TOIIW — The Oncology Institute, Inc.

Summary of The Oncology Institute (TOIIW) Q4 2025 Earnings Call

1. Key Financial Results and Metrics

• Revenue Growth: Q4 revenue reached $142 million, up 41.6% year-over-year. Full-year revenue increased approximately 28% to $502.7 million, surpassing $500 million for the first time.
• Adjusted EBITDA: The company reported its first profitable quarter from an adjusted EBITDA perspective, achieving $147,000 in Q4, a significant improvement from a loss of $7.8 million in Q4 2024.
• Gross Profit: Q4 gross profit was $22.7 million, with a gross margin of 16%, compared to 14.6% in the prior year. Pharmacy revenue grew 71.1% year-over-year to $81.4 million.
• Cash Position: Ended Q4 with $33.6 million in cash and positive operating cash flow of $3.2 million.

2. Strategic Updates and Business Highlights

• Capitated Care Model Expansion: The company initiated nine new capitated contracts in 2025, adding approximately 260,000 patient lives under management. The partnership with Elevance in Florida is expected to double in size in 2026.
• Pharmacy Platform Growth: The Part D dispensing platform generated nearly $270 million in revenue, contributing close to $50 million in gross profit for the year.
• Operational Efficiency: SG&A expenses decreased by 2% year-over-year, reflecting improved operational efficiency as the company scales.
• Leadership Strengthening: New appointments in the leadership team are expected to enhance growth execution.

3. Forward Guidance and Outlook

• 2026 Revenue Guidance: TOI expects revenue between $630 million to $650 million, with approximately $150 million from capitated revenue.
• Adjusted EBITDA: Guidance for adjusted EBITDA is between $0 million to $9 million, with expectations of achieving free cash flow positivity by the end of 2026.
• Capitated Revenue Growth: The company anticipates over 80% growth in capitated revenue for 2026.

4. Bad News, Challenges, or Points of Concern

• Inflation Reduction Act Impact: While the impact on IMBRUVICA is expected to be minor, there are concerns about potential pressures on margins due to maximum fair price negotiations.
• First Quarter Challenges: The first quarter of 2026 is expected to be seasonally weak, with anticipated adjusted EBITDA losses between $3 million to $1 million due to patient deductible resets and annual drug price increases.
• Market Competition: There are concerns about the competitive landscape, particularly regarding how TOI will maintain margins in a potentially lower rate environment for Medicare Advantage.

5. Notable Q&A Insights

• Dispensing Revenue Drivers: Strong performance in Q4 was attributed to operational execution and increased patient encounters linked to capitated contracts.
• Capitated Contracts: The new contracts with Humana and CarePlus in Florida were highlighted as significant wins, with expectations of substantial growth potential in those markets.
• AI Efficiency Gains: The company expects AI-related efficiencies to generate approximately $2 million in SG&A savings in 2026, with ongoing improvements in operational metrics.
• Market Positioning: Management emphasized that TOI's unique care model allows for better control over practice patterns and competitive pricing, positioning the company favorably in a challenging market environment.

Overall, TOI demonstrated strong growth and operational improvements in 2025, with a positive outlook for 2026, despite some anticipated challenges related to market conditions and regulatory impacts.