Weekly Barometer 25 janvier 2012
Global Healthcare M&A – Bigger Is Better
January 2018
ATONRÂ PARTNERS SA 12, Rue Pierre Fatio – 1204 GENEVA – SWITZERLAND - Tel: + 41 22 310 15 01 http://www.atonra.ch
Global Healthcare M&A – Bigger is Better
➢ The Healthcare M&A Index is a long-only, USD-based, actively managed total return Index
➢ The Index invests in companies which are to benefit from M&A potential (takeover targets
and acquirers) as well as from long-term industry drivers and specific company catalysts
in the healthcare sector
➢ After two strong years (2014/15), Global Healthcare M&A decelerated sharply in 2016 due to
a couple of powerful headwinds (regulations targeting US tax inversion, Trump’s election)
➢ M&A activity in the industry is now back in force and will possibly beat the 2015 record this
year as:
✓ the political environment has become more supportive (less noise from the Trump
administration, clearer view from the FDA, and positive implications from the US tax reform)
✓ financing is abundant and cheap (secondary offerings made by Biotech companies over
the last few months were filled in a few minutes…)
➢ The US tax reform notably should give a boost to mega deals as smaller ones are driven by
fundamentals and are more immune to the political and tax landscape
➢ With increased focus on personalized medicine and continued innovations from the Tech
world (wearables, next-generation sequencing, etc.), MedTech is to top the M&A list
2
Investment Case
Global Healthcare M&A – Bigger is Better
➢ Certificate details
✓ Issuing bank: Natixis SA
✓ Index calculation agent: Natixis SA
✓ ISIN: XS1365787826
✓ Currency: USD
✓ Fees: 1.65% + 15% performance fee, high water mark
✓ Bloomberg ticker: NXSRHEMA
✓ Benchmark: MSCI World Health Care Index (MXWO0HC)
3
The AtonRâ Global Healthcare M&A Index
Global Healthcare M&A – Bigger is Better 4
MedTech
Generics/
Biosimilars
Biotech
Personalized
medicine
Healthcare
Services
Rare
Diseases
Global
Pharma
CDMOs/
CROs
Global Healthcare M&A – Bigger is Better 5
Market Dynamics Are Rapidly Changing: Long-Term Drivers Remain Intact…
Ageing world population
560M people are >65 year old
Prevalence of chronic diseases
Cancer, cardio, neurodegenerative and respiratory notably are to make up more than 50% of
global healthcare expenditures by 2020
Precision medicine and innovative technologies
Artificial Intelligence, VR, wearable biosensors and trackers, 3D printing, Next Generation
Sequencing among others are giving life to new or alternative treatments
Global Healthcare M&A – Bigger is Better
M&A is the natural response to these changing market dynamics as it allows to reignite
growth and deliver operating leverage
6
Slowing organic growth
Blockbuster drugs going
off-patent
Consolidation of customers (drug
wholesalers and pharma retailers
notably)
Rising complexity & costs of
regulatory compliance and
R&D costs
Pricing pressures
Intense competition
Margin compression
… But Challenges Have Never Been Higher
Global Healthcare M&A – Bigger is Better
First Signs Of M&A Recovery In 2017…
7
Source: Thomson One
Announced M&A by Top Ten Target Sectors
Target Sector
Full Year 2017 Full Year 2016
% Volume
ChangeVolume $bn Deals Volume $bn Deals
Real Estate 529.7 4040 359.1 3499 48%
Energy and Power 469.7 3305 608 3320 -23%
High Technology 454.8 7396 486.6 6739 -7%
Industrials 428.4 6783 366.6 6402 17%
Financials 330 5282 351.9 5005 -6%
Healthcare 299.2 3543 274.9 3369 9%
Media and Entertainment 221.7 3414 285.9 3314 -22%
Materials 195.8 4308 393.5 3710 -50%
Consumer Products and
Services176.4 5571 117.3 4984 50%
Consumer Staples 160.9 3097 186.9 2994 -14%
Global Healthcare M&A – Bigger is Better
… As Visibility Is Finally Improving
8
US tax reform✓
Improving FDA process
