Dynavox Group.
Hello, I'm Linda Tybring, and I'm the Chief Financial Officer of Dynavox Group, and I will cover the financials in more detail.
Great. For those of you who have participated in these calls before, you will be familiar that we will start with a quick recap about what Dynavox Group does. We will summarize the main takeaways from the quarter. Linda will, as she said, dive deeper into the financials, and we'll thereafter have a Q&A session. You can submit the questions during the Q&A session in the Q&A function here in Teams, or you can ask them live by raising your hand in Teams and unmute yourself, and then we invite you to speak. We, of course, always welcome offline questions sent by email to the above email address, which is linda.tybring@dynavoxgroup.com. Let's start with a brief overview of Dynavox Group.
First and most important is to reiterate our mission and our vision, which I know is very dear, not only to our now over 1,000 colleagues around the world, but also to our ecosystem of partners and investors. Our vision is a world where everyone can communicate. We will contribute to this via focusing on our mission, which reads that we are empowering people with disabilities to do what they once did or never thought possible. This also summarizes two of our main user stories. The first one, the do what you once did. That may be the person who led a normal life until a diagnosis such as ALS, which rendered her unable to control the body or communicate like before.
The other one, the never thought possible, that can refer to the child diagnosed at a very early age with a condition such as autism or cerebral palsy, where, thanks to our solutions, she can do much more than the world around her ever thought possible. On the picture here to the right, you see Linnea, a 12-year-old girl from Gothenburg in Sweden. She was diagnosed with cerebral palsy, and she's a great example of this. Some may know that Linnea was the keynote speaker at the Women in Tech Conference here in Stockholm earlier this spring with our colleague, Grit, thanks to our solutions, she was able to fulfill one of her dreams, was to give a lecture about assistive communication in front of thousands of people. Linnea has been a user of our products since she was about two years old.
The market that we serve is hugely underserved. Some 50 million people have a condition so grave they simply cannot communicate unless they have a solution like ours. Every year, about two million people are being diagnosed, yet we estimate that only some 2% of those are actually being helped, and the rest literally remain silent. The main reason for this spells lack of awareness, also among the professionals and the prescribers that are tasked to assist these users, combined with a poor healthcare reimbursement system. We operate with a global footprint. Today, almost three quarters of our business stems out of the U.S., largely because of a reasonably well-functioning funding system established some 20 years, 30 years ago.
Our comprehensive solutions are sold in more than 65 markets around the world, of which 12 are markets where we sell directly, while the others are served by a network of some 100 plus reseller partners. Our own staff is distributed in a similar way as the revenue, meaning some 50% of our staff are based in North America with our U.S. headquarters in Pittsburgh, in Pennsylvania. Our second-largest office is our headquarter here in Stockholm, but we have branch offices in several European countries as well as in Suzhou, China, Adelaide, Australia, and as of today, we are a little bit more than 1,000 employees in total. We provide what we refer to as a comprehensive portfolio of solutions.
They range from the content and the language system, such as the world's leading library of communication symbols, they're called PCS symbols, and a leading solution for off-the-shelf or custom-made synthetic voices of the highest quality with a large diversity in terms of languages, ages, ethnicities, and so forth. Moving on, we also make highly sophisticated communication software that is then tailored to the type of user which can vary greatly based on the needs of him or her. We develop and designed devices, hardware with cutting-edge technology and medically certified durability, including communication aids that can be controlled via eye tracking, also accessories such as the Rehadapt mounts. We have a services portfolio to help our users through the complexity of obtaining and getting funding for their solution.
Last but not least, we are there to help our users, the therapists, the caregivers, and everyone, through our global teams of support resources. We operate this model globally, and it is important to note that each piece in this is critically important and also a significant differentiator for us, making us absolutely unique. Our go-to-market model is predominantly as prescribed aids. That means some 90% of our revenue comes from either public or private insurance providers. This also means that we have solid paying customers, but also have been resilient towards changes in the overall economic climate. Now we will go back to focusing on the main topic of today, namely our earnings report for the second quarter 2026. If we look at the highlights, we deliver a solid year-on-year revenue growth in the second quarter.
Revenue grew globally by 16% after adjusting for currency effect compared to the same quarter last year. If we recall, last year's growth was an exceptional 38%. The demand for our solutions remains high, proving the solidity of our underlying business, and we see a robust underlying growth across all markets where we operate. The revenue in North America benefited partly from delayed orders from Q1. However, this positive effect was offset by what we see as overall longer prescription processes compared to before. The consequence of that is that it leads to longer handing times, but there is not less opportunity out there, and there is no deteriorated policies or reimbursement, just longer lead times.
