Cardinal Health, Inc. (CAH) Earnings Call Transcript & Summary

January 11, 2021

New York Stock Exchange US Health Care Health Care Providers and Services conference_presentation 41 min

Earnings Call Speaker Segments

Lisa Gill

analyst
#1

Good morning. My name is Lisa Gill, and I'm the health care services analyst with JPMorgan. This morning, I am incredibly happy to kick off my segment of the 39th Annual JPMorgan Healthcare Conference with Cardinal Health. With me this morning I have CEO Mike Kaufmann. Good morning, Mike.

Michael Kaufmann

executive
#2

Good morning, Lisa. It's great to be here.

Lisa Gill

analyst
#3

Thanks for coming virtually. I wish we were in person.

Michael Kaufmann

executive
#4

Yes. Me too. It always makes it a lot more fun. It's a great conference. Sorry, we can't all be there live.

Lisa Gill

analyst
#5

Yes. I agree. Did you have some comments that you wanted to start with?

Michael Kaufmann

executive
#6

Yes. I'm going to go ahead and jump in. So thanks again, and good morning, everyone. Thank you for joining us today. Before I begin, I want to note that I will be making forward-looking statements today. These forward-looking statements are subject to certain risks and uncertainties that may cause our actual results to differ materially from those projected or implied. For a description of these risks and uncertainties, please refer to our Investor Relations website or to our SEC filings. Resilient business models, valued by customers, disciplined capital deployment, investing for growth, these embody who we are at Cardinal Health, and they enable us to advance health care and improve lives. We are a globally integrated health care services and products company, a distributor of pharmaceuticals, a global manufacturer of -- and distributor of medical and laboratory products and a provider of performance and data solutions for health care facilities. Last week, we celebrated our 50th anniversary as a company. Over those last 50 years, change has been the only constant, and it's only gotten faster. We've adapted, and we have a clear vision of where we are going. We aspire to be health care's most trusted partner. We'll do this by building upon our scale and heritage in distribution, products and solutions. We use customer insights, data and analytics to drive growth in evolving areas of health care and address health care's most complicated challenges. And to ensure success, we'll focus our resources on what matters most. Now let me provide some details on the company. First, let me start on Slide 5 with a few high-level essential facts about Cardinal Health. We finished our fiscal 2020 in June with $153 billion in revenues. We operate in over 40 countries and have approximately 48,000 employees worldwide. Beyond these high-level numbers, let me take a moment to highlight the breadth of our company. We serve roughly 90% of the hospitals in the United States through our Medical or Pharmaceutical Distribution, our products or our world-class solutions. Every day, we service more than 29,000 U.S. pharmacies, including large retail chains, grocery stores, individual retail independents and hospitals. We serve more than 3.4 million U.S. patients in their homes with more than 46,000 health care products. We manufacture and distribute more than 50,000 types of Cardinal Health medical products and procedure kits. And we serve more than 10,000 U.S. specialty physician offices and clinics. Now please turn to Slide 7. We aspire to be health care's most trusted partner and create the greatest value for our customers, our shareholders, our communities and our employees. To do this, we are building a consistent track record of delivering on our commitments to each of these stakeholders. Specifically, from a financial standpoint, in both fiscal '19 and fiscal '20, we grew non-GAAP EPS in both years and exceeded our initial EPS guidance ranges. We exceeded enterprise cost-savings targets by driving efficiencies and making improvements to our cost structure. We strengthened our balance sheet with $1.1 billion of debt paydown in fiscal '19 and $1.4 billion in fiscal '20. We made strategic portfolio decisions to optimize and invest for growth. In fiscal '19, we made acquisitions to strengthen our service offerings in pharma, which is a strategic growth area for us. In fiscal '20, we made investments and partnerships in other growth areas like specialty and at-Home. And we successfully divested our minority equity interest in naviHealth. All the while, we continued to return cash to shareholders. Through dividends and share repurchases, we returned over $2 billion during the last 2 fiscal years. To be more specific about how we continue this track record in our fiscal '20, I'll now share some details regarding our performance this past fiscal year. Specifically, in our fiscal '20 ended June 30, we grew revenue 5% to $153 billion. We grew both non-GAAP operating earnings and non-GAAP diluted EPS to $2.4 billion and $5.45, respectively. And we generated a robust $2 