Glen Santangelo

Glen Santangelo followed up on free cash flow, asking for a more detailed breakdown of how the $130 million from dividend suspension, combined with estimated free cash flow and restructuring charges ($55M-$65M), would be allocated across investment, debt paydown, and share repurchases, and how this might change the capital structure in 2026.

Answer

President and CEO Dan Scavilla stated that the dividend elimination funds would be repurposed into both debt retirement and share repurchase, emphasizing that this strategy aims for increased total shareholder return rather than building up cash. He declined to provide specific numbers for capital structure changes, suggesting an offline discussion for detailed model analysis.

Glen Santangelo from Barclays asked for a more detailed financial perspective on the capital structure changes in 2026, specifically how the $130 million freed up from dividend suspension, combined with free cash flow and restructuring charges ($55 million-$65 million), would be allocated across investment, debt paydown, and share repurchases, and if specific debt maturities are due this year.

Answer

President and CEO Dan Scavilla explained that the dividend elimination funds would be repurposed for debt retirement and share repurchases, aiming for increased total shareholder return. He indicated that the company is not looking to build up cash but rather apply it to these areas. Mr. Scavilla suggested taking a detailed look at the model offline for the specific puts and takes of the numbers.

Glen Santangelo inquired about Viatris's path to mid-single-digit revenue growth, the confidence level in six potential product approvals for the year, their expected impact on guidance, and the anticipated timing for realizing the $400 million net savings from the strategic review.

Answer

CEO Scott Smith outlined the strategy for mid-single-digit growth, emphasizing a growing base business, upcoming launches in Japan (Effexor, Tolosent, Spydia) and the U.S. (Quinvlo, low-dose estrogen patch, Ryzumvi, meloxicam), future data readouts (selatogrel, cenerimod), and capital deployment for accretive growth assets. CFO Doretta Mistras detailed the phasing of the $400 million net savings, with approximately 30% in 2026, 30% in 2027, and 40% in 2028.

Glen Santangelo inquired about Viatris's long-term path to mid-single-digit revenue growth, including the impact of 2026 product approvals and the timing of net savings from the strategic review.

Answer

CEO Scott Smith detailed the strategy for achieving mid-single-digit growth through 2026 launches (Effexor, Tolosens, Spydia in Japan; Quinlo, low-dose estrogen patch, Ryzumvi, Milocam in US), future pipeline readouts, and capital deployment for accretive growth assets. CFO Doretta Mistras outlined the phasing of $400 million net savings, with approximately 30% in 2026, 30% in 2027, and 40% in 2028.

Glen Santangelo inquired about other regulatory fronts on Medline's radar, specifically focusing on a CMS proposal that would benefit hospitals buying American-made products, such as domestic PPE.

Answer

CEO Jim Boyle confirmed the reference to domestic PPE tied to Medicare reimbursement, noting it represents about 20% of total healthcare spend and is not currently meaningful. He stated that Medline would need significant incentives to move PPE production domestically due to 3x-7x higher manufacturing costs. Boyle mentioned standing up a face mask facility during the pandemic but believes domestic PPE manufacturing is a discussion, not a near-term policy change.

Glen Santangelo inquired about other regulatory fronts on Medline's radar, specifically a CMS proposal that would benefit hospitals buying American-made products, such as domestic PPE tied to Medicare reimbursement.

Answer

CEO Jim Boyle clarified that the domestic PPE proposal, representing about 20% of total healthcare spend, is not currently meaningful. He highlighted the significant cost disparity (3x-7x higher) for manufacturing these items domestically. Medline advocates for government incentives to make domestic production viable but views it as a discussion, not a near-term policy change, and not a primary focus given current cost models.

Glen Santangelo sought clarification on the Q4 U.S. revenue growth of 17%, specifically whether compounded GLP-1 revenue was a headwind or tailwind, and how to reconcile its 'small part' of the subscriber base with a $65 million Q1 headwind, to understand its contribution to fiscal 2026 guidance.

Answer

CFO Yemi Okupe explained that a shift to lower revenue per order, particularly in the GLP-1 business due to larger ticket sizes, is creating a meaningful revenue and EBITDA impact, especially in Q1. He reiterated that the vast majority of revenue is from non-GLP-1 business, and diversification is expected to continue.

Glen Santangelo followed up on the 17% increase in Q4 U.S. revenue, asking if compounded GLP-1 revenue was a headwind or tailwind, and how to reconcile Andrew's comment about it being a small part of the subscriber base with Yemi's mention of a $65 million headwind in Q1.

