Iberian Pharmacy Market Watch

Iberian Pharmacy Market WatchCORONAVIRUS SPECIAL EDITION2020 WEEK 19: MAY 4 - 10Published May 18, 2020 – Revised

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Coronavirus Special: Executive Summary

• Week 19 2020, from the 4th to 10th of May, was the 1st

week in which Spain entered into “Phase 0” and in which Portugal entered into the first stage of its respective deconfinement process after two months of strict lockdown orders in both countries, meant to contain the spread of the novel coronavirus

• In the 19th week, retail pharmacies in Spain dispensed 40,5 million units, up +34,8% when compared with the same week last year, and up +3,8% in the accumulated period from weeks 4-19 versus the same period last year

• This week’s growth in the Spanish pharmacy market is driven mostly by the sales of consumer health products, especially respiratory face masks and products in some spring season categories

• In Portugal, retail pharmacies dispensed 6,4 million units, down -13,7% when compared with the same week last year, and up +5,3% in the accumulated period from weeks 4-19

• Both markets reflect similar market phenomena regarding the stockpiling and possibly augmented treatment compliance in prescription medicine dispensation, as well as the return of some spring categories with the first week of deconfinement coinciding with warm, sunny weather on the Iberian Peninsula. However, the markets differ in week 19 primarily due to the behavior of the protective face masks category

MARKET WATCH IBERIAN PENINSULA – 2020 WEEK 19 – RETAIL PHARMACY MARKET

Our analysis

SPANISH PHARMACY MARKET SAMPLE: 7.053 PHARMACIES | PORTUGUESE PHARMACY MARKET SAMPLE: 2.457 PHARMACIES COPYRIGHT © 2020 HEALTH MARKET RESEARCH. ALL RIGHTS RESERVED PUBLISHED ON 18 MAY 2020

Weekly Performance of the Spanish Pharmacy MarketWeeks 04 – 26 of the year, 2020 vs 2019 (Volume in millions of units)

2020 Week 1940,5 M Units+34,8% vs W19 2019

+3,8% ACUM W04-W19

Weekly Performance of the Portuguese Pharmacy MarketWeeks 04 – 26 of the year, 2020 vs 2019 (Volume in millions of units)

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Key Dates in Spain1.- First case of Covid-19 detected in Spain (Week 5)2.- First cases of Covid-19 detected in Spain on Iberian Peninsula (Week 09)3.- First SARS-CoV-2 outbreak containment measures announced (Week 11)4.- State of Alarm and national lockdown begins (Week 12)5.- Children under 14 years old allowed outside (Week 18)6.- Phase 0 of deconfinement implementation plan begins (Week 19)

Key Dates in Portugal1.- First case of Covid-19 detected in Portugal (Week 10)2.- Highest Alert state begins (Week 11)3.- State of Alarm and national lockdown begins (Week 12)4.- State of Alarm lifted and Stage 1 of reopening begins (Week 19)

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2020 Week 196,4 M Units-13,7% vs W19 2019

+5,3% ACUM W04-W19

Coronavirus Special: Prescription Medicines

• Week 19 2020, from the 4th to 10th of May, was the 1st week in which Spain entered into its “Phase 0” of the country’s deconfinement process after two months of strict lockdown orders meant to contain the spread of the novel coronavirus

• In the 19th week, retail pharmacies in Spain dispensed 22,2 million units of prescription medicines, down -6,3% when compared with the same week last year, and up +14,3% from the previous week likely due to the May 1st bank holiday in Week 18

• In the accumulated period from week 04 to week 19, prescription medicine dispensation volume is up +1,0% from the same period last year

• The therapeutic classes that show the most growth this week are R06: Systemic Antihistamines and N05: Psycholeptics

• Dispensation of systemic antihistamines grew by more than +21% or +184.000 units this week compared to the same week last year as aerobiological meters recorded exceptionally high concentrations of pollens throughout most of Spain during week 19

MARKET WATCH SPAIN – 2020 WEEK 19 – RETAIL PHARMACY MARKET

Our analysis

SAMPLE: 7.053 PHARMACIES COPYRIGHT © 2020 HEALTH MARKET RESEARCH. ALL RIGHTS RESERVED PUBLISHED ON 18 MAY 2020

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Weekly Dispensation of Prescription MedicinesWeeks 04 – 26 of the year, 2020 vs 2019 (Volume in millions of units)

