Option Care Health Inc (OPCH) 2024 Q3 法說會逐字稿

Good day and thank you for standing by. Welcome to the Option Care Health third quarter, 2024 earnings conference call. At this time. All participants are in a listen-only mode. After the speaker's presentation, there will be a question and answer session to ask a question during the session. You will need to press star 11 on your telephone. You will then hear an automated message advising your hand is raised to withdraw your question. Please press star 11 again.

美好的一天，感謝您的支持。歡迎參加 Option Care Health 2024 年第三季財報電話會議。此時。所有參與者都處於只聽模式。演講者演講結束後，將進行問答環節，在會議期間提出問題。您需要按電話上的星號 11。然後，您將聽到一條自動訊息，建議您舉手撤回問題。請再按星號 11。

Please be advised that today's conference is being recorded.

請注意，今天的會議正在錄製中。

I would now like to hand the conference over to your first speaker today, Nicole Maggio, Senior Vice President of Finance.

現在我想將會議交給今天的第一位發言人，財務高級副總裁 Nicole Maggio。

Good morning. Please note that today's discussion will include certain forward-looking statements that reflect our current assumptions and expectations, including those related to our future financial performance and industry and market conditions. These forward-looking statements are subject to risks and uncertainties that could cause actual results to different materially from our expectations. We encourage you to review the information in today's press release as well as in our form, 10-K and latest form 10-Q filed with the SEC regarding the specific risks and uncertainties we do not undertake any duty to update any forward-looking statements except as required by law during this call. We will use non-GAAP financial measures. When talking about the company's performance and financial condition. You can find additional information on these non-GAAP measures in this morning's press release posted on the investor relations portion of our website. With that, I will turn the call over to John C. Rademacher, President and Chief Executive Officer.

早安.請注意，今天的討論將包括某些反映我們當前假設和預期的前瞻性陳述，包括與我們未來財務表現以及行業和市場狀況相關的假設和預期。這些前瞻性陳述存在風險和不確定性，可能導致實際結果與我們的預期有重大差異。我們鼓勵您查看今天的新聞稿以及我們向 SEC 提交的表格 10-K 和最新的 10-Q 表格中有關特定風險和不確定性的信息，我們不承擔更新任何前瞻性聲明的義務除非法律要求在此通話期間。我們將使用非公認會計準則財務指標。在談論公司的業績和財務狀況時。您可以在今天早上發佈在我們網站投資者關係部分的新聞稿中找到有關這些非公認會計準則措施的更多資訊。接下來，我將把電話轉給總裁兼執行長 John C. Rademacher。

Thanks Nicole and good morning everyone. There have been quite a few developments for option care health over the past 90 days. So I'd like to jump right in overall. The third quarter, results were quite encouraging and generally consistent with how we expected the quarter to materialize.

謝謝妮可，大家早安。在過去 90 天內，選擇性護理健康取得了相當多的進展。所以我想總體上直接跳下去。第三季的結果非常令人鼓舞，並且與我們對本季實現的預期基本一致。

Mike will provide additional color in a few minutes, but we continue to deliver double digit revenue growth and sequential improvement in gross profit dollar generation through our organic growth initiatives.

麥克將在幾分鐘內提供更多信息，但我們將繼續透過我們的有機成長計劃實現兩位數的收入成長和毛利美元生成的連續改善。

While we have substantially recovered operationally from the changed health care incident that we discussed in the past, we continue our efforts to catch up on patient payment obligations which remain impacted and delayed from the disruption earlier in the year.

雖然我們已經從過去討論的醫療保健事件變化中基本恢復了運營，但我們仍在繼續努力趕上患者付款義務，這些義務仍然受到今年早些時候的中斷的影響和延遲。

In addition to solid revenue and earnings results, even with the delayed collections from patients cash flow generation continues to be strong and we finished the quarter with a net debt to EBITDA leverage ratio of 1.5 times the lowest reported level since our merger with Bioscript in 2019.

除了穩健的收入和盈利業績外，即使患者收款延遲，現金流的產生仍然強勁，本季度結束時，我們的淨債務與 EBITDA 槓桿比率為 2019 年與 Bioscript 合併以來報告最低水平的 1.5 倍。

This performance is inclusive of the repurchase of $41.9 million in stock during the quarter.

這一業績包括本季回購 4,190 萬美元的股票。

Over the past month, the dedicated team at Option Care Health has continued our focus on delivering extraordinary care even in the face of hurricanes, Helene and Milton.

在過去的一個月裡，即使面對颶風、Helene 和 Milton，Option Care Health 的專業團隊仍繼續致力於提供卓越的照護。

Hurricane Helene impacted our operations in the southeast in the closing days of the third quarter. And the aftermath of Helene continues to impact our operations, which I will expand upon in a moment.

颶風海倫在第三季末影響了我們東南部的業務。海倫事件的後果繼續影響著我們的運營，我稍後將詳細介紹這一點。

Most importantly, despite considerable disruption, we don't believe our ability to support our patients was materially impacted and our teams work tirelessly to prepare for and then respond to these disasters.

最重要的是，儘管造成了相當大的破壞，但我們認為我們支持患者的能力並未受到重大影響，並且我們的團隊不知疲倦地工作，為這些災難做好準備並做出反應。

The oxygen care health team in the Southeast helped ensure seamless patient support and collaboration with our referral partners during these considerably challenging conditions.

在這些相當具有挑戰性的條件下，東南部的氧氣護理健康團隊幫助確保了患者的無縫支援以及與我們的轉診合作夥伴的合作。

I continue to be humbled by our team members, focus and dedication and I am grateful for their efforts.

我繼續對我們的團隊成員、專注和奉獻感到謙卑，我感謝他們的努力。

The supply chain disruption from hurricane Helene regarding intravenous solution production has had and continues to have a meaningful impact on our operations.

颶風海倫造成的靜脈注射溶液生產供應鏈中斷已經並將繼續對我們的營運產生重大影響。

A large number of our acute patients receive therapeutic doses compounded using intravenous solution containers, also known as ib Bag.

我們大量的急性患者接受使用靜脈溶液容器（也稱為 ib Bag）配製的治療劑量。

Upon learning of the supplier's plant closure and disruption. Our teams in the field implemented immediate inventory conservation initiatives and worked quickly and proactively with manufacturers and distributors to secure supply.

在獲悉供應商工廠關閉和中斷後。我們的現場團隊立即實施了庫存節約舉措，並與製造商和分銷商快速、主動地合作以確保供應。

Having said that we along with most other care providers continue to receive less than optimal levels of IV bags.

話雖如此，我們與大多數其他護理提供者一樣，仍然收到低於最佳水平的靜脈輸液袋。

Our first priority has been and will continue to be providing therapies for our existing patients on service.

我們的首要任務一直並將繼續是為現有患者提供治療。

We believe we have a sophisticated and agile approach to reacting to market conditions like these using our national logistic capabilities that can adjust operations as supply dynamics hopefully improve in the coming weeks and months.

我們相信，我們擁有一種複雜而靈活的方法來利用我們的國家物流能力來應對此類市場狀況，隨著供應動態有望在未來幾週和幾個月內改善，我們可以調整營運。

However, as we sit here today, we are limited in our ability to onboard new patients who are primarily receiving intravenous antibiotics and nutrition support therapy.

然而，當我們今天坐在這裡時，我們接收主要接受靜脈注射抗生素和營養支持治療的新患者的能力有限。

We intend to be supportive of these patient communities as collaborative with our referral sources as possible and we remain in continuous contact with relevant stakeholder groups.

我們打算盡可能與我們的轉診來源合作，支持這些患者社區，並與相關利害關係人團體保持持續聯繫。

At this point, we cannot accurately predict when supply will be more readily available and alleviate restrictions and conservation plans that we've had to put in place.

目前，我們無法準確預測何時可以更容易獲得供應並減輕我們必須實施的限制和保護計劃。

Over the past month, we also learned that a certain large infusion provider has announced its intentions to exit certain acute therapies and no longer accept new patients.

過去一個月，我們也獲悉，某大型輸液供應商宣布打算退出某些急性治療，不再接受新患者。

As we have articulated on many occasions, we have made significant investments over the past several years to establish what we believe is an efficient network of compounding pharmacies and clinical capabilities to support acute therapeutic administration in the home and alternate site setting.

正如我們在許多場合所闡述的那樣，我們在過去幾年中進行了大量投資，以建立我們認為有效的複方藥房網絡和臨床能力，以支持家庭和替代場所環境中的急性治療管理。

We continue to view these therapeutic areas as an attractive opportunity for us based on these investments and our broad capabilities.

基於這些投資和我們廣泛的能力，我們仍然認為這些治療領域對我們來說是一個有吸引力的機會。

Notwithstanding the solution disruption just discussed, we see these market developments as a growth opportunity over the medium term once supply chain dynamics improve.

儘管剛剛討論了解決方案的顛覆，但我們認為，一旦供應鏈動態改善，這些市場發展將成為中期內的成長機會。

Despite a very competitive marketplace. We continue to believe option care health possesses unique differentiated capabilities to position us well to more deeply collaborate with referral sources and serve their patients in need of acute therapies and clinical oversight.

