Get an on-time start. It's my pleasure. I am Jonah Scherl from the Healthcare Investment Banking team here at Jefferies. Today we will be hearing from Chirag and Tasos from the Amneal Pharmaceuticals team, and I will hand it over to you. Thank you very much.
Thank you. Thank you.
Good morning, everyone. Great to see you. Beautiful summer day. Hopefully you guys get to go out and walk around. I think the Canadian air is also cleaned up, so the outside air is feeling good right now. Let me walk you through just a little history. Amneal was founded by my brother and I in 2002 in Paterson, New Jersey. We humble beginning, and it was simple oral solids. We got our first ANDA approved in 2005, and then we started our remarkable journey, growth journey. We were a private company. Until 2018, we were a private company and grew the company from zero to $1.2 billion in sales, became the fifth largest generics company in the United States. Very proud of what we build, still manufacturing many products in the United States, and also build new facilities in India as well to be competitive.
After the initial setup and between oral solids to, it says 2016 injectable, we built out transdermal facilities, topical facilities, liquid manufacturing. We acquired a Johnson & Johnson facility in Ireland to make respiratory products, and we put up injectable facilities as well in India, and now we are putting one in the United States. Specialty, this is the business segment that we acquired through acquisition of Impax in 2018. This is when we went public. A very fascinating story on a specialty. These are the products that mainly we use 505(b)(2) pathway, and recently our two products got approved. Crexont, which is number one therapy for Parkinson's patients today in the market. Remarkable testimonies from the patients, from the provider. Instead of taking seven, eight IR, immediate release tablets, now you take twice a day, and it keeps their symptoms manageable all day long. We're getting rave reviews.
We just launched last end of last year, and already we're about 1,500 scripts per week right now, and it's growing at a 6-7% every week. We expect Crexont to be a very big launch. We're still keeping our forecast the same. It's $300 million-$500 million peak sales, and we should get there sooner. We got great coverage as well. We also licensed out the product throughout the world except China and Japan. Our partners in Europe will be filing very shortly, and also in Canada and South America. Crexont's been such a great launch already. I already mentioned the complex products that Amneal does, ophthalmics, and I'll walk you through a little bit more. They're all categories of generics products, small molecule we have. Basically, there is no dosage form that we don't do. There are multiple device-based products.
As you know, we lead the country in EpiPen, which is our product called Adrenaclick. We have about 37% market share. This is DHE auto-injector in a specialty side, follows the familiar auto-injector format, and I'll walk you through for that as well. Healthcare distribution has been a great success. We acquired the company in 2020, and it has grown double digit, sometimes 20+% every year. We expect similar year this year. Healthcare specializes in distributing products for VA/DOD, enters into direct contract with them, saves money for them, and also distributes products in the hospitals in a unit dose, as well as they have some small general distribution. They are based out of Kentucky. That is where we have our central distribution centers as well. Biosimilars, this is, I'm sure many of you have been very curious about biosimilars.
How do our patients, but market is forming, and there is no way that market cannot form. The reason is the government knows that the savings of almost $100 billion a year can be realized if the biosimilar market forms properly. What do I mean by forms properly? Right now, it takes seven years to develop the product because of the phase three requirement. If FDA gets rid of phase three requirement, it will cut down two to three years in development. Today, it takes about $70 million-$120 million in development. If phase three requirement, which should not be there for biosimilar product, it would lower that to $40 million-$60 million. So $40 million-$60 million, four to five years. Now we can work on over the time, 30 products, 40 products.
There's 70 molecules that have no biosimilars in development right now, seven, zero. And these are over $160 billion of market value today. Competition has actually shrunk because of the investment it required. We have done a smart investment in biosimilars. So far, we have acquired the assets, like in-licensed them for the United States. Going forward, now it's the right time. We wanted to wait until everything is cleared from the FDA and the commercial perspective. Now we feel confident to go ahead and invest more because this business could be a few billion dollars business per year, not only in the United States, also globally. We are very committed and very solid on a biosimilar footprint. I'll walk you through our pipeline, what we have. Crexont, I spoke about earlier. It's doing well, and we expect to keep doing well for Crexont.
