Welcome everybody to our conference call on our results for the full year and the fourth quarter, 2021. As always, all relevant documents can also be downloaded from our investor relations website. Additionally, this presentation can be followed in parallel via the internet link provided to you in the invitation. Today, with me is our CEO, Matthias Gärtner, and our CFO, Falk Neukirch. Matthias will start with an executive summary, followed by Falk, who will then provide details on the financials. Finally, Matthias will comment on the outlook for the current fiscal year. Both gentlemen will then be available to answer your questions. I would now like to hand over to Matthias.
Okay. Thank you, Claudia, and also a warm welcome from my side. Thank you for attending this call and for your interest in Medios. Once again, I'm proud to present record results to you today. Medios' best full year ever. Not only is our M&A strategy paying off, we also have delivered strong organic growth. Even more important, our margins are continuing to improve. This positive development goes along with strong operating and free cash flows. I will start with a short summary of the achievements and highlights for the full year 2021 and the fourth quarter as well. As in the previous calls, I will be referring to the slides of the presentation. Let's go to slide three directly. How can 2021 be best summarized? 2021 was the best year ever in Medios company history. An ongoing successful growth story.
Again, record sales and a disproportionately high EBITDA pre-increase with strong inorganic and organic growth. We have set ambitious targets and have even slightly exceeded the raised sales guidance and also met our earnings guidance. We deliver what we promise. Our growth continues as just outlined. What are the reasons for the excellent full-year results with profitable and sustainable growth? Strong inorganic growth, to a large extent driven by the successful integration of Cranach Pharma. Strong organic growth, also adjusted for M&A effects. We grew at a rate of around 15% for the full year and around 16% for the fourth quarter of 2021. Focus on higher margin products. This was again impressively illustrated by our compounding business. As a result, the EBITDA margin of the respective segment, Patient-Specific Therapies, increased by 1.6% points.
Addition of further specialized pharmacies to our network of now 600 partners. This was also supported by our innovative platform, medios Connect. We rolled out the platform in an additional fourth federal state in Germany and also included an additional indication. Ongoing improved working capital management and free cash flow. The good results normalized inventory levels compared to 2020, as well as the cash inflow from the consolidation of Cranach Pharma led to an excellent operating cash flow of almost EUR 62 million in 2021. Successful further integration of our acquisition with cross-selling already picking up, and finally, no more corona effects. In a nutshell, we are showing dynamic and profitable growth and are excellently positioned for the future. Our strong cash position and additional authorized capital ensure the financing of further potential acquisitions and organic growth.
Our new labs in Berlin currently being set up, new partner pharmacies, cross-selling opportunities, and the digitalization of the healthcare system offer ongoing attractive growth potentials. Worth mentioning are also our internationalization plans and the potential launch of a new segment. In 2021, we made significant progress in further implementing Medios growth strategy. Most significantly, most recent acquisitions offer attractive growth potentials. Please see our summary on slide four. The merger with Cranach Pharma, one of the leading specialized pharmaceutical wholesalers in Germany, strongly accelerated our growth. For the first time in our company history, we cracked the EUR 1 billion sales mark. The recent acquisition of NewCo Pharma will substantially strengthen our attractive higher margin segment Patient-Specific Therapies. The transaction was carried out at attractive conditions, as outlined on slide five.
The purchase price of EUR 118 million reflects an attractive EBITDA multiple of around 8x. Around EUR 33 million was paid in almost 1 million shares and EUR 85 million in cash, mainly by the proceeds of the capital increase conducted in December 2021. What are the main benefits of the acquisition? Please see slide six. Let me summarize the main points. We complement each other, especially regarding the regional coverage. Together, we ensure an almost nationwide supply to our partner network of specialized pharmacies within the shortest possible time. Consequently, we will be able to also serve any time-critical preparation, so-called ad hoc preparations to most of the specialized pharmacies in Germany, a significant competitive advantage. With the five additional compounding facilities of NewCo, we have already tripled our compounding business for individualized therapies to around 320,000 preparations.
I would like to point out that together with the additional labs of our new building in Berlin, we will reach compounding capacities of 500,000-600,000 preparations, and we have clear plans on how to use these capacities. The combination of Medios and NewCo offers significant growth potential through combining our partner networks of specialized pharmacies, expanding our product and service portfolio, as well as synergies and cross-selling. Almost needless to say, the attractiveness and the value proposition of the Medios group will improve for investors and partners. In a nutshell, the remarkable strengthening of our attractive higher margin segment Patient-Specific Therapies will lead to a significant and sustainable increase of earnings margins of the entire Medios group. Both acquisitions, Cranach and NewCo, contribute to the extension of our partner network of now around 600 specialized pharmacies.
