Confidential Materials omitted and filed separately with the Securities and Exchange Commission. Double asterisks denote omissions. SECOND AMENDMENT TO GLOBAL COLLABORATION AGREEMENT

“(c) Not later than the last day of the first month of each Contract Quarter, beginning with the Contract Quarter commencing on January 1, 2014, AstraZeneca and MDCO shall agree in writing on the IHT Target for such Contract Quarter. (For example, the Parties shall agree on the IHT Target for the first Contract Quarter in Period 4 by January 31, 2014.) If AstraZeneca and MDCO do not agree on the IHT Target by the last day of the first month of each such Contract Quarter, then AstraZeneca will establish the IHT Target for such Contract Quarter, which IHT Target will be consistent with the target used in determining incentive compensation for AstraZeneca’s Brilinta brand team for such Contract Quarter.

(i)    Not later than [**], AstraZeneca shall pay to MDCO an additional amount with respect to the first Contract Quarter of Period 4 ([**]), as follows:

For clarity, AstraZeneca shall not pay any additional amount with respect to the first Contract Quarter of Period 4 if IHT Actuals for such Contract Quarter are less than [**]% of the IHT Target for such Contract Quarter.

(ii)     Not later than [**], AstraZeneca shall pay to MDCO an additional amount with respect to the second Contract Quarter of Period 4 ([**]), as follows:

For clarity, AstraZeneca shall not pay any additional amount with respect to the second Contract Quarter of Period 4 if IHT Actuals for such Contract Quarter are less than [**]% of the IHT Target for such Contract Quarter.

(iii)     Not later than [**], AstraZeneca shall pay to MDCO an additional amount with respect to the first Contract Quarter ([**]) of Period 5, if any, as follows:

For clarity, AstraZeneca shall not pay any additional amount with respect to the first Contract Quarter of Period 5, if any, if IHT Actuals for such Contract Quarter are less than [**]% of the IHT Target for such Contract Quarter.

(iv)     Not later than [**], AstraZeneca shall pay to MDCO an additional amount with respect to the second Contract Quarter ([**]) of Period 5, as follows:

For clarity, AstraZeneca shall not pay any additional amount with respect to the second Contract Quarter of Period 5, if any, if IHT Actuals for such Contract Quarter are less than [**]% of the IHT Target for such Contract Quarter.

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(v)     Not later than [**], AstraZeneca shall pay to MDCO an additional amount with respect to the first Contract Quarter ([**]) of Period 6, if any, as follows:

For clarity, AstraZeneca shall not pay any additional amount with respect to the first Contract Quarter of Period 6, if any, if IHT Actuals

for such Contract Quarter are less than [**]% of the IHT Target for such Contract Quarter.

(vi)     Not later than [**], AstraZeneca shall pay to MDCO an additional amount with respect to the second Contract Quarter ([**]) of Period 6, if any, as follows:

For clarity, AstraZeneca shall not pay any additional amount with respect to the second Contract Quarter of Period 6, if any, if IHT Actuals for such Contract Quarter are less than [**]% of the IHT Target for such Contract Quarter.

(vii) Not later than [**], AstraZeneca shall pay to MDCO an additional amount with respect to the first Contract Quarter ([**]) of Period 7, if any, as follows:

For clarity, AstraZeneca shall not pay any additional amount with respect to the first Contract Quarter of Period 7, if any, if IHT Actuals for such Contract Quarter are less than [**]% of the IHT Target for such Contract Quarter.

(viii)    Not later than [**], AstraZeneca shall pay to MDCO an additional amount with respect to the second Contract Quarter ([**]) of Period 7, as follows:

For clarity, AstraZeneca shall not pay any additional amount with respect to the second Contract Quarter of Period 7, if any, if IHT Actuals for such Contract Quarter are less than [**]% of the IHT Target for such Contract Quarter.

(ix) Not later than [**], AstraZeneca shall pay to MDCO an additional amount with respect to the first Contract Quarter ([**]) of Period 8, if any, as follows:

For clarity, AstraZeneca shall not pay any additional amount with respect to the first Contract Quarter of Period 8, if any, if IHT Actuals for such Contract Quarter are less than [**]% of the IHT Target for such Contract Quarter.

(x)    Not later than [**], AstraZeneca shall pay to MDCO an additional amount with respect to the second Contract Quarter ([**]) of Period 8, if any,, as follows:

For clarity, AstraZeneca shall not pay any additional amount with respect to the second Contract Quarter of Period 8, if any, if IHT Actuals for such Contract Quarter are less than [**]% of the IHT Target for such Contract Quarter.”

2.4. An amended Target Hospital list is annexed to this Second Amendment.

2.5 Section 16.2 (h) of the Agreement is deleted and the following is substituted therefor:

“If IHT Actuals for Period 4 are less than the IHT Target for Period 4, AstraZeneca may terminate this Agreement immediately on written notice to MDCO; provided that such notice, if given, must be given not later than ten (10) days after the delivery to MDCO of the IHT Actuals for the Territory for the last Contract Quarter of the Period.”

2.6. Section 16.2 (i) of the Agreement is deleted and the following is substituted therefor:

“If IHT Actuals for Period 4 are equal to or greater than the IHT Target for Period 4, MDCO may terminate this Agreement immediately on written notice to AstraZeneca; provided that such notice, if given, must be given not later than ten (10) days after the delivery to MDCO of the IHT Actuals for the Territory for the last Contract Quarter of Period 4.”

2.7. Section 16.3 (c) of the Agreement is deleted and the following is substituted therefor:

“If (i) AstraZeneca terminates this Agreement pursuant to Section 16.2(j), and (ii) IHT Actuals for Period 6 are equal to or greater than the IHT Target for Period 6, the Parties acknowledge and agree that such a termination will cause MDCO to suffer damages in an amount that is uncertain, not readily ascertainable and incapable of accurate calculation resulting from (A) the efforts and resources expended by MDCO in performance and contemplation of future performance under this Agreement and (B) MDCO’s forgoing other commercial opportunities because of this Agreement. On this basis, the Parties further acknowledge and agree that in the event of such a termination, if and only if IHT Actuals for the Period 6 are equal to or greater than the IHT Target for Period 6 AstraZeneca shall pay to MDCO an amount equal to five million dollars ($5,000,000) (the “Fourth Year Termination Fee”). The Parties acknowledge that the Fourth Year Termination Fee has been agreed upon, after negotiation, as a reasonable estimate of an amount to compensate MDCO for the efforts and resources expended and opportunities foregone by MDCO. The Fourth Year Termination Fee shall be MDCO’s sole and exclusive remedy in respect of a termination by AstraZeneca pursuant to Section 16.2(j) if IHT Actuals for Period 6 are equal to or greater than the IHT Target for Period 6, and the Fourth Year Termination Fee is, therefore, not a penalty but rather constitutes liquidated damages in a reasonable amount that will compensate MDCO for the efforts and resources expended and opportunities foregone by MDCO. For clarity, AstraZeneca’s termination of this Agreement pursuant to Section 16.2(j) shall not constitute a breach of this Agreement, and AstraZeneca shall have no obligation to pay the Fourth Year Termination Fee if IHT Actuals for Period 6 are less than the IHT Target for Period 6.”

By: /s/ illegible    

Name:

Title:

By:/s/ Brent Furse    

Name: Brent Furse

Title: Senior Vice President, Chief Customer Officer