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2013 annual report

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63


2013

annual report

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In 2014

we celebrate our 2


years

anniversary Promoting access to medications for millions of Brazilians 3


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Summary 1._A word from the President ......................... 06 2._ePharma ............................................................. 10 Profile................................................................ 12 Main facts in ePharma’s history ....................... 14 New profile expands company’s operation ....... 17 Business Scenario ............................................ 18

3._Business Strategy........................................... 20 Growth opportunity............................................ 22 Towards an integrated system.......................... 23 Business Model................................................. 24

4._Corporate Governance ................................. 26 5._Business lines.................................................. 34

PBM................................................................... 37 Flex.................................................................... 38 Follow................................................................ 39 Mobile solution for health.................................. 39 Concierge ......................................................... 40 GRS................................................................... 41 Plenus................................................................ 42 In Health............................................................ 42

6._Relationship....................................................... 44

Clients............................................................... 46 Authorized network........................................... 47 People Management......................................... 48

7._Technology ........................................................ 50

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The result network Access to medication at ePharma is the result of technology and know-how focused on the integration of all links of the health chain, forming a network that promotes well-being so that the population around the country can live better.

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A word from the

president

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A word from the

president

Valuing good health management

T

he Brazilian health sector closed 2013 with an optimistic scenario for patients and the market for medication benefits operators. Despite the difficulties imposed by the country’s low economic growth, good news came from the government sector. Two normative resolutions – 310 and 338, published by the National Health Agency (ANS) – became effective, promising to bring benefits to final users and a perspective of greater predictability for companies form the area.

The new measures allow health plans to offer home-use drugs through additional coverage and force them to provide oral products for oncological treatment. These benefits facilitate population access to prescribed medications thus contributing to the improvement of health conditions in the country. We believe that this scenario opens up new growth perspectives for the sector since the NR 310 authorizes an additional charge for pharmaceutical assistance coverage and, consequently, stimulates partnerships with healthcare operators

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with the PBM, an essential element to help providing prompt services to meet the new marked demands. As the leader in the segment of PBM (Pharmacy Benefit Management), ePharma is connected with all ends of this extensive group of institutions dedicated to health. Strategic alliances are necessary to face the new challenges of the Brazilian health market. In 2013, ePharma got ready for the new scenario by strengthening its capital with the arrival of a highly competent investor-partner, with a strong participation in the American PBM and in companies from the health care sector. The presence of an investor fund brings new perspectives for a horizontal growth by acquisition. As our first step in this direction, we incorporated to ePharma an innovative company in patient management programs, the In Health. With this merger, we have structured for 2014 a complete system to meet the provisions of NR 338, getting closer to the needs of the pharmaceutical industry


A word from the

president

access sector, mainly in the growing market of biological and high complexity medications. Company expansion will continue in 2014. The expertise of ePharma Directors and members of the Administration Council will be extremely valuable to the new business options analysis work and also for the consolidation of our current governance structures. Among the good surprises of 2013 was the evolution of some products recently launched in the market such as the Concierge, for medical orientation and preventive health & counselling services. The corporate service area, being used mainly by large companies, was renovated by the inclusion of small and medium-size clients, which shows the importance and value of the medication coverage for workers and companies. In 2014, ePharma will celebrate its 15 years of operation. During this period, we became a significant company for the efficient and productive work of the pharmacies, industry and health system network as a whole. The experience with a challenging market and high tax rate levels that make universal access to medications difficult attests our company’s capacity to adjust to new scenarios and restructure itself to maintain efficacy and prompt services. Our vocation is to contribute to the improvement of people’s health conditions through the innovative work of Pharmacy Benefit Management Programs. We do believe, however, that this mission also requires political will and government strategies to solve old problems such as taxation reductions for the sector. A new vision in this

In 2014, ePharma will celebrate its 15 years of operation. During this period, we became a significant company for the efficient and productive work of the pharmacies, industry and health system network as a whole.

field can contribute to reduce the high cost of products and allows patients to have wide access to medications and treatment. The year of 2013 demanded accurate adjustments and an analysis of the opportunities that are opening up in the health sector. We bet on a future growth generated by new market needs and we are prepared for this moment by investing in acquisitions and partnerships. We thank our collaborators, service users, partners, shareholders and government representatives that are helping ePharma to play its role of an innovative company committed to improve the Brazilian health scenario.

Luiz Carlos Silveira Monteiro, president

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10


ePharma

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ePharma

Promoting access

years

to medications for millions of Brazilians

P

ositioned as a health management company since 1999, ePharma develops products and services as part of the Pharmacy Benefit Management–PBM programs. Professionals and business groups from the sector founded the company with the objective to promote the integration between pharmaceutical assistance and healthcare. From its own online platform, the company operates as an integrator between the pharmaceutical industry, the authorized network of pharmacies and health services.

Our programs connect, in real time, more than 19 thousand pharmacies and drugstores around the country, giving access to medications for more than 28 million beneficiaries.

