Pharmaceutical Growth Opportunities in Brazil, Russia, India and China - Healthcare reform, market dynamics and key players

Executive Summary 12
The external environment in the BRIC markets 12
The market opportunity in the BRIC countries 13
Market composition in the BRIC countries 14
Competitive dynamics in the BRIC region 15
Key players and winning strategies 16

Chapter 1 The external environment in the BRIC markets 18
Summary 18
Introduction 19
Background 20
Healthcare systems and structures across the BRIC markets 21
Healthcare financing 21
Pharmaceutical expenditure in the context of healthcare spends 25
Private and public sources of healthcare financing 27
Epidemiological analysis 29
Major disease states 30
Structural challenges to pharmaceutical marketers in the BRIC countries 34
Healthcare delivery 35
Social aspects 35
Market factors 35
Pricing and reimbursement 36
Healthcare reform in the BRIC countries 38
Profiles of healthcare systems across the BRIC countries 40
Brazil 41
Healthcare system 41
Healthcare financing and expenditure 47
Pricing and reimbursement 48
Political and regulatory issues 49
Russia 51
Healthcare system 51
Healthcare financing and expenditure 56
Pricing and reimbursement 57
Political and regulatory issues 58
India 59
Healthcare system 59
Healthcare financing and expenditure 63
Pricing and reimbursement 65
Political and regulatory issues 66
China 67
Healthcare system 67
Healthcare financing and expenditure 71
Pricing and reimbursement 73
Political and regulatory issues 74

Chapter 2 The market opportunity in the
BRIC countries 78
Summary 78
Introduction 79
BRIC market dynamics 80
Comparative dynamics between the BRIC markets and the global market 81
Market composition by therapeutic areas 84
Market analysis by therapeutic area 87
Cardiovascular market analysis 87
CNS disorders market analysis 92
Cancer market analysis 98
Respiratory market analysis 102
Anti-infectives market analysis 106
Minor therapeutic areas analysis 112
Forecast sales by therapy area 113

Chapter 3 Market composition in the BRIC
countries 118
Summary 118
Introduction 119
Licensing trends: a comparison with the global market 119
Market breakdown by country 123
Brazil 124
Russia 125
India 125
China 126
Therapeutic licensing trends in the BRIC countries 128
Cardiovascular 129
CNS disorders 130
Cancer 132
Anti-infectives 133
Respiratory 135
Other therapeutic areas 136
Current and future potential 139

Chapter 4 Competitive dynamics in the
BRIC region 144
Summary 144
Introduction 145
Competitive dynamics in each BRIC market 146
Brazil 148
Russia 151
India 153
China 155

Chapter 5 Key players and winning
strategies 158
Summary 158
Key players in the BRIC markets 159
Key multinational players 159
Sanofi-Aventis 159
Novartis 163
Pfizer 167
GlaxoSmithKline 171
Key medium-sized international players 175
Gedeon Richter 175
Servier 180
Menarini 184
Key Brazilian regional players 188
Aché Laboratórios Farmacêuticos 188
EMS 192
Medley 195
Key Indian regional players 198
Cipla 198
Nicholas Piramal 203
Ranbaxy 208
Key Chinese regional players 214
HLJ. Harbin 214
Jiang Su Hengrui Medicine 217
Yangzijiang/Yangtze River Group 221
Winning strategies in the BRIC markets 225
Competitive strategy of key multinational players in the BRIC markets 227
Competitive strategy of key medium-sized players in the BRIC markets 229
Competitive strategy of regional pharmaceutical players in the BRIC markets 230
Brazil 230
India 232
China 233
Chapter 6 Appendix 236
IMS sales data 236
Glossary 237
Index 240

