US Pharmaceutical Trends, Issues and Outlook for NACDS TSE

© 2020. All rights reserved. IQVIA® is a registered trademark of IQVIA Inc. in the United States, the European Union, and various other countries.

Presented by:

Doug Long, VP, Industry Relations

Scott Biggs, Director, Supplier Services

August 2021

US Pharmaceutical Trends, Issues

and Outlook for NACDS TSE

IQVIA Template (V2.1.0)

1

Each year at the NACDS Total Store Expo, IQVIA recognizes an industry leader who exemplifies the true meaning

of partnership through the extension of the Bernie Greenberg Pharmacy Partnership Award. Like the

namesake of this award, this recognition is to acknowledge an industry partner who displays and embraces such

traits as leadership, collaboration, and giving back to their organizations and others

This year, rather than awarding this to an

individual or a single industry partner,

IQVIA would like to honor ALL of the

pharmacy leaders, pharmacists, staff, and

pharmacies who have focused on caring

for their patients and customers during

the 2020 and 2021 COVID-19 crisis. You

and they ARE the heroes. As part of this

recognition, IQVIA provides a $10,000

contribution to the NACDS foundation

2013 Rite Aid Robert Thompson

2014 Walgreens Gerry Gleeson

2015 Walmart, Sam’s ClubDarren Townzen

John Luebker

2016 Kroger Phelicia Avery

2017 Walgreens Rick Gates

2018 Albertsons Dan Salemi

2019 WegmansJohn Carlo

Jack Coultry

2020 All pharmacists, staff and pharmacies

2021All pharmacy leaders, pharmacists, staff and

pharmacies

Year Company Winner(s)

IQVIA© 2021 Confidential & Proprietary

2

COVID Cases, Deaths

and Vaccines

IQVIA – Confidential & Proprietary

3

Daily COVID Cases in the U.S. continue to increase in recent weeks


0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

1/2

3/2

0

2/6

/20

2/2

0/2

0

3/5

/20

3/1

9/2

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4/2

/20

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4/3

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6/2

5/2

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7/9

/20

7/2

3/2

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8/6

/20

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9/3

/20

9/1

7/2

0

10

/1/2

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/15

/20

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/29

/20

11

/12

/20

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/26

/20

12

/10

/20

12

/24

/20

1/7

/21

1/2

1/2

1

2/4

/21

2/1

8/2

1

3/4

/21

3/1

8/2

1

4/1

/21

4/1

5/2

1

4/2

9/2

1

5/1

3/2

1

5/2

7/2

1

6/1

0/2

1

6/2

4/2

1

7/8

/21

7/2

2/2

1

8/5

/21

U.S. COVID Daily Cases

New Cases 7-Day Moving Avg

Source: https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases – data as of August 18, 2021

https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases

4

Daily COVID Deaths in the U.S. have also been increasing in recent weeks


0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

1/2

2/2

020

2/5

/202

0

2/1

9/2

020

3/4

/202

0

3/1

8/2

020

4/1

/202

0

4/1

5/2

020

4/2

9/2

020

5/1

3/2

020

5/2

7/2

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6/1

0/2

020

6/2

4/2

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7/8

/202

0

7/2

2/2

020

8/5

/202

0

8/1

9/2

020

9/2

/202

0

9/1

6/2

020

9/3

0/2

020

10

/14

/202

0

10

/28

/202

0

11

/11

/202

0

11

/25

/202

0

12

/9/2

020

12

/23

/202

0

1/6

/202

1

1/2

0/2

021

2/3

/202

1

2/1

7/2

021

3/3

/202

1

3/1

7/2

021

3/3

1/2

021

4/1

4/2

021

4/2

8/2

021

5/1

2/2

021

5/2

6/2

021

6/9

/202

1

6/2

3/2

021

7/7

/202

1

7/2

1/2

021

8/4

/202

1

U.S. COVID Daily Deaths

Daily Deaths 7-Day Moving Avg

Source: https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases – data as of August 18, 2021

https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases

5

Daily Count of Total Doses Administered and Reported


0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

4,500,000

5,000,000

12

/14

/202

0

12

/21

/202

0

12

/28

/202

0

1/4

/202

1

1/1

1/2

021

1/1

8/2

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1/2

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/202

1

2/8

/202

1

2/1

5/2

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2/2

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3/1

/202

1

3/8

/202

1

3/1

5/2

021

3/2

2/2

021

3/2

9/2

021

4/5

/202

1

4/1

2/2

021

4/1

9/2

021

4/2

6/2

021

5/3

/202

1

5/1

0/2

021

5/1

7/2

021

5/2

4/2

021

5/3

1/2

021

6/7

/202

1

6/1

4/2

021

6/2

1/2

021

6/2

8/2

021

7/5

/202

1

7/1

2/2

021

7/1

9/2

021

7/2

6/2

021

8/2

/202

1

8/9

/202

1

Daily Count of Total Doses Administered and Reported to CDC by Date Administered, United States

Total Doses Administered Daily 7-Day Avg Total Doses Daily

Data Source: https://covid.cdc.gov/covid-data-tracker/#vaccination-trends – as of August 14, 2021

https://covid.cdc.gov/covid-data-tracker/#vaccination-trends

6

COVID Vaccines in Retail show an uptick starting mid-July


0

1

2

3

4

5

6

7

8

12

/18

/20

12

/25

/20

01

/01

/21

01

/08

/21

01

/15

/21

01

/22

/21

01

/29

/21

02

/05

/21

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/21

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/19

/21

02

/26

/21

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/05

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/12

/21

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/19

/21

03

/26

/21

04

/02

/21

04

/09

/21

04

/16

/21

04

/23

/21

04

/30

/21

05

/07

/21

05

/14

/21

05

/21

/21

05

/28

/21

06

/04

/21

06

/11

/21

06

/18

/21

06

/25

/21

07

/02

/21

07

/09

/21

07

/16

/21

07

/23

/21

07

/30

/21

08

/06

/21

08

/13

/21

Mill

ion

s

Chain Independents Food Mass Retail Market

Data Source: IQVIA Xponent®

7

As of August 15th, almost 51% of the entire population is vaccinated, with over 80% of the 65+ age group vaccinated

Source: https://covid.cdc.gov/covid-data-tracker/#vaccinations – Based on CDC data as of August 15th

19

8.1

16

8.4

59.7%

50.7%

0%

10%

20%

30%

40%

50%

60%

70%

20

40

60

80

100

120

140

160

180

200

At le

ast 1

Dose

Fully

Vaccin

ate

d

Perc

en

t of P

op

ula

tion

Pop

ula

tion

in M

illio

ns

VACCINES ADMINISTERED

18

5.9

15

9.2

72.0%

61.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

20

40

60

80

100

120

140

160

180

200

At le

ast 1

Dose

Fully

Vaccin

ate

d

Perc

en

t of P

op

ula

tion

Pop

ula

tion

in M

illio

ns


≥ 18

49.7 44.2

90.9%

80.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

20

40

60

80

100

120

140

160

180

200

At le

ast 1

Dose

Fully

Vaccin

ate

d

Perc

en

t of P

op

ula

tion

Pop

ula

tion

in M

illio

ns


≥ 651

97

.9

16

3.2

69.8%

59.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

20

40

60

80

100

120

140

160

180

200

At le

ast 1

Dose

Fully

Vaccin

ate

d

Perc

en

t of P

op

ula

tion

Pop

ula

tion

in M

illio

ns


≥ 12


https://covid.cdc.gov/covid-data-tracker/#vaccinations

8

According to a Kaiser Family Foundation Poll conducted May 18-25, 2021:

Vaccine Hesitancy – Who are the unvaccinated?

Here Are The Biggest Groups That Are Still Refusing The Covid-19 Vaccine, Poll Finds (forbes.com) retrieved on August 10, 2021

AGE

The highest share of

unvaccinated respondents were

30-49 years old (41%), followed

by 29% ages 18-29 and 20%

ages 50-64, while only 9% of

those unvaccinated were

65 and older

SOCIOECONOMIC

STATUS

More likely to have lower

education levels (46% attended

only high school or less) and

lower income levels (42% earn

less than $40,000 per year) than

their vaccinated counterparts,

who are nearly twice as likely to

have earned a college degree

or more

POLITICAL PARTY

AFFILIATION

Nearly half of unvaccinated

respondents were Republicans

(49% versus 29% Democrats),

as opposed to 31% of

vaccinated respondents who

identified as Republicans and

59% Democrats

RACIAL IDENTITY

Both unvaccinated and

vaccinated respondents were

disproportionately likely to be

white (56% unvaccinated versus

64% vaccinated), based in the

suburbs (56% unvaccinated

versus 52% vaccinated) and

have health insurance

(76% unvaccinated versus 88%

vaccinated).


https://www.forbes.com/sites/alisondurkee/2021/06/11/here-are-the-biggest-groups-that-are-still-refusing-the-covid-19-vaccine-poll-finds/?sh=5c12d63c42cc

9

Based on race/ethnicity data available for 57% of people who have received at least one vaccine dose

Figure 1: Race/Ethnicity of People Receiving a COVID-19 Vaccine in the U.S. as of August 2, 2021

KFF

Race/Ethnicity of People Receiving a COVID-19 Vaccine in the U.S. as of August 2, 2021

Note: Totals may not sum to 100 due to rounding, Persons of Hispanic origin may be of any race but are categorized as Hispanic; other groups are non-Hispanic, Other race includes multiple race individuals

Source: Centres for Disease Control and Prevention, Demographic Characteristics of People Receiving COVID-19 Vaccinations in the United States, data as of August 2, 2021, accessed August 3, 2021,

http://covid.cdc.gov/covid-data-tracker/#vaccination-demographic; Latest Data on COVID-19 Vaccinations by Race/Ethnicity | KFF Retrieved on August 10, 2021

59%

45%

61%

10%

15%

12%

16%26%

17%6% 4%

6%1% 1%1%8% 8% 2%

People who have Received at least One Dose People who Initiated Vaccination in Last 14 Days Total U.S. Population

White Black Hispanic Asian AIAN NHOPI Other


http://covid.cdc.gov/covid-data-tracker/#vaccination-demographic

https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/

10

Percent of Total Population that Has Received at Least One COVID-19 Vaccine Dose by Race/Ethnicity, March 1 to August 2, 2021

Figure 4: Percent of Total Population that Has received at Least One COVID-19 vaccine Dose by Race/Ethnicity, March 1 to August 2, 2021

Source: Vaccination data based on KFF analysis of publicity available data on state websites; total population data used to calculate rates based on KFF analysis of 2019 American Community Survey data

7%

11%

15%

20%24%

27%29%

31% 33%34% 36%

38%

5%9%

13%

19%

25%

29%32%

35%38%

39% 41% 43%

13%

19%

25%32%

38%40%

43% 44%46% 47% 48%

49%

11%16%

23%

33%

45%

50%

54%57%

60%62%

65%66%

3/1/202136 States

3/15/202139 States

3/29/202140 States

4/12/202143 States

4/26/202143 States

5/10/202142 States

5/24/202140 States

6/7/202141 States

6/21/202140 States

7/6/202140 States

7/19/202140 States

8/2/202140 States

Black Hispanic White Asian


11

Non-COVID weekly vaccine utilization is flat compared to 2020 after a period of accelerated activity that compensated for lockdown dips


Source: IQVIA Weekly Sales Perspectives (WSP), July 20 – July 21; Note: Data reflects sales to clinic channel as defined by IQVIA –

No methodology has been applied to determine VACCINE USE BY AGE

0

100

200

300

400

500

600

700

07

/20

08

/20

09

/20

10

/20

11

/20

12

/20

01

/21

02

/21

03

/21

04

/21

05

/21

06

/21

Thousands

Weeks

Weekly Volume Unit Clinic Sales for Selected Pediatric Vaccines*

-4%

-80%

-40%

0%

40%

80%

120%

30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28

Weeks

YoY Weekly Growth %Pediatric Vaccine Market Basket vs. Actual 2020

Weekly Growth Cumulative Growth

3%

-100%

-50%

0%

50%

100%

150%

200%

30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28

Weeks

YoY Weekly Growth %Adult Vaccine Market Basket vs. Actual 2020

Weekly Growth Cumulative Growth

0

50

100

150

200

250

300

07

/20

08

/20

09

/20

10

/20

11

/20

12

/20

01

/21

02

/21

03

/21

04

/21

05

/21

06

/21

Thousands

Weeks

Weekly Volume Unit Clinic Sales for Selected Adult Vaccines*

12

Last season flu vaccinations at Retail were up 37% on a YoY basis, the new flu vaccination season is starting slower so far


-

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7/2

/21

7/1

6/2

1

7/3

0/2

1

8/1

3/2

1

8/2

7/2

1

9/1

0/2

1

9/2

4/2

1

10

/8/2

1

10

/22

/21

11

/5/2

1

11

/19

/21

12

/3/2

1

12

/17

/21

12

/31

/21

1/1

4/2

2

1/2

8/2

2

2/1

1/2

2

2/2

5/2

2

3/1

1/2

2

3/2

5/2

2

Total Retail Flu Vaccinations - YoY Trend Comparisons

2019-20 Season 2020-21 Season 2021-22 Season

37.2

51.0

2019-20 Season 2020-21 Season

Flu Vaccines @ Retail – Prior 2 Seasons

Data Source: IQVIA Xponent®

13

The Flu season in Australia can be an early indicator of our season in the US and current trends are showing a weak season


