Better Patient Outcomes and Value Through Supply Chain Partnerships' October 30, 2014

CAPDM’s Vision Ensuring safe, secure and timely access to high quality healthcare products for all Canadians 2Oct. 2014

About the Canadian Association for Pharmacy Distribution Management  The Canadian Association for Pharmacy Distribution Management (CAPDM), founded in 1964, is a leading health care industry association  Represents every participant in the world’s most advanced pharmaceutical supply chain  14 wholesalers & self-distributors that operate over 30 distribution centres and employ over 5,000 Canadians  CAPDM is a reliable, objective, and trusted advisor to federal and provincial governments and regulatory agencies. 3Oct. 2014

About the Canadian Association for Pharmacy Distribution Management 4Oct. 2014

We ensure that patients have timely access to vital medications in a safe, secure, and efficient manner  CAPDM distributors visit almost every pharmacy in Canada every day, ensuring patients have timely access to vital medicines  Next-day delivery, up to 5 days a week to almost all pharmacies  Same-day & 6 days a week service in urban areas  Carrying 30K SKUs of prescription, OTC medicines, and other pharmacy products (including narcotics and slow- moving drugs) 5Oct What Our ‘Invisible Network’ Makes Possible  In most cases, a one-day wait for a rural patient needing an out-of-stock drug  A short-term buffer against drug shortages  Drug recalls being quickly executed  Confidence in the integrity of all drugs, even for cold-chain products  A $1.4 B system of extended credit that bankrolls the pharmacy industry  Opportunities for the government to leverage during pandemics or for vaccine distribution

Pharmaceutical Distributors of CAPDM Added Value - Today Government – Industry Partnerships  Distribution of Public Health Seasonal Flu Vaccine  Mitigation of Drug Shortage Impact 6Oct. 2014

Governments & pharmacies face challenges with flu vaccine distribution 7Oct Government ChallengesPharmacy Challenges  Pharmacy is a growing patient destination for flu vaccinations  Bolus of inventory being pushed to stores  Potential cold chain integrity issues if pharmacies pick up vaccines from public health units  Potential waste if large inventories at pharmacies sit unused, expire, or are destroyed by natural disasters  Inability to redistribute store-level inventories to where they are needed  Cumbersome ordering processes, infrequent deliveries, and/or lack of supply predictability encourage large store-level inventories  Available refrigerator space may not be able to accommodate large bolus inventories

The capabilities of pharmaceutical distributors could improve flu vaccine distribution efficiencies  The core competencies of pharmaceutical distributors could be leveraged to address challenges in servicing the growing demand for seasonal flu vaccines by retail pharmacies:  Cold chain capabilities ensure optimum storage and transportation conditions all the way to the pharmacy  Extensive distribution networks that visit every pharmacy regularly  Inventory systems and manual tracking capabilities can be used to determine flu vaccine inventory at the pharmacy level (in combination with Ministry of Health billing data)  GMP-compliant storage conditions allow flexibility for flu vaccine inventories to be redeployed 8Oct. 2014

Some provinces have already engaged CAPDM and its members for flu vaccine distribution BC: Piloted wholesale model to pharmacies in 2013 AB: Wholesale model already underway PE: Wholesale model already underway 9Oct NS: Used wholesalers for quick in-and-out vaccine distribution in 2013

Early Lessons Learned from PE and AB  Wholesalers have played an instrumental role in stopping hoarding, preserving equitable allocation of vaccine inventories  Daily/weekly reporting gives governments better visibility to how much inventory is within the wholesale network and pharmacy  Wholesale supply chain flexible enough to quickly direct inventories to outbreak areas  Pharmacies able to achieve just-in-time delivery of flu vaccines to meet patient demand 10Oct. 2014

Pharmaceutical Distributors Can Help to Mitigate Impact of Drug Shortages  Working with Governments & Manufacturers  Initiate Product Flow Controls  Ensure Balanced Disbursement of Product  Hold reserves for emergency use While not involved in the root causes of a drug shortage. The Pharmaceutical Distributors can mitigate Drug Shortage impact by ensuring an equitable access to existing product. 11Oct. 2014

Public flu vaccines are just the tip of the iceberg for how governments could leverage wholesalers  Distribution of all public vaccines  Servicing physician offices via their closest pharmacy  Pandemic antivirals and personal protective equipment  Other mass distribution needs (e.g., potassium iodide pills)  Critical medicine stockpiling 12Oct. 2014

Questions? 13Oct David Johnston President Canadian Association for Pharmacy Distribution Management (905)