Max Healthcare Institute Limited analyst Q&A

Thank you very much. The first question is from the line of Neha Manpuria from Bank of America Securities.

My first question is on the brownfield beds that we have added. When do we start seeing them contributing to EBITDA more meaningfully? Did I hear it correctly that all of these brownfield beds will be commissioned in the next two quarters. So, second quarter, third quarter is when they should start showing up more meaningfully on EBITDA?

So they are a lready contributing to EBITDA and it is not any form a negative contribution. But what happens is that you sort of get the better end of operating leverage as you go along because right now, for the total 1,000-odd beds, we have initiated a phased rollout of lesser beds. Say, if you have 400 beds at Max Smart, which are being rolled o ut in a phased commissioning, you would have started with about 100 beds over there. So, as you open up the balance beds over the next couple of quarters, you will see the ent ire operating leverage as the balance beds get occupied because your costs related to even the brownfield are not linear effectively.

Okay. And is it fair to assume that the occupancy and these ramping up should not be a problem ? We should g et to a fairly good level of occupancy as soon as we start these beds. That should not be a problem , right? That would be a fair assumption.

Yes. So, I mean it is a two-way thing. I mean , we do not open beds if we do not have occupancy, but what we have seen is a very good ramp -up of that occupancy. And therefore, you have seen in spite of ne w beds opening up, occupancy remains high. But having said that, I must also point out what is embedded within it is also higher ALOS. So, what tends to happen is you are just a little more efficient when you do not have the beds. When you open up the new beds, there is a tendency for the ALOS to increase. It is slightly temporary in nature. We have tightened it again, but you have seen th at ALOS has gone up by 9%. So, the impact of that is that shows up in both your ARPOB and occupancy – while the occupancy seems a little higher, your ARPOB comes through a little lower.

Understood. My second question is on Gurug ram. Did I hear you correctly tha t we are now expecting Gurugram commissioning by the end of th is fiscal year? I mean I am not sure if I picked that up correctly?

Yes, we are expecting commissioning by the end of the year.

Okay. And we should not be expecting any further delay on that because that is been pushed out a few times now.

That is right.

Okay. And sorry, one last question, if I may. On the Bhubaneswar asset that we have acquired, this will start integrating from first quarter itself? Or is there any approval, etc, that we require before closing this?

Yes, from the first quarter. We have already acquired the majority stake so we will be consolidating it.

Okay. I have a few more questions, but I will get back in the queue. Thank you.

Yes.

Thank you. Next question is from the line of Bansi Desai from JP Morgan.

Yes, thanks for the opportunity. So just again on Gurugram, how should we th ink about the operationalization of beds, assuming we commission towards the end of fiscal '27? What will be the Phase 1 operationalization? And what is the count that we should expect in fiscal '28?

So, I think in fiscal '28, we will be looking at breaking even within the year . I mean, it is a greenfield, as you are aware. Having said that, our experience with the Dwarka greenfield, we operationalized it, we guided to a 1 -year breakeven, but we actually broke even in 6 months. We had an operating loss, consolidated EBITDA loss in the first 6 months of about INR 35 crore. However, by th e end of the 12 - month period, it was less than INR 10 crore. Even if that number is more or less in this case, it is not a meaningful change to perhaps what the projections are going to be.

But in terms o f beds, are we expecting phase -wise manne r of operationalization here, because it’s a 500 bed facility...

Yes. You always do it , even tactically, in that manner . So physically, the beds come out in phases, but even so tactically because if you h ave 500 beds, day one, you are not going to have occupancy of 500 beds. So , you do not operationalize or staff all the 500 beds. So , if I take the example of Dwar ka, we had 300 b eds, we started with 140 beds. We ramped up occupancy, bro ke even with the 140 . So, the balance beds start to yield as you go along. You are seeing a similar sort of story play out in our brownfields right now. And with respect to even the greenfield at Gurgaon, you are going to start with, let's say, about 200-odd beds. And once y ou kind of break even within that, then you start rolling out the balance beds.

