March 30, 2015 Companies: ACT, AZN, BIIB, HSP, MYL, NVS, PFE, SLXP, TSE:VRX, TLV:TEVA

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Teva’s Long-Term Success Will Depend on Strategic Acquisitions

REPORT Linda Richards, lr@blueshiftideas.com

Summary of Findings

Eleven sources who commented offered mixed responses on the

likelihood of Teva Pharmaceutical Industries Ltd. (TLV:TEVA)

overcoming its growing competition as well as the patent cliff for its

Copaxone, an injectable multiple-sclerosis (MS) treatment. Some

said Teva likely will tackle these issues, while others said it would

do so only through strategic acquisitions and co-developments.

Teva’s generic Nexium and the impressive patient conversion rate

to its 40-mg, thrice-weekly Copaxone in the United States will allow

it to weather the release of Mylan Inc.’s (MYL) generic Copaxone

injectable. Pushback by PBMs will vary. Many sources expect Teva

to offer significant rebates to minimize share loss.

Teva CEO Erez Vigodman’s initiatives are viewed as mostly

successful. Thirteen sources described Teva as powerful and

innovative, while three noted a loss in strength for the company.

Five sources said Teva’s pipeline is strong, while four said it is

promising but lacks a blockbuster. Teva’s move into other

injectable products and biosimilars should boost its growth.

Teva’s challenges include pricing pressure from government

scrutiny both in and out of the United States. Sources were mixed

regarding the threat from Pfizer Inc.’s (PFE) acquisition of Hospira

Inc. (HSP), and said competition stems from Biogen Inc.’s (BIIB)’s

oral MS drug Tecfidera, along with Mylan and Actavis plc (ACT).

Seven sources forecast higher generic sales for Teva this year, one

UK source cited lower sales related to regulatory issues, and two

distributors said their Teva orders can vary much based on pricing.

Unlike Blueshift Research’s Jan. 31, 2014, findings, sources more

recently were unaware of employee morale issues at Teva.

Teva’s

Initiatives

Effective

Teva’s

Generic

Sales 2015

Acquisitions

Key to Teva’s

Success

Pharma Distributors,

Executives

Competitors

PBM Executives

N/A

Industry Specialists

Research Question:

Will Teva’s growth initiatives be enough to overcome the Copaxone patent cliff and

increasing generic drug competition?

Silo Summaries

1) Pharmaceutical Distributors and Pharmacy

Executives Five of these seven sources are in the United States,

and are mostly positive about Teva’s growth

initiatives, but four also said Teva must seek out

major acquisitions and co-developments to overcome

the Copaxone patent cliff and the increase in its

competition. The three U.S. sources who commented

on Teva’s 2015 generic sales predicted an increase,

while two cited great variability in their own

companies’ Teva product purchases because of price

fluctuations. Teva’s generic version of Nexium holds

the most potential.

2) Teva Competitors Four of these six sources represent U.S. competitors,

including two who said Teva will have trouble

overcoming the patent cliff and competition in the

long term if it does not introduce significant products.

Of the two non-U.S. sources, one said Teva has lost

share in the United Kingdom because of regulatory

issues, while one said the company faces pricing

challenges in Switzerland. Sources said Teva remains

a strong leader, but two said it has lost some power.

Teva’s generic Nexium carries high potential.

3) PBM Executives These four sources said PBMs will vary in their efforts

to convert patients to the generic Copaxone and will

take rebates from Teva into account. Most were

unsure of Teva’s ability to overcome the patent cliff,

but said the company is a strong, savvy player.

Government scrutiny may slow generic drug price

increases. Oral MS drug manufacturers pose the

biggest threat to Teva.

4) Industry Specialists These six sources offered mixed responses regarding

Teva’s ability to weather its Copaxone patent cliff and

its increased competition. One said Teva is well

situated to benefit from company initiatives, while

three others said Teva’s success will depend on

retaining Copaxone patients or making other major

acquisitions. Two of four expect higher proprietary

and generic sales for Teva this year. Several sources,

including two MS experts, reported being impressed

so far with the conversion rates of patients to Teva’s

40-mg, thrice-weekly Copaxone.

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Teva Pharmaceutical Industries Ltd.

Background

Teva’s fourth-quarter revenue fell by 4%, but its earnings were slightly ahead of estimates and the company maintained its

2015 outlook. Although its generic drug revenues fell by nearly 8% in the fourth quarter, the sector’s profitability rose by a

healthy margin because of the company’s aggressive cost-reduction efforts. Also, Teva’s injectable MS drug Copaxone saw

revenue decline because of competition from recently introduced oral drugs, but its results still beat Wall Street expectations.

Congress has gotten involved with generic price increases, with a subcommittee sending letters to Teva and 13 other generic

drug manufacturers.

Since February 2014, Teva has been under the direction of CEO Erez Vigodman, who has focused on cost cutting and profit

enhancement. Vigodman also has laid out a plan that includes reorienting the company toward inorganic growth, focusing on

business development, pursuing complex generic and specialty drugs, launching seven new generics in 2015, and

maintaining as many Copaxone patients as possible.

Copaxone, which makes up 21% of Teva’s sales and 50% of its profits, is facing the end of patent protection in September

2015. Generic drugs could put heavy pressure on Copaxone as generic small molecule drugs usually capture 70% to 90% of

the market share from the original brand. Teva is engaging in a legal strategy to protect the patent from early elimination. In

addition, it secured FDA approval for a new, longer-acting formulation and is aggressively converting patients to the thrice-

weekly Copaxone. To date, it has converted 63% of its patients and has secured 25.9% of newly diagnosed MS patients. In

2017 Teva settled a deal in order to offer a generic Viagra two years early by paying Pfizer Inc. (PFE) royalties.

Blueshift Research’s Jan, 31, 2014, report found sources were optimistic about Teva’s future and Vigodman’s ability to lead a

company turnaround. Sources highlighted Teva’s strong generic drug portfolio, rich pipeline and reformulated Copaxone as

strengths. Teva’s challenges included converting patients to the thrice-weekly Copaxone, improving employee morale, and

dealing with healthcare reform.

Current Research In this next study, Blueshift Research assessed whether Teva’s growth initiatives would be enough to overcome the Copaxone

patent cliff and increasing competition. We employed our pattern mining approach to establish five independent silos,

comprising 23 primary sources (including 13 repeat sources) and seven secondary sources focused on the rising costs of

generic drugs, drug company regulations in Europe, and feedback on Teva’s new 40-mg, thrice-weekly Copaxone:

1) Pharmaceutical distributors and pharmacy executives (7, including 2 not in the United States)

2) Teva competitors (6, including 2 not in the United States)

3) PBM executives (4)

4) Industry specialists (6)

5) Secondary sources (7)

Next Steps

Blueshift Research will monitor Teva’s growth initiatives, including acquisitions and product co-developments, and its product

approvals and launches. We also will research the adoption rate of the 40-mg Copaxone and the effects of generic Copaxone

use on Teva’s brand-name version.

Silos

1) Pharmaceutical Distributors and Pharmacy Executives Five of these seven sources are in the United States, and are mostly positive about Teva’s growth initiatives, but four also said

Teva must seek out major acquisitions and co-developments to overcome the Copaxone patent cliff and the increase in its

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Teva Pharmaceutical Industries Ltd.

competition. The three U.S. sources who commented on Teva’s 2015 generic sales predicted an increase, while two cited

great variability in their own companies’ Teva product purchases because of price fluctuations. Teva’s generic version of

Nexium holds the most potential in the company’s relatively strong pipeline. One source each in Finland and Canada

described Teva is a strong, competitive company, but said pricing will depend on legislation.

Key Silo Findings Teva’s Overall Performance

- All 5 U.S. sources said Teva’s growth initiatives are somewhat likely to very likely to overcome the patent cliff and

competition, but 4 said success is contingent on strong acquisitions and co-developments.

- All 7 sources said Teva is a solid, innovative leader, and most believe Teva’s CEO has the right strategies.

Teva’s Growth Potential

- All 3 who commented predicted higher generic sales for Teva in 2015 year to year. 2 noted considerable variability in

their companies’ Teva purchases because of price fluctuations.

- 2 said generic Nexium holds great potential. 1 said Teva’s generic Nexium is 80% to 90% of the brand name’s cost.

- 3 who could comment on Teva’s pipeline said it’s good to strong.

- Individual country legislation dictates non-U.S. pricing, with Copaxone pricing higher in Canada than in Finland.

Teva’s Challenges

- 3 said the Pfizer/Hospira merger will be a threat to Teva, but 1 disagreed.

- U.S. sources were mixed on the Copaxone market: 1 said Teva likely will retain 75% share, 1 said market retention

was a possibility, but 2 said this was unlikely due to PBMs’ efforts to cut drug costs.

1) Experienced pharmaceutical sales professional who is a buyer for a closed-door pharmacy; repeat source

Teva’s generic sales growth likely will be “phenomenal” in 2015 because of industry consolidation. Its proprietary sales

will depend on the R&D investment and the pursuit of co-development partnerships. Teva’s success in dealing with the

patent cliff will depend on acquisitions. Going into the generic injectable market could be profitable for Teva. In addition

to the generic version of Nexium, its upcoming asthma and contraceptive drugs hold potential.

Teva’s Overall Performance “The likelihood of Vigodman’s and Teva’s success really comes down to their strategy. … The potential is there just

because Teva is one of the larger generic manufacturers out there. But at this point it really comes down to who is

getting exclusive rights to products becoming generic, then how much of an impact is that specific generic having on

the market and consumers actually wanting that generic the manufacturer makes. When a brand drug goes into

generic, usually one manufacturer has authorized ability to be the first to market it for the first 180 days, and that

allows them to actually create a better imprint in the market for that drug.”

“If Teva applies the exact, same model that Actavis has, I think they will be very likely to succeed at that point. …

Actavis was a very small generic company that grew very rapidly by way of acquisitions. They acquired a lot of

different, smaller generic companies to build up their portfolio, as opposed to investing that money into R&D and

hoping for a blockbuster drug. All of that actually led up to the two major acquisitions in the last couple of years,

which is when Watson acquired Actavis and kept the name of Actavis. And then Actavis purchased Forest

Laboratories. … That model has done a tremendous amount for [Actavis’] stock price right now.”

“If [Teva’s growth initiatives] include acquisitions, I totally agree [it can overcome the Copaxone patent cliff and

increased competition]. For some reason, I have a feeling that Teva is going to attempt to make acquisitions to

strengthen its pipeline and add new products they currently don’t carry under the Teva name, or they are going to

buy out competition in order to prevent redundancies which at that point will increase sales for them.”

“One of Teva’s benefits is that they have a large portfolio of generic drugs. Also, with the current trend of there being

large pricing spikes due to shortages of raw materials, if Teva is able to actually position themselves well enough to

be able to take advantage of that, then they open themselves up to having a stockpile of needed drugs.”

Teva’s Growth Potential

“[Teva sales growth for generics in 2015] is probably going to be phenomenal. … I see a lot of consolidation

happening within the industry, specifically with the larger manufacturers. I know that with the current strategy that

Actavis has, there are rumors that Actavis is supposed to be acquired by Pfizer. If something like that happens, then

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Teva Pharmaceutical Industries Ltd.

the only players of that stature on the generic side will be Teva and Mylan that can actually compete with them, and

that will be a very big coup for Teva.”

“[The large manufacturers such as Teva] are able to keep better control over [smaller wholesalers’] access to drugs

and, in turn, make the amount of money that they actually want to make without there being a bidding war that

usually leads to lower prices. … In the industry I was in there is a certain thing called contract pricing, which is

basically a way in the system to prevent, say, a larger or secondary distributor from selling to a smaller distributor;

this prevents other people from getting into the market specifically selling those products.”

“[As for Teva’s proprietary sales growth in 2015] I think it’s more a question of how much more Teva has invested in

R&D. If they have attempted to actually increase the budget for R&D to [have] a better approach in producing more

proprietary products, then I think they have a great opportunity to actually do a lot better in that area. But if their

budget isn’t really focused [on R&D] or they aren’t at least attempting to do co-partnerships with other existing

companies that probably have the infrastructure to help co-create proprietary products, then I don’t think that they

will be able to have as much of an impact on that side of the market.”

“[The] injectable market is actually a very great strategy [for Teva] to go into

right now just because I know that a lot of people have been paying

attention to that market. And it doesn’t have too many players on the

generic side that are actually able to take advantage of it. Because of that,

there are usually a lot of shortages in the injectable market, which in turn

allows a large price increase that is usually absorbed by hospitals.”

