Boston Scientific Corporation (BSX) Earnings Call Transcript

Good morning, and welcome to the Boston Scientific Third Quarter 2026 Earnings Call. [Operator Instructions] Please note this event is being recorded. I would now like to turn the conference over to Lauren Tengler, Vice President, Investor Relations. Please go ahead.

Thank you, Drew, and thanks to everyone for joining us. With me today are Mike Mahoney, Chairman and Chief Executive Officer; and Jon Monson, Executive Vice President and Chief Financial Officer. During the Q&A session, Mike and Jon will be joined by Joe Fitzgerald, Executive Vice President and Group President, Cardiology; and our Chief Medical Officer, Dr. Ken Stein. We issued a press release earlier this morning announcing our Q3 2026 results, which included reconciliations of the non-GAAP measures used in this release. The release as well as reconciliations of the non-GAAP measures used in today's call can be found on the Investor Relations section of our website. Please note that on the call, operational revenue excludes the impact of foreign currency fluctuations, and organic revenue further excludes certain acquisitions and divestitures for which there is less than a full period of comparable net sales. Guidance excludes our previously announced agreement to acquire Penumbra, which we expect to close in early 2027. For more information, please refer to the Q3 financial and operating highlights deck, which may be found on the Investor Relations section of our website. On this call, all references to sales and revenue are organic and relative growth as compared to the same quarter of prior year, unless otherwise specified. This call contains forward-looking statements regarding, among other things, our financial performance, business plans, market expectations and product performance and development. These statements are based on our current beliefs using information available to us as of today's date and not intended to be guarantees of future events or performance. If our underlying assumptions turn out to be incorrect or certain risks or uncertainties materialize, actual results could vary materially from those projected by the forward-looking statements. Factors that may cause such differences are discussed in the earnings release we issued earlier this morning and our periodic reports and other filings with the SEC, including the Risk Factors section of our most recent annual report on the Form 10-K. Boston Scientific disclaims any intention or obligation to update these forward-looking statements, except as required by law. In addition, this call does not constitute an offer to sell or the solicitation of an offer to buy any securities or solicitation of any vote or approval in connection with the proposed transaction with Penumbra. Boston Scientific has filed with the SEC a registration statement on Form S-4 containing a proxy statement of Penumbra and a prospectus of Boston Scientific that contains important information about Penumbra, Boston Scientific, the proposed transaction and related matters. At this point, I'll turn it over to Mike.

