Retail Pharmacy Presentation Pharmacist Market Research Insights 2H2013

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1 Retail Pharmacy Presentation Pharmacist Market Research Insights 2H2013

2 Overview of the Pharmacy Market Research Patients in the US are increasingly turning to the retail pharmacy for their preventive health care, including vaccinations Merck is continually looking for opportunities to support retail pharmacists vaccination efforts Merck has commissioned ongoing market research to gain a deeper understanding of pharmacists beliefs, perceptions, and behaviors with respect to vaccination The following slides provide information on the methodology used to field the study, and show select findings from this market research

3 Methodology for the Pharmacy Market Research Nationwide survey conducted among 304 retail pharmacists from January March, 2013 Three monthly waves were fielded from January March, 2013 and aggregated for the purposes of reporting This follows a baseline wave among 711 retail pharmacists conducted from August December, 2012 All respondents must have administered either ZOSTAVAX (Zoster Vaccine Live), PNEUMOVAX 23 (Pneumococcal Vaccine Polyvalent), or both, in the past month in order to qualify for the survey Results have been weighted to reflect the mix of store types (chain, grocery, independent, mass merchandiser) among the measurable population

4 Select Insights from the Market Research

5 Many opportunities for pharmacist-initiated conversations about vaccination against shingles are missed 1 Opportunity (patients age 60+) Jan.-Mar Out of 1,000 visits to the pharmacy counter Identification Patient comes to pharmacy for shingles vaccine Patient comes to the pharmacy for other reason Initiation Conversation about vaccination with Rx 6 times without Rx 6 times Patient initiates conversation 8 times RPh initiates conversation 5 times Vaccine Administered 4 patients vaccinated 4 patients vaccinated 4 patients vaccinated 1 patient vaccinated Source: Pharmacy Tracking Study; Jan.-Mar wave (n=304) 13 patients in total leave vaccinated Reference: 1. Data available on request from Merck, Professional Services-DAP, WP1-27, PO Box 4, West Point, PA Please specify information package VACC

6 The use of internal systems to flag or identify candidates increases the number of RPh-initiated shingles conversations 1 Pharmacist-Initiated Shingles Vaccine Conversations (Typical Month) Number of Pharmacist- Initiated Shingles Vaccine Conversations per Month Perceived time constraints continue to be reported as the top barrier to initiating shingles vaccine conversations for RPhs Internal Systems to Flag Vaccine Candidates No Internal Systems to Flag Vaccine Candidates Source: Pharmacy Tracking Study, Jan.-Mar Wave (n=304) Reference: 1. Data available on request from Merck, Professional Services-DAP, WP1-27, PO Box 4, West Point, PA Please specify information package VACC

7 4 Key Market Research Findings 1 Voice of the Pharmacist RPhs indicating an increasing commitment to identifying shingles vaccine candidates and initiating conversations, 1 and an increase in physician reliance on referrals to the pharmacy 2 may reflect a potential shift in the marketplace for ZOSTAVAX (Zoster Vaccine Live) Although the vast majority of RPhs are able to co-administer vaccines 3 consistent with product prescribing information, fewer than 1 in 10 vaccine patients receive multiple vaccines during a single visit to the pharmacy 4 Awareness of the DTC campaigns regarding shingles and ZOSTAVAX is associated with approximately a 2 times higher reported rate of RPh-initiated shingles vaccine conversations 5 Pharmacists that had established a process to proactively identify potentially eligible vaccination candidates had a 2 times higher reported rate of RPh-initiated shingles vaccine conversations 6 1 The percent of pharmacists who indicate strong agreement (4-5 on 5-point scale) with the statements I routinely identify appropriate patients to discuss the shingles and It is my job to initiate discussions about the shingles vaccine with my patients in Aug.-Dec vs. Jan.-Mar The percent of physicians who indicate that they do not stock Zoster Vaccine Live and only refer patients to the pharmacy for vaccination in Q vs. Q vs. Q (Source: US Physician Tracking Study (Shingles Vaccine); Q (n=305); Q (n=301); Q (n=306). 3 The percent of pharmacists who indicate that they are able to co-administer vaccines 4 The percent of patients who have received multiple vaccines during a single visit to the pharmacy in the past year 5 The difference in number of RPh-initiated shingles vaccine conversations between RPhs aware of the DTC campaign (TV or print) and those RPhs who are unaware 6 The difference in number of RPh-initiated shingles vaccine conversations between RPhs who have established a process to proactively identify potentially eligible vaccination candidates and those RPhs who do not Source: Pharmacy Tracking Study; Aug.-Dec Wave (n=711); Jan.-Mar Wave (n=304) Reference: 1. Data available on request from Merck, Professional Services-DAP, WP1-27, PO Box 4, West Point, PA Please specify information package VACC

