Bausch Health Companies Inc. reported its fourth‑quarter and full‑year 2025 financial results, posting consolidated revenue of $10.27 billion—up 7% year‑over‑year and 5% on an organic basis—while adjusted EBITDA reached $3.54 billion, a 7% increase from 2024. The company’s adjusted net income attributable to Bausch Health was $1.40 billion, only a modest $6 million higher than the $1.39 billion reported in 2024, and adjusted earnings per share of $1.08, which missed the consensus estimate of $1.21 by $0.13. GAAP earnings per share were a loss of $0.30, further underscoring the earnings miss. Operating cash flow for the year was $1.40 billion, down from $1.60 billion in 2024, indicating a decline in cash generation despite revenue growth.
The fourth‑quarter revenue of $2.80 billion represented a 9% year‑over‑year increase and a 6% organic rise, driven by double‑digit growth in the Salix and Solta Medical segments—Salix up 11% and Solta up 18%—and a 10% rise in Bausch + Lomb revenue to $1.41 billion, led by a 16% increase in its pharmaceuticals sub‑segment. Xifaxan revenue grew 11% for the year, while Thermage revenue expanded 19% in Asia Pacific, illustrating strong demand in both therapeutic and aesthetic markets.
Adjusted EBITDA growth was supported by the robust performance of Salix and Solta, but the company’s margin compression—adjusted gross margin fell 80 basis points to 71.6%—contributed to the earnings miss. The decline in operating cash flow reflects higher interest expenses and a one‑time charge related to debt restructuring, which offset the cash generated by the operating activities. The EPS miss, despite a revenue beat, signals that cost pressures and pricing headwinds are eroding profitability.
Management highlighted the company’s eleven consecutive quarters of year‑over‑year growth in revenue and adjusted EBITDA, excluding Bausch + Lomb, and noted that full‑year results came in above guidance on all key metrics. "The fourth quarter marks our eleventh consecutive quarter of year‑over‑year growth in Revenue and Adjusted EBITDA for Bausch Health, excluding Bausch + Lomb. These results highlight our global team's unwavering commercial rigor and operational excellence, as full‑year results came in above our guidance on all key metrics," CEO Thomas J. Appio said. The company also emphasized that "Salix and Solta delivered double‑digit top line growth of 11% and 18%, respectively," and that "Xifaxan revenue increased 11% for the year," while "Thermage revenue growth of 19% for the year, anchored in Asia Pacific."
Bausch Health reiterated its full‑year 2026 guidance, projecting revenue between $10.625 billion and $10.875 billion and adjusted EBITDA between $3.875 billion and $4.000 billion. The guidance reflects management’s confidence in continued top‑line momentum, particularly in the Salix and Solta segments, while acknowledging the need to manage margin pressures and cost inflation. The company also reiterated its strategic focus on expanding its aesthetic device business in China through the acquisition of Shibo and on maintaining a disciplined debt‑reduction program.
Headwinds include the anticipated impact of the Inflation Reduction Act on Xifaxan pricing in 2027 and the expected entry of generic competition in 2028, which could compress future revenue. Tailwinds are the strong growth in the aesthetic device market, the expansion of the Solta Medical portfolio, and the acquisition of Shibo in China, which broadens the company’s geographic reach. The earnings miss prompted a 4% decline in after‑hours trading, reflecting investor concern that the company’s profitability is not keeping pace with its revenue growth.
The company’s results underscore a complex picture: robust revenue growth driven by high‑margin therapeutic and aesthetic segments, but earnings and cash flow underperformance due to margin compression, cost inflation, and strategic debt restructuring. Investors will likely reassess the company’s valuation and future earnings potential in light of these dynamics.
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