Outlook
This combined management report contains forward-looking statements, including statements on future revenue, expenses, and investments, as well as potential changes in the healthcare sector, our competitive environment, and our financial situation. These statements were made on the basis of the expectations and assessments of the Management Board regarding events that could affect the Company in the future, and on the basis of our mid-term planning. Such forward-looking statements are subject, as a matter of course, to risks, uncertainties, assumptions, and other factors, so that the actual results, including the financial position and profitability of Fresenius, could differ materially – positively or negatively – from those expressly or implicitly assumed or described in these statements. For further information, please see section Opportunities and Risk Report.
General and mid-term outlook
In a generally ongoing volatile economic environment, the Management Board continues to assess the business outlook of the Fresenius Group as positive at the time of preparing the combined management report. We continue to see steadily growing demand for our products, services, and therapies worldwide.
We are continuously striving to optimize our costs, adjust our capacities, and improve our product mix, as well as to expand our products and services business. This includes plans for cost-efficient production and a further-optimized procurement process. In addition, we can use digital technologies to accelerate central administrative processes and make them more efficient. Furthermore, this provides an opportunity to advance medical quality and increase patient benefits.
Fresenius recognizes very good opportunities to meet the growing demand for healthcare resulting from the aging population with its increasing need for comprehensive care and from technological progress worldwide. Fresenius expects that access to healthcare in developing and emerging countries will continue to improve and that efficient healthcare systems with appropriate reimbursement structures will develop over time. We will continuously review and optimize our activities and growth options in the global regions and look for opportunities to introduce further products from our portfolio in attractive markets that enable profitable growth.
The mid-term business outlook for Fresenius’ Operating Companies is determined by the following factors:
Fresenius Kabi stands for innovation, reliability, and quality in the field of healthcare and thus for improving the quality of life of people who are critically and chronically ill. Building on this foundation, we will strengthen and expand our global leadership positions across our four businesses: Pharma, Nutrition, MedTech, and Biopharma. In Pharma, we aim to strengthen our global position as number one in generic IV drugs and our leading position in the IV fluids market, by developing a strong portfolio of IV drugs in future-relevant therapeutic areas as well as essential IV and irrigation fluids, enabled by superior handling, cost efficiency, and reliable supply. In Nutrition, we aspire to become the leading clinical nutrition provider by augmenting patient treatment with essential, innovative, and disease-specific nutritional products in both parenteral and enteral nutrition. In Biopharma, by transforming into a fully integrated biosimilars provider, developing, manufacturing, and commercializing a portfolio of high-quality and affordable biosimilar products, we aim to enter into the league of the top biosimilars players worldwide. With more original biologics set to lose exclusivity, this market will remain a strong opportunity in the years ahead. For our MedTech business, our ambition is to become a leading global player by delivering superior, innovative technologies and differentiating solutions in infusion and nutrition systems, as well as transfusion medicine and cell therapies. Following Reset and Revitalize, we have now entered the third phase of our #FutureFresenius transformation – Rejuvenate. For Fresenius Kabi, this means instilling a continuous improvement mindset in our organization (upgrade core), continuing to innovate and expand our portfolio (scale platforms), and improving how we deliver on patient and customer expectations (elevate performance).
Fresenius Helios operates almost-nationwide hospital networks in Germany and Spain and provides outpatient care at various facilities. Patient care is to be further improved through the exchange of knowledge and experience (best practice) between Helios Germany and Helios Spain. The increasing number of privately insured patients opens up growth opportunities for Helios Spain, with a very deliberate and targeted allocation of capital for future expansion and hospital construction. Furthermore, the close integration of Helios Spain’s corporate health management facilities with its own hospitals offers additional growth opportunities. In addition to innovative therapies, digitalization creates potential to further expand our market position. Helios Germany and Helios Spain are developing innovative business areas such as digital offerings.
Healthcare sector and markets
The healthcare sector is considered to be widely independent of economic cycles. The demand, especially for lifesaving and life-sustaining products and services, is expected to increase regardless of the macroeconomic challenges, given that they are medically needed and the population is aging. Moreover, medical advances and the large number of diseases that are still difficult to cure – or are incurable – are expected to remain growth drivers.
In the emerging countries, the availability of basic healthcare and the demand for high-quality medical treatment are increasing. As per-capita income increases, individuals increasingly have to cope with the illnesses associated with lifestyle diseases.
On the other hand, experts estimate that further financial constraints in the public sector could result in more pricing pressure and a slowdown in revenue for companies in the healthcare industry. Some countries are experiencing significant financing problems in the healthcare sector due to the strained public finance situation. Especially in the industrialized countries, increased pressure to encourage saving can be expected as healthcare costs constitute a large portion of the budget.