71.5% of

Australians 18-65

have received a flu

vaccine, compared

to 71.8% at the

same time last

year

90.4% of

Australians 65+

have received a flu

vaccine, compared

to 90% at the

same time last

year

Data Source: https://info.flutracking.net/reports-2/australia-reports/Data Source: https://www.9news.com.au/national/influenza-vaccine-

warning-as-number-of-aussies-seeking-flu-shot-falls-by-almost-half-from-

2020/11e65b73-1283-4ef2-adaa-81bd67eb9ed5

14

The FAN® report for all symptoms indicates more cases beginning in May in comparison to the the last two years


0

5

10

15

20

25

30

35

40

45

8/1

5/2

0

8/2

9/2

0

9/1

2/2

0

9/2

6/2

0

10

/10

/20

10

/24

/20

11

/7/2

0

11

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/20

12

/5/2

0

12

/19

/20

1/2

/21

1/1

6/2

1

1/3

0/2

1

2/1

3/2

1

2/2

7/2

1

3/1

3/2

1

3/2

7/2

1

4/1

0/2

1

4/2

4/2

1

5/8

/21

5/2

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1

6/5

/21

6/1

9/2

1

7/3

/21

7/1

7/2

1

7/3

1/2

1

Mill

ion

s

All Symptoms

2020-2021 2019-2020 2018-2019 3-Year Average

Data Source: IQVIA FAN® Report

15

Across the different symptoms on the FAN® report, Cough, Earache, Nasal and Sore Throat are running ahead of seasonal norms


05

10152025303540

8/1

5/2

0

10

/15

/20

12

/15

/20

2/1

5/2

1

4/1

5/2

1

6/1

5/2

1

Mill

ion

s

Cough

2020-2021

2019-2020

2018-2019

3-YearAverage

0

5

10

15

20

25

30

8/1

5/2

0

9/1

5/2

0

10

/15

/20

11

/15

/20

12

/15

/20

1/1

5/2

1

2/1

5/2

1

3/1

5/2

1

4/1

5/2

1

5/1

5/2

1

6/1

5/2

1

7/1

5/2

1

Mill

ion

s

Fever

0

2

4

6

8

10

8/1

5/2

0

9/1

5/2

0

10

/15

/20

11

/15

/20

12

/15

/20

1/1

5/2

1

2/1

5/2

1

3/1

5/2

1

4/1

5/2

1

5/1

5/2

1

6/1

5/2

1

7/1

5/2

1

Mill

ion

s

ILI

0

0.5

1

1.5

2

2.5

8/1

5/2

0

9/1

5/2

0

10

/15

/20

11

/15

/20

12

/15

/20

1/1

5/2

1

2/1

5/2

1

3/1

5/2

1

4/1

5/2

1

5/1

5/2

1

6/1

5/2

1

7/1

5/2

1

Mill

ion

s

Earache

0

5

10

15

20

25

30

8/1

5/2

0

9/1

5/2

0

10

/15

/20

11

/15

/20

12

/15

/20

1/1

5/2

1

2/1

5/2

1

3/1

5/2

1

4/1

5/2

1

5/1

5/2

1

6/1

5/2

1

7/1

5/2

1

Mill

ion

s

Nasal

0

5

10

15

20

25

8/1

5/2

0

9/1

5/2

0

10

/15

/20

11

/15

/20

12

/15

/20

1/1

5/2

1

2/1

5/2

1

3/1

5/2

1

4/1

5/2

1

5/1

5/2

1

6/1

5/2

1

7/1

5/2

1

Mill

ion

s

Sore Throat

2020-2021 2019-2020 2018-2019 3-Year AverageData Source: IQVIA FAN® Report

16

0

1

2

3

4

5

6

7

8

9

8/1

5/2

0

8/2

9/2

0

9/1

2/2

0

9/2

6/2

0

10

/10

/20

10

/24

/20

11

/7/2

0

11

/21

/20

12

/5/2

0

12

/19

/20

1/2

/21

1/1

6/2

1

1/3

0/2

1

2/1

3/2

1

2/2

7/2

1

3/1

3/2

1

3/2

7/2

1

4/1

0/2

1

4/2

4/2

1

5/8

/21

5/2

2/2

1

6/5

/21

6/1

9/2

1

7/3

/21

7/1

7/2

1

7/3

1/2

1

Mill

ion

s

Influenza Like Illness (ILI)

2020-2021 2019-2020 2018-2019 3-Year Average

A focus on ILI from the FAN® report shows that instances of flu continue to remain very low as we wrap up the season


Data Source: IQVIA FAN® Report

17

Market Trends:

UtilizationMedical claims/activity

18

Telemedicine contribution to weekly medical claims growth continues to diminish, reaching 7.8% of total claims


Data for latest week date controlled against prior periods; estimates have been applied to reflect anticipated late-adjudicated claims based on historical rates

Source: IQVIA: Medical Claims Data Analysis, 2021; Week 30 2019 = 8/2/2019; Week 30 2020 = 7/31/2020; Week 29 2020 = 7/24/2020; Week 29 2021 = 7/23/2021

Estimated amounts for latest weeks applied based on likely claims still to be received due to data latency or claim processing delays; See Appendix for further details

0M

5M

10M

15M

20M

25M

30M

35M

40M

45M

50M

30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28

Week

Total Claims by Service Type: 52 weeks through W/E 07/23

INSTITUTIONAL OFFICE TELEMEDICINE

• From 5/7/2021 through 7/23/2021,

total claims volume is decreasing

nearly 2% per week

• Institutional claims have dropped the

most significantly, losing more than

3% per week over the same time

period, with telemedicine not far

behind at 3%

Potential Implications

Cla

ims V

olu

me

-2%

19

Weekly institutional claims continue to stay below LY. Recent weekly growth in office doesn’t yet translate to cumulative growth


-19%-20%

-18%

-18%

-18%

5%

-32%

-14%-14%

-13%-14%

-15%

-15%

-15%

-18%

-17%

-19%-19%

-19%-21%

-24%

0%

-23%

-22%

-19%-17%

-19%

-21%-19%

-32%

-11%-11%

6%3%6%1%2%

12%9%

7%7%5%8%

29%

-13%

9%9%8%

26%

-9%

9%13%

-40%

-20%

0%

20%

40%

30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28

Ye

ar

ove

r Y

ea

r %

Week

Year over Year Growth* – Office Claims Across Time Aligned Weeks

Weekly Growth % Cumulative Growth %

-24%

-6%

-11%

-10%

-11%

4%

-20%-10%

-10%-9%

-10%

-10%

-10%-21%

-4%-9%

-11%

-11%-7%

-12%-13%

-7%

-19%

-11%-10%

-8%

-10%

-9%

-10%-18%

-4%-5%

2%0%2%

7%

1%5%4%

-11%

8%

0%2%

10%

-6%-1%

-1%

-2%

-11%

-32%-30%

-29%-40%

-30%

-20%

-10%

0%

10%

20%

30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28

Ye

ar

ove

r Y

ea

r %

Week

Year over Year Growth* – Institutional Claims Across Time Aligned Weeks


Source: IQVIA: Medical Claims Data Analysis, 2021; Week 30 2019 = 8/2/2019; Week 30 2020 = 7/31/2020; Week 29 2020 = 7/24/2020; Week 29 2021 = 7/23/2021

Estimated amounts for latest weeks applied based on likely claims still to be received due to data latency or claim processing delays; See Appendix for further details

*Week 10-25 continue to be evaluated against a “Calibrated” 2020 both for weekly and cumulative growth calculations


20

23

%

14

%

13

%

6%

7%

10

%

7%

8%

7%

5%

5%

16

%

-17

%

-5%

-15

%

-19

%

-27

%

-47

%

-42

%

-42

%

0%

2%

4%

6%

8%

10%

12%

14%

16%

-500%

0%

500%

1,000%

1,500%

2,000%

2,500%

3,000%

3,500%

4,000%

30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28

TM

Cla

ims a

s %

of A

ll P

/I*

Cla

ims

Ye

ar

ove

r Y

ea

r %

Week

Weekly Growth % TM Claims as % of All P/I* Claims

Week 10 begins the comparison to calibrated 2020 levels, then reverting to vs actual in Week 26

Telemedicine continues a decline from pandemic steady state


Year over Year Growth (2021 vs. Calibrated 2020) – Telemedicine Claims Across Time Aligned Weeks


*All P/I Claims total indicates Telemedicine, Office, and Institutional claims

Source: IQVIA: Medical Claims Data Analysis, 2021; Week 30 2019 = 8/2/2019; Week 30 2020 = 7/31/2020; Week 29 2020 = 7/24/2020; Week 29 2021 = 7/23/2021; Estimated amounts for latest weeks applied based on

likely claims still to be received due to data latency or claim processing delays; See Appendix for further details

Feb.Jul. Aug. Sep. Oct. Nov. Dec. Jan. Mar. Apr. May. Jun. Jul.

21

Elective Procedures: Weekly YoY and cumulative growth


Source: IQVIA: Medical Claims Data Analysis, 2021; Week 30 2019 = 8/2/2019; Week 30 2020 = 7/31/2020; Week 29 2020 = 7/24/2020; Week 29 2021 = 7/23/2021; Elective procedures based on IQVIA custom analysis;

Data includes claims from inpatient and outpatient sites of care; Latest two weeks are estimates using a recency data factor that is adjusted out as all claims are received; See Appendix for further details

Week 10-25 continue to be evaluated against a “Calibrated” 2020 both for weekly and cumulative growth calculations

-9%-10%

-9%

-8%

-7%

20%

-25%

-4%-5%

-3%-2%-2%-4%

-2%

-8%-7%

-9%-10%

-11%-12%

-14%

19%

0%

-20%

-13%-11%

-11%-12%

-9%

-20%

-6%-4%

6%

0%

4%

-3%-4%

8%8%7% 5%

2%5%

29%

-20%

2%1%

-2%

20%

-24%

-8%

-24%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28

Ye

ar

ove

r Y

ea

r %

Week

Year over Year Growth – Elective Procedure Across Time Aligned Weeks


Feb.Jul. Aug. Sep. Oct. Nov. Dec. Jan. Mar. Apr. May. Jun. Jul.

22

0M

20M

40M

60M

80M

100M

120M

140M

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

In 2020 there were almost 1 billion diagnosis visits that did not happen


A leading indicator of long-term impact

-967M

-18.8%

Total Gap of Diagnosis

Visits in 2020 (Unique patient-provider diagnosis events)

-2000 -1500 -1000 -500 0

GASTRO

UROLOGY

NEURO

ONCOLOGY

PCP

RHEUM

ENDO

Leading Specialties in 2020 by Dx Visits Gap/HCP

Dx Visit/HCP Ratio

% of Expected

Diagnosis Visits

in 2020

What is the “diagnosis visit gap”?

Difference between diagnosis visits1 expected during a

hypothetical non-COVID scenario and the number of

diagnosis visits we actually see

IQVIA: Medical Claims Data Analysis, 2021, IQVIA Analysis1A diagnosis visit is for one single diagnosis per patient, per HCP; a patient can have more than one diagnosis visit assigned to them, with either more than one diagnosis per doctor or more than one doctor per diagnosis

Expected diagnosis visits in

2020 if there was no COVID-19

Actual diagnosis visits in 2020

The

Diagnosis

Visit Gap

23

0M

20M

40M

60M

80M

100M

120M

Jan Feb Mar Apr May Jun

Non-COVID vs. COVID Diagnosis Visits 2021

Lower-than-expected total diagnosis visit volumes in May have created more separation than previously forecast; vaccine deployment and other triggers will continue to influence these dynamics

Post-COVID dynamics continue to have an impact – nearly 300M diagnosis visits have not occurred in the first half of 2021


-270.2MTotal Forecast

Diagnosis Visit

Gap in 1H 2021

% of Expected

Diagnosis Visits

in 1H 2021 -10.8%Forecast diagnosis visits in

2021 if there was no COVID-19

Forecast diagnosis visits in

2021 with COVID

(actual data through 5/28/21)

24

US Primary Intelligence

BrandImpact HCP Network = ~3,600 unique HCPs including Oncology, Specialty and Primary Care; Specialty includes, but not limited to, Allergy, Cardiology, Dermatology, Gastroenterology, Endocrinology, Neurology,

Pulmonology, Psychiatry, Rheumatology & Urology

Total Biopharma Patient Visits by Type

Total patient visits in July for Biopharma and Primary Care were lower than last year due to a decline in remote visits

Primary Care Patient Visits by Type

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

Jul

Aug

Sep

Oct

No

v

De

c

Jan-2

1

Feb

Ma

r

Apr

Ma

y

Jun

Jul

In-Person Pt Visits Remote Pt Visits

80%

20%

88%

12%

0

10,000

20,000

30,000

40,000

50,000

60,000

Jul

Aug

Sep

Oct

No

v

De

c

Jan-2

1

Feb

Ma

r

Apr

Ma

y

Jun

Jul

In-Person Pt Visits Remote Pt Visits

88%

12%

81%

19%


25

0M

20M

40M

60M

80M

100M

120M

140M

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Missed diagnosis visits have a direct effect on prescription utilization


-15M

-0.5%

Total Forecast Rx

Lost in 1H 2021 (Based on Average 30 Days Supply)

4%1%

-2%

-21%-26%

CARD PCP DERM ONCOLOGY PED

Selected Specialties by Forecast % Rx Missed in 1H 2021

% of Forecast

Rx Lost in 1H 2021

What is “prescription suppression”?

