UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form 10-Q
Quarterly Report Pursuant to Section 13 or 15(d) of the
Securities Exchange Act of 1934
For the quarterly period ended September 30, 20212022
COMMISSION FILE NUMBER 001-6351
ELI LILLY AND COMPANY
(Exact name of Registrant as specified in its charter)
Indiana 35-0470950
(State or other jurisdiction of (I.R.S. Employer
incorporation or organization) Identification No.)
Lilly Corporate Center, Indianapolis, Indiana 46285
(Address and zip code of principal executive offices)
Registrant’sRegistrant's telephone number, including area code (317) 276-2000
Securities registered pursuant to Section 12(b) of the Exchange Act:
Title of Each ClassTrading SymbolsName of Each Exchange On Which Registered
Common Stock (no par value)LLYNew York Stock Exchange
1.000% Notes due 2022LLY22New York Stock Exchange
7 1/8% Notes due 2025LLY25New York Stock Exchange
1.625% Notes due 2026LLY26New York Stock Exchange
2.125% Notes due 2030LLY30New York Stock Exchange
0.625% Notes due 2031LLY31New York Stock Exchange
0.500% Notes due 2033LLY33New York Stock Exchange
6.77% Notes due 2036LLY36New York Stock Exchange
1.625% Notes due 2043LLY43New York Stock Exchange
1.700% Notes due 2049LLY49ANew York Stock Exchange
1.125% Notes due 2051LLY51New York Stock Exchange
1.375% Notes due 2061LLY61New York Stock Exchange
Indicate by check mark whether the Registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the Registrant was required to file such reports) and (2) has been subject to such filing requirements for the past 90 days.
Yes No
Indicate by check mark whether the Registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the Registrant was required to submit such files).
Yes No
Indicate by check mark whether the Registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large"large accelerated filer,” “accelerated" "accelerated filer,” “smaller" "smaller reporting company," and "emerging growth company" in Rule 12b-2 of the Exchange Act.
Large accelerated filerAccelerated filer
Non-accelerated filerSmaller reporting company
Emerging growth company
If an emerging growth company, indicate by check mark if the Registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.
Indicate by check mark whether the Registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).
Yes No
The number of shares of common stock outstanding as of October 22, 2021:28, 2022:
Class Number of Shares Outstanding
Common 956,592,393950,177,900 



Eli Lilly and Company
Form 10-Q
For the Quarter Ended September 30, 20212022
Table of Contents
Page
2


Forward-Looking Statements
This Quarterly Report on Form 10-Q and our other publicly available documents include forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934 as amended (Exchange Act), and are subject to the safe harbor created thereby under the Private Securities Litigation Reform Act of 1995. In particular, information appearing under “Management's"Management's Discussion and Analysis of Results of Operations and Financial Condition”Condition" includes forward-looking statements. Forward-looking statements include all statements that do not relate solely to historical or current facts, and generally can be identified by the use of words such as “may,” “believe,” “will,” “expect,” “project,” “estimate,” “intend,” “anticipate,” “plan,” “continue,”"may," "believe," "will," "expect," "project," "estimate," "intend," "anticipate," "plan," "continue," or similar expressions or future or conditional verbs.
Forward-looking statements inherently involve many risks and uncertainties that could cause actual results to differ materially from those expressed in forward-looking statements. Where, in any forward-looking statement, we express an expectation or belief as to future results or events, it is based on management's current plans and expectations, expressed in good faith and believed to have a reasonable basis. However, we can give no assurance that any such expectation or belief will result or will be achieved or accomplished. Investors therefore should not place undue reliance on forward-looking statements. The following include some but not all of the factors that could cause actual results or events to differ materially from those anticipated:
the impact of the evolving COVID-19 pandemic or any future pandemic, epidemic, or similar public health threat and the global response thereto;
uncertainties related to our efforts to develop, manufacture, and distribute potential treatments for COVID-19;
the significant costs and uncertainties in the pharmaceutical research and development process, including with respect to the timing and process of obtaining regulatory approvals;
the impact and outcome of acquisitions and business development transactions and related integration costs;
the expiration of intellectual property protection for certain of our products and competition from generic and/or biosimilar products;
our ability to protect and enforce patents and other intellectual property;
changes in patent law or regulations related to data package exclusivity;
competitive developments affecting current products and our pipeline;
market uptake of recently launched products;
information technology system inadequacies, breaches, or operating failures;
unauthorized access, disclosure, misappropriation, or compromise of confidential information or other data stored in our ITinformation technology systems, networks, and facilities, or those of third parties with whom we share our data;
unexpected safety or efficacy concerns associated with our products;
litigation, investigations, or other similar proceedings involving past, current, or future products or commercial activities as we are largely self-insured;
issues with product supply and regulatory approvals stemming from manufacturing difficulties, disruptions, or disruptions,shortages, including as a result of demand, labor shortages, third-party performance, or regulatory actions relating to our facilities;
reliance on third-party relationships and outsourcing arrangements;
regulatory changes or other developments;
regulatory actions regarding currently marketed products;
continued pricing pressures and the impact of actions of governmental and private payers affecting pricing of, reimbursement for, and access to pharmaceuticals;
devaluations in foreign currency exchange rates, or changes in interest rates, and inflation;
changes in tax law, tax rates, or events that differ from our assumptions related to tax positions;
asset impairments and restructuring charges;
the impact of global macroeconomic conditions, and trade disruptions, global disputes, unrest, war, or disputes;other costs, uncertainties and risks related to engaging in business in foreign jurisdictions;
changes in accounting and reporting standards promulgated by the Financial Accounting Standards Board and the Securities and Exchange Commission (SEC); and
regulatory compliance problems or government investigations.
3


More information on factors that could cause actual results or events to differ materially from those anticipated is included from time to time in our reports filed with the SEC, including in our Annual Report on Form 10-K for the year ended December 31, 2020,2021, particularly under the caption “Risk Factors”."Risk Factors." Investors should understand that it is not possible to predict or identify all such factors and should not consider the risks described above and under Part I, Item 1A, "Risk Factors" of our Annual Report on
3


Form 10-K
to be a complete statement of all potential risks and uncertainties.
All forward-looking statements speak only as of the date of this Quarterly Report on Form 10-Q and are expressly qualified in their entirety by the cautionary statements included in or incorporated by reference into this Quarterly Report on Form 10-Q. Except as is required by law, we expressly disclaim any obligation to publicly release any revisions to forward-looking statements to reflect events after the date of this Quarterly Report on Form 10-Q.
4


PART I. Financial Information
Item 1. Financial Statements
Consolidated Condensed Statements of Operations
(Unaudited)
ELI LILLY AND COMPANY AND SUBSIDIARIES
(Dollars and shares in millions, except per-share data)
 
 Three Months Ended September 30,Nine Months Ended September 30,
 2021202020212020
Revenue (Note 2)$6,772.8 $5,740.6 $20,318.5 $17,099.8 
Costs, expenses, and other:
Cost of sales1,430.8 1,326.4 5,262.6 3,763.5 
Research and development1,708.9 1,465.4 5,066.5 4,247.7 
Marketing, selling, and administrative1,577.9 1,569.1 4,839.6 4,567.3 
Acquired in-process research and development (Note 3)174.0 — 498.3 294.1 
Asset impairment, restructuring, and other special charges (Note 5) 101.4 211.6 161.3 
Other–net, (income) expense (Note 11)635.9 (158.9)124.3 (694.9)
5,527.5 4,303.4 16,002.9 12,339.0 
Income before income taxes1,245.3 1,437.2 4,315.6 4,760.8 
Income taxes (Note 7)135.2 228.8 460.0 683.9 
Net income$1,110.1 $1,208.4 $3,855.6 $4,076.9 
Earnings per share:
Basic$1.22 $1.33 $4.25 $4.49 
Diluted$1.22 $1.33 $4.23 $4.47 
Shares used in calculation of earnings per share:
Basic906.7907.2907.7907.5
Diluted910.8911.4911.7911.9
 Three Months Ended September 30,Nine Months Ended September 30,
 2022202120222021
Revenue (Note 2)$6,941.6 $6,772.8 $21,239.6 $20,318.5 
Costs, expenses, and other:
Cost of sales1,579.1 1,430.8 5,081.7 5,262.6 
Research and development1,802.9 1,705.3 5,194.9 5,032.4 
Marketing, selling, and administrative1,614.2 1,577.9 4,797.2 4,839.6 
Acquired in-process research and development and development milestones (Note 3)62.4 177.6 668.4 532.4 
Asset impairment, restructuring, and other special charges (Note 5)206.5 — 206.5 211.6 
Other–net, (income) expense (Note 11)111.0 635.9 580.9 124.3 
5,376.1 5,527.5 16,529.6 16,002.9 
Income before income taxes1,565.5 1,245.3 4,710.0 4,315.6 
Income taxes (Note 7)113.8 135.2 402.9 460.0 
Net income$1,451.7 $1,110.1 $4,307.1 $3,855.6 
Earnings per share:
Basic$1.61 $1.22 $4.78 $4.25 
Diluted$1.61 $1.22 $4.76 $4.23 
Shares used in calculation of earnings per share:
Basic900.7906.7901.8907.7
Diluted903.8910.8904.5911.7
See notes to consolidated condensed financial statements.
5


Consolidated Condensed Statements of Comprehensive Income (Loss)
(Unaudited)
ELI LILLY AND COMPANY AND SUBSIDIARIES
(Dollars in millions)
 
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended September 30,Nine Months Ended September 30,
20212020202120202022202120222021
Net incomeNet income$1,110.1 $1,208.4 $3,855.6 $4,076.9 Net income$1,451.7 $1,110.1 $4,307.1 $3,855.6 
Other comprehensive income (loss), net of tax (Note 10)Other comprehensive income (loss), net of tax (Note 10)114.4 127.8 323.7 (31.5)Other comprehensive income (loss), net of tax (Note 10)(8.1)114.4 47.3 323.7 
Comprehensive incomeComprehensive income$1,224.5 $1,336.2 $4,179.3 $4,045.4 Comprehensive income$1,443.6 $1,224.5 $4,354.4 $4,179.3 
See notes to consolidated condensed financial statements.


6


Consolidated Condensed Balance Sheets
ELI LILLY AND COMPANY AND SUBSIDIARIES
(Dollars in millions)
September 30, 2021December 31, 2020September 30, 2022December 31, 2021
AssetsAssets(Unaudited) Assets(Unaudited) 
Current AssetsCurrent AssetsCurrent Assets
Cash and cash equivalents (Note 6)Cash and cash equivalents (Note 6)$3,788.2 $3,657.1 Cash and cash equivalents (Note 6)$2,617.4 $3,818.5 
Short-term investments (Note 6)Short-term investments (Note 6)37.1 24.2 Short-term investments (Note 6)124.7 90.1 
Accounts receivable, net of allowances of $24.1 (2021) and $25.9 (2020)
5,914.3 5,875.3 
Accounts receivable, net of allowances of $17.7 (2022) and $22.5 (2021)
Accounts receivable, net of allowances of $17.7 (2022) and $22.5 (2021)
6,715.3 6,672.8 
Other receivablesOther receivables1,110.7 1,053.7 Other receivables1,609.5 1,454.4 
InventoriesInventories3,907.4 3,980.3 Inventories3,831.1 3,886.0 
Prepaid expenses and otherPrepaid expenses and other3,050.6 2,871.5 Prepaid expenses and other2,741.9 2,530.6 
Total current assetsTotal current assets17,808.3 17,462.1 Total current assets17,639.9 18,452.4 
Investments (Note 6)Investments (Note 6)3,350.5 2,966.8 Investments (Note 6)2,574.6 3,212.6 
GoodwillGoodwill3,884.1 3,766.5 Goodwill3,891.6 3,892.0 
Other intangibles, netOther intangibles, net7,887.7 7,450.0 Other intangibles, net7,124.1 7,691.9 
Deferred tax assetsDeferred tax assets2,625.6 2,830.4 Deferred tax assets2,384.3 2,489.3 
Property and equipment, net of accumulated depreciation of $9,962.8 (2021) and $9,570.7 (2020)
8,920.4 8,681.9 
Property and equipment, net of accumulated depreciation of $10,074.0 (2022) and $9,976.7 (2021)
Property and equipment, net of accumulated depreciation of $10,074.0 (2022) and $9,976.7 (2021)
9,311.3 8,985.1 
Other noncurrent assetsOther noncurrent assets3,710.4 3,475.4 Other noncurrent assets4,535.7 4,082.7 
Total assetsTotal assets$48,187.0 $46,633.1 Total assets$47,461.5 $48,806.0 
Liabilities and EquityLiabilities and EquityLiabilities and Equity
Current LiabilitiesCurrent LiabilitiesCurrent Liabilities
Short-term borrowings and current maturities of long-term debtShort-term borrowings and current maturities of long-term debt$1,563.0 $8.7 Short-term borrowings and current maturities of long-term debt$1,744.6 $1,538.3 
Accounts payableAccounts payable1,566.8 1,606.7 Accounts payable1,683.2 1,670.6 
Employee compensationEmployee compensation836.6 997.2 Employee compensation984.1 958.1 
Sales rebates and discountsSales rebates and discounts7,185.6 5,853.0 Sales rebates and discounts8,568.4 6,845.8 
Dividends payableDividends payable 770.6 Dividends payable 885.5 
Income taxes payableIncome taxes payable203.5 495.1 Income taxes payable685.6 126.9 
Other current liabilitiesOther current liabilities2,326.5 2,750.3 Other current liabilities1,986.9 3,027.5 
Total current liabilitiesTotal current liabilities13,682.0 12,481.6 Total current liabilities15,652.8 15,052.7 
Other LiabilitiesOther LiabilitiesOther Liabilities
Long-term debtLong-term debt15,522.4 16,586.6 Long-term debt14,143.8 15,346.4 
Accrued retirement benefits (Note 8)Accrued retirement benefits (Note 8)3,878.8 4,094.5 Accrued retirement benefits (Note 8)1,832.5 1,954.1 
Long-term income taxes payableLong-term income taxes payable3,768.5 3,837.8 Long-term income taxes payable3,641.7 3,920.0 
Deferred tax liabilitiesDeferred tax liabilities1,632.5 2,099.9 Deferred tax liabilities171.9 1,733.7 
Other noncurrent liabilitiesOther noncurrent liabilities1,748.7 1,707.5 Other noncurrent liabilities1,852.9 1,644.3 
Total other liabilitiesTotal other liabilities26,550.9 28,326.3 Total other liabilities21,642.8 24,598.5 
Commitments and Contingencies (Note 9)Commitments and Contingencies (Note 9)00Commitments and Contingencies (Note 9)
Eli Lilly and Company Shareholders’ Equity
Eli Lilly and Company Shareholders' EquityEli Lilly and Company Shareholders' Equity
Common stockCommon stock598.2 598.2 Common stock594.1 596.3 
Additional paid-in capitalAdditional paid-in capital6,758.0 6,778.5 Additional paid-in capital6,829.0 6,833.4 
Retained earningsRetained earnings9,639.4 7,830.2 Retained earnings10,006.5 8,958.5 
Employee benefit trustEmployee benefit trust(3,013.2)(3,013.2)Employee benefit trust(3,013.2)(3,013.2)
Accumulated other comprehensive loss (Note 10)Accumulated other comprehensive loss (Note 10)(6,172.7)(6,496.4)Accumulated other comprehensive loss (Note 10)(4,295.8)(4,343.1)
Cost of common stock in treasuryCost of common stock in treasury(52.7)(55.7)Cost of common stock in treasury(50.5)(52.7)
Total Eli Lilly and Company shareholders’ equity7,757.0 5,641.6 
Total Eli Lilly and Company shareholders' equityTotal Eli Lilly and Company shareholders' equity10,070.1 8,979.2 
Noncontrolling interestsNoncontrolling interests197.1 183.6 Noncontrolling interests95.8 175.6 
Total equityTotal equity7,954.1 5,825.2 Total equity10,165.9 9,154.8 
Total liabilities and equityTotal liabilities and equity$48,187.0 $46,633.1 Total liabilities and equity$47,461.5 $48,806.0 
See notes to consolidated condensed financial statements.
7


Consolidated Condensed Statements of Equity
(Unaudited)
ELI LILLY AND COMPANY AND SUBSIDIARIES
Equity of Eli Lilly and Company ShareholdersEquity of Eli Lilly and Company Shareholders

(Dollars in millions, except per-share data, and shares in thousands)

(Dollars in millions, except per-share data, and shares in thousands)
Common StockAdditional
Paid-in
Capital
Retained
Earnings
Employee Benefit TrustAccumulated Other Comprehensive Loss
Common Stock in Treasury(1)
Noncontrolling Interests
(Dollars in millions, except per-share data, and shares in thousands)
Common StockAdditional
Paid-in
Capital
Retained
Earnings
Employee Benefit TrustAccumulated Other Comprehensive Loss
Common Stock in Treasury(1)
Noncontrolling Interests
SharesAmountSharesAmountSharesAmountSharesAmount
Balance at July 1, 2020956,953 $598.1 $6,629.4 $6,617.2 $(3,013.2)$(6,682.9)487 $(55.7)$179.1 
Net income (loss)1,208.4 (4.8)
Other comprehensive income, net of tax127.8 
Cash dividends declared per share: $0.74(671.6)
Issuance of stock under employee stock plans, net25 — (2.3)
Stock-based compensation71.7 
Other(5.2)
Balance at September 30, 2020956,978 $598.1 $6,698.8 $7,154.0 $(3,013.2)$(6,555.1)487 $(55.7)$169.1 
Balance at July 1, 2021Balance at July 1, 2021957,038 $598.1 $6,669.2 $8,530.1 $(3,013.2)$(6,287.1)463 $(52.7)$219.1 Balance at July 1, 2021957,038 $598.1 $6,669.2 $8,530.1 $(3,013.2)$(6,287.1)463 $(52.7)$219.1 
Net income (loss)Net income (loss)1,110.1 (22.6)Net income (loss)1,110.1 (22.6)
Other comprehensive income, net of taxOther comprehensive income, net of tax114.4 Other comprehensive income, net of tax114.4 
Issuance of stock under employee stock plans, netIssuance of stock under employee stock plans, net14 0.1 (1.3)
Stock-based compensationStock-based compensation90.1 
OtherOther(0.8)0.6 
Balance at September 30, 2021Balance at September 30, 2021957,052 $598.2 $6,758.0 $9,639.4 $(3,013.2)$(6,172.7)463 $(52.7)$197.1 
Balance at July 1, 2022Balance at July 1, 2022950,619 $594.1 $6,746.0 $8,556.0 $(3,013.2)$(4,287.7)450 $(50.5)$114.5 
Net income (loss)Net income (loss)1,451.7 (15.7)
Other comprehensive loss, net of taxOther comprehensive loss, net of tax(8.1)
Issuance of stock under employee stock plans, netIssuance of stock under employee stock plans, net14 0.1 (1.3)Issuance of stock under employee stock plans, net8 (2.1)
Stock-based compensationStock-based compensation90.1 Stock-based compensation85.1 
OtherOther(0.8)0.6 Other(1.2)(3.0)
Balance at September 30, 2021957,052 $598.2 $6,758.0 $9,639.4 $(3,013.2)$(6,172.7)463 $(52.7)$197.1 
Balance at September 30, 2022Balance at September 30, 2022950,627 $594.1 $6,829.0 $10,006.5 $(3,013.2)$(4,295.8)450 $(50.5)$95.8 
(1) As of September 30, 2021,2022, there were $500.0 million remaining under our $8.00 billion share repurchase program authorized in June 2018 and $5.00was $3.25 billion remaining under our $5.00 billion share repurchase program authorized in May 2021.
See notes to consolidated condensed financial statements.

8


Equity of Eli Lilly and Company ShareholdersEquity of Eli Lilly and Company Shareholders

(Dollars in millions, except per-share data, and shares in thousands)

(Dollars in millions, except per-share data, and shares in thousands)
Common StockAdditional
Paid-in
Capital
Retained
Earnings
Employee Benefit TrustAccumulated Other Comprehensive Loss
Common Stock in Treasury(1)
Noncontrolling Interests
(Dollars in millions, except per-share data, and shares in thousands)
Common StockAdditional
Paid-in
Capital
Retained
Earnings
Employee Benefit TrustAccumulated Other Comprehensive Loss
Common Stock in Treasury(1)
Noncontrolling Interests
SharesAmountSharesAmountSharesAmountSharesAmount
Balance at January 1, 2020958,056 $598.8 $6,685.3 $4,920.4 $(3,013.2)$(6,523.6)530 $(60.8)$92.2 
Net income4,076.9 95.9 
Other comprehensive loss, net of tax(31.5)
Cash dividends declared per share: $1.48(1,345.6)
Retirement of treasury shares(3,627)(2.3)(497.7)(3,627)500.0 
Purchase of treasury shares3,627 (500.0)
Issuance of stock under employee stock plans, net2,549 1.6 (206.4)(43)5.1 
Stock-based compensation220.3 
Other(0.4)(19.0)
Balance at September 30, 2020956,978 $598.1 $6,698.8 $7,154.0 $(3,013.2)$(6,555.1)487 $(55.7)$169.1 
Balance at January 1, 2021Balance at January 1, 2021957,077 $598.2 $6,778.5 $7,830.2 $(3,013.2)$(6,496.4)487 $(55.7)$183.6 Balance at January 1, 2021957,077 $598.2 $6,778.5 $7,830.2 $(3,013.2)$(6,496.4)487 $(55.7)$183.6 
Net incomeNet income3,855.6 25.2 Net income3,855.6 25.2 
Other comprehensive income, net of taxOther comprehensive income, net of tax323.7 Other comprehensive income, net of tax323.7 
Cash dividends declared per share: $1.70Cash dividends declared per share: $1.70(1,542.9)Cash dividends declared per share: $1.70(1,542.9)
Retirement of treasury sharesRetirement of treasury shares(2,467)(1.5)(498.5)(2,467)500.0 Retirement of treasury shares(2,467)(1.5)(498.5)(2,467)500.0 
Purchase of treasury sharesPurchase of treasury shares2,467 (500.0)Purchase of treasury shares2,467 (500.0)
Issuance of stock under employee stock plans, netIssuance of stock under employee stock plans, net2,442 1.5 (287.1)(24)3.0 Issuance of stock under employee stock plans, net2,442 1.5 (287.1)(24)3.0 
Stock-based compensationStock-based compensation267.5 Stock-based compensation267.5 
OtherOther(0.9)(5.0)(11.7)Other(0.9)(5.0)(11.7)
Balance at September 30, 2021Balance at September 30, 2021957,052 $598.2 $6,758.0 $9,639.4 $(3,013.2)$(6,172.7)463 $(52.7)$197.1 Balance at September 30, 2021957,052 $598.2 $6,758.0 $9,639.4 $(3,013.2)$(6,172.7)463 $(52.7)$197.1 
Balance at January 1, 2022Balance at January 1, 2022954,116 $596.3 $6,833.4 $8,958.5 $(3,013.2)$(4,343.1)463 $(52.7)$175.6 
Net income (loss)Net income (loss)4,307.1 (63.7)
Other comprehensive income, net of taxOther comprehensive income, net of tax47.3 
Cash dividends declared per share: $1.96Cash dividends declared per share: $1.96(1,765.9)
Retirement of treasury sharesRetirement of treasury shares(5,607)(3.5)(1,496.5)(5,607)1,500.0 
Purchase of treasury sharesPurchase of treasury shares5,607 (1,500.0)
Issuance of stock under employee stock plans, netIssuance of stock under employee stock plans, net2,118 1.3 (282.6)(13)2.2 
Stock-based compensationStock-based compensation278.2 
OtherOther3.3 (16.1)
Balance at September 30, 2022Balance at September 30, 2022950,627 $594.1 $6,829.0 $10,006.5 $(3,013.2)$(4,295.8)450 $(50.5)$95.8 
(1) As of September 30, 2021,2022, there were $500.0 million remaining under our $8.00 billion share repurchase program authorized in June 2018 and $5.00was $3.25 billion remaining under our $5.00 billion share repurchase program authorized in May 2021.
See notes to consolidated condensed financial statements.

9


Consolidated Condensed Statements of Cash Flows
(Unaudited)
ELI LILLY AND COMPANY AND SUBSIDIARIES
(Dollars in millions)
 
Nine Months Ended September 30,Nine Months Ended September 30,
20212020 20222021
Cash Flows from Operating ActivitiesCash Flows from Operating ActivitiesCash Flows from Operating Activities
Net incomeNet income$3,855.6 $4,076.9 Net income$4,307.1 $3,855.6 
Adjustments to Reconcile Net Income to Cash Flows from Operating Activities:Adjustments to Reconcile Net Income to Cash Flows from Operating Activities:Adjustments to Reconcile Net Income to Cash Flows from Operating Activities:
Depreciation and amortizationDepreciation and amortization1,101.9 956.4 Depreciation and amortization1,147.5 1,101.9 
Change in deferred income taxesChange in deferred income taxes(709.8)66.2 Change in deferred income taxes(2,195.6)(709.8)
Debt extinguishment loss (Note 6)Debt extinguishment loss (Note 6)405.2 — Debt extinguishment loss (Note 6) 405.2 
Stock-based compensation expenseStock-based compensation expense267.5 220.3 Stock-based compensation expense278.2 267.5 
Net investment gains(271.1)(909.5)
Acquired in-process research and development (Note 3)498.3 294.1 
Net investment (gains) lossesNet investment (gains) losses676.4 (271.1)
Acquired in-process research and developmentAcquired in-process research and development252.0 498.3 
Other changes in operating assets and liabilities, net of acquisitions and divestituresOther changes in operating assets and liabilities, net of acquisitions and divestitures(548.1)(232.2)Other changes in operating assets and liabilities, net of acquisitions and divestitures821.5 (548.1)
Other non-cash operating activities, netOther non-cash operating activities, net504.7 212.2 Other non-cash operating activities, net217.6 504.7 
Net Cash Provided by Operating ActivitiesNet Cash Provided by Operating Activities5,104.2 4,684.4 Net Cash Provided by Operating Activities5,504.7 5,104.2 
Cash Flows from Investing ActivitiesCash Flows from Investing ActivitiesCash Flows from Investing Activities
Net purchases of property and equipmentNet purchases of property and equipment(1,018.4)(933.2)Net purchases of property and equipment(1,353.6)(1,018.4)
Proceeds from sales and maturities of short-term investmentsProceeds from sales and maturities of short-term investments46.6 118.8 Proceeds from sales and maturities of short-term investments83.1 46.6 
Purchases of short-term investmentsPurchases of short-term investments(27.9)(11.4)Purchases of short-term investments(65.0)(27.9)
Proceeds from sales of noncurrent investmentsProceeds from sales of noncurrent investments537.2 574.1 Proceeds from sales of noncurrent investments251.6 537.2 
Purchases of noncurrent investmentsPurchases of noncurrent investments(710.1)(223.7)Purchases of noncurrent investments(474.1)(710.1)
Cash paid for acquisitions, net of cash acquired (Note 3)Cash paid for acquisitions, net of cash acquired (Note 3)(747.4)(849.3)Cash paid for acquisitions, net of cash acquired (Note 3) (747.4)
Purchases of in-process research and developmentPurchases of in-process research and development(460.6)(276.4)Purchases of in-process research and development(574.8)(460.6)
Other investing activities, netOther investing activities, net(2.7)16.3 Other investing activities, net(268.3)(2.7)
Net Cash Used for Investing ActivitiesNet Cash Used for Investing Activities(2,383.3)(1,584.8)Net Cash Used for Investing Activities(2,401.1)(2,383.3)
Cash Flows from Financing ActivitiesCash Flows from Financing ActivitiesCash Flows from Financing Activities
Dividends paidDividends paid(2,313.5)(2,017.1)Dividends paid(2,651.4)(2,313.5)
Net change in short-term borrowingsNet change in short-term borrowings(1.5)(914.3)Net change in short-term borrowings1,741.3 (1.5)
Proceeds from issuance of long-term debtProceeds from issuance of long-term debt2,410.8 2,062.3 Proceeds from issuance of long-term debt 2,410.8 
Repayments of long-term debtRepayments of long-term debt(1,905.3)(276.3)Repayments of long-term debt(1,560.0)(1,905.3)
Purchases of common stockPurchases of common stock(500.0)(500.0)Purchases of common stock(1,500.0)(500.0)
Other financing activities, netOther financing activities, net(295.3)(200.2)Other financing activities, net(295.2)(295.3)
Net Cash Used for Financing ActivitiesNet Cash Used for Financing Activities(2,604.8)(1,845.6)Net Cash Used for Financing Activities(4,265.3)(2,604.8)
Effect of exchange rate changes on cash and cash equivalentsEffect of exchange rate changes on cash and cash equivalents15.0 3.8 Effect of exchange rate changes on cash and cash equivalents(39.4)15.0 
Net increase in cash and cash equivalents131.1 1,257.8 
Net decrease in cash and cash equivalentsNet decrease in cash and cash equivalents(1,201.1)131.1 
Cash and cash equivalents at January 1Cash and cash equivalents at January 13,657.1 2,337.5 Cash and cash equivalents at January 13,818.5 3,657.1 
Cash and Cash Equivalents at September 30Cash and Cash Equivalents at September 30$3,788.2 $3,595.3 Cash and Cash Equivalents at September 30$2,617.4 $3,788.2 
See notes to consolidated condensed financial statements.


