UK Pharmaceutical Market Overview - Pricing and reimbursement challenges dampen future growth

Introduction

The UK prescription pharmaceutical market was valued at $28.4 billion in 2009. Key growth drivers include growing use of chronic high-value innovative treatments driven by a rising elderly population, high public healthcare expenditure as proportion of total healthcare expenditure, relatively light pricing controls through the PPRS, and speedy domestic drug approvals.

Scope

*Overview of the UK's socioeconomic and demographic trends, healthcare system, regulation, pricing and reimbursement and intellectual property position

*Assesses the size of the UK's pharmaceutical market by prescribing setting, therapy area, leading brands and by leading companies

*Examines the UK's generics and biosimilars landscape in terms of regulatory issues, level of penetration, key players and degree of brand erosion

*Quantifies the UK's R&D and manufacturing infrastructure for the leading pharmaceutical companies, including key metrics and domestic M&A analysis.

Highlights

The UK pharmaceutical industry has to some extent been cushioned from the effects of the recession. However, the NHS now faces cuts and with price cuts to be implemented in Southern Europe further stimulating the parallel exportation of drugs out of these markets, branded drug sales in the UK market will certainly be impacted.

The UK's Department of Health is considering imposing mandatory generic substitution at the pharmacist level, as part of the renegotiated PPRS which came into effect in 2009. Mandatory substitution should boost generics volume uptake in the UK, but the extent of the increase is likely to be limited, given the widespread use of generics in the UK.

The UK has a strong track record for drug development. However, Roche and Novartis have threatened to pull out of the UK due to ongoing debates over drug pricing, expensive and bureaucratic clinical trials, and recent non-approval decisions by NICE. Also, a number of key players are downsizing their UK operations in an effort to reduce costs.

Reasons to Purchase

*Evaluate the evolving regulatory landscape and the impact of pricing and reimbursement controls on market access.

*Quantify the size and growth of the prescription pharmaceutical market in the UK, analyzing key therapy areas, brands and companies.

*Assess drivers and resistors of generic and biosimilars uptake in the UK as well as the level of erosion brands can expect to face post patent expiry.

