Good morning, ladies and gentlemen, and welcome to the DocMorris AG 2023 full-year results and Outlook 2024. At this time, all participants have been placed on a listen-only mode. The floor will be open for questions following the presentation. If you want to submit a question, please press 9 followed by the star on your cell phone. Let me now turn the floor over to your host, Walter Hess, CEO DocMorris.
Yeah, thank you very much. Good morning and welcome, everybody, to today's conference call. It is an exceptional call today, as it is the first time in this round that the electronic prescription in Germany is reality. With me today is Marcel, our CFO. We will start the call with a business upgrade and its impact on the evolution of the DocMorris digital health ecosystem, followed by our full-year 2023 results and an outlook on our business year this year. Afterwards, as always, we are looking forward to answering your questions. Let's begin with the key messages, as shown on slide number four. First of all, we can confirm that we are back to growth and achieved the full-year outlook, with an increase of the revenue of 14% in Q4 2023 versus 2022, and growth of our active customer base.
Overall, we improved our adjusted EBITDA by CHF 51 million in 2023 by achieving our milestones in H2, such as streamlining our organizational structure, including the corporate structure, further enhancing our logistics and marketing performance, and generally reducing costs. The most important and most exciting development is that the eScript has been launched mandatorily in January and in no time became the new standard in Germany. We started successfully with ERX. First indications of market shares are promising. Next-day delivery of ERX orders is working very well, and the stability and scalability of our processes and systems are confirmed. Everybody was waiting for the release of the so-called CardLink solution. I'm really happy to confirm today that the final specifications have been published last Tuesday by Gematik and that we immediately have applied for certification the same day, and therefore we expect to go live shortly.
But that's not all. Later on, we will give you an update on the repeat script and our TeleClinic platform as part of the digital health ecosystem. The ramp-up of the number of eScripts since January is simply amazing. By now, 120 million prescriptions that have been issued electronically. In other words, more than 70% of all Rx in the last seven days have been issued electronically, and about 85% of doctors' practices prescribe electronically today. Within Rx, we are broadly in line with our old paper Rx market share and improve month by month despite the fast switch from paper Rx to eRx and our currently limited access to only about 20% of eScripts that are printed out. That's why the full market access with the seamless CardLink solution is absolutely essential for us.
Last spring, our team invented a seamless digital redemption solution to redeem ERX via the NFC-capable eGK with a smartphone, equal to the process in local pharmacies. Together with the European Association of E-Pharmacies, we agreed with the Health Ministry and Gematik to follow a certification process in order to implement the solution called CardLink as the official fourth redemption channel. This week, the final specification, based on a mutual consent between the BSI and Data Protection Officer with Gematik, and really, that's absolutely remarkable, have been published by Gematik, and on the same day, we applied for certification of our product and us as a provider. So the approval and go live is expected shortly. Getting this accomplished is a key milestone and a prerequisite to get access to the full market and to further increase our market share.
The redemption process itself, as you see on the right-hand side on the slide, is very easy and needs only three steps. First, an authentication. Second, a digital scan of the eGK, which lasts normally around five, maybe up to 10 seconds maximum. Third, already the checkout. This enables a fast and easy ordering of prescribed medication with the possibility to add OTC and beauty personal care products within the same ordering process. Importantly, eRx orders received digitally by 8:00 P.M. are delivered by us next day all over Germany. To make it even more convenient, we started an Rx subscription service already last year. In Q3 2023, we launched a pilot initiative of a convenient subscription service for patients with chronic medication demand, which now is ready to scale.
A patient can benefit from a continuous delivery of all his medication throughout the year, which gives him high confidence on medication supply and increases that adherence, which is clinically proven. For doctors, this process has many benefits. The German Health Minister even announced recently that doctors will get all the prescriptions reimbursed for one year upfront the first time they see the patients in the year. The minister will bring the required law into force this year. This will relieve doctors and their practices significantly, freeing up time for them and increasing the efficiency in doctors' practices. Our experience of the last six months with this service is very positive. We can improve all key KPIs significantly, such as basket size, order frequency, retention rate, customer lifetime value, and return on advertising spend.
