Yuan Zhi

Yuan Zhi asked about Neuraceq's market position relative to the leading beta-amyloid imaging agent (Amyvid) and identified key improvement opportunities for gaining market share, such as availability, guideline differences, or pricing strategies.

Answer

Mary Anne Heino (Executive Chairperson and Interim CEO, Lantheus) clarified that Neuraceq is the second most utilized beta-amyloid imaging agent. She identified growth opportunities stemming from changes in guidelines for Alzheimer's diagnosis, increased uptake of disease-modifying therapies (DMTs) requiring imaging for eligibility and monitoring, and specific to Neuraceq, broadening its geographic footprint by expanding PMF sites (from 16 to 22 in 2026) and deepening penetration in existing accounts by leveraging Lantheus's strong nuclear medicine customer relationships. She emphasized that this is not primarily a price-driven strategy.

Yuan Zhi asked Mary Anne Heino about the key improvement opportunities for Neuraceq to gain market share against the leading beta-amyloid imaging agent, specifically inquiring if availability, guideline differences, or pricing were primary factors.

Answer

Mary Anne Heino (Executive Chairperson and Interim CEO) clarified that Neuraceq is the second most utilized beta-amyloid imaging agent, with Lilly's Amyvid being the leader. She identified growth opportunities primarily from changes in guidelines for Alzheimer's diagnosis, increased adoption of disease-modifying therapies (DMTs) requiring associated imaging, and specifically for Neuraceq, broadening its geographic manufacturing footprint and deepening penetration in existing accounts, especially those with PYLARIFY relationships. She emphasized that it is not a price play, but rather driven by availability and leveraging Lantheus' strong nuclear medicine customer base.

Yuan Zhi from B. Riley Securities asked how the new Polarify formulation would affect existing long-term customer contracts and whether it would trigger renegotiations.

Answer

CEO Brian Markison stated that the new formulation will be a "complete add on" as existing contract language already contemplates such additions. He highlighted that this could also provide a beneficial opportunity for a 340B best price reset for the franchise.

Yuan Zhi inquired whether clients with long-term contracts exhibit faster PYLARIFY volume growth and asked about growth rate differences between academic and community centers.

Answer

President Paul Blanchfield explained that there is a distinct difference in growth patterns. Early adopters, such as large academic centers under contract, have high utilization but slower current growth. In contrast, smaller, non-contracted community sites were later adopters and are now exhibiting higher growth rates from a lower base. The company is now evolving its strategy to increasingly focus on these higher-growth accounts.

Yuan Zhi asked how reimbursement dynamics have played out recently, noting that PYLARIFY's reimbursement price is lower than competitors' and that some customers were stocking up before the policy change.

Answer

CEO Brian Markison reiterated that the company's strategic contracts were established over a year ago, anticipating no change, making the new separate payment policy an upside. Chief Commercial Officer Amanda Morgan added that while the market is complex, PYLARIFY's differentiation, broad availability, and strong strategic partnerships have secured the vast majority of its hospital and imaging center business.

Yuan Zhi asked for an explanation of the CMS reimbursement update, questioning why the final rate for PYLARIFY increased from the proposed rule despite the MUC method, and what this implies for potential changes to an ASP-based method in 2026.

Answer

President Paul Blanchfield explained that CMS's final calendar year rate reflects a move to support innovative radiopharmaceuticals, particularly those that recently lost pass-through status. He noted that since Lantheus has consistently reported ASP for PYLARIFY, the company is well-positioned for a potential future shift by CMS to an ASP-based payment methodology, which the agency has indicated it is open to.

Yuan Zhi asked about the economics for Mirion when a large-scale manufacturing site like Novartis's fourth radiopharmaceutical facility in the U.S. is built. He also requested high-level plans for nuclear medicine in 2026.

Answer

Thomas Logan, CEO and Chairman, highlighted the appointment of Shelia Webb as the new head of the nuclear medicine business, focusing on integrating software (EC Squared) and legacy hardware to drive higher traction. He noted proactive efforts in forging strategic relationships with major players in the nuclear medicine infrastructure, including drug makers, isotope producers, CDMOs, radio pharmacies, clinicians, and IDNs. Brian Schopfer, CFO and Medical Group President, emphasized the pull-through of nuclear safety product lines into Novartis facilities, leveraging Shelia Webb's knowledge of both businesses. Logan added that these facilities require significant Mirion equipment, including gamma spec instrumentation, radiation monitoring, health physics instruments, dosimeters, and dose calibration instruments.

