GoodRx Holdings, Inc. Q3 FY2021 Earnings Call

Ladies and gentlemen, thank you for standing by, and welcome to the GoodRx Third Quarter 2021 Earnings Call. As a reminder, today's conference call is being recorded. I would now like to introduce your host for today's call, Whitney Notaro, Vice President of Investor Relations. Ms. Notaro, you may begin.

Thank you, operator. Good afternoon, everyone, and welcome to GoodRx's earnings conference call for the third quarter of 2021. Joining me today are Doug Hirsch and Trevor Bezdek, our Co-Founders and Co-Chief Executive Officers; and Karsten Voermann, our Chief Financial Officer. Before we begin, I'd like to remind everyone that this call will contain forward-looking statements. All statements made on this call that do not relate to matters of historical fact should be considered forward-looking statements, including statements regarding management's plans, strategies, goals, and objectives, our market opportunity, our anticipated financial performance, and the expected impact of COVID-19 on our business. These statements are neither promises nor guarantees but involve known and unknown risks, uncertainties, and other important factors. These factors may cause our actual results, performance, or achievements to be materially different from any future results, performance, or achievements expressed or implied by the forward-looking statements. Factors discussed in the Risk Factors section of our quarterly report on Form 10-Q for the quarter ended September 30, 2021, and annual report on Form 10-K for the year ended December 31, 2020, and our other filings with the Securities and Exchange Commission could cause actual results to differ materially from those indicated by the forward-looking statements made on this call. Any such forward-looking statements represent management's estimates as of the date of this call, and we disclaim any obligation to update these statements even if subsequent events cause our views to change. In addition, we may also reference certain non-GAAP metrics, which are reconciled to the nearest GAAP metric in the company's shareholder letter, which can be found on the overview page of our Investor Relations website at investors.goodrx.com. I'd also like to remind everyone that a replay of this call will become available there shortly as well. With that, I'll turn the call over to Doug.

Good afternoon, everybody, and thank you for joining us today. In September, GoodRx celebrated its 10-year anniversary. Over the past decade, we've worked hard to create ways to help millions of Americans access affordable care. Today, we support patients across each stage of their health care journey, delivering superior savings, trusted information, and access to care to millions of Americans. While many companies talk about making the world a better place, making a difference is what we do. GoodRx has now saved Americans $35 billion on their prescriptions, and consumer savings have increased to 80% of the pharmacy cash price. We have been insurance over 50% of the time, and we continue to increase access to brand drugs for our pharma manufacturer relationships. For many of our users, GoodRx is not just about saving money. It's about whether they will be able to buy their medication or their children's medication or not. In fact, we estimate that we have helped patients obtain at least 80 million prescriptions they otherwise may not have been able to afford. We believe that our impact has never been greater, and with yet another quarter of record results, our business has never been stronger. Because of GoodRx, millions of Americans can now afford care. Because of GoodRx, millions of Americans are more informed and better prepared to make health care decisions from diagnosis to care delivery. And because of GoodRx, millions of patients are empowered to navigate the confusing world of health care, knowing they have a trusted advocate by their side. We continue building our broad and deep competitive moat, which is rooted in the trust we've established with patients, physicians, and companies across all of health care. Patients trust us, and our consumer NPS of 90 is a testament to the important role we play in their care. Physicians and health care professionals trust us with over 2 million prescribers that have a patient that has used GoodRx and a very high provider NPS of 90. Companies look to us as a way to introduce products and services and provide savings to our large and growing audience. We work with more PBMs and pharmacies than ever and have continued to strengthen those relationships. In addition to our 10-year anniversary in September, we also celebrated our 1-year anniversary as a public company. We've made meaningful progress towards creating one of the leading digital consumer health care platforms over the last year and have substantially expanded our highly extensible platform to address more of the consumer health care journey for more Americans. We continue to address more of our TAM by enhancing our prescription savings offering through the acquisitions of Healthy Nation, Rx Saver, and Rx Next, launching brand drug integrated co-pay card, expanding our gold network, entering into distribution agreements with DoorDash, USAA, Vectra awards and others, and establishing or continuing relationships with 95% of the top 20 pharma manufacturers in the U.S. We increased our diagnostic capabilities through the geographical and condition expansion of our telehealth services, rebranding them as GoodRx Care, and created a more unified user experience. We built significant capabilities to support consumers in the research and prevention stage of the health care journey through the acquisition of Healthy Nation and the launch of GoodRx Health. And finally, we've made an exciting step into the insurance marketplace space through our relationship with GoHealth. This has all been fueled by the passion of our team and unrelenting dedication to our mission. Despite our success, Americans still face rising costs, decreasing life expectancy, and poor health outcomes. We feel a tremendous sense of urgency to find more ways to help more people, and we believe that our efforts can help reverse those trends. In the coming years, we see more opportunities to help Americans fill more gaps in their health care journey, including navigating insurance as their trusted advocate, further personalizing the GoodRx user experience, and extending our marketplace. We believe that we are just getting started and have barely scratched the surface of the opportunity to transform health care in the U.S. We won't rest until all Americans have access to affordable, high-quality, and convenient health care. With that, I'll turn it over to Trevor to address key highlights from the quarter and trends in our business.

