Iqv Cowen Germany

Health Care Technology & Distribution: CROs
IQVIA HOLDINGS
EQUITY RESEARCH INITIATING COVERAGE

December 6, 2022
Price: $211.93 (12/5/2022) INITIATE OUTPERFORM: WELL POSITIONED FOR

Price Target: $251.00 EVOLVING LANDSCAPE OF CLINICAL TRIALS
OUTPERFORM (1)
ESG SCORE: 59/100
Charles Rhyee THE COWEN INSIGHT

646 562 1376 We initiate coverage of IQV with an Outperform rating and a $251 PT, and we see multiple
[email protected]
drivers of multiple expansion and share price outperformance including an expanding
Steven Braun TAM, better appreciation of its TAS segment (48% of adj. EBITDA), positioning for DCT
646 562 1322 adoption, increased capital deployment, and more defensive/resilient performance in more
[email protected]
recessionary environments.
Lucas Romanski
646 562 1352 Concerns on Biotech Funding Environment Appear Overblown, In Our View
[email protected]
We believe concerns for weaker biotech funding/macro headwinds (e.g., drove CRO
Key Data
multiples lower) are overdone. We see these concerns as overblown and expect relatively
Symbol NYSE: IQV
healthy growth in biotech/pharma R&D spend in 2023. Our view is supported by results
52-Week Range: $282.61 - $171.86
from our Cowen Biopharma R&D Leader Survey, where 82% of respondents indicated they
Market Cap: $39.4B
anticipate seeing R&D budgets increase in 2023. Weighting responses for total R&D spend,
Net Debt (MM): $11,292.0 we estimate industry R&D budgets increasing 3.2% in 2023.
Cash/Share: $9.00
Dil. Shares Out (MM): 189.4
Technology & Analytics Solutions (TAS) Not Fully Appreciated
Enterprise Value (MM): $51,431.5 We believe the market tends to overly focus on IQV’s R&D segment, thus underappreciating
BV/Share: $28.78 that ~1/2 of its EBITDA comes from its Technology & Analytics Solutions (TAS) segment.
Dividend: $0.00 TAS tends to be more stable in a recession due to the long-cycle nature of IQV’s businesses,
Yield: 0.00% a still increasing demand for its service offerings, and the defensive nature of healthcare.
Secular Shift to DCTs Support L-T Growth
FY (Dec) 2021A 2022E 2023E
Revenue (MM) We believe IQV’s robust Decentralized Trial (DCT) offerings position it to capture the
Year $13,874.0 $14,456.0 $15,530.0 accelerated secular shift to DCT models from academic medical centers and traditional
EV/S 3.7x 3.6x 3.3x
brick-and-mortar sites. We believe DCT adoption should continue to accelerate, as
biopharma companies focus on making studies more inclusive/representative and improve
clinical trial efficiencies. Our Cowen Biopharma R&D Leader Survey found DCTs make up
EBITDA - Adjusted
~21% of clinical trials today and that is expected to increase to 42% in the next 3-5 years.
Year $3,022.0 $3,342.8 $3,640.5
Currently, when pharma does use a DCT model, 67% of the time they use a traditional CRO
EV/
EBITDA:ADJ
17.0x 15.4x 14.1x and use dedicated DCT players 30% of the time.
Accelerated Capital Deployment Supports L-T Growth
EPS
Q1 $2.18 $2.47A $2.62 We estimate IQV's L-T capital deployment strategy ($2.0B-$3.0B/yr to M&A and shr repo)
Q2 $2.13 $2.44A $2.56
implies up to ~+200bp/yr tailwind to L-T revenue growth. We are confident in IQV's ability
to achieve this target, funded by robust FCF generation ($8.81B cumulative in 2022-2026)
Q3 $2.17 $2.48A $2.72
from potential adj. EBITDA margin expansion (+286bps to 24.6% in 2025E vs. 21.8% in
Q4 $2.55 $2.79 $3.15
2021).
Year $9.03 $10.17 $11.05
P/E 23.5x 20.8x 19.2x Initiating Outperform With $251 Price Target
Consensus EPS $9.03 $10.15 $10.91 Our $251 PT (+18% upside to 12/5’s closing price) is based on our 5-year DCF, which implies
Consensus source: FactSet shares can trade at ~16.1x our 2023E adj. EBITDA estimate of $3.64B (vs. consensus of
$3.65B) and 22.7x our 2023 adj. EPS estimate of $11.05 (vs. consensus of $10.91).
Please see pages 33 to 39 of this report for important disclosures. COWEN.COM

COWEN IQVIA Holdings
EQUITY RESEARCH December 6, 2022
AT A GLANCE
Our Investment Thesis Forthcoming Catalysts
IQV is a Durham, NC-headquartered provider of analytics, technology, and clinical research ■ 4Q22 Earnings
services to sponsors of clinical trials globally. The company leverages its industry expertise, ■ Innovation to CI offering
technology capabilities, and big data resources to provide differentiated insights/execution ■ Announcement of M&A
that can accelerate the development/commercialization of new treatments. We believe the
market is overlooking L-T growth drivers at IQV's current valuation. Our $251 price target,
is based on our 5-year DCF, which implies shares can trade at ~16.1x our 2023 adj. EBITDA
estimate of $3.64B (vs. consensus of $3.65B) and 22.7x our 2023 adj. EPS estimate of $11.05
(vs. consensus of $10.91). We believe IQV’s strong market position in a large/expanding TAM,
better understanding of TAS growth drivers (48% of 2021 adj. EBITDA), secular shift to DCTs,
increased capital deployment, and resilient recession performance should result in multiple
expansion.
Base Case Assumptions Upside Scenario Downside Scenario
■ FY23 revenue of $15.53B ■ Faster-than-expected tech innovation or ■ Decelerated technological innovation to

■ FY23 adj. EBITDA of $3.64B more innovative upgrades to CI CI offering
■ TAS revenue of $6.37B and adj. EBITDA ■ Increased TAS rev growth/profitability vs ■ Increased competition in DCTs and/or
of $1.75B in FY23 our ests. decelerated adoption of DCTs
■ RDS revenue of $8.38B and adj. EBITDA ■ Faster-than-expected adoption of DCT ■ Lower-than-expected M&A spend,
of $1.78B in FY23 clinical models resulting in less revenue/adj. EBITDA
■ More than $2.0B-$3.0B/yr capital contribution
deployment could increase rev and adj. ■ Loss/delay of large contracts or multiple
EBITDA growth contracts, could materially impact rev/
adj. EBITDA
Price Performance Company Description
$300 IQVIA Holdings (IQV) is a Durham, NC-headquartered provider of analytics, technology, and
clinical research services to sponsors of clinical trials globally. The company leverages its
280
industry expertise, technology capabilities, and big data resources to provide differentiated
260
insights and execution that can accelerate the development and commercialization of new
treatments. The company operates largely on a service contract model, with customer
240 relationships ranging from months to years in duration, and customers spanning from life
sciences, biotechnology and pharmaceutical companies to other healthcare stakeholders
220
involved in the research and development process. IQV’s business comprises three main
200
segments: Technology & Analytics Solutions, Research & Development Solutions, and
Contract Sales & Medical Solutions.
180
160
Mar-22 Jun-22 Sep-22 Dec-22
Analyst Top Picks
Source: Bloomberg
Ticker Price (12/5/2022 ) Price Target Rating
Walgreens Boots Alliance WBA $41.21 $54.00 Outperform
IQVIA Holdings IQV $211.93 $251.00 Outperform
CVS Health CVS $102.01 $118.00 Outperform
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COWEN ESG SCORES
IQVIA Holdings IQVIA Holdings (IQV) ESG Material Category Rankings as of December 6, 2022
NYSE: IQV
Top 3 Material ESG Categories Dynamic MaterialityTM Score
ESG Score: 59/100 Access and Affordability 30% 58
Energy 18% 79
ESG Industry Percentile: 60th Customer Welfare 13% 81
ESG MATERIALITY
Establishing materiality is critical to evaluating a company’s ESG performance. Factors most material in one sector (or to a particular company) may not be as important to another. In
addition, the factors that are material – and the degree to which factors are material – can change over time.
Applying data to frameworks established by SASB (the Sustainability Accounting Standards Board) and by Truvalue Labs, we present in the chart above the three most material
ESG factors that investors should focus on for the company that is the subject of this report; the Dynamic Materiality™ of each factor (i.e., what percentage of overall materiality the
category represents for the subject company); and a Score for the subject company in each of these three categories (on a 0 to 100 basis, with 50 being average).
We also calculate an overall ESG Score for the subject company, which is presented above (in green) and on the cover of this report. A full explanation of how this ESG Score is derived
is presented below.
HOW ARE COWEN’S ESG SCORES CALCULATED?
Cowen leverages technology from Truvalue Labs to generate our ESG scores. Truvalue Labs uses artificial intelligence to capture the stakeholder view of how companies are
performing on ESG metrics, using the Sustainability Accounting Standards Board (SASB) materiality framework (www.sasb.org). These data are leveraged to calculate a score for each
company, which allows Cowen to have a common framework and uniform way to approach ESG discussions with our clients. Cowen ESG scores appear on Company and Company
Quick Take notes and are updated daily.
HOW DOES THE PROCESS WORK?