Yuan Zhi inquired about the economic implications for Mirion when large-scale radiopharmaceutical manufacturing sites like Novartis's fourth U.S. site are built, and Mirion's high-level plans for nuclear medicine in 2026.

Answer

CEO Thomas Logan announced Sheila Webb's appointment to run the nuclear medicine business, focusing on integrating software and hardware, rapidly evolving the software platform, and forging strategic relationships with key players in the nuclear medicine infrastructure. CFO Brian Schopfer added that Sheila's expertise helps pull through nuclear safety product lines. Thomas Logan further detailed that such facilities require significant Mirion equipment, including gamma spec instrumentation, radiation monitoring, health physics instruments, and dose calibration instruments.

Yuan Zhi inquired about the economic contribution to Mirion from U.S. government investments in Westinghouse nuclear reactors, asking for a percentage of a $10 billion reactor cost that would go to Mirion's NIS systems or Paragon services.

Answer

Thomas Logan, Founder, Chairman and CEO, explained that the dynamic is evolving with recent acquisitions (Paragon, Certrec, Collins Aerospace cyber/physical security). He referenced the Hinckley Point C project, which generated $80-$90 million in backlog for a two-reactor project, and stated that with incremental capabilities, the quantum of the front-end opportunity is expected to increase, though he reserved giving a specific percentage for new builds.

Yuan Zhi asked about the economics contribution to Mirion from U.S. government investment in Westinghouse nuclear reactors, specifically the percentage of a $10 billion reactor build going to Mirion's NIS systems or Paragon services.

Answer

Thomas Logan, Founder, Chairman and CEO, Mirion, explained that the dynamic changes with recent acquisitions (Paragon, Sertrek, Collins Aerospace cyber/physical security). He referenced the Hinckley Point C example ($80-90 million backlog for a two-reactor project) and stated that incremental capabilities improve the front-end opportunity, reserving a specific number for new builds but calling it an 'attractive opportunity.' He also mentioned SMRs having a historically higher dollar per megawatt output (60% higher).

Yuan Zhi from B. Riley Securities inquired about the supply-demand dynamics and pricing sensitivity in the nuclear medicine market, and asked for the conventional nuclear power order growth rate when excluding SMRs.

Answer

CEO Tom Logan described the nuclear medicine market as strong, driven by the 'Theranostic revolution,' with improving margins from both pricing power and a favorable mix shift to software. CFO Brian Schopfer addressed the order question by stating that while not providing a precise number due to lumpiness, year-to-date order growth in nuclear power remains positive even excluding SMRs. He emphasized that the segment's double-digit revenue growth is the most encouraging sign, as it contains very little SMR contribution.

Yuan Zhi asked about the potential for near-term backlog growth, the specific timing of the $300-$400 million in one-time orders, and the risks of project delays within the existing backlog.

Answer

CFO Brian Schopfer stated that while he doesn't comment on quarter-to-quarter backlog movements, he expects backlog to grow as the large projects in the pipeline are secured. He confirmed these large orders are 'back half loaded' for 2025. Schopfer acknowledged that project delays are an inherent risk, particularly in the new build nuclear space, but affirmed that the company accounts for this in its forecasting and remains confident in its full-year guidance.

Yuan Zhi from B. Riley Securities asked about the potential timeline for restarting business in Russia and Ukraine post-conflict and what the company is hearing from customers regarding U.S. nuclear regulation updates and state-level initiatives.

Answer

CEO Tom Logan speculated that business in Ukraine would likely resume before trade normalizes with Russia, and Mirion is prepared to support both existing infrastructure and new builds. On the U.S. regulatory front, Logan described customer excitement driven by favorable state-level actions in Texas and Iowa, the potential revival of the VC Summer plant, and a pro-nuclear stance from federal leadership. He noted the key issue remains streamlining NRC processes for new builds.

Yuan Zhi from B. Riley Securities requested a breakdown of the backlog by business segment and its revenue conversion characteristics, and also asked for more detail on the strategic relationship with EDF, particularly how it influenced the Sizewell-C contract win.