10


Notes to Consolidated Condensed Financial Statements
(Tables present dollars in millions, except per-share data)
Note 1: Basis of Presentation and Implementation of New Financial Accounting Standard
We have prepared the accompanying unaudited consolidated condensed financial statements in accordance with the requirements of Form 10-Q and, therefore, they do not include all information and footnotes necessary for a fair presentation of financial position, results of operations, and cash flows in conformity with accounting principles generally accepted in the United States (GAAP). In our opinion, the consolidated condensed financial statements reflect all adjustments (including those that are normal and recurring) that are necessary for a fair presentation of the results of operations for the periods shown. In preparing financial statements in conformity with GAAP, we must make estimates and assumptions that affect the reported amounts of assets, liabilities, revenue, expenses, and related disclosures at the date of the financial statements and during the reporting period. Actual results could differ from those estimates.
The information included in this Quarterly Report on Form 10-Q should be read in conjunction with our consolidated financial statements and accompanying notes included in our Annual Report on Form 10-K for the year ended December 31, 2020.2021. We issue our financial statements by filing them with the Securities and Exchange Commission and have evaluated subsequent events up to the time of the filing of this Quarterly Report on Form 10-Q.
Certain reclassifications have been made to prior periods in the consolidated condensed financial statements and accompanying notes to conform with the current presentation.
All per-share amounts, unless otherwise noted in the footnotes, are presented on a diluted basis; that is, based on the weighted-average number of common shares outstanding plus the effect of incremental shares from our stock-based compensation programs.
We operate as a single operating segment engaged in the discovery, development, manufacturing, marketing, and sales of pharmaceutical products worldwide. A global research and development organization and a supply chain organization are responsible for the discovery, development, manufacturing, and supply of our products. Regional commercial organizations market, distribute, and sell the products. The business is also supported by global corporate staff functions. Our determination that we operate as a single segment is consistent with the financial information regularly reviewed by the chief operating decision maker for purposes of evaluating performance, allocating resources, setting incentive compensation targets, and planning and forecasting for future periods.
Research and Development Expenses and Acquired In-Process Research and Development (IPR&D) and Development Milestones
Research and development costs are expensed as incurred. Research and development costs consist of expenses incurred in performing research and development activities, including but not limited to, compensation and benefits, facilities and overhead expense, clinical trial expense, and fees paid to contract research organizations.
Acquired IPR&D and development milestones include the initial costs of externally developed IPR&D projects, acquired directly in a transaction other than a business combination, that do not have an alternative future use. Additionally, milestone payment obligations related to these transactions that are incurred prior to regulatory approval of the compound are expensed when the event triggering an obligation to pay the milestone occurs.
Implementation of New Financial Accounting Standard

Accounting Standards Update 2021-01,
Reference Rate Reform, provides for temporary optional expedients and exceptions in applying current GAAP to contracts, hedging relationships, and other transactions affected by the transition from the use of the London Interbank Offered Rate (LIBOR) to an alternative reference rate. The standard is currently applicable to contracts entered into before January 1, 2023. We adopted the standard in the first quarter of 2022. The adoption did not have a material impact on our consolidated condensed financial statements.


11


Note 2: Revenue
The following table summarizes our revenue recognized in our consolidated condensed statements of operations:
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended September 30,Nine Months Ended September 30,
2021202020212020 2022202120222021
Net product revenueNet product revenue$6,189.0 $5,281.1 $18,579.5 $15,762.3 Net product revenue$6,119.2 $6,189.0 $19,123.0 $18,579.5 
Collaboration and other revenue (1)
Collaboration and other revenue (1)
583.8 459.5 1,739.0 1,337.5 
Collaboration and other revenue(1)
822.4 583.8 2,116.6 1,739.0 
RevenueRevenue$6,772.8 $5,740.6 $20,318.5 $17,099.8 Revenue$6,941.6 $6,772.8 $21,239.6 $20,318.5 
(1) Collaboration and other revenue associated with prior period transfers of intellectual property was $43.3 million and $130.9 million during the three and nine months ended September 30, 2022, respectively, and $62.1 million and $136.1 million during the three and nine months ended September 30, 2021, respectively, and $31.5 million and $101.5 million during the three and nine months ended September 30, 2020, respectively.
We recognize revenue primarily from two different types of contracts, product sales to customers (net product revenue) and collaborations and other arrangements. Revenue recognized from collaborations and other arrangements includes our share of profits from the collaboration,collaborations, as well as royalties, upfront and milestone payments we receive under these types of contracts. See Note 4 for additional information related to certain of our collaborations and other arrangements. Collaboration and other revenue disclosed above includes the revenue from the Jardiance® and Trajenta® families of products resulting from our collaboration with Boehringer Ingelheim discussed in Note 4. Substantially all of the remainder of collaboration and other revenue is related to contracts accounted for as contracts with customers.
Adjustments to Revenue
Adjustments to increase (decrease) revenue recognized as a result of changes in estimates for our most significant United States (U.S.) sales returns, rebates, and discounts liability balances for products shipped in previous periods were 3 percent of U.S. revenue for the three months ended September 30, 2022 and less than 1 percent of U.S. revenue during each ofthe nine months ended September 30, 2022 and the three and nine months ended September 30, 2021, and approximately (1) percent and 1 percent of U.S. revenue for the three and nine months ended September 30, 2020, respectively.2021.
Contract Liabilities
Our contract liabilities result from arrangements where we have received payment in advance of performance under the contract and do not include sales returns, rebates, and discounts. Changes in contract liabilities are generally due to either receipt of additional advance payments or our performance under the contract.
The following table summarizes contract liability balances:
 September 30, 2021December 31, 2020
Contract liabilities$278.4 $276.8 
 September 30, 2022December 31, 2021
Contract liabilities$232.5 $262.6 
During the three and nine months ended September 30, 20212022 and 2020,2021, revenue recognized from contract liabilities as of the beginning of the respective year was not material. Revenue expected to be recognized in the future from contract liabilities as the related performance obligations are satisfied is not expected to be material in any one year.

12


Disaggregation of Revenue
The following table summarizes revenue by product for the three months ended September 30, 20212022 and 2020:2021:
Three Months Ended September 30,Three Months Ended September 30,
20212020 20222021
U.S.Outside U.S.TotalU.S.Outside U.S.TotalU.S.Outside U.S.TotalU.S.Outside U.S.Total
Revenue—to unaffiliated customers:Revenue—to unaffiliated customers:Revenue—to unaffiliated customers:
Diabetes:Diabetes:Diabetes:
Trulicity®
Trulicity®
$1,201.4 $398.8 $1,600.1 $791.2 $315.4 $1,106.6 
Trulicity®
$1,418.3 $432.0 $1,850.4 $1,201.4 $398.8 $1,600.1 
Humalog® (1)
347.3 279.4 626.7 390.1 266.9 656.9 
Jardiance (2)
221.2 169.2 390.4 163.3 147.5 310.8 
Jardiance(1)
Jardiance(1)
350.9 222.4 573.3 221.2 169.2 390.4 
Humalog® (2)
Humalog® (2)
248.1 198.8 447.0 347.3 279.4 626.7 
Humulin®
Humulin®
193.4 93.4 286.7 214.0 91.9 305.9 
Humulin®
169.5 68.7 238.2 193.4 93.4 286.7 
Basaglar®
Basaglar®
114.7 78.1 192.8 178.5 69.7 248.2 
Basaglar®
124.8 68.1 193.0 114.7 78.1 192.8 
Other Diabetes65.0 112.2 177.4 61.4 93.1 154.6 
Total Diabetes2,143.0 1,131.1 3,274.1 1,798.5 984.5 2,783.0 
Mounjaro®
Mounjaro®
97.3 90.0 187.3 — — — 
Other diabetesOther diabetes79.7 94.0 173.4 65.0 112.2 177.4 
Total diabetesTotal diabetes2,488.6 1,174.0 3,662.6 2,143.0 1,131.1 3,274.1 
Oncology:Oncology:Oncology:
Alimta®
297.2 159.8 457.0 291.9 286.1 578.0 
Verzenio®
Verzenio®
199.6 135.9 335.5 158.9 75.5 234.4 
Verzenio®
414.8 202.9 617.7 199.6 135.9 335.5 
Cyramza®
Cyramza®
84.8 168.6 253.4 94.5 158.2 252.7 
Cyramza®
87.5 144.6 232.1 84.8 168.6 253.4 
Erbitux®
Erbitux®
114.0 20.3 134.3 122.5 14.0 136.4 
Erbitux®
126.3 18.7 144.9 114.0 20.3 134.3 
Alimta®
Alimta®
64.6 54.8 119.4 297.2 159.8 457.0 
Tyvyt®
Tyvyt®
 125.6 125.6 — 84.4 84.4 
Tyvyt®
 76.8 76.8 — 125.6 125.6 
Other Oncology35.3 65.1 100.3 14.7 32.7 47.5 
Total Oncology730.9 675.3 1,406.1 682.5 650.9 1,333.4 
Other oncologyOther oncology39.5 62.8 102.4 35.3 65.1 100.3 
Total oncologyTotal oncology732.7 560.6 1,293.3 730.9 675.3 1,406.1 
Immunology:Immunology:Immunology:
Taltz®
Taltz®
422.2 170.9 593.1 326.2 128.3 454.5 
Taltz®
493.8 186.1 679.9 422.2 170.9 593.1 
Olumiant® (3)
Olumiant® (3)
194.0 212.9 406.9 14.5 147.5 162.0 
Olumiant® (3)
22.9 160.0 182.9 194.0 212.9 406.9 
Other Immunology 4.9 4.9 6.1 4.5 10.6 
Total Immunology616.2 388.7 1,004.9 346.8 280.3 627.1 
Other immunologyOther immunology 3.6 3.6 — 4.9 4.9 
Total immunologyTotal immunology516.7 349.7 866.4 616.2 388.7 1,004.9 
Neuroscience:Neuroscience:Neuroscience:
Emgality®
Emgality®
99.9 40.1 140.0 81.4 10.1 91.5 
Emgality®
114.0 54.6 168.5 99.9 40.1 140.0 
Zyprexa®
Zyprexa®
8.0 73.4 81.4 13.0 88.7 101.7 
Cymbalta®
Cymbalta®
7.0 125.1 132.0 11.1 175.5 186.6 
Cymbalta®
7.8 54.9 62.7 7.0 125.1 132.0 
Zyprexa®
13.0 88.7 101.7 21.2 91.5 112.7 
Other Neuroscience24.7 51.6 76.5 26.7 53.2 79.9 
Total Neuroscience144.6 305.5 450.2 140.4 330.3 470.7 
Other neuroscienceOther neuroscience16.0 44.5 60.6 24.7 51.6 76.5 
Total neuroscienceTotal neuroscience145.8 227.4 373.2 144.6 305.5 450.2 
Other:Other:Other:
COVID-19 Antibodies (4)
215.5 1.6 217.1 — — — 
COVID-19 antibodies(4)
COVID-19 antibodies(4)
386.6  386.6 215.5 1.6 217.1 
Forteo®
Forteo®
109.6 91.3 200.9 144.6 122.3 266.9 
Forteo®
112.7 64.4 177.1 109.6 91.3 200.9 
Cialis®
Cialis®
(6.5)137.4 130.9 15.1 147.3 162.5 
Cialis®
8.1 107.7 115.7 (6.5)137.4 130.9 
OtherOther36.3 52.4 88.8 33.5 63.6 97.0 Other30.9 35.7 66.6 36.3 52.4 88.8 
Total Other354.9 282.7 637.7 193.2 333.2 526.4 
Total otherTotal other538.3 207.8 746.0 354.9 282.7 637.7 
RevenueRevenue$3,989.6 $2,783.3 $6,772.8 $3,161.4 $2,579.3 $5,740.6 Revenue$4,422.1 $2,519.4 $6,941.6 $3,989.6 $2,783.3 $6,772.8 
Numbers may not add due to rounding.
(1)Humalog revenue includes insulin lispro.
(2) Jardiance revenue includes Glyxambi®, Synjardy®, and Trijardy® XR.
(2) Humalog revenue includes insulin lispro.
(3) Olumiant revenue includes sales for baricitinib for treatment in hospitalized COVID-19 patients, that were made pursuant to Emergency Use Authorization (EUA). or similar regulatory authorizations.
(4) COVID-19 antibodies include sales for bamlanivimab administered alone, as well as sales for bamlanivimab and etesevimab administered together, and for bebtelovimab and were made pursuant to EUAs.



EUAs or similar regulatory authorizations.
13




The following table summarizes revenue by product for the nine months ended September 30, 20212022 and 2020:2021:
Nine Months Ended September 30,Nine Months Ended September 30,
20212020 20222021
U.S.Outside U.S.TotalU.S.Outside U.S.TotalU.S.Outside U.S.TotalU.S.Outside U.S.Total
Revenue—to unaffiliated customers:Revenue—to unaffiliated customers:Revenue—to unaffiliated customers:
Diabetes:Diabetes:Diabetes:
TrulicityTrulicity$3,465.7 $1,122.5 $4,588.2 $2,673.2 $892.5 $3,565.7 Trulicity$4,162.4 $1,341.1 $5,503.5 $3,465.7 $1,122.5 $4,588.2 
Humalog (1)
Humalog (1)
1,009.0 842.3 1,851.3 1,070.4 837.4 1,907.8 
Humalog(1)
855.8 656.4 1,512.3 1,009.0 842.3 1,851.3 
Jardiance (2)
Jardiance (2)
566.8 492.1 1,058.9 453.0 387.3 840.3 
Jardiance(2)
831.4 622.4 1,453.7 566.8 492.1 1,058.9 
HumulinHumulin633.5 290.3 923.8 642.5 292.7 935.2 Humulin562.3 223.1 785.4 633.5 290.3 923.8 
BasaglarBasaglar423.3 226.8 650.1 638.7 203.7 842.3 Basaglar339.9 218.8 558.7 423.3 226.8 650.1 
Other Diabetes185.7 302.6 488.3 185.2 254.4 439.6 
Total Diabetes6,284.0 3,276.6 9,560.6 5,663.0 2,868.0 8,530.9 
MounjaroMounjaro109.9 93.3 203.2 — — — 
Other diabetesOther diabetes195.6 276.5 472.2 185.7 302.6 488.3 
Total diabetesTotal diabetes7,057.3 3,431.6 10,489.0 6,284.0 3,276.6 9,560.6 
Oncology:Oncology:Oncology:
Alimta911.9 714.7 1,626.6 933.4 743.8 1,677.2 
VerzenioVerzenio582.1 363.7 945.8 430.0 201.1 631.1 Verzenio1,100.5 575.1 1,675.6 582.1 363.7 945.8 
CyramzaCyramza266.3 496.3 762.5 277.6 470.8 748.4 Cyramza259.3 434.3 693.6 266.3 496.3 762.5 
AlimtaAlimta490.5 200.5 691.1 911.9 714.7 1,626.6 
ErbituxErbitux357.7 45.9 403.7 356.1 40.6 396.7 Erbitux361.0 47.4 408.3 357.7 45.9 403.7 
TyvytTyvyt 340.2 340.2 — 205.9 205.9 Tyvyt 235.8 235.8 — 340.2 340.2 
Other Oncology83.7 169.9 253.6 26.0 118.2 144.2 
Total Oncology2,201.7 2,130.7 4,332.4 2,023.1 1,780.4 3,803.5 
Other oncologyOther oncology124.1 186.5 310.6 83.7 169.9 253.6 
Total oncologyTotal oncology2,335.4 1,679.6 4,015.0 2,201.7 2,130.7 4,332.4 
Immunology:Immunology:Immunology:
TaltzTaltz1,071.6 493.8 1,565.4 942.9 350.3 1,293.2 Taltz1,212.6 561.6 1,774.2 1,071.6 493.8 1,565.4 
Olumiant (3)
Olumiant (3)
236.5 572.6 809.1 39.0 407.7 446.7 
Olumiant(3)
104.6 520.1 624.7 236.5 572.6 809.1 
Other Immunology15.2 14.5 29.7 13.2 8.1 21.3 
Total Immunology1,323.3 1,080.9 2,404.2 995.1 766.1 1,761.2 
Other immunologyOther immunology0.1 12.1 12.1 15.2 14.5 29.7 
Total immunologyTotal immunology1,317.3 1,093.8 2,411.0 1,323.3 1,080.9 2,404.2 
Neuroscience:Neuroscience:Neuroscience:
Cymbalta30.3 454.0 484.3 30.5 546.5 576.9 
EmgalityEmgality313.5 102.2 415.7 229.3 23.6 252.9 Emgality330.8 144.4 475.2 313.5 102.2 415.7 
ZyprexaZyprexa28.3 264.5 292.8 41.5 266.2 307.7 Zyprexa26.2 235.5 261.7 28.3 264.5 292.8 
CymbaltaCymbalta25.0 194.3 219.3 30.3 454.0 484.3 
Other Neuroscience81.0 154.0 235.0 53.4 165.7 219.2 
Total Neuroscience453.1 974.7 1,427.8 354.7 1,002.0 1,356.7 
Other neuroscienceOther neuroscience62.0 142.7 204.7 81.0 154.0 235.0 
Total neuroscienceTotal neuroscience444.0 716.9 1,160.9 453.1 974.7 1,427.8 
Other:Other:Other:
COVID-19 Antibodies (4)
949.5 226.7 1,176.2— — — 
COVID-19 antibodies(4)
COVID-19 antibodies(4)
1,970.9 14.7 1,985.5 949.5 226.7 1,176.2 
CialisCialis25.8 454.7 480.4 (3.1)541.8 538.7 
ForteoForteo330.1 287.7 617.8 386.7 405.2 791.9 Forteo261.4 191.7 453.0 330.1 287.7 617.8 
Cialis(3.1)541.8 538.7 64.6 421.6 486.2 
OtherOther96.5 164.3 260.8 144.2 225.2 369.4 Other119.4 125.1 244.8 96.5 164.3 260.8 
Total Other1,373.0 1,220.5 2,593.5 595.5 1,052.0 1,647.5 
Total otherTotal other2,377.5 786.2 3,163.7 1,373.0 1,220.5 2,593.5 
RevenueRevenue$11,635.1 $8,683.4 $20,318.5 $9,631.4 $7,468.5 $17,099.8 Revenue$13,531.5 $7,708.1 $21,239.6 $11,635.1 $8,683.4 $20,318.5 
Numbers may not add due to rounding.
(1) Humalog revenue includes insulin lispro.
(2) Jardiance revenue includes Glyxambi, Synjardy,and Trijardy XR.
(3) Olumiant revenue includes sales for baricitinib for treatment in hospitalized COVID-19 patients, that were made pursuant to EUA.EUA or similar regulatory authorizations.
(4) COVID-19 antibodies include sales for bamlanivimab administered alone, as well as sales for bamlanivimab and etesevimab administered together, and for bebtelovimab and were made pursuant to EUAs.


EUAs or similar regulatory authorizations.
14


The following table summarizes revenue by geographical area:
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended September 30,Nine Months Ended September 30,
20212020202120202022202120222021
Revenue—to unaffiliated customers (1):
Revenue—to unaffiliated customers (1):
Revenue—to unaffiliated customers(1):
U.S.U.S.$3,989.6 $3,161.4 $11,635.1 $9,631.4 U.S.$4,422.1 $3,989.6 $13,531.5 $11,635.1 
EuropeEurope1,098.6 1,046.7 3,629.6 2,984.4 Europe1,056.4 1,098.6 3,224.8 3,629.6 
JapanJapan595.0 660.1 1,832.2 1,919.1 Japan487.7 595.0 1,352.3 1,832.2 
ChinaChina400.3 289.1 1,285.0 796.2 China343.4 400.3 1,102.0 1,285.0 
Other foreign countriesOther foreign countries689.4 583.2 1,936.7 1,768.7 Other foreign countries632.0 689.4 2,029.1 1,936.7 
RevenueRevenue$6,772.8 $5,740.6 $20,318.5 $17,099.8 Revenue$6,941.6 $6,772.8 $21,239.6 $20,318.5 
Numbers may not add due to rounding.
(1) Revenue is attributed to the countries based on the location of the customer.

Note 3: Acquisitions
We engage in various forms of business development activities to enhance our product pipeline, including acquisitions, collaborations, investments, and licensing arrangements. In connection with these arrangements, our partners may be entitled to future royalties and/or commercial milestones based on sales should products be approved for commercialization and/or milestones based on the successful progress of compounds through the development process.
In January 2021, and February 2020, we completed the acquisitionsacquisition of Prevail Therapeutics Inc. (Prevail) and Dermira, Inc. (Dermira), respectively. These transactions,. This transaction, as further discussed in this note below in AcquisitionsAcquisition of Businesses, werea Business, was accounted for as a business combinationscombination under the acquisition method of accounting. Under this method, the assets acquired and liabilities assumed were recorded at their respective fair values as of the acquisition date in our consolidated condensed financial statements. The determination of estimated fair value required management to make significant estimates and assumptions. The excess of the purchase price over the fair value of the acquired net assets, where applicable, has been recorded as goodwill. The results of operations of these acquisitions arethis acquisition is included in our consolidated condensed financial statements from the date of acquisition.
We also acquired assets in development which are further discussed in this note below in Asset Acquisitions. Upon each acquisition, the cost allocated to acquired in-process research and development (IPR&D) wasIPR&D is immediately expensed becauseif the compound hadhas no alternative future use. Milestone payment obligations incurred prior to regulatory approval of the compound are expensed when the event triggering an obligation to pay the milestone occurs. We recognized acquired IPR&D and development milestone charges of $174.0$62.4 million and $498.3$668.4 million for the three and nine months ended September 30, 2022, respectively, and $177.6 million and $532.4 million for the three and nine months ended September 30, 2021, respectively, and $294.1 million for the nine months ended September 30, 2020. There were no acquired IPR&D charges recognized in the three months ended September 30, 2020.respectively.
AcquisitionsAcquisition of Businessesa Business
Prevail Acquisition
Overview of Transaction
In January 2021, we acquired all shares of Prevail for a purchase price that included $22.50 per share in cash (or an aggregate of $747.4 million, net of cash acquired) plus 1one non-tradable contingent value right (CVR) per share. The CVR entitles Prevail stockholders up to an additional $4.00 per share in cash (or an aggregate of approximately $160 million) payable, subject to certain terms and conditions, upon the first regulatory approval of a Prevail product in one of the following countries: U.S., Japan, United Kingdom, Germany, France, Italy, or Spain. To achieve the full value of the CVR, such regulatory approval must occur by December 31, 2024. If such regulatory approval occurs after December 31, 2024, the value of the CVR will be reduced by approximately 8.3 cents per month until December 1, 2028, at which point the CVR will expire without payment.
Under the terms of the agreement, we acquired potentially disease-modifying AAV9-based gene therapies for patients with neurodegenerative diseases. The acquisition establishesestablished a new modality for drug discovery and development, extending our research efforts through the creation of a gene therapy program that is being anchored by Prevail’sPrevail's portfolio of assets. The lead gene therapies in clinical development that we acquired were PR001 for patients with Parkinson’sParkinson's disease with GBA1 mutations and neuronopathic Gaucher disease and PR006 for patients with frontotemporal dementia with GRN mutations. Both PR001 and PR006 were granted Fast Track designation from the U.S. Food and Drug Administration (FDA).
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Assets Acquired and Liabilities Assumed
Our access to Prevail information was limited prior to the acquisition. As a consequence, we are in the process of determining fair values and tax bases of a significant portion of the assets acquired and liabilities assumed, including the identification and valuation of intangible assets and tax exposures. The final determination of these amounts will be completed as soon as possible but no later than one year from the acquisition date. The final determination may result in asset and liability fair values and tax bases that differ from the preliminary estimates and require changes to the preliminary amounts recognized.
The following table summarizes the preliminary amounts recognized for assets acquired and liabilities assumed as of the acquisition date:
Estimated Fair Value at January 22, 2021
Cash$90.5 
Acquired IPR&D(1)
824.0
Goodwill(2)
118.8126.8
Deferred tax liabilities(98.0)(106.0)
Other assets and liabilities, net(31.5)
Acquisition date fair value of consideration transferred903.8
Less:
Cash acquired(90.5)
Fair value of CVR liability(3)
(65.9)
Cash paid, net of cash acquired$747.4 
(1) Acquired IPR&D intangibles primarily relate to PR001. In the third quarter of 2022, we impaired the intangible asset related to PR001. See Note 5 for additional information.
(2) The goodwill recognized from this acquisition is not deductible for tax purposes.
(3) See Note 6 for a discussion on the estimation of the CVR liability.
We are unable to provide the results of operations for the three and nine months ended September 30, 2022 and 2021 attributable to Prevail as those operations were substantially integrated into our legacy business.
Pro forma information has not been included as this acquisition did not have a material impact on our consolidated condensed statements of operations for the three and nine months ended September 30, 2021 and 2020.
Dermira Acquisition
Overview of Transaction
In February 2020, we acquired all shares of Dermira for a purchase price of approximately $849.3 million, net of cash acquired. Under the terms of the agreement, we acquired lebrikizumab, a novel, investigational, monoclonal antibody being evaluated for the treatment of moderate-to-severe atopic dermatitis. Lebrikizumab was granted Fast Track designation from the FDA. We also acquired Qbrexza® (glycopyrronium) cloth, a medicated cloth approved by the FDA for the topical treatment of primary axillary hyperhidrosis (uncontrolled excessive underarm sweating). During the nine months ended September 30, 2021, we sold the rights to Qbrexza. See Note 5 for additional information.
Assets Acquired and Liabilities Assumed
The fair values recognized related to the assets acquired and liabilities assumed in this acquisition included goodwill of $86.8 million, other intangibles of $1.20 billion primarily related to lebrikizumab, deferred income tax liabilities of $49.5 million, and long-term debt of $375.5 million. After the acquisition, we repaid $276.2 million of long-term debt assumed as part of our acquisition of Dermira.

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2021.
Asset Acquisitions
The following table summarizes our significant asset acquisitions during the nine months ended September 30, 20212022 and 2020:2021:
CounterpartyCompound(s), Therapy or TherapyAssetAcquisition Month
Phase of Development(1)
Acquired IPR&D Expense
Precision Biosciences,BioMarin Pharmaceutical Inc.Potential in vivo therapies for genetic disordersPriority Review VoucherJanuary 2021February 2022Pre-clinicalNot applicable$107.8110.0 
Merus N.V.CD3-engaging T-cell re-directing bispecific antibodies for the potential treatment of cancerJanuary 2021Pre-clinical46.5
Asahi Kasei Pharma CorporationAK1780, an orally bioavailable P2X7 receptor antagonist for the potential treatment of chronic pain conditionsJanuary 2021Phase I20.0
Rigel Pharmaceuticals, Inc.R552, a receptor-interacting serine/threonine-protein kinase 1 (RIPK1) inhibitor, for the potential treatment of autoimmune and inflammatory diseasesMarch 2021Phase I125.0 
MiNA Therapeutics LimitedPrecision Biosciences, Inc.Pre-clinical targets that could lead to potential new medicinesPotential in vivo therapies for genetic disordersMayJanuary 2021Pre-clinical25.0107.8 
Protomer Technologies Inc.Glucose-sensing insulin programJuly 2021Pre-clinical57.3
Kumquat Biosciences Inc.Pre-clinical small molecules that stimulate tumor-specific immune responsesJuly 2021Pre-clinical55.0
Lycia Therapeutics, Inc.Several potential modalities across a spectrum of therapeutic areas and diseasesAugust 2021Pre-clinical35.0
ProQR Therapeutics N.V.Pre-clinical targets that could lead to potential new medicines for genetic disorders in the liver and nervous systemSeptember 2021Pre-clinical26.7
Sitryx Therapeutics LimitedPre-clinical targets that could lead to potential new medicines for autoimmune diseasesMarch 2020Pre-clinical52.3 
AbCellera Biologics Inc. (AbCellera)(2)
Neutralizing antibodies for the treatment and prevention of COVID-19March 2020Pre-clinical25.0 
Shanghai Junshi Biosciences Co., Ltd. (Junshi Biosciences)Neutralizing antibodies for the treatment and prevention of COVID-19May 2020Pre-clinical20.0 
Petra Pharma Corporation (Petra)
Mutant-selective PI3Kα inhibitor that could lead to potential new medicine
May 2020Pre-clinical174.8 
Evox Therapeutics LimitedPre-clinical targets for the potential treatment of neurological disordersJune 2020Pre-clinical22.0 
(1) The phase of development presented is as of the date of the arrangement and represents the phase of development of the most advanced asset acquired, where applicable.
(2) We recognized an acquired IPR&D expense of $25.0 million in May 2020 upon closing of the transaction.
In connection with our acquisition of Petra Pharma Corporation (Petra), we were required to make milestone payments to Petra shareholders contingent upon the occurrence of certain future events linked to the success of the mutant-selective PI3Kα inhibitor. In the second quarter of 2022, we entered into agreements with substantially all Petra shareholders to acquire their rights to receive any future milestone payments in exchange for a one-time payment. As a result of these arrangements, our partners mayagreements, we recognized a charge of $333.8 million as a development milestone during the nine months ended September 30, 2022. Any remaining contingent milestones payments linked to the success of the mutant-selective PI3Kα are not expected to be entitled to future royalties and/or commercialmaterial. We recognized no other significant development milestones based on sales should products be approved for commercialization and/or milestones based onduring the successful progress of compounds through the development process.three and nine months ended September 30, 2022 and 2021.
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Subsequent Event - Akouos, Inc. (Akouos) Acquisition
On October 17, 2022, we entered into a definitive agreement to acquire Akouos. Pursuant to the terms of the agreement, we have commenced a tender offer to acquire all outstanding shares of Akouos for a purchase price of $12.50 per share in cash (an aggregate of approximately $487 million), payable at closing, plus one non-tradable CVR per share that will entitle the holder to receive up to an additional $3.00 per CVR in cash (an aggregate of up to approximately $123 million) upon the achievement of certain specified milestones. The acquisition will expand our gene therapy portfolio to include potential treatments for hearing loss and other inner ear conditions. The acquisition is not subject to any financing condition and is expected to close in the fourth quarter of 2022, subject to customary closing conditions, including receipt of required antitrust clearance and the tender of a majority of the outstanding shares of Akouos's common stock.

Note 4: Collaborations and Other Arrangements
We often enter into collaborative and other similar arrangements to develop and commercialize drug candidates. Collaborative activities may include research and development, marketing and selling (including promotional activities and physician detailing), manufacturing, and distribution. These arrangements often require milestone as well as royalty or profit-share payments, contingent upon the occurrence of certain future events linked to the success of the asset in development, as well as expense reimbursements from or payments to the collaboration partner. See Note 2 for amounts of collaboration and other revenue recognized from these types of arrangements.
Operating expenses for costs incurred pursuant to these arrangements are reported in their respective expense line item, net of any payments due to or reimbursements due from our collaboration partners, with such reimbursements being recognized at the time the party becomes obligated to pay. Each collaboration is unique in nature, and our more significant arrangements are discussed below.
Boehringer Ingelheim Diabetes Collaboration
We and Boehringer Ingelheim have a global agreement to jointly develop and commercialize a portfolio of diabetes compounds. Currently included in the collaboration are Boehringer Ingelheim’sIngelheim's oral diabetes products: Jardiance, Glyxambi, Synjardy, Trijardy XR, Trajenta, and Jentadueto® as well as our basal insulin, Basaglar. Glyxambi, Synjardy, and Trijardy XR are included in the Jardiance product family. Jentadueto is included in the Trajenta product family.
The table below summarizes the net amount of significant milestones capitalized (deferred) at September 30, 2021 and December 31, 2020 for the compounds included in this collaboration:
Net Milestones Capitalized (Deferred) (1) as of:
Product FamilySeptember 30, 2021December 31, 2020
Jardiance (2)
$141.1 $156.2 
Trajenta (3)
95.1 114.6 
Basaglar(154.0)(168.0)
(1) In connection with the regulatory approvals of Jardiance, Trajenta, and Trajenta,Basaglar in the U.S., Europe, and Japan, milestone payments made for Jardiance and Trajenta were capitalized as intangible assets and are being amortized to cost of sales, through the term of the collaboration. In connection with the regulatory approvals of Basaglar,and milestone payments received for Basaglar were recorded as contract liabilities and are being amortized through the term of the collaboration (2029) to collaboration and other revenue. The milestones pertaining to Jardiance and Trajenta are being amortized through their respective term under the collaboration, which, depending on country or region, is determined based on the latest to occur of (a) a defined number of years following launch date, (b) the expiration of the compound patent, or (c) the expiration of marketing authorization exclusivity. The milestones pertaining to Basaglar are being amortized through 2029. The table below summarizes the net milestones capitalized with respect to the Jardiance and Trajenta families of products and the net milestones deferred with respect to Basaglar as of September 30, 2022 and December 31, 2021:
Net Milestones Capitalized (Deferred)(1)
September 30, 2022December 31, 2021
Jardiance$121.2 $136.1 
Trajenta69.6 88.5 
Basaglar(135.3)(149.3)
(1) This represents the amounts that have been capitalized (deferred) from the start of this collaboration through the end of the reporting period, net of amount amortized.
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(2) The collaboration agreement with Boehringer Ingelheim for Jardiance ends upon expiration of the compound patent and any supplementary protection certificates or extensions thereto.
(3) The collaboration agreement with Boehringer Ingelheim for Trajenta ends upon expiration of the compound patent and any supplementary protection certificates or extensions thereto.
For the Jardiance product family, we and Boehringer Ingelheim share equally the ongoing development and commercialization costs in the most significant markets, and we record our portion of the development and commercialization costs as research and development expense and marketing, selling, and administrative expense, respectively. We receive a royalty on net sales of Boehringer Ingelheim's products in the most significant markets and recognize the royalty as collaboration and other revenue. Boehringer Ingelheim is entitled to potential performance payments depending on the net sales of the Jardiance product family; therefore, our reported revenue for Jardiance may be reduced by any potential performance payments we make related to this product family. Beginning January 1, 2021, theThe royalty received by us related to the Jardiance product family may also be increased or decreased depending on whether net sales for this product family exceed or fall below certain thresholds. We pay to Boehringer Ingelheim a royalty on net sales for Basaglar in the U.S. We record our sales of Basaglar to third parties as net product revenue with the royalty payments made to Boehringer Ingelheim recorded as cost of sales.
The following table summarizes our collaboration and other revenue recognized with respect to the Jardiance and Trajenta families of products and our net product revenue recognized with respect to Basaglar:
Three Months Ended September 30,Nine Months Ended September 30,
Product Family2021202020212020
Jardiance$390.4 $310.8 $1,058.9 $840.3 
Basaglar192.8 248.2 650.1 842.3 
Trajenta96.1 91.7 279.9 261.7 
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Three Months Ended September 30,Nine Months Ended September 30,
2022202120222021
Jardiance$573.3 $390.4 $1,453.7 $1,058.9 
Basaglar193.0 192.8 558.7 650.1 
Trajenta103.8 96.1 293.0 279.9 
Olumiant
We have a worldwide license and collaboration agreement with Incyte Corporation (Incyte), which provides us the development and commercialization rights to its Janus tyrosine kinase (JAK) inhibitor compound, now knownbaricitinib, branded and trademarked as Olumiant, (baricitinib), and certain follow-on compounds, for the treatment of inflammatory and autoimmune diseases.diseases and COVID-19. Incyte has the right to receive tiered, double digit royalty payments on globalworldwide net sales with rates ranging up to 20 percent. Incyte has the right to receive an additional royalty ranging up to the low teens on worldwide net sales for the treatment of COVID-19 that exceed a specified aggregate worldwide net sales threshold. The agreement calls for payments by us to Incyte associated with certain development, success-based regulatory, and sales-based milestones. In 2020, the agreement was amended to include the treatment of COVID-19, with Incyte obtaining the right to receive an additional royalty ranging up to the low teens on global net sales for the treatment of COVID-19 that exceed a specified aggregate global net sales threshold.
In connection with the regulatory approvals of Olumiant in the U.S., Europe, and Japan, as well as achievement of a sales-based milestone, milestone payments of $210.0$330.0 million and $260.0 million were capitalized as intangible assets as of September 30, 20212022 and December 31, 20202021, respectively, and are being amortized to cost of sales through the term of the collaboration. This represents the cumulative amounts that have been capitalized from the start of this collaboration through the end of each reporting period.
As of September 30, 2021,2022, Incyte is eligible to receive up to $100.0 million of additional payments from us contingent upon certain success-based regulatory milestones. Incyte is also eligible to receive up to $150.0 million ofin potential sales-based milestones.
We record our sales of Olumiant, including sales of baricitinib that were made pursuant to EUA or similar regulatory authorizations, to third parties as net product revenue with the royalty payments made to Incyte recorded as cost of sales. The following table summarizes our net product revenue recognized with respect to Olumiant:
Three Months Ended September 30,Nine Months Ended September 30,
2021202020212020
Olumiant$406.9 $162.0 $809.1 $446.7 
Three Months Ended September 30,Nine Months Ended September 30,
2022202120222021
Olumiant$182.9 $406.9 $624.7 $809.1 
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COVID-19 antibodiesAntibodies
In 2020, we entered intoWe have a worldwide license and collaboration agreement with AbCellera Biologics Inc. (AbCellera) to co-develop therapeutic antibodies for the potential prevention and treatment of COVID-19, including bamlanivimab and bebtelovimab, for which we hold development and commercialization rights. AbCellera has the right to receive tiered royalty payments on globalworldwide net sales of bamlanivimab and bebtelovimab with percentages ranging in the mid-teens to mid-twenties. Royalty payments made to AbCellera are recorded as cost of sales.
In 2020, we entered intoWe have a license and collaboration agreement with Shanghai Junshi Biosciences Co., Ltd. (Junshi Biosciences) to co-develop therapeutic antibodies for the potential prevention and treatment of COVID-19, including etesevimab, for which we hold development and commercialization rights outside of mainland China and the Special Administrative Regions of Hong Kong and Macau, and for which Junshi Biosciences currently maintains all rights in mainland China and the Special Administrative Regions of Hong Kong and Macau. Junshi Biosciences has the right to receive royalty payments in the mid-teens on our net sales of etesevimab. Junshi Biosciences also has the right to receivereceived certain development, success-based regulatory and sales-based milestones. In connection with theCapitalized regulatory authorizations of etesevimab (for administration with bamlanivimab) as well as achievement of aand sales-based milestone, milestone payments of $95.0 millionmilestones were capitalized as intangible assets as of September 30, 2021 and are beingfully amortized to cost of sales over the estimated useful life of etesevimab. Asas of September 30, 2021, Junshi Biosciences is eligible to receive up to $100.0 million of potential sales-based milestones.2022.
Pursuant to EUAs or similar regulatory authorizations, we recognized $217.1 million and $1.18 billion of net product revenue associated with our sales of our COVID-19 antibodies duringof $386.6 million and $1.99 billion for the three and nine months ended September 30, 2022, respectively, and $217.1 million and $1.18 billion for the three and nine months ended September 30, 2021, respectively.
Sintilimab Injection
We have a collaboration agreement with Innovent Biologics, Inc. (Innovent) to jointly develop and commercialize sintilimab injection in China, where it is branded and trademarked as Tyvyt. In 2019, we and Innovent began co-commercializing Tyvyt in China. In 2020, we obtained an exclusive license for sintilimab injection from Innovent for geographies outside of China. Innovent, with collaboration from us, has filed the initial registration of sintilimab injection in the U.S., and we will pursue initial registration of sintilimab injection in other markets and all other subsequent registrations of sintilimab injection. We have exclusive commercialization rights outside of China.
In connection with a regulatory approvalapprovals for Tyvyt in China, in the second quartermilestone payments of 2021, we capitalized a milestone payment of$120.0 million and $40.0 million were capitalized as an intangible asset which isassets as of September 30, 2022 and December 31, 2021, respectively, and are being amortized to cost of sales through the term of the collaboration.
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This represents the cumulative amounts that have been capitalized from the start of this collaboration through the end of each reporting period. As of September 30, 2021,2022, Innovent is eligible to receive up to $825.0$115.0 million for geographies outside of China and up to $195.0 million in China in success-based regulatory and sales-based milestones. Innovent is also eligible to receive tiered double digit royalties on net sales for geographies outside of China.
We record our sales of Tyvyt to third parties as net product revenue, with payments made to Innovent for its portion of the gross margin reported as cost of sales. We report as collaboration and other revenue our portion of the gross margin for Tyvyt sales made by Innovent to third parties. The following table summarizes our revenue recognized in China with respect to Tyvyt:
Three Months Ended September 30,Nine Months Ended September 30,
2021202020212020
Tyvyt$125.6 $84.4 $340.2 $205.9 
Three Months Ended September 30,Nine Months Ended September 30,
2022202120222021
Tyvyt$76.8 $125.6 $235.8 $340.2 
TanezumabIn 2020, we obtained an exclusive license for sintilimab injection from Innovent for geographies outside of China, which was subsequently terminated and rights have reverted to Innovent in October 2022.
Lebrikizumab
We have a collaboration agreement with Pfizer Inc. (Pfizer) to jointly develop and globally commercialize tanezumab for the treatment of osteoarthritis pain and cancer pain. In October 2021, we and Pfizer discontinued the global clinical development program of tanezumab for the treatment of osteoarthritis pain and cancer pain following the receipt of a Complete Response Letter from the FDA and a negative opinion from the European Medicines Agency's Committee for Medicinal Products for Human Use.
Lebrikizumab
As a result of our acquisition of Dermira, we have a worldwide licensinglicense agreement with F. Hoffmann-La Roche Ltd and Genentech, Inc. (collectively, Roche), which provides us the globalworldwide development and commercialization rights to lebrikizumab. Roche has the right to receive tiered royalty payments on future globalworldwide net sales ranging in percentages from high single digits to high teens if the product is successfully commercialized. As of September 30, 2021,2022, Roche is eligible to receive up to $180.0 million of payments from us contingent upon the achievement of success-based regulatory milestones and up to $1.03 billion in a series of sales-based milestones, contingent upon the commercial success of lebrikizumab.
As a result of our acquisition of Dermira, weWe have a license agreement with Almirall, S.A. (Almirall), under which Almirall licensed the rights to develop and commercialize lebrikizumab for the treatment or prevention of dermatology indications, including, but not limited to, atopic dermatitis in Europe. We have the right to receive tiered royalty payments on future net sales in Europe ranging in percentages from low double digits to low twenties if the product is successfully commercialized. As of September 30, 2021,2022, we are eligible to receive additional payments of $85.0 million from Almirall contingent upon the achievement of success-based regulatory milestones and up to $1.25 billion in a series of sales-based milestones, contingent upon the commercial success of lebrikizumab.
As There were no remaining contract liabilities as of September 30, 2021 and2022. As of December 31, 2020, $15.3 million and $29.7 million, respectively, were recorded as2021, contract liabilities on the consolidated condensed balance sheets and are expected to be recognized as collaboration and other revenue over the remaining Phase III development period.were not material. During the three and nine months ended September 30, 20212022 and 2020, milestones received and2021, collaboration and other revenue recognized werewas not material.
Petra
As a result of our acquisition of Petra, we are required to make milestone payments to Petra shareholders contingent upon the occurrence of certain future events linked to the success of the mutant-selective PI3Kα inhibitor. Our more significant, near term milestones include a development milestone of approximately $205 million in 2022 contingent upon initiation of its Phase I trial and a further development milestone of approximately $164 million in 2023 contingent upon achieving clinical proof of concept.
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Note 5: Asset Impairment, Restructuring, and Other Special Charges
The components of the charges included in asset impairment, restructuring, and other special charges in our consolidated condensed statements of operations are described below.
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended September 30,Nine Months Ended September 30,
20212020202120202022202120222021
SeveranceSeverance$ $144.4 $11.5 $154.2 Severance$ $— $ $11.5 
Asset impairment (recovery) and other special charges (43.0)200.1 7.1 
Asset impairment and other special chargesAsset impairment and other special charges206.5 — 206.5 200.1 
Total asset impairment, restructuring, and other special chargesTotal asset impairment, restructuring, and other special charges$ $101.4 $211.6 $161.3 Total asset impairment, restructuring, and other special charges$206.5 $— $206.5 $211.6 
Asset impairment, restructuring, and other special charges recognized during the three and nine months ended September 30, 2022 were primarily related to an intangible asset impairment for GBA1 Gene Therapy (PR001), acquired in the Prevail acquisition, as a result of changes in key assumptions used in the valuation due to delays in estimated launch timing.
Asset impairment, restructuring, and other special charges recognized during the nine months ended September 30, 2021 were primarily related to an intangible asset impairment of $108.1 million resulting from the sale of the rights to Qbrexza®, as well as acquisition and integration costs associated with the acquisition of Prevail.
Severance costs recognized during the three and nine months ended September 30, 2020 were incurred as a result of actions taken worldwide to reduce our cost structure. Substantially all of the severance costs incurred during the three and nine months ended September 30, 2020 have been paid.
We recognized a net inventory impairment charge related to our COVID-19 antibodies of $435.1 million during the nine months ended September 30, 2021 in cost of sales in our consolidated condensed statements of operations. As part of our response to the COVID-19 pandemic, and at the request of the U.S. and international governments, we invested in large-scale manufacturing of COVID-19 antibodies at risk, in order to ensure rapid access to patients around the world. As the COVID-19 pandemic has continued to evolveevolved during 2021, we incurred a net inventory impairment charge primarily due to the combination of changes to current and forecasted demand from U.S. and international governments, including changes to our agreement with the U.S. government, and near-term expiry dates of COVID-19 antibodies.

Note 6: Financial Instruments
Financial instruments that potentially subject us to credit risk consist principally of trade receivables and interest-bearing investments. Wholesale distributors of life science products account for a substantial portion of our trade receivables; collateral is generally not required. We seek to mitigate the risk associated with this concentration through our ongoing credit-review procedures and insurance. A large portion of our cash is held by a few major financial institutions. We monitor our exposures with these institutions and do not expect any of these institutions to fail to meet their obligations. In accordance with documented corporate risk-management policies, we monitor the amount of credit exposure to any one financial institution or corporate issuer. We are exposed to credit-related losses in the event of nonperformance by counterparties to risk-management instruments but do not expect any counterparties to fail to meet their obligations given their highinvestment grade credit ratings.
We consider all highly liquid investments with a maturity of three months or less from the date of purchase to be cash equivalents. The cost of these investments approximates fair value.
Our equity investments are accounted for using three different methods depending on the type of equity investment:
Investments in companies over which we have significant influence but not a controlling interest are accounted for using the equity method, with our share of earnings or losses reported in other-net, (income) expense.
For equity investments that do not have readily determinable fair values, we measure these investments at cost, less any impairment, plus or minus changes resulting from observable price changes in orderly transactions for the identical or similar investment of the same issuer. Any change in recorded value is recorded in other-net, (income) expense.
Our public equity investments are measured and carried at fair value. Any change in fair value is recognized in other-net, (income) expense.
We review equity investments other than public equity investments for indications of impairment and observable price changes on a regular basis.
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Our derivative activities are initiated within the guidelines of documented corporate risk-management policies and are intended to offset losses and gains on the assets, liabilities, and transactions being hedged. Management reviews the correlation and effectiveness of our derivatives on a quarterly basis.
For derivative instruments that are designated and qualify as fair value hedges, the derivative instrument is marked to market, with gains and losses recognized currently in income to offset the respective losses and gains recognized on the underlying exposure. For derivative instruments that are designated and qualify as cash flow hedges, gains and losses are reported as a component of accumulated other comprehensive loss and reclassified into earnings in the same period the hedged transaction affects earnings. For derivative and non-derivative instruments that are designated and qualify as net investment hedges, the foreign currency translation gains or losses due to spot rate fluctuations are reported as a component of accumulated other comprehensive loss. Derivative contracts that are not designated as hedging instruments are recorded at fair value with the gain or loss recognized in earnings during the period of change.
We may enter into foreign currency forward or option contracts to reduce the effect of fluctuating currency exchange rates (principally the euro, British pound, Chinese yuan, and Japanese yen). Foreign currency derivatives used for hedging are put in place using the same or like currencies and duration as the underlying exposures. Forward and option contracts are principally used to manage exposures arising from subsidiary trade and loan payables and receivables denominated in foreign currencies. These contracts are recorded at fair value with the gain or loss recognized in other–net, (income) expense. We may enter into foreign currency forward and option contracts and currency swaps as fair value hedges of firm commitments. Forward contracts generally have maturities not exceeding 12 months. At September 30, 2021,2022, we had outstanding foreign currency forward commitments to purchase 707.31.69 billion U.S. dollars and sell 1.71 billion euro; commitments to purchase 2.24 billion euro and sell 2.24 billion U.S. dollars; commitments to purchase 239.5 million U.S. dollars and sell 604.5 million euro,1.63 billion Chinese yuan; commitments to purchase 2.54 billion euro and sell 2.98 billion U.S. dollars, commitments to purchase 151.682.1 million U.S. dollars and sell 980.0 million Chinese yuan, commitments to purchase 144.7 million U.S. dollars and sell 16.1311.86 billion Japanese yen,yen; and commitments to purchase 155.5182.1 million British pounds and sell 212.6206.9 million U.S. dollars, which all have settlement dates within 180 days.
Foreign currency exchange risk is also managed through the use of foreign currency debt, and cross-currency interest rate swaps.swaps, and foreign currency forward contracts. Our foreign currency-denominated notes had carrying amounts of $8.08$6.23 billion and $6.02$7.90 billion as of September 30, 20212022 and December 31, 2020,2021, respectively, of which $5.95$4.94 billion and $4.50$5.79 billion have been designated as, and are effective as, economic hedges of net investments in certain of our foreign operations as of September 30, 20212022 and December 31, 2020,2021, respectively. At September 30, 2021,2022, we had outstanding cross-currency swaps with notional amounts of $2.69$1.56 billion swapping U.S. dollars to euro and $1.00 billion swapping Swiss francs to U.S. dollars which have settlement dates ranging through 2028. Our cross-currency interest rate swaps, for which a majority convert a portion of our U.S. dollar-denominated fixed-rate debt to foreign-denominated fixed-rate debt, have also been designated as, and are effective as, economic hedges of net investments. At September 30, 2022, we had outstanding foreign currency forward contracts to sell 1.34 billion euro with settlement dates ranging through 2023, which have been designated as, and are effective as, economic hedges of net investments.
In the normal course of business, our operations are exposed to fluctuations in interest rates which can vary the costs of financing, investing, and operating. We seek to address a portion of these risks through a controlled program of risk management that includes the use of derivative financial instruments. The objective of controlling these risks is to limit the impact of fluctuations in interest rates on earnings. Our primary interest-rate risk exposure results from changes in short-term U.S. dollar interest rates. In an effort to manage interest-rate exposures, we strive to achieve an acceptable balance between fixed- and floating-rate debt and investment positions and may enter into interest rate swaps or collars to help maintain that balance.
Interest rate swaps or collars that convert our fixed-rate debt to a floating rate are designated as fair value hedges of the underlying instruments. Interest rate swaps or collars that convert floating-rate debt to a fixed rate are designated as cash flow hedges. Interest expense on the debt is adjusted to include the payments made or received under the swap agreements. Cash proceeds from or payments to counterparties resulting from the termination of interest rate swaps are classified as operating activities in our consolidated condensed statements of cash flows. At September 30, 2021,2022, substantially all of our total long-term debt is at a fixed rate. We have converted approximately 1210 percent of our long-term fixed-rate notes to floating rates through the use of interest rate swaps.
21


We also may enter into forward-starting interest rate swaps, which we designate as cash flow hedges, as part of any anticipated future debt issuances in order to reduce the risk of cash flow volatility from future changes in interest rates. The change in fair value of these instruments is recorded as part of other comprehensive income (loss), and, upon completion of a debt issuance and termination of the swap, is amortized to interest expense over the life of the underlying debt. As of September 30, 2021,2022, the total notional amounts of forward-starting interest rate contracts in designated cash flow hedging instruments were $1.75 billion, which have settlement dates ranging between 2023 and 2025.
22


Effective September 15, 2022, we increased our 364-day credit facility from $2.00 billion to $4.00 billion, which will expire in September 2023, and is available to support our commercial paper program. We have not drawn against the $4.00 billion 364-day credit facility as of September 30, 2022.
In September 2021, we issued euro-denominated notes consisting of €600.0 million of 0.50 percent fixed-rate notes due in September 2033, with interest to be paid annually. The net proceeds from the offering have been, and will continue to be, used to fund, in whole or in part, eligible projects designed to advance one or more of our environmental, social, and governance objectives.
In September 2021, we issued euro-denominated notes consisting of €500.0 million of 1.125 percent fixed-rate notes due in September 2051 and €700.0 million of 1.375 percent fixed-rate notes due in September 2061, with interest to be paid annually, and British pound-denominated notes consisting of £250.0 million of 1.625 percent fixed-rate notes due in September 2043, with interest to be paid annually. We paid $1.91 billion of the net cash proceeds from the offering to purchase and redeem certain higher interest rate U.S. dollar-denominated notes with an aggregate principal amount of $1.50 billion, resulting in a debt extinguishment loss of $405.2 million. This loss was included in other-net,other net, (income) expense in our consolidated condensed statement of operations during the three and nine months ended September 30, 2021. The $1.50 billion principal amount of higher interest rate U.S. dollar-denominated notes that were redeemed primarily included $541.8 million of 3.95 percent notes due 2049, $408.7 million of 4.15 percent notes due 2059, and $219.4 million of 3.375 percent notes due 2029. We used the remaining net proceeds from the offering to prefund certain 2022 debt maturities and for general corporate purposes.
The Effect of Risk-Management Instruments on the Consolidated Condensed Statements of Operations
The following effects of risk-management instruments were recognized in other–net, (income) expense:
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended September 30,Nine Months Ended September 30,
20212020202120202022202120222021
Fair value hedges:Fair value hedges:Fair value hedges:
Effect from hedged fixed-rate debtEffect from hedged fixed-rate debt$(10.1)$(14.0)$(60.5)$110.4 Effect from hedged fixed-rate debt$(62.9)$(10.1)$(215.7)$(60.5)
Effect from interest rate contractsEffect from interest rate contracts10.1 14.0 60.5 (110.4)Effect from interest rate contracts62.9 10.1 215.7 60.5 
Cash flow hedges:Cash flow hedges:Cash flow hedges:
Effective portion of losses on interest rate contracts reclassified from accumulated other comprehensive lossEffective portion of losses on interest rate contracts reclassified from accumulated other comprehensive loss4.2 4.1 12.5 12.3 Effective portion of losses on interest rate contracts reclassified from accumulated other comprehensive loss4.1 4.2 12.3 12.5 
Cross-currency interest rate swapsCross-currency interest rate swaps10.0 (30.2)58.1 (54.6)Cross-currency interest rate swaps33.1 10.0 75.0 58.1 
Net (gains) losses on foreign currency exchange contracts not designated as hedging instrumentsNet (gains) losses on foreign currency exchange contracts not designated as hedging instruments50.8 (54.2)110.6 (82.8)Net (gains) losses on foreign currency exchange contracts not designated as hedging instruments129.6 50.8 280.7 110.6 
TotalTotal$65.0 $(80.3)$181.2 $(125.1)Total$166.8 $65.0 $368.0 $181.2 
During the three and nine months ended September 30, 20212022 and 2020,2021, the amortization of losses related to the portion of our risk management hedging instruments, fair value hedges, and cash flow hedges that was excluded from the assessment of effectiveness was not material.
2322


The Effect of Risk-Management Instruments on Other Comprehensive Income (Loss)
The effective portion of risk-management instruments that was recognized in other comprehensive income (loss) is as follows:
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended September 30,Nine Months Ended September 30,
20212020202120202022202120222021
Net investment hedges:Net investment hedges:Net investment hedges:
Foreign currency-denominated notes Foreign currency-denominated notes$119.0 $(181.1)$268.8 $(186.0)Foreign currency-denominated notes$435.1 $119.0 $822.8 $268.8 
Cross-currency interest rate swaps Cross-currency interest rate swaps66.7 (110.4)170.8 (55.4)Cross-currency interest rate swaps92.1 66.7 171.4 170.8 
Foreign currency forward contractsForeign currency forward contracts107.8 — 121.4 — 
Cash flow hedges:Cash flow hedges:Cash flow hedges:
Forward-starting interest rate swaps Forward-starting interest rate swaps19.4 99.6 149.3 (231.9)Forward-starting interest rate swaps57.5 19.4 337.7 149.3 
Cross-currency interest rate swaps Cross-currency interest rate swaps3.1 6.6 22.5 (58.3)Cross-currency interest rate swaps19.9 3.1 38.4 22.5 
During the next 12 months, we expect to reclassify $16.4$16.7 million of pretax net losses on cash flow hedges from accumulated other comprehensive loss to other–net, (income) expense. During the three and nine months ended September 30, 20212022 and 2020,2021, the amounts excluded from the assessment of hedge effectiveness recognized in other comprehensive income (loss) were not material.

2423


Fair Value of Financial Instruments
The following tables summarize certain fair value information at September 30, 20212022 and December 31, 20202021 for assets and liabilities measured at fair value on a recurring basis, as well as the carrying amount and amortized cost of certain other investments: 
  Fair Value Measurements Using    Fair Value Measurements Using 
Carrying
Amount
Cost (1)
Quoted Prices in Active Markets for Identical Assets
(Level 1)
Significant Other
Observable Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
Fair
Value
Carrying
Amount
Cost(1)
Quoted Prices in Active Markets for Identical Assets
(Level 1)
Significant Other
Observable Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
Fair
Value
September 30, 2021
September 30, 2022September 30, 2022
Cash equivalentsCash equivalents$2,373.8 $2,373.8 $2,373.8 $ $ $2,373.8 Cash equivalents$1,246.8 $1,246.8 $1,239.2 $7.6 $ $1,246.8 
Short-term investments:Short-term investments:Short-term investments:
U.S. government and agency securitiesU.S. government and agency securities$11.3 $11.1 $11.3 $ $ $11.3 U.S. government and agency securities$43.0 $43.5 $43.0 $ $ $43.0 
Corporate debt securitiesCorporate debt securities6.8 6.7  6.8 — 6.8 Corporate debt securities51.7 51.8  51.7  51.7 
Mortgage-backed securities0.2 0.2  0.2  0.2 
Asset-backed securitiesAsset-backed securities3.3 3.2  3.3  3.3 Asset-backed securities3.0 3.0  3.0  3.0 
Other securitiesOther securities15.5 15.5 6.6  8.9 15.5 Other securities27.0 27.0  14.8 12.2 27.0 
Short-term investmentsShort-term investments$37.1 Short-term investments$124.7 
Noncurrent investments:Noncurrent investments:Noncurrent investments:
U.S. government and agency securitiesU.S. government and agency securities$129.9 $129.0 $129.9 $ $ $129.9 U.S. government and agency securities$131.4 $148.3 $131.4 $ $ $131.4 
Corporate debt securitiesCorporate debt securities219.7 215.0  219.7  219.7 Corporate debt securities206.4 232.5  206.4  206.4 
Mortgage-backed securitiesMortgage-backed securities110.7 107.9  110.7  110.7 Mortgage-backed securities143.1 156.1  143.1  143.1 
Asset-backed securitiesAsset-backed securities19.7 19.6  19.7  19.7 Asset-backed securities43.6 45.5  43.6  43.6 
Other securitiesOther securities105.6 21.6   105.6 105.6 Other securities152.5 96.3  39.5 113.0 152.5 
Marketable equity securitiesMarketable equity securities1,482.8 420.5 1,482.8   1,482.8 Marketable equity securities549.1 416.1 549.1   549.1 
Equity investments without readily determinable fair values (2)
Equity investments without readily determinable fair values (2)
556.3 
Equity investments without readily determinable fair values(2)
583.7 
Equity method investments (2)
Equity method investments (2)
725.8 
Equity method investments(2)
764.8 
Noncurrent investmentsNoncurrent investments$3,350.5 Noncurrent investments$2,574.6 
December 31, 2020
December 31, 2021December 31, 2021
Cash equivalentsCash equivalents$2,097.9 $2,097.9 $2,097.9 $— $— $2,097.9 Cash equivalents$2,379.5 $2,379.5 $2,361.0 $18.5 $— $2,379.5 
Short-term investments:Short-term investments:Short-term investments:
U.S. government and agency securitiesU.S. government and agency securities$9.9 $9.9 $9.9 $— $— $9.9 U.S. government and agency securities$25.7 $25.6 $25.7 $— $— $25.7 
Corporate debt securitiesCorporate debt securities2.8 2.8 — 2.8 — 2.8 Corporate debt securities43.7 43.7 — 43.7 — 43.7 
Mortgage-backed securitiesMortgage-backed securities0.2 0.2 — 0.2 — 0.2 
Asset-backed securitiesAsset-backed securities1.2 1.2 — 1.2 — 1.2 Asset-backed securities6.2 6.2 — 6.2 — 6.2 
Other securitiesOther securities10.3 10.3 — — 10.3 10.3 Other securities14.3 14.3 — — 14.3 14.3 
Short-term investmentsShort-term investments$24.2 Short-term investments$90.1 
Noncurrent investments:Noncurrent investments:Noncurrent investments:
U.S. government and agency securitiesU.S. government and agency securities$78.7 $74.3 $78.7 $— $— $78.7 U.S. government and agency securities$137.0 $136.8 $137.0 $— $— $137.0 
Corporate debt securitiesCorporate debt securities137.0 126.8 — 137.0 — 137.0 Corporate debt securities235.3 232.7 — 235.3 — 235.3 
Mortgage-backed securitiesMortgage-backed securities106.4 101.4 — 106.4 — 106.4 Mortgage-backed securities109.8 108.1 — 109.8 — 109.8 
Asset-backed securitiesAsset-backed securities24.3 23.7 — 24.3 — 24.3 Asset-backed securities23.1 23.1 — 23.1 — 23.1 
Other securitiesOther securities110.5 31.8 — — 110.5 110.5 Other securities108.1 22.2 — — 108.1 108.1 
Marketable equity securitiesMarketable equity securities1,664.2 311.6 1,664.2 — — 1,664.2 Marketable equity securities1,279.7 487.0 1,279.7 — — 1,279.7 
Equity investments without readily determinable fair values (2)
Equity investments without readily determinable fair values (2)
373.9 
Equity investments without readily determinable fair values(2)
548.1 
Equity method investments (2)
Equity method investments (2)
471.8 
Equity method investments(2)
771.5 
Noncurrent investmentsNoncurrent investments$2,966.8 Noncurrent investments$3,212.6 
(1) For available-for-sale debt securities, amounts disclosed represent the securities' amortized cost.
(2) Fair value disclosures are not applicable for equity method investments and investments accounted for under the measurement alternative for equity investments.
24


  Fair Value Measurements Using 
Carrying
Amount
Quoted Prices in Active Markets for Identical Assets
(Level 1)
Significant
Other Observable Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
Fair
Value
Short-term commercial paper borrowings
September 30, 2022$(1,741.3)$ $(1,738.0)$ $(1,738.0)
December 31, 2021— — — — — 
Long-term debt, including current portion
September 30, 2022$(14,147.1)$ $(11,848.6)$ $(11,848.6)
December 31, 2021(16,884.7)— (18,157.7)— (18,157.7)
25


  Fair Value Measurements Using 
Carrying
Amount
Quoted Prices in Active Markets for Identical Assets
(Level 1)
Significant
Other Observable Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
Fair
Value
Long-term debt, including current portion
September 30, 2021$(17,085.4)$ $(18,354.9)$ $(18,354.9)
December 31, 2020(16,595.3)— (19,038.9)— (19,038.9)

  Fair Value Measurements Using 
Carrying
Amount
Quoted Prices in Active Markets for Identical Assets
(Level 1)
Significant
Other Observable Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
Fair
Value
September 30, 2022
Risk-management instruments:
Interest rate contracts designated as fair value hedges:
Other noncurrent liabilities$(140.2)$ $(140.2)$ $(140.2)
Interest rate contracts designated as cash flow hedges:
Other noncurrent assets355.2  355.2  355.2 
Cross-currency interest rate contracts designated as net investment hedges:
Other receivables81.6  81.6  81.6 
Other noncurrent assets116.9  116.9  116.9 
Cross-currency interest rate contracts designated as cash flow hedges:
Other noncurrent assets8.3  8.3  8.3 
Other noncurrent liabilities(12.9) (12.9) (12.9)
Foreign exchange contracts designated as net investment hedges:
Other receivables108.2 — 108.2 — 108.2 
Other current liabilities(2.9)— (2.9)— (2.9)
Foreign exchange contracts not designated as hedging instruments:
Other receivables48.1  48.1  48.1 
Other current liabilities(93.5) (93.5) (93.5)
Contingent consideration liability:
Other noncurrent liabilities(42.1)  (42.1)(42.1)
December 31, 2021
Risk-management instruments:
Interest rate contracts designated as fair value hedges:
Other receivables$4.8 $— $4.8 $— $4.8 
Other noncurrent assets78.3 — 78.3 — 78.3 
Other noncurrent liabilities(7.6)— (7.6)— (7.6)
Interest rate contracts designated as cash flow hedges:
Other noncurrent assets49.2 — 49.2 — 49.2 
Other noncurrent liabilities(31.7)— (31.7)— (31.7)
Cross-currency interest rate contracts designated as net investment hedges:
Other noncurrent assets31.3 — 31.3 — 31.3 
Other current liabilities(1.2)— (1.2)— (1.2)
Cross-currency interest rate contracts designated as cash flow hedges:
Other noncurrent assets33.2 — 33.2 — 33.2 
Other noncurrent liabilities(1.3)— (1.3)— (1.3)
Foreign exchange contracts not designated as hedging instruments:
Other receivables9.9 — 9.9 — 9.9 
Other current liabilities(35.3)— (35.3)— (35.3)
Contingent consideration liabilities:
Other noncurrent liabilities(70.5)— — (70.5)(70.5)

26


  Fair Value Measurements Using 
Carrying
Amount
Quoted Prices in Active Markets for Identical Assets
(Level 1)
Significant
Other Observable Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
Fair
Value
September 30, 2021
Risk-management instruments:
Interest rate contracts designated as fair value hedges:
Other receivables$8.5 $ $8.5 $ $8.5 
Other noncurrent assets87.2 $ 87.2 $ 87.2 
Other noncurrent liabilities(2.2) (2.2) (2.2)
Interest rate contracts designated as cash flow hedges:
Other noncurrent assets77.3  77.3  77.3 
Cross-currency interest rate contracts designated as net investment hedges:
Other receivables18.7  18.7  18.7 
Other noncurrent assets38.7  38.7  38.7 
Other current liabilities(17.0) (17.0) (17.0)
Other noncurrent liabilities(9.5) (9.5) (9.5)
Cross-currency interest rate contracts designated as cash flow hedges:
Other noncurrent assets10.8  10.8  10.8 
Other noncurrent liabilities(23.0) (23.0) (23.0)
Foreign exchange contracts not designated as hedging instruments:
Other receivables5.5  5.5  5.5 
Other current liabilities(25.7) (25.7) (25.7)
Contingent consideration liability:
Other noncurrent liabilities(70.7)  (70.7)(70.7)
December 31, 2020
Risk-management instruments:
Interest rate contracts designated as fair value hedges:
Other noncurrent assets158.9 — 158.9 — 158.9 
Interest rate contracts designated as cash flow hedges:
Other noncurrent assets38.1 — 38.1 — 38.1 
Other noncurrent liabilities(97.8)— (97.8)— (97.8)
Cross-currency interest rate contracts designated as net investment hedges:
Other current liabilities(92.6)— (92.6)— (92.6)
Other noncurrent liabilities(97.2)— (97.2)— (97.2)
Cross-currency interest rate contracts designated as cash flow hedges:
Other noncurrent assets34.4 — 34.4 — 34.4 
Other noncurrent liabilities(2.9)— (2.9)— (2.9)
Foreign exchange contracts not designated as hedging instruments:
Other receivables41.1 — 41.1 — 41.1 
Other current liabilities(15.2)— (15.2)— (15.2)
27


Risk-management instruments above are disclosed on a gross basis. There are various rights of setoff associated with certain of the risk-management instruments above that are subject to enforceable master netting arrangements or similar agreements. Although various rights of setoff and master netting arrangements or similar agreements may exist with the individual counterparties to the risk-management instruments above, individually, these financial rights are not material.
We determine our Level 1 and Level 2 fair value measurements based on a market approach using quoted market values, significant other observable inputs for identical or comparable assets or liabilities, or discounted cash flow analyses. Level 3 fair value measurements for other investment securities are determined using unobservable inputs, including the investments' cost adjusted for impairments and price changes from orderly transactions. Fair values are not readily available for certain equity investments measured under the measurement alternative.
As of September 30, 2021,2022, we had approximately $781$854 million of unfunded commitments to invest in venture capital funds, which we anticipate will be paid over a period of up to 10 years.
Contingent consideration liability relates to our liability arising in connection with the CVR issued as a result of the Prevail acquisition. The fair value of the CVR liability was estimated using a discounted cash flow analysis and Level 3 inputs, including projections representative of a market participant's view of the expected cash payment associated with the first potential regulatory approval of a Prevail compound in the applicable countries based on probabilities of technical success, timing of the potential approval events for the compounds, and an estimated discount rate. See Note 3 for additional information related to the CVR arrangement.
The table below summarizes the contractual maturities of our investments in debt securities measured at fair value as of September 30, 2021:2022:
 Maturities by Period
  TotalLess Than
1 Year
1-5
Years
6-10
Years
More Than
10 Years
Fair value of debt securities$501.6 $21.6 $157.8 $153.4 $168.8 
 Maturities by Period
TotalLess Than
1 Year
1-5
Years
6-10
Years
More Than
10 Years
Fair value of debt securities$622.2 $97.7 $197.8 $121.0 $205.7 
The net gains (losses) recognized in our consolidated condensed statements of operations for equity securities were $(123.3) million and $(667.6) million for the three and nine months ended September 30, 2022, respectively, and $(246.8) million and $270.1 million for the three and nine months ended September 30, 2021, respectively, and $141.7 million and $905.1 millionrespectively. The net gains (losses) recognized for the three and nine months ended September 30, 2020, respectively. The net gains/losses recognized during the three2022 and nine months ended September 30, 2021 and 2020 on equity securities sold during the respective periods were not material.
We adjust our equity investments without readily determinable fair values based upon changes in the equity instruments' values resulting from observable price changes in orderly transactions for an identical or similar investment of the same issuer. Downward adjustments resulting from an impairment are recorded based upon impairment considerations, including the financial condition and near term prospects of the issuer, general market conditions, and industry specific factors. Adjustments recorded duringfor the three and nine months ended September 30, 20212022 and 20202021 were not material.
A summary of the amount of unrealized gains and losses in accumulated other comprehensive loss and the fair value of available-for-sale securities in an unrealized gain or loss position follows: 
September 30, 2021December 31, 2020September 30, 2022December 31, 2021
Unrealized gross gainsUnrealized gross gains$12.5 $20.9 Unrealized gross gains$0.1 $9.7 
Unrealized gross lossesUnrealized gross losses4.0 0.5 Unrealized gross losses51.6 5.2 
Fair value of securities in an unrealized gain positionFair value of securities in an unrealized gain position293.4 348.9 Fair value of securities in an unrealized gain position13.8 250.7 
Fair value of securities in an unrealized loss positionFair value of securities in an unrealized loss position208.1 11.4 Fair value of securities in an unrealized loss position578.8 290.2 
We periodically assess our investment in available-for-sale securities for impairment losses and credit losses. The amount of credit losses are determined by comparing the difference between the present value of future cash flows expected to be collected on these securities and the amortized cost. Factors considered in assessing credit losses include the position in the capital structure, vintage and amount of collateral, delinquency rates, current credit support, and geographic concentration. Impairment and credit losses related to available-for-sale securities were not material for the three and nine months ended September 30, 20212022 and 2020.2021.
2827


As of September 30, 2021,2022, the available-for-sale securities in an unrealized loss position include primarily fixed-rate debt securities of varying maturities, which are sensitive to changes in the yield curve and other market conditions. Approximately 9795 percent of the fixed-rate debt securities in a loss position are investment-grade debt securities. As of September 30, 2021,2022, we do not intend to sell, and it is not more likely than not that we will be required to sell, the securities in a loss position before the market values recover or the underlying cash flows have been received, and there is no indication of a material default on interest or principal payments for any of our debt securities.
Activity related to our available-for-sale securities was as follows:
Three Months Ended September 30,Nine Months Ended September 30, Three Months Ended September 30,Nine Months Ended September 30,
20212020202120202022202120222021
Proceeds from salesProceeds from sales$49.6 $14.0 $137.3 $246.8 Proceeds from sales$50.5 $49.6 $115.6 $137.3 
Realized gross gains on salesRealized gross gains on sales0.4 0.4 2.2 4.0 Realized gross gains on sales 0.4 0.2 2.2 
Realized gross losses on salesRealized gross losses on sales0.3 0.2 1.1 8.2 Realized gross losses on sales7.5 0.3 9.0 1.1 
Realized gains and losses on sales of available-for-sale investments are computed based upon specific identification of the initial cost adjusted for any other-than-temporary declines in fair value that were recorded in earnings.
Accounts Receivable Factoring Arrangements
We have entered into accounts receivable factoring agreements with financial institutions to sell certain of our non-U.S. accounts receivable. These transactions are accounted for as sales and result in a reduction in accounts receivable because the agreements transfer effective control over, and risk related to, the receivables to the buyers. Our factoring agreements do not allow for recourse in the event of uncollectibility, and we do not retain any interest in the underlying accounts receivable once sold. We derecognized $617.4$356.8 million and $754.9$550.5 million of accounts receivable as of September 30, 20212022 and December 31, 2020,2021, respectively, under these factoring arrangements. The costs of factoring such accounts receivable on our consolidated condensed results of operations for the three and nine months ended September 30, 20212022 and 20202021 were not material.

Note 7: Income Taxes
The effective tax rates were 7.3 percent and 8.6 percent for the three and nine months ended September 30, 2022, respectively, reflecting the favorable tax impact of the implementation of a provision in the Tax Cuts and Jobs Act (2017 Tax Act) that requires capitalization and amortization of research and development expenses for tax purposes starting in 2022, net investment losses on equity securities, and an intangible asset impairment charge. We expect our effective tax rate to be approximately 13 percent to 14 percent for 2022 if the capitalization and amortization of research and development expenses provision of the 2017 Tax Act is deferred or repealed by the U.S. Congress effective for 2022.
The effective tax rate was 10.9 percent for the three months ended September 30, 2021, compared with 15.9 percent forreflecting the three months ended September 30, 2020. The lower effective tax rate for the three months ended September 30, 2021 was primarily due to the incomefavorable tax impact of a debt extinguishment loss and unfavorable mark-to-market adjustmentsof net investment losses on investments in equity securities, partially offset by a lower net discrete tax benefit compared to the three months ended September 30, 2020.detriment. The effective tax rate was 10.7 percent for the nine months ended September 30, 2021, compared with 14.4 percent forreflecting the nine months ended September 30, 2020. The lower effectivefavorable tax rate for the nine months ended September 30, 2021 was primarily due to the incomeimpact of a net discrete tax impacts ofbenefit, a debt extinguishment loss, and a net inventory impairment charge related to our COVID-19 antibodies and a debt extinguishment loss, as well as higher acquired IPR&D charges and lower favorable mark-to-market adjustments on investments in equity securities compared to the nine months ended September 30, 2020, partially offset by a lower net discrete tax benefit compared to the nine months ended September 30, 2020.antibodies.
The U.S. examination of tax years 2016-2018 began in the fourth quarter of 2019 and remains ongoing. The resolution of this audit period will likely extend beyond the next 12 months.
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Note 8: Retirement Benefits
Net pension and retiree health benefit (income) cost included the following components:
Defined Benefit Pension PlansDefined Benefit Pension Plans
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended September 30,Nine Months Ended September 30,
2021202020212020 2022202120222021
Components of net periodic benefit cost:Components of net periodic benefit cost:Components of net periodic benefit cost:
Service costService cost$92.5 $81.7 $277.8 $243.4 Service cost$87.1 $92.5 $264.4 $277.8 
Interest costInterest cost84.5 106.6 253.6 319.0 Interest cost98.9 84.5 299.0 253.6 
Expected return on plan assetsExpected return on plan assets(237.5)(229.5)(712.7)(671.4)Expected return on plan assets(235.1)(237.5)(711.6)(712.7)
Amortization of prior service costAmortization of prior service cost1.0 1.1 3.2 3.2 Amortization of prior service cost0.6 1.0 1.9 3.2 
Recognized actuarial lossRecognized actuarial loss121.9 58.4 366.3 286.5 Recognized actuarial loss85.3 121.9 256.8 366.3 
Net periodic benefit costNet periodic benefit cost$62.4 $18.3 $188.2 $180.7 Net periodic benefit cost$36.8 $62.4 $110.5 $188.2 
Retiree Health Benefit Plans
Three Months Ended September 30,Nine Months Ended September 30,
 2021202020212020
Components of net periodic benefit income:
Service cost$12.4 $10.2 $37.0 $30.6 
Interest cost8.1 10.9 24.4 32.8 
Expected return on plan assets(36.5)(40.3)(109.6)(115.1)
Amortization of prior service benefit(14.9)(21.9)(44.7)(51.6)
Recognized actuarial loss0.8 0.7 2.4 2.1 
Net periodic benefit income$(30.1)$(40.4)$(90.5)$(101.2)

Retiree Health Benefit Plans
Three Months Ended September 30,Nine Months Ended September 30,
 2022202120222021
Components of net periodic benefit income:
Service cost$11.7 $12.4 $35.0 $37.0 
Interest cost9.4 8.1 28.4 24.4 
Expected return on plan assets(38.0)(36.5)(114.1)(109.6)
Amortization of prior service benefit(13.7)(14.9)(41.1)(44.7)
Recognized actuarial loss0.2 0.8 0.7 2.4 
Net periodic benefit income$(30.4)$(30.1)$(91.1)$(90.5)

Note 9: Contingencies
We are involved in various lawsuits, claims, government investigations and other legal proceedings that arise in the ordinary course of business. These claims or proceedings can involve various types of parties, including governments, competitors, customers, suppliers, service providers, licensees, employees, or shareholders, among others. These matters may involve patent infringement, antitrust, securities, pricing, sales and marketing practices, environmental, commercial, contractual rights, licensing obligations, health and safety matters, consumer fraud, employment matters, product liability and insurance coverage, among others. The resolution of these matters often develops over a long period of time and expectations can change as a result of new findings, rulings, appeals or settlement arrangements. Legal proceedings that are significant or that we believe could become significant or material are described below.
We believe the legal proceedings in which we are named as defendants are without merit and we are defending against them vigorously. It is not possible to determine the final outcome of these matters, and we cannot reasonably estimate the maximum potential exposure or the range of possible loss in excess of amounts accrued for any of these matters; however, we believe that the resolution of all such matters will not have a material adverse effect on our consolidated financial position or liquidity, but could possibly be material to our consolidated results of operations in any one accounting period.
Litigation accruals, environmental liabilities, and the related estimated insurance recoverables are reflected on a gross basis as liabilities and assets, respectively, on our consolidated condensed balance sheets. With respect to the product liability claims currently asserted against us, we have accrued for our estimated exposures to the extent they are both probable and reasonably estimable based on the information available to us. We accrue for certain product liability claims incurred but not filed to the extent we can formulate a reasonable estimate of their costs. We estimate these expenses based primarily on historical claims experience and data regarding product usage. Legal defense costs expected to be incurred in connection with significant product liability loss contingencies are accrued when both probable and reasonably estimable.
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Because of the nature of pharmaceutical products, it is possible that we could become subject to large numbers of additional product liability and related claims in the future. Due to a very restrictive market for productlitigation liability insurance, we are self-insured for productlitigation liability losses for all our currently and previously marketed products.
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Patent Litigation
Alimta Patent Litigation
U.S. Patent Litigation
Alimta (pemetrexed) is protected by a vitamin regimen patent until November 2021, plus pediatric exclusivity through May 2022.
In December 2019, we settled a lawsuit we filed against Eagle Pharmaceuticals, Inc. (Eagle) in response to its application to market a product using an alternative form of pemetrexed. Per the settlement agreement, Eagle has a limited initial entry into the market with its product starting February 2022 (up to an approximate three-week supply) and subsequent unlimited entry starting April 2022.
European Patent Litigation
In Europe, Alimta (pemetrexed) was protected by the vitamin regimena patent through June 2021. Despite the recent patent expiration, aA number of legal proceedings that were initiated prior to patent expiration are ongoing.ongoing.
Emgality Patent Litigation
In September 2018, we wereWe are a named as a defendant in litigation filed by Teva Pharmaceuticals International GMBH and Teva Pharmaceuticals USA, Inc. (collectively, Teva) in the U.S. District Court for the District of Massachusetts seeking a ruling that various claims in 9three different Teva patents would be infringed by our launch and continued sales of Emgality for the prevention of migraine in adults. Trial is expectedbegan in MarchOctober 2022. In June 2021, we were named as a defendant in a second litigation filed by Teva in the U.S. District Court for the District of Massachusetts seeking a ruling that 2two of Teva’sTeva's patents, which are directed toward use of the active ingredient in Emgality to treat migraine, would be infringed by our continued sales of Emgality.
Separately, We challenged these two patents by filing requests for Inter Partes Review with the U.S. Patent and Trademark Office's Patent Trial and Appeal Board (PTAB) and in October 2022, the PTAB granted our request to initiate an inter partes review (IPR) to reexamine the validity of the 9 Teva patents asserted against us in the litigation. In February 2020, the PTAB ruled in our favor and found that the claims asserted against us in 6 of Teva's 9 patents were invalid. In March 2020, the PTAB ruled against us on the remaining 3 Teva patents, finding that we failed to show that the remaining 3 patents were unpatentable based on the subset of invalidity arguments available in an IPR proceeding. In April 2020, we appealed the PTAB’s March 2020 ruling, and Teva appealed the PTAB’s February 2020 ruling to the U.S. Court of Appeals for the Federal Circuit. In August 2021, the appeals court affirmed all 9 of the PTAB's decisions. Neither Lilly nor Teva appealed the rulings and accordingly those decisions are final, and the parties have agreed to a stipulation which removes the 6 invalidated patents from therequests.The corresponding district court litigation. This IPR matterlitigation is now closed.stayed while this PTAB proceeding is ongoing.
Jardiance Patent Litigation
In November 2018, Boehringer Ingelheim, (BI), our partner in marketing and development of Jardiance, initiated U.S. patent litigation in the U.S. District Court of Delaware alleging infringement arising from submissions of Abbreviated New Drug Applications (ANDA) by a number of generic companies seeking approval to market generic versions of Jardiance, Glyxambi, and Synjardy in accordance with the procedures set out in the Drug Price Competition and Patent Term Restoration Act of 1984 (the Hatch-Waxman Act). Particularly with respect to Jardiance, the generic companies' ANDAs seek approval to market generic versions of Jardiance prior to the expiration of the relevant patents, and allege that certain patents, including in some allegations the compound patent, are invalid or would not be infringed. We are not a party to this litigation. This litigation has been stayed.
Taltz Patent Litigation
In April 2021, we petitioned the High Court of Ireland to declare invalid thea patent that Novartis Pharma AG (Novartis) purchased from Genentech, Inc. in 2020. Novartis responded by filing a claim against us alleging patent infringement related to our commercialization of Taltz and seeking damages for past infringement and an injunction against future infringement. This matter is ongoing.
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In April 2021 and June 2021, Novartis petitioned the Court of Rome Intellectual Property Division andfor a preliminary injunction (PI) against us related to our commercialization of Taltz in Italy. In May 2021, We commenced patent revocation proceedings against Novartis before the Commercial Court of Vienna, respectively,Milan’s IP Division where we also sought a declaration of non-infringement. Novartis counter-claimed for patent infringement and sought a permanent injunction. A hearing on the PI request before the Court of Rome Intellectual Property Division took place in preliminaryMay 2022 and in July 2022, the court rejected Novartis' request.
In November 2021, Novartis petitioned the Swiss Federal Patent Court for a PI and a permanent injunction in main infringement proceedings against us related to our commercialization of Taltz.Taltz in Switzerland. We petitioned the court to revoke the patent and for a declaration of non-infringement. In June 2021,April 2022, Novartis withdrew its PI request.
In January 2022, we commenced an action in the Hague District Court asking for a judgment that a Novartis Dutch patent is not infringed by our commercialization of Rome Intellectual Property Division dismissed Novartis’ preliminary injunction action.Taltz in the Netherlands and is invalid. In October 2022, Novartis has appealedfiled a counterclaim for infringement and sought a permanent injunction.
In October 2022, we entered into a settlement and mutual release agreement with Novartis, which resolves the rulingabove-described disputes. Without any admission of liability or wrongdoing, we and Novartis have agreed to mutual releases for past claims and mutual covenants not to sue the other in October 2021relation to Taltz and the panel hearing Novartis' appeal appointed a technical expert to assess the merits of the case. Both matters are ongoing.patents Novartis purchased from Genentech.
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Zyprexa Canada Patent Litigation
Beginning in the mid-2000’s,mid-2000s, several generic companies in Canada challenged the validity of our Zyprexa compound patent. In 2012, the Canadian Federal Court of Appeals denied our appeal of a lower court's decision that certain patent claims were invalid for lack of utility. In 2013, Apotex Inc. and Apotex Pharmachem Inc. (collectively, Apotex) brought claims against us in the Ontario Superior Court of Justice at Toronto for damages related to our enforcement of the Zyprexa compound patent under Canadian regulations governing patented drugs. Apotex seeks compensation based on novel legal theories under the Statute of Monopolies, Trade-MarkTrademark Act, and common law. In March 2021, the Ontario Superior Court granted our motion for summary judgement,judgment, thereby dismissing Apotex’sApotex's case. Apotex appealed that ruling to the Court of Appeal for Ontario in April 20212021. In August 2022, the Court dismissed the appeal and a hearingin October 2022, Apotex appealed the decision. This matter is scheduled for February 2022.ongoing.
Product Liability Litigation
Actos® Product Liability
We are named along with Takeda Chemical Industries, Ltd. and Takeda affiliates (collectively, Takeda) as a defendant in 4 purported product liability class actions in Canada related to Actos, which we commercialized with Takeda in Canada until 2009, including 1 in Ontario filed December 2011 (Casseres et al. v. Takeda Pharmaceutical North America, Inc., et al.), 1 in Quebec filed July 2012 (Whyte et al. v. Eli Lilly et al.), 1 in Saskatchewan filed November 2017 (Weiler v. Takeda Canada Inc. et al.), and 1 in Alberta filed January 2013 (Epp v. Takeda Canada Inc. et al.). In general, plaintiffs in these actions alleged that Actos caused or contributed to their bladder cancer. An agreement to settle these actions became effective in May 2021, and the settlement claims administration process is ongoing. The lawsuits have been dismissed or discontinued.
Byetta® Product Liability
We arehave been named as a defendant in approximately 570over 500 Byetta product liability lawsuits in the U.S. whichthat were first initiated in March 2009 and involve approximately 805involved over 800 plaintiffs. Approximately 55 of theseThese lawsuits covering about 285 plaintiffs, arehave been filed in various state and federal jurisdictions, including California state court and coordinated(coordinated in a Los Angeles County Superior Court. Approximately 515 of the lawsuits, covering about 515 plaintiffs, are filed inCourt), and various federal court,courts, the majority of which are coordinated in a multi-district litigation (MDL) in the U.S. District Court for the Southern District of California. NaN lawsuits, representing approximately 2 plaintiffs, have also been filed in various state courts. Approximately 565The majority of the lawsuits, involving approximately 800 plaintiffs,these suits contain allegations that Byetta caused or contributed to the plaintiffs' cancer (primarily pancreatic cancer or thyroid cancer); while 6 plaintiffs allege Byetta caused or contributed to pancreatitis. In addition, 1 case alleges that Byetta caused or contributed to ampullary cancer.. The federal MDL and coordinated California state trial courts granted summary judgment in our favor on claims pertaining to pancreatic cancer, and the plaintiffs have dismissed Lilly from their appeal of us and our co-defendants on the claims alleging pancreatic cancer. The plaintiffs appealed those rulings.
In November 2017,MDL ruling (the parties still await the U.S. Courtorder of Appeals for the Ninth Circuit reversed the U.S. District Court for the Southern District of California's grant of summary judgment in the MDL based on that court's discovery rulings and remanded the cases back to the U.S. District Court for further proceedings. In March 2021, the U.S. District Court granted summary judgment for the defendants. In April 2021, the plaintiffs filed a notice of appeal to the U.S. Court of Appeals for the Ninth Circuit, but we have now been dismissed from that appeal. Certain plaintiffs have agreed to dismiss their lawsuits in exchange for a waiver of costs, and individual plaintiffs have begun dismissing their claims based upon this agreement. Approximately 160Los Angeles County Superior Court). Most of the MDL pancreaticand state court lawsuits have been dismissed as of October 2021. In the state court actions, in November 2018, the California Court of Appeal reversed the Los Angeles County Superior Court of California’s grant of summary judgment based on that court's discovery rulings and remanded for further proceedings. In April 2021, the Los Angeles County Superior Court of California granted summary judgment for the defendants and the parties await entry of the order of judgment.
We are aware of approximately 20 additional claimants who have not yet filed suit. These additional claims allege damages for pancreatic cancer or thyroid cancer.
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Cialis Product Liability
We are named as a defendant in approximately 350 Cialis product liability lawsuits in the U.S. which were first initiated in August 2015. These cases, many of which were originally filed in various federal courts, contain allegations that Cialis caused or contributed to the plaintiffs' cancer (melanoma). In December 2016, the Judicial Panel on Multidistrict Litigation (JPML) granted the plaintiffs' petition to have filed cases and an unspecified number of future cases coordinated into a federal multidistrict litigation (MDL) in the U.S. District Court for the Northern District of California, alongside an existing coordinated proceeding involving Viagra®. The JPML ordered the transfer of the existing cases to the now-renamed MDL In re: Viagra (Sildenafil Citrate) and Cialis (Tadalafil) Products Liability Litigation. In April 2020, the MDL court granted summary judgment to the defendants on all of the claims brought against them by the plaintiffs. In May 2020, plaintiffs filed an appeal in the U.S. Court of Appeals for the Ninth Circuit. The plaintiffs’ appeal was administratively closed until August 2021 pending completion of a procedure to resolve the claims in this litigation. The court has entered an extension until February 2022 to finalize resolution of all claims.
Jardiance Product Liability
First initiated in January 2019, we and Boehringer Ingelheim Pharmaceuticals, Inc., a subsidiary of BI, have been named as a defendant in approximately 95 product liability lawsuits in the U.S., mostly in Stamford Superior Court in Connecticut, alleging that Jardiance caused or contributed to plaintiffs’ Fournier’s gangrene. Our agreement with BI calls for BI to defend and indemnify us against any damages, costs, expenses, and certain other losses with respect to product liability claims in accordance with the terms of the agreement. All pending cases have been paused to allow for settlement negotiations.2022.
Environmental Proceedings
Under the Comprehensive Environmental Response, Compensation, and Liability Act, commonly known as "Superfund," we have been designated as one of several potentially responsible parties with respect to the cleanup of fewer than 10 sites. Under Superfund, each responsible party may be jointly and severally liable for the entire amount of the cleanup.
Other Matters
340B Litigation and Investigations
We are the plaintiff in a lawsuit filed in January 2021 in the U.S. District Court for the Southern District of Indiana against the U.S. Department of Health and Human Services (HHS), the Secretary of HHS, the Health Resources and Services Administration (HRSA), and the Administrator of HRSA. The lawsuit challenges the HHS's December 30, 2020 advisory opinion stating that drug manufacturers are required to deliver discounts under the 340B program to all contract pharmacies. We seek a declaratory judgment that the defendants violated the Administrative Procedures Act and the U.S. Constitution, a preliminary injunction enjoining implementation of the administrative dispute resolution process created by defendants and, with it, their application of the advisory opinion, and other related relief. In March 2021, the court entered an order preliminarily enjoining the government’sgovernment's enforcement of the administrative dispute resolution process against us. In May 2021, HRSA notified us that it determined that our policy was contrary to the 340B statute. In response, in May 2021, we filed a motion for preliminary injunction and temporary restraining order requesting that the U.S. District Court for the Southern District of Indiana enjoin defendants from taking any action against us relating to the 340B drug pricing program until after the court issues a final judgment on the aforementioned litigation. In May 2021, the court denied our motion for a temporary restraining order but deferred resolution of our motion for preliminary injunction. In June 2021, the defendants withdrew the HHS December 30, 2020 advisory opinion. In July 2021, the court held oral argument on the parties’parties' cross motions for summary judgment, the defendants’defendants' motion to dismiss, and our motion for preliminary injunction related to HRSA’sHRSA's May 2021 enforcement letter. In October 2021, the court denied the defendants' motion to dismiss, and granted in part and denied in part the parties' cross motions for summary judgment. Both parties filed notices of appeal related to the court's summary judgment order. Oral argument took place in October 2022 in the U.S. Court of Appeals for the Seventh Circuit. This matter is ongoing.
In January 2021, we, along with other pharmaceutical manufacturers, were named as a defendant in a petition currently pending before the HHS Administrative Dispute Resolution Panel. Petitioner seeks declaratory and other injunctive relief related to the 340B program. As described above, the U.S. District Court for the Southern District of Indiana has entered a preliminary injunction enjoining the government’sgovernment's enforcement of this administrative dispute resolution process against us.
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In July 2021, we, along with Sanofi-Aventis U.S., LLC (Sanofi), Novo Nordisk Inc. (Novo Nordisk), and AstraZeneca Pharmaceuticals LP, were named as a defendant in a purported class action lawsuit filed in the U.S. District Court for the Western District of New York by Mosaic Health, Inc. alleging antitrust and unjust enrichment claims related to the defendants' 340B distribution programs.
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We, with Sanofi and Novo Nordisk, filed a motion to dismiss the lawsuit, which was granted in September 2022. In October 2022, the plaintiffs filed a motion for leave to amend their complaint. This matter is ongoing.
We received a civil investigative subpoena in February 2021 from the Office of the Attorney General for the State of Vermont relating to the sale of pharmaceutical products to Vermont covered entities under the 340B program. We are cooperating with this subpoena.
Branchburg Manufacturing Facility
In May 2021, we received a subpoena from the United StatesU.S. Department of Justice requesting the production of certain documents relating to our manufacturing site in Branchburg, New Jersey. We are cooperating with the subpoena.
Brazil Litigation – Cosmopolis Facility
Labor Attorney Litigation
First initiated in 2008, our subsidiary in Brazil, Eli Lilly do Brasil Limitada (Lilly Brasil), is named in a lawsuitPublic Civil Action brought by the Labor Public Attorney (LPA) for the 15th Region in the Labor Court of Paulinia, State of Sao Paulo, Brazil, (the Labor Court) alleging possible harm to employees and former employees caused by alleged exposure to heavy metalssoil and groundwater contaminants at a former Lilly Brasil manufacturing facility in Cosmopolis, Brazil, operated by the company between 1977 and 2003. In May 2014, the labor courtLabor Court judge ruled against Lilly Brasil, ordering it to undertake several remedial and compensatory actions of unspecified financial impact, including paying lifetime health coverage for the employeesa class of individuals and contractors who worked at the Cosmopolis facility more than six months during the affected years andcertain of their children born during and after this period. We appealed this decision.children. In July 2018, the appeals court (TRT) generally affirmed our appeal of the labor court'sLabor Court's ruling, withwhich included a liquidated award of 300 million Brazilian real, (for moral damages, donation of equipment, and creation of a foundation) which, when adjusted for inflation and the addition of pre and post judgment interest using the current Central Bank of Brazil's special system of clearance and custody rate, (SELIC), is approximately 950 millionone billion Brazilian real (approximately $175$185 million as of September 30, 2021)2022). The appeals court restricted the broad health coverage awarded by the labor court to health problems that claimants could show arose from exposure to the alleged contamination. In August 2019, Lilly Brasil filed an appeal to the superior labor court. In September 2019, the appeals court stayed a number of elements of its prior decision, including the obligation to provide health coverage for contractors, their children,(TST) and children of employees who worked at the Cosmopolis facility, pending the determination of Lilly Brasil’s appeal to the superior labor court. The cost of any such health coverage has not been determined. Inin June 2021, the appeals courtTRT published its decision on the admissibility of Lilly Brasil’sBrasil's appeal, admittingallowing the majority of the elements, of the appealwhich were allowed to proceed;proceed in June 2021; elements not proceeding are subject to an interlocutory appeal to the appeals courtTST that was filed in June 2021. In September 2019, the TRT stayed a number of elements of its trial court decision pending the determination of Lilly Brasil's appeal to the TST.
In June 2019 and September 2020, the LPA filed applications in the Labor Attorney filed an application in the labor courtCourt for enforcement of the healthcare coveragecertain remedies granted by the appeals courtTRT in its July 2018 ruling anddecision, requested restrictions on Lilly Brasil’s assets in Brazil.Brazil, and required Lilly Brasil and Antibióticos do Brasil Ltda. (ABL) to submit a list of potential beneficiaries of the Public Civil Action. In July 2019, the labor courtLabor Court issued a ruling requiring either a freeze of Lilly Brasil’s immovable property or, alternatively, a security deposit or lien of 500 million Brazilian real. Lilly Brasil filed a writ of mandamus challenging thisreal, which ruling, but the court has stayed its decision on this writ was subsequently limited in scope and instead directed the parties to attend conciliation hearings, a process that concluded unsuccessfully in September 2020. Consequently, the partial stay of the proceedings relating to Lilly Brasil's application to appeal in the main proceedings has been lifted and in June 2021, the court reduced the security deposit or lienwas reduced to 100 million Brazilian real fromreal. ABL and LPA appealed the 500 million Brazilian real referredJune 2021 Labor Court ruling to above. In addition, the TST, which appeal is under review. The Labor Attorney's application for preliminary enforcementCourt is currently assessing the status of Lilly Brasil’s and ABL’s compliance with such portion of the July 2018 healthcare coverage ruling was granted. AsTRT decision and an inspection in the conciliation hearings have been unsuccessful, we have filed a brief to strike the Labor Attorney’s application to enforce the previous healthcare coverage. Lilly Brasilindustrial plant is currently awaiting a determination as to whether its application seeking leave to appeal to the superior labor court has been successful.expected. These matters are ongoing.
Individual Former Employee Litigation
We areLilly Brasil is also named in approximately 30over 20 pending lawsuits filed in the same labor courtLabor Court by individual former employees making similar claims. These individual lawsuits are each at various stages in the litigation process,process.
Puerto Rico Tax Matter
In May 2013, the Municipality of Carolina in Puerto Rico (Municipality) filed a lawsuit against us alleging noncompliance with judgments being handed downrespect to a contract with the Municipality and seeking a declaratory judgment. In December 2020, the Puerto Rico Appellate Court (AP) reversed the summary judgment previously granted by the Court of First Instance (CFI) in approximately half ofour favor, dismissing the lawsuits, nearly all ofMunicipality's complaint in its entirety. The AP remanded the case to the CFI for trial on the merits. The trial began in May 2022; however, the Municipality filed a new motion requesting the CFI to award damages. The request was denied by the CFI in our favor and the Municipality filed for revision at the AP, which are on appeal inwe opposed, staying the labor courts.case. This matter is ongoing.
China NDRC Antitrust Matter
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The competition authority in China has investigated our distributor pricing practices in China in connection with a broader inquiry into pharmaceutical industry pricing. We have cooperated with this investigation.

Eastern District of Pennsylvania Pricing (Average Manufacturer Price) Inquiry
In November 2014, we, along with another pharmaceutical manufacturer, were named as co-defendants in United States et al. ex rel. Streck v. Takeda Pharm. Am., Inc., et al., which was filed in November 2014 and unsealed in the U.S. District Court for the Northern District of Illinois. The complaint alleges that the defendants should have treated certain credits from distributors as retroactive price increases and included such increases in calculating average manufacturer prices. TrialFollowing a trial in August 2022, the jury returned a verdict in favor of the plaintiff. The case is scheduled for April 2022.proceeding with post-trial motions after which the court will enter final judgment in the case. This matter is ongoing.
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Health Choice Alliance
We are named as a defendant in a lawsuit filed in June 2017 in the U.S. District Court for the Eastern District of Texas seeking damages under the federal anti-kickback statute and state and federal false claims acts for certain patient support programs related to our products Humalog, Humulin, and Forteo. In September 2019, the U.S. District Court granted the U.S. Department of Justice’s motion to dismiss the relator’s second amended complaint. In January 2020, the relator appealed the District Court’s dismissal to the U.S. Court of Appeals for the Fifth Circuit. In July 2021, the U.S. Court of Appeals for the Fifth Circuit affirmed the dismissal of the lawsuit.We are also named as a defendant in 2 similartwo lawsuits filed in Texas and New Jersey state courts in October 2019 seeking damages under the Texas Medicaid Fraud Prevention Act and New Jersey Medicaid False Claims Act, respectively. In November 2020, therespectively, for certain patient support programs related to our products Humalog, Humulin, and Forteo. The Texas state court action was stayed pending a final determination with respect to the aforementioned federal lawsuit. In April 2021, thehas been stayed. The New Jersey state court action was dismissed with prejudice and in June 2021, the relator filed a notice ofpending an ongoing appeal tobefore the Appellate Division of the New Jersey Superior Court, appealing the state court’s decision.Court. This matter is ongoing.
Pricing Litigation Investigations, and Inquiries
Litigation
In December 2017 and February 2018, we, along with Sanofi and Novo Nordisk, were named as defendants in a consolidated purported class action lawsuit, In re. Insulin Pricing Litigation, and in the U.S. District Court for the District of New Jersey relating to insulin pricing seeking damages under various state consumer protection laws and the Federal Racketeer Influenced and Corrupt Organization Act (federal RICO Act). Separately, in February 2018, we, along with Sanofi and Novo Nordisk, were named as defendants in MSP Recovery Claims, Series, LLC et al. v. Sanofi Aventis U.S. LLC et al., both filed in the same court, seekingU.S. District Court for the District of New Jersey. The cases relate to insulin pricing and seek damages or other relief under various theories, including state consumer protection laws, common law fraud, unjust enrichment, and the federalFederal Racketeer Influenced and Corrupt Organization Act (federal RICO Act.Act). In both In re. Insulin Pricing Litigation and the MSP Recovery Claims litigation, cases, the court dismissed claims under the federal RICO Act and certain state laws. In April 2021, the plaintiffs in In re. Insulin Pricing Litigation amended their complaint to allege additional state law claims for civil conspiracy and violations of state RICO statutes.Also, The court allowed the Arizona RICO statute and certain state civil conspiracy law claims to proceed. Additionally in 2020, we, along with Sanofi, Novo Nordisk, CVS, Express Scripts, and Optum, have been sued in a purportedputative class action, FWK Holdings, LLC v. Novo Nordisk Inc., et al., filed in the same court, in November 2020, for alleged violations of the federal RICO Act as well as the New Jersey RICO Act and antitrust law. ThatThe same group of defendants, along with Medco Health and United Health Group, also have been sued in other purported class actions in the same court, Rochester Drug Co-Operative Inc. v. Eli Lilly & Co. et al. and Value Drug Co. v. Eli Lilly & Co. et al., which were both initiated in March 2020, with the plaintiffs seeking damages for alleged violations of the federal RICO Act. In September 2020, the U.S. District Court for the District of New Jersey granted plaintiffs’plaintiffs' motion to consolidate FWK Holdings, LLC v. Novo Nordisk Inc., et al., Rochester Drug Co-Operative Inc. v. Eli Lilly & Co. et al., and Value Drug Co. v. Eli Lilly & Co. et al. In July 2021, the U.S. District Court for the District of New Jersey dismissed the 3three antitrust claims alleged by plaintiffs in the consolidated litigation and denied dismissal of the federal RICO Act claims.
In October 2018, the Minnesota Attorney General’sGeneral's Office initiated litigation against us, Sanofi, and Novo Nordisk, State of Minnesota v. Sanofi-Aventis U.S. LLC et al., in the U.S. District Court for the District of New Jersey, allegingseeking damages for unjust enrichment, violations of various Minnesota state consumer protection laws, and the federal RICO Act. In March 2021, the U.S. District Court for the District of New Jersey dismissed with prejudice the Minnesota Attorney General’sGeneral's federal RICO claims and false advertising claims under state law; the consumer fraud and other related state law claims remain ongoing. Additionally, in May 2019, the Kentucky Attorney General’sGeneral's Office filed a complaint against us, Sanofi, and Novo Nordisk, Commonwealth of Kentucky v. Novo Nordisk, Inc. et al., in Kentucky state court, alleging violations of the Kentucky consumer protection law, false advertising, and unjust enrichment. In November 2019, Harris County in Texas initiated litigation against us, Sanofi, Novo Nordisk, Express Scripts, CVS, Optum, and Aetna, County ofHarris Texas v. Eli Lilly & Co., et al., in federal court in the Southern District of Texas alleging violations of the federal RICO Act, the state deceptive trade practices-consumer protection act, and common law claims such as fraud, unjust enrichment, and civil conspiracy. Harris County also alleged violations of federal and state antitrust law, but voluntarily dismissed them. This lawsuit relates to our insulin products as well as Trulicity.
In June 2021, the City of Miami, Florida initiated litigation against us, Sanofi, Novo Nordisk, ESI, CVS/Caremark/Aetna, and Optum, asserting state law antitrust, common law fraud, money had and received, unjust enrichment, and civil conspiracy claims. In June 2021, the Mississippi Attorney General’sGeneral's Office initiated litigation against us, Sanofi, Novo Nordisk, Evernorth/ESI, CVS/Caremark, and United/Optum in the Hinds County, Mississippi Chancery Court, alleging state law consumer protection, unjust enrichment, and civil conspiracy claims. After the case was removed to federal court, we, along with the other defendants, filed a motion to dismiss the lawsuit, which was denied. This matter is ongoing.
In May 2022, the state of Arkansas filed suit against us Sanofi, Novo Nordisk, ESI, CVS/Caremark/Aetna, and Optum, asserting state law consumer protection, civil conspiracy, and unjust enrichment claims. The case has been removed to federal court and is ongoing.
In September 2022, the County of Albany, New York filed a suit against us, Sanofi, Novo Nordisk, Evernorth/ESI, CVS/Caremark and United/Optum asserting violations of federal RICO statute and state law claims for deceptive trade practices, unjust enrichment, and civil conspiracy. This matter is ongoing.
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In September 2022, the State of Montana filed a suit against us, Sanofi, Novo Nordisk, Evernorth/ESI, Medco Health Solutions, CVS/Caremark and Optum asserting violations of the Montana Unfair Practices and Consumer Protection Act, unjust enrichment, and civil conspiracy. This matter is ongoing.
Investigations, Subpoenas, and Inquiries
WeIn connection with the pricing and sale of our insulin and other products, we have been subject to various investigations and received a subpoenasubpoenas, civil investigative demand requests, information requests, interrogatories, and other inquiries from various governmental entities. These include subpoenas from the New York andand Vermont Attorney General Offices, and civil investigative demands from the Washington, New Mexico, and Colorado, Illinois, Ohio Attorney General Offices, relating to the pricingDepartment of Justice and sale of our insulin products. The Offices of the Attorney General inFederal Trade Commission, as well as information requests from the Mississippi, Washington D.C., California, Florida, Hawaii, and Nevada have requested information relatingAttorney General Offices. In January 2022, the Michigan Attorney General filed a petition in Michigan state court seeking authorization to investigate Lilly for potential violations of the pricingMichigan Consumer Protection Act (MCPA), and a complaint seeking a declaratory judgment that the Attorney General has authority to investigate Lilly's sale of our insulin products. We also received interrogatoriesunder the MCPA. The court authorized the proposed investigation and the issuance of civil investigative subpoenas. In April 2022, the parties entered into a stipulation providing that the State will not issue any civil investigative subpoena fromto us under the CaliforniaMCPA until the declaratory judgment action is resolved. In July 2022, the court dismissed the case in its entirety. The Michigan Attorney General's Office regarding our competition inGeneral filed a notice of appeal and an application to obtain review by the long-acting insulin market,Michigan Supreme Court, which was subsequently withdrawn in June 2021.remain pending.
We received a request in January 2019 from the House of Representatives’Representatives' Committee on Oversight and Reform seeking commercial information and business records related to the pricing of insulin products, among other issues. We also received similar requests from the Senate Finance Committee and the Senate Committee on Health, Education, Labor, and Pensions, and separate requests from the House Committee on Energy and Commerce majority and minority members. Those requests sought pricing and other commercial information regarding Lilly’s insulin products. In January 2021, the Senate Finance Committee released a report summarizing the findings of its investigation. In December 2021 the House of Representatives' Committee on Oversight and Reform majority and minority staffs released separate reports with findings from their investigations into drug pricing, including of insulin products.
We are cooperating with all of thesethe aforementioned investigations, subpoenas, and inquiries.
Research Corporation Technologies, Inc.
In April 2016, we were named as a defendant in litigation filed by Research Corporation Technologies, Inc. (RCT) in the U.S. District Court for the District of Arizona. RCT is seeking damages for breach of contract, unjust enrichment, and conversion related to processes used to manufacture certain products, including Humalog and Humulin. Both parties moved for summary judgment and a hearing on the motions took place in August 2021. In October 2021, the Courtcourt issued a summary judgment decision finding in favor of RCT on certain issues, including with respect to a disputed royalty. Both parties filed motions for reconsideration, which were denied. We filed supplemental summary judgment motions. A trial date has not been set. Potential damages payable under the litigation, if finally awarded after an appeal, could be material but are not currently reasonably estimable. We intend to appeal the summary judgment decision and related findings. A trial date has not been set.This matter is ongoing.

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Note 10: Other Comprehensive Income (Loss)
The following tables summarize the activity related to each component of other comprehensive income (loss) during the three months ended September 30, 20212022 and 2020:2021:
(Amounts presented net of taxes)(Amounts presented net of taxes)Foreign Currency Translation Gains (Losses)Unrealized Net Gains (Losses) on SecuritiesDefined Benefit Pension and Retiree Health Benefit PlansEffective Portion of Cash Flow HedgesAccumulated Other Comprehensive Loss(Amounts presented net of taxes)Foreign Currency Translation Gains (Losses)Unrealized Net Gains (Losses) on SecuritiesDefined Benefit Pension and Retiree Health Benefit PlansEffective Portion of Cash Flow HedgesAccumulated Other Comprehensive Loss
Balance at July 1, 2021$(1,516.2)$9.1 $(4,569.9)$(210.1)$(6,287.1)
Balance at July 1, 2022Balance at July 1, 2022$(1,844.2)$(27.9)$(2,443.2)$27.6 $(4,287.7)
Other comprehensive income (loss) before reclassificationsOther comprehensive income (loss) before reclassifications(8.0)(2.4)18.6 16.8 25.0 Other comprehensive income (loss) before reclassifications(165.1)(24.9)47.8 63.0 (79.2)
Net amount reclassified from accumulated other comprehensive lossNet amount reclassified from accumulated other comprehensive loss 0.1 86.0 3.3 89.4 Net amount reclassified from accumulated other comprehensive loss 13.5 57.2 0.4 71.1 
Net other comprehensive income (loss)Net other comprehensive income (loss)(8.0)(2.3)104.6 20.1 114.4 Net other comprehensive income (loss)(165.1)(11.4)105.0 63.4 (8.1)
Balance at September 30, 2021$(1,524.2)$6.8 $(4,465.3)$(190.0)$(6,172.7)
Balance at September 30, 2022Balance at September 30, 2022$(2,009.3)$(39.3)$(2,338.2)$91.0 $(4,295.8)
(Amounts presented net of taxes)(Amounts presented net of taxes)Foreign Currency Translation Gains (Losses)Unrealized Net Gains (Losses) on SecuritiesDefined Benefit Pension and Retiree Health Benefit PlansEffective Portion of Cash Flow HedgesAccumulated Other Comprehensive Loss(Amounts presented net of taxes)Foreign Currency Translation Gains (Losses)Unrealized Net Gains (Losses) on SecuritiesDefined Benefit Pension and Retiree Health Benefit PlansEffective Portion of Cash Flow HedgesAccumulated Other Comprehensive Loss
Balance at July 1, 2020$(1,722.5)$15.1 $(4,454.9)$(520.6)$(6,682.9)
Balance at July 1, 2021Balance at July 1, 2021$(1,516.2)$9.1 $(4,569.9)$(210.1)$(6,287.1)
Other comprehensive income (loss) before reclassificationsOther comprehensive income (loss) before reclassifications30.3 0.8 (19.6)82.9 94.4 Other comprehensive income (loss) before reclassifications(8.0)(2.4)18.6 16.8 25.0 
Net amount reclassified from accumulated other comprehensive lossNet amount reclassified from accumulated other comprehensive loss— (0.2)30.3 3.3 33.4 Net amount reclassified from accumulated other comprehensive loss— 0.1 86.0 3.3 89.4 
Net other comprehensive income (loss)Net other comprehensive income (loss)30.3 0.6 10.7 86.2 127.8 Net other comprehensive income (loss)(8.0)(2.3)104.6 20.1 114.4 
Balance at September 30, 2020$(1,692.2)$15.7 $(4,444.2)$(434.4)$(6,555.1)
Balance at September 30, 2021Balance at September 30, 2021$(1,524.2)$6.8 $(4,465.3)$(190.0)$(6,172.7)
The following tables summarize the activity related to each component of other comprehensive income (loss) during the nine months ended September 30, 20212022 and 2020:2021:
(Amounts presented net of taxes)(Amounts presented net of taxes)Foreign Currency Translation Gains (Losses)Unrealized Net Gains (Losses) on SecuritiesDefined Benefit Pension and Retiree Health Benefit PlansEffective Portion of Cash Flow HedgesAccumulated Other Comprehensive Loss(Amounts presented net of taxes)Foreign Currency Translation Gains (Losses)Unrealized Net Gains (Losses) on SecuritiesDefined Benefit Pension and Retiree Health Benefit PlansEffective Portion of Cash Flow HedgesAccumulated Other Comprehensive Loss
Balance at January 1, 2021$(1,427.5)$14.8 $(4,751.0)$(332.7)$(6,496.4)
Balance at January 1, 2022Balance at January 1, 2022$(1,550.2)$3.7 $(2,583.6)$(213.0)$(4,343.1)
Other comprehensive income (loss) before reclassificationsOther comprehensive income (loss) before reclassifications(96.7)(8.8)27.2 132.8 54.5 Other comprehensive income (loss) before reclassifications(459.7)(55.5)72.9 297.2 (145.1)
Net amount reclassified from accumulated other comprehensive lossNet amount reclassified from accumulated other comprehensive loss 0.8 258.5 9.9 269.2 Net amount reclassified from accumulated other comprehensive loss0.6 12.5 172.5 6.8 192.4 
Net other comprehensive income (loss)Net other comprehensive income (loss)(96.7)(8.0)285.7 142.7 323.7 Net other comprehensive income (loss)(459.1)(43.0)245.4 304.0 47.3 
Balance at September 30, 2021$(1,524.2)$6.8 $(4,465.3)$(190.0)$(6,172.7)
Balance at September 30, 2022Balance at September 30, 2022$(2,009.3)$(39.3)$(2,338.2)$91.0 $(4,295.8)
(Amounts presented net of taxes)(Amounts presented net of taxes)Foreign Currency Translation Gains (Losses)Unrealized Net Gains (Losses) on SecuritiesDefined Benefit Pension and Retiree Health Benefit PlansEffective Portion of Cash Flow HedgesAccumulated Other Comprehensive Loss(Amounts presented net of taxes)Foreign Currency Translation Gains (Losses)Unrealized Net Gains (Losses) on SecuritiesDefined Benefit Pension and Retiree Health Benefit PlansEffective Portion of Cash Flow HedgesAccumulated Other Comprehensive Loss
Balance at January 1, 2020$(1,678.0)$4.9 $(4,638.6)$(211.9)$(6,523.6)
Balance at January 1, 2021Balance at January 1, 2021$(1,427.5)$14.8 $(4,751.0)$(332.7)$(6,496.4)
Other comprehensive income (loss) before reclassificationsOther comprehensive income (loss) before reclassifications(14.2)7.6 4.6 (232.3)(234.3)Other comprehensive income (loss) before reclassifications(96.7)(8.8)27.2 132.8 54.5 
Net amount reclassified from accumulated other comprehensive lossNet amount reclassified from accumulated other comprehensive loss— 3.2 189.8 9.8 202.8 Net amount reclassified from accumulated other comprehensive loss— 0.8 258.5 9.9 269.2 
Net other comprehensive income (loss)Net other comprehensive income (loss)(14.2)10.8 194.4 (222.5)(31.5)Net other comprehensive income (loss)(96.7)(8.0)285.7 142.7 323.7 
Balance at September 30, 2020$(1,692.2)$15.7 $(4,444.2)$(434.4)$(6,555.1)
Balance at September 30, 2021Balance at September 30, 2021$(1,524.2)$6.8 $(4,465.3)$(190.0)$(6,172.7)
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The tax effects on the net activity related to each component of other comprehensive income (loss) were as follows:
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended September 30,Nine Months Ended September 30,
Tax benefit (expense)Tax benefit (expense)2021202020212020Tax benefit (expense)2022202120222021
Foreign currency translation gains/lossesForeign currency translation gains/losses$(39.0)$46.0 $(92.3)$34.9 Foreign currency translation gains/losses$(133.3)$(39.0)$(234.2)$(92.3)
Unrealized net gains/losses on securitiesUnrealized net gains/losses on securities0.8 (0.2)3.8 (3.0)Unrealized net gains/losses on securities3.4 0.8 13.1 3.8 
Defined benefit pension and retiree health benefit plansDefined benefit pension and retiree health benefit plans(28.2)11.8 (79.7)(32.8)Defined benefit pension and retiree health benefit plans(22.4)(28.2)(73.2)(79.7)
Effective portion of cash flow hedgesEffective portion of cash flow hedges(5.4)(22.9)(37.9)59.1 Effective portion of cash flow hedges(16.9)(5.4)(80.8)(37.9)
Benefit (provision) for income taxes allocated to other comprehensive income (loss) items$(71.8)$34.7 $(206.1)$58.2 
Benefit (expense) for income taxes allocated to other comprehensive income (loss) itemsBenefit (expense) for income taxes allocated to other comprehensive income (loss) items$(169.2)$(71.8)$(375.1)$(206.1)
Except for the tax effects of foreign currency translation gains and losses related to our foreign currency-denominated notes, cross-currency interest rate swaps, and other foreign currency exchange contracts designated as net investment hedges (see Note 6), income taxes were not provided for foreign currency translation. Generally, the assets and liabilities of foreign operations are translated into U.S. dollars using the current exchange rate. For those operations, changes in exchange rates generally do not affect cash flows; therefore, resulting translation adjustments are made in shareholders' equity rather than in the consolidated condensed statements of operations.
Reclassifications out of accumulated other comprehensive loss were as follows:
Details about Accumulated Other Comprehensive Loss ComponentsDetails about Accumulated Other Comprehensive Loss ComponentsThree Months Ended September 30,Nine Months Ended September 30,Affected Line Item in the Consolidated Condensed Statements of OperationsDetails about Accumulated Other Comprehensive Loss ComponentsThree Months Ended September 30,Nine Months Ended September 30,Affected Line Item in the Consolidated Condensed Statements of Operations
Details about Accumulated Other Comprehensive Loss ComponentsThree Months Ended September 30,Nine Months Ended September 30,Affected Line Item in the Consolidated Condensed Statements of Operations
20212020202120202022202120222021
Amortization of retirement benefit items:Amortization of retirement benefit items:Amortization of retirement benefit items:
Prior service benefits, netPrior service benefits, net$(13.9)$(20.8)$(41.5)$(48.4)Other–net, (income) expensePrior service benefits, net$(13.1)$(13.9)$(39.2)$(41.5)Other–net, (income) expense
Actuarial losses, netActuarial losses, net122.7 59.1 368.7 288.6 Other–net, (income) expenseActuarial losses, net85.5 122.7 257.5 368.7 Other–net, (income) expense
Total before taxTotal before tax108.8 38.3 327.2 240.2 Total before tax72.4 108.8 218.3 327.2 
Tax benefitTax benefit(22.8)(8.0)(68.7)(50.4)Income taxesTax benefit(15.2)(22.8)(45.8)(68.7)Income taxes
Net of taxNet of tax86.0 30.3 258.5 189.8 Net of tax57.2 86.0 172.5 258.5 
Other, net of taxOther, net of tax3.4 3.1 10.7 13.0 Other–net, (income) expenseOther, net of tax13.9 3.4 19.9 10.7 Other–net, (income) expense
Total reclassifications, net of taxTotal reclassifications, net of tax$89.4 $33.4 $269.2 $202.8 Total reclassifications, net of tax$71.1 $89.4 $192.4 $269.2 
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Note 11: Other–Net, (Income) Expense
Other–net, (income) expense consisted of the following:
Three Months Ended September 30,Nine Months Ended September 30,
 2021202020212020
Interest expense$83.6 $89.6 $258.4 $270.4 
Interest income(7.0)(5.8)(18.0)(27.2)
Net investment (gains) losses on equity securities (Note 6)246.8 (141.7)(270.1)(905.1)
Retirement benefit plans(72.6)(114.0)(217.1)(194.5)
Debt extinguishment loss (Note 6)405.2 — 405.2 — 
Other (income) expense(20.1)13.0 (34.1)161.5 
Other–net, (income) expense$635.9 $(158.9)$124.3 $(694.9)

Three Months Ended September 30,Nine Months Ended September 30,
 2022202120222021
Interest expense$81.5 $83.6 $247.6 $258.4 
Interest income(20.1)(7.0)(37.3)(18.0)
Net investment (gains) losses on equity securities (Note 6)123.3 246.8 667.6 (270.1)
Retirement benefit plans(92.4)(72.6)(280.0)(217.1)
Debt extinguishment loss (Note 6) 405.2  405.2 
Other (income) expense18.7 (20.1)(17.0)(34.1)
Other–net, (income) expense$111.0 $635.9 $580.9 $124.3 
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Item 2. Management’sManagement's Discussion and Analysis of Results of Operations and Financial Condition

Results of Operations

(Tables present dollars in millions, except per-share data)
General
Management’sManagement's discussion and analysis of results of operations and financial condition is intended to assist the reader in understanding and assessing significant changes and trends related to the results of operations and financial position of our consolidated company. This discussion and analysis should be read in conjunction with the consolidated condensed financial statements and accompanying footnotes in Part I, Item 1 of this Quarterly Report on Form 10-Q. Certain statements in this Part I, Item 2 of this Quarterly Report on Form 10-Q constitute forward-looking statements. Various risks and uncertainties, including those discussed in "Forward-Looking Statements" in this Quarterly Report on Form 10-Q and “Risk Factors”"Risk Factors" in Part I, Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2020,2021, may cause our actual results, financial position, and cash generated from operations to differ materially from these forward-looking statements.
Executive Overview
This section provides an overview of our financial results, recent product and late-stage pipeline developments, and other matters affecting our company and the pharmaceutical industry. Earnings per share (EPS) data are presented on a diluted basis.
COVID-19 Pandemic
In response to the COVID-19 pandemic, we have focused on maintaining a reliable supply of our medicines; reducing the strain on the medical system; developing treatments for COVID-19; protecting the health, safety, and well-being of our employees; supporting our communities; and ensuring affordability of and access to our medicines, particularly insulin.
We have experienced negative impacts toreceived various regulatory authorizations, including Emergency Use Authorizations (EUA), for our underlying business due to the COVID-19 pandemic, including decreases in new prescriptions, changes in payer segment mix, and the increased use of patient affordability programs intherapies. We supplied the United States (U.S.). Additionally, government approximately 810,000 doses of bebtelovimab during the nine months ended September 30, 2022. Beginning in the third quarter of 2022 and in collaboration with the U.S. government, we have experienced,made bebtelovimab commercially available for purchase by U.S. states/territories, hospitals, and may continue to experience if the COVID-19 pandemic undergoes resurgent or more severe waves, decreased demand as a result of lack of normal access and fewer in-person interactions by patients and our employees with the healthcare system. Prescriptions in most of our therapeutic areas have returned to pre-COVID-19 pandemic levels in thecertain other providers. We do not anticipate any further U.S., and healthcare systems in most of our major markets have largely resumed normal operations as of September 30, 2021. While a majority of in-person interactions by our employees with the healthcare system have resumed, we may decide to halt such activity in the future and, in those cases, expect to resume such interactions as it is safe to do so and in compliance with applicable guidance and requirements. We may experience additional pricing pressures resulting from the financial strain of the COVID-19 pandemic on government-funded healthcare systems around the world. In addition, if the COVID-19 pandemic experiences resurgent or more severe waves, our ability to commercialize some assets in our product pipeline could be delayed or otherwise adversely affected.
Since the start of the pandemic we have worked with a variety of organizations, including governmental agencies, to facilitate access to our COVID-19 therapies in various countries. government orders. The U.S. Food and Drug Administration (FDA) granted Emergency Use Authorizations (EUA)has revised, and may in the future revise, any EUA for bamlanivimabour COVID-19 therapies in response to the prevalence of variants against which our therapies have varying degrees of efficacy, including the new BQ variants. Based on early data, we do not believe that bebtelovimab will neutralize against the new BQ variants.
The COVID-19 pandemic has, and bamlanivimabmay continue to, adversely impact our business and etesevimab administered together for higher-risk patients who have been recently diagnosed with mild-to-moderateoperations. Strain on global transportation, logistics, manufacturing, and labor markets, including as aggravated by the pandemic and global unrest, the focus of resources on COVID-19, protective measures implemented to control the spread of COVID-19, and an increase in overall demand in our industry for baricitinib for treatment withcertain resources and medicines, resulting in changed buying patterns, increased costs, and constrained supply, have negatively impacted and may continue to negatively impact the development, manufacturing, supply, distribution, and sales of our medicines.
The degree to which the COVID-19 pandemic and related challenges impact the development, manufacturing, supply, distribution, and sale of our medicines will depend on developments that are highly uncertain and beyond our knowledge or without remdesivir in hospitalized COVID-19 patients. In April 2021, the FDA subsequently revoked the EUA for bamlanivimab alone. In the third quarter of 2021, the FDA expanded the EUA for bamlanivimab and etesevimab administered together to include post-exposure prophylaxis in certain individuals for the prevention of SARS-CoV-2 infection.control.

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We have,Product Supply
Continued strong demand for Trulicity® in U.S. and willinternational markets, partially due to the ongoing limited availability of competitor therapies, has challenged, and is expected to continue to face unique riskschallenge, our ability to meet demand in most international markets. In the U.S., as demand for Trulicity has continued to exceed historical levels, we anticipate tight supplies will persist until additional manufacturing capacity is operationalized, and uncertaintiesU.S. wholesalers may experience intermittent restocking delays of Trulicity orders. Outside the U.S., we have implemented certain actions to minimize the impact to existing patients, but we expect to experience intermittent disruptions in our development, manufacture, andsupply of Trulicity in international markets.
In addition, the uptake of potential treatmentsMounjaro® for COVID-19, including vulnerabilitytype 2 diabetes following its launch in the U.S. has been very strong. We continue to carefully monitor demand, incretin competitor availability, and supply chain disruptions, higherwith a focus on access for Type 2 diabetes patients.
We anticipate that additional internal and contracted manufacturing costs, difficultiescapacity will become fully operational around the world in manufacturing appropriate quantitiesthe next several years, with significant expansion in 2023, as part of our therapies, heightened regulatory scrutiny of our manufacturing practices, restrictions on administration that limit widespread and timely accessongoing efforts to our therapies, and risks related to handling, return, and/or refund of product after delivery by us. Expedited authorization processes, including our EUA for bamlanivimab and etesevimab administered together, have allowed restricted distribution of products with less than typical safety and efficacy data, and additional data that become available have and may further call into questionmeet the safety or effectiveness of our COVID-19 therapies. Additionally, the availability of superior or competitive therapies, including therapies that can be administered more easily, or preventative measures, such as vaccines, coupled with the transient nature of pandemics, have and could further negatively impact or eliminatesignificant demand for our COVID-19 therapies. Mutations or the spread of other variants of the coronavirus have in some cases impacted the effectiveness of our COVID-19 therapies, and may further render our therapies more or less effective or ineffective. In addition, evolving regulatory priorities have intensified governmental scrutiny of our operations, including our compliance with Good Manufacturing Practices (cGMP), quality assurance, and similar regulations relating to our manufacture of COVID-19 therapies and otherincretin medicines. Any of these risks could prevent us from recouping our substantial investments in the research, development, and manufacture of our COVID-19 therapies. These risks could also affect other aspects of our business, including potentially resulting in delays or denials in the approval or launch of other products.
Our ability to continue to operate without significant negative impacts will in part depend on our ability to protect our employees and our supply chain. We have taken steps to protect our employees worldwide, with particular measures in place for those working in our manufacturing sites and distribution facilities. Effective November 2021, we are requiring COVID-19 vaccinations as a condition of employment in the U.S. and Puerto Rico. We have been able to largely maintain our normal operations. However, uncertainty resulting from the COVID-19 pandemic and its effects, including as may relate to our COVID-19 vaccination policy, could have an adverse impact on our manufacturing operations, global supply chain, and distribution systems, which could impact our ability to produce and distribute our products and the ability of third parties on which we rely to fulfill their obligations to us, and could increase our expenses if the COVID-19 pandemic experiences resurgent or more severe waves.
Although the COVID-19 pandemic has affected our operations and demand for our products, it has not negatively impacted our liquidity position. We expect to continue to generate cash flows to meet our short-term liquidity needs and to have access to liquidity via the short-term and long-term debt markets. As part of our response to the COVID-19 pandemic, and at the request of the U.S. and international governments, we invested in large-scale manufacturing of COVID-19 antibodies at risk, in order to ensure rapid access to patients around the world. As the COVID-19 pandemic has continued to evolve during 2021, we have incurred a net inventory impairment charge related to our COVID-19 antibodies during the nine months ended September 30, 2021, primarily due to the combination of changes to current and forecasted demand from the U.S. and international governments, including changes to our agreement with the U.S. government, and near-term expiry dates of COVID-19 antibodies. We could experience additional impairments of our assets, including inventory related to our COVID-19 antibodies, or significant changes in the fair value of our assets due to the COVID-19 pandemic, including as a result of the factors discussed above.
See “Risk Factors”"Risk Factors" in Part I, Item 1A of our Annual Report on Form 10-K for the year ended December 31, 20202021 for additional information on risk factors that could impact our results.business and operations.
41


Financial Results
The following table summarizes our key operating results:
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended September 30,Nine Months Ended
September 30,
20212020Percent Change20212020Percent Change20222021Percent Change20222021Percent Change
RevenueRevenue$6,772.8 $5,740.6 18$20,318.5 $17,099.8 19Revenue$6,941.6 $6,772.8 2$21,239.6 $20,318.5 5
Gross marginGross margin5,342.0 4,414.2 2115,055.9 13,336.3 13Gross margin5,362.5 5,342.0 16,157.9 15,055.9 7
Gross margin as a percent of revenueGross margin as a percent of revenue78.9 %76.9 %74.1 %78.0 %Gross margin as a percent of revenue77.3 %78.9 %76.1 %74.1 %
Operating expenses$3,286.8 $3,034.5 8$9,906.1 $8,815.0 12
Acquired in-process research and development (IPR&D)174.0 — NM498.3 294.1 69
Research and developmentResearch and development$1,802.9 $1,705.3 6$5,194.9 $5,032.4 3
Marketing, selling, and administrativeMarketing, selling, and administrative1,614.2 1,577.9 24,797.2 4,839.6 (1)
Acquired in-process research and development (IPR&D) and development milestonesAcquired in-process research and development (IPR&D) and development milestones62.4 177.6 (65)668.4 532.4 26
Asset impairment, restructuring, and other special chargesAsset impairment, restructuring, and other special charges 101.4 NM211.6 161.3 31Asset impairment, restructuring, and other special charges206.5 — NM206.5 211.6 (2)
Other–net, (income) expenseOther–net, (income) expense111.0 635.9 (83)580.9 124.3 NM
Net incomeNet income1,110.1 1,208.4 (8)3,855.6 4,076.9 (5)Net income1,451.7 1,110.1 314,307.1 3,855.6 12
EPS1.22 1.33 (8)4.23 4.47 (5)
EPS - dilutedEPS - diluted1.61 1.22 324.76 4.23 13
NM - not meaningful
Revenue increased for the three and nine months ended September 30, 2021,2022, driven by increased volume, partially offset by lower realized prices and the unfavorable impact of foreign exchange rates. Research and development expenses increased for the three and nine months ended September 30, 2022, primarily driven by increased volume. Operatinghigher development expenses defined asfor late-stage assets, partially offset by lower development expenses for COVID-19 antibodies and the sumfavorable impact of research and development and marketing,foreign exchange rates. Marketing, selling, and administrative expenses increased for the three months ended September 30, 2021,2022, primarily driven by higher developmentincreased costs associated with the launch of Mounjaro, partially offset by the favorable impact of foreign exchange rates. Marketing, selling, and administrative expenses for late-stage assets. Operating expenses increaseddecreased for the nine months ended September 30, 2021,2022, primarily driven by higher development expenses for late-stage assets and higher research and development expenses for COVID-19 therapies,the favorable impact of foreign exchange rates as well as higherreduced marketing expenses. The decreasecosts in net income and EPS for the three and nine months ended September 30, 2021 was primarily driven by higher operating expenses and a reduction in other-net, (income) expense,first half of 2022, partially offset by higher gross margin.increased costs associated with the launch of Mounjaro.

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The following highlighted items also affect comparisons of our financial results for the three and nine months ended September 30, 20212022 and 2020:2021:
2022
Acquired IPR&D and Development Milestones (See Note 3 to the consolidated condensed financial statements)
We recognized $62.4 million and $668.4 million of acquired IPR&D and development milestones for the three and nine months ended September 30, 2022, respectively. The charges for the nine months ended September 30, 2022 included the buy-out of substantially all future obligations that were contingent upon the occurrence of certain events linked to the success of our mutant-selective PI3kα inhibitor and a purchase of a Priority Review Voucher.
Asset Impairment, Restructuring, and Other Special Charges (See Note 5 to the consolidated condensed financial statements)
We recognized charges of $206.5 million for the three and nine months ended September 30, 2022, primarily related to an intangible asset impairment for GBA1 Gene Therapy (PR001) due to changes in estimated launch timing.
Other-Net, (Income) Expense (See Note 11 to the consolidated condensed financial statements)
We recognized $123.3 million and $667.6 million of net investment losses on equity securities for the three and nine months ended September 30, 2022, respectively.
2021
Cost of Sales (See Note 5 to the consolidated condensed financial statements)
We recognized a net inventory impairment charge related to our COVID-19 antibodies of $435.1 million for the nine months ended September 30, 2021. As part of our response to the COVID-19 pandemic, and at the request of the U.S. and international governments, we invested in large-scale manufacturing of COVID-19 antibodies at risk, in order to ensure rapid access to patients around the world. As the COVID-19 pandemic has continued to evolveevolved during 2021, we incurred a net inventory impairment charge primarily due to the combination of changes to current and forecasted demand from U.S. and international governments, including changes to our agreement with the U.S. government, and near-term expiry dates of COVID-19 antibodies.
Acquired IPR&D and Development Milestones (See Note 3 to the consolidated condensed financial statements)
We recognized $177.6 million and $532.4 million of acquired IPR&D charges of $174.0 million and $498.3 milliondevelopment milestones for the three and nine months ended September 30, 2021, respectively. The charges for the three months ended September 30, 2021 were related to business development transactions with Protomer Technologies Inc. (Protomer), Kumquat Biosciences Inc. (Kumquat), Lycia Therapeutics, Inc. (Lycia), and ProQR Therapeutics N.V. (ProQR). The charges for the nine months ended September 30, 2021 also included acquired IPR&D charges related toresulting from business development transactions with Rigel Pharmaceuticals, Inc. (Rigel), and Precision BioSciences,Biosciences, Inc. (Precision), Merus N.V. (Merus), MiNA Therapeutics Limited (MiNA), and Asahi Kasei Pharma Corporation (Asahi).
Asset Impairment, Restructuring, and Other Special Charges (See Note 5 to the consolidated condensed financial statements)
We recognized charges of $211.6 million for the nine months ended September 30, 2021, primarily related to an intangible asset impairment resulting from the sale of the rights to Qbrexza®, as well as acquisition and integration costs associated with the acquisition of Prevail Therapeutics Inc. (Prevail).
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Other-Net, (Income) Expense (See Note 611 to the consolidated condensed financial statements)
We recognized a debt extinguishment loss of $405.2 million related to the repurchase of debt for the three and nine months ended September 30, 2021.
We recognized $246.8 million of net investment (losses)losses on equity securities for the three months ended September 30, 2021. We recognized $270.1 million of net investment gains on equity securities of ($246.8 million) and $270.1 million for the three and nine months ended September 30, 2021, respectively.
2020
Acquired IPR&D (See Note 3 to the consolidated condensed financial statements)
We recognized acquired IPR&D charges of $294.1 million for the nine months ended September 30, 2020, related to the acquisition of Petra Pharma Corporation (Petra), as well as business development transactions with Sitryx Therapeutics Limited (Sitryx), AbCellera Biologics Inc. (AbCellera), Evox Therapeutics Limited (Evox), and Shanghai Junshi Biosciences Co., Ltd. (Junshi Biosciences).2021.
Asset Impairment, Restructuring, and Other Special Charges (See Note 5 to the consolidated condensed financial statements)
We recognized charges of $101.4 million and $161.3 million for the three and nine months ended September 30, 2020, respectively, primarily related to severance costs incurred as a result of actions taken worldwide to reduce our cost structure.
Other-Net, (Income) Expense (See Note 6 to the consolidated condensed financial statements)
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We recognized net investment gains on equity securities of $141.7 million and $905.1 million for the three and nine months ended September 30, 2020, respectively.
Late-Stage Pipeline
Our long-term success depends on our ability to continually discover or acquire, develop, and commercialize innovative new medicines. We currently have approximately 45 new medicine candidates in clinical development or under regulatory review, and a larger number of projects in the discovery phase.
The following certain new molecular entities (NMEs) are currently in Phase II or Phase III clinical trials or have been submitted for regulatory review or have received first regulatory approval in the U.S., Europe, or Japan in 2021. In addition, the following table includes certain NMEs currently in Phase I or Phase II clinical trials.Japan. The following table reflects the status of these NMEs, including certain other developments since January 1,our Annual Report on Form 10-K for the year ended December 31, 2021.
CompoundIndicationStatusDevelopments
COVID-19 Therapies
Bamlanivimab administered aloneDiabetes
Tirzepatide (Mounjaro)COVID-19Type 2 diabetesApprovedApproved in the U.S. in the second quarter of 2022 and in Europe and Japan in the third quarter of 2022.
Heart failure with preserved ejection fractionPhase IIIPhase III trials are ongoing.
ObesityPhase III
Emergency Use AuthorizationGranted FDA Fast Track designation(1)
in October 2022. Announced in the firstsecond quarter of 20212022 that athe initial Phase III trial met the primaryco-primary and all key secondary endpoints. The European Medicines Agency's (EMA) Committee for Medicinal Products for Human Use (CHMP) issued a positive scientific opinion in the first quarter of 2021. In the second quarter of 2021 the FDA revoked the EUA for bamlanivimab alone in the U.S.
Bamlanivimab and etesevimab administered togetherCOVID-19Emergency Use AuthorizationAnnounced in the first quarter of 2021 that Phase III trials met the primary and all key secondary endpoints. Additional are ongoing.
Obstructive sleep apneaPhase IIIPhase III trial is ongoing. The FDA granted EUA for higher-risk patients recently diagnosed with mild-to-moderate COVID-19 in the first quarter of 2021. In the third quarter of 2021 the FDA expanded the EUA to include post-exposure prophylaxis in certain individuals for the prevention of SARS-CoV-2 infection. The EMA's CHMP issued a positive scientific opinion in the first quarter of 2021. Submitted in Europe in the first quarter of 2021. Announced a Joint Procurement Agreement with the European Commission to supply up to 220,000 dosesinitiated in the third quarter of 2021.2022.
Bamlanivimab, etesevimab and bebtelovimab (LY-CoV1404) administered togetherNonalcoholic steatohepatitisCOVID-19Phase IIPhase II trial is ongoing.
Basal Insulin-FcType 1 and 2 diabetesPhase IIIPhase III trials initiated in the first, second, and third quarters of 2022.
Orforglipron (GLP-1R NPA)ObesityPhase IIPhase II trials are ongoing.
Type 2 diabetes
Retatrutide (GGG Tri-Agonist)ObesityPhase IIPhase II trials are ongoing.
Type 2 diabetes
Immunology
Lebrikizumab(2)
Atopic dermatitisSubmitted
Granted FDA Fast Track designation(1). Submitted in the U.S. in the third quarter of 2022 and in Europe in October 2022. Phase III trials are ongoing.
MirikizumabUlcerative colitisSubmittedSubmitted in the U.S. in first quarter of 2022 and in Europe and Japan in the second quarter of 2022.
Crohn's DiseasePhase IIIPhase III trials are ongoing.
ANGPTL3 siRNACardiovascular diseasePhase IIPhase II trial initiated in the third quarter of 2022.
BTLA MAB AgonistSystemic lupus erythematosusPhase IIPhase II trial initiated in the second quarter of 2021.2022.
CXCR1/2 Ligands Monoclonal AntibodyHidradenitis suppurativaPhase IIPhase II trial is ongoing.
Peresolimab (PD-1 MAB Agonist)Rheumatoid arthritisPhase IIPhase II trial is ongoing.
Rezpegaldesleukin (IL-2 Conjugate)Systemic lupus erythematosusPhase IIPhase II trial is ongoing.
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CompoundIndicationStatusDevelopments
VIR-7831 and bamlanivimab administered together(2)
COVID-19Phase IIPhase II trial initiated in the first quarter of 2021.
EndocrinologyNeuroscience
TirzepatideDonanemabType 2 diabetesEarly Alzheimer's diseaseSubmitted
Announced in the first and second quarters of 2021 that Phase III trials met the primary and key secondary endpoints.Granted FDA Breakthrough Therapy designation(3). Submitted in the U.S. using a priority review voucher and in Europe in October 2021. Additionalthe second quarter of 2022. Received Priority Review designation under the accelerated approval pathway. Phase III trials are ongoing.
Heart failure with preserved ejection fractionPreclinical Alzheimer's diseasePhase IIIPhase III trial is ongoing.
RemternetugEarly Alzheimer's diseasePhase IIIPhase III trial initiated in the second quarter of 2021.
ObesityPhase III trials are ongoing.
Nonalcoholic steatohepatitisPhase IIPhase II trial is ongoing.
Basal Insulin-FcType 1 and 2 diabetesPhase IIPhase II trials are ongoing.
GGG Tri-AgonistObesityPhase IIPhase II trials initiated in the second quarter of 2021.
Type 2 diabetes
GLP-1R NPAObesityPhase IIPhase II trials initiated in the third quarter of 2021.
Type 2 diabetes
Immunology
Lebrikizumab(3)
Atopic dermatitis2022.Phase III
Granted FDA Fast Track designation(4). Announced in the third quarter of 2021 that Phase III trials met primary and all key secondary endpoints. Additional Phase III trials are ongoing.
MirikizumabCrohn's diseasePhase IIIPhase III trials are ongoing.
Ulcerative colitisAnnounced in the first quarter of 2021 that a Phase III trial met the primary and key secondary endpoints. Additional Phase III trials are ongoing.
PsoriasisNot pursuing submissionAnnounced in the second quarter of 2021 that we do not plan to pursue submission.
CXCR1/2 Ligands Monoclonal AntibodyHidradenitis suppurativaPhase IIPhase II trial is ongoing.
IL-2 ConjugateSystemic lupus erythematosusPhase IIPhase II trial is ongoing.
Ulcerative colitisPhase II trial initiated in the second quarter of 2021.
PD-1 MAB AgonistRheumatoid arthritisPhase IIPhase II trial initiated in the first quarter of 2021.
Neuroscience
DonanemabEarly Alzheimer’s diseaseSubmission initiated
Announced in the first quarter of 2021 that a Phase II trial met the primary endpoint and that we expanded a Phase II trial to become a Phase III trial. Granted FDA Breakthrough Therapy designation(5) in the second quarter of 2021. Initiated a rolling submission in the U.S. for accelerated approval in the third quarter of 2021. Additional Phase III trials are ongoing.
SolanezumabPreclinical Alzheimer's diseasePhase IIIPhase III trial is ongoing.
Epiregulin/TGFα MABChronic painPhase IIPhase II trials are ongoing.
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CompoundIndicationStatusDevelopments
GBA1 Gene Therapy (PR001)Parkinson's diseasePhase II
Acquired in the Prevail acquisition in the first quarter of 2021. Granted FDA Fast Track designation(4)(1). Phase II trials aretrial is ongoing.
GRN Gene Therapy (PR006)Frontotemporal dementiaPhase II
Granted FDA Fast Track designation(1). Phase II trial is ongoing.
PACAP38 AntibodyO-GlcNAcase InhChronic painAlzheimer's diseasePhase IIPhase II trial is ongoing.
SSTR4 AgonistChronic painPainPhase IIPhase II trials are ongoing.
TRPA1 AntagonistPainPhase IIPhase II trials initiated in October 2021.
Tanezumab(6)
Osteoarthritis painare ongoing.DiscontinuedIn October 2021, in collaboration with Pfizer, we discontinued the global clinical development program following receipt of a Complete Response Letter from the FDA and a negative opinion from the EMA's CHMP.
Cancer pain
ZagotenemabPACAP38 AntibodyAlzheimer’s diseaseMigraineDiscontinuedAnnounced in October 2021 that aIn the third quarter of 2022 based on the results of the Phase II trial, did not meet the primary endpoint and we will discontinuediscontinued development.
Oncology
Selpercatinib (Retevmo®)
ThyroidLung cancer
LaunchedApproved(7)(4)
Launched in Europe in the first quarter of 2021. Approved in Japan in the third quarter of 2021. Phase III trials are ongoing. In the third quarter of 2022, the FDA granted accelerated approval in tumor-agnostic RET fusion-positive advanced or metastatic solid tumors and traditional approval in locally advanced or metastatic RET fusion-positive non-small cell lung cancer.
LungThyroid cancer
Sintilimab injectionApproved(8)(4)
Lung cancerSubmittedIn collaboration with Innovent, submitted in the U.S. in the second quarter of 2021.
ImlunestrantER+HER2-metastic breast cancerPhase IIIPhase III trial initiated in October 2021.is ongoing.
Pirtobrutinib (LOXO-305)Mantle cell lymphomaSubmittedSubmitted in the U.S. in second quarter of 2022. Received Priority Review designation under the accelerated approval pathway. Phase III trial is ongoing.
Chronic lymphocytic leukemiaPhase IIIPhase III trials initiated in the first and third quarters of 2021.
Mantle cell lymphomaare ongoing.Phase IIIPhase III trial initiated in the second quarter of 2021.
B-cell malignanciesPhase IIPhase II trial initiated in the second quarter of 2021.is ongoing.
(1) EUAs remain active for certain countries outside of the U.S.
(2) In collaboration with Vir Biotechnology, Inc. and GlaxoSmithKline plc.
(3) In collaboration with Almirall, S.A. (Almirall) in Europe.
(4) Fast Track designation is designed to expedite the development and review of new therapies to treat serious conditions and address unmet medical needs.
(5) Breakthrough Therapy designation is designed to expedite the development and review of potential medicines that are intended to treat a serious condition where preliminary clinical evidence indicates that the treatment may demonstrate substantial improvement over available therapy on a clinically significant endpoint.
(6) In collaboration with Pfizer, Inc (Pfizer).
(7) Continued approval may be contingent on verification and description of clinical benefit in confirmatory Phase III trials.
(8) In collaboration with Innovent Biologics, Inc. (Innovent).
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Our pipeline also contains several new indication line extension (NILEX) products. The following certain NILEX products are currently in Phase II or Phase III clinical testing, have been submitted for regulatory review, or have received first regulatory approval in the U.S., Europe, or Japan for use in the indication described in 2021. The following table reflects the status of certain NILEX products, including certain other developments since January 1, 2021:
CompoundImlunestrantIndicationStatusDevelopments
Endocrinology
Empagliflozin (Jardiance®)(1)
Heart failure with reduced ejection fractionLaunchedLaunched in the U.S. and Europe in the third quarter of 2021.
Heart failure with preserved ejection fractionSubmitted
Granted FDA Fast Track designation(2). In the third quarter of 2021 the FDA granted Breakthrough Therapy designation(3). Announced in the third quarter of 2021 that a Phase III trial met the primary endpoint. Submitted in the U.S. and Europe in October 2021.
Chronic kidney diseasePhase III
Granted FDA Fast Track designation(2). Phase III trials are ongoing.
Immunology
Baricitinib (Olumiant®)
Atopic dermatitisLaunchedLaunched in Europe and Japan. Announced in the third quarter of 2021 that the FDA will not meet the Prescription Drug User Fee Act action date for the submission in the U.S.
COVID-19
Emergency Use Authorization(4)
Announced in the second quarter of 2021 that a Phase III trial evaluating baricitinib 4 mg once daily plus standard of care did not meet the primary endpoint, but did result in a significant reduction in death. In the third quarter of 2021, the FDA broadened the EUA for baricitinib to allow for treatment with or without remdesivir.
Alopecia areataSubmitted
Granted FDA Breakthrough Therapy designation(3). Announced in the first, second and third quarters of 2021 that Phase III trials met the primary and all key secondary endpoints. Submitted in Europe and Japan in the third quarter of 2021. We intend to submit to the FDA by the end of 2021.
Systemic lupus erythematosusPhase IIIPhase III trials are ongoing.
Oncology
Abemaciclib (Verzenio®)
HR+, ER+HER2- Adjuvant breast cancerLaunchedAnnounced in the first quarter of 2021 patient-reported outcomes in combination with standard adjuvant endocrine therapy. Submitted in Japan in the first quarter of 2021. Launched in the U.S. in October 2021.
HR+, HER2+ Adjuvantmetastatic breast cancerPhase IIIPhase III trial initiated in the second quarter of 2021.
Prostate canceris ongoing.Phase IIIPhase III trial initiated in the third quarter of 2021.
(1)In collaboration with Boehringer Ingelheim.
(2) Fast Track designation is designed to expeditefacilitate the development and expedite the review of new therapiesmedicines to treat serious conditions and addressfill an unmet medical needs.need.
(2) In collaboration with Almirall, S.A. in Europe.
(3) Breakthrough Therapy designation is designed to expedite the development and review of potential medicines that are intended to treat a serious condition where preliminary clinical evidence indicates that the treatment may demonstrate substantial improvement over available therapy on a clinically significant endpoint.
(4) The FDA granted EUA for treatment with or without remdesivirContinued approval may be contingent on verification and description of clinical benefit in hospitalized COVID-19 patients.confirmatory Phase III trials.