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ABOUT DATAMONITOR HEALTHCARE 2
About the Healthcare Strategic Analysis Team 2
Country specific reports: 2
Global issue reports: 2
1. Executive Summary 3
Strategic scoping and focus 3
Key findings - UK healthcare drivers and resistors 4
Socio-demographic and economic analysis 8
UK socio-demographic trends 8
UK socio-economic trends 8
Healthcare system and drug regulatory analysis 10
UK healthcare expenditure 10
UK healthcare system overview 11
UK regulatory issues 11
UK pricing and reimbursement issues 11
Prescription pharmaceutical sales analysis 13
UK pharmaceutical market size 13
UK leading therapy areas 13
UK leading prescription pharmaceutical brands 13
UK pharmaceutical companies 13
Drug expiry analysis 15
UK generics market 15
UK brand erosion post patent expiry 15
UK biosimilars market 15
Pharmaceutical industry infrastructure analysis 17
UK pharmaceutical industry infrastructure overview 17
UK R&D infrastructure trends 17
UK manufacturing infrastructure trends 18
Related reports 20
Upcoming related reports 20
Table of Contents 21
2. Socio-demographic and economic analysis 22
Key findings 22
UK socio-demographic trends 22
UK socio-economic trends 22
Demographic trends in the UK 23
UK population growth rate expected to slow 24
Birth rate in UK is declining 26
Proportion of elderly people in the UK expected to rise and then level off 27
Life expectancy will continue to increase in the UK and across other markets 28
Disease burden in the UK 29
Ischemic heart disease is the leading cause of death in the UK 29
Non-communicable diseases are the main cause of overall disease burden in the UK 31
Communicable diseases are a relatively uncommon cause of death in the UK, but healthcare-associated infections are on the rise 32
Political climate in the UK 33
The recent general election has resulted in a change of ruling political party and the formation of a coalition government 33
UK economy still vulnerable after recession 34
Pharma has historically been relatively well insulated from the recession, but the NHS could face cuts 36
The UK has high standards of living, but there are income inequalities 37
Business environment in the UK 37
UK corporate tax rate one of the lowest in the EU 37
Unemployment rate is high 38
3. Healthcare system and drug regulatory analysis 39
Key findings 39
UK healthcare expenditure 39
UK healthcare system 39
UK regulatory issues 39
UK pricing and reimbursement issues 40
Healthcare expenditure - UK lags behind most developed nations 41
Healthcare system in the UK 43
NHS is the main healthcare provider in the UK 43
A number of stakeholders exist within the NHS 44
Investment in the NHS has risen substantially over the last decade, but cuts loom 46
UK is lagging behind other countries in health outcomes 46
Private healthcare provision is supplementary to the NHS 47
Primary versus hospital care - the number of hospital beds is falling in the UK as community care becomes more prominent 48
Healthcare system reform in the UK 48
Regulatory issues in the UK 50
Drug approval and regulatory processes 50
MHRA is the national body in charge of regulating medicines 50
Cost of regulatory filings varies according to type of authorization procedure used 51
UK's MHRA boasts short approval times 52
The application process in the UK is straightforward 53
UK license holders must report adverse drug reactions to EudraVigilance 54
New initiatives aim to reduce regulatory burdens on Pharma 54
The EU centralized procedure is convenient but expensive 54
Decentralized procedure introduced to address disputes in mutual recognition procedure 55
Country order of launch - brands tend to launch early in the UK 55
Intellectual property environment ? UK court determines validity of patents in the UK 56
High number of patent litigations and expensive fees but litigation times are short 56
Supplementary protection certificates give extra protection 57
Data exclusivity issues in the UK - the 8+2+1 rule 57
Pediatric SPC extension provides additional market exclusivity period 58
Drug counterfeiting - UK is becoming an easy target for counterfeiters 58
Drug importation in the UK ? companies wishing to import or export medicines must have licenses 59
Although the UK is generally a target country for parallel trade a recent surge in parallel exports has led to shortages of medicines 60
Pricing and reimbursement in the UK 62
Pricing issues in the UK 64
PPRS is a light form of pricing regulation 64
2009 PPRS introduced flexible pricing to reward innovation 66
Value-based pricing in the future? 66
UK drug prices among lowest in Western markets as a result of weak pound 67
Discounts obtained by hospitals, PCTs and pharmacies add further complexity to determining UK drug prices 68
Reimbursement issues in the UK 68
NICE is the key reimbursement body in the UK 68
