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Diplomat Pharmacy Inc (DPLO)
Q1 2019 Earnings Call
May. 7, 2019, 8:30 a.m. ET
Contents:
- Prepared Remarks
- Questions and Answers
- Call Participants
Prepared Remarks:
Operator
Hello and welcome to Diplomat's First Quarter 2019 Conference Call. (Operator Instructions)
I'd like to turn the call over to Terri Anne Powers, Vice President of Investor Relations.
Terri Anne Powers -- Vice President, Investor Relations
Good morning everyone. As you are aware Diplomat issued First Quarter 2019 financial results before market opened today. Before I turn it over to our Chairman and CEO Brian Griffin, for his remarks, I will read the following safe harbor statement. Some of the company's statements made on this conference call will be forward-looking statements, which may include financial projections or other statements of the company's plans, objectives, expectations or intentions. These matters involve certain risks and uncertainties. The company's actual results may differ significantly from those projected or suggested in any forward-looking statement due to a variety of risks and uncertainties, which are discussed in detail in the earnings release just issued, in the company's annual 10-K report and subsequent filings with the Securities and Exchange Commission. These statements speak only as of the date hereof or the date specified on the call and except as required by law the company does not undertake any obligation to update or otherwise release publicly any revisions to its forward-looking statements.
During this call, the company will also discuss non-GAAP financial measures. Please refer to the tables included in the company's earnings press release just issued for a reconciliation of these non-GAAP measures to the comparable GAAP measures and a related discussion thereof. A replay of the call and associated slide presentation is accessible through a link on the Investor Relations page of the company's website and it will be available for 90 days.
I will now turn the call over to Brian Griffin. Brian, please go ahead.
Brian Griffin -- Chief Executive Officer and Chairman
Thank you Terri Anne and good morning everyone. This morning we'll discuss our first quarter results and then provide an update on our strategy, execution and outlook. But first I'd like to welcome Dan Davison, Diplomat's new CFO to the team. As of today he's been on board almost a month and I and the rest of the Diplomat team are looking forward to working with him to execute on the company's strategy. In addition as you've seen in our press release we've appointed Dave Loschinskey as Chief Operating Officer effective May 2. Dave was most recently Diplomat's Chief Information Officer.
In addition to his CIO duties, Dave was responsible for service reliability across all of Diplomat's operations and leading our change management processes. Dave is a seasoned operations executive with 27 years of experience in a variety of operations and IT roles, including more than 15 years in the specialty pharmacy industry. Dave's longtime focus on service reliability and operational excellence along with a laser focus on patient care have differentiated him and made him more than a technologist.
This morning we reported $1.3 billion in revenue for the first quarter, down 6% year-over-year. First quarter revenue was driven by 1% Specialty segment revenue growth, while as expected PBM sales were down almost 50%. Adjusted EBITDA in the first quarter was $23 million compared to $40 million in the prior year. Adjusted EBITDA results were impacted by top line performance as well as a one-time charge of $3 million for prior years to establish estate sales and gross receipts tax liability. Excluding this charge, adjusted EBITDA would have been $26 million.
In the first quarter, we added six limited distribution drugs, bringing our total portfolio to more than 130. LDDs added were in oncology, multiple sclerosis and other rare diseases. We continue to invest in incremental sales and account management talent across all of our businesses in order to drive incremental volumes to Diplomat and position the company for future growth. We have a robust pipeline of prospects for 2019 and 2020 across the entire company.
For health plans, we continue to have a strong pipeline and are in advanced discussions to expand existing partnerships or be awarded new business in core specialty pharmacy and infusion. We continue to see strong interest from mid-sized health plans and large employers in particular given our access to oncology, limited distribution drugs and our associated clinical care model. Aggressive management in this area is top of mind for these payers because it represents significant cost driver within their benefit.
Within our infusion therapeutic area, Diplomat continues to be successful and partnering with major health plans as a specialty infusion partner and in 2019 is on track to sign more participating provider agreements than in 2018. We continue to observe strong performance in this area and remain positive for 2019.
In addition we are seeing strong activity from hospital systems and are encouraged by recent contract awards. Contracts awarded were with new clients and expanded business with existing clients to provide wraparound LDD access and clinical services and to our 340B services. These awards underscore that our value proposition to the hospital system market is winning. These opportunities are a direct result of the investment in 2018 in our health plan and hospital systems focused sales team and the relationships that we're building in the market. We're encouraged that our value proposition is resonating in the market and we continue to expect additional awards in the coming months.
We don't discuss our pharma services business unit EnvoyHealth very much, but we have recently been awarded new agreements with several pharmaceutical manufacturers to provide hub and medical information services. We're also seeing growth in EnvoyHealth's digital therapeutic service line.
For our PBM business, we continue to receive frequent new RFP requests for both 2019 and 2020. This year, we're seeing requests from larger clients versus our historical focus of 500 to 5000 members. The consultant community is recognizing our improved operating performance in specialty pharmacy clinical value proposition and are including us in larger client RFPs.
