A Prescription Drug Program Presentation February 2007 From Broadreach Medical Resources, Inc.

A Prescription Drug Program Presentation

February 2007

From

Broadreach Medical Resources, Inc.

BMR Proprietary & Confidential – February 2007 2

Table of Contents

I. Broadreach Medical Resources (BMR)

II. Case Study - Summary of Program Costs

III. Case Study - Profile



A. BMR is a Prescription Drug Program Administrator1. New Business Model

2. Different Business Practices

3. BMR Offers all traditional PBM services including 56,000 Pharmacies

4. BMR offers more than Transparency

5. BMR Saves 20% to 30% of Program Cost.


B. BMR Services your Drug Program through its Evidence Based Healthcare Program:1. Initial Comprehensive Pharmacy Claim Audit and Plan

Review (validates savings at no charge)2. Ongoing Database Management

- Risk Management- Clinical Outcomes

3. Periodic Drug Program Evaluations using Proprietary Analytical Software (Repricing, Therapeutic Category Analysis, Cumulative Claims, Risk Stratification)

4. Underwriting Services5. Comprehensive Clinical Management Services6. Program Cost Guarantee




C. BMR Offers Sound Administrative Solutions to Lower and Control Drug Costs

1. BMR’s “Transparency is Absolute.SM”a. BMR’s Administrative Fee is its only source of revenue.

There are no hidden revenue sources, margins or spread pricing.

b. BMR practices Full Disclosure of all Business Practices, Contracts and Pricing.

c. With BMR, there is no Vertical Integration of Delivery Systems (Mail and Specialty Pharmacy with Private Label Programs – Repackaging) that may cause conflicts of interest.


2. BMR Offers Alternative Delivery Systemsa. Mail Order Pharmacies who have agreed to BMR contract

and audit terms (BMR’s MAC, no repackaging, no drug manufacturer marketing programs, and no drug switch programs).

b. Injectable (Specialty Pharmacy) Program on a “cost of medication” plus fixed dispensing fee basis.

c. Carve-Out Diabetic Supply Program.

d. Rebate Contracting through a new “Class of Trade”.

e. New Product for Non-Profits.




3. Product Selection Programsa. Value Based or Economic Formulary – based on clinical

equivalency and cost effectiveness (Dispensing or Prescribing).

b. Aggressive Maximum Allowable Cost Program for Generics (priced below the MAC for Centers for Medicare and Medicaid Services).

c. Mandatory Generic Program.d. Maintenance Drug List.e. Complete monitoring of drugs coming off Patent and Phase 3

clinical trial medications.f. Voluntary – Incentive Based Options.



4. Clinical Management Programs – Appropriate therapies based on patient disease as well as programs that manage costs by therapeutic categories.a. Step Therapy

1) Ulcer2) Cholesterol3) Non-sedating Antihistamines4) Anti-Depressants5) Nasal Decongestants6) Dermatologicals7) Arthritis8) Antidiabetics9) Antihypertensives

b. Dose Optimization (Lipitor 10mg vs. Lipitor 20mg)c. Quantity Limitations – used on an “AS NEEDED BASIS”; i.e., Celebrex 2 per day;

Enbrel 50mg 4 injections per 28 days.d. Prior Authorizations – Human Growth Hormonese. Patient Risk Stratificationf. Physician Profiling (Gatekeeper) g. Integration with Medical Program to identify catastrophic cases with the capability of

monitoring (or providing) of disease management program.5. School Board Product


II. Case Study - Summary of Program Costs

BMR received claim history from the current vendor for the period January 2005 through December 2005. BMR repriced each prescription claim as if it were a BMR program. The following table summarizes BMR Initial Projections and actual client results.

Paid CostPaid Per Rx* per Member

2005 Actual $17,836,842 $57.04 $1,440

2005 Trended to 2006 Benchmark $20,435,665 $62.34 $1,650

BMR Target $18,632,573 $57.83 $1,505

BMR 2006 Actual $16,421,676 $50.09 $1,334

Difference BMR to 2005 Actual ($1,415,167) ($6.95) $106

Difference BMR to 2006 Benchmark ($4,013,990) ($12.25) $316

Plan ComponentsFormulary Physician EducationGenerics with DAW Maintenance Drug ListStep Therapy Injectables Covered in Medical or under arrangements with otherDose Optimization than copay with prior authorization including education & clinicalQuantity Limitations evaluation

* Includes Administrative Fee and Rebates.


