ECOR - NASDAQ

Greetings, and welcome to the electroCore Fourth Quarter and Full Year 2025 Earnings Conference Call. [Operator Instructions] Reminder, this con call is being recorded. Earlier today, electroCore published results for the fourth quarter and full year ended December 31, 2025. A copy of the press release is available on the company's website. I'd like to remind you that members on the call will make statements during the call that include forward-looking statements within the meaning of the federal securities law, which are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Any statements contained in this call that are not statements of historical fact should be deemed to be forward looking. All forward looking statements, including, without limitation, any guidance, outlook or future financial expectations, our operational activity and performance, including any statements regarding first quarter 2026 and full year performance and the path to profitability are based upon the company's current estimates and various assumptions. These statements involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements. Accordingly, you should not place undue reliance on these statements. For a list of these risks and uncertainties associated with the company's business, please see the company's filings with the Securities and Exchange Commission. ElectroCore disclaims any intention or obligation, except as required by law, to update or revise any financial projections, forward-looking statements whether because of new information, future events or otherwise. This conference call contains time-sensitive information that is accurate only as of the live broadcast today, March 19, 2026. It's now my pleasure to introduce Dan Goldberger, electroCore's Chief Executive Officer.

[indiscernible] participating in today's electroCore earnings call. Joining me today are Dr. Thomas Errico, one of our founders and investor and Chairman of the electroCore Board of Directors; and Joshua Lev, our Chief Financial Officer. Before we begin, I want to express the privilege it is to address so many colleagues, partners, investors and their friends who have supported electroCore since I took the CEO position in late 2019. For the years, we've taken meaningful steps in building a great company. I'm Deeply proud of what we accomplished and truly thankful for your support as well as the support and hard work of all the employees worked tirelessly in making our noninvasive pain therapeutics available to patients who need them. With that in mind, I'd like to share an important personal decision about the next chapter for myself and for this organization. After a thoughtful discussion with the Board about the company's next phase of growth I have made a decision to retire as CEO of electroCore effective April 1, 2026. When I joined in late 2019, [indiscernible] was strengthening the company's financial position and establishing a focused commercial strategy. For the past several years, we've made substantial progress on those objectives, including building momentum in the VA channel, expanding our product portfolio and putting the company on a stronger financial footing. With that foundation now in place, the Board and I believe this is the right time to begin a leadership transition as electroCore moves into its next stage of growth. To ensure a seamless transition, the Board of Directors has appointed Joshua Lev as Interim President, electroCore is also hiring a new Chief Operating Officer. These steps will provide stability and operational momentum while the Board conducts a thorough search for my permanent successor. I look forward to continuing to support the company during the transition and to exploring new opportunities where my experience may be helpful. I step away knowing that electroCore is in excellent hands and well positioned for continued success. I'm confident the leadership team will continue building on the progress we've made and drive the company forward in the next phase of growth. It's been an honor to lead this organization and serve you, our shareholders. Thank you for your unwavering support. I look forward to watching electroCore thrive [indiscernible] Now the Chairman, Dr. Errico like to share a few thoughts on strategy and [indiscernible]

