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1 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Practice and Hospital Site.

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Presentation on theme: "1 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Practice and Hospital Site."— Presentation transcript:

1 1 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Practice and Hospital Site of Service Costs Understanding and Utilizing Comparative Data Community Oncology Alliance Managed Care Digest Series ® Richard Frye, Ph.D., General Editor

2 2 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 National Patient Counts, 2011 PHYSICIAN OFFICE HOSPITAL OUTPATIENT TOTAL TUMOR TYPE Colorectal Cancer 64,203 (58%)46,165 (42%)110,368 Prostate Cancer 217,054 (73%)79,993 (27%)297,047 TUMOR TYPEICD-9 CODES Colorectal Cancer 153.0, 153.1, 153.2, 153.3, 153.4, 153.5, 153.6, 153.7, 153.8, 153.9, 154.0, 154.1, 154.8 Prostate Cancer 185

3 3 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 The IMS Health analysis of claims data focuses specifically on prostate and colorectal cancer. Information was obtained through the use of the standard Healthcare Common Procedure Coding System (HCPCS) utilizing J-codes for the billing of chemotherapy and other forms of treatment. These data are obtained from two proprietary databases that are maintained by IMS Health. One database uses claims data from physicians’ offices and clinics (CMS 1500); the other is based on hospital outpatient charges (charge data master or CDM). IMS Health uses algorithms to project its data to national and regional levels. These two data sets can be viewed in parallel but not commingled. The data reporting period is the full calendar year of 2011, with a look back through the patient’s medical history to assign cancer diagnoses. Patients diagnosed and treated for prostate or colorectal cancer were tracked if they received chemotherapy or hormone therapy. Data Methodology: IMS Patient Claims Data

4 4 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Regional Breakdown

5 5 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Percentage of Colorectal Cancer Patients, by Age Group, 2011 PHYSICIAN OFFICEHOSPITAL OUTPATIENT REGION 0–4546–6465–7475–8485+0–4546–6465–7475–8485+ Central6.6%42.1%27.7%20.2%3.1%8.2%42.5%25.2%18.4%5.5% Northeast6.2%41.6%26.4%22.1%3.4%6.3%38.0%26.2%22.3%7.0% Southeast5.9%37.5%30.8%22.0%3.6%9.6%47.3%25.5%13.9%3.4% Southwest6.3%40.2%29.7%20.6%2.9%7.4%45.2%27.3%15.8%3.9% West6.8%41.4%27.5%20.6%3.4%8.6%42.1%26.3%16.9%5.8% NATION6.3%40.5%28.5%21.1%3.3%7.9%42.9%26.0%17.8%5.1%

6 6 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Percentage of Prostate Cancer Patients, by Age Group, 2011 PHYSICIAN OFFICEHOSPITAL OUTPATIENT REGION 0–4546–6465–7475–8485+0–4546–6465–7475–8485+ Central0.1%25.6%36.1%31.7%6.3%0.3%29.5%36.0%25.9%8.2% Northeast0.3%26.5%35.4%31.3%6.4%0.3%26.9%35.1%28.4%9.0% Southeast0.3%22.0%38.2%33.4%5.9%0.5%32.2%39.0%22.6%5.5% Southwest0.2%24.8%38.7%30.9%5.2%0.3%30.9%37.8%23.9%6.9% West0.2%23.3%37.0%32.6%6.6%0.3%25.9%36.9%27.3%9.4% NATION0.2%24.3%37.1%32.1%6.1%0.4%29.2%36.9%25.7%7.6%