Answer

CFO Yemi Okupe clarified that there's a shift to recognizing lower revenue per order, which has progressively occurred over the last 2-3 quarters. He noted that the GLP-1 business has a larger ticket size, leading to a meaningful revenue and EBITDA impact from this shift. He reiterated that the vast majority of revenue comes from the non-GLP-1 business, and diversification is expected to continue.

Glen Santangelo asked for clarity on the expected EBITDA trajectory for 2027 and 2028, considering the impact of IRA pricing changes and Xifaxan's loss of exclusivity. He also followed up on the capital structure and the strategy for monetizing the Bausch + Lomb equity stake.

Answer

JJ Charhon, CFO, reiterated that the average EBITDA for 2026 and 2027 would be similar to 2025, implying a dip in 2027 due to higher CMS discounts, partially offset by other growth platforms. Thomas Appio, CEO, confirmed the focus on business development, leveraging the refinancing for runway and seeking assets that fit commercial capabilities. JJ Charhon, CFO, stated that all options are on the table for BNL equity monetization, guided by shareholder value creation and the flexibility to be patient.

Glen Santangelo asked what Bausch Health might do differently to monetize its Bausch + Lomb (BLCO) stake now that the sales process has ended, and whether pledging BLCO shares for financing would impact the timing or ability to execute a separation deal.

Answer

CFO JJ Charhon responded that the primary goal remains completing the separation of Bausch + Lomb in the most accretive way for shareholders, with no specific timeline. He explained that using the BLCO stake as collateral for financing is a key part of their strategy and does not inherently impact the timing of a potential separation, though any deal would need to account for the terms of the financing.

Glen Santangelo inquired about recent media reports concerning negotiations with creditor groups and sought clarity on the company's dialogue with them. He also asked for a more precise definition of 'appropriately capitalized companies' in the context of the planned Bausch & Lomb separation and what 'other applicable approvals' would be required.

Answer

CEO Thomas Appio reiterated the company's policy of not commenting on stakeholder discussions but firmly stated that Bausch Health is not considering bankruptcy or insolvency. Interim CFO John Barresi added that 'appropriately capitalized' is not a specific leverage number but rather a balanced blend of leverage and the debt maturity profile.

Glen Santangelo asked about the Pharma and Specialty segment, specifically the Red Oak Sourcing program's performance, noting better-than-expected generic volumes. He sought details on the drivers (new introductions vs. existing customer penetration) and comments on generic pricing.

Answer

CEO Jason Hollar clarified that the strength in the generics program was primarily due to robust utilization and consistent market dynamics, rather than a higher-than-anticipated number of new generic introductions. He emphasized that volume growth was the main factor, with no particular call-out regarding margin per unit or pricing. CFO Aaron Alt added that strong service levels and the onboarding of new customers also contributed positively to generic volume trends.

Glen Santangelo asked for more details on the strong performance of the Red Oak Sourcing program within the pharma and specialty segment, specifically inquiring if better generic volumes were driven by new introductions or increased penetration, and for comments on generic pricing.

Answer

CEO Jason Hollar and CFO Aaron Alt clarified that the strength in generics was primarily due to strong utilization and consistent market dynamics, rather than new item introductions or significant price changes. Aaron added that excellent service levels and the onboarding of new customers also contributed positively to generic volume trends.

Glen Santangelo followed up on the North American Pharmaceutical segment's operating profit, noting a ~9% growth this quarter (excluding Rexall) and a wider full-year guidance range, asking if there are any positive or negative trends heading into fiscal Q4 and FY2027.

Answer

CFO Britt Vitalone clarified that the full-year adjusted operating profit growth guidance was raised from 5%-9% to 8%-12%, maintaining the same range width. He attributed the raise to strong Q3 performance, confidence in the business trajectory, robust specialty distribution growth, continued focus on operational excellence, and favorable utilization trends across retail pharmacy and health systems.

Glen Santangelo asked about the expected operating income growth for the remainder of the fiscal year, specifically inquiring about the deceleration observed in the U.S. segment from the September to December quarter and whether this trend of deceleration is anticipated to continue due to more challenging comparative periods or other influencing factors.

Answer

Jim Cleary, Executive Vice President and CFO, explained that the U.S. segment achieved 21% adjusted operating income growth in the December quarter. He clarified that even excluding the strong performance of RCA and OneOncology, the U.S. segment's performance was at the higher end of Cencora's long-term guidance range (7-10%), despite headwinds from a lost oncology customer. He attributed this strong performance to utilization trends, robust specialty sales to health systems and physician practices, and broad-based segment execution. Cleary also noted that the full-year U.S. operating income guidance was raised from 9-11% to 14-16%, and the core business (excluding MSOs) is expected to remain solidly within the long-term guidance range for the balance of the year.

