1. How Medication Adherence and Specialty
Drugs Impact Employer Healthcare Costs
Cole Wilson, PharmD, Assistant VP, Atrium Health
Grady Hardeman, HealthWorks Manager, Atrium Health

2. Atrium Health Overview
Atrium Health is one of the leading healthcare organizations in the Southeast and one of the most
comprehensive, not-for-profit systems in the country.
• Academic medical centers
• Hospitals
• Freestanding emergency
departments
• Healthcare pavilions
• Physician practices
• Outpatient surgical centers
• Laboratories
• Rehabilitation centers
• Home health agencies
• Nursing homes
• Hospice and palliative care
• Pharmacies
• Imaging centers
900+ care locations, including:
licensed beds
7,600
employees
60,000
approximately
Patient interactions
each year
12 million
almost

3. Division of Pharmacy Services
Embedded Clinical Services
Charlotte
BiddlePoint Family Practice (1)
Elizabeth Family Practice (1.5)
Myers Park Clinic (4.5)
NorthPark Family Practive (0.5)
Randolph Behavioral Health (1.5)
Davidson Behavioral Health (0.4)
Integrative Medicine Clinic (various)
Chronic Care Med Mgt (CCMM) | Concord
Ardsley Internal Medicine (2)
Concord Internal Medicine (3)
Kannapolis Internal Medicine (3)
Midland Family Practice (.5)
Senior Health Connection (.5)
(diabetes, anticoagulation, lipids, asthma, COPD, heart
failure, HIV, depression, MTM)
Outpatient Dispensing Services
CMC-Rx Pharmacies
Matthews
Medical Center Plaza
Morrocroft
NE Gateway
NE Pavilion
NorthCross
Steele Creek
(Patient education, medication therapy review, medication
synchronization, discharge services)
Clinic Pharmacies
BiddlePoint
Meyers Park
NorthPark
Randolph BHC
Roaming Vaccination
Clinics
Proposed or Affiliate Programs
Advanced Illness Management (AIM)
MTM services for top 5% of Medicare users.
Transitions Clinic (TC)
MTM services for 30 day high risk recent hospital discharges.
Central Anticoagulation Service (CETH)
Proposed on call service to assist with outpatient or transition issues.
CarolinaCare RX
Employee Pharmacy
Specialty Rx
Other Collaborating Service Areas
Sanger Heart & Vascular
Charlotte Embedded
NE Heart Success Clinic
Transplant Services
CMC-Medication
Quality/Safety Team
Medicaid Partners
CCPGM & CC of SP
Wingate University
AmCare Faculty (4)
Outpatient Oncology
Antimicrobial Stewardship
ASN / OpAT
Anticoagulation Clinic
(Freestanding)
CMC-NorthEast (4.5)
AmCare Residency
NorthEast (3)
Charlotte (1)
Program Director (0.5)
Long Term Care Rx
Nursing Homes & Hospice Meds
Behavioral Health
Virtual Care Team
Ambulatory Care Management (ACM)
Central A & B
NorthEast
South Carolina
South Charlotte
Union
University
West
(referral services, diabetes, polypharmacy, high risk)

4. Atrium Health Overview
• Atrium Health-owned and operated home delivery
pharmacy for teammates and dependents with the
LiveWELL Health Plan
• Opened at the Airport Center complex on 1/1/2005
• Currently ~52,000 members
• 2017 Rx Volume = 217,694 (approx. 860 Rx/day)
• 2005 – 2014 Primary Focus:
• Rx Distribution
• Growth

5. Atrium Health Overview
LiveWELL announces intention to phase-out Traditional
Health Plan offering in 2016 with transition to Consumer
Directed Health Plan only (High Deductible Health Plan)
Fall 2014
Pharmacist team at CarolinaCARE began a series of
weekly brainstorming sessions focusing on member
impact with the CDHP conversion
January 2015
Team presented Pharmacy leadership with plans for the One-on-
One Rx Program offering medication therapy management
services to LiveWELL members and eligible dependents
March 2015
Primary Goals: Affordability, Education, & Adherence

6. What is a CDHP?
Member controls and manages more of
his/her health care dollars
Member controls and manages more
of his/her health care dollars
Consumer-Directed Health Plan
Lower premiums Higher annual deductible
Health Savings Account
(HAS)
Copays & co-insurance
apply after deductible met
High-Deductible Health Plan

