Good afternoon, everybody. My name is Jenny Rabinowitz. I cover U.S. Medtech and Healthcare IT at Goldman. Today, I'm thrilled to be joined by Bioventus. To my left, we have Mark Singleton, CFO, and Dave Crawford, VP, Treasurer and IR. Starting off, I think it would be great to start with a company introduction. The markets you are, your three key segments, what are the key products in all of them?
Great. Thank you for having us. Appreciate it. Bioventus is a $568 million revenue company as of 2025. Our guidance for 2026 is $605 million. We participate in markets of $6 billion plus. A lot of opportunity. We've had a lot of success over the last few years accelerating our revenue, expanding our margins, and generating significant amount of cash flow. We've actually taken our margins, from early 2022 to 13% EBITDA to greater than 20% in 2025. We've increased them by 700 basis points. At the same time, taken our revenue growth from low single digits to mid to high single digits consistently from a performance perspective. Overall, we've also taken our cash flow from the last few years from a negative cash flow to positive free cash flow.
Over the last 12 months, we produced $100 million of free cash flow, and we actually doubled our cash flow from 2025 to 2024. We think this is a really compelling investment. From a portfolio perspective to date, we really look at our portfolio in what our core products are, what our expansion products are, and what our emerging products are. Our core products are our hyaluronic acid, HA, product today. It's also our PRP product, which is a new growth driver. We're establishing four new growth drivers. From the core product, there's also BGS and EXOGEN. BGS and EXOGEN actually produce a lot of the cash and profit of our company. Those are the core products, and they feed the emerging product, which is Ultrasonics, international markets from an expansion, and then the emerging products are PNS and PRP.
Overall, those are how we think about our products, but our segments that we have is our Pain segment, which is PRP, PNS, and HA. We have our Surgical segment, which is our Ultrasonics business and also our bone graft substitutes business. Our Restorative Therapies, which is our EXOGEN business.
Thinking back to the IPO in 2021, Bioventus did a few acquisitions shortly thereafter, two divestitures. How are you thinking about the portfolio you have today and staying with it?
Yeah. We're really excited about the portfolio that we have today. Again, we have the core products, which HA, BGS, and EXOGEN, which really fund the actual future product, which is our expansion and our emerging products. When we think about PNS, as a product that we're really excited about in our portfolio, this is one that's got a lot of attention recently. There were some acquisitions made by Boston Scientific and Medtronic, who bought two of our competitors, and they paid significant multiples for that business. If you look at where we think we can take that business, those multiples would result in more market share than what we actually have for our overall company today. We have that. PNS is a great product.
When we compare ourselves to the competitors, our product is actually designed for the peripheral nerve, whereas our other competitor product were designed for spinal cord. Significantly, more specificity in how we go about developing that product and how we're taking it to market. It also generates a lot more power from that device that can actually reach deeper and larger nerves, so it's much more effective. Then it's also a more smaller wearable device, so it's easier for the patient. This market is for patients that have debilitating pain. The market itself is a $250 million opportunity growing at almost 25% a year. Really a high growth market, which we feel that we can be really successful in over time.
You referenced how the core products fund the growth. From a broader perspective, though, maybe including external as well, how do you think about capital allocation beyond that?
For capital allocation, it's great to get that question today versus a few years ago, where first, second, and third question were about leverage and what we're going to do to reduce our leverage. We've brought our leverage down from almost close to six turns, at the end of the first quarter, it was a little bit more than two turns. Significant reduction, that comes as a reflection of the financial discipline that we put into the company and the actual cash flow that the business is generating today. Significant turnaround. When we think about capital allocation right now, we're really focused on paying down debt, which we've reduced our debt. At the end of the first quarter, it's close to $250 million. Significant reduction with that, as we've talked about with the leverage ratio.
