Quest Diagnostics - Earnings Call - Q2 2025
July 22, 2025
Executive Summary
- Q2 2025 delivered broad-based strength: revenue $2.761B (+15.2% y/y), adjusted EPS $2.62 (+11.5% y/y), with reported EPS $2.47 (+21.7% y/y); operating margin expanded to 15.9% reported and 16.9% adjusted.
- Both revenue and EPS beat Wall Street consensus: revenue $2.761B vs $2.726B* and adjusted EPS $2.62 vs $2.57*; DGX also beat in Q1 2025 (for context) and guided higher for FY25 revenue and EPS.
- Guidance raised: FY25 revenue to $10.80–$10.92B (from $10.70–$10.85B), reported EPS to $8.60–$8.80, adjusted EPS to $9.63–$9.83, CFO reiterating operating margin expansion vs prior year; cash from ops lifted to ~$1.55B, capex maintained at ~$500M.
- Catalysts: accelerating advanced diagnostics (e.g., AD-Detect updates, Haystack MRD), new payer access (Elevance, Centene), and M&A (LifeLabs contribution ~8% of the 10% M&A revenue growth), along with automation/AI productivity gains.
Values retrieved from S&P Global.*
What Went Well and What Went Wrong
What Went Well
- Strong revenue and margin execution: total revenue +15.2% y/y to $2.761B; adjusted operating margin up to 16.9% (from 16.6% y/y), driven by acquisitions and organic growth; reported operating margin expanded to 15.9%.
- Management execution and strategic traction: “We delivered a strong second quarter… revenues growing 15.2% which includes 5.2% organic revenues… adjusted EPS growth of 11.5%,” with productivity gains from automation/digital technologies.
- Advanced diagnostics momentum: double-digit growth across cardiometabolic, autoimmune, brain health (launch of AB4240/PTAU217 panel), and oncology (Haystack MRD adoption affirmed by NEJM study); consumer channel surpassed one million orders on QuestHealth since 2022.
What Went Wrong
- Revenue per requisition declined -0.4% y/y (mix effect from LifeLabs), partially offset by organic Rev/Rec +3.3% from more tests per requisition and mix; wage inflation remained a modest headwind.
- Higher interest expense pressured EPS vs prior year; management noted tariff impacts (Europe/China) in Q2 and expects some negative impact in Q3/Q4, though manageable within guidance.
- Non-GAAP adjustments include a $24M impairment tied to potential business exit and reliance on a $46M CARES Act payroll tax credit in Q2, highlighting one-offs in quarter results.
Transcript
Speaker 4
Welcome to the Quest Diagnostics second quarter 2025 conference call. At the request of the company, this call is being recorded. The entire contents of this call, including the presentation and question-and-answer session that will follow, are the copyrighted property of Quest Diagnostics, with all rights preserved. Any redistribution, retransmission, or rebroadcast of this call in any form without the written consent of Quest Diagnostics is strictly prohibited. Now, I would like to introduce Shawn Bevec, Vice President of Investor Relations for Quest Diagnostics. Please go ahead.
Speaker 0
Thank you and good morning. I'm joined by Jim Davis, our Chairman, Chief Executive Officer, and President, and Sam Samad, our Chief Financial Officer. During this call, we may make forward-looking statements and will discuss non-GAAP measures. We provide a reconciliation of non-GAAP measures to comparable GAAP measures in the tables to our earnings press release. Actual results may differ materially from those projected. Risks and uncertainties that may affect Quest Diagnostics' future results include, but are not limited to, those described in our most recent annual report on Form 10-K and subsequently filed quarterly reports on Form 10-Q and current reports on Form 8-K. For this call, references to reported EPS refer to reported diluted EPS, and references to adjusted EPS refer to adjusted diluted EPS.
Growth rates associated with our long-term outlook projections, including consolidated revenue growth, revenue growth from acquisitions, organic revenue growth, and adjusted earnings growth, are compound annual growth rates. Now, here is Jim Davis.
Speaker 1
Thanks, Shawn, and good morning, everyone. At our Investor Day in March, we communicated our strategy to drive growth through innovative solutions that meet the evolving needs of our customers. Our strong second quarter results reinforced this strategic direction. Given our performance in the quarter and continued utilization trends, we're raising our full-year 2025 guidance. During the quarter, we saw strong top-line growth of 15.2%, including 5.2% organic revenue growth, as increased demand for our innovative clinical solutions and expanded business from enterprise accounts complemented growth from acquisitions. Our adjusted earnings per share grew 11.5% as a result of strong top-line growth combined with productivity gains from our deployment of automation, digitization, and other advanced technologies. Before Sam provides more detail on our results, I'll highlight a few ways our strategy is enabling growth.