The process begins with capturing unstructured data from more than 100,000 sources, in 14 languages. These data are culled from a wide range of sources with varied perspectives,
including industry publications, news outlets, NGOs, trade unions, government sources, legal and regulatory filings, and academic publications.
Natural language processing is used to interpret semantic content from the original sources and generate analytics by applying criteria consistent with established sustainability and
ESG frameworks. Performance is scored on a 0 to 100 scale. A score of 50 represents a neutral impact. Scores above 50 indicate more positive performance, and scores below reflect
more negative performance. A score of NA means not enough data is available on the company to generate a score.
COWEN.COM 3
Investment Summary
We are initiating coverage of IQVIA Holdings Inc. (IQV), with an Outperform rating and
$251 price target. IQV is a Durham, NC-headquartered provider of analytics, technology,
and clinical research services to sponsors of clinical trials globally. The company
leverages its industry expertise, technology capabilities, and big data resources to
provide differentiated insights and execution that can accelerate the development and
commercialization of new treatments. At its current valuation (14.2x NTM EV/EBITDA
vs. 16.0x 5-yr historical avg.), we believe the market is overly focusing on IQV’s R&D
segment and underappreciating 48% of its EBITDA, which comes from its Technology &
Analytics Solutions (TAS) segment. We believe TAS is more stable in a recessionary
environment due to sustainable increasing demand for its service offerings, the long-
cycle nature of IQV’s businesses and the defensive nature of healthcare. This results in
only ~1/2 of its EBITDA potentially being exposed to a future recession. Our $251 price
target (+18% upside to 12/5’s closing price) is based on our 5-year DCF, which implies
shares can trade at ~16.1x our 2023 adj. EBITDA estimate of $3.64B (vs. consensus of
$3.65B) and 22.7x our 2023 adj. EPS estimate of $11.05 (vs. consensus of $10.91). We
believe IQV’s strong market position in a large/expanding TAM, better understanding of
TAS growth drivers (48% of 2021 adj. EBITDA), secular shift to DCTs, increased capital
deployment, and resilient recession performance should result in multiple expansion.
Investment Positives
Concerns on Biotech Funding Environment Appear Overblown, In Our View
The CRO industry has seen declining valuations in 2022 due to market concerns around
the impact of a weaker biotech funding environment and a macroeconomic slowdown.
We see these concerns as overblown and expect relatively healthy growth in
biotech/pharma R&D spend in 2023. Our view is supported by results from our Cowen
Biopharma R&D Leader Survey, where 82% of respondents indicated that they expect
their R&D budgets to increase in 2023. Based on responses and total R&D spend
accounted for in our survey, we estimate that industry R&D budgets could see a 3.2%
increase in 2023. Our view is further supported by IQV's 3Q22 comments highlighting
improving emerging biotech (EBP) funding of $18.7B in 3Q (~$60B/yr, above its 5-yr
avg. of $23.6B). In terms of the potential for seeing a weak biotech funding environment
continue, we anticipate it would have a minimal impact to overall R&D budgets in 2023.
Survey results indicated that while 36% of respondents saw a negative impact to their
2022 R&D spend related to the poor funding environment, on a weighted basis, the
overall impact to R&D spend was just -0.4%.
For context, in its R&D Solutions segment (RDS), IQV operates as a contract research
organization (CRO), offering a wide range of solutions intended to facilitate the research
and development process for sponsors. R&D service offerings include project
management/clinical monitoring, planning/design, DCTs and clinical laboratory services.
We see a tailwind to L-T R&D segment growth/profitability, due to a more optimistic
R&D spending environment and the shift to DCT both supported by results from our
Cowen Biopharma R&D Leader survey. We model R&D revenues reaching $9.58B by
2025 (vs. $7.56B in 2021) and adj. EBITDA at $2.10B (vs. $1.48B in 2021), with adj.
EBITDA margins expanding to 21.9% by 2025 (vs. 19.5% in 2021).
Technology & Analytics Solutions (TAS) Not Fully Appreciated
We believe investors often do not fully appreciate IQV’s Technology & Analytics
Solutions (TAS) business and focus more on the R&D segment, given the R&D Solutions
segment has an established peer group of CROs compared to the TAS segment, which
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doesn’t have any pure-play competitors. IQV’s TAS business, however, has compelling L-
T revenue growth potential (9.2% CAGR 2022-2025E) and is its most profitable business
(27.0% segment EBITDA margins estimated in 2022 vs. 21.3% for RDS and 6.4% for
CSMS). For context, TAS offerings include technology platforms, real-world solutions,
analytics and consulting services, and information offerings. We believe L-T segment
growth will be driven by mid-double-digit growth in real-world solutions, low double-
digit growth in technology platforms, and high single-digit growth in analytics &
consulting. Information Offerings is the foundation of TAS and the catalyst for L-T
growth in all other TAS service offerings. We see potential for increased profitability in
real-world evidence (RWE) solutions due to offering higher-margin recurring solutions
(vs. legacy consulting-type work/margins prior) and potential for technology platforms
to be the most profitable offering.
We estimate IQV’s TAS TAM could expand by 1.8x to $243B by 2030 (vs. $135B
currently) driven by a 10.5% CAGR in RWE and a 6% CAGR for both Connected Health
and Tech-Enabled Commercial Operations. We believe within its TAS business,
RWE/connected health’s TAM is driven by increased complexity of drug
development/regulatory approval due to higher standards of care and new therapies
(e.g., biologics, genetically targeted therapies, gene/stem cell therapies, etc.). In our
opinion, IQV is favorably positioned to capitalize on market growth, given its ability to
develop/commercialize therapies, support/defend the value of medicines, and increase
efficiency for clients through insight-driven decision-making. We model TAS revenue
growth of 9.2% (CAGR in 2022-2025) and adj. EBITDA margins of 27.9% by 2025 (vs.
26.3% in 2021). See below for a more detailed discussion on TAS service offerings and
key segment drivers.
DCT Service Offering Benefits from Secular Shift, Supports L-T Growth
There has been a growing movement, driven by regulators and accelerated by the
pandemic, to move clinical trials away from academic medical centers/traditional brick-
and-mortar sites to include more decentralized clinical trial (DCT) models that engage
patients/providers in the community setting. Our Cowen Biopharma R&D Leader Survey
indicated that spend associated with DCTs will increase by ~66% over the next 3-5
years. Our survey found that ~21% of clinical trials conducted by our respondents used
a DCT model, with respondents expecting it to increase to 42% over the next 3-5 years,
indicating a doubling of clinical studies conducted via DCTs by 2027. Survey respondents
also indicated that their current R&D budget spend allocated to decentralized trials is
expected to grow to 33% of total R&D spend over the next 3-5 years, compared to 20%
of spend in 2022. We expect the increased industry focus to make trial populations
more representative, as well as demand from sponsors to see faster recruitment times,
will support continued adoption of DCT platforms and enabling tools. Given that IQV’s
decentralization capabilities span from patient engagement/recruitment to a fully
integrated platform, we believe that IQV is well-positioned to support sponsors who
want to conduct more decentralized trial models. And given our survey highlighted that
67% of clinical trials are conducted with a traditional CRO versus a dedicated DCT
player, we expect IQV to benefit from this increased utilization of DCTs over the coming
years. See below for a more detailed DCT discussion.
FCF Supports Debt Reduction and Capital Deployment
We believe IQV’s strong free cash flow ($2.30B in 2021) can support debt retirement in
2023 and give the company flexibility to also pursue acquisitions and repurchase shares.
IQV paid down $510M of its 2024 debt, resulting in a leverage ratio of 3.4x, with
management highlighting it intends to retire additional term debt in 2023. We believe
IQV will be able to achieve its 2025 leverage target of ~3.0x and see potential for it to
reach its target earlier, which management confirmed on its 3Q earnings call. IQV
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targets to spend $2-3B/yr towards capital deployment (M&A/share repurchases) in

2022-2025 (vs. $1.34B avg. in 2019-2021). We are comfortable in the company’s ability
to achieve this target, given its robust/expanding adj. EBITDA margins (24.6% projected
in 2025E vs. 21.8% in 2021). Management has also expressed its interest in strategically
acquiring assets to enhance its platform and add services. We expect IQV to continue
deploying capital in high-growth underpenetrated industries including biotech solutions
(+20%-25% revenue CAGR 2022-2025E), DCTs, clinical analytics and tech
interoperability.
We believe IQV will prioritize M&A spend on biotech solutions in the higher growth Asia
Pacific region (+11%-13% growth vs. North America/Europe growth of 4-6%), as China
has seen a robust funding environment with its stake of global early-stage pipeline
drugs increase from 2% to 12% over the past 10 years. Therapeutic areas expected to
see significant investment include oncology, central nervous system, and gene therapy.
IQV’s biotech solution is a standalone business unit with its own dedicated
resources/SOPs/tech stack that offers a differentiated operating model to meet the
specific needs of biotech customers. Our revenue estimates do not include the
incremental benefit from M&A, which could represent upside to our 2022-2025
estimates. See below for a more detailed discussion on FCF, debt reduction and capital
deployment.
Survey Results Support Large/Growing Market Opportunity
We believe IQV’s total market opportunity could expand to >$450B (vs. $285B
currently), growing at a 5.4% CAGR through to 2030. IQV’s market opportunity is split
between three markets: R&D spend ($150B TAM), RWE/Connected Health ($60B TAM)
and Tech Enabled Commercial Operations ($75B TAM). Results from our Cowen
Biopharma R&D Leader survey support long-term market growth and demand for
outsourced R&D services, as survey respondents indicated that outsourced R&D spend
is expected to increase at a 5% CAGR over the next 3-5 years. Based on our global large
cap pharma team’s expectations (covered by Steve Scala, R.Ph., CFA) of seeing total R&D
spend grow at ~4% CAGR through 2030, we believe that outsourced R&D spend can
increase from 50% of total R&D spend in 2022, to 54% in 2030, representing a $116B
opportunity (up from $75B in 2022).
We expect IQV’s industry expertise, technology capabilities, and ability to accelerate the
development and commercialization of new treatments to bolster its market position in
an expanding market. In our view, these dynamics support the company’s L-T growth
and profitability trajectory and justify multiple expansion for IQV. See below for a more
detailed discussion on IQV’s market opportunity, key growth drivers and survey results.
Investment Risks
Continued Need for Technological Innovation
IQV operates in a highly competitive market, often competing for business against its
clients’ internal divisions (e.g., discovery departments, development departments, sales
and marketing departments, information technology departments, etc.). We believe
IQV’s Connected Intelligence technology is a key differentiator, as it can be used across
all IQV’s businesses, all stages of the R&D process to meet the needs of clients. If IQV is
unable to continue investing in Connected Intelligence to innovate and sustain its
competitive advantage over its peers, which would materially reduce demand for its
tech/services, resulting in lower revenue and profitability.
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Restriction to License Data or Refusal to Provide Services by Third-Party Data

Providers
IQV’s TAS businesses (e.g., real-world evidence, technology platforms, analytics &
consulting, and information offerings) are reliant on data the company gets from third-
party data providers. IQV usually enters long-term contracts with these providers;
however, when entering/renewing, providers could increase restrictions on IQV’s use of
data, increase pricing or refuse to license the data to IQV. IQV’s operating and financial
results could be materially impacted if a meaningful amount of data providers-imposed
restrictions and/or refused to provide data.
Loss/Delay of Large Contracts or Multiple Contracts
Most of IQV’s R&D Solutions clients can terminate contracts with 30-90 days' notice and
can delay/terminate/reduce contracts due to delay/terminating a clinical trial, lack of
financing, regulatory action, product-related issues (e.g., shortages and safety failures),
or insufficient patient enrollment in trial. IQV receives a fee for winding down the
project upon contract termination; however, fees are not enough to cover forgone
revenues and incurred costs of the project. The loss/delay of large contracts or of
multiple contracts could adversely affect IQV’s revenues and profitability.
Potential Health Care Regulation/Reform
The U.S. Government is considering healthcare reform legislation and imposing health
industry cost containment measures, which could significantly impact the
biopharmaceutical industry. Other government entities are considering or have adopted
healthcare reforms to control growing healthcare costs. We believe if IQV’s clients’
profitability is adversely impacted by healthcare regulation/reform, this could result in
lower R&D or S&M spend. Lower R&D/S&M client spend would negatively impact IQV’s
financial results, as clients would outsource less business to IQV. If the drug approval
process is simplified, IQV could see weaker demand for its services. Lastly, new or
increased regulatory requirements could negatively impact its clients’ ability to conduct
industry-sponsored clinical trials, decreasing demand for IQV services and negatively
impacting its financials.
F/X Headwinds
IQV has operations in >100 countries, resulting in exposure to ~60 different foreign
currencies. The price of foreign currency exchange rates can fluctuate which could result
in potential earnings/CF volatility for IQV. To mitigate this risk, IQV enters foreign
currency forward contracts (e.g., Service Contract Hedging) to hedge foreign currency
CF’s from service contracts. Note, the company does not enter foreign currency
transactions for investment or speculative purposes. We believe F/X rate fluctuations
could impact the U.S. dollar value of foreign currency revenue/expenses and may have a
significant effect IQV results. IQV quantified >$500M revenue headwind from foreign
currency translation through 3Q22. We believe persistent weakness in foreign currency
R/X rates could adversely affect IQV’s revenues and profitability.
Company Overview
IQVIA (IQV) is a Durham, NC-headquartered provider of analytics, technology, and

clinical research services to sponsors of clinical trials globally. The company leverages its
industry expertise, technology capabilities, and big data resources to provide
differentiated insights and execution that can accelerate the development and
commercialization of new treatments. The company operates largely on a service
contract model, with customer relationships ranging from months to years in duration,
and customers spanning from life sciences, biotechnology and pharmaceutical
COWEN.COM 7
companies to other healthcare stakeholders involved in the research and development

process. IQV’s business comprises three main segments:
 Technology & Analytics Solutions: Technology platforms, real-world evidence

