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ANNUAL REPORT 2010

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OUR MISSION
We want to discover, develop and successfully market innovative products to prevent and cure diseases, to ease suffering and to enhance the quality of life. We also want to provide a shareholder return that reflects outstanding performance and to adequately reward those who invest ideas and work in our company.

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CONTENTS

GROUP REVIEW

Financial Highlights News in 2010 Letter from Daniel Vasella Interview with Joseph Jimenez

4 5 7 15 19 23 35 39 45 51 57 61 67 73 78 83 85 90 101 111 112

HEALTHCARE PORTFOLIO

Contents Pharmaceuticals Novartis Institutes for BioMedical Research Vaccines and Diagnostics Sandoz Consumer Health

CORPORATE CITIZENSHIP

Contents Commitment to Patients Commitment to People and Communities Commitment to the Environment Commitment to Ethical Business Conduct Independent Assurance Report

CORPORATE GOVERNANCE Contents Our Board of Directors Our Management COMPENSATION REPORT Contents Compensation Report NOVARTIS GROUP FINANCIAL REPORT

Contents Operating and Financial Review Equity Strategy Novartis Group Consolidated Financial Statements Financial Statements of Novartis AG Annual Report Photography Key Dates 2011, Contact Information and Forward-Looking Statements

131 134 177 180 252 268 270

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GROUP REVIEW
Novartis provides healthcare solutions that address the evolving needs of patients and societies worldwide. We offer a portfolio focused on broad areas of healthcare to best meet these needs: innovative prescription medicines, cost-saving generic pharmaceuticals, preventive vaccines and diagnostic tools, and consumer health products.

FINANCIAL HIGHLIGHTS
KEY FIGURES (In USD millions, unless indicated otherwise) NET SALES, OPERATING INCOME, NET INCOME, CORE OPERATING INCOME AND CORE NET INCOME 4 (Index: 2005 = 100%)
2010 2009 200

Net sales Operating income Return on net sales (%) Net income Basic earnings per share 1 (USD) Core 2 Operating income Return on core net sales (%) Net income Basic earnings per share 1 (USD) Research & Development As a % of net sales Number of associates (FTE) 3 Return on average equity (%) Free cash flow

50 624 11 526 22.8 9 969 4.28 14 006 27.7 12 029 5.15 8 080 16.0 119 418 15.7 7 860

44 267 9 982 22.5 8 454 3.70
125 150 175

11 437 25.8 10 267 4.50 7 287 16.5 99 834 15.7 5 505
100 2005 2006 2007 2008 2009 2010

Net sales Operating income Net income Core operating income Core net income

SHARE INFORMATION
2010 2009

2010 NET SALES BY REGION (% and in USD millions) 54.95 58.95 2.20 55 56.50 54.43 2.10 53 United States Europe Asia/Africa/Australasia Canada and Latin America Alcon, Inc. 7 Total 31 37 18 9 5 15 863 18 558 9 416 4 361 2 426 50 624

Share price at year-end (CHF) ADS price at year-end (USD) Dividend 5 (CHF) Pay-out ratio 6

2010 average number of shares outstanding: 2 285.7 million (2009: 2 267.9 million) Core results for operating income, net income, earnings per share (EPS) and R&D eliminate the impact of acquisition-related factors and other significant exceptional items. These adjustments are explained in detail starting on page 143. 3 Full-time equivalent positions at year-end, including 16 700 Alcon associates in 2010
1 2