We are focused on delivering solutions that meet the evolving needs of our core clinical customers, physicians and hospitals, as well as customers in the higher growth areas of consumer, life sciences, and data analytics. We enable growth across our customer channels through faster-growing advanced diagnostics in five key clinical areas, which are advanced cardiometabolic, autoimmune, brain health, oncology, and women's and reproductive health. In addition, acquisitions are a key growth driver, and our strategy emphasizes accretive outreach purchases and independent labs. Finally, we are focused on driving operational improvements across the business with the deployment of automation, AI, and other advanced technologies for improved quality, productivity, and customer and employee experiences. Here are some of the updates on the progress we have made in these areas in the second quarter.
In the physician channel, we delivered approximately 20% revenue growth driven primarily by acquisitions complemented by organic revenue growth in the high single digits. Demand for our innovative clinical solutions contributed significantly to organic revenue growth as physicians ordered more tests per requisition across our portfolio, supported by strong commercial execution. We also saw robust growth from large enterprise accounts, particularly in functional medicine, a growing area of preventative healthcare in which providers often order a range of lab tests to identify and act on multiple health risks. Large enterprises value our ability to scale diagnostic innovation to improve access, quality, and affordability. Later this summer, we expect to begin providing laboratory testing under our previously announced relationship with Fresenius Medical Care to support, over time, more than 200,000 kidney dialysis patients in the U.S.
In the hospital channel, revenues grew low single digits, with collaborative lab solutions driving our growth in the quarter. As hospitals grapple with financial pressures and shortages of skilled lab technologists, they are choosing Quest to access our best-in-class expertise, innovation, and efficiency instead of running their own lab. Our acquisition of outreach labs also provides hospitals with capital for investment in their core care missions. Our pipelines for hospital outreach M&A and collaborative lab solutions remain strong. In addition to our physician and hospital channels, we are highly focused on expanding access for our consumer channel. During the quarter, we continue to see strong growth across our expanding array of offerings, including a new women's hormone panel on QuestHealth.com. We recently fulfilled our one-millionth customer order since launching this enhanced online platform in the fall of 2022, demonstrating ongoing consumer demand for greater health information.
Complementing our consumer-initiated channel, we continue to expand our partnerships with top consumer and wellness brands who value our high-quality lab testing, broad access, and flexible technology integrations as the lab engine inside of their offerings. In advanced diagnostics, we delivered double-digit revenue growth in several areas, including advanced cardiometabolic, especially testing for metabolic and endocrine disorders, and chronic kidney disease, as well as for our analyzer autoimmune solution. In brain health, we drove robust growth for our AV Detect blood tests for Alzheimer's disease. During the quarter, we launched our new AB4240 and PTAU217 AV Detect panel, which is designed to help physicians confirm amyloid brain pathology in symptomatic patients. In oncology, we are ramping up our commercial outreach to drive Haystack MRD market adoption, while we also continue to convert participants from our early experience program.
A recent study in the New England Journal of Medicine affirmed the high sensitivity and specificity of our Haystack MRD test, finding it identified complete response to an immunotherapy in phase two trials several months before standard imaging tests. Finally, Quest continues to be at the forefront of serving public health needs. Earlier this month, we announced the launch of a molecular test for diagnosing Oropouche virus, which we developed under a CDC contract to enhance the nation's preparedness for emerging infectious diseases. Turning now to operational excellence, we continue to target 3% annual cost savings and productivity improvements through our Invigorate program. We are deploying innovative automation and AI technologies, including digitizing processes to improve quality, productivity, and customer and employee experiences. We have now installed our front-end automation solution, which speeds specimen aliquoting and labeling in half a dozen sites.
We also recently completed a successful pilot of our automated accessioning platform at our Clifton lab. We plan to roll out both solutions across our lab network through the rest of the year and into 2026. Along with automation enhancements, strong employee retention improves productivity across our operations and service lines. During the quarter, employee retention further improved, building on trends in recent quarters. Overall, we are pleased with our progress in the quarter, executing on our strategy to serve customers and drive gains in revenue and productivity. And now Sam will provide more details on our performance and 2025 guidance. Sam?
