New wins strong, buybacks paused
- Net new business awards rose 23.7% from last year to $618.4 million in Q1 2026.
- Revenue rose 26.5% to $706.6 million, led by high trial activity in core therapeutic areas.
- Backlog was $2.93 billion at March 31, 2026, giving Medpace a large base of future work to convert.
- The company made no share repurchases in Q1 after buying back $912.9 million of stock in 2025.
- The main debate is whether strong bookings can keep beating biotech funding cycles and price risk.
Demand is answering the key question
Medpace is showing clear demand for its focused clinical trial model. Net new business awards were $618.4 million in Q1 2026, up 23.7% from last year. Revenue also grew 26.5% to $706.6 million. That matters because new awards are the best early sign of future sales for a contract research organization, or CRO.
The bull case is simple. Small and mid-sized drug developers still need help running trials, and Medpace offers a full-service model across Phase I through Phase IV. Its backlog gives it work to convert into revenue, and Q1 showed that customers are still signing new work at a healthy pace.
The bear case is not about whether Medpace is a good operator. It is about cycle risk, margins, and price. Biotech clients can cut trial spending when funding gets tight. A larger share of growth can also come from reimbursed out-of-pocket costs, which may carry lower profit than service work. The buyback pause in Q1 removes a major support that helped earnings per share in 2025.
Paid to run the trial machine
Medpace helps drug, biotech, and medical device companies run clinical trials. It designs development plans, manages projects, handles regulatory work, monitors clinical sites, manages data, watches drug safety, and supports lab, imaging, and heart reading services.
Most contracts are fee-for-service. They are usually priced as fixed-fee work or by units of service. That means Medpace can make good money when it estimates trial costs well and keeps teams busy. It can also get hurt when a fixed-fee contract takes more work than planned.
Two numbers drive the model. Net new business awards show fresh signed work after cancellations. Backlog shows contracted work not yet recognized as revenue. The risk is that backlog is not cash in the bank. Customers can delay, cut, or cancel trials, often for reasons outside Medpace's control.
Where the trial work sits
Full-service clinical development
This is the core product. Medpace supports trials from Phase I through Phase IV, which lets clients use one main partner instead of many vendors.
Metabolic Disease trials
Metabolic was the largest disclosed therapeutic area in Q1 2026 revenue. It has been a major driver of recent growth.
Oncology trials
Cancer trials remain one of Medpace's key strengths. These studies are complex, which can favor a CRO with deep scientific and operational skill.
Central Nervous System trials
CNS work covers brain and nerve disorders. Q1 2026 revenue in this area grew quickly from last year.
Cardiology trials
Heart disease work is a long-running clinical research need. Q1 2026 revenue was lower than last year, so this area is not leading the current growth story.
AVAI trials
AVAI means antiviral and anti-infective work. It is smaller than metabolic and oncology, but still part of Medpace's broad trial platform.
One segment, several therapeutic areas
Medpace reports one operating segment. The mix below uses Q1 2026 revenue by therapeutic area from the 10-Q, so it shows where revenue came from, not separate legal business units.
What could break the story
Biotech funding turns down
High impact · Medium oddsMedpace depends heavily on small and mid-sized biopharma clients. In 2025, 82% of net revenue came from small biopharma companies and 13% came from mid-sized biopharma companies. If funding dries up, these clients may delay, shrink, or cancel trials.
Backlog does not convert
High impact · Medium oddsBacklog was $2.93 billion at March 31, 2026, but backlog is not guaranteed revenue. Many clinical trial contracts can be changed or canceled. If conversion slows, revenue growth can fall even when the backlog looks large.
Margin mix gets worse
Medium impact · Medium oddsQ1 revenue growth was strong, but reimbursed out-of-pocket expenses were also large at $312.0 million. These pass-through costs can make revenue look bigger while adding less profit than service revenue. If service margins weaken, the growth headline may hide pressure underneath.
Buybacks stay paused
Medium impact · Medium oddsMedpace bought back $912.9 million of stock in 2025, then made no repurchases in Q1 2026. The company still had $821.7 million left under its authorization. If buybacks do not resume, earnings per share gets less help from a shrinking share count.
AI and tech gap
Medium impact · Medium oddsThe 2025 10-K added a risk about machine learning and generative AI. The risk cuts both ways. Poor controls could hurt quality, but too little investment could leave Medpace behind rivals using better trial tools.
In one breath
What does Medpace do?
Medpace is a contract research organization. It helps drug, biotech, and medical device companies run clinical trials, from early human studies through post-market work.
How does Medpace make money?
Medpace charges clients for clinical development services. Contracts are often fixed-fee or based on units of service, and revenue is recognized as trial work is performed.
Why do investors watch net new business awards?
Net new business awards show new trial work won after cancellations. For Medpace, they are a key early signal of future revenue because awards can later move into backlog and then sales.
Why did the Q1 buyback pause matter?
Buybacks helped reduce the share count in 2025. In Q1 2026, Medpace repurchased no stock, which raises the question of whether management thinks the stock is less attractive at the current price.