IQVIA Holdings Inc. (IQV) Earnings Call Transcript & Summary

Hello, and thank you all for attending today's webinar IQVIA Early Bird Pharma Defining Trends in 2024 and What Lies Ahead. My name is Sophie [indiscernible] and I'm leading the Global Market and Sales Marketing here at IQVIA. In our webinar today, Mohit Agarwal will take you through 2024 pharma growth areas and emerging trends, looking into successive story -- success stories and launch benchmarks and analyze how these are going to shape the pharmaceutical market in the coming years with deep dive into the oncology, immunology and obesity markets. Mohit is a consultant in EMEA Thought Leadership at IQVIA, developing high-impact thought leadership content, specializing in analyzing industry trends and delivering data-driven perspectives on launch excellence and biosimilars, helping stakeholders navigate complex market dynamics. Stefan Lutzmayer from the Thought Leadership team will be leading the Q&A session. Before we begin, I wanted to cover a few housekeeping items. At the bottom of your audience console, multiple application widgets you can use. If you have any questions during the webcast, you can click on the Q&A widget and submit your question. We will try to answer this during the webcast. But if we run out of time, it will be answered later via e-mail. Please be assured that we do capture all questions. If you have any technical difficulty, please click on the help widget. It has a question mark icon and covers common technical issues. At the end of today's webinar, a survey will appear. We would really welcome your feedback. So if you could complete this before you leave the webinar, it would be greatly appreciated. And finally, an on-demand version of the webinar will be available afterwards and can be accessed using the same audience link that you send -- was sent earlier to you. And now it's time to start our webinar. Mohit, over to you.

