LifeMD Aktie

Good afternoon. Thank you for joining us today to discuss LifeMD's results for the first quarter ended March 31, 2026.

Joining the call today are Justin Schreiber, Chairman and Chief Executive Officer; and Atul Kavthekar, Chief Financial Officer. Following the management's prepared remarks, we will open the call for a question-and-answer session.

Before we begin, I would like to remind everyone that during this call, the company will make a number of forward-looking statements, which are subject to numerous risks and uncertainties that may cause actual results to differ materially from those projected.

These risks and uncertainties are described in the company's 10-K and 10-Q filings and within other filings that LifeMD may make with the SEC from time to time. Forward-looking statements made during this call are based on certain information available to companies as of today, May 6, 2026. The company assumes no obligation to update or revise any forward-looking statements after today's call, except as required by law.

Also, please note that the management will be discussing certain non-GAAP financial measures that the company believes are important in evaluating LifeMD's performance. Details on the relationship between these non-GAAP measures and the most comparable GAAP measures and reconciliation thereof can be found in the press release issued earlier today.

Finally, I would like to remind everyone that today's call is being recorded and will be available for replay in the Investor Relations section of the company's website.

Now I would like to turn the call over to LifeMD's CEO, Justin Schreiber. Please go ahead.

Thank you, and good afternoon, everyone. After the market closed today, we issued a press release announcing our first quarter financial results. We've also posted an updated corporate presentation, our Form 10-Q and our shareholder letter on our Investor Relations website at ir.lifemd.com. I encourage everyone to review those materials.

Q1 was a strong start to 2026. We delivered revenue of $50.2 million, ahead of guidance and added more than 42,000 net telehealth subscribers, the largest quarterly net addition in our history. We ended the quarter with over 365,000 subscribers.

In weight management, sign-ups increased approximately 120% sequentially from Q4, and we exited the quarter with strong momentum across all of our key growth areas. We're seeing clear early validation of the strategy we laid out on our last call.

But what matters most is not just the quarter, it's what this quarter says about the platform we're building. As I outlined in our shareholder letter, I think about LifeMD in very simple terms: quality care, quality products, quality revenue.

When we deliver high-quality care, patients trust us. When we offer products and services that genuinely improve their lives, they come back. And when patients engage across more of the platform and stay with us longer, the revenue becomes more durable, higher quality and ultimately more profitable.

Today, we have a 50-state affiliated medical group, a fully integrated pharmacy, in-home and national lab capabilities, expanding insurance coverage, deep pharmaceutical collaborations and a growing set of specialty care programs.

Increasingly, we're layering AI across that infrastructure to make care faster, more efficient and more personalized. LifeMD is no longer just a telehealth company focused on a handful of conditions. We are building what we believe can become one of the most important virtual health care platforms in the country, a trusted destination where patients can access care, medications, labs, insurance-supported services and ongoing clinical support through one connected experience.

Let me walk you through where we're seeing the most progress. First, weight management. This remains the largest opportunity in our business. More than 100 million Americans are clinically eligible for GLP-1 therapy, and it is estimated that fewer than 15% have tried one. These medications represent one of the most significant breakthroughs in consumer health care in decades.

And importantly, the market is becoming more dynamic, not less. We are entering the next phase of GLP-1 adoption. The first phase was access to injectables. The second phase is broader access, including oral therapies, lower-cost self-pay options, insurance coverage, and a deep pipeline of next-generation drugs.

We are built for this phase. We've already benefited from the introduction of oral GLP-1s. Customer acquisition costs improved 4% to 5% sequentially in Q1 even as volumes effectively doubled from roughly 300 to 400 new patients per day to 600 to 1,000 patients per day. We ended the quarter with just under 100,000 weight management patients. And this opportunity is only getting bigger. There are roughly 40 GLP-1 therapies currently in development, including oral formulations, longer-acting injectables, and multi-pathway treatments.

As these therapies come to market, we believe platforms like LifeMD that combine affordable access, insurance integration, and real clinical care will be the long-term winners. Second, women's health. This continues to be one of the programs I'm most excited about. The need is enormous. Tens of millions of women are entering or living through menopause and access to thoughtful evidence-based coordinated care remains limited.

We built this program differently around longitudinal care, not just prescriptions. That includes comprehensive intake, appropriate lab work, structured clinical protocols, and ongoing management by providers trained specifically in women's health. The early results have exceeded our expectations.

Subscriber count grew more than 7x from the Q4 base. Customer acquisition costs remain attractive. On therapy retention is tracking north of 80%. We believe that performance is a direct reflection of the quality of the program.

Over the coming months, we plan to introduce 7 new compounded pharmacy products focused on hormone and bone health, highly complementary to patient needs and well aligned with our in-house pharmacy capabilities.

Women's health has the potential to become one of the largest and most important programs in our company, not just a growth driver, but a category where we can build deep, trusted patient relationships.

Third, RexMD and men's health. RexMD remains one of the most recognized men's health brands in the country and a critical part of our platform. We now have approximately 215,000 active patients with growth across ED, sleep, and hair loss, with sleep currently the fastest-growing category. ED remains the core and our personalized ED medications, combining Sildenafil and tadalafil grew more than 40% versus Q4.

As more fulfillment shifts in-house, we expect continued margin expansion. But RexMD is evolving beyond ED. We are expanding into personalized pharmacy products across sexual health, dermatology, pain management, and longevity.

Just as importantly, Rex provides a large, engaged patient base that can expand into the broader LifeMD ecosystem over time, strengthening retention and lifetime value. Fourth, operating leverage in AI. This is one of the most important components of the LifeMD story for 2026. We are deploying AI aggressively but thoughtfully with quality as the nonnegotiable.

AI is not just a cost initiative. It is becoming foundational to how we build software, how providers deliver care and how we operate the business. Our clinical decision support tools will integrate health records, lab data, biomarker insights, and patient intake information to enable more personalized and efficient care.

Over time, we expect AI to increase provider capacity without adding headcount, which is a key lever for scaling efficiently. We are also embedding AI across intake, documentation, patient support, revenue cycle, compliance, and back-office workflows.

This is not about replacing providers. It's about enabling them to spend more time practicing medicine and less time on administrative work. We expect the margin impact to become more visible in the second half of 2026. And when AI is combined with our 503-A compounding pharmacy, it unlocks something powerful, personalized prescribing at scale, enabled by data, clinical infrastructure, pharmacy capabilities, and national reach. Very few platforms have that combination and LifeMD is one of them.

Fifth, pharmacy, insurance and partnerships. Our affiliated pharmacy continues to scale. We now operate a 22,500 square foot facility licensed in all 50 states with both commercial and 503-A compounding capabilities. The pharmacy is currently processing approximately 20,000 prescriptions per month with significant capacity to expand throughout this year as our pharmacy offerings expand. We view pharmacy as one of our most important long-term margin expansion levers, improving economics, patient experience and speed to market.

On the payer side, our insurance and Medicare infrastructure continues to expand. We ended the quarter with approximately 112 million covered lives and expect to reach approximately 230 million by the end of this month. The Medicare GLP-1 bridge launching July 1 is particularly important as it expands access to GLP-1 therapies for Medicare patients at an affordable monthly cost.

We also continue to see strong momentum with pharmaceutical partners as the industry increasingly shifts toward direct-to-patient models. Our GLP-1 collaborations are a strong proof point of that trend.

On the employer side, we are making progress with enterprise relationships and direct GLP-1 coverage for self-insured groups, a meaningful upside opportunity not yet fully reflected in our outlook.

Stepping back, we feel very good about where we are. We are serving more patients, expanding into larger and more durable categories, strengthening the platform and building a business we believe can compound over the long term.

We are reaffirming our full year guidance of $220 million to $230 million in revenue and $12 million to $17 million in adjusted EBITDA. We continue to expect annualized run rate revenue above $250 million and adjusted EBITDA above $25 million by the fourth quarter.

With that, I'll turn the call over to our new CFO, Atul Kavthekar, to walk through the quarter in more detail. Atul?

Thank you, Justin, and good afternoon, everyone. I'm delighted to be joining my first quarterly call as CFO of LifeMD and pleased to be leading its financial operations. It's been a positive first few weeks, and I've been impressed by the team and their commitment to continuous improvement, their entrepreneurial mindset and their general curiosity. I'll be doing everything I can to continue that culture.

As for results, the first quarter played out largely as we expected, strong subscriber momentum following a planned step-up in patient acquisition spend and the early benefits of platform efficiency beginning to show in our gross margin.

As a reminder, all year-over-year comparisons are on a continuing operations basis, excluding WorkSimpli, which was divested on November 4, 2025.

Revenue for the first quarter was $50.2 million, exceeding our guidance range of $48 million to $49 million and essentially flat versus the prior year period of $50.9 million and with nearly all revenue derived from recurring subscriptions.

Active subscribers grew approximately 26% year-over-year to over 365,000 at quarter end, with over 42,000 net adds in Q1, the largest quarterly net addition in our history. Gross margin for the quarter expanded approximately 420 basis points to 88%, primarily reflecting improvements in lower shipping and fulfillment costs, including the continued scaling of our in-house pharmacy fulfillment that Justin described previously.

Gross profit was $44.2 million, up 3% for the year ago period despite the flat year-over-year revenue growth. Selling and marketing expenses were $29.8 million, an increase of 34% year-over-year, reflecting the strategic front-loaded patient acquisition investment, which is designed to drive subscriber growth in subsequent quarters. Q1 was the peak of our marketing investment for the year.

Marketing spend has begun normalizing, and we expect sales and marketing to step down in Q2 and remain at more typical levels throughout the back half. GAAP net loss from continuing operations attributable to common stockholders was $9.6 million or $0.20 per diluted share compared to a net loss from continuing operations attributable to common stockholders of $2.4 million or $0.06 per diluted share in the prior year period.

Stock-based compensation was $1.4 million, down from $2.5 million in the prior year period, reflecting our continued focus on aligning our management with long-term goals. Adjusted EBITDA, a non-GAAP measure we define as income or loss attributable to common stockholders before various items, as outlined in today's news release, was a loss of approximately $4.5 million for the first quarter, in line with our previously issued first quarter guidance range of a loss of $4 million to $5 million. This compares with an adjusted EBITDA of approximately $3.7 million in the prior year period.

Turning to the balance sheet. We exited the quarter with $34.5 million in cash, no debt and a $30 million undrawn revolving credit facility that we put into place at the start of the year. Our balance sheet remains a strategic asset, providing ample flexibility to fund our expanding growth initiatives.

Looking forward, we are reaffirming our 2026 full year guidance, revenue of $220 million to $230 million, representing 13% to 19% year-over-year growth and adjusted EBITDA of $12 million to $17 million. We expect to return to adjusted EBITDA profitability in the second half of the year as customer acquisition costs declined sequentially and the patient volumes added in Q1 become accretive.

This is in addition to multiple initiatives around our business that we expect to impact the second half. These include the expansion of our pharmacy offerings, which will allow us to capture revenue and margin we do not currently benefit from. As was established during our 2025 Q4 call, we continue to expect annualized run rate revenue exceeding $250 million and annualized run rate adjusted EBITDA exceeding $25 million by the fourth quarter of 2026.

For Q2, we are expecting the business to continue its transition to branded GLP-1s. And as such, we expect to see our Q2 revenue between $47 million to $50 million and adjusted EBITDA of between negative $2 million to positive $1 million as we continue to realize efficiencies and cost savings in our business.

With that, I'll turn it back to Justin.

Thanks, Atul. As we close our prepared remarks, I want to come back to the larger point. Q1 was always going to be an investment quarter. We leaned into the launch of oral GLP-1s, accelerated patient acquisition, made big progress in women's health, expanded our pharmacy and insurance infrastructure, and advanced the AI tools that we believe will make this platform more scalable over time.

What gives me confidence is that the early signals are showing up exactly where we would want to see them, record subscriber additions, strong demand in weight management, rapid early growth in women's health, improving pharmacy economics and a clear path to operating leverage as the year progresses.

As I laid out in our shareholder letter, the model is simple: quality care, quality products, quality revenue. If we deliver high-quality care and build products patients value, they stay longer, use more of the platform and create more durable revenue. That is the foundation of LifeMD's strategy.

The opportunity ahead is tremendous. GLP-1 therapy is entering a new phase with oral medications, broader access and a deep pipeline of next-generation therapies. Women's health is scaling from a small base into what we believe can become one of the most important programs we have ever built.

RexMD continues to give us a large, engaged patient base and a trusted men's health brand. And across the company, AI, pharmacy and insurance are becoming real levers for better care, stronger retention and margin expansion. We are not building a point solution. We are building a platform patients can come back to for more of their health care needs over time.

That is what makes this business more durable, and that is what makes me so excited about the rest of 2026. I want to thank the LifeMD team for their continued execution and our shareholders for their support.

With that, we'll open the call for questions. Operator?

[Operator Instructions] The first question comes from David Larsen with BTIG.

Congratulations on the good start to the year. Can you talk a little bit about your relationship with Novo and also Lilly? Obviously, you guys were sort of leaders in the industry with regards to partnering with the brand manufacturers as opposed to like continuing with a sort of aggressive compound GLP-1 effort. How are you making money with Novo and Lilly? How is the sort of solid oral pill launch progressing? Just any more color there would be helpful.

Hi Dave, thanks for the question. This is Justin speaking. Yes. Look, I think we've commented extensively both in press releases and on calls like this about how important both of these relationships are to LifeMD.

And look, I'd emphasize, as we've talked about a lot that they're -- we view them as very long-term collaborations. So relatively speaking, both of these things are pretty new, and we've been working through just kind of a lot of the different strategies that we think are going to drive long-term patient growth and really help patients access these therapies.

I can't really go into a lot more detail on either of the relationships, except what I will say is that I think that -- what I will say is that we've had really, really productive conversations with both of those companies about compliant ways that we can help kind of more patients access these therapies -- and those discussions are ongoing, and we're extremely optimistic that in the near term, being kind of the next quarter or 2, that at least one, if not kind of both of those relationships will continue to evolve in a way that does kind of help our overall unit economics for this business and helps us to enable more people to access these therapies.

