IQVIA - Q4 2023
February 14, 2024
Transcript
Operator (participant)
Ladies and gentlemen, thank you for standing by. At this time, I would like to welcome everyone to the IQVIA Fourth Quarter 2023 Earnings Conference Call. All lines have been placed on mute to prevent any background noise. After the speaker's remarks, there will be a question and answer session. If you would like to ask a question during this time, simply press star followed by the number one on your telephone keypad. If you would like to withdraw your question, again, press the star one. As a reminder, this call is being recorded. Thank you. I would now like to turn the call over to Nick Childs, Senior Vice President, Investor Relations and Treasury. Mr. Childs, please begin your conference.
Nick Childs (SVP of Investor Relations and Treasury)
Thank you very much. Good morning, everyone. Thank you for joining our fourth quarter 2023 earnings call. With me today are Ari Bousbib, Chairman and Chief Executive Officer, Ron Bruehlman, Executive Vice President and Chief Financial Officer, Eric Sherbet, Executive Vice President and General Counsel, Mike Fedock, Senior Vice President, Financial Planning and Analysis, and Gustavo Perrone, Senior Director, Investor Relations. Today, we will be referencing a presentation that will be visible during this call for those of you on our webcast. This presentation will also be available following this call in the Events and Presentations section of our IQVIA Investor Relations website at ir.iqvia.com. Before we begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements.
Actual results could differ materially from those stated or implied by forward-looking statements due to risks and uncertainties associated with the company's business, which are discussed in the company's filings with the Securities and Exchange Commission, including our annual report on Form 10-K and subsequent SEC filings. In addition, we will discuss certain non-GAAP financial measures on this call, which should be considered a supplement to, and not a substitute for, financial measures prepared in accordance with GAAP. A reconciliation of these non-GAAP measures to the comparable GAAP measures is included in the press release and conference call presentation. I would now like to turn the call over to our Chairman and CEO.
Ari Bousbib (Chairman and CEO)
Thank you, Nick, and, good morning, everyone. Thank you for joining us today to discuss our 2023 results. You saw that we had a good quarter. Let me start the call by sharing the latest of what we are seeing in our end markets, along with our key accomplishments for 2023. On the clinical side, demand from our R&DS clients remained strong. Net new bookings for the quarter exceeded $2.8 billion, the second largest quarter in IQVIA history, representing a quarterly book-to-bill of 1.31. Our quarterly RFP flow was up 13% year-over-year, driven by EBP and large pharma. Our qualified pipeline grew double digits versus prior year. Emerging biotech funding was strong.
According to BioWorld, fourth quarter EBP funding was $21.6 billion, the highest quarter in the last two years, continuing the sequential improvement we've seen throughout the year. For the full year, EBP funding for 2023 was $70.9 billion, up 17% versus the prior year, and that represents the largest year on record if we exclude the outlier years of 2020 and 2021, when there was dramatic outspending due to COVID. As we close 2023, we're proud of what we have achieved in R&DS. The business booked $10.7 billion of net new business, including record-high service bookings of $8.4 billion. Our backlog stands at $29.7 billion, and that's up 9% year-over-year. The business added nearly 400 net new customers in the year.
We made great progress with our clinical research strategies. We significantly expanded our R&D site network and management organization through strategic acquisitions that offer clinical research coordination, study feasibility, and patient recruitment capability. We further expanded the capabilities of the lab business through the launch of a new synthetic antibody discovery offering, which is differentiated from the traditional animal-derived antibodies that are used by our competitors. We partnered with the Coalition for Epidemic Preparedness Innovations, CEPI, to enhance the world's ability to rapidly conduct clinical research for vaccines and other biological countermeasures against emerging infectious diseases in under-developed countries. Turning to TAS. The commercial side of our business continues, of course, to face the macro environment that we've described in the past, as our clients remain cautious with their spending and their cost containment.
Our results in the quarter were slightly better than what we had expected, although discretionary spending has not yet rebounded to the levels that we expect they will, and it continues to be a headwind. Fundamentally, leading market indicators do point to an upcoming improvement. For instance, the FDA approved 55 new molecules in 2023, and that's almost 50% more than the prior year, and it is the highest level since 2018. The spend on new drug launches by our pharma clients is expected to be over $190 billion over the next five years. That's up over 25% compared to the prior five-year period. Frankly, in our own engagement with customers in the recent past, we noted an improved customer sentiment during the quarter.
In fact, the pipeline of opportunities remains strong, even as decision timelines remain elongated and negotiations more difficult, similar to what we indicated last quarter. Based on these dynamics, we continue to expect demand to pick up, but not before the second half of the year. As a result, we may see the 2024 sequential trend for TAS to be the inverse of what we experienced in 2023. You might see revenue growth in the first quarter that resembles the growth of the fourth quarter of 2023, and growth to gradually improve as we move to the back end of the year. Now, despite the more difficult macro environment, the TAS business had some significant achievements in 2023. We continued expanding our commercial technology and analytics offerings. We, in fact, added 33 new clients on our OCE technology platform.
We successfully launched a new software platform, which tracks the performance of 1.6 million drugs, covering 600 diseases across 93 countries. We successfully introduced a first-in-kind MedTech consumption offering that supports the complex journey that medical devices take as they travel from manufacturer to healthcare providers. And we acquired QualityMetric to extend our suite of patient health measurement tools using clinical outcome assessment and patient-reported outcomes. Let me now turn to the results for the quarter. Revenue for the fourth quarter grew 3.5% on a reported basis, and 2.6% at constant currency. Compared to last year, and excluding COVID-related work from both periods, we grew the top line approximately 6% on a constant currency basis, including approximately 1.5% of contribution from acquisitions. Fourth quarter adjusted EBITDA increased 5%, reflecting our ongoing cost management discipline.
