Labcorp Hldgs Q3 2026 Earnings Call Transcript
Labcorp Hldgs (NYSE:LH) reported third-quarter financial results on Wednesday. The transcript from the company’s third-quarter earnings call has been provided below.
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Summary
Labcorp Hldgs reported a strong Q3 2026, with revenue growth of 7% to $3.8 billion and a 14.5% increase in EPS to $4.78, driven by volume and margin expansion.
Diagnostics revenue grew by 6.5% to $2.9 billion, while Biopharma Laboratory Services revenue increased by 8.5% to $867 million.
The company announced several acquisitions, including assets from BioReference Health, Myriad Genetics’ prenatal health testing business, and Millennium Health, expected to be accretive to EPS in the first year.
Labcorp Hldgs raised its 2026 revenue and EPS guidance due to strong organic performance, with revenue expected to grow between 5.9% and 6.7% and EPS to reach $18.30 to $18.70.
Management expressed concerns about proposed PAMA fee schedule changes affecting Medicare reimbursement rates but reaffirmed its long-term outlook, citing strong business momentum and strategic initiatives.
The company highlighted its continued investment in personalized health solutions, companion diagnostics, and technological innovations to drive future growth.
Labcorp Hldgs is actively pursuing business development opportunities and expects more acquisition announcements in the future, with a strong pipeline in place.
Full Transcript
OPERATOR
Good day, and thank you for standing by. Welcome to the Q3 2026 Labcorp Hldgs Earnings Conference Call. At this time, all participants are in listen-only mode. After the speaker’s presentation, there will be a question-and-answer session. To ask a question during the session, you will need to press star 11 on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press star 11 again.
Please be advised that today’s conference is being recorded. I would now like to hand the conference over to your first speaker today, Nicola Russo, VP, Investor Relations. Please go ahead.
Nicola Russo (Vice President, Investor Relations)
Good morning, and welcome to Labcorp Hldgs’ third quarter 2026 financial results webcast. With me today are Adam Schechter, our Chairman and Chief Executive Officer, and Julia Wang, our Executive Vice President and Chief Financial Officer. This morning, in the Events section of the Labcorp Hldgs investor relations website at ir.labcorp.com, we posted both our press release and the Supplemental Financial Presentation with additional information on our business and operations. We will also host a replay of this webcast on the IR website for one year.
On today’s webcast, we will focus on our adjusted non-GAAP results for the third quarter of 2026, our capital allocation strategy, and our updated financial guidance for the full year 2026. Our GAAP results and a reconciliation of the non-GAAP financial measures to the most comparable GAAP financial measures are available in today’s earnings release and the Supplemental Financial Presentation. Please see the Use of Adjusted Measures section in the Supplemental Presentation for more information regarding our use of non-GAAP financial measures in today’s remarks.
The term organic growth excludes the impact from acquisitions, divestitures, and currency, as well as other strategic actions taken in the early development business. Our remarks will also include forward-looking statements including, but not limited to, statements about our updated 2026 financial guidance and long-term financial outlook and the related assumptions of each, the expected impact of various factors on our business, operating and financial results, cash flows and financial condition, global economic and market conditions, our future business strategies, the expected savings, benefits and synergies from acquisitions and other transactions and partnerships, and our potential opportunities for future growth.
Each of these forward-looking statements is subject to change based upon various factors, many of which are beyond our control. More information is included in our most recent annual report on Form 10-K and subsequent quarterly reports on Forms 10-Q and in the company’s other filings with the SEC. We have no obligation to provide any updates to these forward-looking statements even if our expectations change. Now I’ll turn the call over to Labcorp Hldgs’ Chairman and CEO, Adam Schechter.
Adam Schechter (Chairman and Chief Executive Officer)
Adam, thank you, Nicola. Good morning, everyone. We appreciate you joining us today to review our third quarter 2026 results. Labcorp Hldgs delivered another strong quarter with 7% revenue growth driven by volume, margin expansion across the enterprise, and 14.5% EPS growth. Our results reflect disciplined execution as we drive continued momentum in Diagnostics and Biopharma Laboratory Services. With these strong results, we are increasing our 2026 guidance.
Before turning to the specifics of the quarter, I want to briefly address PAMA. We are disappointed by the recent announcement on the proposed fee schedule changes related to PAMA, which is expected to reduce Medicare reimbursement rates for hundreds of laboratory tests beginning in 2027. The preliminary fee schedule is not fully representative of the broader commercial laboratory market. The proposed rates rely on data from only 2% of all laboratories paid under Medicare Part B in 2024 and very limited data from physician office laboratories and hospital outreach laboratories.
In our view, these payment cuts will threaten patient access to laboratory services, they will negatively impact patient care and innovation, and they will impact the viability of laboratories across the United States. We previously considered PAMA-related reimbursement pressure in developing our 2026 to 2029 long-term outlook, and we are reaffirming that outlook today. With our strong underlying business momentum, our strong Biopharma Laboratory business, and the business development opportunities before us, along with our LaunchPad initiatives, we remain very positive about the future. Labcorp Hldgs continues to support the RESULTS Act, a solution with strong bipartisan support that will encourage a sustainable and innovative laboratory diagnostic system in the United States.
Now let’s turn to our strong financial performance for the third quarter. Revenue grew 7% to $3.8 billion, AOI margin expanded 60 basis points to 15%, adjusted earnings per share grew 14.5% to $4.78, and free cash flow was $412 million. Moving to our segments, Diagnostic revenue increased 6.5% to $2.9 billion. Biopharma Laboratory Services revenue increased 8.5% to $867 million, driven by continued strength in Central Laboratories. Our BLS book-to-bill was 1.13 in the quarter and 1.10 in the trailing 12 months.
Julia will talk more about our strong results and increased 2026 guidance in just a moment. At our Investor Day, we laid out the next phase of Labcorp Hldgs’ strategy and the priorities we believe will drive attractive growth over the long term, beginning with leading in specialty testing as new therapies emerge, particularly in high-growth specialty areas like oncology, neurology, autoimmune disease, and women’s health. Labcorp Hldgs’ testing solutions are integral for drug development, diagnosis, therapy selection, and ongoing disease monitoring.
