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Premier Continuum of Care | June 2020

Coronavirus Disease 2019 (C VID-19): What We Know

PLUS • Introducing the Premier Continuum of Care Biosimilars Program • Category Spotlight: COVID-19

RecoveryPremier Portfolio Continuum of Care | June 2020 1 EDITORIAL STAFF EDITOR IN CHIEF Gary Feit, MS Vice President, Corporate Communications CLINICAL EDITOR Liya Davydov, PharmD, BCPS, BCGP Vice President, Clinical Pharmacy Services MANAGING EDITOR Eric Rodriguez Director, Corporate Communications DESIGNER Jaclyn Alvarado Creative Director, J2 Design NYC COPY EDITOR Tina Harlan PROOFREADER Laura F. Yandell

+ Table of Contents Insight | June 2020

555 West 57th St., 12th Floor Coronavirus Disease New York, NY 10019 phone 888.258.3273 fax 646.638.2641 2019 (COVID-19): premierinc.com/alternatesites 1 What We Know Insight magazine is published by Premier and is complimentary for Premier members. For membership information, please call 888.258.3273. To submit ideas for editorial consideration, please contact Eric Rodriguez at 212.901.1242 or [email protected].

Introducing the Premier This publication is intended to provide general information on issues of interest to the members of Premier Healthcare Alliance, L.P., and Continuum of Care its affiliates (collectively, “Premier”) and the general public. It does not constitute, nor should it be used as a substitute for any business, legal, or regulatory advice. Premier hereby disclaims all warranties, Biosimilars Program express or implied, as to the accuracy of any of the information 7 contained herein, whether such information is up-to-date, or its fitness for any particular use or purpose. Nothing contained in it is intended as a treatment recommendation for any particular patient or group of patients. Treating institutions and/ or physicians must make all clinical decisions regarding the use of pharmaceuticals and other products on a case-by-case basis. You should always refer to federal, state, and local laws, rules, and regulations governing the operation of your organization and should consult your own Category Spotlight: legal counsel. The opinions expressed by the authors of articles included in this issue do not necessarily reflect those of Premier, its COVID-19 Recovery affiliates, or its representatives. Furthermore, some of the content contained herein may have been originally prepared by or funded Portfolio by organizations with financial interests in products or services 10 related to the topics discussed in such article. While every effort was made to ensure the accuracy of information conveyed in this magazine, Premier, its affiliates, and its representatives do not accept responsibility and cannot be held liable for any errors that may exist within the publication. Premier is not responsible for the contents of any Web pages that are referenced by this communication. Links from this communication to other sites do not constitute an endorsement by Premier. These links are for convenience only. It is the responsibility of the user to evaluate the content and usefulness of information obtained from other sites. Premier has no control over and is not responsible for the information, practices, or content of these or any other sites. The contents of this publication are protected by copyright and are the property of Premier. They may not be reproduced or transmitted in any form without the express written permission of Premier.

2 | Insight Coronavirus Disease 2019 (C VID-19): What We Know

Liya Davydov, PharmD, BCPS, BCGP Vice President, Clinical Pharmacy Services, Premier Alternate Site Programs