8 Important Information About ZOSTAVAX (Zoster Vaccine Live) About ZOSTAVAX ZOSTAVAX is a live attenuated virus vaccine indicated for prevention of herpes zoster (shingles) in individuals 50 years of age and older. ZOSTAVAX is not indicated for the treatment of zoster or postherpetic neuralgia. ZOSTAVAX should not be used for prevention of primary varicella infection (Chickenpox). Select Safety Information Vaccination with ZOSTAVAX does not result in protection of all vaccine recipients. ZOSTAVAX is contraindicated in: persons with a history of anaphylactic or anaphylactoid reaction to gelatin, neomycin, or any other component of the vaccine; persons with a history of primary or acquired immunodeficiencies; persons on immunosuppressive therapy; pregnant women or women of childbearing age. A reduced immune response to ZOSTAVAX was observed in individuals who received concurrent administration of PNEUMOVAX 23 (Pneumococcal Vaccine Polyvalent) and ZOSTAVAX compared with individuals who received these vaccines 4 weeks apart. Consider administration of the two vaccines separated by at least 4 weeks.

9 Important Information About ZOSTAVAX (Zoster Vaccine Live) Select Safety Information (continued) Serious vaccine-related adverse reactions that have occurred following vaccination with ZOSTAVAX include asthma exacerbation and polymyalgia rheumatica. Other serious adverse events reported following vaccination with ZOSTAVAX include cardiovascular events (congestive heart failure, pulmonary edema). Common adverse reactions occurring in 1% of vaccinated individuals during clinical trials include injection-site reactions (erythema, pain/tenderness, swelling, hematoma, pruritus, warmth) and headache. Transmission of vaccine virus may occur between vaccinees and susceptible contacts. Deferral should be considered in acute illness (for example, in the presence of fever) or in patients with active untreated tuberculosis. Before administering ZOSTAVAX, please read the accompanying Prescribing Information. For additional copies of the Prescribing Information, please call , visit MerckVaccines.com, or contact your Merck representative.

10 Pharmacists Commitment to Improving Vaccination Rates against Shingles is Increasing % of RPhs Who Strongly Agree (Top-2 Box) I routinely identify appropriate patients to discuss the shingles vaccine Aug.-Dec It is my job to initiate discussions about the shingles vaccine with my patients Jan.-Mar Percent of Pharmacists Who Strongly Agree With Each Statement (Top-2 Box) Source: Pharmacy Tracking Study, Aug.-Dec Wave (n=711), Jan.-Mar Wave (n=304) Reference: 1. Data available on request from Merck, Professional Services-DAP, WP1-27, PO Box 4, West Point, PA Please specify information package VACC

11 Most RPhs can and have co-administered vaccines, but only to a small number of patients Qualitative research suggests that a lack of knowledge on the fundamentals of vaccine co-administration poses a significant barrier: What combination of vaccines are allowed? Who are appropriate patients for co-administration? How do I safely administer multiple vaccines? % of Pharmacists % of RPhs allowed to co-administer vaccines Vaccine Co-Administration in the Retail Pharmacy Setting % of RPhs who have co-administered shingles vaccine + flu vaccine in past year Source: Pharmacy Tracking Study, Jan.-Mar wave (n=304) Barriers to Shingles Vaccine Co-Administration in the Pharmacy Qualitative Study; Mar (n=20) % of Patients Although it rarely occurs, RPhs perceive patients to be generally comfortable with coadministration % of patients who have received multiple vaccines in the past year Reference: 1. Data available on request from Merck, Professional Services-DAP, WP1-27, PO Box 4, West Point, PA Please specify information package VACC