Using cutting edge technology, these programs connect, in real time, approximately 19 thousand pharmacies and drugstores around the country to an authorizing system anchored on a substantial database, giving access to medications for more than 23 million beneficiaries. In 2013, the number of online, real time transactions was over 44 million. Pioneer and leader in the segment, the company detains more than half of the pharmaceutical assistance market, with a portfolio of more than 150 client companies, including 1610 programs. Overall, its services, including the operationalization of the FarmĂĄcia Popular (Popular Pharmacy Program) public system, cover what corresponds to 28.5 million lives.

In 2013, the volume of financial transactions reached R$ 1.2 billion, corresponding to 28.8 million of units sold. With this performance, ePharma participation equals to 2.1% of the medications sales operations in Brazil. A team of 153 collaborators makes up the professional structure of the company with headquarters located in Barueri, SP. In 2013, the company also held equity shares from two American investment funds.

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Principles Mission

Provide innovative solutions in pharmaceutical assistance and health actions, generating knowledge and results.

Vision

Through its vocation towards innovation and partnerships based on trust, contribute to help more people improve their health condition.

Values

1. Trust relationships with Ethics and Transparency 2. Respect to life and health 3. Performance innovation and excellence 4. Proud to be ePharma


ePharma The products and services portfolio is organized in seven lines:

FOLLOW treatment adhesion and facilitation management programs

CONCIERGE counselling in preventive health, anti-stress, pharmaceutical, and nutritional assistance and medical orientation

IN HEALTH high complexity medications and rare diseases management

GRS platform of health data integration for monitoring chronic patients

PBM pharmacy benefit management program

PLENUS prepaid drugs benefits plan

FLEX specialty products by mail order

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ePharma

Main facts in ePharma’s history 1999

2001

The first contract triggers the company’s business trajectory.

ePharma is found.

PBM is launched.

2000

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Creation of the Follow Program opens doors in the pharmaceutical.

2002

2005

Implementation of the GRS solution for the analysis of risks and health management.

Broke into the HR corporate market.

2004


ePharma

2007

Petrobrás hires the PBM solution, speeding up the adhesion of other corporations to ePharma services.

Launch of the Aqui Tem Farmácia Popular (Popular Pharmacy Program) program supported by the ePharma system.

2006

2009

Ranked among the 100 Best Companies to Work For, from Revista Isto É.

2011

Launch of the Flex business line and the postal delivery of high complexity medications.

Expansion of the authorized network reaches 10 thousand pharmacies.

2010

2013

Participation of international investors. Acquisition of In Health, a patients’ management plan from the segment of high complexity medications.

Transactions through the ePharma channel go over R$ 1 million. Pharmacies accreditations reach 17 thousand.

2012

15


ePharma

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ePharma

New profile expands company’s operation The several expansion fronts opened by ePharma in 2013 were the result of the company’s capacity to anticipate itself and take advantage of the opportunities that move the health market in the country. From the company’s perspective, innovations will have an increasing impact on revenues in the upcoming years. The acquisition of In Health, the health management company, adds expertise to ePharma’s products and services and opens doors to a new operating segment, in synergy with the Flex line of postal delivery. With this acquisition, the company is able to supply the two ends of the high complexity medication segment with a patients program complemented by a retail channel. The publication of Normative Resolution 338, which determines that individual and collective healthcare plans provide oral oncological medications for in house treatment, finds the company ready to operate with this model with a prepared technical structure and scale capacity With the creation of the prepaid pharmaceutical assistance for medication management, the company anticipated the consequences of Normative Resolution 310 in effect since November 2013. This norm regulates the non-obligation of healthcare operators to offer medications for chronic pathologies and tend to promote an alliance with these companies, going back to the idea behind its creation, according to the American model of PBM. The data bank based on drug dispensation originated from PBM activities, of great application to the demanded actuarial processes, gain strategic value in this scenario. Based on a market research carried out with representatives of the main healthcare operators in the country, ePharma developed a standard model for the prepaid service.

The acquisition of In Health, the health management company, adds expertise to ePharma’s products and services and opens doors to a new operating segment.

In addition to the opportunities created by the changes in legislation and acquisitions, the company tried to restructure its concentration on big clients by pulverizing the portfolio. A solid work for bringing new clients among small and medium-size companies was realized in 2013, a movement helped by the company’s technology scale capacity, which resulted in an increase in the clients portfolio by 10%.

