Kestra Medical Technologies, Ltd. Q4 FY2026 Earnings Call

Good afternoon and welcome to Kestra Medical Technologies' fourth quarter fiscal 2026 earnings conference call. This conference call is being recorded for replay purposes. We will be facilitating a question and answer session following prepared remarks for management. At this time, all participants are in a listen-only mode. I would now like to turn the call over to Neil Balotkar, Vice President of Investor Relations, for introductory comments.

Thank you, Carmen. Good afternoon. Thank you for joining Teshka's fourth quarter fiscal 2026 earnings call. With me today are Brian Webster, President and Chief Executive Officer, and Vasim Mabouf, Chief Financial Officer. This call includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Statements are made on this call that do not relate to matters of historical fact should be considered forward-looking statements. These statements are based on Kestra's current expectations, forecasts, and assumptions which are subject to inherit uncertainties, risks, and assumptions that are difficult to predict. Actual outcomes and results could differ materially from any results, performance, or achievements expressed or implied by the forward-looking statements due to various factors. Please review Kestra's most recent filings with the SEC, particularly the risk factors described in our Form 10-K for additional information. Any forward-looking statements provided during this call, including projections of future performance, are based on management's expectations as of today. Kestra undertakes no obligation to update these statements except as required by applicable law. During today's call, we will also discuss non-GAAP financial measures. These non-GAAP financial measures are in addition to and are not a substitute for or superior to measures of financial performance prepared in accordance with GAAP. Please refer to our earnings release for a reconciliation of these measures to their most directly comparable GAAP financial measures. With that, I will turn the call over to Brian.

