Comprehensive Stock Comparison
Compare Milestone Pharmaceuticals Inc. (MIST) vs Alkermes plc (ALKS) Stock
Analyze side-by-side fundamentals, valuation, growth, and profitability to decide which stock is the better buy.
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Quick Verdict
| Category | Winner | Why |
|---|---|---|
| Growth | ALKS | -5.2% revenue growth vs MIST's -100.0% |
| Stability / Safety | ALKS | Beta 0.61 vs MIST's 1.32, lower leverage |
| Dividends | Tie | Neither pays a meaningful dividend |
| Momentum (1Y) | MIST | +4.9% vs ALKS's -12.3% |
| Efficiency (ROA) | ALKS | 9.7% ROA vs MIST's -66.1%, ROIC 14.9% vs -64.8% |
Who Each Stock Is For
Income & stability
Growth exposure
Long-term compounding (10Y)
Sleep-well-at-night portfolio
Defensive / Recession hedge
Business Model
What each company does and how it makes money
Milestone Pharmaceuticals is a clinical-stage biopharmaceutical company developing novel cardiovascular therapies. It generates revenue primarily through research collaborations and licensing agreements — notably with Ji Xing Pharmaceuticals for its lead candidate etripamil — while advancing toward potential drug commercialization. The company's competitive advantage lies in its proprietary etripamil formulation, a fast-acting nasal spray designed for patient self-administration during acute cardiac episodes.
Alkermes is a biopharmaceutical company that develops and commercializes medicines for central nervous system disorders and other serious conditions. It generates revenue primarily from product sales of its proprietary drugs like VIVITROL and ARISTADA — which treat addiction and schizophrenia — along with royalties from partnered products and manufacturing services. The company's competitive advantage lies in its specialized drug delivery technologies that enable long-acting injectable formulations, creating significant barriers to entry for competitors.
Revenue Breakdown by Segment
How each company's revenue is distributed across its business units
Segment breakdown not available.
Financial Metrics Comparison
Side-by-side fundamentals across 2 stocks. BestLagging
Financial Scorecard
ALKS leads in 3 of 6 categories (Profitability & Efficiency, Total Returns). MIST leads in 1 (Financial Metrics). 1 tied.
Financial Metrics (TTM)
ALKS and MIST operate at a comparable scale, with $1.5B and $0 in trailing revenue.
| Metric | MISTMilestone Pharmac… | ALKSAlkermes plc |
|---|---|---|
| RevenueTrailing 12 months | $0 | $1.5B |
| EBITDAEarnings before interest/tax | -$57M | $281M |
| Net IncomeAfter-tax profit | -$58M | $242M |
| Free Cash FlowCash after capex | -$43M | $520,800 |
| Gross MarginGross profit ÷ Revenue | — | +86.3% |
| Operating MarginEBIT ÷ Revenue | — | +17.2% |
| Net MarginNet income ÷ Revenue | — | +16.4% |
| FCF MarginFCF ÷ Revenue | — | +0.0% |
| Rev. Growth (YoY)Latest quarter vs prior year | — | -10.6% |
| EPS Growth (YoY)Latest quarter vs prior year | +14.3% | -67.0% |
Valuation Metrics
| Metric | MISTMilestone Pharmac… | ALKSAlkermes plc |
|---|---|---|
| Market CapShares × price | $146M | $5.0B |
| Enterprise ValueMkt cap + debt − cash | $175M | $4.5B |
| Trailing P/EPrice ÷ TTM EPS | -2.55x | 21.05x |
| Forward P/EPrice ÷ next-FY EPS est. | — | 32.04x |
| PEG RatioP/E ÷ EPS growth rate | — | — |
| EV / EBITDAEnterprise value multiple | — | 15.89x |
| Price / SalesMarket cap ÷ Revenue | — | 3.38x |
| Price / BookPrice ÷ Book value/share | 8.09x | 2.79x |
| Price / FCFMarket cap ÷ FCF | — | 9571.39x |
Profitability & Efficiency
ALKS delivers a 13.3% return on equity — every $100 of shareholder capital generates $13 in annual profit, vs $-3 for MIST. ALKS carries lower financial leverage with a 0.04x debt-to-equity ratio, signaling a more conservative balance sheet compared to MIST's 4.17x. On the Piotroski fundamental quality scale (0–9), ALKS scores 5/9 vs MIST's 2/9, reflecting solid financial health.