Thanks, Lauren. Thank you, everyone, for joining us today. I want to begin by walking through our third quarter results, provide some fourth quarter outlook and then assumptions behind our updated view of 2027. I'll then provide more details on both the region and business unit performance and outlook. Q3 total company organic sales grew 1.5% versus original guide of 3% to 5%. Q3 adjusted EPS of $0.73 declined 3% versus our guidance range of $0.80 to $0.82. Our Q3 results were impacted by our previously reported cybersecurity incident, which we estimate reduced our sales growth by approximately 300 basis points and adjusted EPS by $0.07 in the quarter. Importantly, after the 2 week outage as a result of the cyber incident, all operations are back up and running as of September 8. I'm very proud of our team's resiliency and the efforts they made to help us return as quickly as possible to supporting physicians and their patients for their products. Turning to Q4. We anticipate that there will be a 200 to 300 basis points of impact from the cyber incident as we work through elevated customer orders at the end of Q3 to replenish inventory levels. Additionally, since our second quarter earnings call, EP share pressure has intensified further accelerated by the cyber incident. We have also seen pricing dynamics in China become more challenging. To that end, we are guiding to organic revenue declines of minus 1% to minus 3% for 4th quarter of '26 and adjusted EPS of $0.77 to $0.79. This results in a full year '26 organic revenue growth guide of approximately 4% and EPS of $3.16 to $3.18. Boston Scientific has enjoyed several years of exceptional growth, driven by strategic investments and strong execution globally, particularly within our EP and WATCHMAN franchises. In '26, we've seen that cycle turn, and those 2 businesses are now weighing on our total company growth as we navigate competition and market dynamics. We believe that 2027 will be the trough in the cycle, and we have several investments and new innovations coming over the course of the next 3 years that we expect will support stabilization and growth for both the EP and WATCHMAN businesses. And while the remaining 75% of our business has grown consistently, we anticipate there will be additional price headwinds in China in '27 and the growth likely won't be enough to offset the pressure from EP and WATCHMAN next year. As a result, we believe we'll be challenged to grow sales and adjusted EPS in '27, excluding our pending acquisition of Penumbra. Having said all that, we are taking immediate actions to prepare for the future including through our previously announced restructuring program and the evolution of our operating structure while ensuring that we continue to make the right strategic investments across a number of growth platforms. We have a very strong cadence of launches in '27 and '28, and anticipate entering several new markets over the next few years that will unlock $25 billion in new market opportunity by 2030. Importantly, we expect these actions to drive meaningful improvement in both our revenue and adjusted EPS performance as we aim to exit the cycle in '27 and return to delivering high performance in '28 with further improvement expected in '29. I'll now provide some more details on Q3 and full year '26. Turning to our regional performance. The U.S. was flat year-over-year on an operational basis, driven by ICVT, IO&E and neuromodulation. Europe, Middle East and Africa grew 6% on an operational basis with strong performance across many of our businesses. But within the quarter, there was some impact from cyber, offset by a transient headwind in third quarter '25 from our ERP platform go live. Asia Pacific declined 1% operationally with growth impacted by the cyber incident as well as price pressure in China. Pricing dynamics in China continue to evolve in a number of our businesses, seeing VBP and other pricing impacts as a result. We expect growth in this market will moderate to single-digit growth. Turning to our business units. I'll start with Neuromodulation. Sales grew 13%. In Pain, growth was broad-based across the portfolio with exceptional performance with our Nalu PNS technology. But within the quarter, data was presented from the IMPROVE study evaluated our Intracept technology with real-world outcomes showing improvements in pain function and quality of life at 3 months. In Brain, growth was driven by our Cartesia X lead and Illumina 3D software, which enable more precise placement and programming. Urology declined 3% this quarter with impact from the cyber incident as well as expanding pricing pressure in China. In stone management, we have received a number of approvals for