IQVIA Holdings, Inc.

Ladies and gentlemen, thank you for standing by. At this time, I would like to welcome everyone to the IQVIA Second Quarter 2021 Earnings Conference Call. All lines have been placed on mute to prevent any background noise. After the speaker's remarks, there will be a question and answer session. If you would like to ask a question during this time, do press star followed by the number one on your telephone keypad. If you would like to withdraw your question, press the pound key. As a reminder, this call is being recorded. Thank you. I will now turn the call over to Nick Childs, Senior Vice President, Investor Relations and Corporate Communications. Mr. Childs, please begin your conference.

Thank you. Good morning, everyone. Thank you for joining our second quarter 2021 earnings call. With me today are Ari Boosby, Chairman and Chief Executive Officer, Ron Brumman, Executive Vice President and Chief Financial Officer, Eric Sherbet, Executive Vice President and General Counsel, Mike Fedock, Senior Vice President, Financial Planning and Analysis, and Brian Stengel, Associate Director, Investor Relations. Today, we will be referencing a presentation that will be visible during this call for those of you on our webcast. This presentation will also be available following this call in the events and presentation section of our IQVIA Investor Relations website at ir.iqvia.com. Before we begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements. Actual results could differ materially from those stated or implied by forward-looking statements due to risks and uncertainties associated with the company's business, which are discussed in the company's filings with the Securities and Exchange Commission, including our annual report on Form 10-K and subsequent SEC filings. In addition, we will discuss certain non-GAAP financial measures on this call, which should be considered a supplement to and not a substitute for financial measures prepared in accordance with GAAP. A reconciliation of these non-GAAP measures to the comparable GAAP measures is included in the press release and conference call presentation. I would now like to turn the call over to our Chairman and CEO, Ari Busby.

