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Healthcare & Life Sciences HEALTHCARE & LIFE SCIENCES INDUSTRY UPDATE │ DECEMBER 2015 www.harriswilliams.com Investment banking services are provided by Harris Williams LLC, a registered broker-dealer and member of FINRA and SIPC, and Harris Williams & Co. Ltd, which is authorised and regulated by the Financial Conduct Authority. Harris Williams & Co. is a trade name under which Harris Williams LLC and Harris Williams & Co. Ltd conduct business. 0 HEALTHCARE & LIFE SCIENCES INDUSTRY UPDATE │ DECEMBER 2015 WHAT WE’RE READING CONTENTS MEDICARE | MEASURING HOSPITAL READMISSIONS . PUBLIC MARKETS OVERVIEW Hospital readmission rates continue to be a key data point for measuring the . EQUITY MARKETS OVERVIEW success of healthcare reform. The Affordable Care Act, in an effort to curb costly . M&A OVERVIEW hospital stays, penalizes hospitals with too many readmissions within 30 days of an inpatient stay. As a result, providers and hospitals have implemented various . DEBT MARKETS OVERVIEW strategies to improve quality data and have largely been very successful as . HEALTHCARE & LIFE SCIENCES measured by readmission rates. However, experts have pointed out that so-called PUBLIC COMPARABLES observation stays are on the rise – and blurring the readmissions metrics utilized as . M&A TRANSACTIONS benchmarks for quality. Observation stays do not trigger penalties under the health law as they are considered outpatient visits. While not all short-term acute- care hospitals have reported a corresponding rise in readmissions rate, some 10% CONTACTS contributed 50% of the overall increase in observation stays from 2010 to 2013. Turner Bredrup While Medicare typically reimburses at a lower rate for observation stays Managing Director (theoretical benefit for taxpayers), the Medicare patients may face significant [email protected] copays and, worse yet, may be excluded from coverage in the case of certain +1 (804) 915-0110 referrals (e.g., nursing homes). Thus, so long as hospitals are incented to compare James Clark favorably vs. defined measurements, someone in the system will continue to bear Managing Director the cost. A link to the article can be found here. [email protected] +1 (804) 915-0119 Cheairs Porter Managing Director ACA EXCHANGES | UNITEDHEALTH CONSIDERS WALKING AWAY [email protected] +1 (804) 915-0130 The President’s administration suffered a major blow when UnitedHealth Group Geoff Smith delivered its Q3 earnings and lowered its full-year 2015 earnings estimates. Managing Director UnitedHealth cited nearly $425 million in losses from health plans sold on the [email protected] exchanges and notified investors it may exit the exchanges altogether by 2017. +1 (804) 915-0195 The company has already significantly curtailed its marketing for the current Open Andy Dixon Enrollment period. UnitedHealth did not participate in the first year of the Director exchanges and noted that its first enrollees over the course of the year were [email protected] “strong users of services” and sicker than expected. Not surprisingly, UnitedHealth +1 (415) 217-3419 has not been the only major insurance carrier to suffer the same fate on the exchanges. The risk that any of the major carriers exit the market altogether could Paul Hepper destroy the viability of the exchanges, particularly given the announced Director [email protected] consolidation in the health insurance marketplace. As a result, the Obama +1 (804) 932-1326 administration will need to find more suitable alternatives to protect the carriers beyond the existing three risk-mitigation programs. A link to the article can be Whit Knier found here. Director [email protected] +1 (804) 932-1321 M&A | TAX INVERSIONS Jacques Fu Vice President Mega deals between Medtronic/Covidien and Actavis/Allergan drew investor [email protected] (and government) attention to the opportunities set forth by tax inversion. In +1 (804) 915-0185 November, Pfizer announced a record-setting price for Allergan equal to Andy Hewlett approximately $160 billion. This marks not only the largest healthcare deal ever, Vice President but also one of the larger tax inversions in recent history. The net effect of [email protected] domiciling in Ireland is an estimated high single-digit reduction in the company’s +1 (415) 217-3427 adjusted tax rate. While politicians and the U.S. Treasury Department have Bill Kayser publicly stated their opposition to such transactions, the Pfizer/Allergan deal Vice President demonstrates their inability to create incentives (or disincentives) to remain [email protected] domiciled in the United States. The article goes on to note that this transaction +1 (804) 915-0180 tops a record setting M&A year, driven by mega deals. Subsequent to publishing, Dow Chemicals