Medpace Q3 2025 Earnings Report

Medpace EPS Results

• Actual EPS: $3.86
• Consensus EPS: $3.50
• Beat/Miss: Beat by +$0.36
• One Year Ago EPS: $3.01

Medpace Revenue Results

• Actual Revenue: $659.90 million
• Expected Revenue: $640.49 million
• Beat/Miss: Beat by +$19.42 million
• YoY Revenue Growth: +23.70%

Medpace Announcement Details

• Quarter: Q3 2025
• Date: 10/22/2025
• Time: After Market Closes
• Conference Call Date: Thursday, October 23, 2025
• Conference Call Time: 9:00AM ET

Medpace (NASDAQ:MEDP) is a contract research organization (CRO) that provides clinical development services to biotechnology, pharmaceutical and medical device companies. The company supports sponsors throughout the product development process, from early planning and protocol design through clinical trials, regulatory submission and post-marketing activities.

Its services include clinical trial management, clinical monitoring, biostatistics, data management, medical writing, pharmacovigilance and regulatory consulting. Medpace also provides laboratory, imaging and other specialized services designed to support the collection, analysis and submission of clinical research data.

Founded in 1992, Medpace is headquartered in Cincinnati, Ohio, and serves clients through operations in North America, Europe, Asia and Latin America. The company focuses on a range of therapeutic areas, including oncology, cardiovascular and metabolic diseases, central nervous system disorders, and medical devices.

Medpace is led by founder August J. Troendle, who serves as chairman and chief executive officer. Its shares trade on the Nasdaq Stock Market under the symbol MEDP.

Medpace Q3 2025 Earnings Call Transcript

Key Takeaways

• Positive Sentiment: Medpace reported strong Q3 results with $659.9 million revenue (+23.7% YoY), $148.4 million EBITDA (+24.9% YoY) and a net book-to-bill of 1.20, driven by solid RFP activity and decision momentum.
• Positive Sentiment: The company says its pipeline is healthier than headline backlog metrics imply: Q3 net new awards were $789.6 million (+47.9% YoY) and the pool of awarded work not yet in backlog is up ~30%, positioning Medpace to refill backlog into 2026.
• Neutral Sentiment: Preliminary 2026 outlook: management expects revenue to grow in the low double-digit range versus 2025 and EBITDA to grow at a high single-digit pace or greater, with formal guidance to be provided with full-year results.
• Negative Sentiment: Management expects elevated pass-through/reimbursable costs to persist, forecasting pass-throughs of about 41%–42% of revenue, a headwind to service-margin leverage and EBITDA expansion.
• Positive Sentiment: Cash generation and capital return remain strong: Q3 operating cash flow was $246.2 million, year-to-date buybacks totaled $912.9 million (2.96M shares) and roughly $821.7 million of repurchase capacity remains.

Presentation

[Operator]

Good day, ladies and gentlemen, and welcome to the Medpace Third Quarter 2025 Earnings Conference Call. At this time, all participants are in a listen-only mode. After the speaker's remarks, there will be a question and answer session. If you'd like to ask a question, please press star one-one on your telephone. If your question has been answered and you'd like to remove yourself from the queue, simply press star one-one again. As a reminder, this call is being recorded. I would now like to introduce your host for today's conference call, Lauren Morris, Medpace's Director of Investor Relations. You may begin.

[Lauren Morris, Director of Investor Relations at Medpace]

Good morning, and thank you for joining Medpace's Third Quarter 2025 Earnings Conference Call. Also on the call today are our CEO, August Troendle, our President, Jesse Geiger, and our CFO, Kevin Brady. Before we begin, I would like to remind you that our remarks and responses to your questions during this teleconference may include forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These statements involve inherent assumptions with known and unknown risks and uncertainties, as well as other important factors that could cause actual results to differ materially from our current expectations. These factors are discussed in our Form 10-K and other filings with the SEC. Please note that we assume no obligation to update forward-looking statements, even if estimates change. Accordingly, you should not rely on any of today's forward-looking statements as representing our views as of any date after today.

[Lauren Morris, Director of Investor Relations at Medpace]

During this call, we will also be referring to certain non-GAAP financial measures. These non-GAAP measures are not superior to or replacement for the comparable GAAP measures, but we believe these measures help investors gain a more complete understanding of results. A reconciliation of such non-GAAP financial measures to the most directly comparable GAAP measures is available in the earnings press release and earnings call presentation slides provided in connection with today's call. The slides are available in the Investor Relations section of our website at investor.medpace.com. With that, I would now like to turn the call over to August Troendle.

