Search This Blog

Sunday, December 1, 2019

Private-Equity Cash Piles Up as Takeover Targets Get Pricier

U.S. private-equity firms, armed with a record amount of cash, are struggling to find ways to spend it.
A year ago, fears of an economic slowdown and worries about trade tensions with China sent a tremor through markets and put some leveraged buyouts on hold. But while stocks rebounded in the new year, buyout activity never fully recovered.
The aggregate value of U.S. buyouts fell 25% year to date through October, compared with the same period a year earlier, according to data provider Preqin. Deals totaled $155.2 billion during the first 10 months of the year — the lowest since 2014.
Private-equity firms traditionally seek to buy up companies they see as undervalued, cut costs or spruce them up to spur growth and sell them or take them public a few years later. With U.S. equity markets surging, already expensive takeover candidates have gotten even pricier, making many of them too rich for even the most optimistic private-equity buyer. Meanwhile, would-be corporate acquirers whose stock prices have run up this year can use their shares as a deal currency, giving them an edge over financial buyers in most auction processes.
The restraint buyout firms are showing suggests a level of discipline that wasn’t present during the last market peak in 2007, when they struck $365.9 billion worth of deals in the U.S. Many of the companies they bought then struggled during the ensuing global financial crisis, and a number have filed for bankruptcy protection.
The drop in deal activity comes as private-equity firms’ unspent cash dedicated to North American buyouts reaches a record $771.5 billion, up nearly 24% since the end of last year and more than double where it stood at the end of 2014, Preqin data show.
A potential buyout of Walgreens Boots Alliance Inc. that KKR & Co. had considered in recent months shows some of the challenges facing private-equity firms. Financing such a deal would always have been tough given Walgreens’ market value of more than $50 billion, but the math has become even more difficult as loan buyers have begun pushing back on what terms they are willing to accept. The parties haven’t been in the same ballpark on valuation, and no deal appears imminent, people familiar with the matter said.
Investors such as pension funds, sovereign-wealth funds and insurance companies have poured money into private markets in hopes of achieving higher returns than those offered by traditional stocks and bonds in an era of low interest rates. Private-equity firms will need to invest that money to satisfy their investors and to begin earning lucrative management fees on it.
U.S. buyout volume may not bounce back next year either, even if the stock market cools off. With an election looming, private-equity investors say uncertainty around monetary, fiscal and regulatory policy — as well as already heightened scrutiny of their industry from Democratic presidential candidates — will cause them to tread carefully.
Some firms have found unique ways to navigate high prices. Blackstone Group Inc. has focused its deal making around investment themes where it is particularly bullish. These include the growth of e-commerce, which has driven its massive purchases of warehouse portfolios, and the ongoing value of live entertainment as more activities move online, motivating its deal for theme-park operator Great Wolf Resorts Inc. Apollo Global Management Inc. has been buying public companies it thinks the market has undervalued by favoring those with faster growth.
Not all areas of the buyout market have slowed. Globally, deal volume is pacing roughly where it was last year. And certain pockets of the U.S. market remain robust. Firms that invest in business software, for example, have kept up their deal-making pace, thanks in part to the proliferation of targets.
“In our space, given that many companies lack profitability, they can be highly volatile,” Orlando Bravo, founder and managing partner of software-focused firm Thoma Bravo LLC said in an interview. “So when their revenue growth slows or they miss numbers, that can provide opportunities.”
The buyout malaise has spread to banks, whose revenue from leveraged finance fell nearly 19% year over year in the first three quarters of the year, according to Dealogic. New issuance of leveraged loans — commonly used to finance buyouts — have tumbled. High-yield bond issuance, another source of deal financing, has climbed, but bankers say much of that has been driven by less remunerative refinancing activity.
Making things more difficult for private-equity firms, the financing market has tightened in recent months. As interest rates have fallen, there have been big outflows from mutual funds that purchase buyout loans that banks carve up and sell. That has made deal financing more dependent on collateralized loan obligations, or CLOs — complex vehicles that buy bundles of below-investment-grade corporate loans.
CLOs, which have historically constituted about 60% to 65% of the market for buyout loans, now represent 72% of the allocations for newly issued leveraged loans, according to a recent report by analysts at Goldman Sachs Group Inc. Creation of new CLOs is also trailing 2018 by 9.5%, the analysts wrote.
That becomes an issue because CLOs, which are typically issued by the credit arms of private-equity firms and banks, have limits on the number of low-rated loans they can own. After years of steadily filling up their tanks with buyout loans, they are now pushing back on the loose credit agreements and borrower friendly terms they once accepted amid worries about rising loan downgrades.
In some cases, that has left banks holding the bag and has raised borrowing costs for private-equity firms, forcing them to lower their return expectations for deals.
Banks in October struggled to sell about $2 billion in debt to fund Apollo’s purchase of online-photo service Shutterfly Inc. and ended up agreeing to buy up to $280 million themselves, The Wall Street Journal reported.