Thank you, Sophie. So setting the context of the webinar today, we'll be starting with the global trends and the growth areas. Then we focus on some therapy areas, particularly oncology, immunology and obesity. Then we'll have a deep dive into the off-patent market. And then we'll summarize and will be open for question answers. Now starting with the global structure of things. So as we deep dive into the global picture, it is important to focus on the key activities that shape the pharmaceutical industry in 2024. This year has been transformative with significant developments across policy, innovation and investment. So let's deep dive into each of these areas to understand the landscape better. 2024 was marked as one of the biggest election year ever, resulting in rightward protectionist shift. This political change is expected to drive forces of divergence within the license sector. Additionally, the United Nations has committed to reducing debt associated with antimicrobial resistance or AMR by 10% by 2030 compared to 2019 levels. This is a crucial step towards global health improvement. The European Union also made headlines by passing the EU AI Act into law, setting a new regulatory framework for artificial intelligence. In the United States, we saw the first negotiated prices under IRA Medicare drug price negotiation program, and that helped as a significant move towards making medications more affordable. From the innovation perspective, 2024 witnessed groundbreaking approval. The U.S. approved first new MOA schizophrenia in decades, the Cobenfy by BMS and the next disease-modifying treatment for Alzheimer's by Lilly. Another milestone was the approval of the first ever treatment for NASH by Madrigal. Moderna's mRESVIA became the first mRNA vaccine outside of COVID to receive approval that was focused on RSV. Additionally, the bispecific antibody, ivonescimab by Akeso and Summit outperformed Keytruda in a non-small cell lung cancer trial, showcasing the potential [indiscernible] therapies. From the investment lens, despite strong fundamentals, major mergers and acquisition deals fail to materialize this year. Factors such as the looming patent claim, high cash burn rates for biotech companies and the need for portfolio renewal remain critical. However, the obesity epidemic drove a significant scramble for manufacturing capacity. Novo Nordisk acquisition of Catalent for $16.5 billion and other global manufacturing investments highlight the industry's response to the growing demand. In summary, 2024 has been a year of significant policy shift, innovative breakthroughs and strategic investments. These developments are shaping the future of the pharmaceutical industry, and we would be exploring them further in this presentation today. Now when we talk about the global scheme of things, it's important to understand the latest market trends. Talking about the latest market trends, when we have a look on the left-hand side of the chart, it is the top 10 pharma companies and their market share from the years 2014, 2019 and 2024. Now the market share for the top 10 companies have been on a rise since the last decade. In 2014, the top 10 companies incorporated 37% of market value, which is now up to 44% in 2024. Interesting to note here is that AbbVie and Johnson & Johnson are the only 2 therapies -- or only 2 cooperations among the top 5 that are among the top 5 players across the board. Moving on to the right side of the graph, we see global therapy areas, the top 3 and their share among the market share. Now when we see, in 2014, the top 3 therapy areas accounted for 21% of the market. But as of now, 2024, it has actually doubled to 42% of the market share. Oncology, immunology and diabetes have been the outperforming therapy areas for quite some time now. Moreover, therapy areas like obesity would soon be contributing a much bigger portion into this global picture. Now let's have a look at the global market in terms of the list price. The market saw strong growth across 2022, 2024, with an average growth rate of 8% to 9%. The exception that we see is in the year 2023, where it grew by 12%. The market is currently based at USD 1.5 trillion, and U.S. constitutes just more than half of the market. Second in the ranking is EU4, plus U.K. This constitutes 15% of the global market. Now talking about where does this growth come from? In terms of the growth drivers for the market, we see that more than half of the growth is attributed to biologics. And even within that category, specialty biologics cover a great portion of them. This part is mainly led by immunology and oncology drugs. But for traditional biologics, anti-obesity drugs were the major contributors. On the right-hand side of the chart, we see innovative biologics for the first time, cover major portion compared to innovative small molecules. And they are now placed at [10%]. Secondly, generics lock 20% of the market and biosimilars covers just 2% of the global market. They grew by 12% last year and that equals to $60 billion in absolute growth. In 2024, the top 3 therapy areas globally accounted for over 70% of innovative biologics. And anti-obesity therapies also made 4% of the growth, but it was a remarkable growth when we compare it year-over-year with a growth of 145%. Now with innovative biologics, constituting the highest market share for the first time, and the launch landscape becoming more competitive than ever before, it's important to understand the launch paradigm. And what strategies can we actually adapt to have a good launch in place. Now we have 3 pillars that we call as the launch pillars of excellence. And these helps us identify the key areas that need to be addressed in terms of having good launch. The first one on the left is health care system readiness. Now fragile health care systems are struggling to keep up with the growing demand of innovation. To address this, pharma companies must optimize care pathways, elevate resource and capacity bottlenecks and increase infrastructure requirements, which are already in place. By doing so, we can support health care systems in managing the influx of new treatments and technologies efficiently. Moving on to the second pillar, that is value and evidence. With squeezed budgets and competing demands, it's vital to develop a multi-stakeholder integrated evidence strategy. This involves combining data from randomized controlled price as well as real-world evidence. And this will help in having a diverse stakeholder need addressed. Moreover, it is something that needs to happen across the product life cycle. Incremental benefits over the standard of care must be highly relevant to patients, payers and even health care systems. And this will ensure that new innovations meet not only the clinical valuability, but even the economic valuability as well. The last pillar that we have here is stakeholder engagement. The landscape of HCP interactions has changed with both reduced and altered engagements. Pharma companies need to reprioritize stakeholders and engage broadly with the diverse stakeholder universe. This requires orchestrated omni-channel engagement led by preferences and increasingly driven by non-promotional medical affairs. By focusing on tailored preference-led interactions, we can rebuild HCP engagement and ensure that every interaction delivers some value. Now when we talk about health system readiness and all of these 3 different pillars that we have in place, it's also important to understand that stakeholder engagement had been suffering for the last few years. Let's have a closer look at the numbers. On this chart, we have a comparison between EU4, plus U.K. countries and U.S. Here, when we focus on the left, we have Germany, France, Italy, and on the right have Spain, U.K. and U.S. Now interesting to note here is, all these countries actually