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93rd Edition HDA
FACTBOOK
The Facts, Figures and Trends in Healthcare (2022–2023)
SPONSORED BY
Gold
Silver
Bronze
The HDA Research Foundation is pleased to release the 93rd Edition HDA Factbook: The Facts,
Figures & Trends in Healthcare (2022–2023), a leading reference tool for the healthcare distribution
industry. Since its debut in 1929, this resource has provided trusted benchmarks and trends for the
pharmaceutical supply chain.
The Factbook highlights the amazing efficiency inherent in the delivery of millions of healthcare products
to pharmacies and providers, with the latest edition detailing the complexity and strength of the
traditional pharmaceutical distribution market. In 2021, approximately 94 percent of all pharmaceutical
sales traveled through distributors, with more than 11 million units picked per day. Pharmaceutical sales
through traditional distribution grew, reaching $598.7 billion. Further, the growth rate of the sector hit a
record high of 9.4 percent in 2021. Inflation likely boosted the year’s growth, which outpaced the
10-year average of 6 percent. But despite better than average growth, distributor margins slid for a
seventh consecutive year.
Chain drug stores comprised 46 percent of customer volume, followed by hospitals and HMOs (18
percent). The market segments that experienced the most growth in 2021 included brand name
prescription products (55 percent) and specialty brand name prescription products (34 percent).
The Foundation is grateful to all who participated in the 2022 surveys and to the following companies,
whose sponsorship made the 93rd Edition of the Factbook possible:
Gold: Apotex Corp and Real Value Rx dba Hospital Pharmaceutical Consulting
Silver: Regeneron
Bronze Sponsors: Ascend Laboratories, LLC, IQVIA, Johnson & Johnson Health Care
Systems Inc., Pharmacy First and Teva Pharmaceuticals
Sincerely,
Perry Fri
Executive Vice President and COO
HDA Research Foundation
HDA Research Foundation 2022 Factbook I

Editorial and Production Staff
Publication Manager
Rachel Newman, Associate Director
Survey Program Data Tabulation

Industry Insights Inc., Columbus, Ohio
Questions/Comments
Inquiries and feedback regarding the HDA Factbook are welcome. Please contact Rachel Newman,
Associate Director, HDA Research Foundation, at rnewman@hda.org.
The HDA Research Foundation is the 501(c)(3) nonprofit charitable organization of the Healthcare
Distribution Alliance (HDA). The Foundation serves as the thought leader in driving research,
education and discussion for all healthcare supply chain stakeholders, enabling the industry’s ability to
deliver efficient, safe and secure patient access to medicines and medical products. Learn more at
www.HDA.org/Foundation.
Copyright © 2022 by the HDA Research Foundation
ISBN: 979-8-9850427-4-0
HDA Research Foundation 2022 Factbook II

TABLE OF CONTENTS
Preface Information Systems

Letter of Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I Section Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Editorial & Production Staff. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II Electronic Data Interchange (EDI) . . . . . . . . . . . . . . . . . . . . . . . 17
Sponsors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V Table 30: Distributor Scanning Profile: 2021. . . . . . . . . . . . . . . . . . 17
Organization and Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . VII Table 31: Barcoded Product Packaging: 2020-2021. . . . . . . . . . . . 18
User’s Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VIII Table 32: Distributor Purposes for Data Capture Through
IQVIA Source Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IX Barcoding: 2020-2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Table 33: Unreadable Barcodes: 2020-2021. . . . . . . . . . . . . . . . . . 19
Table 34: Distributor Serialization Activity: 2020-2021. . . . . . . . . . 20
Distributor Demographics & Characteristics Table 35: Distributor Serialization Profile: 2020-2021. . . . . . . . . . . 20
Section Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Table 36: Lot Number Tracking: 2021. . . . . . . . . . . . . . . . . . . . . . . 20
Table 1: Total Sales Through Distributors: 2018-2021. . . . . . . . . . . . 2 Table 37: Lot Number Tracking by Functional Area: 2021 . . . . . . . 21
Table 2: Distributor Company Net Sales Growth: 2019-2021. . . . . . 2 Table 38: Distributor Electronic Data Interchange
Table 3: Distributor Sales by Product Category: 2020-2021. . . . . . . 2 Transaction Set Use (Sales Under $1 Billion): 2021. . . . . . . . . . . 22
Table 4: Distributor Sales by Customer Category: 2020-2021 . . . . . 3 Table 39: Distributor Electronic Data Interchange
Table 5: Programs and Services Offered by Distributors: 2021. . . . . 4 Transaction Set Use (Sales Over $1 Billion): 2021. . . . . . . . . . . . 23
Table 6: Distributor Program and Service Details: 2019-2021. . . . . . 5 Table 40: Distributor EDI Use in Support of DEA Controlled
Table 7: Average Square Footage of Warehouse Space per Substances Ordering System (CSOS): 2020-2021 . . . . . . . . . . . 24
Distribution Center: 2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Table 41: Distributor Status of Electronic Commerce
Table 8: Average Square Feet of Warehouse Space per Initiatives: 2020-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Distribution Center: 2015-2021 . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Table 42: Product Identification Numbers: 2021. . . . . . . . . . . . . . . 25
Table 9: States Where HDA Distributor Members Have Table 43: DSCSA Compliance: 2021. . . . . . . . . . . . . . . . . . . . . . . . 25
Customers: 2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Table 44: Distributor Customer Location Identifiers Profile:
Table 10: Distributor Sales Force Profile: 2019-2021 . . . . . . . . . . . . 7 2020-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Finance Operations
Section Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Section Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Table 11: Distributor Profitability (FIFO Results): 2019-2021. . . . . . . 9 Table 45: Distributor Supply Chain Management
Table 12: Distributor Return on Investment Model Agreements: 2019-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
(FIFO Results): 2019-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Table 46: Distributor Software Applications: 2019-2021. . . . . . . . . 29
Table 13: Distributor Income Statement: 2019-2021 . . . . . . . . . . . 10 Table 47: Returns: 2019-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Table 14: Distributor Company Expense Statement: Table 48: Returns from Customers to Distributors: 2019-2021. . . . 31
2019-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Table 49: Returned Goods Practices for Distributors: 2019-2021. . 31
Table 15: Distributor Capital Expenditures: 2019-2021 . . . . . . . . . 11 Table 50: Reasons Goods are Returned to Distributors:
Table 16: Distributor Company Personnel Expenditures: 2019-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2019-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Table 51: Reasons Goods are Returned to Manufacturers:
Table 17: Distributor Asset Management: 2019-2021. . . . . . . . . . . 12 2020-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Table 18: Distributor Company Asset Ratios: 2019-2021. . . . . . . . 12 Table 52: Recalled/Withdrawn Prescription Products
Table 19: Distributor Company Credit Memos: 2019-2021 . . . . . . 12 Handled by Distributors: 2019-2021. . . . . . . . . . . . . . . . . . . . . . 32
Administration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table 53: Number of Manufacturers/Suppliers: 2019-2021. . . . . . 33
Table 20: Due Diligence: 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table 54: Distributor Human Resources: 2021 . . . . . . . . . . . . . . . . 33
Table 21: Distributor Minimum Orders: 2021. . . . . . . . . . . . . . . . . 13 Table 55: Companies Handling Temperature-Sensitive, Controlled .
Table 22: Distributor Chargeback Profile: 2019-2021. . . . . . . . . . . 13 Substances and Hazardous Prescription SKUs: 2020-2021. . . . . 34
Table 23: Frequency of Chargeback Submissions to Table 56: Cold Chain Distribution: 2020-2021 . . . . . . . . . . . . . . . . 34
Manufacturers: 2020-2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table 57: Special Handling Rx SKUs: Branded & Generic:
Table 24: Chargebacks Denied: 2020-2021 . . . . . . . . . . . . . . . . . . 14 2020-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Table 25: Sales per Distributor: 2020-2021. . . . . . . . . . . . . . . . . . . 14 Table 58: Over-the-Counter (OTC) Medicines: 2021. . . . . . . . . . . . 35
Table 26: Distributor Inventory Levels—Number of SKUs: Table 59: Distributors Handling Temperature-Sensitive,
2020-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Controlled Substances and Hazardous Over-the-Counter
Table 27: Distributor Company Customer Ordering (OTC) SKUs: 2020-2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Practices: 2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Table 60: Health and Personal Care (HPC) Items: 2021 . . . . . . . . . 36
Table 28: Distributor Personnel Productivity: 2020-2021 . . . . . . . . 15 Table 61: Durable Medical Equipment (DME) and Home
Table 29: Base Salary Adjustments: 2021. . . . . . . . . . . . . . . . . . . . 15 Healthcare: 2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Table 62: General Merchandise (GM): 2021. . . . . . . . . . . . . . . . . . 37
Table 63: Distributor Specialty Products: 2021. . . . . . . . . . . . . . . . 37
Table 64: Distributor Other Product Categories: 2021. . . . . . . . . . 38
Table 65: Distributor Order Characteristics: 2020-2021. . . . . . . . . 38
Table 66: Order Fulfillment: 2021. . . . . . . . . . . . . . . . . . . . . . . . . . 38
Table 67: Customer Accounts and Shipping Points Serviced
by Company: 2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Table 68: Distributor Product Delivery Methods: 2020-2021 . . . . . 39
Table 69: Deliveries per Week of Prescription Products: 2021.. . . . 39
HDA Research Foundation 2022 Factbook III

TABLE OF CONTENTS
Healthcare Products Market Characteristics

Section Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Section Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Table 70: Top 20 Therapeutic Classes by Non-Discounted Table 99: U.S. Healthcare Expenditures: 2014-2024. . . . . . . . . . . . 68
Spending: 2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Table 100: Spending per Capita as a Percent of Gross
Table 71: Top 20 Therapeutic Classes by Prescriptions: Domestic Product (GDP): 2014-2024. . . . . . . . . . . . . . . . . . . . . 68
2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table 101: Projected U.S. Healthcare Expenditures by
Table 72: Prescriptions and Spending by Product Type: Selected Types of Services: 2021-2022 . . . . . . . . . . . . . . . . . . . 69
2015-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Table 102: Projected U.S. Healthcare Expenditures:
Table 73: Top 20 Medicines by Non-Discounted Spending: 2021-2023. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Prescription Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Table 74: Top 20 Generic Medicines by Prescriptions: Table 103: Projected Growth of Medicare and Medicaid
2020-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Spending: 2020-2030. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Table 75: Top 20 Biologic Medicines by U.S. Spending: Table 104: Projected Prescription Drug Spending by Payer:
2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 2021-2024. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Table 76a: Small Molecule Patent Expirations: 2022. . . . . . . . . . . . 46 Table 105: Retail Prescriptions by Payer: 2018-2021. . . . . . . . . . . . 71
Table 76b: Small Molecule Patent Expirations: 2023 . . . . . . . . . . . 46 Table 106: Dispensed Prescriptions (mil): 2016-2021. . . . . . . . . . . 71
Table 76c: Small Molecule Patent Expirations: 2024. . . . . . . . . . . . 46 Table 107: Total Prescriptions Dispensed by Channel:
Table 76d: Small Molecule Patent Expirations: 2025 . . . . . . . . . . . 46 2020-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Table 76e: Small Molecule Patent Expirations: 2026 . . . . . . . . . . . 46 Table 108: Dispensed Prescriptions by Channel: 2016-2021 . . . . . 72
Table 76f: Small Molecule Patent Expirations: 2027. . . . . . . . . . . . 47 Table 109: Growth in Prescription Sales and Dispensing (%):
Table 76g: Small Molecule Patent Expirations: 2028 . . . . . . . . . . . 47 2016-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Table 76h: Small Molecule Patent Expirations: 2029 . . . . . . . . . . . 48 Pharmaceutical Companies . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Table 76i: Small Molecule Patent Expirations: 2030. . . . . . . . . . . . 49 Table 110: Top 20 U.S. Pharmaceutical Manufacturers by
Table 76j: Small Molecule Patent Expirations: 2031. . . . . . . . . . . . 50 Sales: 2019-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Table 76k: Small Molecule Patent Expirations: 2032. . . . . . . . . . . . 51 Table 111: Top 20 Manufacturers by Prescriptions
Table 76l: Small Molecule Patent Expirations: 2033. . . . . . . . . . . . 51 Dispensed: 2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Table 76m: Small Molecule Patent Expirations: 2037. . . . . . . . . . . 51 Table 112: Top 20 Manufacturers by Total Unbranded
Non-Prescription Products. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Generic Prescriptions Dispensed: 2021 . . . . . . . . . . . . . . . . . . . 75
Table 77: Rx-to-OTC Switch List: 2013-2022. . . . . . . . . . . . . . . . . . 52 Table 113: Top 20 Branded Products by U.S. Prescriptions:
Table 78: Top 28 OTC Product Categories by Sales: 2021. . . . . . . 53 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
New Medications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Table 114: Top 15 Manufacturers by Promotional
Table 79: National Drug Shortages – New Shortages by Year Spending: 2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
January 2001 to March 31, 2022 . . . . . . . . . . . . . . . . . . . . . . . . 54 Table 115: Top 20 Generic Manufacturers by Revenue:
Table 80: National Drug Shortages – New Shortages by Year 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
January 2001 to March 31, 2022, % Injectable. . . . . . . . . . . . . . 54 Table 116: Top 10 Biologic Manufacturers by Revenue:
Table 81: National Drug Shortages – Active Shortages 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
by Quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Table 82: Active Shortages: Top 5 Drug Classes. . . . . . . . . . . . . . . 55
Table 83: Common Drug Classes in Short Supply: 2017-2021. . . . 56 International
Table 84: Reasons for Shortages as Reported by Manufacturers Section Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
During UUDIS Investigation: 2021. . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table 117: World Pharmaceutical Market by Market
Table 85: The Drug Development Pipeline: 2016-2021. . . . . . . . . 57 Share: 2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Table 86: Novel Drug Approvals Per Year: 2011-2021 . . . . . . . . . . 57 Table 118: Top 10 Pharmaceutical Markets in the World
Table 87: Novel Approvals: 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . 58 by Dollar Sales: 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Table 88: First Time Generic Drug Approvals: 2021. . . . . . . . . . . . 59 Table 119: Projected World Pharmaceutical Market by
Market Share: 2026. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Table 120: Canadian Unbranded Generic Prescription Drug Sales: . .
Customers 2012-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Section Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Table 121: Top 10 Manufacturers in the Canadian Market
Table 89: Non-Discounted Spending by Channel: 2020-2021. . . . 63 by Revenue: 2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Table 90: Top 10 Drug Chains by Dollar Volume: 2022. . . . . . . . . . 64 Table 122: Top 10 Canadian Branded Products by
Table 91: Top 10 Drug Chains by Store Count: 2022. . . . . . . . . . . 64 Revenue: 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Table 92: Top 10 Drug Store Markets: 2021. . . . . . . . . . . . . . . . . . 65 Table 123: Pharmerging Nations by Growth Projections:
Table 93: Average Annual Returns per Pharmacy Location. . . . . . . 65 2021-2026. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Table 94: Application of Manufacturer Return Policy . . . . . . . . . . . 65 Table 124: Projected Pharmerging Market Growth: 2026. . . . . . . . 84
Table 95: Non-Creditable Product Casual Analysis. . . . . . . . . . . . . 65 Table 125: Projected Indian Pharmaceutical Sales by
Table 96: Return Product Expiration Analysis. . . . . . . . . . . . . . . . . 66 Customer Categories: 2026. . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Table 97: Brand – Generic Return Product Mix. . . . . . . . . . . . . . . . 66 Table 126: Top 20 Pharmaceutical Companies by Sales
Table 98: Manufacturer National Return Policy Summary in India: 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
of Credit Eligibility for Partials and Product Table 127: Top 20 Therapeutic Classes by Sales in India: 2021 . . . 86
Expiration Requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Appendix
Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
HDA Research Foundation 2022 Factbook IV

SPONSORS
HDA Factbook Sponsors

The Foundation would like to give special recognition and thanks to the sponsors of the 93rd Edition HDA
Factbook: The Facts, Figures & Trends in Healthcare (2022-2023). We extend our sincerest gratitude to our
sponsors whose generosity made this effort possible.
GOLD
Apotex Corp., headquartered in Weston, Florida, is the U.S. affiliate of Apotex Inc.
The company is ranked among the top 15 U.S. generic corporations by prescriptions
and by dollars*. Apotex Corp. currently markets 350+ products and is market leader
of 33 product families. For over 45 years, Apotex has never wavered from its mission
to improve lives through high quality generics and reliable supply, and they never
will. At Apotex, they are dedicated to innovating for patient affordability.
*Source: IQVIA 2021

– Ranked #11 largest generic by Rx prescription
**Ranked #15 by US Dollars
Real Value Rx services 5000 independent pharmacies with next day delivery. We
offer best in class customer experience to help preserve the independent pharmacist
who has patient care at the forefront. Our customers deliver medications to every
corner of this country and are considered America’s largest FRONT LINE healthcare
providers and have the most connection to each community they serve as part of a
larger healthcare team.
Real Value Products Corp is a subsidiary of a 35 year wholesale distribution company.

Real Value Rx is licensed to distribute prescription drugs throughout the entire United
States and Puerto Rico. Real Value Rx is a proud member of HDA and is an NABP
accredited Drug Distributor. Real Value Rx was founded to distribute pharmaceuticals
to managed healthcare programs and has expanded to independent pharmacy, drug
chains, physician in office dispensing, hospitals, surgery centers, long term care, and
mail order facilities.
Real Value Rx prides itself on Distribution Excellence, Accuracy & Integrity. We

purchase all of our products directly from the manufacturers and we are fully
compliant with the DSCSA Drug Supply Chain Security Act. As part of our
commitment to the safety of our customers and their patients, Real Value Rx has
implemented automated controls at every level in the operational process, including
electronic ordering technology, warehouse management systems, and access to
online pedigrees. Our Account Managers work diligently with customers to keep
them informed and help them respond to an ever-changing healthcare market.
Customers can rest assured that product is being handled with the utmost care and
professionalism. A partnership built on real value!
SILVER
Regeneron is a leading biotechnology company that invents, develops, and

commercializes life-transforming medicines for people with serious diseases.
Founded and led for nearly 35 years by physician-scientists, Regeneron’s unique
ability to repeatedly and consistently translate science into medicine has led to
numerous FDA-approved treatments and product candidates in development,
almost all of which were homegrown in Regeneron’s laboratories. Regeneron’s
medicines and pipeline are designed to help patients with eye diseases, allergic
and inflammatory diseases, cancer, cardiovascular and metabolic diseases, pain,
hematologic conditions, infectious diseases, and rare diseases.
HDA Research Foundation 2022 Factbook V

SPONSORS
BRONZE
Ascend Labs has marketed itself since 2008. A division of India’s Alkem Labs
Ascend was formed originally as a product development company and ultimately
acquired by Alkem in 2012. Ascend continues to market several of its originally
developed products and today relies upon Alkem’s significant and robust R&D
and Regulatory group to submit on average 10-12 new ANDA submissions to FDA
annually. Marketing over 80 molecules now and combining a strong sales team and
manufacturing assets in both India and the US, Ascend is recognized today as one
of the fastest growing generic companies and one that places a strong emphasis on
both service and efficiency.
IQVIA (NYSE:IQV) is a leading global provider of information, innovative technology

solutions and contract research services focused on using data and science to help
healthcare clients find better solutions for their patients. Formed through the merger
of IMS Health and Quintiles, IQVIA offers a broad range of solutions that harness
advances in healthcare information, technology, analytics and human ingenuity to
drive healthcare forward. IQVIA enables companies to rethink approaches to clinical
development and commercialization, innovate with confidence as well as accelerate
meaningful healthcare outcomes. IQVIA has approximately 55,000 employees in
more than 100 countries, all committed to making the potential of human data
science a reality. IQVIA’s approach to human data science is powered by the
IQVIA CORE™, driving unique actionable insights at the intersection of big data,
transformative technology and analytics with extensive domain expertise.
IQVIA is a global leader in protecting individual patient privacy. The company uses a
wide variety of privacy-enhancing technologies and safeguards to protect individual
privacy while generating and analyzing the information that helps their customers
drive human health outcomes forward. IQVIA’s insights and execution capabilities
help biotech, medical device, and pharmaceutical companies, medical researchers,
government agencies, payers and other healthcare stakeholders tap into a deeper
understanding of diseases, human behaviors and scientific advances, in an effort to
advance their path toward cures. To learn more, visit www.IQVIA.com.
The Janssen Pharmaceutical Companies of Johnson & Johnson address some of the
most devastating and complex diseases faced in our time. With advanced biologic
and other treatments, Janssen is investing in a transformative future, changing the
way diseases are prevented, intercepted, treated and cured.
The mission of Pharmacy First is to preserve and provide enhanced profitability

to independent community and small chain pharmacies through manufacturer-
sponsored new product launch programs; patient medication compliance and
persistency programs; Disease state management and pharmacist/patient
education programs. In pursuit of this mission, Pharmacy First has rapidly emerged
as the leader of more than a dozen networks formed in recent years. Currently 2,500
member pharmacies nationwide.
Teva Pharmaceutical Industries Ltd. (NYSE: TEVA) is a leading global

pharmaceutical company, committed to increasing access to high-quality
healthcare by developing, producing and marketing affordable generic drugs
as well as innovative and specialty pharmaceuticals and active pharmaceutical
ingredients. Headquartered in Israel, Teva is the world’s leading generic drug
maker, with a global product portfolio of more than 1,000 molecules and a direct
presence in about 60 countries. Teva’s specialty pharmaceutical businesses focus
on CNS, oncology, pain, respiratory and women’s health therapeutic areas as
well as biologics. Teva currently employs approximately 46,000 people around
the world.
HDA Research Foundation 2022 Factbook VI

ORGANIZATION AND METHODOLOGY
93rd Edition HDA Factbook: The Facts, Figures & Trends in Healthcare (2022-2023)
The HDA Factbook is an easy-to-use reference guide featuring descriptive data tables on the traditional
pharmaceutical distribution industry. The Factbook offers original data from the HDA Research Foundation’s
annual surveys. Additional secondary data come from other leading healthcare industry organizations.
Information tables are organized into eight sections, each with a brief synopsis highlighting important trends
and performance metrics. A User’s Guide also is included to facilitate readers’ easy retrieval of relevant data.
Methodology
The information provided in the Foundation’s data tables is collected from annual surveys sent to all
Healthcare Distribution Alliance (HDA) traditional primary distributor members. The data are reported solely at
the corporate level. The full sample represents a spectrum of pharmaceutical companies from distributors with
a focused product portfolio and targeted customers to national distributors serving customers with multiple
outlets. Traditional distributors supply pharmaceuticals to primarily chain warehouses, chain and independent
pharmacies, hospitals, clinics, HMOs, nursing homes and mail-order entities.
To compile the information for this Factbook, distributors are requested by the Foundation to complete the
following surveys:
• Company Operations Profile Survey;

• Financial Survey; and,
• Information Technology Survey.
Distributor Response Rate

The 93rd Edition HDA Factbook: The Facts, Figures & Trends in Healthcare (2022-2023) publishes the
responses received from companies whose annual sales are greater than $1 billion. This cohort, referred to as
the “industry profile,” manages 94 percent of all distributor sales in the pharmaceutical supply chain, and their
business practices and operations are the best reflection of the pharmaceutical distribution industry.
Some measures relating to information technology adoption include responses from distributors with annual
sales less than $1 billion. Whenever this is the case, it is noted in the table.
Confidentiality and Data Validation Process

To ensure complete confidentiality and accuracy, the Foundation retained a leading and independent
third-party research firm, Industry Insights, to conduct and collect the surveys. All survey data were tabulated
and reported in aggregate and were scrutinized for accuracy and consistency. Any data inconsistencies are
thoroughly tested through third-party data comparison and historical data panel review. At no point does the
HDA Research Foundation nor HDA have access to individual survey results.
HDA Research Foundation 2022 Factbook VII

