"Return On Education" presentation by HealthEd and Amylin Pharmaceuticals, EXL Digital Pharma West 2011, San Francisco. Presenters: Susan Eno Collins and Susan M. LaRue

1. Return on Education™—Leveraging Patient Education to Improve Treatment Outcomes Susan LaRue, RD,CDE, Clinical Education Specialist, Medical Relations and Information, Amylin Pharmaceuticals, Inc Susan Eno Collins, RD, CHES, SVP, Health Education, HealthEd; Community Leader, SurroundHealth.net

2. Give us the next 30 minutes and we will… Give you an introduction to Return on Education™—a framework you can use to develop effective programs Show you a case study where we incorporated the framework Share the positive results we got Hopefully, answer your questions 6/21/2011 2

3. Return on EducationTM: Starts with a behavior-based approach for developing programs 3 Program Development and Refinement Post (After Program Launch) Pre (In Planning) During (In Development) Uncover Insights Choose Behavior Model Develop Objectives Capture and Analyze Results Launch

4. Education Impact Desired Action And includes a Return on EducationTMframeworkfor evaluating the outcomes of the program 6/21/2011 4 Program/Business Impact Customized based on program objectives Examples include Screening/diagnosis Talking with HCP Fill initial Rx Take Rx as prescribed Conversion Use of device Persuasion (“This is important to me”) + Clarity (“I understand and can apply what I am learning”) + Insight-driven content (“This relates to me and my life”) + Reaction to tactic/program (“This has been worth it. I have learned something new.”) Program Engagement Reach Frequency Business Length on therapy Increased sales Rep access Health Outcomes Symptom alleviation HEDIS measurement Function Clinical measures

5. Case study: Effects of Patient Education Support Program on Pramlintide Adherence

7. Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.

9. The numbers shed light on the product’s challenges 3 Patients taking pramlintide at meal times may already be taking 4 shots of insulin a day Pramlintide becomes 3 additional shots to integrate into a daily routine 50%1 Adherence to medicines across multiple chronic conditions, including diabetes 50% in 2 months2 About 50% of patients starting pramlintide discontinued therapy within 2 months 6/21/2011 8 Sources: 1. World Health Organization: Adherence to long-term therapies: evidence for action. Geneva, World Health Organization, 2003. 2. Data on file. San Diego, CA., Amylin Pharmaceuticals, Inc.

10. Why did patients stop treatment? Their answers revealed a need 6/21/2011 9 Lack of effectiveness (volunteered) Dosing regimen too complicated Did not lose weight Too expensive Side effects (volunteered) Additional injections required Potentially 57% of reasons for discontinuation can be addressed with additional education/realistic expectations Source: Adapted from Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.

11. To develop our program, we started with the Return on EducationTMapproach 10 Program Development and Refinement Post (After Program Launch) Pre (In Planning) During (In Development) Uncover Insights Choose Behavior Model Develop Objectives Capture and Analyze Results Launch

12. Program objectives were based on behavior-change principles Set realistic expectations at the beginning of treatment Build problem-solving and communication skills Increase sense of self-efficacy (“I can do this”) 6/21/2011 11

14. Realistic expectations

15. Hope for improvement

16. Adjustment period/need for flexibility

17. Insulin/appetite changes

18. Weight loss

19. Improved glucose levels, fewer fluctuations

20. Improved AIC

21. Perceived benefits of therapy

22. Increased sense of control of diabetes

23. Weight loss

25. Side effects

26. Therapy disappointment

27. Impact of changes on family dynamics

28. Suboptimal dosing; fewer benefits realized

29. Life demands

30. Lack of healthcare provider support and education

31. Frustration: different routine and considerations

32. Unanticipated hyperglycemia

33. Injection burden and treatment complexity

34. Unexpected side effectsBarriers Barriers

35. Behavior models provide a blueprint for program design 6/21/2011 13 Program designed using Social Cognitive Theory

36. Designed for clarity by integrating health literacy principles 6/21/2011 14 “I have challenges accessing, understanding, and using health information “ “One out of 3 Americans have basic or below basic health literacy skills” Source: National Center for Education Statistics. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. (NCES 2006-483). http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483.

37. Applying the Return on EducationTMapproach to develop the program 15 Program Development and Refinement Post (After Program Launch) Pre (In Planning) During (In Development) Uncover Insights Choose Behavior Model Develop Objectives Capture and Analyze Results Launch

39. Realistic expectations

40. Hope for improvement

41. Adjustment period/need for flexibility

42. Insulin/appetite changes

43. Weight loss

44. Improved glucose levels, fewer fluctuations

45. Improved AIC

46. Perceived benefits of therapy

47. Increased sense of control of diabetes

48. Weight loss

50. Side effects

51. Therapy disappointment

52. Impact of changes on family dynamics

53. Suboptimal dosing; fewer benefits realized

54. Life demands

55. Lack of health care provider support and education

56. Frustration: different routine and considerations

57. Unanticipated hyperglycemia

58. Injection burden and treatment complexity

59. Unexpected side effectsBarriers Barriers

60. To create a holistic, integrated experience 6/21/2011 17 Starting Pramlintide Therapy Maintaining Pramlintide Therapy In-officestarter kit with demo video Welcome kit with goal setting and wellness map Newsletter with expert and patient interviews Share Your Story Newsletters Feedback survey Co-pay card Co-pay card Outbound/inbound calls with nurses 24/7 Information and education Outbound/Inbound calls with nurses 24/7 Information and education

