electroCore, Inc. Aktie

Greetings, and welcome to the electroCore Second Quarter 2026 Earnings Conference Call. [Operator Instructions] As a reminder, this conference is being recorded.

Earlier today, electroCore published results for the second quarter ended June 30, 2026, and the press release is available on the company's website.

Before we begin, I would like to remind everyone that members on the call will make forward-looking statements within the meaning of the federal securities laws made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Any statements that are not historical facts should be deemed to be forward-looking, including, without limitation, any guidance, the company's outlook on third quarter and full year performance and its path to profitability.

These statements involve material risks and uncertainties that could cause actual results to differ materially from those anticipated. For a list of risk factors, please see the company's filings with the Securities and Exchange Commission. electroCore disclaims any obligation to update these statements, except as required by law. This call contains time-sensitive information accurate only as of today, August 6, 2026.

Joining us on today's call from electroCore are Dr. Thomas Errico, one of the company's founders, investor and Independent Chairman of the Board of Directors; Joshua Lev, Interim President and Chief Financial Officer; and Mike Fox, Chief Operating Officer.

It is now my pleasure to turn the call over to Dr. Thomas Errico, electroCore's Founder and Independent Chairman, for opening remarks. Dr. Errico?

Thank you, operator. Good afternoon, everyone, and thank you for joining electroCore's Second Quarter 2026 Earnings Call.

It is a pleasure to have the opportunity to speak with you all again about the transformation and momentum underway at electroCore. As Chairman of the Board, I have been working closely with Josh Lev, Interim President; and Mike Fox, COO for the entire quarter.

Josh has kept the company focused and steady while skillfully managing Investor Relations, while Mike has moved quickly to make important operational changes, including a major transformation of our sales force.

Change is never easy and managing change without disruption takes real skill. Today, I am proud to say that Josh and Mike have helped us make meaningful changes while keeping the organization moving forward.

You are about to hear the results shortly, but we are entering a new phase at electroCore, one defined by accelerating revenue growth and improving operating leverage. Today, we are raising our 2026 revenue guidance to greater than 30%, we are doing so while showing improvement in profitability with GAAP net loss in the quarter improving by 17% to $3.1 million from $3.7 million in the prior year and adjusted EBITDA improving 26% year-over-year and 25% sequentially.

This improvement comes as we deliberately invested roughly $1 million this quarter in initiatives designed to accelerate future growth. We now believe that this trajectory puts us on a path to achieve positive EBITDA in 2027. To me, that is what disciplined execution looks like, investing in durable growth opportunities while staying disciplined and holding the line everywhere on spending.

The Board is extremely pleased with the competency, discipline and leadership Josh and Mike have demonstrated in delivering this execution. Our strategy has not changed. What has changed is the pace and precision with which we are executing it, and that reflects the leadership Josh and Mike are providing across the company.

With that, Josh will provide opening remarks. Mike will walk you through the operational specifics, and then Josh will take you through the quarter and where we go from here. With that, I'd like to turn it over to Josh.

Thank you, Tom. Good afternoon, everyone.

This quarter marked the beginning of a new era for our company as we implemented significant changes across our commercial organization to better position us for long-term success while also improving reported financial performance. That included expanding our sales regions, adding new representatives and redesigning our incentive structure to improve accountability and cost efficiency over time.

While these actions required investments and focus throughout the quarter, we believe they've strengthened our foundation, improved operating efficiency and enhanced our ability to accelerate revenue growth. I'll let Mike walk you through the execution in more detail in a moment.

Now to our results for the quarter. We reported quarterly revenue of $9.5 million, an increase of approximately 28% year-over-year, driven by continued growth in the U.S. prescription sales in the VA and in direct-to-consumer Truvaga sales. We restructured this quarter, making the results especially encouraging given the magnitude of the organizational changes.

While revenue was flat sequentially, we expect revenue growth to accelerate throughout the year, underpinned by orders already received but not yet impacting revenue, as Mike will explain later on in the call. Importantly, we showed continued operating leverage as illustrated by our continued improvement in adjusted EBITDA, up 26% year-over-year and 25% quarter-over-quarter.

We view this performance as a meaningful win, demonstrating the resilience of our business and our ability to execute while positioning the company for long-term profitable growth. The changes implemented during the second quarter are already showing promise. And given the momentum we are seeing across the business, we are raising our full year 2026 revenue guidance to greater than 30% growth over full year 2025 revenue.

As Dr. Errico mentioned, we believe the operating improvements described today position us to execute our plan of achieving positive adjusted EBITDA in the third quarter of 2027.

Turning to the portfolio.

The VA continued to be our largest growth driver in the quarter. Prescription gammaCore revenue grew approximately 11% year-over-year and approximately 16,400 VA patients have now received the gammaCore device, representing approximately 2.7% penetration of the estimated addressable VA headache market.

When we acquired NeuroMetrix last year, we added two Class II medical devices to our portfolio. The first, Quell Fibromyalgia is currently marketed as a prescription therapy through the VA. The second, Quell 2.0 is an FDA-cleared over-the-counter device for lower extremity pain. It is not currently in production or for sale, and we may rebrand and relaunch it direct-to-consumer in the future.

At the time of the acquisition, we saw the opportunity to bring a different technology than gammaCore, sold through the same VA relationships, the same reps, the same call points, just a new product to sell. Since making the acquisition, Quell has become a bright spot in our product portfolio. Sales of the Quell product line were $1.3 million in the second quarter, growing approximately 700% year-over-year and roughly 30% over the first quarter of 2026.

Cumulative Quell revenue is approximately $4 million since our acquisition of NeuroMetrix in May 2025, of which $3.8 million of Quell Fibromyalgia has been sold into the VA. We believe Quell Fibromyalgia continues to be a significant opportunity for the company. where according to an article in Rheumatology Advisor, the prevalence of Fibromyalgia among male and female U.S. service members rose from 2.2% and 2% before deployment to 8% and 11.1% after deployment, respectively. The consistency we're seeing, particularly in Fibromyalgia, reinforces our thesis of providing non-invasive bioelectronic therapeutics for patients in need of non-pharmaceutical options.

Truvaga, our over-the-counter wellness brand, grew approximately 27% year-over-year to $1.3 million. Media costs expanded as competition in the health and wellness space increased, driving up the cost to acquire customers and reducing our media efficiency ratio to 1.91. In the first half of 2025, five competitors bid on Truvaga's own branded search terms. Through the first half of 2026, that grew to eight, a 60% increase in the number of advertising showing up on the exact terms that should be Truvaga's most defensible territory.

As a result, the direct cost per click of acquiring a customer increased by roughly 30%. In response to the increased cost of advertising in the space, we reduced our media spend by 2% in the quarter, allowing us to spend less while still driving to achieve year-over-year Truvaga growth.

In our first quarter of 2026 10-Q, we announced that on May 5, 2026, FDA personnel visited our facility in Rockaway, New Jersey to inspect matters relating to a follow-up 2017 inquiry on our wholly owned subsidiary, NeuroMetrix. On May 27, 2026, the FDA concluded their inspection and issued the company a preliminary 483 letter, citing four observations and two discussion points around how the company addresses and documents patient complaints.

Since receiving the letter, we have responded to the preliminary 483 letter with corrective actions to address the observations and discussion points. These corrective actions will delay the potential rebrand and relaunch of Quell 2.0 direct-to-consumer in the near term, but ultimately, we believe the changes will result in a stronger product and brand, positioning us to update our claims over time to better reflect the broader benefits of a newly branded product.

And now I'd like to turn the call over to Mike to cover some of the specific changes that were implemented during the quarter. Mike?

Thanks, Josh. Good afternoon, everyone. At the time of our last earnings call, I was three weeks into my new position. With nearly four months under my belt, I have never been more confident that electroCore is positioned to drive accelerating revenue growth with greater predictability and enhanced profitability.

My belief is underpinned by progress on three core priorities, which I shared on my first earnings call, expanding VA Medical Center breadth, increased depth of product utilization within each VA, building out the broader federal channel and driving operating principle as we scale. I want to walk you through where each of those stands as of today.

First, within our sales organization. We evaluated how our team was structured against the size of the opportunity in front of us, and the conclusion was very clear. We needed to execute a clear plan to expand coverage and assign clear accountability within the sales team. We doubled the number of sales regions and realigned our regional sales directors against that new structure. providing enhanced focus and stronger leadership over smaller geographical areas, allowing our RSVs to coach, lead and expand advocacy within their assigned regions.

This improved focus provides an immense opportunity for us for increased customer value, stronger patient advocacy and higher return on investment for the efforts of our sales team. Alongside that, we recruited, contracted and trained 17 new 1099 sales representatives who are now covering 29 VA medical centers. This is approximately 20% of the national VAMC network.

Let me stress, this group of new 1099s are not new to the VA market or new to medical device sales. These are some of the most talented and high-performing sales professionals available within the U.S. market. I have personally worked with every one of these new colleagues and can assure you they have all built legacies within their accounts and with their customers due to the many years of dedicated top-level customer service resulting in top-tier performance.

Their addition reflects the highest number of sales colleagues added to our team in any given quarter and illustrates that not only that we are dedicated to adding strength to every position and process within electroCore, but it showcases that the best are wanting to join in on our mission. In a short amount of time with these newly added 1099s, we have opened new VA accounts and expanded the number of new prescribers, representing tangible expansion of our footprint within the VA and Department of Defense accounts, the exact federal channel where we said the opportunity is largest and requires greater penetration.

These additions will help diversify our revenue across more facilities where currently our top 15 accounts produce 54% of our Q2 VA revenue. This diversification is important in mitigating concentration risks where a few albeit large facilities drive a significant portion of revenue.

To that end, in Q2 2026, one of our facilities had a staffing issue in their prosthetics department, creating a backlog of approximately 30 orders from being fulfilled. These orders, while prescribed in second quarter 2026, were filled and fulfilled in July, pushing roughly $145,000 in revenue to Q3 2026. The backlog did not eliminate the revenue, we booked it in the current quarter, but it does illustrate the need to expand the breadth of our facilities selling and fulfilling our prescription products so that no one facility can drastically affect our metrics.

We're also being disciplined on how we measure and impact that expansion. We've updated our KPIs to focus on performance dashboards so we can see new patients and refill rates at the individual VA account level, allowing us to build a pipeline of future scripts and focus on increasing our refill rate by 30% in every region by the end of 2026.

To make sure this newly expanded team performs, we also revised our sales incentive compensation plan to raise the bar on expectations and accountability. We brought on a new dedicated recruiter whose sole job is filling vacant or underperforming VA territories with proven sales talent. This, in combination with those talented sales professionals who are contacting us directly, requesting to join our team, will continue to strengthen our team and results.

These changes are also structured to improve our cost efficiency over time. Redesigning our incentive plan around sustained account-level growth rather than end of quarter volume is intended to reduce the sales and marketing expense associated with each dollar of revenue as it takes hold. And the realignment of territories is aimed at eliminating overlapping inefficient coverage that added costs without building sustainable accounts.

Based on the elimination of paying commission to overlapping sales colleagues, we expect to see a reduction in incentive compensation variable expense from approximately 35% of prescription revenue to approximately 27% by the end of 2027 and reduction of overall sales and marketing expense to approximately 54% by the end of 2027 under the new cost structure and territory alignment.

Beyond the VA, we made two targeted federal hires this quarter as well. We contracted a 1099 representative with a specific mandate to grow our presence within Kaiser outside of California market, and we hired a W-2 employee to bring dedicated focus and expertise to Department of Defense and Federal Workers Compensation, two channels we've talked about in the past as underdeveloped relative to their potential. One of the more structurally important moves this quarter was on the contracting side.

Moving forward, Lovell Government Services will be the sole federal supply schedule contract holder across all electroCore products in both the VA and Department of Defense markets. That simplifies how our products move through the federal procurement process and positions us to scale federal growth more efficiently. It will also cut roughly 3% of our General & Administrative expenses and transaction fees associated with direct sales. This transition for all federal orders processed through Lovell will be completed before the end of this month, August 2026.

We also have consultants identified with contracts being finalized to build advocacy and revenue, specifically within opportunities identified within first responders, Department of Defense and Departments of Women Health within the VA. One of our own Board members has been directly engaged in the women's health initiative, and we're encouraged by the early alignment there.

On TAC-STIM, we're working on adoption outside of active duty military and broadening our pipeline of potential customers. We're engaged in a study evaluating TAC-STIM during annual SWAT Training Academy scheduled in November of this year. We have also engaged another state police department for SWAT team evaluation and other opportunities to help our first responders in their daily roles.

Additionally, we have seen expanded utilization as shown by units purchased and distributed by various domestic law enforcement and U.S. intelligence agencies.

Finally, on marketing and enablement. We hired a marketing director with vast VA training and marketing experience, and we're developing a new training and onboarding curriculum for our existing and expanded sales colleagues that will roll out this quarter in 2026. In parallel, marketing is expanding provider-facing access to the substantial number of our published clinical trials and data sets while updating our materials so they more directly meet the needs of our customers and patients we focus on.

Ultimately, this quarter was about building and growing the infrastructure, people, contracts, data and process. That turns stated strategy of market and specific facility depth into something measurable. We're seeing early signs of success, and we believe this impact to grow over time as business progress translates into greater financial impact.

I'm confident in the foundation that has been established and actions we implemented in the last 90 days. We, as a company, are stronger and have set the blueprint for consistent and sustainable growth. I look forward to sharing more results and KPI metrics as the data develops in the months ahead.

With that, I'll turn it back to Josh to walk through the financials. Josh?

Thank you, Mike. For the three months ended June 30, 2026, electroCore reported net sales of $9.5 million compared to $7.4 million during the same period in 2025, an increase of approximately 28% over the prior year. The increase of $2.1 million was primarily driven by growth in net sales of Quell Fibromyalgia products acquired from NeuroMetrix in May 2025 and prescription gammaCore, which are sold to the VA and continued growth in net sales of the company's non-prescription general wellness Truvaga product.

The company expects that the majority of the fiscal year 2026 revenue will come from the VA. Gross profit increased $1.7 million to $8.2 million for the three months ended June 30, 2026, compared to the three months ended June 30, 2025. The increase in gross profit is attributed to the increase in net sales.

Gross margin decreased from 87.3% to 86.5% for the three months ended June 30, 2026, compared to the three months ended June 30, 2025. The slight decrease in gross margin was primarily due to an increase in our inventory reserve. Research & Development expense was $800,000 in the second quarter of 2026 compared to $500,000 in the second quarter of 2025. The increase was primarily due to increased studies and grants, higher stock-based compensation and initial cost to develop enhancements to our Truvaga mobile application.

Selling, General & Administrative Expense was $10.1 million for the three months ended June 30, 2026, compared to $9.4 million in the prior year period. Sales & Marketing increased $1.4 million from the prior year. The increase in sales and marketing expense was primarily driven by approximately $900,000 of variable expenses that supported the $2.1 million increase in net sales, reflecting the operating leverage embedded in the company's platform as it scales.

General & Administrative expense decreased $700,000 from the prior year. The decrease was primarily driven by $500,000 in bad debt expense associated with the tax and receivable recorded in the three months ended June 30, 2025, that did not repeat in 2026 and a reduction in professional fees in the three months ended June 30, 2026.

Total operating expenses in the three months ended June 30, 2026, were $10.9 million compared to $9.9 million in the three months ended June 30, 2025.

GAAP net loss in the second quarter of 2026 was $3.1 million compared to $3.7 million in the second quarter of 2025. The decrease in GAAP net loss was primarily attributed to higher gross profits associated with the increase in net sales, partially offset by variable sales and marketing expenses associated with the increase in those net sales.

Net loss per share for the second quarter of 2026 was $0.33 compared to a net loss of $0.44 per share in the second quarter of 2025. Adjusted EBITDA net loss in the second quarter of 2026 was $1.8 million compared to an adjusted EBITDA net loss of $2.4 million in the second quarter of 2025, an improvement of approximately $600,000 or 26% year-over-year loss.

Total cash, cash equivalents and marketable securities at June 30, 2026, was approximately $10 million compared to approximately $11.6 million at December 31, 2025. This quarter realized the early infrastructure changes that Mike walked through, including expanded sales regions, growth in sales personnel and focus on new KPIs driving sustained growth, giving us confidence to raise our previous guidance to greater than 30% annual growth over full year 2025.

Based on our current model, we are targeting positive adjusted EBITDA by Q3 of 2027, and we believe we can reach that milestone using our existing capital resources without the need for a dilutive capital raise or additional equity issuances if we can realize the operating leverage described above. I want to spend a moment on strategy because it is essential to how we think about business.

We are changing the narrative from electroCore being a single product, single customer story into electroCore as a multi-catalyst platform in bioelectronic medicine. There are three catalysts we will manage and communicate against every quarter. Let me touch briefly on the catalysts ahead for the second half of the year.

First, Research & Development, pursuing new prescription indications supported by more than 30 investigator-initiated trials currently underway across a range of therapeutic areas at no direct cost to the company and building the clinical evidence base for vagus nerve stimulation.

Number one, we are working towards an FDA submission for CIPN or Chemotherapy-Induced Peripheral Neuropathy using our Quell device and are targeting completion by year-end, subject to ongoing analysis.

Number two, we have begun working with the Dorn Research Institute on real-world studies with the VA to help us aggregate additional information in a post-use environment of our veterans utilizing gammaCore and its possible effects on PTSD. The Dorn Institute is one of the many VA research institutes located across the country with a primary focus on enhancing veteran clinical outcomes and quality of life. We believe this data will help us create an outline for an expanded label in mild traumatic brain injury and PTSD, expanding gammaCore from a headache therapeutic to a neurological health therapeutic. The real-world PTSD data gathering work is now underway at the VA site we selected and feeds directly into our Acacia effort. We'll keep you updated as that program develops.

And three, on the product side, we have begun outlining the framework for our next-generation clinical device, which looks to incorporate a form factor that will allow us to capture biometrics as well as provide vagal nerve stimulation. While we are just at the beginning of this process, we are working to develop a form factor that does not require being held by the user and gives real-time feedback in a closed-loop system, which could be valuable in understanding and addressing the specific needs of individual users or patients.

The second catalyst, we are looking to diversify our commercial customer base outside of acceleration efforts within the VA. That includes: one, push into new markets like TAC-STIM with first responders, such as a study utilizing TAC-STIM during annual SWAT training and other opportunities to help our first responders in their daily roles or progress with other various domestic law and U.S. intelligence agencies; two, expanding our Kaiser Permanente efforts outside of California and federal channels such as DoD and federal workers' compensation through our newly dedicated 1099 and W-2 employee, respectively; and three, new focus on advocacy within the VA's Department of Women's Health assisted by members of our Board.

Third, the last catalyst will be our operating results, accelerating revenue, lowering our cost of sales as a percentage of revenue to roughly 54% by the end of 2027 cutting out 3% of General & Administrative expenses associated with transaction fees on sales made off of our FSS contract and progressing towards positive adjusted EBITDA.

We continue to expect operating leverage to improve as our expanded sales infrastructure matures and VA revenue scales against a largely fixed cost base.

Before I hand the call over, a word on capital. Our approach is disciplined. Our intent is to invest capital behind growth, new indications and new products, not simply to fund operating burn. In the second quarter of 2026, approximately $1 million of the cash used was towards investing in growth, such as inventory purchases to meet our future sales expectations, capital improvements in our Rockaway facility so that our infrastructure can scale with our growth expectations and commercial team reorganization to accelerate revenue.

That discipline, combined with the momentum across the portfolio and $10 million of cash on the balance sheet positions us well for accelerating revenue growth and moderating operating losses through the second half of 2026 and gives us confidence in achieving positive adjusted EBITDA by the third quarter 2027.

With that, I'd like to turn the call over for questions. Operator?

Thank you, Josh. [Operator Instructions] Our first question comes from Jeffrey Cohen from Ladenburg Thalmann.

So, two questions. So firstly, can you give us a better sense of the back half sales and marketing expense as far as the ads? Walk us through the ads again as far as the sales force. You talked about 72 ads out of 1099. Are there any ads on the W-2s and maybe how that relates to back half spend versus front half, please?

Sure. Mike, do you want to take that? Do you want to talk about the changes you're making in the commercial organization?

Yes, that sounds great. Sorry, I'm getting a little back. I don't know if you can hear me back talk, but we'll clear that up for you. Yes, Jeffrey, great question. As you know, 1099s, we pay a percent commission based on revenue. So the additive cost of those 1099s that I said in the discussion points were some of the best in the country. There's no economic additions to that. That's truly just a percent of revenue enhancement to our bottom line. The increase in our regional directors from three to six was an additive cost. However, a few of those were promotions internally because we have a very strong bench internally at the company. So there's very little additional cost to that leadership change, in my opinion. It was a very smart investment and will be easily taken up by the increased revenue based on the focus.

Sorry about that. And then as a follow-up, could you talk about peripheral neuropathy, please? And what is the study that you anticipate to finish by the end of the year? And then how do you plan time-wise and pathway to get to an expanded label, I believe?.

