Oncology in Integrated Delivery Networks

Proximity’s Flagship Syndicated Research Offering“The New Order”: Integrated Customer Organizations

and Cancer Drug Management 2020

IDN Decision-Making Processes Research

Our Innovative Approach Combines Exceptional Scope with Unmatched Depth

Clinical Treatment Pathways Research Value-Based Reimbursement Research

Quantitative survey of oncology pharmacists and other decision makers knowledgeable in IDN cancer drug management policies representing 150+ unique integrated delivery networks, including NCCN institutions, academic medical centers, community hospitals, and other regional & multi-regional networks Deep qualitative follow up including 1:1 interviews, online focus groups, and site visits to gain visibility into the incentives, decision-making processes and implementation challenges that drive restrictions and present manufacturers with both access challenges and partnering opportunities Real-world insights gained from Proximity’s strategic work with our pro-bono oncology group practice regarding the current business environment, as well as the potential impact of alternative payment models

� Treatment pathways for high-volume cancers such as Breast, NSCLC, Prostate and Colorectal are present in over 50% of the IDNs operating a pathway program, yet only 30% of all IDNs surveyed actually maintain a breast cancer pathway� Broad guidelines are more common than restrictive pathways. Guidelines and order sets implemented through EMRs provide pharmacists with a convenient, easy-to-maintain approach to guide oncologists’ treatment selections

� Awareness of an IDN’s participation in the Oncology Care Model Pilot remains lower than expected as we enter the fourth year� Many participating institutions have not engaged oncology pharmacists in either deciding to participate or in managing performance specific to the pilot� Highly-integrated IDNs are most likely to form separate oversight committees to manage value-based performance and take on financial risk

� Although efficacy and safety continue to rank as the two most important product criteria considered, “fiscal concerns” (including support programs), taken as a whole, match efficacy in importance for the second straight year� The decline in efficacy’s importance is due in part to accelerated approvals with single-arm studies, small study populations, and use of response or PFS data which may fail to provide a compelling story around efficacy� IDNs use multiple reference sources when making oncology product assessments, with NCCN guidelines, medical journals and clinical trial data being sited as the top 3 sources. 36% of respondents also use information provided directly by manufacturers

Discussion Topics for 2020

0%

10%

20%

30%

40%

50%

60%

70%

80%

Breast

NSCLC

Prostat

eNHL

Kidney

Colore

ctal

SCLC

Melanoma

Bladde

r

Pancre

atic

Multiple M

yeloma

CML

Head a

nd N

eck

CLLLiv

erAML

Thyroi

d

Ovaria

n

Uterine Brai

nGIST

IDNs with Pathways (N=46) All IDNs (N=105)

Percentage of IDNs With Treatment Pathways for Primary Tumors2019

In this year’s survey, Proximity probed for treatmentpathways that restrict physicians to only 1 to 3 options

39%

7%

23%

11%

19%

60%

No but Yes

Yes but No

Don't Know but yes

Don't know but No

Perceived OCM Participation2019 | N=188 Respondents

30% of respondents could notprovide an educated guess whileanother 30% reported incorrectly

Incorrectperception

Correctperception

Product Criteria Considered When Assessing Treatment2019 I N= 188 respondents; 2018 I N=138

100

Poin

ts T

otal

90%

66%

64%

45%

36%

21%

93%

29%

64%

43%

12%

NCCN guidelines andcompendium

Medical journals

Trial data

Budget Impact models

Information provideddirectly by manufacturer*

AMCP dossiers

2018 2019

Information Sources for Assessments2019 I N= 188 respondents; 2018 I N=138

* Source was not queried in 2018

50 39 40

2421 23

59 10

1420 19

7 11 9

2017 2018 2019Financial margin on the treatmentTotal cost of treatment including the cost of the drugEffectiveness of patient support programsSafety/tolerabilityEfficacy

