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    DGX
    Earnings call· Jun 2026(Q2 FY26)

    QUEST DIAGNOSTICS INC DGX

    Jul 23, 2026 Source

    Executive summary

    Quest Diagnostics Q2 FY26 — Strong Organic Growth and Raised Full-Year Guidance

    Quest Diagnostics delivered a strong second quarter, marked by robust organic revenue and adjusted EPS growth, leading to an upward revision of its full-year guidance. The company's strategic focus on physician, hospital, and consumer channels, alongside advanced diagnostics, is driving sustained demand. While operating margins faced headwinds from strategic investments and business mix, management expects full-year expansion and remains committed to operational excellence and innovation.

    Highlights

    5
    • Consolidated revenues grew by 10.2% to $3.04 billion, driven by broad clinical demand and strategic collaborations.

    • Adjusted diluted EPS increased by 19.1% to $3.12, reflecting strong operating performance.

    • Organic revenue growth was robust at 10%, with Diagnostic Information Services up 10.1% organically.

    • Full-year revenue guidance raised to $11.95 billion - $12.05 billion, and adjusted EPS guidance raised to $11.05 - $11.25.

    • Volume, excluding Corewell and Fresenius, grew by 4.1%, indicating strong underlying demand.

    Concerns

    5
    • Reported operating income margin decreased by 80 basis points to 15.1% of revenues, impacted by investments and business mix.

    • Adjusted operating income margin decreased by 40 basis points to 16.5% of revenues, primarily due to Nova investments, Corewell/Fresenius mix, and deferred compensation expenses totaling 70 basis points.

    • Total revenue per requisition was down 2.8% year-over-year due to the Corewell and Fresenius business mix.

    • Higher fuel costs and increased Nova expenses are anticipated in the second half of the year, impacting margins.

    • Days Sales Outstanding (DSOs) increased due to a shift in business mix towards client-bill and consumer segments.

    Guidance & targets

    18
    CategoryTargetConfidence
    Full-year 2026 Revenue
    $11.95 billion - $12.05 billion
    high materiality
    High
    Full-year 2026 Revenue Growth Rate
    8.3% to 9.2%
    high materiality
    High
    Full-year 2026 Reported EPS
    $9.97 to $10.17
    high materiality
    High
    Full-year 2026 Adjusted EPS
    $11.05 to $11.25
    high materiality
    High
    Full-year 2026 Cash from Operations
    approximately $1.8 billion
    medium materiality
    High
    Full-year 2026 Capital Expenditures
    approximately $550 million
    medium materiality
    High
    Full-year 2026 Operating Margin
    expand versus the prior year
    high materiality
    High
    Full-year 2026 Share Count
    slightly below 2025
    low materiality
    Medium
    Full-year 2026 Interest Expense
    consistent with 2025
    low materiality
    Medium
    Full-year 2026 Adjusted Effective Tax Rate
    consistent with 2025
    low materiality
    Medium
    Full-year 2026 Fuel Costs Impact
    close to about $10 million
    medium materiality
    High
    Full-year 2026 Nova Expenses in H2
    about 70% of the full year
    medium materiality
    High
    ACA Exchange Subsidy Expiration Revenue Impact
    30 basis point impact
    medium materiality
    High
    Corewell Health Revenue Contribution
    $250 million
    medium materiality
    High
    Corewell Health Margin Rate
    low single digits, improving to mid-single digits
    medium materiality
    High
    PAMA RESULTS Act Rates
    stay flat for '27 and '28
    high materiality
    Medium
    PAMA RESULTS Act New Rates Effective Date
    2029
    high materiality
    Medium
    PAMA RESULTS Act Annual Cut Cap
    no more than 5% cuts per year
    high materiality
    Medium