In addition, CastiaRx is making a concerted effort to develop opportunities with larger clients. We've seen RFPs from some larger corporations, which if awarded would be a substantial opportunity relative to the size of the business today. We still expect to be awarded new business in 2019. In addition, our 2020 pipeline is extremely encouraging. It is substantially higher today than it was at the same time last year. We remain confident in our PBM strategy but as we previously indicated 2019 is a rebuilding year. We've significantly improved our operational performance and our service levels remain in line with industry standards. We remain focused on providing the best customer service, retaining clients and building new product offerings to position the company for growth in 2020 and beyond.
Moving to the regulatory environment. Since we last communicated with the market, CMS has provided further clarity surrounding the 2020 bidding process for Medicare Part D prescription drug plans to help reduce risk for participating entities given the uncertainty regarding the implementation of the HHS proposed rebate rule. While it is not certain that the government will implement the rule as of 1/1/2020, we continue to believe that implementation of the rule as it is written will not be material to our PBM business.
CastiaRx has limited government business today and associated rebates are expected to be immaterial in 2019. To the extent that rebates are eliminated at some point in the commercial market whether due to client demand or to congressional action, we still expect to shift profit levers to make up for the loss rebate profits. We've previously indicated that 2019 is a rebuilding year. We're focused on stabilizing the PBM business and have added incremental sales and account management resources to generate new business while maintaining industry-standard levels of customer service.
In Specialty, we've also committed incremental sales resources to combat competitive pressures to create new strategic partnerships with health plans and hospital systems and drive more volumes to Diplomat. We're also implementing operational efficiency initiatives to adjust our cost structure to reflect market conditions. While we remain concerned about increased competitive pressure in a tougher reimbursement environment, we remain encouraged by our pipeline of opportunity across all of Diplomat's businesses and we are continuing to take measures to improve operational efficiency. Our board and management team are singularly focused on rebuilding shareholder value and we remain open to all means of achieving that goal.
I'll now turn the call over to Dan for a review of our financial performance in the quarter. Dan?
Dan Davison -- Chief Financial and Treasurer
Thank you Brian and good morning everyone. It's a pleasure to be on board. As many of you know, I previously worked with and for Brian during the roughly 25 years we both worked at Medco. I'm happy to once again be working with Brian and I'm excited about working with the entire Diplomat team. I decided to join Diplomat because I saw an opportunity to join a great company with a long-standing reputation for strong clinical expertise and high touch patient care and apply my specialty pharmacy and PBM knowledge and experience to help support the company's strategy. And frankly, I'm also here because I believe in the leadership integrity and vision of Brian Griffin.
I've been on board about a month. So it's still early days. I'm currently in the process of evaluating the organization, it's systems and processes and anticipate having better insights by the next quarterly report. In the near term my priorities are first, to complete my deep dive business assessment and develop a plan of action focused on organizational efficiency with an eye on bottom line opportunities as well as ways to support our broader growth strategies through better data analytics and reporting. Second, to establish relationships with all of you and the broader analysts and investor community. Third, to improve working capital management in support of debt paydown and finally to support all opportunities for the enhancement of shareholder value.
Moving on to first quarter results. As Brian noted, total company revenue was approximately $1.3 billion, down $86 million compared to the prior year. Looking at revenue at the segment level in the first quarter, our Specialty segment generated revenue of $1.2 billion, up 1% from the prior year. Segment revenue growth benefited from brand price inflation but was almost fully offset by payer reimbursement compression and volume declines in certain therapeutic areas. Infusion sales grew 8% year-over-year, driven by higher volumes. Oncology sales were flat year-over-year as the benefit of brand inflation was offset by higher generic utilization, reimbursement compression and prescription volume declines.
As we noted during our last report, 2019 Specialty performance is being negatively impacted by increased competition, including narrowing of specialty pharmacy networks and member channel management reducing our volumes in certain therapies. CastiaRx recorded $98 million in revenue, down $94 million from the prior year as we realized the impact of previously disclosed lost business.
Taking a look at gross profit and margin. Total company gross profit was $79 million, down 12% year-over-year and gross margin was 6.3%, down 40 basis points compared to the prior year. Gross profit in the Specialty segment was $68 million, down 7% year-over-year and gross margin in the segment was down 50 basis point year-over-year to 5.8%. Both the gross profit and margin decline were the direct result of lower reimbursement and lower volumes within higher profit therapies.
Specialty prescription volumes increased 1% year-over-year to 225,000 driven by growth in infusion volumes, while other therapeutic area volumes were down year-over-year. Gross profit per script in the first quarter of 2019 was $298 per script compared to $318 per script in the prior year period. CastiaRx reported gross profit of $12 million in the quarter, down $6 million and generated a gross margin of 11.9% versus 9. 2% in the prior year. Gross margin improved year-over-year due to the loss of previously disclosed lower-margin business and the timing of rebate recognition in 2018, which suppressed our margins in the first quarter of the year.
Total company SG&A increased $1 million compared to the prior year to $83 million, primarily driven by investments in the company's sales and account management and executive teams in support of our growth strategy, offset by a decrease in amortization due to the impairment of intangibles in the fourth quarter of 2018 and lower acquisition-related expense. Activities to support operating efficiency remain on track and we continue to expect to generate more than $10 million in efficiencies this year.
