Cosmo: the future is

NOWFebruary 27th, 2018

CREDIT SUISSE LONDON ONE-ON-ONE

HEALTHCARE CONFERENCE

This presentation may include forward-looking statements that are based on our management’s beliefs and

assumptions and on information currently available to our management.

The inclusion of forward-looking statements should not be regarded as a representation by Cosmo that any of its

plans will be achieved. Actual results may differ materially from those set forth in this presentation due to the risks

and uncertainties inherent in Cosmo’s ability to develop and expand its business, successfully complete

development of its current product candidates and current and future collaborations for the development and

commercialization of its product candidates and reduce costs (including staff costs), the market for drugs to treat

IBD diseases, Cosmo’s anticipated future revenues, capital expenditures and financial resources and other similar

statements, may be “forward-looking” and as such involve risks and uncertainties and risks related to the

collaboration between Partners and Cosmo, including the potential for delays in the development programs for

LuMeBlue, and Zemcolo. No assurance can be given that the results anticipated in such forward looking

statements will occur. Actual events or results may differ materially from Cosmo’s expectations due to factors

which include, but are not limited to, increased competition, Cosmo’s ability to finance expansion plans, the results

of Cosmo’s research and development activities, the success of Cosmo’s products, regulatory, legislative and

judicial developments or changes in market and/or overall economic conditions. Cosmo assumes no responsibility

to update forward-looking statements or to adapt them to future events or developments.

You are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the

date hereof, and Cosmo undertakes no obligation to revise or update this presentation.

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Safe Harbor

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2 products on the US market since,respectively, 2007 and 2013

A unique GI player in the colon space and beyond

In USD Mn, 2016: 792.1 In USD Mn, 2016: 155

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Perfectly positioned to exploit its own pipeline without need of external funding

1H 2017 in EUR Mn:

Liquidity at 7.28.2017: 136.3M (Cash & Cash Equivalent only)

Liquidity at 7.28.2017: 263.5M (Including Bonds)

Equity Ratio at 7.28.2017: 95%

Total Equity: 480.7M

Total Assets: 507.3M

End of October 2017 in EUR Mn:

Liquidity at 10.31.2017: 141.8M (Cash & Cash Equivalent only)

Liquidity at 10.31.2017: 252.3M (Including Bonds)

Equity Ratio at 11.09.2017: 94.3%

Total Equity: 471.7M

Total Assets: 500.3M

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New medical device approved in US and EU to remove colonic lesions more safely and quickly

One new product already on the market

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Methylene Blue (formerly LuMeBlue):new diagnostic drug to improve lesiondetection during colonoscopies

which have successfully completedphase III clinical trials

3 new products in the GI space and beyond

Remimazolam

Rifamycin SV (formerly Zemcolo): new antibiotic to treat colonic infections with same side effects as placebo

Remimazolam: new sedation agent to be used in all procedural sedations, including colonoscopies, safer and faster than available alternatives

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US Sales started in June 2017

Aries Inc., Commercial Organization established

45 Sales Reps, 6 Sales managers

10 Medical Science Liasons providing product support

Over 1900 accounts targeted by the Aries team

554 accounts who have ordered Eleview to date.

Market research conducted in late Sept/early Oct. shows that 74% of physicians are somehow between familiar with Eleview (from 40% right after launch), and that 79% of those familiar with Eleview are either Very Likely or Extremely Likely to use Eleview for polyps removal

Signed co-promotion deal with Olympus for US distribution, adding 200 Sales reps, 35 Clinical Education specialists and significantly increasing the number of targeted accounts

Signed distribution deal with Fujifilm for EU distribution, retaining 45% of gross revenues

Eleview 2H 2017 highlights

The future is NOW

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NDA filed July 2017

NDA accepted by FDA

PDUFA date set for May 21 2018

New dedicated plant in Lainate completed in 9 months and already inspected by FDA

Methylene Blue (formerly LuMeBlue) 2H 2017 Highlights

The future is NOW

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FDA granted both Qualified Infectious Disease Product (QIDP) and Fast Track designation for Rifamycin SV for the treatment of patients with travelers’ diarrhea

IBS-D phase II trial started October 17, 25 sites, 342 patients, first patient treated expected as of November end, trial end expected by end of 2018