Our specialty testing business continues to grow about three times faster than the broader diagnostics market. Importantly, this growth creates a halo effect for our core laboratory business as physicians often order specialty tests alongside other Labcorp Hldgs tests for their patients, driving volume growth across both specialty and core diagnostic testing. During the quarter, we expanded our leadership position across important high-growth specialty areas.
In oncology, we meaningfully advanced precision medicine. We announced FDA approval of a companion diagnostic supporting patients with advanced melanoma. This approval supports treatment decisions for both patients and providers and demonstrates the capabilities of our PGDX platform, strengthening our position in companion diagnostics. This platform can support future companion diagnostic opportunities, and we are seeing increased interest from our biopharma clients.
We also announced a collaborative clinical study with the Knight Cancer Institute at Oregon Health & Science University evaluating Labcorp Hldgs’ Plasma Detect Genome MRD test to detect muscle-invasive bladder cancer recurrence, a significant clinical challenge despite advances in treatment. Moving to neurology, new therapies, blood-based biomarkers, and an increasing understanding of neurodegenerative disease are enabling earlier diagnosis, more informed treatment decisions, and improved patient care. Labcorp Hldgs is a leading presence in the space, and our neurology portfolio spans Alzheimer’s disease, Parkinson’s disease, ALS, multiple sclerosis, epilepsy, stroke, and other neurological conditions. Subsequent to the quarter, we launched an FDA-cleared PTAU 15 test for Alzheimer’s disease available in both primary and specialty care settings.
This launch will help bring Alzheimer’s testing to clinical practices, enabling earlier and more accessible detection. This test will also strengthen our position in one of the fastest growing areas of specialty testing. Beyond our specialty focus areas, we continue to leverage science and innovation to address many important healthcare needs. For example, the Hepatitis B reflex test to support early detection of the most severe form of viral hepatitis. We announced a collaboration with Waters Corporation that positions Labcorp Hldgs as the first commercial laboratory to offer the FDA-approved BD Onclarity HPV assay across in-clinic, patient service center, and at-home self-collected screening options.
Focusing now on the priority of being a partner to health systems and leading partnerships and acquisitions, we expand access to testing capabilities and allow us to bring the benefits of scale, science, and operational excellence to customers. During the quarter, we acquired MLM Medical Labs, expanding our global central laboratory capabilities. This acquisition establishes Labcorp Hldgs as the only central laboratory provider with a wholly owned laboratory network across four continents: North America, Europe, Asia, and Africa.
We also partnered with the National Association of Community Health Centers to strengthen leadership development, support practice improvement, and community health initiatives across the nation’s community health center network. Subsequent to quarter end, we signed three acquisition agreements, each of which is expected to meet our financial criteria of being accretive to adjusted EPS in the first year and returning the cost of capital by year three. The timing of each of these is subject to regulatory approvals and customary closing conditions. These include an agreement to acquire select assets of BioReference Health’s laboratory testing business; an agreement with Myriad Genetics to acquire the prenatal health testing business, which includes the Prequel, Foresight, SneakPeek, and First Gene tests; and an agreement to acquire Millennium Health and a credential laboratory. With more than 15 years of experience in drug testing and surveillance, we continue to have a strong pipeline of partnership and acquisition opportunities that support our long-term growth strategy. We look forward to discussing those with you in the future.
Moving to Personalized Health Solutions, which encompasses both precision medicine and consumer health. In addition to several new companion diagnostics, we also launched solutions that help consumers better understand, manage, and improve their health. In the quarter, Labcorp Hldgs OnDemand launched our Advanced Health Panel and the Marker by Labcorp Hldgs Genetic Health Panel. With over 140 panels and tests across many conditions, we provide insights to consumers to understand their health over time.
We also announced a collaboration with Thrive Global to launch the Thrive 5 health tests on Labcorp Hldgs OnDemand, a test that combines lab results with other health biomarkers to help improve cardiometabolic health. In addition to the results, consumers receive personalized educational content plan. These examples demonstrate the value of Labcorp Hldgs’ lab testing capabilities to deliver more meaningful insights for consumers. Shaping our future through technology and innovation continues to be a focus of our organization. Our advanced technology solutions include the MyLabcorp app, Test Finder, and increased automation in our laboratories using robotics, digital pathology solutions to improve customer experiences, to enhance productivity, and to help transform our business.
In the quarter, our Central Laboratory Services business launched the next generation of Labcorp Hldgs Global Trial Connect, helping pharmaceutical sponsors and investigator sites more effectively navigate growing clinical trial complexity, reinforcing our commitment to delivering differentiated, technology-enabled solutions for our customers. The strength of our technology strategy and continued focus on innovation was recognized by Forbes, which named Labcorp Hldgs to its list of America’s Best Employers for Tech Workers.
With that, I’ll hand it over to Julia to discuss our financials in more detail.
Julia Wang (Executive Vice President & Chief Financial Officer)
Thank you, Adam. Our third quarter results represented strong execution and continued progress against our strategic priorities. Enterprise revenue grew 6.9% versus prior year. Adjusted operating margin expanded 60 basis points, primarily driven by organic revenue growth and operating efficiencies. Adjusted earnings per share grew 14.5% and we generated $412 million in free cash flow. These results demonstrated the earnings leverage in our business as solid organic growth, disciplined execution and productivity improvement translated into margin expansion and double-digit earnings growth.
We remain active in capital deployment with $256 million in acquisitions and $58 million in dividends. We ended the quarter with $262 million in cash and $5.9 billion in total debt as approved by our Board of Directors. We currently have approximately $1.4 billion remaining under our share repurchase program, providing continued flexibility to return capital to shareholders. Moving to more details on the quarter, Enterprise revenue was $3.8 billion, up 6.9% from the third quarter of 2025. Organic revenue growth was 5.5%. Net acquisitions contributed 1.5% of growth, partially offset by foreign currency translation of 0.1%. Adjusted operating income was $570 million or 15% of revenue, compared to $513 million or 14.4% of revenue last year. The adjusted tax rate was 22.9%, in line with last year. We continue to expect our full year adjusted tax rate to be nearly 23%.