Thank you, Doug, and thanks to everyone for joining us this afternoon. I'm proud to report another quarter of strong performance. From our record revenue to record adjusted EBITDA and record users, the strength of our business is clear. We grew revenue 39% year-over-year to a record $195.1 million, and our adjusted EBITDA to $61.8 million, a margin of almost 32%. These positive results were not only fueled by the strength and continued growth of our prescription transactions offering, but our ability to expand our platform from our historical focus on prescription discounts. Today, we impact millions of consumers and providers in many meaningful ways. We have built successful TAM-expanding subscriptions, pharma manufacturer solutions, and telehealth offerings that continued to grow rapidly in the third quarter, more than doubling and tripling year-over-year, respectively, in the case of the first two. We believe these offerings will continue to increase the LTV of our millions of users as well as attract incremental consumers to our extensible platform. Our provider NPS improved to 90 in the third quarter, and our consumer NPS remained high at 90. Our strong growth and attractive margins make us what many call a rule of 70-plus company, much better than the traditional rule of 40, which we believe is unique at our size and in our space. During the quarter, we increased our competitive moat by continuing to add new features and improving the user experience across prescriptions and telehealth, increasing our penetration in pharma manufacturer solutions, announcing an exciting agreement with Fetch Rewards to be their exclusive prescription savings provider, and continuing to deliver on our mission to help Americans get the health care they need at a price they can afford. We also launched GoodRx Health, which is a new potentially TAM-expanding focus area for us that we are particularly excited about. GoodRx Health is our next-generation online health resource where doctors, pharmacists, and editorial experts provide authoritative answers to thousands of crucial health questions. The demand for health and wellness information in the U.S. is massive. Millions of users already come to GoodRx every month looking for health information, and with GoodRx Health, we want to increase that number even more. By adding GoodRx Health to our portfolio of resources, we aim to help more Americans at every stage of their health care journey from diagnosis to treatment and care. GoodRx Health allows us to reach more people in more ways through content that empowers them to be advocates for their own health across a wide range of health care decisions. GoodRx Health focuses on four main areas: health knowledge, financial guidance, drug FAQs, and trustworthy original research. It is powered by a dedicated editorial team, including leading doctors, pharmacists, and editorial experts, and aims to tap into current medical perspectives, with the goal of creating the most trusted and most useful health information resource on the Internet. We deliver this information in unique formats to help ensure consumers can quickly find the information they need. GoodRx Health is key to our content strategy. We believe that the addition of GoodRx Health to our platform allows us to increase top-of-funnel traffic, reach more consumers, strengthen our relationships with our existing users, and create new opportunities to leverage M&A to provide incremental services and further lift LTV as we help address the needs of broader consumer and provider audiences. We believe GoodRx Health will particularly support the great momentum we've had with our pharma manufacturer solutions offering. We see a tremendous opportunity to leverage content to help consumers and providers navigate the complex world of brand medications and increase awareness, access, and adherence. GoodRx Health is key to this content strategy, which we started executing earlier this year with the acquisition of Healthy Nation. We believe that the investments we're making in content between GoodRx Health and Healthy Nation have the potential to continue to drive this offering's steep growth trajectory. During the quarter, we also became the exclusive prescription savings provider for Fetch Rewards, further increasing the reach of our prescription transactions offering. Fetch Rewards has over 10 million active shoppers who can now find GoodRx prescription savings directly in the Fetch Rewards app, allowing them to seamlessly access GoodRx discounts on medication at over 70,000 pharmacies nationwide. We're excited to partner with Fetch Rewards and offer its millions of users a way to save on prescription medication, and we see opportunities to expand this partnership in the years