Good afternoon, and welcome to AstraZeneca's third quarter and nine-month results. Delighted to welcome you to the analyst call for the business today, where I'll hand over in a moment to Pascal Soriot, our new Chief Executive Officer, who will then hand on to Simon Lowth, our CFO. After which, there will be time for Q&A. Without further ado, I'll hand over to Pascal. Over to you. Welcome.
Thank you, James, and good afternoon, everyone. As I just joined AstraZeneca on October 1st, it should come as no surprise to you that I'm going to leave the presentation of our third quarter results in the capable hands of Simon. I did want to join the call and introduce myself to those of you who follow AstraZeneca. In addition to the well-known challenges that confront the pharmaceutical sector as a whole, the loss of exclusivity of several of our brands in major markets has largely defined our financial performance in the first nine months of 2012. We will continue to meet these challenges with determination and focus on delivering against our targets. In my first few months, I'm working on three priorities.
First of all, getting out and visiting with as many people as I can, particularly in R&D and commercial, and I have done a fair amount of this already in the last three weeks. Second, meet with shareholders and other stakeholders to clarify their expectations of the company and, importantly, of me in my new role. Finally, to immerse myself in the ongoing annual strategy update. On this last point, I want to be clear. I will take as much time as necessary to engage with the organization and work with the board to see this strategy update to its conclusion and not work to some arbitrary timetable. What should you expect in terms of communications?
I think it would be reasonable to expect that in addition to the 2012 financials and our normal outlook for the coming year, I will be in a position to share with you my initial high-level thinking regarding strategic priorities and general direction at our annual results conference at the end of January, with an aim to flesh that out with more granularity and detail over the following month. As I said when I joined the company, I am excited and honored to have been asked to lead AstraZeneca, and I'm really looking forward to playing my part in restoring the company to growth and to scientific leadership. Now let's turn to the third quarter results, and for that, I will hand over to our Chief Financial Officer, Simon Lowth. Simon, over to you.
Well, thank you, Pascal Soriot, and good morning, afternoon, everyone on the call. I'll focus on five topics. First, I'm going to summarize the headline numbers. I'll then go in and cover the revenue performance by region and for some selected brands. I'll then turn to the core operating performance, with an emphasis on the key drivers of operating profit and margin. I'll briefly touch on cash distributions to shareholders. Then finally, I'll close with our thoughts on guidance for the full year. On to the headline results. Total company revenue was $6.7 billion in the quarter. That's a 15% decline in constant currency terms. Revenue declined by 19% on an actual basis as a result of the negative impact of exchange rate movements.
The dominant feature of our revenue profile in the third quarter, as indeed it has been for the year to date, is the loss of exclusivity on several brands. Seroquel IR alone was down more than $850 million. The disposals of Astra Tech and Aptium Oncology accounted for 1.8 percentage points of the revenue decline. I'll discuss the regional and brand revenue performances shortly. Let's just now continue with the headline numbers. Core operating profit in the quarter was down 14% in constant currency to $2.6 billion. The decline is broadly in line with revenue. To be fair, core operating profit did benefit from the $250 million proceeds from the sale of Nexium OTC rights. Benefits from restructuring and disciplined management of operating costs are also playing their part in helping to mitigate the impact of revenue declines on earnings.
Core earnings per share in the quarter were $1.51, compared with $1.71 last year. That's an 8% decrease in constant currency terms, with the benefit from net share repurchases providing the uplift compared to the core operating profit trend. Reported EPS were $1.22. That's down 50% at constant currency compared with $2.56 last year, which of course included the $1.08 per share from the sale of Astra Tech. Those are the headlines for the third quarter. It's a broadly similar picture for the nine months in constant currency terms, with revenue down 15%, core EPS down 11%, and reported EPS down 36% versus last year. Returning to the third quarter revenue performance. When I refer to growth rates, they'll all be on a constant currency basis.
Revenue in the U.S. was down 19% compared with the third quarter last year, driven by loss of exclusivity for Seroquel IR. Excluding Seroquel IR, the rest of the portfolio increased by 6% in the quarter. Third quarter revenue includes $44 million related to our share of sales of the Amylin Diabetes portfolio following completion of the alliance expansion in August. Revenue in Western Europe was down 20% in the quarter. Loss of exclusivity on four products, Seroquel IR, Atacand, Nexium, and Merrem, accounted for 70% of the revenue decline. In addition, we faced continued headwinds from government interventions. Revenue in established rest of world was down 18%, largely due to a 43% decline in Canada as a result of generic competition for Crestor and Atacand. Revenue in emerging markets was up 6% in the quarter. Revenue increased by 23% in both China and Russia.
Brazil returned to modest growth as the impact from the loss of exclusivity for Crestor and Seroquel IR is now behind us. A weak performance in Mexico in the face of challenging market conditions continues to negatively impact our performance, reducing revenue growth in emerging markets by more than two percentage points. We hope to see some stabilizing the trend in Mexico once we pass the 12-month anniversary of the at-risk launch of generics for Crestor. This slide provides a snapshot of revenue for our key brands. You see we grew revenues for the key brands that retain market exclusivity in most of our major markets, except for Crestor, where we've had generic competition in Canada since April. Excluding Canada, worldwide sales of Crestor were up 7%. Symbicort had a good quarter on strong growth in the U.S. Seroquel XR was up 8%.