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ePharma Geographic Distribution thousand

points of sales

counties

All states and the federal district

delivery centers (delivery)

Points of sales by region Northern region

641 pharmacies Midwestern region

1.652 pharmacies Northeastern region 18

1.900 pharmacies

Northern region

Southeastern region

9.684 pharmacies Southern region

5.227 pharmacies

Northeastern region Midwestern region

Southeastern region

Southern region


ePharma 1.168

1.020

Volume authorized by the ePharma system (in millions of reais)

693

446

338

Amount of authorized medications (in thousands) 26.259

Number of sales transactions (in thousands)

28.780 12.000

18.704 11.000

12.263

2009

2010

2011

2012

2009

2013

13.000

14.000

2010

2011

15.876

2012

17.393

2013

Number of beneficiaries by segment Corporate 1.228.938

Mass 4.783.769

Pharma 10.502.452

Health 6.646.995

2013 Total

23.162.154 Corporate • benefit offered by the company Mass • s ervices connected to health insurance companies

Pharma • Pharmaceutical industry adhesion programs Health • services connected to healthcare operators

and assistance companies - Affinity

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Business strategy

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Business strategy

Building a results network Growth opportunities Some of the long-awaited expectations in the health sector began to get some answers from the State, when ANS normative resolutions 310 and 338 became effective. Although still insufficient, the two resolutions announced a new world for the medications benefit sector. The first starts to regulate the work of pharmaceutical assistance as an additional product for healthcare operators, similarly to the healthcare and dental assistance. By being optional, the measure may represent a rational solution for the aspirations of 50 million plan users for a Regular access practical and accessible to medications, system of pharmaceutical assistance within the among other benefits, PBM format. With the contributes to minimize orientation of the new law, the sector is getting the judicialization of closer to the American health and reduce model that inspired the founding of ePharma in claims in the sector, 1999, through which the two services work inteespecially among the grated.

new Brazilian middle class, anxious for quality services and competitive prices.

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The underlying fear of having to include additional mandatory costs must still be overcome by healthcare operators who should start looking

at the new measure as a new growth generator. Still in 2013, there was an intense move in the sector to measure the risks and opportunities brought by the legislation. Regular access to medications, among other benefits, contributes to minimize the judicialization of health and reduce claims in the sector, especially among the new Brazilian middle class, anxious for quality services and competitive prices. Normative Resolution 338 will also play a disciplinary role in the oncological products market, one of the most inaccessible and, therefore, subject to judicialization. Of mandatory character, the measure tend to stimulate an approximation among operators and the PBMs. In this segment, ePharma is positioned as the first fully organized company in the two ends, with ready patient plans and distribution structure plus an accumulated experience with rendering services to the corporate market. Consolidated concept in the corporate world, pharmaceutical assistance benefitted from the fast recognition of its benefits by human resources professionals, collaborators and unions that represent them. The theme began to be part of collective conventions agendas since the movement of the Chemists Union in 2009, which resulted in the adhesion of Petrobras to the PBM system. Currently, great unions such as the Oil Industry Workers, Civil Construction, Textile and Post Office take into account this clause in their negotiations.


Business strategy

Towards an integrated health system The strategic potential of the PBM system, however, goes beyond simple access to medications. The technological platform that gives support to the system has the potential to become the link among all market agents, playing the integrator role of the several ends. The application of the authorizing system information to the full health cycle – medical consultation, exams, hospital admission and the purchase and use of medications – announces a scenario of integrations for the market as a whole. A fair management of services, the final objective of the sector, becomes more realizable with the complete stratification of users and the adequate formulation of the legibility of each one of them, according to his or her health condition.

With the expertise of a company with an extensive leadership experience in the segment, the objective of ePharma is to become an integrating element in this new scenario for the health industry. The company has a working integration model with great high value information processing capacity ready to be applied to the whole sector. The knowledge generated by this system will help early detection and preventive healthcare not to be evaluated as cost, as it is done today, but that they reach the status of investment. We are finally witnessing a change in culture in the country’s health system and the market is waiting for this solution.

338

ONCOLÓGICOS ORAIS PARA USO DOMICILIAR

Normative Resolution 338 from the National Agency for Supplementary Health (ANS) The resolution makes mandatory for individual and collective healthcare plans to provide 37 oral medications for in house treatment of different types of cancer.

PROVISION OF HOME MEDICATION

Normative Resolution 310 from the National Agency for Supplementary Health (ANS) The resolution allows supplementary healthcare operators to provide in house medications plans for chronic diseases.

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Business strategy

Business Model Flexibility, security and expediency are the characteristics of the business model designed by ePharma and supported by four pillars (see below). Based on these pillars, the company is able to develop medication access management and health prevention and promotion projects adjusted to the needs of public and private organizations. The system helps client companies to manage medications benefits with security and efficiency and with emphasis on preventive health actions. Among the resources rationalization benefits offered is the reduction in the index of absenteeism and accidents. The new working model designed by the 2014 scenario incorporates new players. For the application of NR 338, due to the need to include clinical follow-ups for high complexity medications, ePharma structures a partnership network with laboratories and health clinics. As for the NR 310, the addition of medication coverage to medical services will require the commercial work a network of brokers as in the case of the current market of plans and insurances.

02 01

authorized pharmacies network range and quality.

solid relationship with the pharmaceutical industry to constitute a list of medications.

03

control of the technology to work with flexible solutions and high performance and availability.

04

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knowledge supported by the quality of the human capital.


