Monday, April 2, 2018

US Drug Wholesalers again

Another look at US Drug Wholesalers: Cardinal Health (CAH) and McKesson (MCK).  These companies are part of an oligopoly in an industry not affected by recessions or trade wars, and are cheap now.


These 2 companies have been highly profitable.   Lets look at their past numbers.

I use Cashflows From Operations (CFO).  Since they are distributors with large yearly swings in working capital, exclude working capital changes:

Sustaining capex (mostly PPE) is extremely low, so free cashflows almost matches CFO:

But both companies spend a lot on acquisitions, which consists of the majority of their Cashflows from Investments (CFI):

Here's a look at CFO vs acquisitions and disposals.  In some years, all CFO is used for acquisitions:

Why are they spending so much on acquisitions?

I wonder if some of the acquisition spending is actually part of sustaining capex.  In a fast changing industry that is constantly growing, do you need to constantly acquire new companies to maintain market share?  Running to stand still...


FCF per share is below.  Again, I'm excluding working capital changes to smooth things out - this will inflate CFO a little, as more and more working capital (eg: inventory) is required as a business expands over time:

At $140, MCK is trading at ~11X estimated FCF, and at $60, CAH is around 12X.


Although their past numbers are really good, there are some risks not reflected in them.  Most of these are from the DrugChannels 2017-18 Economic Report on Pharmaceutical Wholesalers and specialty Distributors.

Their pharmacy end customers have been consolidating, putting pressure on Margins.  Operating margins for large pharmacy chains are estimated at ~ 0.5%, versus 1.5% for independent pharmacies.

Generic drugs account for an estimated 70% of their operating profits.  Pricing is horrendously complex, and is a set percentage of the Weighted average Cost price (WAC) - see pages 11 and 13 for examples - which means that rising generic drug prices boost profits.   Starting in 2011-12, there was a boom in generics drug prices due to an artificial shortage.  This has since been resolved, and prices have been coming down since 2016.  We need to keep this in mind when looking at the charts of the historical profits/cashflows above.  The report estimates that 1 in 5 generic drug prices have yet to fall, and that generic drug prices will continue on average to fall in the next 6-18 months.

Although spending on specialty drugs in set to increase, this is not expected to help wholesalers as most specialty drugs are prescribed through large chains and hospitals.  ie: their low margin clients.

Finally, there is a risk of litigation due to the opioid crisis, where the wholesalers were not monitoring - or just ignoring - suspicious orders.  I think McKesson is more vulnerable as they've been sued a lot before.


The positives are: this industry is an oligopoly with a defensible moat.  And pharmacy spending is not affected by recessions.

MCK has better historical numbers and trades at a slightly lower valuation.  But has more litigation risk. 

The stocks are trading at low valuations now due to:
  • A price war last year, bought on by a consolidating customer base.
  • Falling profits in 2016 dues to generic drug deflation.
These trends may continue.  I see no catalyst to move the stocks higher now.  But the industry is cheap.  Are the above risks already priced in?

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