approvals ✓
Favorable financing
conditions ✓
Easing political pressures✓
➢ Less noise from the Trump administration
on drug pricing
➢ The Obamacare repeal effort is stalling
➢ The reshaping of current regulations
seeks to speed up approvals of new
drugs and to promote competition /
reduce prices
➢ Low interest rates
➢ Strong investor appetite for equity
offerings: recent capital increases in
Biotech have been oversubscribed
➢ One-off tax of 15.5% on offshore cash
(instead of 35%) will incentivize Pharma
& Biotech companies to repatriate cash
Global Healthcare M&A – Bigger is Better
➢ M&A allows to reignite growth and/or deliver operating leverage
➢ Low net debt / EBITDA levels (below a max. level of 3-4x) point to a huge M&A firepower
9
1.71.5
1.41.3
1.1
0.80.7
0.60.5
0.4
-0.4
-1.0
Earnings
accretion
& value
creation
Multiples
rerating
High ROCE in the pharma and
medtech segments, low WACC
The acquirer enriches its product pipeline
through the acquisition of a Biotech
Large Healthcare Players Have All Reasons To Look At M&A
Global Healthcare M&A – Bigger is Better 10
APPLE
• Diabetes management
• Smart contact lenses
• Bioelectric medicines
• Surgical robots
• Genomics
• Cancer diagnostics
MUSK (Tesla)
• Brain implants
• Mind-reading devices
AMAZON • Pharmacies
Tech Giants Are Also Potential Predators
Global Healthcare M&A – Bigger is Better 11
Healthcare M&A Usually Comes with Huge Premiums
Acquirer Target Share price
premium
Deal value ($m) Deal announced
Allergan Tobira 498% 1,695 Sept 2016
Roche Anadys 256% 230 Oct 2011
Merck & Co Idenix 239% 3,850 Jun 2014
Bristol-Myers Squibb Inhibitex 163% 2,500 Jan 2012
Valeant Sanitas 160% 440 May 2011
Alexion Synageva 140% 8,394 May 2015
Cubist Adolor 121% 415 Oct 2011
Bristol-Myers Squibb Amylin 101% 7,000 Jun 2012
GlaxoSmithKlineHuman Genome
Sciences99% 3,600 Apr 2012
Mylan Meda 92% 7,200 Feb 2016
Global Healthcare M&A – Bigger is Better 12
2017/Early 2018 Dealflow And Premiums Are Encouraging
Acquirer Target Share price
premium
Deal value ($m) Rank Date
Stryker Novadaq
Technologies96% 679 June 2017
Celgene Juno Therapeutics 91% 9,000 Jan 2018
Johnson & Johnson Actelion 77% 29,539 Jan 2017
Takeda TiGenix 72% 630 Jan 2018
Sanofi Bioverativ 64% 11,600 Jan 2018
Integra Lifescience Derma Science 40% 198 Jan 2017
Fresenius Kabi AG Akorn 35% 4,712 April 2017
Thermo Fisher Patheon NV 35% 7,059 May 2017
Gilead Sciences Kite Pharma 29% 11,855 Aug 2017
PamplonaParexel
International28% 4,629 June 2017
Becton Dickinson CR Bard 25% 23,553 April 2017
Global Healthcare M&A – Bigger is Better
➢ M&A focus by the large Pharma players is near the post-approval phase but, as shown by
the Gilead-Kite deal (announced before an FDA approval), earlier-stage assets purchases
(notably through contingency deals) are likely to accelerate in the next few quarters
Contingency deals are an important part of the ongoing R&D externalization process
together with outsourcing to private contract research organizations (CROs)
13
Source: IFPMA
Duration: 6-7yrs
Share of budget: up to 65%
Chance of success:
✓ 65% in phase I
✓ 40% in phase II
✓ 50% in phase III
Duration: 0.5-2yrs
Share of budget: up to 3.5%
Duration: 3-6yrs
Share of budget: 21.5%
Chance of success: <0.01%
Drug
Discovery
Screening
of 5,000
to 10,000
compounds
Pre-
clinical
250
compounds
IND
Clinical Trials
Phase I
20-100
volunteers
Phase II
100-500
volunteers
Phase IIII
1’000-5’000
volunteers
NDARegulatory
Review and
Market
Authorization
Scale-Up to
Manufacturing
Post-Marketing
Surveillance
Phase IV trials
Duration: ongoing
Share to budget: up to 10%
Chances for
return on investment (ROI):
1:3
RESEARCH DEVELOPMENT APPROVAL
Expect More Contingency And Pre-Approval Deals
Global Healthcare M&A – Bigger is Better
