Pharmacy & Therapeutics - November 2008 - (Page 624)

EDITORIAL Moody’s Musings David B. Nash, MD, MBA S urprise! I bet you thought Moody’s Investors Service rated only bonds and other arcane Wall Street instruments. In fact, Moody’s also evaluates specific sectors of our economy and renders its famous score on a host of individual pharmaceutical companies. I think you’ll find my quick review of Moody’s outlook on the U.S. drug industry to be of interest.1 It should come as no shock to us that Moody’s says, “The outlook for the U.S. pharmaceutical industr y is negative. This outlook expresses Moody’s expectations for the fundamental credit conditions in the industr y over the next 12–18 months.”1 What’s behind this gloomy point of view? I would like to explain the reasons and then discuss some future trends. Moody’s has actually maintained this opinion of our nation’s pharmaceutical sector since October 2007. Moody’s believes that the industry is now in a period of unprecedented uncertainty—the result of several factors, such as the expiration of patents in the next four years, hurdles facing the Food and Drug Administration (FDA), rising pressure from shareholders, merger and acquisition activity, and the potential for more radical shifts in the business model. I was surprised to learn that Moody’s gives individual ratings to individual global companies within the pharmaceutical sector. These ratings look a lot like the service’s famous bond ratings; in this case, they range from Aa to B3. For instance, Johnson & Johnson gets the highest rating (Aa), but Elan gets the lowest (B3). Remember, these ratings are only for major branded pharmaceutical companies throughout the world. I found it interesting that Moody’s went out of its way to cite formularies as a significant factor in the unfavorable ranking for the industr y. The ser vice cites the launch of several drugs that have performed below market expectations, in part because of formulary restrictions adopted by managed care organizations. I was ambivalent about this aspect of the report, in that I was pleased to see that formularies were indeed a part of the conversation but disappointed that Moody’s decided to cite the actions made in regard to the formularies as a negative component affecting this sector. Another surprise was Moody’s mention that although the current state of the industry is generally characterized by strong balance sheets and high levels of cash and investments relative to debt, much of this cash has accumulated in off-shore locations. Moody’s believes that this migration of cash to sites outside the U.S. is a detrimental phenomenon. In the past several years, cash needs in the U.S. (i.e., dividends, repurchases, acqui- Moody’s believes that the [pharmaceutical] industry is now in a period of unprecedented uncertainty. sitions of U.S.-based companies) “have depleted U.S. cash levels while cash has accumulated off-shore.” Therefore, even though cash and investment holdings have grown, the amount considered to be based in the U.S. has rapidly decreased. What about the future? Moody’s envisions more mergers between large drug companies, possibly resulting in a potential significant upheaval. One reason is that similar molecules in the drug pipeline have been developed by multiple companies. Examples include dipeptidyl peptidase–IV (DPP-IV) inhibitors and glucagon-like peptide (GLP)–inhibitors for diabetes, factor X inhibitors for thrombosis, and cannabinoid receptor agonists for obesity. Given the significant research and development costs to achieve the FDA’s approval, followed by the substantial cost involved in marketing new products, Moody’s believes that these pipelines may prove a strong impetus for future mergers among current global giants. The final “Moody’s Musings,” which the service contends will be monitored closely, include areas such as the divestiture of nonpharmaceutical assets currently held by global companies, the ability of the industr y to prepare for upcoming patent expirations, the effect of legislative changes, the way in which the companies deploy large amounts of offshore cash, and the extent to which the companies balance shareholder-friendly strategies with a desire to maintain high credit ratings. There is no question that the pharmaceutical industry is facing many challenges these days, and it is helpful to read experts’ evaluations whenever possible. I wouldn’t make a personal investment decision based on information solely from Moody’s, but its authors’ considerations are clearly important. As always, I am interested in your views. You can reach me at my e-mail address, david.nash@jefferson.edu. I also hope you will visit my blog at http:// departmentofhealthpolicy.blogspot.com. REFERENCE 1. Levesque M, Lee D, Chrysostomou C, et al. Moody’s musings. New York: Moody’s Investors Service; May 2008; 109201:13. I 624 P&T® • November 2008 • Vol. 33 No. 11 http://departmentofhealthpolicy.blogspot.com http://departmentofhealthpolicy.blogspot.com

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - November 2008

Pharmacy & Therapeutics - November 2008 Contents Editorial Medication Errors Prescription: Washington New Drugs/Drug News/New Medical Devices Drug Forecast Heparin-Induced Thrombocytopenia Medication Utilization Patterns and Hypertension-Related Expenditures among Patients Who Were Switched From Fixed-Dose to Free-Combination Antihypertensive Therapy European Society for Medical Oncology and Association for the Study of Bone and Mineral Research Pharmaceutical Approval Update

Pharmacy & Therapeutics - November 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.