“I view Teva’s pipeline as strong due to their attempting to create a diverse

portfolio of drugs. The most exciting drugs from this pipeline, however,

would have to be asthma medication and contraception. … If they allocate

enough funds to properly market these items, they have the best chance of

creating some blockbuster drugs.”

“Getting the first approval to launch generic Nexium ... will be a very big

opportunity for Teva simply because Nexium is one of the last few

blockbuster drugs that the industry has been waiting for the patent to

expire.”

Teva’s Challenges

“In the injectable market, in comparison to Hospira, you’d look at Teva like

a startup and Hospira as a multibillion-dollar conglomerate that has been in

this specific business for a very long while. They won’t even actually cross

each other’s paths.”

“It’s definitely possible [that 75% of patients will remain on the non-generic Copaxone or on the 40-mg Copaxone],

specifically if that’s what the doctors are prescribing. In this market, usually a lot of individuals who are on brands

hate switching to generics if they have been taking the brand [drug] for a very long time. … I definitely believe or can

agree that a lot of the [Copaxone] clients or consumers will probably attempt to stick with the brand. I could probably

agree [with the projected 75%] if it’s within the first five years of the drug going generic.”

“A year ago I saw Teva as simply a powerhouse generic manufacturer, but now with the strategies that they have put

in place, I see them as willing to attempt to compete head to head with the giant brand manufacturers because they

realize the potential billions that await if they are able to obtain any slice of the market share. This strategy is

impressive because it is not going to be easy, but it shows that Teva is willing to innovative and expand their range of

ideas while not being afraid to take educated risks. By educated risks, I mean that Teva is attempting to make an

impact on the difficult yet lucrative brand side so that they can not only benefit off of a drug the 13 or so years it is

patented, but then also benefit on the generic side after the patent expires because they already have a major

impact on that side of the industry.”

2) Executive at a mail order pharmacy that primarily serves employer groups; repeat source

Teva’s initiatives probably will succeed. Without a large acquisition, however, it will only partially address the impending

loss of Copaxone revenues. Payers will have a major say in whether patients use generic Copaxone. Teva is finding it

A year ago I saw Teva as simply

a powerhouse generic

manufacturer, but now with the

strategies that they have put in

place, I see them as willing to

attempt to compete head to

head with the giant brand

manufacturers because they

realize the potential billions

that await if they are able to

obtain any slice of the market

share.

Pharmaceutical Sales Professional,

Buyer for a closed-door pharmacy

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Teva Pharmaceutical Industries Ltd.

harder to preserve its “premium brand/premium value proposition,” and has lost to competitors offering lower prices to

this source’s company; however, this constantly changes and Teva’s generic business overall should increase this year.

Teva’s Overall Performance

“[Teva succeeding with its growth initiatives] is likely. I would say this is not a short-term fix. I don’t know if you can

compare it to McDonald’s in the sense that they can’t go back and do the true-and-tried. They’d probably have to do

something new and innovative.”

“But it’s not going to be over a couple of quarters. … The revenue [decline] from loss of patent protection for

Copaxone is going to be much more immediate.”

“I’d be surprised if you aren’t going to see some major acquisition initiatives from Teva in order to offset any loss on

Copaxone. Acquisitions definitely are going to be part of the arsenal.”

“They are going to do some co-development in specialty and/or complex generics [and likely in biosimilars]. They are

going to do some co-development, and I think they are going acquire some drugs if they are likely to be approved so

they can generate incremental revenue.”

“Teva is a premium brand in generics, along with Mylan and [Novartis AG’s/NVS] Sandoz. They are typically higher

cost for the same generics than many other manufacturers, but they have a better quality reputation. … But

obviously in a commoditized market and a market where there is a lot of price scrutiny, it’s much more difficult to

maintain that premium brand/premium price value proposition. That’s something they will have to continue to work

on. I think the best way to do that obviously is to take out costs.”

Teva’s Growth Potential

“We sell a lot of [Teva generics]. It’s probably one of our larger manufacturers historically. It’s changing as we speak.

Some of the other less-known competitors seem to have gained some pricing power over Teva, but it’s drug by drug

and almost minute by minute.”

“Despite high utilization and the number of manufacturers, there’s still

generic drug price inflation taking place, so [Teva] has that benefit. But

reducing sourcing and manufacturing costs [is] hard work. It isn’t something

that you do that easily overnight. I am sure they will be successful. It’s just

going to take time.”

Teva’s Challenges

“I would suspect multiple manufacturers will come into the market [with

generic Copaxone] as soon as they can, just as you have seen with some of

the other large brands that went off patent.”

“Once it opens up, [the price] is going to fall very quickly.”

“There’s a chance [of Teva keeping 75% of its patients on the 40-mg

Copaxone]. … When [Teva says they] converted [patients], that means they

are working with the clinicians and the doctors, but I think money is going to make that determination as to how

successful [Teva is] going to be. And the payers are going to have a very large say.”

“[Payers] may very well put the two versions [generic and brand name] of the same drug on vastly different copay

tiers. That is going to drive behavior … especially as more and more employers and payers are moving people to high

deductible plans. And for specialty drugs, the copays are typically a percentage now.”

“Absent a major acquisition, [Teva’s] growth initiatives are unlikely to partially offset the Copaxone patent cliff in the

near to medium term. Longer term they will likely succeed.”

“[The increasing generic drug competition] is a headwind for them as well, but that’s not something they haven’t

dealt with in the past.”

“I don’t know that [Pfizer buying Hospira] is any bigger threat to Teva than what is going on [with consolidation]

overall in the market.”

“Pfizer has a screen, and everybody in the world who is in pharmaceuticals is on Pfizer’s screen somewhere. Pfizer

lost Lipitor a couple of years ago, if I remember right, and now they have another big drug coming off patent so they

have to work twice as hard as Teva. I think Pfizer is looking to do a lot of deals and they have a lot of money too.”

Miscellaneous

“Teva is a big company with a lot of success. They know what works. … Probably the reason the former Teva CEO

[left] and the new CEO came in was they hadn’t prepared significantly enough for this event that everyone knew was

on the calendar. This new CEO was brought in to try and accelerate and catch up, but for large companies with a

global footprint, it’s not easy.”

Absent a major acquisition,

[Teva’s] growth initiatives are

unlikely to partially offset the

Copaxone patent cliff in the

near to medium term. Longer

term they will likely succeed.

Executive, Mail Order Pharmacy

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Teva Pharmaceutical Industries Ltd.

“On these biosimilars, the initial indications are that they are going to be 10% to 20% less expensive than the

originals, but obviously you don’t need that many of those drugs to make up for a large number of revenue given that

the drugs are much more expensive than the typical generics.”

“The FDA [recently] approved the very first biosimilar application [Sandoz’s Zarxio]. … What they haven’t really done

is issue guidelines. A biosimilar isn’t identical to the original drugs like they are for generic drugs. …. [I]t is generally

the same, but what they haven’t done is all the research showing that the outcomes are going to be the same as

they are able to do with generics. … Is this a strategy that in the near term is going to help [Teva] generate

incremental income? That’s still to be seen.”

3) Independent pharmacist owner; repeat source

This pharmacy gets Teva products from its wholesale buying group when those are the least expensive, which occurs

about 20% of the time. Pfizer’s acquisition of Hospira could be a major danger to Teva, depending on the product mix

involved. The Teva generic Nexium that the pharmacy has received is maybe 10% to 20% less than the brand name.

Teva’s growth initiatives may succeed, but pricing volatility and acquisitions are unknown factors.

Teva’s Overall Performance “[Teva CEO Erez Vigodman] could have some success [with the initiatives.] I think there’s a lot of volatility in the

generic pricing market. I am sure there are quite a few different generic houses that are probably going to be coming

on the market that he could either buy or merge with and so on.”

“Again, I think there is a tremendous amount of volatility in the generic pricing. I’m hoping that will stabilize over the

next 12 to 24 months. And I would hope that he could bring some stability to [Teva’s] pricing. I don’t think he could

do it for the whole market.”

“I do have some Teva that occasionally comes in the mix. … We belong to a

buying group, and it depends on what the deals that they cut per month

are.”

“It’s so competitive. Like I say, if Teva is not the best deal, then [the buying

group] just isn’t going to buy it. … That’s the reason I get sporadic products;

it might be Teva, it might be another brand. … Probably 20% of the time at

most we get Teva brands as being the most economical.”

Teva’s Growth Potential “I doubt [physicians know a generic version of Nexium is available]. It’s so

new.”

“The [generic Nexium] we have is very high [priced]. It’s probably 80% to

90% of the brand cost.”

“[The generic Nexium] is going to have to get past the six-month exclusion, if

that is in existence [where] Teva is the only one [supplying it]. And I’ll tell you

why it’s priced so high as a single source: When it goes multisource, the

price will drop down and it will be much more economical. I think the PBMs

will actually pay for it then. Rarely ever do PBMs pay for the products that are in that six-month exclusivity range.

They prefer that they just go ahead and get the brand name. ... PBMs will leverage the manufacturer, they leverage

the providers.”

Teva’s Challenges “[Teva] is going to struggle with [a merger between Pfizer and Hospira]. Pfizer is a great, big name, and they are

highly competitive.”

“I don’t handle Copaxone, so I am not sure [if they can keep 75% of patients on the 40-mg Copaxone].”

“If PBMs follow suit with how they do everything else, they are going to steer [patients] away from the [Copaxone]

brand to the cheaper generic. Copays, the prior approval process—that’s how they steer the customers [who are] the

patients.”

“You’d think [Teva’s growth initiatives] would help [it overcome the Copaxone patent cliff and generic drug

competition], but I just don’t know. Like me, they are trying the best they can, and sometimes it doesn’t work out.”

[Teva CEO Erez Vigodman]

could have some success [with

the initiatives.] I think there’s a

lot of volatility in the generic

pricing market. I am sure there

are quite a few different

generic houses that are

probably going to be coming on

the market that he could either

buy or merge with and so on.

Independent Pharmacist Owner

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Teva Pharmaceutical Industries Ltd.

4) Pharmacist in the wholesale drug business; repeat source

Generic drugs are Teva’s “bread and butter,” but the company is trying to move more into proprietary drugs to capitalize

on the pricing profitability. Teva will see a considerable hike in generic sales for 2015. It could retain 75% of its Copaxone

patients by paying PBMs a rebate to equal the generic price.

Teva’s Overall Performance

“[Teva and its CEO are] somewhat likely [to succeed with their initiatives]. I just think they have the money behind

them, they have been pretty successful in the past, and they have a pretty good reputation in the industry.”

“Every generic company is looking to raise prices. The competition dictates that. They are not able to able to in a lot

of instances. I don’t think [Teva is] one of the leaders in increasing prices, but when the competition does increase

prices, it doesn’t take them long to follow.”

Teva’s Growth Potential

“Teva just got the generic Nexium. They have been pretty successful in

getting approvals in the last year. These are not dog items—items that have

no volume. These are all big-volume items.”

“Nexium did just go over-the-counter, but Teva is still going to do very well

with a generic Rx.”

“Teva is going to have some exclusivity [with generic Nexium]. They already

do because they are the only one that has it right now, and it’s under

allocation too. They can’t supply the demand. We can only buy so much.”

“I think Teva’s bread-and-butter is generics. But the brands have a big

advantage because they can just have a price increase to make up for loss

of volume, and that’s what the brand companies have been doing for 50

years. I don’t think that’s going to be a major part of [Teva’s] business but …

I bet you they are trying to get more into the proprietary brand side because

it’s so profitable with price.”

“I don’t think [Teva’s proprietary sales] are going to accelerate [in the second half of 2015]. I think it might increase

some.”

“Teva’s generic sales are going to increase considerably. … They just recently had a price increase on a big, big

volume item.”

“[Generic drug sales will accelerate in the secandond half of 2015] because of [generic] Nexium and price increases.

And they may get some other approvals that we aren’t aware of.”

“I think their pipeline in generics is very good. There’s a lot of competition

with enoxaparin.”

“I’m not familiar with Teva’s proprietary pipeline. I couldn’t comment on

that, but I wouldn’t think it would be very big. I tell you one thing: The

injectable market has a lot of potential.”

“The topicals have gone through the ceiling on the generic side in the last

two years. That’s because they were too cheap before and a lot of people

just got out of the market because it wasn’t profitable.”

Teva’s Challenges

“[The Pfizer/Hospira merger is] going to be a tough competitor. Hospira has

a very big injectable line. Their service level on a scale from 1 to 10 is probably a 2 or 3. … Pfizer is going to have the

money to get that straight. And the first thing they are going to do is raise prices.”

“[The competitors rising in strength] are always going to be the same big boys. Mylan, I understand, is in acquisition

mode. They have a ton of cash. And look at what Actavis has done in the last few years. Actavis has really gone

through the roof, and they have acquired some big brand companies like Forest Labs.

