Public Policy - Baxter Sustainability Report

Public Policy

Public PolicyMany legislative issues affect Baxter's business—reimbursement, tax, trade and a variety of regulatoryconcerns. Baxter's Government Affairs and Public Policy (GAPP) team works with lawmakers, governmentsand policymakers worldwide to support patient access to the company's life-saving therapies, increaseunderstanding of the benefits of those therapies, and address barriers to care and explore possible solutions.This involves dealing directly with governments to improve the regulatory environment and reimbursementstructure for Baxter's therapies, and collaborating with clinicians, non-governmental organizations and patientgroups to increase access to care for millions of patients worldwide.The Public Policy Committee of Baxter's Board of Directors oversees the company’s government affairs activities. The committeereviews Baxter's political contributions, positions on pending legislation and political advocacy activities. For additional information onthe company's government affairs activities, see Baxter's 2012 Political Contributions Report. This report details contributions made in2012 by Baxter and Baxter's Political Action Committee, BAXPAC, as well as information about the company’s membership in certaintrade and industry groups.Recognizing Baxter’s leadership in this area, the company was ranked as the Surgical, Medical, and Dental Instruments and Suppliessector leader for political disclosure, transparency and accountability in the 2012 CPA-Zicklin Index of Corporate Political Accountabilityand Disclosure.Healthcare ReformAdvancing Advocating for Patient Access within Insurance ExchangesHealthcare reform efforts are underway in the United States to improve efficiency, stem rising costs, address disparities in the level ofcare and expand access. Baxter remains committed to advocating for changes that are in the best interests of its patients.Health insurance exchanges—electronic platforms implemented by the federal and state governments, which individuals and smallemployers can use to identify and compare private health plans or enroll in public health coverage—are mandated by the United States’2010 Patient Protection and Affordable Care Act (ACA). To support its patients with rare diseases, Baxter advocates health insuranceexchanges to:• recognize rare diseases;• include an adequate number of in-network providers that address rare conditions;• allow patients with extremely rare diseases access to out-of-network providers without incurring excessive costs;http://www.sustainability.baxter.com/public-policy/index.html© Copyright 2013 Baxter International Inc. All Rights Reserved 2

• provide access to all medically necessary therapies and healthcare providers;• ensure cost sharing does not discriminate or unfairly target any patient or rare disease group;• provide access to third party cost sharing (premium, co-pay and co-insurance) assistance and due process; and• provide transparency surrounding management utilization, medical necessity determinations, appeals and grievances.Adhering to the Physician Payments Sunshine ActBaxter is responding to the federal requirements mandated by the Physician Payment Sunshine Act. See Ethics and Compliance.Supporting the Food and Drug Administration Safety and Innovation ActEvery five years, the United States Congress must reauthorize the law associated with the user fees paid by manufacturers to supportstaff positions at the FDA. In 2012, Baxter supported passage of the Food and Drug Administration Safety and Innovation Act to ensurethe timely review of new drug, device, biologic, biosimilar, and generic applications before the FDA, allowing patients to receive timelyaccess to new and innovative therapies. The new user fee law aims to provide a predictable review process that fosters innovation andhelps ensure that Baxter’s patients continue to receive new therapies.Providing Internet Resources to Patients and CustomersTo assist patients and customers as healthcare reform is implemented at the state level, Baxter created an Internet tool that allows 24-7access to state activities on ACA. It is available at the following Baxter websites, which provide information for patients living withhemophilia and end-stage renal disease, as well as hospital customers:• Hemophilia• End Stage Renal DiseaseSafety and QualityReducing the Economic Burden of HAIsThe World Health Organization (WHO) has identified healthcare associated infections (HAIs) as a leading cause of preventablemorbidity and mortality, and an area where investments in preventive measures can yield significant cost savings and public healthbenefits. According to the WHO, HAIs affect hundreds of millions of patients worldwide each year, with estimates ranging from 3.5-12%of hospitalized patients in developed economies, and 5-19% in developing economies. In some locations, more than 25% of patientsadmitted to hospitals acquire HAIs. 1Raising awareness of the health and economic burden of HAIs among Asia Pacific Economic Cooperation (APEC) policy makers was amajor goal of the APEC Life Sciences and Innovation Forum (LSIF) in 2012. Baxter, a board member of the Association for AdvancedMedical Technologies (Advamed), actively supported Advamed in its role as knowledge partner for this forum.In July 2012, the APEC LSIF convened the first ever APEC High Level Workshop on Reducing the Economic Burden of HAIs, whichbrought together representatives from APEC governments, healthcare organizations, hospitals, the Asian Development Bank andothers. The workshop recommendations stipulate that nations implement policies and allocate appropriate resources to supporthospitals in reducing HAIs. In September 2012, the APEC Ministers adopted the following statement in the Joint Statement of the APECMinisterial Meeting in Vladivostok: “We welcome work to address the economic and public health burden of healthcare associatedinfections. We encourage officials to work with stakeholders to reduce the incidence of infections in healthcare settings.” View the fullstatement: http://www.apec.org/Meeting-Papers/Ministerial-Statements/Annual/2012/2012_amm.aspx.Promoting Integrated Care and EfficiencyIn 2011, Baxter UK established and facilitated a group of thought leaders in health, social care, and other sectors of the National HealthService (NHS) called The 2048 Group. This forward-thinking group—named for the year in which the NHS will turn 100—engages insolutions-focused policy debate about the key issues facing the future of healthcare in Britain. The group met several times last year todiscuss new and innovative ideas about the future of the NHS. In November 2012, the group published INTEGRATED CARE: ACOLLECTION OF ESSAYS, to promote ideas and dialogue about increasing efficiency and improving the quality, safety and delivery ofhttp://www.sustainability.baxter.com/public-policy/index.html© Copyright 2013 Baxter International Inc. All Rights Reserved 3

