IQVIA - Earnings Call - Q4 2024

Executive Summary

• Q4 revenue was $3.958B (+2.3% y/y reported; +3.0% cc), adjusted EBITDA $996M (+3.1% y/y), GAAP EPS $2.42 and adjusted EPS $3.12 (+9.9% y/y). TAS outperformed (+9.5% cc), while R&DS declined modestly (-1.0% cc; ex pass-throughs +2.5% y/y).
• R&DS bookings exceeded $2.5B with a 1.20x quarterly book-to-bill; contracted backlog closed at $31.1B (NTM conversion ~$7.9B). Management highlighted elevated cancellations but stable demand indicators; trailing-twelve-month book-to-bill was 1.19x.
• 2025 outlook reaffirmed: revenue $15.725–$16.125B, adjusted EBITDA $3.765–$3.885B, adjusted EPS $11.70–$12.10; assumptions include ~150 bps FX headwind, >$100M COVID step-down (all in R&DS), and 100–150 bps M&A contribution.
• Catalysts: momentum in TAS and AI initiatives (including NVIDIA collaboration), record quarterly FCF of $721M, and a $2B buyback authorization increase (total remaining $3.013B) could support sentiment; near-term watch items include R&DS cancellation volatility and stranded costs from delayed mega-trials.

What Went Well and What Went Wrong

• What Went Well

  • TAS delivered above-target growth; Q4 TAS revenue $1.658B (+9.5% cc). CEO: “TAS revenue was above target and momentum continues to build into 2025.”
  • Robust R&DS demand indicators despite choppy CRO market: Q4 bookings >$2.5B (book-to-bill 1.20x) and backlog $31.1B (+5.5% cc y/y); management renewed all large pharma strategic partnerships.
  • Cash generation: record quarterly FCF $721M; FY24 FCF $2.114B (+41% y/y); net leverage 3.33x LTM adjusted EBITDA.

• What Went Wrong

  • Elevated R&DS cancellations persisted; CEO noted Q4 cancellations were “not far from $1B” (well above normal), pressuring near-term growth/margins due to stranded costs on delayed mega-trials.
  • R&DS revenue declined y/y in Q4 (-1.0% cc; -1.3% reported), reflecting cancellations/COVID step-down and pass-through dynamics; ex pass-throughs grew +2.5%.
  • Pricing pressure across CRO market and ongoing IRA-driven portfolio reprioritization at large pharma remain headwinds; management still anticipates 1–3 more quarters of volatility.

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 2024 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, please press star one again. As a reminder, this conference is being recorded. I would now like to turn the call over to Kerri Joseph, Senior Vice President, Investor Relations and Treasury. Ms. Joseph, you may now begin your conference.

Kerri Joseph (Head of Investor Relations)

Thank you, Operator. Good morning, everyone. Thank you for joining our Fourth Quarter 2024 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 Pironi, Senior Director, Investor Relations. Today, we'll be referencing a presentation that will be visible during this call for those of you on our webcasts. 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 risk 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.

Ari Bousbib (CEO)

Thank you, Kerri, and good morning, everyone. Thank you for joining us today to discuss our Fourth Quarter and full-year 2024 results. Well, great to see many of you in person at our December Investor Day at Innovation Park headquarters. I hope this helps you appreciate the depth and breadth of our offerings as we showcased product demos and toured some of our industry-leading laboratories. In fact, a number of you commented to me afterwards that they left with a deeper understanding of the breadth and depth of our capabilities and how our strategy to improve patient outcomes is being executed.

As we close 2024, we delivered solid full-year results with revenue growth of 5.5% constant currency, excluding the COVID revenue step-down, adjusted net earnings per share growing over 9%, and free cash flow of $2.1 billion, which represents growth of 41% versus last year, as well as 104% of adjusted net income. I'm very proud of the results the IQVIA team was able to deliver in an industry that faced significant challenges in 2024. We saw the consequences of the Inflation Reduction Act, which led to delayed customer decision-making, reduced discretionary spend, and portfolio reprioritizations. Additionally, we had a challenging macro environment that persisted with geopolitical unrest, continued high interest rates and inflation, foreign currency headwinds, and questions about the impact of political elections in the U.S. and around the world, all of which created a tremendous amount of noise and incremental uncertainty.

In fact, very few companies in our broader industry sector achieved positive growth, and IQVIA really stood out as an outperformer. More specifically, in the fourth quarter, you saw that we had strong operational results. Revenue came in above the high end of our guidance range, representing about 4.5% growth, excluding the impact of foreign exchange and COVID-related work. We delivered just under 10% growth in adjusted net earnings per share, and we achieved a record quarter of free cash flow. On the bookings side, net new bookings for the quarter were over $2.5 billion, and this all highlights the great work that was done by our R&DS team in securing new business contracts. This helped mitigate the outsized level of cancellations that did materialize in the quarter, just as we had anticipated. Now, despite the tough macro environment, the R&DS business had some significant achievements in 2024.