Member Copay SavingsFormulary Compliance and No Zero Billed Rx’s

Total Spend Per Rx Per Member (4)

2005 PSI Member Copayments (1)

$3,788,770 $12.12 $307.11

2006 BMR Actual $2,498,428 $8.60 $202.52

Savings (2) $1,290,762 $3.52 $104.58

(1) Actual 2005 PSI Experience(2) Actual 2006 BMR Experience


III. Case Study - Profile

A. BMR improved pricing by 6.4%.B. .7% (156 of 21,567 users exceed $10,000 per year).C. This group constitutes 12% of program cost.D. The 5 most costly TCAs of medication use were:

1. Ulcer Drugs 9.25%2. Antihistamines 1.97%3. Analgesics – Anti-Inflammatory 3.97%4. Antidepressants 5.17%5. Analgesics - Opioid 2.62%

E. Ingredient Cost AnalysisCV BMR Savings % Savings$81.37 $59.56 $21.81 26.8%

F. Stratification of Risk by Disease StateDisease Patients over $10,000 Patients under $10,000HIV/AIDS/Hep C 13 572Hypertension 78 4,582Diabetes 45 2,019Cancer 24 241


Exhibit 1ASummary of Claims - Benchmark

Claims Days AWP OrigIngCostCurrent

Discount %CoPay Orig Disp Fee Orig Billed

Mail - Brand 31,492 5,618,778 10,031,559.95$ 8,240,742.71$ -17.9% 794,795.00$ 31,479.00$ 7,477,426.71$

Brand Avg. 318.54$ 261.68$ 25.24$ 1.00$ 237.44$

Mail - Generic 8,330 1,486,956 1,203,833.81$ 785,381.55$ -34.8% 123,190.00$ 8,327.03$ 670,518.58$

Generic Avg. 144.52$ 94.28$ 14.79$ 1.00$ 80.49$

MAC 24,109 4,247,840 3,947,583.81$ 1,398,164.09$ -64.6% 292,810.00$ 24,092.00$ 1,129,446.09$

MAC Avg. 163.74$ 57.99$ 12.15$ 1.00$ 46.85$

Total Generic 32,439 5,734,796 5,151,417.63$ 2,183,545.64$ -57.6% 416,000.00$ 32,419.03$ 1,799,964.67$

Generic Avg. 158.80$ 67.31$ 12.82$ 1.00$ 55.49$

Total Mail 63,931 11,353,574 15,182,977.58$ 10,424,288.35$ -31.3% 1,210,795.00$ 63,898.03$ 9,277,391.38$ Mail Per Claim Avg. 237.49$ 163.06$ -31.3% 18.94$ 1.00$ 145.12$

Retail - Brand 69,046 3,626,128 8,898,277.09$ 7,537,192.78$ -15.3% 1,166,445.00$ 171,789.55$ 6,542,814.50$

Brand Avg. 128.87$ 109.16$ 16.89$ 2.49$ 94.76$

Retail - Generic 27,318 1,168,860 1,895,900.09$ 1,206,057.64$ -36.4% 211,085.00$ 66,881.04$ 1,061,879.65$

Generic Avg. 69.40$ 44.15$ 7.73$ 2.45$ 38.87$

MAC 96,532 4,416,022 4,857,730.16$ 1,729,832.52$ -64.4% 674,315.00$ 238,480.74$ 1,294,049.94$

MAC Avg. 50.32$ 17.92$ 6.99$ 2.47$ 13.41$

Total Generic 123,850 5,584,882 6,753,630.25$ 2,935,890.16$ -56.5% 885,400.00$ 305,361.78$ 2,355,929.59$

Generic Avg. 54.53$ 23.71$ 7.15$ 2.47$ 19.02$

Total Retail 192,896 9,211,010 15,651,907.34$ 10,473,082.94$ -33.1% 2,051,845.00$ 477,151.33$ 8,898,744.09$ Retail Per Claim Avg. 81.14$ 54.29$ -33.1% 10.64$ 2.47$ 46.13$

Composite - Brand 100,538 9,244,906 18,929,837.04$ 15,777,935.49$ -16.7% 1,961,240.00$ 203,268.55$ 14,020,241.21$

Brand Average 188.29$ 156.94$ 19.51$ 2.02$ 139.45$

Generic 156,289 11,319,678 11,905,047.88$ 5,119,435.80$ -57.0% 1,301,400.00$ 337,780.81$ 4,155,894.26$

Generic Average 76.17$ 32.76$ 8.33$ 2.16$ 26.59$

Mail & Retail Subtotal 256,827 20,564,584 30,834,884.91$ 20,897,371.29$ -32.2% 3,262,640.00$ 541,049.36$ 18,176,135.47$ Mail & Retail Per Claim Avg. 120.06$ 81.37$ -32.2% 12.70$ 2.11$ 70.77$


Exhibit 1BSummary of Claims – BMR Current

Claims Days AWP BMR Ing CostCurrent

Discount %CoPay BMR Disp Fee BMR Billed

Mail - Brand 4,879 862,146 1,580,717.68$ 1,173,778.08$ -25.7% 107,275.00$ -$ 1,066,688.08$

Brand Avg. 323.98$ 240.58$ 21.99$ -$ 218.63$

Mail - Generic 1,070 186,400 152,222.08$ 76,063.17$ -50.0% 13,817.82$ -$ 62,355.35$

Generic Avg. 142.26$ 71.09$ 12.91$ -$ 58.28$

MAC 3,427 597,224 539,816.77$ 138,819.18$ -74.3% 36,848.15$ -$ 102,313.53$

MAC Avg. 157.52$ 40.51$ 10.75$ -$ 29.86$

Total Generic 4,497 783,624 692,038.85$ 214,882.35$ -68.9% 50,665.97$ -$ 164,668.88$

Generic Avg. 153.89$ 47.78$ 11.27$ -$ 36.62$

Total Mail 9,376 1,645,770 2,272,756.53$ 1,388,660.43$ -38.9% 157,940.97$ -$ 1,231,356.96$ Mail Per Claim Avg. 242.40$ 148.11$ -38.9% 16.85$ -$ 131.33$

Retail - Brand 16,722 898,466 2,146,437.14$ 1,811,741.94$ -15.6% 205,171.56$ 35,822.50$ 1,642,563.02$

Brand Avg. 128.36$ 108.34$ 12.27$ 2.14$ 98.23$

Retail - Generic 9,821 414,184 596,798.77$ 344,163.31$ -42.3% 55,145.07$ 20,628.25$ 309,656.50$

Generic Avg. 60.77$ 35.04$ 5.62$ 2.10$ 31.53$

MAC 26,061 1,239,686 1,284,823.44$ 324,300.19$ -74.8% 134,898.62$ 56,669.52$ 246,089.36$

MAC Avg. 49.30$ 12.44$ 5.18$ 2.17$ 9.44$

Total Generic 35,882 1,653,870 1,881,622.21$ 668,463.50$ -64.5% 190,043.69$ 77,297.77$ 555,745.86$

Generic Avg. 52.44$ 18.63$ 5.30$ 2.15$ 15.49$

Total Retail 52,604 2,552,336 4,028,059.35$ 2,480,205.44$ -38.4% 395,215.25$ 113,120.27$ 2,198,308.88$ Retail Per Claim Avg. 76.57$ 47.15$ -38.4% 7.51$ 2.15$ 41.79$

Composite - Brand 21,601 1,760,612 3,727,154.82$ 2,985,520.02$ -19.9% 312,446.56$ 35,822.50$ 2,709,251.10$

Brand Average 172.55$ 138.21$ 14.46$ 1.66$ 125.42$

Generic 40,379 2,437,494 2,573,661.06$ 883,345.85$ -65.7% 240,709.66$ 77,297.77$ 720,414.74$

Generic Average 63.74$ 21.88$ 5.96$ 1.91$ 17.84$

Mail & Retail Subtotal 61,980 4,198,106 6,300,815.88$ 3,868,865.87$ -38.6% 553,156.22$ 113,120.27$ 3,429,665.84$ Mail & Retail Per Claim Avg. 101.66$ 62.42$ -38.6% 8.92$ 1.83$ 55.34$


Exhibit 2ATherapeutic Category Analysis

NameCurrent % Rx count

Current % ing cost

Current Avg ing cost

BMR % Rx count

BMR % ing cost

BMR Avg ing cost

Savings

ULCER DRUGS 6.88% 9.25% $ 109.81 3.08% 1.99% $ 40.37 $ 1,454,969 ANTIHISTAMINES 2.79% 1.97% $ 80.63 0.84% 0.36% $ 26.92 $ 455,894 ANALGESICS - ANTI-INFLAMMATORY 3.26% 3.97% $ 89.51 3.03% 2.66% $ 54.74 $ 345,194 ANTIDEPRESSANTS 6.30% 5.17% $ 55.30 5.49% 4.20% $ 47.77 $ 144,593 ANALGESICS - OPIOID 4.74% 2.62% $ 40.44 5.00% 2.60% $ 32.42 $ 115,743 ANTIDIABETICS 6.05% 7.61% $ 83.85 7.15% 8.96% $ 78.24 $ 103,527 BETA BLOCKERS 2.64% 1.61% $ 44.45 3.45% 1.99% $ 36.04 $ 67,746 ANTIEMETICS 0.12% 0.44% $ 297.70 0.20% 0.40% $ 123.63 $ 63,994 MIGRAINE PRODUCTS 0.55% 1.31% $ 166.73 0.60% 1.26% $ 131.93 $ 57,830 ANTICONVULSANTS 1.42% 2.56% $ 124.29 1.63% 2.94% $ 112.26 $ 52,005 ENDOCRINE AND METABOLIC AGENTS - MISC. 1.03% 2.03% $ 153.68 1.15% 2.55% $ 137.75 $ 50,169 ANTIANXIETY AGENTS 2.00% 0.63% $ 21.74 1.94% 0.44% $ 14.06 $ 46,717 MUSCULOSKELETAL THERAPY AGENTS 1.55% 0.62% $ 26.95 1.60% 0.47% $ 18.33 $ 40,780 MACROLIDES 1.53% 0.86% $ 41.00 2.07% 1.09% $ 32.93 $ 37,532 ASSORTED CLASSES 0.12% 0.74% $ 443.58 0.13% 0.77% $ 360.55 $ 30,967

