Global Use of Medicines 2023 OUTLOOK TO 2027 JANUARY 2023

Introduction ©2023 IQVIA and its affiliates. All reproduction rights, quotations, broadcasting, publications reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without express written consent of IQVIA and the IQVIA Institute. Reaching a post-pandemic era is an alluring prospect for almost everyone around the world after the disruptions of the past three years. The outlook for global spending on medicines has become clearer as the traumas recede and uncertainties give way to more predictable challenges. Policymakers across developed and emerging economies are shifting from crisis to rebuilding modes with a focus on longer-term issues of sustainability. Complex trade-offs remain, and improved efficiency and quality of healthcare informed by evidence-based decision-making will inform the critical decisions in the coming decade. The largest driver of medicine spending through the next five years is still expected to be global COVID-19 vaccinations, but leaving aside the pandemic, global spending on medicines continues to be driven by innovation and offset by losses of exclusivity and the lower costs of generics and biosimilars. In this report, we quantify the impact of these dynamics and examine the spending and usage of medicines in 2022 and the outlook to 2027, globally and for specific therapy areas and countries. We intend for this report to provide a foundation for meaningful discussion about the value, cost, and role of medicines over the next five years in the context of overall healthcare spending. The study was produced independently by the IQVIA Institute for Human Data Science as a public service, without industry or government funding. The contributions to this report by Mohit Agarwal, Aurelio Arias, Urvashi Porwal, Jamie Pritchett, Sarah Rickwood, Priya Srivastava, Durgesh Soni, Alan Thomas, and dozens of others at IQVIA are gratefully acknowledged. Find Out More If you wish to receive future reports from the IQVIA Institute for Human Data Science or join our mailing list, visit iqviainstitute.org MURRAY AITKEN Executive Director IQVIA Institute for Human Data Science The Global Use of Medicines 2023: Outlook to 2027

Table of Contents Overview 2 Impact of COVID-19 on the use of medicines 4 Outlook for the use of medicines and historic drivers 13 Spending and growth by regions and key countries 19 Key therapy areas 37 Notes on sources 50 Definitions and methodology 51 About the authors 53 About the Institute 55 Table of Contents

As the COVID-19 pandemic enters its fourth year, it has been the most impactful global public health crisis in decades, and yet it has illustrated the resilience of global health systems as they have readily adapted to peaks in demand and developed novel vaccines and therapeutics with significant efficacy, safety, and unusual speed. The global vaccination program that countries and industry have implemented is unprecedented in its speed and reach to lower-income countries previously thought to be inaccessible. While challenges remain in managing the pandemic into an endemic phase, other health concerns are also coming back into focus. Overall, global use and spending on medicines is expected to return to pre-pandemic growth rates by 2024, though the next two years are not without important uncertainties related to viral variants, vaccination rollout for COVID-19, and under-usage of booster shots, as well as economic uncertainties related to global inflation, geopolitical conflicts, and climate change. IMPACT OF COVID-19 ON THE USE OF MEDICINES Global spending on medicines from 2020 to 2027 is expected to exceed the pre-pandemic outlook by $497Bn in aggregate, largely due to new spending on COVID-19 vaccines and novel therapeutics, as well as the impact on other therapeutic areas. Global market growth will return to pre-pandemic projected rates by 2024 despite year-toyear fluctuations and geographical variations. All regions around the world have exceeded previously projected first wave COVID-19 vaccination rates, resulting in 530 million more vaccinated people by the end of 2023 than initially modeled. The largest areas of over-achievement in this area have been in uppermiddle and lower-middle-income countries as defined by the World Bank, with 4.4 billion people vaccinated, 490 million more than earlier estimates. Immunity achieved from COVID-19 infection or vaccines appears to wane after a year, and annual boosters are being recommended, including new versions for emerging viral variants; adoption, however, generally includes less than half of the population who had received the first-wave shots and is lagging in lower-income countries. Ongoing booster usage will likely increase, especially if there are impactful surges with new variants, and these patterns characterize the expected nature of the endemic phase. COVID-19 therapeutics will continue to be widely used and will result in a cumulative spend over eight years of $120Bn through 2027. Other medicine use was disrupted during the pandemic across a range of therapy areas, some related to the symptom profile of the pandemic, others related to disrupted management of chronic diseases. Sustained complications of COVID-19 infection across almost all organ systems, known as ‘long-COVID’, is now better understood, with 10–20% of infected patients suffering with persistent symptoms requiring ongoing demand for treatments, often with older generic drugs. OUTLOOK FOR THE USE OF MEDICINES AND HISTORIC DRIVERS The use of medicines globally plateaued in 2022 following a significant rebound in 2021 as markets recovered from the pandemic. Overall volume is projected to grow 1.6% CAGR in days of therapy through 2027, driven by Asia-Pacific, India, Latin America, Africa and the Middle East, and China, all of which are expected to exceed global volume growth. Higher income countries in Western Europe and North America as well as Japan and Eastern Europe are expected to grow more slowly at 0.1 to 0.4% through 2027, partly due to their already higher per capita use. Eastern Europe volume growth is also hampered by disruptions from the ongoing Ukraine conflict. Per capita use of medicines varies by GDP, with use in higher-income countries typically higher than in lowerincome countries. Countries such as Japan and those in Western Europe have more than double the use of most other regions measured in WHO defined daily doses. Countries vary considerably in the therapy areas which drive most of their volume use of medicines, linked to the burden of disease they experience as well as factors which influence the structure and functioning of health systems. While overall volume has increased by 2% CAGR over the past decade, oncology has increased at 15% per year, driven by the significant advances in novel treatments and improved access to cancer care around the world. 2 | The Global Use of Medicines 2023: Outlook to 2027 Overview

iqviainstitute.org | 3 SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES The global medicine market — using invoice price levels — is expected to grow at 3–6% CAGR through 2027, reaching about $1.9Tn in total market size. Spending and volume growth will follow diverging trends by region with larger established markets growing more slowly, and growth markets in Eastern Europe, Asia and Latin America growing in both volume and spending. The U.S. market, on a net price basis, is forecast to grow -1 to 2% CAGR over the next five years, down from 4% CAGR for the past five years. Prior editions estimated 0–3% CAGR on a net basis. The new forecast, including projected effects of the Inflation Reduction Act, reflects an outlook that has a 1% lower range. Provisions of the new legislation are expected to drive incremental volume by reducing cost exposure for patients and by driving lower prices through inflation penalties and price negotiations. Other aspects of the law will impact the interactions of stakeholders and the responsibility for cost shifts between government, payers, and pharmaceutical manufacturers, especially in the Medicare program. Spending in Europe is expected to increase by $59Bn through 2027, with a focus on generics and biosimilars, and escalating pressures on the value and negotiated prices of novel medicines. The pandemic’s impact on Asia-Pacific countries varies considerably, but a return to steady growth is projected after 2021. Japan medicine spending growth is projected at -1 to 2% through 2027 as robust brand growth is offset by a shift in annual price cuts and ongoing moves to generics. Spending growth in China is expected to slow, with positives driven by greater uptake and use of new original medicines and offset by pressures on off patent and generic pricing. Growth in developed economies continues at relatively steady rates, with new products offset by patent expiries. Latin America, Eastern Europe and parts of Asia are expected to grow strongly from volume and adoption of novel medicines. KEY THERAPY AREAS The key growth area for medicines in the next five years is biotech, which will represent 35% of global spending and will include many of the areas of greatest activity for novel medicines. In addition, global savings from biosimilars will exceed $290Bn in cumulative spending through 2027, which is below estimates without new biosimilars, representing a significant mechanism to generate wider usage of these medicines as well as ease payer budget pressures on overall spending. Specialty medicines will represent 43% of global spending in 2027 and more than 55% of total spending in developed markets, continuing the shift from more traditional medicines underway for over a decade. The two leading global therapy areas — oncology and immunology — are forecast to grow 13–16% and 3–6% CAGR, respectively, through 2027, reflecting diverging trends with one still driven by novel medicines and the other facing biosimilar competition. Oncology is projected to add 100 new treatments over five years, contributing to an increase in spending of $184Bn to a total of more than $370Bn in 2027 and facing limiting new losses of exclusivity. Treatments for auto-immune disorders are forecast to reach $177Bn globally by 2027, driven by steadily increasing numbers of treated patients and new products, and offset after 2023 due to biosimilars. Diabetes spending growth is slowing to low single digits in most developed markets and declining in some, especially net of rebates. New therapies contribute to growth of neurology markets, including greater use of novel migraine therapies, potential treatments for rare diseases, and the potential for therapies for Alzheimer’s and Parkinson’s. The outlook for next generation biotherapeutics includes significantly uncertain clinical and commercial prospects for cell, gene, and RNA therapies, which will grow from current $8Bn spending in 2022 to $27Bn by 2027.

4 | The Global Use of Medicines 2023: Outlook to 2027 • Global spending, including COVID-19 vaccines and therapeutics, is expected to exceed pre-pandemic outlook by $497Bn to 2027. • Global market growth will return to pre-pandemic projected growth rates by 2024 despite year-to-year fluctuations. • All regions around the world have exceeded previously projected first wave vaccination rates while booster utilization is lagging. • Global spending on COVID-19 vaccines is expected to exceed previous estimates, primarily from higher volume. • Medicine use in pharmerging countries has varied greatly since early 2020 and has been more stable in developed countries. • Medicine use was disrupted in some therapies throughout the pandemic, with most countries returning to pre-pandemic levels. • Research has been able to identify sustained complications of COVID-19 infection across almost all organ systems and the degree of impact is becoming clearer. Impact of COVID-19 on the use of medicines The COVID-19 pandemic has transitioned to a new phase with vaccines and therapeutics available but inconsistently used and resulting periodic emergence of infection and hospitalization surges leaving significant uncertainty in the years ahead.

