Ladies and gentlemen, welcome to the conference call of Medios AG. At our customer's request, this conference will be recorded. As a reminder, all participants will be in a listen-only mode. After the presentation, there will be an opportunity to ask your questions. If any participant has difficulties hearing the conference, please press zero followed by the rhombus key for operator assistance. May I now hand you over to Matthias Gärtner, Chief Executive Officer of Medios. Please go ahead.
Okay, thank you very much. Also from my side, ladies and gentlemen, welcome to our conference call on the results for the first quarter 2023. As in the past, all relevant documents can 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. I will start with a summary of the Q1 business development. My colleague, Falk Neukirch, will then go through the financial details and the guidance for 2023. At the end, I will comment on Medios growth strategy. Afterwards, the both of us will be available to answer your questions. We will be a bit briefer than usual today since we talked just six weeks ago in the context of the 2022 full year results.
All in all, we had a successful start into 2022. We were able to successfully cope well with the ongoing challenges, especially regulation issues. Let's go directly to slide three, providing an overview of the highlights for the first quarter 2023. First, we further strengthened our Patient-Specific Therapies segment through the sterile manufacturing collaboration with Apotheken für Spezialversorgungen OHG as part of the acquisition of bbw as of January 2023. We have started the integration process and are supported by our experienced internal post-merger integration team, as was the case in previous acquisitions. This is an important building block to realize good synergies and cross-selling effect, also based on around 15 new partner pharmacies. Second, we posted good first quarter financials.
Record revenue of EUR 431 million and the second best quarterly EBITDA pre of EUR 15 million with a group margin of 3.5%. This development is based on sustainable growth of both business segments, and for the first time, the consolidation of bbw. It must be mentioned the first quarter results are additionally impacted by the strategically driven inventory build-up and by regulatory issues. Intentionally, operating cash flows were negative in Q1. Falk will provide you with some more insights on the financials later. Third, the implementation of our extended growth strategy 2025 is progressing. Meanwhile, our Head of International Business Development, Constantijn van Rietschoten, has started his work to drive forward internationalization as part of the extended strategy. I will come back to this later in more detail.
As briefly stated in our last call, we have started to offer highly specialized parenteral nutrition care for prematurely born babies. Another building block to extend our services. With this, we prevent an impending supply bottleneck, diversify our customer groups, and strengthen our position as a reliable partner in the Specialty Pharma sector. The implementation of our ESG strategy is progressing well. Based on the data of 2022, we are now able to sharpen our climate and environmental targets, in particular in the course of the year. In a nutshell, in the first quarter, we set the course for 2023 as planned. This includes, in particular, to strategically build inventories in expectation of higher prices later in the year, continue to successfully integrate NewCo Pharma and bbw, and intensify work on our internationalization strategy.
Consequently, we expect ongoing growth in 2023 and confirm our full year guidance, taking into account the changed reimbursement scheme in our PST segment since September 2022 and the general economic uncertainty. Let me share a short summary on the Q1 financials as illustrated on slides four to six. Slide four shows the strong quarter-on-quarter growth of our two KPIs, revenue and EBITDA. We achieved consistent growth except for Q4 2022, reflecting the negative impact of the regulatory changes which became effective on September 1st, 2022. This effect is also illustrated on slide 5 with a 10% increase in revenue compared to a 6% EBITDA pre growth, leading to a slightly lower margin compared to last year. Slide 6 shows that we stick to our strategy of focusing more on the higher margin Patient-Specific Therapies segment, to sustainably increase the margin of the entire Medios Group.
Far, we have been able to successfully implement this strategy and increase the EBITDA contribution of the PST segment up to 44%. Let's move to slide seven, which you probably already know very well. It describes our strong network of meanwhile around 720 specialized partner pharmacies, an excellent basis for our further German expansion. Based on our increased capacity and the agreement of manufacturing for AFS that we mentioned before, we target to significantly extend our manufacturing and compound up to more than 400,000 individualized preparations in 2023. On slide eight, please find an update on our ESG activities. As mentioned in March, we have been able to expand the depth and breadth of our ESG database, thanks to our new IT-based ESG software. We will define 2022 as our baseline year regarding our future ESG performance.
