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On Pharmaceutical Stocks in the Post-Trump Era?

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By Vitaliy Katsenelson CFA

vitaly

Trumps Hates Them – We Love Them

 Originally written for Institutional Investor Magazine
 A few weeks after Donald Trump was elected president of the United States, he was asked about pharmaceuticals prices. With typical rhetorical gusto, he declared, “Pharmaceutical companies are getting away with murder.” Well, my firm has been increasing our allocation to those “murderers,” and despite Mr. Trump’s comments, we are very comfortable with our positions in the long run (which lies beyond what may end up being a very volatile short run).

Big Pharma

Pharmaceuticals companies check off a lot of boxes in our quality and growth dimensions. They are usually monopolies or oligopolies when it comes to their specific drugs; they have high recurrence of revenue; their business is not cyclic and thus marches to its own drummer; they have strong balance sheets and a high return on capital, and generate a lot of cash flow; they benefit from a significant growth tailwind as the global population ages (I aged just while writing this); and they enjoy pricing power (more on that later). Yet the pharmaceuticals sector as a whole has been decimated over the past eight months due to perceived political risk — first by pharma pricing critic Hillary Clinton’s “It’s in the bag” expectation of victory and then by Trump’s “They get away with murder” comments. We view the carnage created by the political risk as an opportunity to increase our exposure to this sector. Here is why.

President Trump mentioned that he wants the U.S. government — mainly, its Medicare program — to negotiate directly with drug-makers on price. His remark may create the impression that pharmaceuticals companies today charge the government whatever prices they want. That is not the case. Medicare covers prescription drug costs through a program known as Medicare Part D. Medicare basically outsources the negotiation of drug prices to pharmacy benefit management (PBM) companies such as CVS, Express Scripts, and UnitedHealth Group (a health insurance company that owns its own PBM). In fact, less than a handful of PBMs control this market and so exercise tremendous pricing power; thus the government is already negotiating with pharmaceuticals companies.

The Stats

Here are some useful stats about this market: As of the end of 2015, 290 million Americans had health insurance. Among them, 214 million had private insurance and 52 million were insured by Medicare. Medicare insures a lot of people; however, UnitedHealth — a company whose business model relies on paying as little as possible for prescriptions — insures 70 million Americans and thus already has greater bargaining power than Medicare.

But let’s say President Trump gets his wish, the law is changed, and the government bypasses PBMs and starts bargaining with Gilead Sciences, Amgen, and Allergan directly — the Trump take-no-prisoners approach. Let’s even assume that President Trump’s ingenious negotiating techniques result in a 20 percent concession on price. Since Medicare represents only 18 percent of the total insured population, the net impact on pharmaceuticals companies’ revenue would be 3.6 percent. That’s a small pimple that they’d be able to cover up by raising prices 4 percent on the remaining 82 percent of payers.

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drugs

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Europeans and Canadians

The reality is that the reason Europeans and Canadians are paying much lower prices for their prescriptions is that they have a single-payer system, and thus pharmaceuticals companies are bargaining not with four or five entities but with one: the government. At this stage, however, it is very unlikely that a Republican president and Republican-controlled Congress will move this country to a single-payer system.

If the U.S. starts allowing re-importation of pharmaceuticals from Canada and Europe — another threat made by our president — then American companies will simply start raising prices outside of the United States.

Finally, let’s remember an important but often forgotten fact: Donald Trump is the president of the U.S.; he is not its king and doesn’t have the powers of one. Although we expect his tweets and other remarks to create additional volatility, they will not necessarily have a symmetrical impact on pharmaceuticals companies or whatever other businesses he tweets about.

Assessment

We have taken advantage of price weakness and added to our positions in Amgen (analysis here), Allergan (analysis here), and Gilead (analysis here). We also bought some new positions. Stay tuned for next week, when I’ll reveal those names.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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“What’s wrong with income inequality?”

“What’s wrong with income inequality?”

By Rick Kahler MS CFP®,

Do you think there’s nothing emotional about money?

If so, I dare you to stand up in a town hall meeting anywhere in the US and ask, “What’s wrong with income inequality?” There is a high probability that the responses that follow may have some emotion.

