Good morning, everybody. Jasper and I would like to welcome you to the release of Shop Apotheke Europe's full Q3 financials. To start with the end in mind, against the backdrop as we're all witnessing this of difficult and challenging economic times and many uncertainties everybody is facing right now, I dare to say that Shop Apotheke delivered a solid quarter, which was fully in line with the guidance we had provided earlier this year. Talking about the guidance, Shop Apotheke's management continues to stand behind this guidance, and the guidance at the end of our call will be reiterated by Jasper one more time. Well, you see the usual agenda.
We're going to start with a deep dive into our Q3 performance, and then we just have literally a couple of charts on e-prescriptions in Germany and Shop Apotheke's commitment to sustainable development. At the very end, rest assured we're going to have plenty of time to answer any questions that you might have. Let's start with a deep dive into Q3. At the start of the call, I mentioned that we delivered a successful quarter in line with our guidance. Before we go through the details, let me just take a step back and let me acknowledge that we did reach an important milestone just last week with half a million redeemed e-prescriptions in Germany.
Not surprisingly of course, we would like to see the growth happen at a much faster pace. Still, I think we need to acknowledge that just a couple of months ago, we reached a target that had been set out for the eRx test phase in Germany, which was 30,000 processed e-prescriptions. As of last week, we surpassed the 500,000 mark. Right now, literally every single day, physicians are issuing, pharmacies are filling, and health insurers are reimbursing electronic prescriptions, thousands on a daily basis. Process-wise, certainly e-prescriptions are working smoothly. Shifting gears and looking at Shop Apotheke's performance in Q3, our sales growth went up to 20%. This compares to 15% in the second quarter and 7% in the fourth quarter.
Our non-Rx growth continued at an even faster pace. Looking at this on a year-to-date basis for the first nine months, we showed sales growth year-over-year of 13.5% and sales of EUR 877 million. Our Q3 adjusted EBITDA came in at around 1% of net sales, or EUR 3 million. This is an improvement by 1.8 percentage points versus a year ago, versus Q3 2021, and a very notable improvement versus the first half of this year. More on that from Jasper in a few moments. Our active customer base continued to grow at a rapid pace. We are approaching 9 million active customers.
This is an increase by around 1 million customers since the beginning of this year. More importantly, this is one driver for our customer growth, of course, is the high customer satisfaction level. At the NPS for the Q3 stood at 73 to be precise. Shifting gears one more time, sustainability, sustainable development is very important to what we do at Shop Apotheke. At the end of September, we made the commitment to become net zero by 2040. We are fully committed to bringing carbon emissions down to zero along the entire value chain by 2040. More about this also later in this presentation. So looking at our two reporting segments I already mentioned.
On the left-hand side, over the first nine months, Shop Apotheke's business continued to grow at double digits with 13.5 percentage points. Non-RX grew at a faster pace of around 18%, and our sales over the first nine months of the year were close to EUR 880 million. In the DACH region for the first nine months, we generated top-line sales of around 10%. Non-RX grew by around 15%, and our RX business for the first nine months declined by around 13%. The only driver, and you've heard this before, was still the RX bonus ban. If you just look at the Q3, our RX business didn't just stabilize, but it grew actually a little bit by 4% compared to our RX business in the Q3 2021.
Our international business grew at a faster pace, continued to be a growth driver for Shop Apotheke. Growth was approaching 30% and the total sales were close to EUR 200 million. Before we now switch to our KPIs, we just want to take a moment to reflect on the position that Shop Apotheke has across the seven markets in which we operate today. In Belgium, Shop Apotheke is the undisputed market leader in the online pharmacy space with a wide and a growing margin versus the number two in the Belgian market. In Austria, Shop Apotheke is the undisputed market leader in the online pharmacy space with an even wider margin versus the number two in the marketplace.
In Germany, of course, Europe's biggest pharmacy market, we continue to be the largest and the most frequently visited pharmacy website in Germany, and I can say here again with a wide and a growing margin. In the other four markets in which we operate today, our business is indeed growing, but at the same time, we need to acknowledge we have not yet reached critical mass. We have not yet reached a market-leading position but rest assured, we are working on that. I already referenced our KPIs. Starting on the left-hand side, 8.9 million active customers who have placed at least one order over the last 12 months by the end of September.
An increase by 1.6 million versus September last year, by 1 million versus January this year, and in Q3 alone, we added around 0.3 million active customers. Our net promoter score remained at a high level of 73. We succeeded in maintaining very competitive order delivery times, and we are also very well positioned across the whole range of delivery options, and we're going to talk more about this in a moment. The last KPI that we wanna share, our average order value, was pretty much stable. We saw really just a marginal drop from around EUR 61 a year ago in Q3 2021 to around EUR 60 this year. I already mentioned that our Rx business has stabilized, and as a result of this, our average order value has stabilized as well.
I mentioned when I referenced our customer satisfaction level that we are very well positioned across the whole range of order delivery options. I'm starting on the left here. Of course, today the vast majority of the orders that are placed by our customers are placed through the Shop Apotheke webshops or the Shop Apotheke apps. Through this pathway, we can offer our customers the broadest choice of products, a huge selection of products, but also competitive pricing. Our commitment is that we are going to deliver these orders within one to two days to our customers' doorsteps.
