IPHA

2. Pharmaceutical Healthcare Facts and Figures 2012 IPHA The Irish Pharmaceutical Healthcare Association (IPHA) represents the international research-based pharmaceutical industry in Ireland. Its member companies include both manufacturers of prescription medicines and non-prescription or consumer health care medicines.

3. Pharmaceutical Healthcare Facts and Figures 2012 Introduction The Irish economy has undoubtedly been experiencing one of its most challenging periods over the last four years. As a small open economy, we are more exposed than most to the global downturn, which has in turn been exacerbated by domestic problems in banking and the property market. Real hardship has been experienced, especially by those who have lost their jobs. However, there are signs that better times are ahead as Ireland has implemented strong measures to deal with the banking issue and the national debt. Much uncertainty remains and more austerity measures must be implemented. However, the public finances remain on track for recovery and we are moving in the right direction for a return to economic growth. A key driver in this process of recovery is Ireland’s exports with the international research-based pharmaceutical industry in Ireland leading from the front. Along with chemicals and medical products, the industry already accounts for 50% of our exports, generating a record €55 billion in 2011, consolidating Ireland’s position as the largest net exporter of medicines in the world. For a country of our size, Ireland punches well above its weight in supporting the international research based pharmaceutical industry. Underpinning the industry are more than 120 companies, who as well as playing a key role in meeting the healthcare needs of Irish people through the provision of innovative and effective medicines, provide employment both directly and indirectly, to almost 50,000 people in this country. Numbered amongst the companies with a manufacturing presence here are 13 of the top 15 global players, producing 5 of the top 12 medicines in the world. In order for our industry to optimise its leading role in driving economic recovery, it is essential that conditions prevail that will continue to allow innovation and excellence to thrive. A strong pharmaceutical industry and a domestic economy returning to growth go hand in hand. This 2012 edition of Pharmaceutical Healthcare Facts and Figures compiles the most up to date information on the industry in Ireland, its place in a global context and invaluable data on healthcare trends and innovation. It is an important resource for those seeking an overview of our most dynamic and innovative industrial sector.  IPHA President

4. Pharmaceutical Healthcare Facts and Figures 2012 Healthcare Today Following a period of cutbacks and stagnation in the early 1980’s and 1990’s, Ireland experienced an unprecedented increase in health expenditure between 1999 and 2009. Public expenditure on health almost quadrupled during this period. However, given the economic downturn and its impact on the public finances, a significant decline was seen in 2010 and 2011, with a further projected reduction of €750 million in 2012. Healthcare expenditure in Ireland equals the OECD average. However, in comparison to its close neighbours such as France and Germany, it is coming from a low base. Irish health expenditure as a percentage of GDP was 9.5% versus 11.8% in France in 2009. Relative to the rest of Europe, Ireland continues to have the highest positive perception of health amongst its population. 84% of the population reported either very good or good health in 2009. The Irish healthcare system remains a mix between public and private expenditure. Just under 50% of the population continue to have some form of private health insurance, although this number appears to be decreasing due to the economic recession. The numbers employed in the public health services increased by over 22% between 2001 (90,302) and 2008 (111,025). However, due to the difficult economic situation, the numbers employed in the health services have decreased with a total of 104,287 employed in 2011. Health expenditure in Ireland accounts for approximately 20% of total current public expenditure. In 2010, approximately 13% of healthcare expenditure was spent on medicines and non-drug items supplied to patients under the Community Drug Schemes – this represents a small but vital component. The research-based pharmaceutical industry has recognised that the State continuously faces a challenge in funding healthcare. In an effort to assist with these challenges, the industry has agreed robust, cost effective arrangements for the supply of medicines to the health services. In the period 2006 to 2010 the industry delivered savings in the region of €300 million to ensure the State had the monies to fund new therapies. In 2010, understanding the difficult state of the public finances as a result of the downturn in the economy and following a request from the Minister for Health and Children for immediate savings, the industry put in place arrangements to yield savings to the State of approximately €94 million in a full year. This saving is in addition to the savings of over €105 million generated, from the 2006 arrangements, in 2010. The industry further agreed to provide additional savings of €200 million for the State in 2011.

