Alan Lutz, iLEAD Healthcare Tech and Distribution, equity research here at Bank of America. We are very excited to have here Progyny. We have CEO Pete Anevski and CFO Mark Livingston. Gentlemen, thank you both for joining us.
Thank you for having us.
You know, I think to level set and to start here, I think there's been some volatility in IVF and fertility trends over the past couple of years. I'd love just to lay the land of kind of the most recent thoughts around what happened in 2023, what happened in 2024, and what you're seeing so far in 2025, kind of tell the story of how things have evolved and kind of the utilization trends that you're seeing, you know, through Q1 of this year.
Sure. So we talk about volatility. There are sort of two pieces of when you talk about utilization. There is overall utilization, and then there is care consumption within utilization. If I start with 2023, through our history, we have seen a range of utilization in any given year overall. The range has been roughly 1.03-1.09%. 2023 was a year where it started out what I would call the midpoint of that range in terms of utilization and strengthened throughout the year, where the year ended up being, you know, one of the higher years of 1.09% utilization. Going into 2024, 2024 started comparable to 2023 in the first quarter. Then what happened was utilization softened, both overall utilization, although not as much, but care consumption softened.
Not only softened, but operated differently than it normally does sequentially as the year unfolds, where normally you see an increase in ART cycles per utilizer sequentially as the quarters progress. You saw that in Q2, but then you saw for the first time ever a dip in Q3, but then a return back in Q4. What we are seeing in 2025 is we are seeing more stabilized utilization, whether it is overall utilization in terms of number of people utilizing the benefit and female utilizers when we talk about it, or whether it is care consumption. Both are more stable. We saw that stability again return in Q4 and continue in Q1. Our visibility right now in Q2 is consistent with what we are seeing in both of those periods. I would say a much more stable environment relative to overall utilization and care consumption.
That's great. I appreciate that color. I think that context and background is important. Pete, you mentioned that, you know, what you're seeing now is consistent with what you've seen in Q4 and Q1. You know, maybe this is a question for Mark. As you think about what's embedded in the guidance for the remainder of the year, can you talk through the stabilization you've seen over the past couple of quarters and then what's embedded in the guidance as it relates to what you're seeing today?
Sure. You know, our philosophy on guidance has really remained fairly consistent over time. I think it's really important to us to provide that transparency to investors as to what we're seeing at the time. And our comments have always included, here's what we're seeing, here's what we're seeing looking forward for the quarter that we're currently in. You know, what's different, if you will, is, you know, as we evaluate the variability that we've seen at any one point in time and over the periods, we look to incorporate that into the overall ranges that we're providing. So, you know, Pete described, you know, some of the variability we saw last year. That's now incorporated into the ranges that we began, really frankly, giving in for Q4 last year, for Q1 as we started this year, and now as we look forward for the balance of the year.
You know, and of course, along the way, we've actually provided a bit more KPIs around that from a go forward perspective than we've done historically. It is all about trying to, you know, allow investors to have that point of view into what we're seeing.
That's great. Switching gears a little bit to the 2026 selling season, Pete, you mentioned on the call last week, the pipeline is pretty comparable to what you had last year, but the average number of lives is a little bit lower. I know it's early in the selling season, so maybe remind us kind of where we are in the selling season, but also unpack what do you think's driving that specific piece?
Sure. If you think about the selling season in a benefits business where people are making decisions, the majority of companies in the U.S. are calendar year companies. They are making decisions by October, if you will. They start to evaluate in February. Think of the sales season as pipeline building from February through October. You know, mid-August is when materially the commitments are starting to happen through the end of October. That is your selling season. We are, you know, let's call it three months into the selling season and have another roughly five, six months to go relative to selling season.
Relative to the commentary and the average deal size that we're seeing in the overall pipeline, you know, what we believe is happening early on in the selling season is the uncertainty in the macroeconomic environment could be impacting larger companies more, and they have more of a wait-and-see attitude relative to what might happen to their business vis-à-vis tariffs and how they might impact them. As you might imagine, larger companies are a little bit more complicated. For them, there's a little bit more for them to navigate. You know, they could be pausing as opposed to what would have started already to start to evaluate some of these opportunities. Overall, we're seeing overall number of prospects, again, comparable to positive versus last year. Dollar contribution relative to pipeline comparable to last year. Just the average lives a little lower.
