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Bausch Health Companies Inc. (BHC)

Q4 2018 Earnings Call· Wed, Feb 20, 2019

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Transcript

Operator

Operator

Good morning, and welcome to the Bausch Health Care Fourth Quarter 2018 Earnings Conference Call. [Operator Instructions]. Please note, today's event is being recorded. I would now like to turn the conference over to Art Shannon, Senior Vice President of Investor Relations and Communications. Please go ahead, sir.

Arthur Shannon

Analyst

Thank you, Rocco. Good morning, everyone, and welcome to our Fourth Quarter and Full Year 2018 Financial Results Conference Call. Participating on today's call are Chairman and Chief Executive Officer, Mr. Joe Papa; and Chief Financial Officer, Mr. Paul Herendeen. In addition to this live webcast, a copy of today's slide presentation and a replay of this conference call will be available on our website under the Investor Relations section. Before we begin, we'd like to remind you that our presentation today contains forward-looking information. We would ask that you take a moment to read the forward-looking statement legend at the beginning of our presentation as it contains important information. This presentation contains non-GAAP financial measures. For more information about these measures, please refer to Slide 2 of the presentation. Non-GAAP reconciliations can be found in the appendix of the presentation posted on our website. Finally, the financial guidance in this presentation is effective as of today only. It is our policy to generally not update guidance until the following quarter and not to update or affirm guidance other than through broadly disseminated public disclosure. And with that, it is my pleasure to turn the call over to Joe.

Joseph Papa

Analyst · Evercore ISI

Thank you, Art, and thanks, everyone on the phone for joining us today. Let's quickly review the topics we will cover. I'll begin with a brief summary of our 2018 company highlights before turning the call over to Paul Herendeen, our CFO. Paul will take us through the fourth quarter and the full year financial results and provide our 2019 guidance. I will then review the segment highlights and catalyst before opening the line for questions. Beginning on Slide 4. 2018 was a year of strong execution for Bausch Health. For the full year, the total company grew organically by 2%. This was the first year of total company organic revenue growth since 2015. We also generated organic revenue growth in all 4 quarters of 2018. Now international and Salix, our 2 largest segments grew organically by 6% on a combined basis during 2018. Our top 10 products grew organically by 11% in the aggregate compared to 2017. We generated $1.5 billion of cash from operations. We increased R&D investment by more than 30% in the fourth quarter and approximately 15% for the full year. And we improved our gross margin through manufacturing efficiencies both in the fourth quarter and the full year. And we resolved the XIFAXAN IP litigation, which we believe preserves the products market exclusivity until 2028. Moving to the top right, we launched 10 key products during 2018, including two copromotions, 4 of our Significant Seven products were launched during the year, and we are expecting a decision from the FDA on DUOBRII shortly. We'll also continue to delever our balance sheet, having repaid more than $1 billion of debt in 2018 and cash generated from operations. Finally, in 2018, we refinanced approximately $8.3 billion of debt to extend maturities and provide more flexibility, which gives us the ability to pivot to offense in 2019. Turning to Slide 5. We have a snapshot of the key 2018 financial highlights for each of the 4 segments. Approximately 75% of our total 2018 revenue was generated by the B + L/International segment and the Salix segment combined. B + L/International grew organically by 4% compared to 2017 with organic growth across all 5 reporting businesses. Salix grew by 12% organically in 2018, driven by XIFAXAN, which had a great year with 22% growth. Great results from our two largest segments. Delivering on commitments is important to us. On Slide 6, we show how we perform against the guidance we provided 1 year ago, in February 2018. A year ago, we promised to deliver 2018 revenues in the range of $8.1 billion to $8.3 billion. We actually delivered $8.38 billion. A year ago, we promised to deliver adjusted EBITDA in the range of $3.05 billion to $3.2 billion. We delivered $3.47 billion. Paul will walk you through the fourth quarter and the full year results in more detail. So with that, I'll turn it over to Paul.

