Fresenius Medical Care AG (FMS) 2025 Q2 法說會逐字稿

Ladies and gentlemen, welcome to the report on second-quarter 2025 conference call. I am Sandra, the chorus call operator. (Operator Instructions)

女士們、先生們，歡迎參加2025年第二季報告電話會議。我是桑德拉，合唱團呼叫員。（操作員指示）

The conference must not be recorded for publication or broadcast. At this time, it's my pleasure to hand over to Dr. Dominik Heger. Please go ahead, sir.

會議不得錄製以供出版或廣播。現在，我很高興將發言權交給 Dominik Heger 博士。先生，請繼續。

Thank you, Sandra. I would like to welcome everyone to our earnings call for the second quarter of 2025. As always, I would like to start out the call by mentioning our cautionary language that is in our safe harbor statement as well as in our presentation and in all the materials that we have distributed earlier today.

謝謝你，桑德拉。歡迎大家參加我們 2025 年第二季的財報電話會議。像往常一樣，我想先提及我們在安全港聲明以及我們的簡報和今天早些時候分發的所有資料中的警告性語言。

For further details concerning risks and uncertainties, please refer to these documents and to our SEC filings. We will have 60 minutes for the call to give everyone the chance to ask questions. We would like to limit the number of questions to two. It would be great if we could make this work, as always.

有關風險和不確定性的更多詳細信息，請參閱這些文件和我們的美國證券交易委員會文件。我們將有 60 分鐘的通話時間，讓每個人都有機會提問。我們希望將問題數量限制為兩個。如果我們能夠像往常一樣完成這項工作，那就太好了。

Let me now welcome Helen Giza, CEO and Chair of the Management Board; and Martin Fischer, our Chief Financial Officer.

現在，我歡迎執行長兼管理委員會主席海倫·吉薩 (Helen Giza) 和財務長馬丁·菲舍爾 (Martin Fischer)。

Helen, the floor is yours.

海倫，請你發言。

Thank you, Dominik. I'd also like to welcome everyone to the call. We appreciate you taking the time to join us today and for your continued interest in Fresenius Medical Care. Our second quarter results reflect continued improvement in our operational performance and disciplined execution as we transform and strengthen our company. Building on this momentum, we are well positioned to embark on our next chapter, FME Reignite, which we outlined at our recent Capital Markets Day in June.

謝謝你，多米尼克。我也歡迎大家參加電話會議。我們感謝您今天抽出時間加入我們，並感謝您對費森尤斯醫療保健的持續關注。我們第二季的業績反映出，隨著公司轉型和加強，我們的營運表現和嚴格的執行不斷改善。在此勢頭的基礎上，我們已準備好開啟下一章，FME Reignite，這是我們在 6 月最近的資本市場日上概述的。

Through our clear ambition to lead kidney care through exceptional patient care and innovation, we are ready to unlock our full potential to reignite Fresenius Medical Care and reignite future growth. I will begin my prepared remarks on slide 4.

我們有著明確的目標，即透過卓越的患者護理和創新來引領腎臟護理，我們已準備好充分發揮我們的潛力，重振費森尤斯醫療保健並重新激發未來的成長。我將從幻燈片 4 開始我的準備好的演講。

In the second quarter, we delivered strong organic revenue growth of 7% with positive contributions from all three operating segments. Our FME25+ transformation program continued its momentum, delivering EUR58 million in additional sustainable savings of our targeted EUR180 million for the year. We achieved 13% operating income growth, further driving margin expansion.

第二季度，我們實現了 7% 的強勁有機收入成長，三個營運部門都做出了積極貢獻。我們的 FME25+ 轉型計畫持續保持強勁勢頭，在全年 1.8 億歐元的目標基礎上，額外實現了 5,800 萬歐元的可持續節約。我們實現了13%的營業收入成長，進一步推動了利潤率的擴大。

Our operating cash flow development increased by 75% and our net leverage ratio improved to 2.7 times, which is well within our new target leverage range of 2.5 times to 3 times. The overall phasing of our earnings through the first half of 2025 has developed well in line with our planning, and we continue to expect accelerating earnings development in the second half of the year.

我們的營運現金流成長了 75%，淨槓桿率提高到 2.7 倍，完全符合我們新的目標槓桿率範圍 2.5 倍至 3 倍。到 2025 年上半年，我們的獲利整體進展與計畫一致，我們預計下半年獲利成長將持續加速。

Therefore, we are of course, confirming our full year 2025 outlook. Given the strength of our cash flow profile and our belief that shareholders should meaningfully benefit in the success of our company we announced at our Capital Markets Day that we will initiate a share buyback program of EUR1 billion initially, which will be executed in multiple tranches. We have planned to start with the first tranche already in August.

因此，我們當然確認了我們對 2025 年全年的展望。鑑於我們現金流狀況的強勁以及我們相信股東應該從公司的成功中獲得有意義的利益，我們在資本市場日宣布，我們將啟動一項初步規模為 10 億歐元的股票回購計劃，該計劃將分多次執行。我們已計劃於八月開始發放第一批款項。

Going forward, our new capital allocation framework provides further opportunity for regular share buybacks. This is a key component of our strategy to reignite value creation and with that, shareholder returns. Turning to slide 5.

展望未來，我們新的資本配置框架為定期股票回購提供了進一步的機會。這是我們重新激發價值創造並帶來股東回報的策略的關鍵組成部分。翻到幻燈片 5。

Here I would like to highlight recent developments in each of our now three operating segments, beginning with Care Delivery. In the US, the stable volume development reflects strong and accelerating patient inflow dynamics, which have been unfortunately offset by higher-than-expected patient outflow, due to the very severe flu season earlier in the year.

在這裡，我想重點介紹我們目前三個營運部門的最新發展，首先是護理服務部門。在美國，穩定的診療量發展反映了強勁且加速的患者流入動態，但不幸的是，由於今年早些時候的流感季節非常嚴重，高於預期的患者流出量抵消了這一增長。

I will further unpack the US volume development later in my remarks. Outside the US, international same market treatment growth increased to 1.7%. Second quarter Care Delivery performance benefited from favorable weight and mix development in the US, as well as a positive impact from phosphate binders.

我將在稍後的發言中進一步闡述美國產量的發展。除美國以外，國際同類市場治療成長率增至1.7%。第二季的護理服務業績受惠於美國有利的重量和混合發展，以及磷酸鹽結合劑的正面影響。

Our US clinic network is gearing up for the launch of the 5008X and high-volume HDF, and we will begin to roll out the 5008X to our clinics beginning later in the third quarter and ramping up further from there. On this slide, you will notice that Value-Based Care is highlighted as a separate segment for the first time and is no longer included as part of Care Delivery.

我們的美國診所網路正在為推出 5008X 和大容量 HDF 做準備，我們將從第三季晚些時候開始向我們的診所推出 5008X，然後進一步擴大規模。在這張投影片上，您會注意到基於價值的護理首次被突出顯示為單獨的部分，並且不再包含在護理服務中。

I've announced in June, we have initiated a new reporting segment as part of our ongoing efforts to refine our operating model providing greater visibility into the drivers of this growing business and further enhance our financial reporting transparency. This is important as Value-Based Care has a very different financial profile and market dynamics and Care Delivery.

我已在 6 月宣布，我們已啟動一個新的報告部門，這是我們持續努力改進營運模式的一部分，旨在更清楚地了解這一不斷增長的業務的驅動因素，並進一步提高我們的財務報告透明度。這一點很重要，因為基於價值的護理具有非常不同的財務狀況、市場動態和護理服務。

In the second quarter, value-based care benefited from expanded contracting, leading to an increase in member months. With this positive development, the revenue growth in the first half of the year was at the upper end of our expectations.

