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Global & GCC Pharmaceutical Market trends Prepared for First Coordination Meeting for the Pharmaceutical Industry in the GCC & Yemen Michael Pender-Cudlip: Principal, IMS Consulting Group 11th April 2011
Agenda • Definition: what market(s) are we describing ? • Global and MENA Context • GCC overview • Focus on KSA • Focus on UAE • Issues to be addressed
IMS presentation to GOIC April 2011 2
The global pharma value chain is worth over $700 bn pa, of which R&D accounts for ~16%, manufacture ~29%, and sales and marketing ~36%; we will be focusing on the latter in GCC Research and Development
Sources: IMS Health, Datamonitor, PhRMA, Ernst & Young, HighTech Business Decisions, PAREXEL, PharmaSource, Evaluate Pharma, S&PA analysis. IMS presentation to GOIC April 2011 3
We are able to draw on IMS’s unique proprietary databases and considerable experience with clients in this region •
Where do IMS numbers come from, and what are they measuring ?
IMS collects and compiles detailed data for the private/retail prescription markets worldwide, and combines this with informed estimates for other sectors (e.g. tender/government/hospital sales, consumer health). Product data is prescription pharmaceuticals, whether patent-protected or generic, and whether sold via pharmacies or hospitals, although not all ‘institutional’ markets (hospitals, tenders) are covered. The volume of each item is measured and valued at ‘ex-manufacturer’ prices to ensure consistency across countries with different distribution margins and tax regimes. The data can be reported by product, molecule, dose-form, therapy class, company and country/region, and is adjusted to ensure consistent trend information (e.g. allowing for exchange rates)
Why do IMS figures ‘disagree’ with other figures we may have seen in material issued by (for example) companies and governments ?
IMS measures the use of pharmaceuticals ‘in-market’, so avoids the complication of imports and exports. Companies which report sales rarely do by product, and almost never by product by country, and many companies also incorporate into their sales figures other revenueearning activities (e.g. bulk chemical, consumer products, diagnostics, and distribution) are not covered.
Are IMS insights only derived from its data ?
No. IMS has local offices in Dubai and Jeddah, and has undertaken many consulting assignments within GCC during which it has established high quality relationships with, and understanding of the major stakeholders in the pharmaceutical market IMS also operates globally, so is able to leverage insights from other markets which have relevance to GCC
IMS presentation to GOIC April 2011 4
Pharmaceuticals in the MENA region in which GCC lies is expected to grow at an ‘emerging markets’ rate Global: IMS Regional Pharmaceutical Outlook in 2014 (US$ Billions) Europe (Non- EU) Europe (EU)
Size: US$ ~26bn
Size: US$ ~262bn
Size: US$ ~398bn
Growth: ~3% Asia excl Japan
Growth: ~4% MENA* **
Size: US$ ~132bn
Size: US$ ~116bn
Size: US$ 18bn Growth: ~9%
Size: US$ ~8bn
Rest of Africa (excl. NA**) Size: US$ ~10bn Growth: ~8%
Source: IMS MIDAS; Retail Panel IMS presentation to GOIC April 2011 7
The GCC pharma market is dominated by Saudi Arabia, which accounts for two thirds of the total GCC region value US$ million at Ex-Manufacturer Prices, using Constant Exchange Rates Country
United Arab Emirates
• Saudi Arabia accounts for two-thirds of GCC region’s sales • Together with UAE and Kuwait, it accounts for 91% of GCCsales; it is for this reason that IMS only compiles detailed product information for these three markets • UAE growth, and consumption per head, is significantly faster than elsewhere IMS presentation to GOIC April 2011 8
Over time, local/regional manufacturers have slowly increased their market share, but more in terms of volume than value GCC* Corps, Global vs. Local Top 100
Sales Volume 2010 - SU (Million) (% are estimates)
Sales Value 2010 - US $ (Million) (% are estimates) 2,7
1,6 80% global 80%
BMS 20% local 20%
Source: IMS Health MIDAS December 2010 IMS presentation to GOIC April 2011 9
GCC*: Saudi Arabia, UAE, Kuwait retail only
Focus on KSA
Saudi Arabia currently spends a relatively small fraction of its GDP on healthcare. However, this is expected to change Healthcare spend as a % of GPD Series