We had another strong quarter for our oncology products, Iressa and Faslodex. Saw a good performance for Onglyza, and slow but steady progress on Brilinta. As you can see at the bottom of the slide, loss of exclusivity continues to take its toll on Seroquel IR, Atacand, and Merrem. Nexium has generic competition in Western Europe, but we also had a decline this quarter in Japan, where sales in the third quarter last year was launch stocking, whereas demand so far this year has been significantly constrained by the Yakka kaikitei. Yakka kaikitei, you'll recall, is the regulation that restricts prescriptions for products in their first year on the market into Japan to just a 2-week supply, and that has hindered the launch uptake. Yakka kaikitei was lifted at the beginning of October, and we are now seeing a significant ramp-up in daily sales.
We look forward to a solid performance for Nexium in Japan going forward. There are detailed commentaries on brand performance in the press release, but I'd like to provide some additional color on 3 products, Crestor, an update on the Brilinta launch, and the performance of the diabetes franchise. First, Crestor. Crestor sales were $1.5 billion in the quarter. That's down 3% due to generic competition in Canada. As I mentioned earlier, if you exclude Canada, global sales are up 7%. Crestor sales in the U.S. were up 11% to $833 million. Total prescriptions for Crestor in the third quarter were down a bit more than 3% compared to just under 1% growth in the statin market. Now I'm going to turn to a slide that we've used in the past to look below the surface of total prescriptions and look at the dynamic components to illustrate the trends.
If we look at the yellow hashed line, which is net dynamic volume, you'll note the strong uplift beginning in June of last year following the label change for simvastatin. Part of the slight downturn this quarter is due to the strength of the prior year period. Lipitor first went generic at the end of November 2011, then multi-source generics arrived at the end of May. You can see that the dynamic trend is quite resilient before and after May 2012. I'd like to now take this same data and look at it by payer channel in order to illustrate the second driver to the quarter's TRX performance. On the left is the same dynamic data we showed earlier, but isolating the majority of retail business. That's commercial managed care and Medicare Part D. It shows the same trends as before.
Get a bump from the simvastatin label change last year. Then relative stability spanning the two LIPITOR loss of exclusivity dates. On the right is the same data for Medicaid fee-for-service channel. The half-year results, you may recall Tony Zook mentioned that we were no longer pursuing this low-margin business going forward. You can see the volume erosion beginning in July. I hope that gives you some greater insight into the volume trends for Crestor. Relative stability in the face of multi-source generic atorvastatin, a bit of weakness against the strong third quarter a year ago that was driven by the simvastatin label change. A small decline in the current quarter as a result of our decision to not chase low-margin Medicaid business. Against a low double-digit decline in total prescriptions, how did we generate 11% revenue growth in the quarter?
Well, there was a little bit of inventory movement year-over-year. Mostly this growth is driven by price. Far this year, we've been able to achieve an increase in net realized prices for Crestor. We also said that this would come under pressure once we had to contend with multiple generic atorvastatins. This is proving to be the case as we complete the contracting cycle for 2013. We look to be in a good position for formulary access in 2013, broadly similar to the high access we currently enjoy. This is coming at the expense of price. I don't want to get too far ahead of our financial guidance for next year, I think it's prudent to be thinking of net price declines for Crestor in the U.S. next year.
In the rest of world, I already mentioned the big driver. That is loss of exclusivity for Crestor in Canada. Turning to BRILINTA. Sales were $24 million in the quarter, with $15 million from Western Europe and $7 million in the U.S. In the U.S., we continue to make progress on the key launch metrics. In particular, I would note the increase in trial rates amongst interventional cardiologists, as well as the nice uptick in unrestricted access in Medicare Part D. We have recently prioritized driving trial and utilization where we're already on formulary and protocol. That is helping drive prescriptions. You can see here from the latest data that total prescriptions in the third quarter are 55% higher than in quarter two. Progress to be sure, much, much more to do.
In Europe, the picture is a continuation of the growth trends that we saw in the second quarter. As you can see here in Germany. Bear with us. In Germany and in the Nordics. There's Germany. Let's move on to the next slide. In the Nordic region and in Italy. We launched in France in July, it is still very early days, initial indications are that we're having a launch trajectory on par with other successful launches in Europe. Finally, the diabetes franchise. Revenue from Glyxar was up 42% to $84 million in the quarter. Much of this is still in the U.S., where alliance revenue was $62 million. Total prescriptions for DPP-4s in the U.S. are still growing strongly, up 21% in the quarter.