saw a dip in 2020, the pandemic year. However, countries like U.K. and U.S. have finally been able to perform better than the pre-pandemic levels. Whereas all others that still remain below the pre-pandemic level. The interesting point here is that countries like Germany, France and Italy did not actually resort to the live and telephone detailing or the remote channels for engagement once the pandemic came into play. Moreover countries like U.K., U.S. and Spain, which were quick enough to resort to an omnichannel engagement, increasing the use of remote channels as well as using the face-to-face channels comparatively well, they were able to not only increase the -- not only reach the pre-pandemic levels, but also increase the levels of engagements compared to the pre-pandemic horizon. The best method going forward is having an omnichannel approach and realizing the preference for the HCP and then keeping the perfect channel integration for them to have an effective communication. This approach even becomes more important in certain therapy areas, like oncology, which is full of innovation. And therefore, it's important to deep dive and understand what channels or what therapy areas are actually at the top. Now let's have a deep dive into what therapy areas do we have here. Talking about the top holders here, we have oncology, immunology and antidiabetics. These 3 together constitute over 42% of the global market value. Interesting to note that immunology and antidiabetics in U.S. contribute nearly 3/4 of the market, whereas in oncology, it's just half of the market. For Europe, the trend is a bit different. Europe holds nearly half -- more than half of the market in oncology, but they're not doing -- but is not holding a major share in immunology and antidiabetics. Moreover, when we see the growth rate for the last 5 years, we see that oncology, immunology and antidiabetics have been the only therapy areas in the top 10 that have a double-digit growth rate across the board. Interesting to note here again is anti-obesity. The anti-obesity is now ranked 13 and has done 18 places in the last year to make its way to number 13. IQVIA also predicts it could well be the fourth biggest therapy area very soon. Now let's have a deep dive into some of these therapy areas and understand where does the market sit. So we saw that Oncologic is currently the biggest market therapy area. Oncology market is a highly innovative therapy area. It has a lot of new launches coming in. Now seeing the picture for the oncology market on the left-hand side, we have that the market has actually grown by 15% in the last year, which is higher than the global market value and even across the last 5 years, is the highest percentage growth that oncology has seen. We have divided the oncology market into solid tumors and hematology. Solid tumors hold 3/4 of the market, currently at 73%, whereas heme tumors currently are at 27% of the market value in 2024. Then the red line here demonstrates the growth rate for the heme market, whereas the yellow line demonstrates the growth rates for the solid market. We see that the heme market actually saw a dip in 2023, and has actually gone back to high values in 2024. This 6% dip was due to generic market entry, particularly Revlimid and lenalidomide. And the growth has been back due to indication expansion of certain oncology drugs. On the right, we see the reasonable breakdowns. The left bar shows the market share by region and the right shows the absolute growth contribution last year. U.S. and EU 4, plus U.K. have a higher contribution. Generally, the growth is similar to the market share. U.S. continues to the fastest-growing market, followed by EU 4, plus U.K. in the last year. LatAm and Canada is growing faster than APAC now. Interestingly, if we separate out solid and heme tumors, we find U.S. accounts were higher proportion in heme, whereas in EU4 plus U.K., it is solid tumors that are doing a much better job. Now even better to understand the dynamics by indication. In this bubble chart here, we have the solid tumors represented in light blue and the heme tumors represented in dark blue. The y-axis demonstrates the 5-year future growth rate and the x-axis demonstrates the historical 5-year growth rates. The bubble size presentation of the market value for that particular cancer. Any indications above the diagonal line represents an acceleration going forward, whereas any of the indications below the diagonal line represents the acceleration going forward. Now the top 3 solid tumors are breast cancer, prostate and an NSCLC or non-small cell lung cancer. For all 3, we expect growth to accelerate, and this is significant. Because of the high value of that these cancers already hold, combined with the high acceleration that we see in there, these are well on course to become half of the absolute growth over the next few years. Moving on to the heme tumors, we see multiple myeloma, leukemia and NHL in there. Multiple myeloma is -- growth is expected to decelerate, whereas leukemia, the growth is expected to stay the same. Whereas for NHL, the growth is expected to accelerate even more. There are some outliers that we should call about here around the liver cancer and the small cell lung cancer. These have had high historic growth rates and continue to grow with high growth rates as well. And this is majorly led by 2 checkpoint inhibitors. They would continue driving the growth forward. On the right-hand side in the table, if we see the shares for the breast and the NSCLC market, they together constitute more than nearly 30% of the market value at 2024 globally. Now checkpoint inhibitors and other innovative biologics have been rising in value. And as a result, for the first time, biologics have gone above the value of small molecules despite representing only a small share of the Rx volume. We see on the left-hand side, the global oncology sales split by biologics and small molecules. If we see the year-round trends since 2019, we see that for the first time, biologics are now -- have a greater share than compared to small molecules. On the right-hand side, the left bar shows the market share where we named these biologics constitute -- innovative biologics constituting 47% of the market and 41% of the market is captured by innovative small molecules. In terms of the absolute growth last year, 53% growth came from innovative biologics alone, followed by innovative small molecules that were at 40%. Checkpoint inhibitors in innovative biologics contributed to 54% growth in the last year. Now another interesting therapy area to note is immunology. Talking about immunology, it is one of the top 3 therapy areas. And here on the left-hand side, we have the sales for the last 5 years distributed into 2 halves, that is allergic inflammation and autoimmune. Autoimmune represents rheumatoid arthritis, psoriasis, Crohn's disease and ulcerative colitis. Whereas under allergic inflammation, we have indications like atopic dermatitis and allergic asthma. Within autoimmune, rheumatoid arthritis and psoriasis, each hold about 25% of the market value. The green line here represents the autoimmune growth rate, whereas the yellow line represents the allergic inflammation growth rates. We see that the allergic information growth rate is faster than the autoimmune. And this is primarily due to the immature market that they currently have in place at only 16% of the total market currently. Then we have a look at the regional breakdown for these. We see that 75% of the sales in immunology comes from U.S., followed by plus U.K., which constitutes 12% of the market. Moreover, over the last year, U.S. was responsible for 70% of the growth in this area. Now being a high-value therapy area, there is also a lot of effort that goes into the spending part of things and the promotional part of