LifeMD Q1 2026 Earnings Call - Record Subscriber Growth and Strategic Pivot to Branded GLP-1s and Insurance-Backed Care
Summary
LifeMD reported a strong first quarter of 2026, delivering $50.2 million in revenue and adding 42,000 net telehealth subscribers, marking the largest quarterly net addition in the company's history. The results were driven by a strategic pivot toward branded GLP-1 therapies and a rapid expansion into insurance-backed care models. Management emphasized that while Q1 revenue was flat year-over-year due to a shift away from compounded drugs, the company is laying the groundwork for higher-margin, more durable revenue streams through deeper integration with major pharmaceutical partners and expanded payer coverage.
Looking ahead, LifeMD reaffirmed its full-year guidance of $220 million to $230 million in revenue and expects to return to adjusted EBITDA profitability in the second half of 2026. The company is aggressively investing in AI-driven operational efficiency and scaling its in-house pharmacy capabilities to improve margins. Management highlighted significant early wins in women's health and men's health, alongside a substantial reduction in customer acquisition costs for insurance-supported patients, signaling a potential inflection point in the company's growth trajectory and unit economics.
Key Takeaways
- LifeMD delivered Q1 2026 revenue of $50.2 million, exceeding guidance and marking a strong start to the year despite flat year-over-year growth due to a product mix shift.
- The company added 42,000 net telehealth subscribers in Q1, the largest quarterly net addition in its history, ending the quarter with over 365,000 active subscribers.
- Weight management sign-ups surged approximately 120% sequentially, driven by the launch of oral GLP-1 therapies and improved customer acquisition economics.
- Customer acquisition costs for insurance-backed patients dropped by as much as 50%, with retention rates improving by at least 10 percentage points compared to self-pay cohorts.
- Gross margin expanded 420 basis points to 88%, reflecting lower shipping and fulfillment costs as the in-house pharmacy scales and shifts more volume internally.
- Selling and marketing expenses increased 34% year-over-year to $29.8 million, representing a front-loaded investment in patient acquisition that management expects to normalize in Q2.
- LifeMD is transitioning away from compounded GLP-1s toward branded therapies from Novo Nordisk and Eli Lilly, prioritizing long-term patient retention over short-term revenue per patient.
- The company's insurance infrastructure now covers approximately 112 million lives, with plans to reach 230 million by the end of Q2, including a new Medicare GLP-1 Bridge program launching in July.
- Adjusted EBITDA for Q1 was a loss of $4.5 million, in line with guidance, but management expects a return to profitability in the second half of 2026 as marketing spend declines and operational efficiencies kick in.
- Full-year 2026 guidance remains unchanged at $220 million to $230 million in revenue and $12 million to $17 million in adjusted EBITDA, with expectations for annualized run rates exceeding $250 million in revenue and $25 million in EBITDA by Q4.
Full Transcript
Operator/Moderator: Good afternoon. Thank you for joining us today to discuss LifeMD’s result for the first quarter ended March 31st, 2026. Joining the call today are Justin Schreiber, Chairman and Chief Executive Officer, and Atul Kavthekar, Chief Financial Officer. Following the management’s prepared remark, we will open the call for a question-and-answer session. Before we begin, I would like to remind everyone that during this call, the company will make a number of forward-looking statements, which are subject to numerous risks and uncertainties that may cause actual results to differ materially from those projected. These risks and uncertainties are described in the company’s 10-K and 10-Q filings and within other filings that LifeMD may make with the SEC from time to time. Forward-looking statements made during this call are based on certain information available to the company as of today, May 6th, 2026.
The company assumes no obligation to update or revise any forward-looking statements after today’s call except are required by law. Also, please note that the management will be discussing certain non-GAAP financial measures that the company believes are important in evaluating LifeMD’s performance. Details on the relationship between these non-GAAP measures and the most comparable GAAP measures and reconciliation thereof can be found in the press release issued earlier today. Finally, I would like to remind everyone that today’s call is being recorded and will be available for replay in the investor relations section of the company’s website. Now, I would like to turn the call over to LifeMD CEO, Justin Schreiber. Please go ahead.
Justin Schreiber, Chairman and Chief Executive Officer, LifeMD: Thank you. Good afternoon, everyone. After the market closed today, we issued a press release announcing our first quarter financial results. We’ve also posted an updated corporate presentation, our Form 10-Q, and our shareholder letter on our investor relations website at ir.lifemd.com. I encourage everyone to review those materials. Q1 was a strong start to 2026. We delivered revenue of $50.2 million ahead of guidance and added more than 42,000 net telehealth subscribers, the largest quarterly net addition in our history. We ended the quarter with over 365,000 subscribers. In weight management, sign-ups increased approximately 120% sequentially from Q4. We exited the quarter with strong momentum across all of our key growth areas. We’re seeing clear early validation of the strategy we laid out on our last call.
