Health care's biggest annual gathering — the J.P. Morgan Healthcare Conference — starts Monday in San Francisco as the industry grapples with threats from Washington to Silicon Valley. More than 485 companies from biotech, pharma, insurance, hospital systems and more will give investor presentations to more than 9,000 attendees at the Westin St. Francis hotel this year. Even more consulting companies and law firms will flood hotel suites and conference rooms near Union Square to host meetings that executives compare to speed dating for investors. In its 37th year, the four-day conference has helped shape the agenda for both the industry and individual companies for the year. Some executives share their financial forecasts or milestones investors can expect from drug pipelines. Others touch on themes for the industry, with tax reform being a major focus last year.

Health and Human Services Secretary Alex Azar listens as U.S. President Donald Trump delivers a speech about lowering prescription drug prices from the Rose Garden at the White House in Washington, U.S., May 11, 2018. Jonathan Ernst | Reuters

Drug prices will likely be a major topic this year. As president-elect two years ago, Donald Trump made his now-infamous comment during the conference that drug companies were "getting away with murder." Since then, he has installed Scott Gottlieb as commissioner of the Food and Drug Administration and Alex Azar as Health and Human Services secretary with instructions to lower drug prices. (Gottlieb is presenting his keynote speech Tuesday via teleconference from Washington due to the federal government shutdown.) Health care's intersection with technology will also likely be a major theme throughout the week. One name stoking both excitement and fear: Amazon. The company's worried Wall Street for some time now. But Amazon's entry into the industry is no longer hypothetical with its purchase of online pharmacy PillPack last year.

Amazon CEO Jeff Bezos, founder of space venture Blue Origin and owner of The Washington Post, participates in an event hosted by the Air Force Association September 19, 2018 in National Harbor, Maryland. Alex Wong | Getty Images