Slides
Page 1
Fresenius Medical Care FMEReignite presentation London | June 17, 2025
Page 2
June 2025Capital Markets Day Page 2 Safe harbor statement: In this Safe harbor statement, “the Company” and “Fresenius Medical Care” refer to Fresenius Medical Care AG & Co. KGaA, a German partnership limited by shares, prior to its conversion of legal form, and to Fresenius Medical Care AG, a German stock corporation, after its conversion of legal form. This presentation includes certain forward-looking statements within the meaning of Section 27A of the U.S. Securities Act of 1933, as amended, and Section 21E of the U.S. Securities Act of 1934, as amended. Forward- looking statements are inherently subject to risks and uncertainties, many of which cannot be predicted with accuracy or might not even be anticipated. The Company has based these forward-looking statements on current estimates and assumptions which we believe are reasonable and which are made to the best of our knowledge. Actual results could differ materially from those included in the forward-looking statements due to various risk factors and uncertainties, including changes in business, economic or competitive conditions, changes in reimbursement, regulatory compliance issues, regulatory reforms, foreign exchange rate fluctuations, uncertainties in litigation or investigative proceedings, cyber security issues and the availability of financing. Given these uncertainties, readers should not put undue reliance on any forward-looking statements. These and other risks and uncertainties are discussed in detail in the Company’s Annual Report on Form 20-F under the headings “Forward-Looking Statements” and “Risk Factors” and under the headings in that report referred to therein, and in the Company’s other reports filed with the Securities and Exchange Commission (SEC) and the Frankfurt Stock Exchange (Frankfurter Wertpapierbörse). Forward-looking statements represent estimates and assumptions only as of the date that they were made. The information contained in this presentation is subject to change without notice and the company does not undertake any duty to update the forward-looking statements, and the estimates and assumptions associated with them, except to the extent required by applicable law and regulations. If not mentioned differently the term net income refers to the net income attributable to the shareholders of Fresenius Medical Care. Amounts are in Euro if not mentioned otherwise. Implementation of measures as presented herein may be subject to information and consultation procedures with works councils and other employee representative bodies, as per local laws and practice. Consultation procedures may lead to changes on proposed measures.
Page 3
Fresenius Medical Care Helen Giza CEO and Chair of the Management Board
Page 4
Fresenius Medical Care June 2025Capital Markets Day Page 4 Our DNA is advancing kidney care We are rooted in a long history of innovation and growth 1996 Founding FME (merger of Fresenius Worldwide Dialysis and National Medical Care) Enter into vertical integration 2012 Production 500,000th dialysis machine 2019 Acquisition NxStage Portfolio extension home dialysis, critical care and value- based care 2025 Leading kidney care company (~300k patients and >174m dialyzers per year) Select milestones 1996 - today 2022 Three-way value-based care merger creating Interwell Health 2024 FDA approval of 5008X machine; first HVHDF approval in U.S. 2005 5008 platform launched 2006 Acquisition of Renal Care Group to strengthen FME’s market position 2020 FX CorAL dialyzer platform launched1998 Single-use dialyzers new standard in the U.S.
Page 5
Fresenius Medical Care Page 5 We are the leading kidney care company Capital Markets Day June 2025 We offer a tailored range of products and services for patients with kidney disease Creating a future worth living. For patients. Worldwide. Every day. Dialysis services in our own dialysis centers as well as home therapy options Bundled services including a range of complementary services, such as vascular access, pharmacy and pharma Care Delivery We improve patient outcomes and lower cost of care Value-Based Care Dialysis products, including digital solutions, technical services and operational management Care Enablement
Page 6
Fresenius Medical Care June 2025Capital Markets Day Page 6 Positioned to lead | Attractive market positioning in every segment Note: CKCC = Comprehensive Kidney Care Contracting program, a value-based care program of the Centers for Medicare & Medicaid Services (CMS) Innovation Center 1 Figures refer to FY 2024; 2 Announced October 2024 Care Delivery Value-Based Care Care Enablement #1 in kidney value-based care World’s leading provider of kidney care services Market leading kidney MedTech company ~50% of all dialysis patients worldwide use our products1 174m dialyzers sold in 20241 40% share in hemodialysis product market1 ~300k dialysis patients worldwide1 ~48m dialysis treatments in 20241 ~78% of patients highly recommend our service1 ~$7bn medical costs under management1 All 10 of top 10 highest scoring entities in CKCC program2 2,200+ aligned nephrologists1
Page 7
Fresenius Medical Care June 2025Capital Markets Day Page 7 A cash generative business set for further profitable growth Fresenius Medical Care in FY 2024 Leverage 2.9x Net debt/EBITDA Operating income 1.4 € billion Revenue 19.3 € billion Free cash flow 1.7 € billion
Page 8
Fresenius Medical Care Accelerating momentum during final year of 2025 strategic plan Page 8 Proven execution | Delivering on commitments of three-year turnaround and transformation plan Capital Markets Day June 2025 Structural changes | Simplified and streamlined with change of legal form, introduction of new global operating model and enhanced reporting transparency Focus on the core and profitability | Divestments of non-core and lower-margin assets mostly complete Leadership changes | New MB members (CFO, Care Delivery, Legal, HR and Compliance) and several key next level appointments FME25 | Strong momentum and target for sustainable annual savings raised to €750m by end of 2025 Disciplined financial policy | Strict adherence with net financial leverage ratio lowered to below self- imposed target range Cultural evolution | Continued to strengthen culture and sustainability agenda Capital allocationCulture StructureLeadership Portfolio optimization Operational efficiencies
