Puerto Rico Pharmaceutical Industry Annual Review

Transcription

1 Puerto Rico Pharmaceutical Industry Annual Review As of month ending December 2017 Cerro Gordo, Vega Alta, Puerto Rico

2 Executive Summary 2017 was more than just the hurricanes IQVIA s data capture and quality Generic market erosion Specialty Pharmacies focus Fixed Date [via Insert tab > Header & Footer]

3 Total PR Market Sales and Growth MAT Dec 2017 $4,000 M $3,500 M Sales $ Volume Sales $ Growth $3,236 M $3,593 M $3,766 M $3,635 M 14.00% $3,000 M $2,500 M $2,912 M 11.11% 11.05% 9.00% $2,000 M 3.86% 4.80% 4.00% $1,500 M $1,000 M -1.00% $500 M $ M -3.47% %

4 Total US Market Sales and Growth MAT Dec 2017 $500 B $450 B Sales $ Volume Sales $ Growth $441 B $463 B $470 B 20.00% 18.00% $400 B $394 B 16.00% $350 B $346 B 14.00% $300 B 13.60% 11.95% 12.00% $250 B 10.00% $200 B 8.00% $150 B 4.72% 6.00% $100 B $50 B $ B 5.15% 1.52% % 2.00% 0.00% Source: SMART US Edition December 2017 Data Month

5 PR Channel Sales per Quarter $700 M HOSPITAL NON RETAIL RETAIL $600 M $500 M $400 M $300 M $200 M $100 M $ M Q Q Q Q Q Q Q Q4 2017

6 Total PR Branded Market Sales and Growth MAT 12/ MAT 12/2017 $3,000 M Sales $ Volume Sales $ Growth 18% $2,500 M $2,262 M $2,438 M $2,412 M $2,000 M $1,860 M $2,047 M 10.1% 10.5% 13% $1,500 M 7.8% 8% $1,000 M $500 M 2.9% 3% -1.1% $ M %

7 Total PR Generic Market Sales and Growth MAT Dec 2017 $1,200 M $1,000 M Sales $ Volume Sales $ Growth $974 M $1,120 M $1,120 M $1,034 M 30% 25% $800 M $828 M 17.7% 15.1% 20% 15% $600 M 6.2% 10% $400 M 0.0% 5% 0% $200 M -5% $ M -7.7% %

8 Top 10 Change-in-Value Corporations driving Growth in Sales Corporations MAT Sales MAT Change in Value * MAT Growth BRISTOL-MYERS SQUI $111,848,314 $14,258, % CIPLA USA, INC. $17,759,777 $11,232, % ABBVIE INC $230,200,721 $8,575, % VIIV HEALTHCARE $59,603,098 $8,306, % BOEHRINGER INGEL $56,494,524 $6,433, % GLAXOSMITHKLINE $102,049,759 $5,321, % NEOLPHARMA INC $5,726,380 $4,435, % NOVO NORDISK $49,170,370 $3,977, % AUROBINDO PHARM $20,808,867 $3,168, % BIOGEN IDEC CORP $64,887,511 $3,104, % * Note: Change in Value = MAT Dec 2017 MAT Dec 2016

9 PR Top 15 Change-in-Value Branded Products driving Growth Product USC3 - Code & Name Corporation MAT Sales MAT Change in Value MAT Growth DESCOVY 04/2016 GS HIV ANTIVIRALS GILEAD SCIENCES,IN $59,694,577 $36,579, % TRIUMEQ 09/2014 VII HIV ANTIVIRALS VIIV HEALTHCARE $29,235,176 $10,964, % GENVOYA 11/2015 GS HIV ANTIVIRALS GILEAD SCIENCES,IN $22,277,807 $8,956, % HUMIRA 01/2003 AV ANTIARTH,SYSTEMIC ABBVIE INC $134,047,860 $8,738, % IBRANCE 02/2015 PFZ ANTINEO ENZYME INHIBITORS PFIZER $20,742,105 $8,526, % EPCLUSA 06/2016 GS NON-HIV ANTIVIRALS GILEAD SCIENCES,IN $12,335,400 $7,899, % ODEFSEY 03/2016 GS HIV ANTIVIRALS GILEAD SCIENCES,IN $21,663,527 $7,844, % ELIQUIS 01/2013 BMP ANTICOAGULANTS BRISTOL-MYERS SQUI $15,682,032 $7,191, % SYMBICORT 06/2007 AZN STEROID,INHALED ASTRAZENECA CORP $18,039,660 $6,636, % HUMALOG 08/1996 LLY DIABETES THERAPY, INSULINS LILLY $56,489,953 $6,410, % NEXPLANON 10/2011 ORG CONTRACEPTIVE DEVICE/IMPLAN MERCK & CO $8,136,448 $5,525, % TIVICAY 08/2013 VII HIV ANTIVIRALS VIIV HEALTHCARE $19,441,142 $5,405, % STELARA 09/2009 JAN IMMUNOMODULATORS JOHNSON & JOHNSON $19,091,215 $5,388, % JANUVIA 10/2006 MSD DIABETES,NON-INSULIN MERCK & CO $30,396,305 $5,351, % OPDIVO 12/2014 BMP ANTINEOPLASTICS,MISC BRISTOL-MYERS SQUI $14,147,672 $5,274, %