5. Pharmaceutical Healthcare Facts and Figures 2012 Public Expenditure on Health 2002 – 2012

6. Pharmaceutical Healthcare Facts and Figures 2012 Health Expenditure as a % of GDP 2009

7. Pharmaceutical Healthcare Facts and Figures 2012 Annual Growth Rate of Public Expenditure on Health Per Capita 2009

8. Pharmaceutical Healthcare Facts and Figures 2012 The number of day cases treated in Ireland has increased by 143% since 2002 Number of Day Cases Treated in Ireland2002 – 2010

9. Pharmaceutical Healthcare Facts and Figures 2012 Self-Perceived Health Status by Age Group in Ireland 2009

10. Pharmaceutical Healthcare Facts and Figures 2012 Prevalence and Burden of Chronic Disease Chronic diseases such as diabetes, hypertension, heart disease and stroke are a large and growing burden on the health of Irish people and the Irish healthcare system. The rising prevalence of chronic disease is partly the result of a population that is ageing and increasingly obese. It is estimated that about 60% of adults and about 20% of children and teens in Ireland are either overweight or obese. These percentages are expected to continue to rise. Today, approximately 25% of the Irish population have a chronic disease accounting for 78% of the country’s healthcare spending. Approximately 80% of GP consultations and 60% of hospital days are related to chronic disease and their complications making those people the most frequent users of healthcare in Ireland. 2 out of 3 patients admitted as medical emergencies have exacerbations of chronic disease and 60% of deaths are as a result of a chronic disease. Chronic diseases can be disabling and reduce a person’s quality of life, especially if left undiagnosed or untreated. There is a significant increase predicted in chronic disease due to the estimated doubling of the elderly population over the next 30 years. If the current trends continue there will be significant implications for the healthcare system e.g. it is estimated that bed requirements in hospitals will increase by 50-60% over the next 15 years. Approximately 60% of the disease burden in Europe is accounted for by 7 preventable risk factors including high blood pressure, tobacco, alcohol, high cholesterol, overweight and obesity, poor diet and physical inactivity. Many of the consequences and costs of chronic disease are avoidable through screening, early intervention, behaviour change and the elimination of key risk factors such as poor diet, inactivity and smoking.

11. Pharmaceutical Healthcare Facts and Figures 2012 Self-Care Today Consumers want to actively manage their own health and are taking greater individual responsibility for their healthcare and health choices. The health, social and economic benefits of responsible self-medication are well known and have been extensively reported1. Patients and consumers benefit due to wellness, enhanced productivity and improved health in terms of prevention and increased patient satisfaction as a result of being able to obtain the correct medication directly. Employers gain by having employees attend work when they might otherwise have stayed at home. General Practitioners save time which enables them to better use that time for those patients with complicated or serious illnesses. It is estimated that 51.4 million GP consultations in the UK are solely for minor ailments. Over half these consultations are generated by people aged between 16 and 59. It is estimated that this represents 18% of a GP’s workload. Furthermore, it is estimated that the total cost to the NHS of these consultations is €2 billion2. It also presents more of an opportunity for doctors to educate patients about common ailments and diminishes patient expectations of a prescription for every visit. Pharmacists play a more active advisory role using their skilled knowledge of medicines and expertise in advising on symptoms. Consumers pay less visits to accident and emergency departments and doctor surgeries. This in turn reduces the number of prescriptions, most of which are paid for, directly or indirectly, by the State. The Association of the European Self-Medication Industry (AESGP) has estimated that savings of over €75 million annually could be achieved in Ireland if self-medication was practisedmore widely. These savings could be put to better use elsewhere in the healthcare system. Self-medication is an important element of the total Irish market for pharmaceutical products and was valued at €273 million in 2010 accounting for 11.9% of the total pharmaceutical market. The leading areas of the market include analgesics (€79.9m), cough and cold treatments (€49.7m) and skin treatments (€46.9m). 1 The Story of Self-Care and Self-Medication. 40 years of progress 1970-2010 (WSMI 2010) 2 Royal College of General Practitioners conference on self care (report in GP, 18 November 2010) Report in “The Independent” (16 March 2010)