As shown on slide 7, these mergers offer synergy effects mainly in purchasing and logistics and cross-selling opportunities within our extended partner network. Now a short summary on the financials for 2021, illustrated on slide eight. Impressive continuous growth of revenue and EBITDA pre, clearly proving the de facto end of the corona impact on our business. The same picture on slide nine. Again, a record year with substantial growth year-over-year, record sales, and the disproportionate increase of EBITDA pre as well as EBT pre. As pointed out earlier, revenue and EBT pre exceeded the 2021 guidance, and EBITDA pre fell within the respective guidance range. The main points of our ESG Strategy 2025 are outlined on slide 10. We published our new ESG Strategy in December. It can be downloaded from our website.
This strategy comprises well-defined and ambitious targets that are being realized through concrete measures using more than 50 different internal and external key performance indicators to track and measure target achievements. Therewith, we cover five main fields of action, including governance, products, and environment. Worth mentioning that I am the chair of our sustainability committee that is monitoring the progress of the ESG program. The implementation of a software tool will support us to improve ESG data collection and transparency. I cannot repeat this often enough. Sustainability has and will be an integrated part of our corporate strategy. This is all from my side for the moment. I now hand over to Falk to provide more details on the financials.
Thank you, Matthias. Also from my side, a warm welcome to the conference call. Let's proceed with slide 12, covering the figures for the full year 2021. The full set of financial figures can be found in the annual report 2021 on our website and in the appendix of the presentation as well. If not explicitly mentioned otherwise, I will refer to the full year figures compared to the same period of last year. Once again, these are the best full year results ever from Medios. Revenue more than doubled, almost by 170%. They are almost 102% inorganic and 15% organic growth. Earnings increased disproportionally. The gross margin did not increase to the same extent, which is the result of a weighting effect.
The overproportional increase of the segment Pharmaceutical Supply due to the consolidation of Cranach Pharma led to a decrease in the total average gross margin. At segment level, the gross margin for both operational segments increased year-over-year, primarily because of Cranach's good cost structure and higher margin portfolio compared with NewCo. Personnel and sales expenses developed subproportional compared to sales and gross profit, which led to a disproportional increase of profitability levels like EBITDA pre +155.3% and EBT pre +169.7% year-over-year. EBITDA pre outperformed revenue growth. The conversion rate of gross profit into EBITDA amounts to +55% in 2021, which reflects an increase of more than 15 % points compared to previous year.
EBT pre and EBITDA pre were adjusted by extraordinary expenses for stock options and M&A transactions. EBT pre is in addition adjusted for amortization of customer lists, mainly for Cranach and write-downs on goodwill, mainly relating to Kärchet system. The sharp increase of these extraordinary expenses is mainly a result of, first, the scheduled depreciation of customer lists and non-competition clause, of which EUR 10.1 million relates to Cranach Pharma. Furthermore, write-downs of EUR 2.9 million on the goodwill customer lists and non-competition clause of Cranach Pharma. Finally, higher expenses from share option programs due to the issuance of further stock options, mainly to the executive board, but also to employees. Further details can be found in the appendix of the presentation and the annual report.
The operating cash flow substantially improved to EUR 61.5 million as a consequence of the good operational performance after the acquisition of Cranach Pharma, plus a reduction of stock back to a lower standard due to the successful implementation of the new indication, hemophilia. Investing cash flow was dominated by building up new compounding capacities for Medios, but also included the cash inflow of EUR 30 million from Cranach Pharma as part of the acquisition as a one-off effect, diluting the investing cash flow. Financing cash flow amounted to almost EUR 70 million compared to EUR 51 million last year, which included a capital increase of EUR 73 million, as well as a drawing of the syndicated loan in the amount of EUR 30 million, of which EUR 6 million were repaid in the course of 2021.
An amount of EUR 24 million was paid in connection with the acquisition of Cranach Pharma. The effects just described led to a corresponding increase of cash and cash equivalents from just under EUR 20 million at year-end 2020 to around EUR 168 million as of December 31, 2021. For the NewCo acquisition, an amount of EUR 82.5 million was paid in 2022 as cash component with purchase price. The ratio increased in 2021 to a net debt of 95.2%. On slide 13, we provide a detailed breakdown of our organic growth by segment. In our segment Pharmaceutical Supply, the revenue growth was driven by 102% organic growth, mainly Cranach Pharma acquisition growth year-over-year to 15%. [audio distortion]
Remarkable overall growth of 170% compares to the Corona year 2020. [audio distortion] As just explained, sales development was less in the segment Patient-Specific Therapies, but EBITDA pre and EBT pre rose disproportionately. Pharmaceutical Supply generated 95% of revenues and almost 88% of EBITDA pre. Our target remains to grow in the higher margin segment, Patient-Specific Therapies, which is in line with the strategy to focus on higher margin but usually lower revenue indications in this segment. Both operational segments show significant ongoing earnings margins improvements year on year. Last but not least, because of Cranach's good cost structure and higher margin portfolio compared to Medios. This is all from my side for the moment. I now hand back to Matthias.
