0 Health Care Sector

Johnson & Johnson is the world's largest and most diverse healthcare company. Three divisions make up the firm: pharmaceutical, medical devices and diagnostics, and consumer. The drug and device groups represent close to 80% of sales and drive the majority of cash flows for the firm. The drug division focuses on the following therapeutic areas: immunology, oncology, neurology, pulmonary, cardiology, and metabolic diseases. The device segment focuses on orthopedics, surgery tools, vision care, and a few smaller areas. The last segment of consumer focuses on baby care, beauty, oral care, over-the-counter drugs, and women's health. Geographically, close to half of total revenue is generated in the United States.

UnitedHealth Group is the largest private health insurance provider in the United States, offering medical benefits to nearly 50 million members across its U.S. and international businesses. As the leader in employer-sponsored, self-directed, and government-backed insurance plans, United has obtained unrivaled scale compared with its peers in managed care. Along with its insurance assets, United's continued investment behind its Optum franchises has created a healthcare services colossus that spans everything from medical and pharmaceutical benefits to providing outpatient care and analytics to both affiliated and third-party customers.

Merck makes pharmaceutical products to treat several conditions in a number of therapeutic areas, including cardiovascular disease, asthma, cancer, and infections. Within cancer, the firm's immuno-oncology platform is growing as a major contributor to overall sales. The company also has a substantial vaccine business, with treatments to prevent hepatitis B and pediatric diseases as well as HPV and shingles. Additionally, Merck sells animal health-related drugs. From a geographical perspective, close to 40% of the company's sales are generated in the United States.

Pfizer is one of the world's largest pharmaceutical firms, with annual sales over $50 billion. Pfizer also spends a leading amount on research and development, close to $8 billion annually. While Pfizer historically sold many types of healthcare products and chemicals, now, prescription drugs and vaccines account for the majority of sales. Top sellers include pneumococcal vaccine Prevnar 13, neuroscience drug Lyrica, cancer drug Ibrance, cardiovascular treatment Eliquis, and immunology drug Xeljanz. Pfizer sells these products globally, with international sales representing close to 50% of its total sales. Within international sales, emerging markets are a major contributor, representing over a fifth of total company sales.

Novartis AG develops and manufactures healthcare products through two segments: Innovative Medicines and Sandoz. It generates the vast majority of its revenue from Innovative Medicines segment consisting global business franchises in ophthalmology, neuroscience, immunology, respiratory, cardio-metabolic, and established medicines. The company sells its products globally, with the United States representing close to one third of total sales.

Abbott manufactures and markets medical devices, blood glucose monitoring kits, nutritional healthcare products, diagnostic products and equipment, and branded generic drugs. Products include pacemakers, implantable cardioverter defibrillators, neuromodulation devices, coronary stents, catheters, infant formula, nutritional liquids for adults, and molecular and point-of-care diagnostic equipment. Abbott derives approximately 60% of sales outside the United States.

Medtronic PLC is one of the largest medical device companies, develops and manufactures therapeutic medical devices for chronic diseases. Its portfolio includes pacemakers, defibrillators, heart valves, stents, insulin pumps, spinal fixation devices, neurovascular products, and surgical tools. The company markets its products to healthcare institutions and physicians in the United States and overseas. Foreign sales account for about 45% of the company's total sales.

Thermo Fisher Scientific sells scientific instruments and laboratory equipment, diagnostics consumables, and life science reagents. The firm operates through four segments: analytical technologies (23% of sales); specialty diagnostic products (15%); life science solutions (26%); and lab products and services (41%).

With almost 50% market share by volume of the global insulin market, Novo Nordisk is the leading provider of diabetes-care products in the world. Based in Denmark, the company manufactures and markets a variety of human and modern insulins, injectable diabetes treatments, as well as oral antidiabetic agents. Novo also has a biopharmaceutical segment (constituting roughly 20% of revenue) that specializes in protein therapies for hemophilia and other disorders.