In the light of that, it is reassuring that the operating profit more than doubled compared with the same quarter last year and came in at SEK 105 million, 130% increase, to be precise. The global rollout of our new ERP system that has been long in the making is now successfully concluded for all our main legal entities. In Europe, we continue to strengthen our local presence and our commercial execution, and on April 1, we completed the acquisition of our Italian reselling partner, SR Labs Healthcare, and we welcomed new colleagues to the team. A new health economic study focusing on the U.S. was released, and that shows that high-tech assistive communication solutions like ours significantly improves quality of life for people with disabilities while delivering clear economic benefits to society.
In summary, quality of life for users improves by 65% and pays for itself more than 3x over. This study confirms what previously has also been seen in similar studies conducted in Sweden and in Germany. During the quarter, we filed a lawsuit in the U.S. against AbleNet. Our objective here is to protect our intellectual property and to address alleged practices that, in our view, risks confusion around delivery, support, and reimbursement of assistive communication technology. Last but not least, we announced in the quarter that Jacob Thordenberg has been appointed the new Chief Financial Officer for Dynavox Group, and Jacob will join in September this year. Linda, who you will meet soon, will remain in her role until Jacob joins and will then be available until January 2027, the latest, to ensure smooth handover and support his onboarding.
Now I hand over to Linda to take us deeper into the financials.
Thank you, Fredrik. Let's take a closer look at Q2 financials. Revenue for the second quarter came in at SEK 670 million, a 16% year-on-year growth after adjusting for currency effects. Recent acquisition contributed with 4%, and the organic growth was 13%. Currency fluctuations had -5% impact on revenue. Sales continue to grow across all markets. In North America, as Fredrik already mentioned, we recovered part of the delayed orders from the first quarter. The positive effect was offset by overall more drawn-out prescription processes compared to before. This is partly driven by a higher number of users changing insurance provider at the beginning of the year, resulting in additional administration. We continue to navigate the complexity and bureaucracy of reimbursement processes, which remain a recurring feature of our markets and a headwind during the quarter.
The gross margin ended up at 70%, an increase of 2.6 percentage point. Gross margin benefited from favorable currency effect of close to 1 percentage point and lower freight cost. This was partly offset by higher component costs. EBIT increased by 137% to SEK 105 million, corresponding to an operating margin of 15.7%. Currency adjusted EBIT growth was 145%. Our OpEx increased by 5% organically. The OpEx increase relates mainly to continued investments in sales and marketing staff, but also within our IT organization. During the quarter, we continued to invest in our systems and tools, including our new ERP platform to strengthen scalability. Now we've successfully rolled out the new ERP in all our main legal entities. These non-recurring investments total to SEK 6 million, a decrease of SEK 12 million year-on-year. Acquisitions contributed with SEK 17 million increase over operating expenses versus prior year.
We saw a decline of our long-term incentive program cost of SEK 12 million year-on-year, driven by the share price development. Costs for research and development after capitalization and amortization decreased by SEK 17 million compared to the same quarter last year, mainly driven by higher cost in prior year related to the organizational restructuring. Higher capitalization related to launch of new product and lower amortization contributed further. We look at the basic earnings per share, it totaled to SEK 0.7 per share to be compared to last year's SEK 0.27 per share, which is 150% improvement. For the quarter, cash flow after continuous investment was positive with SEK 67 million. It's encouraging to see that our work on improving processes and operations have had a positive impact on cash flow compared to last year.
We also paid a dividend of SEK 53 million during the quarters to our shareholders. Cash at hand by the end of the quarter was SEK 223 million and net debt was SEK 882 million. The total unused credit facility at the end of the quarter was SEK 300 million. The net debt over last 12 months EBITDA was 1.6x . Fredrik, back to you to conclude today's earnings call.
All right. Great. Thank you, Linda. To summarize before opening up for questions, I'd like to iterate some of the main takeaways and bring further nuance to our performance and our outlook. We continue our strong growth trajectory, a trend that started early spring of 2022, almost four years ago. We grew revenue by 16% adjusted for currency, and that should be seen in the light of a 38% growth in the comparable quarter last year, making the comps quite challenging, and yet we beat that with quite the margin. Sales continued to grow in the quarter across all our markets. In North America, we benefited from deferred orders from Q1, but that was countered by overall longer prescription lead times. This slows down handling times and delays revenue, but it does not deteriorate reimbursement or long-term opportunity.