Fourth-quarter adjusted diluted EPS of $2.84 faced the continuing headwind of the step-up in interest expense and the U.K. corporate tax rate increase. Excluding the impact of these items, our adjusted diluted EPS growth was 11%. Now, a few highlights of this business activity this quarter. Let's start with TAS. A mid-size pharma client awarded IQVIA a four-year outsourcing program to support their life cycle strategy of converting established brands to over-the-counter sales in more than 40 countries. Similarly, IQVIA won a four-year contract with a large pharma client to provide global market intelligence via a single, globally accessible source of commercial data. In the quarter, we won a significant contract with a large pharma in their dermatology, rheumatology, and oncology therapeutic areas. This program will allow our client to access detailed prescribing patterns in local markets and enhance HCP targeting in 18 countries.
The CDC selected IQVIA to provide comprehensive monitoring services following the end of the COVID public health emergency status. IQVIA will support the CDC in analyzing data in near real time on the respiratory virus response, including for influenza and RSV, identifying at-risk groups and improving overall population health. In the quarter, our patient services business, which is showing faster growth within our TAS segment, secured a significant contract with a large pharma that includes adherence monitoring, copay support, and at-home treatment administration. In our real-world business, the National Health Service of England awarded IQVIA a large contract to deploy our privacy technology and to enable the NHS's efforts to ensure the highest standards of patient data governance and privacy controls. Moving to R&DS, a top five pharma client selected IQVIA as a key clinical FSP provider.
Noteworthy here is that a competitor of ours had been the 100% sole provider previously. This partnership will help the client improve clinical trial oversight and manage costs more effectively. In Q4, another top five client awarded IQVIA a full-service phase II study on ALS, also known as Lou Gehrig's disease. IQVIA was selected due to our vast expertise in ALS disease, as well as our faster recruitment timelines. In the quarter, a biotech client selected IQVIA to conduct a complex trial for a promising cell and gene therapy targeting myositis, which is an autoimmune disease. We were selected due to our AI capabilities that allow us to identify sites and develop an innovative trial strategy. Also in the quarter, IQVIA expanded its partnership with a major pharma company by securing six new global oncology trials, consisting of a mix of early and late-stage trials.
We were chosen due to our expertise in oncology and our ability to efficiently manage large, complex trials. A leading biotech firm selected IQVIA to conduct a program comprised of three initial stage studies in cancer research. The client is expanding from local to global development and needed a large-scale partner like IQVIA. In Q4, IQVIA was awarded a major contract from a top 10 global pharma to become its primary pharmacovigilance platform provider. This multi-year program includes replacing their legacy systems with IQVIA's drug safety monitoring technology, which uses generative AI capability to automatically extract adverse event information from unstructured data sources. Finally, and before I turn it to Ron for a detailed financial review, I would like to take the opportunity to acknowledge and congratulate our employees around the world for the nice recognition the company just received.
For the seventh consecutive year, IQVIA was named one of the World's Most Admired Companies in Fortune's annual survey. For the third year in a row, IQVIA was named the number one most admired company in our category. Lastly, before turning it over to Ron, I'd like to specifically mention the prestigious recognition received by Christina Mack, one of IQVIA's senior leaders, who is the Chief Scientific Officer for our real-world business. Christina was named 2023 PharmaVoice 100 honoree. It is a peer-recognized, industry-wide honor. We're very proud at IQVIA of Christina's work and her passion for accelerating innovation in healthcare through the use of evidence-based decision making. Let me now turn it to Ron for our financial review.
Ron Bruehlman (EVP and CFO)
Okay, thanks, Ari, and good morning, everyone. Let's start by reviewing revenue. Fourth quarter revenue of $3.868 billion grew 3.5% on a reported basis and 2.6% at constant currency. In the quarter, COVID-related revenues were approximately $65 million, which was down about $125 million versus the fourth quarter of 2022. Now, excluding all COVID-related work from both this year and last, constant currency growth was approximately 6%. As already mentioned, acquisitions contributed about 150 basis points to this growth. Technology and Analytics Solutions revenue for the fourth quarter was $1.531 billion, up 2.1% reported and 1.3% constant currency. Excluding all COVID-related work, constant currency growth in TAS was 4%.
R&D Solutions' fourth quarter revenue of $2.151 billion was up 4.5% reported and 3.7% at constant currency. Excluding all COVID-related work, constant currency growth in R&DS was 9% in the quarter. Finally, Contract Sales and Medical Solutions, or CSMS, fourth quarter revenue of $186 million grew 2.2% reported and 1.7% at constant currency. For the full year, revenue was $14.984 billion, growing at 4% on a reported basis and 4.1% at constant currency. COVID-related revenues totaled approximately $420 million for the year. Excluding all COVID-related work from both years, constant currency growth was 9%.
Full-year Technology & Analytics Solutions revenue was $5.862 billion, up 2% reported, 2.1% at constant currency. Excluding all COVID-related work, growth at constant currency in TAS was 6%. In R&D Solutions, full-year revenue was $8.395 billion, growing 6% both on a reported and a constant currency basis. Excluding all COVID-related work, growth at constant currency in R&DS was 13%. Finally, in CSMS, that's revenue for the full year was $727 million, which was down 2.2% reported and 0.3% at constant currency. Okay, moving down the P&L, adjusted EBITDA was $966 million for the fourth quarter.
