$100Bn Public Health Problem–Poor Medication Adherence– David Parpart's Research

“Increasing the effectiveness of adherence interventions
will have a far greater impact on the health of the population
than any improvement in specific medical treatments.”
World Health Organization
Confidential - Socially Relevant Inc.
IMPACTMeds

Meaningful Use of Health Information in US
Confidential- Socially Relevant Inc.

Projected Growth to $350-380Bn in 2016
73% ($) from Branded Sales
$226Bn in Chronic Sales
$227Bn in Retail Sales
$188Bn in Losses Due to Poor Adherence
Potential Market $508Bn
$320Bn in US Rx Sales

65,000 outlets
25 Companies own 50%, 40% independent
$227Bn in Rx Sales
95% of American Live within 5 miles
95% of American enter monthly
Pharmacists are trained in medication adherence
Retail Pharmacies

• 2 in 3 US Hospitals Fined for excess readmission (10/12)
• Fines and standards will increase thru 2015
• Pre-admission medication list accuracy only 16%
• 1 in 5 Medicare patients readmitted within 30 days with
adverse drug events
• Poor adherence Rated #1 cause of readmissions
– Costing US insurers $100Bn+ in unnecessary hospital visits
• 29% of Americans take 5 or more medications

67% of People
Who Need Medications
Will Stop Buying Them
Within 24 Month
Confidential Do Not Distribute

POOR ADHERENCE
• Fewer Drugs Sold
• Poor Outcomes
• Higher Costs
• Hospital Admissions
• Unnecessary Deaths
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11
%
Persisting
Months on Lipid Lowering Medication

Patients often suffer from unnecessary complications including
heart attacks, strokes, heart failure, peripheral vascular disease,
amputations. End-stage renal disease,
retinopathy and vision loss.

P O O R A D H E R E N C E
M O N E Y & D E AT H
T H E U N S A V O R Y N U M B E R S

$350 billion in productivity losses
$290 billion in additional hospital costs
$188 billion in lost drug sales
$100 billion in avoidable hospital visits
350 preventable deaths per day

1,000,000 Unnecessary Deaths
can be Prevented this Decade with
Improved Medication Adherence
TogetherwecanmakeaBIG
IMPACT!

Adherence is a rampant problem
even among people undergoing
Treatment for
Dialysis, Transplants and Cancer

SOURCE: Understanding and Improving Adherence for Specialty Products, IMS
Chain Stores
Food
Stores
Independent
Mail Service

0-4
78,785,312
5-17
317,613,579
18-44
1,049,101,771
45-64
1,760,172,012
65-74
686,144,356
75-84
436,241,475
85+
185,128,692
#
of
Prescriptions
Filled
Age of Prescription Consumers (US)
Age of Consumer
0
500,000,000
1,000,000,000
1,500,000,000
2,000,000,000
2,500,000,000
3,000,000,000
0-4 0-5-17 18-44 45-64 65-74 75-84 85+
Impact of Secondary
Adherence
Impact of Primary
Adherence
Current Prescription Sales
#
of
Prescriptions
Filled
Age of Consumer
Increase Prescription Sales by 59% with Improved Adherence
188 BILLION DOLLARS

Increased Adherence = Incremental Sales
#
of
Prescriptions
Filled
0
100000000
200000000
300000000
400000000
500000000
600000000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Sales ($)
Months
Comparative Product Sales
Existing System Income Additional Income (IMPACTMeds) = $3,134,339,366

Improving medication adherence by
only 25%
across 65,000 retail pharmacies will
increase sales by
33 BILLION DOLLARS

What’s Missing?
Social Factors
Economic
Factors
Health System
Factors
Patient-Related
Factors
Condition Therapy

What can you do to stop this
growing crisis
for healthcare stakeholders and
the rising costs of
poor adherence?