billion in operating cash flow. I'll now turn to how we're generating this growth across both of our segments. While we always operate and act as one company in order to drive customer focus, we are organized into 2 reporting segments: Pharmaceutical and Medical. During fiscal '20, our Pharmaceutical segment delivered revenue of $137.5 billion and $1.8 billion in profit. Our Medical segment generated revenue of $15.4 billion with $663 million of profit. On the next 2 slides, I'll give you a little more color on the offerings and key capabilities of each segment. Our pharma segment has 3 key divisions: Pharmaceutical Distribution, Specialty Solutions and Nuclear and Precision Health Solutions. Our PD business at its core distributes branded and generic pharmaceutical and over-the-counter health care products. We make both manufacturers and health care providers more efficient by providing end-to-end logistics and technology solutions. For example, we provide pharmacy management services. And within our connected care business, we provide medication therapy management and pharmacy -- patient outcome services to hospitals, other health care providers and payers. Our Specialty Solutions business, a critical growth area for us, is aligned with the market trends and we are seeing around the growth -- that we are seeing around the growth of specialty medications. This business competes successfully for many types of services, both upstream, with manufacturers and downstream, with providers. We provide distribution services for branded, generic and biosimilar specialty medications for pharmacies and physician offices. We support biopharma manufacturers with 3PL services, data and evidence solutions, commercialization support, regulatory consulting and patient hub services. And finally, our Nuclear Pharmacy business operates the largest radiopharmaceutical network of pharmacies in the United States and offers the most comprehensive portfolio of radiopharmaceuticals. We manufacture both diagnostic and therapeutic products like FDG and iodine. We support manufacturers through contract manufacturing and drug development. Turning now to our Medical segment on Slide 11. Our Medical segment is not only one of the largest medical products distributors and solutions providers but also one of the world's largest manufacturers of high-quality medical products. We manufacture, source and distribute Cardinal Health-branded medical, surgical and laboratory products. These products are sold as Cardinal Health brand but also as well as other well-known brands like Kendall, Monoject, Curity and Kangaroo. These products range from consumable products, like gloves, drapes and gowns to higher-end medical devices that go into the body, like stents. Our portfolio mix is generally oriented around the operating room and higher-margin surgical products. We also support hospitals, ambulatory surgery centers, clinical laboratories and our other health care provider customers by distributing a broad range of national-branded products. In addition, we provide data-drive supply chain solutions that are a strategic focus and include OptiFreight, which help our customers manage their freight cost and WaveMark, which leverages RFID technology to ensure supply chain integrity and reduce waste. Finally, another strategic growth area is our Cardinal Health at-Home solutions business, a leading distributor of medical products to the home. This business is aligned with the industry trend of care shifting to patients homes. As you could see, we play a critical role in both the pharmaceutical and medical supply chains, a role that has come into even sharper focus as we navigate the challenges of the global pandemic. We have been resilient and responsive throughout the pandemic just as we have been through our crisis situations in our history. As the global pandemic unfolded, we moved quickly to protect the health and safety of our employees. We have maintained continuous operations in all pharmaceutical and medical distribution facilities, nuclear pharmacies and our global manufacturing plants. We leveraged our sourcing capabilities through Red Oak to ensure minimal disruptions to the pharmaceutical supply chain. To help mitigate the impacts of the global PPE supply challenges, we acquired additional equipment and onboarded additional suppliers to expand and diversify critical product options while still maintaining our rigorous quality standards. We are partnering with Federal State and local government agencies and our customers to support vaccine access and distribution. For example, we were selected by the Ohio Department of Health to arrange transportation for distribution of COVID-19 vaccines. An agreement -- and in agreement with the CDC, we are acting as a network administrator to enable our retail independents, small chains and long-term care pharmacy customers to participate in the vaccination effort. We remain prepared to help in any way we can. Given the scale and complexity of the vaccine distribution efforts, we believe