Spending outlook change due to COVID-19: $497Bn, 2020–2027 COVID-19 vaccine spending: $380Bn ($315–$42Bn) COVID-19 therapeutics: $120Bn ($105–135Bn) COVID-19 disruption impact: -$4Bn 2020–2027 -19 -75 -62 -87 -106 -99 -76 -43 -4 104 158 211 256 297 338 380 3 -19 -72 57 124 181 247 323 407 497 0 16 53 76 91 103 112 120

10.6% higher growth including vaccines and therapeutics compared to spending without them 4 2022: Significant decline in required spending for COVID-19 vaccines as much of the world is inoculated to some degree 5 Expected budget pressures will emerge from longer-term pressures of sustained pandemic Key events in the outlook 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% -2% 2019 2020 2021 2022 2023 2024 2025 2026 2027 Constant dollar growth forecast (invoice) 1 5 3 4 Post-pandemic volume rebound Incremental COVID-related usage for treatments and vaccines Post-pandemic economic/budget pressures Vaccine spending declines with shift to boosters 2 Demand impact during pandemic

250Mn) Dec-20 Feb-21 Apr-21 Jun-21 Aug-21 Oct-21 Dec-21 Feb-22 Apr-22 Jun-22 Aug-22 Oct-22 Dec-22 Feb-23 Apr-23 Jun-23 Aug-23 Oct-23 Dec-23

8 | The Global Use of Medicines 2023: Outlook to 2027 • Global COVID-19 spending is expected to exceed $50Bn in 2022 and $380Bn in total over seven years to 2027, higher than earlier projections of $251Bn through 2026. • Previous modeling phased the initial vaccination wave more slowly and included half-sized booster shots every other year; the revised assumptions include expected faster achievement of initial vaccination rates in higher-income countries, slower in lower-income countries, and more frequent boosters of the same size as initial shots. • Cost per dose assumptions in the current model reflect a slight upward trend in cost per dose in later years as manufacturers pressure for higher prices, and preference for higher-cost mRNA vaccines impacts average costs. • In this model, vaccinations to-date and segmentation of initial and booster types have been considered to create a base case estimate for the number of people who will be vaccinated in an initial wave and then receive booster shots later. • The number of doses consumed per patient is expected to continue to increase as immunity appears to wane over time and annual boosters, potentially including protection from multiple variants, will be necessary, but will be used by a smaller proportion of patients than in the first wave. Exhibit 4: COVID-19 vaccination spending and volume forecasts Notes: Scenario modeling was conducted by the IQVIA institute based on public information as of October 2022. Estimates of future vaccination trends include input from the public statements of responsible agencies and manufacturers, as well as modeling by the IQVIA Institute. Estimates of cost per patient are based on assumptions of the number and mix of doses of available vaccines, the published prices, and IQVIA Institute estimates of the prevailing prices that will exist across geographies through 2027. As costs are based on public statements, they may overstate the true costs after negotiated discounts. Doses are based on the expected dosing including booster shots. IMPACT OF COVID-19 ON THE USE OF MEDICINES Global spending on COVID-19 vaccines is expected to exceed previous estimates primarily from higher volume Source: IQVIA Institute, Nov 2022; Pricing information from public disclosures as of October 2022; Vaccination trends to date from Ourworldindata.org. • Higher income countries achieved higher than expected vaccination rates earlier in the pandemic while the slower early pace in the developing world has been significantly improved to date, though the overall vaccination rate is still far below wealthier countries • Previous modeling had expected half-size booster doses taken by more of the initially vaccinated. Information to date suggests that booster doses will be the same size as an initial dose but will be taken by fewer people • Although increased competition will drive down cost per standardized dose later in the period, the preference in developed markets for mRNA vaccines resulted in higher-than-expected cost per dose through 2024, and slower booster uptake is a factor in some companies stated plans for future pricing Previous scenarios range Updated base case scenario 120 100 80 60 40 20 0 2021 2022 2023 2024 2025 2027 Constant US$, billion COVID-19 vaccine global spending scenarios $0 $5 $10 $15 $20 Cost per dose scenarios, US$ 2021 2022 2023 2024 2025 2027 2021 2022 2023 2024 2025 2027 2026 2026 2026 Standard doses scenarios, billions Updated 7-year total of base case =$380Bn (315–425) Previous 6-year total of base case =$251Bn (185-295) . Base case key assumptions 0 2 4 6 8 10 Previous base case scenario

iqviainstitute.org | 9 • The impact of the pandemic on medicine use has been highly varied, including both surges in usage of chronic medicines, referred to as stockpiling, and then returning to a more normal trend, with the average for developed markets at baseline volumes by the end of 2020. • Countries with the least impact from the pandemic, largely due to early and effective containment, including Australia and Canada, have then seen drops in volume in more recent periods. • Pharmerging markets have had a much more varied pandemic experience, with significant variations in volume through Q3 2020 but generally returning to higher than pre-pandemic levels for the seven quarters since then. • As the pandemic has continued, developed markets have demonstrated resilience to various logistical disruptions, offering financial assistance to the public and shifting healthcare interactions to remote or virtual settings. • Lower-income countries in the pharmerging group of countries have recovered to an average of 110% of pre-pandemic volume, higher than the average 106% in the 10 developed countries. Exhibit 5: Trends in Defined Daily Doses (DDD) in 10 developed and pharmerging markets indexed to Q3 2019 values (Q3 2019 value = 100) Notes: Defined Daily Doses (DDD) are based on WHO definitions where each medicine is assigned a volume of medicine per day (see definitions & methodology). All charted values are indexed to Q3 2019 values, such that the Q3 2019 value is set equal to 100%. The 10 developed countries are the 10 largest high-income countries (U.S., Japan, Germany, France, Italy, Spain, UK, Canada, Australia, South Korea). Pharmerging includes countries with per capita GDP $1Bn (absolute or rounded) in at least two forecasts. IMPACT OF COVID-19 ON THE USE OF MEDICINES Medicine use in pharmerging countries varied greatly since early 2020 and has been more stable in developed countries Source: IQVIA MIDAS, Jun 2022; IQVIA Institute, Dec 2022. 10 developed Pharmerging 60 40 100 120 80 140 160 2019 Q3 2019 Q4 2020 Q1 2020 Q2 2020 Q3 2020 Q4 2021 Q1 2021 Q2 2021 Q3 2021 Q4 2022–Q1 2022 Q2 2019 Q3 2019 Q4 2020 Q1 2020 Q2 2020 Q3 2020 Q4 2021 Q1 2021 Q2 2021 Q3 2021 Q4 2022 Q1 2022 Q2 Spain, 112.8 Japan, 110.8 U.S., 107.0 Germany, 106.8 Italy, 106.4 Korea, 106.4 France, 106.3 UK, 105.8 Average, 105.9 Australia, 100.4 Canada, 96.4 Chile, 140.1 Indonesia, 132.4 Colombia, 111.1 Average, 110.1 South Africa, 89.5 Ukraine, 54.3

10 | The Global Use of Medicines 2023: Outlook to 2027 • Early in the pandemic, with few treatments appearing to offer benefits for patients, there was an increased use of rescue inhalers normally intended for asthma in patients in ICUs, driving a significant shift in usage in the respiratory market overall and then falling as hospitalization rates fell. • Mental health therapies have seen a gradual rise in usage, though more modest than some had expected, potentially due to barriers to beginning new treatments for mental health disorders, including social stigma. • Pharmerging markets have seen generally less disruption to these therapies, as many countries were later impacted by COVID-19 and experienced less of the early wave of uncertainty-driven behavior changes. • Higher use of vitamins and minerals in pharmerging markets is, as a result of reports in the media in some of those countries, generally not supported with clinical evidence that certain treatments would either be beneficial or protective relative to COVID-19. Exhibit 6: Trends in medicine use in 10 developed and pharmerging markets, standard units indexed to Q3 2019 values (Q3 2019 value = 100) Notes: Indexed values are based on standard units. Common ICU medications are those indicated by the American Society of Health-System Pharmacists: Atracurium Besilate, Cisatracurium Besilate, Dexamethasone, Dexmedetomidine, Epinephrine, Etomidate, Fentanyl, Hydromorphone, Ketamine, Midazolam, Norepinephrine, Phenylephrine, Propofol, Rocuronium Bromide, Vasopressin, and Vecuronium Bromide. Chronic and acute definitions are based on therapy classes predominantly used for maintenance therapy or not. Vitamins and minerals includes OTC when captured. IMPACT OF COVID-19 ON THE USE OF MEDICINES Medicine use was disrupted in some therapies throughout the pandemic with most countries returning to pre-pandemic levels Source: IQVIA MIDAS, Jun 2022; IQVIA Institute, Dec 2022. Pharmerging 10 developed 80 100 120 120 Antidiabetics 80 100 120 120 Common ICU medications Acute therapies Chronic therapies Mental health Vitamins and minerals Respiratory Hypertensives 2019 Q3 2019 Q4 2020 Q1 2020 Q2 2020 Q3 2020 Q4 2021 Q1 2021 Q2 2021 Q3 2021 Q4 2022 Q1 2022 Q2 2019 Q3 2019 Q4 2020 Q1 2020 Q2 2020 Q3 2020 Q4 2021 Q1 2021 Q2 2021 Q3 2021 Q4 2022 Q1 2022 Q2 2019 Q3 2019 Q4 2020 Q1 2020 Q2 2020 Q3 2020 Q4 2021 Q1 2021 Q2 2021 Q3 2021 Q4 2022 Q1 2022 Q2 2019 Q3 2019 Q4 2020 Q1 2020 Q2 2020 Q3 2020 Q4 2021 Q1 2021 Q2 2021 Q3 2021 Q4 2022 Q1 2022 Q2