things for immunology. On the right, we focus on the immunology spending by different companies, and we focus on dermatologists, rheumatologists, gastroenterologists and also direct to consumers as well. Now if we see the graph on the right, we see that there was a flattening of spending between late 2019 and 2022, and that was majorly due to pandemic. In the last 2 years, there has been recovery with respect to spending in immunology. Moreover, the spending in 2024 is now 66% above the pre-pandemic level. Here, we can see that the top 10 actually dominate the market and constitute to nearly 90% of the immunology spend. Moreover, AbbVie constitutes 37% of the market and is a leader here. Now let's deep dive into an indication within immunology, that is psoriasis. Now for psoriasis, it holds around 25% of the market, as we talked about, and has shown and is expected to grow at 5% to 2029, amounting to $51 billion. Now one -- it is one of the main markets in immunology and is already at a mature level. It's interesting to note that certain MOAs like -- targets like IL-23 and IL-17 continue to lead the market forward as well. IL-23 constituted 40% of the market in 2024, followed by IL-27, IL-17 that at 24% of the market. Anti-TNF, though continues to decline a bit and its share is expected to move from 14% to 10% over the next 5 years. On the right-hand side, we can also see the drug-treated patients for global psoriasis. We see that the patient pool is again growing at 5% to reach 2.2 million in 2029. There would be some changes that would come into place in the market with respect to different biosimilars coming to market like the Stelara biosimilar that was launched in Europe in 2024. And in U.S., the biosimilar is expected to be in the first half of this year. Moreover, there have been oral competition in the market as well, and Bimzelx also entered the U.S. market in late 2023. So more patient-related analytics, we are also having a webinar using the MIDAS patient sometime in June. So watch out for that as well. Now moving to another interesting therapy area that has had a lot of talks around is obesity. The reason for why obesity has become such a critical focus area lies in the fact that the rise in obesity rates have been striking. In 2020, 16% of the global population was obese and this number is projected to increase to 25% by 2035, affecting almost 2 billion people. According to a recent study published in the Lancet, more than 50% of adults will be overweight or obese by 2050. The economic impact is quite alarming as well. Currently, it caused the global economy nearly USD 2 trillion annually. This figure is expected to double, reaching USD 4.32 trillion by 2035. These costs include both the health care expenses associated with treating obesity and its related conditions as well. And they also have a broader economic impact of high BMI on productivity. Now the high BMI remain absenteeism, presentism and premature retirement or death as well. Understanding these tactics underscores the urgent need to focus on obesity as a therapy area. Addressing obesity not only improves individual health outcomes, but also will have a significant economic benefit by reducing health care costs and improving productivity as a whole. On this slide, we have a look at the current pipeline for obesity agents. Obesity is currently at an inflection point. Now with the GLP-1s, because it is the first time that the drugs reached meaningful weight loss, but this is only the start, and there are many new agents coming into play. And if we see the levels of bariatric surgery, that was generally 20% to 30%, for the first and we see that certain drugs are also aiming to reach that level as well. Next wave of innovations go beyond GLP-1s with new mechanism of action and also oral formulation. This is a rapidly developing space, and there are some notable even lined up for 2025 as well. When we see the pipeline for antiobesity medications, we see that 55% of the agents in pipeline are subcutaneous, whereas 43% are oral as well. Now when we talk about the key events that are lined up for 2025, we see that Lilly's tirzepatide has shown promising cardiovascular outcomes as well, reducing the risk of worsening heart attacks by 38% in adults. This data highlights a shift from these medications solely focused on the weight loss, but to a better overall profile as well. Then we talk about Novo Nordisk semaglutide that is known for its weight loss benefits. It has now also being studied for its potential to reduce the risk of Alzheimer's disease. Early studies also indicate that there is a significant reduction in dementia showing the drug's broader neuro productive effect as well. Survodutide that was a product of BI and Zealand, they have even -- they are the first competitor to hit the market outside of Novo and Lilly in 2026. They have shown promising results in Phase III trials for obesity as well as related conditions. Lilly's Orforglipron which is the first oral antiobesity medication is set to hit the market and approval in 2026. The Lancet has introduced a new framework for diagnosing obesity, splitting it into clinical and preclinical categories. This approach aims to provide a more accurate diagnosis based on body fat measures and health impacts, addressing limitations that were previously present due to using just a traditional BMI-based definitions. Now as we aim to conclude this section, let's look at the key factors that are to watch out until the year 2028. The obesity market is currently in its early stages, but it's forecasted to grow at an extraordinary rate between now and 2028. It is well onset to become one of the largest therapy areas as well. The pipeline is actually crowded with many companies, mechanism of actions and new formulations as well. As a result, this market will be fast moving, increasingly complex and highly competitive at the same time. Successful product launches in this market would rely heavily on stakeholder engagement. This includes all stakeholders from prescribers, to health systems, to payers and then to patients as well. It's crucial to understand that each stakeholders' ability to keep up with the pace of change in this market and then cater to that diverse needs at all stages of the product life cycle. Effective engagement ensures that all stakeholders are aligned and supportive of the new treatments that are introduced. Now evidence is key to both understanding as well as shaping the market. The future obesity market will be highly segmented in terms of patients. The future obesity market has to be based on gathering evidence that differentiates your product from competitors, and also would involve effectively communicating this evidence to stakeholders. This includes demonstrating the clinical and economic value of new treatments to ensure broad acceptance and adoption as well. Therefore, the obesity market is poised for significant growth and transformation, but by focusing on market developments, stakeholder engagement and robust evidence generation, we can navigate this dynamic landscape and achieve success in this as well. Now when we talk about the future of pharmaceutical of patent and introduction of generics and biosimilars are often key players in deciding the future for both pharmaceutical companies as well as therapy areas. So now let's have a deep dive into the biosimilars uptake for some of the major molecules. On the left-hand side, we see the adoption of biosimilars in Europe, and on the right-hand side, we see the adoption of biosimilars in the United States. Now these have been indexed to quarter 0 of launch, and we also have the launch dates for each of these under the different categories. We see that lately, the uptake for these biosimilars have been steep and quick. For example, when we see the uptake of bevacizumab in Europe. Moreover, we