FT : US charges 200 times UK price for common worm pill

US charges 200 times UK price for common worm pill
Impax sells childhood infection treatment course for $880, against £3.50 in Britain

A US drugmaker has put a price tag of more than $800 on a pinworm treatment — 200 times more expensive than the equivalent medicine on British pharmacy shelves, in the latest example of “price gouging” in the world’s largest healthcare market.

Impax Laboratories started selling mebendazole this year at an average wholesale price of $442 per pill, according to figures seen by the Financial Times, which were checked with several US pharmacy chains including Walgreens and CVS.

Most cases of pinworm, a parasitic infection also known as threadworm, require two pills, meaning a course of treatment costs about $884. The drug is available prescription-only in the US but can be bought over the counter in the UK, where Boots, a British chemist chain, charges £6.99 for a pack of four pills, or £1.75 each.

The pinworm parasite, which is common in children, affects 200m people a year worldwide and up to 40m in the US. It is recommended that family members are treated for the highly contagious infection at the same time, meaning a household of five’s treatment costs more than $4,400.

Mebendazole was first used to treat pinworm and other parasitic infections in the 1970s and is on the World Health Organisation’s list of essential medicines. In the developing world it can be bought for less than 1 cent per pill.

The drug was available as a cheaper generic version priced at around $1.60 per pill until 2011, when it was removed from the market by Teva, the manufacturer, without explanation.

Impax reintroduced a branded version of the pill, Emverm, in April, and is the only provider of mebendazole tablets in the US. It is also the only purveyor of albendazole pills, which treat other parasitic infections, and which doctors sometimes prescribe for pinworm.

“In my opinion, this is the latest example of a pharma bad actor cornering the US market and taking advantage of payers and consumers,” said Michael Rea, chief executive of Rx Savings, which makes software to help reduce the cost of medicines.

Impax declined to comment.

Impax is not a household name, but the group briefly gained notoriety in 2015 after it sold Daraprim, a life-saving drug for Aids and cancer sufferers, to a company controlled by Martin Shkreli, the disgraced pharma entrepreneur.

Mr Shkreli swiftly raised the price of Daraprim from $13.50 to $750 a pill, prompting an international outcry. Like mebendazole, Daraprim was first discovered decades ago, appears on the WHO’s essential medicines list, and is available in developing countries for just a few cents.

Critics say the reintroduction of mebendazole at such a high price more than 40 years after it was first used by doctors — and decades after its patents expired — shows how drugmakers are able to charge huge sums for old medicines that cost them little to develop.

“We’ve been seeing isolated examples of generic price gouging — individual products that become essentially single source, which are able to take enormous price increases,” said Steve Miller, chief medical officer of Express Scripts, a US pharmacy benefits manager that negotiates drug prices on behalf of employers and insurers.

Impax has not released sales figures for the medicine since it went on sale eight months ago, but David Amsellem, analyst at Piper Jaffray, estimates the market could be worth nearly $300m per year.

In its third-quarter earnings, Impax said it would be “building awareness that mebendazole is back” and told investors that Emverm was the “only prescription therapy for pinworm” approved by the US Food and Drug Administration.

For families with good healthcare coverage, their insurer would pick up most of the cost. But a growing number of Americans on cheaper insurance plans contribute up to 50 per cent of the price.

Families unable to afford the medicine must use a powder formulation, pyrantel pamoate, which has not been approved by the FDA. The formula is less effective than mebendazole and can cause side effects such as toxicity in the central nervous system, according to Stanford University.

>>> Barrons Week End Summary

Barrons weekend summary: cautious on DIN, NKE 

* Cover story: Barron's suggests that president-elect Donald Trump should take steps to make U.S. trade policy freer than it is now after a backslide during the past 15 years; Any aggressive push by Trump to hike tariffs will face resistance from a Republican-dominated Congress that has traditionally supported trade liberalization. 

* Features: 1) Story says the bull market has legs, and that after a strong post-election really, Wall Street's top strategists see stocks rising by 5% in 2017; 2) Cautious on DIN: Shares and profits are down this year on sluggish traffic and menu misfires, and the stock could lose up to 30% more during the next year as management implements a turnaround.

* Tech Trader: Consumer technology is faltering, while the building of what's known as infrastructure for companies to use for data processing is on the rise-and 2007 should see a sharper divided than usual between the two sectors. 