Thank you, Dan. On behalf of the Board of Directors, I want to take a moment to recognize Dan Goldberger, for his outstanding leadership. We're grateful for the strong foundation he has built and for the momentum the company carries forward today. As we look ahead, I'm pleased to share an update on our leadership transition, which is designed to ensure continuity and focus as we enter our next phase of growth. Effective April 1, Joshua Lev, our Chief Financial Officer, will assume the role of Interim President, overseeing day-to-day operations while continuing to serve as CFO. Josh has more than 15 years of experience in finance and operations and has played a central role in guiding the company through several key milestones. He is well positioned to lead during this transition as we conduct a search for a permanent successor. In April, we will welcome Michael Fox as our new Chief Operating Officer. Michael joins us from Pro Medtech, where he served as Chief Revenue Officer. He brings more than 3 decades of experience across pharmaceuticals, biotechnology and medical devices with deep expertise in complex federal markets, including the VA system. His operational leadership will be instrumental as we continue to scale across the organization. With this transition in place, the Board and management team remains fully focused on executing our strategy of increasing sales within covered entities such as the VA system and driving long-term value through market expansion into general wellness with our Truvaga product offering. Being now to the business. We remain encouraged by the continued momentum of our noninvasive vagal nerve stimulation or MVNS platform. Before Josh Lev reviews the financials, I'd like to briefly highlight the clinical foundation supporting our portfolio. Our flagship gammaCore device is supported by a substantial body of scientific evidence, including more than 20 peer-reviewed publications and multiple randomized controlled trials, such as AT1, AT2, Presto and premium. These studies have demonstrated statistically significant reductions in migraine and cluster headache frequency, intensity and duration, gammaCore is FDA cleared for both acute and preventive treatments in adult and adolescents and real-world adoption continues to build. For example, U.K. audit data shows that a meaningful portion of cluster headache patients achieved clinically significant response rates alongside measurable cost savings compared to standard care. Beyond gammaCore, exploratory studies plus additional indications, including Schorn syndrome, gastroparesis, traumatic brain injury, and inflammatory conditions related to COVID-19 highlighted the potential for broader anti-inflammatory potential of nVNS. These studies have shown encouraging signals across fatigue, quality of life measures and anti-inflammatory biomarkers. At the same time, ongoing trials in areas such as PTSD, long COVID, substance abuse disorder, muscularskeletal pain and concussions, supported by partnerships, including the NFL and NFLPA funded research support our long-term strategy for indication expansion. In addition, our Quell device is supported by a growing body of peer-reviewed research. -- including randomized controlled trials published in well-regarded journals. These studies demonstrate efficacy across multiple pain-related conditions, including difficult-to-treat fibromyalgia, further strengthening the clinical foundation of our portfolio. On the consumer side, Truvaga continues to gain traction as a wellness product, focused on stress reduction, sleep quality and emotional well-being through parasypthetic nervous system activation. Truvaga has recently received recognition from major lifestyle publications and engagement across social and digital channels continues to grow. For example, national media outlets like women's health and men's health have been driving website traffic. Miranda Kerr mentioned Truvaga on the skinny confidential podcast, [indiscernible] like true met, Ben Greenfield and Luke story have been promoting Truvaga, and Truvaga is now available through online retail outlets like Best Buy and Rehab. Independent in-home studies indicate high levels of user reported commonness and sleep improvement after consistent use. Importantly, this momentum supports diversification of our revenue mix and highlights the scalability of our nVNS technology in direct-to-consumer channels. First, the expanding clinical validation across our product lines continues to support prescription growth, payer engagement and international expansion. We believe this positions the company well for sustained revenue acceleration and long-term value creation as we bolster our commercial team with VA governmental specialists to further execute against our pipeline and strategic priorities while maintaining our attention on operating efficiency to progress towards profitability over time. And now I will turn the call over to our Interim President and CFO, Joshua Lev to walk through the financial results.

