Good morning. I would like to welcome all of you to the earnings release call of Fleury for the third quarter of 2026. We have here with us today Jeane Tsutsui, CEO of the company, José Filippo, CFO of the company, and Mr. Renato Braun, IR Director. I would like to take this opportunity to inform you that this event is being recorded and that we are also providing simultaneous translation into English. First, there is going to be the presentation of company's results, followed by the question and answer session. At the end of the session, Ms. Tsutsui will make her final remarks. All the numbers that are going to be mentioned here are comparable to the same period in the year 2025, unless otherwise specified, and they have been rounded up to the nearest thousand.
Before proceeding, I would like to clarify that this presentation may contain information about future events. Such information is not just historical facts, but would reflect the wishes and expectations of the company's management. The words believe, expect, plan, forecast, estimate, project, target, and similar are intended to identify statements that necessarily involve known and unknown risks. Known risks include uncertainties, which are not limited to the impact of competitiveness of prices and services. Uncertainties also include market acceptance of services, service transactions of the company and its competitors, regulatory approval, currency fluctuation, changes in the mix of services offered, and other risks described in the company's reports. I would like now to hand it over to Ms. Jeane Tsutsui.
Good morning, everyone. Welcome to the Grupo Fleury third quarter of 2026 earning release call. In our agenda today, we will present an overview of our performance in the quarter.
Then we will show our initiatives in the area of diagnostic medicine and precision oncology, and we will close with the financial highlights and the Q&A session. Slide five. We see that in the third quarter of 2026, Grupo Fleury once again delivered consistent results, combining robust organic growth, market share gain, strong profitability, and expansion of return on invested capital. Grupo Fleury's gross revenue reached BRL 2.7 billion in the third quarter, growth of 13.3%. Considering organic growth, the expansion was 9.9%. This organic growth reflects increasing volumes and also capture of commercial opportunities in different regions, reinforcing robustness of our multi-brand portfolio and the differentiation of our service model at Grupo Fleury. B2C unit, which is comprised of diagnostic medicine units of different brands in 13 states and the Federal District of Brazil, advanced 14.1%, or 9.3% if recent acquisitions are excluded.
The quarter's results reflect consistent gains in market share in several geographies and segments. We observed evolution in both the premium and in intermediate brands, supported by the expansion of installed capacity, medical excellence, and increased product and service offerings. Fleury brand grew 8.9% compared to the third quarter of last year, and it has accumulated 11% growth in the past nine months. The other brands in São Paulo grew 31.9%, performance driven by our acquisitions of Femme and Laboratório São Lucas, and 10.6% considering only organic growth. In Rio de Janeiro, B2C operations grew 8.9%, and in Minas Gerais, the advance was 16.4%, of which 12.6% was organic growth, results that show our strength in the largest markets outside São Paulo. Our B2B unit, comprised of lab-to-lab and diagnostic medicine operations for hospitals, expanded 12.7%, and unit Novos Elos grew 8.4% in the period.
EBITDA reached BRL 672.2 million in the quarter, growth of 12.2%, with EBITDA margin of 27.1%. Net income was BRL 262.3 million, with sizable growth of 42.9%. Our net margin was 10.6%, 220 basis points higher than what was obtained in the third quarter 2025. Finally, our ROIC reached 18.7%, 470 basis points higher than in the second quarter of 2023, when we completed the transaction with Instituto Hermes Pardini, a demonstration of our discipline in capital allocation. Slide six shows the transformation that Grupo Fleury has been undergoing in two fundamental aspects of our strategy: consistent growth and diversification of revenue sources. On the left side of the slide, we see the advance in our revenues. Since 2021, we have more than doubled our revenue from BRL 4.2 billion to BRL 9.9 billion in the last 12 months.
Our CAGR has been 13.7% since 2012, with strong results in all business units, brands, and regions in which we operate. On the right, we show the results of geographic diversification and operations. The share of B2C went from 83% to the current 70%. We grew in places such as Minas Gerais, Rio de Janeiro, and the inland areas of São Paulo, creating a multi-brand portfolio with strength in several markets. The B2B unit currently represents 22% of our revenues, and Novos Elos contributes significantly to it. These new sources of revenue make Grupo Fleury even healthier and more resilient, and enhance our growth. On slide eight, we present our initiatives in an increasingly strategic area, precision oncology. Grupo Fleury offers a complete portfolio of diagnostic medicine for oncology, including clinical analysis, imaging, pathological anatomy, and genomics.
More recently, we have expanded the offer of innovative solutions for prevention, early diagnosis, and customization of cancer treatment. Last month, we started offering Galleri, the first multi-cancer early detection test in Brazil, capable of identifying signs of more than 50 types of cancer, including tumors that do not have screening methods. The test has arrived in the country through Gênesis, our joint venture with Albert Einstein Hospital. In June, we have also taken over the commercial operation and logistics of FoundationOne trials throughout Brazil. Developed by Foundation Medicine, an independent Roche affiliate, FoundationOne is based on precision genomics and assists oncologists and hematologists in deciding on the best treatment strategy for their patients. The test was introduced in the country in 2014, and it has since then contributed to the most accurate treatment of 25,000 patients.