7. Increased Leveraging of Pharmacy Drivers
Medication Adherence is a Key Tool for Lowering
Cost and Improving Outcomes
Key Considerations
Ability to pay for medications is the first step toward
adherence. Changing to different medications can
lower costs (low/best)
Affordability
Adherence values is greater for patients with chronic
conditions. Many conditions do not justify the same
level of investment in adherence
Clinical Programs
Plan design focus on overall cost & outcomes will
avoid unintended results. Adherence may increase
pharmacy spend, but also create overall net savings
Plan Design

8. One-On-One RX
• Designed to provide personalized and comprehensive
medication review for Atrium Health teammates and
their families
• Pilot program executed in August 2015
• To identify the impact of a One-on-One Rx pharmacist
encounter for the member experience

9. One-On-One RX
• Private and professional consultation with a licensed pharmacist
• Personalized review of medications and adherence
• Research financial help when appropriate (e.g. copay cards)
• Collaboration with each member and their provider
• Lower cost alternatives, generics, or preferred drugs (87%)
• Collaboration on streamlined, evidence-based regimens
Key Elements

10. One-On-One RX
• Service is offered at no cost to the members
• $100 HSA incentive offered to teammates
• Teammates may schedule a complete medication review
through our online scheduler
• Skype
• Telephone
• In-person at CarolinaCARE
• At the worksite of the teammate

11. One-On-One RX
CarolinaCARE Teammate Report Card
2017
Number of Participants 3,641
Number of Teammates 3,135
Number of Dependents 506
Number of Interventions 1,828
Projected Yearly Savings $3,044,981
Pharmacist Hours Worked 2,007
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
Estimated Annual Savings
Member

12. Connect to Purpose
Karen’s son had a brand name acne gel that we changed to a generic cream that
saved $5200 over the course of the year. To Karen that wasn’t just $5200, it was 9 ½
months of daycare for her youngest child.
Mike was on 2 steroid inhalers which was unnecessary therapy given his diagnosis.
Discontinuing one saved him $3340/yr. which paid for his family’s annual vacation that year.
Laura was on a brand cholesterol medication but when switched to a less expensive alternative
saved $4112/yr. To her that was 26 weeks of groceries.

13. How Will Pharmacy Deliver More Value in the New Paradigm?
Adherence Management – Levels of Care
Care Team Services
• Case Management
• Collaborative with physician
• Shared protocols
• Coordinated medical/lab/Rx
LEVEL 3
Multiple Co-Morbidities
Highest Severity
Expanded Pharmacy Services
Clinical Services:
• Patient education
• Adherence counseling
Communications:
• RPh 1-on-1
• Clinical inquiry –
RPh Q&A
LEVEL 2
Multiple Co-Morbidities
Highest Severity
• Med Sync
• Med Recon
• Clinical outreach
• Referrals to care
team
Base Pharmacy Services
Affordability:
• Low/best program
• Payroll deduction
• Patient assistance
• Affordability outreach
Support Services:
• RPh basic counseling
• Plan information
• Member Q&A
LEVEL 1
All Patients
Communications:
• Incoming orders
• Shipment inserts
• Proactive contacts
• High copay dialog
• Refill reminders
Severity,complexity,co-morbidities,cost

14. One Last Word
• In your traditional PBM world, rebates drive the
formulary – brand name drugs are rebated higher
• Atrium Health is different
• Self-insured
• Since we are in healthcare business, we have the
pharmacist infrastructure
• Prescription and medical benefits are blending more
& more together
• Marry the two to determine total cost
• Drug cost going up may not necessarily be a bad thing
• Specialty drugs are driving costs to skyrocket

15. What is a Specialty Drug?
• Specialized Prescription Processing (prior auth,
formularies, patient financial support)
• Comprehensive clinical support (drug
administration, side effect management, drug
interactions)
• High Cost ($500+ per dose or $100,000 per year)
• Manufacturers and Payers limit access to
qualified partners

