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The Russian
Federation
Prescription for growth*


Part 5: The Russian pharmaceuticals
market is growing very fast, and the
clinical trials sector is booming. But any
company that wants to do business there
faces considerable challenges




*connectedthinking
The pharmaceuticals market in the Russian Federation is growing very rapidly,
with six consecutive years of economic growth and a corresponding rise in living
standards. But the state-run healthcare system is seriously under-funded and most
Russians cannot afford the best new drugs. Moreover, the country still suffers from
Soviet-style management practices; political interference remains a real risk; and the
administrative and legal system is very weak. Russia thus offers genuine opportunities
both for selling and testing pharmaceuticals, but these opportunities come with some
substantial challenges.
The pharmaceutical industry’s                           So where should the industry                       performance – which prompted the                        growth in the third quarter of 2004. But,
main markets are under serious                          leaders look next? Analysis by                     major ratings agencies to raise the                     with crude oil exports bringing in over
pressure. North America, Europe                         PricewaterhouseCoopers shows that                  country’s sovereign credit rating to BBB-               $500 million a day, it is now back on
                                                        several regions offer considerable                 (investment grade) at the start of 2005                 track. PwC Macro Consulting estimates
and Japan jointly account for                           potential, either as areas with untapped           – has been fuelled primarily by energy                  that the economy will increase by 6.0% in
more than 82% of total global                           demand for innovative drugs or as                  exports. Russia possesses huge coal                     2006, and that it will rise by another 5.5%
pharmaceutical sales – which                            suitable places for conducting research            and natural gas reserves. It is also rich               in 2007 – more than in any country except
reached US$ 602 billion in 2005,                        and development (RD). In our fifth article        in non-fuel minerals such as iron ore,                  China and India (see Figure 1).
according to IMS Health. But                            we shall focus on the Russian Federation.          manganese, chromium, nickel, platinum
North America and Europe are                                                                               and titanium.                                           If it can overcome its current difficulties,
                                                                                                                                                                   Russia’s long-term economic potential
experiencing quite sluggish                                                                                However, several factors have impeded                   may be even greater. US investment
growth; sales rose 5.2% in the                                                                             its transition from Communist heartland                 bank Goldman Sachs has identified it
former and 7.1% in the latter. And
                                                        Russia’s strong economic
                                                                                                           to modern industrialised state. Soviet-                 as one of the four biggest developing
though the Japanese market saw                          performance                                        era management practices are still                      economies (together with Brazil, India
its highest year-on-year increase                                                                          widespread and the infrastructure                       and China), and estimates that real GDP
since 1991, with sales rising 6.8%,                     The Russian economy has been                       requires substantial investment. Higher                 will grow by between 4.8% and 1.9% a
                                                        growing rapidly. In 2004, real gross               marginal tax rates in the oil industry and              year for the next 45 years. Should this
this was still a much slower rate                       domestic product (GDP) rose 7.2%,                  higher production costs, as a result of                 happen, Goldman Sachs predicts that
of growth than various emerging                         marking the sixth consecutive year                 rapidly rising wages and the appreciation               Russia could overtake Italy in 2018,
countries experienced.                                  of economic expansion. The federal                 of the rouble, have also taken their toll.              France in 2024, the UK in 2027 and
                                                        budget ran a record surplus of 4.2%                                                                        Germany in 2028 – making it the world’s
                                                        and inflows of foreign direct investment           All these problems contributed to a                     sixth-largest economy, measured by GDP
                                                        peaked at $9.4 billion. This remarkable            marked slowdown in Russia’s economic                    (see Figure 2).



 Figure 1: The Russian economy is expected to grow more rapidly than the economies of almost every other    Figure 2: Russia could become the world’s sixth largest economy by 2050
 country in the world




 *GDP for India refers to fiscal years beginning 1st April
 Source: PwC Macro Consulting                                                                               Source: Goldman Sachs, “Dreaming with BRICS: The Path to 2050”
Higher living standards but                                Furthermore, although living standards       regularly participate in sports or fitness-                  over one million and the United Nations
                                                           have improved, the health of the nation      related activities; hence the fact that                      Development Fund reports that the rate
shorter lives                                              has deteriorated significantly since the     the mortality rate from cancer and heart                     of infection is amongst the highest in
                                                           break-up of the Soviet Union in 1991. Life   disease is much higher in Russia than                        the world.
Russia’s economic strength has already                     expectancy at birth is now just 65 years     it is in many other transitional countries
boosted living standards. Goskomstat,                      – a full decade less than it is in many      (see Figure 4). Alcohol abuse is another                     The effect on the Russian population
the State Statistics Service, reports that                 developed countries – while the infant       major problem and health experts believe                     is already visible; it has fallen from 147
between 2001 and early 2005 the average                    mortality rate is three times higher than    that it accounts for half of all accidents                   million to 143 million over the past
dollar wage tripled from $79 to about                      it is in the EU or US. The discrepancy       – the second leading cause of death.                         16 years, even with surging levels of
$240 per month, while the proportion of                    between the life expectancies of men         The number of people killed in traffic                       immigration from former Soviet states.
the population living below subsistence                    and women is especially notable; at          accidents, for example, is almost the                        But the long-term impact could be far
level fell from 28.9% to 17.8%. But GDP                    59 years and 72 years respectively,          same as it is in the US, a country with                      worse. Goskomstat predicts that, if
per capita (adjusted for purchasing power                  these are the lowest figures and largest     100 times as many cars on the road.                          current trends continue, the population
parity) is still much lower than it is in the              difference by sex for the population of                                                                   could plummet to just 80 million by 2050.
US and EU, including many of the new                       any country reporting to the World Health    The prevalence of infectious diseases
member states (see Figure 3).                              Organisation (WHO).                          is also on the rise. Russia ranks 11th
                                                                                                        on the WHO’s list of 22 countries with a
The gap between rich and poor is also                      The stress generated by the economic         high incidence of tuberculosis; Hepatitis                    A healthcare system under
considerable. In the first half of 2005                    and social upheaval of the past 15 years     C from intravenous drug use is growing
the wealthiest 10% of the population                       has played a big part in this decline,       rapidly; and the spread of HIV/AIDS is                       huge strain
received 29.6% of the country’s total                      compounding the adverse effects of           even more alarming. According to official
income, while the poorest 10% received                     widespread smoking, a diet high in           statistics, there were 300,000 cases                         Despite all these problems, Russia’s
only 2%. Indeed, according to Forbes                       animal fats and lack of exercise. An         of HIV in early 2005, but independent                        expenditure on public healthcare has
magazine, Russia has more billionaires                     estimated 67% of Russian men and 33%         estimates put the actual number of                           been dropping. Government financing
than any other country except the US.                      of Russian women smoke, while only 6%        people infected with the disease at                          of the state-run, free-for-all system


 Figure 3: GDP per capita in 2004 is lower in Russia than it is in many Western countries                Figure 4: The mortality rate from chronic diseases is much higher in Russia than it is in other transitional
                                                                                                         countries




