astrazeneca pharma india ltd share price Management discussions

Indian Economy

India is the 5^th largest economy in terms of 2023 GDP rankings, with an estimated GDP of USD 3.74 trillion.⁽¹⁾ When adjusted for purchasing power, it is ranked third - only behind China, and United States.⁽¹⁾ India was the fastest growing major economy in 2022 with a GDP growth of 6.8%; However, India was one of the worst impacted economies in terms of GDP growth during the pandemic with an estimated GDP contraction of 6.7% for the year 2020. The sharp rebound of the economy is reflective of the countrys resilience against the COVID-19 pandemic, and the innate growth prospects of the Indian economy⁽¹⁾. In terms of future estimated growth, India will continue to remain the fastest-growing major economy in the coming years - with a projected GDP growth averaging 6.1% a year in the years 2023 to 2024.⁽¹⁾

An increase in private consumption, and investments is expected to drive growth amidst an improving business environment, rising incomes, and expanding workforce. Support to economic growth will come from the expansion of public digital platforms and path-breaking measures such as PM GatiShakti, the National Logistics Policy, and the Production-Linked Incentive schemes to boost manufacturing output⁽²⁾ While the broader economy seems to have moved past the pandemic, - the COVID-19 resurgence in the form of new variants of concern - does continue to pose headwinds for the economy.

Indian Healthcare Environment

The healthcare sector on a broad level comprises of pharmaceuticals, diagnostics, medical devices, equipment and supplies, healthcare delivery, clinical trials, and health insurance segments. The industry is forecasted to grow at 22.4% annually, and touch USD 372 billion in 2022.⁽³⁾

A growing burden of Lifestyle or Non-Communicable Diseases (NCDs), aging demographics, rising income, and awareness towards health & wellness coupled with improving access to healthcare, increased diagnostic rates and health insurance coverage are a few of the notable trends contributing to the increased healthcare expenditure.

The Indian medical tourism market was valued at USD 2.89 billion in 2020 and is expected to reach USD 13.42 billion by 2026. According to India Tourism Statistics at a Glance 2020 report, close to 697,300 foreign tourists came for medical treatment in India in FY 2019. India has been ranked 10^th in the Medical Tourism Index (MTI) for 2020-21 out of 46 destinations by the Medical Tourism Association.⁽³⁾

The e-health market size is estimated to reach USD 10.6 billion by 2025⁽³⁾. The country has witnessed the importance of digitally enabled healthcare solutions against the constraints imposed by the COVID-19 pandemic. Hence, a renewed focus remains on creating more resilient, agile, and innovative health ecosystem that embraces digital. The use of digital channels is expected to intensify across major facets of the industry - including healthcare delivery.

Increasing penetration of health insurance will drive the expansion of healthcare services and pharmaceutical market in India.

A growing middle-class, coupled with rising burden of new diseases, is boosting the demand for health insurance coverage. With an increasing demand for affordable and quality healthcare, penetration of health insurance is poised to expand in the coming years.⁽³⁾

The central and state governments budgeted expenditure on healthcare touched 2.1 % of GDP in FY 2023 and 2.2% in FY 2022, against 1.6% in FY 2021, as per the Economic Survey 2022-23.⁽⁴⁾

Under the Union Budget 2023-24, the Ministry of Health and Family Welfare has been allocated 89,155 crore (USD 10.76 billion), an increase of 3.43% compared to 86,200.65 crore (USD 10.4 billion) in 2021-22. Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was allocated 3,365 crore (USD 0.41 billion). Human Resources for Health and Medical Education was allotted 6,500 crore (USD 780 million). National Health Mission was allotted 29,085 crore (USD 3.51 billion). Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was allotted 7,200 crore (USD 870 million).⁽³⁾

AB-PMJAY has 22 crore beneficiaries and The National Health Mission (NHM), and the newly introduced National Digital Health Mission (under the aegis of the NHM) have also seen a substantial increase in allocations. Amongst notable new programmes, The National Tele Mental Health programme has been launched for access to quality mental health counselling & care services.⁽⁴⁾