Speaker 2
Thanks, Jim. In the second quarter, consolidated revenues were $2.76 billion. Up 15.2% versus the prior year. Consolidated organic revenues grew by 5.2%. Revenues for diagnostic information services were up 15.7% compared to the prior year, reflecting recent acquisitions as well as organic growth in our physician and hospital channels. Total volume, measured by the number of requisitions, increased 16.3% versus the second quarter of 2024, with organic volume up 2.1%. Total revenue per requisition was down 0.4% versus the prior year, driven primarily by the impact of the LifeLabs acquisition, which carries a lower revenue per rec. On an organic basis, revenue per requisition was up 3.3% in the quarter versus last year, driven primarily by an increase in the number of tests per requisition and test mix. Unit price reimbursement remained consistent with our expectations. Reported operating income in the second quarter was $438 million.
Or 15.9% of revenues, compared to $355 million. Or 14.8% of revenues last year. On an adjusted basis, operating income was $466 million, or 16.9% of revenues, compared to $398 million, or 16.6% of revenues last year. The increase in adjusted operating income was due to recent acquisitions and organic revenue growth, partially offset by wage increases. Reported EPS was $2.47 in the quarter, compared to $2.03 a year ago. Adjusted EPS was $2.62 versus $2.35 the prior year. EPS in the second quarter was impacted by higher interest expense versus the prior year. Foreign exchange rates had no meaningful impact on our results. Cash from operations was $858 million year-to-date through the second quarter versus $514 million in the prior year. This year-over-year increase of 67.1% was driven by higher operating income, a one-time Cares Act tax credit, and the timing of receipts and disbursements.
Turning now to our updated full-year 2025 guidance. Revenues are expected to be between $10.8 billion and $10.92 billion. Reported EPS is now expected to be in a range of $8.60-$8.80, and adjusted EPS in a range of $9.63-$9.83. Cash from operations is now expected to be approximately $1.55 billion, and capital expenditures are expected to be approximately $500 million. Our 2025 guidance reflects the following considerations. Our updated revenue guidance assumes approximately 3.5%-4% organic revenue growth, in addition to contributions from acquisitions completed in 2024 and announced to date. It does not assume any contribution from prospective M&A. We are making investments in 2025 related to Project Nova, which we expect will modernize our entire order-to-cash process. Most of these investments will occur in the second half of the year. Operating margin is expected to expand versus the prior year.
Our below-the-line assumptions for net interest expense, adjusted tax rate, and full-year share count remain unchanged from our prior guidance. Finally, our updated EPS guidance assumes that we can absorb the impact of tariffs currently in place, primarily in Europe and China. With that, I will now turn it back to Jim.
Speaker 1
Thanks, Sam. To summarize, we delivered robust top-line and bottom-line growth in the second quarter on strong execution of our strategy and utilization trends. Through our sharp customer focus, we grew demand for innovative clinical solutions and expanded business from enterprise accounts to complement growth from acquisitions. Given our performance in the quarter and continued utilization trends, we are raising our full-year 2025 guidance. Finally, I want to thank our more than 55,000 colleagues for their hard work this quarter to fulfill our purpose to create a healthier world, one life at a time. Now we'd be happy to take your questions. Operator?
Speaker 4
Thank you. We will now open it up to questions. At the request of the company, we ask that you please limit yourself to one question. If you have additional questions, we ask that you please fall back in the queue. To be placed in the queue, please press Star 1 from your phone. To withdraw your question, you may press Star 2. Again, to ask a question, please press Star 1. Our first question comes from Anne Hines with Mizuho Securities. Your line is open. You may ask your question.
Great. Thank you. Good morning. I want to focus my question just on the Washington backdrop. Obviously, with the one big beautiful bill passed and the CBO came out yesterday and said this will lead to 10 million more uninsured over the next few years between the ACA and Medicaid. How do you view that many people going uninsured? How should we view that impact on Quest over the coming years? And then secondly, as it relates to Washington, what are your thoughts on PAMA going into 2026? Thanks.
Speaker 1
Okay. Good morning, Anne, and thanks for the question. First, let's put the one big beautiful bill into some context here. First, the U.S. healthcare system, we spend $5 trillion a year, and over the next 10 years, with a 5% inflation, that'll amount to $62 trillion. What the one beautiful bill act is taking out is $1 trillion, so less than right around 1.5%. Now, what we did read yesterday, yes, about 10 million lives could come out over the next 10 years. From a Medicaid standpoint, it's actually no impact in 2026, very, very little impact in 2027, given that they're giving the states time to react to these changes. On the exchange, we estimate that no more than 4%-5% of our revenue today comes from the exchange. Again, given the timing of when these lives would come out of those plans.