[August Troendle, CEO at Medpace]

Good day, everyone. Cancellations were well-behaved in Q3, permitting record net bookings and a net book-to-bill of 1.20. RFP quality remained solid, with decisions progressing on a usual tempo. Initial award notifications were strong, and our total dollar value of awarded work not yet recognized in the backlog was up approximately 30% in Q3 on a year-over-year basis. We are making good progress toward refilling our pipeline of opportunities. We will provide 2026 guidance when we report full-year 2025 results in February. However, I will provide a brief preliminary view in an attempt to avoid significant divergence between our view and analysts' models. We anticipate 2026 revenue to grow in a low double-digit range of our updated 2025 full-year guidance. We expect EBITDA to grow at a high single-digit pace or greater.

[August Troendle, CEO at Medpace]

We believe pass-through costs will remain high compared to historical levels and represent between 41%-42% of revenue. Jesse will now provide comments on the queue. Jesse?

[Jesse Geiger, President at Medpace]

Thank you, August. Good morning, everyone. Revenue in the third quarter of 2025 was $659.9 million, which represents a year-over-year increase of 23.7%. Net new business awards entering backlog in the third quarter increased 47.9% from the prior year to $789.6 million, resulting in a 1.20 net book-to-bill. Ending backlog as of September 30, 2025, was approximately $3 billion, an increase of 2.5% from the prior year. We project that approximately $1.84 billion of backlog will convert to revenue in the next 12 months, and our backlog conversion in the third quarter was 23% of beginning backlog. With that, I'll turn the call over to Kevin to review our financial performance in more detail, as well as our guidance expectations for the balance of 2025. Kevin?

[Kevin Brady, CFO at Medpace]

Thank you, Jesse, and good morning to everyone listening in. As Jesse mentioned, revenue was $659.9 million in the third quarter of 2025. This represented a year-over-year increase of 23.7%. Revenue for the nine months ended September 30, 2025, was $1.82 billion and increased 15.9%. As expected, revenue for the quarter was favorably impacted by higher reimbursable cost activity, particularly investigator sites, driven by a therapeutic mix shift to faster-burning studies in areas which have a higher concentration of reimbursable costs. EBITDA of $148.4 million increased 24.9% compared to $118.8 million in the third quarter of 2024. Year-to-date EBITDA was $397.5 million and increased 14.7% from the comparable prior year period. EBITDA margin for the third quarter was 22.5% compared to 22.3% in the prior year period. Year-to-date EBITDA margin was 21.8% compared to 22% in the prior year period.

[Kevin Brady, CFO at Medpace]

EBITDA margins benefited from productivity and lower employee-related costs, offset by higher reimbursable costs. In the third quarter of 2025, net income of $111.1 million increased 15.3% compared to net income of $96.4 million in the prior year period. Net income growth below EBITDA growth was primarily driven by a higher effective tax rate and lower interest income compared to the prior year period. Net income per diluted share for the quarter was $3.86 compared to $3.01 in the prior year period. Regarding customer concentration, our top five and top ten customers represent roughly 23% and 33%, respectively, of our year-to-date revenue. In the third quarter, we generated $246.2 million in cash flow from operating activities, and our net days sales outstanding was negative 64.3 days. During the quarter, we repurchased approximately 14,649 shares for $4.5 million. Year to date, we repurchased 2.96 million shares for $912.9 million.

[Kevin Brady, CFO at Medpace]

As of September 30th, 2025, we had $821.7 million remaining under our share repurchase authorization program. Moving now to our updated guidance for 2025. Full-year 2025 total revenue is now expected in the range of $2.48 billion-$2.53 billion, representing growth of 17.6%-20% over 2024 total revenue of $2.11 billion. Our 2025 EBITDA is now expected in the range of $545 million-$555 million, representing growth of 13.5%-15.6% compared to EBITDA of $480.2 million in 2024. We forecast 2025 net income in the range of $431 million-$439 million. This guidance assumes a full-year 2025 effective tax rate of 18.25%-18.75%, interest income of $12.2 million, and 29.5 million diluted weighted average shares outstanding. There are no additional share repurchases in our guidance. Earnings per diluted share is now expected to be in the range of $14.60-$14.86.

[Kevin Brady, CFO at Medpace]

Guidance is based on foreign exchange rates as of September 30th, 2025. With that, I will turn the call back over to the operator so we can take your questions.

[Operator]

Thank you. To ask a question, please press star one-one on your telephone and wait for your name to be announced. To withdraw your question, please press star one-one again. One moment while we compile our Q&A roster. Our first question comes from the line of Charles Rhyee with TD Cowen. Your line is open. Please go ahead.

