Myomo Q1 2026 Earnings Call - Recurring Revenue Shift Accelerates as O&P Partnerships and Payer Contracts Expand Market Access

Operator: I would now like to turn the conference over to Bruce Voss of Alliance Advisors. Please go ahead.

Bruce Voss, Investor Relations, Alliance Advisors: Thank you, good afternoon, everybody. This is Bruce Voss with Alliance Advisors IR. Welcome to the Myomo first quarter 2026 financial results conference call. With me on today’s call are Myomo’s Chief Executive Officer, Paul Gudonis, and Chief Financial Officer, Dave Henry. Before we begin, I’d like to caution listeners that statements made during this call by management other than historical facts are forward-looking statements. The words anticipate, believe, estimate, expect, intend, guidance, outlook, confidence, target, project, and other similar expressions are typically used to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance and may involve and are subject to risks, uncertainties, and other factors that may affect Myomo’s business, financial condition, and operating results. These risks, uncertainties, and other factors are discussed in Myomo’s filings with the Securities and Exchange Commission.

Actual outcomes and results may differ materially from what’s expressed in or implied by these forward-looking statements. Except as required by law, Myomo undertakes no obligation to revise or update any forward-looking statements to reflect events or circumstances after the date of this call today, May 7, 2026. It’s now my pleasure to turn the call over to Myomo’s CEO, Paul Gudonis. Paul, please go ahead.

Paul Gudonis, Chief Executive Officer, Myomo: Thanks, Bruce. Good afternoon, and thank you all for joining us today. We remain very excited about the opportunity in front of us to improve lives and grow our company. Chronic arm upper limb paralysis is an underserved medical condition. Each year, stroke leaves hundreds of thousands of Americans with lasting arm impairment. When you add in spinal cord injury, traumatic brain injury, and brachial plexus injuries, the addressable U.S. population reaches into the millions. Globally, millions more. For most of these patients, the standard of care has been a passive brace, ongoing physical therapy with diminishing returns or resignation to permanent loss of function.

Our MyoPro is the only commercially available powered arm orthosis in the U.S. that uses non-invasive EMG sensors to detect the patient’s own muscle signals and amplify them into functional movement, thereby permitting paralyzed individuals to feed themselves, carry objects, return to work, and reclaim independence at home. That’s not an incremental improvement on existing care. It’s really an entirely different category of device, and Myomo owns it. Let me start with a quick real-life story. Our staff just helped Mike, who lost the use of his right arm due to a brachial plexus injury from a motorcycle accident when he was just 17 years old. Now, some 50 years later, he’s using both arms again with the help of a MyoPro. He’s carrying objects safely around his home, and he’s doing household tasks such as mowing his lawn.

Our MyoPro has improved the quality of life for Mike and for his wife, reducing the burden of care from his impairment, and that’s what this is all about. Several positive factors are converging right now to drive Myomo’s success. Reimbursement, distribution, and technology. Reimbursement by CMS in a new Medicare Part B benefit category with HCPCS codes for the MyoPro has opened access to a Medicare population of tens of millions and removed the single largest historical barrier to adoption. New clinical studies and in-network contracts with a growing number of commercial payers has significantly increased market access for patients covered by these plans. We’re transitioning our go-to-market strategy with a distribution system based on recurring patient sources from rehab hospitals and O&P providers to reduce our customer acquisition costs and to build the foundation for accelerated growth going forward.

Our investments in technology are increasing the value to patients and clinicians while reducing our operating costs as we scale the business to sustain profitability. Earlier this year, we established 4 success pillars for 2026: recurring revenue, market access, operating leverage, and innovation. With strong progress against each, first quarter revenue and profitability exceeded our targets. We measure our progress against these 4 success pillars, let’s review each of them. Number 1, the shift to recurring patient sources. We launched the MyoConnect program in mid-2025 to encourage therapists and physicians at rehab hospitals, stroke clinics, and other healthcare facilities to refer prospective MyoPro patients to us or to a local O&P partner. These channels not only provide recurring referrals, they also carry lower acquisition costs and higher conversion rates versus direct-to-patient marketing.