[Current as of April 6, 2020] Premier Continuum of Care | June 2020 1 Origin and date first attention, include difficulty breathing/ and should be worn by either the patient drawing breath, persistent pain/pressure (if it’s feasible, because it may exacerbate recorded in the chest region, lips/face turning difficult breathing patients may already The new coronavirus disease of bluish color and inability to wake up experience) or by the caregivers, when 2019, abbreviated as COVID-19, was first or newly-developed confusion. It’s the patient is not able to.14,15 Moreover, identified in China, and the World Health very important to understand that as to protect themselves and others, it is Organization (WHO) was notified of more is discovered about the disease, advisable by the Centers for Disease the outbreak in late December 2019.1,2 additional signs/symptoms of the disease Control and Prevention (CDC) that a Since that time, the virus has spread may become apparent, and as such, the covering be placed over nose/mouth when globally.1,2 The disease was categorized above list of the manifestations is not people go to public places (it doesn’t have to as a worldwide pandemic by the WHO all-inclusive.7 be an actual surgical mask, as those are to on March 11, 2020 – the first pandemic be reserved for healthcare providers, but Once patients get sick, mild disease caused specifically by a coronavirus.3 something like a scarf, a home-made cloth can linger for about 2 weeks, while As of the first week of April 2020 more mask, or a bandana would be advisable, severe/critical disease can take up to than 150 countries/regions have reported though those coverings have their own 6 weeks to clear.9 It is not yet known confirmed COVID-19 cases.4 associated downfalls).15,16 if it’s possible to be re-infected with COVID-19 after recovering from an Patient items such as utensils, Risk factors for severe original infection with COVID-19, or toiletries, bed sheets/pillow cases, etc. symptoms or fatal if a re-infected patient can develop should not be shared with other members symptoms more than once.10 There are of the household and should be washed outcomes some reports from China, however, (sanitized) separately.15 Furthermore, While there is much to learn about indicating that those who tested negative surfaces that are touched often, and may this disease, some patterns have after originally testing positive (meaning harbor the virus, should be disinfected emerged. For instance, certain groups they have recovered), are now testing every day with an appropriate disinfectant appear to be more affected by the positive again. It is unclear if those (e.g., bleach solutions, alcohol solutions disease and have more severe outcomes, patients were asymptomatic carriers or [containing 70 percent alcohol or higher]).14 including fatalities. Those at higher risk if they were developing a second round include people who are older (age 60 and of disease. Testing errors are also a above), long-term care facility residents, possibility.11 Patients who had COVID-19 Testing or anyone who has underlying conditions symptoms and were in self-isolation, if A lack of specific approved treatments (including uncontrolled diabetes, they are not being tested to see if their and difficulty in preventing disease hypertension, obesity with body mass tests are now negative, are allowed to spread have been worldwide dilemmas. index of at least 40 or higher, chronic leave isolation after at least 72 hours But the U.S. has faced yet another obstacle lung disease [including moderate/severe have passed since the last fever, and the – the slow ramp-up of testing.17,18 The asthma], heart disease, kidney failure, patient has been afebrile for the past 72 tests that were initially available were liver disease or compromised immunity hours without using any anti-pyretic designed to provide results within several [due to chemotherapy, smoking, immune medications. Additionally, at least seven days.18,19 As of April 6, 2020, 28 tests had deficiencies, etc.]). These populations days should have passed since the onset been approved by the Food and Drug tend to be more affected by the disease of symptoms.12 New research indicates, Administration (FDA).20 and have more severe outcomes, however, that in some patients, the virus The approval of Abbott’s ID NOW™ including fatalities.5,6 can still be detected for as long as eight COVID-19 test, on March 27, 2020, was days after the disease clears.13 a huge step forward.21 This test is able Signs and symptoms to show positive COVID-19 results in five minutes, with negative results While this is a novel disease, and Prevention available in less than 15 minutes, and not all manifestations are well known Practicing social distancing from would be immensely useful on front yet, there are a number of signs and others, not touching your hands to your lines for rapid testing, and in any type symptoms that have been identified mouth/eyes/nose/face, washing your of healthcare setting (e.g., urgent care to date. The apparent hallmark signs/ hands frequently with soap and water for entities, health care practitioners’ symptoms include cough, fever and at least 20 seconds (or using alcohol-based offices, etc.). 21 The company advised that shortness of breath, and if they do sanitizer which should contain at least it will be manufacturing about 50,000 develop, it usually takes place within 60 percent alcohol) are all recommended units per day, to meet the demand, 2-14 days after contact with an infected preventative measures.14 Sneezes or beginning the week of March 30, 2020.21 individual (with a tendency for symptom coughs should be contained with a tissue, Another breakthrough was the April development around day five).7,8 The which should then be expediently disposed 1, 2020, approval of a test by Cellex, disease can present with mild symptoms of into the trash.14 Additional protection which identifies COVID-19 antibodies or may progress to severe sickness measures, such as the use of masks and in blood. Test results are available in culminating in death.7 Some of the gloves, apply in circumstances when a about 20 minutes from an authorized severe symptoms, which require urgent person is already sick with COVID-19, laboratory.22

2 | Insight These tests were moved forward under an Emergency Use Authorization Table 1.* Promising treatment modalities under (EUA), which allows the FDA to issue consideration.25,26,28,29,31,32,41-65 approvals more quickly during a public health emergency. Approvals of this Antiviral Antimalarial Disease-modifying Miscellaneous type are valid only for the duration of Drugs Drugs Anti-rheumatic Drugs the specified emergency.20,23 Still eagerly Drugs awaited is the introduction of an at-home test for COVID-19 antibodies that would indicate if an individual has ever had Favipiravir Chloroquine Anakinra Ascorbic acid COVID-19. This is under development (Avigan®, phosphate by Scanwell Health.24 The company has Favilavir) filed an EUA application with the FDA and expects a decision some time in June Remdesivir Hydroxy- Sarilumab Azithromycin chloroquine (Kefzara®) 2020.24 If approved, this would allow sulfate at-home testing and results within a few (Plaquenil®) hours of a simple finger stick.24

Umifenovir Tocilizumab Lopinavir-ritonavir ® Treatment (Arbidol ) (Actemra®) (Kaletra®)** Treatment is primarily supportive Methylprednisolone at this time. It varies by severity of (DEPOMedrol®, symptoms and may include use of SOLUMedrol®) ventilators, oxygen, etc. (in more 25 extreme cases). While there are as Nitric Oxide gas yet no approved pharmacological inhalation treatments or vaccines specifically for COVID-19, several existing drugs as well Sirolimus as newly developed medications and novel vaccines are undergoing extensive *Only select treatment modalities with an anticipated potential for treating COVID-19 are listed in the table. 41 25-28 **A recent study did not show benefit in severely ill hospitalized patients with COVID-19, but another testing. Table 1 describes drugs that study is currently ongoing to find out if the drug may be useful in patients with milder symptoms.42 are currently undergoing investigational studies or have already had studies conducted.25-28 This resource is available at www.ashp.org/-/media/assets/pharmacy-practice/ Earlier, a small study highlighted the resource-centers/Coronavirus/docs/ASHP-COVID-19-Evidence-Table. combined use of hydroxychloroquine ashx?la=en&hash=B414CC64FD64E1AE8CA47AD753BA744EDF4FFB8C.28 The chart with azithromycin, which resulted in also lists drugs that would be best avoided in patients who have tested positive previously positive patients testing for COVID-19.28 Specifically, there is a theory, which is not confirmed, that use of negative for COVID-19 by day five of non-steroidal anti-inflammatory agents (NSAIDs) such as ibuprofen, naproxen, treatment.29 Recently, the FDA granted etc. should be avoided in patients with COVID-19, as they worsen the course of the (under emergency authorization) disease.26, 28, 33 The FDA issued an advisory regarding the use of NSAIDs in COVID-19, healthcare providers permission to indicating that patients taking these drugs for reasons other than COVID-19 should use certain antimalarial drugs (i.e., continue them.26,34 hydroxychloroquine and chloroquine) to treat hospitalized patients with Further, some have theorized that, given the pathway that the virus uses to COVID-19.30-32 As per FDA’s EUA for replicate, use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin- 26,28,35 hydroxychloroquine, the suggested receptor blockers (ARBs) may need to be discontinued. However, the American dosing regimen in qualifying hospitalized Heart Association (AHA), American College of Cardiology (ACC), the Heart Failure patients who weigh at least 50 kg (110 Society of America (HFSA), and the European Society of Cardiology (ESC) continue lbs.) is 800 mg the first day (loading dose), to recommend that ACEIs and ARBs continue to be taken as prescribed and not followed by 400 mg/day for four to seven discontinued arbitrarily. Stopping these drugs abruptly in select patient populations 36-38 days of total treatment duration.31 could lead to negative health outcomes.

