Australian healthcare trends Suite 15/20 Young St Neutral Bay NSW 2089

Consultations With... General PractitionersSpecialistsNurses Pharmacists KOLs Health consumers CarersRepresentatives

Overview Global Themes Industry Responses End of Blockbuster drug era Medication Of Risk Drug Re-positioning Greater investment in Orphan Drugs Pressure to cap rising public health spend P-Health Initiatives Technology-Based Monitoring

Overview Global Themes Industry Responses Rise of Functional Foods & Bevs Increased Demand for Rx Choices Increased Consumer Engagement Personalised Medicine Increased Consumer Influence on Rx Rising promotion & use of natural and alternative therapies Increased pharma engagement with consumers

End of Blockbuster Drug Era

The Patent Cliff 20 years ago, many new and powerful drugs launched Many now coming off patent In US, >$100 billion of branded drug sales expected to go generic In Aus, Lipitor predicted savings to Govt of $529 mill in $546 mill in

medication to prevent illness people educated to expect health/ well being benefits that REMOVES the NEED FOR PERSONAL RESPONSIBILITY Eg nicotine patches increased role for drugs that modulate emotions and behaviour Next Steps Products for memory enhancement Multi-function drugs e.g. Sanofi’s Acomplia Medications for social anxiety disorder & generalised anxiety disorder and for ‘naughty kids’ Big Pharma & Natural Therapy co’s seeing unprecedented profits in disease prevention The Medication Of Risk

Orphan Drug Pipeline increasingly active Probability of market approval ~13%. 1988, 253 orphan drugs-> 36 approved 2011, 2507 orphan drugs-> 393 approved Pharma increasingly working with rare-disease support orgs to advocate for market access and cement relationships

Higher likely re-imbursement than many other markets Govt Preparedness to Pay for Orphan Drugs High In Aust

Pressure to cap rising public health spend

Public Sector - Initiated P-Health To combat rising health costs, incl rising spend on originator drugs Govt Public Health Aims Developing new foods to prevent illness Finding new ways to diagnose disease early Using genes & proteins to predict & prevent ill health Objectives Help Australians live longer Reduce rising cost of health care Public sector becoming an important competitor in disease prevention products

Encouraging Consumers to Self-Regulate Nutritional Analysis Kiosks and software for specific medical conditions (e.g. diabetes/ special diets)

Earlier Identification Intelligent toilets test urine for glucose, kidney disease (eventually even cancer) Test faeces to measure weight and fat content let you know if there's anything unusual going on

Diagnosis Outside Healthcare Settings

Treatment & Monitoring Outside Healthcare Settings Remote Patient Monitoring

Increased consumer engagement

Rise in patients blogs / forums

Bio-oil 600 Youtube videos

Increased Information Access -> Empowerment Customer switching costs are low Don’t define themselves as patients ‘Person Living with.....’ rather than ‘patient’ given it references the individual’s complete experience a ‘chronic condition’ rather than ‘disease’ Consumers becoming more educated and discerning,

Physical Health Mental/Emotional Health Environmental Health Heart disease Physical Appearance Food Scares Stress Depression & Anxiety Animal Welfare Soil erosion, pollution Toxins Better For You products Weight loss products Cosmeceuticals Nutraceuticals Herbal Products Aromatherapy Vitamins & Minerals Vegetarian Products Natural Organics Concept of Health has come a long way from Norm’s ‘Life Be In it’ message Health Is No Longer Just Physical

Realisation that it does not have all the answers Is one of a range of options Greater Willingness to Try Alternatives Failure of western medicine to solve major health issues

Pharma Brand Positioning Much More Important Pharma manufacturers are concerned to raise their parent brand image Significant spend Consumer Empowerment means pharma brands need to have good corporate image to engender long term support

Increased Prevention & Treatment Choices

Rise of Functional Foods & Beverages XANGO The whole fruit puree of the Mangosteen fruit Powerful natural antioxidant & anti- inflammatory XANGO The whole fruit puree of the Mangosteen fruit Powerful natural antioxidant & anti- inflammatory Why would anyone use a drug, if you can get the same benefits from a food?