With Medicare coverage in place and the new MyoPro 2x introduced last year, it was the right time to bring the benefits of the MyoPro to the incidence population of patients who are currently in outpatient therapy, expanding our target market beyond the individuals with chronic arm paralysis and the large prevalence population. We reoriented our field clinical team, added sales specialists, and conducted numerous in-service educational sessions at these rehab locations. I’m pleased to report that now more than 150 rehab facilities are now referring candidates to us. The O&P channel is another source of recurring referrals, and our O&P revenue grew 79% year-over-year as we trained and certified additional CPOs and jointly implemented outreach programs.

Earlier this week, we announced that we’ve been working with Ottobock’s U.S. clinical operations to certify them as MyoPro Centers of Excellence, and we recently conducted training for over 20 clinical specialists from around the country as part of their national rollout. Ottobock is the world’s largest provider of O&P products and clinical services, and we’re very pleased to be working so closely with them. In Germany, we have more than 100 O&P practices working with us to provide the MyoPro to their patients. The insurance environment in Germany is highly favorable, and our international revenues reached a Q1 record of approximately $2 million. We continue to expand our sales and clinical staff in Germany, and later this month, we’ll be attending the OTWorld Conference in Leipzig to engage with additional O&P clinics. This conference is the largest O&P event in Europe.

As a result of these efforts, we’re tracking extremely well against our targets of consistently increasing revenue from recurring patient sources. Pillar number 2, that’s the second success pillar, is to increase market access for patients by signing additional payer contracts. As discussed in March, we signed a national arrangement with Elevance, which manages a number of Anthem Blue Cross Blue Shield plans in 27 states, including large ones like Texas, Ohio, Virginia, and California. We’ve been entering into these payer contracts to secure Myomo as an in-network provider with case-by-case coverage determinations and agreed upon price for the MyoPro. As a result, we’re now seeing a significantly higher authorization rate from these payers’ Medicare Advantage and commercial plans. Over the next several months, I expect we’ll sign additional state contracts under the Elevance national arrangements.

Since we secured Medicare coverage in April of 2024 and added various commercial and Medicare Advantage contracts, we’ve gone from just 9 million covered lives to 158 million lives currently. Pillar 3 is to demonstrate operating leverage and the path to profitability. We demonstrated early operating leverage in the first quarter, with revenue up 3%, while OpEx was down 1% year-over-year. We also expanded gross margin by 100 basis points, and the combination of these accomplishments resulted in a 20% improvement in adjusted EBITDA. Pillar 4 is to continue to invest in product development and clinical research.

At the end of March, we launched a new mobile app, which allows clinicians, patients, and caregivers to use their smartphones to adjust the MyoPro device settings, display their muscle movements and EMG signals, and collect usage data that can be used by therapists and physicians. The app also eliminates the need to ship a laptop with our proprietary software to each user, reducing our MyoPro material cost by about 10%. You’ll see this benefit flowing through to gross margin beginning in the second quarter. Another R&D investment is a randomized control trial being conducted by the University of Utah Rehabilitation Hospital. After a successful pilot last year, the university’s IRB approved a study which will compare the outcomes of users with the MyoPro against those who received the current standard of care of occupational therapy.

We’ve enrolled 18 of the 50 subjects to date, and when completed, and assuming similar results to our pilot last year, this clinical evidence is expected to support increased reimbursement of the MyoPro. Finally, development of the MyoPro 3 next-generation platform is progressing. We’re focused on enhanced functionality and increased processing power to support future software driven innovations. The progress on each of our 4 success pillars is tracking with our targets, and we’re excited to keep on delivering. On the marketing front, we added a new marketing executive and engaged a new digital ad agency in Q1. As a result, we’ve also refined our marketing strategy with a new approach to digital channels and data-driven targeting. We’re also expanding the use of social media to engage directly with healthcare providers and to introduce the MyoPro in geographies with payer contracts.

These initiatives are already improving lead quality, which is resulting in more pipeline adds per lead generated and reducing patient acquisition costs. We expect further efficiency gains as these programs scale throughout 2026. With that overview, I’ll turn the call over to our CFO, Dave Henry, to walk through the financial results in more detail.

