Drugeluting coronary stent market overview Zach Eddy Category

Drug-eluting coronary stent market overview Zach Eddy, Category Advisor Confidential & Proprietary. All Rights Reserved. Lumere © 2019 www. lumere. com

What are drug-eluting coronary stents? Design • Expandable wire mesh tube • Coated with an antiproliferative drug • Pre mounted on a balloon catheter delivery system Function • Inserted into a coronary artery, typically during or immediately after angioplasty • Helps prevent the coronary artery from becoming blocked again (restenosis) • Drug is slowly released over time to help prevent scar tissue growth Confidential & Proprietary. All Rights Reserved. © 2019 Confidential & Proprietary. Rights Reserved. Lumere © 2019 www. lumere. com 2

Primary differentiating attributes • Stent material – Cobalt chromium, platinum chromium, and cobalt alloys • Antiproliferative drug – Everolimus, zotarolimus, sirolimus, or ridaforo limus • Polymer component – Permanent or bioabsorbable • Stent diameter and length • Stent strut thickness • Delivery mechanism Confidential & Proprietary. All Rights Reserved. © 2019 Confidential & Proprietary. Rights Reserved. Lumere © 2019 www. lumere. com 3

Evidence summary No drug-eluting coronary stent has demonstrated superior clinical or operational outcomes • The XIENCE (Abbott), Promus (Boston Scientific), and Resolute (Medtronic) product families have been extensively studied with published data up to five years after implantation, and all have demonstrated equivalence in clinical and operational outcomes • Existing evidence suggests that the Synergy (Boston Scientific) and Orsiro (Biotronik) stents with bioabsorbable polymer coatings have similar clinical and operational outcomes as permanent polymer stents • The Elu. NIR (Cordis) stent has the smallest body of evidence and has demonstrated similar clinical outcomes compared to the Resolute family with one year of published data Source: Lumere analysis of peer reviewed literature and clinical trials; more information available at app. Lumere. com Confidential & Proprietary. All Rights Reserved. © 2019 Confidential & Proprietary. Rights Reserved. Lumere © 2019 www. lumere. com 4

Recent market activity Abbott halted sales of their fully absorbable drug-eluting stent (Absorb) September 2017 Medtronic gained FDA approval for the Resolute Onyx 2 mm November 2017 Cordis gained FDA approval for the Elu. NIR Confidential & Proprietary. All Rights Reserved. © 2019 Confidential & Proprietary. Rights Reserved. Lumere © 2019 www. lumere. com February 2018 Boston Scientific gained FDA approval for the Promus ELITE May 2018 Abbott gained FDA approval for the XIENCE Sierra September 2018 February 2019 Biotronik gained FDA approval for the Orsiro 5

After peaking in mid-2017, Boston Scientific has steadily lost market share to other vendors DRUG-ELUTING CORONARY STENT VENDOR MARKET SHARE (BY UNIT) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Qtr 1 Qtr 2 Qtr 3 Qtr 4 2016 Boston Scientific Qtr 1 Qtr 2 Qtr 3 Qtr 4 2017 Abbott Laboratories Source: Lumere client base Confidential & Proprietary. All Rights Reserved. © 2019 Confidential & Proprietary. Rights Reserved. Lumere © 2019 www. lumere. com Qtr 1 Qtr 2 Qtr 3 Qtr 4 2018 Medtronic Cardinal Health Qtr 1 Qtr 2 2019 Biotronik Vendor released new drug eluting coronary stent 6

Increased competition has resulted in significant pricing pressure AVERAGE DRUG-ELUTING CORONARY STENT PRICE (BY YEAR) $ 1, 200 $ 1, 100 $ 1, 000 $ 900 2016 2017 2018 2019 Source: Lumere client base from 1/1/2016 to 6/30/2019 (does not include rebates) Confidential & Proprietary. All Rights Reserved. © 2019 Confidential & Proprietary. Rights Reserved. Lumere © 2019 www. lumere. com 7

Sourcing strategy 1: consolidate vendors Approach • Consolidate drug eluting coronary stent purchases to a single vendor and leverage the increased share to negotiate lower prices Benefits • Opportunity to achieve lowest market prices Requirements • Strong physician engagement • Monitor physician compliance Risks • Physician migration if preferred vendor is not selected Confidential & Proprietary. All Rights Reserved. © 2019 Confidential & Proprietary. Rights Reserved. Lumere © 2019 www. lumere. com 8

Sourcing strategy 2: capitate pricing Approach • Set a capitated price for all drug eluting coronary stents purchased within your organization Benefits • Physicians have access to a variety of vendors and products Requirements • Strong alignment between physicians and administration • Monitor vendor compliance Risks • Select vendors may not participate Confidential & Proprietary. All Rights Reserved. © 2019 Confidential & Proprietary. Rights Reserved. Lumere © 2019 www. lumere. com 9

Optimal length of dual antiplatelet therapy will be a major focus over the next three years • Several clinical trials are evaluating one month of dual antiplatelet therapy after drug eluting coronary stent implantation in patients at high risk of bleeding – Boston Scientific’s POEM trial will complete in 2019 – Abbott’s XIENCE 28 trial will complete in 2020 – Medtronic’s Onyx ONE Clear trial will complete in 2021 • Medtronic and Boston Scientific are planning to release iterations of their leading drug eluting coronary stent lines • New vendors may attempt to bring their drug eluting stents to the US market, but timing is currently unclear – Micro. Port’s bioresorbable polymer metallic stent (Fire. Hawk) – Reva Medical’s fully bioresorbable polymer stent (Fantom Encore) Confidential & Proprietary. All Rights Reserved. © 2019 Confidential & Proprietary. Rights Reserved. Lumere © 2019 www. lumere. com 10

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