Dr. Errico. Before reviewing the financial results, I want to briefly acknowledge the leadership transition announced earlier. [indiscernible] played an important role in shaping the company over the past several years and the strategy we have in place today reflects that work. On a personal note, I've learned a great deal from working with Dan, and he has been a strong leader for the organization. Our focus remains on executing the [indiscernible] strategy expanding adoption across the VA system and continuing to scale our wellness platform. [indiscernible] details of our fourth quarter and full year 2025 operating performance. electroCore delivered another year of strong top line revenue growth, extending our growth trend and exceeding both revenue and EPS analyst consensus [indiscernible] The VA hospital system remains our largest customer, continues to grow. We expect adoption of our noninvasive same therapeutics. Truvaga sales also showed great strong driven primarily by our e-commerce store at www.truvaga.com and an expanding network of affiliates to actively promote Truvaga to their [indiscernible] Revenue in the fourth quarter of 2025 was our highest ever, reaching a record of $9.2 million, up 31% year-over-year and bringing our full year 2025 revenue to $32 million or 27% over full year 2024. [indiscernible] revenue increased 23% year-over-year to $26 million by continued growth gammaCore and Quell within the VA hospital system. Acquiring the Quell assets in May 2025, [indiscernible] generated $1.5 million in revenue. As of December 31, 2025, [indiscernible] facilities [indiscernible] products, up from 170 a year ago. Approximately 13,400 VA patients [indiscernible] gammaCore device and [indiscernible] we estimate this represents roughly 2% penetration of the addressable VA headache market. Given the scale of the VA system and the number of patients experiencing headaches, related to PTSD and mild traumatic brain injury, we believe there may be a significant opportunity for continued growth. For this opportunity we expanded our VA sales presence during 2025 by adding both internal team members and contracted representatives. In 2026, we will also welcome Michael Fox as Chief Operating Officer. We [indiscernible] experience commercializing products within federal health care systems to help accelerate [indiscernible] and expand our commercial reach. Turning to our general wellness channel Fourth quarter revenue reached $1.4 million, representing 31% year-over-year growth. Full year general wellness revenue totaled $5.5 million, an increase of 97% compared to 2024. [indiscernible] primarily driven by $5.4 million in Truvaga sales, up 93% from 2024. While Truvaga revenue was flat sequentially [indiscernible] quarter included a onetime $500,000 order associated with a third-party clinical trial. Excluding that order, Truvaga revenue grew approximately 40% sequentially. Return on advertising spend or ROAS for the [indiscernible] period was approximately $2.10, meaning for every dollar spent on media, we generated nearly $2.10 [indiscernible] $1.80 in Q3 2025 was primarily driven by a seasonal increase in sales during the holiday season. [indiscernible] across our e-commerce platforms have increased slightly but remain at approximately 12% to 15% with prior periods. We believe that ROAS as a result of the shift away from Amazon and the teams increased [indiscernible] driving sales through other direct-to-consumer platforms. As we look forward to 2025, we expect to expand the potential applications for our NDNS platform while introducing additional wellness offerings, including Quell relief for lower extremity pain. We are also developing our next-generation mobile application signed to complement an [indiscernible] differing more personalized and data-driven user experience, which could support recurring revenue opportunities. Based on the opportunities ahead, we are investing in people, marketing and product development to accelerate growth in 2026 to 2027 while maintaining discipline around operating [indiscernible]. Turning briefly to the full year 2025 financial results. Net sales in 2025 increased 27% to $32 million, driven by growth of prescription gammaCore and Quell fiber biologic products in the VA system as well as increased sales of our nonprescription group data general wellness products. We expect the majority of 2026 revenues continue coming from the U.S. Department of [indiscernible] Net profit increased to $27.8 million for the year ended December 31, 2025. Margin was 87% compared to 5% full year 2024. Research and development expense of $2.7 million decreased by approximately $375,000 compared to the prior year, [indiscernible] primarily related to the development work on our gammaCore Emerald and our next-generation [indiscernible]. Selling, general and administrative expense, $38.2 million year ended December 31, 2025, increased by $7 million compared to $31.2 million in the [indiscernible] marketing increased by $4.3 million from the prior period. The increase in sales and marketing was primarily driven by a $3.8 million increase in burial expenses, which contributed [indiscernible] increase in sales. General and administrative expense increased by $2.7 million from the prior year. This increase was primarily driven by a $800,000 increase in legal fees and early associated development activity, $500,000 [indiscernible] with 1 customer, $300,000 investment [indiscernible] systems and $200,000 of increased transaction fees [indiscernible] Total operating expenses for the full year 2025 were approximately $40.9 million as compared to $33.6 million in the full year of 2024. Other expense of $800,000 for the year ended December 31, 2025, increased by $1 million versus the prior year period. The increase is primarily attributed to nonrecurring expenses, including $0.5 million change in the estimated liability payable pre-closing shareholders of [indiscernible] metrics pursuing to with CDR equipment and interest expense associated with our term debt financing with [indiscernible] other income for the year ended December 31, 2024, which is primarily of interest. Net loss for 2025 was $14 million or $1.65 per share compared to a net loss of $11.9 million or $1.59 per share in 2024. Net loss is primarily attributed to an increase in operating expense and other expense [indiscernible]. Adjusted EBITDA net loss this full year 2025 was $8.7 million compared to $9 million in the prior year. [indiscernible] and adjusted EBITDA primarily reflects a GAAP net loss, offset by adjusting for Neurometrix acquisition-related items [indiscernible] for reserve bad debt expense and IP litigate [indiscernible]. A reconciliation of GAAP net loss to non-GAAP adjusted EBITDA net loss has been provided in the financial statement table concluded [indiscernible] and marketable securities at December [indiscernible] 2025, or approximately $11.6 million approximately $12.2 million as of September 30, 2024. Looking ahead, we remain focused on accelerating growth in our high-margin [indiscernible] particularly within the VA by adding leaders, Michael Fox spent a career successfully commercializing products in the federal channel, while also continuing to build durable inefficient general wellness channel. We believe our full year 2026 revenue has the potential to continue growing at approximately 30%. [indiscernible] However, in light of the leadership transition, you're not issuing detailed guidance at this time and expect to revisit formal guidance when appropriate. We believe the company is well positioned in driving growth and adoption in the [indiscernible] how our wellness platform and maintain discipline on operating efficiency drive long-term shareholder value and profit. I would now like to turn the call over to the operator for Q&A.