Dave Henry, Chief Financial Officer, Myomo: Thank you, Paul, and good afternoon, everyone. As Paul just discussed, we’ve been busy executing against the success pillars we introduced earlier this year, and I’m pleased to report on the progress we’ve made. Our revenue for the first quarter of 2026 was $10.1 million, up 3% versus the prior year period. The increase was driven by a higher average selling price, or ASP, partially offset by a slightly lower number of revenue units. ASP in the first quarter was $58,800, up 9% versus the prior year due to a higher Medicare Part B and Medicare Advantage reimbursement amounts reflecting beginning of year fee updates, as well as a positive channel mix, including higher international and Medicare Advantage revenues. We delivered 172 MyoPro revenue units during the quarter.

Looking at payer mix, Medicare Part B patients in our direct billing channel represented 51% of revenue in the first quarter, which was down 12% in dollar terms compared with the prior year. Medicare Advantage patients on our direct billing channel represented 19% of first quarter revenue, and in dollar terms was up 11% compared with the prior year quarter. As many healthcare providers are seeing, the macro environment for Medicare Advantage plans continues to be challenging. To mitigate the impact, we are focusing on in-network patients obtained through our contracting efforts, where early results are showing higher authorization rates compared with non-contracted payers. The direct billing channel represented 71% of revenue in the first quarter, compared with 79% in the prior year quarter. Direct billing revenue declined as we continued transitioning our business toward recurring patient sources.

Revenue from recurring patient sources represented 49% of first quarter revenue, up from 25% in the prior year. As you can see, we have made significant progress in shifting toward recurring patient sources at a lower patient acquisition cost compared with advertising-driven direct patient revenues, which carry a much higher cost to acquire. Breaking down the recurring patient sources, approximately 20% of first quarter revenue was generated by direct billing referrals. Another 20% was generated by the international channel, 8% from the U.S. O&P channel, and the rest was from VA payers. International revenue was up 53% year over year, and the U.S. O&P channel was up 79% year over year. As of March 31, 2026, the pipeline stood at 1,680 patients, an increase of 10% sequentially and 13% year over year.

During the first quarter, we added 723 patients to the pipeline, which is up 7% sequentially and 3% year-over-year. 11% of first quarter pipeline adds were generated from direct billing referrals, demonstrating the traction so far with the MyoConnect program. 62% of first quarter revenue units were from intra-fill revenue units, which is up from 45% of revenue units a year ago and demonstrates our increased velocity in fulfilling orders. 16% of first quarter orders came from direct billing referrals. We exited the quarter with a backlog of 226 patients.

Gross margin for the first quarter of 2026 was 68.2%, up from 67.2% a year ago, driven by a higher ASP and material cost reductions, partially offset by higher labor and travel costs needed to fit patients on site. Operating expenses for the first quarter of 2026 were $10.1 million, down 1% over the prior year quarter. Decrease was driven primarily by lower R&D and G&A expenses, partially offset by higher sales, clinical and marketing expenses. Operating loss for the first quarter of 2026 was $3.2 million, which narrowed from an operating loss of $3.5 million in the prior year quarter. Adjusted EBITDA for the first quarter of 2026 was a negative $2.3 million, compared with a negative $2.8 million in the prior year quarter.

The improvement was driven by a lower operating loss I just mentioned and higher add backs for depreciation expense and stock-based compensation. First quarter non-operating income includes a mark-to-market gain from the change in fair value of derivative liabilities, partially offset by cash and non-cash interest expense under the Avenue Capital term loan. Net loss for the first quarter of 2026 was $3 million, or $0.07 per share. This compares with a net loss of $3.5 million, or $0.08 per share in the prior year quarter. Turning now to our balance sheet and cash flow. As of March 31st, 2026, cash equivalents and short-term investments were $15.7 million.

Reflective of the improvement in adjusted EBITDA, our use of cash was $2.7 million in the first quarter, compared with $3.2 million used in the first quarter of 2025. Let me conclude my remarks with our forward-looking guidance. As you just heard, we are making tremendous progress on our 2026 objectives. In the first quarter, we achieved higher year-over-year revenue, improved gross margin and lower operating expenses, resulting in improved adjusted EBITDA. Our transition of the business toward recurring patient sources is running ahead of plan. In addition, the marketing changes we initiated are beginning to take effect. As a result, we expect second quarter revenue to be in the range of $10.3 million-$10.8 million, which is up 7%-12% year-over-year and up 2%-7% sequentially.