Indian Pharmaceutical Market (IPM)⁵

The estimated size of IPM for FY 2022-23 is 200,506 crore (USD 24.1 billion). The growth of 7.9% (Value, FY22-23 over FY21-22) is a significant drop from prior years growth of 18.2% (Value, FY21-22 over FY20-21). It is better compared to growth of 4.3% (Value, FY 2020-21 over FY 2019-20). The previous year increment in growth is directly attributable to the base effect combined with surge in uptake of acute therapies such as respiratory and Covid- related therapies of anti-infectives, pain management and vitamins & supplements. Indian companies account for 82% share of the market (value) with a growth of 8.5% (Value, FY 2022-23 over FY 2021-22), while the MNCs grew at 5.0%.⁽⁵⁾

AZ India breaks into top 50 companies in IPM, jumped 4 rankings to rank 49, finished the year with top 10 ranking amongst MNCs and delivered growth of 18.5% (Value, FY22-23 over FY21-22).⁽⁵⁾

Pharmaceutical Business Environment - Outlook

The Indian pharmaceutical market is forecasted to grow at a CAGR of 9% between 2022 to 2025 touching ~USD 36 billion in 2025⁽⁶⁾. Some of the factors that would drive the growth include ageing demographics, rising income & affordability, rising incidence and diagnosis of NCDs, better awareness of wellness, diagnostics and preventive care, expansion of healthcare delivery infrastructure, quicker regulatory approvals, increasing health insurance coverage, conducive investment climate, and increasing adoption of digital solutions in healthcare delivery.⁽⁶⁾ Patient pool expected to increase over 20% in the next 10 years (until 2030), mainly due to rise in population.⁽³⁾

Key risks that could act as a dampener for growth include: rising inflation & consequent pressure on margins - exacerbated by ongoing geopolitical crisis; associated disruptions in supply chains, and exports; downward pressure on prices - arising out of potential NLEM expansion, and generic proliferation amidst LOE in key brands within IPM; resurgence of COVID due to new variants of concern.^(6,31)

Growth and Demand Drivers:

1. Increasing Health insurance coverage: The private health insurance sector is expected to grow over the next decade - driven by rising incomes, aging demographics, increasing awareness and preferences for healthcare spending, tax incentives on private health insurance premiums, and an increase in the range and sophistication of plans offered

in the private health insurance market. In FY22, premiums underwritten by health insurance companies grew to 73,582.13 crore (USD 9.21 billion). The health segment has a 33.33% share in the total gross written premiums earned in the country. ⁽³⁾

2. Cost efficiency: Low cost of production and R&D boosts efficiency of Indian pharma companies, leading to competitive exports. Indian drugs and pharmaceuticals exports reached USD 5.78 billion between April 2021 and June 2021. As of 2019, Indias cost of production ~33% lower than that of the US. Indias ability to manufacture high quality, low-priced medicines, presents a huge business opportunity for the domestic industry.⁽³⁾

3. Expansion of Medical infrastructure: Pharma companies have increased spending to tap rural markets and develop better medical infrastructure. Hospitals market size is expected to increase by USD 200 billion by 2024. Indias medical devices market stood at USD 10.36 billion in FY20. The market is expected to increase at a CAGR of 37% from 2020 to 2025 to reach USD 50 billion.⁽³⁾

4. Increasing adoption of telemedicine and digital platforms:

The governments National Telemedicine Service, eSanjeevani, has clocked 10 crore teleconsultations.⁽⁷⁾ The pandemic- induced constraints and adversities have resulted in the utilisation of innovative models that integrate diagnostics, healthcare delivery as well as engagement with Healthcare Professionals (HCPs) with technology. The increasing proliferation of several health-technology players that offer additional services like EMR, and patient analytics solutions, is clearly indicative of this trend towards the adoption of newer digital platforms in healthcare delivery. Moreover, research has shown that most of the HCPs preferred digital connects with pharmaceutical companies during periods of lockdowns, and this behaviour shift of using digital platforms for communication is here to stay.^(8,9) Most major organised hospital chains have introduced video consultation services and operate them in tandem with regular in-person consultations. This has increased convenience, improved compliance for follow-up, and ultimately broken physical barriers in accessing quality healthcare advice.

