OTC, Self-Care Medical Devices, Food Supplements and Herbal Products: Market trends and Opportunities in Germany and Central Europe

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OTC, Self-Care Medical Devices, Food Supplements and Herbal Products: Market trends and Opportunities in Germany and Central Europe Dr. Frank Wartenberg President Central Europe, GM Germany Copyright 2017 QuintilesIMS. All rights reserved.

Consumer Health Definition Main focus of today OTC Over The Counter PEC Personal Care PAC Patient Care NTR Nutrition Registered and unregistered products Pure OTC/ Pharmacy (and other channels) Examples: Cough/ cold, pain, digestive, vitamins and minerals, etc. Products for beauty and hygiene Examples: Emollients, face and hair care, fragrances, oral hygiene Examples: Test and measurement instruments, wound care, stoma care, contact lens care, etc. Examples: Infant and adult formulas, slimming aids, diabetic food, nutritional products, etc. Including Categorised Traditional/Local Medicine Source: QuintilesIMS 1

OTC market continues to grow strongly despite weaker C&C season in some countries Yr on Yr OTC market value growth 2016 $112bn global OTC market +5.3% 3 year growth +4.8% yr on yr growth Source: QuintilesIMS audits plus estimates (excluding Venezuela) 2

Innovation is a key growth driver for Europe alongside value increase in Western Europe Identifying and embracing innovation is an important growth driver for the whole of Europe Global W.Europe CEE Source: IMS OTC Global Analysis 3

Developing markets are driving faster growth including CEE although Western Europe is slower CEEMEA 17% of market value 29% of market growth W. Europe 20% market value and 10% of market growth Source: IMS OTC Global Analysis 4

CCR is the category that is holding back overall OTC market in Europe and VMS is the star growth category Source: IMS OTC Global Analysis Strong growth in largest markets of Germany, Italy, Russia & Poland 5

Some smaller categories are faster growing in Europe such as Eye Care and Anti-haemorrhoid Artificial tears driven Source: IMS OTC Global Analysis 6

The manufacturers are concentrating via M&A although not necessarily finding growth ahead of market Sanofi +2.6% & BI -1.1% Top 10 Corporations Value Share & Latest Year Growth (%) Europe Growth 3.9% SANOFI+BI 6.8% -0.2% 1.5% GSK CH 5.4% -0.1% 1.2% Top 10 corporations account for 32.8% of OTC market BAYER J&J RB PGT 3.4% 2.7% 2.6% 4.7% -0.1% -0.1% 0.0% 0.0% 0.1% 1.0% 2.0% 3.9% NOVARTIS 2.5% -0.1% -0.6% STADA 1.7% 0.0% 6.7% PERRIGO 1.6% 0.0% 1.7% Stada finds strong growth in Russia, UK & Belgium PFIZER 1.5% 0.0% Value Share of OTC Growth < Market Growth > Market GSK CH is an IMS estimate of GSK-Novartis JV/ Bayer includes Merck/RB growth inflated due to taking back RB brands in Germany Source: IMS OTC Global Analysis 4.1% 7

PAC is with 7% 3yrs CAGR growth driver within PEC, PAC, Nutrition markets; PL & HU is fastest growing PEC, PAC & Nutrition development market value growth 2012-2015 in Europe 3.1 0.7 1.0 1.3 MAT Q3/2012 NUT +2% 3.2 0.7 1.1 1.3 MAT Q3/2014 PAC 3.3 0.7 1.2 1.4 MAT Q3/2015 PEC +1% +8% +1% PEC, PAC & Nutrition growth by European country Last year growth in % 30 25 20 15 10 5 0-5 -10 Portugal Belgium Spain Greece Hungary Germany Poland Italy Austria Switzerland France -2-1 0 1 2 3 4 5 6 7 29 30 Market size Q3/2015 3 yrs CAGR in % Source: IMS OTCIMS International in LCEU, Note: European data only available for: Austria, Belgium, France, Germany, Greece, Hungary, Italy, Poland, Portugal, Spain, Switzerland 8