Our fully digital repeat script service is an excellent example of what our ecosystem stands for: to bring together relevant stakeholders in the healthcare system to enable patients to manage their health in one click. For us, it's another key success factor on the way to profitable growth. The mandatory launch of ERX is really a unique opportunity. We have launched a broad marketing campaign with the Gesundbergs. A family who lives on a remote island is slightly quirky and loves the services and supply from DocMorris. The campaign is focused on switching existing Rx and OTC customers to ERX and, of course, also to gain new customers. On slide number eight, you see some visuals of the campaign, which achieves excellent KPIs with more than 400 million impressions already in digital channels and more than 200 million TV reach up to now.
By scanning the QR code at the bottom right, you can watch one of our spots on YouTube. To summarize and conclude the business update: the tipping point in a EUR 55 million market for prescribed medication in Germany is finally reached. The digitalization of the healthcare system in Germany has definitely taken off. The launch of the mandatory eScript is the foundation on which we can begin to capture the market. The launch of the seamless digital redemption channel for eRx by using the eGK and the smartphone will accelerate to address the full market potential as of now. On top, the combination of the repeat script with the yearly upfront remuneration of the doctors will be a real multiplier for all relevant KPIs.
If that wasn't enough, the digital identity and e-patient record foreseen by the Ministry for 2025 will even further enhance an integrated and fully digital medication supply and healthcare. So what is the impact of all of that on our digital health ecosystem? Digitalization in general and the eScript especially are the ingredients of a most effective and efficient ecosystem. It allows us to extend our offering to patients and customers beyond medication and to complement it with added value services with high margins such as telemedicine, chronic care, or platform as a service. The result, besides higher revenues and margins, is an increased patient loyalty and customer retention. And not to forget, the digital health ecosystem is designed to be used for international expansion and to contribute to long-term profitability.
On the next few slides, we will show you that we have further developed our ecosystem, which is ready to scale with the eScript. Let me give you a concrete example on slide number 12. For specific diseases such as diabetes, for example, we offer to chronic patients solutions which include products, services, and content to cover all their needs along their health journey. And as a result, we first can increase the basket sizes of existing customers. On this slide, you can see, as an example, our solution for diabetes patients who can buy the necessary products, including medication and medical products. Second, acquire and enable new customers by adding relevant content and connecting them to specialists if needed. And third, increase loyalty and minimize churn by offering them our Rx subscription service to cover the chronic demand.
Another concrete example of our integrated digital health ecosystem approach you see on slide number 13. TeleClinic, a company of DocMorris, is the leading telemedicine provider in Germany. Meanwhile, TeleClinic covers almost one-third of all video consultations in Germany. More than 2,000 German doctors use the platform actively, and TeleClinic partners with more than 40 insurance companies. Just recently, they won the tenders of DAK, one of the largest insurance companies in Germany, and ADAC, Europe's largest automobile association with more than 20 million members. Equally, as seen for DocMorris before, also for TeleClinic, regulatory and technology changed from being preventors to being drivers of the future. The digital law will remove the prior limit of 30% reimbursable telemedicine. Additionally, there is no longer a requirement to do telemedicine treatments from the doctor's practice. Doctors can now also treat patients via video from home.
On the technology side, the introduction of the e-sick note in 2023, the eScript this year, and the e-patient record in 2025 are real accelerators of the TeleClinic business model. But not only has TeleClinic high value as part of the DocMorris digital health ecosystem, but also standalone with those highly attractive financials. The very motivated and engaged TeleClinic team doubled their revenue in 2023 with high margins and expects a positive EBITDA in 2024. Similar to DocMorris, they act in a EUR 50 billion, largely untapped market with regulatory tailwind, with an online penetration of less than 1%, and an immense cost reduction potential for the healthcare system in Germany. Let me conclude the first part of today's call with an update on our sustainability activities on slide number 15.
