Good day, and thank you for standing by. Welcome to the Laboratory Corporation of America Holdings' First Quarter 2024 Conference Call. [Operator Instructions] Please be advised that today's conference is being recorded..

I would now like to hand the conference over to your speaker today, Christin O'Donnell, Vice President, Investor Relations. Please go ahead. .

Thank you, operator. Good morning, and welcome to LabCorp's First Quarter 2024 Conference Call. As detailed in today's press release, there will be a replay of this conference call available via telephone and Internet.

With me today are Adam Schechter, Chairman and Chief Executive Officer; and Glenn Eisenberg, Executive Vice President and Chief Financial Officer..

This morning, in the Investor Relations section of our website at www.labcorp.com, we posted both our press release and an Investor Relations presentation with additional information on our business and operations, which include a reconciliation of the non-GAAP financial measures to the most comparable GAAP financial measures both of which are discussed during today's call.

Additionally, we are making forward-looking statements.

These forward-looking statements include, but are not limited to, statements with respect to the estimated 2024 guidance, and the related assumptions, the recently completed spinoff of Fortrea Holdings, Inc., the impact of various factors on the company's businesses, operating and financial results, cash flows and/or financial condition including the COVID-19 pandemic and global economic and market conditions; future business strategies, expected savings, benefits and synergies from the LaunchPad initiatives and from acquisitions and other strategic transactions and partnerships, the planned holding company reorganization and opportunities for future growth..

Each of the forward-looking statements is subject to change based upon various factors, many of which are beyond our control. More information is included in our most recent annual report on Form 10-K and subsequent quarterly reports on Form 10-Q and in the company's other filings with the SEC.

We have no obligation to provide any updates to these forward-looking statements even if our expectations change..

Now I'll turn the call over to Adam Schechter. .

Thank you, Christin. Good morning, everyone. It's a pleasure to be here with you today. We look forward to sharing our first quarter 2024 results and progress on our strategy. But before I do that, I want to address the recent announcement that LabCorp was selected as the winning bidder for select assets of Invitae..

This transaction will advance our strategy to launch and scale specialty testing in areas such as oncology and rare diseases. These are strong assets in important disease areas, and they fit strategically with our focus on specialty testing. Invitae has strong science, a great NGS platform and strong talent.

Upon completion of the transaction, LabCorp expects approximately $275 million to $300 million in annual revenue, with the vast majority in specialty areas, such as oncology and rare diseases. .

The purchase price for the transaction is $239 million. We expect the transaction to be dilutive to adjusted earnings by approximately 2% to 3% in the first full year. We expect the transaction to be accretive in year 2 and to exceed our cost of capital in year 3..

Now I'll move to the quarter. LabCorp delivered strong top line performance in the first quarter driven by growth in both of our businesses, Diagnostic Laboratories and Biopharma Laboratory Services.

We continue to execute well on our strategic priorities through being a partner of choice for health systems and regional local laboratories through launching key new tests in important therapeutic areas and by harnessing science, technology and innovation to bring new tests, services and capabilities to our customers around the world..

Let's turn now to our first quarter financial results. In the first quarter, revenue totaled $3.2 billion and adjusted earnings per share was $3.68. Enterprise revenue for the quarter increased 5% compared to the first quarter of 2023, with Diagnostics revenue up 4% and Biopharma revenue up 8%.

Biopharma's growth was driven by strength in central laboratories, partially offset by early development research laboratories. Enterprise-based business margins are up compared to the prior year. Higher margins in Biopharma were partially offset by Diagnostics margins. We expect margins in both businesses to be up for the full year.

The overall strength in our business enabled us to narrow the range and raised the midpoint of our EPS full year guidance to $14.90 despite a negative impact from currency..

Glenn will provide more details on our results and 2024 outlook in just a moment. In the first quarter, LabCorp advanced key growth initiatives that support our strategy. We began 2024 with positive momentum, reinforcing our position as a partner of choice for health systems and regional local laboratories.

We continue to be active on the acquisition front..

We closed three transactions in March, including health system agreements with Baystate Health in Massachusetts and Providence in California and a regional lab acquisition in California. In March, we also entered into an agreement to acquire select assets of BioReference Health's diagnostic business.

This transaction will increase access to LabCorp's high-quality clinical laboratory services..

These new assets are focused on clinical diagnostics and reproductive and women's health. Our business development pipeline remains strong. Building on the success of our acquisitions and strategic partnerships, we continue to incorporate the power of science, technology and innovation across the organization.

This commitment is demonstrated by how we've expanded our test menu this quarter. We advanced our leadership in neurodegenerative disease with the launch of pTau217 blood-based biomarker test that aids in the diagnosis of Alzheimer's disease and the monitoring of patients undergoing treatment with new therapies..

It's also available to be used in clinical trials. In addition, earlier this month, we announced the launch of our GFAP blood biomarker test for the early detection of neurodegenerative diseases and neurological injuries.