Yes, it's a great question, Jeff. Thanks so much, and always thanks for the support. So our CIPN work is actually already done. When we acquired NeuroMetrix in 2025, there had, a study was already completed around the Chemotherapy-Induced Peripheral Neuropathy. When we took a look at the marketplace, we saw a really big unmet need. I think one of the statistics that I saw was roughly 70% of patients that go through chemotherapy have some form of chemotherapy-induced peripheral neuropathy.

So from our point of view, there's no real additional work per se that needs to happen on a clinical study point of view. Where we are now is really just organizing the data and presenting it a way that we can go ahead and submit to the FDA before the end of the year.

So from a just overall workload perspective, we don't actually anticipate the need right now for any additional data points. It's really more about packaging the information and working with our FDA consultants to go ahead and put it in front of the FDA as an expanded label for the Quell product line.

Okay. I think Jeffrey has asked all his questions. And we're going to go to our next caller. RK. Ramakanth from H.C. Wainwright.

A few questions from me. The first one, the prescription gammaCore revenue certainly grew 11% year-over-year this quarter. However, if my math is correct, sequentially, it is down 4%. So how much of that deceleration is commercial reorg that you just have completed or undergoing versus underlying demand for the product itself at the account level? And if I again, think about the guidance, which is greater than 30%, which means you've got to reach somewhere close to $23 million in the second half. What needs to get done from here to get to that point?

Well, so RK, that was a great question. Thanks so much. And again, thanks so much for participating today. I think from our point of view, if you go ahead and take a look at the gammaCore deceleration, a lot of it has to do, yes, with the change in the new era or the restructuring that we are doing. But I think it's less so about the actual changes that were made or the demand rather than we're changing the KPIs in the way that we're addressing the growth of the business moving forward.

What I mean by that is, historically speaking, we've had a very robust pipeline of refills. Our renewed focus in the way that we're starting to look at the world moving forward is not only necessarily on the refills, but building up that pipeline of future new patient starts as well. So I think what we saw in this quarter was, number one, a change in philosophy where we have our team that's going ahead and starting to shift a little bit of their focus away from what they were doing before to what we're looking forward to them doing in the future.

Then the other thing that I think is important to note is we did have that one hiccup in a particular location in Phoenix with the prosthetics department there. So typically speaking, that VA facility has roughly seven prosthetics agents that are fulfilling orders. That number was down because of resourcing issues to one, which created a backlog. As Mike indicated, that was roughly $145,000 worth of orders, which have since been fulfilled, meaning they are already going to be or they will be recognized in the Q3 revenue.

But going back to it, I think you're asking about the deceleration. I'm not so sure that while on paper, it was decelerated, but I think it's really more of a philosophy and how we worry about the acceleration moving forward, which also then sort of leads into your second question, which is where do we think that acceleration is going to come from.

I think part and parcel of what you saw is the work being done, right, in this particular quarter to help with the acceleration moving forward. We believe based off of the changes that have been made to the commercial organization, and that's a function of not only just the territory reorganization, but also the addition of new 1099s, changing the incentive compensation plan, focused on many of the KPIs or new KPIs that we're going to look for as leading indicators to the growth of our revenue moving forward.

We believe that will start kicking in, in this quarter, meaning in the third quarter of 2023. And then on top of that, when you think about that greater than 30% growth, the other areas where we've had more focus that started towards the back half of the second quarter and now moving into the third quarter in the areas such as TAC-STIM, where Mike had mentioned that we're increasing our work and our efforts primarily around different forms of federal agencies, both in terms of governmental state-wide police organizations as well as different intelligent agencies.

So Mike, as part of his expansion has not only hired 17 new 1099s that he's worked with in the past, but some of those people actually have role indexes and experience selling primarily into new channels, which we really didn't have before.

Mike, is there anything else you want to add to that?

Yes. Thanks, Josh. And exactly what you said. I would say the one thing to remember, RK, is that we try to do our best in some of these federal channels to have stability. But I would say it depends on the stability of the market you're in. The VA has always been one of those. It's hard to consistently expect quarter-over-quarter stability from them, but I am extremely proud of that 11% you talked about.

Because in our transition, if you understand our price points of some of our products we offer to the VA, for example, we have a 90-day for a trial run on the product to make sure things work for gammaCore, then we have a one-year and a three-year. Through this quarter, our new patient starts have been very strong during the transition. The difference is we've had some accounts in some areas that have gone instead of to a three-year prescription have decided to use the one-year prescription to better align with their fiscal year budgets and then also make sure that patients are doing well and are able to maintain therapy before they give them longer-term therapy.

So, it's not a loss. It's really a reformation of the processes in place for treating patients with migraine and cluster headaches. But when we see more patients being treated by more providers and more accounts behind that number, which is the part I see that you haven't been able to see at RK, I'm extremely happy with what I saw.

Would we love that number to be higher? Of course. But to see it at 11%, it is very easy to explain. The second part is why do we have the excitement for moving forward is because of the ability to get into these new accounts and have breadth and depth in so many different accounts, we can do better. But more importantly, we have a lot of providers in various departments, beyond neurology and beyond the headache clinics that treat patients that need our help.

We've hired and are coaching our people up to attain a higher level of expectations. And just like Josh said, there's things outside of the VA within Department of Defense that are extremely of interest. I was just at a Department of Defense meeting yesterday in D.C. And all I can say is the active military need us as much as the VA does. So that is a focus point. Hopefully, that gives you a little clarity.

Perfect. But if I may ask another set of questions. We have been used to certain metrics that electroCore has been giving us over the years. So, this is a question on that. So, you certainly disclosed 16,400 cumulative VA patients. I'm also trying to understand in terms of the facility count or the utilization and reorder metrics, is there some of that information that you can provide on this call? And also, Mike, one of your mandates, was trying to get 75% consistent monthly utilization. Where does that sit? And how far have you been able to get some of the folks really focus on that sort of metric?

Josh, I can take the second one for you first. Yes, RK, great question. It probably is a better answer I could give you territory by territory or account by account. stabilization a lot of times is have we had the right people with the right message because I truly believe in the three Ps, People, Process And Product. We've got extremely strong clinical data.

Sometimes with 1099s, they were not putting us high enough in their order of products that they were selling. So we weren't first or second in their bag. We were not getting priority time with the priority customers. So that is what we've been focusing on. So sustainability of getting more patients and more excitement is really to drive the advocacy with the individual providers in the VA. So that's where I'm seeing the greatest results. We have examples of a few of the 1099s that have come into accounts just in the last six to eight weeks, have gone from zero new patient starts to 12 new patient starts in six weeks just because we have somebody who understands the VA and understands access and how to get to the key advocates.

We have definitely enough patients to take care of in the VA. They need us there. So hopefully, that gives you a little bit more, but it's hard to say nationally what's the one thing because I would say the biggest part is the people and the expectations of performance that we're providing. Does that sound good?

Yes. And then just, RK, in terms of where are we in sort of total number of facilities, our goal this quarter really was not to go ahead and start to open up new facilities. It was to reorganize the team so that we have a plan moving forward for the third quarter. The number of new facilities that we ordered was flat from quarter-to-quarter.

However, the other initiative that we really did start focusing in on is we've had roughly or we've sold, we said publicly, roughly 200 different VA facilities that have purchased our products over the course of over the last few years. However, the last quarter when we were going through this process and this exercise, we noted that only about 1/3 of those facilities were really focused primarily on selling the Quell product. So one of the things that was a big focus of ours in this particular quarter in the second quarter was how do we go ahead and expand that adoption of Quell within the existing accounts that have already purchased from us a product, whether that was gammaCore or something else.

What we've done is change the training and the philosophy as well as the focus, I would say, on some of the sales executives that we have within our organization, whereby some of them now only sell Quell versus selling both. But the broader point here is our focus this quarter was not to increase the number of facilities purchasing. Really what it was is to set the stage for the third quarter, identify the new targets within different territories. And again, we have 17 new 1099s that are going to go ahead and canvas different areas, different facilities that we don't already have as well as increasing adoption of Quell within existing accounts.

I have a quick question on Quell. Actually, I appreciate you mentioning Quell and how you're managing and trying to grow that sales. In that vein, you grew over 30% sequentially on Quell sales. How are you assuring yourselves that, that sort of growth will continue? I know it's a 1.3 million base. It's not a big base, but still, how are you thinking about growth there, as you deepen your relationship within each of the VA facilities?

Yes. So I'll give you just my two cents and then I'll pass it to Mike to add anything that he feels. But I'd say there's a few things. Number one is we're really changing the way that we're thinking about our sales organization and how they're selling different products and who gets to sell Quell and who does not get to sell Quell. That's number one.

Number two is, I had mentioned earlier on the call that the total market according to rheumatology advisers I think it was roughly 2% of active duty military had some form of Fibromyalgia before deployment that came back to roughly 8% to 11% after deployment. This notion of attracting or going after active duty military, I think, is a really, really large opportunity for the organization.

We've historically really focused on the VA. But the Quell product line as its own right, when you think about it, doesn't really have so many natural competitors within the market space of bioelectronic therapeutics, specifically for different forms of Fibromyalgia or Fibromyalgia in general. So the reason why that's important to us is we've changed our training around the way that we go ahead and train for the Quell product line.

Historically, we've had one, call it, a product expert. That product expert is now working on in conjunction with the rest of the new marketing team that was brought in that Mike mentioned. on the resources and the training so that everyone has the ability to sell Quell as well as what I had said before, opening up a new real target market for us, which is active duty military, not something that we focused on in the past. Mike, do you want to add anything to that?

Yes. RK, I was just going to say one other quick, a couple of quick things. You can never get me to say one thing. First off, on the Fibromyalgia side, I think the excitement that we have is if you really look back when we acquired that company, remember, a company was established to standalone on Quell. And if you really look at the market, it could be a stand-alone product by itself. We're lucky to have it as a second product in our armamentarium. So this is, in my opinion, a very exciting time to have both products in the VA, specifically with Quell.

Just as an FYI, Fibromyalgia back in the literature back in the day, they call it chaos. Chronic hurts all over syndrome. The VA needs that type of treatment, and there is a significant number of patients with unmet needs that are medically being treated but not having a quality of life. So there is an opportunity for us to dive deep. I think the biggest answer to your question of what is our focus, it goes to our example with the women's health department. Women have a very high rate of Fibromyalgia versus their male counterparts within the VA and active military. Same is true for migraines.

But there's a large business within the VA that is focused on these type of ailments that we have not aligned with as a company as much as we should have prior to my entrance to the company. So we're focused on the right providers with the right therapy for the right patient. We do that. We're excited about the future with Quell.

Fozia, why don't we go to you? It looks like you've got a question as well.

I just was wondering if you can elaborate on how this transitioning to Lovell government services as your primary federal supply schedule contract holder will improve the process for its VA and DoD customers? And if you can expand on what specific advantages will come with this partnership?

Yes. Josh, do you want me to take that, and I'll turn it back over to you for some of the contracting side of that?

Yes, absolutely. Yes.

So yes, Fozia, great question because if there's not a lot of knowledge about what the difference between some of the opportunities in the FSS, one of them is to contract and have your products through small to stable veteran-owned groups. The advantage is very simple. The VA has requested a certain percent of their business go through those entities. So we're aligning with what the VA and Department of Defense wants.

But most importantly, for our business, they are the experts in basically processing orders and maintaining harmony within the ordering systems within the federal space. Not that we weren't doing a good job, but these are the experts at that job. So we are really lucky to have them taken us as a sole source, but also they offer things that we don't have the ability on our own FSS. They have what's called DAPA. They have ECAT. They also have a web store. They have a lot of other opportunities to help us with active military, such as the military treatment facilities and the VAs. And they have a strong relationship in D.C.

They have their own lobbyist firm. It's a really strong, it's not just a distribution network. It is a partnership. And I've worked with Lovell government services in the past with other companies, and they are the best in the country at helping to identify needs of veterans and taking care of those people that need help. So we chose this because economically, it makes sense, no question, but we did it also because it makes our business stronger, and it helps us do our job of taking care of the VA.

So Josh, I'll turn it over to you if you would like to add anything to that.

Yes. I think, look, on the contracting side and on the just the overall economic point of view, switching over to Lovell is something that we think can really help improve our margins. First and foremost, the way that Lovell gets paid is typically they have a markup to our overall price that we provide to the government. And the reason why that's important to note is when we sell direct from our own FSS contract, there are rebates that come off of that, that we were required to go ahead and pay back to the customer. It's called an IFF.

But that being said, that those rebates, that all comes out of Lovell's economics. So we don't have to pay that. it comes out of their fee. So incrementally speaking, there's no incremental cost to us because we net the same amount that we would have netted beforehand if we were selling direct. The difference is we keep the rebate.

The second piece, which I think is even more substantial, if you will, is whenever we charge a government, and as I'm sure you're familiar with this, the government's prosthetics department typically provides us their credit card. Every time we have a transaction that we swipe a credit card, it's roughly a 3% fee on all direct sales. Again, when we talk about Lovell's fee, their fee, which is incremental, captures that 3%. So typically, what will happen is on an order that we have from direct when we go direct from our own contract, we'll have to pay back the rebate and we'll have to pay the transaction fee.

When we go directly with Lovell, all of that we keep, right? We keep that. So I think that, that's an economic benefit. The only, I would say, "detriment" if you'll call it that, is when you think about our cash-on-cash cycle and our accounts receivable, historically speaking, our accounts receivable has been very, very good. And the reason why is because typically, we swipe the credit card and then we ship. In this particular instance with Lovell or with all Lovell orders, what happens is we get the order from Lovell, we ship the product, the VA pays Lovell and then Lovell goes ahead and pays us.

That extra one or two days is going to change our accounts receivable outstanding. But Lovell has been very, very consistent in paying us well, well, well ahead of what they're supposed to be paying us in terms of what's current and not current. And we don't think it's actually going to be a material change overall in terms of our AR balances increasing. But it is the only real change, I'd say, on the side of the contracting that I wouldn't consider "favorable." Everything else as part of this is a favorable transaction for the organization. So moving to Lovell just from an overall economics point of view, is going to be more favorable than it would be if we were going direct through our own FSS contract.

Great. Thank you. Operator, are there any additional questions coming from members of the call?

Okay. It looks like we've gotten the question here from Jeremy Perlman. Jeremy asks, you increased your full year revenue outlook from approximately 30% growth to greater than 30%. Can you break down what's driving the increased confidence? Is the upside primarily coming from gammaCore and the VA, Quell, Truvaga or all three? Mike, do you want to handle that one?

Yes. Sounds great, Josh. So great question, Jeremy. I know there's a lot of excitement here. So where is it coming from? I would say all of the above that you mentioned. But to put a little color on that, the VA has always been a focus, always will be for both gammaCore and the growth of Quell.

We are excited about the trajectories that we're going to see with both. But the Department of Defense, when we're talking about that down range, we're talking about military treatment facilities. We're talking first responders, the effects and the efforts we're putting at Kaiser and some new entries, people were discussing some potentials of TRICARE. I think the big excitement is because we're not just considering things. We're considering a lot of different points as critical access discussions for the quarter that have started to have actual metrics and results.

So as discussed before, we have had first responder orders from various SWAT teams. We have intelligence agencies ordering product. We do have military treatment facilities make their first order here in the last eight weeks. So we are seeing fruits of our labor. So that's why the excitement is here. It's not because we have good thoughts. We're starting to see results from our actions. So that's what I would say right now, that's where the excitement is coming from.

Thanks, Mike. Jeremy continues. The VA continues to be your largest prescription channel. Are you seeing increased utilization at existing VA facilities, expansion into new VA sites or growth in patients per site? Which of those will be your biggest contributor over the next several quarters?

Yes, Josh, that's a great question, and that's probably the one I love to answer most is, Jeremy, the answer is yes. I would say we have the team, we have the focus. We've got the products. So we have touched many VAs over the years since gammaCore has been here and also recently since the Quell addition, but we need to continue to have consistent utilization and advocacy in more accounts and more depth, and we have seen that during the next phase of which we incorporated here over the last 90 days.

So yes, we are going to continue to focus on that, which is going to have the biggest impact. I would say when a vast majority of VAs, the majority nationally are utilizing and we have a significant number of providers utilizing the technology. I may be somewhat happy at that point, but there's always room to grow. But it's a combination of both. We have to delineate the risk by having a few accounts carry large volume. We need to have more accounts with sustainable, consistent volume, and that's the focus right now that's going to continue to pay the biggest dividends. Back to you, Josh.

Thanks, Mike. All right. Last question from Jeremy. Should investors expect incremental gross profit to increasingly fall to the bottom line? Or do you expect to continue investing aggressively in commercial expansion?

So, Jeremy, again, another great question. I would say we do expect gross profit to increasingly fall to the bottom line. As revenues continue to expand, we expect that gross profit to continue to drop. We are seeing that we are getting operating margin out of our P&L. And the higher the net sales that we're able to generate, the more we believe is going to drop down to the bottom line. In terms of gross margin, however, we continue to guide both analysts and investors to model around that 85% gross profit margin.

We believe that, that number is sustainable, definitely in the short to midterm. And that is what we would guide in order to the analysts, right? So we keep that pretty much fixed.

And then in terms of investing aggressively in commercial expansion, I think Mike has done a lot of explaining of that over the course of the last hour or so on the call. We have taken a lot of steps over the course of this quarter to shepherd us into this new era. And there is a lot of commercial expansion going on, both in terms of our existing customer accounts, but also in terms of the different areas by which we believe that we can show that expansion.

That includes things from federal marketplaces, federal workers' comp, the TAC-STIM examples that Mike had given earlier in different state police departments, SWAT, different intelligence, federal intelligence agencies. And then last but not least, of course, utilizing the data and the product success that we've been having in Quell and bringing that as well as gammaCore to our active duty military.

So with that, that concludes the question-and-answer section of the earnings call. I appreciate everyone's time today. Thank you all to our shareholders for your patience and the continued support. And then, of course, most importantly, to our team, thank you for showing up every day with discipline and the ambition to help us execute on the strategy and really do the things that are required that will help us achieve our goals and the ambition that the opportunity that is in front of us demands.

So with that, we appreciate everyone's participation in today's call, and we look forward to speaking with you again next quarter. With that, that concludes our earnings call. Thank you, everyone, and have a great day.

Good day, and welcome to the IAccess Alpha Virtual Best Ideas Summer Investment Conference 2026. Our next presenting company is electroCore Inc. [Operator Instructions] I'd now like to turn the floor over to today's host, Joshua Lev, Interim President and CFO at ElectroCore Inc. Please go ahead.

Thank you, and thank you very much for participating in today's IAccess Alpha Virtual Investor Conference. A special thank you to [ Wiley Johnson ] for hosting us today. My name is Joshua Lev. I'm the Interim President and CFO of electroCore. We are listed on NASDAQ with the ticker E-C-O-R, ECOR.

We are a bioelectronic medicine and wellness company with our main focus in providing health and wellness products that are noninvasive products, utilizing bioelectronic technologies for different therapeutic areas and for health and wellness. Our products themselves are comprised of 2 different categories. One, our prescription-based products, the other our health and wellness products, which are sold direct-to-consumer.

Over the course of the last few years, we've been able to grow the revenue at a 5-year compounded annual growth rate of approximately 50%. And we've been able to do that while we have been increasing and expanding our gross profit margins from roughly 72% in 2019 to roughly 87% in the first quarter of 2026. Our sales model is variable in that we use a bifurcated sales organization that's comprised of both W-2 employees as well as 1099s or commission-only based sales executives, which allow us to go ahead and scale the business in a way where we can begin seeing operating leverage out of our P&L.

The majority of our revenue comes from the VA, the Veterans Administration or Association, utilizing our prescription-based product, gammaCore. But what's important to understand and note is in April of 2026, we have brought on a new commercial leader, a gentleman by the name of Mike Fox, who has spent the better part of the last decade in commercializing revenues in the federal markets.

In terms of what that means for us, as we look to expand and grow our commercial adoption of our product base over the course of the next few quarters and years, we look to the new commercial leader in Michael Fox to help us expand the commercial adoption, not only through the contacts that he's developed over the course of the last decade, but as well as utilizing some of the strategies and tactics that we believe can help us reduce our overall sales and marketing expense as a percentage of revenue and ultimately get us closer to cash flow breakeven.

As of the first quarter of 2026, we reported $9.6 million of top line revenue and $8.8 million of cash on our balance sheet. From a guidance point of view, we have guided to the Street in excess of 30% of top line revenue growth year-over-year or ending full year 2026 roughly around $42 million of top line revenue. As mentioned earlier, we've got 2 main categories of products. We have our prescription-based products, which you could see on the left, and we have a category of general wellness products, which are sold utilizing the FDA's general wellness guidelines in the middle and on the right.