5. Increasing proliferation of e-pharmacies: The growth of e-pharmacy in India has been significant in recent years.

Indias e-pharmacy market was pegged at 26 billion in 2021.

It is expected to reach around 90 billion in 2027 with a CAGR of 22%, backed by the growing internet penetration and digital payment ecosystem and government support. There has been a significant increase (approximately fourfold) in foreign direct investments (FDI) over the last five years in the Indian pharmaceutical industry.⁽¹⁰⁾

6. Conducive investing climate: There has been an overall focus on facilitating investments - making capital accessible across stages of business - including venture, and early stage. Healthcare sector will certainly be one of the key beneficiaries. Policy focus towards making capital available will only augment the rising interest in India Inc. Notable foreign players in the healthcare sector are setting up R&D centres and hospitals in India. During April-September of financial year 2022-23, FDI inflows has been 8,081 crore. Further, the Department of Pharmaceuticals has approved 21 FDI proposals worth 4,681 crore for brownfield projects during January-November 2022.⁽³⁾

7. Policy Support: In February 2021, the government approved a production-linked incentive (PLI) scheme for the pharmaceuticals sector from FY21 to FY29. The scheme is expected to attract investments of 15,000 crore (USD 2.07 billion) into the sector. It is also expected to lead to incremental sales of 2,94,000 crore (USD 40.63 billion) and exports of

1,96,000 crore (USD 40.63 billion) between FY23 and FY28.⁽³⁾

8. Quicker regulatory approvals: To accelerate Indias fight against Covid, the Drug Controller General of India (DCGI) issued emergency use authorisation for vaccines such as Covaxin and Covishield as well as certain drugs such as Tocilizumab, Regeneron antibody cocktail, and Remdisivir amongst other drugs. Despite the challenges imposed by the pandemic, The Company too had secured quick approvals for a couple of new indications in the recent past.

9. Price hike of essential drugs: As a result of a recent development by the National Pharmaceutical Pricing Authority (NPPA), prices of 384 essential drugs and over 1,000 formulations are set to see a hike of over 11%, due to a sharp rise in the Wholesale Price Index (WPI). These scheduled drugs constitute about 18% of the total domestic pharma retail market. This may have wide-ranging implications on the populations healthcare expenses and in turn lead to further growth of the Indian Pharma Market. ⁽¹¹⁾

10. Increasing R&D investments: The Indian pharmaceutical industry is now seeking to move up the global pharmaceutical value chain by investing in R&D for drug development, drug repurposing, process improvements and digital manufacturing. As per the Union Budget 2022-23, 3,201 crore (USD 419.2 million) has been set aside for research and 83,000 crore (USD 10.86 billion) has been allocated to the Ministry of Health and Family Welfare. India plans to set up a nearly 1 lakh crore (USD 1.3 billion) fund to provide boost to companies to manufacture pharmaceutical ingredients domestically. ⁽³⁾

Risks:

1. Supply chain disruption, and rising input costs: The

ongoing geopolitical crisis has resulted in supply chain disruption and affected multiple industries, in particular, oil and gas-leading to increased costs of fuel and thereby, making Indian exports less competitive.^(12,13) Due to the high reliance on import of APIs, the Indian firms are vulnerable to supply shocks. The governments two Production Linked Incentive

schemes will be a major step in the direction to achieve a 25% cut in API import reliance by 2024 .⁽¹⁴⁾

2. Intensifying downward pressure on prices¹¹⁵¹: Pressure on drug prices will intensify, driven by the imposition of caps on trade mark-ups applied to a growing number of non-scheduled products and an increase in the number of molecules listed on Schedule I of the Drug Price Control Order (DPCO), which are subject to explicit regulatory control. The impact of the DPCO on prices will increase if more products are added to the National List of Essential Medicines (NLEM) and escalate more dramatically if DPCO controls were applied to all forms of molecules on the list.