Adjusted EPS was $4.78, up 14.5% from last year. Free cash flow was $412 million compared to $281 million last year. The increase was primarily driven by improvement in working capital, partially offset by planned increases in capital expenditures. Our strong cash generation provides continued flexibility to invest in the businesses while maintaining a disciplined approach to capital deployment. Turning to our segments, Diagnostics Laboratories continued to perform well. Revenue was $2.9 billion, up 6.5% compared to the prior year. We delivered organic revenue growth of 4.4%, consisting of 3.1% volume growth and 1.3% favorable price/mix, largely driven by higher tests per session. Acquisitions contributed 2.2% to revenue growth. Diagnostics adjusted operating income was $492 million, or 16.7% of segment revenue, compared to $450 million or 16.3% of revenue last year.
The combination of healthy organic growth and continued operating efficiencies drove 40 basis points of margin expansion in Diagnostics. As Adam mentioned, subsequent to the quarter end, we entered into agreements to acquire select assets of BioReference Health, Myriad Genetics’ Prenatal Health Testing business and Millennium Health. In addition to being strong strategic fits, each of these transactions is expected to meet our acquisition financial criteria of being accretive to adjusted EPS in year one and returning cost of capital by year three. As typical with all of our acquisitions, we expect these transactions to become more accretive over time as we fully integrate.
Related to the BioReference Health transaction, we would expect to generate $250 million of revenue in the first 12 months at adjusted operating margins slightly higher than the Diagnostics segment average, resulting in approximately $0.15 of adjusted EPS including financing costs. We currently expect a mid-year 2027 close, subject to regulatory approvals and customary closing conditions. As it relates to the Myriad Genetics transaction, we expect to add approximately $160 million in revenue and to be slightly accretive to adjusted EPS in year one and to reach average Diagnostics segment margins by end of year two.
Once fully integrated, we currently expect an early 2027 close, subject to regulatory approvals and customary closing conditions. BLS revenue was $867 million, up 8.5% compared to last year. Organic constant currency revenue growth was 9.6%. The strong organic growth was partially offset by the strategic actions in Early Development of 1.2%, and acquisitions offset the impact of foreign currency translation in the BLS segment on an organic constant currency basis. Central Lab Services delivered strong revenue growth of 11.3% and Early Development grew 5%. The strong growth in Central Labs was essentially driven by a healthy underlying demand, while favorable timing related to study starts in the quarter also contributed.
BLS segment adjusted operating income was $159 million or 18.3% of revenue compared to $132 million or 16.5% of revenue last year. Adjusted operating margin expanded 180 basis points, driven by organic growth and operating efficiencies from the strategic actions we have taken in Early Development. Our BLS segment ended the quarter with a backlog of $8.9 billion. We expect approximately $2.8 billion to convert into revenue over the next 12 months. Quarterly book-to-bill was strong at 1.1, translating into a strong trailing 12-month book-to-bill of 1.10. The combination of robust organic growth, significant margin expansion and healthy book-to-bill reinforces our confidence in the trajectory of BLS.
Turning to our full year 2026 guidance, strong year-to-date execution and continued business momentum give us increased confidence in our outlook. As a result, we are raising the midpoint of our 2026 enterprise revenue range and adjusted EPS range by $65 million and $0.18, respectively. The increase in our outlook reflects stronger underlying business performance, partially constrained by approximately $10 million in incremental foreign currency headwind versus our prior guidance.
Enterprise revenue is expected to grow 5.9% to 6.7%, which represents a 50 basis point increase at the midpoint. The guidance includes a 30 basis point benefit from foreign currency translation versus a 40 basis point benefit in our prior guidance. Diagnostics segment revenue is expected to grow 5.5% to 6.2%. This is a 20 basis point increase at the midpoint. We continue to expect the majority to be driven by organic performance. BLS segment revenue is expected to grow 7.4% to 8.4%.
We have raised the midpoint of our BLS revenue guidance, primarily driven by continued strength in Central Labs. The current guidance includes a 130 basis point foreign currency tailwind compared with a 150 basis point tailwind in our prior guidance. For the full year on an organic constant currency basis, we now expect Central Lab revenue to grow in the high single digits and continue to expect Early Development to grow in the low single digits.
We continue to anticipate enterprise margins improvement in fiscal year 2026, driven by both Diagnostics and BLS relative to 2025. At the enterprise level, LaunchPad continues to deliver productivity improvement and remains on track for the $125 million full earnings target. Our adjusted EPS guidance range is $18.30 to $18.70, with an implied growth rate at the midpoint of 12.5%. Our free cash flow guidance range remains $1.24 billion to $1.36 billion. We continue to expect capital expenditures to be nearly 4% of revenue. Our full year guidance assumes foreign exchange rates as of September 30th of 2026. The guidance also reflects our current capital allocation assumptions, including the use of free cash flow for acquisitions, share repurchases and dividends.
As we look towards 2027, based on the preliminary fee schedule proposed by CMS, we estimate the impact of PAMA to be approximately $125 million, and we expect to offset a portion of that impact with our underlying business momentum in Diagnostics, strong biopharma business development opportunities and LaunchPad initiatives. We remain very positive about the prospect of 2027, and we look forward to providing 2027 guidance in February. Now I will turn the call back to Adam for closing remarks.
Adam Schechter (Chairman and Chief Executive Officer)
Thank you, Julia. Let me close with a few takeaways. First, we delivered another excellent quarter with strong revenue growth, margin expansion and double-digit adjusted EPS growth. Second, we are translating the strategy we laid out at Investor Day into execution, strengthening our leadership in specialty testing, expanding strategic partnerships and acquisitions, accelerating personalized health solutions and leveraging technology to improve performance.