iqviainstitute.org | 11 • The ongoing COVID-19 pandemic is reported to have increased levels of depression, anxiety and stress in the population at large as well as creating challenges for those with substance abuse disorders or drug dependency, which are often stigmatized. • While quarantines and shutdowns have become less common across many geographies, many patients have remained less engaged with healthcare, likely resulting in continuing numbers of disrupted or delayed diagnoses and treatments especially for those with asymptomatic conditions. • For many asymptomatic and lifestyle-influenced conditions such as obesity, diabetes, and heart disease, the ongoing disruptions to what was normal life before the pandemic are expected to result in greater rates of these chronic diseases, especially as people are more sedentary for sustained periods of time. • The pandemic is also impacting other infectious diseases by limiting patient’s exposure due to pandemic precautions, which may be contributing to elevated rates and severity of respiratory infections in the 2022/2023 seasons for seasonal flu, common cold, RSV, and other respiratory infections. • Disrupted seasonal patterns for these infections may also be a factor contributing to desynced supply and demand issues for antibiotics resulting in shortages. • Vaccine hesitancy for COVID-19 may result in an expansion of these attitudes to other vaccines, generating risk in previously well-controlled infections such as measles, mumps, and rubella, among others. • Clarity is slowly emerging around post-acute sequelae of COVID-19 (PASC), with 10-20% of previously infected people reporting long-term symptoms, largely confirming early concerns about this feature of the virus. Exhibit 7: Summary of expected impacts of the COVID-19 pandemic on patients and therapeutics IMPACT OF COVID-19 ON THE USE OF MEDICINES Increased uncertainty about demand and use of medicines linked to pandemic impact Source: IQVIA Institute for Human Data Science, Nov 2022. Disrupted or delayed diagnoses of conditions Post-COVID-19 conditions Population level mental health Impact on infectious diseases • Vaccine hesitancy spreads to others and results in outbreaks of previously controlled viruses such as measles, mumps, rubella • Other respiratory infections such as RSV (respiratory syncytial virus) and the common cold may be similarly affected by seasonal disruptions • Depression/anxiety, stress disorders • Substance abuse/dependency • Lack of clear understanding of causes and consequences of “long-COVID” conditions • Estimated over 100 million newly diagnosed conditions in COVID-19 patients, particularly in CNS and respiratory • Treatment modalities still being investigated • Interruption of typical healthcare seeking behaviors due to quarantines / shutdowns could have had lasting effects or result in more severe disease when diagnosed, especially cancer • Greater rates of chronic diseases such as obesity, type 2 diabetes and heart disease due to disrupted patterns of daily life • Seasonal flu season disruption could result in more virulent strains in future seasons, especially if vaccination rates drop

12 | The Global Use of Medicines 2023: Outlook to 2027 • COVID-19 infection results not only in debilitating symptoms and sometimes death, but for an important percentage of patients, long-term complications. • Post-COVID conditions are now understood as a multi-organ disorder or syndrome that consist of a constellation of different conditions, which are acute or chronic or both, and vary in terms of severity; estimates of how many people may be affected have varied considerably as multiple organizations have developed widely varying criteria for assessing the presence of post-acute sequelae of COVID (PASC). • Early estimates ranged from 10-30% of COVID-19 patients having PASC, but incompatible definitions relating to the nature of symptoms and duration of persistence had made comparisons across studies unreliable. • For mild or asymptomatic COVID-19 cases, a complication could be thought to be the result of some other pre-existing condition, unless a COVID-19 antibody test were used to verify a previously unknown infection. • Research is ongoing to improve understanding of the prevalence of PASC, as well as to develop specific therapies to address these symptoms where existing medicines are ineffective or have suboptimal outcomes, and while the pandemic continues, the ultimate size of this population remains uncertain but growing. Exhibit 8: Longer-term complications of COVID-19 infection on patients IMPACT OF COVID-19 ON THE USE OF MEDICINES Research has been able to identify sustained complications of COVID-19 infection across almost all organ systems Source: IQVIA Institute: Assessing the Global Burden of Post-COVID-19 Conditions, Dec 2021. Neurological Brain fog, fatigue, headache, strokes, seizures, encephalopathies, nerve disorders, disturbance in smell and/taste, POTS, Parkinson's disease, dementia, dry eyes, pink eye. Endocrine New onset diabetes mellitus. Respiratory Chronic cough, bronchiectasis, pulmonary fibrosis, pulmonary vascular disease, worsening of pre-existing respiratory conditions (asthma/COPD), shortness of breath. Cardiac Dysrhythmias/arrhythmias, hypertension, dyslipidemia, myocardial injury, myocarditis, heart failure, acute coronary syndrome, cardiomyopathy, hypercoagulation, DIC, VTE, cardiogenic shock, cardiac arrest, low blood pressure. Gastrointestinal disorders Post infectious dysmotility, abdominal pain, nausea, diarrhea, anorexia, GI vascular diseases, gastroesophageal reflux. Psychiatric Depression, anxiety, psychotic disorders, mood disorders, sleep disorders, substance misuse, post-traumatic stress disorder, delirium, suicidality. Ear, Nose and Throat (ENT) Tinnitus, sore throat, earache, hearing loss, inner ear disorder. Renal Renal damage, acute renal injury, chronic kidney disease, accentuation of post hypertension/diabetes mellitus renal disorders. Musculoskeletal Myositis, chest pain rhabdomyolysis, muscle pain, joint pain, muscle disorders including increase severity of pre-existing diseases. Dermatological Vasculitis rash, urticaria, chilblains, vesicular purpura, irritant dermatitis, hair loss.

iqviainstitute.org | 13 • The use of medicines plateaued in 2022 following a significant rebound in 2021 as markets recovered from the pandemic. • Overall volume is projected to grow 1.6% in days of therapy through 2027, driven by Asia-Pacific, India, Latin America, Africa/Middle East, and China, all of which are expected to exceed global volume growth. • Higher-income countries in Western Europe, North America as well as Japan and Eastern Europe are expected to grow more slowly at 0.1 to 0.4% through 2027 partly due to their already higher per capita use. • Per capita use of medicines varies by GDP, with use in higher-income countries typically higher than lower-income. • Per capita medicine use varies by region, with Japan and Western Europe having more than double the use of most other regions. • Countries vary considerably in the therapy areas that drive most of their volume use of medicines, and while overall volume has increased by 2% over the past decade, oncology has increased at 15.3% per year. Outlook for the use of medicines and historic drivers Medicine use grew by 36% over the past decade, driven by increased access to medicines in regions around the world, but is projected to slow through 2027. Meanwhile the lowest income countries continue to see declines in access to medicines, potentially putting health improvements at risk.

14 | The Global Use of Medicines 2023: Outlook to 2027 • The global use of medicines — based on modeling medicine volumes shipped according to defined daily dose assumptions — has been growing for the past decade; however, this growth is expected to slow across all markets over the next five years. • As a lagged effect of the pandemic, the use of medicines grew sharply in 2021 and then slowed in 2022 as some of the usage was related to temporary shifts in demand, referred to as ‘stockpiling.’ • The highest volume growth over the next five years is expected in Asia-Pacific, Latin America, India and Africa/Middle East, largely driven by population growth. • Lower volume growth in higher income regions such as North America, Western Europe and Japan are linked to more established health systems and existing access to medicine. • Eastern Europe is expected to slow partly as a result of the regional impacts of the Ukraine conflict. • Lower-income countries have dramatically lower access to medicine; access has been declining for the past five years and is expected to remain steady over the next five years, potentially counteracting other policy initiatives to improve health in those countries. • It is important to interpret these trends with caution, as chronic diseases drive many days of therapy, and treatments for them are often much less common in lower-income countries. Exhibit 9: Historical and projected use of medicine by region, 2012–2027, Defined Daily Doses (DDD) in Billions Notes: Chart represents IQVIA Institute estimates of global defined daily doses (DDD). These estimates are based on IQVIA audited data and application of WHO-DDD factors in IQVIA MIDAS as well as additional DDD calculation assumptions developed by the IQVIA Institute (see Methodology). Asia-Pacific does not include China, India, and Japan which are reported separately. OUTLOOK FOR THE USE OF MEDICINES AND HISTORIC DRIVERS The use of medicines plateaued in 2022 following a significant rebound in 2021 as markets recovered from the pandemic Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Dec 2022. 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 CAGR % 2023–2027 2,318 2,476 2,598 2,659 2,741 2,802 2,876 2,946 3,018 3,160 3,158 3,242 3,335 3,425 3,426 3,422 Global Japan North America China Africa & Middle East Eastern Europe Western Europe Latin America India Asia-Pacific 1.6 0.4 0.1 1.7 2.3 0.5 0.4 2.4 2.4 2.5 Forecast 314 330 351 369 394 433 472 487 510 542 553 577 601 624 625 626 293 305 325 343 351 355 383 393 399 434 443 463 481 499 500 499 175 201 239 263 259 269 281 292 355 368 376 390 407 426 424 424 369 374 379 385 390 392 396 401 402 409 403 407 410 414 414 412 292 322 325 316 330 363 373 382 383 400 369 369 374 379 380 378 317 360 377 372 392 353 332 323 312 311 319 331 342 353 355 357 200 214 232 244 259 270 273 298 286 313 318 328 339 348 348 346 237 250 252 251 249 249 247 248 249 256 253 254 255 256 255 255 121 121 118 118 117 118 120 121 122 126 123 124 125 126 126 125

iqviainstitute.org | 15 • Broadly there is a correlation to gross domestic product per capita, with higher medicine use in higher income countries. • As countries vary in the cost burden patients directly bear, there is some correlation in the way patients use medicine. • The U.S. has the lowest per capita DDD volumes of developed markets, which may be the result of high patient out-of-pocket cost exposure. • Other factors include the disease burden patients face and the aspects of the health system they can readily access to begin using medicines for a specific disease. • Eastern Europe has nearly four times higher use of medicines per capita than China, despite GDP per capita being roughly 50% higher. • Countries in Africa and the Middle East lag the furthest in terms of per capita use, even as some countries in the region are significant outliers with robust GDP and usage. Exhibit 10: Defined Daily Doses (DDD) per capita by region compared to per capita gross domestic product PPP, current international dollars Notes: Chart represents IQVIA Institute estimates of global defined daily doses (DDD). These estimates are based on IQVIA audited data and application of WHO-DDD factors in IQVIA MIDAS as well as additional DDD calculation assumptions developed by the IQVIA Institute (see Methodology). Asia-Pacific does not include China, India, and Japan which are reported separately. OUTLOOK FOR THE USE OF MEDICINES AND HISTORIC DRIVERS Per capita use of medicines varies by GDP with use in higher income countries typically higher than lower-income Source: IQVIA MIDAS, Jun 2022; IQVIA Institute, Dec 2022; The World Bank, Jul 2022; International Monetary Fund, Oct 2022. 1,200 1,000 800 600 400 200 0 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 GDP PPP per capita 2022 (current international dollars) DDD per capita 2022 500Bn 250Bn 100Bn Size of Bubble: Total 2022 DDDs Asia-Pacific India Western Europe Eastern Europe Africa & Middle East Latin America China Japan North America