And I'll go into each of those products in a little bit more detail. Our flagship product is called gammaCore Sapphire. This is the product that's primarily sold into the VA, and it's FDA cleared for different forms of primary headache. That includes items such as cluster headache, migraine, both for use acutely as well as use preventatively and also in adults and adolescents. This product comprises roughly $25 million of our overall revenue that we see. And the reason why the VA has been such a large adopter of this product is primarily because it is a non-opioid-based therapeutic that can be used and leveraged within the VA.

The technology that it uses is called noninvasive vagal nerve stimulation. Or said differently, what we do is we stimulate the vagus nerve noninvasively by utilizing a handheld device that can stimulate for 2 to 4 minutes over a duration of time. The reason why this has been so useful to the VA is not just that it's a non-pharmacological-based therapeutic, but noninvasive vagal nerve stimulation is a systemic approach to therapy rather than a direct approach to therapy. What I mean by that is the vagus nerve, which is also known as the temp cranial nerve, is the largest nerve in the body, and it connects to all the visceral organs.

So when you stimulate the vagus nerve, what you're actually doing is stimulating a nerve that is controlling not just the brain, but also other areas of your body. Because of that, what we see is our noninvasive vagal nerve stimulation product works particularly well with patients that have a lot of things wrong with them. So when you look at the VA patient population and you think about how many of those patients have a lot of comorbidities, not just headache, but headache being a symptom of other issues, the reason why our product has been so effective in the VA and adopted so quickly in the VA is because people that have a lot of different things wrong with them, for example, inflammatory issues, issues with their lungs, they see a lot of benefit utilizing our noninvasive approach versus using just a traditional pharmaceutical product, which is directed specifically to take care of just that headache.

In May of 2025, we acquired a company called NeuroMetrix. NeuroMetrix had a unique platform that they developed called Quell. And the Quell technology had previously been utilized and adopted and sold through a Class II medical designation of over-the-counter. A few years back, NeuroMetrix ran into some issues, and they began to go down the pathway of getting a Class II medical clearance for fibromyalgia. When we acquired this business in May of 2025, they had just launched their Quell fibromyalgia product into the VA, and they were selling approximately $50,000 a month worth of revenue.

We acquired the business with no dilution to the electroCore shareholders. We did not pay any cash. We did not raise any cash, and we also did not dilute the shareholders by providing the NeuroMetrix shareholders with any of electroCore stock. We provided those NeuroMetrix shareholders with the cash that was already on the NeuroMetrix balance sheet as well as a CDR based off of a royalty payment that's capped at $500,000 over the course of 2 years.

As I mentioned before, when they -- when we acquired this business, it was doing approximately $50,000 a month of revenue. In March of 2026, less than a year later, we reported that we did $400,000 of revenue in this individual product. In the first quarter of 2026, we did in excess of $1 million of revenue through this product line.

What was unique about this product and why it made so much sense to us is this is another version of a non-opioid-based pain therapeutic that we're very easily able to add directly to our sales bag. And when we're able to add more products to the bag of our sales organization, which we've already seen to establish as a commercial channel that is working for us, specifically for these noninvasive non-opioid-based pain therapeutics, we were able to see high adoption.

Moreover, utilizing this product is particularly of interest to us because roughly 8% to 11% of active duty military come back from deployment with some form of fibromyalgia. So we believe that this is a very large total addressable market that hasn't been tapped yet, and it already fits in very well to our bag, where we're getting some sales leverage without actually having to incur any additional cost in order to do so.

We sell our noninvasive vagal nerve stimulation products direct-to-consumer, utilizing the general wellness product guideline, which effectively says, if your product is safe, and your product does not cure a medical condition, you are allowed to sell it as a general wellness product. The best example that we can give for that is we could say that our product is used to improve your sleep, but we cannot say that it's used for insomnia. Insomnia is a medical diagnosis. And what we do is utilize our noninvasive vagal nerve stimulation technology and offer it up to the consumer marketplace as a device to help them reduce stress, improve sleep and help with stress over the course of a normal day.

There's a massive market when you think about the total addressable market for health and wellness products. And the way that we look at this market is it is in its an [ infancy ]. And when you look at all the additional products that exist in the market, for example, you have your goop bands, you have your oral rings, you have your Hume bands, all of those different products, what they do is they tell somebody from a health and wellness point of view, that their biometrics are telling them that something isn't necessarily right or something isn't necessarily working.

What's different about our product is our product actually does something. It stimulates the vagus nerve. It helps control the parasympathetic and sympathetic nerve system. And what that does is it helps correct many of the things that those devices such as oral rings and goop and Apple watches are giving you measurements around. We offer 2 different versions of this product direct-to-consumer, both of which are available through our website, truvaga.com. And the version on the left, the Truvaga Plus is our app-enabled noninvasive vagal nerve stimulation product.

And why that's important is as we look to the future and when I talk about the future catalysts, one of the items that we're looking to do is how do you take this app-enabled product that we have and create future generations of product that you can deploy a recurring revenue model or some form of subscription-based model, which will allow the company to increase its lifetime value of this product. The reason why that's so important is as a consumer electronic device, the Truvaga product line is a very expensive product to run.

Similar to all other consumer electronic devices and marketplaces, there is a high marketing cost associated with these products, particularly when you don't have any scale and you don't have any mass adoption or mass adoption or mass knowledge of the brand itself. So fundamentally speaking, what we have said over the course of the last few earnings calls is while we've been able to grow this business at roughly triple digits from 2024 of $2.4 million to approximately $5 million in 2025, we believe from a strategic point of view that it's better to grow this business at roughly 30% to 50% year-over-year and improve our operating metrics and our operating margins rather than continue to grow this at triple digits to the detriment of our operating margins.

The next product line that we offer is called TAC-STIM, which is short for tactical stimulation. This product was developed in conjunction with the Air Force Research Labs Human Performance Wing. And the reason -- this is a general wellness product and the reason why that's important is if you wanted to actually sell this product into the active duty military and deploy it across certain units, they do not want to have the extra red tape associated with having a prescription associated with this product.

This product was created coming off of the backs of 2 different studies that were done. The first was being done by a drone pilot commander, who saw that his drone pilots were having issues working large shifts, 12- to 14-hour shifts, they're taking uppers and downers, and they were trying to modulate their sleep, and they were getting into car accidents on the way home and dying. And what that commander said to us was these are very expensive units to replace. These drone pilots are very expensive assets to replace. So they utilized our product and what they're able to determine is not only was their sleep improved and their mood improved, probably due to better sleep improves your mood, improves your focus, it also improves your cortisol levels, but they were able to identify targets more accurately over a longer duration.

And that's very important when you have a cognitive load, specifically when every little dot that you see on that screen as a drone pilot could be a life or death situation. Around the same time, the Defense Language Institute, which is a government entity that we utilize to train our soldiers on learning second and third languages, did a study that showed that people utilizing our product were actually able to learn a second and third language quicker and retain it longer than those that were.

The reason why that's important is utilizing these 2 different pieces of data, the Air Force Research Labs came to us and developed a military spec version of this product, which is currently purchased by different government units, special forces units from the Army, Special Forces units from the Navy, Air Force that are currently buying this product and deploying it across different members of their units for specifically human performance and mental cognition.

We have large total addressable markets. As mentioned before, we just brought on a new Chief Operating Officer, Mike Fox, who brings us more than a decade's worth of experience selling specifically into the federal marketplaces. But specifically, when we look into the VA, there's approximately 1,300 facilities that can actually write a prescription. We have sold into approximately 200 of those facilities. Of those 1,300, approximately 170 of them have the opportunity to actually dispense a product or have their own budget, and we've sold into approximately 150 of those.

The reason why we think that this is important is there's a tremendous amount of upside that we still have within the VA. And as we look to accelerate our adoption within the federal marketplaces, not only do we see it coming from different areas such as Federal Workers Comp, Tricare and active duty military, but we believe our core customer, which is currently the VA has more than enough opportunity within its own right. There's approximately 600,000 headache patients in the VA. Of those 600,000 patients, we've only sold to approximately 2.5% in that. In addition on the commercial side, in 2025, we got on formulary and on contract with Kaiser Permanente. Kaiser Permanente, just by way of total size and scale, has 12.5 million covered lives within their organization prior to the acquisition of Geisinger. The VA has 9.5 million covered lives. So it's actually a larger managed care system larger than the VA.

So we believe that if we could start showing some adoption within Kaiser, other commercial insurers will follow suit because when commercial insurers look at our patient population, they say VA patients are different and don't really look like our commercial patients. However, the commercial patients within other commercial organizations do look very similar to that of Kaiser. So the Kaiser strategy is our beachhead strategy in order to help adoption with further growing our commercial efforts in the commercial insurer space.

In terms of our technology, I think it's misunderstood that electroCore is a single product, single customer company. Our technology itself, because it touches all the visceral organs, is actually more of a platform technology. We have more than 30 investigator-initiated trials currently ongoing, studying the use of noninvasive naval nerve technology in other functional therapeutic areas such as PTSD, long COVID, stroke, gastroparesis and others. The reason why this is important is as we continue down the pathway of who it is we're looking to become and what it is you want the Street to see, we're really trying to change that narrative around electroCore and why it's an exciting time today to be an investor in electroCore.

We are not a single product, single customer company. We are a platform technology company that has the ability to commercialize its technology, not necessarily in different forms or different indications, but also have it become more widely adopted throughout our commercial channels, both existing and future to come. As we look at the strategic catalysts that we want investors to follow us on and track over the course of the next few quarters and years, we're really pushing to show that we can increase the number of indications that we currently have utilizing noninvasive vagal nerve stimulation as well as maybe some of the technology that we've deployed with our Quell product.

We want to be able to show that we can come out with different products and different form factors that will be utilized on the commercial side. So it's not necessarily from an R&D perspective, just about increasing the number of indications, but the form factors that exist that we can then utilize in different forms of indications. An example of that, not something that we are currently going after today, but an example of that could be, for example, a patch-based deployment method, which could be utilized in acute treatment of stroke.

From a commercial point of view, Mike Fox has the experience has deployed strategies and tactics in order to help grow his previous company from approximately $20 million of revenue to $80 million of revenue within the VA over an 18-month period. And we're looking for him to utilize some of those same tactics and strategies within our own organization. But it's not just about growing the VA. It's also about going to places like federal workers' comp, TRICARE and active duty military, where we are currently very much on contract, but have never actually focused on having our technology being utilized in those different functional commercial areas.

Our goal over the course of the next few quarters is to start showing the Street that we are going to have more adoption in different areas, not just the VA, but hopefully opening up new accounts and new types of customers so that we can diversify our revenue set across a portfolio of different federal systems as well as commercial systems. And last but not least, and maybe the most important is operational, which is we have guided to approximately a 30% year-over-year revenue growth, but we want to be able to continue showing above-market returns relative to our comp set.

If you look at a comparable set of electroCore versus some other companies that we look at and we look at as comp sets, our revenue and our gross margin both outpace those competitive sets. But what we want to continue to do is continue to show that above-market return in terms of growth and in terms of ultimately getting to the point where we can do it in a way that shows operating leverage in our P&L and ultimately gets us to the point of cash flow breakeven.

We believe that our sales and marketing expense as a percentage of overall revenue will be a leading indicator. And one of the main areas of focus that we are looking at specifically starting in this quarter, Q2 and as we look into future quarters as we bring down that sales and marketing expense as a percentage of revenue from its current roughly 60% range to market standard of around 40% range.

Our revenue growth over the course of the last 5 years, as I mentioned earlier, been grown at greater than 50% compounded annually over the course of the last 5-year period, as indicated by the chart. And we've been able to grow our business very effectively. And even on a financing point of view, we've been able to do it in a way that has kept a very clean cap table for shareholders of electroCore. We have no variable rate securities within our cap table. We have no ratchet provisions, no anti-dilutes. We have a very clean cap table that's comprised primarily of shareholders, Board members and insiders and long-term equity incentive for employees.

As mentioned earlier, our leadership team has changed. In April of 2021, our former CEO, Dan Goldberger, retired. I took over as the Interim President and Chief Financial Officer. At the time my prior role with the organization was Chief Financial Officer. And before that, I was the Chief Strategy Officer. We brought on a new Chief Operating Officer by the name of Michael Fox, who comes with 35 years of experience in commercializing medical devices, the last 10 of which for a decade of which has been really focused in the federal marketplaces.

And we also have Dr. Tom Errico and Dr. Peter Staats, who are founders, inventors and investors in this company who have been along with the company since it went public roughly in 2018. Actually, they've been around with the company since 2005 when the company was founded. So with that, our company is traded on NASDAQ. The ticker is ECOR, E-C-O-R. And I'm going to turn over to the Q&A section or portion of the conversation and take any questions that may pop up in the Q&A section of the presentation.

I'm just giving it a moment for questions to come in. First question that came in is, what are the main drivers behind your confidence in achieving 30% growth in 2026?

So great question. We believe that we could have achieved a 30% growth even before we brought in a commercial leader. The way that our systems, CRMs and products work is that we actually track things like new patient starts as well as refills. And based off our overall cadence of business and utilizing percentages, we believe that, that 30% revenue growth is actually something that's very achievable.

Now with that being said, that 30% growth is what we believe we could do prior to making changes in our commercial organization. I can tell you that Mike Fox started in April of 2026, earlier this, this quarter. He has brought on a team of people, including 1099s and other commercial sales executives that he has worked with in the past that have provided him -- that have generated for him revenue in other areas.

So while our current guidance is 30%, I believe that historical prescriptions and refills justify that, that 30% is achievable, and it's typically backloaded in the half of the year. Moreover, as we get better and smarter about the way that we sell and the way that we grow our sales organization, I believe, that 30% has the ability to grow further.

Q1 revenue grew 43%. What drove the strength across the prescription device and consumer wellness business? Great question. I think overall, the 43% growth, a lot of it has to do with those new patient starts that we had, as I mentioned to you in prior years and prior quarters. The company does have a robust inside sales and customer experience organization, where what we're able to do is provide white glove service to all of our customers and patients that come in to ensure that they're staying on compliance and using the device correctly. Really, the more you use it, the better it works and therefore, the pipeline of refills can become a repeatable business.

The VA remains your largest channel, but penetration is still only around 2.5%. What are the biggest opportunities? I think the biggest opportunity right now is changing the makeup of our sales organization. It's one of the things that's currently being done currently by our new Chief Operating Officer. And what I mean by that is a few things. #1, the way that our territories are currently carved up allows for ample opportunity for people -- salespeople specifically to generate revenue.

However, they've got large batches of territories. The best example I can give for the moment is we've got one territory business manager that has Southern Florida as part of his territory. He does very, very well in Fort Lauderdale and he does very, very well in Miami VAs. But there's areas such as Gainesville, which is about a 5.5-hour drive from where he currently resides that doesn't do as well as those 2. If we're able to carve up the territories in a different manner such that we actually have the ability to have someone in that Gainesville VA more frequently, I believe that, that will be an area where we can go ahead and actually grow or to continue to grow our revenue base in a more repeatable fashion.

The other way that we look at this as well is you have to show up in the VA. So one of the things -- and what I mean by that is even though the VA is our largest customer, there is this false premise that we are a single customer product. The way that it actually works is of those VAs, we actually have 150 separate and unique customers. And just like any other business, 80% of our revenue is coming from approximately 20% of our customers. What we need to do is we need to go better in terms of depth of our customer base rather than the breadth of our customer base.

How meaningful could Quell become in the VA? I believe Quell over the course of the next 3 to 5 years may have the ability to surpass gammaCore as it relates to its overall opportunity. The reason why I say that is roughly 8% to 10% of overall active duty military that come back from deployment come back with some form of fibromyalgia. Fibromyalgia is very interesting. It's not necessarily something that has historically been identified as ubiquitously accepted as a diagnosis. There is inflammation, people are in pain, people don't really know why.

Now fibromyalgia is becoming more and more better adopted as a cog diagnosis. But more importantly than that, when you look at companies like products like gammaCore, there are a large number of pharmaceutical-based products commoditized-based products that are used for treating headache, items such as triptans, sumatriptans, even Advil and Tylenol. Fibromyalgia doesn't have that. We are the only device that's currently available to treat fibromyalgia. So I actually see that as being a larger opportunity for us in the future.

How do you think about the long-term opportunity for Truvaga as a general wellness product versus gammaCore and Quell? I think the Truvaga opportunity itself has a much larger total addressable market. So if you think about the context of all the products that exist within the health and wellness space, which -- I'm sorry, Truvaga fits into, I'd say that, that market is a lot higher, but the operating margins on that business are a lot smaller. And it takes a lot of money to get to critical mass. So the way that we're thinking about it now is we really want to grow the medical side of the business, which has much higher operating margins be able to utilize that as a function to basically underwrite, if you will, the future growth of Truvaga rather than having to go to the market every year, every other year to raise additional capital to grow Truvaga.

We believe that we can do it with the high operating margin business that we currently have within the medical side of the business. And our focus is going to be is focused on the high medical side without depleting or getting rid of completely the Truvaga side of the business.

The Department of Defense appears to be underdeveloped opportunity. How does the sales cycle with the VA? It's a great question. I can't answer that question yet because I don't really have the answer to that question. We're just starting now on the Department of Defense side, but we hope to provide additional information in future quarters.

Gross margin remained at 87%. How sustainable is that? We guide all of our analysts that mid-80s is where we believe our margins are going to fall. There'll be some quarters where they're lower than 85%, some that are higher than 85%. So we guide at a roughly 85% gross profit.

Potential label expansion for PTSD and PDI, which pipeline opportunities are the most important strategically. I think that's a great question. PTSD from a strategic point of view, probably makes the most sense because it's the lowest hanging fruit. What I mean by that is our largest customer is the VA, they have a large number of PTSD patients, as you can imagine. There's a very high comorbidity between PTSD patients as well as headache patients. The challenge with that is going to be the data that currently exists. And even though that, that is a large opportunity for us, we also know that our product is being sold off-label already for PTSD.

Other areas like mild traumatic brain injury also exist as a large commercial opportunity. There's other areas of opportunity that we have, for example, CIPN, which is chemotherapy-induced peripheral neuropathy, which is something that we inherited as part of the acquisition for NeuroMetrix that may actually be a lower-hanging fruit than all the other gammaCore related.

For investors new to electroCore, what do you believe is most underappreciated by the company's growth platform today? That's a great question. I really think the answer to that is we are a platform technology business with the opportunity to expand on the commercial opportunities rather than just a single product, single customer company. We are on the precipice of commercial adoption in areas, both accelerating within the VA, but within other areas of the federal marketplaces. And we believe that our P&L is starting to actually show operating leverage. As revenues continue to scale, we ultimately do see the pathway to profitability. We just need to continue the trajectory of revenue growth to ensure that we can cover all of the fixed expenses and now get to the point where we are truly seeing that operating leverage out of the P&L.

And then the last question I have here is how important is your broad IT portfolio? I would say we believe that the technology portfolio is an important part of the assets that we have as an organization. I briefly skimmed over the slide before because of time limits. But fundamentally speaking, we have more than 300 patents and patents pending both in the United States and globally. I think noninvasive vagal nerve stimulation in the cervical area of the neck, primarily in the neck area is going to be very important because vagus nerve stimulation as a product or as a therapeutic has been around for many, many years.

Most of the vagal nerve stimulation products that currently exist on the marketplace that have ubiquitous adoption are implantables. They're implanted utilizing a surgery where you open somebody up, you wrap a stimulator around the vagus nerve and then you close them up. Those are currently being deployed by companies like LivaNova, SetPoint, Cyberonics are all companies that have utilized these products in different areas, functional areas such as epilepsy and depression.

What I think makes us unique is how do you stimulate the vagus nerve noninvasively for all those people that don't want to have a surgery because I believe or we believe as an organization that from an adoption standpoint, vagal nerve stimulation is something that could be ubiquitously adopted for different reasons, which is great. Invasive exists currently. But since the vagus nerve runs up and down the cervical region of the neck, it also touches the auricular area or the ear. Well, when you look at the vagus fibers, roughly 80% to 90% of the vagal fibers run in the cervical region, where roughly 2% to 14% run within the auricular area or the ear.

So if you're going to use noninvasive vagal nerve stimulation, utilizing it in the neck area is going to be more efficacious. It doesn't mean that auricular won't work, but you'll probably be able to do it in a more effective and more timely manner than utilizing auricular-based modalities to stimulate the nerve.

So with that, I appreciate everybody's participation in today's meeting. And again, the ticker is ECOR. Happy to schedule any additional meetings if there is interest. Thank you.

Thank you. That concludes electroCore Inc.'s presentation. You may now disconnect. Please consult the conference agenda for the next presenting company.

Greetings, and welcome to the ElectroCore First Quarter 2026 Earnings Conference Call.

[Operator Instructions].

As a reminder, this conference is being recorded. Earlier today, ElectroCore published results for the first quarter ended March 31, 2026, and the press release is available on the company's website.

Before we begin, I would like to remind everyone that members on the call will make forward-looking statements within the meaning of the federal securities laws made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995.

