US Medicine Review 2010 PDF

The Use of
Medicines in the
United States:
Review of 2010
April 2011
Report by the IMS Institute for Healthcare Informatics

Introduction
The use of medicines is a critical topic for all stakeholders in the U.S. healthcare
system. Last year reinforced the slowing growth trends of the last decade, and
when adjusted for economic and population growth, spending grew by less
than 1 percent.
The volume of medicines consumed also grew at very low volumes, and even
declined in the case of injectables and infusables.
A number of factors contributed to this comparatively and historically low
growth, including fewer patient visits to doctors’ offices, patent expiries for IMS Institute for Healthcare Informatics
11 Waterview Boulevard
branded products, expanded usage of existing generic products and less Parsippany, NJ 07054
spending on new products. USA
info@theimsinstitute.org
This report further illustrates these key trends, helping to put 2010 into www.theimsinstitute.org
context, while also informing decision makers in all areas of healthcare.
©2011 IMS Health Incorporated and its affiliates.
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publications reserved. No part of this publication may be
Michael Kleinrock reproduced or transmitted in any form or by any means,
Director Research Development electronic or mechanical, including photocopy, recording,
or any information storage and retrieval system, without
IMS Institute for Healthcare Informatics
express written consent of IMS Health and the IMS
Institute for Healthcare Informatics.
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The Use of Medicines in the United States: Review of 2010 1

Contents
Executive summary......................3 Comparison of 2010 versus ........15
Spending on medicines ................4 2009 spending
- Total spending - Volume of protected brands Spending $307Bn +2.3%

- Real spending per capita consumed
- Major medicine segments - Price levels of protected brands Real per capita spending growth +0.6%
- New medicines
Volume of medicines consumed ....7
- Brands subject to loss of exclusivity Spending on brands -0.7%
- Orals/nasals and injectables/ - Generics
infusables
Changes in usage and ................23
- Retail prescriptions dispensed
spending in major therapy areas
Prescriptions dispensed 3.99Bn +1.2%
- Retail channels used by patients
- Oncologics
- Patient doctor visit trends Injectable standard units +0.2%
- Prescriptions for new therapy - Respiratory agents
- Lipid regulators
starts Patient visits -4.2%
- Prescriptions for continuation - Antidiabetes
of therapy or refills - Antipsychotics
Patient payment for medicines ...13 Notes on sources .......................29 Average copayment $10.73 -1.8%
- Payment types Appendices ...............................30
- Copay levels About the IMS Institute .............36
Medicare Part D Rx’s 871Mn +6.4%

Executive summary
SPENDING ON MEDICINES PATIENT PAYMENT FOR MEDICINES CHANGES IN USAGE AND SPENDING
IN MAJOR THERAPY AREAS
Spending on medicines exceeded $307Bn in 2010, up Commercial third-party insurance was used by patients
2.3% on a nominal basis. On a real per capita basis to pay for 63% of dispensed prescriptions, down from Therapy area spending growth is largely driven by the
spending increased by 0.6% compared to a 3.1% increase 66% five years ago. Prescriptions filled under a Medicare state of the innovation cycle. Oncologics spending
in 2009. The largest segments of the market, including Part D plan totaled 871 million, or 22% of the total. The growth has slowed since 2006 to 3.5% in 2010 as a result
branded drugs, oral formulations and small molecules, average patient copayment was $10.73 in 2010, down of fewer new products being launched and the broad
each declined or grew more slowly than the total market, 20 cents from 2009 due to shifts in usage to generics. adoption of therapeutic regimens launched in the first
while spending on generics, injectables and biologics half of the decade. Anti-asthmatics remain the key
increased at a higher rate. spending growth driver in respiratory agents in 2010.
COMPARISON OF 2010 VERSUS 2009 SPENDING
Spending on lipid regulators increased by 0.9% as many
of the key innovations in the class are now or will soon
VOLUME OF MEDICINES CONSUMED Spending changes in 2010 were driven by five major
be available generically, while usage of these drugs grew
segments. Whereas protected brands have historically
by 2.3%. Antidiabetes spending grew by $1.9Bn in 2010,
The total volume of medicines consumed in oral form caused volume-based increases in spending – $7.9Bn in
of which $1.3Bn was for human insulins and their
increased by 0.5% in 2010, which corresponds to a 2006 – this segment saw a volume-based decline in
synthetic analogues. Patients filled 165Mn prescriptions
decline of 0.3% on a per capita basis. Medicines spending of $8.3Bn in 2010. Increased spending due to
in 2010, up 3.8% over 2009. Antipsychotic spending
administered by injection or infusion increased by 0.2% price levels of protected brands was $16.6Bn in 2010, but
grew by $1.4B, mainly from leading branded therapies.
or a decline of 0.6% on a per capita basis. The number offset by an estimated $4.5Bn in higher rebates. Total
Patients filled 56Mn prescriptions in 2010 mostly for
of retail prescriptions dispensed totaled 3.99Bn, an spending on new brands has declined in the last five
newer generation atypical antipsychotics.
historically low increase of 1.2% over 2009. Chain years, even as newly launched products brought
drugstores were increasingly chosen by patients to fill significant new therapy options to patients. Brands that in
their prescriptions reflecting both convenience and the the prior year had sales of $32.1Bn were exposed to
availability of discounted generics in these pharmacies. generic competition in 2009 and 2010, the highest
Overall consumption of medicines may be affected by two-year total ever. Over 80% of a brand’s prescription
fewer doctor office visits, which were down 4.2% in 2010. volume is replaced by generics within six months of
The number of patients starting treatment for a chronic patent loss and as a result, total branded and unbranded
therapy was down 3.4Mn from 2009 levels, and generic market share has risen each of the past five years
increasingly these patients are starting therapy with a to now account for 78% of all prescriptions dispensed.
generic drug. The number of therapy continuations or
refills rose in 2010, with all of the increase coming in
the form of generics.

SPENDING ON MEDICINES
Spending on medicines exceeded $307Bn in 2010, up 2.3%

Spending on medicines reached $307Bn in 2010, up 2.3%
Spending
•!• Spending on medicines
on medicines increasedincreased
by 2.3% by
Spending
Spending Growth 2001-2010
Growth 2001-2010 2.3%lower
in 2010, in 2010,
than thelower
5.1% than
growththe 5.1%
recorded
growth in 2009, and continuing
recorded in 2009 the and continu
trend of 5% or lower growth per year that
the trend of 5% or lower growth per
$350 20 has occurred since 2007.
year that has occurred since 2007
300 307 • Total spending in 2010 was $307Bn, an
•! Total spending in 2010 was $307Bn,
$300 281 286 increase of about $60Bn since 2005 and
increase
270 $135Bn since of about $50Bn since 2005
2001.
247 15 $150Bn since 2001
$250 234 • Lower levels of growth in spending in
219 Lower
•! recent yearslevels
reflect of growth
broad in spending
dynamics of in
recent years reflects broad
use ofdynamics
SPENDING $BN
195 lower volume growth, increased
% GROWTH
$200 lowerloss
generics, volume growth,
of patent increased
protection for use
172
10 generics,
major branded loss of patent
products protection fo
and less spending
$150 on major branded products, and less
new drugs.
spending on new drugs
$100
5
$50
Chart notes
Measures total value of pharmaceutical sales, including
$0 0 generics, branded products, biologics, small molecules,
Chart notes
retail and non-retail channels.
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Measures totalat value of pharmaceutical
Value measured Trade Price – the price paid tosales, including
generics, branded products, biologics, small molecules,
wholesalers or manufacturers by retail and non-retail
and non-retail
channels channels
and excluding off-invoice discounts and rebates
Source: IMS Health, National Sales Perspectives, Dec 2010 Value
that lower net pricesatreceived
measured Trade byPrice – the price paid to whole
manufacturers.
or manufacturers by retail and non-retail channels and
Source: IMS Health, National Sales Perspectives, Dec 2010 excluding off-invoice discounts and rebates that lower n
prices received by manufacturers
The Use of Medicines in the United States: Review of 2010