Difference between the number of prescriptions expected

during a non-COVID scenario versus the number of

prescriptions we actually see

COVID-19 Diagnosis Visit Backlog - w/e May 28, 2021; Source: IQVIA: Medical Claims Data Analysis, 2021, IQVIA Analysis1Suppressed monthly prescriptions are calculated by taking the predicted days supply using Dx visits and lever inputs and dividing by 30

Expected Rx’s if there was no

COVID-19

The forecast (achieved)

suppressed Rx’s in 2020 with

actual data through 5/28/21Rx B

ase

d o

n 3

0 D

ay S

up

ply

20

21

26

Specialties with greater gaps in claims in 2020 are working to address the patient backlog – namely ophthalmologists and dermatologists

Hard hit specialists continue to fill the 2020 diagnosis gap

-7%

-9%

-12%

-12%

-13%

-16%

-17%

-17%

-19%

-20%

-20%

-20%

-20%

-21%

-29%

2020 % change from baseline

Source: IQVIA: National Prescription Audit; IQVIA: Medical Claims data. Note: Baseline defined as the average of the first full eight weeks of 2020. NBRx are Retail only. NBRx include all prescriptions a HCP writes, not only those specific to the therapy area.

-17%

59%

-15%

-19%

-14%

-7%

-12%

-20%

-18%

-26%

-22%

-16%

-12%

-22%

-54%PED

OPHTH

ALLER

PCP

PULM

GE

CARD

UROL

OB/GYN

NEURO

ENDO

RHEUM

ONC

PSYCH

DERM

Excluding flu vaccines

in 2020, ONC = -7%

Claims NBRx


Fewer claims, fewer NBRx

More claims, more NBRxFewer claims, more NBRx

More claims, fewer NBRx

ALLER

PCP

OB/GYN

CARD DERM

ENDO

GE

NEURO

OPHTH

PED

PULM

PSYCH

RHEUM

UROL

ONC

ONC, no COVID vaccine NBRx

-40%

-20%

0%

20%

40%

60%

80%

100%

120%

-15% -10% -5% 0% 5% 10% 15% 20% 25%

% C

ha

nge

in

NB

Rx,

20

20

v.

20

21

% Change in claims, 2020 v. 2021

% Change in claims and NBRx, weeks 1–25, 2020 v. 2021

27

Where Are We Now?


28

The Non-Retail channel is recovering from effects of COVID-19

Growth (%) of Sales

Total Market (Retail, Non-Retail and Mail) Retail and Mail

Source: IQVIA, National Sales Perspectives, Jun 2021

Note: Limited to Rx and OTC Insulins; Includes Retail, Non-Retail and Mail

Non-Retail

6.0%

10.6%

7.5%

1.8%

4.9%

6.1%

2017 2018 2019 2020 MATJun

2021

YTD Jun2021

1.9%

6.4%5.8%

4.3%

6.0%7.0%

2017 2018 2019 2020 MATJun

2021

YTDJun

2021

0.3%

4.6% 5.0% 5.4%6.5%

7.3%

2017 2018 2019 2020 MATJun

2021

YTDJun

2021


29

Hospitals and Long-Term Care have been most affected by COVID-19 while Home Health Care is booming!

Gro

wth

(%

) o

f S

ale

s

Clinics Hospitals

-1.1%

6.8%

2.0%

-5.0%

2.6%

4.9%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021

Source: IQVIA, National Sales Perspectives, August 2021


11.2%

13.8%12.1%

5.9%7.3% 7.9%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021

Long-Term Care

0.5% 1.0%

-5.3%

-7.5%

-3.4%

-0.4%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021

Home Health Care

11.1%

34.5%

19.4%

9.4% 11.3% 12.5%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021


30

In MAT June 2021,specialty spend grew by 6.9% while traditional growth grew 5.2%

For the total market, specialty growth is outpacing traditional growth and now has ~49% share of total non-discounted spend

$196.0$218.9

$243.8$261.9

$271.7

$259.0

$264.8$269.2

$275.1 $283.6$455.0

$483.7$513.0 $537.0 $555.3

-30%

0%

30%

$

$100

$200

$300

$400

$500

Gro

wth

N

on

-Dis

co

un

ted

Sp

en

d (

BN

s)

SPECIALTY TRADITIONAL SPECIALTY GROWTH TRADITIONAL GROWTH TOTAL MARKET GROWTH

Source: IQVIA, National Sales Perspectives, June 2021

Share of Sales 2017 2018 2019 2020 MAT JUN 2021

SPECIALTY 43.1% 45.3% 47.5% 48.8% 48.9%

TRADITIONAL 56.9% 54.7% 52.5% 51.2% 51.1%


31

Based on sales dollars, Specialty is increasing at Mail and Non-Retail while slowing at Retail

56.2% 59.1% 62.8% 64.9% 65.8% 67.3%

43.8% 40.9% 37.2% 35.1% 34.2% 32.7%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021

Specialty Traditional

NON-RETAIL

% O

F S

AL

ES

$

14.0% 14.4% 15.1% 15.6% 15.4% 15.3%

86.0% 85.6% 84.9% 84.4% 84.6% 84.7%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021


RETAIL

76.9% 77.0% 79.0% 80.4% 80.8% 81.4%

23.1% 23.0% 21.0% 19.6% 19.2% 18.6%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021


MAIL

11.5%

17.4%

12.0%

4.7% 4.5% 5.2%

-0.9%0.5%

2.0%-0.4%

5.4%8.0%

6.0%

10.5%8.3%

2.9% 4.9%6.1%

-5%

0%

5%

10%

15%

20%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021

Specialty Traditional Total

2.8%

4.9%

7.2%6.3%

3.2%2.3%

-3.0%

1.5% 1.3%2.6%

4.7%5.7%

-2.2%

2.0% 2.1%3.2%

4.4%5.2%

-4%

-2%

0%

2%

4%

6%

8%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021


10.4%8.9%

12.2%10.5% 10.4% 11.3%

-8.4%

8.1%

0.1%1.5%

5.2% 4.9%5.4%

8.7%9.5%

8.6% 9.3% 10.1%

-10%

-5%

0%

5%

10%

15%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021


YO

Y S

AL

ES

$ G

RO

WT

H

Data is based on Rx and OTC Insulins only


32

Immunology showed greatest Specialty growth on spend in Mail

RETAIL

Therapy MAT June

2021

YoY

Growth

HIV ANTIVIRALS 16.4 1.5%

IMMUNOLOGY 7.7 9.5%

ONCOLOGICS 2.3 -3.0%

MENTAL HEALTH 2.2 6.6%

ANTI-INFLAMMATORY AND

DIGESTIVE ENZYMES AND

MODULA2.0 11.3%

VIRAL HEPATITIS 1.2 -16.3%

LIPID REGULATORS 1.0 35.9%

MULTIPLE SCLEROSIS 0.7 -10.5%

SEX HORMONES (ANDROGENS, OESTROGENS,

PROGESTOGENS)

0.6 21.3%

IMMUNOSUPPRESSANTS 0.5 -6.3%

MAIL

Therapy MAT June

2021

YoY Growth

IMMUNOLOGY 61.0 20.3%

ONCOLOGICS 20.2 9.1%

MULTIPLE SCLEROSIS 11.3 -10.2%

HIV ANTIVIRALS 5.1 -0.6%

ALL OTHER

RESPIRATORY3.8 21.6%

OTHER

CARDIOVASCULARS2.3 13.1%

GROWTH HORMONES 2.2 0.2%

RESPIRATORY AGENTS 2.2 13.4%

VIRAL HEPATITIS 2.1 -20.9%

BLOOD COAGULATION 1.9 0.5%

NON-RETAIL

Therapy MAT June

2021

YoY

Growth

ONCOLOGICS 52.8 7.0%

IMMUNOLOGY 15.6 9.9%

MULTIPLE SCLEROSIS 5.2 4.0%

POLYVAL

IMMUNOGLOBLULINS IV&IM4.6 5.6%

HIV ANTIVIRALS 4.5 2.0%

HEMATOPOIETIC GROWTH

FACTORS3.8 -11.6%

ERYTHROPOIETINS 2.7 -9.6%

MENTAL HEALTH 2.1 9.3%

OCULAR ANTINEOVASCULARISATION

1.9 -9.5%

RESPIRATORY AGENTS 1.9 14.2%

Top 10 Specialty Therapies for Retail, Mail, and Non-Retail - MAT June 2021 (in $ billions)


Limited to Rx and OTC Insulins

*For Client’s internal use only


33

33

Slowing growth was occurring prior to COVID-19, and is not the sole contributor

All therapies demonstrate short-term growth except MS; Immunology and Anticoagulants show the greatest one- and five-year growth

Top-10 therapy area growth % ($)

-10%

-5%

0%

5%

10%

15%

20%

25%

-4% -2% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% 22%

RESPIRATORY AGENTS

IMMUNOLOGY

ONCOLOGICS

MENTAL HEALTH

Historic growth (% 5-year CAGR, 2016-2021)

Sh

ort

-te

rm g

row

th (

% Y

oY

,20

20

-20

21

)

ANTIDIABETICS

ANTICOAGULANTS

HIV ANTIVIRALS

MULTIPLE SCLEROSIS

PAIN VACCINES (PURE, COMB, OTHER)

Specialty Traditional Jun 2021 MAT sales, Bn

IQVIA National Sales Perspectives, June 2021, Rx’s and OTC Insulins Only



34

Antidiabetics is the top therapy class and Eliquis is a top product in the Retail Market based on sales dollars

Therapies

Rank Therapy

MAT

June

2021

YoY Growth

1 ANTIDIABETICS 64.0 13.9%

2 RESPIRATORY AGENTS 21.6 -0.1%

3 ANTICOAGULANTS 18.1 16.2%

4 HIV ANTIVIRALS 16.4 1.5%

5 MENTAL HEALTH 13.3 6.4%

6 PAIN 10.2 8.1%

7 ADHD 8.1 0.1%

8 IMMUNOLOGY 7.7 9.6%

9 GI PRODUCTS 6.8 5.1%

10 NERVOUS SYSTEM DISORDERS 6.5 -6.1%

Products

Rank Product

MAT

June

2021

YoY Growth

1 ELIQUIS 10.9 25.5%

2 TRULICITY 8.5 37.2%

3 OZEMPIC 5.6 70.9%

4 JARDIANCE 5.6 40.7%

5 XARELTO 5.4 9.1%

6 BIKTARVY 5.2 27.6%

7 JANUVIA 5.0 3.8%

8 LANTUS SOLOSTAR 4.0 17.2%

9 VYVANSE 3.7 2.8%

10 LATUDA 3.3 11.4%

Top 10 Therapies and Products for Retail based on Sales - MAT June 2021 (MAT in Billions)





35

Farxiga and Trelegy Ellipta show large YoY growth

Therapies

Rank Therapy

MAT

June

2021

YoY Growth

11ANTIHYPERTENSIVES, PLAIN &

COMBO5.9 3.5%

12 DERMATOLOGICS 5.3 -9.4%

13 OTHER CNS 4.6 -4.3%

14 OPHTHALMOLOGY, GENERAL 4.1 1.1%

15VACCINES (PURE, COMB,

OTHER)3.7 10.5%

16 OTHER CARDIOVASCULARS 3.6 9.7%

17HORMONAL CONTRACEPTION,

SYSTEMIC&TOPICAL3.3 -9.4%

18

SEX HORMONES (ANDROGENS,

OESTROGENS,

PROGESTOGENS)3.1 -0.9%

19 LIPID REGULATORS 2.5 5.9%

20 ONCOLOGICS 2.4 -3.5%

Products

Rank Product

MAT

June

2021

YoY Growth

11 HUMIRA 2.9 3.9%

12 SYMBICORT 2.9 -6.8%

13 VICTOZA 3-PAK 2.6 -7.3%

14 NOVOLOG FLEXPEN 2.6 -8.5%

15 TRESIBA 2.6 1.3%

16 FARXIGA 2.4 48.4%

17 TRELEGY ELLIPTA 2.1 56.3%

18 HUMALOG KWIKPEN 2.0 -4.6%

19 BREO ELLIPTA 2.0 -6.5%

20 GENVOYA 1.9 -11.5%

Top 20 Therapies and Products for Retail based on Sales - MAT June 2021 (MAT in Billions)




Brand Inflation has slowed in recent years, currently it is running between 4 and 5% according to Nephron Research