Healthcare Fundamentals: Growing Nicely But There’s Still Much To Be Done
Tech, data analytics, biomarkers and diagnostics for personalized medicine are one of
the real growth engines over the next few years
14
Nb of hospital beds per capita
is one of the world’s lowest in
the US
5% of the US population =
50% of spending
Medicines account for only
14% of total healthcare
spending
A $7 trillion industry growing
at a 4.3% CAGR
➢ 10.4% of global GDP
➢ Expected to reach $8.7 trillion by 2020
➢ Per capita healthcare spending in the US:
$9’450 vs. $5’267 in Germany, $4’608 in
Canada and $6’935 in Switzerland
➢ 90% of drug prescriptions in the US
are generics, but account for only 26%
of overall drug costs
➢ Emerging healthcare markets the main
growth driver
➢ 2.8 per 1’000 in the US vs. 8 in
Germany and 4.5 in Switzerland
➢ Shift in policy towards providing
treatment and care outside hospital
Global Healthcare M&A – Bigger is Better 15
Source: Phrma - **Other: Mostly MedTech related including consumables
4%
13%
14%
12%
31%
18%
8%
US Health
Care
Spending
2015
Govt and Private Health
Insurance
Administration
Physician and
Clinical Services
Hospital Care
Nursing Home,
Home Health and
Related
Other**
Dental
Services
Healthcare Fundamentals: A Detailed Look At The US Market
PRESCRIPTION DRUGS
Brand Manufacturers 7%
Generic Manufacturers 3%
Supply Chain Entities 4%
TOTAL 14%
Global Healthcare M&A – Bigger is Better
➢ Biologics and OTC (over-the-counter) growing the fastest
➢ Oncology the largest therapeutic area → 16% of total pharmaceutical sales by 2021 from
10.7% in 2015
➢ Orphan drugs growing twice (11%) the prescription drug market and to account for more
than 15% of worldwide prescriptions (including generics) by 2021
➢ Increased complexity, larger size
of trials and greater focus on chronic
and degenerative diseases
✓ are the main reasons behind
cost inflation
➢ 70% of drug sales today derive from
drugs initially developed
✓ by smaller companies vs. 30%
during the 1990’s
M&A an important
driver for pipeline enhancement
16
Source: QuntilesIMS - ² Evaluate Pharma 2016
Healthcare Fundamentals: Orphan Drugs, Biologics & Oncology To Stand Out
0
200
400
600
800
1000
1200
1400
1600
2015 2021
Ph
arm
a m
ark
et
siz
e $
bn Biosimilars
Biologics
OTC
Generics
Patented/ Originatorsmall molecule
Global Healthcare M&A – Bigger is Better
➢ Over 14K medicines worldwide are currently in active development…
✓ anticancer therapies leading the pack followed by Neurological and Anti-infective
➢ But “only” 56 (45 FDA approvals of which 47% for rare diseases) were launched in 2015
on a worldwide basis
✓ a strong number as typically out of 10K compounds, only five advance to the human testing
phase and only one is successfully commercialized
17
Source: Pharmaprojects®, January 2017
10,000compounds
250
compounds
5compounds
Stage 3
Drug Discovery
Pre-Clinical
Development
Clinical
Development
Stage 2
Stage 1
Regulatory
Approval
compound
Phases
0- Effect on body
I- Safety in humans
II- Effectiveness at
treating diseases
III- Larger scale safety
and effectiveness
IV- Long term safety
7493
20642357
1025
220 116
1395
79
0
1000
2000
3000
4000
5000
6000
7000
8000
Drug Count
2016 2017
Pipeline by development phase
2017 vs 2016
Healthcare Fundamentals: Number Of Medicines Currently In Development
➢ Over 1/3 of ongoing developments are for rare diseases
➢ Oncology treatment sales (a somewhat crowded space) are expected to reach $190B by
2022¹
✓ 1/3 of total new drugs to be introduced focus on cancer therapies
Global Healthcare M&A – Bigger is Better 18
Source: Evaluate Pharma 2016¹
Cancers
1,919
Infectious Diseases
1,261
Diabetes
401
HIV/ AIDS
208
Cardiovascular Disease
563
Immunological Disorders
1,123
Mental Health Disorders
401