leveraging the existing distribution network will be faster, more cost effective, less complex and less error prone. Finally, while we have experienced an adverse financial impact, primarily from the deferral and cancellation of elective procedures and physician office visits we continue to manage through pandemic related headwinds. And yet, we delivered on our fiscal '20 commitments. And in November, we raised our fiscal '21 EPS guidance. As we collectively navigate the pandemic, we are dedicated to fulfilling our critical role in the health care supply chain so we can support our customers and their patients. Now let me share on Slide 13 how we will be positioning ourselves for the future. First, we will optimize our core businesses. We will do this by enhancing our global supply chain, driving commercial excellence, maximizing all aspects of our generics program and continuing to focus on our cost savings initiatives. Next, we will drive growth. We will make investments in strategic growth areas such as specialty, at-Home, nuclear and our services businesses. Finally, to support optimizing our core and drive this growth, we are diligently managing our capital, which I'll discuss in a minute. I'll now share how we are positioning our portfolio for growth. This positioning begins with optimizing our core pharmaceutical and medical distribution and product offerings. These are our biggest businesses, and our customers count on us to be incredibly efficient in these areas. Just as importantly, we have and will continue to successfully invest in key areas that are positioning us for the long-term growth. Specifically, these areas include specialty, at-Home, nuclear, medical services and Connected Care. These 5 businesses represent $25 billion in total revenue and have had a historical 3-year revenue CAGR in excess of 15%. They are all margin accretive, and they operate in markets with favorable industry trends and strong outlooks. They offer complementary capabilities to our core businesses by providing specialized solutions to support our customers' needs. We are committed to invest in these and other key areas of our business to fuel sustainable growth. Optimizing our core businesses and making these investments for growth require disciplined and thoughtful capital deployment. In order of priority, first, we are investing in the business. We have a strong portfolio of businesses and a pipeline of organic growth opportunities. Second, we are strengthening our balance sheet through taking appropriate action to maintain our investment-grade credit ratings. And third, we are focused on returning cash to shareholders, primarily through our dividend. Opportunistically, we will continue to evaluate tuck-in M&A and partnerships specific to our growth areas as well as share repurchases. This approach best positions us to both maintain flexibility and generate significant value over the long term. So you have heard me talk about our breadth, our business, our resilience and our discipline. Let me sum up by sharing why I believe in Cardinal Health's future. Turning to Slide 16. As we've demonstrated throughout our history and specifically in the last year, we operate resilient business models that perform well even in challenging environment. The inelastic demand for health care, whether for prescription medications or surgical procedures brings stability to our business. As we navigate the challenges of the COVID-19 pandemic, we expect growth in both our segments in fiscal '21 despite a headwind from lower volumes. We bring these offerings to an industry which continues to experience increasing demand driven by demographics. For example, 10,000 baby boomers a day are turning 65. This group is growing faster than the rest of the population and needs the most medical care. And as technology and the effects of the global pandemic influence how patients choose to receive care, we are well positioned to adapt to their evolving needs and preferences. Our focus on efficiency and improvement have become part of our broader cultural mindset. We expect to exceed our 5-year $500 million cost-savings journey. With these efficiencies, we are able to invest in our core and the emerging growth areas that we just discussed. Our focus on generating significant cash flow and our commitment to disciplined capital management allow us to deploy capital in a balanced and shareholder-friendly way. And lastly, at Cardinal Health, everything begins and ends with our customers. With all this in mind, let me close by saying that in a time of unprecedented change, there's no stronger partner than Cardinal Health. We are focused on long-term growth. We're confronting today's challenges and developing tomorrow's solutions with tenacity, agility and innovation that makes Cardinal Health essential to care. Thanks again for joining us this morning. Lisa, I'm now going to turn it back to you to begin the Q&A. And in the meantime, I'm going to ask Jason Hollar, our CFO, to join me. We look forward to answering your questions.

