Table of Contents

CHAPTER 1 EXECUTIVE SUMMARY 4
Scope of the report 4
IMS caveat 4
Scorecard for analyzed countries 5
Patient potential in key emerging markets 6
Socioeconomic trends and business environment in key emerging markets 6
Health system dynamics 6
Pricing and reimbursement environment 7
Regulatory environment in key emerging markets-uncertainties exist but do not present major hurdles 8
Pharmaceutical market dynamics 8
CHAPTER 2 THE PHARMACEUTICAL MARKET IN BRAZIL 13
Tight pricing control is a downside but the overall environment and healthcare provision is improving 13
Demographic trends in Brazil 15
Disease burden is similar to the Western countries 17
Socioeconomic environment in Brazil - a land of inequality 18
Political climate is stable 18
Brazilian economy is growing at a moderate but steady level 19
Regional differences are great 21
Mercosur-the common market of South America 21
There is an abundant semi-skilled and unskilled workforce but the educational level is low 22
Business environment in Brazil-regulation and bureaucracy are considerable 22
Business entities 22
Taxation system is complex 23
Foreign direct investment in Brazil is growing 24
Importation is costly and laborious but export is incentivized 25
The healthcare system in Brazil is based on a public-private mix 26
Healthcare expenditure in Brazil 27
The public sector - the Unified Health System (SUS) 27
The private sector is restricted to the rich 28
After years of focus on hospital care, primary care is now predominant 30
Regulatory issues in Brazil 32
Intellectual property protection: long delays exist 32
Compulsory licenses on HIV/AIDS drugs were used only as a threat until May 2007 33
Registration of drugs-regulatory requirements are tightening 34
Imported pharmaceuticals have to be registered with ANVISA 36
Counterfeit drugs present a problem but a crackdown has started 36
Pricing and reimbursement of drugs in Brazil 37
Multiple mechanisms ensure tight price control on pharmaceuticals 37
Prices of marketed pharmaceuticals are controlled through price freezes and increases 38
Anti-retroviral drugs are priced low 40
Reimbursement is limited but is expected to improve 41
Patients are turning to courts to ensure they receive new treatments 45
Pharmaceutical market dynamics in Brazil 47
Distribution: a highly fragmented market 49
Brazil has a high number of pharmacies 50
Top manufacturers on the Brazilian retail market 51
Top ATC groups by sales value on the Brazilian retail pharmaceutical market 52
Top brands on the Brazilian retail market 54
Hospital sales of pharmaceuticals in Brazil 55
Advertising, marketing and sales of drugs 56
Major foreign pharmaceutical companies in Brazil 56
Sanofi-Aventis 57
Novartis 57
Bayer Schering 57
Pfizer 58
Boehringer-Ingelheim 58
It is difficult for multinational companies to enter the generics market 59
Major domestic pharmaceutical companies in Brazil 59
The generics market is dominated by a small number of leading companies 59
EMS 60
Medley 60
Eurofarma 61
Group Castro Marques (Biolab) 61
Ache Biosintetica 61
Drug manufacturing in Brazil 62
Multinational companies are ramping up export of drugs from Brazil but domestic companies are lagging behind 63
State-owned drug manufacturing is focused on antiretroviral drugs for HIV/AIDS 63
Investment in R&D in Brazil is growing 65
Phytopharmaceuticals-a new opportunity for Brazilian companies? 66
Clinical trials in Brazil 66
CHAPTER 3 THE PHARMACEUTICAL MARKET IN RUSSIA 68
The new reimbursement system and growing out-of-pocket spend have resulted in fast growth of the Russian pharmaceutical market 68
Demographic trends in Russia 71
Basic facts 71
Life expectancy is surprisingly low 71
Ageing and depopulation are resulting from declining birth rates 72
Disease burden in Russia 73
Socioeconomic environment in Russia 74
Political climate in Russia 74
Russia remains a centralized country with the center of power in Moscow 74
Economic environment in Russia: GDP and disposable income are growing 75
The Russian economy is trying to break away from overdependence on natural resources and is diversifying 76
Large regional differences exist 76
Accession to WTO is expected to bring positive changes 77
The labor market in Russia 78
The population is highly educated but the output is low 78