* Trader: "Stocks look ready to deliver double-digit gains in 2016, but 2017 could be the year of living dangerously"; Since 1928, a Republican has taken the White House from a Democrat four times, and after each occurrence the market fell by about 10% during the new president's first year; Cautious on NKE: Apparel giant seems unable to keep pace with a changing footwear landscape, and could find itself on the wrong side of Donald Trump's policy goals; A strong dollar puts U.S. investors in a bind when it comes to global investing. 

* Profile: Tom Bohjalian, manager of the Cohen & Steers Real Estate Securities fund, screens REITs to identify those with the highest standard deviations, based on price-to-net-asset value and price-to-dividend-discount (top 10 holdings: SPG, PLD, UDR, HCP, BRX, AIV, EQIX, DLR, ESS, ARE). 

* Interview: Robert Willens, a leading tax and financial-accounting expert on Wall Street, talks about the potential impact of Donald Trump's tax cut proposals on individuals and corporations. Small Caps: Barron's top picks for 2017 include, AMC, SSP, HMHC, RELY, EQC-the sole holdover from last year's list-all of which are likely to deliver gains for investors. 

* Follow-Up: Positive on CBS: Investors should hold onto the network's shares, which could return another 10% during the next year, but sell VIA shares, which are likely to go down.

* European Trader: "The outlook for European equities is surprisingly bright going into 2017, given the political clouds gathering around the eurozone and the broader European Union" (Positive on Wolsely, BTI, Inditex, EUFN). 

* Asian Trader: "In 2017, conversations about Asia will be dominated by the Japanese yen and the Chinese yuan, as Asia's two most important currencies continue their race to the bottom," offering opportunities in both the Nikkei and China's A shares. 

* Emerging Markets: The one near-certainty for emerging markets is that there will be volatility, providing equity investors with buying opportunities. 

* Commodities Corner: "Commodities should deliver their best annual performance in years, and traders think the rally will roll on in 2017." 
* Streetwise: Uncertainty next year could be further complicated if the unwinding of a 35-year bond bull market becomes unruly.

>>> Edison has Italmobiliare teaming together with F2i in bid for 20-25% stake -

Edison has Italmobiliare teaming together with F2i in bid for 20-25% stake

Investment group Italmobiliare [BIT:ITM] is teaming up with Italian infrastructure fund F2i in a bid for a 20-25% stake in Italian energy group Edison, Italian language daily Il Sole 24 Ore reported. The unsourced report said that the two partners will either take an equal stake in Edison or F2i a slightly smaller one.

The report noted that Edison is presently 100%-owned by EdF [EPA:EDF], the French energy group. The item added that EdF appears to be leaning toward a sale.

The item cited market rumours claiming the consortium is interested in taking a 20%-25% stake in Edison for around EUR 1bn.

>>> British American Tobacco thinking about increasing offer for Reynolds Americ

British American Tobacco thinking about increasing offer for Reynolds American by USD 8 per share - http://bit.ly/2gZPES1

British American Tobacco [LON:BATS] is mulling a USD 8 (GBP 6.40) per share increase to its USD 56.50 per share takeover bid for Winston-Salem, North Carolina-based rival Reynolds American [NYSE:RAI], The Sunday Times reported. The newspaper cited one unspecified source for the information.

BAT is looking to acquire the 58% of Reynolds American shares that it does not already own. The report cited City and Wall Street sources who said UK-based tobacco company is believed to have indicated that it is prepared to sweeten its existing bid by increasing the cash component of the offer. The offer as it stands values Reynolds at USD 47bn.

Approximately 43% of BAT’s offer is cash, with the remainder of the offer comprised of its own shares, the item said. BAT shares have lost 6% of their value since it announced its offer, the article noted.

Bankers working on the deal believe a deal will be agreed early next year, although a deal announcement could come next week, the report continued.

Reynolds American’s share price closed USD 0.11 down at USD 55.54 in New York on Friday, 16 December, giving the company a market capitalisation of USD 79.18bn.

Barron's : Everyone’s Optimistic About the Markets. Is It Time to Worry?

Everyone’s Optimistic About the Markets. Is It Time to Worry?
The consensus is that the positive things that Trump has promised for investors will come to pass in . But will they?

Brother, can you paradigm?