“Medication Adherence is a
$100Bn business opportunity”
New England Health Institute, 2012
“…electronic monitoring devices,
and pharmacist-led counseling
are among the least costly
intervention.”
Roebucks M et al, Health Affairs, 2010

$180/mo.
$3,172* ave. 24 mo. Sales/pt.
iRetainRx
Now
$180/mo.
$2,106 ave. 24 mo. Sales/pt.
Interactive Marketing Channel
Labels
*Assuming persistence increases sales by only 50%

Improving adherence for
Lipitor, Norvasc, Lyrica
and Celebrex alone
Would Increase sales by
$6.5 billion dollars

Estimated Annual Value
$1000-1999M $2,000-4,999M $5,000M+
$100-499M $500-999M
Assuming 20% of customers utilize pharmacist services
and persistence increases sales by only 50%

Estimated Annual Value
$100-999M $1,000-1,999M $2,000M+
$396,000 $50-99M
28,000
Independently
Owned
Pharmacies
Assuming 66 new customers per/mo./pharmacy utilize
services and persistence increases sales by only 50%
for one brand name medication

Health Care Cost-Savings from Adherence

Improving
medication adherence in the US is
capable of reducing
national health spending
by 5.5% (0.98% of GDP)
SOURCE: IMS 2012

350 BILLION DOLLARS
in productivity losses for
US employers is
due to poor medication adherence
for only five conditions
SOURCE: Booz & Company 2012

The Gold Standard Solution
14 years of clinical trials conducted by the American
Pharmacy Association demonstrate an increase in drug sales
by 2x and adherence by 3x
Project IMPACT

0-4
78,785,312
5-17
317,613,579
18-44
1,049,101,771
45-64
1,760,172,012
65-74
686,144,356
75-84
436,241,475
85+
185,128,692
#
of
Prescriptions
Filled
Age of Consumer
0
500,000,000
1,000,000,000
1,500,000,000
2,000,000,000
2,500,000,000
3,000,000,000
0-4 0-5-17 18-44 45-64 65-74 75-84 85+
Impact of Secondary
Adherence
Impact of Primary
Adherence
#
of
Prescriptions
Filled
Age of Consumer
12
15
18
21
24
0
5
10
15
20
25
Current
Model
25% 50% 75% IMPACT
Trials
24
mo.
Sales
(#)
Adherence Increase
IMPACT Clinical Trials Increase Prescription Sales by 104%

0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11
%
Persisting
Months on Medication
• 2x Sales Increase
• 90-93% Persistence at
24 months
• High Patient
Satisfaction
Pharmacists-LedCounseling

Leading the Industry in Pharmacy Research and
Expanding the Role of Pharmacists in Health Care

Prize Winner of the
Sanofi US Innovation Challenge
Specializing in Medication Adherence

E A S Y T R A C K I N G
A T H O M E
• “Caring” Reminders
• Track Administration
• Positive, Side Effects
and Adverse Events
• Self-Monitoring of
Biometrics
• Food Consumption

T O O L S F O R C A R E G I V E R S

I N T E R A C T I V E L A B E L S
F O R S M A R T P H O N E S
• Convenient Way to:
• Track Medication
Administration
• Track Biometrics
• Purchase Refills
For Marketers
NFC vs. QR
• 12x higher Tap rate
• 5-10x time on site (48 sec vs.
5-10 sec)
• 36% tap to action rate

$71Bn in Out-of-Pocket Expenses

Prepaid MedCredits
Name:
Patient No:
Signature:
ACO _________________________
Manufacturer _________________________
Insurance _________________________
John Doe
A987654
Employer _________________________
Date: 04/30/13
100
200
400
QTY
MedCredits
Get answers to medication questions for free and receive special care.
Redeem Med Credits at your local pharmacy or www.IMPACTMeds.com
Med Credits expire in 60 days. Ask your pharmacist for more.
Special Care
Provided by:
™
™
The Users’ Experience
Medicare Part
D
Dallas
Nephrology

HOSPITALIZATION
RISK
HOSPITALIZATION
RISK
HOSPITALIZATION
RISK
Useful
Analytics

Predictive Algorithms and Indexes
Analytics and Predictive Algorithms
Readmission Risk Index
Uses EHR Data to Predicts Readmission Risk &
Future Days in Hospital
Non-Adherence Risk Index
Predicts Medication Non-Adherence
Flags Patient on Providers’ Case Manager Screen
Stimulate Early Personalized Intervention

We Provide Pharmacists and Patients with Simple
Tools to Improve Medication Adherence
IMPACTMeds

The World’s Largest
Medication Adherence Program
Launching Spring 2013
Opportunities Available
• Strategic Partnerships & Alliances
• Program Sponsorship
Join us now and play a leading role!
IMPACTMeds

