Integra LifeSciences Q3 2023 Earnings Call Transcript

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Provided by Quartr
October 25, 2023

There are 13 speakers on the call.

Operator

Good day, and thank you for standing by. Welcome to the Integra Life Sciences Third Quarter 2023 Financial Results Conference Call. At this time, all participants are in a listen only mode. After the speakers' presentation, there will be a question and answer session. Please be advised that today's conference is being recorded.

Operator

I would now like to introduce your host for today's call, Chris Ward, Senior Director of Investor Relations. Please go ahead.

Speaker 1

Thank you, Justin. Good morning and thank you for joining the Integra Life Sciences' 3rd quarter 2023 earnings conference call. Joining me on the call are John DeWitt, President and Chief Executive Officer and Bighan Knight, Chief Financial Officer. This This morning, we issued a press release announcing our Q3 2023 financial results. The release and corresponding earnings presentation, which we will reference during the call, are available in integralife.com under Investor Events and Presentations in a file named 3rd quarter 2023 presentation.

Speaker 1

Before we begin, I would like to remind you that many of the statements made during this call may be considered forward looking statements. Factors that could cause actual results to differ materially are discussed in the company's Exchange Act filed with the SEC and in the release. Also in our prepared remarks, we will reference reported and organic revenue growth and organic revenue growth excluding Boston. Organic revenue growth excludes the effects of foreign currency, acquisitions, divestitures, as well as discontinued products. Organic revenue growth excluding Boston also excludes the revenues from products manufactured in our Boston facility in both periods.

Speaker 1

Management believes that excluding revenues from all products manufactured at the Fosten plant provides useful information when evaluating the company's organic growth because of the unusual nature of the manufacturing stoppage and voluntary global recall. Unless otherwise stated, all disaggregated and franchiselvelrevenuegrowth Reconciliations of any non GAAP financial measures can be found in today's press release, which is an exhibit to Integra's current report on Form 8 ks filed today with the SEC. And with that, I will now turn

Speaker 2

the call over to Jan. Thank you, Chris, and good morning, everyone. I want to begin our remarks today with an update on our progress on the quality system remediation at our Boston manufacturing facility Now return to market plans for Surgivant, Primatrix and our private label products. We recognize this remains So before going into the broader business updates, let's turn to Slide 4. As a reminder, during our last call, we told you we expected to resume manufacturing by the end of Q4 this year.

Speaker 2

It also highlighted that a final external audit of the updated quality system would be conducted in the Q1 2024 with results submitted to the FDA by the end of March 2024. This then paves the way for the resumption of commercial distribution in the mid to late Q2 of 2024. For the past 4 months, we have worked diligently on the remediation of our quality system in BOSS, consistent with the holistic plan we built in alignment with FDA expectations. We've bolstered our Boston operations leadership, Quality expertise, project management capabilities and capacity with internal resources and we further engaged external subject matter experts as well. We recently completed several interim external reviews that confirm the adequacy of the changes we are making.

Speaker 2

So I'm pleased to report that as a result of all this progress, we remain on schedule with the restart timelines we communicated last quarter. Also want to provide insight into a couple of critical milestones along the way. We have plans for an external review shortly after we restart the factory. This review will be in addition to and in preparation for the independent audit we intend to submit to the FDA before the end of March. These activities will then clear the way for us to build sufficient inventory ahead of our relaunch into the market.

Speaker 2

In the meantime, we have also been working closely with our customers to manage through the recall and have now substantially assessed and reconciled our customers' inventory. Our Tissue Technologies sales team is also Working closely with our customers to facilitate product substitutions in about 10% to 15% of cases, on track with our expectations. And finally, our manufacturing and clinical progress keeps us in line for PMA approval for Surgimens in the first half of twenty twenty five. The right side of the slide shows the updated financial impact. Financial results for the Q3 bore the effect of $7,000,000 of returns, which Lia will discuss in more detail.

Speaker 2

In addition to the lost sales for the Q3 we previously communicated. The additional returns impact, albeit isolated to the 3rd quarter only, has impacted our revenues by $7,000,000 Adjusted gross margin by 60 basis points and adjusted earnings per share by 0 point 0 $7 In summary, we're making significant headway towards completing the necessary remediation requirements in Boston to bring This critical technology is back to the market for our customers and their patients and we are on track with our communicated timelines. With that, let's move to Slide 5 for some overall 3rd quarter business highlights. And starting on the right side of this page. Our 3rd quarter revenues were $382,400,000 and decreased by 0.4% on an organic basis.

Speaker 2

These results reflect the Boston impact including the $7,000,000 return reserve increase, which offset otherwise strong organic growth performance. Our top line performance was below our guidance for the quarter. And I realize this will be frustrating for our investors, but We are making things right with our customers and we're taking the necessary steps to get through this period as quickly as possible to position Our business for long term sustainable growth again. Our end markets for both CSS and Tissue Technologies remain strong and continue to grow in line with the expectations we outlined during our May Investor Day. In the Q3, we saw strong demand for our unique technologies Excluding the Boston impact, we delivered organic growth of 7.1% at the high end of our LRP range.

Speaker 2

In our CSS business, we saw organic growth of 7.4%, above our LRP range for this segment. In our Tissue Technologies business, we delivered organic growth of 6.7%, excluding the Boston impact. And our international growth was strong once again at nearly 12%. Now turning to our bottom line. Our 3rd quarter adjusted earnings per share came in at $0.76 within our July guidance range.