Neurological Disorders
1,308
Healthcare Fundamentals: Number Of Medicines By Key Diseases
Global Healthcare M&A – Bigger is Better
The AtonRâ Healthcare M&A Index – Growth Rates And Markets By 2020
19
Source: World Industry Outlook, Healthcare and Pharmaceuticals, The Economic Intelligence Unit, June 2016
CAGR (2015-2020)
Wearable Medical Devices$28
bn 33%
Global
Pharmaceutical$1.5
tn4%-7%
Global Biotech$533
bn8%
CRO’s $60
bn
CDMO’s$100
bn
9%
7%
Generics $380
bn 10%-11%
Orphan drugs$178
bn12%
Healthcare IT $280
bn16%
AtonRâ Healthcare
M&A Focus
Global Healthcare M&A – Bigger is Better 20
HOT
COLD
Orphan Drugs
MedTech
CDMOs & CROs
Generics
NGS (Next Generation Sequencing)
Healthcare services
Biosimilars
Healthcare IT
Our M&A Thermometer
Global Healthcare M&A – Bigger is Better
➢ Orphan definition by patient population → US = <6.37 out of 10K; Europe = <5
patients out of 10K; Japan = <4 out of 10K
➢ As the population becomes older, the number of rare diseases increases, notably
neurological ones, and 80% of them have genetic origins
✓ half of rare diseases hit children as most of genetic diseases occur at childhood, often
a single gene is responsible
➢ Insurers are set to continue covering such drugs (on average $140K vs. $27K for non-
orphan), as it is in most cases the single possibility for patients
➢ 2016 saw a record number of applications (582, a 23% Y/Y growth) made to the FDA
for orphan drug designations
➢ Larger players include Novartis (11.3% share), Roche (8.8%), Celgene (8%)
✓ others include Alexion Pharmaceuticals, Shire, Vertex and Kite (just bought out by
Gilead Sciences), Tesaro and Bluebird Bio
➢ We believe that gene therapies and advances in machine learning, computer vision,
robotic automation and high throughput sequencers are expected to boost the
discovery of new therapies for rare diseases
Fewer FDA restrictions and faster FDA approvals particularly in the Rare Diseases space
are likely to attract a lot of M&A attention
21
Orphan Drugs – Most Of The Biotech M&A Will Take Place Here
Global Healthcare M&A – Bigger is Better 22
Phase I
Phase II
Phase III
Application submitted
25
82
9151
12
10
10
148
7
31
38
11
13
49
Auto-immune Diseases
Blood Cancer
Blood Disorders
Cancer
Cardiovascular Disease
Digestive Disorders
Eye Disorders
Genetic Disorders
Growth Disorders
Infectious Diseases
Neurologic Disorders
Respiratory Diseases
Transplantation
Other
Source: PhRMA – research progress hope
Orphan Drugs - Medicines In Development In The US For Rare Diseases In 2016
Global Healthcare M&A – Bigger is Better
➢ Healthcare IT spans notably Medical Document Management Solutions, Clinical
Analytics and Mobile Health Applications
➢ It’s a $134B market growing at a 16% CAGR¹, one of the fastest growth rates within
Healthcare
➢ More importantly, Technology is positioned as a tool to deliver improved health outcome
rather than as a contributor to rising Healthcare costs
➢ Aside from Artificial Intelligence, Virtual Reality, Augmented Reality, 3D Printing etc., we
believe that the internet of medical things (IoMT) and blockchain could play a very
important role as:
✓ IoMT (including smart pills) supports the integration of wearables and remote monitoring
devices
✓ blockchain, on the other hand, could overcome the privacy and security issues, when it
comes to managing data from hospitals, doctors, and insurance companies
The most interesting targets are those providing a better consumer experience via
wearables and mobile technologies by exploiting people’s data
23
Source: ¹Markets & Markets
Healthcare Technology – Tech Is To Change Everything
Global Healthcare M&A – Bigger is Better
➢ A huge $370 bn industry growing nicely (5% CAGR)
but still highly fragmented
24
