aequitas Group
What Differentiates Our Approach
 Evaluation of Complex Commercialization Factors
Clinical Marketing Health Policy Payor
Assessment Assessment Assessment Assessment
 Analysis and strategy for each aspect of the commercialization process
 Focus on ALL customers and service providers
Patients Providers Payors Company
ROI
Hospital Specialty
Pharmacy & Call Centers Investors
Administrators PBM
INSIGHT | STRATEGY | EXECUTION
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5. The Aequitas Group
Maximizing Patient Access By…
 Obtaining optimal coverage and reimbursement
 Translating product attributes to multiple stakeholders (patients, doctors, HMOs)
 Educating management, field force and call center staff on product attributes and challenges
 Navigating the increasingly complex competitive landscape and regulatory environment
Clinical Trials Product Filings Launch Phase IV New Indication
(NDA, BLA, 510K, PMA)
Pre-Launch Market Launch Post-Launch
 Clinical study  Physician and Sales Force Education  Formulary Kit and AMCP Dossier Development
design review  Reimbursement Billing Guides  Payor Information Tracking
 Competitive  Reimbursement Call Center Training  Formal policy response
Intelligence  Patient Assistance Program Design and  Pharmacoeconomic Studies
 Coverage, Coding OIG Guidance
and Payment Plan  Formulary Placement Appeals
 HCPCS Code Applications
 Pharmaco-  Reimbursement Training
 Payor Messaging and Presentation
economic Studies Development  Ad hoc Reimbursement Commercialization
 Payor Mix Analysis Consulting
 Payor Market Research
 Formulary Analysis  Competitive Intelligence
 Competitive Intelligence
INSIGHT | STRATEGY | EXECUTION
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6. The Aequitas Group
Complementary Specialties
 Reimbursement, distribution and access plan development
 Payor plan data collection and analysis
Managed Markets Consulting
 Named patient programs
 Ad hoc consulting support
 Comparative effectiveness and health economic assessments
Reimbursement Training and Patient  Customized and certified reimbursement training programs
Educators Programs
 Certified patient educator program
 Scenario planning
Competitive Intelligence
 Competitor review and disruptive technology analysis
Call Center  Compliance audit of patient assistance and reimbursement hotlines
Design and Compliance Auditing
 Process optimization based on patient access, channel design and budget
INSIGHT | STRATEGY | EXECUTION
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7. Managed Markets Consulting
Activities To Match Perspectives
Provider Perspective
Patient Perspective Payor Perspective
1 2 3
Patient Perspective Provider Perspective Payor Perspective
 Out-of-Pocket Analysis to Inform  Enhance Prescriber Access  Product Analog Analysis
Patient Assistance Programs Through Coverage Review and  Payor Landscape Review
and Foundation Development Coding Applications
 Payor Marketing Plans and
 Facilitating Clients Through the  Collateral Material Development Message Development
Reimbursement and Patient and Website Content
Assistance Process Population  Product Dossiers
 Competitor Product Review
INSIGHT | STRATEGY | EXECUTION
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8. Managed Markets Consulting
Aequitas Reimbursement Likelihood Ratio™
Clinical Value
Economic Value
Lowest Reimbursement Likelihood Highest
0 100 200 300
INSIGHT | STRATEGY | EXECUTION
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9. Managed Markets Consulting
Coverage Dashboards and Payor Tracking Systems
INSIGHT | STRATEGY | EXECUTION
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10. Managed Markets Consulting
Named Patient Program Support
Is Send Physician
Product No Yes Product Named
Covered Authorized
by
Country Patient letter
Partner LOA PI Forms Price
Yes No
Are Send Letter to
received No
Refer to Partner Physician asking
documents for Missing Info
complete
Send polite letter Yes
Can not provide
drug
Review Request Send Polite “Reject”
by Patient Access Letter. Can not
Committee Provide Drug
Time Frame for Planning a Named
Patient Program Re-label Product as Pass Request to Trade for Get Import License
Required Delivery of Product to Physician
Prepared Documents
and Contracts Ship Product to Physician Using Import
Vendor
 Information for Marketing Authorization
physicians and Anticipated
pharmacists Receive Confirmation of Delivery of
 Dose and Drug and Receipt by Physician
administration of drug Named Patient
 Patient treatment Program Established
criteria
6 Months 12 Months
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11. Reimbursement & Patient Educators Programs
Training Customized by Product and by Need
Post-Graduate Institute of Medicine Certification
Purchasers Payment and
Payor Sites of Coverage and Billing and Objection
and Plan Types Alternative
Introduction Service Payment Coding Handling
Distributors Funding
Initiation Completion
 Medicare  Wholesalers  Physician Office  Medicare Part A  Policies  NCPDP  AWP  Active listening
 Managed Care  Group Purchase  Hospital  Medicare Part B  Bulletins  NDC  ASP  Probing for
 Medicaid Organizations Outpatient  Medicare Part C  Articles  CPT  WAC information
 Veterans Affairs  Wholesalers  Hospital  Medicare Part D  Contracting  ICD-9 and ICD-  Best Price  Fluency with
 Specialty Inpatient 10 FAQs
 Department of  Medicaid FFS  Rebates  FUL
Defense Pharmacies  Home  DRG  Working all Four
 Managed  Utilization  AMP (4) sides of a
 Indian Health  Specialty  Long Term Care Medicaid Controls  HCPCS
Distributors  Samples case
Service  Dialysis Center  Private Pay  Formulary (i.e., patient,
 Pharmacy  Coupons
 Infusion / Shot  Medical  Preferred Drug provider, payor,
Benefit Clinic distributor)
Managers Benefits Lists
 Ambulatory  Pharmacy  Generic
 Physician Surgical Center
Offices Benefits Positioning
 Specialty
Benefits
 Durable Medical
INSIGHT | STRATEGY | EXECUTION
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12. Reimbursement & Patient Educators Programs
A Way to Support Your Providers and Your Patients
 The Institute of Medicine estimates
that health literacy generates an Patient Education Hierarchy
annual cost of 73 billion dollars per
year in healthcare As patients attain greater
Self knowledge, they move
 Seventy-five percent of chronically ill Actualization
up the hierarchy
Americans have low literacy skills Unify
with which allows greater
Personal Life control & autonomy
 Poor literacy yields a longer length of in their personal
stay in healthcare entities, and it’s healthcare
been estimated that poor “health Problem Solve
literate” patients cost four times more Informed
than a “health-literate” patient, to treat Decision
Treatment:
General & Specific
 There is evidence to conclude that
teaching tools, i.e., “videos,
brochures, etc., help with teaching Disease- Patho-Physiology
patients, but a healthcare provider
who is trained on how to educate,
yields the best outcomes in the Safety
progression patient knowledge
INSIGHT | STRATEGY | EXECUTION
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13. Competitive Intelligence
Across the Commercial Lifecycle
 May focus on Regulatory, Global Markets, Direct Competitors, Payors,
Disruptive Technologies  What factors will Influence the
Environmental success or failure of my product
 Informed by primary and secondary research or service?