see that an average 30% is the rate of uptake for biosimilars at first year. And after 2 years, it is at 50% to 60%. The latest entrant in this chart on the right is adalimumab that was launched in the February 2023. It started with a quite shaky start in the U.S., but now is slowly taking hold of the market. It's also important to notice the difference between the update with respect to both Europe and United States as well. Now we also focus on some of the new entrants in the market. These entrants have been in the market for less than a year. And here, we try to understand how has the uptake been in terms of the treatment days and with respect to the month of launch. There, again, we indexed to the month 0 their biosimilar launch in the respective area. Here, we have the comparisons for EU4 plus U.K. and U.S. as well. We see that [ustekinumab] U.K. actually leads the biosimilar uptake, which is in line with the high affinity that we have towards biosimilars for U.K. The biosimilar for [ustekinumab] is still to launch in countries like France and U.S. Moving on to [ranibizumab]. Again, we say U.K. and Italy during the highest uptake rates in terms of treatment days. U.S. has had a launch in terms of [ranibizumab] biosimilar last year, and is actually averaging around 25%. For [natalizumab], we see that the uptake of the biosimilars have been competitively low and is still yet to launch in U.S. Tocilizumab has had pretty low uptake in terms of the different countries at averaging at around 20%. And in U.S., it has been even low with around 6% of the uptake in the market. But ustekinumab has been in the market for less than a year now. And if we see again here, you get actually the leader in terms of having the most adoption in terms of the biosimilars. Now let's have a look at the top generic small molecule therapy areas. These are not just the generic market, but this is generally small molecule therapy areas that we have in here. Now these are the top 10 therapy areas that we have within this category. Pain and antibacterials continue to be the leaders in this. But if we see on the right-hand side, we see that that's coming off a very slow growth rate, which can be attributed to different factors. In pain, there has been concern around the growing use of opioids. Whereas in antibacterials, there have been a lot of more conversations around increasing use of antibacterials and thus also antimicrobial resistance coming into play, which is something as related with the high developed nations. Interesting to note here is of the total global therapy areas that we saw earlier at a global level, we saw that oncologics is the only one among the top 10. Diabetes is currently ranked at #12 and Immunology is ranked at #41. Now Oncology is the first specialty therapy area that is driving growth in this. And even if we see the CAGR for the last 5 years, we see it is the only therapy area that has double-digit growth. The total generic small molecule therapeutic market is currently at $304 billion, which is roughly 20% of the total Rx market. Now similar to the biosimilar uptake, we also have a look at the generic uptake as well. Here we start -- on the left, we have U.S. And when we talk about U.S., it has the highest utilization of generics, which is in line with some of the developing nations like India and Brazil as well. Most of the countries on board see a positive 5-year change, except combined Europe and Mexico. These have a 2-year negative and a 3-year negative -- 3% negative growth rate, respectively. Across EU4 plus U.K., all of the countries have different levels of generic utilization. U.K. and Germany continue to lead the generic utilization among these 5 countries. These countries have a more stringent push down on the prices, and thus there is a high generic uptake in these countries. In countries like Spain and Italy, they have a more focused system on the branded medicines, and this will attribute to the fact that they have low generic utilization here. It is also interesting to note that countries like China, which have a lot more innovative locally manufactured generics are also high in generic utilization at 86% currently. I'm not trying to summarize what challenges do we had at plate and what other opportunities wherein we can actually utilize them, and use the challenges that we have to make the best move forward. In terms of challenges, the health care system capacity is changing. As we discussed in the earlier slide, we saw that there have been wasted and misaligned resources and delay interventions as well. The fragile health system needs innovative approaches and consumerism needs a traditional health care provision in place. In terms of opportunities, we can see that with the AI and digital tech coming into place, they can actually boost health care efficiency. Moreover, there is opportunity for better public and private collaboration, and that is actually the key to innovation. The second challenge that we have is the rise of chronic or high-prevalence disease of aging. Cardio metabolic diseases is a mere cause of illness and death. And along with that, obesity that we discussed earlier, has a 25% global population impact within a decade. These new indications that are coming in for obesity continue to show promise, but there have been concerns from the cost of the drugs. Now opportunities here lies in optimizing the outcomes on obesity spend, and that will be critical for the market going forward. There also needs to be focused on preventive care in primary care settings as well. The last point that we have here is around globalization versus deglobalization. Now when we talk about the global market, we see that the global market is actually disintegrating with tariffs and tariff trade wars coming in place, these may actually disrupt the global market going forward. It is also interesting to note that the withdrawal of U.S. from international institutions and the defunding of Global Public Health is another major concern. The opportunities here lies in boosting resilience by stockpiling and moreover, having a strategic imperative to enhance more of the manufacturing localization and the capacity improvement as well. The risk going forward would be the political instability that we are currently seeing going to the year after elections, the deglobalization that will be [indiscernible] upon, the economic stress with a high need of innovative medicines coming into place and the high cost of medications that we have at hand. Moreover, there is a failure of health system transformation that -- there is a need for health system to transform, but we do not see that transformation happening rapidly. To end the proceedings, we have some links and articles for you people to have a look through. These can be attributed to obesity, commercial environment, health system, patient insights, global health and immunology as well. Within obesity, we have a certain number of blogs that were recently published, and we also have an obesity webinar coming up on the 26th of March, the link to register to which should be in the Resources section below. Within commercial environment, we do have an understanding on a blog to which you can understand the changing channel preference for HCPs and how can we actually cater a better outcome towards those engagements. We also have an outlook from a merger and acquisition perspective blog. And from the health system patient insights, we have a blog in clinical trials, the patient insights on obesity and the unmet need in oncology as well. From Global Health, we have data around antimicrobial resistance and the actions regarding that. And then also obesity in lower middle income countries as well. For immunology, we also have a blog around the rise of novel topicals in immunodermatology. Now we will be open to questions. Over to Stefan.