Taken together, our consolidated adjusted EBITDA for the first quarter was $23 million, down 42% from the prior year period due to factors previously discussed. As Brian mentioned, our adjusted EBITDA was negatively impacted by a one-time charge for prior years of $3 million related to the establishment of a sales and use and gross receipts tax liability for certain states in which we do business. During our ongoing review of state nexus rules, we determined we have a probable liability in certain states. Our 2019 guidance factors in the future impact of this review. Net loss in the quarter was $14 million or $0.19 per share compared to a loss of $500,000 and $0.01 per share in the first quarter of 2018.
Turning to the balance sheet. This quarter, we implemented a new lease accounting standard. This standard requires companies to recognize a lease liability representing our obligation for all future lease payments measured on a discounted basis and a right of use asset on it's balance sheet. For Diplomat, this primarily relates to real estate operating leases. The adoption of this accounting rule resulted in the recording of a right of use asset of $28 million and a lease liability of $29 million on Diplomat's balance sheet as of January 1, 2019.
Our working capital improved by $8 million compared to December 31, 2018, driven primarily by the reduction of inventory, offset in part by the related reduction in accounts payable. We will continue to look at ways to improve our working capital position. We reported $622 million in net debt, including contingent consideration as of March 31, 2019 and our leverage ratio was 4.0x. We paid down debt by a total of $16 million compared to the end of last year mainly on our revolving credit facility. We have significant availability under our credit facility and during 2019, we will continue to utilize excess cash flow to reduce debt. We expect our debt at the end of this year to be lower than at the end of 2018.
Even at the low end of our 2019 adjusted EBITDA guidance range, we expect to remain in compliance with our debt convenance throughout this year. In addition, we see potential improvement over the course of the year as we improve operational efficiency and working capital. Looking to 2019 full year guidance, we are reiterating the guidance previously provided for revenue and adjusted EBITDA. However, we are adjusting GAAP net loss guidance due to an adjustment to our expected income tax provision, which I will more fully explain in a minute. We reiterate consolidated revenues between $4.7 billion and $5.0 billion. This includes Specialty segment revenue between $4.4 billion and $4.6 billion and PBM segment revenue between $300 million and $400 million.
Our adjusted EBITDA is still expected to be in a range of $110 million to $116 million. We expect second quarter adjusted EBITDA to be essentially flat compared to the first quarter and we also expect second half adjusted EBITDA to be stronger than the first half. Consistent with past results, the second half will benefit from seasonal volume increases as well as the impact of greater operational efficiencies. Please note our expectation for interest expense is now $37 million to $40 million versus the prior $40 million to $43 million due to lower expected average debt balances throughout the year. As it relates to the income tax item, we now expect to record income tax expense in the year primarily related to state taxes versus the previously expected tax benefit. The company will not be able to record a federal tax benefit for 2019 losses as we are required to record a valuation allowance against any such benefit due to being in a cumulative loss position.
GAAP net loss expectations for the full year are now between negative $49 million and negative $33 million, which translates into a GAAP EPS loss range of negative $0.65 to negative $0.44. We expect income tax expense to be approximately $2 million. CapEx is still expected to be approximately $20 million to $22 million for the year, primarily related to investments expected to improve unit cost efficiencies as well as enhanced analytic capabilities to support the creation of new solutions for our manufacturer and payer clients. Thank you again for your time and I look forward to working with all of you.
I'll now turn the call back over to Brian.
Brian Griffin -- Chief Executive Officer and Chairman
Thank you Dan. As previously indicated 2019 is a rebuilding year and we're focused on driving new business awards across all of our businesses and executing on companywide efficiency initiatives. I remain confident that Diplomat is making the right investments and executing the right strategy to leverage our competitive strengths and position Diplomat for future growth and profitability. I remain convinced that there is a significant opportunity for an independent specialty focused healthcare services provider to succeed in the market. The board, myself and the rest of the Diplomat management team are committed to enhancing shareholder value, while maintaining focus on rebuilding our PBM business and expanding business with health plans, hospital systems and manufacturer partners. As we continue to execute on our strategy our first priority remains our patients and providing high-quality patient care. And as always I'd like to thank our team members for their continued commitment to our patients, partners and Diplomat.
Thank you for your time and we look forward to your questions.
Terri Anne Powers -- Vice President, Investor Relations
We'll now move to Q&A. (Operator Instructions) Operator, can you please provide the instructions?
Questions and Answers:
Operator
(Operator Instructions) And your first question comes from Lisa Gill with JPMorgan. Please go ahead, your line is open.
Lisa Gill -- JPMorgan Chase & Co. -- Analyst
Thanks very much, good morning. Welcome Dan to Diplomat. I look forward to working with you. So Brian, just going back to your comments about the 2020 pipeline, is there anyway you can potentially size that for us? I know you it was bigger than what it was last year but just to kind of put a dollar value on that. And then secondly, you talked about new product offerings. I'm just curious to what kind of product offerings are potential clients looking for in the marketplace today?