儘管市場競爭非常激烈。我們仍然相信選擇護理健康擁有獨特的差異化能力，使我們能夠與轉診來源進行更深入的合作，並為需要緊急治療和臨床監督的患者提供服務。

Finally, I want to spend a few minutes discussing recent developments impacting our chronic inflammatory therapy portfolio.

最後，我想花幾分鐘討論影響我們慢性發炎治療組合的最新進展。

Since our second quarter. Call on July 31st CMS announced that effective in 2026. It negotiated an approximate 66% reduction in the cost for part D patients on Stelara. A therapy previously announced as part of the 1st 10 drugs subject to negotiation under the Inflation Reduction Act.

自第二季以來。7 月 31 日致電 CMS 宣布自 2026 年起生效。經過協商，D 部分患者的 Stelara 費用降低了約 66%。先前宣布的一種治療方法是根據《通貨膨脹減少法案》進行談判的首批 10 種藥物之一。

Additionally, that therapy is expected to experience biosimilar competition beginning in early 2025.

此外，該療法預計將從 2025 年初開始經歷生物相似藥競爭。

Based on discussions this month, we now believe the manufacturer of this therapy intends to drastically and rapidly reduce the spread in which we acquire this therapy relative to reference price.

根據本月的討論，我們現在相信這種療法的製造商打算大幅、迅速地降低我們獲得這種療法相對於參考價格的價差。

We believe this is unprecedented and inconsistent with how pricing changes have generally transpired with respect to biosimilar introductions including our previous experience with this manufacturer. Although we recognize the Inflation Reduction Act negotiations are a new factor here while we remain actively engaged with them, we believe the impact of their pricing actions will materially impact the gross profit. We realize on providing infusion services to these patients beginning in early 2025.

我們認為這是史無前例的，並且與生物相似藥引入的定價變化通常發生的方式不一致，包括我們之前與該製造商的經驗。儘管我們認識到《通貨膨脹削減法案》談判是一個新因素，同時我們仍積極與他們接觸，但我們相信他們的定價行為將對毛利產生重大影響。我們計劃從 2025 年初開始為這些患者提供輸液服務。

At this point, we are not in a position to provide an estimated dollar impact for 2025 as negotiations are ongoing. And there remain a number of uncertainties as we have reiterated. On many occasions, we do not control drug reference prices nor do we set the spread off the reference prices at which we acquire the drugs.

目前，由於談判仍在進行中，我們無法提供 2025 年美元影響的估計。正如我們所重申的，仍然存在許多不確定性。在許多情況下，我們不控制藥品參考價格，也不設定收購藥品參考價格的價差。

Rest assured this team remains focused on identifying cost efficiencies and additional growth initiatives to help offset some of these headwinds in 2025.

請放心，團隊將繼續專注於確定成本效率和額外的成長計劃，以幫助抵消 2025 年的一些不利因素。

So to close to reiterate, I am very pleased with the team's performance in the third quarter, especially when considering the unique challenges that we were presented with in the quarter and continue to impact us today.

最後重申一下，我對團隊在第三季的表現感到非常滿意，特別是考慮到我們在本季面臨的獨特挑戰以及今天繼續影響我們的情況。

We delivered solid financial results and continue to navigate challenging supply chain dynamics for our acute therapies on the areas in which we have direct control. Our team has executed well and demonstrated agility and resilience.

我們取得了穩健的財務業績，並繼續在我們直接控制的領域為我們的急性療法應對充滿挑戰的供應鏈動態。我們的團隊執行良好，表現出敏捷性和韌性。

And despite the unexpected drug price actions by a certain manufacturer, I believe this enterprise is well positioned to deliver growth and serve more patients over the medium term.

儘管某位製造商的藥品價格行動出乎意料，但我相信該企業處於有利位置，可以在中期內實現成長並為更多患者提供服務。

With that. I'll hand the call over to Mike to provide additional details. Mike.

就這樣。我會將電話轉給麥克提供更多詳細資訊。麥克風。

Thanks John and good morning everyone. Overall, we believe the third quarter financial results were quite strong. Revenue growth of 17% was positively impacted by strong growth within our rare and orphan portfolios and also benefited from continued growth in our more established therapeutic categories.

謝謝約翰，大家早安。整體而言，我們認為第三季的財務表現相當強勁。17% 的收入成長受到我們的罕見和孤兒產品組合強勁成長的正面影響，也受益於我們更成熟的治療類別的持續成長。

As John mentioned, we did see some modest impact in the Southeast in the closing days of the quarter from hurricane Helene, but the impact was not material to our third quarter results, gross profit dollar generation continues to improve. And in the third quarter, we sequentially generated approximately $7.3 million more than the second quarter, which was consistent with our expectations.

正如約翰所提到的，我們確實在本季度最後幾天看到颶風海倫對東南部造成了一些溫和的影響，但這種影響對我們第三季度的業績並不重要，毛利美元生成繼續改善。第三季度，我們比第二季度增加了約 730 萬美元，這與我們的預期一致。

Spending leverage continues to improve as SG and A was down almost 1% compared to the prior year third quarter and represented 12.3% of revenue.

支出槓桿率持續改善，SG 和 A 較去年第三季下降近 1%，佔營收的 12.3%。

We continue to believe that we can drive considerable spending leverage within this platform. And the third quarter results affirm that conviction adjusted ebida of $115.6 million represented 9% of revenue and 5.3% growth over the prior year, which again included transitory procurement benefits that we called out last year.

我們仍然相信，我們可以在這個平台內推動相當大的支出槓桿。第三季的業績證實，信念調整後的稅息折舊及攤銷前利潤為 1.156 億美元，佔收入的 9%，比上年增長 5.3%，其中再次包括我們去年提到的臨時採購收益。

Cash flow generation continues to be strong and we generated $160.4 million in cash flow from operations in the quarter.

現金流產生持續強勁，本季我們的營運現金流達到 1.604 億美元。

We finished the quarter with cash balances of $483 million after deploying approximately $42 million towards share repurchase and as John mentioned, finished with our lowest leverage profile since the merger.

在部署了約 4,200 萬美元用於股票回購之後，我們本季的現金餘額為 4.83 億美元，正如約翰所提到的，我們的槓桿率達到了合併以來的最低水準。

So overall, we believe the balance sheet has never been stronger and we remain engaged on a number of acquisition opportunities and continued belief in our multifaceted capital deployment strategy to that end. As you likely saw in this morning's press release, we have begun reporting adjusted earnings per share as an additional key financial metric.

因此，總的來說，我們相信資產負債表從未如此強大，我們仍然致力於許多收購機會，並繼續相信我們為此目的的多方面資本部署策略。正如您可能在今天早上的新聞稿中看到的那樣，我們已經開始報告調整後的每股盈餘作為額外的關鍵財務指標。

We believe that adjusted earnings per share is an important financial metric and helps articulate the value created through our capital deployment efforts and our organic operating results.

我們認為，調整後每股盈餘是一項重要的財務指標，有助於闡明我們透過資本部署努力和有機經營績效所創造的價值。

Starting in 2025 we expect to provide guidance expectations on adjusted earnings per share. In addition to the other existing metrics on which we provide guidance regarding guidance for the full year 2024 we now expect to generate revenue of $4.9 billion to $4.95 billion and adjusted ebita of $438 million to $443 million.

從 2025 年開始，我們預計將提供調整後每股盈餘的指導預期。除了我們提供的有關 2024 年全年指引的其他現有指標外，我們現在預計將產生 49 億至 49.5 億美元的收入，調整後的稅前利潤為 4.38 億至 4.43 億美元。

Our updated guidance incorporates the IV bag supply chain disruption. John discussed earlier which continues to limit our ability to onboard new patients.

我們更新的指南納入了靜脈輸液袋供應鏈中斷的內容。約翰之前討論過，這繼續限制我們接納新病患的能力。

Additionally, we continue to expect to generate at least $300 million in cash flow from operations.

此外，我們仍然預計營運現金流將至少達到 3 億美元。

Consistent with previous years, we anticipate providing initial guidance for 2025 on our fourth quarter call in late February on that call, we will provide additional color on expectations incorporating the dynamics John articulated earlier.

與往年一樣，我們預計在 2 月底的第四季度電話會議上提供 2025 年的初步指導，我們將結合約翰先前闡述的動態，對預期提供更多資訊。

And while we are not in a position to provide additional color or details on the drug price impact or timing of supply chain improvements on the IV solution situation. At this time, we will provide an update on the Q4 call and with that, we'll open the call for questions, operator.

雖然我們無法提供有關藥品價格影響或供應鏈改進時間對靜脈注射解決方案情況的更多資訊或細節。目前，我們將提供第四季度電話會議的最新情況，然後我們將開始電話提問，接線員。

Thank you. At this time, we will conduct the question and answer session as a reminder to ask a question. You will need to press star 11 on your telephone and wait for your name to be announced to withdraw your questions. Please press star 11 again.

