Optum Rx Empowering better choices for members care

Optum. Rx: Empowering better choices for members, care providers, and plan sponsors Michael Zeglinski Sr. Vice President Specialty Pharmacy, Optum. Rx CEO, Avella and Briova. Rx Specialty Pharmacies Robin Stearns Account Executive United. Healthcare July 23, 2019

Tackling the biggest challenges in health care RISING CONSUMER COST BURDEN SPECIALTY DRUG SPEND MULTIPLE CHRONIC CONDITIONS 1 in 4 consumers Specialty accounts for 41% of total drug spend. By 2022 28% of Americans say they struggle to afford their medication 1 it will be nearly 50% 2 have three or more chronic conditions 3 1. Kaiser Family Foundation. Peterson-Kaiser Health System Tracker. December 2017. ; 2. IQVIA Institute. 2018 and Beyond: Outlook and Turning Points. March 2018. ; 3. Multiple Chronic Conditions in the United States, RAND Corporation, 2017 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 2

OUR MISSION Helping people live healthier lives and helping make the health system work better for everyone Clinical Expertise Enabling clinical choices and quality outcomes based on real world evidence Embedded Technology Providing the right information at the point of decision to drive the right choices Consumer Experience Navigating best care and cost choices with a personalized, connected network Improving outcomes and experiences for everyone we serve while reducing the total cost of care Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 3

Why Optum. Rx: Promoting better choices and outcomes OUR COMMITMENT TO YOU Members Transform the member experience with simplified, synchronized support Care Providers Share unprecedented insights and partner for better care coordination Plan Sponsors Provide insights and flexible choice to meet your needs Improve experiences and outcomes for everyone we serve, while reducing the total cost of care Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 4

Optum. Rx pharmacy care services Optum. Rx manages $40 Supporting 156 K specialty prescribers billion in specialty pharmaceutical spend Servicing over 3, 500 health benefit sponsors Serves about 618 K patients Partnering with over 160 pharmaceutical companies Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 5

Specialty drug overview TRADITIONAL THERAPY • • • Chemically produced Easy to reproduce Generics available VS SPECIALTY THERAPY • • • Intensive clinical support Very few generics Biosimilars not widely available $74 $4, 100 average monthly cost Specialty conditions: inflammatory conditions, multiple sclerosis, HIV, oral oncology, hepatitis C, growth hormone, hemophilia, transplant Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 6

Specialty costs continue to rise Specialty medications will reach nearly 52% of total drug spending by 20221 11% Specialty 42% PHARMACY BENEFIT 33% specialty 67% non-specialty Physician Office TOTAL DRUG SPEND 2 MEDICAL BENEFIT 58% specialty 42% non-specialty Pharmacy & Infusion BREAK DOWN SPECIALTY BENEFIT DRUG SPEND BY SITE OF CARE 2 47% Hospital Outpatient 1. Drug Channels Institute estimates and projections (August 2018). 2. IQVIA 7

Ensuring patient safety Minimizing client financial impact and protect patient safety Pharmacy and Medical Data Pipeline Forecast Modeling Clinical Assessment / Formulary Management Strategies Drug Approval Expedited Implementation Comprehensive Pipeline Monitoring Proactive P&T Review Pre-FDA Approval Trend Modeling and Forecasting Early detection and prioritization of pipeline drugs 12 -18 months prior to FDA approval Expedited P&T clinical review and implementation of sound clinical / financial management strategies Robust analytics before and after drug launch to project and then monitor key clinical and financial metrics Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 8

Pipeline Drugs Expected 2 Q: 2019 to 1 Q: 2020 Diroximel fumarate – Relapsing MS PDUFA = 10/17/2019 Darolutamide – Prostate cancer Medical benefit PDUFA = 10/27/2019 Lasmiditan – Acute migraine Pharmacy benefit PDUFA = 11/14/2019 Brolucizumab – Neovascular AMD PDUFA = 11/15/2019 Ubrogepant – Acute migraine PDUFA = 12/2019 Lemborexant – Insomnia PDUFA = 12/27/2019 3 Q: 2019 2020 4 Q: 2019 Oral semaglutide – T 2 DM PDUFA = 9/20/2019 AR 101 – Peanut allergy Upadacitinib – RA PDUFA = 1/2020 PDUFA = 8/20/2019 Bempedoic acid – Hypercholesterolemia Golodirsen – DMD PDUFA = 8/19/2019 Entrectinib – NTRK+ solid tumors PDUFA = 8/18/2019 Tafamidis – ATTR cardiomyopathy PDUFA = 7/2019 PDUFA = 2/20/2020 Ozanimod – Relapsing MS PDUFA 3/25/2020 Rimegepant – Acute Migraine Filing soon, expect approval early 2020 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 9

Gene therapy tsunami “As a system, it feels sometimes like we’re headed 100 miles per hour at a brick wall in terms of how we are going to pay for these drugs, and how the prices can reflect what we know about their benefits for patients. ” Dr. Steve Pearson, the president of ICER To date, 5 gene therapies have been approved in the US with several more filing in 2019 for 2020 approval An additional 20 -45 gene therapies will launch in the US 2019 - 2025 $2, 100 k $750 k $850 k $475 k $373 k Kymriah Yescarta Spinazra Luxturna Zolgensma $375 k Ref: MIT NEWDIGS Initial Treatment 30 M Americans have some form of rare disease Maintenance If 5% are treated at a cost of $850 k this equals $1. 275 trillion This is 4 x the $330 B that the US spends on all prescription drugs today Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 10