TOTAL $ 81.37 $ 59.56

PERCENT TOTAL 26.80%


Exhibit 2BTCA Level 4

NamePrior

Vendor % Rx count

% ing cost

Avg ing cost BMR % Rx

count% ing cost Avg ing cost

Dif in rx Count

Amoxicill-Clarithro-Lansopraz 0.15% 0.41% 273.34$ 0.73% 5.06% 278.04$ 0.58%Metronid-Tetracyc-Bis Subsal 0.10% 0.15% 198.05$ 0.16% 0.81% 207.95$ 0.06%Glycopyrrolate 0.06% 0.08% 168.33$ 0.31% 0.83% 106.96$ 0.26%Omeprazole 10.14% 10.04% 143.37$ 0.05% 0.07% 54.00$ -10.09%Esomeprazole Magnesium (Nexium) 13.53% 19.34% 129.39$ 10.70% 36.91% 139.29$ -2.83%Lansoprazole (Pravicid) 15.27% 22.03% 127.19$ 5.72% 18.96% 133.88$ -9.55%Rabeprazole Sodium (Aciphex) 11.94% 15.47% 126.82$ 0.58% 1.92% 134.69$ -11.36%Pantoprazole Sodium (Protonix) 21.93% 26.49% 100.56$ 0.84% 2.18% 104.88$ -21.09%Chlordiazepoxide-Methscopol 0.06% 0.06% 65.12$ 0.05% 0.09% 66.92$ 0.00%Propantheline Bromide 0.02% 0.01% 49.86$ 0.05% 0.06% 49.86$ 0.04%Nizatidine 0.18% 0.09% 49.24$ 0.10% 0.18% 69.83$ -0.07%Misoprostol 0.27% 0.15% 48.63$ 0.63% 0.63% 40.50$ 0.36%Famotidine (Pepsid) 6.75% 3.12% 43.94$ 15.10% 5.37% 14.35$ 8.36%Methscopolamine Bromide 0.16% 0.06% 34.99$ 0.05% 0.05% 38.45$ -0.10%Sucralfate 0.77% 0.37% 32.66$ 2.05% 1.90% 37.53$ 1.28%Dicyclomine HCl 1.36% 0.17% 11.70$ 1.73% 0.32% 7.35$ 0.37%Ranitidine HCl (Zantac) 13.16% 1.56% 10.92$ 24.44% 6.44% 10.64$ 11.27%Clidinium-Chlordiazepoxide 0.22% 0.03% 10.00$ 0.26% 0.06% 9.46$ 0.04%Hyoscyamine Sulfate 0.78% 0.08% 9.71$ 0.31% 0.16% 20.85$ -0.47%Cimetidine 2.64% 0.27% 9.35$ 4.04% 0.62% 6.18$ 1.39%Belladonna Alk-Phenobarbital 0.25% 0.03% 5.71$ 1.68% 0.29% 6.97$ 1.43%Hyoscyamine Sulfate 0.29% 0.01% 2.09$ 1.31% 0.54% 16.75$ 1.02%Cimetidine in Saline 0.00% 0.00% -$ 0.00% 0.00% -$ 0.00%Cimetidine HCl 0.00% 0.00% -$ 0.00% 0.00% -$ 0.00%Atro-Hyoscy-Scop-Simeth 0.00% 0.00% -$ 0.00% 0.00% -$ 0.00%Omeprazole Magnesium (Prilosec OTC) 0.00% 0.00% -$ 29.10% 16.54% 22.94$ 29.10%


