Private label & generic competition

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1 Insights to the Chinese Lower Tier Pharmaceutical Market China-Monitor Health Inc.

2 Content The Market Size and Trend for Total Market Insights to Lower Tier Pharmaceutical Markets (Tier1 Hospitals, CHC, Township) What to do and How to do How We Get the findings 2

3 The Total Market and Trend The growth rate for the channel of hospitals in cities expected going up again in 2013; The county channel outperformed all other channels; CHC kept growing, but struggling with the cost and limited product range; The township market has been shrinking since 2009 due to the zero margin policy. Billion RMB (E) Hospital in Cities County Hospitals Township Hospitals CHC Drug Stores Total Hospital in Cities 22.7% 21.9% 20.4% 19.4% 20.5% County Hospitals 20.8% 28.7% 31.6% 27.7% 30.2% Township Hospitals 16.3% 7.8% 4.5% 2.8% 5.1% CHC 21.8% 18.7% 16.1% 16.7% 18.9% Drug Stores 13.1% 12.1% 9.3% 12.4% 10.1% Total 19.5% 18.9% 17.8% 17.7% 18.9%

4 The Total Market and Trend The cost per visit seems to be controlled; however, the visiting patients and times increase rapidly, especially those for tier 3 hospitals, so that the total cost are still out of control. The system swamped with waste, which can t be reduced by EDL / /2011 Tier Hospitals Visiting Number( Billion) Cost Per Visit Visiting Number( Billion) Cost Per Visit Visiting Growth Cost Growth Out-patient % 7.1% Tier % 4.4% Tier % 6.6% In-patient % 5.2% Tier % 2.3% Tier % 3.8% 数据来源 :2013 年中国卫生事业统计公报

Policy Driving Factors for the Growth 以农村为重点中西医并重的方针, 保持医改基本政策的连续性和稳定性, 着力加快健全全民医保体系 ; 反映在筹资方面, 包括城乡居民统筹职工与城市居民统筹区域统筹统筹账户与个人账户合并 ; 目前江苏已有十几个地区实现了医保城乡统筹反映在在支付方面, 包括城镇职工大病保险城镇居民与农村大病补充保险,

5 Policy Driving Factors for the Growth 以农村为重点中西医并重的方针, 保持医改基本政策的连续性和稳定性, 着力加快健全全民医保体系 ; 反映在筹资方面, 包括城乡居民统筹职工与城市居民统筹区域统筹统筹账户与个人账户合并 ; 目前江苏已有十几个地区实现了医保城乡统筹反映在在支付方面, 包括城镇职工大病保险城镇居民与农村大病补充保险, 以及报销病种的扩容 2012 年 8 月 30 日, 六部委关于开展城乡居民大病保险工作的指导意见发布, 明确针对城镇居民医保新农合参保 ( 合 ) 人, 建立大病保险制度, 减轻城乡居民的大病负担, 大病医保报销比例不低于 50% 全国新型农村合作医疗情况同比增长参合人口数 ( 亿人 ) % 参合数 97.50% 98.30% 当年筹资总额 ( 亿元 ) % 人均筹资 ( 元 ) % 当年基金支出 % 当年补偿支出受益人次 ( 亿 ) % 注 : 某些城市实行统一城乡居民基本医保制度, 导致参合人数减少 2013 年, 我国农村医疗保障重点将向大病转移肺癌胃癌等 20 种疾病全部纳入大病保障范畴, 大病患者住院费用实际报销比例不低于 70%, 最高可达到 90% 数据来源 :2013 年中国卫生事业统计公报 5

