The pharmaceutical industry saw major consolidation in 2009 through large mergers and acquisitions that reshuffled the rankings of the top pharma companies. Pfizer emerged as the clear number one company after acquiring Wyeth. Merck's merger with Schering-Plough will likely make it the number four company in 2010. Growth through M&A is expected to continue as companies seek new drugs and markets, and the largest pharma companies are approaching $40 billion in annual revenue. Emerging markets are becoming increasingly important as their drug spending catches up to traditional markets.

1. 68 PHARMACEUTICAL EXECUTIVE
Megamergers shook up the industry in 2009, shuffling the deck
of pharma’s top companies. Find out which companies emerged on
top, who might be next, and how those best positioned to weather
a challenging business environment are poised to rip the rankings
apart over the next few years
By Patrick Clinton and Mark Mozeson

2. MAY 2010 www.pharmexec.com 69
The PHARM EXEC 50
T
he Pharm Exec 50 ranks the world’s largest pharmaceutical companies by
global sales of prescription drugs. The most striking theme in this year’s list 1. Pfizer
is the continued pace of sector consolidation: many companies have disap- 2. Sanofi -Aventis
peared from the list as a result of mergers over the course of 2009. And not just 3. Novartis
smaller companies: Wyeth, last year’s number 10, is now part of Pfizer, providing 4. GlaxoSmithKline
our almost perennial number one company with a solid entrée into biologics and 5. Roche
vaccines as well as a return to OTC medicines. Schering-Plough (last year’s num- 6. AstraZeneca
ber 15) has been combined in a reverse merger with Merck, creating a company 7. Merck
that should rise to the number-four slot next year, with Rx revenues of about 8. Johnson & Johnson
$40 billion. Genentech (19) was acquired by Roche, and Solvay (32) by Abbott, 9. Eli Lilly
while Procter & Gamble’s pharmaceutical unit (39) has become part of Warner- 10. Bristol-Myers Squibb
Chilcott, an Irish firm that has never appeared on the 50 before—but will jump 11. Abbott
to the middle of the list next year thanks to P&G’s Avonex business. 12. Bayer
Growth by acquisition is not always a sign of strength, of course, and it 13. Boehringer Ingelheim
doesn’t always feed into continued organic growth. The track record of the in- 14. Amgen
dustry is mixed when it comes to mergers, but in the current climate, with new 15. Takeda
drug approvals slowing to a trickle, the merger wave is far from over. Where in 16. Teva
recent years, Pharma M&A has been dominated by mid-size deals and “bolt- 17. Novo Nordisk
on” acquisitions, the transformational deals of the past year seem likely to 18. Astellas
inspire renewed interest in mega-mergers. “Big Pharma” is getting bigger, and 19. Daiichi Sankyo
the question is whether it makes sense to try to keep up. 20. Otsuka
Meanwhile, the next round of mergers has already begun, with Novartis 21. Eisai
prepared to take on ophthalmology specialist Alcon (this year’s number 38), 22. Merck KGaA
bringing the Swiss giant to the $40 billion Rx revenue range, and giving the 23. Gilead Sciences
company additional reach into a growing field. And Teva (number 16) contin- 24. Baxter International
ues to merge its way up the list. This year’s target was Germany’s Ratiopharm 25. Mylan
(42, after an abysmal year). Look for the world’s largest generics company to 26. Servier
close in on a top-ten spot within the next year or two. 27. Chugai
Look, too, for the largest pharma companies to hit a new revenue bench- 28. Genzyme
