Exhibit 10.3
 The Medicines Company  requests that the marked portions of the agreement be
 AMENDMENT NO. 1 TO
AMENDED AND RESTATED DISTRIBUTION AGREEMENT
 Amendment The Medicines Company TMC Distributor
 Recitals
 Agreement
   Defined Terms
 Schedule C
 Schedule D
 Effect of Amendment
  The Medicines Company
    
    Integrated Commercialization Solutions, Inc.By:
    
    /s/ John Kelley
    
    By:
    
    /s/ David CheethamName:
    
    John Kelley
    
    Name:
    
    David CheethamTitle:
    
    President; C.O.O.
    
    Title:
    
    President




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REVISED SCHEDULE C
 Data Transfer and Reporting
 Crystal Reports
      FTP Reports
 Weekly Chargeback Reports
 Daily Sales and Returns Report
  1.
    
    Orders Received2.
    
    Packages Shipped
 2




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REVISED SCHEDULE D
 Services
    
    
    
    Fee
 A.
    
    Development Fees(previously paid)B.
    
    Customer Service and Distribution
 Monthly Management Fee
    
    
    
    Percentage of WAC(see chart below)
 
    
    Warehousing Management and Inventory
Administration
    
    Customer Service / Order Entry
    
    Distribution Services
    
    Invoicing and Accounts Receivable Management
    
    Direct Account Set Up
    
    Information Technology
 Drop Ship and Direct HospitalDistribution Model
    
    Shipment Channel
    
    Wholesaler StockingPercentage of WAC
Applied to Gross Sales
    
    [**]%
    
    [**]%
 
 **   Direct to Hospital Fee
    
    $[**]/shipment additional fee
 C.
    
    Contract Pricing(provided in Section 5.4)TMC will reimburse Distributor monthly for any contract sales administered as a direct price
(anything less than current WAC of the product) at time of sale. Reimbursement amount to
Distributor is current WAC at time of contract sale minus contract price.Any direct pricing will be provided by TMC to Distributor.D.
    
    Guaranteed AmountAs additional consideration for the services and obligations of Distributor under this
Agreement, TMC guarantees that in each twelve month period (or portion thereof) during the
term of this Agreement, beginning on October 1, 2007, Distributor will earn, in addition to
the Monthly Management Fee, an amount equal to the greater of (A) [**] multiplied by
Distributors Product sales for the applicable twelve month period (or portion thereof),
measured at then current WAC (the Guaranteed Amount), and (B) [**]; provided that
(i) for the sole purpose of calculating the Guaranteed Amount, WAC shall be no less than the
WAC in effect on the Effective Date, and (ii) the Incremental Margin shall not include any
margin associated with special programs or Product inventory supplied to Distributor at a
discount that is passed to the Distributors customers. In the event that the Incremental
Margin is less the Guaranteed Amount for the applicable twelve month period (or portion
thereof), Distributor will invoice TMC for the amount of the deficiency within 30 days
following the end of such period, and TMC shall pay the invoiced deficiency to Distributor
within 30 days after the date of the invoice. The Guaranteed Amount shall be renegotiated
on an annual basis, effective October 1, 2008.
 3




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