Medadvisor Ltd

ASX:MDR

Earnings Call Transcript

[George Kopsiaftis, executive]

[Technical Difficulty] second quarter FY '25 results briefing. My name is George Kopsiaftis, and I'll be your moderator for today. With us today, we have CEO, Rick Ratliff; and CFO, Ancila Desai.

This morning, MedAdvisor lodged its quarterly update and the presentation with the ASX, and Rick and Ancila will speak to this shortly. Format for today is for a 10 to 15-minute presentation, followed by a 15-minute Q&A session with the aim of finishing around 10 a.m. A recording of the presentation will be provided.

[Operator Instructions]

That completes the housekeeping for today, and I'd now like to pass it over to Rick and Ancila to get us started.

[Richard Ratliff, executive]

Okay. Thanks, George, and good morning to everyone on the call. I want to thank everyone as well for joining us today for our second quarter FY '25 update.

[ Garika ], if we'll move to the third slide, we will get started. There you go. Thank you. So, as many of you know, we provided guidance in December. And for those of you that were able to join us in December, very much appreciate you taking the time, particularly at that time of the year. Today's results are going to carry on the themes that were discussed in that update. And as the title here says, we did experience some headwinds through the period, again, as we shared in the guidance in December. And this was largely due to the vaccine business in the United States. But with that said, we've also positioned ourselves well, we believe, to take advantage of some tailwinds, and I'm going to talk through those in a few minutes and give you some details actually on the vaccine business in the United States, and we'll spend some time on that particular topic.

So, if we look at the group level first on this slide, I think it's important to see that, as we've said, our revenue was down 39% in the quarter and gross profit declined 29%. The decline in the quarter is primarily due to the late start of the flu season in the United States and lower-than-expected vaccination rates by the pharmaceutical manufacturers towards the end of the calendar year. And this led to a delay in a number of vaccine programs and deferral of budgets, and I'll talk more to that as we go through the conversation. Good news is the gross margin did increase due to change in product mix towards the higher-margin THRiV programs. And if you look at the right side of the slide, you'll see that over the last few years, there's been significant growth in THRiV programs in support of these types of initiatives over the last few years.

Our Transformation 360 program is on track. It commenced September of 2024 and is moving forward as was expected. As part of that program, we have conducted some restructuring this week, which is expected to result in annual cost savings of around $5 million in FY '26 with around a $1.4 million benefit in this half of FY '25. It needs to be noted that severance costs associated with the restructuring of around $500,000 will be expensed in the third quarter of FY '25.

As most know, we also announced in November that a formal review process had been initiated, whereby we are evaluating our strategic options to maximize shareholder value of the business. This process is currently continuing as expected through the quarter, and we'll provide more information as it becomes available. I do want to make sure it's clear, though, that it is possible that nothing may come from the process itself. And as such, we're currently continuing business as usual across both the U.S. and Australia.

Looking at the U.S. business for just a minute, you'll see that the full impact of the health programs and the deferrals, particularly the vaccination programs, in the second quarter have had a negative impact on revenue quarter-over-quarter. What's interesting is while vaccine programs were deferred in the quarter, as I mentioned, vaccine programs do continue to be an important part -- a material part of the U.S. business, as we'll talk about more in just a few minutes.

In Australia, the business is very much in line with our expectations. The changes to our SaaS pricing, which we discussed in the first quarter of FY '25, will continue to -- they'll continue to affect our revenue growth through the second half. And I think it's important to note that the transition to MedAdvisor for Pharmacy cloud-based offering is moving as planned. But as we're moving into the cloud, our IT costs or at least some of our technology costs are being recognized in cost of goods sold rather than in overhead and reducing gross margin -- or gross profit rather in Australia. So, on a positive note, we have fully migrated more than 80% of our pharmacy clients across to the new MedAdvisor for Pharmacy platform with the balance expected to be in place by the end of March of this year. We've also seen a significant growth in health program revenue over the quarter, as you can see in the lower right-hand side of this slide.