What matters most is not just the quarter, it’s what this quarter says about the platform we’re building. As I outlined in our shareholder letter, I think about LifeMD in very simple terms: quality care, quality products, quality revenue. When we deliver high quality care, patients trust us. When we offer products and services that genuinely improve their lives, they come back. When patients engage across more of the platform and stay with us longer, the revenue becomes more durable, higher quality, and ultimately more profitable. Today, we have a 50-state affiliated medical group, a fully integrated pharmacy, in-home and national lab capabilities, expanding insurance coverage, deep pharmaceutical collaborations, and a growing set of specialty care programs. Increasingly, we’re layering AI across that infrastructure to make care faster, more efficient, and more personalized.
LifeMD is no longer just a telehealth company focused on a handful of conditions. We are building what we believe can become one of the most important virtual healthcare platforms in the country. A trusted destination where patients can access care, medications, labs, insurance supported services, and ongoing clinical support through one connected experience. Let me walk you through where we’re seeing the most progress. First, weight management. This remains the largest opportunity in our business. More than 100 million Americans are clinically eligible for GLP-1 therapy, and it is estimated that fewer than 15% have tried one. These medications represent one of the most significant breakthroughs in consumer healthcare in decades, and importantly, the market is becoming more dynamic, not less. We are entering the next phase of GLP-1 adoption. The first phase was access to injectables.
The second phase is broader access, including oral therapies, lower cost self-pay options, insurance coverage, and a deep pipeline of next generation drugs. We are built for this phase. We’ve already benefited from the introduction of oral GLP-1s. Customer acquisition costs improved 4%-5% sequentially in Q1, even as volumes effectively doubled from roughly 300-400 new patients per day to 600-1,000 patients per day. We ended the quarter with just under 100,000 weight management patients, and this opportunity is only getting bigger. There are roughly 40 GLP-1 therapies currently in development, including oral formulations, longer-acting injectables, and multi-pathway treatments. As these therapies come to market, we believe platforms like LifeMD that combine affordable access, insurance integration, and real clinical care will be the long-term winners. Second, women’s health.
This continues to be one of the programs I’m most excited about. The need is enormous. Tens of millions of women are entering or living through menopause, and access to thoughtful, evidence-based, coordinated care remains limited. We built this program differently around longitudinal care, not just prescriptions. That includes comprehensive intake, appropriate lab work, structured clinical protocols, and ongoing management by providers trained specifically in women’s health. The early results have exceeded our expectations. Subscriber count grew more than 7x from the Q4 base. Customer acquisition costs remain attractive. On-therapy retention is tracking north of 80%. We believe that performance is a direct reflection of the quality of the program. Over the coming months, we plan to introduce seven new compounded pharmacy products focused on hormone and bone health, highly complementary to patient needs and well-aligned with our in-house pharmacy capabilities.
Women’s health has the potential to become one of the largest and most important programs in our company. Not just a growth driver, but a category where we can build deep, trusted patient relationships. Third, Rex MD and Men’s Health. Rex MD remains one of the most recognized men’s health brands in the country and a critical part of our platform. We now have approximately 215,000 active patients with growth across ED, sleep, and hair loss, with sleep currently the fastest growing category. ED remains the core, and our personalized ED medications, combining sildenafil and tadalafil, grew more than 40% versus Q4. As more fulfillment shifts in-house, we expect continued margin expansion. Rex MD is evolving beyond ED. We are expanding into personalized pharmacy products across sexual health, dermatology, pain management, and longevity.
Just as importantly, Rex provides a large, engaged patient base that can expand into the broader LifeMD ecosystem over time, strengthening retention and lifetime value. Fourth, operating leverage in AI. This is one of the most important components of the LifeMD story for 2026. We are deploying AI aggressively but thoughtfully, with quality as the non-negotiable. AI is not just a cost initiative. It is becoming foundational to how we build software, how providers deliver care, and how we operate the business. Our clinical decision support tools will integrate health records, lab data, biomarker insights, and patient intake information to enable more personalized and efficient care. Over time, we expect AI to increase provider capacity without adding headcount, which is a key lever for scaling efficiently. We are also embedding AI across intake, documentation, patient support, revenue cycle, compliance, and back-office workflows.
This is not about replacing providers. It’s about enabling them to spend more time practicing medicine and less time on administrative work. We expect the margin impact to become more visible in the second half of 2026. When AI is combined with our 503A compounding pharmacy, it unlocks something powerful. Personalized prescribing at scale enabled by data, clinical infrastructure, pharmacy capabilities, and national reach. Very few platforms have that combination, and LifeMD is one of them. Fifth, pharmacy, insurance, and partnerships. Our affiliated pharmacy continues to scale. We now operate a 22,500 square foot facility licensed in all 50 states with both commercial and 503A compounding capabilities. The pharmacy is currently processing approximately 20,000 prescriptions per month, with significant capacity to expand throughout this year as our pharmacy offerings expand.