                                                                                                         Source: World Health Organisation
                                                                                                         Note: Age-standardised death rates from chronic disease (per 100,000)
 Source: CIA World Factbook                                                                              by country for ages 30-69 years, estimates for 2005
has shrunk by more than a third since         private health insurance than to pay the                 major changes to the social protection
Soviet times; in 2004, for example, it        equivalent in wages. Private healthcare                  system with the signing of Law #122-FZ        Changes to the social
was just 2.8% of GDP, roughly half the        is also expensive, since it is largely                   (see sidebar on Changes to the social
level many developed countries invest.        supplied by inefficient public facilities.               protection system).                           protection system
Moreover, the system is badly organised,      So private schemes will probably remain
with the result that much of the money        the preserve of the wealthy for many                                                                   Law #122-FZ came into
it consumes goes on maintaining a vast        years to come.                                                                                         effect on 1 January 2005.
network of hospitals rather than providing                                                             A small but fast-growing                      It replaced a number of
primary care. And because funding is          The federal government is also making
largely regional – there are 89 regions       visible efforts to address the worst of                  pharmaceuticals market                        existing social subsidies
– standards vary widely from one area to      the problems in the public sector. It has                                                              and guarantees to certain
another; some rural hospitals have no hot     lifted funding for the healthcare system to              For obvious reasons, then, Russia             categories of the population,
water, while some have no running water       $3.6 billion this year – an 89% increase                 still spends relatively little on             including victims of
at all.                                       on the $1.9 billion it allocated in 2005. It             pharmaceuticals. IMS Health estimates         Chernobyl and war veterans,
                                              has also proposed a number of reforms,                   that, in 2005, the market was worth
                                                                                                                                                     with cash benefits. It also
The vast majority of Russian patients         such as switching to direct financing                    just $3.74 billion. That said, the market
therefore have to dip into their own          of medical services; reducing the free                   has increased substantially since the         transferred responsibility for
pockets to cover their medical costs,         medical assistance guaranteed by the                     economic crisis of 1998 and is now            compensating those who
since the government reimburses               state; closing down a large number of                    one of the fastest-growing in Europe.         were previously entitled
less than 30% of expenditure on               hospitals; emphasising primary care; and                 Between 2000 and 2004, sales of               to subsidised healthcare
pharmaceuticals. They are also routinely      increasing doctors’ salaries by paying                   pharmaceutical products more than             and drugs from the federal
forced to bribe medical staff to obtain       them for the treatments they dispense                    tripled. Currency fluctuations played a
                                                                                                                                                     government to the regional
services which are supposed to be free        rather than the hours they spend at                      part in the rise, but the market still more
of charge. Research conducted by the          a desk. These reforms have yet to be                     than doubled in constant dollar terms         authorities. The government
INDEM Foundation, one of Russia’s             implemented (and some of them may                        (see Figure 5). This upward trend is          allocated $1.8 billion for
leading non-governmental organisations,       prove quite difficult to introduce), but the             expected to continue; sales are forecast      funding this new programme,
suggests that in 2004 Russians spent          government has already made several                      to increase by about 10% a year between       which covers 14 million
about $400 million on such under-the-                                                                                                                people and more than 2,300
counter payments (compared with $600           Figure 5: The Russian pharmaceuticals market has been growing steadily for the past six years         medicines, in 2005. But
million the previous year).
                                                                                                                                                     industry experts question
The weaknesses of the state healthcare                                                                                                               whether this will be enough
system have driven an increasing number                                                                                                              to redress the lack of public
of people into the private sector, although                                                                                                          funding for medical treatment
health insurance is still relatively rare.                                                                                                           and drugs.
State insurance company Rosgosstrakh
reports that premiums on optional health
insurance reached 38.8 billion roubles
($1.1 billion) in 2004 – up 25% from 2003
– and predicts that the market will grow
by 13-16% a year for the next few years.
However, corporate policies account for
more than four-fifths of all premiums,
because it is often more economically
advantageous for companies to offer            Source: IMS Health
2006 and 2010, on the back of rising                   which passed a first reading in the State                  unlike China, India or large parts of Latin    percentage than in any other market
incomes, greater government expenditure                Duma, would have required doctors to                       America, Russia does not have a history        except China (see Table 2). In the US,
and improvements in distribution.                      use international non-proprietary names                    of using competing alternative therapies.      UK, France, Mexico, Hungary and
                                                       and given pharmacists responsibility                       In 2004, for example, treatments for high      Czech Republic, by contrast, the share
Generics currently account for the lion’s              for deciding whether to dispense a                         blood pressure and cardiac therapies           held by the top 10 companies is more
share of the market – particularly in the              branded product or generic equivalent.                     accounted for 6.4% of retail pharmacy          than 50%.
hospital sector, which generates 20% of                But it was opposed on various grounds                      sales and 2.5% of hospital sales,
all pharmaceutical sales. Indeed, 78% of               and subsequently seems to have sunk                        while psychoanaleptics accounted               Sanofi-aventis leads the way; Russia
the 13,000-odd drugs that are registered               without trace.                                             for 3.6% and 3.3% respectively (see            is one of its main markets for over-the-
in Russia are generics. However, the                                                                              Table 1). Demand for drugs for cancer,         counter (OTC) drugs. But Novartis is
retail sector, which accounts for the                  At present, then, the market for branded                   AIDS and diabetes is likewise on               battling hard to catch up. Sandoz, its
remaining 80% of sales, also features                  products is still quite strong, and the                    the rise. The potential for low-cost           generics arm, reported sales growth
more expensive branded products and is                 majority of those drugs come from                          generics producers and for Western             of more than 30% in Russia between
growing much more rapidly.                             overseas suppliers. Russia imported                        manufacturers operating at the top end         January and September 2005, under the
                                                       more than 60% of all the pharmaceuticals                   of the market is thus greater than the         supervision of Metod Dragonja, former
Concerns about the increasing                          it used in 2004 – nearly two-thirds of                     initial picture might suggest.                 chairman of Lek. Servier has also been
amount of money consumers spend                        them from companies in Western Europe,                                                                    expanding its Russian presence over
on drugs prompted the introduction of                  the US, Canada and Japan. Demand for                       The market is also ripe for consolidation.     the last few years. It sells six of the top
a controversial bill to enforce generic                new treatments for chronic diseases and                    The top 10 companies account for               100 prescription drugs and increased its
prescribing in July 2005. The measure,                 stress is particularly pronounced and,                     just 32.5% of sales – a much lower             share of the retail pharmacy market from
                                                                                                                                                                 2.2% to 2.9% (measured by value) in
                                                                                                                                                                 2004, while Menarini leapt to first place,
 Table 1: Top 10 anatomical therapeutic chemicals by    Table 2: The top 10 companies account for less than a third of sales
                                                                                                                                                                 with 3.7%.
 sales value

