Institutional Equities

Pharmaceutical Sector
16 December, 2022

Key prescription trends in the US market Mitesh Shah

We have compared key prescription trends of various companies under our coverage from 1 st July, 2022 to 30th Research Analyst
November, 2022. Due to a strong flu season in the US, multiple companies, including Lupin, Alembic, Ajanta mitesh.shah@nirmalbang.com
and Zydus saw strong uptick in gTamiflu. Revlimid also continued to see strong traction for Dr Reddy’s (DRL), +91-76668 04995
Cipla and Zydus while Natco faced volume decline due to exhaustion of most of first year’s quantity limit.
Company wise, Biocon’s market share in insulin Glargine continued to inch up, with low single-digit volume Bhavya Sanghavi
growth. Cipla gained market share in Albuterol Sulphate HFA and gBrovana. Zydus continued to maintain a Research Associate
dominant market share in Lialda and Asacol HD. DRL saw strong growth in gKuvan, aided by the launch of bhavya.sanghavi@nirmalbang.com
Key Prescription Trends Update

Javygtor. Sun Pharma continued to gain volume in Levulan, which was offset by volume loss in Absorica LD
+91 22 6273 8188
and Winlevi.
Select key drug-wise US prescription trends
 Lenalidomide (gRevlimid): Alvogen, Cipla, DRL and Zydus have launched their products within the last three months
under the settlement agreement with the innovator. Out of them, DRL is leading among all in terms of market share gain
(23% market share in Nov’22) followed by Alvogen (5%), Cipla (3%) and Zydus (<1%). On the other hand, due to
exhaustion of most of quantity limit for FY23 in 1HFY23, Natco’s market share has declined from 18% to 10% in the last
five months. Natco’s volume is down by ~33% QoQ in 3QFY23. Competition has increased, with more players expected
to launch their products next year. However, due to limited quantity agreements by all the players with the innovators as
well as different timeline of launches, we believe the price erosion would remain low in this product till the patent expires.
 gTamiflu (Oral Suspension): With the onset of a strong flu season in the US, there was a strong uptick in volume in
both capsule (70% of sales) as well as oral suspension (30%) by ~1.9x growth YoY and ~16x growth QoQ. While in the
Capsule segment, Lupin, Alembic and Strides were holding 11.5%, 15% and 15% market share, respectively in Nov’22.
In oral suspension, Ajanta, Lupin and Zydus held 26%, ~13% and 14% market share, respectively in Nov’22.
 Albuterol Sulfate HFA: Lupin has lost market share by 55bps QoQ while Cipla has gained market share by 139bps in
Albuterol Sulfate HFA. Cipla now holds 18% market share compared to Lupin, which holds ~15%. On a monthly run-rate
basis, volume for both Lupin as well as Cipla has increased by 20% QoQ and 7% QoQ, respectively in 3QFY23.

Company-wise US prescription trends

Biocon – Consistent volume ramp-up in Pegfilgrastim; Market share improvement in Ogivria and gAfinitor
 Everolimus (10mg) (gAfinitor): Natco and Biocon saw market share improvement in Everolimus 10mg to the tune of
169bps and 170bps, respectively, aided by strong volume growth of 4% QoQ and 10% QoQ, respectively in 3QFY23. As
of Nov’22, Biocon, Novartis, Breckenridge/Natco and Hikma market share stood at 36%, 15%, 18% and 30%,
respectively.
 Insulin Glargine (Semglee): Biocon’s market share in insulin Glargine has been increasing at a steady pace. The
company’s market share improved by 50bps QoQ while recording a volume growth of 3% QoQ.
 Pegfilgrastim (Fulphila): Biocon continued to see a strong ramp-up in Pegfilgrastim with monthly volume run-rate of 8%
on QoQ basis. The company has gained a market share of 342bps since January’22, which stands at 11.3% as of Nov’22.
 Trastuzumab (Ogivri): Biocon’s market share declined by 15bps QoQ and continued to remain in low single digit at
4.7%. Monthly volume run-rate has increased by 1.5% QoQ in 3QFY23.
Dr. Reddy’s Lab – Launch of Javygtor aids strong growth in gKuvan
 gVascepa: DRL’s monthly prescription volume run-rate remained flattish while market share was stagnant at 16%. Teva
launched gVascepa in Sept’22 and it continues to ramp up production; its current market share is miniscule.
 gCiprodex: DRL’s monthly volume run-rate decreased by 27% QoQ, leading to a loss of market share by 200bps, which
stood at 34.9%. Additionally, Sun Pharma launched the generic version of the product in Sept’22. But, its market share
remains in low single digit.
 gSuboxone: DRL’s market share slightly improved to 19.5% while the volume growth was tepid QoQ.
 gKuvan: In the soluble tablet drug form, DRL’s monthly volume run-rate stood at a robust 73% QoQ, aided by the launch
of branded product Javygtor in partnership with Cycle Pharma in the US. Additionally, the powder form saw a volume
growth of 376% QoQ.
 gInvanz (Ertapenem): DRL’s monthly volume run-rate declined by 9% QoQ in 3QFY23 with a 309bps decline in market
share, which stood at 23%. Fosun Pharma has captured ~10% market share since its launch in March’22.
 gVasostrict: DRL saw a 65% QoQ decline in volume in gVasostrict (20 unit/ml) while its market share continued to
remain insignificant. Aurobindo launched gVasepa in July’22 and has seen a steady volume growth.