SMC is NICE's equivalent in Scotland 69
Cost-effectiveness analysis forms the basis of NICE's appraisal 69
NICE appraises only a subset of drugs 71
NICE's review process - thorough but lengthy 72
Patient empowerment can have an impact on NICE reviews 73
Time delays caused by NICE are a significant issue 74
NICE has issued a number of controversial decisions and negative guidance over the past few years 74
Lack of transparency and over-reliance on QALY draws criticism from pharma industry 75
NICE's appraisal process prompted parliamentary review 76
Risk-sharing schemes are becoming the norm for expensive drugs 77
End-of-life guidance does not guarantee NICE approval 79
Better access to drugs on the horizon in the UK? 80
Will the new cancer drug fund improve access to cancer treatments in the UK? 81
Other pricing and reimbursement issues in the UK 81
Prescription charges do not have a significant impact on which drug is dispensed 81
Top-up payments have been introduced recently but used mostly for drugs not approved by NICE 81
4. Prescription pharmaceutical sales analysis 82
Key findings 82
Pharmaceutical market size in the UK 83
Leading therapy areas in the UK 85
Central nervous system drugs hold the largest share of the UK market value 87
Oncology drugs exhibited the strongest sales during 2005-09 88
Immunology and inflammation drugs showed the fastest sales growth between 2008 and 2009 88
Gastroenterology and cardiovascular drugs saw declining sales 88
Leading prescription pharmaceutical brands in the UK 90
Leading brand Seretide may face competition from faster-growing Symbicort 91
Lipitor has begun to suffer from sales erosion from other generic statins 91
Enbrel's solid growth is attributed to its superior efficacy and having secured approval for multiple indications 91
Leading pharmaceutical companies in the UK prescription pharmaceutical market 94
The leading international companies struggle to maintain growth momentum 95
The leading domestic companies experience impressive growth 98
GlaxoSmithKline 99
AstraZeneca 100
Shire 100
5. Drug expiry analysis 101
Key findings 101
UK generics market 101
UK brand erosion post patent expiry 101
UK biosimilars market 101
UK generics market dynamics 103
UK generics volume uptake 104
UK generics value uptake 105
UK generics market size 106
Drivers and resistors in the UK generics market 107
The proportion of prescribed and dispensed generic drugs has been steadily rising in the UK 108
The government is looking to impose mandatory generic substitution to further drive generic uptake 109
Improved efficiency in generic pricing across PCTs could significantly cut drug costs 110
Savings achievable through increased generic statin use have made them a target for cost-cutting initiatives 110
Large price differential between brands and generics is indicative of a commodity generics market in the UK 111
Key generics players in the UK market 113
Opportunities for the generics industry 114
Small molecule brand erosion in the UK 116
Overview of drugs analyzed 116
Mean level of brand erosion in the UK 117
Brand erosion in the UK retail and hospital setting 118
Brand erosion by therapy area in the UK 120
Brand erosion by drug formulation in the UK 122
UK biosimilars market dynamics 124
Drivers and resistors to biosimilar uptake in the UK - hospital purchasing decisions pivotal to driving biosimilar uptake 124
Key players in the UK biosimilars market 125
Biosimilar epoetin 125
Epoetin volume and value market share 126
Branded epoetin prices in the UK market post biosimilar entry 128
Biosimilar epoetin market share 129
Biosimilar filgrastim 130
Filgrastim volume and value market share 130
Branded filgrastim prices in the UK market post biosimilar entry 132
Biosimilar filgrastim market share 134
Biosimilar somatropin 135
Somatropin volume and value market share 136
New and future biosimilar launches 138
Opportunities for the biosimilars industry 139
Branded monoclonal antibody therapies could soon face biosimilar incursion 142
Biosimilars in development internationally 143
6. Pharmaceutical industry infrastructure analysis 145
Key findings 145
UK pharmaceutical industry infrastructure overview 145
UK R&D infrastructure trends 145
UK manufacturing infrastructure trends 145
UK pharmaceutical industry infrastructure overview 147
R&D and manufacturing strategies in the UK 147
R&D operations downsized to produce more focused pipeline offering higher returns 148
Manufacturers reduce investment in UK facilities and look to outsourcing 149
Key company infrastructure in the UK 149
Pfizer 150
Pfizer's acquisition and integration of Wyeth has resulted in the closure of two R&D sites 153
Pfizer phases out manufacturing in the UK 153
Pfizer enhances its biotech capabilities through M&A activity 155
GlaxoSmithKline 156
GlaxoSmithKline restructures to focus on rare diseases, downsizing R&D in the UK 158
