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Operator
Good afternoon, ladies and gentlemen, and welcome to the Progeny, Inc. Fourth Quarter 2021 Earnings Call. At this time, all participants have been placed on a listen-only mode, and we will open the floor for your questions and comments after the presentation. It is now my pleasure to turn the floor over to your host, James Hart. Sir, the floor is yours.
James Hart
Thank you, John, and good afternoon, everyone. Welcome to our Fourth Quarter Conference Call. With me today are Pete Ineske, CEO of Progeny, Michael Stermer, President, and Mark Livingston, CFO. We will begin with some prepared remarks before we open the call for your questions. Before we begin, I'd like to remind you that today's call contains forward-looking statements, including but not limited to statements about our financial outlook for both the first quarter and full year of 2022, including our expected utilization rates and mix, the impact of COVID-19, including variants on our business, clients, member activity, and industry operations, our ability to acquire new clients and retain and upsell existing clients, our market opportunity, size, and expectation of long-term growth, our plans for the expansion of our business, including expansion into other markets and of other services offered, our business performance, industry outlook, strategy, future investments, plans and objectives, and other non-historical statements as further described in our press release that was issued this afternoon. These forward-looking statements are subject to certain risks, uncertainties, and assumptions, including those related to progeny's growth, market opportunities, and general economic and business conditions. We have based these forward-looking statements largely on our current expectations and projections about future events and financial trends that we believe may affect our business, financial condition, and results of operations. Although we believe these expectations are reasonable, we undertake no obligation to revise any statement to reflect changes that occur after this call. Descriptions of these and other risks that could cause actual results to differ materially from these forward-looking statements are discussed in our periodic and current reports filed with the SEC, including in the section entitled Risk Factors in our most recent 10Q. During the call, we will also refer to non-GAAP financial measures such as adjusted EBITDA, adjusted EBITDA margin, gross margin excluding stock-based compensation, and operating expenses excluding stock-based compensation. Reconciliations with most comparable gap measures are also available in the press release, which is available at investors.progeny.com. I would now like to turn the call over to Pete.
John
Thanks, Jamie. Thanks, everyone, for joining us today. Mark will walk you through the details of Q4 in the full year shortly, but before he does, I'll give you some high-level thoughts. In 2021, the company grew to record levels for both revenue, which grew 45% over 2020, and attained its highest levels of profitability with 13.5% adjusted EBITDA margins. We also maintained our nearly 100% retention rate among our existing clients, driven by our industry-leading clinical outcomes, which we achieved for the sixth year in a row, as well as our exceptional member and client satisfaction, which is evident in our best-ever NPS score of plus 81. On top of this, we had our most successful selling season ever, which is the most important driver to our long-term growth, by adding a record 85 new clients and 1.2 million new covered lives. We accomplished all of this despite the unexpected COVID-related waves that marginally disrupted member activity from time to time, including the most recent disruption due to Omicron at the end of the fourth quarter. When we issued our guidance here in early November, we've been experiencing increased utilization as September, October, and November all had strong sequential growth month over month. When the Omicron variant of COVID-19 emerged in early December and spread across the country faster than any other variant, Overall member activity slowed sharply enough that it had an impact on our results in the quarter that was beyond our ability to predict. To put that into perspective, we typically see in our guidance for Q4 contemplated a decline in member utilization from November to December due to the holidays and routine clinic closures. However, the decline we actually experienced in December due to Omicron was nearly twice what we were anticipating, resulting in a negative impact of revenue of approximately $9 million for the quarter. This Omicron-related impact on member activity continued into January as the variant continued to spread across the country and infection levels hit their peak. However, as the awareness grew that the variant was generally producing more mild illness, our members' mindset with respect to pursuing treatment improved. Based on the visibility we currently have, member activity for February and March, as well as the limited visibility we have into April, has rapidly recovered to normal levels, and the Omicron-related impact on member utilization appears to be behind us. One of the most important themes emerging from the last two years is that the substantial majority of fertility patients recognize the time-sensitive nature of their treatment and have continued to be highly resilient in the pursuit of care, even against the backdrop of the pandemic. This can be seen through the consistency in our quarterly utilization rates over the past two years. Additionally, unlike other areas of healthcare that may be significantly strained or altogether disrupted following a surge in COVID cases, the vast majority of fertility clinics aren't located in hospital settings. Clinics have had the resources they need to remain open and available to care for patients, even as COVID cases spike in parts of the country. And whenever COVID has more acutely impacted our member activity, whether it's been due to an increase in cases because of government recommendations related to shutdowns or reopenings, those effects have been both short-lasting and have only affected activity for a relatively small proportion of members overall. Although we can't control a global pandemic and its marginal impact on utilization, the important takeaway is that we are performing at the highest levels in the areas that we do impact. This includes the member experience with our benefit offering, our industry-leading clinical outcomes that are critical to that member experience, our high levels of client satisfaction, which are due to the