Until the end of 2023, we intend to update our ESG strategy by defining concrete targets for our environmental impact. Furthermore, Medios has now been rated by the most relevant international ESG rating agencies with steady improvement. This is all from my side for the moment. I now hand over to Falk to provide more details on the Q1 financials and on the guidance for 2023.
Thank you, Matthias. Welcome from my side. I will give you a detailed overview of the financials for the first quarter of 2023 now. A full set of financials can be found in the quarterly statement on our website. Let's start with slide 10. As Matthias already said, we had a successful start in 2023. Q1 revenues increased by 9.7% to EUR 431 million due to the continued growth in both operational segments, as well as the consolidation of our latest acquisition, bbw, in January 2023. Gross profit increased to EUR 27.9 million, with a slightly lower gross profit margin of 6.5% compared to 6.7% for Q1 2022, which is mainly due to the regulatory price reductions that have been effective since September 2022 for some cytostatic drugs.
Personnel costs follow the development of headcount. The increase of personnel costs by EUR 4.78 million- EUR 9.0 million is a result of the acquisition of bbw and one-time effects in the PST segment. The increase of other operating expenses by EUR 0.9 million- EUR 5.6 million was mainly driven by the integration of bbw Group. Further cost increases resulted from enlarged rented space as well as higher energy prices and IT costs. EBITDA pre-grew by 5.8%, with an EBITDA pre-margin of 3.5%, almost flat to the comparable margin of 3.6% in the previous year, but higher than in Q4 2022 with 2.8%.
This development is also reflected in the development of earnings per share. It shows the stability of our business model and simultaneously our ability to conquer challenges like the regulatory price adjustments end of 2022. For your background, the adjusted EBITDA, so-called EBITDA pre, was adjusted by extraordinary expenses in the amount of EUR 1.7 million. Thereof, for stock options, EUR 0.4 million, EUR 0.2 million for M&A costs, and EUR 1.1 million for performance-based payments for the acquisition of manufacturing volumes. Depreciation and amortization slightly decreased from EUR 5.4 million-EUR 5.3 million. This includes already effect of the last acquisition in the amount of EUR 0.2 million.
The negative operating cash flow of minus 250.3 million EUR resulted in particular from the strategic build-up of inventories in preparation for expected upward price adjustments in the Pharmaceutical Supply business in the second half of 2023. Sales driven increase in receivables and performance-related payments for the takeover of manufacturing volumes in the amount of 5.7 million EUR further lowered operating cash flow in the reporting period. As already explained, we intend to sell all the higher inventories currently being built up in the second half of the year with a corresponding positive impact on operating cash flow.
Cash flow from investing activities of minus EUR 17.2 million resulted mainly from the net cash component of the purchase price of bbw acquisition of EUR 19.4 million, minus EUR 2.4 million acquired cash. The financing cash flow of EUR 204.1 million resulted primarily from the drawing of EUR 25 million under revolving loan to finance the last acquisition. Due to the effects described above, cash and cash equivalents amount to EUR 60.7 million at the end of the reporting period, down from EUR 79 million at the beginning of last year. The equity ratio decreased from 77.8% by end of 2022 to 73.2%. Let's now switch to slide 11. Both operating segments contributed to the sales increase of 10%.
In the Pharmaceutical Supply segment, external revenue increased by 8.5% to EUR 368.1 million, EUR 11.66 million of which was attributed to bbw. External revenue generated by Patient-Specific Therapies increased by 17.4% to EUR 62.9 million. EBITDA pre for Pharmaceutical Supply segment increased to EUR 10.1 million, which corresponds to an increase of 21.2%. EBITDA pre for Patient-Specific Therapies segment was EUR 6.6 million, slightly below Q1 2022. The decline in margin is mainly due to the regulatory effect. Overall, the margin in PS, Pharmaceutical Supply, was up 4.3 percentage points to 2.8%, whereas the PST margin decreased from 12.9% - 10.4%.