“Dr. Reddy’s [Laboratories Ltd./BOM:500124], an Indian company, is turning into a big player. Pfizer has Greenstone

as their generic division. And … supposedly pretty soon there’s going to be some Chinese companies coming into the

generic market.”

“I don’t think [Teva will achieve 75% of patients staying on the non-generic Copaxone or the 40-mg, thrice-weekly

Copaxone once it goes off patent] because everything is [about] price today, and the PBMs … control everything . The

[Teva and its CEO are]

somewhat likely [to succeed

with their initiatives]. I just

think they have the money

behind them, they have been

pretty successful in the past,

and they have a pretty good

reputation in the industry.

Pharmacist, Wholesale Drug Business

I bet you they are trying to get

more into the proprietary brand

side because it’s so profitable

with price.

Pharmacist, Wholesale Drug Business

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Teva Pharmaceutical Industries Ltd.

doctor can’t practice medicine anymore because the PBM tells him what they are going to pay for and what drugs

they are going to cover.”

“Let me tell you what is going to probably happen and how Teva [could keep 75% of patients on Copaxone]. The

PBMs could say, ‘OK, we will keep using your Copaxone. Instead of us paying [X amount] we are going to charge [that

amount], but you are going to give us a rebate to match what the generic price is.’ … And Teva would probably say

‘Yes,’ because, if not, they are going to lose the business.”

“Teva may come out with their own generic. So they’ll have a generic Copaxone. The terminology used for that is

‘AG’—’authorized generic,’ which just means it’s the same as the brand product.”

Miscellaneous

“Teva is a solid company. We have a good relationship with them. They give us good service, competitive prices.”

“The oral MS drugs are so darn expensive. Some of them were cheap, but they have had price increases.”

5) Manager of a pharmaceutical wholesaler and distributor in Canada

Teva is in a strong position to overcome the patent cliff and compete effectively against other generic drug companies. It

rebranded Copaxone in a way that both created interest among users and allowed the company to hold onto the patent

longer. In addition, Teva’s portfolio is stronger and more complicated than its competitors. The provincial Canadian

governments are working on limiting generic drug pricing. Whether the governments will encourage patients to change

from Copaxone to a generic remains unclear, especially since that 40-mg, thrice-weekly Copaxone may not be released in

Canada and European countries until later in the year.

Teva’s Overall Performance

“Teva is a strong company, and they have made some smart moves. They should be OK. Introducing the newer

Copaxone was a smart idea because with the new U.S. rules, they can hang onto the patent a bit longer. Some of the

other generic companies have smaller, less complicated portfolios, and I don’t think they will be much of a threat.”

“Copaxone three-times-weekly is not approved in Canada or, I believe,

Europe yet. It should be coming out in some European countries very soon,

but I’m not sure when it will be introduced here. … Some people with MS

are looking forward to it because they are tired of daily injections.”

“Teva has its own distributors in Canada. We are not involved with their

drugs. We also hear that their minimum order is very high, so this is not

something that we could compete with.”

“Canada has an evolving cap price on generic drugs. Our prices are higher

than in Europe, possibly as high as some U.S. drugs, but various province

governments are working at bringing these prices down.”

“I don’t know anything about Teva’s employee morale.”

Teva’s Growth Potential

“Teva has always been considered a strong company. There was some

concern last year, with a new president, but they have done well.”

“Because we don’t sell Teva drugs, it is hard for me to comment on their proprietary or generic sales this year. I really

couldn’t say except to say that they have some strong medications on the market.”

Teva’s Challenges

“There have been a lot of drug mergers, and anytime there is one, the other companies are threatened. They should

feel threatened given that they may be faced competing with near-monopolies.”

“Once Copaxone three-times-weekly is presented to Canada and Europe, then it may well experience [total] sales of

more than 63%. It is inevitable. Consider this: The new Copaxone may not be introduced for several months yet,

which means that patients will just be adjusting to it when a generic might come out, say, in the fall. Would they

switch to the generic then? Doubtful, unless they are forced to do so by insurers.”

“Granted, there is a push everywhere for cheaper generic drugs. If a generic Copaxone comes out, patients, insurers,

governments will have to think about this. What price do they pay … for a transfer?”

Our prices are higher than in

Europe, possibly as high as

some U.S. drugs, but various

province governments are

working at bringing these

prices down.

Manager, Pharmaceutical Wholesaler

& Distributor, Canada

301 Battery Street, 2nd Floor, San Francisco, CA 94111 | www.blueshiftideas.com

9

Teva Pharmaceutical Industries Ltd.

6) Director of business development at a pharmaceutical distributor; repeat source

This source would not speculate on Teva’s ability to overcome its challenges but said the company is playing the game

correctly. The 40-mg Copaxone version will extend the patent and may help Teva hang onto market share for a bit longer.

Teva may try to offset drugstore chain and government contracts, but it should not assume its prices will be accepted.

She doubts if the 40-mg Copaxone will reach 75% of total Copaxone sales. Insurance companies almost always dictate

the lower-priced brand drug or a generic drug over a brand name.

Teva’s Overall Performance

“Teva has pulled the old ‘double-the-strength’ of ‘make-it-extended-release’

or ‘get-another-indication-approved’ strategy to extend their patent on

Copaxone. Many brand companies have done this over the years in hopes

of hanging onto some market share.”

Teva’s Growth Potential

“If Teva continues to believe people will pay more for their generics just

because it’s a Teva product, that’s a slippery slope, and their market share

will decline.”

“With higher prices presumably to certain sectors of the market, it appears

like they have chain drugstore and possibly even government contracts

where the pricing is extremely low, so they’re attempting to offset.”

Teva’s Challenges

“I do not believe the [40-mg Copaxone] sales will hit 75% [of total Copaxone

sales]. The generic single-strength will still do well when available. These

days insurance companies dictate what prescriptions the doctors write, and it’s always going to be the generic, even

if the drug must be taken more often.”

“Years ago, when generic drugs were starting to gain market share, nearly everybody wanted Mylan generics

because they were tacitly led to believe [Mylan generics] were better than other versions. Well, that worked for a

while but does not hold true today.”

7) Manager for a pharmaceutical distributor in Finland

Teva may succeed based on its large generic-drug presence in Europe. Finland’s government controls drug prices; people

who want drugs outside of the controlled drug “tube” may chose an original brand, but they must pay the price difference

unless the brand is recommended by their physician.

Teva’s Overall Performance

“Teva is one of the largest generic drug companies in Europe. It may do

well, but I really don’t know.”

“Drug prices vary from country to country [in Europe]; it depends on the

legislation. In Finland, we have a price development act that dropped drug

prices by 40%. The ministry determines the price tube.”

“Drug prices in the Nordic countries are very controlled by their

governments. All drugs have the same price in every pharmacy. There is

some free trade that is fully priced.”

“We deal little with Teva. We only sell brand drugs and not very many MS

drugs. I do not know about their president or morale. I have not met anyone

who works for Teva.”

Teva’s Growth Potential

“Teva is well known in Europe, but I don’t know their drugs to comment.”

Teva’s Challenges

“Patients won’t necessarily be forced to go to generic [Copaxone]. In Finland, patients are reimbursed for MS drugs

100%. They get all drugs for free unless they chose an original brand that is not in the price tube. If they chose to

I do not believe the [40-mg

Copaxone] sales will hit 75% [of

total Copaxone sales]. The

generic single-strength will still

do well when available. These

days insurance companies

dictate what prescriptions the

doctors write.

Director of Business Development

Pharmaceutical Distributor

Drug prices vary from country

to country [in Europe]; it

depends on the legislation. In

Finland, we have a price

development act that dropped

drug prices by 40%.

Manager

Pharmaceutical Distributor, Finland

301 Battery Street, 2nd Floor, San Francisco, CA 94111 | www.blueshiftideas.com

10

Teva Pharmaceutical Industries Ltd.

take an original drug, then they pay the price difference. The doctors may choose to decline a substitution, and the

patient can then stay on the original drug.”

2) Teva Competitors Four of these six sources represent U.S. competitors, including two who said Teva will have trouble overcoming the patent cliff

and competition in the long term if it does not introduce significant products. Of the two non-U.S. sources, one said Teva has

lost share in the United Kingdom because of regulatory issues, while one said the company faces pricing challenges in

Switzerland. Sources said Teva remains a strong leader, but two said it has lost some power. Teva’s generic Nexium carries

high potential. Sources were unaware of employee morale issues at Teva. (can omit strong leader sentence if needed)

Key Silo Findings Teva’s Overall Performance

- 2 who could comment said Teva will have trouble overcoming the patent cliff in the long term.

- No source was aware of Teva employee satisfaction or morale issues.

Teva’s Growth Potential

- No U.S. source was aware or had seen a change in Teva’s sector strength since last year.

- 2 European sources said Teva has lost share in the United Kingdom and faces pricing challenges in Switzerland.

- Teva is a strong leader, but 2 said Teva was not as strong as in the past.

- Teva’s generic Nexium carries high potential.

- Specialty drugs (immunology, neurology and respiratory) also will be important.

Teva’s Challenges

- 2 said Teva can reach and retain 75% brand Copaxone but one says it won’t be enough.

- 3 cited oral MS drugs as a major threat.

1) Senior pharmaceutical sales representative

Teva is a classic generics company, strong in contracting and distribution, but the company may not be able to repeat

Copaxone’s success with another branded drug. A 65% conversion rate to the thrice-weekly Copaxone version would be

an achievement. However, Copaxone sales will flatten and ultimately will decline in the face of more efficacious and oral

options. Expansion into more generics and specialty drugs makes sense for

Teva and plays to its strengths.

Teva’s Overall Performance

“Teva sees the world through a generics lens. Their strengths really lie in

the legal/regulatory team. They are aggressive in patents and generics

development. They have literally revolutionized the approach to executing

rights and distribution contracts.”

“The specialty focus is a good direction for Teva.”

Teva’s Growth Potential

“I expect conversion to the three-times-per-week Copaxone would have

been difficult as it requires a lot of training, increased technical support, as

well as the need to get both prescribing physicians and payers onboard. If

the 65% conversion is truly accurate, this is a good indication for both

continued conversion and persistence.”

“Copaxone will flatten and ultimately fall in the face of newer drugs with

greater efficacy and oral dose options.”

“Teva works with a lot of research centers in fields like immunology and

neurology. There is potential for novel drug pipeline.”

I expect conversion to the

three-times-per-week Copaxone

would have been difficult as it

requires a lot of training,

increased technical support, as

well as the need to get both

prescribing physicians and

payers onboard. If the 65%

conversion is truly accurate,

this is a good indication for

both continued conversion and

persistence.

Senior Pharmaceutical Sales

Representative

301 Battery Street, 2nd Floor, San Francisco, CA 94111 | www.blueshiftideas.com

11

Teva Pharmaceutical Industries Ltd.

“Teva is viewed as a generics company, by both healthcare professionals and investors. There is no brand

preference in this world. Here their channel strength is a big asset.”

Teva’s Challenges

“The concern with Teva is that they may be a one-hit wonder with regard to branded drugs. Copaxone is huge, but

Teva’s identity is a generics company. They may be too reluctant or too conservative to expand on their branded drug

success.”

“Branded drug competitors are Teva’s greatest competition.”

2) CEO of a drug manufacturing competitor

Teva will receive a short-term boost from its 40-mg Copaxone and generic Nexium, but its prospects after six months are

dim because of fierce competition. In addition, acquisitions will be difficult to accomplish because of inflated prices.

Teva’s Overall Performance

“The new CEO wants to get back to the generics space. They want to compete in the generics space, but they won’t

be able to [as in the past]. Competition is so fierce. You can go buy a prescription drug for two pennies when you

can’t even buy candy for that.”

“Teva missed out in the emerging markets.”

“I don’t know about their current employee situation.”

Teva’s Growth Potential

“I don’t know that they’ve gotten stronger since a year ago. I believe Teva will not be able to compete in the generic

space that Teva was doing so well in a decade ago. In fact, I just came from DCAT in New York City: Not once did I

hear or see Teva’s name there. I didn’t realize that until you asked the question.”

“They’re getting bigger in generics; they’re getting back to their roots.”

“In proprietary they have Copaxone, and they have bought some time with

their [40-mg version].”

“They got lucky with Nexium, and it will help them but not after six months.

That’s one reason I’m not that excited for them.”

“The rumored merger with Mylan is not going to happen; it’s not a good fit.

As for acquisitions, I don’t think there’s a good acquisition at a fair price.

Salix [Pharmaceuticals Ltd./SLXP] was bought by Valeant [Pharmaceuticals

International Inc./TSE:VRX], and look at the premium they paid.”