The American Society of In addition to the investigational treatments for the disease, there are over 35 27 Health-System Pharmacists (ASHP) unique vaccines in various stages of development. The very first vaccine trial has released an evidence-based (Moderna mRNA vaccine), funded by the National Institutes of Health, began on March 16, 2020.39 In the absence of an approved vaccine for COVID-19, however, chart of all current potential convalescent sera is being investigated as a potential modality to provide passive treatments under investigation antibody therapy either to prevent people from getting sick with COVID-19, or even to for COVID-19, with applicable 26,40 proposed dosing regimens.28 patients who are experiencing early COVID-19 symptoms.

Premier Continuum of Care | June 2020 3 Summary and additional information COVID-19 is an unfolding pandemic, with seemingly daily discoveries about the disease. Multiple treatment regimens are under consideration, without a single FDA-approved modality specifically for COVID-19. Newly approved rapid tests should enhance testing efficiency, help streamline treatment, and slow the spread of the virus. For additional up-to-date information on COVID-19, please visit the CDC page dedicated to coronavirus at www.cdc.gov/coronavirus/2019-ncov/index.html. For a snapshot of all medications under consideration as investigational agents, current thoughts on their effectiveness, and an explanation of drugs that should potentially be avoided in patients with COVID-19, please refer to this resource developed by ASHP: www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/Coronavirus/docs/ASHP- COVID-19-Evidence-Table.ashx?la=en&hash=B414CC64FD64E1AE8CA47AD753BA744EDF4FFB8C. For current information on vaccine research for COVID-19, please refer to the vaccine tracker at www.raps.org/news- and-articles/news-articles/2020/3/covid-19-vaccine-tracker. For updated information on testing for COVID-19, visit the FDA’s page, which lists all currently approved diagnostic tests for this disease under EUA: www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency- use-authorizations#covid19ivd. For additional resources and to learn more about Premier’s COVID-19 response, visit www.premierinc.com/covid-19-response.

REFERENCES 1. Centers for Disease Control and Prevention, “Coronavirus Disease 2019 (COVID-19): Prevent Getting Sick: How COVID-19 Spreads,” accessed March 28, 2020. https://www.cdc.gov/coronavirus/2019-ncov/about/index.html. 2. Centers for Disease Control and Prevention, “Coronavirus Disease 2019 (COVID-19): CDC’s Response: Situation Summary,” accessed March 28, 2020. https://www.cdc.gov/ coronavirus/2019-ncov/cases-updates/summary.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fsummary.html. 3. World Health Organization, “WHO Director-General’s opening remarks at the media briefing on COVID-19,” March 11, 2020.https://www.who.int/dg/speeches/detail/ who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. 4. 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National Institutes of Health, U.S. National Library of Medicine, “The Efficacy of Lopinavir Plus Ritonavir and Arbidol Against Novel Coronavirus Infection (ELACOI),” accessed April 6, 2020. https://clinicaltrials.gov/ct2/show/study/NCT04252885. 50. National Institutes of Health, U.S. National Library of Medicine, “Clinical Study of Arbidol Hydrochloride Tablets in the Treatment of Pneumonia Caused by Novel Coronavirus,” February 7, 2020. https://clinicaltrials.gov/ct2/show/study/NCT04260594. 51. L. Dong et al. “Discovering drugs to treat coronavirus disease 2019 (COVID-19),” Drug Discoveries & Therapeutics 14, no. 1 (2020): 58-60. DOI: 10.5582/ddt.2020.01012. 52. “Sanofi and Regeneron begin global Kevzara® (sarilumab) clinical trial program in patients with severe COVID-19,” Sanofi US, March 16, 2020.http://www.news.sanofi. us/2020-03-16-Sanofi-and-Regeneron-begin-global-Kevzara-R-sarilumab-clinical-trial-program-in-patients-with-severe-COVID19. 53. P. Mehta et al. “COVID-19: consider cytokine storm syndromes and immunosuppression,” Lancet 395, no. 10229 (March 16, 2020): 1033-1034. Epub ahead of print. DOI: 10.1016/S0140-6736(20)30628-0. 54. “Roche initiates Phase III clinical trial of Actemra/RoActemra in hospitalised patients with severe COVID-19 pneumonia,” F. Hoffmann-La Roche Ltd., March 19, 2020. https://www.roche.com/dam/jcr:f26cbbb1-999d-42d8-bbea-34f2cf25f4b9/en/19032020-mr-actemra-covid-19-trial-en.pdf. 55. National Institutes of Health, U.S. National Library of Medicine, “Ascorbic acid/Vitamin C studies,” accessed April 6, 2020. https://clinicaltrials.gov/ct2/ results?cond=COVID19&term=ascorbic+acid&cntry=&state=&city=&dist=. 56. Dawei Wang et al. “Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China,” Journal of The American Medical Association 323, no. 11 (2020): 1061-1069. DOI: 10.1001/jama.2020.1585. 57. “Sobi to initiate a clinical study to evaluate whether anakinra and emapalumab may relieve complications associated with severe COVID-19 disease,” Swedish Orphan Biovitrum AB (publ) (Sobi™), March 18, 2020. https://www.sobi.com/sites/default/files/pr/202003183346-1.pdf. 58. National Institutes of Health, U.S. National Library of Medicine, “Efficacy and Safety of Emapalumab and Anakinra in Reducing Hyperinflammation and Respiratory Distress in Patients With COVID-19 Infection,” March 27, 2020. https://clinicaltrials.gov/ct2/show/study/NCT04324021. 59. Chaomin Wu et al. “Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China,” Journal of The American Medical Association Internal Medicine (March 13, 2020). DOI: 10.1001/jamainternmed.2020.0994. 60. Josh Farkas, COVID-19 Internet Book of Critical Care (EMCrit Project, 2020), https://emcrit.org/ibcc/COVID19/. 61. National Institutes of Health, U.S. National Library of Medicine, “Nitric Oxide Gas Inhalation Therapy for Mild/Moderate COVID-19 (NoCovid),” March 12, 2020. https://clinicaltrials.gov/ct2/show/NCT04305457?cond=NCT04305457&draw=2&rank=1. 62. National Institutes of Health, U.S. National Library of Medicine, “Nitric Oxide Gas Inhalation in Severe Acute Respiratory Syndrome in COVID-19 (NOSARSCOVID),” March 12, 2020. https://clinicaltrials.gov/ct2/show/NCT04306393?cond=NCT04306393&draw=2&rank=1. 63. National Institutes of Health, U.S. National Library of Medicine, “NO Prevention of COVID-19 for Healthcare Providers (NOpreventCOVID),” March 18, 2020. https://clinicaltrials.gov/ct2/show/NCT04312243?cond=NCT04312243&draw=2&rank=1. 64. C.H. Wang et al. “Adjuvant treatment with a mammalian target of rapamycin inhibitor, sirolimus, and steroids improves outcomes in patients with severe H1N1 pneumonia and acute respiratory failure,” Critical Care Medicine 42, no. 2 (2014): 313-321. DOI: 10.1097/CCM.0b013e3182a2727d. 65. Y. Zhou et al. “Network-based drug repurposing for novel coronavirus 2019-nCoV/SARS-CoV-2,” Cell Discovery 6, no. 14 (March 16, 2020): 1-18. DOI: 10.1038/s41421-020-0153-3.