If we go to Slide 4, [ Garika ]. This graphic is a little busy, but let me spend a few minutes on it because it tells us a story about what's happening with vaccines in the U.S. market. As I've mentioned earlier, the segment has really hit some headwinds in the quarter, which has resulted in an impact on our business, as we'll discuss more. But we do see an opportunity ahead of us. And so, I'll touch on that in a minute. But in this chart, the lines show that the weekly vaccines that are delivered by brand, and the brands are highlighted at the top of the chart. And this is growth between 2020 and end of 2024. You can see that through 2020, 2021, vaccine spikes are primarily driven by U.S. COVID vaccines. So these are the vaccinations that are starting to roll out in 2020 through 2021, and we start to see some spread in 2022, and then it starts to come back into the seasonal time frame that we've seen with the flu season in the United States in the past.

So, as we look across 2022 to 2024, the COVID vaccine spikes, which are the dark line, for the most part, the green line is a different COVID vaccine brand. The blue line is actually Pfizer COVID vaccines and the green line is actually Moderna, and you can see how these are trending over time. You can also see that there are new vaccines that have been introduced, particularly in the 2022, 2023 time frame. The majority of this increase really is in the 2023 time frame when we saw the introduction of new RSV vaccines from both Pfizer and GSK.

So, at the same time, the trend around volume of vaccines being delivered is -- it is declining to some extent. But we are now seeing -- and we're starting to understand a few reasons for these declines, and this is really what's actually creating an opportunity for us. So, the green line -- the light green line is -- across time is related to flu shots. They're somewhat stable, if you will, if you look at the timeline in what we call the fall time frame in the United States. And as you would expect, COVID vaccinations from 2020, 2021 have declined over time since the peak in 2020, 2021. However, we expect to see them actually level out similar to flu, which again is the light green line.

As mentioned in the December guidance and in some other commentary from myself, we have seen a significant decrease in RSV vaccines from the initial launch in 2023 -- I'm sorry, yes, 2023 into 2024, and with around 76% of adults that are aged 60 and over still not being vaccinated for the RSV vaccine. Some of this variance is due to conflicting guidelines from the FDA and CDC, which are related to the target age criteria for the vaccine itself.

The chart also shows the seasonal spikes in vaccinations, as we've talked about in the past, particularly in the winter season in the United States. And through these spike periods and with the introduction of new vaccines and concentration of vaccines, consumers are often inundated with information around the vaccines themselves. This is creating some level of confusion with individuals in the United States, which can increase what is being termed vaccine hesitancy, which is one factor that's affecting the decrease in vaccination rates.

So, now that we've shed a little bit more light on the challenges with vaccines in the U.S., I'll spend a few minutes talking about potential solutions and opportunities if we'll go to the next slide. So, we're starting to work with pharmacies and vaccine manufacturers to look at how we can spread vaccine programs more evenly throughout the year. So, you'll see the shaded parts of the graph that overlay the previous graph, and I'll talk more about that. If we can implement vaccine awareness programs, which are better distributed throughout the year, we're less likely to have some of the spikes that we've seen in the past and some level of leveling out throughout the year. There'll still be some spikes for certain types of vaccines. But we're also more likely to be able to streamline the flow of information in this kind of a process with patients, making it easier for them to understand and, again, spread out vaccinations throughout the year versus a concentration in a certain part of the year.

So, some of the strategies that we're discussing with pharma and pharmacies include delivering educational messaging that support healthy vaccine journey across the course of the year and not just in a particular part of the year or a particular season throughout the year. We're looking at programs like shingles as an example, that are not necessarily seasonally related such that we can drive more promotion and spread those kinds of vaccines out and not have them being promoted and delivered at a specific time of the year such as the peak season towards the end of the calendar year. But we will continue to promote seasonal vaccines like flu during the peak seasons and make sure that we're supporting the promotion of good, improved public health.

So, if you go to Slide 6, the other important point here relative to the vaccine market itself is that this market does continue to be a very strong business for pharmaceutical manufacturers globally and an important element of public health programs across different markets throughout the world. So, if you look at the data on the left side of this slide, the value of the global vaccine market in 2025 is expected to be around $69 billion with a 6% compounded growth rate. We're also seeing that pharma is continuing to invest significantly in vaccines. Value of the 2024 Novavax and Sanofi partnership focused on commercialization and delivery of new vaccines is well over $1 billion. Moderna continues to inject investments into the vaccine market to the tune of over $5 billion. And Blackstone Life Sciences is funding a number of investments in the vaccine space.

