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Outlook 2020: Pharmaceuticals Negative On M&A, Opioid Litigation

S&P Global Ratings' outlook for the pharmaceutical industry is negative for 2020, reflecting our expectation for downgrades to exceed upgrades. This is consistent with the industry's distribution of outlooks and CreditWatch placements of 31% negative and 7% positive as of Dec. 31, 2019 (Chart 1). We continue to view the industry as having many strengths, including relatively high profitability (even after accounting for the high costs of research and development), strong barriers to competition, relative insensitivity to the business cycle, and the essential life-saving and life-enhancing nature of products, all of which support high ratings, particularly in large diversified companies.

However, we forecast two primary sources of downward pressure on ratings:

  • Continued merger and acquisition (M&A) activity: We expect cash and debt-financed transactions will weigh on credit metrics in 2020, but less consolidation among large pharmaceutical companies.
  • Advances to opioid litigation: We believe a broad opioid-related settlement is more likely in 2020, raising the potential for significant legal liabilities associated with the marketing and distribution of opioid products, but also less uncertainty.

Table 1

Pharmaceutical Industry Overview
Updated Expectations For 2020 Expectations Consistent With 2019
Less total M&A: We think pharma mergers and acquisitions (M&A) will reach a lower gross dollar total in 2020 than in 2019, given our expectation for fewer megadeals, but we still expect elevated business development. Negative outlook: We expect downgrades to exceed upgrades.
Little change from regulation/legislation: We do not expect this to fundamentally change the U.S. pharmaceutical market in 2020. A year ago, we thought the bipartisan political rhetoric and social pressure would result in meaningful legislation in the near term related to drug rebates and government drug purchases. Difficulty raising prices: Pharmacy benefit managers, public scrutiny, and legislation have reduced the ability of pharmaceutical companies to annually raise prices in the U.S., lowering potential revenue and margin expansion in the industry.
More certainty to opioid litigation: A broad settlement is more likely to advance in 2020, providing more certainty on the total exposure, particularly for larger pharmaceutical companies involved. Predictability in the EU and the rest of the world: Drug market dynamics remain relatively stable, and we do not expect a single country to materially affect credit metrics.
Increased uptake of biosimilars in the U.S.: We expect growth in biosimilars, especially in more episodic conditions, but the ratings implication is neutral. More drug approvals: We expect a strong pace of U.S. Food and Drug Administration approvals for new drug applications, biologics license applications, and abbreviated new drug applications, likely with a similar or slightly higher approval total compared to 2019.

Rating Trends In The Pharmaceutical Industry

Pharmaceutical sector ratings deteriorated over the past three years (2017-2019), with 26 downgrades and seven upgrades. Despite pockets of operating weakness, including a push to limit price increases on branded products and intense pricing pressure in the generic pharmaceutical product market, the majority of investment-grade downgrades (15 of 21) stemmed from M&A activity. For more details on the drivers of historical rating actions in the sector, see our report, "Lessons Learned: What Leads To Rating Changes For Investment-Grade Pharmaceutical Companies," published Jan. 22, 2019.

Chart 1

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Chart 2

image

M&A Will Likely Continue And Higher Net Leverage Could Weigh On Ratings

While we believe a strong pace of M&A is likely to continue in 2020, we expect the total dollar value of transactions announced to decline year-over-year because of reduced capacity and appetite for consolidation among big pharma. Total M&A activity accelerated in 2019, with a number of sizable transactions.

Table 2

Largest Pharmaceutical M&A Transactions In 2019
Date Announced Acquirer Target Approx. Transaction Value Type of Transaction
Jan 3, 2019

Bristol-Myers Squibb Co.

Celgene Corp.

$74 billion Scale in oncology and pipeline
Jan 7, 2019

Eli Lilly & Co.