mark. It’s not quite visible in this year’s figures, but once the impact of mergers 29. Mitsubishi Tanabe
is taken into consideration, five of the top six pharma companies have revenues 30. UCB
hovering around $40 billion, with Pfizer leaping ahead to more than $60 bil- 31. CSL
lion. Ten years ago, the smallest companies on the 50 had revenues in the $500 32. Allergan
million range. Today, all but four brought in $2 billion or more. Revenue rank- 33. Forest
ings will also be influenced by the success of some companies in large biologi- 34. Menarini
cals, which appear set to replace small molecule drugs like Lipitor as top sellers 35. Nycomed
within the next few years. 36. Biogen Idec
Finally, look for companies to respond aggressively to the most important 37. Shire
piece of pharma news in recent years: Sales in emerging markets, which have 38. Alcon
been growing at a faster rate than sales in established markets, have finally 39. Apotex
caught up. According to IMS Health, over the next five years the “pharmerg- 40. Lundbeck
ing” markets will generate as many new dollars in pharma sales as the tradi- 41. Celgene
tional markets. Though there’s considerable variation, pharma companies have 42. Ratiopharm
been investing in emerging markets for several years—not just in the “BRIC” 43. Cephalon
countries (Brazil, Russia, India, China), but in an expanded roster of countries 44. Dainippon Sumitomo
including Saudi Arabia, Vietnam, Chile, Venezuela, Malaysia, Thailand, Tur- 45. Hospira
key and Mexico. These countries present many challenges, including getting 46. Watson
drugs approved, building distribution systems, protecting intellectual prop- 47. Actavis
erty, and pricing. But given the sharp trend toward further cost containment in 48. Shionogi
the US, Japan and Europe, it is hard to turn away from such an opportunity, 49. Kyowa Hakko Kirin
no matter what the difficulty. 50. Meda

3. 70 PHARMACEUTICAL EXECUTIVE MAY 2010 www.pharmexec.com
The Pharm Exec 50
Rank Company & Headquarters [website] 2009Rx Sales (Billions 2009 R&D spend 2009 Top-Selling Drugs
[2009 Rank] of USD) [change from 2008] (Millions of USD) [Billions of USD]
Lipitor [11.4]
Pfizer
1 [1] New York, New York [pfizer.com]
$45.4 [2.7%] $7845 Lyrica [2.8]
Celebrex [2.4]
Lantus [4.4]
Sanofi -Aventis
2 [3] Paris, France [sanofi -aventis.com]
$42.0 [8.5%] $6567 Lovenox [4.4]
Plavix [3.8]
Diovan/Co-Diovan [6.0]
Novartis
3 [4] Basel, Switzerland [novartis.com]
$38.4 [6.7%] $6308 Gleevec/Glivec [3.9]
Zometa [1.5]
Seretide/Advair [7.9]
GlaxoSmithKline
4 [2] Brentford, England [gsk.com]
$37.8 [26.1%] $6286 Valtrex [2.1]
Pandemic flu vaccine [1.4]
Avastin [6.0]
Roche
5 [8] Basel, Switzerland [roche.com]
$37.6 [78.9%] $8570 MabThera/Rituxan [5.9]
Herceptin [5.1]
Nexium [5.0]
AstraZeneca
6 [6] London, England [astrazeneca.com]
$32.8 [3.8%] $4409 Seroquel [4.9]
Crestor [4.5]
Merck Singulair [4.7]
7 [7] Whitehouse Station, New Jersey
[merck.com]
$25.2 [6.9%] $5845 Corzaar/Hyzaar [3.6]
Januvia [1.9]
Remicade [4.3]
Johnson & Johnson
8 [6] New Brunswick, New Jersey [jnj.com]
$22.5 [-8.5%] $4591 Procrit/Eprex [2.2]
Levaquin/Floxin [1.6]
Zyprexa [4.9]
Eli Lilly
9 [9] Indianapolis, Indiana [lilly.com]
$21.2 [9.7%] $4300 Cymbalta [3.1]
Humalog [2.0]
Plavix [6.1]
Bristol-Myers Squibb
10 [11] New York [bms.com]
$18.8 [6.3%] $3647 Abilify [2.6]
Reyataz [1.4]
Note about the listings: Companies ed in 2009. For most American and US dollars, we have converted their
in the Pharm Exec 50 are ranked ac- European pharmaceutical companies, numbers using the average interbank
cording to global human prescription that means the year ending December rate for the last day of the fi scal year.
