How US pharmaceutical Market behaved during 2008.Why it has behaved like this what it depicts about the future. What the future hold????????? I have started compiling data since 2006 Going forward i will be uploading three presentation series US PMP 2008, US PMP 2009, US PMP 2010 which will briefly summaries present, past and future of US pharmaceutical market. Your valuable comments and criticism will be greatly appreciated and will help me in refining my work further. Please don't hesitate to contact me. My 24 hr Hand phone no. is + 91 963290278

1. US PMP Overview
October 2008
Accenture Research
Jaydeep Adhikari, Dawn M. Melberg, Mikael Stenstrand
1
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2. Accenture Research
Accenture Research
Agenda Agenda
• US Overview
– Summary Conclusions
– Geography & Political Structure
– Key Economic Indicators
– Demographics
• US PMP Overview
• Key PMP Players
• US PMP Outlook
• Appendix
2
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3. Accenture Research
Accenture Research
The US Pharmaceutical and Medical Products industries are facing many
challenges due in part to domestic scrutiny and reforms and global issues
impacting all the major geographic markets US Overview:
Summary Conclusions
Summary
US PMP overview
• US national healthcare spending will increase • The US prescription drug market is currently
by 7.3% in 2008, reaching a total of US $2.1
experiencing a slowdown, in large part due to
trillion
increased utilization of generic drugs and weak
• Currently at 16 percent of gross domestic
performances from newly launched products
product (GDP), U.S. health spending is double
the median of industrialized countries and is • The generics segment is growing rapidly as a
expected to consistently outpace GDP over the
result of the cost-containment measures
coming decade, accounting for 20 percent of
implemented by health insurers
GDP by 2015
• The elderly population (65+) is projected to • The market for OTC drugs is showing stronger
exceed 20% of the total US population by growth than in many years, mainly as a result of
2050, placing a tremendous strain on public
increased Rx-to-OTC switching and the decision
services and programs
by a number of health insurers to reimburse
• Public and private healthcare payers have
certain OTC products
begun to implement cost-saving mechanisms –
eg. Increased premiums and co-payments, • In 2005 Medicare represented 2% of the
tiered health plans and generic drug preference
prescription drug market, that share is expected to
• In 2008, the federal health insurance Medicare
jump to 28% in 2008
expanded its scope to include outpatient care,
including prescription drug subsidies. This
represents a large shift in the way prescription
drugs are paid for in the United States
3
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4. Accenture Research
Accenture Research
Agenda Agenda
• US Overview
– Summary Conclusions
– Geography & Political Structure
– Key Economic Indicators
– Demographics
• US PMP Overview
• Key PMP Players
• US PMP Outlook
• Appendix
4
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5. Accenture Research
Accenture Research
US – Geographic Summary US Overview:
Geography & Political Structure
Geography
Capital City: Washington, DC
Main Language (s): English
Continent/Region: North
America
Population: 300 million
Monetary Unit: US Dollar $
Main Export (s): Capital goods
including transistors, aircraft,
motor vehicle parts, computers
and telecommunication devices;
Consumer goods including
automobiles and medicines;
Industrial supplies including
organic chemicals
Source: Lonelyplanet; US Census Bureau; CIA Factbook
5
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6. Accenture Research
Accenture Research
The United States is a constitution-based federal republic consisting
of 50 states with significant legislative authority US Overview:
Geography & Political Structure
The United States
• The United States’ is a federalist system with a
national government and fifty sovereign states.