Thank you, Mohit, for giving us this really comprehensive overview of what has happened in the pharmaceutical market last year. I've seen that there are already a lot of questions that have been coming in, but I will encourage people to please continue using the Q&A widget at the bottom of your screen, and please continue submitting questions, even if we do not manage to get to your question today, we will follow up, of course, later on via email. But let's maybe start with one of the questions. There's been a lot of questions on the topic around HCP engagement. So maybe Mohit, why do some of the countries continue to have a lower HCP engagement time compared to others, and what are the driving factors around this?

Sure. So as we saw earlier that HCP engagement is something that actually saw a decline post pandemic and only some countries have been able to cope up with that and have now better HCP engagements or more number of engagements compared to the pre-pandemic paradigm. Now HCP engagement is actually dependent on a lot of factors like geography, specialty, age and then gender has well. An effective strategy would be to utilize all of available information about HCP when determining the optimal engagement strategy. And then these need to be orchestrated in a way that the individual is happy with. So there needs to be a buildup in terms of the preference of the HCP as well as what the HCP is getting interacted with. We also recently published a blog that is focused on understanding the HCP channel preference to build a better engagement. And based on these varying factors, a personalized engagement strategy would actually help better engage the HCPs. But it's important to understand that the HCP role would defer in terms of the variance. Specialties, geographies, age and the gender as well.

