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Jefferies Healthcare Conference June 2016

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Page 1: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Jefferies Healthcare Conference June 2016

Page 2: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Today’s Speakers

John Figueroa Chief Executive

Officer

Vic Breed Chief Financial Officer

Joined Genoa in July 2014 Previously served the dual roles of CEO of Apria Healthcare Group Inc. and Coram LLC, as well as CEO and Director of

Omnicare, and earlier served as President of McKesson Corporation’s US Pharmaceutical Group.

Joined Genoa in October 2006 Previously the EVP of Finance and Operations for medical

device company, ClearMedical, Inc., as well as Senior VP for Solucient, LLC and earlier served as the COO and CFO for

HBS International.

Page 3: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Agenda

Genoa Overview

Mental Health Market

Who we are and who we serve

Financial Overview

Page 4: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Advent Sponsor Overview

• One of the largest and most experienced global private equity firms

• $29 billion in assets under management as of December 2015, across developed and emerging markets

• Discrete sector focus across five global sector teams, including Business & Financial Services; Healthcare; Industrial; Retail, Consumer & Leisure; and Technology, Media & Telecom

• Advent recapitalized Genoa, a QoL Healthcare Company on April 30, 2015

• Nautic Partners remains minority investor

Page 5: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

General Overview

• Founded in 2000 and headquartered in Seattle, Washington

• 300+ pharmacies and telepsychiatry services across 41 states and DC

• We serve approximately 500,000 patients annually

• Fully integrated inside Community Mental Health Centers (CMHCs)

• In 2015, we opened 41 new pharmacies and completed 9 pharmacy acquisitions

• Reached over 8.5M scripts and $900M Revenue in 2015

• In addition, we acquired 1DocWay creating Genoa Telepsychiatry

• In 2016 we are on track to exceed 10M scripts and Revenue of +$1B

Largest Nationwide Provider of Mental Health Pharmacy Services

Page 6: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0
Page 7: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Genoa is the largest pharmacy and telepsychiatry operator in the United States specialized in serving the needs of the behavioral health community

− Manages complex and chronic mental illnesses through high touch patient pharmaceutical care and remote psychiatry

− Primary care medications are integrated into our pharmacy care model

− Personalized and outcomes driven care produces 90% medication adherence rates and reductions of hospitalizations (40%) and emergency room visits (12%)

− Fully integrated inside Community Mental Health Centers (CMHCs)

(1)

Business Overview

The majority of Genoa consumers are individuals who suffer from one or more disabling serious mental conditions and are insured through government programs such as Medicaid and Medicare. The majority of those with Medicare coverage are also dual-eligible.

Page 8: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

• More than half of Medicaid beneficiaries with disabilities have a behavioral health disorder

• 80 percent of beneficiaries with schizophrenia or bipolar disorder received psychiatric medications during the year, but only about half maintained a continuous supply of those medications

Mathematica Policy Research - Improving the Quality of Behavioral Health Care for Medicaid Beneficiaries, May 2015

National Quality of Care Concerns

Page 9: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Market Overview – Mental Health

• 1:4 adults, or ~61.5m Americans, experiences mental illness in any given year(1)

• 1:17 adults, or ~13.6m Americans, lives with a serious mental illness(1)

• In 2014, there were nearly 119 medicines in development to treat mental illness, including 36 for schizophrenia(2)

• In 2013, 29.5 million adults used prescription drugs for mental health treatment and a mental health patient is dispensed on average 48 prescriptions a year, compared to the total population average of 12 per year

Market-wide shift towards outpatient care driven by: • Emphasis on lowering cost • Move towards a recovery based care model

In 2015, US medicine spend for the mental health market was $21

Billion. Total spend was $425 billion.(3)

(1) The National Alliance on Mental Illness Fact Sheet. (2) Medicines in Development, Mental Illnesses 2014 Report presented by America’s Biopharmaceutical Research Companies. (3) IMS Institute for Healthcare Informatics, Medicine Use and Spending in the US, April 2016

Percentage of Adults with Past Year Serious Mental Illness who Used Various Services

Prescription Medicine, 62%

Outpatient Services, 47%

Inpatient Services, 8%

Page 10: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Favorable Legislative Environment

• The Mental Health Parity and Addiction Equity Act of 2008 provides for equal coverage between psychiatric or mental health services and physical medical health services(1)

• Several states have adopted parity laws requiring private insurance policies to have the same deductibles, number of office visits, inpatient visits and co-payments for mental health disorders as for other illnesses

Mental Health Parity Legislation

Patient Protection and Affordable

Care Act

Healthcare Reform will Spur

Revenues

• Enables most people who were uninsured to get insurance through an insurance exchange, resulting in healthcare coverage for over 90% of Americans(1)

• Significantly expands options for affordable coverage through Medicaid expansion

• Reform to provide more Americans with insurance and brings mental health and substance abuse coverage on par with that of medical and surgical services

• Healthcare exchanges are subject to the Federal Mental Health Parity Law resulting in more individuals having comparable coverage for mental health

(1) IBISWorld report – “Mental Health & Substance Abuse Centers in the US”, May 2011.