謝謝。這時，我們會進行問答環節，作為提醒提問。您需要按電話上的星號 11 並等待您的名字被宣布才能撤回您的問題。請再按星號 11。

Our first question comes from David mcdonald from Truist. Your line is open.

我們的第一個問題來自 Truist 的 David McDonald。您的線路已開通。

Hey, good morning guys. So just a couple of things. I mean, first of all, just on the IV, topic actually talked about like 90% to 100% by year end. We've heard some other manufacturers talk about increased supply. Can you just talk about how supply is kind of trended since the hurricane? Are you seeing, you know, noticeably better from a couple of weeks ago? And then, you know, should we think about this, hopefully being resolved consistent with what they're saying, kind of late for Q1 and you know, we're dealing with purchasing inefficiencies in the interim.

嘿，早上好，夥計們。所以只有幾件事。我的意思是，首先，就 IV 而言，到年底，這個主題實際上已經討論了 90% 到 100%。我們聽說其他一些製造商談論增加供應。能談談颶風過後供應的趨勢嗎？你知道，與幾週前相比，你有明顯改善嗎？然後，你知道，我們是否應該考慮這個問題，希望能按照他們所說的那樣得到解決，第一季度有點晚了，你知道，我們正在處理過渡期間採購效率低下的問題。

Yeah, Dave is gone. So, you know, from, from the moment of the closure, needless to say, there was immediate actions that we took to not only start to drive conservation but also to prioritize the way that we were going to look at the inventory. We had, we certainly worked closely with suppliers and distributors to secure supply through that process and ensure that we were able to take care of our existing patients. As you would expect the patients on census were the highest priority to make certain that we had continuity of care. As the weeks have progressed. We use a variety of products. And so it's, it's broad with the different IV you know, container, the IV bags that we're utilizing in a broad basis. We are working as aggressively as possible with all of the alternate suppliers as well as with, you know, the impacted supplier around making certain that we can get the most amount of allocation as possible. We think it's going to continue to improve over the weeks and months. As I said in my prepared remarks really hard for us to hazard a guess as to when it's going to come back fully online through that process. But we're seeing encouraging signs of increased supply as we've started to move through the quarter and our expectations are that that's going to continue to move in alignment as importation, you know, comes into the US as well as the plant and other producers can start to ramp up their production.

是的，戴夫走了。所以，你知道，從關閉的那一刻起，不用說，我們立即採取了行動，不僅開始推動保護，而且還優先考慮我們查看庫存的方式。我們當然與供應商和分銷商密切合作，以透過該流程確保供應，並確保我們能夠照顧現有患者。正如您所期望的那樣，人口普查中的患者是確保我們獲得連續性護理的最高優先事項。隨著時間的推移。我們使用各種產品。所以它的範圍很廣，包括我們廣泛使用的不同的靜脈注射容器、靜脈注射袋。我們正在盡可能積極地與所有替代供應商以及受影響的供應商合作，以確保我們能夠獲得盡可能多的分配。我們認為它將在幾週和幾個月內繼續改善。正如我在準備好的演講中所說，我們很難猜測它何時會通過該過程完全恢復在線狀態。但隨著我們開始進入本季度，我們看到了供應增加的令人鼓舞的跡象，我們的預期是，隨著進口進入美國以及工廠和其他國家，供應量將繼續保持一致。 。

And dave it. It's my, the only thing I'd add is naturally you did. You would expect that our guidance range for the fourth quarter in a variety of scenarios around pace and, and and, and volumes of, of recovery. So we're, we're, we're going to play it cautious, but we also have built in, you know, a variety of solutions based on what we're hearing from, from, from them.

戴夫吧。這是我的，我唯一要補充的自然是你所做的。您可能會期望我們對第四季度的指導範圍涉及復甦速度和復甦量的各種情況。所以我們、我們、我們將謹慎行事，但我們也根據我們從他們那裡聽到的信息，內建了各種解決方案。

And then guys just, I guess a second topic just around some of the pharmacy exits out of, you know, a major competitor, should we think about the opportunity is maybe more broad than just kind of where they're exiting? I mean, this is going to be, I would assume for payers, you know, the second scramble drill. You know, this is not the first time we've seen some exits. So, you know, are you guys in a position to go back to payers and be like, look, we're not going anywhere and you know, we've obviously seen a lot of fluidity in the market in terms of potential pharmacy exits.

然後，夥計們，我想第二個話題是圍繞一些藥房退出的，你知道，一個主要競爭對手，我們是否應該考慮這個機會可能比他們退出的地方更廣泛？我的意思是，我認為對於付款人來說，這將是第二次爭奪演習。你知道，這不是我們第一次看到出口。所以，你們知道，你們是否能夠回到付款人那裡，說，看，我們不會去任何地方，你們知道，我們顯然已經看到市場上潛在的藥房退出方面存在很大的流動性。

Yeah, Dave. And, and first and foremost, we've talked a lot about the balance of our portfolio and how much we we have invested into the infrastructure, our network to make certain that we could follow and be able to provide service across that broad spectrum of the acute and chronic patients. We believe that you know, the the investments that we have made create a really attractive opportunity need for us to continue to capture market demand to be a partner of choice for the referral sources, given the breadth of the, the products that we're able to support. And we do think that as payers are looking at their network designs, having organizations that can be able to provide that broad spectrum of of solutions for infusion on needs. We think we'll continue to position us well in the marketplace. Now again, some of the disruption that we just talked about with the IV bags, you know, is, is has to resolve for us to be able to really ramp that up. As I said, we we need to make certain we take care of our existing patient census but as that starts to alleviate and things start to move back as supply, we believe this creates an attractive opportunity for us to leverage the investments that we've made into our people. Process technology and facilities.

是的，戴夫。而且，首先也是最重要的是，我們已經談論了很多關於我們的投資組合的平衡以及我們對基礎設施和網絡的投資，以確保我們能夠遵循並能夠在廣泛的範圍內提供服務。 。我們相信您知道，我們所做的投資創造了一個非常有吸引力的機會，需要我們繼續抓住市場需求，成為推薦來源的首選合作夥伴，考慮到我們所提供的產品的廣度能夠支持。我們確實認為，當付款人正在考慮他們的網路設計時，擁有能夠提供廣泛的解決方案來滿足需求的組織。我們認為我們將繼續在市場中保持良好的地位。現在，我們剛才談到的一些與靜脈輸液袋有關的干擾必須得到解決，以便我們能夠真正提高這一水平。正如我所說，我們需要確保我們處理好現有的患者普查，但隨著這種情況開始緩解，供應開始恢復，我們相信這為我們創造了一個有吸引力的機會，可以利用我們已經進行的投資成為我們的人民。工藝技術和設施。

Okay. And then guys just last one just on Stelara, can I I know you guys have talked before just about, you know, percentage of revenue by that class. You know, any additional detail you can provide just to help us kind of ring fences a little bit in terms of, you know, the class in terms of how much revenue, you know, the product specifically, just any additional detail there to, you know, help us put a little bit of a box around it.

好的。然後大家剛剛在 Stelara 上發表了最後一篇，我能知道你們之前已經討論過該類別的收入百分比嗎？您知道，您可以提供的任何其他詳細信息只是為了幫助我們在收入方面有所幫助，您知道，具體是產品，只是任何其他詳細信息，你知道，幫助我們在它周圍放一個小盒子。

Yeah, David's Mike obviously for for obvious reasons, we we we don't provide therapy, specific concentration ors, but what we have said publicly is that chronic inflammatory therapies in which Delaro is one of the therapies roughly represents 20% of our revenue. That's a, that's a therapy category that includes both biosimilars primarily for Remicade that includes things like Absola and flex and flex. It also does include, you know, two branded therapies, Stelara and Intivia at this point. So that's, that's the extent to which we provided granularity around Stelara.

是的，大衛的麥克顯然出於顯而易見的原因，我們不提供治療、特定濃度或其他治療，但我們公開表示，慢性發炎療法（Delaro 是其中一種療法）大約占我們收入的 20%。那是一個治療類別，包括主要用於 Remicade 的生物相似藥，其中包括 Absola 和 Flex 和 Flex 等。您知道，它目前還包括兩種​​品牌療法：Stelara 和 Intivia。這就是我們圍繞 Stelara 提供的粒度程度。

Okay, thanks very much guys that.

好的，非常感謝你們。

Thank you.

謝謝。

Our next question comes from Constantine devitis from citizens JMP Securities. Your line is open.

我們的下一個問題來自公民 JMP 證券的 Constantine Devitis。您的線路已開通。

Yeah, just following up on Dave's question on Stelara. Can you give us a sense? Maybe just how those discussions are deviating from, from prior precedent, I guess around spread? And I know you said negotiations are ongoing as we sit here today. Is there potential between now and your end that those economics improve? Or do you kind of see it sort of resting where it's where it's sitting today in terms of those negotiations.