Looming labor shortage 78
Business environment in Russia-corruption and lack of transparency create difficulties 79
Foreign direct investment in Russia is mostly in the natural resource industry 79
Corruption is widespread 80
Excessive bureaucracy-red tape 80
Registration of a legal entity in Russia is a long and costly procedure 80
Taxation differs for foreign companies 81
Pharmaceuticals are subject to a reduced VAT rate of 10% 82
Customs duties are slowly becoming in line with the WTO 82
Healthcare system in Russia 84
Mandatory health insurance was introduced in 1991 85
Certain diseases have become a priority of the Russian government 87
The healthcare reform of 1991 signaled the privatization of healthcare 88
Healthcare expenditure is below the level of Western EU countries 89
Increased funding for healthcare is one of the priorities of the government 91
Primary versus hospital healthcare in Russia-focus on hospital care 91
'Under the table' expenditure is high in Russia 92
Access to healthcare is especially problematic for the poor population 93
Companies offering private health insurance are scarce and focus on the top end of the market 93
Regulatory issues in Russia 94
Intellectual property protection-several key issues remain unresolved 94
Patents ( insufficient enforceability of patent laws is a problem 94
Data exclusivity remains an unresolved issue 95
Drug counterfeiting in Russia 96
Registration of drugs in Russia 97
Certification of drugs is cumbersome but is used to detect counterfeit drugs 98
A large proportion of drugs are sold without prescription 99
Pricing and reimbursement of drugs in Russia 100
Pricing of drugs-few restrictions exist 100
Reimbursement-federal and regional lists exist 101
Certain drugs used in hospitals are funded by regional health budgets 102
Introduction of the federal reimbursement system DLO was a major change 102
The DLO program ( growing pains? 103
Drug price cuts and changes to the reimbursement list failed to keep DLO spending within the allocated budget 105
Insufficient planning for demand is putting a strain on the DLO program 107
State is becoming a bigger purchaser of drugs 108
The future of DLO program 108
DLO will be split into two programs in 2008 110
Pharmaceutical market dynamics in Russia 111
The distribution sector is fragmented but is consolidating 112
Foreign investment in the sector is increasing 113
The pharmacy networks sector is fragmented 114
Global pharma lead the Russian pharmaceutical market by sales value 117
Generics dominate the market in volume terms but account for only a fraction of the sales value 118
The retail market segment is growing at a steady rate 119
Top brands in the retail market segment in Russia 119
Top ATC groups by sales in the retail sector in Russia 121
Top manufacturers on the Russian retail market 123
The hospital market segment in Russia 125
Multinational companies dominate the hospital segment 125
Systemic antibacterials are the best selling therapeutic class 127
Consumption of expensive medicines is increasing in the hospital segment 128
The DLO program is one of the major growth drivers of the Russian pharmaceutical market but faces stagnation 130
Antineoplastic and immunomodulating agents were the best selling group in the DLO program in 2006 131
DLO has failed to increase the share of domestic producers and foreign manufacturers dominate 133
The top brands list in the DLO segment in 2006 is dominated by foreign brands 136
The establishment of the DLO drove the growth of the oncology sector 137
The DLO segment faces stagnation in 2007 139
Drugs can be imported into Russia through different channels 140
Top ATC groups of imported drugs 144
Top imported brands in Russia 145
Top foreign manufacturers by sales of imported drugs 147
The Russian pharmaceutical market will continue to grow 148
Export of pharmaceuticals from Russia is low 148
Launch, marketing and branding in Russia 149
Branding is important in Russia 149
Advertising of pharmaceuticals in Russia 150
Merck's co-marketing deal with Otechestvennie Lekarstva ( a first of its kind 151
Innovative drugs have the best market potential in Russia 151
Market entry strategies: acquiring a domestic producer? 151
Major foreign pharmaceutical companies on the Russian market 152