Let me remind you that we have been pioneers in Brazil with Oncotype DX, a test that evaluates the risk of recurrence and predicts the benefit or not of chemotherapy in the early stages of breast cancer, which is one of the most recurrent cancer types among Brazilian women. With more than 580 units and 9,300 partnering labs, Grupo Fleury brings together infrastructure, scientific knowledge, and international partnerships to expand access to new technologies. These advances reinforce the company's role in fighting cancer, contributing to better prognosis, greater longevity, and the sustainability of the health system. I now hand it over to José Filippo, our Chief Financial and Investor Relations Officer, to present the financial highlights of the third quarter.
Thank you, Jeane. Good morning to all. We'll continue with the breakdown of financial information for the third quarter 2026.
Starting from slide 10, we see that gross revenue grew 13.3% compared to the third quarter of 2025, reaching BRL 2.696 billion. All our business units performed strongly, with B2C growing 14.1%, B2B advanced 12.7%, and Novos Elos increased 8.4%. In the first nine months, gross revenue grew 12.6%, reaching BRL 7.6 billion. Slide 11 shows the unit of our B2C unit, which represent very good performance in all different areas and brands. We had BRL 1.9 billion revenues, 14.1% growth compared to the third quarter 2025. Excluding the effect of acquisitions of Femme and Laboratório São Lucas in São Paulo and Hemolab in Minas Gerais, we had growth of 9.3%.
In the period, we gained market share in São Paulo and in markets such as Rio de Janeiro, Minas Gerais, and Rio Grande do Sul, which is a reflection of the power of our brands and actions such as the expansion and optimization of our installed capacity, both in São Paulo and in Rio de Janeiro. We had 4.9 million encounters in our B2C unit as an increase of 15.5%. On slide 12, we analyze our B2B unit, which had in the quarter growth of 12.7% in revenue, reaching BRL 576.4 million. In our B2B unit, lab-to-lab business had strong performance, explained by the growth of our customer bases, showing commercial actions, more outsourcing of basic exams. In 2026, the revenues of the unit reached BRL 1.6 billion, growth of 10.2%.
Now moving on to slide 13, we can see that business unit Novos Elos grew 8.4% in the third quarter, BRL 221.4 million revenues. The performance was driven by infusion of non-cancer drugs. In the nine first months of 2026, the revenues has reached BRL 617.2 million. The next slide 14, we show you gross profit, which grew 16.6% in the quarter and was BRL 718 million. Gross margin was 28.9%, increase of 79 basis points. The change in the company's CapEx profile, with lower volume investments in IT and digital, had a positive impact on the margin, as well as the dilution of costs in personnel and medical services, which was caused by the increasing volume of clinical analysis with automated processing.
On the other hand, the increase in cost of direct material intermediation of exams decreased the margin by 22 basis points due to the strong growth in the volume of clinical analysis. On the nine first months of 2026, gross profit reached BRL 1.99 billion, growth of 16%. Now moving on to the next slide 15, we see that operating expenses fell as a proportion of net revenue, 11.1% in the third quarter 2026 over 11.4% in 2025. This variation is a consequence of the operational leverage resulting from expansion in revenue. Considering the increase in operational expenses, there is an increase in lab-to-lab, which lead to an increase in commercial expenses line, explained by variable compensation of our commercial team.
The next slide 16, we analyze EBITDA, which reached BRL 672.2 million in the quarter, growth of 12.2% as a result of the increase in operating profit. The margin represented 27.1%, slightly below 2025 because of a decrease in depreciation and amortization, in addition to one-off expenses in the integration of Femme. The nine months of 2026 to present, there was BRL 1.8 billion reached with 12.6% growth and a margin of 26.9%. Slide 17, we see the net income, which was BRL 264.3 million in the quarter, growth of 42.9% over 2025. Net margin was 10.6% over the third quarter last year. To present, net income reached BRL 687 million, which has an increase compared to 2025. Now slide 18, talking about investments.
CapEx totaled BRL 102.8 million in the quarter, reduction of 18.4% over the previous year, with less investments in IT, digital, which are more operational, and greater focus on expanding the supply and capacity of technical areas. In 2026, CapEx reached BRL 239.1 million. Next slide 19, we show you the operating cash generation, which grew 11.1% in the quarter and reached BRL 798.5 million. To present, cash operation was BRL 1,758.9 million, with cash conversion reaching and showing our cash generation. Cash conversion was very significant. Next slide 20, we can see that in the quarter, the ROIC of the company grew once again, showing our consistency in strategy to allocate capital and generate value for our shareholders. Since the business combination with Hermes Pardini, our ROIC has grown by 470 basis points, reaching the current 18.7%.
The leverage in the end of the quarter was low, one time EBITDA over net debt. Slide 21, we show you our cash position. In the end of September, was BRL 3.159 billion. And here we have the amortization of our debt, showing a profile with no concentration of payments. In a hypothesis, our current cash would be able to honor all our debt maturities for nearly four years. Before we start the Q&A session, let me hand it back to Jeane for the conclusion of the presentation. Thank you.
Thank you, Filippo. I would like to close this presentation by restating the quality of the results we have delivered. We grew in all our business verticals and in different geographies. We are keeping the pace and preparing Fleury for the future.