We expect gross margin in the second quarter to be higher year-over-year, but lower sequentially due primarily to channel mix. We expect operating expenses to increase slightly versus the first quarter, reflecting a modest increase in advertising spending. For the full year, we are reiterating our revenue guidance in the range of $43 million to $46 million, we affirm our full year operating leverage expectation to limit the growth of operating expenses in 2026 to about one half the growth of revenue. With that financial overview, I’ll turn the call back to Paul.

Paul Gudonis, Chief Executive Officer, Myomo: Thanks, Dave. Well, to summarize, we’re keenly focused on implementing our four success pillars to grow MyoPro volume and revenues while improving key financial metrics, including gross margin, adjusted EBITDA and cash usage. Our technology is making a dramatic difference in the lives of patients who are suffering with this chronic arm paralysis. Now Dave and I are ready to take your questions. Operator?

Operator: Thank you. We will now begin the question and answer session. To join the question queue, please press star then one on your touch tone phone.If you are using a speakerphone, please pick up your handset before pressing any keys. If at any time your question has been addressed and you’d like to withdraw your question, please press star then two. At this time, we will pause momentarily to assemble our roster.

Dave Henry, Chief Financial Officer, Myomo: While we’re waiting for the first question, I’d like to mention that in May, we’ll be participating in the Sidoti Virtual Investor Conference and A.G.P.’s annual healthcare company showcase. On June 23rd and 24th, we’ll be presenting at the iAccess Alpha Select Virtual Conference and holding one-on-one meetings with investors. Okay, operator, let’s take the first question whenever you’re ready.

Operator: Our first question comes from Chase Knickerbocker of Craig-Hallum. Please go ahead.

Chase Knickerbocker, Analyst, Craig-Hallum: Good afternoon. Thanks for taking the questions. Maybe just first on the ASP increase, could you just go into a little bit more detail as far as what drove that, as far as kind of the mix specifically that you were referring to and kind of the drivers within that mix, you know, higher or lower within ASP? I guess the next question is just how sustainable is that? How should we be thinking about kinda ASP sequentially through the year? Thanks.

Dave Henry, Chief Financial Officer, Myomo: Yeah, sure. The ASP was, you know, $58,800. The increase was due in part to the fee increase, like, happens at the beginning of every year with CMS. That also affected the Medicare Advantage payers as well. Both Medicare and Medicare Advantage, those were about 70% of revenues in the first quarter, and those were all subject to that fee increase. Also, you know, international revenues, we get some foreign currency benefit from that. International is our second-largest channel in terms of both revenues and ASP, and they were 20% of revenue. Those are the reasons why.

In terms of sustainability, I do expect that the ASP will come down a bit due to channel mix in the second quarter. I think, you know, I think it’s still prudent to assume maybe around a, you know, a $55,000 or so ASP on a more longer term basis.

Chase Knickerbocker, Analyst, Craig-Hallum: Understood. Maybe just on the advertising efficiency side, can you just kinda break down, you know, what the percentage kinda benefit was in the quarter from MyoConnect? Was the majority of kinda that decrease in cost per pipeline ad driven by MyoConnect, or was there, some improvements that you are seeing on the digital marketing side?

Dave Henry, Chief Financial Officer, Myomo: Just in terms of the metrics, you know, the 11% of the pipeline ads in the quarter were MyoConnect, and those come at a, you know, a low cost per pipeline ad. We’re not advertising to get those. That’s a, you know, that’s a big part of it. You know, just some of the efficiencies we’re seeing, as Paul mentioned, we are seeing sort of a lower cost or more pipeline ads per lead that we’re generating through some of these efforts that we’re making.

Paul Gudonis, Chief Executive Officer, Myomo: We’re finding that the quality of the leads, you know, which was an issue a year ago, Chase, has really turned around. Now we’re getting more of the leads that are generating. We’re engaging with those patients, and they’re medically qualified, so they’re moving into the pipeline. We redid our TV advertising as well with a new 120-second slot. That’s paid off really well. A good cost per call, and the patients that see that or their caregivers are really engaged. Those couple factors have reduced our cost per pipeline ad.

Chase Knickerbocker, Analyst, Craig-Hallum: You had kind of mentioned ramping some of the marketing spend as we go through the year here into Q2. Is that kind of driven by seeing some improvement on that side of things? Or maybe just talk me through kind of the drivers behind that kind of reinvestment.