10 PR Class of Trade Breakout Sales and Growth -10.% 30.% 70.% 110.% INDEPENDENT PHARM -3.8% $1,100 M $1,144 M CHAIN PHARM - MASS MDSE -5.6% $1,049 M $1,111 M MAIL SERVICE 8.5% $665 M $722 M HOSPITAL -7.8% $444 M $481 M CLINICS -14.8% $223 M $262 M MISC -15.4% $53 M $63 M Growth NURSING HOME $44 M 13.2% $39 M -$0.1B $0.1B $0.3B $0.5B $0.7B $0.9B $1.1B $1.3B Sales $ Volume

11 PR and US Top 20 Corporations in MAT Sales (All Channels) Rank PR Corporation MAT Dec 2017 US Corporation MAT Dec LILLY $250,364,022 JOHNSON & JOHNSON $29,449,700,498 2 ABBVIE INC $230,200,721 ABBVIE INC $24,750,940,223 3 SANOFI AVENTIS $194,548,894 PFIZER $24,353,389,002 4 MERCK & CO $190,820,512 GILEAD SCIENCES,IN $23,836,303,612 5 TEVA PHARM USA $188,814,022 AMGEN CORPORATION $22,530,535,204 6 GILEAD SCIENCES,IN $183,901,096 HOFFMANN-LA ROCHE $22,510,589,605 7 PFIZER $182,887,952 MERCK & CO $21,277,691,836 8 JOHNSON & JOHNSON $172,958,577 NOVARTIS $20,046,498,412 9 NOVARTIS $172,025,850 LILLY $19,323,730, AMGEN CORPORATION $126,420,530 SANOFI AVENTIS $19,160,904, HOFFMANN-LA ROCHE $115,988,477 TEVA PHARM USA $16,809,302, BRISTOL-MYERS SQUI $111,848,314 NOVO NORDISK $16,552,712, GLAXOSMITHKLINE $102,049,759 GLAXOSMITHKLINE $14,535,274, ASTRAZENECA CORP $90,351,832 BRISTOL-MYERS SQUI $13,219,870, ALLERGAN, INC $88,666,070 ALLERGAN, INC $12,814,955, MYLAN LABS, INC. $71,591,579 ASTRAZENECA CORP $11,103,647, BIOGEN IDEC CORP $64,887,511 BOEHRINGER INGEL $9,565,607, VIIV HEALTHCARE $59,603,098 BIOGEN IDEC CORP $8,718,246, BOEHRINGER INGEL $56,494,524 SHIRE US CORP $8,596,630, NOVO NORDISK $49,170,370 MYLAN LABS, INC. $8,374,016,635 Source: Puerto Rico MVP (SMART PR) and SMART US Edition December 2017 Data Month

12 Top 20 Corporations. Branded Sales and Growth Corporation MAT Dec 2017 MAT Dec 2017 MAT Dec 2016 MAT Dec 2015 MAT Dec 2014 Sales $ %Growth %Growth %Growth %Growth LILLY $249,156, % 13.% 16.% -2.3% ABBVIE INC $226,922,042 4.% 16.2% 37.9% 16.% MERCK & CO $190,726, % -6.2% -1.5% 0.3% GILEAD SCIENCES,IN $183,901, % 27.% 30.7% 77.9% SANOFI AVENTIS $181,538, % 10.5% 12.8% 16.4% JOHNSON & JOHNSON $165,605, % 9.5% 13.6% 34.5% PFIZER $132,049,223 1.% 4.5% -5.9% 5.2% AMGEN CORPORATION $126,420,530 2.% -1.3% 15.6% 12.4% HOFFMANN-LA ROCHE $114,717, % 16.% -1.2% 0.9% BRISTOL-MYERS SQUI $110,406, % 29.% 25.3% 11.9% GLAXOSMITHKLINE $100,565,231 7.% 11.6% 7.4% 13.5% ASTRAZENECA CORP $90,001, % 1.8% 4.8% 2.6% NOVARTIS $88,605, % -8.1% -3.2% -5.2% ALLERGAN, INC $67,673, % -19.1% -9.9% 21.3% BIOGEN IDEC CORP $64,887,511 5.% 17.% 8.9% 24.4% VIIV HEALTHCARE $59,603, % 30.1% 43.7% 4.4% BOEHRINGER INGEL $56,494, % 20.7% 21.1% 0.8% NOVO NORDISK $33,830, % -3.5% 10.3% 8.4% TEVA PHARM USA $28,622, % 3.9% 6.6% 1.3% VALEANT CORP $15,508, % 0.2% 84.% 34.5%