The board and management of DocMorris have set ambitious short, mid-, and long-term targets to continuously improve in the four sectors of healthier people, sustainable planet, caring company, and reliable partnerships. The most remarkable achievement in 2023 is the reduction of our CO2 emissions by 13%. But, of course, also all other targets are equally important and followed with the same high management attention. Also for the year 2024, we have defined new ambitious targets, which are part of the short-term incentive scheme of the executive board. And with that now, I would like to hand over to Marcel to give us an update of the financials. Thank you, Walter. The financial year 2023 was characterized by three topics. First, our path to profitability. Second, the return to growth. And third, the strengthening of our balance sheet. Let's start with profitability.
We can clearly see on the ongoing progress during the last two years with a significant EBITDA improvement of CHF 83 million. All the measures for break-even shown on this chart have been initiated and will continue to have a significant positive impact in the future. The main focus in the second half of 2023 was on, one, further developing the customer experience, for example, through faster delivery, two, expanding the range of services such as our long-tail marketplace, and three, increasing convenience of the ordering process. Here, the faster checkout was a very important milestone. These altogether will lead us to profitable growth from 2024 onwards. In parallel to the EBITDA improvement, we also managed to return to growth, as is shown on slide 18. We see steady growth in consolidated revenue since H2 2022. In H2 2023, sales increased by 15.5% year-over-year.
We do not feel a lot of influence from inflation as our Rx prices are fixed and our OTC/BPC prices are still significantly cheaper than local pharmacies. Gross margin expanded by 150 basis points year-on-year. The improvement is based on better purchase conditions, sales price optimization, and brand integration. Even though the second half was slightly lower than anticipated due to lower prescription drug sales, the overall positive impact is sustainable. We expect the implemented measures to have a positive impact also in 2024. Our EBITDA margin improved by 430 basis points despite additional roughly CHF 5 million of eScript ramp-up costs for marketing and CardLink development. As usual, we show also the breakdown into the geographical segments. To reflect market standards, in this view, corporate costs are from now on fully allocated to the segments. Obviously, by far, the greatest impact comes from Germany.
I covered the development already with the group figures. In Europe, the consistent focus on break-even leads to a 9% decline on sales but a strong increase in gross margin and a very pleasing EBITDA margin improvement of 10 percentage points. In our underlying KPIs, we see overall a very stable and sustainable development. Corresponding to the inflection point in revenue, also a number of active customers grew again in the second half of 2023 with 300,000 new customers gained in the Q4 . Site visits decreased on a 12 month basis because of the significant reduction in marketing spend to focus on profitable customers and the brand integration in the second half of 2022. Basket size and order frequency are very stable and continue to show the very attractive unit economics of RX, which is our growth area for the coming years.
On slide 21, we see our P&L on a full-year basis. Here, I would like to highlight the significant reduction in operating expenses as a result of the break-even measures. As already explained in the first half communication, the brand integrations together with site closures like medpex and Eurapon were one important driver. This resulted in the financial insourcing of a significant part of the business into the scope of consolidation. More specifically, this leads in general to: one, an increase in consolidated revenue and thus a reduction in the difference to external revenue, two, a significant increase in the gross margin, and three, an increase in personal, marketing, and distribution expenses. Despite this, the absolute numbers of personal and marketing expenses declined because of enhanced marketing efficiency, improved logistics performance, and the streamlining of our corporate structure.
These sustainable developments on all line items show an overall positive trend and strongly support the path to profitability. The EBITDA adjustments for one-offs reduced again and amount to CHF 3.5 million, mainly driven by provisions for restructuring and integration. The financial result was negatively impacted by non-cash foreign exchange translation due to the exchange rate at the balance sheet date. However, cash interest costs remained stable year on year. Together with the net income from discontinuing operations, this leads to a positive contribution to equity. In the balance sheet, we see a clear strengthening, mainly caused by the sale of the Swiss business. The equity ratio increased to roughly 50%. Total assets declined by CHF 233 million and underline the highly attractive asset-light business model.