Paul Herendeen

Analyst · Evercore ISI

Thank you, Joe, I'm going to start on Slide 7, the top level financial results for the quarter. Before I begin, I want to point out that when we talk about organic growth that means on a constant-currency basis and removing the impact of divestitures and discontinuations in the comparative period. One other note, on the Q3 call, I referenced our initiative to reduce the level of channel inventories of our branded U.S. pharma products that would have the effect of reducing our revenues in Q4 and for the full year 2018 by an estimated $100 million. As it turned out, the actual result was a $76 million drag on revenue that was spread across all 4 of our segments. I'm going to reference this item a lot, and we've included a slide in the appendix that shows the impact on revenue and profit by segment. Okay. Let's go. We had a very strong finish to 2018. We posted our fourth consecutive quarter of organic growth despite the completed channel inventory reduction. Q4 revenue was up 1% organically and would have been up 5%, but for the channel inventory reduction, a good stuff. The B + L segment comprising 57% of our revenue was up 5% organically, with 4 of the 5 businesses within that segment delivering organic growth. Salix was up 1% organically despite the dramatic impact of the channel inventory reduction on the Salix segment. Ortho Derm was down 2% and Diversified was down 9% organically. Stepping down to gross profit and gross margin, we post a 150 basis point improvement in gross margin. A good chunk of the improvement was due to mix, but we also realized a meaningful improvement in our supply chain efficiency, driven by the ongoing efforts of Dennis Asharin, our Head of Global…

Joseph Papa

Analyst · Evercore ISI

Thank you, Paul. Moving now to Page 17, our Bausch + Lomb business is a fully integrated eye health business with offerings across the spectrum of vision care, which include contact lenses, surgical, consumer products and prescription ophthalmology. Importantly, this integrated business is being driven by several global megatrends that we see creating increased demand for our eye health products. First, recent statistics indicate that there are approximately 1.3 billion people in the world who live with some kind of vision impairment and 80% of all vision impairment is generally considered to be avoidable. Another megatrend is the graying of the United States population as the baby boomers hit age 65 and above. People over the age of 65 use 8x as many eye care products than those under the age of 65. Clearly, an important megatrend. In addition, the prevalence of myopia or nearsightedness is increasing to epidemic levels. As the graph shows, myopia rates in Hong Kong are steadily increasing. About 30% of those born before 1950 to a staggering 87% of those born in the last 20-or-so years. This data suggests that environmental factors like increased screen time with laptops, cellphones are responsible for the high rates of myopia we are seeing in Hong Kong and in other parts of the world. Myopia statistics are important to our business for obvious reasons, but also because myopia is a risk factor for glaucoma, macular degeneration and retinal detachment. Based on these megatrends, we are projecting growing demand for eye care, and we believe Bausch & Lomb as a global integrated eye health business is well positioned to provide them. On Slide 18, the B&L segment delivered its ninth consecutive quarter of organic growth, generating 2 years of mid-single-digit growth organically. E-commerce sales through Amazon grew by 64% in…

Operator

Operator

[Operator Instructions]. Today's first question comes from Umer Raffat of Evercore ISI.

Umer Raffat

Analyst · Evercore ISI

I wanted to touch upon two topics. First, as we head into 2019, can you -- perhaps this ones for Paul. Paul, can you lay out for us some of the comments you shared at the conference in January, where you talked about growth and the real growth CAGRs relative to the roughly flattish guidance? And could you also give us a sense for the amount of growth to net improvement impact that you expect in 2019? And then my second question is, perhaps for Joe. Joe, I know there's like this 300-plus patient trial for XIFAXAN SSD formulation, potentially due at some point this year. Could you walk us through the timing on that? And perhaps more importantly, how meaningful is that indication because it's my understanding that it's an acute indication, which only requires a couple of days worth of administration. So is that a trial and/or an indication that's commercially meaningful?

Joseph Papa

Analyst · Evercore ISI

Okay. So Paul, why don't you start with that 2019 question and some of the growth and -- hand it back.