Answer

Executive Brian Schopfer explained that the backlog is approximately 75% Technologies and 25% Medical, with the established 45-50% conversion to revenue over the next 12 months remaining consistent. Executive Thomas Logan elaborated on the EDF relationship, noting that the Sizewell-C win was a direct follow-on to their work at Hinkley Point C. He also highlighted a separate, broader strategic frame agreement with EDF that positions Mirion as a sole-source supplier for key systems on up to 20 future reactors, streamlining procurement for EDF's new build program.

Yuan Zhi asked for clarification on the Digital Health revenue outlook for Q4 2025, specifically whether the iCAD acquisition's contribution implies flat or decreasing year-over-year revenue. He also inquired about the breakdown of PET/CT volume growth between oncology and Alzheimer's, and RadNet's preparations for new agent launches in 2026.

Answer

EVP and CFO Mark Stolper clarified that the increased guidance for Digital Health, which includes iCAD's $3.9 million Q3 contribution, does not imply flat or decreasing Q4 revenue, and they expect strong performance. He stated that PET/CT growth is significantly driven by PSMA prostate imaging (12% of volume) and amyloid brain studies (8% of volume), both of which are underutilized. He also mentioned that new tumor-specific radioactive tracers in final clinical trials are expected to further drive PET/CT utilization in the coming years.

Yuan Zhi asked for clarification on the digital health revenue outlook for Q4 after the iCAD acquisition, specifically if it would be flat or decreasing year-over-year, and requested comments on PET/CT volume growth from oncology versus Alzheimer's, including preparations for new agent launches in 2026.

Answer

Mark Stolper, EVP and CFO, clarified that RadNet did not imply a decrease in digital health revenue, having increased guidance by $5 million, with iCAD contributing $3.9 million in Q3, and expects strong Q4 performance. He explained that PET/CT growth is significantly driven by PSMA prostate imaging (12% of volume) and amyloid brain studies (8% of volume), both underutilized. He also noted that several novel radioactive tracers in final clinical trials are expected to further boost nuclear medicine and PET/CT utilization in the coming years.

Yuan Zhi from B.Riley Securities asked how increased industry utilization is impacting capitated contract negotiations, the timeline for deploying remote scanning solutions outside of New York, and RadNet's current capacity for PET and MRI scans amid rising Alzheimer's-related imaging demand.

Answer

Mark Stolper, EVP & CFO, explained that rising utilization leads to re-evaluating capitated contracts, sometimes converting them to more profitable fee-for-service models. Howard Berger, Chairman, President & CEO, stated that remote scanning is already being deployed across states with a goal to have the full MRI fleet enabled by Q1 2026. He confirmed RadNet has capacity for Alzheimer's imaging, noting that diagnostic PET-CT scans drive subsequent demand for multiple MRIs.

Yuan Zhi from B. Riley Securities asked how increased utilization reported by payers impacts RadNet's conversations about capitated contracts. He also inquired about the deployment of the remote scanning solution outside of New York and the current capacity for PET and MRI scans given the rise in Alzheimer's-related imaging.

Answer

Mark Stolper, EVP & CFO, explained that when reimbursement under capitation is inadequate, RadNet converts contracts to fee-for-service, often retaining the volume at better pricing. Howard Berger, Chairman, President & CEO, stated that remote scanning (TechLive) is already being deployed across states and they aim to have the full MRI fleet enabled by early 2026. He also confirmed they have capacity for increased Alzheimer's-related imaging, which drives both PET and MRI volume.

Inquired about TOI's experience with oncology cost trends compared to peers, the revenue recognition timeline for the new Florida contract, and the potential impact of PBMs shifting infusion drugs from medical to pharmacy benefits.

Answer

TOI's medical loss ratio (MLR) is stable despite industry-wide cost trends, which they see as an opportunity. The Florida contract revenue will start being recognized in Q4. A shift of drugs from Part B to Part D would be a net positive for TOI as their risk is primarily on Part B.

Yuan Zhi asked if The Oncology Institute observed similar high utilization trends among Medicare Advantage seniors as recently reported by UnitedHealth. He also questioned if patients are presenting as sicker, how value-based contracts are priced to reflect current patient profiles, the progress on filling capacity in Florida clinics, and sought clarification on the timeline for achieving profitability and positive cash flow.

