Manmohan Mahajan
Interim Global Chief Financial Officer at Walgreens Boots Alliance
Thank you, Ginger, and good morning. Fourth quarter adjusted EPS came in near the low end of the range provided on June 27 and in line with our update on September 1. Our results reflected a further slowdown in respiratory events, shifting consumer behaviors driven by a challenging macroeconomic environment, and lower COVID-19-related contributions. Overall, we delivered 8.3% sales growth on a constant currency basis. This includes $1.4 billion in growth in our healthcare business versus the prior year.
Our U.S. Retail Pharmacy business grew 3.6% and our Boots U.K. business delivered 10.9% sales growth. Adjusted EPS of $0.67 was down 18% on a constant-currency basis. The 18% decline was driven by lower COVID-19 contributions, lower sale leaseback gains net of rent, and a higher tax rate. We saw positive results from underlying retail pharmacy performance, lower incentive accruals, strong international growth, and improved profitability in U.S. healthcare. GAAP net loss of $180 million improved by $235 million compared to prior year. Remember that we had a $783 million non-cash impairment charge in the year-ago quarter. The loss in the quarter was driven by charges for certain legal and regulatory accruals and settlements and onetime charges related to transformational cost management program.
Now let's move to the year-to-date highlights. Fiscal '23 sales increased 5.6% on a constant-currency basis. Adjusted EPS of $3.98 was down 20.3% on a constant-currency basis. Our results reflected lower COVID-19 contributions and increased labor investments. These challenges were partly offset by lower incentive accruals, growth in international, and retail pro formance in the U.S. GAAP net loss was $3.1 billion compared to net earnings of $4.3 billion in fiscal '22. Fiscal '23 included a $5.5 billion after-tax charge for opioid-related claims and lawsuits.
Now let's move to the U.S. Retail Pharmacy segment. Comp sales growth was 5.7%, reflecting higher brand inflation and mix impacts in our pharmacy business and comp script growth. AOI was down 29.4% in the quarter, reflecting a 27% impact from lower COVID-19 contributions and a 17% impact from lower levels of sale leaseback gains net of rent. Higher underlying pharmacy gross profit and lower incentive accruals contributed positively to AOI.
Let me now turn to U.S. Pharmacy. Pharmacy comp sales increased 9.2% in the quarter, driven by brand inflation and mix impacts and comp script growth. A weaker-than-normal respiratory season and impact of Medicaid redeterminations resulted in a weaker overall prescription market during the quarter. Third party market data showed flu, cold, and respiratory activity down 35% compared to the prior-year quarter. Despite these weaker trends, comp scripts grew 1.6% excluding immunizations. We administered roughly 400,000 COVID-19 vaccinations in the quarter, down from 2.9 million in the prior-year quarter. Excluding the impact of COVID-19, fourth quarter adjusted gross profit increased versus the prior-year period.
Turning next to our U.S. Retail business. During the quarter, the retail business was impacted by a weaker-than-normal respiratory season and a continued shift in consumer behaviors, driven by a challenging macroeconomic environment. As a result, comparable sales declined 3.3% in the quarter. There are three main drivers. First, an 80% decline in COVID-19 test kits impacted growth by around 160 basis points. Second, weaker cough, cold, flu sales had an approximately 100 basis points impact. And lastly, we were impacted by approximately 60 basis points from summer seasonal weakness, as customers continued to pull back on discretionary spending, reflecting the challenging macroeconomic environment.
Looking at category performance, we saw a decline in health and wellness, while personal care and beauty both grew low-single-digits. Retail gross margin was impacted by elevated shrink and lower sales in higher margin categories such as cough, cold, flu, seasonal, and COVID-19 test kits. Despite the pressure in the second half, gross margin grew by nearly 100 basis points in fiscal '23 on top of a 100 basis-point increase in the prior year.
Turning next to the International segment, and as always, I will talk in constant-currency numbers. The International segment again performed very well in the quarter, delivering profit ahead of guidance. Sales increased 6.7% with growth across all international markets. Boots U.K. was up 10.9% and Germany wholesale grew 3.5%. Gross profit increased nearly 10%, outpacing sales growth. Boots U.K. experienced continued strong retail growth and improved pharmacy margin compared to the prior-year period. Despite higher inflation and increased store-related costs, SG&A as a percentage of sales improved benefiting from disciplined cost management. These impacts resulted in adjusted operating income growth of 52%.