I also think it's worth pointing out that, again, both of these companies have next-generation therapies that are in the pipeline. And we're going to be a platform for products from those 2 companies, and we've already spoken to a number of other large pharma companies that have next-generation GLP-1 therapies. And we expect those therapies to be available in the LifeMD platform.

So this is a long-term trend. I'll also emphasize that we spend a lot of time looking at the unit economics for the branded therapy business. We have some areas where unit economics are softer than we like, and we have some areas where unit economics are incredible.

One of the areas where unit economics are really strongest on the insurance side of the business, when people are using their health insurance to subsidize the care component and even still paying cash for these medications. These unit economics look really, really outstanding, and there's a lot of demand.

So I hope that, that answers your question. We are obviously under NDA with both of these companies. So we're kind of limited with what we can say on an earnings call.

Okay. Great. It sounds like your relationship with both Novo and Lilly are evolving, and you'll reach some sort of an understanding that benefits both of them and you and obviously, most importantly, the patients and the members that are benefiting from the medications.

Okay. And then can you maybe talk a little bit about the incremental marketing spend in 1Q? Obviously, that put a little bit of pressure on the EBITDA in the quarter. What is the nature of that incremental spend? Is it like just sort of like Google Ads and online ads or something more than that?

Yes, Dave, this is Atul speaking. So look, we had, I think, the elevated marketing spend in the first quarter was actually very productive. And the various channels and the media buys were many of the same that we have used, and certainly, that includes Google Ads and some of the other sort of more typical types of social media places where people are interested in starting to do research.

The upshot, I would think of the elevated spend is really just it was a tremendous opportunity to acquire customers at CPAs that were what I would call historically -- well, at least for the last several quarters, it's really attractive CPAs. So we were able to add to the active base by almost 13% in the quarter.

But also and almost equally important, we really added to our sort of database, our pool of potential targets that we have the ability to market to going forward. So I think -- so in many respects, it was a broad-based general campaign or set of campaigns that I think really will be able to kind of help the company going forward in year in the quarter and the next quarter and then beyond through the rest of the year.

The next question comes from Ryan Meyers with Lake Street Capital.

So thinking about the 230 million or so lives you expect to have covered this month, what are you seeing so far in terms of conversion rates, retention, customer acquisition synergies that you're seeing from these insurance-supported programs so far?

Yes. Thanks. This is Justin. I'll take a stab at that and then Atul can weigh in. The high level, we're seeing a considerable improvement in retention rates for insurance patients, which is one of the reasons that we're super optimistic. We're seeing a significant reduction in customer acquisition costs by as much as kind of 50%. And we do expect that to go up a little bit as we scale these offerings.

But in short, we're seeing a significant reduction in CAC and these patients are paying a much lower platform or membership fee to LifeMD than patients that are not using their insurance. And what we're seeing is at least a 10 point improvement in retention.

Obviously, some of these cohorts are newer, but over the first 3 to 6 months, it's pretty meaningful. So we're getting less money. We're paying less for -- we're getting fewer dollars. We're spending less to acquire them. But overall, like we think that the unit economics profile of this patient is optimal to a self-pay patient.

This is Atul. Let me just add one thing. I think one of the additional things that I was maybe a little bit surprised is for the patients that are coming through the flow, our order flow on the site, they have an opportunity to indicate if they're interested in insurance or not. And I anticipated there'd be a lot of interest in it. I didn't expect it would be in the 75% to 80% range, which just is a further indication that there's a lot of demand. And I think it points to where the business and the makeup of the patient population is going to go over the next quarters and the next few years. So we're really excited about this business.

Okay. Got it. And then as we think about the year-over-year revenue, while you did come in ahead of expectations, it was a year-over-year decline. Can you just remind us if there's any dynamics in the first quarter of last year? And then how we should think about that and the potential impact during the second quarter of this year and how that relates to the guidance?

Yes. And I'm glad you asked the question. So yes, absolutely. The first quarter of '25 had a heavy use of a compounded GLP-1. We have continued to migrate this business where we think the future is, is really around branded drugs. And that's really the delta that you're seeing.

And so today, we have a different set of unit economics around there. We don't make as much. I think we've been pretty upfront about that. But we also do think that those are really exceptional patients, and they are just -- they simply have a meaningfully better retention. So we think that that's the right direction for the business. But that's really what's causing it. It's really simply the change in the product mix.

The next question comes from Sarah James with Cantor Fitzgerald.

This is Gabie on for Sarah. Could you help us get a little bit more comfortable with the second quarter to third quarter EBITDA ramp and maybe expand on what initiatives are kicking in? Maybe the second quarter EBITDA was just slightly softer than we had modeled. So just any additional color there would be great.

Yes. So this is Atul speaking. Nice to meet you, Gabie. Let me try to sort of paint a picture for the -- maybe for the full year in the third quarter for sure, second to third quarter for sure.

But going forward, we are really embarking -- I think we are getting a lot of momentum behind the insurance business. This is a part of our business that I think is going to be really big, as I was just mentioning, the CPAs, as Justin said, were really attractive. We see that being a more and more important part of the revenue growth story, and we see that as an opportunity to kind of strategically capture some of the better-quality patients.

We see that really ramping up in the second half. We've made a lot of technical improvements in the platform, and I can talk more about that later, if you'd like. But we've made a lot of improvements. We are significantly expanding.

In fact, I think next week, we're planning to expand to, I think it's 147 additional plants. That is going to be a big part of the story in the second half of the year. Other parts of it is really around enhanced economics. I think Justin sort of alluded to that a little bit.

I think those are things that we are also expecting. Those are things that affect -- directly affect and impact and improve the revenue as well as the EBITDA. The way our accounting works is that's essentially incremental revenue, so it hits both revenue and EBITDA. It's a very big opportunity for us. And there's more to come on that, not necessarily for today.

There's other areas that are not really -- haven't really been a big focus, and there's a couple of reasons for it, mostly technical in nature, but what we call cross care. So think of a lot of our patients that may be on GLP-1 drugs today that may have the right circumstances or might be interested in other products that we sell, whether it be ED medications, sleep medications, so on and so forth.

That's a big opportunity that, again, for technical reasons that have sort of recently been solved or are about to get solved, really opens up a new opportunity for us to generate revenue that hasn't been there in the past. And so those are really important sort of revenue drivers.

On the cost side of the equation, and you'll start to see this in the second quarter, third quarter, fourth quarter as well, but it's certainly going to be a front-loaded first half of marketing spend. So as you can see the numbers.

In the second quarter, we're expecting somewhere in the vicinity, don't hold us strictly to this, but sort of in the $26 million to $27 million of marketing spend. So I think that the marketing dollars are definitely going to come down.

And in the back half of the year between the 2 quarters, and we will make determinations as to how and when to spend that. But we're sort of -- we're penciling in sort of in the $42 million to $44 million range of marketing spend in the back half.

So from first half to second half, that does come down quite a bit. And then -- and I know we've talked about it, but some of the cost efficiencies that we've been working on, and you've seen some of that. If you look at the SG&A we just reported in Q1 and you compare that to Q4, I mean, as a percentage of revenue that's come down quite some bit over 200 basis points.

Going forward, we will see more of those types of things. And it's not just simply going to be SG&A. It's going to be on the -- affecting the gross margin, things like shipping costs, all those provider efficiencies, fulfillment costs, all of those things that hit across the P&L. We'll see more of that in the second half of the year. And that's kind of what gives us a lot of comfort.

As you can imagine, I probably spent a lot of time on that over the last couple of weeks. And so that's been an area that I think I'm feeling pretty good about. And I think you'll see that unroll, and we'll talk more about that in the coming quarters.

Okay. Great. That was all super helpful. And then if I could just squeeze in one more. The CMS Bridge program was extended through 2027. How does that impact you guys? Does that give you a more positive outlook on your contribution to that program? Or what's the right read-through?

Yes, this is Justin. We're very excited about Medicare beneficiaries having access to GLP-1 medications. As most people listening to this call know, we've put an enormous amount of energy into building a 50-state Medicare program. It's working.

We're turning it on for -- we've already -- it already is on in some states for weight management. We're turning it on for women's health in the next couple of weeks. And we are kind of thinking through the right strategy for patients, Medicare beneficiaries using Bridge. So I'm excited about it. There's still some details to work out, but we haven't built this into our model. But I'm really excited about it. We're working with outside counsel right now on a lot of the particulars. And if it works the way I think the way -- if it all works the way I think it's going to work, I think it's going to be a really, really big opportunity for us in the back half of the year and more importantly, help a lot of Medicare beneficiaries access these medications affordably.

The next question comes from Steven Valiquette with Mizuho Securities.

I guess, 1 or 2. First, it's obviously pretty early days on Foundayo, but curious just to get your thoughts on the uptake so far. Maybe just to set the stage on that.

At a national level, investors are trying to compare the week-by-week launch of Foundayo with the comparable week post the launch of oral Wegovy earlier this year. And so far, the uptake of Foundayo, at least nationally is kind of trailing the initial oral Wegovy uptake.

So I'm wondering, are you seeing that same trend within your own platform, if you are close to the numbers kind of tracking it that way? And if so, just curious to what you think is kind of driving that. So I'll start with that question.

Sure. This is Justin. I know this isn't the answer you're looking for, but I want to be a good collaborator to both of these companies. And I don't think it's appropriate for us to comment on traction, specific traction of one therapy versus another on our platform.

Like what I'll say is that we have -- we do have Foundayo live, and we have a lot of patients choosing both Foundayo and Wegovy pill. And so look, it does it does seem like Wegovy pill has more awareness out there in this space. And maybe that's kind of partly why it is still slightly more popular than Foundayo on our platform. But we don't want to get too much into specifics.

Okay. That's fair. I appreciate that. So second question then, I'll try to ask it maybe a little more high level then, is that one of those 2 manufacturers did make a comment on one of their most recent earnings calls that roughly 55% of their new patient starts are cash pay customers, which I thought would have been pretty positive for you.

So I guess, my -- the question I'll ask in relation to that is I would have thought maybe your 2Q revenue guidance would be just a little bit stronger sequentially versus 1Q just because of that backdrop. So I know in your comments, you talked about 2Q that the evolution of the shift of patients off the compounded drugs and more to brands is still kind of taking shape in 2Q.

But I'm just trying to unpack that a little bit more. Is there something about the falloff on the compounded patients will be a little more rapid in 2Q versus 1Q for whatever reason? Or is there still something that's holding back the brand uptake versus maybe what some of us thought it might be on your platform in 2Q, especially with one of these orals just launching very recently. Hopefully, that question makes sense.

Yes. Thanks, Steve. There's a lot in there. So let me try to remember. I mean, so first of all, the demand for oral therapies is still very, very strong, right? It's actually surprised me at how strong the demand is for oral therapies. So I also think that the success of these self-pay programs has surprised everybody.

And I obviously can't and won't speak for Lilly or Novo, but I think that everybody is pretty surprised at how successful these programs are. I think payers are probably surprised as well. And so I think that -- look, I mean, when we built LifeMD, the initial vision that Stefan and I had for this platform was to build something to help patients access branded medications. It was to do the types of collaborations that we've done with Lilly and Novo.

And I think the fact that they broke the ice in a sense for the rest of the industry and LifeMD's had the privilege of collaborating with both of these companies is an incredible thing. As I think I've emphasized publicly on many different occasions, we've got a number of other really respectable large pharma companies that have come to us and are interested in collaborations, some of which are -- could be very transformational for our business.

And look, the fact that payers -- by the way, the fact that -- I mean one of the things that I found most interesting over the last couple of months is that coverage actually appears to be slightly declining for some of these GLP-1 medications because of the success of the self-pay programs, which, by the way, that's certainly a tailwind for a platform like LifeMD that has -- that essentially facilitates these kind of direct-to-patient programs.

And so -- and remember, like LifeMD can support self-pay and insurance both in the pharmacy and the care side. So I think we're in a great spot. And it's genuine what I said on the call, that because of all of these kind of tailwinds that we're seeing right now, I'm really excited about the trajectory of the business.

On the softness like in Q2 revenue, just to kind of reiterate what Atul said, I mean, our revenue just has changed a little bit, right? It's part of like the transformation that the company is going through. It's part of our focus on quality revenue.

And we're charging less for some of these -- some of the services that we're offering like weight management -- I'm sorry, like women's health. It's more of an a la carte model. Same with weight management. If you look at the insurance population, they're paying less. We're building their insurance. We're still working out some of the kinks with our RCM processes as well.

But like, we're patient, we're not trying to build something here and get as much revenue as we can upfront. Like we want to build -- we want to offer services and products that have strong retention, have a strong value proposition associated with them and are awesome for patients.

And so that's kind of the reason why there's a little bit of softness there. But we're super confident in the back half of the year.

The next question comes from Steven Dechert with KeyBanc.

I was hoping you could give some kind of outlook on the cadence of weight management subscribers through the rest of the year. And then can you talk more about the opportunity with self-insured employers and what you think the upside could be there?

Yes. So this is Atul speaking. So I think the cadence going forward is -- in the first quarter was very strong. We will probably see a similar growth pattern going forward through the year. I think there may be ebbs and flows in quarter-to-quarter.

But over the course of the year, we still see fundamentally, these are very strong tailwinds. We have a very large group and -- of patients that we can market to that we have touched -- they've reached out to us before. We have an opportunity to convert them again. And so we feel pretty good about maintaining a pretty consistent level.

And look, we're going to do everything we can to, in fact, accelerate it, particularly with the insurance offering and opening ourselves up to those patients, notwithstanding some of the challenges that some of the managed care programs and plans have had around covering this, there still are a lot that will.

And as someone was asking earlier about the Bridge program, those are big opportunities for us to grow and maybe even accelerate penetration and patient counts in the GLP-1. But maybe I'll turn it over to Justin for the other question.

Steve, I'll just add, I dedicated a lot of time in the shareholder letter to talking about the revenue streams that are essentially going to be a part of LifeMD's future that we're growing into over the course of the next year.

