DooDiligence Posted October 6, 2018 Share Posted October 6, 2018 Thank you both for your bearish thoughts. Also, thanks to whichever God is answering my plea to lend me the temperament which allows negative views to be accepted as definite possibilities. In the end, Loki (the trickster) will likely be behind my decision to stand pat on NVO. --- The recent decision regarding AmerisourceBergen's illegal activity is making me rethink the integrity of their management. Link to comment Share on other sites More sharing options...
Spekulatius Posted October 6, 2018 Share Posted October 6, 2018 Thank you both for your bearish thoughts. Also, thanks to whichever God is answering my plea to lend me the temperament which allows negative views to be accepted as definite possibilities. In the end, Loki (the trickster) will likely be behind my decision to stand pat on NVO. --- The recent decision regarding AmerisourceBergen's illegal activity is making me rethink the integrity of their management. I didn’t wear my investment hat, when I wrote this, NVO may well be viable as an investment. This price gouging (my opinion) has been going on for at least 30 years and it might work another 20 or 30 years. personally, I would as an investor be aware of what is going on and watch out for political cross currents. this could start in the US but also elsewhere. When this occurs and gains traction, the economics of this business will be permanently changed and not for the better. Link to comment Share on other sites More sharing options...
DooDiligence Posted October 6, 2018 Share Posted October 6, 2018 Thank you both for your bearish thoughts. Also, thanks to whichever God is answering my plea to lend me the temperament which allows negative views to be accepted as definite possibilities. In the end, Loki (the trickster) will likely be behind my decision to stand pat on NVO. --- The recent decision regarding AmerisourceBergen's illegal activity is making me rethink the integrity of their management. I didn’t wear my investment hat, when I wrote this, NVO may well be viable as an investment. This price gouging (my opinion) has been going on for at least 30 years and it might work another 20 or 30 years. personally, I would as an investor be aware of what is going on and watch out for political cross currents. this could start in the US but also elsewhere. When this occurs and gains traction, the economics of this business will be permanently changed and not for the better. I'm going to stick with NVO until governmental intervention becomes impossible to ignore (at which point it would prob be a failed investment.) I like the tailwinds of steadily increasing world prosperity coupled with the subsequent celebratory overeating and resultant health issues and I trust that management will find ways to deliver therapies as affordably as they can. Given their historically excellent ROE's, it appears that there's room to drop margins a bit and still continue R & D and make above average returns for investors. Abuses in healthcare will continue to make headlines as they have with AmersourceBergen's illegal compounding and the double billing offenses. (Not sure if this and the opioid thing will make my choice of ABC turn into a poor one.) Link to comment Share on other sites More sharing options...
John Hjorth Posted October 6, 2018 Share Posted October 6, 2018 Business Insider - Lydia Ramsey [August 28th 2016]: Why a lifesaving drug that's been around since 1923 is still unaffordable. From the article: ... Unlike many common, even newer medicines, a generic option does not exist. ... ... After a few years, however, other companies are allowed to start making generic versions of the drug — cheaper, "off-brand" options that are otherwise exactly the same as the original. Because there's no longer a monopoly and generic manufacturers are only trying to turn a profit — not recoup high research and development costs — generics can be much less expensive and thus more accessible treatment options for the general public. But insulin didn't follow that trajectory. ... The key to understand this sucker of a pharma is to understand the disease. Link to comment Share on other sites More sharing options...