16 | The Global Use of Medicines 2023: Outlook to 2027 • When medicine use is adjusted for population, global medicine use is projected to remain flat over the next five years, indicating growth in medicine use will follow population growth. • After peaking in 2021, medicine use per capita declined in 2022 in some regions due to the increased use of a variety of medicines during the pandemic. • Eastern Europe declined in 2022 related to the Ukraine conflict but is expected to recover slowly through the forecast period. • Most regions have steadily rising usage on a per capita basis, slower than in the past 10 years, and notably declining in North America. Exhibit 11: Historical and projected per capita use of medicine by region, 2012–2027 Notes: Chart represents IQVIA Institute estimates of global defined daily doses (DDD). These estimates are based on IQVIA audited data and application of WHO-DDD factors in IQVIA MIDAS as well as additional DDD calculation assumptions developed by the IQVIA Institute (see Methodology). Asia-Pacific does not include China, India, and Japan which are reported separately. OUTLOOK FOR THE USE OF MEDICINES AND HISTORIC DRIVERS Per capita medicine use varies by region with Japan and Western Europe having more than double the use of most other regions Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Dec 2022; The World Bank, Jul 2022. 5-Year CAGRs 5-Year CAGRs 5-Year CAGRs 2012 2013 2014 2015 2016 2017 2018 2019 2030 2021 2022 2023 2024 2025 2026 2027 Asia-Pacific India Forecast Western Europe Eastern Europe Africa & Middle East Latin America China North America Japan Global 1,200 1,000 800 600 400 200 0 DDD per capita 0.3% 0.7% 7.9% 4.0% -0.4% 2.7% 5.3% 2.8% -0.3% 5.5% 0.3% 0.4% 5.9% 0.2% 1.1% 1.4% 3.8% 3.5% -4.2% 3.0% -0.5% 0.4% 1.6% 0.4% 0.9% 0.7% 1.5% 1.5% 0.0% 1.6%

iqviainstitute.org | 17 • Per capita use of medicines is projected to grow in most regions except Africa and the Middle East, where all volume increases are driven by population growth. • Wealthier countries in Western Europe, Japan and North America have higher levels of per capita use and are expected to grow less through 2027. • Regions with more middle- and lower-income countries are expected to resume historic volume growth trends as access to medicines contributes to volume growth above population growth trends. Exhibit 12: Defined Daily Doses (DDD) per capita by region 2022 and growth to 2027 Notes: Chart represents IQVIA Institute estimates of global defined daily doses (DDD). These estimates are based on IQVIA audited data and application of WHO-DDD factors in IQVIA MIDAS as well as additional DDD calculation assumptions developed by the IQVIA Institute (see Methodology). Asia-Pacific does not include China, India, and Japan which are reported separately. OUTLOOK FOR THE USE OF MEDICINES AND HISTORIC DRIVERS When adjusted for population, per capita use will fall in North America and be flat in Africa and Middle East Source: IQVIA MIDAS, Jun 2022; IQVIA Institute, Dec 2022; The World Bank, Jul 2022; International Monetary Fund, Oct 2022. 120 100 80 60 40 20 0 -20 -40 0% 200 400 600 800 1,000 1,200 DDD per capita 2022 Absolute change in DDD per capita 2023-2027 500Bn 250Bn 100Bn Size of bubble: Total 2027 DDDs Asia-Pacific Africa & Middle East China India Japan Western Europe North America Eastern Europe Latin America

18 | The Global Use of Medicines 2023: Outlook to 2027 • As health systems and disease burdens vary around the world, regions demonstrate important variations in the use of different therapies. • Regions with higher average GDP such as North America, Western Europe and Japan have notably higher use of cardiovascular, diabetes, respiratory and neurology treatments than other regions. • While most major therapy areas have seen growth in medicine use in the last decade, oncology usage has far exceeded the others with a 10-year CAGR through the last full year (2021) of 15.3%. Exhibit 13: Share of Defined Daily Doses (DDD) by therapy area in 9 regions and globally, 2021 Notes: Chart represents IQVIA Institute estimates of global defined daily doses (DDD). These estimates are based on IQVIA audited data and application of WHO-DDD factors in IQVIA MIDAS as well as additional DDD calculation assumptions developed by the IQVIA Institute (see Methodology). Asia-Pacific does not include China, India, and Japan which are reported separately. Oncology includes supportive care. Hematologics are non-oncology. OUTLOOK FOR THE USE OF MEDICINES AND HISTORIC DRIVERS The distribution of medicine usage across therapy areas varies by region Source: IQVIA MIDAS, Jun 2022; IQVIA Institute, Dec 2022. Asia-Pacific India Western Europe Eastern Europe Latin America China Africa & Middle East North America Japan Global All others Respiratory Genitourinary/ Women's health Oncology Infectious disease Endocrinology Immunology Gastrointestinal Neurology Eye & ear Dermatologics Hematologics Vitamins & minerals Cardiovascular 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Global DDD CAGRs % 2012–2021 5.6 3.9 3.0 15.3 0.0 5.6 6.0 2.1 2.7 1.9 5.1 3.3 4.4 4.2

iqviainstitute.org | 19 • The global medicine market — using invoice price levels — is expected to grow at 3-6% CAGR through 2027, reaching about $1.9Tn in total market size. • Spending and volume growth will follow diverging trends by region with larger established markets growing more slowly, and growth markets in Eastern Europe, Asia and Latin America growing in both volume and spending. • The U.S. market, on a net price basis, is forecast to grow -1 to 2% CAGR over the next five years, down from 4% CAGR for the past five years including projected effects of the Inflation Reduction Act. • Spending in Europe is expected to increase by $59Bn through 2027, with a focus on generics and biosimilars, and escalating pressures on the value and negotiated prices of novel medicines. • The pandemic’s impact on Asia-Pacific countries varies considerably, but a return to steady growth is projected after 2021. • Japan medicine spending growth is projected at -1 to 2% through 2027 as robust brand growth is offset by a shift in annual price cuts and ongoing shifts to generics. • Spending growth in China is expected to slow, with positives driven by greater uptake and use of new original medicines and offset by pressures placed on off-patent and generic pricing. Spending and growth by regions and key countries Growth in developed economies continues at relatively steady rates, with new products offset by patent expiries; Latin America, Eastern Europe and parts of Asia are expected to grow strongly from volume and adoption of novel medicines.

20 | The Global Use of Medicines 2023: Outlook to 2027 • Global medicine spending — the amount spent purchasing medicines from manufacturers before offinvoice discounts and rebates — is expected to reach $1.9Tn by 2027, increasing at a rate of 3–6% per year. • This outlook is excluding the separate impact of spending on COVID-19 vaccines and therapeutics modeled separately (see Exhibits 1–4). • Overall growth trends are expected to moderate after the disruptions from the pandemic in 2020 through 2022. • The differing impact of the COVID-19 pandemic across countries is expected to impact growth through 2023 before returning to historic patterns in 2024. • Key drivers of growth through the forecast period include the contribution of new products, the impact of patent expiries and the growing impact of biosimilars. • Payers in developed markets are expected to face budget pressures and act to curb drug spending growth, in part motivated by the costs of managing the pandemic. Exhibit 14: Global medicine market size and growth 2013–2027 Notes: Does not include estimates for COVID-19 vaccines and therapeutics. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES The global medicine market — using invoice price levels — is expected to grow at 3–6% CAGR through 2027 to about $1.9Tn Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Nov 2022. Global spending US$Bn % Growth constant US$ 2,000 1,800 1,600 1,400 1,200 1,000 800 600 400 200 0 12% 10% 8% 6% 4% 2% 0% Spending US$Bn % Growth constant US$ 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 Forecast

iqviainstitute.org | 21 • Regions around the world are growing following diverging trends, with some more volume driven while others have a greater contribution from adoption of innovation. • Countries in Latin America, Asia-Pacific, and Africa and the Middle East are expected to grow more than 10% by volume over the five years to 2027, while spending growth will increase by over 30%, indicating both population-driven volume growth and a shift in the mix of products to more expensive products. • China as the world’s second largest country by pharmaceutical spending, will increase volume by 8% in aggregate over five years, while spending will increase 19%, a more modest rate than in the prior years and still embedding a focus on expanding access to novel drugs via the National Reimbursement Drug List (NRDL). • Eastern Europe spending is expected to increase 45% over the next five years while volume will increase only 1%, hampered by the regional disruptions from the Ukraine conflict, and at the same time reflecting the expected adoption of novel drugs, albeit later than in Western Europe and other developed markets. • North America and Western Europe are expected to show flat to very low overall volume growth over five years, while spending will increase more than 20%, excluding the impact of off-invoice discounts and rebates. • Japan spending growth is expected to be flat over the forecast as price controls evolve to encourage innovation while offsetting with savings on older and off-patent medicines. Exhibit 15: Spending and volume growth by region Notes: Does not include estimates for COVID-19 vaccines and therapeutics. Asia-Pacific does not include China, India, and Japan which are reported separately. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES Spending and volume growth follow diverging trends by region Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Nov 2022. 60% 50% 40% 30% 20% 10% 0% -10% 2023–2027 Percent spending growth constant US$ 2023–2027 percent volume growth standard units -5% 0% 5% 10% 15% Spending growth through 2027 expected to be high, driven by 'mix' (wider use of novel drugs at higher average prices) Above average volume and spending growth through 2027 Below average volume and spending growth through 2027 Below average spending growth, with expanded access to novel drugs driving spending growth faster than volume Africa & Middle East Asia-Pacific China Eastern Europe Western Europe India Japan Latin America North America