drug sales. As far as company docu- 31, 2009; for most Japanese compa- Some charts that appear in this arti-
mentation allows, generics and vac- nies, it means the year ending March cle are based on numbers from IMS.
cines are included; over-the-counter 31, 2009. In the case of private compa- These are calculated differently from
products, royalties, and contract man- nies that do not report results, we have our sales figures. Percentage growth
ufacturing are not. In most cases, num- relied on outside estimates, including figures should be treated with caution,
bers are taken from annual reports or IMS reports. For companies that re- as they can be affected by fluctuating
SEC fi lings for the fi scal year that end- port revenue in currencies other than exchange rates.
*Estimate About the Authors: Patrick Clinton is marketing director, Health & Life Sciences, Oliver Wyman. He can be
reached at patrick.clinton@oliverwyman.com. Mark Mozeson is partner, Health & Life Sciences, Oliver
Wyman. He can be reached at mark.mozeson@oliverwyman.com

4. 72 PHARMACEUTICAL EXECUTIVE MAY 2010 www.pharmexec.com
Abbott
11 [12] Abbott Park, Illinois [abbott.com]
$15.6 [-6.7%] $2744 Humira [5.5]
Bayer Yaz/Yasmin/Yasminelle
12 [13] Leverkusen, Germany [bayer.com]
$15.0 [-0.7%] $2253 [1.8]
Boehringer Ingelheim
13 [16] Ingelheim, Germany
[boehringer-ingelheim.com]
$14.4 [12.3%] $3010 Spiriva [3.4]
Amgen
14 [14] Thousand Oaks, California
[amgen.com]
$14.4 [-2.4%] $2864 Neulasta/Neupogen [4.6]
Takeda
15 [17] Osaka, Japan [takeda.com]
$14.2 [16.6%] $4657 Pioglitazone [4.0]
GLOBAL PHARMACEUTICAL SALES BY REGION, 2009
SOURCE: IMS Health
Percent of Global Sales Market 2009 Sales (US$B) % Growth from 2008
North America $323.8 1.9%
Europe $263.9 7.0%
Asia/Africa/Australia $106.6 15%
Japan $95.0 2.1%
Latin America $47.8 12.7%
30.6
39.8
12.7
11.2
5.7
TOP 15 U.S. PHARMACEUTICAL PRODUCTS BY SALES
US Prescription sales Total US Prescription Market
1 Lipitor
US$ in Billions
7.5
grew by 2
3
4
Nexium
Plavix
Advair Diskus 4.7
5.6
6.3
5.1 percent 5
6
7
Seroquel
Abilify
Singulair 3.7
4.2
4.0
to approximately 8 Actos 3.4
SOURCE: IMS Health
9 Enbrel 3.3
$300 billion 10
11
12
13
Epogen
Remicade
Crestor
Avastin
3.0
3.0
3.2
3.2
14 Neulasta 3.0
15 Oxycontin 2.9
Teva
16 [18] Petach Tikva, Israel [tevapharm.com]
$13.9 [25.2%] $802 Copaxone [2.8]
Novo Nordisk
17 [22] Bagsvaerd, Norway [novonordisk.com]
$9.8 [14.4%] $1521 Insulin analogs [4.1]
Astellas
18 [20] Tokyo, Japan [astellas.com]
$9.8 [1.4%] $1635 Prograf [2.1]
Daiichi Sankyo
19 [21] Tokyo, Japan [daiichisankyo.com]
$8.1 [-7.5%] $1897 Olmesartan [2.2]
Otsuka
20 [25] Tokyo, Japan [otsuka-global.com]
$7.9 [21.1%] N/A N/A

5. 74 PHARMACEUTICAL EXECUTIVE MAY 2010 www.pharmexec.com
Eisai
21 [24] Tokyo, Japan [eisai.co.jp]
$7.8 [8.7%] $1605 Aricept [3.2]
Merck KGaA
22 [23] Darmstadt, Germany [merck.de]
$7.7 [0.8%] $1724 Rebif [2.2]
Gilead Sciences
23 [28] Foster City, California [gilead.com]
$6.5 [26.8%] $940 Truvada [2.5]
Baxter International
24 [26] Deerfield, Illinois [baxter.com]
$5.6 [5.2%] $917 Advate [1.5]
Mylan
25 [29] Canonsburg, Pennsylvania [mylan.com]
$4.8 [11.4%] *
$275 Generics [N/A]
Mergers have been a clear
TOP GLOBAL THERAPEUTIC CLASSES, 2009 part of the growth strategy
Therapeutic Class 2009 Sales (US$M) % Growth from 2008 of the top ten pharmas.