care to patients. Essays covered topics such as vertical integration of services and support for patients, technologies such as telehealththat support patient independence, and how the NHS should shift its focus from individual diseases to viewing a “whole” patientexperience. To read an electronic version of the book, click here. Moving forward, the group will continue to meet to discuss other keypolicy topics.Baxter also continues to implement its Evolving Health program in the U.K., a customer facing strategy which aims to deliver quality andefficiency benefits to the NHS and patients. The company developed the program in response to NHS’s Quality, Innovation, Productivityand Prevention (QIPP) challenge, which aims to achieve up to £20 billion (approximately $26 billion) of savings by 2015. The savingsare intended to help accommodate growing demand for healthcare, partly due to an aging population. To learn more about EvolvingHealth, click here.Access to HealthcareMedicare IVIG Access ActRoughly 10,000 Medicare beneficiaries in the United States have been diagnosed with one of approximately 150 primaryimmunodeficiency diseases (PID). PID prevents patients from fighting infections, making the body highly susceptible to a range ofconditions. Intravenous immune globulin (IVIG) therapy is vital in treating patients with PID. For many people with this condition, hometreatment is appropriate because of the increased risk of infection associated with receiving care in other health care settings.In 2003, Congress changed the law to allow Medicare beneficiaries with PID to receive IVIG treatments at home. However, the lawfailed to include reimbursement for the necessary nursing services and supplies.In May 2011, Representatives Kevin Brady (Republican, Texas) and Doris Matsui (Democrat, California) and Senators John Kerry(Democrat, Massachusetts) and Lamar Alexander (Republican, Tennessee) introduced companion legislation to fix this problem—H.R.1845/S. 960, the Medicare IVIG Access Act. Baxter supported this bill, and lobbied for its enactment throughout 2012.On January 10, 2013, the Medicare IVIG Access Act was signed into law, creating a demonstration program to provide Medicarereimbursement for the nursing services and supplies associated with home infusion of IVIG therapy for up to 4,000 PID patients. Theprogram is authorized for three years.Educating Health Policy Makers in Washington, D.C. about Benefits of Home DialysisBaxter supported and participated in the inaugural National Summit on Home Dialysis Policy in Washington, D.C. in March 2012, tofurther the dialogue about the benefits of home dialysis for those with end stage renal disease. Home dialysis, including peritonealdialysis and home hemodialysis, are alternatives to in-center treatment, which generally requires patients to visit a clinic three times aweek. Despite the widely accepted and well-documented benefits of home dialysis—improved outcomes associated with moreconsistent treatments, enhanced patient satisfaction, improved quality of life and lower costs compared to in-center treatment—approximately ten percent of U.S. dialysis patients received treatment at home in 2012. 2More than 50 patients, clinicians, industry representatives and policymakers assembled at the summit to identify common concerns andopportunities to drive appropriate utilization of home dialysis and identify pathways for collaborative action. The group addressedchallenges in education, training and implementation of home dialysis; the national reimbursement system; quality measures; andinnovation related to the modality. Representatives from the Centers for Medicare and Medicaid Services, United States Renal DataSystem, Department of Veterans Affairs and the Food and Drug Administration were among those who attended.One result of the summit was the launch of the Alliance for Home Dialysis, created as a way for the organizations involved to continuetheir advocacy efforts, develop policy recommendations, and advance thought leadership surrounding home dialysis. Following thesummit, the alliance developed a National Summit on Home Dialysis Policy Report of the Delegates, outlining the group’s policypriorities and objectives.PartnershipsThrough its public policy efforts worldwide, Baxter develops unique public-private collaborations to increase patient access to criticaltherapies.Entering into Agreement with Sanguin to Support Demand for Plasma-Derived Therapieshttp://www.sustainability.baxter.com/public-policy/index.html© Copyright 2013 Baxter International Inc. All Rights Reserved 4