22 | The Global Use of Medicines 2023: Outlook to 2027 • Global medicine spending is expected to slow to 3–6% through 2027, reaching $1.9Tn, with the ongoing impacts of the pandemic impacting medicine spending and usage patterns through 2023 and returning to pre-pandemic trends afterward. • North America medicine spending is expected to slow dramatically in 2023 from the combined effects of a relatively smaller contribution from new products and the impact of significant patent expiries and biosimilars including adalimumab (Humira) in 2023. • Latin America spending growth has been especially high in the first two years of the pandemic, including patients use of established and generic medicines as symptom management for COVID-19. Starting in 2023, growth will average 7-10% CAGR led by Brazil, Mexico, Argentina and Colombia. • The Asia-Pacific region (excluding China, India and Japan) has some of the highest spending growth sustained through the forecast driven by population growth and an expected contribution from economic growth. • Japan’s spending growth is expected to average -2 to 1% with relatively flat trends, a result of a shift to annual price cuts in place of the historic biennial price cut policy. • China’s spending has swung wildly during the pandemic, partly influenced by zero tolerance pandemic policies but expected to return to more moderate 2–5% growth through 2027. Exhibit 16: Spending growth globally and in 9 regions, total market, const US$ 2019–2027 Notes: 2019 is included to show the impacts of the pandemic on spending growth. Asia-Pacific does not include China, India, and Japan which are reported separately. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES The COVID-19 impact varies by region with a return to a more stable trend by 2024 and higher growth in key regions 2019 2020 2021 2022 2023 2024 2025 2026 2027 2019 2020 2021 2022 2023 2024 2025 2026 2027 2019 2020 2021 2022 2023 2024 2025 2026 2027 2019 2020 2021 2022 2023 2024 2025 2026 2027 2019 2020 2021 2022 2023 2024 2025 2026 2027 3–6% $1,900–1,930Bn 2.5–5.5% $790–820Bn 3.5–6.5% $355–385Bn 5.5–8.5% $108–138Bn -2–1% $71–91Bn 4.5–7.5% $54–74Bn 7–10% $115–135Bn 6–9% $100–120Bn 7.5–10.5% $35–39Bn 2–5% $180–210Bn Spending growth 2023–27 CAGRs 2027 Spending 20% 15% 10% 5% 0% -5% 20% 15% 10% 5% 0% -5% Global North America Western Europe Asia-Pacific Africa & Middle East Japan Latin America Eastern Europe India China Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Nov 2022.

iqviainstitute.org | 23 • Spending at net levels in the U.S. is projected to grow at -1 to 2% as rising off-invoice discounts and rebates are expected to be amplified by the provisions of the Inflation Reduction Act (IRA). • In total, off-invoice discounts and rebates result in spending that is estimated at 36% lower than invoice level in 2022 and projected to be 45% lower than invoice level in 2027. • Projections prior to the passage of the IRA showed this gross to net difference reaching 39% in 2026, with growth averaging 0–3% on a net basis, 1% higher than the revised outlook. • In addition to discounts and rebates, ongoing market dynamics around the use of medicines, the adoption of newer treatments, the impact of patent expiries, and new generic or biosimilar competition will all contribute to historically slow market growth in the U.S. for the next five years. Exhibit 17: U.S. medicine spending and growth at invoice-level and estimated net 2013–2027 Notes: Estimates of net manufacturer sales are based on analysis by the IQVIA institute from public sources combined with IQVIA’s audited invoice-level data (see Methodology). SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES The U.S. market, on a net price basis, is forecast to grow -1–2% CAGR over the next 5 years, down from 4% CAGR for the past 5 years Source: IQVIA Institute, Nov 2022. 259 291 318 331 331 344 363 363 385 402 412 420 416 415 420 337 390 437 456 465 493 521 545 588 629 657 680 705 734 763 5-Year CAGRs 5-Year CAGRs Invoice CAGR 7.6% Net 29% below invoice Net CAGR 5.2% Invoice CAGR 6.2% Net 36% below invoice Net CAGR 4.0% Invoice CAGR 2.5-5.5% Net 45% below invoice Net CAGR -1 to 2% 5-Year CAGRs 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 Net sales Invoice to net difference Forecast

24 | The Global Use of Medicines 2023: Outlook to 2027 • Spending on medicines in the U.S. at invoice prices is expected to increase by $134Bn through 2027, slower than the $164Bn increase over the past five years. • The largest driver of growth will be increased usage of existing protected branded products which are expected to add $154Bn in spending over five years, much higher than the $122Bn increase from 2017 to 2022 for products more than two years after their launch up until their loss of exclusivity (LOE). • The contribution from new brands is expected to increase to $110Bn over five years as more than 250 new active substances (NASs) are expected to launch in the period. • The impact of losses of exclusivity is expected to increase dramatically to $141B from $49Bn in the prior five years as both small molecule and biologic product exposure to LOE has increased substantially. • Generics, including biosimilars, have had an only modest impact on growth as price deflation has largely offset growth from the related patent expiry events. • Overall medicine spending at invoice prices is expected to reach $763Bn by 2027 even as off-invoice discounts and rebates are expected to reach 45% and net spending increases by only $18Bn over five years. Exhibit 18: Spending and growth drivers in US 2017–2027 const US$Bn Notes: New brands growth contribution defined as the growth during periods when products had been marketed for less than two years. Growth from products defined as new in each year of the five-year period are aggregated together. Existing brands are those which are no longer new and not yet offpatent. Off-patent brands have faced Loss of Exclusivity (LOE). Generics includes non-original branded products or ‘branded generics’ as well as biosimilars. Other includes OTC/other products. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES Spending in the U.S. is expected to increase by $134Bn through 2027 driven by new and existing brands Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Nov 2022. 465 86 -49 122 5 0 629 110 -141 154 12 -1 763 Forecast New brands LOE Existing brands Generics Others New brands LOE Existing brands 2022 Generics Others spending 2027 spending 2017 spending

iqviainstitute.org | 25 • Losses of exclusivity in the U.S. are expected to be $141Bn through 2027, with significant impact on spending for both small molecules and biologics. • Small molecule expiries are expected to reduce brand spending by $98Bn through 2027, more than double the impact of the last five years, including the impact of high-profile products in the anticoagulants therapy area, including rivaroxaban (Xarelto). • Biologics are expected to result in $42Bn in lower brand spending over five years as biosimilar market dynamics mature and major products face competition, including the continuing impact on ranibizumab (Lucentis) in 2022, as well as adalimumab (Humira) and ustekinumab (Stelara) in 2023. • The approval of interchangeable biosimilars for insulins in the second half of 2021 and for adalimumab pending launch in 2023 suggests more dramatic volume uptake is possible, contributing to the $14Bn impact of biologics overall in 2024. • Questions remain around the relationship of interchangeability, alternative originator formulations, and the commercial and negotiating strategies of stakeholders which could dramatically increase or reduce the impact of these biosimilar events. Exhibit 19: U.S. impact of brand losses of exclusivity 2018–2027, US$Bn Notes: Does not reflect offsetting spending increases from generic or biosimilar competitors. Losses in future periods are modeled based on expected preexpiry growth for the brand and subsequent post-expiry loss of sales for the brands. The rates of loss are based on historic averages in each country and inclusive of adjustments for products with expiries in progress from historic periods where losses extend into the forecast periods. Historic period analyses are based on audited data. Expected loss of exclusivity dates are highly variable and can change due to outcomes of litigation, granting of new patents or changes in the expectation of launch of biosimilars. Information is current as of September 2022. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES The impact of exclusivity losses will increase to $140.8Bn over 5 years including significant biosimilars in 2023 and 2024 -1.2 -1.8 -4.4 -2.2 -0.8 -7.6 -14.2 -8.3 -5.1 -7.1 -7.1 -9.5 -8.8 -5.7 -7.2 -13.6 -14.8 -21.8 -23.2 -24.9 -8.4 -11.3 -13.2 -7.9 -8.0 -21.2 -29.1 -30.1 -28.4 -32.0 Biologic Small $10.4Bn $38.4Bn $48.8Bn $42.3Bn $98.4Bn $140.8Bn 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 Forecast $ Total brand loss due to LOE Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Nov 2022.

26 | The Global Use of Medicines 2023: Outlook to 2027 • There were dramatically fewer new active substance (NAS) launches in the U.S. in 2022 following the record year in 2021, reflecting both fewer approvals and some approved but not yet launched medicines. • Four of the last five years have had more than 50 NAS launches and the next five years are expected to average at least 50 per year, with an aggregate total of more than $22Bn in new brand spending per year. • Over the next five years, more than 250 NASs are expected to launch in the U.S. and new products in aggregate are expected to contribute $110Bn in spending. • New launches in the next five years are expected to include 100 new cancer drugs globally, with most of those available in the U.S. at launch. • Other clusters of innovative drugs include as many as 60 next generation biotherapeutics, which include cell and gene therapies and RNA therapeutics, and which partly overlap with oncology treatments. Exhibit 20: U.S. new brand spending Notes: New brands spending defined as products marketed for less than two years in each year. Number of New Active Substances (NAS) per year reflect launches rather than approvals as there can be a lag between approval and launch. *NAS launches in 2022 Estimated based on information confirmed as of Dec 14, 2022. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES New brand spending in the U.S. is projected to be higher than the last 5 years but a smaller share of spending Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Nov 2022. 8 25 35 34 22 18 22 15 18 12 15 22 24 24 25 12% 10% 8% 6% 4% 2% 0% 40 35 30 25 20 15 10 5 0 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 New brands % of total brand spending New brand spending US$Bn US NAS Launches 41 46 49 30 42 57 51 54 69 41 (39–43) Average launches projected at 50–55/year (250–275 launches within 5-years) New brand spending New brands share of brand spending Forecast Total 2013−17 = $124Bn Total 2018−22 = $86Bn Total 2023−27 = $110Bn

years for biologics • Mechanism and basis for negotiation is pending

28 | The Global Use of Medicines 2023: Outlook to 2027 • Medicine spending in the top five European markets is expected to increase by $59Bn over the next five years, up from $53Bn in the past five years but with large shifts in the drivers of growth. • New brands were the largest driver of growth from 2017 to 2022 and are expected to continue in the next five years but be hampered by lingering effects of the pandemic on marketing operations early in the period and reimbursement decisions later as budget pressures increase. • Generics, including biosimilars, are expected to add $12Bn in growth over the next five years, about the same as in the past five years despite a larger impact of losses of exclusivity as volume gains will be offset by price deflation. • Payer actions will be shaped by the pace of economic and COVID-19 recovery, including broader inflation concerns and the impact on fuel commodity costs in the region related to the Ukraine conflict. • Innovation is expected to be significantly strong in the next five years despite expected greater scrutiny of the value of new medicines in the form of health technology assessments. • It is possible that new brand growth will be lower while older established brands may grow more after they have demonstrated value in the market and negotiated market access, and these dynamics represent an area of significant uncertainty. Exhibit 22: Spending and growth drivers in France, Germany, Italy, Spain, and UK 2017–2027 const US$Bn Notes: Spending in US$ with constant Q2 2022 exchange rates. New brands growth contribution defined as the growth during periods when products had been marketed for less than two years. Growth from products defined as new in each year of the five-year period are aggregated together. Existing brands are those which are no longer new and not yet off-patent. Off-patent brands have faced Loss of Exclusivity (LOE). Generics includes non-original branded products or ‘branded generics’ as well as biosimilars. Other includes OTC/other products. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES Spending in Europe is expected to increase by $59Bn through 2027, driven by new brands Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Nov 2022. 151 38 -9 7 14 2 204 45 -31 31 12 2 263 Forecast New brands LOE Existing brands Generics Others New brands LOE Existing brands 2022 Generics Others spending 2027 spending 2017 spending