List of Figures
Figure 1.1: Comparison of pharmaceutical sales in the markets of BRIC, EU5, US and Japan, 2005 20
Figure 1.2: Average total health expenditure as a proportion of GDP for BRIC, EU5 and the US, 2000-04 22
Figure 1.3: Healthcare expenditures across the four BRIC countries, 2004 23
Figure 1.4: Comparison of spends on pharmaceuticals between the US, 5 major EU markets and the BRIC markets, 2004 25
Figure 1.5: Private healthcare expenditure as a percentage of total healthcare expenditure in the BRIC countries, 2004 27
Figure 1.6: Structural challenges to pharmaceutical marketers in the BRIC countries 34
Figure 1.7: Major challenges in healthcare reform in the BRIC countries 39
Figure 1.8: Average total health expenditure as % of GDP for Brazil and the BRIC economies, 2000-04 43
Figure 1.9: Summary structure of Brazilian healthcare system 46
Figure 1.10: Summary structure of the Russian healthcare system 53
Figure 1.11: Average total health expenditure as % of GDP for Russia and the BRIC economies, 2000-04 54
Figure 1.12: Summary structure of the Indian healthcare system 60
Figure 1.13: Average total health expenditure as % of GDP for India and the BRIC economies, 2000-04 62
Figure 1.14: Summary structure of Chinese healthcare system 68
Figure 1.15: Average total health expenditure as % of GDP for China and the BRIC economies, 2000-04 70
Figure 1.16: Average private health expenditure for China, 2000-04 72
Figure 2.17: Cardiovascular market breakdown by therapy area sales for individual markets of BRIC, 2001-2005 92
Figure 2.18: CNS market breakdown by therapy area sales for individual markets of BRIC, 2001-2005 97
Figure 2.19: Cancer market breakdown by therapy area sales for individual markets of BRIC, 2001-2005 101
Figure 2.20: Respiratory market breakdown by therapy area sales for individual markets of BRIC, 2001-2005 105
Figure 2.21: Anti-infectives market breakdown by therapy area sales for individual markets of BRIC, 2001-2005 111
Figure 3.22: Comparison of sales in the global and BRIC markets by product category, 2005 122
Figure 3.23: Comparison of sales in the BRIC market by product category, 2005 127
Figure 3.24: Penetration of original brands across therapy areas in the BRIC markets, 2005 140
Figure 3.25: Forecast prospects for market development of major categories of brands by indication, 2006-11 141
Figure 4.26: Breakdown of the leading pharmaceutical companies in the BRIC markets, 2005 145
Figure 4.27: Growth dynamics of the leading pharmaceutical companies in Brazil, 2005 150
Figure 4.28: Growth dynamics of the leading pharmaceutical companies in Russia, 2005 152
Figure 4.29: Growth dynamics of the leading pharmaceutical companies in India, 2005 154
Figure 4.30: Growth dynamics of leading pharmaceutical companies in China, 2005 156
Figure 5.31: Presence of multinational pharmaceutical players in the BRIC market, 2005 227
Figure 5.32: Presence of medium-sized international pharmaceutical players in the BRIC market, 2005 229
Figure 5.33: Presence of domestic Brazilian pharmaceutical players in the BRIC market, 2005 231
Figure 5.34: Presence of domestic Indian pharmaceutical players in the BRIC market, 2005 232
Figure 5.35: Presence of domestic Chinese pharmaceutical players in the BRIC market, 2005 234