We successfully renewed all of our large pharma strategic partnerships this past year, even as many clients reevaluated and consolidated their alliances. In addition, we established new relationships, displaced incumbents, and expanded the scope of work in several partnerships, positively positioning our business for future growth. IQVIA now has partnerships with 22 of the top 25 pharma companies. We made significant advancements in our global health business. For example, we helped the World Health Organization control polio virus outbreaks in Africa. We collaborated with the Coalition for Epidemic Preparedness Innovations, CEPI, in Rwanda, so we were able to respond swiftly to a Marburg virus disease outbreak. Finally, we were selected by a large biotech client to expedite a vaccine trial for mpox in sub-Saharan Africa, addressing a critical outbreak and unmet medical needs.

This all comes to show that whenever there is a crisis, IQVIA is the company public health officials turn to. Now, moving to TAS, the growth trajectory materialized just the way we said it would: low single-digit growth in the first half and gradually ramping up each quarter. In fact, growth exceeded our expectations in the second half. Obviously, this was helped by easier compares versus the second half of 2023, but we also had stronger organic demand than expected across all subsegments, with real-world actually returning to double-digit growth. We finished the year with constant currency growth of 5.7% and about 6.5%, excluding the COVID step-down, which was at the high end of our guidance. We expect to sustain this favorable trend into 2025. Reflecting on 2024, we're proud of what we achieved in TAS.

A couple of business highlights: we introduced 60 innovations this past year, including 39 AI-enabled applications. For example, we introduced IQVIA AI Assistant, our first-ever Gen AI interface, that allows customers to interact with a growing number of our products and get answers to their questions almost instantly. We launched a number of AI-enabled patient offerings, including our Patient Relationship Manager, which has already been deployed at eight clients, including three top-10 pharma. Our digital business, which up to now was largely U.S., has begun expanding into Europe, where we've doubled the number of websites, publishers, and partners that are now integrated into our digital network. Now, looking at 2025, we are reaffirming the guidance we provided to you at the December Investor Days. On the TAS side, things have continued to recover as we anticipated.

On the R&DS side, we still have some volatility, so we might see another quarter or two of fluctuating demand and elevated cancellations, but we think the bulk of the portfolio reprioritizations at large pharma has been completed. In fact, we feel good about the R&DS demand environment because leading indicators continue to be favorable. For example, our Q4 RFP flow was up mid-single digits, a little higher actually in the EBP segment. Our qualified pipeline is also up, with positive growth across all segments. EBP funding, as you noted, was strong through 2024. Full-year biotech funding was over $100 billion, which is 44% higher than it had been in 2023. Now, we did have much higher cancellations in 2024 than ever before. In fact, nearly 50% higher in 2024 than the average of the previous three years.

But our gross new bookings before cancellations for 2024 were even stronger and up mid-single digits at constant currency versus 2023, which led to an end-of-year backlog of $31.1 billion, which is, again, at constant currency, 5.5% higher than a year ago. Now, turning to the results for the quarter, revenue for the fourth quarter grew 2.3% on a reported basis and 3% at constant currency. Compared to last year, and excluding COVID-related work from both periods, we grew the top line about 4.5% on a constant currency basis, and that included in the quarter about two points of contributions from acquisitions, mostly on the TAS side. Fourth quarter adjusted EBITDA increased 3.1%, driven by revenue growth and ongoing cost management discipline, which resulted in 20 basis points of margin expansion. Fourth quarter adjusted diluted EPS of $3.12 increased 9.9% year over year.

Let me now give you some color on business activity. IQVIA's success is achieved by continuing to raise the bar in innovation every year and investing in highly differentiated capabilities. You saw the recent announcement of our collaboration with NVIDIA to transform healthcare and life sciences to advanced agentic AI solutions. AI has the potential to transform our industry, for example, by addressing lengthy and complex processes in clinical trials or, on the commercial side, by helping expedite diagnosis and improve treatment adherence by patients. Our collaboration with NVIDIA will help accelerate the introduction of AI agents within our workflows, with AI agents essentially becoming digital companions to researchers, HCPs, and patients. Let me give you some more examples of what was achieved in the quarter, and let me start with TAS.

The business is rapidly evolving as we see increasing demand for integrated solutions that combine information, analytics, and services. This is enabling us to win much larger, longer-term deals with our clients because of our unique ability to deliver these combined offerings. I'll give you a few examples. IQVIA was awarded a strategic partnership to deliver omnichannel marketing solutions to promote a top-10 pharma client's established portfolio. At IQVIA here, we utilize analytics, information, technology, and commercial outsourcing capability. IQVIA is also partnering with a biotech company to launch a new treatment for ovarian cancer, which will be our client's first product in market. This large deal leverages IQVIA's comprehensive commercial capabilities and expertise to execute regulatory process, launch, and commercial activities.

Another EBP client asked IQVIA to support them in launching a new cell therapy for a severe pediatric condition by providing the full comprehensive commercial infrastructure, and that includes field sales, medical and commercial communications, compliance, and OCE. A large pharma client engaged IQVIA to simplify data management by integrating diverse sources from all over 30 countries, reducing complexity and enhancing efficiency. IQVIA will support the client's information strategy to streamline operations and centralize its global information into a single standardized system that we will be operating. Moving now to real-world, IQVIA is using advanced AI to support a top-10 pharma client to demonstrate efficacy for gastric cancer treatment and gain approval in new markets. A top-10, 15 pharma client chose IQVIA to help track disease and treatment efficacy in support of various regulatory submissions in Europe. Let me move now to R&DS.

I earlier noted the success of our R&DS team and want to highlight some notable wins that represent our capabilities across segments, therapeutic areas, and operational dynamics. Let me start with large pharma. The top five pharma clients selected IQVIA to conduct a complex full-service phase three study addressing asthma and COPD patients. We won another full-service global phase three breast cancer study for a top 30 pharma. Another top-10 pharma client awarded IQVIA a large FSP contract. This award is notable because we displaced two large long-time incumbent CROs. MedTech. IQVIA was awarded a study to evaluate a novel medical device specifically targeting a cardiovascular condition. Biotech. Two notable awards include a critical phase three oncology study based on our strong data-driven approach and ability to manage global complex trials efficiently.

Another global study, full-service study for another biotech client for progressive pulmonary fibrosis disease, which involves nearly 1,000 patients in 26 countries. And again, we are able to win this based on our global footprint and therapeutic expertise. A phase two trial for a rare CNS condition with limited previous research. Lots of success in the marketplace with large pharma, MedTech, and EBP. Now, before passing the call over to Ron for more detailed review of our financial results, I'd like to take a minute to acknowledge and congratulate our employees around the world for their extraordinary work this past year. It was challenging, but we delivered. A great team. We also received amazing recognitions throughout the year. I just want to highlight a few. Frost & Sullivan awarded IQVIA the 2024 Global Customer Value Leadership Award for excellence in AI quality and regulatory solutions in healthcare.

IQVIA's SmartSolve Enterprise QMS was recognized for best use of AI in healthcare by the MedTech Breakthrough Awards. My Green Lab awarded IQVIA Laboratories the 2024 Race to Zero Leadership Award for certifying 100% of our laboratories. We received recognition as a leader in Forbes' world's best healthcare and life sciences management. And lastly, for the eighth year in a row, IQVIA was named one of the world's most admired companies in Fortune's annual survey. And importantly, for the fourth year in a row, IQVIA was named the number one most admired company in our category of Healthcare, Pharmacy, and Other Services.

In addition, IQVIA earned number one ranking in the categories of Innovation, Global Competitiveness, People Management, and Use of Corporate Assets. Now, Ron, we'll give you more details on our financial performance.

Ron Bruehlman (Executive VP and CFO)

Thanks, Ari, and good morning, everyone. Let's start with revenue.

Fourth quarter revenue of $3,958 million grew 2.3% on a reported basis and 3% at constant currency. In the quarter, COVID-related revenues were approximately $10 million, which is down about $50 million versus the fourth quarter of 2023. Excluding all COVID-related work, both from this year and from last, constant currency growth was about 4.5%, and as Ari mentioned, acquisitions contributed approximately two points of this growth. Technology and Analytics Solutions revenue for the fourth quarter was $1,658 million, which was up 8.3% reported and 9.5% at constant currency. R&D Solutions' fourth quarter revenue of $2,123 million was down 1.3% reported and 1% at constant currency, but excluding all COVID-related work, R&DS revenue grew over 1% at constant currency, and finally, Contract Sales and Medical Solutions' fourth quarter revenue of $177 million declined 4.8% reported and 3.2% at constant currency. Now, for the full year, revenue was $15,405 million.

That's up 2.8% reported and 3.4% at constant currency. COVID-related revenue totaled approximately $110 million for the year. Excluding all COVID-related work from this year and last, constant currency growth in revenue was 5.5% for the year. Full-year Technology and Analytics Solutions revenue was $6,160 million. That was up 5.1% reported, 5.7% at constant currency, and 6.5% excluding all COVID-related work at constant currency. Full-year revenue in R&D Solutions was $8,527 million, up 1.6% on a reported basis, 2% at constant currency. Excluding all COVID-related work, growth in constant currency in R&DS was over 5%. And finally, our full-year CSMS revenue was $718 million, down 1.2% reported, but up 1.4% at constant currency. As Ari mentioned in his opening remarks, the 2024 growth trajectory in TAS played out as we anticipated, with improvements every quarter.

We experienced a softening in growth rates throughout 2023 due to cautious customer discretionary spending. We predicted that 2024 would be a turnaround year based on our forward-looking indicators in recent history. In fact, that's what happened. In 2024, TAS growth picked up significantly, finishing the second half with high single-digit growth driven by strong mid-single-digit organic growth. As you know, TAS is a short-cycle part of our business, and as we've seen, 2023 gave us early insight into customer spend behavior during the downturn. By the same token, we expect that the 2024 turnaround in TAS serves as a good leading indicator of the industry's recovery for 2025. To move down the P&L, Adjusted EBITDA in the quarter was $996 million, representing growth of 3.1%. Full year Adjusted EBITDA was $3,684 million. That's up 3.2% year over year.

