(Bloomberg) -- Once-untreatable cancers and rare diseases are being vanquished. Medical breakthroughs have put Ebola and HIV on the back foot, even as new viruses emerge. Drug stocks have touched record highs after a decade of gains.
But at the industry’s biggest annual gathering, a San Francisco investor meeting that draws in thousands from biotechnology, pharmaceutical and insurance companies, plus investors, bankers and consultants, there was a sense of uncertainty, even worry.
“The model is broken in the U.S.,” Sanofi Chief Executive Officer Paul Hudson said in an interview.
Despite record scientific and market returns, the health-care industry’s future in the U.S. has never seemed less clear. Candidates for the Democratic presidential nomination have proposed nationalizing the health-insurance system. The president has called for drug-price controls. And after years of struggle, there’s been no winner among the warring factions of drugmakers, health insurers, pharmacy-benefit managers and patients.
For one attendee at the conference, hosted in a cramped hotel in the Union Square neighborhood, it felt like waiting for a metaphorical earthquake.
“I think that these constant price increases create a situation where there’s all this built-up tension, all this built-up energy,” Denny Lanfear, the CEO of Coherus Biosciences Inc., said about his company’s goal to drive down drug prices with lower-cost competitors to expensive biotech drugs. “It’s kind of like the seismic tension along the San Andreas fault: At some point, you simply have an event which causes a tectonic shift in thinking.”
And this week, Johnson & Johnson CEO Alex Gorsky said on a conference call that the long, volatile debate about the U.S. health care system has contributed to “what may sometimes feel like uncertain times.”
Despite the industry’s worries, the market has for weeks suggested that things couldn’t be better. An S&P 500 subindex of health companies, including players like Johnson & Johnson and Pfizer Inc., would hit an all-time high by the conference’s end. Registration for the always-crowded event rose this year, as did San Francisco hotel occupancy, and average hotel rates were $972 a night, according to data from the San Francisco Travel Association.
On Friday, some of that confidence began to crack. Health stocks including Bristol-Myers Squibb Co., CVS Health Corp., Amgen Inc. and others led declines after a report that the Trump administration could make a fresh push to lower prices.
Among the almost 10,200 attendees last week at the conference, one of those small seismic tremors could be felt between the CEO of one major drugmaker and the top executive from CVS, the pharmacy plan and drugstore chain that negotiates drug prices for patients. The company is also one of the U.S.’s leading health insurers.
“We need more regulation of the insurance industry,” David Ricks, CEO of Indianapolis-based drug giant Eli Lilly & Co., said in an interview Tuesday morning in one of the hotel’s lounges. “I don’t think the system will maintain itself like this for the next decade. We’ll have to see reform.”
Moments later, Ricks spotted his counterpart at CVS, Larry Merlo, coming into the room with a group of employees and walked over to him to talk about a long-running business dispute.
“We’ve had some differences in the past,” Ricks said to Merlo, as Whitney Houston’s “Dance With Somebody (Who Loves Me)” played over the speakers. The drug CEO told him that he hoped they could soon find some common ground on coverage of insulin, one of Lilly’s major products, and drug affordability.
The two executives have clashed before, as have their industry lobbies -- blaming the other for the increasingly expensive price tags for U.S. pharmaceuticals. CVS currently excludes Lilly’s top-selling insulin from its main list of covered drugs.
A CVS representative declined to say how the conversation ended, saying CVS would continue to work on getting insulin to patients at the lowest cost.
“We’re willing to work with any part of the supply chain,” said CVS spokesman T.J. Crawford, “but we’re also willing to go it alone.” A Lilly spokesman also declined to comment further on the details of the executives’ conversation.
Later Tuesday evening, Democratic presidential candidates in Iowa for the final debate before the state’s presidential primary caucus took aim at the industry. Vermont Senator Bernie Sanders condemned health-care companies -- three times -- for “greed and corruption.” Former Vice President Joe Biden, who leads many polls, called for price controls: “You don’t have to pay the price. Limit what they can charge,” he said. Senator Elizabeth Warren, Sanders’s main rival, said she would use presidential authority to lower the prices of insulin, EpiPens and HIV medications. And almost all the candidates have either called for nationalizing the health insurance system or creating a government-run competitor to it.
Sanders kept up the broadside a few days later, attacking “price-gouging” pharmaceutical companies Friday after BioMarin Pharmaceutical Inc. said it may place a $2 million to $3 million price on its experimental gene-therapy treatment, according to the Wall Street Journal.
A BioMarin spokeswoman said in an email that the company hasn’t announced a price for its therapy and declined to comment on the Sanders tweet.
President Donald Trump, who is making a bid for re-election this fall, has said he favors a proposal to peg price tags in the U.S. to the much lower levels in other countries, what’s known as an international pricing index. The drug industry is instead is pushing for a cap to how much patients pay out of their own wallets for prescriptions under Medicare’s prescription drug benefit.
“The greatest threat the industry faces right now is President Trump pulling the trigger on international price index. It’s clear he doesn’t want to go into the election with nothing on pricing,” said James Greenwood, who leads industry group the Biotechnology Innovation Organization, which is ramping up lobbying efforts going into the election cycle.
Washington’s appetite for drug pricing reform could even affect the most commercially viable medicines, like cancer treatments, said Chris Boerner, chief commercialization officer of Bristol-Myers.
“Innovation has never been better: immuno-oncology, cell therapy, gene therapy are fundamentally changing diseases,” Boerner said. “But now we unfortunately do see an environment where policies put forth could change the ecosystem that led to those innovations. That’s deeply concerning.”
As scrutiny of the industry’s prices has continued, some drugmakers have turned away from areas where the pressure is most acute. Sanofi announced in December it would halt research in heart disease and diabetes: two legacy areas that faced significant cost pressure. Hudson, who took the helm in September, will double down on medicines for cancer and other diseases where reimbursement is more straightforward -- and often higher.
They’re also making smaller bets, a striking contrast to 2019 mega-mergers like Bristol-Myers’s $74 billion acquisition of Celgene Corp. and AbbVie’s $63 billion bid for Allergan Plc.
With the future uncertain, those type of big bets are no longer fashionable. In favor instead are smaller, “bolt-on” deals.
Lilly announced a $1.1 billion deal on Jan. 10 that CEO Ricks described as “the definition of bolt-on,” while German drugmaker Bayer AG plans deals to invest further in cell and gene therapy, a move that would complement its acquisition of cell therapy-focused biotech BlueRock last year, Stefan Oelrich, president of pharma, said.
Jennifer Taubert, executive vice president and worldwide chairman of pharmaceuticals at Johnson & Johnson, touted the company’s partnerships. “There still is a really good appetite and ability to partner even though there’s other funding mechanisms and things out there,” she said. Sanofi CEO Hudson said he, too, was looking at smaller, earlier-stage deals.
“This year, it’s a tricky year, because with the prospect of drug pricing legislation there’s a number of different outcomes that could influence the type of company you’d want to buy,” said Richard Pops, CEO of biotech Alkermes Plc. “What’s going to be in the crosshairs in terms of regulatory or statutory reform that makes certain businesses more or less attractive?”
“I can see why pharma is waiting to see how the dust settles before they make big commitments to different businesses,” Pops said.
--With assistance from Bailey Lipschultz.
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