USER’S GUIDE
HDA Factbook Sections and Content

The 93rd Edition HDA Factbook: The Facts, Figures & Trends in Healthcare (2022-2023) has been organized
to follow the order of the survey questions and has been divided into the following eight general sections of
healthcare industry information:
1. Distributor Demographics and Characteristics: This section contains tables that illustrate healthcare
distributors’ and distribution centers’ characteristics.
2. Finance: This section includes detailed financial measurements at the corporate level.
• Administration: This subsection is focused on administrative agreements.
3. Information Systems: This section contains tables that display trends on the industry’s rate of technology
adoption and use, and includes tables that depict industry use of the following:
• Electronic Data Interchange (EDI);
• Electronic commerce (e-commerce);
• Barcoding; and,
• Serialization.
4. Operations: This section provides measures of distributor operating efficiency at the corporate level,
which includes data on how orders are picked and processed.
• Special Handling: This subsection includes information regarding the processes by which distributors
at the corporate level accommodate products with special handling requirements.
5. Healthcare Products: This section contains a number of different market statistics for both general and
discrete products handled by the healthcare supply chain, and includes tables that illustrate industry use
of the following:
• Prescription products;
• Non-prescription products; and,
• New medications.
6. Customers: This section provides market information from distributors about retail and
institutional purchasers.
7. Market Characteristics: This section examines the overall U.S. healthcare market, and includes data on
payers, utilization and market performance of top pharmaceutical manufacturers.
• Healthcare Overview: This subsection explores U.S. healthcare expenditures and
payment methods.
• Prescription Use: This subsection includes tables that show trends in prescriptions dispensed
and medication usage.
• Pharmaceutical Companies: This subsection includes detailed information on the top
healthcare manufacturers.
8. International: This section is focused on global healthcare trends as they relate to pharmaceutical
distribution markets.
Understanding Reporting Units

Median: The median represents the midpoint of the data when the data are arranged numerically from
highest to lowest. This statistic of central tendency is used because it is less likely than an average to be
skewed by extremely high or low responses (outliers).
Weighted Averages: The weighted average includes data from all respondents but is adjusted to reflect the
relative size of each company.
HDA Research Foundation 2022 Factbook VIII

IQVIA SOURCE NOTES
IQVIA: Information provided by IQVIA (formerly QuintilesIMS Health) has been collected either at the retail
level or at the manufacturer level. As a result, tables reflect final sales, consumer measures or sales at the
manufacturer level, as opposed to distributor transactions. IQVIA tables are appropriate when seeking a total
industry market figure.
IQVIA National Sales Perspectives (NSP)TM measures revenue within the U.S. pharmaceutical market by
pharmacies, clinics, hospitals and other healthcare providers. NSP reports 100 percent coverage of the retail
and non-retail channels for national pharmaceutical sales at actual transaction prices. The prices do not reflect
off-invoice price concessions that reduce the net amount received by manufacturers.
IQVIA National Prescription Audit (NPA)TM is a suite of services that provides the industry standard source of
national prescription activity for all products and markets.
IQVIA MIDASTM is a unique platform for assessing worldwide healthcare markets. It integrates IQVIA’s
national audits into a globally consistent view of the pharmaceutical market, tracking virtually every product
in hundreds of therapeutic classes and provides estimated product volumes, trends and market share through
retail and non-retail channels.
IQVIA Market PrognosisTM is a comprehensive, strategic market forecasting publication that provides insight
to decision makers about the economic and political issues that can affect spending on healthcare globally.
It uses econometric modeling from the Economist Intelligence Unit to deliver in-depth analysis at a global,
regional and country level about therapy class dynamics, distribution channel changes and brand vs. generic
product spending.
Source notes for Table 114:

“Top 15 Corporations by Promotional Spending: 2020-2021”
US Channel DynamicsTM (US CD) Measures:
Total Promotional Dollars (Total Promo $): This US CD measure brings together select promotion elements
together in a single view. It is the summary of all promotional spending including office promotion (including
service visits), hospital promotion, professional advertising, DTC advertising, and sampling [Total Promotion
Dollars = Cost of Contacts + Cost of Professional Advertising + Cost of DTC Advertising + Retail Value
of Samples]
Cost of Total Contact Dollars (Total Contact $): This measure shows the total cost of detailing visits in
hospital and office-based settings directed to the professional audience. Cost per contact is based on annual
US Inflation Rates and estimated company expenses related to rep salary, training and fringe benefits such
as bonus, car and insurance. Detailing aids, samples and other expenses involved in supporting the detailing
effort are not included.
Cost of Professional Advertising (Journal $): This measure is an estimate of the cost of product advertising
in medical journals. Journal advertising costs are based on Standard Rate and Data Service Rates, including
charges for position, color, bleed and inserts. IQVIA estimates of insert material printing costs is added to the
publisher’s rate for inserts. The advertising insertion frequency for each journal is predicated on advertisers’
average usage during a prior year.
Cost of DTC Advertising (DTC $): includes advertising spend information for pharmaceutical brands across
all available media pertinent to pharmaceutical promotion. It includes occurrence and expenditure data
across 18 expanded media types. Under a joint licensing agreement, a third-party supplies IQVIA with
this information.
Retail Value of Samples (RVOS $): is the retail value of the product sampling activities of pharmaceutical
representatives that are directed to office-based physicians. The retail value of samples is computed using the
dollar and quantity sales information IQVIA gathers from the National Prescription Audit (NPA).
HDA Research Foundation 2022 Factbook IX

DISTRIBUTOR DEMOGRAPHICS & CHARACTERISTICS
Section Overview
The Distributor Demographics & Characteristics section offers information about sales volume, products,
customers, programs and services.
The year 2021 provided new challenges for U.S. healthcare distributors as well as the overall economy.
As vaccinations became widely available in the Spring, the public mostly tried to adjust and move
beyond COVID’s impact. Through a vast combination of PPP funds and other governmental supports,
supply chain restrictions, an extremely low unemployment rate, and a soaring stock market, the U.S.
economy mostly surged – though inflation also jumped to 7.0 percent by year-end. This level of
U.S. inflation hadn’t occurred in 40 years and far exceeded the 1.7 percent rate averaged over the
past decade.
Distributor Sales by Product and Customer Category

Tables 3 and 4 illustrate distributor sales by product and customer, respectively. These tables relay the
percentage of distributor sales by channel and product type. The total sales figures cited in these tables
are those of traditional distributors only; specialty distributor sales are excluded.
Prescription pharmaceutical products accounted for 98.1 percent of distributor sales volume in 2021,
which has remained relatively consistent since 2010. Sales volume of generic pharmaceuticals increased
slightly in 2021 compared with 2020, inching up from $40.3 billion to $40.6 billion.
Chain sales again represented the largest customer category for traditional distributors, accounting
for 46.2 percent of total sales in 2021. Sales include chain drug stores, mass merchandisers and food
stores as well as chain warehouses.
The weighted averages are calculated for distributor sales by product and customer categories,
respectively. The weighted average includes data from all survey respondents but is adjusted to reflect
marketplace dynamics (Tables 3 and 4).
Table 5 highlights the programs and services offered by distributors. In 2021, 100 percent of distributors
offered the following programs and services to customers:
• Disease management programs;

• Generic source programs;
• Durable medical equipment/home health care;
• Promotional material distribution;
• Reverse distribution;
• Third-party distribution; and,
• Zone pricing systems.
HDA Research Foundation 2022 Factbook 1

1 Total Sales Through Distributors: 2018–2021

2018 2019 20203 2021
Estimated distributor sales ($bil)
1
$492.54 $535.14 $552.19 $598.71
Estimated percent of pharmaceutical sales through distributors (%) 2
94%
1
This figure includes all HDA distributor sales for prescription and pharmacy-dispensed diagnostic products, as well as non-prescription drugs, health
and personal care, durable medical equipment and home healthcare, general merchandise and other products.
2
Estimate is based on data from IQVIA and the HDA Research Foundation. An adjusted distributor sales figure was divided by the IQVIA total
prescription sales figure to obtain the estimated percent of product sold through distributors.
3
2020 sales figures have been restated.
Source: HDA Research Foundation
2 Distributor Company Net Sales Growth: 2019–20211

Weighted Average 2021
2019 2020 2021 Average Middle Range Median
Current dollars (percent sales change, not adjusted for inflation) 5.6% 3.7% 9.4% 3.0% 1.5-10.7% 6.2%
1
Excludes sales from specialty distributors or specialty divisions.
NOTE: The weighted average takes into account the proportional relevance of company size.
3 Distributor Sales by Product Category: 2020–2021

2020 Sales ($bil)2 2021 Sales ($bil)
Prescription drugs — brand name $238.51 $266.99
Prescription drugs — brand name, specialty $152.62 $162.76
Prescription drugs — generic $36.80 $37.53
Prescription drugs — generic, specialty $3.48 $3.09
Prescription drugs — biosimilar $2.29 $3.24
Prescription drugs (total) $433.70 $473.61
Non-prescription drugs (OTC) $5.62 $6.04
Health & personal care $1.13 $1.55
General merchandise $0.27 $0.29
Durable medical equipment & home health care $1.41 $1.50
Other $0.00 $0.00
Total sales1 $442.13 $482.98
Percent of total sales: Weighted average Weighted average
Prescription drugs — brand name 53.9% 55.3%
Prescription drugs — brand name, specialty 34.5% 33.7%
Prescription drugs — generic 8.3% 7.8%
Prescription drugs — generic, specialty 0.8% 0.6%
Prescription drugs — biosimilar 0.5% 0.7%
Prescription drugs (total) 98.1% 98.1%
Non-prescription drugs (OTC) 1.3% 1.3%
Health & personal care 0.3% 0.3%
General merchandise 0.1% 0.1%
Durable medical equipment & home health care 0.3% 0.3%
Other 0.0% 0.0%
Total sales 100.0% 100.0%
1
Total sales figure excludes sales from specialty distributors or specialty divisions.
2
NOTES: The weighted average takes into account the proportional relevance of company size.
Rounding differences may result in slight calculation variations.

4 Distributor Sales by Customer Category: 2020–2021

2020 Sales ($bil)2 2021 Sales ($bil)
Chain drug stores $147.19 $165.52
Mass merchandisers & food stores $20.91 $25.02
Chain warehouse sales $30.60 $32.55
Chain sales (total) $198.70 $223.09
Independent drug stores $53.98 $56.80
Hospitals & HMOs $90.37 $86.94
Specialty pharmacies $18.97 $22.56
Clinics and long-term care $21.89 $36.66
Mail order $53.32 $51.82
Other distributors $0.27 $3.24
Physicians/physicians’ offices $0.22 $0.19
Other customers $4.51 $2.61
Total sales1
$442.13 $482.98
Percent of total sales: Weighted average Weighted average
Chain drug stores 33.3% 34.3%
Mass merchandisers & food stores 4.7% 5.2%
Chain warehouse sales 6.9% 6.7%
Chain sales (total) 44.9% 46.2%
Independent drug stores 12.2% 11.8%
Hospitals & HMOs 20.4% 18.0%
Specialty pharmacies 4.3% 4.7%
Clinics and long-term care 5.0% 7.6%
Mail order 12.1% 10.7%
Other distributors 0.1% 0.7%
Physicians/physicians’ offices 0.1% 0.0%
Other customers 1.0% 0.5%
1
Total sales figure excludes sales from specialty distributors or specialty divisions.
2
Rounding differences may result in slight calculation variations.

5 Programs and Services Offered by Distributors: 2021

Of companies offering a program or service, the percent of those who do: (multiple responses allowed)
Disease management program 100.0%
Generic source program 100.0%
Durable medical equipment/home health care 100.0%
Promotional material distribution 100.0%
Reverse distribution 100.0%
Third-party distribution 100.0%
Zone pricing systems 100.0%
Data management services (provide data on sales, inventory, returns, etc.) 75.0%
Indigent patient program 75.0%
Long-term care facilities 75.0%
Medical/surgical services/products 75.0%
Pharmacy management systems & services 75.0%
Point-of-sale scanning equipment 75.0%
Private labels or control labels 75.0%
Rapid distribution (new product launches) 75.0%
Automated pharmacy dispensing 75.0%
Specialty distribution 75.0%
Third-party claims processing 75.0%
Voluntary or co-op advertising program 75.0%
Compliance (prescription)/refill reminders 50.0%
Orphan drug distribution 50.0%
Packaging (e.g., assembling kits, blister packs) 50.0%
Repackaging (bulk to bottle) 50.0%
Rx data capture for customers 50.0%
Special handling distribution (e.g., temperature sensitive, controlled substances, hazardous products) 50.0%
Specialty pharmacy (focuses on high cost, high maintenance, chronic diseases) 50.0%
Veterinary products 50.0%
Direct-to-customer order fulfillment (internet based pharmacies): OTC products 25.0%
Direct-to-customer order fulfillment (internet based pharmacies): Rx products 25.0%
Home infusion program 25.0%
Product testing (e.g., for stability/authenticity) 25.0%
Rack jobbing (in store replenishment) 25.0%
Third-party contract bids 25.0%
Direct-to-customer order fulfillment (internet based pharmacies): HPC products (health/personal care) 0.0%
Samples distribution 0.0%
Other 0.0%
NOTE: Rounding differences may result in slight calculation variations.

6 Distributor Program and Service Details: 2019–2021

2019 2020 2021
Average Median Average Median Average Median
Offer generic source program 80.0% 80.0% 80.0%
(same as generic formulary) for customers:
SKUs in generic source program 9,559 8,478 10,343 8,531 9,949 8,571
Manufacturers featured in generic source program 185 185 220 199 201 174
Over the last 12 months, performance of unit sales volume of products featured in generic source program
compared to other generic program:
Outperformed generic * 75.0% 75.0%
Performed about the same * 0.0% 0.0%
Underperformed generic * 25.0% 25.0%
Provide private labels, control labels and/or 100.0% 80.0% 100.0%
store brands to retail customers
Number of SKUs in each private label * * * * 961 1,043
Offer voluntary and/or co-op 80.0% 80.0% 100.0%
advertising program: (%)
Customer accounts that are voluntaries * * * * 13.6% 13.7%
and/or co-op:
Number of pharmacies participating in voluntary * * * * 2,593 1,302
and/or co-op program
Provide retail customers with recommended 100.0% 100.0% 100.0%
zone pricing systems
Zone pricing is provided for the following products: (multiple responses allowed)
Prescription drugs–brand name 20.0% 20.0% 20.0%
Prescription drugs–generic 20.0% 20.0% 20.0%
General merchandise 100.0% 100.0% 100.0%
OTC drugs 100.0% 100.0% 100.0%
Health and personal care 100.0% 100.0% 100.0%
Durable medical equipment/home healthcare 80.0% 80.0% 80.0%
Other 20.0% 20.0% 20.0%
NOTE: *Insufficient data

7 Average Square Footage of Warehouse Space per Distribution Center: 2021
169,112 165,000
83,833
54,000
Full Line Distributors - Sales Under $1 Billion Full Line Distributors - Sales Over $1 Billion
Average Median
8 Average Square Feet of Warehouse Space per Distribution Center: 2015–2021
147,892
2015
149,800
155,949
2016
203
161,321
211
176 171,341
2017
168,670
150 144
164,282
2018
165,000
170,993
2019
165,000
2020
34 32 32 33 34 170,993 35
165,000
169,112
2021
165,000
Average Square Footage

Median Square Footage

9 States Where HDA Distributor Members Have Customers: 2021

Count
Distributors serving all states and District of Columbia 6

Companies with distribution centers based outside the U.S. and/or its territories (%) 1
11 11 11
10
11
11 11 11
11
11
11 12
11
11
12
10 11 12
11 11 11
11 11 13
11 12 13
12 12
12
11 11 12
12
12 12 11
12 12 Conn. 11
Washington, D.C. 12
Del. 12
12 Mass. 11
Md. 12
N.H. 11
N.J. 12
R.I. 11
Vt. 11
9 Puerto Rico 9
Guam 7
9
American Samoa 6
U.S. Virgin Islands 9
Northern Mariana Islands 6
NOTE: Entries include the active HDA distributor member, not the parent company.
10 Distributor Sales Force Profile: 2019–2021

Average
2019 2020 2021
Number of sales people (in FTEs ) employed on

1
average over the last 12 months (excluding 371 432 404

telemarketing personnel)
Sales Employees by Type (as a % of total sales employees)
Inside sales force * 16.0% 22.3%
Field sales force * 51.5% 52.5%
Customer service center * 32.5% 25.2%
1
Full-time employees (FTEs) calculation is based on the proportion of full-time hours worked for those who don’t work full-time. For example, includes
an employee who worked 20 hours per week as 0.5 employees if the work week is 40 hours; employees who worked full-time for three months out of
the year are counted as 0.25 employees.

FINANCE
Section Overview
The Finance section includes operating ratio measures of profitability and expenses solely at the
corporate level. Administrative, chargeback and service agreement information are also included, as
well as capital expenditure trends in dollars (Table 15), payroll and gross profit per employee (Table 16)
and data for days sales in inventory broken out by branded vs generic products (Table 17). New to this
chapter are data regarding base salary adjustments (Table 29).
Note the following clarifications:

Some tables in this section report a weighted average, which is used to determine the proportional
relevance of company size to the performance measure. See the User’s Guide (p. VIII) for a description.
Distributor profitability, Table 11 notes the following trends:
• Gross profit margin remained relatively consistent 2020 to 2021 at 1.9 percent;
• Net profit before taxes to gross profit decreased from 24.2 percent in 2020 to 21.8 percent in
2021; and,
• Net profit after taxes to gross profit decreased from 19.3 percent in 2020 to 16.3 percent in 2021.
Distributor company net sales growth is reported as a weighted average. Distributors’ sales grew by
9.4 percent in 2021 (Table 2).
The Administration tables in this section address business-partner interaction through contracts,
scorecarding and service agreements. Section highlights include the following:
• Prior to opening a new customer account, all reporting distributors required a detailed
application process, a credit check and federal or state license verification (Table 20);
• Forty percent of distributors required a monthly minimum dollar volume to service
customers (Table 21);
• The total number of annual chargebacks as a percentage of net sales increased to 34.4 percent
in 2021 (Table 22); and,
• The average percentage of chargebacks denied after initial submission decreased from 1
percent in 2020 to 0.8 percent in 2021 (Table 24).
In 2021, the average total number of SKUs that distributors held in inventory was 44,050 — an increase
of 6.4 percent from 2020. Of that inventory, 20,907 SKUs were non-prescription health products, which
includes non-prescription drugs, health and personal care, general merchandise, durable medical
equipment and home health care. Prescription drugs accounted for 23,143 SKUs, an increase from an
average of 22,592 in 2020 (Table 26).
Table 27 represents distributor ordering practices. Online and order entry systems accounted for 97
percent of orders placed in 2021, followed by phone orders (2 percent) and fax (1 percent).

FINANCE
11 Distributor Profitability (FIFO Results): 2019–2021

Gross profit margin 2.0% 1.9% 1.9% 4.1% 1.7% - 3.7% 1.9%
Net profit before taxes to gross profit 31.7% 24.2% 21.8% 31.2% 29.1% - 49.9% 40.9%
Operating profit to net sales 1.1% 0.9% 0.8% 2.3% 0.6% - 1.0% 0.7%
Net profit after taxes to gross profit 25.8% 19.3% 16.3% 26.6% 20.2% - 40.5% 36.0%
Net profit before taxes to net sales 0.6% 0.5% 0.4% 2.2% 0.7% - 1.1% 1.0%
Net profit after taxes to net sales 0.5% 0.4% 0.3% 2.1% 0.7% - 0.8% 0.7%
Net profit after taxes to total assets 3.3% 2.3% 1.7% 11.3% 3.4% - 5.5% 4.5%
Net profit after taxes to net worth 139.1% 100.7% 26.6% 38.1% *-* 8.8%
Return on capital1 6.6% 4.8% 3.6% 12.2% 5.7% - 6.7% 6.4%
1
Return on capital=[Net profits before taxes/(inventory + accounts receivable + cash + cash equivalents)]
*Insufficient data
12 Distributor Return on Investment Model (FIFO Results): 2019–2021

Net profit margin (after tax) (%) Net Profit 0.5% 0.4% 0.3% 2.1% 0.7% - 0.8% 0.7%
Operating productivity Net Sales
Total asset turnover Net Sales 6.4 6.5 5.5 5.6 4.6 - 6.6 5.1
Asset productivity (times) Total Assets
Financial leverage multiplier Total Assets 42.4 44.2 16.8 3.7 *-* 2.6
Capital structure (times) Net Worth
Return on net worth (after tax) (%) Net Profit 139.1% 100.7% 26.6% 38.1% *-* 8.8%
Return on investment Net Worth
Some measures will, by nature, have wide variability in results, such as return on net worth.
*Insufficient data

FINANCE
13 Distributor Income Statement: 2019–2021

Income from product sales (FIFO) as a percent of sales

Gross sales to third parties 103.4% 103.8% 106.2% 105.6% 104.4% - 107.5% 104.5%
Total deductions from gross sales
(returns, allowances & adjustments, 3.5% 3.8% 6.2% 5.6% 4.4% - 7.5% 4.5%
and sales discounts allowed)
Net product sales 100.0% 100.0% 100.0% 100.0% 100.0% - 100.0% 100.0%
Cost of goods sold (FIFO)
1
100.6% 100.5% 100.8% 98.2% 98.2% - 100.7% 100.4%
Cash discounts on purchases (due to 2.5% 2.4% 2.5% 2.3% 2.1% - 2.6% 2.2%
vendor payment terms)
Gross profit after all discounts 2.0% 1.9% 1.9% 4.1% 1.7% - 3.7% 1.9%
Total operating expenses 0.9% 0.9% 1.1% 1.8% 1.0% - 2.6% 1.2%
Drug operating profit (FIFO) 1.1% 0.9% 0.8% 2.3% 0.6% - 1.0% 0.7%
Other income (distribution center only:
non-investment income—gains on sales 0.0% 0.0% 0.0% 0.10% 0.00% - 0.00% 0.00%
of assets, rental income, dividends)
Other miscellaneous expenses 0.4% 0.4% 0.3% 0.22% 0.00% - 0.07% 0.00%
(non-interest)
Net profit before interest and 0.7% 0.5% 0.4% 2.2% 0.7% - 1.1% 1.0%
taxes (FIFO)
1
Cost of goods sold=[beginning inventory plus purchases (net of trade discounts and returns, including freight) minus ending inventory]
14 Distributor Company Expense Statement: 2019–2021

Expenses as a percent of total sales:
Administrative expenses 0.2% 0.2% 0.4% 0.4% 0.3% - 0.6% 0.5%

Information Technology (IT) expenses 0.1% 0.1% 0.1% 0.2% 0.1% - 0.2% 0.2%
Buying expenses 0.0% 0.0% 0.0% 0.1% 0.0% - 0.1% 0.0%
Sales and marketing expenses 0.1% 0.1% 0.1% 0.2% 0.1% - 0.3% 0.2%
Warehouse expenses 1
0.2% 0.2% 0.2% 0.4% 0.2% - 0.5% 0.3%
Delivery expenses 0.2% 0.2% 0.2% 0.3% 0.1% - 0.4% 0.2%
Contracts and chargeback 0.1% 0.0% 0.0% 0.0% 0.0% - 0.0% 0.0%
reconciliation expenses
Occupancy expenses 0.1% 0.1% 0.1% 0.2% 0.1% - 0.2% 0.1%
Total operating expenses 0.9% 0.9% 1.1% 1.8% 1.0% - 2.6% 1.2%
1
Excluding occupancy and capitalized expenses
NOTES: Rounding differences may result in slight calculation variations.
The weighted average takes into account the proportional relevance of company size.