Fourth quarter GAAP net income was $437 million, and GAAP diluted earnings per share was $2.42. For the full year, GAAP net income was $1,373 million, or $7.49 of earnings per diluted share. Adjusted net income was $564 million for the fourth quarter, and adjusted diluted earnings per share was $3.12. That for the full year brought adjusted net income to $2,042 million and adjusted diluted earnings per share to $11.13. R&DS backlog at December 31 was $31.1 billion, an increase of 4.4% year over year and 5.5% at constant currency. To anticipate the question that I think we'll get about why backlog was flat sequentially versus Q3, recall that the dollar strengthened considerably during the fourth quarter, and we have to retranslate the backlog at the end of each quarter for reporting view, and that knocked about $500 million off the backlog, that retranslation alone.

As of December 31, cash and cash equivalents totaled $1,702 million and gross debt was $13,983 million, resulting in net debt of $12,281 million. Our net leverage ratio ended the year at 3.33 times trailing 12-month adjusted EBITDA. Fourth quarter cash flow from operations was $885 million, and CapEx was $164 million, resulting in free cash flow of $721 million for the quarter, a record for quarterly free cash flow. For the full year, free cash flow was $2,114 million, as Ari said, up 41% year over year. Now, you'll note that in the quarter, we repurchased $1,150 million of our shares, bringing our full year share repurchase to $1,350 million, and just yesterday, actually, the IQVIA Board of Directors replenished the share repurchase authorization by $2 billion, which increases the total remaining authorization to approximately $3 billion. I'll turn to the guidance.

For the full year, we're reaffirming our 2025 outlook, which is for revenue growth at constant currency ex-COVID of 4%-7%, adjusted EBITDA margin expansion of up to 20 basis points, and adjusted diluted earnings per share growth of 5%-9%. This translates into total revenue between $15,725 million and $16,125 million, which includes just over a $100 million step down in COVID-related work, which is entirely in R&DS, and of which 75% will be in the first half and 25% in the second half. We expect 100-150 basis points of contribution from M&A activity and an FX headwind should rates continue of approximately 150 basis points versus 2024. Our adjusted EBITDA guidance is $3,765 million-$3,885 million, and adjusted diluted EPS guidance is $11.70-$12.10.

This includes about $675 million of net interest expense, approximately $575 million of operational D&A, an effective income tax rate of about 18.5%, and an average diluted share count of approximately 178 million shares. The guidance also assumes $2 billion of cash deployment split between acquisitions and share repurchase. And finally, the guidance assumes that foreign currency rates as of February 5 continue for the balance of the year. At the segment level, guidance is also unchanged for TAS, R&DS, and CSMS. No changes in any of the segments. We expect TAS revenue to grow 5-7% at constant currency, which translates into $6.3-$6.5 billion. Note we'll have easier comps in the first half than the second half. R&DS revenue is expected to grow 4-6% at constant currency ex-COVID, which translates into $8.7-$8.9 billion of revenue.

This guidance includes over $100 million of step down in COVID-related revenue that represents about 100 basis points of headwind to R&DS growth rate. We anticipate that R&DS growth rates will be lower in the first half and improve sequentially thereafter. Finally, CSMS revenue is expected to be approximately $700 million and flattish year over year. Now, let's look at first quarter guidance. For the first quarter, we expect revenue to be between $3,740 million and $3,790 million. Note that Q1 has the largest impact in the year for both foreign exchange and COVID revenue step down for a total of approximately 300 basis points of headwind. Adjusted EBITDA is expected to be between $870 million and $890 million in the quarter, and Adjusted Diluted EPS is expected to be between $2.60 and $2.70.

As mentioned, our guidance assumes that foreign currency rates of February 5 continue for the balance of the year. Let's summarize. We delivered an excellent fourth quarter, which closed out a strong year. For the full year, revenue grew 5.5% at constant currency excluding COVID-related work. Adjusted EBITDA margin continued to expand, and Adjusted Diluted EPS was up 9.1%. Free cash flow was a record in the quarter at $721 million, bringing the full year to over $2.1 billion, up 41%. In the quarter, we repurchased $1,150 million of our shares. For the full year, share repurchase was $1,350 million. Our board of directors increased our share repurchase authorization by $2 billion, which brings the remaining authorization to approximately $3 billion. During the year, we introduced 60 innovations, including 39 AI-enabled applications, and the momentum continues to build with our recently announced collaboration with NVIDIA.

IQVIA was named a Fortune's list of world's most admired companies for the eighth consecutive year and earned first place ranking in our industry group for the fourth consecutive year. And lastly, we reaffirmed our full year 2025 revenue growth guidance at constant currency of 4%-7%, adjusted EBITDA margin expansion of up to 20 basis points, and adjusted diluted earnings per share growth of 5%-9%. And that concludes our formal remarks. Let me hand it back over to the operator to open up the call Q&A.