DISCLAIMER: Many personal protective equipment (PPE) are regulated by FDA, NIOSH and other authorities. Government regulations restrict the sale, distribution and donation of PPE without proper authorization. While Premier Healthcare Alliance, L.P., and its affiliates (collectively, “Premier”), are not encouraging the sale or distribution of PPE, etc., individuals or entities that decide to make PPE for personal use or use in clinical or other settings do so at their own risk. Consult local hospital requirements, clinical guidelines for COVID-19 safety or applicable FDA, CDC, NIOSH or other government agency guidelines for additional information or guidance, etc. Premier is not responsible for any errors or omissions, or for the results obtained from the use of the information provided in this communication (the “Information”). The Information is being provided for informational purposes and any use of the Information is at the user’s own risk. Premier is not a health care provider, regulatory agency or manufacturer, and it and its affiliates do not actively monitor or approve any Information and are not responsible or liable for verifying the accuracy of the Information. Premier provide this Information and these materials on an “as is” basis, with no representations or warranties of any kind, including with respect to accuracy, completeness, quality, non-infringement, or fitness for a particular purpose. No representation is made that the Information is free of the rightful claim of any third person by way of infringement or the like. Any use of the Information in violation of any third-party patent or other intellectual property rights, including without limitation those held by affiliates of Premier, is specifically prohibited. Violation of patent or other intellectual property rights may result in the imposition of substantial money damages or other civil remedies against you, as well as potential criminal penalties. Premier will not be liable for any damages of any kind arising from the use of, or reliance on, any Information made available to you by Premier including but not limited to direct, indirect, incidental, consequential, special or punitive damages. All other rights reserved. By accessing Premier’s websites, including this page, you agree to be bound by the full Terms & Conditions. See the full Terms & Conditions at www.premierinc.com/terms-conditions.

Premier Continuum of Care | June 2020 5 This is an advertisement.

6 | Insight Introducing the Premier Continuum of Care Biosimilars Program Giving alternate site healthcare providers the tools needed to thrive in the era of biosimilars Eric Rodriguez, Director, Corporate Communications, Premier Alternate Site Programs