Lisa Gill

analyst
#7

Great. Thanks so much, Mike. And Jason, thank you for joining us as well. My understanding is that you want to maybe just give us a couple of thoughts before I get into my questions here on some of the recent trends that you're seeing on your side.

Michael Kaufmann

executive
#8

Yes. I really appreciate that. It's -- before we get into Q&A, I did just want to remind everybody that we have not yet closed our Q2. Our earnings call is scheduled for February 5, and we'll obviously give more color at that time. So therefore, just given the timing, we'll not be making any specific comments on our Q2 results or provide an update on our full fiscal year expectations today. But a couple of things. As a reminder, in November, we raised our FY '21 EPS guidance, which at the midpoint now represents 6% EPS growth. And I'll give you 2 other brief updates. First, as it relates to COVID-19, overall, well, while volumes continue to be lumpy as we stated, there is nothing we are seeing at this point that would be outside the range of scenarios contemplated in our most current guidance back in November. And the second thing, everybody wants to know about brand inflation. I will remind everyone that less than 5% of our brand margin dollars are currently tied to inflation, but that contingent portion is highly concentrated in the month of January. And while we've historically seen this activity occur throughout the whole month, it really doesn't all happen on the first day. So while we're only 11 days in the month, what we've seen so far, the activity has been running roughly in line with our expectations. So those are both encouraging at this point. So I'm going to turn it back to you for other questions, Lisa.

Lisa Gill

analyst
#9

Great. Mike, I think one of the running themes for this conference is going to be around the vaccine. And you noted your comments around the Ohio Department of Health as well as CDC. Can you maybe just talk a little bit more around the role that you anticipate that Cardinal will play? And do you see an opportunity also on the PPE side? I would think that there's going to be increased demand around PPE as we start to dole out the vaccine to individuals.

Michael Kaufmann

executive
#10

Yes. At this point in time, a couple reminders. One, we do not have any upsides or downsides in our guidance related to vaccine distribution. So that's important to know. And specifically, I'll go over the vaccine first. We are not, at this point in time, part of the initial distribution of the vaccine. However, we are working, as I mentioned, the state of Ohio asked us to use our OptiFreight business to help coordinate freight, which that so far is being helpful. We continue to have discussions with local states and federal government around how we can play a larger role going forward. And in fact, we're also talking to some of the manufacturers. And I think everybody is just trying to make sure that we try to get these vaccines to people as quickly as possible. So while we're not currently doing anything other than I mentioned, staying involved, helping with the state of Ohio, and then we signed an agreement with the CDC to help qualify and facilitate with retail independents and some small regional chains, we are staying involved, and we want to be part of the solution. As part of your question related to PPE, I would say that it depends on the product. As far as gloves and masks, we continue to see pretty good supply on gloves and masks. And so we continue to be able to service those at a very high level to our customers. And if other folks do need those as we go forward, we are in a position to do that. I would say that exam gloves, that is the biggest challenge right now that the industry is seeing. And so we're going to keep monitoring that. But of course, we're going to continue to invest in our own manufacturing continue to qualify other manufacturers and sources for these products and make ourselves available to help everybody that we can.

Lisa Gill

analyst
#11

Yes. As it relates to that, I don't want to talk about the quarter specifically. I understand your comments. But just going back to your guidance back in November, can you just remind us what your anticipation was around cough, cold and flu, just based on our discussions and what you're seeing, right, by the CDC, et cetera? We're seeing a lot less cough cold and flu going into this year. Was that already built into your expectations for this quarter? And how do you think about it going into the back half of your year?

Michael Kaufmann

executive
#12

Yes. It's a good question. We do have it built in. But as I mentioned back in Q1 and for a while now, cough, cold and flu, whether it's really strong or really light isn't a big needle mover anymore for us as a company the way things have developed around that. I mean it can be a little bit up and a little down. But in general, it's not a big needle-mover in total for us as a company between -- across M&P. We are seeing much lighter season, which is what we anticipated because with people masking up, social distancing and all those types of things that folks are doing and the fact that the high rate of people are getting vaccinated on the flu vaccine, we are seeing a much lower incidence of flu, cough and cold at this point in time.

