IQVIA Holdings Inc. ($IQV)

Great. Thank you. Good morning, everybody. I'm Dave Windley with Jefferies Healthcare Equity Research. Welcome to our 2026 Global Healthcare Conference. We appreciate you're joining whether here in person or virtually. I really appreciate the interest and attendance in the conference. Also very much appreciate IQVIA's participation this year and Ari Bousbib, the company's CEO, joining me here for our fireside chat. IQVIA, as you know, is the leading player in, let's call it, the broader pharma services and technology space, but particularly in the contract research organization space that I've covered for some time. So thank you very much, Ari, I thought I'd remind folks that we are coming up on the 10-year anniversary of the forming of IQVIA IMS and Quintiles, respectively, had long histories before that. But in terms of putting the companies together, October 1, I think, of this year, would be 10 years. So congrats on the progress. You had -- the industry has been through somewhat of a downturn, a challenging time for the last few years, but seems to be pulling out of it. And your recent quarters show strength that would add to that perspective, I think, the improvement.

So let's start with your views of the first quarter and your takeaways from what you saw first quarter or year-to-date and how that sets you up for the rest of the year, but starting with the first quarter. How do you -- what are your views?

First of all, thanks for reminding us about this upcoming 10th year anniversary. When we put together two companies 10 years ago, I remember, I think, that the pro forma EPS was $3.90. And our guidance for this year at the midpoint is $12.85. So more than triple which is not bad.

I can't do that math in my head.

Okay. All right. So the first quarter you saw was pretty strong. In fact, we came in both on the top line and the bottom line ahead of the high end of our expectation. And I think it's good to look at both of our segments. Yes, you said that clinical trials, yes, area of strength. It's about 55% of our revenues, but we've got a very strong commercial solutions business as well. And both outperformed our expectations on the clinical trial side, the first quarter was about 6% revenue growth. When you strip out FX, which was a tailwind for all of our businesses this past quarter, and the benefit of acquisitions, our organic growth was 3 points. Now that we know what the other -- the ones who report peers have done it's at least a 5-point differential in growth rates. And I guess the only one who has a positive growth. And interestingly, our clinical trial business, [ R&DS ]. Organic growth was 3 points, which was 3x what it was a year ago. So definitely improved results. On the commercial side, Growth in the quarter was double digits. Again, benefit of FX tailwind and acquisitions brings organic growth in the quarter to mid-single digits, which was double what it was a year ago in the first quarter. So again, strong revenue, EPS, be it free cash flow was 100% of net income, again, ahead of our expectations, we did really well in terms of results. [ [Audio Gap] ]

I appreciate you highlighting that I didn't emphasize it enough. But yes, so a little over half the business, R&DS, so close to half, a little under half commercial. Let's start with the bigger of the two, if you don't mind. In the R&DS and clinical trials market, how would you characterize demand and how that is evolving? I think improving, but I'll let you tell us.

You're correct, Dave. The -- look, let's split the market into broad segments. There's a large pharma, and it is everything else, it's EBP and midsize. On the large pharma side, our clients are coming out of a period of a lot of disruption, a lot of noise. The environment is not back to what it was before that noise, that is 2023 or so. But it's improving gradually. I remind you what the noise was, there was IRA in '23, then there was the MFN and the tariffs and the FDA disruptions and so on and so forth. And all of that created turmoil large pharma delayed decision-making, reevaluated their portfolios, a lot of disruption. That's largely behind all of the programs of reprioritizations and pipeline cleansing and so on, a lot are completely behind us. And the environment is, in fact, improving. You looked at our bookings in the quarter. They improved double digits year-over-year. Very strong across the board. Our leading indicators are also up mid- to high single digits, whether it's RFP flow or qualified growth in the qualified pipeline of opportunities. So the environment is generally very stabilizing and is improving. And you could see that in our growth -- in the growth of our bookings. On the non-large pharma side, the single most meaningful leading indicator of demand is funding. And you saw that [ EBP ] funding improved significantly. I think last year, it was double the prior year. The first quarter continued to be very, very strong. April is actually very, very strong. Again, you can't make a trend from a quarter or a month. But certainly, the direction it's based, I think April funding was triple what it was last year's April. So we certainly see a lot more confidence in secondary markets to fund follow-on research for [ EVPs ] as well as venture capital funding. All of that bodes well for the industry. Now if you step back and you look at demand -- long-term demand for clinical trials. Large pharma R&D spend will grow 2% to 3%, okay, long term. And that's not changing. I don't think Yes, there's a lot of noise. People talking about synthetic cohort and looking for reasons. But on the flip side, you've got the advent of AI, which is 95% AI applications at large pharma today and in the foreseeable future or at the discovery stage, which has -- is going to have the consequence increasing the number of molecules. Bear in mind, many large pharmas are looking at a 5-year horizon with a not insignificant number of LOEs. And so they have an interest in replenishing their pipelines. AI helps identify more molecules that are more likely to succeed in trial. The bottleneck in drug development is clinical trials. It's not the discovery. So you're going to identify more molecules. In fact, anecdotally, I'd tell you a couple of weeks ago, we were with some of our clients and they've asked us how fast can we ramp up capacity if we dramatically increased the number of molecules we want to take to trial. So demand environment stabilizing, improving gradually and many signs that it will continue to grow and about 2% to 3%, I think, is a conservative estimate for large pharma is 8% to 9%, and it's long been the major driver of faster growth in the business. In fact, 2025, 65% of new trial starts were from [ EVP ]. So again, all around strong signals that demand is returning both for large pharma and for [ EVP ].