2020 Week 1922,2M Units

- 6,3% vs W19 2019+1,0% ACUM W04-W19

ATC 2

Absolute Growth Volume

Relative Growth Volume

1 R06: Systemic Antihistamines +184,3 +21,7%

2 N05: Psycholeptics +34,7 +1,9%

86 M01: Anti-inflammatories -320,9 -30,0%

85 J01: Antibacterials -320,4 -40,9%

84 N02: Analgesics -132,6 -4,9%

83 A02: Antacids -128,6 -8,2%

82 R05: Cough and Cold -89,6 -52,6%

81 H02: Systemic Corticosteroids -65,2 -27,5%

80 B01: Antithrombotic agents -64,9 -6,8%

Year over Year Change in Prescription Medicine Dispensation Volume by ATC2Week 19 of the year, 2020 vs 2019(Volume in thousands of units)

Week 11 most likely represents both a stockpiling of prescription medications at home by patients with chronic diseases, as well as a change in behaviors towards treatment adherence and complianceWhile at an aggregate level it may appear that the weekly dispensation of prescription medicines are oscillating towards a normalization period after the behavior observed in Week 11, the detailed data suggests that depending on the therapeutic class, there may have been both a stockpiling and exceptional attitudes towards treatment compliance provoked by the current health crisis

Aggregate dispensation of prescription medicines in Week 19 is -6,3% less than last yearThe therapeutic classes that show the largest decreases in levels of dispensation than last year are most likely due to the continued confinement and they are not the therapeutic classes with the largest increases seen in previous weeks.

Coronavirus Special: Selected Therapeutic Classes

• Looking at a few therapeutic classes for chronic diseases, all present reduced levels of dispensation this week versus the same week last year, however all continue to be up between +4% to +7% in the accumulated weeks from W04 to W19

• The classes C10: Lipid Modifying Agents and A10: Drugs used for Diabetes show similar evolutionary trends in that both classes report about a -1,5% reduction in dispensation volume this week versus the same week last year, and in the accumulated weeks 04 – 19, both classes report in increase in dispensation of about +6,5% compared to the same accumulated period last year

• R03: Drugs for Obstructive Airway Diseases, shows a deeper reduction of dispensation this week, down -4,6% from the same week last year, and continues to show a growth of +4,7% in the accumulated weeks from 04 – 19

• Using the example of the dispensation levels R03 subgroup for Short-Acting Beta-Agonists (SABA) in Week 11, it is likely that dispensation levels in these therapeutic classes for chronic diseases sustain accumulated growth levels over the year because of a temporary phenomena of increased treatment compliance during the peak infection weeks of the novel coronavirus outbreak


Our analysis

PUBLISHED ON 18 MAY 2020

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Weekly Dispensation of C10: Lipid Modifying AgentsWeeks 04 – 26 of the year, 2020 vs 2019 (Volume in thousands of units)

Weekly Dispensation in C09: Renin–angiotensin Weeks 04 – 26 of the year, 2020 vs 2019 (Volume in thousands of units)

Weekly Dispensation in A10: Diabetes DrugsWeeks 04 – 26 of the year, 2020 vs 2019 (Volume in thousands of units)

Weekly Dispensation in R03: Asthma / COPDWeeks 04 – 26 of the year, 2020 vs 2019 (Volume in thousands of units)

2020 Week 19 1.379 K Units-1,5% vs W19 2019+6,5% ACUM W04-W19

2020 Week 19 1.659 K Units-2,6% vs W19 2019+4,4% ACUM W04-W19

2020 Week 19 902 K Units-1,4% vs W19 2019+6,8% ACUM W04-W19

2020 Week 19 722 K Units-4,6% vs W19 2019+4,7% ACUM W04-W19

SAMPLE: 7.053 PHARMACIES COPYRIGHT © 2020 HEALTH MARKET RESEARCH. ALL RIGHTS RESERVED

Coronavirus Special: Paracetamol and Ibuprofen

• Dispensation of paracetamol continues to show an increased consumption from last year: this week up +9,8% from the same week last year, and +40% in the accumulated period of weeks 04-19

