Medpace (MEDP) Q4 2025 earnings summary

Executive summary

• Q4 2025 revenue rose 32% year-over-year to $708.5 million; full year revenue was $2.53 billion, up 20%.

• Net new business awards in Q4 were $736.6 million, up 39.1%; full year awards totaled $2.65 billion, up 18.7%.

• Backlog cancellations reached a multi-year high, leading to a Q4 net book-to-bill ratio of 1.04.

• Oncology was the largest therapeutic area in 2025, accounting for 31% of revenue; small biopharma contributed 79%.

• The business environment is described as adequate and improving, with strong oncology bookings and elevated metabolic cancellations.

Financial highlights

• Q4 2025 EBITDA was $160.2 million (22.6% margin), up 20% year-over-year; full year EBITDA was $557.7 million (22% margin), up 16.1%.

• Q4 net income was $135.1 million, up 15.5%; full year net income was $451.1 million, up 11.6%.

• Q4 EPS was $4.67 (up from $3.67); full year EPS was $15.28 (up from $12.63).

• Free cash flow for Q4 was $188.1 million; year-end cash and equivalents were $669.4 million.

• Cash flow from operations in Q4 was $192.7 million; year-end cash balance was $497 million.

Outlook and guidance

• 2026 revenue expected at $2.755–$2.855 billion, representing 8.9%–12.8% growth.

• 2026 EBITDA forecasted at $605–$635 million, up 8.5%–13.9%; net income expected at $487–$511 million.

• 2026 EPS guidance is $16.68–$17.50; assumes 18.5%–19.5% tax rate and no further share repurchases.

• Reimbursable costs expected to be 41%–42% of revenue in 2026, with higher levels early in the year.

• Headcount growth in 2026 anticipated in the mid to high single digits.