Thanks, Neil. Good afternoon, and thank you for joining us on today's conference call. We are excited to discuss the details of our strong performance in the fourth quarter and the significant progress KESTRA made in fiscal 2026. As always, I'd like to begin the call by focusing on what truly differentiates KESTRA. That is, the lives we protect each day and the patients, families, and clinicians we The reality of cardiac recovery is that risk doesn't always resolve when a patient leaves the hospital. For some patients, the journey to recovery is far more complex than anyone anticipates. Every patient is prescribed to SHER with the hope that its protection will never be needed. Unfortunately, cardiac recovery doesn't always unfold that way. One patient recently reminded us of that in a very profound way. The patient was a 43-year-old woman recovering from a recent heart attack and living with advanced heart disease. Like many patients beginning recovery, she was prescribed Assure while her care team monitored her progress and evaluated long-term treatment options. 72 days after her initial prescription, the system detected a life-threatening arrhythmia and delivered life-saving therapy. For many patients, that would have marked the end of the event. For her, it was only the beginning. As she was rushed to the hospital, the arrhythmias didn't stop. Through ambulance transport, hospitalization, and every subsequent cardiac episode, Assure remained with her, delivering therapy each time it was needed. By the time physicians could provide stabilizing treatment, the system had delivered 12 successful therapies, protecting her through a prolonged and unpredictable period of instability. Every patient's recovery is different, and some emergencies are far more complex than anyone could predict. In this case, the patient required 12 separate interventions before she could be stabilized. That level of sustained protection isn't simply a feature. It reflects a deliberate design philosophy centered on supporting patients through even the most demanding clinical scenarios. This is just one patient's story. In fiscal 2026, our cardiac recovery system was used to protect 18,000 patients at risk of sudden cardiac arrest. We remain thankful and humbled by this responsibility entrusted to us by prescribers, their patients, and their families. Now, turning to our financial performance, we concluded fiscal 2026 with another strong quarter. We continue to reach more patients at risk of cardiac arrest, accepting over 6,300 prescriptions written for the Assure system. Revenue was $28.6 million, with growth of 66% compared to the prior year period. For the year, Kestra generated $95 million of revenue, resulting in growth of 59% compared to FY25. Gross margin of 54.8% expanded by over 10 points year-over-year and 200 basis points sequentially, reflecting the attractive unit economics of our rental model. This was our 10-quarter in a row of sequential gross margin expansion. Our full-year gross margin of 51.4% increased by approximately 11 points compared to FY25. We remain confident that Kestr is on a path to 70% plus gross margins over the next few years. Although FY26 was a year of investment, with the strong revenue growth that Kestr is generating, we continue to see improving operating leverage in our business. This growing leverage supports the investments we are making in the company's key growth drivers to take advantage of the large and attractive market opportunity we see. The investments that we believe will drive significant near and long-term value for Kestria include expanding our commercial team, enhancing our revenue cycle management capabilities, growing our fleet of devices, innovating to extend our product advantages, and growing the body of clinical evidence supporting the Assure system. One such example was the investment we made at the start of FY26 to meaningfully enhance our commercial training and onboarding capability. This has reduced how long it takes a new territory manager to reach a key sales ramp productivity milestone. This accelerated Salesforce productivity strengthens operating leverage and positions us to more effectively capture the significant growth opportunity in the WCD market. We continue to expand our sales organization with the goal of further penetrating existing accounts, as well as calling on new potential Assure prescribers. As we had discussed previously, we are targeting geographies in which a high volume of WCD prescriptions are being written and where we also have strong in-network payer coverage. As planned, we ended Fiscal 26 with approximately 130 active sales territories, up from about 80 at the end of Fiscal 25. The impact of this is clear. Our commercial team is winning in the marketplace, with the number of new prescribers for Assure growing by 55% in Fiscal 26, while the number of ordering facilities grew by 65%. And it's exciting to see that some of these new Assure customers are, in fact, new prescribers of WCDs as a category. Turning to the WCD market, we have previously noted that despite the overwhelming evidence that an external defibrillation shock is effective at terminating dangerous cardiac rhythms, WCD therapy remains underutilized with six out of seven patients that are indicated for WCD not being protected by one. We believe the innovation and clinical evidence we have brought to the category started to change this in fiscal 2026. Based on our financials and that of the incumbent, we estimate the WCD market grew in the low to mid-teens. We are still in the early innings of market expansion, and we see this category growing into a multibillion-dollar market in the years ahead. I wanted to illustrate this last point with a few examples of strategies we are employing across various geographies. The first case study is a leading academic medical center in the Southwest that demonstrates how our commercial model drives sustained account expansion. When KESTRA entered the institution in March of 2025, it had never prescribed the Assure System. Fifteen months later, utilization has grown to more than 60 prescriptions, with 40 unique prescribers activated across multiple specialties. That growth has been driven not only by commercial execution, but by repeated clinical validation in our service delivery model. A recent example of this institution highlights that dynamic. Patient experienced ventricular fibrillation while wearing Assure. The system delivered a lifesaving therapy, and our proprietary Assure Assist feature alerted emergency medical services even before the patient's spouse completed a 911 call. Within minutes, the treating physician had been notified, enabling rapid coordination of care as the patient was airlifted for advanced treatment. The event reinforced the value of the entire Assure platform, not just the therapy, but the speed of emergency response, clinical communication, and continuity of care. That experience translated