Teva’s Challenges

“The Pfizer/Hospira merger is a good one for Pfizer. I don’t think that’s a negative for Teva. At the conference I just

attended, everyone is buying into injectables and complex generics. But it’s too late [for Teva].”

“They may get to 75% [of the Copaxone brand market], but that’s is not enough to sustain a business like Teva. I do

expect the generic companies will be ready to roll it out. It will happen sometime this year. Even if it’s early 2016,

that’s only a couple months [reprieve for Teva.]”

“They’ve absolutely missed out in the oral MS market. [Biogen’s] Tecfidera has done $2 billion, [Novartis’] Gilenya

has done $1.5 billion.”

“The [generic] Nexium and the Copaxone [40 mg] will definitely help them short term, but long term, no.”

3) Senior marketing director

Based on the high conversion rate to thrice-weekly Copaxone, retaining 75% patients on brand-name Copaxone should

be achievable. The conversion rate is indicative of patients’ persistence, at least in the short term. Any new side effects

or reduced efficacy with the formulation would result in lost sales. Oral medications are a threat to Teva.

Teva’s Overall Performance

“Based on Teva’s current conversion rate, I expect 75% to be achievable. That said, I don’t know the data behind

their three-time-per-week formulation.”

Teva’s Growth Potential

The [generic] Nexium and the

Copaxone [40 mg] will

definitely help them short term,

but long term, no.

CEO, Drug Manufacturing Competitor

301 Battery Street, 2nd Floor, San Francisco, CA 94111 | www.blueshiftideas.com

12

Teva Pharmaceutical Industries Ltd.

“Those patients who switched to three times per week may have done so

fairly recently and may not be interested in making another switch in the

immediate future. You could take their switch as a sign that they are

reasonably happy with Copaxone and committed to staying with it for the

time being. After all, they’ve had the opportunity to switch to a competing

therapy for some time now and have chosen not to. I would project decent

persistence among those patients.”

Teva’s Challenges

“I see the high conversion to three times per week as a positive sign, but the

newer oral therapies likely remain a threat.”

“Any new side effects emerging with the three-times-per-week formulation could be a significant problem. Some of

the converted patients may have switched to three times per week because they are tired of daily injections. If they

encounter new side effects or perceive disease progression, however, they may abandon Copaxone.”

4) Director at a midsized competitor

Teva is a large, successful company that will benefit from continued price increases and mergers although it was of many

manufacturers named in the investigation into generic drug pricing. This source was mostly unfamiliar with Teva’s growth

initiatives, but said the company’s strength was in line with last year.

Teva’s Overall Performance

“Teva is so big. A lot of our customers think they’re a bit arrogant. The small and medium-sized feel like they get the

short shift from them.”

“[Some price increases] are going to continue for a while, but [Teva and other companies] can’t raise prices without

justification or rationale. There’s a Senate committee investigation. Ten or so players were mentioned who raised

prices 100% in certain situations. Teva was one of them; fortunately we didn’t appear on it.”

“For the longest time generic prices didn’t tend to increase, and it would get so competitive, sometimes dropping

20% to 30% to get share. But with players dropping out and due to mergers, six manufacturers came down to one or

two, maybe three. There’s been a lot of price increases because of opportunistic reasons. It presented an

opportunity for us to get prices back up and to reinvest in our plans.

“I haven’t heard anything, and I would probably know about any morale issues.”

Teva’s Growth Potential

“The strength [of Teva’s generic and proprietary sectors] is about the same. They were on an acquisition binge for a

while there, so they’re huge. They have so many SKUs, I don’t know how their salespeople know what to focus on in a

call. When they stumble or have a supply issue, we pick up their crumbs, and they tend to be big crumbs.”

Teva’s Challenges

“[Its 40-mg Copaxone] is an important play for extending their franchise, to the chagrin of the generic

manufacturers.”

“I don’t have a good feel for what a realistic rate, but 63% [conversion to the 40-mg Copaxone] is impressive.”

“I’m not familiar enough with their growth initiatives to comment.”

5) National channel manager for a large pharmaceutical company in the United Kingdom

Teva will have to move cautiously and correct regulatory or licensing issues in the United Kingdom in order to overcome

competition. Eight of the company’s drugs were cited by the government in the last three years, thereby allowing generic

competitors to fill the void. Although the source was unfamiliar with Copaxone, he said Teva’s strong respiratory portfolio

may help it overcome difficulties in the country. Pricing is strongly regulated by the UK government and is much lower

than in other European countries. He doubts pricing will increase this year.

Teva’s Overall Performance

I see the high conversion to

three times per week as a

positive sign, but the newer

oral therapies likely remain a

threat.

Senior Marketing Director

301 Battery Street, 2nd Floor, San Francisco, CA 94111 | www.blueshiftideas.com

13

Teva Pharmaceutical Industries Ltd.

“Teva will have to move cautiously in the UK and correct medication problems in order to overcome competition. I’m

not familiar with Copaxone, but they have a strong respiratory portfolio, one that we would like. They have a good

group of respiratory products to take to market, which will help them take on competition.”

“Teva is not doing as well as it has in the past in the UK. They have always been the No. 1 manufacturer here, but in

the past few years they have had licensing issues. Teva is bailing itself out of regulatory issues right now; they had to

withdraw some products, and that opened doors for [us]. Other companies are benefitting as well.”

“Pricing is probably lower here than in the rest of Europe. I know that pricing

in Germany is higher. The UK National Health System controls pricing and

keeps it very low. I doubt if pricing will increase this year.”

“I am not sure how Teva is received in the rest of Europe.”

“I haven’t heard anything out of the ordinary about employee dissatisfaction

with Teva.”

Teva’s Growth Potential

“It will be interesting watching Teva make a comeback in the UK.”

“It will take Teva awhile to grasp a stronger handle on the UK market for

both generic and proprietary drugs.”

“I’m not familiar with Teva’s new or developing products although they have

been in the news.”

Teva’s Challenges

“I’m not familiar with the Pfizer/Hospira merger.”

“Teva will need to prove to the UK that all of its products are safe and efficacious.”

6) Marketing access analyst for a large pharmaceutical company in Switzerland

Teva is a strong company, has a top reputation in Germany and Switzerland, and has a top portfolio of varied products, all

of which will help it compete. The source was unfamiliar with Copaxone. Drug prices are controlled by the various

European governments. As a result, he does not expect prices to climb very much this year. To increase operating

margins, pharmaceutical manufacturers must control costs.

Teva’s Overall Performance

“Teva has a top reputation in Europe, especially Germany and Switzerland. I don’t know Copaxone, but they have a

top portfolio of varied products and do well against the competition. I don’t see why they won’t continue to do well.”

“The bottom line is operating margin, and you have to control costs. Of course, drug prices are high in the United

States, and people always complain about it. I don’t know if the new insurance act is helping that or not.”

“Germany’s drug prices are controlled by the government; they do go up

but not very much. The Swiss government is currently in debate with drug

companies in order to have some of the lowest prices in Europe, and this

would mean slashing the current prices. I’m not sure how it will work out.

Every country controls its own pricing according to internal structure.”

“Generic drugs are now encouraged here, and I believe they are

automatically given.”

“Teva may have had some problems in the UK, but that kind of thing does

happen.”

“I’m not too familiar with Teva because our products are different. We do

not compete directly.”

Teva’s Growth Potential

“I still feel that Teva is a strong company. There are a lot of good

competitors, such as Sandoz and subsidiary Hexal, both which are part of Novartis. But Teva has a nice, varied

portfolio, and they make both brand and generic products, so they know how to play the game.”

“We don’t compete directly against Teva, so I couldn’t tell you about their products.”

Teva’s Challenges

“There are always a lot of mergers in pharmaceuticals. That happens all the time. I’m not sure how much of a threat

Pfizer and Hospira are to Teva, although Hospira is strong here in Europe.”

Teva is not doing as well as it

has in the past in the UK. They

have always been the No. 1

manufacturer here, but in the

past few years they have had

licensing issues.

National Channel Manager

Large Pharmaceutical Company

United Kingdom

Teva has a nice, varied

portfolio, and they make both

brand and generic products, so

they know how to play the

game.

Marketing Access Analyst

Large Pharmaceutical Company

Switzerland

301 Battery Street, 2nd Floor, San Francisco, CA 94111 | www.blueshiftideas.com

14

Teva Pharmaceutical Industries Ltd.

3) PBM Executives These four sources said PBMs will vary in their efforts to convert patients to the generic Copaxone and will take rebates from

Teva into account. Most were unsure of Teva’s ability to overcome the patent cliff, but said the company is a strong, savvy

player. Government scrutiny may slow generic drug price increases. Oral MS drug manufacturers pose the biggest threat to

Teva.

Key Silo Findings Teva’s Overall Performance

- 1 of 4 thinks Teva will face challenges with Copaxone patent; others were not sure or didn’t know.

- 2 of 4 said government attention to generic drug costs will force Teva to be more attentive with pricing.

Teva’s Growth Potential

- 2 of 4 were unaware of sector changes since 1 year ago; 1 expects higher generic sales this year, but 1 said sales

will be flat for Teva.

- Teva has a strong pipeline, but 1 said it lacks a blockbuster.

Teva’s Challenges

- The Hospira acquisition will be a positive for Pfizer, but only 1 views it as a threat to Teva.

- 3 said Teva is a strong, progressive player but added that Sandoz, Mylan and Biogen are strong competitors.

- PBMs’ Copaxone response will vary and will depend on cost difference: 1 expects to exert significant pressure to

convert patients that are the 40-mg version to the generic version.

- 2 said oral MS drugs are the biggest threat.

1) Pharmacy vice president of a large PBM; repeat source

Teva should fare well as its CEO is making the right moves. Still, pipeline drugs and future acquisitions are unknown

factors. A 15% to 20% price difference between the generic and brand Copaxone would be typical. This PBM likely will not

be aggressive in moving patients off the 40-mg Copaxone if they are doing well on it. Oral MS drug manufacturers are

Teva’s biggest threat. The strength of Teva’s two sectors has not changed since a year ago.

Teva’s Overall Performance

“They will be all right. The new CEO is doing is exactly what he should be doing, making them leaner while putting

emphasis on drug development and acquisitions. They’re setting it up well, and now the big question is whether their

new drugs will pass muster. And what other assets can they acquire that

will complete their offerings for them?”

“Their acquisitions goal makes sense.”

“I don’t have any knowledge about their sales force or employee turnover.”

Teva’s Growth Potential

“Are they a bigger player than a year ago? Not necessarily.”

“The strength of Teva’s proprietary and generic drug sectors hasn’t

changed since a year ago. I would think their proprietary and generic sales

would be comparable to last year’s. Our industry relations folks certainly

haven’t come to us saying that we’re getting gouged by them.”

“There have been more multiyear contracts, which are largely about price

inflation.”

Teva’s Challenges

“As far as major competitors, I think the main one is Biogen’s Tecfidera,

which has been able to gobble up a lot of market share. If I were Teva, I would be moving from injections to oral.”

“From a national perspective, there won’t be a big plan to get people off the thrice-weekly if they’re responding well.

… Once this type of injectable is deemed appropriate, then you might see clients work on a regional basis. But I don’t

They’re setting it up well, and

now the big question is whether

their new drugs will pass

muster. And what other assets

can they acquire that will

complete their offerings for

them?

Pharmacy Vice President, Large PBM

301 Battery Street, 2nd Floor, San Francisco, CA 94111 | www.blueshiftideas.com

15

Teva Pharmaceutical Industries Ltd.

know if everyone will go that route. You don’t want to bring the hammer down, because patient satisfaction is

important.”

“It’s not like the old medication, such as Prozac, which dropped from $1 a pill to a penny. We’re not seeing those

kinds of price scenarios playing out, because the drugs are inherently more expensive. If I can get 15% to 20% price

difference [with the generic Copaxone], that would be good. But at $2,000, that can have a significant impact.”

“The whole biosimilars and complex generics are in a place where we just don’t know how it’s going to play out.”

2) CEO of a midsized PBM; repeat source

Teva will do well until the Copaxone patent expires. This PBM expects to actively pressure patients on the 20-mg and 40-

mg versions of Copaxone to use the generic, primarily through high copays, and estimates as few as 10% of patients will

remain on the brand name.

Teva’s Overall Performance

“The little I’ve read about [Teva CEO Vigodman] is he’s bold and sounds like he’s slashed a lot, cutting deep in places

like sales force. But who knows? Maybe they needed that. He will either do well or blow up.”

“We are rooting for [Teva]. We used to depend on their manufacturing on the generic side. I believe we lost a lot of

generic SKUs, which was partially responsible for these sky-high prices. I may be wrong about that, but that’s what

I’ve been led to understand. They were driving competition. The more generic drugs they manufacture, the better.”