是的，我只是在跟進 Dave 在 Stelara 上提出的問題。你能給我們一個感覺嗎？也許這些討論與先前的先例有何不同，我猜是圍繞傳播？我知道你今天坐在這裡時說過談判正在進行中。從現在到您結束之前，這些經濟狀況是否有可能改善？或者你是否認為它在今天的談判中處於靜止狀態。

Hey, Constantine, it's Mike. So maybe I'll start with some mechanics and and John can jump in and address some of the more the broader aspect of your question. So I think just to, to rebase with folks again, when we acquire therapies from manufacturers, we're acquiring at a spread off of a reference price, we subsequently bill a payer for a spread over reference price, thereby affording us a margin on that. That drug specifically relates to, to Stelara, you know, that that therapy has enabled us because in many instances or most instances, we're treating patients that have medical necessity where there's an increased clinical requirement. So that spread has afforded us the ability to invest in patient centric investments. And so as John alluded from a mechanical perspective, what the initial communication is is that that spread off of that reference price.

嘿，康斯坦丁，我是麥克。所以也許我會從一些機制開始，約翰可以介入並解決你的問題的一些更廣泛的方面。因此，我認為，再次與人們重新調整基礎，當我們從製造商那裡購買治療藥物時，我們是以參考價格的差價購買的，隨後我們向付款人收取高於參考價格的差價，從而為我們提供了利潤那。對於 Stelara 來說，該藥物特別與該藥物相關，您知道，該療法使我們能夠使用，因為在許多情況下或大多數情況下，我們正在治療有醫療需求且臨床需求增加的患者。因此，這種傳播使我們有能力進行以患者為中心的投資。正如約翰從機械角度提到的那樣，最初的溝通是參考價格的價差。

The intention is that that will be dramatically reduced, that is atypical from what we have seen in such scenarios in the past where typically that spread is either consistent or wider. And when things go biosimilar or adjust that, that is primarily felt through the reference price, which is where we have said consistently that when things go biosimilar or evolve from AAA therapy maturity, we typically see that through the reference price, not through the spread, which is why this is such an atypical situation. So maybe I'll hand the John for any additional.

目的是大幅減少這種情況，這與我們過去在此類情況下看到的情況不同，通常情況下，這種情況的傳播要么是一致的，要么是更廣泛的。當事情變得生物仿製藥或調整時，這主要是透過參考價格感受到的，這就是我們一直說的，當事情變得生物仿製藥或從AAA 療法成熟度演變時，我們通常透過參考價格而不是透過價差看到這一點，這就是為什麼這是一種非典型情況。所以也許我會把任何額外的錢交給約翰。

Yeah, and the only other thing I'd add is, you know, to Mike's point our our normal. And, and I guess the the historical precedence that we we looked at was that's normally a glide down that we see in that reference price. And therefore you would expect that parallel to happen. The fact that this is going in a different direction of that spread being compressed early in the process and not really following that glide down of the reference price is what is unprecedented and why we are you know, calling that out as being something that is drastically different than than what we've seen on a historical basis.

是的，我唯一要補充的是，你知道，麥克的觀點是我們的常態。而且，我想我們看到的歷史優先順序通常是我們在參考價格中看到的下滑。因此你會期望這種平行的情況會發生。事實上，這正朝著不同的方向發展，在這個過程的早期，價差被壓縮，而不是真正跟隨參考價格的下滑，這是史無前例的，也是為什麼我們會說這是一個急劇的變化。在歷史基礎上看到的不同。

Got it. Thanks. And then just one follow up, can you just give us the the revenue split between the chronic and acute therapies this quarter. Thank you.

知道了。謝謝。接下來，請您告訴我們本季慢性療法和急性療法之間的收入分配情況。謝謝。

Yeah, you bet it's roughly 7,525 chronic acute.

是的，你敢打賭，大約有 7,525 個慢性急性病。

Thank you.

謝謝。

Our next question comes from Lisa Gill from JP Morgan. Your line is open.

我們的下一個問題來自摩根大通的麗莎吉爾。您的線路已開通。

Hi, thanks very much and good morning. Just coming back, I just want to go back to a comment that you made around Talera and what's happening that you really believe this is unique. Can, can you maybe just walk me through to understand why you think this is unique and not a new norm from a manufacturer perspective? So John, I think I heard you say that, you know, the manufacturer decided that with the biosimilar coming, they're just going to collapse the growths to spread. Do you think that we could see more of that, that activity where the branded manufacturers trying to to maintain their, their market share with a biosimilar coming? I'm I'm just trying to understand what you know, potentially could be happening in the market.

你好，非常感謝，早安。剛回來，我只想回顧一下您對 Talera 所做的評論以及您真正相信這是獨一無二的事情。可以，您能否引導我了解為什麼您認為這是獨一無二的，而不是從製造商的角度來看的新規範？所以約翰，我想我聽到你說，你知道，製造商決定，隨著生物相似藥的到來，他們只會破壞生長以擴散。您認為我們會看到更多這樣的活動，即品牌製造商試圖透過生物相似藥來維持其市場份額嗎？我只是想了解你所知道的市場上可能發生的情況。

Yeah, I hard for us to you know, to comment on manufacturers pricing strategies on that Lisa. So, you know, in many instances is probably better, better for them to answer on that. There is some uniqueness with this in the fact that we this drug is part of the IRA and was identified as one of the 1st 10 and there is with C MS S announcement in August and the negotiation, there is an endpoint. That's a little bit different than what you see in a traditional biosim type of situation. So, again, within my prepared remarks, also tried to reflect that that is a little bit unique within this. So, you know, I think as we're thinking through as we move forward, you know, we'll, we'll try to factor that in. I think as Mike has said, multiple times, you know, when you think of the portfolio that we have of products, you know, the acute therapy for the most part are generic or generic equivalent in the marketplace. Most of our chronic is in a biosim. There are very few branded products other than what we have in some of the limited distribution drugs and the, the rare and Orphan Space that are of that branded type of, of of stance. So this is one where again, STLA probably represents one of the you know, last of the, the big branded products in our broader portfolio. But we're going to use this as being an opportunity to, to continue to monitor and to review as we're thinking about our forward views and the impact that biosimilar events can have on the rest of the portfolio.

是的，我很難讓我們對麗莎的製造商定價策略發表評論。所以，你知道，在很多情況下，他們可能會更好地回答這個問題。這有一些獨特之處，因為我們這種藥物是 IRA 的一部分，被確定為第 10 種藥物之一，並且 C MS S 在 8 月宣布並進行了談判，有一個終點。這與您在傳統生物模擬類型的情況中看到的有點不同。因此，在我準備好的發言中，我也試圖反映出這其中的獨特之處。所以，我認為，當我們在前進的過程中進行思考時，我們會嘗試將這一點考慮在內。我認為，正如麥克多次說過的，當你想到我們擁有的產品組合時，你知道，大多數急性治療都是市場上的通用或通用等效藥物。我們大部分的慢性病都在生物模擬中。除了我們在一些有限分銷藥物以及屬於該品牌類型的稀有藥物和孤兒空間中所擁有的產品之外，很少有品牌產品。因此，STLA 可能代表了我們更廣泛的產品組合中最後一個大品牌產品。但我們將以此為契機，繼續監控和審查，因為我們正在思考我們的前瞻性觀點以及生物相似藥事件可能對投資組合的其餘部分產生的影響。

No, that's really helpful. And then just, just like for you, when I think about the ebida reduction and that I look at the fourth quarter, you talked about both. You know, what's going on with the IB solution as well as what happened with the hurricane. Should I assume that that's the only impact of, of what the change is for, for the Ebida guidance for 2024 or is there anything else that I should be aware of?

不，這真的很有幫助。然後，就像你一樣，當我考慮 ebida 削減和第四季度時，你談到了這兩個問題。你知道，IB 解決方案發生了什麼以及颶風發生了什麼。我是否應該假設這是 2024 年 Ebida 指南的唯一影響或更改的目的，還是還有其他我應該注意的事情？

Yeah, good morning, Lisa. Those are the big box cars on the rails. As we think about the, the fourth quarter, as you, as you well know, this is a dynamic market. We typically do see some seasonal ramp, especially on the acute therapies going into the later part of the year. I, I'm, I'm comfortable with you characterizing that those are the meaningful verys again, as John highlighted, Helene continues to impact us through the IV bag shortage, you know, II I gotta keep track of all the the storms watching the weather channel. But you know, Milton was really in the early stages of October that wreaked quite a bit of havoc when you think about our pharmacy and more importantly, our patient footprint in the south that created a tremendous amount of patient dislocation and disruption. There was some inefficiencies. Again, I wouldn't characterize it as overly material, but it did create some hurdles earlier in the, in the quarter. And so even though it's in the, in the rearview mirror, you know, the there's still some some recovery. So those, those two are the, the the primary variables that we modeled out affecting the range.