directly into broader physician adoption. Within one week, four additional Assure systems were ordered by physicians who had never previously prescribed our platform. Adoption in this system has since expanded beyond the initial heart failure service line, with electrophysiologists beginning to prescribe Assure after observing its clinical performance, patient experience, and integrated support. This account reflects a pattern we're seeing repeat across the country. While clinical outcomes accelerate adoption within an institution, physician education creates robust prescribing networks that continue to expand long after the initial engagement. The second case study is a territory in the Midwest that illustrates the long-term impact of that strategy. When the Kestra territory was established, the hospital had previously generated about 20 WCD prescriptions annually. Through focused engagement with the heart failure program, fellow education, and ongoing clinical support, utilization more than doubled to 50 prescriptions during FY26. Growth accelerated through a combination of physician champions and clinical education, expanding Assure Adoption among both existing and new prescribers. A key driver was the team's investment in fellowship education. Six of the program's eight fellows became active Assure prescribers during training. As those physicians entered independent practice, they carried that experience with them, prescribing Assure at other hospitals. Rather than expanding a single account, our team is building a growing network of experienced Assure prescribers that continue to drive adoption beyond the original institution. Our strategy also extends to enterprise health systems, where we're working to integrate Assure directly into standardized care pathways. The third case study is one of the nation's largest independent cardiovascular organizations in the southeast that is working with our team to integrate Assure into standardized heart failure care pathways across its physician network. Working alongside physician leadership, advanced practice providers, and clinical operations teams, we're embedding Assure into workflows that support patients from hospital discharge through outpatient recovery. This collaboration began shortly after presentation of the Assure post-approval study data at AHA last November. Since that time, prescribing within the organization has increased by approximately 40 percent, reflecting growing adoption supported by both clinical evidence and operational integration. Today, that organization includes approximately 120 cardiovascular providers, creating an opportunity to expand this care pathway model across multiple affiliated practices in regional markets. This represents another important driver of sustainable long-term growth as we partner to embed Assure into standardized clinical workflows. These examples demonstrate how clinical evidence, physician education, and enterprise partnerships are working together to accelerate market adoption. Turning to clinical evidence, on prior earnings calls, we discussed the results of our ACE-PASS, the largest real-world prospective WCD study to date, with over 21,000 patients enrolled and protected. The study's findings corroborated what patients experience every day with the Assure system, low false alarm rates, comfort that drives higher wear time compliance, and 100% successful conversion of dangerous arrhythmias. I'm pleased to highlight a newly published paper focused on the future of sudden cardiac death prevention that cites the ACE-PASS study as contemporary evidence demonstrating persistent ventricular arrhythmia risk among patients with ischemic and non-ischemic cardiomyopathy. The paper was published in the journal Heart Rhythm, which is a Heart Rhythm Society publication, specifically highlights observed ventricular arrhythmia vent rates. The HRS recommendations state that clinicians should consider WCD use after myocardial infarction or a new heart failure diagnosis while guideline-directed medical therapy is being optimized and better risk stratification tools are being developed. The paper further identifies WCDs as a potential strategy to reduce sudden cardiac death in patients not yet eligible for an ICD. From a strategic perspective, this is a meaningful endorsement. The paper was developed through an HRS-LID think tank that included many of the field's leading experts. The inclusion of ACE-PASS demonstrates that our data is being incorporated into the broader scientific dialogue around risk stratification, sudden death prevention, and the rule of temporary protection for high-risk patients, areas that may ultimately influence guideline development. Regarding our clinical evidence strategy, we plan to publish multiple abstracts and manuscripts over the next 12 months, highlighting compelling data from ACE-PASS, our new enhanced algorithm, and new innovation in our pipeline. We believe this growing body of evidence will support increased share capture and expanded WCD adoption. On the product development front, we continue to pursue innovation that benefits patients and clinicians. In mid-January, we announced a strategic collaboration with BioVeat Technologies to expand diagnostic insight for hypertensive patients prescribed the Assure WCD. That co-development project is progressing as planned. In April, we released an enhanced Assure detection algorithm, which we project will further reduce our already low false alarm rate. This new algorithm is now shipping to all patients. Our team has some other exciting projects in progress intended to further extend our clinical advantage with the performance of the Assure system and also bring new first-in-category capabilities to the market. Over time, we believe this will help us accelerate market growth and win additional market share by further differentiating our product from the incumbent. And more importantly, by providing additional clinical value and diagnostic insights to physicians, we believe it will result in them prescribing WCDs to more of their patients that heretofore had gone unprotected. In conclusion, the fundamentals of the Kestra story and business remained strong. The clinical evidence of the Assure system is compelling. We like our competitive product position in an expanding WCD market. Kestra is delivering premium revenue growth while significantly expanding gross margin. And we have fortified our balance sheet to facilitate investment in that growth. Our execution has been crisp across all elements of the business. and the foundation, we have built positions KESTRA for strong and durable growth for years to come. I'd like to thank our incredible team in the field and also here at the Home Office in Kirkland for their passion and commitment to the KESTRA mission. Now I'll turn it over to Vasim, who will discuss fourth quarter financial results in more detail and provide our fiscal year 2027 revenue values. Vasim?