| Metric | MISTMilestone Pharmac… | ALKSAlkermes plc |
|---|---|---|
| ROE (TTM)Return on equity | -2.8% | +13.3% |
| ROA (TTM)Return on assets | -66.1% | +9.7% |
| ROICReturn on invested capital | -64.8% | +14.9% |
| ROCEReturn on capital employed | -62.2% | +14.4% |
| Piotroski ScoreFundamental quality 0–9 | 2 | 5 |
| Debt / EquityFinancial leverage | 4.17x | 0.04x |
| Net DebtTotal debt minus cash | $29M | -$518M |
| Cash & Equiv.Liquid assets | $25M | $588M |
| Total DebtShort + long-term debt | $55M | $70M |
| Interest CoverageEBIT ÷ Interest expense | -14.42x | 23.55x |
Total Returns (with DRIP)
A $10,000 investment in ALKS five years ago would be worth $15,677 today (with dividends reinvested), compared to $2,277 for MIST. Over the past 12 months, MIST leads with a +4.9% total return vs ALKS's -12.3%. The 3-year compound annual growth rate (CAGR) favors ALKS at 4.0% vs MIST's -18.5% — a key indicator of consistent wealth creation.
| Metric | MISTMilestone Pharmac… | ALKSAlkermes plc |
|---|---|---|
| YTD ReturnYear-to-date | -16.6% | +6.5% |
| 1-Year ReturnPast 12 months | +4.9% | -12.3% |
| 3-Year ReturnCumulative with dividends | -45.9% | +12.6% |
| 5-Year ReturnCumulative with dividends | -77.2% | +56.8% |
| 10-Year ReturnCumulative with dividends | -88.9% | -6.7% |
| CAGR (3Y)Annualised 3-year return | -18.5% | +4.0% |
Risk & Volatility
ALKS is the less volatile stock with a 0.61 beta — it tends to amplify market swings less than MIST's 1.32 beta. A beta below 1.0 means the stock typically moves less than the S&P 500. ALKS currently trades 82.9% from its 52-week high vs MIST's 55.9% drawdown — a narrower gap to the peak suggests stronger recent price momentum.
| Metric | MISTMilestone Pharmac… | ALKSAlkermes plc |
|---|---|---|
| Beta (5Y)Sensitivity to S&P 500 | 1.32x | 0.61x |
| 52-Week HighHighest price in past year | $3.06 | $36.32 |
| 52-Week LowLowest price in past year | $0.63 | $25.17 |
| % of 52W HighCurrent price vs 52-week peak | +55.9% | +82.9% |
| RSI (14)Momentum oscillator 0–100 | 39.6 | 39.0 |
| Avg Volume (50D)Average daily shares traded | 2.5M | 1.6M |
Analyst Outlook
Wall Street rates MIST as "Buy" and ALKS as "Buy". Consensus price targets imply 367.8% upside for MIST (target: $8) vs 52.8% for ALKS (target: $46).
| Metric | MISTMilestone Pharmac… | ALKSAlkermes plc |
|---|---|---|
| Analyst RatingConsensus buy/hold/sell | Buy | Buy |
| Price TargetConsensus 12-month target | $8.00 | $46.00 |
| # AnalystsCovering analysts | 7 | 28 |
| Dividend YieldAnnual dividend ÷ price | — | — |
| Dividend StreakConsecutive years of raises | — | 0 |
| Dividend / ShareAnnual DPS | — | — |
| Buyback YieldShare repurchases ÷ mkt cap | 0.0% | 0.0% |
Historical Charts
Charts are rendered on first load. Hover for details.
Chart 1Total Return — 5 Years (Rebased to 100)
| Stock | Mar 20 | Feb 26 | Change |
|---|---|---|---|
| Milestone Pharmaceu… (MIST) | 100 | 10.44 | -89.6% |
| Alkermes plc (ALKS) | 100 | 164.6 | +64.6% |
Alkermes plc (ALKS) returned +57% over 5 years vs Milestone Pharmaceu… (MIST)'s -77%. A $10,000 investment in ALKS 5 years ago would be worth $15,677 today (including dividends reinvested).
Chart 2Revenue Growth — 10 Years
| Stock | 2016 | 2025 | Change |
|---|---|---|---|
| Milestone Pharmaceu… (MIST) | $0.00 | $0.00 | — |
| Alkermes plc (ALKS) | $746M | $1.5B | +97.9% |
Alkermes plc's revenue grew from $746M (2016) to $1.5B (2025) — a 7.9% CAGR.
