Transcript Presentations

PRESENTED BY
Jack Tuttle
Copyright 2002, IMS HEALTH. No portion of this document may be
reproduced, used or distributed in any form without written
authorization. All trademarks assumed.
Pharma Industry Growth 1997 - 2001
Other
Japan
Europe
N. America
$396B
$296B
CAGR
8%
1997
2001
Copyright 2002, IMS HEALTH
North America Leads the World in
Dollar Percent Growth (Constant Exchange)
Canada
16
USA
13
UK
12
Mexico
12
Spain
10
Germany
9
Key Markets
8
Aust/NZ
7
Italy
France
Japan
5
3
3
Brazil –7
Argentina -52
Comparison is Latest 12 months ending September 2002
vs. Latest 12 Months ending September 2001
Copyright 2002, IMS HEALTH
Rx
Rx
US Pharma Continues to Extend Its
Large Lead
$US Bil
180
160
140
120
100
80
60
40
20
0
A
S
U
an
ce
ny
n
p
a
a
m
Ja
Fr
er
G
Source: IMS HEALTH: MIDAS, 2001
ly
Ita
UK
in
a
Sp
*
*
il*
da
a*
z
co
a
i
n
ra
n
x
hi
a
e
B
C
C
M
* Pharmacy only ** Hospital only
Copyright 2002, IMS HEALTH
2002 Recap
Generics in the Spotlight
Hormone Replacement Concerns
“Personal Importation”
No Medicare Drug Benefit
State Medicaid budget deficits force states to tackle drug
costs
“Truthful” DTC
Pharmaceutical Industry under attack
Three Tier Co pays continue to expand
“Innovation Drought” Continues
Nexium/Prilosec, Clarinex/Claritin transitions
• Claritin—Generic?, OTC, or Other
Amgen/Immunex merger, Pfizer/Pharmacia, Others?
Counterfeit Drugs
Drug Shortages
Copyright 2002, IMS HEALTH
Express Scripts-Top Developments in
the 2002 Pharmaceutical Landscape
•Claritin Goes OTC
•Generic Market Share Reaches All-Time
High
•Prilosec Faces Generic Competition
•Hormone Replacement Studies cause
Concern and Confusion
•Several High-Profile Drugs ApprovedOthers Delayed
•Marketing Landscape Chills For
Pharmaceutical Manufacturers
•Speciality Injectable Drugs Gain Market
Share
Copyright 2002, IMS HEALTH
The 2002 Pharmaceutical Market
Should Exceed $190 Billion Dollars
All Outlets- Ex Wholesale Cost
250
194.4
200
172.2
150
100
128
73.4
82
61.2
66.6
93
94
95
96
92.9
146.8
107.3
50
0
97
98
99
'00
"01*
02E
Compounded Growth = 13.8%
* 2001 had 53 weeks of sales
Copyright 2002, IMS HEALTH
2002 Mid-Year US Dollar Growth
shows a Return to More Historic Levels
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
19%
17%
15%
14%14%
12%
8%
9%
13%
15%
13%
10%
91 992 993 994 995 996 997 998 999 000 001 3Q
9
1
1
1
1
1
1
1
1
1
2
2 AT
2M
0
20
Percent Change vs. Year Ago
CAGR is 13.8%
Copyright 2002, IMS HEALTH
2002 Retail & Mail Prescriptions
Are Growing at 5%
9%
5%
3%
4%
6%
5%
4%
7%
5%
5%
5%
1%
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
20
02
00
M
A
T 20
O 0
ct 1
20
02
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
Percent Change Vs. Year Ago Retail and Mail (excludes LTC)
Copyright 2002, IMS HEALTH
Forecast of Future Rx Dispensed
Growth U.S. Retail Market (Bill.)