第二季度，價值型護理受惠於合約擴大，導致會員月數增加。鑑於這一積極發展，上半年的收入成長達到了我們預期的上限。

Turning to Care Enablement. Care Enablement delivered another strong quarter, supported by volume and price increases. As every year, the volume growth is less strong in the second quarter, which is normal phasing.

轉向護理支援。在銷售量和價格上漲的推動下，Care Enablement 再創佳績，本季業績表現強勁。與往年一樣，第二季的銷售成長不那麼強勁，這是正常現象。

We expect to -- we continue to capture sustainable savings as part of FME25+, driven by disciplined execution of the next level of footprint optimization across both manufacturing and supply chain. As a result, our Care Enablement margin further progressed within the 2025 target band to 8.7%. Care enablement is also well on track for the 5008X launch in the US following the additional FDA approval of release 2.0 in May.

我們期望——作為 FME25+ 的一部分，我們將繼續實現可持續的節約，並透過在製造和供應鏈中嚴格執行下一級的足跡優化來推動。因此，我們的護理支持利潤率在 2025 年目標範圍內進一步提高至 8.7%。繼 5 月 FDA 批准 2.0 版本後，5008X 在美國的推出也進展順利。

Turning to slide 6. If you were able to follow our Capital Markets Day, you will remember that Dr. Frank Maddux outlined the dynamics of volume growth and how both patient inflows and outflows play an equal role in shaping overall patient flow.

翻到幻燈片 6。如果您能夠關注我們的資本市場日，您會記得弗蘭克·馬杜克斯博士概述了數量增長的動態以及患者流入和流出如何在塑造整體患者流量方面發揮同等作用。

This framework is helpful to understand the components of recent volume development in the US, and underscores why we are encouraged about future growth. In the second quarter, patient inflow accelerated a bit more than expected compared to the prior year supported by a higher number of patient referrals and new patient starts.

該框架有助於理解美國近期銷售發展的組成部分，並強調了我們為何對未來成長充滿信心。第二季度，由於患者轉診數量和新患者就診數量增加，患者流入量與前一年相比略有加快，超出預期。

This is an important trend as it signals strength in the underlying volume recovery and also reflects ongoing operational improvements in our own inflow management process. This positive development in patient inflow, however, was offset by higher-than-expected patient outflow.

這是一個重要的趨勢，因為它標誌著基礎交易量復甦的強勁勢頭，也反映了我們自身流入管理流程的持續營運改善。然而，患者流入量的正面發展被高於預期的患者流出量所抵消。

The severe flu season in the first months of the year in the US resulted in significantly increased mortality compared to the already elevated level of the prior year as well as a greater number of missed treatments. The impact of higher mortality early in the year carried forward dampening volume growth in subsequent quarters as well. This clearly impacts our assumption of plus 0.5% plus same market treatment growth in the US in 2025. We now just carefully assume flat to slightly positive, same market seating for 2025.

美國今年頭幾個月的嚴重流感季節導致死亡率與前一年已經很高的水平相比大幅上升，漏診人數也增多。年初死亡率較高的影響延續至今，也抑制了隨後幾季的銷售成長。這顯然影響了我們對 2025 年美國市場治療成長率加上 0.5% 的假設。我們現在只是謹慎地假設 2025 年的市場座位數將持平或略微上升。

I will now hand over to Martin to take you through the second quarter financial performance in more detail.

現在我將讓馬丁向大家更詳細地介紹第二季的財務表現。

Thank you, Helen, and welcome to everyone on the call also from my side. I will pick up on slide 8. In the second quarter, we achieved organic revenue growth of 7%, with all three segments contributing to this strong performance. Revenue increased by 5% at constant currency. The impact from divestitures executed as part of our portfolio optimization negatively impacted revenue development by 110 basis points.

謝謝你，海倫，我也代表我歡迎電話會議中的各位嘉賓。我將從第 8 張投影片開始講起。第二季度，我們實現了 7% 的有機收入成長，三個部門都為這一強勁業績做出了貢獻。以固定匯率計算，營收成長了 5%。作為我們投資組合優化的一部分而執行的資產剝離對收入發展產生了 110 個基點的負面影響。

As a reminder, we decided to absorb the revenue and operating income effects from divestitures executed in 2024 and 2025 in our guidance range. Operating income, excluding special items, increased by 13% on a constant currency basis, primarily driven by growth in Care Enablement. As a result, we realized further margin expansion to 9.9%.

提醒一下，我們決定將 2024 年和 2025 年執行的資產剝離帶來的收入和營業收入影響納入我們的指導範圍。不包括特殊項目的營業收入以固定匯率計算成長了 13%，主要得益於護理支援業務的成長。結果，我們的利潤率進一步擴大至9.9%。

Divestitures had a neutral effect on operating income margin development. Special items negatively affected group operating income by EUR51 million. This mainly includes costs relating to FME25+ and our continued portfolio optimization, offset by positive effects from the remeasurement of our investment in Humacyte.

資產剝離對營業利潤率的發展並沒有產生中性影響。特殊項目對集團營業收入產生了5,100萬歐元的負面影響。這主要包括與 FME25+ 和我們持續的投資組合優化相關的成本，但被我們對 Humacyte 的投資重新計量所帶來的正面影響所抵消。

Next on slide 9. This slide outlines the year-over-year margin development for the second quarter. At the group level, we realized a margin increase of 80 basis points. This increase was driven by positive contributions from both Care Enablement and Care Delivery, with particularly strong results from Care Enablement and was partially offset by a slightly negative impact from value-based care.

接下來是第 9 張投影片。這張投影片概述了第二季同比利潤率的發展。在集團層面，我們實現了利潤率成長80個基點。這一增長是由護理支援和護理服務方面的積極貢獻推動的，其中護理支援的效果尤為強勁，但被基於價值的護理的輕微負面影響部分抵消。

Net corporate costs increased by EUR14 million from the prior year, including a positive EUR9 million contribution from virtual power purchase agreements. In addition, foreign exchange range development unfavorably with a negative EUR16 million impact. The average US dollar exchange rate in quarter two was EUR1.13 compared to EUR1.05 in the first quarter. Let us now have a closer look of the drivers of each segment starting with Care Delivery on slide 10.

公司淨成本較前一年增加 1,400 萬歐元，其中包括虛擬購電協議貢獻的 900 萬歐元。此外，外匯範圍發展不利，造成1,600萬歐元的負面影響。第二季美元平均匯率為1.13歐元，而第一季為1.05歐元。現在讓我們仔細看看每個部分的驅動因素，從幻燈片 10 上的「護理服務」開始。

Care Delivery showed strong organic revenue growth of 3.6%, supported by both Care Delivery US and international. In the US, organic growth of 3.4% was driven by favorable rates and payer mix development, which offset the volume impact from a severe flu season in the first month of the year.

在 Care Delivery 美國和國際業務的推動下，Care Delivery 的有機收入強勁成長 3.6%。在美國，3.4% 的有機成長得益於優惠的利率和付款人組合的發展，抵消了今年第一個月嚴重流感季節對銷售的影響。

Internationally, we realized robust organic growth of 4.5%, driven by 1.7% same-market treatment growth and continued rate increases. The execution of our portfolio optimization negatively impacted revenue development by 190 basis points.

在國際上，我們實現了 4.5% 的強勁有機成長，這得益於 1.7% 的同市場治療成長和持續的費率上漲。我們的投資組合優化的執行對收入發展產生了 190 個基點的負面影響。

Operating income further improved, and the margin expanded to 11.2%. On the earnings side, business growth in the quarter was supported by positive rate and mix effects, as well as contributions from phosphate binders. Further sustainable savings from FME25+ helped compensate higher inflation costs and higher labor costs.