value of our favorable outcomes generate, our client upsells and renewals, which further demonstrate client satisfaction, and our record levels of new business won. With the near 100% client retention that I previously mentioned, today we have more than 265 clients under commitment, reflecting 4 million covered lives, which are up more than 50% from a year ago. This reflects an approximately 3% share of the large self-insured employers in our target market, which doesn't yet include other types of employers, such as fully insured companies, school systems, unions, and governmental entities and agencies. Now, let's turn over to current sales momentum. While it's too soon to provide you with any detailed quantitative comments, since we're in the very early stages of our 2022 selling season, our sales momentum from 2021 is continuing into 2022. We're seeing meaningful increases across all metrics we use to monitor sales progress versus early selling season progress a year ago at this time. including our total active pipeline, our new pipeline development year-to-date, and year-to-date sales wins so far. This early selling season data gives us confidence that the macro trends driving demand for fertility benefits combined with our recognition as the leader in this space position us well to continue to sustain our momentum from last year's selling season into 2022. Given the caliber of the companies that we work with today or are engaging with in our current active pipeline, It's clear that Progeny has become the provider of choice for fertility solutions amongst the best known and most successful companies in the world. A key contributor to our sales success has been our high rate of member satisfaction. And in 2021, our NPS score increased to the highest it's ever been to plus 81. Given that most healthcare companies routinely score barely above zero or in negative digits, We are incredibly proud of this result, which indicates that our members continue to be extremely satisfied with the services we provide them and the results we achieve for them. This is the fourth consecutive year we've increased our MPS, which speaks to our ongoing focus to maintain or improve member-level services, even as we continue to rapidly expand the business. We ended 2021 with more than twice as many clients and covered lives as we had at the time of our IPO a little over two years ago. And over that period of time, our MPS, which is already at an industry-leading levels, increased by an additional 10 points. In January of 2022, we launched the Progeny Benefit to our largest ever cohort of new clients and covered logs. We have a proven track record of scaling the functions and resources that are needed each year in anticipation of the step function increase that we see in our business. And I'm pleased to report that this year's record client launches have been successful across the board. We begin 2022 in our strongest ever competitive position with a solution that is unparalleled. Nevertheless, we remain focused on developing and introducing new enhancements to our solution. This year, we're looking to increase the level of support that we provide to our male members, specifically addressing those issues affecting male infertility by expanding our service and adding new capabilities. This will provide us with an enhanced product for upsell in the future. When looking at the underlying causes of infertility, male factor infertility, meaning the male partner has an issue that has made conception more difficult, is diagnosed equally and as often as female factor is. And while a reproductive endocrinologist is often able to effectively treat the couple regardless of the underlying cause, in a select number of cases, a reproductive urologist, or RU, may be beneficial to properly diagnose and treat the issue for the male partner. Less than 20% of urologists in the country focus on reproductive health issues, and the carriers may not have this subset of providers or coverage of these services in their network. This lack of coverage creates a gap, which is the issue that Progeny is specifically addressing with this enhanced offering. Separately, we're also expanding our geographic footprint by building our solution to be offered in the Canadian market. This is a natural extension for us, given that many of our existing clients have employee populations there. Although the Canadian government provides universal healthcare to its citizens, Comprehensive fertility coverage is not included in that program. Additionally, the employer supplemental coverage for fertility is even further behind where the U.S. was when we launched our benefit in 2016. As a result, significant majority of Canadians have no coverage today and are forced to fund treatment on their own when they can afford to do so. Companies that do provide a fertility benefit under their supplemental health plans typically self-fund these plans in much the same way large employers sponsor health coverage here in the U.S. We have a clear opportunity to address this unmet need in Canada where we can help educate and drive awareness and ultimately help drive access to care similar to what we've been achieving here in the U.S. We've been leveraging our relationship in the industry to build a Canadian network of leading providers which we expect to manage in much the same way that we do our U.S. network, actively monitoring the patient experience, ensuring adherence to best practices, and measuring outcomes to ensure that our members are having healthier pregnancies and greater overall success in their family building journeys. We're excited about these new areas of focus and we'll update you on our progress in these areas, including timing for go-to-market on future calls. These aren't expected to have an impact on this selling season, but they should set us up nicely for future selling seasons beyond 2022. As the leading fertility benefits manager, we've developed a significant competitive advantage in the marketplace. One significant factor is that we already have the most comprehensive fertility data set in the industry, and that data set grows significantly each year. In 2021, we managed over 28,000 R cycles, up nearly 50% from the prior year. The scale at which we are growing R cycles continues to expand our insights, which then widens our competitive advantage because it deepens our understanding of the ways people are pursuing family building. As a result, Progeny is in a unique position to continue to advance its services to enhance the member experience while also delivering value to our clients. Let me now turn the call over to Mark and he'll walk you through the results in more detail.