If you look at our business as a whole, what's really important for the MedAdvisor business is that we're focused on engaging patients through their pharmacy. And in the United States, 90% of Americans live within 5 miles of a community pharmacy, and about 1/3 of the U.S. population actually visit a pharmacy at least once a week. So, with vaccinations being delivered predominantly -- particularly adult vaccinations being delivered predominantly in pharmacies, it's a great market, and it's a great alignment between pharmacy and pharma in relation to improving vaccination rates and, again, public health. Finally, the programs we have been running over the last number of years are delivering fantastic results, as you can see in the lower part of the slide.

Okay. So, now let's turn our attention for a few minutes to Australia. If you go to Slide 7, we've been working on some important initiatives in Australia, including the cloud migration, as I mentioned before, of our pharmacy workflow solution called MedAdvisor for Pharmacy and continued expansion and involvement in the work we're doing on Expanded Scope of Practice pilots across the country. We began our cloud migration, as I mentioned earlier, in September. This migration, to be clear, is designed to enable us to deliver our services into pharmacy to continue to reduce burden on the pharmacies themselves, but also expand their ability to deliver services outside of the pharmacy such as vaccines in school systems or vaccination programs in employer locations, just to name a couple of examples. 90% of all pharmacy customers, as I think I might have mentioned a minute ago, have transitioned to what we call Stage 2 of a 3-stage process for the transition, and more than 80% of pharmacies have completed all 3 stages of the transition to MedAdvisor for Pharmacy. And we do expect 100% of pharmacies to be migrated to the cloud by March of 2025.

On the right-hand side of the slide is some data we continue to share, as we are very excited about the work that we've done with Expanded Scope of Practice and Full Scope of Practice across Australia. We are delivering a number of different programs, including UTI, oral contraceptives, skin conditions, dermatology and more to opening up healthcare services access to the Australia population. The programs -- the statistics, rather, for the programs themselves continue to grow. And as I said, we're very excited about the progress we've made with over 3,800 pharmacies across 7 Australia states and territories actually participating in programs across Expanded Scope of Practice. Through our software and the efforts of the pharmacies themselves, they've engaged over 113,000 patients with a variety of services. Total number of services that have been completed are around 121,000.

So, if we'll turn to the last slide, spend just a few minutes on our outlook. As I mentioned earlier, our U.S. pipeline is looking very strong for the second half. Our sales team has done an exceptional job of diversifying our pipeline opportunities with over 50% more brands compared to same time last year being targeted within our pipeline. And so, in conjunction with the expected vaccine deferrals as we've talked through into the current half of the year, an uplift of U.S. revenue is expected in the second half as compared to the prior corresponding period.

In Australia, our operations continue to perform well, as we've discussed, and are expected to perform to our expectations for the rest of the year. And as I highlighted earlier, the transition of our pharmacies should be complete by the end of March. One thing that we are planning to launch in the next 30 days is a price adjustment to our Software-as-a-Service fees or our subscription fees for MedAdvisor for Pharmacy, which we will see some impact -- positive impact on revenue in the second half of FY '25.

As I mentioned, our restructuring that was implemented this week is expected to create cost savings of over $5 million in FY '26 and a benefit of around $1.5 million in the second half of FY '25. We have -- as I mentioned at the beginning, we have made good progress on our strategic review process. The Board continues to work very closely with our advisers, evaluating all of our options across Australia and the United States to help maximize shareholder value. And when we do have some conclusions and recommendations that we're ready to share with the market, we'll definitely be back to discuss our findings and direction.

So, last of all, through our journey, we do remain focused on driving a profitable business and boosting our operational efficiencies, delivering platform upgrades as we planned, changes through Transformation 360, product innovation, and AI enhancements to our service offerings are still in our product plans for FY '25 going into FY '26.

So, with that, I think we now can open it up to questions. And so, I will -- George, I'll turn it back over to you to see if there's any questions.

[George Kopsiaftis, executive]

Great. Thanks, Rick. [Operator Instructions] First question, Rick, does the ANZ health program include Expanded Scope of Practice?