Page 9
Fresenius Medical Care 2022 2023 2024 DIVIDEND GROWTH CONTINUED Page 9 Proven execution | Clear progress against key performance metrics Capital Markets Day June 2025 1 Adjusted operating income margin as defined by the financial outlook for the respective years; corresponding definitions and reconciliation tables provided in our full year 2024 earnings results documents 2 Excluding U.S. federal relief funding and advanced payments under the CARES Act Target band: 3.0x to 3.5x Dividend per share in € 1.12 1.19 1.44 Accumulated FME25 sustainable annual savings in € million 131 346 567 2022 2023 2024 FME25 SAVINGS AHEAD OF PLAN Net financial leverage ratio (net debt/EBITDA) at year end 2022 2023 2024 3.4²x 3.2x 2.9x LEVERAGE BELOW SELF-IMPOSED TARGET Operating income margin¹ MARGIN IMPROVEMENT ON TRACK 7.9% 8.1% 9.3% 9.5% 9.7% 10.2% 1.9% 2.3% 6.0% 2022 2023 2024 Group
Page 10
Fresenius Medical Care Franklin W. Maddux, M.D. Global Chief Medical Officer and member of the Management Board
Page 11
Fresenius Medical Care 1 United Nations, Department of Economic and Social Affairs, Population Division (2024). World Population Prospects 2024, Online Edition | 2 Age-standardized prevalence of hypertension among adults aged 30-79 years as published in Global report on hypertension: the race against a silent killer. Geneva: World Health Organization; 2023 | 3 IDF Diabetes Atlas 11th Edition - 2025, adults aged 20-79 living with diabetes | 4 FME 2024 Long Range Patient Projection | all numbers rounded and approximations June 2025Capital Markets Day Page 11 Attractive underlying business fundamentals intact Extrapolation from 2020 to 2035 Aging global population Hypertension +60% Diabetes 1/3 Dialysis patients +90%+40% 0.75 billion 1.2 billion 2035e2020 Global population aged 65+1 People living with diabetes3 People on maintenance dialysis4One out of three people worldwide has hypertension2 500 million 690 million 2035e2020 3.7 million ~7 million 2035e2020
Page 12
Fresenius Medical Care ▪ No prior CKD diagnosis or nephrology care ▪ Initiation of dialysis via temporary catheter ▪ Emergency situation with life-threatening symptoms and high risk of complications ▪ Resulting in – Increased mortality rates – Higher rates of hospitalization – Higher total cost of care ▪ Placement of permanent vascular access, such as an AV fistula, in advance of dialysis start ▪ Higher percentage of home therapies ▪ Planned transition under care of a nephrologist ▪ Resulting in improved outcomes, with – Lower mortality rates – Better quality of life – Lower total cost of care Limited early identification and management of CKD despite prevalence Page 12June 2025 45% of U.S. patients “crash” into dialysis Compared to “optimal” dialysis starts FME Value-Based Care realizing 2.5x greater optimal start rate & 50%+ higher home dialysis start rate than national average Value-Based Care | Proven results of scaled care coordination efforts Notes: CKD = Chronic Kidney Disease; AV = arteriovenous Capital Markets Day
Page 13
Fresenius Medical Care June 2025Capital Markets Day Page 13 Patient flow | Growth opportunity from caring for new and existing patients Reducing outflows an important volume component Low inflow Low outflow Stable with low churn Inflow < Outflow Inflow > Outflow High inflow High outflow Ideal growth zone At risk Stable with high churn INFLOW OUTFLOW HighLow Low High Every market has a unique pattern of inflows and outflows
Page 14
Fresenius Medical Care June 2025Capital Markets Day Page 14 Modeling U.S. kidney care patient flow dynamics FME population impact model Kidney transplant Initiation of dialysis ~127,000/year Pre-emptive transplantation ~4,500/year Mortality 6.2%/year Incidence 500,000 - 800,000/year Graft failure 8,000-10,000/year Transplantation ~27,000/year Mortality 17% annual Population 550,000 0 100 200 0 20 40 60 80 100 Population density (k) Age CKD 0 10 20 30 40 0 20 40 60 80 100 Population density (k) Age Dialysis Note: FME estimates
Page 15
Fresenius Medical Care 10.5 1.08 0.55 CKD Stage 3a/3b CKD Stages 4/5 ESRD Modeling U.S. kidney care patient flow dynamics | Patient inflow ▪ 10-12 co-morbidities on average – Hypertension (31%) – Diabetes (44%) – Glomerular diseases (6%) ▪ ~45% of patients “crash” into dialysis ▪ Cardiovascular events primary cause of CKD Stage 3 patients not surviving to CKD Stage 4 and ESRD – Small improvement in survival in total CKD Stage 3 would lead to double the at-risk ESRD population Complex U.S. patient population Scale of U.S. CKD/ESRD patient population (in million) Page 15June 2025 Note: ESRD = End-Stage Renal Disease Capital Markets Day
Page 16
Fresenius Medical Care Mortality ▪ Opportunity to improve through – High-volume HDF treatments – Optimal dialysis starts – Optimize time on dialysis – Enhanced patient quality and safety Modeling U.S. kidney care patient flow dynamics | ESRD patient outflow Opportunity to reduce outflow and improve patient number growth Transplantation ▪ Historical year-over-year growth has leveled off All other outflow ▪ Opportunity to improve through – Reducing avoidable transfers out – Improving new matriculation rate 1% 3% 17% All other outflow Transplantation Mortality Page 16June 2025 U.S. patient outflow – baseline average Mortality Transplantation All other outflow Note: FME estimates Capital Markets Day
Page 17
Fresenius Medical Care High-volume hemodiafiltration (HVHDF) Relationship between CKD survival and future ESRD population trends SGLT2i medication effects Obesity trends and GLP-1A medications Key variables of CKD and ESRD population dynamics Capital Markets Day Page 17June 2025 Other factors ▪ Value-based care ▪ COVID pandemic endemic
Page 18