[Charles Rhyee, Managing Director at TD Cowen]

Oh, yeah. Thanks for taking the questions. Hey, obviously, congrats on the quarter here. When we think about sort of the kind of ranges that you've given for next year, how should we think about the pass-throughs in relation to maybe the increase in metabolic work? You know, obviously, we saw another increase here as a percent of total revenue to 30% in the third quarter from 25% in the first half. You're still calling out for pass-throughs to remain stable in 2026 at that sort of 41%-42% range. You know, when we think out of your current bookings, are you seeing less metabolic trials compared to your current burn, or should we expect to see some kind of leveling off in terms of the higher metabolic mix? Thanks.

[August Troendle, CEO at Medpace]

Yeah. I think over the course of 2026, it'll level off some and might even come down a little bit. It isn't just the shift to metabolic studies. That is the largest driver, which we've talked about, of course. The timing of projects and having a lot of late-stage projects in what we're burning, as you know, we're going to start ramping up new studies. New studies are, even if they have the same mix of pass-through costs, there's greater direct costs incurred earlier in a trial. Pass-through costs are late in a trial. A trial starts, and some trials you can get halfway through the trial in terms of direct fees, and we've earned half of the revenue from our activities, and we haven't paid sites anything hardly. It's startup. If it's a very short trial, and startup's a big part of it.

[August Troendle, CEO at Medpace]

The pass-through parts of a trial are backloaded. If you have a backloaded portfolio of stuff you're burning, you're going to have more pass-through expenses at that time. There are a number of things driving it. Yes, we do expect pass-through to maybe peak in Q4 or so and come down over 2026.

[Charles Rhyee, Managing Director at TD Cowen]

Great. Thank you.

[Operator]

Thank you. One moment for our next question. Our next question comes from the line of Ann Hynes with Mizuho. Your line is open. Please go ahead.

[Ann Hynes, Senior Healthcare Services Equity Analyst and Managing Director at Mizuho]

Great. Thank you. Thanks for the 2026 guidance. Typically, your EBITDA grows above your initial thoughts. Typically, your EBITDA grows above revenue and it's growing lower. Is that just because of the pass-through dynamic, or is there something else going on? If you can just talk about the pricing environment, that would be great. Thank you.

[August Troendle, CEO at Medpace]

Yeah. I think the driver there is the pass-throughs. I mean, look, there's a number of challenges to EBITDA, and that includes exchange rates and a number of factors. The biggest factor, I think, is the pass-through that challenges that a little bit. At pricing, look, we've talked, and everyone's talked about the pricing environment. As things have slowed in the industry over the last couple of years, there has been a bigger focus on pricing. Pure pricing is more an area for large pharma to get really aggressive at and has the clout to do it. It is an area of, you know, it's always a competitive environment. It is, you know, it's always top of mind, but there has been a greater focus. Some clients just can't get the cash to make it work, and so you're looking for ways to help them get there.

[August Troendle, CEO at Medpace]

I do not think pricing is going to drive a meaningful change in margins at all.

[Ann Hynes, Senior Healthcare Services Equity Analyst and Managing Director at Mizuho]

Great. Thank you.

[Operator]

Thank you. One moment for our next question. Our next question is going to come from the line of Michael Cherny with Leerink Partners. Your line is open. Please go ahead.

[Michael Cherny, Senior Managing Director at Leerink Partners]

Good morning, and thanks for taking the question. Maybe if I can go back to your comment, August, on some of the pre-backlog filling. Encouraging to see, especially given your customer base. As you think about what you're positioning with relative to your preliminary views on FY2026, how do you think about the conversion rate of those of the pre-backlog, your win rate, and how that should factor in relative to what you've seen over the last couple of years? Thanks.

[August Troendle, CEO at Medpace]

Yeah. I mean, you know, the conversion of how much of it's going to anticipated, you know, pull into revenue versus backlog, I really don't have that breakout. I provided the number to, you know, there has been some concern that our burn rate has gone up quite a bit. Our backlog hasn't grown much this year. It's a low single digit, a couple % up over the past year. I wanted to let people know that the overall pipeline of awarded studies—I mean, I'm not just talking about pipeline of opportunities—of awarded studies, we got a fixed scope of work. We've negotiated the price on it. They've given us written award of that. It just hasn't gotten to first patient in yet. We may be working on it, etc. It just hasn't gotten to first patient enrolled. That's in our, you know, this bucket pre-backlog. That is up 30%.