“There are a lot of prices that have just skyrocketed the last 12 to 18 months. … They’re going to have to slow down

these price increases.”

“I never heard about the sales force morale issue.”

Teva’s Growth Potential

“[Their generic and proprietary sectors are] about the same. They sure are putting a lot of emphasis on the Copaxone

brand.”

“They’ll do well in their proprietaries and increase market share on the generic side, but it depends on pricing. Most

generics are sold to wholesalers, and GPOs do big deals with Teva. It all boils down to how competitive they get.”

“I looked at their pipeline and it certainly looks promising, but a pipeline is a

pipeline. You never know with the FDA. However, their upcoming ones are

not products we have a lot of therapeutic need for; they’re not

blockbusters.”

“I know Teva has a generic Nexium, which should do well. But they’ll have to

reduce the price because AstraZeneca [plc/AZN] released an OTC product

that dropped the price.”

Teva’s Challenges

“Hospira has been doing [injectables] forever. I don’t know if or how Teva

will be affected, but Hospira is hooking up with a pretty sound company with

Pfizer. Those [drugs] are used more in hospital patient use, which I used to

do. [Manufacturers] don’t have as much of a free hand to do what they want

with injectables.”

“Another competitor that has a similar model would be Sandoz. Mylan … will

continue to do well.”

“If you would have asked me if they would be as successful in moving patients to the long-acting version, I would

have said no, but they’ve had great success. They’ll have more trouble holding it when the patent expires. They might

hold 10% of it. They can always back the pricing down to keep share. We’ll have some trouble with biosimilars, but

with generic Copaxone I’m not viewing it much differently [from the brand]. We’ll push everything we’ve got, including

disincentivizing members who chose not to go to the generic. Primarily we do it with equalizing the difference

between the brand and generic and putting pressure on the member’s copay.”

“During the next six months [Teva] will be OK and will increase revenues and market share, but in six to 12 months

they’ll have some challenges.”

We’ll push everything we’ve

got, including disincentivizing

members who chose not to go

to the generic. Primarily we do

it with equalizing the difference

between the brand and generic

and putting pressure on the

member’s copay.

CEO, Midsized PBM

301 Battery Street, 2nd Floor, San Francisco, CA 94111 | www.blueshiftideas.com

16

Teva Pharmaceutical Industries Ltd.

3) Executive vice president of sales; repeat source

Teva has a solid sales team and distribution system, which will help it address its challenges. Some insurers may force

Copaxone patients to switch to the generic version. All generic drug manufacturers are under pressure to keep pricing

down, and Teva is one of the first companies to start a direct-to-patient model. The source said Teva should monitor the

Pfizer/Hospira merger.

Teva’s Overall Performance

“Teva has a good sales force, one of the best, and a good distribution method. It is one of the better, more notable

brands, so they are in a good position to meet challenges. They may have to develop an even better distribution

system in the future.”

“Teva and the other manufacturers will be under pressure to keep prices down.”

“Generics, and this includes Teva, keep increasing the prices because they think they can. Since branded is out of

the way for the most part, generics are trying to be branded. But they are really pseudo-branded.”

“I can’t address Teva’s strategies. But to offset costs, generics are getting stronger and forming relationships with

wholesalers and retail chains. Some [such as Teva] are starting a direct shipping program to consumers. As primary

branded drugs turn generic, the shipping program is beneficial because it can help retain the customer.”

“PBMs are setting up third-party pharmacies, and they can ship the drug out on behalf of the manufacturer. They are

now serving as a distributor, so to speak. This saves them money as well.”

Teva’s Growth Potential

“Teva has always been a strong player.”

“I can’t address Teva’s sales or their pipeline.”

“When I first started in this business … brand [name] held 80% of the

market. Now it holds 15% in our and other PBMs’ plans.”

Teva’s Challenges

“There is a general belief that Pfizer is one of the premium companies.

Whatever they want, they will figure it out. ... Teva will need to keep an eye

out [on the Pfizer/Hospira merger].”

“I’ve heard a bit about Copaxone. Certainly the convenience of less dosing

would have consumer appeal and help protect the patent, but I couldn’t

make a guess on patient retention.”

“The Copaxone plan was designed because generic will be out there eventually. It is hard to say if an insurer would

force a patient to change from Copaxone, if it were successful, to a generic. This probably would depend on the

plan.”

“It will be hard for the branded companies to get their stronghold back. Manufacturers are in a weaker position. The

primary mistake the brand made was to give rebates on the copay. This worked when the copay was at a certain

level, but when the copay reached $25 to $40, then folks started turning to generics.”

“Specialty drugs increase a plan by 13%. It is a high-margin marketplace. Now with healthcare reforms,

manufacturers and PBMs have to justify what they have done.”

Miscellaneous

“PBMs make more money on generics.”

4) Marketing director of a new PBM

Teva is formidable company that is playing hard in the generics market, but it must differentiate itself to overcome the

patent cliff and competition. This source questions if the 40-mg, thrice-weekly Copaxone is as beneficial as the daily

version. The government is putting a lot of pressure on PBMs and manufacturers to lower costs. As healthcare costs

increase, more mergers will disrupt technologies.

Teva’s Overall Performance

“There are so many factors that go into the [patent cliff]. Teva will need to differentiate itself from what is out there to

succeed.”

Teva has a good sales force,

one of the best, and a good

distribution method. It is one of

the better, more notable

brands, so they are in a good

position to meet challenges.

Executive Vice President of Sales

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Teva Pharmaceutical Industries Ltd.

“Teva is looked at as a progressive, innovative company, and it is cornering the market on the generic piece of it. And

that is a smart move. At the end of the day, that is where the push is, to go generic—from the government to private,

employers to payers. It is all about reducing the cost and still providing a positive patient outcome.”

“Generic prices will increase, but they will not be higher than brand. This goes back to the government, who is putting

a lot of pressure on the PBMs and drug manufacturers. And whether you have the Affordable Care Act or not, it is

costing you money.”

“There are a lot of things that companies can do to increase operating margins. There’s technology and investors,

and they make a huge difference. It is all about keeping costs down. I don’t know how Teva does it.”

Teva’s Growth Potential

“Teva has a strong and varied portfolio.”

“I haven’t done a lot of research on Teva’s pipeline. They are a reputable

company, so if they say they will come out with a new drug, you will see it.”

Teva’s Challenges

“If Pfizer is buying Hospira, that is a very good move. As we see the costs of

healthcare rising, we will see more companies merge and disrupt technology

so that they can advance.”

“I’d look for J&J [Johnson & Johnson/JNJ] to purchase companies as well.”

“I haven’t heard about the sales of Copaxone.”

“If you are taking a daily medication, and now it is three times a week, the question is, how is it sustaining that

disease?”

“Insurers will push for [brand-name Copaxone] users to switch to generic when it becomes available. It is all a matter

of cost. If there is a generic out there that does the job at 90% [of the brand-name price], then they will have to prove

why it is that they need the brand.”

“If you have a chronic disease, it is about the quality of life. People have to take that into consideration.”

Miscellaneous

“Biosimilars will disrupt technology if it hasn’t already. It’s the new future.”

“It will still cost money to do the biosimilar research, to run the manufacturing and operations part of it. How do you

get your return on investment? If the [product] costs are high, companies can always offer rebates.”

4) Industry Specialists

These six sources offered mixed responses regarding Teva’s ability to weather its Copaxone patent cliff and its increased

competition. One said Teva is well situated to benefit from company initiatives, while three others said Teva’s success will

depend on retaining Copaxone patients or making other major acquisitions. Two of four expect higher proprietary and generic

sales for Teva this year. Several sources, including two MS experts, reported being impressed so far with the conversion rates

of patients to Teva’s 40-mg, thrice-weekly Copaxone. One European and three U.S. sources noted pricing pressure for Teva.

Sources said the company’s generic Nexium and upcoming tamper-resistant opioid product hold high potential.

Key Silo Findings Teva’s Overall Performance

- 1 forecast success for Teva in overcoming the patent cliff and competition, while 3 said major acquisitions and

retaining Copaxone patients will be necessary for success.

- 3 of 4, including 1 source in Europe, reported government pressure in limiting generic price increases.

Teva’s Growth Potential

- 1 said Mylan’s generic Copaxone will be 10% to 12% cheaper than Teva’s brand name when it comes out.

- 2 of 4 each expect higher Teva proprietary and generic sales in 2015 year to year.

- Teva’s NTE (New Therapeutics Entity) program bodes well with current U.S. legislation.

- 3 view Teva’s pipeline as promising but without blockbusters; 1 said its pipeline is very promising.

- 4 forecast high potential for Teva’s generic Nexium; 1 mentioned Teva’s upcoming tamper-resistant opioid analgesic.

Biosimilars will disrupt

technology if it hasn’t already.

It’s the new future.

Marketing Director of a New PBM

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Teva Pharmaceutical Industries Ltd.

- 2 MS specialty sources laud Teva’s 40-mg Copaxone, said switches from it to the generic likely will not be

considerable.

- 40-mg Copaxone conversion is impressive; 3 of 4 forecast high patient retention rate for Copaxone brand name.

Teva’s Challenges

- 2 said Pfizer/Hospira merger poses a threat, 2 said it doesn’t.

- Rising competitors include Biogen, Valeant, Actavis and Mylan.

- 2 said oral MS drugs are the biggest threat.

- PBM efforts often depend on cost difference; most will be aggressive if price difference after rebates is 15% to 20%.

1) Carl Schmidt, a business development and consulting executive for biopharmaceutical companies; repeat source

The Teva CEO has done a “pretty good job” from a financial perspective but where the company is headed strategically is

not completely clear. Acquisitions and development deals are needed to overcome the patent cliff. If the FDA does not

permit other companies to sell their generic versions of Nexium, Teva’s sales could be “huge.” Mr. Schmidt does not

think Teva will be able to transfer 75% of its Copaxone patients to the 40-mg, thrice-weekly version

Teva’s Overall Performance

“[Erez Vigodman] has been the CEO for maybe over a year now, and he’s

actually increased the operating margins already but that’s not surprising. It

wouldn’t take much to actually do that, because Teva did a lot of business

development deals over the last 10 years or so and integrated a lot of

different companies. And there are always going to be synergies that you

have to kind of get rid of.”

“From a financial standpoint, I think [Vigodman] has actually done a pretty

good job. From a strategic standpoint on the businesses, I am not sure that

it’s really clear exactly where they are going. There’s definitely an interest

[on Teva’s part] on the specialty side, because you have patent protection

and aren’t constantly fighting the battle over pricing to the extent that you

do with generics.”

“There are a number of factors [affecting the likelihood that Vigodman and

Teva will succeed] because when they talk about complex generics, then

they start talking about injectables. Are they talking about potential biosimilars? … Are they looking globally, or are

they going to focus kind of on the markets they already have?”

“I don’t see Teva taking the route that Actavis did and buying somebody like Allergan or something like that. I do see

some small acquisitions that Teva could do.”

“Valeant is a good example of a company that’s grown significantly in the branded and specialty markets based on

buying a lot of small companies. I think that’s really the only way to go because Teva doesn’t have strong R&D. They

are not a big pharma R&D organization by any stretch of the imagination, so

their only avenue is really co-development or acquisitions. They can’t build

an R&D organization in a very short timeframe and start pulling out

products. They have to buy products or companies that have products in

late-stage development.”

“The generic drug pricing trends will kind of hit Teva in the European

marketplace because there’s a lot pressure to lower those prices. In the

U.S., it seems to be kind of hit-or-miss; some generics have actually gone up

in price over time in certain categories due to scarcity and limited other

generics. … There’s always going to be pressure from [U.S.] health plans and

from PBMs to lower [the higher] generic prices to actually increase their own

margins. It’s hard to say whether Teva is going to increase their share of the

overall generic marketplace; they are not known as having the least

expensive products.”

“I heard something not too long ago … that morale at Teva wasn’t really

great. Teva has done some consolidation. They have closed plants, and they

From a financial standpoint, I

think [Vigodman] has actually

done a pretty good job. From a

strategic standpoint on the

businesses, I am not sure that

it’s really clear exactly where

they are going.

Business Development & Consulting

Executive, Biopharmaceutical

Companies

Valeant is a good example of a

company that’s grown

significantly in the branded and

specialty markets based on

buying a lot of small

companies. I think that’s really

the only way to go because

Teva doesn’t have strong R&D.

