Implication of China 2012 NEDL. Presented by: Li Xingwei Yong Hueyling

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1 Implication of China 2012 NEDL to MNC pharma players Presented by: Li Xingwei Yong Hueyling

2 Content Brief introduction of China NEDL policy China hospital system & MNCs Business Focus Influence of 2012 NEDL on MNCs Counter actions by MNCs and the impact on MR providers 抛 砖 引 玉 Cast a brick to attract jade -- offer a few commonplace remarks by way of introduction so that others may come up with valuable opinion 2

3 China National Essential Drug List (NEDL) Policy The first version of China National Essential Drug List (NEDL) was introduced in 2009, and is to be renewed every 3-4 years. In March 2013 China MOH released the second version of NEDL (more commonly known as 2012 NEDL) NEDL aims to, as well as to ensure access to essential drugs reduce government s spending on healthcare over time General requirements of NEDL Key issues Reasonable pricing Affordability Fulfilling basic healthcare needs Suitable formulation and dosage Accessibility Assurance of drug supply 3

4 Affordability Accessibility China National Essential Drug List (NEDL) Policy To reduce government s healthcare expenditure, drug manufacturers are requested to offer a sharp price cut before they are allowed to bid for NEDL drug tendering Besides that, drug s price is the most important factor in drug choice during tender process, and in some provinces, it is the ONLY consideration Average Price cut after NEDL tender 53% 39% 26% That said Anhui (2010) Shanghai (2011) Beijing (2012) In recent tenders, product quality has been included as one of the evaluation criteria and price is slightly de-prioritized. This change alleviates the excessive competition on price alone and helps MNC players, who are perceived to offer better quality products. 4

5 Affordability Accessibility China National Essential Drug List (NEDL) Policy New revisions in 2012 NEDL: Increased coverage on TAs/ molecules, and Greater enforcement, varies across hospitals of different sizes 2009 NEDL 2012 NEDL Notable changes Total number of molecules Therapeutic focus Basic needs Additional needs Added oncology, blood, pediatric drugs Required revenue ratio from NEDL drugs Small hospitals (Class 1 and primary healthcare centers, e.g. CHCs, Township healthcare center, etc.) 100% 100% NA Medium hospitals (Class 2 hospitals) 25-35% 40-50% +15% Big hospitals (Class 3 hospitals) 15-25% 25-30% +7.5% 5

6 Content Brief introduction of China NEDL policy China hospital system & MNCs Business Focus Influence of 2012 NEDL on MNCs Counter actions by MNCs and the impact on MR providers 6

7 Overview of China hospital system by hospital level Big and medium hospitals generate 75% of total hospital revenues on medication, and manage approx. one third of patients making them the focal point of MNC pharmaceutical companies 100% Contribution from hospitals of different sizes 10% 2% 17% 80% 19% 45% Big hospitals 60% 40% 20% 88% 65% 30% 25% Medium hospitals Small hospitals 0% # of Institution Patient load Hospital revenue on medication 67, billion billion USD Source: MOH year book 2012, IMS China hospital pharmacy audit data

8 Overview of China hospital system by city tier In tier 1-2 cities, medication revenues are mainly generated from big/medium hospitals; to the contrary, small/ medium hospitals play dominant role in lower tier cities. Therefore, the impact from 2012 NEDL will be more felt in lower tier cities % of revenue Contribution to medication revenue by hospital type No. of cities Hospital revenues on medication Tier 1-2 cities Tier 1: Beijing, Shanghai, etc. Tier 2: Nanjing, Shenyang, etc. 18% 24% 58% billion USD Tier 3-4 cities Tier 3: Fuzhou, Nanchang, etc. Tier 4: Yangzhou, Baotou, etc. Tier 5 and below cities Tier 5: Huangshi, Xianyang, Xingtai, etc. 22% 41% 31% 37% Source: MOH year book 2012, IMS China hospital pharmacy audit data % 22% Small hospitals Medium hospitals Big hospitals 101 > billion USD 24.0 billion USD 8

9 MNCs current focus Currently, MNCs business is highly focused on high tier cities and big hospitals MNCs contribution to total pharma market sales (hospital channel only) 100% Sales contribution by hospitals type (SH & BJ) Local MNC 80% 60% 40% 45% 26% 63% Big hospitals Medium hospitals Small hospitals Market size/ USD billion 40% Tier 1 cities 31% Tier 2 cities 24% 22% Tier 3 cities Tier 4 cities < 10% Tier 5 & below (Est.) % 0% 29% Total market 20% 17% MNCs Source: IMS CHPA/CHC database 9

10 MNCs business vs. NEDL direction Hence MNC pharma companies and NEDL are growing in opposite directions on: Hospital coverage Focus on cities Impact of NEDL Big hospitals and High tier cities Greater Greater Small hospitals and Low tier cities Presence of MNC pharma 10