Please refer to the disclaimer towards the end of the document.

 Institutional Equities
Cipla and Lupin – Cipla continues to see volume ramp-up in Albuterol and gBrovana; Lupin
records strong volume growth in gTamiflu
 Albuterol Sulfate HFA: Lupin has lost market share by 55bps QoQ while Cipla has gained market share by
139bps in Albuterol Sulfate HFA. Cipla now holds 18% market share while Lupin’s market share stands at
~15%. On a monthly run-rate basis, volume for both Lupin as well as Cipla increased by 20% QoQ and 7%
QoQ, respectively in 3QFY23.
 gBrovana: Cipla’s market share is consistently ramping up, increasing by 348bps QoQ while Lupin’s market
share declined by 249bps. Teva entered the market in January’22 followed by Sun Pharma in July’22, which
has led to moderation in volume growth for the incumbent players. The innovator, Sunovion Pharma, has
been the biggest loser, having ceded ~2300bps in market share in the last 12 months. As on 31 th Nov’22,
the market share of Sunovion Pharma, Cipla, Lupin and Teva stood at 10%, 43%, 16% and 11%,
respectively. There are currently six players marketing their generic products while two more players –
Vistapharm and Alembic Pharma - have received USFDA approval and are expected to launch their products
in the near term. We can expect significant price erosion in this product going forward.
 gDurezol: Cipla has lost significant market share in gDurezol to Amneal Pharma. Amneal has ramped up
its market share to 79%, eating into the market share of all the incumbent players. Cipla’s market share
declined by 1826bps QoQ to 4% with a volume decline of 83% QoQ.
 Suprep: Lupin launched Suprep in Sept’22 and has seen strong monthly volume growth since the launch.
The company has already cornered ~42% market share.
 gTecfidera: Cipla’s market share in gTecfidera stood at 9% as of Nov’22, which was stagnant compared to
2QFY23. While DRL’s monthly volume run-rate declined by 3% QoQ, it maintained market share at ~7%.
 gTamiflu: With the onset of flu season in the US, there was an uptick in volume for Lupin, which registered
a strong growth of 2.1x YoY and 12.2x QoQ in the combined capsule and oral suspension volume.
 Solosec: Lupin has partnered with Exeltis for marketing Solosec in the US market. The purpose of this
partnership is to unlock value from this asset by leveraging Exeltis’ women’s health focused fieldforce in the
US market. Lupin’s monthly volume run-rate in Solosec continued to remain muted in 3QFY23 as well.
 Levothyroxine Sodium: Lupin’s monthly volume run-rate and volume market share declined by ~10% in
3QFY23.
 Lanreotide Acetate: Cipla is the first generic player to receive approval for a generic version of Lanreotide
Acetate; the product was launched in Feb’22 and is gradually gaining market share. The company’s market
share increased by 102bps QoQ to 4% in 3QFY23.
Zydus Lifesciences – Volume decline in gLialda; Sole generic player in Asacol HD
 gLialda: Zydus’ market share and monthly volume run-rate declined by 394bps and 9%, respectively
compared to 2QFY23. Zydus holds a market share of ~51% for the product.
 Asacol HD: Zydus continued to command majority of the market share for the product. We haven’t seen
any generic player enter the fray despite patent expiry. Monthly volume run-rate remained almost flat
compared to 2QFY23.
Alembic Pharma – Strong growth in Tamiflu; market share gain in gPerforomist; Continues to
cede market share in Losartan
 gTheophylline: Alembic has lost ~145bps market share to Glenmark in the 300mg dosage strength, but
has regained market share in the 450mg dosage strength by ~226bps. Alembic’s monthly volume run-rate
declined by ~4% QoQ in 300mg dosage strength while it remained relatively flat QoQ in 450mg dosage
strength.
 gTamiflu (Capsule): There was a strong uptick in volume for Alembic, which registered a growth of 4.3x
YoY and 37x QoQ in capsule form.
 gPerforomist: Alembic launched gPerforomist in April’22 and has cornered ~14% market share while in the
generic space, Teva continues to remain market leader with a 37% market share. Lupin has launched
gPerformist in the US in the last week of Nov’22, which will increase competitive intensity.