That represented 5% growth, while full-year adjusted EBITDA was $3.569 billion, which was up 6.7% year-over-year. Fourth quarter GAAP net income was $469 million, and GAAP diluted earnings per share was $2.54. For the full year, GAAP net income was $1.358 billion, or $7.29 per diluted share. Adjusted net income was $523 million for the fourth quarter, and adjusted diluted earnings per share was $2.84. For the full year, adjusted net income was $1.901 billion, and adjusted diluted EPS was $10.20.
Excluding the year-over-year impact of the step-up in interest rates and the increase in the U.K. corporate tax rate, adjusted diluted earnings per share grew 11% in the fourth quarter and 12% for the full year. And now, as already reviewed, R&D Solutions delivered another really strong quarter of bookings. Our backlog at December 31 stood at a record $29.7 billion. That's up 9.2% year-over-year and 31% over the last three years. Okay, let's turn to the balance sheet. As of December 31, cash and cash equivalents total $1.376 billion, and gross debt was $13.673 billion. And do the math, that results in net debt of $12.297 billion.
Our net leverage ratio at year-end was 3.45x trailing 12-month adjusted EBITDA. Fourth quarter cash flow from operations was $747 million, and capital expenditures was $179 million, which resulted in free cash flow of $568 million for the quarter. Now, in the quarter, we repurchased $229 million of our shares at an average price of $195 per share, bringing our full-year share repurchase activity to just slightly below $1 billion. This leaves us with just under $2.4 billion of share repurchase authorization remaining under the current program.
Now, as you know, coming out of the merger, we took advantage of the low interest rate environment and deployed a significant amount of capital for internal investments, acquisitions, and share repurchases, which were quite accretive for our shareholders. Now, over that period, our net interest expense was relatively steady at around $400 million per year. But at the end of 2022 and through the middle of 2023, we experienced a rapid and unprecedented rise in interest rates, which drove annual interest expense up by almost $250 million, causing our adjusted EPS to be just slightly over flat in 2023. Now, as you saw in November, we successfully refinanced approximately $2.75 billion of our near-term debt maturities.
The strong demand for IQVIA debt that we experienced allowed us to tighten pricing and lock in an average fixed rate below 4.9% for those issuances after swaps. This refinancing extended approximately $2.75 billion in maturities to 2029 and 2031, and we reduced our interest rate risk exposure by locking in over 80% of our debt at fixed rates. With this refinancing, we now expect net interest expense to be approximately $650 million in 2024. Now, the forward curves point to a reduction in rates in the future. We've included the current market consensus in our 2024 guidance. Further reductions would lower our net interest expense more on our variable rate debt and potentially open opportunities to refinance additional debt in the future.
Now, let's go to our 2024 guidance, which I'll review in detail. For the full year, we expect total revenue to be between $15.4 billion and $15.65 billion. This includes, approximately $300 million of a step down in COVID-related work year-over-year, and about 100 basis points of contribution from M&A activity, and further, FX headwind of approximately 50 basis points versus 2023. Our adjusted EBITDA guidance is $3.7 billion-$3.8 billion. Our adjusted diluted EPS guidance is $10.95-$11.25.
Now, this guidance includes about $650 million of interest expense, approximately $580 million of operational depreciation and amortization expense, an effective income tax rate just under 20%, and an average diluted share count of approximately 184 million shares. This guidance also assumes about $2 billion of cash deployment, split evenly between acquisitions and share repurchase. Finally, our guidance assumes that foreign currency rates as of February 12 continue for the balance of the year. Now, at the segment level, we expect TAS revenue to be between $6 billion and $6.2 billion. Q1 2023 was the last quarter that we had significant COVID-related revenues in TAS, so the COVID step down in TAS will be minimal for the balance of the year.
As Ari mentioned, the guidance now anticipates an improvement in our commercial business towards the back end of the year, which will still result in a year-over-year growth of low- to mid-single digits. R&DS revenue is expected to be between $8.7 billion and $8.8 billion. This guidance includes almost the entire $300 million step down in COVID-related revenue, excuse me, and that represents approximately 350 basis points of headwind to the R&DS growth rate. The guidance also reflects the latest phasing of pass-through revenue, which results in an additional headwind of approximately 100 basis points to R&DS year-over-year. Adjusting for the COVID step down and the pass-through headwind, R&DS revenue growth in 2024 is expected to remain in the high single digits.
CSMS revenue is expected to be approximately $700 million, which is down slightly year-over-year. Now let's review the first quarter guidance. For the first quarter, we expect revenue to be between $3.65 billion and $3.725 billion. The decline in COVID-related work is weighted towards the beginning of the year, with the largest impact in Q1. Also, we expect market conditions in TAS to recover only in the back half of the year, as we've said. Now, adjusted EBITDA in the first quarter is expected to be between $850 million and $870 million, and adjusted diluted EPS is expected to be between $2.45 and $2.55.
Now, keep in mind that Q1 is the toughest comparison for adjusted diluted EPS due to the interest rate increases we saw throughout 2023. Now, as we mentioned, our guidance assumes that foreign currency rates as of February 12 continue for the balance of the year. So let's summarize. Q4 was another strong quarter. R&DS delivered the second-largest booking quarter in IQVIA history at over $2.8 billion, along with another quarter of double-digit RFP growth. For the full year of 2023, revenue grew 9% at constant currency, excluding COVID-related work. Our EBITDA margin expanded by 60 basis points, and adjusted diluted EPS was up 12% if you exclude the year-over-year impact of interest rates and the increase in the U.K. tax rate.