營業收入進一步改善，利潤率擴大至11.2%。在獲利方面，本季的業務成長受到積極利率和組合效應以及磷酸鹽結合劑貢獻的支持。FME25+ 帶來的進一步永續節省有助於補償更高的通貨膨脹成本和更高的勞動成本。

The labor costs were impacted by increasing medical benefit expenses for our US employees. The increase in medical benefit expenses is partially attributable to higher insurance utilization observed across the industry, and partially due to the timing of offsetting initiatives. Consistent with broader industry trends, we expect these costs to moderate in the second half of the year. The unfavorable translation exchange rate development also had a sizable negative impact.

勞動成本受到美國員工醫療福利費用增加的影響。醫療福利費用的增加部分歸因於整個產業的保險利用率提高，部分歸因於抵銷措施的時機。與更廣泛的行業趨勢一致，我們預計這些成本將在今年下半年下降。不利的匯率變化也產生了相當大的負面影響。

Slide 11 will provide an overview of the development in our newly reported segment Value-Based Care. Value-Based Care realized continued strong organic revenue growth with 28% in the quarter. This was mainly driven by significant higher volumes in the form of a higher number of member months mainly due to contract expansion early in the year.

投影片 11 將概述我們新報告的基於價值的護理部分的發展。本季度，價值型護理業務持續實現強勁的有機收入成長，增幅達 28%。這主要是由於年初合約擴大，導致會員月數增加，從而導致交易量大幅增加。

On the earnings side, operating income declined to a loss of EUR9 million due to an unfavorable savings rate and inflation, offsetting positive effects from increased member month. While revenue growth of this operating segment is ahead of expectations, we continue to assume a slightly negative to breakeven earnings development for the year. I will conclude the detailed segment review with Care Enablement on slide 12.

在收益方面，由於儲蓄率和通貨膨脹不利，營業收入下降至虧損 900 萬歐元，抵消了會員月增加的正面影響。儘管該營運部門的營收成長超出預期，但我們仍認為今年的獲利發展將略微為負值至損益兩平。我將在第 12 張投影片上結束對護理支援部分的詳細回顧。

In the second quarter, Care Enablement continued to show strong revenue growth of 3%, supported by 3% organic growth. Revenue development was driven by volume increases for our products overall and continued positive pricing momentum despite volume-based procurement in China.

第二季度，Care Enablement 繼續呈現 3% 的強勁收入成長，這得益於 3% 的有機成長。收入成長主要得益於我們產品整體銷售的成長，儘管在中國進行的是批量採購，但定價動能依然保持積極。

Care Enablement showed a significant 79% increase in operating income, leading to a margin increase of 380 basis points. With 8.7%, the operating segment is further advancing into its 2025 target margin band. Earnings growth reflected strong business growth supported by volume growth and pricing as well as savings from FME25+. These positive effects more than offset the anticipated inflationary pressures and the unfavorable impact from foreign exchange translation.

Care Enablement 的營業收入大幅成長 79%，利潤率因此增加 380 個基點。該營運部門的利潤率達到 8.7%，進一步邁向其 2025 年的目標利潤率區間。獲利成長反映了強勁的業務成長，這得益於銷售成長和定價以及 FME25+ 帶來的節省。這些正面影響足以抵銷預期的通膨壓力和外匯折算的不利影響。

Moving on to slide 13. In the second quarter, we realized a 75% increase in operating cash flow, mainly driven by favorable working capital development. This reflects the recovery against prior year headwinds from the cyber incident at Change Healthcare and the phasing of federal income tax payments in the United States.

轉到投影片 13。第二季度，我們的營運現金流成長了 75%，這主要得益於良好的營運資本發展。這反映了公司克服了去年 Change Healthcare 網路事件和美國聯邦所得稅分階段繳納帶來的不利影響而實現的復甦。

The strong cash flow additionally absorbed and expected seasonality in invoicing compared to last year. Consistent with our strict financial discipline, we further reduced both our total debt and lease liabilities, and our total net debt and lease liabilities compared to the first half of last year.

與去年相比，強勁的現金流進一步吸收了預期的發票季節性。按照我們嚴格的財務紀律，與去年上半年相比，我們進一步減少了總債務和租賃負債以及總淨債務和租賃負債。

As a reminder, at our Capital Markets Day, we announced our decision to lower our self-imposed target range for our net financial leverage as part of our new capital allocation framework. We are now targeting a net financial leverage ratio of 2.5 to 3 times net debt to EBITDA.

提醒一下，在我們的資本市場日，我們宣布決定降低我們自己設定的淨財務槓桿目標範圍，作為我們新資本配置框架的一部分。我們現在的目標是淨財務槓桿率為淨債務與 EBITDA 的 2.5 至 3 倍。

In the second quarter, our net leverage ratio further improved to 2.7 times, well within this new lower range. More recently, in July, we redeemed the EUR500 million bond that had matured. As Helen mentioned, our commitment is to return excess cash to shareholders as part of our new capital allocation framework. We are planning to initiate the first tranche of our announced share buyback already this month.

第二季度，我們的淨槓桿率進一步改善至2.7倍，遠低於這新的較低水準。最近，在7月份，我們贖回了到期的5億歐元債券。正如海倫所提到的，作為我們新資本配置框架的一部分，我們的承諾是將多餘的現金回饋給股東。我們計劃本月啟動已宣布的股票回購的首批計劃。

I will now hand back to Helen to review our outlook.

現在我將交還海倫來審查我們的展望。

Thank you, Martin. I will finish my prepared remarks on slide 15. Given our performance through the first half of the year and our expectations for growth acceleration in the second half of 2025, we are confirming our full year outlook. With the strong growth in Value-Based Care in the first half of the year, which is driven by the contracted risk types, we expect to be at the upper end of our positive to low single-digit percent revenue growth range. This revenue growth in Value-Based Care is not impacting the operating income growth.

謝謝你，馬丁。我將在第 15 張投影片上結束我準備好的演講。鑑於我們今年上半年的業績以及對 2025 年下半年成長加速的預期，我們確認了全年展望。由於上半年價值型醫療業務的強勁成長（這得益於合約風險類型的推動），我們預計營收成長將達到正值至低個位數百分比範圍的上限。價值型護理的收入成長不會影響營業收入的成長。

Therefore, we continue to expect to grow operating income by a high-teens to high-20s percent rate compared to prior year. We are also confirming our operating income guidance range -- this also includes the upper end of our guidance range, which also tells you that we continue to consider this to be a viable outcome for earnings growth. With the planned margin improvements by all three operating segments, including benefits from revenue cycle management, we are fully on track to accelerate our earnings growth in the second half of the year.

因此，我們預期營業收入與上年相比仍將成長百分之十幾至二十幾個百分點。我們也確認了我們的營業收入指導範圍——這也包括我們指導範圍的上限，這也告訴您，我們繼續認為這是獲利成長的可行結果。隨著三個營運部門計畫的利潤率提高，包括收入周期管理的好處，我們完全有望在下半年加速獲利成長。

With that, I will now hand back to Dominik to start the Q&A.

現在，我將把話題交還給 Dominik，開始問答環節。

Thank you, Helen. Thank you, Martin. Before I hand over for the Q&A, I would like to remind everyone to limit your questions to two. If we have remaining time, we can go another round to have a new flavor of the same question, maybe. And with that, I hand it back to Sandra to open the Q&A.

謝謝你，海倫。謝謝你，馬丁。在進行問答之前，我想提醒大家將問題限制為兩個。如果我們還有剩餘時間，也許我們可以再進行一輪，以新的視角看待同一個問題。說完，我把麥克風交還給桑德拉，讓她開始問答環節。

Sandra, please.

請叫我桑德拉。

Thank you. (Operator Instructions)

謝謝。（操作員指示）

Hugo, BNP.

雨果，英國國家黨。

Hi guys, thanks for taking my questions. I have two, please. Maybe in terms of US volume growth, and if we think about 2026, you obviously have a low base in H1, or are you confident to grow volumes in 2026 in the US? That would be my first question.

大家好，感謝你們回答我的問題。請給我兩份。也許就美國銷售成長而言，如果我們考慮 2026 年，您顯然在上半年的基數較低，或者您是否有信心在 2026 年實現美國銷量成長？這是我的第一個問題。

And second on Care Enablement, you have very strong margin expansion, 250 basis points in Q1, close to 400 basis points in Q2. How should we think about the back of the year and the level of comfort to hit probably the high end of the 2025 margin band here?

其次，在護理支援方面，利潤率成長非常強勁，第一季成長了 250 個基點，第二季接近 400 個基點。我們該如何看待今年的後市以及達到 2025 年利潤區間高端的舒適度？

Thank you.

謝謝。

Hi, Hugo, I'll take both of those. With regards to US volume growth, obviously, what we are seeing right now is this continued elevated mortality. And that's why as we've kind of concluded the first half flat, we are calling the back half flat to slightly positive. So I know it's lower small numbers at this point, but that does assume that the growth continues.

嗨，Hugo，我要這兩個。就美國的人口成長而言，顯然，我們現在看到的是死亡率持續上升。這就是為什麼我們得出上半年持平的結論，並稱下半年持平或略有上漲。所以我知道目前這個數字較低，但這確實假設成長仍在繼續。

We are really encouraged by the referrals and the inflows, and we have seen improving trends there for five months in a row now. So that is really encouraging on the front-end funnel. And that comes back to what we've always said that once mortality normalizes, we see the inflows returning, the underlying fundamentals of this business, there's no reason to suggest that that 2% plus is unchanged.

我們確實受到了推薦和流入的鼓舞，而且我們已經連續五個月看到改善趨勢。因此，這對於前端漏斗來說確實令人鼓舞。這又回到了我們一直說的，一旦死亡率恢復正常，我們就會看到資金流入回升，這個行業的基本面，沒有理由認為 2% 以上的成長率不會改變。

So yes, we will expect to see growth going into 2026. And obviously, as we look at the development over the next few quarters, the rate of that slope will be determined in time. So I think that follows the consistent messaging we've been giving there.

所以是的，我們預計到 2026 年將會成長。顯然，當我們觀察未來幾季的發展時，斜率的速率將會及時確定。所以我認為這符合我們一直傳達的訊息。

With Care Enablement, we're really, really pleased and encouraged with what we are seeing there. And as you rightly point out, nice progression in the margin band we -- clearly, we still have the margin band out there for Care Enablement of [H12], and we haven't changed that, but we do see H2 stronger than H1. And then we usually see the back end of the year stronger for Care Enablement, particularly in Q4 because of the sales volume. So it is a little bit seasonal, but the band overall, we're still confirming and really, really pleased with the progress that the Care Enablement is making.

有了 Care Enablement，我們對所看到的情況感到非常非常高興和鼓舞。正如您正確指出的那樣，我們的利潤區間取得了良好的進展——顯然，我們仍然擁有 [H12] 的護理支持利潤區間，而且我們也沒有改變這一點，但我們確實看到 H2 比 H1 更強。然後，我們通常會看到 Care Enablement 在年底表現更強勁，尤其是在第四季度，因為銷售量較大。所以它有點季節性，但對於樂團整體而言，我們仍然確認並且對 Care Enablement 所取得的進展感到非常非常高興。

Veronica, Citibank.

花旗銀行的維羅妮卡。

Hi guys, good afternoon, hopefully you can hear me okay. Thank you for taking my questions. I will also keep it to two, if I can. The first one is just on the patient inflow dynamics, Helen, that you alluded to. Can you maybe talk to sort of how you're thinking about that in terms of the market getting better versus some of the processes that you have in the business?

大家好，下午好，希望你們能聽到我說話。感謝您回答我的問題。如果可以的話，我也會將其保持在兩個。第一個問題是關於患者流入動態，海倫，正如你所提到的。您能否談談，從市場變好的角度以及您在業務中遇到的一些流程的角度，您是如何看待這個問題的？

And I don't know if you can quantify it and also quantify maybe the mortality that you saw in the quarter just to help us with the math as we think about how things accelerate. And then I'm sorry to be on the -- to stay on the same topic, but obviously, you do have that guidance for 2% plus starting next year. So just curious how you're thinking about the ability to get into that 2% plus already in 2026. So given the dynamics that we're seeing at the moment, is that more a 2027 question. Sorry to stick to the same market, but -- those are the two most important things.

我不知道您是否可以量化它，也可以量化您在本季度看到的死亡率，只是為了幫助我們在思考事情如何加速時進行計算。然後，很抱歉，我還是繼續討論同一個主題，但顯然，從明年開始，你確實有 2% 以上的指導。所以我很好奇您是如何看待在 2026 年已經達到 2% 以上的目標的。因此，考慮到我們目前看到的動態，這是否更像是 2027 年的問題。很抱歉堅持同一個市場，但──這是最重要的兩件事。

Thank you.

謝謝。

Thanks, Veronica. We'll see how many times we get asked, a different flavor of that question, but we recognize how important it is and first the share what we are seeing in real time. Look, I think on the patient inflows, as I've mentioned, they are encouraging and positive, and it's the best [too] we've seen in years. But not just the fact that this quarter is strong, but as I mentioned, five months in a row of improving patient inflows and new patient starts, I think it's a bit of both.

謝謝，維羅妮卡。我們會看看有多少次我們被問到這個問題，這個問題有不同的意義，但我們認識到它的重要性，首先分享我們即時看到的內容。看，我認為就患者流入而言，正如我所提到的，他們是令人鼓舞和積極的，這也是我們多年來見過的最好的。但不僅僅是因為本季表現強勁，而且正如我所提到的，連續五個月患者流入量和新患者開始量都在改善，我認為兩者兼而有之。

And I think we're obviously without data trying to tease that out, we're doing a lot of things all at the same time, but we are definitely seeing new referrals coming in. But of course, it is helped by our improved processes to get those patients in and scheduled into treatment. So I think it's a bit of both. And I can't tease out how much is one or the other at the moment other than the inflows are positive.

我認為我們顯然沒有數據來試圖弄清楚這一點，我們同時做了很多事情，但我們確實看到了新的推薦。當然，我們改進的流程有助於讓這些患者入院並安排治療。所以我認為兩者都有。目前，除了流入量為正之外，我無法判斷其中一個或另一個的數量是多少。

I think we -- on your second part of that question on the 2%, we've definitely said that that 2% plus is based on normalized mortality. It is still somewhat elevated coming out of this flu season, and with the positive inflow that helped. So I think if we had normalized mortality and the same trend of inflow that we've been seeing, that 2% obviously is unchanged. And I think as we said, it's that kind of the weight of the slope as we go through 2026 will be key. But we're kind of encouraged by what we're seeing in this last quarter.

我認為，關於您問題的第二部分 2%，我們明確表示，2% 以上是基於正常死亡率。在流感季節過後，該數字仍然略有上升，這得益於積極的流入。因此我認為，如果我們將死亡率和流入趨勢標準化，那麼 2% 顯然不會改變。我認為，正如我們所說的，當我們經歷 2026 年時，這種斜率的重量將是關鍵。但上個季度的業績讓我們感到鼓舞。

Hassan, Barclays.

