U.S
`Pharmaceutical
`Market:
`
`Trends
`Issues
`&
`Outlook
`
`Prepared for
`
`Perform RX
`
`
`
`By Doug Long
`
`VP Industry Relations
`
`dlong@us.imshealth.com
`
`September 15, 2013
`
`IMS Health Overview
`April 2013
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 1
`
`
`Pharmaceutical
`Market:
`
`Trends
`Issues
`&
`Outlook
`
`Prepared for
`
`Perform RX
`
`
`
`By Doug Long
`
`VP Industry Relations
`
`dlong@us.imshealth.com
`
`September 15, 2013
`
`IMS Health Overview
`April 2013
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 1
`
`
`
`2013 Strategic management presentation
`
`All reproduction rights, quotations, broadcasting, publications
`reserved. No part of this publication may be reproduced or
`transmitted in any form or by any means, electronic or
`mechanical,
`including photocopy,
`recording, or any
`information storage and retrieval system, without express
`written consent of IMS HEALTH.
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 2
`
`
`
`US Market Sales and Dispensed Prescription growth
`
`% Growth of sales and prescription of products
`Total market
`
`Source: IMS Health, National Sales Perspectives, Jun 2013
`
`IMS Health, National Prescription Audit, Jun 2013
`
`6%
`
`5%
`
`4%
`
`3%
`
`2%
`
`1%
`
`0%
`
`-1%
`
`-2%
`
`-3%
`
`2009
`
`2010
`
`2011
`
`2012
`
`MAT Jun 2013
`
`YTD Jun 2013
`
`5.3%
`
`5.2%
`
`4.0%
`
`2.1%
`
`2.4%
`
`2.3%
`
`1.1%
`
`0.8%
`
`1.2%
`
`-0.8%
`
`-2.0%
`-2.2%
`
`Sales
`
`TRx
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 3
`
`
`
`Sales and Adjusted TRx monthly growth
`
`YTD
`
`Source: IMS Health, National Sales Perspectives, Jun 2013, National Prescription Audit, Jun 2013
`
`
`
`Dollars
`
`Adjusted TRxs
`
`12%
`
`10%
`
`8%
`
`6%
`
`4%
`
`2%
`
`0%
`
`-2%
`
`-4%
`
`-6%
`
`% GROWTH
`
`S e p- 1 1
`S e p- 1 2
`D e c-1 1
`D e c-1 2
`Ju n -1 1
`Ju n -1 2
`Ju n -1 3
`A pr-1 3
`A pr-1 2
`N o v-1 1
`N o v-1 2
`M a y-1 1
`M a y-1 2
`M a y-1 3
`F e b-1 3M ar-1 3
`F e b-1 2M ar-1 2
`
`
`Ja n-1 3
`Ja n-1 2
`A u g-1 1
`A u g-1 2
`O ct-1 2
`O ct-1 1
`Jul-1 2
`Jul-1 1
`
`1.6%
`
`-2.2%
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 4
`
`
`
`US Respiratory Incidence Level Comparison
`Average Peal-I us. Average Dame Seasons
`
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`
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`
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`
`Peak Seasons: EISIDD.
`
`[|I3.|'[|Ir1
`
`Dome Seasons: DDFD1, D1102, D2103, D4105, D5105, DEJDF, DTFDE, DEEDS, [1911 D, 10111
`
`MYLAN PHARMS. INC. EXHI
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 5
`
`
`
`2013 is greatly impacted by Cough, Cold, Flu
`
`Total TRX %
`Chg
`
`TRX % Chg
`w/o CCF
`
`CCF Lift
`
`2009
`
`2010
`
`2011
`
`2012
`
`2013 MAT June
`
`2.1%
`
`1.1%
`
`0.8%
`
`1.2%
`
`2.4%
`
`2.0%
`
`1.9%
`
`2.1%
`
`0.8%
`
`1.2%
`
`0.1
`
`0.8
`
`1.3
`
`0.4
`
`1.2
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 6
`
`
`
`Largest absolute growth by leading therapy classes,
`Sales & TRx (MAT)
`
`Source: IMS Health, National Sales Perspectives, Jun 2013, National Prescription Audit, Jun 2013
`
`
`
`Dollars
`
`AC
`US$mn
`
`Total Rx dispensed
`
`AC
`TRxs mn
`
`Analogs of human insulin
`
`2172.0
`
`Anti-depressants
`
`Antiarth,biol resp mod
`
`1854.4
`
`Seizure disorders
`
`Neurological disorders
`
`1009.7
`
`Influenza
`
`Dpp-4 Inhib
`
`883.0
`
`Proton pump inhib
`
`Steroid,inhaled bronch
`
`745.0
`
`Influenza Antivirals
`
`Tyrosine kinase inhibitor
`
`743.8
`
`Beta agonists
`
`HIV antiviral combination
`
`718.5
`
`Angiotensin II antagonists
`
`Specific antagonists
`
`585.2
`
`Hormones,cort plain,oral
`
`GI anti-inflam
`
`546.6
`
`Analeptics
`
`Antineo monoclonal antib
`
`518.0
`
`Antinauseant 5HT3 antag
`
`9.6
`
`8.2
`
`6.1
`
`5.9
`
`5.0
`
`4.4
`
`4.2
`
`4.1
`
`4.1
`
`3.8
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 7
`
`
`
`Largest absolute growth by leading products, Sales &
`TRx (MAT)
`
`Source: IMS Health, National Sales Perspectives, Jun 2013, National Prescription Audit, Jun 2013
`
`
`
`Dollars
`
`AC
`US$mn
`
`Total Rx Dispensed
`
`Humira® (Av1)
`
`Cymbalta® (Lly)
`
`Abilify® (Ots)
`
`Lantus Solostar® (S.A)
`
`Enbrel® (Aai)
`
`Avonex Pen® (Bge)
`
`Tamiflu® (Roc)
`
`Copaxone® (Tvn)
`
`Crestor® (Azn)
`
`Xarelto® (Jan)
`
`977
`
`967
`
`695
`
`681
`
`580
`
`568
`
`atorvastatin ca (atx)
`
`atorvastatin ca (myn)
`
`omeprazole (rx) (atx)
`
`escitalopram oxal (tev)
`
`atorvastatin ca (drl)
`
`clopidogrel bisulf (tev)
`
`512 montelukast sod (myn)
`
`480 montelukast sod (tev)
`
`479
`
`474
`
`amlodipine besy (tev)
`
`Xarelto® (Jan)
`
`AC
`TRxsmn
`
`15.2
`
`12.0
`
`9.0
`
`8.0
`
`7.7
`
`6.2
`
`5.4
`
`5.2
`
`5.1
`
`5.0
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 8
`
`
`
`Largest absolute growth by leading corporations, Sales &
`TRx (MAT)
`
`Source: IMS Health, National Sales Perspectives, Jun 2013, National Prescription Audit, Jun 2013
`
`
`
`Dollars
`
`AC US$BN
`
`TRx
`
`AC TRx mn
`
`Johnson & Johnson
`
`Mylan Labs, Inc.