Speaker 2

This result included the approximate $0.07 headwind from the increase in the Boston recall return provision. As we look beyond our 3rd quarter revenue results and back to the left side of the page, We continue to deliver several proof points along our path to the growth commitments we laid out during our Investor Day. First on innovating for outcomes, we're excited about return to market of the severance monitors for our customers and their patients. We relaunched in our 1st international markets and will be broadening our reentry in the Q4. We also filed the updated 510 in the U.

Speaker 2

S. In mid September with an expected launch for the product in the U. S. In the Q1 early in Q1 of 2024. In addition to Centrelink, we also 2nd, we advanced our international growth strategy with further geographic expansions, expansions of our CUSA platform and registrations of Duragen, Duraceal, Mayfield and our dual lighting system in EMEA and Latin America, as well as the launch of DuraGen Plus in China.

Speaker 2

Though each product alone won't be material to our overall revenue growth, collectively, They showcase our strategy to bring our existing technologies to international markets and leverage our commercial footprints. We also made a significant step forward with our in China for China strategy by starting the build out of a leased manufacturing facility near Shanghai. And then 3rd, on an inorganic opportunities and broadening our impacts on Care Pathways, we're delivering on the successful integration of the SIA business with greater than 100 percent revenue growth year to date and advancement of our clinical program for a second PMA approval in the high growth breast reconstruction market. We have also expanded our UBM With a 510 clearance for Microbasics Flex, bringing the 1st organic NPI to the Acell UBM portfolio. We have also strengthened our executive leadership by appointing Chantal Vainon as Chief Human Resources Officer.

Speaker 2

Chatel brings rich experience in driving cultures of talent enrichment, leadership development and accountability. And finally, sustainability remains an integral part of how we do business. Effective ESG management enables us to produce life saving products, commitment to transparency and accountability, we issued our 2nd annual ESG report for 2022. This report details the progress we have made, particularly in our commitments to our customers and patients, building a more rewarding, diverse an inclusive workforce and improving our environmental sustainability. And it also lays out our plans for the coming year.

Speaker 2

With that, I will now turn it to Leah for updates on our financial results and full year guidance.

Speaker 3

Thank you, Jan. Now on to our Q3 financial results, and I'll begin on Slide 6. Our 3rd quarter total revenues We're approximately $382,000,000 representing a decrease of 0.7% on a reported basis and a decrease of 0.4% on an organic basis. As Jan mentioned, the increase to the Boston returns provision was a headwind to our 3rd quarter results, impacting our revenues and our organic growth and driving declines in our gross margins, adjusted EBITDA margins and adjusted EPS. In the Q2, we estimate the returns provision based on the best available information we had at that time.

Speaker 3

However, during the Q3, while working closely with our customers to assess and reconcile their returnable inventory, We recognize the need to make an adjustment to our returns provision. We believe we have adequately provided for any remaining returns. While Boston remains a significant headwind, there is much more to our results for the quarter. We continue to see solid performance across our business outside of Boston with organic growth of 7.1%, once again demonstrating the breadth and resilience of our portfolio. Adjusted gross margin for the quarter was 64.6 percent, down 210 basis points versus the Q3 of 2022, primarily driven by the Boston impact.

Speaker 3

Adjusted EBITDA margin for the quarter was 23%, down 430 basis points and adjusted earnings per share were $0.76 down $0.10 compared to the prior year. Gross margin pressures largely driven by Boston, Our planned growth investments and the year 1 dilution from the SEIA acquisition impacted our adjusted EBITDA and EPS metrics. If you turn to Slide 7, I will go deeper into the 3rd quarter revenue performance of our CSS segment. Reported 3rd quarter revenues in CSS were $268,000,000 an increase of 7.4% on a reported and organic basis from the Overall, the CSS segment delivered quarterly results exceeding the growth range outlined during our Investor Day. Global Neurosurgery sales were up 8% with low double digit growth in CSF Management driven by Certus Postalle, low double digit growth in neuromonitoring driven by ICP Microsensors and high single digit growth in dural access and repair driven by Duragen, Duracell and Mayfield.

Speaker 3

We saw a mid single digit decline in Advanced Energy due to the timing of CUSA Capital orders, offsetting some favorable timing benefits in the 2nd quarter. Overall, excluding Feralink, Capital sales for the quarter were down low double digits due to CUSA Capital. Year to date, our capital sales excluding CERELINK monitors are up Mid single digits and we remain encouraged by the continued momentum in the market for capital and the demand funnels for our capital portfolio. Instruments grew approximately 5%, benefiting from strong demand. The performance of our instruments Continued to exceed long term growth expectations for the market with high single digit growth year to date as the market remains stable and the team continues to take market share and win new business.

Speaker 3

Shifting to international, Sales grew low double digits in the quarter led by China, indirect markets, Australia and Canada. Our growth in China is driven by our regional expansion strategy outlined at our Investor Day with our team in China delivering double digit growth with strong performance across the Nora portfolio as we grow beyond Tier 1 cities. Moving to our Tissue Technologies segment on Slide 8. Tissue Technologies was down 15.6% on a reported basis and 15.1% on an organic basis compared to the prior year. Excluding Boston, organic growth was 6.7%.

Speaker 3

3rd quarter sales in the Wound Reconstruction Franchise, which includes a majority of the Boston products, decreased by 15%. Excluding the recalled products, We experienced organic growth of 7.5 percent driven by double digit growth in Micromatrix, Sitel, and our Amneiotic portfolio as our sales team refocused their selling efforts this quarter following recall related activities in the 2nd quarter. We are pleased to see such strong demand and commercial execution in this franchise, which continue to provide us with confidence in the long term growth potential of this business. In our private label franchise, sales declined 14% versus last year due to lost sales from private label partners associated with the recall. And finally, international sales in tissue technologies were down double digits due to Boston, which offset double digit growth in Integra Skin, Micromatrix and Cytol.