• The use of ibuprofen in prescription and non-prescription strengths continues to be well below last year: this week at -29% versus week 19 last year, and -6% in the accumulated period of weeks 04-19


Our analysis


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Weekly Dispensation of Paracetamol (650mg, 1.000mg)Weeks 04 – 26 of the year, 2020 vs 2019 (Volume in thousands of units)

Weekly Dispensation of Ibuprofen (200mg, 400mg, 600mg)Weeks 04 – 26 of the year, 2020 vs 2019 (Volume in thousands of units)

2020 Week 191.112 K Units

+9,8% vs W19 2019+40,2% ACUM W04-W19

2020 Week 19501 K Units-28,6% vs W19 2019

-6,1% ACUM W04-W19


Coronavirus Special: Consumer Health

• Week 19 2020, from the 4th to 10th of May, was the 1st week in which Spain entered into its “Phase 0” of the country’s deconfinement process after two months of strict lockdown orders meant to contain the spread of the novel coronavirus

• Sales volume of consumer health products in the pharmacy rose by +75% compared to the same week the last year as consumers went to pharmacies to attain face masks

• Facial mask sales volume drove the patient care segment of consumer health products up by +259% versus the same week last year as pharmacies dispensed more than 7,7 million face masks to consumers in 1 week

• The Personal Care segment also experienced growth in week 19 versus the same week last year, likely driven by the entry into Phase 0 along with the warm, sunny weather experienced after a rainy and confined entry into the spring season. The insect repellent category experienced a growth of more than +114%; sunscreens for children experienced more moderate growth of +8%


Our analysis


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Weekly Sales of Consumer Health Products Weeks 04 – 26 of the year, 2020 vs 2019 (Volume in millions of units)

2020 Week 1918,3 M Units+75,1% vs W19 2019+72,2% vs W18 2020

Year over Year Change in Consumer Health Product Sales Volume by Segment(Volume in thousands of units)

Week 19 2020 vs 2019

Absolute Growth Volume

Relative Growth Volume

Consumer Health +7.845,7 +75,1%

OTC Drugs -245,5 -9,0%

Supplements -11,7 -0,9%

Personal Care +84,0 +3,3%

Patient Care +8.136,1 +259,2%

Nutrition -92,8 -17,9%

Homeopathy -15,4 -20,1%

Demand for face masks drove total sales volume in retail pharmacies during Week 19 as agreements were made to make the retail pharmacy the dispensation outlet for face masks (nose and mouth coverings)Week 19 also coincides with Spain’s entry into its “Phase 0” the reopening plan. Personal care products, and notably the categories associated with the Spring / Summer season recorded sales +3,3% higher than the same week last year as Spain began to experience sunny, warm weather during the same period


Coronavirus Special: Effect on Consumer Health Sales

• We have noticed five phenomena in the pharmacy market that have emerged with the spread of the novel coronavirus in Spain that may aid in the understanding of consumer health needs during this period:

1. Stock and Supply Issues– Categories such as respiratory face masks gloves, thermometers, and disinfectants have experienced high consumer demand and supply shortages both in Spain and around the world. In week 19, supply has begun to normalize as the government put measures in place to attain and distribute respiratory face masks to the general public (+2.174%)

2. Extended Winter Season– Categories typically associated with the winter season respiratory ailments such as the common cold and the flu saw a prolonged season this year as the novel coronavirus outbreak in Spain coincided with the winding down of flu season. Week 19 continues the harsh closure to the season (-30%)

3. Exceptional Demand- Categories that previously were not seasonal, but the products are likely employed in preventative measures to stave off infection. Week 19 sales continue above levels in 2019, but to a lesser degree (+27,5%)

4. Beliefs with “Positive” Effects – Categories in which certain sources of information about its use in relation to Covid-19 may have boosted sales. In week 19 sales resemble those seen prior to the novel coronavirus outbreak in Spain (-1,7%)

5. Beliefs with “Negative” Effects– Categories in which certain sources of information about its use in relation to Covid-19 may have diminished sales. Week 19 sales most likely reflect the effects of returning outdoors after two months of home confinement (+5,9%)


