Central and Eastern European (CEE) pharmaceutical markets comparison

Transcription

1 Central and Eastern European () pharmaceutical markets comparison IMS Health Consulting Martin Šlégl, Senior Consultant May

2 There are both common patterns and differences within 10 countries, which call for tailored strategies Management summary We compared 10 Central&Eastern European () countries with each other and with 16 Western European (WE) countries had a higher pharma share in GDP by 0.4pp, but 2.5 times less spending/capita and 2.0 times cheaper overall basket While OTC 3Y CAGR in was faster by 5 p.p. than WE, RX segment showed similar growth spent relatively more on Cardio (17% vs. 9%) and less on Anti-infectives (9% vs.13%) Oncology spending share was similar (19% vs. 20%) The top 4 countries accounted for 75% of the total pharmaceutical market share did not correlate with population or GDP share Estimated unofficial export and payback and rep tax accounted for ca. 10% (ca. 1.8 bn EUR) of the reported market figures even after adjustment BGR, HUN, ROU and SVK spent biggest share of their net income Spending on protected RX varied from 17%-21% in less developed countries to 22%-40% in more affluent ones Reimbursed medicines comprised between 11% and 91% of total sales hospital channel varied from 11% to 32% market growth was driven by protected RX, especially in larger markets (75% of total growth) Distribution (wholesale+retail) margins varied between 16% and 28% across the region, depending on payment timeliness markets were dominated by chain pharmacies, especially in countries with a high number of pharmacies per capita Spending on medicines varied from 14% (SRB) to 24% (ROU) of total healthcare spending A number of factors influenced the role of doctors in shaping the market Bulgarian doctors seemed to have the biggest power regulators used different sets of tools aimed at spending control growing trend to focus on price control Spending on oncology varied from 11% to 26% of total Rx spending, the lowest being in SRB and the highest in SVK Share of new launches in total Rx across four countries did not exceed 6% for Gx and 2% for protected molecules BGR and SVK showed relatively higher volume and price growth than other countries Cough&Cold (OTC1) and Pain Relief (OTC2) medications comprised ca. 50% of the OTC market 1

3 We compared 10 countries with a group of 16 WE countries Central & Eastern Europe () Western Europe (WE) Out-of-scope 1) Countries in descending order of pharma market value Central & Eastern Europe () Poland Romania Hungary Czech Republic Slovakia Croatia Slovenia Bulgaria Serbia Bosnia Data Western Europe (WE) Germany France UK Italy Spain Netherlands Belgium Greece Portugal Sweden Austria Switzerland Finland Norway Ireland Luxembourg If not mentioned otherwise: Period=MAT 7 Pharma market=rx+otc Prices at ex-manufacturer level, at list price value, do not include rebates and discounts 2

4 Agenda 1 2 vs. WE Comparison of the countries A. Pharma market overview B. Growth structure C. Rx therapy spending A. Market & Growth Structure B. Distribution landscape C. Market environment D. Quick look at Rx and OTC separately 3 About us A. IMS Health Consulting B. Authors and contact details 3

5 vs. WE While OTC 3Y CAGR in was faster by 5 p.p. than WE, RX segment showed similar growth Growth structure: Rx vs. OTC 3Y CAGR [ ] Nominal change [ , bn EUR] Value share of Protected in total Rx [ , %] RX 3.2% 2.9% -0.4pp pp % % OTC 5.8% WE -5pp % WE 0.4 3Y Change WE +6 p.p. +4pp +10 p.p. 4 Comments WE RX market value in grew from 12.4bn in 2012 to 13.6bn EUR in 2015 while in WE from 131.3bn to 143.2bn EUR respectively OTC market in grew from 2.3bn in 2012 to 2.7bn EUR in 2015 while in WE from 14.5bn to 14.9bn EUR respectively OTC market although 5.5 x times smaller in value generated similar nominal growth in 3Y as in WE In last 3Y both and WE market growths were driven by protected RX (93% and 100% of nominal growth) OTC market growth was driven in by Cough Cold remedies, whereas in WE by Pain Reliefs WE: Germany, France, UK, Italy, Spain, Netherlands, Belgium, Greece, Portugal, Sweden, Austria, Switzerland, Finland, Norway, Ireland, Luxembourg : Poland, Romania, Hungary, Czech Republic, Slovakia, Croatia, Slovenia, Bulgaria, Serbia, Bosnia WE WE