[Richard Ratliff, executive]

No. The ANZ health programs are similar to the United States in that they are pharma-sponsored programs that are delivered through our network. One of the larger programs actually in the second quarter was related to a -- what's called a GLP-1 weight loss drug, where we actually enabled engagement of pharmacists with individuals that were filling that medication to help educate them on that medication itself and how to properly take that medication, manage it, et cetera. And through that process, there are opportunities to actually pay the pharmacist to -- for that kind of an engagement, and we coordinate that process with pharmaceutical manufacturers, as an example, for those kind of programs.

Expanded Scope of Practice is much different. Expanded Scope of Practice is where we're actually enabling a pharmacist to deliver services somewhat similar to a general practitioner in that -- and these are very defined services. So, in Full Scope of Practice in Queensland, that's 23 different categories that pharmacists can actually deliver, including some of the ones I mentioned around women's health, urinary tract infection, oral contraceptives, skin care, et cetera.

[George Kopsiaftis, executive]

Great. Thanks, Rick. Next question: with the current political party in the U.S., how likely is vaccine delivery going to be a growing area?

[Richard Ratliff, executive]

Very good question. I have not actually looked at the latest relative to RFK's confirmation, but that is actually happening today. And he is the individual that will lead the efforts in a department in the United States that does have oversight on vaccine development and other drug development. That's our FDA organization. And at this point in time, we are not anticipating any negative impact, at least to the work that we've been doing and the work we expect in the future. Vaccine programs themselves are delivered through the local states. And so, state regulations drive the timing and initiatives in relation to public health programs, which include vaccines. So, there's a balance between what can be driven at the federal level. So drug development is one thing, but actual program delivery is a different thing at a local level. So, we believe at this point anyway, and we're continuing to monitor it, as are the pharmaceutical manufacturers, that there would be no negative impact relative to our vaccine program delivery.

[ What will be ] interesting in the United States will be the direction on direct-to-consumer, which is TV advertising. That is a concern on the part of media networks, as well as pharmaceutical companies, because of the level of spending and focus on TV. If there is a pullback on TV and direct-to-consumer advertising, that actually creates more of a need to be able to get to individuals through other channels and our channel through the pharmacy, again, as I mentioned, with vaccines being delivered through -- the majority of vaccines being delivered through the pharmacy is a great opportunity for pharmaceutical manufacturers to bridge that gap if TV advertising does start to get pulled back.

[George Kopsiaftis, executive]

Thank you, Rick. A question here from Thomas Wakim from Bell Potter.

[Thomas Wakim, analyst]

You've talked a lot about the vaccine business. Just looking at the numbers, from what I could calculate, it also looks like some of the non-vaccine revenues have declined versus the previous corresponding period. Have I got that right? And is there any kind of commentary or expectations around that side of the business as well?

[Richard Ratliff, executive]

Yes. So, thanks, Thomas. There was a slight decline. So, about 70% -- 70% to 80% of the decline in the first half was associated with vaccines and budget-related movements. The remaining was related to a few, what I would call, chronic med category brands. And these were brands where there was a shift in strategy in relation to promotion because the brands themselves are going off patent. So, when a brand goes off patent, then the pharmaceutical manufacturers have different strategies relative to the timing of moving that brand to what they might call mature brands, and then they shift their actual funding in relation to what we would call promotion. And so, there were a couple of brands that were intended to run in the second quarter that did not. One of those, it appears, will run in the second half, but they delayed spending as they were evaluating their competitor that was also coming off a patent. So it was a patent-related strategy change that affected that particular situation. Just to note, we're typically in front of that and able to offset that. This is a shift in strategy in the quarter that was not expected.

[Thomas Wakim, analyst]

Great. And if possible, could I ask one follow-up question just around your cash flows? Obviously, cash balance as of 31 December is $12.4 million, and that included a bit of debt that was drawn during the quarter. Any comments you could provide on your expectations for cash flow for either the second half of the year or just moving forward?

[Richard Ratliff, executive]

Yes. So yes, thanks, Thomas. At this point, given where our pipeline is and the modeling and analysis that we're doing as a management team, as well as the modeling that is being done by the Board, there is no current expectation of need for a capital raise and/or additional debt in order to address any type of a cash-related issue. But this is something that we obviously continue to monitor, as does the Board, in this particular situation.