Similar picture holds for PAC only, Medical/Surgical Aids & Tests/Measuring Instruments growing most Last year growth in % 30 25 20 15 10 5 0-5 -10 PAC growth by European country Belgium Germany Spain Switzerland Italy Greece Austria Portugal Hungary Poland France -1 0 1 2 3 4 5 33 Market size Q3/2015 3 yrs CAGR in % Top 10 Categories for PAC in European Region in M LCEU in 2015 Incontinence Care 367.5 Baby Disposables 55.1 Medical/Surgical Aids 48.3 Tests & Measuring Instruments 21.3 Traditional Dressings 16.2 Injection Devices 12.6 Plasters 4.1 Surgical Absorbents 3.7 Bandages 1.5 Fixative & Special Tapes 1.5 Last year growth +28% -2% NA -2% +5% -14% +47% +3% +84% +9% Source: IMS OTCIMS International in LCEU, Note: European data only available for: Austria, Belgium, France, Germany, Greece, Hungary, Italy, Poland, Portugal, Spain, Switzerland 9

Aspects of health innovation are becoming broader and not simply product based 10

Developing regions such as CEE have capacity for further growth in OTC based on per capita spend 11

Europe s future growth is expected to maintain just over 5% with faster growth in developing markets 10% Forecasted OTC Growth rate 5 yr CAGR 2015-2020 9.4% Global OTC grow 5.2% 9% Forecast Annual Growth Rate (%) 8% 7% 6% 5% 4% 3% 2% 1% 0% 5.2% 5.3% Global (Exc Venezuela) 1.8% EMEA N America L America (Exc Venezuela) 5.8% APAC EMEA growth driven by MENA and CEE, with countries such as UAE, Kazakhstan, Bulgaria, Kuwait and Russia expecting double-digit growth In the Americas, low N. America contrasts with high LATAM growth APAC strong growth via a large population, rising awareness of self-medication, favourable government policies and increased marketing activities Source: IMS OTC Global Analysis 12

The new landscape is faster in several ways Faster consumer journeys The journey to get health care products is less and less frequently linked to the traditional additional step of a doctor visit or a prescription Faster purchase decisions Consumer Health is more often part of daily/weekly shopping iterations, when consumers have less time for each purchase decision Faster interaction with brands Consumers have less time on hand to engage with brands via traditional media, and the majority of internet browsing as of 2016 happens on the go via mobile Source: QuintilesIMS 13

The consumer journey is also more complex, becoming more individual and multi-faceted As an example, the Pain Relief consumer journey (as envisioned by RB), can be formed of several different paths Source: RB Investors Day, Nov 2013 14

OTC distribution channels are evolving in response to consumer lifestyle and demands Community pharmacy 15

Across Europe different legislations exist - Poland, UK, Hungary and Netherlands are most liberal Pharmacy Drugstore Super-market Convenience /Gas Mail-Order Germany V V V x V France V x x x x Russia V x x x x Italy V V V x x UK V V V V V Poland V V V V V Spain V x x x V Austria V V V x V Belgium V x x x V Switzerland V V x x V Czech Rep V V V V x Greece V x x x x Netherlands V V V V V Hungary V V V V V Sweden V x V V V Portugal V x V V x Denmark V x V x V Norway V x V V x Source: IMS Consulting team analysis 16

Why is E-Commerce / Mail-Order increasing? Consumers start searching in Wikipedia and then order directly on the Internet More digital patient journeys Convenience Faster delivery of products through advanced logistics Anonymous purchase of sensitive products Privacy Price Large mail-order pharmacies provide 20-60% discount on key OTC brands Source: QuintilesIMS 17

However across Europe channel evolution is moving in different ways and at differing speeds Germany channel shares & 3yr growth Italy channel shares & 3yr growth Netherlands channel shares & 3yr growth Pharmacy Mail Order Drug/Para Pharmacy Mass Market 18