How Big-Box Retailers Can Revitalize Rural Health Care

There’s a surefire, and perhaps unlikely, way to bolster access to health care for underserved Americans—at the shopping mall.
Millions of Americans struggle to get affordable, timely medical care. Roughly one-quarter of rural Americans haven’t been able to get needed care at some point in recent years, according to a May 2019 poll conducted by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health.
Retailers can help overcome these barriers. In many rural communities, the local Walmart or CVS is not just an economic anchor but a civic institution. It’s a gathering place for far-flung residents. And it may be the most convenient place for historically underserved populations to seek health care.
Adding telehealth capabilities to our existing retail infrastructure could significantly expand access to top-notch care—and reduce costs for patients and the healthcare system.

Retail health clinics—low-cost health providers capable of treating minor ailments like fevers, colds, rashes, strep throat, and the like—have proliferated across the country. From 2006 to 2017, the number of clinics jumped from just 350 to 2,800.
It’s easy to see why. For one, they’re less expensive than conventional healthcare facilities. A retail clinic visit is about 30% to 40% cheaper than a trip to the doctor, according to research conducted by a professor at Harvard. It’s 80% less expensive than going to the emergency room.
Consider those savings in real dollars. In Massachusetts, an average visit to a retail health clinic costs just $69—about $830 less than the average ER visit.
What’s more, retail clinics typically publish their prices upfront. So patients can shop around. And they won’t be hit with surprise medical bills.
Retail clinics are convenient, too. They tend to be near where people conduct routine errands. They certainly offer longer hours than the typical doctor’s office. Most don’t require appointments. Indeed, about half of people cited “hours were more convenient,” “no need to make appointment,” and “location was more convenient” as major reasons they chose a retail health clinic in a recent survey from the Robert Wood Johnson Foundation.
There’s still a tremendous potential market for retail clinics. Consider the sheer number of potential locations. Kroger has more than 4,000 stores nationwide. Walmart has nearly 5,000. CVS Health has about 10,000.
Yet Walmart currently runs clinics in just three states. CVS’s MinuteClinic brand operates in about 1,100 locations.
If even a fraction of these stores added health clinics, millions of Americans would be able to access care more easily. After all, 90% of the country lives within a 15 minute drive of a Walmart.
The need for more healthcare infrastructure is certainly acute. Nearly 80 million people live in federally designated Health Professional Shortage Areas. Many of those areas are rural.
Adding telehealth capabilities to a more robust network of retail clinics would maximize their impact. Previously isolated patients could head to their local big-box retailer to connect with top-flight specialists miles away via videoconference. Clinics could even outfit patients with devices to monitor vital signs remotely—and then transmit the data back to their distant specialists.
Fortunately, retail clinics are starting to incorporate telehealth in their offerings. Rite Aid, for example, is installing kiosks in its clinics that connect patients with remote care. With the help of a medical assistant, the kiosk records patients’ vital signs and answers to a medical survey. Then, the patient is connected to a remote physician, who develops a treatment strategy.
CVS is enabling patients to get treatment for minor illnesses, injuries, or skin conditions from their homes. Using the CVS Pharmacy app, patients can connect to a provider in their state via video at any time of the day.
Deploying the latest telehealth technology across our existing retail infrastructure could cost-effectively address the healthcare gaps that afflict rural and other underserved communities.

Biotech week ahead, Dec. 2

Biotech stocks advanced in the holiday-shortened week, with upside driven mainly by the broader market strength. Reflecting the extreme volatility in the space, a few stocks gyrated wildly in reaction to catalytic events.
ChemoCentryx Inc CCXI 1.92% nearly tripled in a single session in reaction to positive Phase 3 data for drug to treat rare inflammatory disease.
Invest in IPO shares before the stock hits the market with ClickIPO. Check it out here
The Medicines Company MDCO 0.18% was another standout gainer, adding about 22% Monday, on a deal to be bought by Novartis AG NVS 0.29%.
Here are the key catalysts for the unfolding week.