key products, including FDA clearance of our Navigator Flex suction sheath, CE mark and FDA clearance for distribution of the 7.5 Slim scope and FDA clearance of our LithoVue Elite single-use ureteroscope. As we look forward, we expect these new stone launches as well as stabilization and productivity from our S&M commercial organization to help our urology improve its growth profile over the course of 2027. Endoscopy sales declined 1% versus Q3 '25, inclusive of an impact from China VBP and cyber. Importantly, the underlying performance of this business continues to be strong, led by AXIOS, our differentiated technology, and as we look ahead, we expect our Endoscopy performance to be slightly pressured closer to mid-single-digit market growth into an annualized impact from the China VBP in fourth quarter '27. Cardiovascular sales delivered growth of 2% and Interventional Cardiology & Vascular Therapies sales grew 12%. Our Interventional Cardiology business had another exceptional quarter, growing 19% with continued strength in our global imaging franchise and drug-eluting technologies. We had another outstanding quarter of our AGENT DCB, which is backed by strong clinical evidence and now has been used to treat over 400,000 patients to date. We remain focused on both the near- and longer-term growth opportunities for this business. And last quarter, we received IDE approval of the VITAL PCI trial that is studied in our VITALYST circulatory support technology in the high-risk PCI population. However, evolving clinical evidence in this space, we've made the decision to shift our strategy and focus our development and clinical efforts on the AMI cardiogenic shock indication, we believe that our device design has the potential to be well suited to treat patients experience in cardiogenic shock and look forward to initiating clinical efforts in '27. Our VITALYST program is one of the largest internal R&D programs and an important long-term growth driver. To solidify funding for the AMI Shock Program, we have entered an agreement with Blackstone Life Sciences and aim to bring this important technology to market in 2030. Our Vascular Therapies business grew 1% with some impact from cyber as well as TCAR supply constraints. Importantly, we anticipate that our key car supply to improve throughout fourth quarter with full resolution by early next year. Our SEISMIQ launch continues to go well. And within the quarter, we received FDA clearance for SEISMIQ IVL -- sorry, SEISMIQ IVL to treat patients with severely calcified peripheral artery disease in small vessel, expanding our size matrix to now treat above the knee and below the knee. We also received FDA approval for the RANGER 035 drug-coated balloon, offering an expanded size and providing a highly complementary offering as most IVL procedures that are performed in lower limbs are also followed by drug-eluting technologies. We remain excited about the opportunity to add Penumbra team to the -- we are excited about the opportunity to add the Penumbra team, and they're highly differentiated in the complementary portfolio to Boston Scientific. We continue to work with the regulators and now expect to close in early '27, subject to the receipt of the remaining regulatory clearances. Our Interventional Oncology & Embolization business grew 5% driven by strong performance in our cancer therapies franchise, partially offset by some supply constraints that we anticipate will be resolved in early 2027. We continue to see strong adoption of our TheraSphere 360, as well as momentum with our hepatic artery infusion technology, providing a portfolio of options for cancer treatment. Cardiac Rhythm Management sales declined minus 2% with some impact from the cyber incident as we navigated usage and activation of technologies that leverage remote monitoring while our systems were down. In Q3, our diagnostics franchise grew high single digits. Our low-voltage business declined mid-single digits and high-voltage business declined low single digits. We anticipate that our performance will improve over the course of '27 with new launches and ongoing momentum. Before I turn to WATCHMAN and EP, I want to acknowledge the pressures in these 2 businesses and the impact that it has on our overall growth. We are acting now to strengthen the LAAC market and focus our EP resources where we can compete most effectively while investing in innovation that we believe can improve over time. On WATCHMAN, sales declined minus 6%, declining to 7% in the U.S. and growing 4% internationally. Within the U.S., concomitant procedures grew approximately 35% and stand-alone procedures declined high teens versus third quarter '25. We continue to believe that