Our analysis


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2020 Week 19+2.174,2% vs W19 2019

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01.Stock and Supply Issues

02.Extended Winter Season

03.Exceptional Demand

04.Beliefs with “Positive” Effects

05.Beliefs with “Negative” Effects

2020 Week 19-30,0% vs W19 2019

2020 Week 19+27,5% vs W19 2019

2020 Week 19-1,7% vs W19 2019

2020 Week 19+5,9% vs W19 2019

Weekly Sales of Nasal Higiene Preparationsand Antiseptic Mouthwashes(Volume in thousands of units)

Weekly Sales of Muscular PainProducts(Volume in thousands of units)

Weekly Sales of Health Care Supplies andMaterials, PPE(Volume in thousands of units)

Weekly Sales of Cough, Cold and Flu Remedies(Volume in thousands of units)

Weekly Sales of Immune System Boosters,Defenses, Multivitamins(Volume in thousands of units)


Coronavirus Special: Lockdown Effects

• We have noticed two phenomena in the pharmacy market that have emerged with the prolonged confinement in Spain that may aid in the understanding of consumer health needs during this period:

1. Spring Season Confinement– Demand for categories associated with the spring and summer season typically begin between the end of May and the beginning of April. Due to the lockdown orders coinciding with this period, these categories decreased sales between 40-50% compared to the same period last year. In week 19, sales were +2,8% higher than the same week last year, thanks to the relaxing of some confinement policies in Phase 0 as well as the rainy start to spring experienced in Spain. Adult sunscreen and anti-age cosmetics are still down versus last year; insect repellents experienced a growth of +114% versus last year and children’s sunscreen a moderate growth of +8% versus the same week last year

2. Prolonged Confinement– Categories associated with tranquilizers and sleep aids, as well as Vitamin D due to the stress provoked by the current health crisis and prolonged confinement. Week 19 sales continue to be well above the volume sold in the same period last year (+33,6%)


Our analysis


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01.Spring Season Confinement

2020 Week 19+2,8% vs W19 2019

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02.Prolonged Confinement

Weekly Sales of Products in Spring / Summer CategoriesSunscreens, Anti-age Cosmetics, Heavy Legs, Insect repellents(Volume in thousands of units)

Weekly Sales of Sleep Aids and Vitamin DSleep Aid Supplements, Vitamin D(Volume in thousands of units)

2020 Week 19+33,6% vs W19 2019


Coronavirus Special: Prescription Medicines

• Week 19 2020, May 04-10, corresponds with the lifting of the state of emergency in Portugal, beginning a gradual “deconfinement” process to reinstate certain activities that were suspended during the state of emergency

• In Week 19, the dispensation of prescription medicines decreased by -18,8% compared to the same week last year

• When compared to the previous week, week 18, dispensation increased by +18,0% likely due to the May 1st bank holiday in week 18

MARKET WATCH PORTUGAL – 2020 WEEK 19 – RETAIL PHARMACY MARKET

Our analysis


Weekly Dispensation of Prescription MedicinesWeeks 05 – 26, 2020 vs 2019Volume in hundreds of thousands (x100.000) of units

Top 10 ATC 2 by Dispensation Volume ChangeWeek 19 2020 vs Week 19 2019 (PY – Previous Year)Week 19 2020 vs Week 18 2020 (LW – Last Week)Volume in hundreds of thousands (x100.000) of units

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ATC2Abs

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Total -10,47 -18,8% +7,16 18,0%