Loxo Oncology $8 billion Targeted oncology platform
Feb 25, 2019

Roche Holding AG

Spark Therapeutics $4.3 billion Gene therapy platform
May 8, 2019

Novartis AG

Xiidra (Takeda) $5.3 billion* Scale in ophthalmology
June 17, 2019

Pfizer Inc.

Array Biopharma $11.4 billion Targeted oncology platform
June 25, 2019

AbbVie Inc.

Allergan PLC

$63 billion Diversification
July 29, 2019

Upjohn Co. (Pfizer)**

Mylan N.V.**

$50 billion** Scale in off-patent and generic drugs
Aug 20, 2019

Elanco Animal Health Inc.

Bayer AG animal health

$7.6 billion Animal health scale/diversification
Aug 26, 2019

Amgen Inc.

Otezla (Celgene) $13.4 billion Psoriasis/inflammation drug
Nov 24, 2019

Novartis AG

The Medicines Co. $9.7 billion High cholesterol drug in development
*Novartis/Takeda deal terms include a $3.4 billion upfront payment with potential milestone payments of up to $1.9 billion.
**Pfizer is spinning off its Upjohn segment and combining it with Mylan to create a new company, Viatris. The $50 billion approximation is based off of Mylan’s equity value and the company’s guidance the combined entity will have approximately $24.5 billion of debt.

We expect robust M&A activity will continue in 2020, although at a slower pace than in 2019, for several reasons:

  • Greater difficulty increasing revenue from a reduced ability to raise prices.
  • Gaps in product pipelines that require acquisitions to fill out a medium-term pipeline and diversify from maturing products.
  • Desire to add emerging technology including gene and cell therapy.
  • Need for differentiated treatment options in crowded but fast-expanding oncology, especially immuno-oncology and gene-targeted medicine.

Companies are frequently investing in longer-term development assets (phase I and II assets and development platforms), and the high premium on these assets and multiyear development period without revenue can compound the impact on credit metrics. We believe acquisitions offer economies of scale and diversification, but often higher leverage more than offsets benefits to the business. This is exacerbated by the current social pressure to reduce reimbursement for medicines that could lower the commercial outlook for future products.

Underlying continued M&A, we believe financial policy is modestly eroding across large pharmaceutical companies, as issuers now have full access to global cash balances following tax reform. The largest issuers are increasing average net debt to EBITDA from historical levels and holding lower cash balances (Chart 3), which we do not expect to return to pre-tax reform levels.

Chart 3

image

In 2020, we expect M&A to focus on small and midsize pharma companies rather than consolidations of large companies like Bristol-Myers Squibb Co./Celgene Corp. or AbbVie Inc./Allergan PLC. A number of companies announced significant transactions in 2019 (including Pfizer Inc., Novartis Inc., Amgen Inc., and Eli Lilly & Co.), firming up pipelines and using up some financial capacity. Moreover, we do not think companies such as Gilead Sciences Inc. (which has an above-average ability to pursue M&A) are likely to combine with a large pharma company because of the advantages of a more nimble, biotech-like company culture and the desire for pipeline assets (as opposed to the benefits of immediate scale and revenue diversification). In addition, the U.S. Federal Trade Commission (FTC) could be making consolidation more difficult. For example it required Bristol-Myers and Celgene to divest Otezla before approving the combination and made a second request for information regarding to the AbbVie/Allergan transaction.

Also discouraging large-scale M&A, market valuations of large pharmaceutical companies appear to be near a multiyear high (Chart 4).

Chart 4

image

Our report, "Big Pharma's Renewed Appetite For M&A Will Put Pressure On Ratings," published Feb. 1, 2019, examines our view of pharma M&A in general, how much capacity each company has within the current rating, and which are most likely to pursue M&A.