to come. Fetch Rewards represents another relationship that is additive to our direct-to-consumer acquisition strategy. It has already helped us serve millions of Americans since we launched our platform a decade ago. In the third quarter, we helped 6.4 million monthly active consumers and 1.6 million subscription members save on their prescription medications. The combined reach of almost 8 million represents approximately 34% year-over-year growth. Our pharma manufacturer solutions offering has continued to grow incredibly fast with another quarter of over 3x year-over-year growth. This reflects our brand strength with consumers and our deep relationships with the health care providers that manufacturers seek to leverage. Approximately 25% of our platform visitors are health care providers, and we have over 400,000 doctor offices distributing GoodRx materials, which are some of the reasons why over 2 million prescribers have a patient who has used GoodRx. During the quarter, we continued to increase our pharma manufacturer brand penetration and started building a promising bookings pipeline for 2022. We have entered into an exciting agreement with CoverMyMeds to further our pharma manufacturer solutions business. This is a joint go-to-market effort to create custom prescription discounts for consumers supported by the pharma manufacturer. This opportunity includes joint commercialization as well as integrated technology components, creating a seamless experience for patients, providers, and pharmacies that provides the patient tools and support most relevant to their specific journey to get on and stay on therapy. CoverMyMeds is a leader in biopharma-supported solutions for patient affordability. As a leader in consumer affordability solutions, we see this as a natural partnership. We're excited about the progress we're making to help increase consumer awareness, access, and adherence related to brand locations. GoodRx Care continued to resonate with consumers with a 3x increase in demand since the onset of the pandemic and is liked for user experience with a 5-star rating. Care focuses on low-cost prescription-associated conditions and provides another entry point for consumers to access our highly extensible platform at a critical point in their health care journey. Approximately 65% of GoodRx Care visits are driving incremental revenue through our other offerings, up from 30% earlier this year, by providing consumers with a quick and easy way to see a licensed medical provider for a range of primary care services. Care helps consumers save time and money while keeping them in the GoodRx ecosystem. We believe this cross-sell increases consumer lifetime value. Before I turn it over to Karsten to discuss our financial results and guidance, I'd like to speak to some market trends that have impacted our expectations. The last 20 months of COVID have certainly been unprecedented, and I'm proud to say we have successfully navigated our way through much of the uncertainty. Our third-quarter record results are a testament to our ability to succeed and to increase our share of the market, even though COVID effects have remained longer than any of us expected. With that said, it continues to be challenging to predict health care utilization trends amid the pandemic. Earlier in the year, when the country largely reopened after the vaccine became more widely available, we expected that health care utilization would rebound to pre-COVID levels and beyond, with normal seasonal trends around flu and acute medication returning in the second half. However, what we have seen so far is a continued diagnosis backlog reflecting a lag in certain areas of health care utilization recovery, as well as volatility in the recovery pattern, whether due to physician office capacity limits, the emergence of new variants, people electing to further delay care, and a variety of other reasons, which we believe are largely temporary. While the exact timing remains uncertain, we continue to believe the unwinding of the diagnosis backlog will serve as fuel for fast future growth. We are continuing to build a platform that we believe delivers significant value to consumers in an area of their life that is nondiscretionary and critical. We believe we are very well positioned when utilization does increase, and regular health care usage and patterns resume. As we reflect on the quarter and our broader mission, I couldn't be more proud of our strong results and the progress we are making toward our goal of filling more gaps in health care. We are just getting started and see exciting opportunities to expand our platform and range of services over time. With that, I'll turn it over to Karsten to discuss our financial results and guidance.