Source: Nephron Research, IQVIA, Glass Box Analytics

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

Dec

-13

Feb

-14

Ap

r-1

4

Jun

-14

Au

g-1

4

Oct

-14

Dec

-14

Feb

-15

Ap

r-1

5

Jun

-15

Au

g-1

5

Oct

-15

Dec

-15

Feb

-16

Ap

r-1

6

Jun

-16

Au

g-1

6

Oct

-16

Dec

-16

Feb

-17

Ap

r-1

7

Jun

-17

Au

g-1

7

Oct

-17

Dec

-17

Feb

-18

Ap

r-1

8

Jun

-18

Au

g-1

8

Oct

-18

Dec

-18

Feb

-19

Ap

r-1

9

Jun

-19

Au

g-1

9

Oct

-19

Dec

-19

Feb

-20

Ap

r-2

0

Jun

-20

Au

g-2

0

Oct

-20

Dec

-20

Feb

-21

Sale

s-W

eigh

ted

In

flat

ion

Hillary Clinton tweets onegregious

drug pricingValeant is

subpoeaned over pricing

actionsAllergan issues its Social Contract and pledges to

take single digit gross increases

Trump tweets that drug makers are "getting away with murder"

Leaked presidential draft proves to be pharma friendly

Manufacturers limited themselves to a single

price increase

January price increases

HHS introduces rebate/discount

rule for 1/1/20

HHS withdraws

Rebate Rule

2H18 price increases rescinded

Pelosi unveils drug plan

+4% to +5% is the new

normal

Trump EO Released

37

311.0

359.0

61.9

8.4 51.6

3.9-78.1

200.0

250.0

300.0

350.0

400.0

450.0

2015 New brands Protected brandsprice

Protected brandsvolume

LOE Generics 2020

Manufacturer net revenue Growth Declines

Net Manufacturer Revenues and Growth 2015–2020, All Channels, US$Bn

Manufacturer net revenues increased by $48 billion over the pastfive years primarily driven by new products and protected brand volume

Source: IQVIA Institute, May 2021

-13.7-18.6

-25

-20

-15

-10

-5

0

5

10

15

20

2016 2017 2018 2019 2020

13.2

13.9

-25

-20

-15

-10

-5

0

5

10

15

20

7.0

-9.5-25

-20

-15

-10

-5

0

5

10

15

20

2016 2017 2018 2019 2020

4.5

18.7

-25

-20

-15

-10

-5

0

5

10

15

20

2016 2017 2018 2019 2020

1.3-0.8

-25

-20

-15

-10

-5

0

5

10

15

20

2016 2017 2018 2019 2020

2016 2020


38

Wholesaler Acquisition Cost (WAC) Growth and Net Price Growth for Protected Brands

Protected brand list prices increased 4.4% in 2020, while netprices decreased -2.9% - the fourth year at or below the CPI


Source: IQVIA Institute, National Sales Perspectives, Dec 2020; Bureau of Labor Statistics, CPI Data, Dec 2015–Dec 2020

7.9%

9.3%

7.0%6.6%

5.2%4.4%

1.6%

2.9%

2.1% 0.3%1.7%

-2.9%

0.7%2.1%

2.1% 1.9%2.3%

1.3%

-4%

-2%

0%

2%

4%

6%

8%

10%

2015 2016 2017 2018 2019 2020

Brands WAC price growth % Estimated net price growth % CPI

39

Unadjusted Rx growth for MAT May is negative and YTD May is positive, but adjusted growth is higher, at 2.5% for MAT May and 3.6% year to date

Growth (%) of Dispensed Rx

Unadjusted Rx Adjusted Rx

-5.6%

-0.6% -0.4%

-2.4%

0.3%

2.7%

-10.0%

-8.0%

-6.0%

-4.0%

-2.0%

0.0%

2.0%

4.0%

2017* 2018 2019 2020 MATJun

2021

YTDJun

2021

-3.8%

2.7% 2.4% 1.9%2.7%

4.2%

-7.0%

-5.0%

-3.0%

-1.0%

1.0%

3.0%

5.0%

7.0%

2017* 2018 2019 2020 MATJun

2021

YTDJun

2021

Source: IQVIA, National Prescription Audit & RxInsight, May 2021; Retail, Mail, and LTC limited to Rx and OTC Insulins

*Note: Declines between 2016 and 2017 are due to VRAF enhancement from 2017 onwards

Gro

wth

(%

)

Gro

wth

(%

)


40

Unadjusted growth trends have been positive for the last several weeks, mainly being driven by COVID vaccinations at Retail

Data Source: IQVIA Xponent - Copyright 2021

-1.2

%

-3.7

%

8.4

%

-9.2

%

1.2

%

0.1

%

-0.9

%

-1.6

%

-1.7

%

-1.9

%

-2.7

%

-5.1

%

-3.0

%

-4.4

%

-4.5

%

-6.3

%

-4.9

%

-7.6

%

-1.5

%

-6.3

%

-4.1

%

-3.0

%

-2.8

%

-4.0

%

-5.4

%

-3.8

%

-12

.4%

-1.0

%

-2.7

0%

-5.3

%

-11

.6%

4.2

%

11

.4%

15

.0%

17

.9%

19

.1%

18

.4%

17

.1%

14

.5%

13

.9%

22

.1%

2.3

%

10

.6%

9.4

%

8.3

%

7.5

%

3.0

%

7.0

%

8.7

%

7.6

%

8.9

%

7.9

%

-50%

0%

50%

8/2

1/2

0

8/2

8/2

0

9/0

4/2

0

9/1

1/2

0

9/1

8/2

0

9/2

5/2

0

10

/02

/20

10

/09

/20

10

/16

/20

10

/23

/20

10

/30

/20

11

/06

/20

11

/13

/20

11

/20

/20

11

/27

/20

12

/04

/20

12

/11

/20

12

/18

/20

12

/25

/20

1/0

1/2

1

1/0

8/2

1

1/1

5/2

1

1/2

2/2

1

1/2

9/2

1

2/0

5/2

1

2/1

2/2

1

2/1

9/2

1

2/2

6/2

1

3/0

5/2

1

3/1

2/2

1

3/1

9/2

1

3/2

6/2

1

4/0

2/2

1

4/9

/21

4/1

6/2

1

4/2

3/2

1

4/3

0/2

1

5/7

/21

5/1

4/2

1

5/2

1/2

1

5/2

8/2

1

6/4

/21

6/1

1/2

1

6/1

8/2

1

6/2

5/2

1

7/2

/21

7/9

/21

7/1

6/2

1

7/2

3/2

1

7/3

0/2

1

8/6

/21

8/1

3/2

1

To

tal U

na

dj.


-1.2

%

-3.7

%

8.4

%

-9.2

%

1.2

%

0.1

%

-0.9

%

-1.6

%

-1.7

%

-1.9

%

-2.7

%

-5.1

%

-3.0

%

-4.4

%

-4.5

%

-6.3

%

-4.9

%

-7.6

%

-1.6

%

-6.9

%

-5.1

%

-4.3

%

-4.6

%

-6.3

%

-7.9

%

-6.6

%

-15

.2%

-4.1

%

-7.2

%

-10

.4%

-16

.8%

-2.4

%

2.5

%

4.9

%

9.8

%

9.8

%

9.0

%

8.8

%

7.4

%

5.4

%

15

.1%

-2.7

%

4.8

%

3.5

%

4.2

%

4.0

%

-0.1

%

3.8

%

4.9

%

3.1

%

4.0

%

2.9

%

-50%

0%

50%

8/2

1/2

0

8/2

8/2

0

9/0

4/2

0

9/1

1/2

0

9/1

8/2

0

9/2

5/2

0

10

/02

/20

10

/09

/20

10

/16

/20

10

/23

/20

10

/30

/20

11

/06

/20

11

/13

/20

11

/20

/20

11

/27

/20

12

/04

/20

12

/11

/20

12

/18

/20

12

/25

/20

1/0

1/2

1

1/0

8/2

1

1/1

5/2

1

1/2

2/2

1

1/2

9/2

1

2/0

5/2

1

2/1

2/2

1

2/1

9/2

1

2/2

6/2

1

3/0

5/2

1

3/1

2/2

1

3/1

9/2

1

3/2

6/2

1

4/0

2/2

1

4/9

/21

4/1

6/2

1

4/2

3/2

1

4/3

0/2

1

5/7

/21

5/1

4/2

1

5/2

1/2

1

5/2

8/2

1

6/4

/21

6/1

1/2

1

6/1

8/2

1

6/2

5/2

1

7/2

/21

7/9

/21

7/1

6/2

1

7/2

3/2

1

7/3

0/2

1

8/6

/21

8/1

3/2

1

Unadju

ste

d Y

oY

Gro

wth

Un

ad

juste

d Y

oY

Gro

wth

less C

OV

ID V

accin

es

41

Adjusted growth trends have run positive for the last several weeks driven by COVID vaccines and last spring’s weak comparison periods

Data Source: IQVIA Xponent - Copyright 2021

2.6

%

0.1

%

12

.9%

-5.3

%

6.0

%

4.2

%

2.6

%

1.9

%

1.8

%

1.9

%

0.9

%

-0.8

%

1.4

%

0.3

%

0.6

%

-1.9

%

-0.1

%

-2.3

%

6.0

%

-0.3

%

1.1

%

2.3

%

1.8

%

1.1

%

-0.3

%

1.0

%

-8.5

%

3.9

%

0.7

%

-2.8

%

-11

.2%

3.0

% 9.4

%

12

.3%

15

.8%

17

.3%

16

.2%

15

.6%

13

.5%

12

.1%

20

.7%

1.4

% 9.0

%

8.7

%

7.3

%

7.7

%

3.4

%

7.8

%

9.3

%

7.9

%

9.2

%

7.7

%

-20%

0%

20%

40%

08

/21

/20

08

/28

/20

09

/4/2

0

09

/11

/20

09

/18

/20

09

/25

/20

10

/02

/20

10

/09

/20

10

/16

/20

10

/23

/20

10

/30

/20

11

/6/2

0

11

/13

/20

11

/20

/20

11

/27

/20

12

/4/2

0

12

/11

/20

12

/18

/20

12

/25

/20

01

/01

/21

01

/08

/21

01

/15

/21

01

/22

/21

01

/29

/21

02

/05

/21

02

/12

/21

02

/19

/21

02

/26

/21

03

/5/2

1

03

/12

/21

03

/19

/21

3/2

6/2

1

4/2

/21

4/9

/21

4/1

6/2

1

4/2

3/2

1

4/3

0/2

1

5/7

/21

5/1

4/2

1

5/2

1/2

1

5/2

8/2

1

6/4

/21

6/1

1/2

1

6/1

8/2

1

6/2

5/2

1

7/2

/21

7/9

/21

7/1

6/2

1

7/2

3/2

1

7/3

0/2

1

8/6

/21

8/1

3/2

1

To

tal A

dj.


2.3

%

2.8

%

7.5

%

-3.8

%

15

.7%

3.4

%

4.8

%

5.1

%

1.4

%

0.5

%

0.4

%

1.0

%

0.9

%

-0.2

%

-14

.7%

2.3

%

22

.3%

-2.9

%

-14

.4%

-12

.1%

27

.0%

11

.4%

-5.9

%

-3.7

%

1.5

%

0.6

%

-13

.3%

0.5

%

4.4

%

1.9

%

-4.9

%

-7.3

%

-15

.1% -1

.4%

6.5

%

8.0

%

10

.3%

11

.6%

9.1

%

7.3

%

10

.0%

1.5

% 8.4

%

5.5

%

4.7

%

3.6

%

-1.1

%

6.6

%

8.5

%

2.5

%

7.0

%

6.0

%

-20%

0%

20%

40%

8/2

1/2

0

8/2

8/2

0

9/4

/20

9/1

1/2

0

9/1

8/2

0

9/2

5/2

0

10

/02

/20

10

/09

/20

10

/16

/20

10

/23

/20

10

/30

/20

11

/6/2

0

11

/13

/20

11

/20

/20

11

/27

/20

12

/4/2

0

12

/11

/20

12

/18

/20

12

/25

/20

1/0

1/2

1

1/0

8/2

1

1/1

5/2

1

1/2

2/2

1

1/2

9/2

1

2/0

5/2

1

2/1

2/2

1

2/1

9/2

1

2/2

6/2

1

3/5

/21

3/1

2/2

1

3/1

9/2

1

3/2

6/2

1

4/2

/21

4/9

/21

4/1

6/2

1

4/2

3/2

1

4/3

0/2

1

5/7

/21

5/1

4/2

1

5/2

1/2

1

5/2

8/2

1

6/4

/21

6/1

1/2

1

6/1

8/2

1

6/2

5/2

1

7/2

/21

7/9

/21

7/1

6/2

1

7/2

3/2

1

7/3

0/2

1

8/6

/21

8/1

3/2

1

Adju

ste

d Y

oY

Gro

wth

Ad

juste

d Y

oY

Gro

wth

le

ss

CO

VID

Va

ccin

es

42

Many specialties show NBRx and TRx recovery over the past 52 weeks, though pediatric volumes continue to lag


Source: IQVIA: National Prescription Audit (NPA), National Prescription Audit: New to Brand (NPA NTB); Time aligned weeks W/E 7/24/20 – 7/23/21

-5%

-11%

12%

2%

8%

4%

11%9%

-2%

-29%

-2%

-11%

-2%

8%

-5%-3%

9%

-3%

2%

-1%

1% 1%

-4%

-21%

-2%

-7%

-2%

2%

-35%

-30%

-25%

-20%

-15%

-10%

-5%

0%

5%

10%

15%

ALLER CARD DERM ENDO GE NEURO OB/GYN OPHTH PCP PED PSYCH PULM RHEUM UROL

YoY Cumulative NBRx/TRx Growth by Selected SpecialtyRolling 52-Week YoY Comparison