Opioid Litigation Could Reach A Settlement In 2020

After one trial in Oklahoma, a flurry of settlements in two Ohio counties, and a proposed global settlement framework, we believe 2020 could bring more clarity to the range of outcomes in opioid litigation, especially for larger defendants. We believe many plaintiffs and defendants have incentive to reach a swift resolution. Plaintiffs gain by directing funds to communities and add a victory to political resumes, lawyers receive payment in the near term, and defendants remove a source of uncertainty weighing on equity prices and shift focus back to operating their businesses. We think the foundation set by the proposed global settlement framework, agreed upon by four state attorneys general, McKesson Corp., Cardinal Health Inc., AmerisourceBergen Corp., Johnson & Johnson, and Teva Pharmaceutical Industries Ltd. will aid nationwide negotiations in 2020. Despite recent reports that more than 20 states rejected the initial proposed framework, we believe broader settlement talks could heat up as trials in New York (expected in March) and West Virginia approach because both parties will likely favor avoiding the expense and uncertainty of a courtroom appearance.

We are less confident that smaller defendants will reach a broad settlement in 2020 because we think a settlement of the size proposed, even if paid over a number of years, could be difficult for smaller participants to digest. It is not clear which companies will be included in future trials, but the following rated companies were named as defendants in complaints consolidated into the opioid multidistrict litigation: Endo International PLC, Mallinckrodt PLC, Allergan PLC, Mylan N.V., and Amneal Pharmaceuticals LLC.

Notably, Endo already agreed to settlements in two counties in Ohio and Oklahoma for relatively small amounts, but Mallinckrodt agreed to larger settlements and has much less balance sheet flexibility. We think Allergan, Mylan, and Amneal are less exposed to a large liability because of more limited opioid product portfolios and relatively low attention from plaintiffs. That said, the uncertainty of litigation could make it more difficult to refinance debt, especially for companies we rate lower.

We have a negative outlook or CreditWatch placement on several pharmaceutical companies with exposure to opioid litigation, including Teva, Endo, and Mallinckrodt. Below is our approximate capacity for discounted, tax-adjusted litigation liabilities at each company (Table 3), and we could consider lower ratings if litigation liabilities exceed those thresholds as of September 2019.

Table 3

Estimated Capacity For Legal Liabilities At Current Rating For Pharmaceutical Manufacturers
As of September 2019
(Bil. $) Issuer Credit Rating S&P Global Ratings-Adjusted EBITDA LTM S&P Global Ratings-Adjusted Debt to EBITDA LTM (x) Downgrade Threshold (S&P Global Ratings-adjusted debt to EBITDA) (x) Cumulative DCF (before share repurchases) for the forecast horizon Estimated Incremental Capacity For Legal Liabilities at Current Rating
Investment Grade

Johnson & Johnson

AAA/Stable/A-1+ 30.8 0.9 1.5 19 20-30

Allergan PLC

BBB/Watch Pos 7 3.2 4 6.5 7-10

Mylan N.V.

BBB-/Developing/A-3 3.4 4 3.5§ 4-5 ~3
Speculative grade

Teva Pharmaceutical Industries Ltd.

BB/Watch Neg/-- 4.7 6.2 5.5§ 2 ~2*

Endo International PLC

B/Negative/-- 1.3 5.8 8 0.4-0.5 2

Amneal Pharmaceuticals Inc.

B/Negative/-- 0.4 6.3 7.5-8 0-0.1 0.5

Indivior PLC

B/Negative/-- 0.35 2.1 5 Negative ~0.5-1

Mallinckrodt PLC

CCC/Negative/-- 1.4 4.1 N.A.† 0.6-0.7 N.A.†
Note: Debt capacity shown reflects the downside cushion to the leverage threshold plus one to two years of discretionary cash flows for deleveraging. This assumes (1) EBITDA is relatively flat over the next one (for speculative-grade issurs to two years (for investment grade), (2) that we believe the company will prioritize deleveraging over the next one to two years, (4) The company suspends all share buybacks over the next one to two years, (5) and that there aren't other elevated risks to our base case. In contrast, capacity would be lower if the company weren't committed to prioritizing deleveraging or if the leverage was raised for the sake of shareholder returns. DCF--Discretionary cash flow. N.A.--Not available. E--Estimate. LTM--Last 12 months.
*$2 billion includes the $646 million of reserves already recorded on the balance sheet.§Target to be achieved over time.†Tied to liquidity constraints or risk of a distressed exchange. **Two years for invesment grade, one for speculative. Mylan's estimated capacity is proforma for announced transaction.