On group level, the EBITDA pre-margin of 3.5% is almost stable compared to 3.6% for Q1 2022. Slide 12 provides an overview of our current financing power for our growth plans. In sum, we have more than EUR 100 million of free funds available, resulting from available cash and our revolving credit facility. I would like to emphasize that Medios net leverage ratio provides further headroom for debt financing by taking advantage of the step up option of the existing twin bond by another EUR 50 million debt and even further loan arrangement. On top of that, we will ask our shareholders to vote for a 10% authorized capital increase at our forthcoming AGM in June, which would further strengthen our financing power for future growth. Let's now switch to slide 14 and 15.
We confirm our guidance for 2023 as presented on the 22nd February with our preliminary results and confirmed in March during our full year reporting. Despite ongoing economic and regulatory uncertainties, we expect revenue to reach the range of EUR 1.6 billion-EUR 1.8 billion. EBITDA pre is expected to rise from EUR 56 million to EUR 63 million. The guidance takes into consideration assumptions as outlined on slide 15. The impact from last year's regulatory price changes is considered in this guidance. Global uncertainties do still exist, such as rising inflation and supply chain bottlenecks. However, the key message remains again the same. Our growth course will continue. A summary of our strategic priorities is outlined on slide 16. For this, I hand over to Matthias.
Okay, thank you, Falk. Now some words to our extended growth strategy 2025, first presented in November last year and at our full year earnings call end of March this year. I will therefore be briefer today and focus on the update. Slide 16 shows the three pillars of our strategy, which remain unchanged. In addition to strengthening our core business in Germany, we intend to expand drug manufacturing operations into other European countries, and we plan to further diversify our business model by entering into the production of personalized medicine. In Germany, we still want to close the wide spots in our geographic coverage by acquiring respective labs and/or conclude cooperation agreements, as well as by rolling out mediosconnect, our innovative digital platform for the PST business.
By increasing the number of doctors and surgeries behind our partner pharmacies, and we will further diversify and expand our indication area. The most recent example is that we started to provide parenteral nutrition for premature-born babies nationwide. We prevent an impending supply bottleneck and strengthen our position as a reliable partner in the Specialty Pharma sector. As this involves inpatient care, we work as the manufacturing partner for hospital pharmacy, and in this way, we diversify our customer group. We already received the necessary special approval from the relevant pharmaceutical authorities at two manufacturing sites, so that the highest level of supply security can be guaranteed. We made progress with the implementation of our internationalization strategy to expand compounding within Europe to gain continued growth while increasing profitability. We pursue two approaches in the implementation, developing mutually benefiting partnerships in Europe and value-enhancing acquisitions.
What could be, among others, achieved by realization of synergies, cross-selling, and leveraging platforms. Constantijn van Rietschoten, our new head of international business development, started in April. Together with our M&A department, we have an excellent market knowledge and extensive network in the European Specialty Pharma market now. The long list of potential targets was intensively analyzed, screened, and discussed, resulting already in a short list of potential acquisition candidates. Talks are initiated with around 10 pharmaceutical companies in Europe about a partnership or potential acquisition. We are very confident about the current development and will inform the market immediately when the first transaction materializes. By internationalizing our business, we can further strengthen our market position and at the same time diversify our customer groups to become more independent of German healthcare regulation. Some information on the third and last pillar of our Extended Growth Strategy.
Entering the groundbreaking personalized medicine market, summarized under the term advanced therapies, meaning medicines based on genes, tissues or cells, all expensive and complex therapies. This fits well as we are already a trusted partner for high value drugs in Germany. In addition, there are already widespread capacity shortages in the manufacture of novel therapies, and market experts expect capacity to lack demand in the future. As outlined by Falk, we have a strong financial basis that enables the financing of our extended growth strategy. Before I conclude the presentation, let's switch to slide 17. At our Capital Markets Day, we presented our group midterm targets 2025-2027 for the first time. One of our main goals is to further increase our EBITDA pre-margin.
That's why we want to tap further opportunities, which will enable us to achieve our objectives by internationalizing our business and by potentially launching new segments, respectively, new services, all within the field of Specialty Pharma. By implementing our extended growth strategy 2025, we aim to achieve a medium-term target of EUR 2 billion in revenue and an EBITDA pre-margin in the mid-single digits % area. Ladies and gentlemen, this concludes our presentation. We hope to see you in person at a conference soon or to hear you at our next earnings call on August 14th. Thank you for your attention. Falk and I are now available to answer your questions. Operator, could you please read out the instructions?