6 Shares of Different Type of Lower Tier Hospitals CHC take the highest share in 20 cities as whole; CHCs take the highest share in Yangzi triangle area, while Tier1 hospitals take more share in pearl triangle area 42.7% 44.5% 27.4% 26.8% 29.9% 28.7% 2011 年 2012 年 CHC_ 社区卫生服务中心 / 站 Tier1 Hospitals_ 一级医院 Township hospitals_ 乡镇卫生院 Cities/ 城市 CHC 社区卫生服务中心 / 站 Township hospitals 乡镇卫生院 Tier1 Hospitals 一级医院 Nanjing_ 南京 99.6% 0.4% 0.0% Wuxi_ 无锡 74.9% 23.7% 1.3% Shanghai_ 上海 69.6% 23.1% 7.3% Dongguan_ 东莞 59.5% 0.0% 40.5% Suzhou_ 苏州 53.5% 46.3% 0.2% Nantong_ 南通 35.8% 44.1% 20.1% Beijing_ 北京 34.7% 21.2% 44.1% Zhenjiang_ 镇江 33.7% 66.3% 0.0% Shantou_ 汕头 31.9% 37.8% 30.3% Guangzhou_ 广州 27.4% 41.7% 31.0% Wuhan_ 武汉 25.1% 17.6% 57.3% Changzhou_ 常州 22.7% 59.7% 17.6% Yangzhou_ 扬州 21.6% 77.4% 0.9% Xuzhou_ 徐州 12.8% 84.4% 2.8% Zhengzhou_ 郑州 9.5% 86.3% 4.2% Foshan_ 佛山 2.9% 6.8% 90.3% Zhongshan_ 中山 1.1% 0.1% 98.9% Zhuzhou_ 珠海 0.5% 99.5% 0.0% Jiangmen_ 江门 0.4% 76.3% 23.3% Shenzhen_ 深圳 0.0% 0.0% 100.0% Total_ 合计 44.5% 28.7% 26.8%

7 The Price Preference 12.5% 7.1% 10.4% 20.9% 20.8% 19.3% 5.2% 3.8% Value MS% 1.6% 1.9% 3.1% 8.0% 11.1% 16.6% 8.8% 49.0% Volume MS% The products with middle-higher(20-50) level price 60above are favorable to lower tier hospitals, and drive the market growing Incremental Sales (K) Price Tier Value Volume above

8 TA Structure in Major Cities Anti-infective take the highest share in most of cities; however, it s shares in Beijing and Shanghai are lower than Cardiovascular system. Cardiovascular system 心血管系统用药 Anti-infective 抗感染用药 Hormones And Related Agents 激素及调节内分泌功能用药 Osteoporosis drugs and SKELETON (TCM) 骨关节用药 Gastrointestinal tract digestive system 消化系统用药 Specialist medicine 专科用药 Respiratory system 呼吸系统用药 Blood and hematopoietic system 血液及造血系统用药 Nervous system 神经系统用药 Qingre 清热剂 Total 合计 Beijing 北京 Shanghai 上海 Suzhou 苏州 Wuhan 武汉 Nanjing 南京 Guangzhou 广州 Wuxi 无锡 Xuzhou 徐州 Dongguan 东莞 Shenzhen 深圳 28.8% 27.7% 43.4% 24.9% 14.5% 37.7% 26.1% 25.1% 26.5% 21.0% 11.6% 20.2% 10.7% 8.7% 35.7% 37.5% 24.1% 24.7% 36.6% 36.7% 27.4% 28.7% 6.2% 7.3% 7.4% 5.4% 4.4% 11.1% 3.9% 4.9% 2.1% 4.1% 2.1% 6.1% 9.9% 4.6% 5.1% 2.1% 3.7% 3.6% 3.5% 2.6% 3.7% 5.0% 5.7% 5.8% 5.4% 4.6% 7.7% 3.4% 6.3% 4.0% 4.1% 8.0% 8.7% 4.6% 4.8% 4.0% 4.1% 2.6% 3.1% 6.3% 3.1% 1.5% 8.3% 11.7% 4.2% 5.0% 5.0% 2.8% 2.0% 2.3% 3.7% 2.7% 3.3% 3.5% 5.6% 4.1% 8.1% 2.0% 1.1% 5.1% 0.7% 2.3% 1.7% 1.0% 1.4% 2.3% 2.6% 3.6% 0.8% 1.4% 4.1% 2.5% 3.1% 1.9% 3.3% 4.8% 1.9% 2.6% 2.5% 1.2% 2.9% 2.5% 1.9% 4.0% 3.5% 2.4% 4.5% 5.0% Others 其它 15.0% 14.6% 17.5% 11.8% 17.6% 9.5% 16.0% 13.0% 16.5% 13.4% 17.4%