13 Top 20 Corporations. Generic Sales and Growth Corporation MAT Dec 2017 MAT Dec 2017 MAT Dec 2016 MAT Dec 2015 MAT Dec 2014 Sales $ %Growth %Growth %Growth %Growth TEVA PHARM USA $146,108, % -21.8% 12.2% 13.2% NOVARTIS $76,513, % 1.1% 12.1% -6.4% MYLAN LABS, INC. $66,724, % -8.9% 11.2% 34.7% SUN PHARMA $43,594, % 24.4% -1.1% 44.7% DR REDDY INC $41,094, % 3.2% 13.8% 16.9% ENDO PHARM INC. $40,810, % -19.5% 12.9% 56.4% LUPIN $39,947, % 12.3% -3.% 11.8% PFIZER $34,768, % -19.% 15.2% -5.6% APOTEX CORP $33,602, % 33.2% 8.3% 1.7% IMPAX LABS $30,238, % 40.6% 28.6% -16.1% FRESENIUS KABI $28,586, % 10.% 6.2% 16.3% GLENMARK PHARMA $24,976,727-5.% 21.8% 37.8% 13.1% HIKMA PHARM $20,926, % -3.9% 21.9% 15.3% AUROBINDO PHARM $20,808, % -2.4% 28.% 23.5% TORRENT PHARM $20,637, % 22.8% 37.8% 103.7% ZYDUS PHARM $19,751, % -11.2% 18.9% 73.2% AMNEAL INC $18,574, % 7.% 24.2% 4.7% ALVOGEN INC $18,254, % 103.7% 57.4% 240.3% VALEANT CORP $18,220, % 54.% 24.8% 6.7% LANNETT $17,924, % 40.9% 52.3% 64.9%

14 PR Generics Pricing Erosion Example Product Corporation MAT Dec 2017 Sales $ MAT Dec 2017 Pack Units MAT Dec 2017 Price/PU MAT Dec 2016 Sales $ MAT Dec 2016 Pack Units MAT Dec 2016 Price/PU MAT Dec 2015 Sales $ MAT Dec 2015 Pack Units MAT Dec 2015 Price/PU ARIPIPRAZOLE 04/2015 TEV TEVA PHARM USA $1,654,584 2,083 $794 $2,515,656 3,213 $783 $3,083,821 4,157 $742 ARIPIPRAZOLE 11/2016 AJA AJANTA PHARMA USA $1,246,128 14,470 $86 $104,220 1,183 $88 ARIPIPRAZOLE 08/2015 AM9 AMNEAL INC $1,005,674 8,676 $116 $624,910 4,383 $143 $6,725 8 $841 ARIPIPRAZOLE 04/2015 TNT TORRENT PHARM $992,775 15,624 $64 $1,691,924 12,870 $131 $1,980,727 4,894 $405 ARIPIPRAZOLE 04/2015 TIG TRIGEN LABS $145, $278 $8,390,624 14,677 $572 $6,385,087 7,648 $835 ARIPIPRAZOLE 04/2015 CM7 HETEROPHARMACEUTIC $73,722 1,166 $63 $198, $1,212 $6,097,260 7,395 $825 ARIPIPRAZOLE 08/2015 SLX SILARX PHARM INC $66, $848 $35, $848 $11, $848 ARIPIPRAZOLE 06/2017 A8H ALEMBIC PHARM $20, $48 ARIPIPRAZOLE 10/2015 AOB AUROBINDO PHARM $18, $257 $31, $651 $771 1 $771 ARIPIPRAZOLE 08/2015 ATX APOTEX CORP $17, $166 $5,188,509 6,818 $761 $2,573,103 3,185 $808 Grand Total $5,241,697 43,233 $121 $18,782,092 43,399 $433 $20,138,510 27,301 $738

15 Top 20 Branded Products Sales and Growth Product Corporations MAT Sales Growth HUMIRA ABBVIE INC $134,047, % LANTUS SANOFI AVENTIS $110,524, % DESCOVY GILEAD SCIENCES,IN $59,694, % HUMALOG LILLY $56,489, % SYNTHROID ABBVIE INC $54,821, % ENBREL AMGEN CORPORATION $54,423, % HUMULIN 70/30 LILLY $52,791, % HUMULIN N LILLY $36,743, % JANUMET MERCK & CO $34,782, % ISENTRESS MERCK & CO $34,352, % JANUVIA MERCK & CO $30,396, % TRIUMEQ VIIV HEALTHCARE $29,235, % RITUXAN HOFFMANN-LA ROCHE $28,560, % ORENCIA BRISTOL-MYERS SQUI $28,319, % HARVONI GILEAD SCIENCES,IN $27,562, % AVASTIN HOFFMANN-LA ROCHE $26,392, % XARELTO JOHNSON & JOHNSON $25,836, % TYSABRI BIOGEN IDEC CORP $24,372,000.56% ADVAIR DISKUS GLAXOSMITHKLINE $24,266, % FLOVENT HFA GLAXOSMITHKLINE $23,624, %

16 Prescriptions

17 TRx Volume PR Pharmaceutical Retail Total Prescriptions (TRxs) and Growth. MAT 12/ MAT 12/2017 TRx Growth 67.0M 66.5M 66.0M TRx Volume TRx Growth 65.8M 66.5M 66.3M 10.0% 8.0% 65.5M 7.1% 6.0% 65.0M 64.5M 3.8% 64.4M 4.0% 64.0M 63.5M 63.0M 63.4M 1.0% -0.2% 2.0% 0.0% 62.5M 62.0M 61.5M -2.9% % -4.0%