Lisa Gill

analyst
#13

And not going to big conferences where you're shaking hands and passing a lot of the flu.

Michael Kaufmann

executive
#14

That's a good point, yes. Exactly. Right.

Lisa Gill

analyst
#15

So just going back to your comments around elective surgeries really being an important component when we think about your Medical business. And obviously, states like California have had a really difficult time and are shut down again. What's your anticipation around elective surgeries coming back? And what have you seen in the more recent times without getting into the specific quarter?

Michael Kaufmann

executive
#16

Yes. I'll have Jason give you a little feedback on that.

Jason Hollar

executive
#17

Sure. Well, first of all, as Mike mentioned upfront, we're not yet closed and, Lisa, as you just mentioned there. So we're not getting into a lot of specifics here. But what we can reinforce and what we've stated before is that volumes continue to be lumpy, and we anticipate they will continue to be lumpy. What we did say also upfront is that we're not seeing anything at this point from a utilization perspective that would be outside of those scenarios. What we said back in November was that we had seen a lot of improvement over the course of the first quarter and exited Q1 down in the mid single-digit range and that we expected it to then recover in a nonlinear way over the course of the remainder of the year and get to at or near pre-COVID levels by the time we exit our fiscal year. So that's where we currently anticipate everything at this stage.

Lisa Gill

analyst
#18

Yes. So just in talking about the Medical division, I think Jason and Mike, you know that I've followed this company for a long time. You talked about a 50-year history. This is my 21st JPMorgan Healthcare Conference. And 20 years ago, the only 2 companies that came into my coverage universe were Cardinal and McKesson. So long, longstanding relationship. I just want to understand, the results of the Medical division over the last couple of years they've been somewhat lumpy. And Mike, you and I have talked a number of times around places around the world, where -- what markets should you be in, what markets have been successful, what products have been successful. What have you learned over the last couple of years? And have things really changed because of COVID? Or do you feel that you're still in that trajectory of really refining the business?

Michael Kaufmann

executive
#19

Yes. I'll start in and if Jason has anything to add. I think the first thing I want to remind everybody is that this will be our second year of double-digit growth in Medical. So that -- while 2 years don't make a trend, I think that's an important and point to note is that we had double-digit growth last year. We expect double-digit growth this year. And so we feel like we are -- have made a lot of progress on some more consistent growth. A reason we've been able to do that is a couple of things. We've made a lot of adjustments to the team. I feel really good about the leadership of Steve Mason as the CEO of that segment as well as the leaders that he has put in place to run sales, to run our at-Home business, of the Head of Sourcing and Global Manufacturing. Scott is world-class. So we have some people that really have the right experience in the roles, which I think was a little bit of a challenge for us historically. What that's enabled us to do is really get after our cost structure and our customer focus in a much better way than we've ever seem to be able to do. I'm really impressed with what the team has been able to do to not only take out costs to make us more efficient but actually to improve our quality, improve our service levels and all that. So they're not doing one at the cost of the other. They're actually looking at the 2 at the same time and being very, very successful. And so I think that's been the biggest driver so far is getting the right people in the jobs, getting the right cost structure in place with still some opportunities going forward there. As you mentioned, one of the cost structure things that we've been working on and we'll continue to work on is the number of countries we're in. At this time, we're in over 40. We continue to evaluate that and make sure that every single country that we're in makes sense not only in the short term but over the long term, whether we should be there or whether we should be distributing ourselves, distributing through someone else, et cetera. So we continue to look at that model, and I think there's still definitely refinement there. My guess is we'll probably be in even fewer countries as we go forward, but we're continuing to evaluate that and make sure that we address it. At one time, we were in close to 70. So we've really gotten after making sure we're in the right countries. The one thing that we're doing in Medical that I believe is still going to have some long -- mid- to longer-term benefit is the work we've been doing in our commercial organization. And we -- a little over a year ago now, it would have been in the fall of '19, we really went out, talked to customers and then put in place a new commercial structure that's more customer-focused. We brought in some significant amount of new talent. And so while that has gone well, obviously, when you have the COVID pandemic and you can't get your new reps in front of folks and they're -- your customers are incredibly focused on just getting through the pandemic, converting items and doing those types of things is maybe a little slower than we had anticipated. But we continue to make up for it in other areas, and we still feel very good about that commercial restructuring and the benefits of that going forward.

