There has been a great deal of discussion about how drug prices will change in coming years. The fact that this is an election year surely sticks in traders’ minds. If you remember back to the 2016 election cycle, biotech shares went into a brutal downturn after Hillary Clinton castigated the pharma industry for its pricing practices. Shares of healthcare stocks eventually recovered as it became clear that the Trump Administration had bigger fish to fry than going after drug prices.
But now the cycle has begun again. Several Democratic candidates are proposing dramatic changes to the American healthcare industry to try to curb runaway drug prices. It seems likely that if re-elected, President Trump would probably need to tackle the issue again as well, as the system left in place from the Affordable Care Act needs modifications. This is a problem for investors. It’s hard to forecast future profits when it’s not clear what the playing field will look like within a couple years.
As such, it’s a good time to take stock of your personal exposure to the healthcare industry before the presidential election heats up and potential market-moving headlines start pouring in. To that end, in general, companies with diversified revenue streams will fare better, while ones relying on a few high-priced drugs face more risk. Here are the outlooks for seven leading biotech, pharma and healthcare stocks in light of the potential pressures on drug prices going forward.
Healthcare Stocks to Watch: Amarin (AMRN)
Amarin (NASDAQ:AMRN) offers a great example of the questions around drug pricing going forward. It recently scored Food and Drug Administration approval to market its fish oil product, Vascepa, to a much wider range of adults with high triglycerides. That should be a huge win for Amarin, right? The stock initially popped to multi-year highs, but slumped back to prior levels quickly.
This week, Amarin stock dropped even farther, and it’s now down 25% from its recent highs. The latest catalyst is that leading health insurance firm UnitedHealth (NYSE:UNH) reportedly dropped Amarin’s Vascepa from its preferred authorization list. UnitedHealth offers Lovaza, the fish oil product initially commercialized by GlaxoSmithKline (NYSE:GSK), instead. Lovaza also aims to improve heart condition outcomes by lowering triglycerides. Unlike Vascepa, however, Lovaza doesn’t have such a wide body of clinical trials supporting its efficacy.
Nonetheless, insurance companies like UnitedHealth might think that one fish oil product is similar to another, and may pick the cheaper one for its customers. It shows the difficulty pharma companies are having as more attention turns to price. With increased attention to drug prices from both the private sector and the government, companies that offer a slightly better version of an existing drug should be careful.
Amarin is a great example of how FDA approval doesn’t necessarily translate into strong demand or profits in the current economic environment. AMRN stock still has plenty of potential upside, particularly in a buyout scenario. But it isn’t the slam dunk winner it might have been five or ten years ago.
Novo Nordisk (NVO)
Unlike the previous example, Novo Nordisk (NYSE:NVO) has a safer route to profits in this regulatory environment. That is to produce drugs that are clearly best-in-class, and sell lots of them at affordable prices. Novo Nordisk does this by selling insulin and other diabetes treatments.
Given the growing diabetes epidemic around the world, Novo Nordisk is riding a huge demographic tide. And it’s significantly harder for health insurers to say no to Novo Nordisk with its vitally important medications. Novo stock has traded up recently; however, it’s still at a reasonable 21x forward earnings given its historic near-double digit earnings-per-share growth rate.
On top of that, Novo Nordisk stock is still only trading at where it previously peaked back in 2015. While earnings and dividends have grown nicely over the past five years, the company’s stock hasn’t yet caught up to its recent growth. Once the stock breaks out over $60 and hits all-time highs, however, it should pick up more momentum.
Johnson & Johnson (JNJ)
One way to lower your political risk, as it comes to drug prices is to run a supremely diversified business. Johnson & Johnson (NYSE:JNJ) manages to do that by having three different operations within the parent corporation. These include consumer products, medical devices and pharmaceutical drugs.
Consumer products generally don’t fall under the FDA’s purview and aren’t hurt by pressure on drug prices. Insurance efforts to crack down healthcare pricing could hurt medical device margins, but it’s a bit of a different animal than drugs.
J&J still has drug pricing exposure to be certain, pharmaceuticals are its large division by a wide margin when it comes to profit. But the two other embedded lines of business lower risk; meanwhile, J&J’s drug portfolio is one of the most broadly diversified ones out there. JNJ stock has traded up a bit recently, but it’s still selling for just 16x forward earnings. Combine that with its unparalleled record of dividend growth, and J&J is a conservative way to get your dose of healthcare exposure.
AbbVie (NASDAQ:ABBV) is the pharma spin-off from healthcare and medical devices leader Abbott (NYSE:ABT). Abbott seems to have made a wise move in spinning off AbbVie. Since the companies parted ways, Abbott’s stock has more than doubled, while AbbVie has had a more difficult road.
