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.
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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
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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
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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 the Client’s Patient Collateral Material Development Message Development
Experience through the and Website Content
Reimbursement and Patient Population Product Dossiers
Assistance Process Competitor Product Review
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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
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 No 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
Managed Utilization AMP Four (4) Sides
Indian Health Specialty Long Term Care Medicaid Controls HCPCS
Distributors Samples of a 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
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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
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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 Informed by primary and secondary research
success or failure of my product
or service?
Scan The Aequitas Group experts filter and interpret data
What trends may derail my
opportunity?
Anticipate issues for proactive management
What other entities have fallen
Review potential competitors by modality, target, or therapeutic area out of development and why?
Pipeline Identify opportunities and threats
Who will be competing for my
clinical trial patients?
Analysis Data may inform clinical trials, publication schedules, launch plans
What endpoints do I need to hit
for differentiation?
Is my strategy informed by the
most up-to-date, reliable market
Review best-in-class strategies to develop yours information?
Scenario Test your plan prior to launch
Am I looking at the right
competitors?
Planning Strengthen your team and develop tactics for strong execution
What are the real issues my
plan will face in the
marketplace?
Actionable Intelligence Informs Critical, Key Decisions
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14. Call Center Design and Compliance Auditing
Is the Fox Guarding the Hen House?
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.
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
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15. Call Center Design and Compliance Auditing
Know the Rules to Design a Sophisticated Program
Insurance Co-Pay Hardship
Documentation
Verification Assistance Exception
Pharmacy Switch Collateral Drug Expense Inclusion of Total
Only? Pre-Populated Service Expense Medical Costs
Legal Interpretation of Website Foundation Design Income Variable or
Programs Allowed for Advocate Letters SPAP Utilization Sliding Scales
Government Covered Attestation/Form FPL or Straight Line
Patients LIS Review
4506-T Income
Language Alternative Formal Signature Alternative
& Literacy Funding Requirement Communication
Foreign Language Transportation Electronic Text Messages
Lines Costs Signatures Email Based
Collateral at Utility Bills Verbal Authorization Communication
Appropriate Quality of Life Items Web Portals
Language Arts Level (e.g., wig for cancer
patients)
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16. The Aequitas Value Proposition
Insight
Strategy Execution
INSIGHT | STRATEGY | EXECUTION
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17. Insight. Strategy. Execution.
12680 High Bluff Road
Suite 110
San Diego, CA 92130
T: 858.847.9126
F: 858.509.4739
www.theaequitasgroup.com
INSIGHT | STRATEGY | EXECUTION
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