At 5.5% CAG Rate
4
3.5
3
2.2 2.3
2.1
1.9 1.9 2.0 2.0
2.5
2
2.5
2.7 2.8
3.0
3.2
3.4 3.5
3.7
1.6 1.6 1.6 1.6
1.5
1
0.5
0
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
02E 03E 04E '05E
Compounded Growth = 5.5% 1 Mail Rx = 1 RX
(Excludes LTC)
Copyright 2002, IMS HEALTH
Rising Rx Expenditures: A Function of
Demand
Increases RXs per
user
Increased Days per
RX
New Drugs
New Users
Other
Price Increases
0
Source: PCS Health Systems 2000
5
10
15
20
25
Copyright 2002, IMS HEALTH
Total Prescriptions Dispensed Have Grown
by 153 Million Rx’s Over the Last Year
(MAT Sept 2002 vs. MAT Sept 2001)
18219
SSRI/SNRI
PPI
12746
Chol. Red
9041
Codeine & Comb
8666
Beta Blockers
8455
Seizure Disorders
7168
Antihistamines
7168
Bisphosponates
Ace Inhibitors
Antipsychotics
6887
5674
4866
Copyright 2002, IMS HEALTH
Non Price Factors Drive Industry
Growth
19
17
15
13
11
9
7
5
3
1
-1
15.0
11.7
7.8
13.0
12.0
10.8
10.8
6.7
7.7
8.5
1.9
1.6
2.5
1995
1996
1997
3.0
4.0
3.9
4.9
4.4
4.2
3.3
1998
1999
2000
2001
2002
1Q
2002
2Q
2002
3Q
Price
Non Price Factors
Source: IMS HEALTH: Retail & Provider Perspective, 2001 with 2001 adjusted for underlying 52 week trend
Copyright 2002, IMS HEALTH
Average Rx Retail Price
At Price To Consumer
All Rx’s
Brands
Generics
1990
22.06
27.16
10.29
1995
30.01
40.22
14.84
2000
45.79
65.29
19.33
4Q 2001
49.27
72.28
22.96
1Q 2002
50.35
72.84
23.11
2Q 2002
52.19
77.14
23.70
3Q 2002
53.29
80.21
24.63
Note: Prices are simple averages not adjusted for product mix and Rx size
Copyright 2002, IMS HEALTH
Cash and Third Party Disbursements
Have Switched Places
100
90
26
80
70
11
55
60
65
60
68
70
73
74
11
11
11
11
50
40
30
12
63
20
33
10
11
29
10
25
21
19
16
14
1998
1999
2000
2001
MAT
Sept
2002
0
1990
1996
Cash
1997
Medicaid
Third Party
Source: IMS HEALTH: NPA+7, Method of Payment Report, YE 2001
Copyright 2002, IMS HEALTH
Co-Payments Are Going Up!
$35.00
$30.00
GF vs. BNF=$3.77
$22.90
$30.56
$25.00
$20.00
$15.91
$15.00
$10.00
$5.00
$6.93
$8.77
$7.66
$5.00
$0.00
1996
Generic(Preferred)
2001
Brand(Preferred)
Brand(Non-Formulary)
Source: Novartis Pharmacy Benefit Report 2001 Edition
Copyright 2002, IMS HEALTH
As Co-payments Increase….
Noncompliance Will Probably Get Worse
25%
20%
15%
10%
5%
0%
Had Not Filled One RX
Source: Harris Interactive Survey
Taken Smaller Dose
Taken Medication
Less Frequently
Action
Copyright 2002, IMS HEALTH
Mail Service Prescriptions Are Growing
Faster Than Retail Prescriptions
12
10
8
6
4
2
0
Ttl. Retail & Mail
'98
'99
Retail
'00
Mail
'01
MAT Aug '02
Copyright 2002, IMS HEALTH
Factors That Influence the
Pharmaceutical Market $ Growth Rate!
1996-2001
•
•
•
•
•
•
Positive
DEMOGRAPHICS
Managed Care Coverage
DTC
Blockbuster New
Products
Growth in Sales Force
Size
Price Increases
•
•
•
Negative
Pressure on Prices
Two Tier Copays
Generics
Copyright 2002, IMS HEALTH
Factors That Will Influence the
Pharmaceutical Market $ Growth Rate!
2001-2006
•
•
•
•
•
•
Positive
DEMOGRAPHICS
Technology
Pipeline Still Strong
Lifestyle Drugs
Under-treated disease
states
Medicare Rx Benefit
•
•
•
•
•
•
•
•
•
Negative
Weak/delayed new
products in 2001 & 2002
Negative Publicity
Multi-tier Copays
Generics
Claritin/Prilosec go OTC
or Generic
Economic slow-down
Slower growth in sales
force size
Personal importation
State programs
Copyright 2002, IMS HEALTH
Pharmaceutical Cost Containment
Strategies may be getting traction
• Increase Co-payments/ Exclude list
• Maximize use of Generics
• Encourage use of Mail Service
• Formularies
• Therapeutic Substitution
• Reimbursement of OTC’s
• Informatics and POS
Copyright 2002, IMS HEALTH
Health Plans Ask Themselves…
• To Merge or Not to Merge
• Targeted Marketing with Strict Pricing
• Concentric Networks with Variable Cost Sharing
• Participate in Medicare + Choice
• NCQA or bust
• How Much Copay Cost Shift to Consumer
• Extent of Utilization and Cost Containment
Copyright 2002, IMS HEALTH
Leading MCO’s
• National Models
•
•
•
•
•
•
Aetna
CIGNA
United Healthcare
Humana
Wellpoint
Anthem
• Regional Models
•
•
•
•
•
•
Kaiser
Health Net
PacifiCare
Oxford
Harvard Pilgrim
The “Blue’s” ??