We look at M&A, we just talked about our portfolio and how we really do like our portfolio today. We think there's a lot of potential to make a shift into these high growth markets and really bring those products to life and ignite the growth drivers over the next few years. We're not going to put our head in the sand and ignore M&A, it's not going to be our first priority. We really want to focus on the portfolio that we have today and bring it to life. One thing that we'll start to look at is stock buybacks potentially, as we get below our two turns and as we expect to do that in the second half of the year. Really right now focused on paying down debt and we'll continue to do that in the short term.
Turning to recent results, can we walk through the drivers that supported 7% growth in Q1? Can you characterize this performance, kind of ex rebate adjustments or any unusual factors?
Our first quarter without the rebate was in line with our expectations. 7% growth on the top line. Again, as we expected overall, in the first quarter without the rebate from an overall company perspective, we'd be in the 3%-4% range. Good quarter overall from our expectations, we think about our surgical business was in the 7% growth range. Our expectation for that is higher than that for the rest of the year, that's more of as we sequence through the year, we expect that business to accelerate. Overall, a good performance. When you look at from a profitability, we actually grew our EBITDA by close to 25% year-over-year in the first quarter, we grew our EPS 100%.
Those would be a little bit less without the rebate, but still an overall excellent performance from a profit perspective. Gets into the expense management and also some of our growth investments that we're making into our growth drivers, the $13 million investments that we've talked about making are going to be accelerating as we go through the year as well.
Dave, the other thing I'd hit on is cash flow. Significant $28 million increase in cash flow in Q1. As Mark talked about, that's been a big turnaround part of the story. We've continued to see that momentum build as we've gone throughout the year.
On that subject, can you walk through the dynamics that led you to hold the organic growth guide, but you did raise the EPS and free cash flow guide, so maybe a bit more on the profitability aspect?
Right. When we think about the first quarter performance as we just talked about, both EPS and cash flow are ahead of our expectations much more significantly than the revenue. Again, the EPS 100% increase year-over-year, that's a reflection of overall good P&L management, but it's also a reflection of the lower debt that we've been paying down with the excellent cash flow that Dave just referenced. We're able to pay down the debt that has less interest expense flowing into the P&L. Year-over-year, a lot of improvement driven just purely on interest expense, but also good management to really get further ahead on those two from a cash perspective and from an EPS perspective than we were on revenue. From a revenue perspective, still have three quarters left over the year. Our decision was to maintain that.
Since you reported earnings, there's been some news flow as it relates to CMS reimbursement for bone growth stimulators, you guys held the guide. Can you walk through the kind of math or how you framed it that helped you get comfortable maintaining your guide in light of this change?
Yeah, I think we really just focused on the impact that that has on our business, it really affects 50% of our business, this new news on the reimbursement. When you look at the amount of that was impacted from a full-year perspective, it was really immaterial. When you also look at our competitors who were also impacted, they had some significant reductions in their revenue and profit that they adjusted with the news of this, they're much more significantly impacted than what we are. Again, we have this business. There's only a small part of the actual half of the business of our EXOGEN business is impacted by this. The other half is not.
I'd also add, when you think about last year, we had some headwinds related to currency and tariffs that we were able to offset. We see this as something similar. We'll have to make some tough decisions, that's why we felt comfortable maintaining the guidance.
As it relates to your competitor, are you less exposed just because as a percentage of sales, or is your product portfolio for BGS different?
We're definitely less exposed.
Okay.
We compete head to head with them, but this is a bigger part of their portfolio, and they also treat other conditions with their products that we don't.
Okay. I guess where else in your portfolio do you see reimbursement risk or maybe benefit? Is there anything else you know CMS is evaluating, maybe?
Yeah, we always stay on top of that from a day-to-day perspective and focusing, but there were some significant changes to HA reimbursement in 2022 that impacted the company, but that has been stable since then, and we don't have any information that would lead us to believe that there would be any future changes or negative impacts to reimbursement at this point in time.
Turning to the segments and starting with the core. In HA, how has DUROLANE been impacted by the market-wide shift towards single injections and away from multi injections?
