Investors are worried about the future of biopharma companies as the attacks on drug makers this election has left scars on the healthcare sector.  

The S&P health care sector index has inched up only 1.4% this year compared with a gain of 5.37% in the Standard & Poor’s 500 index, making it one of the worst performing sectors of 2016.

It is a far cry from consistently being one of the best sectors in the last five years where the index increased 154% from 2010 to 2015 while the S&P rose around 72% in that same period. 

The aftermath of Hillary Clinton’s tweets about price gouging has shown the vulnerability of this sector to these elections. Her comment on Turing’s 5000% price hike last fall sent Nasdaq Biotechnology Index down almost five percent on that day.

And now with Donald Trump also criticizing drug pricing, this issue has become less partisan with every scandal.

Analysts believe that pharmaceutical and biotechnology companies will soon be tested in their ability to successfully navigate the upcoming changes in pricing regulation.  

“Political pressure on drug pricing has reached the point where the ability of biopharma companies to adapt to a more restrained pricing environment will differentiate winners and losers,” wrote Goldman Sachs in their recent report.

One way for the companies to adapt is by focusing more on innovating drugs than selling generic drugs, according to analysts. Based Clinton’s plans on her website, her policy would mostly affect companies that buy older drugs and sell them at a higher price.

Drug makers like Mylan and Valeant, will be more exposed to new regulation than pharmaceutical giant like Bristol-Myers Squibb, which is more diversified and gets a larger portion of its profits from newer drugs.

Valeant Pharmaceuticals, plagued by investigations over its pricing policies and accounting scandals, has seen its price fall around 90 percent last year bringing it from $262 to $23. In its case, investors have already begun pricing in the risk of change in drug pricing, according to analysts.

Another way the biopharma companies might gear up for the future is through an increasing number of mergers and acquisitions, which has been relatively quiet this year.

Healthcare M&A activity set a record last year by increasing 14% to 1,498 transactions, for a total of  $563.1 billion, according to Health Care M&A News.

“Last year was the biggest year for M&A in this sector,” said Jacob Kilstein, analyst at Argus Research Company.  “This year was very muted. It has been picking up, and it is expected to continue to do so.”

Health care has always been a merger and acquisition intensive sector and with the Federal Reserve still keeping the rates low it creates an added incentive for companies.

Acquiring a company is also preferable for larger drugmakers like Pfizer and Sanofi since it immediately adds to the revenue and earnings, and that’s what a company wants, said Kilstein.

“It takes years and billions of dollars to develop a drug and ultimately the company want sales,” he said.  

However, not everyone believes that there’s a tough road ahead for the sector.

Looking at its performance in the recent weeks and the lack of any mention of drug pricing in the first presidential debates is a sign that things are looking better, according to Brian Skorney, analyst at Robert W. Baird.

“I think the tension has gone for the large part,” Skorney said.  “Trump and Hillary didn’t even mention it in the debates. I think they realize there no point vilifying this sector anymore.”

While historically, health care stocks have outperformed the post-election market in five of the last six presidential elections, the one time it didn’t was after Bill Clinton was first elected, according to the recent Morgan Stanley research note.

The reason behind its poor performance was due to Hillary Clinton’s efforts to introduce universal health care. It is also why people are now taking the possibility of changes in drug pricing seriously, despite this being an issue for many years.

Therefore no matter who wins, analysts think that an acceptable strategy is to buy shares of bigger and more diversified biopharma companies like Eli Lilly and Company, to prevent as much exposure as possible to what happens in Washington.