Realspending
Real spendingperper capita
capita increased
increased by 0.6%
by 0.6% in 2010
in 2010
When
•!• When adjusted
adjusted by theby GDPtheprice
GDP price defl
Total
Total $2005Real
$2005 Real Spending
Spending deflator, real total spending increased
Real total spending increased from
from $261Bninin2006
$261Bn 2006 to to$277Bn
$277Bn in 2010.
in 2010.
!'2.1$J#.1$73#-*+-;$$ J#.1$73#-*+-;$3#/$].3+2.$ ]".-;#$+-$J#.1$73#-*+-;$ •!• When
When adjusted for thefor
adjusted estimated total
the estimated tota
Z[EFFS\N-$ Z[EFFS\$ 3#/$].3+2.$^$ population increase, real spending
population increase, real spending pe per
capita increased from $876 in 2006 to
capita
$898 increased from $876 in 2006 t
in 2010.
$274 $277 $876 $877 $866 $892 $898 $898 in 2010.
$261 $264
$263 • The annual change in real spending per
4.9% Thehas
•! capita annual change
fluctuated in past
over the real5 spending
years p
capitaa has
between high fluctuated
of 4.9% in 2006,overthethe
yearpast 5
of years betweenofaMedicare
the introduction high of Part
4.9% D, in 200
3.1% to the yearofof1.3%
a decline theinintroduction
2008. of Medica
Part
• Real D, to per
spending a decline
capita onofall1.3% in 2008.
medicines
Real spending
•! increased by 0.6% inper capita on all medic
2010.
increased by 0.6% in 2010.
0.6%
0.1%
Chart notes
-1.3%
Real spending calculated using GDP price deflator to $2005
from Bureau of Economic Analysis.
2006 2007 2008 2009 2010 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010
Chart Notes:
Per capita spending calculated using July 1 population
Real spending U.S.
estimates from Census Bureau,
calculated usingPopulation
GDP price Division,
deflator to $20
Source:
Source: IMS IMS
Health,Health, National
National Sales Sales
Perspectives, Perspectives,
Dec 2010; Dec
Bureau of Economic 2010;
Analysis; U.S. Bureau of
Census Bureau from Bureau of Economic Analysis
release date: February 2011.
Economic Analysis; U.S. Census Bureau Per capita spending calculated using July 1 population
estimates from U.S. Census Bureau, Population Division,
The Use of Medicines in the United States: Review of 2010 release date: February 2011 5
S
Spending
pengrew
Spend ding 2.3%
grew
grew 2.3%
2.3%
but but
but largest
largestlasegments
rgest segments
segm entsslower
grew slower
sloweroror
ordeclined
declined
declined
••!! S
Spending
• pe nding on
Spending on
on branded
branded
branded drugs
drugs
drugs totaled
totaled $229Bn
totaled $229Bn
Spending
Spending Growth
SpendingGGrowth
rowth 2010
2010
2010 bu
butt declined
declinbut
$229Bn, ed declined
by
by 0.7%,
0.7%by, 0.7%,
while
whilewhile
spending
spending on
on
unbranded
u nbranded
spending ongenerics
ge nerics increased
unbrandedingenerics
creasedincreased
21.7%
21.7% and
and
branded
br anded generics
21.7% andgenerics by
branded by 4.5%.
4.5%.
generics by 4.5%.
FF,%$."B$'N&%O"JDPM"
,%$."B$'N&%O"JDPM" ••!! • pe
S Spending
nding on
Spending on
on medicines
medicinemainly
medicines maindispensed
s mainly
ly dispensed
dispensed b
prby primary
imary care
primary care physicians
care physicians
physicians grewgrew by
by0.5%,
grew by 0.5%,
0.5%,
w while
hile th
while those medicines
ose medicines
those primarily
medicines primarily used byd by
primarily used
use by
+'$3/&/"
+ '$3/&/" S&3
S&3&')R1O"
&')R1O"
+'$3/1O"Q8D9M"
+'$3/1O"Q8D9M" specialists
spe grew
cialists grew
specialists by
grew by 4.8%.
by 4.8%.
4.8%.
E&3&')R1O";D:M"
E&3&')R1O";D:M" J!D9M"
J!D 9M"
• Small molecule spending totaled $240Bn,
••!! S mall molecule
Small molecule spending
spending totaled $240Bn, a
totaled $240Bn,
an increase of 0.5% as biologics grew by
0')B$'4"L$'&"T')(&3">FL1O"8D:M"
0')B$'4"L$'&"T')(&3">FL1O"8D:M" =2&R)$.)1%"T')(&3">FL1O";DUM"
=2&R)$.)1%"T')(&3">FL1O";DUM" iincrease
ncrease ofof 0.5%
0.5% as as biologics
biologics grew
grew by 6.6%
by 6.6%
6.6%, amounting to $67Bn.
a nd amounted
and amounted to $67Bn.
$67Bn.
• Spending on drugs through retail
B$.."B,.&R-.&1O"8D:M"
==B$.."B,.&R-.&1O"8D:M" +),.,E)R1O"VDVM"
+) ,.,E)R1O"VDVM"
••!! S pe ndingincreased
Spending
channels on drugs
on drugs th rough
bythrough
2.0%, retail channels
retail
while channels
iincreased
ninstitutional
creased bybychannels
2.0% as
2.0% arose
s institutional
inby
stitu tional channels
3.0%. channels
rrose
ose byby 3.0%.
3.0%.
• Oral forms of medicines declined by 0.1%,
G&%$).O"JD8M"
G&%$).O"JD8M" W31C%-C,3$.O"PD8M"
W31C%-C,3$.O"PD8M" ••!! O ral spending
Oral forms of
forms oon
f medicines
m edicinesincreased
declinebyd 5.7%.
declined by 0.1%
by 0.1%
but injectables
bu
butt spending
spending on on injectables
injectables increased
increased byby
5.9%
5.9%..
X '$.1O"Q8D!M"
X'$.1O"Q8D!M" W3Y&R%$Z.&1O":D9M"
W3Y&R%$Z.&1O":D9M" X%A&'O"9DUM"
X%A&'O"9DUM"
Chart notes
C
Chart
harAllt Notes:
Ngrowth
otes: amounts based on spending in Nominal Dollars.
All
A ll growth
owth amounts
grLength aofmeach
ounts barbased
based on
segment spending
onrepresents in
in Nominal
spendingtotal No minal Dollars
spending Dforollars
$0 $50 $100 $150 $200 $250 $300 Length
Length of
of each
e a ch bar
bar segment
se gm e nt represents
re presen ts total
tota l spending
spe ndi ng for
for
that segment in 2010.
that
th at segment
segment in in 2010.
2010.
S
Spending
pending $BN
$BN Brands
B
Brands are those products with current or former patent
rands areare those
those products
products withwith current
current or
or former
former patent
patent
protection or other forms of market exclusivity.
protection
pr otection or or other
other forms
forms of of market
market exclusivity.
exclusivity.
Source:
Source: IMS
IMS Health, National Sales
Health, National Sales Perspectives,
Perspectives, Dec
Dec 2010
2010 Specialist driven, Primary care driven and Biologics
Specialist
S pecialist driven,
driven, Primary
Primary carecare driven
driven and
and Biologics
Biologics segments
segments
Source: IMS Health, National Sales Perspectives, Dec 2010 are segments
are based
ba on are
sed on probased
prietaon
proprietary ry proprietary
IMS
IMS Health IMSdefinitions.
Health deHealth
finitiodefinitions.
ns.
The The
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Report by the IMS Institute for Healthcare Informatics 6
Report
Report by by the
the IMS
IMS Institute
Institute for
for Healthcare
Healthcare Informatics
Informatics
VOLUME OF MEDICINES CONSUMED
Total volume of medicines increased by historically low rates in
Total volume of medicines grew by historically low rates in 2010
••! TheThe totaltotal
volumevolume
of drugsofconsumed
drugs consumed
Volume Growth
Volume Performance
Growth Performance increased
increased at historically
at historically low rates fo
low rates for
oral/nasal
oral/nasal forms forms and for
and declined declined for
injectable/infusable
injectable/infusable forms. forms.
Oral Standard Units Injectable Standard Units
••! ForFororal oral andforms
and nasal nasalofforms of medicati
medication,
which
which accountaccount for approximately
for approximately 60% of 60
Volume Growth % Volume Growth % the the
totaltotal spending
spending on medicines,
on medicines, the the
200 12% 3.0 12% volume consumed was up 0.5% in 2
volume consumed was up 0.5% in 2010;
thisthis
corresponds to a decline
corresponds to aofdecline
0.3% on ofa 0.3%
per acapita
per basis.
capita basis.
STANDARD UNITS BN
10% 10%
••! ForForinjectable and infusable
injectable forms, the forms, t
and infusable
175 2.5 totaltotal
volume consumed increased increased
by 0.2%
volume consumed by
% GROWTH
8% 8% in 2010, or a decline of 0.6% on a per
0.2%
capita basis.in 2010, or a decline of 0.6%
per capita basis.
150 6% 2.0 6%
4% 4% Chart notes
125 1.5 Volume is based on Standard Units, a measure of the
number of pills, capsules, vials and ampoules of active
2% 2%
Chart notes:ingredient included in the dispensed
pharmaceutical
medicine.
Volume is based on Standard Units, a measure of the
100 0% 1.0 0% of pills,Units
Standard capsules, vials are
for oral forms andnot
ampoules of active pharma
additive nor
2006 2007 2008 2009 2010 ingredient
comparable to included in the dispensed medicine.
injectable forms.
200520062007200820092010
Standard
Oral StandardUnits for oral
Units include forms
both arenasal
oral and not forms.
additive nor com
to injectable forms.
Injectable Standard Units include both injectable and
Source: IMS Health, MIDAS, Dec 2010 Oral Standard
infusable forms. Units include both oral and nasal forms
Source: IMS Health, MIDAS, Dec 2010 Injectable Standard Units include both injectable and
infusable forms.
Totalprescription
Total prescription volume
volume waswas 3.99Bn
3.99Bn in 2010,
in 2010, up 1.2%
up 1.2%
Medicines
•!• Medicines dispensed
dispensed to patients
to patients through throu
Prescriptions
Prescription Volume 2001-2010
Volume 2001-2010 thethe
retail and long-term
retail and long-term care sectors
care sectors
account for nearly 76% of total spending
account for nearly 76% of total spend
and 88% of the oral/nasal volume.
and 88% of the oral/nasal volume.
4 6 • These medicines are almost entirely
•! These medicines are almost entirely
dispensed through retail prescriptions,
dispensed through retailupprescription
DISPENSED PRESCRIPTIONS BN
which totaled 3.99Bn in 2010, 1.2%

5 over the number dispensed in 2009 and up 1.2
which totaled 3.99Bn in 2010,
3 upfrom 2009 and
from 3.20Bn up from
dispensed 3.20 billion
in 2001.
dispensed in 2001.
4 • On a per capita basis, retail prescription
% GROWTH
On a has
•! volume perbeen
capita
fairlybasis, retail2006,
steady since prescript
volumefrom
increasing has12.7
been fairlytosteady
in 2007 12.9 in since
2 3 2006,
2010, increasing
compared to 11.2from 12.7 in
prescriptions per2007 t
12.9dispensed
person in 2010, in compared
2001. to 11.2
2 prescriptions per person dispensed in
2001.
1
1
Chart notes
Includes all prescriptions dispensed through retail
0 0
pharmacies, including independent and chain drugstores,
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 food store pharmacies, mail order and long-term care
Chart notes:
facilities.
Includes all prescriptions dispensed through retail pharm
Prescription counts are not adjusted for length of therapy.
- including independent and chain drug stores, food sto
90-day and 30-day prescriptions are both counted as one
pharmacies and mail order as well as long term care fa
Source: IMS Health, National Prescription Audit, Dec 2010 prescription.
Prescription counts are not adjusted for length of therap
Source: IMS Health, National Prescription Audit, Dec 2010 90-day and 30-day prescriptions are both counted as o
prescription.
Patients
Patients chose
chose to fill
to fill more
more prescriptions
prescriptions at Chain
at chain drugstores
drugstores
•! •Patients filledmore
Patients filled moreprescriptions
prescriptions at Chain
at chain
Prescriptions
Prescriptions bybyType
Type of
of Pharmacy
Pharmacy drugstores, accounting
drugstores, accounting for for
moremore
than than
54%
54%
of allof all prescriptions,
prescriptions, or 2.2Bn,orin2.2Bn
2010. in
•2010.
Many chains now offer discounted
Chain Stores Independent Food Stores
•! Many chains
generic now offer
prescriptions discounted
including 3-month generic
Long-Term Care Mail Service prescriptions
prescriptions. including 3-month
6.3% 6.7% 6.8% 6.6% 6.6% •prescriptions.
Fewer prescriptions were filled in
7.7% 7.7% 8.0% 8.0%
•! Fewer prescriptions
independent pharmacies were filled
whose in
share
8.0%
independent
declined to 18.7% pharmacies whose share
in 2010, compared to
12.8% 12.5% 12.4% 12.4% 12.3% declined to
20.6% in 2006. 18.7% in 2010, compared to
•20.6%
While thein 2006.
number of prescriptions filled
20.6% 20.5% 19.9% 19.1% 18.7% •! While the number
reflect patient behavior, of prescriptions
they do not filled
reflects patient
necessarily reflectbehavior, they do not
changes between
necessarily
standard 30-day reflect
and changes between
90-day prescriptions.
standard 30-day and 90-day
prescriptions.
52.6% 52.6% 52.9% 53.9% 54.4%
Chart notes
Chart notes:all prescriptions dispensed through retail
Includes
Includes all prescriptions
pharmacies dispensed and
– including independent through
chain retail pharmacies
drug stores,
- including independent
food store andmail
pharmacies and chain drug
order stores,
as well food store
as long-term
pharmacies and mail order as well as long-term care
care facilities.
2006 2007 2008 2009 2010 facilities.
Prescription counts are not adjusted for length of therapy. 90-
Source: IMS Health, National Prescription Audit, Dec 2010 90-day and 30-day prescriptions are both counted as one
day and 30 -day prescriptions are both counted as one
Source: IMS Health, National Prescription Audit, Dec 2010 prescription.
prescription.
The The
Use ofUseMedicines in the United
of Medicines in theStates: Review
United of 2010
States: Review of 2010 9
Report by the IMS Institute for Healthcare Informatics 9
Patient office visits declined by 4.2% in 2010