`
`Novo Nordisk
`
`Roche (incl Genentech)
`
`Gilead Sciences
`
`Otsuka America Ph
`
`Amgen Corporation
`
`Apotex Corp
`
`Dr Reddy Inc
`
`Lupin Pharma
`
`1.6
`
`1.5
`
`1.4
`
`1.2
`
`1.0
`
`0.8
`
`0.7
`
`0.6
`
`0.5
`
`0.5
`
`Apotex Corp
`
`Teva
`
`Aurobindo Pharma
`
`Endo Pharma Inc.
`
`Sun Pharma
`
`Dr Reddy Inc
`
`Wockhardt America
`
`Lupin Pharma
`
`Glenmark Pharma
`
`43.0
`
`38.9
`
`29.9
`
`26.5
`
`19.5
`
`15.6
`
`15.3
`
`12.7
`
` 9.4
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 9
`
`
`
`Specialty market share has increased 6% since 2007
`
`Year 2007
`
`MAT June 2013
`
`12%
`
`20%
`
`2%
`
`19%
`
`27%
`
`1%
`
`66%
`
`Specialty Brand
`
`Specialty Generic
`
`Traditional Brand
`
`53%
`
`Source: IMS Health, National Sales Perspectives, June 2013
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 10
`
`
`
`Generics now account for over 83% of scripts
`
`Branded Generics Disaggregated
`
`Source: IMS Health, National Sales Perspectives, Jun 2013, National Prescription Audit, Jun 2013, Branded generics
`disaggregated
`
` %Dollars %Total prescriptions dispensed
`
`14.2% 14.7% 16.8% 18.1% 20.9% 21.7%
`
`67.9% 70.6% 74.0% 76.7%
`
`80.7% 83.1%
`
`85.8% 85.3% 83.2% 81.9% 79.1% 78.3%
`
`32.1% 29.4% 26.0% 23.3%
`
`19.3% 16.9%
`
`2008
`
`2009
`
`2010
`
`2011
`
`2012
`
`YTD
`Jun
`2013
`
`2008
`
`2009
`
`2010
`
`2011
`
`2012
`
`YTD
`Jun
`2013
`
`Brands
`
`Generics
`
`100%
`
`90%
`
`80%
`
`70%
`
`60%
`
`50%
`
`40%
`
`30%
`
`20%
`
`10%
`
`0%
`
`% MARKET SHARE
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 11
`
`
`
`US patent expiries will total $86Bn through 2017
`
`US Patent Expiry Exposure and Impact
`
`$101Bn
`
`$86Bn
`
`Source: IMS MIDAS, Dec 2012, Institute for Healthcare Informatics
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 12
`
`
`
`U.S. growth recovery helped by health insurance reforms
`and accelerated reviews for innovation
`
`U.S. Spending and Growth, 2008-2017
`
`Forecast
`
`•
`
`• Patent expiries and the impact of low
`cost generics will impact sales growth
`throughout the forecast period, peaking
`in 2012 & 2013.
`• Less impact from expiries contributes to
`approximately half of the higher market
`growth in 2014 relative to 2013.
`Impact of health insurance reforms will
`positively impact growth in 2014; the
`majority of the impact will be seen in the
`retail and primary care sectors.
`• Patent protected brand volume growth is
`expected to slow in advance of key
`patent expiries.
`• Branded price increases above inflation
`will continue though they are expected
`to be offset by off-invoice discounts and
`rebates which are not included in the
`forecasts.
`• New brands contribution to spending will
`increase slightly to $10-12Bn per year as
`the number of approvals increases.