Yeah, DUROLANE has been positively impacted by that. We feel that this is within the HA space. As you said, it's the single injection. It's clinically differentiated versus our competitors. We have a really strong sales force with HA that is in the field selling this all day, every day. We also come at this business with our contract position that we have with different payers as well. We have payers, and if you have UnitedHealthcare, for example, and they have DUROLANE, and if you're UnitedHealthcare, you're going to get DUROLANE through your insurance. We really feel good about that. Even despite, you just mentioned some of the CMS reimbursement items. From 2022 all the way through 2025, there has been strong volume growth. That's really what we focus on with this space.
Going to be responsible with price, but we've seen a lot of volume growth given our great sales force out there that drives us every day, and a combination of them working also with the contracts and payers that we have in place. We really feel we have a powerful combination from an HA perspective, and as the market moves towards single injection, we're there to really benefit from that and take advantage of it.
What do you think is driving the market towards single injection? Is it mostly patient preference, physician preference, payer dynamics, as you kind of touched on?
I think it's a little bit of both and it's less trips to the doctor with the single injection. I think that there's more clinical differentiation with that product as well. Overall, I think it's a natural shift and just I think it's the physicians, it's a little bit of both in all of them, but we also have a broader portfolio than just DUROLANE. We sell our three-injection product, GELSYN-3, sell our five-injection, SUPARTZ FX. There's still steady demand for both of those as well, but there is a shift into the single injection. Overall, I think it's more preferences and then convenience for the doctors and the patients.
Staying with HA, you talked about, here and in other public appearances, targeting profitable growth, definitely a recurring theme. Can you describe to us what does it actually look like out in the field? Are you willing to turn down lower margin contracts? How is this playing out?
Right. That's a good question. Again, been really successful in driving a lot of volume growth over the last few years. Adding new payers, adding new physicians. Really done a good job. We'll continue to do that in 2026. Our expectations for this business are not as high in 2026 as what they were and what we achieved in 2025. It's really about being responsible from a pricing perspective. Pretty much what you're asking us is in that we're not going to chase volume that's not profitable from an overall, it just doesn't make sense from a P&L and financial management perspective. We're going to be rational and really pursue business that feels going to add profitable growth. That's what we've been focusing on with our sales team in 2026. As we talked about before, our first quarter results were in line with what we expected.
There's obviously been some M&A activity from larger players. What do you think is attractive about this market, how are you uniquely positioned to compete against some of these larger players?
Yeah, I think it's, again, it's a $250 million market growing at 25%. These are patients who are really suffering from debilitating pain. I've been out in the field with our CEO, Rob, and seen this live in person, seen some procedures, seen the patients really go from when they've got the device implanted in them, come back to the doctor and really kind of highly questioning us, the Bioventus team, when we were there, that that product was actually going to work for them. You saw it live in person to where we actually after the implant, actually saw that have an impact. We've had our general manager out in the field where a woman really had not been able to really be mobile for a long while. She had the PNS device installed and was able to walk after that and had much higher mobility.
She came to tears after seeing and experiencing that, just really moving experiences that we've seen. It's a great market, it's really treating people with really not just a little bit of pain in their knee, but significant pain that's really impacting their daily lives. That's why it's such a really attractive market with the $250 million growing almost 25%. We feel that we have the advantage versus our competitors, again, because our device was specifically designed for the peripheral nerves versus the other ones being designed for spinal cord stimulation. The power that our device generates is more efficient, and it's more powerful to where it goes from the lead into the deeper and thicker nerves. It's going to have a more effective impact on the nerves and bring the patients to see the results that I just referred to.
It's a wearable device that you have, ours is much smaller than our competitors. We think really the combination of all those things is what gives us the advantage. We really are excited about this product. We have a specific general manager we brought in to run this business, excited about what we see so far, excited about what we can do into the future, I think it's going to be one of our great growth drivers and help change the growth profile of the company over time.