UK impact of brand losses of exclusivity 2018–2027, US$Bn Notes: Does not reflect offsetting spending increases from generic or biosimilar competitors. Losses in future periods are modeled based on expected preexpiry growth for the brand and subsequent post-expiry loss of sales for the brands. The rates of loss are based on historic averages in each country and inclusive of adjustments for products with expiries in progress from historic periods where losses extend into the forecast periods. Historic period analyses are based on audited data. Expected loss of exclusivity dates are highly variable and can change due to outcomes of litigation, granting of new patents or changes in the expectation of launch of biosimilars. Information is current as of September 2022. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES The impact of exclusivity losses will reach $31Bn over 5 years, with more than half due to the availability of biosimilars Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Nov 2022. -0.2 -0.3 -0.6 -0.5 -1.3 -2.3 -2.2 -5.7 -4.9 -2.3 -1.5 -0.9 -0.6 -0.7 -2.4 -3.5 -2.0 -2.7 -2.7 -2.5 -1.7 -1.2 -1.3 -1.2 -3.6 -5.9 -4.2 -8.5 -7.7 -4.8 Biologic Small $2.9Bn $6.0Bn $8.9Bn $17.5Bn $13.5Bn $31.0Bn 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 Forecast $ Total brand loss due to LOE

UK NAS Launches 24 42 37 29 42 36 29 40 50 40 (38–42) Average launches projected at 40–45/year (200–225 launches within 5 years) New brand spending New brands share of brand spending Forecast Total 2013−17 = $42Bn Total 2018−22 = $38Bn Total 2023−27 = $45Bn

iqviainstitute.org | 31 • Latin America and Eastern Europe represent two of the fastest growing regions in terms of medicine spending globally. • Latin America’s growth is led by Brazil and Mexico at 9–12% and 7.5–10.5%, respectively, and together representing two-thirds of the spending in the region overall. • Argentina has been impacted by inflation significantly in recent years, and these issues are at least partly driving the 25% and 37% growth in 2021 and 2022; growth is expected to slow to 3.5–6.5% through the forecast period. • Colombia is the highest growth country of the rest of the region and represents an important stabilization of the market after many years of political and economic instability. • In Eastern Europe, growth is led by Russia, which is projected to grow 6–9% CAGR through 2027. • Turkey’s high growth in the forecast may be a result of ongoing inflation issues and bears careful attention. • Poland and Romania are expected to return to pre-pandemic growth rates from 2023 through 2027. • The largest uncertainty in the region is the Ukraine conflict, which is having direct and demonstrable impacts on that country’s medicine use and spending. • The conflict is also likely impacting neighboring countries with the medical needs of displaced persons, as well as the ongoing effects on economic activity, fuel costs and regional business activity. Exhibit 25: Spending growth in select pharmerging countries 2019–2027, total market, const US$ Notes: 2019 is included to show the impacts of the pandemic on spending growth. Argentina growth in 2021 (25.4%), 2022 (37.2%) and Turkey 2022 (-6%) not plotted. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES Latin America and Eastern Europe are expected to return to steady growth outpacing the global market Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Nov 2022. 2026 2027 Eastern Europe Russia Turkey Poland Romania 2019 2020 2021 2022 2023 2024 2025 2019 2020 2021 2022 2023 2024 2025 2026 2027 2019 2020 2021 2022 2023 2024 2025 2026 2027 2019 2020 2021 2022 2023 2024 2025 2026 2027 2019 2020 2021 2022 2023 2024 2025 2026 2027 2019 2020 2021 2022 2023 2024 2025 2026 2027 Others Latin America Brazil Mexico Argentina Colombia Others 25% 20% 15% 10% 5% 0% -5% 25% 20% 15% 10% 5% 0% -5% Spending growth 2023–27 CAGRs 2027 Spending 7–10% $115–135Bn 9–12% $57–77Bn 6–9% $100–120Bn 6–9% $25–29Bn 7.5–10.5% $15–19Bn 3.5–6.5% $15–19Bn 15–19% $14–20Bn 5.5–8.5% $12–16Bn 6–9% $6–8Bn 3–6% $15–19Bn 7–10% $7–9Bn 3.5–6.5% $41–45Bn

32 | The Global Use of Medicines 2023: Outlook to 2027 • The ongoing conflict in Ukraine has reduced medicine spending by 10.3% in the first half of 2022 and an expected 22% through the full year. • As the duration of intensity of the conflict represents unknowns, scenarios may be helpful to quantify the impacts; in the most pessimistic scenario, the conflict would continue similar to the 2011 conflict in Syria and result in a three-year decline of 20-30% per year followed by a decade-long disruption at 70% below the pre-war level. • A more optimistic view could see the conflict resolved in 2023 with rebuilding and health system reforms hampering spending growth initially, with growth returning to pre-war rates by 2025. • The base case scenario embeds a stabilization of the conflict in 2023, lingering economic disruption and challenges in funding rebuilding that last longer into the forecast period. • Domestic impacts in Ukraine are only part of the impact of the conflict, which has region-wide and global implications. • Ukraine and Russia each have played important roles in regional supply chains for active ingredients and finished pharmaceuticals as well as clinical trial operations for drug development, all of which have been and will continue to be disrupted as the conflict continues. • A Europe-wide winter fuel crisis and inflation are also linked to the events in Ukraine. • In addition to these effects, persons displaced to neighboring Eastern European countries are expected to impact medicine needs in Poland, which has taken in more than 1 million refugees, as well as other countries. Exhibit 26: Ukraine medicine spending scenarios 2012–2027, constant US$Bn Notes: Ukraine estimates based on historic data through June 2022 and IQVIA Institute scenario modeling. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES Ukraine medicine spending has been disrupted by the ongoing war, with substantial sustained impact through the forecast Source: IQVIA Institute, Nov 2022. Modeling with Syria-war growth rates Base case Return to pre-pandemic growth rates in 2025 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 Constant US$Bn 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0 Earlier end to conflict but lingering healthcare reform issues, rebuilding and funding dependent on GDP recovery, growth returns to 2019 rates by 2025 Base case embeds a stabilization of the conflict in 2023, lingering economic disruption and challenges in funding rebuilding that last longer into the forecast period Modeled on historic growth rates in Syria at the beginning of the civil war in 2011 (20-30% declines for 3 years, steady -70% of prewar level after that)

iqviainstitute.org | 33 • The impact of the pandemic on medicine spending growth has been significant in some markets across the Asia-Pacific region, but these are expected to moderate and return to 5.5–8.5% growth through 2027. • Key countries in the region include two higher income developed markets — South Korea with growth 4.5–7.5% and Australia growing at 2–5% before discounts and rebates. • China’s growth has swung wildly in recent years, but is expected to stabilize at 2–5% through 2027. • India continues to grow through volume while costs remain low and medicines focus on generics; spending will increase 7.5–10.5% through 2027, reaching $35–39Bn. • Japan, with growth of -2 to 1% through 2027, is expected to drop from third to become the fourth largest global market by 2027, as policies to control spending growth remain the key focus of the health ministry. Exhibit 27: Spending growth in select Asia-Pacific countries 2019–2027, total market, const US$ Notes: 2019 is included to show the impacts of the pandemic on spending growth. Asia-Pacific excludes China, India and Japan which are shown separately. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES The pandemic’s impact on Asia-Pacific countries varies considerably but a return to steady growth is projected after 2021 Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Nov 2022 Spending growth 2023–27 CAGRs 2027 Spending 25% 20% 15% 10% 5% 0% -5% 25% 20% 15% 10% 5% 0% -5% Asia-Pacific Japan 5.5–8.5% $108–138Bn 2–5% $180–210Bn 4.5–7.5% $21–25Bn 2–5% $16–20Bn -2–1% $71-91Bn 7.5–10.5% $35–39Bn 3.5–6.5% $9–13Bn 7–10% $61–81Bn China India South Korea Australia Indonesia Other Asia-Pacific 2019 2020 2021 2022 2023 2024 2025 2026 2027 2019 2020 2021 2022 2023 2024 2025 2026 2027 2019 2020 2021 2022 2023 2024 2025 2026 2027 2019 2020 2021 2022 2023 2024 2025 2026 2027

