1. What is the current situation?      a. US – slow response, extremely poor national management, high uninsured rate, high out-of-pocket costs, and comparatively low medical system capacity       b. States in competition over purchasing PPE 2. What are other countries doing?      a. International experience – management, global partnering      b. Asian experience – using lessons learned from SARS outbreak      c. European experience – emphasize testing      d. Scandinavia           i. Swedish model – remained open, highest global death rate, economy in worst crisis since WWII           ii. Denmark/Norway – locked down           iii. Finland has low level of immunity – fears of a second wave      e. Taiwan Model           i. Geopolitical fight with China           ii. Serious history of respiratory diseases           iii. Coordinate government’s response           iv. Quick and efficient in deploying counter measures 3. What have we learned?      a. Proactive management like every other pandemic is crucial      b. Global partnerships are crucial      c. Quick and efficient testing      d. US complicated with high uninsured rate, high OOP costs, low medical system capacity      e. US has greater disease burden       f. US has smaller workforce and acute hospital bed capacity      g. Considerable variation among states _____ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: [email protected] Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks

1. What is off-label drug use?      a. Off-label drug use is when doctors prescribe medications for unapproved uses      b. FDA cannot control how doctors prescribe      c. 20% of Rx in US are fore off-label uses 2. Why use a drug for off-label purposes?      a. Tried all other options without success      b. Literature to support drug’s use, even if limited      c. Different dosage form      d. Dosage for which there is evidence that a higher dose may be effective      e. Drug is generic so there is no financial benefit for a manufacturer to obtain approvals 3. What are the risks?      a. Balance between effectiveness and risk is tilted toward risk      b. Investigational studies with close monitoring of safety 4. Approvals      a. Experimental      b. Benefit unknown      c. Risks unknown      d. Plan must pay for all consequences 5. Examples      a. Gabapentin for anxiety      b. High dose/strength opiates for pain      c. Stimulants for weight loss      d. Anti-epileptic medications for mood disorders/bipolar disease      e. Examples of atypical antipsychotics include Seroquel, Zyprexa and Abilify. They are being used to treat an array of conditions off-label, including anxiety, attention-deficit disorder, sleep problems, behavioral problems in toddlers and dementia.      f. Antipsychotics to treat dementia      g. Cancer treatment – estimated 50% are off-label _____ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: [email protected] Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks

1. Goal:  Lower drug cost so that they are affordable to patients      a. US Rate of Inflation (2017-2019) = 2.14% to 1.8%      b. CPI = 2.0%      c. CPI (health care) = 2.8% (2019) 2. Drug Cost Transparency      a. Transparency = cost      b. CA SB17: WAC >= $40 with 16% inflation in prior year, or 32% inflation in last 2 years 3. How do they differ?  Are they effective?  Pros/Cons      a. White House Plan      b. Congressional Action      c. Congress – Democratic Plan 4. State Plans – What are they trying to do?  Pros/Cons      a. California      b. New York  5. Discount Programs      a. GoodRx      b. TimesRx      c. Misc. 6. PhRMA unregulated for innovation      a. Largest PhRMA produce 11% of leading new Rx      b. New Rx develo9ped by universities, academic centers, NIH, hospital research groups      c. 2/3 of new Rx developed by France, Germany, Japan, Switzerland and UK      d. Raw materials from China, India, Israel, Brazil, South Africa, Australia 7. Transparency      a. Shoppable vs. urgent      b. Uwe Reinhardt – Priced Out – health care spending increases private sector > public sector      c. Gag Order Bans (half-of-states)      d. 8 States – PhRMA must provide reasons for reasoning for drug cost decisions _____ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: [email protected] Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks

Science & Data vs. Misinformation & the risks of overemphasizing Covid-19 to the detriment of other diseases 1. Where is the science behind Covid-19? 2. What treatments have been approved? What treatments are of no value? 3. With the emphasis on Covid-19 vaccine, what are the risks for standard vaccinations for measles, mumps, chicken pox, etc.? 4. What should we do to mitigate these risks if physician offices are not open yet? 5. People stress the need for herd immunity, but what do we do if the Covid-19 only covers =< 60% of the people? 6. Do people with immunity and/or herd immunity from common diseases (in #3 above) lose immunity without boosters or additional shots? _____ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: [email protected] Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks

Racism’s Impact on Health Care 1. Scope of topic = any civic, cultural, spiritual divisiveness 2. Scale = racism, sexism, antisemitism, genderism, etc., emblematic of hatred, brutality, senseless violence, exclusion, bias 3. Genesis of this podcast – police murder of George Floyd and a history of police violation of their oath 4. How do health care professionals address hatred in its many forms?      a. Merge physical and behavioral health treatment      b. Consider stress as a genesis for physical and emotional health 5. What is the position of medical, nursing, and pharmacy associations regarding hatred, violence, racism, etc.?      a. They consider it a public health care crisis      b. They conjoin the individual experience with the community experience 6. Mudd Rule 7. Inconsistencies in the health care ethic      a. Abortion      b. Access to care      c. Cost of care      d. Rationing      e. Triaging based on prognosis and responsiveness to care _____ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: [email protected] Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks

1. What has changed?     a. Decreased MD office visits     b. Decreased well visits     c. Decreased oversight of chronic diseases     d. Telehealth     e. Changes in billing rules to allow for indirect patient care 2. How has technology impacted health care?     a. Historical – health care behind other industries     b. Current – catching up with telehealth, apps, home monitoring 3. What is the impact on children and people with disabilities?     a. Did not participate in financial bail-outs     b. Vaccination rates down about 40%     c. Fear of epidemics, e.g., measles 4. What is the impact on MD and DDS offices?     a. Decreased revenue, increased expenses     b. Expect to be barraged with higher severity patients     c. DDS patients delayed discretionary dental work 5. What is the impact on pharmacies?     a. Increased 90-day scripts     b. Shortages of respiratory medications     c. Transparency and drug cost proposals _____ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: [email protected] Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks

1. What does “second wave” mean? 2. What is transmissibility and severity of COVID-19?      a. After relaxation of interventions (social distancing, population behavior change, contact tracing)      b. Covid-19 hits during fall flu season      c. Problem is overcapacity of the health care system 3. Precedence – H1N1 pandemic in 2009 4. Immunity Passports – Chile was first to issue      a. No evidence that patients can’t get the virus again 5. What Must Be Done      a. Testing      b. Contact surveillance      c. Flu Shots 6. Treatment      a. Vaccine is first priority      b. Treatments           i. Expedited, but do not help everyone           ii. Expedite release means that safety is an issue _____ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: [email protected] Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks

QUESTIONS What do you do if you are insured? How do you afford copays and deductibles? What do you do if you are uninsured? Will Medicaid pay? Will Medicare pay? What if you are poor? What if you are an illegal immigrant? OUTLINE Public health experts predict that tens of thousands and possibly millions of people across the United States will likely need to be hospitalized for COVID-19 in the foreseeable future. And Congress has yet to address the problem. On March 18, it passed the Families First Coronavirus Response Act, which covers testing costs going forward, but it doesn’t do anything to address the cost of treatment. While most people infected with COVID-19 will not need to be hospitalized and can recover at home, according to the World Health Organization, those who do need to go to the ICU can likely expect big bills, regardless of what insurance they have. As the U.S. government works on another stimulus package, future relief is likely to help ease some economic problems caused by the coronavirus pandemic, but gaps remain. A new analysis from the Kaiser Family Foundation estimates that the average cost of COVID-19 treatment for someone with employer insurance—and without complications—would be about $9,763. Someone whose treatment has complications may see bills about double that: $20,292. (The researchers came up with those numbers by examining average costs of hospital admissions for people with pneumonia.) Most private health insurance plans are likely to cover most services needed to treat coronavirus complications, but that doesn’t include your deductible—the cost you pay out-of-pocket before your insurance kicks in. More than 80% of people with employer health insurance      have deductibles, and last year, the average annual deductible for a single person in that category was $1,655. For individual plans, the costs are often higher. The average deductible for an individual bronze plan in 2019 was $5,861, according to Health Pocket. 97% of Health Plans waive the copay/deductible for Covid-19 testing In both complicated and uncomplicated cases, patients with employer-based insurance can expect out-of-pocket costs of more than $1,300, the Kaiser researchers found. The costs were similar regardless of complications because many people who are hospitalized reach their deductible and out-of-pocket maximum. _____ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: [email protected] Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks

Questions: What does it mean to map the progress of an epidemic? Is testing crucial? What is an algorithm that is used for predicting the progress of an epidemic? What is the difference between out-brakes and modeling? What happens after modeling? Outline – Notes: Data support Testing data to map a population # hospitalizations Deaths Past infectious disease progress Expert surveys Did lock down occur? Out-brakes vs. Modeling How many are going to get the disease? Out-brakes  -- % of current deaths Modeling  -- % of expected deaths based on looking backward Complicating Factors Social factors Geography Cultures _____ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: [email protected] Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks

Vaccines vs. Treatment -Treatment vs. Prevention    -Treatment is not curative – examples are HTN, anti-diabetic medications, anti-asthma medications    -New options are antibody serum, gene PCR techniques    -Prevention – examples are vaccines, gene transformations -Vaccine manufacturing process    -Production technologies – using flu vaccine as an example       -Egg-based       -Cell based       -Recombinant     -https://www.cdc.gov/flu/prevent/how-fluvaccine-made.htm -Coronavirus vaccine    -Exploratory stage (2-4yrs)    -Pre-clinical stage – animal tests 1-2 yrs.    -Clinical development – ca. 30% make it    -Regulatory review and approval – sign off by FDA and CDC    -Manufacturing – FDA inspects factory and drug labels    -Quality control – quality control review for safet -Vaccine manufacture    -Vaccines are an antigen or foreign body that causes a reaction when introduced into the body.  Foreign antigens illicit antibodies that fight the antigen.    -Live virus    -Inactivated virus    -Vaccine composed of a part of the virus    -Bacterial vaccines _____ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: [email protected] Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks