1 US.NMH © 2008 sanofi-aventis U.S. LLC Government Digest

2 US.NMH © 2008 sanofi-aventis U.S. LLC Medicare Overview Of the nearly 8.7 million Medicare beneficiaries receiving their benefits through Medicare Advantage plans at year-end 2007, 5.7 million (66.1%) were enrolled in HMO risk plans. Between 2006 (5.5 million) and 2007 (6.2 million), the number of Medicare beneficiaries enrolled in HMOs increased 11.6%, the third consecutive annual rise. For the first time since the Digest began tracking this measure, more than half (227 of 443, or 51.2%) of all HMOs operating in the U.S. enrolled Medicare beneficiaries, up notably from 43.5% (195 of 448) the previous year.

3 US.NMH © 2008 sanofi-aventis U.S. LLC Medicare Advantage Enrollment, by Region, 2007 Mid-Atlantic Pacific South Atlantic South Central Mountain East North Central West North Central New England

4 US.NMH © 2008 sanofi-aventis U.S. LLC Medicare HMO Enrollment, by Size Total Number of Medicare HMO Members HMO Membership Size <15,00081,322107,785 15,000–24,999115,758107,849 25,000–49,999243,271389,358 50,000–99,999590,273557, ,000–249,9991,316,4681,220, ,000+3,348,5843,799,471 TOTAL5,539,9546,182,199

5 US.NMH © 2008 sanofi-aventis U.S. LLC Medicare HMO Utilization* Utilization for Medicare HMO Members Utilization Measure Hospital Days/1,000 Medicare HMO Members 1,5291,497 Average Length of Stay (days) per Medicare Hospital Admission Physician Encounters per Medicare HMO Member** Ambulatory Visits per Medicare HMO Member** * Only HMOs that enroll Medicare beneficiaries are included. ** Ambulatory visits differ from physician encounters. Ambulatory visits are visits by an HMO member to an HMO clinic or physician’s office that do not require the services of a physician. Such visits are usually made for tests, prescription refills, immunizations, etc. The term “physician encounter” is self-explanatory. The number of ambulatory visits added to the number of physician encounters gives the total number of encounters.

6 US.NMH © 2008 sanofi-aventis U.S. LLC Medicare HMO Operations* PCPs per 1,000 HMO Members Specialists per 1,000 HMO Members * Only HMOs that enroll Medicare beneficiaries are included. Medicare and non-Medicare HMO enrollees are included in “per 1,000 HMO Members” averages.

7 US.NMH © 2008 sanofi-aventis U.S. LLC Hospital-Based Medicare, 2006 Medicare Patient Percentage Common Diagnoses for Medicare Patients

8 US.NMH © 2008 sanofi-aventis U.S. LLC Medicare HMO Pharmacy Policy* Percentage of HMOs * Only HMOs that enroll Medicare beneficiaries are included.

9 US.NMH © 2008 sanofi-aventis U.S. LLC Medicare Part D Overview Unlike Part A and Part B, Part D drug coverage is available exclusively through plans sponsored by private organizations. Medicare eligibles wishing to obtain drug coverage can choose one of two types of plans: stand-alone prescription drug plans (PDPs), which offer drug coverage only and supplement other Medicare coverage; and Medicare Advantage drug plans (MA-PDs), which combine drug coverage with other Medicare benefits in a single managed care plan.

10 US.NMH © 2008 sanofi-aventis U.S. LLC Enrollment in Medicare Prescription Drug Plans (1),(2) Prescription Drug Plan TypeTotal Stand-Alone Prescription Drug Plan17,340,553 Medicare Advantage with Rx Plans7,645,083 Dual-Eligibles6,645,721 Other Creditable Coverage (3),(4) 5,392,798 Total with Creditable Drug Coverage37,024,155 Total Medicare Beneficiaries43,571,486 % of Total Beneficiaries with Coverage85.0% (1)Part D enrollment data are current as of January 16, 2007, and do not include 410,285 enrollees in U.S. territories. (2)Enrollment totals exclude an estimated 4.9 million with creditable drug coverage for whom data were unavailable. (3)Alternative coverage is deemed to be creditable when it meets or exceeds the actuarial value of the Part D benefit. (4)Other sources of creditable drug coverage for Medicare enrollees include Medicare subsidized employer or union sponsored plans, TRICARE retiree coverage, FEHBP retiree coverage, and other forms of federal coverage.

11 US.NMH © 2008 sanofi-aventis U.S. LLC Medicare Payer Share of Total Prescriptions Dispensed, by Drug Class, 2008* % of Total Prescriptions * Data are as of midyear 2008 and represent the percentages of prescriptions dispensed, by drug class, to all patients.

12 US.NMH © 2008 sanofi-aventis U.S. LLC Percentage of Total Prescriptions Dispensed, by Payer, 2008 Percentage of Total Prescriptions Dispensed Drug Class MedicareMedicaidThird PartyCash Allergies 7.3%8.7%80.0%4.0% Arthritis 11.9%7.3%72.9%7.9% Asthma 11.5%13.4%70.9%4.1% Cholesterol 17.0%5.1%74.5%3.5% Depression 11.4%7.8%74.0%6.7% Diabetes 17.8%7.2%68.9%6.0% Gastrointestinal 13.9%7.7%69.5%8.8% Hypertension 19.7%5.7%67.2%7.5% Oncology 17.8%5.9%71.3%4.9% Osteoporosis 21.4%5.4%71.1%2.0%

13 US.NMH © 2008 sanofi-aventis U.S. LLC Medicaid Overview For the first time since the Digest began tracking this measure, the total number of Medicaid recipients enrolled in MCOs nationwide fell in 2007, to 28.5 million from 28.9 million in Of these 28.5 million Medicaid MCO members nationwide, 19.5 million (68.4%) were enrolled in HMOs, up notably from 18.4 million (63.6%) in The average number of physician encounters per Medicaid HMO member was 4.1 in 2007, up 10.8% from 3.7 in 2006.

14 US.NMH © 2008 sanofi-aventis U.S. LLC Medicaid Managed Care Members, by Type of Managed Care Organization Medicaid Recipients, by Membership in Managed Care Organizations 28.5 million Total 2007 Medicaid MCO Members 44.9 million Total 2007 Medicaid Recipients Medicaid Enrollment in Managed Care Organizations PHPs HIOs Medicaid HMOs PCCMs Medicaid Recipients in MCOs Medicaid Recipients Not in MCOs

15 US.NMH © 2008 sanofi-aventis U.S. LLC Medicaid HMO Utilization Utilization Rates for Medicaid Members in HMOs Utilization Measure Hospital Days/1,000 Medicaid HMO Members Average Length of Stay (days) per Medicaid Hospital Admission Physician Encounters per Medicaid HMO Member** Ambulatory Visits per Medicaid HMO Member** 1.7 * Only HMOs that enroll Medicaid beneficiaries are included. ** Ambulatory visits differ from physician encounters. Ambulatory visits are visits by an HMO member to an HMO clinic or physician’s office that do not require the services of a physician. Such visits are usually made for tests, prescription refills, immunizations, etc. The term “physician encounter” is self-explanatory. The number of ambulatory visits added to the number of physician encounters gives the total number of encounters.

16 US.NMH © 2008 sanofi-aventis U.S. LLC Medicaid HMO Operations* PCPs per 1,000 HMO Members Specialists per 1,000 HMO Members * Only HMOs that enroll Medicaid beneficiaries are included. Medicaid and non-Medicaid HMO enrollees are included in “per 1,000 HMO Members” averages.

17 US.NMH © 2008 sanofi-aventis U.S. LLC Hospital-Based Medicaid, 2006 Medicaid Patient Percent Common Diagnoses for Medicaid Patients

18 US.NMH © 2008 sanofi-aventis U.S. LLC Medicaid HMO Pharmacy Policy Percentage of HMOs Pharmacy Policy for HMOs with Medicaid Members* * Only HMOs that enroll Medicaid beneficiaries are included.

19 US.NMH © 2008 sanofi-aventis U.S. LLC Medicaid Payer Share of Total Prescriptions Dispensed, by Drug Class, 2008* % of Total Prescriptions *Data are as of midyear 2008 and represent the percentages of prescriptions dispensed to all patients. **Attention Deficit Hyperactivity Disorder.

20 US.NMH © 2008 sanofi-aventis U.S. LLC Major Trends: Medicare and Medicaid At year-end 2007, 227 of the 443 HMOs in the U.S. (51.2%) enrolled Medicare beneficiaries, up substantially from 195 (43.5%) in Between January 2007 (78.4%) and January 2008 (85.0%), the overall percentage of Medicare beneficiaries with some form of creditable drug coverage grew nearly seven percentage points. The total number of Medicaid recipients enrolled in MCOs nationwide dropped to 28.5 million in 2007 from 28.9 million in 2006, reversing a decade-long trend of growth.