18 TRx Volume US Pharmaceutical Retail Total Prescriptions (TRxs) and Growth. MAT 12/ MAT 12/2017 TRx Growth 4,800 M TRx Volume 10.0% 4,700 M TRx Growth 4,624 M 4,696 M 4,684 M 8.0% 4,600 M 4,575 M 4,500 M 4,470 M 6.0% 4,400 M 4.0% 4,300 M 4,200 M 2.5% 2.3% 1.1% 1.6% 2.0% 4,100 M -0.3% 0.0% 4,000 M % Source: SMART US Edition December 2017 Data Month

19 PR Retail Sales and TRxs per Quarter Sales TRxs 18.0M 17.0M 16.0M 15.0M 14.0M 13.0M 12.0M Q Q Q Q Q Q Q Q $600 M $580 M $560 M $540 M $520 M $500 M $480 M $460 M $440 M $420 M $400 M

20 Top 10 Change-in-Value Corporations driving Growth in Retail TRxs Corporation MAT MAT Change in Value * MAT Growth CIPLA USA, INC. 1,573,826 1,210, % ACCORD HEALTHCARE 2,473, , % TORRENT PHARM 1,641, , % ASCEND LABS 1,228, , % GLENMARK PHARMA 1,697, , % LEADING PHARMA 360, , % CITRON PHARMA, LLC 545, , % GREAT LAKES WHLSLE 972, , % LANNETT 1,071, , % AUROBINDO PHARM 1,976, , % * Note: Change in Value = MAT 12/2017 MAT 12/2016

21 Top 20 Products Rank Comparison Retail Branded MAT Sales and TRxs Product (Ranked by Sales) MAT Dec 2017 Sales $ TRx Product (Ranked by TRxs) Sales $ MAT Dec 2017 TRx LANTUS $98,923, ,529 SYNTHROID $50,267,615 1,424,356 HUMALOG $50,212, ,008 HUMULIN 70/30 $47,780, ,756 HUMIRA $34,265,403 8,051 JANUMET $33,520,792 93,279 HUMULIN N $32,667, ,540 JANUVIA $28,956,520 75,781 XARELTO $24,343,630 67,631 ADVAIR DISKUS $21,849,489 75,919 LYRICA $21,138,801 69,323 FLOVENT HFA $19,705, ,521 ENBREL $19,634,687 4,919 HUMALOG MIX 75/25 $18,304,446 33,883 SYMBICORT $17,561,166 72,343 ONGLYZA $16,223,002 42,940 KOMBIGLYZE XR $15,159,031 41,530 ELIQUIS $14,513,838 43,980 JANUMET XR $14,035,641 37,883 HARVONI $13,009, SYNTHROID $50,267,615 1,424,356 LANTUS $98,923, ,529 VENTOLIN HFA $10,802, ,652 HUMULIN 70/30 $47,780, ,756 HUMULIN N $32,667, ,540 HUMALOG $50,212, ,008 FLOVENT HFA $19,705, ,521 JANUMET $33,520,792 93,279 ADVAIR DISKUS $21,849,489 75,919 JANUVIA $28,956,520 75,781 SYMBICORT $17,561,166 72,343 LYRICA $21,138,801 69,323 XARELTO $24,343,630 67,631 LUMIGAN $9,345,342 58,587 HUMULIN R $11,155,879 52,127 FLUVIRIN $93,027 49,140 ELIQUIS $14,513,838 43,980 ONGLYZA $16,223,002 42,940 KOMBIGLYZE XR $15,159,031 41,530 LANTUS SOLOSTAR $11,630,296 40,911

22 Top 20 Specialties Total Rxs, Growth and Share Specialty MAT Dec 2017 TRx TRx Growth TRx Market Share GENERAL PRACTICE 22,492, % 37.01% INTERNAL MEDICINE 10,565, % 17.38% FAMILY MEDICINE 5,763, % 9.48% PSYCHIATRY 3,910, % 6.43% CARDIOVASCULAR DISEASES 3,575, % 5.88% PEDIATRICS 2,070, % 3.41% ENDOCRINOLOGY & METABOLIS 1,475, % 2.43% OBSTETRICS/GYNECOLOGY 989, % 1.63% OPHTHALMOLOGY 952, % 1.57% RHEUMATOLOGY 864, % 1.42% NEUROLOGY 793, % 1.31% GASTROENTEROLOGY 779, % 1.28% PULMONARY DISEASES 576, % 0.95% DENTISTRY 495, % 0.82% EMERGENCY MEDICINE 461, % 0.76% NEPHROLOGY 448, % 0.74% UROLOGY 409, % 0.67% DERMATOLOGY 401, % 0.66% CHILD & ADOLESCENT PSYCH 337, % 0.55% GENERAL SURGERY 336, % 0.55%

23 PR Primary Physicians - TRxs per Quarter M FAMILY MEDICINE GENERAL PRACTICE INTERNAL MEDICINE 6.0M 5.0M 4.0M 3.0M 2.0M 1.0M 0.0M Q Q Q Q Q Q Q Q4 2017