Fresenius Medical Care 1 https://www.cdc.gov/nchs/data/hestat/obesity-adult-17-18/obesity-adult.htm | 2 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01548-4/fulltext Current and future obesity trends in the U.S. Rates of obesity and severe obesity increasing1 June 2025Capital Markets Day Page 18 Notes: Data are age adjusted by the direct method to U.S. Census 2000 estimates using age groups 20-39, 40-59, and 60-74. Overweight is body mass index (BMI) of 25.0 – 29.9 kg/m². Obesity is BMI at or above 30.0kg/m². Severe obesity is BMI at or above 40.0 kg/m². Pregnant women are excluded from the analysis. Sources:: National Center for Health Statistics, National Health and Nutrition Examination Surveys. ▪ U.S. 1990-2021 | Obesity increased 158% in male and 186% in female adolescents² ▪ U.S. 2050 (est.): 43 million children and 210 million adults with obesity² ▪ Higher percentages of children born more recently are reaching obesity stages sooner ▪ Expect type 2 diabetes to grow in proportion to rates of obesity over time ▪ Pharmacological strategies will only bend obesity curve if combined with large cultural, structural and economic changes 50% 40% 30% 20% 10% 0 1960- 1962 1971- 1974 1976- 1980 1988- 1994 2001- 2002 2005- 2006 2009- 2010 2013- 2014 2017- 2018 Men Women Overweight Obesity Severe obesity 2015- 2016 2011- 2012 2007- 2008 1999- 2000 2003- 2004
Page 19
Fresenius Medical Care ▪ Introduced into high/growing obesity rate environment ▪ Implies maximum ACE-inhibitor/Angiotensin Receptor Blocker use (only 50% of population) ▪ Implies better cardiovascular (CV) health for both new incident and prevalent ESRD patients = reduced outflow due to CV-related mortality ▪ GLP-1 use in very early-stage CKD shows CV mortality improvements > slowed CKD progression – Delay in onset to dialysis is only 6 to 7 months ▪ High rate of discontinuation: 80% at 2 years – Unknown long-term effect of "weight cycling“ GLP-1A effects on CKD and ESRD populations GLP-1A not a cure for diabetes or advanced CKD1 GLP-1A effects on CKD/ESRD growth trends Page 19June 2025 1 https://www.nejm.org/doi/10.1056/NEJMoa2403347 Capital Markets Day Decline in kidney function Difference in mean annual decline, 1.16 ml/min/1.73 m2 95% Cl, 0.86–1.47; P<0.001 eGFR (ml/min/1.73 m2) 48 46 44 42 40 38 36 0 Weeks since randomization 0 12 52 104 156 208 Placebo Semaglutide
Page 20
Fresenius Medical Care Delayed CKD progression ≠ cure SGLT2i demonstrates reduced cardiovascular (CV) mortality in CKD and ESRD populations ▪ Evidence for reduction in CV mortality and slowed CKD progression to ESRD for several SGLT2i drugs ▪ Main SGLT2i trials show evidence of delayed progression between 6-8 months – This assumes "clinical trial rates" of high medication adherence ▪ Real-world evidence of SGLT2i discontinuation in CKD: 37% at 1 year ▪ No available data for SGLT2i effects on CV mortality in ESRD Page 20June 2025 Dapagliflozin (Farxiga®) Empagliflozin (Jardiance®) Canagliflozin (Invokana®) Time scales of SGLT2i-medicated delays of kidney disease progression in clinical studies Renal-specific composite outcome Progression of kidney disease or death from CV causes Heerspink et al., NEJM (2020) Years of follow-up Herrington et al., NEJM (2022) Months since randomization Perkovic et al., NEJM (2019) Same cumulative incidence after about 8 months Same cumulative incidence after less than 6 months 20 15 10 5 0 Patients w/ an event % 0 6 12 18 24 30 36 42 Placebo Canagliflozin 30 20 10 0 Patients w/ an event % Placebo Empagliflozin 0 0.5 1.0 1.5 2.0 2.5 Placebo 0 4 8 12 16 20 24 28 32 Months since randomization Cumulative incidence % 20 16 12 8 4 0 Dapagliflozin Same cumulative incidence after about 6 months Renal-specific composite outcome Capital Markets Day
Page 21
Fresenius Medical Care Improved removal of key toxins Quantified results from CONVINCE1 Novel treatment modality with many benefits Average extended life expectancy ▪ Switching from high-flux HD to HVHDF results in average extended life expectancy of approx. 21 months (1.76 years) after 2.5 years Baseline mortality rate in U.S. ▪ 17% annually for high-flux HD Adjusted mortality ▪ Survival benefits in CONVINCE emerge after 3 months ▪ 4.4% fewer deaths over 2.5 years of therapy with HVHDF, reflecting a 23% lower risk of mortality over the CONVINCE study period How CONVINCE informs impact of high-volume hemodiafiltration (HVHDF) on patient survival Page 21June 2025 Improved patient reported outcomes HVHDF Improved survival Better anemia control Improved nutritional status Decreased inflammatory markers Decreased intradialytic hypotension 1 https://www.nejm.org/doi/full/10.1056/NEJMoa2304820 Capital Markets Day
Page 22
Fresenius Medical Care Modest attenuations in cardiovascular (CV) mortality could lead to substantial growth in ESRD population ▪ Improved CV mortality/CKD progression "balance" - SGLT2i/GLP-1A/MRA/RAASi: – Longer "timeline" to ESRD balanced by – Improved CV health with new incident ESRD ▪ Value-Based Care | Improved optimal starts – FME’s KCE record: top 17 of 20 for optimal starts ▪ Survival benefits of HVHDF in ESRD (CONVINCE trial) ▪ Role of SGLT2i/GLP-1A/MRA/RAASi in CV mortality for ESRD ▪ Novel pharmaceuticals for improved CV mortality ▪ Higher transplant demand (improved CV mortality) resulting in longer waiting times = Longer tenure on dialysis CKD Dialysis CV mortality Page 22June 2025 0 100 200 0 20 40 60 80 100 Population density (k) Age 0 10 20 30 40 0 20 40 60 80 100 Population density (k) Age Small improvement in survival in total CKD Stage 3 would lead to double the at-risk ESRD population Note: KCE: Kidney Care Entity Capital Markets Day
Page 23
Fresenius Medical Care Page 23FME Strategy 2030 Medical trends and how we are participating June 2025Capital Markets Day Page 23 Looking to the future. Accelerating growth. 2025-2035e CAGR HVHDF Dialysis patients +90% People on maintenance dialysis 3.7 million ~7 million 2035e2020 Global +4-5% Treatment growth further accelerated by additional benefits from HVHDF and value-based care Value-based care Meds improving CKD/ESRD survival Preventive health, AI, diagnostics Personalized medicine U.S. +2% plus Patient number growth U.S. treatment yield Source: FME 2024 Long Range Patient Projection
Page 24
Fresenius Medical Care Helen Giza CEO and Chair of the Management Board
Page 25
Fresenius Medical Care We lead kidney care through exceptional patient care and innovation
Page 26