Excellent. So I appreciate the bifurcation there on the cohorts. Let's drill, maybe double click one step in on large pharma. You had talked over, I think, the last couple of years about a pretty heavy period of reprocurement, lots of resetting of pipelines and resetting of, to your point, kind of the supply chain to execute or prosecute the pipelines. To what extent -- I think you've talked about FSP, about pricing. You just mentioned AI. How would you describe what was contemplated in those reprocurements? Like how much of the deck was already set or has been set in the last couple of years in terms of how they want to execute as opposed to, I think, the market is thinking about AI being a big disruptor now. I'm wondering how much of that type of thing was already contemplated in your discussions?

Look, I mean, this is the narrative and then there is the reality, okay? And unfortunately, and current attend this year accepted -- most people now look at investing as based on a narrative and on headlines as opposed to the old-fashioned way that is looking at the fundamentals. And I know you and a couple of others are an exception. But -- there is a narrative out there that AI is a disruptor. It's not a disruptor. Trials are being conducted exactly the same way. We are bidding on trial the same way. Yes, we are executing with higher speeds, better quality, more efficiency because of the AI [ agentification ] process, which we at IQVIA, by the way, have been working on for 10 years. Artificial intelligence is not something new for us. That was the rationale for the merger you referred to earlier. And we've begun the identification process 2 years ago when we started our collaboration with NVIDIA we've got today over 100 patents, AI patents, 19 of the top 20 large pharma already use at least one or more agents IQVIA AI agents in their workflows, we've got almost 200 agents deployed, both clinical and commercial, representing over 60 use cases. So it's not disruptive. It's a tailwind for our business on the R&DS side, it's a driver of speed, quality and efficiency to the benefit of our clients and enables us to gain share and to have an edge versus competition. Everyone talks about AI. Some of them mean -- how people use CoPilot. And we mean something entirely different. And on the commercial side, it's additive to our revenues because our AI agents, the ones we sell to our clients enable them to perform the traditional commercial functions of launch strategy sales planning, market access, payer reimbursement modeling, et cetera, pricing analytics, all of that, those functions, which require IQVIA data and other people's data. But bear in mind, IQVIA data is 70% of the data that pharma uses worldwide. Then integrate that data with company-specific data needs all kinds of master data management tools, integration tools, a lot of people to perform analytics. Today, we provide already agents. We sell agents to our clients to perform those tasks a lot faster. So that creates an incremental revenue opportunity on the commercial side, and it is one of the elements that drove better-than-expected performance in the quarter and is expected to help us continue to grow sale as well.

In this pendulum swing, I guess, I'll call it, of engagement model with your clients in clinical and R&DS, the swing to FSP is something that does go back and forth over long periods of time. It seems to have moved toward FSP. Kind of wondering if that has -- do you think that has stabilized as a result of kind of the wave of reprocurements that have already happened? Is it perhaps even moving back the other way or hybridizing somewhere in the middle?