Amgen is a leader in biotechnology-based human therapeutics, with historical expertise in renal disease and cancer supportive-care products. Flagship drugs include red blood cell boosters Epogen and Aranesp, immune system boosters Neupogen and Neulasta, and Enbrel for inflammatory diseases. Amgen introduced its first cancer therapeutic, Vectibix, in 2006 and received approval for bone-strengthening drug Prolia/Xgeva in 2010. Amgen's acquisition of Onyx bolstered the firm's therapeutic oncology portfolio with Nexavar and Kyprolis. Recent launches include Repatha (cholesterol-lowering) and Aimovig (migraine).

A merger between Astra of Sweden and Zeneca Group of the United Kingdom formed AstraZeneca in 1999. The company sells branded drugs across several major therapeutic classes, including gastrointestinal, diabetes, cardiovascular, respiratory, cancer, immunology, and neuroscience. The majority of sales come from international markets with the United States representing close to one third of its sales.

Sanofi develops and markets drugs with a concentration in oncology, immunology, cardiovascular disease, diabetes, and vaccines. The company offers a diverse array of drugs with its highest revenue generator, Lantus, representing just under 10% of total sales. About 30% of total revenue comes from the United States and 25% from Europe. Emerging markets represent the majority of the remainder of sales.

Eli Lilly is a pharmaceutical company with a focus on neuroscience, endocrinology, oncology, and immunology. Lilly's key products include Alimta for cancer; Forteo for osteoporosis; Jardiance, Trulicity, Humalog, and Humulin for diabetes; Taltz and Olumiant for immunology; and Cialis for erectile dysfunction.

AbbVie is a drug company with a strong exposure to immunology and oncology. The company's top drug, Humira, represents over half of the company's current profits. The company was spun off from Abbott in early 2013.

In the pharmaceutical industry, GlaxoSmithKline ranks as one of the largest companies by total sales. The company wields its might across several therapeutic classes, including respiratory and antiviral, as well as vaccines and consumer healthcare products. Glaxo uses joint ventures to gain additional scale in certain markets like HIV and consumer products.

In 1984, Danaher's founders transformed a real estate organization into an industrial-focused manufacturing company. Through a series of mergers, acquisitions, and divestitures, including the Fortive separation in 2016, Danaher now focuses primarily on manufacturing scientific instruments and consumables in four segments: life sciences (33% of 2018 sales), diagnostics (31%), environmental and applied solutions (22%), and dental (14%). In 2019, Danaher plans to separate its dental business from the organization through an initial public offering, and Danaher also plans to acquire GE's Biopharma business, which will add to its life sciences segment.

Gilead Sciences develops and markets therapies to treat life-threatening infectious diseases, with the core of its portfolio focused on HIV and hepatitis B and C. The acquisitions of Corus Pharma, Myogen, CV Therapeutics, Arresto Biosciences, and Calistoga have broadened this focus to include pulmonary and cardiovascular diseases and cancer. Gilead's acquisition of Pharmasset brought rights to hepatitis C drug Sovaldi, which is also part of combination drug Harvoni, and the Kite acquisition boosted Gilead's exposure to cell therapy in oncology.

Stryker designs, manufactures, and markets an array of medical equipment, instruments, consumable supplies, and implantable devices. The product portfolio includes hip and knee replacements, endoscopy systems, operating room equipment, embolic coils, and spinal devices. Stryker remains one of the three largest competitors in reconstructive orthopedic implants and holds the leadership position in operating room equipment. Approximately 35% of Stryker's total revenue currently comes from outside the United States.

Bristol-Myers Squibb Co discovers, develops, and markets drugs for various indications, such as cardiovascular, oncology, and immune disorders. A key focus for Bristol is immuno-oncology, where the firm is leading in drug development. Unlike some of its more diversified peers, Bristol has exited several nonpharmaceutical businesses to focus on branded specialty drugs.