Our franchise share was 17.7% in September, that's up 1.2 percentage points since December, with ONGLYZA holding steady while Kombiglyze XR market share is up. We're now in a position to begin launching Komboglyze. That's the combination of ONGLYZA and metformin immediate release in Europe over the next several months. I'll now turn to the third quarter P&L. I'll focus here on core margins and profits. The press release does, of course, contain the statutory numbers and a detailed reconciliation to the core measures. As with sales, when I refer to growth rates, they'll all be on a constant currency basis. Core gross margin in the quarter was 81.1% of sales. That's down 10 basis points compared with the third quarter last year.
There are some moving parts below this broadly flat surface, an unfavorable product mix and higher royalties as a percentage of revenue were broadly offset by benefits from the absence of Astra Tech and a lower net expense related to the Merck arrangements. Core SG&A expense was down 12% compared with the third quarter last year. Restructuring benefits, the absence of Astra Tech costs, and continued discipline in managing costs were partially offset by new sales and marketing spend associated with the Amylin diabetes portfolio, as well as amortization of the related intangible assets. I expect the run rate for SG&A in the fourth quarter to be higher than this quarter. Core other income more than doubled in the quarter, based on the proceeds from the sale of OTC rights for Nexium to Pfizer.
For the year to date, the movement of the U.S. commercial contribution for Zomig from sales to other income is also affecting the comparison to last year. That leads to a core pre-R&D operating margin of 55.7% of revenue. That's above the top of our 48%-54% planning range, and 2.2 percentage points higher than last year. That's largely on the Nexium OTC benefit to core other income. As I said earlier, restructuring and spending discipline is doing its part on mitigating the revenue decline, but of itself would be insufficient. Core R&D investment in the quarter was $1.1 billion. That's a 3% decrease versus last year.
Benefits from the restructuring program in R&D has enabled us to show a decrease in R&D spend while absorbing the partial year effect of bringing on board the new projects from business development, such as Amgen, Ardea, Amylin, which otherwise would have exerted an upward pressure on R&D spend. Core operating profit was $2.6 billion in the quarter. That's 14% lower than last year. Core operating margin was 39.4% of revenue, 30 basis points higher than last year. Turning to our productivity program. For the nine months, we've incurred $1.2 billion of costs associated with the third phase, that was combined with the $0.3 billion charged in the fourth quarter of 2011. We're on pace to take most of the $2.1 billion in program costs by the end of this year.
We remain on track for delivering the estimated $1.6 billion in annual benefits by the end of 2014. Cash generated from operating activities was $4.1 billion for the nine months, compared with $4.8 billion in the same period last year. Lower tax payments and net improvements in working capital only partially offset the lower operating profit. For the nine months, cash outflows on externalization activities reached $4.8 billion, driven by the acquisition of Ardea and the intangible assets associated with our collaboration with Bristol-Myers Squibb on Amylin. Net cash distribution for shareholders for the nine months was $5.9 billion through net share repurchases of $2.3 billion and dividends of $3.7 billion, being the combination of the second interim from 2011 and the first interim in 2012. We announced the suspension of further share repurchases on the 1st of October. Finally, turning to guidance.
As we expected, our financial performance for the first nine months largely reflects the ongoing impact from the loss of exclusivity for several brands in key markets. That's particularly Seroquel IR, but also for Atacand, Merrem, Crestor in Canada, and Nexium in Europe. The disposals of Astra Tech and Aptium obviously also weigh on the year-on-year comparisons. In addition, we continue to face the same challenges that the whole sector is facing: government interventions, payer pressures, and the headwinds of a sluggish recovery in the global economy. Benefits from our restructuring programs and continued discipline in operating expenses have provided headroom for reinvestment in the business while also partially mitigating the impact of declining revenue on core operating profit and margin.
As I mentioned in our first quarter results call, despite continued pressures on revenues and margins, the company will continue to invest to drive future growth and value in sales and marketing to support our new products in growth markets, and in research and development to progress the value-creating assets within our portfolio and from further business development. Based on the performance to date and the outlook for the remainder of the year, the company continues to anticipate that the revenue for the full year will decline in the range of the low to mid-teens in constant currency terms. The company's core EPS target for the full year also remains unchanged in the range of $6-$6.30. For the nine months of 2012, we call that core operating profit and EPS includes one-off items totaling $0.35 per share.
That's $0.19 from the tax settlement in the second quarter, $0.16 from the sale of OTC rights for Nexium in this quarter. Currency was neutral to core EPS versus our guidance rates for the first nine months, I would remind you that the forward look is based on the January 2012 average exchange rates upon which our guidance was based. Takes no account of the likelihood that average exchange rates for the remainder of the year may differ materially from the January 2012 average. Let's now move on to the Q&A session. For those of you who are taking part via the telephone, you press star 1 on your keypad to alert the operator that you wish to ask a question. For those listening via the webcast, you'll find there's a text box on the webcast page to type in your question.
We'll try and answer as many questions as possible. With that, can we have the first question, please, operator?
The line for Sachin Jain is now open.