Source: Evaluate Pharma 2016 & Evaluate MedTech 2016
37%
25%
38%
Top 10Companies
11-30Companies
Rest of Market
$138bn
$93bn
A
fragmented
market
In vitro diagnostics (IVD)
Cardiology
Diagnostic Imaging
Orthopedic Ophthalmics
General & Plastic Surgery
Endoscopy
Drug Delivery
Dental
Wound Mangement
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
16.00%
3.00% 3.50% 4.00% 4.50% 5.00% 5.50% 6.00% 6.50% 7.00% 7.50%
WW
Ma
rke
t S
ha
re %
in
20
22
% Sales Growth: CAGR 2015-22
Note: Size of Bubble = WW Sales in 2022
Top10 Device Areas in 2022,
Market Share & Sales Growth
MedTech – Still A Highly Fragmented Market (I)
Global Healthcare M&A – Bigger is Better
➢ 2015 was a record year for MedTech M&A with a total of 240 deals and $128B in deal value
✓ Abbott was responsible for a large part with the $30.7B acquisition of St. Jude Medical and
the just-completed embattled $5.3B Alere acquisition
➢ Larger companies in the MedTech space are looking for increased market share and scale
in each of their specialty category
✓ as a way to better respond to endlessly larger clients (hospital systems notably) and secure
market share at the expense of lower margins
➢ This market is also disrupted by new startups and Tech giants developing smart medical
devices or turning their usual devices (smartphones, watches) in medical ones
➢ A few examples of the new MedTech and Tech partnerships:
✓ J&J teamed up with Verily Life Sciences (Alphabet) and both created Verb Surgical, which
focuses on better patient outcome and hospital efficiencies
✓ Glaxo also teamed up with Verily and formed Galvani Biosciences, which has a focus on
bioelectronics medicines (harness electric signals in the body to treat chronic diseases)
✓ Boehringer Ingelheim JV with Qualcomm, designed to create an internet-connected
inhaler for certain respiratory diseases
✓ Illumina founded Helix, which develops liquid biopsy to detect diseases by measuring
snippets of tumor DNA in the bloodstream
25
MedTech – Still A Highly Fragmented Market (II)
Global Healthcare M&A – Bigger is Better
➢ Europe, home to 25’000 MedTech companies (for the most part SMEs) with 31% of the
worldwide MedTech market, is ripe for consolidation
✓ ahead of the new European Medical Devices Regulation (MDR) which applies from May
2020
➢ In the US (6’500 companies and 39% worldwide market share), many companies will face
an increasingly intensive competitive environment
✓ vs. larger specialized players
✓ vs. a new breed competitors coming from the Tech world
➢ We believe that the small-to-mid players on both sides of the Atlantic have a great
opportunity just ahead to further consolidate the market
✓ and the chance to make accretive acquisitions
➢ Larger MedTech players on the other side are likely to keep active in their search for higher
market share and are expected to keep adjusting their portfolios (buying or divesting
assets) accordingly
The interest shown from Tech giants for medical devices could give rise to significant
M&A with huge premiums
26
MedTech – Still A Highly Fragmented Market (III)
Global Healthcare M&A – Bigger is Better
➢ The CRO (Contract Research Organizations) industry barely existed ten years ago →
Outsourcing is the logical consequence of a maturing industry
➢ The CRO market is now consolidated, as the top 10 players command 80% of the market
($60B market by 2020 with a CAGR of 9%), with the APAC region growing the fastest
➢ With greater complexity and competition, mounting pressure on drug cost containment and
the need to cut time for product marketing, an ever increasing number of Pharma, Biotech
and MedTech companies outsource many tasks they previously performed in-house,
notably:
✓ site selection and patient enrollment through final regulatory approval (FDA, EMA etc.)