the overall LAAC market slowdown primarily reflects changes in patient identification and referral patterns as physicians assess the clinical evidence published over the last year. Importantly, we are executing against our investment priorities that we laid out in our 2Q call. We held over 200 Med Ed events in second quarter and third quarter providing an opportunity for more than 2,000 referrers and implanters to gain a deeper understanding of the clinical evidence available. We've added more dedicated commercial resources to WATCHMAN to support both concomitant and standalone procedures and support the referral pathway. In the third quarter, we saw increased patient engagement, further reinforcing the strong demand for alternatives to oral anticoagulation and highlighting the significant unmet need of my patients who can't, shouldn't or won't take lifelong OAC. We continue to believe that focusing on these priorities will support our improvement in the LAC market over time. With our third quarter performance largely in line with expectations despite the cyber incident, we are maintaining our previous outlook for our WATCHMAN business. In fourth quarter, within the U.S., we anticipate no improvement in the year-over-year stand-alone procedure performance and continued deceleration in concomitant procedure growth against the very high baseline. Internationally, we anticipate similar performance in Q3 and Q4, resulting in sequential flat low single-digit declines versus Q3 '26 globally. Turning to '27. We believe our investments along with the potential label change will improve the market over time. However, until we see the market improve, we are assuming that the market performance will be similar to Q4 with additional pressure due to a new competitive launch. We believe in the benefit of this therapy and continue to innovate and invest for the future. And within the quarter, we commenced enrollment in the Elite AF clinical trial to evaluate the safety and effectiveness of the next-generation WATCHMAN Elite platform. We anticipate bringing this fourth-generation technology to market in '29. And additionally, we look forward to the late-breaking data presentation of our SIMPLAAFY trial at TCT, studying post-implant drug therapy using WATCHMAN FLX Pro in assessing whether a less intensive drug regimen may help mitigate post-implant bleeding risk. Turning to EP. Sales declined 5% within our international region. But within the quarter, we continue to expand our OPAL footprint and drive more utilization of our mapping systems with our FARAWAVE and FARAPOINT catheters. The EP market has transformed over the past few years, led by our differentiated FARAPULSE platform. We have seen our strong market share position erode as new technologies are introduced and adoption of these different PFA form factors has been highly dynamic. While the cyber incident has accelerated some of the share shift, we do expect continued erosion of our PFA share position until we launched FARAWAVE Ultra, now expected in early '28, we expect our EP performance to meaningfully improve in '28 as we expand our PFA ecosystem with 2D ICE in the second half of '27 and FARAWAVE Ultra in '28 and FARAFLEX, wide-area focal catheter in '29. In the near term, we're focusing our teams where we know we can win. We have the most utilized and studied technology for de novo [ AFib ] procedures with our FARAWAVE catheters. We have a differentiated portfolio available, including our VersaCross transseptal needle and WATCHMAN technology, and we continue to invest to bring differentiated innovation to this large and fast-growing market. In closing, I want to restate that I remain very confident in Boston Scientific's long-term outlook. We operate in attractive markets with approximately 75% of our business, historically growing approximately 6% for many quarters. We have an impactful cadence of future growth catalysts anticipated in '27 and '28 that we expect to drive meaningful improvement to our growth profile in '28 and beyond. We remain focused on execution and delivering our updated '26 guidance, taking appropriate action to evolve our organization that will create greater focus, speed and accountability, while ensuring we are continuing to invest in our long-term growth drivers. I'm incredibly grateful to our global employees for their resiliency and winning spirit and across all of our businesses and regions, I've seen our colleagues step up in extraordinary ways, adapting quickly and supporting one another and doing what it takes to ensure we are focused on what matters, improving patient lives through a relentless pursuit of innovation. With that in hand, I'll hand over to Jon to provide more details.