These types of complexities are quite well-known characteristics of the market in which we operate. Our profitability improved notably, reflecting strong operating leverage while the prior investment related cost continued to taper off. All in all, our EBIT improved by 137%. Not only was the reported earnings encouraging, we deliver a strong cash flow, further underscoring the improved operational efficiency, which we have put a lot of energy into, and cash flow after continuous investment increased by 167%. We continue to expand our direct market presence by closing the acquisition of our Italian reseller partner, SR Labs Healthcare. We continue to monitor all macroeconomic and policy changes development closely. As of today, there have been no changes or alternations to reimbursement or governing laws, but we of course see increasing administration and prescription timelines.
While currency effects and the broader macroeconomic environment can create volatility, we are well positioned to continue deliver on long-term sustainable growth in what we see as a severely under-penetrated market while advancing our mission to provide life-changing solutions to those who need them the most. We reiterate our long-term financial targets when it comes to growth to, on average, grow revenue by 20% per year, adjusted for currency effects, including contributions from acquisitions. In local currencies, the second quarter this year's growth was 16%, which means we continue on the growth trajectory, but also in the light of last year's exceptional growth. The market that we serve remains hugely underserved, but also quite immature.
With the example of growth levers, such as sales team expansion, adding direct markets, and operational excellence, we continue to build on our growth journey and remain confident in our ability to continue delivering on our ambitious plans. We move over to profitability, where the goal is to deliver an annual EBIT margin that reaches and exceeds 15%. We feel that we have proven to build strong growth with incremental improvement in profitability. We need to continue to invest in future growth with improvements in scale, which we have. The recipe is rather simple. Continue revenue growth, high and stable growth margins, and total operating expenses that increases at a lower pace than revenue growth. As a consequence, we see good opportunity to further leverage how revenue growth translates to reaching and exceeding a full year EBIT margin of 15%.
This quarter is a clear evidence of our ability to deliver on this. On dividends, we have an attractive cash flow profile. Given the growth opportunities, we of course, need to maintain a capital structure that enables strategic flexibility to pursue growth investment, and that of course includes acquisitions. It's still expected to over time generate excess cash and our policy is therefore to distribute at least 40% of the available net profits to our shareholders via dividends or share repurchases or similar programs when so allows and when we deem that it's the right participation. 2026 was the first year where we started to pay dividends. Given our ability to translate revenue into cash flow, as was also proven in this quarter, we remain confident in our ability to deliver on this target too going forward. Okey-dokey.
With that said, we are inviting our Corporate Communications Director, Elisabeth Manzi, who will help to moderate and enable us to take questions from you.
Yes. Thank you so much, Fredrik. We do have a couple of people who have raised their hands. If you would like to speak, you will raise your hand, and we will call your name. First one out is Daniel Djurberg. Please unmute and ask your question. If you would like, you can also turn on your camera. Daniel?
Okay, now it's unmuted. Hi there.
Hi, Daniel.
Actually, you can see me as well, I guess. Yeah. Hi, nice to see you. Congrats to solid numbers, good cash flow, and gross margin, et cetera. My first question would be a little bit on this comment on the reimbursement, longer times and so on. Linda, you talked about, but should we expect this to ease off anything or get worse? Is it like Linda said that it's mostly when they are changing financing that this occur and just some more insights.
I can give some more practical flavor of what this actually means in practice. Now we're more or less only talking about the U.S. At the beginning of every new year, that's when people change insurance providers. We see that there is a slight increase for whichever reason this year. When you change insurance providers, it's quite often so that you also have to change therapist because your former therapist was maybe associated with a different payer, and now since you shifted payer, you will have a new therapist. As you can then maybe understand, the lead times increase. I'm not saying that you start from scratch, but there is a little bit of a rework. This is one explanatory factor of why we see that it's not like the reimbursement is taking longer.
It's the entire prescription timeline that we notably see is longer this year than before. I would say that the trend or this function is not new to us. We're quite used to handling this, but it is longer. To give some sort of outlook on when this will taper off or how fast things will go, I cannot tell. We hear anecdotally that waiting times to get an appointment with a new prescriber or therapist, speech language pathologist, for example, in the U.S., are quite long. We hear 30 days or 90 days wait until you can get an appointment. Of course, if you start from zero, that will take longer time. That is the practical consequence. It's hard to tell exactly when or if it will taper off. There's no fundamental change to neither number of users or reimbursement.
In total, it will be annualized at least Q2 2027 given that the longer the impact you saw in Q3.
Your guess is as good as mine here.
Yeah. I would say. May I ask you about the cost for the AbleNet lawsuit in Q2 and also go ahead if we should expect this to be a substantial amount in the OpEx side here, and if you will comment on it as an NRI or not?
It's not substantial at all. It will be a small part of our OpEx.