12 Important Information About AFLURIA (Influenza Vaccine) About AFLURIA AFLURIA is an inactivated influenza vaccine indicated for active immunization against influenza disease caused by influenza virus subtypes A and type B present in the vaccine. AFLURIA is approved for use in persons 5 years of age and older. Select Safety Information AFLURIA is contraindicated in individuals with known severe allergic reactions (eg, anaphylaxis) to any component of the vaccine including egg protein, or to a previous dose of any influenza vaccine. Administration of CSL's 2010 Southern Hemisphere influenza vaccine was associated with postmarketing reports of increased rates of fever and febrile seizures in children predominantly below the age of 5 years as compared to previous years; these increased rates were confirmed by postmarketing studies. Febrile events were also observed in children 5 to less than 9 years of age.

13 Important Information About AFLURIA (Influenza Vaccine) Select Safety Information (continued) If Guillain-Barré Syndrome (GBS) has occurred within 6 weeks of previous influenza vaccination, the decision to give AFLURIA should be based on careful consideration of the potential benefits and risks. If AFLURIA is administered to immunocompromised persons, including those receiving immunosuppressive therapy, the immune response may be diminished. AFLURIA should be given to a pregnant woman only if clearly needed. AFLURIA has not been evaluated in nursing mothers. It is not known whether AFLURIA is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when AFLURIA is administered to a nursing woman. Antibody responses in persons 65 years of age and older were lower after administration of AFLURIA as compared to younger adult subjects.

14 Important Information About AFLURIA (Influenza Vaccine) Select Safety Information (continued) In children 5 through 17 years of age, the most common injection-site reactions observed in clinical studies with AFLURIA were pain, redness, and swelling. The most common systemic adverse events were headache, myalgia, malaise, and fever. In adults 18 through 64 years of age, the most common injection-site adverse reactions observed in clinical studies with AFLURIA were tenderness and pain. The most common systemic adverse reactions observed were headache, malaise, and muscle aches. In adults 65 years of age and older, the most common injection-site adverse reactions observed in clinical studies with AFLURIA were tenderness and pain. Vaccination with AFLURIA may not protect all individuals. Before administering AFLURIA, please read the accompanying Prescribing Information. For additional copies of the Prescribing Information, please call , visit MerckVaccines.com, or contact your Merck representative. AFLURIA is a registered trademark of CSL Limited.

15 Important Information About PNEUMOVAX 23 (Pneumococcal Vaccine Polyvalent) About PNEUMOVAX 23 PNEUMOVAX 23 is a vaccine indicated for active immunization for the prevention of pneumococcal disease caused by the 23 serotypes contained in the vaccine (1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, and 33F). PNEUMOVAX 23 is approved for use in persons 50 years of age or older and persons aged 2 years who are at increased risk for pneumococcal disease. PNEUMOVAX 23 will not prevent disease caused by capsular types of pneumococcus other than those contained in the vaccine. Select Safety Information Do not administer PNEUMOVAX 23 to individuals with a history of a hypersensitivity reaction to any component of the vaccine.

16 Important Information About PNEUMOVAX 23 (Pneumococcal Vaccine Polyvalent) Select Safety Information (continued) Use caution and appropriate care in administering PNEUMOVAX 23 to individuals with severely compromised cardiovascular and/or pulmonary function in whom a systemic reaction would pose a significant risk. The most common adverse reactions, reported in >10% of subjects vaccinated with PNEUMOVAX 23 in clinical trials, were: injection-site pain/soreness/tenderness, injection-site swelling/induration, headache, injection-site erythema, asthenia and fatigue, and myalgia. Vaccination with PNEUMOVAX 23 may not offer 100% protection from pneumococcal infection. Before administering PNEUMOVAX 23, please read the accompanying Prescribing Information. For additional copies of the Prescribing Information, please call , visit MerckVaccines.com, or contact your Merck representative. Copyright 2013 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. VACC /13

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