Free cash flow was strong in the quarter at $568 million, representing 109% of adjusted net income. IQVIA was named a Fortune's 2023 list of the World's Most Admired Companies for the seventh consecutive year and earned the first place ranking within our industry group for the third consecutive year. Lastly, we issued full year 2024 guidance, with underlying revenue growth of 5%-7%, continued margin expansion, and a resumption of EPS growth, with adjusted diluted earnings per share expected to be up 7%-10%. Now, before we open the call to Q&A, I'd like to make you aware of a leadership change within IQVIA's finance organization.
Nick Childs, who has led our investor relations and treasury functions very ably for the past three years, is moving on to become CFO of our North American business. He will be succeeded by Kerri Joseph, who has served as CFO of that business unit for the past five years. Now, Kerri, who is a member of the Global Finance Leadership Team, has had many finance roles of increasing responsibility during his 20+ years with the company. Kerri and Nick have already been working together to transition responsibilities, and Kerri will join Nick on our follow-up calls this quarter, so you will have a chance to meet him. Now, with that, let me hand it back over to the operator to begin our Q&A session.
Operator (participant)
At this time, I would like to remind everyone, in order to ask a question, press star, then the number one on your telephone keypad. We request that you please limit yourself to just one question so that others in the queue may participate as well. We'll pause for just a moment to compile the Q&A roster. Your first question comes from the line of Anne Samuel from JP Morgan. Your line is open.
Anne Samuel (Executive Director of U.S. Healthcare Technology and Distribution)
Hi, guys, congrats on the great print, and thanks for taking the question. My first question was just on TAS. You know, you spoke to expectations for a back-half recovery in this business. You know, it seems like based on your comments and some of those from others, you know, at our recent conference, that others in the life sciences IT space are seeing some early optimism around that. And was just, you know, wondering, you know, what do you expect to be the early indicators that the recovery is happening in that business? And what part of your TAS business will maybe start to see the first green shoots?
Ari Bousbib (Chairman and CEO)
Well, thank you, Anne. I mean, look, we early last year were expecting that, things would turn around the second half of last year, and as you know, it didn't happen.
Now it's got to happen at some point. So we then thought, well, you know, by the second quarter, months later, you know, by the end of the last, of last year's third quarter, I thought, "Okay, second quarter of 2024." We are now expecting this, to happen second half. And in support of all of these, I mentioned some data points in my introductory remarks. Look, the, the, the FDA approved, 50% more molecules than last year, and it's the highest level since 2018. That really generally bodes well for the commercial business as our clients prepare for launching, those drugs into the marketplace.
And those launches come for significant support from the type of services that we provide, whether it's data, you know, launch, consulting, planning, market access, pricing, support, and so on and so forth. And in fact, our own, you know, market expectations of spend by pharma over the next few years, you know, compares very favorably to the prior period. Now, in our own conversations with clients, we're noting more optimism on the outlook for 2024. But perhaps because we've been burnt before, we've tried to be appropriately cautious in planning.
Really, when we build up the forecast for our TAS business based on the pipeline. I might note, I don't think we said that before, or even if we report any of these numbers here, but you know, we have a pipeline of opportunities with a very detailed methodology that's been proven over time. I can tell you that our pipeline for the year, for the 2024 year, is higher than it has ever been on the TAS business. So that gives us comfort that you know, the forecast is appropriately built, and hopefully will be, we have you know upside favorability you know, if things work out perfectly well.
But we've built enough caution on the forecast here that we feel good about the TAS business for 2024, as we presented it. Now, a word of caution, you know, the business saw declining growth through 2023, with every quarter being worse than the previous one. We expect 2024 to be sort of the mirror image of that. That is, the first quarter to be more like last year's fourth quarter, and the second quarter more like the third quarter, et cetera, with a ramp up through the year, and hopefully building momentum as we progress through 2024.
Anne Samuel (Executive Director of U.S. Healthcare Technology and Distribution)
That's really helpful.
Ari Bousbib (Chairman and CEO)
Thank you, Anne.
Anne Samuel (Executive Director of U.S. Healthcare Technology and Distribution)
Thank you. Thank you. And then maybe on the R&DS side, I was hoping maybe you could just provide a little bit of color on just how to think about the cadence for 2024. Just given all the moving pieces. Thank you.
Ari Bousbib (Chairman and CEO)
You mean the cadence? Yeah. Anyone has any
Anne Samuel (Executive Director of U.S. Healthcare Technology and Distribution)
The cadence of revenue, yeah.
Ari Bousbib (Chairman and CEO)
Yeah. Seems nice.
Nick Childs (SVP of Investor Relations and Treasury)
Yeah, I mean, I think you. I mean, I guess I would tell you to look at the linearity that you've seen in prior years.
Ari Bousbib (Chairman and CEO)
Yeah, nothing unusual.
Nick Childs (SVP of Investor Relations and Treasury)
We're not expecting anything to be-
Ari Bousbib (Chairman and CEO)
Nothing unusual
Nick Childs (SVP of Investor Relations and Treasury)
You know, any sort of drop-off or a significant pickup either. No.
Ari Bousbib (Chairman and CEO)
Yeah.
Anne Samuel (Executive Director of U.S. Healthcare Technology and Distribution)
Great.
Ari Bousbib (Chairman and CEO)
Thank you.
Anne Samuel (Executive Director of U.S. Healthcare Technology and Distribution)
Very helpful. Thank you so much.
Ari Bousbib (Chairman and CEO)
Yeah.
Operator (participant)
Your next question comes from the line of Shlomo Rosenbaum from Stifel. Your line is open.
Shlomo Rosenbaum (Managing Director)
Hi, thank you for taking my questions. Ari, can you talk a little bit about the significant contract signings in the quarter, second largest in the company's history? Were there certain really large deals that maybe boosted it? Were there certain therapeutic areas that might have boosted it? Maybe just give us a little bit of color about that.
