the aequitas group capabilities overview
TRANSCRIPT
INSIGHT | STRATEGY | EXECUTION
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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
INSIGHT | STRATEGY | EXECUTION
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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 andOIG 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
INSIGHT | STRATEGY | EXECUTION
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
Eco
no
mic
Val
ue
INSIGHT | STRATEGY | EXECUTION
Managed Markets ConsultingCoverage Dashboards and Payor Tracking Systems
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INSIGHT | STRATEGY | EXECUTION
Managed Markets ConsultingNamed Patient Program Support
Send PhysicianProduct Named
Patient 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 TypesCoverage and
Payment Billing and
Coding
Payment and Alternative
Funding
Objection Handling
INSIGHT | STRATEGY | EXECUTION
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Reimbursement & Patient Educators ProgramsA Way to Support Your Providers and Your Patients
The Institute of Medicine estimatesthat health literacy generates anannual cost of 73 billion dollars peryear in healthcare
Seventy-five percent of chronically illAmericans have low literacy skills
Poor literacy yields a longer length ofstay in healthcare entities, and it’sbeen estimated that poor “healthliterate” patients cost four times morethan a “health-literate” patient to treat
There is evidence to conclude thatteaching tools, i.e., “videos,brochures, etc., help with teachingpatients, but a healthcare providerwho is trained on how to educate,yields the best outcomes in theprogression 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
INSIGHT | STRATEGY | EXECUTION
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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INSIGHT | STRATEGY | EXECUTION
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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
DocumentationCo-Pay Assistance
Hardship 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