New dedicated plant in Lainate completed

Dr. Falk Pharma has filed for marketing authorization of Rifafalk® 200mg (Rifamycin SV MMX® tablets) in Germany as Reference Member State through a de-centralizedprocedure. The procedure is expected to take approximately10 months

Rifamycin SV (formerly Zemcolo) 2H 2017 Highlights

The future is NOW

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Successfully completed phase III trial also in bronchoscopy, thus completing the sets of trials required for registration

NDA filing expected by the end 2018

Remimazolam 2H 2017 Highlights

The future is NOWRemimazolam

Remimazolam

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whose competing edge goes beyond patent protection

A unique pipeline

Methylene Blue: 3 yrs. regulatory exclusivity, a

diagnostic drug acting topically cannot be genericized

without evidence of increase in detection

n. 3 granted patents in the US, last expiring 2031

Rifamycin SV: 5 yrs. regulatory exclusivity as New

Chemical Entity (NCE) + 5 yrs. under the QIPD

according to the GAIN Act, for a total of 10 yrs.

Additionally, 3 yrs. regulatory exclusivity as a New

Molecular Entity (NME) + 5 yrs. under the QIDP for

the additional IBS-D indication

n. 4 granted patents on the US, last expiring 2025

Remimazolam: 5 yrs. regulatory exclusivity as NCE

n. 6 granted patents, last expiring 2033

Eleview (medical device)

n. 3 granted patents, last expiring 2034

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Provides an effective and innovative treatment option for colonic infections and offers significant anti-infective properties with a unique delivery mechanism for treatment of travelers’ diarrhea

significantly reduces TLUS in Traveller's Diarrhea

showed non-inferiority vs Xifaxan in TLUS and treatment success rates in a randomized, double-blind phase II clinical trial

TLUS was significantly shorter in Rifamycin SV compared to placebo in a randomized, double-blind phase III clinical trial

showed non-inferiority in terms of TLUS and similar efficacy, compared to Ciprofloxacin in a randomized, double-blind phase III clinical trial

Compared to Ciprofloxacin, Rifamycin SV has no systemic absorption (very important for resistance) and no warning box issues, thus being way safer in the same context

Compared to Xifaxan, Rifamycin SV allows antibiotic to be delivered directly to the colon, avoiding unwanted effects on the beneficial saprophytic bacterial flora living in the upper portions of the gastrointestinal tract; and it enjoys significantly more potent anti-inflammatory properties

Rifamycin SV (formerly Zemcolo) in a nutshell

The GI franchise beyond Lialda and Uceris

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Based on the EC50 values, Rifamycin SV is100 times more potent than Rifampicin.

Rifamycin SV is at least 1000 times more potent than Rifaximin at stimulating PXR transcriptional activity in a cell line engineered to express a fusion human PXR protein.

In terms of the maximum possible stimulation of PXR activity, Rifaximin at 30 µM only activates up to 60% of the maximum activity with Rifamycin SV at 0.3 µM.

Clear edge vs Xifaxanin anti-inflammatory properties

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The endoscopy franchise

Improve Lesion Detection

Remimazolam

Improve Lesion Removal Improve Procedure Efficiency

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Number of colonoscopies during 2017

Exploiting the colonoscopy mass market

US: 16’000’000

EU: 10’000’000

Potential ROW:

60’000’000

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Methylene Blue enhances the visualization of abnormalities and the detection of lesions by dying the entire colon prior to a colonoscopy

Increases the Adenoma Detection Rate (ADR) substantially beyond the current standard of care HDWL

This increase has an important clinical relevance: for each 1% increase in ADR, a 3% decline in incidence of interval cancer and a 5% decline in incidence of fatal colorectal cancer (CRC) has been scientifically attributed

PDUFA date set for May 21, 2018

Product features

MethyleneBlue

HDWL 200 mg

ADR 47.81% 56.29%

Relative risk increase* 17.7%

P-value 0.0099

Odds Ratio 1.41

[1.09, 1.81]

*Calculated as (ADRLuMeBlue 200 mg / ADRHDWL) - 1

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MethyleneBlue significantly enhances ADR in the full analysis set FAS

