With the shift to value, healthcare payers are insisting that pharmaceutical manufacturers deliver real world evidence of their drug’s efficacy before being allowed on formulary. The cost of new specialty treatments has forced companies to bolster and go beyond clinical trial, proving that their drugs improve health outcomes and reduce the cost of care with real world evidence. So how do pharmaceutical companies gather these data points and what kind of digital tools should they use?

1. 1
How Pharma Can Use
Digital Health to Drive Value
March 15, 2017

2. 22
Benjamin Dean
Digital Strategy - Business &
Monetization
Todd Greenwood, PH.D
Director, Digital Strategy
tgreenwood@medullan.com bdean@medullan.com

3. 33
We’re Digital Health Experts.
• 100% Healthcare since 2005
• Driven by User-Centered Strategy
& Execution
• Geared for Client Collaboration
• Focused on Driving Outcomes

4. 44
Agenda
Understanding
Shift to Value
How Digital
Enables RWE
Collection &
Drives
Revenue
What it Takes to
Get Started &
Take Action

5. 55
Understanding the
Shift to Value

6. 6
Address healthcare costs, quality of care and
patient outcomes
Financial
1
1. Adapted Diagram from Valence Health

7. 7
Address healthcare costs, quality of care and
patient outcomes
Financial
By 2020, 75% of commercial payments will be
through value-based arrangements
Health Care Transformation Task Force (coalition of payers,
providers, patients, purchasers)

8. 8
Performance Against
Competitors
Payment Dependent
on Desired Outcome
Larger Rebate in
Absence of Outcome
Indication Specific
Pricing
Payment based on:
Reduction in
hospitalizations
Aetna, Cigna, Harvard
Health
Heart failure
$5,475 per year
Higher Rebate if:
Missed LDL goals and
utilization
Cigna, Harvard Health
High Cholesterol
$16,920 per year
Rebate based on:
% A1C target vs. other
GLP-1s
Aetna, Cigna, Harvard
Health
Type II Diabetes
$8,967 per year
Higher price in lung based
on:
Better survival rates
vs. pancreatic cancer
Express Scripts
Lung & Pancreatic
Cancer
$105,788 per year

9. 9
Performance Against
Competitors
Payment Dependent
on Desired Outcome
Larger Rebate in
Absence of Outcome
Indication Specific
Pricing
Payment based on:
Reduction in
hospitalizations
Aetna, Cigna, Harvard
Health
Heart failure
$5,475 per year
Higher Rebate if:
Missed LDL goals and
utilization
Cigna, Harvard Health
High Cholesterol
$16,920 per year
Rebate based on:
% A1C target vs. other
GLP-1s
Aetna, Cigna, Harvard
Health
Type II Diabetes
$8,967 per year
Higher price in lung based
on:
Better survival rates
vs. pancreatic cancer
Express Scripts
Lung & Pancreatic
Cancer
$105,788 per year

10. 10
Performance Against
Competitors
Payment Dependent
on Desired Outcome
Larger Rebate in
Absence of Outcome
Indication Specific
Pricing
Payment based on:
Reduction in
hospitalizations
Aetna, Cigna, Harvard
Health
Heart failure
$5,475 per year
Higher Rebate if:
Missed LDL goals and
utilization
Cigna, Harvard Health
High Cholesterol
$16,920 per year
Rebate based on:
% A1C target vs. other
GLP-1s
Aetna, Cigna, Harvard
Health
Type II Diabetes
$8,967 per year
Higher price in lung based
on:
Better survival rates
vs. pancreatic cancer
Express Scripts
Lung & Pancreatic
Cancer
$105,788 per year

11. 11
Performance Against
Competitors
Payment Dependent
on Desired Outcome
Larger Rebate in
Absence of Outcome
Indication Specific
Pricing
Payment based on:
Reduction in
hospitalizations
Aetna, Cigna, Harvard
Health
Heart failure
$5,475 per year
Higher Rebate if:
Missed LDL goals and
utilization
Cigna, Harvard Health
High Cholesterol
$16,920 per year
Rebate based on:
% A1C target vs. other
GLP-1s
Aetna, Cigna, Harvard
Health
Type II Diabetes
$8,967 per year
Higher price in lung based
on:
Better survival rates
vs. pancreatic cancer
Express Scripts
Lung & Pancreatic
Cancer
$105,788 per year

12. 12
Value-based contracts are still rare in the US
Underlying Reasons
o Fragmented U.S. healthcare system
o Plethora of EHR providers with some patient records still in paper!
o Inability to track patient adherence to drug regimen and drug effects on
health
o Patient Privacy concerns
"The basic infrastructure of electronic medical
records, let's call it 'real-world data', is going to have
to increase so that we can easily track and monitor
outcomes”
-Novartis CEO Joseph Jimenez
1. http://www.fiercepharma.com/pharma/novartis-roche-ceos-see-performance-based-future-but-u-s-isn-t-ready-yet

13. 13
Value-based contracts are still rare in the US
Underlying Reasons
o Fragmented U.S. healthcare system
o Plethora of EHR providers with some patient records still in paper!
o Inability to track patient adherence to drug regimen and drug effects on
health
o Patient Privacy concerns
"The basic infrastructure of electronic medical
records, let's call it 'real-world data', is going to have
to increase so that we can easily track and monitor
outcomes”
- Novartis CEO Joseph Jimenez
1. http://www.fiercepharma.com/pharma/novartis-roche-ceos-see-performance-based-future-but-u-s-isn-t-ready-yet