We have advanced in the integration in record time of Femme, a diagnostic network focused on the female audience that we have acquired in May. In early October, we announced the acquisition of Unilab, the largest network of clinical analysis lab in Atibaia. The acquisition reinforced our position in the inland area of São Paulo, a region with high socioeconomic development and private healthcare coverage. Our strong cash generation and profitability, coupled with discipline in capital allocation, shows that we are prepared to continue advancing in the outpatient offer of health services. Worth mentioning that our financial discipline keeps our leverage at very low levels, even after the series of acquisitions we have made. We believe that continuous expansion of our operations is closely related to the focus on preventive medicine and outpatient follow-up of chronic diseases, which are the pillars of the future of the industry.
In a country that is aging rapidly and where the desire to gain years of life with quality and autonomy is increasingly present, a model that prioritizes a more proactive system with early diagnosis of diseases and that provides personalized and accurate treatment becomes an asset for the industry and the society. We aim to contribute to sustainability of the system and increase in access to health. Constancy and solidity of our results in one more quarter strengthen our conviction that we are on the right track. Thank you, and now we are ready for the question and answer session. Thank you.
Well, ladies and gentlemen, we are going to start now our Q&A session. To ask a question, please use raise hand option. To withdraw it from the queue, please click on lower hand. Let me now invite Renato Braun, who is going to carry on this session.
First question, UBS, Olavo.
Good morning. Thank you very much for taking the question. I have two questions. The first one about operational leverage. Commercial expenses increased year-over-year because of variable compensation in lab-to-lab, and lab-to-lab has been increasing significantly with a lower ticket. Therefore, my question is, in terms of leverage, with this kind of mix, where can you see margin expansion in 2027? If you can please give us some more details about the level of commercial expenses over revenue, thinking about the mix. Second question about capital. We've seen strong cash position that you have and the leverage at one time, also the interest on equity and everything.
In this new situation after the presidential elections and thinking about the monetary policies from now on in Brazil, what can you share with us in terms of priorities, thinking about M&A in regions maybe inland in São Paulo, and also the return on shareholders with further sharing of dividends? Thank you.
Good morning, Olavo. Thank you for the questions. You are right. Our operational leverage is provided by the volume we currently hold. You mentioned lab-to-lab, but B2C is also part of that. We've grown more in clinical labs, clinical analysis tests. The ticket is lower by test, but we bring very interesting volumes and good margins in clinical analysis. Lab-to-lab and B2C have increased the proportion, the share of this test over the margin, which brings us an operational leverage, and therefore, our margin, our gross margin benefits from that.
Now, moving ahead, we believe, and of course, not giving you any guidance, but we believe that we will keep on following the same understanding. Growth, which results from organic growth primarily. To date, we have 10% organic growth. B2C, still growth, but lab-to-lab is also growing. We have expanded technical areas. We are benefiting from our very good commercial team. Yes, there is variable compensation, and we've been structuring our lab-to-lab commercial teams to gain more markets. But in general, our margin is very healthy. year-to-date, we've delivered 26.9% EBITDA margin. It was 27.1%, but with an impact of Femme integration, and we have put in place a number of actions to capture the synergy with this new acquisition. Moving ahead, we will have gains in efficiency. We'll keep on obtaining synergy from the most recent acquisitions.
We've made investments in digital technology, and we are already benefiting from that. Over 50% of schedulings in the state of São Paulo are made through digital scheduling, which is also very helpful in terms of gaining efficiency. As you can see, it's a very good path, always analyzing top line, growth of income, improved margins, very much part of our focus. But there is also ROIC. Our ROIC has been growing quarter- over- quarter. Lab-to-lab has a somewhat lower margin compared to B2C, but the ROIC is very good, dispensing additional investments. Therefore, it is a combination, a healthy one, and we'll focus on maintaining healthier margins in our businesses. Concerning your question about capital, yes, we've generated a significant amount of cash. There are some payments of interest on equity and a payout that was quite high in the past.
Considering the post-election status and considering the macroeconomic reality, I believe we are really well prepared. We have low leverage. We are always considering M&A as possibilities. We do not depend on M&A. Our growth is primarily organic. But yes, we are always open to potential M&As with the same disciplines we've always employed, thinking about a strategic pillar, culture, and discipline in economic financial parameters. I don't know if Filippo would like to add anything.
Olavo, concerning capital allocation, we are very much concerned about financial discipline. This is the way we manage, and it's been so for a while. Elevated cost of capital, we don't think it's going to change in the short term. Therefore, capital allocation will be maintained the same guidelines that we have had.
Expanded ROIC, as we've heard, but we are also going to make the necessary capital investments really to offer the best support to our businesses. Especially after the combination of businesses, we've required additional investments in the area of IT and digital technology because of the whole integration. Now we can see some more maturation, right, of these investments, even though which does need some additional updates and maintenance, but we can see a different kind of allocation. What we have today in these lines is just a retrofit of our units and some maintenance of equipment. Of course, CapEx is required to meet the needs of operation and growth. In terms of payout, we've had high payout rates because of opportunities in terms of profit and cash position. But this is a decision that is made the end of the fiscal year.
So probably in the beginning of next year, we are going to revisit the situation. It's a decision of the board. The reference is the leverage, company leverage, our strategy to maintain lower leverage rates. And this is the metric that we use when considering capital allocation, as it has been so. And this is how we analyze with discipline, with concern, to have appropriate control over it. Thank you, Olavo.