It sounds like there might be an advantage on the clinical side just in terms of how the device was designed. I guess, how are you guys thinking about generating clinical data so that the clinical community knows this as well?
That's a good question, and we're in the early stages of that and exploring the opportunities of how we go about doing that. Obviously, that's an investment that we'll need to make to do that. We have not generated that, but we have plans in place. We're assessing that all the time, looking at the benefits of that and how we, in our research and in our R&D team participating in that with the clinical team.
I think something else unique about the PNS portfolio is that there's multiple offerings. There's a trial. Do all of your competitors have this? Is this something unique? Does this help you address maybe a wider range of patients or indications then?
I'd say it's a little bit a part of that market. Not all of our competitors have a complete portfolio like we do, like the company that Medtronic just bought SPR. They just had a temporary device. We have a trial device, and then we have the permanent device. We just came out and launched those, got FDA clearance in 2025. It's important for the patient to go through a 30-day or 60-day trial to really experience the impact of that. Then once they get comfortable with it and how to use it, then we move them to a permanent device. It's really more in line with how the industry does that. There's some patients like I said, the SPR market is more temporary devices. Overall, we think that gives us an advantage.
On the earnings call, you mentioned that half of the planned investments for the year are being dedicated to PNS. Can you walk through what some of the key areas of investment are for this year?
We grew our EBITDA above 20% last year, so really have a unique, from a P&L perspective of either expanding our margins or investing. This is an investment year in 2026 to really invest in the four key growth drivers that we've talked about. From a PNS perspective, the $13 million that we're investing in that, a big portion of that is for the PNS market or product. We're focused on first expanding our sales force there and investing in the sales resources to bring the product to market. Second, this sale also, as we talked about, the clinical trial and the clinical data, really investing in clinical resources who will work alongside the sales team to help in the procedure and answer the questions and make that procedure as efficient and effective as possible. We're investing in those.
We're also increasing the amount of medical education that we're doing overall, increasing our marketing that we're doing for that product. Really, this is really like a startup in a lot of ways for us. There are lots of investments that we're making in the things that we just talked about. When we look at those and think about the return that we're going to have and expect from those, we're again, really excited about the product and confident in the investments that we're making.
Is this level of investment in response to competition coming on? Is this the right time for you guys to?
We believe it's the right time. These investments were planned in 2025 before any of these acquisitions were made, and we looked at our P&L through our planning processes in the fall of 2025, looked at our growth potentials in 2026, and really focused on putting those investments in place then and giving us a head start going into 2026. Really not in response to them. We actually feel these two players, Boston Scientific and Medtronic, coming into this space, really, we welcome it. Our CEO, Rob, would say he's ready to compete with them, which I agree with, but I think it'll bring more attention to the space. It'll expand the market. We really look at this as all upside from a Bioventus perspective and the opportunities that it'll actually bring to us.
Got it. Shifting to PRP, you've highlighted it's the only system that only requires one centrifuge spin cycle. How pivotal is this point of differentiation in terms of clinicians looking to adopt PRP?
Yeah. To answer that question directly, we think that it's an important part of the decision. It's not just because we walk in there and say that they're going to switch on that alone. We think it is one of the differentiators any time, whether it be PRP or another device that you can actually make it easier for physicians, that's going to be an advantage, no matter whether it's PRP or another product. Our thesis in thinking about getting into PRP is really taking advantage of the synergies we get with our HA sales force. We're entering this space with a product that is going to be highly accretive to our bottom line straight away because there's not a significant amount of investment. There are all kinds of synergies.
Our HA reps are going to the office today already, and now they're selling an HA, they're going to bring in PRP. The infrastructure that we have and the success that we've had with our HA sales force, really, in medical device, they talk about having multiple things in the bag. This adds another thing to the bag for our HA sales force. We've seen early on that this has been very beneficial both ways. One, getting conversations with our current customers about PRP and getting those customers to sign up and switch to our device. At the same time, reaching out to some new customers who maybe weren't buying HA from us before, and now they're buying. We're seeing benefits both ways on this and really are excited about the opportunities.