16. Specialty Drug Spend
• Specialty patients represent 3% of the US population
• In 2017, specialty drug spend was $195 billion (44% of total drug spend)
Oncology, $46.8,
26%
Automimmune,
$32.4, 18%
HIV, $21.6, 12%
MS, $19.8, 11%
Other, $41.4 23%
Total 2016 US Specialty Drug Spend ($180 billion)
Hepatitis,
$18, 10%
• 60% increase in specialty drug spend
over the last five years
• 2020 estimates suggest that specialty
spending could reach $400 billion
• 9.1% percent of national health spending

17. Disproportionate Specialty Growth
21% Specialty CAGR
2% Non-Specialty CAGR
Specialty drug spend is growing disproportionately to non-specialty drugs and most other service lines.
Payers are developing strategies to control specialty costs, knowing that savings earned today are likely to
quadruple over the next five years.
$-
$100
$200
$300
$400
$500
2012 2020
U.S. Drug Spend, 2012-2020
($ billions)
Specialty drug spend Non-specialty drug spend
Source: UnitedHealth, “The Growth of Specialty Pharmacy”, April 2014.

18. Specialty Drug Industry – Specialty Drugs

19. Specialty Drug Industry – Manufacturers

20. Specialty Drug Industry – Payers

21. Specialty Drug Industry – Specialty Pharmacies

22. Challenges for Specialty Patients
• Concerning health condition
• Confusion and anxiety
• Concerns with cost of therapy
• Managing treatments and side effects

23. Challenges for Provider Team
• Time and resources demanded by specialty conditions
• Starting patients ON therapy
• Helping patients STAY on therapy
• Connecting with patients BETWEEN practice visits
• Quality metrics and outcomes performance for patient care

24. Challenges for Specialty Payers
• Complexity of controlling the high cost of
specialty conditions
• Avoiding negative impact on patient outcomes
• Navigation burden & affordability
• Avoiding negative impact on providers
• Administrative burden & clinical protocols

25. CHS Specialty Pharmacy Service Learnings
Provider
Hospital Pharmacy
Outpatient Pharmacy
Retail Rx
Drug Manufacturer
Drug Manufacturer
Patient Support
Services
Ancillary roles (navigator,
financial counselor, social worker) Employer
Payer
Prior Auth. Process
Foundation
Support
“Outside” Specialty
Pharmacies
RN/MOA/Staff
Patient

