the aequitas group capabilities overview q409

INSIGHT | STRATEGY | EXECUTION

The Aequitas Group Advantage

Capabilities Presentation


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The Aequitas Group Who We Are

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.

Boutique strategic healthcareadvisory firm

Established December 1999

Venture backed

Corporate office in San Diego, California

Analysis that helps maximize product value for stakeholders Manufacturers Patients Providers Third-party payors Third-party vendors Investors


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The Aequitas GroupWhat 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


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The Aequitas GroupWhat Differentiates Our Approach

Evaluation of Complex Commercialization Factors

Clinical Assessment

Payor Assessment

Marketing Assessment

Health Policy Assessment

Analysis and strategy for each aspect of the commercialization process Focus on ALL customers and service providers

Company

Investors

Patients Providers Payors

Specialty Pharmacy &

PBMCall CentersHospital

Administrators

ROI


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Clinical Study Design Review

Competitive Intelligence

Coverage, Coding, and Payment Plan

Pharmaco-economic Studies

Payor Mix Analysis Formulary Analysis

Physician and Sales Force Education Reimbursement Billing Guides Reimbursement Call Center Training Patient Assistance Program Design and

OIG Guidance HCPCS Code Applications Payor Messaging and Presentation

Development Payor Market Research Competitive Intelligence

Formulary Kit and AMCP Dossier Development Payor Information Tracking Formal Policy Response Pharmacoeconomic Studies Formulary Placement Appeals Reimbursement Training Ad hoc Reimbursement Commercialization

Consulting Competitive Intelligence

The Aequitas Group Maximizing Patient Access By…

Pre-Launch Post-LaunchMarket Launch

Clinical Trials Product Filings (NDA, BLA, 510K, PMA)

Launch Phase IV New Indication

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


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The Aequitas Group Complementary Specialties

Managed Markets Consulting

Reimbursement, distribution, and access plan development Payor plan data collection and analysis Named patient programs Ad hoc consulting support Comparative effectiveness and health economic assessments

Reimbursement Training and Patient Educators Programs

Competitive Intelligence

Call CenterDesign and Compliance Auditing

Customized and certified reimbursement training programs Certified patient educator program

Scenario planning Competitor review and disruptive technology analysis

Compliance audit of patient assistance and reimbursement hotlines Process optimization based on patient access, channel design, and budget


Managed Markets ConsultingActivities To Match Perspectives

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Out-of-Pocket Analysis to Inform Patient Assistance Programs and Foundation Development

Facilitating the Client’s Patient Experience through the Reimbursement and Patient Assistance Process

Enhance Prescriber Access Through Coverage Review and Coding Applications

Collateral Material Development and Website Content Population

Product Analog Analysis Payor Landscape Review Payor Marketing Plans and

Message Development Product Dossiers Competitor Product Review

Provider Perspective Payor PerspectivePatient Perspective1 2 3

Provider Perspective

Patient Perspective Payor Perspective


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0 100 200 300

Managed Markets Consulting Aequitas Reimbursement Likelihood Ratio™

Lowest Highest

Clinical Value

Reimbursement Likelihood

Econ

omic

Val

ue


Managed Markets ConsultingCoverage Dashboards and Payor Tracking Systems

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Managed Markets ConsultingNamed Patient Program Support

Send PhysicianProduct NamedPatient letter

LOA PI Forms Price

Are received

documents complete

Review Requestby Patient Access

Committee

Pass Request to Trade forDelivery of Product to Physician

Ship Product to Physician Using Import Vendor

Receive Confirmation of Delivery ofDrug and Receipt by Physician

Re-label Product as Required Get Import License

Send Polite “Reject” Letter. Can not Provide Drug

Send polite letter Can not provide

drug

Send Letter to Physician asking for Missing Info

Refer to Partner

No Yes

Yes No

No

Yes

Is Product Covered

by Partner

Authorized Country

Time Frame for Planning a Named Patient Program

6 Months 12 Months

Prepared Documents and Contracts

Information for physicians and pharmacists

Dose and administration of drug

Patient treatment criteria

Named Patient Program Established

Marketing Authorization Anticipated

10

No

Yes


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Post-Graduate Institute of Medicine Certification

Wholesalers Group

Purchase Organizations

Wholesalers Specialty

Pharmacies Specialty

Distributors Pharmacy

Benefit Managers

Physician Offices

Reimbursement & Patient Educators ProgramsTraining Customized by Product and by Need