Paul Herendeen

Analyst · Evercore ISI

Sure. And thanks for the questions, Umer. First of all, on the three year growth rate, I think, you characterized, our guidance is flattish. I mean, I referenced in my remarks it's a challenge for us relative to 2019, as we finished the year really, really strong, which we're happy about. So kind of took a little bit of the top off what you see for '19, but what we essentially done is reupped our 3-year CAGR guidance to say 4% to 6% for revenue, 5% to 8% for adjusted EBITDA, the midpoint of our 2019 guidance. There are included in our deck here, a lot of charts and bridges that point out that FX has been a challenge for us that people looking, oh, where are you relative to that? I say we're -- yes, we feel like we are continuing to be on track with our longer-range expectations for growth of both revenue and profitability. The big issue for us in 2019, we expect the profitability, I called out. We're investing more in our business. And so you're not seeing that -- see -- you won't see 2019 wherever we end up with respect to revenue. That to translate directly to adjusted EBITDA growth because the increased investment in R&D and the necessary investments behind selling and promotional expenses for our launched and to be launched products. So we feel pretty good about our prospects for delivering growth over the course of the next several years. Your second question was -- I think was around gross to nets and what you can expect. I'd say that we had a very strong year with respect to gross to nets improving that. And I think we called it out on our last call and even at the beginning of the year, we had some things that we were able to successfully change in the nonretail channel. We had a couple -- I am looking to make sure I get it right. About a 200 basis point improvement, if you looked across the company for gross to net in 2018 via 2017. As we look ahead to 2019 via '18, we expect -- we would not expect that level of improvement. But we would expect to continue to improve our gross to nets across our portfolio in '19 via '18. Does that answer, Umer?

Joseph Papa

Analyst · Evercore ISI

On the second part of your question, you asking us about the ongoing trial that we have in overt hepatic encephalopathy. A couple of things, I'll say. Number one, there are about 156,000 patients that are hospitalized because of hepatic encephalopathy. Obviously, anything we can do to reduce the hospitalization time or let's just say in the hospital as well as rehospitalization is an important question for us that we're looking at in that trial because we obviously think that's an important part of any pharmacoeconomic model and showing the value of our product. But importantly, there's a second reason for this trial. As you probably noted in the data that we're using our SSD formulation there. We expect that, that trial will give us some information on the use of SSD formulation and potential dose response, which can then help us with some of the later trials that we also believe are the larger opportunity. So it's important for our pharmacoeconomics to summarize and then also, it's important because it will give us a dose range and information that will help us as we look at some of the larger trials, for example, the prevention of the complication of decompensated psoriasis as an example, with other indications and other things we're going to look at with either the XIFAXAN 550 or the SSD formulation. So important to us for the near-term pharmacoeconomic and also long term.

Operator

Operator

And our next question today comes from Dave Risinger of Morgan Stanley.

David Risinger

Analyst · Morgan Stanley

So I guess, I wanted to start with LUMIFY. Could you just talk about that ramp and I know that the TV ad was well received. Do you plan to run that more frequently in 2019 to drive greater adoption? Second question is, with respect to the February 25 Lotemax franchise line extension PDUFA, should we expect an on-time approval? Or could that potentially be delayed due to the FDA backlog as a result of the government shutdown this winter? And then finally, just on contact lenses, could you please talk about the potential timing for additional SiHy launches globally?

Joseph Papa

Analyst · Morgan Stanley

Sure. Let me start, on the LUMIFY, we are delighted what we're seeing. As we mentioned in the call that we're now up to approximately a 28% weekly share in the latest data that we've seen just -- since we've launched this product just in May, we're really excited about it. We are back with TV advertising, as you -- now as you speak. We think that's an important part of it, but we also think the other part of it is the integrated eye care approach we have allows our teams in ophthalmologist offices and optometry offices to drop off samples and that's the reason we are getting great referrals and why we're the #1 referral product for the treatment of redness relief from ophthalmologists and optometry. So we think it's the integrated approach that really is helping us with what we're doing and making LUMIFY a better product. And of course, the other important reason I must add is that we believe we've got a better mechanism of action. We do not constrict the arterial blood flow to the eye. We constrict the venous blood flow, which we think is a much better way than approach on the redness relief category. On the question, second question of Lotemax, the 0.38, you're absolutely, correct. We have a late February date for the PDUFA. At this time, I really don't want to speculate as to where the FDA is in terms of approving this product. We're obviously putting together all the information, and we put together that information. We believe we know the FDA is making good progress on it, but I don't want to really speculate as to exact timing what the date is. The PDUFA date is the date, but obviously, we know that the FDA in the case of DUOBRII was not able to complete their PDUFA date filing review on time. So I'm not going to speculate on what's going to happen on the, I think, it's February 25 date. Final comment, contact lenses, as you noted, we did launch the silicone hydrogel in Japan, and we've got plans to roll that out globally. That global rollout will be predominantly -- for example, the U.S. will be sometime in 2020 in terms of our launch plans for the silicone hydrogel launch here in United States.