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Our pipeline also contains several new indication line extension (NILEX) products. The following certain NILEX products for use in the indication described are currently in Phase II or Phase III clinical trials or have been submitted for regulatory review or have received regulatory approval in the U.S., Europe, or Japan. The following table reflects the status of these NILEX products, including certain other developments since our Annual Report on Form 10-K for the year ended December 31, 2021.
CompoundIndicationStatusDevelopments
Diabetes
Empagliflozin (Jardiance®)(1)
Heart failure with preserved ejection fractionApprovedApproved in the U.S. and Europe in the first quarter of 2022 and in Japan in the second quarter of 2022.
Chronic kidney diseasePhase III
Granted FDA Fast Track designation(2). In the first quarter of 2022 the Independent Data Monitoring Committee recommended stopping the Phase III trial early due to clear positive efficacy.
Immunology
Baricitinib (Olumiant®)
Alopecia areataApprovedApproved in the U.S., Europe, and Japan in the second quarter of 2022.
COVID-19ApprovedApproved in the U.S. in the second quarter of 2022.
Oncology
Abemaciclib (Verzenio®)
Prostate cancerPhase IIIPhase III trials are ongoing.
(1) In collaboration with Boehringer Ingelheim.
(2) Fast Track designation is designed to facilitate the development and expedite the review of medicines to treat serious conditions and fill an unmet medical need.
Other Matters
Patent Matters
We depend on patents or other forms of intellectual property protection for most of our revenue, cash flows, and earnings.
Our vitamin regimen patentsFollowing the June 2021 loss of patent exclusivity for Alimta® expired in major European countriesEurope and Japan, in June 2021. We havewe faced, and remain exposedexpect to continue to face, generic competition that has rapidly and severely eroded revenue, and we expect will continue to erode revenue from current levels. In addition, as a result of the entry of multiple generics in the U.S. following the loss of patent and pediatric exclusivity in major European countriesMay 2022, we began facing, and Japan, whichexpect to continue to face, additional generic competition that has eroded revenue, and is likely towe expect will continue to rapidly and severely erode revenue from current levels. In the U.S., we expect the vitamin regimen patent for Alimtato provide us with patent protection through May 2022. However, we and Eagle Pharmaceuticals, Inc. (Eagle) reached an agreement in December 2019 to settle all pending U.S. patent litigation, allowing Eagle a limited initial entry into the market with its product starting February 2022 (up to an approximate three-week supply) and subsequent unlimited entry starting April 2022. We expect that the entry of generic competition in the U.S. following the loss of patent exclusivity will cause a rapid and severeThis decline in revenue has had and will have a material adverse effect on our consolidated results of operations and cash flows. See Note 9 to the consolidated condensed financial statements for a more detailed accountdescription of the legal proceedings currently pending regarding among others,certain of our Alimta patents.
Our compound patentpatents for Humalog® (insulin lispro) hashave expired in the U.S. and major markets. Global regulatorsinternational markets, and we have different legal pathways to approve similaralso introduced lower-priced versions of Humalog as part of our insulin lispro.affordability solutions. A competitor launchedhas a similar version of insulin lispro in the U.S. and in certain European markets in 2017markets. Due to the impact of competition and pricing pressure in the U.S. in the second quarter of 2018. While it is difficult to estimate the severity of the impact of insulin lispro products entering the market, we do not expect and have not experienced a rapid and severe decline in revenue; however,some international markets, we expect additional pricing pressure and some loss of market share that wouldlower revenue due to realized price decline will continue over time.
Our formulation and use patents for Forteo® have expired in major markets. We expect further decline in revenue as a result of the entry of generic and biosimilar competition due to the loss of patent exclusivity in major markets.
Our compound patent for Cymbalta® expired in Japan in January 2020. We have faced, and remain exposed to, generic competition following the loss of exclusivity, which has eroded revenue and is likely to continue to rapidly and severely erode revenue from current levels.
Foreign Currency Exchange Rates
As a global company, with substantial operations outside the U.S., we face foreign currency risk exposure from fluctuating currency exchange rates, primarily the U.S. dollar against the euro, Japanese yen, and Chinese yuan. While we seek to manage a portion of these exposures through hedging and other risk management techniques, significant fluctuations in currency rates can have a substantialmaterial impact, either positive or negative, on our consolidated results of operations in any given period. During the three and nine months ended September 30, 2022, revenue cost of sales,was unfavorably impacted by 4 percent and operating expenses.3 percent, respectively, due to foreign exchange rates. While there is uncertainty in the future movements in foreign exchange rates, fluctuations in these rates couldhave, and we currently expect in the near-term future will, adversely impact our future consolidated results of operations and cash flows.
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Trends Affecting Pharmaceutical Pricing, Reimbursement, Access, and Other Regulatory MattersAccess
Global concern over access to and affordability of pharmaceutical products continues to drive regulatory and legislative debate and action, as well as worldwide cost containment efforts by governmental authorities.Such measures may include the use of mandated discounts, price reporting requirements, mandated reference prices, restrictive formularies, changes to available intellectual property protections, as well as other efforts. In addition, consolidationAugust 2022, the U.S. government enacted the Inflation Reduction Act (IRA). Among other measures, the IRA will allow the U.S. Department of Health and Human Services to effectively set prices for certain single-source drugs and biologics reimbursed under Medicare Part B and Part D. Generally, these government prices apply nine (medicines approved under a New Drug Application) or thirteen (medicines approved under a Biologics License Application) years following initial FDA approval and will be capped at a statutory ceiling price that is likely to represent a significant discount from average prices to wholesalers and direct purchasers. It is too soon to tell how the U.S. government will set these prices as the law specifies a ceiling price, but not a minimum or floor price. One or more significant Lilly products may be selected, which would have the effect of accelerating revenue erosion prior to patent expiry. The effect of reducing prices and reimbursement for certain of our products could significantly impact our business and consolidated results of operations.
Other of the IRA’s provisions provide for penalties on drug manufacturers that increase prices of certain Medicare Part B and Part D medicines at a rate greater than the rate of inflation and replace the Part D coverage gap discount program with a new manufacturer discounting program. Manufacturers that fail to comply with the IRA may be subject to various penalties, including civil monetary penalties. The IRA takes effect progressively starting in 2023, with the first government set prices effective in 2026. The IRA may meaningfully influence our and pharmaceutical industry business strategies. In particular it may reduce the attractiveness of investment in small molecule innovation. Provisions of the IRA may be subject to legal challenges or other reformation, and the full effect of the IRA on our business and the pharmaceutical industry remains uncertain. Additional policies, regulations, legislation, or enforcement, including those proposed and/or pursued by the U.S. Congress and executive branch of the U.S. administration and other regulatory authorities worldwide, could adversely impact our business and consolidated results of operations.
Consolidation of private payors in the U.S. has also significantly impacted the market for pharmaceuticals by increasing payor leverage in negotiating manufacturer price concessions and pharmacy reimbursement rates. Furthermore, restrictive or unfavorable pricing, coverage, or reimbursement determinations for our medicines or product candidates by governments, regulatory agencies, courts, or private payers, such as the Centers for Medicare & Medicaid Services' National Coverage Determination for monoclonal antibodies for the treatment of Alzheimer's Disease, may adversely impact our business and consolidated results of operations. We expect that these actions may intensify and could particularly affect certain products, such as insulin, as governments manage and emerge from the COVID-19 pandemic, which could adversely affect our business. In addition, we are engaged in litigation and investigations related to our 340B program and access to insulin that, if resolved adversely to us, could negatively impact our business and consolidated results of operations. It is not currently possible to predict the overall potential adverse impact to us or the general pharmaceutical industry of continued cost containment efforts.efforts worldwide.
In addition, evolvingEvolving regulatory priorities have also intensified governmental scrutiny of our operations and our industry, including with respect to cGMP,current Good Manufacturing Practices, quality assurance, and similar regulations, and increased focus on business combinations in our industry. Any regulatory issues concerning these matters could lead to regulatory and legal actions, product recalls and seizures, fines and penalties, interruption of production leading to product shortages, import bans or denials of import certifications, delays or denials in the approvals of new products or supplemental approvals of current products pending resolution of the issues, impediments to the completion of business combinations, and reputational harm, any of which would adversely affect our business.
See “Risk Factors”"Business - Regulations and Private Payer Actions Affecting Pharmaceutical Pricing, Reimbursement, and Access" in Part I, Item 1 and "Risk Factors" in Part I, Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2020.2021. See also Note 9 to the consolidated condensed financial statements.
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Tax Matters
We are subject to income taxes and various other taxes in the U.S. and in many foreign jurisdictions; therefore, changes in both domestic and international tax laws or regulations couldhave affected and may affect our effective tax rate, results of operations, and cash flows. CountriesIn 2017, the U.S. enacted the Tax Cuts and Jobs Act (the 2017 Tax Act), which contains a provision that requires capitalization and amortization of research and development expenses for tax purposes starting in 2022. Previously, these expenses could be deducted in the year incurred. The implementation of this provision has increased, and is expected to continue to increase, our 2022 cash payments of income taxes and subsequently decrease our cash payments of income taxes moderately over the five-year amortization period. We expect the implementation of this provision to impact our 2022 cash payments of income taxes by up to $1.50 billion. For the three and nine months ended September 30, 2022, the implementation of this provision favorably impacted other tax items that decreased our effective tax rate by approximately 4 percentage points. If this provision of the 2017 Tax Act is deferred or repealed by the U.S. Congress effective for 2022, we expect our effective tax rate to be approximately 13 percent to 14 percent for 2022.
The U.S. and countries around the world including the U.S., are actively considering and enacting tax law changes. Tax proposals have been introduced by the U.S. Congress and the BidenU.S. administration containcontaining significant changes, including increases to the tax rates at which both domestic and foreign income of U.S. companies would be taxed. In addition, tax authorities in the U.S. and other jurisdictions in which we do business routinely examine our tax returns and are intensifying their scrutiny and examinations of profit allocations among jurisdictions. Further, actions taken with respect to tax-related matters by associations, such as the Organisation for Economic Co-operation and Development and the European Commission, could influence tax policylaws in countries in which we operate. In addition, globalChanges to existing tax law and increased scrutiny by tax authorities routinely examine our tax returnsin the U.S. and are expected to become more aggressive in their examinations of profit allocations amongother jurisdictions which could adversely impact our future consolidated results of operations and cash flows.
Acquisitions
We strategicallyopportunistically invest in external research and technologies that we believe to complement and strengthen our own efforts. These investments can take many forms, including acquisitions, strategic alliances, collaborations, investments, and licensing arrangements. We view our business development activity as an importanta way to achieve our strategies, as we seek to bolsterenhance our pipeline and enhance shareholder value. We continuously evaluate business development transactions that have the potential to strengthen our business.
In February 2020, we acquired all shares of Dermira, Inc. for a purchase price of $849.3 million, net of cash acquired. Under the terms of the agreement, we acquired lebrikizumab, a novel, investigational, monoclonal antibody being evaluated for the treatment of moderate-to-severe atopic dermatitis. Lebrikizumab was granted Fast Track designation from the FDA. We also acquired Qbrexza cloth, a medicated cloth for the topical treatment of primary axillary hyperhidrosis (uncontrolled excessive underarm sweating). During the nine months ended September 30, 2021, we sold the rights to Qbrexza. See Note 5 to the consolidated condensed financial statements for additional information.
In January 2021, we acquired all shares of Prevail for a purchase price that included $22.50 per share in cash (or an aggregate of $747.4 million, net of cash acquired) plus one non-tradable contingent value right (CVR) per share. The CVR entitles Prevail stockholders up to an additional $4.00 per share in cash (or an aggregate of approximately $160 million) payable, subject to certain terms and conditions, upon the first regulatory approval of a Prevail product in one of the following countries: U.S., Japan, United Kingdom, Germany, France, Italy, or Spain. Under the terms of the agreement, we acquired a gene therapy program for patients with neurodegenerative diseases.
See Note 3 to the consolidated condensed financial statements for further discussion regarding our recent acquisitions.

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Revenue
The following table summarizes our revenue activity by region:
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended September 30,Nine Months Ended September 30,
20212020Percent Change20212020Percent Change20222021Percent Change20222021Percent Change
U.S.U.S.$3,989.6 $3,161.4 26$11,635.1 $9,631.4 21U.S.$4,422.1 $3,989.6 11$13,531.5 $11,635.1 16
Outside U.S.Outside U.S.2,783.3 2,579.3 88,683.4 7,468.5 16Outside U.S.2,519.4 2,783.3 (9)7,708.1 8,683.4 (11)
RevenueRevenue$6,772.8 $5,740.6 18$20,318.5 $17,099.8 19Revenue$6,941.6 $6,772.8 2$21,239.6 $20,318.5 5
Numbers may not add due to rounding.

The following are components of the change in revenue compared with the prior year:
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended September 30,Nine Months Ended September 30,
2021 vs. 20202021 vs. 20202022 vs. 20212022 vs. 2021
U.S.Outside U.S.ConsolidatedU.S.Outside U.S.ConsolidatedU.S.Outside U.S.ConsolidatedU.S.Outside U.S.Consolidated
VolumeVolume22 %11 %17 %22 %15 %19 %Volume15 %13 %14 %20 %%15 %
PricePrice(4)— (1)(3)(2)Price(4)(12)(7)(4)(11)(7)
Foreign exchange ratesForeign exchange rates— — Foreign exchange rates— (11)(4)— (7)(3)
Percent changePercent change26 %%18 %21 %16 %19 %Percent change11 %(9)%%16 %(11)%%
Numbers may not add due to rounding.
In the U.S. for the three and nine months ended September 30, 2021,2022, the increase in volume was primarily driven by COVID-19 therapies,antibodies, Trulicity, Verzenio, Jardiance, Taltz®, and Taltz®.Mounjaro, partially offset by decreased volume for Alimta, resulting from the entry of multiple generics in the second quarter of 2022, and for Olumiant, due to the decline in utilization for COVID-19 treatment. In the U.S. for the three and nine months ended September 30, 2022, the decrease in realized prices was primarily driven by Humalog, due to a list price reduction of insulin lispro injection and unfavorable segment mix, and by Trulicity, due to unfavorable segment mix and higher contracted rebates. In the U.S. for the three months ended September 30, 2021,2022, the increasedecrease in realized prices for Trulicity was drivenpartially offset by lower utilization in the 340B program, unfavorable changes to estimates for rebates and discounts for Trulicity in the three months ended September 30, 2020, and modest list prices increases, partially offset by increased rebates to maintain access for products across the business. U.S. price performance was not a major driver during the nine months ended September 30, 2021, as increased utilization in more highly-rebated segments was largely offset by lower utilization in the 340B program, primarily for the diabetes portfolio.discounts.
Outside the U.S. for the three and nine months ended September 30, 2021,2022, the increase in volume was primarily driven by COVID-19 therapies,Verzenio, Trulicity, Verzenio,Tyvyt®, Jardiance, and Taltz.Taltz, partially offset by Alimta and Cymbalta® resulting from generic competition. Additionally outside the U.S. for the three and nine months ended September 30, 2022, we recognized revenue related to a sales collaboration agreement for the right to sell and distribute Mounjaro in Japan. Outside the U.S. for the nine months ended September 30, 2021,2022, the increase in volume was also drivenpartially offset by decreased sales of COVID-19 antibodies and the sale of ourthe rights to Cialis® in China.










China in the second quarter of 2021. Outside the U.S. for the three and nine months ended September 30, 2022, the decrease in realized prices was primarily driven by the impact of government pricing in China from the National Reimbursement Drug List (NRDL) formulary for certain products, particularly Tyvyt and Verzenio, and volume-based procurement (VBP) for Humalog.
4945


The following table summarizes our revenue activity by product for the three months ended September 30, 20212022 and 2020:
Three Months Ended September 30,
20212020
ProductU.S.Outside U.S.TotalTotalPercent Change
Trulicity$1,201.4 $398.8 $1,600.1 $1,106.6 45
Humalog (1)
347.3 279.4 626.7 656.9 (5)
Taltz422.2 170.9 593.1 454.5 30
Alimta297.2 159.8 457.0 578.0 (21)
Olumiant (2)
194.0 212.9 406.9 162.0 NM
Jardiance (3)
221.2 169.2 390.4 310.8 26
Verzenio199.6 135.9 335.5 234.4 43
Humulin®
193.4 93.4 286.7 305.9 (6)
Cyramza®
84.8 168.6 253.4 252.7 
COVID-19 antibodies (4)
215.5 1.6 217.1 — NM
Forteo109.6 91.3 200.9 266.9 (25)
Basaglar®
114.7 78.1 192.8 248.2 (22)
Emgality®
99.9 40.1 140.0 91.5 53
Erbitux®
114.0 20.3 134.3 136.4 (2)
Cymbalta7.0 125.1 132.0 186.6 (29)
Cialis(6.5)137.4 130.9 162.5 (19)
Tyvyt®
 125.6 125.6 84.4 49
Zyprexa®
13.0 88.7 101.7 112.7 (10)
Other products161.5 286.3 447.7 389.6 15
Revenue$3,989.6 $2,783.3 $6,772.8 $5,740.6 18
2021:
Three Months Ended September 30,
20222021
ProductU.S.Outside U.S.TotalTotalPercent Change
Trulicity$1,418.3 $432.0 $1,850.4 $1,600.1 16
Taltz493.8 186.1 679.9 593.1 15
Verzenio414.8 202.9 617.7 335.5 84
Jardiance(1)
350.9 222.4 573.3 390.4 47
Humalog(2)
248.1 198.8 447.0 626.7 (29)
COVID-19 antibodies(3)
386.6  386.6 217.1 78
Humulin®
169.5 68.7 238.2 286.7 (17)
Cyramza®
87.5 144.6 232.1 253.4 (8)
Basaglar®
124.8 68.1 193.0 192.8 
Mounjaro97.3 90.0 187.3 — NM
Olumiant(4)
22.9 160.0 182.9 406.9 (55)
Forteo112.7 64.4 177.1 200.9 (12)
Emgality®
114.0 54.6 168.5 140.0 20
Erbitux®
126.3 18.7 144.9 134.3 8
Alimta64.6 54.8 119.4 457.0 (74)
Cialis8.1 107.7 115.7 130.9 (12)
Zyprexa®
8.0 73.4 81.4 101.7 (20)
Tyvyt 76.8 76.8 125.6 (39)
Cymbalta7.8 54.9 62.7 132.0 (53)
Other products166.1 240.5 406.7 447.7 (9)
Revenue$4,422.1 $2,519.4 $6,941.6 $6,772.8 2
Numbers may not add due to rounding.
NM - not meaningful
(1)Humalog revenue includes insulin lispro.
(2) Olumiant revenue includes sales for baricitinib, for treatment in hospitalized COVID-19 patients, that were made pursuant to EUA.
(3) Jardiance revenue includes Glyxambi®, Synjardy®, and Trijardy® XR.
(4)(2) Humalog revenue includes insulin lispro.
(3) COVID-19 antibodies include sales for bamlanivimab administered alone, as well as sales for bamlanivimab and etesevimab administered together, and for bebtelovimab and were made pursuant to EUAs.EUAs or similar regulatory authorizations.
(4) Olumiant revenue includes sales for baricitinib that were made pursuant to EUA or similar regulatory authorizations.
5046



The following table summarizes our revenue activity by product for the nine months ended September 30, 20212022 and 2020:
Nine Months Ended September 30,
20212020
Product
U.S. (1)
Outside U.S.TotalTotalPercent Change
Trulicity$3,465.7 $1,122.5 $4,588.2 $3,565.7 29
Humalog (1)
1,009.0 842.3 1,851.3 1,907.8 (3)
Alimta911.9 714.7 1,626.6 1,677.2 (3)
Taltz1,071.6 493.8 1,565.4 1,293.2 21
COVID-19 antibodies (2)
949.5 226.7 1,176.2 — NM
Jardiance (3)
566.8 492.1 1,058.9 840.3 26
Verzenio582.1 363.7 945.8 631.1 50
Humulin633.5 290.3 923.8 935.2 (1)
Olumiant (4)
236.5 572.6 809.1 446.7 81
Cyramza266.3 496.3 762.5 748.4 2
Basaglar423.3 226.8 650.1 842.3 (23)
Forteo330.1 287.7 617.8 791.9 (22)
Cialis(3.1)541.8 538.7 486.2 11
Cymbalta30.3 454.0 484.3 576.9 (16)
Emgality313.5 102.2 415.7 252.9 64
Erbitux357.7 45.9 403.7 396.7 2
Tyvyt 340.2 340.2 205.9 65
Zyprexa28.3 264.5 292.8 307.7 (5)
Other products462.1 805.1 1,267.3 1,193.7 6
Revenue$11,635.1 $8,683.4 $20,318.5 $17,099.8 19
2021:
Nine Months Ended September 30,
20222021
ProductU.S.Outside U.S.TotalTotalPercent Change
Trulicity$4,162.4 $1,341.1 $5,503.5 $4,588.2 20
COVID-19 antibodies(1)
1,970.9 14.7 1,985.5 1,176.2 69
Taltz1,212.6 561.6 1,774.2 1,565.4 13
Verzenio1,100.5 575.1 1,675.6 945.8 77
Humalog(2)
855.8 656.4 1,512.3 1,851.3 (18)
Jardiance(3)
831.4 622.4 1,453.7 1,058.9 37
Humulin562.3 223.1 785.4 923.8 (15)
Cyramza259.3 434.3 693.6 762.5 (9)
Alimta490.5 200.5 691.1 1,626.6 (58)
Olumiant(4)
104.6 520.1 624.7 809.1 (23)
Basaglar339.9 218.8 558.7 650.1 (14)
Cialis25.8 454.7 480.4 538.7 (11)
Emgality330.8 144.4 475.2 415.7 14
Forteo261.4 191.7 453.0 617.8 (27)
Erbitux361.0 47.4 408.3 403.7 1
Zyprexa26.2 235.5 261.7 292.8 (11)
Tyvyt 235.8 235.8 340.2 (31)
Cymbalta25.0 194.3 219.3 484.3 (55)
Mounjaro109.9 93.3 203.2 — NM
Other products501.1 743.0 1,244.2 1,267.3 (2)
Revenue$13,531.5 $7,708.1 $21,239.6 $20,318.5 5
Numbers may not add due to rounding.
NM - not meaningful
(1) Humalog revenue includes insulin lispro.
(2) COVID-19 antibodies include sales for bamlanivimab administered alone, as well as sales for bamlanivimab and etesevimab administered together, and for bebtelovimab and were made pursuant to EUAs.EUAs or similar regulatory authorizations.
(2) Humalog revenue includes insulin lispro.
(3) Jardiance revenue includes Glyxambi, Synjardy, and Trijardy XR.
(4) Olumiant revenue includes sales for baricitinib for treatment in hospitalized COVID-19 patients, that were made pursuant to EUA.EUA or similar regulatory authorizations.