9 The Shares of Major Brands in Cardiovascular system 销售额同比增长率 % Yi tai qing _ 伊泰青 Xin ran_ 欣然 Da le_ 达乐 Hyzaar_ 海捷亚 Lotensin_ 洛汀新 Betaloc Zok_ 倍他乐克 Shi hui da_ 施慧达 Aprovel_ 安博维 Cozaar_ 科素亚 Adalat_ 拜新同 Xuan ning_ 玄宁 Diovan _ 代文 Xie ke_ 缬克 Plendil_ 波依定 Norvasc 1.2% 1.2% 1.5% 1.5% 1.7% 1.7% 1.8% 1.5% 2.7% 2.8% 2.7% 2.8% 2.9% 2.8% 3.2% 3.2% 3.5% 3.3% 3.8% 3.8% 4.0% 4.1% 4.1% 3.6% 4.2% 4.3% 5.5% 5.7% 5.8% 6.1% 0.0% 2.0% 4.0% 6.0% 8.0% There are 10 MNC s brands among the top 15 brands; The fastest growing brands are from Novartis and MSD 年 2011 年 20% 15% 10% 5% 0% ZJ Anglikang_ 浙江 JL Sihuida_ 施慧达昂利康药业 SH Xiandai_ GZ 上海现 Bailing_ 贵州百代灵 ZH livzon_ 丽珠集团 ZJ Huahai_ 浙江华海 2012 年心脑血管品类增率 =11.7% MSD_ 默沙东 Sanofi_ 赛诺菲 Bayer_ 拜耳 CZ No.4_ 常州四药 CSPC_ 石药集团欧意 Pfizer_ 辉瑞 Novartis_ 诺华 Astrazeneca_ 阿斯利康销售额份额 % 0% 1% 2% 3% 4% 5% 6% 7% 8%

The Trend for Cardiovascular system in Beijing 43.7% 44.1% Tier1 Hospitals_ 一级医院 Value Growth The market is driven by Tier one hospitals and 21.6% 21.2% 34.7% 34.

10 The Trend for Cardiovascular system in Beijing 43.7% 44.1% Tier1 Hospitals_ 一级医院 Value Growth The market is driven by Tier one hospitals and 21.6% 21.2% 34.7% 34.7% Township hospitals_ 乡镇卫生院 CHC_ 社区卫生服务中心 / 站 CHC, which account for nearly 80% of the total market. The market is driven by high price products. Price Tier Incremental Sales (K) Value Volume above % 25.8% 6.5% 12.7% 10.5% 20.3% 16.4% 20.2% 25.5% 18.6% 15.6% 7.3% 4.1% 0.4% 0.9% 5.5% Value MS% Volume MS% 60above

11 The Market Dynamic for Cardiovascular system in Beijing 千 Lai li xin_ 来立信 Plendil_ 波依定 Aprovel_ 安博维 Chuang cheng_ 创成 Xi neng_ 悉能 Aspirin_ 拜阿司匹灵 Glucophage_ 格华止 Cozaar_ 科素亚 Hyzaar_ 海捷亚 Xuan ning_ 玄宁 Adalat_ 拜新同 Norvasc_ 络活喜 R Novolin R30_ 诺和灵 30R Glucobay_ 拜唐苹 Plavix_ 波立维 1.1% 1.2% 1.1% 1.0% 1.1% 1.0% 1.1% 1.3% 1.2% 1.4% 1.3% 1.2% 1.4% 1.4% 1.4% 1.4% 1.6% 1.4% 1.8% 2.0% 1.9% 1.8% 2.0% 2.0% 3.0% 3.4% 2012 年 2011 年 4.2% 4.2% % 6.0% Sanofi_ 赛诺菲 1.3% Bayer_ 拜耳 Novo Nordisk_ 诺和诺德 0.3% 0.2% 0.1% 0.0% 0.1% -0.4% -0.3% -0.2% -0.1% 0.0% 0.1% 0.0%0.0% MSD_ 默沙东 Value(000) Pfizer_ 辉瑞海南海灵 CSPC_ 石药集团欧意 BMS_ 施贵宝 GZ Baiyunshan_ 广州白云山 Share Change( MS%) Novartis_ 诺华 SZ Zhijun_ 深圳致君制药 Astrazeneca_ 阿斯利康 BX Hengkang_ 本溪恒康制药 Lilly_ 礼来 Top 5 brands from MNC, and 4 of them kept growing momentum. Plavix s share and growing rate are both the highest. 1.5% 1.0% 0.5% 0.0% -0.5% 0.0% 2.0% 4.0% 6.0% 8.0%

