Specialty Pipeline Update

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1 CLINICAL SOLUTIONS Drug Insights > September 2015 Specialty Pipeline Update New Drug Information Xuriden (uridine triacetate): The Food and Drug Administration (FDA) approved Wellstat Therapeutics oral therapy for the treatment of hereditary orotic aciduria, a condition that has been reported in approximately 20 patients worldwide. 1 Xuriden is a uridine replacement product. Lonsurf (trifluridine/tipiracil): Otsuka received FDA approval for their orally administered oncology drug to treat advanced colorectal cancer in patients who are no longer responding to other therapies. Nuwiq (Factor VIII, recombinant): The FDA approved Octapharma s Factor VIII for the on-demand treatment and prophylaxis of bleeding in hemophilia A patients. Nuwiq has been approved in other countries prior to FDA approval. New Indication Humira (adalimumab): AbbVie s Humira received FDA approval for the treatment of moderate to severe hidradenitis suppurativa (HS). HS is a chronic skin condition that features lumps under the skin that can be pea to marble sized. Humira is the first drug to obtain FDA approval for this indication. September News The FDA has awarded priority review status to Sarepta Therapeutics eteplirsen. The regulatory go sign means Sarepta is still tucked in just behind BioMarin in the race to bring a therapy for Duchenne muscular dystrophy (DMD) to market, with analysts tipping the agency to make a decision on both drugs by the end of the year. 2 Bristol-Myers Squibb Company announced updated results from the Opdivo (nivolumab)+yervoy (ipilimumab) arms in CheckMate -012, a multiarm Phase 1b trial evaluating Opdivo in patients with chemotherapy-naïve advanced non-small cell lung cancer (NSCLC). In this study, Opdivo was administered as monotherapy or as part of a combination with other agents, including Yervoy, at different doses and schedules. 3 The Institute for Clinical and Economic Review (ICER) has released a new draft report, titled PCSK9 Inhibitor Therapies for High Cholesterol: Effectiveness, Value, and Value-Based Price Benchmarks. The report includes a comprehensive review of currently available evidence on the newly approved PCSK9 inhibitors alirocumab (Praluent, Regeneron/ Sanofi) and evolocumab (Repatha, Amgen), and also provides analyses of cost-effectiveness and potential budget impact under different utilization assumptions The results of ICER s analyses indicate that the price that best represents the overall benefits these drugs may bring to patients would be between $3,615 and $4,811, representing a 67% discount off the list price. 4 While the information in this newsletter is from sources we believe to be reliable, we do not warrant that the information in this document is free from error. Use it only as a guide. Statements regarding drugs or manufacturers are not intended as promotion; those statements should not be used to make assumptions about formulary status. Each trademarked drug name is the property of its respective owner.

2 Drug Insights > Specialty Pipeline Update Page 3 Specialty New Product Approvals in the Past Twelve Months Generic Name Brand Name Manufacturer Indication(s) Route of Administration Date Approved* Factor VIII, recombinant Nuwiq Octapharma Hemophilia A Intravenous September 2015 uridine triacetate Xuriden Wellstat Therapeutics Hereditary orotic aciduria Oral September 2015 dichlorphenamide Keveyis Taro Primary hyperkalemic and Oral August 2015 hypokalemic periodic paralysis evolocumab Repatha Amgen High cholesterol SC August 2015 daclatasvir Daklinza BMS Hepatitis C (genotype 3) Oral July 2015 ombitasvir, paritaprevir, Technivie AbbVie Hepatitis C (genotype 4) Oral July 2015 ritonavir with ribavirin alirocumab Praluent Sanofi-Genzyme High cholesterol SC July 2015 lumacaftor/ivacaftor Orkambi Vertex Cystic Fibrosis Oral July 2015 coagulation factor IX (recombinant) Ixinity Emergent BioSolutions Hemophilia B Intravenous May 2015 glatiramer Glatopa Sandoz Multiple sclerosis SC April 2015 deferasirox Jadenu Novartis Chronic iron overload Oral April 2015 raltegravir/lamivudine Dutrebis Merck HIV Oral March 2015 cholic acid Cholbam Asklepion Pharmaceuticals filgrastim-sndz (biosimilar to Neupogen ) Bile acid synthesis disorders Oral March 2015 Zarxio Sandoz Neutropenia Intravenous March 2015 darunavir/cobicistat Prezcobix Janssen HIV Oral February 2015 atazanavir/cobicistat Evotaz BMS HIV Oral February 2015 ferric pyrophosphate citrate Triferic Rockwell Medical Iron replacement Intravenous recombinant human parathyroid hormone Natpara NPS Pharmaceuticals Hypoparathyroidism Intravenous secukinumab Cosentyx Novartis Plaque psoriasis Subcutaneous injection ABT-450, ritonavir, ombitasvir (one pill) + dasabuvir Viekira AbbVie Hepatitis C (genotypes 1a and 1b) January 2015 January 2015 January 2015 Oral December 2014 pasireotide Signifor LAR Novartis Acromegaly IM (monthly) December 2014 alemtuzumab Lemtrada Sanofi Multiple sclerosis Intravenous November 2014 recombinant factor VIII Obizur Baxter Hemophilia A Intravenous November 2014 tacrolimus Envarsus Veloxis Pharmaceuticals Immunosuppression in Oral October 2014 kidney transplant ledipasvir/sofosbuvir Harvoni Gilead Hepatitis C Oral October 2014 pirfenidone Esbriet Roche/Intermune Idiopathic pulmonary fibrosis Oral October 2014 nintedanib Ofrev Boehringer Ingelheim Idiopathic pulmonary fibrosis Oral October 2014

