Top Five Pharmacy Trends for 2006

1. Top Five Pharmacy Trends for 2006 BY: Robert Taketomo, Pharm.D,, M.B.A. President/CEO, Ventegra, LLC

2. Today’s MEGATRENDS • Company Consolidation Throughout • Industry • More Government Involvement • Health Care Costs continue to RISE • “Lifestyle”/”Life Enhancing” vs. “Life- • Saving” • Specialty Injectables Drugs – Growing Fast

3. Company Consolidation – Drug Companies Drug companies continue on their quest to become bigger then the competition while trying to turn from red to black. "Drug makers have been struggling for several years to come up with enough new products to keep their revenue growing. Many have sought to complement their internal research by licensing products from smaller biotechnology companies…licensing is becoming increasingly expensive.“ So they look to buy. “(T)heir favored targets could be smaller companies with successful drugs in sought-after therapeutic areas.“ – Wall Street Journal 2/16/05 The latest mergers, or soon to be mergers include: Sankyo and Daiichi - 2005 Fujisawa and Yamanouchi (now Astellas) - 2005 Teva and Ivax - early 2006

4. Company Consolidation – Health Insurance Companies “Acquiring or merging with another company opens commercial doors that might otherwise remained closed. You can open up new markets, gain new customers by using the strength and positioning of another company…" – California Healthline, 8/10/05 UnitedHealth Group bought Pacificare and Definity Health WellpointPoint, Inc. bought Lumenos and Wellchoice CIGNA bought ChoiceLinx Aetna bought HMS Healthcare And that is only California. Anyone got a scorecard?

5. Company Consolidation – Retail Pharmacy Over the past decade, the pharmacy industry has consolidated and diversified their business model. “Mom and Pop” pharmacies of yesteryears are replaced by pharmacies in general merchandise stores, grocery stores and “warehouse” stores. Nothing like convenience! “Several retail store chains have merged, primarily as a way to gain buying power for use in negotiations with drug manufacturers and wholesale distributors.” – The Health Strategies Consultancy, LLC Top Retail Pharmacy Chains Walgreens Company CVS Corporation RiteAid

6. Increase in Government Involvement The latest and greatest(??) move by the government to control healthcare costs for the nation is Medicare – Part D “Prescription Drug Coverage”. Who hasn’t heard about it? Or better yet…does anyone understand it? Other articles of how government is more involved: “Americans Want More RegulationOf Oil, Drug Companies, Poll Shows” - THE WALL STREET JOURNAL, 11/2/05 “Pharmacy-Benefit Managers Suffer Setback in Federal Court” - THE WALL STREET JOURNAL, 11/9/05 “Judge upholds Maine’s PBM disclosure law” - Business Insurance, 4/14/05

7. Healthcare Costs continue to RISE • Life-Style/Life Enhancing vs. Life Saving Treatments Is anyone shocked? Viagra anyone? How about Lunesta? Or Nexium? With the direct-to-consumer marketing by Pharmaceutical companies, spending on average $351 million per month, it is no surprise that drugs that promote improvement in today’s busy life are popular. They address impotence, sleeplessness, hair loss, obesity and smoking cessation, to name a few.

8. Specialty Injectables – Growing Numbers and Growing Costs There has been an increase in the use of specialty injectable drugs as part of patient medication therapies. Branded injectable agents can range in cost from several hundred dollars to tens of thousands of dollars for a given treatment regimen. And, with many injectables losing their patents over the next few years, and many more coming out of the pipeline, the market will see a further surge in this trend. Are we prepared? “…costs will continue to mount, and the industry faces a huge gap with respect to management strategies for injectable drugs.”– Managed Care 4/02

9. Five Pharmacy Trends for 2006

10. #1: Move towards Transparency • Payors desire more disclosure on drug costs, discounts, rebates and fees • More information on how prices are determined by pharmacies, wholesalers and manufacturers • More competition around prescription drug costs

11. #2: Consumer Driven Programs • Driven by need to reduce payor costs • More “defined contribution” than “defined benefit” • defined contribution = program pays first $x and patient pays the rest • defined benefit = patients pays first $x (e.g., copayment) and program pays the rest

12. #3: Growth in Injectable Drugs • Could mean cost explosion for payors • Average generic prescription = $15 • Average brand prescription = $70 • Average injectable prescription > $1,000! • Shift to coinsurance (% copayment) • Injectable drug benefits need to ensure access and affordability by members

13. #4: Medicare Part D Fallout • Depends upon degree of success • Will only the sickest patients join? • Adoption of Medicare policies and practices by commercial sector • Average Sales Price (ASP) concept • Competitive Acquisition Program • Formulary management • Impact to Medicaid plans? • Terms of “clawback” unclear

14. #5: Generic Drugs Availability • Major blockbusters continue to lose patent protection • Generic industry consolidation resulting in higher cost trends for generics than brands • Effective means to increase education and utilization around generics lacking

15. Ventegra is the first managed care Contracting Services Organization (CSO) representing our clients as their fully transparent contracting arm to control rising drug benefit costs by providing a choice of Pharmacy Benefit Administration (PBA) services. Ventegra offers innovative programs to manage NET costs and drug trends, such as VIP (Ventegra Injectable Program). The difference is not in “what we do”…but HOW we do it. Let us show you how truth and integrity can work for you. For more information, please visit www.ventegra.NET or call 858-551-8111.