Health Care

Overweight Buy Into Managed Health Care Weakness Buy Into Managed Health Care Weakness A little over a year ago we moved to the sidelines in the S&P managed health care index, crystalizing significant relative profits of 28% for our U.S. equity portfolio.  Now the time has come anew to explore this niche health care index from the long side and yesterday we moved to an overweight position. Leading indicators of health care insurance profit margins are currently flashing green. Not only are medical costs melting including drug price inflation (second & bottom panels), but also industry cost structures are kept at bay with wages climbing below a 2%/annum rate growth and trailing overall wage inflation (third panel). On the demand front, as the economy is running at full employment, with unemployment insurance claims probing 60-year lows and with wages representing a headache for small and medium business owners, enrollment should stay healthy. Most importantly, the combination of decreasing medical cost inflation and a healthy overall labor market heralds a steep decline in the industry’s medical loss ratio. While risks of a potential “Medicare For All” plan remain nebulous and have clearly weighed on industry stock prices, melting medical cost inflation, BCA’s rising interest rate expectations along with an economy running at full steam, all suggest that managed health care margins and profits will overwhelm in the coming quarters. Bottom Line: We boosted the S&P managed health care index to overweight yesterday; please see Monday’s Weekly Report for more details. The ticker symbols for the stocks in this index are: BLBG: S5MANH - UNH, ANTH, HUM, CNC, WCG.    

Highlights Portfolio Strategy Yield curve dynamics, higher oil prices, recovering balance sheets, and compelling valuations and technicals all suggest that energy stocks will burst higher in the coming months.  Melting medical cost inflation, BCA’s rising interest rate expectations along with an economy running at full steam, all suggest that managed health care margins and profits will overwhelm in the coming quarters. Recent Changes Upgrade the S&P managed health care index to overweight today. Add the S&P energy index to the high-conviction overweight list today. Table 1 Show Me The Profits Show Me The Profits Feature On the eve of earnings season, the SPX ended last week higher as bank profits delivered and allayed fears of recession. All-time absolute highs in the S&P tech sector and in the Philly SOX index suggest that global growth will likely reaccelerate in the back half of the year, vaulting the broad market to new highs. In addition, the suppressed Treasury term premium1 signals that the path of least resistance for equities is higher on a cyclical time horizon (term premium shown inverted, Chart 1). Chart 1All Clear... All Clear... All Clear... Nevertheless, some caution is still warranted from a tactical perspective. Since March 4 when we first turned short-term cautious on the broad equity market,2 the SPX has moved roughly 100 points both ways. Internal market moves, financial conditions, fund flows, complacency and the current economic backdrop all signal that stocks are not out of the woods yet. Namely, the S&P high beta versus the S&P low volatility tilt has failed to confirm the slingshot in the SPX (Chart 2). Similar to the small cap underperformance, mega cap tech is trouncing small cap tech stocks (Chart 3). Not only do large cap technology stocks have pristine balance sheets, but they also have earnings. In contrast, from the 89 S&P 600 tech constituents 54 have no forward profits. The weak over strong balance sheet underperformance is emitting the same signal (top panel, Chart 3). Chart 2...But Some... ...But Some... ...But Some... Chart 3...Caution... ...Caution... ...Caution... The bond market is also sending a warning shot. High yield corporate bonds are underperforming long-dated Treasurys (middle panel, Chart 2). And, the junk bond option adjusted spread has not fallen to the 2018 lows, let alone all-time lows (not shown). While a lot has been said on easier financial conditions, they have yet to return to the early-2018 lows. In fact, similar to the non-confirmation of the all-time SPX highs in late-September, the GS financial conditions index (FCI) is tracing a higher low, warning that equities have room to fall (FCI shown inverted, bottom panel, Chart 2). Mutual fund flows