NBRx % Change TRx % Change

44

Acute and New Rx growth is slowing down over the last three months; driven by COVID vaccines (% change vs. 1 Year ago)

-40%

-20%

0%

20%

40%

60%

80%Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

Acute

-U

nadju

ste

d

-10%

0%

10%

20%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

Main

t. -

Unadju

ste

d


New

-U

nadju

ste

dR

efill

-Unadju

ste

dAll Rx’s shown in Millions

-20%

-10%

0%

10%

20%

30%

40%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

-10%

-5%

0%

5%

10%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

To

tal R

eta

il &

Mail –

Acu

te&

Main

t., N

ew

/Refi

ll –

Un

ad

juste

d R

x’s

45

45

Pain shows negative growth for one and five-year growth

Nervous system disorders 5-year growth is high, but short-term growth is minimal

IQVIA Xponent® June 2021, Retail, Mail and LTC

-8%

-6%

-4%

-2%

0%

2%

4%

6%

8%

10%

-20% -10% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 110%

ANTIHYPERTENSIVES

NERVOUS SYSTEM DISORDERS

MENTAL HEALTH

RESPIRATORY AGENTS

Historic growth (5 year CAGR, 2016-2021)

Short

-te

rm g

row

th (

20

20

-20

21)

LIPID REGULATORS

PAIN

ANTIDIABETICS

THYROID ANTI-THYROID AND IODINE PREPS

ANTI-ULCERANTS

OTHER CNS

Jun 2021 MAT Adj Scripts


46

Based on adjusted Rx’s basis in Retail, Antihypertensives are the leading therapy with Atorvastatin as the top product

Therapies

Rank Therapy

MAT

July

2021

YoY Growth

1 ANTIHYPERTENSIVES, PLAIN & COMBO 1,046.5 2.6%



4 PAIN 377.6 0.2%

5 ANTIDIABETICS 352.6 3.5%

6 ANTI-ULCERANTS 214.2 4.5%

7 NERVOUS SYSTEM DISORDERS 210.9 3.4%

8THYROID ANTI-THYROID AND IODINE

PREPS189.6 1.3%


10 VACCINES (PURE, COMB, OTHER) 180.5 232.0%

Products

Rank Product

MAT

July

2021

YoY

Growth

1 ATORVASTATIN CA 208.3 7.6%

2 LISINOPRIL 154.1 0.6%

3 AMLODIPINE BESY 150.9 5.6%

4 LEVOTHYROXINE SOD 141.2 -2.4%

5 LOSARTAN POT 105.0 5.5%

6 METFORMIN HCL 97.1 3.5%

7 METOPROLOL SUCCIN 84.9 7.2%

8 OMEPRAZOLE (RX) 83.8 16.0%

9 HYDROCHLOROTHIAZIDE 81.2 -0.3%

10 GABAPENTIN 78.5 3.8%

Top 10 Therapies and Products for Retail - MAT July 2021 (Adjusted Rx’s in Millions)




47

When looking at Retail on an unadjusted Rx basis there are no changes for the top therapy and top product

Therapies

Rank Therapy

MAT

July

2021

YoY

Growth

1 ANTIHYPERTENSIVES, PLAIN & COMBO 527.8 -2.9%

2 PAIN 350.8 -0.3%


4 ANTIDIABETICS 208.8 -0.5%


6 VACCINES (PURE, COMB, OTHER) 178.9 242.5%

7 ANTIBACTERIALS 175.8 -16.9%

8 NERVOUS SYSTEM DISORDERS 159.2 0.9%

9 OTHER CNS 155.6 1.1%


Products

Rank Product

MAT

July

2021

YoY

Growth

1 ATORVASTATIN CA 99.6 1.6%

2 LISINOPRIL 75.9 -4.9%

3 AMLODIPINE BESY 74.4 -0.3%

4 LEVOTHYROXINE SOD 69.7 -8.0%

5 PFIZER COVID19 VACC 62.6

6 GABAPENTIN 59.0 2.6%

7 HYCD/APAP 52.9 -1.1%

8 LOSARTAN POT 50.8 -0.1%

9 METFORMIN HCL 49.7 -1.8%

10 OMEPRAZOLE (RX) 47.6 9.9%

Top 10 Therapies and Products for Retail - MAT July 2021 (Unadjusted Rx’s in Millions)




48

Retail Class of Trade

and Method of Payment

Performance

49

Adjusted volumes in all COTs in June 2021 show an uptick from May 2021 volumes

190

200

210

220

230

240

250

260Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Mill

ion

s

2019 2020 2021

50

70

90

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Mill

ion

s

2019 2020 2021

IQVIA Copyright 2021 - Confidential - For Client Use Only

CHAIN

MASS

70

75

80

85

90

95

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Mill

ion

s

2019 2020 2021

INDEP

55

60

65

70

75

80

85

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Mill

ion

s

2019 2020 2021

FOOD

380

400

420

440

460

480

500

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Mill

ion

s

2019 2020 2021

RETAIL

35

40

45

50

55

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Mill

ion

s

2019 2020 2021

MAIL

AD

JU

ST

ED

Rx’s

50

COVID Vaccines are the driver of growth, though it is slowing

-15%

-10%

-5%

0%

5%

10%

15%

20%

Jan

-20

Ma

r-20

Ma

y-2

0

Jul-

20

Sep-2

0

Nov-2

0

Jan

-21

Ma

r-21

Ma

y-2

1

-15%

-10%

-5%

0%

5%

10%

15%

20%

Jan

-20

Ma

r-20

Ma

y-2

0

Jul-

20

Sep-2

0

Nov-2

0

Jan

-21

Ma

r-21

Ma

y-2

1


CHAIN

MASS

-15%

-10%

-5%

0%

5%

10%

15%

Jan

-20

Ma

r-20

Ma

y-2

0

Jul-

20

Sep-2

0

Nov-2

0

Jan

-21

Ma

r-21

Ma

y-2

1

INDEP

-5%

0%

5%

10%

15%

20%

25%

Jan

-20

Ma

r-20

Ma

y-2

0

Jul-

20

Sep-2

0

No

v-2

0

Jan

-21

Ma

r-21

Ma

y-2

1

FOOD

-15%

-10%

-5%

0%

5%

10%

15%

20%

Jan

-20

Ma

r-20

Ma

y-2

0

Jul-

20

Sep-2

0

Nov-2

0

Jan

-21

Ma

r-21

Ma

y-2

1

RETAIL

-15%

-10%

-5%

0%

5%

10%

15%

20%

Jan

-20

Ma

r-20

Ma

y-2

0

Jul-

20

Sep-2

0

Nov-2

0

Jan

-21

Ma

r-21

Ma

y-2

1

MAIL

AD

JU

ST

ED

RX

GR

OW

TH

51

90 Day percentage of Rx’s based on Unadjusted Rx’s shows a slight increase from May to June, excluding Mail

10%

15%

20%

25%

30%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

10%

15%

20%

25%

30%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021


CHAIN

MASS

10%

15%

20%

25%

30%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

INDEP

10%

15%

20%

25%

30%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

FOOD

10%

15%

20%

25%

30%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

RETAIL

70%

75%

80%

85%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

MAIL

90 D

ay P

erc

en

tag

e b

ased

on

Un

ad

j. R

x’s

52

COT market share declines minimally from March 2021

49%

50%

51%

52%Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

12%

13%

14%

15%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021


CHAIN

MASS

15%

20%

25%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

INDEP

14%

15%

16%

17%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

FOOD

Mark

et

Sh

are

based

on

Ad

jus

ted

Rx’s

53

Cash, Med D, and Discount Cards slightly increase; Third Party and Medicaid decrease

2%

3%

3%

4%

4%

5%

5%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

31%

32%

33%

34%

35%

36%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021


CASH

MED D

0%

1%

2%

3%

4%

5%

6%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

DISC. CARDS

36%

37%

38%

39%

40%

41%

42%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

3rd PARTY

11%

12%

13%

14%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

MEDICAID

Mark

et

Sh

are

based

on

Ad

jus

ted

Rx’s

NOTE: Discount Cards are removed

from 3rd Party

54

90-Day % of unadjusted Rx’s show percentages above prior year in all but Cash and Third Party

0%

5%

10%

15%

20%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

0%

10%

20%

30%

40%

50%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021


CASH

MED D

0%

5%

10%

15%

20%

25%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

DISC. CARDS

0%

5%

10%

15%

20%

25%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

3rd PARTY

0%

2%

4%

6%

8%

10%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

MANAGED MEDICAID

90

-Day %

based

on

Un

ad

juste

d R

x’s

0%

2%

4%

6%

8%

10%

12%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

STATE MEDICAID

55

Patients & Adherence

56

An important dynamic

Retail to Mail Shifts


To better understand the deeper

dynamics of patients leaving retail and

going to mail (and then back to retail)

during COVID, we studied groups of

Diabetes (18M), RASA (38M), and

Statin (39M) patients

We looked at patients from the 3 therapies

who had:

• Retail only prescriptions between March

2019 and Feb 2020

• Then had mail prescriptions between

March 2020 - June 2021

• Then had retail prescriptions after the

last mail prescription between March

2020 - June 2021

• Retail ➔ Mail ➔ Retail

- We found that ~2.6% to 3.1%

of retail patients went to mail

- Of those patients going to mail,

~31% (RASA and Statins) to

48% (Diabetes) returned to retail

Summary – a small portion of retail only patients from the three therapies shifted to mail,

and we are seeing less than half of those patients returning to retail

57

While there have been some patients lost to Mail during this pandemic their share of the total market is down

0%

2%

4%

6%

8%

10%

12%


Mail

2019 2020 2021

85%

86%

87%

88%

89%

90%

91%

92%


Retail

2019 2020 2021

58

Without COVID vaccines, 2021 Retail patient counts are lower than 2020 and 2019 through May; with COVID vaccines, the retail patient counts are higher than prior years

30

3233

3736

37

20

22

24

26

28

30

32

34

36

38

40


Patients with 90-Day Rx’s

2019 2020 2021

103103

105

9899

108

96

99

85

90

95

100

105

110

115


Total Retail Patients

2019

2020

2021 With COVID Vaccines

2021 Excluding COVID Vaccines

Patients expressed in Millions

2021 Retail patients with 90-day prescriptions remains higher than 2020 and 2019


Source: IQVIA, Longitudinal Patient Data, MAT June 2021

59

COVID Vaccines boosted patient counts across all the classes of trade while Independents were the only class to gain when COVID vaccines were removed


8.6%

12.6%

8.9%

4.1%

-1.4% -1.8%

0.9%

-7.0%

-10%

-5%

0%

5%

10%

15%

Chain Food Indep Mass

YoY Patient Gain by Class of Trade

Including COVID Vaccine Excluding COVID Vaccine


60

COVID vaccines provided a boost to Food’s patient share while Mass shows declines with and without COVID vaccines

55.0%

17.2%

9.9%

17.9%

55.1%

17.8%

9.9%

17.2%

Chain Food Indep Mass

+0.1%

+0.6% -0.7%

55.0%

17.2%

9.9%

17.9%

55.5%

17.2%

10.2%

17.0%

FoodChain Indep Mass

+0.5%

0.0%

+0.3%

-0.9%

MAT Jun 2021MAT Jun 2020

Patients (Including COVID Vaccines) Patients (Excluding COVID Vaccines)


Patients are counted in each class of trade they visited during the time period


61

Mass Class of Trade lost 39% of the patients from the prior year and gained 32.5% new patients in the current year


Note: This data excludes COVID Vaccines

-39.4%

32.5%

60.6%

-60%

-20%

20%

60%

Lost Gained Continued

% Change – Year over Year


62

Adherence is not uniform regionally and varies by different factors, such as method of payment: Med D is most adherent

State Level

Market

Adherence

Rates by Method

of Payment –

Diabetes

Source: IQVIA, State Level Market Adherence Rates by Method of Payment, MAT June 2021

Significant range of

variability between

states


63

YOY Change continues to demonstrate a focus on the 3 STAR therapies

Source: IQVIA, State Level Market Adherence Rates by Method of Payment, MAT June 2021

Significant range of

variability between

states


64

Actual Adherence Rates include patients in the light and dark blue colors combined.

Across STAR Therapy categories, ~9% of patients have the greatest influence on retailers’ adherence rates

Approximately 4% of

patients are on the cusp

of being adherent.

Retailers may be able to

convert these patients

with minor interventions.

At the same time, an

almost equal proportion of

patients have a PDC

between 80 and 85% and

are at risk of becoming

non-adherent.

