Goldman Sachs' Asad Haider likes the prospects for medical technology companies, mid-cap biotechs, drug distributors. By Josh Nathan-Kazis
Drug companies, health insurers, and hospital operators were thrust into the headlines in the past month, and not in a good way.
First came President-elect Donald Trump's unorthodox picks to run the government's public-health bureaucracy. Then came the startling cultural embrace of the alleged killer of a top UnitedHealth Group executive, which exposed the roiling popular discontent with the healthcare system.
As for healthcare stocks, they have gone begging for fans for several years now. In 2023, while the S&P 500 index returned 27.6%, the Health Care Select Sector SPDR exchange-traded fund returned just 2%. This year, the ETF has returned 4.5% so far, against a return of 29% for the S&P 500 index.
How long will the pain last for the industry and investors? Barron's recently sought answers from Asad Haider, head of the healthcare business unit within Global Investment Research at Goldman Sachs. Haider, who has been at Goldman since 2009, is a healthcare sector strategist with deep experience covering the industry. He shares his views on policy uncertainty, the future of healthcare merger activity, the outlook for weight-loss drugs, and more in the edited interview that follows.
Barron's : Healthcare stocks performed poorly for the past two years. Now President-elect Donald Trump has nominated Robert F. Kennedy Jr. as Health and Human Services secretary, potentially creating enormous uncertainties for the industry. How do you expect healthcare stocks to perform next year?
Asad Haider: Even though there has been a tremendous amount of airtime spent on policy uncertainty, that isn't the reason for the stocks' underperformance. Healthcare underperformed for nine straight weeks heading into the presidential election, for reasons that had nothing to do with RFK or Trump. Policy uncertainty has given general investors another reason to rotate out of, or abandon, the sector.
The real problem is that companies' fundamentals have been in question. Large swaths of the sector have had negative earnings revisions this year. That has to be your starting point in thinking about the healthcare outlook for next year.
What would need to go right for the stocks to outperform the S&P 500 in 2025?
Three things. No. 1, you would need a macro shock -- a hard landing or a recession -- which isn't our house view. If that were to happen, I expect there would be a mean-reversion trade that would make healthcare work.
No. 2, you would need to see some policy certainty. From where we sit today, we are making a meal out of morsels of information. Just as we all became armchair epidemiologists during the Covid pandemic, all the healthcare specialists I talk to have now become armchair political strategists. That's dangerous, but if we get political clarity, that would help.
No. 3, and most important, company fundamentals need to become positive. We need to see earning revisions move in the right direction. The bar for sector-level outperformance, relative to the S&P, is high.
We sense a "but" coming.
The "but" is that we get paid to pick the right stocks. There are massive divergences in industry subsectors. Look at Eli Lilly versus Pfizer, in pharma.
Lilly's stock is up 34% this year, while Pfizer's is down 11%. Is that what you mean?
Yes. You're seeing this across all subsectors in healthcare. More so than in many other sectors, healthcare gives you opportunities. The bar is high for outperformance on a sector level. At a stock level, there is plenty of opportunity.
You have made clear the limits of armchair analysis, but let's do a little of that. What do you make of Kennedy, and Trump's other healthcare picks?
The starting point is that they are going to be deflationary for healthcare. Deflationary could be anything from drug-price reform to cuts in parts of entitlement spending. Medicaid seems to be a target. That is getting expressed in the way hospital operators and providers have been trading. For providers, specifically, it will be hard to shake that overhang until you get more clarity on what happens with the Affordable Care Act subsidies.
Trump hasn't given us much to work with on drug pricing.
But the bottom line is, the policy impact depends on the subsector?
Absolutely. As of now, medtech has been a beneficiary, because you can argue that it's a little bit more insulated from some of the policy variables. But if we're going to talk about big Medicaid cuts and the pressure that -- and the potential expiration of Affordable Care Act subsidies -- puts on hospital finances, we have to think through the second-order effects. What happens when hospital finances are under pressure? What does that mean for procedure volumes? The stock market isn't quite there yet. At some point in 2025, you have to think about the downstream effects.