[August Troendle, CEO at Medpace]

This pre-backlog bucket of awarded, firm award work is larger than our backlog itself and is up 30% over the year. I think that puts us in a good position for refilling our backlog over the next year and not having what a number of people have described as some sort of air gap in our revenue growth and things will stall. We run out of backlog, kind of. We really are improving our opportunities for backlog conversion in 2026 and revenue generation.

[Operator]

Thank you. One moment for our next question. Our next question will come from the line of David Windley with Jefferies. Your line is open. Please go ahead.

[David Windley, Managing Director at Jefferies]

Hi. Thanks. Good morning. That's good timing. I'll come in right behind that. August, in 2023, 2024, a lot of your peers saw their activity levels, which would be more akin to your kind of initial award timing, moderate, decline, begin to feel the impact of lower funding. For you, that materialized for Medpace, I should say, that materialized in the weaker book-to-bill ratios, more in the mid-2024 timeframe as you saw some of that pre-backlog cancel out and not move forward, etc. The same timing dynamic sets up for what was a pretty weak funding environment in the first half of 2025. Your last answer may have been pointing at me specifically. I'll take that. Why is this time different?

[August Troendle, CEO at Medpace]

I think.

[David Windley, Managing Director at Jefferies]

Why is this time different?

[August Troendle, CEO at Medpace]

I don't know. The difference, a big difference, is this has been driven by cancellations, not weak business. There are many challenged clients, and that does affect the business environment. There's been a really highly unusual series of cancellations that we went through. The business environment underlying it has always been pretty okay. Maybe you're saying, I'm not real strong compared to what it had been a few years ago, but it's pretty good. Despite all these huge cancellations out of this pre-backlog awarded study bucket, despite all of those, we still grew that bucket by 30% over the last year. It would have grown much faster, and we'd have a much bigger backlog at this point if we hadn't had those cancellations. The difference is this has been driven by cancellations, not a really weak funding environment causing lack of opportunities.

[David Windley, Managing Director at Jefferies]

Got it. From a kind of metric cycling standpoint, you and I, after the last quarter, talked about your burn rate naturally increasing in at least some large part because you hadn't been adding a lot of early, new-to-start studies into the, call it, the early part of the backlog. Now you're getting into a period where it feels like that is probably going to happen, get healthier, more added to the backlog. I appreciate also the 2026 commentary. If I were to interpret, you would expect backlog to grow faster, burn rate to come down, and then your need to hire to support that growth is probably going to accelerate. Is that the right way to think about how the business is going to evolve?

[August Troendle, CEO at Medpace]

Yeah, I think that's a reasonable scenario.

[David Windley, Managing Director at Jefferies]

Regarding the hiring, we haven't talked about your beginnings of your offshoring activity that I think you started in 2024. How is that progressing, and where is your hiring happening? That'll be my last question. Thanks.

[August Troendle, CEO at Medpace]

Sure. Hiring in the year-to-date and in the last quarter, the largest region of growth was North America, and all that really United States. The second largest would be Asia-Pac. The kind of two outlying areas that we've not really grown staff at all are Europe and China. Throughout Asia-Pac, it's throughout Asia-Pac, although our largest hiring area in Asia-Pac as a single country was India. Over the last few years, starting, as you say, a couple of years back, we started hiring in India, and that has added a substantial number of staff over time. Not compared to our overall numbers, but that's been a focus area in Asia-Pac. I think that it's pretty balanced, and most of the hiring recently has been U.S., and that's kind of a transition in the market. There's been more U.S.-focused work lately, and a lot of the metabolic stuff is more U.S.-focused.

[August Troendle, CEO at Medpace]

That's been a very strong area of growth.

[David Windley, Managing Director at Jefferies]

Appreciate the answer. Thank you.

[Operator]

Thank you. One moment for our next question. Our next question comes from the line of Max Smock with William Blair. Your line is open. Please go ahead.

[Max Smock, Equity Research Analyst at William Blair]

Hey, good morning. Thanks for taking our questions. August, maybe one on the just expectations for book-to-bill here moving forward. You talked about initial awards being up 30% year-over-year, but based on kind of the midpoint of the guide here, I think you need to do 55% growth in bookings in 4Q to put up a 1.2 book-to-bill in the quarter. Can you help us bridge that gap or maybe just elaborate on your booking expectations for 4Q and what you've embedded in your guide for bookings in 2026? Thank you.

[August Troendle, CEO at Medpace]

Yeah. We're not giving a guide to 2026, and I don't know where the bookings are going to come out. I'm not going to get into, you know, trying to set them. We did say that second half of 2025, you know, we did think that we could get to a 1.15. We thought a reasonable, you know, chance of getting there. That's kind of where we're looking at, you know, towards Q4 is sort of the, you know, the target. I think that looks reasonable, but I'm not going to get into next year yet.