Business model

The Company is engaged in the business of manufacture, distribution and marketing of pharmaceutical products and co-ordinates clinical trial services with an overseas group company.

During the year under review, total revenue from operations is amounting to 10,029.7 million out of which sales of pharmaceutical products is 9,417.5 million (93.9%) and sale of services from clinical trials is 612.2 million (6.1%).

Since all the Companys activities fall within a single business segment, separate segment-wise disclosures are not provided in the financials.

Outlook

Across our therapeutic offerings, the Company has introduced a couple of new indications and products in the recent past. Notable launches in the Cardiovascular-Renal-Metabolics (CVRM) business include - Heart Failure (HF), and Chronic Kidney Disease (CKD) indications for Forxiga (Dapagliflozin). The Company has been instrumental in shaping the market for use of SGLT2i class of drugs in these novel indications. Our recent launches, in oncology are seeing significant traction, and gaining quick acceptance amongst the HCPs. A few notable recent approvals include - use of Imfinzi (Durvalumab) in Biliary Tract Carcinoma, and use of Lynparza (Olaparib) in early breast cancer. The recent label expansions for our oncology drugs will have profound implications in improving the prognosis of cancer patients in the country. Our respiratory franchises new inclusion into the portfolio last year, Fasenra (Benralizumab) is helping redefine management of severe asthma in the country. The Company hopes to expand its respiratory portfolio further and tap into its global robust asset offering, and pipeline within Respiratory, Immunology & Infectious diseases. Rare Disease is the latest therapy area that the Company entered this year with the launch of Koselugo (the selumetinib) for treatment of NF1 and has plans to expand the portfolio in the coming years.

In FY23-24, the Company will continue to prioritise investments in its focus areas in-line with its global growth platforms. The Company continues to be committed in making novel therapies/indications available for patients in India - a conducive regulatory pathway remains key for determining feasibility; and speed of new launches, and the Company will continue to pursue accelerated regulatory milestones - leveraging its clinical operations, and evidence generation capabilities wherever applicable.

India harbours a high diabetic burden, and is often cited as the diabetes capital of the world. An estimated 77 million people in India suffer from diabetes-making India the second-highest country in terms of prevalence of diabetes, after China.⁽¹⁶⁾ The Oral

Anti-diabetic (OAD) segment constitutes close to 75% of the total anti-diabetic segment in terms of value, and is valued at 13,453 crore.⁽⁵⁾

The Company has a strong portfolio of oral antidiabetic drugs with presence in 2 key drug classes:- SGLT2 inhibitors, and DPP4 inhibitors. Amidst 100+ generic brands - The Companys innovator brands of SGLT2i have felt the impact - with what was traditionally a growth engine, with double digit growth, now experiencing value degrowth. However, the Company will continue to prioritise the brands of Dapagliflozin, and with the new, bold access maximising price point, The Company hopes to kickstart a new growth phase for the brand, and maximise on the potential for the newer indications. The label expansion of Forxiga (Dapagliflozin) in 2020 to include treatment for HF patients, and CKD patients constitutes a paradigm shift in the management of these diseases. HF is one of the leading causes of hospitalisation and the disease imposes a huge burden world over. CKD is also associated with high morbidity and mortality, and In India, it is estimated that over 100 million people suffer from Chronic Kidney Disease.⁽¹⁷⁾ The Companys DPP4 offering-comprises of the brands of Onglyza (Saxagliptin) and Kombiglzye (Saxagliptin/Metformin). The Companys diabetic portfolio with its clinical evidences, and endorsements by the latest international guidelines for improving patient outcomes - beyond just HbA1C control, would certainly improve the lives of millions of patients.