Business strategy

The flexibility and scale capacity of th ePharma model becomes advantageous not only to the employees of PBM client companies; they also give the whole population access to medications through treatment adhesion programs created by the pharmaceutical industry and supported by Follow services. ePharma technology is also present in the medication access structure of the Farmácia Popular (Popular Pharmacy) program from the Federal government. The information capture potential and modelling flexibility of the GRS line databank offer a detailed segmentation of users according to profile and clinical demand and facilitate the customization of company’s reports. The statistical health profile gathered by ePharm in the databank represents an essential knowledge asset for the preparation of actuarial analysis necessary for the current stage of the country’s health system.

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Corporate Governance

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Corporate governance

Combining efforts to multiply results In 2013, ePharma’s corporate governance went through na extensive revision due to the changes in its shareholders profile with the arrival of a investor-partner and the departure of minority shareholders. Valiant Capital Management and Aberdare Ventures from the US will have a seat at the Administration Council through a representative. In addition to the financial contribution, the company benefits from the knowledge and high capacity added by the two institutions both in technical and governance terms.

The improvement of management, which is beginning to partially meet the requirements of the American legislation, is working towards organizational profile restructuring, processes improvement and the strengthening of governance mechanisms.

The changes in the company’s shareholding status implied in a series of new commitments for ePharma in addition to those already being rigorously followed, according to the Brazilian legislation. The management improvement also begins to partially meet the requirements of the American legislation through the restructuring of its organizational profile, processes improvement and the strengthening of governance mechanisms. One of the steps includes the development of a risk management system. Improvements are being conducted with the support of external consultancy.

Throughout its history, ePharma has worked based on the ethical principles of ethics, legality and transparency. Aiming at the continuity of the business, the company searches for the permanent creation of values for the shareholders. It respects the principle of equality of treatment among partners and guarantees transparency and rigor in its financial-economical statements and company’s results are submitted to external auditing annually.

PBM expertise and new technologies With headquarters in San Francisco, California, the investments funds Valiant Capital Management and Aberdare Ventures concentrate their funds applications in the technology and internet sector and maintain an operation dedicated to the health segment. The two institutions as an important strategic guideline to develop associations with innovative companies. Overall, the consortium made up by the two funds acquired 45% of ePharma, amount used to support company’s organic growth and technological improvements and subsidize growth by acquisition.

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Corporate governance

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Corporate governance

Shareholders composition

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Corporate

Corporate governance structure

governance

Board of Directors - Deliberative Collegiate body responsible for the formulation of the company’s general business policy, including the long-term strategy. It is also responsible, among other attributions provided in the statute, for appointing directors and monitoring and supervising management. In December 2013, the board included 5 shareholders representatives.

Governance Board Deusmar Queiros, President Luiz Carlos Silveira Monteiro, Board member Roberto Faria, Board member Modesto Araujo, Board member Eduardo Marques, Board member

Deusmar Queiros – founder and CEO of the Pague Menos Group, created almost 30 years ago and becoming the largest pharmacy chain in Brazil in revenues and number of stores. Graduated in Economics from Universidade Federal do Ceará (1973), he also holds a Post-graduate degree from the Graduate School of Business Administration, New York. Began his career at IBM and worked in the financial market in 1971 for Credimus Distribuidora de Valores. He was a teacher and coordinator at Universidade de Fortaleza. Roberto Faria – founder and CEO of Distrifar, a pharmaceutical distribution

company. Co-owner and executive director of Drogasmil until its sale in 2009, after having worked as executive director of Distribuidora Faria and Intermed for 18 years. Graduated in Information technology by PUC-RJ and holds a MBA in Business Administration from Universidade Federal do Rio de Janeiro.

Modesto Araujo – founder and CEO of Drogaria Araújo, the largest chain of

pharmacies in Minas Gerais in revenues and number of stores, with almost 100 points of sales. Graduated in Business Administration by Fumec (MG), he also holds an MBA from UMA (MG).

Eduardo Marques – One of the co-founders of Valiant partners, an American

investments fund created in 2008. Previously, he worked as a financial analyst for 3G Capital for five years. Economist, he graduated from PUC-RJ and holds a Master’s Degree by the London School of Economics. 31


Corporate governance

Executive Board The directors of ePharma are the company’s legal representatives, responsible for the business administration and the implementation of the company’s general policies and guidelines. Selected by the Board, they can be dismissed by this body at any time.

Luiz Carlos S. Monteiro

Marcos Inocencio

Marcos Brêda

Pedro Oliveira

President and founder of ePharma, created in 1999. Physician member of the Brazilian Medical Association since 1978, president of the Associação Paulista de Cirurgia Pediátrica (Pediatrics Surgery Association of São Paulo) and director of the Brazilian Medical Association. For 15 years, acted as a Unimed System director.

Finance and Operations director for ePharma since 2001, he worked as a Planning manager for Carrefour. He also worked for Monsanto, Chase and Andersen. Business administrator by PUC-SP and an accountant by Unip (SP), he holds an MBA by IBMEC-SP and holds a Master’s Degree in Business Administration by PUC-SP.

ePharma’s business director since 2009, after having worked as a sales manager in 2002. He held the position of sales director of Coloplast for seven years. Graduated in Business Administration by FFCL-RJ, he holds an MBA from ESPM (SP).

ePharma’s clinical director since 2004, he has 27 years of experience in health management. Physician registered in the Brazilian Medical Association since 1980, he holds a Master’s Degree from São Camilo (SP).