Dave Henry, Chief Financial Officer, Myomo: Yeah. I would say that is the case, it’s also something that we do typically every year. You know, second and third quarters are typically our highest spending for advertising. It comes back down again in the fourth quarter just because of the, you know, the efficiencies that happen during the fourth quarter, or the inefficiencies, I should say, that happen in the fourth quarter.

Paul Gudonis, Chief Executive Officer, Myomo: Well, also due to the revenue cycle, which could be 4 to 6 months or longer, depending on, you know, the patient’s insurance, advertising now builds a good pipeline and backlog for Q3 and Q4 revenue.

Chase Knickerbocker, Analyst, Craig-Hallum: Just last from me, guidance assumes a step up in growth in the second half. You know, guidance has reiterated, the mix on a per quarter basis was a little bit different than what we kind of expected. Can you just kinda walk us through what the top end of your guidance assumes and the bottom end as far as kind of the moving pieces and the assumptions in there? Thank you.

Dave Henry, Chief Financial Officer, Myomo: I think the, you know, the top end of the guidance, I think would reflect, you know, more from the direct billing channel, particularly as it relates to more success on the referrals side of things. You know, MyoConnect, I think, is probably the biggest swing factor in terms of our guidance. You know, like, you know, good news and good traction with that, which so far we’re seeing, would lead us to trend towards the higher end of our guidance. If some, for some reason that were to, you know, some of those results would begin to flatten out or going down, that would, you know, drive us toward the lower end of our guided range.

Chase Knickerbocker, Analyst, Craig-Hallum: Understood. Thank you.

Operator: Our next question comes from Edward Woo of Ascendiant Capital. Please go ahead.

Edward Woo, Analyst, Ascendiant Capital: Yeah. Congratulations on the quarter. My question is on international. Once again, you had another very strong quarter, very good growth, record revenue. How much potential can the German market have, and is there ability to accelerate the growth on near term?

Paul Gudonis, Chief Executive Officer, Myomo: Well, you look at the German market, over 80 million population compared to, let’s say, 330 here in the U.S. It’s, you know, about 25%-30% of the total size of the U.S. market. You can see that there is definitely upside potential there. Also, as we’ve seen, because of the statutory health insurance, social court rulings over there, we’re getting good traction with the insurance companies there. That’s why we’re continuing to add resources, which is the way to grow that German business. I’ll be there later this month in Leipzig, Germany for the OTWorld Conference to recruit more O&P providers. We’ll also start looking at some other international markets.

Edward Woo, Analyst, Ascendiant Capital: That sounds good. You mentioned other international markets. I know you previously have said that the German market was kinda unique. Other European markets or would it be possibly markets in other areas? Any updates on the Chinese market?

Paul Gudonis, Chief Executive Officer, Myomo: Well, probably the other European markets where we can get the reimbursement relatively quickly. We’ll be talking to some O&P providers in these other countries to see what they feel about the reimbursement environment so that you know, we always look at where I’m going to invest another euro, where is the best place to put in. So far, the best return has been in Germany. Also staying in Europe would help us leverage the infrastructure we have over there. In China, we continue conversations with Chinaleaf, which was one of the major investors in the joint venture.

We’ve had regular conversations to introduce new potential partners, medical device manufacturers and investment partners into the JV, but nothing’s been finalized over there as far as the next step with the JV.

Edward Woo, Analyst, Ascendiant Capital: Great. Well, thanks for answering my questions. I wish you guys good luck. Thank you.

Paul Gudonis, Chief Executive Officer, Myomo: Thank you, Ed.

Operator: Our next question comes from Jeremy Pearlman of Maxim Group. Please go ahead.

Jeremy Pearlman, Analyst, Maxim Group: Yeah. Thank you for taking my question. Firstly, I wanted to talk about the MyoConnect. You’ve mentioned that you had roughly 150 rehab facilities that are referring patients currently. You know, how extensive do you think that runway is? How many more rehab clinics, you know, is in the pipeline to convert to this MyoConnect?