Thank you, Brian, and good afternoon, everyone. We had a strong financial performance across the board in the fourth quarter. Total revenue was $28.6 million and an increase of 66% compared to the prior year period. Revenue growth was driven by a 63% year-over-year increase in prescriptions, reflecting market share of gains with existing customers, activation of new accounts, and expansion of our field team. We are also continuing to see improvements in all three key drivers of our revenue model. our prescription bill rate, our bill rate, and our collections performance. As we continue to bring more payers in network and enhance our revenue cycle management capabilities, we expect to see benefits in revenue growth, gross margin, and our profitability profile. We are investing in revenue cycle AI tools and other automation projects that will drive operating leverage as we scale the business. Turning to gross margin, our margins increased to 54.8% in the fourth quarter versus 44.3% in the prior year period. As Brian mentioned, we have now expanded our gross margin sequentially 10 quarters in a row. This continued expansion in gross margin was driven by the attractive unit economics inherent in Castro's business model, an increase in our revenue per fit from more in-network patients and a decline in our cost per fit driven by volume leverage and cost improvement projects. In the quarters ahead, you should expect to see steady and consistent increases in our gross margin as our rental model benefits from the volume leverage. We remain confident in our ability to achieve 70% plus gross margins in the next few years. GAAP operating expenses were $55 million in the fourth quarter, compared to $55.8 million in the prior year period. Excluding non-recurring costs and stock-based compensation, operating expenses were $44.7 million in the fourth quarter of fiscal year 2026, compared to $29.7 million in the prior year period. The increase was primarily attributable to investments in our commercial organization, including support resources and revenue cycle management capabilities to capitalize upon the large and expanding WCD market opportunity. Gap net loss was $38.8 million in the fourth quarter compared to a gap net loss of $51.1 million in the prior year period. Adjusted EBITDA loss was $26.7 million in the fourth quarter compared to an adjusted EBITDA loss of $20.3 million in the prior year period. Cash, cash equivalence, and investments totaled $262 million as of April 30. It is important to highlight that our operating cash burn in the fourth quarter declined on a year-over-year basis. Specifically, net cash use in operating activities was $18.7 million, a reduction from $24.1 million in the prior year period. We expect this trend to continue each year going forward. This afternoon, we also issued a press release about our new $200 million term loan facility that we have entered into with Pharmacon. This non-dilutive financing was a great outcome for Kestrub. It fortifies our balance sheet, reduces the cost of capital, and provides the significant financial flexibility to invest in our commercial strategies and expand our fleet to drive durable, best-in-class growth for years to come. Only $75 million of the facility has been funded at closing, a large portion of which was used to retire our existing term loan. Included unused availability under the new term loan agreement and excluding the uncommitted M&A tranche, CASTRA has a total liquidity of approximately $357 million. In summary, 2026 was a foundational year for CASTRA. We delivered top-tier revenue growth, significant expansion in our gross margin, and fortified our balance sheet with a follow-on offering in December and today's non-dilutive financing. Our investments in the field team and RCM capabilities positioned Kestra to drive durable revenue growth with meaningful operating leverage for years to come. We announced our fiscal-tier 2027 guidance. We expect revenue of $137 million, an increase of 44% compared to fiscal year 2026. We expect prescription growth to be driven by deeper penetration within existing accounts and the activation of new accounts as we invest in the regional coverage. We expect higher revenue per fit to be driven by a higher mix of in-network patients and continued improvements in our revenue cycle management capabilities. We expect Kestr to generate significant operating leverage over the next several years, even as we continue to invest in our business to capitalize on the large, growing, and under-penetrated WCD market opportunity. For that, operator, we have concluded our prepared remarks and are ready to proceed to the Q&A portion of the call.