on all equity related products are contracting on a net sales basis. Historically, fund flows and equity returns are joined at the hip and the current divergence suggests that equity prices will likely succumb to deficient demand (top panel, Chart 4). Chart 4...Is Warranted ...Is Warranted ...Is Warranted On the economic front, last Wednesday we highlighted in an Insight Report, that lumber – a hyper sensitive economic indicator – failed to corroborate the recent equity market euphoria. The weak Citi Economic Surprise Index, also warns that the economic data has yet to turn the corner and should weigh on equities (bottom panel, Chart 4). What ties everything together is SPX profits. The news on this front is mixed, at least for the next little while: EPS will most likely contract in the first half of the year, but equity investors are looking through this earnings recession. Last year’s U.S. dollar appreciation will dent both revenues and EPS, and Q1/2019 is the first quarter where such greenback strength will subtract from corporate P&Ls (Chart 5). Chart 5Dollar Trouble? Dollar Trouble? Dollar Trouble? What worries us most is the sectorial concentration of 2019 profit growth in one sector, financials. Another source of concern is the heavyweight tech sector’s negative profit path for calendar 2019. Such sudden internal profit moves both in magnitude and in a short time frame are far from reassuring, especially given that overall profit estimates are still trimmed. Chart 6A depicts the current sector profit contribution to 2019 growth, and compares it with the January 22nd iteration (Chart 6B). What a difference three months make. Chart 6 Chart 6 In sum, internal equity and bond market dynamics, financial conditions, the economic soft-patch and the looming profit recession all signal that short-term equity market caution is still warranted. This week we upgrade a health care subsector and reiterate our bullish stance on a deep cyclical sector. Catch Up Phase Looms For Energy Stocks Last week we broadened out our research on the yield curve (YC) inversion beyond the S&P 500 to the GICS1 sectors.3 As a reminder, the SPX peaks following the yield curve inversion and on average the S&P energy sector performs the best from the time the YC inverts until the S&P 500 peters out (please refer to Table 3 from the April 8, Special Report). While every cycle is different, if history at least rhymes, deep cyclical energy stocks will likely outperform as the SPX eventually breaks out to fresh all-time highs. Already, year-to-date the S&P energy sector is the third best performing sector, besting the SPX by over 200bps. More gains are in store, especially given the big dichotomy between the oil price recovery and the relative share price ratio (Chart 7). What is perplexing is the ingrained sell-side analyst pessimism (Chart 6A) and lack of belief that oil prices will remain near current levels or even continue their ascent as our sister Commodity & Energy Strategy (CES) service publication predicts. Not only are EPS forecast to contract in every quarter this year, or 10% year-over-year according to IBES, but also revenues are slated to fall in every quarter in 2019. We would lean against this extreme analyst bearishness. While the $3.5/bbl backwardation in WTI oil futures prices one year out, and more than twice that 24-months out, underpins Wall Street’s gloomy energy sector outlook, U.S. oil extraction productivity reinforces sector profits. As U.S. crude oil production hits new all-time highs this is extracted by fewer oil rigs (bottom panel, Chart 7). If BCA’s CES constructive oil price expectation pans out, then energy stocks will easily surpass the profit and revenue bar that analysts have set extremely low for the sector. Delivering on the profit front will likely serve as a catalyst to rerate these deep cyclical stocks higher (Chart 8) and thus a catch up phase looms for energy stocks, at least up to the current level of WTI crude oil prices (top panel, Chart 7). Chart 7Catch Up Catch Up Catch Up Chart 8Bombed Out Valuation Bombed Out Valuation Bombed Out Valuation Granted, the U.S. dollar is a key determinant of oil prices and if BCA’s view proves accurate that global growth will return in the back half of the year (second panel, Chart 9), that is synonymous with a depreciating greenback, which in turn is bullish the broad commodity complex in general and oil prices (and thus energy