It will be increasingly important for companies in the healthcare sector to increase patient benefit, to improve treatment quality, and to offer preventive therapies. In addition, especially those products and therapies that are not only medically but also economically advantageous will be of increasing importance.
The markets for biopharmaceuticals, clinical nutrition, MedTech, generic IV drugs, and IV fluids1
It is forecasted that the market for biopharmaceuticals from the therapeutic areas of oncology, ophthalmology, and autoimmune diseases will experience high-single-digit percentage growth in the upcoming years, whereby the biosimilars segment is clearly in the double-digit range. Today, more than one in three new drug approvals is a biopharmaceutical, resulting in a significant growth projection for this global market, especially for biosimilars in the next few years and decades.
Going forward, we anticipate mid-single-digit growth in the clinical nutrition market. This outlook is underpinned by the growing awareness of the importance of early clinical nutrition, as emphasized in the latest guidelines. Moreover, increasing adaptation of mandatory screening for malnutrition2 is contributing to the positive growth prospects. We see further potential in addressing the substantial number of malnourished hospitalized as well as home-care patients who still lack access to nutrition therapies.
The MedTech Infusion and Nutrition System (INS) market is expected to grow in the mid-single-digit range, mainly driven by infusion management systems. In many countries, we continue to see strong demand in the infusion technology segment, with drivers such as an increase in chronic diseases, geriatric population, and the rising number of surgical procedures. In addition, the infusion pumps already placed in recent years will increase the demand for dedicated infusion sets.
In the MedTech Transfusion Medicine and Cell Therapies (TCT) market, we project mid-single-digit growth in the near future, which is primarily driven by three segments. Firstly, the cell and gene therapy segment, where we expect double-digit growth due to therapies moving towards earlier lines of treatment. Secondly, the plasma collection segment, and, thirdly, the hospital segment, primarily driven by therapeutic apheresis. In the blood center segment, we expect continued single-digit market growth, driven by increased platelet apheresis use in developing markets.
Going forward, the markets for generic IV drugs and IV fluids are expected to grow in the low-to-mid-single-digit range, with significant regional differences. The demand for generic IV drugs is expected to grow based on their significant cost advantage compared to originator drugs. The growth will continue to be driven by several other factors, including the aging population and the rising prevalence of chronic conditions, alongside the expansion of home healthcare and outpatient services. Technological advancements will also play a significant role. Improved healthcare infrastructure, greater access to healthcare in emerging markets, and patent expiration of originator drugs contribute to the overall market of generic IV drugs globally. A factor working in the opposite direction is the price pressure on off-patent brands and generic drugs, as regulators seek to keep healthcare budgets under control, and it is expected that the competitive intensity will further increase.
The hospital market3
Due to the increasing provision of treatments in the outpatient setting, in particular, as well as the growing acceptance and use of digital healthcare services, we assume that the number of inpatient hospital treatments in Germany will continue to have limited growth potential in the future.
According to calculations, the potential for outpatient treatment in German hospitals is around 20% of inpatient cases (excluding births)4. Increasing outpatient treatment is desirable, not least for reasons of the shortage of specialist staff. To promote ambulatory care, the first hybrid DRGs were introduced on January 1, 2024. These services will be substantially expanded in 2026 and also include cases with a length of stay of up to two days.
In addition, a stronger cross-sectoral integration of inpatient and outpatient medicine should ensure high-quality hospital care close to home. Fresenius Helios is well positioned in terms of cross-sector medicine in Germany with its broad range of inpatient and outpatient services.
German hospitals will still be facing challenges in 2026: According to the Hospital Barometer 2025 of the German Hospital Institute (DKI), only 13% of hospitals expect an improvement in their financial situation (2025: 6%). On the other hand, 44% of hospitals expect their economic situation to deteriorate (2025: 65%).
Fresenius Helios expects to continue to grow profitably in Germany in 2026. Since its founding, the company has focused on good organization, cost efficiency, and measurable, high medical quality as well as transparency of medical results.
In January 2025, the hospital structural reform came into force (“Krankenhausversorungsverbesserungsgesetz” – KHVVG). The aim is to make healthcare provision in Germany fit for the future by reorganizing hospital structures and hospital compensation.
It is intended to promote the quality-oriented bundling of care capacities and to increase the level of outpatient care, which is low by international standards. The reform is to be implemented over a period of several years, with a budget-neutral transition phase for 2026 and 2027. From 2028, the maintenance flat rates will be aligned with the assigned service groups. Full implementation is expected from 2030 onwards.
In principle, Helios Germany considers itself to be well positioned for the upcoming reform as it has been strategically focusing on structural changes, new forms of care, and regional healthcare networks (clusters) for many years. Fresenius Helios expects the hospital structure reform to be beneficial rather than detrimental to the company.