Speaker 3

Turning to Slide 9, I will now review the rest of our 3rd quarter P and L metrics. As we look at our gross margin and profitability metrics, we continue to see Boston as the primary headwind to our gross margins, representing an approximate 180 basis point impact with 60 basis points coming from the 3rd quarter return provision adjustment at approximately 120 basis points coming from the impact of the lost sales from the recall. The remaining 30 basis point impact is due to production inefficiencies in other sites. In addition to the impact to gross margins, Our adjusted EBITDA margin and adjusted EPS also reflect planned investments and the strategic priorities for the business We originally outlined in the beginning of the year, including the year 1 dilution from the SEIA acquisition. On our Q2 call, we highlighted these investments as critical to our long term growth and we continue to protect them.

Speaker 3

Finally, we saw an approximate 150 basis point benefit to our tax rate in the quarter from jurisdictional income mix and improved utilization of R and D and international credits. The 3rd quarter tax rate also included a year to date true up. We expect approximately 50 basis points of the benefit to carry forward beyond 2023. If you turn to Slide 10, I will provide a brief update on our balance sheet, capital structure and cash flow. During the quarter, operating cash flow was $27,000,000 and free cash flow was $14,000,000 reflecting increased working capital, primarily from investments in inventory builds.

Speaker 3

Our investment in inventory is to rebuild our safety stock levels and increased inventory for our European markets in preparation for EU MDR. Free cash flow conversion was 43% on a trailing 12 month basis. Our balance sheet remains strong with ample liquidity to support our short and long term plans. As of September 30, net debt was $1,200,000,000 and our consolidated total leverage ratio was 3 times. The company had total liquidity of $1,500,000,000 including $274,000,000 in cash and the remainder available under our revolving credit facility.

Speaker 3

Our balance sheet flexibility has enabled us The accelerated share repurchase we announced on our July earnings call. If you turn to Slide 11, I will provide an update to our consolidated revenue and adjusted earnings per share guidance for the Q4 and full year 2023. 4th quarter revenues are forecasted to be between $397,000,000 to $403,000,000 representing reported growth in the range of approximately minus 0.4 percent to positive 1.1 percent and organic growth in the range of approximately minus 0.8 percent to positive 0.7%. Our reported revenues reflect a strengthening U. S.

Speaker 3

Dollar. Excluding Boston, we are forecasting organic growth of approximately 5.1% at the midpoint, driven by continued strong global demand for our products. For the full year 2023, revenues are forecasted to be in the range of 1.541 to $1,447,000,000 which reflects the 3rd quarter additional Boston recall returns provision and current FX rates. The updated guidance represents reported growth of minus 1.1 percent to minus 0.7 percent and organic growth in the range of approximately positive 0.1 percent to 0.5%. Excluding Boston, we are forecasting organic growth of approximately 6%, reflecting the stable growth in our markets and strong global demand and performance we have demonstrated year to date.

Speaker 3

Turning to adjusted earnings guidance for the Q4, we expect adjusted EPS to be in the range of $0.89 to $0.93 down from the prior year driven by the Boston recall, our planned strategic investments, OpEx management to offset part of the impact of the recall and our tax rate improvements. During our July earnings call, we estimated a modest improvement in gross margin for the full year. We saw an impact to our gross margins in the Q3 due to the increased Boston recall returns and unfavorable sales mix driven by stronger international performance. We are also seeing a slower uptake on net productivity and yield improvements. We now expect a moderate decline in gross margins versus 2022.

Speaker 3

Our full year adjusted EPS guidance is being revised to $3.10 to $3.14 per share, reflecting the strength in the U. S. Dollar, Boston recall returns provision, adjusted gross margin outlook, second half expense management, our recently completed ASR and the tax favorability. Now I will turn the call back over to Jan.

Speaker 2

Thank you, Leah. Please turn to Slide 13 to conclude our prepared remarks. And as we wrap up, I'd like to cover a few highlights from what Lee and I walked you through. First, our progress in addressing And returning to the market remains on track. Interim external reviews confirm the adequacy of our remediation plan and the changes made so far.

Speaker 2

They reflect significant steps made towards the resumption of manufacturing by the end of the Q4 2023 and commercial distribution in mid to late Q2 2024. Product substitutions are within the expected range of 10% to 15%, highlighting the breadth and depth of our Tissue Technologies portfolio. And we remain on target for SurgiMent's PMA approval in the first half twenty twenty five. 2nd, despite the Boston recalls impact and the additional returns provision, our underlying 3rd quarter growth performance has been strong. Our Global CSS and Tissue Technologies segments, excluding Boston, delivered over 7% organic growth.

Speaker 2

Many of our product lines exhibit double digit growth underscoring the appeal of our diversified portfolio and the health of our markets. Additionally, our international business has delivered strong growth again. And finally, related to our long range commitments, We've taken a big step bringing Sadelink back in our international markets and with the regulatory filing Sadelink should be back in U. S. Early Q1.

Speaker 2

We're advancing our growth drivers with a 510 submission for the next generation Aurora Surgical and we're continuing progress on our breast reconstruction PMAs. We're also continuing to expand our international presence and portfolio and we're investing to capture future international potential. In conclusion, our journey has been marked by both significant achievements and significant challenges. The radiations and improvements we're bringing to Integra are making us stronger and are derisking the path to our LRP and will enable us to consistently deliver our financial commitments. As an organization, we remain dedicated to our purpose of advancing healthcare to restore patients' lives.