stocks) in particular (middle panel, Chart 7). As a reminder, oil prices are an excellent global growth barometer, similar to their sibling Dr. Copper. Recovering global growth will boost energy stocks in an additional way: via a favorable supply/demand crude oil balance. Not only is OPEC rebalancing the global oil market through a reduction on the supply front, but a trio of potential supply shocks from Iranian sanctions, Venezuelan infrastructure and Libyan conflict are providing price support. Further, global growth has historically been tightly correlated with rising non-OECD oil demand (Chart 10). Chart 9Global Growth Beneficiary Global Growth Beneficiary Global Growth Beneficiary Chart 10Favorable Supply/Demand Dynamics Favorable Supply/Demand Dynamics Favorable Supply/Demand Dynamics Meanwhile, the broad energy sector is still licking its wounds from the late-2015/early-2016 manufacturing recession and is stabilizing debt and increasing EBITDA (fifth panel, Chart 11), thus the net debt/EBITDA ratio for the index has collapsed from over 11 to around 2, a level similar to the broad market (second panel, Chart 11). Interest coverage (EBIT/interest expense) is also renormalizing higher and is no longer sending a default warning for the energy space as a whole (third panel, Chart 11). The junk energy bond market corroborates/reflects this balance sheet improvement and is no longer flashing red (bottom panel, Chart 9). Finally, bombed out technical conditions are contrarily positive, and such extreme negative readings have marked the start of playable and sizable relative outperformance periods (Chart 12). Chart 11No Red Flags No Red Flags No Red Flags Chart 12Contrary Alert: Depressed Technicals Contrary Alert: Depressed Technicals Contrary Alert: Depressed Technicals Netting it all out, YC dynamics, higher oil prices on the back of rising global growth and a favorable supply/demand crude oil backdrop, recovering balance sheets, and compelling valuations and technicals suggest that energy stocks will burst higher in the coming months. Bottom Line: We reiterate our above benchmark recommendation in the S&P energy sector and today we are adding it to our high-conviction overweight list. Buy Into Managed Health Care Weakness A little over a year ago we moved to the sidelines in the S&P managed health care index, crystalizing significant relative profits of 28% for our U.S. equity portfolio.4 Now the time has come anew to explore this niche health care index from the long side. While we left some money on the table since our late-May 2018 move, relative share prices have come full circle, valuations have fallen roughly 18% from the late-2018 peak and analysts’ euphoria has been reined in (Chart 13). Chart 13Reset Reset Reset The inter- and intra-industry M&A fever has died down from mid-2018 and the rising momentum of a “Medicare For All” bill has weighed negatively on HMO sentiment. With regard to the latter, our geopolitical strategists believe that passage is possible. If the Democrats can unseat an incumbent president in 2020, they will also likely take the Senate and keep the House. This means they will be in the position to pass a major piece of legislation. While Trump is favored to win, barring a recession, the risk of both a Democratic sweep and a push for “Medicare for All” could be as high as 27%, and this would have a dramatic impact on the health care sector.5 Tack on the near 90bps drop in the 10-year U.S. Treasury yield since the November 2018 peak, and factors have fallen into place for a bearish raid in this pure play health insurance index. Thin managed health care margins and profits move in close lockstep with interest rates as roughly 10% of the industry’s operating income is tied to “investment income”. In other words, as insurers receive the premia they typically invest it in Treasurys and that explains the high EPS and margin sensitivity on interest rate moves (Chart 14). While at first sight, the outlook for profits appears grim, BCA’s bond strategists expect a selloff in the bond market to materialize in the back half of the year simultaneously with a pick-up in global growth which will prove a tonic to both margins and EPS. In addition, leading indicators of heath care insurance profit margins are flashing green. Not only are medical costs melting including drug price inflation (second & bottom panels, Chart 15), but also industry cost structures