Paul Herendeen

Analyst · Morgan Stanley

I'm going to just finish up on that because I think the U.S. market depending on the data set, uses approximately 40% of the global lens market, and so it's obviously a big target for us. The U.S. is also a market where more of the lenses are, I think, only -- I'd say, only about 45% of the U.S. market is in daily lenses now, which is low relative to the rest of the world. So we want to be in daily lenses in a daily SiHy because that is a fast growing and expected to continue to be a fast-growing segment of the market.

Operator

Operator

Our next question comes from Chris Schott of JPMorgan.

Christopher Schott

Analyst · JPMorgan

Just two questions here. Maybe first on XIFAXAN and just elaborating a little bit more on the 2019 outlook. Do you see more growth and improvements this year or should we be thinking about 2019 more as a year, where its volume and gross price increases driving growth there? So in '18 that was a big component of growth, and I'm just trying to -- and then talking about the whole business, but XIFAXAN specifically in '19, will that be a component of growth? My second question was on organic delevering. You're allocating more capital to the yields. You're also pivoting to offense a bit here. I guess, can you elaborate just to how you're balancing acquisitions relative to the debt paydown in the story, I guess, in general, should we still think about most of your cash flow being allocated to debt paydown at this point with some smaller deals mixed in or could these transactions actually account for more meaningful piece of your cash flow on a go-forward basis?

Joseph Papa

Analyst · JPMorgan

Sure, good questions. I think the XIFAXAN question and then Paul will comment about the organic delevering. On the XIFAXAN, we're really excited by what we're seeing. If I just look at what's happening so far in the 2019 time frame, we're seeing somewhere in the -- for example, in the month of January, XIFAXAN total prescriptions are up approximately 10%. So very strong growth in XIFAXAN volume. But we are projecting though as we think about is the combination in 2019 will be a combination of what we're seeing on prescription growth, call it high single digits there and then call it some net price improvements, which is a combination of gross price and also some gross to net things that we are doing. So I think, it's really a combination that we think can get XIFAXAN certainly to high single digit, low double digits in terms of the growth rate that we are projecting for XIFAXAN. So we're very excited. But one final comment I will say that some of you don't see, but we're also seeing very strong nonretail growth with XIFAXAN. That's the nonretail category, thinking of nursing homes, convalescent homes, hospital institutions, et cetera, where we're seeing actually they're also double-digit growth and that's another big driver, especially in the area of hepatic encephalopathy. So those have been the primary growth factors for XIFAXAN in 2019. Paul, do you want to take the question on the delevering in the debt?