12. Pharmaceutical Healthcare Facts and Figures 2012 Self Medication Market in Ireland 2010

13. Pharmaceutical Healthcare Facts and Figures 2012 OTC Medicines as a % of the Total Pharmaceutical Market 2010

14. Pharmaceutical Healthcare Facts and Figures 2012 Demographic Trends • The population of the Republic of Ireland increased by over 340,000 in the five year period between April 2006 and April 2011. It is set to exceed 5 million within the next 5 years and projected to rise to over 7 million by 2041. • In 2010, foreign citizens accounted for 8.6% of Ireland’s population. 80% of these citizens were citizens of another EU27 Member State. • With an average age of 35.6 years Ireland has a relatively youthful age structure; however this is set to change. Those aged 65 and over will account for 20% of the population (1.43 million) by 2041 as against just 11% of the population (430,000) in 2001 and the number of those aged 80 and over is set to increase from a 2001 level of 98,000 to 465,000 in 2041. These changes will have significant implications for public spending and in particular healthcare expenditure as the elderly typically require 2 - 5 times as many resources as those under 65. • The life expectancy of those over the age of 65 has improved significantly in recent years. Life expectancy at birth for males increased from 64.5 years in 1950 to 78.7 years in 2010, representing a gain of 14.2 years over the fifty nine year period. The corresponding female rates were 67.1 and 83.2 years, respectively, which represents a gain of 16.1 years. • Although mortality from circulatory diseases has fallen by almost 40% between 2000 and 2010, these diseases still account for 33% of deaths in the Republic of Ireland. • Approximately one in five deaths in Ireland is of a person aged less than 65 years old. Source: Central Statistics Office Department of Health, Health in Ireland : Key Trends 2011

15. Pharmaceutical Healthcare Facts and Figures 2012 Population Projections 2011 – 2041

16. Pharmaceutical Healthcare Facts and Figures 2012 Life Expectancy 2010

17. Pharmaceutical Healthcare Facts and Figures 2012 Impact of Ageing on Public Expenditure

18. Pharmaceutical Healthcare Facts and Figures 2012 Main Causes of Death in Ireland 2010

19. Pharmaceutical Healthcare Facts and Figures 2012 Healthcare Tomorrow • Research and development of new medicines offers an ageing population hope of a longer healthy life, well beyond that of previous generations. For example, there are currently nearly 900 medicines in development to combat cancer, 300 for two of the leading causes of death in Ireland; heart disease and stroke, and 235 for diabetes and related conditions1. • Research based pharmaceutical companies are the engines of medicines innovation. They have discovered and developed over 90% of all new medicines made available to patients worldwide over the last twenty years. • The discovery, development, testing and gaining of regulatory approval for new medicines has become an even more highly complex, lengthy, risky and expensive process. Each success is built on many, many prior failures. On average only one or two of every 10,000 promising molecules will successfully pass extensive tests and stringent regulatory requirements and go on to be approved as medicines, which are suitable for use in patients. The cost of researching and developing a new medicine has gone from €149 million in 1975 to almost €1.4 billion today2. • It takes an average of 12 to 15 years to develop a new medicine from the time it is discovered to when it passes the regulatory standards of safety, quality and efficacy and is available to patients. Once on the market the average medicine has only 8 to 10 years of effective patent protection remaining before facing generic competition. Only three out of ten marketed medicines produce revenues that match or exceed their R&D costs before they lose patent protection. • The European pharmaceutical industry employs over 115,000 people in R&D at a total cost of over €27.4 billion3. • Innovation is central to the creation of the knowledge based economy of the 21st century. In Ireland pharmaceutical industry R&D is responsible for 20% of all business R&D. • The pharmaceutical industry in Ireland invests considerable funding in clinical trials in this country ranging from under €100,000 by smaller companies to over €1.5 million for larger companies. This money is ploughed into equipment, the employment of research nurses, etc. In addition, there are indirect savings associated with industry-sponsored trials in that patients taking part in a trial are provided with the newest most advanced treatments at no cost to the hospital where they are being treated. • Additionally, companies provide research grants (ranging from €5,000 to over €100,000 per annum per company) and bursaries and grants for projects conducted by research students and post-doctorate fellows in Irish universities. As well as the funding that industry provides through its investment in clinical trials, companies have considerable expertise in Good Clinical Practice (GCP) and the general regulatory requirements applicable to clinical trials. • If innovation is to flourish then it must be rewarded. In addition to escalating R&D costs and regulatory issues, the austerity measures introduced by EU countries including Ireland is impacting on the sector. • Emerging economies such as Brazil, China and India are experiencing rapid growth in both the market and research environments, which is leading to an increasing number of pharmaceutical companies, including European ones, deciding to locate new R&D facilities outside Europe. 1 PhRMA, Medicines in Development (2011) 2 Association of the British Pharmaceutical Industry data (2012) 3 EFPIA, The Pharmaceutical Industry in Figures (2011 update)

