Fresenius Medical Care's Q3 2025 Earnings Call: Contradictions in Patient Inflow, Medicare Enrollment, and Pharma Guidance

Date of Call: November 4, 2025

Financials Results

• Revenue: Organic revenue growth 10% (constant currency +8%); divestitures negatively impacted revenue by ~60 bps
• Operating Margin: Group operating income margin 11.7%, expanded from 9.9% (step change in profitability; operating income growth +28% in Q3)

Guidance:

• Reiterate full-year 2025 operating income guidance and expect further Q4 acceleration and margin expansion
• Expect 2025 revenue at the very top end of low single-digit growth (driven partly by Value-Based Care revenue recognition)
• FME25+ savings now expected to total ~EUR 220m for 2025 (upgrade of ~EUR 40m)
• Phosphate binder contribution now expected ~EUR 180m in 2025 (vs prior assumption EUR 100m)
• 2026 outlook to be provided with full-year results in February

Business Commentary:

* Revenue and Profitability Growth: - Fresenius Medical Care AG reported organic revenue growth of 10% for Q3 2025, with an operating income growth of 28%. - The significant revenue and profitability improvements were driven by strong contributions from all three operating segments, including Care Delivery, Value-Based Care, and Care Enablement.

• Phosphate Binder Impact and Share Buyback:
• Phosphate binder sales contributed significantly to Fresenius's performance, with an estimated full-year benefit of EUR 180 million, surpassing the original guide of EUR 100 million.

• The company announced an initial share buyback of EUR 1 billion, with 4.35 million shares repurchased by the end of September 2025.

• High-Volume HDF Therapy Rollout:

• Fresenius is launching high-volume HDF therapy in select U.S. clinics, with positive feedback from nephrologists and patients.

• The rollout of this advanced therapy is expected to become a new standard of care, enhancing patient outcomes and clinical efficiency.

• Challenges and Strategic Focus:

• The company is navigating a U.S. government shutdown and uncertain healthcare policy decisions, which require agile business planning.
• Fresenius is focused on advancing its FME Reignite strategy to drive long-term growth and innovation across its operations, particularly in care delivery and innovation.

Sentiment Analysis:

Overall Tone: Positive

• Management highlighted 'strong third quarter results' with organic revenue growth of 10% and operating income growth of 28%; group margin expanded from 9.9% to 11.7%. Company announced a EUR 1bn buyback program (EUR 188m repurchased through Oct 31) and upgraded FME25+ and phosphate-binder contributions, and reiterated full-year guidance.

Q&A:

• Question from Oliver Metzger (ODDO BHF): Do you see the stronger Q4 progression coming from Care Enablement or Value-Based Care, and on treatment adherence — will normalization occur as COVID-era patients pass away or are there other drivers of elevated missed treatments?
  Response: Management expects continuous improvement across all segments with Care Delivery providing strong support; missed treatments are improving through quality initiatives, mortality remains elevated, and COVID-era patients historically had higher missed-treatment rates.

• Question from Veronika Dubajova (Citigroup): Can you confirm phosphate binders are now expected to deliver EUR 180m this year vs EUR 100m previously, and if you strip out that benefit is there much underlying margin improvement? Also, how do you view Medicare Advantage mix heading into 2026 amid signs of reduced enrollment?
  Response: Phosphate binders are now expected to contribute ~EUR 180m in 2025 (vs EUR 100m prior); pharma strength drove the upside; underlying negatives (softer volumes, FX, medical costs) are being offset by binders and FME25+; Medicare Advantage mix/enrollment is steady today and not expected to be a near-term headwind.

• Question from Hassan Al-Wakeel (Barclays): Why is the EBIT guidance range wide and why is the bottom end not more likely? What was the phosphate-binder benefit in Q3? And how are admissions/missed treatments trending into Q4 and the confidence around returning to 2%+ treatment growth?
  Response: The EBIT range remains wide due to variable levers (FME25+ execution, FX, timing); phosphate binders contributed a mid-double-digit million amount in Q3 and a similar contribution is expected in Q4; admissions and missed treatments are improving, mortality is still elevated but normalization would support returning to ~2%+ treatment growth.

• Question from Hugo Solvet (BNP Paribas): What is driving the FME25+ upside (e.g., production moves) and can you share the number of clinics running HVHDF and whether early learnings change the 2026 rollout plan?
  Response: FME25+ momentum is broad-based across Care Enablement, global functions and Care Delivery supporting the ~EUR 40m upgrade; HVHDF rollout is in very few clinics (added two more last week), early learnings are positive and the company remains on track with its 2026 rollout plan.