哈桑，巴克萊銀行。

Good afternoon. Thank you for taking my questions. A couple from me. Firstly, on the margins, you continue to expect an accelerating earnings development in the second half. And I wonder if the persistent weaker volume dynamics and lowered expectations here has an impact on your H2 expectations and where you expect to land in the range?

午安.感謝您回答我的問題。這是我的一些。首先，從利潤率來看，我們繼續預期下半年獲利成長將加速。我想知道持續較弱的交易量動態和降低的預期是否會對您對下半年的預期產生影響，以及您預期的預期範圍是多少？

And then secondly, on VBC, your guidance assumes EUR100 million of incremental revenue year over year, yet you've banked EUR200 million already in the first half. So if you could talk about the strength here and how we should think about the evolution in the second half, as well as any dilution at the margin level.

其次，關於 VBC，您的指導假設是收入年增 1 億歐元，但您在上半年已經賺了 2 億歐元。因此，如果您可以談談這裡的優勢以及我們應該如何看待下半年的發展，以及利潤率水平的任何稀釋。

Thank you.

謝謝。

Thanks, Hassan. Why don't I tackle the half two trend and then, Martin, maybe you can take the VBC trend. So yes, Hassan, clearly, the softer volume for half two does have an impact. However, we've always said that it's the volume number alone with small numbers, it's quite small. So it was never going to make or break the year.

謝謝，哈桑。為什麼我不先解決一半的趨勢，然後，馬丁，也許你可以採取 VBC 趨勢。是的，哈桑，顯然，第二半的音量較小確實有影響。但是我們一直說這只是數量問題，數量很少，相當小。所以它永遠不會決定這一年的成敗。

We just recognize the underlying metric is obviously important for future growth. So it doesn't have that significant or big impact at all in the back half. What we know is half two is always stronger than half one. And you always -- you've seen this historically, as you've followed us and Q4 is always stronger than Q3, but half two, always stronger. So clearly, we have that built in.

我們只是認識到底層指標對於未來成長顯然很重要。因此，它對後半部根本不會產生那麼顯著或巨大的影響。我們知道二分之一總是比一分之一強。而且您總是——您從歷史上就看到了這一點，正如您關注我們一樣，第四季度總是比第三季度強勁，但第二季度的一半總是強勁。顯然，我們已經將其內建了。

And then in the back half for H2 development, we will see continued benefits from rate and mix. The work that we are doing on web cycle improvement, as we already touched on the [talk hotline] will also hit in. And then we're really pleased with the momentum we're seeing on FME25. And of course, all the work that we are doing, continuing operational improvements, will continue to have that momentum. So it is a little bit of seasonal and also the ramping up of the work that's underway and the programs and initiatives that we are already executing on.

然後在 H2 開發的後半段，我們將看到利率和組合帶來的持續收益。正如我們在[熱線討論]中提到的那樣，我們正在進行的關於網路週期改進的工作也將受到影響。我們對 FME25 的發展勢頭感到非常滿意。當然，我們正在做的所有工作，持續的營運改進，都將繼續保持這種勢頭。因此，這有點季節性，也是正在進行的工作以及我們已經在執行的計劃和舉措的加強。

Martin?

馬丁？

Yeah. Hassan, I'm more than happy to take the VBC one. We are very pleased with what we saw in the first half. Also, we have expanded contracting activities in the meantime, have about 148,000 patients under programs. And we will expect more than EUR1.9 billion [revenue] point in the full year when we look at it.

是的。哈桑，我非常樂意參加 VBC 考試。我們對上半場的表現非常滿意。此外，我們同時擴大了承包活動，約有 148,000 名患者參與了我們的計畫。我們預計全年收入將超過 19 億歐元。

When it comes to the operating margin, we always said that it is slightly negative to neutral. And as we also said, there's a certain dynamic when it comes to gross revenue recognition. And we expect that we still are within that operating margin corridor. So there is a limited conversion that comes from the additional volume to our operating income.

當談到營業利潤率時，我們總是說它略微處於負值到中性水平。正如我們所說，在總收入確認方面存在一定的動態。我們預期我們仍處於該營業利潤率區間內。因此，額外銷售量對我們的營業收入的轉換是有限的。

Oliver Metzger, ODDO.

奧利弗·梅茨格，ODDO。

Yeah, thanks a lot for taking my questions. The first one is also that beneath mortality, you talked also about the missed treatments due to flu season. So is this an area where you already see a return to the normal baseline or at an elevated level?

是的，非常感謝您回答我的問題。第一個問題是，除了死亡率之外，您還談到了由於流感季節而錯過的治療。那麼，您是否已經看到該區域恢復到正常基準或處於較高水平？

The second one is in addition to Hassan's question on Value-Based Care. As now a separate business unit, we have got, thanks to Dominik's team some historic data, but eventually not enough to identify some patterns. So can you give us an indication of when you see some more of this typical pay days? And also vis a vis should think rather in years and quarters about the progress on the bottom line.

第二個問題是對哈桑關於基於價值的護理問題的補充。作為一個獨立的業務部門，我們在 Dominik 團隊的幫助下獲得了一些歷史數據，但最終不足以識別一些模式。那麼，您能否告訴我們您何時會看到更多這種典型的發薪日？而且，我們應該以年和季度為單位來考慮底線的進展。

Yeah. Thanks, Oliver. I think I'll snag those questions. So mortality -- the flu effect obviously impacted mortality and missed treatment. So it's kind of a double effect on outflows, if you will.

是的。謝謝，奧利佛。我想我會回答這些問題。因此死亡率—流感效應顯然影響了死亡率和錯過治療。因此，如果你願意的話，這對資金流出來說是一種雙重影響。

That is still elevated over last year. And as we were kind of quantifying that the flu effect through half one, it is around that 40 to 60 basis points still of elevation over what is already a higher mortality from last year. So I think that it's fair to say that there's still that elevation. And I think as we come into quarter three, seeing how that develops kind of bringing down the mortality level.

這比去年同期仍有所上升。當我們量化流感對上半年的影響時，我們發現，與去年較高的死亡率相比，流感死亡率仍高出 40 到 60 個基點。所以我認為可以公平地說，仍然存在這種高度。我認為，隨著我們進入第三季度，我們會看到死亡率如何下降。

Obviously, the work that we are doing ourselves on this treatment that are in our control, we're tackling as well with the operational improvement. So they are elevated, and we continue to work on those to improve that post-pandemic and post-flu season.

顯然，我們在這種治療上所做的工作是在我們的控制範圍內的，我們也在透過操作改進來應對。因此，這些指標有所提升，我們將繼續努力，以改善疫情後和流感後的狀況。

Martin gave you a nice outline on how we're thinking about Value-Based Care and numbers. Of course, it is a new segment. We are getting under what the right KPIs are. And I think you can expect us to continue to give more transparency on the -- from the KPIs as we move forward. Martin talked about the number of lives that we're covering, but we're also talking about membership and membership months because I think that's an important metric for us to continue to track as well in terms of how many months of members we are covering.

馬丁向您詳細介紹了我們如何看待基於價值的護理和數字。當然，這是一個新的領域。我們正在了解正確的 KPI 是什麼。我認為，隨著我們不斷前進，您可以期待我們繼續在 KPI 方面提供更多的透明度。馬丁談到了我們所涵蓋的生命數量，但我們也在談論會員人數和會員月份，因為我認為這對於我們繼續追蹤我們涵蓋的會員月份數也是一個重要指標。

So I think more to come, Oliver, as we kind of get more mature in our reporting here, as you can appreciate pulling it all out and having the historical data was a good step in the right direction. So for this year, you can see member months and memberships. And obviously, that varies too. And I think as we continue to progress with this segment, we'll figure out if there's more metrics to provide next year.