• Any power not delegated to the federal
government in the U.S. Constitution, nor
prohibited by it to the states, are reserved to the
states
• Both the national government and each state
government are divided into executive,
legislative, and judicial branches
• In the United States, federal and state
government funding of health care needs of its
citizens is limited to Medicare and Medicaid
insurance programs for the eligible senior, very
poor or disabled persons
• Individual states have significant leeway in
regard to healthcare legislation including access
and funding
• State budgets have been heavily impacted by
escalating healthcare costs as federal funding
declines and costs for healthcare services and
medications increase
Source: Plano ISD Instructional Center; CIA Factbook; Legislationline;
6
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7. Accenture Research
Accenture Research
Agenda Agenda
• US Overview
– Summary Conclusions
– Geography & Political Structure
– Key Economic Indicators
– Demographics
• US PMP Overview
• Key PMP Players
• US PMP Outlook
• Appendix
7
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8. Accenture Research
Accenture Research
The United States is the largest economy in the world
Key facts of the United States economy and consumers
GDP , GDP growth Private consumption, population
6% 5%
Germany 2008est. USA 2008
5%
Private consumption
USA
World average
GDP real growth*
3%
GDP* $12.36 bn Population 300m
4%
growth ***
UK GDP real 3.5% Private $16,260
Spain
1% France UK
growth** consumption
USA
3%
France
Spain per capita
GDP p.c. $41,800
2% -1% $0 $5,000 $10,000 $15,000 $20,000
Germany
Germany
1%
-3%
Bubble size = GDP
0% per capita
Bubble size = 2008 Population
0 5000 10000 15000 -5%
*official exchange rate
Private consumption p.c. (2008)
GDP ($bn) **2004/2005
Consumer price index (2000=100)
GDP per capita index (2000=100)
CAGR 120 CAGR
Country 2000/08
125 Country 2000/08
115
Spain Spain
120 3.2% 3.2%
UK UK
2.5%
115 110 2.3%
France France
1.9%
110 1.9%
105
Germany Germany
1.6% 1.6%
105
United States United States
3.8% 100 2.5%
100
95 95
2002 2004 2006 2008 2010 2012 2002 2004 2006 2008 2010 2012
Sources: OECD Factbook, 2006; Pharmaceutical Markets Fact Book 2005, OECD Main Economic Indicators; U.S. Department of Labor, Bureau of Labor
Statistics, World Economic Outlook Database 2006 and The Economist Intelligence Unit Ltd, 2005
8
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9. Accenture Research
Accenture Research
Agenda Agenda
• US Overview
– Summary Conclusions
– Geography & Political Structure
– Key Economic Indicators
– Demographics
• US PMP Overview
• Key PMP Players
• US PMP Outlook
• Appendix
9
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10. Accenture Research
Accenture Research
The United States has one of the largest birth rates of OECD countries with
the population projected to almost double between 2005 and 2050 Germany Overview:
Demographics
Birth rate*, 2008 Expected US population (million), 2005-2050
United States 2.04
France 450
1.89
420
Netherlands 1.75
392
United Kingdom 1.71 400
Sweden 1.71 364
Belgium 1.61 350 336
OECD average (1.56)
Switzerland 1.41
309
296
Austria 1.39 300
Japan 1.38
Germany 1.34
250
Italy 1.29
Spain 1.29
200
2005 2010 2020 2030 2040 2050
0 1 2 3
Note: Birth rate equivalent to number of children born to women aged 15 to 49 Source: US Census Bureau, 2004
Source: OECD Factbook 2008: Economic, Environmental and Social Statistics
10
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11. Accenture Research
Accenture Research
US citizens have historically lived longer than the OECD average however in
2003 the US life expectancy dipped just below the OECD average. Life
expectancy at birth continues to increase for both men and women Germany Overview:
Demographics
Life expectancy at birth (years) US life expectancy at birth by sex (years)
80 85
77.8
77.5
78 80.1
78.8
80
75.4
76
74.9
74.8
74.6
75
74
72
72
70
70.8
70.3
67
70
65
68
60
66
1970 1990 2010
1970 1990 2010
Females Males
United States OECD Average
Source: US CDC, 2008
11
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12. Accenture Research
Accenture Research
The population in the US is ageing, which is illustrated by the fact that people
aged 65 and above are projected to represent 16% of the US population by
2020, compared to 12% in 2000 US Overview:
Demographics
The expected development of the age structure in the US, 2000-2020
Age structure (2000) Age structure (2020)
Population aged 65 and over: 12% Population aged 65 and over: 16%
People ‘000