Hi, it's Sachin Jain from Bank of America. A couple of questions. Pascal, appreciate it's early days, but I just had a couple of high-level questions for you. On capital allocation, is there a timeframe at which you will review the buyback? Clearly, you've stopped it for the time being to retain flexibility, or are you fundamentally against buybacks as a use of cash? Related on M&A, prior management has commented that they weren't interested in large-scale M&A the size of MedImmune or above. Do you retain that view, or do you want to keep a more flexible stance? There are quotes on the wires from the media call this morning that a pipeline review outcome is expected in the first quarter. Could you just provide the context of that? Astra has been through many pipeline reviews in recent years. Is there anything different about this one?
In small group meetings with investors, I think in recent weeks you've been focusing on BRILINTA and Bydureon trajectory as something that you would focus on. Just a brief overview of your assessment of launch trajectory to date and what you think is needed from here. Finally, a very quick question for Simon. I wonder if you could frame the Crestor price declines into next year. Is something around the mid-single digits reasonable to think about? Thank you very much.
I counted to five on that. I think we said in the Q2 call we'll try and limit it to two going forward. I know I might disappoint Peter Verdult, but it gives you a bit of a prep for that. Pascal, if you want to start.
Yes, thanks, James. Thanks, Sachin. Great questions. I'll try to be fast, so we give everybody else a chance to ask questions as well. Capital allocation, I'm definitely not fundamentally against buybacks. The decision we made together with Simon and the board was really to give us flexibility, and of course, we might revisit that if we don't find better use of our cash. I have no fundamental objection to buybacks per se. Acquisitions, I would like to retain flexibility. Essentially, we are doing a review of what we could do, and I want to be open-minded and basically look at the options that are open to us. I don't have much more that I can say at this point. The pipeline.
The context in that is that we, and when I say we, it means the executive team here at AstraZeneca and I, we identified a series of critical questions which I want to engage the organization around to develop plans, to find solutions to address, one of which is the mid- to late-stage pipeline. What I want to do here is look at whether there are assets that could be accelerated and others that could be deprioritized. We have got a number of assets in the pipeline, and I think there are further choices we can make. I am totally aware of the fact that some reviews have taken place in the past, and this is all good work. I don't expect massive changes, but I believe we can make some changes, and I can't comment more on those changes at this point, as you can imagine.
There's a team looking at this, and we have reviews planned end of November, early December, and in the meantime, I'm visiting R&D sites and talking to people. So we will have some outcome of those discussions by Q1. BRILINTA. You probably remember that I was involved in the commercialization of Plavix for a number of years in the U.S., and I was working in collaboration with BMS at the time, and it was before joining Roche. I've looked at this, and the market, of course, has changed, and things are no longer what they were seven years ago, of course. I accept all of that. I've looked at the products, and I think BRILINTA, quite frankly, has a lot going for it. It is a better product in the class, and I think we can do better with this product. We can do well.
I also think AstraZeneca is a great commercial organization. To be frank, we didn't show our best game with BRILINTA, but we are actually taking corrective measures, and my belief, actually, not only my hope, my belief is we can do quite well, and this product has potential. That's also one of the questions that we are working on right now. There's an entire work stream looking at BRILINTA and looking at how do we accelerate the growth of this product, which is really a company transforming product, quite frankly, if we succeed with it. I think I've covered all your questions.
Bydureon? Diabetes and Bydureon.
Diabetes, I think there are three. Let me back up a little bit. At AstraZeneca, we are facing a number of challenges, and of course, the bigger challenges are the patent expiries. I also believe we have a number of growth platforms, and the three biggest ones, in my opinion, are BRILINTA, diabetes, and the emerging markets. Clearly, what I want to do here is look at how do we actually turbo boost the growth of those three platforms. There are others. I would say respiratory as a franchise is something we can strengthen and has potential. I think Japan also is good. Then I think in the meantime, the biologics platform is really a good growth platform potentially. We have quite a few cards in our hands, short and midterm. Diabetes is, of course, a critical one.
We have to work with our partners, BMS, to see how do we build this franchise to establish ourselves as a leader in diabetes. Bydureon, of course, is one of those. Now, I'm sorry if I can't be very specific. You know that I like to talk about products and data, these are early days, I'm engaging in this review process, I don't want to comment too much at this point.
Thanks. Sachin, just your final question on Crestor. It's really much too premature to go beyond just some initial thoughts I shared in my opening remarks. I suggested it'd be prudent to think of net price declines for Crestor. Exactly what the price outcome will be is going to be a function of the concluding process of discussions and negotiations with our customers, but also mix effects and so forth into next year. I think that's probably, Sachin, something we should come back to at Q1, and you'll have some evidence from the run rates in the first part of the year.
Thank you for taking all those questions.
Thank you.
We've got, I think, number 2. Peter, you're number 2 on the call with two questions, we hope.
Two questions, yeah. Peter Verdult, Morgan Stanley, one for Pascal, one for Simon. Apologies if some of this has already been addressed, I had to deal with another set of results when the call started. Pascal, just coming back to capital allocation, I realize it's too early to talk about your new strategy, I would like to get a sense of how you're thinking about the progressive dividend policy that's in place going forward. Are you considering all options, when it comes to planning, do you envisage this remaining intact? For Simon, just on the cost trends. The ability to manage the cost base has surprised the market positively. It seems a point of suggests to me upside risks current EPS guidance for this year.