Copyright 2002, IMS HEALTH
Nationwide Employee Benefit Costs
• Expected to Increase at an Average Rate of 15% this Year
vs 2% overall inflation
• Aggressively Managed Benefits will Increase at 11%
• Those with Minimal Management will Increase at 18%
• Hospital Costs Increase at 25%
• Pharmacy Costs Increase at 17%
• Employees Bear
• 22% of the Cost for Family Coverage
• 17% of the Cost for Single Coverage
Copyright 2002, IMS HEALTH
Insurance Options Offered
• Employers are Streamlining Costs by Offering Fewer
Health Plans and Thereby Negotiating More Aggressively
with Carriers for Larger Volumes
• Examples:
• CalPERS 1.2 million members keeping 5 HMO’s only and
dropping 2 major health plans (Health Net and PacifiCare)
with a rate increase of 25.1%
• Sears, Roebuck and Co dropped 120 HMO’s retaining only 65
• American Express dropped 164 HMO’s keeping 48
• Xerox dropped 92 of its 222 health plans
Copyright 2002, IMS HEALTH
Employers Want Quality
• Leapfrog is a Coalition of Fortune 500 Companies
Mobilizing the Nation’s Biggest Purchasers of Health-Care
Services to Demand Quality
• Leapfrog was Started after a 1999 Institute of Medicine
reported 98,000 Deaths each Year from Medical Errors
• Leaps in Patient Safety and Customer Value Will Be
Recognized and Rewarded with Preferential Use
• 7 State pilot Project Measuring Hospital Quality
• Computerized Physician Order Entry
• Critical Care Trained ICU Daytime Staff
• Evidence Based Hospital Referrals
Copyright 2002, IMS HEALTH
Medicare Prescription Drug Coverage
Republican Proposal
Democratic Proposal
• $35-40 Premium/Month
• $25 Premium/Month
• $250 Deductible
• $0 Deductible
• 70% Coverage to $1,000
• 50% Coverage up to $4,000
• 50% Coverage $1,000 $2,250
• 100% Coverage > $4,000
• No Coverage $2,250 - $5,000
• Medicare and Private PBM’s
Risk
• 100% Coverage > $5,000
• $425 Billion Over 7 years
• Private Insurance Risk
• $350 Billion Over 10 years
Copyright 2002, IMS HEALTH
Medicare Prescription Drug
Coverage Issues
• Private Sector Solution will Likely Increase Role of Large
PBMs
• Increase Purchasing / Negotiating Power
• Impact on Smaller PBMs
• PBMs will Need to Market Directly to Consumers
• Expanded Coverage is Expected to Increase
Pharmaceutical Usage
• Loss of One of the Last Blocks of Cash Business
Copyright 2002, IMS HEALTH
Pharmacy Discount Card (Bush)
• Private Sector PBM Solution
• $25.00 Annual Fee
• Negotiate Discounts with Manufacturers
• Closed Networks
• Preferred Drug Lists
• Mail Service
• Telephone Call Centers
• Retail Pharmacy Sponsored Lawsuit
• Concern Over Limited PBM Oversight
Copyright 2002, IMS HEALTH
Pharmaceutical Industry Response
• GlaxoSmithKline “Orange Card” Giving Discounts To
Qualifying Seniors on all GSK Products, Admin by ESI
• Novartis “Care Card” Gives 25% or Greater Discount,
Enroll Via Pharmacies and Administered by a PBM
• “Pfizer for Living” Share Card Offers a 30-day Supply of its
Drugs for a $15 fee. Currently 80,000 enrollees
• Others: Eli Lily “LilyAnswers” Merck, Pharmacia
• NACDS Pharmacy Care One Card Program
Copyright 2002, IMS HEALTH
Pharmaceutical Industry Response
• Together Rx Card Created by 7 Pharma Co’s for Seniors
without Drug Coverage with Discounts of 20% to 40% on
150 Drugs.
• Qualifying Income is $28,000 individually or $38,000 as a
couple
• The companies sponsoring the card are: Abbott,
AstraZeneca, Aventis, BristolMyers Squibb, GlaxoSmithKline,
Johnson & Johnson and Novartis
• Bristol Myers Squibb and GlaxoSmithKline recently decreased
their discounts so as to not interfere with Medicaid Best Price
Copyright 2002, IMS HEALTH
Rx Financing Challenges
• Overall Pharmacy Benefit Inflation
• Flexibility at What Cost?