Any statements that are not historical facts should be deemed to be forward-looking, including, without limitation, any guidance, the company's outlook on second quarter and full year performance, and its path to profitability.

These statements involve material risks and uncertainties that could cause actual results to differ materially from those anticipated. For a list of risk factors, please see the company's filings with the Securities and Exchange Commission.

ElectroCore disclaims any obligation to update these statements, except as required by law. This call contains time-sensitive information accurate only as of today, May 6, 2026.

Joining us on today's call from ElectroCore are Dr. Thomas Errico, one of the company's founders, Investor and Independent Chairman of the Board of Directors; Joshua Lev, Interim President and Chief Financial Officer; and Mike Fox, recently appointed Chief Operating Officer.

It is now my pleasure to turn the call over to Dr. Thomas Errico, ElectroCore's Founder and Independent Chairman, for opening remarks. Dr. Errico?

Thank you, Amanda. Good afternoon, everyone, and thank you for joining ElectroCore's First Quarter 2026 Earnings Call.

This is the first earnings call since we announced our leadership transition, and I want to take a moment to share how encouraged I am by the progress we have made executing that transition and by the momentum we continue to see across the organization.

Since stepping into the role of Interim President, Josh has provided steady, disciplined leadership while maintaining his focus on financial rigor.

The alignment between our operational priorities and our financial strategy has been evident, and the organization has responded with focus and urgency. The strategy has not changed. The execution has not slowed. If anything, the focus across the organization has sharpened.

At the same time, Michael Fox joined us as Chief Operating Officer on April 13, bringing more than 35 years of commercial leadership experience across complex health care markets, including extensive work within the federal systems and the U.S. Department of Veterans Affairs.

In just 3 weeks, his depth of experience has already provided valuable insights to strengthen our execution, particularly as we continue to expand our presence within complex government channels. He will introduce himself shortly.

Importantly, this transition has not slowed us down. It has reinforced our foundations. We remain firmly committed to our strategy, driving growth within our covered entities, advancing our clinical and scientific leadership in noninvasive vagus nerve stimulation, and expanding our reach into the consumer wellness market.

And we are doing so with discipline, managing the cost base, expanding the margin, and protecting our path to profitability.

In our clinical work, we continue to invest in the evidence base that underpins our portfolio. That evidence remains a key differentiator as we engage with providers, payers, and partners globally as well as domestically, and it positions us to expand into new indications over time.

In the VA, where we have built a credible commercial presence over many years, we believe we have a meaningful long-term opportunity.

Our commercial leadership is leveraging Mike's experience to identify new ways to be more targeted and more effective, particularly within a system where we still have substantial room to penetrate.

On the consumer side, we are building a scalable direct-to-consumer channel with increasing brand visibility, improving unit economics, and a growing network of influencer and affiliate partners that resonate with audiences seeking non-pharmacologic, science-backed wellness solutions.

The early traction we are seeing reinforces our belief in the broader applicability of our technology and its relevance to everyday wellness.

What gives me the greatest confidence is not just the program itself, but how it is being achieved with discipline, alignment, and a clear sense of purpose across the organization.

We are building a strong foundation, and we are doing so in a way that positions the company for durable long-term growth. While our search for a permanent CEO continues, I am confident that the team we have in place today, Josh, Mike, and the broader leadership group, is the right team to execute against our priorities and carry our strategy forward.

I look forward to updating you on our continued progress in the quarters ahead. With that, I would like to introduce our new Chief Operating Officer, Mike Fox. Mike?

Thank you, Tom. Good afternoon, everyone. I joined ElectroCore for one reason. I saw a science-based platform technology with proven published clinical outcomes data that support a credible commercial foundation and significant room for growth, particularly within the federal channels where I spent most of my career.

Three weeks in, that conviction has only strengthened due to my greater exposure to the existing and future data sets being gathered.

I also had the opportunity to meet a vast number of talented colleagues within the company who are dedicated to the mission and the patients we serve.

So, rather than walk through my background, let me tell you what I've been focused on and where the opportunity exists.

A major priority is the VA and Department of Defense markets. We have just scratched the surface of penetrating the addressable VA headache market.

So we have patients being treated with our products in VA medical centers across the country, but we're not attaining the utilization level that meets the needs of our veterans and the dedicated providers caring for these military heroes.

The majority of new patients identified and prescribed our products in Q1 are not spread across the country as expected or needed. That tells me 2 things.

One, we have built real distribution; and two, we are nowhere near saturation. My focus is moving from facility breadth to facility depth, more prescribers per site, more patients per prescriber, and a more consistent customer experience across the system.

My second priority is the broader federal channel. The VA is our largest entry point, but it is not the only one. The Department of Defense across all service branches represents an underdeveloped opportunity for both our prescription products and for TAC-STIM.

Given the heightened tempo of U.S. military operations abroad, the demand environment for noninvasive, drug-free performance-supporting solutions has only intensified.

I spent the last 3.5 decades building relationships in these channels, and I intend to put them to work for this company.

My third priority is operating discipline. Josh and the team have built a high-margin business, 87% gross margin in Q1, and you're starting to see operating leverage show up in the numbers.

My job is to make sure that as we scale, incremental revenue translates to incremental bottom line, not incremental costs. We intend to grow this business efficiently while we establish ElectroCore as a partner of choice to ensure market stability in the years ahead.

I'm 3 weeks in, but trust that my experience in developing company growth and success is from decades of learning and proven execution strategies.

I'm truly excited about the opportunity presented to me here at electroCore. There will be much more for me to share over the coming quarters, but I'm convinced that what is in front of us is real, and I'm truly grateful to be a part of it.

With that, I will turn the call back over to Josh to walk through the quarter. Josh?

Thank you, Mike. Before I get into the details, let me tell you what this quarter represents for electroCore.

We just delivered our highest revenue quarter ever, $9.6 million, up 43% year-over-year. Gross margin expanded to 87%. GAAP net loss was $5.3 million, and adjusted EBITDA loss improved by 24% to $2.3 million.

That combination, accelerating top line, expanding margin, and improving adjusted EBITDA loss in the same quarter, is demonstrating operating leverage, and it is the clearest signal yet that we are executing on our strategy.

We are reaffirming our full-year 2026 revenue guidance of approximately 30% growth. As I'll discuss in a moment, the catalysts in front of us for 2026 give us conviction in that outlook.

Now to the details. The VA hospital system remains our largest customer, and growth there continues to accelerate. Prescription device revenue increased 48% year-over-year to $7.9 million.

Within that, prescription gammaCore grew 26%, and Quell sales surpassed their first $1 million quarter.

Since we acquired the Quell assets from NeuroMetrix in May 2025, Quell fibromyalgia has generated $2.5 million in cumulative revenue, and we are still in the early stages of placing that product across the VA system.

As of March 31, approximately 15,000 VA patients have received the gammaCore device, which we estimate represents roughly 2.5% penetration of the addressable VA headache market.

The underlying patient population continues to expand. A 2024 study published in JAMA Network Open of nearly 500,000 U.S. veterans found that 8.2% of male and 30.1% of female veterans report a history of migraine, roughly 3x the rate observed in the civilian population, and that approximately half of veterans with migraine also meet criteria for PTSD.

The U.S. Department of Defense has reported more than 485,000 service members' traumatic brain injury diagnoses since 2000. Combining with the Veterans Health Administration's emphasis on non-opioid first-line treatment for chronic pain, we believe the runway for prescription gammaCore adoption inside the VA is long, and we are still early.

Turning to our consumer wellness channel. Revenue reached $1.6 million in the quarter, up 44% year-over-year, with Truvaga contributing $1.5 million, up 38% from Q1 of last year.

This quarter, we deliberately tempered top-line growth in favor of efficiency, and the results are showing up in the unit economics. Our return on advertising spend, or ROAS, was approximately 2.37 in the period, a 14% improvement over the prior quarter.

In plain English, every dollar we spent on Truvaga-related media generated nearly $2.37 of revenue. That improvement was driven by a concentrated shift toward affiliate and influencer partnerships that reach consumers already interested in wellness and in vagus nerve stimulation specifically.

Return rates remain in the 12% to 15% range, consistent with prior periods. We believe the macro environment for our consumer wellness offering is meaningful.

The Centers for Disease Control reports that approximately 24.3% of U.S. adults experienced chronic pain in 2023, up from 20.4% in 2019.

Independent industry research projects the global noninvasive vagus nerve stimulation segment will expand at a low double-digit CAGR through 2030, supported by aging demographics, the regulatory and clinical pivot towards non-opioid pain management, and rising consumer awareness of the vagus nerve.

We believe Truvaga is well-positioned to capture a meaningful share of that growth.

On to TAC-STIM, our human performance product. While quarterly TAC-STIM revenue has historically been variable, the underlying demand environment for cognitive performance and fatigue mitigation in the active duty military and federal channels is robust and getting more robust.

Given the heightened tempo of U.S. military operations abroad, particularly around remotely piloted aircraft, drone defense, and other extended duration mission profiles, the need for noninvasive, drug-free solutions to support war fighter alertness, focus, and resilience has only grown.

TAC-STIM is the subject of ongoing research and evaluation across the U.S.

Air Force Special Operations Command, the U.S. Army Special Operations Command, and the Air Force Research Laboratory, and was previously selected by AFRL for inclusion in the real-time assessing and augmenting cognitive performance in extreme environments program, a program designed in part to support multi-day transoceanic operations and long-duration remotely piloted aircraft missions.

With Mike now leading our commercial operation, we see a meaningful opportunity in 2026 and beyond to deepen our engagement and to pull TAC-STIM through as a more consistent revenue contributor.

Now to the financials. Net sales of $9.6 million represented 43% growth over the prior year, driven by gammaCore and Quell within the VA and continued growth in Truvaga.

Gross profit was $8.4 million with gross margin expanding to 87%, a 200 basis point improvement year-over-year. Research and development expense was $740,000, up modestly from the prior year, primarily reflecting work on the ACACIA PTSD study.

Selling, general, and administrative expenses were $12.9 million. That number includes approximately $1.9 million of nonrecurring leadership transition costs and $300,000 of legal expense related to the ongoing IP litigation.

Excluding those items, the year-over-year increase was driven by approximately $1.6 million of variable expense, supporting our $2.9 million revenue increase, a clean illustration of how the cost base scales with the top line.

Other expense of $276,000 includes interest associated with the convertible term debt financing we put in place with Avenue Venture Opportunities Fund.

GAAP net loss in the first quarter was $5.3 million compared to $3.9 million in the prior year period. This increase was driven primarily by the $1.9 million in nonrecurring leadership transition costs.

Net loss per share was $0.59 compared to $0.47 per share in the same period last year. Excluding the leadership transition expenses, net loss per share was $0.37.

And now I want to draw your attention to the 24% improvement in our adjusted EBITDA loss, which I believe is an important indicator of the operating leverage we are building.

Adjusted EBITDA loss for Q1 was $2.3 million compared to $3.1 million a year ago. That improvement happened in a quarter where we absorbed $1.9 million of nonrecurring leadership transition expenses.

Strip those out, and the operating leverage in this business is even more evident. Revenue grew 43%, and adjusted EBITDA loss narrowed 24%. As we scale further, that gap is what gets us to profitability.

A reconciliation of GAAP net loss to non-GAAP adjusted EBITDA net loss is provided in the financial tables in today's press release.

Turning to the balance sheet. Cash, cash equivalents, and marketable securities were approximately $8.8 million at March 31, 2026, compared to $11.6 million at December 31, 2025.

One important note on cash. Q1 is historically our highest cash burn quarter of the year. This year, certain working capital items, primarily the timing of inventory and capital improvements to our Rockaway facility, may extend a portion of that burn into the second quarter.

We are managing the balance sheet with discipline and remain focused on the operating efficiencies that support our path to profitability while also evaluating available capital resources, including our existing shelf registration statement and at-the-market facility.

Before we open the call for questions, I want to spend a minute on the catalysts ahead of us in 2026 because the runway from here is significant.

First, R&D and nVNS as a platform technology. We continue to work towards a platform of products that can be sold through our established sales channels. This comes in the form of indications, products, and features.

The body of evidence supporting the therapeutic potential of nVNS continues to expand.

A new publication in Frontiers in Neuroscience entitled ‘Adjunctive non-invasive vagus nerve stimulation for chronic mild traumatic brain injury with comorbid post-traumatic stress disorder, a post-hoc analysis highlighted findings on the potential benefits of adjunctive noninvasive vagus nerve stimulation in patients with mild traumatic brain injury and PTSD.

Additionally, approximately 20 participants have enrolled in the clinical study conducted by Acacia Clinics in collaboration with the Vagus Nerve Society, designed to evaluate the safety and effectiveness of electroCore's gammaCore nVNS device as an adjunctive treatment for symptoms associated with PTSD.

PTSD is a breakthrough device designation for us. And as the data matures, we expect it to become an increasingly important part of the platform story.

Work on our next-generation Truvaga and Quell mobile platform is underway. We are developing a mobile application designed to complement our consumer products, deliver more personalized features and user experiences, and, if done right, open the doors to recurring revenue, deeper engagement, and richer real-world data.

Second, we remain focused on opening additional commercial channels for our products. Beyond continued VA penetration, Mike's mandate includes expanding our commercial and federal channel presence.

This includes areas such as Kaiser, federal workers' compensation programs, TRICARE, and broader adoption within active duty military and the Department of Defense.

With TAC-STIM already engaged across Air Force Special Operations Command, Army Special Operations Command, and the Air Force Research Laboratory, we see meaningful opportunity for additional federal contract activity.

Quell continues gaining adoption through our current sales channel and primarily within the VA. Sales of the Quell product line surpassed $1 million in quarterly revenue for the first time in Q1 2026, bringing cumulative Quell revenue to approximately $2.7 million since the acquisition from NeuroMetrix in May 2025, including $2.5 million of Quell fibromyalgia sales in the VA.

We have a small cohort of legacy Quell over-the-counter users and expect to relaunch the over-the-counter Quell relief for lower extremity pain later this year.

Earlier this year, in January 2026, we launched Truvaga in the United Kingdom. And as that business scales, we expect to evaluate additional markets.

Third, perhaps the most important catalyst of all, is our path to profitability. The math is straightforward: mid-80s gross margin, accelerating top line, increasingly disciplined cost base.

We are not yet ready to provide a specific quarter for breakeven, but that trajectory is clear, and Q1 is the strongest evidence yet that we are on.

Taken together, these catalysts underpin our reaffirmed full-year 2026 revenue guidance of approximately 30% growth, which translates to roughly $9 million to $10 million of incremental revenue versus our $32 million in 2025.

We expect the majority of that growth to come from continued VA prescription growth, where Q1 alone delivered prescription device revenue of 48% year-over-year.

Truvaga growing in the high 30% range and improving in efficiency is our next meaningful contributor.

Quell Relief and our international launch represent newer contributions that we hope to scale through the back half of the year.

TAC-STIM, while historically variable, represents potential upside as Mike deepens our federal engagement. And our next-generation mobile platform is a 2027 contributor that opens the doors to recurring revenue over time.

In short, 3 catalysts, a clear 30% growth bridge from 2026 and a longer runway into 2027 and beyond.

With that, I would like to open the call for questions. Operator?

[Operator Instructions]

Our first question comes from Jeff Cohen at Ladenburg.

This is Destiny on for Jeff. I just wanted to touch on the VA channel a little bit, and this is going to be a multipart question.

But I'm wondering, as you move away from breadth and more towards depth in this channel, does that change the structure of your sales force in terms of W-2 versus 1099?

And then how are you balancing expanding into new sites versus additional patient treatment or additional patients treated, I should say?

Hi Destiny, thanks so much for the question. Really appreciate it, and I appreciate you being on the call today. I think the best person to answer that question will be Mike. Mike, why don't you jump in and let everyone know what your strategy is?

Yes. Thanks, Josh. I think the question is a really good one because I don't believe it's an either/or in my experience, we definitely want to expand breadth.

We do have VA utilization across the country, but the depth in various specialties and within various patient segment groups is not where it needs to be.

I'm a fan of the 1099 model. I'm a fan of the W-2 model. In my history, as long as we have strong performers that are aligned with the strong mission to help our veterans, we can build a really strong opportunity around that.

So, I don't see this being a big change as much as just an internal alignment focus and opportunity for us to ensure that we're setting appropriate expectations and really hold people accountable to exceeding those expectations for both our gammaCore line and the Q.

Destiny, does that answer your question?

It does. I think I would also just be curious what your target is for the number of clinics for the end of 2026, perhaps a range from that 200 number?

That depends on right now when we say clinics. I really like. Clinic centers. Yes, the VA medical centers depend on what number you want to utilize.

I've always been in the belief that we're not helping at least 75% of the facilities across the country help the vets. We're not doing our job.

I don't know about an exact number, but we need to get really active and have consistent utilization of our products and treat veterans in at least 75% of those accounts on a monthly basis.

And then, as you go into these other DoD channels, how does that process compare to the VA centers? Is it similar in terms of timing?

It probably will be a different story altogether because, as you know, they're both under FSS, but the Department of Defense accounts, like the military health centers, also include the TRICARE component.

So there are different segments. But from a timeline perspective, the VA usually takes a long time to get things established due to FSS and working with our customers, like global government services for some things.

On the Department of Defense side, I would expect by sometime Q3 or Q4, with our plan in place, that we'll start seeing additional revenue.

And then I guess transitioning over to wellness and Truvaga, you have really strong ROAs this quarter, which I think is fantastic. I'm just wondering if there were any changes to the marketing channels that played into that stronger ROAS.

Yes. I'd say that's a great question. It's not so much a change in the marketing channels. It's more a function of where we are deploying and investing our resources.

We made a more concerted effort to work on affiliate programs and influencers. You may have seen that Miranda Kerr posted about us earlier.

That's a co-marketing opportunity that we have. Those are opportunities where what we could do is utilize and leverage the marketing budgets of other people so that they're actually the ones that are putting out there the marketing messaging.

And really, what we're doing is using that halo effect to help lift our efficiency.

So it's not so much a change per se. I wouldn't say that we cut out any of the other channels or media that we've done before. We're just reallocating the resources and looking at it slightly differently.

And have you noticed any differences in repeat purchase behavior or anything of that nature compared to last year?

Not yet, but we also haven't given any formal guidance on that either. But I would say not yet for the time being. Everything seems to be business as usual.

Our next question comes from Fozia Ahmed from Brookline.

First, Mike, thank you for joining the call and coming on board. We look forward to engaging with you.

My question is on the FRONTIER study on PTSD patients, which was very compelling. I was wondering if you could just remind us how this study is aligned with the ongoing ACACIA trial.

Is it set up the same, whether the outcomes are actually designed to capture the same outcomes that were published in FRONTIER or something different?

It's something slightly different. Both of them are there to capture patients with PTSD and the effects of utilizing noninvasive vagus nerve stimulation on patients with PTSD.

The actual protocols themselves are slightly different. And you can look those up on the IRBs if you'd like. But in essence, the idea here is how to aggregate different data points that have PTSD as being tested in a patient population, but the populations themselves may be slightly different.

And then I have a follow-up question. There's a breakthrough designation attached to PTSD. Are there any ongoing discussions with the FDA at this point?

So in previous quarters, we've given information and spoken about how we've gone back and forth with the FDA in terms of the best way to approach expanding the breakthrough designation to what would be a formal PTSD label.

What we're doing with a lot of the work now, primarily with the ACACIA study and what you just referenced a moment ago, is really aggregating more data points and information that we can bring to the FDA to have a full rollout of what would be a PTSD indication and a full label.

And we're doing that sort of in conjunction with them in that they've identified or articulated to us what they're looking for. And based on that information, we're looking to take that and aggregate the data set to provide to them to ultimately apply for the full form PTSD.

Our next question comes from RK Ramakanth at H.C. Wainwright.

Good afternoon, Joshua, and welcome aboard, Michael Fox. Hopefully, you guys are able to hear me.

I have two or three questions. So Josh, just starting off, thanks for reiterating the 30% growth for 2026. But during the first quarter, there was a gain of 43%.

So what is it that's keeping you from being more careful than needed? Do you see something that makes you -- I'm not going to use the word concern, but makes you think that I need to wait for at least one more quarter to change that guidance?

That's a great question, RK, and very astute. The answer is no. More than anything, we have internal projections, as you know, and the guidance that we provided to the Street is really based on what we believe organic growth could look like based on, I would say, an outdated model, if you will.

And what I mean by outdated is that Mike, with all of his experience of coming to the organization, has utilized strategy and tactics, which have helped grow its former businesses 3x to 4x in terms of top-line revenue. Mike's only been here since April 13th.

So it's not really necessarily "fair" hard to expect any more sort of direction or tactics as it relates to how it's going to be able to expand or accelerate that growth, what the timing of that growth is going to look like and the resources required, which is the reason why we keep on going back to -- we are going to provide more detailed guidance when it becomes available and more appropriate.

It just hasn't been enough time for Mike to get his feet wet fully to be able to map out and say, Okay, I think that we can grow by x, but it's going to take this amount of time.