People ‘000
60,000
60,000
50,000 50,000
40,000 40,000
30,000
30,000
20,000
20,000
10,000
10,000
0
0
0-4 19-May 20-44 45-64 65-84 85+
0-4 19-May 20-44 45-64 65-84 85+
Male Female
Male Female
Source: US Census Bureau, Population Projections
Source: US Census Bureau, Population Projections
12
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13. Accenture Research
Accenture Research
Agenda Agenda
• US Overview
• US PMP Overview
– PMP Expenditures
– Regulatory System
– Pharmaceuticals Overview
– Medical Products Overview
– Distributor Overview
• Key PMP Players
• US PMP Outlook
• Appendix
13
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14. Accenture Research
Accenture Research
The United States spends more on healthcare than any other OECD country
both in terms of GDP and per capita – the US has not managed to contain
costs US PMP Overview:
PMP Expenditures
Healthcare spend as a % of GDP, 2008 Healthcare spend per capita (USD*)
CAGR 1999-2008
CAGR 1999-2008
USA 5,711 7.1%
3.8%
USA 15.2%
Switzerland 3,776 5.8%
2.3%
Switzerland 11.5%
Germany 3,001 4.0%
1.2%
Germany 11.1%
Netherlands 2,987 8.9%
2.1%
France 10.1%
France 2,902 5.9%
3.9%
Netherlands 9.8%
Belgium 2,828 7.6%
2.9%
Sweden 9.4%
Sweden 2,704 6.3%
2.5%
Belgium 9.4%
Ireland 2,496 11.3%
Italy 2.2%
8.4%
United Kingdom 2,389 8.9%
United Kingdom 8.0% 2.7%
Austria 2,306 3.0%
Spain 7.7% 0.7%
Italy 5.1%
2,266
Austria 7.5% -0.3%
6.2%
Spain 1,853
Ireland 7.3% 4.2%
6,000 USD
0 2,000 4,000
0.0% 5.0% 10.0% 15.0% 20.0%
Note: Healthcare spend per capita expressed at international dollar rate
Source: WHO Statistical Information System (WHOSIS), May 2008
14
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15. Accenture Research
Accenture Research
Pharmaceutical spending in the US is lower than the OECD average
however per capita spending is significantly higher than OECD peers US PMP Overview:
PMP Expenditures
Pharmaceuticals expenditure per capita, 2008 (USD)
Pharmaceutical spend as a % of total healthcare spend, 2008
Italy 22.1% USA 728
Spain 21.8% France 606
France 20.9% Italy 498
Japan 18.4% Germany 436
OECD average (17.5%)
Germany 14.6% Spain 401
USA 12.9% Switzerland 398
Sweden 12.6% Japan 393 OECD average (380)
Netherlands 11.4% Sweden 340
Switzerland 10.5% Netherlands 340
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 0 200 400 600 800
Source: Health at a Glance, OECD 2005
15
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16. Accenture Research
Accenture Research
The US spends less on medical technology as a percent of total healthcare
spend than the OECD, but maintains the highest rate of spend on a per capita
basis US PMP Overview:
PMP Expenditures
Medical Technology spend as a % of Medical Technology expenditure per capita, 2008
total healthcare spend, 2008 (EUR)
Germany 8.6% USA 278
Netherlands 6.5% Germany 230
France 6.5% Switzerland 188
European average (6.4%)
Netherland
Spain 6.1% 154
s
Italy 5.8% France 150
European average (124)
USA 5.1% Sweden 120
Sweden 5.1% Italy 107
UK 4.8% UK 97
Switzerland 4.5% Spain 73
0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 0 50 100 150 200 250 300
Source: Medical Technology Brief, Eucomed 2008
16
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17. Accenture Research
Accenture Research
Hospital and physician services represent the largest share of total US
healthcare expenditures US PMP Overview:
PMP Expenditures
Distribution of US Healthcare Expenditures, 2008
• National healthcare expenditures are expected
to reach a total of $2.1 trillion in 2008, growing
100%
at a much faster rate than the overall economy
10% Other
• While the largest portion of US health
90% 22%
expenditures is paid for by private funds, the US
14% Administrative
80%
government is projected to spend approximately
2%
7% Nursing home care
$740 billion on healthcare in 2006, representing
70%
7% 14% Pharmaceuticals 34% of total national spending
60% 11% • Hospital care and physician services account for
more than 50% of total healthcare expenditures
50%
Hospital care
29% • Total hospital spending growth is projected to be
40%
7.9 percent in 2005, more than 1.5 percentage
31%
points higher than GDP growth
30%
• Advances in medical technology, growth and
20% aging in the population and the propensity of
Physician/Clinical
31%
services baby boomers to frequently use healthcare
22%
10%
services are all factors contributing to the
increased use of hospital and physician
0%
services
Private healthcare spend Total healthcare spend
Note: Other spend includes dental services, home healthcare, durable medical products, etc.