The last one, GLP-1. This is the partnership we had announced early this year, or actually late last year. This is a company called Medsera, which is now public. Their pipeline is looking really good. It's a very integrated business model we came up with. We do, it's almost a partnership. We do everything on CMC, device selections. We're constructing two sites, one to make peptides up to 4-7 tons. These are using the latest technology, so higher yield, because we will need the higher yield, lower cost for oral solids. Oral solids requires lots of tons of peptides. Injectables only requires 100 kilos, 200 kilos. Cost is not a real issue. We'll be producing both, obviously. The second site we're working on is 100 million cartridge capacity, the prefilled syringes, auto injector.
That is a partnership with Medsera. We got 20 countries licensing rights. We would be marketing the newer GLP-1, ultra long and oral solids in countries like India, certain countries in Southeast Asia, certain countries in the Middle East, Africa. Twenty emerging markets, they also need the GLP-1. This is a brilliant setup. Instead of going generics, which will have tremendous competition, and by the time generics come would be 2030-2031, we are working on a newer molecule, much improved. That is what, as it becomes a consumer product, consumer healthcare product, and cost is not going to be as high as it is now because of the competition and because of what consumers can afford and what the governments and the private insurance can afford. Huge market. I do not have to tell you about the GLP-1 market. This is a multiple growth focus for us.
We're a growth company. We're an entrepreneurial company. We look at long-term views and we invest properly because it's not the investment for one year, two years. It's like biosimilars. We've been there for seven, eight years. We'll be there for another 10 years, 20 years. It's a long term there. Biologics production leads to even ADC production and any other advancement that comes in biologics, we're ready for that. If you look at every area that grows high single digit or double digit, where Amneal goes from today's $3.2 billion in sales in next five years, 10 years is amazing growth for us. Here's what we have done in last five years. We got from $1.6 billion to $3.1 billion. You can expect us to keep thinking in this line to double or even increase our revenue profitably.
Our profits have gone up to $670 million, $650-$675 million. Leverage, which we are, or this is why I have CFO right here sitting here. We are very disciplined to reduce the leverage to below three times. Right now it is 3.9 times. You expect us to keep doing that. We generate very good cash flow. As EBITDA increases and hopefully interest rates go down, we would generate even higher cash flow. Okay, and diversity. In 2019, when we were more generics company, we were more reliant on only, if you see that blue column in 2019, it is mostly generics drugs and which a lot of competition came in 2018, 2019. You saw that blue bar fall down by 10% or so.
If you look at that core business, which is all the products that were approved prior to 2018, it has not gone away. It has not vanished. We still do about $940 million, $950 million instead of $1.3 billion. We lost, if you look at the price erosion in generics, that is what you have. We pick up volume, so it does not go away. It is essential business. The prescriptions are needed every day. The second column is all the new launches. Look how big it has become. It is going to keep becoming bigger because every year we are filing about 25-30 key products and launching them, new product launches. The third one is our specialty business, which is also growing. Even though we are losing exclusivity on Rytary, Crexont is making up more than that and will be making it up more than that.
In the last column is AvKare, which is growing double digit, close to even 20%. In the last five years, CAGR, 11%-13%. We're very proud of it. Here are different areas. We're calling the new category affordable medicines. When you combine biosimilars, small molecule generics, and injectables, we expect that to keep growing high single digit, even double digit because of biosimilars, ophthalmics launches, inhalation product launches, 505(b)(2) product launches. There are different 505(b)(2) than specialty, which we are taking. Like if you look at hospitals, what we did is potassium phosphate, one example. It has been compounded. The drug has been compounded for a long time. Compounding doesn't give you proper sterility. We made the product in sterile environment. We applied for 505(b)(2), got the approval, and immediately hospital moved 90% of those volume. They want sterile manufacturer under GMP to supply those products.