Thank you so much. And to ask a question, please press star 11 on your telephone and wait for your name to be announced. To remove yourself, press star 1-1 again. We ask that you please keep your questions to one and one related follow-up. One moment for our first question, please. It comes from Marie Thiebaud with BTIG. Please proceed.

Hi, good afternoon. Thanks for taking the questions, and congrats on a really strong finish to the fiscal year. Apologies in advance if there's any background noise. I'm in an airport. But I wanted to start here by asking for a little more detail of a theme on sort of what the assumptions are behind the fiscal 27 guidance. Certainly, your prescription growth has been tremendous. Sounds like you're seeing a lot of nice momentum following ACE path. And, of course, the conversion rate has continued to move higher with all the revenue cycle management improvements. So if there's any details you can give us on how you're thinking about that $137 million, the assumptions behind it, that would be very helpful.

Sure, Marie. Thank you for the question. Our revenue growth has historically been driven by prescription and volume growth, a network mix, revenue cycle management improvements, and, quite frankly, the growth of our field team. These KPIs are all tracking in the right direction and give us confidence in guiding to 44% growth in fiscal year 2027. Higher prescriptions will be driven by winning new accounts, going deeper in existing accounts, and, quite frankly, as Brian mentioned, expanding the market. and we expect to continue the in-network mix to be in the low mid 80s as we continue to make progress on the payer side and also the significant improvements that we'll make and have made on the revenue cycle management process. So we are starting the fiscal year with 130 sales territories which is up 80 from the start of fiscal year 2026. So we're really confident in the guide that we are putting out and we'll continue to give you updates as we go through the year.

Okay, that's very helpful. And I guess as a follow-up question here, certainly encouraging to see the Heart Rhythm publication, the recognition of ACE-PASS. What are your latest thoughts on guideline recommendations, stronger support from societies? Is that something we could start to see more of this fiscal year? Thanks for the question.

Yeah, thanks, Maria. This is Brian. I think it's going to be a journey. The papers like this are the start of that journey. You know, we'll be publishing our manuscript for H-PASS soon. That'll be the next milestone. And then we'll continue to work with our clinical advisors to get on the docket for this conversation about guidelines. I do think that what's also meaningful about that recent paper is the insight they had into not just the typical WCD patient who's a post-MI patient, but also the heart failure patient population. So really good news in that, and really good news in that that was a, you know, a parallel activity that, you know, a body of really high-caliber physicians took on to step back away from the evidence and look and say, hey, what should we be doing to improve sudden cardiac death rates? And so I think that's really positive for us.

One moment for our next question. It comes from Travis Steed with Bank of America Securities. Please proceed.

Hey, thanks for the question, and congrats on a good quarter. I guess maybe I'd ask a question about kind of the share gains that you've been getting. I think you're taking about four points of share in the market over the last year. Is that kind of the steady state that we should think about going forward, or is there ways you can accelerate the share gain capture in 27 Salvin, as you expand territories and build up coverage?

Yeah, thanks for the question, Travis. You know, I think that the share gain we saw in 2026, it doesn't fully get the benefit of a lot of the hiring we did in 2026. So I would expect that we'll see even more share gain, in particular in those territories where we were not in before adding new reps. And so as those reps come up the curve, I think we'll see that share gain start to grow. Now, of course, the other good news is it's not just about share capture. It's about market growth. And we're seeing, you know, pretty exciting market growth occurring.

And we'll continue to push for that as we do our market development of the WCB category. and then i did want to follow up on on the financing you know why why raise money needed the equity offering last year why why more money now and then why the structure of the still little unique with different tranches available and one of the tranches mentioned uh availability for acquisitions is this uh a sign that potentially you're going to be a little more acquisitive going forward yeah so let me start right then maybe brian can also provide some color so we when we started the refinancing conversation,

it was purely to go out and seek lower cost of capital. If you remember that return loan that we had with Perceptive was, you know, three years ago when we were a private company. And quite frankly, you know, what we were able to achieve in our cost of capital was a 24% reduction from what we were paying, you know, Perceptive. So that was the impetus for going out and looking into the market. But as we kind of went through that conversation, You know, we decided that we should have and retain the financial flexibility that continues to allow us to invest in our business and gives us the optionality to do different things. So I'd say we didn't need more cash. Like I said, you know, we finished the quarter at $262 million of cash on the balance sheet. This was just purely being opportunistic, working with a great partner now and having the flexibility to do bio B-type tuck-in deals to do more M&A. So, that's really, you know, from a structure and a deal perspective. So, Brian, if you want to comment on that.

Yeah, I would just add that, you know, the M&A tranches is a prospective one. There's not something right in front of us there, but we do continue to be very interested. We're building a, you know, a first-class direct cardiology sales force, and we want to take advantage of that channel. And if there's new technologies that we can bring to the table that can be additive for our clinical partners, then we're going to be very interested in that. I think the other thing it should demonstrate is we're pretty bullish on our story. You know, we want to make sure we've got financial flexibility to be able to invest in the assets to continue to grow the market. And with the market growth showing the way it is, we're leaning in to the Kestra story in the WCD category. And this just provides us a little bit more financial flexibility as we look forward.

Great. Makes sense. Thanks a lot.

Thank you. Our next question is from Matthew O'Brien with Piper Sandler. Please proceed.