26. CHS Specialty Pharmacy Service Learnings
“The Challenge”
When will we be expecting drug to arrive in the pharmacy?...So, we don’t need that info sheet filled out?…This is a problem….I have XXXXX reaching out to XXXXX to find out why this has occurred….This info
has to be filled out, and signed by the prescribing doctor, in order to order the XXXXX…we have been ordering this drug in the past, but he said this restriction is something new…Most likely, we will not get this
product tomorrow when patient is coming in for her infusion. How do you want us to proceed with this? When you have a moment can you check to see if we have access to XXXXX. This drug is manufactured
by XXXXX and is used for plaque psoriasis. Dr. XXXXX with Dr. XXXXX office is asking…This to me indicates we currently don’t have access…. NC Medicaid doesn’t have the drug loaded into their system yet
but I will keep trying to get a paid claim over the next few days…. I have a patient who was previously on study now needed XXXXX...do we have a faster/easier time of getting given our AZ contacts? …Spoke
to XXXXX Rx (the pharmacy benefit manager) they still do not have the drug loaded, they could not give an ETA. We will continue to follow up daily and will update office once we show drug is loaded…. RN
needs to know the strengths available to pass along to Dr XXXXX I can’t find anything on the internet and neither could pharmacist. Please get back to me ASAP RN is waiting!!!!!.. Here is the package insert for
a drug Dr. XXXXX has asked us to look in to. It needs to be kept frozen until 30 minutes prior to injecting, it is injected by the provider so it seems like it might be medically billed…. Spoke to a rite aid and they
too do not have drug. Talked with patient and we are going to get drug to him today via hospital courier…. Dr XXXXX would like patient to start XXXXX 1mg/kg BID immediately. Can you please do a STAT
benefits investigation? I am waiting for confirmation of how many syringes to order, then I will send script electronically. Thank you for your help!... Provider is switching all XXXXX patients to XXXXX. This drug
is currently only offered at XXXXX. WE NEED DRUGACCESS!!!!... Outside pharmacy called the patient back and told them we were not refilling his medication and the wife is now calling us concerned about
why we aren’t continuing the medication. Can you please follow up with someone there regarding this?... RA office sent me a message stating that they have had several patients think that the starter kit (talking
pen) is actual medication. They have been putting this in the fridge with the real drug and in some cases just bringing the talking pen to appointment for injection training?!?!?!... Is it possible for you to transfer
the prescription and fill it and also deliver the medication while patient is in infusion?... This patient's PA was denied. Who would you like me to contact regarding an appeal?...Provider wants Pharmacy to
assist with adverse event management of this new drug…. i was just told that Kmart specialty pharmacy visited LCI concord and is trying to sell their business. their big selling point is they do PAs. How?….
Patient is so anxious about starting medication…. It was a Medicare Part B that was stuck in Error Resolution and it did not populate our QA for us to look at when we do our 6pm rundown…. . The issues is that
Medicaid has 2 systems and Medicaid still needs to update 1 of the 2 systems which could take another week or so…. To finish up his treatment (which again, is likely to be curative), he needs a 30-day supply
of XXXXX , and the copay is apparently in the $5000 neighborhood. He is unable to afford this, and we have been unable to find the patient any help through foundations, etc. Are there any resources through
CHS that may be available to the patient?... Dr. XXXXX wants to know when XXXXX will be loaded into Cerner. He wants it in there ASAP!... patient of Dr. XXXXX with APL. He is currently on XXXXX and
XXXXX treatment. He is having some issues with his insurance as he just recently lost his current insurance. He did apply for new insurance through the Affordable Healthcare Act but it will not kick in until May
1. He just restarted his XXXXX medication and only has 3 days left of this medication. Can you help us please?... I sent en enrollment to the Hub and they sent the Rx to an outside specialty pharmacy because
they said we did not have access…The Cobra check was sent out on April 10th from our AP team. Unfortunately it has to go to Arkansas so it is taking longer than anticipated. I am following his account daily so I
will be sure to let you know when everything is posted and insurance is reinstated…. New RN mistakenly sent a XXXXX script to an outside specialty pharmacy and to manufacture HUB (who also did not think
of CHS SPS). The patient wound up paying $2600.00 when he should have paid no more than $30….because prescriptions had to be sent to an outside specialty pharmacy, patient is going to be a week late on
treatment and is asking if there is anything we can do. She also wants to know if you can get access to it so we can dispense it… There are many clinical steps that the patients have to complete in order to start
XXXXX. Once the insurance information, (#4 on the profile sheet) has been submitted to the manufacturer HUB and the benefits are verified the patient will be triaged to CHS SP after FDO completion. Please
submit the insurance information to the manufacturer HUB if you have not already once you see that the PA has been approved and once the patient completes FDO the triage will be sent to CHS from the
manufacturer HUB…. If we had access “clean fill” 24-48 hrs, “dirty 48-72 hrs depending on how long the PA takes…. just talked to patient to set up delivery and she requested us to have script sent to an outside
specialty pharmacy… Our provider has about 20-25 Hep C patients and all are wanting to receive the medications. We are getting so much information from drug companies our heads are spinning. Can you
help or put us in touch with a source to help us figure this process out and what we need to be doing?... Any luck finding his completed and signed CMS packet to include 5 pages (XXXXX Temporary PA form
and beneficiary readiness eval)?... CHS SPS has been trying to order XXXXX since last Thursday and distributer saying they don’t have the drug? Not sure what that is about. Checking on distributer website
and they have 0 on hand. Last week they had 9…. I am in need of more patient handouts when you can send them to me…. So I have been back on the phone with Cigna because the pharmacy can’t run the
script through. They say the PA that was done on the 19th was denied since this is a part D plan. I told them I know and this is also an Advantage plan that covers both. I am on hold with the medical side
know…As of 10/1/14 the manufacturer XXXXX copay card has ended due to generic availability. If a patient has a card active before this date it will still work, however no one will be able to activate a copay
card for XXXXX from now on…. Could you possible get a list of the pts’ prescribed Hep C treatment for the last six months per CHS practice manager?….
“STAT benefits investigation”
“Patient is so anxious”
“This is a problem”
“Prior Authorization was denied”
“Rx stuck in error resolution”
“Patient copay is apparently
in the $5000 neighborhood” “He wants it in there ASAP”
“Issues with his insurance” “Patient is going to be a week late on treatment
and is asking if there is anything we can do”
“On hold for over an hour”
“Left patient a message for the second time”
“only has 3 days left of this medication”
“NEED DRUG ACCESS!!!”