3 Drug Insights > Specialty Pipeline Update Page 4 New Indications for Approved Specialty Products Generic Name Brand Name Manufacturer New Indication Date Approved* adalimumab Humira AbbVie For the treatment of moderate to severe September 2015 hidradenitis suppurativa cysteamine Procysbi Raptor Pharmaceuticals Pediatric nephropathic cystinosis in patients ages August years old abobotulinumtoxin A Dysport Ipsen Treatment of upper limb spasticity in adults July 2015 sirolimus Rapamune Pfizer To treat lymphangioleiomyomatosis May 2015 aflibercept Eylea Regeneron To treat diabetic retinopathy April 2015 onabotulinumtoxin A Botox Allergan Treatment of upper limb spasticity in adults April 2015 ivacaftor Kalydeco Vertex For use in children aged 2-5 years who have March 2015 one of 10 mutations in the cystic fibrosis transmembrane conductance regulator gene ranibizumab Lucentis Roche Treatment of diabetic retinopathy in patients February 2015 with diabetic macular edema ivacaftor Kalydeco Vertex For patients with mutation R117H January 2015 lanreotide Somatuline Depot Ipsen Pharma Gastroenteropancreatic neuroendocrine tumors December 2014 simeprevir Olysio Johnson & Johnson To be used in combination with Sovaldi for the November 2014 treatment of hepatitis C aflibercept Eylea Regeneron Macular edema following retinal vein occlusion October 2014

4 Drug Insights > Specialty Pipeline Update Page 5 Oncology Product Approvals in the Past Twelve Months Generic Name Brand Name Manufacturer Indication(s) Route of Administration Date Approved* trifluridine/tipiracil Lonsurf Otsuka Colorectal cancer Orals September 2015 gefitinib Iressa AstraZeneca Non-small cell lung cancer Oral July 2015 sonidegib Odomzo Novartis Basal cell carcinoma Oral July 2015 dinutuximab Unituxin United Therapeutics Neuroblastoma Intravenous March 2015 panobinostat Farydak Novartis Multiple myeloma Oral February 2015 palbociclib Ibrance Pfizer Breast cancer Oral February 2015 lenvatinib Lenvima Eisai Thyroid cancer Oral February 2015 nivolumab Opdivo BMS Advanced melanoma Intravenous December 2014 olaparib Lynparza AstraZeneca Ovarian cancer Oral December 2014 blinatumomab Blincyto Amgen Philadelphia chromosomenegative precursor B-cell acute lymphoblastic leukemia (ALL) Intravenous December 2014