Emotional

Make no mistake, money is highly emotional. That emotion isn’t about the inanimate object, the pieces of printed paper that we carry in our wallets. It’s what we project onto money that makes it intensely emotional. And usually what we project isn’t about the money at all.

Consider, for example, envy and jealousy. On the surface, these emotions seem to signify we are not grateful for what we have and that the cure is to focus on what we do have. There’s an element of truth to that, but telling yourself to stop being jealous and instead be grateful probably doesn’t work for long. If you are like most of us, the jealousy is soon back.

The reason is that envy and jealousy are not about what we have, but rather about what we don’t have or we fear losing. Underneath envy is fear that I won’t get something I desire which is enjoyed by another. Suppose I am envious of a friend who lives in a bigger house. Underlying that is fear, perhaps a fear that I am failing my family by not providing enough space for them to live comfortably.

Underneath jealousy is also fear, but this fear is often masked by anger that someone else is getting something that is rightfully yours. I may be jealous of a coworker because they got a job promotion that I felt I deserved. Underlying my resentment of my coworker’s success is fear that my contributions to the company are not valued and that my job isn’t secure.

Similarly, I may feel jealous of someone who earns much more than I do. I may be resentful that they enjoy privileges, a lifestyle, or security that I rightfully deserve. Or I may believe that the money they have accumulated was wrongfully taken from others and that if they continue to accumulate wealth, mine may be next. I may fear for my very survival.

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The  “one-percenters”

Such fears may drive a good portion of the anger toward the so-called “one-percenters.” If my physical and emotional needs are satisfied and I am happy with my life, do I care if someone else has more? Probably not.

But if my physical needs are not met, I am unhappy, and I feel that the money I am entitled to has been taken from me by those that have money, I care a lot. In fact, I can be rage-ful and jealous.

According to a January 17. 2017 article by Amanda Hirsh at unstuck.com, envy and jealousy can be a gift, a trailhead of sorts that can lead us to an unconscious fear. Once we uncover the fear we can often take concrete steps to resolve it, rather than wasting precious energy being stuck in anger and rage toward others.

Hirsh suggests that, the next time you feel yourself becoming envious or jealous, you consider it an opportunity to ask yourself three questions:

  1. What am I afraid of?
  2. What do I really want?
  3. Why do I want that?

Assessment

These are not easy questions to answer. It may be best not to consider them when you are already triggered and consumed by the emotion, but to wait until you are calmer and in a more reflective place. Then the answers may help you move past the jealousy and shift your focus to your own options.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Birth of “Addiction Medicine” as a New Discipline

The Need for an in Utero Diagnostic Assessment Prior to Delivery

By Michael Lawrence Langan MD

One thing is for certain.

When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model.

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Carl Sagan’s Baloney Detection Kit and the Birth of “Addiction Medicine” as a New Discipline: The Need for an in Utero Diagnostic Assessment Prior to Delivery — Disrupted Physician

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct Details

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Prescription Drug Pricing and Research

http://www.MCOL.com

For 15 Companies that Sell the Top 20 Drugs in the US

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct Details

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Tell Us About the Issues Affecting your Medical Practice, Clinic or Hospital

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By staff reporters

Tell us about the issues affecting your medical practice, clinic, hospital or healthcare organization in 2017.

We are conducting a brief survey to learn more about the key issues affecting your healthcare entity, and how they impact your outlook for the coming year.

Just send in your thoughts on the survey form below.

 

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct Details

Product DetailsProduct Details

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Nursing Shortage in the USA

And … Surplus in the USA

By http://www.MCOL.com

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct Details

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Big Pharma Quietly Enlists Leading Professors to Justify $1,000-Per-Day Drugs

THE LONG CON

Langan MD

By Michael Lawrence Langan MD 

Ya gotta spend money to make money, am I right?

The payoffs required are enormous, but once they get in, they make tons of money, and jacking the price of drugs to boot.

President Trump promised that he would take care of that and make a deal to roll back drug prices, but then he met with […]

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businessman-fashion-man-person-1

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The long con: Big Pharma Quietly Enlists Leading Professors to Justify $1,000-Per-Day Drugs — Later On

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct Details

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