Operator (participant)

Thank you. 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 limit yourself to just one question so that others in the queue may participate as well. We'll pause to compile the Q&A roster.

Our first question comes from Shlomo Rosenbaum from Stifel. Please go ahead. Your line is open.

Shlomo Rosenbaum (Managing Director and Senior Equity Research Analyst)

Hi. Thank you very much. Ari, I wanted to just ask you to dig back in a little bit more on how the operating environment progressed through the quarter and relative to what you were expecting in Q4. We had some discussion about reassessment of vendor relationships kind of ending, or the expectation it would end in the fourth quarter, and some of that reprioritizing work ending. We're still talking about some potential volatility for the next one to two quarters. Is that kind of the way you were expecting it coming into the fourth quarter, or is there any change in how you think about that? And as part of that, maybe you could talk about, is there any change in your expectation in those deferred contracts that you discussed last quarter? Thank you.

Ari Bousbib (CEO)

Okay.

Thank you, Shlomo. Well, no, look, we spoke not that long ago in December in Raleigh, and we shared there our sentiment with respect to the operating environment. Not much has changed versus what we told you then. That is, it was a difficult operating environment for all the reasons we mentioned then, and I reiterated in my introductory remarks the macro environment, consequences of the IRA, a bunch of unexpected large cancellations due to futility reasons we had last year, and then the two large fast-burning trials that we had just started that, for reasons independent of IQVIA, were just delayed, and because of the nature of these projects, they basically pushed back to the back end of 2025. Nothing's changed here. We think the bulk of the cancellations and reprioritizations has occurred.

We said then, I'll repeat now, we're still going to have the ones before of some volatility, and sitting here, I can tell you what it's going to be first quarter or second quarter. In December, we were closer to the end of the quarter, so we had more visibility. Frankly, after one month in a quarter, you can never tell. What are we going to book? What are we going to sell? Which deals are going to come in this quarter or going to be pushed up to the next quarter? Which cancellations may or may not occur this quarter? We have no idea. I'm just always shocked when people are able to predict what their bookings and net bookings will be in a given quarter. I have no idea as I stand here one month into the quarter, especially first month of the year, January, not much happens.

So yeah, I mean, I would say, what is it, two-thirds, maybe 70%-75% of it somewhere there, between two-thirds and 75% of the reprioritization that we know of at large pharma essentially is over. So there may still be a little bit of fluctuation here in the next quarter or two, but I can't tell for certain what may or may not happen. With respect to these two trials that were delayed, which was your second question, nothing changed. They're still on. The clients very much want to do them. It causes us to have to maintain some costs through the year, and that's kind of affecting a little bit our gross margin because we have deferred costs, but that's okay. We'll manage that, and we feel good about that. Those will happen, as we said, no change, in the second half of the year.

Shlomo Rosenbaum (Managing Director and Senior Equity Research Analyst)

Thank you.

Operator (participant)

Our next question comes from Elizabeth Anderson from Evercore ISI. Please go ahead. Your line is open.

Elizabeth Anderson (Senior Managing Director)

Hi, Ari. Hi, Ron. Thanks so much for the question. I was wondering if you could give a little bit more color on two things. I think you've been given some nice pharma color. I was wondering if you could talk a little bit more about the biotech environment, how that's going, how you're sort of seeing RFP flow. Are you seeing any kind of unlocking of some of the funds that were raised last year but not spent? And then also talk a little bit more about what you think the drivers on the real-world evidence acceleration are.

Thank you.

Ari Bousbib (CEO)

Okay. All right.

So look, the biotech funding, which is sort of a leading indicator of what is going to happen in terms of the booking environment for that segment, has been strong. Okay? We consistently use the same stats, and according to those stats, it's over $100 billion for 2024. There's been fluctuation quarter in, quarter out, but that's the number. And that's a huge number. That's a record number ever if you exclude the two years of 2020 and 2021, which were, I think, $130 and $120 respectively. But I mean, last year, what was the number last year, guys? It was like in the $70 million? $70 million? $71 billion last year. Okay. So significant growth in funding. Now, as we said before, just because biotech gets funding today doesn't mean that it translates into a clinical trial award the next day. Okay? It takes time.

It takes six months, it takes a year, but it's a good, strong leading indicator. We saw funding start to pick up already a year ago, and therefore, we're starting to see this. RFP flow, as I said, was up mid-single digit for us across the portfolio, which again, in the current environment, is very, very good. And EBP was higher than that. Okay? Higher than the 5%. And yeah, so that's about the environment. So I think we feel good about the EBP segment, lots of opportunity, and we're chasing all of that.

Operator (participant)

Our next question comes from Ann Hynes from Mizuho. Please go ahead. Your line is open.

Ann Hynes (Managing Director and Senior Equity Research Analyst)

Hi. Good morning. Just on cancellations, I know going into Q4, you thought it would be $1 billion. Did it come into that billion dollars, or was it higher?