Thank you, Nick, and good morning, everyone. Thank you for joining today. This morning, we reported second quarter results with outstanding double-digit growth in all key financial metrics. Following this strong performance, we've once again raised our guidance for a year. As you recall, we're tracking ahead of our pre-COVID V22 financial plan. The health of the life sciences industry continues to strengthen. New clinical trial starts are trending well above recent historical figures. They're up 22% versus 2020 levels and up 7% compared to 2019. The pipeline of late stage molecules continues to expand to record numbers. indicating a large backlog of potential launches, some of which have been pushed to the right during the pandemic last year. And finally, biotech funding continues to increase significantly, according to the National Venture Capital Association, funding total $25 billion in the first half of 2021. This represents an increase of 64% compared to the first half of 2020, which itself was already a record first half year. During 2020, the pandemic disrupted execution of clinical trials and businesses requiring face-to-face interactions. But at the same time, it accelerated change in the industry It created new demand for new services. And IQVIA is uniquely positioned to deliver based on the differentiated capabilities such as data analytics, advanced technology offerings, and of course our deep scientific and therapeutic expertise, all of which capabilities were highlighted to our clients during the pandemic. We're confident that these capabilities will continue to drive strong demand for both our clinical and commercial offerings in 2021 into 2022 and beyond. As we begin thinking about our plans during 2022, I am pleased to announce that we will be hosting an investor conference in New York City on November 16th. where we will update you on our V22 progress and share our plans for the next phase in IQVIA's evolution. Nick and the team will of course provide more details once all the logistics are set and available. With that, let's review the second quarter in more detail. Revenue for the second quarter grew 36.4% on a reported basis and 33.2% at constant currency. This represents growth that was $176 million above the midpoint of our guidance range. About 40% of this beat came from strong operational performance, and the reminder was from higher pass-throughs. Second quarter adjusted EBITDA grew 49.5%, reflecting the revenue growth drop-through as well as productivity measures. The $20 million beat above the midpoint of our guidance range was entirely due to the stronger operational performance. Second quarter adjusted diluted EPS of $2.13 grew 80.5%. That was 8% above the midpoint of our guidance range and was driven entirely by the adjusted EBITDA drop-through. I need to provide a little more update and color on the business during the quarter. Starting with our real-world evidence business, it once again performed well, strengthening its leadership position. This included a recent win with a top 20 pharma client to develop an ophthalmology evidence platform for upcoming product launches. The platform integrates primary and secondary data and layers on AI ML tools to monitor patient safety in real time. This will allow this client to add new products and indications to the platform without initiating new studies. This, of course, will save critical amounts of time and money while also reducing the burden on patients and sites. Turning to our commercial technology business, it continues to increase penetration among top 10 life science companies and emerging biopharma clients. A top five pharma client entered during the quarter into a commercial agreement to leverage the IQVIA human data science cloud as part of their core data and digital strategy for one of their large therapeutic areas. This client plans to roll out this platform in over 50 countries to centralize all of their fragmented data assets, resolve data management complexities, and improve speed to insights. Our orchestrated customer engagement offering, OCE, gained additional ground this quarter as nine new clients adopted the platform for commercial operations, including two wins with large biotech clients. One of these OCE biotech clients has the potential for a global rollout to over 20 countries. The other large biotech win represents a competitive win back of the customer facing team in the US. To date, we have 159 client wins for OCD. Our clinical technology solutions team continued our path to innovation in decentralized clinical trials with the introduction of IQVIA's Clinical Data Analytics Suite, or CDAS. This solution, built on our human data science cloud platform, provides life science companies with new approaches to data use and harmonization, as well as producing AI, ML, and analytics-based insights. As an open, scalable cloud platform, CDAS seamlessly works which sponsors existing data archives and systems. We now have all of the top 10 and 18 out of the top 20 pharma clients using at least one of the several modules within our clinical technology suite. By connecting the right technology with the right data sources, IQVIA is enabling customers to identify new opportunities to maximize product value get to market faster, improve departmental and business alignment, and reduce costs. Switching to our R&DS business, during the quarter, it continued to build on its strong momentum with over $2.5 billion of net new bookings on a 6-6 basis. In the quarter, we achieved a contracted net book-to-bill ratio of 1.34 including pass-throughs and 1.37 excluding pass-throughs. As of June 30th, our LTM contracted book-to-bill ratio was 1.45 including pass-throughs and 1.40 excluding pass-throughs. Our contracted backlog in RMBS, including pass-throughs, grew 16.7% year over year to $23.9 billion as of June 30th, 2021. As a result, our next 12 months revenue from backlog increased to $6.6 billion, which is up 19.6% year over a year. I want to highlight the lab business, which continues to be a key driver of growth and therefore will remain an area of strong investment for IQVIA. You'll recall that on April 1, we completed the acquisition of the remaining interest in Q-square solutions from Quest Diagnostics. Following this transaction, we announced our plans to expand our laboratory operations in Scotland to bolster our investment in cutting-edge technologies, including next-generation genomic sequencing and testing. Also in the quarter, we agreed to acquire Myriad RBM, adding to our capabilities in the lab. RBM specializes in biomarker detection and quantification testing that supports early and late stage drug development in key therapeutic areas such as oncology, CNS, and immunology. This acquisition fits nicely into our strategy to develop specialized testing and precision medicine to help support drug development with state-of-the-art solutions. These actions further demonstrate our commitment to advancing outcomes in this space and we are excited to continue to grow and innovate in the lab business. The Myriad RBM transaction is expected to close sometime in the third quarter. I'll now turn it over to Ron for more details on our financial performance in the quarter.