Paul Herendeen

Analyst · JPMorgan

I do, but I want to chime in on the gross net on XIFAXAN because there's -- as financial analyst and I know each one on the phones is financial analyst. It's important, I mean, remember that back in -- when we reported our Q1, we talked about a pretty substantial improvement in gross to net from better pricing in that nonretail channel, Joe just referenced, which is growing quite nicely. We're going to lap that. So that had been kind of a step function, it had been a nice tailwind for us in Q1, Q2, Q3, Q4, for the full year. We're going to lap that, and it's a good thing. I mean, it's all good, but I think, looking ahead to 2019 via '18, Joe said exactly right. It's like we expect something on a unit basis and high single digits and price whatever gross selling price increase we take, we don't obviously expect to net that and realize all of that, but the 2 drivers next year will be -- next year versus '18 will be volume and whatever we can net out of price increases that we take. With respect to the question around how do we expect to deploy our cash flow, Joe finished up with a slide that said, we have a $1 billion to be used for debt and/or bolt-on acquisitions. I mean, this is -- our priority is to reduce that debt. Now that said, it's not a priority where you say when you have a great opportunity that we think is value generative and helpful to all stakeholders. We're going to pursue that, and I think the best example of that is the ongoing situation with Synergy, whereas Joe reported in his remarks, we put in a stocking horse bid. It's $200 million. It's $200 million. If we were successful at that level, I'm not suggesting that's how that will sort out, but if we're successful at that level that $1 billion, $200 million of it would definitely be allocated to business development, and there are other smaller items that throughout the year, we would expect to pursue to continue to add to our R&D portfolios or to our marketed portfolios for each one of our core and important business. So it's a very difficult question because in the absence of something value generative, we're going to reduce our debt. That's super clear. But if there are these opportunities that we chipped in, deploy them against business development, and it makes sense, we're going to do that and in my opinion like, for example, the Synergy thing, that is something that makes an incredible amount of sense based on the strategic fit within our Salix portfolio. So that we will allocate capital to -- for BD and other small things. I don't know if I answer you. I can't answer your question specifically, but I hope I provided at least the way we're thinking about it.

Operator

Operator

The next question comes from Irina Koffler of Mizuho.

Irina Koffler

Analyst · Mizuho

I just wanted to verify that your guidance for next year, does it include any benefit from TRULANCE or any sales force expansion to Salix?

Joseph Papa

Analyst · Mizuho

The guidance that we give does not include any M&A, to be clear. It does include our plans for XIFAXAN, but not specifically related to what we are planning for incremental sales reps or anything along those lines if we are successful in acquiring TRULANCE. Is that clear?

Irina Koffler

Analyst · Mizuho

Yes, and then just one follow-up. You're obviously doing very well in Solta and cosmetic dermatology. Is there any thought to expanding your presence in that segment?

Joseph Papa

Analyst · Mizuho

Yes, Paul made a comment that we have a leader there, Tom Hart, who's doing a absolute phenomenal job in turning around that business, and what we are -- what he's doing is he's really focused on a couple of things. Number one, launching some new products. He's got a new Thermage product that he's launching, and it's doing very well with that product launch. Number two, he is looking at what I would refer to as geographic expansion. He is looking at places where we have an opportunity to do better than existing business, so we do very well in the United States. We do very well in Asia, but we have a significant opportunity in Europe as an example. So Tom is putting some incremental resources to work there to up -- look at what we think is a good opportunity for growth in the European and some of the other areas of the world that we just are not as well represented. So we do think there's some opportunities, a lot of upsides to be clear based on what we think is really strong leadership by Tom Hart and the team.

Paul Herendeen

Analyst · Mizuho

Yes, I want to -- it's Paul. I want to follow-on that as well is I think, the best way to build value is to optimize what you own and what you have in your own internal pipeline. And I daresay before Tom joined us and he was brought to us by Tom Appio, who runs our international business, which was a great thing for us. We had not optimized our existing portfolio nor where we positioned to optimize the new products that we already had the ability to roll out on our own and drive organic growth. That's why i.e. Joe, you can hear his enthusiasm about this business and certainly mine as well. We've called it out a handful of quarter -- quarters in a row here. We have an interesting portfolio. If there are opportunities to add to that, we surely would. But we have a lot of opportunity within that existing portfolio plus new products that we're rolling out from our pipeline. So well positioned in Global Solta.

Operator

Operator

Our next question comes from David Amsellem of Piper Jaffray.

David Amsellem

Analyst · Piper Jaffray

So just have a couple. So just coming back to M&A. I may have missed this, but maybe you can put a number on deal capacity or what you're wherewithal is in terms of deal size or aggregate transaction size and how much is earmarked for transactions. That's number one. And then number two, just talking about the cash pay dermatology model, can you just talk about the mechanics here? I mean, is this going to be products primarily dispensed in the physicians office, like what the Obagi model was and how many medical derm products do you envision falling under this model and then lastly, on the rifaximin studies, you highlighted four. Maybe give us some color on timing for data readouts on those studies?