The dollar contribution is comparable because the cohorts of prospects are in industries that are higher utilizers for us traditionally. That is how we sort of evaluate the overall picture.
That's great. And then, you know, around new products, you know, you talked a lot at Investor Day about new products that you're introducing: maternity, postpartum, menopause, return to work assistance. I know that these specific services and products are not expected to be a material near-term driver of revenue. But when you're talking with your current customers and your prospects, can you talk about how the creation and introduction of these new products is resonating with them and just give us a sense of what those conversations are like?
Sure. I'll start with the last sales season as a data point and indicator of demand for these new products. Where we sold menopause and maternity, pregnancy, postpartum last year, 20% of overall clients took one or more of those expanded products. 40% of new clients took one or more of those expanded products. You talk about the other products that we have when we go into market with. They're overall part of an overall solution that addresses many needs across a larger portion of their population. If you think about sort of the nature of those products, that's positive relative to a benefit manager as they're addressing the needs of their population. It's very much a desire for them.
The second piece so that they enjoy and benefit from both from a member experience perspective, but also from the benefit manager's perspective is being able to go to one place to buy these things is really important because it makes it easier for them from a vendor management perspective, but more importantly, from a member experience perspective, it makes it easier as opposed to having many different individual point solutions addressing all these needs. It is resonating well. A lot of these are informed by both, you know, input that we get from our current clients, but also input we get from the benefit consultants in terms of what people are looking for in areas that they want to address. It has been pretty positive reception so far.
That's great. Maybe a question for Mark around the 2028 expectation for these new products to be 10% of revenue. You know, I guess first, can you talk about your confidence in that target? Second, what's a reasonable cadence? I think they're not material today. If that's, you know, the street's at $1.6 billion for 2028, that would be $160 million. What's a reasonable way to think about the cadence there to get from, you know, maybe a few million today to that 10% in 2028?
Yeah, sure. Look, I think there's two parts to revenue in the case of the new products. One is obviously client demand. As Pete said, you know, great outcome from a client receptivity and uptake in just really our first proper selling season for the product. You know, off to a great start there. Obviously, we hope to continue that success over these coming years. The second is actually member utilization of the products. Unlike the fertility product, where if they need the benefit and there really is no other avenue for them, they come to us. We don't have to, you know, go out and seek them. That contrasts with menopause, for example, where somebody can just suffer with the impacts of menopause, perhaps not even realizing they have a benefit that can help address that.
Part of the, you know, the work, if you will, that we need to do over these coming years is to work with our clients to get that awareness at the member level and to draw them in. It is driving both of those. The model is a bit different in that we have to do that. We see that sort of engaging and, if you will, growing over time. The more that we layer on, you will have, you know, a greater impact and contribution as we get to, you know, from 2026 to 2027 and then 2027 to 2028.
That makes sense. This is a little bit out of order, but the investments that you're making in the mobile app, is that going to be something that is going to drive an acceleration? Can you talk about the strategy around the digital app and, you know, how that can, I guess, drive more retention and customer satisfaction? I guess, what are the things that you're looking at the app to solve for?
It's not just, I'll address the app specifically, but it's not just investments in the app. There's overall investments in product expansion globally. All the areas that we address in the U.S., when you're a multinational company, you want to make sure that you have products that address the same needs OUS as you have in the U.S. That's part of the investment. The other part of the investment is integration of the two acquisitions that we did from a member experience perspective, from an app perspective versus having separate apps today that those companies had. Having members being able to utilize just one app, so full integration of all the services in one app. The last piece is enhancing capabilities within the apps relative to the existing products.