80M Pts 42M Pts 14M Pts 15M Pts 8M Pts


69% 70% 69% 67% 66%

5% 5% 5% 5% 5%4% 4% 4% 5% 4%

22% 21% 22% 23% 25%

0%

20%

40%

60%

80%

100%

Total Retail Chain Food Mass Independent

>=85% 80-<85% 75-<80% <75%


65

Adherence rates in each market are more than 20 points higher for patients getting 90-day Rx’s

90-day Rx’s are an effective way to increase adherence rates


48%

78%55%

80%

53%

79%

0

10

20

30

No 90-day Any 90-day No 90-day Any 90-day No 90-day Any 90-day

DIABETES RASA STATIN

Mill

ion

sPDC>=80% PDC<80%


66

Non-Adherent Antidepressant Patients are the least adherent to their Star Therapy Meds

Patients who are Adherent to Antidepressants are the most adherent to their Star therapies


79% 83% 82%

52% 56% 53%

70%76% 74%

21% 17% 18%

48% 44% 47%

30%24% 26%

0%

20%

40%

60%

80%

100%

DIABETES RASA STATIN DIABETES RASA STATIN DIABETES RASA STATIN

Adherent to Antidepressants Non-Adherent to Antidepressants Not on Antidepressants

Adherent to Star Therapy Non-Adherent to Star Therapy


67

Patient behavior for Adherence in STAR therapy requires an understanding of demographic characteristic risk factors

Applying IQVIA’s knowledge of risk factors to standard adherence performance metrics reveals insights to

those patients at greatest risk

Executive Brand

Risk Factor “High-Risk” Category Cutpoint

Income < $25,000 > 25% of population

Ethnicity Hispanic > 15% of population

Race Black > 18% of population

Education < High School Degree > 14.5% of population

Average Size of Household Larger Households > 2.67 persons

Home Value < $150,000 > 53% of population


68

Adherence typically declines with the compounding of multiple risk factors, adherence at Independents behaves a little differently


60

65

70

75

80

85

CHAIN FOOD INDEPENDENT MASS

Ad

he

ren

ce

Rate

Diabetes Adherence by Number of Risk Factors – Med D Rx’s OnlyJuly 2020 – June 2021

0 Risk Factors 1 Risk Factor 2 Risk Factors 3 Risk Factors 4 Risk Factors 5 Risk Factors 6 Risk Factors


69

Med D Diabetes adherence increased year-over-year for all groups of risk factors, and on average, Chain stores show the most improvement


74

.2% 76

.9%

78

.9%

72

.5% 75

.5%

77

.0%

74

.3%

75

.8%

77

.9%

73

.4%

75

.5%

76.2

%

75

.2%

77

.9%

79

.7%

72

.8% 75

.9%

77

.6%

74

.3%

76

.2%

78

.3%

75

.1%

76

.3%

76

.0%

68%

70%

72%

74%

76%

78%

80%

82%

High Medium Low High Medium Low High Medium Low High Medium Low

CHAIN MASS FOOD INDEPENDENT

Class of Trade and Risk Category Adherence Rates

202006 202106


70

Generics & Biosimilars

71

Un

bra

nd

ed

Ge

ne

ric

sUnbranded generics show negative sales growth and unadjusted volumes



Sales Adjusted Rx’s Unadjusted Rx’s

2.4 2.4 2.4

3.5

1.8

0

1

2

3

4

5

6

2018 2019 2020 MAT Jun2021

YTD Jun2021

Billio

ns

4.5 4.7 4.85.3

2.7

0

1

2

3

4

5

6

2018 2019 2020 MAT Jun2021

YTD Jun2021

Billio

ns55.9 56.4 56.3 56.6

27.9

0

10

20

30

40

50

60

2018 2019 2020 MAT Jun2021

YTD Jun2021

Billio

ns

-5.4%

0.9%

-0.3%

-2.16%

-4.82%

2018 2019 2020 MAT Jun2021

YTD Jun2021

YoY Growth

3.5% 4.2%2.1% 1.1% 1.3%

2018 2019 2020 MAT Jun2021

YTD Jun2021

-5.4%

0.9%

-0.3%

-2.6%

-1.6%

2018 2019 2020 MAT Jun2021

YTD Jun2021


72

Unbranded and branded generics account for 18.4% of spending in 2021

85.9% of prescriptions are dispensed as unbranded generics for 2021 (adjusted)


74.8% 76.8% 78.7% 80.0% 81.0% 81.6%

10.4% 9.4% 9.3% 8.9% 8.7% 10.8%

10.3%10.1% 9.7% 8.8% 8.2% 8.2%

4.8% 4.4% 4.1% 3.6% 3.4%3.3%

14.9% 13.0% 11.6% 11.2% 10.8% 10.3%

84.8% 86.2% 86.6% 87.5% 87.8% 85.9%

2016 2017 2018 2019 2020 2021 2016 2017 2018 2019 2020 2021

Dollars (%) Adjusted Prescriptions (%)

Brands Branded Generics Unbranded Generics



Generic Deflation is running slightly negative and returning to historic levels according to Nephron Research

Source: Nephron Research, IQVIA, Glass Box Analytics

(20.0%)

(15.0%)

(10.0%)

(5.0%)

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Oct-14 Feb-15 Jun-15 Oct-15 Feb-16 Jun-16 Oct-16 Feb-17 Jun-17 Oct-17 Feb-18 Jun-18 Oct-18 Feb-19 Jun-19 Oct-19 Feb-20 Jun-20 Oct-20 Feb-21

Gen

eric

Y/Y

Pri

cin

g C

han

ge CAH expects

inflation to decelerate in

2HFY15

ABC states generic inflation has slowed meaningfully

MCK issues FY17 outlook, resets inflation benefits bexpectations

to a range that includes zeroMCK and WMT announce

ClarusONE sourcing agreement

ClarusOne equalizes termsClarusOne bidding

cycle

WBAD plus ESRX, PMC and RAD begin to re-bid

Teva states contract with ClarusONE finalized

in 2Q17

Endo mentions consortia pressure as a reason for decreased pricing in 1Q

Generic manufacturer portfolio rationalization

expands throughout 2018

FDA approvals ramp considerably

FDA approvals ramp further

RAD renewal with MCK in December 2018 may have added ~125bps to

sell-side deflation

Returning to historic levels

Coronavirus concerns may have modestly elevated oral solid

deflation

74

Biosimilars available as well as in development

Leading Drug Classes

-5%

0%

5%

10%

15%

20%

2015 2016 2017 2018 2019

Biologics Small molecule Total US medicines

Biologics

CAGR 2015-2019:

14.6%

Total US Medicines

CAGR 2015-2019:

6.1%

Small Molecule

CAGR 2015-2019:

1.6%

Total 2019 US Medicine

Spending $493 Billion

Biologic43%

Small Molecule

57%

The U.S. biologics market continues to grow faster than non-biologics on an invoice-basis, and now comprises 43% of spendingTotal U.S. Invoice Spending Growth by Type and Leading Therapy Areas by 2019 Spending, US$Bn

Source: IQVIA MIDAS®; IQVIA Institute, Jun 2020

Year-over-Year Spending Growth

2015 2016 2017 2018 2019

Biosimilars in development

13

15

16

18

20

24

29

62

64

71

- 10,000,000,000 20,000,000,000 30,000,000,000 40,000,000,000 50,000,000,000 60,000,000,000 70,000,000,000 80,000,000,000

Vaccines

Pain

Mental health

Multiple sclerosis

Anticoagulants

HIV antivirals

Respiratory agents

Immunology

Antidiabetics

Oncology*


75

2019 Biologics Market Segmented by Status of Biosimilar Competition, Biosimilar Development and Market Exclusivity

Molecules with biosimilars total $40 billion of invoice spending,while biosimilar development is targeting a further $67 billion

Source: IQVIA MIDAS®; IQVIA Pipeline Intelligence, IQVIA Institute, Jun 2020

Biologics market

$211 Billion

Molecules facing

biosimilar competition

$40 Billion

Non-recombinant/

vaccines

$36 Billion

64%

17%

19%

50%

50%

Molecules with

biosimilars in

development

$67 Billion

Molecules without

biosimilars in

development

$68 Billion

Molecules with

potential future

biosimilars

$135 Billion

91%

88%

12%

Originator protected

$61 Billion

Originator unprotected

$6 Billion

Originator unprotected

$8 Billion

Originator protected

$60 Billion

9%


76

pegaspargasepanitumumab

alglucosidase alfainterferon beta-1b

palivizumabcetuximabfilgrastim

darbepoetin alfateriparatidetocilizumabipilimumabgolimumab

pertuzumabcertolizumab pegol

natalizumabranibizumabeculizumabepoetin alfaomalizumabvedolizumabinsulin aspart

somatropintrastuzumab

bevacizumabdenosumab

pegfilgrastimrituximab

afliberceptliraglutideinfliximab

insulin lisproustekinumab

etanerceptinsulin glargine

adalimumab

0 2 4 6 8 10 12// 20

//

Molecules with launched biosimilars

Molecules with no launched biosimilars

Current Total Molecule Spending and Approved, Launched and Pipeline Biosimilar Products for the Molecule

There are biosimilars launched, approved, or in development for35 molecules

Source: IQVIA Institute, Sep 2020; IQVIA Biosimilar Database, Jun 2020

0 5 10 15 20

pegaspargase

panitumumab

alglucos idase alfa

interferon beta-1b

palivizumab

cetuximab

filgrast im

darbepoet in alfa

teriparat ide

tocilizumab

ipilimumab

golimumab

pertuzumab

certolizumab pegol

natalizumab

ranibizumab

eculizumab

epoetin alfa

omalizumab

vedolizumab

insulin aspart

somatropin

trastuzumab

bevacizumab

denosumab

pegfilgrastim

rituximab

aflibercept

liraglut ide

inf lix imab

insulin lispro

ustekinumab

etanercept

insulin glargine

adalimumab

Launched

Approved

Phase I to pre-registration

Pre-clinical to discovery

2019 Spending US$Bn Number of Biosimilars Drugs by Status


77

42%

25%

39%

6%

28%

20%

38%

0%

10%

20%

30%

40%

50%

60%

70%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Months since biosimilar introduction

bevacizumab 7/2019

epoetin alfa 9/2018

filgrastim 11/2013

infliximab 11/2016

pegfilgrastim 7/2018

rituximab 11/2019

trastuzumab 7/2019

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 5 10 15 20 25 30 35 40 45 50

Weeks since biosimilar introduction

Non-340B Clinics

340B

Overall

All others

Biosimilar Share of Volume Since Biosimilar Launch

Recent biosimilars have achieved high volume shares, projected to reach more than 50% within the first two years, varying by channel

Source: IQVIA MIDAS®, Jun 2020

Biosimilar Share of Days in DDDsBiosimilar Share of Extended Units

Since Bevacizumab Biosimilar Launch


78

0

10

20

30

40

50

2019 2020 2021 2022 2023 2024

Sa

vin

gs f

rom

Bio

sim

ilars

, U

S$

Bn

Savings range high/low Savings base case

5-year Savings Scenarios

18 19

104

-

20,000,000,000

40,000,000,000

60,000,000,000

80,000,000,000

100,000,000,000

120,000,000,000

2010–2014 2015–2019 2020–2024

Source: IQVIA National Sales Perspectives, Jun 2020; IQVIA Institute, Sep 2020

Biologic Estimated Savings from Biosimilars at Invoice Prices

Savings over the next five years as a result of biosimilars areprojected to exceed $100 billion, though uncertainties remain

Biosimilar Savings by Cohort, US$Bn $104 Bn Base Case ($69–140 Bn Range)


79

Developed Markets Impact of Brand Losses of Exclusivity 2016–2025, US$Bn

The impact of exclusivity losses will increase to $166 billion overthe next 5 years mostly due to the availability of biosimilars

Source: IQVIA Market Prognosis, Sep 2020; IQVIA Institute, Feb 2021

Global Medicine and Spending Trends - Outlook to 2025. Report by the IQVIA Institute for Human Data Science.

-1.4 -3.7 -5.5 -5.2-8.5 -7.4

-11.7 -14.1-10.4

-22.1-23.4 -20.5

-21.9

-10.5

-14.6-21.7

-28.7 -22.3 -26.9-22.1-24.7 -24.3

-27.4

-15.7

-23.1

-29.1

-40.4

-36.3 -37.3

-50

-45

-40

-35

-30

-25

-20

-15

-10

-5

0

2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Biologic Small Total brand loss due to LOE

$114Bn $166Bn

Forecast

80

Product Launches


81

FDA approvals have not decreased during the COVID-19 pandemic and brand teams are moving forward with commercialization

49 in 2020 and 44 in 2019

Launches during COVID

Mar-Dec 2020 had 52

launches compared to 61

launches Mar-Dec 2019

Examples of delayed

products include Zeposia

(MS) and Ongentys &

Kynmobi (Parkinson’s)

Sales trajectories

appear to be impacted

by ~60% and EUTRx by

~35%

FDA Approvals

The FDA has not slowed

down NME approvals since

the start of the pandemic

Number of Launches

In FY 2020, there have been

63 launches compared to 69

in FY 2019 (NMEs +

promoted branded generics)

Launches Delayed

Of the 49 products approved,

only 3 announced a delay due

to COVID but are subsequently

launched

Launch Trajectories

feeling the impact of

COVID

Ten months into COVID

launches during COVID do

appear to be impacted


82

Product Company Indication LaunchYr 1 Sales

to 11/2020

Yr 1 NBRx

to 1/1/21

Veklury Gilead COVID-19 Oct-20 $519.5M NA

Tepezza* HorizonThyroid Eye

DiseaseFeb-20 $438.8M N/A

Ubrelvy Allergan Migraine Jan-20 $420.2M 178.9k

Nurtec Biohaven Migraine Mar-20 $236.1M 132.1k

Ruxience Pfizer NHL,CLL, MPA Feb-20 $173.1M N/A

TrodelvyImmuno-

medicsBreast Cancer Apr-20 $105.8M N/A

Zirabev Pfizer

MCRC, NSCLC,

rGBM, mRCC,

CC

Jan-20 $68.4M N/A

Amzeeq Foamix Acne Jan-20 $37.8M 68.2k

Trazimera Pfizer

Breast Cancer,

gastric or GEJ

adenocarcinoma

Mar-20 $32.9M N/A

Koselugo AZ NF1 Apr-20 $30.8M N/A

Oncology37%

CNS 25%

Infectious Disease 10%

Diabetes 5%

Cardiology3%

Dermatology3%

Genito-urinary system and sex hormones 3%

Digestive 3%

Musculo-skeletal

system 3%All Other 8%

Gilead’s Veklury for COVID-19 leads 2020’s launches in sales followed by Horizon’s Tepezza (thyroid eye disease) and Allergan’s Ubrelvy (acute migraine)