27. CHS Specialty Pharmacy Service Learnings
Specialty Pharmacy – New Prescription Process Flow
Referral
Process
01. Intake 02. Rx Entry
03. Benefits
Verification
04. Clinical
Assessment
Order
Process
05. Create
Order
06. Verify Rxs
(PV1)
07. Adjudicate
Claim
08. Pick Order
09. Verify
Order (PV2)
10. Pack Order 11. Ship Order

28. CHS Specialty
Patient Care
Value Promise

29. CHS Specialty Patient Care Value Promise
Integration and Outcomes
Data
Patient Management
Dispensing
Processing
Coordination of Care
(prior authorization, benefits
investigation, financial
assistance, speed of
medication delivery)
Focus on treating
patients, not filling
prescriptions
Ability to evaluate
adherence to evidence-
based standards and
effectiveness of care
Operational efficiency
for providers and staff
Continuity of patient
monitoring and follow
up care
Clinical protocols
developed by
providers who use
them
Complete electronic
medical record
Communication and
flow of information

30. CHS Specialty Patient Care Value Promise
Coordination of Care
(prior authorization, benefits
investigation, financial
assistance, speed of
medication delivery)
Focus on treating
patients, not filling
prescriptions
Ability to evaluate
adherence to evidence-
based standards and
effectiveness of care
Operational efficiency
for providers and staff
Continuity of patient
monitoring and follow
up care
Clinical protocols
developed by
providers who use
them
Complete electronic
medical record
Communication and
flow of information
A patient-centric, integrated
service and clinical care team
model that produces superior,
demonstrable results for patients
with complex, specialty health
conditions is the core CHS value
promise for patients, providers,
payers, plan sponsors,
manufacturers and other
partners

31. What are Key Specialty Metrics that Can
Demonstrate the Value for an IDN?
Patient Satisfaction
• Patient surveys & stories
Provider Satisfaction & Efficiencies
• Patient surveys & stories
Copay Assistance
• Amount of copay assistance secured
• Mitigates key obstacle to therapy
• Valued by drug manufacturers
Time to Therapy
Adherence
• Days patient possessed medication vs. days in treatment
regimen
• Directly affects outcomes
Clinical Outcomes
• Answers “is the therapy working?”
• Varies by disease state
Other Results
• Patients served & Rx’s filled
• Other Identified Health System goals
Demonstrating value is key for IDNs and their partners in care.
• Time from CHS SPS receiving Rx to shipping to the patient
• Directly affects outcomes

32. Adherence Makes a Difference for Everyone
Drug Adherence
BARACLUDE 80%
DAKLINZA 100%
ENTECAVIR 100%
HARVONI 98%
INTRON 100%
OLYSIO 100%
RIBAPAK 100%
RIBAVIRIN 97%
SOVALDI 98%
VIEKIRA 96%
ZEPATIER 100%
All Hepatitis Drugs 97%
Physician Adherence
BARACLUDE 100%
DAKLINZA 100%
HARVONI 100%
RIBAPAK 100%
RIBAVIRIN 95%
SOVALDI 100%
VIEKIRA 93%
ZEPATIER 100%
All Drugs for Dr. Who 99%
Dr. Who
Patient Drug Pre-Treatment SVR Post Treatment SVR Adherence
Doe, Jane RIBAVIRIN 3.9 MIL IU/ML HCV RNA undetectable 94%
Doe, Jane SOVALDI 3.9 MIL IU/ML HCV RNA undetectable 97%
Doe, John HARVONI 5.3 MIL IU/ML HCV RNA undetectable 97%
Disease Adherence
Oncology 87%
RA/DERM/GASTRO 93%
Hepatitis 97%
Multiple Sclerosis 94%
All Diseases 95%
Especially for the
patients that
experience superior
outcomes!

