Patient Claims Databases

Onyx Pharmaceuticals Multiple Myeloma ReportTM, © Onyx 2013 Data source: IMS Health © 2013 0413-ONYX-261Onyx Pharmaceuticals Multiple Myeloma ReportTM, © Onyx 2013 Data source: IMS Health © 20131


Patient Claims DatabasesPhysician Office and Hospital Outpatient Settings

• The IMS Health analysis of claims data focuses specifically on patients diagnosed with multiple myeloma. These data are obtained from CMS-1500 medical forms and include patient-level diagnoses and procedures for visits to U.S. office-based physicians, ambulatory, general health care sites, and hospitals. The CMS-1500 form is the standard reimbursement form for all non-cash claims. This includes all third-party payers, Medicare, and Medicaid.

• The reporting period is for calendar year 2010 through calendar year 2012, with a look back through the patient’s medical history to assign cancer diagnoses. Patients diagnosed and treated for multiple myeloma were tracked if they received chemotherapy. Patients diagnosed with multiple myeloma but not receiving chemotherapy were included if they visited practitioners in the reporting year who potentially could administer chemotherapy (Oncologists or Hematologists). All patients receiving therapy were included regardless of the specialty of the physician providing the therapy.

• Physician office charges include only those drug charges administered in that setting (i.e., chemotherapy, supportive care, steroids). If there is a lab component, this would also be captured, along with administrative service charges. Medication charges incurred in a physician office are usually paid at contracted rates, which can be lower than billed charges. With more than two-thirds of myeloma patients treated in the physician office setting covered by Medicare, physician offices are also disproportionately affected by corresponding Medicare reimbursement rates. As of April 2013, separately paid drugs in physician offices were reimbursed at ASP + 4.3%, reduced from 6.0% in 2012.

• In addition to drug charges, hospital outpatient charges incorporate other aspects of care (i.e., pharmacy, imaging, provider services). Although hospitals and physician offices use the same billing codes, rates still differ. Due to economies of scale and stronger relationships with group purchasing organizations, hospitals generally pay less for chemotherapy drugs and are reimbursed at lower rates.


Hospital Procedure/Diagnosis (HPD) Discharge Data

Inpatient Setting:

• This database contains an extensive set of hospital inpatient and outpatient discharge records, including actual diagnoses and procedures data for about 75% of all hospital discharges nationwide (including 100% of Medicare-reimbursed discharges).

• IMS uses Medicare procedure counts and additional hospital-level information to estimate procedure counts for the remaining 25% of discharges—the non-Medicare hospital discharge information in non-reporting states.

• The hospital inpatient data will include three years of data and will be current as of calendar year 2011.


2012: Age of MM Patients Treated in Physician Offices vs. Hospital Outpatient Settings, Nation

Setting 0–44 45–64 65+

Physician Office 2.6% 39.5% 57.9%

Hospital Outpatient 4.4% 51.9% 43.7%

Multiple Myeloma Patients: Age

Physician Office and Hospital Outpatient


1 Includes HMOs, PPOs, point-of-service plans and exclusive provider organizations.Note: Physician office charges include only those drug charges administered in that setting (i.e., chemotherapy, supportive care, steroids). If there is a lab component, this would also be captured, along with administrative service charges. Medication charges incurred in a physician office are usually paid at contracted rates, which can be lower than billed charges. With more than two-thirds of myeloma patients treated in the physician office setting covered by Medicare, physician offices are also disproportionately affected by corresponding Medicare reimbursement rates. As of April 2013, separately paid drugs in physician offices were reimbursed at ASP + 4.3%, reduced from 6.0% in 2012. In addition to drug charges, hospital outpatient charges incorporate other aspects of care (i.e., pharmacy, imaging, provider services). Although hospitals and physician offices use the same billing codes, rates still differ. Due to economies of scale and stronger relationships with group purchasing organizations, hospitals generally pay less for chemotherapy drugs and are reimbursed at lower rates.

Physician Office


Physician Office


2012: Number of Cycles per MM Patient Treated in Physician Offices, by Payer

Payer Tampa Florida Southeast Region Nation

Medicare 14.0 11.3 11.8 11.5

Commercial Insurance1 6.3 9.6 9.9 11.1

Medicaid 13.0 12.5 11.6 7.5

1 Includes HMOs, PPOs, point-of-service plans and exclusive provider organizations.

Treatment Patterns: Cycles

Physician Office


2012: Common Complications for MM Patients Treated in the Physician Office1

Complication Tampa Florida Southeast Region Nation

Acute Kidney Failure 13.9% 12.9% 11.5% 10.2%

Hypercalcemia 3.7% 5.4% 4.8% 5.2%

Unspecified Anemia 33.7% 36.2% 32.6% 28.5%

Neutropenia 6.2% 4.3% 5.1% 4.9%

Neuropathy 4.6% 2.4% 2.3% 2.8%

1 A complication is defined as a patient condition caused by the multiple myeloma of the patient. These conditions are a direct result of having multiple myeloma.

