Payer Access INFLUENCING KE Y DECISION MAKERS

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1 Payer Access INFLUENCING KE Y DECISION MAKERS Particularly in this ever-changing healthcare system, payers have become an even more influential group in the healthcare landscape than in years past. From their positions within insurance companies, pharmacy benefit managers and health systems, they direct formulary decisions, drug pricing, rep access and even the scope of patient support services for over two-thirds of all physicians. And with outcomes serving as the key measurement of success, their role only grows.

2 DECREASING HCP ACCESS Increasing Importance of Payers The term Payer applies to an array of roles, but it typically refers to third-party providers of medications and care, such as health systems and insurance carriers. While Payers constitute one of the Three Ps of Pharma (Patients, Providers, Payers), access to providers has become increasingly limited for pharma salesforces. A successful marketing effort requires engaging both HCPs and Payers, though few platforms provide such access. BulletinHealthcare offers such a solution. Every weekday, BulletinHealthcare delivers highly valued briefings to more than 40,000 members of the Payer community through its partnerships with three key associations, representing just one part of BulletinHealthcare s growing network of over 1 million physicians, dentists, and other HCPs. 80% % 2016 REPS DECLINING ACCESS While 80% of physicians were deemed accessible to reps when ZS s study began in 2008, just 44% are still routinely opening doors to reps today. 1 ACCESSIBILITY RATINGS BY SPECIALTY AccessMonitor TM rates physician s accessibility by specialty. Physicians in specialties such as urology and rheumatology are more accessible, while those in nephrology and oncology are harder to reach. 2 44% 52% 38% 31% 18% 17% Accessible (reached by >70% of reps) Access Restricted (31 70%) Severely Restricted Access (<30%) 49% 56% 53% 53% 51% 61% 61% 68% 77% 29% 36% 35% 37% 42% 27% 22% 34% 21% 12% 15% 11% 12% 12% 9% 10% 5% 2% 43% 40% 36% 36% 35% 25% 22% 18% 17% 26% 55% 48% 26% 27% Physicians Non-Physicians Urology Rheumatology Allergy Dermatology Endocrinology Neurology OB/GYN Gastroenterology Cardiology Primary Care Psychiatry Pediatrics Neprhology Oncology Source: Khedkar, P.; Sturgis, M. (2015) AccessMonitor TM 2015 Executive Summary: For Pharma Reps, a Challenging Market for Physician Access Gets Even Tougher. ZS Associates.

3 Health System Mergers FURTHER HINDER ACCESS While the reasons for decreasing HCP access for pharma reps are complex, one major hindrance of access is merger activity among health systems, since they employ over two-thirds of all physicians. The 2015 AccessMonitor TM study found that the net impact of 25 recent large health system mergers was an even more accelerated decline in sales rep access in comparison to areas where no health system mergers occurred. Furthermore, the study concluded that pharma brands should expect to see steadily greater restrictions in the future, in virtually all regions and all practice areas. How should pharmaceutical brands respond to these challenging business conditions? One aspect of a comprehensive strategy should be engagement with the payer community. For example, a recent physician survey found that Even when patients request certain medications they often are overruled by their insurers. And as more health systems develop their own insurance plans, they ll further affect the access to care patients have. BulletinHealthcare offers direct access to a payer community of more than 40,000 key decision makers at the most influential payer organizations, such as major health insurers, PBMs, and large health systems. We deliver highly-valued daily briefings to members of the Academy of Managed Care Pharmacy, the American Society of Health-System Pharmacists, and the American Association for Physician Leadership. SHORT TERM IMPACT OF MERGERS 8% Of the 25 largest mergers, most led to even greater declines in access over the 12 months after the deal closed. Access vs. Industry 4% 0% -4% Above Average Access Below Average Access -8% -12% Pre-Merger Access Level vs. Industry % Change (Negative or Positive) Source: Khedkar, P.; Sturgis, M. (2015) AccessMonitor TM 2015 Executive Summary: For Pharma Reps, a Challenging Market for Physician Access Gets Even Tougher. ZS Associates.

4 Access Payers Daily VIA KEY ASSOCIATION BRIEFINGS AMCP Daily Dose Academy of Managed Care Pharmacy ASHP Daily Briefing American Society of Health- System Pharmacists Daily Digest American Association for Physician Leadership AMCP Daily Dose is the official briefing of the Academy of Managed Care Pharmacy. AMCP is the leading society for pharmacists working in managed care settings. ASHP Daily Briefing is the official briefing of the American Society of Health-System Pharmacists. ASHP is the primary national organization for pharmacists practicing in various components of health care systems. Daily Digest is the official briefing of the American Association for Physician Leadership. AAPL membership includes chief executive officers, chief medical officers, medical directors, and other leadership roles. 6,675 27,500 5,400 64% UNIFORM FEATURES ACROSS ALL BRIEFINGS Exclusive delivery to 100% qualified audience Association branded Responsive design across all platforms 25% minimum Share of Voice ISI and/or Black Box ad solutions Specialty, list match, & geo-targeting available

5 Payer Demographics & Engagement AMCP Daily Dose Academy of Managed Care Pharmacy ASHP Daily Briefing American Society of Health- System Pharmacists Daily Digest American Association for Physician Leadership 6,675 27,500 5,400 64% Mobile Open Rate Mobile Open Rate 43% Mobile Open Rate 58% Delivery Rate 99.91% Delivery Rate 99.89% Delivery Rate 99.85% MEMBERS STATISTICS The Academy's more than 6,000 members nationally provide comprehensive coverage to over 200 million Americans. MEMBERS BY WORK SETTING 68% Hospital 25% Other (University, Managed Care, GPO, etc.) 3% Clinical or Medical Office 2% Home Care 1% Long-Term Care Facility 1% HMO MEMBER STATISTICS 62% Buy medical and surgical equipment 50% Work in organizations with revenues of $100 million 77% Buy health care technology OPENS BY PLATFORM OPENS BY PLATFORM OPENS BY PLATFORM 55% 6% 39% 58% 5% 37% 42% 11% 47%

6 KEY INSURANCE COMPANIES TARGETED THROUGH AMCP Represents only a portion of insurance companies targeted through AMCP. PHARMACY BENEFITS MANAGERS TARGETED THROUGH AMCP Represents only a portion of PBMs targeted through AMCP. KEY HEALTH SYSTEMS TARGETED THROUGH AAPL Represents only a small portion of health-systems targeted through AAPL.

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