Advanced Care Scripts & ONS San Francisco Bay Area Chapter Invites you to: Specialty Pharmacy:

1. Advanced Care Scripts & ONS San Francisco Bay Area Chapter Invites you to: Specialty Pharmacy: An Oncology Nursing Perspective

2. Program Objectives • After this program, oncology nurses should have a better understanding of and information about services provided by specialty pharmacies, especially Advanced Care Scripts (ACS) • Topics will include: • ONS:Edge/ACS 2014 Partnership • Best Practices in Specialty Pharmacy • ACS, Oncology, and Oncology Nurses

3. This program is sponsored by Advanced Care Scripts Specialty Pharmacy • No continuing education credit is available for this program • ONS provision of space for this event does not comprise endorsement

4. Agenda • ONS:Edge/ACS 2014 Partnership • Specialty Pharmacy Best Practices • Advanced Care Scripts (ACS) • Nurse Information and Resources • Question-and-answer Period

5. ONS:Edge/ACS Partnership • Components for 2014 • Advisory Board • Congress Ancillary Luncheon • Regional Dinner Series • Email contact campaign • White Paper • Webinar/Webcast

6. Do you know what a specialty pharmacy is?

7. Have you workedwith one or morespecialty pharmacies?

8. Oncology Nurse Advisory Board • Hear first-hand what oncology nurse experience has been with specialty pharmacies and ACS; what they want and need • February 20, 2014, at Pittsburgh ONS Headquarters Building • Nine nurse experts • Members of ACS staff

9. Advisory Board Lessons • Every practice must use at least one specialty pharmacy • Source for oral oncolytics • All participants had used specialty pharmacies • All participants were generally familiar with standard services offered by specialty pharmacies • Nurses decide which specialty pharmacies to use! • Nurses prefer and return to specialty pharmacies that offer fast service, provide a single point of contact, and automatically initiate prior-authorizations, copay assistance, etc. • Nurses were “thrilled to be heard”

10. Has your specialty pharmacyasked what you think of their service?

11. Specialty Pharmacy • According to NCCN,1 no standard definition • Uses of terms “specialty pharmacy” and “specialty drug” vary across health plans and pharmacy benefit programs • No mandatory certification exists for specialty pharmacies or pharmacists • Not regulated at the federal level 1. Schwartz RN et al. NCCN task force report: specialty pharmacy. JNCCN 2010;8[Suppl 4]:S1–S11

12. Specialty Pharmacy Goals • Optimize patient outcomes • Ensure appropriate medication use • Maximize medication adherence • Remove financial barriers to therapy • Patient education

13. Specialty Pharmacy Functions • Distribute medications that are: • High cost • Require complex therapy management, including regimen adherence • Not readily available through Retail pharmacy

14. Participants in Specialty Pharmacy Market

15. What is a Specialty Drug?1 • Two key factors • Cost • Complexity • High research and development costs; special manufacturing requirements • May require special handling, unique inventory management, patient monitoring, greater levels of patient support 1. URAC. Specialty Pharmacy White Paper: The Patient-centered Outgrowth of Specialty Pharmacy. 2011; URAC, Washington, DC.

16. Specialty Drug Definitions • Treats specific, mainly chronic, and often rare conditions • Use initiates with a specialist • Requires special handling • Requires unique distribution channel • High level of therapy management, such as REMS programs and side effect management • High drug cost: $10,000+ per month • Typically requires financial assistance

17. The Future of Specialty Pharmacies • Boom expected1 • 7 of 10 top-selling drugs projected to be specialty drugs by 2016 • Independent retail pharmacies creating collaborative networks • Big chains creating subsidiaries • Independent specialty pharmacies average 3-year growth rate of 208% • Independent accreditation organizations helping smaller players by offering verification of capacity Fein AJ. Spec Pharm Times. Tuesday, May 29, 2012. http://specialty.pharmacytimes.com/publications/specialty-pharmacy-times/2012/June-2012/7-Reasons-Why-Specialty-Drug-Dispensing-Will-Boom. Accessed Feb. 5, 2013.

18. Benefits of Specialty Pharmacy to Manufacturers1 • Closed distribution helps control inventory and data • REMS (Risk Evaluation and Mitigation Strategy) • Mostly high-risk drugs • Require extra data collection • Improvements in compliance/adherence • Consistency of data collection 1. Jorgensen JA. Specialty pharmacy: status and future direction. A J Pharm Benefits. 2010; 2(6):347-348.

19. Benefits of Specialty Pharmacy to Healthcare Providers • Work with copay organizations to help patients pay for medications • Managed care organizations increasing cost share to patient • Copay organizations – charitable groups that assist patients • Independent specialty pharmacies typically have copay assistance specialists to help coordinate financial assistance for patients 1. Kwiatkowski J. Spec Pharm Times. February 20, 2012. Available at: http://specialty.pharmacytimes.com/publications/specialty-pharmacy-times/2012/February-2012/Copay-Organizations-and-Specialty-Pharmacies-Partnering-to-Help-Patients-in-Need. Accessed Feb. 5, 2013.

20. Benefits of Specialty Pharmacy to Healthcare Providers Cont. • Efficiently initiate therapy • Quick turn around time • Overnight medication delivery • Helping to keep patient on therapy • Monitor and address compliance

21. Benefits to Patients • Efficiently initiate therapy • Limit time to drug delivery • Enhance adherence • Facilitate payment, reimbursement, access • Monitor and address compliance • Provide direct patient education • Keep out-of-pocket costs to a minimum • Therapies delivered to the patient’s home 1. Kwiatkowski J. Spec Pharm Times. February 20, 2012. Available at: http://specialty.pharmacytimes.com/publications/specialty-pharmacy-times/2012/February-2012/Copay-Organizations-and-Specialty-Pharmacies-Partnering-to-Help-Patients-in-Need. Accessed Feb. 5, 2013.