If a customer has an expectation to receive the order on the same day the order was placed, of course, we cannot do this for all the markets or the metro areas in which we operate from our facility here in the Netherlands, so we do this through our Shop Apotheke NOW program by collaborating closely with selected local partner pharmacies. Lastly the latest addition to the Shop Apotheke family, First A. If a customer has a need to get an order delivered even faster, we can do this through First A in the metropolitan areas, and then delivery would be in one hour or less. Okay shifting to our web traffic. You are familiar with this picture, but we have added one indicator to show to illustrate a little bit better the underlying trends.
You see the blue bars, you see the green line, and then you see the, and this is new, the dotted red line. I'm going to walk you through all of these indicators one by one, starting with the blue bars. The blue bars indicate the traffic growth across all of our webshops and across all of our apps compared to the exact same week a year ago. At the end of Q2, at the beginning of Q3, you almost see a prototypical peak. Of course this has to be seen against a backdrop of very low traffic levels at the same period last year. For those of you who have been following Shop Apotheke for quite some time, at that time, a year ago, we had to drastically reduce our performance marketing activities because we had constrained logistics capacities.
Of course, we are recycling this time now with very low traffic and as a result of this, you see the peak. Towards the end of Q3, you see that our web traffic growth leveled out between 10%-20%, and that is pretty much in line or pretty close to our top-line development. The green line shows the total, the absolute number of weekly visits to our websites, to our app. What you see here is an elevated level in Q1. Not a surprise to you because Q1 and also Q4 are the busiest periods for any online pharmacy. And then we see a little bit of a leveling off in Q2 and Q3. Of course, we have looked at this in detail. This is purely driven by seasonality.
To take out seasonality, a little bit of what we are sharing with you, we have added the red dotted line. The red dotted line shows you the rolling average weekly visits over the last 52 weeks. In other words, we added up the weekly visits over the last 52 weeks, and then we divided this number simply by 52. You see a steady increase, and again, that is once again broadly in line with the elevated top line growth that we have seen. A moment ago, I mentioned to you that shop-apotheke.com was the most popular pharmacy website in Germany. Well, I have to admit, I didn't tell you the whole story 'cause you've already come to expect from shop-apotheke.com being the most frequently visited pharmacy website in Germany.
In September, according to Similarweb, shop-apotheke.com was actually the most popular, meaning the most frequently visited health website in Germany. Ahead of websites that offer general medical advice or the Robert Koch Institute, which of course was very popular during the COVID pandemic, or websites that offer appointment services. In September, Shop Apotheke was the most frequently visited health website in Germany. We just want to illustrate that Shop Apotheke in Germany, not just in Germany, but here we're talking about Germany, continues to expand and to solidify its position in the German healthcare arena. The last chart I wanna share with you before I hand over to Jasper to walk you through the Q3 numbers. According to Google Analytics, shop-apotheke.com was also the most searched pharmacy brand in Germany.
We are saying here by far, and I know it sounds like a broken record, but Shop Apotheke held the spot by a wide and a growing margin versus the number two in the marketplace. With this, Jasper, I'll hand it over to you.
Yeah. Thank you very much, Stefan, and good morning to everybody who's joining the call today. On this graph, it's the number of orders per quarter for 2020, 2021, and then the three quarters of the current year, 2022. In the last quarter three, we processed in total 5.4 million orders, which is an increase of 1 million compared to the Q3 of last year. The Q3 was somewhat soft, but still, of course, it's a significant increase.
Also, if you would compare the current Q3 to two years ago, so quarter three to 2020, which was still of the First And the full corona year, the increase from 4 to 5.4 is an increase of 1.4 million orders that we processed or an increase of 35% in two years. The other thing to mention on this slide is that, again, we were able to welcome a lot of returning customers. Actually, the number that Stefan just quoted, the 0.3 million new active customers to our base is a number that we are internally very proud of. Despite the fact of adding those new customers this quarter, we had a total of 85% of the total sales that were from loyal customers, returning customers to our website.
Not only to our website to place an order. To the next slide, please. What this means for our numbers. This is the table going from sales up to and including the adjusted EBITDA. Before I talk about the table, in the footnote, we make very clear what the adjustments are and equal to what you have seen in the past three quarters. Equally, as I explained it, the adjustments increased year-over-year significantly only due to the booking, the accounting of 2021 business acquisition that we do as of quarter four of 2021. Apart from that, the other two customary items in the adjustments are related to stock options and a very small amount related to external project costs.
The key thing of those adjustments is that they are all, for the majority, the far majority, non-cash items. Of course, our P&L reflects the correct and the best representation of the financial results. If you look at the EBITDA, EBIT and net income, actually the adjusted EBITDA, the adjusted EBIT and the adjusted net income, as you can find in our interim report, are much closer connected to our operational and to our cash performance. Exactly for that reason, to once again emphasize, to be as close as possible to our real cash performance, we make those adjustments. Now, going to the table.