是的，早上好，麗莎。那些是鐵軌上的大貨車。正如我們所知道的，第四季是一個充滿活力的市場。我們通常確實會看到一些季節性的成長，特別是在今年下半年的急性治療中。我，我，我對你的描述感到滿意，這些再次是有意義的，正如約翰強調的那樣，海倫繼續通過靜脈輸液袋短缺影響我們，你知道，我必須跟踪所有正在觀察的風暴天氣頻道。但你知道，米爾頓在 10 月初確實造成了相當大的破壞，當你想到我們的藥房時，更重要的是，我們在南部的患者足跡造成了大量患者的混亂和混亂。存在一些效率低的情況。再說一遍，我不會將其描述為過於實質性，但它確實在本季度早些時候造成了一些障礙。因此，即使在後視鏡中，你知道，仍然有一些恢復。因此，這兩個是我們建模的影響範圍的主要變數。

Okay, great. Thanks, sir. Thank you.

好的，太好了。謝謝，先生。謝謝。

Thank you so much.

太感謝了。

Our next question comes from Matt Lero, from William Blair. Your line is open.

我們的下一個問題來自威廉布萊爾的馬特萊羅。您的線路已開通。

Hi, good morning. Just following up on, on Lisa's last question. So just to confirm the sort of ongoing negotiations or potential impact from the, from our manufacturer, it is not a part of, of Q4 in terms of the guidance change and, and really will only impact 25. And then, then I guess as a follow up thinking about the go forward, I mean, you've obviously in the last four quarters, average top line growth has been kind of low to mid 10s. Gross profit growth has continued despite a variety of headwinds this year. So just sort of confirming that as you think on a go forward basis, despite the swirling headwinds you've referenced today, including the Lara that, that you would believe that would continue in terms of that cad to growth.

嗨，早安。只是跟進麗莎的最後一個問題。因此，只是為了確認正在進行的談判或來自我們的製造商的潛在影響，它不是第四季度指導變更的一部分，實際上只會影響 25。然後，我想作為對未來發展的後續思考，我的意思是，很明顯，在過去的四個季度中，平均收入成長一直在 10 左右。儘管今年面臨各種不利因素，但毛利仍在持續成長。因此，我只是想確認一下，儘管你今天提到了包括勞拉在內的逆風，但你在未來的基礎上思考，你會相信這種情況會繼續增長。

Hey Matt, it's Mike confirming your your first that there there is no 24 impact. That is, that is correct. We would expect that as John said to be drastic and rapid in early 25. Look, I think as it relates to how we're thinking about things, you know, a little historical context. You know, interestingly, we entered the year, our initial top line range was 44.6 to 4.8 we've now brought up the bottom end of, of our, of our revenue range $300 million in the year. So, really encouraged by the momentum on the top line again, a lot of that and is from our chronic therapy portfolio, both existing as well as some of the new rare orphans which do again carry a lower gross profit rate. You know, as, as I mentioned, my prepared remarks, nice momentum sequentially in the gross profit dollar generation, again, more than $7 million up versus Q3, which is kind of how we socialize things in in late July. You know, and, and while we don't provide gross profit growth when you normalize for the procurement benefits last year, you know, we were in the 6% to 7% kind of same store sales growth profit range. So really encouraging and, and, and that's kind of how we're, we're thinking about things obviously, you know, with the range going into the fourth quarter, we're, we're maniacally focused on gross profit dollar generation, but there are some challenges around our acute therapies which as you know, our higher gross profit therapies for us.

嘿，馬特，這是麥克向您確認的第一件事：沒有 24 小時的影響。也就是說，這是正確的。我們預計，正如約翰所說，這將在 25 年初變得劇烈而迅速。聽著，我認為這與我們如何思考事物有關，你知道，有一點歷史背景。你知道，有趣的是，我們進入了這一年，我們最初的收入範圍是 44.6 到 4.8，我們現在已經達到了今年收入範圍 3 億美元的下限。因此，再次受到營收動能的鼓舞，其中許多來自我們的慢性治療組合，既有現有的，也有一些新的稀有孤兒藥，它們的毛利率確實較低。你知道，正如我所提到的，我準備好的講話，毛利潤美元生成的良好勢頭，再次比第三季度增加了 700 萬美元以上，這就是我們在 7 月下旬社交活動的方式。你知道，雖然我們沒有提供去年採購效益正常化時的毛利成長，但你知道，我們的同店銷售成長利潤範圍在 6% 到 7% 之間。所以真的很令人鼓舞，而且，這就是我們的方式，我們顯然正在考慮一些事情，你知道，隨著進入第四季度的範圍，我們，我們瘋狂地專注於毛利潤美元的產生，但我們的急性療法存在一些挑戰，如您所知，我們的毛利較高的療法。

Right? Okay. That makes sense. And then just the the the patient payment dynamic in terms of sounds like that's the one the green item from the change disruption. You know, obviously initially post merger patient collections and that that was, was really something you improved upon. And that was a kind of a nice driving factor for the P&L and just any way to think about what kind of a timeline interruption or size of, of impact this, this might be, I assume it's sort of a one time catch up and then hopefully sort of back to normal.

正確的？好的。這是有道理的。然後，就病患付款動態而言，這聽起來像是變革中斷中的綠色專案。你知道，顯然最初是合併後的患者集合，這確實是你改進的東西。這對損益表來說是一個很好的驅動因素，無論怎樣思考時間線中斷或影響的大小，這可能是，我認為這可能是一次性的趕上，然後希望能恢復正常。

Yeah, I think if you think about where we were entering the third quarter, you know, we were still in recovery mode from change health. We utilized a lot of their capabilities and applications to correspond with patients and enable efficient patient collections and payment through our, our, our website. And you know, much of that functionality was down even, you know, into the, the third quarter. And you know, that, that that's an area where frankly all health care providers, you know, find it challenging, I would say on a broad level matt, our ability to convert revenue to cash is still very, very high. And that's something that we we focus on every single day and, and with patient collection. It's a process, I, I think we feel very good where we're, we're you know, reflecting that in the balance sheet and how we provided for it. And, you know, it's just something that we continue to to focus on. And I think our cash flow in the third quarter just reaffirms that, you know, we've effectively recovered from the the change situation okay, thanks.

是的，我想如果你想想我們進入第三季的情況，你就會知道，我們仍處於健康狀況變化的恢復模式。我們利用了他們的大量功能和應用程式來與患者進行通信，並透過我們的網站實現高效的患者收款和付款。你知道，很多功能甚至到了第三季就已經下降了。你知道，坦白說，所有醫療保健提供者都發現這個領域具有挑戰性，我想說，從廣義上講，我們將收入轉化為現金的能力仍然非常非常高。這是我們每天關注的事情，也是收集病人的重點。這是一個過程，我，我認為我們感覺非常好，我們在資產負債表中反映了這一點以及我們如何為其提供資金。而且，你知道，這只是我們繼續關注的事情。我認為我們第三季的現金流再次證明，我們已經有效地從變化中恢復過來，謝謝。

Thanks Matt.

謝謝馬特。

Thank you.

謝謝。

Our next question comes from Brian tanquilit from Jeffreys. Your line is open.

我們的下一個問題來自 Jeffreys 的 Brian tanquilit。您的線路已開通。

Hey, good morning guys. Maybe Mike or John just not not to harp back on the STLA issue, but as I think about, you know, some of the PB M is already announcing partnerships to manufacture biosimilar version of Stelara. How would that impact the dynamics as we get into 2025 for this specific issue?

嘿，早上好，夥計們。也許 Mike 或 John 只是不想重複 STLA 問題，但正如我所想，你知道，一些 PB M 已經宣佈建立合作夥伴關係來生產 Stelara 的生物仿製藥版本。當我們進入 2025 年時，這會對這個特定問題的動態產生什麼影響？

Yeah, Brian, I'll start and, and certainly Mike can come in. We are continue to have you know, relationship and, and develop relationships with the biosim manufacturers as well on that process. And you know, that's, that continues to be something that we're, we're working through around how that moves and how that moves forward. You know, with the type of products again, just so that everyone understands the, the role we play a lot of the product in general is self administered in the marketplace. The patients that we have on service are ones that have letters of medical necessity that require a health care professional to help oversee the infusion event because their prescriber you know, requires that that they have that additional help and oversight. So it's somewhat of a unique cohort of patients in which we serve and their, the medical complexity that they have in the, the clinical oversight that we can provide is a benefit on that you know, through that process. So, you know, as we're working forward, you know, part of it, the, the thing that has to try to be factored in is what is going to be that conversion of these patients that require this health care, professional oversight onto a biosimilar through that process. What we hear from our prescribing physicians is as a patient responds well to a therapy. They're not inclined to just immediately move them over to another product through that. So part of this is going to be that conversion rate onto the biosimilars, part of it's going to be the ability for us to you know, pull that into our portfolio and the economics around each of those biosimilars through that process and then how we see that conversion move over time. So, you know, I think as we're looking at at all of those dynamics, and some of the uncertainties and that, that's kind of what we're, we're, we're trying to factor in and will be part of what we provide in our 25 guidance. Knowing that we have all of these different variables that are going to have to be factored into the way that we're looking at 25 and beyond.