Speaker 2

I would like to thank our dedicated teams for their unwavering support and hard work. Together, we're shaping a future in which we continue to make a meaningful impact on patients and deliver lasting value to our shareholders. Thank you for your time this morning. This concludes our prepared remarks. And operator, we can open the lines for questions.

Operator

Thank you. Please stand by. We'll compile the Q and A roster. And we ask that you limit yourself to one question and one follow-up. Again, that's one question and one follow-up And our first question comes from Matt Taylor from Jefferies.

Operator

Your line is now open.

Speaker 4

All right, great. Thanks so much for taking our questions. This is Actually, Young in for Matt. I guess maybe to start, just on Boston, I mean it seemed like it had a bigger impact than Good to hear the substitution rates are in line, but maybe if you can provide a little bit more color Why the $7,000,000 increase in return provisions? And as you're going forward, Boston impact assumptions Right sized.

Speaker 4

Maybe you can also talk a little bit about customer attrition and how you can regain their business post remediation.

Speaker 3

Yes. So why don't I talk about kind of The impact that we saw in Q3, Liana, I can turn it over to you for any sort of customer dynamics. And thank you for the question. So, as we mentioned, so when we announced the recall and then in our Q2 call, we were about, 45 days post the recall. So at that point, while we had obviously already done some initial work working with customers, We had limited visibility to all of the inventory that was out there and potentially returnable.

Speaker 3

So based on the information we had at that time, we projected what The appropriate provision would be for returns. Since that time, as you can imagine, we've had an opportunity to now work with Essentially all of our customers and get more even more insight and visibility into their inventory to be able to more accurately assess What's returnable? And so that's the incremental $7,000,000 that you saw impact our Q3 results. And so we're confident based on the work that we've done that and the visibility that we now have that we've accurately That means is as we move forward, we wouldn't expect to see any impact from a P and L perspective for any future returns Because it's been provided for us as part of our reserve. And that's the only incremental Boston impact we saw for Q3.

Speaker 3

So as you think about the full year dynamic for 2023, we had originally called out a Boston impact of about $60,000,000 top line, that number is now $67,000,000 top line. We had called out an EPS impact of $0.35 that number is now $0.42 But it is isolated to 2023. In our July call, we had mentioned we had called out while we did not provide guidance on 2024, We did articulate our expectations of the Boston impact on 2024. And at that time, we have Communicated an impact of $50,000,000 top line and $0.30 to EPS. That projection remains unchanged.

Speaker 3

As I mentioned, the nature of what happened in Q3 really was isolated to returns and does not have an impact on what we called in 2024. So hopefully that answers your question.

Speaker 4

Yes, that's very clear. Appreciate the color, Leo. I guess maybe

Speaker 2

Yes, Matt, you had your second question. Okay, if I answered that one?

Speaker 4

Yes. So thanks for that. So for the follow-up question, I guess, was wondering In terms of share loss, how much do you expect to recapture following the relaunch in May 24. And how are the impacted reps doing during this time? If you can Comment about what they're focused on, what they're doing?

Speaker 2

So let me get in Three parts, right, all linked to how are we prepping for commercial return. First, the sales force, the reps, A lot of attention, both from a perspective of communication, but also compensation, the planning with them. We stay close to them, keep them closely informed. We definitely have some higher attrition than Louisville, but well in control, I would say. 2nd, that sales force remains in touch with our customers and that's where the substitution is important, Both in the wound reconstruction as well as in the surgical reconstruction, we have substitute products which that allows Sales force to be in the door, be in the procedures and work with customers to maintain the relationships and As we indicated, between 10% to 15% of the procedures have substitutes.

Speaker 2

And then 3rd, from a Relaunch perspective, our sales teams and sales leadership Estimate that we will be back to about 100% of our business in about 12 months after the launch. And that's really driven by 2 elements: 1, the strength of the relationship and then second, the merits of the projects Yes, that come out of our Boston facility. These were projects that were getting market share before we did the recall, All for good reasons and those reasons will be still there when we announce the

Speaker 4

All right. Thank you so much.

Operator

And thank you. And our next question comes from Vik Chopra from Wells Fargo. Your line is now open.

Speaker 5

Hey, good morning and thanks so much for taking the questions. 2 for me. I'll start with the first one. So we've heard about increased anti corruption issues in I know that could make access to hospitals more difficult. Maybe just remind us what percent of your sales are from China and what impact this could have on Tegra, and then I just had a follow-up.

Speaker 2

Okay. So I'll take that, Vic. Our China sales about 5%, 6% of our total. Specifically to your question on the anti corruption, I think like many medtech companies, we've seen confusion and some freezing of some commercial and professional education activities in the 1st week, right, specifically in the month of August, we've seen it improve Over September and then continue to significantly improve over October. When we look Our impact on the business, it's not material.

Speaker 2

And that's linked to our portfolio we have In China, that 5%, 6% of total is essentially neurosurgery portfolio, a lot of consumables And therefore linked with procedures. Now neurosurgery procedures are cannot be delayed Yes, for significant times we've seen that also during COVID. And in addition, the procedures themselves don't lead themselves to much Judgments or overuse, okay. So the tightening of some controls doesn't translate into tightening What goes on with neuro procedures? And in addition, we have strong internal controls and policies So from a how we operate, there's no need or no change that we're using in our process.

Speaker 2

So yes, overall, We've seen some of the waves in August, but as you see in our Q3 numbers and what we expect is Yes, no material impact on our business.

Speaker 5

Great. Thank you for that color. And then my follow-up question, Pretty topical, I guess, it's on GLP-1s. Maybe just any thoughts on what you have about GLP-1s near term and long term, Kind of what it means for Integra. I just don't think that the impact is as clear for Integra as for some other companies.