Two manufacturing plants to shut due to lower demand as a result of generic competition 159
Berkshire Hathaway buys a small stake in GlaxoSmithKline 161
Sanofi-Aventis 162
Sanofi-Aventis restructures, cutting R&D spend in favor of R&D partnership agreements 164
Lower demand for maturing drugs leads to closure of a UK manufacturing plant 164
Sanofi-Aventis's acquisition of Acambis expands its vaccines offering 166
AstraZeneca 167
AstraZeneca to implement heavy cuts in R&D workforce 169
Manufacturing capabilities replaced by outsourcing 169
Merck & Co. 171
Roche 175
Roche's strengthens its pipeline with promising early-stage compounds 179
Johnson & Johnson 180
DePuy strengthens its hip implants offering through the acquisition of Finsbury Orthopaedics 182
Eli Lilly 184
Novartis 188
UK manufacturing site helped Novartis reach record sales in 2009 190
Latest restructuring plan has created a leaner operating environment 191
Boehringer Ingelheim 192
7. Bibliography 196
Executive summary 196
Publications and online articles 196
Datamonitor reports and products 196
Socio-demographic and Economic analysis 196
Publications and online articles 196
Datamonitor reports and products 198
Healthcare system & drug regulation 198
Publications and online articles 198
Datamonitor reports and products 204
Pharmaceutical sales analysis 205
Publications and online articles 205
Datamonitor reports and products 205
Drug expiry analysis 205
Publications and online articles 205
Datamonitor reports and products 208
Industry infrastructure analysis 209
Publications and online articles 209
Datamonitor reports and products 211
APPENDIX 212
Exchange rates 212
UK brand erosion - additional data and analysis 213
UK brand erosion - methodology 215
UK brand erosion - therapy area classification 217
About Datamonitor 218
About Datamonitor Healthcare 218
Datamonitor consulting 218
Disclaimer 220
List of Tables
Table 1: UK - changes in the key value drivers of the UK pharmaceutical market, 2005-09 6
Table 2: UK - demographic indicators, 2005 and 2010 8
Table 3: UK - key economic indicators, 2005-2012 9
Table 4: UK - healthcare expenditure indicators, 2006-09 10
Table 5: UK - pricing and reimbursement tools, 2010 12
Table 6: UK - sales and volume of the prescription pharmaceutical market ($ and IMS Standard Units), 2009 14
Table 7: UK - key metrics for the generics and biosimilars market, 2010 16
Table 8: UK - pharmaceutical industry metrics, 2007-09 17
Table 9: UK - R&D and manufacturing infrastructure mean data for top 10 pharma companies in the UK, 2008-2010 19
Table 10: UK - demographic indicators, 2005 and 2010 23
Table 11: UK - top 10 causes of mortality, 2004 29
Table 12: UK - disability-adjusted life years (DALY) rates compared to Australia, Japan, the BRIC nations, North America and other key European markets, 2004 31
Table 13: UK - key economic indicators, 2005-2012 34
Table 14: UK - healthcare expenditure indicators, 2006-09 42
Table 15: UK - hospital bed and healthcare worker density, 2002 and 2007 48
Table 16: UK - fees payable to Medicines and Healthcare products Regulatory Agency (MHRA). 2010 51
Table 17: Order of launch for new molecules in the US, Japan, France, Germany, Italy, Spain, UK, Canada and Australia 55
Table 18: UK - a range of pricing and reimbursement tools are used 62
Table 19: UK - Pharmaceutical Price Regulation Scheme (PPRS) mandated price adjustments, 2009-2013 65
Table 20: UK - comparison of ex-manufacturer prices in the UK with selected developed nations, 2004-08 67
Table 21: UK - NICE has rejected a number of drugs on the basis of poor cost-effectiveness 75
Table 22: UK - risk-sharing agreements companies entered into with NICE, 2009-2010 77
Table 23: UK - sales and volume of the prescription pharmaceutical market ($ and IMS Standard Units), 2009 84
Table 24: UK - pharmaceutical sales by therapy area ($m and %), 2005-09 86
Table 25: UK - pharmaceutical volume by therapy area (SUm and %), 2005-09 87
Table 26: UK - sales growth for top 20 pharmaceutical brands ($m and %), 2009 92
Table 27: UK - volume growth for top 20 pharmaceutical brands (SUm and %), 2009 93
Table 28: UK - sales growth for the leading international pharmaceutical companies ($ and %), 2009 96
Table 29: UK - volume growth for the leading international pharmaceutical companies in the UK (SU and %), 2009 97
Table 30: UK - sales growth for the leading UK-based pharmaceutical companies ($ and %), 2009 98
Table 31: UK - volume growth for the leading UK-based pharmaceutical companies (SU and %), 2009 99
Table 32: UK - key metrics for the generics and biosimilars market, 2010 102
Table 33: UK - comparison of generic penetration versus other major pharmaceutical markets ($ billion and %), 2007-08 103
Table 34: UK - leading generics companies, 2009 113
Table 35: UK - brands exposed to generic competition, 2010-12 114