Ron. Thanks, Ari, and good morning, everyone. Let me first start with revenue. Second quarter revenue of $3,438,000,000 grew 36.4% on a reported basis and 33.2% at constant currency. First half revenue was $6,847,000,000, growing at 29.8% reported and 27% at constant currency. Technology and analytic solutions revenue for the second quarter was $1,353,000,000. That was up 22% reported and 17.9% at constant currency. For the first half, tech and analytic solutions revenue was $2,701,000,000, up 21.3% reported and 17.5% at constant currency. R&D Solutions' second quarter revenue of $1,891,000,000 was up 53.1% at actual FX rate and 50.7% at constant currency. Now, excluding the impact of pass-through, second quarter R&D revenue grew 44.6% year-over-year. For the first half, revenue in R&D Solutions was up 44.5% reported and 38.5% at constant currency. CSMS revenue of $194 million in the quarter grew 9.6% reported and 7.3% on a constant currency basis. And that brings the first half CSMS revenue to $387 million. up 3.8% reported and 1.3% as constant currency. And moving down to P&L and going to adjusted EBITDA, that was $722 million in the second quarter, which represented growth of 49.5%. Bringing first half adjusted EBITDA to $1,466,000,000, up 40.3% year over year. Second quarter GAAP net income was $175 million, and GAAP diluted earnings per share was 90 cents. For the first half, we had GAAP net income of $387 million, or $1.99 per diluted share. Adjusted net income was $416 million for the second quarter, and adjusted diluted earnings per share grew 80.5 percent to $2.13. For the first half, adjusted net income was $841 million, or $4.32 per share. Let's turn briefly to R&D solutions. As Ari mentioned, we delivered another outstanding quarter of net new business. You see backlog grew 16.7% year over year to $23.9 billion at June 30th, and next 12-month revenue from backlog increased at June 30th stood at $6.6 billion, up 19.6% year over year. Okay, now on to the balance sheet. June 30th cash and cash equivalents totaled $1.8 billion, and debt was $12.3 billion, which results in net debt of $10.5 billion. Our net leverage ratio at June 30th came in at 3.74 times trailing 12-month adjusted EBITDA. Cash flow was again strong in the quarter. Cash flow from operations was $539 million, and CapEx was $145 million, resulting in free cash flow of $394 million. This brought a free cash flow for the first half of 2021 to over $1.1 billion, which is a material improvement over our 2019 and 2020 results. In the quarter, we repurchased $45 million of our shares, leaving us with $822 million of share repurchase authorization remaining under our latest program. Now on to guidance. We're raising our full year 2021 revenue guidance by $275 million at the midpoint, reflecting the strong second quarter and the continued operational momentum that we see in the business. Our new revenue guidance is $13,550,000,000 to $13,700,000,000, which is year-over-year growth of 19.3% to 20.6%. I would note there's no FX impact versus our previous guidance. Compared to prior year, FX continues to be a tailwind of 150 basis points to full-year revenue growth. Looking at the segments, we continue to expect full-year technology and analytic solutions revenue to grow low to mid-teens, and R&D solutions revenue to grow mid to high 20s, while we now expect the CSMS business to be low single digits. You saw that we also raised our profit guidance. As a result of the stronger revenue outlook, we've increased our full-year adjusted EBITDA guidance by $43 million at the midpoint. Our new full-year guidance is $2,950,000,000 to $3,000,000, which represents growth of 23.7% to 25.8%. Moving to EPS, we increased or adjusted diluted EPS guidance by 18 cents at the midpoint. Our new guidance range is $8.70 to $8.90. which is growth year over year of 35.5% to 38.6%. Our full year 2021 guidance assumes that June 30th foreign currency rates remain in effect for the second half. Now let's review the revenue guidance for the third quarter. Third quarter revenue is expected to be between $3,290,000,000 and $3,365,000,000. representing growth of 18.1% to 20.8%. We expect adjusted EBITDA to be between $710 million and $730 million, up 17.5% to 20.9%. And finally, adjusted diluted EPS is expected to be between $2.06 and $2.13, growing 26.4% to 30.7%. And again, our third quarter 2021 guidance assumes June 30th foreign currency rates remain in effect for the quarter. So to summarize, we delivered very strong second quarter results. We had double-digit growth in all key financial metrics. We posted revenue growth of over 20% in our TAS segment and over 50% in R&DF segment. RNDS backlog improved again to $23.9 billion, up 16.7% year-over-year. Next 12-month revenue from that backlog increased to $6.6 billion. That's up 19.6% year-over-year. We reported another strong quarter of free cash flow. And given the momentum that we see in the business and our strong second quarter results, we're once again raising our full-year guidance for revenue, adjusted EBITDA, and adjusted diluted EBS. So with that, let me hand it back over to the operator for questions and answers.

At this time, I would like to remind everyone, in order to ask a question for a star, thank you, number one, on your telephone keypad. We'll pause for just a moment to compile the Q&A roster. Your first question comes from the line of Eric Caldwell with Baird.