and DuPont announced a $130 billion merger of equals, capping Nick Owens Vice President off the year amidst market some market volatility. A link to the article can be found [email protected] here. +1 (804) 887-6027 www.harriswilliams.com PAGE | 1 HEALTHCARE & LIFE SCIENCES INDUSTRY UPDATE │ DECEMBER 2015 PUBLIC MARKETS OVERVIEW Key Trading Statistics (detail begins on page 6) Median TEV/ Median TEV/ Number of Aggregate Sector Enterprise Value Change in Stock Price LTM Multiples Forward Mulitples Companies ($ mm) 3 mos. 12 mos. Revenue EBITDA Revenue EBITDA Clinical Laboratories 3 $37,063 (0.8%) 16.2% 2.4x 11.7x 2.2x 10.5x Contract Pharma Manufacturing 2 6,252 11.5% 78.5% 3.7x 18.1x 3.6x 14.7x Contract Research Organizations 9 38,504 0.5% 22.4% 2.7x 14.3x 2.7x 13.2x Disease Management 2 8,022 (5.4%) (5.7%) 1.9x 13.7x 1.9x 12.6x Emergency Services 1 2,392 15.4% (1.5%) 2.3x 8.4x 2.2x 8.3x Healthcare Staffing 5 17,489 (7.8%) 51.9% 1.4x 14.0x 1.3x 12.3x HMO - Medical 10 307,440 (6.0%) 16.4% 0.8x 9.5x 0.7x 9.5x Services Information Services 13 42,309 5.2% 8.5% 4.8x 16.5x 4.5x 13.6x Specialty Managed Care 3 7,786 14.3% 26.5% 1.5x 12.9x 7.3x 5.4x Specialty Pharmacy 1 2,389 (12.2%) 30.8% 0.8x NM 0.9x NM Retail Pharmacy 3 247,472 (4.4%) 22.5% 0.9x 11.9x 0.8x 11.4x Payor, Provider, Support & Pharmacy Specialty Pharmacy Management 2 74,398 2.0% 29.4% 0.7x 10.3x 0.7x 10.0x Dental Products 3 120,976 12.7% 10.3% 3.5x 16.6x 3.5x 15.2x Durable Medical Equipment 3 14,050 12.9% 12.0% 2.7x 17.3x 2.0x 12.8x Life Sciences Tools 4 130,024 7.3% 3.3% 3.7x 16.6x 3.3x 13.2x Devices Medical Devices and Products 14 662,217 (0.3%) 5.3% 3.8x 14.7x 3.8x 13.8x Products &Products Medical / Surgical / Dental Supplies & Distribution 6 124,742 1.2% 7.0% 0.3x 12.0x 0.3x 10.1x Acute-Care Hospitals 4 103,985 (28.7%) (16.6%) 1.1x 7.8x 1.0x 7.4x Assisted Living 3 12,183 6.2% (18.4%) 2.5x 13.1x 2.1x 13.0x Diagnostic Imaging 3 9,084 (2.0%) (26.4%) 1.5x 8.8x 1.7x 9.2x Dialysis Services 2 56,535 5.1% 13.6% 1.8x 10.2x 1.8x 9.9x Home Care, Hospice, and Home Infusion 6 6,372 5.6% 49.9% 1.4x 13.1x 1.4x 12.5x Long-Term Care 3 6,559 0.8% 14.7% 1.0x 10.0x 0.8x 8.1x Physician Practice Management 2 8,006 (12.5%) 9.0% 3.0x 13.2x 2.9x 12.8x Behavioral Health / Management 6 27,221 (1.0%) 13.7% 1.5x 11.3x 1.4x 10.4x Provider-Based Services Provider-Based Surgicenters / Rehabilitation 5 18,965 (3.8%) 21.1% 2.1x 13.8x 2.0x 11.2x Payor, Provider, & Pharmacy Support Services 54 $791,516 (4.1%) 14.7% 1.3x 11.7x 1.3x 10.7x Products & Devices 30 $1,052,009 4.6% 1.3% 3.4x 13.7x 3.4x 12.8x Provider-Based Services 34 $248,911 (7.9%) 7.5% 1.9x 10.6x 1.8x 10.0x HW&Co. HCLS Composite Index 118 $2,092,436 0.6% 15.2% 2.5x 12.7x 2.5x 11.9x S&P 500 4.6% 0.6% Public Company Sector Performance (12-month % change in stock price) Contract Pharma Manufacturing Healthcare Staffing Home Care, Hospice, and Home Infusion Specialty Pharmacy Specialty Pharmacy Management HMO - Medical Retail Pharmacy Contract Research Organizations Surgicenters / Rehabilitation HMO - Medical Clinical Laboratories HW&Co. HCLS Composite Index Long-Term Care Behavioral Health / Management Dialysis Services Durable Medical Equipment Dental Products Physician Practice Management Information Services Medical / Surgical / Dental Supplies & Distribution Medical Devices and Products Life Sciences Tools S&P 500 Emergency Services Disease Management Acute-Care Hospitals Assisted Living Diagnostic Imaging (60.0%) (50.0%) (40.0%) (30.0%) (20.0%) (10.0%) 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% PAGE | 2 HEALTHCARE & LIFE SCIENCES INDUSTRY UPDATE │ DECEMBER 2015 EQUITY MARKETS OVERVIEW Healthcare & Life Sciences Industry Stock Performance 220% 200% 180% 178.4% 160% 159.5% 146.9% 140% 120% 100% 80% 60% 40% Nov-12 Feb-13 May-13 Aug-13 Nov-13 Feb-14 May-14 Aug-14 Nov-14 Feb-15 May-15 Aug-15 Nov-15 S&P 500 Dow Jones U.S. Health Care Index HW&Co. HCLS Index Top Equity Offerings (by proceeds) Closing Date Issuer Ticker Transaction Type Gross Proceeds ($ mm) 11/12/15 VWR Corp VWR Follow-On $328.9 11/25/15 Spark Therapeutics Inc ONCE Follow-On 175.0 11/03/15 Revance Therapeutics Inc RVNC Follow-On 134.6 11/10/15 Voyager Therapeutics Inc VYGR IPO 80.5 11/11/15 Loxo Oncology Inc LOXO Follow-On 74.2 11/04/15 Kura Oncology Inc KURO Follow-On 55.1 11/19/15 Axsome Therapeutics Inc AXSM IPO 51.0 11/06/15 Marinus Pharmaceuticals Inc MRNS Follow-On 30.3 11/06/15 Cancer Genetics Inc CGIX Follow-On 12.0 11/06/15 Rexahn Pharmaceuticals Inc RNN Follow-On 7.0 PAGE | 3 HEALTHCARE & LIFE SCIENCES INDUSTRY UPDATE │ DECEMBER 2015 M&A OVERVIEW Announced Healthcare & Life Sciences M&A QUARTERLY HEALTHCARE TRANSACTION M&A ACTIVITY HIGHLIGHTS 400 Announced Target Buyer 14 11/24/2015 Superior Vision Serv ices, Inc.
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