61. Outcomes of a Behaviorally Based Program

62. Did the Return on EducationTMapproach work? 19 Program Development and Refinement Post (After Program Launch) Pre (In Planning) During (In Development) Uncover Insights Choose Behavior Model Develop Objectives Capture and Analyze Results Launch

63. Education Impact Return on EducationTMframework guided the evaluation plan 6/21/2011 20 Desired Action Program/Business Impact Persuasion Behavior Change Model Metrics Change in Knowledge Change in Attitudes Change in Skills + Clarity Clear by Design + Insight-driven content Tone Relevance Accuracy of Information + Reaction to tactic/program Satisfaction Appeal Usefulness Needs Met Impact Intended/Actual use of materials Customized based on program objectives Examples include Screening/diagnosis Talking with HCP Fill initial Rx Take Rx as prescribed Conversion Use of device Program Engagement Reach Frequency Enrollment Channel preference Site visits Business Length on therapy Increased sales Rep access Market expansion Health Outcomes Symptom alleviation HEDIS measurement Function Clinical measures

64. Program was relevant 75%: same or more vs. 11% less Q: Would you like to have more, less or about the same: Information about organizing my medicines 6/21/2011 21 75% of respondents want the same or more level of information about organizing their medicines Source: Data on file. San Diego, CA., Amylin Pharmaceuticals, Inc.

65. Program had high appeal 71% of respondents want the same or more tools for talking with their HCP 71%: same or more vs. 13% less Q: Would you like to have more, less or about the same: Tools for talking with my HCP Source: Data on file. San Diego, CA, Amylin Pharmaceuticals, Inc.

66. Program was useful 6/21/2011 23 Percentage of Patients The same/longer duration of calls The same/more frequent diabetes information The same/more frequent contact The same/more frequentnewsletters Patients Wanted: Source: Adapted from Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.

67. Prompted patients to talk with their HCPs Most respondents agree that the program helps them talk with their HCPs Q: The Support Program has helped me talk with my HCP about my pramlintide treatment Source: Data on file. San Diego, CA, Amylin Pharmaceuticals, Inc. 24

68. 6/21/2011 25 Percentage of Patients Patients Reported: High self-reported compliance and persistency On and continuing therapy the first 3 months Administration of maintenance dose Dosing 2 or 3 times daily Source: Adapted from Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.

69. Improvements were demonstrated 6/21/2011 26 Patients in program were on pramlintide 50% longer relative to those not in program Source: Adapted from Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.

70. Program refinement based on analysis

71. Using the Return on EducationTMapproach to refine ©2011 HealthEd Group, Inc. 28 Program Development and Refinement Post (After Program Launch) Pre (In Planning) During (In Development) Uncover Insights Choose Behavior Model Develop Objectives Capture and Analyze Results Launch

72. Teachable moments shouldn’t be missed Web enrollments make up 50% of enrollees and often occur outside of business hours of call center. 6/21/2011 29 Video-based FAQs feature call center nurse Video on BRAND.com creates continuity and familiarity

73. Educational game developed to address confusion about Major Meals 6/21/2011 30 Brand Brand Brand.

75. Realistic expectations

76. Hope for improvement

77. Adjustment period/need for flexibility

78. Insulin/appetite changes

80. Frustration: different routine and considerations

81. Unanticipated hyperglycemia

82. Injection burden and treatment complexity

83. Unexpected side effectsBarriers

84. A challenge and opportunity for you

85. You can use the Return on EducationTMapproach to createa solution that promotes action and change 33 Program Development and Refinement Post (After Program Launch) Pre (In Planning) During (In Development) Uncover Insights Choose Behavior Model Develop Objectives Capture and Analyze Results Launch

86. Education Impact Desired Action And evaluate your Return on EducationTM 6/21/2011 34 Program/Business Impact Customized based on program objectives Examples include Screening/diagnosis Talking with HCP Fill initial Rx Take Rx as prescribed Conversion Use of device Persuasion + Clarity + Insight-driven content + Reaction to tactic/program Program Engagement Reach Frequency Business Length on therapy Increased sales Rep access Health Outcomes Symptom alleviation HEDIS measurement Function Clinical measures

87. This is a complicated recipe 6/21/2011 35

88. What patients have to manage day to day can also be complicated 6/21/2011 36 “My Day”

89. Retention ratesof different learning styles1 Hands On 90% Within just a few minutes of leaving the doctor’s office, patients may remember less than 50% of the critical information the doctor shared.2 Discussion 60%-70% Audiovisual 40%-50% Seeing HearRead Digital solutions can help make learning more effective 37 10%-20% 5%-15% HCP Office Visit 1. Adapted from Edgar Dale’s “Cone of Experience. 2. Davis TC, Williams MV, Marin E, Parker RM, Glass J. Health literacy and cancer communication. CA Cancer J Clin. 2002;52:134-149.

90. Which can lead to positive health outcomes 6/21/2011 38 “My Health”

91. Thank you! Time for your questions 6/21/2011

92. To contact us Susan LaRue Susan.LaRue@amylin.com Susan Eno Collins s.collins@healthed.com To obtain a copy of this presentation, go to www.healthed.com 6/21/2011 40