That's good to know.
I think what we said in some prior calls, this should not influence our long-term guidance.
Yeah.
This is within, like Linda said, within our financial envelope.
Financial.
Super. Now when you see net debt coming down here to 1.6x rolling EBITDA, any comments on M&A and what you have thinking there? Because the 20% growth target is, I guess with some minor M&A as well included.
Yeah. I still think it should be seen that our play is largely organic. We sometimes use the word that M&A is sprinkle on the cake. If you look historically, it's been low single-digit percentage points of our growth that has been related to M&A. Also, when you make the types of acquisitions that we have made more recently, meaning that we buy our own resellers or distributors, the addition is actually quite small because in currency or in money, the only difference when you buy a reseller is the difference from what we sold to that reseller and what that reseller sold to the market.
Yeah.
M&A is not a fundamental part of our overall growth story. It is organic.
Perfect. Thank you. Finally, I just want to thank you, Linda, so much for a great work done and good collaboration and the best wishes ahead and have a great summer, both of you.
Yeah. Thank you so much, Daniel.
Thank you, Daniel.
It's been a pleasure.
Thank you, Daniel. We will now invite Philip Wetterquist to ask questions. Philip, if you're there, you can unmute. If you would like to, you can also turn on your camera.
There we go.
I think we can see you now almost. Philip? You might want to turn on your sound.
Hello?
Yes. Now we hear.
Hey, there we go. Okay.
Yes. Thank you.
There we go. There we have the camera as well. Perfect.
Perfect.
All right. Good morning. Just coming back on the prescription lead times. I assume this was an effect you saw in Q1 as well. You talked a lot about the weather being a big effect in Q1, I would assume this is an effect as well, looking back at that quarter.
Correct. Not to say an excuse, it is sometimes difficult for us to understand why a certain therapist's meeting with a user was delayed or deferred, whether it was weather, whether it was a new therapist, since we are not part of the journey. You're absolutely right. There could have been some effects. That being said, when we interviewed both our own reps and prescribers in the market, the weather effect that we experienced in Q1 was quite extraordinary and was definitely a big contributing factor.
Should we view this as more like revenue as being deferred and not lost
Yes
These longer lead times?
Yes.
Yeah.
It wouldn't be right of us to try to quantify the timeline for that. Again, if you just look objectively, there's no changes to reimbursement. The laws haven't changed. There is obviously no less prescribers and no less users. This should be caught up eventually.
Yeah. You talked in the Q1 presentation about March being back to historic growth levels, which I assume is 20%-30%, and then we see a slower growth than that here in Q2. Can we then assume that March was just like, it picked up because of the lost revenue in January and February, you got that in March? It was an effect of that?
I don't have an exact number, but you're probably right. There's an element of what was lost due to weather or what was lost due to changes in insurance coverage also in March, because as you noted, we did see a strong momentum in March and that comfort. We do have a slight increase in growth Q2 versus Q1, even though it's merely one percentage point. There are such fluctuations. If you recall, we have a fairly clear seasonality pattern. Q1 is our weakest, Q2 slightly better, Q3 slightly better, and Q4 slightly better. Interestingly enough, we have within each quarter also a similar trend, where the first month of a quarter is typically more shaky or weaker, and then you have a little bit more of a push through at the end of the quarter.
Yeah. You reiterated in the report your growth, 20% FX-adjusted growth target. Do you see that as still possible for 2026, given that we are some 5 percentage points below in H1, or do you more view it as a long-term target?
I think we should read it exactly how it's spelled out, that it's long-term and that it's on average per year. We didn't say that every year or every quarter or shorter periods. That being said, we remain confident because if you go up in the helicopter a little bit, looking at the market, what we offer, how we do it, to be able to deliver an annual growth of 20% is something we feel that we both have the capability and the demand is out there.
Just one last question. The number of employees increased quite a lot this quarter, about 5% quarter-over-quarter or 50 people. Do you expect to keep this hiring pace throughout the year, or should we expect it to slow, or how should we look at that?
Linda may want to answer that.
Yeah. I think you should remember that we also acquired a company in the quarter as well. That kind of brings additional people into it. I think that's the explanation.
Other than that, the main focus areas where we add headcount is within our market-facing roles.
Yes.
Reps out in the field, et cetera. We expect that specifically given the investment in organization and back-end system, that the rest of the organization, if you will, should scale much better.
Perfect. Thank you very much.
Thank you.
Thank you, Philip. Next in line is Jakob Lembke. Jakob, if you can unmute and turn on your camera, you're welcome.
Yes. Good morning.
Hey, Jakob.