And I mean, we talked about one of the areas that we focused on is obviously revenue streams from pharmaceutical collaborations. We think that's going to be meaningful. We think that we have a deep pipeline right now of pretty big partnerships, which is very similar to enterprise revenue, right?

It's essentially a large partnership, large partners of ours that are effectively offering our services to their customer base or to their membership. We're really excited about those. And we have some of those in place now, but there are some other very significant ones in the pipeline and we expect to continue to develop that pipeline.

We also -- we do have -- we do think the employer opportunity is pretty big, and we're working on some programs right now for employers. There's a lot of interest there. Quite frankly, there's a tremendous amount of interest from the pharma channel and from the strategic partner channel.

And because of that interest, we've been deprioritizing the programs for employers. But it's certainly in the plans, and we understand kind of the -- we understand like the attractiveness of that revenue, obviously.

The next question comes from Yi Chen with H.C. Wainwright.

This is [ Katie ] on for Yi. Looking at the FDA's proposal to exclude semaglutides and that sort of drugs from the bulk list. Your shift to branded drugs kind of puts you ahead of that a little bit. How should we think about where you guys stand and how this could play out, whether it goes either way?

And then as a follow-up, what is your prescriber documentation framework for that individualized medical necessity standard? And have you guys talked to the FDA about that at all?

This is Justin. Thanks for the question. The changes to the bulk drug list have 0 impact on the business, so completely irrelevant to us. We don't compound these medications. We have some patients that are still on a personalized compound for third-party pharmacies.

As far as, look, again, this is not something that we really spend much time on because of the kind of overwhelming focus of helping patients access branded therapies. But I'm sure that all of our provider documentation is best-in-class.

Does that answer your question?

Okay. Maybe we lost Katie. Operator, we can conclude.

This concludes our question-and-answer session. I would like to turn the conference back over to Justin for any closing remarks.

I just want to say thank you, everybody, for your time and for tuning in for our earnings call. We look forward to talking to you next quarter, and I hope everybody has a good evening. Thanks.

Thank you. The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.

Good afternoon. Thank you for joining us today to discuss LifeMD's results for the fourth quarter and full year ended December 31, 2025. Joining the call today are Justin Schreiber, Chairman and Chief Executive Officer; and Marc Benathen, Chief Financial Officer. Following management's prepared remarks, we will open the call for a question-and-answer session.

Before we begin, I would like to remind everyone that during this call, the company will make a number of forward-looking statements, which are subject to numerous risks and uncertainties that may cause actual results to differ materially from those projected. These risks and uncertainties are described in the company's 10-K and 10-Q filings and within other filings that LifeMD may take with the SEC from time to time. Forward-looking statements made during this call are based on current information available to the company as of today, March 9, 2026. The company assumes no obligation to update or revise any forward-looking statements after today's call, except as required by law.

Also, please note that management will be discussing certain non-GAAP financial measures that the company believes are important in evaluating LifeMD's performance. Details on the relationship between these non-GAAP measures and the most comparable GAAP measures and reconciliations thereof can be found in the press release issued earlier today.

Finally, I would like to remind everyone that today's call is being recorded and will be available for replay in the Investor Relations section of the company's website.

Now I'd like to turn the call over to LifeMD's CEO, Justin Schreiber. Please go ahead.

Thank you, and good afternoon, everyone. After the market closed, we issued a news release announcing our fourth quarter and full year financial results and posted an updated corporate presentation on our website at ir.lifemd.com.

LifeMD delivered a very strong fourth quarter and full year with solid performance across all of our business lines. We entered 2026 with over 322,000 active subscribers, nearly $37 million in cash and no debt, giving us the strongest balance sheet and liquidity position in the company's history. Across our platform, we now onboard approximately 1,200 new patients per day, and we received more than 120,000 unique daily visitors to our websites, a clear reflection of the strength of our brands and the growing demand for our services. Our weight management business alone is seeing record patient acquisition volumes in the first quarter with new sign-ups approaching 700 per day, while customer acquisition costs have declined sequentially, a combination we are very excited about.

Weight management remains a significant long-term growth opportunity for us. More than 100 million Americans are clinically eligible for GLP-1 therapy, yet only a fraction have been prescribed treatment. Subsequent to year-end, we successfully launched oral Wegovy through our collaboration with Novo Nordisk, significantly expanding access for patients who prefer an oral option. We are one of the few virtual care providers fully integrated with both Novo Nordisk and Eli Lilly affiliated pharmacies, and we are optimistic these collaborations will continue to evolve and deepen. Beyond our current partnerships, we see significant pipeline opportunities with other large pharmaceutical companies and strategic partners. And we believe LifeMD's infrastructure and patient base make us a highly attractive partner in this space.

Our second biggest area of focus after weight management is women's health. We have invested more resources into the launch of this offering than anything we've launched in the history of our company. We started by acquiring Optimal Human Health, a virtual concierge women's health company founded by Dr. Doug Lucas. Dr. Lucas is a former orthopedic surgeon and bone health specialist, who has built a significant social media presence with over 160,000 followers and more than 10 million views across platforms, establishing himself as a recognized authority in women's hormonal and bone health. We also partnered with Dr. Tara Scott, known as the Hormone Guru. Dr. Scott is an internationally recognized physician who is board-certified in OB/GYN, functional medicine and integrative medicine with 26 years of private practice experience and 2 decades of work in the menopause space.

We have more advisers of this caliber joining our Women's Health Advisory Board in the weeks and months to come. As we've shared on prior calls, we are committed to building the highest quality virtual women's health care offering in the country focused on menopause, perimenopause, hormonal health and bone health. The market need is clear. Nearly 50% of U.S. counties lack an OB/GYN and 1.3 million women enter menopause each year, creating massive unmet demand for expert hormonal health care. While still early, we are seeing unit economics move in the right direction and expect women's health to be a meaningful contributor to growth in 2026 and a major driver in the long term.

Upcoming catalysts include the launch of Insurance and Medicare support for our women's health offerings, pharmacy bundles that combine GLP-1, hormone and other therapies and strategic media and influencer programs in the pipeline for later this year. Turning to men's health. Our RexMD brand now with approximately 215,000 active patients returned to growth in the second half of 2025 and continues to perform strongly on a profitable basis. We are focused on expanding RexMD's clinical offering beyond its core sexual health programs into other personalized generic and compounded medication categories. In the last week, we launched the RexMD integration with NovoCare and now offer injectable and oral Wegovy directly to RexMD patients. We are launching 5 new men's health care offerings and treatments from our pharmacy in the first half of 2026 in areas including insomnia, erectile dysfunction, dermatology and topical pain relief.

Further, we are closely following FDA guidance on peptide therapies and are prepared to launch those that are permitted to be compounded and are supported by strong clinical data. A key enabler across all these verticals is our affiliate pharmacy, which is now licensed in all 50 states and processing approximately 20,000 prescriptions per month. With our recently licensed 503-A compounding operation, we have the ability to produce personalized compounded medications at scale, supporting our efforts across men's health, women's health and other specialty verticals.

We view our pharmacy infrastructure as another growth driver for the company with the potential to meaningfully expand margins and deepen patient engagement across the platform. In March, we beta launched a 30-state virtual cardiology offering. This program allows new and existing LifeMD patients to book a cash pay or insurance covered visit with board-certified cardiologists from the comfort of their home. Our affiliated cardiologists can treat a range of conditions in a virtual environment, prescribe and manage medications and provide diet and lifestyle care plans. Importantly, the diagnostics and care delivered to this program are driven by an AI-supported intake process that pulls in the patient's medical history from a health information exchange and synchronizes it with biomarker data from labs and information provided during patient intake.

The result is a significantly more efficient experience for the cardiologist, an enhanced experience for the patient and most importantly, improved clinical outcomes. I am excited to see this program scale, and I believe it will serve as a blueprint for how we triage, diagnose and treat patients across our entire platform in the years to come. Let me now review our infrastructure priorities for 2026. We are focused on 3 areas that we believe will meaningfully accelerate growth and operating leverage across the business. First and most importantly is artificial intelligence. We have built a dedicated world-class AI and engineering team inside LifeMD that is focused exclusively on deploying advanced Agentic AI capabilities across care delivery, diagnostics and patient operations, supported by strong governance controls. This is not something that we are outsourcing or experimenting with on the side. It's central to our strategy and is embedded throughout our platform today.

In the first half of this year, we plan to launch our AI clinical decision support tool. As I mentioned with our cardiology offering, this tool connects directly to a patient's medical record, pulls in data from health information exchanges and integrates biomarker data from labs to support diagnosis and personalized treatment recommendations of our affiliated providers. We expect our AI clinical decision support tool to drive new patient acquisition, improve the efficiency of message-based and synchronous consults and enable even more patients to access the industry-leading care provided by our affiliated clinicians. One area where we see particularly high demand is personalized prescribing, especially with compounded medications.

Our AI tools will be able to analyze a patient's clinical profile, lab results and treatment history to help providers design highly individualized compound formulations tailored to each patient's specific needs. When you combine that capability with our 503-A compounding pharmacy, you get something that is very difficult to replicate, AI-driven personalized medicine manufactured and fulfilled in-house at scale. We believe this intersection of AI and pharmacy is a major differentiator and will drive both better patient outcomes and improved unit economics across the platform. We believe LifeMD will be a leader, if not the leader, in delivering urgent and specialty health care using AI. The combination of our proprietary technology, our 50-state affiliated medical group, our pharmacy infrastructure and the structured clinical data we have accumulated from over 1.3 million patient consults gives us what we believe is one of the most compelling AI-enabled care platforms in virtual health.

Beyond the clinical side, we are embedding AI and automation deeper into our operational workflows, enabling us to handle significantly more volume without proportional increases in overhead. We see a clear path to substantially improving our G&A efficiency throughout 2026 and we expect these investments to be a meaningful contributor to margin expansion as the year progresses. Our second infrastructure priority is benefits. Today, our platform covers over 110 million lives through commercial and government payer contracts. By the end of the second quarter, we expect that number to grow to over 220 million lives through an expanded partnership with a leading third-party benefits partner. This is a critical competitive advantage. When patients are able to use their insurance on our platform, we've seen customer acquisition costs decline by as much as 30% plus we expect meaningful improvements in retention in this population. As we layer insurance enablement across weight management, women's health and primary care, we believe this infrastructure will be a significant long-term differentiator for LifeMD.

The third infrastructure priority is our technology platform. We are investing in building a true platform experience for our patients, one that is architected to incorporate emerging AI capabilities and insurance benefits infrastructure in a way that feels invisible to the patient. This means rethinking how our platform is built at a foundational level, modernizing our underlying systems, creating flexible integration layers and designing patient-facing workflows that can seamlessly absorb these technologies without adding complexity. Today, AI tools and benefits verification exists largely as point solutions that sit outside of the core patient journey. Our goal is to enhance the platform so these capabilities are native to the experience woven into how patients access care, communicate with their providers and manage their treatment. Getting the architecture right is what makes a seamless patient experience possible at scale, and it is what will allow us to move quickly as both AI and the insurance landscape continue to evolve. We made meaningful progress on this in 2025, and it remains a top priority in 2026.

In summary, LifeMD entered 2026 from a position of strength with record demand in weight management, a diversifying specialty care platform, a scalable pharmacy operation, deepening pharmaceutical collaborations and the financial flexibility to invest aggressively in growth. We are confident in our growth trajectory and excited about the road ahead.

With that, I'll now turn the call over to our CFO, Marc Benathen, to provide more detail on our fourth quarter and full year financial results and outlook. Marc?

Thank you, Justin, and good afternoon, everyone. Our fourth quarter results were very strong and ahead of our previous guidance, driven by outperformance in all areas of the company. During the quarter, we added over 13,000 net new subscribers to our patient subscriber count. This was the largest net gain of any quarter in 2025 and is reflective of the strong business momentum as a result of LifeMD making significant inroads with the penetration of branded therapy within our weight management subscriber base and a consistent multi-quarter return to sequential growth in our men's health business.

To date, in the first quarter, we have seen this momentum continue and even accelerate in the first quarter of 2026 with GLP-1 patient new sign-ups at record levels and over 80% of new patient sign-ups going on branded therapy. We are leveraging our pristine balance sheet to invest in accelerating the acquisition and onboarding of patients to best position us for long-term growth and significant momentum in the back half of 2026.

Now turning to the fourth quarter numbers. Revenue grew 4% versus the year ago period to $46.9 million. Telehealth subscriber growth remains strong with the number of active subscribers increasing 16% year-over-year to nearly 323,000 at quarter end. Gross margin for the fourth quarter was 87.1%, an expansion of 570 basis points versus the prior year due to revenue mix and increasing operational efficiency as we scale. Gross profit was $40.8 million, an increase of 11% from the year ago period. Our GAAP net income attributable to common stockholders for the fourth quarter of 2025 was $19 million or $0.41 per share. This figure includes the onetime benefit from the sale of WorkSimpli last November.

Excluding this onetime gain, our GAAP net loss from continuing operations was $1.9 million or $0.04 per share. This compares with a GAAP net loss from continuing operations for the fourth quarter of 2024 of $6.8 million or a loss of $0.16 per share. Adjusted EBITDA is a non-GAAP measure we define as income or loss attributable to common shareholders before various items as outlined in today's news release. Adjusted EBITDA totaled $4.8 million for the fourth quarter of 2025, up from $1.1 million in the year ago period.

Now turning to the full year numbers. Revenue grew 25% versus the year ago period to $194.1 million. Gross margin for 2025 was 85.7%, a slight decrease of 50 basis points versus the prior year due to mix. Gross profit was $166.3 million, an increase of 25% versus 2024. Our GAAP net income attributable to common stockholders for 2025 was $11.2 million or $0.25 per share. This figure includes the onetime benefit from the sale of WorkSimpli. Excluding this onetime gain, our GAAP net loss from continuing operations was $13.3 million or $0.30 per share. This compares with a GAAP net loss from continuing operations for the full year 2024 of $26.3 million or a loss of $0.64 per share.