The cash and cash equivalents, including current financial assets of CHF 150 million, enable the repayment of the bond maturity in November and support our operations. As at the balance sheet date, the cash position was negatively impacted by a temporary increase in working capital of CHF 24 million. The reason for this was to ensure delivery capability over the holidays and prevent bottlenecks in incoming goods. The normalization with a positive cash impact already happened in the Q1 2024. In addition, the sale of the Swiss property will generate further cash inflow in Q2. In summary, we continue to show strong progress. We have achieved our 2023 targets and are reliably on the path to profitable growth on the basis of a strong balance sheet. With that, I hand back to Walter for the outlook.
Yeah, thank you, Marcel. Yeah, so let's conclude the presentation with our financial outlook, which is especially difficult to provide this year and therefore is indicative. Let me explain how we think about 2024. First, we would like to remind you again that the German prescription market, with meanwhile EUR 55 billion, is 5x larger than the OTC market and has an online penetration of 0.7% only as of now. The deep dive into the unit economics, as shown on the left-hand side of the slide, shows that the annual revenue and the contribution margin of a patient with chronic demand in absolute value is more than 5 times higher than for an OTC customer. Combined with a significantly higher retention rate, this leads to a 10x higher customer lifetime value. So what does this mean for us in this year?
Our starting point is break-even in our base business. The eScript is a reality, and the convenient digital ordering solution via CardLink is confirmed and coming very soon. Based on the unit economics and the customer lifetime value comparison, it makes a lot of sense to invest in RX customer acquisition now. We already started our campaign, and we follow a milestone-based marketing approach to educate patients and acquire new RX customers. Even how dynamic this market is, flexibility is required on the absolute amount of marketing spend. Depending on the speed of adoption of the online channel, the RX contribution margin can partially or completely compensate the marketing expenses and might lead overall to a negative to neutral EBITDA in 2024. Coming to the concrete outlook now. Today, the ERX ramp-up is not entirely predictable.
However, as the eScript is a reality now, we include ERX in our 2024 outlook. Based on this, we provide an indication for our outlook. External revenues in constant currencies to grow above 10% for the full year 2024 compared to 2023. Adjusted EBITDA is expected in the range of break-even to -CHF 35 million in 2024. Capital expenditure for 2024 is planned between CHF 30 million and CHF 40 million, and our mid-term EBITDA margin target is confirmed at around 8%. A look into the current trading shows that altogether sales are in line with this indication. OTC sales grow nicely, also partially based on the fact that we still were in consolidation phase one year ago. Paper RX sales, of course, decline as patients adopt to ERX quickly. Our ERX market share, based on the still limited accessible printout part, is encouraging, which largely compensates the paper RX decline.
We expect the first half-year figures will give us further clarity on the ERX ramp-up and a more accurate view on the outlook. With this, we complete our presentation and now are looking forward to answering your questions. Thank you.
Ladies and gentlemen, if you want to submit a question, please Press nine followed by the star on your cell phone. If you want to withdraw your question, please Press nine followed by the star again. Please Press nine Star now to submit a question. The first question comes from Sebastian from UBS.
Hello, good morning. Can you hear me?
Yes, yes, we do.
Great. I would ask three questions. I would ask them one by one. The first one is on the guidance with regard to the adjustments that you would include there for your EBITDA. Do you have any sort of indication or sort of a ballpark which we can look at in that regard?
In general, we do not really plan on adjustments because they are one-offs. But what we see is due to the sale of the property for the Swiss business, there will be an exceptional gain because the expected sales price is above booking value.
Got it. Quickly with regard to the balance sheet, obviously with regard to the cash position, just having a couple of things that I want to throw at you and I want to know how you think, how we think in that regard. We have these CHF 150 million as a starting point. There will be the earnout. There will be the sale and lease back that potentially adds some CHF 70 million, so we get to CHF 220 million. Then you have the bond takes out CHF 90 million, so we get to CHF 130 million. And then I have the EBITDA of -CHF 17 million.
I have some CapEx of -CHF 35 million. And I assume you will grow eventually and therefore potentially then you will also have some working capital, more working capital needs of around maybe CHF 20 million, which would bring me to around CHF 60 million by the end of the year.
Is that the sort of the direction from a cash bridge that you also think in this sort of directions, or do you have any other thoughts that you would like to share in this context?