7 7 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Percentage of Colorectal Cancer Patients, by Payer PHYSICIAN OFFICEHOSPITAL OUTPATIENT MedicareMedicaidCommercial 1 MedicareMedicaidCommercial 1 REGION201020112010201120102011201020112010201120102011 Central49.6%45.9%6.0%7.0%44.3%47.0%28.7%27.2%4.6%5.1%66.6%67.5% Northeast39.4%37.8%6.8%8.5%53.7%53.6%29.8%26.8%5.4%5.5%64.6%67.6% Southeast52.6%51.5%6.1%6.6%41.1%41.7%18.7%16.2%5.0%4.8%76.2%78.8% Southwest51.4%50.3%5.4%5.3%43.1%44.3%22.1%20.6%8.2%8.4%69.5%70.8% West39.8%40.5%5.5% 54.6%53.9%17.7%17.1%8.3%8.8%73.8%74.0% NATION46.7%45.6%5.9%6.5%47.2%47.8%24.0%21.9%5.8%5.9%70.1%72.0% 1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

8 8 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Percentage of Prostate Cancer Patients, by Payer PHYSICIAN OFFICEHOSPITAL OUTPATIENT MedicareMedicaidCommercial 1 MedicareMedicaidCommercial 1 REGION201020112010201120102011201020112010201120102011 Central62.5%60.6%1.8%2.0%35.5%37.3%40.7%37.3%1.6%1.7%57.6%60.9% Northeast50.3%49.1%3.3%4.0%46.2%46.8%36.3%33.0%2.5%2.4%61.1%64.5% Southeast66.3%65.6%1.9%1.6%31.7%32.6%25.2%22.1%1.8%1.7%72.9%76.0% Southwest62.5% 2.5%1.8%34.9%35.5%32.0%27.0%3.6%3.0%64.2%69.8% West58.4%57.6%1.9%1.7%39.6%40.6%18.1%16.5%3.0%3.2%78.8%80.1% NATION60.5%59.6%2.2% 37.1%38.0%31.0%27.8%2.3% 66.6%69.8% 1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

9 9 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 PHYSICIAN OFFICEHOSPITAL OUTPATIENT REGION2010201120102011 Central28.8%29.3%35.7%38.2% Northeast23.5%24.9%26.1%25.7% Southeast25.3% 34.5%36.1% Southwest25.7%26.1%31.0%33.0% West28.5%29.5%31.1%31.7% NATION26.3%26.9%31.2%32.1% Percentage of Colorectal Cancer Patients with Metastatic Cancer

10 10 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Percentage of Prostate Cancer Patients with Metastatic Cancer PHYSICIAN OFFICEHOSPITAL OUTPATIENT REGION2010201120102011 Central5.5%5.8%13.8%14.3% Northeast5.2%5.9%8.5%9.2% Southeast5.0%5.4%11.6%12.1% Southwest6.3%7.0%12.0%12.8% West8.3%8.9%11.3%10.7% NATION5.8%6.3%10.8%11.2%

11 11 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Percentage of Colorectal Cancer Patients with Metastatic Cancer, by Payer PHYSICIAN OFFICEHOSPITAL OUTPATIENT MedicareMedicaidCommercial 1 MedicareMedicaidCommercial 1 REGION201020112010201120102011201020112010201120102011 Central27.2%26.6%30.0% 31.5%36.9%40.8%41.3%45.1%34.7%36.4% Northeast21.3%22.2%30.9%34.1%24.0%25.2%27.5%27.2%25.9%27.3%25.5%24.9% Southeast23.6%23.5%31.1%28.8%26.5%26.9%33.7%35.8%34.0%41.7%34.5%35.8% Southwest23.9% 35.2%34.0%26.5%27.5%30.3%32.5%36.6%36.9%30.5%32.6% West25.9%25.4%34.5% 29.7%31.7%33.3%28.7%37.3%34.1%29.9%31.9% NATION24.4%24.3%32.2%32.3%27.3%28.5%31.3%32.4%32.8%35.6%31.0%31.8% 1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