Thanks, Mike. Before I provide details on our third quarter financial performance, I want to express my gratitude to our customers, physicians and employees for their patience and partnerships as we work through the recent cyber incident. I'm very proud of our global teams who have worked diligently to restore operations and continue to support our customers and the patients that they serve. The cyber incident caused significant disruption to our business operations and it materially impacted our third quarter financial results. Despite these challenges, we remain focused on taking the necessary actions to drive improved financial performance. So turning now to the quarter. Third quarter consolidated revenue of $5.138 billion represents 1.5% reported growth versus third quarter 2025 and includes a neutral impact from foreign exchange which was in line with expectations. As a result, operational and organic revenue growth were also 1.5% in the quarter, below our third quarter guidance range of 3% to 5%. We estimate the cyber incident had a net negative impact of approximately 300 basis points on third quarter organic revenue growth. This impact reflects the 8 business day disruption to our global network during which we are unable to manufacture or ship product, partially offset by revenue recovered as operations resumed. Third quarter 2026 adjusted earnings per share of $0.73 declined 3% versus 2025, below our third quarter guidance range of $0.80 to $0.82. As Mike mentioned, third quarter results include an approximate $0.07 unfavorable impact from the cyber incident primarily driven by lower-than-expected sales and the additional manufacturing and operation -- operating costs associated with the cyber incident. Adjusted gross margin for the third quarter was 68.0% representing a 300 basis point decrease versus the third quarter of 2025, primarily driven by unfavorable manufacturing absorption during the cyber-related disruption. Third quarter adjusted operating margin was 26.5%, contracting 150 basis points versus the third quarter of 2025, primarily driven by the impact of the cyber incident on gross margin. On a GAAP basis, third quarter operating margin was 16.1%. These results include an approximate $80 million charge primarily related to certain product liability cases. Moving to below the line. Third quarter adjusted interest and other expenses totaled $124 million, which was in line with expectations. On an adjusted basis, our tax rate for the third quarter was 14.3%, which was higher than expected due to certain discrete tax items. Fully diluted weighted average shares outstanding ended at $1.452 billion in the third quarter and free cash flow for the third quarter was $867 million, with $1.047 billion from operating activities less $180 million in net capital expenditures. As of September 30, 2026, we had cash on hand of $609 million and our gross debt leverage ratio was 1.9x. Our capital allocation approach remains disciplined and growth oriented. Our top priorities remain strategic tuck-in M&A and opportunistic share repurchases, while we continue to evaluate and fund the opportunities that we believe will create the greatest long-term value for our shareholders. We look forward to closing our acquisition of Penumbra, which we believe will strengthen our long-term growth profile through its innovative portfolio and strong strategic fit within our cardiovascular business. In addition to tuck-in M&A, we're leveraging strategic partnerships to advance innovation, ensuring we're directing capital towards high-growth opportunities. Consistent with this approach, we recently entered into an agreement with Blackstone Life Sciences to co-fund the development of our VITALYST Circulatory Support System for the treatment of patients with cardiogenic shock. Under the agreement, Boston Scientific will receive funding from Blackstone, which will be recognized as a reduction to R&D expense as the related costs are incurred. Upon achievement of certain milestones expected starting in 2030, Blackstone will be eligible to receive a return on the actual amount funded for the program plus royalties on sales of VITALYST. This agreement allows us to continue advancing VITALYST while accelerating investments in other high-growth opportunities. Before I discuss guidance, I want to acknowledge that we need to rebuild confidence in our forecast. We've implemented meaningful enhancements to our forecasting process, which we believe provide a stronger foundation for more accurate forecasting going forward. And so now I'll walk through our guidance for the fourth quarter and full year 2026. We now expect full year 2026 reported revenue growth to be approximately 4.25% versus 2025. Excluding an approximate 50 basis point tailwind from foreign exchange based on current rates, we expect full year 2026 operational and organic growth to be approximately 3.75%. We expect fourth quarter 2026 reported revenue to decline in a range of down 3% to down 1% versus fourth quarter 2025. We anticipate no impact from foreign exchange based on current rates, and therefore, expect fourth quarter 2026 operational and organic revenue to also decline in a range of down 3% to down 1%. As Mike mentioned, our fourth quarter guidance contemplates a headwind from the cyber incident reflecting elevated customer ordering at the end of the third quarter, which we expect to normalize over the course of the fourth quarter. We expect full year 2026 adjusted gross margin to be below full year 2025, reflecting a less favorable product mix, investment in our global supply chain and quality systems and the additional impact of the cyber incident. We now expect full year 2026 adjusted operating margin to be approximately 27.6%, reflective of gross margin pressures. We continue to expect full year 2026 adjusted below the line expense to be approximately $485 million. Under current legislation, including enacted laws and issued guidance, we now expect a full year 2026 adjusted tax rate of approximately 12%. We expect full year 2026 free cash flow to be approximately $3.6 billion, reflecting a reduced operating income outlook. We expect full year 2026 adjusted earnings per share to be in a range of $3.16 to $3.18, representing growth of 3% to 4% versus 2025, including an approximate $0.06 headwind from foreign exchange, and we expect fourth quarter adjusted earnings per share to be in the range of $0.77 to $0.79. As Mike outlined, we anticipate continued top line pressure into 2027, which we expect will make it challenging to grow revenue and adjusted earnings per share, excluding Penumbra. We expect our underlying business dynamics in Q4 to persist into 2027 and believe our fourth quarter guidance provides a reasonable baseline for next year's revenue and adjusted earnings per share outlook. Importantly, we're taking decisive actions to drive greater focus, speed and accountability, most notably through our company-wide restructuring program. This comprehensive initiative is focused on org structure evolution, supply chain optimization, back-office transformation and reductions in other categories of spend. We expect these efforts to deliver sustained cost efficiencies while allowing us to prioritize investments that support long-term growth. In closing, we believe we're well positioned in attractive markets. We're making the right investments and taking the necessary steps to strengthen our financial performance. I'm confident that these actions will position us to stabilize Boston Scientific in 2027 and then drive improved revenue and adjusted earnings per share growth in 2028 and then further acceleration in 2029. For more information, please check our Investor Relations website for third quarter 2026 financial and operational highlights, which outlines more details on third quarter results and 2026 guidance. And so Lauren, with that, I'll turn it back to you to moderate the Q&A.