Thank you.
The next question by JP Morgan, Guilherme Vilela.
Good morning. Thank you for taking my question. First, about the change in the working hours, six to one. I know physicians are service providers, but I'd like to know about nursing staff, phlebotomists, and can you just adapt that? Can you just deal with the new legislation? It might impact your costs in 2027, so what have you been anticipating? Second question about Femme and M&A.
What is the ramp-up we can anticipate? How have you observed the synergies, and what can we expect in terms of margins for the next quarters?
Good morning, Guilherme. Thank you. Concerning the change of working scale from six to one to five to two, we know it has been approved, but there are a number of uncertainties, especially concerning some specific areas. Healthcare is being discussed through Abramed, ANAHP, CNSaúde. What would be the impact on healthcare at large? These uncertainties still are not solved. We have been monitoring the conversation. We have an active role in these discussions, but there is still no clear definition. In the meantime, we have been working with different scenarios to mitigate the impact.
There are some people within hospitals, for example, that work 12 by 36 in terms of their work scale. We would have to analyze if all units would have to be opened, let's say, during Sunday, for example. It is a broader discussion, you see, in terms of healthcare. This is what is being conducted by different organizations. I think healthcare, as it is a very sensitive area because we provide services to the population, we were going to have this broader discussion. Concerning Femme, we have already shared the results of Femme for this quarter. What has led to the growth of other brands reaching 31.9%, and there was an impact on the margin, but we are very glad with the process of integration between the companies.
There was some time where we planned all the analysis of synergies because there was this period in which the antitrust authorities were analyzing that. Once we got the okay that the business could be closed, then we started working. You see, as of October, the systems are integrated, scheduling, services, and also ERP, fully integrated. The important point is there are a number of opportunities in Femme, and we said that during the acquisition, the drop in multiples post-synergy will be very important, and we have been working since day one concerning changes in processes, expansion of medical schedule. Femme has a very important brand recall with women, and it offers a number of imaging tests and also clinical labs. Femme used to outsource their labs. It means that now we are going to process it. We have been speeding up the integration of Femme.
We are very glad with the results we have reached so far. We have already reduced by 50% the time taken to start and register a patient right into the system just by coordinating with our system. Femme will also have opportunities of growth, of offering more tests, and also offering more availability of time and tests thanks to the optimization. We are fully dedicated on capturing the synergies from Femme as quickly as possible, and during the fourth quarter, we will certainly have the results of Unilab in Atibaia, an acquisition that was made now in the beginning of October. It is an asset that doesn't have to be approved by the antitrust authorities, so we are working on the integration with this company. This position that we have in the state of São Paulo is really strong. Fleury brand is widely recognized, and it has been growing significantly.
There are other brands in São Paulo which also have observed double-digit organic growth. Now we are even stronger in the inland area of São Paulo because there was Confiança acquisition in Campinas, then São Lucas in Rio Claro, and now as of the fourth quarter, Unilab in Atibaia and region, and Femme here in the city of São Paulo. As you can see, we are getting stronger and stronger, especially in a market that has a very good potential of full coverage of private healthcare services. The process of integration has been learned throughout time, so now we can do it faster, and certainly, we will see benefits to our group in upcoming quarters and years. Thank you.
Great. Thank you.
The next question comes from Safra, Thiago Marmo.
Good morning, everyone. Great results. Thank you for taking my question. I have two questions. First, about tax.
The tax rate in the quarter was 17%, significant improvement compared to what we had expected, and we have also noticed a significant decrease of tax rate in recent results. I believe the company has explained the better use of Lei do Bem and also interest on equity. How much of that lower tax rate can show adjustments to previous quarters, and what is the expected level from now on? As the fourth quarter has different seasonality, maybe the nine-month rate 26 would be a reference for the run rate from now on. I do not know if you could give us some indication about that. Second question, CapEx and depreciation. We have been observing a change in CapEx profile for a while, less investments in digital and IT, and more investments in the physical or the different assets of the company.
How do you anticipate the CapEx investments in upcoming years, and how is that going to impact depreciation and amortization lines? Maybe the D&A level is a good reference, current one, or should we expect changes in these lines as well? Thank you.
Hi, Thiago. Let me start from your first point, effective tax rate. We work with always thinking about our budget in the beginning of the year, and as we move on, we try to see how well we are performing, how we can use interest on equity, different investments that would be applicable according to all the benefits of the government. There is a natural alignment. You tend to be more conservative in the beginning of the year, and as we gather more and more information, we make the adjustments.
What we saw in the third quarter was an adjustment within this, let us say, calibration of numbers, and it took us to an effective rate of the year of 20.1%. This is the number you make reference to. So 17% in the quarter, but 20% year, all over year. Last year, the tax rate was 20.8%. So we have maintained the same level. It depends a little bit on the results, on interest on equity, et cetera. We cannot give you really what would be the trend from now on, but considering how we have calculated that and previous years' performance, that can be a helpful reference. Always doing all we can to capture benefits. In terms of CapEx and depreciation, and you talked about that, it always starts from CapEx, right? Always starts from investment.