Fresenius Medical Care June 2025Capital Markets Day Page 26 Our strategy will Reignite Value Creation Reignite Growth & Innovation Reignite our Culture Reignite the Core Strengthen core operations Drive profitable growth and innovation Develop together and strengthen our culture Reignite Value Creation€
Page 27
Fresenius Medical Care June 2025Capital Markets Day Page 27 Our strategy | Reignite the Core Reignite the Core Strengthen core operations Be operationally excellent – with our core assets Drive scalable, high-quality care to further enhance patient health Standardize and improve our operations to increase efficiency and margins Make focused investments in technology and special programs to enhance speed, agility and efficiency
Page 28
Fresenius Medical Care June 2025Capital Markets Day Page 28 Our strategy | Reignite Growth and Innovation Reignite Growth & Innovation Drive profitable growth and innovation Further enhance clinical outcomes and patient safety Increase R&D efficiency by developing a global product platform and products Launch HVHDF in the U.S. to set a new standard of care Continue to grow clinic network purposefully internationally Drive AI-powered transformation in patient care, research and operations Leverage leading product positioning to further expand market share and drive volume growth
Page 29
Fresenius Medical Care June 2025Capital Markets Day Page 29 Our strategy | Reignite our Culture Reignite our Culture Develop together and strengthen our culture Attract, retain and engage the best talent with a passion to make an impact Become the employer of choice in healthcare Foster a culture of care and living our core values We Care, We Connect, We Commit
Page 30
Fresenius Medical Care June 2025Capital Markets Day Page 30 Develop together and strengthen our culture Reignite Culture We Connect with employees, patients, customers and communities to set the standard in renal care. We Commit to delivering industry-leading outcomes, meeting the highest standards, and growing our business. deeply for our patients, our people, and for creating a healthier, more sustainable future for all. We Care
Page 31
Fresenius Medical Care June 2025Capital Markets Day Page 31 Reignite FME | Leveraging the power of vertical integration Introduction of Value-Based Care as a separate segment Provide high quality care that improves quality outcomes and reduces costs Care Delivery Care Enablement Support practice management and relationships with partner nephrologists Clinics recognize customer needs to drive innovation in technology Apply innovation in medical technology to drive improved patient outcomes Provide differentiated therapies to clinics Value-Based Care Medical value creation Patient data and insights, future innovation and R&D €5.6bn Revenue 2024 €14.0bn Revenue 2024 €1.8bn Revenue 2024
Page 32
Fresenius Medical Care Our Ambition Deliver both industry-leading outcomes and margins with above-market growth
Page 33
Care Delivery June 2025Capital Markets Day Page 33 Reignite Value Creation Reignite Growth & Innovation Reignite our Culture Reignite the Core Strengthen core operations Drive profitable growth and innovation Develop together and strengthen our culture €
Page 34
Fresenius Medical Care June 2025Capital Markets Day Page 34 Enhancing operational efficiency and strengthening realized rate to drive robust, sustainable financial performance Managing payor and service mix by ensuring in-network access for patients Improve average reimbursement Improving revenue cycle management to increase yield Complementary programs to strengthen revenue and drive cost efficiencies will produce sustainable margin enhancement Productivity and operational excellence Improvements to realized dialysis rates Further standardizing core processes Maintaining workforce and productivity enhancements Reignite the Core
Page 35
Fresenius Medical Care June 2025Capital Markets Day Page 35 Care Delivery portfolio positioned for profitable growth Dialysis clinic network treating >200k patients in >2,600 clinics across the U.S. Provides outpatient vascular care services to individuals requiring dialysis access Produces and distributes drugs and pharmaceuticals, including Vifor JV Provides dialysis medications, delivered to dialysis centers or to patients at home ▪ Provides dialysis therapy in ~25 core markets ▪ Primarily in EMEA and APAC regions Care Delivery revenue Care Delivery U.S. Care Delivery International Reignite the Core U.S. Int’l 82% 18% €14.0bn FY 2024
Page 36
Fresenius Medical Care June 2025Capital Markets Day Page 36 Ensuring we have the right assets in the right markets to support patients and drive financial performance Continuously optimizing and maximizing profitable growth in our international footprint Continuous, systematic review of U.S. dialysis clinic footprint Execution of select assets of Spectra Laboratories divestment to unlock new laboratory cost savings Honing Care Delivery’s portfolio of assets will bolster the core business and favorably position FME for future growth Continued footprint optimization Strategic divestment to strengthen performance Reignite the Core
Page 37
Fresenius Medical Care Reignite Growth & Innovation June 2025Capital Markets Day Page 37 Unlocking volume growth through clinical quality enhancements and best-in-class patient experience HVHDF launch in the U.S. Accelerated quality and patient safety initiatives Seamless patient access and admissions Strengthened patient treatment adherence Improved patient retention Excellence in clinical quality and patient experience will extend patient survival and reduce patient outflows, driving growth and deepening Care Delivery’s position as kidney care partner of choice Clinical quality to help patients live longer and healthier Exceptional experience to retain patients Continued home therapies program enhancements
Page 38
Fresenius Medical Care 1 Assuming no major disruptions as outlined in 2030 aspiration assumptions . Note: Operating income excluding special items; margin as percent of revenue June 2025Capital Markets Day Page 38 Care Delivery | Advancing to industry-leading margins by 2030 Path to mid-teens operating income margin aspiration 11.4% Mid-teens 2024 2030e Reignite Value Creation Headwinds1 | Labor and inflation € (Increasing inflow) Increasing patient new starts (Reducing outflow) Patient quality and safety, retention (Reducing outflow) U.S. HVHDF rollout Realized dialysis rate FME25+ Productivity and efficiency Portfolio optimization