Multiple Myeloma Patients: Complications

Physician Office


2012: Annual Charges per MM Patient Treated in the Physician Office, by Common Complication1

Complication Tampa Florida Southeast Region Nation

Acute Kidney Failure $47,190 $34,294 $37,437 $38,386

Hypercalcemia $21,434 $40,203 $40,696 $41,172

Unspecified Anemia $47,417 $39,070 $41,408 $41,377

Neutropenia $24,957 $39,046 $49,714 $42,054

Neuropathy — $49,314 $42,770 $42,188

1 A complication is defined as a patient condition caused by the multiple myeloma of the patient. These conditions are a direct result of having multiple myeloma.

Note: Physician office charges include only those drug charges administered in that setting (i.e., chemotherapy, supportive care, steroids). If there is a lab component, this would also be captured, along with administrative service charges. Medication charges incurred in a physician office are usually paid at contracted rates, which can be lower than billed charges. With more than two-thirds of myeloma patients treated in the physician office setting covered by Medicare, physician offices are also disproportionately affected by corresponding Medicare reimbursement rates. As of April 2013, separately paid drugs in physician offices were reimbursed at ASP + 4.3%, reduced from 6.0% in 2012. In addition to drug charges, hospital outpatient charges incorporate other aspects of care (i.e., pharmacy, imaging, provider services). Although hospitals and physician offices use the same billing codes, rates still differ. Due to economies of scale and stronger relationships with group purchasing organizations, hospitals generally pay less for chemotherapy drugs and are reimbursed at lower rates. Some physician office charge data were unavailable for the selected markets.

Financial Impact: Complications

Physician Office


Note: Hospital outpatient data on this slide are based on all short-term, acute-care, nonfederal hospitals and are effective as of end-of-year 2011. Psychiatric, rehabilitation, and children’s hospitals are excluded.

Hospital Outpatient


Total and Average Number of Outpatient Cases per Hospital, Multiple Myeloma, 2011

Market # of Community Hospitals Avg. Outpatient Cases Total Outpatient Cases

Tampa 30 201.9 6,057

Florida 187 152.9 28,588

Southeast Region 677 124.9 84,547

Nation 4,334 146.9 636,844

Hospital Outpatient

Multiple Myeloma Patients: Case Counts

Note: Hospital data are based on all short-term, acute-care, nonfederal hospitals and are effective as of end-of-year 2011. Psychiatric, rehabilitation, and children’s hospitals are excluded.


Hospital Outpatient


2011: Average Length of Stay (Days) per MM CaseDisease State Tampa Florida Southeast Region Nation

Multiple Myeloma 9.8 8.6 8.5 8.7

Treatment Patterns: Average Length of Stay

Hospital Inpatient

Note: Hospital data are based on all short-term, acute-care, nonfederal hospitals and are effective as of end-of-year 2011. Psychiatric, rehabilitation, and children’s hospitals are excluded.


2011: Charges per Inpatient MM CaseTampa Florida Southeast Region Nation

Multiple Myeloma $102,102 $89,143 $77,785 $85,059

Financial Impact: Charges

Hospital Inpatient

1 Charge data are per-case averages for inpatients with a particular diagnosis of interest. Charges may be for treatment related to other diagnoses.


2011: Top Ten Procedures for Inpatients With a Primary Diagnosis of MM

ICD-9 Code Description Florida Southeast Region Nation

99.04 Transfusion of Packed Cells 31.5% 35.6% 39.0%

41.31 Biopsy of Bone Marrow 24.5% 24.3% 23.5%

99.25 Injection or Infusion of Cancer Chemotherapeutic Substance 22.9% 30.2% 37.5%

41.04 Autologous Hematopoietic Stem Cell Transplant Without Purging 19.1% 22.1% 22.9%

99.05 Transfusion of Platelets 10.3% 13.2% 18.5%

38.93 Venous Catheterization 9.9% 11.0% 12.4%

39.95 Hemodialysis 9.6% 9.2% 8.8%

38.95 Venous Catheterization for Renal Dialysis 6.2% 4.6% 4.5%

38.97 Central Venous Catheter Placement With Guidance 4.9% 4.3% 7.1%

92.29 Other Radiotherapeutic Procedure 4.5% 5.1% 5.5%

Secondary Diagnoses and Procedures

Hospital Inpatient

Documents

Patient Claims Databases