Thank you, Mohit. And a related question on HCP interaction, there's a question on whether we can break down HCP interaction by therapeutic areas?

Yes, we certainly can do that with the help of certain IQVIA databases. And according to the recent studies that we did, we find that certain therapy areas like oncology, actually saw much more difference in terms of the pre-pandemic versus a post-pandemic HCP engagements compared to some other specialties as well.

Makes sense. And then maybe last one, and then we move on to another area on engagement. Can you maybe explain sort of what are the differences? Some countries like the U.S. seem to have -- doctors seem to have more time compared to other countries. Do you have any insights on what is driving the differences from U.S. compared to Europe and then maybe across European countries, what are the drivers or different that we see there in digital versus face-to-face interactions?

Sure thing. I'll just move back to the slide that we have on this, and that would be best place to answer this question. Yes. So when we see the HCP interactive engagement contact time, we see that even in 2020, Countries like U.S. already had an existing life and telephone detailing channels in place along with the face-to-face digital channels -- detailing channels. Whereas when we talk about a country like Germany, to start with, in the year 2020, it was majorly focused on the face-to-face detailings and had very little to no telephone and live detailing. Once the pandemic hit into play, it became instrumental for companies for HCPs to actually have a communication with all the barriers that were in place. Now the companies that -- or the countries that already had these remote channels in place were quick enough to utilize them and expand on them. And moving forward, now we also see in countries like U.S. that the shift that they saw in the pandemic year with using live and telephone detailing, they do not take that away. But now there is a totally new mix that we see, with a mix that is more inclined towards face-to-face, but also has a competitive higher share of live detailing and telephone detailing as well. So it is highly dependent on what the HCPs within a particular geography require and then catering to the best needs with that particular interactions in place.

That makes sense. Thanks, Mohit. So let's move on to another topic. There was a question around the topic of launch. Can you maybe elaborate a bit more on the challenges of launches, how they've been doing? And whether that's uniformly applicable across geography, where the differences in performance of launches across regions -- countries?

Sure thing. So when we talk about the year that the pandemic hit, that is 2020, we saw that all countries were underperforming at different time rates. And even the effect of pandemic was different for different countries. But as the time progressed, we saw that different countries responded in a different way to the launches. The gap or the difference between the countries in terms of the launches widened, with countries like U.S. doing much better compared to pre-pandemic, whereas countries like France and Italy continue to underperform. And this is actually in line with what we saw with the HCPs engagements earlier as well. Better engagements did lead to better launch strategies and hence better launches as well.

Thanks, Mohit. And there seems to be a lot of people have greetings to the Middle East that they're asking on specific -- data specifically for the Middle East. So what's the status of data -- from IQVIA data for the Middle East, Mohit?

Yes. So across different databases that we have been using in this presentation starting with MIDAS and then IQVIA channel dynamics, all of these do have data at Middle East countries level as well, and they can surely reach out to some of the IQVIA folks, and we could get back with them for more regional specific answers as well.

Thanks you. And there are also a couple of questions on the topic of off-patent, specifically on biosimilars. Can you maybe I would just try to paraphrase and summarize two questions here. Can you comment on the differences in uptake of biosimilars in U.S. versus Europe? And why is that the uptake in Europe better or higher compared to the United States?