Thank you, Trevor. Good afternoon, everyone, and thank you for joining us today. The third quarter was another strong quarter for our business. We continued to deliver record revenue at attractive margins while growing our consumer and provider base, deepening our competitive moat and extending our platform. Revenue for the quarter was $195.1 million, growing 39% year-over-year. Prescription transactions revenue grew by 25% year-over-year to $155.7 million, driven by a 31% year-over-year increase in our monthly active consumers, which reached a record 6.4 million. This was partially offset by a year-over-year decrease in prescription transactions revenue per MAC related to ScriptCycle and RxSaver, which have lower revenue per consumer. GoodRx prescription transaction economics have otherwise remained consistently strong. This is the first quarter that our MAC number includes estimated RxSaver Max. RxSaver's prescription transactions revenue and MAC count are de minimis relative to GoodRx's scale. The RxSaver MAC count is an estimation due to incomplete consumer information. However, it is immaterial relative to GoodRx's MAC account. As a reminder, monthly active consumers represent the number of unique consumers who use GoodRx to save on their prescriptions in a given month, and it does not include consumers of our other offerings such as subscriptions, pharma manufacturer solutions, and telehealth. When presented for a quarter, monthly active consumers represent the average of the calendar months in the quarter. Monthly active consumers from acquired companies are only included beginning in the first full quarter following the acquisition. Subscription revenue grew rapidly, up 111% year-over-year to $16.2 million. We finished the quarter with 1.13 million subscription plans and approximately 1.6 million members benefiting from our subscription offerings, since our family subscriptions generally serve multiple consumers. Our subscription count and subscription revenue should provide a more holistic view of our growing consumer base and reflect another way we monetize a portion of the millions of visitors on our platform. Looking at our total prescription-related offerings, we had 6.4 million MAC in our prescription transactions offering and over 1.6 million members associated with our 1.13 million subscription plans. We continued to invest in sales and marketing spend and investments in our general and administrative infrastructure as we began operating as a public company. We continue to generate strong cash flow with net cash from operating activities of $48.6 million for the quarter. Now turning to guidance. For the fourth quarter of 2021, we expect revenue of $212 million to $222 million, reflecting 38% to 45% year-over-year growth. We believe this growth will be driven by a continued triple-digit increase in other revenue based largely on the continued momentum in our pharma manufacturer solutions offering, combined with continued growth in subscription and prescription transactions revenue. On the adjusted EBITDA front, we expect an adjusted EBITDA margin of approximately 30% for the fourth quarter. Looking at the full year, our fourth quarter guidance implies full-year revenue guidance of $744 million to $754 million, with the midpoint at approximately the midpoint of our prior guidance range we provided on our first-quarter earnings call. On the adjusted EBITDA front, our 30% fourth-quarter guidance puts us at the midpoint of the full-year 30% to 32% range we provided on that May earnings call as well. As we discussed during our third-quarter earnings call, COVID's trajectory, as well as its second-order impact that may potentially reduce acute volumes in the 2021 to 2022 cold and flu season impacted like last winter, present challenges around predicting results. When we provided our full-year guidance during our first-quarter earnings call, our assumptions included a return to normal health care utilization and customary seasonal trends around acute and flu starting in the second half of the third quarter. We continue to see modest improvements, which our record revenue reflects, but we have not seen a return to normal in all areas of utilization. It is too early to assess the size of the impact of the cold and flu season, which historically contributed materially to our revenue. You may recollect we discussed the flu impact of approximately $5 million last winter. These effects impacted both initial fills and new prescriptions; they also reduced our refill volume. The COVID and cold flu predictability challenges also contributed to our decision not to update full-year guidance during the second-quarter earnings call, as we discussed then. Both because of the unpredictability of COVID and cold flu activity and the fact that people may defer health care visits into the new plan and deductible period starting in January 2022, we believe it is prudent to continue to provide a wider revenue range for the fourth quarter than we may otherwise have. Depending on the trajectory through the rest of the fourth quarter, this unpredictability could impact our results, particularly with respect to prescription transactions and subscription revenue. Our current guidance assumes that as COVID continues to recede, the cold and flu season will revert to higher historical levels and utilization will rise through year-end, though the exact timing and magnitude remain uncertain. We view COVID-related health care utilization effects as temporary, and we look forward to the unwinding of the $1 billion-plus diagnosed condition backlog, which we expect to amplify new prescription and prescription transactions revenue growth in 2022 and possibly beyond. The other reason for our wider guidance range relates to our exciting pharma manufacturer solutions offering, which has been our fastest-growing offering at over 3x year-over-year growth and has over 150% net revenue retention with extremely attractive unit economics. Pharma Manufacturer Solutions is growing rapidly and has the potential for large deals in the fourth quarter, which is typical in this space. These deals may accelerate growth even further, driving some additional variability in our results. Consistent with the trend in the last few quarters, we expect our non-prescription transaction revenue offerings, which are reflected in subscription revenue and other revenue, to continue to make up a higher percentage of our total revenue. In the third quarter, they made up 20% of total revenue, an increase of approximately 400 basis points compared to the first quarter, and we expect that to increase by 200 to 400 basis points more to approximately 22% to 24% of total revenue in the fourth quarter. The reasons for this wider range of mix outcomes are similar to those I described around variability, both in prescription transactions revenue and pharma manufacturer solutions. This means prescription transaction revenue, which is driven by MAC, will make up a smaller share of total revenue as more visitors and MAC convert to subscribers and as we continue to grow pharma manufacturer solutions. Before I conclude, I have one note on our income tax provision or benefit. As you can see, the volatility in our tax provision continues, and after recording a significant tax benefit in the second quarter, we had a $19.2 million tax expense in the third quarter. We continue to expect unpredictability in our future tax provision or benefit amounts due to multiple elements and estimates that impact the interim income tax accounting calculations. One of the most significant elements is excess tax benefits or deficiencies resulting from stock awards. This element is challenging to forecast as it is generally driven by factors outside of our control, such as the stock trading price and the decision of employees relating to their awards. This is one of the reasons we are presenting adjusted net income and adjusted tax. GoodRx's impact has never been greater, and with yet another quarter of record results, our business has never been stronger. We are building the leading consumer-focused digital health care platform in the U.S. and plan to continue investing our strong cash flows in our platform, product, user experience, and our brand with the goal of creating the best consumer experience and improved health care affordability and access for all Americans. Thank you for your continued interest in GoodRx. We look forward to sharing our progress in the quarters to come. And with that, I'll now turn the call over to the operator for questions.