11 Content Brief introduction of China NEDL policy China hospital system & MNCs Business Focus Influence of 2012 NEDL on MNCs Counter actions by MNCs and the impact on MR providers 11

12 Change in tendering policy In the past, most MNCs were able to choose Non-NEDL market, and give up NEDL market in order to maintain its premium pricing. However, going forward, giving up NEDL market will mean losing total China market. As the latest policy demands all NEDL enlisted drugs to enter hospitals via NEDL tender ONLY, this means PRICE CUT is inevitable Past Future Non-NEDL tendering: No price cut Can t enjoy NEDL benefit NEDL tendering: Price cut Enjoy NEDL benefit NEDL drugs NEDL tendering: used as NEDL drug 12

13 2012 NEDL s impact on MNCs business Compared to 2009 NEDL, the latest NEDL will have greater impact on MNCs as number of molecules and products involved had doubled. Influence of 2009 NEDL vs NEDL to MNCs revenues ~4X ~2X 3,732 mil. USD ~2X mil. USD No. of moleculars involving MNCs No. of MNC products invovled Total revenue (hospital channel) 13

14 2012 NEDL s impact on MNCs And several leading companies will be greatly influenced by the new NEDL Company % of NEDL drugs in total company revenues Change Bayer 29% 51% +22% Sanofi 2% 49% +47% Baxter 10% 45% +35% BMS 21% 38% +17% AstraZeneca 28% 30% +2% Novartis 4% 29% +25% Pfizer 17% 24% +7% GSK 8% 24% +16% Otsuka 22% 23% +1% 14

15 Great potential of NEDL market With greater enforcement, NEDL market is believed to offer higher potential in the future, esp. small hospitals in lower tier cities, which have been neglected by MNCs in the past. Current vs. future market size of NEDL drugs (Based on the required revenue ratio of NEDL drugs) 23% 11.2 Bil USD 27% 13.6 Bil USD 35% Tier 1-2 cities 5.0 Bil USD 5.9 Bil USD 12.9 Bil USD 21% 25% 54% Small hospital 50% 25.1 Bil USD 26% 39% Tier 3-4 cities Tier 5 and below cities Current NEDL market Future NEDL market (Est.) Source: MOH Report on pharmaceutical industry operation 2012, IMS China Hospital Pharmacy Audit

16 Content Brief introduction of China NEDL policy China hospital system & MNCs Business Focus Influence of 2012 NEDL on MNCs Counter actions by MNCs and the impact on MR providers 16

17 MNCs broad market strategies To counter the situation, some MNC drug companies have expanded their footprints into broad markets and smaller hospitals Pfizer Spring Blossom Project Bayer Go West Project In May 2010, Pfizer sponsored a program in collaboration with China International Medical Foundation to provide trainings for doctors from basic health institutions. The project will be carried out over a period of 3 years time, covering 2 million healthcare professionals from rural healthcare centers, CHC, nation wide. 17 Up until June 2011, Bayer s Go West Project has enabled the company to provide professional trainings for 4,000 doctors spanning across 13 provinces in mid-west China. From 2012 to 2017, Bayer is committed to provide more trainings to county doctors, esp. on academic, hospital management, and patient relationship management, etc.

18 More research needs in low tier markets In the past few years, more studies are conducted in smaller cities, esp. tier 5 and below, indicating increased interest and focus on these markets 25,000 No. of samples collected in different tier of cities by IMS Fieldwork in the past 3 years (for primary research only) 20,000 15, ,000 5,000 - Tier 1 cities Tier 2 cities Tier 3-4 cities Tier 5 cities and below 18

19 Measures taken by MNCs Core market Broad market Pricing strategies: - Newly NEDL enlisted products: nationwide pricing adjustment - New products: outlast EDL price cuts before patent expiry Branding: - Differentiate from MNC and local competitions Exploring new patient segments/ indications/ line extensions Bringing in novel products: - Expedite launches of new novel drugs that are less affected by current policy, e.g. rare disease Pricing strategies: - To compete with local players Branding: - Establish brand values - Differentiate from local players Broad market strategy Affordable and innovative services, e.g. video conferencing, web meetings, telemarketing, etc. Generic alliances, M&A, partnership with local distributors 19

20 New challenges facing MR providers 1. More needs for tried and tested techniques in Pricing / value research Brand differentiation New patient segment exploration, etc. 2. Building FW capability in broad markets Continued efforts needed to build FW capability in low tier cities More affordable data capture methods 3. To keep up to date and strengthen knowledge in various therapeutic areas, i.e. rare diseases, etc. 4. Exploring better ways to conduct competitor intelligence studies, to address requests for due diligence, part of M&A requirement. 20

21 Implication of China 2012 NEDL to MNC pharma players Presented by: Li Xingwei Yong Hueyling 21

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