• New Drugs with Higher Replacement Costs
• Disease Management
• Prevention Emphasis
• Improved Compliance
• Expansion of Prescription Drug Coverage
• Direct to Consumer Advertising
• Management of Injectable Drugs
Copyright 2002, IMS HEALTH
PBM Membership
Impact of Consolidation
Advance PCS
Medco Health Solutions
Express Scripts
MedImpact
Wellpoint
CaremarkRx
New Eckard
Pharmacare/CVS
First Health
Prescription Solutions
Prime Therapeutics
Aetna
Walgreens
75,000,000
65,000,000
47,000,000
38,500,000
29,000,000
23,000,000
16,000,000
12,000,000
9,400,000
5,300,000
5,000,000
4,800,000
2,100,000
Copyright 2002, IMS HEALTH
2001 HMO Average PMPM Expenditures
by Line of Business
60
50.6
50
40
30.13
29.61
27.11
30
20
10
0
Commercial / Group
Medicaid
Medicare
Overall
Source: Novartis Pharmacy Benefit Report™
Copyright 2002, IMS HEALTH
Level of Pharmacy Benefit
Management Control
• 92% of all Rx’s are Filled Within the Formulary
• 58% of Rx’s are Filled with Branded Drugs
• 82.1% of all HMO’s Require Generic Substitution
• 68.7% Require Some Additional Charge for the
Branded Drug When a Generic is Available
Copyright 2002, IMS HEALTH
Three Tier Copays
• Cover Approximately 35% of IPA HMO Enrollees
• Expected to Rise to 47% of All Beneficiaries by
year end 2002
• Average Copays will Approach $10/$25/$40
within next 12 months
• Source: Health Industries Three Tier Copay Report Spring 2001
Copyright 2002, IMS HEALTH
Copay Variations
• Humana Four Tier Program
•
•
•
•
Generic $10
Brand $25
Brand with Lower Drug Price Alternative $45
Expensive “Top of the Line” Drugs 25% of Retail Price
• Express Scripts Five Tier Program
• Employers Select Copay and Drugs by Tiers
• Selected Based in Cost, Effectiveness and Rebates
• Wellpoint Reference Policy Pricing Plan
• Reference Price Established by Therapeutic Company
• Prime Therapeutics
• Tiers are Based on Evidence of Value to Patient & System
Copyright 2002, IMS HEALTH
Pipeline Presentations
• Customers are Closely Tracking Products in Development 2
– 5 years from Launch
• Potential for Formulary Impact
• Copay Assignment
• Coverage Policies / Limitations
• Specific Pipeline Committees Separate and Distinct from
the Pharmacy and Therapeutics Committees
• Drug Trend Reports Produced by
• Medco Health Solutions
• Express Scripts
• PCS
Copyright 2002, IMS HEALTH
Managed Injectables and Specialty
Pharmacy Providers
• MCO’s Carving Out the Management of High Cost
Injectable Drugs
• MCO Heighten Level of Interest to Control Cost of
Injectables
• Exclusivity?
• Administrative Challenges
• Specialty Pharmacies May Be Stand Alone Companies or
Subsidiaries of PBMs or Wholesalers
• Specialty Pharmacies Provide Integrated Distribution,
Training, Reimbursement Hotlines, Patient Assistance
Programs, Educational Services and Reporting
Copyright 2002, IMS HEALTH
Electronic Prescribing:
Ideal Functionality
• Single Device Per Practice
• Connect to all PBM Systems
• Include all Formularies
• Conduct Real Time Drug Utilization Review
• Provide Reference Sources
• Interface with Electronic Transmission Vendors
• Integrated into the Physician Practice System
• Wireless Connection to Office System
Copyright 2002, IMS HEALTH
RxHub
• Connectivity Hub for Electronic Prescribing Information
between Physicians, Pharmacies, PBM’s, Health Plans
• Formed Through the Joint Partnership of AdvancePCS,
Express Scripts and Medco Health Solutions
• 60 Million Capital Invested Recovered Over 5 Years
Through Transaction Fees
• Open to all Players, Not Just Funding PBM’s
• Transaction Fees Same for All Players
• No Charge to MD’s
• Pre-Adjudication will Check for Drug Interactions,
Formulary Status, Prior Authorization Requirements and
Step Care Guidelines
Copyright 2002, IMS HEALTH
The US Market Will Exceeded $190
Billion in 2002 (Mail is Projected)
12 months ending September 2002
$ Bil
Retail Channels
143.3
%
%
Change
75.2%
13.1%
Chains
Independents
Mail Order
Food Stores
Mass Merchandisers
55.8
30.9
26.1
17.2
13.0
29.3
16.3
13.7
9.0
6.8
11.3
10.3
21.4
15.3
9.7
Institutional Channels
47.2
24.8
12.7
21.5
15.0
8.5
1.5
0.8
11.3
7.9
4.5
0.8
0.4
8.9
17.4
16.8
3.0
12.5
190.2
100.0
13.0
Hospitals
Clinics
LTC/HH
HMOs (Staff Model)
Others
Total
Source: IMS HEALTH: DDD & Statistical Services. Trade Prices.
Mail Service is projected
Prescription Pharmaceuticals and Insulin, 2002
Copyright 2002, IMS HEALTH
Chains & Independents Still Largest, But
Not Fastest Growing
$ Share of US Rx Market
(ex-manufacturer)
{
Chain
29.3%
Staff HMO 0.8%
Misc 0.4%
LTC/HH 4.5%
Clinic 7.9%
Mass Mdse 6.8%
Food Store
9.0%
Largest
Independent
16.3%
Source: IMS HEALTH: DDD, 2001
12 months ending December 2001 Mail Service Projected
Fastest
Growing
Mail Service
13.7%
Hospital
11.3%
Copyright 2002, IMS HEALTH
Average Health Care Cost Increases
Active Employees
16%
14%
12%
10%
8%
6%
4%
2%
0%
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Est.