Thanks very much. Good morning. I have two questions. Ron, first, congrats on the great cash flow performance year to date. I'm just hoping you can give us some more details on where you're making the biggest gains, changes supporting these improvements, and Any color commentary on your outlook for the future? Second question, just COVID-related. It's, you know, the typical standard ask. If you could give any insights on COVID revenue in the quarter, bookings, backlog, thoughts on the tail end of 2022, that would be helpful as well. Thanks very much, guys.

To your first question, Eric, on cash flow, there are two principal drivers of our strong cash flow performance. The first, of course, would be our earnings growth, which was quite good. But beyond that, we've made substantial progress and continue to make progress in reducing our day sales outstanding. We've had a real focus on that over the past year, bringing down past dues, improving our billing terms with customers. billing sooner because we have substantial unbilled amounts. And all of that has contributed to strong collections. The one caveat I would say is that some of the COVID-related work does come with some advances that will burn off over time. So we're still targeting to have cash flow in any given year in the range of 80% to 90% of adjusted net income. Now, obviously, substantially stronger than that so far this year. I think it's probably about 125% for the first half. And, you know, if we can beat that 80% to 90% range, great. But I think that's a good kind of medium-term sort of target for cash flow in a normal environment. But we're very happy with the progress we've made on cash flow and expect cash flow to continue to be strong for the future.

Yeah. I mean, Eric, good morning. And thank you for highlighting that aspect of our performance in the second quarter. As you know, We were not happy with our cash flow performance back in 2018. Our total yearly free cash flow was $600 million. So just barely half of what the first half performance was this year. In 2019, I think it was around $800 million. And last year in 2020, we bumped that up to $1.3 billion or thereabouts. So we're very, very pleased with our performance. And just for the reasons that Ron highlighted, especially grateful to the finance team for focusing on the management of our receivables, collections, and generally, you know, built-to-cash type of process improvements. That took a lot of efforts, but we think we'll continue to pay dividends. We also remember had committed to investors that we would reduce our leverage ratio from the mid to high fours on the net basis to four or less by the end of 2022. And I would note that for two quarters in a row, we are below that for probably a year early. Now, again, we might see the average ratio move up and down depending on circumstances and our stand on M&A and share repurchases, but that's where we are and we're very pleased with that performance. The second question you had was on COVID work and how much it represents. I think it's always probably best to look at how much COVID work is in our backlog. And I just want to say that the large COVID vaccine trials, which have represented the bulk of our work in COVID, represent less, actually much less than 5% of our total backlog. And so that gives you a sense. And in terms of Now, having said that, we expect COVID work to continue to remain part of our business for the foreseeable future. We expect COVID studies to have a long tail through 2021, well into 2022, and perhaps 2023. There'll be a need for vaccines from multiple manufacturers. We still have in our pipeline RFPs for vaccine work from different companies around the world. There are new vaccines being developed for the variants. there are alternative vaccines that are being needed for adverse safety events quality issues manufacturing delays and then there are a bunch of novel treatment programs that are targeted at specific populations and conditions so all of that you know is still in our pipeline but again the large vaccine work is less way less than five percentage points of our total backlog including pass-throughs So any other commentary you want to make on revenue or impact is really not significant.

Well, look, even if you were on the revenue side, if you were to pull out all of the COVID-related work, we still have very strong revenue growth, double-digit revenue growth in both the TAS segment and the RDS segment. So, yes, COVID was a contributor in the quarter, but the underlying non-COVID-related work was growing strongly also. And, of course, COVID is a reality these days. It's part of the business. We want to participate in that work, and we have been participating in that work. Okay. Next.

Your next question comes from the line of Shalom Moe, Rosenbaum with Stiefel.

Hi, good morning. Thank you for taking my questions. I have two questions. One is more of a housekeeping thing. Ron, maybe you could provide the precise organic revenue growth metrics for each segment, you know, TAS and RDS. And then secondly, I want to ask you a bit more about what, you know, what Ari started out with in terms of the growth in the real world evidence business. You know, what's the size of the business at this point in time? What was the growth in the quarter? How is that contributing to the overall business growth? And, you know, just more detail. It seems like that's, you know, a significant differentiator for IQVIA versus a lot of the competition. I thought we could flesh some of that out.