2 Pharmaceutical Sector
 Institutional Equities
 Losartan Potassium and Losartan Hydrochlorothiazide: The volume trend reflected a sharp contrast for
Alembic and Lupin in both the products. Alembic saw its volume decline by 6% QoQ in Losartan Potassium
and by 13% QoQ in Losartan Hydrochlorothiazide. In contrast, Lupin’s volume increased sharply by ~17%
QoQ and ~48% QoQ in Losartan Potassium and Losartan Hydrochlorothiazide, respectively.
Natco Pharma – Flat trend in Copaxone with volume decline in Revlimid
 Lenalidomide (gRevlimid): As expected, there was a sharp volume decline of ~33% QoQ in 3QFY23.
Competition has increased for gRevlimid with four generic companies, namely Alvogen, Cipla, DRL and
Zydus launching their products within the last three months under the settlement agreement with the
innovator. Additionally, Sun Pharma is slated to launch the product in the near term. The market share of
Natco, Alvogen, Cipla and DRL stood at 10%, 5%, 3% and 23%, respectively as of Nov’22.
 Everolimus (gAfinitor, 10mg): Natco/Breckenridge’s Everolimus (10mg) volume increased by 10% QoQ,
and ramped up its market share by 170bps QoQ.
 gCopaxone: Copaxone volume was flattish while its market share improved by 46bps QoQ. Teva continued
to hold a dominating market share of ~49% in gCopaxone.
Indoco Remedies – Strong Brinzolamide volume aided by a large order inflow
 Brinzolamide: Indoco/Teva’s volume improved drastically by 157% QoQ on the back of a large order, which
the company was expected to receive in 3QFY23. Teva’s market share stood at ~21%, an improvement of
1274bps on QoQ basis.


Sun Pharma - Continued to gain volume in Levulan Cequa and Odomzo while witnessed volume
decline in Absorica LD and Winlevi.
 Absorica – Prescription volume run-rate for Absorica was flattish while it declined by 8% QoQ for Absorica
LD.
 Levulan – Growth remained strong in Levulan; Monthly prescription volume run-rate saw a sharp
improvement of 121% QoQ.
 Cequa – Monthly prescription volume was up by 9% QoQ. We have not seen any direct volume impact on
Cequa sales post the launch of generic Restasis.
 Ilumya – Monthly prescription volume run-rate was flattish QoQ.
 Winlevi – Monthly prescription volume run-rate decreased by 11% QoQ.
 Odomzo – Monthly prescription volume improved by 12% QoQ.
 Ezallor Sprinkle – Monthly prescription volume improved by 1% QoQ.
 Kapspargo Sprinkle – Kapspargo Sprinkle’s average monthly prescription volume improved by 2% QoQ in
3QFY23.
 Xelpros – Monthly prescription volume run-rate decreased by 6% QoQ in 3QFY23.
 Drizalma Sprinkle – There was a decline of 18% QoQ in Drizalma Sprinkle volume in 3QFY23.
 Mesalamine (Pentasa, 500mg) – Monthly prescription volume run-rate increased by 1% QoQ. Sun Pharma
has maintained a market share of ~58% in the 500mg dosage strength, an improvement of 260bps vs
2QFY23.

3 Pharmaceutical Sector
 Institutional Equities
Exhibit 1: Prescription volume growth and bps change in market share of key products
Change in Market
Company Product Volume Growth (%)* Importance
Share (bps)**
Everolimus (10mg) 4 169 High
Semglee 3 50 High
Biocon
Fulphila 8 115 Medium
Ogivri 1 (15) Medium
gVascepa 1 33 High
gCiprodex (27) (200) High
gVasostrict (Injectable, 20unit/ml) (65) (32) High
Dr. Reddy’s
gSuboxone 0 40 High
gKuvan (Soluble Tablet) 74 491 Medium
Ertapenem (9) (309) Medium
Albuterol Sulfate (Inhalant) 7 (55) High
Arformoterol Tartrate (13) (249) High
Solosec (6) NA High
Suprep NA 3441 High
Lupin gTamiflu (Oral Suspension) 875 (609) High
gTamiflu (Capsule) 1289 (16) High
Losartan Potassium 17 15 Low
Losartan Hydrochlorothiazide 48 61 Low
Levothyroxine Sodium (4) (10) Low
Albuterol Sulfate (Inhalant) 20 139 High
Arformoterol Tartrate 8.4 348 High
Cipla
gDurezol (83) (1826) High
gTecfidera (1) 3 Medium
gLialda (9) (394) High
Zydus Lifesciences
Asacol HD (2) 26 High
gTheophylline (300mg; 450mg) (4);1 (145);226 High
gTamiflu (Capsule) 3592 731 High
Alembic Pharma Losartan Potassium (6) (40) Medium
Formoterol Fumarate 50 453 Medium
Losartan Hydrochlorothiazide (14) (146) Medium
Everolimus (10mg) 10 170 High
Natco Pharma Lenalidomide (33) (503) High
Glatiramer Acetate (1) 46 High
Indoco Remedies Brinzolamide 157 1274 High
Mesalamine (Pentasa, 500mg) 1 260 Medium
Absorica LD (8) NA High
Levulan 121 NA High
Sun Pharma
Cequa 9 NA High
Ilumya 0 NA High
Winlevi (11) NA High
Source: Symphony, Nirmal Bang Institutional Equities Research
* Trx monthly run-rate prescription growth / monthly integrated volume run-rate growth from 1stJuly, 2022 to 30thNovember, 2022.
**Change in Market Share from 1stJuly, 2022 to 30thNovember, 2022..
Source: Symphony, Nirmal Bang Institutional Equities Research

4 Pharmaceutical Sector
 Institutional Equities
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5 Pharmaceutical Sector
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6 Pharmaceutical Sector