Jamie
Mark. Thank you, Pete, and good afternoon, everyone. I'll begin by taking you through our fourth quarter and full year 2021 results and then provide our expectations for 2022. In the fourth quarter, revenue grew 27% to $127.6 million. While revenue increased meaningfully on a sequential basis from the third quarter, driven by strong utilization in October and November, the onset of the Omicron variant impacted member activity in December. As Pete mentioned a moment ago, the sequential monthly decline we actually experienced in December due to Omicron was nearly twice what we were anticipating, resulting in a negative impact to revenue of approximately $9 million in the quarter. And while Omicron continued to have an effect on activity in January, we have seen member utilization return to more typical levels in February, and based on the visibility we have also in March. For the full year, revenue grew 45% to 500.6 million. We are pleased to have reached the milestone of a half a billion dollars in annual revenue in what was just our sixth year of offering the benefit. It was only three years ago, in 2018, that we crossed 100 million in annual revenue, which puts the rapid growth we've achieved into perspective. Turning to the components of the top line, Medical revenue increased 19% in the fourth quarter to 89.2 million, while growing 40% over the full year to 355.6 million. The growth in medical revenue, both in the quarter and the year, was driven by our higher number of clients and covered lives, though our growth in the fourth quarter was impacted by the Omicron variant. Pharmacy revenue increased 50% in the fourth quarter to 38.4 million, Over the full year, pharmacy revenue grew 59% to $145 million. Our growth in pharmacy was primarily driven by the increase in number of clients who have Progeny Rx as compared to a year ago. Though, as was the case for medical revenues, our pharmacy revenue growth in the fourth quarter was also impacted by Omicron. Since launching the pharmacy benefit in 2018, we've seen an uptick each year in the percentage of our newest clients selecting the integrated benefits. Two years ago, 75% of our new clients chose to launch with the pharmacy benefit. That increased to 84% the following year, and in the most recent selling season, 93% of clients added ProgenyRx. As a result, on a blended basis, the percentage of our clients who have ProgenyRx is growing from 73% in 2021 to 81% of all of our existing and committed clients for 2022. And while we're very pleased with the adoption of ProgenyRx to date, there continues to be a meaningful future upsell potential with those remaining clients. We ended the quarter with 191 clients, representing an average of 2.9 million covered lives during the fourth quarter. This compared to 135 clients, or an average of 2.3 million covered lives in the fourth quarter last year, reflecting a 25% growth in covered lives over the past year. The growth in covered lives throughout 2021 was again the result of new client additions as well as organic growth within the existing client base as a number of our clients continue to expand their workforce during the year. Turning now to our utilization metrics. During the quarter, 7,623 art cycles were performed, reflecting a 33% increase as compared to the fourth quarter of 2020. For the full year, art cycles grew nearly 50% reflecting the continued high rate of demand we are seeing for fertility services among our members. Female utilization, which is what principally drives our financial results, given that the female partner is the one who undergoes the more extensive treatment facility, was 0.46 this quarter as compared to 0.45% a year ago. For the full year, female utilization was 1.07%. This compared to 0.97% in 2020, which I'll remind you, had been negatively affected by the temporary closure of most fertility clinics at the onset of the pandemic in the spring of 2020. As a point of comparison, our female utilization rate for 2021 is consistent with what we reported in 2019. While utilization can vary due to a number of factors, the recovery in our full year utilization to what we had been seeing pre-pandemic reinforces both the essential nature of fertility treatments as well as its time sensitivity for most patients. Treatment mix is also a contributing factor to revenue, as utilization associated with consultations and diagnostic testing and procedures, which occur during the earliest stages of fertility treatment, contribute a lower revenue value as compared with more advanced procedures that happen later in a member's fertility journey. Interruptions in the member's journey caused by the emergence and rapid spread of omic of the Omicron variant also negatively impacted MIX in December. Turning now to our margins, gross profit increased 22% from the fourth quarter of 2020 to 25.1 million. Our reported gross margin of 19.7% this quarter reflects a decrease of 90 basis points from the fourth quarter last year due primarily to the impact of non-cash stock-based comp, which was partially offset by the operating efficiencies in care management. In early November, we issued a broad-based grant of new equity to our workforce, which has increased the level of non-cash stock-based compensation in our cost of services and operating expenses. Excluding the impact of stock comp in both periods, gross margin in the fourth quarter increased 170 basis points over the fourth quarter of 2020 to 23.4%, reflecting the impact of renewals with our providers and pharmacy program partners as well as operating efficiencies in the delivery of care of our care management services. For the full year, gross profit increased 60% to $112.1 million. Our reported gross margin of 22.4% for the full year reflected an increase of 210 basis points from 2020. Gross margin excluding the impact of stock-based comp was 24.2% in 2021 reflecting an increase of 300 basis points from a year ago due to the same reasons that affected the fourth quarter. The press release issued today includes a table reconciling the impact of stock-based comp to gross profit and gross margin, as well as our operating expenses lines. Turning now to operating expenses, sales and marketing expense was 6% of revenue in the fourth quarter as compared to 4.8% in the fourth quarter a year ago. Excluding the impact of stock comp in both periods, sales and marketing was 3.6% of revenue in the quarter, reflecting an improvement of 60 basis points from the fourth quarter a year