5 Drug Insights > Specialty Pipeline Update Page 6 New Indications for Approved Oncology Drugs Generic Name Brand Name Manufacturer New Indication Date Approved* brentuximab vedotin Adcetris Seattle Genetics To treat patients at high risk of relapse immediately after an autologous hematopoietic stem cell transplant (HSCT) to help prevent progression of the disease carfilzomib Kyprolis Onyx/Amgen To be used in combination with lenalidomide and dexamethasone for the treatment of patients with relapsed multiple myeloma who have received one to three prior lines of therapy ramucirumab Cyramza Eli Lilly For use as a second-line treatment option for metastatic colorectal cancer August 2015 July 2015 April 2015 nivolumab Opdivo BMS Advanced non-small cell lung cancer March 2015 ibrutinib Imbruvica Johnson & Johnson Waldenström's macroglobulinemia February 2015 lenalidomide Revlimid Celgene First-line treatment for multiple myeloma February 2015 ruxolitinib Jakafi Incyte Polycythemia vera December 2014 ramucirumab Cyramza Eli Lilly Metastatic non-small cell lung cancer December 2014 bevacizumab Avastin Roche In combination with other chemotherapy to treat platinum-resistant recurrent ovarian cancer bortezomib Velcade Millennium Pharmaceuticals November 2014 Previously untreated patients with mantle cell lymphoma October 2014

6 Drug Insights > Specialty Pipeline Update Page 7 Pipeline Watch Generic Name Brand Name Manufacturer Indication(s) Route of Administration Anticipated FDA Decision Date* pegfilgrastim N/A Apotex Neutropenia (biosimilar to Intravenous 3Q 2015 Neulasta ) infliximab Remsima Celltrion Multiple indications Intravenous 4Q 2015 (biosimilar to Remicade ) filgrastim Grastofil Apotex Neutropenia (biosimilar to Intravenous October 2015 Neupogen ) talimogene N/A Amgen Metastatic melanoma Injection October 2015 laherparepvec Factor X concentrate Coagadex BioPorducts Laboratory Factor X deficiency Intravenous October 2015 emtricitabine/tenofovir N/A Gilead HIV oral November 2015 alafenamide elvitegravir/cobicistat/ N/A Gilead HIV oral November 2015 emtricitabine elvitegravir/cobicistat/ N/A Gilead HIV oral November 2015 emtricitabine/tenofovir alafenamide mepolizumab Nucala GlaxoSmithKline Eosinophilic asthma SC November 2015 cobimetinib N/A Genentech Metastatic melanoma Oral November 2015 epoetin alfa Retacrit Hospira Anemia (biosimilar to Procrit ) Intravenous November 2015 HIV-therapeutic vaccine Remune Immune Response HIV Injection November 2015 daclizumab high-yield process Factor VIII, recombinant, pegylated Zinbryta Biogen/AbbVie Multiple sclerosis SC December 2015 Adynovate Baxalta Hemophilia A Intravenous December 2015 sebelipase alfa Kanuma Synageva Enzyme replacement therapy Intravenous December 2015 asfotase alfa Strensiq Alexion Enzyme replacement therapy SC December 2015 albutrepenonacog alfa [coagulation Factor IX] N/A CSL Behring Hemophilia B Intravenous December 2015 Recombinant Factor VIII Kovaltry Bayer Hemophilia A Intravenous December 2015 selexipag Uptravi Actelion Pulmonary arterial Oral December 2015 hypertension vonicog alfa N/A Baxter Von Willebrand disease Intravenous December 2015 drisapersen N/A BioMarin Duchenne s muscular dystrophy SC December 2015 * Anticipated approval dates are predictions made by Prime Therapeutics based on industry information.

7 Drug Insights > Specialty Pipeline Update Page 8 Watch List Criteria for inclusion on the Watch List include: Drug is submitted to the FDA and is anticipated to have material impact to trend and/or material impact to preferred product strategies (medical or pharmacy). Brand (generic)/ manufacturer Uptravi (selexipag)/ Actelion drisapersen/biomarin eteplirsen/sarepta Therapeutics Proposed indication/ route of administration Pulmonary arterial hypertension (PAH)/Oral Duchenne s muscular dystrophy (SC) Duchenne s muscular dystrophy (IV) Anticipated approval (PDUFA date) 12/22/2015 Similar products (by indication) Orenitram PDE-5 inhibitors and ERAs Spend* Net new impact to PMPM* pharmacy benefit $-$$ $-$$ none 12/27/2015 None $-$$ $-$$ none 2/26/2016 None $-$$ none $ *Notations: $ < $0.08 per member per month (PMPM), $$ = $0.08-$0.39 PMPM, $$$ = $0.40- $2.00 PMPM, $$$$ > $2.01 PMPM Net new impact to PMPM* medical benefit References B1 Prime Therapeutics LLC 09/15

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