2020 – 63 Launches 2020 – Top 10 Performers

MCRC – metastatic colorectal cancer; NSCLC Non-squamous non-small cell lung cancer

rGBM – recurrent glioblastoma; mRCC – metastatic renal cell carcinoma; CC- cervical cancer

NHL - non-Hodgkin’s lymphoma; CLL -chronic lymphocytic leukemia; MPA - microscopic polyangiitis;

NF1 - neurofibromatosis type 1; GEJ - gastroesophageal junction

N/A: NBRx unavailable or likely understated owing to non-retail and non-mail channel distribution

*Likely understated owing to product reporting blocksIQVIA© 2021 Confidential & Proprietary

83

Only products with unambiguous and clear value propositions were successful

Products launching during the pandemic lag pre-COVID launches by ~50% to ~75%, with long-term implications

• The few successful launches in 2021 had very specific

value propositions:

- Gilead’s Veklury (remdesivir) treats COVID-19

- Ubrelvy (Allergan) and Nurtec (Biohaven) are oral

migraine drugs optimally set up for digital channels

- Horizon’s Tepezza treats an ultra-rare eye disorder

with no marketable treatments

- Pfizer’s Ruxience is a rituximab biosimilar

$0

$2

$4

$6

$8

$10

$12

$14

$16

Month 1 Month 2 Month 3 Month 4 Month 5 Month 6

Mill

ion

s

2020 Launches pre-COVID vs COVID Time Aligned Average Monthly Sales

2015 (n=67) 2016 (n=43) 2017 (n=53)

2018 (n=61) 2019 (n=46) 2020 (n=54)

2020 Pre-COVID (n=11) 2020 COVID (n=43)

Year 6M Sales % Diff

COVID (n=43) $13.6M

2015 (n=67) $38.3M -64.5%

2016 (n=43) $54.3M -74.9%

2017 (n=53) $40.3M -66.2%

2018 (n=61) $24.4M -44.3%

2019 (n=46) $49.3M -72.4%

2020 Pre-COVID (n=11) $35.5M -61.7%

IQVIA – Confidential & ProprietaryIQVIA© 2021 Confidential & Proprietary

84

Product launch summary

38Launches thru

Jun 2021

23Of the 27 FDA approved New

Molecular Entities (NMEs) in 2021

show evidence of launch based on

supply in channel or active websites

In 2020, the FDA approved New

Molecular Entities (NMEs). Of those

44 out of 49 show evidence of launch.

Top Therapy Areas of 2021 Launches

Oncology

$13.0

$7.7 $7.6

Menquadfi(Mar 21)

Nyvepria(Jan 21)

Orgovyx(Jan 21)

Top 2021 Launches by Sales (millions)

37%

Pharmaceutical companies continue to bring new products to market despite the uncertainty

introduced by the COVID-19 pandemic; there were 71 launches through December 2020 in line with

69 launches for the same period in 2019. To date, 2021 has seen a similar rate of product launches

compared to 2019 and 2020

Prostate

Cancer

Meningococcal

vaccineFebrile

Neutropenia

Infectious

13%

CNS

16%


85

Clinical Trial Starts by Month and Phase Jan 2019–Mar 2021

Monthly clinical trial starts declined significantly in early 2020 butrecovered from June to higher levels than in 2019


86

Opioids


87

Over 90,000 drug overdose deaths occurred in the US in the 12 months ending September 2020


90

,23

7

70

,72

3

47

,52

3

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

Sep-2

0

Apr-

20

Nov-1

9

Jun

-19

Jan

-19

Aug-1

8

Ma

r-18

Oct-

17

Ma

y-1

7

Dec-1

6

Jul-

16

Feb

-16

Sep-1

5

Apr-

15

12 Month-ending Provisional Number of Drug Overdose Deaths

https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html

88

Prescription Opioid Use in Morphine Milligram Equivalents (MME) per Capita, 1992–2020

Continued declines have brought normalized per capita prescription opioid use near the 2001 level


Source: IQVIA Xponent, Apr 2021; IQVIA National Prescription Audit; IQVIA Institute, Jul 2021

0

100

200

300

400

500

600

700

800

900

199

2

199

3

199

4

199

5

199

6

199

7

199

8

199

9

200

0

200

1

200

2

200

3

200

4

200

5

200

6

200

7

200

8

200

9

201

0

201

1

201

2

201

3

201

4

201

5

201

6

201

7

201

8

201

9

202

0

Dis

pe

nse

d M

ME

pe

r ca

pita

367

334

2019 MME per capita level 2020 MME per capita level

89

Prescription Opioid Use Segmented by Morphine Milligram Equivalents (MME) per Day, 2011–2020

The greatest reduction in prescription opioid use has been in thehighest risk segment, which contain more than 90 MMEs per day


Source: IQVIA Xponent, Apr 2021; IQVIA Institute, Jul 2021

0

50

100

150

200

250

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

MM

Es d

ispe

nse

d B

n

% Change 2011–2020

90+ MME per Day

50<90 MME per Day

20<50 MME per Day

<20 MME per Day

Total -55%

-15%

-38%

-36%

-74%

90

Number of Prescription Opioids Dispensed by Pay Type, Millions, 2011–2020

The number of Medicare opioid prescriptions is unchanged since 2011, while other pay types have declined


Source: IQVIA Xponent, Apr 2021; IQVIA Institute, Jul 2021

Change in Opioid Prescriptions

2011–2020

Commercial

Medicare

Medicaid

Cash

Total -44%

-68%

-50%

0%

-55%

0

50

100

150

200

250

300

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

24

32

53

149

8

16

53

67

91

Prescription Levels of Opioid, Medication-Assisted Treatment, and All Other Medications as aPercentage of Baseline (first 8 weeks of 2020), March 2020-July 2021

During the COVID-19 pandemic, as many as 44% fewer newpatients received prescription opioids while MAT was less impacted


Source: IQVIA New to Brand Weekly, Jul 2021

50%

60%

70%

80%

90%

100%

110%

120%

Base

line

4/3

5/8

6/1

2

7/1

7

8/2

1

9/2

5

10/3

0

12/4

1/8

2/1

2

3/1

9

4/2

3

5/2

8

7/2

Total prescriptions (TRx) Continuing brand prescriptions (CBRx) New to brand prescriptions (NBRx)

Base

line

4/3

5/8

6/1

2

7/1

7

8/2

1

9/2

5

10/3

0

12/4

1/8

2/1

2

3/1

9

4/2

3

5/2

8

7/2

Base

line

4/3

5/8

6/1

2

7/1

7

8/2

1

9/2

5

10/3

0

12/4

1/8

2/1

2

3/1

9

4/2

3

5/2

8

7/2

Prescription Opioids Medication-Assisted Treatment All Other Prescriptions

92

Patients Taking Any Benzodiazepine-Opioid, Benzodiazepine, or Opioid Therapy by Age, Millions

Patients taking benzodiazepines, opioids, or a combination of both, have declined from 86 million to 60 million between 2016 and 2020


Source: IQVIA U.S. Prescription Claims (LRx), Jul 2021; IQVIA Institute, Nov 2020

64.759.3

51.746.3

41.2 42.2

21.3

21.2

20.3

19.6

18.6 19.5

86.0

80.4

72.0

65.9

59.8 61.7

2016 2017 2018 2019 2020 2021*

Under 65 Over 65

+2.4%

-3.1%

-12.7% -11.0%

+4.5%-5.2%

-4.2%

-0.7%

-10.5%-8.4%

93

“AMA report shows evolving, deadlier overdose epidemic”*9

,61

0

5,7

77

6,8

41 1

3,0

51

12

,74

7

19

,50

0

7,6

10

10

,45

8 15

,55

1

14

,53

4

28

,65

9

10

,43

5

14

,06

9

15

,59

3

14

,55

9

31

,52

5

12

,84

3

14

,80

2

15

,10

2

12

,62

0

36

,50

9

16

,27

9

15

,97

4

14

,07

9

11

,90

4

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Fentanyls Stimulants Cocaine Heroin PrescriptionOpioids

# of Deaths by Substance

2015 2016 2017 2018 2019

-7%

8%

134%

182%

280%

-100% 0% 100% 200% 300%

Prescription Opioids

Heroin

Cocaine

Stimulants

Fentanyls

2015-2019 Growth

2015-2019 Growth

Data Source: CDC Provisional Drug Overdose Death Counts, https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

* https://www.ama-assn.org/press-center/press-releases/ama-report-shows-evolving-deadlier-overdose-epidemic


https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

94

Outlook for 2021


95

There have been a series of legacy considerations recognized across stakeholders

Pharmacies

• Reimbursement

• Controlled Substances

• Access to Specialty Drugs

• Purchasing Alliances

• Track and Trace

• Amazon, Digital pharmacies and cash customers

Generic Manufacturers


• Portfolio Optimization (“Shrink to Grow”) / Market Saturation

• Brand /niche drugs (complex generics)

• Generic Price Deflation

• Which approvals to launch?

Wholesalers

• Contract Negotiations

• Controlled Substances

• Generic Price Deflation / Slow Brand Inflation

• Track and Trace


Payers

• Managing Specialty Drug Costs

• Rising Oncology costs

• Formularies blocks and exclusive launches

Brand/Specialty Manufacturers

• Price increase backlash

• Becoming more specialized / Oral Specialty

• Declining Hep C and Pain Dollars

• Orphan Drugs

• Copay accumulators

Consumers

• Rising costs: high out-of-pocket costs / coinsurance /

accumulators

• Quality of Insurance Coverage

• Specialty Tiers


96

Drugstore News recently put the following question out to their readers, “What is pharmacy’s biggest challenge?”

https://drugstorenews.com/poll-results-reimbursement-top-mind, 8/4/2021

35%

27%

17%

12%

9%

Other

DIR Fees

Reimbursement Pressure

Payers Pushing for Online/Mail-Order Pharmacies

Amazon


Among the 12% who didn’t think

any of the answers supplied by

DSN constituted the biggest

challenge in the industry,

staffing concerns emerged as

a leading area of concern —

with many noting that fewer

people staffing the pharmacy

counter means pharmacists are

spread too thin.

https://drugstorenews.com/poll-results-reimbursement-top-mind


97

What factors will influence the rebound of the 86 million acute Rx’s lost between 2019 and 2020?

Positive Impacts –

Increases in Rx’s*

• Testing options – better identification of

cases = improvement in quarantine practices =

reduction in overall COVID cases = increases

in non-COVID Rx’s

• More elective surgeries – increase in non-

COVID Rx’s (pain, anti-infectives)

• More routine office visits – increase in non-

COVID Rx’s (> Avg Rx per visit than

telehealth)

• Mask mandates lifted – increases in

cough/cold flu Rx’s

• Improved access to vaccine – decrease in

cases = return to normal life = overall increase

in non-COVID Rx’s

• LTC – shifting back to pre-COVID levels –

increase in LTC (chronic and acute) Rx’s

Negative Impacts –

Decreases in Rx’s

• Telemedicine – plateauing but likely here to

stay = fewer Rx’s per visit than traditional in

person visit

• Flu vaccines – will they match the historic

numbers from last season? If so, could result

in decreases in non-COVID/Cough/Cold Rx’s

Unknown Impacts – not certain

how this will impact Rx’s

• Hand washing & hand sanitizer – ingrained

in daily lives = decrease in cough/cold/flu =

decrease in Rx’s but potentially leading to

fewer COVID cases = increase in overall non-

COVID Rx’s

• Return to school/work/travel/conventions/

dining/entertainment – could result in

increases in cough/cold/flu cases and

associated Rx’s but could also increase

COVID cases which could decrease non-

COVID Rx’s

*Assumption is that lower COVID cases = higher non-COVID/Cough/Cold Rx’s (increased MD visits, more exposure to other illnesses).