ago. For the full year, sales and marketing was 4% of revenue, reflecting a 40 basis point improvement from 2020. When excluding the impact of stock comp, sales and marketing was 2.9% in 2021, an improvement of 90 basis points from 2020. Although we've continued to rapidly grow the business through the combination of adding more new clients and lives each year, as well as by retaining a very high rate of existing clients, we have been able to improve our sales and marketing efficiency each year. G&A was 13.8% of revenue this quarter as compared to 14.7% in the fourth quarter a year ago. Excluding stock comp from both periods, G&A as a percentage of revenue improved by 410 basis points. The improvement is primarily due to the elimination of previously disclosed legal expenses, which didn't carry forward into 2021. For the full year, G&A was 11.9% of revenue, which compared to 13.5% in 2020. Excluding the impact of stock comp from both periods, G&A was 8.1% of revenue in 2021. This was a 320 basis point improvement from 2020 and reflects the elimination of the certain legal costs as well as the efficiencies that we've realized in our back office functions as we expand the business. With the margin improvements we've made throughout the business, adjusted EBITDA increased significantly in both the quarter and the year. In the fourth quarter, adjusted EBITDA grew 28% to $15.1 million. Adjusted EBITDA margin of 11.9% in the fourth quarter reflected a modest expansion from the year-ago period as we ramped up resources in Q3 and Q4 in advance of the onboarding the record number of clients we sold for 2022. For the full year, adjusted EBITDA more than doubled to 67.3 million, primarily reflecting our higher revenue and improved operating leverage across the business. Adjusted EBITDA margin of 13.5% in 2021 reflected an increase of 410 basis points from 2020. We continue to believe that margin incremental revenue is an indicator of where the business is trending. On that basis, our adjusted EBITDA margin on incremental revenue in 2021 was 22.4%, reflecting a meaningful increase as compared to the 16.7% that we achieved in 2020. The increase highlights our expanding rate of margin capture on new revenue. Net income was 15.1 million in the fourth quarter, or 15 cents per share. This compared to net income of 39.1 million, or 39%, cents per share in the fourth quarter of 2020. The decrease was primarily due to a lower benefit for income taxes, as the fourth quarter a year ago reflected a $38 million tax benefit in connection with the release of our valuation allowance on deferred tax assets, as well as the higher non-cash stock-based comp expense in 2021, partially offset by operating efficiencies realized on our higher revenues. In 2021, net income was 65.8 million or 66 cents per share. This compared to 46.4 million or 47 cents per share in 2020. The increase was due primarily to operating efficiencies realized throughout the business, partially offset by a lower benefit for income taxes. Turning now to our cash flow and balance sheet. Operating cash generated in the quarter was 8.8 million as compared to cash generated of 6.5 million in the year-ago period. The improvement was due to our higher profitability as well as ordinary timing items in both periods. For the full year, we generated $26 million of operating cash flow, which compares to $36.2 million a year ago. I'll remind you that our cash flow in 2021 reflects a change in the timing of payments that we're receiving under the new pharmacy partner arrangements that were entered into at the beginning of the year. In effect, we chose to leverage the strength of our balance sheet by lengthening the timing of when we receive our pharmacy rebates in order to deliver more margin and profitability. As of December 31st, we had total working capital of approximately $160 million, reflecting $119.4 million of cash, cash equivalents and marketable securities, and no debt. Turning now to our expectations for the first quarter and full year 2022. For the first quarter of 2022, we are projecting revenue of between 165 million to 170 million, reflecting growth of between 35 and 39%. This range incorporates the impact that the Omicron variant had on member activity in January, as well as a return to more expected levels in February and March. Our full year guidance reflects the clients and upsells that are expected to go live in Q2 and the small portion that are expected to go live at the beginning of Q3, which collectively account for 40 to 45 million of anticipated revenue in 2022. For adjusted EBITDA, we expect between 23.5 to 24.5 million dollars, along with a net loss of between 2.1 million to 1.4 million, or between two cents and one cent loss per share, on the basis of approximately 102 million fully diluted shares. I'll remind you that our net income projections do not contemplate any discrete income tax items, including the income tax benefit related to equity compensation activity. To the extent that the related activity occurs, we will continue to benefit from those discrete tax items throughout 2022. For 2022, we project revenue to be between $730 million to $775 million, reflecting growth of between 46% and 55%. or 50% growth at the midpoint of our range. For adjusted EBITDA, we expect between $110 to $122 million, and for net income of between a loss of $1.4 million to income of $7 million, or between a loss of one cent and an income of seven cents per share on the basis of approximately 105 million fully diluted shares. At the midpoints of this guidance, we are expecting to see continued expansion of our margins in 22 with adjusted EBITDA margin on incremental revenue of more than 19%. I wanted to close by highlighting that we recently issued our first corporate social responsibility report, which is available now on the investor relations section of our website. We've seen a growing number of our public company clients reference the progeny benefit in their CSR ESG reporting because these companies have recognized that progeny provides them with a tangible way of demonstrating their commitment to the principles of diversity, equity, and inclusion in their workforce. Our benefit provides all populations with equal access to care, eliminating the discriminatory impact of traditional plan designs while also delivering culturally competent care that is specific to the needs of diverse populations and achieving superior clinical outcomes. Let me now turn the call back over to Pete.