Conferences

  • International Alliance of Amyotrophic Lateral Sclerosis/Motor Neurone Disease, or ALS/MND, Annual Meeting – Dec. 1-2 in Perth, Australia
  • 34th World Cardiology Conference – Dec. 2-3 in Barcelona, Spain
  • Annual Congress on Antibiotics and Antimicrobial Resistance – Dec. 2-3 in Paris, France
  • 6th Annual Conference on Stroke and Neurological Disorders – Dec. 2-3 in Rome, Italy
  • 10th International Conference on Immunology & Immunogenetics – Dec. 2-3 in London
  • 12th Clinical Trials On Alzheimer’s Disease, or CTAD – Dec. 4-7 in San Diego, California
  • Piper Jaffray 31st Annual Healthcare Conference – Dec. 3-5 in New York City
  • Evercore ISI HealthCONx Conference – Dec. 3-5 in Boston, Massachusetts
  • 2nd Global Conference on Cardiovascular Research and Clinical Cardiology – Dec. 6-7 in Montreal, Canada
  • American Epilepsy Society, or AES, 2019 Annual Meeting – Dec. 6-10 in Baltimore, Maryland
  • 61st American Society of Hematology, or ASH, Annual Meeting – Dec. 7-10 in Orlando, Florida

PDUFA Dates

The FDA is scheduled to give its verdict on Roche Holdings AG Basel ADR’s RHHBY 0.05% Tecentriq in combination with Bristol-Myers Squibb Co’s BMY 1.16% chemo medications Carboplatin and Abraxane in patients with metastatic non-squamous NSCLC, who do not have EGFR or ALK genomic tumor aberrations. The PDUFA action date is fixed for Monday.

Clinical Readouts

CTAD Presentations

ACADIA Pharmaceuticals Inc. ACAD 3.64% – detailed Phase 3 data for pimavanserin in dementia-related psychosis (Wednesday)
Biogen Inc BIIB 1.17% – Detailed data from the Phase 3 EMERGE study of aducanumab in Alzheimer’s disease (Thursday)
Cassava Sciences Inc SAVA 2.78% – Phase 2a data for PTI-125 in Alzheimer’s disease (Thursday)
Alector Inc ALEC 1.48% – Phase 1 data for AL002, a monoclonal antibody, in Alzheimer’s disease (Friday)

International Alliance of ALS/MND Annual Meeting Presentations

Cytokinetics, Inc. CYTK 1.04% – Responder and subgroup analyses of data from the Phase 2 study of Reldesemtiv in ALS (Thursday)

AES Annual Meeting Presentations

GW Pharmaceuticals PLC- ADR GWPH 1.67% – Phase 3 data for Epidiolex in tuberous sclerosis leukemia (Saturday)

ASH Presentations

(Scheduled for Saturday)
Magenta Therapeutics Inc MGTA 0.53% – initial Phase 1 data for MGTA-145 in healthy volunteers
Bristol-Myers Squibb – Phase 1 data for liso-cel, or JCAR017, in relapsed/refractory B cell non-Hodgkin lymphoma
Fortress Biotech FBIO 4.57% and Mustang Bio Inc MBIO 9.69% – Phase 1/2 data for MB-107 in X-linked severe combined immunodeficiency
Sierra Oncology Inc (NASDAQ: SRRA – Phase 3 data for momelotinib in myelofibrosis
Actinium Pharmaceuticals Inc ATNM 17.9% – Phase 3 data for lomab-B in acute myeloid luekemia
bluebird bio Inc BLUE 0.86% – Phase 1/2 data for LentiGlobin in sickle cell disease
Morphosys Ag MOR 0.2% – Phase 2 data for MOR208 and Gilead Sciences, Inc. GILD 0.18%‘s Zydelig in chronic lymphocytic leukemia Unum Therapeutics Inc UMRX 0.75% – Phase 1 data for ACTR707 with Roche’s Rituxan in CD20 positive non-Hodgkin lymphoma and Phase 1 data for ACTR087 plus Rituxan, also in non-Hodgkin lymphoma
Verastem Inc VSTM 3.79% – Phase 2 data for duvelisib in peripheral T-cell lymphoma
Autolus Therapeutics Ltd – ADR AUTL 4.97% – interim Phase 1 data for AUTO3 in relapsed/refractory diffuse large B-cell lymphoma and updated Phase 1 data for AUT01 in acute lymphoblastic leukemia
TrovaGene Inc TROV 1.42% – Phase 1/2 data for ovansertib in acute myeloid leukemia
Cyclacel Pharmaceuticals Inc CYCC 3.77% – initial Phase 1 data for CYC065 plus AbbVie Inc ABBV 0.66%‘s venetoclax in chronic lymphocytic leukemia
Oncternal Therapeutics Inc ONCT 6.67% – Phase 1/2 data for cirmtuzumab plus AbbVie’s ibrutinib in chronic lymphocytic leukemia and mantle cell lymphona
Sangamo Therapeutics Inc SGMO 0.37% – Phase 1/2 data for SB-525 in hemophilia A
Acceleron Pharma Inc XLRN 1.05% and Bristol-Myers Squibb – Phase 2 data for luspatercept in hemophilia A