12 12 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Percentage of Prostate Cancer Patients with Metastatic Cancer, by Payer PHYSICIAN OFFICEHOSPITAL OUTPATIENT MedicareMedicaidCommercial 1 MedicareMedicaidCommercial 1 REGION201020112010201120102011201020112010201120102011 Central5.8%6.3%11.1%10.0%4.5%4.6%14.5%16.9%18.8%17.6%12.8%12.6% Northeast5.8%6.5%3.0%5.0%4.3%4.9%10.2%11.2%8.0%8.3%7.4%8.1% Southeast5.4%5.8%5.2%6.3%3.5%4.3%11.5%13.6%16.7%11.8%11.5%11.4% Southwest7.0%7.8%8.0%11.1%4.6%5.1%11.6%13.7%13.9%20.0%12.0% West8.9%9.4%10.5%11.8%7.3%7.9%14.4%13.9%13.3%12.5%10.4%9.9% NATION6.3%6.9%9.1% 4.9%5.3%11.6%12.9%13.0% 10.2%10.3% 1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

13 13 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Number of Cycles for Colorectal Cancer Patients, by Age Group, 2011 Physician OfficeHospital Outpatient REGION 0–4546–6465–7475–8485+0–4546–6465–7475–8485+ Central7877866766 Northeast7777867778 Southeast7777667677 Southwest888766666— West777774545— NATION7777766668

14 14 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Length of Therapy (Days) for Colorectal Cancer, by Age Group, 2011 PHYSICIAN OFFICEHOSPITAL OUTPATIENT REGION 0–4546–6465–7475–8485+0–4546–6465–7475–8485+ Central153176172170230144181 168163 Northeast154171165181196154177191176199 Southeast153169170212148147169149171124 Southwest159164176165142143153146137— West142159172163158104143125104— NATION152168171179183147170171167161

15 15 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Number of Cycles for Prostate Cancer Patients, by Age Group, 2011 PHYSICIAN OFFICEHOSPITAL OUTPATIENT REGION 0–4546–6465–7475–8485+0–4546–6465–7475–8485+ Central—655653445 Northeast4665535555 Southeast—665595544 Southwest4565645556 West—5554—3435 NATION5665545555 NOTE: Some regimen metric data were unavailable for the selected regions.

16 16 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Length of Therapy (Days) for Prostate Cancer Patients, by Age Group, 2011 PHYSICIAN OFFICEHOSPITAL OUTPATIENT REGION 0–4546–6465–7475–8485+0–4546–6465–7475–8485+ Central20520017215029485105112124101 Northeast—17218115719662127152149164 Southeast—17117617819117613814113088 Southwest1181741961472298417619513786 West—173164167176—13010273214 NATION148178180161215105136145137144 NOTE: Some regimen metric data were unavailable for the selected regions.

17 17 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Number of Cycles for Colorectal Cancer Patients, by Payer PHYSICIAN OFFICEHOSPITAL OUTPATIENT MedicareMedicaidCommercial 1 MedicareMedicaidCommercial 1 REGION201020112010201120102011201020112010201120102011 Central777678776666 Northeast777778776667 Southeast877777666756 Southwest777788777656 West776687555445 NATION777678776656 1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

18 18 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Length of Therapy (Days) for Colorectal Cancer Patients, by Payer PHYSICIAN OFFICEHOSPITAL OUTPATIENT MedicareMedicaidCommercial 1 MedicareMedicaidCommercial 1 REGION201020112010201120102011201020112010201120102011 Central212178165148193171203190186162187169 Northeast207179187142202168229208157152185172 Southeast220187173156197165203184190171170155 Southwest209175163137190164198195196153138134 West195174141148181155151134142120140133 NATION210179168147192165211195177158173160 1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

19 19 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Number of Cycles for Prostate Cancer Patients, by Payer NUMBER OF CYCLESLENGTH OF THERAPY (DAYS) MedicareMedicaidCommercial 1 MedicareMedicaidCommercial 1 REGION201020112010201120102011201020112010201120102011 Central663755545354 Northeast669675664555 Southeast666655654545 Southwest665665467644 West655465354433 NATION666665555545 1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

20 20 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Length of Therapy (Days) for Prostate Cancer Patients, by Payer PHYSICIAN OFFICEHOSPITAL OUTPATIENT MedicareMedicaidCommercial 1 MedicareMedicaidCommercial 1 REGION201020112010201120102011201020112010201120102011 Central23618360162185168140125154—121101 Northeast212173258117224173211160138128153136 Southeast215177218165192178175138207203141131 Southwest231181198169182166188195283155131159 West2001601511122161871401812111628898 NATION218175203151204175184152202155138132 1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations. NOTE: Some hospital outpatient regimen metrics were unavailable for the selected regions.