Exhibit 3Cumulative Claims

Dollar Range Users % of Users Rxs % Rxs original AWP % Orig AWP orig Ing Cost

% Orig Ing Cost Ing Cost % Ing Cost

$.00 - $9.00 1946 9.02% 2311 0.90% 1,413$ 0.15% 10,487.46$ 0.05% 12,744.59$ 0.06%$10..00 - $19.00 1337 6.20% 2558 1.00% 1,984$ 0.21% 19,470.00$ 0.09% 21,000.06$ 0.10%$20..00 - $29.00 854 3.96% 1978 0.77% 2,041$ 0.22% 20,814.24$ 0.10% 23,030.36$ 0.11%$30..00 - $39.00 689 3.19% 1780 0.69% 2,235$ 0.24% 24,133.34$ 0.12% 25,334.28$ 0.12%$40..00 - $49.00 692 3.21% 1788 0.70% 3,722$ 0.40% 31,362.19$ 0.15% 33,459.12$ 0.16%$50..00 - $59.00 517 2.40% 1589 0.62% 2,887$ 0.31% 28,357.08$ 0.14% 29,274.00$ 0.14%$60..00 - $69.00 620 2.87% 1676 0.65% 3,662$ 0.40% 40,475.99$ 0.19% 40,734.09$ 0.20%$70..00 - $79.00 455 2.11% 1664 0.65% 3,198$ 0.35% 34,225.17$ 0.16% 34,281.52$ 0.17%$80..00 - $89.00 424 1.97% 1576 0.61% 3,327$ 0.36% 35,998.35$ 0.17% 36,914.32$ 0.18%$90..00 - $99.00 385 1.79% 1512 0.59% 3,124$ 0.34% 36,442.30$ 0.17% 36,805.97$ 0.18%

$100..00 - $149.00 1454 6.74% 7033 2.74% 14,910$ 1.61% 180,230.45$ 0.86% 180,681.25$ 0.88%$150..00 - $199.00 1066 4.94% 6515 2.54% 13,954$ 1.51% 185,885.60$ 0.89% 185,147.18$ 0.90%$200..00 - $499.00 3091 14.33% 27462 10.69% 65,194$ 7.04% 1,011,778.62$ 4.84% 1,025,480.90$ 5.01%$500..00 - $999.00 2377 11.02% 33002 12.85% 90,956$ 9.83% 1,719,280.08$ 8.23% 1,743,328.73$ 8.51%

$1000..00 - $1499.00 1487 6.89% 27107 10.55% 82,138$ 8.87% 1,834,463.04$ 8.78% 1,807,421.94$ 8.82%$1500..00 - $1999.00 1042 4.83% 22837 8.89% 65,687$ 7.10% 1,805,911.68$ 8.64% 1,765,600.09$ 8.62%$2000..00 - $2999.00 1247 5.78% 34620 13.48% 107,409$ 11.60% 3,072,932.28$ 14.70% 2,966,359.24$ 14.48%$3000.00 - $3999.00 668 3.10% 21659 8.43% 67,800$ 7.32% 2,313,536.78$ 11.07% 2,216,879.46$ 10.82%$4000..00 - $4999.00 440 2.04% 17597 6.85% 62,335$ 6.73% 1,958,677.65$ 9.37% 1,877,665.50$ 9.17%$5000..00 - $5999.00 250 1.16% 11278 4.39% 37,556$ 4.06% 1,367,218.08$ 6.54% 1,316,587.59$ 6.43%$6000..00 - $6999.00 174 0.81% 8701 3.39% 32,104$ 3.47% 1,123,616.78$ 5.38% 1,088,103.70$ 5.31%$7000..00 - $7999.00 93 0.43% 4874 1.90% 17,607$ 1.90% 696,097.22$ 3.33% 663,448.49$ 3.24%$8000..00 - $8999.00 69 0.32% 3854 1.50% 22,333$ 2.41% 585,421.24$ 2.80% 555,606.76$ 2.71%$9,000.00 - $9,999.00 36 0.17% 2225 0.87% 18,129$ 1.96% 340,912.44$ 1.63% 327,791.18$ 1.60%

$10,000.00 - $14,999.00 104 0.48% 6526 2.54% 74,218$ 8.02% 1,233,630.88$ 5.90% 1,313,206.19$ 6.41%$15,000.00 - $19,999.00 28 0.13% 1632 0.64% 79,315$ 8.57% 485,237.28$ 2.32% 473,652.90$ 2.31%$20,000.00 - $29,999.00 16 0.07% 964 0.38% 30,549$ 3.30% 386,964.54$ 1.85% 381,717.68$ 1.86%$30,000.00 - $39,999.00 6 0.03% 338 0.13% 8,716$ 0.94% 216,000.33$ 1.03% 207,207.14$ 1.01%$40,000.00 - $49,999.00 2 0.01% 171 0.07% 7,158$ 0.77% 97,810.20$ 0.47% 93,881.43$ 0.46%

21,567 100.00% 256,827 100.00% 925,659$ 100.00% 20,897,371.29$ 100.00% 20,483,345.67$ 100.00%