Poland and Germany show high differences in Online drug trade development Online OTC drug sales are common in EU countries, some of them allowing also RX sales E-commerce pharma landscape description E-commerce drug sales started in 2004 after EU Court decision to allow it in all member states Only OTC drugs can be sold online Companies have to own at least one brick and mortar pharmacy to sell online Drug delivery to nearest pharmacy only E-commerce pioneered by biggest chains E-commerce pharma landscape description E-commerce drug sales started in 2004 after EU Court decision to allow it in all member states Germany allowed RX medicines to sell online Online consultations are available Drug delivery is possible E-commerce pioneered by foreign chains (major chains don t exist in Germany) E-commerce market share in total OTC market, % E-commerce market share in total OTC market, % 7,0% 12,0% 0,0% 1,0% 2,5% 0,5% 2005 2010 2015 2005 2010 2015 Source: IMS Consulting team analysis 19

While chains flourish in some markets, the independent pharmacist remains key in many countries Independents 52% 20

At the same time pharmacy faces a wide range of other challenging issues Environment is changing making it harder to maintain growth without channel differentiation Increased efficiency + find new revenue sources Differentiate from new channel competitors Increased support requirements Understand needs & professional relationships 21

In addition consumer market trends are at play regionally and globally and changing habits 22

Counterfeit drugs remain a concern Source: ASOP EU 23

Politicians take actions and continue efforts to highly control the pharmaceutical supply chain Introduction of Falsified Medicines Directive Objective: Protection of patients from falsified medicines in the legal distribution chain Content: Pan-European system to verify the authenticity of medicinal products Scope: All Rx-bound products); OTCproducts cannot be subject to authentication Due date: Implementation in all countries by Q1/2019, Non compliance puts sales at risk!!! Source: EU Falsified Medicines, ESM A European Medicines Verification System 24

European medicines verification is expected to enhance good distribution practice European legislation requires at risk medicines to carry additional safety features All member states will have to implement exactly the same legislation To enable the systematic verification of the authenticity of the medicine at the point of dispense Pack 2D code Anti-tampering + + = Resulting in additional tasks and new costs for the pharmaceutical supply chain Source: EU Falsified Medicines, ESM A European Medicines Verification System 25

Implementation of Falsified Medicines Directive The European Medicines Verification Organisation (EMVO) is a stakeholder model Implementation is due in 2019 2011 2013 2016 2019 July 2011 Publication of FMD Jan 2013 FMD except safety features implemented Q1 2016 Publication of Delegated Regulation Non compliance puts sales at risk!!! Source: EU Falsified Medicines, ESM A European Medicines Verification System 36 months Q1 2019 Implementation in all countries* * Italy, Greece & Belgium have 3 years longer for implementation 26

Highlights & Implications While W. Europe region growth slows, higher growth levels are found in the CEE. Identifying pockets of growth in Europe is becoming critical Innovation is a key growth driver for Europe and innovation could be broader than new products Understanding innovation growth areas is an important sales driver Consumer lifestyle and demands are driving channel change although pharmacy is still King in Europe Building on pharmacy advisory strengths with new services will be important Building on pharmacy strengths in Europe will be key to maintaining channel position Reinforcing pharmacy as a point of professional advice for key consumer groups is a key differentiator 27

Please contact me for further information Dr. Frank Wartenberg President Central Europe frank.wartenberg@quintilesims.com +49 (0) 69 6604-4315 Follow me on Twitter: @FrankWartenberg 28

2017, IMS HEALTH GmbH & Co. OHG All rights reserved. The information may not be duplicated, stored, further processed, nor be made accessible in whole or in part to any third party without the prior express written consent of IMS HEALTH. In connection with data/figures used terms, such as patient, doctor, medical practice, prescriber or pharmacy, do not designate any personal data but exclusively anonymous information (in accordance with 3 Abs. 6 Bundesdatenschutzgesetz German Federal Data Protection Act) IMS employs high sophisticated technologies and methods which ensure all its Information Services to meet the applicable data-protection requirements, regardless the way data are combined with one another. 29