98

Healthcare must address COVID

disruption - pharma has a role

• Telehealth

• Reinforced supply chains

• Self-administered therapy options

• Remote/digital HCP engagement

• COVID testing and vaccines

However, with the pandemic, new trends may define 2021—and beyond

Prices scrutinized; increasing pressure

to demonstrate value

Widespread and successful vaccination

now seems more likely; immunity

longevity remains a question mark

Successful vaccination will not

necessarily mean a return to

business as usual

All geographies and stakeholders

impacted by the pandemic

NCE launches must adapt to an uncertain

environment; biosimilars grow into

maturity

Some markets showcase resilience

and growth

2020s


99

263 254 256284 311 323 324 338 356 359 367 373 378 385 391

328 319333

380

427446 455

484511

539560 578

595614

634

0

100

200

300

400

500

600

700

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Net sales Invoice to net difference

U.S. Medicine Spending and Growth at Invoice-level and Estimated Net 2011–2025

The U.S. spending forecast reflects an increasing gap between invoice level spending and manufacturer net revenues

Source: IQVIA Institute, Feb 2021

Forecast

Net

CAGR

3.9%

Net 27%

Below

Invoice

Invoice

CAGR

6.3%

5-Year CAGRs


Net

CAGR

2.9%

Net 33%

Below

Invoice

Invoice

CAGR

3.5%

5-Year CAGRs

Net

CAGR

0-3%

Net 38%

Below

Invoice

Invoice

CAGR

2-5%

5-Year CAGRs

Invoice

100

Patients visit pharmacies 10x more frequently than they see other healthcare providers1

Pharmacists’

roles are

expanding

Chronic Disease Management Health & Wellness Care

Conduct Therapeutic

Interchange

Minor Ailment Care

Immunizations

Preventive Health Screenings

Specialty Medicare Care

& Counselling

Pharmacogenomics

Counselling

Transitions of Care

Medication Optimization

1 Hemberg N, Huggins D, et al. Innovative Community Pharmacy Practice Models in North Carolina. North Carolina Medical Journal. June 2017. http://www.ncmedicaljournal.com/content/78/3/198.full


http://www.ncmedicaljournal.com/content/78/3/198.full

101

Other key findings

The most frequently used healthcare

services; Vaccinations and

Routine Screenings

51% of pharmacy customers have used health and wellness services over the last year according to J.D. Powers

43%

48%51%

2019 2020 2021

Pharmacy Customers using

health and wellness services

Source: J.D. Powers 2021 US Pharmacy Study

Customers who use at least 1 health and

wellness-oriented service spend an

average of $5 more than those who do

not use these services

Overall satisfaction and brand advocacy

scores also increased 24 points when

customers utilized wellness services

Mobile app integration in pharmacies is

becoming increasingly vital:

-26 percent of brick-and-mortar

customers

-27 percent of small order

customers accessed their

pharmacy’s mobile app

Satisfaction with brick-and-mortar mobile apps

landed at 848, and overall satisfaction with

mail-order mobile apps was 868

Researchers noted that both of these scores

are higher than the average mobile app or text

message satisfaction score of

826 seen in the J.D. Power 2021

Commercial Member Health Plan Study


102

The IQVIA Institute produces a number of reports on a regular basis that you might find useful, check them out


This report examines the

trends in pharmaceutical

research and development

through the end of 2020. It

provides an analysis of

initiated clinical trials,

including the impact of the

pandemic and COVID-19-

specific research. Research

on clinical development

productivity is also

presented, as well as

profiles of the R&D pipeline,

R&D funding trends, and

characteristics of new drug

approvals and launches.

Despite the COVID-19

pandemic having a

substantial impact on patient

care during 2020, the

scientific advances in clinical

trial activity, the pipeline of

new treatments, and the

increased use of available

therapeutics, continued

largely unaffected and

reflect the commitment to

advancing care for patients

by oncologists, other care

providers, governments and

payers, and life sciences

companies.

The U.S. health system

demonstrated resilience and

flexibility during 2020,

recovering toward its pre-

pandemic levels of activity

and progressing into 2021,

even as the backlog of

missed or delayed activity

remains substantial.

Medicine supply was largely

maintained and spending on

medicines increased by less

than 1% on a net price

basis.

The future level of global

spending on medicines has

implications for healthcare

systems and policymakers

across developed and

emerging economies, and

these issues are even more

important in light of the

ongoing global COVID-19

pandemic.

The opioid epidemic has

captivated the country for a

decade, although it lost

attention this year in the face

of the COVID-19 pandemic,

which affected the life and

healthcare of patients with

chronic pain and addiction

and so many others.

Innovation in digital health

tools, including mobile

health apps and wearable

sensors, bring new

approaches to the

management of health

conditions. Digital

therapeutics to treat human

disease are being approved

by regulatory agencies

around the world and routes

to reimbursement are being

established as developers

generate and submit high-

quality data on effectiveness

to payers and employers.

All these reports and others can be found at: https://www.iqvia.com/insights/the-iqvia-institute/reports

https://www.iqvia.com/insights/the-iqvia-institute/reports

103

Disclaimer:

• The analyses, their interpretation, and related information contained herein are made and provided subject to the

assumptions, methodologies, caveats, and variables described in this report and are based on third party sources

and data reasonably believed to be reliable. No warranty is made as to the completeness or accuracy of such

third party sources or data.

• As with any attempt to estimate future events, the forecasts, projections, conclusions, and other information

included herein are subject to certain risks and uncertainties, and are not to be considered guarantees of any

particular outcome.

• All reproduction rights, quotations, broadcasting, publications reserved. No part of this presentation 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 IQVIA.

• ©2020 IQVIA Incorporated and its affiliates. All rights reserved. Trademarks are registered in the United States

and in various other countries.

Thank you


104

Doug Long is Vice President of Industry Relations at IQVIA (formerly QuintilesIMS), the world’s

largest pharmaceutical information company. IQVIA offers services to the pharmaceutical industry

in over 100 countries around the globe. Doug has been with IQVIA since 1989.

His fundamental task is to help secure data for all existing and new databases supported by

IQVIA, manage supplier, manufacturer & association relationships, and develop information for

data partners. As direct consequence of his involvement in these areas, Doug has considerable

experience with, and a unique perspective on, the changing U.S. and global healthcare

marketplace and pharmaceutical distribution.

Doug is a frequent industry speaker and the recipient of many awards from trade groups. Before

joining IQVIA Doug held positions at Nielsen Market Research for 16 years in various sales and

marketing capacities. A native of Illinois, Doug received a BA from DePauw University and holds

an MBA in management from Fairleigh Dickinson University.

[email protected]


105IQVIA© 2021 Confidential & Proprietary

Scott Biggs, Director, Supplier Services

Scott Biggs is Director of Supplier Services at IQVIA (previously known as

QuintilesIMS), the world’s largest pharmaceutical information company, serving over

101 countries. He has been with IQVIA since 2011.

Prior to IQVIA Scott worked for other pharmaceutical information companies for

several years and worked at Rite Aid Corporation in multiple roles for over 10 years.

Scott received a BS degree from Penn State University in Accounting and has been

working with pharmacy data for almost 25 years.

In his role at IQVIA Scott has worked with retailers, software vendors and other data

suppliers where he has helped them to understand their performance in the market

place through business reviews and market analysis.

106

Brand Adjusted and Unadjusted Rx growth has exploded due to COVID vaccines

Source: IQVIA, Xponent®, April 2021

Note: Limited to Rx and OTC Insulins; Includes Retail and Mail

Un

ad

jus

ted

Rx

’sA

dju

ste

d R

x’s

Brand Branded Generic Generic

-12.6%

0.0%

-3.5% -2.1%

25.1%

54.3%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021

-14.0%

-7.5%

-13.1%

-8.5%-5.1% -4.5%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021

-4.2%-0.3%

0.6%

-2.1% -2.6% -1.6%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021

-12.9%

1.3%

-1.3% -0.3%

20.4%

41.7%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021

-11.7%

-4.0%

-9.9%

-2.7%

0.5% 0.1%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021

-2.2%

3.2% 3.3% 2.3% 1.1% 1.3%

2017 2018 2019 2020 MAT Jun2021

YTD Jun2021


107

Bra

nd

COVID Vaccines drive Brand Rx volumes

Source: IQVIA, National Sales Perspectives, August 2021, Xponent®


Sales Adjusted Rx’s Unadjusted Rx’s

425.9 411.1 402.5

497.9

271.2

0

100

200

300

400

500

600

2018 2019 2020 MAT Jun2021

YTD Jun2021

Millio

ns

454.1 449.2 451.2

625.2

334.4

0

100

200

300

400

500

600

700

2018 2019 2020 MAT Jun2021

YTD Jun2021

Millio

ns

380.3409.8 433.5 452.6

230.4

0

100

200

300

400

500

2018 2019 2020 MAT Jun2021

YTD Jun2021

Billio

ns

9.0%7.8%

5.8%

7.6%8.8%

2018 2019 2020 MAT Jun2021

YTD Jun2021

YoY Growth

1.9%

-1.1%

0.4%

20.4%

41.7%

2018 2019 2020 MAT Jun2021

YTD Jun2021

0.1%

-3.5% -2.1%

25.1%

54.3%

2018 2019 2020 MAT Jun2021

YTD Jun2021


108

In MAT June 2021, specialty spend increased 8.6% while traditional products grew 5.1%

For retail and mail channels (combined), specialty growth is outpacing traditional growth and now has ~41% share of total non-discounted spend

$117.3 $126.5 $140.3 $153.6$160.6

$205.6$211.1

$214.3$220.3 $226.8$322.9

$337.6$354.7

$373.9 $387.4

-30%

0%

30%

$

$60

$120

$180

$240

$300

$360

Gro

wth

N

on

-Dis

co

un

ted

Sp

en

d (

BN

s)


Source: IQVIA, National Sales Perspectives Restricted to Retail and Mail Channels, Jun 2021

Share of Sales 2017 2018 2019 2020MAT JUN

2021

SPECIALTY 36.3% 37.5% 39.6% 41.1% 41.4%

TRADITIONAL 63.7% 62.5% 60.4% 58.9% 58.6%

109

In MAT June 2021, specialty spend increased 3.2% while traditional grew 5.0%

For the retail channel, traditional growth is outpacing specialty growth and now has ~84% share of total non-discounted spend

$30.9 $32.4 $34.7 $36.9 $37.4

$180.3 $183.7 $186.8 $192.4 $198.1$211.2 $216.1 $221.6 $229.3 $235.5

-15%

0%

15%

$

$50

$100

$150

$200

$250

Gro

wth

N

on

-Dis

co

un

ted

Sp

en

d

(BN

s)


Source: IQVIA, National Sales Perspectives Restricted to Retail Only, June 2021

Share of Sales 2017 2018 2019 2020MAT

JUN 2021

SPECIALTY 14.6% 15.0% 15.7% 16.1% 15.9%

TRADITIONAL 85.4% 85.0% 84.3% 83.9% 84.1%

110

Absolute Value Growth for Top Specialty Therapy Areas

In 2021, Immunology, Oncologics, All other respiratory Specialty absolute value growth while Multiple Sclerosis, Viral Hepatitis and Hematopoietic Growth factors vaccine contributed most to value decline


$12.4

$5.1

$0.3

-$1.2

$0.3

$0.9

$0.3

-$1.1

$0.5

-$0.5

$0.4

$0.2

-$5 $0 $5 $10 $15

IMMUNOLOGY

ONCOLOGICS

HIV ANTIVIRALS

MULTIPLE SCLEROSIS

POLYVAL IMMUNOGLOBLULINS IV&IM

ALL OTHER RESPIRATORY

MENTAL HEALTH

VIRAL HEPATITIS

RESPIRATORY AGENTS

HEMATOPOIETIC GROWTH FACTORS

BLOOD COAGULATION

All Other

Absolute Value Growth (US$ BNs)

∆Change from MAT JUN 2020 to MAT JUN 2021

$49.4

$33.5

$8.7

$0.1

$2.8

$3.3

$2.0

-$12.5

$2.7

-$1.2

$2.0

$10.7

-$20 -$10 $0 $10 $20 $30 $40 $50


∆Change from 2016 to MAT JUN 2021

111

Absolute Value Growth for Top Traditional Therapy Areas

Antidiabetics, Anticoagulants and Other Cardiovasculars lead traditional products absolute value growth


$8.7

-$0.1

$3.1

$0.7

$0.7

$0.5

$0.4

-$0.5

$0.0

$0.2

$0.9

-$0.6

$0.2

-$4 $0 $4 $8 $12

ANTIDIABETICS

RESPIRATORY AGENTS

ANTICOAGULANTS

PAIN

MENTAL HEALTH

VACCINES (PURE, COMB, OTHER)

GI PRODUCTS

NERVOUS SYSTEM DISORDERS

ADHD

ANTIHYPERTENSIVES, PLAIN & COMBO

OTHER CARDIOVASCULARS

DERMATOLOGICS

All Other


∆Change from MAT JUN 2020 to MAT JUN 2021

$31.9

$3.8

$14.4

-$4.0

-$1.7

$3.1

$1.3

-$2.7

-$2.4

-$1.5

$1.4

-$5.0

-$23.7

-$30 -$20 -$10 $0 $10 $20 $30 $40


∆Change from 2016 to MAT JUN 2021

112

Cash, Med D, and Discount Cards slightly increase; Third Party and Medicaid decrease

2%

3%

3%

4%

4%

5%

5%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

31%

32%

33%

34%

35%

36%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021


CASH

MED D

0%

1%

2%

3%

4%

5%

6%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

DISC. CARDS

36%

37%

38%

39%

40%

41%

42%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

3rd PARTY

11%

12%

13%

14%

Jan

Feb

Ma

r

Apr

Ma

y

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2019 2020 2021

MEDICAID

Mark

et

Sh

are

based

on

Ad

jus

ted

Rx’s

NOTE: Discount Cards are removed

from 3rd Party

Date post:	26-Jan-2022
Category:	Documents
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US Pharmaceutical Trends, Issues and Outlook for NACDS TSE

Documents