Individualized Medicine Pharmacogentics Right Dose. Right Time. First Time. Susan Kolyno, BA, CMA, Vantari Laboratory Representative

Why Pharmacogentics Avoidable Medical Problem 700, , , , ,000 Heart Cancer Stroke RX Car Accidents 2.2 MILLION severe adverse drug reactions per year PATIENTS ARE AT RISK 100,000 deaths per year By PROPERLY PRESCRIBED MEDICATIONS COST LEADER for Mal-Practice If a patient had “double” or “triple hit” genetic variations, wouldn’t you want to know that prior to their procedure?

Prevalent in Disease states Treatment Failures Prevalent in Disease states “Keeping in Step” “Do No Harm” Cancer 75% Alzheimers 70% Arthritis 50% Diabetic 43% Asthma 40% Anti-depressants 38% GENETIC differences in metabolism = Treatment Failure More than 100 medications have drug to gene interactions and are identified in the FDA packet and black box labels

Poly-Pharmacy Complications in Prescribing Patients Taking More than 3 Medications Are you concerned about drug drug interactions and the possibilities of ADRs or lowered effectiveness of drug regimen? AT RISK - 40% are over 65 More than 75% of the population have documented genetic variations that increase their risk for ADR's. Medicines most commonly associated with ADR's are 8X more likely to go through pathways with genetic variants. More than 75% of the population have documented genetic variations that increase their risk for ADR's. Medicines most commonly associated with ADR's are 8X more likely to go through pathways with genetic variants.

Considering Patient Interactions & Safety Have you experienced incidences with Pain medications, Anti depressives, statins or any other drug where it took several office visits with trial and error methodology to prescribe the right medication ? Do your patient’s anti-depressants inhibit their metabolism of their blood pressure medication? How do you prevent that from reoccurring with your patients in the future? If you have been concerned about drug drug interactions and the possibilities of ADRs or lowered effectiveness of a drug regimen... the following information will be of interest to you:

Cytochromes Metabolic Highways Cytochromes are metabolized in the liver and intestines. To illustrate, think of these as highways,,,, and the drugs as cars on the = highway,, the Drugs on that highway can ONLY be only processed via certain CYPS. Genes, OTC medications, herbal remedies, vitamins and other drugs change CYP levels making it difficult for the cars to pass,,, 75% of patients have variations in at least one CYP and do not metabolize medications normally 75% of patients have variations in at least one CYP and do not metabolize medications normally

Avoiding ADR's Getting Right the First Time Pharmacogenetics is the understanding of how the genetic variation alters drug response. Cytochromes (CYPs) are the metabolic factories in the liver and intestines. Pharmacogenetics is the understanding of how the genetic variation alters drug response. Cytochromes (CYPs) are the metabolic factories in the liver and intestines. Poor Metabolizers: Reach maximum levels very quickly Intermediate Metabolizers: Half the highway is shut down, a patient can still metabolize but it is very difficult. Ultra Metabolizers: Have additional pathways, these patients never reach therapeutic effect. Normal Metabolizers: Have both roads open and metabolize close to normal. Poor Metabolizers: Reach maximum levels very quickly Intermediate Metabolizers: Half the highway is shut down, a patient can still metabolize but it is very difficult. Ultra Metabolizers: Have additional pathways, these patients never reach therapeutic effect. Normal Metabolizers: Have both roads open and metabolize close to normal.

Changing the Pattern Will YOU make the Difference? Interactions involve cytochromes: 2C9, CYP2D6, CYP2C19 & CYP3A4 Individual DNA varies in Medications and Metabolism impacting more patients than Common Genetic testing. Interactions involve cytochromes: 2C9, CYP2D6, CYP2C19 & CYP3A4 Individual DNA varies in Medications and Metabolism impacting more patients than Common Genetic testing. MEDICATION MANAGEMENT BASED ON PATIENT METABOLISM MEDICATION MANAGEMENT BASED ON PATIENT METABOLISM. Do some of your patients have a variety of undiagnosed issues that might be related to polymorphic variance of the enzymes (MTHFR) that regulate Folic acid metabolism ?

Why Vantari? Focus IS On the Patient Vantari centers it's approach on testing & hard copy results FOR the PATIENT,, SPEACILIZING IN PHARMACOGENETICS Referencing our Partner CPIC, an independent consortium and 2014 date publication for physician results & poly- pharmacy recommendations. Highly complex CLIA certified. Simply put,,,”you have now found a reliable way to screen patients for metabolic compatibility and avoid Adverse Drug Reactions, it is worth the protection!”