FPR HDWL

29,7%

FPR MethyleneBlue

23,3%

FP 97

Pts 326Pts 356

FP 83

MethyleneBlue decreases

FPR by 14,4% vs HDWL

p-value: < 0,0001

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MethyleneBlue FPR is significantly better than HDWL

Total MethyleneBlue pts: 485

Total HDWL pts: 479

ADR IN PTS WITH EXCISION ≤ 3

HDWL 35.9

MethyleneBlue 45.3

RRI 26.2%

ADR IN OVERALL PTS POPULATION

HDWL 47.81

MethyleneBlue 56.29

RRI 17.7%

HDWL

Pts 362 Pts 376

45.3

35.9

RRI 26.2

HDWL

Pts 485 Pts 479

56.29

47.81

RRI 17.7

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MethyleneBlue efficacy has even greater diagnostic efficacy in largest market segment

ADR IN PTS WITH EXCISION 0 - 1

HDWL 18.94

MethyleneBlue 26.18

RRI 38.2%

ADR IN OVERALL PTS POPULATION

HDWL 47.81

MethyleneBlue 56.29

RRI 17.7%

HDWL

Pts 233 Pts 264

26.2 18.9

RRI 38.2

HDWL

Pts 485 Pts 479

56.29

47.81

RRI 17.7

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MethyleneBlue shows max diagnostic value increase in the segment with 0 - 1 excision

Data from FAS

*Calculated as (ADRLuMeBlue 200 mg / ADRHDWL) - 1

HDWL 200 mg

Patients with diminutive adenomas 144 178

Percentage overall population 30.06% 36.70%

Relative risk increase* 22.1%

P-value 0.0342

Odds Ratio 1.35

[1.03, 1.76]

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MethyleneBlue flags more diminutive adenomas than HDWL

HDWL 200 mg

Pts with non-polypoid lesions 168 213

Percentage overall population 35.07% 43.92%

Relative risk increase* 25.2%

P-value 0.0056

Odds Ratio 1.45

[1.12, 1.88]

*Calculated as (ADRLuMeBlue 200 mg / ADRHDWL) - 1

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MethyleneBlue flags more subjects with non-polypoid lesions than HDWL

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Positive Remimazolam data in procedural sedation in U.S. Phase III study during colonoscopy, bronchoscopy and in III/IV ASA patients

primary endpoint and important secondary endpoints were achieved with high statistical significance

All trial data confirmed Remimazolam’s safety profile and tolerability

pre-NDA meeting with FDA before filing for approval is under planning

filing for approval expected n the second half of 2018

Product features

RemimazolamRemimazolam

Remimazolam

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Reduces Time to Reach Sedation

Medians

4.0 3.5 3.5

19.5 19.0

21.0

19.0 19.0 19.0

0

5

10

15

20

25

MOAA/S 3 Peak Sedation

Min

ute

s

Start Procedure

Placebo

Midazolam

Remimazolam

Remimazolam

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Reduces Time Back to Normal

7.2

21.3

15.7

5

0

10

15

20

25

Remimazolam Placebo Midazolam

Min

ute

s

End of procedure to fully alert

*R vs. M: Anova F-test for equal means in 2 groups

331

572 553

0

200

400

600

800

Remimazolam Placebo Midazolam

Min

ute

s

Time to back to normal

(Patient Reported)

Remimazolam

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Qolotag is a liquid, blue coloured emulsion as an enema formulation to be used for cleansing and simultaneous staining of the sigmoid colon and rectal mucosa to aid visualization of the structure and mucosal lesions by the endoscopist during flexible sigmoidoscopy evaluation

Product features allow for a faster and better enhancement of the detection of eventual small lesions or dysplasias

Long-term IBD patients generally are monitored with endoscopic system for evaluating the activity of the disease and for dysplasia detection

Cosmo intends to license Qolotag for the EU and is currently assessing the regulatory pathway for an approval in the USA

Product features

Qolotag

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an FDA 510(k)-cleared, ready-to-use submucosal injection composition, that provides an immediate and long-lasting cushion for gastrointestinal endoscopic resections of polyps, adenomas, and other lesions, is ramping up

appropriate for challenging polyps, regardless of size, location, or type and the immediate, long-lasting cushion can hold for up to 45 minutes

improves margin visibility and helps decrease the risk of gastrointestinal perforation and damage to the external muscular layer, which can lead to gastrointestinal perforation

decreases the time and volume needed to resect a lesion while reducing both reinjections required and piecemeal excisions, as compared to saline