因此，奧利佛，我認為隨著我們的報道越來越成熟，我們還會有更多的報道，正如你所理解的，把所有信息都提取出來，並擁有歷史數據是朝著正確方向邁出的良好一步。因此，今年您可以看到會員月份和會員資格。顯然，情況也各有不同。我認為，隨著我們在這一領域的不斷進步，我們將弄清楚明年是否會提供更多的指標。

Richard, Goldman Sachs.

理查德，高盛。

Thank you very much. Thanks for taking my questions. Two, please. So the first one is how much benefit was there from phosphate binders in H1? And how should we think about the remaining benefit into the second half?

非常感謝。感謝您回答我的問題。請給我兩份。那麼第一個問題是，磷酸鹽結合劑在 H1 中有多大益處？那我們該如何看待下半年剩餘的利益呢？

And then the second one is another one on treatment volume dynamics. But could you help us put there the five months of better inflow into historical context? I mean, is it fair to say that that's the first time since COVID that you've seen that consistency in patient inflate? That would be really helpful just to sort of frame that shift.

第二個是關於治療量動態的另一個問題。但是您能否幫助我們將這五個月的較好流入情況放在歷史背景中來看呢？我的意思是，是否可以說這是自 COVID 以來您第一次看到患者人數如此持續增加？這對於確定這種轉變確實很有幫助。

Thank you.

謝謝。

Martin, do you want to take the binders half one and then --

馬丁，你想把活頁夾拿一半，然後--

Yeah. So regarding phosphate binders, we did see quarter two develop in line on how we expected the quarter to develop. We did see a double-digit million positive contribution for Care Delivery. As we pointed out, we also had highlighted in the first half that in quarter one, we had a bit of a stronger development. And then in quarter two, it came in, in line with what we assumed. So we are, for the first half in line with our expectations.

是的。因此，就磷酸鹽結合劑而言，我們確實看到第二季的發展與我們預期的一致。我們確實看到了對護理服務的兩位數的積極貢獻。正如我們所指出的，我們在上半年也強調過，在第一季度，我們的發展更加強勁。然後在第二季度，它的結果與我們的預期一致。因此，上半年的業績符合我們的預期。

Thanks, Martin. And Richard, on treatments, yeah, I think it's fair to say that this has been our strongest quarter two since 2020 from an inflow perspective, and that not just that it's the strongest quarter we've seen, but also the monthly improvement we have seen over the last five months consistently is a new plan for us as well.

謝謝，馬丁。理查德，關於治療，是的，我認為可以公平地說，從流入的角度來看，這是我們自 2020 年以來表現最強勁的第二季度，這不僅是我們所見過的最強勁的一個季度，而且我們在過去五個月中持續看到的月度改善對我們來說也是一個新的計劃。

So for us, we can kind of see that that work has clearly started at the back. Even though we had few we could see this inflow in referrals improving Q1 into Q2, and the work that we are doing is clearly paying off there.

因此，對我們來說，我們可以看到這項工作顯然已經從後面開始了。儘管我們收到的推薦很少，但我們可以看到推薦的流入使第一季和第二季的情況有所改善，而且我們所做的工作顯然得到了回報。

James, Jefferies.

詹姆斯、傑弗里斯。

Thanks so much for taking my questions. Two if I may, please. Confirming the guidance range, including the upper end, I'm just kind of curious the levers to get you there at the upper end of the margin range if volumes are expected to remain flat this year.

非常感謝您回答我的問題。如果可以的話，請給我兩份。確認指導範圍，包括上限，我只是有點好奇，如果預計今年的銷售量將保持平穩，那麼如何才能讓你達到保證金範圍的上限。

And then the second question just again regarding lower volumes. If volumes don't get to the 2% plus as an exit rate next year, how does that impact your thoughts on timing for capital allocation decisions just given cash flow so reliant on higher volumes?

然後第二個問題再次涉及較低的音量。如果明年的交易量沒有達到 2% 以上的退出率，鑑於現金流如此依賴更高的交易量，這會如何影響您對資本配置決策時機的想法？

Thank you.

謝謝。

Hey James, I'll take the first one, and I'll give the capital allocation question to Martin. Obviously, what we tried to do is lay out the building blocks of the headwinds and tailwinds on guidance. And there's a range for them all. And I think it's fair to say if we hit the bottom end of all those building blocks, we'd be at the bottom end of the range. And if we hit the top end, the converts would be true.

嘿，詹姆斯，我來回答第一個問題，我將資本配置問題交給馬丁。顯然，我們試圖做的是製定出指導方針中逆風和順風的基石。並且它們都有一個範圍。我認為可以公平地說，如果我們觸及所有這些建構模組的底端，那麼我們就會處於該範圍的底端。如果我們達到最高水平，皈依者就會是真正的皈依者。

And obviously, we are -- our job as management is to balance all of those to make them all as strong as possible. The building blocks that we gave in -- with 2024 are the same building blocks, that hasn't changed. So we are continuing to track quite well within those blocks, and we're managing our way through those.

顯然，作為管理層，我們的工作是平衡所有這些，使它們盡可能強大。我們放棄的基石——2024 年的基石是相同的，這一點沒有改變。因此，我們將繼續在這些區塊內進行良好的跟踪，並設法解決這些區塊的問題。

I think what maybe we want to reiterate is in kind of what I said in an earlier answer, is we know that there is acceleration in the back half. Some of that is the natural phasing and stronger business performance with the volume seasonality, particularly on CE, but H1 was completely in line with our plan. And we always knew that our H1 phasing would look like this. But the continued momentum on rate and mix, the revenue cycle, as we mentioned, the strong momentum in FME25, the operating improvements, labor, so we obviously touched on the softness on volume.

我想我們可能想要重申的是我之前所說的內容，我們知道後半部有加速。其中一些是自然階段和更強勁的業務表現與銷售季節性有關，特別是在 CE 方面，但 H1 完全符合我們的計劃。我們一直都知道我們的 H1 分階段將會是這樣的。但正如我們所提到的，利率和組合的持續勢頭、收入週期、FME25 的強勁勢頭、營運的改善、勞動力，所以我們顯然觸及了交易量的疲軟。

Labor, [regular] inflation is tracking kind of favorable -- sorry, in line with our expectations, but we did have an unfavorable hit in Q2 for the medical benefit costs. I think, like the whole -- many corporations are seeing, and you saw across the insurance companies' higher claims and higher cost of claims.

勞動力、[常規]通貨膨脹正在追蹤一種有利的——抱歉，符合我們的預期，但第二季醫療福利成本確實受到了不利的打擊。我認為，就像許多公司看到的那樣，而且你也看到保險公司的索賠金額和索賠成本都在增加。

But I think that is more of a half one phenomenon. So I think we're just managing each one of these building blocks with a high degree of rigor, a high degree of focus, pulling through on the programs, and that's what's giving us the confidence for the back half to development.

但我認為這更像是一種「半一」現象。所以我認為我們只是以高度的嚴謹性和高度的專注度來管理每一個構建模組，完成這些計劃，這就是讓我們對後半部分的發展充滿信心的原因。

Yeah, James. And on capital allocation, we did outline in the Capital Markets Day, the clear prioritization of investment into the core with our CapEx of EUR500 million to EUR1 billion with a lower leverage ratio and returns to our shareholders. And we have announced the EUR1 billion over two years. And you saw that we have a strong cash flow generation in quarter two and development.

是的，詹姆斯。在資本配置方面，我們確實在資本市場日概述了對核心投資的明確優先順序，我們的資本支出為 5 億歐元至 10 億歐元，槓桿率較低，並向股東提供回報。我們已經宣布將在兩年內投入10億歐元。並且您將看到，我們在第二季度和發展中擁有強勁的現金流產生。

And you also see that the first half, as Helen outlined expected in line with our expectations, and we expect acceleration for the second half. So we will start with the first tranche of the share buyback in August, and we feel very confident about our ability to execute the program overall as planned.