That's 505(b)(2). We have multiple areas that we are targeting, which are mostly 95% complex in nature, devices involved. This is why we, in a competitive affordable medicine segment, are still growing. Specialty, same story. I would walk you through a couple of these products, but Crexont, we expect a huge growth. Patent protection goes up to 2040. Ongentys is an adjacent therapy to Parkinson's. It's a smaller product, about $20-25 million. Rytary will lose its exclusivity at the end of July this year. So far, we don't know who's going to launch. The new approval, Brivia, it's for DHE auto-injector, and it is for the cluster headache and severe migraine headache patients, which I'll talk a little bit more about. AvKare, as I said, it's growing well. When you put all together, we're growing.
This is why you saw the CAGR of 11-13%. Here's a little journey from a humble beginning in Paterson, New Jersey. It's an American entrepreneurial story. It's the only country you can do this without any hindrance, without knowing anybody, just working hard, be committed, have great teams, right purpose, and boldly innovate new areas, invest into making transdermal drug. It's not in-licensed products. We hardly in-license products. We make most of the products by ourselves. That gives us obviously higher margins and more control on our supply chain. As you can see, we continued our, we never stop on these innovation and growth. We keep thinking about new, new things. Fortunately, the area of business we are is very vast. It fills 92% of United States prescription. We save a lot of money for the healthcare systems.
There's always a new thing coming up. Right now, you may be hearing that we do not make any antibiotics in America. Zero. Everything comes from, 90% is controlled, the key starting material that you need for antibiotics is from China. There is 20% production in Europe. About 60% comes from India. China supplies the finished products as well. We have 1% in the United States. You can imagine that if you are the White House and Congress or Department of Defense, they are very concerned. Obviously, we've been working with them for six years. We have given a proper proposal on how to do it. It can be done. We should be producing a certain portion of the total volume to have capability and capacity in case there is some emergency or our friendly countries cannot supply, or there is an issue with China's negotiation.
Who knows, right? The magnet thing. If it comes properly through the legislative channel, you expect Amneal to be one of the leaders in investing in America. We're an American company and we'll continue to hold as much manufacturing as we can. 70% of value of our manufacturing still in the United States. Volume-wise, we're 50-50. This is our global network. I'll skip this. This is back to the specialty products, which I have covered in the Crexont growth. You can see the prescription growth is amazing. This is just because the product is doing so well. Of course, we have our great sales team and marketing team. Ultimately, the product is speaking by itself. You know there are 1.1 million Parkinson's patients. About 660,000 are on CDLD treatment.
Out of that, only 40,000 are on long-acting like Rytary, which is our previous product. Now Crexont. It is about 5%-6% are on a proper therapy. We expect in the way product is working, there is no reason they should be on IR. Now we are marketing to general neuro. We have a huge social media campaign. We could get to 10% market share among the CDLD or 20%. We are not going to stop because that is the product. Crexont is the one they should be on, not on IR. This is the new product, DHE auto-injector. This is what is happening today. There are a certain number of patients that have cluster headaches, which is the worst headache of all. They bang their heads on the wall. They have to get the treatment.
The treatment is the existing couple of treatments, but this is a gold standard DHE. They go to the hospital emergency room and get IV injected and feel good. That process could take three, four hours, including the migraine patient. We took the same drug and put it in auto injector, just like GLP-1. It's a beautiful auto injector. Somehow we chose color pink. You just give it 10 seconds on the thigh and drug is delivered. It avoids all this transportation and while you have headache going to the emergencies, clinics, hospitals. We believe this is a very useful innovation. We expect a good uptake for this product. We'll keep you posted. We'll be launching in September. So far, the feedback is really good. This is the collaboration with Medsera.
Huge opportunity for us to play in a GLP-1 properly, not generics. We will do some generics later on, but that's not the priority right now. Priority is just be a solid partner with Medsera supply, put them in a proper place with a peptide supply, which is the main key. And then we have enough capacity for oral solid. And then we can make, we're building a new capacity. We have existing capacity for auto-injector, but it's not enough. They wanted to have 100 million units capacity. So we have already ordered the lines. The lead times are 12-18 months, but somehow we got in because Lily has ordered so many, Noah has ordered so many. So it's hard to get.