21 21 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Annual Charges, by Age Group, Colorectal Cancer, 2011 PHYSICIAN OFFICEHOSPITAL OUTPATIENT REGION 0–4546–6465–7475–8485+0–4546–6465–7475–8485+ Central$32,865$36,922$31,843$27,601$22,550$91,415$86,424$94,272$73,940$94,816 Northeast$29,427$33,114$26,037$23,030$23,401$104,475$108,221$106,073$96,949$81,207 Southeast$48,870$47,926$45,724$38,035$30,368$106,207$128,399$109,342$88,709$67,463 Southwest$68,032$65,522$54,985$46,572$32,098$81,810$84,959$98,019$82,637$83,543 West$50,074$46,891$43,446$33,459$32,937$84,234$94,175$87,632$83,213$71,630 NATION$45,509$45,841$40,281$33,197$28,013$99,791$108,805$103,902$89,965$79,227 NOTE: Regarding Medicare reimbursement, hospitals and physicians' offices use the same billing codes, but rates differ. Medication charges incurred in a physician's office are usually paid at contracted rates, which can be lower than billed charges. Hospitals generally pay less for chemotherapy and are reimbursed at lower rates, but receive fees that include average sales price (ASP) + 6% in the physician office setting. Separately paid drugs in hospital outpatient departments are expected to be reimbursed at ASP + 4% in 2013. Physician office claim charges include only those drug charges administered in the office setting (i.e., chemotherapy, supportive care, steroids). If there is a lab component, this would also be captured, along with physician office administrative service charges. Hospital outpatient charges incorporate all aspects of care, including direct (i.e., pharmacy, imaging, administrative provider services) and indirect (i.e., financial services, information technology, operations expenses) overhead.

22 22 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Annual Charges, by Age Group, Prostate Cancer, 2011 PHYSICIAN OFFICEHOSPITAL OUTPATIENT REGION 0–4546–6465–7475–8485+0–4546–6465–7475–8485+ Central$21,142$42,548$36,855$41,637$23,234$91,501$70,182$86,932$82,294$82,348 Northeast$58,645$45,269$37,944$33,437$17,063$37,006$77,994$89,790$78,359$68,169 Southeast—$62,756$51,664$38,067$21,503$37,655$86,573$101,150$106,560$92,335 Southwest$31,993$52,911$49,080$43,148$26,543$30,428$61,514$59,212$55,985$88,520 West$11,110$38,096$39,315$28,525$12,115$24,756$56,399$80,183$71,171$45,867 NATION$22,800$48,330$44,062$36,480$19,575$41,297$76,550$89,370$84,943$75,083 NOTE: Regarding Medicare reimbursement, hospitals and physicians' offices use the same billing codes, but rates differ. Medication charges incurred in a physician's office are usually paid at contracted rates, which can be lower than billed charges. Hospitals generally pay less for chemotherapy and are reimbursed at lower rates, but receive fees that include average sales price (ASP) + 6% in the physician office setting. Separately paid drugs in hospital outpatient departments are expected to be reimbursed at ASP + 4% in 2013. Physician office claim charges include only those drug charges administered in the office setting (i.e., chemotherapy, supportive care, steroids). If there is a lab component, this would also be captured, along with physician office administrative service charges. Hospital outpatient charges incorporate all aspects of care, including direct (i.e., pharmacy, imaging, administrative provider services) and indirect (i.e., financial services, information technology, operations expenses) overhead.