Understood. That is clear. And my second question is on the onco share decl ine that we have seen in Q4. While clearly, the reason highlighted i s a discontinuation of chemo drugs, but it still feels a bit sharp, given we had quantified onco drug impact to be about INR80 -odd crore. So, if you could help us understand what has happened here? And by when do we expect this to reverse?

There are two things. You have the onco drugs, that i s day care , the m argins on which were coming out a little perverse to us. So , discontinuation of thes e high- value drugs not only impacts your top line, but also impacts your OBDs (occupied bed days), which are related t o it beca use some of the patients , which are coming for day care, are also admitted in the night. So, it has a knock -on effect on that as well. Our OBDs have sort of come down by about 5% to 6% in oncology, which is related to this.

So, I mean, d o we h ave a plan in place, how do we replace it? What alternative protocols would you have?

Basically, some of this is permanent because we know that we will not be able to do this kind of a business on the minus -margin basis. As you have also seen in this quarter, although the OBDs have degrown by 6% in oncology, but we have overall OBDs have grown. That means the other specialties have been able to compensate for it. So , I think that is the plan even going forwar d, that we do not expect the share of oncology come back to 25 -26% as it was earlier. It will continue to hover around 21-22%, and we will then have the other specialties fill up that vacuum.

Got it. And the CGHS rate revision benefit, has that started to flow through in Q4?

Yes. All except the super specialty rates. A very large part is already in, but there is a small part, which i s left out, which is around INR 25-30 crore per annum. Tha t will be phased out over this year. It has started to come in two hospita ls, but balance is still pending. But that is all in this quarter.

We are expecting that to come in the next few months.

Thank you. Next question is from the line of Damayanti Kerai from H SBC Securities and Capital Markets (India) Private Limited.

My first question is clarification. Abhay, you mentioned you are rolling out beds in a phased mann er, even for say facility like Smart. So , help me to understand this better. In the past, whenever you have opened or commissioned brownfield facility, I understand the ramp-up happened much faster than what we are seeing right now. So according to you, anyth ing has changed since then? That is why you are going for more gradual phased way of prescribing beds.

No, we have always opened brownfields in a ph ased manner. Whether brownfield or greenfield, it has always been opened in a phased manner . And it is opened in a phased manner because as soon as any part of a new facili ty, any floors are r eady, there is always a tearing need for those floors. And you have seen that play out in the occupancy as well. So , we try to put it to work as soon as poss ible. So whichever floors are ready, and it is the same at Nanavati, it is the same at Mohali, it is the same at Smart. It has been same in the past at Shalimar Bagh or Vaishali or every facility, which we have rolled out has been rolled out in this manner.

We mentioned in the speech also, our available capacity of operational beds have gone up by 8%. So , the OBD has gone up 8%. As and when the beds are ready, they are being taken up. In context, the Smart beds have become live within 26-27 months of the project starting. So typically, a project of this size takes about 36 months. But because we are taking our projects to operations within a shorter time, floor by floor, hence, they are also being taken up floor by floor.

Sure. And when it comes to ramp -up of some of the newer facilities. You mentioned about Dwarka. Similarly, can you update on the status of the Noida unit, how it is rampi ng up in terms of occupancy, et c.? Last quarter, if I remember correctly, you mentioned there are some issues which you are trying to resolve. So , if some update you can share on Noida unit?

So, the Noida has ramped up well now in this quarter . So the occupancies have been more than around 64-65%. There is further room to grow. But on the revenue side, it has done well compared to last quarte r. And we have also hired doctors in that hospital. I would say we are happy with where we are with respect Noida when it comes to quarter-on-quarter growth.

Yes, I think it has pulled around very well. And in terms of EBIT DA, also, it is a substantial growth that we have seen over there. It is well on its way.

It is in line with our expectations, right?

Yes, absolutely. We are very encouraged by the last quarter and more.

Okay. And it can very well go to the Network level occupancy of say 75% or so?

Absolutely. I think maybe shortly, we will need to do a br ownfield over there and add more beds as well.