And third, as a result of our performance, we are increasing the midpoint of our full year guidance for revenue and EPS and expect to move into 2027 with solid momentum. We are confident in our strategy, we are encouraged by the opportunities ahead of us, and we are well positioned for continued strong performance moving forward. Operator, we will now take questions.
OPERATOR
Thank you. As a reminder, to ask a question, please press star 11 on your telephone and wait for your name to be announced. To withdraw your question, please press star 11 again. In the interest of time, we do ask that you limit yourself to one question. Please stand by while we compile the Q and A roster. And our first question comes from Erin Wright of Morgan Stanley. Your line is open.
Adam Schechter (Chairman and Chief Executive Officer)
Good morning, Erin.
Erin Wright (Analyst)
Good morning. So I have a question about margins and margin into next year and kind of where things land in the context of EMMA, in the 75 to 150 basis points of margin expansion over three years that you laid out at the Investor Day and also moving in sort of the acquisitions that you recently announced, how do you think about that margin cadence, particularly into 2027, can you expand margins next year? And what are some of those moving pieces on that front if PAMA is implemented and obviously those deals close.
Adam Schechter (Chairman and Chief Executive Officer)
Yep, thank you, Erin, for the question. And you know, the good news is we have a lot to talk about here. We have continued strong momentum in our business. If you look at our Diagnostic business and you look at margins, we’ve increased our margins for many quarters in a row now. And we expect, if you put PAMA aside, that we would continue to improve those margins as we move into the future. Obviously, we’ll wait to see what happens with PAMA and the results. Obviously, the year that PAMA is introduced, we’ll do as much as we can to offset PAMA. I think we have four strong levers to do that: the underlying Diagnostic business, the strength in our Biopharma Laboratory business, the LaunchPad initiatives that we’ll continue to push really hard, particularly in a PAMA year, and also the business development opportunities that we’ve announced—and we have others.
So all those things will help offset the impact of PAMA. But obviously the year that PAMA’s implemented will be a tougher year than the other years. It will get easier after the PAMA years. It also depends on the timing of the business development and when we close those deals. We expect each one of them to be accretive in the first year. So they should be helpful in terms of accretion. But it takes a bit of time before the margins get to our average margins. For example, the Myriad deal, which is a great deal, would not have margins reach our average margins until the end of year two. So it would take a little bit of time for the margins to get there.
And it really depends on the exact timing of those deals. For example, for the Myriad deal, we expect it to happen in early 2027, so we’ll provide exact guidance in February of next year. But what I’ll say is we are confident that we’re moving into 2027 with momentum. We reaffirmed our guidance today even after giving what we expect PAMA to be in year one. So it tells you that we’re confident in the margin expansion over time.
Julia Wang (Executive Vice President & Chief Financial Officer)
Hi, good morning, Erin. Maybe to add a bit more color as it relates to margin, we’re very pleased with the progression we have made as an enterprise. Actually, Q3 represented the sixth consecutive quarter of margin progression across the enterprise, inclusive of the two operating segments. The other factor I would share is that when you step back and look at The fundamental drivers of our margin expansion, it really boils down to strong organic growth for both operating segments, particularly in the leading Diagnostic and CLS business. It’s our relentless focus on operating efficiencies through our LaunchPad initiatives. And of course, this year we also benefited from the strategic actions that we have taken in early development. And as Adam also shared just now, when you look at 2027, we really have multiple levers that we can pull, whether through the continued strength in diagnostics or continue the momentum in BLS.
But business development will be another lever in addition to our focus on LaunchPad, which we will be leveraging advanced technology to help us fundamentally drive the cost out of the system in a sustainable way of working. So, all in all, we are looking forward to wrapping up 2026 with strength and going into 2027 with momentum. So stay tuned with more guidance coming in February of 2027.
OPERATOR
Thank you. And our next question comes from Lisa Gill of JPMorgan. Your line is open.
Adam Schechter (Chairman and Chief Executive Officer)
Good morning, Lisa.
Lisa Gill (Analyst)
Good morning, Adam. Good morning, Julia. I want to follow up on those comments on the business development side. Adam, you’ve done four deals here in the last couple of weeks. Can you maybe just talk about what you’re seeing? Current pipeline, number one, we’ve had some concerns from investors about the margin progression for some of these acquisitions because inside of some of the current companies, they’re not accretive. So can you maybe help people to understand?
Is it that you just convert that to the contracts you have with managed care and that’s why you have the visibility around how the margin profile will look for the business development? And then just lastly, anything else you would want to share? As we think about the M&A pipeline as it goes into ’27, is it increasing? Do you see incremental opportunities? Just how do we think about business development?
Adam Schechter (Chairman and Chief Executive Officer)
Sure. Thank you, Lisa. So first of all, the pipeline remains strong. And it’s interesting. I’ve been talking about the strong pipeline for some time now and keep talking about it. When are these deals going to happen? I think this just shows you can’t control the exact timing of deals. But when the pipeline is strong, the deals will come. We have other deals in the pipeline. I’m excited about that pipeline. We expect to have more announcements in the future as we move forward.
The pipeline remains strong. The interesting thing about PAMA, where on the one hand it has a significant impact to us in one year, I think it also increases the pipeline for business development. I think smaller hospital laboratories, regional local laboratories, they’re going to struggle a lot with PAMA and it really does cause them to rethink their business. The second question regarding the individual deals and margin expansion, I would say each of these deals are a little bit different.
MLM is a deal that was for our central laboratory business. It expands our capabilities. It gives us a presence in a part of the world where clinical development is very strong. And it’s a very separate part of our business that’s integrating that deal. If you look at the other three deals, we’ll start with the Myriad deal, which I think is a very good deal for us because it’s in women’s health. It’s an area we know well. It brings new tests to us. The first gene, the prequel, the fourth night, the sleep week. They’re all good women’s health products that we can add to our existing portfolio of products. And, you know, we already have Salesforce. I think that together we can reach more patients, we can improve access, we can bring new tests that we don’t currently have to the patients that need those tests and the physicians that want those tests.