Following the launch of our ATN profile last fall, these two significant advances in the company's testing portfolio extend our leadership in a rapidly accelerating field of blood-based biomarkers for neurodegenerative diseases..

We continue to accelerate our leadership in oncology. We launched LabCorp plasma detect, the first clinically validated whole genome sequencing MRD solution for early-stage colon cancer to identify patients at increased risk of reoccurrence after surgery or adjuvant chemotherapy.

LabCorp plasma detect developed by our PGDx laboratory is a significant achievement that enhances our liquid biopsy portfolio and strengthens our position at the forefront of driving better patient outcomes in oncology..

We introduced a weight loss management test portfolio in the quarter, a suite of tests that supports individuals and physicians with accessible and convenient testing options to guide weight loss management decisions and treatment, including lifestyle modifications, GLP-1 medications or bariatric surgery.

LabCorp OnDemand introduced a magnesium test and a micronutrient test to measure key vitamin and mineral levels to support individual wellness. We also announced an STI pass for Mgen. Mgen can be as widespread as chlamydia and gonorrhea.

This test includes a reflex to identify resistance to macrolides, a commonly used treatment addressing high antibiotic resistance and treatment failures associated with the infection..

In April, we received emergency use authorization from the FDA for our Mpox PCR test, a home collection kit. The test is the first at-home collection kit authorized by the FDA to aid in the diagnosis of infection with Mpox. Physicians can order for patients 18 years of age or older who are suspected of Mpox infection.

In addition, we launched our electronic requisition digital capability to help Biopharma customers and investigator sites, improve protocol compliance by reducing errors, queries, holes and data revisions. .

Earlier this month, we released our latest corporate responsibility report, which highlights the significant progress that we're making as we pursue our mission to improve health and to improve lives in a sustainable way. .

We invite you to take some time to review the report that can be found on our Investor Relations website. As part of our earnings release this morning, we also announced our intention to create a new holding company named LabCorp Holdings Inc. to more closely align with our brand and better position us as a global organization.

I'd like to thank our team of more than 67,000 employees around the world. Their ongoing commitment has once again earned us recognition of Fortune's World's most Admired Companies list. We're extremely proud of this recognition..

In summary, we continue to make progress against our strategy and to achieving both near-term and longer-term goals. We remain focused on our position as leaders in science, technology and innovation, and driving further value for our customers, our shareholders and our employees..

With that, I'll turn the call over to Glenn. .

Thank you, Adam. I'm going to start my comments with a review of our first quarter results, followed by a discussion of our performance in each segment and conclude with an update on our full year guidance. For reference, we've also included additional business information that can be found in our supplemental deck on our Investor Relations website..

Revenue for the quarter was $3.2 billion, an increase of 4.6% compared to last year. Primarily due to organic Base Business growth and the impact from acquisitions, partially offset by lower COVID testing. The Base Business grew 6.7% compared to the Base Business last year, while COVID testing revenue was down 70%.

Organically, in constant currency, the Base Business grew 4.3%. Operating income for the quarter was $321 million, 10.1% of revenue or 14.3% on an adjusted basis..

During the quarter, we had $49 million of restructuring charges and special items, primarily related to acquisitions and LaunchPad initiatives. In addition, we had $22 million of expense for transition service agreements related to the spin of Fortrea, with the corresponding income recorded in other income.

Excluding these items and amortization of $60 million, adjusted operating income in the quarter was $453 million or 14.3% of revenue compared to $448 million or 14.7% last year..

The margin decline was due to lower COVID testing. Base Business margins were up as the benefit of demand and LaunchPad savings were partially offset by higher personnel costs. Our LaunchPad initiative continues to be on track to deliver $100 million to $125 million of savings this year, consistent with our long-term target.

The adjusted tax rate for the quarter was 23% compared to 22.1% last year..

The higher adjusted tax rate was primarily due to a stock-based compensation benefit in the prior year. We continue to expect the full year adjusted tax rate to be approximately 23%. Net earnings from continuing operations for the quarter were $228 million or $2.69 per diluted share..

Adjusted EPS were $3.68 in the quarter, up 7% from last year. Operating cash flow from continuing operations was a use of $30 million in the quarter compared to $186 million generated a year ago. The reduction in cash flow was due to lower cash earnings, primarily related to deferred taxes and the timing of working capital requirements.

Capital expenditures totaled $134 million in the quarter or 4.2% of revenue..

This compares to $78 million or 2.6% in the prior year, which was impacted by the pending spin of Fortrea. For the full year, we continue to expect capital expenditures to be approximately 3.5% of revenue. Free cash flow from continuing operations for the quarter was a use of $164 million.

The first quarter is seasonally the company's lowest quarter for free cash flow..

We continue to expect free cash flow for the full year to be between $1 billion to $1.15 billion. During the quarter, the company invested $259 million in acquisitions and paid out $62 million in dividends. At quarter end, we had $99 million in cash, while debt was $5.1 billion. Our leverage was 2.5x gross debt to trailing 12 months adjusted EBITDA..