Hey. My first question is, I guess I'm repeating the other ones, but on these drawn-out prescription processes, just want to be clear and understand that is this something that has increased compared to Q1? Also if that means then that the growth for Q2 is lower than what you ended Q1 with in March, which you said was strong.
That's a very good question. If I can dare to answer that question on gut feeling, I think you are all right. We do see that the reimbursement processes have been drawn out. There is definitely so that for the people who did not change insurance provider that had their processes started, say, in November or December, of course, there was no change to that. When you have a larger population changing insurance provider, and then adding to that you also change therapist, I would say it's likely to say that it was longer in Q2 than it was at least before. Whether that was exclusively in Q1 or not, I don't know.
I also want to reiterate what I think I answered before, is that the funding process, the process for once the prescriber says, "Yes, this patient is suitable for one of the products," until he or she actually receives it, that process hasn't slowed down. It's more on what happens before that that has been slower, which is also slightly more outside of our control, to be fair.
Okay. I'm also wondering if you have any sense of how much of the weather-related deferred sales that were recouped in the quarter and how much is left to recoup?
No.
Okay. I'm moving on to a question on your thoughts on, I guess, investments in sales and marketing. I guess last year you probably took a quite big leap in the sort of sales efficiency in the U.S., but given the slower growth here in Q1 or in H1, I guess that has taken a step back now. Given this, I'm just wondering on your thoughts in continuing to recruit for sales and marketing. It seems like you're continuing to recruit quite fast.
We are. We should also know that it's not like the hiring process is exactly even across the year. If we look back at last year, we did add a fairly significant amount of reps during the end of last year. Of course, that means that those new people are not fully up to speed yet. They're not up and running, and we should probably start to see efficiencies from that happening pretty much now, if you will. Other than that, our recipe hasn't changed that the best way for us to educate and build the market is by having more people, typically with a clinical background themselves, but they represent us, work for us out in the market. So far, we see that What do you say, Linda?
What is the average kind of, how long does it take to have a rep be up and running?
Yeah, we say that it's about six months until they're profitable, and after 12 months, they need to perform according to the set KPIs that we have.
Yeah. We see no shift in that. Now we're looking at kind of a global level. We're quite detailed on this. We analyze every region, every state, every market, where we see that is there incremental benefit of splitting territories and adding more reps, or should we kind of pause for now? That's something we do on a daily basis.
Okay. Just if I may follow up, given that you have recruited quite a lot of sales people here in recent quarters, do you expect to see a benefit to growth from this in the second half of the year?
Absolutely. Otherwise, we wouldn't do it.
Good. On the gross margin, which is quite strong here in Q2. Well, first of all, do you think that this is a level you can remain at going forward? Also, if you think you will have any material impact from the price increases that Apple announced here during the quarter?
Yeah, I think, first of all, we had a positive impact on FX this quarter on almost one percentage point, which we cannot account for in the coming quarters. We are seeing increase both on other components and the iPad or Apple cost. We think from a rolling 12 perspective, it's slightly below one percentage point going forward that we might have impact on gross margin.
Good. Finally, I have a question. I've heard some reports that your competitors, or you have a competitor that's being favored because they are able to get their devices out faster to the users. I guess the question is just if you are agreeing with this and also if you have any plans to mitigate this.
Oh, this is a big topic. I think this is partly associated with a lawsuit that we issued earlier in the year. Our focus is to, A, of course, make sure that the therapist and the prescribers that work with our patients are competent in doing what they do, that the products that we deliver are of the highest possible quality, both in terms of actual quality and also how they function, ensuring that the users are successful. Of course, that everything is done with a minimum of delay. We can always become better. I do see, however, that reimbursement systems are very complex material to handle, and making sure that you stay within the boundaries of what is legal, what is according to the policies, is critically important if you want to maintain a high-quality business.
We believe that we can probably do things better, but when we see that there are players who take shortcuts, of course, we should see, is this something we can improve on or is there other reasons? I think this is actually related to the lawsuit that was announced. There is more material and quite good infographics on a website that you can click on in the press release related to the. Then you can get more flavor on that, why this is not a super simple topic to answer. We want to make sure that we are top-notch.
Yeah. If I may follow up then on the lawsuit, just what's the feedback been from users and also the therapists from the lawsuit?
I don't know. I think it is probably all over the place. This is a market with extremely high ethical and moral standards. Almost everyone that works in this space does it because they want to make a difference. They want to make an improvement to the users and the families around them. I think doing things right is a fundamental part of how everybody in this space wants to operate, and that is also the majority of the feedback that we're hearing on making sure that we also do things right, also legally and procedurally.