Deliverables Presented in Multiple Formats to Provide Maximum Value & Insight

Accompanying IDN Database

Syndicated Report Series

“Insights to Access” Podcast Series

� Proximity’s IDN Survey Report reads out our annual quantitative study and our qualitative follow-up interviews. It includes an in-depth analysis of IDN organizational structure, cancer drug management strategies, brand findings in a variety of tumor types, biosimilar management and possible future trends (published in Q2)� Our IDN Landscape Update Report provides data and insights on the most recent trends in provider consolidation, payment reform, and key policy developments (published in Q3)� Our Annual Special Report addresses a different and pivotal access-related topic nominated by our biopharmaceutical sponsors each year (published in Q4)

�Delivers “on-demand” commentary and insights based upon our current research for both home office-based and field-based client stakeholders�Focuses on implications for cancer drug developers: What you need to know and how you need to respond� Three 30-minute podcasts will address key access-related issues among integrated customer organizations within the oncology space throughout our 2020 Research Year

� Aggregate Data Sections I & II provide sponsors the opportunity to explore meaningful trends and conduct further analyses independently � Data set provides both summary data tables and tables aggregated by Proximity’s three main archetypes� Data includes all IDNs participating in our annual quantitative research �Delivered in an attractive and easy to use Excel workbook format

� IDN-level Data Sections III – V provide sponsors the opportunity to develop internal segmentations based upon 150+ health systems’ oncology characteristics � Informs account profiling, planning and prioritization process � Users can create dashboards with pre-selected criteria or develop customized profiles for individual IDNs � Data is provided as a separate record for each IDN included

For more information on pricing, or to schedule a capabilities presentation, please contact:

Steve Clark O: +1 (610) 454-7231 Senior Director C: +1 (610) 331-6062 Business Development & Client Services E: steve@proximityhealth.us

Proximity’s Flagship Syndicated Research Offering“The New Order”: Integrated Customer Organizations

and Cancer Drug Management 2020

Proximity’s Excel-based solution for analysis and profiling

The IDN DataSet contains five data sections

• Section I: Aggregate Respondent Analysis

• Section II: Aggregate IDN Analysis

• Section III: Archetype Summary

• Section IV: Dashboard

• Section V: IDN Profile Data

Table of Contents provides overview of data availableand navigation links to certain data analysis

User Guide and Definitions provides details tomethodology, terms and definitions used in the IDNDataSet

Proximity Health IDN Data Set 2019Table of Contents

The Proximity Health IDN DataSet contains both aggregate analysis and individual IDN level data based on our Annual Oncology Drug Management Survey. Data presentation, aggregation, segmentation, classification that are generated based on Proximity Health's analysis is considered proprietary information and is licensed for our research sponsors' private use only

Note: In order to utilize the navigation and selection functionalities of the DataSet, please "enable macros" either by accepting the macro warning and enable request upon opening the DataSet or go to File>Options>Trust Center>Macros>Select "Enable Macros"

User Guide and DefinitionsRefer to the guide for user instructures, methodology details and definition of terms specific to dataset or specific sections. Note: Links to definitions and instructions are also available within each of the sheets or relevant sections throughout the DataSet

Section I: Aggregate Respondent AnalysisIncludes aggregate results and trends generated from all respondents in the following order (click on links below to access the section directly)Organizational StructureFinancial Risk ProfileCurrent Oncology Drug ManagementOncology Drug Management by Therapy AreaFuture Management (including Biosimilars)Partnering Opportunities with Manufacturers

Section II: Aggregate IDN AnalysisIncludes aggregate results and trends segmented into IDN archetypes in the following order (click on links below to access the section directly)Organizational StructureFinancial Risk ProfileCurrent Oncology Drug ManagementOncology Drug Management by Therapy AreaDevelopment of Management PolicyFuture Management Considerations (including Biosimilars)

Section III: IDN Archetype SummaryIncludes summary view of each IDN by overall archetype and level of centralization for each of five criteria as specified by Proximity Health

Section IV: IDN DashboardLeverages choice of pre-determined key criteria to generate list of IDNs that exhibit criteria and level of centralization - Suitable as an initial or high level screener of criteria or characteristics

Section V: IDN Full Data ViewProvides flexible criteria navigation and comprehensive set of individual IDN data - Suitable for detailed understanding of IDN within the dataset