The Bank for International Settlements, the central bank for central banks, posed the question “A paradigm shift in markets?” in the title of its latest quarterly report. One infers that it was not meant to be rhetorical, even though it was not answered directly, as might be expected from typically elliptical central bankers.

Clearly, the U.S. election results have produced marked changes in asset markets, with stocks, bond yields, and the dollar all higher. Those moves have been based on expectations of strong growth in the economy and corporate profits, along with higher inflation. But as for an actual change in paradigm in terms of how the economic and financial world works, that’s still in the future.

Even so, the expectations are so strong as to border on certainty that the platforms on which Donald J. Trump campaigned for the presidency will be enacted as he presented them, and promptly. To be sure, after his inauguration on Jan. 20, odds favor the Republican-controlled Senate and House of Representatives approving the Trump program—that is, assuming there are no weird upsets in the Electoral College count Monday. But there is no sure thing, no matter the odds, as this bizarre year has proved dramatically.

Those expectations are encapsulated in the forecasts for the economy and markets for the coming year, a sample of which appears in our Outlook 2017 section. After dutifully perusing the deluge of predictions that land in email in-boxes this time of year, we find a similarity that calls to mind Dorothy Parker’s acid review of Katharine Hepburn, who she said “runs the gamut of human emotion from A to B.”

The range of projections seem about as narrow, with most forecasts of gross domestic product clustering around 2% growth, after inflation. Interest rates, as represented by the 10-year Treasury note, could move somewhat higher, perhaps to 3% from 2.59%. U.S. stocks should provide returns in the mid-single-digit percentage range, with a modal estimate for the Standard & Poor’s 500 index of 2400 by New Year’s Eve 2017, from 2258 on Friday.

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This tight consensus, envisioning such benign outcomes, recently moved not one, but two sage market observers—David Rosenberg, Gluskin Sheff chief economist and strategist, and Doug Kass, head of Seabreeze Partners—to invoke Rule No. 9 of Bob Farrell, Merrill Lynch’s legendary former market guru: “When all the forecasters and experts agree, something else is going to happen.”

After a year that featured not one, but two electoral shocks—Brexit and Trump—both of which stunned the markets and initially sent them sprawling, such certainty seems surprising, at the very least.

What’s especially striking is the absence of uncertainty evident in various risk measures. The CBOE Volatility Index, or VIX, which measures premiums on S&P 500 options, hovers near the year’s lows around 12; that indicates buyers of put options, which hedge against price declines, are loath to pay up for downside insurance.

That serene confidence also is evident in the high-yield bond market, where investors are settling for 4.2 percentage points in extra yield over Treasuries as compensation for the risk they bear, according to the Bank of America Merrill Lynch Master II High Yield Index. That’s less than half the 8.64 percentage points they demanded last February amid the slide in energy and other commodity prices, which imperiled the balance sheets of many highly leveraged producers of oil and metals, and the least since September 2014.

The consensus also assumes a President Trump will follow through on some of his plans on Day One of his administration, at least those that don’t need congressional approval. Among them is to declare China a currency manipulator for allegedly pushing down the yuan to gain an advantage for exports.

The Chinese currency has been weakening steadily, nearing the psychologically important mark of seven to the greenback. In that regard, the yuan is hardly alone in losing ground to the surging dollar, which has gotten a further boost from the Federal Reserve’s one-quarter percentage-point interest-rate hike last week and its announced expectation of three more such moves in 2017. Compared to the currencies of its other trading partners, however, China’s yuan has been relatively stable.

China also hasn’t fulfilled all of the U.S.’s four criteria to be declared a currency manipulator: at least $55 billion in trade with the U.S. a year, a $20 billion trade surplus with the U.S., a current-account surplus equal to 3% or more of GDP, and purchases of foreign assets equal to more than 2% of GDP. On the latter score, China has been dumping its foreign-currency assets, notably U.S. Treasury securities. According to the most recent Treasury Department data released last week, Japan has supplanted China as the largest foreign holder of Treasuries.

China, in fact, has been liquidating foreign assets at a rapid pace to stabilize the yuan, or at least slow its descent—precisely the opposite of accusations that Beijing is pushing it lower. The Chinese monetary authorities are fighting capital flight, as individuals try to get their legal $50,000 a year out of the country and businesses make acquisitions, in no small part also to move money abroad. The result has been akin to a bank run, with Chinese government bonds crashing last week, forcing a halt in bond futures trading, amid the slide in the yuan.