Source: Harris Interactive Survey
Copyright 2002, IMS HEALTH
Average Health Care Cost Increases
are going up dramatically
20%
15%
10%
5%
0%
1993
1994
Yellow is Retirees
1995
1996
1997
1998
1999
2000
2001
2002
2003
Est.
Green is Active Employees
Source: Towers Perrin 2002 health care cost survey
Copyright 2002, IMS HEALTH
US Rx Growth Draws Attention
Despite its Relatively Small Share . . .
Where it Went...
16.4% Rx
Growth
Other
Medical
11%
9.6% Total HC Growth
Pgm Public Hlth
Admin
Activity Research &
7%
4%
Constr
3%
Pharmaceutical
10%
Hospital
Care
30%
Nursing/ HH
10%
Source: CMS (HCFA),
2001 projected data
Physician Svcs
25%
Copyright 2002, IMS HEALTH
Hospital Outpatient is Outpacing
Pharmaceutical Growth
18
16
14
12
10
8
6
4
2
0
2000
2001
2002
All Services
RX Drugs
Hospital
Outpatient
GDP
Strunk Et Al Health Affairs Sept. 25, 2002
Copyright 2002, IMS HEALTH
29% of People think the the
Pharmaceutical Industry is doing a
bad job of servicing their consumers
Type
Good
Bad
Type
Good
Bad
1
Banks
74
20
8
Telephone
58
36
2
Hospitals
73
17
9
Life Ins
55
21
3
Car Mfgr
64
23
10
Health Ins.
51
38
4
Airlines
63
16
11
Oil
38
44
5
Comp Soft
60
12
12
HMO’s
33
45
6
Comp Hard
59
10
13
Tobacco
25
61
7
Pharmaceutical
59
29
Copyright 2002, IMS HEALTH
The Pharmaceutical Industry
Approval Rate is Declining
80
70
60
50
40
Doing a Good Job
30
20
10
0
1997
1999
2001
Copyright 2002, IMS HEALTH
Most New Drugs Aren’t “New”?
55
New Versions of
Drugs with Old Active
Ingredients
35
Drugs with new active
ingredients
New Drugs with same
active ingredient as
an identical drug
already on the market
11
0
5
10
15
20
25
30
35
40
45
50
55
60
Source: National Institute for Health Care Management
Copyright 2002, IMS HEALTH
R&D Spending Continues to
Increase, Mostly in the US
R&D Expenditures
in $ Millions
30,000
Research and development abroad
6,454.9
US Research and development
25,000
4,667.1
20,000
3,839.0
15,000
4,219.6
3,333.5
10,000
1,617.4
17,222.5
18,499.3
1998
1999
21,363.7
23,887.8
11,874.0
5,000
6,802.9
0
1990
1995
2000
2001e
Source: PhRMA, Pharmaceutical Industry Profile 2002
Copyright 2002, IMS HEALTH
Approval Times Beginning to Rise
Mean approval time (months)
54
52
50
48
46
44
42
40
38
36
34
32
30
28
26
26
24
22
20
18
16
14
12
10
1992
Total # new molecular entities
approved each year
53
39
35
30
28
27
25
24
22
19
1993
1994
1995
1996
1997
1998
1999
2000
2001
Source: US FDA, 2001
Copyright 2002, IMS HEALTH
2001 Global Pipeline Is Fully
Loaded
6,225
To December 2001  8,722 Products
935
1,067
328
PRECLINICAL PHASE I
71%
11%
PHASE II
12%
167
PHASE III PRE-REG/REG
4%
2%
Source: IMS Lifecycle CD ROM December 2001
Copyright 2002, IMS HEALTH
Importation & Reimportation
Concerns
•
•
•
•
Fear of Tampering
Counterfeit Medicines
Regulatory Supervision
Poisoning by Terrorists
The Number of FDA Criminal Counterfeit
Cases is Growing
1999
2000
2001
2002 YTD
6 cases
10 cases
23 cases
16 cases
Copyright 2002, IMS HEALTH
Generics are Gaining Traction
% Total Prescriptions Dispensed
100
90
7
9
6
8
7
8
7
9
8
9
80
38
38
38
38
39
12
12
11
11
11
50
51
51
51
50
1998
1999
2000
2001
2002
Est
70
60
50
40
84
86
85
85
84
30
20
10
0
1998
1999
2000
Brands
2001
2002
Est
Branded Generics
Generics
Source: IMS HEALTH: NPA+7, Method of Payment Report, YE 2001
Copyright 2002, IMS HEALTH
2002 Patent Expirations
Product
Company
2001 Sales
Glucophage
BMS
$2.0 Billion
Prilosec
AZ
$4.6 Billion
Zestril
AZ
$933 Million
Prinivil
Merck
$683 Million
Accutane
Roche
$566 Million
Augmentin
GlaxoSmithkline
$1.6 Billion
Claritin
Schering
$1.3 Billion
Ultram