Afternoon. Thanks for taking the questions. And maybe to follow up a little bit on Travis and Marie's question on guidance, when I do the math on the growth rate in the market that you guys are accelerating, plus your share taking, which, you know, Travis is right, it's 400 basis points last year. But if it's up to 500 this year, whatever it may be, I'm getting script numbers that are at least 10% and more like 12 to 13% higher than kind of where you're guiding roughly. So what is it that we're missing, especially with all these new reps and all this momentum that you're seeing that would, you know, put the guide into the 137 range versus something higher? Is there something competitively, something else just in terms of adding all these reps at once, something else like that that we should really be considering? And then I do have a follow-up.

Well, I would say very clearly that there's not a competitive dynamic to that that's driving that. I think it's us just being a rational management team. It's the start of the year. We want to make sure that, you know, as we get the year kicked off and we do absorb a lot of these new sales reps, that we set ourselves up for success. And so I think 44% growth as an initial guide is pretty darn fantastic. And we're excited about the year ahead.

Okay, fair enough, Brian. 44% is great. But, Seem, on the profitability side, I know you said the operating cash burn came down by about $5.5 million year over year. But, you know, the revenue number was up about $11 million. So, you know, and when I look at the SG&A per new script, it's the lowest, it's the, you know, the lowest, the highest amount of SG&A per script that we've seen in several quarters. So, how do we think about the profitability on the, you know, on the EBITDA side trending or maybe even on the operating cash burn trending throughout, you know, fiscal 27? Because from a revenue perspective, it seems like you're about a year ahead. from a profitability perspective, you seem like you're kind of on track or maybe a little bit behind. You think this is a year we see a bigger catch-up as far as profitability goes? Thanks so much.

Yeah, no, that's a great question, Matt. I think, you know, fiscal year 2026 was a foundational year, as we have talked about from an investment perspective, right? We hired the 130 TM goal we got sooner. We invested in regional leadership with commercial support resources like clinical specialists to really help form those accounts and see the prescription trend that you saw. Our prescriptions grew 17% in the fourth quarter, a thousand higher than, you know, the previous quarter. And quite frankly, it even beat our own internal expectation in the fourth quarter. And we have invested in our end cycle management capability. And this really positions us to drive durable growth in fiscal year 2027 and beyond. Now, having said that, even this level of investment, you know, of our operating cash burden declined by $5 million. So you should look at that, right? So our operating one was down five. So we'll continue to invest in 2027, but maybe not at the same pace in 2026. But really, you should start to see some good operating leverage in 2027 and 2028 as we continue to drive the top line higher based on the investments that we made in 2026.

One moment for our next question. It's from Rick Weiss with CESOL. Please proceed.

Good afternoon, and I'll add my congratulations on the excellent finish to the year, Brian. I thought maybe you could expand on your comments a little bit about your sales territory goals. I mean, obviously, $130 to finish the year up from $80, that's a big expansion, and you've always been very clear about the metrics that you want to see related to reimbursement, How many more ideal or optimal opportunities are there, and do we see similar expansion in numbers for the year ahead? Is that the right way to think about it? Yeah.

Yeah, Rick, thank you for the question. I think that as we're looking, as we're sitting here today looking at FY27, we're probably thinking that we'll add another 40 or so reps in the fiscal year, so maybe a little bit slower than FY26, but not a lot more. We still have uncovered territories in the U.S., and even more importantly, we have territories where we have a rep who's assigned to certain accounts, but that rep might have 15 or 18 accounts, and we need to go deeper and split some of those territories. So we will be adding additional horsepower here in a pretty balanced way throughout the year. I don't think we're going to front-load it because we're still kind of absorbing the big income ads that we added at the back half of FY26. But it will be another year of expanding the commercial footprint. And with that, not only territory managers, but also clinical account specialists. Gotcha.

And I wanted to touch on both innovation, some of your innovation commentary and the competitive dynamics. I mean, obviously, you're taking share. Obviously, you're growing faster than the market. But I was hoping you would update us on just whatever your incremental thinking perspectives are on the competitive dynamics generally, but how innovation is tying into those dynamics. The shipping of the new algorithm clearly differentiates your product from the competitors, but maybe talk about how that manifests itself in the P&L in terms of volume or margin. Are there any implications beyond just that broad statement about differentiation, which is meaningful, obviously?