FINANCE
15 Distributor Capital Expenditures: 2019–2021

Capital expenditures as a percent of total capital expenditures — investment by category:

Information technology 46% 49% 40% 48% 4% - 84% 47%
Machinery & equipment 5% 12% 12% 11% 0% - 21% 5%
Land, building, vehicles, & all other 49% 38% 47% 41% 11% - 67% 32%
Capital expenditures dollars-investment by category
Information technology ($000) $9,637 $11,768 $14,638 $30,919 $1,100 - $7,633 $2,893
Machinery & equipment ($000) $997 $2,912 $4,461 $12,374 $0 - $7,982 $500
Land, building, vehicles, & all other ($000) $10,168 $9,123 $17,238 $48,117 $750 - $99,890 $18,626
Total ($000) $20,801 $23,803 $36,337 $91,410 $2,350 - $169,570 $102,783
16 Distributor Company Personnel Expenditures: 2019–2021

Personnel expenditures as a percent of gross profit:

Total company payroll as a % 14.1% 15.6% 17.2% 18.1% 14.8% - 18.4% 16.2%
of gross profit margin
Total company benefits as a % 3.2% 3.2% 3.5% 4.4% 2.4% - 5.3% 3.5%
of gross profit margin
Total company payroll/benefits as a 17.3% 18.9% 20.7% 22.5% 16.0% - 21.9% 21.5%
% of gross profit margin
Personnel expenditures as a percent of net total sales
Total company payroll as a % 0.3% 0.3% 0.3% 0.6% 0.3% - 1.1% 0.3%
of net total sales
Total company benefits as a % 0.1% 0.1% 0.1% 0.2% 0.1% - 0.3% 0.1%
of net total sales
Total company payroll/benefits as a 0.3% 0.4% 0.4% 0.8% 0.4% - 1.5% 0.4%
% of net total sales
Personnel Productivity
Sales per employee ($000) $22,824 $23,447 $24,228 $19,685 $6,379 - $32,659 $19,533
Gross profit per employee ($000) $455 $439 $449 $493 $334 - $620 $559
Compensation per employee ($000) $64 $69 $77 $95 $87 - $99 $95
Contribution per employee ($000) $391 $371 $371 $398 $262 - $521 $437

FINANCE
17 Distributor Asset Management: 2019–2021

Net sales to ending total assets (FIFO) (times) 6.4x 6.5x 5.5x 5.6x 4.6x - 6.6x 5.1x
Inventory turnover rate (Q/M, FIFO) (times)
1
14.8x 14.7x 14.5x 14.1x 13.7x - 15.7x 13.8x
Average monthly collection period (days) 21.8 23.6 23.8 24.5 21.9 - 28.3 22.0
Days sales in inventory (average monthly) (days) 24.7 24.9 25.3 26.4 23.3 - 26.7 26.5
Days sales in inventory: branded products2 * 19 19 22 *-* 19
Days sales in inventory: generic products 2
* 34 32 38 *-* 33
1
Inventory turnover is based on average quarterly or monthly FIFO-based inventories.
2
This data not collected prior to 2020.
18 Distributor Company Asset Ratios: 2019–2021

Asset Ratios:
Current assets to current liabilities 0.8x 0.8x 0.7x 1.1x 0.9x - 1.5x 0.9x
(times) (an overall measure of liquidity)
Total assets to net worth (FIFO) (times) (a
measure of financial leverage, or the extent to 42.4x 44.2x 16.8x 3.7x *-* 2.6x
which debt versus equity financing is used to
fund the business)
Days payable (days) (average monthly)
(indicates the typical number of days for 52.9 50.6 58.7 55.0 45.5 - 54.9 52.8
paying bills)
Debt to assets1 (%) (measures the percent of 97.6% 97.7% 94.1% 83.5% 61.9% - 104.0% 82.9%
total funds provided by creditors)
Acid test ratio2 (times) (how well a company 0.3x 0.3x 0.3x 0.4x 0.4x - 0.7x 0.4x
can meet its obligations immediately)
Cash ratio (times) (same as acid test, but leaves 0.05x 0.05x 0.05x 0.09x 0.04x - 0.10x 0.07x
out AR)
1
Debt to assets=total debt/total assets
2
Acid test ratio=(cash + marketable securities + AR)/current liabilities
*Insufficient data
19 Distributor Company Credit Memos: 2019–2021

Credit memo lines as a percent of total invoice 1.5% 1.8% 2.0% 2.4% 1.1% - 3.2% 2.9%
lines (%)
Credit memo dollars as a percent of net sales 2.0% 1.9% 1.8% 2.5% 2.0% - 2.7% 2.2%
Dollars per credit memo line ($) $438 $285 $318 $617 $183 - $472 $363

FINANCE
Administration
20 Due Diligence: 2021
Average
Due diligence practices used prior to opening a customer account
2021
Detailed application process 100.0%

Undertake a credit check 100.0%
Verify federal or state license 100.0%
On-site inspections 80.0%
Require an insurance/indemnity agreement 40.0%
Require an application fee 20.0%
Other 20.0%
21 Distributor Minimum Orders: 2021

Average
2021
Distributors with monthly minimum dollar volume to service a customer 40.0%

Distributors with a required minimum monthly dollar volume to qualify for a buy plan 1
40.0%
1
A buy plan is an internal financial analysis model for a given piece of business.
22 Distributor Chargeback Profile: 2019–2021

Chargebacks as a percent of net sales:
Total annual chargebacks (%) 31.8% 31.4% 34.4% 26.3% 18.4% - 30.4% 23.8%
Monthly chargebacks outstanding (%) 0.3% 0.3% 0.3% 0.4% 0.3% - 0.4% 0.4%
23 Frequency of Chargeback Submissions to Manufacturers: 2020–2021

Weighted Average
2020 2021
Daily 60.0% 60.0%

Weekly 20.0% 20.0%
Monthly 0.0% 0.0%
As received 0.0% 0.0%
Other 20.0% 20.0%

FINANCE
24 Chargebacks Denied: 2020–2021

2020 2021 Average Middle Range Median
Percent of chargebacks denied after initial submission 1.0% 0.8% 0.8% *-* 1.0%
NOTE: *Insufficient data.
25 Sales per Distributor: 2020–2021

2020 2021
Average Average Middle Range Median
Sales per square foot of warehouse $20,100 $21,329 $4,794 - $27,282 $23,659
Sales per invoice line $277 $291 $180 - $341 $293
26 Distributor Inventory Levels–Number of SKUs: 2020–2021

Number of SKUs Percent of Lines Picked
2020 2021 2021 2020 2021 2021

Avg. Avg. Median Avg. Avg. Median
Company Inventory
Prescription drugs — brand name 4,855 5,463 5,392 18% 17% 16%
Prescription drugs — brand name, specialty 909 833 420 2% 3% 1%
Prescription drugs — generic 15,902 15,858 18,263 53% 53% 51%
Prescription drugs — generic, specialty 915 974 36 2% 3% 0%
Prescription drugs — biosimilar 11 15 0 0% 0% 0%
Non-prescription drugs 8,121 7,621 7,289 18% 17% 16%
Health & personal care 6,274 6,139 5,465 2% 3% 1%
General merchandise 1,793 1,824 1,150 1% 1% 0%
Durable medical equipment & home healthcare 2,617 5,323 3,850 4% 4% 3%
Prescription drugs (total) 22,592 23,143 23,655 75% 76% 79%
Non-Rx health products (total) 18,805 20,907 17,619 25% 24% 21%
Overall Number of SKUs 41,397 44,050 41,274 100% 100% 100%
NOTE: Rounding differences may result in slight calculation variations.

FINANCE
TABLE 27 – Distributor Company Customer Ordering Practices
27 Distributor Company Customer Ordering Practices: 2021
Phone 2.2%
Fax 0.6%
Order entry systems & Online 97.2%
Other 0.0%
NOTE: Multiple responses allowed.

28 Distributor Personnel Productivity: 2020–2021

2020 2021
Weighted Weighted Average Middle Range Median

Average Average
Compensation as a percent of gross profit (%) 15.6% 17.2% 18.1% 14.8% - 18.4% 16.2%
Gross profit per employee ($000) $439 $449 $493 $334 - $620 $559
Compensation per employee ($000) $69 $77 $95 $87 - $99 $95
Contribution per employee ($000) $371 $371 $398 $262 - $521 $437
Sales per employee ($000) $23,447 $24,228 $19,685 $6,379 - $32,659 $19,533
Number of employees (#) 1,205 1,306 3,576 438 - 5,309 4,120
29 Base Salary Adjustments: 2021

Average Median
Base salary adjustments made in 2021

Executive employees 2.8% 3.0%
Full-time employees (manager) 2.8% 3.0%
Full-time employees (non-manager) 3.3% 3.0%
Part-time employees 2.8% 3.0%
Base salary adjustments anticipated for 2022
Executive employees 3.0% 3.0%
Full-time employees (manager) 3.0% 3.0%
Full-time employees (non-manager) 3.5% 3.3%
Part-time employees 2.9% 3.3%

INFORMATION SYSTEMS
Section Overview
The Information Systems section includes metrics on the use and adoption of Electronic Data Interchange
(EDI), barcoding, scanning profile, product serialization and electronic commerce (e-commerce).
Note the following clarifications:

Reported data (unless otherwise stated) reflect the industry profile. As in previous Factbook editions, data
are reported when appropriate for companies with less than $1 billion in revenue and are used to highlight
this segment’s behavior (e.g., tables showing distributors’ EDI and barcoding use).
Barcoding
Approximately 80 percent of distributors with more than $1 billion in sales scan barcode labels when
receiving product inbound from suppliers up from 56 percent in 2020.
• All distributors scan the NDC number when receiving product inbound from
suppliers (Table 30); and,
• All distributors scan barcodes received from manufacturers at the case level and item level (Table 31).
In 2021, all distributors reported the following reasons for capturing data through barcodes:
• Order checking; • Product receipt;
• Complying with FDA regulations; • Product shipment;
• Returned goods processing; • Stock movement; and,
• Picking; • Generating advanced shipment
• Stock put-away; notices (Table 32).
Eighty percent of distributors reported tracking product distribution by lot numbers. Federal regulatory/
legislative requirements were the main reason cited for tracking by lot numbers (Table 37).
EDI
All distributors with sales of less than $1 billion reported using the following transaction sets (Table 38):
• 810 Invoice; • 855 Purchase order acknowledgement;

• 832 Catalog; • 856 Advance ship notice; and,
• 844 Chargeback; • 997 Functional acknowledgements.
• 849 Chargeback/reconciliation;
• 850 Purchase order;
All distributors with sales of more than $1 billion reported using the following EDI transaction sets
in 2021 (Table 39):
• 810 Invoice; • 852 Product activity data;

• 820 Payment order/remittance advice; • 855 Purchase order acknowledgement;
• 832 Catalog; • 856 Advance ship notice;
• 844 Chargeback; • 867 Product transfer; and,
• 845 Bid award/change notification; • 997 Functional acknowledgements.
• 849 Chargeback/reconciliation;
• 850 Purchase order;
E-Commerce
All distributors reported using Internet EDI to assist in trading partner relationships.

INFORMATION SYSTEMS
Electronic Data Interchange (EDI)

30 Distributor Scanning Profile: 2021
Under $1 Billion in Sales Over $1 Billion in Sales
When receiving product inbound from suppliers, do you 55.6% 80.0%

receive the shipment by scanning barcode labels?
Barcoded information scanned when receiving product inbound from suppliers:
Quantity 20.0% 25.0%
NDC # 100.0% 100.0%
Serial # 60.0% 50.0%
Lot # 60.0% 75.0%
Expiration date 60.0% 50.0%
GTIN 60.0% 50.0%
Barcode symbologies captured:
Linear 100.0% 100.0%
EAN/UPC 80.0% 100.0%
GS1 128/Code 128 60.0% 75.0%
Interleaved 2 of 5 (ITF-14) 40.0% 50.0%
Reduced Space Symbology (RSS)/GS1 DataBar 0.0% 25.0%
Two-dimensional symbology 80.0% 75.0%
GS1 Data Matrix/Data Matrix 80.0% 75.0%
GS1 Stacked Databar 20.0% 25.0%
Other 0.0% 0.0%

INFORMATION SYSTEMS
31 Barcoded Product Packaging: 2020–2021

2020 2021
Percent of product received from manufacturers barcoded at this packaging level

Pallet
Percent of pallets barcoded by manufacturers
Average * *
Median * *
Percent of distributors that scan barcodes at pallet level 66.7% 40.0%
Case
Percent of cases barcoded by manufacturers
Average 97.0% 73.8%
Median 98.0% 92.5%
Percent of distributors that scan barcodes at case level 100.0% 100.0%
Shelf Pack/Inner Pack
Percent of shelf packs/inner packs barcoded by manufacturers
Average * 35.0%
Median * 50.0%
Percent of distributors that scan barcodes at shelf pack/inner * 50.0%
pack level
Item Level (saleable unit)
Percent of saleable units barcoded by manufacturers
Average 96.8% 96.0%
Median 99.0% 99.5%
Percent of distributors that scan barcodes at item level 100.0% 100.0%

INFORMATION SYSTEMS
32 Distributor Purposes for Data Capture Through Barcoding: 2020–2021

2020 2021
Purposes for capturing data through barcodes:

Order checking 100.0% 100.0%
Complying with FDA regulations (DSCSA) 100.0% 100.0%
Returned goods processing 100.0% 100.0%
Picking 100.0% 100.0%
Stock put-away 100.0% 100.0%
Product receipt 100.0% 100.0%
Product shipment 80.0% 100.0%
Stock movement (secondary to primary locations) 100.0% 100.0%
Generating advanced shipment notices (ASN) 80.0% 100.0%
Cycle counting 80.0% 80.0%
Product tracing (history/tracking) 20.0% 80.0%
Recalls 60.0% 60.0%
Checking lot numbers 60.0% 60.0%
Checking expiration dates 60.0% 60.0%
Checking serial numbers 40.0% 60.0%
Complying with customer demand 40.0% 40.0%
Establishing package quantity 40.0% 40.0%
Other 0.0% 0.0%
33 Unreadable Barcodes: 2020–2021

2020 2021
Percent of barcodes received inbound from manufacturers' shipping cases that are unreadable on first scan
Average 3.2% 5.6%
Median 2.0% 5.0%

INFORMATION SYSTEMS
34 Distributor Serialization Activity: 2020–2021

2020 2021
Scan serialized product received from manufacturers?

2D Barcodes
Yes – Pilot program 40.0% 80.0%
Yes – Production 60.0% 40.0%
No – Receive but don't use serialization 40.0% 20.0%
No – Not applicable 0.0% 0.0%
If "no" or "not applicable" is company planning to scan 2D barcodes on serialized product in the future?
Yes, within 6 months * *
No current plans * *
35 Distributor Serialization Profile: 2020–2021

2020 2021
Number of SKUs received inbound from manufacturers with * 15,420

product identifier encoded in 2D barcodes:
Percent of SKUs received inbound from manufacturers with 74.4% 83.4%
product identifier encoded in 2D barcodes:
Packaging level used to scan 2D barcodes:
Case level 100.0% 100.0%
Shelf pack/inner pack 0.0% 75.0%
Item level 100.0% 100.0%
36 Lot Number Tracking: 2021

Majority of Sales Full Line Distributors
from Generic
Products < $1 Billion > $1 Billion
Does your company track any distribution of product by lot numbers?

Yes 100.0% 100.0% 80.0%
No 0.0% 0.0% 20.0%

INFORMATION SYSTEMS
37 Lot Number Tracking by Functional Area: 2021

2021
Does your company track any distribution of product by lot numbers?

Yes 80.0%
No 20.0%
For each functional area, select if your company records lot number and/or serialized identifiers.
Receiving from vendor
Track by lot # 100.0%
Track by unique serialized identifiers 50.0%
Internal stock transfer
Put away
Track by lot # *
Track by unique serialized identifiers *
Picking
Shipping to customer
Returns from customer
Returns to manufacturers
Recalled products to manufacturers
For what reason(s) does your company record/track by lot numbers? (Multiple responses allowed)
Federal regulatory/legislation requirements 100.0%
Company directed requirements 75.0%
Contractual obligations 75.0%
Operational effectiveness 75.0%
State regulatory requirements 25.0%
Supply forecasting 0.0%
Demand forecasting 0.0%
Other 0.0%

INFORMATION SYSTEMS
Distributor Electronic Data Interchange Transaction Set Use

38
(Sales Under $1 Billion): 2021
Of those not using the
Of those using the EDI set, percentage using EDI set, plan to use in
with each trading partner the future
Exchange
Exchange Exchange Plan to No current
Currently with
EDI transaction set with with use in next plans
using 3rd party
manufacturers customers 12 months to use
processor
180 Return merchandise 0.0% * * * 0.0% 100.0%

authorization notification
810 Invoice 100.0% 77.8% 77.8% 11.1% * *
812 Credit/debit adjustment 25.0% * * * 16.7% 83.3%
816 Organizational relationships 0.0% * * * 0.0% 100.0%
820 Payment order/remittance advice 50.0% 75.0% 50.0% 75.0% 25.0% 75.0%
832 Catalog 100.0% 0.0% 88.9% 0.0% * *
836 Procurement notices 0.0% * * * 0.0% 100.0%
840 Request for quotation 0.0% * * * 0.0% 100.0%
843 Response to request for quotation 0.0% * * * 0.0% 100.0%
844 Chargeback 100.0% 88.9% 0.0% 0.0% * *
845 Bid award/change notification 87.5% 100.0% 0.0% 14.3% * *
846 Inventory inquiry/advice 14.3% * * * 16.7% 83.3%
849 Chargeback/reconciliation 100.0% 88.9% 0.0% 0.0% * *
850 Purchase order 100.0% 88.9% 88.9% 11.1% * *
852 Product activity data 87.5% 100.0% 0.0% 0.0% * *
855 Purchase order acknowledgement 100.0% 44.4% 88.9% 0.0% * *
856 Advance ship notice (ASN) 100.0% 88.9% 77.8% 0.0% * *
857 Shipment billing notice 11.1% * * * 0.0% 100.0%
861 Receiving advice/ 0.0% * * * 0.0% 100.0%
acceptance certificate
867 Product transfer 87.5% 100.0% 0.0% 28.6% * *
889 Promotion announcement 0.0% * * * 0.0% 100.0%
943 Warehouse stock transfer 0.0% * * * 0.0% 100.0%
shipment advice
997 Functional acknowledgement 100.0% 100.0% 62.5% 37.5% * *

INFORMATION SYSTEMS
Distributor Electronic Data Interchange Transaction Set Use

39
(Sales Over $1 Billion): 2021
Of those not using the
Of those using the EDI set, percentage using EDI set, plan to use in
with each trading partner the future
Exchange
Exchange Exchange Plan to use No current
Currently with
EDI transaction set with with in next plans
using 3rd party
manufacturers customers 12 months to use
processor
180 Return merchandise 80.0% 0.0% 100.0% 25.0% * *

authorization notification
810 Invoice 100.0% 100.0% 100.0% 40.0% * *
812 Credit/debit adjustment 80.0% 25.0% 100.0% 25.0% * *
816 Organizational relationships 50.0% * * * * *
820 Payment order/ 100.0% 60.0% 60.0% 40.0% * *
remittance advice
832 Catalog 100.0% 40.0% 80.0% 20.0% * *
836 Procurement notices 0.0% * * * 0.0% 100.0%
840 Request for quotation 0.0% * * * 0.0% 100.0%
843 Response to request 0.0% * * * 0.0% 100.0%
for quotation
844 Chargeback 100.0% 100.0% 20.0% 40.0% * *
845 Bid award/change notification 100.0% 100.0% 40.0% 20.0% * *
846 Inventory inquiry/advice 75.0% 0.0% 100.0% 0.0% * *
849 Chargeback/reconciliation 100.0% 100.0% 20.0% 20.0% * *
850 Purchase order 100.0% 100.0% 100.0% 60.0% * *
852 Product activity data 100.0% 100.0% 20.0% 40.0% * *
855 Purchase order 100.0% 60.0% 100.0% 60.0% * *
acknowledgement
856 Advance ship notice (ASN) 100.0% 100.0% 100.0% 40.0% * *
857 Shipment billing notice 40.0% * * * 33.3% 66.7%
861 Receiving advice/ 75.0% 66.7% 66.7% 0.0% * *
acceptance certificate
867 Product transfer 100.0% 80.0% 40.0% 40.0% * *
889 Promotion announcement 0.0% * * * 20.0% 80.0%
943 Warehouse stock transfer 40.0% * * * 0.0% 100.0%
shipment advice
997 Functional acknowledgement 100.0% 100.0% 80.0% 60.0% * *

INFORMATION SYSTEMS
Distributor EDI Use in Support of DEA Controlled Substances Ordering

40
System (CSOS): 2020–2021
2020 2021
Does this company use EDI transaction sets to support DEA’s CSOS?
Yes, with vendors only 0.0% 0.0%
Yes, with customers only 0.0% 20.0%
Yes, with vendors and customers 100.0% 80.0%
No, do not use EDI transaction sets to support CSOS 0.0% 0.0%
Of customers ordering controlled substances, percentage using DEA’s CSOS
Average 86.1% 88.1%
Median 90.0% 90.0%
Average percent of company’s EDI transactions that require 11.3% 29.5%
DEA CSOS?
Average percent of DEA order forms that are submitted 87.8% 91.8%
using CSOS?
41 Distributor Status of Electronic Commerce Initiatives: 2020–2021

Currently Using
2020 2021
Technology
Internet EDI 100.0% 100.0%
Media conversion services 60.0% 66.7%
Online catalogs & databases 75.0% 66.7%
Processes
Distributor service agreements/fee for service agreements 75.0% *
Electronic contract administration * *
Returned goods processing * *
Scorecarding 66.7% *
Vendor managed inventory (VMI) * *
Inventory management agreements (IMA) 50.0% *
Collaborative planning forecasting & replenishment (CPFR) * *

INFORMATION SYSTEMS
42 Product Identification Numbers: 2021

855 Purchase
Types of Product Identification Numbers in Use, 810 850 Purchase Order 856 ASN/
by Transaction Set Invoice Order Acknowledgement Manifest
GTIN 20.0% 40.0% 20.0% 40.0%

NDC 100.0% 100.0% 100.0% 100.0%
Catalog number 100.0% 100.0% 100.0% 100.0%
Other 20.0% 20.0% 20.0% 0.0%
43 DSCSA Compliance: 2021

Exchanging transaction information/history/ Customized Blockchain
statement with trading partners to support EDI/ASN EPCIS Software Paper Technology Other
compliance with DSCSA Solution
Exchange with upstream supplier 100.0% 80.0% 20.0% 20.0% 0.0% 0.0%
Exchange with downstream customer 80.0% 40.0% 40.0% 40.0% 20.0% 20.0%

INFORMATION SYSTEMS
44 Distributor Customer Location Identifiers Profile: 2020–2021

2020 2021
Currently using customer location numbers 100.0% 100.0%

Type of location identifier used with the following customers:
Pharmacies (chain or independent)
Company's own proprietary numbering 100.0% 100.0%
Global Location Number (GLN) 60.0% 60.0%
DEA registration number 80.0% 60.0%
Health Industry Number (HIN) 60.0% 40.0%
DUNS+4 20.0% 40.0%
Data Universal Numbering System (DUNS) 40.0% 20.0%
Other 0.0% 0.0%
Not Applicable 0.0% 0.0%
Hospitals & HMOs
DUNS+4 0.0% 20.0%
Other 0.0% 0.0%
Clinics
DUNS+4 0.0% 0.0%
Other 0.0% 0.0%

INFORMATION SYSTEMS
44 Distributor Customer Location Identifiers Profile: 2020–2021

2020 2021
Physicians/physicians offices
DUNS+4 0.0% 0.0%
Other 0.0% 0.0%
Mail Order
DUNS+4 0.0% 0.0%
Other 0.0% 0.0%
Other Distributors
DUNS+4 0.0% 0.0%
Other 0.0% 0.0%

OPERATIONS
Section Overview
The Operations section includes information on supply chain management agreements, product picking,
order value, order fulfillment, employee productivity, special handling conditions, distributor returns
volume, recalls and expenses. New to this chapter are data regarding reasons goods are returned to
manufacturers. Note: data are reported at the corporate level.
Returns
Total annual costs associated with the returns process averaged $4.4 million per company in 2021, a
decrease from $5.6 million in 2020 (Table 47). Among other reasons, customers returned products to
distributors because:
• Products were overstocked (66 percent);

• Products were damaged (20.8 percent); and,
• Products were mis-shipped (4.6 percent) (Table 50).
All participating distributors accept returns of saleable controlled-temperature products from customers.
All used third-party processors/reverse distributors to process returns required by manufacturer policy
and law, and 80 percent used third-party processors/reverse distributors for their company’s own returns
and recalls (Table 49).
Products Requiring Special Handling

Most distributors handle and stock prescription SKUs that require special handling, including those that
are temperature sensitive, controlled substances or hazardous products. Among SKUs that required
special handling in 2021, controlled substances accounted for 38 percent and generic products
comprised 66.1 percent (Table 55).
All companies stock cold chain SKUs. On average, 5 percent of prescription SKUs required cold chain
handling (Table 56).
On average, distributors stocked 10,628 non-prescription drug SKUs in 2021 (Table 58), 6,456 health
and personal care SKUs (Table 60), 1,884 durable medical equipment (DME) SKUs (Table 61) and 1,609
general merchandise SKUs (Table 62).
Distributor Order Characteristics

The average number of units picked per day per distribution center was 108,173 in 2021, compared to
104,030 in 2020. Distribution centers handled an average of 4,304 orders per day, with an average of 11
lines per order and 65.7 percent of distributors used automated picking methods (Table 65).
Table 68 highlights distributor product delivery methods, including those made by:
• Contract couriers/carriers (95.4 percent);

• Common air carriers (UPS Air, FedEx, etc.) (2.5 percent);
• Common surface carriers (UPS, U.S. Postal Service, etc.) (1.5 percent); and,
• Company-operated vehicles (0.7 percent).