Sanofi-Aventis is the top foreign pharmaceutical company in Russia 152
Novartis's presence in Russia is growing 152
Servier 152
Roche 153
Gedeon Richter 153
Nycomed 154
Eli Lilly 154
Novo Nordisk 154
Bayer Schering 155
Actavis has strengthened its position in the Russian market through the acquisition of ZIO Zdorovie 155
Stada has increased its presence in the Russian market through three different entities 156
Major domestic pharmaceutical companies on the Russian market 156
Pharmstandard 159
Veropharm 159
Domestic producers will grow 160
Innovation is lagging behind the West 160
Manufacturing drugs in Russia 161
Clinical trials in Russia: a growing opportunity 162
CHAPTER 4 THE PHARMACEUTICAL MARKET IN INDIA 166
Improved patent protection environment fails to deliver on its promise but economic growth keeps the potential alive 166
Demographic trends in India: a trend toward ageing and urban population growth 169
Disease burden in India 170
Socioeconomic environment in India 172
Political climate in India - open to economic liberalization 172
Economic growth is steady and is concentrated in mid-sized and small urban centers 173
Poverty is declining for the first time since independence 174
Middle class income population is booming 175
Inadequate infrastructure is a major obstacle to faster growth 176
India is a member of the World Trade Organization 177
India has a high number of educated scientists 178
Business environment in India 178
India is opening up to Foreign Direct Investment 178
Legal entities in India 179
Corporate taxes in India are high but R&D incentives are given 180
Indirect taxes are very high in India and create a barrier for foreign companies 181
The central excise duty charging system was changed in 2005 181
Value added tax (VAT) was introduced in 2005 in India 182
Import tariffs are high in India 183
Export is encouraged through subsidies and special economic zones 183
Transparency and corruption in India 184
Healthcare system in India 184
Public health expenditure is low in India 185
Alternative medicine-AYUSH 186
Only a small fraction of the population has social security or private health insurance 188
Access to healthcare is poor especially in rural regions 190
Public health programs in India 192
Regulatory issues in India 193
Intellectual property protection in India is insufficient 193
Case study: Glivec was refused patent protection on the basis that incremental innovation is not patentable 194
Case study: AstraZeneca's patent application for Iressa was also rejected 195
Pfizer's maraviroc patent was granted - a change of tide for IP environment 196
India is benefiting from compulsory licenses for HIV/AIDS drugs in other countries 196
India is a major source of counterfeit drugs 197
Registration of drugs in India is straightforward 197
Importation of pharmaceuticals into India 200
Pricing and reimbursement of drugs in India 201
Control on drug pricing is getting tighter and is threatening to reduce the growth of the Indian market 201
Prices of certain pharmaceuticals in India are subject to price controls 201
Prices of drugs not subject to price control are being increasingly monitored and capped 204
Only a small number of drugs in India are reimbursed 205
Pharmaceutical market dynamics in India 205
The distribution sector in India is highly fragmented 206
Retail pharmacy chains are starting to appear 208
Top manufacturers on the Indian retail market-domestic companies dominate 209
Anti-infectives and gastrointestinal drugs hold almost 50% of the total market 211
Top brands on the Indian pharmaceutical market 214
Export of drugs from India is growing 215
Major foreign pharmaceutical companies in India 215
GlaxoSmithKline 216
Sanofi-Aventis 217
Abbott Laboratories 218
Pfizer 218
Major domestic pharmaceutical companies in India 219
Ranbaxy 219
Cipla 220
Nicholas Piramal 220
Zydus Cadila 221
Sun Pharma 221
Alkem Laboratories 222
Lupin 222
Dr Reddy's 222
India is a major hub of drug manufacturing activity 223
India is developing its capacity for development and manufacturing of biosimilars 224
R&D activities are increasing in India 225
Clinical trials in India - a growing opportunity 227
CHAPTER 5 THE PHARMACEUTICAL MARKET IN CHINA 231
A growing economy is fuelling demand and its R&D potential is attracting investment 231