As we have just said, in recent years, we have made higher investments in IT and digital because of combination of business and other aspects. This kind of investments just go over the assets and have a faster amortization. The CapEx is now being translated into depreciation and amortization. When we get to the level in which the requirements are going down, and we have seen that year-to-date in 2026, lower percentage, because of less investment in IT and digital, there is less depreciation and amortization.
This is what we have been experiencing. This is our current standard, and to some extent, this is what we can anticipate as the expected profile. It always depends, of course, on the needs of investment and the amortization time. Depreciation is reflecting this profile. The current level is what would be expected because of the investments lines we have made. That is it. Thank you.
Thank you.
Next question comes from XP, Gustavo Tiseo.
"Thank you. I have two questions. Jeane has talked about it, but I would like to go further. Integrated medicine is an advantage. It is improving margins. I would like to understand the history, the track record, and what is going to make the margins change. Integrated medicine had some more challenging years, one year, one year and a half ago, and now it is speeding up growth. Can you please give us some more details and what we can expect in terms of margins? We can see some positive indications. What can we expect from now on? 10%, 12%, 15% margin by the end of 2027, just to understand what you have been thinking about. Secondly, more in the short term, short-term volumes for the fourth quarter. Is it aligned with the third quarter, beginning of October, November?
Just to understand if you have maintained strong volumes as we have seen in previous quarters." That is it. Thank you.
Hi. Thank you for the questions. Yes, integrated medicine, and we have diagnostic medicine, primarily B2C, and integrated medicine brings on board a number of businesses such as lab-to-lab, Novos Elos, and new small businesses. Throughout time, we have been improving our margin, as you observed yourself, and this is the trend. Yes, there were some impacts from previous years and quarters. The change in our hospital portfolio, for example, whenever we go into a new hospital, we tend to increase volume gradually, reducing cost and improving margins. Likewise, in Novos Elos, we have faced some challenges. A competitive scenario which was stronger in the past, and the infusion of immunobiologicals. Now we can see better situation. We had told you that we were not going to reduce prices to gain volume.
We believe that it is important to maintain business profitability. This is what we have done, and now we can see that, a more positive perspective. In lab-to-lab, we have been expanding volumes. Lab-to-lab is a business in which the volume makes a difference. We have developed new technical areas. The investments in the south of Brazil, in Farrapos, is a large technical area, all focused on lab-to-lab, and a whole floor here in São Paulo, in our operational technical center, Polaris, all focused on lab-to-lab. There is fixed cost at first, but as you grow in volume, there is a dilution of such cost. Even though we are not going to give you any guidance, we see our performance towards improving margins in integrated medicine. The second point concerning our short-term perspective. Once again, no guidance being given to you.
What we've observed is that the beginning of the fourth quarter is as expected. The fourth quarter, and you know it is subject to seasonality because of the holidays, right? The year-end holidays. We tend to speed up somewhat our investments. Filippo has already talked about CapEx, but in general, there is some level of seasonality. Then we have unit retrofitted period of the year. We replace large devices, just taking the best of the holiday season where there are fewer patients. But the fourth quarter so far has been within the expectations. No changes concerning what we have observed. Year- to- date, our two business, B2C and B2B, including lab-to-lab, have performed quite well. During these nine months, we've delivered total growth of income of 12.6%, even though there have been a change in mix, and Fleury brand, our centennial brand, amounts to 25% of our revenue.
Growth is smaller than we have for B2C and other segments, including lab-to-lab. But still, we maintain an EBITDA margin of 26.9% year-to-date, and we also have an increasing ROIC because of our discipline in capital allocation, and because of increasing lab-to-lab. We are very confident in what is being observed in terms of capital allocation, market share gains, and the combination of all different brands, all different businesses, gives us more resilience and the possibility of capturing markets in different sites, different cities. This is really important moving ahead. It's important to have this resilience as an organization to keep on capturing all opportunities. Thank you.
Thank you.
Next question comes from Itaú, Vinícius Figueiredo.
Good morning. Thank you for taking my question. I have two points. First about your premium brand.
You talk a lot about the gaining market share, and the calculation that you can have, right? The number of patients going to units and the number of beneficiaries of all different healthcare plans. I would like to understand the denominator of this calculation. When we think about the healthcare insurance plans giving access to the premium brand, are there more healthcare insurance plans giving access to your premium brand? Among them, had there been a significant increase in number of lives, or is the database stable? The second point concerns healthcare, because all healthcare insurance plans want to work with leaner and more affordable systems. Considering the closeness you have to Bradesco, it would make sense to think that in regions where Bradesco would like to have a leaner network, maybe Fleury would be the main partner in terms of diagnostic tests.
Has it been something relevant in your strategy? Can we think about some specific regions where you have observed that? So these are my questions. Thank you.
Hi, Vinícius. Good morning. Thank you for your questions. Concerning our premium brand, I would like to remind you that our brand Fleury, and this is part of our chart on page six, from 2012 to year-to-date, the CAGR of Fleury brand was 9.1% year-over-year. We all know that there is some level of limitation in terms of increase of beneficiary in the super premium segment where we operate, but we've maintained constant growth and market share gain. Understanding that Fleury brand has a very high market share. Your question makes sense. The question is, are we gaining more lives in this segment or are we just gaining effective market share? So I'm going to share with you some points.