Thanks, Jon. Drew, let's open it up for questions for the next 30 minutes or so. In order for us to take as many questions as possible, please limit yourself to one question. Drew, please go ahead.

[Operator Instructions] The first question comes from Robbie Marcus with JPMorgan.

A lot to dig into. I'll stick with one here and focus on guidance. Maybe you could -- and there's a lot of questions I'm getting from investors. So hopefully, this will help clarify. How do we think about sort of the actual underlying impact from the hack disruption in third quarter? It sounds like there was some order benefits. What's the actual impact and why bleeding into fourth quarter? And with the no growth comment on 2027, how much of that is conservatism related to the hack and how much is new information of end market and product timing?

Jon, do you want to take the cyber question?

Sure. Yes. Thanks, Robbie. So let me lay out the impacts of cyber. So in Q3, we estimate a roughly 300 basis point headwind to our revenue from cyber, so call it roughly $150 million of headwind on the top line and then bottom line impact to EPS of $0.07. So the impact of the lost sales -- we did have unfavorable manufacturing absorption that contributed to the $0.07 of EPS as well as other direct costs, expedited shipping, cost of experts that impacted Q3 cyber. For the fourth quarter, we expect an ongoing impact of approximately 200 to 300 basis points. And so what we saw, Robbie, coming out of the cyber incident is a level of stocking of -- from customers. And over the fourth quarter, we'll burn off some of those inventory levels. So that's why you see the ongoing impact into the fourth quarter of that 200 to 300 bps. And that drops through down to EPS, roughly $0.04 to $0.05 of impact in the fourth quarter.

Yes. Maybe just some comments on the '27 question. When we think about it, we obviously aim to exceed these expectations. But just to frame and we'll give our guidance, obviously, in January. We really do expect some of the underlying business dynamics that we see in the fourth quarter to persist in 2027. So if you look at that, you've got a number of our businesses doing extremely well, interventional cardiology, vascular, IO&E, endoscopy's underlying business is doing quite well despite the pressures in China. So the overall base business, we feel has consistently grown about 6%. We expect about 1 point of impact due to the comprehensive China pricing issues, and that represents about 75% of the business. So the 2 key areas -- questions are, what will be the impact of WATCHMAN and EP in 2027? So for the basis of our early framing of guidance, we wanted to be appropriately conservative. So we're assuming that the WATCHMAN market dynamics do not improve over current state. And we're obviously doing a lot to turn that around. But those underlying markets today are growing about negative 7, negative 8-ish percent in that area. And we do have a competitive launch coming in 2027. So the error bars are on the market around the WATCHMAN assumptions are quite wide, given that we are assuming no improvement in the market despite some of our efforts and an anticipated label change where we're assuming that the market baseline stays similar to Q4 with competitive entry in '27. Similarly, in EP, EP will be a challenging year for us in '27, and we're very optimistic about '28 and '29 based on our product launch cadence. But in '27, we are lacking new product launches. The market continues to be fairly healthy, but we expect to continue to see share in 2027 in EP, similar to the rates that we've seen in the second half of 2026. Until we successfully launched a ICE program in second half of '27, an excellent platform upgrade with FARAWAVE Ultra, ideally late fourth quarter, early first quarter, '27. And as you know, we've initiated our clinical trial FARAFLEX platform, which will be an early '29 launch. So hopefully, that gives you some context for 2027.

The next question comes from Larry Biegelsen with Wells Fargo.

So super helpful color on 2026 and 2027. Mike, just talk about your confidence in improving sales and EPS growth in '28. I'm not looking for specifics, obviously, but what are the drivers it looks like FARAFLEX, the launch was pushed out to 2029 in the slides, if I'm reading that correctly. And I think there are some concerns about new PFA competition coming in '28 with the novel wave form. And so how are you factoring that in?