Yeah, I can follow your thinking. Maybe two topics. One is in terms of net working capital, we will have a positive impact or we already had now in Q1 because I mentioned the CHF 25 million increase temporarily on the balance sheet date. This we already reduced, so there is a positive inflow. And the second point is in the CHF 150 million, the earnout of the Swiss business is already included.
Perfect. That would actually bring me to my last question. If you could sort of spend a couple of words on these CHF 150 million, what is actually all in there? Let's put it that way, these current financial assets. If I'm not mistaken, I didn't find a sort of a composition of that one in any report and sort of have a better understanding of what is in there. If you can break it into pieces, that would be helpful.
We have our cash position. Then we have a cash deposit as an asset, and then it's the earnout. So these three parts.
Got it. So in that sense, the earnout minus the cash equals essentially the deposit.
Yeah, correct.
Many thanks. That have been all my three questions.
The next question comes from Urs Kunz from Research Partners. Stage, it's yours.
Yes, hello, good morning. I have also several questions. First question on the outlook. This part of -35, so that the lower end, -35 of EBITDA, am I correct that would be kind of the case if sales of RX wouldn't rise at all this year and marketing campaign would be EUR 35 million for RX? And then maybe you can give a little bit of a hint of how you get to the EUR 0 million EBITDA line, how much RX sales would that imply? And then on the top line growth of +10%, which I think this is slightly conservative. I see it's a 10%+. But alone on the OTC side, I see if you just keep on the running rate for Q4 2023, you would have already on the OTC Germany side a growth of approximately 12% for this year in euro.
Maybe you can elaborate a little bit on OTC Germany, what you expect this year, how much growth you expect there. And am I correct in the marketing budget for this year? You can't give us a real figure because it depends on how things evolve on the RX, but can you give us at least kind of a range in what kind of marketing budget you're thinking about for 2024? Thanks.
Yes, maybe starting with the last one. On our base case, we have a marketing-based marketing approach, and we see marketing spend for eScript between EUR 20 million and EUR 30 million and need, of course, the flexibility to steer this really on the achieved milestones during the year. And with this, to your first question about the scenario of the -EUR 35 million, yes, your thinking is correct. We spend all the marketing, and there is less or few contributions out of additional sales. Given also that the base business is in line with expectation, this would lead to this approximately -EUR 35 million. And on the other hand, if it's more like in Sweden where we do not need any marketing spending to get additional new RX customers, then we will approach the neutral EBITDA line. Then the other question was about the growth of the OTC business.
Our overall guidance is that we go above 10%, including RX. You mentioned the growth rate of OTC in the Q4 last year. There is very important to see the comparison in previous year, and this was quite low and will increase during the year 2024. Therefore, we see the OTC growth below the growth we have shown in the last quarter.
Maybe back to the OTC growth. Even if I take only the Q4 OTCs in Germany and multiply that by 4, I get to a growth rate of more than 10% for 2024. Is it correct that that's the minimum you would also expect?
Our assumption is that we will grow our OTC business in line with market development. In this base guidance of more than 10%, our assumption is a high single-digit OTC growth. The focus still is on the break-even for our base business also in 2024.
Okay, thanks.
The next question comes from Srikant Lakhani from HSBC.
Good morning, all. Thanks for the opportunity to ask questions. One for me, please. I'm asking them on behalf of Christopher Johnen. So my question is on the CardLink. Can you discuss the schematic comment that CardLink will be temporary in nature? And in relation to that, I mean, does it matter how preferential is CardLink in your view versus the digital health ID?
Yeah. So thank you for that question. Yeah, so CardLink has now been the specification has been published. As said, we have handed in the certification, the approval for certification. And the date, which has been communicated with March 2026, refers to a partial software piece within CardLink called VSDM. So it's a connection to VSDM. And this has to be replaced by March 2026, by gematik, to a software piece called PoPP. So they are not ready yet. They will change it. And this is even written in the law. And that counts not only for CardLink, but for all eGK-related solutions, so also in the local pharmacy. By then, this software piece has to be changed. And it's a step towards the digital identity because, of course, the digital identity, this will be the final and target solution for the whole market.