Quarter three last year, quarter three this year, the better worse year-over-year, then quarter three compared to the first six months of the year, and for reference, the nine months of last year and the nine months of this year. Later, I have also bridges in explaining the latter two. In quarter three 2021, we hit a total EUR 238 million, and this year that increased by 19.6% to EUR 284 million. We achieved that with a significantly increased gross profit margin that was year-over-year three percentage points higher. Comparing quarter-over-quarter, that's mainly the net impact of product and pricing mix. The remainder, compared to the quarter of last year, is actually impacted by a non-repeat of some negatives related to the corona assortment last year.
Apart from that, we continue to see and benefit from better sourcing conditions and more media income. Three percentage points up compared to last year, but also 0.9 percentage points better than the first six months of this year. To the selling and distribution as a percentage of sales. This quarter, it ended at 23.8% with an increase of 1.1 percentage point to the same quarter last year. And that is mainly as a percentage of sales. This increase compared to last year is mainly last mile, and the remainder is from IT and labor. The interesting thing is, compared to last year, while actually we see of course inflation in cost, our operational cost as a percentage of sales were lower than last year and marketing did not increase.
That's a lot of words, so let me summarize it again. The increase compared to last year is mainly because of last mile cost that increased and actually our operational performance that we can influence was even better than last year. Then a very important number on the S&D as a percentage of sales is the 1.7 percentage point improvement compared to the first six months of this year. Admin is basically hovering around 3.2-3.3% of sales. Adding up all the numbers I just mentioned, last year Q3 was a -0.9% margin. This year is a +0.9%. It's an increase of 1.8 percentage points from -2% to +3% is an increase of EUR 5 million.
Moreover, this margin of this quarter of 0.9 is 2.4 percentage points higher than the first half of the year. The gross profit margin. On this slide, you see the increase of the gross profit margin from 25.4% after nine months last year to 27.4% this year. Number one of the building blocks is improvements in sourcing. Number two is a small number for the impact of a net pricing and product mix after nine months. Roughly half is coming from net pricing and half is coming from an increased impact of our platform business models. Then there is mix, mainly the Rx/OTC mix, and the remaining relatively large block is again mainly related to the non-repeat of negatives related to corona that we saw in last year.
To the right side again, this 27.4 is the gross profit margin after nine months, but from the end of Q2 to quarter three, there was an increase of the gross profit margin of 0.9%. Next, please. Then the selling and distribution cost as a percentage of sales. Before I walk you through the changes, I think it's also very relevant to take a helicopter view, because actually from our perspective, quarter one 2021 is quite a while ago. Imagine, for example, in quarter one 2021 was still in the full corona period. There was much more paper Rx. We hadn't MedApp in the Netherlands yet. We didn't have SmartPatient in Germany.
Our core business still needed to move to the new distribution center, and we hadn't even the distribution center in Italy yet that we opened in the past quarter. Still, these are the numbers of the nine months of this year compared to the nine months of last year. Many things have happened since. If we start with marketing, and marketing is generally our decision, how fast we want to grow, balancing sales and margins. In this comparison, as you see here, it's also relevant to note that quarter one 2021 still had a lot of paper Rx, did have a lot of corona, and in quarter two, as Stefan also just mentioned, we reduced our marketing because of our capacity constraints back then.
More substantial remarks I can make on the shipping, which is the next one, because we do see an increase of shipping cost here, the last mile cost as a percentage of sales. We see some higher fees, and we see some mix from the fact that we have more same-day deliveries, and we grow international even faster than we grow in DACH. Operational labor, in this comparison, -0.2%. As I already pre-announced in quarter two, and luckily we were able to realize it, if you look at quarter three versus quarter three, despite inflationary pressure, cost pressure, we actually had lower operational cost as a percentage of sales this quarter three compared to quarter three last year. The last one, other, is mainly related to IT.
Most important to mention here on this slide is that compared to the cost as a percentage of sales after six months, which stood at 25.5%, we lowered our cost by 1.7%. We increased our focus on efficiency, and we also took out cost in order to achieve these numbers. What does it mean for our cash? We ended in our balance with cash and cash equivalents well above EUR 200 million. We stood at EUR 228 million to be precise. After the nine months of this year, you see the first two blocks together is that our operating cash flow was basically a black zero. It was EUR 0.3 million.
We invested EUR 44 million, which includes acquisitions, the opening of our distribution center in Italy, but it mainly relates to the core of our business, and that is investments in IT. The financing here is half interest and half related to leases. All in all well above EUR 200 million. With that, I give it back to you, Stefan.
Okay. Thank you, Jasper.
Yeah.
As we mentioned at the beginning of the call, this time we keep the strategy or the general business update pretty brief. We are focusing on e-prescriptions, and then we're going to say something about sustainable development at Shop Apotheke. Starting of course, with e-prescriptions, that's top of mind not just for you, but for all of us. On the left-hand side, you see the graph. We are seeing a steady growth in the number of e-prescriptions. In this case, it's e-prescriptions filled by pharmacies. In parallel that's something you are not seeing on this chart, but we're also seeing a steady growth of doctors that are issuing e-prescriptions. Last week, I just wanna reemphasize this again because we think it's really an important milestone. We passed a 500,000 mark of e-prescriptions.