At best, worst-case scenario, we estimate no more than a 30-40 basis point impact on volume in 2026. We don't really see that big of an impact in 2026 or in 2027. I think the other thing to keep in mind is with the people that are on the exchange, these people are working. They have jobs. In some cases, they're small business owners or they're self-employed. They have incomes, and they may be able to pay higher premiums to keep their insurance. We also know that some people go to the exchange because they are subsidized, and they could hop on to their employer's health insurance, but they're choosing the exchange today because it is a cheaper alternative than signing on to their own employer's health plan.
Speaker 2
Anne, this is Sam. Good morning. Just to underscore or re-emphasize the financial assumptions that Jim briefly mentioned. I am sure we'll get more questions on this on the call, so I just want to make sure people are clear. For the Medicaid impact, we do not believe there is a material impact. We do not believe there is any impact in 2026 and an immaterial impact in 2027. For the exchange impact, assuming these subsidies are not renewed at the end of this year, we expect in 2026 approximately 30 basis points of impact on our volumes. That is what we have sized. Obviously, there are assumptions around that, but that is what we believe.
Speaker 1
Now, Anne, you also asked about PAMA. Here's the most recent update. Look, we're pursuing two strategies. Number one is PAMA reform, and number two is a sixth delay in the cuts. With respect to PAMA reform, our Acla Trade Association has introduced language that would turn into legislation and a bill to the three committees, two in the House and one in the Senate, that ultimately decide on healthcare policy in the U.S. That language is in front of the committees. We expect that to be turned into a bill later this summer, and then the traditional process will start from there. The committees discuss the bills. If there's differences between the two committees in the House and the one in the Senate, they get together, they reconcile this, and our hope is that it will turn into a bill.
Whether it gets voted on as an independent bill or it gets put into some larger healthcare type of package towards the end of the year, that remains to be seen. The alternative path is obviously continue to push for another delay if we don't see the PAMA reform getting enacted this year. I can tell you we have strong bipartisan support in each of the three committees where this legislation will be discussed.
Speaker 2
Operator, next question, please.
Speaker 4
Thank you. Our next question comes from Kevin Caliendo with UBS. Your line is open. You may ask your question.
Speaker 2
Good morning, guys. Thanks for taking my question.
Speaker 1
Wanted to talk about the comment. The modernization investments. It sounds like some of it may have come forward into Q2. Are you still anticipating sort of $0.20 for the full year? I guess the second part of that is, in the context of margins expanding year over year, you've been able to do that the first two quarters. Do you still anticipate that happening in the second half, even with these modernization investments? Yeah. Good morning, Kevin. This is Sam. Let me tackle the two components of your question here. With regards to modernization expenses, we had called out approximately $0.20 around modernization, and we had talked about also some QRA expenses that we're going to incur as well. We said that we're going to incur these expenses this year. We've had some QRA expenses already in the first half.
We haven't had much in terms of modernization expenses yet in the first half, so the bulk of those are going to occur in the second half. In terms of margin expansion, yes, we had good, healthy margin expansion in Q2 and in the first half. Our expectation for the full year is that we continue to have operating margin expansion for the full year. That's still the prevailing assumption in our guidance.
Speaker 2
Great. Thank you. Operator, next question, please.
Speaker 4
Thank you. Our next question comes from Elizabeth Anderson with Evercore ISI. Your line is open. You may ask your question.
Hi, guys. Good morning, and thanks so much for the question. Maybe a follow-up from Anne's question about the HICS exposure and maybe more broadly. If we think back to sort of uninsured utilization rates, are the 30 basis points of impact that you're talking about, what are you assuming in your assumptions for potential utilization of an uninsured population, and how do we think about that as maybe a potential offset to some of the headwinds that you described from the one big beautiful bill?
Speaker 1
Yeah. Thanks for the question. The uninsured is a very small portion of our revenue today. Now, again, if you take all the lives that you expect to fall out of the exchange, again, we believe, call it 65-70%, are going to find other alternatives. Alternative number one is they just simply pay the higher rate. Alternative number two is they hop onto an employer's insurance plan that already exists out there. The third alternative is that they go uninsured. Again, we do not think that is going to be the majority of the people because, again, the majority of the folks that are on exchange programs today, they have income. By definition, they are not on Medicaid because they have incomes. Again, they have the two alternatives. We do not feel like it is going to be a major impact, as Sam said.