    Segment performance

    13
    SegmentRevenueYoYQoQMargin
    Consolidated
    Consolidated revenues for the second quarter.
    $3.04 billion10.2%
    Consolidated Organic
    Consolidated organic revenue growth.
    10%
    Diagnostic Information Services
    Reflecting strong growth in physician, hospital, and consumer channels.
    Organic Growth: 10.1%
    10.3%
    Physician Channel
    Driven by broad-based demand for clinical innovations, new customer wins, and increased business with existing customers.
    high single-digit
    Hospital Channel
    Primarily from Co-Lab Solutions with Corewell Health in Michigan.
    double-digit
    Hospital Channel - Core Reference Business
    Hospital labs referring work out to Quest Diagnostics.
    Volume Growth: slightly higher than mid-single digits
    mid-single digits
    Hospital Channel - Co-Lab Business (ex-Corewell)
    Same-store sales growth.
    mid-single-digit
    Consumer Health Channel
    Questhealth.com continued to generate robust revenue growth and strong demand for existing wellness panels and new services.
    robust
    Advanced Cardiometabolic and Endocrine
    Includes tests like ApoB, Lp(a), and liver fibrosis testing.
    double digits
    Autoimmune
    Driven by analyzer solution for diagnosing autoimmune disorders.
    double digits
    Brain Health
    Across portfolio of AD detect blood tests, including amyloid beta, pTau, and other biomarkers.
    robust double-digit
    Oncology
    Includes Haystack MRD and other cancer tests.
    double digits
    Women's and Reproductive Health
    One of the five key clinical areas with double-digit revenue growth.
    double digits

    Operational metrics

    35
    Chronic Kidney Disease Patient Population
    36 million
    current

    Number of people in the U.S. with chronic kidney disease, relevant to Fresenius Medical Care collaboration.

    Invigorate Program Cost Savings and Productivity Improvements
    3%
    annual

    Company remains on track to deliver this target.

    Total Volume (Requisitions)
    13.1%YoY
    Q2 FY26

    Measured by the number of requisitions.

    Organic Volume
    13%YoY
    Q2 FY26

    Organic volume growth.

    Corewell Health and Fresenius Medical Care Volume Contribution
    9%
    Q2 FY26

    Contribution to total volume.

    Volume Excluding Corewell and Fresenius
    4.1%YoY
    Q2 FY26

    Underlying volume growth excluding strategic collaborations.

    Revenue per Requisition
    -2.8%YoY
    Q2 FY26

    Total revenue per requisition.

    Revenue per Requisition (Adjusted for Mix)
    2.9%YoY
    Q2 FY26

    Adjusted for the Corewell and Fresenius business mix.

    Unit Price Reimbursement
    flat
    Q2 FY26

    Consistent with expectations.

    Adjusted Operating Income
    $502 millionvs $466 million LY
    Q2 FY26

    Increase largely due to organic revenue growth.

    Operating Margin Impact from Nova
    20 bps
    Q2 FY26

    Impact on operating income as a percent of revenues.

    Operating Margin Impact from Corewell and Fresenius Mix
    30 bps
    Q2 FY26

    Impact on operating income as a percent of revenues due to lower operating margin rate associated with ramp-up.

    Operating Margin Impact from SDCP
    20 bps
    Q2 FY26

    Impact on operating income as a percent of revenues from supplemental deferred compensation expenses.

    Total Operating Margin Impact from Specific Drivers
    70 bps
    Q2 FY26

    Sum of Nova, Corewell/Fresenius mix, and SDCP impacts.

    Adjusted EPS Growth
    19.1%YoY
    Q2 FY26

    Improvement in EPS largely driven by strong organic operating performance.

    Adjusted EPS Growth (Excluding One-time Tax Benefit)
    15.3%
    Q2 FY26

    Excluding the $0.10 EPS contribution from favorable resolution of tax contingencies.

    One-time Tax Benefit Contribution to EPS
    $0.10
    Q2 FY26

    From favorable resolution of various tax contingencies.

    ACA Req Volume Growth
    -8%
    Q2 FY26

    Volume growth for requisitions from ACA exchanges.

    ACA Test per Req Growth
    6%
    Q2 FY26

    Increase in tests per requisition from ACA exchanges.

    ACA Test Volume Growth
    -2%
    Q2 FY26

    Total test volume from ACA exchanges.

    ACA Revenue Impact
    flattish
    Q2 FY26

    Due to mix of tests, test per req, and payer mix offsetting volume decline.

    Fresenius Medical Care Revenue Increase
    ~$100 million
    YoY

    Significant revenue increase year-over-year from this collaboration.