Cumulative ClaimsDollar Range Users % Users Rx Count % Rx Count AWP % AWP Orig Ing Cost % Orig Ing Cost Ing Cost % Ing Cost$.00 - $9.99 377 5.87% 470 0.64% 6,666.63$ 0.09% 2,207.67$ 0.04% 2,188.01$ 0.04%$10.00 - $19.99 283 4.41% 526 0.72% 10,066.53$ 0.14% 4,192.84$ 0.07% 3,669.42$ 0.07%$20.00 - $29.99 196 3.05% 440 0.60% 9,560.06$ 0.13% 4,933.97$ 0.09% 4,048.58$ 0.08%$30.00 - $39.99 205 3.19% 454 0.62% 11,518.28$ 0.16% 7,142.03$ 0.12% 6,047.13$ 0.11%$40.00 - $49.99 168 2.62% 397 0.54% 10,687.57$ 0.15% 7,508.64$ 0.13% 6,464.60$ 0.12%$50.00 - $59.99 150 2.34% 425 0.58% 13,458.79$ 0.19% 8,308.45$ 0.15% 7,500.49$ 0.14%$60.00 - $69.99 150 2.34% 421 0.57% 15,173.59$ 0.21% 9,785.88$ 0.17% 8,875.19$ 0.17%$70.00 - $79.99 120 1.87% 326 0.44% 13,081.63$ 0.18% 9,001.29$ 0.16% 8,372.60$ 0.16%$80.00 - $89.99 151 2.35% 436 0.59% 18,733.29$ 0.26% 12,824.00$ 0.22% 11,438.93$ 0.21%$90.00 - $99.99 123 1.92% 382 0.52% 16,812.94$ 0.23% 11,684.98$ 0.20% 10,628.32$ 0.20%$100.00 - $149.99 510 7.95% 1,960 2.67% 85,589.51$ 1.18% 62,809.16$ 1.10% 56,707.13$ 1.06%$150.00 - $199.99 392 6.11% 1,885 2.57% 92,743.44$ 1.28% 67,860.95$ 1.19% 61,132.32$ 1.15%$200.00 - $499.99 1,274 19.85% 9,468 12.90% 556,482.67$ 7.68% 419,532.00$ 7.34% 388,633.93$ 7.29%$500.00 - $999.99 826 12.87% 10,479 14.27% 765,567.67$ 10.57% 586,893.28$ 10.26% 542,314.59$ 10.17%$1000.00 - $1499.99 438 6.82% 8,154 11.11% 683,039.14$ 9.43% 533,748.87$ 9.33% 496,403.95$ 9.31%$1500.00 - $1999.99 286 4.46% 6,524 8.89% 623,552.53$ 8.61% 493,392.54$ 8.63% 460,080.28$ 8.63%$2000.00 - $2999.99 318 4.95% 9,226 12.57% 979,008.24$ 13.52% 779,107.99$ 13.63% 730,465.54$ 13.70%$3000.00 - $3999.99 175 2.73% 6,804 9.27% 762,500.84$ 10.53% 602,451.77$ 10.54% 560,046.12$ 10.50%$4000.00 - $4999.99 112 1.74% 4,741 6.46% 621,406.90$ 8.58% 502,818.59$ 8.79% 465,366.97$ 8.73%$5000.00 - $5999.99 42 0.65% 2,676 3.65% 300,502.38$ 4.15% 228,975.90$ 4.00% 220,729.50$ 4.14%$6000.00 - $6999.99 29 0.45% 1,722 2.35% 236,180.60$ 3.26% 187,159.14$ 3.27% 176,715.69$ 3.31%$7000.00 - $7999.99 18 0.28% 1,139 1.55% 165,671.85$ 2.29% 135,167.82$ 2.36% 123,843.01$ 2.32%$8000.00 - $8999.99 12 0.19% 951 1.30% 124,041.55$ 1.71% 101,571.34$ 1.78% 95,522.41$ 1.79%$9000.00 - $9999.99 10 0.16% 514 0.70% 113,359.09$ 1.57% 93,728.39$ 1.64% 89,113.02$ 1.67%$10,000 - $14,999 30 0.47% 1,665 2.27% 438,919.47$ 6.06% 365,746.23$ 6.40% 337,667.41$ 6.33%$15,000 - $19,999 15 0.23% 501 0.68% 306,457.88$ 4.23% 262,697.41$ 4.59% 250,945.81$ 4.71%$20,000 - $29,999 8 0.12% 676 0.92% 218,943.80$ 3.02% 179,572.53$ 3.14% 170,875.96$ 3.20%$30,000 - $39,999 1 0.02% 51 0.07% 43,427.89$ 0.60% 37,350.74$ 0.65% 36,573.49$ 0.69%

6,419 100.00% 73,413 100.00% 7,243,154.72$ 100.00% 5,718,174.40$ 100.00% 5,332,370.44$ 100.00%


Risk Stratification of Diabetics

BMR Analytical Software classifies patients– By dollars– By disease state

Client Illustrations– Cumulative Claims– Patient Profiles– Classification by Severity


How Diabetic Medications Relate to Rx and Health Plan Costs

Number of Diabetics in a health plan population is approximately 7%.