Ari Bousbib (Chairman and CEO)
Okay. Well, thank you, Shlomo, for the question. There was no specific contract or particular award or anything like that. I would just say that by segment, the EBP segment was particularly strong. I mentioned funding was very strong in the quarter, the highest on record. Again, if you exclude the COVID years. And so EBP was particularly strong. I'd say with the—Again, we don't talk about book to bill per segment, but the EBP book to bill, if you will, was higher than our 1.31. So comparatively, we had. And about, I would say about 25%. Is that correct, guys? 25% of our bookings in the year were EBP.
Nick Childs (SVP of Investor Relations and Treasury)
Yes.
Ari Bousbib (Chairman and CEO)
So that, you know, that's a little bit of color that I can give you, but nothing, you know, no, no one-time big big award or anything that that skewed the numbers. No, pretty, pretty strong across the board.
Nick Childs (SVP of Investor Relations and Treasury)
Therapeutic area, we continue to excel in Oncology and Cell and Gene Therapy and the complex clinical trials. So no, no change.
Ari Bousbib (Chairman and CEO)
Right. Correct.
Shlomo Rosenbaum (Managing Director)
Great.
Ari Bousbib (Chairman and CEO)
Thank you so much.
Shlomo Rosenbaum (Managing Director)
Thank you. Can you just comment anything about competitively in the marketplace? Has there been any changes? I know it's a long cycle business. But anything you could talk about either on TAS or R&DS with any of the, you know, well-known competitors that are out there?
Ari Bousbib (Chairman and CEO)
Yeah, well, you know, I don't generally like to comment on competitors, but yeah, there have been a number of disruptions, you know, the company is being acquired or spun off, you know, in the CRO space. And that always, you know, introduces some level of disruption. I mean, some of these companies had been in trouble. You know, the fact that they've been acquired by private equity or conversely, spun off in the public markets, does that mean that they'll be more competitive, less competitive? You know, it's hard to tell. It's disruption, often happens.
You know, if you take a longer view of this question, you know, we believe that our merger seven years ago, you know, significantly disrupted the industry and led to a large number of subsequent transactions, which resulted from what we believe was, you know, reactions to the clear competitive advantage that we think we established, that enabled us over the past few years to, you know, gradually gain market share. But other than that, I mean, I wouldn't further comment. Thank you, Shlomo.
Shlomo Rosenbaum (Managing Director)
Thank you.
Operator (participant)
Your next question comes from the line of Tejas Savant from Morgan Stanley. Your line is open.
Tejas Savant (Executive Director and Senior Healthcare Equity Analyst)
Hey, guys. Good morning. My first question here is on the R&D side of things. Can you help us think through just a shift in mix in FSP versus hybrid versus full service work and the margin implications of that? Similarly, sort of any shift in the mix of work as you head into 2024 on therapeutic area basis, and what that might mean for your backlog burn rates?
Ron Bruehlman (EVP and CFO)
The question was about the mix shift and margins between FSP and full service, correct?
Tejas Savant (Executive Director and Senior Healthcare Equity Analyst)
That's right.
Ron Bruehlman (EVP and CFO)
Yeah. Well, look, FSP tends to be somewhat lower margin than full service. Now, take into account, though, that full service comes with pass-through, significant pass-through revenues that FSP doesn't. And so when you look at the average margins, including pass-throughs, they're not that different. But yeah, in general, there has been. There is some margin degradation as a result of the shift towards FSP. On the other hand, this shift is a very gradual shift that's going on. It, you know, it's. You're talking about points of, you know, single points of shift, not huge, a huge flight to FSP. And it takes place over time. Remember, you know, the average trial is four plus years to complete, so there really hasn't been any dramatic impact on our margins as a result of that.
Of course, we're working all the time to, you know, optimize and take costs out and do things to improve our margins, independent of whatever contracts we happen to be signing. I would say not a, not a big impact there. You see in our EBITDA margins, they've actually, you know, continued to improve overall, and that's with R&DS being over 50% of our revenue.
Ari Bousbib (Chairman and CEO)
Yeah.
Tejas Savant (Executive Director and Senior Healthcare Equity Analyst)
Got it.
Ari Bousbib (Chairman and CEO)
I mean, look, yeah.
Ron Bruehlman (EVP and CFO)
And then your second question, can you just-
Tejas Savant (Executive Director and Senior Healthcare Equity Analyst)
Yeah, my second question actually, I'm going to switch to the TAS comments. Guys, I mean, are you encouraging to see sort of expectations of a recovery in the back half of the year? And you talked about sort of your detailed bottom-up pipeline build there. But I just want to put a finer point on it in terms of just the timing of the recovery, right? So what gives you confidence that this comes through in 2H 2024 versus getting pushed to 2025? Is it something related to sort of contracted work that you have clear line of sight to, versus work that could be sort of delayed? Or is it some large real-world evidence projects that you see coming through here in the back half?
Ari Bousbib (Chairman and CEO)
Yeah. Thank you, Tejas. No, it's not anything, any one or contract or specific lever. It's, as I mentioned, the overall sentiment, you know, you're bubbling up into a pipeline that I mentioned is the highest that we've had ever. Now, the pipeline doesn't always translate exactly as it is. You know, it's probability adjusted and so on and so forth, but that's a good indication from a metric standpoint, that we should be up for the year, you know. And we've built some level of cushion here because we've been burned or delayed, you know, last year. And so that's what kind of gives us a little bit of confidence, along with the conversations we're having with our clients.