20. Pharmaceutical Healthcare Facts and Figures 2012 Evolution of Innovative Medicines

21. Pharmaceutical Healthcare Facts and Figures 2012 Life Cycle of an Innovative Medicine

22. Pharmaceutical Healthcare Facts and Figures 2012 Cost of Developing an Innovative Medicine

23. Pharmaceutical Healthcare Facts and Figures 2012 Number of New Chemical or Biological Entities (1991-2010)

24. Pharmaceutical Healthcare Facts and Figures 2012 Benefits of Innovative Medicines

25. Pharmaceutical Healthcare Facts and Figures 2012 Need for Continued Medicines Innovation

26. Pharmaceutical Healthcare Facts and Figures 2012 Medicines in the Community Expenditure on the community medicines schemes has risen steadily in recent years. The factors behind that growth include: • Ireland’s increasing population: the country has experienced a significant increase in its population as outlined in the section on demographic trends. This increase in population directly impacts on the numbers eligible for the community drugs schemes which in turn increases the consumption of medicines. • Ireland’s ageing population: Ireland has an ageing population with people living longer, and as they do so, they make a greater call on all health services, including medicines. For example, in June 2011, an estimated 11.6% of the population were over the age of 65 years. This is expected to double over the next twenty years. • The development of new treatments becoming available and more patients availing of them: for example in the areas of preventative medicine and the long-term treatment of chronic illness. This has resulted in improved life expectancy and quality of life, less time being spent in hospital, less time off work and less sick pay. However, the availability of these treatments on the community medicines schemes presents increasing costs to the State. • The introduction of Government initiatives to improve public health: Irish people currently have one of the lowest levels of life expectancy in Western Europe. Initiatives such as the cardiovascular strategy and the cancer strategy were launched with a view to improving these poor health outcomes. They have resulted in more people being treated and an increase in the utilisation of medicines.

27. Pharmaceutical Healthcare Facts and Figures 2012 Medicines in the Community • Epidemiological evolution: Chronic diseases such as diabetes, hypertension, heart disease and stroke are a large and growing burden on the health of Irish people and the Irish healthcare system. The rising prevalence of such diseases is partly the result of a population that is ageing and increasingly obese. Today, approximately 25% of the Irish population have a chronic disease accounting for 78% of the country’s healthcare spending. The increased incidence of chronic and non-communicable diseases is generally quite costly to treat. Ireland has the fourth highest incidence of asthma in the world, and increasing levels of diseases like diabetes and obesity. • State decisions on eligibility and administration of the community medicines schemes: The decisions to grant medical cards to everyone over 70, between 2001 and 2008, and to introduce the Drugs Payment Scheme (DPS) have had a significant impact on the State bill for medicines. In 2002, the first full year of everyone over 70 being provided with medical cards, the cost of the GMS Scheme grew by 28%. • Rising unemployment: Rising unemployment means that the proportion of the population eligible for a medical card is rising continuously. There has been a 20% increase in the number of medical cards since 2008, with almost 140,000 cards issued to applicants in 2010 alone. Currently there are approximately 1.7 million people in Ireland who have a medical card. • Increasing research and development costs: The development of a new medicine is an extremely expensive, high risk and lengthy process with, on average, only one or two of every 10,000 promising substances successfully passing extensive testing to be approved as a marketable product. This must be factored into the pricing of new medicines so that future innovation and R&D can continue. Figures show that R&D costs have risen from €149m in 1975 to almost €1.4 billion today. The growth in medicines expenditure should also be seen in the context that Ireland historically had one of the lowest levels of consumption of medicines per head of population. It is only to be expected that spending on medicines will increase as the healthcare system endeavours to improve life expectancy and quality of life. It also has to be seen in the context of the large scale increases in Irish health spending that occurred in the boom years, a momentum which has been reversed since 2010 and is set to continue in 2012 with cuts of €750 million being targeted.

28. Pharmaceutical Healthcare Facts and Figures 2012 Irish Pharmaceutical Market Decline 2002 – 2011

29. Pharmaceutical Healthcare Facts and Figures 2012 Community Medicines Schemes Expenditure 2010

30. Pharmaceutical Healthcare Facts and Figures 2012 Most Commonly Prescribed Products 2010 Source: HSE Primary Care Reimbursement Service Financial and Statistical Analyses 2010

31. Pharmaceutical Healthcare Facts and Figures 2012 Most Commonly Prescribed Products 2010 Source: HSE Primary Care Reimbursement Service Financial and Statistical Analyses 2010

32. Pharmaceutical Healthcare Facts and Figures 2012 GMS Expenditure Overall Cost of Medicines 2002 - 2010 The GMS Scheme provides free medical services to persons who would not otherwise be able, without undue hardship, to afford such services.

