XLV EM range 17 = weak downtrend. Healthcare is theoretically a defensive rotation target, but on 03/20 (Quad Witching), 42/47 names closed red. This is NOT defensive rotation — this is broad liquidation. The 03/19 $522M institutional put wall was pre-positioning for OpEx expiry chaos. MRK was the singular bright spot: flat on a slow tape with $3.5B demand-heavy darkpool and accumulation ladder. PGR bucked at +1.6% with $1.03B accumulation. Everything else was sold.
| Ticker | Price | Δ% | DP Vol | DP L1 | Ladder | GEX | Opt Side | Conf | Tier |
|---|---|---|---|---|---|---|---|---|---|
| ABBV | $205.07 | -0.56% | $4.11B | DIST | ACCU(E)⚠ | -0.42 | BULL | LOW | ⚠️ |
| ABT | $105.46 | -1.61% | $7.40B | DIST | — | +0.12 | BULL | LOW | ⚠️ |
| AMGN | $347.80 | -0.61% | $807M | DIST | ACCU(E)⚠ | -0.17 | BULL | HIGH | ⭐ |
| ARWR | $56.33 | -1.11% | $53.6M | DIST | — | -1.84 | BULL | HIGH | ⚠️ |
| AXSM | $156.92 | -1.23% | $18.6M | DIST | ACCU(S)⚠ | -4.43 | — | — | — |
| AZN | $183.60 | -2.82% | $60.7M | DIST | — | -1.60 | — | — | — |
| BBIO | $68.54 | -2.18% | $35.8M | DIST | ACCU(M)⚠ | -10.78 | BEAR | MOD | ⚠️ |
| BMY | $57.48 | -1.08% | $909M | DIST | ACCU(M)⚠ | +1.47 | BEAR | HIGH | ⭐⭐🔻 |
| BSX | $69.48 | -0.59% | $227M | DIST | ACCU(M)⚠ | +0.74 | BEAR | MOD | ⭐🔻 |
| CI | $262.84 | -0.65% | $200M | DIST | — | -0.21 | — | — | — |
| CNC | $34.40 | -3.29% | $281M | DIST | ACCU(E)⚠ | -0.31 | — | — | — |
| ELV | $291.48 | +0.11% | $100M | ACCU | DIST(E) | -2.22 | — | — | — |
| GEHC | $69.65 | -1.04% | $179M | DIST | — | -0.49 | — | — | — |
| GH | $85.18 | -4.38% | $21.2M | DIST | — | -3.29 | — | — | — |
| GILD | $137.21 | -2.76% | $239M | DIST | — | +0.41 | BULL | HIGH | ⚠️ |
| GRAL | $46.84 | -3.36% | $3.4M | DIST | — | -1.97 | BEAR | LOW | — |
| HIMS | $22.02 | -8.86% | $120M | DIST | DIST(M) | +23.2 | BULL | MOD | ⚠️ |
| INSM | $136.00 | -5.56% | $44.5M | DIST | — | -15.6 | — | — | — |
| JNJ | $235.37 | -0.94% | $719M | DIST | — | +0.99 | BEAR | LOW | — |
| LLY | $906.70 | -1.18% | $1.68B | DIST | ACCU(S)⚠ | -3.14 | BEAR | HIGH | ⭐⭐🔻 |
| MCK | $885.84 | -1.46% | $208M | DIST | — | +1.32 | BEAR | HIGH | ⭐🔻 |
| MDGL | $441.16 | -2.88% | $13.6M | DIST | DIST(S) | -1.06 | BULL | HIGH | ⚠️ |
| MDT | $86.16 | -0.82% | $87.4M | DIST | — | -5.73 | — | — | — |
| MIRM | $88.51 | -2.44% | $109M | DIST | ACCU(S)⚠ | -10.5 | — | — | — |
| MOH | $139.41 | -1.97% | $804M | DIST | ACCU(M)⚠ | +1.16 | — | — | — |
| MRK ⭐ | $114.18 | -0.02% | $3.50B | LEAN BL | ACCU(M) | +0.25 | BULL | LOW | ⭐⭐🔺 |
| NTRA | $195.28 | -3.67% | $7.2M | DIST | DIST(M) | +1.00 | — | — | — |
| NVO | $36.53 | -1.48% | $34.2M | DIST | — | -3.35 | BEAR | LOW | ⭐🔻 |
| NVS | $146.03 | -1.46% | $18.3M | DIST | DIST(M) | -13.7 | — | — | — |
| PFE | $26.97 | -1.61% | $781M | DIST | — | -1.37 | BULL | LOW | ⚠️ |
| PGR | $206.00 | +1.64% | $1.03B | ACCU | DIST(M)⚠ | -1.68 | — | — | ⭐ |
| PTGX | $98.87 | -2.76% | $20.2M | DIST | ACCU(S)⚠ | -1.87 | — | — | — |
| REGN | $732.87 | -0.62% | $82.2M | DIST | — | +1.86 | BULL | HIGH | ⚠️ |
| RNA | $13.13 | +3.47% | $6.3M | ACCU | DIST(M)⚠ | +18.2 | — | — | — |
| RYTM | $87.45 | -3.17% | $16.2M | DIST | — | -0.69 | — | — | — |
| SYK | $335.67 | -1.20% | $390M | DIST | — | -1.13 | — | — | ⭐🔻 |
| TEM | $46.96 | -3.65% | $1.5M | NEUT | — | -2.99 | BEAR | HIGH | ⚠️🔻 |
| TMO | $474.39 | +0.89% | $352M | ACCU | — | -1.07 | — | — | ⭐🔺 |
| TWST | $42.07 | -6.09% | $5.3M | DIST | — | -24.5 | — | — | — |
| UNH | $275.59 | -1.73% | $8.36B | DIST | ACCU(E)⚠ | -1.68 | BEAR | LOW | ⭐⭐⭐ |
| VKTX | $32.33 | -4.69% | $27.0M | DIST | — | +0.54 | — | — | — |
| VRTX | $454.00 | -0.88% | $56.3M | DIST | DIST(E) | -2.23 | BEAR | HIGH | ⭐⭐ |
| WST | $237.03 | -1.37% | $105M | DIST | — | -0.07 | — | — | — |
| ZTS | $115.67 | -0.28% | $900M | DIST | DIST(M) | — | — | — | — |
| ZYME | $23.32 | -3.68% | — | — | — | — | — | — | — |