Supporting the customers is very important for us.
Yeah.
Okay, good. That is all from me today.
Great. Thank you, Jakob.
Thank you, Jakob. We do have a question from the audience in the chat as well, from someone who has not posted their name. "Education is your bread and butter in many ways. Can I get an estimate on how many clinicians you train each year, and how many sessions you conduct annually? How does that compare historically, for example, five years ago?
Okay. I cannot give exact numbers, but I can describe the process and also how we operate. The model, which was a strategy I think we implemented in 2017 or so, that is more than five years ago. It was meant that training is the new selling, which means that our salespeople, if you will, they are not salespeople in the sense that they go out and close orders. They are typically almost exclusively clinicians themselves who have been operating for many, many years with the patient groups. Now, rather than working with individual patients, they work to educate the prescribers who in turn, work with patients. This means that the only thing our field reps do is to be out there and educate. That is what they fill five workdays a week with, along with, of course, the supporting.
We have, over the past couple of years, increased our field sales staff by, what would you say, Linda, 20% or so annually?
Yeah.
Which of course means if you have 20% more feet on the ground and they're continuing to train more, that's probably a number. In addition to that, e-learning, all types of new technologies, how we can conduct training without necessarily sitting in a car, driving for hours, et cetera. Getting scale for that has obviously improved. In real terms, the number of prescribers touched every year, et cetera, is growing even faster than that. That's what we do.
Yeah. Good. Thank you.
I hope that answered to some degree.
I think it did. We will bring in someone who has raised their hand. So Nikola Kalanoski, if you are still on the call and would like to unmute and turn on your camera, please.
There we go. Perfect.
Hey.
Yes.
Hey.
Hey, guys. Hope you're well. Just curious on a few things from my end. I thought maybe I would just follow up for a clarification on one of the previous questions, and I think in particular one on component costs and those relating to memory-related price hikes from the likes of Apple and so on. Did I understand correctly that you now expect about a one percentage point impact on the margin rather than the previous tens of basis points estimate impact from such hikes, or am I mixing it up with the FX impact on the gross margin?
No, you're right. The outlook is that we think that slightly below one percentage point will have an impact on the gross margin if we look at the coming 12 months perspective. It will come gradually over the period.
I can though maybe add some flavor. As we grow, we also continue to scale, which means that part of the tailwind we had in this quarter is that freight costs are going down. It's not like saying that we automatically, all things alike, will get a one percentage point kind of headwind from that. There are other things, how our operations scale and potentially. There's also, if you look at the slightly longer perspective, our aim is of course, to make sure that this is also offset by increases in reimbursement in markets where we control pricing, of course, making sure that is reflected there. In absolute terms, if you just look isolated on component costs, then of course, that calculation that was just mentioned is correct.
Hmm. Yeah, I guess maybe if I follow up on that comment, I guess it's relating to then pricing power. In which markets do you get the most, maybe sympathy is the wrong word, but where are you able to get compensated with price increases from your end? When you're being pressured, which kinds of markets are you able to then compensate with price increases?
A good question. We should go back to looking at where our revenue comes from. We have more than 70% or 75% of our revenue stemming out of the U.S. The U.S. is not one country. U.S. is 50 states, several hundreds of various payers. The payer in the U.S. that sets what refers to as the allowable or the reimbursement amount is Medicare. Medicare updates their pricing schemes every year, typically December-ish or so. Historically, they've always been related to some KPI, cost inflation, et cetera. Similar to gasoline or whatnot, component prices is in that too, but it's less in our control, and we more follow.
Whereas if you look at Europe, currently representing, what, 19% of our total revenue, there is more of a mixed bag of tender markets where the prices are set for one or two years, versus markets where we simply send out the price list.
Yeah. Okay. That's, I think, in line with some of the market expectations.
Maybe if we go into Europe, I think you wrote in the Chief Executive Officer commentary here something along the lines of there being a full underlying momentum, not yet being visible in the financials.
Yeah.
Is that something related to the ERP transition, or does it also refer-
No
To something else in terms of business momentum?
It's much more basic. First of all, if you just look at, we've now had our reseller partner in Italy in our company for three months, the one in Germany for nine months or so. This is also an integration project and has largely to do with humans. There's also an element of, prior to owning them, we sold to their inventory. Exactly if they had a good month or a bad month, we couldn't tell because we sold to the inventory, and then they sold from their inventory. Now, that middle layer, that buffer, if you will, is going away. Hence, doing direct comparisons year-over-year is not entirely correct.