• Question from Graham Doyle (UBS): Given phosphate binders lapping next year, how confident are you to generate volume growth (which drives operating leverage) versus relying on binders and cost savings? When will HDF meaningfully affect U.S. treatment counts?
  Response: Management says growth will rely on a mix of recovering volumes, pricing/mix, operating efficiencies and HDF ramp; HDF patient benefits appear after ~3 months on therapy, so measurable effects should begin as rollout scales in 2026 but full impact comes later.

• Question from David Adlington (JPMorgan): Will you quantify the EBIT impact if ACA exchange subsidies aren't extended (as peers have done) and were Q3 volumes affected by sales-day mix that would reverse in Q4?
  Response: No quantitative estimate was provided on subsidy risk while 2026 planning is ongoing; Q3 same-market treatment growth (0.1%) is reported like-for-like (normalized for days).

• Question from Anna Ractliffe (BofA Securities): Could HVHDF positively impact U.S. same-market growth via referrals as soon as next year, and can you quantify the Care Delivery growth split between rate/mix and reduced implicit price concessions and how those trends look into Q4?
  Response: HDF is expected to improve referrals and contribute to growth during the 2026 ramp; revenue-cycle improvements (rate/mix and fewer implicit price concessions) increased Q3 revenue yield and are expected to remain a positive into Q4.

Contradiction Point 1

Patient Inflow and Mortality Impact

It directly impacts the company's outlook for patient inflows and treatment growth, which are critical for revenue and operational planning.

Will treatment adherence normalize over time due to patient deaths or other factors? - Oliver Metzger (ODDO BHF Corporate & Markets)

2025Q3: I would say that mortality is still elevated. We are seeing improvements in missed treatments, but I wouldn't say that it is because we are seeing a normalization in mortality levels. We see it more because we have better alignment between our patient, our physician, our clinician. - Helen Giza(CEO)

What is driving patient inflow, and can growth exceed 2% by 2026? - Veronika Dubajova (Citigroup Inc.)

2025Q2: If mortality normalizes, the 2%+ growth assumption remains, though the rate of growth will depend on how mortality evolves in 2026. - Helen Giza(CEO)

Contradiction Point 2

Medicare Advantage Enrollment Trends

It involves differing perspectives on the impact of Medicare Advantage enrollment trends on the company's business, which is crucial for revenue projections and market positioning.

Can you confirm the phosphate binder benefit expected this year? How will Medicare Advantage trends impact your business? - Veronika Dubajova (Citigroup Inc.)

2025Q3: We are optimistic about steady Medicare Advantage enrollment despite some payer changes, as the mix remains consistent and enrollment numbers are stable. - Helen Giza(CEO)

What trends are you observing in U.S. trading in April? How does this support your confidence in maintaining full-year guidance of 50 bps or more growth? Did phosphate binders contribute to Q1 results, and do you still expect €50M–€100M operating income benefit for the year? - Victoria Lambert (Berenberg)

2025Q1: We are increasing our overall U.S. same-market treatment growth forecast to approximately 1% for 2025. - Martin Fischer(CFO)

Contradiction Point 3

Market Growth Expectations

It involves differences in the company's expectations for market growth and mortality normalization, which are critical for forecasting future performance and investor expectations.

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2025Q3: We are concluding that trend is improving gradually. We have made significant progress in the U.S. with the new payment model. But we all agree there is still a ways to go. - Helen Giza(CEO)

What are your expectations for 2025 segment margins, particularly incremental improvements versus Care Enablement's remaining growth potential? What is the expected market growth and timeline for market share recovery in 2025? - Hassan Al-Wakeel (Barclays)

2024Q4: Market growth is expected to ramp up throughout the year, moving from 0.5% growth in Q4, with a view to 2% growth in 2026 as mortality normalizes. - Helen Giza(CEO)

Contradiction Point 4

Phosphate Binder Benefit Expectations

It involves changes in financial forecasts, specifically regarding the expected benefit from phosphate binders, which are a significant contributor to the company's pharma business.

Can you confirm the expected phosphate binder benefit this year? How do Medicare Advantage trends impact your business? - Veronika Dubajova (Citigroup Inc.)

2025Q3: The phosphate binder benefit is now expected to be EUR 180 million for the year. - Helen Giza(CEO)

What are your April U.S. trading trends so far? How does this support the full-year guidance of 50 bps or more growth? What were phosphate binders' Q1 results, and do you still anticipate the €50 million to €100 million operating income benefit for the full year? - Victoria Lambert (Berenberg)

2025Q1: We expect a full fiscal year effect of approximately EUR 50 million to 100 million. - Martin Fischer(CFO)