Okay, thank you, Falk. I will now comment on the outlook. Our guidance for the fiscal year 2022 is shown on slide 17. We expect consolidated revenue of EUR 1.45 billion-EUR 1.6 billion and an EBITDA pre of EUR 52 million-EUR 58 million with a respective EBITDA pre-margin increase to 3.6%. As a result of the NewCo Pharma acquisition, the share of Medios overall EBITDA pre accounted for by the high margin compounding business will rise from the current level of around 21% in 2021 to around 40% in 2022, and will significantly contribute to the guided margin improvement. Since the start of the current fiscal year, we have only been using the two KPIs, sales and EBITDA pre, as announced in our press release regarding preliminary results of 2021.
At the beginning of my speech, let me explain why the lower end of the revenue is not higher and if the revenue forecast is not too conservative. The answer is quite simple. We considered the outlined possible risk in our forecast. Furthermore, we expect additional costs due to the integration of NewCo and due to the implementation of our new labs in Berlin, for example, double rent and a higher number of employees. However, we expect a significant increase of our EBITDA pre-margin, a result of the consolidation of NewCo Pharma and the ongoing focus on higher margin indications and products. This goes along with higher margin but usually lower revenue of the manufacturing business. The explanation why the revenue guidance is not too low.
It is important to know we would be able to increase sales at an even faster rate, but that would be at the expense of our profit margins. We have opted for profitable and sustainable growth. Our compounding business is a good example of this. Stable sales but better margins. We are highly confident that all these investments will pay off in 2022 and the years beyond. Ladies and gentlemen, as you can see, the overall growth model of Medios is intact and showing excellent results. We are very well prepared to continue our successful and sustainable growth story. For this, we have a clear strategy. A summary of our growth initiatives, both organic and via M&A, is outlined on slide 18. Our growth strategy remains unchanged and its implementation will further advance.
We are on track and well-positioned to drive future growth, not only in 2022, by expanding our compounding business. The new building in Berlin and NewCo's five compounding facilities give us the potential to sustainably increase our production capacities in the future. By exploiting the blister business with high future potential and synergy effects, focusing mainly on high-priced products. By further organically and inorganically expanding our partner network of specialized pharmacies and extending business with already existing specialized partner pharmacies. By further market penetration through the innovative digital platform, Medios Connect, and by further expanding and diversifying the indication areas. On top of this, we will drive growth via M&A, in particular in the fields of compounding business, which will help leverage our additional compounding capacities. Also, geographically, we would be interested in expanding our partner network, especially in Bavaria and/or Eastern Germany.
As we want to further increase our EBITDA pre-margin, we want to tap the potential opportunities which will enable us to achieve our objective, international expansion of our activities. We still benefit from the high market potential in Germany with the consolidating market. However, we want to internationalize our business in the future and are considering launching new segments, respectively, new services and/or products within the field of specialty pharma. Ladies and gentlemen, this completes our presentation. Thank you for your attention. Falk and I am now open and available to answer your questions. Let me again begin answering your probably most important question. Why is the lower end of the revenue guidance for 2022 not higher?
As already explained, to cover potential risks and as a precaution, we have taken into account such factors as an ongoing high inflation, supply chain bottlenecks, geopolitical risks, and we also do not know how COVID-related effects will advance in the second half of 2022. In addition, for 2022, we also considered higher costs in the context of the integration of NewCo Pharma and costs related to setting up of our new labs in Berlin. We will continue to focus on the higher margin, but usually lower revenue compounding business. This is also the answer to the next question. Why did revenue for 2021 not grow stronger? Fully in line with our strategy, we focused more on the higher margin but usually lower revenue compounding business. Now let's come to the question number three.
Surely you want to know if the operating cash flow will remain as attractive as reported for 2021. Falk, I'm sure you will have the right answer to this question.
Yes. Thank you, Matthias. The short answer is yes, but you probably want to know more. I mean, the operating cash flow peaked really in 2021 with almost EUR 62 million. There are one-off effects included. You remember probably. Are there still, again, technical problems? Can you hear me clearly?
Yes.
Yes.
So there are one-off effects included. You remember probably the building up stock for entering the hemophilia market in the Pharmaceutical Supply segment. This created, of course, a very positive one-off effect in the operating cash flow in 2021. A normalized amount would be around EUR 40 million, I would say. Looking forward and based on the guidance we've given, and we again, I mean, Matthias has mentioned that we are not focusing on the low end. There are risks in the area and in the world. We have gave it a broader range. At the end, this guidance, of course, the EBITDA guidance is very relevant for the cash flow for next year.
If you assume something in the middle, I guess we will end up with operating cash flow next year. This is not a third item, guidance item, but I guess as you will ask this, we will be around EUR 50 million in operating cash flow, which is very reasonable, very sound. This is something we feel comfortable with based on the EBITDA we expect. I think this was the question to the cash flow.
Okay. Thank you very much for attending this call, for your interest in Medios, and I wish you all your best. Stay safe and healthy, and speak soon. Thank you very much.
Thank you. Bye-bye.
Bye-bye.