Demographic trends-the world's most populous country is ageing 233
Disease burden in China 234
Socioeconomic environment in China 235
Political climate-stable and supporting economic growth 235
China's economy continues to grow but remains over-reliant on exports 236
Fast economic growth has fueled China's energy demand 238
China's middle class is growing 238
China - a good education system 239
Business environment in China 239
Foreign direct investment is contributing to economic growth 239
Business entities in China 240
Taxation system in China 240
Corruption is widespread 241
The difference between Chinese and Western cultures and the language barrier are a difficulty 241
Healthcare system in China 241
Healthcare expenditure-growing but insufficient 242
Growing out-of-pocket spend is the main contributor to the rising healthcare expenditure 244
Healthcare reforms have resulted in lower healthcare utilization 244
Access to healthcare services is difficult and discriminatory against the poor and the rural population 245
The density of healthcare workers is low and the hospital facilities are in a great need of an overhaul 246
Health insurance coverage is increasing in both urban and rural areas but is insufficient 248
The introduction of the urban employee Basic Medical Insurance System has improved healthcare coverage in cities 248
Rural health insurance coverage is increasing but the benefits are insufficient 249
The unemployed may be offered a very basic health insurance 250
Traditional Chinese Medicine still plays a role in Chinese healthcare 250
Regulatory issues in China-an improving environment 251
Intellectual property protection-improving but still a way to go 251
New drug regulations have failed to improve the IP protection and to satisfy the global pharmaceutical industry 254
Compulsory license provision in China? 255
Counterfeit drugs represent a particular threat 255
Registration of drugs in China is a complex process 256
Priority review procedures have been put in place to tackle health crises 258
China has resorted to drastic measures to improve its safety record 259
Pressure from export partners is forcing China to introduce practical measures to improve safety record 260
Obtaining import drug licenses is a long and costly process 261
Traditional Chinese Medicine is not tightly regulated 261
Pricing and reimbursement of drugs in China 262
Price cuts of reimbursable drugs threaten to reduce profit margins of manufacturers 262
In order to reduce the healthcare cost burden for patients the government is imposing heavy price cuts 263
Prices of drugs sold in hospitals are over-inflated 264
Reimbursement is negotiated at local level 264
Pharmaceutical Catalog classification 265
Pharmaceutical market dynamics in China 267
The distribution system in China is complex 269
Sales of drugs through retail pharmacies are encouraged 270
Several large multinational companies are among the top drug manufacturers in China 271
Top ATC groups in China-anti-infectives remain at the top but their growth is slowing down 272
Top products on the Chinese hospital market 276
Major foreign pharmaceutical companies in China 278
Pfizer 278
AstraZeneca 278
Bayer Schering 279
Roche 280
Novartis 280
Sanofi-Aventis 281
GlaxoSmithKline 282
Major domestic pharmaceutical companies in China 283
Yangtze River Pharmaceutical Group 283
Jiangsu Hengrui Medicine Company 283
The Harbin Pharmaceutical Group 284
Drug manufacturing in China-GMP is improving but IP protection is insufficient for Western manufacturers 285
Several Chinese biotechnology companies already have biosimilars products on the Chinese market 286
Many multinational companies have opened R&D centers in China 287
Clinical trials in China - international interest is high 290
CHAPTER 6 THE PHARMACEUTICAL MARKET IN TURKEY 293
Low drug prices limit the market potential but the overall environment is improving 293
Demographic trends in Turkey 296
Disease burden in Turkey 297
Socioeconomic environment in Turkey 298
Political climate-the new government supports foreign investment in Turkey 298
Desired accession to the EU is a stimulant for economic growth 299
Turkey is a member of the WTO and has entered the Customs Union with the EU 300
Labor market in Turkey-lack of educated workforce 300