BMR has found that Diabetics constitutes approximately 26.9%* of Rx program cost across an integrated active and retiree population.

Diabetic and related medication costs, therefore, comprise approximately 6% of health plan costs.

* Due to diabetes-related complications and co-morbidities

Source: BMR Plan Experience


What will be Coming

Users - Total 6,419

Users - Above $10,000 54

Drug Class

Total Number of Users in Drug Class Disease State

Total Number of users over

$10,000

Antivirals 190 HIV/AIDS/HEP C 15Antihypertensives 1,179 Hypertension 2Antidiabetics 522 Diabetes 5Antineoplastics 63 Cancer 5

Prediabetics: 1,044


Disease States in Individuals > $10,000INDIVIDUAL

1 Migraines2 Mental health Osteoporosis Herpes3 HIV4 Mental health Infection Pain Cardiovascular Hyperlipidemia5 Cancer- Leukemia6 Mental health7 Fertility8 Transplant Mental health9 HIV

10 Hepatitis Herpes11 HIV Infection12 HIV13 Transplant14 Asthma Mental health Infection Pain Hyperlipidemia15 Mental health IBD16 Rheumatoid Arthritis17 Cancer- Leukemia Osteoporosis Mental health18 HIV Diabetes IBD19 Mental health20 Osteoporosis Hyperlipidemia Ulcer21 HIV Seizures22 HIV23 Prostate cancer?24 Rheumatoid Arthritis25 Asthma Mental health Cardiovascular Ulcer26 Transplant Hyperlipidemia Ulcer Cardiovascular27 Pain Cardiovascular

DISEASE STATES


Disease States in Individuals >$10,000INDIVIDUAL

28 Mental health Seizures Ulcer29 Diabetes Ulcer Pain Hyperlipidemia Cardiovascular30 Old Age IBD Pain Mental health Ulcer Osteoporosis Asthma31 Mental health Hyperlipidemia Ulcer Herpes Pain Infection32 Asthma Infection Pancreatic Insufficiency33 Cancer Herpes Mental health Pain34 Rheumatoid Arthritis Mental health35 Diabetes Rheumatoid Arthritis Osteoporosis Ulcer Asthma Pain Infection36 MS Mental health Herpes Asthma37 Mental health Hyperlipidemia Asthma Pain Cardiovascular38 HIV39 Diabetes Ulcer Hyperlipidemia Cardiovascular Pain40 MS Hyperlipidemia Mental health41 HIV Mental health Herpes42 HIV Mental health43 Rheumatoid Arthritis Mental health44 MS Mental health45 Rheumatoid Arthritis Migraine Mental health46 HIV47 Rheumatoid Arthritis Mental health48 Osteoporosis Herpes Ulcer Pain49 HIV50 Rheumatoid Arthritis Hyperlipidemia Mental health Herpes51 HIV52 Transplant Osteoporosis Hyperlipidemia53 HIV54 Cardiovascular Diabetes Asthma Infection

DISEASE STATES


Cost Per Diabetic User Progression

Dollar Amount% Total Ingredient

Cost Users Cost Per User$0-$2499 330,247.10$ 5.78% 348 948.99$ $2,500-$4,999 444,846.05$ 7.78% 126 3,530.52$ $5,000-$7,499 190,432.39$ 3.33% 32 5,951.01$ $7,500-$10,000 93,383.43$ 1.63% 11 8,489.40$ >$10,000 83,770.75$ 1.46% 5 16,754.15$


Diabetic Patient ProfilesDollar Range

Sum of Ingredient Cost

Drug Class Therapeutic Class Drug Name

1,052.26$ *Thiazolidinediones*** *ANTIDIABETICS* Actos 469.48$ *Biguanides*** *ANTIDIABETICS* Metformin HCl 423.00$ *Sulfonylureas*** *ANTIDIABETICS* Amaryl 275.60$ *Sulfonylureas*** *ANTIDIABETICS* Glimepiride

81.08$ *Antifungals - Topical Combinations*** *DERMATOLOGICALS* Clotrimazole-Betamethasone