To ease comparability, all figures in this chart for the years 2005 to 2007 exclude the Consumer Health Divison Nutrition operations divested in 2007 Dividend payment for 2010: proposal to 2011 Annual General Meeting 6 Pay-out ratio is calculated based on net income attributable to shareholders of Novartis AG 7 Regional data for Alcon, Inc. is not available
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NEWS IN 2010
PERFORMANCE Recently launched products drive strong top-line growth across broad healthcare portfolio. Net sales rise 14% (+14% in constant currencies) to USD 50.6 billion driven by strong growth in all businesses, including USD 2.4 billion from consolidation of Alcon. Operating income advances 15% to USD 11.5 billion on business expansion and productivity improvements. Core operating income rises 22% to USD 14.0 billion. Net income up 18% and core net income up 17% to USD 10.0 billion and USD 12.0 billion, respectively. PRODUCTS Products launched since 2007 account for 21% of net sales, as more than 13 major pharmaceutical regulatory approvals in 2010 in the US, Europe and Japan continue to rejuvenate the portfolio. Approvals include Gilenya (multiple sclerosis) in the US, new indications for Lucentis (treatment of diabetic macular edema) in the EU and also for Tasigna (newly diagnosed CML) in the US, EU and Japan. Other key approvals include new vaccine Menveo (meningococcal disease) in the US and EU as well as US approval for generic enoxaparin. Industry-leading pharmaceutical pipeline with 147 projects in development and 16 major submissions in 2010 in the US, EU and Japan including ACZ885 in gout in the EU, Lucentis in retinal vein occlusion in the EU, SOM230 in Cushing’s disease in the EU, and Afinitor in advanced neuroendocrine tumors in the EU and the US. Early pipeline in Vaccines progresses rapidly as Bexsero, a breakthrough meningococcal B vaccine, is filed for EU approval. Significant investment focusing on areas of greatest patient need and high scientific promise at the Novartis Institutes for BioMedical Research aims to discover novel therapies. Biologics account for an increasing proportion of the exploratory pipeline. Strengthening our focused portfolio, Novartis completes the purchase from Nestlé S.A. of majority control of Alcon, Inc., the world’s leading eye care company and reaches merger agreement with Alcon, Inc., to acquire all outstanding publicly held shares. Sandoz acquires Oriel Therapeutics, gaining rights to a portfolio of generic respiratory products and in Vaccines and Diagnostics the acquisition of a majority holding in Zhejiang Tianyuan nears completion. Engaging with society to improve healthcare is integral to how Novartis operates. Accessto-medicine programs for those in need reach 85 million patients in 2010 and, together with our R&D institutes for diseases in developing countries, totaled USD 1.5 billion or 3% of net sales. 14th consecutive dividend increase with 5% raise proposed for 2010 to CHF 2.20 per share (2009: CHF 2.10 per share), a dividend yield of 4.0%. Group leadership strengthened as Joseph Jimenez is promoted to CEO with Daniel Vasella continuing as Chairman of the Board of Directors. David Epstein replaces Mr. Jimenez as Division Head, Pharmaceuticals, and Jonathan Symonds succeeds Raymund Breu as Chief Financial Officer.

PIPELINE

RESEARCH

PORTFOLIO

CORPORATE CITIZENSHIP

DIVIDEND

LEADERSHIP

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DEAR SHAREHOLDER

Let me summarize the results achieved in the last year: – Net sales grew 14% (+14% in constant currencies) to USD 50.6 billion.

I am pleased to report record results for 2010, both in sales and in profits. The past year was shaped by repercussions from the global financial crisis and considerable currency turbulence. Despite these difficult conditions, Novartis was very successful. Our well-balanced business portfolio and long-term strategy focused on innovation once more have proved to be robust and appropriate for the future. The ability to repeatedly launch new and better products, and thus establish market positions, is decisive for the sustainability of our success. We demonstrated both of these core competencies last year. New and recently launched products were a key growth driver in 2010 and hold more promise for the future. Joe Jimenez, our new CEO since February 2010, has successfully continued this strategy and launched new initiatives to improve productivity. His nomination has proven to be right both in terms of timing and in terms of the division of labor between the Chairman and the CEO. In addition, since August 2010, Novartis has held majority ownership of Alcon, Inc., the global leader in eye care. This year we will propose to you a merger that will fully integrate Alcon into Novartis. While this will result in an increase of the Novartis share capital, the merger not only provides you with a new growth platform but also is expected to allow for the realization of substantial synergies between the two organizations.

– Operating income rose by 15% (+17% in constant currencies) to USD 11.5 billion. – Net income climbed 18% (+20% in constant currencies) to USD 10.0 billion, faster than operating income. – Free cash flow before dividends reached USD 12.3 billion. – Alcon was fully consolidated from August 25 when we completed the purchase of an additional 52% stake in the eye care leader. From that date, Alcon net sales totaled USD 2.4 billion; operating income amounted to USD 323 million; and core operating income was USD 852 million. The Pharmaceuticals Division (USD 30.6 billion, +6% in constant currencies) achieved strong volume growth of eight percentage points. Sales of recently launched products were USD 6.6 billion accounting for 21% of the division’s sales, a significant increase from 16% the previous year. This enabled Novartis to grow significantly faster than the industry average. One of the most important regulatory approvals was for Gilenya, the first oral medication for first-line treatment of relapsing forms of multiple sclerosis (MS), the most common forms of the disease. Currently 2.1 million people worldwide suffer from MS, a lifelong, progressive and disabling disease. Compared to the standard of care, Gilenya represents a major break-

Daniel Vasella, M.D.