Brian Griffin -- Chief Executive Officer and Chairman
Good morning Lisa, thanks for the question. Yes, I think that's cuts across a pretty big range. So in terms of the pipeline, I don't have a dollar figure that we're prepared to share. But the pipeline as you think about the PBM business it's significantly higher than it was last year. So, obviously we've introduced the whole new sales organization into the PBM and they're starting to get some nice traction. So I think the great news is I think the operating issues -- operational issues that we had mid-2018 into the back half of the year, we've stabilized and we're now in great shape from an operating perspective across all of our key operating metrics and I think that's being recognized by the broker and consultant community and now that we've got a seasoned sales force in place within the PBM they're really driving significant level of new RFP activity, again both for 2019 as well as I think even more impressive in 2020.
On the Specialty side of the business, that also as you know is a new sales strategy, the idea that we're focused on building strategic partnerships with health plans and hospital systems is new for the company and that team is also a new but very seasoned. So these are folks that are former colleagues of ours from Medco and Walgreens and other organizations that have been focused on building relationships with health plans and hospitals so that -- while it's a new team it's a seasoned team and I've been really impressed with what they've been able to develop thus far and I'm expecting that we'll see some activity here in 2019 and a significant level of new opportunity into the new year.
In terms of -- and I should note also that we're having a really nice success in the hospital systems part of that sales process and that is also new for us in terms of an area of focus. As I think about the -- your question around new product offerings it cuts across on the PBM side, we'll be introducing some new clinical programs into the future. So we've had a team working on expanding out the clinical programs within the PBM and as I think about how the PBM value proposition will likely evolve moving forward I think having really strong clinical programs with performance guarantees is an example. It's going to be a differentiated advantage for our PBM value proposition.
As we turn over to the Specialty business, we've been making significant investments in 2018 that now position us in 2019 to deliver on a much broader set of analytics to our health plan and hospital system partners and that includes offering predictive analytics that integrates medical pharmacy specialty infusion data and identifies gaps in care to basically position the health plan to manage the specialty benefit across both the pharmacy and medical benefits. So I think those are a couple of the key investments that now have really enhanced our product offerings and put us in a position to offer new products.
Lisa Gill -- JPMorgan Chase & Co. -- Analyst
Great, thank you.
Terri Anne Powers -- Vice President, Investor Relations
Thanks. Next question please.
Operator
Your next question comes from Steven Valiquette with Barclays. Please go ahead, your line is open.
Steven Valiquette -- Barclays Bank -- Analyst
Thanks, good morning everybody and thanks for taking the question. I guess for us what really stood out to me is kind of a positive data point was the Specialty prescription number. You guys talked about losing some volume to competitors but you actually grew that number year-over-year in the first quarter. So I'm just curious to hear more about maybe the sustainability of those scripts for all of calendar 2019, may be showing modest growth instead of a -- I am also modeling some sort of decline in the specialty scripts for calendar 2019. Thanks.
Brian Griffin -- Chief Executive Officer and Chairman
Good morning Steve. This is Brian. Let me take a crack at it and then I'll ask Dan to add some color to it. But obviously to add to your point, we're able to grow volume and I think we've introduced a number of measures. We pointed to on our last earnings call kind of what we've seen is the increasing use of what we've referred to as patient channel management techniques to drive script volumes into the big three and larger health plans. And -- so we've introduced a set of countermeasures there and I think we're being successful there particularly in the Medicare part of our business. And then the other key factor was just the growth within our infusion business. We saw some really strong growth in infusion. Our projection is we'll see continued growth in that portion of the Specialty segment.
Dan Davison -- Chief Financial and Treasurer
And I would just add that that's one of the reasons we expect second half EBITDA -- adjusted EBITDA to be stronger than the first half is the strength we're seeing in volumes and infusion volumes in particular.
Brian Griffin -- Chief Executive Officer and Chairman
And Steve just note last comment. We are seeing expansion within certain of our health plan and hospital system relationships where they're introducing, for example, new therapeutic categories into the relationship. So, we're seeing that expansion have an impact as well.
Steven Valiquette -- Barclays Bank -- Analyst
Okay. That's helpful. Thanks.
Terri Anne Powers -- Vice President, Investor Relations
Thanks. Next question please.
Operator
Your next question comes from A.J. Rice with Credit Suisse. Please go ahead. Your line is open.
A.J. Rice -- Credit Suisse -- Analyst
Hi everybody. First just to ask about a little more on the current selling season and the PBM side. Obviously there's some competitive changes going on as and so there's probably impacting landscape and obviously your focus on both the larger but the middle market as well means that you're selling all year for next year launches. Can you just give us a little bit more flavor as to what you're seeing and how much do you think you see in the spring versus how much continues to be bid in the business you're going after as the year progresses?
Brian Griffin -- Chief Executive Officer and Chairman
Thanks A.J. Yes, we are seeing nice activity here in 2019, which reflects effective dates here toward the back half. So I'm happy with the level of activity that we're seeing here in 2019 and as I referenced in my introductory comments here we're seeing a much higher level of RFP activity for 1/1/20 and beyond and to your point while we've historically been focused on the middle market, we are seeing incremental RFP activity really driving toward larger corporate accounts. So that's new for us and again I think that's reflective of the fact that we've stabilized the PBM and with that we're demonstrating superior overall operating performance. And that's again it's being recognized by the brokers and consultants that are driving this market. And the idea that we potentially move upstream into the large group market is happening a little quicker than I expected.