solutions, analytics and consulting services, and commercialization insights.
 Research & Development Solutions: Project management and clinical

monitoring, clinical trial support services, clinical laboratory services, strategic
planning, and study design, and decentralized clinical trials.
 Contract Sales & Medical Solutions: Health care provider and patient
engagement services, and medical affairs services.
Figure 1 – Core Capabilities
Source: IQV Analyst Day Presentation 2021
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Technology & Analytics Solutions
IQV’s Technology & Analytics Solutions (TAS) segment, provides critical information,
technology solutions and real-world insights/services to life science clients. TAS service
offerings include information offerings, technology platforms, real-world solutions, and
analytics & consulting. We believe investors often do not fully appreciate IQV’s TAS
business and focus more on the R&D segment, given that the R&D Solutions segment
has an established peer group of CROs compared to the TAS segment, which doesn’t
have any pure-play competitors. IQV’s TAS business has compelling L-T revenue growth
opportunity (9.2% CAGR 2022-2025E) and is its most profitable business (27.0%
segment EBITDA margins estimated in 2022 vs. 21.3% for RDS and 6.4% for CSMS). We
believe L-T segment growth will be driven by mid-to-high double-digit growth in real-
world solutions, low double-digit growth in technology platforms, and high single-digit
growth in analytics & consulting. Information Offerings is the foundation of TAS and
catalyst for L-T growth in all other TAS service offerings. We see potential for increased
profitability in real-world solutions due to offering higher-margin recurring solutions (vs.
legacy consulting-type work/margins prior) and potential for technology platforms to be
the most profitable offering. In 2021, TAS accounted for 40% of IQV’s revenue (flat vs.
2019) and 48.2% of adj. EBITDA (vs. 45.9% in 2019). Our model has TAS revenues
reaching $7.62B by 2025 (vs. $5.53B in 2021) and adj. EBITDA at $2.12B (vs. $1.46B in
2021). See below for a detailed discussion on TAS service offerings and key segment
drivers.
 Information Offerings (30% of TAS): Information Offerings is the foundation of

TAS and catalyst for all other businesses within the segment. This offering
provides performance metrics on national and various sub-national levels
relating to sales, prescribing, and medical treatment activity via its database
that tracks >23M healthcare professionals across >100 countries. By providing
its clients with global drug performance metrics, IQV’s clients are essentially
viewing “report cards” on global drug performance. Services offered in
Information Offerings are typically provided under a fixed-price contract basis,
with IQV receiving compensation under either a non-cancelable subscription
model or one-time fee model, and contracts lasting 1-3 years. For context, IQV
is the largest global provider of global prescription sales and utilization data.
 Technology platforms (20% of TAS): Comprises a wide range of cloud-based

applications and the implementation thereof. Its SaaS solutions are designed to
span much of the clinical development and commercialization process, with
capabilities including CRM, marketing services, data management,
compliance/safety reporting, sales force management and social media
monitoring. A key feature of IQV’s technology offering is its access to
healthcare data, which includes >1.2B non-identified, privacy-protected patient
records such as prescription data, medical claims, electronic health and medical
records, patient-reported outcomes, genomics, and social media data. IQV has
access to ~150K data suppliers and receives ~100B healthcare data points
annually. This comprehensive data resource, when combined with IQV’s
proprietary algorithms, can be personalized to client needs under the Global
Market Insight group of offerings and are used in some capacity by most
biopharmaceutical companies. Most contracts IQV enters with clients in this
category span a year or less in duration.
 Real-World Solutions (25% of TAS): IQV works with life sciences and
healthcare provider customers to enable real-world evidence generation and
dissemination and draw conclusions about drugs’ safety, efficacy, and
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economic value. With a strong emphasis on privacy and data security, IQV
applies standard models and natural language processing technology to its
pool of data to create proprietary clinical evidence platforms, especially within
oncology and rare disease. It also continuously works with stakeholders to
source additional data and develop appropriate reimbursement models.
Management believes a key differentiator for this offering is its ability to offer
retrospective research to clients through utilizing its >1.2B non-identified
patient records. IQV believe this allows clients conducting Ph. 4 trials to build
larger cohorts of patients at a lower cost. We believe IQV’s exorbitant amount
of data helps clients assemble longitudinal patient history in a more efficient
way vs. competitors. RWE consistently grows at a mid-teens growth rate, but
management noted it has exceeded 20% in a few quarters.
Figure 2 – Real-World Solutions Highlights
 Analytics & Consulting (25% of TAS): Service offerings within analytics &
consulting include strategic/implementation consulting, as well as analytics
and process outsourcing, to assist life sciences companies with improving
operational efficiency, reducing costs, and engaging with other stakeholders. It
also offers consulting throughout the drug development process, enabling
sponsors to navigate strategic hurdles. Consulting on pricing, market access,
and brand strategy is also available, with IQV offering expertise across
geographies and indications to maximize the success of a drug’s commercial
launch. Analytics & Consulting had historically been a mid-single-digit growth
business, but COVID accelerated growth to low double digits (last 18-months).
While IQV continues to hire in this segment and management does not see
growth slowing any time soon, its L-T guidance assumes growth does
moderate a bit to high single digits.
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Research & Development Solutions
In its R&D Solutions segment, IQV operates as a contract research organization (CRO),
offering a wide range of solutions intended to facilitate the research and development
process for sponsors. In 2021, its R&D Solutions segment accounted for 54% of revenue
(vs. 52% in 2019) and 49% of adj. EBITDA in 2021 (vs. 48% in 2019). Our Cowen
Biopharma R&D Leader survey and Modernizing R&D: A Primer On Decentralized Clinical
Trials – Ahead of the Curve report suggests a tailwind to L-T growth for IQV, driven by
the increased adoption of DCTs and clinical trial tools by biopharma/pharma companies.
This could result in R&D revenues reaching $9.58B by 2025E (vs. $7.56B in 2021) and
adj. EBITDA at $2.10B (vs. $1.48B in 2021). See below for a detailed discussion on R&D
service offerings and key segment drivers.
 Project management and clinical monitoring: This capability offered by IQV can
involve coordination and execution of entire clinical Phase II to Phase IV trials
across a network of sites identified and operated by the company. IQV has
demonstrated its ability to reduce the time and steps needed to collect data
through its technology-enabled capabilities such as patient recruitment and
site startup.
 Planning and design: This offering is provided to clients in need of strategic

guidance for either a sponsor’s overall portfolio of therapies or protocols for a
specific trial. Service offerings include risk/benefit management, regulatory
planning, biostatistics/biomarker consultations, modeling/simulation, and
personalization of medicine.
 Decentralized clinical trials (DCTs): This relatively novel approach to clinical

research, which has garnered significant attention due to the COVID-19
pandemic and a permissive regulatory environment, uses technology to
capture data outside of the traditional location of the trial site. IQV’s
decentralization capabilities span from patient engagement and recruitment to
a fully integrated platform enabling remote visits, electronic data capture, use
of connected devices, and patient support. IQV emphasizes the importance of
“diversity by design,” which we outline in greater detail in AOTC report on
Clinical Trial Diversity. IQV’s Diversity by Design platform a priori identifies the
life cycle of the pathway to ensure diversity in clinical trials, which the
company notes start well before protocol finalization. The company notes that
during RFPs, it will also analyze and recommend whether a sponsor’s proposed
trial protocol adequately considers diversity, whether the client asks for it or
not. IQVIA also works downstream in the community developing a diversity
alliance network that includes diverse investigators as part of a hub and spoke
network. It also has personnel and clinical trial educators, RNs, etc., that it
deploy to diverse investigator sites as well as its more traditional non-diverse
investigators to train them on developing more relationships locally. It also
trains the staff on how best to engage with various patients using behavioral
training programs. IQVIA also works with local pharmacies, patient advocacy
groups, and other community organizations to inform them of clinical research
opportunities. The company has demonstrated its ability to reach diverse and
underrepresented populations at a rate of 1.7x the industry average using its
DCT platform, which has hosted over 1M patient users. Further, IQV reports
71% faster site activation and 82% faster recruitment among trials using its
DCT technology when compared to historical norms for similar trials.
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Figure 3 – Decentralized Clinical Trial Capabilities
 Clinical laboratory services: A highlight of IQV’s R&D Solutions segment, in our

opinion, which includes a full range of trial laboratory and research services, as
well as supply chain logistics. In April 2021, IQVIA acquired Q2 Solutions, which
has allowed the business to expand its suite of offerings within central
laboratory, genomic, bioanalytical, discovery, vaccine, and biomarker services.
This follows the 2018 acquisition of BioFortis, which introduced virtual
biobanking and consent tracking. IQV sees the lab business as a potential
growth driver in the future given a growing emphasis on biomarkers in clinical
research and notes that the growth rate of this business currently significantly
exceeds the mid-single-digit growth rate of its addressable industry. Notably,
IQV continues to innovate rapidly in this area, with over 3,000 new laboratory
tests being introduced in the last five years. Therapeutic areas of focus include
oncology, infectious disease, and central nervous system.
12 COWEN.COM
Figure 4 – Laboratory Services Highlights
 Clinical trial support services: A range of support services for clinical trial
sponsors fall under this umbrella, including assistance with data collection,
analysis, and reporting. Most of the revenue generated by IQV’s R&D Solutions
segment is derived from service contracts from clinical research, with IQV
responsible for the capture and documentation of clinical trial data in
accordance with regulatory standards. Management has noted that this
segment has seen strong demand that is expected to continue through 2025,
with a target opportunity of $67B for R&D Solutions by this time.
Contract Sales & Medical Solutions
The third segment of IQV’s business is Contract Sales & Medical Solutions. Under this
segment, IQV offers health care provider engagement services, patient engagement
services, and medical affairs services. Most of the revenue generated by IQV’s Contract
Sales & Medical Solutions segment is derived from contract sales to the biopharma
industry and wider healthcare market. Contracts typically involve one or more
performance obligation that may include recruiting, automation, or deployment of a
client’s sales force. Contract Sales & Medical Solutions accounted for 6% of total revenue
in 2021 (vs. 7% in 2019) and 2.9% of adj. EBITDA (vs. 6.6% in 2019). We see potential for
incremental partnership/contracting opportunities with biopharma companies in the
Asia Pacific region as IQV accelerates investment in the Asia Pacific biotech industry.
See below for a detailed discussion of each business within this segment.
 Healthcare provider engagement services: Involves working with biopharma

and life sciences companies to create personalized engagement solutions for
products ranging from new market entrants to established brands toward the
end of their patent. This can include providing contract sales and market access
experts.
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 Patient engagement services: IQV typically provides these services by utilizing

nurses to interact with patients and provide disease- and coverage-specific
care navigation across multiple channels, which has been demonstrated to
improve adherence and outcomes.
 Medical affairs services: These services enable sponsors to transition to the

commercialization phase from the clinical trials phase. Services included in this
offering are on-site education, engagement with key opinion leaders and
decision-makers, and scientific strategy consulting.
Connected Intelligence (Across All the Segments To Leverage Data)
A core component of IQV’s differentiation strategy is constantly innovating its