Oncologics $52,372 8.8 Easily visible in the chart
Lipid Regulators $35,281 4.9
Respiratory Agents $33,596 11.0 below are Pfizer’s merg-
Antidiabetics $30,406 13.4 ers with Warner Lambert
Anti-ulcerants $29,610 0.6
Antiotensin II Antagonists $25,209 11.5
(completed in 2000, with
Antipsychotics $23,248 4.6 results appearing in the
Antidepressants $19,416 -1.3 2001 Pharm Exec 50) and
SOURCE: IMS Health
AutoImmune agents $17,961 18.0
Platelet Aggr. Inhibitors $14,604 9.0 Pharmacia (with revenue
HIV Antivirals $13,758 14.9 jumping up in 2005).
Anti-epileptics $12,995 -19.8 Other key mergers during
Narcotic analgesics $11,235 8.6
Non-narcotic analgesics $11,174 7.3 the period include Sanofi
Eythropoietins $10,806 -4.1 Synthelabo with Aventis,
Novartis with Chiron, Glaxo
Wellcome with SmithKline
Beecham, and Roche with
TEN YEARS OF THE 2010 TOP 10 Genentech.
50
45
Prescription drug revenue
40
in billions of USD
35
30
25
20
15
10
5
0
Pfizer Aventis Novartis GSK Roche AstraZeneca Merck J&J Lilly BMS
Servier
26 [27] Neuilly-sur-Seine [servier.com]
$4.6 [-10.9%] *
N/A N/A
Chugai
27 [35] Tokyo, Japan [chugai-pharm.co.jp]
$4.3 [23.1%] $599 Tamiflu [0.8]
Genzyme
28 [31] Cambridge, Massachusetts
[genzyme.com]
$4.1 [-2.9%] $856 Cerezyme [0.8]
Mitsubishi Tanabe
29 [34] Osaka, Japan [mt-pharma.co.jp]
$3.9 [9.1%] $751 Remicade [0.4]
UCB
30 [30] Brussels. Belgium [ucb.com]
$3.8 [-10.6%] $966 Keppra [1.3]

6. 76 PHARMACEUTICAL EXECUTIVE MAY 2010 www.pharmexec.com
CSL
31 [38] Victoria, Australia [csl.com.au]
$3.7 [9.4%] $251 Gardasil [0.1]
Allergan
32 [36] Irvine, California [allergan.com]
$3.7 [5.3%] $706 Botox [1.3]
Forest
33 [37] New York, New York [frx.com]
$3.6 [3.9%] $661 Lexapro [2.3]
Menarini
34 [41] Florence, Italy [menarini.com]
$3.6 [16.1%] *
N/A N/A
Nycomed
35 [40] Zurich, Switzerland
$3.5 [0.9%] $285 Pantaprazole [N/A]
THE TOP TEN POST-MERGER
Pfizer + Wyeth
Sanofi-Aventis
Major mergers are reshaping the top ten.
This chart shows the impact recent and
Novartis + Alcon
recently announced mergers would have had
on the top ten if they’d taken place January
Merck +
Schering-Plough 1, 2008. Pfizer leaps forward, Merck jumps
from seventh place to fourth. Roche (which
GlaxoSmithKline + reported a full year of Genentech revenue)
Stiefel
moves from eighth place in 2009 to sixth.
(This chart omits several minor mergers.)