33. CHS SPS Adherence*
• Adherence directly affects clinical outcomes & treatment cost
• CHS SPS collaborative care model produces superior adherence
Sources: “Multiple Sclerosis: New Perspectives on the Patient Journey”; Milliman, April, 2016. “High-cost hepatitis C pill sees 8% non-adherence rate”/CVS Health Study; HealthIt Analytics, September 18, 2014. “Adherence and resource use among patients
treated with biologic drugs: findings from BEETLE study”; Clinicoecon Outcomes Res. 2014;6: 401 – 407. Leading RA drug mfg. internal adherence data. “Specialty Pharmacy Improves Adherence to Imatinib”; Am J Pharm Benefits 2013 (Special Issue):SP33-SP39
* Adherence calculated using Medication Possession Ratio (MPR) - % of patients meeting respective therapy targets

34. Time to Therapy
• Industry survey 74% filled in fewer than 10 days but up to 20 days reported
• Better time-to-therapy leads to better outcomes
Sources: “Speed-to-Therapy Insights in Specialty Pharmacy”; Specialty Pharmacy Times, November 2013.
Survey Avg.
(N=105)

35. IDN RA Outcomes Result
CHS SPS unique care model delivered 11% greater improvement and 17% less deterioration.
CHS SPS performed RAPID3 assessments in collaboration with providers creating efficiencies & improving outcomes.

36. CHS SPS Hepatitis C Results
CHS SPS unique care model delivers industry-leading treatment success and avoids cost of re-treatment.
Patients managed by CHS SPS are 4 times more likely to have viral load checks monitored and recorded in the EMR.
“Undetectable
Viral Load”
(253 Patients)

37. CHS SPS Copay Assistance Facts
On average, CHS SPS secured copay assistance that paid for
85% of patient copay vs. industry of 60%. Overall, CHS SPS
patients paid an average copay of $29 per prescription.
CHS SPS secured copay assistance for qualified
prescriptions, of which patients paid an average of $20 per
prescription (97% reduction)
• Copays are often obstacles to starting & staying on therapy.
• Poor adherence increases treatment failure & re-treatment cost.
Sources: “Specialty Drug Coupons Lower Out-of-Pocket Costs and May Improve Adherence at the Risk of Increasing Premiums”; Health Affairs October 2014 33:101761-1769.
CHS SPS Specialty Coupon Utilization Jan16 thru Jun16.
0%
20%
40%
60%
80%
100%
120%
0
1000
2000
3000
4000
5000
6000
7000
Avg. Price / Rx Insurance Copay Assist Copay
Specialty Rx withCopay Assistance
Avg. Price / Rx % Paid
$5950
$5364
$566
$20

38. Select CHS SPS Copay Assistance Facts
Source: CHS SPS Specialty Coupon Utilization Jan16 thru Jun16.
Key Therapies
Disease % of Rx w/Assist Avg. Price Avg. Copay Result
Oncology 30% $8,602 $800  $6 99% Reduction
Hepatitis 35% $25,903
$1,328  $5
99.6% Reduction
RA/Derm/Gastro 68% $4,188
$530  $6
99% Reduction
Multiple Sclerosis 64% $5,948
$520  $1
99.8% Reduction