Glen Santangelo asked for a retrospective on commercial hurdles that may have tempered the FUROSCIX adoption ramp and inquired what could accelerate growth. He also asked for commentary on 2025 revenue consensus versus the rising gross-to-net (GTN) discount and the company's cash burn rate.

Answer

Executive John Tucker identified high patient out-of-pocket costs as the primary headwind in 2024. He stated that the 2025 Medicare redesign, which lowers the out-of-pocket max and introduces a smoothing option, is a significant tailwind that should boost demand and fill rates. Tucker explained that while GTN will increase, the benefit of improved patient access outweighs the cost for scPharmaceuticals, as the company did not previously have preferred status with large rebates. Regarding financials, he noted the cash burn rate is decreasing as revenue grows against relatively flat OpEx and expressed confidence in the company's growth trajectory.

Glen Santangelo asked for details on the incremental $17 million in Q4 service costs, questioning the specific cause and whether these costs are one-time or will persist into fiscal 2026.

Answer

EVP and CFO James Lucania explained the costs stemmed from sophisticated fraud activity, covering both member reimbursements and increased contact center expenses. He noted this was a continuation of a trend from Q3 and expects these elevated costs to persist through the first half of fiscal 2026 before normalizing.

Glen Santangelo of Jefferies inquired about the HOPE Act, asking for an estimate of the current HSA Total Addressable Market (TAM), the potential expansion from the act, and the perceived likelihood of its passage.

Answer

Vice Chair and Founder Dr. Steve Neeleman estimated the current HSA TAM at 60-65 million accounts and projected the HOPE Act could add 40-45 million households by expanding access to individuals on Medicare, Medicaid, and other plans. He highlighted strong bipartisan momentum. CEO Jon Kessler added that such accounts are critical for easing the tax burden of out-of-pocket medical costs.

Glen Santangelo of Jefferies asked for clarity on custodial rates, focusing on the repricing of cash in the next fiscal year and the potential impact of a declining yield curve, particularly with the growing mix of enhanced rate products.

Answer

EVP and CFO James Lucania confirmed that cash currently yielding in the mid-3% range will reprice at similar levels plus a spread, providing a tailwind. He highlighted the more significant opportunity over the next two fiscal years, with about $6.5 billion priced in the high 1% range set to roll over at much higher rates. Lucania also reiterated the goal of reaching 60% of HSA cash in enhanced rates over three years, which is expected to reduce future volatility.

Glen Santangelo asked for clarification on key financial metrics, questioning if the 84% gross margin seen in Q4 is a good proxy for 2025 and seeking more detail on the meaning of "modestly" increased operating expenses to understand the model's leverage.

Answer

CFO Steven Pieper confirmed that the Q4 gross margin of 84% is a good starting assumption for 2025. He explained that operating expenses will see leverage, with modest increases driven by the full-year impact of the 2024 Recorlev commercial expansion and incremental R&D for XP-8121, noting that significant clinical trial spending for XP-8121 is expected more in 2026.

Glen Santangelo of Jefferies asked for a breakdown of the growth algorithm for the Generics business, seeking to understand the contribution from organic volumes, price, and new product launches like Prucalopride for the fiscal 2025 outlook.

Answer

Executive Nikhil Lalwani attributed the expected low double-digit growth to a combination of factors: the full-year impact of 17 products launched in 2024, new 2025 launches including Prucalopride with 180-day exclusivity, and the balancing of erosion from older products. He emphasized that growth is driven by volume, and the guidance does not assume any material benefit from competitor supply disruptions.

Glen Santangelo followed up on the organic growth outlook, suggesting that the pricing assumptions imply a modest volume slowdown, and asked where any deceleration might be occurring.

Answer

CFO Wetteny Joseph clarified that the guidance range allows for a balance of price and volume at the high end, similar to 2024. He pointed to the normalization of livestock growth to the industry average of 2-4% (from 6% organic in 2024) as a key factor, rather than a broad-based slowdown in companion animal volume. He reiterated that underlying demand trends entering 2025 remain strong.

Glen Santangelo of Jefferies questioned the source of management's confidence in achieving another year of above-average price increases and asked for an update on the percentage of companion animal business from alternate channels and its impact on pricing.

Answer

CEO Kristin Peck reiterated that confidence in pricing stems from the value of their diverse and innovative portfolio on a product-by-product basis, not macro trends. CFO Wetteny Joseph stated that alternative channels (retail, online, home delivery) now represent close to 15% of the U.S. business and grew 34% year-over-year, highlighting that strong volume growth continues even with price increases, demonstrating the value of their products.

