Table of Contents

CHAPTER ONE: EXECUTIVE SUMMARY

• Out of Pocket Spending
• Healthcare Legislation
• State of the Pharmaceutical Industry, 2009 • Meeting Investor Expectations • Erosion of Blockbuster Sales • Increased Generic Competition • Pricing Pressures • Pipeline Output Slowing Compared to ROI • Mergers &Aquisitions
• Retail Clinics
• OTC/Generic Drugs

CHAPTER TWO: INTRODUCTION

• The U.S. Healthcare System Today
• Overview THE NEED FOR ALTERNATIVES
• High Cost of Care
• Healthcare Reform

CHAPTER THREE: OUT-OF-POCKET EXPENDITURES: THE MARKET IN 2009

• Types of Expenditures
• Insurance Co-Payments
• Direct Payments
• Premiums and Plan Fees
• Cash or Check
• Credit Cards
• Loans and Lines of Credit
• Flexible Spending Accounts
• Health Savings Accounts
• Medical Financing
• Elective Procedures
• Non-Elective Procedures and Prescription Drugs Consumers Who Pay Out Of Pocket
• The Uninsured and Underinsured
• Medicaid Recipients
• The Disabled
• Senior Citizens
• The Mentally Ill
• The Obese
• Persons with Chronic Conditions

CHAPTER FOUR: OUT-OF-POCKET EXPENDITURES: THE MARKET IN 2009 – 2013

• Out-of-pocket Expenditure Growth Drivers
• Payment Methods
• Consumers Who Pay Out-of-pocket

CHAPTER FIVE: OVER THE COUNTER DRUGS: IN POSITION

• United States Market
• OTC and Recession: Avoiding the Copay
• Behind the Counter Drugs?

CHAPTER SIX: INFLUENTIAL PHARMACISTS

• Markets – Pharmacists Impact
• The Prescribing Pharmacist
• Main Drivers For Increased Pharmacist Prescription Authority

CHAPTER SEVEN: MEDICAL TOURISM: BOOM OR BUST?

• Motivations for Medical Tourism
• Impact of Recession
• True Medical Tourism vs. All Healthcare for Foreigners

CHAPTER EIGHT: STATE OF THE PHARMACEUTICAL MARKET: OFFSHORING AND OUTSOURCING

• Meeting Investor Expectations
• Erosion of Blockbuster Sales
• Increased Generic Competition
• Pricing Pressures
• Pipeline Output Slowing Compared to ROI
• M&A Offshoring Clinical Trials
• Size and Growth of the Market
• Outsourcing: No Longer Optional For Pharma
• Strategic Outsourcing
• Outsourcing Manufacturing Operations

CHAPTER NINE: GENERIC DRUGS: COMING BOOM?

• Overview
• Issues in Generics

CHAPTER TEN: RETAIL CLINICS

• Retail Clinics Business
• Competition with Primary Care Providers
• Regulation

CHAPTER ELEVEN: IMPACT OF HEALTHCARE LEGISLATION

• Overview
• Change for Pharma
• Focus on Cost – Cutting
• Healthcare Reform

CHAPTER TWELVE: COMPANY PROFILES

• APFUSA
• Atlantic Care
• Aurora Quick Care
• Capitol One Healthcare Finance
• Care Credit
• Cerner Corporation
• Products and Service
• Key Competitors
• Credit Medical
• CSI Financial Services
• E- Financing Solutions
• GlaxoSmithKline
• History and Lines of Business
• Strategic Alliances
• Vaccine Products
• OTC Products
• Financial Information
• Hospira Inc.
• Med Basics
• McKesson Corporation
• Company Overview
• Products and Service
• Medco Health Solutions, Inc.
• Merck & Co. Inc
• History and Lines of Business
• Strategic Alliances
• Vaccine Products
• Financial Information
• Med choice Financial
• MedDirect
• Minute Clinic
• Novartis
• History and Lines of Business
• Strategic Alliances
• Vaccine Products
• My Healthy Access
• Now Medical Centers
• Pfs
• Quick Health
• Rediclinic
• Reliance Medical Finance
• Solantic
• Take Care Health Systems
• Target Clinic Medical Associates
• TEVA Pharmaceutical Industries, Ltd.
• Wyeth (Pfizer)
• History and Lines of Business
• Vaccine Products
• OTC Products
• Financial Information
• Siemens Medical Solutions
• Key Competitors
• Growth Strategy
• Locations
• Wal – Mart

LIST OF EXHIBITS CHAPTER TWO: INTRODUCTION

• Figure 2-1:National Health Expenditures (NHE) and NHE as a Percent of GDP, 1980 – 2013
• Figure 2-2: Unnecessary Deaths Resulting From Variations in Health Care Quality, by Condition (Prenatal Care, Diabetes Care, Beta Blocker Treatment, Breast Cancer Screening, Cholesterol Management, High Blood Pressure, Diabetes)
• Figure 2-3:HEDIS Scores by Quality of Health Care Plan, 2008
• Table 2-1: U.S. Health Care Coverage by State, 2008