39. What Have We Learned at CHS Specialty
Pharmacy Service “The Reward”
Distributer now says that we are good to go. The shipment is scheduled to arrive tomorrow morning via FedEx by 10:30am EST…. We appreciate all that you and your staff do to assist us each day…. During the
scariest time of his life, he is faced with medications that he can now afford with no Medicare Part D coverage. …. We have access now to sign patients up for copay card for XXXXX through an online portal….
The patient was approved for the 30 day voucher assistance and will get drug Friday…. I have always heard how amazing you all are…. I appreciate your help…Thanks for your help. This med is always
hard….Awesome job…The PA has been approved. The patient has a copay of $277.60. I was able to get him assistance with XXXXX Foundation for $6,000.00…. . It’s so great to see our collaboration grow
into such a tangible, lean process…. the claim went through for a copay of $2,615.77. I spoke with both the patient and husband and based on household size and income I was able to secure $7500.00 in
assistance from PANF so the patient will have a copay now of $0…The medication is leaving our pharmacy today and patient will receive medication tomorrow….the medication arrived two days later, the process
was expedited in a highly professional manner. When it comes to words, there is one very special phrase that everybody can bank on. That is the simple, but powerful expression “thank you”…. I am so thankful
that we were able to restart my son’s medication, and at the same time receive financial assistance from the Patient Access Network Foundation…Thanks so much for your pleasant voice and patient attitude
over the phone during our phone calls this week. You were so helpful working to resolve a stressful situation for our family…. I just got the override in place to allow CHS SPS to fill the XXXXX for a $10
copay. Due to the circumstances we are willing to take the risk this time. Dr. XXXXX, can you please e-scribe a prescription to our pharmacy. Also we are able to deliver the med bedside today in rehab. Please
provide room number…. As usual, CHS SPS is an all-star… Wow! Thank you !You guys always go above and beyond for our patients (my nurses tell me so all the time). Thank you!... AWESOME work!! You
guys rock!!... I spoke with the patient again and he finally gave me a ballpark figure for his income. With that information I was able to obtain assistance through PANF in the amount of $7500.00. Our pharmacy
is ordering the medication and it should arrive tomorrow around 11am directly from the manufacture. The patients copay is $0. If he is still on campus we will deliver to him bedside tomorrow, and if he has been
discharged we will STAT currier the package to his house…. Dr. XXXXX, attached is the Free Trial offer for XXXXX. Please let me know if CHS SPS can help in any other way…. Thanks sooooo much for all that
you do!! I seriously could not do my job like I need to do it if I didn't have the assistance of CHS SPS. I am thankful for you guys everyday…. I just wanted you and your staff to know how honored I have been to
work with you all. A true sign of a professional is someone who sees a need, takes the leap and makes something good. That is what you and your staff have done with the specialty pharmacy at CHS
SPS. There is not another department that I have worked with in almost 23 years that has made my job easier every time I called…And thanks so much for helping Mr. XXXXX get assistance. He’s one of my
favorite patients, and I really try to look out for him.. and when I heard his copay was so much, I felt so bad…CHS SPS expedited patient medication for $0 so he could be discharged from the hospital on Friday,
and not have to wait for his meds to be delivered a week later!... Thank you so much for all of your help with XXXXX and his medication, the patient received the medication today! Thanks for always making my
job much easier and answering my crazy emails and phone calls!... Pharmacists work directly with doctors. They bridge the gap between the patient and the physician – and when you’re dealing with a life-and-
death illness, that’s priceless…. CHS SPS really went above and beyond the call of duty. They researched financial aid opportunities and helped us fill out the paperwork, which ultimately saved us a substantial
amount of money. They were able to help us in ways retail pharmacies can’t…CHS patient initial copay $2000.00 on XXXXX tried PANF for RCC assistance, funding closed went to manufacturer HUB 7 days
later they noted PANF open I call and 15 min later $7500.00 approved patient still getting med 7 days before start date…. XXXXX sent to CHS SPS today and coordinated through outside specialty pharmacy to
secure drug to patient tomorrow (sat) instead of Tuesday, with a $0 copay…CHS SPS received a prescription for XXXXX for a patient from Dr. XXXXX. Patient went to Wal-Mart to fill and has no insurance cash
price was $150.00 patient needs to start and could not afford. RN called and asked if I could help, our cash price is $14.67. Called patient and she was thrilled she could afford that and will get medication
tomorrow…PA just got approved $0 copay and patient will have med tomorrow…. We are saving the patient about 1800.00 per month…. Patient at rehab needs specialty medication ASAP. Patient should be
discharged by end of week (8/10/12) and assistance will be in place by discharge….. Patient is able to start tonight while inpatient with an original $50 co pay that we brought down to a $10 co pay with available
co pay card…. Patient had $120 total copay and after getting assistance through manufacturer patient now pays $0. Since CHS SPS were so quick in turnaround patient start date for radiation can be 7 days
earlier!... Thank you guy’s for the quick response and resolution!... Dr. XXXXX just said you are a Miracle worker! …You guys are GREAT GREAT!!!... Thank you so much for getting the specialty meds out today
to our patient! We are amazed on how quick this process was and couldn't believe the patient already received his meds! I just wanted to say thank you for your help not only with this patient but with all of our
patients!...Practice initially sent patient to local pharmacy for XXXXX. Patient was told $1700.00 copay. RN rerouted Rx to CHS SPS for patient assistance. Patient copay reduced to $3….Nurse wishes she
called CHS SPS first before trying to find medication locally would have saved her hours!... RN thinks we saved her at least a week in turn around time….
“improved outcomes”
“Prior authorization
has been approved”
“A true sign of a professional is someone who sees
a need, takes the leap and makes something good”
“pleasant voice and right patient attitude”
“Dr. XXXXX just said you are a Miracle worker!”
“Nurse wishes she had called CHS SPS first”
“Patient copay reduced to $3”
“I seriously could not do my job like I need
to do it if I didn't have your assistance”
“bridge the gap between the
patient and the physician”
“couldn't believe the patient
already received his meds”
“thank you for your help not only with this
patient but with all of our patients”
“Saved us so much time”