6 vs. WE countries spent relatively more on Cardio class and less on Anti-infectives Oncology spending share was similar RX - Therapy spending Spending structure by therapy - ATC1 [2015, %] WEU +1pp -8pp +4pp 31% 33% 19% 20% 17% 9% 12% 14% 12% 11% 9% 13% Oncology (L) Cardiovascular (C) Nervous (N) Alimentary & metabolism (A) Anti-infectives (J) Others Comments Top 5 ATC1 classes represented ca. 70% of total Rx value in and WE In per capita spending on Oncology was only one third of WE average (24 EUR vs. 69 EUR ) Patients in used considerably less protected products than in WE the share of protected RX in TOP5 ATC1 classes is lower by 8 p.p. on average in compared to WE Differences are driven mainly by different reimbursement policies, price control efficiency and financial strength of payers 5 WE: Germany, France, UK, Italy, Spain, Netherlands, Belgium, Greece, Portugal, Sweden, Austria, Switzerland, Finland, Norway, Ireland, Luxembourg : Poland, Romania, Hungary, Czech Republic, Slovakia, Croatia, Slovenia, Bulgaria, Serbia, Bosnia

7 Market & Growth Structure Estimated unofficial export, payback and rep tax accounted for 1.8 bn EUR, ca. 10% of the reported market figures Estimated local sales Estimated local pharma sales 1) without unofficial export, payback and rep tax 2) [2015, bn EUR] Adjustment 5.5 5% Local sales Unofficial export: 7% Payback: 11% Rep Tax: 4% Total adjustment = 1.8 bn EUR (10% of the initial value) POL Comments ROU 19% HUN 2) 22% CZE 1) RX+OTC, excluding FS 2) Rep tax present in Hungary only 8% SVK 17% BGR 18% HRV % High share of unofficial export, payback and rep tax in total market were observed in ROU, SVK, HUN and BGR Further analysis was based on non-adjusted figures, as it was focused on relative market structure (not nominal values) and impact of the adjustment is not equal across therapies (it can be only assumed that more expensive medicines are more prone for unofficial export) SRB SVN 5% BIH

8 Rx+OTC back up Reimbursed medicines comprised between 11% and 91% of total sales hospital channel varied from 11% to 32% Retail and hospital market structure [RX+OTC] Market Structure by country [2015] HOSPITAL RETAIL Reimb RETAIL Non-Reimb POL ROU 18% 15% 36% 42% 46% 43% HUN CZE SVK 2) 24% 27% 20% 50% 44% 53% 26% 29% 27% BGR 20% 31% 49% HRV 32% 59% SRB 20% 47% 33% SVN 23% 55% 22% BIH 1) 11% 89% 1) BIH Reimb. and Non-reimb. calculated together 2) Hospital tenders sales adjusted 9% Comments In 64% of pharma market value is reimbursed 10.2bn out of 16.1bn EUR Total retail channel in reached ca. 12 bn EUR in 2015 Retail channel generated 72% of total sales and accounted for ca. 70% of total growth in retail channel 3Y CAGR was slower than Hospital channel (3% vs. 6%) The share of nonreimbursed medicines is also driven by size of the OTC segment High share of hospital in Croatia resulted from relatively higher spending on Onco and Nervous therapies 7 LC DB, IMS MIDAS

9 Market environment A number of factors influenced the role of doctors overall Bulgarian doctors seemed to have the biggest power Doctors importance in shaping pharmaceutical Rx retail market Weak Strong Elements limiting importance POL ROU HUN CZE SVK BGR HRV SRB SVN BIH General importance INN prescribing x x 4 Rx substitution on a pharmacy level x x x x x x x x Control procedures after prescribing x x x x x x 3 x 5 Spending cap per specialist x x Therapeutic guidelines x 1 x 1 x 2 x 1 x 2 x 1 x 1 x 1 x 1 x 1 E-prescription (also with brand suggested by system) x x x x 6 Share of OTC 23% 13% 16% 13% 11% 16% 8% 14% 9% 14% Weak access to specialist x x x x x Tax on representatives Payer s Gx tenders in RET by INN Single payer x x x x x x x x 8 1) Indicative 2) Obligatory 3) At pharmacy level 4) Present in one region only 5) In practice if budget exceeded 6) Present only in part of the country (~50% of population)

10 Overview IMS provides clients with a comprehensive and tailored analysis Scope of possible detailed comparison Prevalence & treatment Disease structure Weak healthcare areas Patient compliance and awareness Distribution Wholesalers strategies Pharmacy chains business models, e.g. centralization Private labels TA focused OTC Oncology Diabetes Nervous Macro Regional view on all attributes Cost containment measures Public debt & government Population structure by age Education level Digitalization Doctors Universe structure by specialization Educational system/ path to specialization Detailed & dedicated comparison Pricing List prices Available discounts RSAs Regulatory Time to market entry (time to registration/obtain reimbursement) Price review policies Practical tools to limit access to reimbursed products Doctors prescription limitations/quotas Innovative products protection (e.g. expiry date) Ex-ante prescription monitoring Access to innovative drugs (registered, reimbursed, etc.) 9 IMS Health Consulting in South East Europe

11 Please contact us for full version of study/more information Martin Šlégl Senior Consultant, CZ&SK