Adjusted EBITDA totaled $15.3 million for the full year 2025 as compared with $3.7 million in the year ago period. We exited the fourth quarter and full year 2025 with $36.8 million in cash and no debt. Turning to financial guidance. We expect first quarter 2026 revenue in the range of $48 million to $49 million with adjusted EBITDA loss in the range of $4 million to $5 million. This expected loss is purely being driven by record volumes of approximately 700 new patient sign-ups a day in our GLP-1 weight loss business amidst significant demand for our branded and oral therapy business. We see this discretionary investment as a major driver for potential growth in the coming quarters.

At the same time, we have achieved this record demand with a 4% sequential decline in CACs within this business line. Our very strong balance sheet allows us to easily finance this investment. LifeMD plans to return to adjusted EBITDA profitability in the second quarter following this investment. For the full year 2026, we expect revenue of between $220 million and $230 million and adjusted EBITDA between $12 million and $17 million. By the fourth quarter of 2026, we expect our annualized run rate for revenue to exceed $250 million and for adjusted EBITDA, our annualized run rate to exceed $25 million.

With that, let's now -- Justin?

Thanks, everybody. I think now we'll open up to questions.

[Operator Instructions]

And we'll take our first question from David Larsen with BTIG.

Congratulations on the good quarter and the good year. Can you talk a little bit about the demand you're seeing for, I guess, the Wegovy pill and the brand products? How does that compare to like, say, 3Q and 4Q of '25 heading into 1Q of '26?

Dave, this is Justin Schreiber. I'll take that one. I mean the demand, as we mentioned on the call, has been very strong since this product launched in early January. If you were to compare it I mean, as you can -- as we said, we doubled -- nearly doubled new patient acquisition in the weight loss business. And a lot of that was driven by Wegovy pill. So I think that's the best way to illustrate that. And we also saw really encouraging unit economics, which is why we decided to kind of spend more money than we otherwise might have on new patient acquisition in this area.

Okay. And then when you say patient or unit economics, can you maybe expand a little bit on that? Like what is the revenue model for the Wegovy pill? Is it being priced at like $150 a month, which I think is the cash pay price that Novo charges? Just any additional color there, like gross margins on that product would be very helpful.

Yes. So David, this is Marc. So it will depend upon dosage. But yes, typically, it's at $249 a month price all in as a bundle and can move up from there. The gross margins are healthy. I mean we're in approximately $100 an order or so in margin, which is pretty healthy. We treat it from an accounting and financial statement standpoint, similar to how we've treated other bundled relationships and that we recognize the net amount into the P&L, which is purely driven by the margin since essentially the product today, there may be other opportunities in the future.

But today, the product is essentially a pass-through and the margin that we make is on the additional services that we provide to our patients. So it's very similar economics to what we've seen on branded injectables, which are strong economics that have multifold returns on a 3-year basis.

Okay. That's great. And then just any more color on the investments you're going to be making in 1Q of '26 that's going to create that sort of EBITDA margin phenomenon?

Yes, this is Marc. Yes, I would expect -- I mean, look, the big increase is going to be in the sales and marketing line. If you look in '25, we're typically around that $20 million to $22 million mark in the sales and marketing line within the telehealth business. Obviously, the first few quarters, we also have WorkSimpli there. But telehealth around that $20 million to $22 million. We're going to be $30 million to low 30s in the first quarter, but that's also with CAC reducing sequentially about 4% to 5% and volumes doubling, which is pretty impressive that we're able to drive that much more volume with reduced CAC.

Obviously, because of the volume, it's going to drive incremental dollars. Those dollars will pay back to us in the coming quarters, particularly in the back half of '26. And given the demand out there and where LifeMD is positioned in the market, our insurance capabilities, we collectively believe it makes a lot of sense for us to go and capitalize upon that.

Okay. And just one last quick one before I hop back in the queue. The ramp in revenue, I think you're sort of talking about maybe $63 million in revenue in the fourth quarter. It's a pretty good ramp from 1Q. Just what will be the drivers of that increase as we progress through the year, please?

Predominantly subscriber count growth. It's mostly going to take place in the GLP-1 weight business, the growth in the women's health business, which is obviously at its infancy. And then look, the Rx business is back to sequential growth. It's going to continue to be a consistent grower as we move through each of the quarters. But those will be the 3 areas, and you're going to see it in subscriber count growth as we move throughout the year.

We'll move now to Sarah James with Cantor Fitzgerald.

Congrats on a great quarter and exciting outlook. There's a lot of growth levers here to unpack. So I want to stick on the topic of the run rate revenue and earnings. Is there any way that you can help us frame up when you're getting to that $25 million annualized EBITDA by exiting '26. How much of that growth is coming from women's health versus weight management versus cross care pharmacy? What are the main drivers there in '26?

Yes. Sarah, this is Marc. So first, I think it's important to understand when we launch a new offering like women's health, while we do breakeven, obviously, on the unit economics, typically in around the 6- to 7-month mark, sometimes a little sooner, sometimes a month or 2 later. As you scale into that business, it's not going to be EBITDA positive on a consolidated basis in the first year. It obviously will add a good amount to revenue, likely along the ranges of around $10 million on a full year basis with run rate being higher by the fourth quarter, but you're not going to be EBITDA positive in that first year.

So where the EBITDA accretion comes this year, and by the way, it will be very accretive next year in our financial plan in 2027 as we scale. And it will be -- we would expect it on a run rate basis to be EBITDA positive slightly by the fourth quarter. But where a lot of it comes from, we have obviously more mature men's health and weight management businesses, continuing to scale subscriber count in those businesses across highly leverageable fixed costs, albeit we are making a discretionary marketing investment now, particularly in the weight management business and to a lesser degree in scaling some complementary offerings and existing offerings in men's health. That's where a lot of the accretion will happen this year. Women's health will be in a great position at the end of the year, probably slightly accretive on a run rate basis and then significantly accretive in 2027.

Great. That's helpful. And just so we can get a better basis of understanding on the women's health. When you think about the early performance of your entrance into weight management or REX, how is women's health comparing on things like CAC conversion to care plans, early retention. What does the ramp there look like versus other markets you've entered?

Sarah, it's Justin. I'll take that one. So we've seen -- I think from a CPC basis, I mean, we've seen higher intent for these offerings than anything we've ever launched, which has been really, really encouraging on the marketing side. We've struggled a little bit on the kind of just the conversion rate side of the business and where we've been putting an enormous amount of energy into figuring that out. That was one of the comments I made on the call is that we've invested in just in our brand, in our assets and in incredible advisers. And just we've really kind of invested more than we've ever invested in a launch in the company's history in the women's health program. And we're starting to see like the benefits of that. I mean we've cut the CPA at least in half over the last 30 days or approximately in half, I would say. And there's still a lot of room for improvement.

So we can tell there's an enormous amount of demand there. We know that we have like an incredible service offering, the pharmacy products that we're offering. We also have a very big kind of portfolio of offerings -- pharmacy products that we're offering, including compounded hormone therapies, which are priced better than almost everybody else out there, I mean, especially considering how high quality our offering is. And the other thing that we're exciting to see, and we're already seeing the early signs of this is just like really, really good on therapy and retention rates. And so some of these like the initial on therapy and retention rates are north of 80%, which is really strong. And so like our whole kind of -- our plan from when we started designing this program was build something with an incredible value proposition. We know there's kind of a massive need there in the market, price it properly, and we're going to have amazing retention. And yes, look, it's a little bit early to make too big of a statement here, but the initial numbers are really good, and everybody internally is super excited about it.

We'll take our next question from Steve Dechert with KeyBanc.

Congrats on a solid quarter. Just wondering the level of stickiness you're seeing with people on the Wegovy pill versus the injectable? And then if that is a higher stickiness level, given it is early, only a couple of months here, but how much is that factored into your '26 guidance?

I'll take that one. So it's a little bit too early, as you said, to understand too much on the retention side of things. I mean it's not something that's like, I think, a big contributor to the run rate we said we'd reach in Q4 of this year. We've been -- we've taken kind of a very conservative stance on it. We've seen really strong on therapy rates, which is probably just driven by the fact that people that are coming to LifeMD and they know they want the Wegovy pill and they're getting on therapy and they qualify for therapy, and they're also okay with paying cash. The interim price for that drug is $149. So it's a very attractive price point. So the on therapy rates and the initial retention rates are certainly better than the injectable, but like long-term kind of retention is still TBD.

Okay. And then just on your weight management platform compared to competitors. I mean we've had Lilly announced a weight management offering. I think that was last week and then Amazon coming out with a kind of a direct-to-consumer offering as well. I think that was this morning. Just how does your platform compare to some of these competitors out in the market?

I mean, look, I think there are a couple of big things, and we put out a new -- we released a new investor presentation in the last hour that's up on our website that details some of these differentiators as well that I would encourage everybody to take a look at. But look, you compare LifeMD to Amazon. One, we operate our own 50-state provider group that's staffed mostly with full-time providers, which are just really highly trained in the areas that they practice. They specialize in women's health, they specialize in weight management. I mean that's a very big differentiator from the Amazons of the world. We also -- we're a platform for care, right? So we offer different types of specialty care.

We offer women's health. We offer weight management. We offer hormone therapy. Patients can access behavioral health and psychiatry. So I think having those -- having those kind of -- having that like portfolio of specialty care available is something that's also very unique when you compare what LifeMD is doing versus Amazon and really versus like most others. And we also offer the synchronous care that we offer. That's something that Amazon does offer through third-party providers in some verticals, like you can book a synchronous care or a video visit with a provider in urgent care. I don't know how their weight management business is structured, though. And compared to most people out there, that is a very unique thing about LifeMD is that you can do a message-based console, but if you want to have a real visit with a provider via video or audio, you can do that, and you're going to get a visit with, again, a highly trained provider in weight management that works for LifeMD's affiliated medical group and not a 1099 provider out there that's part of a massive third-party staffing business.

So those are a couple of the things. I mean it's a big market, right? And some people are going to use Amazon, some people have loyalty to other brands, but we're seeing incredible demand for LifeMD services and our pharmacy products. And we've had this conversation before around Amazon launching for instance, an erect outysfunction product, and it doesn't materially, especially in markets this big. And as you know, the GLP-1 market is even bigger than the ED market, it doesn't have a material impact on our business.

We'll take our next question from Ryan Meyers with Lake Street Capital Markets.

First one for me, just thinking about the patient acquisition channels that you guys are investing in here in Q1. Are you going after any different marketing channels? Is the marketing strategy any different here? Or is it similar to what you guys have done in the past?

It's mostly -- Ryan, this is Justin Schreiber. It's most -- it's very similar to what we've done in the past. We do have some new partnerships on the media side that have been spectacular performance-wise. They've delivered thousands and thousands of new patients. I don't have an exact number to share with you. We also had some -- we had several smaller employers that we've onboarded in the last 30 days, which is a program that we're piloting. And the reviews there and the feedback there from the employers are using our platform has been incredible. We're working on some other significant partnerships as well with some very large companies that could be transformational for LifeMD if we get them across the finish line. And those are things that we could see in the next 60 to 90 days. So we've got a very active pipeline right now of opportunities that would drive patient acquisition.

Okay. Got it. That's helpful. And then thinking about the benefits infrastructure being on track to cover the over 220 million Americans by the end of Q2. When you think about the potential lifetime value of a covered patient versus a cash pay patient, is there a big difference there?

It's a great question, Ryan. And I don't know the answer to that. I mean I don't have a precise answer for that because the insurance business for us is so new. I believe that retention is going to be stronger for a patient that uses their insurance or their commercial insurance or their Medicare on the LifeMD platform and pays their co-pay and has a lower membership fee, right, than a patient that comes in and pays cash and is not using their insurance. And so I think you're going to see better LTVs and you're going to see better retention. But we need to -- we still need to prove that out. I mean that's -- look, we're excited about the opportunity for -- the opportunity around insurance on the platform. We did -- we were surprised internally at the demand for insurance when we turned it on in the last couple of months. We talked a little bit about this on the last call, and I think we had turned it on with a week or 2 ahead of the call and saw a couple of days of really good demand. We turned it back when we opened up even more states and contracts. And we were impressed with the impact that it had on CPA.

Now it was a lower-priced offering, and we needed to work out some kinks in our billing processes. So we don't have the clear -- we don't have the -- I mean, we don't have as clear a picture as we would like on what the long-term value looks like on these patients. But we have enough data at this point, I think, to know that there's like a great and viable long-term business model here. We just need to kind of continue to figure it out. So I'm excited about it. I think you're going to see the business move more and more towards commercial and government insurance patients over the coming quarters. And I expect this to be a number that we actually kind of report on in much more detail to investors in the quarters to come.

We'll move now to Yi Chen with H.C. Wainwright.

This is Eduardo on for you. I guess I had a question. Could you just reiterate the total number of subscribers and detail again the number of them that came on specifically for the pill and for the Wegovy pill. I'm curious if you're seeing any migration from previously patients who were on the injectables that are going to the pill? Or is it primarily new customers who are signing up as subscribers for the orally available drug?

Yes, it's Mark. So we have 322,000 overall subscribers. As we indicated in our presentation that was updated presentation was published to the Investor Relations website today, approximately 80,000 plus are weight management subscribers. We haven't released like the exact count that our oral Wegovy pill, but we're seeing very strong demand for that product this year. Obviously, it only started selling in January. We haven't reported our subscriber count in Q1. So we're not at liberty to release that at this time, but obviously, it will be included in future updates. You're seeing some folks coming on to it, but it's honestly driving a lot of new patient demand for us.

Got it. That's really helpful. And then going to the pharmacy, I'm curious which -- now that you're 5 license, what percentage of RexMD and Shapiro MD fulfillment is currently handled in-house? And what's the incremental margin lift with the in-house fulfillment?

Yes. We are approaching the 70% mark with in-house fulfillment. The margin lift, we've been seeing -- and we haven't fully completed this exercise, but we're probably seeing along the range of 150 to 200 basis point margin improvement from internal. It also gives us obviously a lot more flexibility. And that's the real long-term benefit, the flexibility that we have with personalized and 503-A compounded products, which we can now do out of the pharmacy and those lifestyle conditions.