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Bruna De Vivo

Carlos Pappini Jr.

ePharma’s pharmaceutical manager since 2002, with experience with the PBM market since 1999. Member of the São Paulo Pharmacy Council, she holds a degree in Pharmacy from Unisantos and holds an MBA from PUC-SP.

Marketing and In Health business unit director, with more than 20 years of experience in area of health. He also worked for health operators (Amil) and for the pharmaceutical industry (MerckSharp Dohme, Baxter, Cristália and Bayer). Business administrator with post-graduation in Marketing, an MBA in Health Economics by Unifesp and a Master’s degree in Business Administration by PUC-SP.

From left to right: Marcos Inocencio, Marcos Brêda, Carlos Pappini Jr., Bruna De Vivo, Pedro Oliveira e Luiz Carlos S. Monteiro.


Corporate governance

Ethics and Conduct The Code of Ethics and Conduct – is the most important ePharma internal document which introduces guidelines and procedures that must be followed by all collaborators, executive body and shareholders. Code norms regulate the relations and activities developed with clients, suppliers, authorities and company’s services users. Based on a preventive and guiding approach, the document raises issues that demand care in relation to socially acceptable principles, company values and current legislation. Throughout 2014, the company plans to develop a continuing work of dissemination of the Ethics Code guidelines, aiming at its effective assimilation. The Ethics Committee - was created to deal with the issues raised by the code. A collegiate body was also created, formed by two directors, two managers and one collaborator from the operational team which also works as a channel for complaints and denouncements. All information is confidential, and there is a specific commitment towards the integrity of the author of the communication. Identified or anonymous reports have two channels of access to Ethics Committee: intranet and an exclusive email address. Anti-corruption and Anti-Money laundering Policies and Procedures – before the Anti-corruption Law became effective, ePharma prepared , at the end of 2013, a specific document to fight such practices and their operations. The new legislation regulates companies’ responsibilities in the administrative and civil spheres, which are extensive to directors, advisors, collaborators commercial partners and consultants. The measure also meets the demand of the new investor-partner whose activities are submitted to the American Federal Law Foreign Corrupt Practices Act (FCPA), which inspired the Brazilian law. In addition to the compliance instruments already implemented, the measures include the creation of a Collaborators Council and a development program for all the publics involved.

Institutional Relations Involved with the development of its operating sectors, ePharma has worked actively to improve market practices, aiming at the society’s well-being. Through its leaders, it maintains frequent and transparent relations with representatives of regulatory bodies and contributes to the construction and improvement of public health policies. The company is a member of the Brazilian Association of PBM Operator Companies (PBMA) and the Alliance for Population Health (Asap). The president of ePharma, Luiz Carlos Silveira Monteiro, is the current president of PBMA.

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Business lines

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Business lines

Meet our expertise network ePharma’s attention focused on the expansion of its portfolio of products and services and on performance consolidation.

In 2013, a year dedicated to business expansion, ePharma’s focused its attention on the expansion of its portfolio of products and services and on performance consolidation. With the structural changes that the new legislation will bring to the sector, the company worked to be ready for the opportunities and challenges implicit in this scenario.

The year’s performance and the evolution of new products such as the Concierge da Saúde (Health Concierge) and the GRS, which has been experimenting increasing use, changed the mindset of users and client companies towards greater care with prevention and adherence to the treatment.

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Business lines

Benefits for collaborators, results for companies

The ePhama medication benefits management card represents an integrating element that makes access to a health service possible to more than 23 million people, combining facility, access security, quality of services and cost control. Due to its flexibility and robustness, the system is prepared to provide services to publics originating from corporate programs, health operators and public health programs. In the corporate segment, around 1.2 million beneficiaries from more than88 companies make use of this service, customized according to the human resources policies adopted by each company and controlled by financial resources destined to this benefit. Integrated to the health management, the online card authorization makes possible the monitoring of each rule established by the client company among a set of criteria. In the Affinity and Health sectors, approximately 5 millions of beneficiaries have their access to medication facilitated and privileged by companies and health operators who have contracted ePharma services. Beneficiaries have access to more than 19 thousand authorized pharmacies and a list of reference medications with more than 2 thousand presentations, favored by discount agreements with the pharmaceutical industry. A multidisciplinary team of physicians and pharmacists helps the client during the elaboration and maintenance of the program, a special care that is extended

throughout the duration of the contract. The use of the benefit is is followed permanently by reports prepared in several formats, according to the management processes convenience. Besides the retail network, the program is connected to 109 authorized delivery centers for medications programmed delivery (mail order). It also makes possible the access to high complexity medications sold by Flex, the retail face of ePharma, supported by a call center with multidisciplinary assistance for companies and patients.