are kept at bay with wages climbing below a 2%/annum rate growth and trailing overall wage inflation (third panel, Chart 15). Chart 14Overdone Overdone Overdone Chart 15Melting Cost Inflation Melting Cost Inflation Melting Cost Inflation On the demand front, as the economy is running at full employment, with unemployment insurance claims probing 60-year lows and with wages representing a headache for small and medium business owners, enrollment should stay healthy (Chart 16). Most importantly, the combination of decreasing medical cost inflation and a healthy overall labor market herald a steep decline in the industry’s medical loss ratio. All of this is unambiguously bullish for margins and profits. Finally, relative valuations and technicals have both corrected from previously stretched levels and offer a compelling entry point for fresh capital (Chart 17). Chart 16Full Employment Is Bullish Full Employment Is Bullish Full Employment Is Bullish Chart 17Unloved And Under-Owned Unloved And Under-Owned Unloved And Under-Owned Netting it all out, despite the risks that “Medicare For All” pose, melting medical cost inflation, BCA’s rising interest rate expectations along with an economy running at full steam, all suggest that managed health care margins and profits will overwhelm in the coming quarters. Bottom Line: Boost the S&P managed health care index to overweight today. The ticker symbols for the stocks in this index are: BLBG: S5MANH - UNH, ANTH, HUM, CNC, WCG.   Anastasios Avgeriou, U.S. Equity Strategist anastasios@bcaresearch.com Footnotes 1      According to the NY Fed: “Treasury yields can be decomposed into two components: expectations of the future path of short-term Treasury yields and the Treasury term premium. The term premium is the compensation that investors require for bearing the risk that short-term Treasury yields do not evolve as they expected.” https://libertystreeteconomics.newyorkfed.org/2014/05/treasury-term-premia-1961-present.html 2      Please see BCA U.S. Equity Strategy Weekly Report, “The Good, The Bad And The Ugly” dated March 4, 2019, available at uses.bcaresearch.com. 3      Please see BCA U.S. Equity Strategy Special Report, “10 Most FAQs From The Road” dated April 8, 2019, available at uses.bcaresearch.com. 4      Please see BCA U.S. Equity Strategy Report, “Seeing The Light” dated May 29, 2018, available at uses.bcaresearch.com. 5      If there is a 60% chance the Democrats nominate a left-wing candidate, and a 45% chance they win the election, then there is a 27% chance that they are in a position to push for “Medicare for All” with fair odds of passage. Everything will depend on the specific outcomes of the Democratic primary, presidential campaign, general election, post-election government policy priorities, and congressional passage. Stay tuned as in the coming months we will be publishing a Special Report on “Medicare For All” and health care sector implications co-authored with our sister Geopolitical Strategy service. Current Recommendations Current Trades Size And Style Views Favor value over growth Favor large over small caps

Underweight In last month’s downgrade of the S&P pharma index to underweight, we highlighted that headwinds to drug prices would weigh on the sector’s earnings profile.1 This week’s CPI report confirmed this negative pricing view with prescription drugs falling into outright deflation; in fact industry pricing power is falling at its fastest rate in more than 15 years (second panel). Despite collapsing prices, pharma inventories have continued to climb which indicates that prices may have to fall further to clear out excess supply (third panel). The upshot is that, though they still trail the broad market by a wide margin, the recent uptick in both short- and long-term relative earnings estimates may be premature (bottom panel). Bottom Line: An increasingly difficult pricing environment means more downside lies in store for S&P pharma earnings estimates and, consequently, share prices; stay underweight. The ticker symbols for the stocks in this index are: BLBG: S5PHAR – JNJ, PFE, MRK, LLY, BMY, ZTS, AGN, MYL, NKTR, PRGO. Deflating Drug Prices Bode Ill For Pharma Profits Deflating Drug Prices Bode Ill For Pharma Profits Deflating Drug Prices Bode Ill For Pharma Profits   1      Please see BCA U.S. Equity Strategy Weekly Report, “ Reflating Away” dated February 19, 2019, available at uses.bcaresearch.com.