Cardiovascular (CV) disease continues to be the leading cause of death in the country. The Company with its strong CV portfolio of drugs is committed to alleviating the burden imposed by CV diseases. Brilinta (Ticagrelor) - belonging to Oral antiplatelet (OAP) category of drugs, used in the management of Acute Coronary Syndrome (ACS), continues to remain the market leader. The past year has witnessed the launch of over 30 generics following the patent expiry of Ticagrelor in 2019. Brilinta, by virtue of its value proposition, hopes to sustain its market leadership with double digit growth and save even more patient lives in the coming year.

The Companys respiratory portfolio comprise of offerings for both Asthma, and COPD. India has a very high prevalence of chronic respiratory illness. Poor air quality on account of pollution in some of the major cities continues to be a major cause of high respiratory disease burden in the country. Symbicort - the Companys ICS/ LABA inhaler with an innovative delivery mechanism continues to be one the fastest growing ICS/LABA brands with a growth almost double the market. Fasenra (Benralizumab) - has seen good patient enrolments, and has been well accepted by HCPS, gaining a lot of interest. We hope that Fasenra with its superior value proposition will redefine the standard of care for the management of severe asthma.

Every year, over a million new patients are diagnosed with cancer, and it has become a major cause of mortality in India. The Companys oncology portfolio spans across areas of womens cancer with a strong presence in Breast & Ovarian, Lung cancer, Prostate, and Hematology, and has been the growth engine for the Company. AstraZeneca is the third fastest growing MNC in India, and is 3^rd largest Oncology company in India as per MAT December 2022 (IPSOS). The success has been enabled by the strong ecosystem of market access, scientific & regulatory prowess, and continued innvoation. Tagrisso (Osimertinib) is the leading brand in lung cancer by sales value. Lynparza (Olaparib) is the number one ovarian cancer brand. Recent label extensions will continue to drive the next phase of growth for both these brands. Imfinzi (Durvalumab) continues to recruit newer patients and make

significant contributions to the lung franchise. AZ had entered into Gastro-Intestinal Cancer space with Imfinzis indication expansion into Biliary Tract Carcinoma, and it boasts a strong pipeline of exciting label expansions in near future.

The Company is delighted to introduce a diverse selection of innovative therapies to the patients, aimed at addressing COPD, Breast Cancer, and Neurofibromatosis 1 (NF1). This moment is particularly exciting as we eagerly anticipate the much-awaited introduction of Enhertu (Trastuzumab-Deruxtecan), poised to revolutionise the treatment approach for HER2-expressing tumor types. Additionally, the Company will be extending its reach in the near future by venturing into the Rare Disease sector with the introduction of Koselugo for NF1, marking a significant expansion of our portfolio.

The pandemic has been profoundly disruptive across multiple facets of life. It has greatly altered ways of working, customer interactions, and accelerated the eventual adoption of digital. Virtual connectivity solutions deployed in response to the pandemic imposed constrains are here to stay. Our HCPs continue to be open to using digital channels for interactions with our sales and medical teams. This has increased flexibility, and productivity of customer connect while at the same time enabling quality customer interactions.

Diverse and committed workforce remain integral to the success of our Company. The Company continues to emphasise continuous learning for people development. It has made available multiple avenues and tools to learn new skills, and hone existing expertise. Apart from industry leading educational platforms, the Company also actively offers cross country immersion stints/roles to help its people develop cross culture leadership, build global networks, and replicate best practices, and learnings in various markets. The great place to work certification- 4 times in a row is a testament to our engaged and motivated workforce. The Company also ranks highly amongst inclusive, and best companies for women.

The Company is dedicated to fostering innovation and utilising strategic partnerships to provide patient-centric solutions, driving sustainable growth. Through collaborations with cutting-edge health technology player, the Company empowers healthcare professionals (HCPs) with comprehensive, beyond-the-pill solutions, specifically targeting the holistic management of chronic conditions such as - Diabetes and Cardiovascular Diseases. These solutions have witnessed a notable increase in adoption and patient enrolment.