So we're seeing those RFPs coming in from the consultant community and then in addition to that we've got our sales team focused on driving up market. So obviously I lost some revenue in the beginning of the year and obviously we've talked quite a bit about that. So this is a great opportunity for me to go into the upstream market and capture higher levels of revenue. So right now I'm feeling good about the level of activity in 2019 but I feel like we've got -- we're positioned well for 2020 as well.
A.J. Rice -- Credit Suisse -- Analyst
Okay. And if I could just slip in a follow-up. I appreciate the comments on the covenants. You feel pretty comfortable about those but I wondered if we could I know a lot of times numbers get adjusted in the covenant calculation versus what you report. I guess, is there any way to give a flavor for how close you think you will be, how much cushion you have as you get to the latter part of the year and which quarter do you think will actually be the tough, the closest quarter you get, maybe just a little more flavor on your comfort level around those numbers?
Dan Davison -- Chief Financial and Treasurer
Sure, A.J. This is Dan. Thanks for the question. We basically have two covenants. We have a leverage covenant and an interest coverage covenant. We're at 4 times on the leverage and the threshold is 5.75, excuse me, changes to 5.5 at the end of September. We expect to remain in the high 3s, maybe creep about 4, so we're comfortably within that covenant. In terms of interest coverage, we plan to be in compliance throughout the year. We're going to bring down our debt through the year, and bring down our interest expense and with the combination of that with the operational efficiencies and growth in EBITDA, adjusted EBITDA in the back part of the year, we're going to be comfortably within the limit on the interest coverage ratio as well.
Operator
Thanks A.J. Next question please.
Your next question comes from John Kreger with William Blair.
Jon Kaufman -- William Blair -- Analyst
Hi, good morning. This is Jon Kaufman on for Krieger. On the infusion business, that seems to be quite a bright spot right now. Can you remind us why is infusion more immune from some of the pressures that you've been discussing on the Specialty pharmacy side? And I guess specifically, what prevents an integrated PBM from directing patients to their own infusion offerings much as they have in the rest of the Specialty pharmacy portfolio?
Brian Griffin -- Chief Executive Officer and Chairman
Good morning Jon. This is Brian and just in terms of infusion, obviously that I come from a health plan background, and this is still across the health plans across the country, still fairly fragmented, meaning that the health plans haven't, that are obviously the key drivers of volume, haven't really narrowed their networks dramatically. Our infusion leadership team and sales team has been just tremendously successful in building these relationships with health plans, which obviously drive volume. So they're doing a great job for us and we're, as you think about the potential for narrowing networks for health plans, I think we're actually pretty well positioned because we're delivering on a superior clinical performance here and our nurses that are out in the field have tremendous experience in home infusion. You know that our business is home infusion and I think our reputation in terms of our clinical performance is resonating really well within the health plan universe.
Jon Kaufman -- William Blair -- Analyst
Okay. Great. And then just one quick follow-up. Have your assumptions for branded price inflation this year changed?
Brian Griffin -- Chief Executive Officer and Chairman
We're still expecting 4% to 6% brand price inflation for the year.
Jon Kaufman -- William Blair -- Analyst
Okay. Thank you.
Terri Anne Powers -- Vice President, Investor Relations
Thank you Jon. Next question please.
Operator
Your next question comes from David Larson with Leerink. Please go ahead, your line is open.
David Larsen -- SVB Leerink -- Analyst
Hi, can you talk about limited distribution product deals that you may have gotten on year-to-date or you expect to get on this year and how does that compare to previous years? Thanks.
Brian Griffin -- Chief Executive Officer and Chairman
Good morning Dave. In terms of the limited distribution portfolio, you know the team has done a great job there. We've introduced six new limited distribution partnerships since the beginning of the year and since our last report out. So we've got an industry relations team that I think is, leverages our clinical reputation to capture share in the LDD market and so we're excited about that. We think that there's more opportunity for us, particularly in the oncology area to capture more LDDs here moving forward. But this is just the team executing day in and day out and our very strong relationships with our pharma partners.
David Larsen -- SVB Leerink -- Analyst
Okay. Great. Thanks very much. And can you just remind me with regards to rebates, I'm sorry if you covered this earlier, but assuming rebates evaporate, like what's it's final comes out, how are you thinking about your overall portfolio, what may getting steps can you take to keep yourself whole, and do you expect this to impact both the commercial abd Medicare and Medicaid sides of the business? Or do you think it will be limited more to Medicare? Thanks.
Brian Griffin -- Chief Executive Officer and Chairman
Yes, I think it will be limited more to the government business and as we've indicated, we, at this point that business is really immaterial to the overall business. As you think about our market, the commercial middle-market, we are not seeing at this point an increase in demand from the broker and consultant community or even from directly from our direct relationships with accounts, a different model versus the traditional model. I should note by the way that we do offer our clients a structure where we're pushing rebates through to the point-of-sale at the consumer level and we're really not seeing much uptick on that and so we're -- we continue to compete more on a traditional basis.