Contact information:
BenjaminBluml,R.Ph.
VP Research
APhA Foundation
www.APhAFoundation.org
2215 Constitution Ave. NW
Washington, DC 20037
202-429-7571
bbluml@aphanet.org
DavidParpart,D.C.
CEO
iRetainRx
www.iRetainRx.com
440 N Wolfe Rd.
Sunnyvale, CA 94085
408-329-9344 Ext:1001
drparpart@sociallyrelevant.com
IMPACTMeds

Easy-to-use mobile apps and NFC
labels for interactive medication
reminders, education and
tracking usage
MOBILE ENGAGEMENT

MedCredits
iRetainRx Specializes in
Retention Marketing for Medications.
Med Credits provide Manufacturers & Retailers
with a Simple Mechanism to Invest
in Retaining High Value Customers

MedCredits
1.) Manufacturers & Retailers
Select High-Value Customers and
Provide Their Customers with Med Credits.
2.) Customers use Med Credits Virtual Currency
to Purchase Services and Tools that
Improve Medication Adherence and Sales, such as
Pharmacist Counseling, NFC Sticker, Glow Caps etc.

The Users’ Experience
The Clinic/Pharmacy
personal device report
in stantly ac c essib le to
d oc tors an d p h armac ists
At Home u se mob ile or
computer to upload, share and
view p erson al p rofile d ata

Co-operative Marketing
IMPACTMeds enables stakeholders
to dramatically increase medication adherence,
something they have been unable to scale
despite $188Bn in Losses

IMPACTMeds enables stakeholders
to dramatically increase medication adherence and
customer lifetime value (LTV), something they
have been unable to scale despite $188Bn in Losses

$180/mo.
iRetainRx
Now
$180/mo.
*Assuming persistence increases sales by only 50%
Pfizer Pharmacy
Months to
Discontinue
Current Lipitor Sales $2,106 2,106 12
Sales with IMPACTMeds $3,172 $3,172 18
Increased Sales $1,066 $1,066 6
Pfizer Pharmacy Patient
APhA and
iRetainRx
IMPACTMeds Marketing Distribution ($550) $275 $180 $95
EXAMPLE 1

$180/mo.
iRetainRx
Now
$180/mo.
*Project IMPACT Hyperlipidemia persistence rate
Pfizer Pharmacy
Months to
Discontinue
Current Lipitor Sales $2,106 2,106 12
Sales with IMPACTMeds $4,120 $4,120 23
Increased Sales $2,034 $2,034 11
Pfizer Pharmacy Patient
APhA and
iRetainRx
IMPACTMeds Marketing Distribution ($860) $500 $230 $130
EXAMPLE 2

Poor Adherence Costs
$188Bn
Lost
Lost $’s /
Penaltie
s
$290Bn
Costs
$125Bn
Lost
$188B
n Lost
Pharmacists
/Manufacturers
$188Bn Lost Sales
Insurers/Employers
$290Bn in add’l Costs
$100Bn Unnecessary
Hospital Visits
Employers
$125Bn in Productivity
Losses
Doctor and Hospitals
Less ACO/PCMH Revenues
Readmissions Penalties
Consumers
Strokes, Heart Attacks,
Suicide, Amputations etc.

IMPACTMeds
Incentive Slide for Employers/Insurers and the Government

Improving medication adherence by only
25%
just for Lipid Lowering Drugs would
increase Pharmaceutical sales by
3.6 BILLION DOLLARS
SOURCE: Comparing Adherence & Persistence, J Managed Care Pharm and 2011 industry data from IMS

Improving medication adherence by only
25%
just for Diabetes Drugs would
increase Pharmaceutical sales by
2.9 BILLION DOLLARS
SOURCE: Estimated Annual Pharmaceutical Revenue Loss Due to Medication Adherence, Capgemini Consulting

127 BILLION DOLLARS
in productivity losses for
UK and German employers is
due to poor medication adherence
for only five conditions
SOURCE: Booz & Company 2012

SOURCE: Booz & Company
Improved medication adherence is
capable of producing
€ 20Bn to € 43Bn
in productivity gains for employer
in the UK, Germany and the Netherlands