12 The Trend for Cardiovascular system in Shanghai 5.8% 5.6% 22.2% 21.2% Tier1 Hospitals_ 一级医院 Value Growth CHC is major channel for the TA, and drive the 72.0% 73.3% Township hospitals_ 乡镇卫生院 CHC_ 社区卫生服务中心 / 站 market growth as well. Products with Middle- Higher price are popular in Shanghai s lower tier market. Price Tier Incremental Sales (K) Value Volume 5 元以下元元元元元元元以上 % 0.4% 0.0% 2.0% 0.2% 0.0% 33.7% 28.7% 23.3% 37.3% 27.5% 12.5% 0.7% 4.6% 4.1% Value MS% 20.7% Volume MS% 60above

13 The Market Dynamic for Cardiovascular system in Shanghai Da le_ 达乐 Betaloc Zok_ 倍他乐克 Aprovel_ 安博维 An li bo_ 安利博 Ao bi xing_ 奥必欣 Lotensin_ 洛汀新 Adalat_ 拜新同 Xin ran_ 欣然 Plendil_ 波依定 Li si de_ 力斯得 Diovan _ 代文 Xuan ning_ 玄宁 Cozaar_ 科素亚 Xie ke_ 缬克 Norvasc_ 络活喜 1.4% 1.4% 1.5% 1.7% 1.6% 1.8% 2012 年 1.7% 1.8% 2.0% 1.7% 2011 年 2.1% 2.4% 2.1% 2.3% 2.4% 2.7% 3.0% 3.6% 3.3% 2.8% 4.4% 3.5% 4.5% 4.3% 5.1% 4.3% 7.0% 7.4% 7.1% 7.9% % 1.0% Value(000) Share Change( MS%) 0.6% 0.5% % 0.2% 0.2% 0.1% % -0.2% -0.1% -0.3% 0.0% -0.4% -0.4% -0.4% % -0.8% -0.5% 0-1.0% Z No.4_ 常州四药 Pfizer_ 辉瑞 Novartis_ 诺华 MSD_ 默沙东 ZH livzon_ 丽珠集团 ZJ Huahai_ 浙江华海 CSPC_ 石药集团欧意 Astrazeneca_ 阿斯利康 GZ Bailing_ 贵州百灵 ZJ Jianfeng_ 浙江尖峰 SH Xiandai_ 上海现代 ZJ Anglikang_ 浙江昂利康 Bayer_ 拜耳 Sanofi_ 赛诺菲 KM Yuanrui_ 昆明源瑞 MNC s products are challenged by the local brands in Shanghai lower tier hospital market. The share of Pfizer and AstraZeneca came down significantly, MSD and Novartis performed better. 0.0% 2.0% 4.0% 6.0% 8.0% 10.0 %

The Trend for Cardiovascular system in Nanjing Value Growth CHC s sale accounted for almost 100% of the market. Products with middle higher price drove the market growth.

14 The Trend for Cardiovascular system in Nanjing Value Growth CHC s sale accounted for almost 100% of the market. Products with middle higher price drove the market growth. Price Tier Incremental Sales (K) Value Volume % 0.4% 2.4% 0.1% 52.7% 23.4% 11.6% 6.4% 0.8% Value MS% 33.5% 21.3% 16.1% 17.6% 9.1% Volume MS%

