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Originally spun out of Hewlett-Packard in 1999, Agilent has evolved into a leading healthcare firm. Today, Agilent's measurement technologies serve a broad base of customers within three operating segments: life science and applied equipment (49% of sales), cross lab (which includes consumables and services at 34%), and diagnostics and genomics (17%). The United States and Europe account for 34% and 27% of revenue, respectively, with China and Japan accounting for the majority of remaining sales. Agilent is headquartered in California.

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.

AmerisourceBergen is a leading global third-party logistics provider engaged in wholesale pharmaceutical sourcing and distribution of specialty, brand-name, and generic pharmaceuticals and related services to acute-care hospitals and health systems, independent and chain retail pharmacies, mail order pharmacies, medical clinics, long-term care and alternate site pharmacies, physician practices, dialysis clinics, and other healthcare customers. By acquiring smaller companies, management has attained the ability to compound sterile preparations, distribute veterinary pharmaceuticals and vaccines, transport biopharmaceuticals, and provide inventory and reimbursement consulting services to providers.

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.

Aetna is one of the largest managed-care organizations in the U.S., with over 22 million medical members. This large member count helps the firm diversify its operating risk and has formed the basis for material competitive advantages. The firm provides health insurance services to its members through products that encompass every major insurance market--individual, group, and government sponsored. Aetna and CVS recently announced their intention to merge operations, and if approved, it would form one of the most powerful players within the healthcare space.

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.

Alexion Pharmaceuticals specializes in developing and marketing drugs for rare, life-threatening medical conditions. Its blockbuster product, Soliris, is approved for paroxysmal nocturnal hemoglobinuria, atypical hemolytic uremic syndrome, and generalized myasthenia gravis. Next-generation Ultomiris was recently approved in paroxysmal nocturnal hemoglobinuria. Strensiq and Kanuma target other ultrarare metabolic diseases. Alexion's pipeline targets rare diseases with high unmet need and complement-mediated 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).

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.

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.

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.

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.

BioMarin's focus is on rare-disease therapies. Genzyme (now part of Sanofi) markets Aldurazyme through its joint venture with BioMarin, and BioMarin markets Naglazyme, Vimizim, and Brineura independently. BioMarin also markets Kuvan and Palynziq to treat the rare metabolic disorder PKU (in addition to long-standing U.S. rights, BioMarin has reacquired international rights for Kuvan and Palynziq from Merck KGaA). BioMarin has a hemophilia A gene therapy and a treatment for achondroplasia in late-stage clinical trials.

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.

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.

Cardinal Health is the third-largest global logistics provider engaged in wholesale pharmaceutical and medical products. Similar to the other two peers, the company has evolved over time and has become entrenched in the sourcing and distribution of brand-name and generic pharmaceuticals and related services to hospitals, healthcare systems, pharmacies, ambulatory surgery centers, clinical laboratories, and physician offices. Through acquisitions, Cardinal Health has the ability to manufacture commodity products and certain medical devices.

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.

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.

Centene Corp offers healthcare plans to the United States government-sponsored healthcare programs, with a focus on uninsured individuals. It helps members access care, coordinates referrals to health and social services, and provides education and outreach programs to help its members select healthcare services. Centene's managed care segment provides health plan coverage to individuals through government subsidized programs, including Medicare and Medicaid. The specialty services segment consists of specialty companies offering healthcare services and products to state programs, correctional facilities, healthcare organizations, and other commercial organizations. The managed care segment contributes to the vast majority of the firm's overall revenue.

Quest Diagnostics is a leading independent provider of diagnostic testing, information, and services in the U.S. The company generates about 90% of its revenue through clinical testing, anatomic pathology, esoteric testing, and substance abuse testing at its national network of 2,000 patient service centers. The firm also runs a diagnostic solutions segment that provides clinical trials testing, risk assessment services, and information technology solutions.

After the spin-off of Fortive in 2016, Danaher is a diversified and mostly healthcare-focused instrument and supplies manufacturer. After the spin, Danaher retains four main business segments: Life Sciences, Diagnostics, Dental, and Environmental & Applied Solutions. Each segment represents approximately 31%, 32%, 15%, and 22% of revenue, respectively.

DaVita Inc is the largest provider of dialysis services in the U.S., boasting market share levels that eclipse 35% measured by both patients and clinics. The firm operates 2,905 facilities worldwide, with 2,664 located in the United States, and treats over 225,000 patients globally each year. Management began to build out a fledgling international business in 2011, but we anticipate this business will need to continue to expand before it garners the scale needed to earn attractive returns. Government payers dominate dialysis reimbursement--DaVita receives approximately 69% of U.S. sales at Medicare and Medicaid reimbursement rates, with the remaining 31% coming from commercial insurers.

After a string of acquisitions and divestitures, Endo is a specialty pharmaceutical company with a considerable presence in pain management. The acquisitions of Auxilium and Par increased the company's presence in urology and generics, respectively.

Express Scripts is the largest pharmacy benefit manager in the United States. Through its mail-order pharmacy and network of retail pharmacies, Express Scripts processes approximately 1.4 billion adjusted prescriptions annually for its payer clients.

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.

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.

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.