There hasn't been much significant merger-and-acquisition activity in healthcare in 2024. Will there be bigger deals next year?
The preconditions for M&A haven't changed. We're one year closer to pharma patent cliffs than we were. These companies are sitting on a tremendous amount of M&A capacity. The innovation is in small names. Yet, M&A hasn't really been happening. Why?
Companies say that the properties they view as potentially attractive are already priced for that M&A optionality. Also, we're still hearing that potential acquirers want to see how the Medicare drug-price negotiation program plays out.
There is a view that under Trump you will have a more lenient Federal Trade Commission [one more willing to approve deals]. That remains to be seen. There is a line of thinking that Lina Khan's agenda could outlive her tenure. [Under Khan, current chair of the FTC, the commission has sought to block numerous M&A deals.] M&A is going to pick up at some point next year. Bolt-on deals, like the ones we're seeing, are going to continue.
The new obesity medicines from Eli Lilly and Novo Nordisk were the dominant theme in healthcare for the past couple of years. Now it seems like the wheels are rattling on that trade. What will happen with the obesity companies and their shares next year?
At a minimum, we can all agree that the evolution of the obesity trade into its next phase is going to be a lot more complicated than the duopoly trade that dominated the early part. That trade has wobbled for many reasons. You need to bet on who has the new-product-cycle upside. There is a reasonable line of thinking that Lilly is in the pole position, and I don't think that changes.
Novo has a little more uncertainty. A binary outcome is coming with regard to CagriSema, and everyone is nervous about it. [Novo is expected to report new data on the efficacy of CagriSema, an updated obesity drug, soon.] It seems everyone is leaning a little short, or underweight Novo, into that.
One question we're asking ourselves is why a small-cap obesity name hasn't been bought [by a big pharmaceutical company].
There had been speculation that Merck would buy one of the obesity-focused biotechs.
I recently had lunch with a large investor and asked him this question. And he said, look, they're all me-toos. When you have the big caps in a pole position, why would you want to go into the me-too? As I mentioned, the obesity trade gets more complicated. [On Dec. 18, after this interview, Merck licensed an early-stage obesity pill from a Chinese drugmaker.]
The rush by the large insurers into the Medicare Advantage market has begun to feel this year like it may have been a mistake. What did investors get wrong about this?
What everyone got wrong was the velocity and magnitude of the recovery in [healthcare] utilization post-Covid among older people. An aging demographic that had put off care during the pandemic is now healthier and feeling more confident about getting medical procedures. That's what investors got wrong.
What companies got wrong was pricing for that uptick. It was hard to call. They had no visibility.
So, what are investors doing? They're saying, look, UnitedHealth Group has been the growth compounder over a long time. It has also been the most diversified business. If I'm going to bet on a management team that has enough offsets in both the P&L [profit and loss statement] and in the way it executes, it is UnitedHealth.
Biotech stocks haven't had a good year in a long time. Will they ever do well again?
There is no new generalist demand for biotech right now. We entered this year with a lot of hope that after the many years of underperformance things would turn around. There was a lot of conversation that all of the M&A deals you saw exiting 2023 would lead to a redeployment of capital back into [biotech]. But it was a false start.
Interest rates need to stabilize. There will be mergers and acquisitions, but none of the deal activity will be big enough to shift sector-level psychology. There will be a tremendous amount of opportunity in biotech if you pick the right stocks. Trade around the edges.
Do you have a favorite stock or healthcare subsector heading into next year?
We wouldn't recommend abandoning the areas where we see true product-cycle-driven growth inflections. In medtech, Intuitive Surgical and Boston Scientific are two names that have potential upside from the product cycle.
We rate Lilly Neutral, but there is probably an opportunity. People are going to want to give them the benefit of the doubt.
Within subsectors, the drug and medical-supply distributors -- Cencora [formerly AmerisourceBergen], Cardinal Health, McKesson -- have traded well recently. There is probably a place for those in a healthcare portfolio. It's the only subsector where I am seeing positive earnings revisions.
In mid-cap biotechs, we like Madrigal Pharmaceuticals, Insmed, and Argenx. That area to us seems interesting.
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