15 The Market Dynamic for Cardiovascular system in Nanjing Xin ran_ 欣然 Da le_ 达乐 Xuan ning_ 玄宁 Xi luo ning_ 西络宁 Cozaar_ 科素亚 0 hao_ 降压 0 号 Lotensin_ 洛汀新 Betaloc Zok_ 倍他乐克 Aprovel_ 安博维 Adalat_ 拜新同 Xie ke_ 缬克 Norvasc_ 络活喜 Shi hui da_ 施慧达 Diovan _ 代文 Plendil_ 波依定 1.3% 1.0% 1.6% 1.2% 1.7% 2.0% 1.9% 1.6% 3.3% 3.6% 3.9% 3.9% 4.6% 5.3% 6.2% 6.4% 6.6% 6.3% 7.0% 8.0% 7.1% 7.8% 7.7% 7.0% 7.8% 8.1% 2012 年 2011 年 11.0% 9.3% 15.2% 15.9% 0.0% 5.0% 10.0% 15.0% 20.0% Astrazeneca_ 阿斯利康 -0.4% Novartis_ 诺华 1.1% JL Sihuida_ 施慧达药业 -0.3% Pfizer_ 辉瑞 0.7% CZ No.4_ 常州四药 -0.6% Value(000) -1.0% 0.3% Bayer_ 拜耳 Sanofi_ 赛诺菲 BJ Shuanghe_ 华润双鹤药业 0.3% 0.4% 0.2% 0.0% -0.3% -0.2%-0.3% -0.2% MSD_ 默沙东 HNJ Aolidanaide_ 黑龙江澳利达奈德 Share Change( MS%) 江苏万高药业 CSPC_ 石药集团欧意 SH Xiandai_ 上海现代 HN Huanglong_ 海南皇隆 NCPC_ 华北制药 The market is more concentrated than these in Beijing and 1.5% 1.0% 0.5% 0.0% -0.5% -1.0% -1.5% Shanghai; Plendil is the market leader, taking as much as 15.2% of share in The shares of Bayer and AstraZeneca came down, while Pfizer and Novartis s brands did well.

16 The Trend for Cardiovascular system in Zhenjiang Value Growth The share and growth rate of CHC and township hospitals are almost the same in Zhenjiang. The products with middle-lower price are the driver of the market growth. Price Tier Incremental Sales (K) Value Volume % 0.0% 3.7% 1.1% 0.0% 11.4% 6.5% 14.1% 40.7% 50.8% 22.0% 15.0% 25.9% 4.4% Value MS% Volume MS%

The Market Dynamic for Cardiovascular system in Zhenjiang 10000 1.1% 1.4% Value(000) Share Change( MS%) 2.0% 1.5% 0.4% 0.5% -0.4% 0.1% 0.0% 0.6% 0.2% 0.2% -0.1% -0.2% 0.0% 1.0% 0.5% 0.0% -0.7% -0.

17 The Market Dynamic for Cardiovascular system in Zhenjiang % 1.4% Value(000) Share Change( MS%) 2.0% 1.5% 0.4% 0.5% -0.4% 0.1% 0.0% 0.6% 0.2% 0.2% -0.1% -0.2% 0.0% 1.0% 0.5% 0.0% -0.7% -0.5% -1.0% -1.8% 0 CZ No.4_ 常州四药 Astrazeneca_ 阿斯利康 JS Lianhuan_ 江苏联环药业 ZH livzon_ 丽珠集团 BJ Shuanghe_ 华润双鹤药业 Novartis_ 诺华 ZJ Haizheng_ 浙江海正药业 CZ Changzhou_ 常州制药 LY Jiangbo_ 莱阳江波制药 ZJ Nanyang_ 浙江南洋药业 ZJ Huahai_ 浙江华海 NCPC_ 华北制药 ZJ Anglikang_ 浙江昂利康 SH Xiandai_ 上海现代 GL Huaxin_ 桂林华信制药 -1.5% -2.0% 13 of the top 15 brands come from local manufacturers, and only AstraZeneca and Novartis are at present in Zhenjiang lower tier hospital market.

18 The Trend for Cardiovascular system in Xuzhou 64.7% 64.0% Tier1 Hospitals_ 一级医院 Township hospitals_ 乡镇卫生院 Value Growth Township Hospitals take 64% of share of the market in Xuzhou lower tier hospitals. 33.2% 33.9% CHC_ 社区卫生服务中心 / 站 Middle-Lower price products drove the market growth. Price Tier Incremental Sales (K) Value Volume % 3.1% 0.8% 0.3% 5.4% 13.5% 13.8% 21.3% 37.5% 61.0% 29.6% 11.3% Value MS% Volume MS%

The Market Dynamic for Cardiovascular system in Xuzhou 10000 0 CZ No.4_ 常州四药 -0.9% BJ Shuanghe_ 华润双鹤药业 2.7% Astrazeneca_ 阿斯利康 1.0% JL Sihuida_ 施慧达药业 -0.5% CZ Changzhou_ 常州制药 Value(000) 0.0% -0.3%-0.