Answer

CEO Dan Virnich stated that TOI has not observed a similar jump in oncology care utilization or a change in patient acuity within its populations. He explained that contract pricing uses recent historical utilization data and cost trends, making it relatively current. Virnich also confirmed that capacity fill in Florida is tracking to plan with potential upside. CFO Rob Carter reaffirmed guidance, clarifying that the company still expects to achieve positive adjusted EBITDA and free cash flow in Q4 2025, not for the full second half.

Inquired about healthcare utilization trends in their MA population compared to reports from UnitedHealth, whether they are seeing sicker patients, how contracts are priced, progress on filling capacity in Florida, and for clarification on the timing of achieving profitability.

Answer

The company has not observed the same utilization spikes or sicker patient profiles in their oncology practice as reported elsewhere. Contracts are priced using recent data to reflect current trends. Florida clinic capacity is filling as planned, and the guidance for achieving positive cash flow and EBITDA in Q4 2025 remains unchanged.

Yuan Zhi inquired about the primary drivers for the 2025 guidance, the expected contribution from patient services versus the dispensary, a comparison of operating metrics in Florida versus California, current clinic capacity utilization, and the potential impact of the reimbursement landscape.

Answer

CFO Rob Carter confirmed that 2025 growth relies on new capitated contracts and organic growth, with the capitated segment being the most significant driver of profitability. CEO Dan Virnich added that new markets like Florida offer higher value creation opportunities due to higher benchmark utilization and a focus on Medicare Advantage. Virnich noted Florida clinics are at about 40% capacity, offering significant growth potential, and stated that macro trends like the IRA and potential 340B changes are favorable for TOI's value-based model.

Yuan Zhi asked about the role of free samples in the initial launch ramp and the expected out-of-pocket costs for patients on commercial and Medicare insurance.

Answer

President and CEO Dan Paterson clarified that there are no "free samples" but a patient assistance program for bridging insurance approval, which has seen very little use. He stated the most used program is co-pay assistance, which results in zero out-of-pocket costs for the majority of commercial patients. For Medicare patients, the annual out-of-pocket limit applies.

Yuan Zhi of B. Riley Securities asked for clarification on whether potential tariffs have impacted international orders, inquired about the geographic mix of Q1 revenue, and questioned the company's visibility and confidence in its various order buckets for the remainder of 2025.

Answer

CFO Brett Hale stated that tariffs have had no material impact on the business to date. While not providing a specific geographic revenue mix for Q1, he noted the quarter's strong average selling price of $254,000 per system. President and CEO Maria Sainz addressed visibility by explaining that the second half will be supported by a more balanced portfolio of hospital, international, and new office-based deals, which increases their confidence despite the current reliance on longer-cycle hospital deals in Q2.

Asked about the differences in perception between U.S. and EU doctors regarding Alzheimer's treatment monitoring, and about the market dynamics in the EU, including MRI demand, capacity, and reimbursement.

Answer

The company stated there is a global consensus on the MRI bottleneck for Alzheimer's monitoring. European regulators are more conservative on therapy approvals but interest in the company's solution is high. Market conditions like MRI density and reimbursement vary by country in Europe, but clinicians are very positive about the technology's value based on the latest software generations.

Asked about the standard testing frequency for transplant rejection, the testing frequency in the company's trial, and the clinical utility and subsequent treatment pathway for detecting subclinical rejection.

Answer

The current market average is about 2.3-2.5 tests per patient under management. The company's clinical trial uses a single time point for its primary endpoint. The key benefit of detecting subclinical antibody-mediated rejection (ABMR) is that effective treatments (like anti-CD38 drugs) are now available, making early diagnosis actionable to prevent graft loss. The test can also monitor treatment response and recurrence.

Yuan Zhi of B. Riley inquired about perceptual differences between U.S. and European physicians on Alzheimer's treatment criteria and MRI monitoring, following recent industry conferences. He also asked about the European expansion, specifically regarding MRI demand, capacity issues, and reimbursement models compared to the U.S.

Answer

CEO Maria Sainz, reporting from her attendance at the CTAD conference, stated there is a global consensus on the MRI monitoring bottleneck for Alzheimer's therapies. She noted European regulators are more conservative but observed significant interest from clinicians and pharmaceutical firms. Sainz explained that while MRI density and waitlist issues vary across Europe, the value of the Swoop system is highly appreciated, especially with the latest software. She cited a Glasgow study on stroke triage as evidence of the system's perceived value in workflow optimization.