✓ independent data generation, proving concrete evidence of clinical superiority and cost-
effectiveness of products, a key feature for the future of personalized medicine
➢ Sophisticated data analysis (including AI & machine learning) in clinical trials (and trial
designs) is critical to the drug development process and payer reimbursement strategies
➢ We believe that CROs are to shift their focus to the IT world as shown by the merger of
product and healthcare service provider Quintiles with IT provider IMS Health, creating one
of the largest pure-play service providers in the personalized medicine space
M&A in the Medical Software space is likely as large Tech companies are to play an ever
more important role over the next few years
27
CROs & CDMOs – Tech To Take The Lead in CROs
Global Healthcare M&A – Bigger is Better
➢ The same dynamics apply to CDMOs (Contract Development Manufacturing
Organizations)
➢ CDMOs, a highly fragmented market, has a 25% share of the outsourced manufacturing and
packaging functions (top 10 companies have a 30% combined market share)
➢ CROs bear 50% of the Pharma’s clinical trials → Consolidation in CROs took place fast as
larger CROs were preferred by the Pharma & Biotech industry
✓ with their end-to-end product offering (multiple geographies and multiple complex trials)
➢ We believe that CDMOs mergers are on every banker’s mind as the next logical step would
see CROs and CDMOs merging → The best example is the just completed $7.2B (30%
premium) acquisition of Patheon by Thermo-Fisher
✓ thanks to this merger, Thermo-Fisher has become (for now at least) the sole fully integrated
player servicing the Pharma & Biotech industry
✓ offering services spanning from solutions for drug development, delivery and manufacturing
➢ Companies such as Swiss-based Lonza and US-based Catalent are topping the list of
potential consolidators/M&A targets
The battle for targets is likely to intensify, notably in Europe (the leading CDMO market)
as private equity firms and corporations compete
28
CROs & CDMOs – Toward A Merger Of Both Businesses?
Global Healthcare M&A – Bigger is Better
➢ Due to complexities in the manufacturing process and to reluctance from physicians
prescribing these drugs (very small changes can affect safety/effectiveness), biosimilars are
in a completely different shape from generics as:
✓ discounts vs. branded drugs are lower (in the range of 30% in the US and 50% in Europe) vs.
generics (90% on average)
✓ development costs in the range of $100M/$200M vs. $1M to $2M for generics
✓ dominated by a few large players such as Sandoz (generic arm of Novartis), Pfizer
(Hospira), Amgen, German privately-held Boehringer Ingelheim and South Korean
Celltrion
29
Aspirin
21 atomsHuman Growth Hormone
~ 3000 atoms
Monoclonal antibody
~ 25,000 atoms
SMALL MOLECULE DRUG SMALL BIOLOGIC LARGE BIOLOGIC
INCREASING COMPLEXITY
Biosimilars – Closely Held By The Large Pharma Players But… (I)
Global Healthcare M&A – Bigger is Better
➢ Roughly 50% of biosimilars sales will go off-patent in the next four years
➢ The 3 best-selling biosimilars (out of seven approved by the FDA so far) - Humira,
Enbrel and Remicade - were FDA-approved but only Pfizer’s Inflectra (biosimilar of
Remicade) is currently commercialized
➢ as Humira and Enbrel are held-up in patent litigation and are not expected to be
commercialized before 2018
➢ In Europe the number currently stands at 32 and the main difference between the two
continents is regulations
➢ In the US there are two FDA approval pathways: “highly similar” or “interchangeable”
➢ interchangeable (allows for automatic substitution by pharmacists) means that the
biosimilar is expected to have the same results as the original biological drug
➢ No one of the approved biosimilars got the “interchangeable” status in the US so far and
a such it represents a “legislative” loophole which is to delay the entry of biologics in the
US market but clouds are clearing out under the helm of the new FDA Commissioner
M&A within the biologic manufacturing space is to gain speed as it’s one of the few
growing markets in the pharma space
30
Biosimilars – Closely Held By The Large Pharma Players But…(II)
Global Healthcare M&A – Bigger is Better