[Max Smock, Equity Research Analyst at William Blair]

Maybe just following up on that point. I mean, 1.15 still kind of implies 45%+ bookings growth in 4Q. Is that disconnect from the 30% growth in initial awards to that 45%, give or take, on net new business awards in 4Q? Is that disconnect? Is that typically there in a quarter? What's your visibility into that bookings in 4Q given that initial awards up 30%?

[August Troendle, CEO at Medpace]

As I said, that bucket's a little bit bigger, and it's 30% growth, not 30% increase in awards. I'm talking about the total bucket is up 30%. Awards, new awards were up sequentially a bit, but it's the total bucket. How much of that is needed to drive a given booking number? I don't know.

[Max Smock, Equity Research Analyst at William Blair]

Yeah. Okay, that makes sense. Thank you for clarifying on that. Maybe just as a quick follow-up here, you gave some color on decisions progressing at a usual tempo. Just wondering how those decision-making timelines have changed more recently and what you're hearing from customers around this confidence in the funding environment moving forward.

[August Troendle, CEO at Medpace]

Yeah. No, I think things are moving along. Q1, we had a sort of a things were held up. We weren't getting our sort of pending RFPs, total dollar pending decisions. It's kind of spiked, and there was a lot of slowdown in things. That's then improved quite a bit. It's been now, I wouldn't say, yeah, there's still funding challenges for clients. Some are delayed, etc. I think overall things are going on a pretty reasonable pace. It certainly, it's somewhat normalized. I don't, there isn't a big, a large jump in sort of that pending work and people not making decisions and holding things up. I think they're moving along. Things are moving along pretty well. That's what we hear in terms of feedback. People are getting funding. I think things are moving along. There's a parallel group that are stalled and having trouble.

[August Troendle, CEO at Medpace]

We have the flexibility to jump where we need to be.

[Max Smock, Equity Research Analyst at William Blair]

Got it. Thanks again for taking our questions.

[Operator]

Thank you. One more moment for our next question. Our next question will come from the line of Jaylen Dressing with Truist Securities. Your line is open. Please go ahead.

[Analyst at Truist Securities]

Thank you, and thanks for taking my questions. First, a quick clarification on your preliminary 2026 growth expectations or numbers. Just to clarify, that underlying assumption there is the environment looks similar to what you are seeing in Q3 in terms of bookings, flow, and pipeline, right? That's the underlying assumption. I want to make sure that.

[August Troendle, CEO at Medpace]

Yeah. We kind of always push forward the environment. A lot of 2026 is already kind of, you know, cancellations are the biggest sort of wildcard. Yes, you're right. The business environment, there still are things that, you know, to be newly awarded now that will affect next year. Most of the pipeline is there. The big question mark is cancellation rate. What we're assuming is, actually, it could be a little bit higher than where it has been this quarter and last quarter, or in Q3 and in Q2. It doesn't jump up again to like levels of Q1 and Q4 and things like that.

[Analyst at Truist Securities]

Okay. My quick follow-up on the margin trends. Thanks for the color on the growth number for next year. Outside of pass-through, as you think about the margins on the core direct service revenue business, can you talk about the leverage on gross margin? As you know, you had a nice kind of improvement this quarter. Just trying to understand the trends there. Do you think that you are pretty much at the peak on those margins, again, outside of pass-through impact?

[Kevin Brady, CFO at Medpace]

Yeah. Joan, as August mentioned, we provided some color on both revenue and EBITDA for 2026. The margin, for the most part, is expected to remain in a very good spot. We're continuing to see improved productivity from our existing employee base. Some of that is just driven by improved attrition rates. They remain very low. Great utilization levels, and studies are progressing at a very good pace. As we said in the third quarter, we are seeing improved funding. With the fewer cancellations, things are progressing in a very good way. We do expect margins to remain in a good spot in 2026. It's really driven by just continued productivity of the business.

[Analyst at Truist Securities]

Great. Thanks a lot.

[Operator]

Thank you. One moment for our next question. Our next question is going to come from the line of Dan Leonard with UBS. Your line is open. Please go ahead.

[Dan Leonard, Managing Director and Research Analyst at UBS]

Thank you very much. I'm curious how you would describe the breadth of outperformance in Q3. Would you attribute the upside to a narrow set of one to two customers, or was it broader than that?

[August Troendle, CEO at Medpace]

No, Dan. In terms of what? Revenue?

