IQVIA Holdings Inc. (IQV) Earnings Call Transcript & Summary

All right. We're live. Next up, we have IQVIA. Representing IQVIA is Ari Bousbib. Ari, welcome.

Thank you, Dan.

Ari, you just reported your third quarter results, and I was hoping we could start there. If you could walk us through the highlights. What did you find encouraging? And where is there more work still to do?

Well, no news, but we reported financial numbers at the high end of our guidance, and that was -- that's good. We try to do that always. We gave guidance for the balance of the year, which is also consistent. We plan to deliver over 5% of revenue growth. We shared our main metrics. We booked quite a bit of business in the third quarter. We had a decent book-to-bill of 1.15. We booked on a net basis, $2.6 billion of new business in our clinical business. The leading indicators trended favorably. We look in particular, and we've increased our focus on measuring decision time lines, which had become elongated during the period of uncertainty that we just went through in our industry. And those decision time lines have started to trend towards normal decision time lines. Our request for proposals increased very strongly. They were up 20% in dollars year-over-year. We think end of '24, beginning of '25 was probably the trough of the cycle we just went through. And relative to the first quarter, our bookings in Q3 were up over 21%. They were up 13% year-over-year. So again, good trends, favorable trends and an improvement overall in the environment.

Okay. And one of the themes that came through in your call was this concept of the uncertainty lifting in pharma. And I was hoping you could talk more about that because at least just tracking the dates of the news flow, Pfizer Tuesday didn't happen until September 30. So presumably, that ought not to have affected your third quarter. So tell me what you're seeing in your interactions.

Well, look, I mean, we just went through a period of significant turmoil in our industry. And I would -- even before that period of uncertainty, which started exactly a year ago with the new administration and the nomination of RFK Jr. and all the preannounced policy changes that we've heard of. I think, firstly, you have to remember, there was a period of overspending and overinvestment in the industry, frankly, in the '20 to '22 time frame because of the COVID pandemic. Every available and unavailable capital flowed into the industry. We had a massive amount of investments, a lot of it towards infectious diseases, vaccines, COVID-related therapies. And post-COVID, all of that went away. I mean our own company grew 20% plus during that time year-over-year for a company our size, that's quite significant. And so we've got the climbing down from that peak period and the restraint that accompanied that period of time where people were -- the pendulum swung the other way. There was no capital available really on the emerging biotech front. That's number one headwind that we faced. Secondly, we had the IRA under the Biden administration, which included provisions to begin negotiating certain prices of drugs. And we had a period where in the end of '23 and through '24, where large pharma, in particular, spent a lot of time revisiting their pipeline of projects in light of potentially new pricing assumptions and the resulting more unfavorable IRRs. As a result, we had an elevated number of cancellations of clinical trials that had either just started or that had been awarded but not started. That was a second significant headwind that the industry faced and of course, tempered our net reported bookings because we were facing elevated level of cancellations, not just due to futility reasons, but also to this process that [ Claus Pharma ] went through and cancellation wave based on economic reasons. That is largely behind us as well. And the third macro headwind was the uncertainty you described. So it's not just one thing, but it's a series of macro events that created a difficult environment for us. The wave of uncertainty triggered about a year ago, the changes at the FDA, different people in charge in and out, talks about tariffs, talks about MFN, et cetera. And that created a lot of uncertainty because those pronouncements weren't clarified for a long period of time. And when you do not have good information, you don't want to make large capital investment decisions. No one wants to take those kinds of risks. And as a result, while our pipelines continue to grow, decision time lines continue to elongate as large pharma sort of paused decisions and biotech investors paused their investment decisions. Secondary markets were closed, as you know, and unavailable. And so all of that created a difficult climate. So after having faced elevated cancellations, now we were facing a reduced number of available trials and demand that was constrained. So that was through the first part of this year, but already beginning in the second quarter and certainly confirming it through the third quarter and continuing now, we see that level of uncertainty being lifted. It's not so simple to have tariffs in biopharmaceuticals. It's the issues about pricing of drugs, which are always an issue that people like to talk about. The implementation, the executive orders that were issued sort of clarified what it would apply to and removed a lot of uncertainty. And we knew this before the September 30, meaning...

Before the Pfizer announcement.

Yes. And I think that's one element. The other element, which sort of is independent of what the administration decides is if you have a good drug that's got a molecule that has very good preclinical results, possibly good Phase I data, if you want to go -- you know that it's going to take 3, 4 years before that drug gets to market if everything proceeds well. And you want to be there quickly. Every month that you waste is a lot of money for. And pharma is valued on the pipeline. And you also have an upcoming wave of expirations -- of patent expirations between now and 2030. And the growth in this industry essentially is driven by the net of new molecules approved minus patent expirations. So you want to constantly refill your pipeline. And if you are holding off on investments, you're just delaying that. And so in conversations with clients, it became apparent that we cannot wait forever to understand exactly what the administration will do or will not do, we need to proceed. And I think that started even before those meetings and all of those elements that -- all of these events that sort of contributed to reduce the level of uncertainty.