Premier Continuum of Care | June 2020 7 As key biologics continue to lose disparities in reimbursement between Enter the Premier their patent protections,1 biosimilars are biosimilars and their reference products poised to play a vital role in reshaping — such as the removal of the biosimilar Continuum of Care (COC) treatment options for some of the most exclusion from the Medicare Part D Biosimilars Program complex, chronic illnesses. In addition to coverage gap discount program4 — The Biosimilars Calculator producing clinically equivalent outcomes financial hurdles remain. For instance, When evaluating the savings potential to their reference products, biosimilars many private payers list innovator of a biosimilar, providers must examine are also projected to help lower overall biologics (i.e. the original, branded the initial acquisition cost, possible healthcare costs. drugs) as their preferred agents and conversion opportunities, and payer require a different prior authorization This paradigm shift is creating new reimbursement rates. To help alternate process for the reimbursement of opportunities for alternate site healthcare site healthcare members through this non-preferred formulary products, providers to implement biosimilar multifaceted evaluation process, Premier creating an additional administrative strategies and advance efforts to have recently launched a biosimilars calculator. burden for providers.3 Moreover, some the products included on formularies. To payers will only cover biosimilars if Developed with extensive feedback determine which biosimilars are suitable the patient has an intolerance or an from members, the online-based tool helps for inclusion, providers must evaluate ineffective response to the innovator estimate reimbursement for contracted both the overall savings opportunity and biologic, presenting yet another biosimilar products from the Centers the specific value proposition offered by challenge for providers looking to switch for Medicare & Medicaid Services (CMS) each product. to a specific biosimilar.3 and from private payers. Once members input dosage requirements and negotiated “Although biosimilars are projected reimbursement rates for the biosimilar The Current Biosimilars to be priced up to 30 percent below their products in question, the system Landscape branded counterparts, today’s intricate generates estimated reimbursement According to a 2018 report published biosimilar reimbursement landscape for that specific product and dose. The by RAND Health Quarterly, biosimilars has created a situation where biosimilar calculations are based on the number of offer a total savings potential of $54 adoption doesn’t automatically lead to contract units entered (see Figure 1). enhanced post-reimbursement value,” billion from 2017 to 2026.2 However, “One key benefit of the calculator is that says John Klosek, Senior Vice President, realizing these savings will require it provides members with an estimation Alternate Site Contract and Clinical providers to overcome potential of potential revenue/loss before the drug is Services, Premier. “When it comes to industry-related constraints and adopt bought and administered,” says Liya biosimilars, providers must keep up-to- biosimilars more readily than in the past. Davydov, PharmD, BCPS, BCGP, Vice date on the changing reimbursement One of the most significant obstacles to President, Alternate Site Clinical Pharmacy policies of each payer in order to the uptake of biosimilars during the last Services, Premier. “By using the tool, continue providing high-quality, three years has been reimbursement.3 members will be able to preserve their low-cost patient care.” While policy changes have been existing business model, while ensuring proposed or enacted to help ameliorate that their patients are being treated in the most cost-effective fashion without sacrificing efficacy of a provided Figure 1: Biosimilars Contract Advantage Calculator treatment.” Drug Name How does the calculator work? To view reimbursement estimates, Private Plan Reimbursement Per J-Code Per Billing Units members must: 1. Choose a drug from the drop-down menu. Dosage 2. Enter the amount the commercial payer of the patient pays for one billing unit of the drug (based on the HCPCS code Medicare Part B Reimbursement Rate Private Plan Reimbursement Rate description, provided for the biosimilar Billing Units Billing Units next to the entry box). Reimbursement Per Billing Unit Reimbursement Per Billing Unit 3. Select the number of contract units

Differential Per Billing Unit Differential Per Billing Unit needed for the patient. Contract Units Contract Units Once this data is entered, the calculator Reimbursement Per Contract Unit Reimbursement Per Contract Unit will then automatically generate two sets of

Differential Per Contract Unit Differential Per Contract Unit results: reimbursement by CMS (Medicare Part B) and private plan reimbursement (a Differential Per Dosage Differential Per Dosage member’s private negotiated plan rate).

All information contained herein is rounded up to the nearest two decimal points and is subject to change “The generated calculations are based on with or without notice. Premier’s contracted price at the time when

8 | Insight Figure 2: U.S. Biosimilars in the Alternate Site Healthcare Setting (Premier Contracted & Non-Contracted Biologic Products)

Tumor necrosis Therapeutic Hematopoietic agent Anti-neoplastic agent class factor blocker Biosimilars • Zarxio • Fulphila • Retacrit • Inflectra • Truxima • Mvasi • Kanjinti • Nivestym • Udenyca • Renflexis • Ruxience • Zirabev • Ogivri on contract • Ziextenzo • Trazimera • Herzuma • Ontruzant