So it’ll actually be a very competitive environment of which we can now compete much more effectively with these tests than before. It will be accretive in the first year. It folds in nicely to a business we know how to run and we’ve done deals with Myriad before. So we know how to work with them and how to integrate. So it’s an exciting opportunity for us. If you look at the Millennium deal, that’s a part of our business, that’s a separate business unit. We do very well in that business. But this increases our presence in parts of the country that we don’t have a presence in or we don’t have a strong presence right now. So it’s a business we know how to run. It’s a business we’ve been involved in for many years. And it just expands our geographic footprint and enables us to be more competitive, improve access to parts of the country that we don’t have as much access to as of today.
And if you look at the BioReference deal, we’ve done two deals with them already. We know how to work with them very well. We’ve worked with them on integration, so we know how to integrate with them very well. They have presence in parts of the country that we’re not as strong in. So it increases our relevance in parts of the country where we want to increase our presence, increases access, and we know how to work with them to integrate the business well into our existing business.
So the timings, we tried to give you a sense of what those timings were: Myriad, early 2027; BioReference, mid 2027; Millennium, later this year. And then based upon the timing, we would expect that margins would be accretive to earnings in the first year. Margins would improve over time.
OPERATOR
Thank you. And our next question comes from Ann Hynes at Mizuho. Your line is open.
Adam Schechter (Chairman and Chief Executive Officer)
Morning, Anne.
Ann Hynes (Analyst)
Good morning. Thank you. Staying on that women’s health topic, I know we’ve seen some meaningful changes in cardiovascular screening recommendations from the AHA and the American College of Cardiology. I think in March they expanded testing for high certain risk patients. But yesterday they really expanded recommendations for women’s cardiovascular health. When major organizations like this do change the recommendations, how should we think about the potential impact for you?
Do physicians typically change their ordering patterns quickly? Is there like a lag time and adoption time? And just from an insurance perspective, some of these tests aren’t covered. Do they usually start covering them because of these organizations’ recommendations?
Adam Schechter (Chairman and Chief Executive Officer)
Yeah, no, thank you, Ann. I think women’s cardiovascular health has been something that I’ve personally been focused on for a long time and I’m glad to see that it’s now being focused on by these additional societies and so forth. It’s an underdiagnosed disease, particularly in women. It goes undiagnosed in the way in which it presents itself, cardiovascular disease. And I think there’s a lot more that we can do to enhance the cardiovascular health of women.
So it’s nice to see that the societies will move in that direction. I would say many physicians have already moved in that direction, have already begun to screen women for cardiovascular. They teach women how cardiovascular disease presents very differently at times in women versus men. And I think that we’ve seen a movement to actually improve cardiovascular health in women already separate and distinct from that. When societies provide recommendations, I do think it’s a way for us to reinforce with payers who are paying for those tests. I do believe that physicians will tend to prescribe more of those tests faster when they become a core recommendation of a very strong society or group of highly thought-of physicians and thought leaders.
So I do think it’s helpful. Although when you do 750 million tests per year, it’s hard to kind of pull out any type of change like this. I do think that it’s for the benefit of women. I do think it will help us over time.
OPERATOR
Thank you. And our next question comes from Eric Caldwell Baird. Your line is open.
Adam Schechter (Chairman and Chief Executive Officer)
Good morning, Eric.
Eric Caldwell Baird (Analyst at Baird)
Good morning. And congrats on really nice results and outlook. I’m probably going to deliver my worst question of the quarter here because a lot. So we actually like your deals. You’ve been very clear about the capital deployment. But I have been particularly concerned about the BioReference, the BRL deal because we do have their financials, we know the revenue that you expect. I think we have a reasonable estimate on cost of capital, etc., etc. And it was very hard for me to initially come up with year one accretion on that deal, particularly when the first quarters are typically, you know, well below what your exit rate is post synergy.
So help me figure out what I’m missing here. You know, is there like a tax benefit driving that 15 cents of accretion? Because, you know, at face value, rough scratch pad on the math, it looks like you’re actually guiding to a year one operating margin of something like 22 or 23% to get to 15 cents of accretion. And I’m just, you know, tell me, tell me what I’m missing on this because that’s, quite frankly, a lot better than I expected.
Adam Schechter (Chairman and Chief Executive Officer)
Yeah. So, you know, once again, BRL is a company that we’ve worked with, we’ve done two deals with. So we understand their systems, we understand their cost structure, we understand the way in which they do business very well. And when we looked at the business, they’re in geographies where we think we can increase access, we can bring our testing capabilities more broadly. And they’re in areas where, frankly, we’re not as strong and where they were strong overall.
When we gave the revenue estimate, we’ve included the impact from PAMA that could be in there. We’ve included some other things in terms of where the revenue we expect to be in the first year versus what they might have reported before. But we also have a very good handle on what their cost structure is and what that would look like in our hands versus in their hands. I don’t know, Julie, if there’s anything you would add to that.
Julia Wang (Executive Vice President & Chief Financial Officer)
Yeah, I think—
Eric Caldwell Baird (Analyst at Baird)
Hey, just— Julie, I appreciate any comments you make. I guess I just want to, like— I think if I remember they have something like 80 service centers. Are you planning to just do, like, big consolidations here, drive all of their volume to your lab in the area? I’m just— anything you could help us with on the synergy path and the cost path would be helpful to assuage the concerns that at least I had.
Adam Schechter (Chairman and Chief Executive Officer)
So over time, when it comes to the service centers, where there’s overlap, we’ll decide which service center is best to keep. So it could be that we close down some Labcorp service centers, could be that we close down some BRL. But where there’s overlap, we would look, obviously, to have synergies. We also will be able to look at the capacity in their laboratory, the capacity we have in our Raritan laboratory, both of which are close to each other, and where we were going to expand because of our business development growth opportunities, we might not have to expand in areas that we had before.