Business Development & Consulting

Executive, Biopharmaceutical

Companies

301 Battery Street, 2nd Floor, San Francisco, CA 94111 | www.blueshiftideas.com

19

Teva Pharmaceutical Industries Ltd.

have laid off people. Whenever you do that, your morale is going to be low. And the previous CEO and even the

current CEO, I don’t think, communicate the plan particularly well to the organization.”

Teva’s Growth Potential

“Teva’s proprietary group, because of recent acquisitions, is a little bit stronger than it was a year ago.”

“[As for] the generic sector, I know they have a couple of new drug approvals and things like that. We’ll just have to

wait and see what happens with those.”

“Teva has an agreement in place with AstraZeneca to sell an authorized

version of Nexium. … This could be a potentially huge sales number unless

the FDA allows others to sell their generic versions. … If Teva has the only

product available in the U.S. market, they could take up to 80% of the

Nexium business within three to four months as a relatively high price point.

If other generics become available very soon, the price point will drop very

quickly.”

“Is Teva a little bit stronger compared to its competitors? It depends on who

you define as its competitors. If I were looking at proprietary, for Teva, their

No. 1 product is Copaxone. I think [Teva’s] competitors’ strength for

treatment of MS is a lot stronger than Copaxone is. Probably the No. 1

company for MS is Biogen Idec.”

“I saw something not too long ago that said the expectation for Mylan for

2015 is that they will have greater than 10% growth. That means they are on

a stronger curve than Teva, because Teva’s not going to have 10% growth

on the generic side unless they are doing something. … Granted, they have

some new generic approvals, but Mylan has a lot more than they do.”

“[Teva’s 2015 proprietary sales] depend on whether they launch the

products they say they are going to launch in the second half of the year. [If they do,] I expect they will do mid- to-high

single digit increase in sales. … If they are going to launch [the new products] in either the second or third quarter,

they will bring in some cash. The generic Copaxone won’t come out until September, which means if they take any

hit, it will be in the fourth quarter. They are going to take some hit, but I don’t see them going from the level they are

at and losing 80% of their [Copaxone] business within three months.”

“I can almost guarantee you that when Mylan comes out with a generic [Copaxone], the price is going to be about

10% to 12% less expensive than what the brand is because they want to make as much money as they can during

that 180-day period. After that, the prices will drop significantly.”

Teva’s Challenges

“I don’t see [the proposed merger between Pfizer and Hospira] as much of

a threat to Teva. I think it’s a great opportunity for Pfizer. Teva will be

competing with them in what I call the complex injectable generic

marketplace. It’s kind of a specialty generic marketplace. I think the

advantage of this from Pfizer’s standpoint is the biosimilars it’s picking up

[from Hospira]. Hospira has two approved biosimilars already on the market

in Europe, and they can expand that out from a global perspective, not to

mention the U.S. marketplace.”

“I don’t think Teva will achieve switching 75% of patients to the new dosage

regimen. I think with the newer launched products with similar or better

dosing regimens or the new oral formulations will capture some of

Copaxone’s share and switches. Teva’s ability to hold its market share will

be challenged [over the next year] by the generic version and newer

injectable and oral products.”

“Once the generic Copaxone becomes available, there’s going to be some

pressure from health plans and PBMs for patients to consider requesting a

switch. I don’t think [the plans and PBMs] can automatically switch [people

already on Copaxone to the generic]. Unless they have done a crossover

study that shows it truly is a generic equivalent, I think you are going to get

a lot of neurologists saying, ‘You know, I am not convinced the generic

makes a lot of sense.’ … This is the same issue that comes in with

I can almost guarantee you that

when Mylan comes out with a

generic [Copaxone], the price is

going to be about 10% to 12%

less expensive than what the

brand is because they want to

make as much money as they

can during that 180-day period.

After that, the prices will drop

significantly.

Business Development & Consulting

Executive, Biopharmaceutical

Companies

If Teva’s growth initiatives are

the new launches and product

approvals, I don’t see them

likely overcoming the Copaxone

patent cliff. If the growth

initiatives are not only the new

products but also new

acquisitions and business

developments deals … then it’s

a little bit more likely that they

will be able to overcome that

patent cliff.

Business Development & Consulting

Executive, Biopharmaceutical

Companies

301 Battery Street, 2nd Floor, San Francisco, CA 94111 | www.blueshiftideas.com

20

Teva Pharmaceutical Industries Ltd.

biosimilars and even with [other] injectable generics.”

“When the new generic comes out, the health plans may push new patients to try the generic first before the brand,

but that’s a small number of patients really.”

“If Teva’s growth initiatives are the new launches and product approvals, I don’t see them likely overcoming the

Copaxone patent cliff. If the growth initiatives are not only the new products but also new acquisitions and business

developments deals … then it’s a little bit more likely that they will be able to overcome that patent cliff.”

“Will their growth initiatives overcome the generic competition that’s out there? I’m not sure what their growth

initiatives for the generic piece of the business are unless they really do get into more specialty generics more than

anything else.”

“If their growth initiatives are acquisitions and new product development deals for 2015, from the generic

standpoint, I think that they can really create growth as opposed to what’s occurred in 2014, which was basically flat

vs. 2013 from a sales point of view. Their operating margins were considerably higher for 2014, which is really a

pretty short-term fix. The growth initiatives take a little bit longer.”

2) Senior consultant to pharmaceutical companies; repeat source

Teva will overcome the Copaxone patent cliff and the increasing competition by innovating around the rivalry. It has been

successful in using a strong sales force to convert daily Copaxone users to the 40-mg version, and has many good but

difficult-to-formulate products in its pipeline. While competitors may be challenged by the 21st Century Cures Initiative,

Teva is in a position to take advantage of the legislation.

Teva’s Overall Performance

“I firmly believe Teva will overcome [the patent cliff and the heightened competition]. The company is still quite

successful in converting daily Copaxone patients to Copaxone 40 [mg]. In addition, Teva has so many good products

in the pipeline that are more difficult to make.”

“Not every Tom, Dick, and Harry in the industry can manufacture the drugs that Teva is making. Teva is good at going

after the more difficult-to-formulate drugs that are long-lasting, like time-release drugs.”

“It would be naïve to say that Teva won’t feel the competition somewhere. But they are prepared for what will come.

Teva has innovated around the competition.”

“Necessity is the mother of invention. This is why we’ve always been so high on generics. If it weren’t for generics,

the brand companies would never be motivated; there would be no incentive to change.”

“Teva has three or four brand products that will be launched this year and also some hard-to-formulate generic

products. Teva has the research capability to get new therapeutic indications for their drugs and pick up another five

years. They knew all along that Copaxone would expire, and they were ready. They’ve done a great job of preparing

for that and beefing up their pipeline to fill the void.”

“Teva will succeed. I’m not sure of their leveraged position or cash flow, but their branded stuff and new therapeutic

indications fit right in with the 21st Century Cures legislation. This legislation will be beneficial to Teva regarding

exclusivity for new uses of existing drugs, and that is what Teva’s NTE program is all about.”

“I haven’t met the new CEO yet, but the investors and sales analysts have confidence in him. He knows what he is

doing.”

“Teva’s president of global generics, Siggi Olafsson, is probably the brightest guy in generics, and he has helped Teva

turn the corner. With their new NTE program, which came from their past CEO, they have a robust ability to innovate.”

“There is a lot of pressure on generics in terms of pricing right now. The Hill is getting involved. I do know that Teva’s

margins have gone up in the fourth quarter to almost 29%, and in the past four years the margins have increased

from 20% to 25.6%. But I’m not sure about going forward.”

Teva’s Growth Potential

“I feel bullish toward Teva. My opinion on Teva has not changed from a few years back. Even then, Sandoz, Mylan,

Watson [now known as Actavis]—they all had 7% to 8% of the market share, and Teva was always up there at 18%.”

“Teva has good brand products. Their pipeline is strong, and we are looking at three to four [new products] this year.”

“In the Western European market, Teva is in the top three of 26 of the European markets. There are price controls in

Europe, but the controls haven’t changed and the generic market is growing. I’m not sure why.”

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Teva Pharmaceutical Industries Ltd.

“The FDA just approved Teva’s generic version of Nexium, the heartburn medication that has brand sales of $2

billion. AstraZeneca made a label change shortly before generic approval, and they held up the launch. But now

Teva’s esomeprazole has 180-day exclusivity, and it has good capability.”

Teva’s Challenges

“The Pfizer/Hospira merger is not a threat. Teva already competes with Pfizer, which has Greenstone LLC and

Hospira anyway, so this is not new. Pfizer may be looking to add value to its generics side of the business, combine it

with Greenstone and possibly sell it all off in one big package. On the other

hand, Pfizer may be looking to get into biosimilars, and Hospira has a few in

the pipelines.”

“A few generic companies like Teva, Sandoz and Hospira [are working on

biosimilars]. According to their earnings call, Teva will really have to beef up

to keep up with the second wave, which will occur around 2018 to 2020

with products that are harder to make.”

“I didn’t think Copaxone 40 [mg] would get 50% of the total Copaxone sales.

Teva didn’t do a forced conversion; they did not take the daily off the

market. Teva has a great MS sales force, and they relied on the sales force

and their relationship with MS doctors to migrate patients from the once-a-

day to the three-times-weekly, and they have done fabulously.”

“Three challenges could be in Teva’s favor: the opioid law, Nexium and the

21st Century Cures exclusivity. Teva has some good opportunities. The

opioid abuse deterrent industry guidance will be probably be approved by

the FDA in May. [These] molecules are patented, and the companies have a monopoly on the formulation. Teva has

submitted an NDA for a tamper-resistant opioid analgesic and is ahead of the curve on this as far as generics go.”

“Teva’s NTE program is heavy on lifecycle management. Teva could have stopped making the once-a-day, but they

reinvented Copaxone. And they were able to gain 180-day exclusivity for generic Nexium. 21st Century Cures

increases exclusivity from three to five years for new therapeutic indications. This is right up Teva’s alley and will be

in Teva’s favor.”

3) Pharmacist, industry expert and former pharmaceutical company employee; repeat source

Teva will not experience any “magical turnaround,” and will be in for “a run for its money” if Pfizer does acquire Hospira.

Raising generic prices to improve operating margins would be problematic for Teva in the current market. Teva must be

moderately to very effective in converting and keeping patients on the 40-mg Copaxone to offset the patent cliff.

Teva’s Overall Performance

“Short term, Teva will have some success because [Vigodman] is reducing margins [by] cutting some expenses. I

think long term, there is some concern that you can’t cut your way to profitability or more profitability.

“They are one of the largest, if not the largest, generic company in the world. I think they will continue to be

successful, but I don’t think that you are going to see overwhelming results vs. what they have done historically. I

don’t think it’s going to be some wonderful, magical turnaround. I’d say [Teva is] somewhat likely to continue their

success.”

“He could continue to cut to improve [Teva’s] operating margins. But to do that through price increases through [the

company’s] generic drug portfolio, I think would prove to be difficult because of the pressure in the generic business

right now. I’d say it would be somewhat difficult for them to continue to raise prices in the generic sector.”

Teva’s Growth Potential

“Teva is having a number of new drug launches, which I think is going to put them in a much better position vs. their

competitors, but they are going to get some significant competition if the Pfizer/Hospira merger goes through.”

“If it does, I think it’s going to give Teva a run for its money.”

“Their generic sales are pretty solid. It appears to me that with proprietary as well as generics, companies tend to

have annual price increases. I’d say their sales in 2015 vs. 2014 for the generics would be flat to higher because

those products are already off patent. Unless you see anything unique in the generic business, I’d say their sales

would increase in 2015 over 2014. Keep in mind that’s the generic component; that’s not the proprietary products.

There’s such a risk with Copaxone [if a generic comes out in the fourth quarter].”

Teva has a great MS sales

force, and they relied on the

sales force and their

relationship with MS doctors to

migrate patients from the once-

a-day to the three-times-weekly,

and they have done fabulously.

Senior Consultant

Pharmaceutical Companies

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22

Teva Pharmaceutical Industries Ltd.

“If you are looking at their portfolio as a whole, I think it’s a nice offering. I don’t know if any of them really jump out

at me as really high potential vs. others other than the generic Nexium. That would be the one that I would think

could pose some pretty high potential, but outside of that one, I don’t think any of these are really game-changing.”

Teva’s Challenges

“If patients have anything to say about it … you’re going to have a lot of

patients who are going to want to stay on a three-times-a-week injection vs.

a [daily] injection.”

“I don’t think PBMs can directly force the patient [to go to a daily Copaxone

generic], but I think they can have a conversation with the doctor. You’ll

have nurse practitioners or pharmacists from the PBMs probably calling the

doctors, explaining to them that the once-daily [generic] is comparable and

that it’s a better price for all involved.”