At the same time, of course, you know, we need to acknowledge if we would love to see the graph on the left-hand side to grow at a much faster pace, or we would like to see an even steeper curve. Exactly today, Jasper, I think two weeks ago, we went to a physician office.
Yep.
In the Westfalen-Lippe region to see firsthand how e-prescriptions are working on a day-to-day basis. We talked to a physician. She issues on average 150-200 e-prescriptions every single day. She does not issue paper prescriptions anymore. According to what she showed us, what she told us, e-prescriptions for her are working very smoothly. Patients, once they get used to them, they like them. It did not just bring disruption. It did not just not bring disruption to her office but it actually helped her to further enhance internal workflows or processes. For example, there is no physician assistant that has to run anymore after the doctor in order to capture a signature. For her, e-prescriptions are working very, very smoothly.
We at Shop Apotheke, together with many other participants, of course, we try to convince more and more physicians of the benefits once you have adopted e-scripts, of the benefits of electronic prescriptions. We are talking to regulators. We are talking to the Gematik. We're talking to a lot of other market participants in order to address some data privacy concerns that have been raised, but also to address questions that have been raised by physicians in terms of again, what does this mean for their practices and for their day-to-day processes. These discussions, the discussions with all different types of market participants, they are literally going on a day-to-day basis. I personally was in Berlin for a couple of meetings last week. I will again be there the week after next week.
This is of course not just done by me. A lot of individuals at Shop Apotheke are totally focused on making e-prescriptions a success. At the same time, I cannot disclose exactly what we have proposed to the various players in this discussion right now. What I can tell you is when we outline the proposals that we have made, again in order to address some of the concerns that have been raised over the last few months, I think the proposals are very well received. I would quite frankly, I think I would jeopardize the success of these conversations if I disclose too many details in public right now. Well, in closing, when we look at e-prescriptions, they are working smoothly. We are confident that they will continue to penetrate the Rx market in Germany.
We will continue to see a steady increase of e-prescriptions, and we remain confident that e-prescriptions will be a very significant catalyst for Shop Apotheke's growth going forward. Well, without any doubt, e-prescriptions and you can talk to anybody at Shop Apotheke, and I'm pretty confident you will get a very similar answer, they are the top priority for everybody at Shop Apotheke. At the same time we have some other priorities as well, and one of the other priorities is our commitment towards sustainable development.
At the end of September, Shop Apotheke Europe joined the growing number of large and small companies to commit to becoming net zero by 2040. We are fully committed to decarbonizing our entire value chain and to make sure that we succeed in decoupling our business growth from our emissions. In 18 years, in 2040, Shop Apotheke Europe will be a very, very different company from what it is today. We'll be much, much larger, but our business growth will be decoupled from emissions, which will simply be zero by 2040. Well we are not just talking about 2040.
Our sustainable development initiative was started two years ago in 2020, and we have already achieved some very tangible, some very hard benefits. In 2020, we had set out a target for ourselves to reduce our carbon emissions, our Scope 1 and Scope 2 carbon emissions, by 80% by 2025. As of the end of September, we can say with a lot of confidence and a little bit pride that we have already achieved the target to reduce our Scope 1 and Scope 2 emissions by 80% by the end of September this year.
Both of our distribution facilities in the Netherlands and in Italy have been switched to 100% renewable energy and to ensure that we continue to establish ambitious internal goals, to continue to make progress, and to rigorously also monitor our progress against these goals. We have compiled, reviewed, and discussed our first very comprehensive ecological balance sheet for the first time based on the numbers for the first six months of the year. Going forward, this ecological balance sheet or sustainable development will be part of how we operate Shop Apotheke. It will become part of our forecasting processes. It will become part of our annual planning processes. It will become part of how we do things at Shop Apotheke.
I hope I succeeded in conveying to you that sustainable development for Shop Apotheke, it's not an empty shell. It's something that's very close to our heart, and it will continue to impact. It already has and it will continue to impact how we do things at Shop Apotheke Europe. With this, Jasper, I think you're close.
Okay. Yeah. Absolutely, Otto. Thanks again. Yeah, a nice anecdote in line with what you just said is that in 2020, with the move to the facility where we're presenting from, our main central distribution facility, for ecological reasons, we decided to totally not use any gas in this facility. There you see nicely how the business model and actually sustainability goes hand in hand because not having any gas is actually also financially a huge benefit this year, that we have at Shop Apotheke. The outlook and guidance, next slide, please.
Basically, what Stefan just said, we are very happy and we wanna thank all the people in Shop Apotheke also for making this possible, that we are able to, in this very exciting dynamic, many challenges ongoing in the outside world environment, we are able to once again reconfirm with confidence the guidance that we gave to you at the start of the year. For our ongoing business, as of the start of this year, 2022, we expect to continue to grow our non-Rx by 15%-25%. Our Rx, we don't give guidance in the adjusted EBITDA margin between minus and plus 1.5 percentage points. Mid to long term, also unchanged. As you can see to the left side, we added a target, which is the net zero by 2040.