Again, I wouldn't—this is not like, we, we're not seeing a sharp uptick all of a sudden, okay? Our clients are, especially large pharma, very, very focused on cost containments. They've all announced significant cost reduction programs. Some of them in anticipation of, you know, really unknown impact of the IRA, some in anticipation of, you know, some LOEs coming soon in the next few years or, or other or other variables. But the fact is, there are these large pharma cost discussions that we're having with clients as well, and we are a significant vendor, and therefore, those conversations have tended to be more difficult than they were in the past with respect to negotiations and pricing and so on. That is still there.
The number of opportunities, the number of projects, the number of conversations, all of which translate into a pipeline, the request for proposals and so on, that we're having, are clearly up. And, given the life cycle of these sales processes as we know them, we are anticipating that those would concretize into sales towards the back end of the year.
Ron Bruehlman (EVP and CFO)
Tejas, just one point of emphasis here, too. In the TAS business particularly, it's hundreds and hundreds of projects. So you're, you're not gonna have any individual project move the needle there.
Ari Bousbib (Chairman and CEO)
Thank you.
Tejas Savant (Executive Director and Senior Healthcare Equity Analyst)
Thanks, guys. Appreciate it.
Operator (participant)
Your next question comes from a line of Luke Sergott from Barclays. Your line is open.
Luke Sergott (Director of Healthcare Equity Research)
Yeah, guys. Can you talk about the, you know, we keep talking about the TAS recovery, but, you know, and the big pipeline that you guys have, but can you kind of double-click into what that looks like versus discretionary versus the sticky side? I think there's a lot of confusion about, you know, where the weakness has been in TAS and where the strength has been, and if there's actually any change or improvement on the side of, you know, like regulatory and medical writing, things like that, to give more confidence in that back half recovery that you're talking about.
Ari Bousbib (Chairman and CEO)
Yeah. Well, look, you know, we ourselves are, as I mentioned before, putting a fair amount of caution and, you know, conservatism, if you wanna call it that way, in our own forecast because of some of the factors you mentioned that we've experienced last year. The business continues to grow. Look, the general environment so far is consistent with what we were experiencing at the end of last year. And you've seen, you know, our large cap companies that operate in the same business actually forecast even declining sales for their own businesses for 2024. Now, we're not there because, as you correctly point out, some of these services that we sell are not exactly discretionary. So, look, the data business, for example, continues to hold up well.
It's never been a fast growth business, but it's holding up. We saw headwinds in the more discretionary part of the TAS segment, which is the analytics and consulting business. But I have to say that the business started to pick up a bit with sequential improvements in growth in Q4 compared to Q3. So even this more discretionary side, we saw an uptick. Not again, not a steep curve up, but we saw you know positive movement even on the discretionary side. Now, the impact on the discretionary project part of the real world business that you know is a little bit of a longer cycle within TAS. We started seeing that in Q3, and it continued in Q4, and it did impact the performance of our real world business in Q4.
So if I might summarize, the data business holding up, maybe a little bit even better, doing a little bit better. The totally discretionary piece of analytics and consulting, little movement and some uptick that we are perceiving. The Real World piece, you've got the stuff that they need to do, that hasn't changed, and then there is the stuff that's more discretionary. Because it's more, it's a longer cycle, the deceleration impacted our numbers more in Q3 and further in Q4. So the issues we saw in analytics and consulting in the early part of the year, we started seeing in Real World in Q3 and Q4, and we expect that to continue in Q1. But if you. I hope that gives you enough color here to get a sense for what we're seeing.
Luke Sergott (Director of Healthcare Equity Research)
It does. It does. And then I guess-
Ari Bousbib (Chairman and CEO)
Thank you
Luke Sergott (Director of Healthcare Equity Research)
.....to follow up-
Ari Bousbib (Chairman and CEO)
Yeah
Luke Sergott (Director of Healthcare Equity Research)
... on the, you know, there's a lot of concern here. You know, the, some of your peers talked about biotech RFPs slowing in 4Q. But just as you look at the actual step-up needed to maintain the book-to-bill and the bookings levels that you guys have had, do you see that that level of RFP volume across all your segments is enough to sustain it over the next six months? Or could we see some softening here, maybe in the 1Q? And, you know, obviously, this is just more of a quarterly dynamic as the full year kind of paces out as what you're talking about.
But just when you're thinking about the actual bookings getting, you know, you closing that sales cycle, could some stuff get pushed out to more of the back half of the year?
Ari Bousbib (Chairman and CEO)
I mean, look, you've got a lot of hypothetical here,
Luke Sergott (Director of Healthcare Equity Research)
Sorry
Ari Bousbib (Chairman and CEO)
I know you're referring to a competitor commentary. I didn't hear any of that, and we're not seeing that. Again, you know, this is interesting. People want to see bad news and hang their hat on something. I would point to you that, you know, going back a couple of years at least, people were competitors, quote-unquote, "whining" about EVP funding. And you know, all CRO stocks suffered as a result of this whining. We kept telling the world that we weren't seeing it. We ended up being correct. There was no dramatic drop-off in funding. It didn't happen. If anything, now, as I mentioned, it's even growing further at record levels. So EBP is good, and actually was very, very strong in terms of bookings. We see that trend continuing.
You know, when things get funded in a quarter, typically the bookings come in over the course of the following year, so I don't see that happening on the EBP segment. Large pharma, yeah, there is a little bit of reprioritization of projects. You've heard that from us, from others, you know, looking at different programs, but it's not like people are saying all of a sudden, "We're not doing research anymore." There's a little bit of at the moment, as we discussed earlier, Ron mentioned, you know, a bit of a pendulum moving more towards FSP. But again, we play in that segment, too. We play in every segment. But other than these dynamics, I don't see anything that would lead me to believe that all of a sudden we have to be worried. Quite the opposite.