Source: 2008 Medical Cost Reference Guide, Blue Cross Blue Shield Association
17
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18. Accenture Research
Accenture Research
Pharmaceutical spend as a percent of total healthcare expenditures
has slowed to single digit growth over the past several years US PMP Overview:
PMP Expenditures
Total Pharmaceutical Spend and % of Total Healthcare*
• Prescription drug expenditures reached $224 billion in
2005, representing 11.5% of total national healthcare
expenditures
$600 16%
• Prescription drug spending has slowed over the past
14% few years, growing at a rate of 8.2% in 2005 as
$500
opposed to the double digit growth of the mid nineties
12% through 2003
(in billions)
$400 • Slower growth rates are in part attributed to a
10%
slowdown in drug usage prompted by increased
consumer out-of-pocket expenditures and recent
$300 8%
concerns over drug safety
• The industry outlook is characterized by conflicting
6%
$200 factors which will both accelerate and slow growth –
The former include practice patterns that involve
4%
prescribing existing drugs to a larger segment of the
$100
2% population and high-cost specialty drugs designed to
treat rare conditions; growth constraints include
$0 0% projected growth in the use of generics and increased
cost sharing in the form of rising co-payments and
additional deductibles or both
Note: 2005-2014 projected
Source: 2008 Medical Cost Reference Guide, Blue Cross Blue Shield Association
18
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19. Accenture Research
Accenture Research
Pharmaceuticals are primarily financed by private insurance in the US,
however with the introduction of Medicare Part D legislation in 2006 there is
expected to be a significant increase in federal funding US PMP Overview:
PMP Expenditures
Prescription drug spend, by source, $bn, 2000-2010 • Currently, the private sector represents the largest
share of prescription drug purchasing with a
projected share of over 80% in 2006
• A shift is underway in prescription drug funding with
400
private insurers attempting to reduce drug
350 expenditures through higher co-pays and increased
use of generic substitutes
300
• The federal government’s share of prescription
250
drug spending is expected to increase significantly
with the passage of Medicare Part D legislation
200
which provides previously unavailable outpatient
150
drug coverage to Medicare members
100 • Under Medicare Part D, Medicare beneficiaries will
be able to join a private health plan for out-patient
50
coverage, or sign up to a stand-alone Medicare
0 prescription drug scheme
2000 2005 2006 2008 2009 2010
• The Medicare share of prescription drug spending
is expected to increase from 2% in 2005 to 27% in
Total Out-of-Pocket Total Private
2006
Total Public Medicare Medicaid
Source: US Centers for Medicare and Medicaid Services, 2008
19
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20. Accenture Research
Accenture Research
US managed care companies are increasingly demanding higher co-
payments for prescription drugs US PMP Overview:
PMP Expenditures
Prescription drug co-payments demanded by HMOs (% of all prescriptions covered)
Prescription Co-Payments 2004 2008 2012 [Projected]
Generic
$5 46 24 23
$10 40 52 51
$15 - 6 9
Brand Formulary
$10 28 10 7
$15 30 15 14
$20 26 35 31
$30 - 7 13
Brand Non-Formulary
$10 9 4 2
$25 21 5 6
$30 22 11 10
>$30 24 38 40
Source: Global Insights Report: United States (Healthcare and Pharma). October, 2008.