[Dan Leonard, Managing Director and Research Analyst at UBS]

Yeah, exactly. Just looking at the revenue in Q3 compared to Q2, it looks like the growth came in top five. It came in metabolic. I'm just looking for color on breadth versus what otherwise might suggest that there was just a big trial that landed in the quarter.

[August Troendle, CEO at Medpace]

Yeah, Kevin, you want to?

[Kevin Brady, CFO at Medpace]

Yeah, yeah. Dan, I'd say it's pretty broad-based. Certainly, some of that was just influenced by the pass-throughs. Pass-throughs continued to increase. I think for the quarter, we were right around 42%. That certainly had an influence. Also, just the carryover of the improvements that we saw coming out of our conversation in Q2, where we saw improved funding in those studies progressing forward, the fewer cancellations in the second quarter, and that translating further into the third quarter. It's pretty broad-based. I wouldn't say it's isolated to a handful of studies.

[Dan Leonard, Managing Director and Research Analyst at UBS]

Okay. Appreciate that. Just a quick follow-up. Do you need to accelerate headcount growth further to service your sales forecast for next year, or is that low single-digit growth rate in headcount growth the right number?

[Jesse Geiger, President at Medpace]

Yeah, we expect headcount acceleration as we head into next year.

[Dan Leonard, Managing Director and Research Analyst at UBS]

Got it. Thank you very much.

[Operator]

Thank you. One moment for our next question. Our next question will come from the line of Luke Sergott with Barclays. Your line is open. Please go ahead.

[Luke Sergott, Director of Healthcare Equity Research at Barclays]

Great. Thanks for the questions. I'm also one of those that thought that there would be an air pocket. I just want to talk about the competitive win rate that you guys are seeing. You know, we're hearing from some of the larger CROs that typically haven't played in your part of the market, that they're going to start competing or entering or bidding on some of this business. Are you guys starting to see the likes of them show up or just any color around that?

[August Troendle, CEO at Medpace]

Yeah. They've always been there. I don't know about the additional effort or attention there. Certainly, there's a lot of talk about it, but we see the same players, and it is the large providers that we're often competing against. Our win rate has been okay. I mentioned last quarter it was actually down a little, but awards were actually good because the total decisions were elevated. Our win rate did come back up this quarter, and some fewer number of decisions, but again, good awards. We don't see a trend towards greater competition causing our win rate to deteriorate. There has been some movement over the last year or so to bring more providers to an opportunity. Instead of what you'd often see was three, maybe four CROs, now it's often six, or even more. That obviously reduces the win rate a little bit for everybody.

[August Troendle, CEO at Medpace]

I think you're correct for those situations, and I think our competitive position is very strong.

[Luke Sergott, Director of Healthcare Equity Research at Barclays]

Great. I guess a follow-up here, not to beat a dead horse, but on the burn rate and kind of how you're thinking about that through next year, where do you think that, like, not even through the end of next year, but where do you think that this kind of settles out as we think about kind of the out years? Could it be more elevated versus what you had in, let's say, before it started ramping up in like the high teens?

[Kevin Brady, CFO at Medpace]

I don't think we can answer that question in terms of long term. It's a lot dependent on our mix of programs, where they are in their life cycle. It depends on future bookings. If you go back to a couple of years, coming out of COVID, when our bookings were very strong, our burn rate came down quite a bit. It is influenced by how things are progressing, from award notifications into programs in the backlog. It's hard to say. Our range has been quite wide.

[Luke Sergott, Director of Healthcare Equity Research at Barclays]

All right. Great, thanks.

[Operator]

Thank you. One moment for our next question. Our next question comes from the line of Justin Bowers with DB. Your line is open. Please go ahead.

[Justin Bowers, Equity Research Analyst at DB]

Hi. Thank you, and good morning, everyone. I just want to follow up on Luke's comment and your remarks on the win rate, August. You said fewer decisions, but good awards, and the win rate was up. Are we to infer that your average award size was larger, or at least substantial this quarter? That's part one. Part two is, can you give us a sense of how your conversion or retention or win rates have been trending, call it, over the last couple of years of programs that progress from phase two to phase three?

[August Troendle, CEO at Medpace]

Yeah. I don't think there's been any change in that. You know, it's kind of all over the map, but, you know, usually, we can progress from phase two to three. You know, there's a lot of times that products in our clientele are sold or moved to someone else. Sometimes we also just don't win the phase three. We're considered not strong enough in a particular market or something. I don't know that that's changed at all.

[Justin Bowers, Equity Research Analyst at DB]

Okay. In terms of the award size in the quarter?

[August Troendle, CEO at Medpace]

I'm sorry. I don't actually have that. Anybody on the line have that?