Test Results - Insurance In 3-5 Days – No Out of Pocket Your screening tests and follow-up are billable. IF Federal Scrutiny of your prescriptions IS causing you to lose time while questioning the uncertainty regarding the efficacy of certain Pharma products, then billable screenings are the solution.

What Do You Think? Your Opinion Makes a Difference With Pharmacogentics becoming a recognized medical benefit and insurance reimbursement management program, would you want to participate in the "Do No Harm" continuum that is creating a paradigm shift in the way doctors prescribe medicine? If the Federal Government recommended Pharmacogentic testing and CMS agreed to reimburse for this testing why would you object to implementing it in your office ? With the Affordable Health Care Act requiring you to work twice as hard for half the pay, if I could show you how to increase your bottom line by $ per patient with very little effort on your part, would that be of interest?" THERE IS A SIMPLE NO COST SOLUTION

Pharmacy Management With the movement towards accountable care organizations,,, CAN you forsee Pharmacogenomics playing a significant role in reducing your health care cost ? With the movement towards accountable care organizations,,, CAN you forsee Pharmacogenomics playing a significant role in reducing your health care cost ? If you answered YES to any of the questions throughout this overview, we can help by starting a Trial Pharmacy (run) Management program Scientific Review Diagnose causes for drug related side effects. Assists the healthcare provider to select appropriate drug and dose for their patient. Achieve optimal therapeutic response. Minimize side effects of toxicity. Avoid therapeutic failure.

No Cost -Trial Pharmacy Management Program Complete the simple form with your Vantari representative: SET A DATE MONTHLY - Book patients for an OFF day for screening. Representative will assist and follow up with billing or office management. NO OUT OF POCKET Compliance Regulated – Request Clinical Studies, Dossiers, access to CPIC.

YOUR Vantari Team Accreditations Nick G. Arroyo -Chief Executive Officer - Nick Arroyo earned his Bachelor of Science Degree in Molecular Biosciences and Biotechnology from Arizona State University. He began his career working in research in the Department of Gene and Cellular Therapy at the Arizona Heart Institute where he helped to develop an investigational stem cell therapy for heart failure and was responsible for the cell manufacturing processes required for obtaining FDA approval for phase I clinical trial. Sean Parrish - Chief Operating Officer - Sean Parrish is co-founder of Vantari Genetics and our Chief Operating Officer. Mr. Parrish's responsibilities encompass national commercialization of our molecular diagnostics services across the entire value chain from test inception through customer development and product distribution. Mr. Parrish has been part of the development, launch and marketing strategy for SimpleCF™, Vantari's cystic fibrosis carrier screening test. Mr. Parrish obtained a Bachelor of Science degree from the University of Arizona. Shaun R. Opie, PhDChief Science Officer - Dr. Opie holds a PhD in Biomedical Sciences/Molecular Genetics. He led all laboratory operations for an investigator initiated Phase I clinical trial using stem cells to treat cardiac disease and helped develop a proprietary cardiovascular disease gene data set for a publicly traded genomics company. In addition to clinical trial design and management for FDA regulated investigational new drugs and devices, Dr. Opie has over 10 years of operations management directing major collaborations with industry and academic partners in molecular diagnostics research and development. He has held adjunct faculty appointments in bioengineering and has numerous publications in peer reviewed medical journals and textbooks. Phil Lamb -Senior Advisor - Phil has a track record of successfully leading growth businesses into highly responsive, client-focused service organizations. He provides legal, financial, and strategic advice to the Vantari Genetic team. In addition to his role with Vantari Genetics, he is also a principal in Infinity Software Solutions, a leading Human Resources Information System (HRIS). Phil received his J.D. from Harvard Law.

Contact I can provide case studies, clinical data and insurance information on pharmacogentics and the impact upon the medical profession that is NOW changing prescribing methods rapidly. Please feel free to contact me with any questions or individualized studies geared to your practice. YOUR VANTARI REPRESENTATIVE: Susan Kolyno Website: RIGHT DOSE. RIGHT TIME. FIRST TIME

Thank You Right Dose. Right Time. First Time. Preventative Patient Care Susan Kolyno, Account Manager, Vantari Laboratories or