Cigarbutt Posted October 7, 2018 Share Posted October 7, 2018 Business Insider - Lydia Ramsey [August 28th 2016]: Why a lifesaving drug that's been around since 1923 is still unaffordable. From the article: ... Unlike many common, even newer medicines, a generic option does not exist. ... ... After a few years, however, other companies are allowed to start making generic versions of the drug — cheaper, "off-brand" options that are otherwise exactly the same as the original. Because there's no longer a monopoly and generic manufacturers are only trying to turn a profit — not recoup high research and development costs — generics can be much less expensive and thus more accessible treatment options for the general public. But insulin didn't follow that trajectory. ... The key to understand this sucker of a pharma is to understand the disease. Just to be clear, this focus on the downside is meant to be constructive. After all, some of the best performers in the last decades have been sin stocks (including within the tobacco “cartel”) and the threesome that includes NVO sells insulins which are life-saving or live-prolonging products. In 20 years, NVO is likely to be still around selling globally its newer versions and management will continue to play along the profit maximization curve. And, on a relative basis, the ill-defined pricing pressure black clouds may be partially priced in. Still, some thoughts (just ignore if saturation point reached). -The 2015 NEJM publication that is referred to in the Business Insider article described how newer versions of the “generic” insulin likely brought value to the system but also described how, incrementally, progressively less and less additional value was added with the newer forms, a key fact which has been relatively suppressed in “sponsored” publications. NVO et al can show significant costs (with a larger piece of the pie going eventually to marketing…) and can underline the importance of R&D but there has been an increasing divergence between the diminishing clinical benefits per evergreening maneuvers and the significantly rising price of the newer versions. A squeezed lemon will eventually run dry. -In the healthcare system overall and at the patients’ level who, more and more, face rising out-of-pocket expenses, there is a growing sense of rising price sensitivity which is quite different from before even if the industry has been able to enjoy, for various reasons, very low price sensitivity as a baseline, for quite a long time. Rising prices and rising price sensitivity don’t mix well and may explain louder calls for the older and cheaper versions of insulin (which somehow are no longer available). -For the biosimilars, risk is hard to define but is probably manageable. One thing I would watch is the potential development of smaller outsider players introducing a product and building data in lower-income countries and then partnering with, or being acquired by, a pharma with deep pockets who does not occupy the insulin market in higher-income countries. Global and affordable access to insulin will continue to be challenging and differential pricing will continue to be controversial. The easy solution would be to continue the present global trend of eradication of poverty but History is not always kind. As long as Spekulatius is not hired as a consultant by the CMS or the FDA in order to break the cartel :) and as long as America First doesn’t go too far, :( NVO will probably be fine although occasionally challenged. Link to comment Share on other sites More sharing options...
DooDiligence Posted October 7, 2018 Share Posted October 7, 2018 Business Insider - Lydia Ramsey [August 28th 2016]: Why a lifesaving drug that's been around since 1923 is still unaffordable. From the article: ... Unlike many common, even newer medicines, a generic option does not exist. ... ... After a few years, however, other companies are allowed to start making generic versions of the drug — cheaper, "off-brand" options that are otherwise exactly the same as the original. Because there's no longer a monopoly and generic manufacturers are only trying to turn a profit — not recoup high research and development costs — generics can be much less expensive and thus more accessible treatment options for the general public. But insulin didn't follow that trajectory. ... The key to understand this sucker of a pharma is to understand the disease. Just to be clear, this focus on the downside is meant to be constructive. After all, some of the best performers in the last decades have been sin stocks (including within the tobacco “cartel”) and the threesome that includes NVO sells insulins which are life-saving or live-prolonging products. In 20 years, NVO is likely to be still around selling globally its newer versions and management will continue to play along the profit maximization curve. And, on a relative basis, the ill-defined pricing pressure black clouds may be partially priced in. Still, some thoughts (just ignore if saturation point reached). -The 2015 NEJM publication that is referred to in the Business Insider article described how newer versions of the “generic” insulin likely brought value to the system but also described how, incrementally, progressively less and less additional value was added with the newer forms, a key fact which has been relatively suppressed in “sponsored” publications. NVO et al can show significant costs (with a larger piece of the pie going eventually to marketing…) and can underline the importance of R&D but there has been an increasing divergence between the diminishing clinical benefits per evergreening maneuvers and the significantly rising price of the newer versions. A squeezed lemon will eventually run dry. -In the healthcare system overall and at the patients’ level who, more and more, face rising out-of-pocket expenses, there is a growing sense of rising price sensitivity which is quite different from before even if the industry has been able to enjoy, for various reasons, very low price sensitivity as a baseline, for quite a long time. Rising prices and rising price sensitivity don’t mix well and may explain louder calls for the older and cheaper versions of insulin (which somehow are no longer available). -For the biosimilars, risk is hard to define but is probably manageable. One thing I would watch is the potential development of smaller outsider players introducing a product and building data in lower-income countries and then partnering with, or being acquired by, a pharma with deep pockets who does not occupy the insulin market in higher-income countries. Global and affordable access to insulin will continue to be challenging and differential pricing will continue to be controversial. The easy solution would be to continue the present global trend of eradication of poverty but History is not always kind. As long as Spekulatius is not hired as a consultant by the CMS or the FDA in order to break the cartel :) and as long as America First doesn’t go too far, :( NVO will probably be fine although occasionally challenged. Provocative & eloquent ;) as usual. If only everyone were able to deliver potentially damaging news in such an acceptable manner. Link to comment Share on other sites More sharing options...