Thirty basis point impact on volume in 2026.
Okay. That's helpful. Thank you.
Speaker 2
Yeah. Operator, next question, please.
Speaker 4
Thank you. Our next question comes from Erin Wright with Morgan Stanley. Your line is open. You may ask your question.
Great. Thanks so much. Last quarter, you talked a little bit about how it progressed throughout the quarter in terms of utilization trends and how that was accelerating. Some of that was because of the weather dynamics at the time. How are we trending now into kind of the third quarter? I guess, how would you characterize the utilization throughout the quarter as well? Was it relatively consistent? Anything you can, I would guess, parse out in terms of underlying utilization versus market share gains, that would be helpful. Thanks.
Speaker 1
Yeah. Thanks for the question. We did see strong utilization in the second quarter. Yes, it was a definite uptick from the first quarter. I would tell you that the drivers of that utilization, first and foremost, it's our expanded access that we gained on January 1 of this year. You don't instantly just start to pick up that business. We saw a nice steady increase from Q1 to Q2. What I'm talking about is our access through Elevance and our access through Centene. Elevance got us in network in Nevada, Colorado, West Virginia, Georgia. Together with the Centene plan, we picked up a million new lives. We feel good about the progress that we're making there. Second is our advanced diagnostic tests, our Alzheimer's AB4240 test, our advanced cardiometabolic test. We continue to see nice volume growth in some of these advanced diagnostics testing.
Finally, as you cite, yes, weather had a big impact in our Q1 results. I'm sure just the timing of people coming back into the healthcare system after they missed general health and wellness exams certainly did help in the second quarter. In terms of utilization rates, as we sit here in the first part of Q3, no real changes. It's consistent with what we've been seeing. Again, there's a combination of good utilization plus some big wins and the expanded access through the new health plan access.
Speaker 2
Operator, next question, please.
Speaker 4
Thank you. Our next question comes from Michael Turney with Leerink Partners. Your line is open. You may ask your question.
Good morning, and thanks for taking the question. Maybe if I can just ask a question on mix. I think, Jim, you said 3.3% organic RevCorrect mix. Can you dive a little bit more into what were the drivers of that dynamic? How much of it was contracting on your side, offensive moves versus just the way the market developed, and how that should factor into your guidance for the remainder of the year?
Speaker 1
Yeah. I would say the majority of it is offensive. So you're right, 3.3% organic RevCorrect increase. We've said for the year price is flattish. It'll come in somewhere between plus or minus 30 basis points. The other components in RevCorrect are test per rec and test mix and business mix, payer mix. Test per rec, again, continue to be very strong. We see it, again, with the advanced diagnostics testing, our AB4240 significant growth. Quarter over quarter as well as year over year. Our work with functional medicine entities continues to grow in a very meaningful way. Our own CIT business, as we mentioned in the script, was up 40%. With that comes strong test mix, strong test per rec improvement. Those are the underlying drivers. I don't see a change in those drivers, to tell you the truth.
We just kind of expect it'll continue here the rest of the year.
Speaker 2
Operator, next question, please.
Speaker 4
Thank you. Our next question comes from Patrick Donnelly with Citi. Your line is open. You may ask your question.
Hey, guys. Thanks for taking the questions. Maybe a quick one to say just on the cadence of the second half. Can you just talk about the 3Q setup in terms of margins, earnings would be helpful. Then a follow-up on PAMA. Can you just talk about the financial setup here, what the implications are, how you guys think about potential offsets, what the pacing there would be helpful just to frame up the PAMA piece of it? Thank you, guys.
Speaker 1
Yeah. Thanks, Patrick. I think I heard your question. Just let me know if I didn't quite capture it all. So I think you had mentioned. What's the pacing here, especially as it relates to Q3 in terms of margin and earnings. And then you wanted some more color on PAMA, the financial impact and potential action. In terms of the pacing, really, I'd reiterate what we've said at the beginning of the year, and I think on the Q1 call as well, which is we do expect that. The pacing usually is that Q2 is our best margin and earnings quarter of the year. Q3 is usually, and I'm talking about traditionally what we've seen, and especially if you take out and normalize some of the COVID impacts that we've seen in past years, at least the last few years.