Patient visits have been declining since mid-2009 and fell 4.2%
in 2010 • The number of patient office visits
Patient Visit Trends •! remained
The number level from
of patient mid-2008
visits remained to mid-
level
Patient visit trends 2009, a period of significant
from mid-2008 to mid-2009, a period of
uncertainty, reduced consumer
economic
confidence
Patient Visits significant economic uncertainty, reduced
6% and increased unemployment.
consumer confidence, and increase in
unemployment rates.
• Patients with health insurance, and
4% •! concerned about
Patients with health insurance future coverage, may
but concerned
about future coverage
have increased may
their have
visits increased
during this
% GROWTH
2% their visits during that time and offset a by

time, offsetting a decline in activity
declinethose
in activity
affectedbyby those affected by
the economic the
downturn
0% and uncertainty; however,
economic downturn and uncertainty; howeverthere is no
there isclear evidence
no clear of thisofbehavior.
evidence this behavior.
-2% •! Since•mid-2009 the number
Since mid-2009, the numberof patient visits
of patient visits
to doctor officesoffices
to doctor has declined and were
declined, down 4.2% down
in
-4% 4.2% in 2010
2010, compared
compared to thetoprior
the prior
year. year.
•! This may
• Thisreflect the enduring
may reflect effects
the enduring of the
effects of the
-6% macroeconomy,
macroeconomy,high unemployment
high unemployment levels,
levels
rising healthcare costs, and also may include
and rising healthcare costs; it also may include
more patients losinglosing
more patients coverage andand
coverage others
others
-8% managing carefully their healthcare spending.
managing their healthcare spending carefully.
-10% Chart notes
Jan-08
Mar-08
Apr-08
Jun-08
Aug-08
Sep-08
Oct-08
Nov-08
Dec-08
Jan-09
Mar-09
Apr-09
Jun-09
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
Mar-10
Apr-10
Jun-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
May-08
May-09
May-10
Jul-08
Jul-09
Jul-10
Feb-08
Feb-09
Feb-10
Patient visits calculated using national sample based

methodology of office visits.
Chart notes:
Margin of error of patient visit growth is 3.9% (shown
Patient visits calculated using national sample based
ROLLING MAT on chart).
methodology of office visits
Source: IMS Health, National Disease and Therapeutic Index, Dec 2010 Margin of error of ispatient
Growth for thevisit
rolling twelveismonth
growth 3.9%period
(shownover
onprior
Source: IMS Health, National Disease and Therapeutic Index, Dec 2010 chart) year period.
TheThe
UseUse of Medicines
of Medicines in the in the United
United States:
States: Review of Review
2010 of 2010 10
Report by theby
IMS Institute for Healthcare Informatics Informatics 10
Report the IMS Institute for Healthcare
Fewer patients are beginning new chronic therapy treatment

Fewer patients began new chronic therapy treatment
Newtherapy
•! • New therapystartsstarts
for 17 for 17 chronic
chronic
Chronic Chronic
Therapy NewNew
Disease Therapy
TherapyStart
StartsTrends conditions
conditions declined
declined by 3.4Mn
by 3.4Mn patients patients
in2010
2010.
Brands Generics Total Gainsmore
•! • 3.2Mn of 3.2Mn
patientsin generic
started their therapy
therapy sta
7
were offset by 6.6Mn in declining bran
with a generic while 6.6Mn fewer
patients started therapy with a brand.
new therapy starts.
6
NEW THERAPY STARTS MN
Chart notes
3
Analysis of national-level prescription audit combined with
Chart notes:
anonymized patient-level data.
Analysis of national-level prescription audit combined wi
17 chronic therapy areas representing two-thirds of all
2 anonymized patient-level data
chronic prescriptions, 47% of dollars and 38% of
17 chronic therapy
prescriptions areas
in the total representing more than two-th
market.
of all chronic prescriptions and 47% of dollars and 38%
Therapy areas covered include: ADHD, Alzheimer’s, BPH,
1 prescriptions in the total market
Cholesterol, COPD-Asthma, Depression, Diabetes, HIV,
Therapy areas covered include:OverADHD, Alzheimer’s, BPH
Mar-08
Apr-08
Jun-08
Jul-08
Aug-08
Sep-08
Oct-08
Nov-08
Dec-08
Jan-09
Feb-09
Mar-09
Apr-09
Jun-09
Jul-09
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
Feb-10
Mar-10
Apr-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
May-08
May-09
May-10
Hypertension, Insomnia, Migraine, Active Bladder,

Cholesterol,
Osteoporosis, COPD-Asthma,
Parkinson’s, Proton Depression, Diabetes, HIV,
Pump Inhibitors,
Hypertension, Insomnia,
Antipsychotics and Seizure. Migraine, Over-active bladder, ,
Osteoporosis, Parkinson’s, Proton Pump Inhibitors,
A New Therapy Start occurs when a new patient begins on
Psychotics and Seizure
medication and they have not filled any other prescriptions
Source: IMS Health, NPA Market Dynamics, Dec 2010 Afor
New
thisTherapy
condition Start
during occurs
the priorwhen
year. a new patient begins
medication. It is the first prescription the patient uses to
Source: IMS Health, NPA Market Dynamics, Dec 2010 treat this new condition where they have not filled any o
prescriptions for this condition during the prior year.

Continuing therapies grow slowly as brands continue decline

Continuing therapies grew slowly as brands continued to decline
Continuations
•!• Continuations andwithin
and refills refills17within 17
Chronic Chronic
Therapy Continuing
Disease Therapy
Continuing Therapy Trends chronic
chronic therapy
therapy areas increased
areas increased by by 6
patients
6.7Mn in 2010.
in 2010.
110 Brands Generics Total Generic
•!• Generic continuations
continuations increasedincreased
by 11%, by 1
or 67.8Mn prescriptions in 2010, and
or 67.8Mn in 2010, and now represent
100 about two-thirdsabout
represent of all continuations.
two-thirds of all
• The continuations.
number of brand continuations
90
RX-CONTINUATIONS
•! declined by 12% orof61Mn

The number brand prescriptions
continuations
in 2010.
& REFILLS MN
80 declined 12% or 61.Mn prescriptions

2010.
70
Chart notes
60 Analysis of national-level prescription audit combined with
anonymized
Chart notes: patient-level data.
17 chronic therapy areas representing two-thirdsaudit
of all combined w
50 Analysis
chronic
of national-level
prescriptions and 47%
prescription
of dollars and 38% of
anonymized patient-level data
prescriptions in the total market.
17 chronic therapy areas representing more than two-
40 Therapy areas covered
of all chronic include: ADHD,
prescriptions andAlzheimer’s, BPH, and 38%
47% of dollars
Cholesterol, COPD-Asthma, Depression,
prescriptions in the total market Diabetes, HIV,
Hypertension, Insomnia, Migraine, Over Active Bladder,
30 Therapy areas
Osteoporosis, covered
Parkinson’s, include:
Proton ADHD, Alzheimer’s, BP
Pump Inhibitors,
Cholesterol, COPD-Asthma, Depression, Diabetes, HIV,
Mar-08
Jul-08
May-08
Aug-08
Sep-08
Oct-08
Dec-08
Jan-09
Feb-09
Mar-09
Jul-09
May-09
Aug-09
Sep-09
Oct-09
Dec-09
Jan-10
Feb-10
Mar-10
Jul-10
May-10
Aug-10
Sep-10
Oct-10
Dec-10
Apr-08
Apr-09
Apr-10
Jun-08
Nov-08
Jun-09
Nov-09
Jun-10
Nov-10
Antipsychotics and Seizure.
Hypertension, Insomnia, Migraine, Over active bladder
Continuations
Osteoporosis, and Parkinson’s,
refills defined as patients
Proton continuing
pump a
inhibitors,
previous therapy which
Psychotics, and Seizure had been dispensed during the
prior year. Continuing therapy using a new prescription for
Continuations and refills defined as patients continuing
the same drug, once authorized prescription refills have
previous therapy which had been dispensed during the
Source: IMS Health, NPA Market Dynamics, Dec 2010 been used, is also a continuation.
year. Continuing therapy using a new prescription for
Source: IMS Health, NPA Market Dynamics, Dec 2010 same drug, once authorized prescription refills have be
used is also a continuation.

PATIENT PAYMENT FOR MEDICINES
Payment type continues shift toward Medicare Part D and Medicaid