Page 39
Value-Based Care June 2025Capital Markets Day Page 39 Reignite Value Creation Reignite Growth & Innovation Reignite our Culture Reignite the Core Strengthen core operations Drive profitable growth and innovation Develop together and strengthen our culture €
Page 40
Fresenius Medical Care ESRD patients in VBC programs 2019 - 2023 1 MCUM = medical costs under management as of 2023; Kidney VBC companies include VBCs focusing on renal care (e.g. Evergreen Nephrology, Monogram Health, Somatus). Hospital Accountable Care Organizations (ACOs) include hospitals that are implementing VBC programs through CMS and directly contracting with health plans. 2 Includes ESRD patients on dialysis. Sources: USRDS, CMS, NAACOS, Pitchbook, FME estimates June 2025Capital Markets Day Page 40 Rapidly evolving VBC market plays an important role in the industry and our future Renal VBC is a large and growing market Currently poised for stability and growth phase 25% CAGR 11% 34%55% $18bn FME VBC Other Kidney VBC Hospital ACO CKD 4-5 MCUM1 12% 47% 41% $38bn ESRD2 MCUM1 Emergence 2010 - 2018 Rapid acceleration and innovation 2019 - 2024 Stability and growth 2025+ ▪ Value-based kidney care recognized as a critical opportunity for payors, including U.S. government ▪ Renal services industry has attracted an inflow of well-funded new entrants: $2bn+ in industry investments ▪ Growth expectations are normalizing ▪ Industry focusing on scaling proven models and phasing out unviable ones
Page 41
Fresenius Medical Care FME’s Value-Based Care company Interwell Health is the leading, differentiated player in renal VBC Connectivity to FME 82% of ESRD patients have access to an FME dialysis clinic Leading provider network 2,200+ aligned nephrologists, growing from 1,600 in 2022 Unique Acumen EHR technology Nephrology-specific electronic health record used by 71% of aligned providers 82% June 2025Capital Markets Day Page 41 *Medicare Advantage. **Includes revenue from Acumen >130k Patient lives Business at a glance $7bn Medical costs under management ESRD CKD 26% 49% 25% Subcap Shared risk CKCC 94% €1.8bn Revenue MA* CKCC Other** Three unique sources of differentiation 58% 42% 4%2% 2024
Page 42
Fresenius Medical Care We have established a strong reputation for high quality and meaningful clinical results for patients Sources: CMS 2.5x optimal start rates compared to national averages improving patient survival on dialysis 80% of FME KCEs qualified as high performers in the Kidney Care Choices Program 80% of gross savings in Kidney Care Choices Program were delivered by FME KCEs June 2025Capital Markets Day Page 42
Page 43
Fresenius Medical Care ▪ VBC directly improves outcomes and survival for dialysis patients, a key growth driver for FME ▪ Benefits other parts of FME: a lever for driving HVHDF adoption in the U.S. ▪ Anchors our participation in a ‘must play’ space through a leading asset poised for growth June 2025Capital Markets Day Page 43 Our vertical integration creates an advantage for this growing business and we are lending greater visibility into performance Initiating new reporting segment to increase financial reporting transparency Creating greater insight into drivers of growing part of FME VBC creates value for FME FME creates value for VBC ▪ FME gives VBC access to patients and clinics to accelerate growth ▪ FME best practices and resources support VBC in its growth Benefits of vertical integration Visible value creation
Page 44
Fresenius Medical Care Page 44 Value-Based Care | We take responsibility for the integrated health care of our patients Capital Markets Day June 2025 Reignite Growth & Innovation Coordinated transitions Optimal patients starts to dialysis Enhancing quality and patient safety initiatives Creating mutual value between FME and VBC through key quality and outcomes initiatives Drive profitable growth and innovation Focus on patient engagement to impact behavior, drive down MLR Optimize go-to-market and contracting strategies Reignite the Core Accelerate growth through operational and technology levers Advance adoption of beneficial therapies and innovations such as HVHDF and home therapies Leverage data and analytics to improve quality and coordination of care Note: MLR = medical loss ratio
Page 45
Fresenius Medical Care 1 Assuming no major disruptions as outlined in 2030 aspiration assumptions. Note: Operating income excluding special items; margin as percent of revenue June 2025Capital Markets Day Page 45 Value-Based Care | Path to profitable growth Low single digit 2024 2030e Headwinds1: Pricing pressure by payors | Elevated Medicare Advantage claims Reignite Value Creation -1.6% Low single digit € Shifting contract mix towards more profitable segments Reducing medical cost (e.g. enhancing patient engagement) Cost efficiencies / synergies Path to low single digit operating income margin aspiration
Page 46
Care Enablement June 2025Capital Markets Day Page 46 Reignite Value Creation € Reignite Growth & Innovation Reignite our Culture Reignite the Core Strengthen core operations Drive profitable growth and innovation Develop together and strengthen our culture
Page 47
Fresenius Medical Care June 2025Capital Markets Day Page 47 Commercial excellence and operational efficiency will enable robust growth and margin expansion in Care Enablement Enhancing customer experience Geographic expansion in profitable markets Driving excellence in pricing and contracting Embrace our culture with strong ethical standards and unwavering commitment to quality Strengthening of direct procurement Harmonizing quality management system Restructuring of manufacturing footprint and supply chain Patient-centric product development Above-the-market growth, value- based pricing and share gain Operational excellence Reignite the Core
Page 48
Fresenius Medical Care Attractive, industry-leading renal MedTech portfolio Page 48 U.S. APAC EMEA LatAm FME Strategy 2030 June 2025Capital Markets Day ▪ €5.6bn FY 2024 revenue, across three verticals: In-Center Home Critical Care ▪ Globally, and in each region, in- center represents the majority of revenues ▪ In-center mix, broadly – 25% machines – 75% consumables Diverse, international footprint with U.S. representing around one-third of total revenues Reignite the Core Care Enablement