John Hjorth Posted October 7, 2018 Share Posted October 7, 2018 Provocative & eloquent ;) as usual. If only everyone were able to deliver potentially damaging news in such an acceptable manner. lol! - And I'm extremely evasive right now towards the posts by Spekulatius and Cigarbutt because I'd rather read Howard Mark's new book! [ : - D] Link to comment Share on other sites More sharing options...
Cigarbutt Posted October 7, 2018 Share Posted October 7, 2018 ^When people think of Muhammad Ali, they often focus on his innate ability to hit hard and have this in mind: https://www.nbcnews.com/news/sports/muhammad-ali-greatest-all-time-dead-74-n584776 But often people underestimate the power of evasiveness and resilience as well as his ability to roll with the punches: This probably also applies to NVO and investors in general (ie Mr. Buffett rules #1 and #2) Link to comment Share on other sites More sharing options...
Spekulatius Posted October 7, 2018 Share Posted October 7, 2018 ^ Great Posts above and I agree with everything they has been said here. As an investor , it is important to look at inefficient markets, which can allow for extraordinary profits for a long time. I think various parts of Pharma (insulin, rare disease treatments) but also alcohol and tobacco are in these buckets. I am less convinced about tobacco going forward, due to competition from smokeless cigs, but I am long CUERVO.MX in decent size. Whatever kills people ever so slowly while they are having fun, or extends live for people suffering from chronically diseases seems to work best. Link to comment Share on other sites More sharing options...
DooDiligence Posted October 7, 2018 Share Posted October 7, 2018 Provocative & eloquent ;) as usual. If only everyone were able to deliver potentially damaging news in such an acceptable manner. lol! - And I'm extremely evasive right now towards the posts by Spekulatius and Cigarbutt because I'd rather read Howard Mark's new book! [ : - D] I wish I had time to read his book... Link to comment Share on other sites More sharing options...
DooDiligence Posted October 7, 2018 Share Posted October 7, 2018 ^ Great Posts above and I agree with everything they has been said here. As an investor , it is important to look at inefficient markets, which can allow for extraordinary profits for a long time. I think various parts of Pharma (insulin, rare disease treatments) but also alcohol and tobacco are in these buckets. I am less convinced about tobacco going forward, due to competition from smokeless cigs, but I am long CUERVO.MX in decent size. Whatever kills people ever so slowly while they are having fun, or extends live for people suffering from chronically diseases seems to work best. Nice restatement of Nietzsche! Link to comment Share on other sites More sharing options...
Sharad Posted October 9, 2018 Share Posted October 9, 2018 Thank you both for your bearish thoughts. Also, thanks to whichever God is answering my plea to lend me the temperament which allows negative views to be accepted as definite possibilities. In the end, Loki (the trickster) will likely be behind my decision to stand pat on NVO. --- The recent decision regarding AmerisourceBergen's illegal activity is making me rethink the integrity of their management. I didn’t wear my investment hat, when I wrote this, NVO may well be viable as an investment. This price gouging (my opinion) has been going on for at least 30 years and it might work another 20 or 30 years. personally, I would as an investor be aware of what is going on and watch out for political cross currents. this could start in the US but also elsewhere. When this occurs and gains traction, the economics of this business will be permanently changed and not for the better. Has anyone analyzed the chances that Eli Lilly's phase 2 mid-stage results could have a long-term impact on NVO's earnings/moat (which I believe has caused much of the drop in the stock)? LLY introduced a dual peptide drug that has resulted in dramatic weight-loss and improvement of blood sugar stability (see: https://pharmaphorum.com/news/lilly-diabetes-unveils-promising-data-from-dual-action-diabetes-drug/). NVO is only in phase 1 for a similar treatment (see: Novo Nordisk PYY 1562), but should move to phase 2 soon (based on what I see, Novo introduced studies on PYY 1562 in 2013 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4027376/). The question becomes: are people willing to accept an injection over an oral medication to improve blood sugars and improve weight loss? Could Novo Nordisk leapfrog LLY by introducing an oral dual-acting drug that is marginally less-effective than the LLY injection drug? These are the questions I ponder given LLY's drug will be a game changer (if there are no side effects). FYI: I think LLY is attempting to get an accelerated path to market from the FDA given the mid-stage results of its phase 2 study. Does anyone have any expertise in this area? Link to comment Share on other sites More sharing options...