Okay. Good to hear. And my second question is a clarification on discontinuation of oncology drugs. You me ntioned 5-6% OBD got knocked off because of it. Just wanted to understand, these drugs are like high in terms of ticket size, etc. but were they meaningful contributor at the EBITDA level also?

Yes, earlier, they were giv en at MRP, and we ha d 15-16% margins on those. So that used to flow to the EBITDA.

It was a 16% margin. But because now we have to give a 30% discount to MRP, so we sort of discontinued it.

Earlier they were contributing to EBITDA. So, that is the reason when we gave to the price impact of the CGHS, we netted off that. To that ex tent it has been absorbed through the price increase.

We suggested I think it is a INR200 crore net benefit...

INR140 crore after GST.

After GST, it was INR140 crore. With the CGHS rate revision, while we have got higher rates, but we got capped out on this high -value drugs. So , from a CGHS standpoint, the net benefit was INR 200 crore. There was also an impact of GST, so net off it the total benefit was INR 140 crore.

INR200 crore, you mentioned it is a gross number and then when you include the GST impact, etc., INR140 crore is the number, which was coming from it…

That is right. Of this INR 30 crore, as I m entioned is super specialty rates, which has not flowed in yet.

So that is about INR 100-110 crore has flowed in. About I NR30-40 crore is yet to flow.

This is all annual numbers.

Sorry, just to process, another INR30 crore flow out from here?

Yes. So out of I NR 140 crore, INR 30-40 crore is yet to fl ow in. About INR100 - 110 crore has already flown in on an annualized basis.

And I think my last question is on the pipeline projects, which you indicated, which are coming up in '28 or so. Is any facility there wher e we are seei ng some delays, etc., in terms of approvals or it is just like completion of the facility, which should be done as per your indicated time line? So, any regulatory clear ance or any other clearances which are due?

No, nothing . No regulatory clear ance is pending over and above what has been anticipated. In the past, there ha ve been delays because of G RAP 3. We ha ve had delays because of shortage of manpower due to the LPG crisis. Forest approval was delayed because there was an issue with respect to Delhi tree transplantation where the Supreme Court ha d taken cognizance of . There was a matter between the Lieutenant Governor versus the Supreme Court - contempt of court matter because of which it got stalled. So, these are not typically regulatory approvals, which have been sort of delayed. But I think we had issues and incidents with respect to pollution and shutdowns of construction or tree tr ansplantation or Ira n war causi ng shortage of LPG a nd therefore, manpower not showing up at site.

Okay, that is helpful. Thank you. I will get back into the queue.

Thank you. Next question is from the line of Karan Vora from Goldman Sachs.

The first question is with respe ct to doctor costs. So , we see that our doctor costs have gone up and we have hired in advance. But just wanted to get a sense on for which all expansions have we hired and like which are the hospi tals where further doctor additions are still pending, which might hit the cost line item in the next one to two quarters?

That is a very good question. So , there are two things. End of 2024, we essentially added close to 25% to 30% more capacit y. This w as whether through Dwarka, whether through the J aypee acquisition, Sahara done some time before that or Alexis in Nagpur. This year we have already started a phase d rollout of 20% plus more capacity, which includes Mohali (Punjab), Nanavati (Mumbai), Smart (Saket) as well as we added more beds in Lucknow as well. So, somebody asked me a question before this about Noida. And we ha ve seen meaningful im provement over there because we ha ve expanded our doctor base. We have seen t he same in Luck now where we are ramping up . We have seen the same in Sma rt. We ha ve seen t he same in Nanavati, Mumbai. We ha ve seen the same in Mohali. So, all of these new ones which are coming, we have added doctors. Even Dwarka, now it i s operating at 80-85% capacity. But t hrough through the l ast quarter, we had added some more people over there as well. So yes, so I think it has been pretty much quite secular across the portfolio because it has been a multi-location addition of capacity . You are going to see the same thing in Bhubaneswar now because we will add manpower over there. Although it should not move the overall needle simply because there is just one hospital. But the minute you a re doing it in 4 or 5 multi-locations and at the same point of time, you are going to see a little bit of lumpiness.