Glen Santangelo asked for clarity on the primary drivers of Doximity's current momentum, questioning whether it stems more from new products or the rollout of the client portal.

Answer

CEO Jeff Tangney described the momentum as a '1-2 punch.' He explained that the client portal is highly effective for smaller, mid-year upsells due to its efficiency, while the new integrated programs were key during the large, year-end budget cycle. These programs leverage Doximity's data science to create personalized campaigns, a feature highly requested by clients.

Glen Santangelo asked for clarification on the drivers of Doximity's Q2 revenue beat and the reasoning behind the weak implied Q4 revenue growth guidance.

Answer

CEO Jeff Tangney attributed the strong Q2 results to a combination of market stabilization, over 100% growth in new products, and market share gains. CFO Anna Bryson explained the conservative Q4 outlook is due to clients becoming more disciplined with calendar-year budgets, reducing revenue spillover, and the longer launch timelines associated with the company's newer, fast-growing workflow products. She emphasized that the annual growth rate is the best measure of business performance.

Glen Santangelo asked for context on the strong volume forecast relative to the broader ortho industry and requested a breakdown of the anticipated 2025 ASP decline between foreign exchange and product mix.

Answer

CEO Joe Hogan attributed volume strength to regional momentum in Europe and parts of APAC, noting that while the U.S. ortho market is flat, Align has seen strong growth with GPs globally. CFO John Morici clarified that the 2025 ASP decline is primarily driven by an approximate 2-point headwind from unfavorable foreign exchange (FX) due to the strong U.S. dollar.

Glen Santangelo of Jefferies asked for commentary on the competitive landscape, particularly against rivals like Maven and Caritas, and inquired about upcoming client renewals. He also asked if revenue growth in 2025 is a reasonable expectation.

Answer

President Michael Sturmer stated that Progyny saw consistent win rates against competitors, including in highly competitive jumbo accounts, and noted the success in converting some health plans from competitors to partners. CEO Pete Anevski added that the company maintained a 99% client retention rate. Regarding 2025, he called revenue growth a 'fair assessment' based on lives growth but withheld definitive comments due to recent market variability.

Glen Santangelo asked what new CEO Chuck Divita is doing that is 'meaningfully different' from his predecessor, given the commentary about having the right assets but facing operational issues.

Answer

CEO Chuck Divita provided a tangible example of his new approach: consolidating market requirements, product development, and solution delivery, which were previously managed by four separate leaders, into a single, streamlined structure. He stated this move has already generated millions in annual savings and improved operational effectiveness.

Glen Santangelo questioned what is meaningfully different about the new CEO's strategy, noting that the themes of having the right assets but needing to fix operational issues sounded similar to the previous leadership's message. He asked for more clarity on the tangible changes being made.

Answer

Chief Executive Officer Chuck Divita provided a tangible example of a key change: consolidating functions that were previously siloed under four separate leaders—such as market requirements, product development, and delivery—into a single, streamlined structure. He stated this move has already generated millions in annual savings and improved effectiveness, as reflected in the quarter's results. He emphasized that new capabilities are being built that did not previously exist to better leverage the existing business.

Glen Santangelo questioned the degree of forward visibility Phreesia has on its fiscal 2026 provider adds and asked about industry penetration rates and the competitive landscape, particularly from EHR companies.

Answer

Executive Balaji Gandhi stated that Phreesia has high visibility, around 90%, into its subscription and payment revenue entering a fiscal year, with most variability in Network Solutions. CEO Chaim Indig commented that the company is winning more deals due to its diversified product suite and is seeing venture-backed competitors struggle to keep pace with investment.

Asked for confirmation that no new compounded cantharidin is entering the market, whether a sales inflection for YCANTH is imminent as compounded inventory depletes, and for comments on the competitive landscape, particularly Ligand's newly approved product.

Answer

The company confirmed they are not seeing new incremental compounded products, only the bleed-out of existing inventory. They expect a sales inflection for YCANTH as this inventory is depleted and former competitor accounts convert. They view the new competitor (ZELSUVMI) as a positive for the market that will increase awareness and ultimately benefit YCANTH, which they consider the gold standard.

Asked about the timeline for payer coverage updates and its impact on guidance, the reason for the quarterly decline in total prescriptions, and the components (scripts vs. price) of the $300 million peak sales target.

Answer

The company doesn't control the payer update timeline but expects it to take a few months, with revenue growth starting in Q2. The decline in scripts was a deliberate result of reducing unprofitable prescriptions, which led to higher overall revenue. The $300M peak sales target is expected to be driven by growth in prescription volume, not significant increases in net revenue per script.