Now I'll review our segment performance, beginning with Diagnostics Laboratories. Revenue for the quarter was $2.5 billion, an increase of 4.1% compared to last year, with organic growth of 1.8% and acquisitions net of divestitures contributing 2.2%.

The Base Business grew 6.8% compared to the Base Business last year, while COVID testing revenue was down 70%. Organically, in constant currency, the Base Business grew 4.4%..

Total volume increased 3.4% compared to last year. Base Business volume grew 4.9% compared to the Base Business last year as organic volume increased 2.7%, while acquisitions contributed 2.2%. Price/mix increased 0.6% versus last year due to an organic base business increase that was partially offset by lower COVID testing.

Base Business organic price/mix was up 1.7% compared to the base business last year..

Diagnostics adjusted operating income for the quarter was $418 million or 16.9% of revenue compared to [ $442 ] million or 18.5% last year.

The decrease in adjusted operating income was due to a reduction in COVID testing, while Base Business income was up as the benefit of demand and LaunchPad savings were partially offset by higher personnel costs.

The decrease in adjusted operating income margin was due to the reduction in COVID testing, the negative impact from weather and the mix impact from lab management agreements, which we expect to improve over time..

Now I'll review the segment performance of Biopharma Laboratory Services. Revenue for the quarter was $711 million, an increase of 7.5% compared to last year due to an increase in organic revenue of 5.1% and foreign currency translation of 2.4%.

The revenue growth was driven by continued strength in Central Labs, which was up 13%, while early development was down 4% due to continued higher-than-normal cancellations and lower orders. While cancellations are higher than normal, we have seen a sequential improvement from last quarter..

Biopharma adjusted operating income for the quarter was $100 million or 14.1% of revenue compared to $74 million or 11.1% last year. Adjusted operating income and margin increased due to organic growth and LaunchPad savings, partially offset by higher personnel costs.

We ended the quarter with a backlog of $7.9 billion, and we expect approximately $2.5 billion of this backlog to convert into revenue over the next 12 months. The trailing 12 months book-to-bill was 1.00, which we expect to increase throughout the year..

Now I'll discuss our updated 2024 full year guidance, which assumes foreign exchange rates effective as of March 31, 2024, for the remainder of the year. The enterprise guidance also includes the impact from currently anticipated capital allocation, with free cash flow targeted for acquisitions, share repurchases and dividends.

We expect Enterprise revenue to grow 4.8% to 6.4% compared to 2023..

Compared to prior guidance, this is a narrowing of the range with the same midpoint despite a 50 basis point headwind from currency. We continue to perform well in diagnostics and are narrowing the full year guidance range and increasing the midpoint. We expect Diagnostics revenue to be up 4.8% to 6% compared to 2023.

This is an increase at the midpoint from our prior guidance of 140 basis points, primarily due to stronger base business demand as well as acquisition revenue that is now forecasted in this segment, where it was previously only included in the enterprise guidance prior to the closing of the transactions..

We expect Biopharma revenue to grow 3.7% to 5.7% compared to 2023. The decrease at the midpoint from our prior guidance of 180 basis points is due to currency. This guidance includes the year-over-year positive from foreign currency translation of 40 basis points versus 220 basis points in the prior guidance.

An improvement in the outlook for Central Labs is expected to be offset by early development. We continue to expect margins in Diagnostics and Biopharma to be up in 2024 versus 2023, driven by top line growth and LaunchPad savings. Our guidance range for adjusted EPS is $14.45 to $15.35. .

We have narrowed the range and increased the midpoint of guidance by $0.05, driven by improvement in Diagnostics, partially offset by the change in currency. The free cash flow guidance range is $1 billion to $1.15 billion, unchanged from prior guidance.

In summary, we expect to drive continued profitable growth and strong free cash flow generation that will be used for acquisitions that support our strategy and supplement our organic growth, while also returning capital to shareholders through our share repurchase program and dividends..

Operator, we will now take questions. .

[Operator Instructions] And our first question comes from Jack Meehan of Nephron Research. .

So I wanted to focus on the Invitae deal here. Let's start with Adam.

Can you talk about the strategic value of these assets why you're excited to acquire them out of bankruptcy? And how does the oncology business complement? What you're doing already internally?.

Yes, Jack, so they're strong assets. And we've always said that oncology is one of our core therapeutic areas, and they have a very big hereditary oncology business, much bigger than the business that we have in that area. So it certainly augments what we're doing and it accelerates it in a fairly significant way.

They also have quite a bit of rare disease work that they've done, and that augments our focus on specialty testing..

They have a very good NGS platform. We have a platform, but we're going to look to see what we can use that they have and use what we have and get the best platform we can possibly get. They have very good talent. And I think we're able to do it at a reasonable deal.

It's a company that people have looked at for years and years that their valuation you could never get past. But the science was always very good. Their capabilities were always very good. So strategic that feel fits very well for us. .