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through by significantly reducing relapses and improving patients’ quality of life. Our oncology portfolio expanded further during 2010. Longer-term studies demonstrated Tasigna continues to surpass the highly effective Gleevec/Glivec in patients with newly diagnosed Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML), a form of blood cancer. Tasigna was approved in the US, the EU, Japan and Switzerland for treatment of patients with newly diagnosed Ph+CML. The sharp rise in Vaccines and Diagnostics Division net sales to USD 2.9 billion (+25% in constant currencies) resulted mainly from sales of influenza A (H1N1) pandemic vaccines, which totaled USD 1.3 billion during the first half of the year. Among the newly developed vaccines, Phase III studies showed that Bexsero has the potential to be the first broad coverage vaccine against meningococcal B (MenB) disease. Meningococcal disease is a leading cause of bacterial meningitis, an often deadly disease in infants. The generics division Sandoz achieved double-digit growth (USD 8.5 billion, +15% in constant currencies), thanks to stronger growth in the US, Canada, Italy and emerging markets compared to the previous year. The division’s growth rate in Central and Eastern Europe is four times faster than the market – and three times faster in Turkey, the Middle East and Africa. Sandoz posted an excellent result due to the firstto-market launches in the US of differentiated generic versions of complex products such as enoxaparin (the most successful product launch ever by Sandoz), tacrolimus and lansoprazole. This underscores the division’s ability to expand its portfolio

with complex and differentiated products. Growth also was attributable to biosimilars, as sales rose 63% in constant currencies. With patents expected to expire over the next five years on biologics with global sales of USD 64 billion, the full strategic importance of our leading position in biosimilars will soon become apparent. The Consumer Health Division overcame the effects of the global recession and increased net sales by 7% (6% in constant currencies) to USD 6.2 billion. With this solid growth, the Consumer Health Division excelled in its respective markets, and continues to grow thanks to the strong performance of several key brands. With sales up 6.4% (in constant currencies) the CIBA Vision Business Unit recorded solid growth, while Animal Health benefitted from some of its top brands. OTC sales growth was driven by analgesics and Prevacid24HR for treatment of heartburn.
We achieved strong growth in 2010 despite a global political and economic situation shaped by considerable challenges and uncertainties. Our strategy, which focuses

consistently on growth areas of the healthcare market while paying careful attention to risks, has proved its value in this dynamic environment. Also in the future, based on this strategy of focused diversification, we expect our company to develop in a more stable way than several of our important competitors. Our acquisition of global eye care leader Alcon is expected to soon provide an additional growth platform with considerable synergy potential. In view of our sustainable success, it is not surprising that our strategy is imitated today. In the long-term, success is reserved for those companies that can systematically focus on their core business, recognize the

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inevitable associated risks, and handle them rationally, with strategic vision.
At the core of our corporate culture is the high significance we place on innovation. For

several years Novartis has received more approvals for new medicines than competitors. We are recognized as having one of the best pipelines in the industry, and we continue to invest steadily in research and development. Cuts would increase profit in the short-term – but only at a much higher long-term cost. This can already be observed today at other companies that reduced their R&D investments in recent years. Through our ongoing commitment of people and other resources to innovation, we develop differentiated medicines, vaccines and other new products to benefit patients. Apart from the approvals for Gilenya and Tasigna mentioned above, we achieved other impressive breakthroughs during the past year. A clinical trial showed Onbrez Breezhaler, r r, a treatment for chronic obstructive pulmonary disease (COPD), was superior to salmeterol, currently one of the mainstays of therapy for this condition. Onbrez Breezhaler is already approved in more r than 40 countries, including the EU. Menveo, a groundbreaking vaccine to prevent meningococcal disease, was launched in the US, the EU, and certain countries in Latin America and Asia-Pacific. Menveo is an important tool for prevention of meningococcal disease, a life-threatening infection that causes illness in more than 500 000 people each year. Indication extensions are proceeding according to plan and should help to further strengthen this brand.

Biosimilars – high-quality, cost-effective follow-on versions of biologic medicines that are difficult to develop and manufacture – continue their strong sales growth. They are led by products such as Omnitrope, which is gaining ground against originator medicines to treat growth hormone deficiency, and by Binocrit (epoetin alfa) and Zarzio (filgrastim), which were introduced for oncology indications. This success is paving the way to further extend the position of Sandoz as market leader in the field of biosimilars. Novartis has several very promising medicines in the pipeline for patients with unmet medical need. For example, SOM230 is the first medical therapy to show efficacy in a Phase III trial in Cushing’s disease, a debilitating hormonal disorder. There are currently no approved medicines to treat Cushing’s disease. These outstanding innovation milestones will play a key role in sustaining the growth momentum of our company.
Expanding our presence in emerging countries and continuously increasing our productivity are decisive elements of our growth strategy. Last year we were able to further

margin pressures. These investments are critical to sustain growth in our industry.
The demand for medicines and therapies will continue to rise in the future for the

following reasons: – An aging world population with an increasing need for medical care. The importance of this trend is accentuated by the increasing incidence in the elderly of chronic conditions such as degenerative diseases of the joints, the cardiovascular system and the central nervous system, as well as a heightened risk of cancer. – Unhealthy lifestyles and environmental pollution are causing chronic illnesses on a pandemic scale. Unhealthy eating hab-

its, sedentary lifestyles and environmental pollution have serious consequences including obesity, chronic cardiovascular disorders, diabetes, cancer and pulmonary disease. – Rapid economic growth of emerging markets, with better access to medical care.