Yes. Look, this FSP versus full-service debate has been going on forever. In fact, 10 years ago, when we did the merger, I was told, that's it. Everyone is moving to FSP. And the truth is when demand slows for whatever macro reasons, and we talked about some of the disrupting macro forces over the past 3 years, when demand slows and goes into a trough typically pharma reinsource some activities still need us because you want to be able to flex capacity. Why does pharma outsource clinical trials. There's 3 reasons. One is cost. Another one is therapeutic expertise. And the third one is capacity. The ability to flex capacity on demand. So this FSP debate is, again, not a real debate has relatively been a stable part of our bookings and backlog. It's about -- it's in the high teens. You can even round it up to 20%. I think it's 17% or 18% of our backlog. And in recent quarters, it's been a lower percentage than that, much lower potential than that in our bookings. I don't know if we are representative or not, but it might seem to indicate that we're going back to more full service. Bear in mind, more molecules identified in discovery because of AI, as we discussed before. And the increasing complexity of trials is undeniable, the difficulty of identifying the target patient populations, the difficulties of identifying the sites, all of that creates the need for expertise that pharma cannot economically maintain in-house. Pharma is looking to go to different therapy areas, [indiscernible] therapy area. Say you have a diabetes drug, and you all of a sudden, discover that diabetes drug is effective for obesity or liver disease or cardiac or anything else, you may not have the obesity therapeutic expertise in-house. So to conduct that trial, you're going to have to go outside it, which is exactly what happened. So the need to access site networks that pharma does not have, we see our industry in general, and in particular, have unmatched spectrum of therapeutic expertise, site network relationships, our own sites. So all of that leads you to the conclusion that outsourcing is a continuing trend, will continue to occur. Today, I think it's 47% of all R&DS spend is outsourced, and we see a regular increase of that proportion year-over-year. So I'm not so concerned about this FSP. Again, it manifests itself when there is a trough in demand or constrained in the environment and pharma pulls back. It's just a phenomenon that has happened a number of times. It happens every 5, 6 years but we go back to a full service. And I want to remind you that EVP is 100% outsourced from service.

Yes. Ari, I think your point about complexity is really important. So people are focused on AI as a deflator, but complexity is an inflator and has been for a very long time, and perhaps AI is even necessary for the industry to be able to handle the complexity. Before we move to commercial, on the EVP end of things and your attempts to gain share in there earlier in '25, you had a kind of a mantra of see more, win more. I believe, in talking to your team that you've maybe been able to put that on cruise, maybe not push that as hard, but I'd let you describe, how are you thinking about growing your share in EVP, how are you positioning IQV?

So EVP is an entirely different segment than large pharma in the sense that it requires shall I say, wide growth handling, more handholding, limited resources, a small group of people, a molecule much earlier engagement is necessary to stick with the customer. We typically, as a large CRO historically weren't much focused on that. I mentioned before, that 65% of the clinical starts last year were from EBP. If you look at our business, it's exactly the flip side. 65% of our bookings and business is with large pharma. And clearly, it's a great opportunity for us, smaller focused CROs have had a field day because they haven't had us compete with them in that segment as hard as we could. And so therefore, over the past couple of years, we've decided, as you said, to see more and win more in that segment by engaging earlier the chaos that the FDA benefited us. We hired quite a significant number of former FDA, therapeutic experts that for that specific purpose, we use them at the regulatory stage to help and support EVPs at a much earlier stage. We used to never do that. We would wait till the biotech got some good data in Phase I, Phase II and ready now to engage into a real serious trial akin to trials that we conduct for large pharma because at the end of the day, the trial that you're going to conduct for [ EVP ] is exactly the same as the conduct for a large pharma. But the engagement within EVP is very different. It requires earlier engagement, more focus on the regulatory side, more handholding. And so we created a specialized units, IQVIA Biotech, we regulatory experts that are able to accompany the [ EBP ] earlier in the process. And in fact, if you listen to reports from other competitors that are specialized in [ EVP ], they will tell you that they've seen more competition on their domain or the historic domain and that's us. We've been very, very aggressive there. And we've made -- we are growing our EVP bookings are growing strong double digits I mentioned before, the segment is growing 8% to 9% long term. And we've seen our growth there strong double digits. So we are making strong inroads there.