A Healthier GE With Less Healthcare A Healthier GE With Less Healthcare Overweight General Electric took the S&P industrial conglomerates index higher yesterday on news it had agreed to sell its BioPharma business to Danaher, the former home of GE’s relatively new CEO. The deal, which will raise more than $21 billion for the firm, was celebrated by investors who delivered one of the best share price moves for the company in a decade. Importantly, GE promised to use the proceeds of the transaction to pay down the debt load that has weighed on the stock since the GFC. Further, the deal will see Danaher assuming the pension obligations of the group, another source of shareholder angst. We share investor sentiment with respect to deleveraging; more is better for this highly indebted sector and yesterday’s news is another step in the right direction (third panel). Tack on the catalyst that relief in the trade war with China adds (please see our previous Insight Report) and the recent rally in the still reasonably valued S&P industrial conglomerates index (bottom panel) looks very sustainable; stay overweight. The ticker symbols for the stocks in this index are: BLBG: S5INDCX - GE, MMM, HON, ROP.

...Pharmas Pain ...Pharmas Pain Underweight In mid-2017, we went underweight the S&P pharma index and booked healthy gains roughly a year later when we lifted exposure to neutral. Since then, Big Pharma has enjoyed a reprieve on the back of congressional inaction and the fact that the Trump Administration’s drug pricing wrath was less severe than initially feared. However, the time has come to trim the S&P pharma index to underweight. The top panel shows that pharmaceutical companies have been nearly uninterruptedly raising prices for the past four decades. Higher selling prices have been synonymous with higher profits and thus higher share prices. However, profit margins crested in the midst of the late-1990’s M&A boom and have never reclaimed their previous zenith (middle panel). Neither have relative share prices. Worryingly, pharma prices have hit a wall during the past four years and can barely keep up with overall inflation, despite still being opaque (bottom panel). As both Democrats and Republicans are united to bring down health care costs in general and drug prices in particular, pharma profits will likely suffer a secular downdraft. The implication is that, as pharma revenues erode they will deal a blow to profits. Consequently, the outlook for relative share prices is dim. Bottom Line: We trimmed the S&P pharma index to underweight yesterday; please see our Weekly Report for more details. The ticker symbols for the stocks in this index are: BLBG: S5PHAR – JNJ, PFE, MRK, LLY, BMY, ZTS, AGN, MYL, NKTR, PRGO.

Biotechs Gain Is... Biotechs Gain Is... Overweight Biotech stocks have been the center of attention recently as the BMY/CELG deal put the whole sector in play, and yesterday we boosted exposure to overweight in the S&P biotech index. We doubt the merger mania is over and we continue to believe that more mega deals are in store, either intra or inter-industry, with Big Pharma hungry and in a hurry to replenish their drug pipeline. In our Weekly Report, we highlight a number of positive catalysts that can propel the S&P biotech index higher but surprisingly, the sell-side community does not share our enthusiasm. Relative profit growth is forecast to be nil in the next year. In the coming five years, biotech stocks are expected to trail the overall market’s profit growth by 4%/annum (second panel, Chart 8). This is extremely pessimistic and a first in the 24-year history of the I/B/E/S data set, and it is contrarily positive. Relative revenue growth forecasts are also grim for the upcoming 12 months and both revenue and profit forecasts present low hurdles to overcome (third panel). Meanwhile, from a valuation perspective, the S&P biotech index trades at a 25% discount to the SPX forward P/E and well below the historical mean (bottom panel). Bottom Line: We lifted the S&P biotech index to overweight yesterday; please see our Weekly Report for more details. The ticker symbols for the stocks in this index are: BLBG: S5BIOT – ABBV, AMGN, GILD, BIIB, CELG, VRTX, REGN, ALXN, INCY.