Baxter uses plasma to produce medications that treat immune disorders, hemophilia, trauma and other critical conditions. In July 2012,Baxter entered into a manufacturing services agreement with Stichting Sanquin Bloedvoorziening (Sanquin Blood Supply Foundation), anot-for-profit organization responsible for the blood supply in the Netherlands, to provide additional plasma fractionation capacity insupport of global demand for Baxter’s plasma-derived therapies. Baxter will pay Sanquin a fixed fee to fractionate plasma used forthese medications; the partnership is expected to result in up to 1.6 million liters of incremental plasma fractionation capacity annually.The initial term of the agreement is 10 years, with production beginning in 2014, and Sanquin reaching the full 1.6 million liters annuallyby the end of 2016.Partnering with Brazil to Increase Access to Therapy for Hemophilia A PatientsIt is estimated that more than 10,000 people in Brazil are living with hemophilia A, and today the vast majority are treated with plasmaderivedfactor VIII therapy. 3 To provide these patients with greater access to recombinant factor VIII (rFVIII) therapy, Baxter entered intoan exclusive 20-year partnership in November 2012 with Hemobrás (Empresa Brasileira de Hemoderivados e Biotechnologia), a publiccompany dedicated to creating greater self-sufficiency in the production of life-saving therapies for people in Brazil with hemophilia,primary immunodeficiency disease, cirrhosis, severe burns, cancer and AIDS. Through this partnership, Baxter will be the exclusiveprovider of Brazil's recombinant FVIII treatment over the next 10 years while the companies work together on the technology transfer tosupport development of local manufacturing capacity by Hemobrás.Advancing Private-Public Partnerships in Vietnam to Ensure Sustainable HealthcareTo address access to quality healthcare solutions that support the Vietnamese government’s healthcare objectives, Baxter’s Vietnamteam participated in the "Workshop on Public Private Partnerships in the Health Sector” in December 2012. Attended by over 160representatives from the healthcare sector and officials from the Ministry of Health (MOH), other government agencies, the U.S.Embassy and healthcare industry companies, this forum encouraged dialogue between the public and private sector to strengthen thehealthcare system in Vietnam. It was also the country’s first public-private sector discussion on how both sectors can work together toaddress Vietnam’s evolving healthcare needs. Baxter participated in conversations about reducing the burden in overcrowded hospitalsand developing human resources through education and training, as well as developing educational programs that will help provideaccess to PD treatment and encourage a preventative/prophylactic approach to hemophilia treatment. The company’s Vietnam teamalso sponsored a Leaders’ Dinner that convened guests of honor including co-hosts of the seminar—Dr. Nguyen Thi Kim Tien,Vietnam’s Minister of Health, and David Shear, U.S. Ambassador to Vietnam.1 Report on the endemic burden of healthcare-associated infection worldwide. World Health Organization, Geneva, Switzerland, 2011. Available at http://whqlibdoc.who.int/publications/2011/9789241501507_eng.pdf.2 Neumann, Mark. "Some bright spots for home dialysis." Nephrology News & Issues. (July 13, 2012). Web. http://www.nephrology-digital.com/201208/201208/5/03 Federação Brasileira de Hemofilia. Accessed on: 10 March 2011. Available at: http://www.hemofiliabrasil.org.br2012 Political Contributions ReportBaxter respects local political customs and obeys all laws about engaging in the political process everywhere it operates. Thecompany’s Code of Conduct, which sets forth the core principles that govern Baxter’s business practices, contains a section on PublicAffairs and Political Activities, including rules governing participation in the political process.The Public Policy Committee of Baxter's Board of Directors oversees Baxter's government affairs program and Political ActionCommittee, BAXPAC, reviewing annually political contributions, positions on pending legislation, and other political advocacy initiatives.This Political Contributions Report provides information about corporate contributions made in the United States by Baxter as well ascontributions made by BAXPAC. It also includes information about Baxter's lobbying expenses and membership in trade and industrygroups.• Corporate Contributions• Baxter Political Action Committee• Lobbying Expenses• Certain MembershipsCorporate ContributionsThe U.S. Supreme Court decision in the Citizens United case in 2010 broadened the ability of corporations to make independenthttp://www.sustainability.baxter.com/public-policy/index.html© Copyright 2013 Baxter International Inc. All Rights Reserved 5