I'm just trying to get a sense as to what swing factors you're considering in Q4 that prevented guidance from being raised, and whether there are any phasing issues that we need to consider, be it on R&D or SG&A that helped in Q3.
Maybe let me quickly address the first one, Peter. Thanks for that question. I know it's in everybody's mind, so it's an important one to address. Let me just reconfirm, I would say, that our dividend policy is very stable, and I'd just like to restate what we've said before. We'll stick to our stable to improving dividend payout, the dividend policy. I would not want to say here a written flexibility. I think we are committed to this dividend policy.
Peter, to your questions about cost trends. Good question. Probably, sort of looking at the SG&A run rate, which I think did come in a little bit lower than, I think, the consensus we collate has come up with. Actually, if you look at our run rate over the first three quarters, Peter, it's been pretty steady. It does reflect the combination of actions we took at the end of last year and the beginning of this year around our above-market sales and marketing, our channel mix, but also our G&A cost base. We have seen a pretty steady reduction in the course of this year, quarter on quarter. As I mentioned in my remarks, the fourth quarter is typically quite a busy year for us, as quite a lot of investment activity does tend to take place, and this year is no exception.
We're pleased, actually, with some signs of strong recovery in a number of emerging markets. You saw China, Russia with strong growth. We continue to look hard, I think Pascal mentioned this, at our growth platforms. We want to ensure that we're investing fully behind those. We do expect to see the SG&A rate up in the fourth quarter relative to the third. That, I think, is one of the factors that weighed on our decision to retain our guidance range for this year. Perhaps, if I may take it off you just to elaborate upon that, because investment in the fourth quarter is one factor that will drive the outcome in the fourth quarter. The second is it's been a dynamic, some would say volatile year.
We've had government pricing interventions, generic activity, there does remain perhaps more uncertainty on those fronts than we've seen in prior years, and that's also weighed on our decision to keep the range. Obviously, Peter, you'll recall, last year, we had a number of intangible impairments in the final quarter. With a portfolio which is more externalized, we do therefore run with more potential for intangible impairment decisions. It's those factors which have led us to leave our earnings in the range of $6-$6.30. We can see scenarios where we might be the upper end of that, but equally, we can see scenarios that we could be at the lower end of that. Peter, I hope that helps you.
Yeah. Very helpful. Thanks.
Good. Next question, Tim Anderson at Sanford C. Bernstein. Tim.
Thank you. If I could just go back to one of the earlier questions, just so I understand, Pascal, your view on M&A. Are you kind of suggesting that all options are on the table at this point? Within that same line of questioning, your preliminary views on drug company diversification. Roche was pretty much a pure play. AstraZeneca is, too, and I'm wondering if you think pure play is the right way to go. Second question, you talked about restoring AstraZeneca's scientific leadership. To me, that means rebuilding R&D, which suggests that you could see R&D costs increase. I'm wondering if you can talk about whether it's possible to rebuild R&D without increasing investment and kind of what, in absolute terms, R&D investment at AstraZeneca might look like going forward.
Thanks, Tim. The first question regarding M&A. At this point, we really want to be completely open-minded and look at all the options that we have. I can't be more specific than this, quite frankly, but I don't have any restrictive view. We've discussed it here, and everybody's on the same page. We will look at all options that make sense to create value for this company. In term of diversification and pure versus pure play, I'm a believer that the core of this company is innovation. I'm a believer that we are here to actually discover and develop medicines that are differentiated and help patients. I'm a supporter of the previous choices that were made to not be in pure generics or in OTC and diversifying those fields, and we will confirm that, and I'm completely aligned with this.
I think we can diversify within our core focus of innovation, and if we do this, we would do it around businesses that would be innovation driven and would have synergies together with our core pharmaceutical innovative business. Essentially, we are really focused on innovation. Finally, R&D rebuild. When I talk about scientific leadership, it doesn't mean spending more money. Scientific leadership is, I think you could call it productivity. You're not going to be a scientific leader because you spend lots of money. You're going to be a scientific leader because you're productive, because you have the best scientists in the world, and you have the best science in the world, and you come up with products that everybody else would like to have.
My priority would be to make sure that we actually build an R&D organization or continue building an R&D organization that is one of the best in the industry. I really have productivity in mind. It may well be that over time, we have to increase R&D. Of course, you have to be open to all possibilities, but I will not do this. I will only do that when I'm sure that our productivity is good, and I think Base Camp One is productivity-focused. There's no doubt about that.
Yeah. I guess if I just look at who are commonly viewed as the scientific leaders in pharma, they tend to outspend their peers on R&D as a % of sales, which, that's why I asked the question. Thank you for the answer.
Yeah. No, it's a good point. Outspending your peers is a good thing if you produce a lot of value out of what you spend. In the end, the debate is not how much do you spend, it's how much do you produce out of what you spend. If you're able to produce a lot out of what you spend and create value in the long run, everybody should be happy, starting with our shareholders, and certainly our customers should be happy. I don't think we are here yet. I think, really, our focus in the near term, is really about productivity.