Yes, that makes a ton of sense. And then a second one for Glenn. Can you just talk about the strategy to work down the dilution? Prior to the bankruptcy, I think Invitae was targeting a burn of over $200 million.

Some of that's related to things you're not acquiring, but your target -- you laid out calls for maybe $30 million to $50 million burn was my math.

Can you just talk about the confidence it won't be worse than that and then the action steps to get to accretion in year 2?.

Yes, Jack. So again, as Adam commented, we're very excited about the acquisition. And frankly, going out of acquiring the select assets through bankruptcy from a purchase price, obviously, relative to other deals that we see of similar focus in our therapeutic areas is quite attractive.

As we think about long-term value creation, you heard in the opening comments that we expect this to exceed our cost of capital in year 3 and have a very attractive overall return on our investment..

But to your point, in the near term, it will be dilutive. This is a business that has a high cost structure. And from our perspective, like other acquisitions that we've done of similar ilk we'll be able to leverage the cost structure within LabCorp to leverage. It's a business that has a very high gross margin, which is, again, very attractive to us.

Obviously, we'll continue to instill LaunchPad disciplines that we have which will benefit them as well. But the big opportunity to improve their profitability is on the cost side. They spend a fair amount in R&D, which we would expect to continue. Obviously, the value of what we're acquiring.

But from sales, marketing and especially general administrative costs, where we can leverage our infrastructure we'll be able to get it profitable, as Adam said, within the first year. So it's all about integration.

We'll do it on a very disciplined and timely manner, but we expect it to ultimately be accretive in the second full year of our ownership. .

And our next question comes from Erin Wright of Morgan Stanley. .

Could we talk a little bit about what's embedded in guidance as it relates to the acquisition contribution versus organic growth and base business strength in the Diagnostics segment. I just want to make sure kind of can you remind us what's embedded in the enterprise level guidance versus the segment level guidance as well. .

When we talk about the 3 acquisitions that we announced in the quarter, that's adding obviously to the change in the guidance we did for diagnostics. So when you look at the change, just use the midpoint of our guidance, it improved 140 basis points, I assume roughly half of that is from those 3 acquisitions..

And again, those were already incorporated in our enterprise guidance but not until the segment, until the deals were closed. So half of it is due to the acquisitions, and then the other half of the growth is demand. The strength that we saw in the first quarter that we also expect to see continued through the year. .

Okay. That's helpful.

And then switching to the Biopharma segment, what are you expecting for the balance of the year at this point? What are you seeing in terms of RFP flow and cancellations? And how would you just characterize the underlying health, particularly across that early development business?.

Yes. So I'll start overall and then I'll answer early development specifically, Erin. So overall, Biopharma Laboratory Services grew 8% and Central Labs had very strong growth at 13%. Now realizing Central Labs had a relatively easy compare versus first quarter of last year.

You probably remember in first quarter of last year, there were a lot of personnel issues at investigator sites. If you look at the ED growth, it's coming back slower than we anticipated, but it's being offset by the strength in our Central Lab business..

If you look at RFP flow, for Central Lab, everything looks normal, everything looks really strong. That business is very healthy. If you look at early development, we still continue to have good RFP flow. The win rates are good. The cancellations still remain higher than what we would expect.

The first quarter was a bit better than fourth quarter of last year, but still higher than what we anticipate.

So as we go through the rest of the year, we were able to maintain the revenue guidance for BLS, if you just adjust only for foreign exchange where Central Labs is going to continue to outperform, and we expect it's going to take a bit longer for the early development business to fully come back. .

And our next question comes from Patrick Donnelly of Citi. .

I want to pick up kind of right where you left off there on the Biopharma piece. Can you just dive a little bit deeper into early development. Obviously, again, the book-to-bill softened a little bit there on the BLS side. There's a lot of focus on the early development piece.

Can you just talk about the visibility on that front? And again, the expectations as we work our way through the year, maybe both on orders and the revenue side would be helpful. .

Sure. So I'll start with the book-to-bill. So the book-to-bill was 1.0 that's lower than we would typically like. However, we've got insight to the book-to-bill for second quarter already and insight to the rest of the year. And I expect the book-to-bill to continue to grow starting next quarter throughout the rest of the year.

The health of the book-to-bill still looks good across the business. It's an early development part of the book-to-bill, which frankly, is a little bit less relevant because early development, a lot of the studies start in the year and finish in the year. Typically with the book-to-bill, you look for things that go more than a year or over time..

So as I look at the early development book-to-bill, it's not where we would like it at the moment, but the RFPs are good. The win rate looks good. It's the cancellations that are driving the majority of the issues. But that can correct itself faster typically because the burn rate is so much quicker.

As we go through the rest of the year, we expect that the early development business starting in the second half will begin to be stronger than the first half. .

Yes. The only thing I'd add too, Patrick, is when you put the size of the business in perspective, obviously, it's less than 10% of the company. But even within Biopharma you have 2/3 of the segment, let's say, Central Labs.

And that's really where the backlog, if you will, the book-to-bill is probably more applicable because the backlog that we have in Central Lab is effectively supporting most of the revenues over the next 12 months.