Addressing the US market with Olympus and EU with Fujifilm

Product features

Eleview

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Unique &Novel Mechanism

Upon injection:

Eleview®: Reconfigures to form a colored cushion1

Creates an “artificial net” formed by polymer chains2

Traps water within to build a colored cushion of

optimal shape, height, and duration1

1 Eleview® Instructions for use, Aries Pharmaceuticals, Inc. April 2017

2 Data on File, Aries Pharmaceuticals, Inc.

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Outline of trial primary endpoints all in favor of Eleview

Endpoint StatisticsEleview®

(N=102) (n=102)

Reference Comparator

(N=109) (n=110)

Total injected volume to

complete EMR procedure (mL)

Mean (±SD) 16.1 (±9.8) 31.6 (±32.1)

Range (min-max) 3.0 – 41.0 4.0 - 248.0

P value < 0.001

Total injected volume per

lesion size (mL/mm)

Mean (±SD) 0.53 (±0.32) 0.92 (±0.65)

Range (min-max) 0.09 – 1.75 0.20 – 4.96

P value < 0.001

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Outline of trial primary endpoints all in favor of Eleview (CONTD)

Endpoint StatisticsEleview®

(N=102) (n=102)

Reference

Comparator

(N=109) (n=110)

Time to resect the lesion

(minutes)

Mean (±SD) 19.15 (±16.80) 29.70 (±69.18)

Range (min-max) 1-100 2-687

% differenceª -35.5%

P value 0.326

aEleview® vs reference comparator.

This can be attributed to the high variability of data, particularly in the reference comparator arm (SD Eleview® = 16.80 m; SD reference comparator =69.18 m → 4 times increase)

Nevertheless, it is evident that there is a positive trend toward a reduction of the time needed to complete the procedure

using Eleview®with respect to comparator: reduction of 35.5% (10.6 minutes/procedure). This trend is confirmed by the

whole colonoscopy time (one of the secondary end points)

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Outline of trial Secondary endpoints all in favor of Eleview

Endpoint StatisticsEleview®

(N=102) (n=102)

Reference Comparator

Eleview® n (%)

Sidney Resection Quotient

(SRQ)

Mean (±SD) 10.3 (±8.1) 8.0 (±5.7)

P value 0.044

Number of resection piecesMean (±SD) 5.70 (±6.03) 6.47 (±5.04)

P value 0.052

Injected volume to provide

initial lift (mL)Mean (±SD) 10.4 (±7.0) 15.3 (±11.7)

P value < 0.001

Proportion of subjects with

en bloc resections N(%)Mean (±SD) 19 (18.6%) 12 (11.0%)

P value 0.125

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Complication Eleview® n (%)Reference Comparator

Eleview® n (%)

Subject with at least one complication 17 (15.0) 17 (15.2)

Intraprocedural bleeding

Early (<24h) bleeding

Delay bleeding (≥24h post EMR)

Perforation

Postpolypectomy syndrome

Hospital admissions for any post

procedural clinically relevant complication

8 (7.1)

2 (1.8)

0 (0.0)

0 (0.0)

6 (5.3)

1 (0.9)

11 (9.8)

1 (0.9)

1 (0.9)

1 (0.9)

3 (2.7)

0 (0.0)

Eleview is as safe as the standard saline solution

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FY17 Operating Expenses of $40m

Prelaunch Plans for mid-year launch of MB and Rifamycin SV are being implemented

Sales force expansion planned following MB approval – likely an additional 110 sales reps plus managers will be added

All Sales Reps (~155) are expected to promote all three products (Eleview, MB and Rifamycin SV)

Prelaunch planning for a 2019 launch of Remimazolam has begun

An additional expansion of the sales force to support Remimazolam is being evaluated

Update on Aries set-up

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File Rifamycin SV NDA

Extend Eleview deals to RoW

Start treating patients in Rifamycin SV IBS-D phase II

File Remimazolam NDA

Further expand pipeline

Next steps:

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Cosmo Pharmaceuticals NV

Riverside II

Sir John Rogerson’s Quay

Dublin 2, Ireland

media@cosmopharma.com

Mr. John Manieri

+353 1 817 03 70