Payment type continued shift toward Medicare Part D and Medicaid
•! •Medicare
Medicare Part
Part D D beneficiaries
beneficiaries filled 871Mn
filled
Prescriptions
Dispensed by Payment
Prescriptions Type
by Payment Type prescriptions in 2010, up 6.4%
871Mn prescriptions in 2010, up 6.4% and
accounting
and accountingfor for
nearly
nearly22%
22%of of all
all
prescriptions.
prescriptions.
Cash Medicaid Commercial Third-Party Medicare Part D
•! •Medicaid
Medicaid prescriptions increased
prescriptions increased by by
13.7%
13.7% toto337Mn
337Mninin2010 2010 while
while cashcash
14.6% payments declined by 10.3%
payments declined by 10.3% to 273Mn to 273Mn
18.4% 20.3% 20.7% 21.8% prescriptions
prescriptions.
•! •Commercial third-party(excluding
Commercial third-party (excluding
Medicare
Medicare Part
Part D)D)accounted
accounted forfor
62.9%62.9%
of of
prescriptions
prescriptions in 2010 versus 64.1% in 2009.in
in 2010 versus 64.1%
2009.
• Patients with Medicare Part D or
•! Patients
Medicaidwith Medicare Part Dofor allMedicaid
66.4% coverage filled 30.2%
63.9% 64.4% coverage filled 30.2% of all prescriptions
64.1% 62.9% prescriptions in 2010, compared to 22.1%
inin2010,
2006, the first year of the Part D in
compared to 22.1% 2006, the
program.
first year of the program.
Chart notes
Method of payment measured at prescription level at point
7.5% Chart notes:
6.8% of payment.
7.0% 7.5% 8.4% Method of payment measured at prescription level at point of
All payment types are mutually exclusive; commercial
payment.
11.5% 10.9% 8.3% 7.7% 6.9% third-party includes all private third-party insurers and
All payment types are mutually exclusive; commercial third-
partyexcludes
includes Medicare Part Dthird-party
all private plans. insurers, and excludes
2006 2007 2008 2009 2010 Medicare
IncludesPart
all Dprescriptions
plans. dispensed through retail
pharmacies,
Includes including independent
all prescriptions dispensedand chain drugstores,
through retail pharmacies
Source: IMS Health, National Prescription Audit, Dec 2010 - including
food storeindependent
pharmacies, andmail chain drugstores,
order and food store
long-term care
Source: IMS Health, National Prescription Audit, Dec 2010 pharmacies
facilities.and mail order and long term care facilities.
Theof
The Use Use of Medicines
Medicines in the
in the United United
States: States:
Review of 2010Review of 2010 13
13
ReportReport by the IMS Institute for Healthcare Informatics
by the IMS Institute for Healthcare Informatics
PATIENT PAYMENT FOR MEDICINES
Copayments declined
Copayments 1.8%
declined due
1.8% to shifts
mostly due to generics
to shifts to generics
• The average prescription copayment
Change in Copayments from 2009 to 2010 declined from $10.93 in 2009 to $10.73
•!The average prescription copayment
Change in Copayments from 2009 to 2010 in 2010, a decrease of 1.8%.
declined from $10.93 in 2009 to $10.73
$15 in •2010,
Averagea decrease
copays forofgenerics
1.8%. increased by
$0.12 •!Average5.2% in 2010
copays forto $6.06 per
generics prescription.
increased by
$0.10 5.2% in 2010
• Average to $6.06
copays per prescription.
for preferred and non-
•!Average copaysbrands
preferred for preferred and non-
grew by 7.1% and 7.3%
$10.93 $10.73 preferred brands grew by 7.1% and
respectively, taking the average payment
$0.30
7.3% to respectively,
$23.65 and $34.77.taking the average
$10
-$1.32 payment to $23.65 and $34.77.
• Branded generic copayments increased
•!Branded generic copayments
6.0% to an average $22.73. increased
6.0%
• Thetooverall
an average $22.73.
reduction in copays was the
$0.60 •!The overall
result reduction
primarily ofinmovement
copays was by the
patients
result primarily of movement by patients
to generics which, after the increases in
$5 to generics
each typewhich, after
of copay, the increases
contributed $1.32 in
to
each type of copay, contributed
the decline in average copayments. $1.32 to
-$0.20 the decline in average copayments.
Chart notes
Chart notes:
Average copayments weighted by prescription volume in 2009.
Average copayments weighted by prescription volume in 2009.
Change in mix reflects changes in volume share of segments.
Change in mix reflects changes in volume share of segments.
$0 Preferred Non Branded Generic Change Change
Analysis includesincludes
Analysis prescriptions
prescriptions wherewhere insurance
insurance was was
usedused-
Brand Preferred Generic in Mix in Avg - including Commercial Third-Party insured, Medicare Part D
including Commercial Third Party insured, Medicare Part D and
2009 Brand Copay 2010 Medicaid,and
andMedicaid, and transactions
transactions with zero with zerocopayment.
patient patient copayment.
Includes Includes
1.54Bn 1.54Bn dispensed
dispensed prescriptions,
prescriptions, 45% 45% of retail,
of retail, but but
excludesexcludes
OTC products, and the
OTC products, and value of coupons
the value of couponsororvouchers.
vouchers.
Source: IMS Plantrak Copay, Formulary Focus Dec 2010 PreferredPreferred
and non-preferred brands
and non-preferred are IMS
brands proprietary
are IMS proprietary
Source: IMS Health, Plantrak Copay, Formulary Focus, Dec 2010 definitions.
definitions.
The
The Use of Use of Medicines
Medicines in the
States: States:
Review Review of 2010
of 2010 14
14
Report
Report by the IMSbyInstitute
the IMS for Institute
Healthcare for Healthcare Informatics
Informatics
Spending
Spending changes
changes driven
driven bybyfive
fivemajor
majorsegments
segments
•!Total spending on medicines

• Total spending increased
on medicines fromfrom
increased
Componentsof
Components of Change
Change in Total
Total Spending
Spending$Bn
$Bn $300.3Bn in 2009
$300.3Bn to $307.4Bn
in 2009 to $307.4Bnin 2010.
in 2010.
•!The decline
• Theindecline
the volume
in the of protected
volume of protected
branded products
branded reduced
products spending
reduced in in
spending
2010 by $8.3Bn
2010 compared
by $8.3Bn to 2009.
compared to 2009.
•!Increases in the pricing
• Increases of protected
in the pricing of protected
-0.2 branded products
branded – without
products consideration
– without consideration
7.6 to off-invoice discounts
to off-invoice or rebates
discounts - –
or rebates
-12.6
16.6 raisedraised
spending by $16.6Bn.
spending by $16.6Bn.
4.0 •!Brands •that lostlosing
Brands patent protection
patent or or
protection
-8.3 exclusivity in 2010
exclusivity or earlier
in 2010 caused
resulted a
in a reduction
reduction in spending
in spending of $12.6Bn.
of $12.6Bn.
307.4 •!Spending growth for
• Spending new for
growth brands
new was
brands was
$4.0Bn in 2010.
$4.0Bn in 2010.
300.3
•!Spending on generics
• Spending – including
on generics both both
– including
volume and price
volume effects
and price - increased
effects by by
– increased
$7.6Bn in 2010
$7.6Bn compared
in 2010 to 2009.
compared to 2009.
Chart notes
Chart notes:
Each segmentEachissegment
mutuallyis exclusive
mutually exclusive and the
and reflects reflects the change
change in
2009 Protected Protected LOE New Generics Other 2010 spending between 2009
in spending and 2010
between 2009inand
billions
2010ofindollars.
billions of dollars.
Brands - Brands - Impact Brands Protected brands (brands
Protected brandsthat havethat
(brands not have
reached patent expiry)
not reached patent have
Volume Pricing been split based on growth through pricing dynamics and
expiry) have been split based on growth through pricingvolume
(absent pricing dynamics).
dynamics and volume (absent pricing dynamics).
Source: IMS Health, National Sales Perspectives, Dec 2010 New Brands segment includes all new products launched in 2009 and
2010. New Brands segment includes all new products launched in
LOE – Loss2009 and 2010.– includes branded products that lost
of exclusivity
exclusivity LOE
during 2010
– Loss of or previous–years.
Exclusivity includes branded products that
Source: IMS Health, National Sales Perspectives, Dec 2010 lost exclusivity during 2010 or previous years.

A broad volume
Historical range ofgrowth
products historically
drivers slowed orcontributed
declined into2010
expanded
spending but declined in 2010
Top spending
• Increased
•! volume caused
performers
by higher expanded us
Protected
Protected Brand
Brand Volume Spending
Volume Spending Growth
Growth
volume of brands was $2.6Bn in
$2.6Bn in 2010 compared to $4.2Bn 2010
compared to $4.2Bn in 2009.
Top 10 Volume Gainers Top 10 Volume Losers
•! Declining
• Declining spend duespend fromvolume
to lower a broad was set of
$4.3Bnof in
-4.3Bn
2010 vs.in$0.4Bn
2010invs. -$0.4Bn in 200
2009.
All Other Brands Net Protected Volume Growth The largest
•! largest
• The volume increases
volume spending spending in increas
2010 2010 were®Crestor
were Crestor (rosuvastatin), Lu
(rosuvastatin),
15 (ranibizumab
Lucentis ® (ranibizumab) injection),
and Lantus®and Lantus
(insulin
SoloSTAR glargine).
® (insulin glargine).
SPENDING GROWTH $BN
• The
•! products
The products with thewith
largestthe
volume
largest volum
10 declines, each over $500Mn, were due to a
declines, each with declines over $5
combination of upcoming patent expiries
were atransitioning
and patients combination of upcoming pat
to newer
5 7.9 expiries
therapies: Lipitorand patients has
® (atorvastatin) transitioning
steadily to
therapies.
declined since 2006 and will lose patent
3.8
0 •! Lipitor
protection (atorvastatin)
later in 2011; Seroquel has®
been stead
declining
(quetiapine) since 2006 and loses paten
patent will expire in 2012;
-0.2 Provigil® (modafinil) has declined since
-1.4 protection later this year
-5 -8.3 next generation sleep disorder product
•! Seroquel
Nuvigil (quetiapine)
® (armodafinil) launched in patent
2009. expiry
•! Provigil (modafinil) has declined as n
-10
generation sleep disorder product Nu
launched in 2009
Chart notes
Protected brands include brands before loss of exclusivity and
-15 excludes new brands on the market for less than 24 months.
Chart notes:
2006 2007 2008 2009 2010 Volume growth is defined as dollar growth driven by
Protected
volume and mixbrands
changes,include
excludingbrands before loss of exclus
price changes.
Topand excludes
10 gainers and new
losers brands on the with
include products market
the for less than
Source: IMS Health, National Sales Perspectives, Dec 2010 highest absolute dollar change in volume driven spending.
months
Source: IMS National Sales Perspectives, Dec 2010 Volume growth is defined as dollar growth driven by
volume and mix changes, excluding price changes
The Use of Medicines in the United States: Review of 2010 Top 10 gainers and losers include products16 with the h
Report by the IMS Institute for Healthcare Informatics absolute dollar change in volume driven spending
Spending
Spending due
due totobrand
brand pricing
pricing trending
trended up,up
butbut offset
offset by by
rebates
rebates
•! • Spending
Spending onon protected
protected brands
brands increased
Protected
Protected BrandBrand
PricePrice SpendingGrowth
Spending Growth increased
by $16.6Bn by $16.6Bn
in 2010 due toininvoice
2010pricedue to
changes, compared to $15.8Bn
invoice price changes, compared to in the
prior year. in the prior year.
$15.8Bn
Brand Price $BN
•! • Growth
Growth ofofspending
spending duedue to protected
to protected
Brand Invoice Price Growth Contribution % brand invoice pricing contributed
brand invoice pricing contributed to to
20 8%
overall spending growth by 5.8% in 2010,in
overall spending growth by 5.8%
PRICE CONTRIBUTION TO GROWTH %

Estimated Net Price Growth Contribution % compared to 5.7% into2009.
2010, compared 5.7% in 2009.
PRICE SPENDING GROWTH $BN
•! • Increasing
Increasing levels of off-invoice
levels discounts
of off-invoice
15 6% and rebates have
discounts and accompanied
rebates have these
accompanied these invoiceinprice
invoice price increases resulting an
estimated $4.5Bn
increases or 1.6%
resulting (+/-estimated
in an 0.25%)
lower net price growth contribution for
$4.5Bn or 1.6% (+/- 0.25%) lower
10 4% protected brands.
net price growth contribution for
protected brands.
5 2% Chart notes
Protected brands include brands before loss of exclusivity.
Chart notes:
Price spending growth is dollar growth driven by invoice
Protected brands
price changes andinclude
excludesbrands before
the impact loss of
of rebates andexclusivity
Price spending growth is dollar
contract pricing agreements. growth driven by invoice
0 0% price changes and excludes the impact of rebates and
Price contribution to growth is contribution to market
contract pricing agreements
2006 2007 2008 2009 2010 growth and does not reflect a price growth rate.
Price contribution to growth is contribution to market
Estimated
growth and Net
doesPrice
notGrowth is abased
reflect ongrowth
price a comparison
rate of
company reported net sales and IMS reported sales at
Estimated Net Price Growth is based on a comparison of
Source:
Source: IMS National
IMS Health, Health, National
Sales Sales
Perspectives, Perspectives,
Dec 2010 Dec 2010 invoice prices from wholesaler transactions.
company reported net sales and IMS reported sales at
invoice prices from wholesaler transactions.