24 Puerto Rico Retail TRxs State Ranking Share and MAT Growth Rank State MAT TRxs Growth MS% 21 ARIZONA 82,515, % 1.78% 22 MARYLAND 79,941, % 1.73% 23 WISCONSIN 79,370, % 1.71% 24 SOUTH CAROLINA 78,895, % 1.70% 25 MINNESOTA 67,982, % 1.47% PUERTO RICO 64,420, % 1.39% 26 OKLAHOMA 59,166, % 1.28% 27 CONNECTICUT 56,267, % 1.22% 28 MISSISSIPPI 54,764, % 1.18% 29 ARKANSAS 54,151, % 1.17% 30 COLORADO 52,088, % 1.13% Source: Puerto Rico MVP (SMART-PR) and SMART Regional MVP December 2017 Data Month

25 Specialty Pharmacies (Non-Retail)

26 Total PR SPP (Non Retail) Market Sales and Growth (MAT 12/2013-MAT 12/2017) $800 M $700 M 55.3% Sales $ Volume Sales $ Growth $671 M $728 M 70% 60% $600 M $552 M 50% $500 M $485 M 40% $400 M $371 M 30.8% $300 M 30% $200 M $100 M $ M 21.6% 20.4% 8.4% % 10% 0%

27 MAT Growth Top 5 SPP (Non Retail) USC2 Markets Based on MAT Sales and Growth Millions 80% $250 $230 Sales $ Volume 70% Sales $ Growth $200 60% $176 50% $150 40% 30% $96 $100 20% 10% 0% 16% 9% 16% $57 $23 4% 4% $50 $0

28 PR Top 15 Change-in-Value SPP (Non Retail) Products driving Growth Product USC3 - Code & Name Corporation MAT Sales MAT Change in Value MAT Growth HUMIRA 01/2003 AV ANTIARTH,SYSTEMIC ABBVIE INC $95,916,699 $8,484, % IBRANCE 02/2015 PFZ ENZYME INHIBITORS PFIZER $16,027,988 $6,626, % STELARA 09/2009 JAN IMMUNOMODULATORS JOHNSON & JOHNSON $14,893,963 $5,464, % KEYTRUDA 09/2014 MSD ANTINEO MONOCLONAL ANTIBODI MERCK & CO $5,583,862 $3,726, % OPDIVO 12/2014 BMP ANTINEO MONOCLONAL ANTIBODI BRISTOL-MYERS SQUI $10,134,014 $3,385, % ENBREL 11/1998 AAI ANTIARTH,SYSTEMIC AMGEN CORPORATION $33,719,954 $3,293, % TECFIDERA 04/2013 BGE NEUROLOGICAL/NEUROMUSC,OTH BIOGEN IDEC CORP $20,352,142 $3,269, % EPCLUSA 06/2016 GS NON-HIV ANTIVIRALS GILEAD SCIENCES,IN $4,610,200 $3,164, % SENSIPAR 04/2004 AAI CALCIMIMETIC AGENTS AMGEN CORPORATION $9,979,056 $3,118, % XELJANZ XR 03/2016 PFZ ANTIARTH,SYSTEMIC PFIZER $3,564,230 $2,853, % IMATINIB MESY 08/2016 ATX ENZYME INHIBITORS APOTEX CORP $2,943,827 $2,798,187 1,921.31% OCREVUS 04/2017 GTC IMMUNOMODULATORS HOFFMANN-LA ROCHE $2,681,250 $2,681, % GILENYA 09/2010 NVR NEUROLOGICAL/NEUROMUSC,OTH NOVARTIS $18,165,272 $2,591, % IMBRUVICA 11/2013 P/Y ENZYME INHIBITORS ABBVIE INC $7,767,907 $2,116, % HERCEPTIN 10/1998 GTC ANTINEO MONOCLONAL ANTIBODI HOFFMANN-LA ROCHE $14,772,437 $1,975, %

29 Top 10 Oncology Products Sales in SPP (Non Retail) MAT Dec 2016 MAT Dec 2017 RITUXAN, 15.7M SPRYCEL, 11.1M RITUXAN, 15.7M SPRYCEL, 12.4M OPDIVO, 6.7M ZYTIGA, 11.6M OPDIVO, 10.1M ZYTIGA, 12.9M IMBRUVICA, 5.7M AFINITOR, 5.3M IMBRUVICA, 7.8M AFINITOR, 5.9M IBRANCE, 9.4M AVASTIN, 16.7M IBRANCE, 16.0M AVASTIN, 18.4M HERCEPTIN, 12.8M ERBITUX, 7.6M HERCEPTIN, 14.8M ERBITUX, 6.9M TOTAL ALL Oncology Products: $198.1M TOTAL ALL Oncology Products: $229.7M Source: Puerto Rico MVP (SMART-PR) and SMART Regional MVP December 2017 Data Month

30 Top 10 Autoimmune Products Sales in SPP (Non Retail) MAT Dec 2016 MAT Dec 2017 TECFIDERA, $17.1M STELARA, $9.4M TYSABRI, $22.0M COPAXONE, $20.5M ENBREL, $30.4M TECFIDERA, $20.4M STELARA, $14.9M TYSABRI, $22.5M COPAXONE, $17.4M ENBREL, $33.7M RITUXAN, $15.7M GILENYA, $15.6M RITUXAN, $15.7M GILENYA, $18.2M REMICADE, $14.4M REMICADE, $15.6M ORENCIA, $20.5M HUMIRA, $87.4M ORENCIA, $21.8M HUMIRA, $95.9M TOTAL: $253.1M TOTAL: $276.0M Source: Puerto Rico MVP (SMART-PR) and SMART Regional MVP December 2017 Data Month