Cigarbutt Posted October 11, 2018 Share Posted October 11, 2018 Has anyone analyzed the chances that Eli Lilly's phase 2 mid-stage results could have a long-term impact on NVO's earnings/moat (which I believe has caused much of the drop in the stock)? LLY introduced a dual peptide drug that has resulted in dramatic weight-loss and improvement of blood sugar stability (see: https://pharmaphorum.com/news/lilly-diabetes-unveils-promising-data-from-dual-action-diabetes-drug/). NVO is only in phase 1 for a similar treatment (see: Novo Nordisk PYY 1562), but should move to phase 2 soon (based on what I see, Novo introduced studies on PYY 1562 in 2013 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4027376/). The question becomes: are people willing to accept an injection over an oral medication to improve blood sugars and improve weight loss? Could Novo Nordisk leapfrog LLY by introducing an oral dual-acting drug that is marginally less-effective than the LLY injection drug? These are the questions I ponder given LLY's drug will be a game changer (if there are no side effects). FYI: I think LLY is attempting to get an accelerated path to market from the FDA given the mid-stage results of its phase 2 study. Does anyone have any expertise in this area? Some comments. Going from phase 2 to phase 3 requires larger numbers and, in general, edges end up less than discounted. Also, one has to differentiate statistically significant form clinically significant. The marketing side will put emphasis on the game-changing features but, when long term studies end up being done, they usually don't get much press (popular or financial) coverage because 1-the newer wonder drugs often don't result in significant long term benefits (ie mortality, quality of life) and 2-the hype component goes elsewhere: now for type 2 diabetes, the interest is in cardio-vascular complications and weight loss but, at some point in the future, the interest will be somewhere else. Interesting to follow these developments with a magnifying glass and some people may be very good (or lucky?) with the outcomes of single blockbusters but, from my perspective, would invest in NVO or similar pharmas using Philip Phisher criteria #2 and #3 and determining a reasonable entry point with an adequate long term price power horizon, not based on a single or even a few projects. Sorry for the lack of enthusiasm but I think that the significant breakthrough here came when Banting and Best injected pancreatic extracts into sick candidates and even perhaps secondarily when delayed action formulations were designed but that was before the obesity epidemic. :) -Fisher's relevant criteria used over the longer term 2. Does the management have a determination to continue to develop products or processes that will still further increase total sales potentials when the growth potentials of currently attractive product lines have largely been exploited? 3. How effective are the company’s research and development efforts in relation to its size? If you follow the evolution of "guidelines": https://www.aace.com/sites/all/files/diabetes-algorithm-executive-summary.pdf When the "summary" is 30 pages long... Link to comment Share on other sites More sharing options...
DooDiligence Posted October 11, 2018 Share Posted October 11, 2018 Rumble in the diabetic jungle. Rope-a-dope baby ;) Link to comment Share on other sites More sharing options...
Cigarbutt Posted February 21, 2019 Share Posted February 21, 2019 Patriot Act with Hasan Minhaj on drug pricing, specifically insulin manufactured by Novo and the likes: Nothing to add from my side, though would appreciate any perspectives here. Interesting guy. A lot of what he is describing (including charts) can be found in (for a similar perspective but using a different presentation): http://care.diabetesjournals.org/content/diacare/41/6/1299.full.pdf A few days ago, the HCCI published this: https://www.healthcostinstitute.org/research/publications/entry/spending-on-individuals-with-type-1-diabetes-and-the-role-of-rapidly-increasing-insulin-prices Today, I'm reading Intelligent Fanatics: Standing on the Shoulders of Giants. Chapter 1 is about Henry Wellcome who founded what was eventually amalgamated into GlaxoSmithKline. I would say things have changed and not for the better. The fanatics used to reach heights in order to see further. Now, it's all about non-transparency. I'll be looking out for Martin Shkreli's adaptation of “Principles of Corporate Governance". Link to comment Share on other sites More sharing options...