See our article, "Opioid Litigation Developments Point To Increased Liability And Downgrades For Global Drug Manufacturers", published Sept. 23, 2019.

U.S. Drug Pricing Reform Presents A Downside Ratings Risk, But We Believe Legislation Is Unlikely To Pass In 2020

With drug pricing a prominent policy issue in the 2020 U.S. presidential election, we expect continued media attention and negative headlines for the industry. Nevertheless, given elevated partisan dynamics in an election year, we don't expect meaningful legislation to pass before the election. There is a wide variety of proposals for drug price reform among legislators and the administration, but we do not have a strong view on which are more likely to be successful.

Drug pricing reform is likely to occur eventually given the unsustainable growth in pharmaceutical spending (about 4%-5% annually). We believe over time, regardless of regulation, the industry's profit margins will contract moderately because of more difficulty negotiating annual price increases. That said, we think new, innovative products will still set high prices, and the industry's relatively healthy fundamentals will continue to attract capital and fund innovation.

For more on drug pricing initiatives and how they might disproportionately affect certain ratings, see our report, "Which Pharma Company Ratings Could Be At Risk If U.S. Drug Pricing Reforms Become Law?", published Oct. 31, 2018.

Other Notable Industry Trends for 2020

Biosimilars will expand in 2020, but ratings impact is muted.

We expect the near-term adoption of biosimilars to be modestly negative to creditworthiness in the coming year because we think the decrease in revenue to branded manufacturers will be more meaningful than the increase in revenue from biosimilar sales. In 2020, we do not expect lost revenue from biosimilar competition to directly affect ratings, but there could be negative pressure from M&A in anticipation of medium-term biosimilar competition.

For example, we expect Roche Holding AG to take a multibillion dollar hit to sales in 2020 from biosimilar competition to three large biologic products, Herceptin, Avastin, and Rituxan, but we expect biosimilar manufacturers of those same products to generate less than $1 billion in sales. Although biosimilars are expected to have a significant impact on Roche's revenue, the company has built out a diversified portfolio of marketed and pipeline products to offset the expected revenue decline, and therefore, our 'AA/Stable/A-1+' rating is unchanged.

Contrastingly, we expect to lower the rating on AbbVie to 'BBB+' after the close of its acquisition of Allergan, which we believe was partially motivated by biosimilar competition to Humira.

In general, we expect significant growth for biosimilars in 2020, but adoption is still hindered by regulatory and structural challenges, especially in the U.S. Hurdles include demonstrating interchangeability of medications, access to reference drugs in studies, and difficulty converting chronic patients. The U.S. Food and Drug Administration (FDA) provided guidance in 2019 on how to demonstrate interchangeability of biologic drugs so they can be substituted similarly to a small-molecule generic drug, but no biosimilars have yet gained interchangeable status. In addition, the cost and ability to procure reference drugs to conduct equivalency studies is still a challenge to broader biosimilar adoption. Without an interchangeability designation, insurance companies cannot force patients to change prescriptions from an original biologic to a biosimilar.

We expect higher biosimilar adoption for episodic conditions than with chronic conditions. We believe a new patient will be more likely to use a biosimilar for cost savings, and patients with episodic conditions (such as cancer) are typically treatment naïve (new patients). On the other hand, a higher proportion of patients with chronic conditions such as rheumatoid arthritis are less likely to switch to a biosimilar when their condition is well-managed by current medication.

We also think Europe will continue to lead the way in biosimilar adoption. Drug prices are frequently negotiated in a single-payer government system, and governments can decide to only provide insurance coverage for a biosimilar if the reference product is deemed too expensive. This negotiating position has led to a higher volume of biosimilar prescriptions in Europe than in the U.S., where patients have more choice in treatment.