`
`Source: IMS Market Prognosis, Apr 2013 at ex-manufacturer price levels, not including rebates and discounts. Contains
`Audited+Unaudited data
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 13
`
`
`
`NME approvals reached levels not seen in the past
`decade, but most are specialist-driven therapies
`
`NUMBER OF NME APPROVALS
`
`Source: FDA, IMS Institute for Healthcare Informatics, Feb 2013
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 14
`
`
`
`Retail & Mail Sales and Dispensed Prescription growth
`
`% Growth of sales and prescription of products
`Retail and mail order channels
`
`Source: IMS Health, National Sales Perspectives, Jun 2013
`
`IMS Health, National Prescription Audit, Jun 2013
`
`5%
`
`4%
`
`3%
`
`2%
`
`1%
`
`0%
`
`-1%
`
`-2%
`
`-3%
`
`-4%
`
`2009
`
`2010
`
`2011
`
`2012
`
`MAT Jun 2013
`
`YTD Jun 2013
`
`4.4%
`
`2.9%
`
`2.2%
`
`2.7%
`
`2.8%
`
`2.3%
`
`1.1%
`
`0.7%
`
`1.3%
`
`-1.8%
`
`-2.4%
`-2.9%
`
`Sales
`
`TRx
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 15
`
`
`
`Sales by Channel - YTD
`
`Source: IMS Health, National Sales Perspectives, Jun 2013
`
`
`
`Channels
`
`Retail
`
`Chain/Mass
`
`Mail service
`
`Independents
`
`Food stores
`
`Institutional
`
`Clinics
`
`Hospitals
`
`Long-term care
`
`Home health care
`
`HMO
`
`Others
`
`Total
`
`US$bn
`
`116.7
`
`55.6
`
`32.1
`
`17.8
`
`11.0
`
`46.5
`
`20.0
`
`16.5
`
`6.9
`
`1.3
`
`1.3
`
`0.5
`
`71.5
`
`34.1
`
`19.7
`
`11.0
`
`6.8
`
`28.5
`
`12.2
`
`10.1
`
`4.2
`
`0.8
`
`0.9
`
`0.3
`
`163.3
`
`100.0
`
`YTD Jun 2013
`
`% Market
` Share
`
`% Growth
`
`-2.7
`
`-1.0
`
`-5.0
`
`-5.3
`
`-0.3
`
`-0.1
`
`1.5
`
`1.5
`
`-6.3
`
`-6.3
`
`-2.5
`
`-1.3
`
`-2.0
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 16
`
`
`
`Dispensed prescriptions by Channels YTD
`
`Source: IMS Health, National Prescription Audit, Jun 2013
`
`
`
`Channels
`
`Retail
`
`Chain/Mass
`
`Independents
`
`Mail service
`
`Food stores
`
`Non retail channels
`
`LTC
`
`Total
`
`YTD Jun 2013
`
`% Market
` Share
`
`% Growth
`
`2.1
`
`4.2
`
`-1.0
`
`-7.1
`
`2.3
`
`4.5
`
`4.5
`
`2.3
`
`TRxs mn
`
`1,900
`
`1,150
`
`367
`
`122
`
`261
`
`171
`
`171
`
`91.7
`
`55.5
`
`17.7
`
`5.9
`
`12.6
`
`8.3
`
`8.3
`
`2,072
`
`100.0
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 17
`
`
`
`Specialty Pharmaceuticals
`
`Source: IMS Health, National Sales Perspectives, MAT Jun 2013
`
`
`
`Channels
`
`Retail
`
`Chain/Mass
`
`Mail service
`
`Independents
`
`Food stores
`
`Institutional
`
`Clinics
`
`Hospitals
`
`Long-term care
`
`Home health care
`
`HMO
`
`Others
`
`Total
`
`US$Bn
`
`MAT Jun 2013
`
`% Market
` Share
`
`% Growth
`
`46.9
`
`9.5
`
`30.8
`
`5.1
`
`1.6
`
`45.1
`
`27.6
`
`12.6
`
`1.8
`
`1.9
`
`0.8
`
`0.4
`
`51.0
`
`10.3
`
`33.5
`
`5.5
`
`1.7
`
`49.0
`
`30.0
`
`13.7
`
`1.9
`
`2.0
`
`0.9
`
`0.4
`
`92.0
`
`100.0
`
`12.9
`
`7.9
`
`15.3
`
`8.8
`
`10.0
`
`0.8
`
`-0.8
`
`3.3
`
`7.2
`
`-6.9
`
`37.9
`
`-5.9
`
`6.6
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 18
`
`
`
`Specialty Pharmaceuticals
`
`Source: IMS Health, National Prescription Audit, MAT Jun 2013
`
`
`
`Channels
`
`Retail
`
`Chain/Mass
`
`Mail service
`
`Independents
`
`Food stores
`
`Institutional
`
`Long-term care
`
`Total
`
`TRX(Mn)
`
`MAT Jun 2013
`
`% Market
` Share
`
`% Growth
`
`64.5
`
`34
`
`12.6
`
`10.5
`
`7.3
`
`4.8
`
`4.8
`
`69.4
`
`93.1
`
`49.1
`
`18.3
`
`15.2
`
`10.5
`
`6.9
`
`6.9
`
`100.0
`
`13.9
`
`20.3
`
`5.8
`
`1.3
`
`21.9
`
`10.0
`
`10.0
`
`13.6
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 19
`
`
`
`Traditional Pharmaceuticals
`
`Source: IMS Health, National Sales Perspectives, MAT Jun 2013
`
`
`
`Channels
`
`Retail
`
`Chain/Mass
`
`Mail service
`
`Independents
`
`Food stores
`
`Institutional
`
`Clinics
`
`Hospitals
`
`Long-term care
`
`Home health care
`
`HMO
`
`Others
`
`Total
`
`US$Bn
`
`183.8
`
`100.2
`
`33.2
`
`30.4
`
`20.0
`
`47.6
`
`12.3
`
`20.1
`
`11.8
`
`0.8
`
`2.0
`
`0.6
`
`231.4
`
`100.0
`
`MAT Jun 2013
`
`% Market
` Share
`
`% Growth
`
`79.4
`
`43.3
`
`14.4
`
`13.1
`
`8.7
`
`20.6
`
`5.3
`
`8.7
`
`5.1
`
`0.3
`
`0.9
`
`0.3
`
`-6.1
`
`-2.9
`
`-14.8
`
`-8.7
`
`-1.9
`
`-2.1
`
`6.2
`
`-0.5
`
`-10.9
`
`-6.1
`
`-6.9
`
`-4.5
`
`-5.3
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 20
`
`
`
`Traditional Pharmaceuticals
`
`Source: IMS Health, National Prescription Audit, MAT Jun 2013
`
`
`
`Channels
`
`Retail
`
`Chain/Mass
`
`Mail service
`
`Independents
`
`Food stores
`
`Institutional
`
`Long-term care
`
`Total
`
`TRX(Mn)
`
`3717.5
`
`2241.9
`
`239.8
`
`724.1
`
`511.8
`
`332.9
`
`332.9
`
`91.8
`
`55.3
`
`5.9
`
`17.9
`
`12.6
`
`8.2
`
`8.2
`
`4050.5
`
`100.0
`
`MAT Jun 2013
`
`% Market
` Share
`
`% Growth
`
`2.1
`
`3.1
`
`-3.5
`
`-0.4
`
`4.2
`
`3.5
`
`3.5
`
`2.2
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 21
`
`
`
`Specialty Pharmaceuticals
`
`
`Sales US$BN % Sales Share
`
`% Growth
`
`Total market
`
`336.7
`
`100%
`
`-1.9%
`
`Specialty
`
`Oncologics
`
`Autoimmune
`
`HIV Antivirals
`
`Multiple sclerosis
`
`Immunostimulants
`
`Erythropoietins
`
`All others specialty
`(<4US$BN)
`
`93.0
`
`25.5
`
`15.9
`
`12.1
`
`9.4
`
`4.7
`
`4.1
`
`21.1
`
`27.6%
`
`7.6%
`
`4.7%
`
`3.6%
`
`2.8%
`
`1.4%
`
`1.2%
`
`6.3%
`
`7.0%
`
`5.3%
`
`17.7%
`
`9.0%
`
`16.5%
`
`0.2%
`
`-9.5%
`
`2.2%
`
`Non-specialty
`
`243.7
`
`72.4%
`
`-4.9%
`
`Source: IMS Health, National Sales Perspectives, June 2013
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 22
`
`
`
`Most notable things about 2013
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`Strong flu season continued into March
`
`TRXs up 2.4% YTD
`
`Dollars down 2.0% YTD
`
`Hycd and Combinations to Schedule 2?