Roche + Genentech Even without additional mergers, Pharma’s
Top Six should all have revenues of $40 bil-
AstraZeneca lion and up.
Johnson & Johnson
SOURCE: Oliver Wyman
Eli LIlly
2009 pro forma
2009 actuals
Bristol-Myers Squibb
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0
Biogen Idec
36 [42] Cambridge, Massachusetts
[biogenidec.com]
$3.2 [12.6%] $1283 Avonex [2.3]
Shire
37 [43] Dublin, Ireland [shire.com]
$2.7 [-3.8%] $638 Adderall [0.6]
Alcon
38 [44] Hünenberg, Switzerland [alcon.com]
$2.7 [3.0%] $665 Glaucoma products [1.1]
Apotex
39 North York, Ontario [apotex.com]
$2.6 [74.3%] *
N/A Generics [N/A]
Lundbeck
40 [45] Copenhagen, Denmark [lundbeck.com]
$2.6 [23.5%] $615 Cipralex/Lexapro [1.5]

7. 78 PHARMACEUTICAL EXECUTIVE MAY 2010 www.pharmexec.com
The Top 10: The Year In Review
Pfizer Acquired Wyeth in $68 billion Roche Completed $47 billion acquisi- Johnson & Johnson Acquired
deal, giving company entrée to the vac- tion of Genentech. Fifty-nine new molec- Elan’s rights and assets in the Al-
cines and (again) consumer products ular entities in clinical testing, including zheimer’s Immunotherapy Program, a
markets. Launched Toviaz for overactive eight in Phase III/registration. Actemra/ joint venture with Wyeth, Completed
bladder in the US. Prevnar 13 approved RoActemra for rheumatoid arthritis ap- acquisition of Cougar, a biotech with
in 40 countries. 133 R&D programs, proved in EU (and in January 2010 in a Phase III drug for metastatic pros-
Phase I through registration. Created the US). Signed 51 new research/tech- tate cancer. Launched Nucynta, a nov-
regenerative medicine unit, and signifi- nology deals, including a partnership el oral drug for chronic pain, co-de-
cantly boosted licensing partnerships. with Tekmira Pharmaceuticals to bring veloped with Gruenenthal. Simponi, a
Roche’s first RNA interference products monthly, injectable anti-TNF drug for
into human testing. rheumatoid arthritis, approved in the
US, EU, and Canada.
Sanofi-Aventis Multiple acquisitions
of generics companies including Medley
(Brazil’s largest), Kendricks (Mexico), AstraZeneca Launched Onglyza (for
and Zentiva (Czech republic). Announced diabetes) in the US & EU. Launched Ir- Eli Lilly Launched translational
purchase of Chattanooga-based OTC essa for non-small cell lung cancer in medicine unit and opened new biotech
company Chattem for $1.9 billion. Ac- the EU after having withdrawn its ap- center in San Diego. Adcirca (with
quired Oenobrol, French maker of nu- plication in 2005 Divested portfolio of the same active ingredient as Cialis—
tritional beauty supplements. Launched over-the-counter products. Submitted tadalafil) approved for pulmonary ar-
Multaq, anti-arrhythmia drug, in US, EU, US NDA for ticagrelor (tentatively to be terial hypertension in the US, EU, and
and Canada. known as Brilinta) an oral antiplatelet Japan. Co-promotion deal with Kowa
treatment. Announced acquisition of for the statin Livalo. Effient, an anti-
infection-research company Novexel platelet agent co-developed with Dai-
and expanded anti-infective partnership ichi-Sankyo, approved in the US.
Novartis Joe Jimenez appointed new with Forest.