[Kevin Brady, CFO at Medpace]

I mean, it's pretty normal, I would say, Justin. There's been no significant decisions. Remember, you know, decisions where we're notified of an award, those don't go in the backlog, right? Those fit into that kind of pre-backlog bucket. I wouldn't say there was anything out of the ordinary in the quarter from a decision standpoint.

[Justin Bowers, Equity Research Analyst at DB]

Okay. In terms of the pre-backlog, how does the therapeutic mix of that compare to the revenue that you're showing right now? Just to sort of frame things a little bit, like oncology is 30%, was 30% in Q3, and metabolic was 27%. When you look at the pre-backlog, is it over-indexed or under-indexed relative to those two therapeutic areas?

[August Troendle, CEO at Medpace]

It's over-indexed in metabolic, as you might expect.

[Justin Bowers, Equity Research Analyst at DB]

Okay. All right. Thanks so much.

[August Troendle, CEO at Medpace]

Not massively, but you know, it's a higher proportion. You know, that again fits in with what we're currently seeing and burning.

[Operator]

Thank you. One moment for our next question. Our next question will come from the line of Eric Coldwell with Baird. Your line is open. Please go ahead.

[Eric Coldwell, Managing Director at Baird]

Thanks very much. Good morning. I have maybe three. First, on the preliminary views of 2026, talking about the revenue outlook. If we run various inputs on what the fourth quarter service revenue might look like, and also what does low double-digit growth mean in 41%-42% pass-throughs, you can run various scenarios. They all lead to service revenue implied growth or preliminary view growth of being somewhere in the upper mid-single digits to low double digits growth. Is that your interpretation as well, or am I missing something?

[August Troendle, CEO at Medpace]

I believe you're mad. I don't know, Kevin, do you have a comment on that?

[Kevin Brady, CFO at Medpace]

Eric, did you say that again? Upper mid-double digits?

[August Troendle, CEO at Medpace]

Yeah, I don't know. Upper single.

[Kevin Brady, CFO at Medpace]

100 million.

[Eric Coldwell, Managing Director at Baird]

Oh, sorry. Go ahead.

[August Troendle, CEO at Medpace]

Go ahead, Evan. Go ahead. Say it again.

[Eric Coldwell, Managing Director at Baird]

Yeah. Look, I mean, it's going to be annoying on the call here, but I don't know if you're going to do $400 million of service revenue in Q4, $410 million. I don't know what that number is. There's various bases from which we have to grow. If I model low double digit revenue growth and I take it all the way up to 12.5%, which is my view of the low end of low double or the high end of low double digit, and then I say pass-throughs at the low end of mix, 41%, even using various inputs like that, I'm coming up with service revenue growth somewhere in the mid to upper single digits on the low end of the range up to low double digits on the high end of the range. The only reason I'm focusing on that. Yeah.

[Kevin Brady, CFO at Medpace]

That's fair. Yeah, that's fair.

[Eric Coldwell, Managing Director at Baird]

Yeah. I thought, and maybe I'm still taking too many crazy pills here, but I thought last quarter we came off thinking it was going to be more like 15% service revenue growth. I, you know, maybe I misinterpreted comments last quarter, but admittedly, I was a bit higher on my service revenue outlook for next year.

[August Troendle, CEO at Medpace]

Yeah. I don't think we made any comments about next year's growth at all, let alone service revenue.

[Eric Coldwell, Managing Director at Baird]

I might have misinterpreted something. On the pre-backlog, the three to six, or I'm sorry, you said pre-backlog, you kind of again confirmed that it's above backlog. It's above $3 billion. I think there's a range out there of where it might be. You know, obviously, more than three, but less than X. I was hoping you could give us a little more specificity because I still think there's a lot of confusion on the street about these quarterly net new business awards. They're really not things that are happening in the quarter. It's the amalgamation of everything you've built up in the past that's moving into revenue generation phase. Having a sense on that bucket, is it $4 billion, $5 billion, $6 billion?

[Eric Coldwell, Managing Director at Baird]

Having a sense on that bucket could help, maybe help people think about what magnitude of that pre-backlog actually needs to convert to revenue generation phase whereby it then goes into your reported backlog.

[August Troendle, CEO at Medpace]

Right. I mean, look, it's part of an overall pipeline. There are firm awards at that point, but it is part of an overall pipeline. We do tend to see or have seen some very large cancellations there. We don't treat it like backlog because until the study is actually running and gets patients in, there is a higher risk. I don't want to get into putting numbers on that and then tracking just the size of it and the size of what other buckets, etc. I think we provide adequate information on the overall parameters that we look at and measure and pay attention to to give trends. The bucket is somewhere under $4 billion, right?