Hologic manufactures proprietary products for the healthcare needs of women. The company operates in five segments: breast health (38% of sales), diagnostics (26%) surgical (13%), medical aesthetics (10%), and skeletal health (3%). While the company traditionally focused on breast health, the acquisition of Gen-Probe put greater emphasis on commercial diagnostics, and the purchase of Cynosure establishes a footprint in the cosmetic laser market. The United States accounts for the largest portion of the firm's revenue (74%), followed by Europe (12%), Asia (9%), and other international markets (5%). Hologic is headquartered in Bedford, Massachusetts.

Henry Schein is one of the largest wholesalers of dental and medical products in the United States. The firm has a focus on dental practice and medical products. It also offers dental practice management products that include software products, technical, financial, and educational services to thousands of dental practices throughout North America.

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.

Idexx Laboratories primarily develops, manufactures, and distributes diagnostic products, equipment, and services for pets and livestock. Its key product lines include single-use canine and feline test kits that veterinarians can employ in the office, benchtop chemistry and hematology analyzers for test-panel analysis on-site, reference lab services, and tests to detect and manage disease in livestock. Idexx gets about 39% of its revenue from outside the United States.

Illumina is a major player in life science tools for analyzing genetic material. Revenue from microarray and genome sequencing machines and disposables make up most of the company's revenue, but approximately 18% of the company's sales come from testing services. Essentially all of Illumina's growth stems from the company's genome sequencing products, which include the company's high-throughput NovaSeq and HiSeq instruments in addition to its benchtop NextSeq, MiSeq, and MiniSeq, and iSeq product lines.

Incyte focuses on the discovery and development of small-molecule drugs. The firm's lead drug, Jakafi, treats two types of rare blood cancer and is partnered with Novartis. Incyte's other marketed drugs include rheumatoid arthritis treatment Olumiant, which Eli Lilly licenses, and oncology drug Iclusig for chronic myeloid leukemia. Incyte's pipeline includes a broad array of oncology and autoimmune programs, including next-generation JAK inhibitor itacitinib.

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.

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.

Laboratory Corporation of America is the nation's second- largest independent clinical laboratory, with roughly 20% of the independent lab market. The company operates more than 1,800 patient-service centers, offering a broad range of clinical lab tests, ranging from routine blood and urine screens to complex oncology and genomic testing. With the addition of Covance, LabCorp also has a sizable footprint in the global contract research organization market.

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.

McKesson Corporation is the largest and most complex of the leading third-party logistics providers. The company is engaged in wholesale pharmaceutical and medical products sourcing, distribution and dispensing, contract manufacturing, and related IT services to acute care hospitals and health systems, independent and chain retail pharmacies in North America, Europe, and Canada. Through acquisition and joint ventures McKesson also runs the fourth largest pharmacy chain and provides technology and consulting services to manufacturers, pharmacies, physician offices, surgery centers, long-term care facilities, and home healthcare businesses.

One of the largest medical device companies, Medtronic 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.

Mallinckrodt PLC is a specialty pharmaceutical company that was spun off from Covidien and historically focused on pain therapeutics. After recently moving its generics business into discontinued operations, Mallinckrodt now focuses entirely on branded drugs following the sale of its nuclear imaging business in 2016. Mallinckrodt's products now span a number of therapeutic areas, but a significant portion focus on hospital and clinical 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 half of the company's sales are generated in the United States.

Mettler-Toledo International Inc supplies weighing and precision instruments to customers in the life sciences (50% of sales), industrial (42%), and food retail industries. Its products include laboratory and retail scales, pipettes, pH meters, thermal analysis equipment, titrators, metal detectors, and X-ray analyzers. Mettler leads the market for weighing instrumentation and controls more than 50% of the market for lab balances.

Mylan is one of the world's largest generic pharmaceutical manufacturers with operations in the United States, Europe, Asia, Middle East, Africa, and Australia. Generic drug sales constitute approximately 90% of revenue. Remaining sales come from a handful of branded products, primarily epinephrine injector EpiPen. Mylan also owns Matrix, an Indian active pharmaceutical ingredient manufacturer.

Patterson is one of the largest distributors and wholesalers of dental and animal health products, equipment, and devices in the United States. The firm offers dental practice management products, including office software products, technical, financial, and educational services, to thousands of dental practices throughout North America. It also is a major supplier of animal health products to vets and production companies in the United Kingdom.

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 drugs Enbrel and 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.

PerkinElmer provides instruments, consumables, and services to the pharmaceutical, biomedical, chemical, environmental, and general industrial markets. The company operates in two segments: diagnostics, which includes prenatal screening and infectious disease testing, and discovery and analytical solutions, composed of life science, industrial, environmental, and food applications. PerkinElmer offers products and services ranging from genetic screening to environmental analytical tools.

Perrigo is the largest store-brand over-the-counter pharmaceutical and infant formula manufacturer. The company operates three major segments: consumer healthcare, branded consumer healthcare, and prescription pharmaceuticals. As of mid-2018, Perrigo plans to divest the prescription segment. In the United States, Perrigo sells about 2,100 products with 9,000 stock-keeping units. Following the acquisition of Omega Pharma, approximately 30% of the company's revenue comes from outside the U.S.

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.

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.

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%).