31 Top 5 Corporations Driving SPP (Non Retail) by % Sales Contribution (Total MS% and Growth%) MAT Growth 20% 18% HOFFMANN-LA ROCHE JOHNSON & JOHNSON 10.7% 8.6% 16% 14% ABBVIE INC 16.7% 12% 10% AMGEN CORPORATION 9.1% 8% 6% 4% 2% BIOGEN IDEC CORP 7.8% 0% $30 $40 $50 $60 $70 $80 $90 $100 $110 $120 $130 $140 MAT Dec 2017 Sales Millions

32 PR Top 10 TRxs SPP (Non Retail) Products Product USC3 Corporation MAT Dec 2017 TRx HUMIRA ANTIARTH,SYSTEMIC ABBVIE INC 20,158 SENSIPAR CALCIMIMETIC AGENTS AMGEN CORPORATION 7,756 ENBREL ANTIARTH,SYSTEMIC AMGEN CORPORATION 7,534 RENVELA SPECIFIC ANTAGONISTS SANOFI AVENTIS 6,478 ORENCIA ANTIARTH,SYSTEMIC BRISTOL-MYERS SQUI 6,454 PROLIA BONE DENSITY REGULATORS AMGEN CORPORATION 4,736 TYSABRI IMMUNOMODULATORS BIOGEN IDEC CORP 3,639 RITUXAN ANTINEO MONOCLONAL ANTIBODI HOFFMANN-LA ROCHE 2,975 LUPRON DEPOT ANTINEOPLASTICS HORMONES/AN ABBVIE INC 2,919 TECFIDERA NEUROLOGICAL/NEUROMUSC,OTH BIOGEN IDEC CORP 2,838

33 Total PR SPP (Non Retail) Market TRxs and Growth (MAT 12/2015-MAT 12/2017) $ M TRxs Volume 151,717 70% $ M TRxs Growth 130,330 60% $ M 110,111 50% $ M 40% $ M $ M $ M $ M 10.3% 18.4% 16.4% 30% 20% 10% $ M %

34 2018

35 All Sales January and February 2017 vs 2018 $350,000,000 Sales $ $300,000,000 $250,000,000 $200,000,000 $150,000,000 $100,000,000 $50,000,000 $ Jan 2017 Jan 2018 Feb 2017 Feb 2018 Jan 2017 Jan 2018 Feb 2017 Feb 2018 Presentation Title [via Insert tab > Header & Footer]

36 All TRxs January and February 2017 vs ,000,000 TRx 5,000,000 4,000,000 3,000,000 2,000,000 1,000,000 0 Jan 2017 Jan 2018 Feb 2017 Feb 2018 Jan 2017 Jan 2018 Feb 2017 Feb 2018 Presentation Title [via Insert tab > Header & Footer]

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38 Appendix

39 PR Top 15 Change-in-Value SPP Products driving decline Product USC3 - Code & Name Corporation MAT Sales MAT Change in Value MAT Growth HARVONI 10/2014 GS NON-HIV ANTIVIRALS GILEAD SCIENCES,IN $9,135,000 -$12,820, % SOVALDI 12/2013 GS NON-HIV ANTIVIRALS GILEAD SCIENCES,IN $28,000 -$3,164, % COPAXONE 03/1997 TVN NEUROLOGICAL/NEUROMUSC,OTH TEVA PHARM USA $17,407,408 -$3,137, % VIEKIRA PAK 12/2014 AV NON-HIV ANTIVIRALS ABBVIE INC $277,730 -$2,777, % GLEEVEC 05/2001 NVR ENZYME INHIBITORS NOVARTIS $2,909,889 -$2,056, % IMATINIB MESY 02/2016 SPI ENZYME INHIBITORS SUN PHARMA $1,056,331 -$1,738, % SYNAGIS 09/1998 MIM IMMUNOMODULATORS ASTRAZENECA CORP $5,501,514 -$1,515, % CYCLOPHOSPHAMIDE 11/2014 SDZ ALKYLATING AGENTS NOVARTIS $378,574 -$1,490, % CAPECITABINE 08/2014 MYN ANTINEO ANTIMETABOLITES MYLAN LABS, INC. $957,566 -$1,333, % ELIGARD 05/2002 TP ANTINEOPLASTICS HORMONES/AN TOLMAR INC. $2,254,770 -$1,285, % AVONEX PEN 05/2012 BGE IMMUNOMODULATORS BIOGEN IDEC CORP $7,814,741 -$1,261, % DAKLINZA 07/2015 BMP NON-HIV ANTIVIRALS BRISTOL-MYERS SQUI $21,000 -$1,218, % CIMZIA 04/2008 UCB GI ANTI-INFLAM UCB INC $1,905,090 -$1,079, % CUBICIN 11/2003 MSD ANTNFCT,BROAD/MED SPEC MERCK & CO $1,782 -$1,064, % ALIMTA 02/2004 LLY ANTINEO ANTIMETABOLITES LILLY $2,643,030 -$924, %