We think the biggest advantage we have is the sales force that we've been so successful with in selling DUROLANE, GELSYN-3 and SUPARTZ FX, and really adding this to their bag to get synergies. Also from a look at it from an investment, again, we'll have the growth profit through the revenue growth that we drive, and that will be going to the bottom line because there's not a lot of investment to really drive this. We're excited about that one for HA reps to be able to have something else to sell in their bags and also the benefits and the P&L that will actually bring from a financial EBITDA and also cash flow.
I'd say there's one other differentiation besides just the centrifuge spin is the benchtop processor. It allows more customization for the surgeon or physician to choose leukocyte- rich, leukocyte- poor, depending upon what the patient is requiring to be treated. That allows them to have just one system. A lot of these orthopedic doctors will have multiple systems because of what they want to do. They're able to customize it just using our own system. Not just a quicker process, but one that's more efficient and customizable.
Great. I think for PNS and PRP together, you said should contribute 200 basis points to growth for the year. How are you tracking against that so far? What KPIs are you monitoring? Just any comments on that goal.
Our expectations for the first half of the year were not to be at 200 basis points. The 200 basis points was a full-year commitment. We're tracking in line with our first half expectations, and would expect the back half to be more than 200, while the first half is less than that. In addition to just the pure revenue, we've developed a sales pipeline. Obviously you want to look at the opportunities that you have. What we talked about before with the temporary devices or the trial devices to see how many. If you get a trial, most are going to get a perm. We were tracking the number overall from a PNS perspective, looking at the number of physicians that we've actually trained or surgeons that we've actually trained, and then how many of them are adopting it.
All of those are internal things that we're assessing and looking at. We haven't started to quote any of those externally at this point in time. That's something that we eventually want to do, really looking at those internally from a PRP perspective, looking at the capital placements that we have, obviously looking at the sales funnel, developing all of those things early on with these new businesses, really looking at those metrics and monitoring them over time, that's where we'll help us get more and more confident about the future.
Shifting to ultrasonics. These are first-of-kind product offerings. How are you thinking about the investment required given that you're being the market creators here?
The ultrasonics product came through us a few years ago through an acquisition. For those that don't know about this is really a game-changing technology. Again, another field visit that I did with Rob early on in his tenure, we met with a surgeon, probably a gentleman about my age. He'd been working and doing surgery for a significant amount of time, unprovoked or unsolicited, he told Rob and I that he thought this technology was revolutionary. That was a direct quote from him. Literally, the devices that we're competing with today are hammer and chisel. It's night and day different. We strongly believe that we have the ability to change standard of care in this space over time. The surgeon has much more precision and control with this device. There's a lot less blood loss for the patient.
It also extends the life of the surgeon because they're not in there with their hands, moving things around and hammering and chiseling. Safe. Technology that we're excited about. We win in this space with this technology.
On international markets, any markets you guys are interested in entering, what are you eyeing? Any criteria that you're evaluating whether it makes sense then entering a country?
Yeah. We're always looking at all of our investments from an ROIC lens. When we think this is another growth driver for us, we think it has a significant amount of potential. I think Rob's come into the company and the business that he used to run before Bioventus was 25% of the revenue was in the U.S. and 75% was in international. Bioventus is pretty much the direct inverse of that, is that we have 10% of our business internationally and 90% the U.S. He understands how to go to market internationally and has had a proven track record on how to be successful. First start with that and his experience there. He's brought new leadership into this business that has similar track record in business and international markets and how to go about that. We've added talent one, through adding Rob and his commercial experience.
He's added talent that we've put in place there that's really looking at these markets a lot different and has had early success early on. The areas that we're actually looking at and that we think we have the most opportunity are going to be in Asia, APAC. Specifically within APAC, China and Japan. We're not really penetrating those markets much at all today. An immaterial amount of business in both of those. We're working through regulatory processes, looking at all of the things we have to do to enter those markets and working through that. The other area is going direct in Germany. This is not a market that we really, even though it's a mature market, it's not something that we've penetrated very much there.