So to your point on visibility with early development, we have less visibility because it's a much lower percentage of the backlog with that business and much shorter lead times. So it just puts in a little bit more volatility, if you will..

But on a positive side, as we ultimately see the rebound in that business, we'll be able to get those revenues and bring them into revenues on a quicker basis than we could have within Central Labs. .

And our next question comes from Michael Cherny of Leerink Partners. .

Maybe just one quick clarification on Invitae. You talked about the financial impact in the first full year post close.

Is there any financial impact currently embedded in the guidance?.

So Michael, this is Glenn. When you look at the guidance that we've given, and we always kind of say the midpoint of the range is what our expectation is, and then there's always going to be pluses and minuses, which is why we put a range. So at the midpoint of our guidance, the answer is Invitae is not in those numbers..

But when you look at the guidance range, so relative to the revenues of Invitae or the potential dilution in the first year, that would be incorporated, if you will, sizing it within the range we've given. So I guess the answer is it's not in the explicit guidance, but it's captured within the range that we've provided.

We're looking to close this and it will obviously depend when we do, but let's say it's in the third quarter. Obviously, when we have our announcement of our quarterly call, we will update our guidance to reflect, obviously, a half a year left.

But obviously, acquisitions that would have been completed as well which, again, we may see Invitae over that time frame. .

Okay. That's helpful, Glenn. And then maybe just on price and rev per rec.

Can you just give us a sense on how it tracked over the quarter relative to your expectations? And in terms of the Base Business guidance increase for the Diagnostic Laboratories business, how much of that is the difference between improvements in volume versus improvements in price?.

Yes. So overall, we normally talk about our growth weighted to volume versus price mix and kind of 3:1 ratio, if you will. Obviously, it was a little different during the quarter, but strength, frankly, on both volume and on price mix. The price/mix frankly is mix related. We would normally say unit price is relatively flat.

But the improvement that we saw in the quarter from a mix standpoint was the live management agreements, was the -- our test per session..

We continue to see favorable movement and we're seeing a higher percent of our growth coming from our esoteric business versus routine. So all those three kind of improved our mix. But clearly, the growth that we expect to see is driven off of demand, which is volume. .

And our next question comes from Ann Hynes of Mizuho Securities. .

So I just want to talk about just the volume and obviously, the Diagnostics segment is very strong. And it's in line with what your largest period as reported.

And I'm just -- I'm trying to figure out like how much is driven by underlying demand, which is strong, but also how much is driven by maybe the national companies taking market share? And if you are taking market share, who are you taking it from?.

Yes. So and I'll give you -- broadly speaking, and then maybe Glenn can add some details. But broadly speaking, if you look at the hospital deals that we're doing, there's a significant number of them that we had last year, at the end of the quarter, going into this year. And when you do those, those are, by definition, getting some market share.

And then when you think about what's happening in the marketplace around those hospitals, you expect that you'll pick up some market share there as well..

So I think a lot of it is that the market is strong. You're seeing a lot more people getting procedures and so forth. But in addition to that, I think there is some share gains that you're seeing because of what we're doing and the strength that we have in the hospital market sector. .

Yes. No, the only thing I'd add is just that we had a good quarter, and we took our full year outlook up to reflecting the stronger demand than we've been seeing. We also look back to pre-pandemic, and we're tracking well within the range that we would normally expect to be.

So some of the year-over-year improvement arguably has driven a bit about and not fully recovered year -- the prior year. But to see that kind of growth, we feel very good about and expect that to continue. .

All right.

And then secondly, heading into the final LDT rules from the FDA, what is LabCorp looking? Like what are the key things we should look for that you won't change in the final rule?.

Yes. So the first thing I'd say is that the LabCorp was supportive of the Valid Act, which we thought was the right way to provide oversight of the FDA of LDTs. It was legislation that was fit for purpose for our industry. We're not supportive of the current rule, although we haven't seen the final rule.

We still have to see that in a whole judgment until we see exactly what's in there. What I worry about most -- and we have great quality organization. We have terrific scientists, and we do so many -- so much research and need to [indiscernible] marketplace. What I worry about is speed to market of LDTs.

And patients that need these LDTs, they're typically smaller groups of patients. Other people aren't necessarily developing tests for them and they need to test as quickly as possible. .

So the real question to me is going to be how fast the FDA will be able to review the new LDTs and get them into the marketplace. .

Our next question comes from Elizabeth Anderson of Evercore ISI. .

I was wondering if you could comment on the pacing of the lab management deal integration.

Anything to pick up on proceeding as sort of as you guys thought, any learnings you would say in terms of others as you continue on that path?.

Yes. So we've gotten quite good at being able to efficiently and effectively run the lab management agreements that we have. When you do 100 hospitals with one organization quickly, you become an expert pretty fast. So what I would say is we take our time because the most important thing is to ensure that there's no patient disruption.