`
`Massachusetts shuts down 11 Compounding Pharmacies
`
`New head of OGD resigns after 8 months on the job
`
`Bipartisan vote to drop the 2.3% Med device tax
`
`Millions in fines paid on Controlled Substance abuse
`
`Parts of Fed run State exchanges delayed to 2015 (New Estimate 13.8 million new lives)
`
`Cancer clinics are turning away thousands of Medicare patients- blame sequester
`
`Medicaid MC and rationing begins: States limiting RXs for Medicaid patients
`
`Alzheimer’s costs top Cancer and Heart disease
`
`Probe finds 3 NC hospitals reaped millions from 340 B programs
`
`• WAG/ABC relationship
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`India does another compulsory license
`
`FDA bans generic versions of original OxyContin
`
`DOJ socks Novartis twice
`
`Oregon Medicaid study
`
`Higher dosage forms of APAP combinations banned in 2014
`
`Supreme Courts favors FTC on Pay for Delay
`
`Mergers involving Ireland Tax treatments
`
`
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 23
`
`
`
`Top Specialty Products
`
`
`Sales US$BN
`
`% Sales Share
`
`% Growth
`
`SPECIALTY
`
` 93.0
`
`27.6%
`
`HUMIRA
`
`ENBREL
`
`REMICADE
`
`COPAXONE
`
`NEULASTA
`
`RITUXAN
`
`ATRIPLA
`
`AVASTIN
`
`TRUVADA
`
`EPOGEN
`
` 5.1
`
` 4.6
`
` 4.0
`
` 3.8
`
` 3.5
`
` 3.3
`
` 2.9
`
` 2.7
`
` 2.3
`
` 2.2
`
`1.5%
`
`1.4%
`
`1.2%
`
`1.1%
`
`1.0%
`
`1.0%
`
`0.9%
`
`0.8%
`
`0.7%
`
`0.6%
`
`7.0%
`
`23.7%
`
`14.5%
`
`8.5%
`
`14.5%
`
`1.2%
`
`6.0%
`
`4.5%
`
`1.6%
`
`5.1%
`
`-9.8%
`
`Source: IMS Health, National Sales Perspectives, June 2013
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 24
`
`
`
`Five out of the top 10 specialty classes have more than 50% of
`sales from retail and mail order channels
`
`Specialty Class
`
`Spec
`Rank
`
`Total
`Rank
`
`Ttl Volume
`($B)
`
`% Chg. Vs.
`Yr. Ago
`
`Ret. & Mail
`Volume
`($B)
`
`Ret. & Mail
`Share
`
`ONCOLOGICS
`
`AUTOIMMUNE DISEASES
`
`HIV ANTIVIRALS
`
`MULTIPLE SCLEROSIS
`
`IMMUNOSTIM AG EX
`INTFRON, GLATIRAMER
`ACE
`
`ERYTHROPOIETINS
`
`IMMUNOSUPPR FOR
`ORGAN TRANSPLANTS
`ANTIVIRALS,
`EXCL. ANTI-HIV
`OCULAR ANTINEO-
`VASCULARISATION
`POLYVAL
`IMMUNO-GLOBL I.V
`
`1
`
`2
`
`3
`
`4
`
`5
`
`6
`
`7
`
`8
`
`9
`
`10
`
`1
`
`6
`
`9
`
`12
`
`18
`
`21
`
`25
`
`26
`
`37
`
`39
`
`25.5
`
`15.9
`
`12.1
`
`9.4
`
`4.7
`
`4.1
`
`2.6
`
`2.5
`
`1.7
`
`1.7
`
`Source: IMS Health, National Sales Perspectives, June 2013
`
`5.3
`
`7.7
`
`17.7
`
`10.6
`
`9.0
`
`16.5
`
`0.2
`
`-9.5
`
`12.2
`
`-23.2
`
`-0.9
`
`-18.1
`
`9.4
`
`8.4
`
`0.4
`
`0.4
`
`1.8
`
`2.1
`
`0.0
`
`0.1
`
`30.0
`
`66.8
`
`77.6
`
`88.6
`
`9.4
`
`8.6
`
`69.4
`
`84.4
`
`2.2
`
`5.1
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 25
`
`
`
`Five out of the top 10 specialty classes have more than 50% of
`sales from retail and mail order channels
`
`Specialty Class
`
`Retail &
`Share of
`Total
`
`Share of
`Ret &
`
`Retail
`Share of
`Ret &
`
`Chain
`Share of
`Retail
`
`Ind.
`Share of
`Retail
`
`Food
`Share of
`Retail
`
`
`AUTOIMMUNE DISEASES
`
`66.8
`
`74.0
`
`26.0
`
`56.1
`
`27.5
`
`16.4
`
`HIV ANTIVIRALS
`
`77.6
`
`44.7
`
`55.3
`
`61.0
`
`32.9
`
`6.1
`
`MULTIPLE SCLEROSIS
`
`88.6
`
`89.1
`
`10.9
`
`58.6
`
`24.9
`
`16.5
`
`IMMUNOSUPPR FOR
`ORGAN TRANSPLANTS
`
`ANTIVIRALS,
`EXCL. ANTI-HIV
`
`69.4
`
`44.1
`
`55.9
`
`69.8
`
`20.7
`
`84.4
`
`66.5
`
`33.5
`
`42.7
`
`50.9
`
`9.5
`
`6.4
`
`Source: IMS Health, National Sales Perspectives, June 2013
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 26
`
`
`
`Retail and mail order channels account for the majority of sales
`for many of the top specialty products
`
`Specialty
`Product
`
`Retail &
`Share of
`Total
`
`Share of
`Ret. &
`
`Retail
`Share of
`Ret. &
`
`Chain
`Share of
`Retail
`
`Ind.