** *** **** Reference • Neupogen • Neulasta • Procrit • Remicade N/A N/A N/A (filgrastim) (pegfilgrastim) (Epoetin (infliximab) biologic/ [Amgen] [Amgen] Alfa) [J&J] [J&J] manufacturer • N/A* N/A marks the original reference biologics that are NOT on contract with Premier at this time (note: please refer to the corresponding asterisks below for non-contracted original reference biologic product/manufacturer information). The rest of the listed reference biologics in the table above are currently on contract with Premier for various classes of trade. Additonally, the drugs highlighted in red signify biosimilars on contract ONLY for the Physician Practice class of trade (COT). *Epogen (epoetin alfa); Amgen [visit https://www.epogen.com/ for more information]. **Rituxan (rituximab); Genentech [visit https://www.rituxan.com/ for more information]. *** Avastin (bevacizumab); Genentech [visit https://www.avastin.com/ for more information]. **** Herceptin (trastuzumab); Genentech [visit https://www.herceptin.com/hcp.html for more information]. the inquiry is being made,” notes Davydov. “If a negotiated price isn’t currently DID YOU KNOW? available for a particular class of trade, then Premier offers alternate site healthcare members an entire suite of clinical the calculator will automatically pull in calculators. In addition to biosimilars, we currently provide calculators for the wholesale acquisition cost (WAC) of the contracted IVIG and hemophilia products. To learn more about our suite of drug and clearly indicate that WAC is being clinical calculators, please contact your representative at 888.258.3273 or used for the calculations that are generated.” email [email protected]. The Premier COC Biosimilars Portfolio is a necessary component of building a taken off. These important ewn drugs not When examining the financial impact successful biosimilar strategy, Premier has only offer expanded therapeutic options for that a biosimilar product will have on an developed a number of educational offerings chronically ill patients, they also represent organization, it’s vital to understand the and training resources to help alternate site an enormous opportunity for alternate site setting in which a biosimilar is administered, healthcare members on that front. healthcare providers to manage costs and since reimbursement models and acquisition “Our biosimilar-specific educational bring additional value to their patients. costs fluctuate based on sites of care. “With a offering is designed to address common Klosek sums it up: “The time is now for growing number of biosimilars in the pipeline misconceptions and highlight information providers to establish a biosimilars strategy. that are used in the alternate site healthcare regarding the approval pipeline, efficacy, and To be successful in this endeavor, alternate setting, reimbursement becomes even more safety,” notes Davydov. “As is customary for site leaders need to proactively take steps to complex, and therefore, even more important our valued-added CE-accredited educational ensure their organization truly understands for organizations to fully understand in terms programs, information is presented via a the market dynamics at play, including of the potential cost savings that could be number of modalities, including monthly pricing strategies, payer and reimbursement generated,” Klosek explains. teleconferences, in-person programming, influences, and regulatory policies.” and written educational programs.” Since 2015, Premier has been working Premier offers alternate sitehealthcare closely with the manufacturers of Is Your Organization members comprehensive resources to biosimilars coming to market to successfully help support their biosimilar evaluation gain a contract position for various Prepared for the Era of and strategy development. For more alternate site classes of trade (see Figure 2 Biosimilars? information about our biosimilars for currently contracted biosimilars). “In With contending biosimilar versions program, suite of clinical calculators, or a market which was once slow to add new of game-changing biologics already on the complimentary CE member offerings, products, there has recently been a flurry market, the era of biosimilars has officially contact us today. of activity that we anticipate will continue throughout the rest of the year,” says Klosek. REFERENCES “As of June 2020, there are 27 biosimilars 1. Suzanne Elvidge, “Why biosimilars could be market disruptors,” BiopharmaDive.com, January 23, 2017. https:// approved, yet due to patent litigation, not all www.biopharmadive.com/news/why-biosimilars-could-be-market-disruptors/434392/. 2. Andrew W. Mulcahy et al, “Biosimilar Cost Savings in the United States: Initial Experience and Future have been able to enter the market.” Potential,” Rand Health Quarterly 7, no. 4: 3 (Epub: March 30, 2018). https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6075809/. Continuing Education (CE) 3. James Smeeding et al, “Biosimilars: Considerations for Payers,” P & T 44, no. 2 (January 2019): 54-63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355057/. Understanding that prescriber and 4. Barbara A. Gabriel, “Medicare Part D Discounts Now Cover Biosimilar Drugs,” AARP.org, February 20, 2018. pharmacist confidence in biosimilars https://www.aarp.org/health/medicare-insurance/info-2018/biologics-save-money-fd.html. Premier Continuum of Care | June 2020 9 Category Spotlight: COVID-19 Recovery Portfolio

As parts of the country gradually re-open in the wake of PPE & Medical Supplies COVID-19, healthcare practices face pressure to quickly adapt to (face masks, face shields, a new reality. Your organization needs a strategy to: gloves, infrared & touchless thermometers) Help ensure the safety of your employees Sanitizing Products and patients (hand sanitizer, soaps, wipes & disinfectants) Strive to meet expectations for higher levels of cleanliness Touchless Products throughout your facilities (door entry, faucets & soap dispensers) Work to reduce the need for contact to the greatest extent possible Shield Protectors and Barriers

As your group purchasing organization (GPO), we understand that organizations like yours may need our support more than Foodservice Disposables ever. We value the trust you have placed in us and want you (paper goods, food and beverage to know that we stand ready to help. Through our purchasing containers & dispensers) program and stockd®, Premier’s online marketplace, your organization has access to an available supply of items you’ll need to get back in business:* *Access to products are subject to availability from suppliers.

10 | Insight Group Purchasing Contracts/stockd Product Listing

Contract Contract Title Contracted Supplier Contract Number Expiration Date PERSONAL PROTECTIVE EQUIPMENT (PPE) SUPPLIES 3 Ply Disposable Masks stockd Marketplace CLICK HERE >

Black Nitrile General Purpose Gloves stockd Marketplace CLICK HERE >

Disposable Non-Sterile Protective Amd-Ritmed PP-NS-1186 11/30/21 Apparel Encompass Group PP-NS-1188 11/30/21 O&M Halyard PP-NS-1189 11/30/21 S2S Global PP-NS-1191 11/30/21 Sloan Medical PP-NS-1192 11/30/21 Tronex International PP-NS-1193 11/30/21 Welmed PP-NS-1194 11/30/21 Exam Gloves Ansell Healthcare Products PP-NS-1225 04/30/22 Innovative Healthcare Corporation PP-NS-1228 04/30/22 Medgluv PP-NS-1229 04/30/22 O&M Halyard PP-NS-1227 04/30/22 PlatinumCode CO-NS-106 10/31/20 S2S Global PP-NS-1231 04/30/22 Sempermed PP-NS-1232 04/30/22 Tronex International PP-NS-1233 04/30/22 Face Shields stockd Marketplace CLICK HERE >