IPO Quiet Period Expirations

Centogene N.V./EQ CNTG 2.82%
Galera Therapeutics Inc GRTX 0.32%
TELA Bio Inc TELA 15.19%
CNS Pharmaceuticals Inc CNSP 1.2%
89bio Inc ETNB 3.82%

Cost-saving NHS plan will ‘ration’ tests and treatments for millions

The NHS is planning to “ration” dozens of common tests and treatments which will impact millions of people in England.
The health organisation has prepared a list of 34 tests and treatments which patients in England will only be granted access to in rare circumstances if plans go ahead, the Guardian reported .
Millions of patients will no longer be permitted to have X-rays on their sore backs, hernia repair surgeries pr scans of their knees to detect arthritis under the new controversial NHS plans which will see doctors ration “unnecessary” treatment.
Future patients in England will only be allowed access to these tests in exceptional circumstances.
If the plan is implemented, it will represent an unprecedented restriction of patient’s access to procedures.
The NHS scheme would also see patients advised to use physiotherapy or painkillers to dull the pain of an arthritic knee rather than undergo an exploratory operation called an arthroscopy.
Other types of surgery including some CT and MRI scans and some blood tests are also on the list.
Millions of patients could be impacted by the clampdown on 34 diagnostic tests (Image: Getty Images)
An NHS spokesman told the Guardian the plan had not been approved or implement, adding there was “strong support from senior doctors in the Academy of Medical Royal Colleges for action to eliminate wasteful interventions that don’t benefit patients”.
Rachel Power of the Patients Association said the plan, if implemented, could lead to patients having to suffer the pain of their condition or pay for private health remedies.
She said a range of NHS treatments had been cut back in recent years.

Ms Power said: “Often there are good reasons for not using these ‘low-value’ treatments as a first choice, but they are appropriate for some patients.
“We are unhappy at any new barriers being erected between patients and the treatments they need.”
Some blood tests could be rationed as part of new NHS cost-cutting plans (Image: Getty Images)
    The 50-page NHS plan is the result of months of detailed secret discussion but has now been revealed.
    Many medical professionals believe these interventions should be scrapped or used sparingly, because they can put patients in danger or make them anxious.
    The four medical bodies were reportedly prepared to publish proposals this month but were forced to delay in accordance with purdah rules.

    UPS employees busted in massive drug scheme

    A group of UPS (NYSE:UPS) employees allegedly helped to import and traffic massive amounts of drugs and counterfeit vaping oils from Mexico during the past decade, the Washington Post reports.
    The scheme exploited a vulnerability in the company’s distribution system, according to police, and at times involved moving thousands of pounds of marijuana and narcotics each week.
    Standard cardboard boxes were carefully routed through UPS’s trucking and delivery systems, and obscured the origin and destination of drug shipments.