OPERATIONS
45 Distributor Supply Chain Management Agreements: 2019–2021

2019 2020 2021
Suppliers (%)
Collaborative planning forecasting & replenishment (frequent product 80.0% 80.0% 100.0%
replenishment based on actual/forecasted demand)
Inventory management agreements (IMAs) 100.0% 100.0% 80.0%
Distributor service agreements (if separate from IMAs) 100.0% 100.0% 100.0%
Vendor managed inventory (VMI) (i.e., replenishment managed by supplier based 20.0% 20.0% 20.0%
on agreement with trading partner)
Consignment—(i.e., Inventory owned by supplier to point of final customer sale) 20.0% 20.0% 0.0%
Other 0.0% 20.0% 0.0%
None 0.0% 0.0% 0.0%
Customers (%)
Collaborative planning forecasting & replenishment (frequent product 80.0% 80.0% 100.0%
replenishment based on actual/forecasted demand)
Consignment 20.0% 20.0% 20.0%
Vendor managed inventory (VMI) (i.e., replenishment managed by supplier based 20.0% 20.0% 20.0%
on agreement with trading partner)
Other 0.0% 0.0% 0.0%
None 20.0% 20.0% 0.0%
46 Distributor Software Applications: 2019–2021

2019 2020 2021
Warehouse Management Systems (WMS)

Non-proprietary 40% 40% 40%
Proprietary 80% 80% 80%
Do not use 0% 0% 0%
Inventory Management Systems (IMS)
Do not use 0% 0% 0%
Transportation Management Systems (TMS)
Do not use 40% 40% 40%
Supply Chain Event Management (SCEM)
Do not use 60% 60% 40%

OPERATIONS
47 Returns: 2019–2021
2019 2020 2021
Total dollar value of returns per employee associated with the returns process
Average $17,247,410 $16,865,789 $14,955,700
Median $18,378,494 $19,063,375 $16,868,629
Total annual costs associated with the returns process
Average $5,063,053 $5,570,701 $4,447,350
Median $5,943,434 $6,766,413 $3,282,097
Number of personnel (FTEs) associated with the returns process
Average 63.2 70.4 71.2
Median 87.0 81.0 82.0
Number of personnel associated with returns process as % of total FTEs
Average 3% 3% 3%
Median 2% 2% 2%
What is the recover rate on unsaleable returns?
Average 94.9% 93.3% 90.7%
Median 97.0% 96.9% 93.5%
What is the percentage of saleable returns to gross sales?
Average 1.1% 1.0% 0.8%
Median 1.0% 1.0% 1.0%

OPERATIONS
48 Returns from Customers to Distributors: 2019–2021

2019 2020 2021
Percent of returned product that is saleable

Rx
Average 90% 86% 84%
Median 95% 95% 93%
Non-Rx
Average 78% 80% 83%
Median 89% 88% 91%
Cost of processing returned goods as a percent of total dollar value of returns
Average 0.4% 0.5% 0.6%
Median 0.5% 0.4% 0.5%
Percent of returned goods pieces that were controlled substances
Rx
Average 2.5% 4.0% 2.3%
Median 2.6% 3.8% 2.2%
Non-Rx
Average 0.0% 0.0% 0.0%
Median 0.0% 0.0% 0.0%
49 Returned Goods Practices for Distributors: 2019–2021

2019 2020 2021
Accepts returns of saleable controlled temperature products 100.0% 100.0% 100.0%

from customers
Accepts returns of repacks from customers 40.0% 20.0% 20.0%
Accepts partial product returns for credit (even conditionally) 40.0% 20.0% 20.0%
Use a 3rd party processor/reverse distributor to process (receive, sort, check policy, etc.) returned goods for:
Company's own returns 80.0% 80.0% 80.0%
Recalls 80.0% 80.0% 80.0%
Returns required by manufacturer policy 100.0% 100.0% 100.0%
Returns required by law 100.0% 100.0% 100.0%
Other * * *

OPERATIONS
50 Reasons Goods are Returned to Distributors: 2019–2021

2019 2020 2021
Overstocked 90.4% 73.7% 66.0%

Damaged 1.5% 18.7% 20.8%
Mis-shipped 1.2% 0.7% 4.6%
Partials 0.0% 0.0% 2.0%
Outdated 1.4% 1.5% 1.8%
Recalls 0.3% 0.2% 1.2%
Short Dated 0.6% 0.9% 1.0%
Discontinued 0.0% 0.0% 0.2%
Promotional 0.0% 0.0% 0.0%
Repackaged 0.0% 0.0% 0.0%
Other 4.7% 4.2% 2.4%
51 Reasons Goods are Returned to Manufacturers: 2020–2021

2020 2021
Overstocked 63.3% 39.5%

Outdated 11.3% 34.6%
Damaged 26.7% 9.5%
Discontinued 0.3% 3.2%
Short Dated 0.0% 2.6%
Recalls 0.5% 2.3%
Mis-shipped 0.8% 1.2%
Promotional 0.0% 0.4%
Other 0.0% 7.1%
Recalled/Withdrawn Prescription Products Handled by Distributors:

52
2019–2021
2019 2020 2021
Number of recall events processed

Average 225 189 188
Median 284 184 184
Total dollar value of returned products as % of total sales
Average 2.5% 2.5% 1.8%
Median 2.0% 1.9% 1.8%

OPERATIONS
53 Number of Manufacturers/Suppliers: 2019–2021

Number of manufacturers/suppliers you purchase from 2019 2020 2021
Median 1,100 1,089 1,049

Average 1,417 1,469 1,350
75th Percentile 1,998 1,839 1,188
25th Percentile 785 780 738
54 Distributor Human Resources: 2021

Full-Line Distributors
Sales Under $1 Billion Sales Over $1 Billion
Number of work shifts typically used in warehouse facilities 2.7 2.0

Employee turnover rate:
Day shift 6.4% 23.3%
Night shift 7.0% 27.3%
Weighted Average
Pay incentives offered to non-exempt, full-tme warehouse employees:

Yearly bonus 36.3%
Paid for performance 97.1%
Shift differential 95.1%
Other 8.8%
Do not offer 0.0%

OPERATIONS
Companies Handling Temperature-Sensitive, Controlled Substances and

55
Hazardous Prescription SKUs: 2020–2021
Weighted Average
2020 2021
Companies that stock Rx SKUs requiring special handling 98.1% 98.0%

Percent of all Rx SKUs requiring special handling 13.3% 15.2%
Number of Rx SKUs that require special handling 1,472 1,706
Percent of special handling Rx SKUs that are controlled substances (%) 38.8% 38.0%
Percent of special handling Rx SKUs that are generic products (%) 60.2% 66.1%
56 Cold Chain Distribution: 2020–2021

2020 2021
Companies that stock cold chain SKUs: (%) 100.0% 100.0%

Percent of Rx SKUs that require cold chain handling (%)
Average 4.4% 5.0%
Median 4.1% 4.0%
Company monitors the temperature of cold chain products in transit 40.0% 40.0%
Company records the temperature of cold chain products in transit 20.0% 0.0%
Number of full-time employees (FTEs) associated with cold chain distribution (#)
Average 3.4 3.0
Median 3.0 3.0

OPERATIONS
57 Special Handling Rx SKUs: Branded & Generic: 2020–2021

Weighted Average
2020 2021
Branded Special Handling Rx SKUs (%)

Controlled substances - DEA schedule II 1.5% 1.9%
Controlled substances - DEA schedule III, IV and V 1.6% 1.9%
Temperature-sensitive products - Rx 3.7% 5.5%
Hazardous products - Rx 1.6% 1.5%
Specialty products (not listed elsewhere) 1.2% 1.1%
Other 0.0% 6.5%
Total Rx SKUs comprised of these products 9.6% 18.4%
Generic Special Handling Rx SKUs (%)
Controlled substances - DEA schedule II 3.7% 4.0%
Controlled substances - DEA schedule III, IV and V 4.1% 4.3%
Temperature-sensitive products - Rx 1.5% 1.5%
Hazardous products - Rx 3.1% 3.1%
Specialty products (not listed elsewhere) 0.9% 1.1%
Other 0.1% 8.7%
Total Rx SKUs comprised of these products 13.3% 22.7%
58 Over-the-Counter (OTC) Medicines: 2021

2021
Non-prescription drug SKUs

Average 10,628
Median 8,634
What approximate percent of all your OTC SKUs goes to an inpatient setting?
Average 38.5%
Median 38.5%

OPERATIONS
Distributors Handling Temperature-Sensitive, Controlled Substances and

59
Hazardous Over-the-Counter (OTC) SKUs: 2020–2021
2020 2021
Companies that stock OTC SKUs requiring special handling (%) 100% 100%
Special Handling OTC SKUs:
Hazardous products
Average 296.0 265.2
Median 149.0 180.0
DEA listed chemicals
Average 47.4 103.0
Median 15.0 52.0
Temperature-sensitive products
Average 25.2 29.8
Median 21.0 31.0
Other
Average 0.0 0.0
Median 0.0 0.0
Total OTC SKUs comprised of these products
Average 368.6 398.0
Median 185.0 266.0
60 Health and Personal Care (HPC) Items: 2021

2021
Number of HPC SKUs

Average 6,456
Median 5,012
Companies that stock HPC SKUs requiring special handling (%) 40.0%
Percent of HPC SKUs that require special handling
Average *
Median *
Number of HPC SKUs that require special handling
Average *
Median *

OPERATIONS
61 Durable Medical Equipment (DME) and Home Healthcare: 2021

2021
Number of DME SKUs

Average 1,884
Median 1,987
Companies that stock DME SKUs requiring special handling/conditions (%) 0.0%
62 General Merchandise (GM): 2021

2021
Number of GM SKUs
Average 1,609
Median 1,750
Companies that stock GM SKUs requiring special handling (%) 20.0%
Percent of GM SKUs that require special handling
Average *
Median *
Number of GM SKUs that require special handling
Average *
Median *
Note: *Insufficient Data
63 Distributor Specialty Products: 2021

2021
Company stocks Rx specialty product SKUs (%) 80.0%

Percent of all company’s Rx SKUs that are considered specialty products
Average 4.0%
Median 2.9%

OPERATIONS
64 Distributor Other Product Categories: 2021

Companies that stock these product categories 2021
Veterinary products 20.0%

Dental products 20.0%
Company stocks PPE? (i.e., masks, gowns, gloves, shoe coverings, face 80.0%
coverings etc.)
Company's total number of PPE SKUs
Average 122
Median 110
65 Distributor Order Characteristics: 2020–2021

Weighted Average
2020 2021
Number of units picked per day per distribution center 104,030 108,173
Number of orders per day (#) per distribution center 4,234 4,304
Number of lines per order (#) 10.5 10.7
Invoice lines picked per day per distribution center 44,705 46,103
Handling cost per invoice line1 $3.67 $3.78
Number of units picked per invoice line 2.3 2.3
Percent of companies using automated picking methods: (%) 65.1% 65.7%
Of those using automation, percent of invoice lines picked by 45.6% 46.0%
automated methods
1
An outlying response has consistently been removed from the sample.
NOTE: Business days equal 252 to 254 days/year (non-holiday, non-weekend), depending on year.
66 Order Fulfillment: 2021

2021
Average "raw order" fill rate (% of invoice lines) 93.0%

Reason for inability to ship (as % of invoice lines):
Manufacturer unable to ship 78.4%
Distributor out of stock 21.6%
Average fill rate (% of sales) 95.8%
Reason for inability to ship (as % of sales):
Manufacturer unable to ship 77.1%
Distributor out of stock 22.9%

OPERATIONS
67 Customer Accounts and Shipping Points Serviced by Company: 2021

2021
Number of active customer accounts served by company per distribution center

Average 1,411
Median 600
Customer shipping points serviced by company per distribution center
Average 1,118
Median 1,072
68 Distributor Product Delivery Methods: 2020–2021

Percent of deliveries made by: 2020 2021
Contract couriers/carriers 94.8% 95.4%

Common air carriers (UPS Air, FedEx, etc.) 2.5% 2.5%
Common surface carriers (UPS, U.S. Postal Service, etc.) 2.3% 1.5%
Company operated vehicles 0.4% 0.7%
Other 0.0% 0.0%
69 Deliveries per Week of Prescription Products: 2021

Deliveries per week: 2021
1 day/week 5.5%
2 days/week 2.2%
3 days/week 1.7%
4 days/week 1.8%
5 days/week 81.8%
6 days/week 3.2%
7 days/week 0.1%
More than 7 days/week 3.6%

HEALTHCARE PRODUCTS
Section Overview
The Healthcare Products section includes information on therapeutic, branded and generic pharmaceutical
products’ market share, sales, prescriptions, price and growth. This section also includes information on
brand patent expirations, drug approvals and drug shortages. In addition, sales information is available for
over-the-counter (OTC) and supplement healthcare products.
In 2021, pharmaceutical sales for the top 20 therapeutic classes increased slightly to 83.9 percent,
accounting for $485.6 billion of the total market. Immunology products took first place, growing by
19 percent with sales of $91.8 billion in 2021, up from $77.2 billion in 2020. The diabetes therapy class
was second and grew by 15.9 percent, with sales of $86 billion (Table 70).
The top 20 therapeutic classes ranked by prescriptions accounted for 87.1 percent of the total market
in 2021. The top three therapeutic classes by prescriptions remained the same in 2021, with the highest
number of prescriptions, 636.7 million, written for antihypertensive medications; followed by 411.8
million for mental health medications; and 370.3 million for pain medications (Table 71).
In 2021, the market share of U.S. pharmaceuticals by prescription volume was again dominated by
unbranded generic drugs, which made up 82.9 percent of prescriptions. The percent of prescriptions for
branded generics fell slightly in 2021, accounting for 3.2 percent (Table 72).
The top 20 biologic products by U.S. sales reached $163.8 billion in 2021. Of those products, Humira®,
a tumor necrosis factor (TNF) blocker, grew by 14 percent, with sales of $28.2 billion.
• Eliquis® was second with $15.9 billion in sales; followed by,

• Trulicity®, with $12.2 billion in sales (Table 75).
Non-Prescription Products
The top-ranked OTC category in 2021 was upper respiratory products, with sales of $9.2 billion,
followed by internal analgesics, with sales of $4.6 billion (Table 78).
New Medications
In 2021, the FDA approved 50 novel drugs, down from 53 in 2020 (Table 86).

HEALTHCARE PRODUCTS
70 Top 20 Therapeutic Classes by Non-Discounted Spending: 2021

Rank Therapy Class 2020 ($ bil) 2021 ($ bil) Market Share Growth
1 Immunology $77.2 $91.8 15.9% 19.0%

2 Antidiabetics $74.1 $86.0 14.8% 15.9%
3 Oncologics $72.9 $79.4 13.7% 8.9%
4 Respiratory agents $31.4 $32.1 5.5% 2.0%
5 Antithrombotics $23.2 $26.8 4.6% 15.1%
6 HIV antivirals $26.4 $26.0 4.5% -1.5%
7 Mental health $17.9 $18.6 3.2% 4.0%
8 Pain $16.2 $17.6 3.0% 8.5%
9 Multiple sclerosis $18.1 $16.8 2.9% -7.1%
10 Vaccines (pure, comb, other) $13.4 $12.9 2.2% -3.9%
11 Other cardiovasculars $10.3 $11.0 1.9% 7.3%
12 Nervous system disorders $9.2 $9.5 1.6% 2.9%
13 GI Products $8.9 $9.2 1.6% 3.6%
14 ADHD $8.7 $9.1 1.6% 4.7%
15 Antihypertensives,
$8.5 $8.5 1.5% 0.6%
plain & combo
16 Other CNS $7.8 $7.6 1.3% -2.5%
17 Dermatologics $6.7 $6.3 1.1% -5.5%
18 Ophthalmology, general $5.9 $5.8 1.0% -1.6%
19 Polyval immunoglobulins IV&IM $5.0 $5.4 0.9% 6.6%
20 Sex hormones (androgens,
$5.0 $5.4 0.9% 6.4%
oestrogens, progestogens)
Total top 20 $446.8 $485.6 83.9% 8.7%
Total market $537.3 $578.9 100.0% 7.7%
NOTE: Limited to Rx and OTC Insulins.
Autoimmune Diseases now reflected in Immunology
Source: IQVIA, National Sales Perspectives, April 2022

HEALTHCARE PRODUCTS
71 Top 20 Therapeutic Classes by Prescriptions: 2021

2020 Prescriptions 2020 Market 2021 Prescriptions 2021 Market
Rank Therapy Class Growth
(# mil) Share (# mil) Share
Antihypertensives,
1 652.0 15.9% 636.7 14.7% -2.4%
plain & combo
2 Mental health 402.8 9.8% 411.8 9.5% 2.3%
3 Pain 368.0 9.0% 370.3 8.5% 0.6%
Vaccines (pure,
4 68.5 1.7% 274.1 6.3% 300.4%
comb, other)
5 Lipid regulators 247.0 6.0% 251.3 5.8% 1.7%
6 Antidiabetics 217.2 5.3% 220.0 5.1% 1.3%
7 Antibacterials 197.0 4.8% 205.2 4.7% 4.2%
8 Nervous system disorders 196.3 4.8% 197.6 4.6% 0.7%
9 Other CNS 171.9 4.2% 172.5 4.0% 0.4%
10 Respiratory agents 176.0 4.3% 170.4 3.9% -3.2%
11 Anti-ulcerants 149.7 3.7% 153.1 3.5% 2.3%
Thyroid anti-thyroid
12 121.6 3.0% 118.0 2.7% -3.0%
and iodine preps
13 Dermatologics 110.0 2.7% 117.6 2.7% 6.9%
14 ADHD 94.8 2.3% 101.4 2.3% 6.9%
15 Antithrombotics 76.8 1.9% 76.9 1.8% 0.1%
Corticosteroids,
16 63.9 1.6% 70.4 1.6% 10.2%
plain & combo
Hormonal contraception,
17 71.7 1.7% 67.1 1.5% -6.4%
systemic & topical
18 Vitamins & minerals 65.8 1.6% 65.9 1.5% 0.2%
19 GI products 53.4 1.3% 56.3 1.3% 5.4%
BPH (benign
20 44.0 1.1% 44.6 1.0% 1.1%
prostatic hypertrophy)
Top 20 3,548.5 86.6% 3,781.3 87.1% 6.6%
Total U.S. market 4,097.4 100.0% 4,342.0 100.0% 6.0%
Source: IQVIA, National Prescription Audit, April 2022

HEALTHCARE PRODUCTS
72 Prescriptions and Spending by Product Type: 2015–2021

Prescriptions Spending
Year Unbranded Generics Branded Generics Brands Unbranded Generics Branded Generics Brands
2021 82.87% 3.17% 13.97% 9.53% 7.99% 82.48%

2020 86.65% 3.51% 9.84% 10.54% 8.24% 81.21%
2019 86.44% 3.75% 9.81% 11.04% 8.84% 80.13%
2018 85.58% 4.29% 10.12% 11.58% 9.71% 78.71%
2017 85.32% 4.61% 10.06% 13.02% 10.14% 76.84%
2016 84.06% 5.07% 10.87% 14.90% 10.34% 74.76%
2015 82.99% 5.40% 11.61% 16.07% 10.20% 73.74%
Source: IQVIA, National Prescription Audit, National Sales Perspectives, April 2022
73 Top 20 Medicines by Non-Discounted Spending: 2021

2020 Sales 2021 Sales
Rank Product Company Growth
($bil) ($bil)
1 Humira® AbbVie Inc. $24.8 $28.2 14.0%

2 Eliquis® Bristol-Myers Squibb $12.8 $15.8 23.5%
3 Trulicity ®
Lilly $8.7 $12.2 40.4%
4 Stelara ®
Janssen Pharm $8.3 $10.7 28.1%
5 Keytruda® Merck & Company $8.3 $9.9 18.9%
6 Biktarvy® Gilead Sciences $8.0 $9.6 19.0%
7 Ozempic ®
Novo Nordisk $5.1 $8.6 68.9%
8 Enbrel ®
Amgen Inc $7.8 $8.1 3.5%
9 Jardiance® Boehringer Ingelheim $5.7 $8.0 41.0%
10 Xarelto® Janssen Pharm $6.6 $7.1 7.7%
11 Januvia ®
Merck & Company $6.3 $6.4 2.5%
12 Dupixent ®
Sanofi Aventis Phr $3.6 $5.6 54.5%
13 Lantus Solostar® Sanofi Aventis Phr $4.6 $5.1 10.1%
14 Opdivo® Bristol-Myers Squibb $4.0 $4.2 7.0%
15 Imbruvica ®
Pharmacyclics, Inc $3.9 $4.2 8.9%
16 Ocrevus ®
Genentech, Inc. $3.5 $4.1 16.8%
17 Vyvanse® Takeda Pharm USA $3.8 $4.1 9.1%
18 Latuda® Sunovion $3.7 $4.0 7.5%
19 Taltz ®
Lilly $2.7 $4.0 47.1%
20 Farxiga ®
AstraZeneca $2.3 $3.7 62.2%

HEALTHCARE PRODUCTS
74 Top 20 Generic Medicines by Prescriptions: 2020–2021

2020 Prescriptions 2021 Prescriptions
Rank Product Growth
(#mil) (#mil)
1 Atorvastatin Calcium 121.3 125.3 3.3%

2 Amlodipine Besylate 89.3 90.1 0.9%
3 Lisinopril 92.2 88.4 -4.1%
4 Levothyroxine Sodium 87.4 83.4 -4.6%
5 Gabapentin 68.8 70.7 2.7%
6 Losartan Potassium 60.0 60.1 0.1%
7 Metformin HCL 59.1 58.2 -1.5%
8 Hycd/Apap 56.2 55.2 -1.7%
9 Omeprazole (Rx) 56.3 54.3 -3.5%
10 Sertraline HCL 51.9 53.6 3.2%
11 Metoprolol Succinate 49.5 50.8 2.8%
12 Albuterol HFA 39.0 45.7 17.1%
13 Hydrochlorothiazide 50.4 45.6 -9.5%
14 Pantoprazole Sodium 43.3 45.5 5.1%
15 Escitalopram Oxalate 42.1 44.9 6.6%
16 Amoxicillin 39.9 43.6 9.1%
17 Prednisone 39.2 40.4 3.2%
18 Rosuvastatin Calcium 34.3 40.1 17.0%
19 Trazodone HCL 38.2 39.2 2.7%
20 Ibuprofen (Rx) 36.5 37.7 3.4%
Top 20 1,154.8 1,172.8 1.6%
Total Generics Market 3,695.0 3,736.5 1.1%
*Generic includes Unbranded Generic, Branded Generic and Other Rx (2-Way Rx Split between Brands and Generics)

HEALTHCARE PRODUCTS
75 Top 20 Biologic Medicines by U.S. Spending: 2021
2020 Sales 2020 Market 2021 Sales 2021 Market
Rank Product Company Growth
($ bil) Share ($ bil) Share
1 Humira® AbbVie Inc. $24.8 4.6% $28.2 4.9% 14.0%