➢ The Cancer profiling market is set to grow from $25B in 2015 to $62B by 2021, a 19%
CAGR, as personalized medicine allows a better prediction of cancer and better targeted
therapies with less side-effects
➢ Understanding the molecular bases of the disease and identifying biological markers
(DNA, RNA, Proteins) associated with safety and tolerance for each patient is
fundamental and will spark the personalized medicine take-off
As Next Generation Sequencing (NGS) is to capture the lion’s share of this market, it is
likely to attract M&A interest
31
73% of cancer medicines
42% of new medicines
In the
PIPELINE
have the
potential to be PERSONALIZED
MEDICINES
Personalized Cancer Therapy
Personalized Medicine For Cancer Therapy – NGS Is A Hot Space
Global Healthcare M&A – Bigger is Better
➢ The Generics industry is seeing increased competition, most notably from Indian drug
makers (24% market share in the US), which pressures industry margins
✓ as volume growth is unable to offset declining prices (Mylan citing high-single digit price
erosion)
➢ The FDA, which approved a record of 800 generics in 2016, is speeding up the
approvals for generics (from four years to ten months), notably on those generic drugs
where fewer or no competition exists
✓ as a way to drive overall drug prices lower
➢ At the same time, manufacturing capacity of products becoming generic is divested from
Pharma, which is an additional catalyst for consolidation in the CDMO space
➢ Finally, from 2018 onwards, the number of drugs going off-patent is expected to
decline sharply, a negative catalyst for this industry
➢ For the generics industry there is no alternative but to search for even larger “economies
of scale” to survive the present environment
✓ entry into Biosimilars is a bet they have to do in the next few quarters or they will take the
risk of being left out from this market
While it might already be too late for small players, large scale M&A is likely to take
place in the next few quarters
32
Generics – Consolidation Among Large Players Is Now Needed
Global Healthcare M&A – Bigger is Better
➢ This is the largest pie of the Global Healthcare sector, representing 2/3 of the total
➢ The future in this space is driven by further consolidation across all segments including
hospitals, physicians organizations, surgery centers, imaging centers and many others as:
✓ downward pressure on margins is set to continue in the next few years
➢ The industry issues are compounded by baby boomers which are exiting the job market and
are adding to an already strained shortage of nurses and physicians
✓ salaries (and costs) are expected to grow more than the rate of inflation
➢ While IT is likely to alleviate some burdens of the labor shortage (telehealth, wearables,
apps etc.), the service providers standing to benefit and to gain market share are those
which are able to be the most efficient ones
The Healthcare services segment is not the key focus of our M&A portfolio but
opportunities can pop up from time to time
33
Healthcare Services – No Choice But To Consolidate In Order To Survive
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While all reasonable effort has been made to ensure that the information contained is not untrue or misleading atthe time of publication, no representation is made as to its accuracy or completeness and it should not be reliedupon as such.
Past performance is not indicative or a guarantee of future results. Investment losses may occur, and investorscould lose some or all of their investment.
Any indices cited herein are provided only as examples of general market performance and no index is directlycomparable to the past or future performance of the Certificate.
It should not be assumed that the Certificate will invest in any specific securities that comprise any index, norshould it be understood to mean that there is a correlation between the Certificate’s returns and any index returns.
Any material provided to you is intended only for discussion purposes and is not intended as an offer orsolicitation with respect to the purchase or sale of any security and should not be relied upon by you in evaluatingthe merits of investing in any securities.
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