We view pharmacy as one of our most important long-term margin expansion levers, improving economics, patient experience, and speed to market. On the payer side, our insurance and Medicare infrastructure continues to expand. We ended the quarter with approximately 112 million covered lives and expect to reach approximately 230 million by the end of this month. The Medicare GLP-1 Bridge launching July 1 is particularly important as it expands access to GLP-1 therapies for Medicare patients at an affordable monthly cost. We also continue to see strong momentum with pharmaceutical partners as the industry increasingly shifts toward direct patient models. Our GLP-1 collaborations are a strong proof point of that trend. On the employer side, we are making progress with enterprise relationships and direct GLP-1 coverage for self-insured groups, a meaningful upside opportunity not yet fully reflected in our outlook.
Stepping back, we feel very good about where we are. We are serving more patients, expanding into larger and more durable categories, strengthening the platform, and building a business we believe can compound over the long term. We are reaffirming our full year guidance of $220 million-$230 million in revenue and $12 million-$17 million in adjusted EBITDA. We continue to expect annualized run rate revenue above $250 million and adjusted EBITDA above $25 million by the fourth quarter. With that, I’ll turn the call over to our new CFO, Atul Kavthekar, to walk through the quarter in more detail. Atul?
Atul Kavthekar, Chief Financial Officer, LifeMD: Thank you, Justin. Good afternoon, everyone. I’m delighted to be joining my 1st quarterly call as CFO of LifeMD and pleased to be leading its financial operations. It’s been a positive 1st few weeks, and I’ve been impressed by the team and their commitment to continuous improvement, their entrepreneurial mindset, and their general curiosity. I’ll be doing everything I can to continue that culture. As for results, the 1st quarter played out largely as we expected. Strong subscriber momentum following a planned step-up in patient acquisition spend, and the early benefits of platform efficiency beginning to show in our gross margin. As a reminder, all year-over-year comparisons are on a continuing operations basis, excluding WorkSimpli, which was divested on November 4, 2025.
Revenue for the first quarter was $50.2 million, exceeding our guidance range of $48 million-$49 million, and essentially flat versus the prior year period of $50.9 million, and with nearly all revenue derived from recurring subscriptions. Active subscribers grew approximately 26% year-over-year to over 365,000 at quarter end, with over 42,000 net adds in Q1, the largest quarterly net addition in our history. Gross margin for the quarter expanded approximately 420 basis points to 88%, primarily reflecting improvements in lower shipping and fulfillment costs, including the continued scaling of our in-house pharmacy fulfillment that Justin described previously. Gross profit was $44.2 million, up 3% for the year ago period, despite the flat year-over-year revenue growth.
Selling and marketing expenses were $29.8 million, an increase of 34% year-over-year, reflecting the strategic front-loaded patient acquisition investment, which is designed to drive subscriber growth in subsequent quarters. Q1 was the peak of our marketing investment for the year. Marketing spend has begun normalizing, and we expect sales and marketing to step down in Q2 and remain at more typical levels throughout the back half. GAAP net loss from continuing operations attributable to common stockholders was $9.6 million or $0.20 per diluted share, compared to a net loss from continuing operations attributable to common stockholders of $2.4 million, or $0.06 per diluted share in the prior year period. Stock-based compensation was $1.4 million, down from $2.5 million in the prior year period, reflecting our continued focus on aligning our management with long-term goals.
Adjusted EBITDA, a non-GAAP measure we define as income or loss attributable to common stockholders before various items, as outlined in today’s news release, was a loss of approximately $4.5 million for the first quarter, in line with our previously issued first quarter guidance range of a loss of $4 million-$5 million. This compares with an adjusted EBITDA of approximately $3.7 million in the prior year period. Turning to the balance sheet, we exited the quarter with $34.5 million in cash, no debt, and a $30 million undrawn revolving credit facility that we put into place at the start of the year. Our balance sheet remains a strategic asset, providing ample flexibility to fund our expanding growth initiatives.
Looking forward, we are reaffirming our 2026 full year guidance, revenue of $220 million-$230 million, representing 13%-19% year-over-year growth, and adjusted EBITDA of $12 million-$17 million. We expect to return to adjusted EBITDA profitability in the second half of the year as customer acquisition costs decline sequentially and the patient volumes added in Q1 become accretive. This is in addition to multiple initiatives around our business that we expect to impact the second half. These include the expansion of our pharmacy offerings, which will allow us to capture revenue and margin we do not currently benefit from.