[Eric Coldwell, Managing Director at Baird]

Okay. That's super helpful, actually. Last one, thank you for allowing my time here. You made a comment earlier about this total bucket of awarded work that isn't in backlog being up 30% year-over-year. In that same vein of commentary, you said something about haven't gotten to first patient in. I got thinking, are you basically telling us that you don't put an award here until you actually have the first patient in the study? I used to think that the parameter was that you needed to be within 30 days of revenue generation, but maybe the real parameter is you actually are live in the study generating revenue before you put something into street-facing backlog.

[August Troendle, CEO at Medpace]

That's correct. It could be that there's revenue prior to, you know, and even sometimes a chunk of revenue prior to reaching backlog.

[Eric Coldwell, Managing Director at Baird]

This is how the revenue started growing before the headcount did. I'm just trying to get a sense. Like things started, the work sped up maybe a bit faster than you were thinking six months ago when you had some cancels and market uncertainty. The work sped up sometime between April and, you know, July. The tone and the messaging clearly shifted. It just feels like maybe this work really picked up pace and you were sitting right there, not quite in backlog, but suddenly this stuff is in backlog and now, you know, we get the big revenue spike. I'm just trying to get a sense on, you know, what really are these dynamics between reported backlog, the pre-backlog, and then the, you know, the notion that your revenue actually accelerated pretty quickly before your headcount growth did. That.

[August Troendle, CEO at Medpace]

Yes, you're right. We put it in very late. Generally, a patient doesn't mean that, but a patient's got to be, you know, kind of, we think a patient's going to go in in a very short, near term. It's right about when you get the first patients in. There's other reasons why there might be some concern on that. There are studies where we have a manufacturing problem. Actually, that was an issue recently, and in terms of, it's right up to a lot of work being done and we haven't got the patient in, but there's an uncertainty around drug availability. There may be some other, they need some decision at some regulatory authority to move forward with this. Those kind of things we don't put in backlog. There are a number of gates. Things can be very close to large-scale revenue generation when they go into backlog.

[Eric Coldwell, Managing Director at Baird]

Very helpful. Thanks again, guys. I appreciate it.

[Operator]

Thank you. One moment for our next question. We have a follow-up question from the line of David Windley with Jefferies. Your line is open. Please go ahead.

[David Windley, Managing Director at Jefferies]

All right. Thanks for taking my follow-up. Eric asked one of the two I was going to follow up on. The other one is on your metabolic indexing. A lot of the inbound questions I get on this particular topic assume GLP-1. I wondered if, August, you'd be willing to provide some color on the breadth or lack of your participation in metabolic. My sense is that it is broader than just GLP-1 and maybe mostly non-GLP-1, but I wondered if you'd be willing to comment on that just so we'd have a better perspective of what your, you know, what the drivers are of that fast-growing part of your revenue and backlog things.

[August Troendle, CEO at Medpace]

Yeah. GLP-1 is probably two-thirds of our obesity, so it is a big chunk. You know, in the GLP-1 class, it is a large portion of the overall obesity, but it's not all of it. There's still a fair amount of other.

[David Windley, Managing Director at Jefferies]

Is that spread across multiple clients, I would presume?

[August Troendle, CEO at Medpace]

Oh, yes.

[David Windley, Managing Director at Jefferies]

Great. Thank you.

[August Troendle, CEO at Medpace]

Yep.

[Operator]

Thank you. I'm showing no further questions, and I would like to hand the conference back over to Lauren Morris for closing remarks.

[Lauren Morris, Director of Investor Relations at Medpace]

Thank you for joining us on today's call and for your interest in Medpace. We look forward to speaking with you again on our fourth quarter 2025 earnings call.

[Operator]

This concludes today's conference call. Thank you for participating, and you may now disconnect. Everyone, have a great day.

Participants

Executives

• Lauren Morris, Director of Investor Relations
• August Troendle, CEO
• Jesse Geiger, President
• Kevin Brady, CFO

Analysts

• Charles Rhyee, Managing Director at TD Cowen
• Ann Hynes, Senior Healthcare Services Equity Analyst and Managing Director at Mizuho
• Michael Cherny, Senior Managing Director at Leerink Partners
• David Windley, Managing Director at Jefferies
• Max Smock, Equity Research Analyst at William Blair
• Analyst at Truist Securities
• Dan Leonard, Managing Director and Research Analyst at UBS
• Luke Sergott, Director of Healthcare Equity Research at Barclays
• Justin Bowers, Equity Research Analyst at DB
• Eric Coldwell, Managing Director at Baird