Goggles stockd Marketplace CLICK HERE >

Gowns stockd Marketplace CLICK HERE >

KN95 Masks stockd Marketplace CLICK HERE >

Physical Therapy Products & Performance Health Supply PP-NS-1299 02/28/23 Exercise Equipment Reusable Textiles & Textile Services American Dawn PP-FA-702 11/30/21 Calderon Textiles PP-FA-703 11/30/21 CareandWear II PP-FA-704 11/30/21 Encompass Group PP-FA-705 11/30/21 GoBioMed CO-FA-102 10/26/20 Hinson & Hale Medical Technologies PP-FA-706 11/30/21 Phoenix Textile Corporation PP-FA-708 11/30/21 Standard Textile Co. PP-FA-709 11/30/21 Surgical & Isolation Masks GM Nameplate CO-OR-104 10/31/20 GoBioMed CO-OR-120 10/31/20 Key Surgical CO-OR-101 10/19/20 Label Source CO-OR-109 10/31/20 Mobility Exchange CO-OR-110 10/31/20 O&M Halyard PP-OR-1691 12/31/22 PlatinumCode CO-OR-107 10/31/20 Precept Medical Products PP-OR-1692 12/31/22 Prestige Ameritech PP-OR-1689 12/31/22

Premier Continuum of Care | June 2020 11 Contract Contract Title Contracted Supplier Contract Number Expiration Date Surgical & Isolation Masks Project Graphics CO-OR-116 10/31/20 (continued) S2S Global PP-OR-1688 12/31/22 Surain Industries CO-OR-113 10/31/20 Tidi Products PP-OR-1690 12/31/22 Thermometry GoBioMed CO-NS-123 10/31/20 Vinyl General Purpose Gloves stockd Marketplace CLICK HERE >

DISINFECTANT/SANITIZING PRODUCTS Bottled Hand Sanitizer stockd Marketplace CLICK HERE >

Electrical & Plumbing Building Materials Wesco PP-FA-595 04/30/22 Fire & Life Safety Products & Services Life Safety Services PP-FA-741 06/30/22 Hospitality Supplies, Equipment & American Hotel Register Company PP-FA-798 02/28/23 Distribution Housekeeping Products Betco PP-FA-635 04/30/21 Diversey PP-FA-636 04/30/21 Midlab Incorporated PP-FA-637 04/30/21 Procter & Gamble Distributing PP-FA-638 04/30/21 Spartan Chemical Co. PP-FA-639 04/30/21 Wexford Labs PP-FA-640 04/30/21 Intermediate-Level Disinfectant Wipes Certol International PP-NS-1026 04/30/21 Clorox PP-NS-1345 04/30/23 Diversey PP-NS-1347 04/30/23 Metrex Research Corporation PP-NS-1346 04/30/23 Professional Disposables International PP-NS-1344 04/30/23 (PDI) Laundry Products & Maintenance Betco PP-FA-719 12/31/21 Diversey PP-FA-720 12/31/21 Gurtler Industries PP-FA-721 12/31/21 Procter & Gamble Distributing PP-FA-722 12/31/21 Spartan Chemical Co. PP-FA-723 12/31/21 State Industrial Products PP-FA-724 12/31/21 UNX Incorporated PP-FA-725 12/31/21 Maintenance, Repair & Operations AirSupply Tools PP-FA-590 04/30/22 WW Grainger PP-FA-591 04/30/22 Microfiber Products, Mats & Accessories American Dawn PP-FA-654 01/31/21 Aramark Uniform and Career Apparel PP-FA-690 01/31/21 Cintas Corporation PP-FA-656 01/31/21 Contec PP-FA-657 01/31/21 Encompass Group PP-FA-658 01/31/21 Phoenix Textile Corporation PP-FA-659 01/31/21 S2S Global PP-FA-605 01/31/21 Standard Textile Co. PP-FA-660 01/31/21 Unifirst Corporation PP-FA-691 01/31/21 Non-healthcare Soaps, Lotions & Betco PP-FA-668 04/30/21 Waterless Rinses Buckeye International PP-FA-675 04/30/21 Diversey PP-FA-670 04/30/21

12 | Insight Contract Contract Title Contracted Supplier Contract Number Expiration Date Non-healthcare Soaps, Lotions & Essity PP-FA-671 04/30/21 Waterless Rinses Kimberly-Clark PP-FA-674 04/30/21 (continued) Office Supplies & Business Services American Office Products Distributors PP-MM-479 07/31/20 FriendsOffice PP-MM-476 07/31/20 Guy Brown PP-MM-477 07/31/20 Office Depot PP-MM-481 07/31/20 Staples PP-MM-480 07/31/20 Paper & Janitorial Supply Distribution Afflink PP-FA-606 10/31/20 Network Services Company PP-FA-607 10/31/20 Office Depot PP-FA-608 10/31/20 Strategic Market Alliance PP-FA-609 10/31/20 The Home Depot Pro PP-FA-610 10/31/20 Triple S PP-FA-611 10/31/20 Room Environment Infection American Green Technology PP-MM-496 01/31/21 Prevention Products Diversey PP-MM-673 03/31/21 Patho3gen Solutions (fka Green Earth PP-FA-810 03/31/21 Medical Solutions) Surfacide PP-MM-501 03/31/21 TMG Health Technologies PP-FA-816 03/31/21 TOMI Environmental Solutions PP-MM-502 03/31/21 Tru-D Smart UVC PP-MM-503 03/31/21 UltraViolet Devices (fka Clorox Sales PP-MM-497 03/31/21 Company) Xenex Disinfection Services PP-MM-504 03/31/21 Service Awards & Positive Promotions PP-MM-739 08/31/22 Promotional Products Soaps, Lotions & Waterless GoBioMed CO-NS-105 10/26/20 Hand Rinses SC Johnson Professional PP-NS-1085 09/30/20 Warewashing Chemicals & Related Ecolab PP-DI-1611 04/30/22 Products TOUCHLESS/BARRIER PROTECTION Cubicle Curtains, Tracks & Cube Care Company PP-FA-711 11/30/21 Privacy Screens Encompass Group PP-FA-712 11/30/21