John Hjorth Posted February 21, 2019 Share Posted February 21, 2019 I will call the HCCI Brief linked to by Cigarbutt materially flawed - in short, a pseudo-analysis. Page 1, lower part: ... A note on drug rebates and coupons: We did not have information on manufacturer rebates onr coupons for insulin, because this information is proprietary and not publicly available. Thus, we measured gross spending using the point-of-sale prices that are reported on a claim for a prescription drug. Rebates and coupons result in lower net spending (for both payers and patients). Although we cannot incorporate data on rebates and coupons into our analysis of total spending or prices, we do provide an illustrative example of their effect – which still indicates that rising insulin prices were the largest river of spending growth for this population. ... Page 10, upper part: ... Recognizing manufacturer rebates and coupons are not trivial, we considered a case where rebates and coupons offset 50% of the gross cost of insulin in each year. This implicitly assumes that the costs offset by coupons or rebates change proportionately with any changes in the point-of-sale cost of insulin. In this case: ... Page 12, upper part: It is possible that manufacturer rebates and coupons for insulin have increased as a share of list prices over the study period. ... <Some Medicare details omitted here, John> ... If similar patterns exist for insulin products, our findings will overstate the percent change in spending and prices. - - - o 0 o - - - Please compare that with the attached screenshot of note 2.1 in Novo Nordisk Annual Report 2018 [Not the same time span as the time span analyzed in the brief, but it confirms the evolution of insulin pricing practices in the US just continues into the extremes - it gets worse for every year that passes. It's a pseudo-analysis, because it's an analysis of what can be analyzed using statistical methods, but about the real issue at hand here there is "just" some assumptions, and disclaimer stated under "Limitations". So in short, the brief assumes itself out of the real issue, which can basically be phrased like this: "Price on your insulin in the US is dependent on who you are and how you're "connected" [by agreements & Health Care regulation]." I come to think about that "hammer & nail" phrase here. Link to comment Share on other sites More sharing options...
DooDiligence Posted February 21, 2019 Share Posted February 21, 2019 I will call the HCCI Brief linked to by Cigarbutt materially flawed - in short, a pseudo-analysis. Page 1, lower part: ... A note on drug rebates and coupons: We did not have information on manufacturer rebates onr coupons for insulin, because this information is proprietary and not publicly available. Thus, we measured gross spending using the point-of-sale prices that are reported on a claim for a prescription drug. Rebates and coupons result in lower net spending (for both payers and patients). Although we cannot incorporate data on rebates and coupons into our analysis of total spending or prices, we do provide an illustrative example of their effect – which still indicates that rising insulin prices were the largest river of spending growth for this population. ... Page 10, upper part: ... Recognizing manufacturer rebates and coupons are not trivial, we considered a case where rebates and coupons offset 50% of the gross cost of insulin in each year. This implicitly assumes that the costs offset by coupons or rebates change proportionately with any changes in the point-of-sale cost of insulin. In this case: ... Page 12, upper part: It is possible that manufacturer rebates and coupons for insulin have increased as a share of list prices over the study period. ... <Some Medicare details omitted here, John> ... If similar patterns exist for insulin products, our findings will overstate the percent change in spending and prices. - - - o 0 o - - - Please compare that with the attached screenshot of note 2.1 in Novo Nordisk Annual Report 2018 [Not the same time span as the time span analyzed in the brief, but it confirms the evolution of insulin pricing practices in the US just continues into the extremes - it gets worse for every year that passes. It's a pseudo-analysis, because it's an analysis of what can be analyzed using statistical methods, but about the real issue at hand here there is "just" some assumptions, and disclaimer stated under "Limitations". So in short, the brief assumes itself out of the real issue, which can basically be phrased like this: "Price on your insulin in the US is dependent on who you are and how you're "connected" [by agreements & Health Care regulation]." I come to think about that "hammer & nail" phrase here. Thanks John. I wonder if flattish net sales after rebates is also happening widely at other pharma co's? I hope someone shows that NVO slide to legislators. Not that they'd understand what they were seeing. Also, not that they'd care since big pharma is the enemy of the people, right? Or is that "the news media is the enemy of the people"? I forget, we have so many enemies now. Link to comment Share on other sites More sharing options...