Okay. Fantastic. So transitioning to commercial, some players in the commercial space away from you have seen some weakness in pharma advertising and commercial budgets, your business has actually kind of accelerated, I think, since a slower period. To what would you attribute that?

Yes. So look, overall, what's driving our commercial business is the number of drugs approved. And a number of drugs approved has increased. I think the second half of '25 saw the FDA approve 31 molecules, I think, which was double -- more than double what was approved in the first half. We see the first quarter was very strong, too. And typically, it takes between 6 months and 1 year, 1.5 years between the approval and the launch of the drug. This is really the bread and butter of our business. So more approval means more business for us. The second big driver of growth, and we saw that in the first quarter is what we call patient solutions which includes the parts of real-world solutions that stayed with the commercial business. [ Patient solutions ], they're a big issue with patients is adherence. We've got a lot of engagement on behalf of pharma directly with patients. In fact, AI plays a role here. I saw a couple of weeks ago, great IQVIA AI agents, I saw. Not a real person, but almost there that can help predict when a patient is going to get off the medication and therefore, prompts an intervention by another agent to make sure the patient stays on the drug based on the massive amount of data we have on patients sticking to a drug or getting off and what are the signals that can help us anticipate [ when a patients ] of that drug. So a lot of good work on patient engagement, analytics and consulting. Again, AI makes our clients want more help, not less help. And you saw that our analytics solutions business was very strong. Our pipelines there are at historic levels. Our growth rates in analytics and consulting or higher, I mean, the last time we saw that growth rate was, I think, 3.5 years ago. And so really strong demand despite what we might have thought would be an area of vulnerability for AI. So analytics and consulting very strong. Commercial engagement services where we -- which includes the former CSMS, which is where we contract sales reps, but not just sales reps, nurses, an entire spectrum of commercialization services, including distribution, in some cases, large pharma has decided to get out of commercializing themselves usually legacy drugs usually in overseas markets and have begun outsourcing, including to us we want some significant large multiyear engagements for top 10 pharma companies in various parts of the world, in South America, in Europe, in Asia, where we take on the responsibility of essentially commercializing a set of drugs in a particular therapy. And we see that pipeline of opportunities grow as well. So these are the 3 main drivers of growth on the commercial side. Digital marketing, you see that people are reducing generally their advertising budgets in large pharma. It's true all over. But the exception is on the digital channels. And there, as you know, we have a very good thriving business. And finally, AI agents whereas on the clinical side, AI identification, again, is a tool for increasing speed, improving quality and increasing efficiency. On the commercial side, it's incremental revenue stream for us.

Yes. With a couple of minutes left, I want to try to touch on AI a little more. You've touched on it through the questions here, but I'm going to start with a little bit of a conceptual question. And it drives it, who's best placed to bring purpose-built AI agents to your customers. So you've got the Anthropics and OpenAIs partner with NVIDIA, and they are the technology experts. They are bringing some tools to market, but this is an industry that's highly regulated, that's very complex, the management of these projects takes years and a lot of people. And it seems to me that subject matter expertise, which you have tons of matters a lot. And so kind of help the audience understand why this is not a generalist game.

I mean there are 3 things you need for really many [ many things ] but let's say, 3 primary ingredients you need for AI [ agentification ]. One, is the content. And for us, that means the data. Now for most of the headline conversations, that data is available because of the Internet. In our industry, it's not. It's proprietary data. I mentioned before, 70% of all data used by pharma worldwide is IQVIA data. So that's number one ingredient. It's now available. Two, expertise, as you mentioned, not so simple. This is not about diagnosing a disease, it's not about writing a legal brief. It's a lot more complicated than that. A typical clinical trial can have over 800 standard operating procedures with very, very complex workflows. And three, the regulatory compliance, privacy requirements, which are very high we already 2 years ago, put in place what we call health care-grade AI, which includes all the safeguards and all the privacy requirements, all the compliance requirements. Bear in mind, every country has different protocols, treatment patterns, even the names of the drugs have different the treatment protocols are different. The reimbursement models are different. And so you say, yes, conceptually, a generic horizontal AI toolkit can get to all of that. but it's actually very complex. And the data, again, go back to the first degree is just not available. In fact, we've realized the value of our data has increased exponentially because of AI.

I appreciate you throwing that in. That would have been my next question If I had time. So very much appreciate that.