Let me take the first question, Shromo, on organic growth. The contribution of acquisitions in the quarter to our revenue growth was insignificant. If you look back over the past number of quarters, you can see our acquisition activity tailed off quite a bit, and it's only recently beginning to pick back up. So there's almost no contribution whatsoever of you know, acquisitions to our growth. So organic growth for all intents and purposes equals reported growth in those segments.

Yeah, and then slow-mo on the real-world side, you know, that business is about a billion dollars, as we talked about before. It continues to grow double digits. This quarter was high double digits again. Continue to see very, very strong results in that business and continues to for you to deliver for us and drive the size growth.

Thank you.

Your next question comes from one of John Kruger with William Blair.

Hey, thanks very much. Maybe just a quick follow-up on real-world evidence. I think previously this year you talked about doing some significant government COVID tracking work, but that was expected to tail off. What are your current thoughts about the durability of that program, and sort of what are you assuming in your guidance for the year?

John, we're expecting that work to continue through the balance of the year, but it will be Last contribution in the second half and the first half, we'll see whether it continues on into 2023 or not. That sort of work tends to be pretty quick burn and rapidly changing, but we do expect some incremental contribution from the government COVID-related work through the balance of the year. In particular, when you get into the fourth quarter, compared to last year's fourth quarter when we had a substantial amount of it, it's going to be negative. But you see overall for implied fourth quarter guidance that it remains very strong for the company as a whole.

Thanks, Ron. That's helpful. And maybe a follow-up. Can you guys just talk a little bit about the staffing environment? We hear a lot about labor shortage. Just curious if you're seeing any constraints in your ability to recruit and hire and if that's driving any pressure on margins. Thanks.

Yeah, look, there's no secret that given the strength of the industry backdrop, there's obviously strong competition for talent. And it's also no secret that when people need the highly qualified talent, they come after iStudia talent because they know we train people well and we get a broad range of skills and training programs. However, you know, we are confident that we continue to be able to attract and retain the talent simply because we are the premier company in the industry. And also, frankly, because we've been investing in our employees, especially during the pandemic. We've been looking after our employees. We didn't restructure. We continue to pay our people well. Now, does it cause a certain amount of anxiety in the industry? And yes, it's true. And does it cause some level of wage deflation? Yes, that is true. There is also a little bit of an apathy in attrition levels as a consequence of all of that. All of that is true. But again, we feel confident we do not anticipate this to cause any significant, there will be some level of headwind to our margins, but we have so many programs and productivity measures and process improvement measures in place that we are confident we will overwhelm. And you can see that our margins have been performing very well and growing faster than we had anticipated.

Yeah, John, obviously any cost pressure we're feeling is fully baked into our 2021 guidance.

Great. Thanks, guys.

Your next question comes from the line of Tycho Peterson with JPMorgan.

Okay. Thanks, Ari. On the 16.7% backlog growth, I'm just wondering if you could provide any more color, you know, how much of this, in your view, is kind of pent-up demand, catch-up work, and then any kind of lingering concerns around site accessibility and, you know, the variant potentially impacting conversion and back-up here?

Well, obviously, you've got a compare issue quarter to quarter that's driving some of those just unusually high growth rates. But I think we've got a combination of a lot of factors. One is catch-up work. You're correct. I mean, there's a lot of work that was done last year remotely and we still need to have site document on-site site document verification activities that need to take place so that's another boost to our growth thirdly there is um you know the simple fact that projects that were supposed to get started last year were pushed to the right uh and so that also adds a demand fourthly we've been gaining market share we've been saying it over and over again and i think the members are pretty clear given our consistently higher book to bid ratios and the size of our revenues i think the math clearly will indicate that we are gaining share and we are now beginning to execute on all of these projects that started with some delay last year. And finally, there is the COVID work. So all of that contributes to these very strong growth rates that we have reported. Your other question, which were operational metrics, site access, and so on. Look, we are essentially, I think we could say about 80% or so, or approaching 80% in terms of site access, even though the flare-ups, infection grows in different parts of the world. But our guidance for 2021 takes a lot of factors into account, including site accessibility. We also believe we are at critical mass. In other words, at 80% we can deliver with a combination of different methods we have perfected in terms of remote visits and so on. It's good to monitor site access as a metric when assessing the general recovery. but they don't correlate exactly with revenue recognition. There's many other metrics we track, the site startups, which have essentially returned to the baseline of 2019, patient recruitments, which are running at or above the 2019 averages, patient visits, which are essentially close to the pre-pandemic levels. So all of those bottom line These metrics provide us with the confidence that the non-COVID trial pipeline is not only being awarded, as illustrated by our strong bookings, but also it's starting to be delivered, meaning the sites are enrolling, the patients are enrolling, and the patient visits are taking place. So I hope that clarifies where we are operationally in RNDS.