Let's now look in more details at Boots U.K. Comp retail sales increased 11.7% on top of a 15.2% comp in the prior-year quarter. Boots grew market share for the 10th consecutive quarter, approximately 1 percentage point versus the prior-year quarter, with gains in beauty and health and wellness. Boots.com sales grew 29% year-on-year and represented over 13% of our U.K. retail sales.
Turning next to U.S. Healthcare. U.S. Healthcare segment results were in line with the guidance provided on June 27, with AOI and adjusted EBITDA both up sequentially and year-over-year. The business continues to rapidly scale, with fourth quarter sales of $2 billion, reflecting the acquisition of CareCentrix, the acquisition of Summit Health by VillageMD, and growth in all businesses. Segment pro forma sales grew 19%, driven by VillageMD sales of $1.4 billion, up 17% on a pro forma basis. The growth was led by higher value-based lives, expansion of the clinic footprint, and increased fee for service volumes as clinics mature. CareCentrix sales were up 24% on a pro forma basis and Shields delivered pro forma sales growth of 29%. Segment gross profit improved 29% sequentially. Adjusted EBITDA was a loss of $30 million, an improvement of $103 million from the prior-year quarter.
Turning next to the cash flow. We generated $2.3 billion of operating cash flow in fiscal '23, reflecting lower COVID-19 contributions, opioid settlement payments, and losses in our U.S. Healthcare segment. Fiscal '23 capital expenditures of $2.1 billion increased by approximately $400 million compared to the prior year. This was driven by growth initiatives including VillageMD and the micro-fulfillment center rollout. This resulted in free cash flow of $665 million. We also reduced debt by $2.6 billion in fiscal '23. As Ginger discussed, we are taking a number of actions to drive improvement in free cash flow in fiscal '24, including approximately $600 million in reduced capital expenditures, and approximately $500 million benefit from working capital optimization initiatives.
I will now turn to our fiscal '24 guidance. We are guiding to fiscal '24 adjusted EPS of $3.20 to $3.50, down from $3.98 in fiscal '23. Before discussing underlying performance, I want to mention some key headwinds that we will face in fiscal '24. These include lower sale and leaseback contributions, a higher tax rate, and lower COVID-19 contributions. We're also assuming continued macroeconomic pressure on the consumer and a weaker respiratory season compared to the prior year. Excluding the impact of these headwinds, our forecast assumes underlying growth, which is primarily driven by two factors. First, we expect accelerating profitability in our U.S. Healthcare business in 2024, as the segment continues to scale, with adjusted EBITDA expected to be at or around breakeven. Second, we expect U.S. Retail Pharmacy underlying adjusted operating income to be driven by immediate actions to improve the cost base and modest underlying growth in both retail and pharmacy.
Let me now illustrate the larger moving pieces as we bridge from fiscal '23 to fiscal '24. I mentioned three notable headwinds to adjusted EPS. Sale and leaseback is estimated to have a negative year-on-year impact of between 11% to 13%. As we have said before, we do not expect any contribution from sale and leaseback beyond fiscal '24. Tax rates will be higher in 2024, increasing by approximately 10 percentage points compared to 2023, due to higher international rates and benefits recognized in 2023 that are not expected to repeat in 2024. Finally, we're projecting lower COVID-19 contributions that result in a 6% to 7% year-on-year impact. Excluding these impacts, we expect underlying growth of 9% to 12%, driven by accelerating profitability in U.S. Healthcare and immediate actions to improve our cost base across the company.
Let me now walk you through the 2024 guidance in greater detail. Overall, we expect total sales in fiscal '24 to be up 1% to 4% on a constant-currency basis. Adjusted operating income is expected to be down 5% to 12% on a constant-currency basis.