`Share of
`Retail
`
`Food
`Share of
`Retail
`
`
`HUMIRA
`
`93.4
`
`74.6
`
`25.4
`
`55.0
`
`27.4
`
`17.6
`
`ENBREL
`
`93.5
`
`73.2
`
`26.8
`
`58.2
`
`25.6
`
`16.1
`
`COPAXONE
`
`94.6
`
`88.3
`
`11.7
`
`56.1
`
`25.5
`
`18.4
`
`ATRIPLA
`
`80.0
`
`31.0
`
`69.0
`
`67.4
`
`26.1
`
`TRUVADA
`
`77.3
`
`25.4
`
`76.6
`
`61.7
`
`32.9
`
`6.5
`
`5.4
`
`GLEEVEC
`
`88.8
`
`71.5
`
`28.5
`
`55.9
`
`27.7
`
`16.4
`
`AVONEX
`
`89.2
`
`83.8
`
`16.2
`
`58.9
`
`23.8
`
`17.3
`
`REBIF
`
`93.4
`
`89.3
`
`10.7
`
`64.5
`
`21.5
`
`13.9
`
`Source: IMS Health, National Sales Perspectives, June 2013
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 27
`
`
`
`Nearly one-third of spending is concentrated in the
`top 5 therapy classes
`
`
`Spending in Leading Therapy Areas
`
` Therapy Area
`ONCOLOGICS
`ANTIDIABETES
`MENTAL HEALTH
`PAIN
`RESPIRATORY AGENTS
`AUTOIMMUNE DISEASES
`LIPID REGULATORS
`ANTIHYPERTENSIVE, PLAIN & …
`HIV ANTIVIRALS
`ANTIULCERANTS
`ADHD
`MULTIPLE SCLEROSIS
`ANTIBACTERIALS
`NERVOUS SYSTEM DISORDERS
`VACCINES (PLAIN, COMBO, …
`HORMONAL CONTRACEPTION
`OTHER CNS
`IMMUNOSTIM AG EX INTFRON
`SEX HORMONES
`DIABETES TESTS & OTHER …
`
`Specialty
`
`Traditional
`
`Source: IMS Health, National Sales Perspectives, June 2013
`
`$BN
`25.5
`22.7
`21.2
`19.9
`19.8
`15.9
`15.2
`13.4
`12.1
`10.5
`9.9
`9.4
`8.2
`7.5
`6.4
`5.6
`5.3
`4.7
`4.2
`4.2
`
`GROWTH
`5.3%
`7.4%
`-22.7%
`4.1%
`-10.7%
`17.7%
`-30.0%
`-4.7%
`9.0%
`-0.3%
`2.8%
`16.5%
`0.0%
`7.9%
`12.4%
`4.7%
`9.7%
`0.2%
`11.5%
`2.6%
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 28
`
`
`
`Dispensed prescriptions of leading therapy classes
`
`Source: IMS Health, National Prescription Audit, Jun 2013
`
`
`
`Leading therapy class
`
`US Industry
`
`1 Anti-depressants
`
`2 Lipid regulators
`
`3 Codeine & comb
`
`4 Ace inhibitors
`
`5 Seizure disorders
`
`6 Proton pump inhib
`
`7 Beta blockers
`
`8 Thyroid hormone,synth
`
`9 Calcium blockers
`
`10 Benzodiazepines
`
`Top 10
`
`TRxs mn
`
`4,120
`
`271
`
`249
`
`206
`
`162
`
`130
`
`130
`
`130
`
`111
`
`101
`
`94
`
`1,583
`
`38.4
`
`MAT Jun 2013
`
`% Market
` Share
`
`% Growth
`
`1.0
`
`6.6
`
`6.0
`
`5.0
`
`3.9
`
`3.2
`
`3.1
`
`3.1
`
`2.7
`
`2.5
`
`2.3
`
`2.4
`
`3.7
`
`0.3
`
`-3.4
`
`0.1
`
`6.7
`
`4.8
`
`1.7
`
`2.8
`
`3.0
`
`0.2
`
`1.6
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 29
`
`
`
`Dispensed prescriptions of 11-20 therapy classes
`
`Source: IMS Health, National Prescription Audit, Jun 2013
`
`
`
`Leading therapy class
`
`11 Antiarth,plain
`
`12 Angiotensin II antagonists
`
`13 O/C estrogen/progestogen
`
`14 Beta agonists
`
`15 Biguanides
`
`16 Macrolides & related
`
`17 Penicillins
`
`18 Hormones,cort plain,oral
`
`19 Analeptics
`
`20 Non-barb,oth (Sleep)
`
`Top 20
`
`2,279
`
`55.3
`
`TRxs mn
`
`MAT Jun 2013
`
`% Market
` Share
`
`% Growth
`
`90
`
`89
`
`80
`
`68
`
`67
`
`66
`
`61
`
`58
`
`58
`
`57
`
`2.2
`
`2.2
`
`2.0
`
`1.7
`
`1.6
`
`1.6
`
`1.5
`
`1.4
`
`1.4
`
`1.4
`
`3.7
`
`5.0
`
`3.3
`
`6.9
`
`5.1
`
`-0.5
`
`2.4
`
`7.6
`
`7.6
`
`-4.0
`
`2.3
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 30
`
`
`
`Top 10 Molecules by TRX for MAT June 2013
`
`RK Molecule
`
`TRX (000s) % Change Abs. Chg.