Or we’ll look to say, are there synergies there as well? So it could be a reduction of the expansion that we were planning based upon the number of deals that we’ve done in this part of the country. So I think that you’ll find synergies across the business, Eric. But in addition to that, I just believe when contracting and stuff like that, there’s always things that are helpful.
Julia Wang (Executive Vice President & Chief Financial Officer)
Yeah. Good morning, Eric. I think Adam has covered the ground. I think the only thing I would say is that, as Adam already said, because we have had this long-term partnership with BioReference with two prior acquisitions already having been successfully integrated and demonstrated our ability to really deliver against our expectation as it relates to return on investment, we are feeling very comfortable with the outlook that we put out there as it relates to the first year contribution.
And actually if you step back, look
Adam Schechter (Chairman and Chief Executive Officer)
At the few transactions we’ve just announced subsequent to the quarter end, they are all tuck-in in nature whereby we have a very perfect track record of successfully integrating them into our extensive operating scale and infrastructure and then being able to really drive synergistic value through both growing the top line and also optimizing the cost structure. So we look forward to updating you as we continue to make progress. But we are confident of our ability to really continue to drive acquisitions to contribute 1.5% to 2.5% revenue growth to our overall growth trajectory, but also continue to drive more accretion over time as we fully integrate those transactions.
And the last thing I would say, Eric, is when you look at our procurement capabilities, you look at our costs based upon the scale of what we do, all that comes into play and is helpful as well. Thank you.
Eric Caldwell Baird (Analyst at Baird)
Thank you very much, guys. Great job with the quarter.
Adam Schechter (Chairman and Chief Executive Officer)
Thank you. Thank you.
OPERATOR
Our next question comes from Michael Cherney of Leerink Partners. Your line is open.
Adam Schechter (Chairman and Chief Executive Officer)
Good morning, Michael.
Michael Cherney (Analyst)
Good morning, Adam. Thank you so much for the question. One is quick housekeeping, and one additional question. First, just on the change in revenue guidance, can you remind us how much is from M&A in terms of what’s built into the update for the year and then relative to PAMA? Adam, I think we all hear you completely on your view on the RESULTS Act and the logic behind it. That being said, it is a tough environment in D.C. Can you give us a flavor as you think about the offsets for ’27, what the organization is starting to do now to prepare for that?
Julia Wang (Executive Vice President & Chief Financial Officer)
Yeah. Good morning, Michael. Let me start addressing the questions related to the guidance you raised. I would say that the raise is driven by strength in the organic performance of our businesses. So if I break it down segment by segment, starting with BLS, we raised the midpoint of our guidance by 190 basis points, $59 million on an absolute basis. And in addition to strength in organic performance, particularly in CLS, we also shared in the release that we have about 10 basis points of FX headwind when you look at this guidance versus prior guidance.
And that FX impact was actually offset by expected contribution from the MLM acquisition that we closed in September. And then if you were to move to the Diagnostics segment, we raised the midpoint of our guidance by 20 basis points and $22 million on an absolute basis. I would say there’s a little bit of expectation about potential revenue contribution from the Millennium Health acquisition, which we expect to close later in this year, but it’s very minimal in the scheme of things. I would really consider that as immaterial.
So, in short, we are raising the midpoint of our guidance for the full year from a revenue perspective by 50 basis points, $65 million. And if you neutralize FX, it would be a raise of 60 basis points and $75 million. All driven by strength in the organic performance of our business.
Adam Schechter (Chairman and Chief Executive Officer)
And then regarding PAMA, obviously we remain disappointed by the recent announcement, but in our base case, we’re going to assume that PAMA happens next year, that there’s $125 million impact from the traditional Medicare and Medicaid segment. We’re still cautiously optimistic about RESULTS. We’ll still continue to fight for that. We’ll fight for delay if RESULTS doesn’t get passed this year. But in our base case, we want to assume that it does happen next year.
So if you look at the four things that we’re doing to offset it, one is the underlying Diagnostics business is strong and we will continue to focus on it. The volume looks good. Our strength is there. So the underlying business, we expect to remain strong. The second thing is our BLS business continues to remain strong, and we’re going to continue to focus on that to grow that business. The book-to-bill looks great. So that’s another way to offset part of it.
Our LaunchPad initiatives, we’re accelerating and we’re already focused on that. We have things underway that we’re putting in place in fourth quarter, prepared for first quarter. We’ll give you the exact amount you saw at Investor Day. We raised our expectation of what we expect for LaunchPad from prior guidance. So it’s meaningfully higher now than it has been in the past, and we’re accelerating our efforts as we speak today. And then the fourth thing is the business development, which you’ve seen us announce four business development things, and there’s more to come. We’re continuing to have a very strong pipeline. There’s a lot we can do there. You can’t accelerate those per se, but we continue to focus on those other opportunities. And I would expect that there’s more to come in the not too distant future.
Michael Cherney (Analyst)
Thank you.
OPERATOR
And our next question comes from Luke Surgot of Barclays. Your line is open.
Adam Schechter (Chairman and Chief Executive Officer)
Good morning, Luke.
Luke Surgot (Analyst)
Good morning. I just want to talk on the pharma services and the demand that you guys are seeing. You had really strong pickup there in bookings. I understand it’s a little bit easier comp, but really nice acceleration. And so your conversion is also kind of picking up as well. Can you just walk through the dynamics where you’re seeing the demand? Is it any particular indication or therapy? And just give us an overlay of how that visibility into that continuing through the beginning of next year?
Adam Schechter (Chairman and Chief Executive Officer)
Yeah. So if you look at central laboratory business in particular, it’s very strong growth. And in the quarter the growth was driven by healthy underlying demand. We also had some favorable timing related to study starts in the quarter. But it’s mostly the underlying demand. As you look to the book-to-bill, as you said, it is strong. And I would say that it’s strong in both our central laboratory business, but also in our early development business.