Now that being said we have been working on developing alternative models and I referenced this I think in my response to Lisa's initial question. We are focused on delivering on an improved clinical value proposition in terms of our kind of move forward go-to-market strategy. So to the degree that the commercial market ultimately either by an act of Congress or through just a shift in the commercial market starts to focus on rebate value being pushed through at the point-of-sale, I think we'll be very well positioned to recapture that the rebate margin in the form of other of our financial levers, including that clinical value proposition.
David Larsen -- SVB Leerink -- Analyst
Great. Thanks very much.
Terri Anne Powers -- Vice President, Investor Relations
Thanks Dave. Next question please.
Operator
Your next question comes from Eric Coldwell with Baird. Please go ahead, your line is open.
Eric Coldwell -- Baird -- Analyst
Thanks, good morning. I guess first question. How many new client facing account executives have you been talking about? And I'm really talking about on a net basis for the upgraded sales team. And then can you give some status on the sizing of your health system initiatives? And I have a maybe a follow-up or two after that. Thanks.
Terri Anne Powers -- Vice President, Investor Relations
(inaudible) on the provider that's all we can disclose.
Brian Griffin -- Chief Executive Officer and Chairman
So, good morning Eric. Yes, in terms of the the PBM team as I think we've referenced in some of our one-on-one discussions, the legacy PBMs really did not have large sales and account management. So this literally is an all new team from -- starting from last year and we've just added two to three additional sales resources just here over the last quarter. Some -- then again they're really seasoned folks some of whom that worked with Dan and I at Medco as an example and I have some great new sales talent that we've added. We have very high expectations of that talent, I should note.
And on the other side of the business, meaning the focus on the health plan and hospital system business, we've added a dozen plus new folks across from a sales perspecive across that book of business. And we've also added additional account management staff to manage those relationships. So as we build a relationship with a hospital system, for example, we need account managers to obviously to manage that relationship and to expand that relationship. So, we've added staff there as well.
Eric Coldwell -- Baird -- Analyst
I guess my -- that's helpful. My follow-up is obviously I'm sure you saw the headlines that Premier is exiting their health system focus Specialty pharmacy business and frankly kind of a giveaway looking at the price tag. I'm curious if that wasn't something that was perhaps interesting to you given your initiatives to grow that business. You could've touch tap a billion of revenue pretty quickly there. So I'm just curious on your thoughts on if there was a look and if not why not?
Brian Griffin -- Chief Executive Officer and Chairman
So obviously I can't comment on whether there was a look or not but I think what we've been focused on there is growing that organically. We've got a very strong sales team on that and what we've also been focused on as I alluded to in my introductory comments here, is a different level of analytics that we're providing in support of those relationships and as a result of that I think we're seeing expansion of the relationship both in terms of therapeutic categories that are covered under the relationship, the expansion of our LDD platform in the hospital system relationship. So we're growing pretty nicely just based on that focused effort with a new value proposition.
Eric Coldwell -- Baird -- Analyst
Last one for me. Just a quick one here. Chandler distribution facility. I'm just curious if you have an update on how that's progressing and whether it might or how it might impact your inventory levels and therefore cash flow as the year progresses?
Brian Griffin -- Chief Executive Officer and Chairman
So yes it's going very well. So, Chandler is officially up and running. Our call center is staffed and the -- from an operational perspective, obviously we have now the redundancy that we were looking for with the addition of Chandler. Obviously, as I've referenced in previous calls that positions us very nicely with respect to regional and national health plans who look for a platform that provides that level of redundancy. Our ScriptMed platform, which is as you know our Specialty operating platform, is running in Chandler. We've got our oncology center of excellence up and running in the facility. And then during the remainder of the year in terms of the implementation, the plan is kind of a balanced approach to our back and dispensing across all of our products and looking to do that before June 1. So, it's going well.
Dan Davison -- Chief Financial and Treasurer
And in terms -- this is Dan, Eric. In terms of the inventory, we would expect a bit of a bump in our inventory as we launch that site but we will quickly bring that back down in the back part of the year.
Terri Anne Powers -- Vice President, Investor Relations
Thanks Eric. Next question please.
Operator
Your next question comes from Rivka Goldwasser with Morgan Stanley. Please go ahead, your line is open.
Rivka Goldwasser -- Morgan Stanley -- Analyst
Yes hi, good morning. So you're assuming some pretty nice acceleration in EBITDA in the second half of the year. I know you mentioned the ramping infusion volume. But can you just give us a little bit more color on what's kind of that driving the second half pickup?
Dan Davison -- Chief Financial and Treasurer
Sure Ricky. This is Dan. Besides the infusion volume, we see a pickup in our existing generics and the launch of some new generics in the back part of the year that's going to drive EBITDA. In terms of the PBM, we see higher gross margins in the back part of the year due to seasonality and the timing of rebate recognition. We're looking at some improvement in our cost of goods and our cost of sales. And then we do anticipate a significant contribution from our operational efficiency initiatives across the entire business. So that's all back half weighted driving that EBITDA growth.