 ATC group	               Share in pharmacy sales, %
                                                        	 2004 sales ($m)	 Growth, US$ %	                                      Growth, constant	   % of market
 		                              2003	         2004
                                                        			                                                                         currency %
                                                                                                                                                                 Limited domestic production
 Antibacterials for systemic use	 6.4	          6.9     Total Russia	                            3069	                   45	                36	        100.00
 Analgesics	                       5.7	         6.5     sanofi-aventis	                            203	                  47	                38	            6.6
                                                                                                                                                                 In fact, local production is now quite
 Vitamins	                         4.9	         5.2     Novartis	                                  137	                  53	                44	            4.5
                                                                                                                                                                 limited. During the Soviet era, Russia’s
 Agents acting on the 	            3.9	         4.0     Servier	                                   113	                  66	                57	            3.7   pharmaceutical industry was under
 Rhenin-Angiotensin system                              Gedeon Richter	                            106	                  41	                33	            3.5   federal control and supplied 70% of
 Psychoamaleptics	                 3.6	         3.7     Menarini	                                  105	                  84	                73	            3.4   the country’s needs. Today, most of the
 Cough and cold preparations	      3.4	         3.5     Pfizer	                                     88	                  48	                40	            2.9   700-odd domestic drug manufacturers
 Sex hormones and modulators 	 3.2	             2.9     Krka	                                       66	                  41	                32	            2.2   focus exclusively on the production of
 of the genital system                                                                                                                                           generics. The relatively low prices of
                                                        Valeant	                                    64	                  38	                30	            2.1
 Antiinflammatory and 	            3.0	         2.7                                                                                                              such products, compared with imports,
                                                        GlaxoSmithKline	                            61	                  21	                14	            2.0
 antirheumatic products                                                                                                                                          explains why, according to research
                                                        Roche	                                      54	                  56	                47	            1.8   conducted by DSM Group, domestic
 Immunomodulationg agents	         2.9	         2.5
 Cardiac therapy	                  2.5	         2.6
                                                        Top 10	                                    997			                                                32.5    production accounted for 69% of sales
                                                        Total Others	                            2072	                   42	                34	          67.5    measured by volume, but only 25% of
 	                                39.3	        40.5
                                                                                                                                                                 sales measured by value, in the first half
 Source: AIPM-RMBC Market Bulletin                                                                                                                               of 2005.
 (February 2005)                                        Source: IMS Health
The variable quality of domestic drug        expanded into pharmaceuticals with           CenterWatch reports that there were           However, any company conducting
production is a major problem. Many          the purchase of a majority stake in the      523 new trial starts in 2004, including       clinical trials in Russia must overcome
companies economise on raw materials,        Moscow-based Akrikhin.                       252 international studies, 167 local          several serious obstacles. Language
for example. Indeed, some industry                                                        studies of local or international products    is one major barrier. All study-
experts estimate that only 15% source                                                     and 104 bioequivalence studies. This          related documents usually need to
directly from manufacturers; the rest buy                                                 represents a 118% increase on the total       be translated into Russian because
their materials from offshore sources        An under-funded                              number of trials started five years ago.      the study personnel lack sufficient
and the quality of such materials is often                                                The number of international studies has       English – and this presents the added
inferior or the expiry date is imminent.     research base                                risen an even more significant 136% over      challenge of using the Cyrillic alphabet.
Most Russian drug makers also lack                                                        the same period.                              There is also a shortage of trained and
modern manufacturing facilities – and        If domestic pharmaceutical production                                                      experienced local staff to manage trials
though the government introduced a new       has suffered since the end of the            The introduction of Good Clinical             in some parts of the country.
national standard for good manufacturing     Communist era, so has medical research;      Practice (GCP) regulations in 1999
practices (GMP) with effect from January     chronic under-funding has eroded the         accounts for much of the surge. But,
2005, it will take them a number of years    country’s formerly strong scientific base.   like other transitional countries, Russia
to comply with the rules.                    In 1992, Russia employed about 900,000       has several additional advantages. The        Distribution and retailing
                                             researchers in military, medical and other   patient population is treatment-naïve and
Yet, despite the relative lack of domestic   forms of research. By the start of the       keen to participate in clinical trials, for
production, very few multinationals          millennium, it employed just 450,000         example, because this is the only way         As clinical development becomes easier,
currently have manufacturing operations      researchers – of whom only about             most people can secure access to new          so the distribution network is also
in Russia – although there are signs that    100,000 spent more than half their time      drugs and high standards of medical           improving. It is still quite fragmented;
this may soon change. In a survey of the     exploring new terrain.                       care. They are also easier to reach than      there are an estimated 4,000 registered
leading foreign manufacturers recently                                                    patients in countries where primary care      distributors, ranging from national and
conducted by PwC and the Association         However, a few centres of excellence         plays a much larger role (see Table 3).       regional firms to niche operations which
of International Pharmaceutical              have survived and the country still          In large cities such as Moscow and            specialise in particular products or
Manufacturers (AIPM), 33% said that they     retains a strong position in certain         St Petersburg (with populations of 8.3        working with particular manufacturers.
were thinking about establishing their       therapeutic areas such as immunology         million and 4.6 million respectively), most
own production facilities in Russia within   and virology. In 2004, for example,          patients are seen at the big teaching          Table 3: Medical resources in Russia (2004)
the next two or three years, and 19%         Biomed launched Affinoleukin, a new          hospitals. But even in less urban areas,
said that they were thinking about doing     active substance that boosts the cellular    healthcare is provided primarily through
so within the next five years – largely      immunity of patients suffering from          specialist medical centres.
because they are concerned about the         persistent bacterial or mycotic diseases.                                                   Number of physicians per 10,000 population	    48
competition or keen to expand their          Shekovsk Vitamins launched a second          The Russian government has also taken
                                                                                                                                         Number of medium-level medical
regional cover.                              new active substance – a nootropic drug      a number of steps to open its health           personnel per 10,000 population		             109
                                             called Phenotropil.                          system to foreign clinical research and
Several generics manufacturers                                                            reduce the bureaucracy. And since many         Number of hospital beds per
have also acquired local facilities. In                                                   doctors earn less than $100 a month,           10,000 population			                          113
January 2005, for example, Germany’s                                                      they are often eager to supplement their
                                                                                                                                         Number of medical institutions providing
STADA Arzneimittel beat off several          Clinical development                         incomes by working as investigators
                                                                                                                                         outpatient care per 10,000 population	         22
other suitors with an €80m-€85m bid                                                       or even as clinical research assistants.
for Nizhfarm, Russia’s fourth-largest                                                     Lastly, the cost savings are considerable;     Capacity of polyclinics (visits per shift)
pharmaceutical producer. Similarly,          Though Russia’s pure research base           the clinical fees element in the overall       per 10,000 population			                      251
Health Tech Corporation (the holding         may have been decimated, it is rapidly       cost of a trial may be as much as 50%
company behind a Cypriot firm which          becoming an increasingly attractive          less than it is the West.                      Source: Goskomstat
makes biologically active food additives)    place in which to conduct clinical trials.
But only 700 of these firms are major           Intelligence and Remedium suggests          Organisation (WTO), with which it
Import tariffs                    players, and the sector is consolidating        that OTC drugs currently constitute         is actively negotiating to become a
                                  rapidly. The top three distributors – CV        about 35% of total pharmaceutical           member. The new code simplified the
                                  Protek, SIA International and Shreya            sales, although the average unit price is   customs process and established a
Russia revised its tariff         Corporation – now control 40% of                just $0.68.                                 comprehensive list of documents and
system in January 2001.           the market.                                                                                 data required for the customs clearance
Under the current regime,                                                                                                     of goods. However, it has not yet been
some medicines are exempt         The leading distributors wield                                                              fully implemented and some customs
from customs duties. Tariffs      considerable power. SIA International           Red tape                                    facilities have been slow in making the
                                  has just bought a stake in three                                                            shift to new procedures (see sidebar on
otherwise range from 5%
                                  manufacturing plants run by the Pharm                                                       Import tariffs).
to 20%, depending on              Center Group, which specialises in the          The Russian pharmaceuticals market has
whether the product being         production of antibiotics, for example.         more promise than might first seem the      The import licensing procedure
imported constitutes raw          Similarly, CV Protek has invested in            case, then. Yet Russia is by no means an    can likewise be quite burdensome.
materials, semi-finished          several facilities for producing generics       easy country in which to trade. The old     Import licences and activity licences
goods, foodstuffs or finished     and a number of pharmacy chains.                Soviet system has been comprehensively      are required for all pharmaceuticals,
                                                                                  dismantled, but the administrative,         and the licensing requirements are
products. Value Added Tax
                                  This interest in the retail sector reflects     tax and legal framework is still very       very broad and often confusing. In
(VAT) is also applied to almost   the speed at which it is expanding;             inefficient.                                December 2002, the Russian Ministry
all imports at the current        Russia now has more than 20,000                                                             of Health also established a mandatory
rate of 18% – although there      pharmacies and about 5,000 smaller              In January 2004, for example, Russia        conformity assessment scheme, which
is a fixed rate of 10% for        outlets such as kiosks, over 40% of             introduced a new Customs Code               duplicates some of the other certification
pharmaceuticals and medical       which are privately owned. But it is also       to bring its customs regimes and            requirements. The ministry intended to
                                  a way of capturing a share of the OTC           procedures more closely into line with      replace this scheme with self-certification
equipment.
                                  market. Research from Espicom Business          the requirements of the World Trade         in 2004, but it has not yet issued any
                                                                                                                              new guidelines.
                                   Figure 6: Deterrents to production in Russia
                                                                                                                              The bureaucratic challenges are even
                                                                                                                              greater for companies setting up
                                                                                                                              manufacturing operations in Russia.
                                                                                                                              Indeed, research conducted by PwC
                                                                                                                              and AIPM shows that red tape is one of
                                                                                                                              the biggest obstacles cited by foreign
                                                                                                                              pharmaceutical companies thinking of
                                                                                                                              setting up production facilities there (see
                                                                                                                              Figure 6).