10.4 8.8 6.3
6.0 in 2020 5.0 2.7
Forecast healthcare expenditure to around 6% of GDP by 2020 will sustain the growth of healthcare and pharmaceutical industries Source: WHO 2010; IMS market prognosis; IMS analysis IMS presentation to GOIC April 2011 10
Focus on KSA
Government policy to provide the highest possible quality of care has driven public spending to ~80% of the total
Healthcare Spending by Sector (2008) c.$14bn (SAR54bn) 8% 6%
• The Government is the major provider of healthcare in Saudi Arabia accounting for ~80% of all healthcare expenditure • Saudi nationals and some public sector expats are eligible to receive free public health services and pharmaceuticals
Government Expenditure (Public) Private Health Insurance
• As well as the MoH, some Saudis and their dependants are eligible to receive healthcare from other governmental institutions such as the National Guard, Ministry of Defense and others • The remaining expenditure is derived from private sources including private health insurance and out-of-pocket expenditure
Out-of-Pocket (Private) Other Private Expenditure* Source: WHO 2010; IMS Analysis Note: *Other Private Expenditure includes non-profit institutions, resident corporations and quasi-corporations not controlled by government IMS presentation to GOIC April 2011 11
Focus on KSA
The Saudi pharmaceutical market is subject to many pressures
Saudi Generics Sales
Drug expenditure will decrease from 22% to 18% of healthcare spend by 2020
Establishment of NUPCO
Price Cuts from SFDA Push for use of lower cost drugs Increased Access to Healthcare Population and Economic Growth 4% GDP growth assumed for forecast period
IMS presentation to GOIC April 2011 12
Healthcare expenditure forecast to increase from 3.5% to 6% of GDP within 10 years
The share of local and regional generic companies will grow at the current, faster rate over the forecast period
Focus on KSA
The KSA government has invested heavily to improve access to high quality healthcare, and this can be expected to accelerate Total Health Expenditure as % GDP (‘07): 3.4% Saudi Arabia
Per Capita Health Expenditure-PPP(’07, US$): $768 768
Saudi Arabia 587
Healthcare sector spend (’07) 8%
Government Expenditure (Public)
Private Health Insurance 78%
Out-of-Pocket (Private) Other Private Expenditure**
Healthcare Infrastructure • • • •
3489 pharmacies 110 hospitals 16 physicians per 10,000 population 22 hospital beds per 10,000 population
Source: WHO; Business Monitor International; IMS analyses IMS presentation to GOIC April 2011 13
Healthcare Dynamics • Saudi Arabia has one of the most developed and sophisticated healthcare systems in the region • The healthcare system consists of 3 tiers: primary (healthcare centres), secondary (general hospitals) and tertiary (specialist hospitals). Health Centres are assigned to catchments areas with a defined population and they act as the first point of contact for patients • The MoH and the other governmental institutions (e.g. National Guard, Ministry of Defence) account for >75% of the healthcare expenditure – The MoH is responsible for the management, financing and regulation of the healthcare system; it is the major provider of national healthcare services – Saudi nationals and some public sector expats are eligible to receive free public health services and pharmaceuticals • The remaining expenditure is derived from private sources including private health insurance and outof-pocket expenditure
Focus on KSA
The dynamics within the KSA market can be expected to benefit local producers, with volume growth and price constraint Historic & forecast market evolution (LC US$ Bn)*
General Market Drivers & Constraints
Drivers Strong economic credentials with growing
Total market Gx Rx n.a. 8.7%
6.3% 2.4 57%
affluence despite the economic downturn Growing local population generating solid domestic demand Rising chronic disease burden (e.g. diabetes) Continued investment from the government to modernise and expand healthcare infrastructure Broader health insurance coverage (e.g. compulsory co-operative insurance for all expats and Saudi nationals in the private sector) Persistent dominance of patented and imported products which tend to have higher price
Saudi Arabia is projected to contribute 30% of the total regional market (2010)