Table 36: UK - key metrics for the biosimilars market, 2009 124
Table 37: UK - leading biosimilar companies, 2009 125
Table 38: Biosimilars approved and rejected in Europe by the European Medicines Agency (EMA) to May 2010 138
Table 39: UK - sales (based on 2009 sales data) of biologics both expired and expected to come off-patent in 2010-15 141
Table 40: UK - pharmaceutical industry metrics, 2007-09 147
Table 41: UK - prescription sales growth for the top 10 pharmaceutical companies ($m and %), 2009 149
Table 42: UK - Pfizer's R&D and manufacturing infrastructure (post-merger with Wyeth), 2010 150
Table 43: UK - Pfizer's R&D and manufacturing infrastructure data (post-merger with Wyeth), 2010 151
Table 44: UK - Pfizer's UK-based M&A activity, 2008-2010 155
Table 45: UK - GlaxoSmithKline's R&D and manufacturing infrastructure, 2010 156
Table 46: UK - GlaxoSmithKline's R&D and manufacturing infrastructure data, 2010 157
Table 47: UK - GlaxoSmithKline's UK-based M&A activity, 2008-2010 161
Table 48: UK - Sanofi-Aventis's R&D and manufacturing infrastructure, 2010 162
Table 49: UK - Sanofi-Aventis's R&D and manufacturing infrastructure data, 2010 163
Table 50: UK - Sanofi-Aventis's UK-based M&A activity, 2008-2010 166
Table 51: UK - AstraZeneca's R&D and manufacturing infrastructure, 2010 167
Table 52: UK - AstraZeneca's R&D and manufacturing infrastructure data, 2010 168
Table 53: UK - Merck & Co's R&D and manufacturing infrastructure (post acquisition of Schering-Plough), 2010 171
Table 54: UK - Merck & Co's R&D and manufacturing infrastructure data (post acquisition of Schering-Plough), 2010 172
Table 55: UK - Roche's R&D and manufacturing infrastructure, 2010 175
Table 56: UK - Roche's R&D and manufacturing infrastructure data, 2010 176
Table 57: UK - Roche's UK-based M&A activity, 2008-2010 179
Table 58: UK - Johnson & Johnson's R&D and manufacturing infrastructure, 2010 180
Table 59: UK - Johnson & Johnson's R&D and manufacturing infrastructure data, 2010 181
Table 60: UK - Johnson & Johnson's UK-based M&A activity, 2008-2010 183
Table 61: UK - Eli Lilly's R&D and manufacturing infrastructure, 2010 184
Table 62: UK - Eli Lilly R&D and manufacturing infrastructure data, 2010 185
Table 63: UK - Novartis's R&D and manufacturing infrastructure, 2010 188
Table 64: UK - Novartis's R&D and manufacturing infrastructure data, 2010 189
Table 65: UK - Boehringer Ingelheim's R&D and manufacturing infrastructure, 2010 192
Table 66: UK - Boehringer Ingelheim's R&D and manufacturing infrastructure data, 2010 193
Table 67: Currency exchange rates, 2010 212
Table 68: ATC (anatomical therapeutic chemical) classification codes assigned to a given therapy area 217
List of Figures
Figure 1: UK - key value drivers of the UK pharmaceutical market, 2009 4
Figure 2: UK - drivers and resistors facing branded pharmaceutical companies 7
Figure 3: UK - population and population growth rate, 1950-2050 24
Figure 4: UK - population growth compared to the other seven major markets, Australia, Japan, the BRIC nations, North America and other key European markets, 1950-2050 25
Figure 5: UK - birth rates per 1,000 individuals compared to the other seven major markets, Australia, Japan, the BRIC nations, North America and other key European markets, 1950-2050 26
Figure 6: UK - proportion of population over 65 years compared to the other seven major markets, Australia, Japan, the BRIC nations, North America and other key European markets, 1950-2050 27
Figure 7: UK - life expectancy compared to the other seven major markets, Australia, Japan, the BRIC nations, North America and other key European markets,1950-2050 28
Figure 8: UK - GDP per capita growth rate compared to, Australia, Japan, the BRIC nations, North America and other key European markets, 2005-09 35
Figure 9: Debt trap rankings for the UK, France, Germany, Italy, Spain, US, Canada, Australia and Japan, 2010 36
Figure 10: Unemployment rates in the UK, France, Germany, Italy, Spain, US, Canada, Australia, Japan, Brazil, India, Russia and China, 1990-2008 38
Figure 11: UK - the proportion of GDP expenditure on healthcare is lower compared to most other developed nations, 2007 41
Figure 12: UK - flow of money and accountability within the National Health Service (NHS) 44
Figure 13: UK - primary care trusts (PCTs) are the key stakeholders within the National Health Service (NHS) 45
Figure 14: UK - structure of the private healthcare system 47
Figure 15: UK - four routes for obtaining market authorization in the UK 51
Figure 16: UK - Medicines and Healthcare products Regulatory Agency (MHRA) application process 53
Figure 17: EU - the 8+2+1 market exclusivity rule 57
Figure 18: UK - a number of different bodies impact drug prescription and use 63
Figure 19: UK - advantages and disadvantages of the Pharmaceutical Price Regulation Scheme (PPRS) for the UK pharmaceutical industry 66