Page 11: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Genoa’s Growth Trajectory

1 2 4 6 9

42 65

85 101

120 143

175

206

240

288

330+

2000 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

In November 2015, acquired 1DocWay creating

with 216 locations.

2015 was a major year of growth and acquisitions. We acquired 1DocWay in the telehealth space, acquired 9 pharmacies and opened 41 new locations.

The July 2014 merger of two great companies created

In Aug 2000, the first Pharmacy for Qol Meds

opened in Pittsburg, PA

In Nov 2002, the first Pharmacy for Genoa Healthcare opened in Oregon

City, OR

Page 12: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Genoa currently provides pharmacy and telepsychiatry services in 41 states and the District of Columbia -- 6th largest US Drug Store Chain by store count

Leading Geographic Footprint

Page 13: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Where we stack up in the Pharmacy Rankings

US Pharmacy Chains 2015 Sales

($M) 1 Walgreens 53,340.0 2 CVS Health 47,900.0 3 Walmart 23,990.0 4 Rite Aid 18,110.0 5 Kroger 9,030.0 6 Health Mart 8,000.0 7 Target 5,060.0 8 Albertsons/Safeway 4,980.0 9 Diplomat Pharmacy 2,220.0

10 Ahold USE 2,200.0 11 Costco 1,840.0 12 Medicine Shoppe 1,790.0 13 Publix Super Markets 1,780.0 14 H-E-B 1,420.0 15 Kmart/Sears Holdings 1,280.0 16 Southeastern Grocers 1,170.0 17 Hy-Vee 939.0

18 Genoa, a QoL Healthcare Company 900.0 19 Giant Eagle 867.9 20 Fred's 825.5

We are among the Top 20 Retail Pharmacies

according to the Chain Drug Review as of Aug

2015

Page 14: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Most Severe

Hospital

Residential

Key Pharmacy and Telepsychiatry Services: •eMARs, blister card packaging, delivery, med carts, consulting, Pyxis

Severe

Residential

Intensive Case Management

ACT/PACT/FACT

Community Support Services (CSS)

Key services: •Adherence packaging, prior

authorization, delivery, data, online profile access

Moderately Severe

Case Management, CSS

Higher ratio of staff to consumers

Services vary greatly on need

Key Services: •Prior authorization, refill synchronization, adherence packaging, delivery, data

Outpatient Psychiatry and Medication Management

Key Services:

•Prior authorization, data, mail/delivery, convenience refill synchronization, call center, reminder calls

more independence

Who we Serve: Consumers with Complex Behavioral Healthcare Needs

Our high touch model is designed to provide services based on individual needs across the Care Continuum

24/7 ER Psychiatry Triage Telemedicine Services

Telepsychiatry to reduce wait times

Page 15: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Genoa provides specialized services − Full-service pharmacy, fill all medications

- Increased communication with program staff - Clozapine Monitoring / Phlebotomy Services - Specialized and Synchronized Packaging (Convenient Adherence

Packaging) - Prior Authorizations Assistance - Online access to consumer pharmaceutical records

- Proprietary medication adherence analytics - Medication Profiles / Drug Utilization

- Refill Management - Reminder calls / Synchronization / Medication Adherence

- Delivery / Mail Options - 24 Hour On-Call Services - Assistance with Insurance Plans, including Medicare D

− Medication Administration Records MARs/eMARs − Patient Assistance Program (PAP) assistance − Billing Assistance − Medication Counseling

Services provided by Genoa’s On-Site Pharmacy

Page 16: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Improving access to care

• Over 4,000 shortfall of Mental Health Professionals

• Innovative solution for the unique needs of the behavioral health community

• Acceptable, effective, and accessible to our partners to deliver quality mental healthcare

• High demand from current clinic partners

Outpatient telepsychiatry provider that offers a simple, easy-to-use platform to connect mental health providers and patients.

Page 17: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Medication Adherence

Genoa far exceeds retail pharmacy adherence averages

• A recent study conducted by the RAND Corporation found that average adherence rates for retail pharmacies is 50% (Predmore, Mattke, and Horvitz-Lennon, 2015).

• According to the study described on the following slide, 50% adherence translates to a 18.5% re-hospitalization rate.

• Genoa’s average MPR is 90%, which according to this study translates to a re-hospitalization rate of 8.3%.

• In this example, this improvement correlates to $1.7 million** in savings per 1,000 clients served at a Genoa pharmacy versus retail pharmacy.

*Assumes $16,416 per hospitalization per 2012 data from Healthcare Cost & Utilization Project, US Dept Health & Human Services

Page 18: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Historical Sales Growth

Proven track record of growth and operational efficiency

Revenue ($Millions)

317 417 451

574

730

913

~[VALUE]

2010 2011 2012 2013 2014 2015 2016P

Page 19: Jefferies Healthcare Conference · Previously served the dual roles of CEO of Apria Healthcare ... 8 Albertsons/Safeway : 4,980.0 9 Diplomat Pharmacy . 2,220.0 10 Ahold USE : 2,200.0

Historical FCF Growth

Proven track record of growth and strong Free Cash Flow Conversion

Low capital expenditure requirements

86%

90% 88%

95% 97% 97%

95%

2010 2011 2012 2013 2014 2015 2016P

Free Cash Flow FCF Conversion