Your first question comes from the line of Elizabeth Anderson with Evercore ISI.

I was wondering if you could give some nice color on the impact of COVID in the quarter and sort of what you're seeing in terms of the rebound and visits. Can you talk to us a little bit more about how maybe the trend continued as Delta declined over the course of the quarter? And if you could remind us how you sort of think about usage of GoodRx for perhaps cold, cough, and flu type prescriptions versus something that you might think of more as deferred care type situations?

Thank you very much for the question. Karsten, could you speak to this?

Sure. Elizabeth, thanks for the great question, and great to speak to you again, too. We're really proud of the results we had this quarter with another quarter of record revenue, record adjusted EBITDA, and record users, even with that sort of legacy of COVID still hovering over us to some degree. We think it's a testament to our ability to succeed and increase our market share even with those kinds of headwinds. We have seen modest improvements in prescription volumes, which are reflected in the robust sequential growth. We see the market as a whole slowly inching back towards pre-COVID levels. That said, we expect it to take a quarter or two for prescription volume to return fully to those pre-COVID levels, particularly in relation to acute conditions and new prescriptions, even with our expectations that this year, we'll probably see a normal cold and flu season, a more robust one like two years ago, as opposed to the one we had last year. It's important to note that for GoodRx, it’s not only about total prescription volume; it’s also about new therapy starts, the mix of acute versus chronic, and seasonal trends like the cold and flu. If you recall last winter, when we talked on our calls, we mentioned that the weak cold and flu season cost us about $5 million in revenue, which is significant, of course. The other aspect is that after 20 months of lower new therapy starts through COVID, that translates into a lower rate of refills, too. Again, we think that our record outcomes occurred despite that reality. As for cold and flu specifically, since you raised that as well, the numbers we're seeing so far look better than last year, but it's a little too early since they are still small at this stage to fully assess the impact. As far as we thought about it from a guidance perspective, with our 38% to 45% year-over-year revenue growth guide of 41.5% at the midpoint for the quarter, we're assuming that cold and flu will be back this year with respect to that. Finally, the other elements that will be significant are our pharma manufacturer solutions and the contribution of subscriptions, as well as our prescription transactions revenue. I think we'll see volumes continually increase on the prescription transaction side through the rest of the fourth quarter. The variability in acute cold and flu and seasonal trends are things that we expect will benefit us this year. The most important point is to reiterate the point Trevor made earlier in the call: when the country largely reopened and the vaccine became available, we expected health care utilization to rebound to pre-COVID levels quickly, with normal seasonal trends around cold and flu and acute also returning quickly in the second half. However, what we've seen so far is a continuing diagnosis backlog that reflects lags in certain areas of utilization, as well as general volatility, and it may take a couple more quarters for those to fully smooth out even with the positive impacts of cold and flu. Hopefully, that's helpful. Apologies for the long answer, but there's a lot of meat in that question.

Your next question comes from the line of Jailendra Singh with Credit Suisse.

I actually wanted to follow up on your GoodRx Health platform you have rolled out. I kind of want to better understand the benefits this might generate for your Pharma Manufacturer Solutions business. Help us understand how it differentiates GoodRx? And do you expect to see benefits to your other businesses as well? And the last part there is that with GoodRx Health now live, have you seen incremental interest from manufacturers for your Pharma Solutions business?

Thank you very much for the question. I'm excited to speak about GoodRx. As we look at what we've accomplished since our IPO a year ago, one of the things we're really excited about is that we've extended our platform to reach consumers across even more stages of the health care journey. GoodRx Health is another way for us to advance that effort. We have millions of users who are already coming to GoodRx every month to navigate their health care, and lots of them are looking for health information. By adding GoodRx Health, we can increase that number; we can help even more consumers navigate more stages of this journey. We find that not everyone has the need to use our prescription-related or telehealth offerings when they come to the platform. But if we can help them in other ways, such as insights and tools, we start building relationships with them, and then we deliver value over time. GoodRx Health is this great online health resource where consumers and providers can find answers to critical health questions. It has over 2,500 videos covering 350 conditions, which we augmented by acquiring Healthy Nation earlier this year. It's already made an impact with a 60% year-over-year increase in our content traffic; our newsletter has now reached 5 million sign-ups earlier this month. To your question about pharma manufacturers, it definitely helps drive growth in the pharma manufacturer solution side of the business. That part of our business is doing extremely well with the more than 3x year-over-year growth that we've discussed. It helps us increase awareness, access, and adherence for brand drugs to these other areas. It drives volume and acquisition into all areas of our business, and this will continue to help us deliver strong results like this quarter with the record revenue, record profit, and record users that we're happy to report.

Your next question comes from the line of Sean Dodge with RBC Capital Markets.

On the PTR per MAC, the take rate you all have shared has crept up the increase there. Is that just a function of PBM mix, you're driving more volume through PBMs that you have more favorable agreements with? Or is this more same-store driven where you're negotiating more favorable economics maybe when the PBM contracts come up for renewal? And ultimately, what I'm looking for is just some help better understanding what kind of runway remains for driving PTR per MAC higher over time?

Karsten, could you speak to this one?

Yes, I'd love to, and thanks for the great question. GoodRx's unit economics and the prescriptions transactions offering have been pretty consistent, and it's been increasing on a steady trajectory over time. We believe that this is really sustainable because the volume we drive for our PBM partners is largely incremental and goes almost directly to their bottom line. Another good piece of evidence is that we've continued to expand our PBM network, and our take rate has continued to modestly increase in the mid-teens. Realistically, the PBMs, I think, absent GoodRx, would have lower revenue and lower contribution as well. If you look at it through the lens of PTR per MAC, as you did, we see PTR per MAC increasing, which was up about 1% quarter-over-quarter compared to the second quarter, primarily because of PBM mix and continued improved economics. On a year-over-year basis, PTR per MAC looks like it's down, but that's solely due to M&A and elements like ScriptCycle and RxSaver. If you ignore those, PTR per MAC is actually up in the mid-single-digit percentage points exactly as you'd suggested it would be. It's not really a KPI we manage to, but when that happens and manifests, given the nature of our relationships with our PBMs, the volumes we drive to them, and the benefits those volumes give us, ultimately, the strength of the business overall is leading to drive this volume to our PBM partners. We're really pleased to continue this trajectory, and we expect to maintain our strong unit economics. So to your question of a little help, I think we expect that the historical trends that you've seen so far will manifest themselves as well.