political expenditures in the context of federal elections (although not the ability to make direct contributions to federal candidates).However, Baxter has not made independent political expenditures or contemplated this form of activity, and does not anticipate that thedecision will impact how the company contributes or engages in the political process. Baxter strives to make contributions to candidateswho champion and protect the legislative interests of the company, its employees and patients, without regard for the private politicalpreferences of Baxter’s officers and executives. In 2012, the company did not participate in any ballot measures and it is not generallyBaxter’s practice to do so.In the United States, Baxter contributed $22,000 to state candidates in 2012 after approval from the BAXPAC Board. U.S. law does notallow companies to make contributions to federal candidates. As discussed below, contributions to federal candidates may be made byBAXPAC.Baxter’s Corporate Contributions to U.S. State Candidates, 2012Member District Party AmountArkansasDismang, Jonathan S28 R $250Hopper, Karen H100 R $250Irvin, Missy S18 R $250Key, Johnny S17 R $250Leding, Greg H86 R $250Lindsey, Uvalde S4 D $250Teague, Larry S10 D $250Tyler, Linda S35 D $250Williams, Darrin H36 D $250Wood, Jon S7 R $250FloridaCocoran, Richard H37 R $500Crisafulli, Steve H51 R $500Latvala, Jack S20 R $500Robertson, Ken H75 R $500GeorgiaChannell, Mickey H116 R $750Grant, Johnny S25 R $250Holt, Doug H112 R $250Jeffares, Rick S17 R $250Jerguson, Sean H22 R $750Williamson, Bruce H111 R $250IllinoisAlthoff, Pamela J. S32 R $250Bellock, Patricia H47 R $500Cole, Sandy H262 R $250Cross, Tom HD84 R $1,250Cullterton, John J. SD6 D $1,500Duffy, Dan S26 R $250http://www.sustainability.baxter.com/public-policy/index.htmlhttp://www.sustainability.baxter.com/public-policy/political-contribution-report.html© Copyright 2013 Baxter International Inc. All Rights Reserved 6

Feigenholtz, Sara H12 D $750Harmon, Don SD39 D $650Hunter, Mattie SD33 D $250Link, Terry S30 D $500Madigan, Michael J. H22 D $1,500Mayfield, Rita HD60 D $250Murphy, Matt S27 R $500Osmond, JoAnn H61 R $250Pritchard, Robert H70 R $250Radogno, Christine S41 R $1,250Righter, Dale S55 R $250Steans, Heather S7 D $750Sullivan, Ed H51 R $250Syverson, Dave S35 R $250Trotter, Donne E. S17 D $850MississippiBryan, Hob S7 D $500Burton, Terry S31 R $500Frierson, Herb H106 R $500Mims, Sam H97 R $500Reeves, Terry Lt. Gov R $500Total $22,000Baxter's Corporate Contributions to 501(C)(4) and 527 Organizations, 2012Membership in 501(c)(4) and 527 organizations is another avenue through which Baxter engages to advance the company'sinterests and those of its patients.Baxter contributed the following to these 501(c)(4) organizations during 2012.The Ripon Society $25,000Third Way $32,500Total* $57,500Through its GAPP team, Baxter contributed to the following 527 organizations during 2012.Democratic Governors Association $25,000Republican Governors Association $25,000Total* $50,000*Only includes organizations for which GAPP pays the annual dues.http://www.sustainability.baxter.com/public-policy/political-contribution-report.html© Copyright 2013 Baxter International Inc. All Rights Reserved 7

Young, ToddChristopherX IN9 R $5,000LouisianaRichmond,CedricMarylandVan Hollen,ChristopherMichiganBenishek,DanielX LA2 D $1,000X MD8 D $3,500X MI1 R $2,000Camp, Dave X MI4 R $3,000Dingell, John X MI2 D $1,000MississippiThompson,BennieX MS2 D $1,000MontanaBaucus, Max X MT D $2,000New JerseyPallone, Frank X NJ6 D $1,000New YorkHochul,KathleenX NY27 D $3,000OhioAmstutz, Ron X OH3 R $1,000PennsylvaniaAdolph Jr.,WilliamBaker,MatthewX PA165 R $500X PA68 R $500Costa Jr., Jay X PA43 R $500http://www.sustainability.baxter.com/public-policy/political-contribution-report.html© Copyright 2013 Baxter International Inc. All Rights Reserved 9