2,596.20$ *Human Insulin*** *ANTIDIABETICS* Novolin N PenFill 542.89$ *Antidiabetic - D-Phenylalanine Derivatives*** *ANTIDIABETICS* Starlix 330.96$ *Biguanides*** *ANTIDIABETICS* Metformin HCl 194.94$ *Needles & Syringes*** *MEDICAL DEVICES* NovoFine 30

84.93$ *Diagnostic Reagents*** *DIAGNOSTIC PRODUCTS* Accu-Chek Comfort Curve 20.72$ *Thiazides and Thiazide-Like Diuretics*** *DIURETICS* Hydrochlorothiazide

1,586.05$ *Thiazolidinediones*** *ANTIDIABETICS* Actos 1,236.92$ *Sulfonylurea-Biguanide Combinations*** *ANTIDIABETICS* Glyburide-Metformin 1,131.57$ *HMG CoA Reductase Inhibitors*** *ANTIHYPERLIPIDEMICS* Lipitor 1,046.01$ *Fibric Acid Derivatives*** *ANTIHYPERLIPIDEMICS* Tricor

890.65$ *Human Insulin*** *ANTIDIABETICS* Lantus 404.21$ *Diagnostic Reagents*** *DIAGNOSTIC PRODUCTS* One Touch Ultra Test 258.79$ *ACE Inhibitors*** *ANTIHYPERTENSIVES* Enalapril Maleate

46.47$ *Needles & Syringes*** *MEDICAL DEVICES* Insulin Syringe/Needle

$0-$2,500

$2,500-$5,000

$5,000-$7,500


Diabetic Patient ProfilesDollar Range

Sum of Ingredient Cost

Drug Class Therapeutic Class Drug Name

3,077.10$ *Quinolinone Derivatives*** *ANTIPSYCHOTICS* Abilify 1,923.68$ *Anticonvulsants - Misc.*** *ANTICONVULSANTS* Gabapentin 1,320.32$ *Incretin Mimetic Agents*** *ANTIDIABETICS* Byetta 10 MCG Pen 1,155.42$ *Angiotensin II Receptor Antagonists*** *ANTIHYPERTENSIVES* Cozaar

637.26$ *Stimulants - Misc.*** *ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS* Provigil 527.39$ *Biguanides*** *ANTIDIABETICS* Glucophage XR 125.90$ *Thyroid Hormones*** *THYROID AGENTS* Armour Thyroid 102.72$ *Needles & Syringes*** *MEDICAL DEVICES* B-D U/F Pen Needle

77.54$ *Intestinal Cholesterol Absorption Inhibitors*** *ANTIHYPERLIPIDEMICS* Zetia 52.89$ *Ophthalmic Antibiotics*** *OPHTHALMIC AGENTS* Tobrex 26.77$ *Azithromycin*** *MACROLIDES* Azithromycin 26.59$ *Imidazole-Related Antifungals - Topical*** *DERMATOLOGICALS* Econazole Nitrate

2,065.09$ *Thiazolidinediones*** *ANTIDIABETICS* Actos 1,647.85$ *Human Insulin*** *ANTIDIABETICS* Humalog 1,501.65$ *Human Insulin*** *ANTIDIABETICS* Lantus 1,446.33$ *Proton Pump Inhibitors*** *ULCER DRUGS* Omeprazole 1,233.08$ *HMG CoA Reductase Inhibitors*** *ANTIHYPERLIPIDEMICS* Lipitor

723.88$ *Angiotensin II Receptor Antagonists*** *ANTIHYPERTENSIVES* Avapro 691.92$ *Anticonvulsants - Misc.*** *ANTICONVULSANTS* Gabapentin 479.45$ *Diagnostic Reagents*** *DIAGNOSTIC PRODUCTS* FreeStyle Test 295.71$ *Needles & Syringes*** *MEDICAL DEVICES* B-D Insulin Syringe Ultrafine 119.82$ *Potassium*** *MINERALS & ELECTROLYTES* Potassium Chloride Crys CR 105.76$ *Tramadol Combinations*** *ANALGESICS - OPIOID* Tramadol-Acetaminophen

79.96$ *Cardiac Glycosides*** *CARDIOTONICS* Digoxin 43.57$ *Imidazole-Related Antifungals - Topical*** *DERMATOLOGICALS* Oxistat 23.96$ *Loop Diuretics*** *DIURETICS* Furosemide 22.89$ *Potassium*** *MINERALS & ELECTROLYTES* Potassium Chloride CR

5.00$ *Beta Blockers Cardio-Selective*** *BETA BLOCKERS* Metoprolol Tartrate

> $10,000

$7,500-$10,000

A Prescription Drug Program Presentation February 2007 From Broadreach Medical Resources, Inc.

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Transcript of A Prescription Drug Program Presentation February 2007 From Broadreach Medical Resources, Inc.