| Tier | Ticker | Direction | Change | Justification |
|---|---|---|---|---|
| ⭐⭐⭐ | UNH | SHORT | — | 6/6 bearish DP. $8.36B OpEx distribution. Prior $522M put wall. Ladder dying. |
| ⭐⭐ | LLY | SHORT | 🔻 was LONG | Bull thesis BROKEN. HIGH-conf bearish options + $1.3B DP outflow. Ladder cracking. |
| ⭐⭐ | BMY | SHORT | 🔻 NEW | $3.85M Jan 2027 LEAPS put bought (structural). HIGH conf. DP distribution. |
| ⭐⭐ | VRTX | SHORT | — | 5/5 bearish DP + HIGH-conf $1.2M pure put buying. Distribution ladder forming. |
| ⭐⭐ | MRK | LONG | 🔺 was ⭐ | $3.5B demand-heavy on flat tape. ONLY lean-bullish DP in sector on 03/20. |
| ⭐ | TMO | WATCH | 🔺 was SHORT | Single-session DP reversal from 3/3 bearish. Needs confirmation. Wait. |
| ⭐ | PGR | LONG | NEW | $1.03B accumulation on +1.6%. Defensive rotation name. Needs options confirmation. |
| ⭐ | MCK | SHORT | NEW | $1M pure bear (calls sold + puts bought) on HIGH conf. DP supply heavy. |
| ⭐ | AMGN | LONG | NEW | $1.1M calls bought (97%) on HIGH conf. But DP distribution on OpEx = conflict. |
| ⭐ | BSX | SHORT | 🔻 was ⭐⭐ | 5/5 bearish DP but options only MOD conf. Downgraded from prior cluster. |
| ⭐ | NVO | SHORT | 🔻 was ⭐⭐ | Continued DP distribution. Options LOW conf (39% unknown). GLP-1 peer pressure. |
| ⭐ | SYK | SHORT | — | 4/5 bearish DP. $390M distribution on OpEx. No options confirmation today. |
| ⚠️ | HIMS | AVOID | — | -8.86% crash but contrarian put selling. Conflicted. GEX floor at $25. |
| ⚠️ | TEM | DAMAGED | 🔻 was ⭐ | Options flipped bearish on HIGH conf. Prior bull thesis invalidated. |
MRK is the sole institutional conviction long — $3.5B demand-heavy accumulation while 10 peers sold off. LLY thesis broke on 03/20 (HIGH-conf bearish options + $1.3B outflow). BMY received a $3.85M structural LEAPS put. JNJ, PFE, ABBV all distributed but with LOW-conf options (high unknown %). The "pharma as safe haven" thesis failed on Quad Witching — only MRK held.
VRTX is the cleanest short (5/5 bearish + pure put buying). INSM cratered -5.56% with -$15.6 GEX (extreme negative gamma). HIMS -8.86% but conflicted options. BBIO has MOD-conf bearish options against a stale accumulation ladder. XBI range 10 = biotech trend is barely alive. No biotech longs have conviction.
TMO is the sole reversal candidate (+0.89% accumulation after 3/3 bearish). SYK continues its waterfall ($390M distribution). BSX demoted from ⭐⭐ to ⭐ (options only MOD conf). MDT -5.73 GEX with no options signal. The device names tracked institutional selling all week — TMO's flip needs confirmation.
UNH is the sector's highest-conviction short (⭐⭐⭐). PGR is the standout long (+1.6% accumulation). CI, CNC, MOH all distributed on OpEx. ELV barely green (+0.11%) on slow tape. Insurance is split: PGR getting defensive inflows while managed care names (UNH, CNC, MOH) face policy headwinds.
Post-OpEx Mechanics: -$25.8B total put delta expired on 03/20. For healthcare, this means: (1) UNH's massive $8.36B distribution was partly OpEx-amplified — volume will normalize Monday but direction should persist; (2) LLY's $900 GEX strike provides a mechanical floor — any bounce to $917-930 is a sell zone given the options profile; (3) MRK's $3.5B accumulation on a flat tape is the most structurally bullish signal in the sector — the $119 GEX ceiling is the first test.
Key Levels: UNH: $280 GEX support, break below = cascade. LLY: $900 floor, $930 sell zone. MRK: $119 ceiling. VRTX: $435 put target. BMY: $55 LEAPS put strike = institutional floor estimate.
Watch for 03/24-03/25: Post-OpEx dealer delta has flipped SHORT (floor). A mechanical bounce is expected across indexes. Healthcare names that FAIL to bounce (remain red when SPY/QQQ green) are confirmed distribution — add to short conviction. MRK and PGR should outperform if the bounce materializes.