Yeah, thank you for that question as well. I love talking about innovation. They won't always let me talk about innovation, but I'd love to talk about it. You know, I think our goal with the new algorithm update was to just really make that algorithm bulletproof and give us that just really clear differentiation of the market. We've accomplished that, and that product is now, every product is going out within the algorithm. We continue to invest in new innovation that you will see over the next 12 months, and we're excited about that. On the other hand, you know, the question always comes, well, what is your competitor doing when it comes to answering that? And we feel like the competitor has shown their cards. They've, you know, launched a product last year that they are starting to roll out. And remember, in this business, it's a fleet, right? So you don't have the opportunity to replace your entire fleet all at the same time. And so they will be rolling out their new product that we view as being incremental and not transformative. And so we view that they will be rolling that out over the next three to five years, three at the most aggressive, more likely five years. And so we kind of know what we're playing against. We love our positioning from a product on competitiveness, and we love the pipeline that we have, and we're really excited about where we're going with future innovation at Kestro.

Thank you very much.

Thank you. Our next question comes from the line of Michael Pollark with Wolf Research. Please proceed.

Hey, good afternoon. Thank you for taking the questions. I have a question on your primary competitor. There was news of a warning letter that that firm received public in June, dated late April. I don't see any specific mentions related to the wearable defibrillator product, but there were focus items on the AEDs, electrode components, and other similar inputs. So, my question for you, Brian and the team, is there something going on here with your competitor that might strengthen your position, or do you view that letter as primarily noise as it relates to your business?

Yeah, Mike, thanks for the question. You know, I think any time that there's regulatory actions in an industry, you would be wise to pay attention, And we're certainly paying attention. My understanding of that particular situation is it was directed at a different part of their business. Having said that, you know, most medtech companies try and standardize their quality systems across divisions. And so I'm sure that our competitor is evaluating, even in their LifeFest business, evaluating their quality system to make sure that, let's say, that contagion doesn't spread. And so I'm sure they're looking at that. But my understanding right now is that that was not directed at that particular division. It was directed at their AD and ventilator business.

Very helpful. So maybe for the follow-up, a short-term modeling question, perhaps for Vaseem, just the current July quarter, it's almost the end of July, so you're about to finish the first quarter.

Should we take the full-year revenue growth vision 44% and just kind of have that as the year-on-year growth rate throughout the four quarters, or should we consider something different about phasing, can you help level-set models for the current July quarter? or um yeah obviously we can comment on the first quarter um like nice drive but um i think uh based on our guidance the 44 reflects the total year but same thing as we said last year if you remember um we we were hiring reps and as you know there's a six-month ramp period for those reps so you should start to see some accelerating growth uh from the first half to the second half um you You know, as Brian said, we brought in those 130 TMs sooner, and they're all kind of in the journey of their ramp up, and we should start to see some really exciting growth here in the second half versus the first half. But regardless, you know, we feel really optimistic and comfortable with the guide that we have provided out there. And as Brian said, you know, our credibility is our biggest asset, and we continue to have a repeat of fiscal year 2025 and 2026, sorry, 2026 and 2027. Thank you.

One moment for our next question. It comes from Larry Biggelson with Wells Fargo. Please proceed.

Good afternoon. Thanks for taking the question, and congrats on the strong finish here. Maseem, maybe just two modeling questions for me. a gross margin. I think it was up 1,100 basis points year over year in 2026. Any color on the cadence to expect for 27? And the conversion rate, it looks like it was relatively flat year over year in fiscal 26. Why is that, and how do we think about that going forward?

Sure. So, Larry, on the conversion rate, as we have said in the past, we will continue to see acceleration on an annual basis. We finished the year at 46, about 46%, which was up actually slightly over two points compared to year and fiscal year 2025 to 26. So we get well on our conversion rate journey. We continue to see, you know, all of our KPIs, you know, the fill rate, our in-network mix, our collections performance, they're all trending in the right direction. And quite frankly, in the fourth quarter, the conversion rate was slightly lower, but that was because of the massive prescription intake that we had. Our prescriptions were up 17%, as I mentioned earlier, and a lot of that came in month three. So as you guys know, that month three will translate into revenue here in the first quarter. So we feel really good about that. And then on the gross margin, again, we are really, really excited about our gross margin trending. as I said, 10 quarters in a row of gross margin expansion, and we continue to expect to see that gross margin progression through the year, and that's really a testament to the model as we have now demonstrated multiple quarters in a row. So you should expect to see sequential improvement on gross margins all through this year, and we think that for the full year, it's going to be in the 700 basis point range and increase year over year.

