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2010
France 38.9
38 6.3
6 3 0.9
0 2.7
% %
Sales Market % Sales Market %
Global Rank US$bn Share Growth Global Rank US$bn Share Growth
Angiotensin II antag.
antag 26 6
26.6 5 8%
5.8% 7 6%
7.6% Antidiabetics 15.8 4.8% 12.7%
Platelet aggr. inhib. 15.2 3.3% 3.8% Narcotic analgesics 11.9 3.7% 7.8%
Vitamins & minerals 12.7 2.8% 6.8% Erythropoietins 10.7 3.3% -1.2%
Cephalosporins & combs. 11.3 2.5% 7.3% Hospital solutions 9.5 2.9% 7.9%
Source: IMS Health, MIDAS, Market Segmentation, MAT Dec 2010, Rx only. *Market Segmentation universe
After strong growth recovery in 2009; 2010 sales
growth slows to 2
2.3%
3% and 11.0%
0% TRX growth
Dollars Growth
TRx Growth
$310 10
4 5
9
4.5
$300
8
4
7
$290 3.5
.
.
5.1% 6
CHANGE
.
3
S$ BN
e BN
$280 5 2.1%
GE
2.5
% CHANG
TRx Volume
%C
Sales US
4 2
$270
3 1.5
2 1
$260
2.3% 1 1.0% 0.5
$250 0 3 0
2006 2007 2008 2009 2010 2006 2007 2008 2009 2010
Source: IMS Health, National Sales Perspectives, Dec 2010 Source: IMS Health, National Prescription Audit, Dec 2010
US market growth in 2010 was 2.3%
$350 20
$300
$250
15
GE
BN
% CHANG
ALES US$B
$200
10
$150
$100
SA
5
$50
$0 0
US Growth Rate
5.0 10
9
4.0 8
E BN
7
TRX VOLUME
TRX PPG
3.0
5
4
2.0
3
T
2
1.0 1
0
0.0 -1
Unbranded generics
Brands
Branded generics
250
200
150
TRxs MN
100
50
0
AC T
-50
-100
-150
-200
200
2006 2007 2008 2009 2010
Specialist 44%
8% driven
6%
% Absolute
4%
%
%G
change
h US$
2%
Primary care 21%
driven
0%
2006 2007 2008 2009 MAT Nov
2%
-2% 2010 Specialist 79%
driven
-4%
80%
ARE
70% 57.7%
61.2%
65 3%
65.3%
MARKET SHA
30%
20% 42.3% 38.8%
34.7%
30.4% 27.8% 24.6%
10%
0%
2005 2006 2007 2008 2009 YTD 2005 2006 2007 2008 2009 2010
Nov
2010
Brands Generics
Source: IMS Health, National Sales Perspectives, Nov 2010, Branded generics disaggregated,Source: IMS Health, National
Prescription Audit, Branded generics disaggregated, Dec 2010
US is impacted by continued patent expiries, and
historically low contribution from new products
• Demographic factors
• Approvals of innovative
therapies
•Cash-flow
•Cash flow and credit issues
Distributors •Reduced inventories to minimise financial exposure
3 •Increase in distribution costs
•Consolidation among local distributors
6%
Patient Visit Growth
4%
WTH
2%
ROLLIING MAT GROW
0%
-2%
-4%
-6%
-8%
-10%
10%
Jan-08
Mar-08
May-08
Sep-08
Nov-08
Mar-09
May-09
Sep-09
Sep-10
Jul-08
Jan-09
Nov-09
Jul-09
Jan-10
Mar-10
May-10
Nov-10
Jul-10
ROLLING MAT
Source: IMS Health, National Disease and Therapeutic Index, Nov 2010, Confidence Interval shown (+/-3.9%)
The declines in consumer sentiment in the US were
not matched by TRx declines or claims
110
100
90
INDEX
80
70
Index of C onsumer Sentiment
60 Index of Employment
Monthly C laims
50
TRX
40
Apr-077
Jun-077
Jul-07
7
Aug-077
Apr-088
Jun-088
Jul-08
8
Aug-088
Apr-099
Jun-099
Jul-09
9
Aug-099
Apr-100
Jun-100
Jul-10
0
Aug-100
Jan-077
Feb-077
Mar-077
May-077
Sep-077
Oct-077
Nov-077
Dec-077
Jan-088
Feb-088
Mar-088
May-088
Sep-088
Oct-088
Nov-088
Dec-088
Jan-099
Feb-099
Mar-099
May-099
Sep-099
Oct-099
Nov-099
Dec-099
Jan-100
Feb-100
Mar-100
May-100
Sep-100
Data for the last month of reported claims remains volatile until late reporting physician’s claims are added
Source: IMS Health, National Prescription Audit, Sep2010, LifeLink Sep2010; Reuters / University of Michigan Surveys of
Consumers, Sep 2010; Bureau of Labor Statistics, Sep 2010; Car sales from Bureau of Economic Analysis, National Economic
Accounts, Last Revised in Dec 2010
US market grows 2.3% in 2010
2010
% Market
Channels US$bn % Growth
Share
Retail 167.3 54.4 2.0
Chain/Mass 108.1 35.2 2.6