Though that sounds very far away, as Stefan just explained how much we did already on Scope 1 and 2 already in the past one and a half years. With that, please, operator, could you go to the slides to ask questions with a slightly hopefully improved procedure to ask questions.
Sure. Thank you very much. Ladies and gentlemen, as a reminder, if you would like to ask a question, please press star one on your telephone keypad, or you could pre-register for the Q&A either via the link you've received via the invitation or via the button on the webcast link. Thank you. We'll now take our first question from Chris of HSBC. Your line is open. Please go ahead.
Yes. Thanks everyone for
Yeah. Thanks everyone for taking my questions. I first want to get back to a comment that you, Stefan, made earlier with respect to the discussions you were having with the market participants. I understand that you said that you could not discuss too many details. I would be curious and maybe I just didn't get that what particular parts are you discussing? Is this in relation to the privacy concerns, the EGK in general, you know, changes to the phase rollout? I mean, what sort of discussions are you having at the moment?
Yeah. Chris, thanks for the question. Yes, the discussions focus on two topics, and they are closely related. How is the e-prescription, and it's not the e-prescription, it's the token, it's the QR code. How is the token transmitted from the doctor to the patient? Secondly, how can online pharmacies also participate in the EGK solution? That is the focus of the discussions we're having right now.
I know again, within the lines of what you can say, I mean still today, a lot of paper scripts are sent via fax, right? I mean, if this is something that is being brought up, I mean, what sort of is there nothing, no pushback to be said on that, right? I mean, why now after so many years, is the token which has been, you know, the sort of fundamental, you know foundation of the whole eRx setup, why is this now all of a sudden becoming a topic of discussion? I don't know. I just don't get it. It amazes me, to be quite honest.
Yeah. Chris, you know, we are also asking the question ourselves as well. When we talk to physicians, and again, Jasper and I, we went to, you know, a supporter of e-prescriptions, two weeks ago, and what she said is, again, she loves it. It's so much easier for her. But there was one but that she had, and it was, you know, that she still has to print out the prescriptions. It's not a you know, insurmountable obstacle, but it's something that she didn't like and probably many other physicians don't like. We have sketched out a way to transmit the QR code to the doctor from the doctor to the patient without having to print anything.
At the same time, I think I, you know, shared this anecdote in the past. We think for patients to start with something that they can put their hands around, meaning a paper printout at the beginning at least, that might actually increase the trust patients have in paper prescriptions because they can still read exactly what the doctor has prescribed. I'm going back to the start of the COVID vaccinations. When we went to restaurants, at least in Germany, you saw a lot of people with their paper certificates coming into the restaurant when they, at the time when they had to show them. A couple of months later, you didn't see this anymore, or you hardly ever saw this anymore because people got used to using the app.
I think we are going to experience something very, very similar once electronic prescriptions have been introduced. Again, the doctor we talked to she was very excited when she talked about a 75-year-old patient that successfully used the Gematik app for the first time. There are some hoops that you have to jump through in order to get there. Once the patient was there, the doctor issued the prescription, and literally a fraction of a second later, it appeared in the Gematik in the e-prescription app of the patient. Again, once people get used to it's working smoothly.
Okay, that's understood. Now the difficult question. I mean, first on, I mean, you gave the example of this one doctor. I mean, if she does 150-200 e-scripts a day, then she basically accounts for 2% of all of the e-scripts that are issued nationwide, right? I mean, in Westfalen-Lippe there's probably 9,000 or 10,000 doctors. That's obviously the initial adaptation is poor, to say the least. It seems that the doctors are not willing to take this up unless they're being forced, and so far there has been, presumably no force.
Do you see any chance, this is maybe also part of your discussions, of anything on the horizon that, the doctors will be forced into this framework? Because the way it stands right now, I'm not even sure that, you know, we will necessarily see nationwide rollout in the second half of next year, if the numbers keep where they are. Yeah, any sort of views on that?
Yeah. Chris, of course, that's a political decision. Our sense is that the current health minister, the current government in Germany, they want to do this in a collaborative approach together with the physicians. They want to convince, they want to address the concerns. Some of these are legitimate concerns that have been raised by by physicians. It is our sense that they don't want to mandate this and force physicians to use e-prescriptions, but they want to convince them and want to bring them on board. Again, Chris, these discussions, especially with physician associations, they are ongoing as we speak.
I mean, what is your current expectation for the nationwide rollout? I mean, we all know about the current set of terms with respect to phase one, phase two, and phase three. Yeah, I'd be happy to pick your brain on that because you are probably also doing the same math that we are doing and, yeah, maybe we're missing something.
Yeah. I think the original timeline that came out of the, you know, gematik shareholder meeting, you know, a couple of months ago, I think that is, at this point of time, it's not going to happen. We're not going to see an additional 6 federal states or regions in Germany to officially start with e-prescriptions on the first of December. What we have stated before is we are confident, we remain confident that we're going to see, you know, nationwide a rollout in Germany sometime next year. At the same time, what we are seeing right now, every doctor across all of Germany who wants to issue electronic prescriptions can do it today. There's nothing that prevents him or her from doing this. It's just not part of these. Right now, the pilot region is limited to Westfalen-Lippe.