20
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21. Accenture Research
Accenture Research
In the United States, the manufacturer receives 76.5% of the reimbursed drug
price (excluding taxes), which is among the highest of European peers. In
Germany PMP Overview:
contrast, US pharmacies get a lower margin than their European counterparts PMP Expenditures
Share of final drug price (excluding taxes) in selected countries, per type of player, percentage 2008
Taxes
Sweden 82 2 16 0
United States 76.5 3.4 20.1 0
Norway 75.3 4.9 19.8
Denmark 74.7 20.3 26.6
Switzerland 73.5 0 26.5 2
Portugal 71.6 8.4 20 5.3
France 70.5 3.2 26.3 5.3
Finland 68.6 3.5 27.9 16.3
Netherlands 68.1 10.6 21.3 6.4
Italy 67 6.6 26.4 9.9
Spain 65.6 7.3 27.1 4.2
Ireland 64 11 25 0
Germany 64 4.7 31.4 16.3
Belgium 59.6 9.6 30.9 6.4
UK 87.5 4 8.5 0
0 20 40 60 80 100 120 140
Manufacturers Wholesalers Pharmacies Taxes
Source: Statistics 2008 VFA (The German Association of Research-Based Pharmaceutical Companies)
21
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22. Accenture Research
Accenture Research
Agenda Agenda
• US Overview
• US PMP Overview
– PMP Expenditures
– Regulatory System
– Pharmaceuticals Overview
– Medical Products Overview
– Distributor Overview
• Key PMP Players
• US PMP Outlook
• Appendix
22
© 2008 Accenture. All rights reserved. Adhikari,Dawn & Melberg - accenture H&LS consultant

23. Accenture Research
Accenture Research
The US Food & Drug Administration (FDA) is the primary regulator of the
pharmaceutical and medical products industries in the US US PMP Overview:
Regulatory System
•All drugs must be accepted by the FDA
prior to being marketed and sold in the US
•The FDA requires that pharmaceutical
manufacturers perform extensive testing to
US FDA
prove that their products are safe and
effective before it will sanction commercial
sale
•New drugs must pass through a three
Enforces US food
stage process of Clinical Trials before
& drug laws
receiving final approval from the FDA
•The FDA estimates that, of 20 drugs
Regulates the Introduction
entering clinical trial testing, an average of
of New Drugs
Monitors the manufacture,
13 to 14 will successfully complete phase I
Transport & storage of
– of those only 9 will finish phase II and
food, drugs and cosmetics
only 1 or 2 will pass phase III
•Due to recent concerns over drug safety,
Clinical Trials
The FDA is working on improving ways to
track the safety of drugs already
Phase I Phase II Phase III on the market; Tightening label
requirements and planning to expand the
duties of advisory committees are two
New Drug Application
measures currently underway to achieve
(NDA)
more effective post-market surveillance
Source: Pharmaceutical Industry Survey. Standard & Poor’s. May 25, 2006.
23
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24. Accenture Research
Accenture Research
Unlike its European counterparts, the US pharmaceutical industry is
characterized by no direct pricing controls US PMP Overview:
Regulatory System
• Currently, US drug pricing is primarily affected by:
• Free market dynamics: Includes the relative efficacy and
safety profile of a drug versus its rivals, the size of its
market, the competition it faces, and its development costs
• Discount and rebate programs resulting from leverage
exacted by large buying groups: Large-scale buyers (such
as hospital chains and other institutional customers) usually
pay well below list price, because their huge volume
purchases enable them to negotiate heavy discounts.
Government organizations, such as the Department of
Defense, the Department of Veterans Affairs, and Medicaid,
for example, typically negotiate some of the steepest
discounts for drugs.
• Patient assistance programs: Programs run by
pharmaceutical companies to provide free medications to
people who cannot afford to buy their medicine
• Generic competition: When some easy-to-manufacture
blockbuster drugs go off-patent, half a dozen or more
generic competitors may enter the market simultaneously at
prices that are 50% to 80% or more below brand
• Because US drug prices tend to be an average of 16-18%
higher than in European countries, there have been an
increasing number of calls for the US to adopt more direct
pricing controls
Source: Pricing & Reimbursement in the US. Datamonitor. June, 2008; Pharmaceutical Industry Survey.