40 PR Channel 3-Months AVG Sales Month HOSPITAL NON RETAIL RETAIL $250 M $200 M $150 M $100 M $50 M $ M Source: Puerto Rico MVP (SMART PR) February 2018 Data Month

41 Sales $ Volume Growth % Total PR Market Sales and Growth by Channel MAT Dec 2017 $2.4B Growth 2016 Growth 2017 $2236 M $2255 M $2149 M 30.% 20.% $1.9B 12.51% 13.83% 10.% $1.4B 2.26% 0.86%.% $0.9B -7.45% $843 M $960 M $981 M -4.70% -10.% $0.4B $440 M $495 M $458 M % % -20.% -30.% $74 M $56 M $46 M -$0.1B HOSPITAL NON RETAIL NON-RPT WHOLESALERS RETAIL -40.%

42 Puerto Rico Top 15 USC3 Markets. Sales and Growth -43% -33% -23% -13% -3% 7% 17% 27% 37% 47% 57% DIABETES THERAPY, INSULINS 2.2% $354 M HIV ANTIVIRALS -3.5% $293 M ANTIARTH,SYSTEMIC 4.0% $267 M DIABETES,NON-INSULIN ANTINEOPLASTICS,MISC STEROID,INHALED IMMUNOMODULATORS ANTICOAGULANTS ANTINEO ENZYME INHIBITORS 7.6% 19.2% 1.1% 15.9% 7.9% 20.1% $169 M $166 M $125 M $107 M $97 M $95 M CHOLESTEROL RED RENIN ANGIOTENSIN ANTAG ANTNFCT,BROAD/MED SPEC -32.5% -18.8% -14.8% $90 M $86 M $85 M THYROID HORMONE 2.6% $79 M MAT Dec BRONCHODILATORS GENERAL 4.1% $66 M Growth NEUROLOGICAL/NEUROMUSC,OTH 5.2% $66 M -$300 M -$200 M -$100 M $ M $100 M $200 M $300 M $400 M Sales $ Volume

43 US Top 15 USC3 Markets. Sales and Growth -25% -15% -5% 5% 15% 25% 35% ANTIARTH,SYSTEMIC 15.2% $35 B DIABETES THERAPY, INSULINS 6.2% $30 B ANTINEO MONOCLONAL ANTIBODI HIV ANTIVIRALS IMMUNOMODULATORS DIABETES,NON-INSULIN ENZYME INHIBITORS STEROID,INHALED ANTICOAGULANTS 17.1% 10.3% 29.1% 9.5% 14.4% 1.1% 18.5% $21 B $21 B $20 B $19 B $16 B $15 B $14 B NON-HIV ANTIVIRALS -23.1% $13 B NEUROLOGICAL/NEUROMUSC,OTH 0.7% $11 B ANTIPSYCHOTICS -4.0% $11 B BRONCHODILATORS GENERAL 5.2% $10 B MAT Dec GI ANTI-INFLAM 1.1% $10 B Growth ANALEPTICS -6.9% $9 B -$29 B -$19 B -$9 B $1 B $11 B $21 B $31 B $41 B Sales $ Volume Source: SMART US Edition December 2017 Data Month

44 Growth Top 5 Corporations Driving Non Retail SPPs & Mail Service by % Sales Contribution (Total MS% and Growth%) % ABBVIE, 12.2% J&J, 9.7% 100.0% AMGEN, 8.3% 80.0% BIOGEN, 9.5% 60.0% 40.0% 20.0% 0.0% ABBVIE, 15.6% ROCHE, 12.5% AMGEN, 8.7% ABBVIE, 16.5% BIOGEN, J&J, 8.1% 8.6% ROCHE, 10.7% AMGEN, 7.9% J&J, 8.9% AMGEN, ROCHE, 9.1% 10.0% J&J, 8.0% ABBVIE, 16.7% BIOGEN, ROCHE, 7.8% 11.1% BIOGEN, 8.2% $ $50 $100 Millions $150

45 MILLIONS PR Retail 3-Months AVG Sales and TRxs Sales TRxs $300 M 7.0 $250 M $200 M 4.0 $150 M 3.0 $100 M $50 M 0.0 $ M Source: Puerto Rico MVP (SMART PR) February 2018 Data Month

46 PR Brand and Generics Growth Impact by Retail Total Rx s. 5.0% BRAND BRANDED GENERIC GENERIC OTHER 0.0% -5.0% -2.0% -0.6% -10.0% -15.0% -9.4% % -25.0% -20.2% Brand/Generic MAT Dec 2016 MAT Dec 2017 TRx TRx Growth TRx TRx Growth BRAND 5,478, % 4,963, % BRANDED GENERIC 1,568, % 1,251, % GENERIC 53,622, % 52,576, % OTHER 5,663, % 5,627, % Grand Total 66,332, % 64,420, %