Becton, Dickinson is the world's largest manufacturer and distributor of medical surgical products, such as needles, syringes, and sharps-disposal units. The company also manufactures diagnostic instruments and reagents, as well as flow cytometry and cell-imaging systems. International revenue accounts for 45% of the company's business. With CareFusion, BD has entered into medical systems (such as infusion pumps and ventilators) as well as procedural solutions businesses. The Bard deal gives the company a presence in urology, vascular, and oncology.

Celgene is a biopharmaceutical firm that discovers, develops, and markets therapeutics for the treatment of cancer and immunological diseases. Celgene markets Thalomid and Pomalyst to treat multiple myeloma and Revlimid, a less toxic thalidomide derivative, to treat myelodysplastic syndromes, multiple myeloma, and mantle cell lymphoma. Acquisitions have brought MDS drug Vidaza, T-cell lymphoma drug Istodax, and cancer drug Abraxane. The firm's first immunology drug, Otezla, was approved in the U.S. in 2014. Recent acquisitions of Juno and Impact bring additional drugs for Celgene's blood cancer pipeline.

Anthem is one of the largest private health insurance organizations nationwide, providing medical benefits to over 40 million members. The company offers employer-sponsored, individual, and government-backed coverage plans. Anthem differs from its peers in its unique position as the largest single provider of Blue Cross Blue Shield branded coverage, operating as the licensee for the Blue Cross Blue Shield Association in 14 states.

Long a leader in the self-funded employer health insurance market, Cigna has expanded its reach both organically and through the recent merger with Express Scripts. The firm now operates more on par with its peers, having both a medical and pharmaceutical benefits capability that should help level the playing field in the years to come. In addition, the firm is a leader in accident, disability, and life insurance globally, although these businesses have become much less important to the overall enterprise after the Express Scripts merger to bulk up its healthcare offering.

Intuitive Surgical develops, produces, and markets a robotic system for assisting minimally invasive surgery. It also provides the instrumentation, disposable accessories, and warranty services for the system. The company has placed nearly 5,000 da Vinci systems in hospitals worldwide, with 3,200 installations in the United States and a growing number in emerging markets.

Boston Scientific Corp produces less-invasive medical devices that are inserted into the human body through small openings or cuts. It manufactures products for use in angioplasty, blood clot filtration, cardiac rhythm management, catheter-directed ultrasound imaging, structural heart disease, upper gastrointestinal tract tests, and treatment of incontinence. The firm markets its devices to healthcare professionals and institutions globally. Foreign sales account for nearly half of the firm's total sales.

Zoetis sells anti-infectives, vaccines, parasiticides, diagnostics, and other health products for animals. The firm earns more than 55% of total revenue from production animals (cattle, pigs, poultry, and so on), and companion animal (dogs, horses, cats) products make up the remainder. The firm has the largest market share in the industry and was previously Pfizer's animal health unit.

Allergan is one of the largest specialty pharmaceutical manufacturers. It specializes in aesthetics, ophthalmology, women's health, gastrointestinal, and central nervous system products. In 2016, Allergan sold its generics and distribution segments to Teva.

Spun off from Baxter International in 2000, Edwards Lifesciences designs, manufactures, and markets a range of medical devices and equipment for advanced stages of heart disease. Its key products include surgical tissue heart valves, transcatheter valve technologies, surgical clips, catheters and retractors, and monitoring systems used to measure a patient's heart function during surgery. The firm derives about 55% of its total sales from outside the U.S.

Baxter manufactures medical products across seven major reported business segments. The renal segment (33% of 2018 sales) includes peritoneal dialysis and hemodialysis products for chronically ill patients while its acute therapies segment (5%) offers kidney or other organ support tools in intensive care situations. The medication delivery segment (24% of sales) sells IV pumps, administrative sets, and solutions while its nutrition segment (8% of sales) offers parenteral nutrition therapies. The pharmaceuticals segments (19% of sales) offers injectable drugs, anesthetic gases, and compounding services. The advanced surgery segment (7% of sales) provides hemostastic products and biosurgical sealants. Contract manufacturing rounds out the remaining 5% of sales.