Standard & Poor’s. May 25, 2008.
24
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25. Accenture Research
Accenture Research
Agenda Agenda
• US Overview
• US PMP Overview
– PMP Expenditures
– Regulatory System
– Pharmaceuticals Overview
– Medical Products Overview
– Distributor Overview
• Key PMP Players
• US PMP Outlook
• Appendix
25
© 2008 Accenture. All rights reserved. Adhikari,Dawn & Melberg - accenture H&LS consultant

26. Accenture Research
Accenture Research
For a long time, the market-based nature of the US Pharmaceuticals market
has enabled it to grow faster than the Pharmaceuticals market in any other
major developed country US PMP Overview:
Pharmaceuticals Overview
Growth of the largest Pharmaceutical markets, 2004-2010
[projected]
• The Pharmaceutical market in the US has been
growing faster than in any other major developed
Index 1998=100
220 country over the last decade
• While tight price controls from central governments
USA has limited growth in many other OECD-countries,
200
the US market is still characterized by free market
pricing and a large number of independent buyers,
leading to higher prices in general
180
Spain
• In addition, the strong development of the US
economy, the introduction of new
UK
160 products/treatments and an aging population have
driven growth in volume consumption. For instance,
Italy in 2010 an estimated 51% of the population took
140 France prescription drugs on a daily basis and 27% took
three or more drugs daily
Germany
Japan
120
100
2004 2005 2006 2007 2008 2009 2010
Sources: Statistics 2008, VFA (The German Association of Research-Based Pharmaceutical Companies); Health Care Costs Survey, USA Today/Kaiser Family
Foundation/Harvard School of Public Health, 2008
26
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27. Accenture Research
Accenture Research
Over the last few years value growth has stagnated, mainly as a result of
increasing competition from generic drugs, but also due to falling
productivity among manufacturers US PMP Overview:
Pharmaceuticals Overview
Prescription Pharmaceutical sales (at wholesale
prices) and annual growth rates, 2005-2008($bn) • Between 2005 and 2008 the US prescription drugs market grew
from $194 bn to $252bn, recording a Compound Annual
Growth Rate (CAGR) of 9.1%
$ bn
• Yet, the annual growth rate fell every year during the same
300 14.0%
period to reach a low 5.4% in 2008
13.0%
• This decelerating growth in terms of value is underpinned by
12.0% several factors, of which a few stand out:
11.3%
– Lower number of approvals for New Chemical Entities
10.4% (NCEs)
252 10.0%
– Fewer and lower-performing product launches
250
239
– The increasing use of generic drugs, which in turn is driven
8.0%
mainly by two different facts:
• The implementation of greater cost-sharing measures by
216
most health insurers
6.0%
5.4%
• The fact that many major drugs lost their patent
194
200
protection over the last few years
4.0%
– The withdrawal (for safety reasons) of a number of major
products
2.0% – A large number of switches by prescription drugs to OTC
status
• At the same time it should be noted that in terms of volume the
150 0.0%
market continues to expand
2005 2006 2007 2008
Size Growth
Sources: IMS Health press release 22 Feb 2008; PharmaHandbook 2008, VOI Consulting 2008, United States Healthcare and Pharma, Global Insight, Oct 2008
27
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28. Accenture Research
Accenture Research
Pharma sales by therapeutic category US PMP Overview:
Pharmaceuticals Overview
Pharmaceutical Retail Sales by Therapeutic Category, 2008 (USD m)
577 25,098
Contracting < -ve growth 2005-2008 389