Yes. Thank you. Just a backdrop a bit and maybe not new news. '23 to '25, we experienced a very high growth cycle much on the heels of our base business being strong and the tremendous growth of our WATCHMAN and EP. We also had a decent first half despite some of our forecasting challenges growing 8% in the first half of 2026. We are clearly in the middle of a down cycle, which is a short-term phenomenon for Boston Scientific that you will see -- that we predicted in fourth quarter based on our guide in 2027. We are very confident about the return to growth and kind of pushing off the bottom in '27 as we enter '28. And a high-level formula for growth in '28, potentially below our WAMGR, but solid growth and growth above our WAMGR in '29 really are the -- if you look at our 3 segments. Our biggest segment, as you look at 2028, will be our Interventional Cardiology, Vascular and Penumbra business. We expect that collection of businesses to comfortably grow above their market WAMGR as Penumbra goes organic and they continue to drive excellent momentum. And with a very strong portfolio cadence in that business with our IVL platforms in peripheral and vascular potentially hypertension in 2028 and a strong cadence of imaging capabilities as well as launches within our EP, IO&E platform. So that will represent our biggest segment, very much on offense growing above WAMGR and propelling the growth of the company. Our MedSurg business, with a number of key launches, you saw a couple of key approvals just this quarter in our urology business. We expect our MedSurg segment businesses to essentially grow at our market WAMGR or grow at their market WAMGR, call it, mid-single digits. So then it really comes down to what happens to EP and WATCHMAN and CRM. The good news in CRM is we'll be launching a significant platform launch with [ mCRM ], our defibrillator platform, which we expect CRM will comfortably return to growth in 2028 to help that segment. And then in WATCHMAN, we will anniversary a competitive launch in 2028. We'll be in the midst of a trial of our fourth-generation platform. As you know, we've got a very, very strong share in WATCHMAN, and we expect to maintain that strong leadership position during this case. We'll also aim to have an approved label change ideally by 2028. So we see the WATCHMAN business kind of maximum down and will return to a healthier position in 2028. Similar with our EP business, again, it's driven by portfolio and cadence. And as I mentioned before, we'll have our ICE platform launch, our full year of FARAPULSE Ultra and pending approval or Flex business. So we expect the overall Rhythm Solutions business with a stronger growth in CRM and improving cadence of effective launches in EP and WATCHMAN to significantly improve the growth profile of Rhythm in '28, whereas 2027 that segment is driving the challenges.

The next question comes from Joanne Wuensch with Citi.

Two parts. One part is, internally, it sounds like you're doing quite a bit to build the bridge between today and 2028, which could include any number of things such as sales force realignment expense reduction, et cetera, et cetera. Could you please address what you're doing internally to build that bridge? And then second of all, the Penumbra delay, is there a way to share the steps to that resolution?

Sure. We're certainly -- and Jon, you can comment a bit more. As you would expect, we're aligning our cost structure to a reality of what we see in fourth quarter in 2027. So the team has gotten ahead of that about 6 months ago and are implementing a pretty meaningful restructuring program, both in terms of where we -- our discretionary spend headcount. We want to delayer the company a bit more, increase some of the spans and layers in the organization and get after some SG&A offsets. So that program is very much in flight. Importantly, we maintain the really important cultural values of Boston Scientific that makes it a special place to work and focus on advancing science for life and our winning spirit. So we believe we will continue to drive an important culture within Boston Scientific focused on the future despite the needed restructuring initiatives. Importantly, while we're doing that, we're also continuing to invest in these big growth platforms that will drive the company's growth back to a decent growth in '28 and above market WAMGR and entering all these new markets that we're taking on. So I think it's important that we show the discipline to drive those cost savings and invest in our growth drivers at the same time.