Thank you.
Great, Tim, thanks. Alexandra, Alex, you're next up.
Thank you. Alexandra Horvath from J.P. Morgan. A lot of questions have already been asked. I have just a couple of small questions on pricing, actually. In the U.S., a lot of products are running significantly ahead of their prescription run rate, and you've already explained Crestor. I assume there is a similar effect with Nexium, average realized net prices have increased, but we do not have a change such as multi-source generics, which you already have had for some time. Are these average net price increases for Nexium a bit more sustainable? Also on, similar question, but basically, if you look at SEROQUEL XR, the price increase which you have taken, which was quite a massive one, seems to just stick. Same thing for Symbicort actually shows to grow even stronger than pricing and prescriptions combined, is there some stocking in there?
In Europe, the decline was the same as in the second quarter, despite the fact it didn't have the supply issues. Does that mean pricing has got worse, or is this just the incremental effect from our accounts, which we're seeing this quarter also impacting the European performance?
Okay, Alex, that's great. We're going to count those as all pricing questions and they're for one question. Let me deal firstly with Europe. I think you answered your own question. We've had essentially a greater cumulative effect from patent expiration. The pricing dynamic through the year has not been intensified in the third quarter. We've faced a very demanding pricing environment all year. It's not abated, it's not intensified. For those on the call, you know we've talked in the past about European pricing facing low to mid-single digit, where we're comfortably in the mid-digit zone this year. Coming back to your U.S. questions, let me just run through them very quickly. Start with Symbicort. We did see, as you'll have seen, good growth in the quarter and indeed year to date on Symbicort in the U.S.
The majority of that is actually coming from volume growth, not price. The slightly confounding factor, Alex, is that the script trends, which we cited of 12%, excludes some quite healthy growth amongst the Veterans Administration part of our business. We've had good growth in that part of our business, which has given us an underlying volume growth in excess of the retail TRX growth. I hope that helps you on Symbicort. It's essentially a market share volume benefit, reflects the strength of that brand and the commercial performance behind it. If you go to SEROQUEL XR, that indeed is a brand that has benefited from strong net pricing power, both in the quarter and year to date, reflects the fact that it brings a strong differentiated proposition to certain patient segments.
As you've seen, the share of SEROQUEL XR, we saw a little bit of a dip in switches to IR right at the time of genericization. Actually, since then, we haven't experienced that, and I think that's further testament to the fact that it's well-positioned separately to Seroquel IR in the marketplace and can sustain that price premium as a consequence. On Nexium, actually, this is mainly a mix effect, and we've just had a business moving towards a higher price realization segment. It's predominantly a mix effect. Hope that gives you what you needed, and thanks for the question. We'll return now to Mattias Häggblom at Danske Markets. Mattias.
Good afternoon. Thanks so much. Mattias Häggblom, Danske Markets. Two questions, please. Both for Pascal, I'm afraid. Firstly, you've known AstraZeneca as a competitor for many years, but now you have come to know it as your company, for less than one month, though. What, during this very brief period of time, has surprised you the most? Secondly, one, it's obviously too early for detailed strategy thoughts. I'd be interested in hearing your general thoughts on true acquisitions versus in-licensing an asset, how to best balance those, and what drives the preference for each of those decisions, if you, as a buyer, can choose.
Thanks, Mattias. Actually, AstraZeneca was never a big competitor of Roche. We, the two companies, operated in different fields. In oncology, of course, there is a clear competition with Iressa and Tarceva, but in the grand scheme of things, there was limited competition. Never mind, this was not your question. Your question was about what surprised me the most. I must say, what really excited me, and it was also a little bit of a surprise when you consider the change that this organization has gone through and the challenges that it has gone through over the last couple of years and the fact that we all know there are still challenges ahead of us. What is really impressive is the incredible level of commitment and enthusiasm that exists here. It's really, truly a great company with a great culture. I knew that before.
Well, I thought I knew that before coming here because I had been told by a number of people, but I saw it with my own eyes. The level of commitment and willingness of people to do well and do the right thing is really incredible. There's a strong base to work from. There are also quite a number of challenges, and certainly a lot of things we will have to address and change over the next few months if we want to turn ourselves around. In terms of acquisitions versus pure product business development opportunities, quite frankly, I don't have any religion here. Of course, the simpler approach and where there is a lot more opportunities is in the products area, and that's certainly where the bulk of our efforts go. Sometimes products are companies. If you look at Amylin, it certainly was a product/company opportunity.
I don't have any specific religion. Our effort is very much on products, of course, but as I said earlier, we'll look at all the opportunities there. Since I talk about Amylin, by the way, I was trying to be a bit fast a bit earlier answering Sachin's question, but in diabetes, we just got approval for Forxiga in Europe.
We're waiting.
We're waiting for approval, sorry, for Forxiga in Europe, we should hopefully get that very soon. In the U.S., we've just started promoting, sorry, Amylin Bydureon with both sales forces, BMS and AstraZeneca, since about, I think, two weeks now. There's a lot of growth potential ahead of us in the diabetes franchising.