19 The Market Dynamic for Cardiovascular system in Xuzhou CZ No.4_ 常州四药 -0.9% BJ Shuanghe_ 华润双鹤药业 2.7% Astrazeneca_ 阿斯利康 1.0% JL Sihuida_ 施慧达药业 -0.5% CZ Changzhou_ 常州制药 Value(000) 0.0% -0.3%-0.3% -0.4% -0.8% Novartis_ 诺华 JS Lianhuan_ 江苏联环药业 CD Diao_ 成都地奥制药 AH Huanqiu_ 安徽环球药业 HRB Sanlian_ 哈尔滨三联 Share Change( MS%) 0.3% 0.2% -0.1% 0.0% -0.1%-0.1% HN Huluwa_ 海南葫芦娃 GL Huaxin_ 桂林华信制药 ZJ Tailisheng_ 浙江泰利森药业 CSPC_ 石药集团欧意 SX Tongda_ 山西同达药业 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% -0.5% -1.0% -1.5% There are 4 MNC s brands in the top 15 brands, but the local brands took more shares.

20 What to do and How to do

21 The Objectives 如果按照美国药品占卫生总费用的比例计算, 中国的处方药药品费用应该是 2879 亿人民币从这个意义上讲, 中国医院处方药销售 7000 亿, 中国的药品费用有 4000 多亿的空间可以从医院终端挤压出来 ; 用药结构遵从度渠道 2622 其中约 1000 亿来自高价普药的使用 ; 美国在用药遵从度上的浪费最大, 高达 3174 亿美金, 占卫生总费用的 12.2% 按照这个比例计算, 中国仅在遵从度服务上的费用就有 2979 亿人民币的空间 70% 保险公司 10% 20% 品种转换渠道转换到药店 5% 10% 25% 数据来源 :ESI Trend Report 遵从度提高渠道转换到药店现存和新增费用的压缩政府达成慢病用药免费使用的政治目标 ; 用节约的费用, 不断增加大病医疗的投入, 最终完成全民健保, 解决因病致贫的问题 ; 保险公司增加保户和险种, 从而提高收益 ; 药店增加客流, 正式纳入医保体系, 形成可持续的盈利模式 ; 医院专注于提高诊疗水平, 而不是卖药 ; 慢病用药报销报 70% 的基金 100% 报销报 60% 的基金报 50% 的基金 100% 报销 100% 报销将低质量的品种和厂家淘汰出局

22 Business Model and Operation Platform 业务需求品种需求药品 ( 甲乙类目录 ) 保健品处方需求方便需求定点药店 / 网点网购服务需求就医用药客服中心药品交易平台网上购药处方审核后药店配送药品配送平台药品分装快递邮寄患者一般服务 Q&A 销售服务专业服务导医导药药店分销平台 20

23 System Design 20

24 Findings Based on more than samples

25 The Chinese Pharmaceutical Market(CMH) City Tier3 & 2 Hospitals (60%) County Hospitals (10%) Community & (Township Hospitals) (21%) Drug Stores (19%) Purchasing Report (Tier3 and 2 Hospitals) Purchasing Report (Tier3 and 2 Hospitals) Purchasing Report (Tier1/CHC/Township) Trend Report National Projection National Projection National Projection Provincials(31) Provincials(6) National Projection Provincial (6) Provincial(15) By City(105) By CIty(127) By City(73) By City(63) KA Chains(120) Hospitals (2990) Hospitals (532) Hospitals (9057) Hospitals (8300)

26 Thanks! China-Monitor Health Inc. Guangzhou Office Beijing Office: Add. :13Floor Tower A, R&F Yingtai Plaza, No.100 Huangpudadao West, Guangzhou, Tel. : Add. :Suite 902, Part 2, Jin Yun Complex No.43, Xi Zhi Men North Street, Beijing, Tel. :

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