Chart 3Net Margin Trend — 10 Years
| Stock | 2016 | 2025 | Change |
|---|---|---|---|
| Milestone Pharmaceu… (MIST) | -2.9% | -59.7% | -1989.2% |
| Alkermes plc (ALKS) | -28.0% | 16.4% | +158.6% |
Alkermes plc's net margin went from -28% (2016) to 16% (2025).
Chart 4P/E Ratio History — 3 Years
| Stock | 2023 | 2025 | Change |
|---|---|---|---|
| Alkermes plc (ALKS) | 13.2 | 19.6 | +48.5% |
Alkermes plc has traded in a 13x–20x P/E range over 3 years; current trailing P/E is ~21x.
Chart 5EPS Growth — 10 Years
| Stock | 2016 | 2025 | Change |
|---|---|---|---|
| Milestone Pharmaceu… (MIST) | -0.34 | -0.67 | -97.1% |
| Alkermes plc (ALKS) | -1.38 | 1.43 | +203.6% |
Alkermes plc's EPS grew from $-1.38 (2016) to $1.43 (2025).
Chart 6Free Cash Flow — 5 Years
Milestone Pharmaceuticals Inc. generated $-29M FCF in 2024 (+13% vs 2021). Alkermes plc generated $1M FCF in 2025 (-99% vs 2021).
MIST vs ALKS: Frequently Asked Questions
8 questions · data-driven answers · updated daily
01Is MIST or ALKS a better buy right now?
Alkermes plc (ALKS) offers the better valuation at 21.0x trailing P/E (32.0x forward), making it the more compelling value choice. Analysts rate Milestone Pharmaceuticals Inc. (MIST) a "Buy" — based on 7 analyst ratings — the highest consensus in this comparison. The "better buy" depends entirely on your goals: growth investors should weight revenue trajectory, value investors should weight P/E and PEG, and income investors should weight dividend yield and streak.
02Which is the better long-term investment — MIST or ALKS?
Over the past 5 years, Alkermes plc (ALKS) delivered a total return of +56.8%, compared to -77.2% for Milestone Pharmaceuticals Inc. (MIST). A $10,000 investment in ALKS five years ago would be worth approximately $16K today (assuming dividends reinvested). Over 10 years, the gap is even starker: ALKS returned -6.7% versus MIST's -88.9%. Past returns do not guarantee future results, and the stock with the higher historical return may already have its best growth priced in.
03Which is safer — MIST or ALKS?
By beta (market sensitivity over 5 years), Alkermes plc (ALKS) is the lower-risk stock at 0.61β versus Milestone Pharmaceuticals Inc.'s 1.32β — meaning MIST is approximately 118% more volatile than ALKS relative to the S&P 500. On balance sheet safety, Alkermes plc (ALKS) carries a lower debt/equity ratio of 4% versus 4% for Milestone Pharmaceuticals Inc. — giving it more financial flexibility in a downturn.
04Which has better profit margins — MIST or ALKS?
Alkermes plc (ALKS) is the more profitable company, earning 16.4% net margin versus 0.0% for Milestone Pharmaceuticals Inc. — meaning it keeps 16.4% of every revenue dollar as bottom-line profit. Operating margin tells a similar story: ALKS leads at 17.2% versus 0.0% for MIST. At the gross margin level — before operating expenses — ALKS leads at 86.3%, reflecting greater pricing power or product mix advantage. Stronger margins indicate durable pricing power, lower cost of revenue, or higher mix of software/services. They are one of the clearest signs of business quality.
05Is MIST or ALKS more undervalued right now?
Analyst consensus price targets imply the most upside for MIST: 367.8% to $8.00.
06Which pays a better dividend — MIST or ALKS?
None of the stocks in this comparison currently pay a material dividend. All are effectively zero-yield and should be held for capital appreciation rather than income.
07Is MIST or ALKS better for a retirement portfolio?
For long-horizon retirement investors, Alkermes plc (ALKS) is the stronger choice — it scores higher on the combination of lower volatility, dividend reliability, and long-term compounding (low volatility (β 0.61)). Both have compounded well over 10 years (ALKS: -6.7%, MIST: -88.9%), confirming both are viable long-term holds — but the lower-volatility option typically results in less emotional selling during corrections. Retirement portfolios generally favour predictability over maximum returns. Consult a financial advisor before making allocation decisions.
08What are the main differences between MIST and ALKS?
Both stocks operate in the Healthcare sector, making this a peer-level intra-sector comparison — the same macro tailwinds and headwinds will affect both. These fundamental differences mean investors should not choose between them on a single metric — the "better stock" depends entirely on which of these characteristics aligns with your investment strategy.
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