The second thing is to make sure that the physicians are very satisfied with the way in which they can order and the speed in which they get their results. And then over time, we find ways to use our size, our scale and our ability to synergize to reduce cost. And we've learned that the most important thing is to do it really well.

And although the margins never get to our average margins, they start off low and they increase over time. I think you've seen with the announcement of several deals closing in the first quarter, multiple deals closing at the end of last year. There's a slight impact on our margin in the beginning. But over time, the margin is going to improve.

And that's why we believe our Diagnostics margin will increase when you look at the totality of '24 versus '23. .

Got it. That's helpful. Anything you can comment to in the early development business about sort of non NHP growth? Because I just wanted to like sort that out in terms of the impact on the revenues in the quarter. .

Yes. So what I would say is that there's no longer a supply issue with NHP. The only thing that we're seeing with NHP is a bit of a revenue drag because the cost of NHPs when there was a supply issue were much higher. We were charging the higher price, but we weren't making a margin on that higher price.

So now that the prices have come down, the actual revenue for those studies come down with the price. So you're seeing less revenue growth in that area, which I would say is probably a bit artificial because of the price of the NHPs coming down. .

Yes, that makes sense. I just wanted to sort of understand that versus the dynamics in the non-NHP portion of the business. .

Yes. I would say that dynamics in the non-NHP portion you're seeing growth rates that would be a bit higher than the NHP. But again, that's more -- they're both less than what we have seen historically because of what's happening in the biotech world. We are beginning to see signs of recovery in the biotech world.

So both of those parts of the business should recover over time. .

[Operator Instructions] And our next question comes from Kevin Caliendo of UBS. .

I want to talk or ask a little bit about... .

Kevin, we can't hear you. You're breaking up pretty significantly. .

I'm sorry, is it better?.

No. .

I'll try to ask you again, why don't you talk a little bit about margin expectations in the DX segment, specifically around your expectation of labor trends and actual margin in the DX business going forward, like in the first quarter as we're jumping off [indiscernible]. .

Yes. Are you talking margins in CLS or Diagnostics? I couldn't tell. .

Diagnostics, sorry. .

Okay, in Diagnostics. What I would say is that if you look at the Diagnostics business, the business performed very well. We had basically 7% growth in the Base Business and volume was good at almost 5%. The margin was down versus prior year was driven by three things. It was driven by COVID. There was some impact from weather.

And as I previously mentioned, there was some impact from the lab management agreements as we begin to roll those out in the fourth quarter of last year, so in the first quarter, we'll see the margins get better as we go through the year. Overall, we expect the diagnostic margins in '24 to be higher than the margins in '23. .

Yes. The only thing I'd add too is, as Adam said, margins up even despite COVID and weather and lab management agreements for the full year margins to be up slightly but also to see that expected beginning in the second quarter where you'll see nice growth year-over-year. We'll have the normal seasonality.

So when you look at the absolute margins, they'll fluctuate based on seasonality, but the year-over-year improvement, you'll see pick up nicely beginning in the second quarter that gives us the confidence that the margins will be up for the full year. .

Our next question comes from Andrew Brackmann of William Blair. .

Maybe just to piggyback off some of those margin questions on the Diagnostics front, but more specifically on the specialty diagnostics side of things.

I guess, how should we be thinking about moving, the moving pieces there moving forward? Obviously, you gave some color around Invitae, but just as that entire specialty business grows, how are you thinking about its impact on total segment margins here?.

Yes. So the first thing I would say is as we look at the businesses, they're both strong right now are routine testing as well as our specialty testing. We are seeing the specialty testing grow at a slightly accelerated rate versus the routine testing, but routine testing is still the vast majority of the business that we do.

A big part of the reason that specialty testing is important is, number one, they're typically very serious diseases. Number two, when people get specialty testing, they get a lot of routine tests around those specialty tests as well..

And then third of all, they typically or show how strong you are in science and innovation, and it's got a good kind of overhang of the company because we are a scientifically based organization.

So for those three reasons, you'll see specialty testing growing faster than routine testing, but routine tends to go with the specialty testing to some degree. .

Okay. That's helpful. And then I guess maybe a little bit unrelated, but as it relates to your Alzheimer's portfolio more specifically.

Can you maybe just give us a sense of the current scale for that business today? And I guess, as you think in longer term here, just can you talk about the market opportunity that you see in that segment moving forward?.

Yes. What I would say right now, it's not a large part of our business. It's a very small part of our business. But it's an important part because there are new therapies that we believe will become available over time, it's such an important disease and it's growing in the United States and around the world.

So we want to have the broadest portfolio for physicians to use to help with the diagnosis and monitoring of Alzheimer's patients. But once again, many of those patients not only need these Alzheimer's tests, but they'll use a lot of routine tests as they learn to diagnose these patients and monitor them over time..

I would expect, over time, that market will grow, those tests will grow, but I think it will be to some degree, commensurate with how fast the overall prescription drug market grows because when diagnosed, the physicians also want to know what can I do about that. And what should I do about that. .