Your next question comes from the line of Stephanie Davis with SVB Leerink.

You've announced a bunch of partnerships over the past few months. We've had patched Surescripts a bunch going on. So I was hoping you could walk us through how we should think about the follow-on impacts of these partnerships, both on the membership side and on the marketing spend side?

I appreciate the question. We want to reach consumers across all of the different areas we can. We're really excited about the growth of our prescription and offerings. We now have nearly 8 million monthly users, made up of 6.4 million monthly active consumers and 1.6 million subscription members. We're always looking for additional ways to reach and help more Americans. Regarding the partnership we announced this quarter about being the exclusive prescription savings provider for Fetch Rewards, it is the fastest-growing consumer loyalty and shopping rewards platform in the U.S. This lets us reach their 10 million active shoppers, so the reach is significant. Those users can now find our prescription savings directly in the Fetch app. This is another great relationship that lets us aggregate consumer demand. It's similar to the ones we entered into with USAA and DoorDash earlier this year. These relationships allow us to continue driving great growth we're seeing in prescription-related offerings, where we saw users grow 34% year-over-year, resulting in this record quarter. When we look at this overall, we see demand aggregation as a whole just being another way to help lower the cost of acquisition and reach more consumers through these B2B efforts. We’re seeing success in these partnerships as well as through the other ways we generate demand across the business.

Your next question comes from the line of John Ransom with Raymond James.

This is probably for Karsten. In your 4Q guidance, what is the estimate for marketing spend?

Karsten?

Thank you, Trevor. Appreciate it. Yes, I think when we look at the fourth quarter and we look at the guidance generally, again, the focus was on the top line. From that perspective, I think it's 38% to 45%, and about 41% to 42% at the midpoint, driven by what we've seen in the trajectory of the business so far. As it relates to marketing spend specifically, we haven't broken that out in the guidance, but we expect to continue to make marketing investments consistently with the ones we made in prior quarters. When we started the year off and discussed our guidance, even at the end of last year around this time, we had said that 2021 would be a year in which we invested heavily in product and marketing in anticipation of coming out of COVID, having the deferred undiagnosed condition backlog receipt, etc. And so that was the focus for and the catalyst for continuing to invest in those two areas, marketing and product. From where we stand now, too, we're looking at a bunch of effects in the first quarter of next year potentially. Folks are entering a new deductible plan year; they're making decisions about their health care right now and entering into next year. We see COVID continuing to recede. It took longer than we may have expected than most may have expected this year earlier. However, the continued receding of it will provide us, we believe, a nice tailwind into next year, too. We want to put enough marketing behind that in the fourth quarter already to take advantage of it. So hopefully, that gives you a bit of perspective on how we're thinking about marketing and teeing up 2022 and beyond.

Your next question comes from the line of George Hill with Deutsche Bank.

I'm wondering if you are in a position yet to try to quantify what you think the impact of COVID-19 has been in the 2021 fiscal year? And maybe if you're able to think about quantifying how we should think about the diagnosis backlog just as we think about what is the right jumping-off point from a user's basis on a prescription basis as we look for 2022?

Thank you very much for the question. I'll let Karsten also speak to this answer.

Yes, George, we see the diagnosis backlog as a pretty huge opportunity. Just today, looking at another chart of physician visits over time, we're running according to what I was looking at today at least physician visit volumes that are pretty much identical to what they were back in 2016. And that's subsequent to them having grown in '17, '18, and '19 before falling off again in COVID. Generally, the net effect of all of that on our view of our business going forward in '22 and beyond, in particular, is that the unwinding of that backlog is just inevitably going to be a significant tailwind. I think the other impact is that even now as we go into the fourth quarter, our belief is that the cold and flu season will return in more robust form too, just given the opening of the economy. With respect to specific '22 guidance, we're not going to do that now, but we are evaluating and analyzing the degree to which both the decreased new prescription starts during COVID and the related refills have impacted the business to gain more perspective for ourselves and for everyone on this call with respect to 2022 and how 2022 could be differentially benefiting from a shift back to normality. Because we do see not just that initial fill but also the associated refills as having been a drag that we've had to fight through to be able to deliver the record numbers that Trevor alluded to in the call earlier today.

Your next question comes from the line of Doug Anmuth with JPMorgan.

I don't think you talked about Surescripts. I was just hoping you could talk a little bit more about the integration there and how the rollout is going, and perhaps how we should think about the timing for some bigger impact there? And then secondly, just on Manufacturer Solutions, pretty clear the strength within other revenue. Just curious how you're thinking about when that business might be able to shift from a mostly fixed fee structure to something that's based more on a CPM model over time?