Cigarbutt Posted February 21, 2019 Share Posted February 21, 2019 After doing a security analysis, it's nice to see reports done by others. Some reports include limitations and disclosures and are probably worth reading. I still like NVO on a long-term basis. If my analysis holds, the revenue and profit (especially) per US patient is still way above what is achieved, for instance per European patient or perhaps per Canadian patient and that may induce inversion thinking. The US drug price regulation will evolve and you have to ask yourself which direction this is going to go before reaching a new equilibrium. Opening the books will be detrimental even, if for some, it will be about collateral damage. Of course, it's the system's fault and the US will go through its own unique way to deal with the distortions but it's possible that there may be private interest entities that will be financially rewarded when they can disrupt the margin as an opportunity. The story of the discovery of insulin is really interesting. The discoverers, atypically, shared their Nobel Prize emoluments with their assistants. These guys didn't know how to "share" according to the capitalist definition. I'm just saying that the pendulum has moved too far in the other direction. The number of Americans who have to skip or ration insulin due to prices, at least to me, doesn't make any sense. In another life, I was involved with regulators as a capitalist and while it is true that you can fool them most of the times, it can be a mistake to consider them stupid. https://fas.org/sgp/crs/misc/IF11026.pdf Link to comment Share on other sites More sharing options...
Cigarbutt Posted February 28, 2019 Share Posted February 28, 2019 I had decided to avoid another annoying post about NVO but listening to a certain Mr. Flatt discussing the importance of informational advantage and downside protection made me change my mind. :) Here's a relevant link: https://assets.realclear.com/files/2019/02/1194_importing.pdf The author has a certain political inclination which is unavoidable in this terrain but does a good job at: -describing the evolving legislative landscape and possible cost-containment bipartisan work that may come out -helping to balance the external reference pricing (countries looking at prices in other countries, in order to lower them) pressures against the free-rider problem (prices in the US may be higher for good reasons, among others) As NVO is continuing its balancing act (new products with new (and higher) prices against cheaper legacy products), I thought the above-mentioned link helped to define potential outcomes. IMO, there are good reasons for prices to be higher in the US but cost containment pressures will keep increasing, whoever is in power, and pharmas should consider putting less focus on superficial marketing and more on the real value that they provide. Most countries in Europe (and Canada) use external reference pricing and Denmark, apparently, does not use it much and has developed its own internal mechanisms to keep drug prices relatively low. Link to comment Share on other sites More sharing options...
DooDiligence Posted March 1, 2019 Share Posted March 1, 2019 I strongly agree with the last paragraph regarding overconsumption of healthcare. We've created a nation of entitled & overmedicated hypochondriacs. Feeling crazy? Take a pill. Want to lose weight? Take a pill. I remember seeing ads for "restless leg syndrome" & thinking that these companies are just dreaming stuff up. Should ads include pricing? Aren't PBM's supposed to produce formularies where patients bear more of the cost for questionable therapies? Who's really paying for drugs that the patient gets cheap or practically free? Why can government set prices for dialysis but not drugs? This is a complicated problem & just thinking about it makes me want to sell everything & buy rental properties. Link to comment Share on other sites More sharing options...
Cigarbutt Posted March 1, 2019 Share Posted March 1, 2019 ... I remember seeing ads for "restless leg syndrome" & thinking that these companies are just dreaming stuff up. ... This is a complicated problem & just thinking about it makes me want to sell everything & buy rental properties. Interesting because you may have nailed it with the restless leg syndrome trivia. https://www.health.com/health/condition-article/0,,20188807,00.html Controversial topic and, unsurprisingly, most people taking pills for this "disease" don't get relief and now are turning more and more to various supplements... First World problem I guess. -----) back to NVO Link to comment Share on other sites More sharing options...