23 23 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Annual Charges, by Payer, Colorectal Cancer, 2011 PHYSICIAN OFFICEHOSPITAL OUTPATIENT REGION MedicareMedicaidCommercial 1 MedicareMedicaidCommercial 1 Central$33,260$36,205$33,548$100,468$76,780$83,470 Northeast$26,843$27,047$30,638$95,841$76,263$112,082 Southeast$45,441$41,387$46,347$99,753$125,117$119,788 Southwest$53,441$57,902$65,199$119,353$99,465$77,079 West$41,077$43,670$45,881$62,962$60,604$103,340 NATION$40,418$40,532$43,492$99,154$93,379$106,950 1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations. NOTE: Regarding Medicare reimbursement, hospitals and physicians' offices use the same billing codes, but rates differ. Medication charges incurred in a physician's office are usually paid at contracted rates, which can be lower than billed charges. Hospitals generally pay less for chemotherapy and are reimbursed at lower rates, but receive fees that include average sales price (ASP) + 6% in the physician office setting. Separately paid drugs in hospital outpatient departments are expected to be reimbursed at ASP + 4% in 2013. Physician office claim charges include only those drug charges administered in the office setting (i.e., chemotherapy, supportive care, steroids). If there is a lab component, this would also be captured, along with physician office administrative service charges. Hospital outpatient charges incorporate all aspects of care, including direct (i.e., pharmacy, imaging, administrative provider services) and indirect (i.e., financial services, information technology, operations expenses) overhead.

24 24 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Annual Charges, by Payer, Prostate Cancer, 2011 PHYSICIAN OFFICEHOSPITAL OUTPATIENT REGION MedicareMedicaidCommercial 1 MedicareMedicaidCommercial 1 Central$38,066$25,730$41,697$81,954$97,147$79,841 Northeast$36,914$23,808$35,355$86,459$66,168$79,845 Southeast$44,392$43,036$52,546$104,997$45,214$97,141 Southwest$46,709$50,838$44,638$65,198$84,545$55,212 West$31,349$22,909$36,023$67,786$46,806$70,063 NATION$40,092$35,666$41,474$87,742$64,271$82,482 1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations. NOTE: Regarding Medicare reimbursement, hospitals and physicians' offices use the same billing codes, but rates differ. Medication charges incurred in a physician's office are usually paid at contracted rates, which can be lower than billed charges. Hospitals generally pay less for chemotherapy and are reimbursed at lower rates, but receive fees that include average sales price (ASP) + 6% in the physician office setting. Separately paid drugs in hospital outpatient departments are expected to be reimbursed at ASP + 4% in 2013. Physician office claim charges include only those drug charges administered in the office setting (i.e., chemotherapy, supportive care, steroids). If there is a lab component, this would also be captured, along with physician office administrative service charges. Hospital outpatient charges incorporate all aspects of care, including direct (i.e., pharmacy, imaging, administrative provider services) and indirect (i.e., financial services, information technology, operations expenses) overhead.

25 25 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Practice and Hospital Site of Service Costs Site of Service Case Study for Florida

26 26 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Percentage of Florida Cancer Patients, by Age Group, 2011 PHYSICIAN OFFICEHOSPITAL OUTPATIENT TUMOR TYPE 0–4546–6465–7475–8485+0–4546–6465–7475–8485+ Colorectal Cancer 4.0%29.7%33.8%27.4%4.9%8.2%51.8%22.3%13.7%3.7% Prostate Cancer 0.2%16.1%37.9%38.6%7.0%0.3%28.3%39.5%24.4%7.3%

27 27 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Percentage of Florida Cancer Patients, by Payer PHYSICIAN OFFICEHOSPITAL OUTPATIENT MedicareMedicaidCommercial 1 MedicareMedicaidCommercial 1 TUMOR TYPE 201020112010201120102011201020112010201120102011 Colorectal Cancer 55.7%58.3%6.9%7.7%37.3%33.8%20.0%18.4%11.0%11.5%68.9%70.0% Prostate Cancer 66.4%69.5%2.5%2.4%31.0%28.0%26.2%25.2%3.8%4.4%69.8%70.3% 1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