而且您還會看到，正如海倫所概述的，上半年的業績符合我們的預期，我們預計下半年的業績將會加速成長。因此，我們將在 8 月開始第一批股票回購，我們對按計劃全面執行該計劃的能力非常有信心。

Graham, UBS.

格雷厄姆，瑞銀。

Hi guys, thanks for taking my questions. They kind of the repeat of what we heard earlier, but maybe for some slightly different information. In terms of phosphate binders and their contribution to the business growth in Care Delivery, how much more do you think we have to go in the second half?

大家好，感謝你們回答我的問題。它們有點像是重複了我們之前聽到的內容，但可能包含一些略有不同的訊息。就磷酸鹽結合劑及其對護理服務業務成長的貢獻而言，您認為下半年我們還能取得多大的進步？

And what do you think makes us -- takes up differential if that sort of eases in terms of contribution in the second half? And then you've talked a lot about the inflows, which is super helpful. Could you give us a sense as to what the percentage growth is? So is it like 1%, 2% in terms of year-over-year -- and has that been trending like this for quite some time? And then just a quick one. Is there any way of discerning what is like share gains versus what is just the kind of funnel picking up?

您認為，如果下半年的貢獻緩解，我們會產生什麼差異？然後你談了很多關於資金流入的問題，這非常有幫助。您能告訴我們成長百分比是多少嗎？那麼，以年率計算，這個數字是 1% 還是 2%？這種趨勢已經持續了相當長一段時間了嗎？然後就簡單說一下。有什麼方法可以辨別什麼是份額成長，什麼是漏斗成長？

Thank you.

謝謝。

Okay. Martin, do you want to take the binders, and I'll take the inflows?

好的。馬丁，你想拿活頁夾，我拿流入的資金嗎？

Yeah, more than happy to. Graham, as I outlined, the first half developed in our expectation with a double-digit million contribution for the second quarter and starting stronger in the first quarter. But then after the first half, we feel good about what we saw with phosphate binders. There are still certain topics that we are very close to like utilization and certain pricing developments. But so far, we are feeling good about what we saw, and that also gives us confidence for our full year overall assumptions.

是的，非常樂意。格雷厄姆，正如我所概述的，上半年的發展符合我們的預期，第二季度的貢獻達到數千萬，並且第一季的開局更加強勁。但在上半場結束後，我們對磷酸鹽結合劑的效果感到滿意。我們仍然非常關注某些主題，例如利用率和某些定價發展。但到目前為止，我們對所看到的情況感覺良好，這也讓我們對全年的整體假設充滿信心。

Yeah, Graham. And then on inflows, look, I think a couple of things to your question. The trend that we're seeing, that referral improvement that we have seen these last five months equates to just under about 1% improvement in referrals year-to-date. But about a little more than that in Q2. So it was closer to 2% improvement in that referral improvement in Q2. So that also speaks to the kind of the improving trend since 2020, but also the last five months.

是的，格雷厄姆。然後關於流入，看，我認為你的問題有幾點。我們看到的趨勢是，過去五個月的建議量有所改善，相當於今年迄今的推薦量提高了約 1%。但第二季的增幅會略高於此。因此，第二季的推薦改善接近 2%。這也說明了自 2020 年以來以及過去五個月以來的改善趨勢。

In terms of your question on share gains, we know that the work that we are doing operationally internally is paying off. And I think those improvements are clearly visible in our operation. We'll obviously have to see how the rest of the market kind of reports out this quarter. But I think for us, it's definitely kind of the patient trend and the work that we're doing is supporting that effort.

關於您關於份額成長的問題，我們知道我們在內部營運方面所做的工作正在取得成效。我認為這些改進在我們的營運中是顯而易見的。顯然，我們必須看看本季其他市場的表現如何。但我認為對我們來說，這絕對是一種耐心趨勢，而我們所做的工作就是支持這種努力。

Improving that cancellation rate is also adding to our accepted referral growth. So it kind of -- there's a lot -- even when you've kind of got the new patient starts, we have been struggling to get them in and scheduled in time. The front-end work on improving the scheduling is also a key driver of this.

提高取消率也促進了我們接受的推薦成長。所以，即使有新的病人開始就診，我們也一直在努力讓他們準時入院並安排就診。改進調度的前端工作也是實現這一目標的關鍵驅動因素。

So I think this trend, we have been seeing it for a few quarters now. It's not just the last month or so. It's been a consistent trend that we're encouraged by. And obviously, we had a lot of work to do with the turnaround in Care Delivery. So I think that is speaking for itself. But I also recognize that we're still talking small numbers.

所以我認為這種趨勢我們已經看到幾個季度了。這不僅僅是上個月左右發生的事情。這是一個持續的趨勢，令我們感到鼓舞。顯然，我們在扭轉醫療服務方面還有很多工作要做。所以我認為這是不言而喻的。但我也認識到我們談論的仍然是小數字。

David, JPMorgan.

摩根大通的戴維。

Hey guys, thanks for the questions. Slightly different [tax]. So maybe just first, early thoughts on 2026 and the headwinds you might have from the annualization of phosphate binders and also the exploration of ACA subsidies?

嘿夥計們，謝謝你們的提問。略有不同[稅]。那麼也許只是首先對 2026 年的初步想法以及您可能遇到的來自磷酸鹽結合劑年化和 ACA 補貼探索的阻力？

And then second question, it would be good to get your recent thoughts or your thoughts on the recent clinical data out of ProKidney for the impact on progression of their product on CKD.

第二個問題，如果您能談談您最近的想法，或者您對 ProKidney 的最新臨床數據的看法，以了解其產品對 CKD 進展的影響，那就太好了。

Thank you.

謝謝。

Hey, David. Look, I think we're definitely not giving 2026 guidance and kind of sizing out the headwinds and tailwinds today, more to come on that. But what I would say on binders is we've got this half one development, and Martin touched on this already.

嘿，大衛。聽著，我認為我們絕對不會給予 2026 年的指導，也不會在今天就評估逆風和順風，以後還會有更多相關內容。但我想說的是，關於活頁夾，我們已經取得了一半的進展，馬丁已經談到了這一點。

There's a lot of things at play here. We've got the -- we got the patient numbers, utilization rates. We've got generics, we've got branded. We've got the impact that's hitting on the clinics business. We've got the impact that is hitting pharma business. We've got the impact that's hitting pharmacy.

這裡有很多事情在發生。我們掌握了——我們掌握了患者人數和使用率。我們有仿製藥，也有品牌藥。我們已經意識到這對診所業務產生了影響。我們已經感受到了對製藥業的影響。我們已經感受到了對藥局的影響。

So I think we're trying to get our arms around or not arms, we've got our arms around what we see in 2025, and it is progressing quite nicely as planned. Obviously, this utilization and what happens here every quarter will shape what 2026 looks like.

所以我認為我們正在努力實現目標，或者說，我們已經實現了 2025 年的目標，一切進展順利，正如計劃的那樣。顯然，這種利用率以及每季發生的情況將決定 2026 年的狀況。

I think the thing that is key to watch for us is obviously post-TDAPA period, which is January of 2027. But we're going to learn a lot about the uptake and utilization of these products by then. So I think, David, this is one where it's a quarter-by-quarter through '25. We'll obviously try and size '26, and then we'll see what happens post-TDAPA.