But usually, Q3 is a slight step down from Q2. And then Q4 is a step down from Q3, with Q1 being the weakest quarter. And so that's usually our, I would say, normal pacing in terms of margin and earning. In terms of PAMA, I would say. The impact that we currently size is approximately $100 million. If PAMA does not get deferred for another year or if we don't get a permanent fix, we're looking at about $100 million in terms of pricing impact on our business. We've mentioned that. Previously. Now. We will take some actions to offset some of that. I will not give you a number in terms of how much exactly that would be, but we will offset a portion of that. It's not going to be the majority. We're unable to take actions to offset the majority of $100 million.
But we will take some actions to offset a portion of this. Negative impact if there is no permanent fix or if there is no delay.
Speaker 2
Operator, next question, please.
Speaker 4
Thank you. Our next question comes from Peter Chickering with Deutsche Bank. Your line is open. You may ask your question.
Hey, good morning, guys. Thanks for taking my question. Question here on tariffs for your presentation. You talked about how you're absorbing the impact of tariffs from China and Europe. Can you quantify the impact that you're absorbing? Any color on how that hits the third quarter and fourth quarter? Should we analyze a fourth quarter impact as we think about 2026?
Speaker 1
Yeah. We're not going to give a specific number, Peter. But as we've said before, I'll go back to our previous comments. We think the impact is manageable within our guidance. We are estimating that we would absorb this impact. If we have tariff impact in Q2, yes, we had some impact from tariffs in Q2 that we absorbed in our results. Q3 and Q4, we do expect some negative impact. Again, we can manage it within our guidance and the updated guidance that we provided on the call. What's assumed in our guidance today is the tariffs that are in place, that are currently in place and currently implemented per law. I know there's a lot of uncertainty around what's going to happen August 1, or I mean, there's always a lot of scenarios around that.
We have contracts in place with almost 80% of our spend on the supply side. Again, we believe that even with an August 1 scenario where tariffs do go up on certain products, we can offset that impact through the contracts that we have in place and through the alternate sourcing supply channels that we have, looking at different vendors where we can resource some of the supplies from US manufacturers or at least US-based manufacturing, not China-based manufacturing. Yeah. Just again, to frame this, our spend of $2 billion, 80% of that spend is in the US. We said less than 1% was China. We had already executed on some moves away from China that minimized, as Sam said, the impact in Q1 and Q2.
The other 20% is spread outside the US, outside of China, with the majority of that coming from Europe with our traditional big suppliers that are located there. As Sam said, we have contracts in place. The language is favorable to us, so we feel very comfortable that it is manageable within the guidance that we've given this year.
Great. Thanks.
Speaker 2
Operator, next question, please.
Speaker 1
Yep.
Speaker 4
Thank you. Our next question comes from Jack Mann with Nephon Research. Your line is open. You may ask your question.
Thank you. Good morning, everyone. I wanted to ask about the LifeLabs acquisition. Is it possible you could call out within the $240 million or so of M&A contribution in the quarter, how much came from LifeLabs versus other deals? And then just more broadly, how's the integration going and just latest thoughts around EPS accretion? Thanks.
Speaker 1
I'll start and maybe talk just briefly on the financials. Maybe Jim can give some qualitative commentary on the acquisition. Listen, the acquisition is going really well is the punchline. In terms of the contribution, Jack, on revenue, we had 10% growth from M&A in the quarter. I would say approximately 8% was from LifeLabs. That's the portion of the growth that came from LifeLabs of the 10% contribution from M&A. In terms of financial cadence or improvements that we're seeing, we had said operating margin is going to take a couple of years to get to be on parity with overall enterprise Quest rates. I think we're tracking to that goal, if not better. It's generating the EPS contribution that we expect when we size this deal and when we put our plans in place for this year.
Progressing really well, but maybe I'll let Jim speak to the other qualitative points. Yeah. Jack, first, we have a very strong management team in place in Canada that is doing a terrific job from an execution standpoint. I would tell you that we've already gotten some really good procurement synergies, as you would expect, when we look at contracts that we have, contracts that they have. We've gotten what I would call nice operational know-how synergies, right? How we do things, how they do things. By the way, some things, it's not just a one-way street. We've certainly learned some things from them from an operational standpoint that have helped us. Put all that together, and as Sam said, we're really pleased with the execution. We're pleased with the acquisition. It's generating nice top-line growth for us.
Obviously, it's inorganic, but when we look at the growth of LifeLabs itself, even though it wasn't in our numbers last Q2, we're pleased with that growth. All in all, we're really happy with how we're tracking.