PBMs and FDA initiatives will continue to influence drug pricing in 2020.

In 2020, we expect continued pricing pressure in the U.S. from pharmacy benefit managers (PBM), especially for medicines with viable or "good-enough" alternatives from competing brands (e.g., in hepatitis C, HIV, and migraines) and generics (e.g., in high cholesterol). PBMs also could negotiate more aggressively because of sector consolidation and vertical integration with insurance companies that provides additional scale and knowledge of the pharmaceutical industry. PBMs also appear emboldened to exercise their main negotiation lever, formulary exclusion. For example, CVS Health Corp. and Express Scripts Inc. excluded a record number of drugs in their 2020 base formularies--60% more year-over–year by CVS. The volume impact of PBM formulary exclusions is often tempered because products are typically still available to patients, but require prior authorization or patients are expected to try other treatments first. In addition, drugs excluded from formularies typically are not discounted and are then reimbursed at a high price when prescribed.

For more on our view of the PBM industry, see our article "Pharmacy Benefit Managers In 2020: Less Regulatory Overhang, More Consolidation", published Jan. 21, 2020.

In addition to PBMs, we believe the FDA is contributing to increased pricing pressure by lifting the pace of both branded and generic drug approvals, and by clarifying the generic pathway for certain complex generics (e.g., per recent FDA guidance documents).

Chart 5

image

We expect pressures in the U.S. generic industry to ease in 2020

While pricing trends were very negative in the U.S. generics subsector in 2017-2018, we expect more normal, mid-single-digit percentage pricing declines on mature drugs in 2020. We think generic manufacturers can return to flat or modest revenue growth with contribution from new product launches. This follows a few quarters of sequential stabilization of generic operating results in the U.S. Underlying this is that generic group purchasing organizations have consolidated into three, controlling roughly 90% of the market. We do not expect further consolidation.

In addition, most of the low-hanging price reductions have already occurred from the FDA working off its backlog of generic drug applications. Generic manufacturers have cut costs and rationalized portfolios, and are now refocused on developing and launching new products, especially complex dosage forms and biologics. Following a volatile year in 2018, there were additional examples of missed revenue in 2019, including Amneal and Sandoz Corp., but we believe these cases are more idiosyncratic and related to competition to large generic products. At this point, we think competition has reached most large, easier-to-manufacture products, so we expect fewer negative earnings surprises.

We are also watching developments related to allegations and investigations of price-fixing potentially affecting many generic companies. At this time, we do not include any expectations for cash outflows related to price-fixing litigation settlements or penalties.

Less M&A risk, more operational risk is seen for smaller pharmaceutical companies.

While our negative outlook on the pharmaceutical industry applies to both big pharma and smaller specialty companies, there are some distinct characteristics for smaller companies:

  • They often rely on one or two products for the majority of revenue, so competition and patent expiry are typically prominent credit risks.
  • Several smaller companies (including Mallinckrodt, Endo, and Amneal) have substantial exposure to opioid litigation, and are generally less equipped to bear the burden of a large legal liability.
  • We see lower risk to ratings from M&A for smaller pharma companies because they are often already highly leveraged and have limited capacity for significant acquisitions, often favoring partnerships with lower up-front capital requirements.
  • We see less pricing risk for smaller companies because specialty manufacturers often do not need first-line therapy designations from PBMs. They allocate significant resources to help patients acquire reimbursement for drugs that face prior-authorization requirements or other hurdles.
Companies are divesting noncore segments.

Even as the pace of acquisitions picks up, many companies are increasing focus on their core businesses by divesting smaller segments, including mature products, generics, consumer health, and animal health businesses. While we generally view divestitures as negative for diversification, these often don't result in a lower rating given the potential deleveraging effect of asset sales, or when the divested segment represents only a relatively small portion of earnings.