And Michael Fox, as I said, welcome aboard. I have a quick question for you. As you were doing your due diligence and trying to get on board, gammaCore has been marketed to the VA facilities for quite a while now.

We have about 200 centers, actually not only acquiring but also stocking the product. From your experience and from what you have done in the past, what are the easy pickings in the VA market to move to a larger number of centers?

And also outside of the VA, can you name one or two additional federal centers where you think this can be an easy sell?

RK, that's a really good question. And I would say, from what I've seen in my experience in the VA, the best way to adjust within the VA is to work with them.

The VA has a lot of standardizations. They've got a lot of requests for algorithms and treatment protocols, medical necessity. I find a lot of companies do a lot of great things, one account at a time, but they're not working with the leadership at the business level or national level to really place where this product fits and get support from top down.

I believe this company has done a phenomenal job of generating support from the bottom up.

What I can do is continue to work with that information, that data, the patient-provided outcomes, and the information gathered by our providers in the VA to generate more opportunities for us to standardize treatment and put a really strong position for gammaCore within the federal space.

On the second part of your question, outside of the VA, I know there's a large federal workers' comp opportunity with the number of headaches and migraines within that space.

Within the Department of Defense, whenever you say Department of Defense, you've got to think of places like Walter Reed, SAMMC, Portsmouth, Naval, and Balboa.

There are so many medical facilities that treat patients post-deployment who come back with various things that we can definitely assist them with.

So it's early in my evaluation of where we will be able to start, but I promise, for the Department of Defense, it will be with key opinion leaders within the headache space on those active military bases with a focus on the larger centers first, probably closer to the East Coast where we're based.

Does that answer your question, RK?

Yes, yes. So, if I can, one more question for you, Mike. In terms of Kaiser Permanente, this is one of those entities where you really need to generate internal KOLs that can drive the growth of the product.

I'm not sure. In terms of your experience, do you see that as a real way to do it? Or are there any other levers that need to be pulled? Because I believe once you can get that going, it can be a good draw for the product.

RK, that's a phenomenal question. And I think a lot of companies ask the same thing about Kaiser because everyone knows the importance of a place like that for business.

I can't say all the details of our propositions to date with Kaiser. I have been on numerous calls. I'm very excited about what we have going on in the key opinion leader support within Kaiser.

It is a phenomenally well-organized and standardized group. So within the foundation, I know there's a lot of support. So the work is definitely being done in the California market, and we're going to address some other outside-of-market opportunities.

But I don't want to get too deep into the Kaiser description of what's going to happen, but we have a very favorable position now that we need to really just understand what's holding us back so we can generate that necessity from the customers.

But you are right, we need internal providers requesting it. And I can tell you from my early meetings, we have national headache and migraine experts already doing that.

So we're in a good spot. We've got to, I would say, tie a bow a little bit and figure out what's missing, but we're getting a lot of momentum there.

On the Quell Fibromyalgia, you have $2.5 million cumulative in the VA market. How big is the opportunity within the VA for Quell?

And is there any opportunity outside of the VA, because it looks like it was not sold much as an over-the-counter sort of product, because you have quite a bit of experience now with Truvaga? And I'm just trying to understand how that can be translated into Quell OTC, if I can call it that?

Well, that's a great question, okay, because within the VA, obviously, we're treating some of the multidisciplinary types of patients with multifactorial disorders. And fibromyalgia as a percentage is a large population in the VA.

I think there are some recent statistics just on even active military. It's very low before they go on deployment. But upon return from deployment, it's about 11% just on active duty.

So the veterans as a whole are always exposed to greater and bigger issues. So it is a market by itself, which is very, very scalable as a product like Quell. 

Outside of the VA, I think we all have family members and friends who have been dealing with fibromyalgia. It is a big opportunity outside there. But I would say we talked about Kaiser a little bit earlier.

I think those are the markets that would be the first ones to address as we continue to explore, maybe some opportunities to talk with Triwest and Optum for some of the active military. That's the plan for at least the immediate future, but we still have to verify what the best spot is.

And look, RK, it's also definitely worth noting as we look at the number of facilities that are out there prescribing our products, the fibromyalgia product as well is being prescribed in roughly 1/3 of the number of facilities that gammaCore-S is being prescribed.

So if you think about that in the context of the overall runway, we acquired the company a year ago. We've been able to grow that to about $2.5 million within the VA system.

But of that VA system, it's concentrated in one area of the region. We just need to spend more time being out there and selling. So there's a lot of opportunity, I think.

So I don't mean to hog the call, but one last question on Truvaga. What learnings can you take from the U.S. to the U.K. part of it?

That's a great question. Right now, we've only launched in the U.K. with our Truvaga 350.

We've had a lot of inbound interest that is coming from the U.K., and people who are expressing the need or the desire to get more access to vagus nerve, noninvasive vagal nerve stimulation for the wellness space. So it's early days there. We really just launched it in January. It's a soft launch. 

What I mean by that is we're not actively putting any media dollars behind it right now. Really, what we're trying to get a better understanding of is what the uptake for that Truvaga 350 unit is?

And does it make sense, and what is the business opportunity more broadly, not just in the U.K., but also in other areas outside of the U.S., but also outside of the U.K., to go ahead and launch a next-generation product like the Truvaga?

Okay. Josh, our next question comes from Jeremy Perlman from Maxim. 

His first question is actually for Mike. He says, " Where does Mike see the easiest wins, the lowest hanging fruit? And what are his longer-term plans to drive increased utilization?

Thanks for the question, Jeremy. In my vast 4 weeks of experience, the low-hanging fruit opportunity is, as we discussed, the federal space.

I think the VA and the unmet needs of our veterans are a key focus for us. We know we have a really strong opportunity there and other federal channels, as we discussed, with the Department of Defense.

I think long-term plans are a good starting spot, but we all know that it's a good place to help our veterans, but we have to go beyond. That's where I think the longer-term plan will continue to work on the commercial segments and figure that system out as a way for us to expand beyond the FSS and DSA opportunity.

So that's still in development, still being identified, but that's the long-term plan, so we can develop the revenue for the long term.

Jeremy's next question is what the Quell release commercialization rollout looks like in target markets and users.

Yes. So great question. So first and foremost, Jeremy, there is a small cohort of users of the Quell over-the-counter product that we inherited when we acquired the NeuroMetrix business.

You may recall that when NeuroMetrix was at its peak, it was doing somewhere in the tune of $12 million to $15 million of Quell over-the-counter related business.

And a lot of that went away after the company decided to do a strategic pivot, had the FTC issue, and move to a medical device Quell fibromyalgia product.

So from our point of view, what we're really focused on is making sure, number one, that we can still go ahead and service those legacy consumers that have been using the product or that may want to continue using the product, but it's no longer available. That's number one.

And then number two is we need to do it in a way that makes sure that we have addressed all of the concerns that NeuroMetrix had addressed regarding the FTC.

So, in terms of overall rollout and commercial strategy, the answer is going to be that it's going to be slow. and it's going to be well defined, but it's going to be deliberate in that we're purposely going to make sure that we've addressed the concerns that NeuroMetrix had earlier in their iteration as an over-the-counter product so that we can go ahead and do it in a way that's balanced between offering a Quell fibromyalgia FDA-cleared product or FDA-approved product and then also a consumer product as well.

Okay. And our last question from Jeremy. What are your leading indicators, pipeline, reorder rates, and device utilization that give confidence in continued acceleration in guidance?

So again, Jeremy, great question. I tried to really focus on it at the end of my remarks, but there's really, we look at this in terms of 3 main categories of catalysts.

The first is R&D related, so that could be additional indications. PTSD is putting out additional information about how the studies are going.

If you look and you follow our IR page, you'll note that we put out recent press releases, noting the ACACIA study, noting some other publications where data is coming out to help support what could be the makings of a PTSD label. That would be an R&D effort.

Products or features that we had mentioned as it relates to Truvaga and Quell, we are investing in our second generation or our next-generation mobile application.

Those features will allow us to hopefully get to a point where, if done correctly, we'll be in a situation where we can have a recurring revenue model. So that would be the first catalyst.

The second catalyst will be commercial, being able to go ahead and announce items such as launching Truvaga outside the United States, as we recently did in January, the opportunity or the probability of ultimately launching the Quell Relief or the Quell over-the-counter product as its own stand-alone consumer product.

Hopefully, Mike is coming to the table and being able to announce either further traction within places like Kaiser, new orders within the federal marketplace like federal workers' comp, perhaps TRICARE. So opening up different commercial avenues.

Lastly, which is the third catalyst will ultimately be the operating results. We believe that we can be in a situation where these other catalysts will help drive increased total addressable market and adoption of noninvasive nerve stimulation products or devices.

And we believe that acceleration will yield higher revenue growth. and be able to do it in a way that we're managing our costs and expenses.

So ultimately speaking, can we accelerate our revenue while also reducing our overall cost to do that, whether that's a percentage of sales and marketing as a percentage of revenue as an indicator, so on and so forth.

So those are really the 3 main catalysts that we're here focused on, and we're going to be very mindful about them as we go into the remainder of 2026 and beyond, so that we can give very specific milestone updates as to these different areas that we are strategically focused on.

Mike, I don't know if you've got anything else you want add on.

Jeremy, I'd just like to add in my opening comments, I talked about what I knew about the company before I got here as far as how clinically in-depth this location is and what they're doing to continue to enhance the strength of the clinical platform since joining the company and seeing Dr. Stats and his team and all the investigator-initiated research and the resources the company is putting behind the products to prove more and to do more is one of the reasons I'm extremely excited about the future. 

So when you talk about acceleration, it's not just always using the same product as the same, and just trying to get momentum.

It's building the platform that Josh has talked about. And that's what I believe is a really exciting factor of this company: what you will see in the future that we really can't discuss today, but the economics and the efforts are being placed here at electroCore to make it happen.

Okay. We have now concluded the live Q&A portion of the call. With that, I will turn the call back over to Josh for closing remarks.

Thank you, Amanda. I wanted to take the opportunity to thank our shareholders for your patience and your continued support.

To our patients, our providers, and our partners, thank you for trusting us with your care and your time. And most importantly, to our team, thank you for showing up every day with the discipline and the ambition this opportunity demands.

I really appreciate everyone's participation in today's call. We look forward to speaking with you again next quarter, and I wish you all a happy afternoon.

That concludes today's call. Thank you for your participation.

Greetings, and welcome to the electroCore Fourth Quarter and Full Year 2025 Earnings Conference Call. [Operator Instructions] Reminder, this con call is being recorded. Earlier today, electroCore published results for the fourth quarter and full year ended December 31, 2025. A copy of the press release is available on the company's website. I'd like to remind you that members on the call will make statements during the call that include forward-looking statements within the meaning of the federal securities law, which are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Any statements contained in this call that are not statements of historical fact should be deemed to be forward-looking.

All forward-looking statements, including without limitation, any guidance, outlook, or future financial expectation or operational activity and performance, including any statements regarding first quarter 2026 and full year performance and the path to profitability, are based upon the company's current estimates and various assumptions. These statements involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements. Accordingly, you should not place undue reliance on these statements. For a list of these risks and uncertainties associated with the company's business, please see the company's filings with the Securities and Exchange Commission. electroCore disclaims any intention or obligation, except as required by law, to update or revise any financial projections or forward-looking statements, whether because of new information, future events, or otherwise.

This conference call contains time-sensitive information that is accurate only as of the live broadcast today, March 19, 2026.

It's now my pleasure to introduce Dan Goldberger, electroCore's Chief Executive Officer.

[indiscernible] participating in today's electroCore earnings call. Joining me today are Dr. Thomas Errico, one of our founders and investor and Chairman of the electroCore Board of Directors; Joshua Lev, our Chief Financial Officer.

Before we begin, I want to express what a privilege it is to address so many colleagues, partners, investors, and friends who have supported electroCore since I took the CEO position in late 2019. Over the years, we've taken meaningful steps in building a great company. I am deeply proud of what we accomplished and truly thankful for your support, as well as the support and hard work of all the employees who work tirelessly in making our non-invasive pain therapeutics available to patients who need them. With that in mind, I'd like to share an important personal decision about the next chapter for myself and for this organization.

After thoughtful discussion with the board about the company's next phase of growth, I have made the decision to retire as CEO of electroCore effective April 1, 2026. When I joined in late 2019, my priority was strengthening the company's financial position and establishing a focused commercial strategy. Over the past several years, we've made substantial progress on those objectives, including building momentum in the VA channel, expanding our product portfolio, and putting the company on a stronger financial footing. With that foundation now in place, the board and I believe this is the right time to begin a leadership transition as electroCore moves into its next stage of growth. To ensure a seamless transition, the Board of Directors has appointed Joshua Lev as Interim President. electroCore is also hiring a new Chief Operating Officer.

These steps will provide stability and operational momentum while the board conducts a thorough search for my permanent successor. I look forward to continuing to support the company during the transition and to exploring new opportunities where my experience may be helpful. I step away knowing that electroCore is in excellent hands and well-positioned for continued success. I'm confident the leadership team will continue building on the progress we've made and drive the company forward in the next phase of growth. It's been an honor to lead this organization and serve you, our shareholders. Thank you for your unwavering support. I look forward to watching electroCore thrive from afar.

Now, the chairman, Dr. Errico, would like to share a few thoughts on strategy and the future.

Thank you, Dan. On behalf of the board of directors, I want to take a moment to recognize Daniel Goldberger for his outstanding leadership. We're grateful for the strong foundation he has built and for the momentum the company carries forward today. As we look ahead, I'm pleased to share an update on our leadership transition, which is designed to ensure continuity and focus as we enter our next phase of growth. Effective April 1, Joshua Lev, our Chief Financial Officer, will assume the role of interim president, overseeing day-to-day operations while continuing to serve as CFO. Joshua has more than 15 years of experience in finance and operations and has played a central role in guiding the company through several key milestones.

He is well-positioned to lead during this transition as we conduct a search for a permanent successor. In April, we will welcome Michael Fox as our new Chief Operating Officer. Michael joins us from ProMedTek, where he served as Chief Revenue Officer. He brings more than three decades of experience across pharmaceuticals, biotechnology, and medical devices with deep expertise in complex federal markets, including the VA system. His operational leadership will be instrumental as we continue to scale across the organization. With this transition in place, the board and management team remains fully focused on executing our strategy of increasing sales within covered entities such as the VA system and driving long-term value through market expansion into general wellness with our Truvaga product offering. Turning now to the business. We remain encouraged by the continued momentum of our non-invasive vagus nerve stimulation or nVNS platform.

Before Joshua Lev reviews the financials, I'd like to briefly highlight the clinical foundation supporting our portfolio. Our flagship gammaCore device is supported by a substantial body of scientific evidence, including more than 20 peer-reviewed publications and multiple randomized controlled trials such as ACT 1 ACT 2, PRESTO, and PREMIUM. These studies have demonstrated statistically significant reductions in migraine and cluster headache frequency, intensity, and duration. gammaCore is FDA-cleared for both acute and preventative treatments in adult and adolescents, and real-world adoption continues to build. For example, U.K. audit data shows that a meaningful portion of cluster headache patients achieve clinically significant response rates alongside measurable cost savings compared to standard care. Beyond gammaCore, exploratory studies across additional indications, including Sjögren's syndrome, gastroparesis, traumatic brain injury, and inflammatory conditions related to COVID-19, highlighted the potential for broader anti-inflammatory potential of nVNS.

These studies have shown encouraging signals across fatigue, quality-of-life measures, and anti-inflammatory biomarkers. At the same time, ongoing trials in areas such as PTSD, long COVID, substance abuse disorder, musculoskeletal pain, and concussions, supported by partnerships including the NFL and NFLPA-funded research, support our long-term strategy for indication expansion. In addition, our Quell device is supported by a growing body of peer-reviewed research, including randomized controlled trials published in well-regarded journals. These studies demonstrate efficacy across multiple pain-related conditions, including difficult-to-treat fibromyalgia, further strengthening the clinical foundation of our portfolio. On the consumer side, Truvaga continues to gain traction as a wellness product focused on stress reduction, sleep quality, and emotional well-being through parasympathetic nervous system activation. Truvaga has recently received recognition from major lifestyle publications, and engagement across social and digital channels continues to grow.

For example, national media outlets like Women's Health and Men's Health have been driving website traffic. Miranda Kerr mentioned Truvaga on The Skinny Confidential podcast. Affiliates like TrueMed, Ben Greenfield, and Luke Storey have been promoting Truvaga. Truvaga is now available through online retail outlets like Best Buy and RehabMart. Independent in-home studies indicate high levels of user-reported calmness and sleep improvement after consistent use. Importantly, this momentum supports diversification of our revenue mix and highlights the scalability of our nVNS technology in direct-to-consumer channels. Overall, the expanding clinical validation across our product lines continues to support prescription growth, payer engagement, and international expansion.

We believe this positions the company well for sustained revenue acceleration and long-term value creation as we bolster our commercial team with VA governmental specialists to further execute against our pipeline and strategic priorities while maintaining our attention on operating efficiency to progress towards profitability over time.

Now, I will turn the call over to our interim president and CFO, Joshua Lev, to walk through the financial results.

Thank you, Dr. Errico. Before reviewing the financial results, I want to briefly acknowledge the leadership transition announced earlier. Dan played an important role in shaping the company over the past several years, and the strategy we have in place today reflects that work. On a personal note, I've learned a great deal from working with Dan, and he has been a strong leader for the organization. Our focus remains on executing against that strategy, expanding adoption across the VA system, and continuing to scale our wellness platform. Turning to the details of our fourth quarter and full year 2025 operating performance. electroCore delivered another year of strong top-line revenue growth, extending our growth trend and exceeding both revenue and EPS analyst consensus estimates. The VA hospital system remains our largest customer and continues to grow with the expanded adoption of our non-invasive pain therapeutics.

Truvaga sales also showed strong growth, driven primarily by our e-commerce store at www.truvaga.com and an expanding network of affiliates who actively promote Truvaga to their audience. Revenue in the fourth quarter of 2025 was our highest ever, reaching a record of $9.2 million, up 31% year-over-year, and bringing our full year 2025 revenue to $32 million or 27% over full year 2024. Prescription device revenue increased 23% year-over-year to $26 million by continued growth of gammaCore and Quell within the VA hospital system. Acquiring the Quell assets in May 2025, Quell Fibromyalgia generated $1.5 million in revenue. As of December 31, 2025, 200 VA facilities purchased gammaCore products, up from 170 a year ago. Approximately 13,400 VA patients received gammaCore device.

Based on our analysis, we estimate this represents roughly 2% penetration of the addressable VA headache market. Given the scale of the VA system and the number of patients experiencing headaches related to PTSD and mild traumatic brain injury, we believe there may be a significant opportunity for continued growth. Towards this opportunity, we expanded our VA sales presence during 2025 by adding both internal team members and contracted representatives. In April 2026, we will also welcome Michael Fox as Chief Operating Officer, whose extensive experience commercializing products within federal healthcare systems will help accelerate adoption and expand our commercial reach. Turning to our general wellness channel, fourth quarter revenue reached $1.4 million, representing 31% year-over-year growth. Full year general wellness revenue totaled $5.5 million, an increase of 97% compared to 2024.

This increase was primarily driven by $5.4 million in Truvaga sales, up 93% from 2024. While Truvaga revenue was flat sequentially, the third quarter included a one-time $500,000 order associated with a third-party clinical trial. Excluding that order, Truvaga revenue grew approximately 40% sequentially. Return on advertising spend or ROAS for the period was approximately $2.10, meaning for every dollar spent on media, we generated nearly $2.10. Increase in ROAS from $1.80 in Q3 2025 was primarily driven by a seasonal increase in sales during the holiday season. Return rates across our e-commerce platforms have increased slightly but remain at approximately 12% to 15%, 14% with prior periods.

We believe the increase in ROAS is a result of the shift away from Amazon and the team's increased focus on driving sales to other direct-to-consumer platforms. As we look forward to 2026, we expect to expand the potential applications for our nVNS platform while introducing additional wellness offerings, including Quell Relief for lower extremity pain. We are also developing our next generation mobile application designed to complement Truvaga and Quell, which brings more personalized and data-driven user experience, which could support future recurring revenue opportunities. Based on the opportunities ahead, we are investing in people, marketing, and product development to accelerate growth in 2026 and 2027 while maintaining discipline around operating efficiency and our path to profit. Turning briefly to the full year 2025 financial results.

Net sales in 2025 increased 27% to $32 million, driven by growth of prescription gammaCore and Quell Fibromyalgia products in the VA system, as well as increased sales of our non-prescription Truvaga general wellness products. We expect the majority of 2026 revenue to continue coming from the U.S. Department of Veterans Affairs. Profit increased to $27.8 million for the year ended December 31, 2025. Gross margin was 87% compared to 85% for the full year 2024. Research and development expense of $2.7 million increased by approximately $375,000 compared to the prior year. This increase was primarily related to the development work on our gammaCore Emerald and our next generation mobile application.