Speaker 5

Thanks so much for taking the questions.

Speaker 2

Yes. So GLP-one, we have not seen and we don't foresee any material Impact, that's also what we hear back from interactions with our customers. If you look at our Business and our LRP growth drivers and then the link with GLP-one, it's Very limited, right. If you look at neurosurgeries, it's difficult to argue that the incident rates of traumatic brain injuries, tumors, Hydrocephalus would be impacted by decline in the prevalence of diabetes or obesity. And I would say the same for tissue technologies.

Speaker 2

The vast majority of our sales are in the acute settings and for non diabetic foot ulcer Linked Wound Care. So again, here difficult to see the link between incidents rates of burns, traumatic wounds and breast reconstruction Yes. And the impact of GLP-one. So as I said, we have not seen and we don't foresee any material impact.

Operator

And one moment for our next question. And our next Question comes from Robbie Marcus from JPMorgan. Your line is now open.

Speaker 6

Great. Good morning. Thanks for taking the questions. I wanted to start with 2024 and how we should think about the recovery of the lost sales from the Boston products. And one clarification is the $50,000,000 headwind off of the reported 23 or ex What you would have done without the recall?

Speaker 6

And how do we think about lost sales and the recovery there? You have been off the market for a long time. This is a highly competitive market. Doctors will likely have moved on and tried other devices. How do we think about the ability to regain share?

Speaker 6

Is it 25%, 50%, 75% of the lost sales? And how long do you think that will take?

Speaker 3

So Ravi, I'll start with just framing kind of what the $50,000,000 relates And so really just to ground you, if you take a look at our the guidance that we provided going back to April, so on a full year basis, What we thought the business was going to be, you apply the growth factor That we assumed as part of our Investor Day in terms of how we projected the business to grow. The $50,000,000 is off of that. So that's how to think about the impact that we characterize from Boston in 2024. And then I'll let Jan maybe some of the questions around getting back Into the market.

Speaker 2

Robbie, as I also touched when with I think Matt's question, If you look to our Boston portfolio, the portfolio where we were building share. And so getting back in the market is first getting back to where we were and then getting beyond that. In terms of Getting back to where we were, say, mid-twenty 23, that's where our sales force It's planning in and assuming it will take them 1 year to get back to where we were and then continue

Speaker 6

Great. And if I could just squeeze one more in. As you think about your forecasting, your modeling, it looks like And is that something that may move around up or down as we move through next year? Or is that a number you think will not move any lower? Thanks a lot.

Speaker 3

So you're asking about CERELINK. So CERELINK, We are anticipating an early Q1 launch. I think, what we've said in the past in terms of as you think about the size of that business, And once we've relaunched in all markets, for monitors, we'd expect the business to be kind of back at the run rates we saw previously, which was about $12,000,000 annually. So that's CERELINK. The $50,000,000 impact that I characterized earlier to your first question Specific to kind of Boston based product portfolio and the impact to that portfolio as a result of Coming back into commercial distribution in the mid to late Q2 timeframe.

Speaker 3

So that would be independent of CerroLink. So I'm not sure if I missed

Operator

And our next question comes from Ryan Zimmerman from BTIG. Your line is now open.

Speaker 7

Good morning. Thanks for taking the questions. I want to talk about the tissue technologies business for a moment if I could. You guys did 6.7% organic growth ex Boston. If I'm not mistaken though, you estimate the markets are growing at 7% to 9% from the Analyst Day.

Speaker 7

And so help me understand, I mean, even if we remove Boston, is the market getting worse in the 3rd quarter? Is that spillover from Boston? And just how you think about your growth in tissue ex Boston relative to the market?

Speaker 3

Yes. So, maybe I'll start and then, we can I'll have Jan chime in. So and thank you for the question, Ryan. So again, if you think about from a tissue tech perspective, We saw in Q2, ex Boston, we saw that business grow at about 3.8%. And we knew at that time that we had even though we had that's the ex Boston portfolio, there was some Distraction in the sales force as they were part of the efforts to manage the recall.

Speaker 3

And we had anticipated that, that growth would accelerate into Q3 as we started to reposition the sales team, which is exactly what we saw happen, right? So that growth accelerated from 3.8% to what we talked about, which is the 6.7%. To your point, it's not quite at the LRP kind of rate, but I think a lot of that has to do with the fact that again for Q3, we were still in the process of re Positioning, developing our substitution strategy, executing on that. And so I don't know that we were necessarily hitting On all cylinders from the absolute beginning of the quarter to the end, but I think the clear momentum pickup that we saw in Q3 versus Q2 It illustrates what we have the potential that this business has in terms of what we can drive and deliver in growth. And as we look out to Q4, we would expect that to continue such that on a full year basis, we would expect again Ex Boston to be in that kind of 7% to 9% range that we communicated at Investor Day.

Speaker 3

And I know there was a second part of your question. I don't know if I answered that fully, Brian.

Speaker 1

Well, well, yes, no.

Speaker 7

Thanks, Lynn. It was just kind of how you think about the growth and the impact. As you're remediating Boston, we all can see kind of what the growth is Ex Boston, but what kind of spillover impact does that have in the other businesses? I mean, You would think the SIA acquisition is growing 100%. So clearly, it's making up for some of the losses on Boston, But can you grow at or above market rate ex Boston with everything going on there?

Speaker 7

And that's kind of the point of that question.