Divestiture announcements in 2018-2019 include:

  • In June 2018, Novartis AG (AA-/Stable/A-1+) sold its noncore 36.5% stake in its consumer health joint venture with GlaxoSmithKline PLC (GSK; A+/Negative/A-1) to GSK for $13 billion. The company also announced plans to divest its Alcon Inc. eye care devices business, but keep the ophthalmology pharmaceutical products.
  • In August 2018, Perrigo Co. PLC (BBB-/Stable/--), which specializes in over-the-counter drugs, announced plans to divest its generics prescription segment.
  • In September 2018, Sanofi (AA/Negative/A-1+) completed the divestiture of its European generic drug business to simplify and reshape the company.
  • In September 2018, Novartis announced it would also sell its Sandoz U.S. dermatology business and generic U.S. oral solids portfolio, to refocus its business.
  • In November 2018, Bayer AG (BBB/Stable/A-2) announced plans to exit the animal health businesses and the sun care and foot care product lines within its consumer health business. This may stem in part from financial pressures following a large acquisition and litigation.
  • In November 2018, AstraZeneca PLC (BBB+/Stable/A-2) divested five noncore products to two different buyers.
  • In December 2018, Pfizer (AA-/Watch Neg/A-1+) and GSK announced plans to combine their consumer health businesses in a joint venture as a first step for both companies to shed the consumer health business.
  • In December 2018, GSK announced its intention to divest its Horlicks brand and other consumer products sold in India for net proceeds of approximately £2.4 billion.
  • In December 2018, Merck KGaA (A/Stable/A-1) divested its consumer health business to Procter & Gamble Co. (AA-/Stable/A-1+) to focus on innovation.
  • In March 2019, Spain-based pharmaceutical company Almirall S.A. (BB-/Stable/--), which focuses on dermatology, announced the sale of its aesthetic medical device business.
  • In March 2019, Eli Lilly (A+/Stable/A-1+) completed the spin-off of its animal health business, Elanco.
  • In April 2019, Novartis spun off Alcon, which has an enterprise value of about $31 billion.
  • In July 2019, Pfizer announced its intention to divest Upjohn Co., its portfolio of mature, off-patent drugs, and combine it with Mylan (BBB-/Developing/A-3).
  • In February 2020, GSK announced its plans to separate its consumer health care and pharmaceutical business over two years.
  • In February 2020, Merck & Co. Inc. (AA-/Watch Neg/A-1+) announced its intention to spin off a portfolio of noncore branded drugs to focus its portfolio.
Partnerships and risk-sharing arrangements will continue.

The trend of more-frequent partnership arrangements for product development is a way to share development costs and reduce or spread out product specific risks. We expect that to continue in 2020, especially as combination therapies increase. Depending on the agreement, partnerships sometimes result in a contingent consideration liability. We typically include those development-related contingent liabilities in our measure of debt, particularly when the achievement of such milestones does not necessarily translate into additional profit. In contrast, we tend to treat milestones tied to revenue like royalties, including those amounts in our measure of EBITDA, but not in debt.

Appendix

Chart 6

image

Among investment-grade companies, fewer are rated in the 'AA' and 'A' categories over the last six years, primarily because of M&A. At the same time, the 'BBB' category has expanded from a combination of newly rated companies and downgrades from the 'AA' and 'A' categories.

The 'B' category has by far the most pharmaceutical issuers. We now rate more highly leveraged, private equity-owned companies, especially contract manufacturers and similar service providers. We also rate more publicly traded specialty and generic pharma companies in the 'B' category that have fallen from the 'BB' category primarily from operating weakness after sizable acquisitions and other idiosyncratic challenges.