Rivka Goldwasser -- Morgan Stanley -- Analyst
Okay. And one follow-up question. I know Brian you talked about the HSS rebate rule that refers to the PBM business. But when we think about the Specialty pharmacy business there are also some suggestions in the rule regarding kind of a pharmacy reimbursement and treatment of DIR fees. Do you have any early thoughts of what if the rule is implemented is proposed what it would mean to the Specialty business?
Brian Griffin -- Chief Executive Officer and Chairman
Yes Ricky, good morning. First of all, we don't anticipate the rule having a significant impact on our Specialty business and maybe the second part of the question is around the potential changes in Part B, which is related to that and we don't expect that to impact our infusion business either.
Rivka Goldwasser -- Morgan Stanley -- Analyst
Okay, thank you.
Terri Anne Powers -- Vice President, Investor Relations
Thanks. Next question please.
Operator
Your next question comes from Charles Rhyee with Cowen. Please go ahead, your line is open.
Charles Rhyee -- Cowen and Company -- Analyst
Thanks for taking my question. Brian, you talked early about sort of the uptick in sort of RFP activity. Can you discuss now with the new organization that you kind of sales organization put in place and your expectations around or how should we think about the conversion of that RFPs because if I recall last year we did see good activity at the beginning, it was something we weren't quite able to close as much on by the end of the year. Can you talk about sort of what you're seeing so far in conversions? Thanks.
Brian Griffin -- Chief Executive Officer and Chairman
Yes, good morning. So in terms of -- I don't have a specific number or win rate to share with you. We have won some clients for 2019 and I think last year as you think about how we've reported out on that we won in to a fair amount of detail in Q1 and really what we're saying is that our new name didn't offset some of the losses that we sustained in the beginning of the year, which again I think we're largely tied to some of the service issues that we had in 2018 tied to the integration of the two legacy PBM businesses. But -- so on the PBM side, we're seeing again very strong RFP activity significantly increased over last year and we are winning.
But the other side of the business meaning on the Specialty organization and that level of RFP activity, we were seeing some release nice trends and by that I'm referring to obviously just an increase on overall activity but then very specifically we're seeing more of a trend toward carveout of Specialty and maybe more specifically a focus on the management of the specialty benefit across both medical and pharmacy. And I think I'm excited about that because I think that's an area that where we excel -- where we have excelled historically and then in addition to it when you include the incremental set of analytics that I outlined earlier I think that that really positions us well to manage across both the medical and pharmacy benefit pretty well. So that -- my point of that was to say that I think we'll be in a position to close more because of that new value proposition that we're going to market within the specialty carveout business.
Charles Rhyee -- Cowen and Company -- Analyst
Great, that's helpful. And then just a follow-up on the Specialty pharmacy side. Following maybe Eric's question around, Premier, when they talked about getting out of the specialty pharmacy business they highlighted sort of a continued DIR fees slowing kind of market environment, but they also kind of point toward PBM consolidation and challenges as the larger integrated sort of PBMs kind of push volume to specialty pharmacy, obviously something you guys have pointed out a little bit in the past as well. Anything that you are seeing sort of in the market moment that you think can start to change maybe for the better as we think about the rest of this year maybe in the next year?
Brian Griffin -- Chief Executive Officer and Chairman
Yes to your point obviously we pointed to in our last earnings call, we talked about the continuation of reimbursement pressure. I think that's been a constant. We also referred to what we've seen more recently as an increased narrowing of networks as well as this member channel management, which I think we referred to for the first time in our last call. So we understand the pressures that they may have referenced. I didn't see the specific references but certainly from an industry perspective we see that.
In terms of what might mitigate against that I think it's really the whole new strategy that we've introduced as of last year to build relationships with health plans and I referenced it in my prepared comments that we're absolutely seeing a near-term opportunity and a longer-term opportunity tied to being an independent specialty focused provider. I think that is really what's resulting in the market. So with -- in the face of the vertical integrations and to some degree that the vertical integrations are contributing toward the pressures that I just outlined. On the other side of that, there are major health plans, blue systems that are looking for an independent player to be their strategic partner and I think that puts us in a position to capture big chunks of volume through those -- through building those relationships.
Charles Rhyee -- Cowen and Company -- Analyst
Great, thanks a lot guys.
Terri Anne Powers -- Vice President, Investor Relations
Thanks Charles. Next question please
Operator
Your next question comes from John Ransom with Raymond James. Please go ahead, your line is open.
John Ransom -- Raymond James & Associates -- Analyst
Hi, on your Specialty pharmacy what is the mix today of limited distribution drugs versus non-limited distribution? And do you see a margin difference in those two categories?
Dan Davison -- Chief Financial and Treasurer
This is Dan, John. About 75% of the drugs are limited distribution. I'm sorry, 50% with that number on. And the profile is not that different between limited distribution and our regular drugs.
John Ransom -- Raymond James & Associates -- Analyst
So I mean would the conclusion flow from that is those are no more immuned from margin pressure, reimbursement pressure than the more widely available drugs or are they just bigger drugs that structurally just have lower margins?