Highlights Portfolio Strategy The path of least resistance is higher for the broad equity market on the back of a reflationary impulse and a less dogmatic Fed. Now that the SPX forward EPS bar has been lowered to the ground, upward surprises loom, especially if the third catalyst we have been highlighting in recent research materializes: a positive resolution to the U.S./China trade spat. The recent M&A fever, a less dogmatic Fed that has suppressed the 10-year Treasury yield and a pick up in the U.S. credit impulse can serve as catalysts to unlock excellent value in the S&P biotech index. Upgrade to overweight. A profit margin squeeze on the back of soft pharma pricing power, weak operating conditions and a race to buy out biotech stocks to build up drug pipelines warn that the derating phase has just began for the S&P pharma index. Downgrade to underweight. Recent Changes Boost the S&P biotech index to overweight today. Trim the S&P pharma index to underweight today. Table 1 Reflating Away Reflating Away Featured The S&P 500 has been flirting with its 200 day moving average and once it categorically clears this hurdle there are high odds that previous resistance will turn into support. The next important level is 2,800, as we highlighted in recent research, a level where the SPX failed numerous times last year.1 Encouragingly, the character of the market has changed from December’s extreme daily weakness to this year’s significant daily resilience. As we first posited on January 18, while everyone is looking for a retest to re-enter the equity market, we already had the retest in December and are now in a slingshot recovery eerily similar to the 2016 and 1998 episodes.2 Importantly, what has changed since the post-December Fed meeting carnage is that the bond market has completely priced out Fed hikes for 2019 and the 10-year Treasury yield is 15bps lower. Chart 1 highlights this reflationary backdrop for U.S. stocks. Our proprietary Reflation Gauge (RG, comprising oil prices, interest rates and the U.S. dollar) is probing levels last hit in 2012. Historically, our RG and equity momentum have been joined at the hip and the current message is to expect a rebound in the latter. Chart 1Heed The Reflation Message Heed The Reflation Message Heed The Reflation Message The latest ISM manufacturing survey also corroborates the signal from our RG. The jump in the ISM new orders-to-inventories ratio underscores that the rebound in stocks has further to run (bottom panel, Chart 1). Granted, a lot rests on EPS and in order for stocks to propel to fresh all-time highs later this year, as we expect, profits will have to deliver. On that front, despite recent steep downward EPS revisions across the board, we believe the level of quarterly EPS will hit fresh all-time highs in the back half of the year, carrying stocks into uncharted territory (Chart 2). As a reminder, BCA’s view remains that the U.S. will avoid recession in 2019. Chart 2Joined At The Hip Joined At The Hip Joined At The Hip One key profit driver that has put pressure on recent earnings releases and will continue to weigh on internationally-exposed P&Ls is the greenback. With a delayed effect, the first two quarters of this year should bear the brunt of last year’s steep U.S. dollar climb, but that effect will reverse in the back half of 2019. Not only is the greenback inversely correlated with the SPX, but also with the global manufacturing PMI (trade-weighted U.S. dollar shown inverted and advanced, Chart 3). Chart 3Dollar The Reflator... Dollar The Reflator... Dollar The Reflator... Thus, the greenback is a key macro variable that we are closely monitoring. On that front, global U.S. dollar based liquidity is one of the most important determinants/drivers of global growth. The longer U.S. dollar liquidity gets drained, the more downward pressure it will put on SPX momentum and SPX EPS (Chart 4). Once U.S. dollar based liquidity starts to get replenished at the margin, it can serve as a catalyst for a global growth recovery. A Fed tightening cycle pause and recent acknowledgment that the balance sheet asset roll off is important and the Fed stands ready to tweak it, are a net positive for at least a trough in global U.S. dollar liquidity. Chart 4...But Watch Global Dollar Liquidity ...But Watch Global Dollar Liquidity ...But Watch Global Dollar Liquidity Adding it up, the path of least resistance is higher for the broad equity market on the back of a reflationary impulse and a less dogmatic Fed. Now that the SPX forward EPS bar has been lowered to the ground, upward surprises loom, especially if the