2026, we had grown 11% year-to-date. In the third quarter, there was 8.9% growth, but over a third quarter last year in which Fleury brand grew 12.2%. In other words, the first half year 2025, Fleury brand had smaller growth, and this year we had 12% increase in the first half year, and the second half, we've had 8.9% growth over the growth of 12.2% in the third quarter 2025. It shows the vitality of our brand. The number of lives in Fleury brand is increasing slightly. It does not explain the growth of 11% year-to-date. The gain in number of lives is small, which really takes us to the point of market share gains. First, there is the supply of products and services. Fleury is where we have our integrated centers, where we are a reference to physicians.
I've mentioned some tests that we have added, such as Galleri, which is a test, it's a blood test where you can have early screening of over 50 types of cancer, such as pancreas, liver, biliary tract, that have no early detection or screening methods. We also have FoundationOne, Oncotype, sophisticated tests as well. I believe that throughout time, our innovation and our positioning in the avant-garde of health and medicine is something important. Of course, it's cascading down to all brands, but it all starts from Fleury brand. We maintain a positive understanding of a centennial brand. This year, we also opened our 100-year anniversary unit with a longevity center. It's doing great. We also have our units in the cities of Jundiaí and Campinas performing quite well, where we increase the square meter of the unit and service portfolio.
We believe that some healthcare insurance plans giving access to the premium brand have been attracted. There are few more. This is a result of market share, slight increase in number of lives because of new healthcare insurance plans, but a strong performance as a result of all the differentiating elements we have. Increase in square meters, increase in service portfolio, strength of medical relationship, all the celebration of the 100-year anniversary. We think that this brand will maintain its importance concerning all the different aspects. Concerning Bradesco Saúde, it's important to say that Bradesco Saúde is a very strong partner, very close partner to us. The potential of an organization such as Bradesco shows the opportunities that we still have in healthcare. We are a country where there are going to be more chronic diseases, aging of the population.
Therefore, there should be assets of quality that really consider the best treatment of patients. Bradesco Saúde has been increasing with regional products. Products in Rio, for example, Rio de Janeiro, where we are partners and in other regions. We are very close to them, but not only to them. We have a relationship with different healthcare players. Our outpatient position contributes to system sustainability. Thinking about prevention, early diagnosis, treatment, monitoring of chronic patients, maintaining them stable, and avoiding high-cost events and increased claims really is strong. Really reducing loss ratio and considering the really balance of all elements. We are a player of quality. We advocate appropriate use of resources. We build diagnostic algorithms so that each test can be properly used in terms of process. We don't deliver simply a result. It's the whole diagnostic process, and this position is appreciated by payers.
Therefore, we can see opportunities of being closer to the main payers, the main players in the market, bringing the idea of prevention, of monitoring the outpatient journey. This is our strategy, and this is something that we're going to maintain. Thank you.
Next question, Bank of America, Flavio Yoshida.
Hello. Thank you for taking my questions. I'd like to understand the B2C growth. It's still a strong level, of course, but there was some decrease compared to what the company reported in the first half of the year. There was a decrease in brand Fleury in all the different regions that you've been working, except Rio de Janeiro. Is it because of a comparison basis? What would be normal levels? And how confident are you to pick up it once again or to maintain the growth at the current levels? Second question concerns oncology.
Jeane has already made a number of points on the focus you have on oncology, especially through diagnosis. We know about your share of Croma, but do you also consider expansion in infusion? You've recently had the M&A that you've tried to have with Oncoclínicas. Do you see the role of Fleury in oncology more concentrated on diagnosis, or is there still room to go into infusion? If you decide to go into infusion, what would be the main challenges if you do anything outside Croma?
Thank you for the questions, Flavio. B2C is performing quite well, but there had been a difference between the first half and the third quarter 2026. Small difference, really. Our comparison basis is different. The first half of 2025, there was a strong impact of different bank holidays, and we talked about number of days of operation.
This first half of 2026, we've observed very significant growth of B2C, and it has maintained. B2C is delivering 14.1% growth, organic growth of 9.3%, but over the third quarter 2025, which was the quarter that grew the most in 2025. Last year, we had expanded in the third quarter with units of a service center with an increase of 16%. Therefore, once we go into specific metrics, in our opinion, the performance has been good, strong, 8.9% growth of Fleury, which is quite good for a brand with high market share, in which there had been very small growth in number of users. The 11% year-to-date means that 12% in the first quarter was over smaller growth rates last year. The different units of Fleury, if we analyze them at the same time last year, there had been a 7.4% increase only.
This year, we've had 11% growth year-to-date. We believe we have different basis for comparison, but throughout time, we've been gaining market share, not only in São Paulo, but also in markets such as Rio de Janeiro. We always highlight Rio. The 9% growth in the quarter and the year is an important growth for an area where there are no increase in number of members. In Minas Gerais, we've been gaining market share. Organic growth of 12.5 with some level contribution from Hemolab. But it shows that our strategy of keep on making constant investments, expansion of units, square meter use, mobile services, medical relationship, everything that we do has produced results, and this is what we'll keep on doing. And we are ready to capture market share gains in all areas where we work.