                                                                                                                              Political interference

                                   Source: PricewaterhouseCoopers/Association of International Pharmaceutical
                                                                                                                              Economic and political risks come a
                                   Manufacturers Survey, 2005                                                                 close second on the list of deterrents
                                                                                                                              multinationals cite – arguably with good
cause. Indian pharmaceutical company           One such instance of the potential              WTO. At present, for example, it does         3.5% and 12% of the pharmaceuticals
Dr Reddy’s Laboratories has already            minefield facing overseas investors is the      not provide protection for test data          market in Russia, although independent
fallen foul of the authorities in the course   so-called “Grandfather Clause”, which           for pharmaceuticals. The enforcement          experts suggest that the figure could be
of trying to sell its stake in the formerly    theoretically gives preferential treatment      regime is also weak; judicial corruption      higher – and domestic manufacturers
state-owned Biomed Russia to another           to “priority” projects undertaken by            is endemic, and the legal system is           are thought to be amongst the main
Russian firm. Moscow’s office of the           Russian companies in which foreign              ill-prepared to handle sophisticated          culprits. In 2003, the ministry suspended
public prosecutor issued an injunction         shareholders own more than 25% of               patent cases, although a specialised          the licences of 321 pharmaceuticals
ordering the return of the shares to           the equity. The clause stipulates that all      higher patent chamber has now been            companies for manufacturing and trading
the authorities, on the grounds that           such companies should be protected              established, bringing greater expertise       in counterfeit medicines.
Dr Reddy’s had failed to implement             from increases in federal taxes and             and efficiency to the resolution of
the investment programme to which              import duties until the initial investment      patent disputes.                              Russian Health Minister Mikhail Zurabov
it had committed itself when it bought         has been recouped, but since there                                                            also promised that the ministry would
its stake in the vaccine producer in           are no corresponding tax and customs                                                          develop a new system for supervising
1995. But political considerations may         regulations the relief it affords is entirely                                                 pharmaceutical production; however,
also have played a part in the legal           hypothetical.                                   Corruption                                    it has not yet done anything. One
tussle; according to several newspaper                                                                                                       suggestion is to mark products with
reports, Biomed stores vital vaccines          Nevertheless, the government has                                                              a bar code and hologram, but few
for the Russian Ministry of Emergency          now introduced certain incentives               In fact, corruption is rife in Russia         industry commentators believe this will
Situations – prompting queries as to           (including exemptions from customs              – and, if anything, getting worse.            work, since the use of special marks for
why the government allowed Dr Reddy’s          duties and VAT in respect of charter            The latest Transparency International         licensed video and audio production
to acquire shares in such a “strategic         capital contributions) which may be             Corruption Perceptions Index ranks            has done nothing to stop the Russian
facility” in the first place.                  attractive to foreign companies setting         Russia 126th on the list of 159 countries     market from being flooded with fake
                                               up manufacturing operations in Russia.          surveyed and reports that the situation       DVDs and CDs.
                                               It has also supported the creation              has deteriorated since 2004 (when
                                               of special economic zones, like the             Russia was ranked 90th). A wide-
Foreign investment                             Kaliningrad economic zone, which                ranging study released by the INDEM
                                               provide customs and tax breaks for              Foundation confirms these findings. It        A weak infrastructure
                                               investors and companies operating in            estimates that companies pay about
There are also numerous official and           such areas.                                     $316 billion in bribes every year, and that
unofficial barriers to overseas investment                                                     the average “sweetener” is $135,800           Russia’s transport infrastructure is
in Russia, a fact that explains why                                                            – 13 times more than in 2001. Moreover,       also lacking in a number of respects.
Russia does relatively badly in the                                                            government officials are amongst the          It possesses one of the largest rail
international competition for foreign          Poor enforcement of                             worst offenders, even though President        networks in the world, but the shift from
finance. According to preliminary                                                              Putin came to power vowing that he            a planned economy to a market-driven
balance-of-payments data from the              intellectual property rights                    would fight corruption.                       economy has dramatically changed
Central Bank of Russia, foreign direct                                                                                                       the demands on the transport sector,
investment (FDI) flows into the non-           Russia’s poor record of enforcing                                                             producing conditions that favour road
financial sector reached $16.7 billion         intellectual property rights is another                                                       rather than rail transport. Rail freight
in 2005, but Russia’s total cumulative         source of concern. It has been on the           Counterfeiting                                volumes are now about 60% of their
ratio of FDI to GDP is still only about        US Special 301 Priority Watch List                                                            historical peak – and lower revenues
6%. This is six times less than the            since 1997, and its failure to comply                                                         have prevented the system from being
amount China attracts and less than            with the TRIPS Accord on trade-related          Counterfeiting is another major problem.      maintained as thoroughly as it should be.
one‑third of the level in many other           aspects of intellectual property rights         According to the Russian Ministry for
transitional economies.                        remains one of the biggest stumbling            Healthcare and Social Development,            The situation when it comes to roads is
                                               blocks in its negotiations to join the          fake drugs currently account for between      even worse. The Russian government
recognises the importance of creating         border. It therefore makes sense to target
a viable transport infrastructure, but the    these areas first.
World Bank estimates that it is spending
less than a sixth of the money required to    Even so, the limitations of Russia’s
produce a road network that will meet the     transport infrastructure and the fact that
country’s future needs. Despite a 35%         distribution is particularly important in
increase in the last decade, for example,     a highly competitive market dominated
the density of the road network in            by generics mean that any Western
Western Russia (where traffic is greatest)    company wanting to break into Russia
is still only one-sixth of that in Latvia,    will have to form a strategic partnership
one-fifth of that in Estonia and one-third    with a distributor – and, here, the mid-
of that in Ukraine.                           sized firms offer most promise. They are
                                              generally more willing than the leading
                                              distributors to work with a wide range
                                              of products and establish long-term
Strategies for entering                       relationships with manufacturers and
                                              retail outlets.
the market
                                              New entrants may also want to consider
Yet the difficulties associated with          forming an alliance with a local producer;
trading in Russia should not obscure its      this is often an easier way of securing
potential. The Russian pharmaceuticals        a foothold in new markets than setting
market has grown faster than the              up independently. If the arrangement
markets of the developed world since the      proves successful, they can then
start of the millennium. This performance     acquire their partners, but they will
is expected to continue, with sales           need to choose the firms with which
reaching about $6 billion by 2010 – 61%       they work very carefully and ensure that
more than they were in 2005. Moreover,        they adhere to Russia’s anti-monopoly
if the country maintains its positive         legislation. This specifies, for example,
economic trajectory over the long term,       that when a company with assets of
disposable incomes will rise still further,   over $103m acquires a stake of more
putting more patients in a position to buy    than 20% in another company, it must
Western medicines.                            obtain prior consent from the Federal        for pharmaceutical companies prepared        a centre for clinical testing – no small
                                              Anti-monopoly Service (FAS). It must also    to invest in the region. The potential for   consideration, as development costs
So how should the pharmaceutical              obtain consent for any further increases     companies that focus on areas of unmet       continue to soar. And though the legal
majors prepare to capitalise on these         in its shareholding.                         need – including chronic conditions          system for protecting patent rights
opportunities? One of the biggest                                                          like heart disease, diabetes and HIV         remains a serious concern, there is
challenges is the country’s sheer scale.                                                   – is particularly significant. Conversely,   reason to believe that this will improve.
Russia is nearly double the size of the                                                    although the market for generic drugs is     Russia has made no secret of its desire
US, covers 10 time zones and suffers          Conclusion                                   much larger in terms of volume, it is much   to join the WTO by the end of 2006, after
from some of the planet’s harshest                                                         more competitive.                            more than a decade of discussions, and
weather conditions. But over 80% of                                                                                                     better provision for intellectual property
the population is concentrated in the         In short, the Russian Federation presents    The introduction of GCP and easy             may well seem a price worth paying to
“European” part of the state, west of the     some undeniable challenges, but it also      access to a large patient population         resolve its differences with the existing
Ural Mountains, and along the southern        provides some genuine opportunities          has also increased Russia’s appeal as        member states.
This paper draws on the expertise of PricewaterhouseCoopers’                                    For further information, please contact the following pharmaceutical territory leaders:
pharmaceutical industry group and the pharmaceutical division of the
WINS team, a business development group that analyses companies
from a market perspective, creating a “market mirror” of how analysts                           Russia
view those firms.
                                                                                                Christian Ziegler
                                                                                                + [7] (495) 232 5461	   christian.ziegler@ru.pwc.com