As I said, our RFP flow was up 13% in Q4, and that's across the board. Strong double digits in EBP and in large pharma as well. That was in Q4. Full year, same thing, very strong, and EBP even stronger for the full year. Awards, which is sort of, if you will, a leading indicator of bookings, because as you know, we and maybe a small number of others actually report bookings and book-to-bill based on contracted work. But some still report only awards, which is kind of before contracted. And awards are also at a record high level. If you look at our pipeline, the total pipeline is at high single digits, you know, very high single digits. Again, at a record level.
Qualified pipeline, which is, you know, we look at. We have our own methodology to screen all the opportunities and come down to those that we think are the ones we want to pursue, and that are the most viable and the most likely to come to fruition. The qualified pipeline is up strong, double digits, again, across the board. So I don't know what else to tell you. I don't, you know. If you heard anything that I don't know, let me know.
Luke Sergott (Director of Healthcare Equity Research)
No, that's why I'm in my seat and you're in your seat. Appreciate it.
Ari Bousbib (Chairman and CEO)
Okay.
Luke Sergott (Director of Healthcare Equity Research)
Thank you.
Ari Bousbib (Chairman and CEO)
All right. Thank you.
Operator (participant)
Your next question comes from the line of Elizabeth Anderson from Evercore ISI. Your line is open.
Elizabeth Anderson (Senior Managing Director)
Hi, guys. Thanks so much for the color on the complexity of the demand environment. I had a question about the 4Q bookings. Can you comment on sort of what percentage was FSP? I know you said it obviously, with the revenue shift, it's very incremental over the course of the year, but I would just be curious to sort of level set what you're seeing in the current environment there.
Ari Bousbib (Chairman and CEO)
The question is, how much of our bookings was FSP? I think a little over 20%. Is that correct?
Ron Bruehlman (EVP and CFO)
Yeah
Ari Bousbib (Chairman and CEO)
Guys?
Ron Bruehlman (EVP and CFO)
Low 20s is-
Ari Bousbib (Chairman and CEO)
Yeah
Ron Bruehlman (EVP and CFO)
... was our bookings in the quarter, and that's, consensus-
Ari Bousbib (Chairman and CEO)
For the full year.
Ron Bruehlman (EVP and CFO)
For the full year.
Ari Bousbib (Chairman and CEO)
Yeah.
Ron Bruehlman (EVP and CFO)
For FSP.
Ari Bousbib (Chairman and CEO)
How much I could give you more?
Elizabeth Anderson (Senior Managing Director)
Got it.
Ari Bousbib (Chairman and CEO)
Well, how much was EBP? 25%?
Ron Bruehlman (EVP and CFO)
Yeah. Yeah, the EBP, total EBP is about a quarter of our bookings for the year.
Ari Bousbib (Chairman and CEO)
Right, right. And this FSP is mostly large pharma, right?
Ron Bruehlman (EVP and CFO)
Correct.
Ari Bousbib (Chairman and CEO)
Yeah.
Elizabeth Anderson (Senior Managing Director)
Got it.
Ari Bousbib (Chairman and CEO)
It's almost entirely.
Ron Bruehlman (EVP and CFO)
Yeah.
Ari Bousbib (Chairman and CEO)
Yeah.
Elizabeth Anderson (Senior Managing Director)
Then how would you comment on sort of the rate card as we think about 2024, in terms of both full service work and FSP?
Ari Bousbib (Chairman and CEO)
Uh, yeah.
Ron Bruehlman (EVP and CFO)
You're talking about pricing?
Ari Bousbib (Chairman and CEO)
Yeah, I don't know, rate card.
Elizabeth Anderson (Senior Managing Director)
Yeah.
Ari Bousbib (Chairman and CEO)
You know, the rates, labor, and so on. Yeah, I mean, look, this continues to be pressure from clients and tough negotiations. You know, that's been the biggest surprise for me, at least from over the past several years, and that is that you got a better moat, you got a better company, a better delivery system, better capabilities, and we should be able to actually charge more. But, you know, lo and behold, we've got competitors, and as I said before, you know, clients are clients that we want to continue to have, we have with whom we sell a lot, you know, to whom we sell a lot of stuff, and we have strong relationships.
When the client tells you, "Listen," when a CEO calls you and tells you, "You know, I need you to, you know, to lower the rate here on this because it's going to help me in my cost reduction program," you know, it's hard to say, you know, "Listen, I'm better than a competitor, and I'm..." And the answer is no. So we don't say yes to everything, but, you know, this is part of managing our long-term relationships, and we—I wouldn't hide the fact that we are having, you know, maybe more pressure than we had before, generally on pricing. That's across the board. There's no secret there.
Elizabeth Anderson (Senior Managing Director)
Got it. That's super helpful. Thank you.
Operator (participant)
Your next question comes from the line of David Windley from Jefferies. Your line is open.
David Windley (Managing Director)
Hi, good morning. Thanks for taking my question. A little bit of a follow-up to Elizabeth there. Ari, we spent in December quite a bit of time talking about the kind of decision cycle environment with, I think, principally large pharma. So I joined late, but I've heard you describe that your RFP flows look pretty good, your awards look pretty good. Those things seem to be holding up. But you had described that whether it was IRA or pending loss of exclusivity of important products or whatever, that the clients were, you know, kind of mulling over their prioritizations and processes a lot longer than normal.
I suppose part of that is probably also a little bit of Elizabeth's question around pricing and trying to meet, you know, budget cut targets and things like that. How would you—you know, I'd love for you to elaborate on that environment, and do you feel like you're closer to the end of it, or are we still in the middle of it? You know, when do we think large pharma will be back to business, so to speak?
