v3.25.4

ENTITY WIDE DISCLOSURES (Tables) | 12 Months Ended
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Dec. 31, 2025
Entity Wide Disclosures [Abstract] |
Summary of Property and Equipment, Net by Geographic Region | The following table summarizes property and equipment, net by geographic region and is further broken down to show countries which account for 10% or more of total as of December 31, if any (in thousands):
| 2025 |  | 2024
Property and equipment, net: |  |  |
United States | $ | 83,898 |  |  | $ | 80,692 |
Europe |  |  |
Belgium | 22,998 |  |  | 18,557 |
Other | 6,822 |  |  | 7,456 |
Total Europe | 29,820 |  |  | 26,013 |
Asia-Pacific | 14,910 |  |  | 14,552 |
Other | 2,427 |  |  | 2,358 |
Total property and equipment, net | $ | 131,055 |  |  | $ | 123,615 |
Summary of Revenue by Major Source | The following table disaggregates the Company’s revenue by major source (in thousands):
| Year Ended December 31,
| 2025 |  | 2024 |  | 2023
Therapeutic Area |  |  |  |  |
Oncology | $ | 747,585 |  |  | $ | 651,237 |  |  | $ | 587,097 |
Metabolic | 744,957 |  |  | 457,542 |  |  | 376,842 |
Other | 408,548 |  |  | 431,384 |  |  | 404,844 |
Central Nervous System | 254,838 |  |  | 181,977 |  |  | 160,057 |
Cardiology | 239,371 |  |  | 230,454 |  |  | 193,690 |
AVAI | 134,935 |  |  | 156,460 |  |  | 163,312 |
Total revenue | $ | 2,530,234 |  |  | $ | 2,109,054 |  |  | $ | 1,885,842 |
Schedule of Segment Reporting Information, by Segment | Information about the reportable segment, significant segment expenses and a reconciliation to consolidated net income is as follows (in thousands):
| Year Ended December 31,
| 2025 |  | 2024 |  | 2023
Revenue, net | $ | 2,530,234 |  |  | $ | 2,109,054 |  |  | $ | 1,885,842 |
Operating expenses: |  |  |  |  |
Direct service costs, excluding depreciation and amortization - Employee compensation | 588,786 |  |  | 545,417 |  |  | 499,528 |
Direct service costs, excluding depreciation and amortization - Other segment items (a) | 143,342 |  |  | 136,678 |  |  | 138,721 |
Reimbursed out-of-pocket expenses | 1,037,488 |  |  | 770,654 |  |  | 723,088 |
Total direct costs | 1,769,616 |  |  | 1,452,749 |  |  | 1,361,337 |
Selling, general and administrative | 197,559 |  |  | 180,184 |  |  | 161,352 |
Depreciation | 27,178 |  |  | 27,808 |  |  | 24,129 |
Amortization | 946 |  |  | 1,443 |  |  | 2,199 |
Total operating expenses | 1,995,299 |  |  | 1,662,184 |  |  | 1,549,017 |
Income from operations | 534,935 |  |  | 446,870 |  |  | 336,825 |
Other income (expense), net: |  |  |  |  |
Miscellaneous (expense) income, net | (5,338) |  |  | 4,056 |  |  | (655) |
Interest income (expense), net | 12,780 |  |  | 24,996 |  |  | (488) |
Total other income (expense), net | 7,442 |  |  | 29,052 |  |  | (1,143) |
Income before income taxes | 542,377 |  |  | 475,922 |  |  | 335,682 |
Income tax provision | 91,254 |  |  | 71,536 |  |  | 52,872 |
Segment net income | $ | 451,123 |  |  | $ | 404,386 |  |  | $ | 282,810 |
Reconciliation of profit or loss |  |  |  |  |
Adjustments and reconciling items | — |  |  | — |  |  | — |
Consolidated net income | $ | 451,123 |  |  | $ | 404,386 |  |  | $ | 282,810 |
(a) Direct service costs, excluding depreciation and amortization - Other segment items includes costs related to inventory, leases, project subcontractors and other direct service costs.

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- Definition Tabular disclosure of the names of foreign countries in which material long-lived assets other than financial instruments, long-term customer relationships of a financial institution, mortgage and other servicing rights, deferred policy acquisition costs, and deferred tax assets are located, and amount of such long-lived assets located in that country or foreign geographic area. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 41 -Subparagraph (b) -Publisher FASB -URI https://asc.fasb.org/1943274/2147482810/280-10-50-41 + Details
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- Definition Tabular disclosure of the profit or loss and total assets for each reportable segment. An entity discloses certain information on each reportable segment if the amounts (a) are included in the measure of segment profit or loss reviewed by the chief operating decision maker or (b) are otherwise regularly provided to the chief operating decision maker, even if not included in that measure of segment profit or loss. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 25 -Publisher FASB -URI https://asc.fasb.org/1943274/2147482810/280-10-50-25 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 22 -Publisher FASB -URI https://asc.fasb.org/1943274/2147482810/280-10-50-22 Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 30 -Publisher FASB -URI https://asc.fasb.org/1943274/2147482810/280-10-50-30 + Details
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