In the coming months, additional regions are going to join. Chris, it would really be speculative to say, you know, another six states are going to enter in two, three or four months. We simply don't know. Nobody. Again, we are having, we've had, and we're having many conversations. We haven't heard from anybody that we should go back to the drawing board or we should stop this. Everybody sees the benefits, but there remain a couple of obstacles that need to be addressed and that need to be overcome.
Okay, perfect. Thanks a lot for your time.
Thank you. We will now take our next question from Volker Bosse of Shop Apotheke. Your line is open. Please go ahead.
Yeah, thank you. Volker Bosse, Baader Bank. I would like to start with the consumer sentiment drop, which we see here in Germany and across Europe. How do you see this consumer sentiment drop impact your business in the moment? Or is there any impact in any way, for example, higher price sensitivity or higher demand for private labels? Would be the first question. The second question would be on the adjusted EBITDA. In 2019 and 2020, you reported a positive EBITDA in the Q4 , which was always better than in the Q3. Would you expect to follow this pattern, which you showed historically in the Q4 this year? Being Q4 adjusted EBITDA better than in Q3 as a kind of helper for calculation.
The last question would be on your cash. Where do you think to end up cash at end of the year? Just for confirmation. Thank you.
Yeah, Volker, thanks for your 3 questions. Number one, on the impact of customer sentiment, we of course watch this very closely. But I think the summary at this moment for us is, and we are active in 7 markets, where we are growing in quarter three and year to date by double digits in each of the 7 markets at the moment. Of course, you see sometimes some things happening there. In sum the best conclusion is that until now in the market where we are active, which is healthcare and medicines, we don't see significant impact of a recession or a change in consumer behavior. That's the best summary of what we're seeing at the moment. No impact at the moment at Shop Apotheke.
Thank you.
At the same time, you also see that we increasingly focused on our cost from quarter two to quarter three because we want to be prepared for everything. Responding to your question, we don't see significant impact. Adjusted EBITDA, what's quarter four gonna be? I got this question this morning a lot already. Volker, I can only say we have full year guidance. We are very happy that we can reiterate that guidance continuously, but that's all, we gonna say about the expectations. The only thing I can add there is that the start of October was good. Not exceptionally strong, not exceptionally bad. It was a continuation. The start seems to be good, but that's not saying a lot about quarter four. We still have Black Friday and December. Who knows about the cold and flu season, et cetera.
I cannot answer that question for you, Volker. The same goes a little bit for cash because we have our guidance on the growth of nominal Rx and the adjusted EBITDA. We don't have any guidance on cash. Generally in quarter four, that's always the case. We have a thing which is named in Germany, die Winterbevorratung, where we generally build some inventories in order to do very good promotions in January and February. Probably you will see that also this quarter again. That's a seasonality that you might see in working capital, increased requirements in quarter four, but that's then reversing to the positive in the Q1 of next year.
Yep. Got the message. Thank you very much. Yep, all the best.
Yeah. Thank you.
Thanks.
Thank you, Volker.
Thank you. We'll move on to our next question from Otto Sieber. Your line is open. Please go ahead.
Good morning, both. It's Otto speaking from Barclays. Thank you very much for taking my questions. Just a quick clarification. Stefan, you said that you remain confident in the nationwide rollout of the Rx next year, but you also said that your sense is that there won't be a mandatory rollout next year. What would actually be then different next year in that rollout? Are you saying that you're confident that there will be a rollout, but it will definitely not be mandatory? Because kind of in my mind is voluntary is one stage, the second stage would be mandatory without penalties, and the third stage would be mandatory with penalties. If it's definitely not gonna be mandatory next year, what would actually drive the eRx adoption then next year?
Well, Otto, I mentioned that, and I know that you have your conversations there as well. Our sense is that the current government does not wanna go for a mandate. They don't want to force. That could change tomorrow. Nobody knows. That is what we've been picking up.
I mentioned that we are, of course, seeing an increasing number of e-prescriptions. The progress is not as fast as we would like to see it. We see more doctors coming, you know, on board and issuing e-prescriptions. This trend is going to continue and if some of the concerns that have been addressed by doctors, if they are going to be addressed, at least I think if there is a solution that is on the horizon and we're not talking about, you know, years, but we are talking about months in order to address some of the concerns that have been raised. We remain confident that more and more doctors are going to adopt e-prescriptions and are going to start issuing e-prescriptions.
Although the benefits of e-prescriptions, and now I don't wanna go back to the very beginning of the e-prescription conversation, but they're so obvious with this. You know, in terms of drug therapy safety, in terms of efficiencies, you know that can be gained. At some point of time, these issues are becoming much bigger. You know that Germany is facing a huge deficit. The public health insurers are facing huge deficits. I think all of this is coming into play and will result in an accelerating trend of e-prescriptions that are being issued. But again, at this point of time, we don't assume that there will be a mandate coupled with.
Because we have a mandate today, it's in the law, but coupled with sanctions, that is not the assumptions that we use when we look forward.