是的，布萊恩，我先開始，麥克當然也可以進來。我們將繼續讓您了解、建立和發展與 Biosim 製造商的關係以及在此過程中的關係。你知道，這仍然是我們正在研究的事情，我們正在研究它如何發展以及如何向前發展。您知道，再次討論產品類型，只是為了讓每個人都了解，我們在許多產品中所扮演的角色一般來說是在市場中自我管理的。我們服務的患者擁有醫療必要性證明，需要醫療保健專業人員幫助監督輸液事件，因為您知道，他們的處方者要求他們獲得額外的幫助和監督。因此，我們所服務的患者是一群獨特的患者，他們的醫療複雜性，我們可以提供的臨床監督是您知道的，透過這個過程的好處。所以，你知道，當我們向前努力時，你知道，必須考慮的一部分是，這些需要醫療保健和專業監督的患者的轉變通過該過程轉化為生物仿製藥。我們從處方醫生那裡聽到的是，患者對治療反應良好。他們不傾向於立即將其轉移到另一個產品。因此，其中一部分將是生物相似藥的轉化率，一部分將是我們能夠將其納入我們的投資組合以及透過該過程圍繞每種生物仿製藥的經濟效益，然後我們如何看待這種轉變隨著時間的推移而變化。所以，你知道，我認為，當我們考慮所有這些動態以及一些不確定性時，這就是我們正在努力考慮的因素，並將成為其中的一部分。我們知道我們擁有所有這些不同的變量，我們在考慮 25 歲及以後的情況時必須將這些變量考慮在內。

Got it. And then maybe Mike, I noticed and you're prepared to mark how much you emphasize the, where the balance sheet is today and the buy back. So obviously, leverage is low cash flow generation is pretty good. How should you be thinking about M&A and future capital deployment opportunities or this, this disruption was still our open M&A opportunities as well. So I just want to hear and talk to that. Thanks.

知道了。然後，也許麥克，我注意到，你準備標記你對資產負債表今天的位置和回購的重視程度。顯然，槓桿率低的現金流產生相當不錯。您應該如何考慮併購和未來的資本部署機會，或者說，這種破壞仍然是我們開放的併購機會。所以我只想聽聽看並談談這一點。謝謝。

Yeah, first and foremost, the team has just performed incredibly well in driving the cash generation again, converting revenue to cash and, and leading to a a leverage profile that that frankly is, is by far the lowest since the merger five years ago. And so, you know, generating the capital just gives us the confidence both in the business. We'll continue to invest back in a lot of the acute capabilities that John talked about. But we've really built a capital efficient enterprise that again, we expect will generate more than $300 million of cash. How we deploy that in the shareholders' best interest is something as we've talked about in the past. We take very, very seriously and we, we believe that we have the flexibility and the capability to deploy capital through two primary avenues through share repurchase and we haven't been shy about deploying capital towards share repurchase. But with this balance sheet that also affords us the ability to look for both strategic and economically attractive opportunities. And again, you know, we, we're incredibly thoughtful, we're disciplined. We don't chase just to get an M&A headline and we, we need to make sure Brian that we're looking you in the eye and saying that anything we do is both strategically, quite attractive. And is, is more advantage under our ownership as well as it's generating an accretive opportunity for the shareholder. And we think that there's a number of those that again, we remain actively involved in. And I think the expectation is that we will continue to do what we've been doing, which is actively deploy capital. Again, we said, we've said that we are very comfortable operating up to three times net leverage over the medium term, which would imply that, you know, we've, we've built a balance sheet with considerable dry powder under that. Thank.

是的，首先也是最重要的是，該團隊在再次推動現金生成、將收入轉化為現金方面表現得非常出色，坦白說，槓桿率是自五年前合併以來迄今為止最低的。所以，你知道，產生資本只會讓我們對業務充滿信心。我們將繼續投資約翰談到的許多敏銳的能力。但我們確實已經建立了一家資本高效的企業，我們預計該企業將產生超過 3 億美元的現金。正如我們過去討論過的那樣，我們如何為了股東的最佳利益而部署這一點。我們非常非常認真地對待，我們相信我們有靈活性和能力透過股票回購這兩個主要途徑來部署資本，而且我們並不羞於將資本部署到股票回購上。但有了這個資產負債表，我們也有能力尋找策略和經濟上有吸引力的機會。再說一次，你知道，我們非常體貼，我們遵守紀律。我們不只是為了成為併購頭條新聞，我們需要讓布萊恩確信，我們正在看著你的眼睛，並說我們所做的任何事情都具有戰略意義，而且非常有吸引力。而且，在我們的所有權下具有更多優勢，並為股東創造了增值機會。我們認為，我們仍然積極參與其中的許多活動。我認為我們的期望是我們將繼續做我們一直在做的事情，即積極部署資本。我們再次說過，我們已經說過，我們非常願意在中期內以高達三倍的淨槓桿率運營，這意味著，你知道，我們已經建立了一個資產負債表，其中包含相當多的乾粉那。感謝。

You.

你。

Thanks, Brian. Thanks, Brian.

謝謝，布萊恩。謝謝，布萊恩。

Thank you.

謝謝。

Our next question comes from Jamie Perse from Goldman Sachs. Your line is open.

我們的下一個問題來自高盛的 Jamie Perse。您的線路已開通。

Hey, thanks, good morning. One short term question just on acute and the IV bag shortage. It sounds like acute and antibiotics and nutrition are probably the areas most affected by that. First. Can you confirm that or if there's more on the chronic side that's impacted by this? And then relatedly just thinking about the competitive exits in the acute space, how should we think about sizing there and when you can potentially get back to new patient enrollment with an acute?

嘿，謝謝，早安。一個關於急性和靜脈輸液袋短缺的短期問題。這聽起來很嚴重，抗生素和營養可能是受其影響最嚴重的領域。第一的。您能否證實這一點，或者是否有更多慢性病受到此影響？然後，相關地考慮急性領域的競爭退出，我們應該如何考慮那裡的規模以及何時可以重新招募新的急性患者？

Sure, Jamie. Yeah, on the acute side, you're absolutely right. We use intravenous solution containers primarily to support our antibiotic in our parenteral nutrition. Patient cohorts that those are mostly what are prepared in in clean room settings. Look early to tell. But again, is, as John mentioned, I think we feel very good about, you know, the opportunity once we return to a more normal supply chain situation. Again, I think as we've characterized these therapeutic categories, the the broader our growth profile is, you know, low to mid single digit growth, these are more mature therapies. But I think for a lot of the reasons that John outlined, I think we feel very confident in our unique platform, the investments we've made are are consistent patient support. We're not going anywhere with these therapies. And I think that should enable us to grow faster than the market, how much faster. And when that kicks into a higher gear, I think again, as we've said, it's somewhat contingent on the the supply chain situation in the near term. But I I think we're, we're, we're excited about the opportunities in the future.

當然，傑米。是的，從尖銳的角度來看，你是完全正確的。我們使用靜脈注射溶液容器主要是為了支持我們的腸外營養中的抗生素。這些患者群體大多是在無塵室環境中準備的。早點看就知道了。但正如約翰所提到的，我認為一旦我們恢復到更正常的供應鏈狀況，我們就會對這個機會感覺非常好。再次，我認為，隨著我們對這些治療類別的描述，我們的成長概況越廣泛，你知道，低到中個位數的成長，這些是更成熟的療法。但我認為，出於約翰概述的許多原因，我認為我們對我們獨特的平台非常有信心，我們所做的投資是持續的患者支持。我們不會用這些療法去任何地方。我認為這應該使我們能夠比市場成長得更快，快多少。當這種情況進入更高階段時，我再次認為，正如我們所說，這在某種程度上取決於近期供應鏈的情況。但我認為我們對未來的機會感到興奮。

Okay? And, and, and then you guys are calling out these gross profit headwinds next year. You, you, you must also be thinking about the other side of things, right? Which is how you refill the gross profit GAAP that this creates, I know that's not an overnight process, but how are you thinking about the you know, the drug portfolio, the pipeline, you know, maybe operating infrastructure to to kind of, you know, build back some of those gross profit and IDA dollars over time.