[George Kopsiaftis, executive]

The next question comes from Elyse Shapiro from Canaccord.

[Elyse Shapiro, analyst]

Rick, quickly on vaccines, are you starting to see more vaccine opportunities come through in non-respiratory areas, I guess, like shingles or GARDASIL or any other vaccines? Or are you still highly, highly exposed to kind of COVID and flu and RSV?

[Richard Ratliff, executive]

Good question. We actually -- trying to do the math in my head, I'm sorry. So, actually, about 40% of the revenue in the second quarter, probably first quarter, second quarter, probably have to look at both, was related to, if you want to call it, non-respiratory. You probably take pneumococcal out of that. So, I would look at it more as shingles. And so, about 30% to 40% of that revenue was associated with non-respiratory type vaccines. That demand is actually continuing through this year, and we have commitment to run those programs already in the first -- I'm sorry, the third and the fourth quarter.

[Elyse Shapiro, analyst]

Got it. And then, just delving into kind of the pharma programs a bit, you talked to some large kind of -- larger scale growth in the pipeline and new brands. Are these smaller projects? Or are you kind of coming across pricing pressure at all as well, either from competition or pharma willingness to spend?

[Richard Ratliff, executive]

Good question. A couple of things there. First of all, we're not running into any price pressures for the programs we're running, at least at this point in time. That's one thing. The second thing is the program size does seem to vary based on the category and the level of competition with new brands. So, some new brands, we will see a lower contract value as they enter in. We do have one large brand we expect to finalize here in the next week, actually, which is similar size, actually -- [ and it's a ] new brand -- similar size program to some of the vaccine programs we've run. So it's not consistent relative to small versus large, but we would tend to see more small to medium-sized programs for new brands that are new to our platform. But we are seeing a couple of outliers where we're seeing some larger commitments, both from a contract value, as well as time -- terms of the agreements.

[George Kopsiaftis, executive]

Great. Thanks, Elyse. Look, I'm aware it's just after 10. For anyone that needs to go, just a reminder, we will be providing a recording of this session. So we'll make that available to everyone. And Rick and Ancila, if you're okay, we'll just keep going with the questions. There's still a few.

[Richard Ratliff, executive]

Sure. Okay, yes. Next question comes from Sarah Mann.

[Sarah Mann, analyst]

A couple of clarification questions. So, at the guidance in December, you guys guided to kind of positive EBITDA for the first half but also kind of reaffirmed that for the second half and the full year. I just wanted to check that, that is still the case. Or has anything changed on that front?

[Richard Ratliff, executive]

So, the -- as we'll report in the first half -- for the first half in February, the first half is positive EBITDA. And in the second half, we are analyzing the pipeline and the direction, Sarah, to confirm the expectation on positive for the half. We do -- based on current analysis, we are expecting the full year to be positive EBITDA, but that's based on the current analysis, and we're continuing to analyze that as we see the pipeline -- the speed of the pipeline conversion.

[Sarah Mann, analyst]

Great. And then just on the U.S. pipeline, so you've obviously pointed to kind of a stronger second half, and that's a combination of probably dollar terms being higher, also clearly the number of programs being higher. Historically, you've provided, I suppose, a percent of the pipeline that's been contracted. Is it possible to get any color around that and how this kind of compares to kind of percent contracted at the same time last year? Or just whatever color you're willing to provide around that.

[Richard Ratliff, executive]

Yes. I would say that our expectation would be to provide more details in the -- for the half year. At this point, the -- as I mentioned, it is -- we have a sales team that's selling at a much different level than prior sales teams within the manufacturers and the brand organizations themselves. They've built a very strong pipeline that's being tracked much closer than in the past. We have, in the last few weeks, seen better conversion rates than we had been seeing previously as we were coming into the end of the year, and we're continuing to monitor that so that we can start to provide more clarity. But currently, the pipeline is significantly -- from an unweighted perspective, is a multiple of our current revised budget for the half and the full year. I'll probably leave it at that for right now.