Result for the health of all Brazilians In the public sector, the ePharma card connects millions of Brazilians with medications subsidized by the public health system of the Aqui Tem Farmåcia Popular program. The chain of pharmacies, structured by the PBM system since 2000, and the online authorizing system that connects it, has played a fundamental role in the acceptance and expansion of the Federal Government program, launched in 2006. The ePharma system beat the logistics challenge of integrating thousands of pharmacies in one single online system and in real time to get purchasing authorization from the government. Transactions made through this channel are a relevant part for company’s operations, involving the dispensation of more than 13 million of medication units to more than 5.3 million of benefitted people.

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Business lines

Special health results 17.801 units of 368 different types of medication were sold through Flex

Top performance in 2013, Flex went over growth forecasts by 50%, due to corporate interest in offering differentiated health benefits as na attraction factor to retain talents. The product concept (an online delivery pharmacy as an innovative logistics model and a patient support service) was introduced in Brazil by the company. Chronic patients and complex and debilitating diseases carriers receive an approach that goes beyond medications management and includes care management during dispensation and clinical-pharmaceutical support. Specialized in high complexity products, Flex must receive a strong boost with the enactment of NR 338. Even before the law

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became effective, ePharma closed corporate plan contracts to provide this service and expects a growth rate higher than 100% for 2014. In addition to the direct purchasing of medications with discounts, the service brings other benefits such as home delivery. The system contributes to the engagement of the patient in the treatment to prevent eventual problems with the access to medication. The follow-up system, a dedicated team of pharmacists working to follow prescriptions and guarantee delivery and the correct use of the product, is going through a reformulation to make procedures even more efficient.


Business lines

Industrial scale access and results pharmaceutical industry programs management

The patients program expansion developed by ePharma for the pharmaceutical industry turn into a reference in the health market. Through the technological capacity that was able to insert in the system, the company offered an essential tool for the management of treatment adhesion programs. By carrying Follow cards, chronic patients began to have a safer, more simplified and cost-effective routine, access to 19 thousand pharmacies connected in real time and are

be able to benefit from discounts offered for medications in general. The system is capable to adapt the project to the specificities of the company and the medication itself, providing customized reports with a metrics of results and prescription control and identification. It also provides an efficient reposition process together with the retail. Process efficiency made the service eligible for NR 338 resolutions regarding access to high complexity oncological medications.

Mobile solution for health To the many relationship channels offered to patients, ePharma added another one, the practicability of the cell phone. The company developed a partnership with 3Cinteractive, leader in mobile phones solutions in the US and developer of a mobile tool that helps people to follow medical recommendations. With a cell phone at hand, the patient has facilitated access to healthcare and motivation to increase adhesion to medications. Among the many possibilities of this app, messages send nan alert signal about times, send nutritional information, notify when it is time to buy medications and send new a new purchase message. The system also expects to offer healthcare services to patients with chronic diseases.

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Business lines

The link between information and health results information channel and health guide

Market recognition indicator, the Health Concierge Program grew 62% in 2013. According to ePharma, this result shows a maturation process in relation to the importance of preventive healthcare and personal responsibility with health. The program was designed as a facilitator to help develop autonomy and people’s initiative towards their own health, with the advantage of receiving it as a benefit granted 40

by the contracting companies. The service, provided remotely though phone contact, is organized as a counselling center conducted by specialized health professional. The team, including physicians, pharmacists, psychologists and nutritionists, are responsible for providing guidelines of informative character.


Business lines

Promoting health: no risk results health risk management

Integrated to the medication benefits program, the Health Risk Management system, GestĂŁo de Risco em SaĂşde (GRS) in Portuguese, deals with issues such as lack of preventive care and treatment avoidance by chronic patients, which leads to rising expenses and costs. It is a platform that integrates data from several sources to monitor themes that worry professional and managers from the sector and citizens in general. The tool becomes complete with the additional consulting services and nursing call, which are summoned after the needs and risks profile of a determined group of people is defined. The monitoring is designed mainly for chronic patients to minimize lack of treatment adhesion, one of the factors

with the highest impact on health expenses. Among the important themes, the agenda includes chronic diseases, sedentary lifestyle, bad eating habits and the inadequate use of medications, focused by the nutritional, pharmaceutical and stress reduction services, plus support to situations of risk. Equally important to the system is vaccination care and assistance to smokers. Using the available data, the multidisciplinary team is responsible for providing information on prevention and health promotion and to follow the involvement of beneficiaries with the treatment and with the process of changing habits. Due to its characteristics, HRM will become a strategic component of the NR 338 compliance structure.

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Business lines

Results for operators, facility for beneficiaries total pharmaceutical assistance coverage PROVISION OF HOME MEDICATION

ePharma responded promptly to the possibilities brought by NR 310 by launching Plenus, a Medication Benefits Plan designed in 2013 and forecasted to be launched in the beginning of 2014. Designed initially for the corporate segment, the product is not restricted to discounts but it will provide coverage of up to 100% of all medications in the market. It can be contracted like a health or dental plan through a network of brokers and offered as a benefit to company’s employees. Service regulation meets the demand of the corporate world. Even with the advances represented by the outpatient clinics and hospital services coverage for the employees’ health, many times, they fail to complete the treatment due to the high cost of the prescribed medications. By demanding more consultations and more exams with the worsening of the disease, the health expenses their access to become more onerous for companies in an increasing scale. The objective of Plenus is to offer a safe, simple and predictable system to help the flow of health services for the corporate world. All medication access service network structured by ePharma will be available to the new product.