List of Tables
Table 1.1: Recent statistics on healthcare sector in the BRIC markets, 2004 24
Table 1.2: Comparison of spends on pharmaceuticals between the US, 5 major EU markets and the BRIC markets, 2004 26
Table 1.3: Public and private healthcare financing in the BRIC markets, 2004 28
Table 1.4: Prevalence rates of cardiovascular diseases among the 4 BRIC markets, 2004 30
Table 1.5: Incidence rates* of cancer among the 4 BRIC markets, 2004 31
Table 1.6: Summary of pricing and reimbursement policies across the BRIC markets, 2004 37
Table 1.7: Number of healthcare facilities in Brazil by type of care and type of holding facility, 1980-2002 44
Table 1.8: Health system expenditure & financing in Brazil, 2000-04 47
Table 1.9: Healthcare facility statistics for Russia, 2000-04 55
Table 1.10: Health system expenditure & financing in Russia, 2000-04 56
Table 1.11: Health system expenditure & financing in India, 2000-04 63
Table 1.12: Health system expenditure & financing in China, 2000-04 71
Table 2.13: Pharmaceutical market dynamics across the BRIC countries, 2004-05 80
Table 2.14: Breakdown of sales by major therapeutic area across the combined BRIC market, 2004–05 81
Table 2.15: Breakdown of sales by major therapeutic area across the global market, 2004–05 82
Table 2.16: Breakdown of sales by therapeutic area across the BRIC and the global markets, 2005 84
Table 2.17: Sales by major classes across the BRIC cardiovascular market, 2004–05 87
Table 2.18: Cardiovascular sales in the BRIC markets by indication and country, 2004-05 90
Table 2.19: Sales by major classes across the BRIC CNS market, 2004–05 93
Table 2.20: CNS sales in the BRIC markets by indication and country, 2004-05 95
Table 2.21: Sales by major classes across the BRIC cancer market, 2004-2005 98
Table 2.22: Cancer sales in the BRIC markets by indication and country, 2004-05 99
Table 2.23: Sales by major classes across the BRIC respiratory market, 2004–05 102
Table 2.24: Respiratory sales in the BRIC markets by indication and country, 2004-05 103
Table 2.25: Sales by major classes across the BRIC anti-infectives market, 2004–05 106
Table 2.26: Anti-infectives sales in the BRIC markets by indication and country, 2004-2005 108
Table 2.27: Sales of other therapeutic categories in the BRIC markets, 112
Table 2.28: Forecast sales by therapeutic area across the BRIC markets, 2005-11 114
Table 3.29: Sales in the BRIC countries and global pharmaceutical markets by product category, 2004-05 120
Table 3.30: Sales in the BRIC pharmaceutical markets by category, 2004-05 123
Table 3.31: Therapeutic sales in the BRIC pharmaceutical markets by product category, 2005 128
Table 3.32: Sales of cardiovascular therapeutics in the BRIC markets by product category, 2005 129
Table 3.33: Sales of CNS therapeutics in the BRIC markets by product category, 2005 130
Table 3.34: Sales of cancer therapies in the BRIC markets by product category, 2005 132
Table 3.35: Sales of anti-infectives in the BRIC markets by product category, 2005 133
Table 3.36: Sales of respiratory in the BRIC markets by product category, 2005 135
Table 3.37: Licensing trends in other therapeutic areas of the BRIC markets, 2005 136
Table 4.38: Sales of leading companies in the BRIC markets, 2004-05 147
Table 4.39: Sales of leading pharmaceutical companies in Brazil, 2004-05 149
Table 4.40: Sales of leading pharmaceutical companies in Russia, 2004-05 151
Table 4.41: Sales of leading pharmaceutical companies in India, 2004-05 153
Table 4.42: Sales of leading pharmaceutical companies in China, 2004-05 155
Table 5.43: Sanofi-Aventis’ sales by country in the BRIC pharmaceutical markets, 2004-05 160
Table 5.44: Sanofi-Aventis’ portfolio sales in the BRIC pharmaceutical markets, 2004-05 161
Table 5.45: Novartis’ sales by country in the BRIC pharmaceutical markets, 2004-05 164
Table 5.46: Novartis’ portfolio sales in the BRIC pharmaceutical markets, 2004-05 165
Table 5.47: Pfizer’s sales by country in the BRIC pharmaceutical markets, 2004-05 167
Table 5.48: Pfizer’s portfolio sales in the BRIC pharmaceutical markets, 2004-05 168
Table 5.49: GSK’s sales by country in the BRIC pharmaceutical markets, 2004-05 171
Table 5.50: GSK’s portfolio sales in the BRIC pharmaceutical markets, 2004-05 172
Table 5.51: Gedeon Richter’s sales by country in the BRIC pharmaceutical markets, 2004-05 176
Table 5.52: Gedeon Richter’s portfolio sales in the BRIC pharmaceutical markets, 2004-05 176
Table 5.53: Gedeon Richter’s corporate agreements, 2000-2006 178
Table 5.54: Servier’s sales by country in the BRIC pharmaceutical markets, 2004-05 180
Table 5.55: Servier’s portfolio sales in the BRIC pharmaceutical markets, 2004-05 181
Table 5.56: Servier’s corporate agreements, 2000-2006 183
Table 5.57: Menarini’s sales by country in the BRIC pharmaceutical markets, 2004-05 184
Table 5.58: Menarini’s portfolio sales in the BRIC pharmaceutical markets, 2004-05 185
Table 5.59: Menarini’s corporate agreements, 2000-2006 186
Table 5.60: Aché’s sales by country in the BRIC pharmaceutical markets, 2004-05 188
Table 5.61: Ache’s portfolio sales in the BRIC pharmaceutical markets, 2004-05 189
Table 5.62: Aché’s corporate agreements, 2000-2006 191
Table 5.63: EMS’ sales by country in the BRIC pharmaceutical markets, 2004-05 192
Table 5.64: EMS’s portfolio sales in the BRIC pharmaceutical markets, 2004-05 193
Table 5.65: EMS’s corporate agreements, 2000-2006 194
Table 5.66: Medley’s sales by country in the BRIC pharmaceutical markets, 2004-05 195
Table 5.67: Medley’s portfolio sales in the BRIC pharmaceutical markets, 2004-05 196
Table 5.68: Medley’s corporate agreements, 2000-2006 197
Table 5.69: Cipla’s sales by country in the BRIC pharmaceutical markets, 2004-05 198
Table 5.70: Cipla’s portfolio sales in the BRIC pharmaceutical markets, 2004-05 199
Table 5.71: Cipla’s corporate agreements, 2000-2006 202
Table 5.72: Nicholas Piramal’s sales by country in the BRIC pharmaceutical markets, 2004-05 203
Table 5.73: Nicholas Piramal’s portfolio sales in the BRIC pharmaceutical markets, 2004-05 204
Table 5.74: Nicholas Piramal’s corporate agreements, 2000-2006 207
Table 5.75: Ranbaxy’s sales by country in the BRIC pharmaceutical markets, 2004-05 209
Table 5.76: Ranbaxy’s portfolio sales in the BRIC pharmaceutical markets, 2004-05 210
Table 5.77: Ranbaxy’s corporate agreements, 2000-2006 213
Table 5.78: HLJ. Harbin’s sales by country in the BRIC pharmaceutical markets, 2004-05 215
Table 5.79: HLJ. Harbin’s portfolio sales in the BRIC pharmaceutical markets, 2004-05 216
Table 5.80: JS.Hengrui’s sales by country in the BRIC pharmaceutical markets, 2004-05 217
Table 5.81: JS.Hengrui’s portfolio sales in the BRIC pharmaceutical markets, 2004-05 218
Table 5.82: JS. Hengrui’s corporate agreements, 2000-2006 220
Table 5.83: Yangtze’s sales by country in the BRIC pharmaceutical markets, 2004-05 221
Table 5.84: Yangtze portfolio sales in the BRIC pharmaceutical markets, 2004-05 222
Table 5.85: Yangtze’s corporate agreements, 2000-2006 224