Connected Intelligence technology, as this could be a key growth driver for clients.
Connected Intelligence focuses on addressing three important challenges, which
adversely affect trial sponsors: the ability to find insights within a pool of data, apply
them within the organization, and improve operational execution and performance
based on them. From the perspective of IQV, while gathering large amounts of data is
simple, separating the meaningful data points and drawing connections efficiently is the
key to driving value. IQV’s effort to simplify this process is known as Connected
Intelligence. From connecting patient data with artificial intelligence and machine
learning capabilities for improved patient recruitment, to connecting sales and market
data with these capabilities for improved commercialization, IQV leverages Connected
Intelligence to meet the needs of clients across all three business segments and all
stages of the R&D process.
Figure 5 – Connected Intelligence Overview
Connected Intelligence has seen both widespread adoption and proven results since its
introduction. The technology has been used in 1,488 trials across 353 customers, and
over 296,000 patients have enrolled across more than 100 countries. It has been used in
14 COWEN.COM
revision of protocols to mitigate risk in over 90% of trials, has led to an average 33%
reduction in time to identify sites compared to historical benchmarks, and has sped up
recruitment rates by an average of 34%.
Growth Strategy
IQV currently serves over 10,000 clients in over 100 countries. The majority of revenues
come from life sciences companies, including those in the pharmaceutical,
biotechnology, device and diagnostic, and consumer health verticals. IQV serves the vast
majority of the top 100 global pharmaceutical and biotechnology companies by revenue,
and many client relationships span several countries. IQV also offers its services to other
healthcare stakeholders, including payors, government agencies, healthcare providers,
and pharmaceutical supply chain companies. The company’s sales are well diversified
across its customer base, with the largest client by revenue making up approximately
7% of sales in 2021. An illustration of some of IQV’s key customers can be seen below.
Figure 6 – Customer Base
IQV recently implemented a strategic plan referred to as “20 by ’25,” indicating

management’s intention to reach a revenue target of $20B by 2025 (reiterated targets
in 3Q22). It aims to reach this target by executing across several strategies to build an
increasingly patient-centric approach. First, the company intends to continue using
Connected Intelligence as an engine for innovation to enable continued delivery of new
technology capabilities to clients. It also aims to deepen existing client relationships and
ultimately expand into the broader healthcare marketplace to serve payors, providers,
and other healthcare professionals. Specifically, management believes it can add value
for these stakeholders by optimizing the cost of care delivery, offering registry
technology to patient and professional communities, and providing system
implementation and platform migration services to providers. Finally, IQV has expressed
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an interest in strategically acquiring assets and businesses to enhance its platform and
add on services.
Figure 7 – Business Trajectory
IQV anticipates that several areas of the business will drive growth through 2025.
Firstly, given high rates of capital raising and growth in the biotechnology sector, the
company expects its biotech solutions to grow by over 20% through 2025. We note that
IQV’s biotech solutions are a standalone business unit with dedicated resources and
technology, which is a differentiating factor from competitors that we believe may set
the company up to outperform the industry in this area. Additionally, management
anticipates the Asia-Pacific geographical region, and especially China, will continue to
grow at a rapid rate given strong funding. IQV has invested significantly in building out
its capabilities in this region, including by rolling out IQV Biotech in Asia in May 2021,
and we believe it stands to gain from these positive trends. Finally, as oncology, central
nervous system, and gene therapy continue to gain share in clinical research, and the
drug development process evolves to become more tech-enabled, IQV expects that its
Connected Intelligence and patient-driven approach will set it apart in these areas.
16 COWEN.COM
Market Opportunity
We believe IQV’s total market opportunity could expand 1.6x to >$450B (vs. $285B
currently), growing at a 5.4% CAGR to 2030. IQV’s market opportunity is split across
three markets: R&D spend ($150B), RWE/Connected Health ($60B) and Tech Enabled
Commercial Operations ($75B). Market growth is driven by overall innovation in life
sciences, accelerated R&D spend by SMID biotech, increasing complexity of drug
development/regulatory approval, demand for efficiency gains and ability to
demonstrate value of new therapies. We see these key growth drivers supporting TAM
expansion for IQV and demand for its businesses (e.g., research and development
services, technology & analytics solutions and contract sales and medical solutions). See
below for a detailed discussion on each market opportunity/key growth drivers.
Figure 8 – IQV Total Market Opportunity ($B);
IQV TAM Analysis ($B) 2021 2022E 2023E 2024E 2025E 2026E 2027E 2028E 2029E 2030E
Internal R&D Spend $75 $77 $80 $82 $84 $87 $89 $92 $94 $97
% chg y/y 3.0% 3.0% 3.0% 2.9% 2.9% 2.9% 2.9% 2.9% 2.8%
Outsourced R&D Spend $75 $79 $83 $87 $91 $96 $101 $106 $111 $116
% of total 50.0%
% chg y/y 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0%
Total R&D Spend $150 $156 $162 $169 $175 $182 $190 $197 $205 $213
% chg y/y 4.0% 4.0% 4.0% 4.0% 4.0% 4.0% 4.0% 4.0% 4.0%
Real-World Evidence $20 $22 $24 $27 $30 $33 $36 $40 $44 $49
% chg y/y 10.5% 10.5% 10.5% 10.5% 10.5% 10.5% 10.5% 10.5% 10.5%
Connected Health $40 $42 $45 $48 $50 $54 $57 $60 $64 $68
% chg y/y 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0%
Total RWE/Connected Health $60 $65 $69 $75 $80 $86 $93 $100 $108 $117
% chg y/y 7.5% 7.5% 7.6% 7.6% 7.7% 7.7% 7.8% 7.8% 7.8%
Tech Enabled Commercial Ops $75 $80 $84 $89 $95 $100 $106 $113 $120 $127
% chg y/y 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0%
Total IQV TAM $285 $300 $316 $333 $350 $369 $389 $411 $433 $457
% chg y/y 5.3% 5.3% 5.3% 5.4% 5.4% 5.4% 5.4% 5.5% 5.5%
Source: Cowen and Company, IQVIA, Cowen R&D Biopharma Survey
Research & Development Solutions – TAM Analysis
Outsourced R&D: IQV operates broadly in the contract research organization (CRO)
industry, which provides pharmaceutical, biotech and medical device companies with
outsourced product development services that help bring new drugs to market in a
quick and more cost-effective manner. While the CRO market in its present form
originated in the 1980s, the outsourcing market has seen dramatic expansion over the
past two decades as biotech and pharmaceutical companies (“biopharma”) turned to
outsourcing previously in-house, pre-clinical and clinical trial processes. Our Cowen
Biopharma R&D Leader Survey indicates that in 2022 roughly 50% of the industry’s
$150B in total R&D spend among biotech and pharma companies was outsourced to
CROs. We estimate outsourced spend will increase by 5% y/y and represent a $116B
opportunity in 2030, ~54% of total R&D spend.
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Figure 9 – What percentage of your clinical development is outsourced to Figure 10 – In the next 3-5 years, what % of your clinical development do you
CROs? (by R&D budget size) expect to be outsourced to CROs? (by R&D budget size)
Source: Cowen Biopharma R&D Leader Survey, November 2022 N=50 Source: Cowen Biopharma R&D Leader Survey, November 2022 N=50
Biopharma R&D Spend: We estimate total R&D spend will grow at ~4% CAGR through
2030, based on our global large cap pharma team’s estimates (covered by Steve Scala,
R.Ph., CFA) and our Cowen Biopharma R&D Leader Survey responses. While the CRO
industry has seen declining valuations due to market concerns surrounding weak
biotech funding and a macroeconomic slowdown, we see these concerns as overblown
and expect healthy growth in R&D spend in 2023. In our Cowen Biopharma R&D Leader
Survey, 82% of respondents indicated they anticipate seeing R&D budgets increase in
2023 (Figure 11). Based on responses and total R&D spend accounted for in our survey,
we estimate that industry R&D budgets will see a 3.2% increase in 2023. In terms of the
weak biotech funding environment, we anticipate minimal impact to R&D budgets in
2023. When asking our survey participants what the overall impact from the weak
funding environment had on their current R&D budgets, 36% of survey participants
responded that their R&D budgets were adversely affected, with another 36%
answering that they saw no impact (Figure 12). However, on a weighted basis (by total
R&D spend) our survey indicated that the overall impact of the weak funding
environment, impacted total R&D spend by just -0.4%.
Figure 11 – In 2023, what are your expectations for year-over-year Figure 12 – How has the biotech funding environment in the last 18
growth in your company’s R&D budget, relative to 2022? months (e.g., since 2021) impacted your current R&D budget?
18 COWEN.COM
Decentralized Clinical Trial Market: We estimate the total spend on decentralized clinical
trials to be ~$30B and see it growing at 10% CAGR to $71B in 2030. Our DCT TAM is
based on results from our Cowen Biopharma R&D Leader survey, which suggests over
the next 3-5 years, 42% of clinical trials will use DCTs vs. traditional model (vs. 21% in
the last three years, Figure 13). We believe the increased emphasis placed on making
clinical trial populations more representative and inclusive as well as the desire to see
faster trial enrollment times, both advantages of the decentralized clinical trial model,
will allow DCTs to see rapid growth in utilization from biopharma over the coming years.
And while we have seen a rise of dedicated DCT companies enter the market with
innovative technology platforms to enable this growing DCT trend, our survey found
that roughly 2/3 of decentralized trials are conducted with traditional CRO partners
(Figure 14), indicating that traditional CROs will also be a beneficiary of DCTs’ growing
popularity.
Figure 13 – Over the NEXT 3-5 years, what % of your clinical trials will Figure 14 – Please estimate the proportion of DCT trials you conduct
use DCTs vs. traditional model? with each of the following entities.
Technology & Analytics Solutions - TAM Analysis
IQV estimates its Technology & Analytics Solutions (TAS) TAM is ~$135B across two
markets: Real-World Evidence/Connected Health ($60B TAM) and Tech-Enabled
Commercial Operations ($75B TAM). We estimate its TAS TAM could expand to $243B
by 2030, driven by a 10.5% CAGR in RWE and a 6% CAGR for both Connected Health and
Tech-Enabled Commercial Operations. We outline market drivers and assumptions for
IQV’s TAS segment below.
Real-World Evidence (RWE) and Connected Health TAM: IQV estimates a total
addressable market for real-world evidence and connected health spending of around
$60B in 2021. This opportunity is split between $20B in demand from life sciences for
post-launch evidence generation, market access, and patient services, and $40B from
connected healthcare for revenue cycle management, analytics, and decision support
services. McKinsey’s Digital R&D report notes applying big-data strategies to better
inform decision-making could generate up to $100B/yr in value across the US
healthcare system by optimizing innovation, improving the efficiency of research and
clinical trials, and building new tools for physicians, consumers, insurers, and regulators
to meet the promise of more individualized approaches. Importantly, the report
highlights that biopharma is expected to increase its use of RWE studies to further
demonstrate the efficacy, safety, and outcomes of its products beyond the controlled
conditions of a clinical trial. RWE trials represent a new model for conducting clinical
COWEN.COM 19
trials where patients are enrolled as part of their routine care and rich data is collected
through non-interventional means to examine how approved medications perform once
they are introduced into the population. RWE studies have the ability to improve the
speed, cost, and quality of conducting post-approval drug research. We estimate the
TAM could expand to $115-120B by 2030E, with RWE’s TAM reaching $49B and
Connected Health expanding to $68B. We believe RWE’s TAM could grow at a 10.5%
CAGR and Connected Health could grow at a 6% CAGR.
Figure 15 – Real-World Evidence and Connected Health TAM ($B)
Source: Bloomberg, SDLC Partners, L.P. Company Data, Cowen and Company
Tech-Enabled Commercial Operations: IQV estimates a $75B TAM for its tech-enabled
commercial operations, which includes data services, software applications, IT services,
and commercial services such as consulting and sales operations. We see the necessity
for the biopharma industry to continuously innovate and the evolving need to integrate
and structure increasing sources of data driving mid-single-digit growth the tech-
enabled commercial operations market. We see IQV’s marketing opportunity growing to
$125-130B by 2030E, assuming a 6% CAGR.
20 COWEN.COM
Figure 16 – Tech-Enable Commercial Operations TAM ($B)
Source: Company Data, Cowen and Company
Competitive Landscape
IQV’s Technology & Analytics Solutions business competes with a wide range of
companies that offer information, analytics, technology, and consulting services to life
sciences companies and other healthcare stakeholders. On the global level, IQV has
identified several competitors, a representative sample of which is listed below. It also
competes with governments, payors, and other stakeholders that provide data services,
as well as startups looking to disrupt the healthcare information services space.
Figure 17 – Technology & Analytics Solutions Competitors
On the Research & Development Solutions side, IQV operates in a highly competitive
market. Its primary source of competition is traditional CROs, and while there are
COWEN.COM 21
several hundred entities in this space offering limited services, IQV most closely
resembles larger CROs that have a global footprint as well as offerings that span the
spectrum of clinical trial operations. Like IQV, several of the largest players have
updated their offerings to add tools, technologies and platforms that support
technology enabled and DCT models. In addition to these entities, IQV competes against
in-house R&D teams at biopharmaceutical companies, academic institutions, and
hospitals. Finally, it competes with companies offering a narrower range of solutions in
this area, including DCT capabilities, clinical laboratories, and other supporting services.
Figure 18 – Research & Development Solutions Competitors
IQV’s Contract Sales & Medical Solutions business competes with biopharmaceutical
company in-house sales/marketing departments, as well as other organizations offering
contract pharmaceutical sales/related services and pharma consulting. In the United
States, this division primarily competes with Syneos Health, Eversana and UDG
Healthcare.
22 COWEN.COM
Management Overview
Ari Bousbib, Chairman & CEO: Ari Bousbib is chairman and chief executive officer of
IQVIA. He has served in this role since October 2016 following the merger of Quintiles
and IMS Health. From 2010 until the merger, he was chairman and CEO of IMS Health.
Prior to his appointment at IMS Health, he spent 14 years at United Technologies
Corporation, where he held several senior leadership positions. Mr. Bousbib joined UTC
in 1997 as chief strategy and development officer, became chief operating officer of
subsidiary Otis in 2000 and chief executive officer of Otis in 2002. In 2008, he was
appointed president of UTC Commercial Companies. Mr. Bousbib is a former partner at
global management and technology consulting firm Booz Allen Hamilton, having joined
the firm in 1987.
Ron Bruehlman, EVP & CFO: Ron Bruehlman is executive vice president and chief
financial officer of IQVIA. He assumed this position after serving from October 2016
through July 2020 as senior advisor to the CEO of IQVIA. Prior to that, Mr. Bruehlman
was chief financial officer of IMS Health from July 2011. Before joining IMS Health
following the 2010 leveraged buyout, he had a 23-year career at United Technologies
Corporation, where he held multiple senior finance leadership roles, including running its
global corporate development and strategy group and serving as chief financial officer
of subsidiary Carrier Corporation. He holds a B.S. from the University of Delaware and
an M.B.A. from the University of Chicago Booth School of Business.
Karl Guenault, SVP & Chief Information Officer: Karl Guenault is senior vice president
and chief information officer for IQVIA. Previously, he served as chief information officer
and vice president, operations at IMS Health. Prior to joining the company in May 2015,
he held a variety of technology and general management leadership roles during a two-
decade career at Cegedim, most recently responsible for the global IT department and
operational effectiveness activities. He also led global support functions, served as
general manager, CRM France, and served as senior vice president of the global CRM
business unit. Mr. Guenault holds a master’s degree from Institut d’Informatique
d’Enterprise.
Sanjay Chikarmane, Chief Product Officer: Sanjay Chikarmane is the chief product
officer for IQVIA. Prior to joining the company in August 2021, he served as chief
product officer and general manager at Hitachi Vantara Corporation from July 2018 to
January 2021. Prior to this he held several executive leadership roles with Illumina, SAP,
and BEA Systems, mainly in the areas of technology and informatics. Mr. Chikarmane
holds a bachelor’s degree from Indian Institute of Technology and a M.S. from Syracuse
University.
Jim Berkshire, SVP of Business Operations: Jim Berkshire is senior vice president, of
Business Operations at IQVIA. Previously, he was vice president of Organizational
Effectiveness at IMS Health. Mr. Berkshire led the Cegedim integration at IMS Health, as
well as technology transformation initiatives and LEAN activities from 2012 to 2017.
He joined IMS Health in 1995 and has held operational and business planning roles at its
corporate and Europe headquarters. He began his career in IT and Financial Audit and
holds a bachelors’ degree from Indiana University.
COWEN.COM 23
ESG Discussion
We believe that IQV should score positively on ESG, given its commitment to increasing
its leadership position in ESG practices that further its corporate purpose of improving
healthcare outcomes for patients and advancing healthcare. IQV’s sustainable business
practices focus on the three pillars (e.g., People, Public and Planet), which we believe can
have a positive impact on social capital, health equity and environmental factors,
detailed below. Importantly, IQV emphasizes the importance of “diversity by design,”
which we outline in greater detail in Cowen’s AOTC report on Clinical Trial Diversity.
IQV’s Diversity by Design platform a priori identifies the life cycle of the pathway to
ensure diversity in clinical trials, which the company notes starts well before protocol
finalization. The company notes that during RFPs, it will also analyze and recommend
whether a sponsor’s proposed trial protocol adequately considers diversity whether or
not the client asks for it. IQVIA also works downstream in the community developing a
diversity alliance network that includes diverse investigators as part of a hub and spoke
network. It also has personnel and clinical trial educators, RNs, etc., that it deploys to
diverse investigator sites as well as its more traditional non-diverse investigators to
train them on developing more relationships locally. Additionally, it trains the staff on
how best to engage with various patients using behavioral training programs. IQVIA also
works with local pharmacies, patient advocacy groups, and other community
organizations to inform them of clinical research opportunities.
Increasing Social Capital
We believe IQV’s commitment to creating an inclusive and diverse working environment