We monitor closely our NPS, and we can see that the whole strategy has shown very good results, and our teams are focused on that. Concerning oncology, I would like to emphasize the importance we already have in oncology. Oncology is an area that is going to keep on increasing. Numbers of the Instituto Nacional de Câncer show 60,000 new cases from 2026 to 2028. Oncology represents a very important share in terms of costs of all healthcare insurance companies. With population aging, those over the age of 60 have three times more likelihood of having cancer than those who are younger than 60. Therefore, population aging will bring more cancer cases. Historically, we have had a very important role in oncology. First, prevention.
A woman that undergoes mammogram every year, or a man that has a prostate abdominal ultrasound or tests for PSA, or a smoker that performs CT scan, this is screening. Same applies to colonoscopy. This is cancer screening. There is also the important role we play in clinical and anatomical pathology. We perform about five million anatomical pathology analysis per year, and over 90% of them are for cancer diagnosis. As you can see, we have a very strong position. Throughout time, we have positioned ourselves as a very relevant player in genetics and genomics for oncology. We have a joint venture with Einstein Hospital to develop new panels and tests for oncology, especially in precision oncology, comprising early diagnosis to treatment. We already have a very relevant position in oncology. We offer distribution. We have 584 patient service centers. We know how to work in them.
Through lab-to-lab, we can also offer services throughout Brazil and unfold further. We understand this specialty is very important. You have talked about infusion. This is another area that we joined in 2021. We have been learning a lot from this area. I recall that we have very relevant sales from medication infusion as an outpatient services, including subcutaneous home infusion. As a company, we have learned a lot from these specialties, which go beyond diagnostic medicine.
Therefore, yes, we consider the outpatient journey of patient care. There are learning points, and we are addressing them. I have answered that in the previous question, that we have had a curve to improve the margin of some of our businesses, and that is exactly what we have been doing. We expand units, but we have to capture gains and to have stability of margins before we go into new cycle of expansions.
This is what we have been doing in the area of infusion. Thank you, Flavio.
Thank you, Jeane.
Next question by Antonio Cardoso with Jefferies.
"Good morning. Great results. I have two questions. First, in the B2C, an expansion of services, number of services and encounters, we have 15.5% increase in the quarter. I would like to take a step back and think about this growth between customers and frequency or attendance. How can we set up of, let us say, new customers and those who keep on coming? Concerning the increasing number of tests, what is the dynamics you currently have? Are there some specific kind of tests presenting better results? Let us say, liver test, glucose, lipid profile, considering now GLP-1 analog users in Brazil, especially in the most wealthy regions of the country."
Good morning. Thank you for the questions. You have talked about number of encounters.
In B2C, we had 15.5% growth in number of encounters in the quarter. In tests, that was 14.3% increase. I would say that tests by encounter has maintained a stable number, 10.3%. Looking closely, we have higher volume of tests being performed, which is something important, because of clinical labs primarily throughout time, not only organically, but also inorganically. We have been growing more in labs than in imaging. These are important factors, and as you pointed out, the clinical labs, there are what, 9,000 different types. But the ones that we call to be routine, glucose, cholesterol profile, hormones, are part of automation lines. The more volume we have, the more automated they will be. When we analyze the line of costs, there had been a reduction in personnel and medical costs because of that, because the tests are being more automated.
Those who are just more esoteric, let us say, more different out of the routine, are performed by humans and highly qualified technicians, of course. So, what we do as part of a routine, and some patients tend to come more frequently, GLP-1, for example, and I would like to add patients with chronic diseases in general. A patient with diabetes, hypertension, would be more frequently tested. Sometimes they have more than one physician, endocrinologist, cardiologist. So in chronic patients, the frequency of testing is higher than those in patients who are healthy and just go for annual health checkup. This is why we say that the increase of chronic disease will change the demand because of that. Clinical labs also collected from patients' home offer a benefit. If they are routine tests, they are highly automated in terms of processing.
There is a cost of material, of course, but there is a dilution of cost because of the automation in processing. Of course, we have a very specialized portfolio. This is why physicians refer patients to us, and this is what really sets us apart in the market. But the routine tests are very important for cost dilution, not only in B2C, but also lab-to-lab. There was an 18% increase in volume of tests in B2C, 14% increase, which shows this trend of greater volume, especially routine tests, and it helps us dilute costs and be more competitive in B2C. That is it. Thank you.
Thank you.
Next question, Mauricio Cepeda with Morgan Stanley.
Hi, everyone. Thank you for taking my question. I have two questions, and they are related to the moving parts of the mix.
The effect of clinical labs on the average ticket, that is very well known, and ultimately, it improves margins. But I have the impression that with the progression of B2B, and based what I understood in your explanatory notes, that integrated medicine can have a smaller margins, one more component really to be accounted for. So it seems that the gain of volume will be increasingly more important so that you can maintain your bottom line. First question about B2C. Your comparison basis is getting more and more demanding.
We have talked about the premium brand, but is there still space to get more space outside the premium brands to maintain the volumes growing as much as they have grown? Or is it just the attempt of getting more based on your established basis? Now, B2B. We can see in the increasing trend of outsourcing, what has really convinced customers to outsource?
Is it cost issue, CapEx, portfolio? What's going on, and is it sustainable? Can we expect to have the same volumes? Will it keep on favoring bottom line increase?