34 | The Global Use of Medicines 2023: Outlook to 2027 • Spending growth in Japan is expected to maintain a consistent -2 to 1% growth rate over the next five years as COVID-19 recovery continues and long-term trends affecting long-listed brands continue. • While 2020 had the impact of being a price-cut year on top of the pandemic, the more muted rebound in 2021 included an off-cycle price-cut as well as the lingering effects of the pandemic on the market. • Annual frequency of pricing revisions is expected through the full forecast period, though the annual off-year impacts may be lower than the established biennial price cut years. • Over the past decade, protected brands share of spending has risen from 48% to 54%, reversing a long historical trend where share would decline over time, and reflecting a shift in investment by manufacturers launching earlier in Japan and government focus on enabling earlier access to novel medicines. • Long-listed products have declined from 25% of spending in 2013 to 13% in 2022 and are expected to drop to 9% by 2027. • Generic share of spending is also expected to rise, supported by policies that have been largely effective over this entire 15-year period, encouraging doctors to substitute available generics with a combination of incentives and penalties. • Pharmaceutical spend associated with long-COVID is expected to represent up to an additional 3-5% of spend over the forecast period, declining over time and likely focused in generic and long-listed segments, though the uncertainty in this area will continue. Exhibit 28: Japan medicine spending by product type 2013–2027, constant US$Bn Notes: Medicine spending at ex-manufacturer level, segmented according to Japan-specific product types which differ from segmentations used elsewhere in this report. Price revisions historically have taken effect in April, every other year. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES Japan medicine spending is forecast nearly unchanged over 5 years as innovation is offset by shift to annual price cuts Source: IQVIA Market Prognosis, Sep 2022; IQVIA Japan, Sep 2021; IQVIA Institute, Nov 2022. 68 69 73 74 73 72 74 72 73 73 74 74 74 74 75 420 5-Year CAGRs 5-Year CAGRs 2.0% 3.9% 16.4% 10.3% -5.2% 0.2% 1.1% 2.8% 1.1% -5.4% 0.3% 1.5% -0.1% -8.5% 2.1% 4.3% 1.4% 0.6% 3.5% -1.3% -6.6% 5-Year CAGRs 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 Protected brands Long-listed products Generics NHI others Non-NHI products OTC/others Forecast

iqviainstitute.org | 35 • Medicine spending in China has risen from $93Bn in 2013 to $166Bn in 2022. • Over the past five years spending growth was driven by original branded products, most often from multinational companies, which grew at an average of 10.1% per year to reach 28% of spending in 2022, up from 22% five years earlier. • Over the next five years, the government policies to update the National Reimbursement Drug List (NRDL) annually is contributing to a greater share of new original medicines being reimbursed, resulting in higher levels of spending, though these are generally subject to lower negotiated net prices. • Over the next five years original brands will grow by more than 5% per year, while other types of products will grow at 4% or less, contributing to the overall growth rate slowing to 2–5%. • Non-original brands, including versions of medicines originated by multi-nationals, are the second largest segment of spending in China but are expected to grow by less than 1% per year, partly as a result of a government focus on curbing spending growth in hospitals. • By 2027, China is projected to exceed $194Bn, an increase of almost $30Bn in the next five years. Exhibit 29: China medicine spending by product type 2013–2027 Notes: Original brands are those marketed by their originator (or licensed partner) and includes vaccine products by all manufacturers. Analysis does not include COVID-19 vaccines. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES Spending growth in China is expected to slowly recover post-COVID, driven almost entirely by new original medicines Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Nov 2022. 93 105 113 123 131 137 155 157 163 166 169 175 182 187 194 420 5-Year CAGRs 5-Year CAGRs 9.6% 12.2% 9.1% 7.8% 11.2% 5.0% 10.1% 1.5% 2.8% 8.5% 3.1% 5.7% 0.7% 2.3% 4.3% 5-Year CAGRs 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 Unbranded products OTC & others Non-original brands Original branded products Forecast 200 150 100 50 0 Medicine spending const US$Bn

36 | The Global Use of Medicines 2023: Outlook to 2027 Exhibit 30: Global medicine spending and growth by product type Notes: Developed markets is a term related to World Bank Income bands and includes high-income and upper-middle-income countries. The 10 developed countries are the 10 largest high-income countries (U.S., Japan, Germany, France, Italy, Spain, UK, Canada, Australia, South Korea). Pharmerging includes countries with per capita GDP $1Bn (absolute or rounded) in at least two forecasts. SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES Medicine spending and growth by product type varies by region Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Nov 2022. ORIGINAL BRANDS NON-ORIGINAL BRANDS UNBRANDED GENERICS OTHER TOTAL Spending 2022 US$ Global 902.1 244.5 150.2 185.5 1,482.3 Developed 788.8 109.3 101.0 89.3 1,088.3 10 Developed 722.4 83.9 90.8 71.9 968.9 Other developed 66.4 25.4 10.2 17.4 119.4 Pharmerging 105.7 124.4 47.8 93.0 370.8 Lower-income countries 7.7 10.8 1.5 3.2 23.2 Constant dollar CAGR 2018–2022 Global 6.8% 6.1% 3.0% 5.2% 6.1% Developed 6.6% 7.6% 0.4% 3.6% 5.7% 10 Developed 6.6% 7.7% -0.1% 3.1% 5.7% Other developed 6.2% 7.2% 6.2% 5.8% 6.4% Pharmerging 9.2% 5.0% 10.0% 6.8% 7.2% Lower-income countries 4.4% 5.8% 9.7% 9.2% 6.0% Spending 2027 US$ Global $1,155–1,185 $325–355 $160–190 $215–245 $1,900–1,930 Developed $1,000–1,030 $150–165 $105–115 $98–108 $1,370–1,400 10 Developed $910–940 $117–127 $92–102 $75–85 $1,207–1,237 Other developed $83–103 $34–38 $12–16 $21–25 $156–176 Pharmerging $133–153 $157–177 $62–64 $114–134 $487–518 Lower-income countries $9–11 $12–16 $2-3 $2.5–5.5 $29–33 Constant dollar CAGR 2023–2027 Global 3–6% 5–8% 1–4% 3–6% 3–6% Developed 3–6% 5–8% -1–2% 0.5–3.5% 2.5–5.5% 10 Developed 3–6% 5–8% -1–2% -0.5–2.5% 2.5–5.5% Other developed 4–7% 5–8% 3.5–6.5% 3.5–6.5% 4–7% Pharmerging 5–8% 5–8% 4.5–7.5% 5–8% 5–8% Lower-income countries 4–7% 4–7% 6.5–9.5% 6–9% 4.5–7.5% • The types of medicines driving spending and growth vary considerably across countries broadly correlated with a degree of economic development. • Generally wealthier countries have higher levels of spending on original branded products, especially earlier in the patented periods of these products. • Lower-income countries have a greater reliance on generic drugs, and sometimes prefer non-original branded versions, sometimes called branded generics, and when patent enforcement is less stringent these are referred to as ‘copy products.’ • Developed countries typically have higher shares from original branded products but vary to the degree they shift usage to generics or non-original products after patent expiry, contributing to differences in spending share for originators including those that are off-patent. • Pharmerging and lower-income countries have much lower shares of spending from originator products, with a greater focus on either generics or non-original branded products, and all products typically have lower prices.

iqviainstitute.org | 37 • Global savings from biosimilars will exceed $290Bn in cumulative spending through 2027 — below estimates without new biosimilars. • Specialty medicines will represent 43% of global spending in 2027 and over 55% of total spending in developed markets. • The two leading global therapy areas — oncology and immunology — are forecast to grow 13–16% and 3–6% CAGR, respectively, through 2027. • Oncology is projected to add 100 new treatments over five years, contributing to an increase in spending of $184Bn to a total of more than $370Bn in 2027 and facing limited new losses of exclusivity. • Treatments for autoimmune disorders are forecast to reach $177Bn globally by 2027, driven by steadily increasing numbers of treated patients and new products, and offset after 2023 due to biosimilars. • Diabetes spending growth is slowing to low single digits in most developed markets and declining in some, especially net of rebates. • New therapies contribute to growth of neurology markets, including greater use of novel migraine therapies, potential treatments for rare diseases, and the potential for therapies for Alzheimer’s and Parkinson’s. • The outlook for next generation biotherapeutics includes significantly uncertain clinical and commercial prospects for cell, gene and RNA therapies, which will grow to $27Bn in spending by 2027. Key therapy areas Biotech will represent 35% of spending globally and include both breakthrough cell and gene therapies as well as a maturing biosimilar segment. Major advances are expected to continue, especially in oncology, and immunology. Notable small molecule innovations are also expected in these diseases as well as neurology.

$235Bn

iqviainstitute.org | 39 Exhibit 32: Global savings from biosimilars 2023–2027 Notes: Savings estimated by calculating spending in a scenario where historic trends continue and compared to modeled impact of brand losses of exclusivity and biosimilar uptake. Range reflects uncertainty of the level of uptake, price deflation, and incremental volume after LOE. Modeling includes the impact in the 5-year period of savings from earlier biosimilar introductions. KEY THERAPY AREAS Global savings from biosimilars will have a significant impact on country medicine spending through 2027 Source: IQVIA Market Prognosis, Sep 2022; IQVIA Institute, Nov 2022. Savings Savings high-low range 250 200 150 100 50 0 2023 2024 2025 5-year savings scenarios $383Bn base case ($290–476Bn range) 2026 2027 • Incremental savings from biosimilars are expected to be a cumulative $383Bn globally from 2023 to 2027. • Annual savings could exceed $100Bn in 2026 and 2027 as some of the largest spending biologic molecules will have well developed biosimilar competition for several years by this time. • This level of savings will also likely mean the opening of access to relevant biologic medicines to more people globally, as costs of treating patients for cancer or autoimmune disorders are reduced to affordable levels for patients or governments across all countries. • Incremental usage of biologic therapies has been observed in periods after biosimilar entry, and this is expected to be particularly important in lower-income countries, but the largest savings will still be focused on developed markets, which already have very high levels of usage and spending on the originator versions of these medicines. • Key upcoming biosimilars are expected to reach patients throughout the next five years, but particularly notable are autoimmune therapy adalimumab, currently the world’s leading medicine by spending, with the first biosimilar launching in the U.S in January 2023.