    Patient Concessions as % of Revenues
    ~5%slightly improved vs LY
    current

    Tracked closely, no material deterioration.

    Days Sales Outstanding (DSOs)
    upYoY and sequentially
    Q2 FY26

    Due to higher DSOs and longer collection periods for client bill and consumer segments.

    Tests per Requisition
    >4.5vs 3.5-4 pre-COVID
    current

    Continuing to improve, making a big difference on revenue per requisition.

    Consumer Business (Direct and Indirect) Size
    $250 million
    FY25

    Sized last year.

    Consumer Business Growth Rate
    high side of 20-30%
    FY26

    Expected growth rate for 2027, currently performing at the high end.

    PAMA Original Cuts Estimate
    $2.5 billion
    over 10 years

    Original estimates on PAMA cuts by [indiscernible].

    PAMA First 3 Cuts Actual Savings
    $4 billion
    over 3 years

    Actual savings from cuts executed in '18, '19, and '20, indicating the process did not work as intended.

    PAMA Data Collection End Date
    July 30
    CY26

    Current data collection process by CMS.

    PAMA Data Collection Results Expected
    late September, early August
    CY26

    Expected timing for CMS to report out on the data collection.

    PAMA Labs Submitted Data (Last Time)
    1%
    prior data collection

    Only 1% of labs submitted data, indicating a biased statistical sample.

    PAMA Delays
    6
    historical

    Number of times PAMA implementation has been delayed, acknowledging unsustainability of original cuts.

    Elevance Access States
    4
    Q1 FY25

    States where Quest gained access with Elevance.

    Flatiron Health Onco EMR Molecular Profiling Integration Clinicians
    4,700
    current

    Number of clinicians Flatiron's platform reaches, for broader access to cancer tests like Haystack MRD.

    Industry KPIs

    2
    MetricValueDetails
    Utilization trends13.1%%
    Adjusted EPS EBITDA leverage guidance$3.12 (Adjusted EPS), $2.84 (Reported EPS)USD

    Product announcements

    2
    ProductTypeDetails
    IntelliDrawlaunch
    AI tool for patient service centersroadmap

    Deals & partnerships

    5
    Corewell HealthCo-Lab Solutions

    Collaboration in Michigan, contributing to double-digit revenue growth in the hospital channel. JV expected to launch early next year.

    Fresenius Medical CareCollaboration

    Fostered new capabilities for serving nephrologists and other providers caring for chronic kidney disease patients.

    Regional health system in CaliforniaCo-Lab agreement

    New Co-Lab agreement with a nonprofit regional health system, described as a supply chain relationship.

    Flatiron HealthOnco EMR Molecular Profiling integration platform

    Extends access to cancer tests such as Haystack MRD to Flatiron's 4,700 clinicians and other providers nationwide. Pilot began with American Oncology Network.

    American Oncology NetworkPilot of Flatiron Health integration

    Leading community oncology organization piloting the Flatiron Health integration for Haystack MRD.

    Risks & headwinds

    5
    ACA exchange subsidy expirationFY26

    30 basis point impact on full-year revenue

    Mitigation: Sicker patient mix leading to higher test per requisition and flattish revenue impact from the exchange business; full-year guidance already incorporates this impact.

    Project Nova expensesH2 FY26

    Increased spend in H2 2026 (70% of full-year expenses in H2 vs 60% previously)

    Mitigation: Continued strong volume growth and the lapping of Corewell/Fresenius dilution in Q4 are expected to offset these headwinds and lead to full-year operating margin expansion.

    Higher fuel costsH2 FY26

    Close to $10 million impact for FY26 (high end of range)

    Mitigation: Continued strong volume growth and the lapping of Corewell/Fresenius dilution in Q4 are expected to offset these headwinds and lead to full-year operating margin expansion.

    PAMA reimbursement riskCY27 onwards

    Potential for new rates effective January 1 if current data collection leads to cuts and RESULTS Act is not passed or another delay not secured.

    Mitigation: Advocacy for the bipartisan RESULTS Act, which proposes a third-party data collection and would stabilize rates for 2027-2028 with a 5% annual cut cap thereafter. If RESULTS Act fails, company will push for another delay.