14. 14
High-profile value based contracts
Year Drugs Condition Pharma Payer
2009 Januvia and Janumet Type 2 Diabetes Merck & Co Cigna
2011 Rebif MS EMD Serono Cigna
2012 Rebif MS EMD Serono Prime Therapeutics
2015 Harvoni Hepatitis C Gilead / Catamaran Cigna
2015 Repatha Cardiovascular Amgen Harvard Pilgrim
2016 Praluent Cardiovascular Sanofi / Regeneron Cigna
2016 Repatha Cardiovascular Amgen Cigna
2016 Ernesto Heart Failure Novartis Cigna
2016 Ernesto Heart Failure Novartis Aetna
2016 Januvia and Janumet Type 2 Diabetes Merck & Co Aetna
2017 Enbrel Rheumatoid Arthritis Amgen Harvard Pilgrim

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Priorities are not aligned
o Immediate cost containment
o Real-world Evidence data (RWE)
o Comparative data sets
o Standard adherence and patient
experience programs
o Data from randomized clinical
trials against a placebo (RCT’s)
EY Progressions 2014: Navigating the payer landscape.
Payers Want Pharma Provides

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Randomized Clinical Trials
(RCTs)
Real World Evidence (RWE)
o Prospective data collection
o Limited segment of the population is eligible
o Good patient adherence and compliance
o Important for demonstrating efficacy & safety
o Limited ability to investigate costs
o Prospective and/or retrospective data collection
o Broader more representative of the patient
population
o Real world patient adherence and compliance
o Shows benefits of drug in everyday clinical practice
o Ideal for showing value within local health economy

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RWE takes a robust platform
Steps to RWE Acquisition
1. Generating patient-centered data
2. Compiling existing data from disparate
sources including Pharmacy POS,
utilization claims, EHR claims and
notes
3. Leveraging data for contracting and
patient-centric purposes
NEHI: Real World Evidence: A New Era for Health Care Innovation

18. 1818
How Digital Enables
RWE & Drives Revenue

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The Digital Continuum
Increasing Complexity, Connectivity, Comprehensiveness, and Points of Engagement
App
o Standalone product
o Discrete focus
o Limited enterprise support
& integration

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o The right combination of
technologies and ecosystem
partners
o Behavior changing interventions
and content
o Digital and non-digital
(multi-channel) set of
components
The Digital Continuum
Increasing Complexity, Connectivity, Comprehensiveness, and Points of Engagement
App
o Standalone product
o Discrete focus
o Limited enterprise support
& integration
Solution

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o The right combination of
technologies and ecosystem
partners
o Behavior changing interventions
and content
o Digital and non-digital
(multi-channel) set of
components
o A first-class operation
around bringing the solution
to market
o Focused on continuous
improvement of outcomes
o Strategic asset of real world
evidence for clinical studies
and value-based leadership
The Digital Continuum
Increasing Complexity, Connectivity, Comprehensiveness, and Points of Engagement
App
o Standalone product
o Discrete focus
o Limited enterprise support
& integration
PlatformSolution

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What Digital Offers
Developing medicine in better ways Developing better medicine
– Accelerated clinical trials
– Improved patient tracking
– Real world outcomes
– Learning health systems
– Clinical research as a care
option
– Virtual trials
– Personalized medicine (genomics,
proteomics, metabolomics)
– Companion digital therapeutics
– Adherence controls
– Inter-disciplinary therapies
Two sides of the same coin

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Product Lifecycle
MedicalR&D Product Supply Comm. Launch
Modeling / simulation
Genomics
RWE packaging
E-clinical Recruitment
Digital monitoring
Medical information
AE Reporting and
Social Listening
e-Safety
Smart factory with
IoT
Digitized supply chain
Omni-channel
Post-marketing
monitoring
Patient marketing
Digital therapeutic
Data Analytics, Storage and Security
Treatment
Patient Journey
Fitness/Wellness Tracking
Genomics
Social media
Electronic health records
Remote monitoring
Telemedicine
Patient communities
Diagnosis
Self-care

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Monetization Potential of Digital Technologies
Epidemiology
underlying Drug
Forecasting
Prevalence
Incidence
Seeking Treatment
Prescribed Drug
Compliance
Sales

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Behavioral Change Opportunities
o Increase incidence through screening
o Drive patients to seek treatment through
education and campaigns
o Influence Rx habits by educating and raising
awareness of both patients and providers
o Improve compliance through behavioral therapy
Monetization Potential of Digital Technologies
Prevalence
Incidence
Seeking Treatment
Prescribed Drug
Compliance
Sales

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Freemium Set Monthly Fee Reimbursement
Performance-based Gain-Share Bundled as PSP
Sample Business Models

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What it takes
to get started

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5. Anticipate needed investment for the latter half of the year
How can you get started down this path?
4. Test a “Fail Fast, Succeed Faster” Mindset
3. Establish a baseline for existing channels and tools
2. Seek and drive internal alignment
1. Measure the success of your current workflow

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Thank You.
Director, Digital Strategy
Todd Greenwood, PhD
tgreenwood@medullan.com @medullan
Digital Strategy – Business &
Monetization
Benjamin Dean
bdean@medullan.com @Ben_Dean