Let me now walk you through the assumptions and guidance for each of our reporting segments, starting with U.S. Retail Pharmacy. U.S. Retail Pharmacy segment sales are projected to be flat to up 2%. AOI will be negatively impacted by approximately 8 percentage points from the lower COVID-19 contributions, and roughly, 11 percentage points of lower sale and leaseback gains. Excluding these impacts, the underlying business is projected to drive 5% to 10% AOI growth.
I will now take you through the key business drivers. First, we anticipate script volume growth driven by overall market growth. On reimbursement, we have roughly 75% of the contract signed for calendar year '24. We do expect reimbursement pressure to be less of a headwind in fiscal '24 than in fiscal '23. We're projecting approximately five million COVID vaccinations in 2024. Quarter-to-date, we're well on track and have already administered over three million COVID vaccinations. In retail, we expect margins to benefit from our category performance improvement program, and a roughly 1-percentage point increase in own brand penetration. At the same time, we're adopting a prudent approach. We see a continuation of the challenging trends that impacted the second half of fiscal 2023. We're projecting flat comparable sales due to a milder cough, cold, and flu season year-on-year, lower COVID OTC test kit volume, and continued consumer pressure. We're also planning a higher level of shrink, which has been increasing in the last several months and continues to represent a serious systemic issue across the retail industry. Within SG&A, we expect to achieve over $1 billion of cost savings during fiscal 2024, as Ginger has already described.
Turning next to guidance for the International segment. Segment sales are projected flat to up 4% on a constant currency basis. We expect adjusted operating income of $745 million to $770 million, representing a constant-currency decline of 18% to 21%. The year-on-year decline is entirely driven by property transactions during fiscal '23, which will not be repeated, and the pending sales of the business in Chile. Excluding those impacts, we expect AOI growth to be flat to up 2%, with continued execution within Boots U.K. retail business held back by the impact of inflationary pressures.
Now let's turn to U.S. Healthcare. We are focused on driving improved financial performance for U.S. Healthcare in 2024. We expect fiscal '24 sales of $8.3 billion to $8.8 billion, reflecting first full year of Summit Health and ongoing growth in all businesses. On a pro forma basis, we see sales growth of 10% to 17% and expect fiscal '24 adjusted EBITDA to be breakeven at the midpoint of the guidance range. This represents an increase of $325 million to $425 million compared to fiscal '23, driven by growth in full risk lives, fee-for-service volume, optimization of the clinic footprint, and realignment of the cost base at VillageMD, robust growth at Shields, and Walgreens Health business growth driven by scaling of our clinical trial business and healthcare services and through cost management. We assume an effective tax rate of approximately 19% to 20%, with the year-over-year increase driven by higher international statutory tax rates and benefits recognized in 2023 that are not expected to repeat in 2024. Interest expense is expected to decrease by approximately $80 million.
In the first quarter, we will be lapping the prior year quarter's adjusted EPS of $1.16. The following five factors are expected to have an outsized impact in the first quarter this year. First, we had a significant tax benefit in prior year period, which will not repeat in the first quarter of 2024. Second, we're expecting COVID-19 contributions to be lower in the first quarter, reflecting last year's Omicron wave and seasonality. Third, we anticipate lower contributions from sale and leaseback activity. Fourth, we're lapping elevated levels of labor investments in our pharmacy staff. Finally, we also expect a more normalized flu season in fiscal '24, peaking in the second quarter versus the early start in the prior year.
Moving beyond the first quarter, we will see sequential improvement, and I will discuss the top four drivers. First, we're executing a series of actions to lower our cost base. These will have limited impact on the first quarter, but will start to ramp in the second quarter. There is adjusted EPS benefit of $0.50 to $0.60 in the balance of the year compared to the first quarter. Second, in our U.S. Healthcare segment, we expect profitability to improve from optimizing the clinic footprint, growing patient panels, and realigning costs. Third, we expect growing contributions from retail initiatives, including sequentially improving retail comps and margin expansion programs. Finally, seasonality plays a role in our business, benefiting the second quarter, which is usually the height of the cough, cold, flu season in the U.S., and is when Boots U.K. sees significant profit driven by the holiday season.
With that, let me now hand it over to John to discuss our U.S. Healthcare business.