Silentia PP-FA-716 11/30/21 Custom Solutions Mobility Exchange PP-IT-230 06/30/22 Doors, Frames & Hardware ASSA ABLOY Sales and Marketing Group PP-FA-663 12/31/21 Foodservice Equipment & Supplies Edward Don & Company PP-DI-1734 05/31/23 Distribution & Kitchen Design Services Hubert Company PP-DI-1736 05/31/23 Interior & Exterior Signage Berry and Homer PP-FA-787 02/28/23 Low Voltage Systems Accu-Tech Corporation CC-IT-007 07/31/22 Paper Towels, Tissues & Dispensers Carlisle Foodservice Products PP-FA-771 09/30/22 Essity PP-FA-768 09/30/22

Georgia-Pacific PP-FA-769 09/30/22

Kimberly-Clark PP-FA-770 09/30/22

Premier Continuum of Care | June 2020 13 Contract Contract Title Contracted Supplier Contract Number Expiration Date FACILITY/LAUNDRY PRODUCTS & SERVICES Air Filtration Products AAF International PP-FA-686 08/31/21 Camfil PP-FA-687 08/31/21 Koch Filter Corporation PP-FA-688 08/31/21 Tri-Dim Filter Corp. PP-FA-689 08/31/21 Can Liners I.B.S. Solutions Corporation PP-FA-600 07/31/20 Novolex Holdings PP-FA-599 07/31/20 Plastics Solutions PP-FA-601 07/31/20 Environmental & Aramark Uniform and Career Apparel PP-SV-211 03/31/22 Facility Management Services FacilitySource PP-SV-212 03/31/22 Medtegrity Medical Laundry PP-SV-216 03/31/22 Sodexo Operations PP-SV-214 03/31/22 LAB TESTING Clinical Reference Laboratory NeoGenomics Laboratories PP-LA-485 09/30/23 Testing Services Quest Diagnostics Incorporated PP-LA-486 09/30/23 THERMAL SCANNING SOLUTIONS Custom Solutions Mobility Exchange (Temperature & environmental monitoring sensors and PP-IT-230 06/30/22 cameras) Hardware & Software Resellers PC Connection (Advantech infection prevention solution with video AI PP-IT-164 10/31/20 integration; Meridian temperature verification kiosk) Low Voltage Systems Accu-Tech Corporation (Herring technology mobile camera with thermal CC-IT-007 07/31/22 imaging) WW Grainger (Infrared smart phone Maintenance, Repair & Operations PP-FA-591 04/30/22 adapters) Office Depot (Tidel intelligent entry Office Supplies & Business Services PP-MM-481 07/31/20 scanner) Staples (Meridian temperature PP-MM-480 07/31/20 verification kiosk) Paper & Janitorial Supply Distribution The Home Depot Pro (Meridian temperature verification kiosk; Tauri PP-FA-610 10/31/20 series temperature-check tablets) PULSE OXIMETRY Pulse Oximetry & Capnography Devices Masimo Americas PP-MM-615 04/30/21 Smiths Medical ASD PP-MM-612 04/30/21 FOODSERVICE DISPOSABLES Foodservice Disposables Anchor Packaging PP-DI-1633 06/30/22 Cascades PP-DI-1639 06/30/22 Dart PP-DI-1629 06/30/22 Eco-Products PP-DI-1632 06/30/22 Georgia-Pacific PP-DI-1631 06/30/22 Handgards PP-DI-1638 06/30/22 Hoffmaster PP-DI-1636 06/30/22 Pactiv PP-DI-1630 06/30/22 S2S Global PP-DI-1637 06/30/22 Sabert PP-DI-1635 06/30/22 US Foods PP-DI-1640 06/30/22 WNA PP-DI-1634 06/30/22

14 | Insight Contract Contract Title Contracted Supplier Contract Number Expiration Date REMOTE WORK IT SERVICES/SOLUTIONS Call Center Services AnswerNet PP-SV-241 09/30/22 Voice Products PP-SV-244 09/30/22 Credit Card Services Sun Communications PP-SV-184 02/28/23 Hardware & Software Insight PP-IT-166 10/31/20 Resellers PC Connection PP-IT-164 10/31/20 Zones PP-IT-165 10/31/20 Managed Print Services, Konica Minolta PP-IT-222 07/31/22 Devices & Accessories REMOTE WORK TRANSPORTATION SERVICES Ride Sharing Services Kaizen Health PP-SV-226 01/31/21 Lyft PP-SV-189 01/31/21 STAFFING Workforce Solutions - Staffing AMN Healthcare PP-SV-175 03/31/25 TELEHEALTH SOLUTIONS Television Hardware Software Telehealth Services PP-FA-794 02/28/23 Custom Solutions Mobility Exchange PP-IT-230 06/30/22

Eligibility is subject to supplier approval. While every reasonable effort has been made to make this listing accurate, information changes rapidly and Premier makes no guarantees of any kind, including guarantees as to the accuracy of this listing. The listing is for informational purposes only and does not create a legal agreement or place any obligations on Premier.

For real-time COVID-19 updates, please visit Premier’s COVID-19 response webpage, our Disaster Response Community on PremierConnect, and the Premier Safety Institute®.

Premier Continuum of Care | June 2020 15 +

16 | Insight