Speaker 2

So maybe go a bit deeper, Ryan. So one, when you said 7% to 9%, Definitely our breast strategy and therefore Boston is a growth accretive dryer within that mix. So The comeback next year will further put that portfolio into the right mix. That said, when we look at the rest of the portfolio, our ACEL, Micromatrix, Gentherx Cytelle portfolio, I mean very strong, Strong double digit growth that we continue to deliver there. Demand for Entegra Skin is strong.

Speaker 2

Part of that is substitution Yes, from Parametric. So we when we look at the portfolio and how it performed over the Q3, we feel good with that portfolio. We feel good with the markets. Of course, we're missing the Boston products. And like Leah said, July from a sales perspective, they were Still very much chasing to understand the inventory and drive the recalls back from the field.

Speaker 2

And that's as of August That came a lot more back to normal.

Speaker 7

Okay. That's very helpful, Jan. And then the follow-up question, Just to be clear, because I think there's some fears out there that and this is a potential what if, but if there is a government shutdown later this year, Has that impacted Billy of the FDA to come into your facilities? And so just to kind of be clear, can you just very Specifically walk us through kind of what's required to get the Boston facility given the green light to proceed as normal to manufacture again. Do you is it just external third party reviewers?

Speaker 7

Does the FDA need to come in at any point? It would be helpful just to understand that more specifically.

Speaker 2

So the short, Ryan, is that the FDA does not have to come in. So the requirements from the FDA is that when we decide that we're substantially complete with the remediation, We bring in an external auditor. We've shared that name of that company with the FDA. They've approved of that. So they will come in, Okay.

Speaker 2

Do the audits, okay, we assume that given all the preparation we've done that this will be a satisfactory audit. We decide on our own terms to restart the factory. The only thing that the FDA wants is that we sent or shared that audit report with the FDA. But there's no go or check by the FDA Before we start the factory or start shipping again, certainly.

Speaker 7

Okay. Very helpful, Yan. Thank you.

Operator

And thank you.

Speaker 3

And just Ryan, if I could I'm sorry, one other clarification or just a final point on that. So that's with respect to Boston. The one other thing is with respect to our 510 submission for clearance for in the U. S. For CERELINK.

Speaker 3

Because that submission occurred prior to any official government shutdown, Our understanding is that timeline will remain unpacked, so that we won't see an impact from that either. If we had submitted it post the government shutdown, then we would be at risk. But our understanding is at this point, we our timeline for that is still tracking to what we communicated.

Speaker 7

Thank you, Leah.

Operator

And thank you. And one moment for our next question. And our next question comes from Craig Bijou from Bank of America Securities. Your line is now open.

Speaker 8

Good morning, everyone. Thanks for taking the questions. I wanted to ask on CERELINK. So You started the relaunch in, I guess, a couple of international markets. So Jan, maybe just talk a little bit about Kind of the strategy and when you'll get to the full international Relaunch and then I know it's been asked before, but how to think about any contribution from either the international launch or U.

Speaker 8

S. Launch and how it could potentially ramp once It's fully launched both here and outside the U. S.

Speaker 2

First on the international launch, you're correct. So end of the Q3 September, we launched Several countries, Canada, South Africa, the Nordic countries. The priority is very much determined by 2 factors. 1, there's the timeline of The local regulators, which go from very short to reasonably short. And then second, there's a couple of basic logistics assumptions there.

Speaker 2

In the month of October, we're relaunching several Other European countries, Southern Europe, a bit of Eastern Europe, UK is going on, Switzerland is going on. And so every month over the next 2, 3 months, we will be bringing on more countries in Europe. And that brings us to January when U. S. Should start to be launched in the market.

Speaker 2

Again, from the question on ramp up, like what we picture is a ramp up comparable to the first The year of the CERINK launch in 2021, 2022 where in the 1st 12 months We were 12 months on the market before we recall that we sold almost 12,000,000 So roughly $1,000,000,000 a month. And so we model in function of that ramp up in 2021, 2022. Got it. That's helpful.

Speaker 8

And then on the Boston facility, wanted to see I understand the process there, but wanted to see, have you had any additional or incremental conversations with the FDA on your plan? And if not, do you plan to, Recognizing that you guys have already set out the plan with a 3rd party, but just wanted to see if there's Any other additional conversations that you expect with the FDA?

Speaker 2

So the short answer is yes, Right. So remember, we in end of July got this warning letter. We responded to that warning letter within 2 weeks with our plan to address those issues and the broader holistic plan. We got a confirmation from the FDA that they are aligned With this, this goes back to some of the dates that the FDA has put down like Yes, doing that external audit before March 31 next year. We also had a telephone call with the FDA to make sure That we each other understand each other well, okay, plus we shared some of the external companies we're using and will use for that External audit.

Speaker 2

So we wanted to have that aligned with the FDA in which they are fully aligned. As of that point, every 2, 3 months, we do send updates to the FDA. So we keep them informed on

Speaker 8

Great. Thanks.

Operator

And thank you. And one moment for our next question. And our next question comes from Richard Newitter from Truist Securities. Your line is now open.

Speaker 9

Hi, thanks for taking the

Speaker 10

questions. I was wondering if I could just ask on Surgimant. We're getting close to the FDA, I think, providing feedback On the clinical addendum that you had filed for that product, what can we expect to come out of that? And is there anything in there that Could potentially delay timelines for that?

Speaker 2

So expectations, I We communicated, we submitted in July that addendum and there's some further information that's being shared. We expect early next year to get feedback and to go on that clinical part of the PMA. Now what you tried to explain last time is that the critical path for the PMA It comes to the pre market inspection of the Boston facility, which can only happen when the factory and the commercial is Fully up and running. And so we expect that premarket audits to happen either End of 2024 or early 2025, which leads us to PMA approval in the first half of twenty twenty five.