33. Pharmaceutical Healthcare Facts and Figures 2012 GMS: Decreasing Euro Cost of Medicines Per Person 2005-2011 The number of persons eligible for a medical card has increased by almost 550,000 since 2005. However, following the implementation of the IPHA/HSE 2006 Agreement and the subsequent savings provided by IPHA Members in 2010 and 2011, figures show that the € cost of medicines per person has decreased significantly.

34. Pharmaceutical Healthcare Facts and Figures 2012 The Evolution of the GMS 1994 - 2011 The number of cardholders aged 65 and over has increased by approximately 44% since 1994 (a trend significantly accentuated by the granting of medical cards to everyone over 70 years old in 2001).

35. Pharmaceutical Healthcare Facts and Figures 2012 Drugs Payment Scheme Expenditure 2002-2010

36. Pharmaceutical Healthcare Facts and Figures 2012 Long Term Illness Scheme Expenditure 2002 - 2010 The Long Term Illness Scheme is for persons who suffer from one or more defined long term illnesses. It gives such persons the right to obtain, irrespective of income, relevant medication free of charge.

37. Pharmaceutical Healthcare Facts and Figures 2012 Making Headroom for Innovation Per Item Cost on the GMS, DPS and LTI is reducing Savings made by the industry continue to provide the essential resources for innovation.

38. Pharmaceutical Healthcare Facts and Figures 2012 The Medicines Industry • The international research-based pharmaceutical industry in Ireland is a crucial hub of economic activity and plays a vital role in the health of Irish people. • More than 120 pharmaceutical companies have a presence in Ireland, of which 13 of the world’s top 15 companies have substantial operations and manufacture 5 of the top 12 medicines in the world here. As well as being a major source of revenue to the State, with over €3 billion paid in taxes annually, almost 25,000 people are employed directly by these companies, half of whom hold a third level qualification, while a further 25,000 depend on the provision of services to the sector for their livelihoods1. • Pharmaceutical production in Ireland currently generates nearly 50% of our exports, which along with chemicals and medical devices, was worth a record €55 billion in 20112. • For such a small country, Ireland punches well above its weight when it comes to pharmaceuticals and such a performance is sustaining our position as the largest net exporter of medicines in the world. • Nearly €7 billion has been invested by the pharmaceutical sector in Ireland over the last decade. According to IDA Ireland, the replacement value of the investment by the pharmaceutical sector in the Irish economy is over €40 billion. 1 PharmaChemical Ireland: Ireland - the Location of Choice for Scientific Investment (2011) 2 Central Statistics Office (March 2012)

39. Pharmaceutical Healthcare Facts and Figures 2012 Leading Companies by Sales Globally 2010 Source: IMS Health Midas, (December 2010) Pharmalive, (August 2011)

40. Pharmaceutical Healthcare Facts and Figures 2012 Distribution of Global Pharmaceutical Sales by Region 2010

41. Pharmaceutical Healthcare Facts and Figures 2012 European Trade in Pharmaceuticals 2009 Source: Eurostat (COMEXT database - February 2011)

42. Pharmaceutical Healthcare Facts and Figures 2012 Top Ten EU Countries by Pharmaceutical Employment 2009

43. Pharmaceutical Healthcare Facts and Figures 2012 Pharmaceutical Production in Europe, Japan and the US

44. Pharmaceutical Healthcare Facts and Figures 2012 5 of the World’s Top 12 Medicines are Produced in Ireland Source: IMS Health Midas 2010 Product names shown are IMS International Product names. Products marketed around the world with different names or marketing companies are grouped together. The names generally reflect the name in the country where the product was launched first. A match on two of three criteria (local brand name, marketing corporation and active ingredient) will be grouped together.