Thank you for your questions. In our opinion, that volume increased throughout time, and what we've observed in working very actively with our commercial initiatives and with different partners, that there has been increase, bringing more volume. It helps us dilute our costs and be more competitive. It's a win-win strategy. We've seen some healthcare insurance companies getting more lives, and we really expect to strengthen this partnership. We need to maintain growth, and we believe that growth in clinical lab, clinical analysis, will favor our bottom line results throughout time. There is growth at the intermediate level, lab-to-lab, which really puts pressure to our margins, but we've maintained them throughout time, very healthy margin.
Lab-to-lab has been growing significantly with a smaller need for capital. We are growing quite well. We see an increase of revenue of 12.6%. We maintain healthy margins year-to-date, 26.9%, despite B2B, lab-to-lab, operations, and the inclusion of other brands where we can capture synergies. We've been increasing our ROIC progressively in terms of capital allocation. We've been offering very good return on invested capital and also good return to our shareholders. Our strategy is very consistent. I can see the possibility of increasing outsourcing. We've been observing the lab-to-lab market. It is a market that increases more than B2C because of a higher percentage of outsourcing. It went up from 25% to 30% of the total.
Smaller labs, and we know there are 22,000 to 30,000 small labs, especially with the macro environment and high cost of capital, investments have to be made in the units, purchase of equipment, but it won't make sense, because as a result of volume and efficient logistics, we can be competitive in terms of cost and have a turnaround time which is appropriate. These are the two important points that really make sure that we can grow further. Specific portfolio, and this is not what makes the difference actually, even though it's important, but we have a competitive price, we have volume, strong negotiations with our suppliers, and we have a turnaround time which is appropriate, because some of the tests need some time for processing. What we've been doing is to increase productive capacity in some regions.
We were in the region of Santa Catarina, and we expanded the technical area of the south. Here in São Paulo, we have also expanded our productive capacity, and we plan to expand that in other regions of Brazil as well, in which turnaround time will help us increase market share. In other words, diagnostic medicine will keep on growing. We've been monitoring results. There is no reason why it wouldn't keep on growing. Diagnostic medicine is essential for decision-making process of physicians in 70% of the cases, and the combination of scale, and we know how to do it efficiently. At the same time, we maintain the differentiation, especially in brands such as Fleury brand. This is a set of characteristics that makes us believe that we are on the right track, maintaining results which are very consistent quarter over quarter. Thank you.
Thank you, Jeane.
Last question by Santander, Caio Moscardini.
Hello. Thank you for taking my question. I have a question concerning CapEx. You started the year believing that the CapEx would be 1% of the revenue, then we adjusted it to 5%. You have been running at 3.5% over the revenue in terms of CapEx. We know you have used the last quarter to make retrofit and so on, but you would have to really spend a lot now to increase it to 5%. What can we forecast in terms of CapEx for the last months of the year and for next year? Second question concerning days of receivables. We have seen it improving one day last year, from five to four. One-day improvement in the second quarter, and now third quarter, two-day improvement in the average receiving time. Can you see better negotiation terms with your payers?
What kind of discussions have you had, and can we really expect improvements in days of receiving from now on?
Thank you. Hi, Caio. Let me answer your question, starting from CapEx. We have indicated a somewhat different level compared to the previous ones, and this is associated with what we have said today about the investments profile in digital and IT. Let me remind you that the percentage of CapEx on digital and IT in 2022 was 36% of the total invested capital. Then from 2023 to 2025, we needed it more because of the integration, especially because with business combination with Pardini. It went up to 47% of the CapEx dedicated to digital and IT. We are back to 36% investments in digital, and that is very coherent, right, if we analyze our profile. Therefore, we have a percentage below that of previous years, as you have pointed out yourself.
You said we were talking about 5%, reasonable number. To present, it has been 3.5% year-to-date. LTM, it was 4.5%. We always analyze our investments very carefully, make calculations to really make sense. Whatever is approved in the budget for the year, before it is executed, it is revisited, and we validate the assumptions that had been used in terms of return on investment, and we do that for all items. We do that because of the cost of capital. The cost of capital is quite high, and we analyze that regardless of our capacity to execute the plan. The fourth quarter, we tend to have increased in investment to avoid carryover for the upcoming year and others. So events that would maybe make the percentage go up, and we will probably observe that. We cannot really predict that.
I am not going to tell you the final number, but it is expected to be below previous years in terms of percentage over the revenues. Concerning days of receivables, there is no influence of negotiations. I think it is just the result of the receiving cycle, and we have talked about that before. There had been a concern on working capital cycle, so the receiving days, it was from shared service, we brought it to the financial area, and now we are really working it very closely, not only days of receivables, but also addressing different suppliers, inventory management, and we have been extra careful in monitoring it. I think that the stability in days of receivable results from our very close monitoring to avoid imbalances and to avoid the impact on our cash generation capacity.
As you can see, we really have good cash generation because we have good working capital management. Nothing different. We just have well-focused management of our treasury elements. Thank you.
If there are no further questions, we are going now to close our Q&A session. I would like to hand it over to Ms. Jeane Tsutsui for her closing remarks.
Thank you all very much for joining us in the earnings release call. One more quarter where we have shown discipline in execution, and we have delivered robust organic growth, increasing profitability, expansion of ROIC, and strong cash generation. Consistency and solidity of our results strengthen our conviction that we are on the right track. Thank you very much, and hope to see you on the earnings release call of the fourth quarter 2026. Thank you. Have a great afternoon.