New
New brands
brands accounted
accounted forfor 2.8%
2.8% of of spending
spending
• Total drug spending on products that
New Brand Spending drug
•!Totalhave spending
been available on products
to patients for that
less have
New Brand Spending been
than available
24 months to haspatients
dropped to for$4.0Bn
less thanin
242010, down from $6.7Bn the prior year,in
months has dropped to $4.3Bn
100 New Brands in Market 2010, down from
and $11.0Bn $6.7Bn the prior year
in 2006.
and $11.0Bn in 2006.
New Brand Spending • Spending on new medicines is now 2.8%
75 of totalon
•!Spending new
brand medicines
spending, downis from
now5.0%2.8% of
NEW BRAND SPENDING $BN
12 6% total brand spending, down from 5.0% in

in 2006.
% OF TOTAL BRAND SPENDING

50 2006.
10 5% • The number of products in this group
number
•!The totaled 69 of
in products
2010, downinfrom
this96 group
in
25 totaled 69 in 2010, downinfrom 96 in
8 4% 2006, reflecting the decline products
2006, reflecting
emerging the decline
from research in innovation
and development
0 emerging from research and
6 3% laboratories and receiving regulatory
X
2006 2007 2008 2009 2010 development
approval. laboratories and receiving
4 2% New Brand Average regulatory approval.
$150 • Average spending per new branded
Spending $Mn •!Average spending per new branded product
product was $62Mn in 2010, down from
2 1% was $62m
$114Mn inin 2010,
2006, downafrom
reflecting $114m
shift in the in
$100 2006,
mix of new products toward orphan of new
reflecting a shift in the mix
0 0% products
drugs andtoward
productsorphan
with thedrugs
same and
2006 2007 2008 2009 2010
$50
products
mechanism with the same
of action mechanism
as existing products.of
New Brands action as existing products.
% of Spending
$0
2006 2007 2008 2009 2010 Chart notes
ChartNew
notes:
brands defined as brands launched in the prior 24 months
Source:
Source: IMSNational
IMS Health, Health,SalesNational Sales
Perspectives, Perspectives, Dec 2010
Dec 2010 New brands
where defined
sales as brands
are reported in NSP. launched in the prior 24 months
where sales are reported in NSP.

ReportThe Use
by the IMS of Medicines
Institute in the
for Healthcare United States: Review of 2010
Informatics
18
Significant new therapy options became available to patients

• 10 innovative products were launched
Brand Launches in 2010 by Type with novel mechanisms of action
including a new oral therapy for multiple
BRAND LAUNCHES IN 2010
PRODUCT INDICATION PRODUCT INDICATION
sclerosis, a monoclonal antibody for
osteoporosis and bone metastases, and a
Actemra® rheumatoid arthritis Ablavar® blood-pool agent
therapeutic vaccine for prostate cancer.
Egrifta™ lipodystrophy Actoplus Met®XR type 2 diabetes
Ella® emergency contraceptive Beyaz-28™ oral contraceptive • There were also 6 NCEs bringing new
Cysview™ imaging agent for bladder cancer options with existing mechanisms
NEW MECHANISM
Gilenya™ multiple sclerosis

Halaven™ breast cancer
Duet DHA™Balanced prenatal vitamins including new treatments for rheumatoid
osteoporosis
Dulera® asthma arthritis, prostate cancer and meningitis.
Prolia™
Ilotycin® antibiotic
Provenge® prostate cancer • 5 orphan drugs were launched in 2010
Iprivask™ thrombosis
Victoza® diabetes BPH
bringing new options to patients in
Jalyn™
Vpriv® Gaucher disease Kombiglyze™XR type 2 diabetes
diseases with smaller prevalence.
OTHER BRANDS
Xgeva™ bone metastases Lo Loestrin™FE oral contraceptive • More than half of new brands in 2010
Fanapt® schizophrenia Lumizyme® Pompe disease were not NCEs.
EXISTING MECHANISM
Jevtana® prostate cancer Menveo® meningococcal bacteria

Livalo® cholesterol Mirapex®ER™ Parkinson's disease
MuGard™ chemotherapy oral protectant Chart notes
Natazia™ oral contraceptive Brand launches include all branded products launched in
Prevnar 13® pneumonia
Pradaxa® thrombosis 2010 and exclude products approved in 2010 but not
Quadramet® bone metastases launched.
Xeomin® muscle activity
Tekamlo™ hypertension Other brands are not New Chemical Entities (NCE) or novel
Ampyra® multiple sclerosis, walking ability macular degeneration biologics; new and existing mechanism and orphan are NCEs.
Tozal®
Folotyn® T-cell lymphoma (CTCL) Tribenzor™ hypertension New and existing mechanism products refer to whether they
ORPHAN
T-cell lymphoma (CTCL) are first or subsequent to use the mechanism of action when
Istodax® Vimovo™ osteoarthritis pain launched in a therapy area.
Kalbitor® angioedema Zyclara® skin irritation Orphan products are defined by FDA as treatments for
Zortress® renal cell carcinoma Zyprexa®Relprevv™ schizophrenia diseases affecting less than 200,000 people per year.
Due to different approved indications, denosumab is
marketed under two distinct names Prolia® and Xgeva®.
Source: IMS Institute for Healthcare Informatics

Brands first exposed to generics totaled $71.4Bn since 2006

Brands first exposed to generics totaled $71.4Bn since 2006
• In 2010, $12.6Bn in branded products
Spending on Products Before Generic Entry faced patent loss and the entry of
•!In 2010, $12.6Bn
competition fromingenerics
branded products
compared to faced
Spending on Products Before Generic Entry patent loss and the entry
$19.5Bn of products in 2009. This of competition
from generics
combined 2-yearcompared
time periodto ($32.1Bn)
$19.5Bn of
Spending in Year Prior to Patent Expiry $BN products
representsinthe2009.
highestThis combined
amount ever. 2-year
25
10%
time period ($32.1B) represent the
% of Prior Year's Sales • Major products that have had patents
highest
expiringamount
in 2010 ever.
include Aricept®
•!Major productsLovenox
that have had patents
% OF PRIOR YEAR'S SPENDING

8%
20 (donepezil), ® (enoxaparin) and
19.5 expiring
Flomax in(tamsulosin),
® 2010 include which each had
Aricept®(donepezil),
annual spending above $1Bn Lovenox®
during the
15 15.8 6%
(enoxaparin), and Flomax® (tamsulosin),
12 months prior to their patent expiration.
which
• 2010 each had annual spending
share of above
13.8 expiries bring the total the
12.6 $1Bn
market facing generic competition fortothetheir
during the 12 months prior
10
4%
patent expiration.
first time to 25.7% over the past 5 years,
9.7 •!2010upexpiries
from 22.9% brings the
in the total
prior share of the
5 years.
market facing generic competition for the
5
2% first time over the past 5 years to 25.7%
up from 22.9% in the prior 5 years.
0
0% Chart notes
2006 2007 2008 2009 2010 Sales in prior year of brands that lost patent protection in
each year.
ChartPercentage
notes: of prior year spending represents the pre-expiry
YEAR OF PATENT EXPIRY Salesspending
in prior for
year of brands
products facingthat lost
patent patent
expiry protection
compared to in
Source: IMS Health, MIDAS, Market Segmentation, Dec 2010 each total
year.market spending in the previous year.
Percentage of prior year spending represents the pre-expiry
Source: IMS Health, MIDAS, Market Segmentation, Dec 2010 spending for products facing patent expiry compared to total
market spending in the previous year.