40. Thank you.

41. One-on-One Rx
Employer Pilot Program
September 2018

42. Background
EMPLOYER DEMOGRAPHICS FOR
ONE-ON-ONE RX PILOT PROGRAM
• Charlotte-based
• Self-funded
• 350 covered lives
• Manufacturing industry with relatively high Vietnamese
workforce (health literacy is a critical factor)
FACTORS CONTRIBUTING TO
EMPLOYER SELECTION
• Existing client relationship
• Out of control pharmacy costs that rise each year
• All employees covered under Preferred Provider
Organization (PPO) plan
• Atrium rolled out the program to its teammates
when transitioning to a full HDHP with HSA

43. One-on-One Rx Pharmacy Pilot Program Goals
HEALTHWORKS hoped to
achieve the following goals
through the pilot program:
Improve the health of
the population
Reduce pharmacy claims
expenditure
Reduce employee out of
pocket costs

44. Implementation
Employer provided 12-month historical pharmacy
claims file and pharmacy benefit plan documentation.
Atrium clinical pharmacist performed a retrospective
review of all pharmacy claims data, in addition to
benefit plan documentation.
Based on this analysis, thirteen areas of
opportunity were identified for our On-on-One Rx
pharmacy pilot program across three key categories.
Affordability
Health &
Safety
Medication
Adherence

45. Implementation
Data revealed 137 individuals we hoped to engage in the program – nearly 40%
• Conveyed personal benefits related to program participation,
including reduced out of pocket costs and overall improved health
• Compelling employer incentive: $20 Walmart gift card
• Pharmacists attended employer health fair
• Sessions offered in person and telephonically
Marketing and communications campaign
to generate program awareness
Took soft approach and invited all employees and
spouses to participate in a free One-on-One Rx session

46. PILOT PROGRAM RESULTS
Number of Participants 56
Average Age 54.5 years
Appointment Type
Face-to-Face
Phone
85.7%
14.3%
Insured Status
Employee
Spouse or dependent (18 years or older)
96.4%
3.6%
Appointment Length
≤15 minutes
16-30 minutes
31-45 minutes
46.4%
48.2%
5.4%
Total # of Interventions 83
Average # of Interventions Per Appointment 1.5
Total Estimated Cost Savings Per 90 Days $4,429
Average Estimated Cost Savings Per 90 Days (Range) $79 ($0-$1,051)
Average Estimated Cost Savings Per 90 Days
For Patients For Which Interventions Were Made
$214

47. Number of Interventions
19, 34%
14, 25%
10, 18%
7, 12%
4, 7%
1, 2% 1, 2%
No Interventions
1 Intervention
2 Interventions
3 Interventions
4 Interventions
5 Interventions
7 Interventions

48. Types of Interventions
19
4
6
2 2
1 1 1 1
3 3
1 1 1
3
8
1
3
5
21
7
4
0
5
10
15
20
25

49. Cost Savings Per 90 Days
35
9
3 3
0
1
0
3
1 1
0
5
10
15
20
25
30
35
40
0 $1-$50 $51-$100 $101-$150 $151-$200 $201-$300 $301-$400 $401-$500 $501-$1000 >$1000

50. What We Would Do Differently
Be more strategic about program participation
• To qualify, participants must take at least one
maintenance medication (excluding birth control)
Load historical & net new monthly pharmacy
claims data into our claims analytics platform
• Would allow us to quantify true incurred savings
to the employer’s health plan
Tailor marketing efforts to better engage
spouses and dependents over age 18

51. Thank you.