As part of the Act on the Expansion of Powers and Deregulation in Nursing (“Gesetz zur Befugniserweiterung und Entbürokratisierung in der Pflege” – BEEP), it was established in December 2025 that, for the agreement on the state base case value for 2027, the state base case value for 2026 will be increased by 1.14%.
The increase in the compensation for hospital services in Germany is determined, among other things, by what is known as the change value. It amounts to 2.98% for 2026. The hospital financing system also provides for various surcharges and discounts for acute hospitals.
In the period from November 1, 2025 to October 31, 2026, hospitals in Germany will receive a surcharge of 3.25% on the costs of inpatient or partially inpatient hospital treatment for patients covered by statutory health insurance. The financial effect for 2026 is therefore 2.71%. The surcharge is granted to financially support hospitals, as they have been heavily burdened in the past, particularly due to inflation-related cost increases.
The German federal government justifies the surcharge as an immediate measure to stabilize hospital finances in the context of high inflation costs and transformation expenditures related to the hospital reform.
According to our expectations, we anticipate that the private hospital market in Spain in 2026 will continue to grow in the mid-single-digit percentage range in terms of revenue. Spain’s private insurance market is growing, especially among higher-income earners and those seeking shorter wait times5. The continuing increase in the number of privately insured patients should open up opportunities for private operators in the future.
Relevant indicators, for example nationwide healthcare spending and bed density, indicate the further market development potential in the Spanish healthcare system compared with other EU countries. This also provides opportunities for the establishment of new hospitals. Investments are made both by the public sector and by private hospital operators5.
In addition, the highly fragmented Spanish private hospital market offers further consolidation potential.
The availability of skilled workforce will continue to change in the coming years. It is expected that more people will leave the labor force than will enter it. This will also lead to changes in hospitals, which will aim to use existing resources efficiently and effectively. Digitalization, robotics, and innovative forms of collaboration offer possible solutions for meeting this challenge.
This is another reason to expect the trend towards digitalization in the healthcare sector to become even more important. Increasingly, the degree of digitalization will be central to the future viability and competitiveness of a hospital. Networks and the use of digital solutions are opening up new opportunities to make processes more efficient and safer and thus to break new ground in patient care. Digitalization is a core element in enabling agile responses to upcoming changes.
Group revenue and earnings
The company acknowledges that the prevailing trends of fast-moving macro-economic and geopolitical environment continue, resulting in increased volatility and a higher level of operational uncertainty. The guidance does not take into account potential extreme scenarios that could affect the company, its peers, and the healthcare sector as a whole. Potential implications of the United States Supreme Court ruling as of February 20, 2026, are currently being evaluated but cannot be fully assessed at this stage and are hence not reflected in FY/26 guidance.
Regardless of this, the Management Board assesses the business prospects for the Group as positive and expects a successful fiscal year in 2026.
Fresenius will continue to closely monitor the potential impact of increased volatility and reduced visibility on its business and balance sheet.
All of these assumptions are subject to considerable uncertainty.
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Targets 2026 |
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Base 2025 |
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Revenue growth (organic) |
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4–7% |
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€22,554 m |
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Core EPS growth1 (in constant currency) |
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5–10% |
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€2.87 |
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Revenue and earnings expectations of the business segments
In 2026, we expect revenue and earnings development in our business segments as shown in the table below:
Operating Companies1 |
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Targets 2026 |
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Base 2025 |
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|---|---|---|---|---|---|---|---|---|---|---|
Fresenius Kabi |
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Revenue growth (organic) |
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Mid-to-high-single-digit percentage growth |
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€8,612 m |
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EBIT margin |
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16.5–17% (structural margin band: 17–19%) |
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€1,413 m |
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Fresenius Helios |
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Revenue growth (organic) |
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Mid-single-digit percentage growth |
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€13,550 m |
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EBIT margin |
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10–10.5% (structural margin band: 10–12%) |
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€1,328 m |
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Expectations for other key figures
Expenses
For fiscal year 2026, we expect selling, general, and administrative expenses (before special items) as a percentage of consolidated net revenue to slightly increase compared to fiscal year 2025 (2025: 11.6%).
Tax rate
For fiscal year 2026, we expect a tax rate between 24% and 25% (2025: 25.6%).
Profitability, liquidity and capital management
Indication for EBIT margin (before special items): An EBIT margin of ~11.5% is expected for fiscal year 2026. This metric (EBIT margin) is provided solely for modelling purposes and does not form part of the official guidance.
For fiscal year 2026, we expect a cash conversion rate of slightly below 1.0.