Generics capture over 80% of a brand’s volume within 6 months

Generics capture over 80% of a brand’s volume within 6 months
•!Within 6 months
• Within of patent
six months loss,
of patent loss,patients
patients
Brand Prescription Share of Molecule Post-Expiry received the generic form of
received the generic form of the the molecule
80% of the
molecule time
80% in 2010.
of the time in 2010.
•!This reflects an increasingly
an increasinglyefficient
efficient set
set of
% SHARE OF PRE-EXPIRY MOLECULE TOTAL RX
• This reflected
mechanisms for encouraging
of mechanisms for encouraging use of use of
100%!
2006 generics
generics versus the original
versus original brands brands,
and and
2007 compared
compared to 55%generic
to 55% generic share
share of the
of the
molecule
moleculefor for those products
those products thatthat faced
faced
2008 generic
genericcompetition
competition forforthe
thefirst
first time in
time
75%!
2009 2006.
in 2006.
2010
50%!
Chart notes
25%! ChartChart
notes:
measures the percentage of branded pre-expiry
Chart(1measures the percentage
month) prescription share thatof remains
branded in pre-expiry
each month (1
month) prescription
post expiry. share that remains in each month post
expiry.
Brand shares include line extensions such as long-acting
Brand shares include line extensions such as long-acting
0%! branded formulations of the molecule which may not be
branded formulations of the molecule which may not be
available generically.
-1! 0! 1! 2! 3! 4! 5! 6! 7! 8! 9! 10! 11! 12! available generically.
Chart includes
Chart includes availabledata
available data,and
and2010
2010 expiries
expiries have
havenotnot all
MONTHS SINCE PATENT EXPIRY all reached 12 months
reached 12 months post-expiry.post-expiry.
Prescriptions dispensed
Prescriptions dispensedinclude
includeretail
retail pharmacies,
pharmacies,
Source: IMS Health, National Prescription Audit, Feb 2011 independent
independentandand
chain drugstores,
chain drugstores, food storepharmacies,
food store pharmacies,
Source: IMS Health, National Prescription Audit, Feb 2011 mail order andand
mail order long-term
long-termcare
care facilities.
facilities.
The The
Use ofUse of Medicines
Medicines in the
States: States:
Review Review of 2010
of 2010 21 21
Report
Report by the
by the IMS IMSfor
Institute Institute
Healthcarefor Healthcare Informatics
Informatics
Total generic market share has risen over each of the past 5 ye
Total generic market share has risen over each of the past 5 years
•! Generic prescription share reached 78%
Generic Share
Generic Shareof
of Total Prescriptions
Total Prescriptions
• Generic prescription share reached 78% in
2010
2010 which which
was 4%was 3% than
higher higher
2009than
levels.2009
levels.
Market Available for Generic • This share gain is caused by a 3% gain in
•! This share gain is caused by a 3% gain
Substitution the available market for generics
the
(81 to available
84% in 2010) market
as wellfor
as agenerics
1% gain (81 to
100%!
84%
70% 74% 79% 81%
in84%
generic in efficiency
2010) as(93% wellvs.as92%).
a 1% gain in
80%!
generic efficiency (93% vs. 92%).
Generic Market Share • Most states allow pharmacists to
60%! Most states
•! substitute genericsallow
when pharmacists to subst
available, others
40%! generics
require whendirect
a doctor’s available, others
instruction or require
74%
78% 20%! doctor’s
restrict direct instruction
substitution or restrict
for specific therapies
72%
67% substitution
where differencesfor specific
between therapies
brands and wher
63% 0%!
differences
generics between
may impact brands and generi
patients.
2006 2007 2008 2009 2010
may impact patients.
X
• The broad availability of discounted generics
100%
•! is The broad
a further availability
positive of efficiency.
influence on discounted
Generic Efficiency
generics is a further positive influence
92% 93% efficiency.
91% 91% Chart notes
90%
Chart notes:dispensed include retail pharmacies and long-
Prescriptions
Prescriptions dispensed include retail pharmacies,
term care facilities.
independent and chainrepresents
Generic prescription share drug stores, food store
the percentage of pharmac
mail order and long-term care facilities.
unbranded and branded generic prescriptions dispensed
2006 2007 2008 2009 2010 Generic
annually. prescription share represents the percentage of
80% unbranded and branded
Generic availability generic
is measured prescriptions
by evaluation of productsdispensed
annually
at the form level that have a comparable generic available
2006 2007 2008 2009 2010
Generic availability
on the market is measured
in the time period. by evaluation of produc
the form level that have a comparable generic of
Generic efficiency is calculated based on the percentage available
Source: IMS Health, National Prescription Audit, Dec 2010 the market in the time period
generic prescribing of the generically available market.
Source: IMS Health, National Prescription Audit, Dec 2010 Generic efficiency is calculated based on the percentage
generic prescribing of the generically available market
CHANGES IN USAGE AND SPENDING IN MAJOR THERAPY AREAS
Therapy
Therapy area
area spending
spending growth
growth reflected
reflected thethe innovation
innovation cycle
cycle
•!The•top
The5top 5 classes
classes in in 2010based
2010 based on on
Spending
Spending in in LeadingTherapy
Leading Therapy Classes
Classes spending were oncologics ($22.3Bn),
spending were Oncologics ($22.3Bn),
respiratory agents
Respiratory Agents ($19.3Bn),
($19.3Bn),lipid Lipid
2010 Growth % regulators ($18.7Bn), antidiabetes
Regulators ($18.7Bn), Diabetes (16.9Bn)
(16.9Bn) and antipsychotics ($16.1Bn).
and Antipsychotics ($16.1Bn).
Oncologics 3.5%
Respiratory Agents 6.5% • Absolute
•!Spending spending
growth gains growth
weregains were for
highest
Lipid Regulators 0.9% highest for
Diabetes, HIVantidiabetes,
Antivirals, antipsychotics,
Antipsychotics
Antidiabetes 12.5%
respiratory agents,
and Autoimmune Disease. HIV antivirals and
autoimmune disease.
Antipsychotics 10.0% •!Specialty class spending had greater than
Anti-Ulcerants -15.3% 10% gainsclass
• Specialty from HIV Antivirals
spending was up more andthan
Antidepressants 1.3% Autoimmune Diseases, but less than 3%
10% in HIV antivirals and autoimmune
Autoimmune 9.6% gains from
diseases, butOncology
up less thanand3%Erythropoietins
in oncology
HIV 12.2% in and
2010.erythropoietins in 2010.
Angiotensin II 1.2% •!14 classes had
• 14 classes over
had over$6Bn
$6Bn in
in spending
spending inin
Narcotic Analgesics 5.1% 2010
2010with
withanti-epileptics spending
anti-epileptics spending falling
falling
ADHD 14.5% from
from$6.8Bn
$6.8Bn toto $5.5Bn
$5.5Bn inin2010
2010 following
following
Antiplatelets 9.1% thethe
entry
entryof of generics.
generics.
Erythopoietins -3.6%
0 5 10 15 20 25 Chart notes
Chart Therapy
notes: class and Specialty definitions based on
SPENDING $BN
Therapy class and
proprietary IMSSpecialty definitions based on proprietary
Health definitions.
Specialty classes
-20000 -15000 -10000 -5000 0 IMS Health definitions
Value measured at Trade Price – the price paid to
Value wholesalers
measured or atmanufacturers
Trade Price –bythe price
retail and paid to wholesalers
non-retail
or manufacturers by retail off-invoice
channels and excluding and non-retail channels
discounts and
and rebates
Source: IMS Health, National Sales Perspectives, Dec 2010 excluding off-invoice discounts and rebates that
that lower net prices received by manufacturers. lower net
Source: IMS Health, National Sales Perspectives, Dec 2010
prices received by manufacturers

The
Report byUse ofInstitute
the IMS Medicines in theInformatics
for Healthcare United States: Review of 2010 23
Oncologics spending growth has slowed since 2006
Oncologics spending growth has slowed since 2006
Spending
•!• Oncologics led on oncologics
all classes in 2010
in spending in was
Oncology
OncologyGrowth
Growth bybyArea
Area $790Mn
2010 higher than in 2009, the low
at $22.3Bn.
level of growth in the past 5 years a
• Spending grew by $790Mn, the lowest
4 much
level lower
of growth in growth
the past 5than
years, the
and $3Bn
Cytotoxics Hormonals Targeted Net Growth recorded in 2006
much lower growth than the $3Bn
Each in
•! recorded class
2006.of agents (Hormonal,
3 Targeted
• Hormonal and Cytotoxics)
therapies, has slowed
typically for breast
SPENDING GROWTH $BN
andfrom 2006
prostate levels
cancer with
reduced hormonal
spend by age
showing
$394Mn fromathe decline for the
2010 patent expiryfirst
fortime in
key2010 ®
product Arimidex (anastrozole).
2 Targeted
•!• Targeted agentsagents – Avastin
– such as such ®as Avastin
(bevacizumab),
(bevacizumab), Herceptin
Herceptin (trastuzum
® (trastuzumab)
andand Rituxan (rituximab) - have slow

Rituxan ® (rituximab) – have slowed
spending growth
spending from $2.2Bn
growth from in 2006 toin 200
$2.2Bn
1
$1.1Bn in 2010.
$1.1Bn in 2010
Chart notes
-1 Therapy classes defined using ATC defined product groups
and synthesized based on proprietary IMS Health
2006 2007 2008 2009 2010 Chart notes:
definitions.
Therapy classes
Spending growth defined
defined using
as dollar ATC driven
growth defined product grou
by price,
Source: IMS Health, National Sales Perspectives, Dec 2010 and synthesized
volume, based
new products onchanges.
and mix proprietary IMS Health defini
Source: IMS Health, National Sales Perspectives, Dec 2010 Spending growth defined as dollar growth driven by pri
volume, new products and mix changes
Anti-asthmatics remain as the key spending growth driver in
Respiratory growth
respiratory in 2010
agents slowed to half of 2009 growth
in 2010
Respiratory
•!• Respiratory agentagent
spendingspending growth i
was $19.3Bn
Respiratory
RespiratoryGrowth
Growth byby Area
Area 2010 Spending
in 2010. slowed growthfrom $2.2Bn
slowed toin 2009 to
$1.1Bn
$1.1Bn in 2010in 2010.
from $2.2Bn in 2009,
Anti-Asthmatics
•! mostly due to slowing growth
Anti-asthmatics from B2-
contributed 61% of
A-Cholinergics Plain&Combo stimulants - often referred to as rescue
spending growth within respiratory i
Short-Acting B2-Stimulants, Inhalant inhalers - which saw spending growth slow
2010inwith
to $1Mn 2010730Mn in new
from $417Mn spending.
in 2009.
All Other
3 asthmatic products include Advair Di
Net Growth • Anti-asthmatics contributed 61% of the
SPENDING GROWTH $BN
(fluticasone/salmeterol) and Singula

spending growth within respiratory in
(montelukast)
2010 with $730Mn in new spending.
Anticholinergic
•! Anti-asthmatic products agents
includeused
Advairin the
2 treatment
Diskus ®
of COPD contributed
(fluticasone/salmeterol) and $430
in growth
Singulair ®
in 2010 similar to 2009 lev
(montelukast).
Products inagents
• Anticholinergic this class
used ininclude
the Spiriva
1 Handihalier (tiotropium bromide
treatment of COPD contributed $430Mn
inhalation
in growth powder)
in 2010, and
similar to 2009Combivent
levels.
Products in this and
(albuterol class include Spiriva®inhalation
ipratropium
®
Handihaler (tiotropium bromide
0
inhalation powder) and Combivent®
(albuterol and ipratropium inhalation).
Chart notes
Therapy classes defined using ATC defined product groups
-1 and synthesized based on proprietary IMS Health definitions.
2006 2007 2008 2009 2010 Chart notes:
Spending growth defined as dollar growth driven by price,
volume, new products
Therapy classes and mixusing
defined changes.
ATC defined product grou
Source: IMS Health, National Sales Perspectives, Dec 2010 and
COPDsynthesized based Pulmonary
– Chronic Obstructive on proprietary
Disease. IMS Health defini

Spending
Spending onon lipidregulators
lipid regulators increased
increased by by $160Min
$160Mn in2010
2010
• Lipid regulators were the third largest
Lipid Regulators Growth •! Lipid
therapyRegulator spending
class by spending growth
in 2010 at
Lipid Regulators Growth remained positive
$18.7Bn, growing by in 2010
only 0.9%but
withslowed
from
much2009of the to $160Mn
class versus $490Mn in
now available
Lipitor Crestor 2009
generically.
Zocor/simvastatin Vytorin/Zetia •! •Crestor (rosuvastatin)
2010 growth of $160Mn slowedled spending
from
3 All Other Products Net Growth increases in 2010 with $717Mn in new
$490Mn in 2009.
•growth
Dispensed prescriptions exceeded 255Mn
2 •! Lipitor
in 2010,continues to lead spending
with in the
SPENDING GROWTH $BN
up from 210Mn in 2006,

class, but is expected to face generic
54% of prescriptions filled with a generic
1 and the remainder
competition filled
in late as brands,
2011
primarily Lipitor® and Crestor®.
0 • Crestor® (rosuvastatin) led spending
increases in 2010 with $717Mn in
-1 new growth.
• Lipitor® (atorvastatin) continues to lead
-2 spending in the class, but declined by
4.1% in 2010. It was second to generic
-3 simvastatin in prescription volume in the
class, and is expected to face generic
competition in late 2011.
-4
Chart notes
-5
Chartand synthesized based on proprietary IMS Health
notes:
2006 2007 2008 2009 2010 definitions.
Spending growth
and synthesized defined
based on as dollar growth
proprietary IMSdriven by price,
Health definitions
Source: IMS Health, National Sales Perspectives, Dec 2010 volume, new products and mix changes.
Source: IMS Health, National Sales Perspectives, Dec 2010 Spending growth defined as dollar growth driven by price,