2 Eliquis® Bristol-Myers Squibb $12.8 2.4% $15.9 2.7% 23.7%
3 Trulicity ®
Lilly $8.7 1.6% $12.2 2.1% 40.5%
4 Stelara ®
Janssen Pharm $8.3 1.5% $10.7 1.8% 28.2%
5 Keytruda® Merck & Company $8.3 1.5% $9.9 1.7% 18.9%
6 Biktarvy® Gilead Sciences $8.0 1.5% $9.6 1.7% 19.1%
7 Ozempic ®
Novo Nordisk $5.1 0.9% $8.6 1.5% 69.0%
8 Enbrel ®
Amgen Inc $7.8 1.5% $8.1 1.4% 3.5%
9 Jardiance® Boehringer Ingelheim $5.7 1.1% $8.0 1.4% 41.1%
10 Xarelto® Janssen Pharm $6.6 1.2% $7.2 1.2% 7.9%
11 Januvia ®
Merck & Company $6.3 1.2% $6.4 1.1% 2.6%
12 Dupixent ®
Sanofi Aventis Phr $3.6 0.7% $5.6 1.0% 54.5%
13 Lantus Solostar® Sanofi Aventis Phr $4.6 0.9% $5.1 0.9% 10.2%
14 Opdivo® Bristol-Myers Squibb $4.0 0.7% $4.2 0.7% 7.0%
15 Imbruvica ®
Pharmacyclics, Inc $3.9 0.7% $4.2 0.7% 8.9%
16 Ocrevus ®
Genentech, Inc. $3.5 0.7% $4.1 0.7% 16.9%
17 Vyvanse® Takeda Pharm USA $3.8 0.7% $4.1 0.7% 9.1%
18 Latuda® Sunovion $3.8 0.7% $4.0 0.7% 7.6%
19 Taltz ®
Lilly $2.7 0.5% $4.0 0.7% 47.2%
20 Farxiga ®
AstraZeneca $2.3 0.4% $3.7 0.6% 62.3%
Top 20 Biologic Products $134.5 25.5% $163.8 28.3% 21.8%
Total Biologic Market $537.3 100.0% $579.3 100.0% 7.8%
Source: IQVIA, National Sales Perspectives, May 2022

HEALTHCARE PRODUCTS
76a Small Molecule Patent Expirations: 2022

Brand Manufacturer Expiry Date
Selzentry GlaxoSmithKline Feb 2022

Abraxane Celgene Corp Mar 2022
Myrbetriq Astellas Pharma Mar 2022
Vimpat UCB Mar 2022
Spiriva Handihaler Boehringer Ingelheim Apr 2022
Teflaro Allergan Apr 2022
Pradaxa Boehringer Ingelheim Jun 2022

Iressa AstraZeneca Jul 2022
Serevent Diskus GlaxoSmithKline Nov 2022
Zioptan Akorn Dec 2022
76b Small Molecule Patent Expirations: 2023
Savella Allergan Jan 2023

Toviaz Pfizer Jan 2023
Mozobil Sanofi Jul 2023
76c Small Molecule Patent Expirations: 2024
Duavee Pfizer May 2024

Radicava Mitsubishi Tanabe May 2024
Bepreve Valeant Pharma Sep 2024
76d Small Molecule Patent Expirations: 2025
Ixempra R-Pharm US LLC Feb 2025

Juxtapid Novelion Mar 2025
Pomalyst Celgene Corp Jun 2025
Farxiga AstraZeneca Oct 2025
76e Small Molecule Patent Expirations: 2026
Bridion Merck & Co Jan 2026

Briviact UCB Feb 2026
Natazia Bayer May 2026
Vyndaqel Pfizer May 2026
Fycompa Eisai Jul 2026
Tekturna Noden Pharma USA Aug 2026
Avonex Biogen Sep 2026
Sensipar Amgen Sep 2026
Eliquis Bristol-Myers Squibb Nov 2026

HEALTHCARE PRODUCTS
76f Small Molecule Patent Expirations: 2027

Nevanac Novartis Jan 2027

Gilenya Novartis Jun 2027
Fanapt Vanda Pharm Nov 2027
Yondelis Johnson & Johnson Nov 2027
Esbriet Genentech, inc. Dec 2027
76g Small Molecule Patent Expirations: 2028
Symproic BioDelivery Sci Jan 2028

Xifaxan Salix Pharmaceuticals Jan 2028
Alvesco Covis Pharma Feb 2028
Otezla Amgen Inc Feb 2028
Harvoni Gilead Sciences Mar 2028
Viberzi Allergan Mar 2028
Intrarosa Millicent Pharma Aug 2028
Jardiance Boehringer Ingelheim Aug 2028
Enstilar Leo Pharmaceutical Sep 2028
Erivedge Genentech,Inc. Nov 2028
Velphoro Fresenius USA Nov 2028

HEALTHCARE PRODUCTS
76h Small Molecule Patent Expirations: 2029

Odomzo Sun Pharmaceutical Feb 2029

Zohydro Er Currax Pharma LLC Mar 2029
Ninlaro Millennium Pharm Jun 2029
Ofev Boehringer Ingelheim Jun 2029
Zelboraf Genentech,Inc. Jun 2029
Evotaz Bristol-Myers Squibb Sep 2029
Genvoya Gilead Sciences Sep 2029
Prezcobix Janssen Pharm Sep 2029
Stribild Gilead Sciences Sep 2029
Symtuza Janssen Pharm Sep 2029
Glyxambi Boehringer Ingelheim Oct 2029
Ingrezza Neurocrine Bio Oct 2029
Talzenna Pfizer Oct 2029
Travatan Z Novartis Vision Oct 2029
Vitrakvi Bayer Healthcare Oct 2029
Xalkori Pfizer Oct 2029
Belsomra Merck & Company Nov 2029
Verzenio Lilly Dec 2029

HEALTHCARE PRODUCTS
76i Small Molecule Patent Expirations: 2030

Tafinlar Novartis Rx Jan 2030

Copiktra Secura Bio Feb 2030
Entereg Merck & Company Feb 2030
Zejula GSK plc Mar 2030
Zorvolex Zyla Life Sciences Apr 2030
Bevespi Aerosphere AstraZeneca May 2030
Xigduo Xr AstraZeneca May 2030
Alecensa Genentech,Inc. Jun 2030
Aristada Alkermes Inc Jun 2030
Olumiant Lilly Jun 2030
Nexplanon Organon Jul 2030
Segluromet Merck & Company Jul 2030
Steglatro Merck & Company Jul 2030
Steglujan Merck & Company Jul 2030
Xospata Astellas Pharma US Jul 2030
Piqray Novartis Rx Sep 2030
Arnuity Ellipta GlaxoSmithKline Oct 2030
Jublia Bausch Health Oct 2030
Nubeqa Bayer Healthcare Oct 2030
Akynzeo Helsinn Therapeutics Nov 2030
Rocklatan Aerie Pharma Nov 2030
Neupro UCB Pharma Dec 2030
Relistor Salix Pharmaceuticals Dec 2030

HEALTHCARE PRODUCTS
76j Small Molecule Patent Expirations: 2031

Besivance Bausch Health Jan 2031

Dovato Viiv Healthcare Jan 2031
Invega Sustenna Janssen Pharm Jan 2031
Juluca Viiv Healthcare Jan 2031
Triumeq Viiv Healthcare Jan 2031
Kisqali Femara Novartis Rx Feb 2031
Nurtec Biohaven Pharma Feb 2031
Quillivant Xr Tris Pharm Feb 2031
Austedo Teva CNS Mar 2031
Braftovi Pfizer Mar 2031
Balversa Janssen Pharm Apr 2031
Jevtana Sanofi Aventis Phr Apr 2031
Orkambi Vertex Pharma Apr 2031
Spiriva Respimat Boehringer Ingelheim Apr 2031
Seysara Almirall May 2031
Zepatier Merck & Company May 2031
Ztlido Scilex Pharma May 2031
Multaq Sanofi Aventis Phr Jun 2031
Venclexta AbbVie Inc. Jun 2031
Vabomere Melinta Therapeut Aug 2031
Zilretta Flexion Therap Aug 2031
Dayvigo Eisai Inc Sep 2031
Uceris Salix Pharmaceuticals Sep 2031
Xofluza Genentech,Inc. Sep 2031
Cleviprex Chiesi USA, Inc Oct 2031
Pifeltro Merck & Company Oct 2031
Fetroja Shionogi USA Nov 2031
Qulipta AbbVie Inc. Nov 2031
Ubrelvy Allergan Nov 2031
Rhofade EPI Health Dec 2031
Rhopressa Aerie Pharma Dec 2031

HEALTHCARE PRODUCTS
76k Small Molecule Patent Expirations: 2032

Delstrigo Merck & Company Jan 2032

Sublocade Indivior PLC Jan 2032
Ilevro Novartis Vision Mar 2032
Veklury Gilead Sciences Mar 2032
Bijuva Therapeutics MD May 2032
Mavyret AbbVie Inc. May 2032
Calquence AstraZeneca Jul 2032
Aptiom Sumitomo Dainippon Aug 2032
Tagrisso AstraZeneca Aug 2032
Zubsolv Orexo AB Sep 2032
Epclusa Gilead Sciences Nov 2032
Sofosbuvir/Velpata Asegua Therapeutics Nov 2032
76l Small Molecule Patent Expirations: 2033
Idhifa Bristol-Myers Squibb Jan 2033

Tibsovo Servier Jan 2033
Qelbree Supernus Pharma Feb 2033
Lorbrena Pfizer Mar 2033
Trijardy Boehringer Ingelheim Mar 2033
Rinvoq AbbVie Inc. Aug 2033
Vumerity Biogen Idec Sep 2033
Biktarvy Gilead Sciences Dec 2033
Imvexxy Therapeutics MD Dec 2033
76m Small Molecule Patent Expirations: 2037
Nuplazid Acadia Pharma Mar 2037

NOTE: From 2018-2030, list includes small molecule brands with more than $15M in sales in MAT MAR 2018
From 2031-2033, list includes small molecule brands with more than $15M in sales in 2021
Source: IQVIA Institute, April 2022

HEALTHCARE PRODUCTS
Non-Prescription Products
77 Rx-to-OTC Switch List: 2013–2022
Approval
Drug Name NDA Purpose
Date
Oxytrol® for Women NDA 202211 Overactive bladder 1/25/2013

Nasacort® Allergy 24HR (nasal spray) NDA 020468/S-035 Allergic rhinitis 10/11/2013
Nexium 24 HR (esomeprazole
®
NDA 204655 Frequent heartburn 3/28/2014
magnesium)
Flonase® Allergy Relief (fluticasone NDA 205434 Allergic rhinitis 7/23/2014
proprionate)
Rhinocort Allergy Spray NDA 20476/S-032 Allergic rhinitis 3/23/2015
Differin Gel (adapalene), 0.1%
®
NDA 020380/S-010 Anti acne 7/18/2016
Flonase® Sensimist Allergy Relief NDA 022051/S-013 Allergic rhinitis 8/02/2016
(fluticasone furoate)
Xyzal Allergy 24HR (levocetirizine Allergic rhinitis and
NDA 209090 1/31/2017
dihydrochloride) solution perennial allergic rhinitis
Xyzal Allergy 24HR (levocetirizine Allergic rhinitis and
NDA 209089 1/31/2017
dihydrochloride) tablets perennial allergic rhinitis
January 1 through December 31, 2018 - there are no switches for this period of time.
January 1 through December 31, 2019 - there are no switches for this period of time.
Temporary relief of arthritis pain.
Voltaren Arthritis Pain (diclofenac Hand, wrist, elbow (upper body
NDA 22122/S-014 2/14/2020
sodium) areas). Foot, ankle, knee
(lower body areas)
Temporary relief of itchy and red eyes
Pataday Twice Daily Relief NDA 020688/S-032 due to pollen, ragweed, grass, animal 2/14/2020
(olopatadine hydrochloride, 0.1%) hair, or dander
Temporary relief of itchy eyes due to
Pataday Once Daily Relief NDA 021545/S-022 pollen, ragweed, grass, animal 2/14/2020
(olopatadine hydrochloride, 0.2%) hair, or dander
Temporary relief of itchy eyes due to
Pataday Once Daily Relief NDA 206276/S-005 pollen, ragweed, grass, animal hair, 7/13/2020
(olopatadine hydrochloride, 0.7%) or dander
Sklice (ivermectin) lotion, 0.5% NDA 202736/S-006 Treats head lice infestation 10/27/2020
Temporarily relieves these symptoms
Astepro Allergy and Children’s due to hay fever or other upper
Astepro Allergy (azelastine NDA 213872 respiratory allergies: nasal 6/17/21
hydrochloride) nasal spray, 0.15% congestion; runny nose; sneezing;
itchy nose
Temporarily relieves itchy eyes due
Lastacaft (alcaftadine ophthalmic NDA 022134/S-008 to pollen, ragweed, grass, animal hair 12/10/21
solution), 0.25% and dander
Temporarily relieves these symptoms
Nasonex 24HR Allergy (mometasone due to hay fever or other upper
furoate) nasal spray, 50 mcg/spray, NDA 215712 respiratory allergies: nasal 3/17/22
metered congestion; runny nose; sneezing;
itchy nose
Source: U.S. Food and Drug Administration
http://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDER/ucm106378.htm

HEALTHCARE PRODUCTS
78 Top 28 OTC Product Categories by Sales: 2021

OTC Category 2021 ($mil)
1 Upper respiratory $9,172

2 Analgesics, internal (includes other pain products) $4,640
3 Toothpaste $3,224
4 Antiperspirants $2,569
5 Heartburn $2,196
6 Laxatives $1,676
7 Oral antiseptics and rinses $1,636
8 First aid $1,516
9 Eye care $1,450
10 Suncare $1,409
11 Analgesics, external $1,286
12 Lip/oral treatment $1,216
13 Anti-smoking products $986
14 Female contraceptive $647
15 Hand sanitizer $563
16 Sleeping aid $437
17 Foot care $391
18 Multi-symptom GI $373
19 Feminine itch & yeast treatment $339
20 Antidiarrheals $321
21 Eczema & psoriasis $302
22 Acne $270
23 Hemorrhoid treatment $242
24 Gas relief $197
25 Hair growth product $120
26 Petroleum jelly $120
27 Motion sickness $112
28 Lice treatments $99
Total $37,509
NOTE: Sales are in millions of U.S. dollars. A few categories include a combination of OTC medicines as well as health-related products which are not
classified as medicines by the Food and Drug Administration.
https://www.chpa.org/about-consumer-healthcare/research-data/otc-use-statistics
Source: The Nielsen Company - total U.S. all outlets (food, drug, mass, select club and dollar store retailers, convenience and military stores)

HEALTHCARE PRODUCTS
New Medications
National Drug Shortages - New Shortages by Year
79 January 2001 to March 31, 2022
300
267
250
211 204
200 185 186
166 166
149 154 146
150 140 142
120 129 129
114
100 88
73 74 70
58
50 32
0
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22
Note:the
NOTE: Each column represents Each column
number represents
of new theidentified
shortages number during
of newthat
shortages
year identified during that year.
University of Utah Drug Information Service
Erin.Fox@hsc.utah.edu, @foxerinr
Source: University of Utah Drug Information Service
National Drug Shortages - New Shortages by Year

80 January 2001 to March 31, 2022, % Injectable
300
57% Column1
250 Injectable
63% 46% Non-injectable

200 45% 55%
45% 39%
55% 50% 45% 63% 58%
150 50%
73% 61% 66%
100 64%
52% 64% 60%
57%
50 66%
0
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22
Note: Each
NOTE: Each column represents thecolumn
numberrepresents the number
of new shortages ofduring
identified new shortages
that year. identified during that year.
University
Erin.Fox@hsc.utah.edu, @foxerinr of Utah Drug Information Service Erin.Fox@hsc.utah.edu, @foxerinr

HEALTHCARE PRODUCTS
81 National Drug Shortages - Active Shortages by Quarter

350
300 276 282 276

265 264 263 265 260 271
251 246 242
250 238 236
224 220
195 191 202
200 174 176 176 174 174 183
150
100
50
0
Q2 6
Q3 6
Q4 6
Q1 6
Q2 7
Q3 7
Q4 7
Q1 7
Q2 8
Q3 8
Q4 8
Q1 8
Q2 9
Q3 9
Q4 9
Q1 9
Q2 0
Q3 0
Q4 0
Q1 0
Q2 1
Q3 1
Q4 1
Q1 1
2
-1
-1
-1
-1
-1
-1
-1
-1
-1
-1
-1
-1
-1
-1
-1
-1
-2
-2
-2
-2
-2
-2
-2
-2
-2
Q1
Note: Each
NOTE: Each point represents point represents
the number the number
of active shortages of active
at the end of eachshortages
quarter. at the end of each quarter.
Erin.Fox@hsc.utah.edu, @foxerinr of Utah Drug Information Service
University
82 Active Shortages: Top 5 Drug Classes

Active Shortages March 31, 2022
40
Injectable
35 Non-injectable
30
25 17
16
20 31
11
15
10 10
15 16
5 12
4 6
0
Antimicrobials Cardiovascular CNS Fluids/Elytes Hormones
University of Utah Drug Information Service Erin.Fox@hsc.utah.edu, @foxerinr
NOTE: Active shortagesGreen
March=31, 2022
injectable, yellow = non-injectable

HEALTHCARE PRODUCTS
Common Drug Classes
in Short Supply – 5 Year Trend
83 Common Drug Classes in Short Supply: 2017–2021
60
50
40
30 2017
2018
20
2019
10 2020
0 2021
y
es
s
ic
ar
GI
S
NT
e
tic
CN
ap
on
m
ul
yt
EE
io
no
r
rm
sc
ol
he
tib
va
tr
to
Ho
ot
ec
An
io
Au
em
El
rd
Ca
Ch
University of Utah Drug Information Service

Erin.Fox@hsc.utah.edu,
Source: University of Utah @foxerinr
Drug Information Service
Reasons for Shortages as Reported by

Manufacturers DuringasUUDIS
Reasons for Shortages ReportedInvestigation
by Manufacturers
84 During UUDIS Investigation: 2021
2021
3% 2%
4%
42%
Unknown
22% Supply/Demand
Manufacturing
Business decision
Regulatory issue
Raw material issue
27%
University
Erin.Fox@hsc.utah.edu, @foxerinr of Utah Drug Information Service
Source: University ofErin.Fox@hsc.utah.edu,
Utah Drug Information Service
@foxerinr

HEALTHCARE PRODUCTS
85 The Drug Development Pipeline: 2016–2021

Clinical Phase 2016 2017 2018 2019 2020 2021
Phase I 1,279 1,534 1,788 2,052 1,976 1,796

Phase II 1,498 1,638 1,826 2,035 2,090 2,043
Phase III 585 665 745 819 824 883
Pre-registered/registered 266 298 320 314 357 313
NOTE: Drugs in the clinical stage of development are included in Phase I. Technology, diagnostic agents and other non-therapeutic agents are excluded.
Source: IQVIA Pipeline Intelligence, accessed 15 May 2022
86 Novel Drug Approvals Per Year: 2011–2021

59
53
45 50
46 48
39
41
30
27
22
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Source: The U.S. Food and Drug Administration

https://www.fda.gov/drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products/novel-drug-approvals-2021

HEALTHCARE PRODUCTS
87 Novel Approvals: 2021

Approval Approval
Name Active Ingredient Name Active Ingredient
Date Date
Adbry tralokinumab-ldrm 12/27/21 olanzapine and

Lybalvi 5/28/21
samidorphan
Leqvio inclisiran 12/22/21
Truseltiq infigratinib 5/28/21
Vyvgart efgartigimod alfa-fcab 12/17/21
Lumakras sotorasib 5/28/21
Tezspire tezepelumab-ekko 12/17/21
Pylarify piflufolastat F 18 5/26/21
Cytalux pafolacianine 11/29/21
Rybrevant amivantamab-vmjw 5/21/21
Livtencity maribavir 11/23/21
Empaveli pegcetacoplan 5/14/21
Voxzogo vosoritide 11/19/21
loncastuximab
Besremi ropeginterferon 11/12/21 Zynlonta 4/23/21
alfa-2b-njft tesirine-lpyl
Scemblix asciminib 10/29/21 Jemperli dostarlimab-gxly 4/22/21
Tavneos avacopan 10/7/21 Nextstellis drospirenone and estetrol 4/15/21
Livmarli maralixibat 9/29/21 Qelbree viloxazine 4/2/21
Qulipta atogepant 9/28/21 Zegalogue dasiglucagon 3/22/21
Tivdak tisotumab vedotin-tftv 9/20/21 Ponvory ponesimod 3/18/21
Exkivity mobocertinib 9/15/21 Fotivda tivozanib 3/10/21
Skytrofa lonapegsomatropin-tcgd 8/25/21 serdexmethylphenidate

Azstarys 3/2/21
and dexmethylphenidate
Korsuva difelikefalin 8/23/21
Pepaxto melphalan flufenamide 2/26/21
Welireg belzutifan 8/13/21
Nulibry fosdenopterin 2/26/21
Nexviazyme avalglucosidase alfa-ngpt 8/6/21
Amondys 45 casimersen 2/25/21
Saphnelo anifrolumab-fnia 7/30/21
Cosela trilacicilib 2/12/21
Bylvay odevixibat 7/20/21
Evkeeza evinacumab-dgnb 2/11/21
Rezurock belumosudil 7/16/21
Ukoniq umbralisib 2/5/21
fexinidazole fexinidazole 7/16/21
Tepmetko tepotinib 2/3/21
Kerendia finerenone 7/9/21
Lupkynis voclosporin 1/22/21
asparaginase erwinia
Rylaze chrysanthemi 6/30/21 cabotegravir and
Cabenuva 1/21/21
(recombinant)-rywn rilpivirine (co-packaged)
Aduhelm aducanumab-avwa 6/7/21 Verquvo vericiguat 1/19/21
Brexafemme ibrexafungerp 6/1/21

Current as of: 5/13/2022
**The listed “FDA-approved use” on this website is for presentation purposes only. To see the FDA-approved conditions of use [e.g.,
indication(s), population(s), dosing regimen(s)] for each of these products, see the most recent FDA-approved Prescribing Information.
https://www.fda.gov/drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products/novel-drug-approvals-2021

HEALTHCARE PRODUCTS
88 First Time Generic Drug Approvals: 2021

Approval
Generic Drug Name General Manufacturer Brand Name Date
Centaur Pharmaceuticals
93 Ivabradine Tablets, 5 mg and 7.5 mg Corlanor (Ivabradine) Tablets, 5 mg and 7.5 mg 12/30/21
Private Limited
Vasopressin Injection, USP, 20 Units/mL

92 Eagle Pharmaceuticals, Inc. Vasostrict (Vasopressin) Injection, 20 units/mL 12/15/21
Multiple Dose Vials
Amphotericin B Liposome for Injection, AmBisome (Amphotericin B) Liposome for Injection,

91 Sun Pharmaceutical 12/14/21
50 mg/vial Single-Dose Vial 50 mg/vial
Timolol Maleate Ophthalmic Solution Timoptic (Timolol Maleate) in Ocudose Ophthalmic

90 USP, 0.25% (base) and 0.5% (base), IdentiRx Pharmaceuticals, LLC 12/13/21
Solution, 0.25% and 0.5%
Single-Dose Vials
Glycerol Phenylbutyrate Oral Liquid, Ravicti (Glycerol Phenylbutyrate) Oral Liquid,

89 Par Pharmaceutical, Inc. 12/2/21
1.1 grams/mL 1.1 grams/mL
88 Lubiprostone Capsules, 8 mcg and 24 mcg Amneal Pharmaceuticals LLC Amitiza (Lubiprostone) Capsules, 8 mcg and 24 mcg 11/30/21
Atropine Sulfate Ophthalmic Solution

87 Apotex Inc. Atropine Sulfate Ophthalmic Solution, 1% 11/26/21
USP, 1%
Betaine Anhydrous for Oral Solution, Cystadane (Betaine Anhydrous) For Oral Solution,
86 Novitium Pharma LLC 11/23/21
180 grams/bottle 180 grams/bottle
85 Dasatinib Tablets, 80 mg and 140 mg Apotex Inc. Sprycel (Dasatinib) Tablets, 80 mg and 140 mg 11/23/21
Nelarabine Injection, 250 mg/50 mL