Independents 37.9 12.3 1.3
Food stores 21.3 6.9 0.5
Mail Service 52.6 17.1 2.1
Institutional 87.6 28.5 3.0
Clinics 36 2
36.2 11 8
11.8 4 2
4.2
Hospitals 31.9 10.4 0.6
Long-term care 14.8 4.8 6.4
Home health care 2.5 0.8 -0.6
HMO 1.1 0.4 0.4
Others 1.0 0.3 -1.2
Total 307.5 100.0 2.3
2010
% Market
Channels TRxs mn % Growth
Share
Retail 3,646 92.0% 1.2
Chain/Mass 2,173 54.8% 2.1
Independents 748 18.9% -0.8
Food stores 490 12.4% 0.5
Mail Service 235 5.9% -1.0
Non retail channels 319 8.0% 0.9
LTC 319 8.0% 0.9
Total 3,965 100.0 1.0
AC AC
Dollars Total Rx dispensed
US$mn TRxs mn
Antipsychotics,oth 1520.7 Anti-depressants 7.7
Analogs of human insulin 1205.9 Seizure disorders 7.3
Analeptics 971.1 Codeine & comb 6.4
Anti-platelets,oral 650.8 Vitamin D 6.2
Antiarth,biol resp mod 637.9 Lipid regulators 5.9
Alzheimer-type dementia 598.9 Analeptics 4.4
HIV antiviral combination 550.9 Calcium blockers 4.2
GI anti-inflam 518.3 Biguanides 4.1
Neurological disorders 505.1 Benzodiazepines 3.3
Codeine & comb 466.2 Mus relx,non-surg 2.7
Source: IMS Health, National Sales Perspectives, Nov 2010, National Prescription Audit, Nov 2010
Relative growth of leading therapy classes
% %
Dollars Total Rx dispensed
Growth Growth
HIV integrase inhib 58 Vitamin D 47
Biguanides 40 Antinauseant 5HT3 antag 35
Pneumococcal 38 Dpp-4 Inhib 16
Miscellaneous,oth 32 Specific
f antagonists 15
Antineoplastics,misc,oth 31 Antihyperlipidemic agt 12
Neurological disorders 30 Analeptics 10
Newer gen psycother agt 29 H2 antagonists 8
Hormones,androgens 28 Analogs of human insulin 8
Ophth preps,oth 26 Ophth corticoids 8
Ophth anti-inflam,oth 24 Alpha-beta blocker 7
Source: IMS Health, National Sales Perspectives, Nov 2010, National Prescription Audit, Nov 2010
Absolute declines of leading therapy areas
AC AC
Dollars Total Rx dispensed
US$mn TRxs mn
Ace inhibitors -242.0 Proton pump inhib -1.6
Calcium blockers -261.6 Narc cgh/anthst -1.8
Quinolones, systemic -269.2 Angiotensin II antagonists -1.8
Immunosup/transplant age -419.3 Glitazones -1.9
Platinum coordination -471.6 Quinolones, systemic -2.2
Anti-migraine -500.6 Macrolides & related -2.3
Herpes Antivirals -527.7 Synth narc,analg -2.4
UT benign prostate -806.5 O/C estrogen/progestogen -2.4
Seizure disorders -1663.0 Beta blockers -2.4
Proton pump inhib -2257.2 Osteoclast Inhibitors -4.1
Source: IMS Health, National Sales Perspectives, Nov 2010, National Prescription Audit, Nov 2010
Fastest growing products-Absolute growth
AC AC
Dollars Total Rx Dispensed
US$mn TRxsmn
venlafaxine hcl er (tev) 877 metoprolol succin (wts) 9.8
Prevnar 13® (Pfz) 732 amlodipine besy (lu.) 9.2
Crestor® (Azn) 694 simvastatin (lu.) 8.9
Copaxone® (Tvn) 559 hycd/apap (qlt) 8.2
enoxaparin sod (sdz) 540 gabapentin (am9) 7.6
Abilify® (Ots) 535 lisinopril/hctz (lu.) 6.3
Plavix® (Bsa) 534 omeprazole (rx) (myn) 62
6.2
budesonide (tev) 508 azithromycin (tev) 5.9
Humira® (Abt) 405 albuterol (myn) 5.8
Atripla® (Bmg) 368 prednisone (w-w) 5.7
Source: IMS Health, National Sales Perspectives, Jan 2011, National Prescription Audit, Jan 2011
Relative growth of leading products
% %
Dollars Total Rx Dispensed
Growth Growth
valacyclovir hcl (rby) >999 amlodipine besy (lu.) >999
venlafaxine hcl er (tev) >999 albuterol (myn) >999
Prevnar 13® (Pfz) >999 valacyclovir hcl (rby) >999
enoxaparin sod (sdz) >999 amlodipine besy (gmk) >999
amphetamin salt er (glb) 682 metoprolol succin (wts) 908
pantoprazole sod (spi) 342 gabapentin (am9) 665
budesonide (tev) 235 ti
paroxetine hcl
h l (zyd)
( d) 275
Renvela® (Gzy) 144 furosemide (rby) 253
Trilipix® (Abt) 144 alendronate sod (wts) 239