And our next question comes from Eric Coldwell of Baird. .

It's going to be an embarrassing question when you're afraid to ask it.

But on the NHP and the pricing comments, I'm curious if you could give us any more detail on where your pricing is today, what it looks like going forward versus the recent past? One of your smaller competitors recently shared with the Street that it saw pricing down about 18% versus last quarter. I'm curious if you could frame it for you.

And then I believe at the top of the market, NHP was about half of your early development work in total. I'm curious if you could give us a sense of what that mix looks like today. .

Yes. Eric, with regard to NHP pricing, we've not given what the step down in the pricing has been. And obviously, it impacts the mix and where we get the [ primates ] from and where they're used in the studies.

What we've commented is that it's been a nice reduction in the price from when we were capacity constrained and obviously, the prices were significantly higher.

And I think Adam referenced this earlier as well that from our perspective, while it impacts our revenues, it's really not impacting our profitability because most of the step down in the price of NHPs were pass-through. So the positive is it shows us a lower cost for our customers to get their studies done.

So they're seeing the benefit of it without a negative impact from us overall. To your point, roughly half of the studies that we do are in HP based with the other half that are not, that mix really hasn't changed very much. .

Thanks, Glenn. I appreciate that. Just maybe another macro question. The HLM deals come in at a lower margin, as you've always said, and you've done a flurry of them here recently and then the very big deal with Ascension. I know you're talking about improvements as you integrate and get those onboarded each over the next year each time.

But could you give us an update on where Ascension is at this point, kind of the journey on that contract from the beginning to the present and how it's stacking up on a margin profile and possibly also a revenue profile versus your original expectations?.

Yes. I'll let Glenn answer that question, Eric, but before you guys, I think it's important to note that no two hospital deals are exactly the same, and it really it's three pieces to them, right? There's a lab management part where you run a hospital's labs. There's the outreach business and there's the referral business.

Ascension was kind of an outlier to most of the deals that we do because so much of it was the lab management part of the business, and that has by far the lowest margin that starts out low and improves over time. Most of the deals that we do, they start out with a lower margin.

But overall, with the kind of portfolio of the three types of business, they get to about or average margins over time. So that's the typical deal. Ascension is a bit of an outlier, but maybe you can talk about Ascension, Glenn. .

Yes. No. I think that's right, especially given the size of the transaction overall, let alone the percentage that was live management. But we normally, and Ascension was a good example. Let's say, would be starting a mid-single-digit kind of margin, obviously, mixing us down that we've talked about.

And then we normally see the margin step up over the years with that one, while we expect to see a step up, probably not as strong in just the second year of ownership as relative to others is we continue to share on a value basis, if you will, some of the synergies and the savings that we get, we're obviously passing on to that our large partner there and thereafter starting to see the step up.

So positive direction, but we'll see more of an incremental improvement next year. .

And the revenue for that looks very strong. It's slightly above what we had guided to originally. .

And our next question comes from Michael Ryskin of Bank of America. .

This is John Kim on for Mike. So you've done a lot of deals. You have Invitae, BioReference and the 3 health system agreements that you closed in the first quarter. And Glenn, you talked about how, given the range that Invitae would be included in the top end of the guidance.

So could you just update us on your thoughts on the deal funnel and your capital allocation priority, are there any other larger deals, independent labs or health systems that are still coming our way?.

Yes. So when you think about -- to your point, the transactions that we've done this year and as we commented, embedded in our guidance is the assumption that we'll use our free cash flow for acquisitions, dividends and share repurchases. We have been -- this has been a good year for M&A.

We've always talked about that we've had a strong pipeline of deals, and we're seeing them come to fruition this year. .

But between the 3 deals that we closed in the first quarter the announcement of BioReference and Invitae, you're looking from an M&A standpoint over $700 million of capital allocated to M&A this year. And then you put that with the dividends, you're getting closer to $1 billion. So on the positive side, we had a strong balance sheet.

So another $100 million of call it, free cash flow-ish that will be used between M&A and share repurchases. .

But we're currently leveraged at around 2.5x debt-to-trailing 12 months EBITDA, and we're at the low end of 2.5x, and we give a targeted range of 2.5 to 3x. So within that, call it, 0.5 point on a, call it, a $2 billion plus EBITDA basis, we have another $1 billion of capacity.

So we'll still have a lot of financial flexibility to do share repurchases, to do tuck-in acquisitions that we feel are strategic, but we feel very good about the deals that we've announced this year.

Obviously, we'll spend a lot of time integrating them into the company, but we have the -- obviously, the financial flexibility as well as still a good pipeline of potential opportunities on the deal front going forward. .

Got it. I appreciate that. And if I could ask one on the Biopharma early development. So you talked about the cancellations coming down still a little high. But I wanted to ask, you previously talked about targeting perhaps medium-sized clients.

Any -- has there been any shift or your win rates are good and at least in the Central Labs, has there been any shift in that direction in terms of garnering attention or RFP from the medium-size clients?.