84 Zydus Pharmaceuticals (USA) Inc. Arranon (Nelarabine) Injection, 250 mg/50 mL 11/17/21
(5 mg/mL), Single Dose Vial
83 Fingolimod Capsules, 0.25 mg Teva Pharmaceuticals USA, Inc. Gilenya (Fingolimod) Capsules, 0.25 mg 11/12/21
Potassium Chloride (20 mEq) in Lactated Potassium Chloride (20 mEq) in Lactated Ringer's
82 Ringer's and 5% Dextrose Injection USP, Fresenius Kabi USA, LLC 11/9/21
and 5% Dextrose Injection
Single-Dose Containers
Valsartan Oral Solution, 20 mg/5 mL

81 Novitium Pharma LLC Prexxartan (Valsartan) Oral Solution, 20 mg/5 mL 11/2/21
(4 mg/mL)
Everolimus Tablets, 0.25 mg, 0.5 mg, Zortress (Everolimus) Tablets, 0.25 mg, 0.5 mg,
0.75 mg and 1 mg 0.75 mg and 1 mg
Lenalidomide Capsules , 2.5 mg, 5 mg, Revlimid (Lenalidomide) Capsules , 2.5 mg, 5 mg,
79 Dr. Reddy's Laboratories Limited 10/14/21
10 mg, 15 mg, 20 mg and 25 mg 10 mg, 15 mg, 20 mg and 25 mg
Carglumic Acid Tablets for Oral Carbaglu (Carglumic Acid) Tablets for Oral
78 Novitium Pharma LLC 10/14/21
Suspension, 200 mg Suspension, 200 mg
Mivacurium Chloride Injection, 10 mg/5 Mivacron (Mivacurium Chloride) Injection,

77 mL (2 mg/mL) and 20 mg/10 mL (2 mg/ Woodward Pharma Services, LLC 10 mg/5 mL (2 mg/mL) and 20 mg/10 mL 10/12/21
mL) Single-dose Vials (Preservative Free) (2 mg/mL) Single-dose Vials
Romidepsin for Injection, 10 mg/vial,

76 Fresenius Kabi USA, LLC Istodax (Romidepsin for Injection), 10 mg/vial 10/12/21
Single Dose Vial
75 Oxymetazoline Hydrochloride Cream, 1% Taro Pharmaceuticals Inc. Rhofade (Oxymetazoline Hydrochloride) Cream, 1% 10/4/21
Zolmitriptan Nasal Spray USP, 2.5 mg Zomig (Zolmitriptan) Nasal Spray USP, 2.5 mg
74 Padagis Israel Pharmaceuticals Ltd. 9/30/21
and 5 mg and 5 mg
73 Brimonidine Topical Gel, 0.33% Padagis Israel Pharmaceuticals Ltd. Mirvaso (Brimonidine) Topical Gel, 0.33% 9/23/21
Ceftaroline Fosamil for Injection, 400 mg Teflaro (Ceftaroline Fosamil) for Injection, 400 mg
72 Apotex Inc. 9/21/21
and 600 mg Single-Dose Vials and 600 mg Single-Dose Vials
Vortioxetine Tablets, 5 mg, 10 mg, Trintellix (Vortioxetine) Tablets, 5 mg, 10 mg,

71 Zydus Pharmaceuticals (USA) Inc. 9/17/21
and 20 mg and 20 mg
70 Eliglustat Capsules, 84 mg Aizant Drug Research Solutions Pvt. Ltd. Cerdelga (Eliglustat) Capsules, 84 mg 9/8/21
Paroxetine Oral Suspension, 10 mg

69 Novitium Pharma LLC Paxil (Paroxetine) Oral Suspension, 10 mg/5 mL 9/3/21
(base)/5 mL
68 Linagliptin Tablets, 5 mg Sunshine Lake Pharma Co., Ltd. Tradjenta (Linagliptin) Tablets, 5 mg 8/31/21

HEALTHCARE PRODUCTS

Approval
Linagliptin and Metformin Hydrochloride Jentadueto (Linagliptin and Metformin Hydrochlo-

67 Tablets, 2.5 mg/500 mg, 2.5 mg/850 mg, Sunshine Lake Pharma Co., Ltd. ride) Tablets, 2.5 mg/500 mg, 2.5 mg/850 mg, and 8/30/21
and 2.5 mg/1,000 mg 2.5 mg/1,000 mg
Tofacitinib Extended-Release Tablets, Xeljanz XR (Tofacitinib) Extended-Release Tablets,

66 Zydus Pharmaceuticals (USA) Inc 8/19/21
11 mg and 22 mg 11 mg and 22 mg
Sunitinib Malate Capsules, 12.5 mg, Sun Pharmaceutical Industries Sutent (Sunitinib Malate) Capsules, 12.5 mg, 25 mg,
65 8/16/21
25 mg, 37.5 mg and 50 mg Limited 37.5 mg and 50 mg
Loperamide Hydrochloride Capsules USP,

64 Strides Pharma Global Pte. Limited Loperamide Hydrochloride Capsules USP, 2 mg (OTC) 8/11/21
2 mg (OTC)
63 Varenicline Tablets, 0.5 mg and 1 mg Par Pharmaceutical, Inc. Chantix (Varenicline) Tablets, 0.5 mg and 1 mg 8/11/21
62 Enalapril Maleate Oral Solution, 1 mg/mL Bionpharma Inc. Epaned (Enalapril Maleate) Oral Solution, 1 mg/mL 8/10/21
61 Difluprednate Ophthalmic Emulsion, 0.05% Cipla Limited Durezol (Difluprednate) Ophthalmic Emulsion, 0.05% 8/9/21
Glycopyrrolate Oral Solution, 1 mg/5 mL Cuvposa (Glycopyrrolate) Oral Solution, 1 mg/5 mL

(0.2 mg/mL) (0.2 mg/mL)
Ibuprofen and Famotidine Tablets, Duexis (Ibuprofen and Famotidine) Tablets,

59 Alkem Laboratories Limited 8/3/21
800 mg/26.6 mg 800 mg/26.6 mg
Buprenorphine Buccal Film, 75 mcg, 150 Belbuca (Buprenorphine) Buccal Film, 75 mcg,
58 mcg, 300 mcg, 450 mcg, 600 mcg, 750 Alvogen Malta Operations Ltd. 150 mcg, 300 mcg, 450 mcg, 600 mcg, 750 mcg, 8/3/21
mcg, and 900 mcg and 900 mcg
Potassium Chloride in 5% Dextrose and

0.225% Sodium Chloride Injection USP, Potassium Chloride in 5% Dextrose & 0.225%
57 10 mEq/500 mL (1.49 mg/mL) and 20 Fresenius Kabi USA, LLC Sodium Chloride Injection USP, 10 mEq/500 mL 7/30/21
mEq/1000 mL (1.49 mg/mL) in Sin- (1.49 mg/mL) and 20 mEq/1000 mL (1.49 mg/mL)
gle-Dose Containers
Atropine Sulfate Injection USP,

0.25 mg/5 mL (0.05 mg/mL), 0.5 mg/5 mL Atropine Sulfate Injection USP, 0.25 mg/5 mL,
56 Accord Healthcare Inc. 7/26/21
(0.1 mg/mL), 1 mg/10 mL (0.1 mg/mL) 0.5 mg/5 mL, 1 mg/10mL
Single-Dose Syringe
Paliperidone Palmitate Extended-Release Invega Sustenna (Paliperidone Palmitate) Extend-

Injectable Suspension, 39 mg/0.25 mL, 78 ed-Release Injectable Suspension, 39 mg/0.25 mL,
55 Teva Pharmaceuticals USA, Inc. 7/6/21
mg/0.5 mL, 117 mg/0.75 mL, 156 mg/mL, 78 mg/0.5 mL, 117 mg/0.75 mL, 156 mg/mL, and
and 234 mg/1.5 mL 234 mg/1.5 mL
Eslicarbazepine Acetate Tablets, 200 mg, Aptiom (Eslicarbazepine Acetate) Tablets, 200 mg,
54 Dr. Reddy's Laboratories Inc. 6/29/21
400 mg, 600 mg, 800 mg 400 mg, 600 mg, 800 mg
Arformoterol Tartrate Inhalation Solution, Brovana (Arformoterol Tartrate) Inhalation Solution,

53 Axar Pharmaceuticals, Inc. 6/22/21
15 mcg/2 mL, Unit- Dose Vials 15 mcg/2 mL, Unit- Dose Vials
Arformoterol Tartrate Inhalation Solution, Brovana (Arformoterol Tartrate) Inhalation Solution,

52 Glenmark Pharmaceuticals Limited 6/22/21
15 mcg/2 mL, Unit- Dose Vials 15 mcg/2 mL, Unit- Dose Vials
Formoterol Fumarate Inhalation Solution, Perforomist (Formoterol Fumarate) Inhalation

51 Cipla USA, Inc. 6/22/21
20 mcg/2 mL Single-Dose Vial Solution, 20 mcg/2 mL Single-Dose Vial
Formoterol Fumarate Inhalation Solution, Perforomist (Formoterol Fumarate) Inhalation

20 mcg/2 mL Single-Dose Vial Solution, 20 mcg/2 mL Single-Dose Vial
Etravirine Tablets, 25 mg, 100 mg, Intelence (Etravirine) Tablets, 25 mg, 100 mg,
49 Amneal EU, Limited 6/14/21
and 200 mg and 200 mg
Carfilzomib for Injection, 10 mg, 30 mg, Kyprolis (Carfilzomib) for Injection, 10 mg, 30 mg,
48 Breckenridge Pharmaceutical, Inc. 6/11/21
and 60 mg Single-Dose Vials and 60 mg Single-Dose Vials
Lopinavir and Ritonavir Tablets USP, 100 Kaletra (Lopinavir and Ritonavir) Tablets, 100 mg/25
47 Hetero Labs Limited 6/4/21
mg/25 mg, 200 mg/50 mg mg and 200 mg/50 mg
46 Tofacitinib Tablets, 10 mg Ajanta Pharma Limited Xeljanz (Tofacitinib) Tablets, 10 mg 6/1/21
Zinc Chloride Injection USP, 10 mg/10 mL Zinc Chloride Injection USP, 10 mg/10 mL
45 Exela Pharma Sciences, LLC. 5/21/21
(1 mg/mL) Single-Dose Vials (1 mg/mL) Single-Dose Vials
Lenalidomide Capsules, 5 mg, 10 mg, Revlimid (Lenalidomide) Capsules, 5 mg, 10 mg, 15

44 Natco Pharma Limited 5/21/21
15 mg and 25 mg mg and 25 mg

HEALTHCARE PRODUCTS

Approval
Calcitonin Salmon Injection USP, 400 USP Miacalcin (Calcitonin Salmon) Injection USP, 400
43 units per 2 mL (200 USP units per mL) Custopharm, Inc. USP units per 2 mL (200 USP units per mL) Multi- 5/14/21
Multi-Dose Vial Dose Vial
42 Enzalutamide Capsules, 40 mg Actavis Laboratories FL, Inc Xtandi (Enzalutamide) Capsules, 40 mg 5/14/21
Sodium Acetate Injection USP, 100 Sodium Acetate Injection USP, 100 mEq/50 mL (2
mEq/50 mL (2 mEq/mL) and 200 mEq/100
41 Milla Pharmaceuticals, Inc. mEq/mL) and 200 mEq/100 mL (2 mEq/mL) Phar- 5/4/21
mL (2 mEq/mL) Pharmacy Bulk Package macy Bulk Package Vials
Vials
23.4% Sodium Chloride Injection USP, 23.4% Sodium Chloride Injection USP, 120 mEq/30
40 120 mEq/30 mL (4 mEq/mL) Single Fresenius Kabi USA, LLC 4/28/21
mL (4 mEq/mL)
Dose Vial
Sodium Chloride Injection, USP, 14.6% Sodium Chloride Injection, USP 14.6% 50 mEq/20
39 Fresenius Kabi USA, LLC 4/28/21
50 mEq/20 mL and 100 mEq/40 mL mL and 100 mEq/40 mL
38 Tiopronin Tablets, 100 mg Teva Pharmaceuticals USA, Inc Thiola (Tiopronin) Tablets, 100 mg 4/26/21
Pregabalin Extended-Release Tablets, Lyrica CR (Pregabalin) Extended-Release Tab-

37 Apotex 4/13/21
165 mg, 330 mg lets, 165 mg, 330 mg

36 MSN Laboratories Private Limited 4/13/21
82.5 mg, 165 mg, 330 mg lets, 82.5 mg, 165 mg, 330 mg

35 Mylan Pharmaceuticals Inc. 4/13/21
82.5 mg lets, 82.5 mg


33 Alvogen Pine Brook LLC 4/13/21
Tirofiban Hydrochloride Injection, Aggrastat (Tirofiban Hydrochloride) Injection, 12.5

32 12.5 mg/250 mL (50 mcg/mL) Gland Pharma Limited 4/8/21
mg/250 mL (50 mcg/mL)
Single-Dose Container
31 Macitentan Tablets, 10 mg Zydus Worldwide DMCC Opsumit (Macitentan) Tablets, 10 mg 4/6/21
Deoxycholic Acid Injection, 20 mg/2 mL Kybella (Deoxycholic Acid) Injection, 20 mg/2 mL

30 Slayback Pharma LLC 4/2/21
(10 mg/mL) (Single-Dose Vial) (10 mg/mL)
29 Ibrutinib Capsules, 70 mg and 140 mg Zydus Worldwide DMCC Imbruvica (Ibrutinib) Capsules, 70 mg and 140 mg 3/31/21
Isotretinoin Capsules USP, 10 mg, 20 mg, Absorica (Isotretinoin) Capsules USP, 10 mg, 20 mg,
28 Actavis Laboratories FL, Inc. 3/31/21
25 mg, 30 mg, 35 mg and 40 mg 25 mg, 30 mg, 35 mg and 40 mg
50% Dextrose Injection USP, 25 g/50 mL International Medication Systems, 50% Dextrose Injection USP, 25 g/50 mL (0.5 g/mL),
27 3/26/21
(0.5 g/mL), Single-Dose Prefilled Syringes Limited Single-Dose Prefilled Syringes
Atropine Sulfate Injection USP, 8 mg/20 Atropine Sulfate Injection USP, 8 mg/20 mL (0.4
26 Accord Healthcare Inc. 3/19/21
mL (0.4 mg/mL), Multiple-Dose Vial mg/mL), Multiple-Dose Vial
Potassium Chloride Injection, 10 mEq/100

mL (7.45 mg/mL), 10 mEq/50 mL (14.9 mg/ Potassium Chloride Injection, 10 mEq/100 mL, 10
25 mL), 20 mEq/100 mL (14.9 mg/mL), 20 Nexus Pharmaceuticals Inc. mEq/50 mL, 20 mEq/100 mL, 20 mEq/50 mL, and 3/18/21
mEq/50 mL (29.8 mg/mL), and 40 mEq/100 40 mEq/100 mL
mL (29.8 mg/mL) Single-Dose Containers
Potassium Chloride in 5% Dextrose and Potassium Chloride in 5% Dextrose and 0.45%

0.45% Sodium Chloride Injection USP, Sodium Chloride Injection , 10 mEq/1000 mL, 20
24 10 mEq/1000 mL, 20 mEq/1000 mL, 30 Fresenius Kabi USA, LLC 3/9/21
mEq/1000 mL, 30 mEq/1000 mL, and 40 mEq/1000
mEq/1000 mL, and 40 mEq/1000 mL in mL
Potassium Chloride in 5% Dextrose and Potassium Chloride in 5% Dextrose and 0.9% Sodi-
0.9% Sodium Chloride Injection USP, 20
23 Fresenius Kabi USA, LLC um Chloride Injection USP, 20 mEq/1,000 mL and 3/9/21
mEq/1,000 mL and 40 mEq/1,000 mL, 40 mEq/1,000 mL
Hydrocodone Bitartrate Extended-Release Hysingla ER (Hydrocodone Bitartrate Extended-Re-

22 Tablets, 20 mg, 30 mg, 40 mg, 60 mg, 80 Alvogen Pine Brook LLC lease) Tablets, 20 mg, 30 mg, 40 mg, 60 mg, 80 3/1/21
mg, 100 mg and 120 mg mg, 100 mg and 120 mg

HEALTHCARE PRODUCTS

Approval
Droxidopa Capsules, 100 mg, Northera (Droxidopa) Capsules, 100 mg,

21 Ajanta Pharma Limited 2/18/21
200 mg, 300 mg 200 mg, 300 mg

20 Aurobindo Pharma Limited 2/18/21
200 mg, 300 mg 200 mg, 300 mg

200 mg, 300 mg 200 mg, 300 mg

18 ScieGen Pharmaceuticals, Inc. 2/18/21
200 mg, 300 mg 200 mg, 300 mg

17 Alkem Laboratories Limited 2/18/21
200 mg, 300 mg 200 mg, 300 mg

16 Tasman Pharma Inc. 2/18/21
200 mg, 300 mg 200 mg, 300 mg

200 mg, 300 mg 200 mg, 300 mg

14 Hikma Pharmaceuticals USA Inc. 2/18/21
200 mg, 300 mg 200 mg, 300 mg

13 Zydus Pharmaceuticals (USA) Inc. 2/18/21
200 mg, 300 mg 200 mg, 300 mg

12 MSN Laboratories Private Limited 2/18/21
200 mg, 300 mg 200 mg, 300 mg
Northera (Droxidopa) Capsules, 100 mg,

11 Droxidopa Capsules, 300 mg Annora Pharma Private Limited 2/18/21
200 mg, 300 mg
Droxidopa Capsules, 100 mg, 200 mg, Northera (Droxidopa) Capsules, 100 mg,
10 Lupin Limited 2/18/21
300 mg 200 mg, 300 mg
Apremilast Tablets, 10 mg, 20 mg

9 Unichem Laboratories Limited Otezla (Apremilast) Tablets, 10 mg, 20 mg and 30 mg 2/18/21
and 30 mg
Loteprednol Etabonate Ophthalmic Lotemax (Loteprednol) Etabonate Ophthalmic

8 Akorn Operating Company LLC 2/10/21
Gel, 0.5% Gel, 0.5%
Linaclotide Capsules, 145 mcg

7 Mylan Pharmaceuticals Inc. Linzess (Linaclotide) Capsules, 145 mcg and 290 mcg 2/9/21
and 290 mcg
Topiramate Extended-Release Qudexy XR (Topiramate Extended-Release) Cap-

6 Capsules, 25 mg, 50 mg, 100 mg, Glenmark Pharmaceuticals Inc., USA 2/1/21
sules, 25 mg, 50 mg, 100 mg, 150 mg, and 200 mg
150 mg, and 200 mg
5 Imiquimod Cream USP, 3.75% Taro Pharmaceutical Industries Limited Zyclara (Imiquimod) Cream, 3.75% 1/26/21
Argatroban Injection, 50 mg/50 mL Argatroban Injection, 50 mg/50 mL (1 mg/mL)

4 Caplin Steriles Limited 1/21/21
(1 mg/mL) Single-Dose Vial Single-Dose Vial
Epoprostenol for Injection, 0.5 mg/Vial Veletri (Epoprostenol for Injection), 0.5 mg/Vial and
and 1.5 mg/Vial 1.5 mg/Vial
Ferumoxytol Injection, 510 mg Iron/17 mL Feraheme (Ferumoxytol) Injection, 510 mg Iron/17

2 Sandoz Inc. 1/15/21
(30 mg/mL) Single-Dose Vials mL (30 mg/mL) Single-Dose Vials
Levothyroxine Sodium Capsules, 88 mcg, Tirosint (Levothyroxine Sodium) Capsules, 88 mcg,

100 mcg, and 125 mcg 100 mcg, and 125 mcg
NOTE: As outlined in the Proposed Criteria for First Generic Submissions for Purposes of ANDA, certain ANDAs are deemed “first generic” for the purposes of review
prioritization. In this context, a first generic application is any received ANDA: (1) That is a first-to-file ANDA eligible for 180-day exclusivity, or for which there are no
blocking patents or exclusivities; and (2) for which there is no previously-approved ANDA for the drug product.
*This table reflects current data as of the date the listed approval was made. Post-approval status changes, including approved use or indications, approval date, approval
status, etc. are not reflected here. To view the most current information on any ANDA listed, please check its Drugs@FDA listing.
+Due to space limitations, abbreviated indications are listed. For full indication information, please check Drugs@FDA.
https://www.fda.gov/drugs/drug-and-biologic-approval-and-ind-activity-reports/2021-first-generic-drug-approvals


CUSTOMERS
Section Overview
The Customers section includes pharmaceutical sales and market share by customer categories,
including chain stores, clinics and independent pharmacies, top drug chains by pharmacy sales and drug
store markets. This chapter also includes returns data (quantities, policies and product mix).
As reported by IQVIA in 2021, U.S. pharmaceutical spending by channel grew to $578.9 billion,
with 7.8 percent growth from 2020. Retail customers accounted for 69.8 percent of pharmaceutical
market share ($403.8 billion), while clinics (18.2 percent) and non-federal hospitals (6.9 percent)
comprised the largest portions of non-retail sales.
• Retail sales increased by 7.9 percent in 2021:

- The largest retail category, chain stores, grew by 6.3 percent;
- Food stores increased by 8.6 percent; and,
- Mail service continued to climb in both market share and dollar volume,
growing 10 percent.
• Non-retail sales increased by 7.4 percent (Table 89).
Retail Drug Stores

Tables 90 and 91 highlight the top drug chains by dollar volume and top drug chains by store count in
2022, respectively. Walgreens ranked first for chain sales ($112 billion) and second in store count
(8,965 stores). CVS ranked second in sales ($100.1 billion) and first in store count (9,877 stores).
Returns Data
More than half (61.3 percent) of companies accept returns for credit and 79.3 percent accept returns
up to 6 months prior to expiration (Table 89). An average of 634 pieces were returned per pharmacy
location with a dollar value of $43,865 (Table 93). In terms of product mix, the majority of returned
pieces were generic (83.2 percent) though the generic pieces accounted for only 31.7 percent of return
processed value (Table 97).
89 Non-Discounted Spending by Channel: 2020–2021

2020 2021
Sales ($bil) Market Share Sales ($bil) Market Share Growth
Retail $374.3 69.7% $403.8 69.8% 7.9%

Chain stores $151.2 28.1% $160.6 27.8% 6.3%
Mail service $144.9 27.0% $159.3 27.5% 10.0%
Independent $49.6 9.2% $52.7 9.1% 6.4%
Food stores $28.7 5.4% $31.2 5.4% 8.6%
Non-Retail $162.9 30.3% $174.9 30.2% 7.4%
Clinics $97.6 18.2% $105.4 18.2% 8.0%
Non-federal hospital $36.5 6.8% $39.7 6.9% 8.6%
Long-term care $14.7 2.7% $15.4 2.7% 4.4%
HMO $2.6 0.5% $2.3 0.4% -11.8%
Home health care $7.5 1.4% $8.3 1.4% 10.3%
Federal facilities $2.7 0.5% $2.7 0.5% -1.8%
Miscellaneous $1.3 0.2% $1.2 0.2% -2.8%
Total U.S. Market $537.3 100.0% $578.9 100.0% 7.8%

CUSTOMERS
90 Top 10 Drug Chains by Dollar Volume: 2022

Rank Store 2022 Sales ($bil)
1 Walgreens $112.0
2 CVS Health $100.11
3 Good Neighbor $16.7
4 Rite Aid $16.62
5 Health Mart $12.93
6 Shoppers Drug Mart $11.84
7 McKesson Canada $9.05
8 Metro $6.35
9 London Drugs $2.65
10 Hy-Vee $2.3
1
Reflects retail/long-term care sales only.
2
Retail Pharmacy segment sales only, estimated by CDR.
3
CDR estimate.
4
Translated from Canadian to U.S. dollars at the rate of 0.8, the same as a year earlier.
5
CDR estimate in U.S. dollars.
Source: Racher Press Research, Chain Drug Review
91 Top 10 Drug Chains by Store Count: 2022

Rank Store Count
1 CVS Health 9,877

2 Walgreens 8,965
3 Health Mart 4,690
4 Good Neighbor 4,371
5 McKesson Canada 3,000
6 Rite Aid 2,438
7 Shoppers Drug Mart 1,345
8 PharmaChoice 998
9 Pharmasave 826
10 Metro 651
Source: Racher Press Research, Chain Drug Review