Dermody,FrankX PA33 D $500Hughes,VincentX PA7 D $500Smith, Samuel X PA66 R $1,000Turzai,MichaelX PA28 R $1,000South CarolinaClyburn,JamesX SC6 D $5,000TexasBurgess,MichaelX TX26 R $4,000UtahHatch, Orrin X UT R $4,000Matheson,JamesX UT4 D $1,000WashingtonLarsen, Rick X WA2 D $5,000WisconisnKind, Ron X WI3 D $5,000WyomingBarrasso,John AnthonyX WY R $1,000Total $83,000Other BAXPAC Contributions. 2012PayeeAmountBuilding Relationships in Diverse Geographic Environments PAC $5,000Congressional Black Caucus PAC $5,000Committee for Hispanic Causes/Building Our Leadership Diversity PAC (CHC BOLD PAC) $5,000Democratic Congressional Campaign Committee $15,000Democratic Senatorial Campaign Committee $5,000http://www.sustainability.baxter.com/public-policy/political-contribution-report.html© Copyright 2013 Baxter International Inc. All Rights Reserved 10

Every Republican is Crucial $5,000Kidney Care Partners (KCP) PAC $2,000National Republican Congressional Committee $5,000National Republican Senatorial Committee $15,000New Democrat Coalition PAC $5,000Republican National Committee $15,000Total $82,000Lobbying ExpensesIn 2012, Baxter spent approximately $2,590,000 on federal lobbying-related activities in the United States, to promote policies thatsupport the company's objectives. This amount includes the salaries and overhead expenses of Baxter employees dedicated to thisarea, the value of time and related expenses of internal partners (such as corporate counsel), payments to external consultants andlobbyists, and trade association dues used for lobbying. Baxter adheres to all federal, state and local laws to ensure compliance in thisarea. Outside the United States, Baxter also complies with all applicable laws and regulations. Baxter's federal lobbying data wasreviewed by an external firm.Certain MembershipsBaxter maintains memberships in numerous industry and trade groups including organizations that engage in lobbying activities. Thetable below includes the amount that Baxter has been notified has been spent on federal-related lobbying activity during 2012 by anyorganization to which to the best of its knowledge Baxter paid more than $50,000 in dues or otherwise during the year. Baxter believesthat membership in these organizations is generally consistent with the company's interests as well as those of its shareholders,customers and patients. Even when Baxter does not share all of the views of one of these organizations, it believes that membership isworthwhile because such organizations encourage dialogue on important policy issues and help to move the industry to a consensus inthese areas.Federal-Related Lobbying Expenditures by Certain U.S.-based Trade Associations, 2012*AdvaMed $26,040Alliance for Home Dialysis Policy $18,500Biotechnology Industry Organization (BIO) $120,450GPhA Generic Pharmaceutical Association $25,000Healthcare Institute of New Jersey $12,500Kidney Care Partners (KCP) $14,490Plasma Protein Therapeutics Association (PPTA) $10,555.50US ASEAN Council $200US India Business Council $5,000*Only includes groups of which GAPP is aware. These dues are paid by Baxter’s businesses and not by GAPP.View Baxter's 2011 Political Contributions Report, 2010 Political Contributions Report, 2009 Political Contributions Report and 2008Political Contributions Report.http://www.sustainability.baxter.com/public-policy/political-contribution-report.html© Copyright 2013 Baxter International Inc. All Rights Reserved 11

American and Pacific Islander Congressional Caucus leaders. They addressed healthcare issues affecting the Asian Americancommunity, including access; language barriers and disparities in care; increasing awareness of and screening for hepatitis B, hepatitisC, tuberculosis and HIV; and enhancing data collection for Asian groups. As a result of the visit, the Asian Leadership Networkidentified opportunities to continue engagement with stakeholders including policy makers, patients and physicians and sharedfeedback with Baxter business leaders regarding potential collaboration opportunities."It was wonderful to connect with the Asian American and Pacific Islander (API) policy makers and leaders," said Michelle Luo, director,market access for Baxter's Medical Products business. "Some of them even commented that we were the first company to do so."http://sustainability.baxter.com/quick-links/case-studies/2012-report/affinity-advocacy.html© Copyright 2013 Baxter International Inc. All Rights Reserved 13