In our central laboratory business, it’s driven by— and it’s driven by not only oncology and specialty areas where we’ve seen growth in the past, but we are seeing an increase in cardiometabolic areas. And when you look at the GLP-1s and a number of different trials and types of trials, we are seeing some opportunities in that area as well. When it comes to early development, we’re seeing that the funding environment looks pretty good. It’s driven by smaller biotechnology companies.
But we are trying to change that a bit by getting more large pharma business in that area, and we are beginning to see some early signs of success in doing that. In summary, both businesses are doing well. The business is driven by central laboratories. Central laboratories’ book-to-bill looks really strong. Specialty areas, particularly in oncology, continue to grow, but we are also seeing more growth in areas like cardiometabolic.
Luke Surgot (Analyst)
And then a follow-up on that. The demand continues to pick up. Can you talk about what you’re seeing from a capacity expansion in the industry? How tight is that getting? And then obviously it would go well from a price perspective as we think about the out years.
Adam Schechter (Chairman and Chief Executive Officer)
Yeah. So as I look at our capacity, we continue to have plenty of capacity. So we have a very large footprint. We have central laboratories now in four continents as wholly owned subsidiaries. But we also have access to other parts of the world and we’re increasing our access in other parts of the world, like, for example, Latin America. So our geographic presence, our ability to have these large laboratories gives us capacity for even more growth as we go into the future.
So I’m not concerned about our ability to take on new business. In fact, we’re looking for as much new business as we can get moving forward.
Luke Surgot (Analyst)
Great, thank you.
Julia Wang (Executive Vice President & Chief Financial Officer)
Earlier we shared that we are in the process of building a state-of-the-art lab facility in Indianapolis. Actually, that is in response to anticipated continued strong momentum growth, particularly for the CLS business. So we’re in the middle of that engagement right now, and that is reflected in our capital expenditure for this year and next couple of years.
Luke Surgot (Analyst)
Great. Thank you.
Adam Schechter (Chairman and Chief Executive Officer)
Thank you.
OPERATOR
Our next question comes from Tycho Petersen of Jefferies. Your line is open.
Adam Schechter (Chairman and Chief Executive Officer)
Good morning, Tycho.
Tycho Petersen (Analyst)
Good morning, Adam. I want to follow up on the Myriad deal. You are buying the assets after the management team talked about a 60% revenue decline, share loss, and payer friction. And that was all before the CLFS rate proposal, which is an additional drag on revenue. So why is now the right time to do that deal? And why are you the right partner to turn around that business?
Adam Schechter (Chairman and Chief Executive Officer)
Yeah, no, great question, Tycho. We feel very comfortable and confident in taking over that business. In fact, it’s a very strong business for us today. But they have, in particular, the FirstGene test, which we think has tremendous opportunity. So it’s newly launched. It’s an innovative single-gene NIPT solution. It screens for chromosomal conditions, select single gene disorders, maternal carrier status and RHC compatibility. So it’s going to compete really well in the fastest-growing part of the segment where we don’t necessarily compete today.
So taking our strong existing tests and infrastructure and relationship with customers and our scale, now combining it in particular with this new test, which will compete in a very competitive part of the market, I think bodes well for us to be the right group to launch that and also the right time to launch it because that market is still being defined and we think we can be a winner ultimately.
Tycho Petersen (Analyst)
Okay, that’s helpful. And then one quick follow-up on BLS. Appreciate all the momentum and strength you’re seeing, especially on the pharma side. I guess as we think about biotech funding getting a little softer here, how do you think about the impact there on early development?
Adam Schechter (Chairman and Chief Executive Officer)
Yes, again, the early development business, much smaller, much less important part of our business, but it is performing well right now. We’ve made some good strategic moves. We’re seeing our RFPs strong there. The study starts are strong there. We’re trying to kind of switch more of our load to larger pharma, and we’re seeing some early signs of success. So I feel good about where we are today.
Tycho Petersen (Analyst)
Okay, thank you.
Adam Schechter (Chairman and Chief Executive Officer)
Thank you.
OPERATOR
And our next question comes from David Westenberg of Piper Sandler. Your line is open.
Adam Schechter (Chairman and Chief Executive Officer)
Good morning, David.
David Westenberg (Analyst)
Good morning, Adam and Julia. I asked a question about PAMA. I prepared for a bunch of questions on Myriad and FirstGene and all that, but it seems to be a lot of acquisition, so I’m going to pivot to PAMA. I’m sorry the question is bad because I was prepared for something else. But I want to talk about PAMA from kind of a multi-year perspective. We know the worst part is obviously in year one, which is being 2027. A number of tests are above that 15%, which kind of suggests there could be some headwinds in ’28 and ’29.
Can you talk about the strategies both from a Labcorp Hldgs perspective and kind of how you anticipate industry might change and the way they’re thinking about contracting or dissident or any other approach that the industry and Labcorp Hldgs again is going to take to maybe think about if indeed PAMA is the law of the land, how the industry might evolve and you evolve in terms of discipline and all that kind of thing?
Adam Schechter (Chairman and Chief Executive Officer)
Yeah, no, thank you for the question. And the majority of the impact is in 2027, the first year. Again, that assumes that PAMA actually happens, which is the base case. But we’re still cautiously optimistic about RESULTS and/or delay. There are incremental impacts in ’28 and ’29, but they are meaningfully less than what ’27 would be. And I believe they’re manageable and they’re within what we should be able to manage in our kind of ongoing running of the business.
As I think about over time, we continue to decouple other parts of our contract from referring to the fetal and will continue to do that. But I feel like 2027 will be the biggest impact that we can manage through the outer years.
OPERATOR
Thank you. And our next question comes from Luli of Bank of America. Your line is open.