Lisa Gill

analyst
#20

Mike, as we think about the pandemic and we think about services in the home, you've talked about Cardinal at-Home and the success of that. Can you talk about how the pandemic has driven sales there and what the future expectations are around that business? And do you need to add other businesses to it or see other opportunities for tuck-in type of opportunities within it?

Michael Kaufmann

executive
#21

Yes. That's a great question, Lisa. That is definitely an area where we will -- we continue to see it as a strategic growth area that we will allocate capital there if we see the right opportunities to grow either organically or through M&A. So we -- that is key for us. We have been investing significant dollars, for example, in their IT systems to -- in order to improve our back office, not only our cost structure there but also the employee or the -- I'm sorry, the customer experience so that they can really see us as differentiated. As you can imagine, it's an industry that is very complicated with getting approvals and you got to get prior approvals. And there's a lot of paperwork and things like that. So we have the widest array of relationships with payers. We leverage that already, but we want to leverage it to make it more efficient for the payers and for the patients on the other end. So we didn't really see, I would say, an incremental large uptick with COVID at the home. I think the patients that are at the home, that itself is growing because demographics have more and more people needing care at the home. So I wouldn't necessarily say that's a business that grew significantly incrementally because of COVID while like our lab business did. That business saw more volumes from COVID. I would say the at-Home's significant continued growth is really just from the natural demographics of more and more care moving to the home.

Lisa Gill

analyst
#22

Coming back to your drug distribution business for a minute. You made a comment around generic supply and Red Oak and the fact that working through that, the pandemic that you've been in a good position. As we think about the conversation you and I had in March, I think there was a lot of concern around API and coming out of China and other countries and what would happen with the pandemic. Can you just maybe give us an update around where things are in API, your confidence level around being able to secure product at a reasonable price? Because I know Red Oak is important to Cardinal Health initiatives.

Michael Kaufmann

executive
#23

Yes. Absolutely. I'll tell you, the Red Oak team there has just done a fantastic job. It is such a great group of folks there, and they've really shined during this pandemic. Because as you mentioned, rightfully so, back in March and April, if you remember, there was serious COVID-related issues in Italy. India became an issue later in the summer. And so there were some very much concerns around API and being able to translate that into finished doses. The Red Oak team did an excellent job of understanding through constant communication and analysis what were the API plants that were shutting down and having challenges, which were the finished goods' manufacturers that, that would translate to. And they moved product around in order to make sure that we saw limited impact from that. So while we saw a lot of challenges in API and, in some cases, finished good manufacturing, we really mitigated the vast majority of those because of the excellence performance of the Red Oak team. So we didn't really see as much of impact from lack of supply in generics as we could have seen. We have seen impact on generics just because of COVID volumes in general being down and physician offices being down. So the volumes, as you can imagine, are definitely impacted. But I think Red Oak did a great job of getting through. And at this point in time, I'm not seeing anything that we can't manage through at this point in time and for the rest of the year, at least the way things look right now as it relates to API or finished goods and generics.

Lisa Gill

analyst
#24

Yes. Mike, a question that constantly comes up, and I know you and I've talked about this a number of times, is opioids. And I always remain hopeful, and I know Cardinal was the first one to actually put it on your balance sheet, that we would actually have a settlement. And we sit here almost over a year later from the first kind of global settlement that was set out there. Can you maybe just help us and investors understand the time line, where we stand, why it's taking as long as it is? I would think that, especially during this time of the pandemic, these individuals could really use these dollars to help people that have opioid addiction, et cetera.