1 N02 - Analgesics -1,14 -23,2% +0,41 11,5%

2 N05 - Psycholeptics -0,48 -11,5% +0,61 18,8%

3 C09 - Agents acting on renin-angiotensin system -0,43 -11,3% +0,59 20,3%

4 C10 – Lipid-regulating/anti-atheroma -0,24 -8,0% +0,49 20,8%

5 A10 – Drugs used in Diabetes -0,35 -12,6% +0,39 18,4%

6 B01 – Antithrombotic agents -0,26 -10,7% +0,35 18,6%

7 N06 - Psychoanaleptics -0,25 -10,6% +0,31 17,2%

8 A02 – Antiacids, antiflatulents and antiulcerants -0,33 -15,5% +0,26 16,3%

9 C07 - Beta-blocking agents -0,20 -12,4% +0,23 18,8%

10 M01 - Anti-inflammatories -0,75 -37,7% +0,20 18,2%

Week 11 most likely represents both a stockpiling of prescription medications at home by patients with chronic diseases, as well as a change in behaviors towards treatment adherence and complianceWhile at an aggregate level it may appear that the weekly dispensation of prescription medicines are oscillating towards a normalization period after the behavior observed in Week 11, the detailed data suggests that depending on the therapeutic class, there may have been both a stockpiling and exceptional attitudes towards treatment compliance provoked by the current health crisis


A10 – Drugs used in DiabetesWeeks 05 – 26, 2019 vs 2020 Weekly sales volume (x1.000 units)

Coronavirus Special: Selected Therapeutic Classes

• Looking at a few therapeutic classes for chronic diseases, all present reduced levels of dispensation in week 19 versus the same week last year

• While reduced in volume, the dispensation trends seem to follow the same pattern as last year with the reduced dispensation in week 18 likely due to the bank holiday

• The various therapeutic classes show increases in dispensation versus the previous week:

o C10 – Lipid-regulating/anti-atheroma preparations (+20,8%) ,

o C09 – Agents acting on renin-angiotensin system (+20,3%),

o A10 – Drugs used in Diabetes (+18,4%),

o R03 – Anti-Asthma and COPD Products (+13,9%)


Our analysis


C10 – Lipid-regulating/anti-atheroma preparationsWeeks 05 – 26, 2019 vs 2020 Weekly sales volume (x1.000 units)

C09 - Agents acting on renin-angiotensin systemWeeks 05 – 26, 2019 vs 2020 Weekly sales volume (x1.000 units)

R03 – Anti-Asthma and COPD ProductsWeeks 05 – 26, 2019 vs 2020 Weekly sales volume (x1.000 units)

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Coronavirus Special: Consumer HealthMARKET WATCH PORTUGAL – 2020 WEEK 19 – RETAIL PHARMACY MARKET

Our analysis


Consumer Health (CH) Product SalesWeeks 05 – 26, 2019 vs 2020 Weekly sales volume (units)

CH Sales Growth by Segment Week 19 2020 vs Week 19 2019 (PY – Previous Year)Week 19 2020 vs Week 18 2020 (LW – Last Week)Volume in units

In week 19 we see a positive trend, driven by the Patient Care segment, but already visible in all segments

• In Week 19 of 2020, May 4-10, sales of consumer health products in the pharmacy grew + 17,3% from the previous week despite the negative growth vs the same week of 2019 (-5,9% corresponding to -110,6K units)

CH shows an exceptional increase in demand in Week 11, followed by a decrease vs the previous period in the following weeks (with a slight increase of +1,0% in Week 16), which is only mitigated by the Patient Care segment dynamic, that continues to show remarkable growth

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Abs Growth

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Total CH -110 649 -5,9% +260 252 +17,3%

Nutrition -12 808 -24,4% +3 868 +10,8%

OTC -218 681 -24,8% +88 633 +15,4%

Patient Care +232 827 +54,4% +111 497 +20,3%

Personal Care -81 837 -25,3% +38 394 +18,9%

Supplement -30 150 -15,8% +17 860 +12,5%


• According to our market understanding, we grouped the effects of the return to routines of the Portuguese population, with the lifting of the state of emergency. The following phenomena might be related to the motives we indicate presently:

1. Ophthalmic Products – the return to the exterior in allergy season and generalized use of face masks might create some ocular discomfort, which might motivate an increase of health products of this category.

2. Extended Winter Season– the demand for products usually associated with cold and flu season peaked on Week 11 of 2020, showing a decrease after this point, which still stands.

3. Return to Outdoor Activities – the end of the state of emergency allows the return of physical activity to levels closer to those before this situation, while still conditioned by the impossibility of attending gyms.

4. Spring Categories – the resumption of outdoor activities, whether in hygienic strolls, sports or return to work, might motivate an increase of purchasing of Spring related categories, such as bug repellents and antihisthamines, both typical for this time of the year.