All of it is also tied into a backend infrastructure that sort of enables all that and enables you to be able to do that efficiently. The focus is always about having the best member experience possible. To the extent that members, you know, have preference in terms of utilizing apps versus engaging with coaches for a portion of their experience, the app will do that and will do that in the best way possible. To the extent that it's a tool that the PCAs and other coaches across the products can leverage and refer people to, but still have heavy coaching experience because that's what an individual member prefers, that's what it'll do.
It just makes the overall experience a lot better for the member for whatever portion of the experience that they prefer to have digitally versus with a coach being the best that it could be. As a result, that does create greater stickiness, more member satisfaction, less frictionless experience in your journey, whatever your journey is, makes it a better experience and therefore a stickier product for your clients.
Going back to the cross-sale opportunity that Pete, you were talking about a little bit, I think you said in a normal year, you see 20-25% of the base take additional services up. Last year was 30% as, you know, you've benefited from some of the newer services on the platform. What's your expectation for that number moving forward? Because you're, you know, several years ago, it was really just the pharmacy piece that was the main add-on. How do you think about that, you know, over the next several years where that can go and where that should go?
There are a couple of factors that have contributed to this, but I do not expect it to be, I expect it to be in the same ballpark that it has been. In particular, in the prior year where there was more uptake on the expanded products, I do not expect that to stop. I expect that to continue. Conversations with existing clients are positive relative to what they are experiencing today and what they have today. They are all positive relative to what else we have to offer. As we continue to add and expand products, which we will continue to do, it is that many more things that we could address more and more of their members in different milestones in their life in different areas and different needs, right care, right time. That will also contribute to continued positive upsell activity into the future.
The conversation that we'd have by the business was there's 80 million self-insured, large self-insured lives. That's our target market. At your Investor Day, you know, you talked about a pretty significant expansion of that addressable market, federal, global, and then smaller employers. As you think about those specific new buckets of opportunity, can you give us a sense of, you know, maybe not rank order, but can you just talk about, you know, where you're most excited? You know, you're obviously investing for a global expansion. Of those three, just kind of talk about the opportunity sets there and what you're most excited about.
Yeah. To frame it, when we started, our addressable market was commercial market, which was roughly 80 million lives in the U.S. We expanded that where we added labor to that addressable market. That grew us to roughly 100 million in the U.S. Then on top of that, as we penetrated a portion of the federal population, federal employee population, it is roughly 105 million now. One of the things we are working on now is expanding that market further into fully insured, which is roughly another 50 million lives. That is a product we are developing right now and the capabilities around that and the licensure around that, and that will position us well.
If you think about it from a needs perspective, right, the fully insured has the same needs because they're all humans, as I like to say, and they have the same incidence and prevalence, whether you're working for a small company or a big company. The overall trend in birth rates and the number of people having babies later in life is constant across industries and across size of company. That is a pretty big opportunity. The reason why we haven't gone after that before is because it wasn't efficient relative to client acquisition and the cost to do that. There are ways to do it now, and that is part of what we're developing and doing to be able to grab portions of that population in an efficient way.
As it relates to the increase relative to global, the global opportunity addresses really multinational companies that always have the desire to have an offering that addresses not only their U.S. population, but their OUS population. That is important from that perspective. The U.S. population for us is the most important relative to financial opportunity, if you will, of financial contribution. The OUS is important relative to their desires and needs to address their overall population. That is probably the best way I can describe sort of, you know, those different addressable markets.
Yeah, that makes sense. Shifting gears again, the Trump administration, there was an executive order on IVF back in February, which feels like a very long time ago. Are you having conversations with the Trump administration? I guess is the first question. Has this executive order changed the conversation with maybe some of your smaller regional prospects? Are they more open to IVF or providing fertility benefits given the executive order? Just really any commentary around the Trump administration and the executive order would be helpful.