47 Top 20 Corporations. Total Retail Prescriptions and Growth Corporation MAT Dec 2017 TRx MAT Dec 2017 TRx Growth MAT Dec 2016 TRx Growth MAT Dec 2015 TRx Growth MAT Dec 2014 TRx Growth TEVA PHARM USA 7,507, % -15.5% -4.9% -4.0% MYLAN LABS, INC. 4,004, % -5.0% 6.3% 2.1% NOVARTIS 3,778, % -4.2% -0.2% 2.2% ENDO PHARM INC. 2,747, % -13.1% -4.0% 21.0% ACCORD HEALTHCARE 2,483, % 28.8% 77.7% 64.6% LUPIN 2,406, % -8.1% 1.2% -0.2% AUROBINDO PHARM 1,979, % 19.7% 23.2% 5.0% AMNEAL INC 1,789, % -11.9% -7.9% -0.4% GLENMARK PHARMA 1,699, % 27.8% 24.2% 3.9% SUN PHARMA 1,665, % -14.2% -18.7% 4.4% TORRENT PHARM 1,642, % 10.6% 18.4% 51.7% DR REDDY INC 1,612, % -2.4% -2.7% 23.1% CIPLA USA, INC. 1,576, % % % 7.2% PFIZER 1,533, % -23.3% -7.7% -6.5% APOTEX CORP 1,528, % 6.1% 4.6% 16.6% ABBVIE INC 1,481, % 2.9% 1.8% 6.5% ASCEND LABS 1,230, % 38.1% 35.2% 88.9% HIKMA PHARM 1,175, % 2.9% 0.7% -15.4% ZYDUS PHARM 1,087, % -7.5% 1.3% 15.1% SOLCO HEALTHCARE 1,078, % 75.0% 51.2% 132.8%

48 Puerto Rico Top 10 USC2 Markets. TRxs and Growth -22.0% 18.0% 58.0% 98.0% 31 VASCULAR AGENTS -2.8% PARASYMPATHETICS -1.4% DIABETES THERAPY -1.1% NEUROLOGICAL DISORDERS 1.3% ANTIHYPERLIPIDEMIC AGENTS 0.8% GASTROINTESTINAL -3.5% ANALGESICS -3.7% 3.3 MAT Dec ANTI-INFECTIVES SYSTEMIC -9.6% 2.9 Growth 72 THYROID THERAPY 0.1% RESPIRATORY THERAPY 1.4% TRxs Volume Millions

49 Top 20 Products Rank Comparison Retail Generic MAT Sales and TRxs Product (Ranked by Sales) Sales $ MAT Dec 2017 TRx METOPROLOL SUCCIN $20,765, ,178 BUDESONIDE $20,672, ,574 ATORVASTATIN CA $20,156,754 1,471,906 FENOFIBRATE $17,789, ,908 ENALAPRIL MAL $16,993, ,983 DICLOFENAC POT $16,346, ,517 LEVOTHYROXINE SOD $13,644,954 1,238,805 GABAPENTIN $10,600,665 1,620,585 AZITHROMYCIN $9,921, ,407 MONTELUKAST SOD $9,913, ,342 CLOTRIM/BETAMETH DIPR $9,112, ,489 RIVASTIGMINE $8,638,063 32,684 OMEPRAZOLE (RX) $8,435, ,063 LOSARTAN POT $8,197,523 1,529,018 BUPROPION HCL XL $8,053, ,180 RALOXIFENE HCL $8,038,953 71,825 CLOBETASOL PROP $8,027,203 41,951 KETOCONAZOLE $7,980, ,180 LOSARTAN POT/HCTZ $7,221, ,437 AMOX TR/POT CLAVUL $6,832, ,943 Product (Ranked by TRxs) MAT Dec 2017 Sales $ TRx GABAPENTIN $10,600,665 1,620,585 METFORMIN HCL $5,624,523 1,612,504 SIMVASTATIN $4,691,135 1,561,890 LOSARTAN POT $8,197,523 1,529,018 ATORVASTATIN CA $20,156,754 1,471,906 RANITIDINE HCL $5,530,678 1,415,223 CLONAZEPAM $3,390,807 1,260,184 LEVOTHYROXINE SOD $13,644,954 1,238,805 AMLODIPINE BESY $1,911,326 1,220,423 OMEPRAZOLE (RX) $8,435, ,063 LISINOPRIL $1,473, ,044 ENALAPRIL MAL $16,993, ,983 LOSARTAN POT/HCTZ $7,221, ,437 MONTELUKAST SOD $9,913, ,342 METOPROLOL SUCCIN $20,765, ,178 AZITHROMYCIN $9,921, ,407 TEMAZEPAM $2,308, ,854 HYDROCHLOROTHIAZIDE $1,288, ,490 SERTRALINE HCL $2,088, ,105 ATENOLOL $863, ,503

50 MILLIONS PR Retail 3-Months AVG Sales and TRxs Sales TRxs $300 M 7.0 $250 M $200 M 4.0 $150 M 3.0 $100 M $50 M 0.0 $ M Source: Puerto Rico MVP (SMART PR) February 2018 Data Month

51 Thousands Total Prescriptions per Payment Type Cash Medicaid (PR-Health Reform-FSS) Other 3rd Party Medicare Part D 3,000 2,500 2,000 1,500 1, Source: Xponent PlanTrak Puerto Rico MVP February 2018 Data Month