New and better results in specialty products management Late in 2013, ePharma incorporated in its portfolio the expertise of In Health as a business area – patients plans management focused on high complexity and rare diseases medications. The objective of the In Health service is to give support to the pharmaceutical industry regarding paManagement, Strategy and Health Access. tients relationship management and to facilitate their access to high cost medications, becoming also responsible for monitoring therapy. The relationship with specialized diagnostic and infusion clinics as well as with the medical class is also part of this process.

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The acquired company’s team will be integrated to the ePharma functional staff. It is composed by 44 professionals from the health sector, distributed in contact centers or directly in rehab centers and infusion clinics. In 2014, when NR 338 becomes effective, ePharma will be ready to operate in the sector with a complete structure. In Health clients, about 20 pharmaceutical companies that hold ptents in the segment of molecular biology will be added to the ePharma portfolio. The acquisition will strengthen the work already initiated by the special medications segment and will complement the Follow lines (relationship with the industry), HRM (Health Risks Management) and Flex (special care).


Business lines

Special patient care The innovation of the pharmaceutical industry has guaranteed patients with rare and high complexity diseases access to medications developed from cutting edge research and technology. For part of the population, this represents life conditions improvement and longer life expectancy. High costs, geographical barriers and lack of information on some pathology are challenges that prevent patients in dramatic situations to benefit from medications generated by these technological advances. In Brazil, In Health, as a products and services manager, has contributed to help special patients to gain even more access to these expensive treatments through pharmaceutical industry programs. Working in synergy with ePharma, these services can be extended to a greater number of people. Management involves a complex work flow and involves professional from several areas. The technical team disseminates the program to specialized physicians and other health professionals or directly to patients when they are unable to go on with the recommended treatment. Once authorized by the program, the patients will receive the necessary assistance to begin with the treatment. The program includes orientation manuals on the pathology, access to diagnostics laboratories and infusion medication application (intravenous application) clinics, products sent by email order, thermal bags for products conditioning and medications use follow-up by the pharmacosurveillance team. Some pathology requires the visit of nurses and health professional to centers of therapy administration. Interaction with the patient is fundamental and constant. The network of integrated providers is connected in real time with the contact center, providing the the system with the indispensable expediency to deal with the situation. For the industry, In Health offers an online diagnostics and infusion investments management, treatment adhesion reports and other essential management data. This integrated network works towards expanding patients adhesion to cutting edge treatment, helping many return to their normal life routine.

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44


Relationships

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Relationships

Links that make up our results network Clients ePharma’s products and services are part of the benefits package of the main Brazilian corporations and several small and medium-size companies. They are 150 client companies that search for safe and quality medication programs to guarantee cutting edge health resources to 23 million beneficiaries.

Some of our clients:

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Relationships

ePharma referential form Periodically, the P&T Committee, formed by physician and pharmacists, updates the form to guarantee prescription adaptations in terms of quality and cost-benefit.

900

2.197

13

66

Products

Therapeutic classes

Presentations

Subclasses

20

Laboratories

401

Active ingredients

1.297 900 Generics

Brands

Authorized network Present, in real time, in more than 19 thousand pharmacies, ePharma services play a structuring role in the national access to medications. In a territory with large continental dimensions like Brazil, characterized by strong development contrasts, the online management platform guarantees the necessary technological standardization for the functioning of the health system that the company maintains connected. With the network connection offered by the ePharma card, distances become relative and points of sales are the final stage in this wide operation to integrate the Brazilian frontiers to a quality heath structure. Integrated to the country’s best pharmacies and drugstores and to 109 delivery centers, the ePharma authorized network covers 2.186 counties located in 26 states and in the Federal District. It has the necessary range and quality to meet the requirements and special needs of public and private organizations around the country. The scale capacity of the authorized network promotes the incorporation of new establishments at any point of the national territory.

Some of our authorized chains:

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Relationships

People management In its operation model, ePharma relies on its technical capacity, dynamism and team initiative as one of the company’s business pillar. The cutting edge technology made available to millions of users, 24 hours a day, is solidly supported by an intellectual capacity of 191 people, prepared to meet the demands of a services company specialized in health management. They are the professionals who, on a daily basis, add value to the business, guaranteeing its longevity. With most employees in the 30-year-old age group, most team members have a college degree (45%) or is currently attending college (23%), and 4% has post-graduation degrees. Women represent 72% of this contingent. In 2013, the company started the integration process of 44 employees incorporated by the acquisition of In Health.

To have a motivated and competent team able to work at its full potential, the company has been improving its organizational structure and investing in career development, nurturing new competencies and developing leadership.