[Operator Instructions] Our first question comes from Jeffrey Cohen of Ladenburg. Jeffrey, can you please unmute?

Congrats on all the accomplishments and we wish you well. I guess, firstly, could you talk about the channels? Talk about the VA and talk about DTC for both gammaCore as well as Quell where you anticipate in '26. I know that you've done a great job in adding centers of excellence PAs. How might the outlook into 2026 and steps and thoughts about the DTC business for both Truvaga as well as Quell.

Jeff, thanks so much. Appreciate you joining the call and always appreciate your great questions. From the VA channel, we've had a lot of acceleration over the course of the last year in 2025. And we've been pretty adamant that we believe the way for us to go ahead and grow that is to increase the number of boots on the ground, either through W-2 employees or through a 1099 network. And we've done a really nice job over the course of the 2025 of increasing those 1099s, which is a variable expense as it relates to the overall sales and marketing, right? It doesn't add any headcount. But we're really enthusiastic that we have a new commercial leader joining and Michael Fox, who's joining mid-April. Michael comes to us with a background in selling primarily into the federal channels. He has years of experience and actually decades of experience in building out commercial-related teams, primarily focused in accelerating growth within those federal channels, particularly in the VA. So as we think about how we think the VA is going to grow over the course of 2026, while we haven't given any specific guidance to that. Our thought is that we have an existing team, which has been proven successful to go ahead and grow within those channels. And then we've got Michael who's going to come in and bring his know-how, his knowledge and hopefully, some of his relationships to help accelerate growth within the VA. When it comes to the direct-to-consumer channel, I think what we realized earlier on this year is we're much more effective in terms of our efficiency of media spend. when we're focused primarily in driving traffic to our own website at www.truvaga.com. And the way that we've been able to go ahead and grow that most efficiently is by increasing the number of affiliates and influencers that we have that are out there that are talking about electroCore and our Truvaga product. So as we look into 2026, our goal is to focus on identifying more partnerships such as the Miranda Kerr relationship that we talked about earlier, we have Mark, Best Buy, things of that nature that will help us with the growth in the channel that will help grow around the truvaga.com traffic.