And then I know you said that you successfully renewed all your RFP activity. Can you just talk about pricing on those renewals and how that's playing out from a competitive landscape? Thanks.

Ari Bousbib (CEO)

Right. Well, first of all, I never said the word a billion. I said that historically, the average quarterly cancellation is about $500 million a quarter, quarter in, quarter out. I mean, I defy anyone to predict what the cancellations will be in a given quarter, ever. That's a flow. And there were quarters where we had $300 million, where there were quarters where we had $600 million. But on average, that's kind of the number. Okay?

If you take a look at the past, so what I said was, given the amount of work that large pharma is doing and the scrutiny that they are placing on those programs and the increased level of cancellations we saw through the years, I was suggesting that it wouldn't be surprising if the fourth quarter was double that. It basically was that. It wasn't a billion, but it was way above the higher end of what we could have imagined. It was somewhere around that. Not far from a million, but not quite a billion. It was very high. In fact, for the year, and I think that's an interesting, I think I mentioned it in my introductory remarks.

If you look at the average cancellations in a given year, let's take the last three years, for example. It's just somewhere close to a couple of billion, a little bit under $2 billion, right, for the year. Okay? Consistent with what we've experienced. This year, it was almost 50% higher, meaning this year. 2024 was 50% higher than that. And despite that, we grew our backlog, we grew, and that's because we were able, on the gross level, to book even more business than last year, offsetting, more than offsetting, the higher level of cancellations. So on the demand side, things are good. The cancellations were very elevated. Again, no surprises there. It came in essentially as we expected. And I think you—I just don't know what they're going to be next quarter or two, but we are going to navigate that environment.

We feel good that the bulk of that is behind us. You asked about the pricing environment of things, right?

Ann Hynes (Managing Director and Senior Equity Research Analyst)

Yes.

Ari Bousbib (CEO)

So I think, yeah. I mean, yeah. I mean, look, in the current environment, you would expect and anticipate that pricing is going to be more difficult because it's tough competition. There are lots of CROs out there. I mean, people tend to forget there are 4,000 CROs out there. Okay? So they don't all participate in every single bit, but it's not unusual that when EBPs go around and shop their deal around, they talk to a lot of people. And on the large pharma side, as we mentioned, they decided last year to reopen all their partnerships. And thankfully, we won. We re-signed with all these partners and, in fact, expanded our portfolio.

Large pharma wanted to consolidate the spend, and we were on the winning side of that exercise. That was very good, and it bodes well for the future.

Ann Hynes (Managing Director and Senior Equity Research Analyst)

Great. Thanks.

Operator (participant)

Our next question comes from David Windley from Jefferies. Please go ahead. Your line is open.

David Windley (Managing Director)

Hi. Good morning. Thanks for taking my questions and a good segue from the last. Ari, you've talked a fair amount about the push toward FSP. You've talked about pricing pressures. You just kind of highlighted generally, but that pricing pressure also in FSP with these partnership reprocurements. And then you've also talked about carrying costs for these mega trials. I was actually surprised at the investor day that you could expand margin at all.

So my question is, what are the cost levers that you're pulling to be able to eke up your margin just a little bit in the face of all those pressures? And then just more simply, in the navigation on gross margin versus SG&A and EBITDA, are we seeing some of that business mix shift toward FSP and the P&L already, like in the fourth quarter? Thank you.

Ari Bousbib (CEO)

Thank you, Dave. As always, you're right on the mark, and you are highlighting essentially the TAS that we have day in and day out. How do we offset all of those headwinds? Yes, you are absolutely correct. And you express surprise at how we're able to still grow margins. I mean, bear in mind, since the merger at the end of 2016, we've grown our margins. I mean, we ended the quarter with over 25% adjusted EBITDA margins.

In those days, you might recall we were more in the 20% kind of range. So we expanded margins. Now, in the early years, we expanded margins a lot more. Now, obviously, it's harder, but that is what we do here. We try our best to grow our margins and try to grow our profits faster than our revenue. That's our operating mode here. How do we do that? Yes, you're right. The mix can influence the gross margin. I don't think that was the case in Q4. Yeah, I think the gross margin was a little depressed in Q4, but I don't think it is a reflection of the higher FSP mix. The higher FSP mix is in the bookings. It's going to take time. Okay? It's not yet in the P&L, to be precise and answer your question. It's more quarter in, quarter out.

If you look at Q3, for example, of last year, we had gross margin expansion. So it's really the given mix of revenue that you recognize in a quarter, plus obviously the TAS business also influences that. For example, within TAS, I can tell you that real world is a little lower margin than the rest, right? It's lower margin than data, lower margin than analytics, and lower margin than tech. And in the fourth quarter, real world was very strong. Really strong. I mentioned it was back to double digits. And so that, of course, affects the mix. And then I remind you that from the fourth quarter, we had this high level of stranded costs from those two mega trials that also affected our gross margin. But we pulled the usual levers. And you've been covering us for a while. You know what we do.