As was established during our 2025 Q4 call, we continue to expect annualized run rate revenue exceeding $250 million and annualized run rate adjusted EBITDA exceeding $25 million by the fourth quarter of 2026. For Q2, we are expecting the business to continue its transition to branded GLP-1s, As such, we expect to see our Q2 revenue between $47 million-$50 million and adjusted EBITDA of between -$2 million to $1 million as we continue to realize efficiencies and cost savings in our business. With that, I’ll turn it back to Justin.
Justin Schreiber, Chairman and Chief Executive Officer, LifeMD: Thanks, Atul. As we close our prepared remarks, I want to come back to the larger point. Q1 was always going to be an investment quarter. We leaned into the launch of oral GLP-1s, accelerated patient acquisition, made big progress in women’s health, expanded our pharmacy and insurance infrastructure, and advanced the AI tools that we believe will make this platform more scalable over time. What gives me confidence is that the early signals are showing up exactly where we would want to see them. Record subscriber additions, strong demand in weight management, rapid early growth in women’s health, improving pharmacy economics, and a clear path to operating leverage as the year progresses.
As I laid out in our shareholder letter, the model is simple: quality care, quality products, quality revenue. If we deliver high quality care and build products patients value, they stay longer, use more of the platform, and create more durable revenue. That is the foundation of LifeMD’s strategy. The opportunity ahead is tremendous. GLP-1 therapy is entering a new phase with oral medications, broader access, and a deep pipeline of next generation therapies. Women’s health is scaling from a small base into what we believe can become one of the most important programs we have ever built. Rex MD continues to give us a large, engaged patient base and a trusted men’s health brand. Across the company, AI, pharmacy, and insurance are becoming real levers for better care, stronger retention, and margin expansion. We are not building a point solution.
We are building a platform patients can come back to for more of their healthcare needs over time. That is what makes this business more durable, and that is what makes me so excited about the rest of 2026. I want to thank the LifeMD team for their continued execution and our shareholders for their support. With that, we’ll open the call for questions. Operator?
Operator/Moderator: Thank you. We will now begin the question and answer session. To ask a question, you may press star then 1 on your touchtone keypad. If you’re using a speakerphone, please pick up your handset before pressing any of the keys. If at any time your question has been addressed and you would like to withdraw your question, please press star then 2. At this time, we will pause momentarily to assemble our roster. The first question comes from David Larsen with BTIG.
David Larsen, Analyst, BTIG: Hi. Congratulations on the good start to the year. Can you talk a little bit about your relationship with Novo and also Lilly? Obviously, you guys were sort of leaders in the industry, with regards to partnering with the brand manufacturers, as opposed to, like, continuing with a sort of aggressive, you know, compound or GLP-1 effort. How are you making money with Novo and Lilly? How is the sort of solid oral pill launch progressing? Just any more color there will be helpful. Thank you.
Justin Schreiber, Chairman and Chief Executive Officer, LifeMD: Hi, Dave. Thanks for the question. This is Justin speaking. Yeah, look, we I think we’ve commented extensively both in press releases and on calls like this about, you know, how important both of these relationships are to LifeMD. Look, I’d emphasize, you know, as we’ve talked about a lot, that they’re we view them as very long-term collaborations. You know, relatively speaking, you know, both of these things are pretty new, we’ve been working through, you know, just kind of a lot of the different strategies that we think are going to drive, you know, long-term patient growth and really help patients access these therapies.
you know, I can’t really go into a lot more detail on either of the relationships, except what I will say is that we’ve had really productive conversations with both of those companies, about, you know, compliant ways that we can help kinda more patients access these therapies. you know, those discussions are ongoing, and we’re extremely optimistic that in the near term, being, you know, kind of the next quarter or two, that at least one, if not kind of both of those relationships will continue to evolve in a way that, you know, does kind of help our overall unit economics for this business, you know, and helps us to, you know, enable more people to access these therapies.
I also think it’s worth pointing out that, you know, again, both of these companies have next generation therapies that are in the pipeline. You know, we’re gonna be a platform for products from those two companies, and we’ve already spoken to a number, you know, of other large pharma companies that have next generation GLP-1 therapies, and we expect those therapies to be available in the LifeMD platform. This is a long-term trend. I’ll also emphasize that, you know, we spend a lot of time looking at the unit economics for, you know, the branded therapy business. We have some areas where, you know, unit economics are softer than we like, and we have some areas where unit economics are incredible.
One of the areas where unit economics are really strong is on the insurance side of the business when people are using their health insurance to subsidize the care component and even still, you know, paying cash for these medications. These unit economics look really outstanding, and there’s a lot of demand. I hope that answers your question. You know, we are obviously under NDA with both of these companies, we’re kinda limited with what we can say on an earnings call.