We're same manufacturers making these our lines, but somehow we got in and placed the order for three lines because of our prior history with those and business we were doing with those manufacturers. This is a very exciting project. Commercialization, you know, where it's an early stage, but we're evaluating markets. They're not the 20 countries that we got, including India will be the biggest one in that. That's nothing to sneeze at because that rough number right now is about 55 million patients can afford in India to be on GLP-1. They should be on GLP-1. It includes both diabetes and weight loss. They could afford to pay somewhere around $700 per year, so about $60 a month. That would be affordable. If you can do the math, it's a big market for us.
I already covered that affordable medicine segment. This is the pipeline evolution. That 96% is all complex products now. We do not work on commodity generics where you could have 10, 12, 14, 8 competitors. We have stopped working on those products for the last five years almost and revamped the company as a specialty, biosimilars, injectable, more complex products, device-based products. That is what is giving us a great growth. This is the biosimilar current pipeline. That most exciting product here is Xolair. It's only Celtrion has filed. It looks like we could be number two. Teva is working on as well. Two to three competitors in the biosimilars market is an amazing product. Even four competitors. Once it gets to five, six, seven, eight, then it becomes a so-so product. It's still good.
This is why you see the main players will be affordable medicines leaders like us, Teva, Sandoz. Yes, Amgen has a division, but they're not, that's not the company for them. You have two Korean companies, Celtrion and Samsung, big companies there. Indian one big company, Biocon. You have Kabi with mAbxience in Europe. It is pretty much Alvotech in Iceland. You're done. Alvotech is partnered with Teva. It is a seven, eight serious competitor. Would have to be vertically integrated at some point and have to work on 10-20 products at a time to become the top five in biosimilars. I bet top five globally will do somewhere between $2 billion-$5 billion in revenue in the next five years, six years, seven years. Our aim is to be in top five. It's amazing.
Production is very challenging as well. It is not like small molecule. Comparatively, small molecule commodity markets, there are 150 competitors. In complex GX small molecule, about 20-25 competitors. In this one, there would be seven to eight competitors to work on 70 molecules. Many of them are not being worked on. That is a very exciting growth for biosimilars. Commercially, what is happening is there is a buy and build category, which is slow growth. You can stay there a longer time. You need certain payer coverage, not everything. There is a PBM buying directly like Humira. You saw CVS entered into an agreement with Sandoz, and all of a sudden, they have 15-20% market share. Those are Part B products, which would be quick in market share, but lower in value.
Product like Xolair, half is buy and build and half is PBM driven. It's a classic combination. You see future product like Orencia is similar. You would have to strategize with both. Fortunately, the small molecule, they're our friends for a long time because we've been doing business with CVS and Express Scripts and Optum for years. We know how to make deals with them in advance. We're just not making deals for a couple of biosimilars, right? We have a 200-300 product portfolio for them. It's a very huge portfolio that we are offering. We will do well there. We're about 60 people right now doing sales for our existing product, Avastin, Neupogen, Neulasta. We have set the commercial team for buy and build as well. We're set for both sides to commercialize this product.
That could be, our hope is to bring another 10, 20, 30 by the time 2032, 2033 comes, plenty to work on. This is EvCare, awesome growth. They continue to grow. And VA/DOD, they do smart things, buy product directly. Unlike Medicare and Medicaid, they let the middlemen buy the products. You'd be surprised the reimbursement rate. Medicare, if they're reimbursing $1 for the generic drug, $0.80 is going to the middleman and only $0.20 coming to the manufacturer. There's a huge imbalance. VA/DOD is obviously their direct manufacturing cost. These are our latest numbers. How did we end up? The Q1, at 3.9 leverage. That's great. The debt is 2.5 now. It's going to keep coming down and EBITDA will keep going up. We're getting the credit agencies are recognizing and we're going up on our rating, which is great.
I do not have much time. These are already spoke about these key points. We have about a minute left. Took a little longer than I usually leave three or four minutes for a question. Thank you very much. Have a great day.