In addition, undrawn credit lines under syndicated or bilateral credit facilities from banks provide us with sufficient financial headroom.
Planned financing activities in 2026 will be largely geared towards refinancing existing financial liabilities maturing in 2026 and in the first quarter of 2027.
For fiscal year 2026, we expect interest expenses to remain broadly in line with fiscal year 2025 (2025: €324 m).
Without further acquisitions and divestments, Fresenius expects the net debt / EBITDA6 ratio at the end of 2026 to be within the self-imposed target corridor of 2.5× to 3.0× (December 31, 2025: 2.7×6).
There are no significant changes in the financing strategy planned for 2026. Adherence to our self-imposed target corridor will continue to be of central importance to us.
Investments
In 2026, we expect to invest about 5.5% of revenue in property, plant and equipment. About 54% of the capital expenditure planned will be invested at Fresenius Helios and about 39% at Fresenius Kabi.
Fresenius Helios will primarily invest in measures at the individual hospital locations in Germany and in new hospital buildings and expansions in Spain.
Fresenius Kabi will mainly invest in expansion and maintenance. This includes, in particular, the expansion of production facilities and in-licensing projects for biosimilar molecules.
With a share of around 86%, Europe is the regional focus of investment in the planning period. Around 6% of the investments are planned for North America and around 8% for Asia-Pacific, Latin America, and Africa. About 39% of the total funds will be invested in Germany.
For 2026, we expect return on invested capital (ROIC) to be above 6.5% (2025: 6.6%).
Capital structure
For fiscal year 2026, we expect the equity ratio to increase by about 1 percentage point compared to fiscal year 2025 (2025: 48%). Furthermore, we expect that financial liabilities in relation to total assets will slightly decrease in fiscal year 2026 (2025: 29%).
Dividend
Fresenius is committed to generating attractive and predictable dividend yields as set out in the Fresenius Financial Framework. As part of the full-year reporting in February 2025, Fresenius defined a new dividend policy. Our target is to distribute 30% to 40% of core net income (net income excluding Fresenius Medical Care, before special items). The new dividend policy reflects the capital allocation priorities in line with the #FutureFresenius strategy. It also underscores our intention to reinvest in growth, reduce leverage, maintain a solid investment-grade rating, and provide attractive shareholder returns.
Fresenius will propose to the 2026 Annual General Meeting to distribute a dividend of €1.05 for fiscal year 2025. This corresponds to a payout ratio of around 37%.
Non-financial targets
The KPIs cover the key sustainability topics of medical quality and employees and these quantitative ESG KPIs are reflected in the short-term variable Management Board compensation (Short-Term Incentive – STI).
The topic of employees is measured with the key figure of the Employee Engagement Index (EEI) for the Fresenius Group. Fresenius is aiming for an EEI of 4.12 (achieved 2025: 4.14) for fiscal year 2026 (corresponds to 100% target achievement).
The Medical Quality topic is composed of equally weighted key figures that are defined at the business segment level. The indicators are based on the respective relevance for the business model.
Fresenius Kabi aims for an Audit & Inspection Score of at most 2.3 (achieved 2025: 0.9; 100% target achievement).
Helios Germany aims to achieve an Inpatient Quality Indicator (G-IQI) score of at least 88% (achieved 2025: 91.9%; 100% target achievement), and Helios Spain aims to achieve a score of at least 75% (achieved 2025: 77.4%; 100% target achievement).
1 Market data refers to Fresenius Kabi’s addressable markets. Those are subject to annual volatility due to currency fluctuations and patent expiries of original drugs in the IV drug market, among other things. Percentage increase based on market value (price × volume).
2 Sources: New ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2022 41:958-989; by Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, et al.; most recently implemented e.g., in Portugal: “National Policy for effective screening implementation”; Directorate General of Health DGS
3 Sources: Company research; German Hospital Institute (DKI), Krankenhaus Barometer 2025
4 Care Compass BARMER Institute for Health Systems Research (bifg, 2023a)
5 Spain Healthcare Statistics, Trends & Facts (2025)
6 At average exchange rates for both net debt and EBITDA; pro forma closed acquisitions / divestitures, before special items, including lease liabilities, including Fresenius Medical Care dividend, net debt adjusted for the valuation effect of the exchangeable bond
Core Net income is calculated from the net income attributable to shareholders of Fresenius SE & Co. KGaA before special items, less the earnings contributions of Fresenius Medical Care.
Core Net income serves, among other purposes, as the basis for calculating Core Net income per share, which is determined by dividing Core Net income by the weighted average number of shares outstanding.
Invested capital = total assets + accumulated amortization of goodwill - deferred tax assets - cash and cash equivalents - trade accounts payable - accruals (without pension accruals) - other liabilities not bearing interest.