CEO. Approvals include Afinitor (for
renal cell cancer), Ilaris (cryopyrin-as-
sociated periodic syndromes), Onbrez Bristol-Myers Squibb Acquired
Breezhaler (EU, for COPD), Valturna (hy- Merck Merged with Schering-Plough the shares it did not already own of
pertension). Acquired EBEWE Pharma’s in $41 billion deal. Announced acquisi- Medarex, a biotech focused on fully
specialty generics business. 145 projects tion of Avecia, a contract manufacturer human monoclonal antibody drugs
in clinical development. Launched bi- of biologics. Divested itself of its stake for cancer, autoimmune diseases, in-
osimilars in Japan and Canada. in Merial, an animal health joint ven- flammation, and infection. Divested
ture with Sanofi-Aventis. In April, struck holdings in Mead Johnson Nutrition,
ground-breaking, much-discussed deal completing a transition toward pure-
with the health insurer Cigna over dia- play pharma. Onglyza (a drug for Type
GlaxoSmithKline Product approvals betes drugs Januvia and Janumet, pro- II diabetes, developed and marketed
include Votrient, an oral medication for viding bigger discounts to the plan for with AstraZeneca) approved. Entered
renal cell cancer. Launched Arzerra (for achieving better patient results. partnerships with ZymoGenetics, Nis-
refractory chronic leukocytic leukemia) san Chemical Industries, Teijin Phar-
in the US. Filings include Benlysta, poten- ma, Adler Biopharmaceuticals.
tially the first new drug for lupus in more
than 60 years. Acquired Stiefel, a specialty
dermatology company with revenues of
$900 million. With Pfizer created ViiV,
specialty company dedicated to HIV.

8. 80 PHARMACEUTICAL EXECUTIVE MAY 2010 www.pharmexec.com
TOP 15 GLOBAL PRODUCTS, 2009
Product
1
2
Lipitor
Plavix
2009 Sales (US$M)
$9,100
$13,288 In 2009, there were 29
3
4
5
Nexium
Seretide
Seroquel $6,012
$8,236
$8,099 mergers & acquisitions
6
7
Enbrel
Remicade
$5,863
$5,453
in the pharmaceutical industry
8 Crestor $5,383
SOURCE: IMS Health
9
10
11
Zyprexa
Humira
Avastin
$5,357
$5,032
$5,015
worth $126.5 billion
12
13
Singulair
Mabithera
$4,986
$4,681 That compares with
14
15
Abilify
Lovenox
$4,673
$4,572
48 mergers & acquisitions
worth $51.1 billion in 2008
REVENUE DISTRIBUTION, THE TOP 50
50.0
45.0 Revenue continues to
40.0 be concentrated in the
Prescription drug revenue
35.0 largest companies. In this
in billions of USD
30.0 year’s Top 50, the Top 10
SOURCE: Oliver Wyman
25.0 accounted for just under
20.0 60 percent of revenue,
15.0 while the top 20 were
10.0 responsible for about 80
5.0 percent of sales.
0.0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49
Ranking
Celgene
41 Summit, New Jersey [celgene.com]
$2.6 [20.1%] $471 Revlimid [1.7]
Ratiopharm
42 [33] Ulm, Germany [ratiopharm.com]
$2.4 [-35.4%] N/A Generics [N/A]
Cephalon
43 [47] Frazer, Pennsylvania [cephalon.com]
$2.2 [13.2%] $395 Provigil [1.0]
Dainippon Sumitomo
44 [46] Osaka, Japan [ds-pharma.co.jp]
$2.1 [1.2%] $543 Amlodin [0.6]
Hospira
45 [48] Lake Forest, Illinois [hospira.com]
$2.1 [15.2%] $241 N/A
Watson
46 [49] Corona, California [watson.com]
$2.0 [13.1%] $197 CNS generics [0.8]
Actavis
47 [50] Hafnarfjörður, Iceland [actavis.com]
$1.8 [0.9%] * N/A Generics [N/A]
Shionogi
48 Osaka, Japan [shionogi.co.jp]
$1.8 [-0.7%] $543 Crestor [0.2]
Kyowa Hakko Kirin
49 Tokyo, Japan [kyowa-kirin.com.jp]
$1.7 [55.7%] $497 Espo/Nesp [0.4]
Meda
50 Solna, Sweden [meda.se]
$1.7 [34.3%] N/A Astelin [0.2]