The India Sweden Healthcare Innovation Centre (ISHIC) is a platform that aims to develop an open innovation ecosystem, allowing startups and healthcare stakeholders to collaborate and tackle present and future challenges in Indias healthcare sector. The platform supports the incubation of frugal innovation solutions, promoting affordable and accessible healthcare, in alignment with the goals of the Government of India. ISHIC is a tripartite collaborative effort involving AIIMS Delhi, AIIMS Jodhpur, and the Swedish Trade Commissioners office, with the Company serving as the knowledge partner for ISHIC. The Company facilitates key initiatives and provides guidance when needed. ISHICs flagship annual health innovation challenge has attracted numerous disruptive solutions from start-ups, focusing on addressing the burden of non-communicable diseases (NCDs) in the country.

To enhance the diagnosis for our patients, the Company has implemented initiatives and programmes specifically designed to enhance diagnosis and enable early detection. These efforts are aimed at improving the prognosis and outcomes for our patients.

Our sustainability priorities encompass improving access to diagnostics and raising disease awareness. In line with these objectives, we have our flagship Ganga Godavari Programme in collaboration with the Indian Cancer Society and the Charities Aid Foundation India. This programme focuses on facilitating early cancer screening and awareness specifically for women, particularly in areas where healthcare facilities are limited. The programme includes specialised cancer screening camps for oral, breast, and cervical cancer, community health education activities to promote awareness, and robust follow-up processes to ensure timely referral for treatment at cancer hospitals. This initiative has already made a positive impact on the lives of over 8,500 patients and will remain a top priority for the Company. Additionally, the Company is dedicated to making strides towards greener and more environmentally friendly operations.

The Company will continue to emphasise transparency and high standards of ethics in all of its operations. Patient centricity remains at the core of our actions and guides our day-to-day decision-making. The Company will remain committed to high product quality, which underpins the safety and efficacy of its medicines. The Company will maintain a strong focus on cost optimisation and controls. The Company is undertaking measures to reduce unproductive discretionary and non-customer facing spending. It also continues to develop simple and more efficient processes to encourage accountability and improve decision-making and communication.

Internal control systems and their adequacy to whom

The Company has internal control systems comprising of authority levels and powers, supervision, checks and balances, policies, procedures and internal audit. During the year, the Companys Internal Finance Control was independently tested and validated by external auditors through the AstraZeneca Financial Control Framework (FCF). The Company ensures that the internal control system is reviewed and updated on an on-going basis through FCF and the use of external management assurance services.

The Company monitors and manages risks in its interactions with third parties (Vendors) through its Third-Party Risk Management (3PRM) framework. This framework provides methodology, guidance and tools for managing third-party risks related to Anti-Bribery and Anti-Corruption, Data Privacy, Confidentiality, Trade Control and Competition, Product Communication and Product Security. Internal audits for the Financial Year 2022-23 were carried out by independent auditors, based on the audit plan approved by the Audit Committee. The plan included the audit of the depots of the Company, key processes within Operations and Marketing units including enabling functions. The Audit Committee and the Management have reviewed the recommendations of the Internal Auditors and appropriate remediation steps are being taken to implement their recommendations.

Discussion on financial performance with respect to operational performance

During the year ended March 31, 2023, the Companys total income was at 10,290.7 million as against 8,203.6 million reported in the corresponding previous year.

The total cost was at 8,547.4 million during the year as compared to 7,373.2 million in the previous year. The profit after tax was 992.9 million during the year compared to 616.0 million in the previous year.

Significant changes in Financial Ratios

During the year, the significant changes in the financial ratios of the Company, which are more than 25% as compared to the previous year are summarised below:

Financial Ratio	2022-23	2021-22	Change	Reason for change
Net Profit Ratio	10%	8%	30%	Increase is on account of higher net profit due to change in product mix
Return on Capital Employed	23%	16%	39%	Increase is on account of higher net profit due to change in product mix
Return on Equity Ratio	17%	12%	40%	Increase is on account of higher net profit due to change in product mix
Debt Service Coverage Ratio	30%	23%	30%	Increase is on account of higher net profit due to change in product mix
Debt-Equity Ratio	1.2%	1.7%	-27%	Decrease is on account of increase in equity due to higher profits during the year

Development in Human Resources/Industrial Relations

We grew and prospered by recruiting, retaining and developing talented people. We do that by being a great place to work, encouraging and rewarding innovation, entrepreneurship and high performance.