好的？然後，然後你們就會大聲疾呼明年的毛利逆風。你你你一定也在想事情的另一面吧？這就是你如何補充由此產生的毛利 GAAP，我知道這不是一個一夜之間的過程，但你如何考慮你知道的藥物組合、管道，你知道，也許運營基礎設施，你隨著時間的推移，可以恢復部分毛利和IDA 資金。

Yes, Jimmy. So, you know, first and foremost, this team is very focused around always looking for operating efficiencies and cost effectiveness in the way that we're operating the, the model. And, and you know, some of the investments we've made into technology and into our facilities allows us to continue to look for ways to drive that efficiency as we move forward. And we don't, we don't believe that that has capped out. We, we think there's ample opportunity and we had announced earlier this year, some of the work we're doing pun here around some of the machine learning and and repetitive process automation and other things that we're going to continue to pursue aggressively as we look at those opportunities, we're also encouraged by, you know, the investments that we made into our infusion suites and some of the capabilities that we have within infusion clinics, those advanced practitioner models. We think that Alzheimer's, you know, continues, we're doing some experiments on that of being able to serve Alzheimer's patients with the multiple products that are available in the market that are overseen by the nurse practitioner model within that. And we were you know, encouraged by early indications there. Certainly, as you had called out, we think there's opportunities in the acute area as supply chain starts to settle as we move forward, and we continue to you know, with confidence be in the marketplace with the broad spectrum of products that we have there. We continue to invest in the rare and orphan area to look that those opportunities like we had called out with by jubi of using the platform that we have of a national reach and with the payer relationships from a market access standpoint that will continue to do there. And we do think that oncology pre presents some unique opportunities as that marketplace continues to evolve and and think about how we can utilize the infrastructure, not only of our pharmacy infrastructure, but the Infusion Suite infrastructure to serve a broader spectrum of of therapy. So we think that there remains you know, significant opportunities for us to find additional vectors of growth of continue to work upstream with BioPharma to be a platform of choice for them to help to introduce new products and the rare and orphan as well as a new entrance space. And we think there's a robust pipeline of infused products that are moving through the FDA approval process that we think our platform is unique and presents a really a strong partner for them to be able to bring their products in the marketplace. And we're going to continue to pursue all of those aspects is where we've always looked to reload and continue to reinvigorate the portfolio products that we've had as we've gone through these different cycles of products, moving either generic or biosimilar or other products. Reaching the end of their life cycle. You know, as as we manage through that.

是的，吉米。因此，您知道，首先也是最重要的是，團隊非常專注於始終以我們營運模式的方式尋求營運效率和成本效益。而且，您知道，我們對技術和設施的一些投資使我們能夠在前進的過程中繼續尋找提高效率的方法。我們不相信，我們不相信這種情況已經結束。我們認為有充足的機會，我們在今年早些時候宣布，我們正在做的一些工作圍繞著一些機器學習和重複流程自動化以及我們將繼續積極追求的其他事情我們關注這些機會，你知道，我們對輸液套件的投資以及我們在輸液診所中擁有的一些能力，以及那些先進的從業者模型，也讓我們感到鼓舞。我們認為阿茲海默症仍在繼續，我們正在做一些實驗，以便能夠為阿茲海默症患者提供市場上可用的多種產品，這些產品由護理從業者模型監督。你知道，我們受到早期跡象的鼓舞。當然，正如您所指出的，我們認為隨著供應鏈隨著我們的前進而開始穩定下來，在這個尖銳的領域存在著機會，而且我們繼續您知道，我們對市場上擁有的廣泛產品充滿信心。我們繼續投資於稀有和孤兒領域，以尋找像我們在 Jubi 所呼籲的那樣的機會，利用我們在全國範圍內擁有的平台，並從市場准入的角度與付款人關係，這將繼續在那裡進行。我們確實認為，隨著市場的不斷發展，腫瘤學預科提供了一些獨特的機會，並思考我們如何利用基礎設施，不僅是我們的藥房基礎設施，還有輸液套件基礎設施來服務更廣泛的治療。因此，我們認為，您知道，我們仍然有重大機會尋找其他成長載體，繼續與生物製藥上游合作，成為他們的首選平台，幫助推出新產品、稀有和孤兒產品以及新產品入口空間。我們認為，有一個強大的輸注產品管道正在通過 FDA 審批流程，我們認為我們的平台是獨一無二的，並為他們提供了一個真正強大的合作夥伴，使他們能夠將他們的產品推向市場。我們將繼續追求所有這些方面，我們一直在尋求重新加載並繼續重振我們已經擁有的產品組合，因為我們經歷了這些不同的產品週期，無論是通用產品還是通用產品生物仿製藥或其他產品。到達其生命週期的終點。你知道，正如我們設法解決的那樣。

All right, I'll leave it there. Thank you.

好吧，我就把它留在那裡。謝謝。

Thanks, Jamie.

謝謝，傑米。

Thank you.

謝謝。

Our next question comes from Peto Ticking from Deutsche Bank. Your line is open.

我們的下一個問題來自德意志銀行的 Peto Ticking。您的線路已開通。

Hey, good morning guys and apologize for sticking on the Stelar topic here. But you know, I guess the first question is what percent of your patients on Stelar are, are the first time in IV. What percent of them are the medically assisted subcu and what percent of them are on IV? Because they can't tolerate subcu.

嘿，大家早上好，很抱歉在這裡停留在 Stellar 主題上。但你知道，我想第一個問題是，接受 Stelar 治療的患者中，有多少百分比是第一次接受 IV 治療。其中有多少百分比是接受醫療輔助的 Subcu，有多少百分比接受靜脈注射？因為他們無法容忍subcu。

We're not going get into specifics po But I think based on John's comments, you can assume that the the majority of our patients are ones that are not on the self admin subcu it's patients that have that medical necessity and required additional clinical oversight.

我們不會討論具體細節，但我認為根據約翰的評論，您可以假設我們的大多數患者都沒有自我管理子庫，而是具有醫療必要性並需要額外臨床監督的患者。

Okay. And then you know, like if they, the thing that's for how, how does rebates flow? You know, I was moving to the bio similar as the mechanics here. If, if we collapse the reference pricing and if you ship 100% of your va you know, market share into biosimilars, is it because the new pricing of the biosimilars is low enough, there's not enough spread for the rebates to offset the lost EBIT you're getting today. Is that true how this is flowing through?

好的。然後你知道，如果他們的話，回扣是如何流動的？你知道，我正在轉向與這裡的機制類似的生物。如果，如果我們折疊參考定價，並且如果你將100% 的VA 運送到生物仿製藥，你知道，市場份額是否是因為生物仿製藥的新定價足夠低，沒有足夠的回扣利差來抵消損失的息稅前利潤你今天得到了。這是真的嗎？

I'm not sure I'm following exactly how you map that out, Peto. But look again when when things are going to go biosimilar, we would expect that that reference price will compress considerably again in my, in my comments earlier, in response to one of the questions, one of the things that has enabled us to maintain our investment and patient support and clinical models is maintaining that spread off of which even at a lower reference price due to biosimilar competition, we can maintain a margin which enables us to again invest and maintain that higher level of clinical care based on the the engagement thus far. Again, what is unique about this is that not only would we expect over the course of next year, that reference price to compress as as biosimilars are introduced. What we're talking about this morning is simply that that margin or that spread based on recent conversations is basically being dramatically reduced. And so putting aside what we would expect the reference price to do again, part of the reason why things going biosimilar in previous experience hasn't been as punitive is because again, in many instances, we were able to expand that spread because of the competitive dynamics.

我不確定我是否完全遵循你的想法，Peto。但再看看，當事情要走向生物相似藥時，我們預計參考價格將再次大幅壓縮，在我之前的評論中，為了回答其中一個問題，使我們能夠維持我們的投資、患者支持和臨床模型正在維持這種分佈，即使由於生物相似藥競爭而導致參考價格較低，我們也可以保持一定的利潤，這使我們能夠根據參與度再次投資並維持更高水平的臨床護理遠的。同樣，這一點的獨特之處在於，我們不僅預計明年的參考價格會隨著生物相似藥的推出而壓縮。我們今天早上談論的只是基於最近對話的利潤或價差基本上正在急劇減少。因此，拋開我們期望參考價格再次出現的情況不談，在以往的經驗中，生物相似藥之所以沒有那麼具有懲罰性，部分原因是因為在許多情況下，我們能夠擴大這種價差，因為競爭動態。

So.

所以。

You know, do you have a range as to where you think that the for either the biosimilar and or the new price and net price will be as of January 1?

您知道，您認為自 1 月 1 日起生物相似藥和/或新價格和淨價的範圍是多少？

Because we have Cigna talking about, you know, sort of $5000 range. It sounds like it's going to be coming up below that.

因為我們有 Cigna 在談論，你知道，大約是 5000 美元的範圍。聽起來它會低於這個值。

Unfortunately, PTO for a variety of reasons. At this point, we're on a, we're not in a position to provide any ranges or more specific expectations.

不幸的是，PTO由於多種原因。目前，我們無法提供任何範圍或更具體的期望。

Okay. So, you know, a last question here, you know, the stocks are obviously getting pretty hard, you know, you know, getting hit hard, hard here as, as you people are trying to underwrite for this commentary on material gross profit impact next year. And I know it's too early to size it up with the conviction. But can you give some ranges of when you say material impact to gross profit so people can help put ranges on that as people you know, look to value the company. Thanks.

好的。所以，你知道，這裡的最後一個問題，你知道，股票顯然變得相當困難，你知道，你知道，受到沉重打擊，就像你們試圖承銷有關重大毛利潤影響的評論一樣明年。我知道現在判斷這個信念還為時過早。但是，當您談到對毛利潤的重大影響時，您能否給出一些範圍，以便人們可以幫助確定範圍，因為您認識的人希望對公司進行估值。謝謝。

Yeah, look, Peter. The reason we brought this up is obviously as we've been, you know that John and I and Nicole have been spending quite a bit of time engaged with shareholders. We understand that this is a topic that is near the top of the list is people think about 25 and beyond. And so while we're not in a position to provide any specific ranges or any more granularity, for obvious reasons, we did want to try to be transparent to highlight that this is something again based on recent dialogues we believe will be material. Now again, we're not in a position to debate what material means and put a number behind it. But again, I think we have a track record where things come up. We strive to be as transparent as responsible with the investors in the enterprise.