David Larsen, Analyst, BTIG: Okay, great. It sounds like your relationship with both Novo and Lilly are evolving and you’ll reach some sort of an understanding that benefits both them and you, and obviously most importantly, the patients and the members that are benefiting from the medications. Okay. Then can you maybe talk a little bit about the incremental marketing spend in 1Q? Obviously, that put a little bit of pressure on the EBITDA in the quarter. What is the nature of that incremental spend? Is it, like, just sort of like Google Ads and online ads or something more than that?
Atul Kavthekar, Chief Financial Officer, LifeMD: Yeah, Dave, this is Atul speaking. You know, look, we had, I think the elevated marketing spend in the first quarter was actually very productive. The various channels and the media buys were, you know, many of the same that we have used, and certainly that includes, you know, Google Ads and some of the other sort of more, you know, typical types of social media places where people are interested in starting to do research. The upshot I would think of the elevated spend is really just it was a tremendous opportunity to acquire customers at CPAs that, you know, were what I would call historically, well, at least for the last several quarters, it’s really attractive CPAs.
We were able to add to the active base, by, you know, almost 13% in the quarter. Almost equally important, we really added to our sort of database, our pool of potential, you know, targets that we have the ability to market to going forward. I think so in many respects it was, you know, a broad-based, general campaign or set of campaigns that I think, you know, really will be able to kind of help the company going forward in year and in the quarter and the next quarter and then beyond through the rest of the year.
David Larsen, Analyst, BTIG: Okay. Congrats on a good quarter. I think you probably have a bunch of people on the line, so I’ll hop back in the queue.
Atul Kavthekar, Chief Financial Officer, LifeMD: Thanks, Dave.
Operator/Moderator: The next question comes from Ryan Meyers with Lake Street Capital.
Ryan Meyers, Analyst, Lake Street Capital: Hey, guys. Thanks for taking my question. You know, thinking about the 230 million or so lives you expect to have covered this month, you know, what are you seeing so far in terms of conversion rates, retention, you know, customer acquisition synergies that you’re seeing from these insurance-supported programs so far?
Justin Schreiber, Chairman and Chief Executive Officer, LifeMD: Yeah, thanks. This is Justin. I’ll take a stab at that and then Atul can weigh in. High level, we’re seeing a considerable improvement in retention rates for insurance patients, which is one of the reasons that we’re super optimistic. We’re seeing a significant reduction in customer acquisition costs by as much as kind of 50%, we do expect that to go up a little bit as we scale these offerings. You know, in short, we’re seeing a significant reduction in CAC and, you know, these patients are paying a much lower platform or membership fee to LifeMD than patients that are not using their insurance. What we’re seeing is, you know, at least a 10-point improvement in retention.
Obviously, some of these cohorts are newer but, you know, over the first three to six months, it’s pretty meaningful. We’re getting less money. We’re getting fewer dollars. We’re spending less to acquire them. Overall, you know, like we think that the unit economics profile of this patient is optimal to a self-pay patient.
Ryan Meyers, Analyst, Lake Street Capital: Okay. Got it.
Atul Kavthekar, Chief Financial Officer, LifeMD: Yeah. This is Atul. Let me just add one thing. I think, you know, one of the additional things that I was maybe a little bit surprised is for the patients that are coming through the flow, our, you know, our order flow on the site, they have an opportunity to indicate if they’re interested in insurance or not. You know, I anticipated there’d be a lot of interest in it. I didn’t expect it would be in the 75%-80% range, which just is a further indication that there’s a lot of demand, and I think it points to where the business and the makeup of the patient population is gonna go over the next, you know, quarters and the next few years. We’re really excited about this business.
Ryan Meyers, Analyst, Lake Street Capital: Got it. You know, as we think about the year-over-year revenue, you know, while you did come in ahead of expectations, it was a year-over-year decline. Can you just remind us if there was any dynamics in the first quarter of last year, and then how we should think about that and the potential impact during the second quarter of this year and how that relates to the guidance?
Atul Kavthekar, Chief Financial Officer, LifeMD: Yeah. I’m glad you asked the question. Yes, absolutely. The first quarter of 2025 had a heavy use of, you know, a compounded GLP-1. We have continued to migrate this business where we think the future is really around branded drugs, and that’s really the delta that you’re seeing. Today we have a different set of unit economics around there. We don’t make as much. I think we’ve been, you know, pretty upfront about that. But we also do think that those are really exceptional patients, and they simply have a meaningfully better retention. We think that that’s the right direction for the business. That’s really what’s causing it. It’s just, it’s really simply the change in the product mix.
Ryan Meyers, Analyst, Lake Street Capital: Okay. Got it. Thanks for taking my questions, guys.
Atul Kavthekar, Chief Financial Officer, LifeMD: Thank you.
Operator/Moderator: The next question comes from Sarah James with Cantor Fitzgerald.