China also puts great symbolic importance in the yuan’s being added to the International Monetary Fund’s Special Drawing Right, which officially took place on Oct. 1. With its currency reeling despite its support, being accused by Washington of manipulating it in the opposite direction would be an affront to Beijing.

At a gathering of some high-powered investment minds last week, one in attendance suggested such a scenario could provoke a confrontation in the South China Sea to test the new Trump administration. Events on Friday seemed to overtake such speculation after a Chinese warship seized an underwater survey drone used there by a U.S. Navy oceanographic survey ship.

Such geopolitical disturbances aren’t discounted by the serenely confident markets. They also assume that Trump’s fiscal plans will sail through Congress almost immediately, especially his tax cuts, which have substantial support among Republicans, who control both houses. The possibility of opposition from staunch deficit hawks to either tax cuts or an increase in the federal debt ceiling, which will be needed in a few months, falls outside the consensus.

Another possibility raised at our gathering: Some GOP stalwarts may push a Supreme Court nomination to fill the vacancy left by the late Justice Antonin Scalia as a first priority. That could delay any fiscal action, which might mean no stimulus would be felt until perhaps 2018, and doesn’t figure into the 2017 relatively rosy outlook.

One other possible skunk that could ruin the bulls’ picnic could be a renewed swoon in oil prices. A year ago, as noted, crude prices were in near free fall, which threatened the solvency of much of the junk-bond market and other lenders to the energy sector. Since oil has returned to the $50-a-barrel range, the stock and high-yield bond markets have recovered, with equities hitting records and the Dow Jones Industrial Average nearing the 20,000 mark.

Saudi Arabia’s agreement to produce just over 10 million barrels a day, from a peak of 10.7 million in July, has been key. One motivation might be to bolster oil stocks, as the Saudis prepare their initial public offering of shares in Aramco, which could be the biggest IPO in history. Whether the Saudis would continue to curb output—and with it, much needed revenue—once the IPO is placed is another question raised at this salon. As the past couple of years have shown, as goes crude, so goes the stock market.

None of these developments qualify as black swans, to be sure. But looking ahead to 2017, there seems to be heady anticipation that the positives promised from November’s elections will come to pass, and quickly. Yet the record of 2016 is that what was expected didn’t happen, and what couldn’t happen, did. That suggests risks ahead—and opportunities for those ready to pounce on them and having the cash to do so.

ANOTHER POSSIBLE SURPRISE: The tax exemption of municipal bonds could be targeted as an offset to the cost of the Trump tax cuts, according to a public-finance lobbyist at a recent conference quoted by Bloomberg. Munis’ tax exemption is projected to cost the Treasury about $420 billion between 2017 and 2026, relatively small change in Uncle Sam’s couch cushions.

Munis have fared poorly in the bond selloff, since tax cuts would reduce the appeal of tax-free income. That has gone too far, as colleague Amey Stone quotes John Mousseau, head of fixed-income investing at Cumberland Advisors in Sarasota, Fla., in Barrons.com’s Income Investing blog. Long-term munis with double- and single-A ratings are yielding 4% to 4.25%, more than comparable Treasuries, even without the tax advantage. “These yield levels need to be embraced,” Mousseau writes rather passionately. Muni yields also tend to fall, relative to those of taxable bonds, in a rising-rate environment, he adds.

Much of the rise has been due to bond-fund redemptions, which probably also has been spurred by tax-loss selling. Even harder hit have been closed-end muni funds, which Amey also reported were upgraded last week by Stifel Nicolaus analyst Alexander Reiss, who presciently downgraded a bunch last August near their peak prices. Sell high, buy low—a concept that could catch on in 2017?

Barron's : Japanese, Chinese Shares to Lead Asia in 2017

Japanese, Chinese Shares to Lead Asia in 2017
The yen and yuan will fall further, supporting both Tokyo and Shanghai stocks. Sony looks attractive.

In 2017, conversations about Asia will be dominated by the Japanese yen and the Chinese yuan, as Asia’s two most important currencies continue their race to the bottom. We think the falling currencies will provide opportunities in both the Nikkei and China’s A shares.