A large working age population 300
Educational level is low compared to the West 301
Business environment in Turkey 301
Foreign direct investment is low but is growing 301
Legal corporate entities in Turkey 302
Taxation is becoming investor-friendly 302
Turkey is in Customs Union with the EU 303
Foreign trade zones and free ports have special customs treatment and tax advantages 303
Corruption is present but the government is fighting against it 304
Healthcare system in Turkey - universal healthcare coverage is on its way 304
Access to healthcare is poor in rural regions 306
The Health Transformation Program is reforming healthcare and driving the growth of the pharmaceuticals sector 307
Primary and family care is important for provinces with traditionally poor access to healthcare 308
Private health insurance accounts for a very small percentage of the population 308
Expenditure on pharmaceuticals accounts for a high proportion of the healthcare spend 309
Regulatory issues in Turkey 310
IP and data exclusivity in Turkey-improved but still a way to go 310
Turkey is a source of counterfeit drugs 311
Registration and importation of drugs in Turkey 312
Pricing and reimbursement of drugs in Turkey 314
Reimbursement is available but criteria and decisions are not transparent 314
There is no rationalization of drug but may be introduced 315
Lack of transparency is a problem 316
Tight price controls have resulted in price decreases 316
Pharmaceutical market dynamics-tight pricing controls are stumping growth 318
Distribution is dominated by several large companies 320
Retail pharmacy chains are not permitted 321
Top ATC groups by sales value in Turkey 321
The top brands list in Turkey is dominated by foreign products 324
The top manufacturers list is dominated by foreign companies 325
Imported versus local drugs 327
Major foreign pharmaceutical companies in Turkey 327
Novartis 327
Sanofi-Aventis 327
Roche 328
GlaxoSmithKline 328
Pfizer 328
Bayer-Schering 329
Eli Lilly 329
Major domestic pharmaceutical companies in Turkey 329
Abdi Ibrahim 330
Zentiva has acquired a stake in Eczacibasi 330
Bilim Pharmaceuticals 330
Actavis acquired Turkey's Fako 331
Drug manufacturing in Turkey-an unexploited opportunity? 331
Export of pharmaceuticals from Turkey is low 332
Conducting clinical trials in Turkey 333
Registration of clinical studies-approval times may be shortened 334
Local CRO industry is starting to emerge 335
CHAPTER 7 BIBLIOGRAPHY 336
Publications and online articles 336
Conference literature 361
Datamonitor resources 361
Websites 361
Exchange rates 362
Suggested reading 363
APPENDIX 365
Russian Pharmaceutical Market: additional data 365
Domestic manufacturers on the Russian market 367
Retail market segment in Russia 367
Top 20 drug manufacturers in the retail segment 368
Top brands in the Russian retail market in 2006 369
The hospital market in Russia 369
Top manufacturers 370
Top brands in the hospital segment 371
The DLO market segment in Russia 372
Top manufacturers in the DLO segment 372
Top brands in the DLO segment 374
IMS Health sales data for the Russian pharmaceutical market 376
Top manufacturers on the Russian market 376
Top brands in Russia 377
Top ATC groups in Russia 378
IMS Health's MIDAS sales data audit 379
Glossary 383
List of Tables
Table 1: Scorecard for the pharmaceutical markets in Brazil, Russia, India, China and Turkey 5
Table 2: Key demographic indicators for Brazil, 2005 16
Table 3: Top mortality causes in Brazil, 2002 17
Table 4: Brazil's average annual growth rate of GDP and exports (%), 1986-2010 20
Table 5: Key economic indicators for Brazil, 1986-2006 20
Table 6: Healthcare expenditure indicators in Brazil, 2004 27
Table 7: Density of healthcare workers and hospital capacity in Brazil, 2000 31
Table 8: Growth of the Brazilian pharmaceutical market by volume (%), 2003-06 39
Table 9: Branded generics dominate the Brazilian pharmaceutical market, 2006 48
Table 10: Brazil - average cost of units sold, 2003-06 49
Table 11: Top 15 Drug manufacturers in Brazil, 2006 51
Table 12: Segmentation of the Brazilian retail pharmaceutical market by ATC group sales value, 2006 52
Table 13: Top 15 brands in Brazil, 2006 54
Table 14: Key demographic indicators for Russia, 2004-2006 71
