Paysign, Inc. Q4 FY2025 Earnings Call

Good afternoon. My name is Kevin, and I'll be your conference operator today. At this time, I'd like to welcome everyone to Paysign Inc.'s Fourth Quarter and Full Year 2025 Earnings Conference Call. As a reminder, this conference call is being recorded. The comments on today's call regarding Paysign's financial results will be on a GAAP basis unless otherwise noted. Paysign's earnings release was disseminated to the SEC earlier today and can be found on the Investor Relations section of our website, paysign.com, which includes reconciliations of non-GAAP measures to GAAP reported amounts. Additionally, as set forth in more detail in our earnings release, I'd like to remind everyone that today's call will include forward-looking statements regarding Paysign's future performance. Actual performance could differ materially from these forward-looking statements. Information about the factors that could affect future performance is summarized at the end of Paysign's earnings release and in our recent SEC filings. Lastly, a replay of this call will be available until June 24, 2026. Please see Paysign's Fourth Quarter and Full Year 2025 Earnings Call announcement for details on how to access the replay. It's now my pleasure to turn the call over to Mr. Mark Newcomer, President and CEO. Please go ahead.

Thank you, Kevin. Good afternoon, everyone, and thank you for joining us today for Paysign's Year-end 2025 Earnings Call. I'm Mark Newcomer, President and Chief Executive Officer. Joining me today is Jeff Baker, our Chief Financial Officer. Also on the call are Matt Turner, our President of Patient Affordability; and Matt Lanford, our Chief Payments Officer, both of whom will be available for Q&A following our prepared remarks. Earlier today, we announced our fourth quarter and full year financial results for 2025, which demonstrated continued strength and exceptional growth across all key metrics. For the full year, revenue increased 40.5% to $82 million. Net income increased 98% to $7.6 million and adjusted EBITDA increased 107% to $19.9 million. Importantly, operating margins increased 723 basis points, providing clear evidence that we've reached a key inflection point where future revenue growth should drive increasing operating leverage and profitability. We continue to deliver strong growth in our patient affordability business. Annual revenue grew 168% year-over-year, reaching $33.9 million compared to $12.7 million in 2024 and claims processed increased by approximately 79%. For those newer to our story, our patient affordability platform helps pharmaceutical companies ensure patients can access high-cost medications by administering co-pay assistance programs. In 2025, our platform helped deliver nearly $1 billion in financial assistance to patients, supporting access to high-cost therapies for more than 840,000 individuals. At the same time, we help manufacturers better control how those dollars are spent, which is one of the key value propositions we provide. A key differentiator of our platform is our dynamic business rules technology, which helps pharmaceutical manufacturers avoid unnecessary costs associated with co-pay maximizer programs. In 2025 alone, this solution saved our clients over $325 million. And this year, we have already saved our clients almost $150 million. That level of savings represents a meaningful economic benefit for our customers and highlights the value of our platform. We added 55 programs during the year, bringing total active programs to 131 across more than 70 patient affordability clients. A mix of transition programs and new launches contributed to both immediate and long-term revenue growth. Our programs span both retail and specialty pharmacy as well as in-office administered and infused products. Oncology and other cancer treatment products remain a significant portion of our program base and biologics represent approximately 50% of claim volume across the platform. We continue to see strong expansion within our existing client relationships. For example, following the onboarding of one of the nation's largest pharmaceutical manufacturers in 2024, those programs scaled successfully throughout 2025. and we added 4 additional programs from that same manufacturer during the year. This type of expansion within large pharmaceutical clients highlights both the scalability of our platform and the durability of demand. Paysign now has active programs with 6 of the top 10 U.S. pharmaceutical manufacturers ranked by revenue. Next month, we attend the Asembia Specialty Pharmacy Summit here in Las Vegas. As in prior years, we are seeing strong interest from potential clients evaluating our solutions, and we enter the conference with a robust pipeline. Over the past several months, we've had conversations with shareholders, analysts and prospective investors to help them better understand the patient affordability business and the broader industry landscape in which we operate. Increasingly, those discussions have touched on legislative, regulatory and policy-related topics. So I thought it would be helpful to ask Matt Turner, our President of Patient Affordability, to provide some additional context.