Okay. Got it.

The reason I mentioned in end of '24 is that when you do sudden acquisitions, it i s not as if you are able to do all your hiring in the next 6-12 months. It takes time and moves in a phased manner, particularly if there is competition in those areas.

Okay. Got it. And sir, just to better understand, so this INR435 crore for doctor fees in Q4, that should not materially cha nge going forward, at least for the next few quarters. Is that the fair way to think about it?

Yes, it should actually start getting operating leverage in fact. My belief is that marginally all of this percentages start coming down

Got it. And this Kalinga Hospital. So , any start -up losse s or like what about breakeven time lines? How should we think about that?

It is al ready profitable. I think there i s about INR 10-odd crore of EBITDA. S o, you are not starting with a negative.

Annual.

Annual. Okay. Got it. And so, we have like unlike some other places where we had to discontinue businesses, right, because we wanted to streamline practices. All those thing s have been taken care of. And even after that, we should be abl e to maintain broadly that EBITDA run rate. So , no chance of it going into negative, that is what I am trying to.

Let me just correct you. Even in the other places, where we corre cted the business behaviour, so to say, it did not go into negativ e, we just made less profit. None of these acquisitions have been loss -making or even after taking over when we did whatever actions we took, it did not go into a negative territory.

Okay. Got it. Thanks for the clarification.

Even in this case, it is INR 10 crore positive and we have just done the acquisition. So, you are going to see it ramp up and in case we are taking some actions, you still would not see meaningful negative numbers.

Got it. And the last question would be with respect to the new units or whatever we have operationalized in the last 12 to 15 months, how have their overall revenue and margin trajectory look like, any colour there will be helpful?

Basically before rolling out this 20-25% capacity rollout that we have recently done over the last 3 to 5 months, the previous generation for about 12-13 months, we did not really add any capacity. We added it before that, again, which was a little lumpy. We did Lucknow, Nagpur, Dwarka, Jaypee; so are those the four you are referring to?

Yes.

Okay. I think all four have done significantly well. Lucknow, for example, is doing pretty much 5x of EBITDA of what we acquired it for. The meaningful addition in Nagpur, and in Noida also we have seen that. Dwarka is not only operating at 80 - 85% capacity utilization, but we a re already planning a brownfield over there of another 200-plus beds. In fact, oncology bunker over there and the oncology center over there is in Dwarka yet to start, which is going to st art by next month. So that should reap even further benefits. So, we are seeing those benefits come through.

Got it. Helpful. Thanks.

Yes. But you are going to see a bit of a hockey stick t here because you have th e benefit. When you move from like, let u s say, in Noida, when you move from the 65% to that 75 -80%. You see at 50-55%, you break even right, mos t units. At 60- 65%, you start doing very well, b ut the real juice starts coming from that 60 -65% up to that 80%-odd occupancy that we do.

Thank you. N ext question is from the line of Tushar Manudhane from Motilal Oswal Financial Services Ltd.

Thanks for the opportunity. This was more on the Lucknow side, while we have a very decent land bank as far as Sahara hospital is concerned. And, of course, in the history you see Shaheed Path land was also acquired m ore or less at t he similar timeline. So how are we evaluating in terms of which land bank to sort of set up? I understand that the Board has given sort of approval for Shaheed Path. But if you could help understand how are we going to sort of utilize both the land banks a nd build up Lucknow sort of hospital network.

So, I think it i s a very good question. We have a land bank of about 27 acres o f land at Gomti Nagar , which is right in the heart of Lucknow , and 5 -plus acres , which is on Shaheed Path. We are exp anding our capacity over the next few months, you will see our capacity of Gomti Nagar go up to about 570 beds. What we intend to do is we intend to start another hospital . We want to have a multi - location strategy of about 700 beds in Shaheed Path, w hich we will be operating in a phased manner. It should take about 3 years to build it. Simultaneously, we believe we will b e running out of cap acity at Lucknow at Gomti Nagar as well. So , we will be adding another 200 -300 beds over there. So, we are going to have a multi -pronged strategy. I think one does not have much to do with the other because these are 2 locations, which means we will have two sets of doctors and clinicians. It allows you to do that. You see, if we have one, in terms of the strength of senior clinicians, you have one Chairman cardiology, one Chairman oncology, etc., so it becomes a choke point for other senior personnel coming in. When you have multiple locations, it allows you to do that. And we have seen that advantage play out for us in Delhi , in other places, etc. so, we like the whole clust er approach. I mean, you have benefits of brownfield, but it is also beneficial to have a cluster approach and then have brownfields emerging at multiple locations.