191

189

145 129

2009

124

2010

2011

2012

2013

In the leadership of the technological resources is a multidisciplinary team that gathers professionals from management, technology and health areas. With solid educational background and experience, the health team is made up of physicians, pharmacists, nutritionists and nurses. It is these professionals responsibility to develop solutions demanded from clients in a customization work complemented by the talent of IT professionals. In order to have a motivated team capable of working at its full potential, the company has been improving its organizational structure and investing in career development, nurturing new competencies and developing new leaderships. Last year, a special attention was given to the preparation of a new commercial staff aligned with the intense dynamics of the segment, boosted by innovation and entrepreneurship.

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Relationships The development process of the collaborators predicted, for 2013, the mapping of internal competences to give more assertiveness to the functional profile desired by the company. Due to its characteristics, ePharma values proactive people capable of aligning technical competence and servicing skills in addition to lead internal and third party teams. As for the process of retaining talents and developing successors, a career consulting firm has started a coaching process with leaders on improvements and self- awareness. For the management positions, the company allocates subsidies for post-graduation courses up to 70% of the cost. To become eligible, the curse needs to be connected to the manager’s activity. Still related to the objective of retaining its talents, ePharma is in the process of designing a Shares Acquisition Option for leaderships, expected to begin in 2015. In 2014, a performance evaluation system will be included as one of the people’s management tool, guided by the competence mapping results realized in 2013. With this initiative, the company intends to provide a clear notion of the learning and career development possibilities to become more attractive to its collaborators. The new program is based on the granting of Profits and Results Participation (PRP) bonuses. The benefits package offered by ePharma is allied with those practiced by the market in which it operates. It includes health and dental plan coverage, food tickets, food stamps, life insurance, among others. The collaborator also has access to the company’s medications subsidy services. Employees with children also receive daycare center support of half of the minimum wage for children under 6.

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50


Technology

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Technology

A network of connected efficacy and results The great ePharma’s movement in 2013 towards offering a more robust portfolio and being ready to meet with expediency the new demands of the market was received with readiness by the technology team. Designed to meet the demands of clients’ products and services customization, the IT team responded with a series of improvements in the processes and system throughout the year. With these investments, ePharma’s capacity to detect companies’ needs and offer a solutions portfolio that allows an integrated and flexible model, either in technology, products or services, became stronger. The partnership with 3Cinteractive, leader in mobile phone solutions in the US, is making possible the assimilation of new expertise by the company.

The company’s technological platform kept efficiency levels as the connecting point among 19 thousand pharmacies, 23 million PBM card users, client companies and the pharmaceutical industry.

Last year, the company put a lot of extra effort the revision and improvement of backup processes which are translated into managerial reports. These improvements will have a great impact on services quality in 2014.

Average transactions Month

Day

3.708.369

123.612

Hour Minute 5.151

86

Second (TPS) 1,43

It performance in 2013 maintained the same level of excellence. Daily medications purchasing transactions through the ePharma system reached 123.6 million, guaranteeing an average of three seconds of waiting time for processing and approving the transactions. The company’s technological platform kept efficiency levels as the connecting point among 19 thousand pharmacies, 23 million PBM card users, client companies and the pharmaceutical industry.

Managed by cutting edge servers, authorizing system operations are registered in real time and stored in a databank. The model followed by ePharma helps to gather a detailed set of segmented information on the attended public (see the operational cycle stages table), promoting the parameterization of programs and client customization. The safety and sustainability of the technological park are supported by redundant systems that prevent invasion and guarantee data traffic confidentiality.

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Technology Operational Cycle Stage

In the pharmacy, the the prescription and the ePharma card.

1

2

The pharmacist feed the card number and prescription data into the system

3

The physician prescribes the drug.

The system responds to the pharmacy authorization request.

5

4 6

The pharmacy requests authorization through the system. The system compares the data sent by the pharmacy to the registered eligibility rules for the

The request number is registered at the cashier. Sales information is forwarded automatically to ePharma.

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Corporate Information

Acknowledgements

Head Office ePharma/PBMs do Brasil S.A. Av. Mamoré, 989 – 9º andar – Alphaville CEP: 06454-040 – Barueri – SP www.epharma.com.br

Creation and Coordination Concêntrica – Comunicação e Conteúdo

Contacts Luiz Carlos Silveira Monteiro President

Editors Paulo de Jesus e Dida Dourado

Marcos Inocencio Finance and Operations Director

Revision Adriana Duarte

Marcos Brêda Business Director

Graphic Project Gabriel Siqueira Marcelo Pimentel

Pedro Oliveira Clinical Director Independent auditors Ernst & Young Auditores Independentes S/S 60

Editorial Office Maria Inês Araújo Godinho Thiago Zanetin


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ePharma | PBM do Brasil S.A. Al. Mamoré, 989, 9º andar Alphaville - Barueri – SP CEP: 06454-040 Phone: +55 11 4689.8686 Fax: +55 11 4689.8689

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negocios@epharma.com.br www.epharma.com.br


2013 annual report