That does. That's helpful. And then for a follow-up, two quick ones. I'm wondering if you can update us on the orchestrated clinical trial rollout, how that's going, and then separately on the acquisitions. I understand they're not big revenue contributors. I'm just curious if the accretion assumptions have changed. I think you previously talked about $0.12 accretion from the Q2 acquisition. I just want to make sure that's still the case.

You asked about decentralized, right?

Decentralized trial, okay.

Yeah, not decentralized. Yeah, again, on the acquisition, just to clarify, on the 40% acquisition of the minority Q squared of the lab that we didn't own, there was zero impact on revenue and EBITDA since we already consolidated as we were a 60% owner. But there was this accretion There's accretion on the bottom line, and always the accretion of the exact number for the balance of the year. For the balance of the year. For the balance of the year.

We put that into our guidance.

And that's in the guidance. Yeah, that was already done at the time.

Yeah, nothing has changed on that.

Now, I'm not clear on your first question. Was it about decentralized trials, about OCT?

It was about the orchestrated clinical trials, OCT, you know, the sweet launch and how that's going.

Okay, fine. So that's going well. I mentioned in my introductory remarks that every single one of the top 10 pharma clients is using one module of our clinical technology suite and 18 of the top 20. So we are gaining ground and making progress. The Essentially all of the suites have been launched and most modules are being used and the sales pipeline continues to increase. We see a lot of interest from our clients. For the platform itself and also for individual suites or standalone modules, we've seen interest from all customer segments. I talked about the top 20, but it's also true for the mid and EBP. We have demands for multiple products within the digital patient suite. Some of that is driving some of the growth that you saw on the TAS business. The CDAS suite, which I talked about in my introductory remarks, is the clinical data analytics suite, connects structured and unstructured data from clinical trials into a central repository that creates one version of the truth that allows predictive analytics to be run, etc. It's a key benefit for clients, which, as you know, the big vaccine issue in healthcare is the interoperability of data between customers, between the people who run the trials, like Acuvia in this case, and various competitor applications and data sources. So the CDaaS product eliminates the need to reconnect individual applications to each other. And instead, these applications, they connect directly to CDaaS and enables to harmonize the data and provide an intuitive and scalable solution to map multiple clinical data sources enables us to use AI ML layers of analytics using this single data ecosystem. So we are very pleased with the progress. Our clients are beginning to understand the value, and we are beginning to penetrate that customer base.

Thank you.

And that question comes from the line of Jack Meehan with Nefron Research.

Thank you. Good morning. Ari, I was hoping you'd give a little bit more color on the progress at OCE. So now 159 clients. What's the revenue base for this business, and where do you think you are in the growth curve? Is it still an investment mode, or has the business turned profitable at this point?

Right. I don't think we disclose how much it represents, but we've said that so far in 2021, we've had 19 client wins, which brings the total since launch three and a half years ago to 159 client wins. We continue to have a disproportionate share of the wins. I think it's two out of three, and that has been consistent. We are performing well with the large pharma deployments, which we have talked about. I think Roche already has 15,000 or so users in deployment. So we haven't seen any slowdowns in the implementations as a result of COVID, other than isolated issues which we dealt with. We even see some deployments that have accelerated timelines. So the feedback is overall positive. The field reps are very engaged. All is going better than planned for the launch of OC, which I remind you was only three and a half years ago.

Great. And then you started by talking about the strength of the funding environment and the VC activity going on. I was wondering if you're seeing any themes emerge from a therapeutic perspective area perspective and how you thought IQVIA was stacked up for that? And one specific area I was hoping you could weigh in on is Alzheimer's and, you know, just, you know, whether you think that's an area where you could see new investment coming in.