CUSTOMERS
92 Top 10 Drug Store Markets: 2021
Rank Market Location Total Drug Store Sales ($bil)
1 NYC-Northern N.J.- Long Island, NY-NJ-PA $26.66

2 Los Angeles-Long Beach- Santa Ana, CA $11.59
3 Chicago-Naperville-Joliet, IL-IN-WI $8.98
4 Philadelphia-Camden-Wilmington, PA-NJ-DE-MD $7.26
5 Miami-Fort Lauderdale-Pompano Beach, FL $7.20
6 Boston-Cambridge-Quincy, MA-NH $5.36
7 Dallas-Fort Worth- Arlington, TX $5.19
8 Houston-Sugar Land-Baytown, TX $5.17
9 Washington-Arlington-Alexandria, DC-VA-MD-WV $4.75
10 Detroit-Warren-Livonia, MI $4.26
Source: U.S. Census Bureau, CDR Estimate, Chain Drug Review
93 Average Annual Returns per Pharmacy Location

Return Processed Value Returned Pieces
Annual $43,865 634

Calendar Quarter
First $9,185 124
Second $15,934 176
Third $10,910 176
Fourth $8,832 175
Source: Kindler & Crimmins Associates
94 Application of Manufacturer Return Policy

Return Processed Value Returned Pieces
Meets credit eligibility criteria 76.9% 52.7%

Does not meet credit eligibility criteria 23.1% 47.3%
95 Non-Creditable Product Casual Analysis

Return Policy Exception Return Processed Value Returned Pieces
Partial product not accepted 39.0% 36.8%

Prescription vials and repacked product not accepted 31.5% 20.1%
Manufacturer does not accept returns or NDC-specific
19.4% 35.8%
policy exclusion
Product dating (outside of manufacturer policy) 6.2% 4.6%
Missing information (lot number or expiration) 3.9% 2.6%
Product damaged 0.1% 0.1%

CUSTOMERS
96 Return Product Expiration Analysis

Return Processed Value Returned Pieces Note
Returned an average of 67 days

Product returned prior to expiration 65.1% 62.3% prior to expiration
Returned an average of 139 days
Product returned after expiration 26.5% 20.9% after expiration
Prescription vial or expiration
Expiration date unknown 8.4% 16.8% date obscured/illegible
NOTE: Products with known expiration date are returned an average of 26 days prior to expiration
97 Brand - Generic Return Product Mix

Product Type Return Processed Value Returned Pieces
Brand 68.3% 16.8%

Generic 31.7% 83.2%
Manufacturer National Return Policy Summary of Credit Eligibility

98 for Partials and Product Expiration Requirements
Yes No
Percent of companies that accept returns for credit 61.3% 38.7%

Percent of companies that accept partial products for credit
14.7% 85.3%
(% based on companies that accept returns, not all companies)
For companies that accept returns for credit
Percent of companies that accept returns prior to expiration: %
Within 3 months of expiration 9.9%

More than 3 and up to 6 months before expiration 69.4%
More than 12 months before expiration 3.2%
Must be expired 15.6%
Percent of companies that accept returns after expiration: %
Up to 3 months after expiration 3.0%

More than 3 and up to 6 months after expiration 20.8%
More than 12 months after expiration 2.6%
Must be unexpired 1.9%

MARKET CHARACTERISTICS
Section Overview
The Market Characteristics section includes information on national healthcare expenditures, sources
of health insurance, prescription spending by payer, prescription use and top pharmaceutical
manufacturing companies.
According to the Centers for Medicare & Medicaid Services, Office of the Actuary, U.S. health
expenditures increased by 4.2 percent in 2021, reaching $4.3 trillion (up from $4.1 trillion last year).
In 2021, per capita U.S. healthcare spending as a percent of Gross Domestic Product decreased
from 19.7 percent to 18.8 percent (Tables 99 and 100).
In 2022, hospital care spending was projected to reach 6.2 percent of the U.S. Gross Domestic
Product, with spending of $1.4 trillion, which is a 6.9 percent increase over 2021 (Table 101). Projections
of prescription drug spending by payer are broken into four categories:
• Private health insurance, 39.8 percent;

• Out-of-pocket payments, 12.8 percent;
• Medicaid, 10.9 percent; and,
• Medicare, 31.7 percent in 2021 (Table 104).
As reported by IQVIA, 54 percent of prescriptions dispensed were paid by commercial third parties;
followed by Medicare Part D, 27.7 percent; Medicaid, 15.2 percent; and, cash, 3 percent (Table 105).
Prescriptions
As reported by IQVIA, total prescriptions dispensed by all channels were as follows:
• Chain stores and mass merchandisers, 55.1 percent, up slightly from 54.6 percent in 2020;
• Independent pharmacy, 14.3 percent, up slightly from 2020;
• Food stores, 16.8 percent, down from 17 percent in 2020;
• Long-term care, 8.6 percent, down from 9.2 percent in 2020; and,
• Mail services, 5.1 percent, down slightly from 5.3 percent in 2020 (Table 107).
Pharmaceutical Companies
Table 110 notes AbbVie was the number-one-ranked manufacturer with sales of $38.7 billion in 2021.
• Janssen ranked second, with sales of $37.4 billion;

• Lilly, third, with sales of $31.7 billion; and,
• Novo Nordisk ranked fourth, with sales of $30.2 billion in 2021.
Comparing the top 20 manufacturers by prescriptions dispensed:
• Aurobindo took first place, with the highest number of prescriptions dispensed — 311.8 million.
Teva was second, with 302.8 million prescriptions (Table 111).
• For unbranded generic prescriptions, Aurobindo again held the top spot, with 307 million
prescriptions dispensed, capturing 8.5 percent of the generic market (Table 112).
• The top two prescription products were COVID-19 vaccines. Pfizer was the leader with
128.8 million prescriptions dispensed in 2021. Moderna’s vaccine was second with
84 million prescriptions dispensed (Table 113).
The top 10 biologic manufacturers by revenue accounted for $312 billion of the $441.1 billion total
biologic market in 2021.
• AbbVie ranked first with sales of $41.8 billion; followed by,

• Roche with sales of $41 billion (Table 116).

99 U.S. Healthcare Expenditures: 2014–2024

$6,000.0
$5,000.0 9.7%
$4,000.0
$3,000.0 5.4% 5.0% 5.1%

5.2%
$2,000.0 4.5% 4.3% 4.6% 4.3% 4.6%
4.2%
$1,000.0
$0.0
2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024
Cost Change (%)
NOTE: Numbers may not add to totals because of rounding.

Source: Centers for Medicare & Medicaid Services, Office of the Actuary.

Spending per Capita as a Percent of Gross Domestic Product (GDP)

100 2014–2024
$16,000
19.7%
$14,000
$12,000 18.8%
$10,000 18.2% 18.2% 18.3%
$8,000 17.7% 17.7%17.6% 17.6%

$6,000 17.4%
17.1%
$4,000
$2,000
$0
2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024
Spending Per Capita Gross Domesc Product
NOTE: Numbers and percents may not add to totals because of rounding.
Sources: Centers for Medicare & Medicaid Services, Office of the Actuary; U.S. Department of Commerce, Bureau of Economic
Analysis; and U.S. Bureau of the Census.

Projected U.S. Healthcare Expenditures by Selected Types of Services:

101 2021–2022
2021 2022
Type of Service Spending ($bil) Percent Change Spending ($bil) Percent Change
Hospital care $1,342.1 5.7% $1,435.2 6.9%

Professional care $1,144.4 7.0% $1,200.7 4.9%
Nursing care facilities and continuing
$181.6 -7.7% $188.1 3.6%
care retirement communities
Prescription drugs $364.8 4.7% $380.4 4.3%
Net cost of private health insurance $302.4 0.3% $309.3 2.3%
Government public health activities $212.1 -5.2% $187.3 -11.%
Total of the Selected Services $3,547.4 $3,701.0
Total National Health Expenditure $4,124.0 4.2% $4,496.6 4.6%
NOTE: Numbers may not add to totals because of rounding.
Source: Centers for Medicare & Medicaid Services, Office of the Actuary

102 Projected U.S. Healthcare Expenditures: 2021–2023

2021 ($bil) 2022 ($bil) 2023 ($bil)
Out-of-Pocket-Payments $406.5 $431.3 $455.0

Private Health Insurance1 $1,224.2 $1,326.2 $1,420.7
Medicaid 1
$923.0 $991.9 $1,050.4
Medicare 1
$740.8 $783.2 $802.9
Other Third Party Payers3 $405.0 $377.0 $399.1
1
Includes Private Health Insurance (Employer Sponsored Insurance and other private insurance, which includes Marketplace plans), Medicare, Medic-
aid, Children’s Health Insurance Program (Titles XIX and XXI), Department of Defense, and Department of Veterans’ Affairs.
3
Includes worksite health care, other private revenues, Indian Health Service, workers’ compensation, general assistance, maternal and child health,
vocational rehabilitation, other federal programs, Substance Abuse and Mental Health Services Administration, other state and local programs, and
school health.
NOTE: Per capita amounts based on estimates that reflect the U.S. Bureau of Census definition for resident-based population (which includes all
persons who usually reside in one of the fifty states or the District of Columbia, but excludes (i) residents living in Puerto Rico and areas under U.S.
sovereignty, and (ii) U.S. Armed Forces overseas and U.S. citizens whose usual place of residence is outside of the United States) plus a small (typically
less than 0.2% of population) adjustment to reflect Census undercounts. Projected estimates reflect the area population growth assumptions found in
the Medicare Trustees Report. Numbers and percents may not add to totals because of rounding. Dashes (—) indicate “not applicable”.

Prescription Use
103 Projected Growth of Medicare and Medicaid Spending: 2020–2030
1800
1600
1400
1200
1000
800
600
400
200
0
2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Medicaid ($ bil) Medicare ($ bil)
Source: U.S. Congressional Budget Office

104 Projected Prescription Drug Spending by Payer: 2021–2024

Payer 2021 2022 2023 2024
Private Health Insurance1 39.8% 39.3% 38.9% 38.5%

Out-of-Pocket Payment 12.8% 12.4% 12.0% 11.7%
Medicaid 1
10.9% 11.0% 10.9% 11.1%
Medicare 1
31.7% 32.6% 33.5% 34.2%
1
Includes Private Health Insurance (Employer Sponsored Insurance and other private insurance, which includes Marketplace plans), Medicare, Medic-
aid, Children’s Health Insurance Program (Titles XIX and XXI), Department of Defense, and Department of Veterans’ Affairs.
NOTE: Per capita amounts based on estimates that reflect the U.S. Bureau of Census definition for resident-based population (which includes all persons who
usually reside in one of the fifty states or the District of Columbia, but excludes (i) residents living in Puerto Rico and areas under U.S. sovereignty, and (ii) U.S. Armed
Forces overseas and U.S. citizens whose usual place of residence is outside of the United States) plus a small (typically less than 0.2% of population) adjustment to
reflect Census undercounts. Projected estimates reflect the area population growth assumptions found in the Medicare Trustees Report. Numbers and percents
may not add to totals because of rounding. Dashes (—) indicate “not applicable”.

105 Retail Prescriptions by Payer: 2018–2021

2018 2019 2020 2021
Commercial Third-Party 51.9% 52.5% 52.0% 54.0%

Medicare Part D 28.4% 28.5% 29.5% 27.7%
Medicaid 15.3% 15.2% 15.2% 15.2%
Cash 4.4% 3.7% 3.4% 3.0%
NOTES: Retail Channel prescriptions only
Limited to Rx and OTC Insulins.
Source: IQVIA National Prescription Audit, US SMART, Managed Care, April 2022
106 Dispensed Prescriptions (mil): 2016–2021
4,487
4,237 4,214 4,342
4,196 4,097
Millions
2016 2017 2018 2019 2020 2021

NOTE: Includes prescription products and insulins
Limted to Rx and OTC Insulins
107 Total Prescriptions Dispensed by Channel: 2020–2021

Prescriptions (#Mil) Market Share (%)
Channel 2020 2021 2021 Growth (%) 2020 2021
Chain stores 2,235.6 2,394.5 7.1% 54.6% 55.1%

Independent 572.6 622.8 8.8% 14.0% 14.3%
Food stores 695.6 728.6 4.7% 17.0% 16.8%
Long-term care 378.4 373.6 -1.3% 9.2% 8.6%
Mail service 215.3 222.5 3.4% 5.3% 5.1%
Total U.S. Market 4,097.4 4,342.0 6.0% 100.0% 100.0%

108 Dispensed Prescriptions by Channel: 2016–2021

2016 2017 2018 2019 2020 2021
Chain Stores 2,576.7 2,397.5 2,370.7 2,318.1 2,235.6 2,394.5

Independent 740.5 532.5 531.4 561.8 572.6 622.8
Food Stores 558.9 706.8 702.9 706.1 695.6 728.6
Long-Term Care 386.8 388.7 395.1 404.5 378.4 373.6
Mail Service 224.2 211.6 213.7 205.6 215.3 222.5
Total U.S. Market 4,487.2 4,237.1 4,213.8 4,196.1 4,097.4 4,342.0
109 Growth in Prescription Sales and Dispensing (%): 2016–2021
20.1%
13.0%
3.6%
-0.6% 7.8%
6.3% 6.1% 6.0%
5.0% 4.7%
2.3%
-0.6% -0.4% -2.4%

-5.6% -5.6%
2016 2017 2018 2019 2020 2021
Sales Growth Prescripon Growth

Source: IQVIA, National Sales Perspectives, National Prescription Audit, April 2022

Pharmaceutical Companies
110 Top 20 U.S. Pharmaceutical Manufacturers by Sales: 2019–2021
Rank 2019 ($bil) 2020 ($bil) 20201 ($bil)
1 Janssen Pharm $30.8 Janssen Pharm $33.3 AbbVie Inc. $38.7

2 AbbVie Inc. $29.2 AbbVie Inc. $33.0 Janssen Pharm $37.4
3 Genentech,Inc. $27.5 Lilly $26.6 Lilly $31.7
4 Amgen Inc $24.6 Genentech, Inc. $25.6 Novo Nordisk $30.2
5 Lilly $23.5 Amgen Inc $25.5 Bristol-Myers Squibb $27.6
6 Novo Nordisk $22.2 Novo Nordisk $24.8 Amgen Inc $26.3
7 Merck & Company $21.2 Bristol-Myers Squibb $23.5 Merck & Company $24.6
8 Bristol-Myers Squibb $20.3 Merck & Company $22.6 Genentech,Inc. $24.5
9 Gilead Sciences $20.1 Gilead Sciences $21.8 Gilead Sciences $23.5
10 GlaxoSmithKline $17.8 GlaxoSmithKline $18.6 GlaxoSmithKline $19.4
11 Pfizer $16.8 Pfizer $18.2 Pfizer $18.6
12 Novartis Rx $14.6 Novartis RX $15.9 Boehringer Ingelheim $17.7
13 Takeda Pharm USA $14.3 Sanofi Aventis $15.2 Sanofi Aventis Phr $17.7
14 AstraZeneca $13.8 Boehringer Ingelheim $14.9 AstraZeneca $17.5
15 Takeda
Sanofi Aventis Phr $13.2 $14.8 Novartis Rx $17.4
Pharmaceuticals USA
16 Takeda
Boehringer Ingelheim $12.4 AstraZeneca $14.7 $15.6
Pharmaceuticals USA
17 Allergan $12.1 Allergan $13.1 Allergan $14.4
18 Viatris $11.4 Viatris $7.8 Viatris $7.0
19 Biogen $7.9 Biogen $6.8 Teva Pharmaceuticals $5.4
20 Teva Pharmaceuticals $6.2 Teva Pharmaceuticals $5.5 Astellas $5.4
NOTES: Rankings Represent current corporate structure.
In November 2020, Mylan merged with Upjohn, Pfizer’s off-patent medicine division, to form Viatris.
Source: IQVIA, National Sales Perspective, April 2022

111 Top 20 Manufacturers by Prescriptions Dispensed: 2021

Rank Company Total Prescriptions (#mil) Market Share (%) Growth (%)
1 Aurobindo Pharm 311.8 7.2% 6.1%

2 Teva Pharmaceuticals 302.8 7.0% -12.8%
3 Lupin Pharma 224.4 5.2% 1.1%
4 Amneal Pharmaceuticals 158.6 3.7% 4.8%
5 Viatris 154.8 3.6% -4.7%
6 Zydus Pharmaceuticals 148.3 3.4% -0.3%
7 Pfizer 138.0 3.2% 984.2%
8 Accord Healthcare 122.2 2.8% 5.3%
9 Dr Reddys Lab 101.0 2.3% -3.9%
10 Ascend Labs 99.2 2.3% -1.1%
11 Cipla USA, Inc. 94.9 2.2% 18.0%
12 Apotex Corp 93.8 2.2% -8.4%
13 Camber Pharmaceuticals 93.6 2.2% 10.0%
14 Sandoz 91.4 2.1% -5.9%
15 Northstar Rx 90.2 2.1% 1.4%
16 Hikma Pharmaceuticals 89.3 2.1% -1.9%
17 Moderna Inc 84.0 1.9% 56,488.6%
18 Glenmark Pharma 80.9 1.9% 12.9%
19 Solco Healthcare 75.2 1.7% 0.4%
20 Torrent Pharma 66.9 1.5% -9.6%
Top 20 2,621.1 60.4% 8.1%
Total U.S. Market 4,342.0 100.0% 6.0%
In November 2020, Mylan merged with Upjohn, Pfizer’s off-patent medicine division, to form Viatris.
Rankings Represent current corporate structure.

112 Top 20 Manufacturers by Total Unbranded Generic Prescriptions Dispensed: 2021

Rank Company Total Prescriptions (#mil) Share of Generic Market (%) Growth (%)
1 Aurobindo Pharm 307.0 8.5% 5.2%

2 Teva Pharmaceuticals 283.8 7.9% -11.8%
3 Lupin Pharma 217.9 6.1% 2.0%
4 Amneal Pharmaceuticals 153.7 4.3% 4.9%
5 Viatris 148.3 4.1% -4.2%
6 Zydus Pharmaceuticals 148.0 4.1% -0.4%
7 Accord Healthcare 122.2 3.4% 5.3%
8 Dr Reddys Lab 99.4 2.8% -4.1%
9 Ascend Labs 99.2 2.8% -1.1%
10 Cipla USA, Inc. 94.9 2.6% 18.0%
11 Camber Pharmaceuticals 93.6 2.6% 10.0%
12 Apotex Corp 93.0 2.6% -8.3%
13 Hikma Pharmaceuticals 88.9 2.5% -1.9%
14 Sandoz 88.7 2.5% -6.3%
15 Northstar Rx 85.9 2.4% 1.8%
16 Glenmark Pharma 78.7 2.2% 13.4%
17 Solco Healthcare 75.2 2.1% 0.4%
18 Torrent Pharma 66.9 1.9% -9.6%
19 Mallinckrodt 57.7 1.6% -0.3%
20 Unichem Pharm USA 55.7 1.6% -0.8%
Top 20 2,458.6 68.4% -0.3%
Total U.S. Market 3,593.0 100.0% 1.4%
NOTE: Limited to Rx and OTC Insulins; Unbranded Generics

113 Top 20 Branded Products by U.S. Prescriptions: 2021

Total Prescriptions
Rank Product Company Market Share (%) Growth (%)
(#mil)
1 Comirnaty Pfizer 128.8 21.3% 34,430.6%

2 Covid-19 Vaccine Moderna Inc 84.0 13.9% 56,488.6%
3 Eliquis Bristol-Myers Squibb 25.5 4.2% 15.2%
4 Synthroid AbbVie Inc. 14.1 2.3% -6.8%
5 Vyvanse Takeda Pharm USA 12.0 2.0% 4.8%
6 Xarelto Janssen Pharm 10.5 1.7% -0.4%
7 Trulicity Lilly 10.1 1.7% 29.3%
8 Jardiance Boehringer Ingelheim 9.5 1.6% 29.9%
9 Lantus Solostar Sanofi Aventis Phr 9.5 1.6% 2.5%
10 Fluzone Hd Quadri Sanofi Aventis Pas 9.2 1.5% 1.1%
11 Januvia Merck & Company 8.4 1.4% -4.2%
12 Symbicort AstraZeneca 7.5 1.2% -8.2%
13 Shingrix GlaxoSmithKline 7.5 1.2% -20.4%
14 Fluad Quadrivalent Seqirus 7.2 1.2% -11.2%
15 Covid-19 Vaccine Janssen Pharm 7.2 1.2% NA
16 Ozempic Novo Nordisk 6.9 1.1% 59.3%
17 Flucelvax Quadval Seqirus 6.6 1.1% -36.1%
18 Fluzone Sanofi Aventis Pas 6.5 1.1% -25.8%
19 Flovent HFA GlaxoSmithKline 6.0 1.0% -5.0%
20 Breo Ellipta GlaxoSmithKline 5.3 0.9% -13.7%
Top 20 382.1 63.1% 133.7%
Total Branded Maket 605.5 100.0% 50.5%

114 Top 15 Corporations by Promotional Spending: 2021

Changes in 2020 Promotional 2021 Promotional
2021 Rank Corporation
rank vs 2020 Spending ($mil) Spending ($mil)
1 1 AbbVie Inc $4,580.8 $5,287.4

2 9 Gilead Sciences,In $1,240.4 $2,172.0
3 4 Novo Nordisk Corp $1,467.4 $1,966.8
4 6 AstraZeneca Corp $1,310.1 $1,755.2
5 12 Johnson & Johnson $1,096.7 $1,519.4
6 2 Novartis $1,988.2 $1,513.9
7 13 Sanofi Aventis $1,012.5 $1,386.2
8 7 Boehringer Ingelheim $1,305.0 $1,367.7
9 8 Otsuka Pharma Co $1,243.9 $1,301.0
10 5 Lilly $1,332.2 $1,281.8
11 10 Bristol-Myers Squibb $1,129.8 $1,061.1
12 11 Amgen Corporation $1,105.7 $1,033.4
13 3 Pfizer $1,503.9 $1,026.5
14 14 GlaxoSmithKline $838.4 $947.8
15 15 Merck & Co $748.0 $844.7
Source: IQVIA, Channel Dynamics Q4 MAT 2021, accessed April 2022

115 Top 20 Generic Manufacturers by Revenue: 2021

Rank Company Sales ($bil) Share of Generic Market (%) Growth (%)
1 Teva Pharmaceuticals $4.3 7.8% -5.2%

2 Viatris $4.3 7.7% -9.1%
3 Prasco Labs $2.2 3.9% -22.1%
4 Amneal Pharmaceuticals $2.1 3.8% -9.4%
5 Sandoz $2.0 3.7% -17.4%
6 Hikma Pharmaceuticals $1.8 3.3% 11.0%
7 Par Pharmaceuticals $1.6 3.0% -10.6%
8 Lupin Pharmaceuticals $1.6 2.9% -13.1%
9 Zydus Pharmaceuticals $1.5 2.6% -9.5%
10 Aurobindo Pharma $1.4 2.6% -7.4%
11 Fresenius Kabi USA $1.4 2.6% -16.5%
12 Dr Reddys Lab $1.3 2.4% 1.8%
13 Apotex Corp $1.3 2.4% -7.1%
14 Pfizer $1.3 2.4% 5.6%
15 Grifols USA $1.1 2.0% -4.2%
16 Perrigo $1.0 1.9% -16.8%
17 Northstar Rx $1.0 1.8% 2.3%
18 Glenmark Pharma $0.9 1.6% 7.9%
19 Sun Pharmaceutical $0.9 1.6% 8.2%
20 Cipla USA, Inc. $0.8 1.4% 13.4%
Top 20 Companies $33.7 61.2% -7.5%
Total Unbranded Generic
$55.1 100.0% -4.7%
Market
NOTES: Ranking Based on Sales of unbranded generic products.
Rankings represent current corporate structure. *In November 2020, Mylan merged with Upjohn, Pfizer’s off-patent medicine division,
to form Viatris.