Joseph Papa

Analyst · Piper Jaffray

Paul, why don't you take the first one? And I'll take the cash pay and rifaximin.

Paul Herendeen

Analyst · Piper Jaffray

Yes, sure, I mean -- David, thanks for the question. It's hard to put a number on what we might be willing to doing in M&A. We obviously have a limited capacity because of the level of our debt and limitations of our ability to generate free cash flow, which we can choose to either use to reduce debt or to deploy against the value-generative BD opportunities. I daresay, if we do Synergy this year it's going to be the -- that takes a good amount of our capacity out for 2019. If we're so fortunate as to be able to conclude that deal, it is one of the challenges that we face as we are a company that carries a lot of debt. We are highly levered and so we need to be incredibly judicious in the deployment of capital for BD, and it's just -- we don't have a big checkbook. We just don't, and that's the way it is until we can change it. And I'm not sure I answered your question, but I can't give you and say, oh, it's 40% of whatever. It's not. It's based on our ability to balance between the absolute requirement that we continue to prioritize using cash to reduce debt and not -- and being willing to place strategic bets on situations that we think are really going to be good for us in the long term.

Joseph Papa

Analyst · Piper Jaffray

David, on the second part of your questions about the cash pay model and dermatology. What we're trying to solve here is what the problems are in the dermatology space and some of the products, especially in areas like acne, for example, there is an uncertain environment with prior authorizations. There is uncertainty there for both the physician and the patient. There is expensive co-pays often in that category, and there is variable formulations from the generic companies, especially in the topical products. What we are going to seek to do is to bring forward a brand formulation that we believe will have predictable access, in other words, your patients will know, physicians will know how to get it, either through the physician's office, through retail stores or through a mail-order facility. So predictable access, and it will have known pricing, very predictable pricing otherwise, we'll be able to give our belief that we could make this product available at a set price. So that's what we think will be very helpful to a large number of patients and physicians because the market will become very predictable versus what -- unfortunately, we see today is a very unpredictable market. So Bill Humphries, our leader in this derm business is moving forward with this. We have a lot more to say about specific products but think about some of the older products that we have in the areas of acne, also in some of the topical dermatitis and other areas that will be coming forth with our products. So a lot more to say about this as we roll it out, but we think it's a good way to look at it. On the third part of your first question was rifaximin. You can hear our excitement that we're doing two…

Operator

Operator

And our next question today comes from David Steinberg of Jefferies.

David Steinberg

Analyst · Jefferies

I have a few questions on your GI business. So first, back to XIFAXAN. Your unit growth has been steadily improving, I think, up to 8% according to IMS. You've recently had some positive data in pain associated with IBS-D and Joe, you mentioned that about 90% of the market is untapped. So just curious, now that you've settled with Teva and you have a runway for 5, 6, 7 years what sort of unit growth -- given these dynamics what sort of unit growth you think you can put up in the near to medium term for XIFAXAN given it's your biggest drug? And then secondly, on Synergy, what sort of sales -- it's a good strategic fit, but what sort of sales would you need to achieve assuming you get it to start turning a profit, and what sort of PK sales expectations would you have for TRULANCE? And then finally, Cosmo is now been approved for rifaximin in the case for traveler's diarrhea. From what you can see in the market, are they taking share and what's your view on any off-label prescriptions or indications like IBS-D and HA?