Antidiabetes spending grew by $1.9Bn in 2010
Antidiabetes spending grew by $1.9Bn in 2010
•! Diabetes spending growth remained
Antidiabetes
Antidiabetes Growth
Growth byby Area
Area
strong
• Diabetes
at $1.9Bn
with $1.9Bn
spending
in 2010
in gainshigh
growth remained
versus $2.2Bn in
in 2010
2009.
versus $2.2Bn in 2009
• Patients filled 165Mn prescriptions in
Human Insulins Traditional Type II Antidiabetes Human
•! 2010, up 3.8% Insulins contributed
over 2009; additionally, 64% of
DPP-IV GLP-1 growth
more than 59% ($1.3Bn) in with
were filled 2010 followed by
generics.
Glitazones All Other Products DPP-IV
• Human products
insulins and synthetic analogues
Net Growth Glitazones
•! contributed 64%remained flat in 2010
of growth ($1.3Bn) led
following
by Lantus ®
safety (insulin
SoloSTAR ®
related issues with
glargine).
3
Avandia usinginthe
2008
SPENDING GROWTH $BN
• Products DPP-IV mechanism

contributed steady growth since their
initial introduction in 2007 and include
2 Januvia® (sitagliptin) and OnglyzaTM
(saxagliptin).
• GLP-1 products Byetta® (exenatide) and
Victoza® (liraglutide) together had
1 spending growth of $137Mn.
Chart notes
-1 and synthesized
Chart notes: based on proprietary IMS Health
definitions.
2006 2007 2008 2009 2010 Therapy classes defined using ATC defined product grou
Spending
and growth defined
synthesized basedas on
dollar growth driven
proprietary by price,
IMS Health defini

Antipsychotic spending grew in 2010 by $1.4B

Antipsychotic spending grew in 2010 by $1.4Bn
Antipsychotic
•! • Antipsychotic spending
spending grew bygrowth
$1.4Bngrew by
Antipsychotics Growth
Antipsychotics Growth by Area
by Area in$1.4Bn in 2010
2010 versus $300Mnversus $300M
in 2009, whenin 2009
2009 spending
expiry of was impacted by entry
®
•! the patent Risperdal
3 Abilify Seroquel/Seroquel XR
(risperidone) in 2008 impacted
generic Risperdal (risperidone) spending.
in 2008
Zyprexa Risperdal/Risperidone Top brands
•! • Patients Abilify
filled 56Mn (aripiprazole)
prescriptions in and
All Other Net Growth 2010, up 2.1%, with 90% prescribed
Seroquel (quetiapine) lead spending
newer
growthgeneration
in 2010 atypical antipsychotics.
2
• Top brands Abilify® (aripiprazole),
SPENDING GROWTH $BN
Seroquel® (quetiapine) and Zyprexa®

(olanzapine) led spending growth in 2010
1 with a combined $1.4Bn.
-1
Chart notes
-2 and synthesized based on proprietary IMS Health
Chart notes:
2006 2007 2008 2009 2010 definitions.
Spending
and growth defined
synthesized as dollar
based on growth driven
proprietary by price,definition
IMS Health
Source: IMS Health, National Sales Perspectives, Dec 2010 Spending growth defined as dollar growth driven by price,

Notes on sources IMS National Sales Perspectives (NSP)TM IMS National Disease and Therapeutic
measures spending within the U.S. Index (NDTI)TM is a database produced
This report is based on the IMS services detailed in pharmaceutical market by pharmacies, using a panel of physicians to project
the panel on the right. clinics, hospitals and other healthcare patient contacts for the universe of office-
Analyses exclude OTC products and focus on providers. It is the only source to report 100 based physicians in the U.S. Each panel
prescription-bound products (including Insulins percent coverage of the retail and non-retail member reports on all patient contacts for
which are available without prescription). Spending channels for national pharmaceutical sales two consecutive workdays each quarter for
is reported at wholesaler invoice prices and does not at actual transaction prices. use in projections. Information collected
reflect off-invoice discounts and rebates. includes patient demographics, diagnosis
IMS National Prescription Audit (NPA)TM and treatment information, and physician
is a suite of services that provides the demographics.
industry standard source of national
prescription activity for all products. IMS MIDASTM is an analysis platform used to
assess worldwide healthcare markets. It
NPA Market Dynamics (NPA-MD)TM aggregates IMS’s global audits and
is a national-level prescription offering that normalizes to international standards of
links NPA with anonymized patient-level product naming, company ownership,
data (APLD) which tracks patients over time currency exchange rates, volume metrics,
and enables analysis such as whether a and product segmentations, and estimates
patient’s prescription was new, switched of price levels at different points in the
from another medicine, or added to an supply chain. Segmentations include therapy
existing regimen in the last year. classes, forms, dosages, price levels and
Diagnoses, compliance and persistence, as those related to brands, generics and patent
well as ethnicity analytics are among other protection. IMS has created a new
analyses that are possible. international standard that measures the
protected, unprotected and generics
markets.
IMS Formulary FocusTM & Plantrak CoPayTM
are part of the IMS Managed Market Services
suite and include tracking of health plan
formulary design, link to IMS NPA suite, and
measure copayments at the point of sale.

Appendix 1
Top Therapeutic Classes by Spending
SPENDING $BN 2010 2009 2008 2007 2006
TOTAL US MARKET 307.4 300.3 285.7 280.5 270.3
1 Oncologics 22.3 21.5 19.7 18.1 15.8
2 Respiratory Agents 19.3 18.1 16.0 15.1 13.1
3 Lipid Regulators 18.8 18.6 18.1 19.4 22.4
4 Antidiabetes 16.9 15.0 12.8 11.4 10.2
5 Antipsychotics 16.1 14.7 14.3 12.8 11.4
6 Anti-Ulcerants 11.9 14.1 14.2 14.6 14.1
7 Antidepressants 11.6 11.5 11.7 11.7 13.3
8 Autoimmune Diseases 10.6 9.7 8.6 7.6 7.0
9 HIV Antivirals 9.2 8.2 7.1 6.2 5.6
10 Angiotensin II 8.7 8.6 7.6 6.5 5.7
11 Narcotic Analgesics 8.4 8.0 7.3 6.7 5.7
12 ADHD 7.2 6.3 5.2 4.6 4.0
13 Platelet Aggregation Inhibitors 7.1 6.5 5.7 5.0 4.7
14 Erythropoietins 6.1 6.3 6.9 8.4 9.8 Appendix notes
15 Multiple Sclerosis 5.7 4.9 4.1 3.4 3.2 Therapy classes defined using ATC defined product groups
16 Anti-Epileptics 5.6 6.9 11.1 10.0 8.7
definitions.
17 Vaccines (Pure, Comb, Other) 5.0 4.6 5.0 5.9 3.9
Report reflects Prescription-bound products including
18 Hormonal Contraceptives 4.8 4.7 4.5 4.1 3.9 Insulins (and excludes other products such as OTC).
19 Anti-Alzheimers 4.5 4.0 3.4 2.9 2.5 IMS routinely updates its market audits, which can and
20 Immunostimulating Agents 4.2 4.1 4.1 4.1 4.0 does result in changes to previously reported market size
and growth rates.
Source: IMS Health, National Sales Perspectives, Dec 2010 Updated April 7, 2011.

Appendix 2
Top Therapeutic Classes by Prescriptions
DISPENSED PRESCRIPTIONS MN 2010 2009 2008 2007 2006
Total US Market 3,995.2 3,949.2 3,866.3 3,824.9 3,706.4
1 Lipid Regulators 255.4 249.7 237.1 228.8 210.4
2 Antidepressants 253.6 246.1 239.8 236.5 231.1
3 Narcotic Analgesics 244.3 241.0 238.6 230.5 220.7
4 Beta Blockers (Plain & Combo) 191.5 167.8 160.7 160.3 156.6
5 Ace Inhibitors 168.7 165.7 160.2 158.0 154.2
6 Antidiabetes 165.0 159.0 154.7 152.1 147.8
7 Respiratory Agents 153.3 152.4 146.3 146.0 139.8
8 Anti-Ulcerants 147.1 145.7 138.8 133.9 127.9
9 Diuretics 131.0 131.7 132.4 135.2 138.1
10 Anti-Epileptics 121.7 115.3 109.3 101.8 94.9
Appendix notes
11 Tranquilizers 108.6 104.0 100.0 97.6 94.4
12 Thyroid Preps 107.2 105.3 105.5 102.8 101.4
13 Calcium Antagonists (Plain & Combo) 97.9 94.9 91.9 90.4 90.5 definitions.
14 Antirheumatics 95.0 92.5 89.8 89.0 88.6 Report reflects Prescription-bound products including
15 Hormonal Contraceptives 92.3 93.9 93.8 94.0 94.3 Insulins (and excludes other products such as OTC).
16 Angiotensin II 83.7 84.4 86.1 83.1 78.5 Includes all prescriptions dispensed through retail
17 Penicillins 76.1 76.6 74.5 77.1 79.1 pharmacies - including independent and chain drug stores,
food store pharmacies and mail order as well as long-term
18 Macrolides & Similar Type 73.9 69.3 66.4 62.8 60.9
care facilities.
19 Vitamins & Minerals 71.9 69.8 64.7 61.6 60.6
20 Hypnotics & Sedatives 66.0 65.5 60.3 57.4 52.3 90-day and 30-day prescriptions are both counted as one
prescription.
Source: IMS Health, National Prescription Audit, Dec 2010 Updated April 7, 2011