Gabby, Analyst, Cantor Fitzgerald: Hey, everyone. This is Gabby on for Sarah. Could you help us get a little bit more comfortable with the second quarter to third quarter EBITDA ramp and maybe expand on what initiatives are kicking in? Maybe the second quarter EBITDA was just slightly softer than we had modeled. Just any additional color there would be great.
Atul Kavthekar, Chief Financial Officer, LifeMD: Yeah. So this is Atul speaking. Nice to meet you, Gabby. Well, let me try to sort of paint a picture for the, maybe for the full year. You know, in the third quarter for sure, second to third quarter for sure. Going forward, you know, we are really embarking. I think we are getting a lot of momentum behind the insurance business. This is a part of our business that I think is going to be really big. You know, as I was just mentioning, the CPAs, as Justin said, were really attractive. We see that being a more and more important part of the revenue growth story, and we see that as an opportunity to kind of strategically capture some of the better quality patients. We see that really ramping up in the second half.
We’ve made a lot of technical improvements in the platform. I can talk more about that later if you’d like. We’ve made a lot of improvements. We are significantly expanding. In fact, I think next week we’re planning to expand to, I think it’s 147 additional plans. That is gonna be a big part of the story in the second half of the year. Other parts of it is really around enhanced economics. I think Justin Schreiber sort of alluded to that a little bit. I think those are things that we are also expecting. Those are things that affect that directly affect and impact and improve the revenue as well as the EBITDA. The way our accounting works is that’s essentially incremental revenue. It hits both revenue and EBITDA.
It’s a very big opportunity for us. There’s more to come on that, not necessarily for today. There’s other areas that haven’t really been a big focus. There’s a couple reasons for it, mostly technical in nature. You know, what we call cross-care. Think of a lot of our patients that may be on GLP-1 drugs today that may have the right circumstances or might be interested in other products that we sell, whether it be ED medications, sleep medications, so on and so forth. That’s a big opportunity that, again, for technical reasons that have sort of recently been solved or are about to get solved, really opens up a new opportunity for us to generate revenue that hasn’t been there in the past.
Those are, you know, really important sort of revenue drivers. On the cost side of the equation, you’ll start to see this in the 2nd quarter, 3rd quarter, 4th quarter as well, but it’s certainly gonna be a front-loaded first half of marketing spend. As you can see the numbers, in the 2nd quarter, we’re expecting somewhere in the vicinity, don’t hold us strictly to this, but sort of in the $26 million to $27 million of, you know, marketing spend. The marketing dollars are definitely gonna come down. In the back half of the year between the 2 quarters and we will make determinations as to how and when to spend that.
We’re, you know, we’re penciling in sort of in the $42 million-$44 million range of marketing spend in the back half. From first half to second half, that does come down quite a bit. I know we’ve talked about it, but some of the cost efficiencies that we’ve been working on, and you’ve seen some of that. You know, if you look at the SG&A we just reported in Q1 and you compare that to Q4, I mean, as a percentage of revenue, that’s come down quite some bit. You know, over 200 basis points. Going forward, we will see more of those types of things.
It’s not just simply gonna be SG&A, it’s going to be, you know, on the, you know, affecting the gross margin, things like shipping costs, all those you know, provider efficiencies, fulfillment costs, all of those things that hit across the P&L. We’ll see more of that in the second half of the year, and that’s kind of what gives us a lot of comfort. As you can imagine, I probably spent a lot of time on that over the last couple of weeks. That’s, that’s been an area that I think, you know, I’m feeling pretty good about, and I think, I think you’ll see that unroll, and we’ll talk more about that in the coming quarters.
Gabby, Analyst, Cantor Fitzgerald: Okay, great. That was all super helpful. Then if I could just squeeze in one more. The CMS Bridge program was extended through 2027. How does that impact you guys? Does that give you a more positive outlook on your contribution to that program? What’s the right read-through?
Justin Schreiber, Chairman and Chief Executive Officer, LifeMD: Yeah. This is Justin. We’re very excited about, you know, Medicare beneficiaries having access to GLP-1 medications. As most people listening to this call know, we’ve put a enormous amount of energy into building a 50-state Medicare program. It’s working. We’re turning it on. It already is on in some states for weight management. We’re turning it on for women’s health in the next couple weeks. We are kind of thinking through the right strategy for patients, Medicare beneficiaries using Bridge. I’m excited about it. There’s still some details to work out. We haven’t built this into our model. I’m really excited about it. We’re working with outside counsel right now on a lot of the particulars.
If it all works the way I think it’s gonna work, I think it’s gonna be a really, really big opportunity for us in the back half of the year and, you know, more importantly, help a lot of Medicare beneficiaries access these medications affordably.
Gabby, Analyst, Cantor Fitzgerald: Okay, awesome. Thank you so much.
Atul Kavthekar, Chief Financial Officer, LifeMD: Thank you.