Paul Gudonis, Chief Executive Officer, Myomo: Well, you know, we’ve had tremendous results in just the first 9 months, Jeremy, you know, since we started that in mid 2025. I expect we’re gonna add, you know, new clinics every month. You know, I’d love to get to the point where we have several hundred by the end of this year. There are about 1,500 stroke clinics in the U.S., plus many other major hospitals that treat stroke patients. On top of that, you know, we’re finding a lot of success with these smaller private rehab clinics. You know, there are therapists out there who have their own clinic, and they are referring MyoPro patients to us. Our goal is to grow the number of rehab facilities to a couple hundred by the end of the year.

Also see what I call same store sales growth, where after referring that first patient, they’ll refer a couple of others, and that should grow not only this year, but well into next year. That’s why I see we’re laying the foundation for accelerated growth next year. You can imagine hundreds of these clinics, you know, then growing the number of patients they refer next year, plus new clinics that come online next year as MyoConnect partners. Plus, you have more and more O&P providers coming on. We just announced Ottobock. They’ve got over 50 locations in the U.S. We just trained 20 some of their clinicians around the country. They’re gonna be spreading the word within their territories. We’ve got other major national accounts, you know, lined up for similar type of training going on.

Jeremy Pearlman, Analyst, Maxim Group: Okay, that’s great. To just, you know, to follow up, you mentioned that you hope this is laying the foundation for accelerated growth. The, you know, hopefully, they’ll refer these clinics. Once they refer the first patient, they’ll refer more. Is it too early to tell? Have you seen that play out with the rehab clinics that are already using the MyoConnect program? Does that give you confidence that in 2027 we could see a big uptick?

Paul Gudonis, Chief Executive Officer, Myomo: You know, we are starting to see those sort of green shoots. You know, remember that, you know, most of these have just come online. They made their first referral in December or January, then the patient has to go through the insurance process, has to get fit with the device, then goes to that clinic for therapy services, then they see the outcome. It may be 6 months from the time they make their first referral till we make the second. I’m confident that in the way our device performs for these patients, that we’ll get these ongoing referrals.

Jeremy Pearlman, Analyst, Maxim Group: Okay. Understood. Also just related to the last question related to the MyoConnect. Do a higher percentage of the patients that are referred through this program convert eventually to the backlog into a paying customer, or is it similar to, you know, that’s your legacy advertising direct to consumer marketing that pulls into patients where, you know, this certain percentage drops off and then whatever percentage goes to the final MyoPro?

Paul Gudonis, Chief Executive Officer, Myomo: Oh, yeah. That’s a good observation. That’s a very good observation because these patients are better in two respects. One, we’ve trained the clinicians that are referring to pre-qualify these patients for us. They are sending us better quality patients, meaning they are more likely to benefit from MyoPro in terms of their medical qualifications. That’s a plus. They’re a higher quality patient than what comes in from the general advertising. Number two, because these clinicians know that Medicare will cover this, they’re sending us a higher % of Medicare than in the general population. It’s almost like a double win from these referrals from the MyoConnect program.

Jeremy Pearlman, Analyst, Maxim Group: Okay. That’s great. Understood. Just last question. I know you mentioned on the last, you know, last year, your Investor Day, a big part of-- there was a section about adjudicating denied claims. I just wonder any follow-up, maybe how is that, the success rate of that? Is that steady? Has it been improving? Maybe anything you could talk about that would be great.

Paul Gudonis, Chief Executive Officer, Myomo: Yeah. We are continuing to do these ALJ hearings. Still running about that same success rate. However, as we mentioned, where we have contracts with these various plans, we have a much higher authorization rate right up front, and so we don’t even have to go to the hearings.

Jeremy Pearlman, Analyst, Maxim Group: Okay. That’s great. All right. Thank you for taking my questions. I’ll hop back in queue.

Paul Gudonis, Chief Executive Officer, Myomo: Yeah. Thank you.

Operator: Once again, if you have a question, please press star then one. This concludes our question and answer session. I would like to turn the conference back over to Paul for any closing remarks.

Paul Gudonis, Chief Executive Officer, Myomo: Well, thanks, operator. Thank you all for joining us today and for your questions. We look forward to seeing and hearing from you in the coming months. Thanks again. Have a good evening.

Operator: This concludes today’s conference call. You may now disconnect your lines. Thank you for participating and have a pleasant day.