We constantly evaluate how to optimize the average labor rate across all of our geographies. We constantly explore opportunities to increase our economies of scope, that is, restructure, flatten the organization. We constantly lever IT infrastructure. And for the past year, we've accelerated the deployment of AI tools within our own processes. I mentioned before that the next big thing, certainly operationally within our own workflows, is to leverage AI tools as much as can be. And we start to see some impact of that, and we plan to continue use and deployment of those. And these are the levers that help us mitigate all the cost pressures that you just highlighted. So it's a day in, day out, deep in the trenches, strong operational discipline, and a relentless focus on continuing to optimize our costs.

David Windley (Managing Director)

Good for you for that. Thank you very much. It was very helpful.

Operator (participant)

Our next question comes from Charles Rhyee from TD Cowen. Please go ahead. Your line is open.

Charles Rhyee (Managing Director and Senior Research Analyst)

Yeah. Thanks for taking the question. Ari, I just wanted to go back maybe then to the TAS segment. I think earlier you just mentioned, obviously, real-world evidence had sounded like you said double-digit growth in the quarter. Maybe can you give us a sense for sort of the trends you're seeing across between both RWE analytics and consulting and maybe technology platforms? And give us a sense for within the 25 outlook, how you see those kind of separate parts of it, kind of the outlook for each of those relative as we think about the mix going forward.

Ari Bousbib (CEO)

Yeah. Well, thank you for the question. Yeah. I mean, look, the TAS business should have been and should remain a very resilient business with very consistent type of growth.

So, info, as you know, is a low single-digit. Right? It's about a 1% grower that did not change through the period. That's a very sticky subscription-based repetitive business. The analytics and consulting is where we had seen a dramatic impact of the cautionary spending trends we saw end of 2023 and early 2024 because some of that, a significant part of that, is discretionary spend. And that essentially got shut down. So we had negative quarters in analytics and consulting earlier in the year. And as we evolved through the year, it went back towards these mid-single-digit kind of mark towards the end of the quarter here. And then the higher growth businesses, which had been higher growth, real-world and tech, basically for the full year, essentially went back to high single-digits. And in the quarter, back into double-digits. So that's what we saw.

Now, because we anticipated this, why did this happen? And why were we confident in the recoveries? Because a lot of the work in real-world tech and also some in analytics and consulting are must-do activities for our clients. When our clients get the drug approved, and as you know, in 2023 was a record year, I think we had 55 approvals in 2023. By the way, 2024 was also good. I think it was about 50 approvals. These are very high numbers if you look back historically. These approvals, typically within six to nine months, you've got to launch the project. And that's where we come in. This is where our services play. It's in launching the drug, promoting the drug, commercializing the drug, pricing the drug, etc., etc. Supporting the efficacy demonstrations and safety demonstrations and supporting pricing for the drugs.

All of that is what's included in our analytics business and in our real-world business. And so those needed to be done. And clients delayed that, but eventually, they had to do it. And that's why we saw a strong return of the business in the second half.

Charles Rhyee (Managing Director and Senior Research Analyst)

Great. Thank you. We appreciate it.

Operator (participant)

Our next question comes from Jack Meehan from Nephron Research. Please go ahead. Your line is open.

Jack Meehan (Partner and Senior Equity Research Analyst)

Thank you. And good morning. I had a couple of questions for Ron just on the interim statement. First was the gross margins in the fourth quarter. I was wondering if you could just walk us through the dynamics there. So they were down a little over 100 basis points year over year, but you had lower pass-throughs. So was this the trapped cost related to those two trials, or just any other color would be great?

Ron Bruehlman (Executive VP and CFO)

The first thing I would caution is when you're looking at gross margins, you're looking at reported and not adjusted. So if you're trying to tie the gross margins and SG&A on our income statement back to our Adjusted EBITDA, there's a difference right there because those are reported and not adjusted numbers. But having said that, Ari did already give you some insight into that. We have stranded costs associated with those trials that got delayed. Certain of our businesses that had strong growth, like the real-world business, tend to be lower margin businesses for us. So there's a mixed impact in there certainly. But again, anytime you're looking at the reported numbers, remember that things like restructuring or other adjustments that get added back can affect the percentages that you're calculating straight off the income statement.

Jack Meehan (Partner and Senior Equity Research Analyst)

Got it. Okay. That makes sense.

One for Ari, just on the policy front. We're a couple of weeks into the new administration here. Just any thoughts on the implications for pharma biotech customers? And then, second, one question we get is just any exposure to NIH funding or anything related to that would be great. Thank you.

Ari Bousbib (CEO)

I mean, the short answer to that question is zero. Zero impact, zero NIH, nothing. The longer answer is, I think overall, it's going to be a more business-friendly environment. That's clear. The new administration, apparently, from what we've gathered, is maybe open to address some of the aspects of the IRA, looking into differences between small and large molecules and a number of adjustments. And we are in dialogue at the appropriate levels. There could be some reforms that have been discussed on the PBM side, on the reimbursement side, and so on.