Got it. What's your degree of conviction that all of the IRA reprioritizations are behind us?

Well, look, we work with everyone in the industry. I think there's no one in the world of biopharma that doesn't buy something from IQVIA. And so we have very good relationships with our clients, and we've participated in those processes. And we are very convinced that that's over.

Okay. And what's your level of conviction that we're not going to have an MFN reprioritization wave?

Look, the events that you referred to and the administration has more or less clarified what they will focus on. No one can be certain. We could always be surprised with the new executive order. But I think in conversations with the industry and with people in the administration, I think we are fairly confident that essentially, we know where it's going.

Okay. Moving on to some of the leading indicators you mentioned, specifically the 20% growth in RFPs year-on-year, that's accelerated every quarter year-to-date. There's been a lot of discussion in the investment community over the past 12 months about the reliability of that as a leading indicator given potential changes in customer behavior. Do you feel that, that 20% RFP growth is a genuine demand signal that you're confident in?

Well, I mean, yes, not every request for proposal turns into an award. But -- and we don't include in our RFP metrics any request for proposals. These are all validated both in terms of the science and in terms of the availability of funding for those programs. So I'm not sure what you're referring to here, but we've always looked at RFPs in dollars as a very important leading indicator. And we go back in history, if the RFP flow went down to low single digits or negative that usually in the following 2, 3 quarters, you had the difficult bookings. And if your RFP flow is strong, then you also -- it has to come together with a good -- stable win rate. If we had an RFP flow that's increasing and at a win rate that decreases, then yes, you could say, well, I'm seeing a lot more opportunities either because I'm more aggressive commercially or because there are more people that are throwing bids out there, but I'm winning less. So it's -- I would agree that it's relevant. But in our case, we are winning more, okay? So yes, and of course, an RFP doesn't translate into a booking immediately. It does sometimes in the same quarter, sometimes in the following quarter and sometimes 2 or 3 quarters later, it depends on the nature of the trial. But I think it's a pretty good indicator. And we don't rely just on that. We have a pipeline, a qualified pipeline. It's supplemented with a lot of conversations with our clients.

Sure. And you answered my question with the win rate, but what I was referring to, to clarify is this concept that clients might be issuing RFPs to 6 providers instead of 3 providers, almost inflating the RFP velocity, if you will.

So this is absolutely not true for large pharma. It's actually the opposite. Large pharma went through a process over the past year, 1.5 years, where they essentially decided to reopen all of their relationships with vendors and requalify who they wanted to do business with. And the main objective was to consolidate a lot of the spend. So if anything, with respect to large pharma, it's less people that are bidding on a given trial, not more because it's been prequalified and it's within the context of already negotiated market, master service agreements. With respect to the EBP, I mean, it's a very, very vast market. There are smaller CROs. We spend our time talking about the R&DS segment of our business, which is 55% of our total, but we also have a large and well-performing commercial business. But on the R&DS side, there are smaller competitors that are focused essentially on the biotech sector. And I was myself surprised when I saw that some of them -- actually one of them deliver extraordinary results and our teams report that they never meet them, right? We never see them in the marketplace that essentially tells you that it is an entire part of the market that we are not even looking at. So the market is on the EBP side is much bigger than what people think. And certainly, we've decided to go after that -- those segments of the markets that we weren't looking at before. So that may be part of why we have more RFPs. But we are -- again, our win rate is increasing across segments, large pharma or EBP.

Can you comment on how your biotech win rate is trending specifically?

Going up -- similar. Actually higher than even in large pharma.

Yes. And how is the -- apologies for the R&DS loaded portion of the Q&A. We'll get to TAS. But how is the pricing environment trending post those reopening of all the large pharma contracts and the funding challenges in EBP? I think there were some comments on pricing a couple of quarters ago, which caught investors' attention, and I'm hoping for an update.

It has largely subsided that environment, and it has essentially stabilized. There's no -- currently, things are stable. Yes.

Okay. And another topic, FSO versus FSP. I feel like that's volatile for IQVIA quarter-to-quarter, but can you tell me where is the direction of travel? Where is the trend between those 2 different service offerings?