Sure. As a reminder, the executive order was asking for a recommendation around both protecting IVF as well as, so access and also affordability. Us and other participants in the ecosystem have been having conversations with the White House, and those sort of focused on the recommendation. The conversations have been, you know, educational, if you will, relative to how things work mechanically, how, you know, players in the space, you know, et cetera, and those kind of conversations. We have not been able, us or others in the industry have not been able to glean anything from those conversations relative to what those recommendations might become. The recommendations generally, the belief is that they will generally affect potentially populations of the federal employees versus sort of beyond that, because without legislative activity, the recommendations cannot impact commercial. They could only impact the employees that the federal government controls, right?
That said, we do not know where the recommendations are going to go. To us, overall, the spirit of the executive order is positive relative to wanting to create both access and affordability. That is a good thing. Affordability comes in many ways, including just coverage. We would be positive to start with expanding coverage for federal employees, whether they are DOD, whether they are the veterans, whether they are the full federal population. That could set a tone for states to start to do more mandates, set a tone for other employers. As it relates to the question about whether or not more conversations are happening with smaller employers as a result of that, I am not hearing that. It is not like people heard this executive order and all of a sudden they feel more or less compelled. If they do, they are not saying it to us.
Got it. Around that, would you be surprised? You mentioned legislative, there would need to be legislative activity for something more material to take place. Would you be surprised if there was legislative activity, either heavily incentivizing or mandating IVF coverage for employers or different subsets of the American population?
I do not know that I would be surprised. I think the devil is in the details in terms of what the mandate would be. There are different mandates now in every state, as an example, and whether or not the mandate would be really comprehensive or the mandate would be a toe in the water relative to getting more coverage across the country, I do not know. I think, you know, if there is legislative activity around a mandate, the question would be what that mandate would look like. I think, you know, that to me would be more the surprise than whether or not any activity happened. It is an area that on both sides of the aisle is positive, not negative, including in states.
There's positive activity relative to protecting access already in certain states that are, you know, anti-abortion states, for example, where the question is, you know, personhood in terms of an embryo versus, you know, is it property. That has been positive. I would not be completely surprised, but it is more about the details of what would be mandated.
I want to talk about the competitive landscape a little bit. As you think about it, you know, kind of going back to the question on, you know, your core 80 million commercial lives, now you're looking at sort of a global offering. You're going after smaller employers as well. Is the competitive landscape in those new markets different than just the commercial self-insured? If so, can you kind of talk about the ways that it is different?
The competitive landscape overall, just start with just some general comments about the competitive landscape. It's not any more competitive than it's been in the past. In fact, some small players have sort of already fallen out relative to, you know, being competitors, right? As it relates to the specific offerings, whether it's global or whether it's fully insured populations or whether it's a labor market, you know, others are, you know, attempting to do those things. They don't have the same resources that we do. So who knows? We'll see, you know, how much traction they get there. Overall, it's no more competitive than it is in the commercial market. In some places, less competitive relative to those populations.
Either way, we feel good about, you know, the resources we have and the head start that we have in a lot of areas around those markets and continue to advance ourselves to address those markets successfully.
As we think about Progyny's competitive position, we think about, you know, how important channel partnerships have been to the growth of the business. You know, we've talked in the past about Cigna. Can you talk about, as you think about your top-line revenue growth, your selling season, how important, you know, you have sort of a direct salesforce, you have the channel partnerships. Is there any way to frame the relative contributions or, I guess, the scope of those partnerships and how they've grown in relevance over the past, you know, since the IPO? Is there just a way to frame? Are they more important? Are they as important? Just curious if you can provide any commentary around that.
The direct salesforce still does the heavy lifting relative to all selling, even if forced from any of those channel partners. The channel partners provide a couple of really important things. One is they provide credibility relative to them choosing you as a preferred partner in an area that's important to their clients, as opposed to them, you know, take the payers, for example, like Cigna or take, you know, some of the other regional payers that we announced. As opposed to them, you know, doing it, them sort of recommending you as the preferred partner to do it is really positive from a credibility standpoint. They also, to the extent that certain clients prefer that, they also give a pathway to easier contracting where you just have an amendment on the back of their agreements as opposed to, you know, having a full contract directly with us.