We are committed to foster a culture of lifelong learning, strengthening and evolving our capabilities, and instilling confidence to challenge convention and explore possibilities. Employees (947 as on March 31, 2023) are encouraged to take ownership of their own development and leaders are expected to spend time supporting and enabling their employees development needs. In 2022, we invested in developing a culture of lifelong learning to support the up-skilling of our people. 59% of our employees used Degreed - our global online learning platform that provides employees with access to an extensive amount of educational resources. In addition to providing improved online resources, we offer a range of different learning programmes that have been developed to provide more targeted learning opportunities through Global, Regional and Local programmes. We celebrated Lifelong learning & development in September 2022 as iDevelopment month with a series of workshops, panel discussions, degreed pathways, gamification and other events throughout the month.

We aim to create an inclusive workplace and a workforce that reflects our communities and the patients we help, delivers diversity of thought, incorporates cultural understanding, and ultimately stimulates an atmosphere where our employees feel respected and empowered. We do this by:

• Empowering Inclusive Leadership

• Fostering an environment where people "Speak their Minds"

• Building and sustaining a diverse leadership and talent pipeline

It is our endeavour to focus on employee well-being. "Celebrating YOU" is an employee engagement initiative where the focus is on Financial well-being, Mental well-being, Physical well-being. The programme had a defined wellness calendar with multiple engaging sessions and initiatives planned throughout 2022.

Our biannual employee opinion surveys help us measure employee sentiment and progress in our aim of being a great place to work.

In our most recent survey (November 2022), we continued to score highly, achieving an average result of 84% across all questions. Our response rate also reflects the high levels of engagement with 93% of all employees choosing to participate in the survey.

In 2022, we have earned the following external recognitions:

• ‘Great Place to Work certifications

• ‘Working Mother & Avtar Best Companies for Women in India (BCWI)

Cautionary Statement

Statements made in the Management Discussion and Analysis Report describing the Companys objectives, projections, estimates, and expectations may be forward-looking statements within the meaning of applicable securities laws and regulations. Actual results could differ materially from those expressed or implied. Important factors that could make a difference to the Companys operations include amongst others, economic conditions affecting demand/ supply and price conditions in the domestic and overseas markets in which it operates, changes in government regulations, tax laws, and other statutes and incidental factors.

References:

1. IMFs World Economic Outlook Database, April 2023; (Growth is based on real GDP, i.e. constant prices; size of the economy is expressed in nominal GDP - i.e. at current prices)

2. Ministry of Finance Press release on economic survey 2023

3. IBEF - Healthcare sector Industry analysis November 2022 Report

4. Ministry of Finance Press release on healthcare expenditures

5. IQVIA March 2023 TSA dataset

6. IQVIA prognosis market model September 2021

7. Ministry of Health and Family Welfare Press Release - February 2023

8. Market research: COVID-19 Oncology Impact Study:

Wave 2, IPSOS

9. Market research: Doctor engagement during COVID-19 period, April 2020, IQVIA

10. Online article-Inc - April 1,2023 By Lloyd Mathias

11. Online article - The Hindu by BINDU SHAJAN PERAPPADAN - March 2023

12. Online article - Business Today - Neetu Sharma,

February 2022

13. Online article - Bloomberg quint - Utkarsh Dev, April 2022

14. Online Article - India Business TOI - Sushmita Dubey - April 2022

15. IQVIA India Prognosis Report Q1-2020

16. International Diabetes Federation (IDF), (Idf.org, accessed April 27, 2022)

17. CKD Prevalence of 17.6% - Epidemiology and risk factors of chronic kidney disease in India - results from the SEEK,

A.K. Singh et. al,