John
Thanks, Mark. We believe the increasing focus on ESG among leading companies is providing us with additional momentum in our new sales efforts. We begin 2022, as I mentioned before, in our strongest ever competitive position as a brand of choice in fertility and family building benefits. And with the macro trends that have been fueling our rapid growth intact and a business that's been built to achieve sustained long-term success, we look forward to providing you with further updates on our progress throughout the year. With that, operator, I'd like to open it up for questions.
Operator
Thank you. Ladies and gentlemen, the floor is now open for questions. If you have any questions or comments, please press star 1 on your touchtone phone at this time. Pressing star 2 will remove you from the queue should your question be answered. And lastly, while posing your question, please pick up your handset if listening on speakerphone to provide optimum sound quality. Please hold while we poll for questions. Once again, that's star 1 if you have a question or a comment. And the first question is coming from Ann Samuel from J.P. Morgan. Your line is live.
Ann Samuel
Hi, guys. Thanks for taking the question. I was wondering if maybe you could provide a little bit of color on what kind of utilization recovery is embedded within the full year guide. You know, it seems like the first quarter is only about 70% of where you were expecting to shake out, but you've said that February has, you know, recovered back to normal levels. So, you know, that feels a little low. Just was hoping you could provide a little more color there.
Jamie
Yeah. So, hi, Annie. As far as the recovery goes, January really reflected what was happening with caseloads and how people were generally seeing the impact of Omicron and its being relatively mild. So we've seen the activity really come back pretty quickly in February and March. So our guide for Q1 and for the full year sort of factors in everything that we're seeing as we sit here now. As far as, and I didn't quite catch your 70%, but You know, I think if you're asking sort of Q1 and how it relates to the full year, you know, just to remind that, you know, generally the first quarter and the first half of the year tend to be a little bit less than the full year overall in terms of the, you know, percentage of revenue. It's not sort of evenly spread. Just as a reminder, so new clients as they get up to speed, you know, typically have a higher proportion of initial consults in the earlier months as they were progressing along their member journey. So if you look, so for example, the way that we, we model this all out in detail by client as we do all of our expectations and projections, but we also do sanity checks on what we're seeing. And so if you, for example, if you take 2021 and you look at the first quarter and you look at its relationship to the full year, now if you add the nine million that we've mentioned that dropped off here in December, You're looking at a ratio of about 4.2 to 1. So if you take our guidance for Q1 and you extend that out by that same ratio and then add the revenue for clients that have not yet launched here that will be launching here in Q2 and a small number early in Q3 of about $40 to $45 million, that gets you pretty close to what our full year guide is.
Ann Samuel
That's really helpful, Culler. Thank you. And then, you know, you noted in your remarks that there's some time sensitivity to fertility. So, you know, how should we be thinking about where these loss cycles are going? Do you expect to see some kind of catch up at any point?
John
Yeah. Here's how I think about it, right? To the extent that anyone is deferring treatment, whether it's hesitation relative to the backdrop of the pandemic, whether it's the hesitation that we saw over the summer relative to what we believe was faster reopening, I think, and the impact of folks just deferring to sort of take advantage of getting out of the house again, if you will, go on vacation, et cetera. It cycles, right? And so to the extent that those are deferring and they do effectively come back on board, those that learn that they have a challenge with having a baby naturally and need fertility but then have trepidations and are a new cohort, sort of it cycles. And so it catches up in the short term relative to those that deferred at some level, and we never know exactly how many defer and defer indefinitely. But those that become aware of a challenge that they have that are newly aware, but then also have any trepidations are going to sort of defer. And so it sort of cycles over time. So it doesn't all come back all at once because everybody doesn't understand all at once that they even have a challenge. It's something that you learn. It's the reason why utilization happens all year long. You know, different people at different points in time make a decision to try and have a baby and then, you know, may learn they have a challenge, you know, throughout the year.
Ann Samuel
That makes sense. And if I could just squeak in one more. You know, you've been seeing some really nice margin expansion, particularly on the gross margins, you know, recently. And I was just wondering how much more room is there for expansion and what might some of those drivers be there?
John
The expansion that will always be inherent in our business is primarily around the care management services, right? So to the extent that they're embedded in cost of operations and to the extent that we continue to grow the business at the rate that we're growing it, you're going to see continued expansion and leverage off of those services. And then to the extent that there are opportunities in the future around the entire supply chain, if you will, of what we deliver, whether it's on the medical or pharmacy side, as we continue to grow and scale, we're going to hopefully be able to continue to take advantage of that purchasing power that we have. And as we always do, we share a little bit with our clients and we keep a little bit. So I can't tell you how good that's going to be or sort of how much it's going to be. I can just tell you that based on where we're at in our growth cycle, we believe that we'll be able to continue to expand those margins.