Look, I've been in the past 8, 9 years through several cycles of this where I'm told that everything is going FSP and then the pendulum swings back. I can't quote the exact number, but it's between 15% and 17% of our backlog, RFP flow and revenue on the R&DS side, that's FSP. And it moves -- it has tilted up slightly, meaning from 15% to 16% to 17%. But certainly, in the last quarter, I think it was a very like low single digits of our bookings. So it tends to swing. Look, in times of tightened demand and large pharma tends to try to use its own people. And so they switch to FSP. In our experience, they find that it actually is more expensive and then they come back. That's one element where you've got more FSP. The other one is it's difficult to do FSP when you don't have all the capabilities in-house. Very often, large pharma acquires innovation. Large pharma buys biotech companies. If you look over a long time series, the majority of new drugs comes on biotech and large pharma essentially buys that innovation. And often, they don't have that -- those capabilities in-house. That's large pharma. EBP is 100% FSP, right, outsourced. And again, when people express concerns about the sort of a deceleration of R&D spend growth going forward, it's true but it's only mathematically because you had this huge spike of spend in the COVID years where you had 7%, 8% annual R&D spend. And now it's -- I'm talking about large pharma and usually, the forecasts are for the top 15 pharma companies. They are around a 3% annual growth. It's still growth. And when you exclude the spike of the COVID years, it's really a regular trend, and these are very large numbers. But people often ignore the EBP segment, which grows 8% to 10% per year in terms of R&D spend over long time periods. So smaller in terms of aggregate dollars, but it grows a lot faster.

And that would balance any FSP trend in large pharma.

Correct.

Got it. Understood. Well, maybe let's move on to TAS. We had a conversation at dinner last night that Wall Street had mismodeled TAS in the third quarter, and I'll confess I'm guilty of that as well. So the message was TAS came in line versus your internal plan. Our models were a little bit too high. Can you talk about that, though, because the growth did decelerate in Q3 compared to the first half of the year. And I know there was a comparison issue, but if I strip out acquisitions, if I strip out M&A, the comp didn't seem that bad. I think it was a 5% organic figure in the prior year quarter. So just help me understand getting from that, we calculated a 1% organic growth figure for TAS in Q3, how that accelerates from here? And maybe performance by subunit because I know TAS did a lot of different things.

Yes. I mean, look, first of all, sequentially, it still grew, right, in Q3, even organically versus Q2. And if you go back and you look 10 years, 5 years, you will see that Q3 most years is down versus Q3 -- Q3 is down versus Q2 sequentially. And that's because Q3 is essentially -- is the lowest quarter on the commercial side. Europe is shut down for 2 months. And so this quarter, we had actual growth Q3 over Q2 in dollar terms. Last year, you pointed out to our growth. I don't know that your numbers are correct, but we reported around 9%, was it, 8.6% last year growth, which was really unusually high. So we had already alerted investors to the fact that we will have a compare issue year-over-year. So nothing surprising, and it came in line with what we expected. We always told you that the TAS business has essentially 3 big parts. One is a data business, which has very high margins, but very low growth. The fastest-growing piece of the TAS business is the real-world evidence business, which grows double digits or more. And then you've got all the analytics and the advisory, the consulting work, which is sort of mid-single digits type of grower. So that's kind of where we see TAS in the 5% to 7% long-term growth.

And so the recovery that you're hoping for is in that latter piece you mentioned, the tech and analytics?

That's right.

Okay. What do the leading indicators look like there?

Well, again, pipelines are strong. The project wins are also good. We went through a period where even though it wasn't connected to IRA or the excessive post-COVID spend on projects that didn't matter or the uncertainty on the new administration's policies, but pharma constrained their budgets, and they are only now starting to do projects that they need to do. When a drug is approved, and there have been a record number of molecules approved last year, you need to launch the drug. And launch activities are one of the major drivers of growth in that analytics business for us because pharma needs to understand where are they going to launch, which segments, which HCPs need to be targeted, what's the pricing, what are the promotional activities. So launch activities are really the sweet spot of that section of the business. And many of the launches have been delayed due to the uncertainty period that we just went through, and all those are now being released. So because of that, we see the business coming back.

Okay. One more TAS question before I zoom out. Can you talk about the agreement announced with Veeva? How did that agreement come about? And what are the implications?

Look, we had a long-running dispute with Veeva around IP infringement and so on. People probably misunderstand why we decided to resolve this. I don't like to use that word so much, but for lack of better terminology, the pharma works with an ecosystem of companies. And with the advent of AI and agentification of processes, a lot of the old technologies and applications, CRM and all that stuff is going to become irrelevant. The way pharma operates increasingly requires the collaboration of the people who provide the ingredients and the content and the services with people who provide technology applications. Those technology applications need to speak to each other, we have suites of applications. Veeva has suites of applications. If you can't put our data into their applications and we can't use their applications with our services, then you've got too much friction in the system. It's not just Veeva, it's a bunch of other technology companies that participate in any given clinical trial or in any given set of commercial activities. And so this wasn't good for clients. And we're both very big providers of different things to our clients, and we needed to work together and not against each other. And that kind of drove a decision to just settle our disputes, and we were satisfied that our concerns were addressed. And so was with Veeva and we moved forward.