expand our circle of patients and customers in our six key emerging markets, and posted corporate growth of approximately 12% (in constant currencies) compared with the previous year.
It is imperative to steadily increase productivity, particularly in these times of restricted public spending. By consistently simplifying

Expanding populations and increasing prosperity are creating a new middle class of about 2 billion people. The demand for better healthcare is rising disproportionately in China, India, Russia and Brazil. The build up of sustainable healthcare systems also is playing a significant role, as in the case of China, where such expansion is being pursued with substantial political energy. – Scientific and technological advances enable new approaches in pharmaceutical research, leading to innovative medicines against previously incurable diseases or those that lacked sufficient treatment.

our processes, we can provide added value for patients. This ensures our ability to invest in the future, despite price reductions and

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Cost increases, which result from rising demand for healthcare services, diagnostics and medicines, have led to a political backlash, aiming to reduce the price of patented medicines and strengthen generics. With financial problems of public healthcare systems exacerbated by the consequences of the global recession, everyone is required to use their resources as efficiently as possible.
We are responding to these intensifying challenges primarily by mobilizing our organization around a common overarching goal: to make the right medicine available to the right patient at the right time. As our com-

circumstances. At Novartis, we are committed to developing technology-based healthcare solutions. Examples include applications to remind patients to take their medicines, redeem their prescriptions or check their vaccination status – as well as telemonitoring of patients using mobile technology.
Political debate all too often ignores the fact that medical problems have heavy costs for healthcare systems, but also have various socioeconomic cost implications. Far more

pany incorporates the rigorous demands of society, patients and payors into its processes, and strives to bring medicines with an optimal cost-benefit profile to market, we will continue to position ourselves as a driver of change. Novartis, which is recognized as an innovative company, has no reason to fear these growing demands, for true innovation will always be valued by society. Novartis also is responding to increasing pressure on prices by implementing innovative pricing models, in which payment is clearly linked to added value for patients. In Germany, for example, the payment for our osteoporosis medicine Aclasta is refunded if a patient suffers a fracture attributable to osteoporosis within one year of treatment. Similarly, in the United Kingdom, we have introduced innovative pricing models for our asthma medicine Xolair as well as for Lucentis, a treatment r for age-related macular degeneration. Technological advances also help us to respond flexibly and creatively to changing

political attention should be paid to indirect cost savings realized through preventing or treating disease with innovative therapies and procedures. Because the indirect cost of illness is not covered by government budgets, however, it rarely receives systemic cost-benefit analysis or is the subject of debate. Who calculates the economic benefits of a quicker recovery and faster reintegration into work? Moreover, too little attention is paid to the fact that patented innovations become less expensive with widespread use and the length of time they remain on the market; this is particularly true after patent expiry. Everyone benefits in the end from this price reduction process. Novartis makes a substantial contribution in this respect through Sandoz, a global leader in generics. Medicines generally account for 10% to 15% of total healthcare costs. A rational assessment of drug prices should take into consideration the average price over the entire life cycle. Broad availability of medical advances played a decisive role in the dramatic improvement of public health in the 20th century. Healthcare must not be allowed to fall victim to shortsighted austerity mea-

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sures that ignore the fundamental connections between prevention and treatment. Medicine has seen enormous progress that has vastly improved the treatment and prevention of various illnesses, particularly during the last 50 years. People live longer today and they stay healthier longer. In the middle of the 20th century, cancer patients still had very little chance of survival. Today, almost two-thirds of cancer patients survive at least five years after initial diagnosis. During the last 25 years, deaths of children due to cancer have decreased by 60%. It is a dangerously short-term view to deny that research and development requires enormous investment to deliver innovation. In other words, innovation has – and must have – its price. Allowing austerity to become the principal aim of healthcare policy not only risks lowering the quality of medical care, but also endangers the fundamental impetus for medical progress. Progress requires tangible incentives. Certainly, it is not always easy to make investments that do not bear fruit for years, or even until the next generation. Such longterm investments, however, are a hallmark of sound policy. The pharmaceutical industry is accustomed to long cycles but, here again, it is not always easy to raise R&D expenditures amid the pressures of shortterm expectations.
The post-crisis sobriety now reigning in many of the world’s prosperous nations may also have a positive side. Now is the time to

education and training – or will budgets important for the future be cut, and other politically sensitive areas spared instead? We should remember that our prosperity is founded on innovation and that, especially today, global economic competition is primarily a competition in innovation. Even in today’s increasingly volatile and polarized political climate, innovation remains the rational core of society and must be upheld. I place my trust with the majority who see more opportunities than risks in progress, because our industry in particular needs a society that supports the idea of progress. Novartis too can make social progress a reality rather than merely an empty phrase, namely by helping to solve significant social problems. That is the case in particular for health problems arising from extreme poverty in developing countries, precisely during these times of increasing protectionism and shrinking development aid budgets. Long-term engagement and a clear strategic direction are also essential for corporate citizenship. In view of today’s economic uncertainties, both development aid and corporate citizenship face an uncertain future. Moreover, the term corporate citizenship (or corporate social responsibility) risks being devalued from overuse by many economic players. Today, for those who take corporate citizenship truly seriously, stringent requirements must apply. It must be strategically embedded and it must be quantifiable through concrete indicators. And it must not lose sight of the fact that our successful core business constitutes our main contribution to public welfare: We discover and