Joseph Papa

Analyst · Jefferies

Sure. I think you got a lot of questions in there David, but I'll try to -- if I don't catch them all, let me -- remind me. On the first one, though, we're very excited to what we're seeing with XIFAXAN. The only thing I'm going to comment on is at least during the month of January, we actually saw about 10% growth in our year-over-year growth with XIFAXAN, so very strong unit in growth and as I mentioned in the nonretail segment, we're seeing even higher growth. So very excited about it, but just in terms of what we're expecting over the long term, I think it was really the nature of your question. I think if you think about volume growth in XIFAXAN, somewhere in that like, call it high single digit that's probably what I would stick with, not going into that double-digit side. Obviously, if we can get some additional net pricing, it might help grow -- show even more but high single digits is the unit volume growth I would probably think about as you're modeling. On the question of Synergy, I think, I said in the call, we're really excited about it. We think there's a great opportunity there with Synergy, especially given the fact that we bring some important experience we have experienced in the gastroenterologist office, which we think is helpful to what we need to do with Synergy. Number two is we've got a great supply chain capability. Dennis Asharin and the team, both of you are doing really well on the supply chain and then we've got some problems we have to fix with Synergy. So that is what we think is an important competitive advantage that we bring to this situation. And then finally, one of the areas that we were concerned about as we were watching externally was the market access side for Synergy. We think we also have new leadership in our market access team and a good market access team that can help us to get the appropriate opportunity for the future, assuming we can get Synergy at the right price. Final comment, question I think you asked was in terms of what's happening with Cosmo. I can say that our sales force has not seen any activity or sales presence in the gastroenterologist or primary care offices from Cosmo. We can say with conviction, we know there are some significant barriers to entry in the GI offices, and we're very pleased with our position for rifaximin and specifically, XIFAXAN as we sit here today, but we have not seen anything from Cosmo at this time, in the marketplace. I think I got all your questions David. Operator, I think we have time for one last question.

Operator

Operator

Today's final question comes from Louise Chen of Cantor.

Louise Chen

Analyst · Cantor

So I have two questions. First question I had was you've said that your Significant Seven products are expected to double again in 2019. Just curious which products are driving that? And are there any, in particular, that you're very excited about? And then secondly, are you still considering options to meaningfully delever your balance sheet? And if so, what are some of those key options that you're considering?

Joseph Papa

Analyst · Cantor

Sure. I'll take that first part and then Paul, you want to take the comment on the second part of delevering. On the Significant Seven, I think, probably the best way to say it is that we like all the 7. We think all 7 of them are really the opportunity for growth, and we put them together specifically because as we talked about going back to 2019, they were under, call it, $75 million of revenue, and we thought about what was going to drive the growth of our business, and we said, these 7 products are going to be key to us. Clearly, there's a big, big opportunity in dermatology as we bring SILIQ to the market. We get BRYHALI approved and upon the approval of DUOBRII, we think those 3 products are going to be an important driver not only of our Significant Seven but also the turnaround in dermatology. So I'd have to say that those are clearly important drivers to our future success with our dermatology turnaround. But we do think just to summarize my comment, all 7 products are important to us for the point of view of both the growth aspects, but also how we'll turn around the overall dermatology business. Paul, do you want to take the second part of Louise's question?

Paul Herendeen

Analyst · Cantor

Yes, sure. I mean, obviously, the best way is for us to delever or grow our adjusted EBITDA. Secondarily, to prioritize use of cash flow to continue to reduce that debt. And last on that list would be to consider potential equity or equity-linked securities. I'd say that we have made an enormous amount of progress in managing our cap structure, particularly the liability side of our cap structure over the last couple of years. Great leadership from Will Woodfield, our treasurer. It's -- right now, we're okay with where we are leverage wise, and if we look at our forecast over the next few years, we will generate enough cash to help us significantly advance the ball and reducing our leverage in addition of the obvious benefits of growing our adjusted EBITDA. So we feel pretty good about where we are right now and not compelled to do anything. We'll just continue to look at for managing the cap structure side at opportunities to continue to target those debt stacks that come due. I mean, even though we've made such great progress I'll -- looking out to 2023, where there's a hefty amount of almost circa $6 billion of unsecured debt that comes due out there that we want to start looking at and thinking about taking that out. But in terms of steps that its stay the course, let's grow our EBITDA, let's prioritize use of our cash to reduce debt, and we'll see how it goes.

Joseph Papa

Analyst · Cantor

Thank you, everyone, for joining us today, and look forward to having a chance to catch up with everyone over the next weeks ahead of us. Thank you. Have a great day, everyone.

Operator

Operator

And thank you, sir. Today's conference has now concluded. And we thank you all for attending today's presentation. You may now disconnect your lines, and have a wonderful day.