We're making investments from a sales force perspective and really taking Ultrasonics itself into Germany and some of the other products. The last market I'd say is the Middle East and specifically Saudi Arabia, where we really think that we have opportunity. Again, some specific examples of success from Rob's past and the leader that we have in our international business have been very successful in those markets. Obviously, there's some turbulent times over there right now, but we believe in those areas that we have a lot of opportunity to really accelerate growth and hasn't really been, I'd say, explored before as a company.
Got it. Turning to the P&L a little bit, how would you frame the margin profile of some of the expansion emerging products that we talked about? As these scale, should these be accretive to corporate average?
Yeah. Our gross margin is peer leading overall. Compared to anybody else, we're either the best or close to the best, and it's really a strength of our P&L, where we have the ability to grow. We have a high margin, generates lots of gross profit dollars, so we can either expand our margins, drop it to the bottom line like we did last year, or we can take that money and invest it in the P&L like we're doing this year. From a margin profile of our growth drivers, we start with PNS.
It's a little bit less than our average from a gross margin perspective, that's today early on, and as we get more volume through that, over time, we'll have the ability to lower our cost structure and bring that margin more in line with the corporate average of 75%. From a PRP perspective, that margin is a little bit lower than our corporate average. Again, the thesis for that investment was fully knowing that that margin is lower. When you look at that from the actual variable profit to the bottom line, it'll be significant because the amount of investments that we're putting into that, we've really already invested in the sales force, which is the biggest thing we need to do to drive that growth. From an Ultrasonics perspective, it's actually north of our corporate average.
Overall, that is accretive to our growth margin. Again, high growth potential, really strong growth margin combination. Our international markets. Markets today, that margin is less than our corporate average, but we don't feel that these growth drivers are going to, over time, as we get success in each of these areas, we're going to have better negotiating power. We're always going to be looking at our cost structure and how to bring it down. We don't think that the growth drivers and where our future growth is going to come from is going to be a meaningful difference in our actual growth margin that we have today and still fully expect that we'll be in that range over time.
We talked about how 2026 is an investment-heavy year, and you've also said that you're expecting to hold EBITDA margins at 20%. How should we think about the balance between reinvestment and margin expansion beyond 2026?
I think that that's a wait and see a little bit of that to see the success that we have this year and the new things that we discover by taking these new products to market. The great thing is we have the flexibility, right? We've proven that we can do that last year. I think this year our margin will be a little bit less from an EBITDA perspective. We'll grow EPS. That's how our guidance is set up. When we get into 2027, we'll evaluate the milestones of how we're doing. Are we making the progress that we expected, yes or no? Really look at that.
We do believe that these growth drivers have so much potential that we're going to invest in them to realize their full potential, and that may mean another investment year, but we haven't gotten to the point to where we've really fully decided on that.
With the last minute, let me turn it back to you guys. Anything we didn't discuss that you want to highlight, something underappreciated, or anything you want to share?
I think, one, thank you for having us. We really feel our story in total is underappreciated. We've said Bioventus is a very different company today than it was a few years ago. We've made significant progress overall on our revenue growth, on expanding our margins, on changing our cash flow from negative to positive. We think this is a really compelling investment. It's rare and a really unique opportunity to get into the company. When we look into the future with these four growth drivers that we have that we're investing in, we really be able to take our growth profile that we have today and really accelerate it over time. At the same time, expanding our margins and driving more cash flow. Overall, we feel like we've had a good track record of what we've accomplished to get the company where it is today.
We have a really strong foundation. Now it's really bringing these growth drivers, igniting them, and driving that into the future. We think it's a great opportunity to get into an exciting company that has a bright future.
Perfect. Thank you guys for coming.
Thank you.