40 | The Global Use of Medicines 2023: Outlook to 2027 • Specialty medicines have been increasing as a share of spending in higher-income countries, such as the 10 largest developed countries and other high and upper-middle-income countries, where they have reached 49% and 39%, respectively, in 2022, up from 28% and 27% 10 years earlier. • Pharmerging countries have lagged behind largely due to cost, and had 16% of spending in 2022 on specialty medicines, expected to be unchanged as a share of spending in 2027. • Globally specialty medicines will be 43% of global spending by 2027, with more than half of spending on these products in major developed markets. • Specialty medicines are those which treat chronic, complex and rare diseases, and while they have a range of characteristics — including the complexity of disease management or distribution — the most commonly noted attribute is that they are more expensive than other more traditional medicines. • As specialty medicine share of spending increases, it is notable that they treat only 2–3% of patients; and while the unmet needs of these few patients are being addressed, by contrast other patients getting traditional therapies are seeing their costs decline. Exhibit 33: Specialty medicines share of spending Notes: For details on specialty medicine definition, see the methodology and definitions section. KEY THERAPY AREAS Specialty medicines will represent about 43% of global spending in 2027 and 56% of total spending in developed markets Source: IQVIA Institute, Nov 2022. 10 developed Other developed Pharmerging Global Forecast 2012 2017 2022 2027 28% 40% 49% 56% 27% 36% 43% 47% 10% 12% 16% 16% 24% 32% 39% 43%

iqviainstitute.org | 41 • The therapy areas with the highest forecast spending in 2027 are oncology, immunology, and anti-diabetics, followed by cardiovascular. • Oncology is expected to grow 13–16% CAGR through to 2027 as novel treatments continue to be launched for the treatment of cancer. • Immunology is expected to grow slowly in the range of 3-6% due to the launch of biosimilars; while several biosimilars are already launched in Europe, leading to slow growth of the immunology segment, the launch of adalimumab biosimilar in 2023 in the U.S. is further expected to impact growth. • With nearly $168Bn by 2027, diabetes is expected to be the third largest therapy area globally, with growth estimated to be 3–6% over the next five years. • Most other therapy areas are expected to grow in low- to mid-single digits through 2027 with the exception of obesity, which is projected to grow from 10 to 13% as highly effective treatments have become available and are expected to gain wider usage across many countries. Exhibit 34: Top 20 therapy areas in 2027 in terms of global spending with forecast 5-year CAGRs, const US$ KEY THERAPY AREAS Oncology and obesity lead growth while immunology slows due to biosimilars, many other classes growing in mid-single digits Source: IQVIA Forecast Link, IQVIA Institute, Nov 2022. 5–Year CAGR 2023–2027 const US$ 2026 spending 13–16% 3–6% 3–6% 1–4% 3–6% 2–5% 2–5% 2–5% 3–6% 0–3% 3–6% 1–4% -1–2% 1–4% 4–7% 1–4% 5–8% -1–2% 10–13% 5–8% 377 177 168 126 92 81 74 58 52 48 42 36 33 31 29 25 20 20 17 15 Oncology Immunology Diabetes Cardiovascular Respiratory CNS Infectious diseases GU sexual health GI products Mental health Pain HIV antivirals Ophthalmology Musculoskeletal Dermatology Blood coagulation Lipid regulators Vaccines ex flu and COVID-19 Obesity Cough Cold incl flu vaccines & antivirals

42 | The Global Use of Medicines 2023: Outlook to 2027 • The biggest contributors to the growth in the next five years are oncologics, immunology, anti-diabetics and obesity drugs, the result of a continuous influx of innovative products and offset by exclusivity losses. • Many therapy areas are expected to grow more slowly in the next five years than in the past five. • Lipid regulators, which have been declining steadily since leading product expiries a decade ago, are expected to return to growth with new therapies for some patients. • Spending growth for vaccines (excluding flu and COVID-19 vaccines) is expected to decline slightly over the next five years as some of the growth in the past five years was from adoption of newer vaccines, which are now more established in usage. • Cough, cold and flu, including flu vaccines, are expected to grow over 5% through 2027 as seasonal respiratory infections are projected to be generally higher. • Nervous system (CNS), musculoskeletal (including pain) and mental health treatments collectively include a range of neurology treatments where patent expiries will offset growth from novel therapies. Exhibit 35: Global historic and forecast growth for top 20 therapy areas Notes: COVID vaccine and therapeutics are not included. Oncology and obesity plotted separately. KEY THERAPY AREAS Oncology and obesity to lead growth through 2027 while immunology and diabetes growth to slow Source: IQVIA Forecast Link, IQVIA Institute, Nov 2022. $350Bn $100Bn $25Bn 10% 15% 20% 10% 12% 14% 16% 18% 20% Size of bubble: Spending in 2027 Historic 5-yr CAGR 2017–2022 Historic 5-yr CAGR 2017–2022 Forecast 5-yr CAGR 2022–2027 -5% 0% 5% 10% -5% 0% 5% 10% 15% Forecast 5-yr CAGR 2022–2027 30% 35% 40% 40% 42% 44% 46% 48% 50% Forecast 5-yr CAGR 2022–2027 Immunology Diabetes Cardiovascular Respiratory CNS Infectious diseases GU sexual health GI products Mental health Pain HIV antivirals Ophthalmology Musculoskeletal Dermatology Blood coagulation Lipid regulators Vaccines ex flu and COVID-19 Cough cold incl flu vaccines and antivirals Oncology Obesity

$184Bn

24% (3-6% CAGR) 30 35 42 52 62 73 83 95 108 125 143 154 163 168 172 177

iqviainstitute.org | 45 • Diabetes spending in developed markets reflects both the consistent use of older therapies as patients’ Type 2 disease progresses, and the adoption of novel therapies later in the treatment pathway. • The key element in assessing trends in diabetes is that net revenue in the U.S. is currently 60% lower than invoice level, with that percentage projected to reach 75% lower than invoice by 2027. • As the U.S. Inflation Reduction Act will cap patient out of pocket costs at $35, the combined effects of payer negotiations and market competition are expected drivers of this increasing level of gross to net differences. • The estimate of U.S. net spending provides a more comparable trend to the other developed markets and embeds the significant impacts in recent years (and projected to 2027) from rising discounts and rebates. • Other countries may have important off-invoice discounts and rebates, though these are thought to be lower than in the U.S. Exhibit 38: Diabetes spending and growth Notes: Estimates of U.S. net manufacturer revenues based on comparisons of IQVIA audits to company-reported net spending in the U.S. (see Methodology). Ex-U.S. spending has not been adjusted to an estimate of net level as company net spending is not reported on a country-by-country basis and estimates can only be based on less reliable methods. KEY THERAPY AREAS Diabetes spending growth in low single-digits in most developed markets with declines in some, including the U.S., on net basis Source: IQVIA Institute, Nov 2022. Invoice to net adjustment Net manufacturer revenues Forecast Forecast % Net sales adjustment 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 0% 10% 20% 30% 40% 50% 60% 70% 80% 0 20 40 60 80 100 120 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 % Net sales adjustment Net manufacturer revenue and estimated difference to invoice spending US$Bn Diabetes spending: U.S. estimated net spending and discount to invoice Diabetes spending in developed markets const US$Bn -6– -3% 1–4% -1–2% -2–1% -2–1% 4–7% 4–7% 0–3% 2–5% -1–2% 5-Year CAGR 2022–2026 const US$ UK Italy Germany Korea Canada Australia France Spain Japan U.S. est. (net)

$37.6Bn Range of scenarios

iqviainstitute.org | 47 • In the last five years, a new wave of rare disease neurological treatments, including dozens with orphan designations, have been approved; other diseases with larger populations such as migraine, depression and anxiety have also seen a range of new treatments approved and launched. • Expected spending growth in mental health areas is generally lower than in neurology treatments, but both reflect levels of innovation for unmet needs across these diseases. • New mental health treatments are generally focused on specific subsets of patients, and older established therapies continue to be used for most patients. • Migraine treatments have seen significant shifts with the introduction of CGRP inhibitors and these are expected to continue to drive growth through the forecast period. • The historic lack of disease-modifying treatments in Alzheimer’s and Parkinson’s may begin to be addressed with new approvals, including adacanumab (Aduhelm), which launched in 2021 and lecanemab, which could be approved in 2023. • Recent scientific advances in genomics, biomarkers, diagnostics, and imaging techniques and/or regenerative medicine, combined with the emergence of disruptive digital technologies, are changing the fundamentals of CNS innovation. Exhibit 40: Leading CNS disorders global market growth dynamics Notes: Migraine therapies are included in this analysis while otherwise indicated as pain management in this report. KEY THERAPY AREAS New therapies in rare neurological disorders, Alzheimer’s, and migraine are expected to drive spending growth in neurology Source: IQVIA Forecast Link, IQVIA Institute Nov 2022. -5% 0% 5% 10% 15% -15% -10% -5% 0% 5% 10% 15% 20% 25% 30% Global % CAGR const US$ 2017–2022 Global % CAGR const US$ 2022–2027 $25Bn $10Bn $2Bn Size of Bubble: Spending in 2027 Alzheimer's Anxiety/Depression ADHD Schizophrenia/Bipolar Epilepsy Gout Other Pain Other CNS Migraine Multiple Sclerosis Parkinson's

48 | The Global Use of Medicines 2023: Outlook to 2027 • In addition to the 30 cell, gene or RNA-based therapies launched globally to date, an additional 55–65 are expected to be launched by 2027, with a dozen new per year on average, up from the average of three per year in the past five years. • While there is considerable R&D activity related to these mechanisms of action, there remains significant uncertainty about the emergence of safety risks and the pace of clinical trials and regulatory reviews. • Total global spending to date has reached $8Bn and is expected to rise to $27Bn by 2027, but with the potential for both higher or lower scenarios. • Usage of these medicines and the associated spending to date has been relatively limited for most of the products, with a few driving larger amounts of spending, as they have been in very rare diseases. • Many of these therapies have very high costs, which combined with uncertain numbers of patients is generating significant attention and resistance from payers and dampens expected spending levels in the lower end of expectations. • Health technology assessments (HTAs) are likely to limit access and/or prices especially in Europe, while clinical complexity is likely to limit adoption of cell and gene therapies to highly specialized clinics or hospitals in developed markets. • Even considering the large number of these products, they are not expected to be more than 20% of the estimated 300 new drugs launched in the period and are expected to be less than 15% of the spending on new drugs in the next five years in the base case. Exhibit 41: Cell, gene and RNA therapeutics Notes: Spending estimates based on company financials and IQVIA audited data to address potential underreporting of therapies with unique distribution methods. RNA excludes mRNA vaccines. KEY THERAPY AREAS The outlook for next generation biotherapeutics includes significantly uncertain clinical and commercial successes Source: Company Financials; IQVIA Institute Nov 2022. Base case Range of scenarios 0 10 20 30 40 50 60 70 80 90 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 Global spending constant US$Bn