But I mean, again, all of that is net positive for us, frankly. And yeah, I mean, we don't, so I think there's a strong possibility the new administration will embrace life sciences innovation sector more positively relative to other competing economies like China or Europe and support more ongoing investments of U.S.-based research, manufacturing, etc. I think there are a lot of positives here. And I don't see any of the noise around the specific nominations affecting us at all, frankly. I think that that's just basically noise. What we see in our dialogue so far has been actually very constructive and very positive. We're very pleased with the nominations at head of the FDA and head of NIH. All of those are very, very good. We have good relationships. They all support strong evidence-based science, which is exactly the business we're in. The M&A environment would be more favorable.

I think all of that are net positives.

Jack Meehan (Partner and Senior Equity Research Analyst)

That all sounds good. Thank you.

Operator (participant)

Our next question comes from Michael Ryskin from Bank of America. Please go ahead. Your line is open.

Michael Ryskin (Managing Director and Senior Equity Research Analyst)

Great. Thanks for taking the question. Ari, I want to go back to something you touched on earlier. You made some comments in the prepared remarks in terms of pharma reprioritization, sort of working through it, still expect maybe a couple of quarters of some volatility going forward, but thinking you're mostly through it. I think you said something about 70%-75% of the reprioritization is done. Just wondering sort of how you're arriving at that number, just put it bluntly. I mean, we've had some announcements just in the last 24 hours, and it just seems like there's still. You never know.

Companies could come back and decide they're going to do more in a second cut and a third cut and a fourth cut. So just what are the conversations you're having with the pharma companies, especially your top 20, top five?

Ari Bousbib (CEO)

Yeah. I mean, thank you. Thanks for the question. When I said earlier, 2%-70%, maybe 75%, so I saw Kerri put his head in his hands because he told me, "Phil, don't give them a number because someone is going to tell you, 'Well, what is it? 70%-71%, maybe it's 65%, maybe it's 76%.'" So look, we're trying to give you a sense, okay? How do I know? Because we speak to our clients, okay, day in and day out, and we know what they're looking at. So if they're done, they're done. It's not like they're going to go back, okay?

So we know that there are still a few large programs that are kind of where they haven't made a decision. And that's where I say maybe a quarter to a third of those more to go. But that's an estimate. Again, I repeat, I have no idea what will get canceled in the ensuing quarter or what will get booked. I just don't know, okay? I'm basing myself on conversations that we're having with clients at every level. We know what their pipe is. We know what the programs that they have are. We know what they're prioritizing. And they tell us what they are looking at. In fact, in many cases, we help them review these programs and reanalyze them. So that's how we know. But it's all based on these analyses. And that's my best guess for now.

I mean, I would caution you always not to focus on a given quarter, okay? I mean, I see. Someone reports that you've heard me before. I'm going on another tangent here, but when I whine about this obsessive focus on what are the bookings in the quarter, what's the book-to-bill, that infamous number. What is it? And then there are implications for an entire industry from what one company reports. You just can't do that. It's a long cycle business. One quarter is a window. There's been some volatility. There might be some overlapping activity. I just don't know. Also, frankly, you have very little visibility on the sector. I said before, there are 4,000 CROs out there. You have no idea what their numbers are. Actually, our next best, largest competitor is part of a larger company, and they report nothing about this competitor of ours. Nothing.

No revenues, no margins, no bookings, no backlog, certainly no book-to-bill. So we have no idea. You have no idea. We have no idea. There are only four publicly traded CROs. Each and every one of them is extremely different from the others. You cannot derive what we report from what they report, what's going to happen to them. You cannot derive what they report, what's going to happen to us. I saw that before, earlier, in a few past quarters. Just because one of our competitors says something, all of a sudden, our stock goes up or down. It's ridiculous. Everyone is extremely different. You just cannot extrapolate. Plus, frankly, it's causing issues with our customers. Someone was asking me before about customers and pricing. That obsessive quarterly focus on this book-to-bill ratio causes our clients to know that at large pharma. They know that.

So at the end of the quarter, they haggle another $10 million here, another $12 million there. That affects pricing. It affects our bottom line long term, and it's detrimental to investors. So there is somewhat obsessive focus on these quarterly numbers in a long cycle business that are not that great. Plus, again, I remind you, we are a large company. We're not just a CRO. The CRO business is just over half of our business. And to infer any thesis about what's going on in the industry for the quarter or two of cancellations or book-to-bills or what have you is intellectually flawed. I'm sorry if I can share with that. Again, my people here are agitated. But okay, I'll end with that. I'm sorry for the answer.

Michael Ryskin (Managing Director and Senior Equity Research Analyst)

No. That's helpful. I appreciate it. Thank you.

Ari Bousbib (CEO)

Okay. All right. So we have another question, or we're done here?

[crosstalk] We're done. Okay. Fine. Okay, guys. Kerri?

Kerri Joseph (Head of Investor Relations)

Thank you. Thank you, guys. Thanks for taking the time to join us today. And we look forward to speaking with you again on our first quarter of 2025 earnings call. The team will be available the rest of the day to take any follow-up questions you might have. Thank you.