oxaliplatin (t+p) 135 ranitidine hcl (g
(gmk)
) 193
Source: IMS Health, National Sales Perspectives, Nov 2010, National Prescription Audit, Nov 2010
Fastest declining products-Absolute declines
AC AC
Dollars Total Rx Dispensed
US$mn TRxs mn
Source: IMS Health, National Sales Perspectives, Jan 2011, National Prescription Audit, Jan 2011
Absolute Growth Vs. Yr. Ago-Companies
Dollars AC US$BN
$ TRx AC TRx mn
Source: IMS Health, National Sales Perspectives, Sep 2010, National Prescription Audit, Sep 2010
Sales of leading corporations (Top 10)
$98 bn
2014(f) 2014(f)
2013(f) 2013(f)
2012(f) 2012(f)
2011(f)
() 2011(f)
()
2010(f) 2010(f)
2009(f) 2009(f)
2008 2008
2007 2007
2006 2006
2005 2005
2004 2004
50 45 40 35 30 25 20 15 10 5 0 5 10 15 20 25 30 35 40 45 50
# NCE PROTECTION EXPIRIES # NCE APPROVALS
Source: FDA, IMS Health, Market Insights Team Analysis, Oct 2009
Global launches of innovative products declining,
d i
driven b
by fewer
f primary
i care products
d t
OF NCE LAUNCHES
NUMBER O
Source: IMS Health, New Product Focus, Jan 2011. *Preliminary estimate
31
Active pipeline continues to grow in each stage of
clinical development except Phase I
1600
NE
Phase I Phase II
S IN PIPELIN
933 1159
1000 864 1093
807 995
734 941
800 893
648
572
600
Source: IMS Health, R&D Focus, Jun 2010 and previous year slides
Global R&D pipeline compared against previous
year
2,721
,
1 763
1,763 (patterned segment) Specialist Driven Products
1,516
1,253
915
833 444
958
601 272 185
420 103
172 82
Pre-clinical Phase I Phase II Phase III Pre-reg/reg
44.5% 20.5% 24.8% 7.3% 3.0%
% share of active pipeline
Review
i delays
d l
20% of PDUFA goals missed in 2008*
FDA staff shortage
Source: IMS, Market Insights Research. *Jan-Oct 2008.
71 “traditional” drugs have REMS programs
Program Complexity
80
75%
70
60
50
40
30
23%
20
10
0% 2% 0% 0%
0
MG MG + CP CP + ETASU + IS MG + ETASU MG + ETASU + IS MG + CP + ETASU + IS
Program Complexity
60
57%
50
40
Aranesp
Epogen/Procrit
30
Nplate
Sabril
19% Onsolis
20
Zyprexa Relprevv
9%
10 4% 7%
3%
0
MG MG + CP CP + ETASU + IS MG + ETASU MG + ETASU + IS MG + CP + ETASU + IS
% TRx Dispensed
100
15 19 19 20
21
42
75 49 55
60 65
68 71 73 74 73 72 72
50 13 66 64 63 63
61
13
12
11
10
25 11 11
44 11 11 13 14 16
38 33
29 25 8 8 8 9 10
21 19 16 14 14
14 12 11 10 9 9 8
0
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
09
10
19
19
19
19
19
19
20
20
20
20
20
20
20
20
20
20
20
Cash Medicaid All Other 3rd Party Medicare Part D
• Providing • Improving
insurance to the quality of
the currently care that is
uninsured A
Access Quality delivered
• Lowering costs
of existing
Affordability
activities
• New sources of
funding
The most certain impacts are negative in the short
term but more positive or uncertain longer term
Upside
Expanded coverage of
current uninsured
350
LLIONS)
250
Nongroup/Other -5 -2
200
Employer -4 +8
NUMBER OF
150
Medicare 0 +14
50
0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Source: CMS, CBO Healthcare Reform Reconciliation Bill Analysis, Mar 2010
Sales and prescription performance-2011
10% 2007
2008
2009
2010
MAT Feb 2011
WTH U
5 0%
5.0%
5% 4.6%
3.8% 4.0%
3.2%
2.6%
2.3% 2.1% 2.0%
1.8%
1.1% 1.2%
0%
Sales TRx
Source: IMS Health, National Sales Perspectives, Feb 2011 IMS Health, National Prescription Audit, Feb 2011
What’s In?
• Slower market growth
• Generics & Patent Cliff
• Specialty is growing but at a slower pace
• RX to OTC
• Private label OTC
• Chain & Mass, Mail service, Clinics, & LTC
• Medicaid
M di id & M
Medicare
di Part
P tD
• Cough, Cold and Flu
• Price Increases
• REMS
• Drug Shortages
What’s out and what’s ahead???