Speaker 2
Operator, next question, please.
Speaker 4
Thank you. Our next question comes from David Westenberg with Piper Sandler. Your line is open. You may ask your question.
Thank you very much. Congrats on a good quarter. First of all, I want to talk about one of the slides that has client pay. It looks like it has contracted by about 5% over the last few years, and then government has kind of gone up. Is some of that LifeLabs? If not, what else would that be? How should we look at that on a go-forward basis? Just to clarify on wage increases, you kind of mentioned acquisitions helped drive net operating income offset by a little bit of wage inflation. Are we trending back to normal? Is that at least still going down? I know you had that. That has been a headwind for the last few years. I mean, at least is that heading in the right direction now? Thank you.
Speaker 1
Yeah. Just in terms of the payer mix, it's all driven by. You're adding in. What will be over $700 million of LifeLabs revenue this year. So all of the other categories are just going to mix down by that amount. So that's what's driving that. Yeah. And David, we kind of lost you there on the other parts of the question. Can you repeat? Because maybe it's on our end, but we didn't hear the other part of the question.
It was on the wage increases?
I said the mixed part.
Oh, yeah, the wage increases.
Yeah. Wage inflation has stayed in the 3-4% range for the year, for the first half of the year. We do not expect that to change in the second half of the year. What has changed from a labor standpoint, though, is our attrition continues to come down. And we are in the mid-teens and getting very, very close to where we were pre-pandemic. As you know, that really helps us from a productivity standpoint. Pleased with that.
Speaker 2
Operator, next question, please.
Speaker 4
Thank you. Our next question comes from Andrew Brackman with William Blair. Your line is open. You may ask your question.
Speaker 1
Guys, good morning. Thanks for taking the question. Jim, a few times you mentioned working with functional medicine entities as sort of a larger growth driver for you guys. Can you maybe help us size that as a broader opportunity? What further investments are you making there? Thanks.
Yeah. I don't want to give exact numbers. But it's a sizable chunk of our business that's growing almost in line with our own consumer-initiated testing business. In many ways, when we sell through functional health, it is generally either patient-paid or physician-paid, and then the physician is charging the consumer. As you know, in functional medicine, the goal is to analyze a lot of things in the human body: hormone levels, obviously all the cardiometabolic, all the chemistry testing. Functional medicine seeks to treat the patient through nutritional changes, exercise changes, sleep changes, maybe supplements, but treat the patient in a very natural and holistic way. We're seeing just a surge in this across the US with all the focus on prevention, wellness. Just people wanting to live longer. You see it in the podcasters, Peter Attia, Rich Roll, Andrew Huberman.
These guys, in essence, are generating a lot of free marketing for us. They have these podcasts. They start talking about ApoB and Lp(a) little. The next thing you know, we see a surge in ApoB and Lp(a) little testing. It's become a real trend in the US as people are focused again on prevention and wellness and longevity. It's sizable, and we expect it to grow double digits here as we move forward.
Speaker 2
Operator, next question, please.
Speaker 4
Thank you. Again, if you'd like to ask a question, just press star one. Our next question comes from Tycho Peterson with Jefferies. Your line is open. You may ask your question.
Hey, this is Noah Un for Tycho. Thank you for taking our question. I wanted to unpack the revenue guidance a little bit. You had raised it by around $80 million-$85 million. And I'm wondering what contribution you have baked in from new tests, things like Haystack, AD Detect, LumaPulse, and then other buckets there like acquisition would really be helpful.
Speaker 1
Yeah. So just in terms of breaking it down between acquisitions and organic growth, Noah, we talked about the fact that we expect organic revenue growth now to be between 3.5%-4%. By default, that would tell you that acquisitions are 6%-6.5%. Listen, we're seeing strong—so two things that are driving this. I won't go into the specifics as to which tests are driving how much. We have talked about the fact that some of our advanced diagnostic tests in those high-growth areas that Jim quoted earlier are driving good upside and good performance, AD Detect being one of them. We have many tests across these high-growth areas that are contributing to it. Utilization is strong. As you saw in Q2, we are seeing positive utilization driven by increased access in some of those states where we got access as of January 1 this year.