Got it. That's very helpful. Thank you. One more question on kind of the competitive environment in the German market right now. Your key competitor, Rosspelly advertising less aggressively right now. Have you seen any kind of changes to your customer acquisition costs so far, or are you seeing any in October so far?
We don't comment on these kinds of questions related directly to our competition. What we do already for so many years to have the best possible proposition that is leading to the best contribution per order and that's what we continue to do. Sometimes there's a bit more and sometimes there is less competition and that's all. I think you will understand that I don't comment on that directly.
Fully understand. Thank you.
Thank you. Yeah.
We'll now move on to our next question of Olivier Calvet. Your line is open. Please go ahead.
Yes. Hi.
Hey, good morning, Olivier.
Yes. Hi, good morning, Stefan Jasper. I have about mostly one question left. I was just wondering why you are not giving guidance on the group top line now that RX has stabilized year-on-year. Kind of related, you know, sub question is you know are you expecting any impact from eRx or from how you apply the bonus topic in Q4? And is there any update on the topic of these bonuses that you could provide?
Should I do the first?
Yeah.
Okay. Hey, yeah. Hi, Oliver again. No, there was just because at the start of the year with the paper Rx and the unpredictability of eRx that we also discussed in this call. No, there's not anything ongoing there. What's very clear is that we are seeing already Q3 last year, Q4 last year, Q1, Q2, Q3 this year, we see the paper Rx fully bottomed out. We feel very confident about the current level that we're having. There will be no reason to not include that, but we didn't know that at the start of the year, though we included in our guidance that we expected a bottoming out. The eRx at this moment predicting that.
We have all our scenarios there, but I think you will fully understand that we don't give guidance on that, on the quarterly or on a year basis. That's related to the guidance. It's not a negative, but it's a positive reason that we do it for non-Rx. We don't see any change in paper Rx at the moment ongoing, compared to the last quarter. Then something on the bonus.
Yes.
Yeah.
You've been following us, of course, for a long time. Nothing has changed. We remain convinced that the bonus ban enacted by the German government or the German parliament is a violation of European law that will be decided through the legal pathway. Legal proceedings are ongoing. Initially, of course, this will be in front of a German court, depending on the decisions by the German court, then the question is whether this will have to go to the European level or not. This is ongoing as we speak.
Okay. Thank you.
Thank you. We'll move on to our next question from Jan Koch. Your line is open. Please go ahead.
Hi, this is Jan Koch from Deutsche Bank. Thanks for taking my questions. I would like to start with some questions on your margins. Obviously great to see that you were able to increase your gross profit margins again. How much of this is sustainable in your view and support the margin in future quarters? In regard to this question, you mentioned in your press release that it is partly driven by procurement improvements. Have you already exploited the full potential here or do you expect to achieve further improvements? Secondly, a question on your adjusted EBITDA margin.
I understand that we can't just extrapolate your margin in Q3, but are there any upcoming projects in the foreseeable future which could burden your margin again, similar to what we have seen in the first half of 2022? Finally, very briefly given the slow uptick in e-prescription, do you plan to maybe temporarily reduce your marketing spending in this regard?
Start with the margin 1.
Yeah.
Yeah. Hi Jan, good morning again. There's not anything unsustainable in what we achieved in quarter three margin wise. That is also not saying that it will be the same in other quarters because price is a very important element in the overall proposition we have. And in the same basket as marketing and all kinds of other costs, also price, we consider in continuously optimizing what we think is working best. In the Q3, we had, according to my definition, a very large increase of 0.3 million active customers, high customer satisfaction, and growing everywhere and gaining market share. And we kept a good proposition as we had. That's the first half of your question.
There is not anything unsustainable in that, though, there are many parts that we decide upon on almost a daily basis, what are the right levels, so it can go up, it can go down. Sustainable of course, we have purchasing savings, optimization of our assortment, and also increasingly media income and income from our platform models. Procurement and improvements, I think I addressed, but if the question was, No, I think I addressed there. Then the last one before I hand over to you, about the adjusted EBITDA margin. Let me. Can you please remind me what your question was there?
Sure. Do you have any upcoming projects?
Yes
... like you had in the first half of the year?
Not anything significant to mention. I think you refer to the fact that we have, of course, in the first half of the year, we opened our marketplaces, we opened Italy, et cetera. I think it's a rather stable business that we have in quarter four compared to all the projects we successfully launched in the first half of the year.
Great. Briefly-
Yeah.
Great. Briefly, if I may. Is the margin you showed in the recent quarter, is it a good indication for future quarters?
No, I cannot. No, no. I can only refer to the full year guidance. That's all we have on margin.
Okay, great.
Yeah. What it is reflecting is that it is relatively easy for us to take some action and be in sustainable cash flow positive territory.
Thank you. We'll now move on to our next question from Alexander Thiel.