Ann Samuel
That's great. Thanks, guys.
Operator
Okay, the next question is coming from Michael Cherney from Bank of America. Michael, your line's live.
Michael Cherney
Good afternoon, and thank you for all the callers so far. Pete, Mark, if I can, I would love to dive a little bit more into the revenue growth guidance. Clearly, there's a lot of moving pieces you alluded to over the course of 2021. You also noted it seems like there's a good line set of visibility even into April. That being said, as you think about the guidance especially the range of the guidance being very wide on the revenue side what are some of the moving pieces you're looking for to get yourself comfortable with different areas low end midpoint high-ended guidance and as you think through what you've learned during covid is there another potential set of leading indicators that you think could be more important understanding upside downside to guidance over time so look um you know
Jamie
Right now, we have really good visibility, obviously, into what's happened already, so January and February, and a pretty good view on March. We do have an early peak, I'd say, at April, but again, you have to be a little bit careful on extrapolating really big numbers. But again, we take all of that into consideration. It's what drives our models. I think maybe giving you some color around how we view the guidance itself and the range that we put out there. So on the high end, that reflects what we're seeing now and it reflects a normal level of utilization and mix, et cetera. And we obviously have a more sizable guide because the numbers overall are that much bigger. So that's obviously driving a big part of that when you look at the full year. So, you know, when you look at the overall range, though, it does factor in, you know, some level of perhaps less favorable mix, some slight changes in utilization, because it does vary from time to time, quarter to quarter, so maybe some slight unfavorable changes in those patterns. You know, possibly the impact of a variant that we don't know about right now, but it also factors in, and I've already mentioned it, that we have a little bit higher number of clients that are launching in Q2 and Q3 than we normally do. And that's just a factor of contracting in there. Everybody's committed, it's just a factor of when they're choosing to launch. And that represents about 40 to 45 million. To the extent that they decide to delay that at some point any further, that's a risk that would effectively hopefully be caught up within the range that we've put out there. Those are some of the big pieces that we're looking at as we considered that width.
Michael Cherney
Along those lines, you mentioned understandably the starting point, the start of the year of more initial consults and visits. That being said, over the course of 2021, I think revenue per art cycle dropped fairly immediately over the course of the year. Where are we looking for the turn, and what do you think are the most important parts that would drive the turn in that number?
Jamie
Yeah, so I think you're looking at mix that impacted us in ways that was really abnormal for us. I know we talked about that. Certainly in the middle of the summer as we saw sort of a pause in treatment progress. So when you have those initial, you always start with the initial consult which is comparatively lower revenue. If you pause your treatment at that point, the impact of that is overall revenue dropping or if you're in the midst of your treatment. Really that's a similar pattern that we saw. There was a number of things that obviously affected December. But that was also something that we saw in December where the mix of revenue was a little bit slowed.
Dev Weirasharia
Okay.
John
The other thing to think about is that as we continue to grow across the country, right, you know, rates from earlier years, sort of pre-COVID, right, where the concentration of our members and our member experience and utilization was on the east and west coast where you do have the highest prices, as you continue to grow the dispersion of members, right, engaged across the country grow, you know, rates do vary. And so it's not necessarily that it's going to, you know, as you described it, turn and sort of get back to those low levels, because it's all about mix and averages and prices across the country. And so it's not as simple as sort of, you know, only impacted by mix of utilization during COVID, but it's also the reality of of a growing client base, a growing member base across the country, and varying prices across the country that aren't primarily concentrated as they were in the early years, you know, much more so on the east and west coast disproportionately versus where we're at today.
Michael Cherney
Got it. Thanks, guys. Appreciate it.
Operator
Okay. Up next, we have Glenn Santangelo from Jefferies. Glenn, your line is live.
Glenn Santangelo
Oh, yeah. Thanks for taking my questions, and good evening. Hey, guys, I just want to follow up on the previous questions around the revenue guide, maybe in a couple different ways. And I apologize if I missed this, but I know you're expected to be at 4 million members. Do we know exactly when you'll be at that 4 million member mark? I seem to remember I thought it was second quarter or middle of the year.
Jamie
Yeah, second quarter, you know, the majority of those that have not yet launched, We'll be launching in the second quarter. There's a few in Q3, but it's comparatively smaller.
Glenn Santangelo
Right, right. So I guess what my question is, if you look at the membership growth sort of year over year, you know, even if you use, you know, the 4 million members, I mean, your membership growth is a good chunk below where your revenue growth is kind of implying some uptick in utilization. And now where we're sitting... you know, with January maybe being a little bit behind the eight ball, as we look to the midpoint of your 22 revenue guide, I think what we're all trying to understand is, you know, you said it sort of incorporates what you're seeing today, but do we need improvement from where utilization currently sits to ultimately get to the midpoint of that guidance? I think that's what we're all trying to understand.