Speaker 10

Okay. And then second question,

Speaker 2

can you just

Speaker 10

bridge us Between the gross margin from 2Q to 3Q, just one more time, I just want to make sure I have all of the components right there to get there. And then also any comments on M and A just capital deployment given the space and valuation compression over the last few months? Thanks.

Speaker 3

Yes. Happy to take the question. And so let me provide a couple of data points. So as we looked at our gross margin was 64.6%

Speaker 2

for the

Speaker 3

quarter, It was down about 250 basis points from kind of internally where we had been tracking. And that's made up of 3 elements. First, the Boston returns had a direct impact on margins and that was about 60 basis points. But then we also saw an acceleration of growth internationally that was higher than we had anticipated And that did have a negative margin impact, coupled with some within the U. S.

Speaker 3

Some product mix dynamics that also had a negative margin impact. And that was about 90 basis points together. And the remaining 100 basis points is driven by kind of the slower uptake on Productivity improvements that we had anticipated. So that's the dynamic that played out in Q3 relative to what we were expecting. As we move into Q4, we'll see a couple of things.

Speaker 3

1, we won't have the Boston return repeat, Right. So that 60 basis points comes back. We also would expect to see more normalized kind of revenue mix Growth dynamics between international U. S. And some of the product timing that gave rise to negative margin dynamics should alleviate, So that should come back as well.

Speaker 3

What likely won't come back in the Q4 timeframe is the Net improvement and productivity initiatives that we had outlined, so that will likely continue to be a gap. And that's why we're now calling a moderate decline year on year full year 2023 versus full year 2022. As I characterize kind of the nature of that net productivity uptake or slower uptake, A lot of it is we've talked about we see opportunity to drive improvement in our gross margins. We've deployed teams To go after not only identifying initiatives, but starting to execute, but we started to do it kind of in small pilot areas. And what we've Been able to confirm is that the value is there, greatest value being in some of the tissue tech sites that we have.

Speaker 3

But the expertise needed to execute on those initiatives is the same expertise that we need to help support the Boston restart plan. And so we were not able to deploy as many resources against that effort as we had anticipated. And so that's what's causing the slower uptake versus what we had anticipated. So I'll pause there on gross margins And I can go into M and A if you want.

Speaker 10

That was very helpful. Thank you.

Speaker 2

Yes. Rich, And Rich, on your M and A question, I mean clearly M and A will continue to be a priority for capital allocation As part of our long range planning though at this point, I would say we temporarily are tempering somewhat and specifically in tissue tech, which I think is Quite obvious given that management is very focused on getting Boston back. That said, we have our strategic game boards. Often, we don't fully control the timing. So we are continuing to explore and then primarily on our CSS, our Codman Specialty Surgical sites and Simply, we'd say midsized store tuck in deals that meet our return on investment requirements are strategically Yes, fitting to our business and also fit within our financial discipline, which remains strong

Speaker 10

Okay, very helpful. Thank you.

Operator

And thank you. And our next question comes from Steve Lichtman from Oppenheimer and Company. Your line is now open.

Speaker 11

Thank you. Good morning, everyone.

Speaker 2

Lee, I just wanted to follow-up

Speaker 11

on gross margin. You talked about some of the near term dynamics And the efficiency opportunities you see, I guess, you certainly as Boston becomes less of a focus for the team. But Can you give us your updated thoughts overall where you see gross margin tracking over the next couple of years? I mean update If you could on other drivers that you see for gross margin, particularly now with you having more time in the CFO seat?

Speaker 3

Yes, Steve. Happy to take the question. So bigger picture, longer term. So A, just To be clear, we're not providing an update on any LRP guidance at this point. But to your point, I have taken additional time to drill into the that we have to improve gross margin.

Speaker 3

I remain convinced that there is value there for us to create, But it's a lot to unpack. And so if you recall at Investor Day, we said there's about 300 to 500 basis point opportunity for Improvement in gross margin over our LRP period and it was coming from 3 primary places. Volumemixprice was kind of 1 bucket. The productivity yield initiatives that I referenced earlier was kind of bucket 2 and then footprint optimization was the 3rd bucket that we had articulated. And I would tell you the volume mix price is totally embedded in how we are driving revenue and bringing MPI to market.

Speaker 3

And so that still remains very viable. And as you saw based on our results in Q3 in terms of the business Outside of Boston, that business is growing at our LRP Investor Day levels. And so as that continues to happen, as we bring MPI To market, we will realize that the gross margin improvements related to that. The second piece that I articulate around productivity yield, Those are the areas where it's a slower uptake, but the opportunity is still there. We will need to redeploy resources or accelerate The deployment of resources against those efforts, in order to extract it.

Speaker 3

And so that's what we're looking at now to understand from a timing perspective, When that happens and the overall magnitude. So that's how we're thinking about it right now. And more to come. We'll have an official update as we finish going through our LRP process.

Speaker 11

Okay, understood. And then just a follow-up on, I don't think we touched much on Aurora in the 510 filed. I think you gave some long Thoughts on the market or the product opportunity for you guys in 'twenty seven. How are you thinking about sort of the ramp of that product

Speaker 2

So as we communicated in the past couple of years, we're limited release to learn. In the case of the stethoscope, the 8 millimeter stethoscope that has led to some upgrades to the product and that's the 510. We consider that 2024 is the 1st real commercial year, okay, where we have Robert said, we have the sales force and we'll start to go into the market. We're not sharing projections or guidance yet on what we expect Yes, definitely a different rhythm, a different slope in terms of commercial opportunity and commercial drive. Just

Speaker 3

to put a point on that, within Q3, we did see strong growth on Aurora. It was up high double digits For the quarter, so some momentum building there.