Table 15: Life expectancy and healthy life expectancy in Russia compared to the seven major markets, 2002 and 2005 72
Table 16: Top causes of mortality in Russia, 2002 73
Table 17: Russia is experiencing a steady growth in GDP, 2001-06 75
Table 18: Disposable income is also growing in Russia, 2002-05 76
Table 19: Healthcare expenditure in Russia, 2004 and 2005 90
Table 20: Hospital and healthcare capacity in Russia, 2003 92
Table 21: Top 20 pharmacy networks in Russia, 2006 116
Table 22: Top 20 drug manufacturers by sales value in the Russian pharmaceutical market, 2005 and 2006 118
Table 23: Top 25 brands by pharmacy sales value on the Russian market, 2006 120
Table 24: Sales structure by ATC group on the retail market, 2006 121
Table 25: Top 15 ATC2 groups by pharmacy sales value in Russia, 2006 123
Table 26: Top 25 manufacturers in the retail segment of the Russian market by value, 2006 124
Table 27: Top 25 manufacturers in the hospital segment in Russia, 2006 126
Table 28: Sales within the hospital segment by ATC group, 2006 127
Table 29: Top 25 products by hospital sales in Russia, 2006 129
Table 30: Sales structure by ATC groups of the DLO market, 2006 131
Table 31: Top 15 ATC1 groups in the DLO segment according to Pharmexpert, 2006 132
Table 32: Top 25 manufacturers within the DLO segment in Russian by value, 2006 134
Table 33: Top 25 brands in the DLO segment in 2006 136
Table 34: Top 10 oncology products in Russia, January-September 2006 138
Table 35: Top 10 manufacturers in the oncology segment in Russia, January-September 2006 139
Table 36: Shares in import value of different groups of drug importers in Russia, 2005 and 2006 141
Table 37: Top 10 representatives of foreign manufacturers by drugs import value, 2006 142
Table 38: Top 25 importers by import value in 2006 143
Table 39: Top 15 ATC2 groups of imported drugs to Russia by value, 2006 144
Table 40: Top 25 drugs imported in Russia by sales value, , 2006 146
Table 41: Top 25 foreign drug manufacturers by sales value of their imported drugs regardless of the import route, 2006 147
Table 42: Top 10 domestic manufacturers in Russia according to Pharmexpert, 2006 158
Table 43: Key demographic indicators for India 169
Table 44: Top 10 causes of mortality in India, 2002 171
Table 45: Key economic indicators for India, 2003-06 173
Table 46: Public healthcare expenditure indicators, 2004 185
Table 47: Traditional and indigenous systems of medicine in India 187
Table 48: Types of medical centers in the Indian public health sector 191
Table 49: Density of healthcare workers in India is extremely low 192
Table 50: Top 25 drug manufacturers in India, 2006 210
Table 51: Market segmentation in India according to ATC groups 211
Table 52: Top 15 brands on the Indian retail market, 2006 214
Table 53: Export of pharmaceuticals from India is growing, 2001-02-2006-07 215
Table 54: Recent R&D deals between Indian and multinational companies 227
Table 55: Key demographic indicators for China, 2005 233
Table 56: Top 10 causes of mortality in China, 2002 234
Table 57: Key economic indicators for China, 2003-06 236
Table 58: Several ministerial-level agencies have varying degrees of health authority in China 242
Table 59: Key Chinese health expenditure indicators, 2004 243
Table 60: Healthcare worker density in China is insufficient 247
Table 61: Categories of drug applications submitted to the SFDA and their data protection periods 252
Table 62: Top 25 pharmaceutical companies in China, 2006 271
Table 63: Anti-infectives were the largest ATC group by revenue in 2006 272
Table 64: Top 25 brands in China, 2006 276
Table 65: Top 25 drug molecules by sales value in China, 2006 277
Table 66: Many multinational companies have engaged in R&D in China 288
Table 67: Basic population facts for Turkey, 2005 296
Table 68: Top causes of death in Turkey in 2002 297
Table 69: Turkey - economic indicators, 2005 299
Table 70: Key health expenditure indicators for Turkey, 2004 305
Table 71: Health worker density in Turkey, 2003 306
Table 72: Maximum wholesaler and pharmacy margins in Turkey are based on a regressive scale 318
Table 73: Consumption of medicines in Turkey (million boxes per year), 2000-06 320
Table 74: Market segmentation in Turkey by ATC group spend, 2006 321
Table 75: Top 20 pharmaceutical brands in Turkey, 2006 324