I think, look, undoubtedly the area where we see the most funding is oncology, especially those subcategories of oncology where um you know it's been difficult to have effective drugs so people are pulling a lot of vc funds into oncology cns is another area and alzheimer's yes we've got quite a few things going on there a cardiovascular strong growth as well And of course immunology prompted by what happened with the virus and COVID. There's a lot of interest in immunology and that also I would say is the fourth main area of funding. Thank you.

Our next question comes from the line of Dan Leonard with Wells Fargo.

Thank you. So hoping first you could elaborate a bit more on your decentralized trial offering and maybe update specifically on study hub trends.

Yeah. I mean, look, as we mentioned, the decentralized trial offering opportunity was identified well before COVID. We talked about it before. We used to call it virtual trials, hybrid trials. We talked about it and we felt we were making great progress. And then the pandemic happened and we saw how critical those capabilities were and that accelerated the developments. Basically, it's a combination of remote technologies and digital parts of the clinical trial that can be digitized. So the suite for us combines e-consent, which you're familiar with, telemedicine, modules, e-coa, and of course, a lot of digital communication. It basically optimizes and virtualizes the relationships between local labs, healthcare providers, when it's necessary. It sort of establishes a virtual network of investigators and care professionals. And what we do is that we agree on preset terms with the investigators that agree to participate. We have internally operationalized this business and we have a separate team, a decentralized trial team. For example, we've got a decentralized clinical trial clinical research coordinator that can support the sites in a remote way, help navigate technology. This is new for all of the investigators and certainly for the patients. So we figured out during the pandemic that we needed a centralized team. to assist sort of a kind of a help desk, if you will. There is also sort of a wide-growth service to help patients and sites through the decentralized trial process. We also have research nurses and phlebotomy solutions team that build on our global network to support the decentralized studies. So again, we moved from the pre-2020 piloting phase, where we had, I believe at the time, sort of 60 or so small trials that essentially were experimental in nature, and people wanted to sort of try it out, to a maturing phase. We have added many wins. So far in 2021, I think we have more than a dozen larger decentralized clinical trials that were won. We added new therapeutic areas. We're working with five of the top ten large pharma clients. And I would note that one of the reasons we were able to win so many, a bigger proportion than anyone else of the COVID work, whether it's therapeutic trials or vaccine trials, was our more advanced decentralized trial capability. And again, we cover probably 10 or so therapeutic areas, nephrology, oncology, psychiatry, CNS, dermatology, etc. And it's moving to a more mature phase, and we will speak more about that in the future. Again, in the context of the very large R&D and business we have, it's still not something that's kind of moving the needle in the numbers, given the very strong growth that we have. You know, it's not

Yeah, and just to put some numbers around what Ari just said, I think we had 81 trials now that are fully deployed on StudyHub, and there's approaching 250 trials or so that have some piece of StudyHub. And at any given point in time, we'll have close to 1,000 full-service clinical trials going on. It's a piece of our business. It's a growing piece of our business, but still not the majority of what we're doing. Okay, that's very thorough and helpful. And just a quick follow-up to Jack's question earlier.

Possible, I'm curious if you could frame and size the Alzheimer's opportunity for IQVIA. I remember when something had to come out of backlog a couple years ago, it was rather sizable, and been wondering how sizable things coming into backlog could be. Thank you.

Yeah, I don't think it's... Listen, at the time, our bucket was much smaller, and when we came out, it was sizable, but it We didn't, you know, it was like seamless. We never felt it. It was not an issue at all. Neither when it left nor when it came back partially. So I'm not sure what you're referring to. It's not significant partial. I don't know that we disclosed that, but it's not. it wouldn't be material and would be in the rounding, given the size of our backlog.

Yeah, the current Alzheimer's contribution to our backlog is not material. Now, could there be more coming in the future? Sure, we hope there is, but we'll see.

Okay, thank you.

Your next question comes from Dr. Patrick Donnelly with CD.