Operator/Moderator: The next question comes from Steven Valiquette with Mizuho.
Steven Valiquette, Analyst, Mizuho: Yeah, thanks. Good afternoon, guys. Thanks for taking the questions. I guess 1 or 2. You know, first, it’s obviously pretty early days on Foundayo, but curious just to get your thoughts on the uptake so far. Maybe just to set the stage on that. You know, at a national level, investors are trying to compare the week-by-week launch of Foundayo with the comparable week post the launch of oral Wegovy earlier this year. So far, the uptake of Foundayo, at least nationally, is kinda trailing the initial oral Wegovy uptake. I’m wondering, you know, are you seeing that same trend within your own platform? If you are, you know, close to the numbers, are you kinda tracking it that way? If so, just curious to what you think is gonna drive in that. I’ll start with that question. Thanks.
Justin Schreiber, Chairman and Chief Executive Officer, LifeMD: Sure. This is Justin. I know this isn’t the answer you’re looking for, but I wanna be a good collaborator to both of these companies, and I don’t think it’s appropriate for us to comment on traction, specific traction of, you know, of one therapy versus another on our platform. Like, what I’ll say is that we do have Foundayo Live. You know, we have a lot of patients choosing both Foundayo and Wegovy pill. Look, it does seem like Wegovy pill has more awareness out there in the space and maybe that’s kind of partly, you know, why, you know, it’s, it is still slightly more popular than Foundayo on our platform.
We don’t wanna get too much into specifics.
Steven Valiquette, Analyst, Mizuho: Okay. That’s fair, and I appreciate that. Second question then, I’ll try to ask it maybe a little more, little more high level then, is that, you know, one of those two manufacturers did make a comment on one of their most recent earnings calls that roughly 55% of their new patient starts are cash pay customers, which I thought would have been pretty positive for you. I guess the question I’ll ask in relation to that is, yeah, I would have thought maybe your 2Q revenue guidance would be just a little bit stronger sequentially versus 1Q just, you know, because of that backdrop.
Yeah, I know in your comments you talked about 2Q that the, you know, the evolution of the, you know, shift of patients off the compounded drugs and more to brands is still kinda taking shape in 2Q. I’m just trying to unpack that a little bit more. Is there something about the fall off on the compounded patients will be a little more rapid in 2Q versus 1Q for whatever reason? Is there still, you know, something that’s holding back the brand uptake versus maybe what some of us thought it might be, on your platform in 2Q, especially with, you know, one of these orals just launching very recently? Hopefully that question makes sense. Thanks.
Justin Schreiber, Chairman and Chief Executive Officer, LifeMD: Yeah. Thanks, Steven. I mean, there’s a lot in there, so let me try to remember.
Steven Valiquette, Analyst, Mizuho: Yeah.
Justin Schreiber, Chairman and Chief Executive Officer, LifeMD: what you asked. I mean, first of all, the demand for oral therapies is still very, very strong, right? It’s actually surprised me at how strong the demand is for oral therapies. I also think that the success of these self-pay programs has surprised everybody. I obviously can’t and won’t speak for Lilly or Novo, but I think that everybody’s pretty surprised at how successful these programs are. I think payers are probably surprised as well. I think that Look, I mean, when we built LifeMD, the initial vision that Stefan and I had for this platform was to help patients access, you know, branded medications.
It was to do the types of collaborations that we’ve done with Lilly and Novo, and I think the fact that they broke the ice in a sense for the rest of the industry, and LifeMD’s had the privilege of collaborating with both of these companies, is an incredible thing. As I think I’ve emphasized publicly on many different occasions, we’ve got a number of other really respectable large pharma companies that have come to us and are interested in collaborations, some of which are, you know, could be very transformational for our business.
Look, the fact that payers, by the way, the fact that I mean, one of the things that I found most interesting over the last couple of months is that, you know, coverage actually appears to be slightly declining for some of these GLP-1 medications because of the success of the self-pay programs, which, by the way, that’s certainly a tailwind for a platform like LifeMD that, you know, has, you know, that essentially facilitates these kind of direct-to-patient programs. So, remember, like LifeMD can support self-pay and insurance, both on the pharmacy and the care side. So I think we’re in a great spot.
I’ve, and I, you know, it’s genuine what I said on the call, that, you know, because of, you know, all of these kind of tailwinds that we’re seeing right now, I’m really excited about the trajectory of the business. On the softness, like in Q2 revenue, you know, just to kind of reiterate what Atul said, I mean, our revenues just has it’s changed a little bit, right? It’s part of like the transformation that the company’s going through. It’s part of our focus on quality revenue, we’re charging less for some of the services that we’re offering, like weight management. I’m sorry, like women’s health. It’s more of an à la carte model. Same with weight management. If you look at the insurance population, they’re paying less. We’re billing their insurance.
