Graham Doyle

Graham Doyle inquired about the comfort level with the 2026 guidance, particularly regarding market visibility and the expected phasing of revenue growth, given strong Q4 2025 exit rates and softer prior-year comps.

Answer

CEO David Endicott stated that the balanced view on market growth for 2026 is prudent, aligning with Q4 2025 rates (3% for surgical, 4% for vision care). CFO Tim Stonesifer added that surgical growth, driven by PanOptix Pro and Unity, is expected in the first half, while vision care, Tryptyr, PRECISION7, and TOTAL30 will drive the back half, leading to a relatively balanced year.

Graham Doyle asked about Alcon's comfort level with the 2026 guidance, specifically regarding market visibility and the potential for first-half revenue to be at the middle or upper end of the range given strong Q4 exit rates and soft prior-year comparisons.

Answer

David Endicott, CEO, stated that market conditions improved in Q4 but are not yet back to normal, leading to a disciplined 3-4% market growth assumption for 2026. Tim Stonesifer, CFO, added that surgical growth, driven by PanOptix Pro and Unity, is expected in the first half, while Vision Care, Tryptyr, PRECISION7, and TOTAL30 will drive the back half, resulting in a relatively balanced year.

Graham Doyle from UBS Group pressed on the mid-term guidance, asking if it was reasonable to expect Alcon to achieve its 12-15% EPS growth target in 2026, given that the goal will not be met in 2025.

Answer

CFO Tim Stonesifer reiterated that the 12-15% target is a multi-year CAGR and declined to give specific 2026 guidance. CEO David Endicott added color, expressing optimism for 2026 based on an expected rebound in surgical markets and the significant contribution from a portfolio of new product launches, stating that 'next year looks really good to us.'

Graham Doyle pressed for more concrete evidence to support the forecasted second-half growth acceleration, such as the strength of the order book for Unity or early traction with PanOptix Pro, given recent guidance revisions.

Answer

Chief Executive Officer David Endicott cited the soft Q1 U.S. market as the reason for narrowing the guidance range. He expressed confidence based on strong preorders for Unity VCS in Japan, a positive reception for PanOptix Pro at ASCRS, and the fact that major new product shipments only begin late in Q2. Chief Financial Officer Tim Stonesifer added a framework suggesting a 3,000-unit annual replacement cycle for the installed equipment base, which would drive a significant revenue lift.

Graham Doyle asked for more context on Alcon's "next phase of growth in 2025," questioning if the growth dynamics could be similar to 2024 given the strong pipeline of new products. He also requested an update on the timing for data from the PowerVision accommodating IOL trial.

Answer

CEO David Endicott stated it was too early to provide specific growth guidance for 2025 but emphasized the significant product flow expected next year, including Unity VCS, AR-15512, Precision7, and PanOptix Pro. He noted these launches will require investment and are expected to drive substantial growth in the coming years. Regarding PowerVision, Endicott confirmed they are finishing the first-in-human trial and expect to have data to review in the next several months.

Graham Doyle questioned if the phosphate binder and TDAPA catheter contributions accounted for most of the Q4 2025 Care Delivery year-over-year growth, and if the catheter payment was more than half of the EUR 90 million for FY2025. He also asked about the relevance for 2027, specifically if a further EUR 250 million unwinding from TDAPA and phosphate binders is expected, and how this impacts growth ability.

Answer

CFO Martin Fischer confirmed that the Citra-Lock solution contributed approximately EUR 70 million in Q4 2025 due to higher adoption, and this solution will be year-over-year neutral for 2026. He reiterated the binder details, with EUR 220 million in 2025 and EUR 100 million expected to remain in 2026. CEO Helen Giza explained that the TDAPA period ends in 2026, with payments moving into the bundle, and pricing erosion is anticipated. She noted that the company is not providing year-by-year breakdowns but expects underlying operational performance, driven by HDF and other initiatives, to lead to low teens CAGR excluding the binder impact.

Graham Doyle asked for clarification on the Q4 2025 Care Delivery beat, specifically the contribution from phosphate binders and TDAPA catheter solutions, and whether it accounted for most of the year-over-year growth. He also questioned the expected impact of a further EUR 250 million reduction from TDAPA and phosphate binders into 2027 on the company's ability to grow.

Answer

CFO Martin Fischer confirmed a EUR 70 million contribution from the Citra-Lock solution in Q4 2025 due to higher adoption, noting it would be year-over-year neutral for 2026. He reiterated the EUR 220 million binder contribution in 2025 and the EUR 150 million-EUR 200 million regulatory headwinds for 2026. CEO Helen Giza explained that the TDAPA period ends in 2026, with payments moving into the bundle, and the company is monitoring pricing erosion. She highlighted that the low teens CAGR (excluding binder noise) reflects underlying operational performance and future benefits from HDF and other initiatives.

Graham Doyle of UBS asked about the expected contribution from phosphate binders in the second half and sought quantification of the recent patient inflow growth, including whether it represented market share gains.

Answer

CFO Martin Fischer stated that H1 performance of phosphate binders provides confidence for the full-year outlook. CEO Helen Giza quantified the patient referral improvement at just under 1% year-to-date and closer to 2% in Q2, attributing the trend to internal operational improvements like better scheduling rather than definitively claiming market share gains.