                                                                                                Alina Lavrentieva
                                                                                                + [7] (495) 967 6250	   alina.lavrentieva@ru.pwc.com

                                                                                                Natalia Kozlova
                                                                                                + [7] (495) 967 6184	   natalia.kozlova@ru.pwc.com



                                                                                                Global Leader
                                                                                                Simon Friend	
                                                                                                +[44] (20) 7213 4875	   simon.d.friend@uk.pwc.com

                                                                                                Global Tax Leader
                                                                                                Michael Swanick
                                                                                                +[1] (267) 330 6060	    michael.f.swanick@us.pwc.com

                                                                                                US
                                                                                                Mark Simon
                                                                                                +[1] (973) 236-5410	    mark.d.simon@us.pwc.com

                                                                                                Pharmaceuticals Industry Analyst
                                                                                                John MacDonald
                                                                                                +[44] (20) 7212 5642	   john.macdonald@uk.pwc.com
The member firms of the PricewaterhouseCoopers network (www.pwc.com) provide
industry‑focused assurance, tax and advisory services to build public trust and enhance value   Global Pharmaceuticals Director of Marketing
for its clients and their stakeholders. More than 130,000 people in 148 countries across our    Attila Karacsony
network work collaboratively using Connected Thinking to develop fresh perspectives and
practical advice.
                                                                                                +[1] (973) 236 5640	    attila.karacsony@us.pwc.com

© 2006 PricewaterhouseCoopers. All rights reserved. ‘PricewaterhouseCoopers’ refers to the
network of member firms of PricewaterhouseCoopers International Limited, each of which is a
separate and independent legal entity. Ref 2006BHM21578.
                                                                                                                                                                                          10
Prescription for growth