Great. Well, thanks. Move on then to Nicolas Guillon at Exane.
Yes. Thanks very much for taking my question. Actually, I have three quick ones, please. Two first one emerging market. First, talking about China. Another strong quarter. We saw that 23%. This led China to now represent more than one-fourth of your total emerging market sales. Don't you think there is a risk of being overly exposed to one country? Secondly, talking about your strategy in emerging market. You have no mainstream healthcare offer, such as commodity generics or OTC, nor a premium cancer portfolio like the one you enjoy at Roche. Therefore, do you think that the strategy that you had about flexible pricing or dual branding could be also applicable at Astra? My last question is just, what is life like for a French citizen running a British large cap? Thank you very much.
I think those are probably, the latter one, Pascal, I think is probably for you.
Oh, yeah.
Why don't you start with that and I'll-
Okay. That's a good question, Nicolas. The thing is that I'm still working on the accent, but I see myself as an adopted Australian citizen, so I don't know that I can answer that French question. Life in London is great. It's one of the great cities in the world because it's a very diverse city, and it's a wet city, and everybody here has been extremely welcoming. It's very good. Again, I don't see myself as a French or anything else for that matter. I've worked around the world in many different geographies, and my family lives in Australia, so that's how I see myself. That's important because that's how I would like to see the company develop, a truly international global company. Which we are today, but we definitely need to build on that.
Let me just say a few words about your questions regarding the emerging markets. I think that for sure, China is big. Often when we talk about the emerging markets, really, China has an enormous impact for those markets for any company. I don't think we can say we are unbalanced. We have a strong presence in China. We have a strong presence in many other countries. Our portfolio, I think the important point is that our portfolio, quite frankly, is the ideal portfolio for those countries. Because if you really think about those markets, in many ways, they are where Europe was 20, 25 years ago, and many of the unmet needs are in the area of infection, cardiovascular medicine, hypertension, diabetes, lipid disorders, et cetera. Respiratory medicine, respiratory disorders are growing in importance, and that's exactly the portfolio of products that AstraZeneca has.
I think there is enormous potential there. The challenge for us is in some parts of China, for instance, like in some countries in those emerging market regions, the challenge is really to ensure that patients can access our products, because sometimes they are a bit too expensive. Even a product like Crestor is sometimes too expensive for some parts of China. The challenge for us is really to look at how do we get access, and how do we find strategies that will enable access. In fact, that's one of the work streams that I have launched looking at this, how do we leverage our full pipeline? Quite frankly, this will be my first priority before we explore any other options, looking at additional products, because I really believe we have the best portfolio for those markets.
Great. Nicolas, thanks for the questions. Let me now move on to Jo Walton, Credit Suisse. Jo.
About some of the emerging markets outside of China, and just your perception on whether the recovery that we've seen reflects strength of AstraZeneca's products or strength of the market, and just your perception on growth rates for emerging markets. A specific one of how you're going to be positioning sales forces, both DPP-4s and the GLPs. Do you find that that's going to be a difficult message to sell with both products?
If you want to answer.
Shall I start, Pascal, and then hand over to you? Jo, I think we missed the first part of your question, but I think it was sort of an overall perspective on forward growth in emerging markets.
That is correct, yes.
On China. I think we've always felt that the fundamentals, while the emerging market is a pretty heterogeneous group, they're tied together with some strong underlying fundamentals of demographics, economic growth, more people living longer, higher aspirations for healthcare, and with more money, publicly or privately. We do believe those fundamentals remain very firmly in place. We recognize that the flip side of continuing strong demand is increasingly payers, whether they're public or private, needing to manage pricing in order to contain the revenue growth associated or the cost growth associated with that. We've seen an impact of pricing and access interventions in emerging markets, similar to those that we've seen in other parts of the world. Overall, we think the fundamentals remain very strong.
I think, as Pascal just said, we have long believed that our portfolio is very well aligned to emerging market needs. This year, our growth rates have been depressed by a couple of factors. Firstly, loss of exclusivity on some brands, particularly actually Brazil and Mexico, in the final part of last year. Secondly, the supply chain issues. We like to feel that as we move into Q3 and Q4, we're starting to get those effects behind us. Clearly, there's a lot of work to do to realize the potential of those markets, and that's going to be about making sure we've got the right product portfolio at the right level of investment. The final of your other questions quickly, and then perhaps hand over to Pascal for further comments.
On the diabetes portfolio, we see this as obviously a very large disease area growing strongly. It's a progressive disease, it's a disease of stratified patient populations, and therefore, a role for different medications to play over time, and indeed multiple medications for individual patients. There's a role for DPP-4s, we believe. There's a role for SGLT2s, and certainly a role, and a growing role for GLPs. Exactly how they're positioned will depend to an extent on the practices in individual markets. That's obviously the sorts of issues we're working through as we progressively launch the products. Pascal, that's sort of to some extent where we've come from, and be interested to hear you to add to that.