Fluctuating oil prices affecting government’s healthcare budgets Cost containment initiatives including strict price controls and enforced price cuts Increasing generics usage as a result of the efforts of MoH and insurance companies to lower pharmaceutical costs
Source: IMS Market Prognosis; Business Monitor International; IMS analyses IMS presentation to GOIC April 2011 14
Focus on UAE
UAE has the highest per capita health spend in the region; the government is committed to provide high quality of care Healthcare Dynamics
Total Health Expenditure as % GDP ‘07: 2.7% UAE
Per Capita Health Expenditure-PPP’07, US$: $982 982
Healthcare sector spend ’08
Government Expenditure Private Expenditure
Healthcare Infrastructure • 15 physicians per 10,000 population • 19 hospital beds per 10,000 population
Source: WHO; BMI; IMS analyses
• UAE has a comprehensive, government-funded healthcare system although the level of insurance coverage varies in the different emirates • UAE nationals receive free healthcare funded by the government • >50% of the population e.g. blue collar workers lack public health insurance cover, although non-insured could still receive free basic treatments in public facilities • Expats must pay for healthcare services –In Abu Dhabi, this is done through the compulsory health insurance where the premiums are paid by the employer –In Dubai and other emirates, this is done through either private insurance or out-of-pocket • The private sector is relatively new but its importance in providing quality care is expected to increase in the coming year, especially for UAE nationals and uppermiddle class expats –Private clinics and hospitals are usually found in most urban centres and the quality of the facilities and services are highly variable • Most insurers offer virtually the same range of services with minor differences in terms of which services and medicines they reimburse
IMS presentation to GOIC April 2011 15
*Data averaged from Algeria, Egypt, Lebanon, Morocco, Saudi Arabia and UAE; **Other Private Expenditure includes non-profit institutions, resident corporations and quasi-corporations not controlled by government
Focus on UAE
The UAE pharma market has retained a strong preference for originator, branded products Historic & Forecast Market Evolution LC US$ Bn*
General Market Drivers & Constraints
Total market Gx Rx n.a.
16.0% 1.5 1.3 1.1
0.8 0.6 0.4
61% 31% 8%
UAE is projected to contribute 9% of the total regional market Limited generic penetration
Source: IMS Market Prognosis; BMI; IMS analyses IMS presentation to GOIC April 2011 16
Small but growing and wealthy population base Government’s significant investment in health infrastructure Expansion of the private health sector Promising economic outlook Prescriber’s and KOL’s reference for branded products Increasing public-private partnerships as evidenced in Johns Hopkins’ takeover of management control of Tawam Hospital in ’06 Exports
Increasing generics usage in Abu Dhabi in accordance to the basic insurance policies Regionally fragmented healthcare system and insurance coverage, leading to an uneven access to healthcare services
Issues to be addressed
A number of conclusions can be drawn from this relatively brief analysis • GCC pharmaceutical markets have shown, and can be expected to continue to show sustained growth given favourable economic and demographic factors. • Significant investment has taken place in GCC to strengthen the ecomomic, scientific, regulatory and healthcare infrastructure. • However, with a few notable exceptions, local manufacturers have gained a relatively low proportion of the value in this market • There are locally-HQ’d companies, and some of them have strong branded generics portfolios. However, few of them have a significant presence outside GCC and in most cases they market branded generics or products developed by, and licensed in from multinational companies • The GCC pharmaceutical industry is therefore relatively poorly positioned along the pharmaceutical value chain, and in particular the Discovery/Research into innovative products and formulations • We believe that opportunities both within and outside GCC should be identified and evaluated using consistent evidence-based criteria. We will discuss during a separate session how these might best be addressed