There was one more question about the eRx, whether there's an opportunity to reduce eRx marketing spending because there is, you know, a slower uptake than we had anticipated. At this point of time, you know, our marketing spending on eRx is minuscule. We are doing a little bit of, you know, CRM type of activities in the regions where eRx, you know, are more widely available. But once eRx go into, you know, move ahead full steam, then what we're going to see is a shift of the marketing spend that focuses on non-Rx today to eRx. So you're not going to see any drastic changes from one quarter to another because eRx is delayed or is going ahead full steam.
Thank you. We'll move on to our next question from Alexander Thiel. Your line is open. Please go ahead.
Hi, Stefan and Jasper. Good to see you. I hope you can hear me. Couple of questions.
Yes
Left from my side. I would like to take them one by one. My first one is on the sentiment you're currently getting from the BMG. Do you feel that eScript is still a high priority for the health minister? And would you actually go to court if the government does not proceed in time to introduce the eScript according to law? The first one.
I didn't get the second part, Alex, of your question. Whether we would go to court?
Yeah. If you would actually sue kind of the government for not introducing the eRx in time according to law.
That is not something that we have considered at this point of time. The sentiment that we're getting when we're talking to the BMG, nobody, even between the lines, even if we really try to, you know, push them, would give up on e-prescriptions. It's quite the opposite. Again, they. You have been following, you know, this whole story for quite some time. They. Compared to the last government, they're taking a more collaborative approach. Also the recent public statements by the health minister, you know, they were almost, like enthusiastic about the benefits that e-prescriptions are going to bring to the German healthcare system. We are not. Even between the lines, we're not picking up any kind of, you know, softening of the enthusiasm around e-prescriptions, but it's a different approach.
Okay. My second one would be on the adjustment for First A, and thank you for being so transparent this quarter. My question is basically on the absolute level in Q3 versus Q4 upcoming. Should we roughly assume the same amount?
Yeah, you can assume the same amount, roughly. Yeah, absolutely. Yeah.
Okay, perfect. Thank you.
Thank you.
Thank you. We'll take our last question from Aisyah Noor. Your line is open. Please go ahead.
Great. Thank you for taking my questions. Can you hear me?
Yes, Aisha. Yeah, we hear you.
Great. My first question was just on the new distribution center in Italy. Could you give us an update on your expectations for the ramp up? Should we see this growth acceleration take place in Q4 itself? Is it more of a 1H 2023 event, and then Q4 sees another slowdown in growth? That's my first question. The second question was around purchasing behaviors. Not sure if it's possible for you to implicitly detect this, but have you seen any signs of down trading towards kinda lower price brands or alternatives? Perhaps in that vein, could you talk about the performance of your own branded or the Redcare segment and whether that's gonna see any benefit in the quarter? Thank you very much.
In terms of Italy, I'll start with Italy. Italy is ready. The DC is ready to scale. Of course, now, you know, the customer demand has to scale as well. We've been growing very, very nicely. As you know, we don't disclose country-specific information, but Italy is growing at a very aggressive pace, so it's certainly above what we disclosed for the international segment in total. This is not a game that's going to be played from one quarter to another. This is something that we are going to see developing and continuing to grow over the coming years. Again, all the capacity, the infrastructure in order to scale very, very quickly, is in place.
It was a very smooth go live from an operational point of view.
Yeah, the second one, about purchasing behavior by our customers, I also in part addressed that already in a prior question. Basically, in summary, we say, "Okay, we don't see significant impact there at the moment." Of course, in detail, we see things that are really relevant for us to optimize. At the start of the year, that was in quarter one, we saw actually that some customers in the highest price segments like vitamins or things to live a healthier life were a little bit less popular. That actually that decline faded a bit into quarter three. That was not there anymore. A bit perhaps contrary to what your expectation could be and what also my hypothesis is, continuously we don't see significant impact there.
Of course, we as a total company know that we in all our communication focus a lot on price, on our own brand alternative, on our broad assortment, where you can make your own choice in what price category you wanna shop. It's a part of how we optimize. It's not an unlikely scenario that actually in the increasingly recession area where we potentially are in or could be in, it doesn't seem to be a bad place to have an online pharmacy web shop that is significantly better priced than offline alternatives. That could also in part lead to some positive to Shop Apotheke or has potentially led already to some positive at Shop Apotheke.
Within the mix, what your question was with our assortment, the impact is what I can disclose is not significant.
Great. Thanks. If I could slip in one last one on paper Rx. Could you give some guidance on what sort of run rate you're seeing in Germany Rx sales this quarter and how you are thinking about the trajectory for 2023?
Yeah. For each quarter, you can take EUR 30 million or a little bit more or around EUR 30 million. Yeah.
Great. Thank you very much.
Thank you.
Thank you. That's all the time we had for Q&A. I will now hand it back to Stefan Feltens for closing remarks. Thank you.
Okay. We are a little bit over time, so thanks for your interest in Shop Apotheke. Again, I hope we could convey to you that we had a solid quarter. We reiterated our guidance. This is something. You know, you look at different industries, you are getting different messages there. We are very happy that we are in a position to confirm, to reiterate guidance. I would wanna just close by, just by reiterating what you just mentioned. Looking forward, the pharmacy space, the healthcare market, if we get into recessionary territory, probably is not the worst place to be in. With this, I wanna thank everybody again and wish you a great day.