third catalyst we have been highlighting in recent research materializes: a positive resolution to the U.S./China trade spat.3 This week we make a couple of subsurface changes to a defensive sector; these changes do not alter our recommended benchmark allocation to the overall sector. Biotech’s Gain Is... Biotech stocks have been the center of attention recently as the BMY/CELG deal put the whole sector in play, and today we are boosting exposure to overweight in the S&P biotech index. We doubt the merger mania is over and we continue to believe that more mega deals are in store, either intra or inter-industry, with Big Pharma hungry and in a hurry to replenish their drug pipeline. While this is not the sole reason for an above benchmark allocation, 50-60% M&A deal premia are a boon for investors (Chart 5). Chart 5M&A Frenzy M&A Frenzy M&A Frenzy From a long-term macro perspective biotech stocks have been the primary beneficiaries of the 35-year bond bull market. In other words, the multi-decade grind lower in the U.S. Treasury yield has been synonymous with biotech outperformance (10-year U.S. Treasury yield shown inverted, Chart 6). Chart 6Biotech Equities And Rates Move In Opposite Direction Biotech Equities And Rates Move In Opposite Direction Biotech Equities And Rates Move In Opposite Direction The Fed’s recent monetary policy U-turn is a welcome development and these high growth stocks will benefit from the 55bps fall in the 10-year Treasury yield since the early-November peak. In addition, another macro tailwind is working in the S&P biotech index’s favor. The resurgent U.S. credit impulse is unambiguously bullish for this health care index that excels when margin debt availability is rising and liquidity is plentiful (bottom panel, Chart 7). Chart 7Revving Credit Impulse Says Buy Biotech Stocks Revving Credit Impulse Says Buy Biotech Stocks Revving Credit Impulse Says Buy Biotech Stocks Surprisingly, the sell-side community does not share our enthusiasm on any of these positive catalysts. Relative profit growth is forecast to be nil in the next year. In the coming five years, biotech stocks are expected to trail the overall market’s profit growth by 4%/annum (middle panel, Chart 8). This is extremely pessimistic and a first in the 24-year history of the I/B/E/S data set, and it is contrarily positive. Relative revenue growth forecasts are also grim for the upcoming 12 months and both revenue and profit forecasts present low hurdles to overcome (fourth panel, Chart 8). Chart 8Analysts Have Thrown In The Towel Analysts Have Thrown In The Towel Analysts Have Thrown In The Towel With regard to technicals and valuations, investors are doubtful that biotech stocks can stage a playable turnaround. Cyclical momentum remains moribund, printing below the zero line. Meanwhile, the S&P biotech index trades at a 25% discount to the SPX forward P/E and well below the historical mean (second & bottom panels, Chart 8). Chart 9 shows that biotech stocks are also cheap on a relative dividend yield basis. The S&P biotech index has been so oversold that it now sports a dividend yield higher than the S&P 500. Nevertheless, there is one key risk we are closely monitoring. Biotech initial public offerings are at all-time highs, with private equity and venture capital funds rushing for the exit doors. This is worrisome as it offsets the supply reduction owing to the M&A fever and has historically coincided with biotech relative share price peaks (Chart 10). Chart 9Compelling Relative Value Compelling Relative Value Compelling Relative Value Chart 10Watch This Risk Watch This Risk Watch This Risk Netting it all out, the recent M&A fever, a less dogmatic Fed that has suppressed the 10-year Treasury yield and a pick up in the U.S. credit impulse can serve as catalysts to unlock excellent value in the S&P biotech index. Bottom Line: Boost the S&P biotech index to overweight today. The ticker symbols for the stocks in this index are: BLBG: S5BIOT – ABBV, AMGN, GILD, BIIB, CELG, VRTX, REGN, ALXN, INCY. …Pharma’s Pain In mid-2017 we went underweight the S&P pharma index and booked healthy gains roughly a year later when we lifted exposure to neutral. Since then, Big Pharma has enjoyed a reprieve on the back of congressional inaction and the fact that the Trump Administration’s drug pricing wrath was less severe than initially feared. However, the time has come to trim the S&P pharma index to underweight. Chart 11 shows that pharmaceutical companies have been nearly uninterruptedly raising prices for the past four decades. Higher selling prices have been synonymous with higher profits