This makes sense. AbbVie inherited a complicated situation. Its blockbuster drug, Humira, currently makes up two-thirds of its overall revenues. However, Humira is set to face generic competition shortly, with its profits likely to head off the patent cliff by 2023. It’s unclear if AbbVie will be able to make up the revenue gap that it will soon face.
It intends to do so via its upcoming mega-merger with Allergan (NYSE:AGN). Allergan is famous for Botox, and it has numerous other products in the aesthetics space, along with other drugs for things such as eye care and womens’ health. AbbVie hopes that merging with Allergan will diversify its revenue stream enough to withstand the loss of Humira revenues. However, it is taking on a ton of debt to do this deal. And it’s not clear that Allergan, which had a similar business model to the now infamous Valeant, will fare well in a world with more drug pricing pressure.
A lot of folks own AbbVie for the generous 5.3% dividend yield. But it’s far from certain whether the Allergan purchase will be enough to sustain the dividend at that elevated level. Particularly if drug pricing pressures increase, that dividend could be on the chopping block in coming years. I’m a seller of ABBV stock here.
Gilead Sciences (GILD)
Gilead Sciences (NASDAQ:GILD) could fare better than most other biotech companies in a challenging drug pricing market. There are several reasons for that. For one, GILD stock has already been one of the biggest losers of the past few years within biotech, so expectations are already low.
Second, Gilead has seen its profits fall because its Hepatitis C products actually cure patients, rather than merely treat symptoms. A Bloomberg article noted the unfortunate situation, saying that Wall Street Wants The Best Patents, Not The Best Drugs. The author concluded that Gilead had a “bad business model” because curing diseases “just doesn’t pay.” That is, unfortunately, a seemingly accurate assessment of the current healthcare system.
With an increased focus on pricing and getting the most bang for the buck, however, companies like Gilead should be more attractive to insurers and other end payers. Folks are increasingly sick of pharma companies jacking up prices for drugs that are only fractionally better than the previous version. Gilead hasn’t played the same milking their patents for the most bucks game, and instead brought revolutionary products to market. After years of sorry stock price performance, however, Gilead may finally get its chance to shine in 2020.
Thermo-Fisher Scientific (TMO)
Thermo-Fisher Scientific (NYSE:TMO) has quietly become one of the largest healthcare companies in the U.S., with its market capitalization now exceeding $125 billion. It has also been one of the strongest performers in the Health Care Select Sector SPDR ETF (NYSEARCA:XLV). With minimal volatility along the way, Thermo-Fisher shares have nearly tripled since early 2016.
Their secret is that they are the proverbial company selling shovels to the gold miners. That’s to say that Thermo Fisher sells lab equipment, pharmaceutical components, diagnostic tools and the like. Companies that want to create new pharma drugs, along with many other healthcare applications, have to buy raw materials from Thermo Fisher.
Lower drug prices might smack profits for biotech companies. But a firm like Thermo Fisher is insulated. Its components are a small portion of the overall price of healthcare products and services. Additionally, it has other customers, such as governments and academic institutions, that buy from it as well. As long as the world continues to spend more on healthcare research and diagnostics in the coming years, Thermo Fisher should be a safe bet to keep on rallying. The stock isn’t dirt cheap at 24x forward earnings, but it’s not a bad deal for a company that has much less regulatory/pricing risk than most biotech and pharma companies.
Cardinal Health (CAH)
Finally, we have the drug distribution companies. While there are various firms in this category, let’s use Cardinal Health (NYSE:CAH) as our representative stock, as Cardinal has been a popular dividend play and turnaround pick for 2020. And, to be sure, Cardinal has a great track record, including being a Dividend Aristocrat, which means that it has hiked its dividend more than 25 years in a row.
I can’t get on board with the bullish sentiment for this stock now, however. If you were looking for firms directly in the crosshairs of upcoming changes in drug prices, drug distributors would be right there. It’s not clear what role, if any, these companies would even have in a Medicare For All world where the government controlled the supply chain.
For the longest-time, the thesis on these companies has been that U.S. healthcare spending will inevitably rise as the population ages. That’s been a good bet so far. But now U.S. spending per capita is far above levels seen in just about every other developed country. It seems healthcare and in particular drug prices are reaching a limit, and betting on middlemen like Cardinal to keep getting more profits over time might not be a wise move anymore. People have been buying the stock on expectations that the drug distributors will be able to handle their opoiod lawsuit obligations at a modest cost. That may be true, but even if it is, don’t overlook the existential risk to this business model going forward. CAH stock is cheap for a good reason, it has the classic look of a value trap.
At the time of this writing, Ian Bezek owned JNJ, NVO, and GILD stock. You can reach him on Twitter at @irbezek.