Selling, general, and administrative expense of $38.2 million for the year ended December 31, 2025 increased by $7 million compared to $31.2 million. Sales and marketing increased by $4.3 million from the prior period. The increase in sales and marketing was primarily driven by a $3.8 million increase in personnel expenses, which contributed to a $0.9 million increase in sales. General and administrative expense increased by $2.7 million from the prior year. This increase was primarily driven by $800,000 increase in legal fees, primarily associated with development activity. $500,000 associated with one customer, $300,000 investment in IT and systems, and $200,000 of increased transaction fees associated with.

Total operating expenses in the full year 2025 were approximately $40.9 million as compared to $33.6 million in the full year of 2024. Other expense of $800,000 for the year ended December 31, 2025 increased by $1 million versus the prior year period. The increase was primarily attributed to non-recurring expenses, including a $0.5 million change to the estimated liability payable to pre-closing shareholders of NeuroMetrix pursuant to its CVR agreement and interest expense associated with our term debt financing with. Other income for the year ended December 31, 2024, which consisted primarily of interest income. Net loss for 2025 was $14 million or $1.65 per share, compared to net loss of $11.9 million or $1.59 per share in 2024.

The increase in net loss is primarily attributed to an increase in operating expense and other expense as described. Adjusted EBITDA net loss for the full year 2025 was $8.7 million compared to $9 million in the prior year. The change in adjusted EBITDA primarily reflects the GAAP net loss, offset by adjustments for NeuroMetrix acquisition related items, a reserve for bad debt expense and IP litigation related. A reconciliation of GAAP net loss to non-GAAP adjusted EBITDA net loss has been provided in the financial statement table included in. Cash equivalents and marketable securities at December 31, 2025 were approximately $11.6 million as compared to approximately $12.2 million as of December 31, 2024.

Looking ahead, we remain focused on accelerating growth in our high-margin prescription device business, particularly within the VA, by adding leaders such as Michael Fox, who spent a career successfully commercializing products in the federal channels, while also continuing to build a durable and efficient general wellness channel. Again, we believe our full year 2026 revenue has the potential to continue growing at approximately 30%. Third quarter activity indicates continued adoption. However, in light of the leadership transition, we are not issuing detailed guidance at this time and expect to revisit formal guidance when appropriate. Overall, we believe the company is well-positioned to continue driving growth, to reach expanded adoption in the VA system, scale our wellness platform and maintain a disciplined focus on operating efficiency to drive long-term shareholder value and profitability.

I would now like to turn the call over to the Operator for Q&A.

[Operator Instructions] Our first question comes from Jeffrey Cohen of Ladenburg.

Dan, congrats on all the accomplishments, and we wish you well.

Thank you.

I guess, firstly, could you talk about the channels, talk about the VA and talk about DTC for both gammaCore as well as for Quell, where you anticipate in 2026? I know that you've done a great job in adding centers of excellence at VAs. How might that look into 2026 and steps and thoughts about DTC business for both Truvaga as well as Quell?

Jeff, thanks so much. Appreciate you joining the call and always appreciate your great questions. From the VA channel we've had a lot of acceleration over the course of the last year in 2025. We've been pretty adamant that we believe the way for us to go ahead and grow that is to increase the number of boots on the ground, either through W-2 employees or through a 1099 network. We've done a really nice job over the course of 2025 of increasing those 1099s, which is a variable expense as it relates to the overall sales and marketing, right?

Doesn't add any headcount. We're really enthusiastic that we have a new commercial leader joining in Michael Fox, who's joining mid-April. Michael comes to us with a background in selling primarily into the federal channels. He has years of experience and actually decades of experience in building out commercial related teams, primarily focused in accelerating growth within those federal channels, particularly in the VA.

As we think about how we think the VA is going to grow over the course of 2026, while we haven't given any specific guidance to that, our thought is that we're an existing team, which has been proven successful to go ahead and grow within those channels. Then we've got Michael, who's going to come in and bring his know-how, his knowledge, and hopefully some of his relationships to help accelerate growth within the VA. When it comes to the direct-to-consumer channel, I think what we realized earlier on this year is we're much more effective in terms of our efficiency of media spend when we're focused primarily in driving traffic to our own website at www.truvaga.com.

The way that we've been able to go ahead and grow that most efficiently is by increasing the number of affiliates and influencers that we have that are out there that are talking about electroCore, and our Truvaga product. As we look into 2026, our goal is to focus on identifying more partnerships, such as the Miranda Kerr relationship that we talked about earlier, RehabMart, Best Buy, things of that nature that'll help us with the growth in the channel that'll help grow around the truvaga.com traffic.

Okay. That's perfect. One more as a follow-up. Can you talk about OUS channels and any expectation into '26, OUS and any specific geographies worth calling out today?

Yes. You know, from our perspective, NHS England is still a channel that's worthwhile in terms of mentioning as it just relates to our overall revenue. We have the most adoption within the NHS in England.

Yes.

You know, the NHS does have a bit of a bottleneck because of the way that the rules are written as it relates to who specifically has to write the prescription in order to get prescriptions adjudicated and ultimately fulfilled through the program. While we have interests in other countries outside of England, we've got distributors in locations such as Belgium, where we have some reimbursement.

We're still developing the infrastructure, if you will, or the adjudication infrastructure more than anything, to make sure that there's a pathway for which patients can go ahead and actually either get this covered or pay through cash providers, and we're doing that through third-party distributors. Right now, I'd say NHS England is really going to be our focus as it relates to the main driver of OUS revenue. As additional distribution partners become available and reimbursement opens up, we'll be sure to update the street on that.

Our next question comes from Charles Wallace of HCW.

Hi, this is Charles on for RK. Thanks for taking my questions. Dan, congrats on all you've done for electroCore, and it was great working with you.

Thank you.

For my first question, with the changes with management and the new hiring of Michael Fox and increased responsibilities for Joshua, I wanted to better understand these new leadership dynamics. Will Michael focus primarily on kind of the VA business while Joshua handles the wellness and ex-VA? Thank you.

Charles, great question. The short answer to your question is yes, but, Charles, I'm sorry. Michael is really has a strong background and history in driving and building commercial organizations. Our expectation is going to be that Michael's going to need to come in here, get his feet wet a little bit, and get a firm understanding as to how our sales operations currently work. We believe that Michael's background primarily around commercial and whether that's not just VA, but it could be other federal systems as well, it could also be other commercial systems, perhaps such as, Kaiser or commercial insurers, is really going to fall under, Michael's purview.

As it relates to the day-to-day activities as well as Truvaga, right now the plan is for that to fall in my court.

Perfect. Can you remind us of the prior VA contracts? With the onboarding of Michael, is there going to be any adjustment to this contract?

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

Great. For my final question. You know, Dan's kind of been the architect on kind of TAC-STIM in the military channel. With him leaving, does that mean that there might be a de-emphasis on the TAC-STIM product?

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

Our next question comes from Charles Wallace.

Okay, let's go to Jeremy Pearlman. Jeremy, do you want to unmute?

Thank you for taking my question. First related, you mentioned earlier on the call the Quell Relief. Is that going to be sold into the VA/DoD channels? Is that going to be in general wellness? Also, is that a first half or second half '26 event? And is revenue from that going to be baked into the guidance, or you think anything from any revenue generated would just be icing on the cake?

Hey, Jeremy. Thanks so much for the question. Our Quell Relief product, which is also internally we know as Quell over-the-counter, it's technically an over-the-counter product, so it's not technically a general wellness product. Our plan is to launch that product in the first half of 2026. Our expectations for that product are similar to how when we originally launched Truvaga. I'm not sure if you recall, but we did a very soft launch early on just to see what kind of access and traction we got.

The Quell brand itself has legacy users and legacy demand, and we're hoping that by doing a soft launch of the program, we could start getting a sense as to where to best spend our media dollars, which will then give us a more robust plan as to how we go ahead and grow that into its own product category. To answer your question, right now, when we look at our 30% guidance that we've given year-over-year, anything that would come out of the Quell OTC or the Quell Relief product would be incremental to that.

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

That's a fantastic question. You know, the true answer is it really depends, right? We have a team of dedicated people that look at our return on advertising spend on a daily basis, and they move our media dollars around based off of where we're getting the highest efficiency or the highest return on our investment. From what we've seen in the category, we think industry would be somewhere between the 2 to 2.5 range. There have been times within Truvaga's lifespan that we have actually achieved greater than 3% return on media spend.

Typically what happens is the more efficient you get over time in a particular channel, that efficiency then hits its you know its peak and then starts coming down, and you have to find different avenues. So to answer your question, I think that our goal for the year is going to try to have that above two. Having that above 2 or $2 of revenue for every dollar of media is a good place as a sort of conservative number. Then our expectation would be is that we try to hover around that, call it between 2 and 2.5 on an average basis for the year.

Okay. Understood. Just last question. You know, in the past, any updates on your insurance reimbursement coverage, and maybe what do you think the biggest barriers to broader reimbursement adoptions are you're facing? You know, it's always been it seems like it's been a struggle over time. Thanks.

Yes. Thank you. Thank you. Just from an update point of view, I think the biggest opportunity we have in front of us is the work that we've been doing with Kaiser. We've spent some time talking about it in the past. Earlier on in this year, we finally got on contract with Kaiser, so not only were we on formulary, but we're also on contract. That allows us to give us a license to sell, if you will, within the organization and gives prescribers an easier opportunity to actually prescribe the product itself, but it's not necessarily the end-all be-all. We've spent the better part of the last quarter, and within 2026, what we plan to do is spend more time trying to develop the right KOLs and subject matter experts, advocates for the product within the system.

I think Kaiser will remain to be our largest sort of opportunity, if you will, as it relates to from an insurance point of view, where can we get coverage? The reason why I say that is Kaiser is the largest of these managed care systems. Typically they're kind of like a beachhead strategy. If you can get Kaiser and show other managed care systems that it works, other managed care systems will follow suit. Right now we've guided in the past that we've got dedicated resources focused primarily on trying to get Kaiser up and running. If we do, our plan would be to leverage that success and turn it into additional adoption throughout other managed care, insurers.

Okay. You think that, that could be a 2026 event?

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

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

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

We wish you the very best in your retirement and in the next chapter ahead.

That concludes today's call. Thank you for your participation.

This podcast for informational purposes only and is not provided as financial, legal or any other advice. The information is not investment advice or an offer to buy or sell any securities or make an investment.

The views expressed by guest speakers are their own and any reference to third-party products, services or information does not constitute an endorsement thereof by SNN or its affiliates. SNN expressly disclaims all liability for any individual's use of the information presented in this podcast.

Welcome to the due diligence series here on the Planet MicroCap podcast. I'm your host, Robert Kraft. My guest today is Dan Goldberger.

He's the CEO of electroCore. It's a publicly traded company. The symbol is ECOR on NASDAQ.

electroCore is a commercial-stage neuromodulation company developing a suite of non-invasive vagus nerve stimulation devices, delivering a two-minute therapy session designed to rebalance the autonomic nervous system.

Built around its nVNS platform, the company operates across three channels, prescription medical devices for headache and migraine, the fast-growing Truvaga direct-to-consumer wellness brand and a specialized military and government division, built around its ruggedized TAC-STIM product.

Founded in 2006 as a noninvasive alternative to implanted vagus nerve stimulators, electroCore has evolved into a multi-indication business with 7 FDA authorizations for headache, serving major customers like the U.S. Department of Veterans Affairs and the U.K.'s National Health Service.

I invited Dan to this show to discuss all of this as well as how the nVNS platform works and the science behind vagus nerve modulation, electroCore's evolution from implanted alternatives to multichannel neuromodulation, the prescription business model across the VA, NHS and managed care, Truvaga's growth in the wellness market and why awareness is the primary competitor, the TAC-STIM military program and its role as a meaningful revenue stream, strategic priorities heading into 2026, profitability, capital allocation and commercial execution, challenges around insurance coverage and overcoming the chicken and the egg problem and the path toward becoming a $150 million to $200 million business and the long-term vision for the platform.

With that, pleased to join my conversation with Dan Goldberger, CEO of electroCore. Dan, thank you for joining me today. How are you doing?

I'm doing very well. Thank you, Robert. Really big fan of what you do with Planet MicroCap. So thrilled to have this opportunity.

Awesome. So that's very kind of you to say. And I guess I won't totally grill you, "No, I'm just kidding." But Dan, I really do appreciate it. And you were at our event back in Vegas this year. And look, I wanted to invite you on to kind of get a progress report.

I wanted to give a full picture of what the company does because I don't think -- we may have done the short form one, but either way, I wanted to give folks kind of a more broad picture of what's going on at electroCore, both leading up to today and potentially what some of your goals are moving forward.

So with that, for those that have no familiarity with electroCore whatsoever, what would you say is that one line that best describes the company?

ElectroCore has a growing suite of noninvasive nerve stimulation products for health and wellness and for certain medical conditions. So that's the overview. And we're growing rapidly, and we're entering new channels, and it's a super exciting time for the company. Did I mention that the ticker is ECOR on NASDAQ?

Well, I did at the beginning, so don't worry about it. But -- so okay, so that was a great little start there. So I mean, let's take a little bit of look back at the company's history and what let us look at where we're at today.

So when was the company founded? And what was the original thesis for its founding?

So great question. This company is an overnight success that was started 20 years ago in 2006. The founders of the company, Peter Staats is a physician, Thomas Errico is a physician, Charles Theofilos is a physician. All 3 of them have -- are physician entrepreneurs, I should have said, and have had business success alongside of their academic and medical practices.

Implanted nerve stimulators and specifically implanted vagus nerve stimulators were first commercialized in the 1990s for pain indications and the vagus nerve stimulators are specifically on label for treating epilepsy and depression.

And the founders of the company were looking at less invasive or noninvasive ways to replace the implant. And the implant involves a minor surgery, but it's still surgery.

The physical device is relatively expensive. They don't always work. There are some complications. And so the thought was, can we do this less invasively.

Early clinical trials were directed towards epilepsy and immune system response, allergy response. There was a significant trial started to treat epilepsy and more and more comments came back that it's helping me with my epilepsy, but my headache went away.

And so the company anecdotally pivoted to headache and in 2017, got our first FDA authorization through a de novo process to treat cluster headache. Commercial operations started in 2017, 2018. We've now got, I believe, it's 7 indications around different forms of headache, migraine headache, cluster headache, prevention, acute treatment, adults and in adolescents.

We've also gotten breakthrough designation to treat the symptoms of PTSD, and we have a program working to get an authorization in PTSD. A couple of years ago, we also launched some lower energy products into the health and wellness market for stress, for sleep, for focus and attention. And that business is smaller today, but it's growing very, very rapidly.

Very good. So I mean, what would you say makes the noninvasive vagus nerve stimulation, based on what you guys do for all these various indications. What would you say makes it unique and different compared to some of your peers and/or maybe other standards of care that are available right now?

So great question. Our device is -- it's a personal use device. It's handheld. It's portable. It only takes 2 minutes to deliver that nerve stimulation. We have a large and growing body of clinical research publications that talk about effectiveness certainly in headache, but also in behavioral health issues like PTSD.

And there was publications earlier this year in mild traumatic brain injuries or concussion. And then on the health and wellness side, more and more biohackers and longevity spokespeople are talking about and tinkering with the benefits sort of -- real-life benefits around managing stress, around getting better quality sleep, around focus and attention.

The Air Force and Army, in particular, have done some really exciting work on those areas, focus and attention and sleep, but it's classified. So I'm not allowed to talk about it.

Absolutely. So let's also talk core customer base. From my understanding, it's available to everybody, but you had -- you had previously a contract with the VA and then a new contract with VA. Tell us a little bit more about who's actually using your products right now.

Right. So on the prescription side, the VA hospital system is our largest customer. In the VA hospital system, the therapy is free to the patients. Doctor or a nurse writes a prescription. We get a purchase order from the VA hospital system. We ship it directly to the patient.

We have a customer service organization that helps with in service, whether it's with YouTube videos or Zoom call or phone call. And then we get paid directly by the hospital.

The National Health Service in the United Kingdom is our second largest customer, same business model. It's free to headache patients in the U.K., and we get paid by NHS.

We talked about on our conference call that we -- earlier this year, I think it was in September, we went on contract with a large regional managed care organization.

I'm not allowed to say the name. And that business is very similar, but it's a little bit different because in the managed care system, the members have deductibles and co-pays. And so we work with a durable medical equipment distributor, Joerns. What Joerns does is they administer the prescription. They figure out which benefit plan, where that particular individual is on co-pays.

They collect from the insurer, they collect from the customer and then they give us most of the money that they collect and they keep a little bit as their fee for that adjudication service.

So all in, the VA hospital system is 9.5 million covered lives. The other regional insurers like the one I just described are probably another 20 million covered lives. So we still have a lot of work to do on getting coverage for headache.

In contrast, we launched the Truvaga brand a few years ago. Truvaga is a wellness product. So it's sold directly to consumers. Most of our sales are through an e-commerce website, www.truvaga.com. You can go there, hit the buy now button and for $499, get our Truvaga Plus, which is a mobile app-enabled consumer product. It's lower energy than our prescription devices, but it works beautifully and consumers really like that mobile app functionality. And that business has been growing very rapidly over the last 3 years -- 2 years, really.

Absolutely. So what's some of the hurdles in getting more regional coverage for -- just to get your product in front of you?

Yes. So for better or worse, our products have been classified as durable medical equipment. And with most of the carriers, including CMS and Medicare, it's a chicken and egg problem, right? They want to see claims data, but you can't really get claims data until you have some coverage.

And so we've been building a database of not just safety and effectiveness, but also health care economics.

But how many years do they need? I mean you've been commercial, we forget 2017, 2018, it's long enough to go now, I believe 8 years of data, like what's going on -- clinical data -- I don't understand.

I don't -- well, welcome to my life. And we go there and we show them 3 years of health care economics data from NICE in the United Kingdom, and they say, that's great, come back with 4 years.

There was actually a paper published out of Stanford that said that was talking about exactly this problem that medical devices that had gotten breakthrough designation from the FDA, how long it took from that breakthrough designation by FDA to actually get coverage, Medicare coverage through CMS and the mean is 7 years.

That's where we are. So in the meantime, we're building a profitable, fast-growing business where we do have coverage. And we'll get to it. We'll get to that tipping point, but it always seems to be just over the horizon.

No, listen, Bureaucracy is...

Fun...

It's fun with every business, but...

Every business.

Especially medtech is just peachy as always, to say the least. All right. Well, let's talk VA specifically because, look, the #1 thing that most investors want to see with any business, public or not is predictable revenue.

Obviously, they know that you had this previous contract with them. I think there was maybe a fear of -- with all the budget cuts and DOGE and everything going on at the end of '24. But correct me if I'm wrong, was the contract renewed in March of this year? Talk a little bit more about that.

So yes, technically, we started down the renewal path. There was a lot of -- as you know, there was a lot of distraction in the federal government earlier this year.

I don't remember the technical reasons, but we ended up with a completely new 5-year contract instead of -- instead of merely getting an extension of the original 3-year contract.

The pricing in our 5-year -- I mean 5-year contract was improved a little bit, but it just removed that overhang, that uncertainty about why it's taking so long to get the contract renewed.

And since then, things have been going very, very smoothly in that channel on the supply chain side.

Absolutely. So I mean, let's also talk a little bit more about Truvaga. This is pretty interesting. I mean, tell us a little bit more about the product itself.

And I'm curious as to who you're really competing with on the -- like, for instance, I mean, this is totally different, but I'm a runner, and I use some -- I've tried out those -- the compression stuff that's supposed to activate your nerves and the muscle, all that good stuff.

Obviously, that's for the legs. What we're talking about is for headaches, migraine and stuff like that. So who's kind of your main competition on that front on the direct-to-consumer side?

So really, it's a huge blue ocean opportunity. I think our competition fundamentally is awareness. the benefits....

and Ibuprofen, maybe.

Ibuprofen. The holistic benefits of vagus nerve stimulation have been known for centuries. There's a lot of writings from Asia, for example, meditation is used, cold plunge is used. And there are various yoga maneuvers that are designed to stimulate the vagus nerve.

But the fundamental benefits of stimulating the vagus nerve are that it restores balance. And at the risk of oversimplifying, we all know what it feels like to be in that sort of fight-or-flight state, and we all know what it feels like to be in that rest and digest state.

And what stimulating the vagus nerve does is it brings you back to balance. So in other words, if you're anxious, you're feeling that fight-or-flight sensations, stimulating the vagus nerve will bring you back down.

If you're lethargic, if you're drowsy, stimulating the vagus nerve will bring you back up again. And so that's the fundamental function of the device and the benefit that you get.

Now you can get there with meditation, you can get there with yoga. That takes time and effort and a little bit of technique or you can use our gadget. It's a 2-minute stimulation of the vagus nerve and you get for many people, the same benefit that you get from the traditional techniques of getting balance in your nervous system. This is mine.