and thus higher share prices. Chart 11Margin Trouble Margin Trouble Margin Trouble But, something happened in the new millennium. Relative performance peaked as pharma embarked on a mega M&A boom in the late-1990s with the Pfizer/Warner Lambert deal breaking all-time industry M&A records. Why? Because profit margins crested and have never reclaimed their previous zenith (top and middle panels, Chart 11). Neither have relative share prices. Worryingly, pharma prices have hit a wall during the past four years and can barely keep up with overall inflation, despite still being opaque (bottom panel, Chart 11). As both Democrats and Republicans are united to bring down health care costs in general and drug prices in particular, pharma profits will likely suffer a secular downdraft. The implication is that, as pharma revenues erode they will deal a blow to profits. Consequently, the outlook for relative share prices is dim. Importantly, pharma executives have not been frugal enough to offset the soft pricing power backdrop. Headcount has been expanding consistently since 2012 and a wide gap has opened up relative to industry selling price inflation, akin to the one in the mid-2000s that suppressed relative share prices (Chart 12). Chart 12Pricing Power Pressure Pricing Power Pressure Pricing Power Pressure Similar to the M&A boom of the late-1990s, there has been a global pharma M&A race with multiple deal announcements in the past few months, underscoring that the industry is not standing still. As Big Pharma CEOs compete to outdo their peers and buy drug pipelines mostly in the biotech space (Chart 5), they will continue to degrade the industry balance sheet (third panel, Chart 12). Our strategy is to overweight the hunted (biotech) and avoid the hunters (Big Pharma). On the operating front, a supply check reveals that pharma wholesale and manufacturing inventories are growing, whereas shipments are on the verge of contraction. Pharma industrial production has petered out and industry productivity gains are waning (Chart 13). This deteriorating operating backdrop will weigh on relative profits. Chart 13Deteriorating Operating Metrics... Deteriorating Operating Metrics... Deteriorating Operating Metrics... With regard to the macro front, a vibrant U.S. economy – with the ISM manufacturing survey ticking higher and the labor market firing on all cylinders – suggests that defensive pharma relative profits will resume their downtrend (bottom panel, Chart 13). Tack on the U.S. dollar’s reversal since the November peak and defensive pharma equities will remain under pressure (second panel, Chart 14). Chart 14...But EPS Bar Is On The Floor ...But EPS Bar Is On The Floor ...But EPS Bar Is On The Floor Nevertheless, there are three risks to our negative S&P pharma view. First, the M&A fever dies down and there are no additional purchases of biotech outfits. Second, Congress and the President drag their feet and fail to agree on new hawkish pharma pricing legislation. Finally, sell-side analysts have thrown in the towel and maybe most of the bad news is reflected in bombed out relative profit and sales growth estimates (third & fourth panels, Chart 14). In sum, a profit margin squeeze on the back of soft pharma pricing power, weak operating conditions and a race to buy out biotech stocks to build up drug pipelines warn that the derating phase (bottom panel, Chart 14) has just began for the S&P pharma index. Downgrade to underweight. Bottom Line: Trim the S&P pharma index to underweight. The ticker symbols for the stocks in this index are: BLBG: S5PHAR – JNJ, PFE, MRK, LLY, BMY, ZTS, AGN, MYL, NKTR, PRGO. Health Care Remains In The Neutral Column Despite these two subsurface health care sector moves, our overall exposure to the S&P health care sector remains intact at neutral. Please look forward to reading our upcoming research where we will be updating the S&P managed health care, S&P health care facilities and S&P health care equipment subsectors.   Anastasios Avgeriou, Vice President U.S. Equity Strategy anastasios@bcaresearch.com Footnotes 1      Please see BCA U.S. Equity Strategy Weekly Report, “Trader’s Paradise” dated January 28, 2019, available at uses.bcaresearch.com. 2      Please see BCA U.S. Equity Strategy Insight Report, “Don’t Bet On A Retest” dated January 18, 2019, available at uses.bcaresearch.com. 3      Please see BCA U.S. Equity Strategy Weekly Report, “Dissecting 2019 Earnings” dated January 22, 2019, available at uses.bcaresearch.com. Current Recommendations Current Trades Size And Style Views Favor value over growth Favor large over small caps