ICON Reports $3.3B in Gross Bookings and 1.42x Net Book-to-Bill in Q1 2026 as CRO Backlog Reaches $22.7B

• ICON plc (NASDAQ: ICLR), a world-leading CRO, reported Q1 2026 gross bookings of $3.3 billion — up 22% year-over-year — and net business wins of $2.88 billion, a 42% year-over-year increase, yielding a net book-to-bill of 1.42x and a total CRO backlog of $22.7 billion as of March 31, 2026.

• Revenue of $2.03 billion increased 0.9% year-over-year on a reported basis, while adjusted EBITDA of $317.7 million represented 15.6% of revenue — down from 19.8% in Q1 2025 — as business mix dynamics and foreign exchange effects weighed on profitability; the company reaffirmed full-year 2026 guidance of $7.85–$8.15 billion in revenue and adjusted diluted EPS of $10.00–$11.00.

ICON plc (NASDAQ: ICLR) reported its Q1 2026 financial results on June 23, 2026, from Dublin, Ireland, delivering strong commercial performance headlined by gross bookings of $3.3 billion — a 22% increase year-over-year — and net business wins of $2.88 billion, up 42% year-over-year, with a net book-to-bill ratio of 1.42x. Total CRO backlog reached $22.7 billion as of March 31, 2026, up 4% from $21.8 billion at December 31, 2025, reflecting robust new award activity and unusually low cancellations of $383 million in the quarter — well below management’s characterization of a normal range for a company of ICON’s scale.

Revenue for the quarter was $2.03 billion, representing a 0.9% increase on Q1 2025 on a reported basis and a 1.9% decrease on a constant currency basis. Adjusted EBITDA was $317.7 million, or 15.6% of revenue, a 20.2% decline versus Q1 2025, as business mix dynamics — specifically a higher proportion of functional service partnership revenue relative to full-service direct fee work — and foreign exchange effects compressed margins. Adjusted net income was $192.9 million, with adjusted diluted EPS of $2.50, compared to $3.27 in Q1 2025. GAAP net income was $104.8 million, or $1.36 per diluted share, versus $1.99 a year earlier. Operating cash flow was $167 million and free cash flow was $136.2 million, with net debt of $2.6 billion and a leverage ratio of 1.8x net debt to adjusted trailing 12-month EBITDA.

The commercial result was the headline of the quarter. ICON reported strong win rates across large pharma, mid-size pharma, and biotech full-service sectors, with improved biotech engagement supported by partnerships added in the second half of 2025 and two new strategic partnerships added during Q1 2026. Management noted that the strong full-service book-to-bill performance recorded in both Q4 2025 and Q1 2026 is expected to be more material to 2027 revenue than 2026, as backlog conversion timelines for full-service programs are typically 12 to 18 months or longer. Strategic operational investments in the quarter included expansion of ICON’s central laboratory facility in Singapore and enhancement of oncology research capabilities in the United States.

ICON also highlighted the continued development of Orbis, its secure, governed agentic AI platform, with Microsoft selected as a preferred technology partner to advance the program. The enterprise-wide deployment of Microsoft 365 Copilot alongside an enterprise-grade cloud, data, and AI infrastructure is designed to further scale Orbis across ICON’s clinical development workflows — supporting operational efficiency, data management, and AI-enabled trial execution for sponsors across ICON’s global network of approximately 40,350 staff in 97 locations across 55 countries.

“ICON maintained strong commercial momentum in quarter one, delivering net bookings of $2.9 billion, and a net book-to-bill of 1.42, driven by robust gross award activity and low levels of cancellations. The improved win rates in quarter four sustained into this quarter, supported by partnerships added in H2 2025 and the addition of two new partnerships during the quarter.”

Barry Balfe, Chief Executive Officer, ICON plc