market new medicines to help patients worldwide. Last year Novartis contributed USD 1.5 billion or 3% of net sales through access-tomedicine programs as well as investment in research targeting diseases that are prevalent in the developing world. We strive to eradicate – in the mid-term – diseases such as malaria that can be prevented and treated to alleviate future suffering. In 2010 alone, Novartis access-to-medicine programs reached 85 million patients in need, of whom 81 million were malaria patients. The last few years have taught us that merely providing medicines is not enough. Here again, a holistic approach is indispensable for sustainable success. Training, logistics management and other forms of technical expertise are necessary to achieve effective solutions. I am pleased that the Novartis Malaria Initiative has been recognized repeatedly for its effectiveness, and as a role model. Last year our antimalarial medicine Coartem and the Novartis Malaria Initiative won the US Prix Galien for Best Pharmaceutical Product, as well as the World Business and Development Award. Our contributions to corporate citizenship do not depend on the economy or business cycles, but solely on the long-term success of Novartis.
As shareholders you are obviously interested in the development of the value of our company. Our total shareholder return

ask and answer some fundamental questions. How important is health to us? How important is innovation? Is society willing to continue investing in basic research,

since the founding of Novartis amounts to 9% annually, including continuously increasing dividends and business divestments. Our total shareholder return surpasses not only that of the global market,

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but also the pharmaceutical industry index and share price performance of important competitors. Again for 2010, this confirms that Novartis not only fulfills its primary mission effectively, but also represents a sustainable investment, which, especially in times of severe fluctuations and ongoing unease in financial markets, is attractive. Our strategy of focused diversification, together with the traditional strength and consistency of our dividend payout, will ensure Novartis remains an attractive investment in the future.
For 2011, we expect further growth of net sales in local currencies and further improvement in net operating income. Thanks to a

leading position in innovation, accelerating our growth, and increasing our productivity. Once again, we will work together to focus our company firmly on the needs of patients throughout the world. Finally, I thank you, our shareholders, for the trust you place in our company. I am pleased to be able to propose an increase in the dividend to CHF 2.20 (+5%) at the next Annual General Meeting.

S in c e r e l y, Sincerely,

number of recently launched products with rapid sales growth, Novartis is less affected by patent expiries than most of its competitors. In the last year, 21% of net sales (excluding Alcon) was attributable to products launched since 2007. Furthermore, we have one of the best pipelines in the industry, with some very promising products at advanced stages of development. Gilenya has impressive growth potential, and strong successor products are already on the market to replace Gleevec/Glivec and Diovan. We are confident of our ability to compensate for lost sales due to expiry of Diovan patents. Our broad portfolio with varied business cycles should deliver sustainable development compared with the industry. Therefore we have a good chance to more than compensate for the loss in sales, given of course a little luck.
I would like to thank all our associates for their ongoing engagement and tireless commitment. Thanks to our associates we

Daniel Vasella, M.D. D a n i e l Va s e l l a , M . D .
Chairman of the Board

succeeded again last year in sustaining our

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Joseph Jimenez

rapid aging of the population, greater access to medical care in emerging markets, and advances in science will create more opportunities for us to help improve healthcare and enhance the lives of patients. On the other hand, an uncertain economy and regulatory reform will create downward pressure on the industry. Tensions will grow as healthcare spending outpaces growth in GDP. We have already seen this impact healthcare budgets in many countries, resulting in extreme pricing pressures. These are challenges we will continue to encounter in the years ahead. However, we have a clear vision for how we will navigate the pressures and strengthen our leadership over the next five years. We are adapting to these changes by shifting from a transactional approach to a more integrated approach where we work together with physicians and our customers to enable better patient outcomes. We are working closely with hospitals, payors and physicians, and initiating pilot programs to determine how best to meet changing customer needs.
NOVARTIS EXPECTS TO GROW IN THE NEXT FIVE YEARS, DESPITE THE LOSS OF PATENT PROTECTION ON BLOCKBUSTER MEDICINES IN MAJOR MARKETS. WHAT WILL DRIVE THIS GROWTH?

the last three years we have brought more NMEs to the market than our peers in both the EU and in the US. During 2010, medicines launched since 2007 generated net sales of USD 6.6 billion, 21% of the total net sales at the Pharmaceuticals Division. Our pipeline and new products will truly transform our portfolio and our future. We also leverage this core R&D competence across our other divisions. Sandoz, our generics division, is the world leader in biosimilars, biologic medicines that have lost patent protection. During the next five years, patents will expire on biologics with global sales of USD 64 billion and Sandoz is positioned to take full advantage of that opportunity. In the mid-term, flu and our emerging meningococcal franchise will be the key growth drivers for our Vaccines and Diagnostics Division, and I believe we have one of the best vaccine pipelines in the world. Animal Health and OTC also have built successful franchises by developing selfmedication and veterinary formulations of human prescription medicines.
YOU HAVE SUSTAINED AGGRESSIVE INVESTMENT IN RESEARCH AND DEVELOPMENT AS CEO. WHY?