John
Biggest driver of why your revenue growth is outpacing your member growth is your adoption of Rx. So to the extent that possibly Rx is a much bigger part of your existing client base that's live, and they're also part of the new client starts, if you will, from an upsell perspective in there as well, that's going to help drive the overall revenue number vis-a-vis your member growth. And you also got to look at member growth your membership growth on average for the year, not just where we're exiting the year, but on average for the year versus where we started the year, we were at roughly 2.3 million and went up to 2.9 million. So it's really on average in how much you're growing and how much you'll continue to grow. And remember, the last piece is that the existing client base, just like it grew this year, whether it's going to grow at the same rate or not, we'll never know. But the existing client base is going to start the year with a number of members in eligible lives, and as they grow as companies, more and more members will be eligible for the benefit throughout the year. So you've got to factor all those things in, which is what we do in our detailed models when we put out the overall guidance.
Jamie
But again, even at the high, that basically assumes a normal level of utilization. So although January was somewhat affected by Omicron, and February and March, we've seen really good activity there, you know, we're not necessarily, you know, riding, you know, an extra, you know, a little bit of extra goodness in February and March through the balance of the year. It is based on what would be a normal level.
Glenn Santangelo
Okay, perfect. And then maybe just a quick follow-up on the expense side. I mean, I look at the EBITDA guide, the adjusted EBITDA guide, seems pretty decent. I was kind of curious. I wanted to ask about the stock-based comp. You talked about a fair amount in your prepared remarks. If I look at that 22 stock based comp level of, of, of 110 million. I mean, if I'm, if I'm comparing that correctly to 2021, that number's up almost four X. And so you mentioned that that stock award that you gave to everyone in the company, I'm kind of curious, could you give us more color around that award? Did anything else change in your comp plans and you know, are you replacing any, any type of cash compensation with equity compensation? Any more details around that would be helpful. Thanks.
John
I'll answer the last part of the question first. We're not replacing any level of cash comp with stock comp. You have to remember that we're recently public. As a result of being recently public, the significant amount of grants that were out there already were pre-IPL at a much lower level. When you do a broad-based grant, even though the shares relative to shares outstanding in our existing comp plans were small, when you grant them at a much higher stock price and you do a black shows value, it's going to have a much bigger impact from a stock compensation perspective, which is why we break that number out and we give you the color around our results with and without stock compensation. So we're not doing anything different. In fact, there's still a significant amount of remaining shares that we have available to grant that we didn't grant. And so we just did what we felt were We're very judicious in how we do those grants. We did a level that we felt was important relative to the existing client base, you know, shares they had remaining and shares that we put in place to sort of continue our retention. But the jump up is really a function of, you know, just the strike price, you know, at the time of grant, which was way higher than what we, you know, had prior to that in 2021-20, any year you look at where the majority of shares were issued, you know, pre-IPO.
Jamie
Yeah, and we'll be filing our 10-K tomorrow, and, you know, obviously the usual disclosures in and around this will be in there, so you'll be able to very clearly see, you know, that step up in Black-Scholes valuation that Pete's talking about between what, you know, what had been previously granted and outstanding versus this grant that we did. Well, it'll be for the year, but substantially in November.
Glenn Santangelo
Okay, thanks for the details.
Operator
Very helpful. Up next we have Sarah James from Barclays. Sarah, your line's live.
Sarah James
Thank you. So you guys talked about 22 margins on incremental business being over 19%, which is a step down from the 22.4 in 21. Is that just conservatism or is there a different mix going on or like a capacity type of investment going on that would drive this step down?
Jamie
No, actually, I think the answer is actually fairly straightforward here. So in 2021, we do have a bit of a favorable comparison versus 2020. You'll remember that we had, you know, we had that deep drop in revenue in Q2 of 20 as the clinics were being closed in the early days of the pandemic. And, you know, we retained all of our staff, you know, during that period in order to, one, service the members because they were still going through transition at that point, but also we hoped and it obviously came to pass that activity would ramp back up really quickly. But that period alone, it was sort of enough to drive the few points that you're seeing between the favorable results here in 21 compared to 20 versus what we're now guiding to for 2022.
Sarah James
Okay. Then how do you think about client size trending for the next few years as you look at the companies in your pipeline and who you're talking to? You had a little bit of a step down in client size this year. Is that the way your pipe's going to look as the market matures, or was this kind of like a one-off?
John
Well, I'm not sure about the step down you're referring to. From a new client sales perspective, in 21 for 2022 launches, you know, we return back to normal levels in terms of average client size, you know, and the lives that they represent versus, you know, the 2020 selling season that launched in 2021. You know, they were a lot smaller because a lot of the larger companies paused their benefits as they were managing through their workforce, you know, being a remote workforce. you know, dramatically, and so, you know, we're choosing not to make many benefit decision changes. Based on what we can see right now in our pipeline, you know, it looks more like it did for 21 selling season than it did in, you know, sort of the dip that we experienced in 2020.
Sarah James
Okay, thank you.
Operator
Okay, the next question is coming from Stephanie Davis from SVB Lyric. Your line is live.