It's a little handheld device. There are 2 electrodes on the business end. There's a power button. It talks to my mobile app. We train people to palpate the neck. You find your carotid artery. Most of us can feel it pulsing. And then you place the electrodes directly over that location.

The vagus nerve travels in that same sheath with the carotid artery. So it's pretty easy to physically place it and then you hold it in place for 2 minutes. It will time out of 2 minutes, but obviously, if it's not comfortable, you just take it away.

Interesting. And the main goal for that is to really just reduce pain, migraine, and that's the primary...

On prescription side, it's headache, it's PTSD, it's concussion. But on the direct-to-consumer side, it's these health and wellness opportunities. We talk about stress, we talk about quality of sleep.

To get real pain reduction, you need to move up to our prescription strength device, although between you and me, you can get the same benefit as our prescription strength device if you do 2 or 3 sessions with our over-the-counter device.

In other words, 2 minutes is what we label it for, but you can give yourself a second or a third dose and get to that prescription strength efficacy, but I didn't say that.

For sure. I mean, obviously, there's a lot of blue sky opportunities, great. I mean, have there been conversations with sports teams and leagues and all that kind of stuff as well? Because I mean, I would assume they are probably going to evaluate any potential gadget that can help.

Right. The most surprising uptake has been in our active duty military. Air Force Research Laboratories has been working with neurostimulation for these attributes for focus attention, sleep, stress for a long time, probably for 20 years. About 5 years ago, they found us, and we didn't even realize it, but they began doing studies with earlier versions of our device.

They have published a little bit. They published about language learning. They publish about drone pilots. And so a little bit about drone pilots, right? They're sitting in a skiff, a secure room, they're staring at video screens, and they have a pot of coffee.

They've got a fridge full of energy drinks and they have one of these sitting on the bench. And what Air Force found was that the drone pilots were more accurate and responding faster on target identification when they had access when they were using the nerve stimulator.

That was the primary benefit, and they published on this. The secondary benefit, which was unexpected, is that these kids are using less caffeine, less stimulants when they're on shift.

And then they don't have to self-medicate when they come off shift in order to relax. And so there was a quality of life benefit that they've seen.

So fast forward to today, the Air Force gave us a grant to take our standard consumer device put it in a mil-spec heavier vibration-proof, dustproof water-resistant package that we now call TAC-STIM, and that's a significant revenue stream for us.

So it's only available to active duty military. Several Army Special Forces units are using it. Air Force is deploying it, for example, at Air Mobility Command, which are the big planes that go for hours and hours, the long-distance bombers are using it.

So -- and then if we could talk about it, right, obviously, there's civilian crossover to the gamer community to first responders. You mentioned elite athletes.

We are in the training room with several football teams, with several hockey teams, with several baseball teams, both at the professional level and at the division 1 level, but they never let us talk about it, right?

I guess -- but another thing that maybe think of is like it almost seems like this is kind of a first-generation looking device. Sorry, we're talking -- for those watching on YouTube, you'll be able to see it, but it looks like a first-generation kind of device.

Is there already things going on in the back end to make it even more or less bulky? I mean not that -- if it works, it works, right? Like that's one thing.

But like I'm sure you're also maybe hearing from some consumer brands of like, all right, cool, it works, great. We're seeing the -- but can we Apple it up a little bit to make it like that? I mean what's going on that front?

Yes. And that's a conversation that we have in the boardroom. You're going to see a refresh of the mobile app, for example, we've got great ideas to do exactly what you said.

But I'm dragging my feet a little bit on the R&D spend so that we can get to profitability, right? Our focus in 2026 is to get to profitability.

And R&D, we've got great ideas. I'd love to be spending more, but not right now.

So on that front, when it comes to allocation and capital allocation, the company in '25 did an acquisition. You bought NeuroMetrix Quell platform. Tell us a little about why this acquisition and why now? Why now? I mean this year?

Yes. So the Quell for fibromyalgia product that we acquired is an exquisite technology that was inside of a struggling enterprise. The clinical data around treating fibromyalgia is fantastic.

And since we took it over in May, the revenue has grown very, very rapidly. And all we're doing is selling it. We added it to our VA hospital contract. That process went pretty smoothly.

And so we've got salespeople in the VA hospital system and just added it to their bag, and it started selling very, very well. It's unfortunate what happened to the parent company and the financial distress that the company was in.

But out of their distress, we got a very, very nice asset for a very, very low acquisition price. And it fits into our distribution panel, that distribution channel is very, very smoothly. So -- and it is also a noninvasive nerve stimulator.

And so there's a technology adjacency, there's clinical adjacency, there's a distribution adjacency that all makes it look very, very exciting right now.

Absolutely. All right. Dan, I'm going to now transition to some of my devil's "advocitty" type questions.

Everything is all exciting and that but we also got to come back to earth a little bit. But what would you say -- and I ask this to every CEO on this series here.

But what would you say after you were at our conference in Vegas. You've done the dog and pony show, you meet with a ton of investors at all the time, catching up a shareholders and investors, all that stuff.

What would you say even after you get potentially new investors, new calls, new meetings, all that stuff. After they've done their research, done their due diligence a little bit, what would you say investors still get most confused about when trying to put their thesis together around electroCore?

So the cash runway dilution, when will the company be generating enough cash flow to be self-sustaining?

I think management has some credibility around our forecasts -- some credibility challenges around the guidance we've been giving in our forecasts. And so we're focusing on execution.

And I'm very proud of the operating results that we've posted, but those operating results haven't been good enough to satisfy the investing community.

I feel like we are unfairly in the dog house, given our revenue growth, given our gross margin profile, given the discipline around operating expenses, but we're still in the dog house.

For sure. I mean, in your opinion, what are -- what's the company doing in order to hit some of those execution goals that you want to see and it sounds like investors want to see as well.

So most of our investment in the second half of this year, beginning of next year is going to be around sales and marketing on the -- in the prescription channel, we need more feet on the street to drive penetration in the VA to drive penetration at the Kaiser system that we just put on contract.

We need -- we're spending a little bit on market access, right, to expand insurance coverage for our prescription products.

And then on the consumer side, it really is largely driven by media spending, whether that's social media or sponsoring podcasts or signing up affiliates and the return on advertising spend keeps getting better and better.

I mean, amongst all those initiatives, what would you say -- and tell me to [ F*** off ] if I'm asking -- if it's too forward thinking -- too forward-looking.

But of all these initiatives that you're looking to achieve, what would you say of all of them is like, all right, we get this minimum, even just this one, that's the catalyst where you'll see that self-sustaining growth and put all your...

Yes. So for 2026, -- it's more -- it's adding sales assets in our prescription channel. That's a very profitable business. We know the model. We're 2% penetrated in the VA hospital system.

So adding sales assets to get to 4%, 5% or 6% penetration, that's execution, not very risky. Adding sales assets to focus on the Kaiser opportunity where we just went on contract.

That's going to be a slower burn because it always takes longer to get -- we have 8 or 9 or 10 patients that have -- that are starting to generate revenue in that system.

So tiny numbers, but we're getting that flywheel going. Beyond that, it's additional coverage decisions, but that's really a 2027 catalyst to look at, getting label extensions, especially the PTSD.

That's something that I'm optimistic will happen in 2026. If we can get that label extension, that increases the total addressable market for our existing prescription products.

And then in parallel, the consumer opportunity is huge, but it needs to get to scale in order to be profitable.

Is there -- I'd also love to better understand electroCore's moat around each of these verticals. What's stopping -- obviously, there's FDA and all that kind of stuff.

But I would assume with the kind of the heat around looking for alternative methods to migraine this -- like there's a lot of folks that are working on this problem as well.

So what's kind of the moat around what you're doing with electroCore and all your various products and services that prevents maybe somebody with a better mousetrap from entering the market or something like that?

Yes. So look, our primary protection are patents. We have a large and growing patent portfolio. A European competitor filed a declaratory judgment basically saying that they do not infringe our patents earlier this year.

I think I want to say it was May or June. So they filed a declaratory judgment in Federal Court in the District of New Jersey.

And we countersued them with a dozen of our patents, trademark issues, restraint of trade issues. So I really -- the lawyers won't let me comment on it, but I really don't understand why they decided to be aggressive and try to get a declaratory judgment.

So patents are our primary defense. They're being tested now. Obviously, our lawyers say we're going to win in a slam duck. We'll see. Beyond patents, it's execution, right?

As you said, the FDA clearance process, the contracting process with different channels, all of those are -- take years to execute properly.

And so that becomes another level of protection. And then the third level of protection is doing well, right? As we get more penetration, as our distribution channels become more compelling, it's harder for somebody to break in, but it also creates opportunities like this NeuroMetrix acquisition to add product to our portfolio.

Absolutely. So what's also stopping one of these larger med tech companies like saying, right, again, we get it. This is kind of the first line of defense because really, that's how you're positioning, right?

It's like, all right, this is the first thing you try when you have chronic migraines, let's give this a shot. If it's not working, we'll go to something more intense.

Why isn't -- aren't some of these larger med tech saying, "Hey, buy or partner with you in order to get more penetration."

Yes. So to be clear, nobody is knocking on the door right now. But I think it's just size, right? We're now at a size where this product line would be accretive for one of the obvious consolidators, whether they're small or midsize, right?

With our gross margin profile, you take out the C-suite and the business is incredibly profitable. So I think that will happen, but I don't think we're big enough yet to make it worth somebody's while.

Absolutely. Well, aside from that happening, you really answered a ton of my questions here today. I think we've covered quite a bit.

But my final question I always like to ask everybody on here is, assuming you don't get taken out in the next 1 or 2 years, where -- from what you can tell us, where do you see the company in 3 to 5 years?

Where you want it to be in 3 to 5 years? And what would you say are some of the inflection points that will get you there?

Yes. So look, the Board and I are all about building a great company. We've got tremendous momentum right now. I think our core franchise in vagus nerve stimulation is going to continue to grow.

We haven't given guidance for 2026 yet. But if you look at our 5-year CAGR, there's every reason to believe that our core business will continue to grow at that rate.

The consumer business, the Truvaga brand is going to grow faster than that. We have to balance how fast -- how we can invest in that business with our path to profitability.

But once we turn the corner on profitability, I think we'll have more resources to invest in that blue ocean opportunity, label extensions increase the total addressable market. So every reason to believe that this is going to be a $150 million, $200 million revenue business within that planning horizon.

All right. Well, Dan, I think we're there. Did I miss anything? Was there anything else that you maybe wanted to for an investor audience to know regarding...

I know -- you gave me a great opportunity and the ticker is ECOR on NASDAQ.

Very cool. All right. Well, Dan, with that, where can our audience go and find more information on electroCore?

Electrocore.com, sec.gov. You can look at our commercial sites at gammacore.com or truvaga.com or quell.com.

Very cool. Well, Dan, thanks so much for joining me today. I really do appreciate.

Thank you, Robert. Really appreciate the opportunity. And I said it before, you and Planet Micro do a great job of creating a platform for good ideas. So keep doing it.

Absolutely. Really appreciate it. It was very kind of you. Good luck. Stay safe. We're recordings before Thanksgiving, so have a nice Thanksgiving and....

Happy holidays.

Happy holidays, too.

Greetings, everyone, and welcome to the electroCore Third Quarter 2025 Earnings Conference Call. [Operator Instructions] As a reminder, this conference is being recorded.

It's now my pleasure to introduce you to your host, Dan Goldberger, electroCore's Chief Executive Officer. Dan?

Thank you all for participating in today's electroCore earnings call. Joining me today are Dr. Thomas Errico, one of our founders and investor and our newly elected Chairman; Joshua Lev, our Chief Financial Officer; and our Investor Relations team from FNK IR.

Earlier today, electroCore published results for the third quarter ended September 30, 2025. A copy of the press release is available on the company's website. I'd like to remind you that management will make statements during the call that include forward-looking statements within the meaning of the federal securities laws, which are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995.

Any statements contained in this call that are not statements of historical facts should be deemed to be forward-looking statements. All forward-looking statements, including, without limitation, any guidance, outlook or future financial expectations or operational activities and performance are based upon the company's current estimates and various assumptions.

These statements involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements. Accordingly, you should not place undue reliance on these statements. For a list of the risks and uncertainties associated with the company's business, please see the company's filings with the Securities and Exchange Commission. electroCore disclaims any intention or obligation, except as required by law, to update or revise any financial projections or forward-looking statements, whether because of new information, future events or otherwise.

This conference call contains time-sensitive information that is accurate only as of the live broadcast today, November 5, 2025.

To begin, our Chairman would like to share a few thoughts on the company's strategy and future. Dr. Errico?

Thank you, Dan. Good afternoon, everyone, and thank you for joining electroCore's Third Quarter 2025 Earnings Call. My name is Tom Errico, and as the newly elected Chairman of the Board, it's an honor to address you today. As a founder, practicing physician, consistent investor and daily user of our noninvasive vagal nerve stimulation technology for over 15 years, I am deeply committed to our mission of transforming lives.

Today, I'll outline our strategic vision and discuss the background behind our key shift to accelerate growth. Dan and Josh will follow with an in-depth review of our financial and operational performance.

Let's begin. electroCore was established to modernize vagal nerve stimulation by developing a noninvasive technology, starting with our FDA-approved medical device for the prevention and treatment of migraines and cluster headaches. While I personally do not suffer from these conditions, I use noninvasive vagal stimulation daily.

About 12 years ago, during investment meeting on vagal nerve stimulation in New York City, Dr. Kevin Tracey, the pioneer of VNS, was asked if he used the technology himself. At that time, he used an auricular device for at least 20 minutes a day. When questioned about this commitment, he answered, because it gives me a daily overwhelming sense of well-being. As a routine user of VNS, his words strongly resonated with me and helped explain the positive performance-enhancing effects I was experiencing.

Fast forward a decade or so and research from Air Force Labs has further confirmed the remarkable performance benefits of noninvasive vagal nerve stimulation associated with electroCore's technology. As a practicing physician working with both adults and children, I encounter patients daily who could benefit from the substantial health and wellness impacts of VNS.

Expanding access to this technology inspired us to launch Truvaga. As a microcap company listed on NASDAQ, we are uniquely positioned to innovate, although we contend with challenges related to scale and visibility.

Previously, the company anticipated achieving positive quarterly cash flow from operations by the end of 2025. Along the way, opportunities emerged to significantly boost shareholder value by redirecting investments towards areas with higher growth potential. We were confident navigating this pivot, having experienced quarters with modest shortfalls but approaching positive cash flow on an adjusted EBITDA basis.

After a thorough evaluation, the Board determined that maintaining the status quo would cap our growth and market penetration, failing to realize ECOR's full potential and meet shareholders' expectations. To accelerate progress, we executed targeted investments, completed a strategic acquisition, expanded our medical division through key hires, onboarded a new software AI partner to enhance our wellness app and welcomed 2 new Board members from Microsoft and Google. These immediate investments may slightly delay near-term profitability, but we are confident that they will set the stage for accelerated revenue growth in future quarters. We are managing these expenditures rigorously and strategically to ensure sustainable long-term value creation.

To provide greater transparency and detail, our path to profitability would have likely yielded limited short-term gains, primarily from one FDA-cleared medical device within the VA and the single wellness product, Truvaga. Instead, we chose to defer profitability and invest in 3 priority areas: to broaden our product range; diversify revenue streams; and enhance long-term shareholder value. This intentional diversification also reduces customer concentration risk and is expected to increase electroCore's resilience over time.

Pivot 1, the NeuroMetrix acquisition. We acquired the Quell portfolio, including a second FDA-cleared neuromodulation therapy from NeuroMetrix at a minimal upfront cost aside from the transaction expenses and a minor capped royalty. Quell Fibromyalgia gained FDA de novo authorization in 2022, becoming the first nondrug device indicated for fibromyalgia-related chronic pain.

In addition to Quell Fibromyalgia, we added the over-the-counter Quell Relief brand to our platform. According to Persistence Medical Research via a Global Newswire article, global fibromyalgia treatment revenue reached $1.3 billion in 2022 with a projected CAGR of 7% to $2.7 billion by 2033. This acquisition diversifies our offering within the VA and meaningfully mitigates product risk in that channel.

We launched Quell Fibromyalgia through our sales force in July, and its early performance has exceeded expectations. Third quarter and fourth quarter projected results should cover the full acquisition cost and support years of revenue growth. Dan will share more details on this.

Pivot 2, strengthening our VA channel. Our foundation in VA medical sales is robust. Although we saw a temporary slowdown in Q4 2024 due to external macroeconomic and political factors, we navigated these headwinds effectively. VA revenue growth resumed, and we secured a new 5-year contract and upgrade from our previous 3-year agreement. We are selectively expanding our VA sales team and pursuing multiple strategies to boost adoption and drive growth within the VA.

Beyond VA, there are short-term opportunities in certain managed care systems. Even though our therapy has been included in formularies, we recently finalized a contract that provides a clear route to access and coverage. We have made a modest investment in a dedicated sales team to create a sustained revenue stream.

Pivot 3, developing our wellness division. We have enhanced our expertise in the Wellness division and strengthened our Board. James Theofilos, formerly at Microsoft and now at Google is a member of the Theofilos family, our largest investor, and I look forward to continued collaboration with him on the Board.

More recently, we welcomed Elena Bonfiglioli from Microsoft to our Board. She brings expertise in artificial intelligence, international product development and wellness. Her insights are shaping our approach to developing integrated software applications for our wellness products. Through her introduction, we partnered with StratejAI, a European software and AI firm to build software that complement Truvaga and Quell, providing users with personalized data-driven experiences and potentially generating new recurring revenue streams.

We're not just participating in the $600 million global VNS market. We're targeting the fast-growing noninvasive category, aiming at an $80 million to $120 million global wellness opportunity with Truvaga and Quell. If we succeed in building out AI integrated software, we could establish a recurring revenue model in a market growing 15% annually with data supported by InsightAce Analytics and Global Wellness Institute.

Additionally, I want to mention another significant investor in electroCore, Stephen Zhang, an experienced China-based investor. electroCore is broadening its options outside the U.S. through a royalty-based arrangement with his company to commercialize electroCore products in China. Time lines for approval and commercialization depend always on local regulatory processes, but this arrangement requires no capital investment from ECOR. Regulatory and commercialization efforts fall to the licensee. We appreciate Mr. Zhang's ownership and enthusiasm for our products.

This teamed with Ms. Bonfiglioli's residents and connections in the EU and the Middle East, we have made a direct decision to broaden our opportunity outside of the U.S. Dan can provide more specifics.

As a founder, investor and daily user of noninvasive VNS, I remain confident that prioritizing focused investments over immediate quarterly profitability is the right long-term strategy for our shareholders. Dan will outline our revised time line shortly.

The Board's decisions are intended to transform how people manage their health by merging the ancient practice of neuromodulation with cutting-edge AI and data technology.

In summary, electroCore stands at a pivotal moment. Through acquisitions, expanded channels, board enhancements and advanced software integration, we aim for sustained growth and broader impact. We are evolving into the company we always aspire to be.

Thank you for the ongoing support from our shareholders, employees and users. I look forward to what the future holds.

I'll now hand things over to Dan for a detailed review of our quarterly performance. We welcome your questions. Thank you. Dan?

Thank you, Tom. Turning to the details on the third quarter. electroCore delivered another strong performance, extending our growth trend and strengthening our foundation for scale. The VA hospital system remains our largest customer and continues to grow.

Following the closing of the NeuroMetrix acquisition on May 1, 2025, Quell is showing strong early traction as a noninvasive pain therapeutic for fibromyalgia in the VA hospital system. Truvaga sales also returned to growth, driven primarily by our e-commerce store at www.truvaga.com and an expanding network of affiliates who actively promote Truvaga to their audiences.

As Dr. Errico noted, electroCore pioneered noninvasive vagus nerve stimulation. Today, we are broadening that innovation into a suite of noninvasive bioelectronic technologies that improve quality of life for patients and for wellness consumers in the United States and select international markets. Science and data continue to guide every step we take.

In the third quarter of 2025, revenue reached a record $8.7 million, up 33% year-over-year and 18% sequentially. Gross margins remained strong at 86%, up slightly from 84% last year. We model gross margins in the mid-80s going forward.

Prescription device revenue grew 19% year-over-year to $6.8 million, driven by both gammaCore and Quell sales in the VA hospital system. As of September 30, 2025, 195 VA hospital facilities have purchased prescription gammaCore products, up from 166 a year ago. The VA Headache Centers of Excellence estimates approximately 600,000 patients are being treated for headache in the VA hospital system, including approximately 24,000 cluster headache patients.

We have now dispensed 12,000 gammaCore devices, roughly 2% of the addressable VA headache market, with additional opportunity among patients experienced headaches related to PTSD and mild traumatic brain injury. We believe there are as many as 550,000 fibromyalgia patients in the VA hospital system based on published incidence and prevalence data.