J&J
$600 Million
Copyright 2002, IMS HEALTH
Other Possible Patent Expirations
2002
Intron A
Axid
Relafen
2003
Cipro
Singulair
Flovent
Flonase
Engerix B
2004
Lovenox
Diflucan
Lupron
Lamisil
Paraplatin
Xenical
2005
Zocor
Prevacid
Zoloft
Pravachol
Zithromax
Biaxin
Zofran
Aredia
Zoladex
Source: Generic Pharmaceutical Associations
Copyright 2002, IMS HEALTH
Generics Gain Quick Acceptance
when Patents Expire
Generics Share of NRX’s
90
88
86
84
82
80
78
76
74
72
70
After 5 Weeks
After 10 Weeks
Current 9/6/02
IMS NPA Plus
Copyright 2002, IMS HEALTH
The Top 10 Manufacturers Represent
58.0% of the US Rx Industry
MAT September 2002
Corp by Legend Drugs
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Pfizer
GlaxoSK
Merck
Johnson & Johnson
Astra Zeneca
BMS
Novartis
Wyeth
Pharmacia
Lilly
$ in Mil
% Shr
% Chg
19,319
17,292
12,917
12,470
10,969
9,436
7,608
7,397
7,069
6,668
10.1
9.0
6.7
6.5
5.7
4.9
4.0
3.9
3.7
3.5
+ 15%
+ 16%
+ 11%
+ 24%
+ 16%
- 7%
+ 18%
+ 14%
+ 13%
- 13%
Leading corporations. Prescription products and insulin. All Audited Channels. Excludes co-marketing and
JV agreements. Data run by custom redesign to include recent M&As.
High Growth
Source: IMS HEALTH: Retail & Provider Perspective, 2002
Copyright 2002, IMS HEALTH
The Top 10 Manufacturers Represent
61.2% of the US Rx Industry
MAT September 2002
Corp by Legend Drugs
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Pfizer/Pharmacia
GlaxoSK
Merck
Johnson & Johnson
AstraZeneca
BMS
Novartis
Wyeth
Lilly
Schering
$ in Mil
% Shr
% Chg
26,968
17,292
12,917
12,470
10,969
9,436
7,608
7,397
6,668
6,061
13.8
9.0
6.7
6.5
5.7
4.9
4.0
3.9
3.5
3.2
+ 15%
+ 16%
+ 11%
+ 24%
+ 16%
- 7%
+ 18%
+ 14%
- 13%
+ 2%
Leading corporations. Prescription products and insulin. All Audited Channels. Excludes co-marketing and
JV agreements. Data run by custom redesign to include recent M&As.
High Growth
Source: IMS HEALTH: Retail & Provider Perspective, 2002
Copyright 2002, IMS HEALTH
Top 20 Companies Represent
79.0% of US Market
MAT September 2002
Corp by Legend Drugs
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Schering Plough
Aventis
Amgen
Abbott
TAP
Hoffman-LaRoche
Boehringer Ingelheim
Forest
Teva
Mylan
$ in Mil
6,061
5,878
5,275
5,265
4,684
4,165
2,448
2,161
2,145
1,977
% Shr
% Chg
3.2
3.1
2.8
2.8
2.4
2.2
1.3
1.1
1.1
1.0
+ 2%
+ 26%
+ 21%
+ 9%
+ 6%
+ 11%
+ 27%
+33%
+ 37%
+22%
Leading corporations. Prescription products and insulin. All Audited Channels. Excludes co-marketing
and JV agreements. Data run by custom redesign to include recent M&As.
High Growth
Source: IMS HEALTH: Retail & Provider Perspective, 2002
Copyright 2002, IMS HEALTH
Absolute Growth- Corporations
12 Months ending September 2002
Dollars
Inc. $ Mil.
TRX Dispensed
Inc
TRX’s
Mil.
Pfizer
+2.55
Pfizer
+20.1
Johnson &
Johnson
GlaxoSmithkline
+2.40
Barr Labs
+18.2
+2.37
Mylan Labs
+17.5
AstraZeneca
+1.49
Par
+14.3
Merck
+1.29
Mallinkrodt
+13.0
Aventis
+1.21
AstraZeneca
+10.2
Novartis
+1.16
Ranbaxy
+9.9
Amgen
+.90
URL/Mutual
+9.6
Wyeth
+.89
Upsher Smith
+8.9
Pharmacia
+.83
Qualitest
+8.2
Copyright 2002, IMS HEALTH
Cholesterol Reducers Are the
Leading Class By Sales Volume
CATEGORY
MAT September 2002
$ (Mil)
% Chg
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
12,138
11,202
9,991
5,925
5,670
5,045
4,833
4,704
4,554
3,964
Cholesterol Reducers
Proton Pump Inhibitors
SSRI/SNRI
Anti-psychotics
Erythropoietins
Seizure Disorders
Cox-2 Inhibitors
Anti-histamines
Calcium Blockers
Ace Inhibitors
20%
23%
10%
27%
26%
26%
12%
22%
1%
12%
Leading USC 4 classes. All Audited Channels.