Thanks for the question. So first for Surescripts, we have incredibly deep, long-standing health care provider relationships. Health care providers were some of the earliest champions of GoodRx. We're extremely proud of these deep relationships we've built with health care providers over the past decade, and they're a really important driver of consumer awareness. As we've mentioned in the past, there are 2 million prescribers in the U.S. that have a patient who has used GoodRx. According to our survey, 80% of physicians recommend us, and GoodRx's awareness among physicians is remarkable at 88%. So the agreement with Surescripts creates another exciting way to continue to strengthen that physician relationship and make it easier for health care professionals to recommend GoodRx. By working with Surescripts, we can help prescribers make informed decisions and address prescription cost concerns for uninsured patients and patients whose coverage is not available via Surescripts. With more health care professionals and consumers accessing our prices in a simple and easy way, we're glad to be working with Surescripts to support providers at the point of care. While it's early, we are pleased with the progress of our work with Surescripts so far. Regarding manufacturer solutions, our pharma manufacturer solutions offering has continued to grow incredibly fast with another quarter of over 3x year-over-year growth. That reflects the brand strength we have with consumers and our deep relationship with the health care providers that manufacturers are also seeking to leverage. So last quarter, we talked about the relationships we now have with 19 of the top 20 manufacturers. We continue to penetrate those accounts. We're starting to increase sell-through with 1,000 brands that are part of that, and in the third quarter, we just continued to increase the manufacturing and penetration. We're also excited that we're offering these additional solutions such as the agreement we have with CoverMyMeds. One thing we also like to mention on the front of health providers is they now make up 25% of our website visitors, and the NPS with health care providers has increased from the 86 that we were happy to speak to you about before to now an NPS of 90 with health care providers. Pharma Manufacturer Solution is our fastest-growing offering, has extremely high net revenue retention, over 150%, and very attractive unit economics. We're not trying to optimize rates right now relative to fixed or such; we're trying to gain market share. This is a $30 billion TAM that we can penetrate from both the consumer and provider standpoint, and we're just getting started there. But it's going great and growing very quickly, and we're very pleased with the overall progress.

Your next question comes from the line of Craig Hettenbach with Morgan Stanley.

You commented that 2021 has been a year of investment. How are you thinking about this into 2022? Does it sustain? Or are you anticipating more operating leverage as you roll into next year?

Thank you for the question. Karsten, can you speak to this?

Sure, Craig. And thanks, Trevor. Yes, as we look into the years to come, we believe that marketing will ultimately provide us with incremental leverage going forward. This ties a lot to unaided awareness levels, among other factors. As awareness levels improve, each dollar of marketing spend becomes more valuable. We’ve seen a positive trajectory in our unaided awareness levels, which will be the foundation for that, Craig. From that perspective, our long-term view of the business hasn't shifted in terms of being margin accretive on both the marketing side and the product side, since product investments made for just a few users or for many, many users generally take the same amount of investment to produce. We look forward to being able to leverage the business on multiple fronts. We also have other lines of business, like the one Trevor was speaking about – which is manufacturer solutions. That makes up an increasingly larger portion of our revenues and is effectively nearly all margin, since it's just the sales cost associated with it. That ends up pulling overall margins for the business up as a share of revenue increases. One point that sometimes gets overlooked is that there have been some permanent shifts in how pharma manufacturers address health care professionals, in particular. As Trevor stated, we have incredibly strong relationships with them; first, champions of GoodRx. About 400,000 of them have GoodRx materials in their offices, and many, many more use GoodRx, as Trevor articulated. All these folks have one thing in common, which is that they don’t love pharma reps coming into their offices, especially in a COVID-ridden environment. That's made a permanent shift to more digitally based marketing by pharma manufacturers, which we're benefiting from, as we have such amazing health care provider access and can offer coordinated messaging that allows pharma manufacturers to reach health care providers and patients through GoodRx in tandem. We're very passionate about that and excited for it. Again, to your margin question, it's not only about the OpEx side and leveraging marketing and tech development. It's also about driving margin on the revenue side through the mix in revenue we’ll be achieving in the years to come.

Your next question comes from the line of Vikram Kesavabhotla with Baird.

I wanted to ask about the subscription revenues. Obviously, another strong quarter of growth there, but it just looks like the year-over-year growth decelerated a little bit versus the last quarter. I'm curious to get your thoughts on how we should think about the progression of growth on that line moving forward. And as you look at the user base today, what's the realistic mix of subscribers versus MAC that you think you can achieve over time based on the utilization behavior that you're observing on the platform?

Thank you for the question. Yes, GoodRx serves millions of consumers every month with different solutions. We have prescription discounts, telehealth services, pharma manufacturing solutions, and content insights through GoodRx Health, as we discussed today. The usage of our platform continues to increase across the board, so we're extremely excited about the strong 68% year-over-year growth in subscribers across GoodRx Gold and the fact that we've reached 1.6 million subscription members. We're also excited about the 34% year-over-year growth when combining the monthly active consumers and the subscribers. That's how we typically evaluate consumer reach and the scale within our prescription-related offerings. The reason we look at our combined reach is that our goal is really to get users to the product that makes more sense to them, and we test within our funnel, which is largely a similar funnel for prescription transactions and subscriptions that reflects our efforts to match users with the best product for them. The rate of growth of subscribers will also depend on the pace at which we add benefits like mail and discount telehealth and how quickly we expand the Gold pharmacy network, such as adding new partners this year. We remain excited about the future of GoodRx Gold and our subscription offering as a whole, and we plan to continue delivering additional benefits to the subscriber base to increase the value proposition over time. This aligns with our larger growth strategy and ability to reach record user numbers, which helps us achieve the record revenue and profit that we're able to report this quarter.