NeuroMetrix has dispensed less than 700 Quell fibromyalgia stimulators since launch in 2024. So we believe there's plenty of room to grow here as well. We plan to continue growing our VA hospital business by adding W-2 and 1099 staff in select locations through 2026. While the VA remains our largest customer, we are also investing in sales talent to focus on a large commercial managed care system.

In the third quarter, our DME distributor, Joerns, was finally able to add gammaCore Sapphire to their contract with that managed care system. This step could remove a lot of the friction prescribers have faced and opens an additional pathway for growth.

Health and wellness product revenue reached $1.9 million, a 54% increase sequentially and 121% year-on-year. That includes a $500,000 onetime Truvaga order for a third-party clinical trial. Excluding that transaction, Truvaga revenue grew 18% sequentially and 79% year-on-year. We believe this return to sequential growth is a result of the shift away from Amazon and the team's increased focus on driving sales through other direct-to-consumer platforms.

Return on advertising spend, or ROAS, ROAS for the period was approximately 1.80, meaning for every $1 spent on media, we generated nearly $1.80 of revenue. Return rates across our e-commerce platforms are approximately 11% to 12%, consistent with prior periods. We have sold more than 19,000 Truvaga handsets, powering more than 1.6 million user sessions on our mobile app. We plan to continue making marketing and promotional investments in our Truvaga platform to drive growth in 2026 and beyond.

For example, national media outlets like Women's Health and Men's Health have been driving website traffic. Miranda Kerr mentioned Truvaga on The Skinny Confidential podcast this month. Affiliates like TruMed, Ben Greenfield and Luke Storey have been promoting Truvaga and Truvaga will soon be available through online retail outlets like Best Buy and Rehabmart.

We expect to add new use cases in target demographics for our nVNS products and launch additional health and wellness offerings such as Quell Relief for lower extremity pain.

In addition, on the recommendation of our new Board member, Elena Bonfiglioli, we've begun developing our next-generation application to complement Truvaga and Quell, creating personalized data-driven user experiences and potentially a new recurring revenue stream.

Based on the opportunities in front of us, we are investing now in people, marketing and product to accelerate growth and drive scale in '26 and 2027. As Dr. Errico described, this is a strategic decision to prioritize growth and long-term value creation, delaying company-wide profitability as measured by adjusted EBITDA until the back half of 2026.

We believe that a Truvaga copycat from Eastern Europe has been infringing our patents and trademarks. You may have seen some filings in the Federal Court in the District of New Jersey about our escalating dispute. The case is ongoing, and we will refrain from commenting beyond the public filings.

Josh will discuss operating expense, cash trajectory and guidance in more detail later in the call. However, our cash balance as of September 30, 2025, was $13.2 million. We used approximately $1.5 million in the 3 months ended September 30, 2025, and a total of approximately $6.5 million in the first 9 months of the year to fund operations. We forecast a pro forma cash balance at December 31, 2025, at approximately $10.5 million.

Let me return to the 3 pivots that Dr. Errico mentioned earlier. The NeuroMetrix acquisition closed on May 1, 2025, was integrated and launched in our VA hospital channel ahead of schedule and has exceeded our revenue expectations. We had to increase our estimate of future royalties due to the legacy NeuroMetrix shareholders because revenue is ahead of plan, resulting in a noncash hit to EPS of about $0.05 per share. That's actually great news even though it negatively impacted our income statement.

We're strengthening our VA hospital sales channel by adding talent in key geographies. We are further investing in developing a parallel channel through a large managed care system. We're strengthening our wellness initiatives through the addition of key people, recruiting influencers, affiliates and new outlets and investing in products. Quell Relief for lower extremity pain could be an exciting new offering in our direct-to-consumer channel.

I expect that operating expenses will increase as we scale marketing and sales. Accordingly, the quarterly revenue required to reach cash positive operations is expected to rise. On our August 25 earnings call, we indicated that approximately $12 million in quarterly revenue would cover our OpEx plan and support positive cash from operations as measured by adjusted EBITDA. Based on our current trajectory, we believe that we can achieve these levels and deliver positive adjusted EBITDA in the second half of 2026.

Just to summarize our guidance. First, we are increasing full year 2025 revenue guidance from $30 million to $31.5 million to $32.5 million. Second, we expect to have approximately $10.5 million of cash at December 31, 2025. Third, we believe that the business can achieve cash positive operations as measured by adjusted EBITDA at approximately $12 million in quarterly revenue.

Fourth, we expect to reach $12 million in quarterly revenue and positive adjusted EBITDA in the second half of 2026. And finally, we expect to use approximately $5 million of cash to fund operations in the first 9 months of 2026, after which we expect the business operations will become self-funding.

Now I'll turn the call over to Josh for a review of our financials and select guidance. Josh?

Thank you, Dan. Net sales for the third quarter of 2025 were $8.7 million, an increase of 33% as compared to $6.6 million for the third quarter of 2024. The $2.1 million increase was driven primarily by higher sales of prescription devices and growth in the company's non-prescription general wellness Truvaga product.

Gross profit for the third quarter was $7.5 million as compared to $5.5 million for the third quarter last year. Gross margin was 86% compared to 84% for the third quarter last year. Research and development expense in the third quarter was $662,000 as compared to $521,000 in the third quarter last year. This increase was primarily due to increased development costs associated with our next-generation health and wellness mobile application in the 3 months ended September 30, 2025, as compared to the 3 months ended September 30, 2024.

Selling, general and administrative expense was $9.7 million for the 3 months ended September 30, 2025, an increase of $2.1 million as compared to $7.6 million for the previous year. This increase was primarily due to greater investment in selling and marketing costs, consistent with the company's increase in sales. For the remainder of 2025, the company plans to continue to make targeted investments in sales and marketing to support its commercial efforts.

Total operating expenses in the third quarter were approximately $10.4 million as compared to $8.1 million in the third quarter last year. Total other expense was $521,000 for the 3 months ended September 30, 2025, which consisted primarily of $384,000 of acquisition-related costs in connection with the change in the estimated liability payable to pre-closing shareholders of NeuroMetrix pursuant to a contingent value rights agreement or CVR, and $150,000 of interest expense on the convertible debt financing with Avenue Capital. This compares to total other income of $154,000 for the 3 months ended September 30, 2024, which consisted mainly of interest income.

GAAP net loss in the third quarter of 2025 was $3.4 million or a loss of $0.40 per share as compared to net loss of $2.5 million or a loss of $0.31 per share in the third quarter of 2024. The increase in net loss is primarily attributed to an increase in other expense related to the CVR liability and interest expense on the convertible debt financing with Avenue Capital. GAAP net loss per share includes a loss of $0.05 per share and $0.02 per share attributed to the CVR liability and interest expense, respectively.

Adjusted EBITDA net loss in the third quarter of 2025 was $2 million as compared to adjusted EBITDA net loss of $2.1 million in the third quarter of 2024. A reconciliation of GAAP net loss to non-GAAP adjusted EBITDA net loss has been provided in the financial statement tables included in today's press release.

Cash, cash equivalents, restricted cash and marketable securities at September 30, 2025, totaled approximately $13.2 million as compared to approximately $12.2 million as of December 31, 2024. On August 4, 2025, we secured a term debt facility with Avenue Capital, providing approximately $7.2 million of net cash at closing. Additional details on the Avenue Capital facility can be found in our filings.

On October 2, 2025, we closed a small private placement with certain institutional investors in satisfaction of an aggregate of approximately $1.9 million of legal services rendered or to be rendered to the company by the investors.

Our balance sheet has been strengthened by these transactions, and we have no plans to access the capital markets at this time. For the full year of 2025, the company is increasing its revenue guidance to $31.5 million to $32.5 million and a cash balance of approximately $10.5 million as of December 31, 2025.

And now I'll turn the call back over to you, Dan.

Thank you, Josh. I echo Dr. Errico's enthusiasm about the future of electroCore. We continue to report above-market operating results. Prescription device sales continue to grow with sales of both our gammaCore and Quell Fibromyalgia products. Our strategy of offering a suite of bioelectronic products and technologies into our established channels is developing nicely.

Demand for prescription devices in the VA hospital channel is driven by clinical data and our increased presence in the field. The launch of prescription Quell Fibromyalgia has exceeded our expectations. We plan to hire additional W-2 territory business managers to increase adoption of our technologies in the VA hospital system as well as dedicating resources to accelerate adoption in managed care systems. We currently have approximately 80 sales agents, including sub reps, managed by an internal sales team of 16 salaried employees.

Truvaga Plus has been favorably received by the market since its April 2024 launch. The brand continues to show tons of potential as a direct-to-consumer general wellness offering and has returned to sequential growth. We sell Truvaga products direct-to-consumer through our e-commerce site, www.truvaga.com, and through Truvaga partners like Ben Greenfield, Perks at Work, TruMed, Rehabmart, Best Buy Online and through a growing number of affiliates and influencers.

We continue exploring the expansion of the Truvaga proposition through new product offerings and have begun development of our next-generation mobile application. We believe the Truvaga brand has potential to become a significant player in the health and wellness space, and the evolution of the brand is important for providing shareholders with long-term value.

For the third quarter of 2025, our sales and marketing expense increased sequentially by approximately $640,000, while sales grew by roughly $1.3 million, demonstrating operating leverage in spite of those increased investments. The acquisition and integration of NeuroMetrix exceeded our expectations. Adding products like Quell Fibromyalgia into the prescription VA channel allows our field sales team to offer a growing suite of bioelectronic self-administered therapies for certain debilitating conditions.

As we continue to add new products to our established channels, we'll also continue working towards additional indications for prescription gammaCore to treat post-traumatic stress disorder and other clinical opportunities.

In summary, I believe we are poised to accelerate growth and we'll be increasing our investment in the high-margin prescription device space to help underwrite investments in the health and wellness channel. With our current cash position, we believe we have access to sufficient liquidity to execute this plan as we get closer to breakeven in 2026.

At this time, I'll return the call to the operator. Operator, please open the line for questions.

Thanks, Dan. We're now going to open the line for Q&A. [Operator Instructions] But just note, if we run out of time and have a constraint, someone from the IR team will get back to you if your question is not asked on today's call.

With that, we're going to go and open up the call, and we'll start with Jeff Cohen from Ladenburg.

Sorry, can you hear me okay?

Just a couple of quick questions for you. So firstly, congrats on the Quell in both the VA channel as well as the other channels. Can you remind us previously what channels NeuroMetrix was selling into before the acquisition?

So the prescription Quell for fibromyalgia was sold in 4 or 5 VA hospitals off contract through open market access prior to the acquisition. And there were a few cash pay customers who were served through HealthWarehouse, which is a PDM, but small numbers.

Okay. Got it. Can you give us any further color on the [indiscernible] Truvaga sale for a clinical trial? I'm assuming one clinical trial.

Yes. It's one clinical trial that's being run in long COVID subjects. There are a variety of other therapies that are being evaluated. It's a pretty large trial. Candidly, we don't know very much about it because it's an investigator-initiated trial, and they really didn't share the protocol with us, et cetera.

Got it. Okay. And then lastly, talk about the next-gen mobile app that you're working on. I'm assuming it's software-only, and will it be usable for all your platforms being gammaCore, Truvaga and Quell?

So great question. So the next update of our app will be Truvaga Plus only. It will work with the legacy Truvaga Plus that we've been selling since inception in April of last year, but it is not set up to work with gammaCore or Quell. Quell has its own app, mobile app environment. As we wrap our arms around it next year, we're going to look at harmonizing the various mobile apps for vagus nerve stimulation and for the Quell fibromyalgia apps, but that's going to take us a little bit longer to get our arms around it.

Our next question comes from RK of H.C. Wainwright.

RK, are you there?

Can you hear me, Dan?

Yes.

And thanks to Dr. Errico for giving those comments, which is really helpful for us. So I have a few questions. So let me start off with a high-level one in terms of how the strategy of acquisition of Quell fibromyalgia seems to be doing much better than what we were in internal expectations? So can you kind of comment on what's helping this product especially in the VA space? And what sort of learnings do you have at this point that you can help the next class of salespeople that you're going to bring on board?

Great question. Thanks, RK. So the time line is that -- in May and June, we did 2 things. We moved the production facility down here to Rockaway, New Jersey, and we were able to add prescription Quell for fibromyalgia to our VA hospital contract. Once we did that, once we had product and contract in June and July, we were able to start training our sales team.

They, in turn, were able to start demoing the product to their accounts. And the uptake has been much faster than we expected. Our primary headache call point is neurology. The primary call point for fibromyalgia is rheumatology, but both of those cross over in pain and in polytrauma. And we've been very upside surprised at the willingness given the safety profile that we've already demonstrated with gammaCore, the safety profile of the NeuroMetrix, Quell for fibromyalgia. The folks in pain and polytrauma have been very quick to adopt the fibromyalgia solution. Part of it is the safety profile. The other is that fibromyalgia patients don't have a lot of other options. It's a surprisingly unmet clinical need.

Fantastic. So thanks for actually telling -- giving me commentary on what is causing that pull. So now that you have it in the VA segment. Is it -- how easy is it to replicate in other areas, other segments, especially like the Kaiser Permanente or other hospital systems given the knowledge that you have now?

So we're going to do that carefully. We've just got on contract at a large managed care system. I'm not allowed to say Kaiser. But that contract is specific for gammaCore Sapphire. We have not even attempted to bring Quell fibromyalgia to that system. But obviously, that's something that we're going to do once we gain traction with Kaiser.

Perfect. And then maybe you made some comments that I didn't listen. I was looking on some commentary on TAC-STIM and what is -- what should be our expectations in terms of Air Force procurement and not just for this year, for the next 45 days, but thinking about '26, I do understand it is a lumpy business, but just trying to get a feel for things.

Yes. So it's a tale of 2 cities. The anecdotes, the research, the use cases that we hear about from Army and Air Force is incredibly enthusiastic, but the actual revenue generation continues to be small and lumpy. We did roughly $140,000 of revenue in the September 30 quarter for TAC-STIM products sold to active duty military.

The current quarter, the fourth quarter has come to a screeching halt largely because of the government shutdown. I think we will get some orders in November and December, pending, of course, the government opening up, et cetera, et cetera.

Our internal forecast for 2026 is about $400,000 for the full year, similar to the sort of $100,000 per quarter pace that we've had in 2025. There's huge upside, RK. I just can't -- and we're talking -- we're in conversations about some very large orders, but I just have no credibility to say what the timing of those orders is going to be. So we're going to be conservative for 2026.

Okay. And then last question from me is as Dr. Errico was talking about China, how meaningfully in a higher market is that going to be? And how do you really plan to commercialize that opportunity?

So great question. We, as electroCore, do not plan to commercialize it at all. Mr. Zhang now owns roughly 10% of electroCore. He has a license to commercialize our technology in China and only in China for the time being. He seems to have significant resources, financial and access to product development and access to manufacturing. And what he has shared with me is that he plans to go through the CFDA process in China with a product that uses our technology, but of his own design, it will be manufactured in country and will pay us a royalty on unit sales and revenue.

Our next question comes from Jeremy Pearlman of Maxim Group.

Okay. Can you hear me?

Yes.

Congrats on the quarter. Just firstly, the current growth, let's say, just specifically the VA segment, is that coming from more new accounts or increased utilization from existing customers?

It's both, right? We're going deeper into our existing customers. We added what -- almost 40 new VA hospitals over the course of the last year. And so that's the leading indicator is opening up new hospitals. And then the Quell fibromyalgia project -- Quell fibromyalgia product was meaningful revenue in this quarter.

Right. Is there an expectation for 2026, how many additional VA hospitals you hope to start prescribing in?

Yes. But it's a secret.

Secret. Okay. Then for a year's time, we'll hopefully get that answer.

And then maybe also, is there maybe -- could you tell us what specific geographies? You said there's only -- you've only tackled 2% of the potential patient population in the VA system. Where do you see the most growth potential geographical-wise?

So that's a good question. Right now, we are strong in Texas. We're strong in the Southeast and all up and down the West Coast. The New England, Mid-Atlantic, the -- we're pretty good in the Chicago area, but New England, Mid-Atlantic, the rest of the Midwest is all greenfield territory geographically for us.

Okay. Understood. And then just maybe one more question related to your clinical development pipeline. In the past, you've talked about many other indications. Maybe any update on the progress of how any of those trials are going? And when we could expect maybe potential new indications?

Yes. So I've put -- we've been putting the most energy into PTSD, gammaCore in PTSD. And we had meetings with the FDA over the course of this year. We're still trying to convince them that the data that we have is adequate. But in the background, we're spinning up yet another pivotal trial in PTSD that will start enrolling next year.

I don't think we needed to get the label, but even if we don't need it to get the label, it will be great for marketing support. And if FDA continues to be difficult, we'll have the additional data once and for all to get across the finish line.

We've had a couple of publications about mild traumatic brain injury, what I know of as concussion. And so now we are doing some planning around what would it take to collect pivotal data to support a de novo submission around mild traumatic brain injury. So that's going to be a 2027 initiative.

NeuroMetrix has quite a bit of data in neuropathy secondary to chemotherapy. And so we're going to look at whether or not we should go after a label extension for the Quell product line in that indication. And then there's intriguing data in low back pain that we'll take a look at as we get into 2026.

Our next question comes from Walter Schenker of Maz Partners.

Just one quick question. My first comment is my wife and I do use the product every day and at least -- and we are very happy that we use it every day. So it can't hurt to have us do a plug through just our Chairman.

Thank you.

The Quell royalty is capped, which means that -- and this is actually a question that for the current year, since you just paid $400,000, you've largely paid and then incrementally, there should be minimal payments. And next year, it's capped at a lower level so that incrementally next year, the royalty payment will be less than it was this year. Is that correct?

Yes, in Spirit, what we didn't pay anything. We adjusted the estimate that flowed through the income statement and now sits on the balance sheet as a future liability. The payment, the cash doesn't go out until May or June of next year. But otherwise, the income statement effect, you are correct.

But the income statement, I understood, I should have stated it more clearly. The income statement effect both in the next quarter and in the coming year will be -- will decline?

Correct.

Year-over-year and quarter-over-quarter?

Yes.

And secondly, although someone asked the main question, I was curious about given how large the market is and given that your Chinese investor is a significant investor having filed on the company, just to further expand. So he is planning on moving forward as best you know, as a medical device, not as a consumer device.

Correct. He is moving forward as a prescription medical device for a really exciting list of indications. And what I should have mentioned to the previous caller is that given the clinical studies that he's planning to underwrite, we may be able to migrate some of his data back to the U.S. for additional indications.

And don't answer the question, if you don't owe me answer, I'm going to ask it anyway. As he looks at the Chinese market and given what you just said, their trials are as lengthy as ours. So even if he is very successful, we're talking substantial number of years before that data might be useful either in China or here...

That's my understanding. In headache and in PTSD, where the clinical trial protocol is pretty well understood, he can get up and running relatively quickly. But for some of the other like rheumatoid arthritis things that he wants to chase, it's going to take longer. But in any case, it's years, not months.

And lastly, not as a question, but as a comment, I was -- the most positive thing in this whole call for me is the fact that you have finally -- so it's a left-handed compliment or something. You finally meaningfully accelerated the penetration in the VA hospital system given the fact that there are -- we were at 10% penetration, and there's a lot of opportunity there if we can continue to expand the hospital penetration.

Very well said and thank you for the compliment. It was not left-handed at all.

Okay, Dan, Josh, in our last few minutes here, we're going to try to bang out all of the texted-in questions.

First, what is being done to combat the copycat marketing vagus nerve stimulation devices?

Yes. So there's a European company, they go by the name Pulsetto. We have sued -- they sued us for the declaratory judgment that they do not infringe our patents earlier this year. We very quickly filed a cross complaint that's not only do you infringe that patent, you infringe this laundry list of additional patents. And by the way, there are a bunch of trade-related and trademark-related cross complaints in all of that.

The filings are in the in Federal Court District of New Jersey, and my lawyers will not let me comment beyond what's in those public filings.

Obviously, since we are in litigation, we want to focus on winning and winning big. There may be other infringers. We've put them on notice, but we're going to focus on the pending litigation.

Can you guys break out what neuro revenue contributions were for the quarter? The question came in from [Andrew Rem].

So Quell fibromyalgia or actually the full Quell line was $595,000 of net revenue in the third quarter.

Okay. And how about on Truvaga. Can you -- did you break that out? Could you break that out on Q3?

I think we did, but it was $1,674,000.

Okay. Well, everyone, thanks for your participation. Dan, I'm going to turn the call back to you for your closing comments.

Thank you, Rob. Thank you all for your time and attention. I know this was a little bit longer call. A special thank you to Dr. Tom Errico, our new Chairman, who has been a profound champion for this technology and for this company for many, many years.

I want to thank all of our employees and sales reps out there that are working hard every day. I want to thank the folks in the VA hospital system and our other customers, but especially the federal workers who are struggling under this ridiculous government shutdown stuff going on right now.

And yes, there's probably a bunch of other people I need to thank. But thank you all for your time and attention. Have a great day.