Prescription products and insulin
Source: IMS HEALTH: Retail & Provider Perspective, 2002
Copyright 2002, IMS HEALTH
Lipitor is the Top Dollar Product
12 Months ending September 2002
Brand
Mfgr
2002
Rank
MAT Sept
2002 $ Vol
2002 %
Change
Share of
Market
Lipitor®
Pfizer
1
$6.0
+22
3.1
Zocor ®
Merck
2
4.3
+29
2.2
Prilosec ®
AstraZeneca
3
3.9
-16
2.0
Prevacid ®
TAP
4
3.7
+6
1.9
Procrit ®
J&J
5
3.0
+33
1.6
Zyprexa ®
Lilly
6
2.8
+20
1.5
Epogen ®
Amgen
7
2.8
+16
1.5
Celebrex ®
Pharmacia
8
2.7
+6
1.4
Zoloft ®
Pfizer
9
2.5
+28
1.3
Paxil ®
Glaxo
10
2.4
+18
1.3
Source: IMS HEALTH Retail & Provider Perspective
Copyright 2002, IMS HEALTH
Absolute Growth- Products
12 Months ending September 2002
Dollars
Inc. $
Mil.
TRX Dispensed
Inc
TRX’s
Mil.
(AZ)
+1.40
Nexium
+10.9
(Pfizer)
+1.07
HYCD/APAP
Advair Diskus (GSK)
+1.05
Lipitor
Nexium
Lipitor
Zocor
(AZ)
(MKR)
+9.2
(Pfizer)
+8.6
(Merck)
+.95
Advair Diskus (GSK)
+7.8
(J&J)
+.76
Fluoxetine
(Barr)
+6.9
(Wyeth)
+.59
Celexa
(Forest)
+6.2
(Eisai)
+.54
Toprol-XL
(AZ)
+6.1
Plavix (BMS/Sanofi)
+.54
Protonix
(Wyeth)
+6.0
Celexa
(Forest)
+.53
Fosamax
(Merck)
+5.1
(Lilly)
+.47
Glucophage XR (BMS)
Procrit
Protonix
Aciphex
Zyprexa
+5.0
Copyright 2002, IMS HEALTH
Worldwide Biotechnology Dollar
Sales
1992-2002*
36
32
28
US$bn
24
20
16
12
8
4
0
1992
1993 1994
1995 1996
1997
1998 1999
2000 2001 2002*
*Estimated 2002 Sales
Copyright 2002, IMS HEALTH
Worldwide Biotechnology Dollar Sales
1992-2002*
36
32
28
US$bn
24
GLOBAL
USA
ROW
20
16
12
8
4
0
1992
1993 1994
1995 1996
1997
1998 1999
2000 2001 2002*
*Estimated 2002 Sales
Copyright 2002, IMS HEALTH
The Top 10 US Biotech Companies Account
for 88.1% of Dollar Sales
(MAT June 2002)
Amgen/Immunex
29.2%
J&J
24.0%
Lilly
10.2%
Genentech
8.4%
Biogen
Schering
Medimmune
Novo Nordisk
Serono
Schering AG
4.7%
3.1%
2.7%
2.1%
2.1%
1.6%
Copyright 2002, IMS HEALTH
The Top 10 US Biotech Products Account for
66.4% of Dollar Sales
(MAT June 2002)
Procrit
17.0%
Epogen
15.4%
Neupogen
7.0%
Remicade
5.7%
Enbrel
5.0%
Rituzan
4.8%
Avonex
Synagis
Humalog
Humulin NPH
4.7%
2.6%
2.1%
2.1%
Copyright 2002, IMS HEALTH
Fastest Growing U.S. Biotech Corporations
Mat/June/2002 Based Absolute Growth
Top 10 Corporations
Rank Absolute Growth % Change
($ Millions)
U.S. Biotech Market
+3,304.9
J&J
2
1,274.4
47.0
Amgen/Immunex
1
710.6
17.2
Roche (Genentech)
4
344.1
32.7
Lilly
3
241.2
16.6
Aventis
12
154.1
313.9
Biogen
5
151.9
24.2
10
147.4
131.3
8
87.0
32.4
Pharmacia Corp
18
81.0
145.1
CSL
22
54.8
Schering Plough
Novo Nordisk
980.1
Copyright 2002, IMS HEALTH
U.S. Leading Biotech Products
Mat/June/2002 Based on US Dollar Sales
Top 10 Products
Rank
U.S. Biotech Market
US $ (Millions)
% Change
16,587.1
24.9
Erypo/Procrit
1
2,825.1
38.7
Epogen
2
2,554.0
12.9
Neupogen
3
1,153.0
11.7
Remicade
4
940.1
103.0
Enbrel
5
827.3
13.8
Mabthera/Rituxan
6
803.0
58.4
Avonex
7
780.3
24.2
Synagis
8
424.8
14.2
Humalog
9
346.1
57.0
10
343.1
-6.7
Copyright 2002, IMS HEALTH
Humulin NPH
Syntex