Physician Office

Hospital Outpatient

Hospital Inpatient

Home Long Term Care Dialysis Center Infusion / Shot

Clinic Ambulatory

Surgical Center

Medicare Part A Medicare Part B Medicare Part C Medicare Part D Medicaid FFS Managed

Medicaid Private Pay Medical

Benefits Pharmacy

Benefits Specialty

Benefits Durable Medical

NCPDP NDC CPT ICD-9 and ICD-

10 DRG HCPCS

Active Listening Probing for

Information Fluency with

FAQs Working all

Four (4) Sides of a Case (i.e., Patient, Provider, Payor, Distributor)

Policies Bulletins Articles Contracting Rebates Utilization

Controls Formulary Preferred Drug

Lists Generic

Positioning

AWP ASP WAC Best Price FUL AMP Samples Coupons

Medicare Managed Care Medicaid Veterans Affairs Department of

Defense Indian Health

Service

Initiation Completion

Payor Introduction

Purchasers and

Distributors

Sites of Service Plan Types Coverage and

Payment Billing and

Coding

Payment and Alternative

Funding

Objection Handling


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Reimbursement & Patient Educators ProgramsA Way to Support Your Providers and Your Patients

The Institute of Medicine estimates that health literacy generates an annual cost of 73 billion dollars per year in healthcare

Seventy-five percent of chronically ill Americans have low literacy skills

Poor literacy yields a longer length of stay in healthcare entities, and it’s been estimated that poor “health literate” patients cost four times more than a “health-literate” patient to treat

There is evidence to conclude that teaching tools, i.e., “videos, brochures, etc., help with teaching patients, but a healthcare provider who is trained on how to educate, yields the best outcomes in the progression patient knowledge

Patient Education Hierarchy

Safety

Disease- Patho-Physiology

Treatment: General & Specific

Problem Solve

Unifywith

Personal Life

Informed Decision

Self Actualization

As patients attain greater knowledge, they move

up the hierarchy which allows greater control & autonomy

in their personal healthcare


Competitive IntelligenceAcross the Commercial Lifecycle

Actionable Intelligence Informs Critical, Key Decisions

May focus on Regulatory, Global Markets, Direct Competitors, Payors, Disruptive Technologies

Informed by primary and secondary research The Aequitas Group experts filter and interpret data Anticipate issues for proactive management

Environmental

Scan

What factors will Influence the success or failure of my product or service?

What trends may derail my opportunity?

Review potential competitors by modality, target, or therapeutic area Identify opportunities and threats Data may inform clinical trials, publication schedules, launch plans

PipelineAnalysis

What other entities have fallen out of development and why?

Who will be competing for my clinical trial patients?

What endpoints do I need to hit for differentiation?

Review best-in-class strategies to develop yours Test your plan prior to launch Strengthen your team and develop tactics for strong execution

ScenarioPlanning

Is my strategy informed by the most up-to-date, reliable market information?

Am I looking at the right competitors?

What are the real issues my plan will face in the marketplace?

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Call Center Design and Compliance AuditingIs the Fox Guarding the Hen House?

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

Call center audits are normally delivered by specialized firms who possess expertise regarding the industry and who are trained to identify gaps and propose methods of correction.


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Call Center Design and Compliance AuditingKnow the Rules to Design a Sophisticated Program

Pharmacy Switch Only?

Legal Interpretation of Programs Allowed for Government Covered Patients

InsuranceVerification Documentation Co-Pay

AssistanceHardship Exception

Language & Literacy

Alternative Funding

Formal SignatureRequirement

Alternative Communication

Collateral Pre-Populated

Website Advocate Letters Attestation/Form

4506-T

Drug Expense Service Expense Foundation Design SPAP Utilization LIS Review

Inclusion of Total Medical Costs

Income Variable or Sliding Scales

FPL or Straight Line Income

Foreign Language Lines

Collateral at Appropriate Language Arts Level

Transportation Costs

Utility Bills Quality of Life Items

(e.g., wig for cancer patients)

Electronic Signatures

Verbal Authorization

Text Messages Email Based

Communication Web Portals


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The Aequitas Value Proposition

Insight

Strategy Execution


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Insight. Strategy. Execution.

12680 High Bluff RoadSuite 110San Diego, CA 92130

T: 858.847.9126F: 858.509.4739

www.theaequitasgroup.com