28 28 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Percentage of Florida Cancer Patients with Metastatic Cancer PHYSICIAN OFFICEHOSPITAL OUTPATIENT TUMOR TYPE 2010201120102011 Colorectal Cancer24.9%24.4%31.2%32.1% Prostate Cancer4.8%5.4%10.8%11.2%

29 29 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Length of Therapy (Days) for Florida Cancer Patients, by Age Group, 2011 PHYSICIAN OFFICEHOSPITAL OUTPATIENT TUMOR TYPE 0–4546–6465–7475–8485+0–4546–6465–7475–8485+ Colorectal Cancer 122159183181143197150166167131 Prostate Cancer —190172168181—10512716361 NOTE: Some regimen metric data were unavailable for the selected regions.

30 30 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Annual Charges for Florida Cancer Patients, by Age Group, 2011 PHYSICIAN OFFICEHOSPITAL OUTPATIENT TUMOR TYPE 0–4546–6465–7475–8485+0–4546–6465–7475–8485+ Colorectal Cancer $50,981$53,714$44,461$36,376$36,576$126,496$96,935$97,29386,276$48,532 Prostate Cancer —$41,541$50,540$29,906$13,375—$68,666$99,061$65,807$36,327 NOTE: Regarding Medicare reimbursement, hospitals and physicians' offices use the same billing codes, but rates differ. Medication charges incurred in a physician's office are usually paid at contracted rates, which can be lower than billed charges. Hospitals generally pay less for chemotherapy and are reimbursed at lower rates, but receive fees that include average sales price (ASP) + 6% in the physician office setting. Separately paid drugs in hospital outpatient departments are expected to be reimbursed at ASP + 4% in 2013. Physician office claim charges include only those drug charges administered in the office setting (i.e., chemotherapy, supportive care, steroids). If there is a lab component, this would also be captured, along with physician office administrative service charges. Hospital outpatient charges incorporate all aspects of care, including direct (i.e., pharmacy, imaging, administrative provider services) and indirect (i.e., financial services, information technology, operations expenses) overhead.

31 31 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Practice and Hospital Site of Service Costs, for Prostate Cancer, by Specialty

32 32 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Percentage of Prostate Cancer Patients, by Specialty, Physician Office Setting, 2011 1 SPECIALTY REGION OncologyUrologyOther 2 Central5.4%92.4%2.1% Northeast5.9%91.6%2.3% Southeast6.8%90.5%2.5% Southwest10.0%81.7%8.1% West12.6%80.7%6.6% NATION7.7%88.3%3.9% 1 Specialty data were available for the physician office setting only. 2 “Other” includes internal medicine, radiation oncology, family medicine, geriatric medicine and others.

33 33 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Length of Therapy and Number of Cycles, by Specialty, Prostate Cancer, Physician Office Setting, 2011 1 ONCOLOGYUROLOGY REGION Length of Therapy Number of Cycles Length of Therapy Number of Cycles Central19761354 Northeast16961824 Southeast18161624 Southwest19061424 West16851614 NATION18161584 1 Specialty data were available for the physician office setting only.

34 34 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Length of Therapy and Number of Cycles, by Specialty, Metastatic Prostate Cancer, Physician Office Setting, 2011 1 ONCOLOGYUROLOGY REGION Length of Therapy Number of Cycles Length of Therapy Number of Cycles Central20561255 Northeast16561605 Southeast18661555 Southwest19061315 West16661095 NATION18561375 1 Specialty data were available for the physician office setting only.

35 35 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Average Annual Charges, by Specialty, Metastatic Prostate Cancer, Physician Office Setting, 2011 1 SPECIALTY REGION OncologyUrologyAll Specialties Central$35,607$61,309$41,190 Northeast$39,820$59,047$44,016 Southeast$54,050$62,585$55,845 Southwest$52,916$57,209$53,133 West$40,098$43,095$40,097 NATION$45,516$57,092$47,444 1 Specialty data were available for the physician office setting only.

36 36 Managed Care Digest Series ®, © 2013 sanofi-aventis U.S., A SANOFI COMPANY Data source: IMS Health © 2013 US.NMH.13.02.033 Questions


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