Understood. So, this is not so much more sort of a cannibalizing given tha t it is hardly a 14 kilometers distance, it will be more like a multi-location playing out?

Absolutely.

Yes. Also, on this Shaheed Path, the capacity can go up to roughly 900 beds. So, I mean, there is more we can build there even after these 700 beds.

So, I mean , it refle cts the kind of conf idence you have on this Lucknow as a location, building up such a strong almost it will be about 1,000, in fact, more than 1,000 plus sort of a bed size eventually and not like immediately, but over a period of time?

Absolutely. Let me put it this way, over the next decade, I see even probably Gomti Nagar going close to perhaps 2,000 beds, in just that one location. We will do it in a phased manner. We have the land bank over there. And the kind of ramp -up we are seeing is because our clinical programs are very strong over there.

Understood, second, sir, are you seei ng the risk of these medicines being taken directly by the, let us say, health scheme or CGHS in other therapies?

Firstly, because of b eing in Delhi, we ha ve a larger amount o f institutional business, which was coming to our Delhi hospitals and this impacts that largely. What they basically said is that we have to provide these drugs at 30% discount to MRP. And so, they have not selected the drugs. They said all medicines at a 30% discount to MRP or alternatively CGHS, patients can g et the medicine from CGHS . So, from a hospital standpoint, if your margins are less than 30%, then you probably discontinue it because it becomes loss -making, but the patient has the option of buying it from the CGHS dispensary. But our present margins, on a drug-on-drug basis also is reflective of that action. It is not a government action, it is a CGHS price revision. So , you get some and you lose some, I guess. The net benefit is INR 200 crore. After GST impact, which is a separate hit that we got, it becomes INR 140 crore net benefit.

I got you. Sir, just tha t clarification, this is onco therapy specific or this is more between CGHS doing it across the therapies?

All chemotherapies.

Yes, this is why I was trying to ask that , is this getting expanded to other the rapies where the patient...

No. This is the first time they made any changes on the price in 14 years.

Understood. And practically, if CGHS is able to provide the medicines on a timely basis? Or do you think the patient will come back to the hospital pharmacy or the hospital?

I think there is a lot of noise among the CGHS pensioners, etc due to delays.

We have been given to understand that they are reconsidering it. But again, one does not know. There has been a lot of representation made even by patients on this.

Got it, sir.

One of the problems is that this also applies to ECHS, for example and other PSUs. But while CGHS has dispensar ies to dispense th ese drugs, ECHS and other PSUs do not have the ir dispensaries and they cannot access CGHS dispensaries. So, the problem with these drugs are that they are not accessible to them.

Got it. So effectively, this should sort of start getting reflected back probably in maybe some time in future?

Sorry, it should get reversed you are saying?

Yes.

I mean it stands to reason.

Understood. Got it.

Got it. And just lastly, with Gurugram, we h ad to sort of start second half. So, is it like now we are indicating in for a few mo nths, sort of taking some time? Is that the way to think about?

No, that is right. We were saying second half and we meant middle of second half, and now it is end of the second half. But there have been two issues over here. One was a lot of labour went back during elections, particularly Bengal elections. It was a bit of a festive season for them from that standpoint. So yes, we had a lot of reduction in manpower at the sites. Second is also the LPG issue. Most labour, they cook their own food , so we had disruption over there because the labour did not have LPG. We have started serving meals for all labour at our sites now, in order to surpass that. The labour is not on our books , they are the contractor’s labour. So, there is a particular method that you have to follow to even initiate that because literally, we have got about 1,100-1,200 people working on the Gurugram site. So, our kitchen is supplying meals to the 1,100 -1,200 people. So yes, these are the issues which have caused a delay of a couple of months.