Hence, I don't like gut feeling, our gut feeling currently, specifically if I talk, for example, in Germany, is that the underlying momentum and demand is very encouraging, and we should see that kind of normalize over time, and then obviously also shown in our P&L. I don't know if you want to add something there, Linda.
No, I think that when you look at our revenue, you should look at FX-adjusted revenue, and that's 26% in the quarter. I think that's important because it's such a mix of how the business has looked historically versus now.
Yep.
That makes a ton of sense. Thank you for clarifying that. That's great. Then just a final one for me, and this is a very basic one. In the U.S., one of your key drivers that we talk about is how many new solutions consultants are you hiring, and that improves your density and so on, and the efficacy per person. Should we think about it the same way for other markets in Europe, like Germany, let's say, or should we also consider something else that is unique for European markets compared to the U.S. markets?
All European markets in Germany included is more immature. The density is lower. We probably have an even higher task to educate the basics, et cetera. U.S. has a longer tradition, more sophisticated, little bit maybe more clear legal support. Other than that, the model is the same.
Yeah. Perfect. Wonderful. Well, that's it for me. Thank you very much.
Great.
Thank you.
Thank you, Nikola.
Thank you. We will invite Mikael Laséen then to ask your question. We're running a bit low on time, so if you can be quite quick on joining, we will have time. Yes, good. I can see you there, Mikael. Go ahead.
We can't hear you, Mikael. There's some mute button somewhere that needs to be clicked.
No.
Now? Can you hear me now?
Yes.
Yes.
Hello.
Okay, good. I want to follow up on the prescription process. Is it possible to quantify the effect? Where you see the effect, if it's broad based across the U.S., for example, different types of end users, all types of insurance, or funding sources, if you can be a bit more specific how this works.
As you note, there are fairly big discrepancies between different states and different payers. This is not unusual. That has almost always been the case. The discrepancy is quite large between certain states and certain months. One state that could be slow because of a hiccup or because someone is trying to implement something might actually be reversed the following quarter, et cetera. I don't have a kind of a bigger number or more gross number to share. Linda, I don't know if you have any.
No, I don't have anything else.
Okay.
It's also, like I said in the previous question, that it's not the reimbursement process per se. It's actually what happens before.
Before
The prescription has even been submitted.
Okay. Does that mean that you see the incoming requests sort of have slowed a bit? When they come into your process, it takes the same amount of time as before, and the rejections are the same?
We don't see that incoming orders are slowing down. The question is, since incoming means that our rep has been there, we have flagged that specific case. That process hasn't slowed down. It's what we have seen prior to that. New prescriber, new therapist is meeting a new patient. They're starting the assessment, A, will you benefit from a communication aid? B, if so, which communication aid and so forth. It's that part of the process that we believe is taking longer. Once they've actually come to us, to your point, we don't see that the reimbursement process is taking longer, and we don't see that denials or so is percentage-wise going up.
Okay. The insurance companies, for example, are not rejecting or taking longer time to evaluate and make a decision about the remuneration that you will get.
Not on average.
Okay. Good. Just want to double-check as well. We've heard that CMS, for example, has, in Q1, made some comments about making the reimbursement processes much more thorough and higher quality. Has that impacted the market dynamics in any way here short term?
No.
It's actually music to our ears because we believe that making sure that there are no room for shortcut, there is deep scrutiny, and that there are no attempts to kind of fool the system. That's exactly what we want to stand behind. There's an element of that also kind of ensures that there's high-quality players in the game.
Okay. Another thing here, topic in the market, I think, during the second quarter, The Wall Street Journal had a series of articles about autism and created quite a lot of questions around the entire process.
Yeah.
Can you comment on this, and what's your view, and how is this maybe changing or not changing the market dynamics? You mentioned that you haven't seen any fundamental changes.
No
Could it delay any processes in the market, have maybe indirect effects in any way?
No. I think what that specific article or whatever is related to therapy of users, which is a different space, a different reimbursement, funding code, et cetera, than durable medical equipment that we provide. It's more, "I can help your child to get rid of her autism diagnosis," whatever, "through our therapy." Typically very costly. I think in that specific article, the cost for a month of therapy was equivalent of the total cost for our device that is prescribed every five years. It's a different arena, if you will. It's treatment, not product.
Yeah, I understand that. They are not at all related.
No
those type of.
No.
Okay. Just want to double-check. Okay.
For example, those therapies don't include using devices. It's other things.
Yeah. Got it. I think your organic growth in Europe was around 5%. Could you break down the growth rates by region or market or where you see growth in line with your targets? Is this a temporary slowdown, or how should we view that 5% number? Linda, do you want to?