`
`1 APAP/HYCD
`
`2
`
`3
`
`LEVOTHYROXINE
`
`LISINOPRIL
`
`4 SIMVASTATIN
`
`5 METOPROLOL
`
`6 OMEPRAZOLE
`
`7 AMLODIPINE
`
`8 METFORMIN
`
`9 ALBUTEROL
`
`10 ATORVASTATIN
`
`131,606
`
`108,823
`
`92,192
`
`81,270
`
`79,142
`
`69,764
`
`68,475
`
`63,940
`
`63,395
`
`61,069
`
`-3.5%
`
`-4,696
`
`2.7%
`
`3.4%
`
`2,838
`
`3,020
`
`-10.9%
`
`-9,935
`
`3.1%
`
`7.6%
`
`7.0%
`
`6.2%
`
`8.6%
`
`2,347
`
`4,927
`
`4,461
`
`3,713
`
`5,038
`
`26.3%
`
`12,698
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 31
`
`
`
`Fastest growing molecules by TRX
`
`Molecule
`
`ATORVASTATIN
`
`LOSARTAN
`
`ALBUTEROL
`
`OMEPRAZOLE
`
`GABAPENTIN
`
`Absolute Change (000s)
`
`12,698
`
`6,808
`
`5,038
`
`4,927
`
`4,859
`
`Source: IMS Health, National Prescription Audit, June 2013
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 32
`
`
`
`Fastest growing molecules by TRX
`
`Molecule
`
`LOSARTAN
`
`ATORVASTATIN
`
`GABAPENTIN
`
`PRAVASTATIN
`
`FLUTICASONE
`
`Percent Change
`
`29.4%
`
`26.3%
`
`13.7%
`
`10.9%
`
`9.9%
`
`Source: IMS Health, National Prescription Audit, June 2013
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 33
`
`
`
`Slowest growing molecules by TRX
`
`Molecule
`
`SIMVASTATIN
`
`APAP/HYCD
`
`APAP/OXY
`
`ZOLPIDEM
`
`ATENOLOL
`
`Absolute Change (000s)
`
`-9,935
`
`-4,696
`
`-1,653
`
`-1,643
`
`-1,398
`
`Source: IMS Health, National Prescription Audit, June 2013
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 34
`
`
`
`Slowest growing molecules by TRX
`
`Molecule
`
`SIMVASTATIN
`
`ATENOLOL
`
`APAP/OXY
`
`ZOLPIDEM
`
`APAP/HYCD
`
`Percent Change
`
`-10.9%
`
`-4.3%
`
`-4.3%
`
`-3.7%
`
`-3.5%
`
`Source: IMS Health, National Prescription Audit, June 2013
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 35
`
`
`
`Largest absolute neg growth by leading products, Sales
`& TRx (MAT)
`
`Source: IMS Health, National Sales Perspectives, Jun 2013, National Prescription Audit, Jun 2013
`
`
`
`Dollars
`
`AC
`US$mn
`
`Total Rx Dispensed
`
`AC
`TRxs mn
`
`Solodyn® (Mcd)
`
`-312
`
`tramadol hcl (am9)
`
`Pegasys Conven Pac® (Roc)
`
`-326
`
`omeprazole (rx) (sdz)
`
`Lovenox® (S.A)
`
`Incivek® (Vre)
`
`-392 warfarin sod (tev)
`
`-602
`
`lorazepam (atv)
`
`enoxaparin sod (sdz)
`
`-690
`
`simvastatin (drl)
`
`Tricor® (Av1)
`
`-766 metoprolol tart (myn)
`
`Diovan Hct® (Nvr)
`
`-1096 omeprazole (rx) (myn)
`
`Actos® (Tak)
`
`-2442 hycd/apap (atv)
`
`Singulair® (Msd)
`
`-4523 simvastatin (a6d)
`
`Lipitor® (Pfz)
`
`-5023 prednisone (w-w)
`
`-3.4
`
`-3.8
`
`-4.1
`
`-4.1
`
`-4.5
`
`-4.8
`
`-5
`
`-5.4
`
`-5.5
`
`-5.8
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 36
`
`
`
`Abilify® is the leading product in the US
`
`Source: IMS Health, National Sales Perspectives, Jun 2013
`
`
`
`Products
`
`US Industry
`
`1 Abilify® (4/20/15)
`
`2 Nexium® (5/27/14)
`
`3 Crestor® (5/2/16)
`
`4 Cymbalta® (12/11/13)
`
`5 Humira®
`
`6 Advair Diskus®
`
`7 Enbrel®
`
`8 Remicade®
`
`9 Copaxone®
`
`10 Neulasta®
`
`Top 10
`
`Company
`
`US$mn
`
`MAT Jun 2013
`
`% Market
` Share
`
`% Growth
`
`
`
`OTS
`
`AZN
`
`AZN
`
`LLY
`
`AV1
`
`GSK
`
`AAI
`
`JAN
`
`TVN
`
`AAI
`
`
`
`323,359
`
`100.0
`
`6,226
`
`5,982
`
`5,290
`
`5,202
`
`5,092
`
`5,048
`
`4,570
`
`3,991
`
`3,778
`
`3,473
`
`1.9
`
`1.9
`
`1.6
`
`1.6
`
`1.6
`
`1.6
`
`1.4
`
`1.2
`
`1.2
`
`1.1
`
`48,650
`
`15.0
`
`-2.2
`
`12.6
`
`-1.9
`
`10.0
`
`22.8
`
`23.7
`
`5.7
`
`14.5
`
`8.5
`
`14.5
`
`1.2
`
`10.7
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 37
`
`
`
`Half the products in the top 20 are now in Specialty
`
`Source: IMS Health, National Sales Perspectives, Jun 2013
`
`
`
`Products
`
`11 Rituxan®
`
`12 Atripla®
`
`13 Spiriva Handihaler®
`
`14 Januvia®
`
`15 Oxycontin®
`
`16 Avastin®
`
`17 Lantus Solostar®
`
`18 Lantus®
`
`19 Truvada®
`
`20 Lyrica®
`
`Top 20
`
`Company
`
`US$mn
`
`MAT Jun 2013
`
`% Market
` Share
`
`% Growth
`
`GTC
`
`BMG
`
`B.I
`
`MSD
`
`PUF
`
`GTC
`
`S.A
`
`S.A
`
`GS-
`
`PFZ
`
`
`
`3,284
`
`2,929
`
`2,923
`
`2,801
`
`2,719
`
`2,684
`
`2,540
`
`2,432
`
`2,288
`
`2,215
`
`1.0
`
`0.9
`
`0.9
`
`0.9
`
`0.8
`
`0.8
`
`0.8
`
`0.8
`
`0.7
`
`0.7
`
`75,465
`
`23.3
`
`6.0
`
`4.5
`
`10.0
`
`13.9
`
`-3.6
`
`1.6
`
`36.6
`
`14.0
`
`5.1
`
`17.2
`
`10.2
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 38
`
`
`
`Novartis is now the leading company
`
`Source: IMS Health, National Sales Perspectives, Jun 2013
`
`
`
`Leading corporations
`
`US$mn
`
`MAT Jun 2013
`
`% Market
` Share
`
`% Growth
`
`US Industry
`
`323,359
`
`100.0
`
`1 Novartis (incl Sandoz)
`
`2 Merck & Co
`
`3 Pfizer (incl Greenstone)
`
`4 Astrazeneca
`
`5 Roche (incl Genentech)
`
`6 Teva
`
`7 Lilly
`
`8 Amgen Corporation
`
`9 GlaxoSmithKline
`
`10 Johnson & Johnson
`
`19,504
`
`17,334
`
`16,978
`
`16,413
`
`16,229
`
`15,724
`
`14,656
`
`14,277
`
`13,019
`
`12,828
`
`6.0
`
`5.4
`
`5.3
`
`5.1
`
`5.0
`
`4.9
`
`4.5
`
`4.4
`
`4.0
`
`4.0
`
`Top 10
`
`156,961
`
`48.5
`
`-2.2
`
`-4.2
`
`-16.8
`
`-23.6
`
`-14.2
`
`8.3
`
`-0.3
`
`1.8
`
`5.2
`
`1.6
`
`14.3
`
`-5.1
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 39
`
`
`
`Since 2008, there has been an 18% increase in the controlled
`substance drugs in CS Ratings but only 5% in the market
`
`Select Controlled Substance Products
`Total Dispensed Prescriptions
`
`Millions
`180
`175
`170
`165
`160
`155
`150
`145
`140
`135
`130
`
`2008
`
`2009
`
`2010
`
`2011
`
`2012
`
`Oral Solid products only
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 40
`
`
`
`FLORDIA ACTION UNRAVELS NATIONWIDE ISSUE
`
`4
`Other
`Docs
`in
`Same
`Clinic
`
`17000
`Patients
`from
`38
`States
`
`2 Docs
`Indict
`ed in