Your next question comes from the line of Stephen Valiquette with Barclays.

So a couple of questions here that are somewhat related. First, from time to time, you guys have provided some approximations for the percent of your users that are uninsured versus the percent that may have a commercial and/or Medicare prescription drug coverage. I'm curious if you have any updates on the evolution of those trends and where that stands right now. Also tied into that, with a high probability that millions of Medicaid enrollees will likely lose coverage during '22 and into '23, I'm curious how much of that is on your radar screen as a potential catalyst for new user growth. Do you have any special levers to capitalize on that population beyond your normal DTC advertising channels?

Thank you for the question. As we look at the mix, it’s relatively unchanged, even with the slight changes in the population mix in the U.S. As we look at our users, the percentages continue to be about the same; over 75% of our users have insurance. Relative to Medicaid, as people unfortunately lose coverage and end up without solutions, that will drive more people to look for benefits with us. So in this case, an unfortunate positive for our business. As to how to capture that, all of the general demand generation efforts we do continue to help in a situation like this too. We try to make sure people become aware of GoodRx in their time of need, which happens via the marketing we do. The largest way we acquire customers is through unpaid acquisition: it's health care providers telling their patients to use GoodRx and the extremely high satisfaction customers express with our solutions. Our consumer NPS is 90, which drives this continual referral at the point of care. Unfortunately, in this case, it's likely a net benefit to growth.

Your next question comes from the line of Justin Post with Bank of America.

Yes, I think first, I'd love to hear any update on the GoHealth initiative. Are you seeing more activity around Medicare patients? And then just high level, some of the legislation around drug pricing, any thoughts on that on whether there will be any impact to your business or not?

Great. Thank you for the question. I'll speak about the GoHealth and then hand it over to Doug to speak about regulation. On the GoHealth side, we've built the GoodRx platform and the business to be highly extensible and scalable. Today, we offer prescription savings, telehealth services, pharma manufacturer solutions, but we see significant opportunities to help even more gaps in the consumer health care experience. As I mentioned, we’re extremely happy this year with how much we have offered consumers additional services along their health care journey. Insurance is a large addressable category that we find very compelling since, as I just said previously, 75% of our users have insurance and over 30% are on Medicare. Of these larger users navigating insurance and helping them get on Medicare is something we hadn't specifically addressed before. However, in the case of GoHealth specifically, we are helping people get on Medicare plans. The GoHealth agreement lets us help Medicare-eligible consumers find and enroll in the best Medicare plans for their needs. We’ve worked closely with GoHealth to deliver a great user experience that guides people through Medicare plan navigation. Open enrollment for Medicare just started last month, and so far, we're pleased with the traction we're seeing. This is just one of many platform extensions we're working on to help this large and growing audience navigate even more stages of their health care journey. I expect people to see even more expansions in our scope. Now let Doug speak about the other part of your question.

Sure. Thanks again for the question, and thanks for having us. Look, GoodRx has been around for about a decade, and we've seen many proposals and policies across multiple administrations. With this bid administration, we continue to be aligned with the political objectives of driving affordability and access to health care for all Americans. There have been a ton of discussions, as you know, everything from an Asia policy document to discussions about the reconciliation and build back better plan. They’re primarily focused on Medicare, as you indicated, but within Medicare, they’re really focused on a few dozen expensive brand drugs. This administration supports transparency, and that's what GoodRx has been about since day one. We want to educate patients and give them the information they need. We believe some regulations in this area, such as data affordability rules, are good for Americans and good for our business as well. We actively track these legislative developments and continue to engage with policymakers. In fact, GoodRx is often quoted in policy discussions because we have the ultimate vantage point on consumers. We feel incredibly confident about where we are, and we don't see any specific impact on our business from any of the proposed legislation to date.

And that concludes our question-and-answer session for today. I will now turn the call back over to Mr. Trevor Bezdek for closing remarks.

The third quarter was another record quarter for our business. We continued to deliver record revenue at attractive margins while growing our consumer and provider base, extending our platform, and accessing a larger TAM. Over the past decade, we have learned a lot about the challenges Americans face when it comes to their health care, and we continue to innovate to provide meaningful and impactful solutions. In the coming years, we see tremendous opportunities to continue to help Americans navigate their health care journey as their trusted advocate. We believe our trusted brand and the strength of our relationships, combined with our highly extensible platform and offerings, position us well to win across the $4 trillion health care ecosystem for years to come. Thank you for joining us on this journey.

Ladies and gentlemen, this concludes today's conference call. Thank you for participating. You may now disconnect.