Graham Doyle from UBS Group AG questioned the commercial strategy for the new HDF therapy, asking if the pitch focuses on mortality benefits or operational efficiencies, and inquired at what level of U.S. volume growth operating leverage would significantly impact margins.

Answer

CEO Helen Giza explained the HDF pitch includes both a potential 23% mortality improvement and significant operational benefits like simpler use, reduced downtime, and faster training. She noted that while specifics on margin outlook would come at the Capital Markets Day, returning to volume growth would clearly improve operating leverage.

Graham Doyle from UBS asked about the expected phasing of EBIT contribution in 2025, particularly for Q1, and questioned the company's long-term sustainable margin potential post-FME25 if volume growth remains subdued. He also asked if the HDF rollout would benefit new or all patients.

Answer

CEO Helen Giza noted that Q1 is traditionally the weakest quarter but provided no further specific phasing guidance for 2025. Regarding long-term margins, she deferred detailed discussion to the upcoming Capital Markets Day but highlighted the potential of HDF to significantly improve patient mortality and thus drive volume growth. She confirmed that the company believes all patients, not just new ones, could benefit from HDF treatment.

Graham Doyle of UBS Group AG asked about the necessary volume growth rate to optimize margins in the medium term and sought clarification on plans to narrow the 2025 guidance. In a follow-up, he questioned the sustainability of positive price/mix contributions and the historical context of the recent mortality spike.

Answer

CEO Helen Giza stated that a 2-3% growth rate allows for maximum operating leverage and that there's no reason to believe the business won't return to that level. Regarding 2025 guidance, she expressed a desire to see a few more months of data before narrowing the range. Giza also confirmed the importance of profitable growth through favorable commercial and MA mix, which she sees as sustainable. She characterized the recent mortality spike as a function of a prolonged flu season, which has been more pronounced than in the immediate post-COVID years but is cyclical.

Graham Doyle of UBS Group AG asked about the timing of lower-cost inventory from closed manufacturing sites flowing through the P&L and whether the company has explored options like the Nairobi treaty to avoid U.S. tariffs on hips and knees.

Answer

CEO Deepak Nath confirmed that the full benefits of network optimization will materialize in H2 2025, though some positive impacts are already present. Regarding tariffs, he stated that all mitigation strategies are being explored, but the £15-20 million impact estimate remains. CFO John Rogers clarified that the tariff impact is more significant for the Wound and Sports segments than for Orthopaedics due to the latter's U.S.-based manufacturing footprint.

Graham Doyle of UBS Group asked if the benefits from lower-cost inventory following site closures have begun to flow through and questioned if the company could mitigate tariffs on hips and knees using the Nairobi treaty, similar to a peer.

Answer

CEO Deepak Nath confirmed that while some benefits have been realized, the full impact of network optimization will manifest in H2 as planned, driving margin expansion. Regarding tariffs, he stated they are exploring all options but have based their £15M-£20M impact guidance on their current manufacturing network. CFO John Rogers added that the tariff impact is greater on the Wound and Sports businesses than on Ortho due to its U.S.-based manufacturing.

Graham Doyle from UBS Group AG asked about the completion of the Personal Health destocking in China, the translation of increasing tender activity into orders for medical equipment in the region, and the expected tariff impact for 2026.

Answer

CEO Roy Jakobs confirmed the China destocking program completed in Q2 as planned and noted improving sell-out trends, though the company remains cautious on the full-year outlook. He described the medical equipment recovery as slow, with tenders increasing but the process remaining prolonged. CFO Charlotte Hanneman stated that the company's trajectory towards mid-single-digit growth and mid-teens margins beyond 2025 already incorporates the new tariff reality.

Graham Doyle from UBS Group asked about the completion timeline for the Personal Health destocking in China, current trends for medical equipment tenders and orders in the country, and how to model the impact of tariffs for 2026.

Answer

CEO Roy Jakobs confirmed that the China destocking program was completed in Q2 and that underlying sell-out is improving, though the company remains cautious. He noted that while medical equipment tender activity is increasing from a low base, the process remains prolonged and competitive. CFO Charlotte Hanneman stated that the company's long-term financial trajectory beyond 2025, aiming for mid-single-digit growth and mid-teens margins, already incorporates the new tariff reality.

Graham Doyle asked how to think about the annualized tariff impact for 2026 compared to the 2025 guidance. He also requested more color on the timeline for completing the inventory destocking in the China Personal Health business.

Answer

CFO Charlotte Hanneman advised that it is too early to provide a 2026 outlook but expects the benefit from mitigation actions to increase over time. She specified that the destocking in China's Personal Health segment is expected to be finalized at the end of Q2 2025, after which the business will see a mechanical sales uplift due to easier comparables, though underlying consumer sentiment remains subdued.

Graham Doyle probed the cautious nature of the China guidance, asking if it assumes the recent market uptick will cease. He also asked about the timeline for reducing consent decree-related incidental costs and the process for returning to sleep system sales in the U.S.

Answer

CEO Roy Jakobs confirmed the cautious stance on China is deliberate, as the company has not yet seen a structural inflection point and finds it too early to call a change in momentum. Regarding the consent decree, he stated that related costs will taper off over time but are currently high. He reiterated that the timing for a return to the U.S. market is up to the FDA and that the company's financial plan is not dependent on it.