Okay. I'll zoom out here in the last 7 minutes. Can we talk a little bit about 2026? You made some comments on your earnings call framing 2026, I think, is at least a 5% growth year. Can you elaborate on that and talk through what your expectations would be by segment?

So I'm not going to talk about 2026. I probably shouldn't have spoken about 2026 on the earnings call. The finance team here wasn't happy about that. But as you and colleagues do a good job at trying to extract more visibility. And all I said was, look, I'd be surprised if we don't deliver top line growth that's at least what we are planning to deliver this year, okay? We spoke about all the headwinds and the difficulties we've been through. And we still are going to deliver over 5% growth this year. So with all of that uncertainty receding with our bookings, improving with the pipeline of projects we have on the commercial side, all of that, I think, again, we haven't finished our planning period, and we will share detailed guidance as we always do when we release Q4 and full year earnings early in '26. But it's hard to see that we will grow our top line faster than what we grew our top line this year. That's all I said.

Sure. And is that reflecting that we're in a period right now of maximum uncertainty. So you would expect, given your leading indicators, things shut down.

Sure. We think that the environment generally is very favorable. And I think if you speak to other participants in the industry, you will hear the same. So it's not just us. Yes.

So that 6% to 9% growth long-term construct, that remains fully in play.

Yes, absolutely.

What about the flat to positive 30 basis points of EBITDA margins that are embedded in that construct?

Right. So that's a long-term guide. You know that we've been growing our margins for the past decade, almost consistently. This year, we -- I think our margins last year, EBITDA margins were about 24%. And this year, they'll be about 23.5%, so about 50 bps of contraction. You have to think about our operating margins as follows. What influence margins if we do nothing else, is the business mix. I mentioned as an example, real-world evidence growing much faster, obviously, than the data business within TAS and real-world evidence is lower margins than the data business. You brought up FSP. If you have more FSP mix in a given year, then you have an unfavorable mix on margins because FSP margins are lower than full service margins. So in 2025, the headwinds from business mix were 50 bps. In addition to that and separate from the business mix, we account for pass-throughs as revenue. Several years ago, the SEC made a change and require that from an accounting standpoint, we report pass-throughs, reimbursed expenses as revenue. Now obviously, that comes with no margin. Pass-throughs are essentially mostly investigator fees that we pay to investigators, to doctors and pharma reimburses us for that. There are many complex trials that require a lot of imaging, MRIs, PET scans, all of those procedures, we pay for and the sponsor reimburses us. So these are pass-throughs. It's significant. We disclose what they are, but they come with no margin. So if you have a mix of more complex trials that have a lot of pass-throughs. And by the way, full service trials have a lot of pass-throughs. FSP have no pass-throughs. So we do want a lot of pass-throughs because that reflects a better margin profile on the RDS. But the pass-throughs themselves come with no margins. This year, in '25, pass-throughs cost us 50 bps additional to the 50 bps I call, approximately, I'm just framing the numbers. So really, if we hadn't done anything, we would have gone from 24% margins to 23% margins. Now obviously, people know we work constantly on efficiency. We have the largest scale in the business. We've got a lot of -- we have, I think, 30,000 people in India, in Nepal, in the Philippines, and we constantly balance the mix of where we do work and where our labor is. We haven't spoken much about this, and we don't have the time, but we've been engaged on a -- for exactly a year on a process of identifying our SOPs together with the help of NVIDIA and others and that creates efficiency. So all of those activities have offset 50 bps of that 100 basis points of margin erosion. So absent the pass-through impact, which is really not predictable and not relevant to the dollar numbers on our operating margin, we would have had essentially flat margins this year despite all the uncertainty and the headwinds we talked about. So I think that going forward, it all depends on the mix of business, on the mix of pass-throughs and how much we can offset. In general, we feel very good that we can at least offset, if not do better with our cost reduction initiatives than the headwind caused by business mix. So that flat to 30 bps of margin expansion on average per year going forward still stands. And it's supported long term by the AI agentification activities that we are engaged in and which are really not comparable to anything else because it's all dependent on, as you know, AI agents are only as good as the ingredients they're trained on. And only we have those ingredients in the industry.

Okay. Well, Ari, with that, we're out of time. Thank you so much for sharing your insights.

Perfect. Thank you so much. Thank you for the invitation.