116 Top 10 Biologic Corporations by Revenue: 2021

Rank Company Sales ($bil) Share of Biologic Market (%) Growth (%)
1 AbbVie $41.8 9% 15%

2 Roche $41.0 9% 2%
3 Novo Nordisk $40.8 9% 22%
4 Lilly $33.9 8% 17%
5 Johnson & Johnson $32.1 7% 23%
6 Sanofi $31.7 7% 15%
7 Amgen $28.9 7% 6%
8 Merck & Co $26.6 6% 20%
9 Novartis $20.1 5% 19%
10 Bristol-Myers Squibb $15.1 3% 11%
Top 10 $312.0 71% 14%
Total Biologics Market $441.1 100% 14%

NOTE: Rx only
Source: IQVIA, MIDAS Q4 MAT 2021, accessed May 2022

INTERNATIONAL
Section Overview
The International section includes information on global pharmaceutical sales, market share and
growth, as well as Canadian drug store chains and prescription sales. This section also addresses
emerging markets.
In 2021, IQVIA reported that the worldwide pharmaceutical market exceeded $1.2 trillion.
North America, (excluding Mexico and Central America), accounted for 48.5 percent of the global
pharmaceutical market share, with sales of $597.1 billion. Europe accounted for 23.9 percent, with sales
of $294.1 billion, followed by Asia/Africa/Australia with sales of $217.4 billion in 2021 (Table 117).
The top 10 pharmaceutical markets in the world by dollar share accounted for $987.3 billion in 2021.
The U.S. continued to lead by percent of global market share, with 47 percent or $567.3 billion in sales;
followed by China, with 9.5 percent or $115.3 billion; and Japan, with 6 percent or $72 billion (Table 118).
Canadian Drug Sales

The top 10 Canadian manufacturers by revenue in 2021 accounted for $13.2 billion of the $24.9 billion
total market. Johnson & Johnson was the leading manufacturer with sales of $3 billion; the company
accounted for 12 percent of the market. Additionally:
• Novartis Pharmaceuticals ranked second, with $1.9 billion; followed by,

• AbbVie, with $1.4 billion in sales (Table 121).
In 2021, the top 10 branded products by revenue accounted for $4.6 billion of the total Canadian market
(18 percent). Remicade®, used to treat autoimmune disorders, held the top ranking in 2021 (Table 122).
Pharmerging Nations
According to IQVIA, “pharmerging” nations by growth projections indicated that China’s total spending
(including branded and generic drugs) will increase from $171.7 billion in 2021, to $205.6 billion in 2026
(Table 124).
Table 125 reflects projected Indian pharmaceutical sales by customer categories that are broken down
into four sectors: retail, hospital, dispensing doctors and unaudited market. The total market in 2021
accounted for $25.4 billion in pharmaceutical sales and is expected to reach $39.4 billion by 2026.
• The retail sector is expected to reach $29.2 billion in revenue;

• Hospitals, $3.2 billion;
• Dispensing doctors, $2.1 billion; and,
• The unaudited market, $5 billion by 2026.
India’s Pharmaceutical Market

The top 20 pharmaceutical companies by revenue in India accounted for $11.7 billion of the total
market, which was $16.8 billion in 2021. Sun Pharma was the top-ranked pharmaceutical company, with
sales of $1.4 billion (comprising 8 percent of the market).
• Cipla ranked second, with sales of $1.05 billion and 6 percent of the market share; and,
• Abbott ranked third, with sales of $1.03 billion, also accounting for 6 percent of the market
share (Table 126).
India’s total market of therapeutic classes by sales in 2021 accounted for $16.8 billion; the top 20 classes
make up 84 percent of the market share, with sales of $14.1 billion. The top three therapy classes by
sales were:
• Antibacterial, with sales of $2.4 billion;

• Antidiabetics, with sales of $1.9 billion; and,
• Antihypertensive, with sales of $1.5 billion in 2021 (Table 127).

INTERNATIONAL
117 World Pharmaceutical Market by Market Share: 2021

Growth (%) CAGR (%)
Region Sales ($bil) Market Share (%)
2020-2021 2016-2021
North America $597.1 48.5% 8.3% 5.7%

Europe $294.1 23.9% 12.5% 7.2%
Asia/Africa/Australia $217.4 17.7% 13.4% 6.8%

Japan $76.2 6.2% -1.2% -0.5%
Latin America $45.9 3.7% 12.5% -2.0%

Total Global Sales $1,230.8 100.0% 9.7% 5.4%
NOTE: Rx only, Sales and market share are reported in in LCD$ (converted to US$ using constant exchange rates). Growth rates are calculated
using constant exchange rates.
Source: IQVIA, MIDAS, Q4 MAT 2021, accessed May 2022
118 Top 10 Pharmaceutical Markets in the World by Dollar Sales: 2021

Rank Country Sales ($bil) Market Share (%) Growth (%)
1 USA $567.3 47.0% 8.0%

2 China $115.3 9.5% 8.1%
3 Japan $72.0 6.0% 1.8%
4 Germany $53.2 4.4% 7.6%
5 France $37.2 3.1% 9.0%
6 Italy $33.5 2.8% 7.1%
7 UK $32.4 2.7% 11.7%
8 Spain $27.4 2.3% 9.8%
9 Canada $24.9 2.1% 7.1%
10 Brazil $24.1 2.0% 12.6%
Total Top 10 $987.3 81.7% 7.8%
Total Global Sales $1,208.0 100.0% 8.3%
NOTE: Rx only; Sales and market share are reported in in LCD$ (converted to US$ using constant exchange rates). Growth rates are calculated using
constant exchange rates.

INTERNATIONAL
119 Projected World Pharmaceutical Market by Market Share: 2026

Rank Country 2021 2026
1 USA 44% 42%

2 China 13% 12%
3 Japan 6% 5%
4 Germany 5% 5%
5 France 3% 3%
6 UK 3% 3%
7 Italy 3% 3%
8 Brazil 2% 3%
9 Spain 2% 2%
10 Canada 2% 2%
11 India 2% 2%
12 South Korea 1% 1%
13 Australia 1% 1%
14 Mexico 1% 1%
15 Argentina 1% 1%
16 Saudi Arabia 1% 1%
17 Poland 1% 1%
18 Indonesia 1% 1%
19 Belgium 1% 1%
20 Taiwan 1% 1%
NOTE: Rank is based on 2021 spending in U.S. Dollars with constant exchange rates
Source: IQVIA, Market Prognosis, May 2022
120 Canadian Unbranded Generic Prescription Drug Sales: 2012–2021

Year Generic* Drugs (LCD$bil) Total (LCD$bil)
2012 $3.62 $15.15

2013 $3.50 $15.40
2014 $3.53 $16.09
2015 $3.64 $17.16
2016 $3.85 $18.04
2017 $3.97 $19.13
2018 $3.70 $20.07
2019 $3.69 $21.60
2020 $3.90 $23.26
2021 $4.17 $24.90
*Unbranded Generic Rx only; Limited to Rx Only
Source: IQVIA, MIDAS, Q4 MAT 2012-21, accessed in May 2022

INTERNATIONAL
121 Top 10 Manufacturers in the Canadian Market by Revenue: 2021

Growth (%) CAGR (%)
Rank Company Sales (LCD$mil) Market Share (%)
2020-2021 2016-2021
1 Johnson & Johnson $3,042.1 12% 5% 11%

2 Novartis $1,927.5 8% 4% 5%
3 AbbVie $1,406.5 6% 4% 10%
4 Merck & Co $1,094.1 4% 8% 11%
5 GlaxoSmithKline $993.4 4% -3% 6%
6 AstraZeneca $987.7 4% 6% 11%
7 Bayer $937.2 4% 10% 13%
8 Apotex $937.0 4% 2% 1%
9 Sanofi $934.2 4% 9% 12%
10 Pfizer $894.4 4% 10% 11%
Top 10 $13,154.0 53% 5% 9%
Total Others $11,743.2 47% 9% 5%
Total Audited Market $24,897.2 100% 7% 7%
NOTE: Limited to Rx only.
122 Top 10 Canadian Branded Products by Revenue: 2021

2021 Sales Market Share Constant Dollar 2016-2021
Rank Product Therapeutic Subclass
(LCD$mil) (%) Growth (%) CAGR (%)
1 Remicade® Autoimmune diseases $847.2 3% -1% 1%

2 Humira® Autoimmune diseases $718.7 3% -4% 7%
3 Eylea®
Ocular antineovascularisation $519.3 2% 18% 22%
4 Stelara ®
Autoimmune diseases $491.3 2% 21% 38%
5 Ozempic® Antidiabetics $432.2 2% 85% n/a
6 Keytruda® Oncologics $410.6 2% 41% 95%
7 Eliquis ®
Anticoagulants $324.5 1% 15% 25%
8 Imbruvica ®
Oncologics $306.7 1% 13% 33%
9 Lucentis® Ocular antineovascularisation $262.1 1% 7% -1%
10 Jardiance® Antidiabetics $247.0 1% 24% 65%
Top 10 Brands $4,559.7 18% 15% 17%
Other Brands $13,790.0 55% 5% 6%
*Total Innovative Branded Market $18,349.8 74% 7% 8%
Total Ethical Market (Rx) $24,897.2 100% 7% 7%
NOTE: Limited to Rx only. *Total innovative branded market excludes non-original branded products.

INTERNATIONAL
123 Pharmerging Nations by Growth Projections: 2021–2026

Tier Countries 2021-2026 Absolute Growth (US$bil) 5 year CAGR, 2021-2026 %
1 China $33.9 4%
2 Brazil and India $34.4 10%
Mexico, Turkey, Poland
3 $28.7 13%
and Argentina
NOTE: No data available on Russia (Tier 2)
124 Projected Pharmerging Market Growth: 2026

2021 2026
Country
Total Spending ($bil) Total Spending ($bil)
China $171.7 $205.6

Brazil $31.6 $52.0
India $25.4 $39.4
Russia No data available No data available
NOTE: Sales are reported in LCD$ (converted to US$ using constant exchange rates).
125 Projected Indian Pharmaceutical Sales by Customer Categories: 2026

2021 Constant Dollar Sales (US$mil) 2026 Constant Dollar Sales (US$mil)
Retail Sector $18,837 $29,191

Hospital Sector $2,037 $3,170
Dispensing Doctors $1,344 $2,084
Unaudited Market $3,190 $4,950
Total Market $25,407 $39,395
NOTE: LC$ = local currency sales converted to US dollars using a constant exchange rate

INTERNATIONAL
126 Top 20 Pharmaceutical Companies by Sales in India: 2021

Rank Company 2020 Sales ($mil) 2021 Sales ($mil) Market Share (%) Growth (%)
1 Sun Pharmaceutical $1,217.8 $1,388.2 8% 14%

2 Cipla $897.7 $1,045.6 6% 16%
3 Abbott $905.6 $1,032.6 6% 14%
4 Mankind Pharma $652.8 $782.4 5% 20%
5 Lupin Laboratories $602.1 $683.8 4% 14%
6 Alkem $498.6 $622.2 4% 25%
7 Intas $509.6 $597.9 4% 17%
8 Macleods Pharma $488.8 $594.9 4% 22%
9 Aristopharma $442.0 $556.9 3% 26%
10 Zydus Cadila $474.8 $552.1 3% 16%
11 Torrent $497.7 $548.7 3% 10%
12 Dr Reddys Lab $432.2 $534.4 3% 24%
13 Glenmark Pharma $347.2 $440.0 3% 27%
14 GlaxoSmithKline $343.9 $379.0 2% 10%
15 Emcure $281.0 $361.5 2% 29%
16 USV $322.5 $349.8 2% 8%
17 Sanofi $308.9 $339.6 2% 10%
18 Ipca Labs $274.2 $318.9 2% 16%
19 Pfizer $242.0 $277.1 2% 14%
20 Alembic $229.1 $270.2 2% 18%

Total Top 20 $9,968.6 $11,675.9 70% 17%
Total Market $14,185.1 $16,773.9 100% 18%
NOTES: Countries are ranked by 2021 sales and sales are reported in LCD$ (converted to US$ using constant exchange rates). Growth rates are
calculated using constant exchange rates.
Limited to Rx

INTERNATIONAL
127 Top 20 Therapeutic Classes by Sales in India: 2021

2020 Sales 2021 Sales Market Share
Rank Therapy Class Growth (%)
($mil) ($mil) (%)
1 Antibacterials $1,870.8 $2,391.5 14% 28%

2 Antidiabetics $1,771.2 $1,901.7 11% 7%
3 Antihypertensives $1,369.6 $1,456.8 9% 6%
4 Pain $817.6 $971.2 6% 19%
5 Anti-ulcerants $786.2 $922.5 5% 17%
6 GI products $622.4 $767.1 5% 23%
7 Cough, cold, incl flu antivirals $503.9 $691.2 4% 37%
8 Dermatologics $580.8 $645.9 4% 11%
9 Respiratory agents $502.2 $594.7 4% 18%
10 Nervous system disorders $505.9 $560.1 3% 11%
11 Lipid regulators $454.2 $504.0 3% 11%
12 Vitamins & minerals $344.3 $413.8 2% 20%
Sex Hormones (Androgens, Oestrogens,
13 $322.1 $398.0 2% 24%
Progestogens, Gonadotrophins)
14 Antithrombotics $241.9 $322.7 2% 33%
15 Other CNS $274.7 $312.9 2% 14%
16 Other cardiovascular $263.5 $294.9 2% 12%
17 Oncologics $197.1 $273.7 2% 39%
18 Mental health $212.7 $235.1 1% 11%
19 Respiratory antivirals excl flu $111.7 $227.8 1% 104%
20 Allergy, systemic & nasal $192.5 $223.5 1% 16%
Total Top 20 $11,945.1 $14,109.0 84% 18%
Total Market $14,185.1 $16,773.9 100% 18%
NOTES: TAs are ranked by 2021 sales and sales are reported in LCD$ (converted to US$ using constant exchange rates). Growth rates are
calculated using constant exchange rates.
Limited to Rx
Source: IQVIA, MIDAS, Q4 2021, accessed May 2022

ACKNOWLEDGEMENTS
Industry Data Contributors

The HDA Research Foundation would like to recognize and thank these leading industry organizations
that provided information for the 93rd Edition HDA Factbook (2022-2023). We encourage you to contact
the organizations listed below for further details and information in their areas of expertise.
Chain Drug Review U.S. Centers for Medicare and

126 Fifth Avenue, 12th Floor Medicaid Services
New York, NY 10001 7500 Security Blvd
Ph: 212-213-6000 Baltimore, MD 21244
https://www.chaindrugreview.com/ Ph: 877-267-2323
www.cms.gov
Consumer Healthcare Products Association
1625 Eye Street, NW, Suite 600 U.S. Congressional Budget Office
Washington, DC 20006 Ford House Office Building, 4th Floor
Ph: 202-429-9260 Second and D St. SW
www.chpa.org Washington, DC 20515
Ph: 202-226-2602
IQVIA https://www.cbo.gov/
83 Wooster Heights Road
Danbury, CT 06810 U.S. Food and Drug Administration
Ph: 203-448-4600 10903 New Hampshire Ave
www.iqvia.com Silver Spring, MD 20993
Ph: 888-463-6332
Kindler & Crimmins Associates www.fda.gov
2010 State Road, 2nd Floor
Camp Hill, PA 17011
https://kindler-crimmins.com/
University of Utah Drug Information Services

50 North Medical Drive A050
Salt Lake City, UT 84132
Ph: 801-581-2121
https://pharmacyservices.utah.edu/
Industry Insights, Inc.

The staff at Industry Insights, a leading and independent survey research firm, continues to provide
invaluable research support through survey management, data preparation, and confidentiality
protection services. We thank Scott Hackworth, CPA, President and Marcy Dolnicek, Senior Project
Director, for their dedication and excellent service.
Survey Participants
To all of the entities that participate in our annual survey program, we would like to express our deepest
gratitude and thanks. We appreciate the time and effort you contribute to collect and report the data
and look forward to working with you again next year.

GLOSSARY
These terms are used in the pharmaceutical distribution industry and may be found in the text of the
93rd Edition HDA Factbook: The Facts, Figures & Trends in Healthcare (2022-2023). Words or phrases
defined uniquely by the cited source are listed as table notes.
ANDA Abbreviated New Drug Application
ASN Advance Ship Notice
AWP Average Wholesale Price
Drug stores with four or more stores primarily in the business of retail sales of
Chain Drug Stores pharmaceuticals and OTC products
The amount a distributor bills back to a manufacturer when a product is sold to a customer
Chargeback at a contract price that is less than the distributor's cost
[Beginning inventory + purchases (net of trade discounts & returns, freight, value of
Cost of Goods Sold inventory shrinkage and sales or use taxes) - ending inventory]
Collaborative Planning Forecasting and Replenishment — frequent replenishment of
CPFR product based on actual and forecasted demand
CRM Customer Relationship Marketing
CSOS Controlled Substances Ordering System
DC Distribution center
DEA Drug Enforcement Administration (U.S.)
DME Durable Medical Equipment
Direct to Consumer — pharmaceutical advertising directed to the patient, rather than to

DTC the healthcare professional
DSCSA Drug Supply Chain Security Act
DUNS Data Universal Numbering System
EC Electronic Commerce
EDI Electronic Data Interchange

Electronic Product
Code Information A messaging standard that enables trading partners to share information about the
physical movement and status of products as they travel throughout the supply chain.
Services (EPCIS)
Employee The average number of employees divided by the number of employees leaving in the
Turnover Rate past 12 months
FDA Food and Drug Administration (U.S.)
First In First Out — a method of valuing the cost of goods sold that uses the cost of the
FIFO oldest items in inventory first
The percent of both total sales invoice lines and total sales dollars ordered that are
Fill rate shipped without error or backorder
Full-Time Employees, where the proportion of full-time hours worked is reported for those
FTE’s who do not work full-time
GDP Gross Domestic Product
GLN Global Location Number
GM General Merchandise
Group Purchasing Organization — negotiates buying contracts for healthcare products at

GPO discounted fees for hospitals and health plans

GLOSSARY
Health and Beauty Care — products that do not treat a therapeutic class, (e.g., toiletries
HBC and cosmetics)
HHC Home Healthcare products
HIN Health Industry Number
Health Maintenance Organization — provides, offers or arranges coverage of health

HMO services for a fixed, pre-paid premium
HPC Health and Personal Care (used interchangably with HBC)
IMA Inventory Management Agreement
IMS Inventory Management Systems
Institutional Customers who purchase healthcare products without the primary intention of reselling
Customers them, including hospitals, nursing homes, prisons or institutions
Independent Drug Drug stores with no more than one to three locations, and are not part of a larger chain
Stores
Sales staff that work customer accounts from an office where calls are received for products
Inside Sales Force or services
ISD Insufficient Data
Line Extension Dollar amount of a single invoice line (quantity multiplied by price)
MAT Moving Annual Total
Media Conversion Fax-to-EDI or Web-based solutions to electronically capture information from

Services non-EDI-capable trading partners
NA Not Applicable
NDA New Drug Application
NDC National Drug Code
NME New Molecular Entity
NPA National Prescription Audit
NSP National Sales Perspectives
Non-Stock Sales Products sold by a distributor, but not put into inventory — sold mainly to chain drug warehouses
OTC Over-the-Counter
PBM Pharmacy Benefit Management
Q/M Quarterly/Monthly
R&D Research and Development
Radiographic Drugs used for diagnostic tests, such as dyes, barium and drugs for nuclear diagnostics
Products
Repackaging Removing product from the original package and dividing it into smaller quantity packages
Products unsaleable at the retail level (damaged, outdated, overstocked, etc.) returned to
Returns a manufacturer or distributor for credit
RFID Radiofrequency Identification

GLOSSARY
RONW Return on Net Worth
Saleable Product that may be sold or resold and replaced into inventory
SCEM Supply Chain Event Managment
SKU Stock Keeping Unit — code that identifies each unique product form
Scorecarding An evaluation that assesses the order fulfillment process between trading partners
The process by which specialty products move through the supply chain. Specialty products
are generally defined as products that treat chronic, complex and rare diseases; and have a
minimum of four out of seven following additional characteristics related to the distribution,
care, delivery and/or cost of the medicines: Are high in cost ($6000 or more per year),
Initiated/maintained by a specialist, Require administration by another individual or healthcare
Specialty professional (i.e., not self-administered), Require special handling in the supply chain (e.g.,
Distribution
refrigerator, frozen, chemo precautions, biohazard), Require patient payment assistance,
Distributed through non-traditional channels, Medication has significant side effects that
require additional monitoring/counseling (including, but not limited to REMS programs) and/
or disease requires additional monitoring of therapy (e.g., monitoring of blood/cell counts to
assess effectiveness/side effects of therapy).
Typically a pharmacy function that focuses on high cost, high maintenance products that
treat chronic diseases, such as rheumatology or oncology. These products are nearly
Specialty Pharmacy always injectable, biotech products. Many are associated with complex reimbursement
issues, require specialized shipping and handling, and require disease state management
tools to maximize therapeutic benefit and assure patient compliance
Stock Sales Sales of product that have been unpacked and placed in distributor inventory
TMS Transportation Management Systems
TRx Total Prescription
Unit Dose The package level for a single dose of therapy
Unit of Use The package level for one course of therapy

Healthcare products retuned to distributors or manufacturers which cannot be sold, or
Unsaleable
re-placed into inventory and re-sold
Vendor Managed Inventory — replenishment is managed by the supplier based on the
VMI
trading partner agreement
WAC Wholesale Acquisition Cost
WMS Warehouse Management Systems

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93rd Edition HDA

HDA Research Foundation 2022 Factbook I

Survey Program Data Tabulation

Copyright © 2022 by the HDA Research Foundation

HDA Research Foundation

HDA Research Foundation 2022 Factbook II

Preface Information Systems

HDA Research Foundation 2022 Factbook III

Healthcare Products Market Characteristics

HDA Research Foundation 2022 Factbook IV

HDA Factbook Sponsors

*Source: IQVIA 2021

Real Value Products Corp is a subsidiary of a 35 year wholesale distribution company.

Real Value Rx prides itself on Distribution Excellence, Accuracy & Integrity. We

Regeneron is a leading biotechnology company that invents, develops, and

HDA Research Foundation 2022 Factbook V

IQVIA (NYSE:IQV) is a leading global provider of information, innovative technology

The mission of Pharmacy First is to preserve and provide enhanced profitability

Teva Pharmaceutical Industries Ltd. (NYSE: TEVA) is a leading global

HDA Research Foundation 2022 Factbook VI

• Company Operations Profile Survey;

Distributor Response Rate

Confidentiality and Data Validation Process

HDA Research Foundation 2022 Factbook VII

HDA Factbook Sections and Content

Understanding Reporting Units

HDA Research Foundation 2022 Factbook VIII

Source notes for Table 114:

HDA Research Foundation 2022 Factbook IX

Distributor Sales by Product and Customer Category

• Disease management programs;

HDA Research Foundation 2022 Factbook 1

1 Total Sales Through Distributors: 2018–2021

2 Distributor Company Net Sales Growth: 2019–20211

2019 2020 2021 Average Middle Range Median

3 Distributor Sales by Product Category: 2020–2021

HDA Research Foundation 2022 Factbook 2

4 Distributor Sales by Customer Category: 2020–2021

HDA Research Foundation 2022 Factbook 3

5 Programs and Services Offered by Distributors: 2021

Generic source program 100.0%

Durable medical equipment/home health care 100.0%

Promotional material distribution 100.0%

Reverse distribution 100.0%

Third-party distribution 100.0%

Zone pricing systems 100.0%

Indigent patient program 75.0%

Long-term care facilities 75.0%

Medical/surgical services/products 75.0%

Pharmacy management systems & services 75.0%

Point-of-sale scanning equipment 75.0%

Private labels or control labels 75.0%

Rapid distribution (new product launches) 75.0%

Automated pharmacy dispensing 75.0%

Specialty distribution 75.0%

Third-party claims processing 75.0%

Voluntary or co-op advertising program 75.0%

Compliance (prescription)/refill reminders 50.0%

Orphan drug distribution 50.0%

Packaging (e.g., assembling kits, blister packs) 50.0%

Repackaging (bulk to bottle) 50.0%

Rx data capture for customers 50.0%

Veterinary products 50.0%

Direct-to-customer order fulfillment (internet based pharmacies): OTC products 25.0%