INTERVIEW WITH JOSEPH JIMENEZ
WHAT ARE SOME OF THE CHALLENGES AND OPPORTUNITIES YOU SEE, BASED ON YOUR FIRST YEAR AS CHIEF EXECUTIVE OFFICER (CEO)?

I have inherited a great company with a distinctive strategy that sets us apart from competitors. This strategy of focused diversification was established by Dan Vasella and the Board many years ago – their foresight anticipated many of the major trends that are transforming healthcare today. Over the past year, along with my colleagues from our business divisions, I have met with patients, customers, and government leaders in markets as diverse as China, Russia, the US and Saudi Arabia. Through these discussions, I have crystallized my thinking about how we will make Novartis the most successful and respected healthcare company in the world. While healthcare is a growth industry, there are both positive and negative trends impacting how we operate. On one hand, the

We have a long-established track record of being able to outgrow our markets through innovation. From 2005 through 2010, Novartis delivered compound annual net sales growth of 10% – compared to 6% weighted average sector growth for our divisions – an “innovation premium” of more than four percentage points. We must ensure that our research strategy sustains our position as the most productive R&D group, with more new molecular entities (NMEs) than our competitors. Our track record is excellent in this area and over

Innovation is fundamental to our business. In 2010, we invested 16% of net sales in R&D (20% of Pharmaceuticals sales), and we will sustain our high level of investments. We have one of the strongest and most productive pipelines in the industry with 147 projects in clinical development, 63 of which are NMEs. Our research strategy is centered on an understanding of the science of disease and unmet medical need. By understanding the molecular pathways that may be shared by various diseases, we are able to better search for novel therapies.

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For example, we developed Ilaris to treat CAPS, a rare set of autoimmune diseases, which affects only about 6 000 people worldwide. We are now studying the potential for additional indications, including the potential to treat and prevent painful gout flares, treat chronic obstructive pulmonary disease (COPD) and type 2 diabetes, and prevent cardiovascular events in patients with type 2 diabetes. Our scientific expertise sustains our position as an industry leader. We are committed to continuing to attract the best scientists in the industry and funding them, even as our peers are cutting spending and outsourcing.
HOW DO YOU EXPECT NEW COMMERCIAL MODELS AND AN INCREASING FOCUS ON PATIENT OUTCOMES TO FOSTER GROWTH?

new medicines. They will then commercialize companion diagnostics to sell alongside our new drugs. Understanding the right drug for the right patient could greatly improve response rates and patient outcomes. Information technology has a vast untapped potential to help address areas of unmet medical need. For example, we have initiated a number of pilot programs supporting use of remote monitoring devices that provide physicians with a wealth of information – including adherence to treatment – to proactively manage the health of patients. Of course, ensuring that applications of telemonitoring remain compatible with patient privacy will be essential to broad adoption of this technology. Still, you can imagine the potential that remote monitoring offers to improve patient outcomes and reduce costs. Novartis also has emerged as an industry leader in working with health authorities in designing clinical trials to generate data required for rapid health economic assessments. In addition, Novartis has pioneered innovative pricing arrangements including money-back guarantees and other types of performance-based pricing, to accelerate reimbursement negotiations with governments and ensure patients early access to new medicines.
HOW IS NOVARTIS ENCOURAGING EFFICIENCY?

We are seeing the convergence of regulators and payors toward the common objective of demanding a positive patient outcome with the therapies we provide. Reimbursement and market access increasingly are going to be linked to the ability to demonstrate positive outcomes. In response, we are shifting from a one-sizefits-all, transactional approach to more flexible sales organizations, tailored to local conditions. We’re also implementing broader use of key account management, which is well-established in many other industries but still somewhat new to pharmaceuticals. We need to understand the needs of hospital groups and retailers – and to interact with them in ways that we have not done in the past. In the future, payors and regulators may require companion diagnostics with new therapies. Our dedicated Molecular Diagnostics Unit seeks to improve the efficacy of our medicines by identifying biomarkers in patient groups who respond to the

We reduced Sales and Marketing expense as a proportion of net sales by almost three percentage points from 2007 through 2010, in spite of rising net sales and an unprecedented number of new product launches. Pulling costs out of the system will help fund investments in innovation and expansion in emerging markets. During the next five years, we aim to optimize our production network by creating manufac-

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turing centers of excellence. We are looking to improve network utilization to around 80% by 2015, from approximately 50% today, so that we can upgrade our plants to ensure quality and use of new technologies. We also are scaling up our procurement organization, and our target is to deliver sustainable savings between 6% and 8% per year.
WHY IS CONTINUED EXPANSION IN EMERGING MARKETS ANOTHER KEY ELEMENT OF THE NOVARTIS LONG-TERM STRATEGY?