Okay. Thanks for that clarification. And just lastly, if I may, just one more, if I may squeeze in. With respect to doctor talent cos t, given the kin d of bed addition and starting of hospitals by multiple corporates probably over the last , maybe couple of years and subsequently over the next 4 to 5 years. Are you seeing this doctor talent cost sort of the negotiating power moving to doctors from corporate?

There are two things. Firstly, it is not a new phenomenon that hospitals come up in locations where there are existing hospitals. And it is not as if in any micro market, it is like you have got five hospitals and three more have come up or four more have come up. It is pretty much been one here and one there. But when that happens, you know your own clinicians tend to negotiate their compensations and it does go up from that standpoint. But having said tha t, it does even ou t and it is transfer red over a period of time to the patient because eventually, it’s still a 10-12% PAT margin business , it is capital intensive, and we are reinvesting. It is a natural phenomenon. It gets a little lumpy sometimes. But it is not as if it is not passed through - you will see this normalize across the board. I am not just saying it for Max, but I believe for the entire industry.

Got it sir this is helpful. Got it. Thanks a lot.

Thank you. Next question is from th e line of Aditya Chheda from InCred Asset Management.

Hi, thank you for the opportunity. It seems like confusion regarding the discontinuation of chemo drugs due to MoU conditionalities, this is specific to Max Healthcare in a region or th is is industry -wide pan-India. And if I understood it correct, it had a knock of negative impact on revenue to the tune of INR130 crore, and they had around 16-17% EBITDA margins, if you can help clarify that?

Firstly, this is an industry -wide p henomenon. Secondly , a s a proportion of its business, Max perhaps does the maximum amount of oncology business. And then within that, if you actua lly see, we probably do the maximum amount of institutional business as well , which is CGHS , ECHS, etc . So, al though it is an industry-wide phenomenon, the impact would be felt maximum by us for these reasons.

The overall impact of the discontinuation of these drugs is INR 200 crore in the drug billing, i.e. top line.

Is this the quarterly impact?

This is the annual number. Annual billing of chemotherapy drug s will come down by INR 200 crore because of the discontinuation.

Got it. Thank you. Thanks for the clarification.

Thank you. Next question is from the line o f Abdulkader Puranwala from I CICI Securities.

Just a follow-up on this CGHS part. So, if I see the contribution from CGHS, it is barely moved the needle. And where our onco revenues are seeing a sizable dip. And within that, if you could help us understand that what portion of your CGHS revenues actually comes from oncology and how should we look ahead as well?

Obviously, there's a less er impact on the beds for this. These chemotherapies are billed in the daycare. When you discontinue these drug bi llings or providing these drugs to the patient , there's an impact on the revenue but there's no impact on the beds. Nevertheless, there are some of these patients who also then avail surgeries in the network and some of these patients are also then admi tted in the hospital. To that end, the Occupied Bed Days (OBDs) for oncology patients have come down by 6% YoY. Now your question is that within the overall CGHS business, how much is oncology? That'll be probably around 35-40%.

It used to be 50% as it is reduced to 40% now.

Understood, sir. And sir, then on your existing Network that is prior to any bed additions that you have done, in terms of the steady state revenue and EB ITDA growth, sir, h ow should we look at in terms of your, say, bed network, what you had developed for '25 or for '26. And the levers of growth, would it be more ARPOB driven? There is some element of case mix as well, which can help to at least post a single digit kind of a growth.

Basically, there are two elements which make the revenue go up. One is the ARPOB and other is the Occupied Bed Day s (OBDs). You know that even at the existing hospitals, we are adding more beds . There is brownfield expansion being done in Mohali, Nanavati, Lucknow and Smart. Our role is to make sure that where we have 8 0-85% occupancies, then we add more beds there and try to ensure that there is OBD growth also. So, if we do not have O BD growth, then the only growth would be the AR POB growth rate, which will be, let us say, 6 -7% of the revenues. But our role is to ensure that wherever we find this high-occupancy situation, then we add more beds.