Okay. That's perfect. And then one more as a follow-up. Could you talk about OUS channels and any expectation into '26 of US or any specific geographies worth calling out today?

Yes. From our perspective, NHS England is still a channel that's much -- that's worthwhile in terms of mentioning as it just relates to our overall revenue. We have the most adoption within the NHS in England. But the NHS does have a bit of a bottleneck because of the way that the rules are written as it relates to who specifically has to write the prescription in order to get prescriptions adjudicated and ultimately fulfilled through the program. While we have interest in other countries outside of England, we've got distributors in locations such as Belgium, where we have some reimbursement -- we're still developing the infrastructure, if you will, or the adjudication infrastructure more than anything to make sure that there is a pathway for which patients can go ahead and actually either get this covered or pay through cash providers. And we're doing that through third-party distributors. So right now, I'd say NHS England is really going to be our focus as it relates to the main driver of OUS revenue. But as additional distribution partners come available and reimbursement opens up, we'll be sure to update the Street on that.

Our next question comes from Carl Wallace of HCW.

This is Charles on for RK. And Dan, congrats on on all you've done for electroCore, and it was great working with you.

Thank you.

So for my first question, with the changes with management, the new hiring of Michael Fox and increased responsibilities for Joshua. I wanted to better understand these new leadership dynamics. And so will Michael focus primarily on kind of the VA business. Will Joshua handles the wellness in ex-VA.

Charles, great question. Yes. So the short answer to your question is yes. But Charles -- I'm sorry, Michael has really -- has a strong background and history in driving and building commercial organizations. So our expectation is going to be that Michael is going to need to come in here, get his feet wet a little bit and get a firm understanding as to how our sales operations currently work. But we believe that Michael's background primarily around commercial and whether that's not just VA, but it could be other federal systems as well. It could also be other commercial systems, perhaps such as Kaiser or commercial insurers is really going to fall under Michael's purview. As it relates to the day-to-day activities as well as Truvaga, right now, the plan is for that to fall in my court.

Perfect. And then can you remind us of the prior VA contracts? And with the onboarding of Michael, is there going to be any adjustment to this contract?

Great question. At the moment, the answer is I don't know, but I don't think so. Our VA contract already has our products listed on it. The name and who's the at the helm of an organization doesn't really necessarily change the nature of the contract in its own right. That said, Michael is coming to us with years and decades of experience in selling to these different channels. So if there are opportunities for us to make that contract more efficient for both electroCore or for the VA for that matter for the customer then what's absolutely on the table that we would consider it.

And then for my final question. So Dan has kind of been the architect on kind of TAC-STIM in the military channel. So with him leaving, does that mean that there might be a deemphasis on the TAC-STIM product?

No, I don't think so. TAC-STIM has always been a lumpy business for the company, and we still have a robust pipeline of different military groups and military organizations that are of interest. If anything, I think that there could be an opportunity here to maybe pull through some of that or accelerate, as mentioned before, Michael Fox's experience isn't just necessarily in the VA, it's all federal systems. So I do think that there could be -- it doesn't mean that there will be, but there could be an operation to maybe pull forward some of those revenue opportunities. Because we have someone that's been in depth in working with those with the Hill and different military organizations.

Our next question comes from Charles Wallace. Okay. Let's go to Jeremy Pearlman, Jeremy, do you want to unmute?

First related, you mentioned earlier on the call the Quell relief -- is that going to be sold into the VA DoD channels? Is that going to be in general wellness also is that a first half or second half '26 event? And is revenue from that going to be baked into the guidance? Or do you think anything from any revenue generated would just be icing on the cake.