where its employees are respected will increase social capital. The company provides
equal opportunity and advancement to its employees and prioritizes the health/safety
of its employees, which we believe will also increase social capital.
Improving Health Equity
We believe IQV will have a positive impact on health equity, as the company works
alongside governments, NGOs, and academia to enable faster/more robust approaches
to solving the most pressing health challenges. IQV does this through shifting its focus to
health/wellness approached prior to onset of the disease and using AI for early disease
detection, treatment response prediction, and adverse event management. The
company also accelerates discovery/development of new treatment modalities for high-
disease burden conditions, increases delivery of scientific advances and reduces care
delivery burden on patients, caregivers, and communities.
Commitment to Climate Changel
We believe IQV’s focus on being part of the solution to climate change should have a
positive impact on the environment. For example, In 2021, IQV reduced its global real
estate portfolio to 5.7M sq/ft. (from 6.4M sq/ft.) as the company increased its focus on
providing alternative workplaces to employees globally. IQV has also transitioned to
renewable energy sources as evidenced by utilizing solar power panels for power at its
Marlborough Tech Park in MA and its Livingston, Scotland lab running on 100%
renewable energy. Furthermore, the company is working with My Green Lab, a
nonprofit whose mission is to improve the sustainability of scientific research to identify
enhancements within its labs.
24 COWEN.COM
Model Discussion
IQV reports its financial results via its three segments: Technology & Analytics Solutions,
Research & Development Solutions and Contract Sales & Medical Solutions. IQV is a
well-established CRO that has been able to see 9% CAGR growth since 2017 and above
industry adj. EBITDA margins of ~21% (vs. industry average of 19.7% in 2022). At its
investor day last November, management issued L-T financial targets (“20 by ‘25”),
which include revenue growth of 10-12%, adj. EBITDA growth of 11-13%, and double-
digit growth in adj. EPS through 2025. We detail other key L-T guidance metrics in
Figure 19 below. We believe IQV is well positioned and on track to achieve these targets
by 2025, which the company reaffirmed on its 3Q call.
Figure 19 – IQV L-T Financial Guidance (20 by ’25)
Source: Cowen and Company
We estimate revenue of $14.46B in 2022E (+4.2% y/y) and see that growing to $19.38B
in 2026E (~8% CAGR). Our revenue estimate assumes over the next 5 years, Research &
Development Solutions can grow at a 7% CAGR driven by innovation, accelerated R&D
spend and increasing complexity of drug development, with Technology & Analytics
Solutions growing at 9% CAGR driven by in growth in real-world evidence trials, as well
as increased demand for IQV’s analytics & consulting services and technology platforms.
We estimate 2022E adj. EBITDA of $3.34B and see it growing to $4.87B in 2026E. This
implies a margin expansion of +335 bps from IQV’s 2021 adj. EBITDA margin of 21.8% to
our 2026 estimate of 25.1%.
COWEN.COM 25
Figure 20 – IQV Total Revenue by Segment Figure 21 – IQV Total Adj. EBITDA & Margin
$25.00 $6.00 26.0%

25.1%
$5.00 24.6% $4.87 25.0%
$20.00
$0.84
$0.82 $4.03 $4.44
$4.00 $3.64 24.1% 24.0%
$0.81
$15.00 $0.78 $3.34
$0.76 23.4%
$10.22 23.1%
$9.58 $3.00 23.0%
$8.95
$10.00 $8.38
$7.85
$2.00 22.0%
$5.00 $1.00 21.0%

$6.96 $7.62 $8.32
$5.84 $6.37
$0.00 $0.00 20.0%

FY22E FY23E FY24E FY25E FY26E FY22E FY23E FY24E FY25E FY26E
TAS RDS CS&MS Adj. EBITDA ($B) Adj. EBITDA Margin
Source: Company Data, Cowen and Company Source: Company Data, Cowen and Company
Valuation Discussion
Our $251 price target (+18% upside to 12/5’s closing price), is based on our 5-year DCF,
which implies shares can trade at ~16.1x our 2023E adj. EBITDA estimate of $3.64B (vs.
consensus of $3.65B) and 22.7x our 2023 adj. EPS estimate of $11.05 (vs. consensus of
$10.91). We are comfortable in our PT and implied multiple due to IQV’s multiple
growth levers (e.g., large/growing TAM, underappreciated TAS, accelerated shift to
DCTs, increased capital deployment and resilient business model), which should support
its L-T revenue and adj. EBITDA guidance of 10-12% and 11-13% (CAGR in 2022-2025),
respectively.
Figure 22 – DCF Analysis
Model Assumptions
Terminal Growth Rate 2.75%
Discount rate 10.00%
Year Ended December 31,

2022E 2023E 2024E 2025E 2026E
EBIT $ 2,021 $ 2,303 $ 2,558 $ 2,837 $ 3,127

Tax rate 19.9% 21.0% 21.0% 21.0% 21.0%
EBIAT $ 1,618 $ 1,819 $ 2,021 $ 2,241 $ 2,471
+ Depreciation and Amortization 1,026 1,146 1,272 1,403 1,521
- Change in Working Capital (139) 26 30 20 30 Terminal
- Capital Expenditures (650) (722) (799) (881) (952) Value
Free Cash Flow $ 3,433 $ 3,661 $ 4,062 $ 4,506 $ 4,914 $ 69,644
PV Factor 0.91 0.83 0.75 0.68 0.62 0.62
NPV of Free Cash Flow $ 3,121 $ 3,026 $ 3,052 $ 3,077 $ 3,051 $ 43,244
NPV of Future Cash Flows $ 58,571