“[Teva keeping 75% of patients on the 40-mg Copaxone] is a very realistic

possibility. If the PBMs aren’t successful in convincing the physicians to

change it, I think you’d be very likely to get to the 75%. It’s more about

patient satisfaction and quality of life.”

“Physicians are going to be somewhat reluctant if their MS patients are

stable to change them to a generic version.”

“[Whether Teva’s initiatives are enough to overcome the patent cliff and

competition] has to do with how accepted the seven-days-a-week generic version is by physicians and patients. Teva

has a nice portfolio of products that they are coming out with. … I’d say if Teva is moderately to very successful in

keeping patients from moving from a three-times-a-week [proprietary] to the seven-days-a-week generic, with [Teva’s]

portfolio [of drugs coming out], that will be enough to offset the cliff.”

“[Once there’s a generic, there will be growth for the three-times-a-week branded Copaxone]. It’s a selling point for

them. If I am a new MS patient and my insurance covers it, I only want to get a shot three times a week vs. seven.”

Miscellaneous “If [the MS patient] were to have a relapse, the relapse could be much more costly than the money they would save

from moving them from a three-days-a-week proprietary to a seven-days-a-week generic.”

4) Pharmacy benefits consultant; repeat source

A generic Copaxone will result in lost revenue for Teva. Most PBMs will apply pressure to move Copaxone users to the

generic if the cost difference is 15% to 20% after rebates. The generic Nexium shortage suggests demand is high, but

Teva lacks a blockbuster in its pipeline.

Teva’s Overall Performance

“I know they have a lot of products and some general things about them, but not about their restructuring or their

CEO.”

“We do a lot of tracking of drug prices. I’m not familiar with individual company prices. But we’re showing average

brands are increasing 11% to 12% a year. Generics have a slower rise, but it’s happening for older products.”

Teva’s Growth Potential

“I’m not aware of the strength of their proprietary or generic drug sectors

changing since a year ago.”

“Medicare plans are done on a yearly basis, but it wouldn’t surprise me if

Teva was doing multiyear contracts with commercial competitors.”

“I have heard about the shortage of generic Nexium, which they’re saying is

a short-term issue. That happens a lot, especially when it exceeds their

expectations.

“In looking at [their pipeline], there’s nothing all that exciting.”

Teva’s Challenges

“I don’t see the Hospira/Pfizer merger being an issue. Hospira will continue

to do what they have been doing.”

“Medicare programs will dictate what patients get, and others will require a

[Teva keeping 75% of patients

on the 40-mg Copaxone] is a

very realistic possibility. If the

PBMs aren’t successful in

convincing the physicians to

change it, I think you’d be very

likely to get to the 75%. It’s

more about patient satisfaction

and quality of life.

Pharmacist & Industry Expert

I have heard about the

shortage of generic Nexium,

which they’re saying is a short-

term issue. That happens a lot,

especially when it exceeds their

expectations.

Pharmacy Benefits Consultant

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23

Teva Pharmaceutical Industries Ltd.

prior authorization from the doctor to get the Copaxone 40 [mg] if it’s a lot more expensive. I think a smart PBM

would look at the price of the 40 [mg] and the generic 20 [mg] and do what’s economically in the best interest for

the PBMs. Right now you don’t know what that cost differential is. If after rebates there’s a 15% to 20% difference, I

can see how a payer will go after that. If it’s a 5% or 10%, it’s up to the payer whether to go for it. There’s no gold

standard out there.”

“Teva will step up to the plate and provide rebates to make sure they don’t lose much. They of course want a big

conversion to the 40 [mg] but will be competing with the generic manufacturer on price.”

“I wouldn’t classify Copaxone as a specialty drug, and this is not something that people are concerned about, like

they are with hepatitis C. It’s not in the limelight.”

“What they should do is become an authorized generic manufacturer for Copaxone. Then they’re just running a

different label.”

“They’ll lose some money [when they lose the patent], but I don’t know what their balance is. They’re not going

anywhere soon.”

5) Industry expert in biologics

The reduced risk of injection-related side effects would warrant keeping a patient on thrice-weekly Copaxone. Pfizer’s

Hospira acquisition could jeopardize Teva’s expansion plans. The injectable and topical markets are growing.

Teva’s Overall Performance

“Unless physicians can find a good reason to justify a prior authorization to the insurance company [for Copaxone],

then more than likely they aren’t going to be likely to keep people on the brand.”

“They will be able to justify [keeping someone on thrice-weekly injections] by saying that there is lower risk of having

lipoatrophy, which is one of the side effects, and lower risk of just general injection site reaction because they are

injecting themselves less frequently.”

“If the three-times-a-week [Copaxone] goes generic, then I think Copaxone and Teva will be in trouble. If it doesn’t go

generic, I think they are going to be safe because they will be able to justify keeping patients on branded because of

reduced side effects.”

“Teva started the three-times-a-week study because they realized that most patients weren’t taking their [Copaxone]

medication every day and it was having the same effect.”

“When I was selling MS drugs, one of the things that we’d ask physicians is to ask their patients to bring in any

Copaxone they haven’t used just so that physicians would get a visual of how much they weren’t taking, because

most patients were not injecting every day.”

“If the patient is doing fine on Copaxone or whatever they are on, physicians are unlikely to switch them to another

drug. And it would really be considered bad medicine to switch them, because an MS patient could be doing fine on

a drug that a lot of people are doing terribly on, but if that particular patient is responding, then the physician

probably will not switch them regardless. They would, however, probably switch them to a generic.”

Teva’s Growth Potential

N/A

Teva’s Challenges “[The proposed merger between Pfizer and Hospira] is a big threat actually [to Teva’s plans to expand its injectable

and complex generic markets] because Pfizer is a highly respected company. Pfizer knows how to do things the right

way and get it done.”

“The injectable market is a growing market, as are topicals.”

“An extended release [hydrocodone] would only increase the chances of a patient potentially being addicted.”

Miscellaneous “For the most part MS is a slow disease, so it’s very hard in a two-year study to see a lot of change one way or the

other.”

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6) Nurse educator at a multiple-sclerosis patient support organization; repeat source

MS patients have faith in Teva and Copaxone, which is one of the oldest and safest MS drugs. Daily injections are

difficult, so many patients have switched to the 40-mg, thrice-weekly version. However, Copaxone does not work or

creates side effects for some patients. Generic drug prices will increase further this year.

Teva’s Overall Performance

“I can’t address how the company is doing. I can say that they did recognize the need and value of limiting patient

injections. We have confidence in Copaxone and the company. And we hope that patients who are taking Copaxone

with success will be allowed to continue.”

“Drug prices—and this includes the generic prices—keep going up. I imagine they will go up again this year. This is

very hard because the copays continue to increase as well. It is very difficult for some patients.”

Teva’s Growth Potential

“Copaxone has been around the longest [since 1996] of just about all the drugs for multiple sclerosis. It has history,

and we have a great deal of confidence in the safety of this drug. However, for a percentage of patients—and I

couldn’t say how many—Copaxone simply doesn’t work. This is true of almost every drug. There are also other

patients for whom Copaxone would be ideal, but they refuse to use any type of needle.”

“That Copaxone has fewer side effects than the other drugs is huge. You

never know who will develop side effects. … In addition to skin reactions

from the injections, these drugs can cause serious side effects, such as

liver problems and low white blood cell counts. People on these drugs need

to be monitored all the time.”

“I’m not familiar with any of Teva’s other drugs.”

Teva’s Challenges

“Daily injections are very difficult for people. It damages their skin and is

uncomfortable. So as soon as they came out with the three-times-weekly

injection, people started moving over right away. And they are not going

back. I should think many patients will move to [the 40-mg Copaxone].”

“Should a generic version come out, will patients be forced to switch drugs?

I do not know the answer to that one, but it is a topic of concern for all the

MS groups. We talk about it all the time. Not all generics are created equal.”

Miscellaneous

“Copaxone is part of what we call the ABCNR drugs: [Biogen’s] Avonex,

[Bayer AG’s/BAYRY] Betaseron, Copaxone. There is also Novantrone, or mitoxantrone, a [now generic] chemotherapy

approved for MS; and [Pfizer’s] Rebif, another interferon. All of these drugs are injections, with the exception of

Novantrone, which is an infusion. They have been used for years.”

Secondary Sources

The following seven secondary sources discussed the rising costs of generic drugs, drug company regulations in Europe, and

feedback on Teva’s new 40-mg, thrice-weekly Copaxone.

The Rising Prices of Generic Drugs New York’s attorney general accused Actavis of coercing its Namenda users to switch to a new form of the drug in order to

prevent generic versions from competing. Meanwhile, generic drug prices are rising, and lawmakers have subpoenaed drug

companies to provide reasoning behind the increases.

March 19 Kaiser Health News article

Actavis allegedly is pushing its Namenda users to switch to the updated version of the drug while limiting the availability

of the old drug. Lawmakers and experts claim Actavis employed this tactic to prevent generic versions of Namenda from

taking Actavis’ share once the patent expires later in the year.

Daily injections are very difficult

for people. So as soon as they

came out with the three-times-

weekly injection, people started

moving over right away. And

they are not going back. I

should think many patients will

move to [the 40-mg Copaxone].

Nurse Educator, Multiple-sclerosis

Patient Support Organization

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“Executives at drug company Actavis knew they had to move fast to avoid a plunge in sales of their top-selling drug,

Namenda, a treatment for Alzheimer’s disease which would lose patent protection in July. When that happened,

generic knockoffs would flood the market and doctors and pharmacists could switch patients to the lower-cost

equivalents.”

“Late last year, [Actavis] touted a new, extended-release version of the drug, called Namenda XR, which can be taken

once a day and carries patent protection until 2029. Such a move is not unusual, but Actavis took the campaign a

step further by limiting distribution of the original tablet to a single mail-order pharmacy and requiring doctors to

submit a note stating the old drug was ‘medically necessary’ for patients.”

“Those efforts are the focus of a closely watched antitrust lawsuit that pits the international drugmaker against New

York’s attorney general, who says Actavis’ strategy was designed to force patients to switch to another drug and

discourage them from moving to soon-to-be-released generics. The suit calls the strategy anticompetitive and illegal.”

“‘Actavis was trying to ‘squeeze every last dollar out of their Namenda [franchise] with no concern about the effects

on vulnerable Alzheimer’s patients,’ Attorney General Eric Schneiderman argued in court papers.

“Brought by a regulator, rather than a rival drug company, the lawsuit signals growing activism by government ‘at a

time when patients, physicians and payers are hyper-aware of rising drug costs,’ wrote Fenwick & West attorney

Michael Shuster in an article about the case.”

“New York won an injunction in December that blocked the firm from limiting access to Namenda, a ruling appealed

by the drugmaker and now before the U.S. Court of Appeals for the Second Circuit. A decision could come as soon as

next month and may help define how far drugmakers can go to protect brand-name profits from generic rivals when

their patents expire.”

“Dublin-based Actavis, which bought Namenda-developer Forest Labs last summer, said it has not violated any laws.

It describes its moves as a common-sense business decision to shift customers to what it describes as a better,

more convenient product. Actavis argues that the injunction benefits its generic rivals —and stymies future drug

innovation —by forcing it to devote scarce resources to manufacturing and distributing a product that it wants to

withdraw.”

“Once [drug companies’] patents and exclusivity expire, generic equivalents approved by the FDA can compete—

often driving down prices by 80 percent.”

Nov. 21, 2014, Philly.com article

Overall drug spending in the United States is slowing, but many generic drug prices are skyrocketing. Some lawmakers

are questioning generic drug companies’ reasoning behind the price hikes.

“The Centers for Medicare and Medicaid Services said in January that the national rate of retail prescription drug

spending slowed in 2012, growing only 0.4 percent because of ‘numerous drugs losing patent protection, leading to

increased sales of lower-cost generics.’ No market can be perfect, even good, for every participant all the time, and

some of the 12,000 generic drugs on that market have skyrocketed in price in the last 18 months, according to

people in the industry.”

“Generic drugs usually still cost less than their brand-name equivalents, but makers of generic drugs are in business

to make money. Companies have stopped making certain products or stopped selling them in certain places

because the competition is too great or the demand too low to make what they deem an acceptable profit.

Companies have bought out competitors to pare the field.”

“‘We are the only country in the world where drug companies can charge whatever they like because they can, and to

me, it’s not right,’ said Bridesburg resident Casimir Janczewski, who saw the out-of-pocket price of his generic

prescription skin cream rise from about $26 in April to about $112 in October, even with insurance from Aetna.

Janczewski’s annoyance increased when he learned that the drug’s manufacturer, Teva Pharmaceutical Industries

Ltd., had increased its profits on generics.”