We see the benefit of our broad portfolio, particularly in these markets. We are able to compete from the level of essential drugs all the way up to new innovative medicines. This is already showing great results. Sandoz, for example, is growing at four times the market rate in Central and Eastern Europe, and three times the market rate in the Middle East, Turkey and Africa.
HOW ARE GENERICS AND INNOVATIVE PHARMACEUTICALS COMPLEMENTARY?

occurring in our industry, while also balancing risk. We have leading businesses in science-based, fast-growing segments of healthcare. We will build sustainable leadership across our portfolio: innovative pharmaceuticals, generics, vaccines and diagnostics, and consumer health, as well as eye care through our planned merger with Alcon. Our diversified portfolio also allows us to leverage cross-divisional synergies and drive more value as “one Novartis” to customers and patients. In addition to being a strategic business platform, this allows us to touch more patient lives and address unmet needs across the healthcare spectrum.

There is a rebalancing of power in the overall global economy – emerging markets are predicted to represent 60% of the global GDP in just the next 20 years. This growth, coupled with the fact that these governments are devoting more resources to healthcare, provides a tremendous platform for our business. At the same time, this will require an adjustment in the global and organizational strategy for our industry. At Novartis, we are continuously expanding in emerging markets, outpacing our growth in more developed markets, with a particular focus on Russia, China, Brazil and India. Novartis Group sales grew 13% in emerging markets over last year. Our top six emerging markets grew 12% in 2010, accounting for about 10% of net sales (excluding Alcon, Inc.). That figure will double over the next five years – we will continue investing in emerging markets because of the growth rates we are seeing. We are also rapidly expanding the vaccine business in emerging markets, and our planned acquisition of a majority holding in Zhejiang Tianyuan Bio-Pharmaceuticals Co. will pave the way for local production of vaccines in China. In Brazil, we are building a plant for local manufacture of vaccines and we also are producing rabies vaccine in India.

Fundamentally, Novartis is pro-patent. Strong protection of intellectual property ensures recovery of R&D investment, and ensures future innovation through a virtuous circle of reinvestment. However, we also believe that when those patents expire, it is our obligation to offer low-cost, very high-quality generics, to help lower the overall cost of healthcare, and improve access to medicines for societies around the world. This is not a contradiction. These objectives are absolutely consistent. We have shaped our portfolio of businesses to address the fundamental needs of patients. A broad, diversified portfolio is going to become increasingly important as more and more payors look for low-cost generics, preventive vaccines, and self-pay over-the-counter medicines as complements to innovative pharmaceuticals.
FINALLY, IN YOUR VIEW, WHAT MAKES NOVARTIS DISTINCTIVE?

Two things: our people and our strategy. First and foremost, Novartis has what I consider to be the best workforce in the industry. Our talent really set us apart from the rest of our competitors. Second, our strategy of focused diversification helps us to fully leverage the changes

4 | GROUP REVIEW

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HEALTHCARE PORTFOLIO
Innovation is flourishing, addressing unmet needs of patients and healthcare systems. In 2010, medicines and vaccines from Novartis were used to treat and protect more than 913 million people around the world, according to internal estimates. While healthcare remains a growth industry, both positive and negative trends are impacting the way we operate. On one hand, rapid aging of the population, greater access to healthcare in emerging markets and advances in science create opportunities to enhance the lives of patients. At the same time, an uncertain economy and regulatory reform exert downward pressure. Tensions will grow as healthcare spending outpaces economic growth. Novartis has a clear vision for how to navigate these pressures to meet changing customer needs and strengthen our leadership over the next five years. Our strategy of focused diversification helps us to fully leverage the changes occurring in our industry, while also balancing risk.

C O N T EN T S
HEALTHCARE PORTFOLIO Healthcare Portfolio Overview Pharmaceuticals Novartis Institutes for BioMedical Research Vaccines and Diagnostics Sandoz Consumer Health 21 23 35 39 45 51

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BUILDING SUSTAINABLE LEADERSHIP IN HEALTHCARE
Novartis strategy is based on focused diversification. Our uniquely broad portfolio focuses on science-based healthcare sectors that are growing, reward innovation, and enhance the lives of patients.

PHARMACEUTICALS

VACCINES AND DIAGNOSTICS Reflecting a commitment to prevention of disease, Novartis is a leader in influenza vaccines. The division has a broad development pipeline, including an emerging platform of meningococcal vaccines. Our diagnostic tools help safeguard blood supplies and ensure patient safety.