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Prescription for growth

  • 1. The Russian Federation Prescription for growth* Part 5: The Russian pharmaceuticals market is growing very fast, and the clinical trials sector is booming. But any company that wants to do business there faces considerable challenges *connectedthinking
  • 2. The pharmaceuticals market in the Russian Federation is growing very rapidly, with six consecutive years of economic growth and a corresponding rise in living standards. But the state-run healthcare system is seriously under-funded and most Russians cannot afford the best new drugs. Moreover, the country still suffers from Soviet-style management practices; political interference remains a real risk; and the administrative and legal system is very weak. Russia thus offers genuine opportunities both for selling and testing pharmaceuticals, but these opportunities come with some substantial challenges.
  • 3. The pharmaceutical industry’s So where should the industry performance – which prompted the growth in the third quarter of 2004. But, main markets are under serious leaders look next? Analysis by major ratings agencies to raise the with crude oil exports bringing in over pressure. North America, Europe PricewaterhouseCoopers shows that country’s sovereign credit rating to BBB- $500 million a day, it is now back on several regions offer considerable (investment grade) at the start of 2005 track. PwC Macro Consulting estimates and Japan jointly account for potential, either as areas with untapped – has been fuelled primarily by energy that the economy will increase by 6.0% in more than 82% of total global demand for innovative drugs or as exports. Russia possesses huge coal 2006, and that it will rise by another 5.5% pharmaceutical sales – which suitable places for conducting research and natural gas reserves. It is also rich in 2007 – more than in any country except reached US$ 602 billion in 2005, and development (RD). In our fifth article in non-fuel minerals such as iron ore, China and India (see Figure 1). according to IMS Health. But we shall focus on the Russian Federation. manganese, chromium, nickel, platinum North America and Europe are and titanium. If it can overcome its current difficulties, Russia’s long-term economic potential experiencing quite sluggish However, several factors have impeded may be even greater. US investment growth; sales rose 5.2% in the its transition from Communist heartland bank Goldman Sachs has identified it former and 7.1% in the latter. And Russia’s strong economic to modern industrialised state. Soviet- as one of the four biggest developing though the Japanese market saw performance era management practices are still economies (together with Brazil, India its highest year-on-year increase widespread and the infrastructure and China), and estimates that real GDP since 1991, with sales rising 6.8%, The Russian economy has been requires substantial investment. Higher will grow by between 4.8% and 1.9% a growing rapidly. In 2004, real gross marginal tax rates in the oil industry and year for the next 45 years. Should this this was still a much slower rate domestic product (GDP) rose 7.2%, higher production costs, as a result of happen, Goldman Sachs predicts that of growth than various emerging marking the sixth consecutive year rapidly rising wages and the appreciation Russia could overtake Italy in 2018, countries experienced. of economic expansion. The federal of the rouble, have also taken their toll. France in 2024, the UK in 2027 and budget ran a record surplus of 4.2% Germany in 2028 – making it the world’s and inflows of foreign direct investment All these problems contributed to a sixth-largest economy, measured by GDP peaked at $9.4 billion. This remarkable marked slowdown in Russia’s economic (see Figure 2). Figure 1: The Russian economy is expected to grow more rapidly than the economies of almost every other Figure 2: Russia could become the world’s sixth largest economy by 2050 country in the world *GDP for India refers to fiscal years beginning 1st April Source: PwC Macro Consulting Source: Goldman Sachs, “Dreaming with BRICS: The Path to 2050”
  • 4. Higher living standards but Furthermore, although living standards regularly participate in sports or fitness- over one million and the United Nations have improved, the health of the nation related activities; hence the fact that Development Fund reports that the rate shorter lives has deteriorated significantly since the the mortality rate from cancer and heart of infection is amongst the highest in break-up of the Soviet Union in 1991. Life disease is much higher in Russia than the world. Russia’s economic strength has already expectancy at birth is now just 65 years it is in many other transitional countries boosted living standards. Goskomstat, – a full decade less than it is in many (see Figure 4). Alcohol abuse is another The effect on the Russian population the State Statistics Service, reports that developed countries – while the infant major problem and health experts believe is already visible; it has fallen from 147 between 2001 and early 2005 the average mortality rate is three times higher than that it accounts for half of all accidents million to 143 million over the past dollar wage tripled from $79 to about it is in the EU or US. The discrepancy – the second leading cause of death. 16 years, even with surging levels of $240 per month, while the proportion of between the life expectancies of men The number of people killed in traffic immigration from former Soviet states. the population living below subsistence and women is especially notable; at accidents, for example, is almost the But the long-term impact could be far level fell from 28.9% to 17.8%. But GDP 59 years and 72 years respectively, same as it is in the US, a country with worse. Goskomstat predicts that, if per capita (adjusted for purchasing power these are the lowest figures and largest 100 times as many cars on the road. current trends continue, the population parity) is still much lower than it is in the difference by sex for the population of could plummet to just 80 million by 2050. US and EU, including many of the new any country reporting to the World Health The prevalence of infectious diseases member states (see Figure 3). Organisation (WHO). is also on the rise. Russia ranks 11th on the WHO’s list of 22 countries with a The gap between rich and poor is also The stress generated by the economic high incidence of tuberculosis; Hepatitis A healthcare system under considerable. In the first half of 2005 and social upheaval of the past 15 years C from intravenous drug use is growing the wealthiest 10% of the population has played a big part in this decline, rapidly; and the spread of HIV/AIDS is huge strain received 29.6% of the country’s total compounding the adverse effects of even more alarming. According to official income, while the poorest 10% received widespread smoking, a diet high in statistics, there were 300,000 cases Despite all these problems, Russia’s only 2%. Indeed, according to Forbes animal fats and lack of exercise. An of HIV in early 2005, but independent expenditure on public healthcare has magazine, Russia has more billionaires estimated 67% of Russian men and 33% estimates put the actual number of been dropping. Government financing than any other country except the US. of Russian women smoke, while only 6% people infected with the disease at of the state-run, free-for-all system Figure 3: GDP per capita in 2004 is lower in Russia than it is in many Western countries Figure 4: The mortality rate from chronic diseases is much higher in Russia than it is in other transitional countries Source: World Health Organisation Note: Age-standardised death rates from chronic disease (per 100,000) Source: CIA World Factbook by country for ages 30-69 years, estimates for 2005
  • 5. has shrunk by more than a third since private health insurance than to pay the major changes to the social protection Soviet times; in 2004, for example, it equivalent in wages. Private healthcare system with the signing of Law #122-FZ Changes to the social was just 2.8% of GDP, roughly half the is also expensive, since it is largely (see sidebar on Changes to the social level many developed countries invest. supplied by inefficient public facilities. protection system). protection system Moreover, the system is badly organised, So private schemes will probably remain with the result that much of the money the preserve of the wealthy for many Law #122-FZ came into it consumes goes on maintaining a vast years to come. effect on 1 January 2005. network of hospitals rather than providing A small but fast-growing It replaced a number of primary care. And because funding is The federal government is also making largely regional – there are 89 regions visible efforts to address the worst of pharmaceuticals market existing social subsidies – standards vary widely from one area to the problems in the public sector. It has and guarantees to certain another; some rural hospitals have no hot lifted funding for the healthcare system to For obvious reasons, then, Russia categories of the population, water, while some have no running water $3.6 billion this year – an 89% increase still spends relatively little on including victims of at all. on the $1.9 billion it allocated in 2005. It pharmaceuticals. IMS Health estimates Chernobyl and war veterans, has also proposed a number of reforms, that, in 2005, the market was worth with cash benefits. It also The vast majority of Russian patients such as switching to direct financing just $3.74 billion. That said, the market therefore have to dip into their own of medical services; reducing the free has increased substantially since the transferred responsibility for pockets to cover their medical costs, medical assistance guaranteed by the economic crisis of 1998 and is now compensating those who since the government reimburses state; closing down a large number of one of the fastest-growing in Europe. were previously entitled less than 30% of expenditure on hospitals; emphasising primary care; and Between 2000 and 2004, sales of to subsidised healthcare pharmaceuticals. They are also routinely increasing doctors’ salaries by paying pharmaceutical products more than and drugs from the federal forced to bribe medical staff to obtain them for the treatments they dispense tripled. Currency fluctuations played a government to the regional services which are supposed to be free rather than the hours they spend at part in the rise, but the market still more of charge. Research conducted by the a desk. These reforms have yet to be than doubled in constant dollar terms authorities. The government INDEM Foundation, one of Russia’s implemented (and some of them may (see Figure 5). This upward trend is allocated $1.8 billion for leading non-governmental organisations, prove quite difficult to introduce), but the expected to continue; sales are forecast funding this new programme, suggests that in 2004 Russians spent government has already made several to increase by about 10% a year between which covers 14 million about $400 million on such under-the- people and more than 2,300 counter payments (compared with $600 Figure 5: The Russian pharmaceuticals market has been growing steadily for the past six years medicines, in 2005. But million the previous year). industry experts question The weaknesses of the state healthcare whether this will be enough system have driven an increasing number to redress the lack of public of people into the private sector, although funding for medical treatment health insurance is still relatively rare. and drugs. State insurance company Rosgosstrakh reports that premiums on optional health insurance reached 38.8 billion roubles ($1.1 billion) in 2004 – up 25% from 2003 – and predicts that the market will grow by 13-16% a year for the next few years. However, corporate policies account for more than four-fifths of all premiums, because it is often more economically advantageous for companies to offer Source: IMS Health