“For patients with more serious conditions, that is not an option. And Janczewski is not alone in his concern. A

federal grand jury in Philadelphia and the Connecticut attorney general are looking into possible antitrust violations

by generic drugmakers. The U.S. Senate Subcommittee on Primary Care and Aging will hold a hearing Thursday in

Washington in the hope of getting some answers.”

“‘We’ve got to get to the bottom of these enormous price increases,’ the subcommittee chairman, Bernie Sanders

(Ind., Vt.), said in a statement. ‘It is unacceptable that Americans pay by far the highest prices in the world for

prescription drugs. Generic drugs were meant to help make medications affordable for the millions of Americans who

rely on prescriptions to manage their health needs, and now some of them are becoming unaffordable.’”

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“A spokesman for the Generic Pharmaceutical Association (GPhA), an industry trade group, cited numerous articles

and studies about how generic drugs have lowered the cost of health care and increased the availability of medicine.

He declined to comment Wednesday on the Senate hearing, but said the association would release a statement

Thursday. On Sept. 24, the 30th anniversary of the signing of the Drug Price Competition and Patent Term

Restoration Act, the CEO of the GPhA, Ralph Neas, noted that studies suggest the law saved $239 billion in health-

care costs in 2013 and created “a new framework allowing safe, affordable generic drugs to come to the market.”

“Sanders’ committee sent letters to 14 generic-drug companies, seeking explanations for price increases. Twelve of

the 14 companies have headquarters or U.S. generic operations in Pennsylvania or New Jersey.”

“In alphabetical order, the Pennsylvania companies were Endo International P.L.C. (Malvern), Impax Laboratories

Inc.’s subsidiary Global Pharmaceuticals (Chalfont), Lannett Co. (Philadelphia), Mylan Inc. (Canonsburg), and Teva

Pharmaceutical Industries Ltd. (North Wales). The New Jersey companies were Actavis P.L.C. (Parsippany), Dr.

Reddy’s Laboratories Ltd. (Princeton), Heritage Pharmaceuticals Inc. (Eatontown), Par Pharmaceutical Cos.

(Woodcliff Lake), Sun Pharmaceutical Industries Inc. (Cranbury), West-Ward Pharmaceutical Corp. (Eatontown), and

Zydus Pharmaceuticals USA Inc. (Pennington).”

“Impax and Lannett said in filings with the Securities and Exchange Commission that they received subpoenas Nov.

3 from the Justice Department’s antitrust division, which wanted documents relating to “communications or

correspondence with competitors regarding the sale of generic prescription medications,” according to the Lannett

filing.”

European Regulators Switzerland is pressuring pharmaceutical companies to lower their prescription drug pricing after discovering neighboring

countries are paying 5% less. The European Medical Agency suspended the sale of more than 100 drugs that were tested by

GVK Bio, claiming the Indian organization did not properly monitor some of its procedures.

Sept. 27, 2014, article from The Motley Fool

Switzerland is pressuring drug companies Roche and Novartis to lower prices on their drugs since neighboring EU

countries pay 5% less than Swiss residents. The country must walk a fine line between enforcing pricing regulations

without taking effective treatments off the market.

“Switzerland is prepared to dip its toes further into the prescription cost control waters. According to Reuters, though

Switzerland’s per-capita prescription drug spending of $562 is well below the $1,010 spent per American on

prescription drugs, it pays an average of 5% more for its drugs than the six-country benchmark of Denmark,

Germany, Austria, France, Netherlands, and the U.K. As such, Switzerland is taking on two of its most critical

employers Roche and Novartis in an effort to keep drug costs in its privatized healthcare system from rising even

further.”

“We’ve been witnessing the battle over drug pricing between pharmaceutical companies and insurers/governments

for decades around the world. Pharmaceutical companies need to charge a relatively high price for branded products

in order to make up for the costs associated with researching and developing that drug, as well as for other drugs

that failed to make it to market. On the flipside, consumers are getting fed up with the rising tide of prices, wanting

considerably better efficiency from pharmaceutical companies if they’re going to foot bills that can sometimes come

in above $100,000 annually.”

“Switzerland may have had enough. Roche, for example, balked at the Swiss government’s request that it drop the

price of its HER2-positive late-stage breast cancer drug Perjeta about 20% below what it sells the drug for in a

number of other EU countries. In response, Switzerland’s healthcare ministry put its foot down and recently removed

the drug from the nation’s approved list of reimbursable drugs.”

“The Swiss market only makes up between 1% and 2% of total worldwide pharmaceutical sales, so it’s not as if

Roche’s Perjeta sales are suddenly going to fall through the floor, but the appeal of exclusionary cost controls could

spread to other industrialized nations that are more important to Roche.”

“The pharmaceutical industry accounts for about 40,000 jobs in Switzerland and is responsible for roughly 6% of

GDP. In other words, placing too many pricing restrictions on brand-name drugs could cause one or both of these

companies to respond with cost-cutting layoffs, which would be bad for the Swiss economy.

Additionally, removing drugs from the approved reimbursement list might reduce medical cost inflation over the short

run, but it could be devastating to long-term costs if truly superior drugs are being excluded. The reasoning is that it

could cause patients in need of excluded drugs to wait longer to receive treatment—a number of high-priced

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excluded drugs treat cancer, and cancer patients simply don’t always have the luxury of waiting—and it may also flat

out deny access to critical medicines for those in Switzerland who don’t have some form of supplemental insurance.”

Jan. 23 Wall Street Journal blog

The EMA suspended hundreds of drugs that were authorized for use by GVK Bio. The EMA accused the Indian

organization of improperly monitoring the trials.

“The European Medicines Agency recommends suspending the sale of hundreds of drugs that were authorized for

use across the continent based on ‘flawed’ clinical studies that were conducted by GVK Biosciences, a clinical

research organization based in Hyderabad, India.”

“The decision follows an inspection last May by French regulators that raised concerns about the reliability of several

studies conducted at the site between 2008 and 2014 on behalf of various drug makers. The inspection found

anomalies in the way that electrocardiograms were being monitored for the trials.”

“Since then, several countries—including Belgium, Luxembourg and Germany—suspended approval of medicines that

were tested by GVK, prompting the EMA to conduct a review. The medicines (here is the list) are sold by various drug

makers, including Mylan Laboratories, Teva Pharmaceuticals. Dr. Reddy’s Laboratories, and the Sandoz unit of

Novartis.”

“In a statement, the EMA says that more than 1,000 doses and strengths of medicines were studied at the GVK site

in India and that sufficient supporting data from other sources were available for more than 300 of those drugs,

which will remain on the market, and that the medicines for which supporting data was lacking should only be used

only if patients have a ‘critical’ need. The EMA adds, however, there was no evidence of harm or lack of effectiveness

with any of the medicines” studied by GVK Biosciences.”

Feedback on Teva’s 40-mg Copaxone MS patients in review boards and other message boards discussed the new 40-mg, thrice-weekly Copaxone drug. Most were

excited to switch from the once-daily version, but a few reported increased soreness, difficulty remembering the injection day,

and insurance refusing to cover the drug.

Jan. 15 Drugs.com review board

A 40-mg Copaxone version user reported itching from the injection that went away after a home-remedy solution that

involved oatmeal. Other users report initial irritation that goes away over time.

“I was just diagnosed Nov. 2014. Started on Copaxone 40 mg just a couple of weeks later. I have had all of the

typical site reactions with every injection. The worst has been the itching. That of which I have been unable to control

with ANYTHING until this last injection. I researched and have used every over the counter remedy. Started looking at

the natural remedies for itching. Could not [bear] to invest any more money. Came across the use of oatmeal for

itching (forgot all about that). I had steal cut oats on hand. Ground them into a flour-like texture. Put the ground

oatmeal in a cheap knee high stocking, dipped it in hot water, allowed the concoction to drain so that it was not

messy but still wet. Apply. AMAZING RELIEF."

"Copaxone has been excellent, for me, as far as slow -> minimal progression. I hate injections. However, I much

prefer the 20 mg daily injection over the 40 mg 3 x week. I have fewer localized reactions."

"I have been on Copaxone now for 6 weeks. Started on Tecfidera and that was just a horrible experience so switched

to Copaxone three times a week. I also encountered an Autoject problem and after one week switched to doing the

injection manually. The site reactions are pretty much gone but I do use heat prior and ice post injection to keep

whatever reaction occurs to a minimum. I have only been diagnosed for 3 months now but I have so much more

energy than I have had for a very long time so my experience has definitely been positive!"

Sept. 10, 2014, MSWorld.org forum

Copaxone users discussed successes and issues with the treatment. A few users reported more swelling and even

lesions with the 40-mg version. Many users did not see any changes in efficacy or side effects. Some users’ insurance

will not cover the 40-mg dose.

“I was stable on the 20mg for over a year, switched to the 40mg and within 3-4 months had new lesions. I had no

problems taking it though. I am new to MS, Copaxone was my first DMD, I have no proof switching caused new

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lesions and I realize everyone reacts differently. Personally, if I ever have to go back to Copaxone, I’d do the daily.

Hoping that never happens.”

“I have been using Copaxone since 1998. Last year, I was in the Glacier study [which] looked at Copaxone 20 daily

vs Copaxone 40 3 times a week. I was in the Copaxone 40 part of the study. I have been on Copaxone 40 since June

30, 2013. I do my injections on Tues, Thurs, & Sat. When I started the Copaxone 40 injections, I had some stinging &

redness. Nothing major in my book. Those symptoms have lessened over time. It has also nice to only do 3 injections

a week....144 versus 365....my injection sites like that...LOL”

“I love it. Took it daily for 15 years. Three x per week is great. Not feeling any difference.”

“I too have noticed no difference in site reactions in the 40 mg vs the 20 mg. When I was on the 20 mg I ended up

down to just every other day but changed to the 40 three days per week in February this past year. Now though I am

taking just 40 mg two times per week. I feel the best now compared to the past five years when I got diagnosed, so

of course, I think that it is working for me.”

Does anyone else on 40 get bruises at the injection sites? Is there something I can do to lessen them? They are

lasting longer and longer. I’ve been on since June.”

“I’m currently on the 20mg Copaxone. Insurance won’t cover the 40mg. I have experienced random bouts of anxiety

the next day after injection.”

Feb. 13, 2014, Babycenter.com community group

Group members shared successes and setbacks with the 40-mg Copaxone version. One member noticed no change in

efficacy and appreciated not having to prick herself as often during the week. Another reported more soreness and

difficulty remembering which days to administer the injection. A third discovered that her insurance would not cover the

new version.

erlo: “I noticed the emphasis on the flushing, rapid heart beat side effect. I had that happen once on the 20mg dose

but I think it was a time i stuck it right into a vein. Anyone know if it is actually expected to occur in more people and

why?”

LogicMom: “couple weeks now and there’s absolutely no difference between the 20 and 40. Other than, you know, 4

LESS SHOTS A WEEK!!! Which has really been freeing. I totally understand wanting to wait it out—that’s what I am

doing with Tecfidera. But since Copaxone has been around so long and so well-studied, I’m honestly not that worried.

Just my perspective. I’m on Copaxone after refusing meds for a year after my diagnosis because I felt it had the least

amount of side effects. So far, for me, it really has none.”

jmallen11: “I’ve been on the new Copaxone for 3 weeks. I love the freedom that it gives with only 3 days/wk. But, I

feel like the skin reactions, especially redness and itchiness is a little worse than the 20mg. Hoping that it will get

better over time.”

JDL_359: “My main problem with Copaxone was the hard sore lump I’d have for a few days after each shot. But I’ll

take half as many and not deal with the constant stomach and intense flushing episodes [as I did with Tecfidera].”

NurseMommy1988: “I was on Copaxone before I got pregnant in 2011 and I HATED IT! It burned so badly! I was so

happy to be put on Tecfidera! But if I had to, I would definitely take Avonex over Copaxone any day. I also had an

allergic reaction to the medication twice after my son was born and it sent me to the ER. I hope it works out better for

you than it did for me.

JDL_359: “I’ve been on the 40 for a few weeks now. I still get a really sore spot but having 3 per week is better than

6 or 7. I still have trouble remembering to do it on the right days though. I like to do it right after my shower while

skin is warm; I think even warmer skin would be better but remembering to heat up the pad, use it and do the shot is

tough for me. That sounds silly but my mornings are pretty crazy.”

cal5dreamer: “I was so excited about this, and now so disappointed. My insurance won’t cover it, so I’m in the

process of an appeal. And I called Shared Solutions to ask about financial help, and they said that if my insurance

won’t cover any part of it, then they can’t help me. SO discouraging. Yet my insurance WILL cover the new oral

meds.”

Additional research by Pam Conboy, Renee Euchner and Karen Lusky.

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