Jeremy, thanks so much for the question. So our Quell Relief product, which is also internally, we know as Quell over-the-counter is it's technically an over-the-counter product. So it's not technically a general wellness product. Our plan is to launch that product in the first half of 2026. Our expectations for that product are similar to how when we originally launched Truvaga. I'm not sure if you recall, but -- we did a very soft launch early on just to see what kind of access and traction we got. The Quell brand itself has legacy users and legacy demand. And we're hoping that by doing a soft launch of the program, we could start getting a sense as to where to best spend our media dollars. Which will then give us a more robust plan as to how we go ahead and grow that into its own product category. But to answer your question, right now, when we look at our 30% guidance that we've given year-over-year, anything that would come out of the Quell OTC or the Quell relief product would be incremental to that.

Okay. Understood. Great. And then maybe if we could jump to your return on advertising spend. You said it was $2.1 million ex this quarter. And you did mention on one of the earlier questions, you are trying to identify more partnerships to help growth. Is that -- is there a goal for 2026? And how much can you really increase that return? Is it -- you can get into the 3x range even more? Or is it an incremental gain?

That's a fantastic question. The true answer is it really depends right? We have a team of dedicated people that look at our -- look at our return on advertising spend on a daily basis, and they move our media dollars around based off of where we're getting the highest efficiency or the highest return on our investment. From what we've seen in the category, we think industry would be somewhere between the 2 to 2.5 range. If we -- there have been times within Truvaga's lifespan that we have actually achieved greater than 3% return on media spend. But typically, what happens is the more efficient you get over time in a particular channel, that efficiency then hits its it's peak and then starts coming down and you have to find different avenues. So to answer your question, I think that our goal for the year is going to try to have that above 2, having that above 2 or $2 of revenue for every dollar of media is a good place as a sort of conservative number. And then our expectation would be is that we try to hover around that, call it, between 2 and 2.5 on an average basis for the year.

Okay. Understood. And then just last question. in the past, you -- maybe you could any updates on your insurance reimbursement coverage? And maybe what do you think the biggest barriers to broader reimbursement adoptions are you're facing? It's always been -- it seems like it's been a struggle over time.

Yes. Thank you. So just from an update point of view, I think the biggest opportunity we have in front of us is the work that we've been doing with Kaiser. We've spent some time talking about it in the past. Earlier on in this year, we finally got on contract with Kaiser. So not only are we on formulary, but we're also on contract. That allows us to give us a license to sell, if you will, within the organization and gives prescribers an easier opportunity to actually prescribe the product itself, but it's not necessarily the end all be all. We spent a better part of the last quarter. And within 2026, what we plan to do is spend more time trying to develop the right KOLs and subject matter experts advocates for the product within the system. I think Kaiser will remain to be our largest sort of opportunity, if you will, as it relates to from an insurance point of view, where can we get coverage. And the reason why I say that is Kaiser is the largest of these managed care systems. Typically, they're kind of like a beachhead strategy. If you can get Kaiser and show other managed care systems that it works. Other managed care systems will follow suit. So right now, we've guided in the past that we've got dedicated resources focused primarily on trying to get Kaiser up and running. If we do, our plan would be to leverage that success and turn it into additional adoption throughout other managed care insurers.

Okay. And you think that, that could be a 2026 event?

No, I would think that Kaiser, some Kaiser success the plan is or the hope is for it to be in 2026. I think other additional insurers would be after that. It would be 2027 and 2028.

And Josh, I'm going to turn the call back over to you for a closing statement that has exhausted our questions from live callers.

Well, great, Rob. Thank you so much. Just wanted to thank everyone for the opportunity and for joining us today. I want to recognize the team for their continued hard work and their commitment to our patients to the health care providers and to our customers, especially as we go through this transition. I also want to thank our shareholders for their continued support. Before we conclude, I'd like to extend our sincerest appreciation to Dan for all of his leadership and the foundation that he's leaving behind. We're excited about the opportunities ahead and remain focused on execution, disciplined investment and long-term value creation for our shareholders. On behalf of myself, the employees of electroCore and everyone who has benefited from your leadership. Dan, thank you for your dedication, your vision and the lasting impact you've made on the organization. We wish you the very best in your retirement and in the next chapter ahead.