Michael Kaufmann

executive
#25

Yes. We -- I'll tell you, we really do think that folks could use the dollars and that, as we've all said, not only Cardinal but as an industry that we all want to be part of the solution on this, even though we could argue all day long, whether that -- we should be in this situation we're in, we all want to be part of that solution. I will tell you, this is one of the most complex negotiations that you can imagine. There's a lot of parties involved, right? You have 50 states. You have local cities and counties. And we don't want to rush. We don't want to put something in place that isn't going to work for us. And so we do continue to make progress. Conversations continue to happen between both sides. And it is really impossible for me to really give you any type of time line. I wish I could. I wish I had one. All I know is that we continue to make progress. I think we all agree this is the best path forward, all parties involved, but we don't want to rush to something that doesn't give us as much possible global peace and certainty as we can get. And so we're just going to continue to do the right things and be patient to get the right deal in place.

Lisa Gill

analyst
#26

I'm going to bring Jason in on the conversation here towards the end. Jason, I think this is your first time, at least, at Cardinal Health, participating in our conference. So welcome. Can you maybe just give us your thoughts on capital allocation going forward? And how important is the dividend versus share repurchase? And Mike did lay out some of the priorities earlier today. But just on a go-forward basis, what are some of the things you're thinking about?

Jason Hollar

executive
#27

Yes. Well, he did lay it out, and I'll give you a little bit more perspective on that. But disciplined capital management is very important to us, and we focus on it a lot. As Mike indicated, first and foremost, we're going to invest in the business to enable that strong organic pipeline and to make sure that we have sufficient internal organic growth. And even this discussion that we just had about the Medical business, I think, is evidence of some of those investments that were made in the past that we start to see the fruition of now. Second then is, of course, maintaining that strong investment-grade balance sheet. Again, we just talked about opioids and having the context of ensuring we maintain that investment grade. We paid down about $2.5 billion of debt over the last couple of years. So we've shown a lot of evidence behind ensuring that we have a robust capital structure in place for that. And then thirdly is returning cash to capital to shareholders primarily through the dividend, as you mentioned. We are going to be opportunistic as it relates to the tuck-in M&A as well as share repurchases. But those first 3 priorities are going to be where we're going to focus on first.

Lisa Gill

analyst
#28

Great. I guess here in the last 2 minutes, Mike, I'd like to end our conference with what will people appreciate 12 months from now they don't appreciate today. Let's just say, last year, we sat together, no one appreciated we were going to have a worldwide pandemic 2 months later. So it kind of puts everything in perspective. But if you could just give us your thoughts of what you think people will appreciate around Cardinal in the next 12 months.

Michael Kaufmann

executive
#29

Sure. I think it's a great question, and so thanks for asking that. I would say 3 things. I'm hoping 12 months from now what people will really have in their mind. Hopefully, they're seeing this first one right now. But -- and that is the resiliency of our business models. And not just Cardinal specifically, which obviously is most important to us, but also our industries in which we operate. So whether it's pharma distribution, nuclear, specialty, medical products, medical distribution, et cetera, all of our businesses, even in a very challenging environment. And not just this environment, but when you go back and look at 2008 and various other challenges over the years, we do operate and work in very resilient industries, and we have very resilient business models. So I think that's something I hope people will appreciate more and more going forward. The second thing I hope is that people are feeling that we're incredibly committed to driving efficiencies and to being disciplined stewards of our capital. That's really important that we want people to know that because it's important to us. And we're going to get after our cost and make sure we're focused on our capital. And then finally, that we have a differentiated portfolio. We're very focused on our core businesses. We know how important those are, but we also have really positioned ourselves for strong future growth with the other businesses that we've mentioned.

Lisa Gill

analyst
#30

Great. Well, thank you very much for your time today. I really appreciate it. Mike, Jason and everyone who tuned in, thanks very much.

Michael Kaufmann

executive
#31

Thanks, Lisa. Take care.

Lisa Gill

analyst
#32

Thank you.

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