Great, thanks for taking the question, guys. Ari, you touched on the M&A a little bit and obviously the cash flow performance, where the leverage is. Can you just talk about kind of the landscape, what the pipeline looks like? Obviously a lot of activity in the space. And then secondarily, you know, given some of the mergers and movements around the space, are you seeing any disruption opportunity for share gains? Any commentary from customers suggesting, you know, this is an opportunity for you guys at the moment?

yeah i mean you know the latter part of your question refers to the consolidation and soon enough we're going to be the only one standing here that's independent but we we look generally the clinical trial business is an attractive area it's a high growth area it's something that's well into the long-term room to deliver superior returns. We believe as an industry, and that is attracting a lot of interest from buyers, whether it's private equity or other large entities that are in search of opportunities to accelerate their revenue or profit growth. So all of that is good news for our industry. In terms of what are the consequences strategically, operationally, I think you know, it's pretty clear that, first of all, we don't need to participate, quote-unquote. Obviously, we look every time, and most of these companies have been shopped to us, obviously. We look at these companies, and in all cases, we've passed because we think the valuations or our ability to gain share does not require us to buy or to participate in this in this M&A trend, it's hard to gain a lot for a CRO to acquire another CRO. I mean, there are opportunities to complement capabilities, whether it's therapeutic-wise or geographic-wise, that could be areas of the business, preclinical phase one, phase two, phase three, complementary strengths. So again, these are the three dimensions, geography, therapy areas, or a stage in the drug development process that could lend themselves to more or less complementarity or overlap. Now, the consolidation has taken place that provides opportunities. As you know, I said before, we have been gaining share significantly. So we don't need to do that. It is a fact that when there is a large merger or large acquisition, there is disruption. We've lived it ourselves. So there is generally a loss of talent. We are seeing it coming from others. And there is generally a desire by customers to keep two, three, or four providers. And so if providers overlap when they serve the same customer, you can expect that the sponsor will look to further diversify their provider base. So all of this is true. Look, both talent and customer are present opportunities, but we're not We're not so focused on this. We're focused on executing on our strategy. It's worked so far. We're confident it will continue to work. Other acquisitions, obviously, we're looking at things as always. There's a rich pipeline always. You've noted we haven't done much last year. We haven't done much this year so far, or say for the Q-squared minority acquisition. But we are looking at other things, always in the technology space, and we have a rich pipeline. It's a binary thing. Acquisitions happen or they don't happen, so can't really talk much about that.

Now, that's helpful. And maybe just a quick follow-up. You know, CFMS doesn't get the most airtime, but, you know, it's nice to see the recovery ongoing. I think you bumped guidance from low single-digit decline to low single-digit growth. Can you just talk about the market recovery going on there and the outlook?

Yeah. I mean, look, a lot of clients did not cancel contracts last year because they didn't know how long this was going to last. And while our field reps weren't able to actually be in the field, but many of them remained on the bench with contracts kind of suspended or renegotiated, that caused some disruption. And as we have begun turning the business around, so it slipped and went back into the red in terms of revenue growth. But now we're seeing that we're going back And I mean, look, this is never going to be a double-digit grower, I don't think. So this is the best it's going to be, single-digit growth. And we are managing it. It's becoming less of a flashpoint simply because in the size of our company and the growth of the rest of the business, this is becoming relatively small now. Look, you will recall that shortly after the merger, nearly five years ago, we tried to sell it as a whole. We then found that it wouldn't fetch much of a value, and therefore we pulled the business, integrated it into our regions. It's very integrated now into our commercial operations. There are contracts for which it's very useful. In fact, I mentioned before the decentralized trial business where we are using nurses from the CFMS business to help with the virtual aspect for going to visit patients at home and so on. kind of an added value. It's not going to move the needle one way or the other as it used to be in the old quintiles days or in the early IQVIA days. That's helpful. I appreciate it, Ari. Thank you very much. Okay. Last question.

Our last question comes from Sandy Draper with Chu Securities.

Thanks very much. This should be a pretty quick one. Ron, just when I look at the third quarter guidance, looking down sequentially, I just want to confirm, I would assume most of that is because of an expected decline in pass-through revenue and R&D. Is there anything else? That's really the driver.

You're correct, Sandy.

Okay. That's my question. Thanks. Congrats. Thank you, guys.

That's it. Thank you, everyone, for joining us today. We look forward to speaking to all of you again on our third quarter call. Me and the team will be available later for any follow-up questions you might have and look forward to talking to you. Thanks, everyone.

This concludes today's conference call. You may now disconnect.