Page 49
Fresenius Medical Care June 2025Capital Markets Day Page 49 Leveraging attractive global market share to continue to drive pricing and contracting excellence 40% 10% 8% 7% FME Competitor 1 Competitor 2 Competitor 3 Reignite the Core 62% 26% Competitor 1 FME All other competitors 37% 30% 5% 4% Competitor 1 FME Competitor 2 Competitor 3 <3% each In-center HD products Home products (PD & HHD) Critical care FY 2024 | Market share distribution Source: Company internal market analysis
Page 50
Fresenius Medical Care June 2025Capital Markets Day Page 50 Drive growth of Home HD Grow PD share in profitable markets, while improving economics of the business Redefine the market in introducing point-of-care fluid generation in PD Achieve market leadership with expansion of premium product portfolio in Americas and APAC Expand ICU portfolio Drive market to outcome- improving therapies Introduce digitally-connected ecosystem based on new technology platform In-Center Home Critical Care Striving for cost leadership through a patient-centric development process Reignite Growth & Innovation Grow our market leader position and transform kidney care
Page 51
Fresenius Medical Care 1 Assuming no major disruptions as outlined in 2030 aspiration assumptions. Note: Operating income excluding special items; margin as percent of revenue June 2025Capital Markets Day Page 51 Care Enablement | Accelerating profitable growth to 2030 Path to mid-teens operating income margin aspiration 6.0% Mid-teens 2024 2030eHeadwinds1: Inflation costs | FX transaction Reignite Value Creation € Pricing excellence and market share expansion U.S. HVHDF (5008X) rollout Focused R&D program | Innovation FME25+ Operational and process efficiencies
Page 52
Strategy in action U.S. HVHDF roll-out June 2025Capital Markets Day Page 52 Reignite Value Creation Reignite Growth & Innovation Reignite our Culture Reignite the Core Strengthen core operations Drive profitable growth and innovation Develop together and strengthen our culture €
Page 53
Fresenius Medical Care June 2025Capital Markets Day Page 53 U.S. HVHDF roll-out | Game changer to transform the standard of care in the U.S. and leverage FME’s vertical integration ▪ Better outcomes for patients – 23% survival benefit (CONVINCE study) ▪ Reduced hospitalization rate ▪ Improved quality of life ▪ Machine sales with large install base and captive consumables ▪ Pricing to reflect the innovative value FME has created ▪ Opportunity to rethink reimbursement ▪ Creating a first mover advantage for our FME clinics to drive substantial growth due to survival improvement ▪ Machine-related clinic labor efficiencies ▪ Supply efficiencies (no saline) and potential for reduced drug usage ▪ Increase in treatments and improved operating leverage Potential to improve thousands of patient lives Streamlining clinic operations to drive highest quality care Accelerating FME’s performance
Page 54
Fresenius Medical Care FME launch 2025 start External Launch June 2025Capital Markets Day Page 54 U.S. HVHDF roll-out | Strategic approach to benefit stakeholders across renal community Preparation for commercial launch with comprehensive consideration across all key stakeholders Payors (government and private) Potential for incremental reimbursement commensurate to benefits HVHDF therapy brings External dialysis providers 5008X CAREsystem machine/consumables pricing, marketing approach, commercialization strategy and timing, support offerings Dialysis patients Engagement with and education for dialysis patients on HVHDF benefits, quality of life improvement, survival benefits Renal healthcare/scientific community Generation of U.S. real-world evidence to complement the existing clinical data Physicians and JV partners Engagement with nephrologists to position HVHDF as standard of care via trust, education, and advocacy; alignment with patient care and business goals of JV partners
Page 55
Fresenius Medical Care Aspiration to achieve 100% consumables market share for 5008X by 2030 June 2025Capital Markets Day Page 55 U.S. HVHDF roll-out | Care Enablement 90% machine market share ▪ Total U.S. in-center HD machines ~160k ▪ Current installed base of 2008T ~145k 66% of external disposable market share of 2008T installed base Around 1,000 Around 15,000 Up to 20,000 Annual 5008X production capacity U.S. addressable market 2025e 2026e 2027 - 2030e per year
Page 56
Fresenius Medical Care June 2025Capital Markets Day Page 56 U.S. HVHDF roll-out | Care Delivery 15% - 30%2026e 2027e 2028e 2029e 2030e 30% - 50% 50% - 70% 70% - 90% 100% ▪ Survival benefits in CONVINCE emerge after 3 months ▪ 4.4% fewer deaths over 2.5 years of therapy with HVHDF, reflecting a 23% lower risk of mortality over the CONVINCE study period Planned 5008X penetration in FME clinics Improved mortality rates following HVHDF penetration
Page 57
How our strategy enables Value Creation June 2025Capital Markets Day Page 57 Reignite Value Creation Reignite Growth & Innovation Reignite our Culture Reignite the Core Strengthen core operations Drive profitable growth and innovation Develop together and strengthen our culture €
Page 58
Fresenius Medical Care 2030 segment margin aspirations1 Page 58 Advancing to industry-leading margins Capital Markets Day June 2025 2030 group margin aspiration1 Care Delivery Mid-teens11.4% Care Enablement Mid-teens6.0% Value-Based Care Low single digit-1.6% Mid-teens 9.3% 2030e2024 2024 2030e Reignite Value Creation € 1 Assuming no major disruptions as outlined in 2030 aspiration assumptions. Note: Operating income excluding special items; margin as percent of revenue
Page 59
Fresenius Medical Care June 2025Capital Markets Day Page 59 Strong cash generation to drive enhanced shareholder returns Reignite Value Creation New dividend policy 30% to 40% payout ratio of adjusted net income New share buyback program €1bn within two years and further opportunity for regular buybacks New capital allocation framework Invest in core business for profitable growth Optimize capital structure >€2.5bn Operating cash flow, annually in 2025-2030e Shareholder returns from excess cash €
