RSV is a common virus that can cause severe infections in high-risk infants. Synagis is a medication that can prevent RSV hospitalizations but is very expensive. RSV Logic is a clinical program designed to optimize outcomes and control costs for patients receiving Synagis through activities like clinical assessments, medication education, and 24/7 support from nurses and pharmacists. The program aims to ensure high-risk infants receive Synagis only when truly needed based on their individual risk factors and medical history.

1. Overview of Respiratory Syncytial Virus (RSV) and RSV Logic Designed for Clinical Program Managers

3. Describe key aspects of RSV prophylaxis and pharmacotherapy

4. Describe the overview of our clinical program, RSVLogicJuly 2009

6. Most common cause of lower respiratory tract infection (LRTI) in children <1 year of age1

7. Infection can be severe and costly

8. Leading cause of infant viral death2

9. Annual infant hospitalizations

10. 125,000/yr4-6 and $700 million/yr1

11. The key to Synagis therapy and controlling cost is to TARGET THE RIGHT PATIENTS AT THE RIGHT TIMEJuly 2009

13. At least 90% of children have been infected by age 21

15. Can cause pneumonia and bronchiolitis in premature and high risk infantshttp://www.cnmcpc.com/announcements/8 July 2009

16. 6 RSV: Disease Information July 2009

17. 7 When is Medical Treatment Needed? Usually diagnosis and specific medical treatment are not needed However, treatment is need for more severe infection July 2009

20. Approximate costs

21. $2,000/month

22. $10,000/5 month course

23. Synagis is covered 60% of the time under the payer’s medical benefit and 40% of the time under the prescription benefitJuly 2009

25. Premature babies (<35 weeks)

26. Chronic Lung Disease (CLD)

27. Congenital Heart Disease (CHD)http://pediatrics.about.com/od/newbornsandbabies/ig/Premature-Babies/Premature-Baby.htm July 2009

28. 10 Documented RSV Risk Factors For 32-35 Week GA Infants School-age siblings, Daycare attendance, Exposure to environmental air pollutants, Severe neuromuscular disease, Congenital abnormalities of the airways, Low birth weight , Crowded living conditions, Multiple birth, Family history of asthma, Young chronologic age ≤ 12 weeks http://synagis.com/HCP/sub/potential-candidates.aspx

30. Varies by geographical location

31. Varies year to year and is based on historic data as well as current season datahttp://www.cdc.gov/Features/dsRSV/

32. AAP Guidelines The American Academy of Pediatrics (AAP) 2006 Guidelines virtually the same as MedImmune and the FDA’s indications 2009 AAP Guidelines substantially different from current practice and the 2006 edition of the guideline lack reference to scientific evidence New guidelines are being evaluated by ESI and MedImmune not likely to be accepted by either as standard of care 12 www.chspediatrics.com

34. Administration IM monthly, preferably into the anterolateral aspect of thigh 1st dose should be given prior to the areas RSV season Monthly doses should be continued throughout RSV season, even if RSV infection develops July 2009

37. 16 Hospitalizations for RSV RSV Hospitalizations (%) 11 10 10 8,9 #1 cause of hospitalization in infants &lt;1 yr of age July 2009

38. A Look at the Pipeline Motavizumab derivative of Synagis 10-20 times more potent Anticipated for 2010-2011 RSV Season 17 http://www.medimmune.com/pipeline/index.asp

39. 18 July 2009

40. 19 RSV Logic A Look at our High-touch Care Management Program July 2009

44. Gestational age, weight, diagnosis, risk factors

45. RSV education

46. RSV season, prophylaxis (e.g. smoking cessation, hygiene), when to call doctor

47. Medication education

48. Side effects, missed dose/complianceJuly 2009

49. 22 Clinical Assessments: Examples Indications? Risk Factors? July 2009

50. 23 Summary RSV is a common virus that leads to hospitalizations in some high risk patients Synagis® is a high cost medication that can prevent RSV hospitalizations in these patients RSV Logic is a clinical solution that is already in place, and it is designed to optimize outcomes and control cost For more information direct questions to your sales support director or see the RSV Client Facing Deck July 2009

51. 24 References Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and Management of Bronchiolitis, American Academy of Pediatrics. 2006;1774-1793. Thompson WT et al. JAMA. 2003;289:179-86. Mayo Clinic Staff. Respiratory Syncytial Virus (RSV), http://www.mayoclinic.com,2007. Accessed November 2008. Shay DK, Holman RC, Newman RD, et al. JAMA. 1999;282:1440-1446. McLaurin KK, Leader S. Pediatric Academic Societies Meeting, May 14-17, 2005. Abstract #936. Leader S, Kohlhase K. Recent trends in severe respiratory syncytial virus (RSV) among US infants, 1997 to 2000. J Pediatrics. 2003;143(5 suppl):S127-S132. Synagis (palivizumab) [package insert]. Galtherburg, MD: MedImmune; 2008. Shay DK et al. JAMA.1999;282:1440-1446. Hall CB.Respiratorysynctial virus. In:Feigin RD, Cherry JK.eds. Textbook of Pediatric Infectious Diseases. 4th ed. Philadelphia.PA:WB Saunders;1998. The Impact-RSV Study Group. Pediatrics. 1998; 102:531-537. Feltes TF et al.J Pediatr.2003;143:532-540. MedImmune. RSV Protection.com. http://www.rsvprotection.com/index.aspx. Accessed July 7, 2009. Other References as Cited on individual slides. Last Updated July 2009 July 2009