We can do it both ways, but it's another avenue. Overall, the effort around selling is still a direct sales effort. They're just another vehicle for an introduction, you know, to a prospective client. They're positive, but not the biggest catalyst. It's still us selling.
Okay. And then, you know, we only have a few minutes left here. So Mark, I want to get you more involved here. As we think about the guidance for 2025, can you talk about maybe the most important drivers that get us to the top and the bottom end of the range for that 2025 cut?
Let me tell you, I'll start by saying what we don't need to happen. We never set our guidance with the expectation of having future sales or additional clients that need to come on board in order to get there. You know, again, all of our framework is around, you know, what we're seeing today based on, you know, all of the history and the historical patterns that we've seen for like customers, new customers, and how they progress throughout the year, patterns that we see within pharmacy dispensing, for example. All of those things are what's considered in the guidance. We take those forward.
The, you know, let's call it the more negative variability that we've seen in the past, you know, weighs more heavily towards the low end of the guide to the extent that, you know, so we've talked about stabilization, to the extent that stabilization continues and/or begins to show the sequential growth in ART cycles per female unique utilizer, for example, that's what pulls us up closer to the high end of the range. You know, there's no sort of other magic, if you will, that's baked in there. It's really what we're seeing today and how history has instructed us as to how these things progress throughout the year.
Yeah. And then, Pete, going back to the selling season comments, you know, as you think about the top of the funnel for the selling season around those that, you know, they were interested last year, but they pushed off to, you know, maybe re-engage this year. Can you give us a sense of what were the major reasons last year some of these prospects said, you know, this isn't the right year? I guess we can start with that and go from there.
Yeah, you know, unfortunately, they're never crystal clear in terms of why they didn't buy in the year. They're just basically evaluating and deferring their decision. There's not a list of reasons that they give you. They're very, very, you know, it's a priority, but not a priority for this year kind of explanations without sort of, you know, explanations as to what became a bigger priority for them, if anything, right? The good news is, as this year is beginning, similar to prior years, their early commitments at this point comparable to what they were a year ago are positive and come from the not-nows materially. That's consistent with what we see pretty much every year where the early part of the sales year has commitments from not-nows from the prior year.
A lot of the not-nows are still remaining pipeline, you know, for the balance of the sales year. Early commitments and behavior from not-nows are consistent. There isn't really, you know, explicit reasons that they give you as to why they didn't buy in the year that they evaluated.
Yeah. You are making some capital and operating investments in the business that you have talked about. You mentioned some of the areas that you are doing that. Can you talk about the duration of those investments? How long should we expect them to go on for? How do you think about generating a return on those investments just, you know, from a high level of the framework that went into making those decisions?
Sure. As relates to the duration, the incremental investments relative to what we've done in the past, both CapEx and OpEx that we're doing this year, materially, most of the investments will be, you know, in this year relative to those dollars, right? There may be some that spills over into next year, but materially, they'll be this year. As it relates to ROI, it's member engagement, it's NPS, it's retention, it's all the normal things that you would expect. Plus also, you know, all the investment in infrastructure on the back end also enables us to bring to market, you know, as we expand our product offering, those products even faster than what we could do today.
Makes sense. And then the last 30 seconds or so, you know, I'll give you a minute plus, you know, at least here. You know, what are you most excited about for the next year as it relates to Progyny and the story? You know, when we have this conversation a year from now, you know, what are you going to be most excited to talk about a year from now?
The things we're talking about now. We're already well positioned vis-à-vis all the addressable markets that we're going after. We already have the market-leading product relative to fertility and family building. The products that we're expanding into and investing in are pretty exciting. I think continuing that, finishing our investment in our infrastructure and the digital products and member engaging products that we'll have will even advance us further and enhance our lead and extend our lead vis-à-vis our competitor partners. We look forward to taking advantage of all of the addressable markets with not only the products we have now, but we continue to expand those products for the future and address as much of the clients' needs for as many in their populations as we can.
I'll only add, we'll also be helping tens of thousands of people build their families.
Perfect. Great, great place to end. Thank you guys. Really appreciate the time.
Thank you so much for having us.