Brian Griffin -- Chief Executive Officer and Chairman
I was just going to add. I think we're seeing pricing pressure across the whole mix. My hope is and the focus that I have had in driving a new analytics set of capabilities for the company, is to be able to leverage that to improve our margin profile on limited distribution drugs. I think I believe that there's a broader set of opportunities with pharma around data analytics beyond what we're doing today even in support of our limited distribution partnerships and so my hope is that we'll be able to improve the margin profile as it relates to the LDDs.
John Ransom -- Raymond James & Associates -- Analyst
Okay and just kind of flipping to the PBM for a minute. When you talk to a real world clients in the commercial marketplace, how much excitement really is there for point-of-sale rebates and if that's not a trend if the government is just trying to force something that's not there, what are companies doing to address the real problem of affordability. The intersection of affordability and less prices and I could pay plans if they're not going to do the point-of-sale rebates. What other strategies are you seeing with some of your more forward-looking RFPs or clients?
Brian Griffin -- Chief Executive Officer and Chairman
Yes great question. And again we're not seeing an increase in demand there at all for point-of-sale rebates. As we've discussed, the rebates have been kind of the underpinning supporting not only the pharmacy benefit but the overall health benefit. So this is -- the rebates retained at a planned sponsor level are offsetting overall costs and ultimately to the degree that they are passed through at the point-of-sale obviously, for an insured client there'd be an increase premium, for a self-insured client there would likely be an increase in costs sharing levels et cetera.
So there are real impacts and from a employer perspective, they're at least with respect to our middle market. They continue to be focused on the traditional model that has the PBM rebate as part of that financial equation. So what are they focused on to try to lower cost, I think they really are the traditional PBM levers -- really the clinical programs that we bring to bear to reduce overall program costs our formulary management prior authorization to ensure appropriate clinical utilization of the products and those as you know were the traditional methods for bending the cost curve from an employer perspective.
John Ransom -- Raymond James & Associates -- Analyst
So I mean why wouldn't you though I saw what Express Scripts did with insulin. Why wouldn't we think about these high co-pay and if you're talking about medical and pharma, is it really make sense to have high co-pay if the net effect is a patient wins (inaudible). Are we seeing more sophistication of deterring of some of these co-pays or you think it's still there is a big one tool and there's really not any move to try to fix this issue?
Brian Griffin -- Chief Executive Officer and Chairman
Yes great question. And I've seen this evolve over time and I'm really referring to last several years here with smarter cautious levels and that's tied to drugs selection, meaning formulary and as well as the clinical data that are deployed by the PBMs. But I'd say from my perspective, plan design is getting smarter, it's not just a blunt instrument to your point. And I think you can be pretty effective with the right kind of plan design to drive appropriate utilization and behavior. So I think while there's more opportunity there, I think the industry has been pretty effective at the moving toward smart design.
John Ransom -- Raymond James & Associates -- Analyst
And the last one for me and thanks for the color. The $3 million add back is that added back to your adjusted EBITDA guide? In other words should we use $26 million of the base for the year or should we use $23 million as the base for the year?
Dan Davison -- Chief Financial and Treasurer
You can use $26 million, that was a one-time prior period item.
John Ransom -- Raymond James & Associates -- Analyst
Is there a reason you didn't break that out in your press release? I think there's a bit of confusion this morning about the performance. Wouldn't it be better to put it there, provide just a little color as to what adjusted EBITDA was?
Dan Davison -- Chief Financial and Treasurer
I'm sorry. Repeat the question.
John Ransom -- Raymond James & Associates -- Analyst
I'm just curious why that add back wasn't spiked out in the press release.
Dan Davison -- Chief Financial and Treasurer
Well, I think the intent was to cover during the call.
John Ransom -- Raymond James & Associates -- Analyst
Okay. I guess with my unsolicited opinion that it might have been helpful to put in there but I'm glad you broke it out. Thank you.
Dan Davison -- Chief Financial and Treasurer
Okay.
Terri Anne Powers -- Vice President, Investor Relations
Great, thank you. Next question please.
Operator
I'm showing no further questions at this time. I will turn the call back over now to Brian Griffin for any closing remarks.
Brian Griffin -- Chief Executive Officer and Chairman
Thanks very much everybody for your time today. We are -- obviously we're going to be available after the call if any of you have any further questions and we're also looking forward to seeing many of you at the Bank of America Health Care Conference next week. So we look forward to seeing you then. Thanks very much for joining us today.
Operator
And ladies and gentlemen this concludes today's conference call. You may now disconnect.
Duration: 56 minutes
Call participants:
Terri Anne Powers -- Vice President, Investor Relations
Brian Griffin -- Chief Executive Officer and Chairman
Dan Davison -- Chief Financial and Treasurer
Lisa Gill -- JPMorgan Chase & Co. -- Analyst
Steven Valiquette -- Barclays Bank -- Analyst
A.J. Rice -- Credit Suisse -- Analyst
Jon Kaufman -- William Blair -- Analyst
David Larsen -- SVB Leerink -- Analyst
Eric Coldwell -- Baird -- Analyst
Rivka Goldwasser -- Morgan Stanley -- Analyst
Charles Rhyee -- Cowen and Company -- Analyst
John Ransom -- Raymond James & Associates -- Analyst