  • 6. 2006 and 2010, on the back of rising which passed a first reading in the State unlike China, India or large parts of Latin percentage than in any other market incomes, greater government expenditure Duma, would have required doctors to America, Russia does not have a history except China (see Table 2). In the US, and improvements in distribution. use international non-proprietary names of using competing alternative therapies. UK, France, Mexico, Hungary and and given pharmacists responsibility In 2004, for example, treatments for high Czech Republic, by contrast, the share Generics currently account for the lion’s for deciding whether to dispense a blood pressure and cardiac therapies held by the top 10 companies is more share of the market – particularly in the branded product or generic equivalent. accounted for 6.4% of retail pharmacy than 50%. hospital sector, which generates 20% of But it was opposed on various grounds sales and 2.5% of hospital sales, all pharmaceutical sales. Indeed, 78% of and subsequently seems to have sunk while psychoanaleptics accounted Sanofi-aventis leads the way; Russia the 13,000-odd drugs that are registered without trace. for 3.6% and 3.3% respectively (see is one of its main markets for over-the- in Russia are generics. However, the Table 1). Demand for drugs for cancer, counter (OTC) drugs. But Novartis is retail sector, which accounts for the At present, then, the market for branded AIDS and diabetes is likewise on battling hard to catch up. Sandoz, its remaining 80% of sales, also features products is still quite strong, and the the rise. The potential for low-cost generics arm, reported sales growth more expensive branded products and is majority of those drugs come from generics producers and for Western of more than 30% in Russia between growing much more rapidly. overseas suppliers. Russia imported manufacturers operating at the top end January and September 2005, under the more than 60% of all the pharmaceuticals of the market is thus greater than the supervision of Metod Dragonja, former Concerns about the increasing it used in 2004 – nearly two-thirds of initial picture might suggest. chairman of Lek. Servier has also been amount of money consumers spend them from companies in Western Europe, expanding its Russian presence over on drugs prompted the introduction of the US, Canada and Japan. Demand for The market is also ripe for consolidation. the last few years. It sells six of the top a controversial bill to enforce generic new treatments for chronic diseases and The top 10 companies account for 100 prescription drugs and increased its prescribing in July 2005. The measure, stress is particularly pronounced and, just 32.5% of sales – a much lower share of the retail pharmacy market from 2.2% to 2.9% (measured by value) in 2004, while Menarini leapt to first place, Table 1: Top 10 anatomical therapeutic chemicals by Table 2: The top 10 companies account for less than a third of sales with 3.7%. sales value ATC group Share in pharmacy sales, % 2004 sales ($m) Growth, US$ % Growth, constant % of market 2003 2004 currency % Limited domestic production Antibacterials for systemic use 6.4 6.9 Total Russia 3069 45 36 100.00 Analgesics 5.7 6.5 sanofi-aventis 203 47 38 6.6 In fact, local production is now quite Vitamins 4.9 5.2 Novartis 137 53 44 4.5 limited. During the Soviet era, Russia’s Agents acting on the 3.9 4.0 Servier 113 66 57 3.7 pharmaceutical industry was under Rhenin-Angiotensin system Gedeon Richter 106 41 33 3.5 federal control and supplied 70% of Psychoamaleptics 3.6 3.7 Menarini 105 84 73 3.4 the country’s needs. Today, most of the Cough and cold preparations 3.4 3.5 Pfizer 88 48 40 2.9 700-odd domestic drug manufacturers Sex hormones and modulators 3.2 2.9 Krka 66 41 32 2.2 focus exclusively on the production of of the genital system generics. The relatively low prices of Valeant 64 38 30 2.1 Antiinflammatory and 3.0 2.7 such products, compared with imports, GlaxoSmithKline 61 21 14 2.0 antirheumatic products explains why, according to research Roche 54 56 47 1.8 conducted by DSM Group, domestic Immunomodulationg agents 2.9 2.5 Cardiac therapy 2.5 2.6 Top 10 997 32.5 production accounted for 69% of sales Total Others 2072 42 34 67.5 measured by volume, but only 25% of 39.3 40.5 sales measured by value, in the first half Source: AIPM-RMBC Market Bulletin of 2005. (February 2005) Source: IMS Health
  • 7. The variable quality of domestic drug expanded into pharmaceuticals with CenterWatch reports that there were However, any company conducting production is a major problem. Many the purchase of a majority stake in the 523 new trial starts in 2004, including clinical trials in Russia must overcome companies economise on raw materials, Moscow-based Akrikhin. 252 international studies, 167 local several serious obstacles. Language for example. Indeed, some industry studies of local or international products is one major barrier. All study- experts estimate that only 15% source and 104 bioequivalence studies. This related documents usually need to directly from manufacturers; the rest buy represents a 118% increase on the total be translated into Russian because their materials from offshore sources An under-funded number of trials started five years ago. the study personnel lack sufficient and the quality of such materials is often The number of international studies has English – and this presents the added inferior or the expiry date is imminent. research base risen an even more significant 136% over challenge of using the Cyrillic alphabet. Most Russian drug makers also lack the same period. There is also a shortage of trained and modern manufacturing facilities – and If domestic pharmaceutical production experienced local staff to manage trials though the government introduced a new has suffered since the end of the The introduction of Good Clinical in some parts of the country. national standard for good manufacturing Communist era, so has medical research; Practice (GCP) regulations in 1999 practices (GMP) with effect from January chronic under-funding has eroded the accounts for much of the surge. But, 2005, it will take them a number of years country’s formerly strong scientific base. like other transitional countries, Russia to comply with the rules. In 1992, Russia employed about 900,000 has several additional advantages. The Distribution and retailing researchers in military, medical and other patient population is treatment-naïve and Yet, despite the relative lack of domestic forms of research. By the start of the keen to participate in clinical trials, for production, very few multinationals millennium, it employed just 450,000 example, because this is the only way As clinical development becomes easier, currently have manufacturing operations researchers – of whom only about most people can secure access to new so the distribution network is also in Russia – although there are signs that 100,000 spent more than half their time drugs and high standards of medical improving. It is still quite fragmented; this may soon change. In a survey of the exploring new terrain. care. They are also easier to reach than there are an estimated 4,000 registered leading foreign manufacturers recently patients in countries where primary care distributors, ranging from national and conducted by PwC and the Association However, a few centres of excellence plays a much larger role (see Table 3). regional firms to niche operations which of International Pharmaceutical have survived and the country still In large cities such as Moscow and specialise in particular products or Manufacturers (AIPM), 33% said that they retains a strong position in certain St Petersburg (with populations of 8.3 working with particular manufacturers. were thinking about establishing their therapeutic areas such as immunology million and 4.6 million respectively), most own production facilities in Russia within and virology. In 2004, for example, patients are seen at the big teaching Table 3: Medical resources in Russia (2004) the next two or three years, and 19% Biomed launched Affinoleukin, a new hospitals. But even in less urban areas, said that they were thinking about doing active substance that boosts the cellular healthcare is provided primarily through so within the next five years – largely immunity of patients suffering from specialist medical centres. because they are concerned about the persistent bacterial or mycotic diseases. Number of physicians per 10,000 population 48 competition or keen to expand their Shekovsk Vitamins launched a second The Russian government has also taken Number of medium-level medical regional cover. new active substance – a nootropic drug a number of steps to open its health personnel per 10,000 population 109 called Phenotropil. system to foreign clinical research and Several generics manufacturers reduce the bureaucracy. And since many Number of hospital beds per have also acquired local facilities. In doctors earn less than $100 a month, 10,000 population 113 January 2005, for example, Germany’s they are often eager to supplement their Number of medical institutions providing STADA Arzneimittel beat off several Clinical development incomes by working as investigators outpatient care per 10,000 population 22 other suitors with an €80m-€85m bid or even as clinical research assistants. for Nizhfarm, Russia’s fourth-largest Lastly, the cost savings are considerable; Capacity of polyclinics (visits per shift) pharmaceutical producer. Similarly, Though Russia’s pure research base the clinical fees element in the overall per 10,000 population 251 Health Tech Corporation (the holding may have been decimated, it is rapidly cost of a trial may be as much as 50% company behind a Cypriot firm which becoming an increasingly attractive less than it is the West. Source: Goskomstat makes biologically active food additives) place in which to conduct clinical trials.
  • 8. But only 700 of these firms are major Intelligence and Remedium suggests Organisation (WTO), with which it Import tariffs players, and the sector is consolidating that OTC drugs currently constitute is actively negotiating to become a rapidly. The top three distributors – CV about 35% of total pharmaceutical member. The new code simplified the Protek, SIA International and Shreya sales, although the average unit price is customs process and established a Russia revised its tariff Corporation – now control 40% of just $0.68. comprehensive list of documents and system in January 2001. the market. data required for the customs clearance Under the current regime, of goods. However, it has not yet been some medicines are exempt The leading distributors wield fully implemented and some customs from customs duties. Tariffs considerable power. SIA International Red tape facilities have been slow in making the has just bought a stake in three shift to new procedures (see sidebar on otherwise range from 5% manufacturing plants run by the Pharm Import tariffs). to 20%, depending on Center Group, which specialises in the The Russian pharmaceuticals market has whether the product being production of antibiotics, for example. more promise than might first seem the The import licensing procedure imported constitutes raw Similarly, CV Protek has invested in case, then. Yet Russia is by no means an can likewise be quite burdensome. materials, semi-finished several facilities for producing generics easy country in which to trade. The old Import licences and activity licences goods, foodstuffs or finished and a number of pharmacy chains. Soviet system has been comprehensively are required for all pharmaceuticals, dismantled, but the administrative, and the licensing requirements are products. Value Added Tax This interest in the retail sector reflects tax and legal framework is still very very broad and often confusing. In (VAT) is also applied to almost the speed at which it is expanding; inefficient. December 2002, the Russian Ministry all imports at the current Russia now has more than 20,000 of Health also established a mandatory rate of 18% – although there pharmacies and about 5,000 smaller In January 2004, for example, Russia conformity assessment scheme, which is a fixed rate of 10% for outlets such as kiosks, over 40% of introduced a new Customs Code duplicates some of the other certification pharmaceuticals and medical which are privately owned. But it is also to bring its customs regimes and requirements. The ministry intended to a way of capturing a share of the OTC procedures more closely into line with replace this scheme with self-certification equipment. market. Research from Espicom Business the requirements of the World Trade in 2004, but it has not yet issued any new guidelines. Figure 6: Deterrents to production in Russia The bureaucratic challenges are even greater for companies setting up manufacturing operations in Russia. Indeed, research conducted by PwC and AIPM shows that red tape is one of the biggest obstacles cited by foreign pharmaceutical companies thinking of setting up production facilities there (see Figure 6). Political interference Source: PricewaterhouseCoopers/Association of International Pharmaceutical Economic and political risks come a Manufacturers Survey, 2005 close second on the list of deterrents multinationals cite – arguably with good