Ari Bousbib (Chairman and CEO)
Well, again, you know, it's—I want to make sure... I mean, it's not like back to business. It's not like people are on hold, and they're not doing anything again. I mean, look at our backlog continues to grow. The RFP flow is up double digits, you know?
Nick Childs (SVP of Investor Relations and Treasury)
Second highest bookings quarter ever.
Ari Bousbib (Chairman and CEO)
Right. We had the second highest bookings quarter ever, and the first, the one that was the highest, which was last year, I think?
Nick Childs (SVP of Investor Relations and Treasury)
Yeah.
Ari Bousbib (Chairman and CEO)
We had a very big proportion of pass-throughs from a specific large award. That's why it was like over $3 billion.
Nick Childs (SVP of Investor Relations and Treasury)
Right.
Ari Bousbib (Chairman and CEO)
If I recall, in that quarter. So this quarter, we had, what? $2.8 billion. I mean, that and that was like a regular quarter with, with nothing unusual, no, you know, big one-timer award or anything like that. So it's a pretty. You know, the numbers are the numbers. Now, the conversations are more difficult, longer, more negotiations, but the volume, the answer to your question is, think the volume and the number of opportunities, it keeps going up. And again, EBP funding, very strong, all-time high. We saw particular strength on EBP, and we see that continuing, this year. So, you know, not like we're on hold and thinking about when are we back to business?
That's perhaps a question we were asking ourselves on the TAS segment, and that we are in the middle of, and we see some sign or green shoots, as Elizabeth told us before. Or Anne, I think, was the one who used that expression, some green shoots on the commercial side towards the back end of the year. But on the R&DS side, we're experiencing the pressure, the more difficult environment with respect to pricing and negotiations and so on. We are in those conversations, but no one is saying, "I'm on hold, and I'm not doing anything." You know, again, the numbers show it. Numbers of RFPs, the pipeline at an all-time high, the qualified pipeline up strong double digits. And again, across the board, it's not like there's one segment or another.
So I would say quite the opposite. I think the number of opportunities, the environment is very fertile in terms of chasing opportunities and responding to requests for proposals. We are very, very busy.
David Windley (Managing Director)
Okay, so if I could follow up then, to go the next step and ask, perhaps what might be the factors that are influencing the disconnect between a high single digit to double digit RFP award pace with a, you know, a below mid-single digit revenue growth. So I understand part of that is TAS. I'm going to try to head off a little bit at the TAS. Part of that is TAS. I know that, so we'll set that aside, and I know you also attribute some to COVID, but COVID is now small enough that it is like any other big project that you would, you know, see come to a conclusion in any given year and, you know, ramp, transition those people to a new project and ramp that up.
So it would seem that you're to a point where the backlog growth should be translating to R&DS revenue growth, and there's a disconnect there. So to what would you attribute-
Ari Bousbib (Chairman and CEO)
Yeah.
David Windley (Managing Director)
-that?
Ari Bousbib (Chairman and CEO)
Yeah. So again, if you take R&DS, it's not. COVID is not like one, you know, a project like any other. It's not the case. We really have, you know, COVID revenue is very specific. It took specific resources, it's specific projects, and in 2024, you know, it's coming down by $300 million. That represents a direct headwind to growth of 350 basis points to R&DS growth. 350 basis points. In addition, and this is more of a mixed issue, I mentioned in my introductory remarks a number of wins, and we continue to win in the oncology area. We're happy about that because that's the fastest growing therapeutic area, hands down, all around. It has been for a while and will continue to be.
We are winning in oncology. The issue with that therapeutic area is that the burn rate is much lower. It takes time, it's more difficult to recruit patients, it's more complex, and therefore, you know, it translates into revenue slower than anything else, and we have a disproportionate share in that market. Third reason, in the mix we do have, we happen to be, and that's just a consequence. It's hard to explain, but some years we've got tailwinds from pass-throughs, and some years we have headwinds from pass-throughs. As you know, you know, pass-throughs are, I'm not gonna say irrelevant, but, you know, they come with no profit. They come with, it's just an artificial accounting add to our.
But the fact of build up forecast for 2024, higher pass-throughs will be a headwind to R&DS growth, and that represents 100 basis points, approximately, of headwind to top line growth of R&DS, again, inclusive of pass-throughs. So if you add 350 basis points of headwind from COVID, from the step down in COVID, and 100 basis points of headwind from the pass-through mix, that's 450 basis points. So you're right. But, you know, if you add back this, and you normalize, our underlying business is growing high single digits. Very high single digits, so on the R&DS side. So I think that's the reconciliation.
You're right, David, you're, you know, you're a smart analyst, and you point to the apparent disconnect between the strong growth of our bookings and the reported growth in 2024, which again, we hope to be out of that in 2025. And it certainly bodes well. 2025 should be a sweet year. I don't want to make projections for 2025 here. We're barely talking about 2024. But I think, you know, based on everything we're seeing, we should certainly be behind, you know, all of those issues. But thank you, David, and I think that was the last question. Thank you.
David Windley (Managing Director)
Thank you.
Operator (participant)
This ends our question and answer session. Mr. Childs, I turn the call back over to you.
Nick Childs (SVP of Investor Relations and Treasury)
Thank you very much, and thank you everyone for joining us today. We look forward to speaking to you again on our first quarter earnings call in April. The team and I will be available the rest of the day to answer any follow-up questions you have. Thank you, thank you very much.
Operator (participant)
This concludes today's conference call. You may now disconnect.