    Weather disruptionQ3 FY26

    Unquantified

    Mitigation: Building 'weather req' into outlook; last year had very little disruption.

    What to watch in Q3 FY26

    5

    PAMA Data Collection Results

    late September, early October
    CurrentData collection ends July 30
    TargetCMS report on data quality and potential new rates

    Why it matters

    The outcome will determine the near-term reimbursement landscape for laboratory testing, impacting revenue and profitability.

    We expect to hear something, let's say, late September, early August.

    Q&A highlights

    5

    What is driving double-digit growth in the hospital channel, how are relationships progressing, and are there any bad debt concerns given broader hospital headwinds?

    Management clarified that the hospital business, including reference and Co-Lab (ex-Corewell), is seeing mid-single-digit growth. They confirmed no slowdown in reference testing or Co-Lab same-store sales and stated that bad debt is not a concern, with no adverse trends observed in collections from hospitals or patient concessions.

    Our core reference business, which is hospital labs referring work out to Quest Diagnostics, the revenue growth was mid-single digits and actually the volume growth slightly higher than that. So we are seeing no slowdown at all from reference testing coming to Quest Diagnostics.

    asked by Erin Wilson Wright · answered by James Davis

    2 min read6 chapters

    Detailed Narrative

    01

    Strategic Execution and Growth Drivers

    Quest Diagnostics demonstrated strong performance in Q2 FY26, driven by focused execution of its strategy to connect people and providers with innovative testing. The company reported broad clinical demand from physicians, hospitals, and consumers, alongside increased volume from collaborations with Corewell Health and Fresenius Medical Care. Growth was particularly strong in advanced diagnostics across five key clinical areas: advanced cardiometabolic and endocrine, autoimmune, brain health, oncology, and women's and reproductive health, with double-digit revenue increases in several of these segments.

    02

    Operational Excellence and Innovation

    The company remains on track to achieve 3% in annual cost savings and productivity improvements through its Invigorate program. Investments in AI and automation are enhancing operations, services, and customer experiences. Examples include the installation of the Hologic Genius digital diagnostic system in additional labs for Pap test analysis, front-end specimen processing automation, the launch of IntelliDraw (a web-based tool for specimen collection guidance), and the planned implementation of an AI tool at patient service centers to streamline supply chain management.

    03

    Hospital Channel Dynamics

    The hospital business, encompassing both reference testing and Co-Lab solutions, saw significant growth, primarily fueled by the Corewell Health relationship. The core reference business experienced mid-single-digit revenue growth, and the Co-Lab business (excluding Corewell) also showed mid-single-digit same-store sales growth. Management noted a strong pipeline for potential collaborations and acquisitions of hospital outreach and independent labs, driven by hospitals seeking partners to improve quality, expand access to innovations, and maximize cost efficiencies.

    04

    Consumer Health Channel Performance

    The consumer health channel continued to generate robust revenue growth, with questhealth.com showing strong demand for existing wellness panels and new services like thyroid testing. The company is attracting new partners due to its diagnostic innovations, flexible technology integrations, and scale. The total consumer business (direct and indirect), which was approximately $250 million last year, is currently growing at the high end of its projected 20-30% range for 2027.

    05

    PAMA Outlook and Advocacy

    Management discussed three potential outcomes for PAMA: new rates implemented by CMS based on current data collection (ending July 30), passage of the RESULTS Act, or another delay. Quest Diagnostics is actively advocating for the RESULTS Act, which has strong bipartisan support and proposes a third-party group to collect adjudicated claims, aiming for a more effective and fair determination of market prices for lab data. If passed, the Act would keep rates flat for 2027 and 2028, with new rates in 2029 capped at 5% annual cuts.

    06

    Haystack MRD Milestones

    Key milestones were achieved for Haystack MRD during the quarter, including New York State approval, which allows commercial efforts to extend to all 50 states. This approval is significant due to New York's rigorous quality criteria. Additionally, Quest Diagnostics became the largest reference lab to extend access to cancer tests like Haystack MRD through Flatiron Health's Onco EMR Molecular Profiling integration platform, with a pilot underway and a broader rollout planned for later this year to Flatiron's 4,700 clinicians.

    AI-generated summary of the company’s earnings call. Not investment advice.