`2011
`
`41% of
`patients
`visited
` 2 – 9
`Docs,
`
`5%
`visited
`> 10
` Docs
`
`1985
`Stores,
`
`668
`Out
`of State
`
`60,000
`CS Rx’s
`
`47,000
`Paid in
`Cash
`
`44
`
`IMS Confidential and Proprietary Information
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 41
`
`
`
`Multiple stakeholders may be involved in illicit CS activities, but
`no single provider has the full picture
`
`• Retail Pharmacies can only see Rx activity in their stores
`
`− No visibility into physician prescribing or patient purchases outside their
`stores
`
`• Prescribers can only see patient visits/histories in their office
`
`− No visibility into patient visits or Rx history with other physicians
`
`• Wholesalers can only see their own customers’ purchasing
`behaviors
`
`− No visibility into customer purchasing from other sources
`
`
`
`No one stakeholder can identify if activity is normal, or if it should be
`considered an outlier.
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 42
`
`
`
`The Nation's Health Dollar ($2.7 Trillion),
`Calendar Year 2011: Where It Went
`
`1 Includes Research (2%) and Structures and Equipment (4%).
`2 Includes Durable (1%) and Non-durable (2%) goods.
`3 Includes expenditures for residential care facilities, ambulance providers, medical care delivered in non-traditional settings (such as community
`centers, senior citizens centers, schools, and military field stations), and expenditures for Home and community Waiver programs under Medicaid.
`Note: Sum of pieces may not equal 100% due to rounding.
`
`SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group.
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 43
`
`
`
`Spending on health care is driving US federal deficits
`
`Source: 2011 CBO Long-Term Budget
`Outlook
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 44
`
`
`
`Medicaid consumes 11% of the Federal
`government budget and 24% of State budgets
`
`Medicaid as a Proportion of National and State Budgets
`
`US Federal Budget 2011
`$3.6 Trillion
`
`Total of States’ Budgets 2011
`$1.6 Trillion
`
`Medicaid Defense Social Security Elementary & Secondary Education Higher Education All other spending
`
`Source: National Association of State Budget Officers, State Expenditure Report, 2010-2012; Congressional Budget Office
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 45
`
`
`
`Fewer patients made office visits, while ER visits
`increased
`
`Percent Change in Hospital Admissions & Office Visits
`
`Source: IMS Health, National Disease and Therapeutic Index, IMS Hospital CDM, Dec 2012
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 46
`
`
`
`A minority of patients account for the vast majority of
`healthcare costs
`
`Percent of Health Plan Members Ranked by Healthcare Spending ($)
`
`Top 1%
`(≥$48,735)
`
`Source: IMS PharMetrics, Jun 2012
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 47
`
`
`
`Patients’ use of medicines declined by 0.1% in 2012, driven by
`the largest population group, adults aged 26-49
`
`Percent Population, Prescriptions & Per Capita Change in
`Dispensed Prescriptions by Age
`
`Source: IMS Health, Vector One® National, Dec 2012; U.S. Census Bureau
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 48
`
`
`
`Cost Containment Opportunities
`
`Readmissions
`
`Coordination of Care
`
`Pharmacy
`
`20%
`
`$300B
`
`$500B
`
`1 in 5 Medicare FFS patients
`readmit within 30 days
`of discharge1
`
`Treating 60% of high-cost
`chronic condition patients
`yields $300B in savings
`over 10 years3
`
`8% of total health expenditure
`= $500B globally can be
`avoided with optimized
`use of medicines4
`
`21K
`
`AMI
`readmissions
`
`$62B
`
`50%
`
`13.4% or 21,000 AMI Medicare
`admissions readmit within
`15 days, at a cost of $136M2
`
`1.1% of global total
`health expenditure or 62B
`worldwide, can be avoided
`with timely treatment4
`
`Prescriptions not taken as
`directed5 drive $260B in
`additional care costs4
`
`Sources:
`1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among Patients in the Medicare Fee-for-Service Program. New England Journal of Med. 2009;360(14):1418–28
`2. MedPAC. Report to Congress: Promoting Greater Efficiency in Medicare, Oct 2008
`3. David Blumenthal, MD, “More focus on high-cost patients could save $300B,” Healthcare Finance News, Apr. 2012
`4. IMS Institute, Advancing the Responsible Uses of Medicines, October 2012
`5. Lars Osterberg and Terrence Blaschke, “Adherence to Medication,” New England Journal of Medicine, 2005
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 49
`
`
`
`Key takeaways from assessing medicine use
`
`• Over $200 billion in healthcare costs are incurred annually due to
`medicines not being used responsibly
`
`− Patient adherence and delayed evidence-based treatment are the largest
`factors
`
`− Antibiotic use, medication errors, suboptimal generic use and mismanaged
`polypharmacy are also important contributors
`
`• Pharmacies have a critical role to play in addressing key the
`opportunities for improvement
`
`− Unique role and understanding of medicines, direct engagement with patients,
`and link to other stakeholders
`
`− Pharmacists can bring high value to each of the six areas of avoidable costs
`
`• A number of actions can be taken immediately to seize this opportunity
`
`− Barriers to pharmacies playing their full role are formidable but addressable
`
`− A number of actions can be taken immediately
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 50
`
`
`
`Why focus on responsible use of medicines?