    Saturday, November 30, 2019

    New York City is a hot spot for illegal Medicaid enrollment

    New York state is grappling with a Medicaid shortfall in the billions of dollars. And one of the main reasons is improper enrollment.
    Using annual information from the Census Bureau to assess the demographic make-up of Medicaid enrollees over time, researcher Aaron Yelowitz and I estimated that 2.3 million to 3.3 million Medicaid enrollees nationally make an income in excess of what is allowed.
    This is of increasing importance given that ObamaCare massively expanded what was historically a welfare program for vulnerable populations like the disabled and low-income children and pregnant women — and tens of billions of taxpayer dollars are at stake.
    Excluding traditional pathways onto Medicaid (such as through disability or pregnancy), Yelowitz and I concluded that the number of working-age New York state residents on Medicaid who have incomes above the eligibility threshold rose by more than 80 percent between 2012 and 2017. We estimated that between 337,000 and 433,000 working-age New York state residents with income above the allowed limit are improperly enrolled in Medicaid.
    And nearly half of this improper enrollment is in New York City, with 30 percent in The Bronx and Queens, where a few neighborhoods have among the highest percentage of improper enrollees of anywhere in the country.
    In The Bronx, particularly the Concourse, Highbridge and Mount Eden regions, we found that roughly 40 percent of all working-age adults with incomes exceeding income eligibility thresholds were enrolled in Medicaid in 2017. The next-worst area is in Queens — the Elmhurst/South Corona, Jackson Heights/North Corona and Sunnyside/Woodside regions. In those areas, there are likely tens of thousands of ineligible Medicaid enrollees.
    ObamaCare deserves much of the blame for the surge in improper enrollment. It created a new category of Medicaid recipients — lower-income, able-bodied, working-age adults — with the federal government paying a much larger share of their expenses than for traditional enrollees.
    From 2013 — the year before ObamaCare’s Medicaid expansion took effect — to 2018, there has been a surge of Medicaid payments out of compliance with legal criteria. In fact, improper Medicaid payments more than tripled.
    While states bear some of the burden for improper spending, most of the bill is picked up by the federal government. We estimated that improper payments now exceed 20 percent of federal Medicaid expenditures, an amount above $75 billion each year.
    As a result of ObamaCare’s more generous Medicaid funding, many states — including New York — have stopped properly assessing whether applicants are eligible before they enroll.
    While the health-care industry, particularly insurance companies, has benefitted from ObamaCare’s windfall of federal cash and improper Medicaid enrollment, traditional enrollees face a harder time obtaining care — and taxpayers are stuck with an enormous tab.
    ‘We estimated that improper payments now exceed 20 percent of federal Medicaid expenditures, an amount above $75 billion each year’
    The inspector general at the federal Department of Health and Human Services found substantial problems with New York state’s process for reviewing Medicaid eligibility. The state made large numbers of errors and did not always maintain documentation. An audit of the entire state’s program found 15 percent of applicants improperly enrolled. The size of the error was staggering, with the inspector general estimating that New York state improperly claimed more than $1.8 billion in a six-month period on behalf of more than 900,000 ineligible enrollees or people who were enrolled without having submitted all the proper documentation.
    In order to get a handle on its budget crisis, New York should conduct targeted eligibility reviews in The Bronx and Queens. If the state doesn’t act, the federal government must step in and require eligibility reviews in these hot spots and others around the country. Some level of government owes it to taxpayers and to those who are truly eligible to get enrollment right.
    Brian Blase, a special assistant to President Trump at the National Economic Council from 2017-19, is president of Blase Policy Strategies. Aaron Yelowitz is an economics professor at the University of Kentucky and a senior fellow at the Cato Institute. They are co-authors of the new Mercatus Center study, “The ACA’s Medicaid Expansion: A Review of Ineligible Enrollees and Improper Payments.”

    People on Medicare due to disability make up most opioid-linked deaths

    New findings from The University of Texas Medical Branch at Galveston show that patients qualifying for Medicare because of a disability have the highest rates of opioid overdose deaths compared with older Medicare beneficiaries and commercial insurance beneficiaries. The findings are now available in JAMA Network Open. The study, led by Yong-Fang Kuo, UTMB professor in the department of preventive medicine and population health, found that Medicare beneficiaries who qualify because of a disability are a growing group of patients hospitalized for opioid or heroin overdose and account for 25 percent of deaths from prescription opioid overdose each year. Previous research shows that not many of these patients make use of opioid treatment programs.
    In the study, the researchers analyzed a nationally representative sample of Medicare data, including 1,766,790 people who qualified for Medicare because of a disability to assess the rate of opioid overdose deaths and identify its associated risk factors. Although these disability patients account for only 14.9 percent of the entire Medicare population, they were also found to represent 81 percent of all opioid-related deaths among this group.
    “We found that among the patients who have Medicare because of disability, the rates of opioid overdose deaths were higher among people who grapple with substance misuse, psychiatric diseases or chronic pain,” said senior author Kuo of UTMB.
    “Right now, there’s a large federal push to increase access to opioid misuse treatment programs and these efforts work more effectively with accurate targeting of high-risk populations. Our findings suggest that Medicare data can help to identify people who can really benefit from these programs.”
    ###
    Other authors include UTMB’s Mukaila Raji and James Goodwin.