No, it is very tough to do it now. You can do it in the probably first month or two, but then the patients start to mingle. So, when we put another Brownfield tower, we will not be able to separate the revenues or EBITDA of Tower 1 and Tower 2.

Because what you also do, for example, is move certain specialties into A -Tower versus B-Tower. So, when you move those specialties, then wherever you move it from, those beds get occupied by other specialties and where you move it to, that gets occupied, so, both will have its own trajectory. Let's say, if I move oncology into a new tower, then that becomes a onco -tower. So, in the previous place where it was occupying those beds, those beds get occupied by other specialties. Whereas in the new tower, you will have largely oncology , so you will have different ARPOBs and different EBITDA per bed, etc.

Okay, understood.

But on a consolidated basis, what we have seen is that there is no real pressure on margins.

Okay, got it.

Thank you. Next question is from the line of Lavanya from UBS Securities India Private Ltd.

Hello. Thank you for the opportunity, sir. Just a clarification on chemo drugs, again, sorry, here, we are losing out on OBD also. So, if it is only the dispensary and the drugs to who are -- I mean, to whom we are losing the OBD patients in general, the 5 -6% impact on OBD, clarification on that will be great? And Q1 so far -- I mean until now, you are seeing a fu ll impact of this chemo drugs, at least, right?

That is correct. Quarter 4 has already had the full impact. We started to discontinue these drugs in Oct ‘25. So, to that extent, quarter 4 has the full impact of discontinuation of all these chemo drugs. What we have not gotten yet is the full impact of the price gain on the CGHS side, which will come starting this quarter. So, as I said, 2 of the hospitals have already got the super specialty rates. And during the course of the year, we will have more hospital also getting those rates.

So, on the other question that you have on the O BDs, wh om are we losing to? Well, we do not e xactly know. They go , perhaps, to the disorganized sectors or smaller nursing homes.

Okay. Got it. And here do we expect any resolution or this is going to be there for the next couple of quarters and until the base of Q3, like it will start to...

Like I said earlier, it d oes not seem to stand to reason, because it is not as if our margins are any different from the price at which perhaps the government is buying it. These are medicines like Keytruda, which is the larg est and the fastest -growing oncology medicine in the world. And they do not make any exceptions for anybody in terms of what the margins are, for example, one is that. Secondly, the CGHS and CGHS rate applied to the other public sector undertakings and ot her panels like EC HS, which is ex -servicemen and so on. While CGHS patients have an option of pr ocuring the drugs directly from the CGHS dispensary or their pharmacy. The ECHS and PSUs do not have that option because they do not have those pharmacies. So of course, a l ot of patients are complaining because they are unable to access these drugs, at least Keytruda, and they have to move to other medicines. And it is not a necessity, since every patient is different. For some patient s, it is necessary. I guess they are finding i t difficult to source this , so we are facing a lot of complaints, and I am sure so is the CGHS . And we are hoping that they will reconsider this. But asking for time lines, it is difficult to pin that down.

Okay. Got it. So just a clarification, E CHS on the PSU patients are seeing disruption to the treatment for the last 6 months or they are moving out to other medicines, whatever is alternate available?

Same thing. They are going to behave the same way as the CGHS patients.

Yes, and there are other alternatives to some of these medicines.

Okay, got it.

It is not that there are no alternativ es to it, there are alternatives, okay? But they may not be preferred alternatives from a clinic al standpoint. The question is the efficacy. If a doctor believes that this particular branded drug has more efficacy for A particular patient may not be for B patient, but for A particular patient. I mean, very simply, each one of us reacts differently to different paraceta mol. Reacts differently to even a different antibiotic, let alone chemo.

Thank you very much. Ladies and gentlemen, we will take that as the last question. I will now hand the conference over to the management for closing comments.

Thank you, everyone, for joining us today. We appreciate all your time and look forward to interacting with you again next quarter.

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