DooDiligence Posted March 1, 2019 Share Posted March 1, 2019 ... I remember seeing ads for "restless leg syndrome" & thinking that these companies are just dreaming stuff up. ... This is a complicated problem & just thinking about it makes me want to sell everything & buy rental properties. Interesting because you may have nailed it with the restless leg syndrome trivia. https://www.health.com/health/condition-article/0,,20188807,00.html Controversial topic and, unsurprisingly, most people taking pills for this "disease" don't get relief and now are turning more and more to various supplements... First World problem I guess. -----) back to NVO "New or intense gambling, sexual or other urges" that ought to sell a ton of this stuff ;D Is it at all effective for Parkinson's? --- My weak bullish pushback on a sector of pharma that doesn't treat nonsense like RLS, but does throw up a lot of ads. NVO could withstand a good bit of margin compression & still produce a lot of cash for shareholders. I like their market position & they were doing buybacks before buybacks were cool 8) https://www.igeahub.com/2018/05/19/top-10-pharmaceutical-companies-2018-diabetes/ https://www.statista.com/statistics/309730/top-anti-diabetic-pharmaceutical-companies-by-market-share-worldwide/ Novo would be the last thing I'd sell to buy real estate. But CVS, maybe. Link to comment Share on other sites More sharing options...
Cigarbutt Posted March 1, 2019 Share Posted March 1, 2019 ^There are certainly headwinds that seem immediate but there are tailwinds also: -From the CDC, the rate of type 2 diabetes increased from 0.93% of the U.S. population in 1958 to 7.4% in 2015, before "jumping" to 9.4% by 2017. It’s projected to rise to more than 30% by 2050 if current trends persist. -From the WHO (not the band):), the global rate of type 2 diabetes rose from 4.7% of the population in 1980 to 8.5% in 2014. Whatever happens, probably the last thing one wants to do, if long-term thinking is the framework, is to get restless. Sidenote: The treatment results for Parkinson's have been quite disappointing (over the last decades). Efforts to bring products to the market (including Requip) have so far failed (in terms of significant value added to the person) to demonstrate true neuroprotective or disease-modifying effects. At most, some kind of delay of progression with some side effects can now be temporarily hoped for. I hope you stay healthy to enjoy your NVO dividends in the next 20 to 30 years or more. Link to comment Share on other sites More sharing options...
John Hjorth Posted March 3, 2019 Share Posted March 3, 2019 I had decided to avoid another annoying post about NVO but listening to a certain Mr. Flatt discussing the importance of informational advantage and downside protection made me change my mind. :) Here's a relevant link: https://assets.realclear.com/files/2019/02/1194_importing.pdf The author has a certain political inclination which is unavoidable in this terrain but does a good job at: -describing the evolving legislative landscape and possible cost-containment bipartisan work that may come out -helping to balance the external reference pricing (countries looking at prices in other countries, in order to lower them) pressures against the free-rider problem (prices in the US may be higher for good reasons, among others) As NVO is continuing its balancing act (new products with new (and higher) prices against cheaper legacy products), I thought the above-mentioned link helped to define potential outcomes. IMO, there are good reasons for prices to be higher in the US but cost containment pressures will keep increasing, whoever is in power, and pharmas should consider putting less focus on superficial marketing and more on the real value that they provide. Most countries in Europe (and Canada) use external reference pricing and Denmark, apparently, does not use it much and has developed its own internal mechanisms to keep drug prices relatively low. I'm sorry for a late reply here, I'm gradually surfacing from being sick within the last week+. This piece from Freedom Works Foundation certainly has merit. In a way, it represents a new line of thinking, and - albeit also - represents some mental [political [<- ?]] constraints to the line of thinking about the whole diabetes issue for the US. - - - o 0 o - - - For a NVO investor, the whole thing appears just soo frustrating, short or medium term. Link to comment Share on other sites More sharing options...
John Hjorth Posted March 4, 2019 Share Posted March 4, 2019 Just as we talk : Eli Lilly & Co. - Press Release [March 4th 2019] : Lilly to Introduce Lower-Priced Insulin. Eli Lilly & Co. - LillyPad [March 4th 2019] : A Catalyst for More Affordable Medicines. - - - o 0 o - - - How difficult is the whole thing actually? - How many flies slapped here in one swing? [i can count at least more than one!] - - - o 0 o - - - Perhaps somebody is now waking up at Novo Allé 1, DK-2880 Bagsværd. Link to comment Share on other sites More sharing options...
Recommended Posts
Create an account or sign in to comment
You need to be a member in order to leave a comment
Create an account
Sign up for a new account in our community. It's easy!
Register a new accountSign in
Already have an account? Sign in here.
Sign In Now