Gene therapy: Million dollar treatments GENE THERAPY RNA THERAPY Introducing a healthy gene as a way to replace a missing or malfunctioning gene Ribonucleic acid: chemical messenger that transfers genetic code from DNA to where proteins are made Zolgensma® (SMA) One-time cost of $2. 1 million ($425, 000/year for 5 years) Onpattro® and Tegsedi™ (h. ATTR) $450, 000 per patient per year (administered for life) Clinical trials underway for: • hemophilia • oncology • cystic fibrosis • sickle cell anemia Clinical trials underway for: • hemophilia • oncology • cystic fibrosis • multiple sclerosis • HIV Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 11

Optum. Rx has the resources to help Home Delivery Specialty Pharmacy Infusion Services Integrated Site (HD + Specialty + Infusion) Home Delivery + Specialty Pharmacy + Infusion Mental Health Clinic Pharmacy Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 12

Going beyond the traditional specialty approach COST MANAGEMENT Briova. Rx Complete Care Traditional Specialty Management • Formulary and drug cost management • High touch • Open and preferred pharmacy alternatives • Adherence focused condition management • Dispensing and delivery Capabilities Care Driving down overall healthcare costs, not just specialty trend Taking care of the whole person, not just the specialty prescription Connections Synchronizing care to improve overall health outcomes, not just adherence HEALTH OUTCOMES Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 13

Briova. Rx Infusion Services 2020 Vision to Transforming Specialty Infusion Briova. Rx Infusion Services is committed to empowering people in the pursuit and delivery of exceptional patient care. Our 2020 vision seeks to drive needed change and transformative specialty infusion management. Market Needs & Strategic Solutions Sky rocketing costs are challenging plan sponsors to seek innovative solutions and partnerships to: reduce total cost of care, address fragmented care, and lower drug trend all while placing superior patient experience and care first. Reducing Total Cost of Care Clinical Solutions Performance-based Contracts Network Optimization Synergistic specialty infusion solutions and capabilities Site of Care Total Cost Reductions PBM Infusion Management • Eliminate out of network costs • Improved PMPM cost control • Determines most effective site of care Value-based Contracts Care Exchange Dose Specific Pricing Patient Engagement • Proactive patient outreach • condition-specific teams to help transition patients • Patient incentives Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 14

Avella and Optum. Rx: Better together Investments in capital and expanded capabilities Agile, innovative approach to care and support services Better Together Avella’s nimbleness with Optum. Rx’s resources Enhanced programs, specialties, services, and analytics Extensive access to LDD drugs Expanded offerings in oncology compounding and 340 b Innovations in patient engagement Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 15

Avella + Briova. Rx: Focus on whole person health outcomes Offering a patient-first culture, process and tools keeps our patients engaged, satisfied, and on the road to better health. This improves outcomes and materially lowers total cost of care, not just pharmacy costs. OVERALL SATISFACTION Therapy Solutions TOOLS & RESOURCES Briova. Live Adherence Technologies 9% 99. 9% 7% patient satisfaction rate 1 more patients were adherent 2 Consumer Promises +20 points in NPS 1 INNOVATION & TECHNOLOGY increase in patient adherence 4 Briova. Community Care Exchange 10% $50 -$100 K more adherent patients 3 in drug cost savings for halting certain prescribed medications 5 1. 2018 internal survey; 2. 2014 ISPOR Study; 3. 2015 internal analysis; 4. 2016 internal analysis; 5. 2018 internal analysis Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 16

Briova. Rx Therapy Solutions video Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 17

Therapy Solutions – making a difference Establish care and partnership Program Results ~2% higher adherence than retail pharmacies INFLAMMATORY 20% higher adherence 4% lower medical costs HEP C 21% higher adherence 10% lower medical costs Ongoing support Optimize connections Condition-specific Outcomes • Hemophilia: 1. 18% assay variance = $22. 4 M savings vs. industry standard • Oncology – 81% first fill consult rate and VOC of 83 – Split Fill savings of $2, 500 per discontinued patient per year* • Multiple Sclerosis – Order conversion increased 2. 2% – 20 point NPS increase in 4 months Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 18

Oncology Therapy Solutions video Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 19

Oncology Therapy Solutions Ø Single source provider for oral and infusion oncology therapies, including limited distribution products Ø First-to-market with a concerted Split Fill medication delivery and pay for therapy without an increase in total copay Ø The only oncology program with dedicated in-home supportive care regardless of oncology therapy (hydration, anti-emetic, etc. ) Ø Medical management of patient with ability to incorporate medical data Ø Medical PA solution with experts in oncology for health plans Ø Direct-to-patient or in-office coordinated oncology solution Ø Seamless patient experience across all oncology therapies DOSE OPTMIZATION SMART BOTTLES TO TRACK ADHERENCE LDD Access Oncology Medications 99% Split Fill Program prevents waste and saves money 49% Discontinue therapy within 90 days 1 41% Discontinued drug and avoided waste 1 $1. 2 M Net Split Fill Program savings to date 1 MOBILE HEALTH TECHNOLOGY REDUCED HOSPITALIZATIONS 1. Internal analysis Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 20

Flexible options to lower total cost of care Clients want more than a one-size-fits-all approach to managing specialty pharmacy. Through our consultative management approach and our Briova. Rx exclusive program, we help our clients achieve better outcomes for members at lower costs. Flexible Cost Management Solutions Pharmacy Care Services focused on specialty medications 24% lower specialty PMPM spend 1 Specialty Medical Management Hospital Cost Mitigation $17, 500 30 -50% per avoided readmission for each oral oncology patient 2 per infusion savings when compared to a hospital outpatient setting 3 $14, 900 for each transplant patient 2 1. 2018 internal analysis; 2. 2018 internal analysis; 3. 2017 internal analysis Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 21

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