Participating Pharmacies Delivering IMPACT
Persistence: 90-93%

• IMPROVED PATIENT
HEALTH
• INCREASED PROFITS
• NEW REVENUE STREAMS
• INCREASED PATIENT
ENGAGEMENT, LOYALTY &
STICKINESS
• IMPROVED EFFICIENCY
• TECHNOLOGY SOLUTIONS
• DRUG
MANUFACTURERS
• PHARMACIES
• ACOs & PCMHs
• HOSPITALS
• SPECIALITY MEDICAL
GROUPS
• HEALTH IT & MOBILE
DEVELOPERS
WHO WE SUPPORT WHAT WE PROVIDE
OUTCOMES DELIVERED
• MULTI-SYSTEM
INTEGRATION
• CROSS-PLATFORM
DELIVERY
• ADHERENCE EXPERTISE
• EASY TO IMPLEMENT
ADHERENCE TOOLS &
TECHNOLOGY
• PATIENT-CENTERED
OUTREACH & SUPPORT
• PATIENT EDUCATION
• ADHERENCE RESEARCH
& RISK ANALYSIS
IMPACTMeds

Gives Prescription (Rx)
to Pharmacy Employee
Fills Out
Patient Profile
Adherence Risk Assessment
Arrive at
Pharmacy
Greets
Customer
(RPh/Tech)
Personalized
Receives &
Checks Rx
(RPh/Tech)
Computer
Entry (Tech)
Fill Rx
(Tech)
Ok’d byRPh
Pharmacy
Exterior
Parking
Appearance
of Non-pharmacy
Departments
Employee
Dress
Non-prescription
Merchandising
Waiting Area
Patient Information
Brochures
Signs
Line of Interaction
Line of Internal Interaction
Line of Visibility
Clarification Needed?
Yes No
Calls MD’s
Office(RPh)
Drug Interaction or
DUR Notification?
Do not fill
Insurance DUR
Notification
Check Rx
(RPh)
Clarification or Change
Made with Rx
Profile Reviewed
(RPh)
Picks Up
& Pays for Rx
Is Counseled
About Rx
Tablet Visual Aids
Appearance
of Rx Labels
Appearance of
Drug
Bill
Drug Information
Insert
Mobile Application
Medication Wallet Card
Presents Bill
for Rx and
Merchandise
(RPh/Tech)
Counsels Patient (RPh)
MTM Dashboard for
Targeted Interventions
Service Blueprint for Dispensing Services

M E D I C AT I O N D O C U M E N TAT I O N E X C H A N G E
The Basis For Scalable Medication Adherence
Confidential- Socially Relevant Inc. 66
Community
Pharmacies
General
Practitioners
Dispense and Prescription Queries
E-Prescriptions
Dispense References
Care Information
Broker (Act Registry)
PRESC GP1 PAT1
PRESC GP1 PAT2
PRESC HOSP1 PAT1
…
DISP PHARM1 PAT1
DISP PHARM2 PAT2
…
ADVICE PHARM1 PAT1
ADVICE PHARM1 PAT1
Med Administration
Self-Monitoring
Patient Generated
Advice, Education &
Counseling (MTM)
PHARM Laboratory
Hospital
Dependance
Pharmacy
GP
GP
GP centre
Hospital

67
Prescription
Dispense
Use/administration
X
Advice, education &
counseling

Architecture
Patient Self-
Management
Credentialing
Caregivers
Connect
MTM App with
RooBroo

0-4
78,785,312
5-17
317,613,579
18-44
1,049,101,771
45-64
1,760,172,012
65-74
686,144,356
75-84
436,241,475
85+
185,128,692
#
of
Prescriptions
Filled
Age of Consumer
0
500,000,000
1,000,000,000
1,500,000,000
2,000,000,000
2,500,000,000
3,000,000,000
0-4 0-5-17 18-44 45-64 65-74 75-84 85+
Impact of Secondary
Adherence
Impact of Primary
Adherence
#
of
Prescriptions
Filled
Age of Consumer
Current
Model
25% 50% 75%
IMPACT
Trials
Sales 11.6 14.6 17.6 20.6 23.6
0.0
5.0
10.0
15.0
20.0
25.0
24
mo.
Sales
(#)
Effect of Increased Adherence on Life Time Value
IMPACT Clinical Trials Increase Prescription Sales by 104%
Adherence Increase

• Administer Patient Assistance
Programs
• Risk Evaluation Mitigation
• Corporate Social Responsibility–
Track Impact and ROI
More Opportunities For
Manufacturers

Data: Adherence and Persistence
What data do we want to capture?
At Pharmacy:
Patients’ adherence knowledge, skills and performance
Pharmacists interventions and medication documentation
Claims and persistence
At Home:
• Medication administration
• Self Monitoring- Glucose, BMI, A1C, BP
• Meds Dose/response relationship
• Diet
• Exercise
• Positive, Side Effects and Adverse Events
• Anthropometric
How do interventions affect adherence and persistence?
How does adherence in one intervention relate to other interventions?
Anatomized Data Provided for Safety Analysis

Imp rove Pat ie nt Adh e re n ce w it h Co lla b o rat ive Treatme nt
IMPACTMeds

Imp rove Pat ie nt Adh e re n ce w it h Co lla b o rat ive Treatme nt
Adherence Solutions
•Safety; Side effects; Efficacy
•Self-Care
Patient Education
•Mobile
•Telephone IVR
Reminders
•Synchronize Refills
•Frequency
Simplify Dosing Regimen
•Payment Assistance Programs
•Rewards programs
Costs
•Blister Packs
Specialty Packaging
•Laboratory Tests
•Self-Care
Disease Management
•Doctors
•Family Caregivers
Coordination of Care

0
50000000
100000000
150000000
200000000
250000000
300000000
350000000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Income ($)
Time (in months)
Comparative Product Income
Existing System Income Additional Income (Project ImPACT: 2012) = $1,399,356,000
Additional Annual Sales
in Texas and California Alone
Increased Retention– Manufacturer Profits

FAMILY CAREGIVERS
DRUG MANUFACTURERS
PHARMACIST
PHYSICIAN
PATIENT
IMPACTMEDS Supports the Adherence Team

Getting and annual flu shot
Avoid overeating
Getting enough exercise
Getting enough sleep
Eating a healthy diet
Avoid smoking
Taking medication as prescribed
Most Important Health Behavior , All Respondents
4 0 , 0 0 0 R a n d o m l y S e l e c t e d A m e r i c a n s 1 8 o r O l d e r C u r r e n t l y Ta k i n g
M e d i c a t i o n U s e d t o T r e a t a t L e a s t O n e C h r o n i c C o n d i t i o n
When survey participants ranked the importance of several health behaviors
MEDICATION ADHERENCE WAS VALUED AS THE MOST IMPORTANT!

Retention Risk
Index
Doctor Visits
Pharmacy Refills
Help People Take Medication Correctly

CAREGIVER & FAMILY
MANUFACTURERS
PHARMACIST
PHYSICIAN
PATIENT
PAT I E N T - C E N T E R E D C A R E

P h a r m a c i s t s E n g a g e P a t i e n t s a n d C a r e g i v e r s i n
A d h e r e n c e A s s e s s m e n t , C o u n s e l i n g a n d E d u c a t i o n
Grandpa’s Story

While many interventions (e.g. education in self-management (25-34); pharmacy
management programmes (35,36); nurse, pharmacist and other non-medical health
professional intervention protocols (37-43); counselling (44,45); behavioural interventions
(46,47); follow-up (48,49) and reminders, among others), have been shown to be effective in
significantly improving adherence rates (50-54), they have tended to be used alone. A single-
factor approach might be expected to have limited effectiveness, if the factors determining
adherence interact and potentiate each other's influence as they are likely to do.
The most effective approaches have been shown to be multi-level - targeting more than one
factor with more than one intervention. Several programmes have demonstrated good results
using multilevel team approaches (55-57). Examples include the Multiple Risk Factor
Intervention Trial Research Group, 1982 (58) and the Hypertension Detection and Follow-up
Program Cooperative Group, 1979 (59). In fact, adequate evidence exists to support the use of
innovative, modified health care system teams rather than traditional, independent physician
practice and minimally structured systems (60,61).
Various interventions are already being implemented by many different health care actors.
Although not all of these actors are directly responsible for providing health care, they
nevertheless have an important role in improving adherence because they can influence one
or more of the factors that determine adherence.
The work that is being done to improve adherence and the persons performing the work are
described below. Excerpt from World Health
Comprehensive/Personal Approach.
No one-size fits all.