Page 60
Fresenius Medical Care Martin Fischer CFO and member of the Management Board
Page 61
Fresenius Medical Care 1 Operating income excl. special items and Tricare settlement (2023) June 2025Capital Markets Day Page 61 Financial profile | Strong track record of delivered improvements since 2022 Global segments CD and CE started in January 2023 Strongly enhanced internal data availability and reporting Dividend CAGR of 13% in 2022-2024, 2024 dividend highest in FME history Deleveraging from 3.4x in 2022 to 2.8x in Q1 2025, below target range Strict financial policy followed, including stringent capex management Investment Grade ratings strengthened, outlook upgraded to stable in 2024 Well established in bond market, successful bond issuance in 2025 Transparency & Focus Profitability Capital allocation Rating & Refinancing Consistent operating income margin1 improvement toward 2025 target band FME25 savings target expanded twice to €750m, one-time costs tightly managed
Page 62
Fresenius Medical Care 1 Operating income excluding special items; margin in percent of revenue; 2 Disruptions include but are not limited to changes in regulatory environment and reimbursement systems, disruptions in financial markets, of global supply chains and at our manufacturing sites as well as new or potential export/import restrictions across key markets June 2025Capital Markets Day Page 62 FME 2030 | Advancing to industry-leading margins Operating income1 margin aspirations by 2030 Assumptions to margin aspirations ▪ Patient number growth of 4-5% p.a. globally and of 2 plus % in the U.S. ▪ Moderate reimbursement rate increases and continued payor mix improvement ▪ Moderate labor cost increases and cost inflation ▪ Normalized labor situation ▪ Broadly stable currency exchange rates ▪ No further escalating geopolitical conflicts, tariffs and trade barriers ▪ Excluding major disruptions2 Care Enablement Value-Based Care Care Delivery 2024 2030e Fresenius Medical Care Mid-teens9.3% Care Delivery Mid-teens11.4% Care Enablement Mid-teens6.0% Value-Based Care Low single digit-1.6%
Page 63
Fresenius Medical Care June 2025Capital Markets Day Page 63 Reporting transparency | Care Delivery and Value-Based Care as separate segments going forward Value-Based Care Care Delivery 1,277 1,752 +37% 14,558 14,003 +0.7% -96 -28 -7.5% -1.6% Margin Aspiration low single digit % 1,597 1,593 11.0% 11.4% Aspiration mid-teens % Margin +0.2% ▪ Organic revenue growth in 2024 and operating income margin improvement mainly driven by favorable rates and payor mix development ▪ Divestitures impacted revenue by -390 bps ▪ Aspirational margin target of mid-teens % ▪ Organic revenue growth in 2024 mainly driven by memberships, benchmark growth under contract as well as additional contracts ▪ Operating income growth in 2024 mainly driven by higher CKCC savings and lower operating expenses due to scaled operations ▪ Aspirational margin target of low single digit % Revenue in € million; organic growth1 in % Operating income in € million; excluding special items, growth in % at cc Highlights 1 Adjusted for Tricare settlement in 2023; Organic revenue growth is presented at constant currency and adjusted for certain reconciling items including revenues from acquisitions, closed or sold operations and differences in dialysis days 2 Differences in revenue sums of Care Delivery (new) plus Value-Based Care and Care Delivery (old) are due to inter-segment elimination Care Delivery Value-Based Care Care Delivery (old)2 15,388 15,275 1,501 1,565 202420231 202420231 2030e +71%
Page 64
Fresenius Medical Care G&A = General and Administrative areas; one-time costs to be reported as special item to operating income June 2025Capital Markets Day Page 64 Extending FME25+ | Additional €300m savings until 2027 through operational efficiencies to drive sustainable earnings growth Planned phasing of FME25+ One-time costs Innovative application of technology including AI 2026–2027e2025e Sustainable savings FME25+ additional savings until 2027e ▪ Manufacturing and supply chain optimization ▪ Restructuring of international commercial operations Care Enablement ▪ Further expansion of Global Business Services ▪ Process optimization across all three segments ▪ Procurement optimization G&A areas ~25% ~35% ▪ Supply chain optimization ▪ Clinic footprint optimization ▪ Efficiencies in real estate operations Care Delivery ~40% ~35% ~45% ~20% 2021-2027e Innovative application of technology including AI in € million +750 +1,050 -700 to -750 -300 -1,000 to -1,050 +300 €300m€1,050m
Page 65
Fresenius Medical Care 1 Net income attributable to shareholders of the FME AG June 2025Capital Markets Day Page 65 Reignite Value Creation | Clear set of priorities focus on shareholder value generation Invest in core business for profitable growth Optimize capital structure Return of excess capital to shareholders>€2.5bn Operating cash flow, annually in 2025-2030e Strong cash generation to further increase over time Operating cash flow of 13-15% of revenue in 2025-2030e Invest in core business for profitable growth Capex of €0.8bn to €1.0bn p.a. in 2025-2030e Optimize capital structure Strong balance sheet, financial flexibility and commitment to a sustainable Investment Grade rating New self-imposed target band: net leverage of 2.5x to 3.0x Return of excess capital to shareholders New dividend policy: payout ratio of 30% to 40% based on net income¹ excluding special items Share buybacks to complement new dividend policy as instrument to return excess capital Cash generation Capital allocation
Page 66
Fresenius Medical Care June 2025Capital Markets Day Page 66 Reignite Core | Capex of €0.8 to €1bn annually for sustainable profitable growth ▪ Capex focused on organic growth of core business ▪ Capture growth opportunities, invest in further enhance quality levels, patient experience and technology upgrades ▪ Capex of €0.8bn to €1bn p.a. in 2025-2030e − CD to account for approx. 55% − CE to account for approx. 45% − VBC to account for low % ▪ Capex requirement for 5008X roll-out in the U.S. included in the planned capex target band ▪ No major growth M&A planned; selective clinic acquisitions and JVs entries/adjustments considered part of ongoing core business 1,036 829 687 669 685 2019 2020 2021 2022 2023 2024 2025e 2026e 2027e 2028e 2029e 2030e Net Capex for PP&E % of revenues 6.4% 5.8% 4.7% 3.5% 3.4% 3.5% Net Capex for PP&E Future target band 4-5% target Capex development 1,113 €1.0bn €0.8bn in € million