As I said earlier, you should look at Europe as FX-adjusted, so you should include the M&A. It's also a small part of our revenue. You should look at 26% FX-adjusted growth. Just as Fredrik explained earlier, the timing impact when you don't own a partner and when you own a partner becomes a little bit volatile. Look at it in total instead.
All right.
I could add that as we write in the report, I don't believe that the full potential of what we're seeing in Europe is yet being reflected in our P&L and might take some time. It is encouraging what we hear and see.
Okay. Can I just ask one final thing here about seasonality going into the second half? Is there anything what you see in your processes and pipelines and sales activities that suggest that these things, the delayed processes, drawn-out processes could improve, and we can have maybe a stronger seasonality situation in the second half, or should we expect normal seasonality to continue as always?
I think we can expect the normal seasonality patterns. To your point, if we're talking about delays, that eventually means that once the delay is over, then that will have normalized. Whether that takes one or four quarters or whatnot, I actually don't know. It's important to note that there is no reduction in demand or reimbursement, et cetera, which of course that would've been a different story.
Okay. Thank you.
Thank you, Mikael.
Thank you so much, Mikael. We do have one question that I wanted to read out here from somebody who has been working with students that use Tobii Dynavox devices in Sweden and know that some devices end up in cupboards. I should mention these students are 16 years-18 years old. This person has their theories, but what is your understanding as to what amount of devices do end up not getting used as they should, and therefore not gaining the benefit that is expected? Furthermore, if you can comment on the Swedish market as an example, what is the reason for devices not being used the way they should?
This is a common dilemma in our industry that people give up. I think the reason people give up is largely not related to the device or the technology itself, it's life. You have a condition of your child, which is technically life-altering, et cetera. Making sure that your child stays alive, that the basic fundamental needs in your life obviously always take precedence over literacy, being able to communicate, et cetera. The main reason, and this is universal, is that the infrastructure around the patient, meaning the therapist, the school, everything around it, is not solid enough so that ends up being that the patient gives up. I think the story I'm talking about now more has to do with people with developmental delays or cognitive disabilities. Of course, you have areas where you have degenerative neurological conditions such as ALS, et cetera.
Of course, unfortunately, one of the reasons why you give up is because patients pass away, or for other reasons are no longer able to use the product. That's smaller. I would say that the giving up feature is the number one problem. That is no different in Sweden versus some other countries. I would still say that the competence among people tasked with helping our users is tragically low in almost every country in every region where we operate, and that's what we are here to change. Sweden doesn't stand out. There's also, in Sweden specifically, fairly large variations from region to region, and that also has to do with competence and resources.
Good. Thank you, Fredrik, for that answer. Jakob, I see that you're back. Do you have a follow-up question before we close? Please make it short.
Just quickly on the price increases, or potential for price increases in the U.S. Just wondering, are you charging the maximum you can within the reimbursement codes right now, or are there some room that you can increase to those maximums?
We negotiate with every payer. Mark well, we have several hundred. I don't know what the latest number that we're announcing are.
Over 700 payers. Yeah.
Yeah. 700 payers or so. With those payers, we can actually negotiate. Basically, in exchange for less administration, a more smooth prescription or funding process, we are actually willing to adjust our price, and that's typically a win-win situation because it costs less for us to process, and it costs less for them to process. There are fairly large variations, I would say. If you look at kind of the median price that we charge for equivalent product, they are quite similar across payers.
Okay, good. If I just very quickly may ask also on Europe, can you elaborate on what the sort of volume growth is in the acquired units in this quarter? Sort of towards the end users or customers or what have you.
I don't even have that number.
I don't have that in front of me. We are growing faster when it comes to autism, for example, even in Europe, that means that the quantity is probably slightly higher than the total revenue growth.
Right. Yeah, those are products with slightly lower price tags.
Slightly lower ASP. Yeah.
Let's say just the sales growth out, that's neutral for this acquisition effect, maybe inventory and so on.
We don't know because of the fact that prior to acquiring a reseller, there was a buffer with their own inventory. Whether inventory was high or low, we don't know that. We should also bear in mind that what did Linda say? That Europe specifically is 19% of our total revenue. We don't have that number in front of us. Would you say, Linda, that it varies greatly?
Within markets?
Volume growth versus Yeah.
Good. I think we need to close by that. Hopefully everybody got their answers to their questions. Over to you, Fredrik, to close the call.
Okie dokie. I love the fact that there is so much interest. We will continue to work. We will continue to be there. We will go back and make sure that we deliver on our plan. On October 21st, that's when we summarize our business for the third quarter, and that's when we will have a similar session like today again. Thank you so much.
Thank you. Happy supper