IMPACTMeds

Why Does IMPACT Improve Medication Adherence?
Patients Explain, “I Feel My Pharmacist Cares”
IMPACTMeds
It’s NOT a Tough Egg to Crack
Internal Forces Applied to Break an Egg Generates New Life

People Persist on Medications they BELIEVE are
Important from Pharmacists that CARE
IMPACTMeds
It’s NOT a Tough Egg to Crack
Internal Forces Applied to Break an Egg Generates New Life

IMPACTMeds

iRetainRx
Now
Distribution of Brand Information
F DA &
B ra n d e d
P r i n t a t
P o i n t - o f - C a re
We b s i t e s
At H o m e A p p s
F DA &
B ra n d e d
P o i n t - o f -
C a r e
O n - t h e - G o

Benefits to Sponsors
• First Look/Priority Access to Stats and Data
• PR/Marketing Brand Awareness
• Premium Networking Opportunities
• Brand Visibility
• Advertising and Educational Marketing to Providers
Doctors and Pharmacists
• Co-Branding of Consumer Hardware
NFC Labels and NFC Smart Stickers
Personal Medication Record Wallet Card

• Increase Adherence & Sales
• Increase Brand Awareness
• Increase Brand Loyalty
• Extend Brand Name Product Life
• Competitive Advantage & Differentiation
• Improved Patient Outcomes
• Increased Prescription Rate
• Personal Channel
• Opt-in Education Marketing Channel
• Integrated Education & Purchasing
• Access to New Innovative Value Layer for
Adherence Stakeholders
Benefits For Manufacturers

• Monthly Rx Cost >$80
• Losses From
– Rapidly Declining Persistence
– Missed Doses
– Generic Competition
– Class Competition
• Medium to High Margins
• Customer Retention Marketing
Budget
Benefiting Products

Premium Networking Opportunity
For Medication Adherence Stakeholders
• Pharmacies
• Pharmaceutical Manufacturers
• Medical Groups, PCMH & ACOs
• Specialty Medical Groups
• Employers/Insurers
• Governments
• Pharmaceutical Distributers
• State and Nation Associations
• Payments and Credit Cards
• Information Technology
• Telecommunications
IMPACTMedsCONFERENCES

 
Part 1 of 5 – PSPC
Overview
Website: http://www.hrsa.gov/publichealth/clinical/patientsafety/index.html

 US Department of Health and Human Services
 Health Resources and Services Administration (HRSA)
o Improving access to health care services for people who are
uninsured, isolated or medically vulnerable.
o Healthcare Systems Bureau - Office of Pharmacy Affairs
provides leadership and oversees the 340B program as well as
PSPC
98
PSPC Overview

 More than 133 million Americans live with chronic
illnesses1
 91% of all prescriptions filled for a chronic condition2
 1.5 million people are injured each year as a result of
medication3
 Uncoordinated care costs an estimated $240Billion/year
4
99
1. CDC National Center for Chronic Disease Prevention and Health Promotion: Chronic Disease Prevention
http://www.cdc.gov/nccdphp/overview.htm
2. American Heart Association. Heart Disease and Stroke Statistics–2008 Update. Dallas, Texas: American Heart Association;
2008.http://www.americanheart.org
3. Institute of Medicine (IOM), To Err Is Human: Building a Safer Health System, Washington, DC: National Academy Press; 2000
4. Owens, MK “The Health Care imperative: Lowering Costs and Improving Outcomes”, The Institute of Medicine, 2010
PSPC Overview

WHAT: Quality Improvement Collaborative aimed at
improving health outcomes and patient safety for high-
risk patients (Adapted IHI Breakthrough Series
Collaborative Model)
Improve the delivery system where there are gaps by:
o Enhancing care coordination among the providers and
partners involved
o Fostering multidisciplinary, team based care approach
o Strengthening patient centered medical home
o Integrating medication management and other services to
minimize harm related to adverse drug events and maximize
optimal health outcomes
100
PSPC Overview

PSPC 5.0 AIM:
Inter-professional teams that improve the health outcomes
and safety for high medication risk populations through
patient-centered, cost-effective medication management
services aligned with quality national standards.
PSPC’s vision:
To engage 3,000 communities in the US who will have
integrated care teams that will ensure optimal health
outcomes and safety for every patient.
101
PSPC Overview