CHAPTER THREE: OUT-OF-POCKET EXPENDITURES THE MARKET IN 2009

• Figure 3-1:Premium Increases vs. Increases in Workers Earnings and Prices, 1989 – 2008
• Figure 3-2: Consumer Out-of-pocket Health Care Expenditures,
• Figure 3-3:Consumer Out-of-pocket Health Care Expenditures by Payment Type,2008
• Table 3-1: Credit Card Debt of Consumers With Medical Debt, 2007
• Table 3-2: Credit Card Debt of Consumers With Medical Debt, 2007
• Table 3-3: Main Business Activities of Selected Medical Financing Companies,
• Figure 3-4:by Percentile of Total Health Spending,
• Figure 3-5:Methods of Financing Elective Procedures,
• Figure 3-6: Average Share Paid Out-of-pocket by U.S. Residents with Health Care Spending by Type of Service, 2008
• Figure 3-7: by Percentile of Total Health Spending and Type of Service, 2008
• Figure 3-8: Distribution of Out-of-pocket Spending on Non-Elective Procedures for the Average Person, 2008
• Figure 3-9: Distribution of Out-of-pocket Spending for the Average Person, by Spending Level, 2008
• Figure 3-10: Drug Cost Coverage by Payor Type (Public, Private, Cash) 1965, 1986, 2000, 2004, 2008
• Table 3-4: Obesity in the United States, 1980 – 2013
• Figure 3-11: Proportion of Adults Under Age 65 With Chronic Conditions, 2008

CHAPTER FOUR: FORECASTED OUT-OF-POCKET EXPENDITURES: THE MARKET IN 2009 – 2013

• Table 4-1: Selected Rx-to-OTC Switches in the United States, 1990 – Present
• Table 4-2: Rx-to-OTC Switch Candidates in the United States, 2009 – 2013
• Table 4-3: Consumer Out-of-pocket Expenditures per Worker 2003-2013 (in $)
• Table 4-4: Consumer Out-of-pocket Expenditures by Type, 2003-2013
• Figure 4-1: Proportion of Consumer Out-of-pocket Spending by Type of Health Care Expenditure
• Table 4-5: Consumer Out-of-pocket Expenditures by Type, 2001-2011
• Figure 4-2: Proportion of Consumer Out-of-pocket Spending by Payment Type, 2003, 2008, 2013
• Table 4-6: Amount of Consumer Out-of-pocket Expenditures for Elective Procedures That Are Financed, 2003-2013
• Table 4-7: Amount of Consumer Out-of-pocket Expenditures for Non-Elective Procedures That Are Financed, 2001-2011
• Figure 4-3: Proportion of Consumer Out-of-pocket Spending for Elective ProceduresThat is Financed (All Methods),
• Figure 4-4: Distribution of Out-of-pocket Spending on Non-Elective Procedures for the Average Person, 2008, 2013
• Figure 4-5: Proportion of Consumer Out-of-pocket Spending for Non-Elective Procedures That is Financed (All Methods),2008 – 2013
• Table 4-8: Size of High Risk Groups for High Out-of-pocket Health Care Expenditures, 2003-2013 (Millions of Persons)

CHAPTER FIVE: OVER THE COUNTER DRUGS: IN POSITION

• Table 5-1: Projected US OTC Revenues 2008-2012

CHAPTER SIX: INFLUENTIAL PHARMACISTS

• Figure 6-1: Declining Drug Purchases Not Influenced By Pharmacists, 2006-2012
• Table 6-1: Pharmacists Influence in Drug Selection and/or Therapy Aspect: 2007 and 2012
• Table 6-2: States Likely to Implement Independent Prescribing First

CHAPTER SEVEN: MEDICAL TOURISM: BOOM OR BUST?

• Table 7-1: Cost Savings From Medical Tourism For Various Procedures, 2008
• Figure 7-1: US ‘True Medical Tourism’ Revenues, 2008, 2010

CHAPTER EIGHT: STATE OF THE PHARMACEUTICAL MARKET,: OFFSHORING AND OUTSOURCING

• Table 8-1: Clinical Trial Market in Select Countries 2006-2012
• Table 8-2: Global Prescription Pharmaceutical Contract Manufacturing Market Primary, Secondary and Biomanufacturing 2003-2013

CHAPTER NINE: GENERIC DRUGS: COMING BOOM?

• Table 9-1: US Generic Drug Market 2008-2012

CHAPTER TEN: RETAIL CLINICS

• Figure 10-1: Growth of U.S. Retail Clinic Services

CHAPTER ELEVEN: IMPACT OF HEALTHCARE LEGISLATION

• Table 11-1: Likely Impact of Events and Proposed Legislation (Propsed Change, Probability, Positive Impact, Negative Impact)

CHAPTER TWELVE: COMPANY PROFILES