Page 67
Fresenius Medical Care 1 Excl. U.S. federal relief funding and advanced payments under the CARES Act June 2025Capital Markets Day Page 67 Optimal capital structure | Financial leverage refined to 2.5x to 3.0x ▪ Successful deleveraging in the past quarters on the back of improving operating income and proceeds from portfolio optimization ▪ New self-imposed target band for net leverage ratio reflects a focused capital allocation framework − Commitment to a strong balance sheet and a sustainable Investment Grade rating − Flexibility for financing of growth opportunities and returning excess capital to shareholders − Balance between optimization of financing cost and financing requirements − Financial flexibility to absorb the impact of external uncertainties ▪ New range reflects macro environment with elevated volatility Future target band 3.0x 2.5x Net financial leverage ratio 3.2x 2.9x 3.0x 3.4x 3.2x 2.9x 1.5 2.0 2.5 3.0 3.5 4.0 2019 2020 2021 2022 2023 2024 2025e 2026e 2027e 2028e 2029e 2030e Major asset divestitures Major market exits Mainly CD operations in Argentina, Chile, Colombia, Ecuador, Hungary, Sub-Saharan Africa, Türkiye, Curacao, Guatemala and Peru Ratio of net debt to EBITDA 1 1 1
Page 68
Fresenius Medical Care 1 As of March 31,2025; based on utilization of major financing instruments, excl. Commercial Paper and other cash management lines | 2 EUR 300m tendered on April 10, 2025 | 3 New bond issued on April 08,2025 | 4 Calculations based on total financial debt, excluding Lease & Purchase Money Obligations June 2025Capital Markets Day Page 68 Optimal capital structure | Building on sound and proven financing strategy ▪ In line with our business profile, targeting both EUR and USD bond markets is a cornerstone for our financing strategy ▪ EUR bond transaction in combination with EUR bond tender (2026 maturities) executed in April 2025 ▪ High oversubscription of last EUR bond transaction proves strong market access ▪ Balanced maturity profile as a mitigation for volatile capital markets 500 8002 750 6003 500 750 5003 786 462 1,526 25 200 0 400 800 1,200 1,600 2,000 2025 2026 2027 2028 2029 2030 2031 2032 EUR Bonds USD Bonds Schuldschein Loans 300 tender offer executed Issued April 2025 Issued April 2025 in € million Share of fixed rate4: 88% Average maturity4: 3.5 years Average interest4: 2.3% Currency mix EUR/USD: ~40%/~60% Strong access to debt capital marketUpdated, further balanced maturity profile1
Page 69
Fresenius Medical Care 1 Net income attributable to shareholders of the FME AG June 2025Capital Markets Day Page 69 Reignite Value Creation | Attractive new dividend policy Dividend to be based on payout ratio of 30% to 40% of net income1 excluding special items ▪ Long-term track record of attractive dividend growth and payout ▪ 2024 dividend per share highest in company history ▪ New policy aligned with overall capital allocation framework ▪ Allowing for stable and predictable dividend development 0.80 0.96 1.06 1.17 1.20 1.34 1.35 1.12 1.19 1.44 € - € 0.25 € 0.50 € 0.75 € 1.00 € 1.25 € 1.50 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 Dividend payout ratio (based on net income1 excl. special items) 47%23% 24% 27% 30% 28% 29% 39% 36% 46% Dividend development
Page 70
Fresenius Medical Care June 2025Capital Markets Day Page 70 Reignite Value Creation | New regular share buyback program Focus on attractive shareholder return and value creation Share buybacks to complement new dividend policy as instrument to return excess capital Shareholders to participate in the strength and future value creation of our business Optimizing our capital structure with a strong balance sheet and Investment Grade rating Initial share buyback program of €1bn within two years ▪ Intention to acquire own shares on the stock exchange and to cancel them ▪ Execution in multiple tranches in line with new capital allocation framework starting in H2 2025 ▪ Completion within two years supported by continued strong cash generation ▪ Renewal of the 10% authorization for share buybacks at the AGM 2026 as precondition for future tranches
Page 71
Fresenius Medical Care June 2025Capital Markets Day Page 71 Future financial profile | Investment in profitable growth, optimized capital structure and return of excess capital to shareholders Further increase through additional VBC segment as of Q2 2025 reporting Further enhancing internal data availability and reporting Attractive new dividend policy and initial share buyback program of €1bn within two years Strong balance sheet: new target band for net leverage of 2.5x to 3.0x New capex policy of €0.8-1.0bn p.a. focused on profitable growth of core business Clear commitment to solid Investment Grade ratings Fully on track for refinancing of 2026 maturities Transparency & Focus Profitability Capital allocation Rating & Refinancing FME25+ program to deliver additional €300m savings until 2027 Advancing group and segments to industry-leading margins
Page 72
Fresenius Medical Care Helen Giza CEO and Chair of the Management Board
Page 73
Reignite Growth & InnovationReignite the Core Reignite our Culture Reignite Value Creation 30-40% dividend payout plus share buyback program 2030 Aspiration Mid-teens percent operating income margin
Page 74
Fresenius Medical Care Page 74June 2025 Contacts Capital Markets Day Alicia Cahill Senior Director Investor Relations +1 860-609-2394 Alicia.Cahill@ FreseniusMedicalCare.com Ilia Kuerten Vice President Investor Relations +49(0) 6172-268 5966 Ilia.Kuerten@ FreseniusMedicalCare.com Dr. Dominik Heger Head of Investor Relations and Head of Investor Relations, Strategic Development & Communications | EVP +49(0) 6172-609-8795 Dominik.Heger@ FreseniusMedicalCare.com Fresenius Medical Care AG Investor Relations Else-Kröner-Str. 1 61352 Bad Homburg v. d. H. Germany ir@FreseniusMedicalCare.com Ticker: FME and FMS (NYSE/ADR) WKN: 578 580 ISIN: DE00057858002 CUSIP (ADR): 358029106