Sure thing. So when we talk about the biosimilar uptake in U.S. and Europe, it's important to understand that the market is quite different. In Europe, we talk about a large number of countries within which some countries are more open to biosimilars, whereas some are not. When we talk about certain drugs like adalimumab, it had actually quite a good uptake in Europe. But in U.S., the uptake is still not up to the mark or with 5 or 6 quarters since its launch, it has actually not even at the average that we see for most of the biosimilars in the market. And this is highly attributed to the fact that U.S. market is very different in terms of how do they approach innovative medicines. And with IRA also coming into play, the price and the competition changing drastically as compared to Europe, in which some countries like the U.K. are highly open to the generics and the biosimilars as well.

Okay. makes sense. And any differences among the substances that it could drive uptake?

I think with respect to the different substances, that would be focused upon the adoption rates in those countries and also the demand within those countries. So I think for that, having a look at maybe the patient level data or even having a comparison at the originator level molecule can also help to draw some insights from there as well.

Yes. Good. And also a couple of questions that just came in around the topic and a topic that would further explored in the webinar that Mohit mentioned on the 26th of March, but that's a question on reimbursement of anti-obesity drug. We saw them rapidly climbing the ranks obesity as a therapeutic carrier even the active reimbursement rate is actually low. Can you give a perspective on sort of the road towards reimbursement of obesity drugs in the near future?

Yes. So anti-obesity drugs have been the talk of the town, and we do have a webinar, as Stefan mentioned on the 26th. Now reimbursement for anti-obesity medications in Europe specifically, that is something that varies by country. Some countries like Norway, Netherlands, Poland and Italy have actually started perhaps reimbursement policies in place for these medications. Even the NHS in England offers some access to a GLP-1 receptor antagonist. I think it was Saxenda. Then in contrast, when we talk about the central and the European countries, they generally yet do not reimburse the obesity drugs for obesity treatment. And that, I think the landscape is evolving with recent health technology assessments in France and Germany taking place. So they are actually recommending reimbursement of these medications, but there have been no updates with reimbursements happening in these countries yet.

Thank you, Mohit. Maybe let's take another one on the class of obesity, major classes being the GLP-1 agonists. And there are a couple of questions that are going towards the same direction. What -- do you think there will be an impact on the role of GLP-1 in the wider class of antidiabetics and beyond? Will there be an impact on the uptake of these medicines with the increasing usage of GLP-1s in obesity?

Yes. I think as we discussed earlier, these GLP-1 medications currently are the only medications that are available. But with new regimens coming into place and additional clinical trials that are happening for these medications, we see that most of these drugs are actually being also assessed for additional indications as well, like for the [indiscernible] for Alzheimer's as we saw. So once we have more clinical data on these drugs and the correlation between these drugs not only points towards a better obesity improvement, but an overall health perspective that is something that would actually push forward the GLP-1s as well.

Yes, that makes sense. And probably links back to the question around reimbursement because health systems will reimburse these additional benefits, not weight loss alone.

Yes.

Let's leave the although exciting space of obesity and have another question, maybe more on the overall sales value. You had a chart in the beginning, essentially showing that the market is getting more concentrated. But we know that biopharma, smaller biotechs are doing a lot of the innovation work. So do we see a higher share of the smaller biotechs in the overall value share across the globe?

I think for smaller biopharmas, there have been a lot of development lately in terms of the different molecules that they're trying to bring into the market. But there also have been collaborations between these pharmas and the global leaders as well. So for instance, certain times, these drugs are actually being developed by small biopharmas. But since the -- when they come to the market, it is actually being led by most of the leaders in the market currently. So we have in the future, we can see global pharmas or the local pharmas doing well. But again, these global pharmas already have a global presence. And thus, they continue to provide a major share of the market.

Thank you, Mohit. Given that we are almost close to the hour, I think we can call it and close the Q&A session now. And for those questions that we did not get to, to answer you in the live session, we will make sure to get back to you via e-mail. And for the closing, I will hand back to Sophie.

Thank you, Stefan, and thank you, Mohit, for this really valuable insights. It was a great session. And thank you all for attending today's session and for submitting your questions because we've had a lot, a lot of questions. So great to see such engagement across the whole session. So as Stefan mentioned, if we didn't get to yours, we'll make sure to follow up with you via e-mail. So before you leave, it would be greatly appreciated. Again, if you could fill in the survey. And this way, you can also indicate if you want to receive the slides then that's where you can ask for it. So please, please do so before leaving. And also, if you want to discuss any of these topics that were raised during the session, if you have any specific questions as well, you can mention them in the survey. So thanks a lot for your attendance, and I wish you all a good rest of your day.