Figure 20: UK - NICE's topic selection process 71
Figure 21: UK - NICE's review process 73
Figure 22: UK - drivers and resistors of entering into risk-sharing agreements 78
Figure 23: UK - three new schemes aim to improve access to drugs, 2010 80
Figure 24: UK - relative sales and volume of the UK prescription pharmaceutical market (indexed against volume or value in 2005), 2005-09 83
Figure 25: UK - pharmaceutical sales by therapy area (%), 2005-09 85
Figure 26: UK - sales growth for the leading pharmaceutical brands ($m and %), 2009 90
Figure 27: UK - sales growth for leading pharmaceutical companies (%), 2005-09 94
Figure 28: UK - comparison of generic volume uptake versus other major pharmaceutical markets (%), 2007-08 104
Figure 29: UK - comparison of generic value uptake versus other major pharmaceutical markets (%), 2007-08 105
Figure 30: UK - comparison of generics market size versus other pharmaceutical markets ($ billion), 2007-08 106
Figure 31: UK - key factors influencing the UK generic industry, 2010 107
Figure 32: England - generic prescribing and dispensing (%), 1998-2008 108
Figure 33: UK - brand sales at risk of generic erosion ($m), 2010-12 115
Figure 34: UK - mean erosion (by value and volume) of branded small molecules during the first 2 years of generic competition (%) 117
Figure 35: UK - mean erosion (by value and volume) of branded small molecules by prescribing setting during the first 2 years of generic competition 119
Figure 36: UK - mean erosion (by value and volume) of branded small molecules by therapy area during the first 2 years of generic competition 121
Figure 37: UK - mean erosion (by value and volume) of branded small molecules by formulation during the first 2 years of generic competition 123
Figure 38: UK - biosimilar versus branded epoetin alpha volume uptake (%), 2009 126
Figure 39: UK - biosimilar versus branded epoetin alpha value uptake (%), 2009 127
Figure 40: UK - unit price for Aranesp, NeoRecormon and Eprex, 2008-09 128
Figure 41: UK - biosimilar epoetin market share by volume (%), 2008-09 129
Figure 42: UK - biosimilar versus branded filgrastim volume uptake (%), 2008-09 130
Figure 43: UK - biosimilar versus branded filgrastim value uptake (%), 2008-09 131
Figure 44: UK - unit price for Neupogen and Granocyte ($/SU), 2008-09 132
Figure 45: UK - unit price for Neulasta ($/SU), 2008-09 133
Figure 46: UK - biosimilar versus branded filgrastim market share by volume (%), 2008-09 134
Figure 47: UK - biosimilar versus branded somatropin volume uptake (%), 2006-09 136
Figure 48: UK - biosimilar versus branded somatropin value uptake (%), 2006-09 137
Figure 49: UK - sales (based on 2009 sales data) of biologics both expired and expected to come off-patent during 2010-15 140
Figure 50: Drivers and resistors to biosimilar monoclonal antibody entry, 2010 143
Figure 51: Key biosimilars in development internationally by product class, 2010 144
Figure 52: Pharma's strategic responses to slowing sales and operating profit growth 148
Figure 53: UK - Pfizer's R&D presence (post-merger with Wyeth), 2010 152
Figure 54: UK - Pfizer's pharmaceutical operations (post-merger with Wyeth), 2010 154
Figure 55: UK - GlaxoSmithKline's R&D and manufacturing presence, 2010 158
Figure 56: UK - GlaxoSmithKline's pharmaceutical operations, 2010 160
Figure 57: UK - Sanofi-Aventis's R&D presence, 2010 164
Figure 58: UK - Sanofi-Aventis's pharmaceutical operations, 2010 165
Figure 59: UK - AstraZeneca's R&D and manufacturing presence, 2010 169
Figure 60: UK - AstraZeneca's pharmaceutical operations, 2010 170
Figure 61: UK - Merck & Co's R&D and manufacturing presence (post acquisition of Schering-Plough), 2010 173
Figure 62: UK - Merck & Co's pharmaceutical operations (post acquisition of Schering-Plough), 2010 174
Figure 63: UK - Roche's R&D presence, 2010 177
Figure 64: UK - Roche's pharmaceutical operations, 2010 178
Figure 65: UK - Johnson & Johnson's pharmaceutical operations, 2010 182
Figure 66: UK - Eli Lilly's R&D and manufacturing presence, 2010 186
Figure 67: UK - Eli Lilly's pharmaceutical operations, 2010 187
Figure 68: UK - Novartis's R&D presence, 2010 190
Figure 69: UK - Novartis's pharmaceutical operations, 2010 191
Figure 70: UK - Boehringer Ingelheim's R&D and manufacturing presence, 2010 194
Figure 71: UK - Boehringer Ingelheim's pharmaceutical operations, 2010 195
Figure 72: UK - sales erosion of branded small molecules during the first 2 years of generic competition 213
Figure 73: UK - volume erosion of branded small molecules during the first 2 years of generic competition 214
Figure 74: Drugs experiencing generic erosion between Q1 2006 and Q2 2007 215
Figure 75: Erosion curves for each drug experiencing generic entry 216
Figure 76: Mean erosion curve for drugs A, B, and C experiencing generic entry 217

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