Table 76: Top 20 drug manufacturers in Turkey by value, 2006 326
Table 77: Exchange rates for national currencies 362
Table 78: Segmentation of the Russian pharmaceutical market in 2005 366
Table 79: Top domestic manufacturers in Russia by sales value in 2006 367
Table 80: Top 20 drug manufacturers by pharmacy sales value in the Russian commercial market in 2005 and 2006 368
Table 81: Top 20 manufacturers on the Russian hospital segment, 2005-06 370
Table 82: Top 20 brands in the hospital segment of the Russian market in 2006 according to Aston Consulting 371
Table 83: TOP 20 drug manufacturers by DLO consumption in 2005 and 2006 373
Table 84: Top 20 brands by pharmacy sales value in the DLO segment in 2005 and 2006 374
Table 85: Top 20 drug manufacturers on the Russian market, 2006 376
Table 86: Top 20 brands on the Russian pharmaceutical market, 2006 377
Table 87: ATC group spend in Russia, 2006 378
Table 88: IMS MIDAS audit (1 of 4) 379
Table 89: IMS MIDAS audit (2 of 4) 380
Table 90: IMS MIDAS audit (3 of 4) 381
Table 91: IMS MIDAS (audit 4 of 4) 382
List of Figures
Figure 1: Key macroeconomic factors and healthcare system characteristics impacting the pharmaceutical market in Brazil 14
Figure 2: Pharmaceutical market dynamics in Brazil: an attractive proposition for foreign companies 15
Figure 3: Retail pharmaceutical market in Brazil, 2002-2006 47
Figure 4: Comparison of market shares of different ATC groups between Brazil and the six major markets 53
Figure 5: Key macroeconomic factors and healthcare system characteristics impacting the pharmaceutical market in Russia 69
Figure 6: Pharmaceutical market dynamics in Russia 70
Figure 7: The Russian healthcare system includes many bodies both at the federation and regional level 84
Figure 8: Mandatory Health Insurance Fund financing in Russia, 2007 86
Figure 9: The DLO reimbursement chain 104
Figure 10: Size and segmentation of the Russian pharmaceutical market ($ billion), 2004-2005 111
Figure 11: Top six distributors in the Russian market, 2005-2006 113
Figure 12: Advantages and disadvantages of carrying out clinical trials in Russia 163
Figure 13: Key macroeconomic factors and healthcare system characteristics influencing the pharmaceutical market in India 167
Figure 14: Pharmaceutical market dynamics in India 168
Figure 15: Maximum retail prices of controlled drugs in India are calculated using a formula 202
Figure 16: The retail pharmaceutical market in India is growing faster than the country's GDP, 2003-06 206
Figure 17: Drug distribution network in India 207
Figure 18: The market share of different ATC groups in India differs substantially from the six major markets 212
Figure 19: Advantages and disadvantages of conducting clinical trials in India 229
Figure 20: Key macroeconomic factors and healthcare system dynamics in China 231
Figure 21: Key pharmaceutical market dynamics in China 232
Figure 22: Protection of pharmaceutical products in China with or without a patent, 2006 253
Figure 23: Key steps for drug approval in China, 2006 257
Figure 24: Drug reimbursement in China 266
Figure 25: The growth rate of the Chinese hospital market is slowing down, 2002-06 267
Figure 26: The growth of the Chinese market is driven largely by growth in value not volume, 2002-06 268
Figure 27: Drug distribution channels in China, 2006 269
Figure 28: The market share of the individual ATC groups differs significantly between China and the six major markets 273
Figure 29: Revenues of all ATC groups are growing but anti-infectives are slowing down 275
Figure 30: Advantages and disadvantages of conducting clinical trials in China 291
Figure 31: Key macroeconomic factors and healthcare system characteristics impacting the pharmaceutical market in Turkey 294
Figure 32: Pharmaceutical markets in Turkey 295
Figure 33: The drug approval process in Turkey is complicated and lengthy 313
Figure 34: Pharmaceutical market size in Turkey, 2002-2006 319
Figure 35: Positioning of different therapy groups on the Turkish market 322
Figure 36: The relative market shares of each ATC group differ substantially between Turkey and the six major markets, 2006 323
Figure 37: The size and segmentation of the pharmaceutical market in Russia, 2005-06 365
Figure 38: Russian pharmaceutical market, 2002-06 366