+ Excess Cash (11,029)
Value of Equity $ 47,542
Total Number of Share 189
Value per share $ 251
Source: Cowen and Company
26 COWEN.COM
We also look at relative valuation as a secondary measure (e.g., NTM EV/EBITDA and
NTM P/E), given the company’s solid L-T revenue/adj. EBITDA growth of 10-12%/11-
13%, margin expansion opportunity (+286bps to 24.6% in 2025E vs. 21.8% in 2021) and
robust FCF generation ($2.09B in 2025E vs. $844M in 2021). At its current valuation
(14.2x NTM EV/EBITDA and 20.1x NTM P/E), we believe the stock is attractively valued
relative to peers on both NTM EV/EBITDA (ICLR at 13.6x and SYNH at 8.2x) and NTM
P/E (ICLR at 17.2x and SYNH at 8.6x). IQV is also trading -1.8x below its 5-yr historical
average NTM EV/EBITDA of 16.0x and -2.0x below its 5-yr historical average NTM P/E
of 22.0x. We believe the discount to its 5-year avg. multiple as unwarranted, as well as
trading at a similar multiple to ICLR. We believe IQV’s robust L-T rev/adj. EBITDA
growth, solid FCF generation ($8.81B cumulative in 2022-2026 vs. $2.74B 2018-2021)
and capital deployment strategy should result in meaningful multiple expansion.
Figure 23 – Historical NTM EV/EBITDA vs. Peers Figure 24 – Historical NTM P/E vs. Peers
Source: Thomson Reuters Eikon, Cowen and Company Source: Thomson Reuters Eikon, Cowen and Company
COWEN.COM 27
Figure 25 – IQVIA Holdings - Annual Income Statement, F2019-F2026E
($’s in millions, except per-share data)

2019 2020 2021 2022E 2023E 2024E 2025E 2026E
Revenue 11,088 11,359 13,874 14,456 15,530 16,713 18,022 19,384

Costs of revenue 7,300 7,500 9,233 9,387 10,011 10,690 11,455 12,263
Gross profit 3,788 3,859 4,641 5,069 5,519 6,023 6,567 7,121
gross margin 34.2% 34.0% 33.5% 35.1% 35.5% 36.0% 36.4% 36.7%
bps (105) (19) (52) 162 47 50 40 30
Selling, general and administrative expenses 1,734 1,789 1,964 2,003 2,053 2,176 2,311 2,456
% of total revenue 15.6% 15.7% 14.2% 13.9% 13.2% 13.0% 12.8% 12.7%
Depreciation and amortization 1,202 1,287 1,264 1,026 1,146 1,272 1,403 1,521
Impairment costs - - - - - - - -
Restructuring costs 75 52 20 19 16 16 16 16
Operating income 777 731 1,393 2,021 2,303 2,558 2,837 3,127
operating margin 7.0% 6.4% 10.0% 14.0% 14.8% 15.3% 15.7% 16.1%
Interest income (9) (6) (6) (11) (16) (16) (16) (16)
Interest expense 447 416 375 418 589 569 523 472
Loss on extinguishment of debt 24 13 26 - - - - -
Other expense (income), net (37) (65) (130) 59 20 20 20 4
Pre-tax income 352 373 1,128 1,555 1,710 1,985 2,310 2,667
pre-tax margin 3.2% 3.3% 8.1% 10.8% 11.0% 11.9% 12.8% 13.8%
Income tax (benefit) expense 116 72 163 310 359 417 485 560
income tax rate 33.0% 19.3% 14.5% 19.9% 21.0% 21.0% 21.0% 21.0%
Income before equity in earnings of unconsolidated affiliates 236 301 965 1,245 1,351 1,568 1,825 2,107
Equity in earnings of unconsolidated affiliates (9) 7 6 (17) (20) (20) (20) (20)
Net income 227 308 971 1,228 1,331 1,548 1,805 2,087
Net income attributable to non-controlling interests (36) (29) (5) - - - - -
Net income attributable to IQVIA Holdings Inc 191 279 966 1,228 1,331 1,548 1,805 2,087
net income margin 1.7% 2.5% 7.0% 8.5% 8.6% 9.3% 10.0% 10.8%
Adj. net income 1,276 1,252 1,760 1,941 2,081 2,352 2,631 2,942
adj. net income margin 11.5% 11.0% 12.7% 13.4% 13.4% 14.1% 14.6% 15.2%
Diluted weighted average common shares outstanding 200 195 195 191 188 187 186 183
Adj. EPS $ 6.39 $ 6.42 $ 9.03 $ 10.17 $ 11.05 $ 12.56 $ 14.16 $ 16.08
GAAP EPS $ 0.96 $ 1.43 $ 4.95 $ 6.44 $ 7.06 $ 8.26 $ 9.71 $ 11.41
Adj. EBITDA 2,400 2,384 3,022 3,343 3,641 4,027 4,441 4,871
adj. EBITDA margin 21.6% 21.0% 21.8% 23.1% 23.4% 24.1% 24.6% 25.1%
% change y/y:
Revenues 6.5% 2.4% 22.1% 4.2% 7.4% 7.6% 7.8% 7.6%
Gross profit 3.3% 1.9% 20.3% 9.2% 8.9% 9.1% 9.0% 8.4%
Adj. EBITDA 7.9% -0.7% 26.8% 10.6% 8.9% 10.6% 10.3% 9.7%
Pretax income 7.3% 6.0% 202.4% 37.9% 9.9% 16.1% 16.4% 15.5%
Adj. net income 10.4% -1.9% 40.6% 10.3% 7.2% 13.0% 11.9% 11.8%
Adjusted EPS 15.1% 0.4% 40.6% 12.7% 8.6% 13.7% 12.7% 13.6%
GAAP EPS -23.1% 49.5% 246.2% 29.9% 9.7% 17.0% 17.5% 17.5%
Source: Company Reports and Cowen and Company
28 COWEN.COM
Figure 26 – IQVIA Holdings - Quarterly Income Statement, F2021–F2024E
($’s in millions, except per-share data)

1Q21 2Q21 3Q21 4Q21 1Q22 2Q22 3Q22 4Q22E 1Q23E 2Q23E 3Q23E 4Q23E 1Q24E 2Q24E 3Q24E 4Q24E
Mar-21 Jun-21 Sep-21 Dec-21 Mar-22 Jun-22 Sep-22 Dec-22 Mar-23 Jun-23 Sep-23 Dec-23 Mar-24 Jun-24 Sep-24 Dec-24
Revenue 3,409 3,438 3,391 3,636 3,568 3,541 3,562 3,785 3,784 3,796 3,859 4,091 4,075 4,078 4,146 4,414
Costs of revenue 2,293 2,323 2,253 2,364 2,323 2,331 2,321 2,412 2,450 2,480 2,495 2,586 2,618 2,644 2,660 2,768
Gross profit 1,116 1,115 1,138 1,272 1,245 1,210 1,241 1,373 1,334 1,316 1,364 1,505 1,457 1,434 1,486 1,646
gross margin 32.7% 32.4% 33.6% 35.0% 34.9% 34.2% 34.8% 36.3% 35.3% 34.7% 35.3% 36.8% 35.8% 35.2% 35.8% 37.3%
bps (103) 2 (183) 84 216 174 128 130 36 50 50 50 50 50 50 50
Selling, general and administrative expenses 442 482 498 542 488 483 517 515 511 503 506 533 542 532 536 566
% of total revenue 13.0% 14.0% 14.7% 14.9% 13.7% 13.6% 14.5% 13.6% 13.5% 13.3% 13.1% 13.0% 13.3% 13.1% 12.9% 12.8%
Depreciation and amortization 323 343 336 262 255 270 248 253 278 281 287 301 309 312 318 334
Impairment costs - - - - - - - - - - - - - - - -
Restructuring costs 9 4 2 5 7 4 4 4 4 4 4 4 4 4 4 4
Operating income 342 286 302 463 495 453 472 601 541 528 567 667 602 586 628 742
operating margin 10.0% 8.3% 8.9% 12.7% 13.9% 12.8% 13.3% 15.9% 14.3% 13.9% 14.7% 16.3% 14.8% 14.4% 15.2% 16.8%
Interest income (1) (1) (2) (2) (1) (2) (4) (4) (4) (4) (4) (4) (4) (4) (4) (4)
Interest expense 99 94 92 90 86 94 108 130 145 147 149 148 146 144 141 139
Loss on extinguishment of debt 24 - 1 1 - - - - - - - - - - -
Other expense (income), net (37) (29) (62) (2) 10 33 8 8 5 5 5 5 5 5 5 5
Pre-tax income 257 222 273 376 400 328 360 467 395 380 417 518 455 442 486 602
pre-tax margin 7.5% 6.5% 8.1% 10.3% 11.2% 9.3% 10.1% 12.3% 10.4% 10.0% 10.8% 12.7% 11.2% 10.8% 11.7% 13.6%
Income tax (benefit) expense 44 48 12 59 71 71 70 98 83 80 88 109 96 93 102 126

income tax rate 17.1% 21.6% 4.4% 15.7% 17.8% 21.6% 19.4% 21.0% 21.0% 21.0% 21.0% 21.0% 21.0% 21.0% 21.0% 21.0%
Income before equity in earnings of unconsolidated affiliates 213 174 261 317 329 257 290 369 312 300 329 409 360 349 384 476
Equity in earnings of unconsolidated affiliates 4 1 - 1 (4) (1) (7) (5) (5) (5) (5) (5) (5) (5) (5) (5)
Net income 217 175 261 318 325 256 283 364 307 295 324 404 355 344 379 471
Net income attributable to non-controlling interests (5) - - - - - - - - - - - - - - -