SANDOZ

CONSUMER HEALTH

ALCON

Novartis discovers and develops innovative patent-protected medicines that enhance outcomes for patients and healthcare providers. Our Pharmaceuticals Division is a leader in oncology and cardiovascular medicines, with a strong specialty pipeline. Successful innovation has rejuvenated our product portfolio to drive growth; recently launched medicines represented 21% of division sales in 2010.

Sandoz is the number two generics company worldwide, providing affordable, high-quality medicines. Sandoz focuses on differentiated generics that are more difficult to develop, manufacture and market, but offer higher growth and profitability. Sandoz is also the worldwide leader in biosimilars.

Novartis develops and markets a range of self-medication products and veterinary medicines. The three Novartis Consumer Health businesses – OTC (over-the-counter medicines), Animal Health and CIBA Vision – have delivered sustained abovemarket growth in recent years.

Alcon is the global leader in eye care, with three major product areas: surgical, pharmaceuticals and consumer eye care. Through a 77% ownership stake in and a planned full merger with Alcon, Novartis has added a dynamic new growth platform to our diversified portfolio.

PATIENT-CENTRIC PORTFOLIO

STRATEGIC PRIORITIES
Extend lead in innovation Our research is driven by a distinctive scientific and clinical strategy, focusing on unmet medical need and knowledge of disease. This approach has resulted in an established track record of outgrowing our markets through innovation. Since 2007, Novartis has received approvals for more innovative medicines in Europe and the United States than any other company. Accelerate growth We are tailoring our commercial model to the rapidly changing healthcare environment, with the aim to better address needs of patients and deliver positive treatment outcomes. We also are leveraging our broad portfolio to expand aggressively in emerging and established markets. Drive productivity We continuously simplify and streamline processes, and reduce costs, allowing us to reinvest in innovation.

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HEALTHCARE PORTFOLIO OVERVIEW
NET SALES BY SEGMENT (Index: 2005 = 100%; Vaccines and Diagnostics since 2006 acquisition) CORE OPERATING INCOME 1 BY SEGMENT (Index: 2005 = 100%; Vaccines and Diagnostics since 2006 acquisition)

300

300

250

250

200

200

150

150

100

100

50 2005 2006 2007 2008 2009 2010

50 2005 2006 2007 2008 2009 2010

Pharmaceuticals

Vaccines and Diagnostics

Sandoz

Consumer Health

2010 NET SALES BY SEGMENT (% and in USD millions) Pharmaceuticals Vaccines and Diagnostics Sandoz Consumer Health Alcon, Inc. Total
2

2010 CORE OPERATING INCOME 1 BY SEGMENT (% and in USD millions) 30 558 2 918 8 518 6 204 2 426 50 624 Pharmaceuticals Vaccines and Diagnostics Sandoz Consumer Health Alcon, Inc.
2

60 6 17 12 5

67 7 11 9 6

9 909 1 066 1 685 1 253 852 – 759 14 006

Corporate Expenses, net Total

2010 NET SALES BY REGION AND SEGMENT (% and in USD millions excluding Alcon, Inc.) Pharmaceuticals United States Europe Asia/Africa/Australasia Canada and Latin America Total 33 36 22 9 10 043 10 877 6 720 2 918 30 558 Vaccines and Diagnostics 41 27 22 10 1 184 784 645 305 2 918 Sandoz 31 50 12 7 2 630 4 273 1 032 583 8 518 Consumer Health 32 42 17 9 2 006 2 624 1 019 555 6 204

1 2

Core operating income eliminates the impact of acquisition-related factors and other significant exceptional items. These adjustments are explained in detail starting on page 143. Since August 25, 2010 consolidation

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1 9 | H E A LT H C A R E P O R T F O L I O H e althc are Po r t fo lio O ve r view

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21

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PHARMACEUTICALS OVERVIEW
KEY FIGURES (In USD millions, unless indicated otherwise)
2010 2009

PORTFOLIO REJUVENATION (% and total net sales in USD millions)
2007 2008 2009 2010

Net sales Operating income Return on net sales (%) Core operating income 1 Return on core net sales (%) Core Research & Development As % of net sales Free cash flow Net operating assets Additions to property, plant & equipment 2 Number of associates (FTE) 3
1

30 558 8 798 28.8 9 909 32.4 6 153 20.1 10 681 15 212 777 58 424

28 538 8 392 29.4 9 068 31.8 5 715 20.0 9 170 14 519 922 56 310

24 025

26 331

28 538 16

30 558 21

6 34

11 32

32

31

38

37

35

33

22

20

17

15

Core operating income eliminates the impact of acquisition-related factors and other significant exceptional items. These adjustments are explained in detail starting on page 143. 2 Excluding impact of business combinations 3 Full-time equivalent positions at year-end
1

Recently launched (since 2007) Mature products (>10 years)
Excluding products launched since 2007

Established products (

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