Got it. And -- I don't know if you'd be willing to detail any additional drugs you guys are considering compounding and bringing into your offering that you think would be key growth drivers for the pharmacy company.

Yes, we're not at liberty to -- we have a strong internal road map. We're just not at liberty to detail that at this moment.

At this time, there are no further questions in queue. I will now turn the meeting back to Justin Schreiber for closing remarks.

Thank you, everyone, for your questions and for your interest in LifeMD. We look forward to speaking with you once again when we report our first quarter results. Have a great evening.

Thank you. This brings us to the end of today's meeting. We appreciate your time and participation. You may now disconnect.

Good afternoon. Thank you for joining us today to discuss LifeMD's results for the third quarter ended September 30 and 2025. Joining the call today are Justin Schreiber, Chairman and Chief Executive Officer; and Marc Benathen, Chief Financial Officer. Following management's prepared remarks, we will open the call for a question-and-answer session. Before we begin, I would like to remind everyone that during this call, the company will make a number of forward-looking statements, which are subject to numerous risks and uncertainties that may cause actual results to differ materially from those projected. These risks and uncertainties are described in the company's 10-K and 10-Q filings, and within other filings that Life MD may make with the SEC from time to time.

Forward-looking statements made during this call are based on current information available to the company as of today, November 1, 2025. The company assumes no obligation to update or revise any forward-looking statements after today's call, except as required by law. Also, please note that management will be discussing certain non-GAAP financial measures that the company believes are important in evaluating Life MD's performance. Details on the relationship between these non-GAAP measures to the most comparable GAAP measures and reconciliations thereof can be found in the press release issued earlier today.

Finally, I would like to remind everyone that today's call is being recorded and will be available for replay in the Investor Relations section of the company's website. Now I'd like to turn the call over to Life MD CEO, Justin Schreiber. Please go ahead

Thank you, and good afternoon, everyone. After the market closed, we issued a news release announcing our third quarter financial results and posted an updated corporate presentation on our website at ir.lifemd.com. LifeMD made considerable progress executing on our strategic plan in the third quarter. Our RexMD business returned to growth adding approximately 10,000 net new subscribers, and our weight management offering has stabilized and is now well positioned for significant growth in 2026. We also continued to deliver strong year-over-year performance with Telehealth revenue up 18% and adjusted EBITDA increasing 30% compared to the prior year period. That said, the most exciting thing about LifeMD today is not our past performance or even the results this quarter, but the important foundational steps we have taken to set the company up for an exceptional 2026. During and following the third quarter, we made substantial progress on our women's health and behavioral health offerings. 2 verticals that we believe have the potential to each become 9-figure businesses over the next 3 years. We also advanced the development of our Life & D membership and in-app health marketplace, which we expect will meaningfully enhance patient experience, deepen engagement and strengthen long-term retention.

In addition, we secured regulatory approval for our nonsterile 503-A compounding pharmacy, a major milestone that will dramatically expand our ability to produce personalized medications at scale and a significantly improved economics compared to relying on third-party pharmacy partners. We were also pleased to successfully divest our majority interest in work simply. This transaction strengthened our balance sheet and allows us to operate as a pure-play virtual care and pharmacy company. While it was a difficult decision, the opportunity in front of our core business is so substantial that we felt it was essential to dedicate 100% of our focus and resources to our core health care platform. As we look ahead to 2026, our strategic priorities are clear. one, accelerating high-quality growth in our weight management offering by leveraging our collaborations with Novo Nordisk, Eli Lilly and others; two, scaling our virtual women's and behavioral health businesses built around synchronous care delivered by highly trained providers and personalized therapies. Three, expanding and diversifying RexMD particularly through personalized compounded medications and hormone therapies and; four, launching a more robust unified Life & D platform and marketplace designed to increase patient engagement improved cross care participation and deliver a significantly enhanced experience across both mobile and desktop applications.

LifeMD has made a deliberate decision to play the long game in the GLP-1 space. We are one of the few virtual care providers fully integrated with both Novo Nordisk and Eli Lilly. And we believe these collaborations represent a significant and durable competitive advantage, especially as prices come down on branded therapies and oral therapies come to market. The last 2 quarters have been challenging in the wave management category due to intense competition from low cost and, in many cases, low-quality compounded GLP-1 marketers, offering prices we cannot and will not match. While many of these compounded products are less effective and in some cases, unsafe, aggressive marketing and artificially low entry price points have drawn in a portion of consumers and created near-term pressure. Despite this environment, we have maintained our market share, remain disciplined and continue investing in the high-quality, clinically sound weight management model that we believe will create long-term shareholder value. We have consistently believed that branded GLP-1 manufacturers would ultimately reduce pricing to broaden patient access. And that moment is now clearly underway.

Just this morning, we announced that through our collaboration with Novo Nordisk, LifeMD will begin offering Wegovy and Ozempic to self-pay patients for $199 for the first 2 doses a 60% reduction from current prices. Higher doses will be available to self-pay patients for $349 per month, representing a 30% reduction. Eli Lilly also recently announced that self-pay patients will be able to access the Zepbound multidose pen if FDA approved at $299 for the lowest dose and up to $449 for the highest dose. Even more exciting is the expected approval of Gobi pill with a PDUFA date in late December. Analysts widely anticipate FDA approval and commercial availability in early January. LifeMD will be among the first virtual care providers to offer oral Wegovy through our collaboration with Novo Nordisk. While formal pricing has not been publicly released, we expect lower dose levels to be approximately $149 per month based on recent public remarks from President Trump. The Wegovy pill is expected to be the most effective oral medication for weight loss ever approved by the FDA. In clinical trials, patients achieved on average 15% weight loss over 68 weeks with sites profiles comparable to the injectable formulation.

In addition, Eli Lilly plans to launch its oral GLP-1 [indiscernible] later in 2026. And which we also anticipate offering through our platform at accessible pricing. The bottom line is clear. oral therapies combined with substantial price reductions will fundamentally broaden access accelerate demand and reshape the GLP-1 landscape. With more than 130 million Americans eligible for treatment, LifeMD is uniquely positioned to be a leading virtual destination for high-quality longitudinal care. Care is essential for patients to achieve the long-term outcomes these medications can deliver. Our Men's Health platform, RexMD, also had a strong quarter overall. Demand for our personalized ED medications, which combines sildenafil and tadalafil has been exceptional. And these formulations now represent 25% of all new ED prescriptions on the platform. These medications are currently fulfilled through a third-party pharmacy partner, so we plan to bring the majority of this fulfillment into LifeMD's in-house pharmacy in early 2026.

This transition will meaningfully reduce COGS improve gross margins and give us full control of the end-to-end patient experience. Our hormone replacement therapy offering is also demonstrating strong momentum and clear signs of future scalability. Early patient retention has been strong. New patient acquisition continues to grow. Demand is robust across age groups, and we have expanded into men's HRT coverage to 35 states. In addition, RexMD continues to broaden its portfolio with new men's-focused pharmacy products across behavioral health, weight loss, dermatology and more. We believe that our recently licensed 503A compounding pharmacy will be a major enabler of RexMD's growth, allowing us to offer personalized therapies, lower-cost compounded options and superior margins across multiple men's health categories in 2026 and beyond. In addition to our weight management and Men's Health businesses, we are very optimistic about the 2026 opportunity in both women's health and behavioral. Demand in both categories is very strong. And while these businesses are not yet contributing meaningfully to revenue, the initial engagement metrics interest levels, click-through rates and acquisition costs are on par with categories like ED and weight loss that scaled rapidly within their first year.

In both verticals, our focus is on building high-quality, high retention revenue streams. In my view, industry-leading retention is driven by 3 things: an exceptional product, great patient care and customer service and transparent pricing and strong value proposition. We also believe that enabling patients to use their commercial or government insurance is a critical part of the equation. While insurance enablement has been slower to deploy in our platform than planned, it remains a top strategic priority and will be an important component of our 2026 story. Our Women's Health business is highly differentiated. We have built and continue to expand an exceptional advisory Board of national leaders in women's hormonal health, menopause, bone health and longevity. We've also assembled a dedicated, highly trained clinical team to deliver this care, and we are confident in our ability to scale as demand accelerates. Patients can choose between bundled care and prescription cash pay programs or flexible models where they pay a la carte or use insurance to cover visits, lab words and commercially available medications.

In addition, our in-house compounding pharmacy will enable affordable access to compounded therapies for hormone optimization, sexual health, dermatology and more. We believe this will be the highest quality, most comprehensive and most accessible virtual women's health offering in the country and we expect demand to be extremely strong. Our psychiatry offering follows a similar structure, combining a la carte consults with bundled care plus medication programs that deliver discounted access and long-term, high-quality tier. Most patients begin with a synchronous consultation with a state license provider before transitioning into asynchronous message-based ongoing care. While the current patient count is small relative to our overall business, we saw meaningful quarter-over-quarter traction and expect psychiatry to become a sizable business in 2026. We believe this category will be another powerful durable growth engine for LifeMD. Given the strength of our balance sheet and the promise of these new offerings, we intend to invest in growth in these verticals early on in 2026 to rapidly build the patient base in these 2 verticals and in our offering to drive superior long-term retention.

Lastly, we are investing significant energy and resources into launching the core functionality and features that will enable LifeMD to execute on its long-term vision, building the leading integrated marketplace for virtual care, pharmacy, laboratory services and wellness. Much of this functionality including a comprehensive relaunch of the LifeMD website and mobile app, we'll be rolling out between now and early Q1 2026. These upgrades will allow patients to effortlessly participate across multiple care programs, access a broad suite of pharmacy offerings and order convenient in-home lab testing through a partnership we expect to formally announce early next year. Enabling seamless navigation across cash pay and insurance supported workflows is not easy, but it is essential to our long-term strategy. When completed, these enhancements will not only broaden the depth and breadth of services we provide, they will also deliver a significantly improved patient experience with clear pricing, more flexibility and expanded a la carte options.

Our objective is for patients to view LifeMD as a true virtual care destination, a place where they can access synchronous or asynchronous visits with trusted clinicians obtain generic, branded or compounded medications at transparent prices and conveniently order the labs that support their health goals and inform long-term care plans across both primary and specialty programs. We believe the integration of these capabilities will meaningfully differentiate LifeMD, deepen patient relationships and serve as a key driver of sustainable growth as we move into 2026 and beyond. With that, I'll now turn the call over to our CFO, Marc Benathen, to provide more detail on our third quarter financial results and outlook. Marc?

Thank you, Justin. Good afternoon, everyone, and thank you for your flexibility as we reschedule this call from November 6 to today. Our third quarter Telehealth business results were solid with year-over-year growth of 18% in revenue and 30% in adjusted EBITDA. Our REX business rebounded from its late second quarter lows with a net gain of 10,000 new members in the third quarter. We've also executed initiatives to significantly strengthen our balance sheet, including the divestiture of our majority ownership position and work simply and the payoff of all of our debt. Following these transactions, LifeMD has the strongest balance sheet and liquidity position in the company's history. This will enable us to operate from a position of strength in 2026 as we continue to invest in scaling our core offerings, plus further diversifying our platform through growth and recently launched offerings.

Now turning to third quarter numbers. Consolidated revenue grew 13% versus the year ago period to $60.2 million. Telehealth revenue increased 18% to $47.3 million with Telehealth adjusted EBITDA growing 30% to $2.9 million. Telehealth subscriber growth remained strong with the number of active subscribers increasing 14% year-over-year to over $310,000 at quarter end. Gross margin for the third quarter was 88%, a decline of 290 basis points versus the prior year due to revenue mix. Gross profit was $52.8 million, an increase of 9% from the year ago period. Telehealth gross margin was 86% as compared to 89% in the year ago period, driven by the revenue mix. Our GAAP net loss attributable to common stockholders for the third quarter of 2025 was $4.6 million or a loss of $0.10 per share. This compares with a GAAP net loss attributable to common stockholders for the third quarter of 2024 of $5.4 million or a loss of $0.13 per share.

Adjusted EBITDA is a non-GAAP measure we define as income or loss attributable to common shareholders before various items as outlined in today's news release. Adjusted EBITDA totaled $5.1 million for the third quarter of 2025 as compared with $4.3 million in the year ago period. Telehealth adjusted EBITDA is a non-GAAP measure defined as adjusted EBITDA for only the ongoing telehealth business, excluding work simply. This measure was $2.9 million for the third quarter of 2025 as compared to $2.2 million in the year ago period. We exited the third quarter with $23.8 million in cash and no debt. As previously disclosed on November 5, we identified adjustments following system migrations related to the recognition of revenue with offsetting related balance sheet accounts for 2022, 2023, 2024 and 6 months ended June 30, 2025. This resulted in an approximate $4.6 million impact in over recognition of revenue attributable for the total period. This adjustment had no impact on the company's cash flow or cash position.

Turning to financial guidance. Following the divestiture of our majority ownership and WorkSimpli resulting in a pure play stand-alone Telehealth business, we expect fourth quarter revenue in the range of $45 million to $46 million, with adjusted EBITDA in the range of $3 million to $4 million. For the full year 2025, we expect revenue in the range of $192 million to $193 million and adjusted EBITDA in the range of $13.5 million to $14.5 million. Full year guidance represents growth of 24% for revenue and 254% for adjusted EBITDA versus 2024. With that, let's now open the call to your questions. Operator?

[Operator Instructions] Our first question comes from David Larsen with BTIG.

Congratulations on a good quarter. Can you talk a little bit about the mix of Telehealth product revenue especially in like weight loss, like how much is coming from branded scripts? How much is coming from compounded scripts. There was obviously a sequential decline. Just any color of why that happened? Just any thoughts around 2026 in the obesity health sort of product line.