Net income attributable to IQVIA Holdings Inc 212 175 261 318 325 256 283 364 307 295 324 404 355 344 379 471
net income margin 6.2% 5.1% 7.7% 8.7% 9.1% 7.2% 7.9% 9.6% 8.1% 7.8% 8.4% 9.9% 8.7% 8.4% 9.1% 10.7%
Adj. net income 425 416 423 496 477 466 470 528 495 483 512 592 555 545 580 672
adj. net income margin 12.5% 12.1% 12.5% 13.6% 13.4% 13.2% 13.2% 14.0% 13.1% 12.7% 13.3% 14.5% 13.6% 13.4% 14.0% 15.2%
Diluted weighted average common shares outstanding 195 195 195 195 193 191 189 189 189 189 188 188 187 187 187 187
Adj. EPS $2.18 $2.13 $2.17 $2.55 $2.47 $2.44 $2.48 $2.79 $2.62 $2.56 $2.72 $3.15 $2.96 $2.91 $3.10 $3.59
GAAP EPS $1.09 $0.90 $1.34 $1.63 $1.68 $1.34 $1.49 $1.92 $1.63 $1.57 $1.72 $2.15 $1.89 $1.84 $2.02 $2.51
Adj. EBITDA 744 722 728 828 812 800 814 917 867 857 901 1,016 960 947 995 1,125
adj. EBITDA margin 21.8% 21.0% 21.5% 22.8% 22.8% 22.6% 22.9% 24.2% 22.9% 22.6% 23.4% 24.8% 23.6% 23.2% 24.0% 25.5%
% change y/y:
Revenues 23.8% 36.4% 21.7% 10.2% 4.7% 3.0% 5.0% 4.1% 6.1% 7.2% 8.3% 8.1% 7.7% 7.4% 7.4% 7.9%
Gross profit 20.0% 36.5% 15.4% 13.0% 11.6% 8.5% 9.1% 8.0% 7.2% 8.8% 9.9% 9.6% 9.2% 9.0% 9.0% 9.4%
Adj. EBITDA 32.4% 49.5% 20.5% 12.7% 9.1% 10.8% 11.8% 10.7% 6.7% 7.1% 10.7% 10.8% 10.7% 10.5% 10.4% 10.7%
Pretax income 152.0% -988.0% 167.6% 93.8% 55.6% 47.7% 31.9% 24.3% -1.2% 15.9% 15.8% 10.8% 15.2% 16.2% 16.6% 16.3%
Adj. net income 44.6% 81.7% 33.0% 20.7% 12.2% 12.0% 11.1% 6.5% 3.7% 3.6% 8.9% 12.2% 12.3% 12.8% 13.3% 13.5%
Adjusted EPS 45.2% 81.1% 32.7% 20.8% 13.1% 14.2% 14.6% 9.5% 6.1% 4.9% 9.6% 13.1% 13.3% 13.6% 13.9% 13.9%
GAAP EPS 159.6% -858.5% 157.9% 167.5% 54.5% 49.2% 11.8% 17.8% -3.3% 16.9% 15.3% 11.8% 16.5% 17.2% 17.5% 16.8%
Source: Company Reports and Cowen and Company.
COWEN.COM 29
Figure 27 – IQVIA Holdings - Balance Sheet, F2019–F2026E
($’s in millions)
2019 2020 2021 2022E 2023E 2024E 2025E 2026E
Assets:
Cash and cash equivalents 837 1,814 1,366 1,726 1,915 2,708 3,500 4,520
Trade accounts receivable and unbilled services, net 2,582 2,410 2,551 2,600 2,731 2,873 3,025 3,176
Prepaid expenses 138 159 156 163 175 188 203 218
Income taxes receivable 56 56 58 60 65 70 75 81
Investments in debt, equity and other securities 62 88 111 111 111 111 111 111
Other current assets and receivables 451 563 521 543 583 628 677 728
Current assets 4,126 5,090 4,763 5,203 5,580 6,577 7,591 8,834
Property and equipment, net 458 482 497 807 1,160 1,556 1,994 2,458
Operating lease right-of-use assets 496 471 406 406 406 406 406 406
Investments in debt, equity and other securities 65 78 76 76 76 76 76 76
Investments in unconsolidated affiliates 87 84 88 88 88 88 88 88
Goodwill 12,159 12,654 13,301 13,948 13,948 13,948 13,948 13,948
Other identifiable intangibles, net 5,514 5,205 4,943 4,642 4,292 3,894 3,448 2,953
Deferred income taxes 119 114 124 129 139 149 161 173
Deposits and other assets 227 386 491 512 550 591 638 686
Total assets 23,251 24,564 24,689 25,811 26,239 27,287 28,350 29,622
Liabilities:
Accounts payable and accrued expenses 2,512 2,813 2,981 3,222 3,461 3,725 4,016 4,320
Unearned income 1,014 1,252 1,825 2,017 2,167 2,332 2,515 2,705
Income taxes payable 108 102 137 143 153 165 178 191
Current portion of long-term debt 100 149 91 91 91 91 91 91
Other current liabilities 211 242 207 216 232 249 269 289
Current liabilities 3,945 4,558 5,241 5,688 6,104 6,562 7,069 7,596
Long-term debt, less current portion 11,545 12,384 12,034 11,793 11,543 10,793 9,793 8,793
Deferred income taxes 646 338 410 427 459 494 533 573
Operating lease liabilities 396 371 313 313 313 313 313 313
Other liabilities 456 633 649 676 726 782 843 907
Common stock 11,049 11,095 10,777 10,885 10,994 11,104 11,215 11,327
Retained earnings 998 1,277 2,243 3,471 4,802 6,350 8,155 10,242
Treasury stock (5,733) (6,166) (6,572) (7,037) (8,296) (8,705) (9,164) (9,723)
Accumulated other comprehensive (loss) income (311) (205) (406) (406) (406) (406) (406) (406)
Equity attributable to IQVIA Holdings Inc.’s stockholders 6,003 6,001 6,042 6,913 7,094 8,342 9,799 11,440
Non-controlling interest 260 279 - - - - -

Total shareholders’ equity 6,263 6,280 6,042 6,913 7,094 8,342 9,799 11,440
Total liabilities & stockholders' equity 23,251 24,564 24,689 25,811 26,239 27,287 28,350 29,622
30 COWEN.COM
Figure 28 – IQVIA Holdings - Free Cash Flow Analysis, F2021–F2026E
($’s in millions)
2021 2022E 2023E 2024E 2025E 2026E
Operating Activities
Net income 971 966 1,228 1,331 1,548 1,805
Adjustments to reconcile net income to cash provided by operating activities:

Depreciation and amortization 1,264 1,026 1,146 1,272 1,403 1,521
Amortization of debt issuance costs and discount 17 20 22 26 30 34
Amortization of accumulated other comprehensive loss on terminated interest rate swaps - - - - - -
Stock-based compensation 170 207 211 216 221 226
Impairment of goodwill and identifiable intangible assets - - - - - -
Gain on disposals of property and equipment, net - - - - - -
Earnings from unconsolidated affiliates (6) (17) (20) (20) (20) (20)
Loss (gain) on investments, net (16) - - - - -
Benefit from deferred income taxes (138) - - - - -
Changes in operating assets and liabilities:
Accounts receivable and unbilled services (138) (49) (131) (141) (153) (151)
Prepaid expenses and other assets (15) (28) (52) (58) (64) (66)
Accounts payable and accrued expenses 244 241 239 264 292 304
Unearned income 591 192 150 165 183 190
Income taxes payable and other liabilities (2) 14 27 29 32 34
Net cash provided by operating activities 2,942 2,571 2,821 3,084 3,471 3,876
Acquisition of businesses, net (1,458) (1,012) (500) (500) (500) (500)

Acquisition of property, equipment and software (640) (650) (722) (799) (881) (952)
Issuance of common stock (59) (59) (59) (59) (59) (59)
Repurchase of common stock (406) (1,200) (350) (400) (500) (750)
Proceeds/(repayment) of debt, net 30 (510) (250) (750) (1,000) (1,000)
Other (857) 1,220 (750) 218 261 404
Net increase/(decrease) in cash (448) 360 190 793 792 1,019

Cash, cash equivalents and restricted cash at beginning of period 1,814 1,366 1,726 1,915 2,708 3,500
Cash, cash equivalents and restricted cash at end of period 1,366 1,726 1,915 2,708 3,500 4,520
COWEN SUMMARY:
Cash Flow from Operations1 2,942 2,571 2,821 3,084 3,471 3,876
Capital Spending (2,098) (1,662) (1,222) (1,299) (1,381) (1,452)
Owners' Cash Flow 844 909 1,599 1,785 2,090 2,424
Financing 30 (510) (250) (750) (1,000) (1,000)

Non-Recurring Items (1,458) (1,012) (500) (500) (500) (500)
1
Excludes non-recurring items
COWEN.COM 31
Figure 29 – IQVIA Holdings - Historical Cash Flow, F2019–F2021
($’s in millions)
2019 2020 2021
Operating Activities
Net income 227 308 971
Adjustments to reconcile net income to cash provided by operating activities:
Depreciation and amortization 1,202 1,287 1,264
Amortization of debt issuance costs and discount 13 18 17
Amortization of accumulated other comprehensive loss on terminated interest rate swaps - - -
Stock-based compensation 146 95 170
Impairment of goodwill and identifiable intangible assets - - -
Gain on disposals of property and equipment, net 1 - -
Earnings from unconsolidated affiliates 9 (7) (6)
Loss (gain) on investments, net (43) (25) (16)
Benefit from deferred income taxes (157) (176) (138)
Changes in operating assets and liabilities:
Accounts receivable and unbilled services (122) 255 (138)
Prepaid expenses and other assets (92) (146) (15)
Accounts payable and accrued expenses 240 253 244
Unearned income (2) 180 591
Income taxes payable and other liabilities (5) (83) (2)
Net cash provided by operating activities 1,417 1,959 2,942
Investing Activities
Acquisition of property, equipment and software (582) (616) (640)
Acquisition of businesses, net of cash acquired (588) (177) (1,458)
Disposition of business, net of cash disposed - -
(Purchases) sales of marketable securities (3) (9) (10)
Investments in unconsolidated affiliates, net of payments received - 10 (5)
Investments in equity securities (22) (2) 5
Other 5 (2) 5
Net cash used in investing activities (1,190) (796) (2,103)
Financing Activities
Proceeds from issuance of debt 1,900 1,591 1,951
Payment of debt issuance costs (47) (33) (40)
Repayment of debt (899) (864) (2,091)
Proceeds from revolving credit facility 2,522 1,250 810
Repayment of revolving credit facility (2,776) (1,635) (600)
Principal payments on capital lease obligations - - -
Proceeds related to employee stock option plans 11 (44) (59)
Repurchase of common stock (949) (447) (406)
Distributions to non-controlling interests, net (18) (13) (758)
Contingent consideration and deferred purchase price payments (20) (22) (42)
Net cash used in financing activities (276) (217) (1,235)
Effect of foreign currency exchange rate changes on cash (5) 31 (52)

Decrease in cash and cash equivalents (54) 977 (448)
Cash, cash equivalents and restricted cash, beginning of period 891 837 1,814
Cash, cash equivalents and restricted cash, end of period 837 1,814 1,366
32 COWEN.COM
VALUATION METHODOLOGY AND RISKS
Risks To The Price Target
Risks to our Outperform rating include 1) reduced technological innovation, narrowing its
competitive moat, 2) increased competition in DCTs and/or decelerated adoption of DCTs,
3) Tempered Pace of Capital Deployment (M&A/Share Repurchases), 4) loss/delay of large
contracts or multiple contracts.
COWEN.COM 33
ADDENDUM
Stocks Mentioned In Important Disclosures
Ticker Company Name
CVS CVS Health
IQV IQVIA Holdings
WBA Walgreens Boots Alliance
Analyst Certification
Each author of this research report hereby certifies that (i) the views expressed in the research report accurately reflect his or her personal views about any and all of the subject
securities or issuers, and (ii) no part of his or her compensation was, is, or will be related, directly or indirectly, to the specific recommendations or views expressed in this report.
Important Disclosures
Cowen and Company, LLC and or its affiliates make a market in the stock of IQVIA Holdings, CVS Health and Walgreens Boots Alliance securities.
Cowen and Company, LLC is a client of IQVIA Holdings, Inc.
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"Cross-Asset Research" report may differ from the views offered in the firm’s equity research reports prepared for our clients.
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34 COWEN.COM
Additionally, the complete preceding 12-month recommendations history related to recommendation in this research report is available at https://cowen.bluematrix.com/sellside/
Disclosures.action
The recommendation contained in this report was produced at December 05, 2022, 20:12 ET. and disseminated at December 06, 2022, 05:28 ET.
Cowen ESG Scores: Cowen leverages technology from Truvalue Labs to generate our ESG scores. Truvalue Labs uses artificial intelligence to capture the stakeholder view of how
companies are performing on ESG metrics, using the Sustainability Accounting Standards Board (SASB) materiality framework (www.sasb.org). (See below.) These data are leveraged
to calculate a score for each company, which allows Cowen to have a common framework and uniform way to approach ESG discussions with our clients. Cowen ESG scores appear on
Company and Company Quick Take notes and are updated daily.
The algorithms are sensitive to both intensity and frequency. Truvalue Labs data contribute an indication of how stakeholder issues and potential controversies may affect a company,
based on real-time information. Truvalue assesses positive and negative ESG events contained in unstructured data and assigns a score per topic for each passage based on the
magnitude of sentiment. The score reflects not only whether performance is positive or negative, but also how positively or negatively the company is performing on the topic
reflected in the datapoint. For example, the algorithms would assign a relatively more negative score to a catastrophic oil spill affecting multiple workers and communities than to a
workplace incident that caused a minor injury to one worker. In both cases, the sentiment-based score would be negative, but performance would be evaluated as significantly more
negative in the first case than in the second case.
Cowen introduced its own ESG scoring methodology because we believe that existing ratings systems are mostly backward-looking. Data are often supplied by companies and thus are
subject to “greenwashing” (i.e., using data selectively to spin a story that is better than it actually is). In addition, most ratings systems generally don’t align with SASB, which we think
is emerging as a standard on the buy side.
Dynamic Materiality™ is Truvalue Labs’ approach acknowledging that companies, industries, and sectors have unique materiality signatures that evolve over time, determined by
factors such as shifts in business models, changing consumer preferences, emerging technologies, and new regulations. Dynamic Materiality™ is driven by how stakeholders respond
to events, behaviors, and externalities experienced in relation to a company or an industry. This stands in contrast to the view that materiality is relatively static and can be defined by
a company. For example, if a company appeared in 100 different sources over a trailing 12-month period, and 30 of the sources were related to the SASB Employee Health & Safety
category, the Employee Health & Safety Dynamic Materiality™ would be 30%. Furthermore, 30% of the company’s overall score would be driven by the Employee Health and Safety
Insight Score.
Copyright, User Agreement and other general information related to this report
© 2022 Cowen and Company, LLC. All rights reserved. Member NYSE, FINRA and SIPC. This research report is prepared for the exclusive use of Cowen clients and may not be
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Cowen and Company, LLC. New York 646 562 1010 Boston 617 946 3700 San Francisco 415 646 7200 Chicago 312 577 2240 Cleveland 440 331 3531 Atlanta 866 544 7009
Stamford 646 616 3000 Washington, D.C. 202 868 5300 London (affiliate) 44 207 071 7500
COWEN AND COMPANY EQUITY RESEARCH RATING DEFINITIONS
Outperform (1): The stock is expected to achieve a total positive return of at least 15% over the next 12 months
Market Perform (2): The stock is expected to have a total return that falls between the parameters of an Outperform and Underperform over the next 12 months
Underperform (3): Stock is expected to achieve a total negative return of at least 10% over the next 12 months
Assumption: The expected total return calculation includes anticipated dividend yield
Cowen and Company Equity Research Rating Distribution