是的，看，彼得。我們提出這個問題的原因顯然與我們一直以來的情況一樣，你知道約翰、我和妮可已經花了相當多的時間與股東接觸。我們知道，這個話題是 25 歲及以上的人最關心的話題。因此，雖然出於顯而易見的原因，我們無法提供任何具體範圍或任何更大的粒度，但我們確實希望嘗試透明地強調，這再次基於我們認為將是重要的最近對話。現在再說一遍，我們無法爭論材料的含義並在其後面加上數字。但同樣，我認為我們在出現問題方面有記錄。我們努力對企業投資者保持透明和負責任。

Great, thanks so.

太好了，非常感謝。

Much.

很多。

Thank you.

謝謝。

Our next question comes from Joaquin Martinez from Bank of America. Your line is open.

我們的下一個問題來自美國銀行的華金·馬丁內斯。您的線路已開通。

Hi, this is.

嗨，這是。

Actually Joanna Grick in here. Can you hear me?

事實上喬安娜·格里克就在這裡。你聽得到我嗎？

Yeah, Joanna Crystal Clear. Hi, how.

是的，喬安娜水晶般清澈。你好，怎麼樣。

Are you? Yes, I think Joaquin set up the 10 for this call. So this is actually my line but thank you so much for taking the question. So just to follow up on these comments around the the offsets to the stla with margin pressure, I guess kind of question like PTO had but can you grow ebida next year.

你是？是的，我認為華金為這次通話設定了 10。這實際上是我的台詞，但非常感謝您提出這個問題。因此，為了跟進這些關於邊際壓力對 stla 的抵消的評論，我想像 PTO 那樣的問題，但明年你能增加 ebida 嗎？

Joanne? At this point, we're not in a position again, is as you know, we provide guidance on our fourth quarter call, which we would expect to be in late February. Obviously, as I mentioned on that call, we'll be in a position to provide initial thoughts on 25 outlook. We're obviously very much managing real time information on the supply chain dynamics. What are some of the growth opportunities like the acute opportunities that that lie in front of us? And again, based on ongo dialogue, we would expect by that point that we'll have more substantive expectations around the potential impact that we talked about from the drug pricing impact at this point. We're not in a position where we're going to stick to our, our protocol, which is to provide guidance on the February call.

喬安妮？在這一點上，我們再次陷入困境，如您所知，我們為第四季度的電話會議提供了指導，我們預計將在二月下旬舉行。顯然，正如我在那次電話會議中提到的，我們將能夠提供有關 25 展望的初步想法。顯然，我們非常重視管理供應鏈動態的即時資訊。我們面前有哪些像緊急機會這樣的成長機會？再次，根據正在進行的對話，我們預計到那時我們將對我們此時討論的藥品定價影響的潛在影響產生更實質性的期望。我們不會堅持我們的協議，即為二月份的電話會議提供指導。

No, I understand. And I guess as we think about this drop also moving into the biosimilar zone and such, you know, does this impact your, I guess long term growth algorithm, you know, looking, you know, beyond 25.

不，我明白。我想，當我們考慮這種下降也進入生物仿製藥區域時，你知道，這是否會影響你的，我想長期增長演算法，你知道，看起來，你知道，超過 25。

Yeah, look, I think we've been consistent in that we believe and we've articulated that on an organic basis, we view this enterprise as a high single digit top line opportunity and given the leverageability and the scalability, we think that translates into a low double digit enterprise over the medium and long term. I think if you look at the track record over the last five years, we have significantly exceeded both of those guardrails. And even when there are things we've called out like the procurement benefits last year, we try to be as transparent and forthright with the investors on some of these dynamics, frankly, some of which we don't control such as the spread on, on the drug. So does this change our conviction in the medium term growth opportunity? No, it does not. I think for a lot of the things that John articulated around, you know, the acute opportunity and our ability to differentiate there, we're starting to see some, some green shoots around Alzheimer's with some of our clinical experimentation and some of the the opportunities on rare and orphan and chronic categories. I don't think that that, you know, I I think as we've articulated there will be likely an impact in 2025 but over the medium term there that we're not wing from our confidence in this platform.

是的，看，我認為我們一直堅信，並且我們已經明確表示，在有機的基礎上，我們認為這家企業是一個高個位數的頂線機會，考慮到槓桿率和可擴展性，我們認為這可以轉化為中長期內將轉變為低兩位數企業。我認為，如果你看看過去五年的記錄，我們已經大大超過了這兩個護欄。即使我們已經提出了一些事情，例如去年的採購優惠，我們也會盡力對投資者就其中一些動態保持透明和直率，坦率地說，其中一些動態是我們無法控制的，例如利差，關於藥物。那麼這是否會改變我們對中期成長機會的信念？不，事實並非如此。我認為，對於約翰所闡述的許多事情，你知道，緊迫的機會和我們的差異化能力，通過我們的一些臨床實驗和一些研究，我們開始看到阿茲海默症周圍的一些新芽。 、孤兒和慢性類別的機會。我不認為，正如我們所闡明的，這可能會在 2025 年產生影響，但從中期來看，我們不會放棄對這個平台的信心。

Thank you. And if I may follow up on, on different topic around your insurance suites, any update there, did you add more locations and how you're thinking about this or that sort of, you know, much just the story of maturation of these clinics. Thank you.

謝謝。如果我可以跟進有關您的保險套件的不同主題，那裡有任何更新，您是否添加了更多地點以及您如何考慮這個或那個，您知道，這只是這些診所成熟的故事。謝謝。

Yeah, Joanne, it's gone. So in the quarter, we added three additional infusion suites into the the network, we continue to drive utilization of that. Again, the positive aspects that we've called out before is we see a really high patient satisfaction in the utilization of the it drives operating efficiencies and and certainly, as we put more facilities closer to where the patients are and in their activities of daily living, it just increases the opportunities for us to move that forward. We also operate that you know, multiple I guess two different models of the infusion suites of operating as a home or alternate treatment site as well as those that have an advanced practitioner. That provides that oversight in the model and our ability right now to kind of utilize both of those and experiment and learn as Mike said to make certain that we are approaching and identifying opportunities for a expanded use of that advanced practitioner model are things that we're encouraged by. And we think we'll continue to make investments in that space, not only in the Infusion Suite in its traditional sense of an alternate treatment sites, but also in these infusion clinics that have an advanced practitioner to oversee the infusion and to help you know, expand the portfolio of products that we are able to service.

是的，喬安妮，它不見了。因此，在本季度，我們在網路中添加了三個額外的輸液套件，我們繼續提高其利用率。同樣，我們之前指出的積極方面是，我們看到患者對它的使用非常高的滿意度，它提高了運營效率，當然，隨著我們將更多的設施設置得更靠近患者所在的地方以及他們的日常活動，生活，它只會增加我們前進的機會。您知道，我們也經營多種不同型號的輸液套件，作為家庭或備用治療場所以及擁有高級執業醫師的輸液套件。這提供了對模型的監督，以及我們現在利用這兩者以及實驗和學習的能力，正如邁克所說，以確保我們正在接近和識別擴大使用該高級從業者模型的機會，這是我們的事情。重新受到鼓勵。我們認為我們將繼續在該領域進行投資，不僅是傳統意義上的替代治療場所的輸液套件，而且還有這些輸液診所，這些診所擁有高級執業醫師來監督輸液並幫助您了解，擴大我們能夠提供服務的產品組合。

Thank you.

謝謝。

Thank you, Jan.

謝謝你，簡。

Thank you.

謝謝。

This concludes the question and answer session. I would now like to turn it back to management for closing remarks.

問答環節到此結束。我現在想將其轉回給管理層以供結束語。

Thank you all for joining us this morning and participating on our call as we outlined, the third quarter was very productive and our team continued to execute at a very high level even with significant disruptions in the marketplace.

感謝大家今天早上加入我們並參加我們的電話會議，正如我們所概述的那樣，第三季度非常富有成效，即使市場出現嚴重混亂，我們的團隊仍繼續以非常高的水平執行。

Despite the unexpected gross margin pressures that will impact our business in 2025 our team remains focused on identifying cost efficiencies and additional growth initiatives to help offset some of these headwinds. We understand the important role that we play in delivering care to our patients and their families. This remains the light that guides us as we continue to grow and deserve even more patients in 2024 and beyond. Thank you very much and have a great day.

儘管毛利率壓力將在 2025 年影響我們的業務，但我們的團隊仍專注於確定成本效率和額外的成長計劃，以幫助抵消其中的一些不利因素。我們了解我們在為患者及其家人提供護理方面發揮的重要作用。這仍然是指引我們不斷成長的光明，我們值得在 2024 年及以後接待更多病人。非常感謝您，祝您有美好的一天。

Thank you for your participation in today's conference. This does conclude the program and you may now disconnect.

感謝您參加今天的會議。這確實結束了程序，您現在可以斷開連接。