Table 4

Distribution Of Pharmaceutical Outlooks
Positive Stable Negative Developing Total
Outlook/CreditWatch Outlook/CreditWatch Outlook/CreditWatch
Investment-grade (count, % of total issuers)
(1, 4%) (20, 71%) (6, 21%) (1, 4%) (28, 100%)
Allergan PLC Abbott Laboratories Pfizer Inc. Mylan N.V.
Bristol-Myers Squibb Co. Takeda Pharmaceutical Co. Ltd.
Johnson & Johnson GlaxoSmithKline PLC
Eli Lilly & Co. Sanofi
Bayer AG AbbVie Inc.
Amgen Inc. Merck & Co. Inc.
AstraZeneca PLC
Novartis AG
Biogen Inc.
Fresenius SE & Co. KGaA
Merck KGaA
Novo Nordisk A/S
Roche Holding AG
RPI Finance Trust (dba Royalty Pharma)
Gilead Sciences Inc.
Zoetis Inc.
Perrigo Co. PLC
CSL Ltd.
Lonza Group Ltd.
Vifor Pharma AG
Speculative-grade
(5, 11%) (23, 52%) (16, 36%) (0, 0%) (44, 100%)
Ache Laboratorios Farmaceuticos S.A. Bausch Health Cos. Inc. Teva Pharmaceutical Industries Ltd.
Huvepharma EOOD Hypera S.A. Endo International PLC
Sam Bidco S.A.S. Grifols S.A. Albany Molecular Research Inc.
Hikma Pharmaceuticals PLC Jazz Pharmaceuticals PLC Alvogen Pharma US Inc.
Aenova Holding GMbH Alkermes PLC Mallinckrodt PLC
Akorn Inc. Amneal Pharmaceuticals LLC
Almirall S.A. GHD Verwaltung GesundHeits GmbH Deutschland
Financiere Top Mendel SAS Indivior PLC
Advanz Pharma Corp. Lannett Co. Inc.
Horizon Therapeutics PLC Arbor Pharmaceuticals Inc.
Antin Amedes Bidco GmbH IWH UK Finco Ltd.
Catalent Inc. YanAn Bicon Pharmaceutical Listed Co.
Lantheus Holdings Inc. Ai Sirona (Luxembourg) Acquisition S.a r.l.
Innoviva Inc. Alcami Corp.
CHEPLAPHARM Arzneimittel GmbH Elanco Animal Health Inc.
BCPE Max Dutch Bidco BV Assertio Therapeutics Inc.
Rossini Acquisition S.a r.l.
UniFin SAS
Curium Midco S.à r.l.
Diocle SpA
Antigua Bidco Ltd.
Aldevron LLC
Cambrex Corp.
Data as of Feb. 12, 2020. Source: S&P Global Ratings.

This report does not constitute a rating action.

Primary Credit Analysts:Matthew D Todd, CFA, New York + 1 (212) 438 2309;
matthew.todd@spglobal.com
David A Kaplan, CFA, New York (1) 212-438-5649;
david.a.kaplan@spglobal.com
Marketa Horkova, London (44) 20-7176-3743;
marketa.horkova@spglobal.com
Nicolas Baudouin, Paris (33) 1-4420-6672;
nicolas.baudouin@spglobal.com
Tulip Lim, New York (1) 212-438-4061;
tulip.lim@spglobal.com
Makiko Yoshimura, Tokyo (81) 3-4550-8368;
makiko.yoshimura@spglobal.com
Adam Dibe, Toronto + 1 (416) 507 3235;
adam.dibe@spglobal.com
Viral Patel, New York +1 212-438-2403;
viral.patel@spglobal.com
Sabrine Boudella, Paris (33) 1-4075-2521;
sabrine.boudella@spglobal.com
Manuel Vela Monserrate, Madrid + 34 914 233 194;
manuel.vela@spglobal.com
Additional Contacts:Arthur C Wong, Toronto (1) 416-507-2561;
arthur.wong@spglobal.com
Shannan R Murphy, Boston + 1 (617) 530 8337;
shannan.murphy@spglobal.com
Anna Overton, London (44) 20-7176-3642;
anna.overton@spglobal.com

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