`
`Medicines are an integral
`part of healthcare
`
`
`
`But often managed in
`isolation from other parts
`of care.
`
`
`
`Avoidable utilization of health services and costs occur
`each year as a result of medicines not being used
`responsibly
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 51
`
`
`
`Focus of study was limited to six areas
`
`Medicine access and pricing were not addressed
`
`Medication nonadherence
`
`Delayed evidence-based
`treatment
`
`Antibiotic misuse
`
`Medication errors
`
`Suboptimal generics use
`
`Improvement
`in health
`outcomes
`
`Decline in
`healthcare
`costs
`
`Increase in
`medicines
`value
`
`Mismanaged polypharmacy
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 52
`
`
`
`The economic stakes are high for the healthcare system
`
`Estimated avoidable costs by lever ($Bn), 2012
`
`Nonadherence
`
`Delayed
`evidence-
`based
`treatment
`practice
`
`Antibiotic
`misuse
`
`Medication
`errors
`
`Suboptimal
`generics
`use
`
`Total
`Mismanaged
`
`polypharmacy avoidable
`in the elderly
`costs
`
`Source: Avoidable Costs in U.S. Healthcare Study
`
`$35.1
`
`$20.0
`
`$11.9
`
`$1.3
`
`$213.2
`
`$39.5
`
`$105.4
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 53
`
`
`
`The financial costs are caused by avoidable use of
`healthcare services by patients
`
`$213 Bn
`
`Millions of lives affected
`
`10 million hospital visits
`
`78 million outpatient visits
`
`246 million prescriptions
`
`4 million emergency room visits
`
`Utilization
`
`Avoidable Costs,
`US ($Bn)
`
`Source: Avoidable Costs in U.S. Healthcare Study
`
`140
`
`45
`
`22
`
`6
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 54
`
`
`
`Avoidable costs due to nonadherence in the six
`disease areas studied are substantial
`
`Avoidable costs by disease, US$Bn
`
`Avoidable costs by settings of care, US$Bn
`
`105.4
`
`$105.5
`
`44.0
`
`24.6
`
`18.6
`
`15.5
`
`1.8
`1.0
`
`105.4
`
`72.3
`
`23.2
`
`5.1
`4.8
`
`Congestive Heart Failure
`Osteoporosis
`Diabetes
`
`HIV
`Hypertension
`Hypercholesterolemia
`
`ER
`Outpatient
`
`Pharmacy
`Hospital
`
`Source: Avoidable costs in healthcare study
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 55
`
`
`
`Medication adherence is now a more addressable issue
`
`What’s different now
`
`Evidence
`
`The economics of
`adherence have
`changed
`
`• Greater availability of low-cost medicines
`Increased impact from broader range of
`•
`lower-cost interventions
`
`New information and
`analytics capabilities
`can be applied
`
`• Advent of mobile health, social media and
` electronic records
`• Predictive analytics to understand patient
` behavior
`
`More stakeholders
`care
`
`• Payers are paying more attention (e.g. CMS
`Star Ratings)
`• Pharmacies more actively engaged
`• ACO performance metrics
`
`Solutions do not have
`to be high-tech or
`complex
`
`• Growing role for relatively low-cost solutions
`(e.g. mHealth)
`•
`Improved segmentation of interventions to
`•
`lower average cost
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 56
`
`
`
`Avoidable costs due to delayed evidence-based
`treatment practice are substantial in diabetes
`
`Avoidable cost, by disease, US$Bn
`
`Avoidable costs by settings of care, US$Bn
`
`39.5
`
`35.3
`
`2.1
`
`1.3
`0.7
`
`Atrial Fibrillation
`
`HCV
`
`CHD
`
`Diabetes
`
`Source: Avoidable costs in healthcare study
`
`39.5
`
`19.8
`
`14.4
`
`4.4
`
`0.9
`
`ER
`
`Pharmacy
`
`Hospital
`
`Outpatient
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 57
`
`
`
`Timely evidence-based treatment is also receiving
`more attention
`
`What’s different now
`
`Evidence
`
`Access to healthcare
`is expanding
`
`•
`
`Introduction of exchanges and expansion of
`Medicaid program brings new potential
`patients into the healthcare system
`
`Diagnostics
`increasingly available
`at no patient cost
`
`• Expansion of no-cost diagnostic tests
`recommended by NPSTF
`• Greater focus by risk-based providers on
`getting high-cost diseases diagnosed early
`
`Clinical guidelines
`reinforced by use of
`EHRs
`
`• EHRs can build in evidence-based guidance
`for clinicians on risk factors, testing protocols,
`and treatment initiation guidelines
`
`Greater availability of
`more convenient
`medicine forms
`
`• New and more medicine options, including
`oral forms, becoming available for many
`diseases e.g. Atrial fibrillation, Hepatitis C
`
`MYLAN PHARMS. INC. EXHIBIT 1120 PAGE 58
`
`
`
`Avoidable costs due to antibiotics misuse are
`primarily hospital-based
`
`Avoidable cost by settings of care US$Bn
`
`Avoidable outpatient pre
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