Appendix 3
Top Products by Spending
SPENDING $BN 2010 2009 2008 2007 2006
Total US Market 307.4 300.3 285.7 280.5 270.3
1 Lipitor® 7.2 7.6 7.8 8.1 8.6
2 Nexium® 6.3 6.3 5.9 5.4 5.1
3 Plavix® 6.1 5.6 4.8 3.9 2.9
4 Advair Diskus® 4.7 4.7 4.4 4.2 3.9
5 Abilify® 4.6 4.0 3.0 2.3 1.9
6 Seroquel® 4.4 4.2 3.8 3.4 3.0
7 Singulair® 4.1 3.7 3.5 3.4 3.0
8 Crestor® 3.8 3.0 2.1 1.7 1.3
9 Actos® 3.5 3.4 3.1 2.9 2.6
10 Epogen® 3.3 3.2 3.0 3.0 3.2
11 Remicade® 3.3 3.2 3.0 2.7 2.5
12 Enbrel® 3.3 3.3 3.1 3.1 3.1
13 Cymbalta® 3.2 2.8 2.4 1.9 1.2
14 Avastin® 3.1 3.0 2.5 2.2 1.7
15 Oxycontin® 3.1 2.9 2.3 1.0 0.8
16 Neulasta® 3.0 3.0 3.0 3.0 2.8
17 Zyprexa® 3.0 2.7 2.5 2.4 2.4
18 Humira® 2.9 2.5 2.1 1.5 1.2
19 Lexapro® 2.8 2.8 2.7 2.6 2.4
20 Rituxan® 2.8 2.6 2.4 2.2 2.0
Appendix notes
21 Aricept® 2.5 2.3 1.9 1.6 1.4
22 Lovenox® 2.3 2.8 2.6 2.3 2.0 Report reflects Prescription-bound products including
23 Atripla® 2.2 1.9 1.4 0.9 0.2 Insulins (and excludes other products such as OTC)
24 Copaxone® 2.2 1.7 1.4 1.1 1.0 IMS routinely updates its market audits, which can and
25 Spiriva®Handihaler® 2.0 1.7 1.4 1.1 0.7 does result in changes to previously reported market size
and growth rates.
Source: IMS Health, National Sales Perspectives, Dec 2010 Updated April 7, 2011

Appendix 4
Top Products by Prescriptions
Total US Market 3,995.2 3,949.2 3,866.3 3,825.1 3,706.4
1 hydrocodone/acetaminophen 131.2 128.2 124.1 119.2 112.4
2 simvastatin 94.1 83.8 67.5 47.9 14.4
3 lisinopril 87.4 82.8 76.8 71.1 65.2
4 levothyroxine sodium 70.5 66.0 61.2 54.6 49.8
5 amlodipine besylate 57.2 51.3 44.6 27.9 —
6 omeprazole (RX) 53.4 45.4 35.1 26.6 18.0
7 azithromycin 52.6 53.8 51.0 46.3 36.5
8 amoxicillin 52.3 52.4 50.9 53.2 54.7
9 metformin HCL 48.3 44.3 42.3 40.2 38.4
10 hydrochlorothiazide 47.8 47.9 48.5 48.5 48.0
11 alprazolam 46.3 43.9 41.7 39.8 37.6
12 Lipitor® 45.3 51.7 58.5 65.8 74.0
13 furosemide 43.4 43.5 44.1 44.2 44.3
14 metoprolol tartrate 38.9 41.1 32.6 31.6 29.2 Appendix notes
15 zolpidem tartrate 38.0 35.1 29.9 16.0 — Report reflects Prescription-bound products including
16 atenolol 36.3 39.3 41.8 44.7 46.1 Insulins (and excludes other products such as OTC).
17 sertraline HCL 35.7 34.2 32.7 31.6 10.8
Generics of the same molecule manufactured by different
18 metoprolol succinate 33.0 26.9 41.5 21.0 0.6
companies combined .
19 citalopram HBR 32.1 27.1 22.4 17.8 14.0
20 warfarin sodium 32.0 31.6 30.2 28.8 26.7 Includes all prescriptions dispensed through retail
21 oxycodone/acetaminophen 31.9 30.2 28.4 25.9 22.8 pharmacies - including independent and chain drug stores,
22 ibuprofen (RX) 31.1 30.3 28.5 27.7 26.8
care facilities.
23 Plavix® 29.5 29.9 28.9 25.1 18.4
24 gabapentin 29.3 25.4 22.2 20.0 18.5 Prescription counts are not adjusted for length of therapy.
25 Singulair® 28.7 28.6 29.0 31.0 28.1 90-day and 30-day prescriptions are both counted as
one prescription.

Appendix 5
Dispensing Locations by Spending
SPENDING $BN 2010 2009 2008 2007 2006
Total US Prescription Market 307.4 300.3 285.7 280.5 270.3
Chain Stores 108.1 105.4 99.7 96.0 91.9
Mail Service 52.6 51.5 46.5 44.1 42.7
Independent 37.9 37.3 36.9 37.5 36.5
Clinics 36.2 34.8 33.0 32.7 29.8
Non-Federal Hospitals 28.0 27.6 26.8 26.4 26.1
Food Stores 21.3 21.2 20.4 21.5 21.9
Long-Term Care 14.8 13.8 13.7 13.3 12.8
Federal Facilities 3.9 4.1 3.9 4.0 3.7
Home Health Care 2.5 2.5 2.5 2.5 2.4
HMO 1.1 1.1 1.3 1.5 1.6
Miscellaneous 1.0 1.0 1.0 1.0 0.9
Appendix notes
Insulins (and excludes other products such as OTC)
IMS routinely updates its market audits, which can and
does result in changes to previously reported market size
and growth rates.
Source: IMS Health, National Sales Perspectives, Dec 2010 Updated April 7, 2011

Appendix 6
Dispensing Locations by Prescriptions
Total US Prescription Market 3,995.2 3,949.2 3,866.3 3,825.1 3,706.4
Chain Stores 2,173.6 2,129.5 2,046.8 2,012.0 1,946.8
Independent 748.3 754.6 769.4 782.7 764.8
Food Stores 490.3 487.8 481.2 478.1 475.5
Long-Term Care 318.8 316.0 307.4 295.0 287.1
Mail Service 264.2 261.3 261.5 257.3 232.2
Appendix notes
Insulins (and excludes other products such as OTC).
Includes all prescriptions dispensed through retail
pharmacies - including independent and chain drug stores,
care facilities.
90-day and 30-day prescriptions are both counted as
one prescription.

RESEARCH AGENDA GUIDING PRINCIPLES
The research agenda for the Institute centers The Institute operates from a set of
on five areas considered vital to the Guiding Principles:
About the Institute advancement of healthcare globally:
The IMS Institute for Healthcare Informatics leverages The advancement of healthcare globally is
collaborative relationships in the public and private Proving the effective use of information by a vital, continuous process.
sectors to strengthen the vital role of information in healthcare stakeholders globally to improve
advancing healthcare globally. Its mission is to provide health outcomes, reduce costs and increase Timely, high-quality and relevant
key policy setters and decision makers in the global access to available treatments. information is critical to sound healthcare
health sector with unique and transformational insights decision making.
into healthcare dynamics derived from granular analysis Demonstrating the performance of medical
of information. care to optimize and drive better Insights gained from information and
understanding of disease causes, treatment analysis should be made widely available to
Fulfilling an essential need within healthcare, the healthcare stakeholders.
Institute delivers objective, relevant insights and research consequences and measures to improve
that accelerate understanding and innovation critical to quality and cost of healthcare delivered to
patients. Effective use of information is often
sound decision making and improved patient care. complex, requiring unique knowledge
With access to IMS’s extensive global data assets and and expertise.
Understanding the future global role for
analytics, the Institute works in tandem with a broad set biopharmaceuticals, the dynamics that
of healthcare stakeholders, including government The ongoing innovation and reform in all
shape the market and implications for
agencies, academic institutions, the life sciences industry aspects of healthcare requires a dynamic
manufacturers, public and private payers,
and payers, to drive a research agenda dedicated to approach to understanding the entire
providers, patients, pharmacists and
addressing today’s healthcare challenges. healthcare system.
distributors.
By collaborating on research of common interest,
Personal health information is confidential
it builds on a long-standing and extensive tradition of Researching the role of innovation in health and patient privacy must be protected.
using IMS information and expertise to support the system products, processes, and delivery
advancement of evidence-based healthcare around systems, and the business and policy The private sector has a valuable role to
the world. systems that drive innovation. play in collaborating with the public sector
related to the use of healthcare data.
Informing and advancing the healthcare
agendas in developing nations through
information and analysis.


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The Use of

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The Use of Medicines in the United States: Review of 2010 1

- Total spending - Volume of protected brands Spending $307Bn +2.3%

The Use of Medicines in the United States: Review of 2010 2

The Use of Medicines in the United States: Review of 2010 3

Spending on medicines exceeded $307Bn in 2010, up 2.3%

195 lower volume growth, increased

The Use of Medicines in the United States: Review of 2010

which totaled 3.99Bn in 2010, 1.2%

52.6% 52.6% 52.9% 53.9% 54.4%

Patient office visits declined by 4.2% in 2010

2% their visits during that time and offset a by

Patient visits calculated using national sample based

Fewer patients are beginning new chronic therapy treatment

Hypertension, Insomnia, Migraine, Active Bladder,

The Use of Medicines in the United States: Review of 2010

Continuing therapies grow slowly as brands continue decline

•! declined by 12% orof61Mn

80 declined 12% or 61.Mn prescriptions

The Use of Medicines in the United States: Review of 2010

Payment type continues shift toward Medicare Part D and Medicaid

•!Total spending on medicines

The Use of Medicines in the United States: Review of 2010 15

PRICE CONTRIBUTION TO GROWTH %

The Use of Medicines in the United States: Review of 2010 17

12 6% total brand spending, down from 5.0% in

% OF TOTAL BRAND SPENDING

The Use of Medicines in the United States: Review of 2010 18

Significant new therapy options became available to patients

Gilenya™ multiple sclerosis

Jevtana® prostate cancer Menveo® meningococcal bacteria

The Use of Medicines in the United States: Review of 2010 19

Brands first exposed to generics totaled $71.4Bn since 2006

% OF PRIOR YEAR'S SPENDING

The Use of Medicines in the United States: Review of 2010

Generics capture over 80% of a brand’s volume within 6 months

The Use of Medicines in the United States: Review of 2010 23

andand Rituxan (rituximab) - have slow

(fluticasone/salmeterol) and Singula

The Use of Medicines in the United States: Review of 2010

up from 210Mn in 2006,

The Use of Medicines in the United States: Review of 2010 26

• Products DPP-IV mechanism

The Use of Medicines in the United States: Review of 2010 27

Antipsychotic spending grew in 2010 by $1.4B

Seroquel® (quetiapine) and Zyprexa®

The Use of Medicines in the United States: Review of 2010 28

The Use of Medicines in the United States: Review of 2010 29

The Use of Medicines in the United States: Review of 2010 30

The Use of Medicines in the United States: Review of 2010 31

The Use of Medicines in the United States: Review of 2010 32

The Use of Medicines in the United States: Review of 2010 33

The Use of Medicines in the United States: Review of 2010 34

The Use of Medicines in the United States: Review of 2010 35

The Use of Medicines in the United States: Review of 2010 36

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