1. Can Sanofi provide how many units of each insulin were sold in the years listed in my spreadsheet? I would like to have this information to understand how much of the revenue came from utilization vs. price. Sanofi does not disclose the number of units it sells of its products. What I can share is that U.S. sales of Lantus in 2018 declined by 66% since 2014 (-$3.7B) with more than half of that decline (57%) resulting in a decline in net price and 43% due to a decline in volume. Further, it would be difficult to extrapolate the cost of each product. Given the complexities of the healthcare marketplace, the cost of each medicine purchased by a patient varies based on the product’s negotiated rebate with a pharmacy benefit manger and what tier that patient’s insurance chooses to cover, or not cover, the product. 2. Sanofi's revenue from insulin had increased almost every year from 2008-2015, but has declined since then — is that largely due to Lantus losing its major patent in 2015? Sanofi diabetes revenue in the U.S. has decreased due to a number of factors including increased competition, loss of formulary coverage for Lantus, and a decrease in our net price. From a competition standpoint: • Sanofi lost its insulin glargine compound patent in 2015 which resulted in Eli Lilly launching Basaglar, the first follow-on insulin glargine product, in the U.S. in 2016. While Lantus is still the most prescribed insulin, Basaglar has taken a share of the market. • Basaglar’s launch also resulted in CVS deciding to no longer cover Lantus on their formulary which reduced access of the medicine to millions of patients. • In addition to Basaglar, several other disease modifying medicines (e.g. GLP-1s, SLGT-2s, etc.) have come to market which have taken share aware not only from Lantus, but the insulin market overall. Regarding our net price: • Since 2012, the net price of Sanofi insulins has declined by 41 percent, yet patient out-of-pocket costs have continued to rise. • Over the same period, the net price of our most prescribed insulin, Lantus, has actually fallen 42 percent, while average out-of-pocket costs for patients with commercial insurance and Medicare has risen approximately 62 percent. 3. However, revenue still stands at 4.6 billion euros globally among its insulins. Rebates/negotiations from pharmacy benefit managers have played a role in some fluctuations, but how does Sanofi explain the marked increase in revenue from 2008-2015? AND 4. Even after adjusting for medical inflation, it appears these revenue figures (and list price figures) are well above what one would expect for growth. How does Sanofi describe the near doubling of insulin revenue over this time frame as it relates to outstripping medical inflation? When Lantus – our most prescribed diabetes product – was first approved in the U.S. in 2001, it transformed the way diabetes was treated. Over the subsequent years, Sanofi secured approval and launched Lantus in 106 countries across the world. In addition, the launch of our SoloStar pen delivery device in 2007 provided patients with a new way to administer their insulin instead of through a syringe and vial. All of these factors contributed to Lantus sales peaking in the U.S. in 2014 and Globally in 2015. Sanofi fully understands that the price and affordability of our products is important for patients. That is why in 2017 we announced a progressive, industry-leading pricing principles, which includes a pledge to keep annual list price increases at or below the CMS-calculated National Health Expenditure (NHE) growth rate, to help stakeholders understand our pricing decisions and to advance a more informed discussion of issues related to the pricing of medicines. You can read more about our Pricing Policy in our 2019 Pricing Report here. We are also finalizing our 2020 Pricing Report which I can share with you when it is ready in the coming weeks. 5. How much does it cost Sanofi to manufacture one unit of each type of insulin? In other words, how much does Sanofi profit from each type of insulin? Sanofi does not disclose manufacturing costs or profits of its products. 6. What is Sanofi's response to the fact that Lantus lost its main patent, yet still generates billions in revenue every year? Has Sanofi ever engaged in patent “evergreening”? Sanofi supports a robust and competitive marketplace. In fact, Eli Lilly launched the first follow-on insulin glargine pen product in the U.S. in 2016, the year after Sanofi’s insulin glargine compound patent expired. However, Sanofi also believes in defending our patented inventions which help pave the way for the discovery of new medicines and approaches to treat diseases that address unmet medical needs. Every patent represents a problem solved and we are proud of our scientific contributions that have transformed treatments for diabetes.