Morgan Stanley, which made the correct—and contrarian—bullish call on the yen a year ago, now sees the currency weakening all the way to 130 per dollar by the middle of 2018. The yen has fallen by about 12%, to 118 to the dollar, since Donald J. Trump won the U.S. presidency, but it has room to fall further. Driving the yen down will be the countries’ divergent rate policies. The yield on the 10-year U.S. Treasury will be pushed up to 2.75% in 2017 from about 2.56% last week, while the Bank of Japan will continue to buy bonds to keep its benchmark 10-year Japanese government bond yield at 0%, argues strategist Jonathan Garner. Morgan Stanley sees the U.S. Federal Reserve following last week’s rate hike with five more, pushing the federal-funds rate to 1.875% by the end of 2018 from last week’s 0.625%.

A weaker yen is good news for export-oriented Japan. Companies listed on the broad Topix stock index get about 40% of their revenue from overseas, so a weaker yen could propel the Topix to 1800 by the end of 2017, or roughly 17% above last week’s level, says Garner. Morgan Stanley expects Japanese companies to grow earnings by 28% in 2017, redeeming a bruising 16% slump in corporate profits this year.

Burned by ineffective central-bank policies, foreign investors on balance sold $37 billion of Japanese stocks in 2016, in effect canceling all of their purchases since 2013. But they’re heading back. The latest Bank of America Merrill Lynch survey shows that institutional investors’ allocation to Japanese stocks jumped from net 5% underweight in November to net 21% overweight in December, a U-turn since Trump’s victory. In the past month, foreigners net bought over $14 billion of Japanese stocks. The iShares MSCI Japan exchange-traded fund (ticker: EWJ) returned 6.8% in 2016. Morgan Stanley now favors Japan’s exporters and is bullish on cosmetics maker Kose (4922.Japan), Sony (SNE), and Sumitomo Mitsui Financial Group (SMFG).

Garner, who downgraded Chinese stocks in May 2015, just ahead of Shanghai’s spectacular summer crash, thinks that China’s mainland market is “re-entering a bull market.” He expects the Shanghai Composite Index to hit 4400 next year, which would be a 40% gain in yuan terms. Garner’s reasoning is simple: Individual investors’ money has to go somewhere. As the government curtails the property bubble, retail capital will be drawn back into stocks. Individuals already own more than 40% of mainland stocks.

China’s onshore markets are quieter these days, but bullish spirits are still alive. Both the Shanghai and Shenzhen markets trade at a 30% premium to their five-year averages, “a major difference in comparison with the prolonged bear market of the 2010 to 2014 period,” says Garner. In addition, corporate China seems to be recovering, with producer price inflation recently hitting a five-year high. Morgan Stanley expects corporate earnings to grow by 7% in 2017, versus a 9% decline in 2016.

We shouldn’t expect another fast and furious run in Shanghai like the one in the spring of 2015. The government is now more vigilant in restricting trading excesses. For example, Beijing this month cracked down on what it called the “barbaric” practice of insurance companies borrowing money to buy blue-chip stocks. New limits sent a rallying market down 5%. Clearly, the government wants measured increases, and that’s what investors should expect.

BY COMPARISON, Morgan Stanley is more cautious toward Hong Kong and U.S.-listed Chinese stocks, because of the yuan. Unlike Japanese exporters, publicly listed Chinese companies are mostly domestic and unaffected by the dollar. And unlike in mainland China, Hong Kong and other foreign-listed Chinese companies make money in yuan but report earnings in dollars. (The Hong Kong dollar is pegged to the U.S. dollar.) Since Morgan Stanley sees five more rate hikes, it thinks the U.S. Dollar Index could hit 109 by the end of 2017, from 102.8 now. As such, the bank forecasts that the yuan will weaken further, from 6.96 to 7.30 in 2017 and 7.43 in 2018.

Going “naked long” on U.S.-listed companies such as Alibaba Group Holding (BABA) is dangerous, says Junheng Li, founder of China research firm JL Warren Capital. She notes that Chinese companies use the yuan’s current spot rate when forecasting 2017 earnings, so they could miss guidance quarter after quarter if the yuan gets weaker.

In the mainland China market, Morgan Stanley favors Spring Airlines (601021.China), hydropower generator China Yangtze Power (600900.China), and drugmaker Jiangsu Hengrui Medicine (600276.China).