The transformational goal of the PSPC:
 Integrate the healthcare delivery system, across multiple
healthcare partners, to create a service delivery system for
high-risk patients that will produce breakthroughs in the
following three areas:
o 1) Improved patient health outcomes
o 2) Improved patient safety
o 3) Increase utilization of cost-effective and integrated medication
management services
102
PSPC Overview

WHO: Community based teams across the country
o Organizations include safety net provider and hospitals, public
health departments, and HIV clinics
o Partners include colleges of pharmacy, primary care
associations, and Quality Improvement Organizations
o Multidisciplinary care teams delivering patient centered services
to improve medication safety and health outcomes
This is about saving patient lives!
103
In our 4th year (2011-2012), we had over 200+
community based teams from 48 states + DC, PR and
VI participate!
PSPC Overview

 In our 3rd year (2010-2011)* some of the accomplishments
include:
o The 39 Teams tracking improvement for the Diabetes PoF reported
an average improvement in the health status marker of 35%
o The 12 Teams tracking improvement for the Hypertension PoF
reported an average improvement in the health status marker of
40%
o Teams also reported a decrease in the average number adverse
drug events (ADE) from 0.7 to 0.5 ADEs per patient.
o The average number of potential errors per patient decreased from
1.5 per patient encounter at start up to 0.8.
o In 2011, APhA Foundation honored PSPC with the Pinnacle Award
for being able to demonstrate approaches that assist patients and
their caregivers in achieving better outcomes from their medications
*4th year accomplishments still being compiled
104
PSPC Overview

 Patient-Centered
 Interdisciplinary Care Team
 Cross-Organizational with Health Homes at the Center
 Systematically Addresses Medication Management,
Safety and Risk -- Huge Issues for Ambulatory Care
Patients
 All Teach, All Learn
 Align with national efforts (ex: Partnership for
Patients)
It Is Truly the
Next Generation of Collaboratives!
105
PSPC Overview

Consider the impact of this non-compliance on both the manufacturer of Plavix and the
healthcare system as a whole. Bristol-Myers Squibb reported $2B in sales of Plavix in 2010.
With an 83% compliance rate within the first four months of therapy, THERE COULD BE
$400MM OF LOST REVENUE EVERY FOUR MONTHS.
THIS TRANSLATES INTO$1.2B ANNUALLY IN LOST REVENUE DUE TO NON-ADHERENCE.
Prior to the patent expiration of Plavix, there were an estimated 4MM patients on Plavix. In
addition to these patients, there are an additional 3MM patients on Coumadin and other anti-
platelets. If there is a similar non-adherence rate for Coumadin and other anti-platelets, the
TOTAL ANNUAL REVENUE LOST FOR THE PHARMACEUTICAL INDUSTRY IS OVER $2B.
Adherence is hindered by two factors 1.) the lack of disease and therapy specific information
and tools for adherence and 2) the limited ability for the pharmaceutical industry to have
interaction with the patients.
“We are seeing a sizable portion of patients drop off treatment in a fairly short time . . . Points
to a need and opportunity to provide dedicated and proactive patient support.”
Eric Stanck
Vice-President, Research, Medco

Sponsor Market Segments for Sponsor
of Study
– Drug Manufacturers
– EHR systems that want to get closer to physicians and
pharmacists
– IT companies making healthcare products: Intuit, Qualcom,
AT&T, T-Mobile, Cisco,
– McKesson Increase transaction=makes more money and
provide their IT System users with competitive advantage.
– Device Companies: OMRON, LifeScan, Sanofi
– Payments- Co-Branding of NFC Smart Stickers
• 1Mn units at $20/unit (MasterCard and Discover interested)
– OTC’s for Branded NFC Labels, Wallet Card and Cross Sell
– Nutraceuticals- Branded NFC Labels, Cross Sell at
Pharmacy
– Chain Drug Store

$95Bn at Risk to Generic Competition in the US by 2014

Longer-term Upsides to Pharma Growth are Possible

REMS Programs and more active FDA safety program will
bring new risk/benefit dynamic

Impact are Negative in the Short Term but more positive or
uncertain in longer term

Key Biologics and U.S. Patent Expiries

Sales of Leading Therapy Classes

The Economic Crises Impacts All Stakeholders
The danger for pharma is losing share of voice!

$100Bn Public Health Problem–Poor Medication Adherence– David Parpart's Research

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