Speaker 11

Great. Thank you.

Operator

And thank you. And our next question comes from Matthew O'Brien from Piper Sandler. Your line is now open.

Speaker 7

Good morning. Thanks for taking the questions.

Speaker 11

Real quick, don't you need the warning letter listed at the Boston facility before you can submit the SurgiMed TMA?

Speaker 2

Yes. And so that's the reason why after we get going, we'll have We have the end to audits, right, both auditing linked to the warning letter and auditing to the pre markets audit for the PMA. So between, say, mid next year and end next year, there will be FDA audits in there.

Speaker 7

Okay. But you need to

Speaker 11

have it lifted before you can submit. Okay.

Speaker 2

And then Well, we can submit Sorry, Matt. We can't submit before the audits, but the FDA will only approve after successful PMA.

Speaker 11

Left of the warning letter. Got

Speaker 2

it. Yes.

Speaker 11

Okay. And then on the Boston impact, Can you can I tease that out a little bit more just in terms of is that impact a gross impact or a net impact that includes Positive offsets from the substitute products that you're selling in kind of 10% to 15% of your cases?

Speaker 3

Yes. So that's it does not include the substitution impact.

Speaker 7

Okay. So it's just it's a

Speaker 11

gross impact, it's not a net impact?

Speaker 3

Yes, correct. Correct. Not net of subscription. Correct.

Speaker 11

Got it. Okay. That was it for me. Thank you.

Operator

And thank you.

Speaker 2

Thanks, Matt.

Operator

And one moment for our next question. And our next question comes from Jayson Bedford from Raymond James. Your line is now open.

Speaker 9

Thanks and good morning. Just a couple of quickies. On the timelines To return to market, Jan, you mentioned in line with previously communicated timelines. Just to be clear, The expectation is late Q2 2024, is that correct?

Speaker 2

Mid May to end Q2. Okay. So that's the timeline we project and plan for. And that's also what we communicated 3 months ago.

Speaker 9

Yes, just to be clear. Thank you. And then can you just remind me of the revenue breakout between Private label and the rest of tissue tech from the Boston facility and can we assume that the private label component is Pretty sticky and the challenge will be more on the rest of the business?

Speaker 3

Yes. So in terms of kind of dimensionalizing it, So our private label business is within the Boston portfolio is about 20% of the Boston portfolio. And if you recall, Boston, we dimensionalize at about 5% of our total revenue base. And so, obviously, we are continuing to work with our private label partners during this time to help them understand our remediation plan, give them as much insight And collaboration throughout the process, obviously, they have to make the kind of their own determination at the end of the day in terms of the path that they will take. But we are being very collaborative in terms of our interactions with them.

Speaker 9

And is it your expectation that you keep 100% of that private label business?

Speaker 2

I think Jason, as you said, it is sticky in the sense that for a private label Customer to develop new supply validate, it takes significant time and effort. That said, I mean, definitely at this point in time, our private label customers are frustrated With us, we're staying close to make sure information wise, they know what to have and they can have the planning. I think as we get Closer to commercial release, that's where we'll see if and where we would have impact on our private label This is for it.

Speaker 9

Okay. Thank you.

Operator

And thank you. And our next question comes from David Turkaly from JMP Securities. Your line is now open.

Speaker 12

Hey, good morning. Just a quick one on the guidance. It looks like you updated 23%, you're able to offset some of the Boston impact with The lower tax and the lower share count, and I know it's probably just high level $0.24 but you reiterated the impact and the EPS of $0.30 Could we view that as possibly conservative given that some of those the share count specifically and the tax may carry through?

Speaker 3

Yes. So just to be clear, we did not provide guidance for 2024, but to your point, when we quantified the Boston impact 4.24, that was only looking at Boston in isolation. So I think to your point, As we have tax benefit that will carry forward, that is not reflected in that EPS number that I gave you, because that was Boston only.

Speaker 12

And the share count as well, right? I imagine that's fair.

Speaker 2

Okay.

Speaker 7

And then

Speaker 12

just one quick follow-up please. The 10% to 15%, you guys have so many options there, synthetics and biologics. I'm curious if you think that that might be too low. I know you said that you're in line with that now, but given the options you have, Could that change?

Speaker 2

The answer is yes. This is a learning process both for our sales force as for our customers. And definitely from a sales force perspective, we've seen them every month getting better at understanding what, where and How to bring that portfolio to. So we are driving to hopefully be at the higher end or

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Key Takeaways

  • Integra remains on schedule to restart manufacturing at its Boston facility by end of Q4 2023, with an independent external audit in Q1 2024 and commercial distribution expected mid to late Q2 2024.
  • The Q3 results included an additional $7 million reserve for product returns related to the Boston recall, shaving about 60 basis points off adjusted gross margin and reducing adjusted EPS by $0.07.
  • Excluding the Boston impact, third-quarter organic revenue grew by 7.1%, driven by 7.4% growth in the CSS segment, 6.7% in Tissue Technologies, and nearly 12% international growth.
  • Full-year 2023 revenue guidance was adjusted to $1.441–$1.447 billion (organic growth of 0.1%–0.5%), ex-Boston growth of ~6%, and EPS forecast to $3.10–$3.14 per share.
  • Key product milestones include the relaunch of Cerelink monitors internationally (with U.S. launch early Q1 2024), on-track PMA approval for SurgiMent by H1 2025, and a 510(k) submission for the next-generation Aurora Surgical device.
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Earnings Conference Call
Integra LifeSciences Q3 2023
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