Revenue of Trulicity, a treatment for type 2 diabetes and to reduce the risk of major adverse cardiovascular events in adult patients with type 2 diabetes and established cardiovascular disease or multiple cardiovascular risk factors, increased 52 percent and 30 percent in the U.S. during the three and nine months ended September 30, 2021, respectively, driven by increased demand and, to a lesser extent, higher realized prices due to segment mix, including lower utilization in the 340B program, and modest list price increases, partially offset by increased rebates to maintain access. Trulicity's higher realized prices in the U.S. during the three months ended September 30, 2021 were also due to unfavorable changes to estimates for rebates and discounts in the three months ended September 30, 2020. Revenue outside the U.S. increased 26 percent during the three and nine months ended September 30, 2021, driven by increased volume and, to a lesser extent, the favorable impact of foreign exchange rates, partially offset by lower realized prices.
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Revenue of Humalog, an injectable human insulin analog for the treatment of diabetes, decreased 11 percent and 6 percent in the U.S. during the three and nine months ended September 30, 2021, respectively, driven by lower realized prices, partially offset by increased demand. Revenue outside the U.S. increased 5 percent during the three months ended September 30, 2021, driven by the favorable impact of foreign exchange rates and increased volume, partially offset by lower realized prices. Revenue outside the U.S. increased 1 percent during the nine months ended September 30, 2021, primarily driven by the favorable impact of foreign exchange rates, largely offset by decreased volume. While it is difficult to estimate the severity of the impact of insulin lispro products entering the market, we do not expect and have not experienced a rapid and severe decline in revenue. However, due to the impact of competition and due to pricing pressure in the U.S. and some international markets, we expect some price decline and loss of market share to continue over time.
Revenue of Alimta, a treatment for various cancers, increased 218 percent in the U.S. during the three months ended September 30, 2021, primarily2022, driven by higher realized prices, partially offset by decreased demand and customer buying patterns. Revenue decreased 2 percent in the U.S. during the nine months ended September 30, 2021, primarily driven by decreasedincreased demand, partially offset by higherlower realized prices. Revenue outsideThe lower realized prices in the U.S. decreased 44 percent duringfor the three months ended September 30, 2021, primarily driven by decreased volume2022 were due to entry of generic competitionunfavorable segment mix and higher contracted rebates, partially offset by changes to a lesser extent, lower realized prices.estimates for rebates and discounts. Revenue outsidein the U.S. decreased 4increased 20 percent during the nine months ended September 30, 2021, driven by lower realized prices and decreased volume, partially offset by the favorable impact of foreign exchange rates. We have faced and remain exposed to generic competition following the loss of exclusivity in major European countries and Japan in June 2021, which has eroded revenue and is likely to continue to rapidly and severely erode revenue from current levels. We expect the limited entry of generic competition in the U.S. starting February 2022, and subsequent unlimited entry starting April 2022. We expect that the entry of generic competition following the loss of exclusivity in the U.S. will cause a rapid and severe decline in revenue. See "Executive Overview - Other Matters- Patent Matters" for more information.
Revenue of Taltz, a treatment for moderate-to-severe plaque psoriasis, active psoriatic arthritis, ankylosing spondylitis, and active non-radiographic axial spondyloarthritis, increased 29 percent and 14 percent in the U.S. during the three and nine months ended September 30, 2021, respectively, primarily driven by increased demand, partially offset by lower realized prices due to increased rebates to gain commercial access. Taltz's lower realized prices in the U.S. during the three months ended September 30, 2021 were also driven by unfavorable segment mix partially offset by changes to estimates for rebates and discounts.higher contracted rebates. Revenue outside the U.S. increased 338 percent and 4119 percent during the three and nine months ended September 30, 2021,2022, respectively, driven by increased volumedemand, partially offset by the unfavorable impact of foreign exchange rates and, to a lesser extent, the favorable impact of foreign exchange rates, partially offset by lower realized prices.
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Revenue of COVID-19 antibodies, treatments that were authorized pursuant to EUAs for mild to moderate COVID-19 for higher-risk patients and for post-exposure prophylaxis in certain individuals for the prevention of SARS-CoV-2 infection, was $215.5$386.6 million and $949.5 million$1.97 billion in the U.S. during the three and nine months ended September 30, 2021,2022, respectively. Revenue outside the U.S. was $1.6 million and $226.7 millionnot material during the three and nine months ended September 30, 2021, respectively.2022. The availability of superior or competitive therapies, including therapies that can be administered more easily, or preventative measures, such as vaccines, coupled with the transientunpredictable nature of pandemics, have and could further negatively impact or eliminate demand for these COVID-19 antibodies. In addition, mutations orThe FDA has revised, and may in the spread of other variants of the coronavirus have in some cases impacted the effectiveness offuture revise, any EUA for our COVID-19 antibodies and may further renderin response to the prevalence of variants against which our antibodies more or less effective or ineffective.have varying degrees of efficacy, including the new BQ variants. Based on early data, we do not believe that bebtelovimab will neutralize against the new BQ variants. We supplied the U.S. government approximately 810,000 doses of bebtelovimab during the nine months ended September 30, 2022. Beginning in the third quarter of 2022 and in collaboration with the U.S. government, we have made bebtelovimab commercially available for purchase by U.S. states/territories, hospitals, and certain other providers. We do not anticipate any further U.S. government orders.
Revenue of Taltz, a treatment for moderate-to-severe plaque psoriasis, active psoriatic arthritis, ankylosing spondylitis, and active non-radiographic axial spondyloarthritis, increased 17 percent and 13 percent in the U.S. during the three and nine months ended September 30, 2022, respectively, driven by increased demand, partially offset by lower realized prices. Revenue outside the U.S. increased 9 percent and 14 percent during the three and nine months ended September 30, 2022, respectively, driven by increased volume, partially offset by unfavorable impact of foreign exchange rates and lower realized prices.
Revenue of Verzenio, a treatment for HR+, HER2- metastatic breast cancer and high risk early breast cancer, increased $215.1 million and $518.4 million in the U.S. during the three and nine months ended September 30, 2022, respectively, primarily driven by increased demand. Revenue outside the U.S. increased 49 percent and 58 percent during the three and nine months ended September 30, 2022, respectively, driven by increased demand, partially offset by lower realized prices due to the impact of the NRDL formulary in China and the unfavorable impact of foreign exchange rates.
Revenue of Humalog, an injectable human insulin analog for the treatment of diabetes, decreased 29 percent and 15 percent in the U.S. during the three and nine months ended September 30, 2022, respectively, driven by lower realized prices due to a list price reduction of insulin lispro injection and unfavorable segment mix. Revenue outside the U.S. decreased 29 percent and 22 percent during the three and nine months ended September 30, 2022, respectively, driven by lower realized prices due to the impact of VBP in China and the unfavorable impact of foreign exchange rates. Due to the impact of competition and pricing pressure in the U.S. and some international markets, we expect that lower revenue due to realized price decline will continue over time.
Revenue of Jardiance, a treatment for type 2 diabetes, to reduce the risk of cardiovascular death in adult patients with type 2 diabetes and established cardiovascular disease, and to reduce the risk of cardiovascular death plusand hospitalization for heart failure in adults with heart failure, with reducedregardless of left ventricular ejection fraction, increased 3559 percent and 2547 percent in the U.S. during the three and nine months ended September 30, 2021,2022, respectively, primarily driven by increased demand. Revenue outsideThe increase in revenue in the U.S. increased 15 percent during the three months ended September 30, 2021,2022 was also driven by changes to estimates for rebates and discounts. Revenue outside the U.S. increased 31 percent and 26 percent during the three and nine months ended September 30, 2022, respectively, primarily driven by increased volume,demand, partially offset by the unfavorable impact of foreign exchange rates. Revenue outside the U.S. increased 27 percent during the nine months ended September 30, 2021, driven by increased volume and, to a lesser extent, the favorable impact of foreign exchange rates. See Note 4 to the consolidated condensed financial statements for information regarding our collaboration with Boehringer Ingelheim involving Jardiance.
52


Revenue of Verzenio,Alimta, a treatment for HR+, HER2- metastatic breast cancer and high risk early breast cancer, increased 26 percent in the U.S. during the three months ended September 30, 2021, driven by increased demand, partially offset by lower realized prices. Revenue of Verzenio increased 35 percent in the U.S. during the nine months ended September 30, 2021, primarily driven by increased demand. Revenue outside the U.S. increased 80various cancers, decreased 78 percent and 81 percent during the three and nine months ended September 30, 2021, respectively, primarily driven by increased volume.
Revenue of Humulin, an injectable human insulin for the treatment of diabetes, decreased 10 percent and 146 percent in the U.S. during the three and nine months ended September 30, 2021,2022, respectively, primarily driven by lower realized prices and decreased demand. Revenue outsidedemand due to the U.S. increased 2 percent duringentry of multiple generics in the three months ended September 30, 2021, driven by higher realized prices and, to a lesser extent, the favorable impactsecond quarter of foreign exchange rates, largely offset by decreased volume.2022. Revenue outside the U.S. decreased 1 percent during the nine months ended September 30, 2021, driven by decreased volume, largely offset by the favorable impact of foreign exchange rates and higher realized prices.
Revenue of Olumiant, a treatment for adults with moderately-to-severely active rheumatoid arthritis, and of baricitinib, a treatment authorized pursuant to EUA, with or without remdesivir, of hospitalized patients with COVID-19, increased $179.5 million and $197.5 million in the U.S. during the three and nine months ended September 30, 2021, respectively, driven by utilization for the treatment of hospitalized patients with COVID-19 during the third quarter of 2021. Revenue outside the U.S. increased 4466 percent and 4072 percent during the three and nine months ended September 30, 2021,2022, respectively, driven by increased volume and, to a lesser extent, the favorable impact of foreign exchange rates, partially offset by lower realized prices.
Revenue of Cyramza, a treatment for various cancers, decreased 10 percent and 4 percent in the U.S. during the three and nine months ended September 30, 2021, respectively, primarilylargely driven by decreased demand partially offset by higher realized prices. Revenue outsidedue to generic competition. Following the June 2021 loss of patent exclusivity for Alimta in Europe and Japan, we faced, and expect to continue to face, generic competition that has rapidly and severely eroded revenue, and we expect will continue to erode revenue from current levels. In addition, as a result of the entry of multiple generics in the U.S. increased7 percentfollowing the loss of patent and 5 percentpediatric exclusivity in May 2022, we began facing, and expect to continue to face, additional generic competition that has eroded revenue, and we expect will continue to rapidly and severely erode revenue from current levels. See "Executive Overview - Other Matters- Patent Matters" for the three and nine months ended September 30, 2021, respectively, driven by increased volume. In addition, the increase in revenue outside the U.S. for the three months ended September 30, 2021 was partially offset by lower realized prices and the unfavorable impact of foreign exchange rates.additional information.

5348


Gross Margin, Costs, and Expenses
Gross margin as a percent of revenue decreased 1.6 percentage points to 77.3 percent and increased 2.0 percentage points to 78.9 percent and decreased 3.9 percentage points to 74.176.1 percent for the three and ninemonths ended September 30, 2021,2022, respectively. The increasedecrease in the gross margin percent for the three months ended September 30, 20212022 was primarily driven by a benefit in the gross margin for the three months ended September 30, 2021 due to favorable product mixthe partial reversal of inventory impairment charges related to our COVID-19 antibodies that were recognized in the first and favorable effectsecond quarters of foreign exchange rates on international inventories sold.2021. The decreasepartial reversal of inventory impairment charges related to our COVID-19 antibodies was driven by an unexpected increase in our COVID-19 antibodies sales as the COVID-19 pandemic evolved during the third quarter of 2021. The increase in gross margin percent for the nine months ended September 30, 20212022 was primarily driven by lower gross margin on COVID-19 therapies, including the impact of $435.1 million of a net inventory impairment charge related to our COVID-19 antibodies. As part of our response to the COVID-19 pandemic, and at the request of the U.S. and international governments, we investedantibodies recognized in large-scale manufacturing of COVID-19 antibodies at risk, in order to ensure rapid access to patients around the world. As the COVID-19 pandemic has continued to evolve during 2021, we incurred a net inventory impairment charge primarily due to the combination of changes to current and forecasted demand from U.S. and international governments, including changes to our agreement with the U.S. government, and near-term expiry dates of COVID-19 antibodies.
Research and development expenses increased 17 percent to $1.71 billion and 19 percent to $5.07 billion2021. Additionally, for the three and nine months ended September 30, 2021, respectively. The increase in research2022, lower realized prices and increased expenses due to inflation and logistics costs were offset by favorable product mix, including the impact of lower sales of Olumiant for the treatment of COVID-19, and the favorable impact of foreign exchange rates.
Research and development expenses increased 6 percent to $1.80 billion and 3 percent to $5.19 billion for the three and ninemonths ended September 30, 2022, respectively, primarily driven by higher development expenses for late-stage assets, partially offset by lower development expenses for COVID-19 antibodies and the favorable impact of foreign exchange rates.
Marketing, selling, and administrative expenses increased2 percent to $1.61 billion for the three months ended September 30, 2022, primarily driven by increased costs associated with the launch of Mounjaro, partially offset by the favorable impact of foreign exchange rates. Marketing, selling, and administrative expenses decreased 1 percent to $4.80 billion for the nine months ended September 30, 2022, primarily driven by the favorable impact of foreign exchange rates as well as reduced marketing costs in the first half of 2022, partially offset by increased costs associated with the launch of Mounjaro.
We plan to take compensatory actions to improve retention and address wage inflation which will impact our costs and consolidated results of operations.
We recognized $62.4 millionand$668.4 million of acquired IPR&D and development milestones for the three and nine months ended September 30, 2021 was primarily driven by higher development expenses for late-stage assets.2022, respectively. The increase in research and development expensescharges for the nine months ended September 30, 2021 was also driven by higher research2022 included the buy-out of substantially all future obligations that were contingent upon the occurrence of certain events linked to the success of our mutant-selective PI3kα inhibitor and development expenses for COVID-19 therapies.
Marketing, selling, and administrative expenses increased 1 percent to $1.58 billion and 6 percent to $4.84 billion for the three and nine months ended September 30, 2021, respectively. The increase in marketing, selling, and administrative expenses for the nine months ended September 30, 2021 was primarily driven by lower marketing expenses for the nine months ended September 30, 2020 due to pandemic-related spending reductions.
a purchase of a Priority Review Voucher. We recognized $174.0$177.6 millionand $498.3$532.4 million of acquired IPR&D chargesand development milestones for the three and nine months ended September 30, 2021, respectively. The charges for the three months ended September 30, 2021 were related to business development transactions with Protomer, Kumquat, Lycia, and ProQR. The charges for the nine months ended September 30, 2021 also included acquired IPR&D charges related tofrom business development transactions with Rigel Precision, Merus, MiNA, and Asahi. Precision. See Note 3 to the consolidated condensed financial statements for additional information.
We recognized $294.1asset impairment, restructuring, and other special charges of $206.5 million of acquired IPR&D charges for the three and nine months ended September 30, 2020,2022, primarily related to an intangible asset impairment for GBA1 Gene Therapy (PR001) due to changes in estimated launch timing. There were no asset impairment, restructuring, and other special charges recognized for the acquisition of Petra, as well as business development transactions with Sitryx, AbCellera, Evox, and Junshi Biosciences.
three months ended September 30, 2021. We recognized asset impairment, restructuring, and other special charges of $211.6 million for the nine months ended September 30, 2021, primarily related to an intangible asset impairment resulting from the sale of the rights to Qbrexza, as well as acquisition and integration costs associated with the acquisition of Prevail. We recognized asset impairment, restructuring, and other special chargesSee Note 5 to the consolidated condensed financial statements for additional information.
Other–net, (income) expense was expense of $101.4$111.0 million and $161.3$580.9 million for the three and nine months ended September 30, 2020,2022, respectively, primarily related to severance costs incurred as a result of actions taken worldwide to reduce our cost structure.
Other–net, (income) expense wascompared with expense of $635.9 million and $124.3 million for the three and nine months ended September 30, 2021, respectively, compared with income of $158.9 million and $694.9 million for the three and nine months ended September 30, 2020, respectively. The decrease in other-net, (income)other expense for the three months ended September 30, 20212022 was primarily driven primarily by a debt extinguishment loss of $405.2 million related to the repurchase of debt and unfavorable mark-to-market adjustmentsin 2021, as well as lower net investment losses on investments in equity securities during the three months ended September 30, 2021in 2022 compared to favorable mark-to-market adjustments on investments2021. The increase in equity securities during the three months ended September 30, 2020. The decrease in other-net, (income)other expense for the nine months ended September 30, 20212022 was primarily driven by lower favorable mark-to-market adjustmentsnet investment losses on investments in equity securities andin 2022 compared with net investment gains on equity securities in 2021, partially offset by a debt extinguishment loss of $405.2 million related to the repurchase of debt partially offset by income from patent settlements in Europe for Alimta.2021.
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The effective tax rates were 7.3 percent and 8.6 percent for the three and nine months ended September 30, 2022, respectively, reflecting the favorable tax impact of the implementation of a provision in the 2017 Tax Act that requires capitalization and amortization of research and development expenses for tax purposes starting in 2022, net investment losses on equity securities, and an intangible asset impairment charge. We expect our effective tax rate to be approximately 13 percent to 14 percent for 2022 if the capitalization and amortization of research and development expenses provision of the 2017 Tax Act is deferred or repealed by the U.S. Congress effective for 2022.
The effective tax rate was 10.9 percent for the three months ended September 30, 2021, compared with 15.9 percent forreflecting the three months ended September 30, 2020.favorable tax impact of a debt extinguishment loss and of net investment losses on equity securities, partially offset by a net discrete tax detriment. The effective tax rate was 10.7 percent for the nine months ended September 30, 2021, compared with 14.4 percent forreflecting the nine months ended September 30, 2020. The lower effective tax rate for the three months ended September 30, 2021 was primarily due to the incomefavorable tax impact of a debt extinguishment loss and unfavorable mark-to-market adjustments on investments in equity securities, partially offset by a lower net discrete tax benefit, compared to the three months ended September 30, 2020. The lower effective tax rate for the nine months ended September 30, 2021 was primarily due to the income tax impacts ofa debt extinguishment loss, and a net inventory impairment charge related to our COVID-19 antibodies and a debt extinguishment loss, as well as higher acquired IPR&D charges and lower favorable mark-to-market adjustments on investments in equity securities compared to the nine months ended September 30, 2020, partially offset by a lower net discrete tax benefit compared to the nine months ended September 30, 2020.antibodies.

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Financial Condition and Liquidity
We believe our available cash and cash equivalents, together with our ability to generate operating cash flow and our access to short-term and long-term borrowings, are sufficient to fund our existing and planned capital requirements. For a discussion of our capital requirements, see “Management's"Management's Discussion and Analysis of Results of Operations and Financial Condition”Condition" in Part II, Item 7 of our Annual Report on Form 10-K for the year ended December 31, 2020.2021.
We plan to invest more than $2 billion over several years in two new facilities in Lebanon, Indiana to manufacture existing and future products and more than $1 billion over several years in a new facility in Concord, North Carolina to manufacture parenteral (injectable) products and devices. We plan to invest more than 400 million euro over several years in a new facility in Limerick, Ireland to expand our manufacturing network for biologic active ingredients. These investments, and other capital investments that support our operations, will result in capital expenditures being higher than recent historical levels for the next several years.
Cash and cash equivalents increaseddecreased to $3.79$2.62 billion as of September 30, 2021,2022, compared with $3.66$3.82 billion as of December 31, 2020.2021. Refer to the consolidated condensed statements of cash flows for additional information on the significant sources and uses of cash for the nine months ended September 30, 20212022 and 2020.2021.
In addition to our cash and cash equivalents, we held total investments of $3.39$2.70 billion and $2.99$3.30 billion as of September 30, 20212022 and December 31, 2020,2021, respectively. See Note 6 to the consolidated condensed financial statements for additional information.
In January 2021, we acquired all shares of Prevail for a purchase price that included $22.50 per share in cash (or an aggregate of $747.4 million, net of cash acquired) plus one non-tradable CVR per share. The CVR entitles Prevail stockholders up to an additional $4.00 per share in cash (or an aggregate of approximately $160 million) payable, subject to certain terms and conditions. The acquisition was funded primarily through cash on hand. See Note 3 to the consolidated condensed financial statements for additional information.
As of September 30, 2021, total debt was $17.09 billion, an increase of $490.1 million compared with $16.60 billion as of December 31, 2020. In September 2021, we issued euro-denominated notes consisting of €500.0 million of 1.125 percent fixed-rate notes due in September 2051 and €700.0 million of 1.375 percent fixed-rate notes due in September 2061, with interest to be paid annually, and British pound-denominated notes consisting of £250.0 million of 1.625 percent fixed-rate notes due in September 2043, with interest to be paid annually. We paid $1.91 billion of the net cash proceeds from the offering to purchase and redeem certain higher interest rate U.S. dollar-denominated notes with an aggregate principal amount of $1.50 billion. We used the remaining net proceeds from the offering to prefund certain 2022 debt maturities and for general corporate purposes In addition, in September 2021, we issued euro-denominated notes consisting of €600.0 million of 0.50 percent fixed-rate notes due in September 2033, with interest to be paid annually. The net proceeds from the offering will be used to fund, in whole or in part, eligible projects designed to advance one or more of our environmental, social, and governance objectives. See Note 6 to the consolidated condensed financial statements for additional information.
As of September 30, 2021,2022, total debt was $15.89 billion, a decrease of $996.3 million compared with $16.88 billion as of December 31, 2021. See Note 6 to the consolidated condensed financial statements for additional information.
As of September 30, 2022, we had a total of $5.24$7.26 billion of unused committed bank credit facilities, $5.00$7.00 billion of which is available to support our commercial paper program. We believe that amounts accessible through existing commercial paper markets should be adequate to fund short-term borrowing needs.
During the nine months ended September 30, 2021,2022, we repurchased $500.0 million$1.50 billion of shares under our $8.00$5.00 billion share repurchase program authorized in June 2018.May 2021. As of September 30, 2021,2022, we had $500.0 million$3.25 billion remaining under this program. In May 2021 we authorized an additional $5.00 billion share repurchase program. There were no shares repurchased under the $5.00 billion share repurchase program during the nine months ended September 30, 2021.
During the nine months ended September 30, 2021,2022, we paid dividends of approximately $2.31$2.65 billion, or $2.55$2.94 per share, to our shareholders. In October 2021,2022, we declared a dividend for the fourth quarter of 20212022 of $0.85$0.98 per share on outstanding common stock. The dividend of approximately $770$882 million is payable on December 10, 20219, 2022 to shareholders of record at the close of business on November 15, 2021.2022.
See "Executive Overview - Other Matters - Patent Matters" for information regarding recent and upcoming losses of patent protection.
Both domestically and abroad, we continue to monitor the potential impacts of the economic environment; the creditworthiness of our wholesalers and other customers, including foreign government-backed agencies and suppliers; the uncertain impact of health care legislation; various international government funding levels; and fluctuations in interest rates, foreign currency exchange rates (see "Executive Overview - Other Matters - Foreign Currency Exchange Rates"), and fair values of equity securities.

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Critical Accounting Estimates
Financial Expectations
We have updated certain elementsFor a discussion of our 2021 financial guidance on a reported basis.
Earnings per share for 2021 are now expectedcritical accounting estimates, refer to be"Management's Discussion and Analysis of Results of Operations and Financial Condition" in the range of $6.38 to $6.48.
We now anticipate 2021 revenue to be between $27.2 billion and $27.6 billion. This increase reflects additional revenue from COVID-19 antibodiesPart II, Item 7 and the underlying core business. Estimated revenue from COVID-19 antibodies is now expectednotes to be $1.3 billion.
Gross margin as a percentour consolidated financial statements in Part II, Item 8 of revenueour Annual Report on Form 10-K for 2021 is unchanged and expected to be approximately 75 percent. Research and development expenses for 2021 are unchanged and remain in the range of $6.9 billion to $7.1 billion. Marketing, selling, and administrative expenses for 2021 are unchanged and remain in the range of $6.2 billion to $6.4 billion.
Acquired IPR&D is now expected to be $498.3 million reflecting charges related to business development transactions with Lycia Therapeutics, Inc. and ProQR Therapeutics N.V. recognized during the three monthsyear ended September 30,December 31, 2021.
Other—net, (income) expense for 2021 is now expected to be expense in the range of $150 million to $250 million, reflecting the impact of a debt extinguishment loss related See also Note 1 to the repurchase of debt and unfavorable mark-to-market adjustmentsconsolidated condensed financial statements. There have been no material changes to our critical accounting estimates since our Annual Report on investments in equity securities duringForm 10-K for the three monthsyear ended September 30,December 31, 2021.
The effective tax rate for 2021 is now expected to be approximately 11 percent, reflecting primarily the tax impact of the charges associated with a debt extinguishment loss related to the repurchase of debt and acquired IPR&D, as well as unfavorable mark-to-market adjustments on investments in equity securities during the three months ended September 30, 2021.

Available Information on our Website
We make available through our company website, free of charge, our company filings with the Securities and Exchange Commission (SEC) as soon as reasonably practicable after we electronically file them with, or furnish them to, the SEC. The reports we make available include annual reports on Form 10-K, quarterly reports on Form 10-Q, current reports on Form 8-K, proxy statements, registration statements, and any amendments to those documents.
The website link to our SEC filings is investor.lilly.com/financial-information/sec-filings.
We routinely post important information for investors in the “Investors” section of our website, www.lilly.com. We may use our website as a means of disclosing material, non-public information and for complying with our disclosure obligations under Regulation FD. Accordingly, investors should monitor the “Investors” section of our website, in addition to following our press releases, filings with the SEC, public conference calls, presentations, and webcasts. We may also use social media channels to communicate with investors and the public about our business, products and other matters, and those communications could be deemed to be material information. The information contained in,on, or that canmay be accessed through, our website or social media channels, is not incorporated by reference into, and is not a part of, or incorporated by reference in, this Quarterly Report.Report on Form 10-Q.

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Item 4. Controls and Procedures
(a)Evaluation of Disclosure Controls and Procedures. Under applicable SECSecurities and Exchange Commission (SEC) regulations, management of a reporting company, with the participation of the principal executive officer and principal financial officer, must periodically evaluate the company’s “disclosurecompany's "disclosure controls and procedures," which are defined generally as controls and other procedures of a reporting company designed to ensure that information required to be disclosed by the reporting company in its periodic reports filed with the SEC (such as this Quarterly Report on Form 10-Q) is recorded, processed, summarized, and reported on a timely basis.
Our management, with the participation of David A. Ricks, president and chief executive officer, and Anat Ashkenazi, seniorexecutive vice president and chief financial officer, evaluated our disclosure controls and procedures (as such terms are defined in our Annual Report on Form 10-K for the year ended December 31, 2020)2021) as of September 30, 2021,2022, and concluded that they were effective.
(b)Changes in Internal Controls. During the third quarter of 2021,2022, there were no changes in our internal control over financial reporting that materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.
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PART II. Other Information
Item 1. Legal Proceedings
We are a party to various currently pending legal actions, government investigations, and environmental proceedings. See Note 9 to the consolidated condensed financial statements for information on various legal proceedings.
This Item should be read in conjunction with "Legal Proceedings" in Part I, Item 3 of our Annual Report on Form 10-K for the year ended December 31, 2020.2021.

Item 1A. Risk Factors
Our material risk factors are disclosed in "Risk Factors" in Part I, Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2020.2021. There have been no material changes from the risk factors previously disclosed in our Annual Report on Form 10-K for the year ended December 31, 2020.2021.

Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
Information relating to the principal market for our common stock and related shareholder matters is described in "Management's Discussion and Analysis of Results of Operations and Financial Condition" in Part II, Item 7 and in "Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters" in Part III, Item 12 of our Annual Report on Form 10-K for the year ended December 31, 2020.2021.
The following table summarizes the activity related to repurchases of our equity securities during the three months ended September 30, 2021:2022:
PeriodTotal Number of
Shares Purchased
(in thousands)
Average Price Paid 
per Share
Total Number of Shares
Purchased as Part of
Publicly Announced
Plans or Programs
(in thousands)
Approximate Dollar Value of Shares that May Yet Be Purchased Under the Plans or Programs
(in millions)
July 20212022— $— — $5,500.03,250.0 
August 20212022— — — 5,500.03,250.0 
September 20212022— — — 5,500.03,250.0 
Total— — — 
During the three months ended September 30, 2021,2022, we did not repurchase any shares under our $8.00 billion or $5.00 billion share repurchase programsprogram authorized in June 2018 and May 2021, respectively.2021.
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Item 6. Exhibits
The following documents are filed as a part of this Quarterly Report:
ExhibitDescription
EXHIBIT 3.1
EXHIBIT 3.2
EXHIBIT 10.1
EXHIBIT 10.2
EXHIBIT 10.3
EXHIBIT 31.1
EXHIBIT 31.2
EXHIBIT 32.
EXHIBIT 101.Interactive Data Files (embedded within the Inline XBRL document)
EXHIBIT 104.Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101)
(1) Indicates management contract or compensatory plan.
(i) Long-term debt instruments under which the total amount of securities authorized does not exceed 10%10 percent of our consolidated assets are not filed as exhibits to this Quarterly Report. We will furnish a copy of these agreements to the SECSecurities and Exchange Commission upon request.


Signatures
Pursuant to the requirements of the Securities Exchange Act of 1934, the Registrant has duly caused this Report to be signed on its behalf by the undersigned thereunto duly authorized.
ELI LILLY AND COMPANY
(Registrant)
Date:October 27, 2021November 1, 2022/s/Anat Ashkenazi
Anat Ashkenazi
SeniorExecutive Vice President and Chief Financial Officer
Date:October 27, 2021November 1, 2022/s/Donald A. Zakrowski
Donald A. Zakrowski
Senior Vice President, Finance, and Chief Accounting Officer
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