45. Pharmaceutical Healthcare Facts and Figures 2012 Pharmaceutical R&D Expenditure – Annual Growth Rate (%)

46. Pharmaceutical Healthcare Facts and Figures 2012 Medicines and Global Health • Of the 340 medicines on the World Health Organisation (WHO) essential drugs lists, 95% of them have no patent. This means that there is no patent obstacle preventing cheap generic copies of the vast majority of essential medicines being produced locally for poor people in developing countries. But those people are not getting them. • Patents do not prevent access to medicines. The real barrier hindering access to treatments is in fact a lack of the basic healthcare infrastructure required to get existing medicines to people. Other factors such as a lack of access to essentials such as food, adequate housing and clean water, simple prevention measures like condoms and mosquito nets coupled with continuing armed conflict, corruption and bureaucracy unfortunately mean that poor health is endemic for the world's poorest people. • Pharmaceutical companies globally were involved in 213 health programmes in the developing world in 2010, up from 202 in 2009. These programmes have expanded beyond infectious diseases and include child and maternal health and chronic diseases. They also support primary healthcare programmes and capacity building, including the training of doctors and nurses. • In the period 2000 to 2008, the industry provided enough health interventions – medicines, vaccines, equipment, health education and training – to help nearly 1.75 billion people in developing countries. • The industry has made available medicines, vaccines, equipment, training and health education worth $9.2 billion to the developing world since the United Nations announced the Millennium Development Goals. • Pharmaceutical companies also contribute greatly to R&D programmes to combat diseases in developing countries and were involved in 75 separate programmes in 2009, up from 67 in 2008. The industry is now the largest source of funding for R&D in the developing world after the US Government and the Bill and Melinda Gates Foundation. Source: IFPMA, Developing World Health Partnerships Directory, 2010

47. Pharmaceutical Healthcare Facts and Figures 2012 Industry Supported Programmes in the Developing World

48. Pharmaceutical Healthcare Facts and Figures 2012 Number of Positive Health Interventions Made in the Developing World A positive intervention is: (a) the delivery of sufficient medicine to cure one person of one disease (b) the provision of a course of therapy sufficient to manage one disorder in one person for one year, (c) provision of sufficient vaccine to immunise one person against one disease for at least one year or (d) delivery of a proven programme of health education or training for one person. These metrics were used because while companies know the number of doses they make available, they have a less precise view of the number or patients actually treated. Source: IFPMA www.ifpma.org/healthpartnerships

49. Pharmaceutical Healthcare Facts and Figures 2012 Map of Pharmaceutical Locations in Ireland Dublin Shared Services Sites Abbott Laboratories Actelion A Menarini Pharmaceuticals Alliance Pharmaceuticals Amgen AstellasPharma AstraZeneca Pharmaceuticals Bayer Consumer Care Bayer Schering Pharma Biogen Idec BoehringerIngelheim Bristol Myers Squibb Celgene Chugai Pharma Daiichi Sankyo Ireland Eisai Eli Lilly & Company Giuliani International GlaxoSmithKline GlaxoSmithKline Consumer Healthcare GrünenthalPharma Ipsen Pharmaceuticals Janssen-Cilag (J&J) Jazz Pharmaceuticals Labopharm Europe LEO Pharma Lundbeck McNeil Healthcare (J&J) Merck Serono MSD Mundipharma Novartis Novartis Consumer Health Novo Nordisk Pfizer Healthcare Ireland Pfizer Treasury Reckitt Benckiser Roche Products Sanofi-aventis Sanofi Pasteur MSD Servier Laboratories Shire Pharmaceuticals Takeda TillottsPharma UCB Pharma Manufacturing Sites Amgen Bristol Myers Squibb Covidien (J&J) HelsinnBirex Ipsen Merrion Pharmaceuticals Pfizer Rottapharm MSD Swords Laboratories (BMS) Takeda Meath Shared Services Sites MEDA Manufacturing Sites BASF Ireland Westmeath Manufacturing Sites Elan Kildare Manufacturing Sites Pfizer Wicklow Manufacturing Sites MSD Sigma Aldrich Ireland Ltd Servier Laboratories Takeda Carlow Manufacturing Sites MSD Waterford Manufacturing Sites Genzyme GlaxoSmithKline TEVA Tipperary Manufacturing Sites Abbott Alza Ireland (J&J) Clonmel Healthcare MSD Mayo Manufacturing Sites Allergan Charles River Laboratories Sligo Manufacturing Sites Stiefel Laboratories Abbott Laboratories (3 Sites) Clare Manufacturing Sites Roche Schwarz PharmaLtd Cork Shared Services Sites GlaxoSmithKline Manufacturing Sites Cara Partners Centocor Biologics Eli Lilly & Company FMC International Fournier Pharma GE Healthcare Gilead Services GlaxoSmithKline Hovione Ipsen Janssen-Pharmaceuticals (J&J) Novartis Recordati Ireland Ltd Pfizer (3 Sites) MSD Leo PharmaWexport Kerry Manufacturing Sites Astellas Ireland Temmler Limerick Manufacturing Sites Pfizer Cavan Manufacturing Sites Abbott Longford Manufacturing Sites Abbott Donegal Manufacturing Sites Abbott

50. Pharmaceutical Healthcare Facts and Figures 2012