Yes. David, this is Marc. I'll let Justin take the second part of the question on go-forward product strategy. As far as the revenue mix, so weight management still is more than 50% of the companies. Total revenue mix. Yes, there was a slight sequential decline that we had quarter-on-quarter. The subscriber base was roughly flat. It was down about quarter-on-quarter, although that has stabilized and looks to be stable through the balance of Q4 and then with some of the product innovation in 2026 should return back to growth levels the biggest, I'd say, mix-wise, as far as new patient sign-ups, we're seeing more than half of them coming in through branded therapy. It's less than half of the total revenue because that -- the new patient base obviously needs time to build up relative to the existing base on the patients that are coming through branded therapy of which obviously, there's a substantial portion at this point.

As we mentioned, we -- the only real difference in the economics is the fulfillment fee that was on the personalized compound. So obviously, we do lose that. That was roughly -- for the majority of the time period was roughly about $50 in orders. So we have had some impact from that. That we expect to have some additional impact in Q4, which is reflected in the guidance that we put out today. And then we expect ourselves, particularly with a lot of the product innovation going on in the market and where we're positioned with our collaboration partners to be able to capitalize upon pretty solid growth heading into next year.

This is Justin. I'll just add quickly on 2026. I mean there are 2 big things that we expect to drive the weight management business. The first, as we emphasized in the call, is better pricing for branded therapies, which, as you know, we've made a kind of big investment in and so I think you're already seeing the writing on the wall there. I also think that as pricing for the cash pay programs comes down, I think you'll see more and more payers covering these medications. We've also obviously, seeing the outline of a program for Medicare to cover these drugs, which is also something that LifeMD is set up for. So I mean we're generally like really, really positive on 2026. The other -- like the other big thing that would help us would be the Trump administration doing something and I think this is likely, not just possible, but likely that as these -- as the branded therapies that are FDA approved, become more affordable to patients. I think it is highly likely that you see FDA crack down on compounding, which would be an amazing thing for our business if FDA were to slow that down.

Right now, we're getting beat up every single day by just a lot of these very low-priced semaglutide and tirzepatide offers out there that are all compounded, and it's very difficult for us to compete in that kind of a marketplace.

So Justin, I think you had been talking at one point about the percentage of new obesity health members coming on the platform in December of 25 expected to be around either 50% or 75%. Does that -- is that still true, like the majority of new patients are on branded products?

Yes. I mean that's what Marc just said. I don't have the precise number as of the last 30 days, David. But I mean, I still think that, that range is certainly extremely likely. I think we're at the lower end of that range now. But I think as these prices come down and especially when the initial doses come down into the $200 to $300 range per month, it makes it very competitive with a lot of the other compounded offers that are out there. So I mean, I think you easily could see that number going to 75% or even higher in the very near future.

Okay. That's very helpful. And then in terms of your coverage, your insurance coverage like Medicare, Medicaid, commercial, just I mean, it seems to me like now that Medicare and Medicaid apparently will cover these branded products in 2026. I'm not sure when that's going to start in 26, but assuming that it does happen, I mean, it seems like that could be a significant revenue stream for you. What portion of your revenue now is, I guess, Medicare or Medicaid or insurance covered versus cash pay and by the end of '26, what percentage of your revenue do you think will be insurance related?

I'm not really prepared to -- Marc or I are prepared today to give you an exact number for -- on a percentage by the end of '26. What I can say is that we are 100% ready to go with Medicare once these drugs are covered. So I think that's going to be a very significant thing for our business. And we have actually been seeing -- I don't think traction is the right word, but like we did turn on -- we have right now, it's somewhere between 100, I think it's somewhere between 100 million and 150 million lives under coverage right now. And we actually turned this on for the first time broadly last week. And we saw over a 1/3 reduction in our CPA. So it actually is a very, very positive thing for acquisition costs. So I think that -- I don't want to say anything, but the team at LifeMD is really energized around this. It's 1 of our differentiators. It's been frustrating how long it's taken for us to get these programs live. But I think that also speaks to like the difficulty for others that try to launch a 50-state payer network, right? So I think it's going to be a very positive thing for the business. And I'm really hopeful that we'll start to see that in the coming quarters and be able to talk in more detail about that becoming a greater share of our patients.

Any sense for what percentage of the members that are on your platform now actually have insurance? Or what percentage that would -- that perhaps don't join the platform, don't because they wanted insurance, but now that you take it, they can join in '26, just any -- can you put some numbers or anything around the potential lift in revenue we might see with insurance coverage?

Well, I can tell you, Dave, a decent percentage, I mean almost at least 25% of patients that sign up for our program end up not continuing with the program because they don't have insurance coverage for the medication. So that's a big thing. And as coverage increases these medications, it's going to be a massive thing for our business. So on the care side, I think it's significant. I mean I think that -- look, I mean, the stat I just gave you, we saw a 33% ballpark reduction in customer acquisition costs when we turned on the ability to use your health insurance for like, I don't know, 1/3 of the population, probably even less. So I mean that's a great sign. Like there's massive demand out there. And once we get these programs live and functioning the way we needed a function of scale, like it actually will have a really positive repercussion on the overall business.

And then just one more before I hop back in the queue. Can you talk about your clinical services and your retention levels amongst members? So let's say these GLP-1s go solid oral in early '26. Like the value that LifeMD brings to members that, say, for example, an Amazon would not -- or a typical like Costco maybe would not, can you maybe just talk about the value you bring and the retention levels or the weight loss that your members typically see that they may not see otherwise at a different platform?

Sure. So I mean, some of the other partners are like the Costcos of the world are going to have these drugs inventory just like I think it's pretty likely at some point that LifeMD will be able to direct ship these medications as well from our pharmacy directly to patients. So not a big differentiator there. Where I think there is a really big differentiator is in the portfolio of services and products that LifeMD offers. So the way I envision it, David, is like people may come to LifeMD and they make as an alternative to Costco or their family Doctor's office. They start with they typically start with an amazing visit with a state license provider, and they're going to use that to access -- initially, the goal might be to access the GLP-1 medication and use their insurance for the pharmacy coverage maybe even use their insurance to cover the cost of the visit. But no one has one need. And most people that are using a GLP-1 have many other health needs, whether it's preventative care, whether it's lab work for -- it could be something that most of these people have never had a provider speaking to them about their hormone health, LifeMD is also launching a cardiovascular offering in late this quarter, early January, which is going to be an incredible program.

There's an incredible shortage right now cardiologists throughout the country. So we're very excited about that. The ability to get a different medication. So we obviously don't compound GLP-1 medications, but we have a full-blown compounding pharmacy here that if somebody needs a hormone or a dermatology product where we can compound that at a fair price, ship it directly to them. So like this is the type of thing that I think the many of these other retailers that you mentioned, I don't want to name names, but I think they would all love to have this type of marketplace and even the brand associated with that marketplace. that's going to be the big difference between Life MD and these other places. Also mentioned also, it's worth pointing out that Costco doesn't have a doctor or a nurse practitioner if they don't have the provider, they can write the script. So you can go pick up your drug at Costco or some other or CVS, right? But like you still need a provider.

And that's where life comes into play. I think with Amazon, you obviously get the provider. But look, there's a big difference in the life of De brand and Amazon's brand. And there's certainly people that are going to be very loyal to Amazon. And but it's a big space, right? I mean there's going to be room for a number of high-quality players in this market.

Great. And last one, Marc, was there any revenue impact from that, I guess, restatement, we'll call it? Was there a -- would revenue have been $4 million higher? Or was it -- there was no impact?

It was not a restatement, it was a revision. The revision had a $1.1 million impact on this year. However, the revisions were made in the quarters that they applied to. So there was no impact to this quarterly results from it.

We'll now move on to Steven Valiquette with Mizuho.

So I think you kind of touched on this a little bit, but I guess I was kind of curious just also on kind of like the brand uptake, how that's going to track relative to your expectations? You gave some comments on less than half is still on brand, but I guess what kind of jumps out to me is just the fact that since you guys announced your brand drug partnership deals with Novo back in April and May, we've seen Novo Nordisk sign partnership deals for low-cost branded drive with a whole bunch of other companies in the virtual care space and pharmaceutical supply channel. So I'm wondering if some of those deals have diluted your expected uptake in any way. You have some of those other deals actually helped you in some ways again. Just trying to get a better sense of your ability to capture your fair share of customers seeking the lower-cost brand drugs in the weight management category and diabetes, too?

Sure. This is Justin. I'll answer that. So I think we knew that Novo and Lilly would do multiple deals. I think -- look, I don't think that them collaborating with other retailers and pharmacies and telehealth companies has an impact on the demand or the take rate on -- or the conversion rate on our platform. I think it's all about -- I think -- and I can tell you that I'm pretty sure they agree with me. Look, I think it comes down to price. And in a world where FDA ignores what's happening in the compounding world, and you can go out there and get a compounded therapy for, I don't know, even half the price or more a lot of times of what where the branded therapies are priced. It just makes it really difficult. And the competitiveness of even the compounding world, something that we didn't expect as -- since these drugs have come off of -- since these drugs have come off the shortage list, the number of players out there, the number of direct marketing firms that are competing in the compounded GLP-1 world has skyrocketed.

I don't have an exact number, but it's just gotten -- we expected it to get better, and it actually just got a lot worse and a lot more competitive. So when people are seeing a branded therapy that's priced at $349 to $499 they're seeing -- while they're purchasing and immediately after they purchase while they're waiting for a visit, right, we're seeing 10, 20 other ads, right, for these drugs sometimes as low as $99 for the first month. And usually, the prices are quickly escalate a lot of times in ways that aren't clearly disclosed to the consumer. But that's the current landscape. So we're really optimistic about -- we're really optimistic about branded therapy continuing to -- these branded therapies continuing to like perform on our platform. I think there's a big demand. We think the price point, they need to be in the $200, $300 range to be competitive with a lot of these offers, we need to see better coverage.

We think oral therapies, and I mean, most importantly, we think that the Wegovy pill that's likely to be launched in January is going to be -- could be a massive catalyst for the business. And so that's kind of where we're at today.

We'll now move to Anderson Schock with B. Riley Securities.

So first, on the return to RXMD growth, how much of this volume has been driven by the men's HRT offering versus the ED business returning to historical levels? And how does ED patient acquisition outlook compared to historic levels? I know you previously mentioned it was back to around 80% to 90% of historic levels as of the call in August.

Yes. So this is Marc. Most of the growth, so the 10,000, about 8,000 came from the sexual health business, which is mostly D. The balance of it came from a mix of the HRT business, hair loss and insomnia. As far as the acquisition volume, I mean, the acquisition volume is very close to where it was at historical levels. I'd say the caps are about $5 to $10 higher than what they had been, but still healthy unit economics comparable to where they have been, and the levels are very close to where they have been historically.

Got it. And then Telehealth's gross margin declined around 350 basis points. Could you provide some more color on what drove this? And how should we think about that Telehealth?

Yes. So this is Marc. Nothing in the business drove it like-for-like Product lines or service lines, the margins are the same, but it was really -- it was a couple of fold. One, as we mentioned, we're shifting more to branded product and the way management business, that branded product, obviously, doesn't carry with it some of the medication processing or medication processing fulfillment. Fees that we had on the personalized compounds. That contributed probably about 150 basis points of that change. And we had always mentioned that before when we had spoken about the change from compounding to branded. The balance of the rest of it is mix in business. So today, wave management is over 50% of the company's total revenue. If you were to flip back a year ago, Rex was the biggest part of our revenue rec, particularly Rex sexual health will have the highest gross margins that will sit in the upper 80s.

So the mix in that business and the shift there contributed to the rest.

Got it. And how should we think about the telehealth margins going forward with the new offerings in women's and behavioral health and also as you scale the 503 pharmacy

Yes. So in general, we would expect gross margins on a rate basis to probably be slightly below where they are today. And the reason for that is a fewfold. One, Mental health is a big area of opportunity for us, which will be very accretive to the company's top line and bottom line. But with that being said, gross margins in that business are not going to be $85 million to 87% or so. They are going to be lower. They'll typically have a 7 in front of them from a gross margin standpoint, which is if you operate very well, which we do operate our business very well. Secondly, some of the compounded offerings, the gross margins will be slightly lower even after we transition, although after we transition fully to our pharmacy, they'll probably get back to where the generic is are very close there. But in the interim, there will be -- the gross margins will be slightly lower and we expect that ratio shifting to branded therapy and weight to continue to go up and up to gross margins under current arrangements today where the product is a complete pass-through to the end customer, that would also have a mild impact on gross margins.

All of these businesses, we do expect to be accretive to the bottom line and they all have massive ability to scale and growth opportunities. Some of them have lower advertising costs than some other businesses that we've been in. So there are puts and takes there. But from a pure GM rate standpoint, we would expect a mild erosion in the rates just due to mix of business.

Thank you. We'll now move on to Sarah James with Cantor.

Earlier, you mentioned turning on insurance broadly last week and you talked about an observation of customer acquisition costs being down 33%. I'm wondering if you have any other observations from turning it on broadly? And then just if you could clarify the 33%, was that the lower cost of customers with insurance coming on? Or was it that the cost for customer acquisition costs for those with insurance would be even lower and you just had a big mix shift to those with insurance.

Sarah, it's Justin. I'll take that one. Look, I think what it demonstrates -- I think what it demonstrates is that a lot of patients that are coming through the medical intake process that click on LifeMD ad or business because it's something they sell on TV. I think it just demonstrates that a lot of these -- a lot of people like want to use their insurance for health care. And one of the unique things about the platform that we have that is still mostly synchronous is that we can participate in the benefits world. So it's just a function of more people getting through the flow, being able to check the insurance route versus the self-pay route, obviously, they're seeing a lower price point as well if they choose the insurance route. So there's also like a kind of exercise that we need to go through to kind of rework the financial model and see how that all plays out. But it was super encouraging and I think there's a lot more optimization that we could do as well.

And so where I get really excited about this, especially is things like Medicare where if you have broad coverage for these drugs, and we know we're going to get paid for a consult, and it's really just about the patient going through the initial benefits verification process. And then you have the visit and the medication that are covered and then we can ship the medication directly from our pharmacy to the patient. I think that's super exciting. And I think it just -- I think we've always known that this would have a big impact. We were just pleasantly surprised to see that it was that big of an impact without optimizing it more.