Stephanie Davis
Hey, guys, thank you for taking my question. You kind of answered this in a prior answer, but I was hoping I could dig in a little more. What gave you the confidence to re-hit your 22 guidance? Was that reflective of some cushion baked in, or did you just find out about the Rx attached rates more recently, so that was more of the driver of the upside?
John
I think more... went through sort of all the different factors that went into our guidance that we put out there, you know, both high and low end of the range and all the components, including the timing of new client starts, you know, the beginning of the year versus the portion of those that are starting in Q2 and a little bit in Q3. It's really all of those things rolled up that, you know, give us the, you know, plus obviously the current activity relative to member engagement that we're seeing already for you know, February, March, a little bit of visibility into April, et cetera, that we're seeing that we use as predictive for what we should expect during the year. So really, those are all the factors. I'm not sure there's any other color we can give you relative to our expectations, but just to tell you that it's based on sort of all those factors all rolled up into what, you know, ends up being the guidance that we're comfortable with. you know, putting out there.
Jamie
Yeah, and just based on the attach rate, when we get commitments from clients, we are getting it. We have, again, preliminary information about the size of the client, the number of smart cycles they want, but also whether or not they're going to anticipate launching with the progeny benefit. And so, you know, we obviously, you know, want to get that under contract, get the clients launched, and to really see the activity around it. But that's not sort of, you know, to us anyway. The attach rate isn't really very new information. I think we even commented at JPMorgan that we had an uptick in the take rate for this new cohort of clients that are going live.
Stephanie Davis
I'm just trying to ask kind of the guidance question, not only besides the utilization. Thank you. Skipping a bit. You know, I was like, how do I add utilization another way? But skipping a bit then just to the big uptick in ProgenyRx, could you maybe walk us through what pushed so many folks through the finish line and kind of the economics of bundling versus what we've seen historically?
John
Yeah. I think we've talked about sort of in the past when people ask the question, how come everybody doesn't sign up for Rx right away? And the answer in the past which drives sort of why the adoption both for new clients but also for upsells is now the other constituents within a company that make a decision to sign up with Progeny Rx versus their existing prescription benefit are sort of those folks right and so to the extent that more and more people both let's start with sort of new sales understand the better member experience, and also the financial benefits of Prozny Rx, that's resonated and has resonated as we continue to have a larger portion of sales that are not nows, and so they've been introduced to these ideas in prior periods. And so when they buy, that contribution of new sales in the past sales year was bigger than it was the year before, which is usually bigger than it was the year before that, et cetera. So that's a contributor. But overall, it's just more awareness and less friction in the sales process. The other thing I would tell you is that our CVS relationship as a channel partner that we announced in the beginning of last year also helped with that relative to new sales adoption, you know, relative to project in the RX. But overall, it's the, you know, understanding of a way better member experience when you're managing the benefit on the medical and RX side under one umbrella because they are pretty integrated in terms of the solution.
Stephanie Davis
Super helpful. Thank you both.
Operator
The next question is coming from Dev Weirasharia from Barenburg. Your line is live.
Dev Weirasharia
Hey, good evening. Can you hear me? Yes, perfect. Sorry, I caught me with a brownie in my mouth. I was just trying to get some sugar in here. All right, I think we got some good color on utilization. I just want to circle around kind of the sales side of things. I think in the Q3 call, there was a mention that maybe a portion of the 85 client ads, a portion of that could have been kind of delays from 2020 into 2021. I know you mentioned strong momentum in the early season here. to step up in kind of the number of clients, you know, from client ads from 2020 to 2021. You know, do you expect kind of a similar step up in 2022? Any color on that would be helpful and have a couple of follow-ups. Thank you. Yeah.
John
So, no, I wouldn't, you know, certainly it's early in the sales year, so we don't know where we're going to end up. But all indicators are that the sales momentum that we experienced in 2021 should continue to 22. When I say that, I mean our goal has always been to add more lives and logos than we added in the prior year. The increase in new sales won both in lives and logos in 21 versus 20 sales year was pretty pronounced and impacted by the fact that in 2020, as I mentioned before, mostly large clients Chose not to make any benefit changes, not just infertility, but in general, any benefit changes. And we won a lot of smaller clients, and even the volume was less, you know, because people were managing through and companies were managing through, you know, a remote workforce that they weren't at that time used to. 2021 returned to more normal levels. And so our comments around sales momentum and what we're seeing so far is really around the goal that we've always stated, which is to sell more logos and lives than we had in the prior year. And so I would point you to those comments.
Operator
Okay, that concludes today's Q&A portion of the conference call. I'd now like to turn the floor back to James Hart for closing remarks.
James Hart
Thank you, John, and thank you, everybody, for joining us this afternoon. Please be sure to reach out to me if you have any follow-up questions. Otherwise, we look forward to seeing you at a couple of the upcoming conferences and then our first quarter earnings call in the spring.
Operator
Thank you, ladies and gentlemen. This does conclude today's conference call. You may disconnect your phone lines at this time, and have a wonderful day. Thank you for your participation.
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