22. Specialty Pharmacy and Oncology • In oncology, specialty pharmacies distribute • Oral Chemotherapy • Self-injectable • Support Medications (anti-emetics and steroids)

23. A Specialty Pharmacy Care Model for Oral Oncolytics Patient Education Adherence Oversight Screening: Lab Values Counseling on Side Effects Patient Interventions by Specialty Pharmacies CARE PLAN Interventions by Healthcare Practitioner Adherence Oversight Dose Optimization Therapy Adjustments Side-Effect Management 1. Adapted from: Correia RJ. Spec Pharm Times. Dec. 5, 2011. http://specialty.pharmacytimes.com/publications/specialty-pharmacy-times/2011/May-2011/Oral-Oncology-Therapies-Specialty-Pharmacys-Newest-Challenge- Accessed Feb. 5, 2013.

24. Oral Agents Can Be Specialty Drugs • High cost – in 2011, average monthly cost was $4,400 • High complexity – may cause serious adverse events, require detailed follow-up and monitoring • High levels of patient education to control adverse events and ensure adherence 1. Correia RJ. Spec Pharm Times. Dec. 5, 2011. http://specialty.pharmacytimes.com/publications/specialty-pharmacy-times/2011/May-2011/Oral-Oncology-Therapies-Specialty-Pharmacys-Newest-Challenge- Accessed Feb. 5, 2013.

25. REMS = Risk Evaluation and Mitigation Strategy, usually requires special handling, training of pharmacist and provider. 1 Ness S. Spec Pharm Times. Feb. 14, 2014. http://www.specialtypharmacytimes.com/publications/specialty-pharmacy-times/2014/february-2014/specialty-drugs-year-in-review-2013/P-2Accessed March 11, 2014.

26. Specialty Pharmacy Adherence Roles • Scheduled, proactive patient contact • Clinical pharmacist and nurse monitoring of adverse effects and therapy compliance • Refill monitoring and reminders • Contact patients for refill reminders and mandatory surveys if applicable

27. Specialty Pharmacy Clinical Roles

28. Financial Need1 • 2011 study on out-of-pocket (OOP) costs for oral oncolytics • 1,737 Medicare patients; 8,771 commercially insured patients • If OOP costs exceeded $500, 25% abandoned therapy on initial claim • High abandonment rates linked to number of prescriptions, low incomes, and Medicare coverage Streeter S, Schwartzber L, Husain N, et al. Patient and plan characteristics affecting abandonment of oral oncolytic prescriptions. J Oncol Pract. 2011;7(3S):46s-51s

29. How Specialty Pharmacies Help • Copayment Assistance Programs • Manufacturer copay card, coupon, etc. • Not need based, no application • Not available to government sponsored insurance plans (Medicare, Medicaid, and Tricare/Railroad Workers) • Drug Manufacturer Assistance Programs • Patient assistance programs (PAPs) offer free or low-cost drugs • Eligibility requirements/no insurance • Variations regarding Medicare, Medicaid patients

30. ACS Specialty Pharmacy Services Specialty pharmacy services overview: • Quick turn around time • Complete clinical management programs • Co-pay assistance program access and 501c(3) foundation expertise • Single point of contact to simplify experience • Disease-specific compliance & adherence solutions  • Daily dose compliance packaging for all oral medications  • Access to limited distribution drugs • 24/7 access to clinical (Nurses & Pharmacist) support • Free overnight specialty medication delivery nationwide

31. Advanced Care Scripts Patient Services • Benefits investigation and coordination of benefits • Reimbursement support services to help patients maximize their insurance benefits • Prior Authorization Assistance and Initialization • Medicare determination of part B and D patients as well as private and commercial plans

32. Advanced Care Scripts Patient Services cont. • Copayment Assistance Programs • Non-profit disease specific foundations • Manufacturer copay cards • Drug Manufacturer Programs • Patient assistance programs (PAPs) offer free or low-cost drugs (Eligibility requirements/no insurance) • Variations regarding Medicare, Medicaid patients ACS Secured over $75,000 million in Copay Assistance for our patients last year!

33. Advanced Care Scripts Patient Services cont. • Maximizing Medication Adherence • Nurses and pharmacists closely monitor patients for adverse events and intervene when necessary. • Written and online educational materials are provided to patients with the most up-to-date information about their prescribed therapies. • ACS offers oral medications to be dispensed in daily dose compliance packaging. This packaging brings simplicity to complex dosing schedules and increases medication adherence.

34. Advanced Care Scripts Patient Services cont. • Assistance from trained Patient Care Specialists to support patients in staying adherent and in control of their therapy once on treatment • Scheduled proactive patient contact - 2 weeks after the start of a new treatment - Monitoring refill dates and use • Superior customer service to our patients

35. ACS helps the Oncology Practice • Access to specialty therapies • Single point of contact to simplify experience • Management from nurses and trained pharmacists to closely monitor patients for adverse events and intervene when necessary • Refill reminders faxed to the physician office • Four ways to refill medications (phone, fax, Escribe, and email)

36. Advanced Care Scripts Drugs In addition, ACS dispenses anti-emetics for the management of chemotherapy-induced nausea and vomiting.

37. ACS Present: ACS Specialty Pharmacy Services ACS Receives URAC Accreditation • Specialty Pharmacy Accreditation from URAC • URAC, Washington, DC-based healthcare accrediting organization that establishes quality standards for the healthcare industry. URAC offers the only third-party, voluntary accreditation program of this scope for the pharmacy benefit management and prescription services industries. • Received February, 2014

38. Questions?

39. Advanced Care Scripts www.acs-rx.com 877-985-MEDS (6337)

40. Thank you!