Great. And the new consumer-facing app and website that you're launching, do have any thoughts on how that could impact cross-selling ability?

Yes. I mean it's massive. I mean, the number of kind of cross care sign-ups per day. I mean I think it could easily be 50 or 100 consults per day off the bat and various care programs without us doing any work except for just the technology functioning. So I'm really excited about it. I mean, I think -- I know that it has the -- I know that it's the potential to like totally change the profile of the business. And also just totally LTV and retention rates across the business. So it's been a big effort and the new app is going to be beautiful. It's going to look -- I mean, I think our current app looks good. But what we're launching is just leagues ahead of where we are today. And I think it's going to have a big impact on the brand and also on the cross care rate and ultimately the LTV for the business.

We'll now move on to Yi Chen with HCW.

This is Eduardo on for Yi. I had a question regarding the 503A pharmacy. You mentioned that you're licensed in 14 states now. I'm just curious if you have an anticipated time line to reach the 50-state coverage and how much margin impact do you think that will have once you're fully scaled?

Yes. I think -- this is Justin again. The licensing process is pretty quick for a pharmacy that's already licensed up across the country like we are. So I would expect to be -- I would expect to be 35 state licensed in the next 60 to 90 days at the latest, it could be even sooner. And then the next kind of 15 states will trickle in, I think, let's just say another 30, 60, 90 days from there with 1 or 2 like California being difficult. So it's not a long-term thing, let's just say, I think we can be 50-state licensed for compounding, maybe with the exception of 1 or 2 difficult states in the next couple of months.

Got it -- and then regarding the...

And your question on the margin, I mean, the reality is it does have -- I mean owning and operating a 503-A compounding pharmacy is a big, big competitive advantage for us. It's extremely difficult to get the COGS to where you need them to be for our type of business. working with a third-party pharmacy. We do have some great third-party company pharmacy partners, and they're not going anywhere. But again, being able to bring these things in-house, control the patient experience really leverage kind of our supply chain capabilities as well, which are really good, especially in pharmacy to drive down COGS. I mean it just makes these things so much more accessible for patients.

Got it. And regarding the oral obesity products that we anticipate coming on to market soon. Do you have any visibility? Is there any market research to indicate what kind of bump like what fraction of patients are really holding back because they don't like the needle, right? I'm just to get a feel for your impression of how much these oral bioavailable obesity products are going to have on uptake of these therapies.

I think it's big, but I think your guess is as good as mine and probably as good as the drug manufacturers, right? I don't think there's never been an oral medication for weight loss with the type of efficacy profile that we got will have that's been approved by FDA. So it's really difficult. I think it's enormous. I mean in my social circles, especially people that are a little bit older, I think it could expand the market by 25% to 50%. I personally know a number of people that I would never think would avoid a very small needle like this or injectable, but that are just waiting for the oral product to come to market. So I think it's going to be very big. I mean to put a number on it, it's very difficult, but there is going to be massive demand is what I think.

Thank you. At this time, we've reached our allotted time for questions. I'll now turn the call back over to Justin Schreiber.

Thank you for your questions and for your interest in LifeMD. And we look forward to speaking with you once again. We reported our third quarter results -- or sorry, when we report our fourth quarter results in March of next year. Have a great evening.

Thank you. This brings us to the end of today's meeting. We appreciate your time and participation. You may now disconnect.

Good afternoon. Thank you for joining us today to discuss LifeMD's results for the second quarter ended June 30, 2025. Joining the call today are Justin Schreiber, Chairman and Chief Executive Officer; and Marc Benathen, Chief Financial Officer.

Following management's prepared remarks, we will open the call for question-and-answer session. Before we begin, I would like to remind everyone that during this call, the company will make a number of forward-looking statements, which are subject to numerous risks and uncertainties that may cause actual results to differ materially from those projected.

These risks and uncertainties are described in the company's 10-K and 10-Q filings and within other filings that LifeMD may make with the SEC from time to time. Forward-looking statements made during this call are based on current information available to the company as of today, August 5, 2025. The company assumes no obligation to update or revise any forward-looking statements after today's call, except as required by law.

Also, please note that the management will be discussing certain non-GAAP financial measures that the company believes are important in evaluating LifeMD's performance. Details on the relationship between these non-GAAP measures to the most comparable GAAP measures and reconciliations thereof can be found in the press release issued earlier today.

Finally, I would like to remind everyone that today's call is being recorded and will be available for replay in the Investor Relations section of the company's website. Now I'd like to turn the call over to LifeMD's CEO, Justin Schreiber. Please go ahead.

Thank you, and good afternoon, everyone. After the market closed, we issued a news release announcing our second quarter financial results and posted an updated corporate presentation on our website at ir.lifemd.com. LifeMD made tremendous progress executing on our strategic plan in the second quarter.

Our core telehealth business continued to deliver a strong performance, demonstrated by a 30% year-over-year increase in telehealth revenue and adjusted EBITDA growth of 560%. Our weight management program continued its momentum despite a large transition to branded GLP-1 medications. And our WorkSimpli business also continued to perform strongly, generating nearly $3.7 million in adjusted EBITDA on a stand-alone basis.

As we look to the second half of the year, we remain focused on several key strategic priorities: one, continuing to grow our leading care-based weight management program, emphasizing patient experience and helping our patients access both branded and genericized GLP-1 therapies as well as oral non-GLP-1 prescription weight loss therapies.

Two, returning our RexMD brand to double-digit growth by scaling our HRT peptide, prescription weight management and personalized ED and hair loss treatment programs.

Three, scaling our recently launched behavioral health offering and upcoming women's health program, both of which we see as opportunities that address large underserved markets.

Four, further expanding and investing in our LifeMD+ membership service and marketplace to drive deeper patient engagement, enhanced retention and improved health outcomes.

And five, executing on additional enterprise partnerships and collaborations designed to introduce significant new patient volume into our LifeMD+ and specialty care programs.

Our weight management business remains robust, consistently attracting over 400 new patient sign-ups per day. Notably, we've seen a significant increase in patients accessing branded therapy options through our platform. Given current trends and the improvements we expect to see in pricing and insurance coverage, we expect that by year-end, the vast majority of new patients will be on an insurance covered GLP-1 therapy, an affordable cash-based therapy or one of our oral prescription therapies for weight loss.

We continue to invest in improving the care platform that supports our weight management program. This decision is validated by the fact that we are seeing a growing number of weight management patients using our platform to access non-weight-related health care services and products. While our weight management segment did outperform our second quarter guidance plan for this segment, weight management has been impacted by a higher-than-anticipated refund rate driven by patients either lacking insurance coverage for their medications or being unable to afford the out-of-pocket cost of branded therapies.

Although this is a near-term headwind, we are actively enhancing our new patient intake process to include real-time benefit verification and other key improvements. These updates are designed to significantly improve the patient experience and drive higher conversion rates on to therapy. As part of these efforts, we are expanding access to a broader range of oral generic weight loss medications and adding liraglutide as a covered option. We remain highly confident in the long-term opportunity within prescription weight management. This is a large and underserved market, and we believe the steps we're taking will further strengthen our leadership position despite the temporary challenges.

Turning to Rex. We experienced a challenging second quarter, primarily due to temporarily elevated customer acquisition costs in the highly competitive ED market. However, we have since adjusted our marketing and product strategies and early third quarter data suggests a return to healthier customer acquisition levels. We remain confident in RexMD's long-term growth trajectory, especially as we continue to broaden our offerings into hormone replacement therapy, personalized compounded treatments for ED and hair loss as well as additional men's health categories.

While these offerings are still small relative to the size of the overall brand, early learnings from these new areas have been encouraging, and we believe that they have the potential to contribute meaningful growth in future quarters. In the same vein, we're especially excited about LifeMD's ongoing platform diversification into high-value clinical areas.

Our recent launch of a nationwide behavioral health offering focused on adult anxiety and depression directly addresses significant unmet patient needs and is highly complementary to our existing offerings, including our recently launched LifeMD+ primary care membership. The mental health market is a large opportunity as about 23% of U.S. adults have a diagnosable mental health condition each year and only half of these people receive professional treatment.

That leaves an estimated 28 million to 30 million adults with unmet behavioral health needs every single year. LifeMD's platform and affiliate provider group is well positioned to help address this enormous unmet clinical need. We expect this business line to begin scaling in Q4 and become accretive to 2026 results.

Similarly, the upcoming launch of our holistic women's health program will address critical care gaps related to menopause, hormone therapy and bone health, areas historically underserved in traditional health care. Currently, we operate a profitable concierge women's health service through Optimal Human Health, which we acquired in the second quarter.

We look forward to tapping into the significant market opportunity with a more affordable and scalable program on the LifeMD platform that is expected to be launched at the end of Q3. We believe the market fundamentals here are compelling as over 50 million women in the U.S. are aged 45 or older, with more than 30 million in perimenopausal or postmenopausal stages.

Approximately 2 million U.S. women reach menopause annually. And by 2030, over 60 million women in the U.S. will be postmenopausal. The care gaps are substantial. Approximately 60% to 80% of perimenopausal and menopausal women fail to receive adequate care for their symptoms. Additionally, up to 70% of women at high risk for osteoporosis remain untreated, representing a significant gap in screening and intervention.

LifeMD's clinical capabilities following the Optimal Human Health acquisition, along with our fully integrated telehealth platform uniquely position us to capture a meaningful share in this large, growing and historically underserved care market.

This program will begin scaling in the fourth quarter, and we expect it to be accretive to 2026 results. Before I hand it over to Marc, I want to briefly highlight our clear vision for long-term margin expansion, which is fundamental to LifeMD's continued growth.

Conventional health care still struggles with persistent issues like repetitive paperwork, fragmented records and inefficient processes, challenges that frustrate both patients and providers. At LifeMD, we're directly addressing these pain points by thoughtfully integrating AI into every aspect of our operations. Our goal is simple. Free up our providers from administrative tasks so they can focus on patient care and create a smoother, more efficient patient experience.

By streamlining routine tasks, intelligently routing patient requests and surfacing essential information exactly when it's needed, we're improving patient outcomes, provider productivity and ultimately driving our overall business performance.

We're equally excited about our recently launched LifeMD+ membership program, a premium offering designed to provide personalized patient care through around-the-clock access to licensed practitioners, same-day prescription renewals, comprehensive lab testing and numerous additional benefits. Although LifeMD+ is still in its early stages, we've already seen promising traction with nearly 50 new patient sign-ups per day. We believe this program will be central to deepening long-term patient relationships, boosting retention and making preventative care, including annual wellness visits, lab tests and medication adherence as simple, convenient and affordable as possible.

Together, the strategic integration of AI and continued investment in LifeMD+ position us strongly for sustainable profitability and long-term growth. With that, I'll now turn the call over to our CFO, Marc Benathen, to provide more detail on our second quarter financial results and outlook. Marc?

Thank you, Justin, and good afternoon, everyone. As Justin noted, our long-term financial outlook remains strong. Weight management, though experiencing some impact from higher refund rates from patients without coverage or for whom discounted cash pay pricing is still inaccessible, performed ahead of guidance plan in the second quarter.

New subscribers for weight management continued at strong levels and regularly exceeded 400 new patient sign-ups per day. WorkSimpli maintained its strong bottom line performance with quarterly adjusted EBITDA of nearly $3.7 million on a stand-alone basis. Our quarterly results were mostly impacted by temporary performance challenges impacting our RexMD business, which are largely behind us.

Looking at the numbers, consolidated revenue grew 23% versus the year ago period to $62.2 million. Telehealth revenue increased 30% to $48.6 million, with stand-alone adjusted EBITDA growing 560% to $3.4 million. WorkSimpli adjusted EBITDA grew 119% to $3.7 million. Telehealth subscriber growth remained strong with the number of active subscribers increasing 16% year-over-year to over 297,000 at quarter end.

The number of WorkSimpli active subscribers contracted by 6% to 149,000, primarily due to their continued focus on acquiring higher LTV customers to maximize profitability. Gross margin for the second quarter was 88%, a decline of 210 basis points versus the prior year due to a higher allocation rate of physician costs to COGS driven by higher utilization.

Gross profit was $54.5 million, an increase of 19% from the year ago period. Our GAAP net loss attributable to common stockholders for the second quarter of 2025 was $2.9 million or a loss of $0.06 per share. This compares with a GAAP net loss attributable to common stockholders for the second quarter of 2024 of $7.7 million or a loss of $0.19 per share. Adjusted EBITDA is a non-GAAP measure we define as income or loss attributable to common shareholders before various items as outlined in today's news release.

Adjusted EBITDA totaled $7.1 million for the second quarter of 2025 as compared with $2.2 million in the year ago period. Telehealth adjusted EBITDA is a non-GAAP measure defined as adjusted EBITDA for only our telehealth business, excluding WorkSimpli. This measure was $3.4 million for the second quarter of 2025 as compared to $0.5 million in the year ago period.

We exited the quarter with $36.2 million in cash and strengthened our balance sheet by fully repaying our senior venture debt subsequent to quarter end. This early retirement of our debt will save LifeMD approximately $1.1 million of cumulative future interest payments, makes our business debt-free and reflects the ongoing confidence we have in our long-term outlook.

Turning to financial guidance. We are revising our consolidated 2025 revenue guidance to be in the range of $250 million to $255 million from $268 million to $275 million previously. Telehealth stand-alone revenue guidance is now $195 million to $200 million compared with $208 million to $213 million. We're also revising our consolidated adjusted EBITDA guidance to be in the range of $27 million to $29 million from $31 million to $33 million previously.

We now expect 2025 telehealth stand-alone adjusted EBITDA guidance to be between $14 million and $16 million compared with $21 million previously. Updated adjusted EBITDA guidance still reflects a year-over-year increase of 89% to 116% versus prior year. This wraps up our financial results. I'd now like to turn the call back over to Justin.

Thanks, Marc. Before we open up for Q&A, I'd like to quickly revisit the second quarter. While we weren't satisfied with our overall performance, we believe these short-term issues are largely behind us and remain extremely confident in RexMD's long-term growth potential and a strategic role within LifeMD's broader platform.