We’re still working out some of the kinks with our, you know, RCM processes as well. Like, we’re patient. Like, we’re not trying to build something here and get, you know, as much revenue as we can upfront. Like, we wanna offer services and products that have strong retention, have a strong value proposition associated with them, and, you know, are awesome for patients. That’s kind of the reason why there’s a little bit of softness there. We’re super confident in the back half of the year.
Steven Valiquette, Analyst, Mizuho: Okay. That sounds great. Thanks.
Operator/Moderator: The next question comes from Steven Dechert with KeyBank.
Steven Dechert, Analyst, KeyBank: Hey, guys. Thanks for the questions. I was hoping you could give some kind of outlook on the cadence of weight management subscribers through the rest of the year. Then could you talk more about the opportunity with self-insured employers and what you think the upside could be there? Thanks.
Atul Kavthekar, Chief Financial Officer, LifeMD: Yeah. This is Atul speaking. I think the cadence going forward in the first quarter was very strong. We will probably see a similar growth pattern going forward through the year. I think, you know, there may be ebbs and flows in quarter to quarter, but over the course of the year, we still see fundamentally these are very strong tailwinds. You know, we have a very large group of patients that we can, you know, market to that we have touched. They’ve reached out to us before. We have an opportunity to convert them again.
We, we feel pretty good about maintaining a pretty consistent level and, you know, look, we’re gonna do everything we can to in fact accelerate it, you know, particularly with the insurance offering and opening ourselves up to those patients, notwithstanding some of the challenges that, you know, some of the managed care programs and plans have had around covering this. There still are a lot that will. As someone was asking earlier about the Bridge program, those are big opportunities for us to grow and maybe even accelerate penetration and patient counts in the GLP-1. Maybe I’ll turn it over to Justin for the other question.
Justin Schreiber, Chairman and Chief Executive Officer, LifeMD: Steve, I’ll just add. I dedicated a lot of time in the shareholder letter to talking about the revenue streams, you know, that are essentially going to, you know, be part of LifeMD’s future that we’re growing into over the course of the next year. I mean, we talked about, you know, one of the areas that we focused on is obviously revenue streams from pharmaceutical collaborations. We think that’s going to be meaningful. We think that, you know, we have a deep pipeline right now of, you know, pretty big partnerships. Which is very similar to enterprise revenue, right? It’s essentially large partners of ours that are effectively offering our services to their customer base or to their membership. We’re really excited about those.
We have some of those in place now. But there’s some other very significant ones in the pipeline, and we expect to continue to develop that pipeline. We also have, you know, we think the employer opportunity is pretty big, and we’re working on some programs right now for employers. There’s a lot of interest there. Quite frankly, there’s a tremendous amount of interest from the pharma channel and from the strategic partner channel. Because of that interest, we’ve been deprioritizing the programs for employers. It’s certainly, it’s certainly in the plans and, you know, we understand like the attractiveness of that, you know, of that revenue, obviously.
Steven Dechert, Analyst, KeyBank: Great. Thanks, guys.
Atul Kavthekar, Chief Financial Officer, LifeMD: Thank you.
Operator/Moderator: The next question comes from Yi Chen with H.C. Wainwright.
Katie, Analyst, H.C. Wainwright: Hey, this is Katie on for Yi Chen. Looking at the FDA’s proposal to exclude semaglutide and that sort of drug from the bulk list, your shift to branded drugs kind of puts you ahead of that a little bit. How should we think about where you guys stand and how this could play out, whether it goes either way? As a follow-up, what is your prescriber documentation framework for that individualized medical necessity standard? Have you guys talked to the FDA about that at all?
Justin Schreiber, Chairman and Chief Executive Officer, LifeMD: Hi, this is Justin. Thanks for the question. The changes to the bulk drug list have zero impact on the business, completely irrelevant to us. You know, we don’t compound these medications. We have some patients that are still on a personalized compound for third-party pharmacies. As far as Look, again, this is not something that we really spend much time on because of the, you know, the kind of overwhelming focus of helping patients access branded therapies. I’m sure that all of our provider documentation is, you know, is best in class.
Operator/Moderator: Does that answer your question?
Justin Schreiber, Chairman and Chief Executive Officer, LifeMD: Okay, maybe we lost Katie.
Sorry.
Operator, maybe we can go to-
Operator/Moderator: Okay. Thank you. This concludes our question and answer session. I would like to turn the conference back over to Justin for any closing remarks.
Justin Schreiber, Chairman and Chief Executive Officer, LifeMD: I just wanna say thank you, everybody, for your time and for tuning in for our earnings call. We look forward to talking to you next quarter, and I hope everybody has a good evening. Thanks.
Operator/Moderator: Thank you. The conference has now concluded. Thank you for attending today’s presentation. You are now disconnected.