[Sarah Mann, analyst]

No problem. And just like the last question, which you've kind of alluded to, but given the new U.S. government, have you had any changes in how your pharmaceutical manufacturer clients are thinking about kind of their marketing budgets over the course of this year relative to what you outlined in December? Or is it still kind of consistent and there's been no change?

[Richard Ratliff, executive]

There's -- a good question. There's been no change. But with that said, there's definitely a lot of discussion, and that discussion could intensify depending upon the results of today. Like I said, I haven't looked to see what the results are on RFK's confirmation. But that is -- that's definitely top of mind for the pharmaceutical manufacturers. With that said, we've not seen them change budgeting processes or expectations on spend and where they're going to spend at this point. But it's not to say that, that won't happen because we're just 1 week into the new administration, and key individuals are just getting confirmed.

[George Kopsiaftis, executive]

Thanks, Sarah. A question that's come in. Do you expect an outcome of the strategic review by the end of March? Or could this drag into the fourth quarter? And a follow-up, have you engaged [ EVOIs ] in this process as yet?

[Richard Ratliff, executive]

Good question. Let me say this, we're making very good progress with the strategic evaluation. We have talked to many advisers, as well as strategic organizations in Australia, and it would be the types of organizations you would expect us to talk to. So I'll leave it at that. But basically, we're finding confirmation that our hypothesis that the respective components of the business are not being valued where they should be, and we see some positive indications of opportunities as we move forward. When we're at a point where we can share that we have something that's more definitive and we can share the details, we'll definitely do that.

Relative to the timeline, it would be my hope, and at this point, in line with the Board's expectation, that we would be at closer, if not, we'd have significant clarity on direction by the end of March.

[George Kopsiaftis, executive]

Great. Thanks, Rick. There's a couple of questions here around cash flow, so I'll consolidate them. But basically, it's saying, could you please comment on the $7.9 million cash burn in the first half? And what's your expectation for the full year? Ancila, maybe one for you.

[Richard Ratliff, executive]

Yes. $7.9 million, do you want to talk to that, Ancila?

[Ancila Desai, executive]

Yes. I think we've already addressed the cash question in terms of cash flow. So, this is something we're looking at very closely. I don't believe we have a cash burn as such in the first half. We're very close to -- as we've mentioned, we're profitable in the first half. A lot of it is timing of expenses and payments. But in the second half, in particular, it's something we're watching very closely. The Board is reviewing our cash position. We don't expect anything to change in the short term, as Rick mentioned already.

[George Kopsiaftis, executive]

Great. Thanks, Ancila. And a question around Australia and its revenue. Can you explain how the SaaS transition is impacting revenue? And a follow-up, can you quantify the ESoP revenues?

[Richard Ratliff, executive]

Do you want to talk to that?

[Ancila Desai, executive]

I can maybe just answer -- yes, so I can give clarity on one of those questions. So, if you see in our financial statements, if you look at FY '24, you'll see Note 6, and that's where we highlight clearly the SaaS revenue and the transaction fees. So, Scope of Practice revenue is in our transaction fee revenue. For the one half numbers, these are not yet out, but the one half numbers, you will see again, the transaction fee revenue is $2.4 million, which is separated from the health programs revenue. So, I think your question in relation to what's health programs, what's SaaS, what's transaction fees, we actually separate them in the financial statements, both for the first half and the second half.

[George Kopsiaftis, executive]

Great. Thank you, Ancila. Look, that seems to be all the questions at the moment. I might just pass it back to you, Rick, for any closing remarks.

[Richard Ratliff, executive]

Sure. Thanks, George. And again, I want to thank everyone for taking the time this morning to spend with us as we've hopefully walked through some additional details to help provide some improved clarity relative to the U.S. business. And we will look forward to continuing to share with you any new changes to the business as we move forward, and we will be back in the February time frame with more details on our first half results. So, thanks again for your time and appreciate the support from many of you as we've gone through this process.

And with that, George, I'll turn it back to you to finish things up.

[George Kopsiaftis, executive]

Great. Thank you, Rick and Ancila. And again, just a reminder that this session has been recorded, and we'll make it available to everyone. Also, if you have any follow-up questions, please feel free to reach out to myself or the company. That concludes the investor briefing for today, and thank you to all participants.