我認為我們需要關注的關鍵點顯然是 TDAPA 之後的時期，也就是 2027 年 1 月。但到那時，我們將對這些產品的吸收和利用有更深入的了解。所以我認為，大衛，這是一個到 25 年逐季進行的研究。我們顯然會嘗試確定 26 的規模，然後看看 TDAPA 之後會發生什麼。

The other thing on this piece as well is obviously the noise on pharma pricing and potential tariffs. So I think it's just such a fluid situation. We've got good line of sight into '25 and obviously will shape '26.

這篇文章的另一件事顯然是關於藥品定價和潛在關稅的噪音。所以我認為這是一個非常不穩定的情況。我們對 25 年有了很好的展望，顯然也會對 26 年產生影響。

The ACA, I think we had already sized that on the previous call. Of course, we expect for 2026, and I can save this one for '26 because we already have that it would be about 2% of US, CD EBIT.

我認為我們在上次通話中已經對 ACA 進行了評估。當然，我們預計是 2026 年，我可以把這個數字留到 2026 年，因為我們已經知道它將占美國 CD EBIT 的 2% 左右。

Obviously, past '26, we also have to see how this plays out, and what happens with the extended tax credits and so these patients end up somewhere else of exchanges in different coverage and what insurance they would take. So I think too early to call back yet, but obviously, we've got our arms around it. And then you had another question, ProKidney.

顯然，過了 26 年，我們還必須看看情況會如何發展，以及延長稅收抵免會帶來什麼後果，因此這些患者最終會去其他地方的交易所，享受不同的保險範圍，並考慮他們會購買什麼保險。所以我認為現在下結論還為時過早，但顯然我們已經準備好了。然後你還有另一個問題，ProKidney。

(inaudible)

（聽不清楚）

Dominik. (laughter)

多米尼克。（笑聲）

Yeah. Dominik here, talking. So we'll wait for the ASN. I think they'll start their clinical study or the next phase of their clinical study. I think pricing, I think there's rumors where pricing would be. But I think -- our understanding is you have to see what's the long-term effect of those shots.

是的。這是多明尼克，正在說話。因此我們將等待 ASN。我認為他們將開始臨床研究或臨床研究的下一個階段。我認為定價，我認為有關於定價的傳言。但我認為——我們的理解是，你必須看看這些注射的長期效果是什麼。

I think they now do one shot versus two shots. We are not the experts on that, but you have to see how long it actually holds and how long it would improve the outcomes, right? That's the big question. How it works?

我認為他們現在只打一槍而不是打兩槍。我們不是這方面的專家，但你必須看看它實際上能持續多久以及它能改善結果多久，對嗎？這是一個大問題。它是如何運作的？

I think even the medical people don't fully understand, but it seems to have an effect, and I think we'll have to wait for or the long-term impact to see if there's more shots they need and what's then the pricing of it. But yeah, I think it's maybe not a very qualified answer, but I think there is not more that we could know by now.

我認為即使是醫務人員也不完全了解，但它似乎有效果，我認為我們必須等待長期影響才能知道他們是否需要更多的注射以及它的定價是多少。但是是的，我認為這可能不是一個非常合格​​的答案，但我認為我們現在無法知道更多。

That's fair enough. And maybe just one follow-up. Just in terms of the phosphate binder double-digit impacts. Could you sort of narrow down a bit whether it's low, medium, high because that's 10% to 99% range.

這很公平。也許只需要一個後續行動。僅就磷酸鹽結合劑的兩位數影響而言。您能否稍微縮小一下範圍，看看是低、中或高，因為這是 10% 到 99% 的範圍。

Yeah. So it's more -- well, to give you an indication for the point when we talk double digit, it's more on the lower, below mid, so to say.

是的。所以它更像是——好吧，給你一個指示，當我們談論兩位數時，它更像是在較低、低於中間水平，可以這麼說。

Falko, Deutsche Bank.

法爾科，德意志銀行。

I'm fine with just my two questions. Thank you all. Firstly, could you briefly remind us on the next steps for your new high-volume HDF machine rollout in the US? Are there things we should be looking out for here, and how meaningful this could potentially be for your financials this year and next? And then secondly, at current spot rates, what is your expected FX headwind on adjusted EBIT for the full year and also on sales?

我只要問兩個問題就行了。謝謝大家。首先，您能否簡單介紹一下您在美國推出新型大容量 HDF 機器的下一步計畫？我們該注意哪些事項？這對您今年和明年的財務狀況可能有多大影響？其次，以目前現貨匯率，您預期外匯對全年調整後息稅前利潤和銷售額的影響有多大？

Thank you.

謝謝。

Thanks, Falko. Now this is my favorite topic. So I will take the HDF question, and Martin, not surprising we will take the exchange rate question. We're continuing to go all systems fast on HDF.

謝謝，法爾科。這是我最喜歡的話題。因此，我將回答 HDF 問題，馬丁，毫不奇怪，我們將回答匯率問題。我們將繼續加快 HDF 上所有系統的運作速度。

As you heard me say, we have all the approvals we need. We already have one clinic fully converted. And the plan is to have 30 clinics and 600 machines converted during Q3, Q4. So really excited about the traction and the work that is happening around that.

正如您聽到我所說的，我們已經獲得了所需的所有批准。我們已經有一家診所完全改造了。計劃在第三季和第四季期間改造 30 家診所和 600 台機器。因此，我對這項進展和圍繞這一進展開展的工作感到非常興奮。

In fact, in 2025 somewhat limited, obviously, the big ramp up hits in 2026. But everything going to plan and excited to get our own US real data and hear firsthand from how our patients are feeling and doing after the treatment. So we'll continue to update that -- on that as the year goes to -- as the year goes by, Falko.

事實上，2025 年的成長幅度有些有限，但顯然，大規模的成長將在 2026 年實現。但一切都按計劃進行，我們很高興能獲得我們自己的美國真實數據，並直接聽到患者在治療後的感受和情況。因此，隨著時間的推移，我們會繼續更新這一點，Falko。

Yeah. And Falko, for the FX, we do see quite some volatility currently in the market over the last couple of weeks. So I'll give you a reference rate because it also changed from the last quarter to this quarter where we did see a significant development also of US dollar and euro. Over the last couple of weeks, we saw a 1.17-ish. It now came down a bit. But when you take that as a reference, we would expect a 3% to 4% impact on both revenue as well as earnings if it were to stay for the remainder of the full year on that level, and that effect would also then be a full year effect that we have.

是的。法爾科，就外匯而言，我們確實看到過去幾週市場出現了相當大的波動。因此，我會給你一個參考匯率，因為它也從上個季度到本季發生了變化，我們確實看到美元和歐元也有了顯著的發展。過去幾週，我們看到的漲幅在1.17左右。現在有所下降。但是，當你以此為參考時，我們預計如果全年剩餘時間保持在該水平，則收入和收益將受到 3% 至 4% 的影響，並且該影響也將是我們對全年的影響。

Okay. Perfect. So thank you very much. We will close the call now. Thank you for listening in, in the summer. We do wish you all a great summer break and are looking forward to be in touch after the break. And see you on many conferences, roadshows, and looking forward to reconnect.

好的。完美的。非常感謝。我們現在結束通話。感謝您在夏天的收聽。我們衷心祝福大家有個愉快的暑假，並期待假期結束後與我們保持聯繫。希望在許多會議和路演中見到您，並期待再次聯繫。

Thank you, everybody. Enjoy what's left for the summer. Take care.

謝謝大家。享受夏天剩下的一切。小心。

Thank you, Take care.

謝謝，保重。

Ladies and gentlemen, the conference is now over. Thank you for choosing chorus call, and thank you for participating in the conference. You may now disconnect your lines. Goodbye.

女士們、先生們，會議到此結束。感謝您選擇合唱集錦，感謝您參加本次大會。現在您可以斷開線路了。再見。