We saw a good bounce back from some tough weather months in January and February. Q2 generally was strong utilization, which gives us confidence in increasing the guidance for the full year. We're seeing very strong revenue per requisition, 3.3% organic revenue per requisition in Q2, which again gives us confidence on the fact that the test per rec assumptions that we have are durable and sustainable. We're seeing good, healthy mix in terms of payer mix. All of those things are really driving our confidence in terms of increasing the revenue guide by this $85 million at the midpoint that you quoted. One other thing I would just add at the end, Noah, is the fact that pricing is still—we are still expecting our price overall across the Quest book of business to be flattish with a potential range of outcomes of plus or minus 30 basis points.
Pricing is still within the assumptions that we had earlier.
Speaker 2
Operator, next question, please.
Speaker 4
Thank you. Our next question comes from Michael Turney with Bank of America. Your line is open. You may ask your question.
Hey, this is Aaron Un for Mike. Thanks for the question and congrats on the quarter. I wanted to touch on Haystack a little bit and ask about any oncologist feedback or impressions and just get an overall update on progress made there.
Speaker 1
Yeah. We're making good progress. As we stated previously, we ran this early experience program. We're seeing really nice conversion of people that sent us work as part of the early experience program and becoming full-time customers. The feedback from oncologists thus far has been very positive. They recognize the superior limits of detection that we have with this test. They like the turnaround time. They like the hands-on touch that they get, the personal touch from our client team. We're pleased with the progress. We continue to make progress from Q1 to Q2, and we expect to continue to grow that business significantly Q3, Q4, and into 2026.
Speaker 2
Thank you. Operator, next question, please.
Speaker 4
Thank you. Our final question comes from Luke Surgot with Barclays. Your line is open. You may ask your question.
Hi, guys. This is Anna Krzemski on for Luke. Thank you for taking our questions and congrats on the quarter. I'm wanting to ask about organic tests per day. It's a nice 2.5 step up this quarter. I'm just curious, how should we be thinking about this going forward since last year this only increased about 1% each quarter? If you could just talk about what's driving that upside. Thanks.
Speaker 1
Yeah. Let me start, and Sam, can add. As we said, what's really driving it from Q1 to Q2 was our access, right? We got into network with Elevance and Centene on January 1 of this year, and we've seen a nice steady ramp-up of new clients as a result of having access to over a million new lives. That includes in the states of Nevada, Colorado, West Virginia, and Georgia. The other thing driving it, we said, was our advanced diagnostics testing, just an uptick in some of these advanced cardiometabolic, autoimmune testing, women's healthcare testing, especially the advanced diagnostics, NIPT, and QHERIT. Obviously, our new brain health offerings have also helped. We did cite, yes, weather impacted the business in Q1. People that missed appointments, especially general health and wellness, popped back in Q2. All of that contributed to the strong organic revenue growth.
Now, the other thing we saw in the quarter is, recall last year we had said that our employer businesses, the two employer businesses, Employer Pop Health plus our employer drug testing business, were a significant headwind in terms of volume and revenue growth. I would tell you those two businesses have stabilized this year. It's still a bit of a volume headwind, but those two businesses combined had revenue growth in the quarter, which obviously means if it's a volume headwind, but it helped from a growth standpoint, it means we've been raising prices in those two segments. We've raised those prices, and they're sticking, especially in our employer drug testing business, which we're very pleased with. Put all of those things together, and that's what got us the strong organic volume growth. Our expectation is it's going to continue in that range for the rest of the year.
Just one last point maybe to add to Jim's great explanation, because I'm not sure if this is also something that you want to color on. Rep per rec as well, organic rep per rec was up 3.3% in the quarter, and a big portion of that was driven by tests per rec. I would say almost close to 70% of that was tests per rec appreciation. The growth of tests per rec that we've seen over the past few years, before the pandemic, it was less than four tests per rec that we were seeing, and now we're seeing more than four tests per rec. The rec density that we see across our business has improved as well.
Speaker 4
Got it. Super helpful.
Speaker 2
Operator, any last questions?
Speaker 4
At this time, I'm showing no further questions.
Speaker 1
Okay. Thanks, everyone, for joining in today. Appreciate all your questions and feedback and look forward to talking to you all soon. Have a great week ahead. Thank you.
Speaker 4
Thank you for participating in the Quest Diagnostics Second Quarter 2025 conference call. A transcript of remarks on this call will be posted later today on Quest Diagnostics' website at www.questdiagnostics.com. A replay of the call may be accessed online at www.questdiagnostics.com/investor or by phone at 866-388-5361 for domestic callers or 203-369-0416 for international callers. Telephone replays will be available from approximately 10:30 A.M. Eastern Time on July 22nd, 2025, until midnight Eastern Time on August 5th of 2025.