HCA Healthcare is a Nashville-based healthcare provider organization operating the largest collection of acute-care hospitals in the U.S. The firm owns and operates 179 hospitals and 120 outpatient surgery centers with more than 1,800 alternate site locations including physician offices, urgent care clinics, and freestanding emergency rooms across 20 states and a small foothold in England.

Vertex Pharmaceuticals discovers and develops small-molecule drugs for the treatment of serious diseases. Its key drugs are Kalydeco, Orkambi, and Symdeko for cystic fibrosis, in addition to several pipeline candidates targeting this market. Vertex's pipeline also includes therapies for cancer, pain, inflammatory diseases, influenza, and other rare diseases.

Biogen and Idec merged in 2003, combining forces to market Biogen's multiple sclerosis drug Avonex and Idec's cancer drug Rituxan. Today, Rituxan and next-generation antibody Gazyva are marketed via a collaboration with Roche. Biogen also markets novel MS drugs Tysabri and Tecfidera. In Japan, Biogen's MS portfolio is co-promoted by Eisai. Hemophilia therapies Eloctate and Alprolix (partnered with SOBI) were spun off as part of Bioverativ in 2017. Biogen has several drug candidates in phase 3 trials in neurology and neurodegenerative diseases and has launched Spinraza with partner Ionis.

Illumina provides tools and services to analyze genetic material with life science and clinical lab applications. The company generates revenue from sequencing tools and dedicated consumables (about 70% of sales). Illumina's high-throughput technology enables whole genome sequencing in humans and other large organisms. Its lower throughput tools enable applications that require smaller data outputs, such as viral and cancer tumor screening. Illumina also sells microarrays (12% of sales) that enable lower-cost, focused genetic screening with primarily consumer and agricultural applications. Services account for 18% of sales and include basic maintenance services, clinical lab applications (such as noninvasive prenatal, oncology, and rare-disease screening), and whole genome sequencing.

Philips is a diversified global manufacturer operating in two segments: healthtech and personal health. About 60% of the company's revenue comes from the healthtech segment, which features imaging systems, ultrasound equipment, patient monitoring systems, and image-guided therapy solutions. Personal health products like domestic appliances, health and wellness, and personal care contribute the remainder of Philips' turnover. In 2017, Philips generated EUR 17.8 billion of sales and had 105,000 employees in over 100 countries.

Humana is one of the largest private insurance organizations participating in the Medicare Advantage program. The firm has built a niche specializing in government-sponsored programs, with nearly all its medical membership stemming from individual and group Medicare Advantage, Medicaid, and the military's TRICARE program. Additionally, the firm is a leader in stand-alone prescription drug plans offered to seniors enrolled in traditional fee-for-service Medicare. In addition, the firm has a nascent commercial offering focusing on risk arrangements alongside specialty offerings such as dental, vision, and life for smaller employers.

Regeneron Pharmaceuticals discovers, develops, and commercializes products that fight eye disease, cardiovascular disease, cancer, and inflammation. The company has six marketed products: Eylea, approved for wet age-related macular degeneration and other eye diseases; Praluent for LDL cholesterol lowering; Zaltrap in colorectal cancer; Dupixent in atopic dermatitis and asthma; Libtayo in cutaneous squamous cell carcinoma; Arcalyst in CAPS; and Kevzara in rheumatoid arthritis. Regeneron is also developing monoclonal antibodies with Sanofi in immunology and cancer.

IQVIA is the result of the 2016 merger of Quintiles, a leading global contract research organization, and IMS Health, a leading healthcare data and analytics provider. The CRO segment focuses primarily on providing outsourced late-stage clinical trials for pharmaceutical, device, and diagnostic firms. The legacy IMS business provides aggregated information and technology services to clients in the healthcare industry, including pharmaceutical companies, providers, payers, and policymakers.