  • 9. cause. Indian pharmaceutical company One such instance of the potential WTO. At present, for example, it does 3.5% and 12% of the pharmaceuticals Dr Reddy’s Laboratories has already minefield facing overseas investors is the not provide protection for test data market in Russia, although independent fallen foul of the authorities in the course so-called “Grandfather Clause”, which for pharmaceuticals. The enforcement experts suggest that the figure could be of trying to sell its stake in the formerly theoretically gives preferential treatment regime is also weak; judicial corruption higher – and domestic manufacturers state-owned Biomed Russia to another to “priority” projects undertaken by is endemic, and the legal system is are thought to be amongst the main Russian firm. Moscow’s office of the Russian companies in which foreign ill-prepared to handle sophisticated culprits. In 2003, the ministry suspended public prosecutor issued an injunction shareholders own more than 25% of patent cases, although a specialised the licences of 321 pharmaceuticals ordering the return of the shares to the equity. The clause stipulates that all higher patent chamber has now been companies for manufacturing and trading the authorities, on the grounds that such companies should be protected established, bringing greater expertise in counterfeit medicines. Dr Reddy’s had failed to implement from increases in federal taxes and and efficiency to the resolution of the investment programme to which import duties until the initial investment patent disputes. Russian Health Minister Mikhail Zurabov it had committed itself when it bought has been recouped, but since there also promised that the ministry would its stake in the vaccine producer in are no corresponding tax and customs develop a new system for supervising 1995. But political considerations may regulations the relief it affords is entirely pharmaceutical production; however, also have played a part in the legal hypothetical. Corruption it has not yet done anything. One tussle; according to several newspaper suggestion is to mark products with reports, Biomed stores vital vaccines Nevertheless, the government has a bar code and hologram, but few for the Russian Ministry of Emergency now introduced certain incentives In fact, corruption is rife in Russia industry commentators believe this will Situations – prompting queries as to (including exemptions from customs – and, if anything, getting worse. work, since the use of special marks for why the government allowed Dr Reddy’s duties and VAT in respect of charter The latest Transparency International licensed video and audio production to acquire shares in such a “strategic capital contributions) which may be Corruption Perceptions Index ranks has done nothing to stop the Russian facility” in the first place. attractive to foreign companies setting Russia 126th on the list of 159 countries market from being flooded with fake up manufacturing operations in Russia. surveyed and reports that the situation DVDs and CDs. It has also supported the creation has deteriorated since 2004 (when of special economic zones, like the Russia was ranked 90th). A wide- Foreign investment Kaliningrad economic zone, which ranging study released by the INDEM provide customs and tax breaks for Foundation confirms these findings. It A weak infrastructure investors and companies operating in estimates that companies pay about There are also numerous official and such areas. $316 billion in bribes every year, and that unofficial barriers to overseas investment the average “sweetener” is $135,800 Russia’s transport infrastructure is in Russia, a fact that explains why – 13 times more than in 2001. Moreover, also lacking in a number of respects. Russia does relatively badly in the government officials are amongst the It possesses one of the largest rail international competition for foreign Poor enforcement of worst offenders, even though President networks in the world, but the shift from finance. According to preliminary Putin came to power vowing that he a planned economy to a market-driven balance-of-payments data from the intellectual property rights would fight corruption. economy has dramatically changed Central Bank of Russia, foreign direct the demands on the transport sector, investment (FDI) flows into the non- Russia’s poor record of enforcing producing conditions that favour road financial sector reached $16.7 billion intellectual property rights is another rather than rail transport. Rail freight in 2005, but Russia’s total cumulative source of concern. It has been on the Counterfeiting volumes are now about 60% of their ratio of FDI to GDP is still only about US Special 301 Priority Watch List historical peak – and lower revenues 6%. This is six times less than the since 1997, and its failure to comply have prevented the system from being amount China attracts and less than with the TRIPS Accord on trade-related Counterfeiting is another major problem. maintained as thoroughly as it should be. one‑third of the level in many other aspects of intellectual property rights According to the Russian Ministry for transitional economies. remains one of the biggest stumbling Healthcare and Social Development, The situation when it comes to roads is blocks in its negotiations to join the fake drugs currently account for between even worse. The Russian government
  • 10. recognises the importance of creating border. It therefore makes sense to target a viable transport infrastructure, but the these areas first. World Bank estimates that it is spending less than a sixth of the money required to Even so, the limitations of Russia’s produce a road network that will meet the transport infrastructure and the fact that country’s future needs. Despite a 35% distribution is particularly important in increase in the last decade, for example, a highly competitive market dominated the density of the road network in by generics mean that any Western Western Russia (where traffic is greatest) company wanting to break into Russia is still only one-sixth of that in Latvia, will have to form a strategic partnership one-fifth of that in Estonia and one-third with a distributor – and, here, the mid- of that in Ukraine. sized firms offer most promise. They are generally more willing than the leading distributors to work with a wide range of products and establish long-term Strategies for entering relationships with manufacturers and retail outlets. the market New entrants may also want to consider Yet the difficulties associated with forming an alliance with a local producer; trading in Russia should not obscure its this is often an easier way of securing potential. The Russian pharmaceuticals a foothold in new markets than setting market has grown faster than the up independently. If the arrangement markets of the developed world since the proves successful, they can then start of the millennium. This performance acquire their partners, but they will is expected to continue, with sales need to choose the firms with which reaching about $6 billion by 2010 – 61% they work very carefully and ensure that more than they were in 2005. Moreover, they adhere to Russia’s anti-monopoly if the country maintains its positive legislation. This specifies, for example, economic trajectory over the long term, that when a company with assets of disposable incomes will rise still further, over $103m acquires a stake of more putting more patients in a position to buy than 20% in another company, it must Western medicines. obtain prior consent from the Federal for pharmaceutical companies prepared a centre for clinical testing – no small Anti-monopoly Service (FAS). It must also to invest in the region. The potential for consideration, as development costs So how should the pharmaceutical obtain consent for any further increases companies that focus on areas of unmet continue to soar. And though the legal majors prepare to capitalise on these in its shareholding. need – including chronic conditions system for protecting patent rights opportunities? One of the biggest like heart disease, diabetes and HIV remains a serious concern, there is challenges is the country’s sheer scale. – is particularly significant. Conversely, reason to believe that this will improve. Russia is nearly double the size of the although the market for generic drugs is Russia has made no secret of its desire US, covers 10 time zones and suffers Conclusion much larger in terms of volume, it is much to join the WTO by the end of 2006, after from some of the planet’s harshest more competitive. more than a decade of discussions, and weather conditions. But over 80% of better provision for intellectual property the population is concentrated in the In short, the Russian Federation presents The introduction of GCP and easy may well seem a price worth paying to “European” part of the state, west of the some undeniable challenges, but it also access to a large patient population resolve its differences with the existing Ural Mountains, and along the southern provides some genuine opportunities has also increased Russia’s appeal as member states.
  • 11. This paper draws on the expertise of PricewaterhouseCoopers’ For further information, please contact the following pharmaceutical territory leaders: pharmaceutical industry group and the pharmaceutical division of the WINS team, a business development group that analyses companies from a market perspective, creating a “market mirror” of how analysts Russia view those firms. Christian Ziegler + [7] (495) 232 5461 christian.ziegler@ru.pwc.com Alina Lavrentieva + [7] (495) 967 6250 alina.lavrentieva@ru.pwc.com Natalia Kozlova + [7] (495) 967 6184 natalia.kozlova@ru.pwc.com Global Leader Simon Friend +[44] (20) 7213 4875 simon.d.friend@uk.pwc.com Global Tax Leader Michael Swanick +[1] (267) 330 6060 michael.f.swanick@us.pwc.com US Mark Simon +[1] (973) 236-5410 mark.d.simon@us.pwc.com Pharmaceuticals Industry Analyst John MacDonald +[44] (20) 7212 5642 john.macdonald@uk.pwc.com The member firms of the PricewaterhouseCoopers network (www.pwc.com) provide industry‑focused assurance, tax and advisory services to build public trust and enhance value Global Pharmaceuticals Director of Marketing for its clients and their stakeholders. More than 130,000 people in 148 countries across our Attila Karacsony network work collaboratively using Connected Thinking to develop fresh perspectives and practical advice. +[1] (973) 236 5640 attila.karacsony@us.pwc.com © 2006 PricewaterhouseCoopers. All rights reserved. ‘PricewaterhouseCoopers’ refers to the network of member firms of PricewaterhouseCoopers International Limited, each of which is a separate and independent legal entity. Ref 2006BHM21578. 10