Thanks, Simon. Yeah, Jo, I think first of all, in the emerging markets, we have strong growth in not only China, in Russia we do well, in a number of Latin American markets, in the Middle East. It is clear that with the kind of products we have, some of the issues we have to deal with are price reductions. The volume upside is extremely large. When you consider China, I think always people forget the scale of China and the fact that the economy is developing so rapidly that a lot of patients who historically could not have access to medicines are now getting access to medicines. The volume uplift is enormous, and we just have to keep managing, of course, the price pressures.
In term of diabetes, this is, as I said, one of the growth platform in my mind, and it's sort of obvious, but it is clear we have to manage three products. That's one of the things we are discussing with our partners at BMS. To be honest, in the short term, we are in a relatively simple situation. We have in the U.S. ONGLYZA and Bydureon, and quite frankly, different physicians will see different use of those products. As Simon was saying, this is a progressive disease, number one. Number two, as you know, most patients end up with combination therapy. Today we only have two products.
You could argue, you could start with Bydureon as a first line, but most physicians will start with an oral agent. You use ONGLYZA, and then as you progress, you might use Bydureon in combination or alone, and before insulin or in combination with insulin. Here the situation is relatively simple. It will become more complicated as we prepare to launch Forxiga, because then you have two oral agents and one injectable, the GLP-1. Again, there is a place for all those products because of the multiplicity of combination therapies. It may be that we have to allocate products to different sales forces to make sure we fully maximize them. We are looking into this and we'll do what it takes to get to the full potential of every single of those products.
Thank you.
Thanks, Jo. Moving on now to Lars Havering at Citi. Mark.
Thank you. Just one very quick question, just a top-down one on R&D. Do you think the company is positioned appropriately from a geographic perspective to capture as much innovation as possible? Thank you.
Yeah, Lars, thanks for the question. I get that question often. To be honest, I think today the science is spread around the world. You have to be connected to scientists in many different places. It's not because you live next to a reputable scientific center that you do better necessarily. It's more a question of mindset. Having said that, your question is a very relevant one. I can't answer that one today. To me, what is important and what I'm going to try and do, what I will do over the next three months is get a good understanding of where do we have distinctive science, where do we have a chance to be differentiated from a scientific viewpoint? Where do we have products that we could accelerate? Both the discovery and the development part.
As a result, we'll have to conclude what does this mean from a footprint viewpoint. It is clear that if you are in Boston or if you are in Gaithersburg for our MedImmune colleagues close to NIH, close to Johns Hopkins, if you're in Boston, if you're in Cambridge, you're suddenly very connected to science and this is a dimension to consider. It's not the only one. I can't answer your question at this point. I've started visiting those sites. We have a number of processes in place to review the pipeline, review the science, and by Q1 next year, I'll be in a better place to comment.
Okay, thanks.
Great, Lars. Thanks for the question. I think, just looking here, James, we've got probably time for one more question. Lars Havering from SEB, you have the final slot. Lars, over to you.
Thank you. Could you just please update on the development program for the prefilled pen, the weekly version of Bydureon? If you could maybe comment on the expectations on full-year cash flow, how that would realign with your core EPS guidance.
Well, on the question of the pen, I think the timetable is looking, I think from memory, mid-2013 filing is the current plan, Lars. In terms of cash flow, I think I'm not quite sure what the question is. Is there any further guidance you're expecting or looking to maybe give on cash flow for the full year? Is that?
Yes. We've seen the 15% decrease in cash flow for the first nine months over the same period last year. If we could expect a similar year-over-year performance for the full-year operating cash flow.
Okay, the cash flow from operations, I think you'll need to consider that in the context of the guidance we've provided in our core EPS and therefore the implications for Q4 in operating profit terms and the range around it. As I stressed, we've retained that wide range around it. There's no other discontinuities that I would call out on the other elements of the cash flow at this stage. Probably the only other possible thing to bear in mind is that we have benefited from some one-offs. I mentioned the Nexium OTC, there's been a little bit of lumpiness in the cash flow, I would broadly follow what you're looking at in an earnings line.
Okay. Thank you.
That's it, I think, Simon, in terms of Q&A. Don't know if you want to just wrap up the call.
Will indeed. Thank you very much indeed. Thank you to all of you for joining the call today. Let me just quickly sort of few final closing remarks. I think we expected this year would be a challenging year for AstraZeneca, it has proven. We've had loss of exclusivity on some key products, particularly Seroquel IR, that really has driven that 15% decline in revenues for the year to date. We've kept our focus on management of our cost base through restructuring and sort of disciplined management of cost through the business. That, combined with the proceeds realized on the sale of OTC rights for Nexium, those have helped us mitigate the impact on core operating profit and also allowed us to step up investment in a number of areas, for example, the externalization efforts.
Where we do have exclusivity, the brands have performed well. We pulled out a few of those examples on the call. Symbicort, Iressa, ONGLYZA, and good resilience in Crestor as well. Overall, we're able to confirm our core EPS guidance range for this year. With that, what I'd like to do is conclude our call. Thank Pascal and welcome to his first analyst call, and thank all of you for joining and look forward to the next call.
Thank you so much.
That does conclude our conference for today. Thank you all for participating. You may now disconnect.