Copyright IMS HEALTH
Retail Perspective, Provider Perspective
Numbers Are In Thousands (000)s
Tot Dollars
CalYr/12/1992
ANAPROX
CARDENE
CELLCEPT
FEMSTAT
LIDEX
NAPROSYN
NASALIDE
NORINYL
SYNALAR
SYNAREL
TICLID
TORADOL
VAGITROL
187,423
62,342
11,736
42,977
561,727
29,025
39,079
8,095
18,705
22,176
201,228
179
1,184,693
MAT OCT/02
DOL TOT
4,898
13,516
434,665
79
7,227
10,430
7,898
14,649
1,665
4,780
6,937
2,281
Growth In
Dollar Sales
-97%
-78%
-99%
-83%
-98%
-73%
-63%
-79%
-74%
-69%
-99%
-100%
509,025
Copyright 2002, IMS HEALTH
Syntex
Twelve Months of Sales in 1992 Compared to Twelve
Months of Sales Ending October 2002
Dollars (000's)
600,000
500,000
Tot Dollars
CalYr/12/1992
400,000
MAT OCT/02
DOL TOT
300,000
200,000
100,000
L
V
A
G
RA
D
IT
R
O
O
L
LI
D
TO
A
N
SY
TI
C
RE
L
R
LA
SY
N
A
Y
RI
N
O
N
SA
A
N
PR
O
A
N
L
E
LI
D
N
SY
EX
LI
D
ST
AT
FE
M
LC
EP
T
CE
L
EN
D
R
CA
A
N
A
PR
O
X
E
-
Products
Copyright 2002, IMS HEALTH
Syntex
Copyright IMS HEALTH
NPA 20K - Monthly Rx Audit
Numbers Are In Thousands (000)s
Dispensed NRX
CalYr/12/1992
ANAPROX
CARDENE
CELLCEPT
FEMSTAT
LIDEX
NAPROSYN
NASALIDE
NORINYL
SYNALAR
SYNAREL
TICLID
TORADOL
VAGITROL
921
511
516
989
8,019
647
282
268
28
149
2,309
1
MAT NOV/02
NRX
49
25
690
1
87
71
41
29
28
4
12
27
Dispensed TRX
CalYr/12/1992
1,338
1,699
654
1,529
13,349
1,246
1,208
389
62
322
2,793
1
MAT NOV/02
TRX
82
99
674
1
131
120
93
119
38
8
47
36
Growth Growth
In NRx's In TRx's
-95%
-95%
-94%
-94%
-100%
-91%
-99%
-94%
-90%
-90%
-86%
-92%
-99%
-100%
-100%
-91%
-99%
-93%
-90%
-90%
-87%
-85%
-99%
-100%
Copyright 2002, IMS HEALTH
Syntex
New Prescriptions For Twelve Months in 1992 Compared to New
Prescriptions For Twelve Months Ending October 2002
Prescriptions (000's)
9,000
8,000
7,000
Dispensed NRX
CalYr/12/1992
6,000
MAT NOV/02
NRX
5,000
4,000
3,000
2,000
1,000
L
V
A
G
RA
D
IT
R
O
O
L
LI
D
TO
A
N
SY
TI
C
RE
L
R
LA
SY
N
A
Y
RI
N
O
N
SA
A
N
PR
O
A
N
L
E
LI
D
N
SY
EX
LI
D
ST
AT
FE
M
LC
EP
T
CE
L
EN
D
R
CA
A
N
A
PR
O
X
E
0
Products
Copyright 2002, IMS HEALTH
Syntex
Total Prescriptions For Twelve Months in 1992 Compared to Total
Prescriptions For Twelve Months Ending October 2002
Prescriptions (000's)
14,000
12,000
Dispensed TRX
CalYr/12/1992
10,000
MAT NOV/02
TRX
8,000
6,000
4,000
2,000
L
V
A
G
RA
D
IT
R
O
O
L
LI
D
TO
A
N
SY
TI
C
RE
L
R
LA
SY
N
A
Y
RI
N
O
N
SA
A
N
PR
O
A
N
L
E
LI
D
N
SY
EX
LI
D
ST
AT
FE
M
LC
EP
T
CE
L
EN
D
R
CA
A
N
A
PR
O
X
E
0
Products
Copyright 2002, IMS HEALTH
The Future Looks Good, But More
Challenging
•Price restraint
•Formulary enforcement
•Generic exposure
•Recession pressures
•Delayed launches
•Negative public opinion
_
11-14%
+
•Demographics
–Older
–Smarter
•Med/tech
advances
–Pipeline
•Expanded access
& awareness
CAGR
2003-2006
Copyright 2002, IMS HEALTH
Jack Tuttle
IMS HEALTH
Copyright 2002, IMS HEALTH. No portion of this document may be reproduced, used or
distributed in any form without written authorization. All trademarks assumed.
Year End 2002