Until the digital identity is fully rolled out in Germany, this will take time, 2, 3, maybe even 4 years. Until the market is there, it is needed to use the eGK, and it is needed for us to use the CardLink solution.
Understood. Thank you.
Dear questioners, please mute the webcast audio while you're speaking because we got double audio then. Thank you. The next question comes from Jan Koch from Deutsche Bank.
Hello. Thanks for taking my questions. I also have three, if I may. The first one is on the market share in the QR code market. Could you share some color on your market share within the eRx market in Q1? You mentioned that you are back at your old market shares, but what exactly does this mean? And then secondly, on the doctor reimbursement changes Karl Lauterbach is planning to implement, do you have in view when this could be approved by the cabinet, and when do you expect this to be discussed by the German Parliament? And then finally, I have to try my luck. On the NFC solution, you mentioned you expect a launch shortly. Is it fair to assume that you can launch your solutions over the coming two weeks, or could it take a bit longer? Thanks.
Yeah. So on the QR code and market share question, so as you know, at the moment, we really have only access to e-prescriptions, which are printed out at the doctor's offices or practices. And our estimate is that this is maximum 20%. And as of this number, this share of the market, we are, meanwhile, in March back at the market share we had before on the total market with pRx, with the paper prescriptions. So this is what we refer to. On the second question, it's called the Versorgungsstärkungsgesetz 1. Sorry for not translating it in English, but that's the official name. And there we expect, and the minister, the health minister, plans to publish a first draft in April or May latest. And he plans to put the law in force still this year.
So we expect it might be in end of Q3 or maybe in Q4. So that's what we see at the moment. And the third question was about the launch of our CardLink solution, the timing. And yeah, we expect it to be within that range, within a few weeks, be it two weeks or three weeks. So we will see. There is also Easter where people take our vacation. But it is really ahead of us in a short term.
Great. Very helpful. Thank you.
The next question comes from Sven Sauer from Kepler Cheuvreux.
Hello, gentlemen. Thank you for taking my one question. It's a theoretical question on how the CardLink actually works. If I were to go to a practitioner and I would get a prescription, and then I would scan my card through, and then for some reason, I would lose my electronic health card, and someone would pick it up, and he were to scan it with the CardLink, what would he be able to see? Would he be able to see my previous prescriptions? I mean, obviously, if I lose the card, my birthdate and picture will be accessible, but will also be my address or previous prescriptions be accessible? Thanks.
Yeah. First of all, we make a link between the card, the cardholder, and the account holder. And I would compare it to the situation in local pharmacy. If you lose your health card, someone picks it up and walks into the local pharmacy and just shows the card and says, "This is my brother. I just pick up now his prescriptions." There you will see and hear the same information with CardLink as you would see in a local pharmacy. And it's completely comparable, and it's the same specification and the same process, basically.
Thanks.
The next question comes from Michael Heider from Warburg Research.
Yes. Hi. For taking my question. I have only one left, which is regarding the bonus on Rx. What is the situation there? Are you planning to give bonus also on eRx, or is this simply for paper pRx orders? Thanks.
Well, basically, the fully digital redemption channel in combination with repeat script has really an outstanding customer experience. We think that this will be and has to be the driver for sales and for patients who redeem the prescriptions with DocMorris. We have different loyalty programs also for different brands. So the details I just ask you to see on the website as everything is published there.
Okay. Thanks.
At the moment, there are no further questions. So I would hand over back to Mr. Hess.
Yeah. Okay. Thanks a lot to all of you. Thank you for taking your time. For us, it is really, and I hope also for you, a special moment. This tipping point is really exceptional. We worked many, many years to come to that point. As said before, up to now, regulatory and also approved technologies were more pretenders for our business. They change now. They will not block us anymore, but they will even help. This is what we worked for a very long time. Now it's really time to execute. I can just guarantee you all the DocMorris team is extremely motivated and engaged to do so. Therefore, yeah, we are looking forward to seeing you soon on the road. Yeah, wish you a very nice day. Thanks a lot to all of you.