Tackling the U.S. opioid crisis using blockchain Andrew Lee, Jen McGann, Luis Suarez, Becca Wolfe February 28, 2017

Health and social costs related to prescription opioid abuse is $55 billion each year Why this crisis exists: The Doctor: The Pharmacist: The Patient: The Payer: No visibility to other doctor’s prescriptions for the patient Pain is subjective No transparency across state lines Cannot see prescriptions filled at other pharmacies No time for extra diligence for each patient Medication prescribed is very addictive Easy to counterfeit a script Can profit from selling drugs Cannot see if patient has prescription filled from another insurer If formulary changes even slightly, will not flag system Problems exist across all the major players in the health care continuum Efforts currently in place to curb the crisis: The Doctor: The Pharmacist: The Patient: The Payer: Better education on prescribing habits (CMS, HHS) Being trained to treat the consequence (addiction) Databases available to log patient use (not mandatory and does not go across state lines) Drugs come with a “black box” warning Last year, the federal government asked for an additional $1B of funding No universal, secure method of communicating prescription drug patterns across all parties

01 02 03 04 05 Our solution: A decentralized database and software Datapill uses an ethereum private blockchain to track the person-prescription-medicine link How it works: Security: Fingerprint used to prove identity, SSN used as unique ID Key players: Distributed among doctors, pharmacies, government and datapill, transactions validated by a trusted third party Process: Ethereum smart contracts enable the transactions to happen Prescription is entered into a database that every doctor and pharmacy has visibility into 2 Prescription 5 While the medicine is being consumed the patient is not allowed to buy another opioid Doctor Token Patient A doctor validates that the patient needs an opioid by giving a prescription Prescription enables a token that is valid to be spent once in different pharmacies for specific period of time Ethereum private blockchain that keeps track of the person-prescription-medicine link SSN is used as the unique ID Fingerprint is used to prove identity Distributed among doctors, pharmacies, government and datapill Software with the interface to the database A trusted third party (datapill or the government) validates the transactions A prescription enables a token that can be spent to get an opioid during a certain period of time Ethereum smart contracts enables the transactions to happen 3 1 Pharmacy Pharmacy validates that patient has a token, takes token in exchange for medicine and makes entry to the database 4

$245M revenue opportunity Contract with the federal government to build a national, government–funded blockchain Federal State State mandated conversion and use of technology Cost of technology subsidized by state and federal Doctor Payer Pharmacy $45M $183M $17M 10% - 25% Rx Reduction Opioid Prescriptions1: 259M $250 - $300 annual fee per pharmacy Total Pharmacies3: 62K $0.25 – $0.75 per Enrollee Total Enrollees2: 319M 1National Institutes of Health, America’s Addiction to Opioids 2Kaiser Family Foundation, Market Share and Enrollment of Largest Three Insurers by State 3IMS Health, National Pharmacy Market Summary

Steps to implementation Strong incentives across the healthcare ecosystem Datapill will serve as a shared source of truth across stakeholders Doctor Increased accuracy and fidelity Transparency incentivizes ethical behavior Pharmacy Reduced liability and less fraudulent prescriptions filled Increases efficiency of pharmacists Steps to implementation Partner with government to obtain federal approval for technology Build and test proof of concept Pilot program via launch in California and Florida Educate participating stakeholders and rollout technology nationally 1 Government Already top priority through Opioid Initiative1 Cost-savings for government-run health insurance 2 3 Payer Cost-savings as currently bearing majority of over $55B annual cost of opioid abuse2 Patient 4 Reduced levels of addiction Increased convenience through electronic storage of data Provider Immediate view into patient prescriptions, ensuring accuracy and fidelity Transparency of blockchain incentivizes doctors to act ethically Pharmacy Reduced risk of liability, less fraudulent prescriptions filled Frees up time for pharmacists to perform other revenue-generating services Government Already top priority for HHS through Opioid Initiative with ~$1B budget1 Cost-savings for government-run health insurance by improving prescribing practices Payer Currently bearing majority of cost of opioid abuse (over $55B annually2) so high cost-savings as a result of curbing abuse Patient - Reduced levels of addiction Increased convenience through electronic storage of prescription data Future state: Extend beyond opioids to all prescriptions, explore international market opportunity 1US Department of Health and Human Services, The Opioid Epidemic 2Triple Pundit, Drug Companies, Corporate Responsibility and the Prescription Opioid Crisis