Adam Schechter (Chairman and Chief Executive Officer)
Good morning, Luli, how are you? Yeah, so if you look at the diagnostic business, it was very strong. We had 6.5% growth over last year. The organic growth was 4.4%; 2.2% came from acquisitions. If you look at the organic growth, 3.1% was organic volume growth, which was very strong, and that’s what we would like to see. Organic price/mix growth was 1.3% and it’s driven by what we want it to be driven by, which is an increase per accession. And we expect tests per accession to continue to increase as we go over time. If you look at any one quarter, I wouldn’t look at any trend. You are going to see fluctuations between organic volume and organic price/mix quarter over quarter. But over time we expect them both to be strong.
Julia Wang (Executive Vice President & Chief Financial Officer)
Yeah. And maybe a little bit more considerations. If you look at esoteric revenue as a percentage of our total diagnostic revenue, it was about 38% in the first quarter of 2024 and in the third quarter it went up to 42%. So clearly you can see the strength of our strategy and execution. And when you look at the guidance for diagnostics at the midpoint, the revenue growth was 5.9%. And we continue to expect the majority to be coming from organic performance.
And within that, we expect the volume growth to slightly outpace price/mix variability. Thank you.
OPERATOR
Our next question comes from Kevin Kaliando of UBS. Your line is open.
Kevin Kaliando (Analyst at UBS)
Morning, Kevin. Good morning, Adam. Good morning, Julia. Thanks for getting in. Really happy about all the color on the deals that you had. It’s interesting to me that there really hasn’t been a traditional hospital deal announced. And just wondering if this is more your own preference around what’s happening in the marketplace and where the opportunity lies or is it just the availability of assets that are out there or is it just simply people are waiting on PAMA and want to know what the rules are going to be and what the economics look like.
Adam Schechter (Chairman and Chief Executive Officer)
Stay tuned. Again, you can’t control the timing of deals. The pipeline looks strong. The pipeline looks strong for hospital deals, partnerships, local regional laboratories. They’re just timing things. So I would say that the deal pipeline continues to be strong. I do think if PAMA comes, it could get even stronger. But stay tuned. And there’s a lot that we’re working on. It’s a strong pipeline.
Kevin Kaliando (Analyst at UBS)
Appreciate that. Thank you.
OPERATOR
Thank you. And our next question comes from Elizabeth Anderson of Evercore ISI. Your line is open.
Adam Schechter (Chairman and Chief Executive Officer)
Good morning, Elizabeth.
Elizabeth Anderson (Analyst)
Hi, good morning. Thanks so much for the question, Adam and Julia, maybe a two-parter. Just any updates in your assumptions around the ACA impact on the business? And then two, any reasons why we wouldn’t continue to see the traditional 4.2 seasonal step up in BLS? Even some of the things you highlighted in one of the earlier questions. Thank you.
Julia Wang (Executive Vice President & Chief Financial Officer)
Hi, good morning, Elizabeth. In terms of the ACA impact, it was a slight headwind of about 30 basis points of diagnostic volume in the third quarter, which was essentially in line with the second quarter. And we continue to expect a similar level of impact in the fourth quarter. Of course, we’ve already incorporated this into the update that we just provided this morning. It’s also important to note that this particular insured population accounts for a very small percentage of our overall diagnostic volume. It’s less than 4 to 5% overall.
And then in terms of the cadence for the BLS business, I would say that if you look at the release we just shared this morning, we have raised the midpoint of our guidance to a degree. At this moment we expect, on an organic constant currency basis, the CLS business to grow high single digits and then the ED business to continue to grow in low single digits. So based on the strength and the momentum, we feel good about that guidance and we look forward to continue to march forward to deliver against that expectation.
Elizabeth Anderson (Analyst)
Yeah, that made sense. And that would continue in bookings too. I’m sorry if my question was unclear.
Adam Schechter (Chairman and Chief Executive Officer)
Again, we expect continued strength in bookings, but quarter over quarter does vary quite a bit. Sometimes things get moved into the quarter, things get moved out of the quarter. And especially with Pharma at the end of fourth quarter, you never know what Pharma will be thinking. So the underlying book-to-bill we expect to remain very strong, very fair.
Elizabeth Anderson (Analyst)
Thank you.
OPERATOR
Thank you. And our next question comes from Jack Meehan of Operon Research. Your line is open.
Adam Schechter (Chairman and Chief Executive Officer)
Good morning, Jack.
Jack Meehan (Analyst)
Good morning, Adam. Good morning, Julia. Thanks for squeezing me in. Adam, I was wondering, just on the topic of PAMA, can you remind me the actions that you’ve taken to disconnect the non-Medicare business from the fee schedule and just wanted to confirm the $125 million estimate. Does that assume any bleed-through to other payers? How are you handling that?
Adam Schechter (Chairman and Chief Executive Officer)
Yeah, no. Thank you, Jack. So the $125 million is a traditional Medicare Medicaid. You know we’ve done a lot to try to decouple that over time and we’re going to continue to work on that. But the additional impact to me are things that you just manage within your day-to-day business and that’s what we would expect to do. And you always have some pushes and pulls that you work on. So the $125 million is the traditional Medicare Medicaid. There is some spillover into other parts of the business. We’re going to manage that as we would manage other parts of our business.
Jack Meehan (Analyst)
Excellent. If I can squeeze in one more, any updates on your progress toward launching the MRD test and have you chosen which sequencer you’re planning to launch that on? Thank you.
Adam Schechter (Chairman and Chief Executive Officer)
So we are continuing to make progress on the MRD test. In fact, we just announced a collaboration with Knight Cancer Institute of Oregon Health System, and that was a clinical study that’s evaluating Plasma Detect Genome Ultra, and it’s really looking at recurrence for patients with muscle-invasive bladder cancer. So we’re continuing to look across the portfolio of MRD opportunities. This is just another example of us building data in order to support reimbursement over time. I remain very excited about our portfolio of products, and to my knowledge, I don’t believe we’ve finalized working with any one machine yet at this point in time.
Jack Meehan (Analyst)
Appreciate it. Thanks, Adam.
Adam Schechter (Chairman and Chief Executive Officer)
Thank you.
OPERATOR
This concludes our question and answer session and also today’s conference call. Thank you for participating. And you may now disconnect.
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