And Joanne, I'd just add with the restructuring program, I'll fill in a couple of pieces there. So anticipate to achieve over $500 million of savings from the program over the next 3 years, been some tough decisions, but I've been very pleased with how we've been tracking. We're a little ahead of where I thought we'd be at this point in the program. I expect to achieve over half of those savings exiting 2027. So back to Larry's question, that contributes to our confidence in 2028. Mike went through the top line, but from an EPS perspective as well. Program itself, focused on streamlining org structures, back-office transformation to streamline our processes, leverage shared services. There's a supply chain optimization looking across our global supply network, to better leverage technology, AI and streamline across supply chain and then a broader initiative just looking at other pools of spend like T&E meetings, like use of external vendors to reduce our spend there. So it's a very broad initiative, but very focused. And again, I've been pleased with how we've been tracking. We're a little ahead of our schedule there.

And sorry, Joanne, on the Penumbra comments, maybe some good and bad news. Overall, we're super impressed with the Penumbra results for 2026. And the good news is with a bit of an extended closing period, we've continued to get to know the Penumbra team extremely well, how they run the business, the synergies that are very obvious on growth side and some on the cost side when you combine 2 powerful businesses with intervention cardiology vascular in the Penumbra business. So we're very bullish on the Penumbra team, the progress to innovation pipeline they have and how they will work very seamlessly within Boston Scientific to drive ongoing strength in Penumbra and our ICVT business. On the regulatory process has taken a bit of time. We're still very confident in closing the transaction. But based on some of the discussions with the regulatory authorities, we anticipate an early first quarter close.

The next question comes from Rick Wise with Stifel.

Mike, I was hoping maybe you could further unpack the MedSurg outlook a little bit. You said, I think, just a moment ago, you expected the combined business to grow mid-single digits sort of in line with the WAMGR market growth. But maybe talk us through each piece. Historically, these are businesses that total grew 7% or 8%. Why can't we dream or aspire for you to get back to that kind of range? And maybe what needs to happen in urology endoscopy and neuro to get back there? And what are the key drivers here as we look ahead to the next year or 2?

Yes, I would agree. 5 to 6 mid-single-digit growth is not what we want MedSurg to be and not what it's been and not what the potential is. Just to break through the 3 of them really quickly. Neuromodulation is doing very well. Our Brain franchise is doing well. We've really diversified our Pain business into more minimally invasive alternatives in addition to spinal cord stim. And we continue to have additional growth drivers in that business with the whole new SCS launch that will happen in 2028. So overall, I would assume kind of over a period of time, the Neuromod business will continue to be accretive to the MedSurg growth profile. Our Endo business is very strong. We've got a list of quite a few product launches in that area with scopes and our versatile platform and a number of others. The headwind in 2027 for Endo is China. Significant pricing erosion we will see in our China business in 2027. So the Endo business will anniversary that China pricing impact in fourth quarter 2027. So we expect kind of our Endo business to be at that mid-single-digit growth range in '27 accelerated '28 based on launching and getting -- lapping that China piece. The challenge, quite frankly, has been urology. And we've been wrong on calling the growth trend in urology. Obviously, a lot of efforts are going on in that area. So we expect the Urology business to improve in 2027, not back to its previous levels, but certainly not at a negative growth profile that we see in 2026. And this business is all about people and portfolio. We just announced in our script there, we've got 3 stone launches that -- or, 3 stone approvals, which has been the one segment that's been lagging the growth for that franchise. So we expect our core stone business to improve in 2027. And as you know, you've heard for many quarters now, we've struggled a bit with the Axonics integration. We've done great with the [ Relievant ] integration, with [ Apollo ] integration, but we struggled with Axonics based on significant commercial turnover. We've done a lot to hire a lot of new reps and clinical people in that area. It takes a bit of time for them to get season in their territories, but we expect to see improvement in that in 2027. So in short, '27, we think Endo-Uro will be in that kind of lower to mid-single-digit range. and neuro slightly higher and Endo and Uro both lapping significant China VBP pricing in fourth quarter '27 to have a stronger '28. But we -- overall, we do aim to get back to kind of that 7 to 8-ish numbers that we used to see.

The next question comes from Travis Steed with Bank of America.

I wanted to ask on the pipeline. There was a lot of things kind of across the board pushed out. Is there something bigger picture going on the pipeline of the derisking of the pipeline? And also, Jon, you mentioned better forecasting abilities. So just curious if you could elaborate on that as well.