The strategic initiatives we laid out at the start of 2025 continue to deliver meaningful results across all areas of our business. We've made tremendous strides in expanding and enhancing our comprehensive telehealth offerings, reinforcing our platform's capabilities and elevating patient experience at every step. Our patient satisfaction scores remain outstanding, averaging 4.91 out of 5, validating the quality and effectiveness of our care model.

We continue to expand and diversify our weight management offering and our recent strategic expansions into women's health and behavioral health represent significant steps forward, addressing large historically underserved patient populations with high-quality virtual care. These offerings, combined with our increasingly robust LifeMD+ membership program set the stage for meaningful patient retention, higher engagement and lasting relationships that will drive margin expansion and overall business performance.

Looking ahead, our priorities remain clear. We will continue investing in and scaling high-value clinical areas like behavioral and women's health further optimize and expand our LifeMD+ program and leverage our fully integrated pharmacy and insurance capabilities.

All of these efforts align with our overarching commitment to deliver the most patient-centric comprehensive and seamless health care experiences available anywhere. LifeMD is uniquely positioned to shape the future of health care, and I'm excited about the path ahead as we continue to deliver outstanding care, strong growth and long-term value for both our patients and shareholders. With that, let's now open the call to your questions. Operator?

[Operator Instructions] We'll take our first question from David Larsen from BTIG.

This is Jenny Shen on for Dave. Just on the insurance business, can you speak more about the insurance opportunity where you are right now? For example, how many states you're in? What portions of members are you taking insurance for? And what does the margin profile look like for those members compared to cash pay?

Jenny, this is Justin. So as of today, we are contracted with over 100 insurance plans across 40 states. We have just under 80 million lives under coverage. And importantly, like I expect, as we've previously guided, that to double between now and the end of the year.

It's still a very small percentage of the business. It's really important, I think, that we reach kind of -- that we have extremely broad coverage before like we can really run direct-to-patient kind of advertising for these offerings. So I really think you're going to start to see the insurance business scale considerably in '26.

One thing that's worth pointing out, though, is we have seen -- we have obviously submitted claims across both commercial to commercial payers and the government payers, Medicare. And the unit economics here are strong, and we're actually like really, really encouraged about launching programs, especially in areas like women's health, also in the weight management vertical once we see broader coverage for GLP-1 medications, the unit economics work.

And it can be -- we can see better LTVs with insurance-sponsored patients than we do with cash pay patients. So to be clear, like we're not -- we haven't scaled it today. And so although we've seen that with a very small population. But the data that we've seen, both from claims we've submitted and from kind of third parties and peers that we've looked at, like the unit economics can be very, very strong.

Sounds great. And then just a quick follow-up. Any comments on your relationships with Novo and Lilly? We're assuming that those relationships are still strong.

Yes. No comment. I mean those -- again, the integrations with Lilly Direct and NovoCare are in place, and we're continuing to see a greater number of patients access the self-pay branded therapies that are through those pharmacies that are available through the integrations that LifeMD has.

And we'll take our next question from Sarah James with Cantor Fitzgerald.

I was hoping you could give a little bit more color on what was going on with the rep customer acquisition costs. So looking at the guide change compared to what revenue had been running at, we're getting it was about 5% of revenue. Is that in the ballpark of what the step-up in customer acquisition cost was for that segment? And can you explain a little bit more about how that happened? Was that pricing? Or was it just the sales that converted from the leads changing?

Yes. So this is Marc. No. I mean, in general, we had -- it bounced around a bit throughout the quarter. We had some periods where CACs were up 15% to 25% sequentially over the prior quarter. Obviously, we had some other periods during the quarter where it was 5% up.

Obviously, when CACs go up by that amount, we're going to pull back on the amount of volume that we drive through that business. And one of the initiatives that we're really working on and we're going to make -- we started to make a lot of headway on, and we're going to make a lot more headway by the end of the year is continuing to diversify the business, which obviously gives us a lot more places to repurpose that capital should you see temporary disruptions in certain markets like what occurred in the Rex market, particularly within ED.

But a lot of it was higher CACs, competitive spending that in turn drove down our volumes, which in turn obviously had because the unit economics would erode at some of those CACs. And in turn, that would have an impact on both acquisition revenue and related subscription revenue from those subscribers.

Got it. And when you think about results going forward, do you mean that you're having tighter control on your acquisition spend? Or is it more that you think that the sales that are generated from that are going to go back to historical levels?

Yes. I mean, look, we've under -- I don't want to get into the exact sort of competitive specifics, but we've essentially seen through some actions that we took improvements in the acquisitions per day that are not quite at the Q4, Q1 levels, but they're very much approaching there, and they're significantly closer.

And the CACs have returned to the historical levels also, again, through some proactive actions that we took. There were changes in the market, and we just had to readjust what we were doing. Could we have been a bit faster doing that? Yes. But we did adjust, and I think we're in a good place now.

Sarah, this is Justin. I'll just add, like remember, we had a -- we had an enormous transition, right, this past quarter with the weight management business, which just really required a lot of energy from almost everybody in the organization. And some of the -- we did see -- we obviously saw these changes.

In the competitive environment, but some of it was just think we took our eye off the ball for a little bit, and it's -- we should have gotten this thing back online a little quicker, and we didn't. But again, as we try to -- as we communicated in the -- on the call earlier, like we feel really good about where the business is. There's a lot of exciting kind of new product opportunities for RexMD and we really want to communicate that this isn't something that we're going to -- we think we -- people should be concerned about going forward.

And next, we're going to go to Ryan Meyers with Lake Street Capital Markets.

Just kind of as a follow-up to the last question. I just want to make sure I fully understand it. So the full year guide down, that's totally related to the dynamics faced with the RexMD business despite the fact that you guys now have that resolved. Just want to get an understanding of any impact that we would see from that in Q3 and then more recently in Q4.

Yes. So the majority of it is related to that. There's a small proportion, as you mentioned, in the short term, there's some higher refund rates on the weight management patients. We're talking a few percentage points higher. That was a small proportion of the changes, which we've built into the Q2 and Q3 -- sorry, the Q3 guide.

But the vast majority of it was the impact from performance in Rex in Q2 and then the downstream impact associated with less new subscribers that came in the door in Q2, retaining those people throughout the year and slightly softer sales performance than we had historically seen. Obviously, we're building back.

But I'd say right now in terms of sales per day, we're at about 85% to 90% of where we've been historically, which is a big improvement over where we had been in the middle of Q2. But all of that is baked into the guidance. Now we've not assumed any potential complete rebound in Rex within that guidance. So we think we've taken a prudent point of view on that.

Okay. Got it. And then just on the topic of the LifeMD+ offering, any way we should be thinking about sort of marketing and any sort of spend that's associated with that as that continues to become larger and you guys put more kind of emphasis on that business?

Yes. This is Marc. Look, we have all of that baked into our plan. I mean, historically, as we've said, our marketing spend does tend to go up quarter-on-quarter. That was baked into the back half of the year. I mean, do any of these businesses require a very significant investment? No, but you do have to make the initial investment.

And look, today, we're bringing on about 50 new sign-ups there. Obviously, we'd like to scale that significantly higher, but we're going to end up doing it in a measured fashion as we do with a lot of our new launches to balance profitability with the growth of the company.

And we'll next go to Anderson Schock with B. Riley Securities.

Could you provide any color on what percentage of patients with insurance coming in for GLP-1s are being approved for coverage?

We don't have an actual percentage, Anderson. But I mean, again, like I can emphasize that we're seeing really, really great uptake and especially like a lot of the cash pay programs of Zepbound -- I'm sorry, Wegovy -- I'm sorry, Zepbound being the kind of #1 performer and then Wegovy also performing really well.

And one of the things that we mentioned in the script is I'm actually super confident that by the end of the year, I think we'll probably see -- I think it's safe to say that we'll see 75% of new patients either on an insurance covered GLP-1 medication like Wegovy or Zepbound or paying for one of the kind of self-pay products there.

So it's been like performing really, really well. We're also launching more of the kind of oral -- generic oral therapy options. So we think that, that probably can be somewhere between at least 10% and 20% of the business based on what we've seen with peers of ours in the virtual care world.

Okay. Got it. That's helpful. And then could you provide an update on the recent launch in behavioral health? I guess, how many initial subscribers have you seen? And how should we think about revenue contribution from this launch in the back half of the year?

Yes. I mean this is Justin again. So look, we've put a lot of work into getting this live. It's currently live across all 50 states. I don't have -- we're not ready to release like an exact patient number, but we are onboarding patients onto the program every day.

The way these things typically work is over the first couple of months when we launch one, it's all about testing and kind of working out not kinks at all in the care, but more kinks in like the intake process and just making sure everything is working smoothly, making adjustments and then it comes down to scale.

So we're really -- right now, it's definitely not -- it's not scaling per se, but we're really, really bullish on this, and it's something that we're extremely confident is going to start to scale over the next 30, 60 days.

Okay. Got it. And then how is the initial launch of your Medicare fee-for-service initiative progressed since April? Have you been able to expand as expected, reaching 49 states and 60 million beneficiaries at the end of the second quarter?

So we're still on track to expand this to 49 states by the end of the year. We had to rework some structural things with the medical group over the course of the last like 90 days. So we haven't started to scale the Medicare program yet, but it's something that we expect will scale in the back half of this year.

And we'll next go to Steven Dechert with KeyBanc.

I guess just curious on what the refund rate policy is with your customers? And then just anything that drove that to be higher in the quarter? Did anything have to do with de Novo or Lilly partnerships?

Sorry, you were kind of breaking up a little bit there, Steven. Can you just repeat the -- I heard the first part of your question on refund rate and refund policy. But what was the second one?

Just is any of that tied to the Novo or Lilly partnerships with those going into effect this past quarter?

Yes, sure. So I mean, our refund policy is extremely liberal. I mean if a patient comes in and doesn't get treatment or doesn't have insurance coverage, doesn't want to pay for a cash pay therapy, they basically get a refund, right? Some patients will pay. I mean, technically, according to the policy, like if they have a consult, they would pay -- they would need to pay for the consult. But in reality, if somebody wants a refund, they get a refund, and they get a full refund. So that's the policy.

Look, I don't think that -- certainly, like the collaborations with Lilly and Novo have not -- I mean, the collaborations with those pharmacies have not had a direct -- have not had a direct effect on the refund rate. But I mean, what does have an effect on the refund rate is just the fact that for a lot of patients, right, the self-pay drugs are branded drugs are much more expensive, right?

So patients are faced with oftentimes getting a $500 a month branded therapy through LifeMD or they can go -- there's another 100 providers out there that are still offering a $100 to $150 per month compounded semaglutide or tirzepatide product. And we look, we appreciate that -- look, the bottom line is like there still is not a reduction in the number of competitors out there selling exact replicas of tirzepatide and semaglutide.

So that, as you can imagine, like we have a lot of patients that come in and if they don't have insurance coverage and we can't submit a prior auth and get them covered for a medication. Many of them do request to refund and go elsewhere and find a cheaper alternative of the medication.

Okay. And then just wondering on personalized GLP-1s. Is that still something you guys are offering? And if so, kind of what roughly percentage of your weight management subscriber base is on those?

Yes. I don't have an exact percentage to share with you, but certain patients that qualify for a personalized GLP-1, again, like our providers are willing to send prescriptions to third-party pharmacies for personalized GLP-1 medications if the clinical presentation of the patient is appropriate, right? So I think we're very -- our providers are very conservative with this. But in certain situations, yes, our providers will send personalized prescriptions to third-party pharmacies.

And next, we'll go to Yi Chen with H.C. Wainwright.

This is [indiscernible] on for Yi. I was hoping to get a little bit more color on the -- to get a feel for the number of subscribers that are currently using the weight management versus the telehealth active subscriber count and see what fraction of users using each of those business segments?

Yes. Yes. I mean, look, we haven't historically broken it out. But in general, the weight management subscriber count as a percentage of the active is roughly kind of in that range of 30% to 35% of the total.

And then obviously, the largest proportion is within Rex. Obviously, the average weight management customer is worth more on a 1-year basis than the average Rex customer. And then you have other indications a rounded out sleep, hair loss and things like that.

Got it. That's really helpful. And do you -- are you guys open to providing any numbers on the attrition rates in each of those kind of to understand what retention looks like in each of those business segments?

Yes. I mean, look, what we've disclosed publicly is typically, we retain about 1/3 of cohorts after 12 months. I mean, look, we have 1, 3, 6 months. In some cases, we've had 12-month subscriptions. So we try to normalize it at the 1-year mark. But historically, we will retain about 1/3 of the initial cohort at the end of 12 months. Obviously, in the weight management business, a big chunk of that falloff occurs in the first 30 days with refunds for people that don't actually get on therapy. If you go by the folks that are on therapy, the retention rate is obviously much higher.

Got it. Got it. And in general, you've mentioned a few times about your focus and prioritization of getting good insurance coverage for your patients and connecting that into your system. Do you think that's your most meaningful differentiating feature for -- against other telehealth competitors?

Sure. This is Justin. I think that -- look, I think that's certainly one of our -- one of the big differentiators with LifeMD is the infrastructure for medical and pharmacy benefits that we're building. I think it's also our ability to operate a high-quality synchronous care platform across all 50 states at the scale that we do. If you look across a lot of the larger peers of ours, many of them are completely async programs, and that's kind of a very different offering.

So I think that we think that our model of offering medical and pharmacy benefits, offering a marketplace that -- where patients can use their insurance if they want to or their Medicare and subsidize the cost of their care and access like either, again, asynchronous care if it's more convenient for them or synchronous care if they really want to speak to a doctor, which -- and have a face-to-face visit, which a lot of people do. We think that's super unique. And in fact, we know that's super unique.

And that concludes our Q&A portion of the call. I will now turn the call back over to Justin Schreiber.

Thank you for your questions and for your interest in LifeMD. We look forward to speaking with you once again when we report our third quarter results in November. Have a great evening.

This does conclude today's program. Thank you for your participation. You may disconnect at any time.