Functional Foods & Beverages Mainstream manufacturers making functional products Disease prevention claims (e.g. anti-cancer) currently restricted “ Functional foods an increasingly popular alternative to preventive medicines

Natural Therapies Australians spend ~$2.3 billion a year (4 x their spend on pharmaceuticals) 120% increase in spend since 1993 Over half of Australians use ~40% with chronic diseases use 60% of women & 44% of men (and increasing) visit alternative practitioners Significant and growing use reflecting consumer preferences

Vit C injections Ginkgo Biloba Lycopene Zinc Naturopathy Chiropracty Oxygen therapy Colonic irrigation

Natural Therapies Beliefs Look for safety above proven clinical efficacy Wide availability from non- pharmacy outlets and derivation from natural products has promoted perceptions of safety. The ‘ wellness’ market often demonises pharmaceutical products Patterns of Use To complement rather than replace conventional treatment pragmatically select treatments to best fit particular medical and health problems Upsurge in use as anti-depressants cholesterol reducers improving CV health

Reasons For Growth Disillusionment with orthodox medicine/ hospitals given perceptions of reduced quality of care. Dissatisfaction with doctor-patient interactions Practitioners regarded as more convincing, informative, considerate and available many using evidence-based methods Consumers increasingly dissatisfied with using just prescription pharmaceuticals

Strong DTC Advertising Presence

Increased consumer influence on treatment decisions

Self-Dx & Treatment A Growing Possibility Will Growing Availability of Cheap OS product erode local sales?

A challenge for Pharma and HCPs pressure to increase counseling & support nurses and allied HCPs’ increasingly important in providing credible patient information Industry Responses… Patient Support Programs? Personalised Medicine?

Personalised, Integrative Medicine ‘the capacity to predict disease development and influence decisions about lifestyle choices or to tailor medical practice to an individual’ Uses knowledge of individual metabolism or genetic make-up History ABX resistance testing (bacterial infection) Viral resistance testing (eg HIV) Genomic Medicine Gene Sequencing Genetic Mutation testing (eg breast cancer, IBD) Drugs targeted to narrower indications, hence limited populations Well established in Europe & US

Personalised, Integrative Medicine Can facilitate disease prediction, prevention and treatment : determine if increased risk of disease, followed by promotion of and support for compliance with prevention Diagnosing earlier using optimal surveillance, allowing more effective interventions or treatment options; enhancing therapeutic efficacy by ensuring the most appropriate drug is used and that dosing takes into consideration any genetic variants, which may influence metabolism of the drug; avoiding preventable drug related complications and side effects

Personalised, Integrative Medicine Opened Aug 2012 Incorporates a wellness centre offering complementary therapies eg acupuncture, massage, mind body therapy.

Genea Holistic to add safe and comprehensive complementary healthcare to our world leading fertility science and care – giving you the best possible chance of conceiving a healthy baby. aims to deliver you the maximum benefit from complementary healthcare to give you the best possible chance of a healthy baby. individualised programs that address your particular needs and incorporate the most appropriate treatments for you

 Earlier identification and treatment of risk factors for disease  Increase in self-prescription & self-medication  Convergence of pharmaceuticals, complementary medicines, functional foods & beverages  Increasing community adoption of preventive health measures

At point of purchase:  Self-service computer technology to help diagnose, prescribe and dispense on-line  Self-service terminals in supermarkets Consumers can plug in age, family medical history & lifestyle Provide a printout of recommended vitamins, herbs, supplements and food choices  One-stop shop model of product purchase  Specialised pharmacies

Pharma Industry Opportunities Closer relationships with end-users  Increasing consumer awareness of Big Pharma’s community involvement  Complementary medicine partnerships to  boost consumer perceptions of a ‘holistic health’ provider  better monitor/control disease management  Sponsoring ‘wellness’ clinics and disease screening services  Micro-chip technology (implants) to record health/disease status and monitor drug intake Capitalising on the political trend towards disease prevention

Micro Chipping Consumers VeriChip™ - There when you need it Used to access a subscriber-supplied database providing personal information Cannot be lost, stolen, misplaced or counterfeited. Can be scanned when necessary Provides instant access to a Subscriber Registry - secure, password protected web access. Future potential to track brand-switching …?