5. Confinement and Anxiety – possibly due to the challenges of confinement and the uncertainty environment, there is an increase of tranquilizer sales in product healthcare classes, trending to values close to those of 2019.

6. Sunscreens– due to confinement, the supply and demand patterns of products in the categories related to sun exposure remain much lower than the expected values for this season.

Coronavirus Special: Consumer Health EffectsMARKET WATCH PORTUGAL – 2020 WEEK 19 – RETAIL PHARMACY MARKET


Weekly Sales of Spring CategoriesOral/topic antihistamines, bug repellent(Volume in units)

Weekly Sales of Sleep AidsSleep Aids(Volume in units)

Weekly Sales of SunscreensSolar Exposure(Volume in units)

Weekly Sales of Ophthalmic ProductsArtificial tears and lubricants, ophthalmic antihistamines(Volume in units)

Weekly Sales of Winter CategoriesAnalgesics, Cold&Flu, Cough(Volume in units)

Weekly Sales of Muscular and Joint PainAnti-inflammatories, muscular massage, products for sports…(Volume in units)

01.Ophthalmic Products

02.Extended Winter Season

03.Return to Outdoor Activities

04.Spring Categories

05.Confinement and Anxiety

06.Sunscreens

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Our analysis

Coronavirus Special: Sunscreens

• The sunscreen market has been one of the most affected by the confinement situation that the population in general has suffered over the past few weeks. In this time of year, when it is usual to start selling significant volumes of products related to solar exposure, we see that the demand is quite below expectations, compared to the same period from the previous year.

• In a daily analysis of these classes over the past 4 weeks (since Week 16), there is, in the last days of Week 19, an increment of Sell Out volume, possibly motivated by the resumption of daily routines, with more frequent and regular solar exposure, despite still being considerably lower than volumes from 2019.

• There is also a change in the trendline, where its slope becomes steeper in the “deconfinement” period (Trend 2), when compared to the trendline observed during confinement (Trend 1), outlooking an increase of demand for this product category.


Our analysis


Daily Sales of SunscreensMonday, April 13 to Sunday, May 10, 2020 Volume in units

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Sunday, March 3, 2020State of Alarm Lifted in Portugal

Trend 1

Trend 2


Coronavirus Special: Baby & Mom Categories

• Baby & Mom categories also present an increment in sales volume of about +3,9K units when compared to the previous week (Week 18), although sales are still below the volumes of the same week in 2019, with an absolute difference of -3,6K units

• The sales volume of Baby & Mom products in Week 19 of 2020 totals 27,5K units, corresponding to a decrease of -11,5% vs the same week in 2019

• Mom – Unlike the other categories of the market, the products for Mom, such as lactation devices, decrease when compared both to the previous week (-24,7%) and to the same week las year (-28,6%).

• Infant & Toddler – this category, composed of products for children (baby bottles, cups, toys), experienced a sales peak and subsequent decrease , shows an increasing trend (+17,0%) towards levels of last year

• Baby – Baby categories (pacifiers, chewers) show sales similar to the previous category, presenting an increase in Week 19 vs Week 18 of +17,1%, although still being below the values from the previous year


Our analysis


Baby & Mom Categories Weekly Product SalesWeeks 05 – 26, 2019 vs 2020 Volume in units

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H28.2. – Infant & Toddler Products(Weekly Sell Out in units)

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H28.3. – Maternal Products(Weekly Sell Out in units)

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H28.1. – Baby and Newborn Products(Weekly Sell Out in units)

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2.500

3.000

S05 S07 S09 S11 S13 S15 S17 S19 S21 S23 S25

0

5.000

10.000

15.000

20.000

25.000

30.000

35.000

S05 S07 S09 S11 S13 S15 S17 S19 S21 S23 S250

2.000

4.000

6.000

8.000

10.000

S05 S07 S09 S11 S13 S15 S17 S19 S21 S23 S25


• In an earlier distributed version of this report, the first page, “Executive Summary”, incorrectly reported the total dispensation volume of the Portuguese retail pharmacy market. This Is the only page where this information was used.

ErrataMARKET WATCH IBERIAN PENINSULA - 2020 WEEK 19 – RETAIL PHARMACY MARKET

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Iberian Pharmacy Market Watch