Yes. So we're trying to improve our mix to more larger to medium-sized clients. It takes some time because many of those clients have master service agreements and you have to wait for us to expire or find ways to be part of those. But over time, I'm confident that we'll continue to shift the mix more towards the medium to larger size pharma. .

And our next question comes from Brian Tanquilut of Jefferies. .

I guess my question for you guys. In the past, as we thought about hospital lab acquisitions and outsourcing contracts, the distress in the space or the pressures in the hospitals was one of the driving factors. So as we're seeing broad utilization pickup in the hospital industry health seems to be improving.

Adam, have the conversations changed? Or what does that pipeline look like today? And yes, just curious what those dynamics are and how they're playing into future deals and agreements with hospitals?.

Yes. No, it's a good question, Brian. And it's good news that the systems are doing better and that the hospitals are performing better. I think that's good for all of health care, frankly. So I'm pleased that they are beginning to rebound and do better.

The interesting thing was before the issues with the health systems, a lot of the discussion was can you do it and can you do it well? And should we take the risk that things aren't going to go well..

Because we've done so many -- in so many large institutions, I don't think people have that question anymore. They realize that we are really good at this, that we can manage it better than they probably can by themselves that we'll have no physician interruption or patient interruption of note.

So therefore, they're willing to look and talk to us about continuing to do these deals. Now I think there was a sense of urgency that caused these deals to move quicker in the past. So I'm not quite sure the sense of urgency is there as much as it was before. But the number of discussions and the types of discussions we're having remain very good. .

And our next question comes from Pito Chickering of Deutsche Bank. .

You've got Kieran Ryan on for Pito. I noticed you didn't touch on waiver when discussing the diagnostic margin drivers. I think one of your peers cited some modest improvement in the environment.

So can you just give us an update on what you're seeing on labor as it relates to things like wage growth and turnover?.

Yes. So I'll start with turnover. And I'll give a sense, overall, across LabCorp, our turnover is better now than it was last year or the year before that. In our Biopharma business, I'd say it's back to pre-COVID levels, maybe even a little bit better. So the turnover there has really improved.

In our Diagnostics, we see in certain areas, there's still a higher turnover than what we would have seen prior to the pandemic, particularly in frontline employees, where they have not only other choices in health care, but in other industries. But even there, we start to see less turnover than what we've seen in the past.

There's been a significant inflation of cost due to retaining employees in the past as we go forward, I think it will move back more towards the level of inflation of about 3% or so. .

Got it. And then just a quick follow-up. The prior question was kind of talking about the strong demand that hospitals and some providers you're seeing now.

I was just wondering, does the top line guide in Diagnostics at all contemplate a normalization in kind of broader utilization? Or are you just really not seeing anything outside of what you'd expect at this point?.

Yes. I would say that we're seeing what we would expect at this point is slightly higher, we give a range because there's a range of different things that may or may not occur. But overall, we think that the environment is healthy. .

Yes. When you look at the -- also, I guess, our implied guidance, so you're looking at a stronger top line growth than what we did in the first quarter with our guidance, but that's just really driven off of COVID becoming less of an issue.

It was a bigger issue in the first quarter decline year-on-year, plus that's where we had the adverse impact from weather. So really when you adjust for that, as Adam's commented, the demand that we're seeing, which is came in a little bit stronger than we expected. We expect that to be similar demand going forward throughout the rest of the year. .

And our next question comes from Stephanie Davis of Barclays. .

I feel bad asking about early development because I said we're all focusing on this as a really small part of your business. But I have to ask because you did talk about some risk of potential share shifts when I saw you in March.

So I think about the cut, is this more a function of higher for longer environment that could be impacting biotech funding? Is it something defensive early on, just in case maybe there are some potential share shifts.

And how do we think about the underlying assumptions in terms of how they may have changed in use on cancellations and biotech funding in order to kind of enter new numbers. .

Yes. So as I think about the early development business, I don't think that it's a share shifting. I think our share is remaining consistent within the parts of the market that we compete, we don't compete in all aspects of our -- we don't have a contract manufacturing organization, for example. But in the areas that we compete.

Our win rates look good, our RFPs look good. So I believe that our market share is being maintained. I think we're seeing more that there's still a higher level of cancellations than what we've seen in the past.

And in some instances, it's taking a bit longer for the companies to make their final decisions because they're still managing what I would say is a rather restricted budget even with the funding being better than it has been before..

So the good news is central laboratory, which is by far the largest part of that business remains very strong. and we continue to expect it to be strong, and it's offsetting the weakness that we continue to see in ED that could go on for a bit longer.

But even if it does, we feel that the strength that we're seeing in the largest part of the business offsets that. .

Thank you. I'd now like to turn it back to Adam Schechter for closing remarks. .

I want to thank you all for joining us today. And hopefully, you can see we continue to advance our strategy and make significant progress, and we're going to continue our mission to improve health and improve lives around the world. Hope everybody has a good day. .

This concludes today's conference call. Thank you for participating, and you may now disconnect..