Distribution of Ratings/Investment Banking Services (IB) as of 09/30/22
Rating Count Ratings Distribution Count IB Services/Past 12 Months
Buy (a) 694 71.92% 156 22.48%
Hold (b) 266 27.56% 17 6.39%
Sell (c) 5 0.52% 0 0.00%
(a) Corresponds to "Outperform" rated stocks as defined in Cowen and Company, LLC's equity research rating definitions. (b) Corresponds to "Market Perform" as defined in Cowen
and Company, LLC's equity research ratings definitions. (c) Corresponds to "Underperform" as defined in Cowen and Company, LLC's equity research ratings definitions. Cowen and
Company Equity Research Rating Distribution Table does not include any company for which the equity research rating is currently suspended or any debt security followed by Cowen
Credit Research and Trading.
Note: "Buy", "Hold" and "Sell" are not terms that Cowen and Company, LLC uses in its ratings system and should not be construed as investment options. Rather, these ratings terms
are used illustratively to comply with FINRA regulation.
COWEN.COM 35
CVS Health Rating History as of 12/02/2022

powered by: BlueMatrix
(1):$83.00 (1):$84.00 (1):$83.00 (1):$85.00 (1):$89.00 (1):$87.00 (1):$93.00 (1):$95.00 (1):$105.00 (1):$98.00 (1):$103.00 (1):$114.00 (1):$119.00
11/06/19 02/24/20 04/24/20 05/06/20 08/12/20 10/23/20 11/09/20 02/16/21 06/07/21 08/09/21 11/15/21 12/09/21 02/09/22
130
120
110
100
90
80
70
60
50
Jan 20 Apr 20 Jul 20 Oct 20 Jan 21 Apr 21 Jul 21 Oct 21 Jan 22 Apr 22 Jul 22 Oct 22
(1):$120.00 (1):$118.00
08/15/22 11/02/22
Closing Price Target Price
IQVIA Holdings Rating History as of 12/02/2022

300
250
200
150
100
50
Walgreens Boots Alliance Rating History as of 12/02/2022

(2):$60.00 (2):$54.00 (2):$48.00 (2):$46.00 (2):$41.00 (2):$53.00 (2):$55.00 (2):$50.00 (2):$49.00 (2):$43.00 (1):$54.00
10/28/19 02/10/20 05/19/20 07/17/20 10/23/20 03/29/21 11/15/21 04/11/22 06/08/22 07/19/22 11/22/22
65
60
55
50
45
40
35
30
Legend for Price Chart:

I = Initiation | 1 = Outperform | 2 = Market Perform | 3 = Underperform | UR = Price Target Under Review | T = Terminated Coverage | $xx = Price Target | NA = Not Available |
S=Suspended
36 COWEN.COM
COWEN ESG SCORES
HOW ARE COWEN’S ESG SCORES CALCULATED?

Cowen ESG Scores: Cowen leverages technology from Truvalue Labs to generate our ESG scores. Truvalue Labs uses artificial intelligence to capture the stakeholder view of how
companies are performing on ESG metrics, using the Sustainability Accounting Standards Board (SASB) materiality framework (www.sasb.org). (See below.) These data are leveraged
to calculate a score for each company, which allows Cowen to have a common framework and uniform way to approach ESG discussions with our clients. Cowen ESG scores appear on
Company and Company Quick Take notes and are updated daily.
HOW DOES THE PROCESS WORK?

The algorithms are sensitive to both intensity and frequency. Truvalue Labs data contribute an indication of how stakeholder issues and potential controversies may affect a company,
based on real-time information. Truvalue assesses positive and negative ESG events contained in unstructured data and assigns a score per topic for each passage based on the
magnitude of sentiment. The score reflects not only whether performance is positive or negative, but also how positively or negatively the company is performing on the topic
reflected in the datapoint. For example, the algorithms would assign a relatively more negative score to a catastrophic oil spill affecting multiple workers and communities than to a
workplace incident that caused a minor injury to one worker. In both cases, the sentiment-based score would be negative, but performance would be evaluated as significantly more
negative in the first case than in the second case.
WHY DO WE BELIEVE THAT OUR APPROACH IS BETTER THAN OTHERS?

Cowen introduced its own ESG scoring methodology because we believe that existing ratings systems are mostly backward-looking. Data are often supplied by companies and thus are
subject to “greenwashing” (i.e., using data selectively to spin a story that is better than it actually is). In addition, most ratings systems generally don’t align with SASB, which we think
is emerging as a standard on the buy side.
DYNAMIC MATERIALITY™
Dynamic Materiality™ is Truvalue Labs’ approach acknowledging that companies, industries, and sectors have unique materiality signatures that evolve over time, determined by
factors such as shifts in business models, changing consumer preferences, emerging technologies, and new regulations. Dynamic Materiality™ is driven by how stakeholders respond
to events, behaviors, and externalities experienced in relation to a company or an industry. This stands in contrast to the view that materiality is relatively static and can be defined by
a company. For example, if a company appeared in 100 different sources over a trailing 12-month period, and 30 of the sources were related to the SASB Employee Health & Safety
category, the Employee Health & Safety Dynamic Materiality™ would be 30%. Furthermore, 30% of the company’s overall score would be driven by the Employee Health and Safety
Insight Score.
COWEN.COM 37
38 COWEN.COM
POINTS OF CONTACT
Analyst Profiles
Charles Rhyee Steven Braun Lucas Romanski

New York New York New York
646 562 1376 646 562 1322 646 562 1352
[email protected] [email protected] [email protected]
Charles Rhyee is a senior analyst covering Steven Braun is a vice president covering Lucas Romanski is an equity research
health care IT and distribution, which he has health care IT and distribution. He joined associate covering health care IT and
followed since 1999. He joined Cowen in Cowen in 2022. distribution. He joined Cowen in 2022.
2011.
Reaching Cowen
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Health Care Technology & Distribution: CROs

EQUITY RESEARCH INITIATING COVERAGE

Price: $211.93 (12/5/2022) INITIATE OUTPERFORM: WELL POSITIONED FOR

Charles Rhyee THE COWEN INSIGHT

Please see pages 33 to 39 of this report for important disclosures. COWEN.COM

Our Investment Thesis Forthcoming Catalysts

Base Case Assumptions Upside Scenario Downside Scenario

■ FY23 revenue of $15.53B ■ Faster-than-expected tech innovation or ■ Decelerated technological innovation to

Price Performance Company Description

COWEN ESG SCORES

HOW ARE COWEN’S ESG SCORES CALCULATED?

HOW DOES THE PROCESS WORK?

Concerns on Biotech Funding Environment Appear Overblown, In Our View

Technology & Analytics Solutions (TAS) Not Fully Appreciated

FCF Supports Debt Reduction and Capital Deployment

targets to spend $2-3B/yr towards capital deployment (M&A/share repurchases) in

Survey Results Support Large/Growing Market Opportunity

Continued Need for Technological Innovation

Restriction to License Data or Refusal to Provide Services by Third-Party Data

Loss/Delay of Large Contracts or Multiple Contracts

Potential Health Care Regulation/Reform

IQVIA (IQV) is a Durham, NC-headquartered provider of analytics, technology, and

companies to other healthcare stakeholders involved in the research and development

 Technology & Analytics Solutions: Technology platforms, real-world evidence

 Research & Development Solutions: Project management and clinical

Figure 1 – Core Capabilities

Source: IQV Analyst Day Presentation 2021

Technology & Analytics Solutions

 Information Offerings (30% of TAS): Information Offerings is the foundation of

 Technology platforms (20% of TAS): Comprises a wide range of cloud-based

Figure 2 – Real-World Solutions Highlights

Source: IQV Analyst Day Presentation 2021

Research & Development Solutions

 Planning and design: This offering is provided to clients in need of strategic

 Decentralized clinical trials (DCTs): This relatively novel approach to clinical

Figure 3 – Decentralized Clinical Trial Capabilities

Source: IQV Analyst Day Presentation 2021

 Clinical laboratory services: A highlight of IQV’s R&D Solutions segment, in our

Figure 4 – Laboratory Services Highlights

Source: IQV Analyst Day Presentation 2021

Contract Sales & Medical Solutions

 Healthcare provider engagement services: Involves working with biopharma

 Patient engagement services: IQV typically provides these services by utilizing

 Medical affairs services: These services enable sponsors to transition to the

Connected Intelligence (Across All the Segments To Leverage Data)

A core component of IQV’s differentiation strategy is constantly innovating its

Figure 5 – Connected Intelligence Overview

Source: IQV Analyst Day Presentation 2021

Figure 6 – Customer Base

Source: IQV Analyst Day Presentation 2021

IQV recently implemented a strategic plan referred to as “20 by ’25,” indicating

Figure 7 – Business Trajectory

Source: IQV Analyst Day Presentation 2021

Figure 8 – IQV Total Market Opportunity ($B);

Source: Cowen and Company, IQVIA, Cowen R&D Biopharma Survey

Research & Development Solutions – TAM Analysis

Technology & Analytics Solutions - TAM Analysis

Figure 15 – Real-World Evidence and Connected Health TAM ($B)

Figure 16 – Tech-Enable Commercial Operations TAM ($B)