Scan  What trends may derail my
 The Aequitas Group experts filter and interpret data opportunity?
 Anticipate issues for proactive management
 What other entities have fallen
 Review potential competitors by modality, target or therapeutic area
Pipeline out of development and why?
 Who will be competing for my
 Identify opportunities and threats
Analysis clinical trial patients?
 What endpoints do I need to hit
 Data may inform clinical trials, publication schedules, launch plans for differentiation?
 Is my strategy informed by the
most up-to-date, reliable market
 Review best-in-class strategies to develop yours
Scenario information?
 Am I looking at the right
 Test your plan prior to launch
Planning competitors?
 What are the real issues my
 Strengthen your team and develop tactics for strong execution plan will face in the
marketplace?
Actionable Intelligence informs critical, key decisions
INSIGHT | STRATEGY | EXECUTION
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14. Call Center Design and Compliance Auditing
Who is Watching?
Pharmacists Medical Offices Patients & Care Givers
Competitors Insurers
INSIGHT | STRATEGY | EXECUTION
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15. Call Center Design and Compliance Auditing
Is the Fox Guarding the Hen House?
Call center audits are normally delivered by specialized firms who posses expertise regarding
the industry and who are trained to identify gaps and propose methods of correction.
 Performance gaps: The gaps may cover specific teams, the entire operation and
even identify individual contributors
 Compliance: Review of how well the organization observes the various laws and
regulations that guide the operations and responses
 Organizational Risks: Listing of various factors that constitute an internal or an
external risk
 Reporting: The audit may cover metrics and other information used by managers
to guide their decisions
 Opportunities: Internal and external situations that present improvement or cost
minimization opportunities
 Weaknesses: Any areas that are clearly not at par and that must be addressed in
order to improve the overall functioning of the call center
 Technology: An in depth look at the technology used by the call center to handle
call routing, staffing, forecasting, etc.
 Quality: Call center QA scores, approach to scoring and coaching, feedback loop
 Management: Support staff competency, career paths, management philosophy
and approach
INSIGHT | STRATEGY | EXECUTION
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16. Call Center Design and Compliance Auditing
Managing the RFP Process
The Aequitas Team Criteria Percentage
 Design RFP with Procurement and MM Team needs in mind HIPAA Covered Entity and Disaster Recovery 5%
 Define optimal process Distribution Capabilities 5%
 Manage review
Previous Experience in Therapeutic Area 5%
 Summarize key findings
 Submit cost Model to procurement for review Problem Solving 5%
Technology / Innovation 10%
Cost 10%
Quality Assurance / Escalation Process 10%
Training and Ongoing Information Sharing 10%
Coordination with the Field 10%
Credentials Criteria Lead(s)
of Account Review 15%
Collaboration Reporting Capabilities 15%
HIPAA Covered Entity and Utilizes BA agreements
Disaster Recovery
Distribution Capabilities US Oncology Distribution Services and
CareAdvantage Specialty Pharmacy Services
Previous Experience in Yes. Oncology, Neuro and HIV
Therapeutic Area
Problem Solving; Question Answer showcases understanding of payor
53 of the RFP environment, but it is very light in regard to
Our Client understanding the variety of approaches and
solutions allowed for PAP and
 Define optimal process Reimbursement Hotlines. Small volume
clients may mean that Vendor has not been
 Review summary findings
challenged to find solutions
 Select vendor
INSIGHT | STRATEGY | EXECUTION
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17. Call Center Design and Compliance Auditing
Designing the Process To Match Your Patient’s Needs
Benefits
Investigation
Initial Payor
Prescription Coordination
Received
Financial Prior
Billing Reassessment Authorization
Patient Assistance
Process
Optimized Financial
Distribution Coordination
INSIGHT | STRATEGY | EXECUTION
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18. Buying Factors
Service
Price Quality
INSIGHT | STRATEGY | EXECUTION
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19. The Aequitas Value Proposition
Insight
Strategy Execution
www.theaequitasgroup.com
INSIGHT | STRATEGY | EXECUTION
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