And I just want to ask one on the revenue growth. We've seen an acceleration, I think now four quarters in a row. Could you put a finer point on what you think is really, like, driving the acceleration if there's, you know, a couple things you would point to?

Yeah, thanks, Larry. Appreciate the question. I think it's a combination, as we have said, that we have a higher mix of in-network patients because of our insurance contracting success, and so that leads to higher revenue per fit. we have more sales territories opening up. So that's just Salesforce math. And then I think we have, as we've gotten experience with some of our existing sales territories, and then you put really great clinical data into the field, that just gives them the ability to further penetrate those accounts and so we're seeing nice account penetration and expanding the existing accounts so it's a combination of all three of those things and you know we have some the top tier in our vernacular last year was platinum sales territories and we continue to have people moving off into the platinum sales territories as they drive significant volume

So, thank you very much.

Thank you. And our last question comes from David Roman with Goldman Sachs. Please proceed.

Thank you. Good afternoon, everyone. I wanted just to follow up on some of the commercial comments that were made earlier in the call. I think, Brian, in response to one of the questions you talked about building out a general cardiology sales force, Can you maybe talk about just at which customer the Salesforce expansion is targeted, cardiologist versus EP, and where do you see the opportunity? Is it in the upstream referral channel? Is it in market share capture on downstream prescribing? And then I had one follow-up.

Sure. Thanks, David. I appreciate the question. Yeah, when I say we're building a direct to cardiology, I'm using that in a fairly general term because, in reality, our reps are calling on EPs. An EP generally will not do a lot of the writing of the prescriptions, but they will sort of give us a license to hunt in terms of the technology. And so our reps end up spending a lot of their time all the way back into the cath lab as the patient is revascularized and moving up to general cardiology and also heart failure. So when we're looking at reps that we're putting in the field, we're not just going after those reps who have one specialty and relationships there. and we're really looking across the whole board when it comes to the cardiology suite.

Okay, and then maybe just a related follow-up on the commercial side. You talked about having territories that aren't covered at this point in time. Can you give us any framework to think about what percentage of relevant territories you have covered? Is the right way to look at it as prevalence of heart failure patients by territory or some other metric to help us think about what you have covered today versus where the remaining gaps are and how long it takes for you to get to whatever your definition is of full coverage.

Yeah, when we talk about full coverage, what we're talking about is what percentage of the WECD prescribing universe, if you will, does a Kestr ref have assigned to them. And so you might have, as an example, you might have a rep who's in, you put your first rep in the city of Chicago. Well, in the city of Chicago, that one rep might have 20 accounts, which they can't possibly service. And so although we count that as coverage, we've got a rep in Chicago, so they're covered. So when we're talking about coverage, we think that with the 130 that we landed on at the end of the year, we think that gets us somewhere around 70% of that geographic coverage. But don't mistake that for full penetration coverage where in that Chicago example, we might end up with five or six reps as we get to a more manageable level of account. So I think it's reasonable to think that over the next two years, we probably would get to a pretty good level of what we would call full coverage in the market. And we'll pace that according to, you know, how well we're doing when it comes to ramping up reps and how well, you know, we continue to progress against our plans.

Great. Thanks for taking the questions.

And this will conclude our Q&A session. I will pass it back to Brian Webster for closing comments.

Thank you very much. And thanks again, everybody, for joining us. Again, very proud to announce our results today. FY26 was indeed a year of investment for Kestra. We think FY27 affords us new opportunities for investment as we see the opportunity to win. We see the market growing. We've got a really, really great product. And most importantly, we've got a team of incredibly committed people. So we couldn't be more excited about the future of the category and the future of Kestra. And we're looking forward to a really strong FY27. Thank you all for joining the call today.

And this concludes our conference. Thank you for participating. And you may now disconnect.