522
661 2% 100%
2%
694
Underperforming market <6%2003-2008 2%
1,102 3% N/A 0.5%
3%
3%
1,321 3%
4% 2%
Out performing Market >6% growth 2003-2008* 1,387 -9%
5% 12%
1,858 6% -7%
7%
1,902 8%
-3%
8%
1,995
3%
8%
3,836
16%
15%
-2%
3,839
15%
8%
Sales ($m) 5,015
Share of total 20%
Growth (03-04) -9%
Erythropoietins
Bisphosphonates
Antipsychotics, other
Other
Monoclonal
Anti-platelets, Oral
Total
Statins
Seizure Disorders
Calcium Blockers
Ace Inhibitors
SSRI
Proton Pump
Insulin Sensitizer
Angiotensin II
Antibodies
Antagonists
Inhibitors
Source: PharmaHandbook 2008, VOI Consulting * IMS reported 6% growth in retail sales 12m to May-08 $26.8B
28
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29. Accenture Research
Accenture Research
Pfizer’s cholesterol reducer Lipitor is by far the best-selling drug on the US
market. At the same time, a number of biotech products, such as Amgen’s
Aranesp and Enbrel, are rapidly becoming major growth engines US PMP Overview:
Pharmaceuticals Overview
Leading prescription drugs, 2008, at wholesaler prices
Company Class Sales (USD bn) Change (2005-2008)
Lipitor Pfizer Statin 8.4 +8%
Zocor Merck & Co Statin 4.4 -5%
Nexium AstraZeneca Proton pump inhibitor 4.4 +15%
Prevacid TAP (Takeda/Abbott) Proton pump inhibitor 3.8 -2%
Advair Diskus GlaxoSmithKline Beta 2 agonist 3.6 +22%
Plavix Bristol-Myers Squibb Platelet ADP antagonist 3.5 +15%
Zoloft Pfizer SSRI 3.1 -2%
Epogen Amgen Erythropoietin 3.0 -1%
Procrit Johnson & Johnson Erythropoietin 3.0 -9%
Aranesp Amgen Erythropoietin 2.8 +46%
Enbrel Amgen TNFa inhibitor 2.7 +36%
Note: Biotech products shaded
Source: IMS National Sales Perspectives, 1/2008 IMS Health
29
© 2008 Accenture. All rights reserved. Adhikari,Dawn & Melberg - accenture H&LS consultant

30. Accenture Research
Accenture Research
The US prescription drug market is still dominated by US-headquartered
companies. However, weak performances by companies like Pfizer and Merck
& Co has recently paved the way for some of the larger European companies
US PMP Overview:
to increase their market share Pharmaceuticals Overview
Leading Pharma companies, by US prescription drug sales, 2008
• Pfizer has dominated the US prescription drugs
market for many years and has maintained its
market share mainly by acquisitions. Examples
Sales Change Market Ranking
include the acquisition of Warner-Lambert in
(USD bn) (2004-2008) share in 2000
2000 and of Pharmacia in 2003
Pfizer 27.2 -12% 10.8% 1 • In the last few years, however, Pfizer’s market
share has dropped, mainly due to falling
GlaxoSmithKline 19.9 +6% 7.9% 2
productivity, patent expiries and the withdrawal
of some marketed products, such as the COX-2
Johnson & Johnson 16.0 -4% 6.3% 6
inhibitor Bextra in 2005
Merck & Co 15.2 0 6.0% 3
• Two other major US companies, Merck and
Bristol-Myers Squibb have also lost market
AstraZeneca 12.3 +10% 5.1% 5
share recently. In Merck’s case the withdrawal
of one of its best-selling products, the COX-2
Novartis 12.3 +11% 4.9% -
inhibitor Vioxx in September 2004 marked the
Amgen 11.9 +23% 4.7% - beginning of a tough time for the company
• This has paved the way both for European
Sanofi-Aventis 11.0 +9% 4.4% -
companies like Novartis and Sanofi-Aventis,
and for biotech companies like Amgen, who
Eli Lilly 8.7 +6% 3.4% 8
have all increased their market share over the
Bristol-Myers Squibb 8.4 -10% 3.3% 4 last few years. In the case of Novartis, sales of
generic drugs within its Sandoz division has
contributed to sales growth
Source: IMS National Sales Perspectives, 1/2008, IMS Health; IMS 2000
30
© 2008 Accenture. All rights reserved. Adhikari,Dawn & Melberg - accenture H&LS consultant