Thank you, Mark. Before addressing some of the questions we've been hearing from investors and analysts about potential headwinds to our business, I want to briefly give an overview of how our patient affordability business fits within the broader health care ecosystem. Our platform is focused on helping pharmaceutical manufacturers support patient access to high-cost branded therapies, primarily within the commercially insured patient population. These are typically branded medications where out-of-pocket costs can be significant and where co-pay assistance programs are essential to ensuring patients can begin and stay on therapy. At the same time, our platform helps manufacturers better manage how those assistance dollars are deployed, particularly in an environment where payer dynamics can introduce inefficiencies into the system. That combination of improving access while also driving economic value is what underpins the demand for our solutions. With that context, I'll address a few areas we've been asked about. First, on the expansion of the direct-to-consumer, also known as DTC and cash pay models, these programs have existed in various forms for over a decade and are not new. They were built primarily for products with little or no commercial insurance coverage. That is a very different segment from where we operate today. For the types of high-cost branded therapies on our platform, where list prices can be tens of thousands of dollars, which represents approximately 90% of the drugs in our platform, cash pay and discount alternatives are simply not a viable solution for most patients. Commercial insurance, combined with manufacturer co-pay assistance remains the most effective model for patients. As a result, we view DTC expansion as a complementary solution in certain cases, but not a meaningful substitute for our core business. Second, regarding pharmacy discount programs such as GoodRx, TrumpRx, Cost Plus or similar offerings. These products have existed for more than 20 years and serve an important role in reducing cost for lower-priced generic medications or for those patients without insurance. They are not designed for nor do they compete with branded specialty medications where commercial insurance and co-pay programs are the standard of care. Our business is squarely focused on that branded drug segment and the more than 850 specialty drugs. So these programs are simply not relevant to what we do. Third, and perhaps most important, given the current policy environment on legislative and regulatory considerations, most of the activity around co-pay accumulator and maximizer programs have taken place at the state level. And despite ongoing discussions and congressional committees, there has been no meaningful federal action to date nor do we expect any in the foreseeable future. The key reason is simply structural as a large portion of commercially insured Americans are covered under employer-sponsored health plans governed by ERISA, which limits the impact of state-level regulations. We do not see that as changing. As a result, these programs continue to operate despite changes in state laws. Importantly, demand for our dynamic business rule solutions, which helps manufacturers navigate maximizer programs continues to grow. As Mark said, this year, we have already saved our clients almost $150 million that would otherwise have been absorbed by those programs. So stepping back, we continue to monitor the competitive and regulatory landscape closely. But based on what we see today, we do not view these dynamics as a material threat to our business. If anything, they continue to reinforce the need for solutions like ours, which is reflected in the continued growth of our business and pipeline. Our differentiated dynamic business rules capability is a driving tangible ROI for our pharma customers while we enhance affordability for hundreds of thousands of consumers. Back to you, Mark.

Thank you, Matt. Turning to our plasma donor compensation business. In 2025, plasma compensation contributed $45.6 million in revenue, representing a 4% increase over 2024's $43.9 million. We believe the business will continue to exhibit revenue growth driven primarily by center filling excess capacity rather than new center openings. That said, we do expect a modest number of new center openings in 2026, maintaining our market share of just under 50%. We exited 2025 with 595 centers, an increase of 115 centers over the previous year, and we continue to engage the remaining plasma collection companies who are currently not our customers. We believe our expanded suite of donor management and engagement tools we acquired last year creates additional opportunities to grow our footprint in this space. As we await FDA 510(k) review of our donor management system, also known as a BECS or blood establishment computer system, we are actively working to integrate the BECS with a number of plasmapheresis device and strengthen our relationship with those manufacturers to make installations and transitions to our solution as seamless as possible. This integration is included in our latest filing with the FDA. Our broader suite of solutions continue to receive positive feedback from blood and plasma collection organizations across the United States, Europe and Asia, and we are highly encouraged by the long-term growth potential of this business. 2025 marked a meaningful step forward as our patient affordability business scaled and became a central driver of growth and profitability, while our plasma business continued to provide a stable foundation. We believe we are still in the early stages of our patient affordability opportunity and enter 2026 with strong momentum in which to build upon. With that, I'll turn it over to Jeff for additional details on our quarterly and full year-end financial results.

Thank you, Mark. Good afternoon, everyone. As Mark highlighted, the fourth quarter and full year results reflect both strong growth in our patient affordability business and the early benefits of operating leverage across the platform. For 2025, total revenues increased 40.5% to $82 million. Pharma industry revenue increased 167.8% to $33.9 million, driven by the addition of 55 net patient affordability programs launched during the past 12 months and a corresponding increase in monthly management fees, setup fees, claim processing fees and other billable services such as dynamic business rules and customer service contact center support. Process claims increased over 79%. This growth reflects continued expansion of our platform and increasing demand for solutions that improve patient access while helping manufacturers better manage their co-pay assistance spend. Plasma revenue increased 4% to $45.6 million, primarily due to the addition of 115 net plasma centers added during the past 12 months, offset by a decline in average plasma donations per center as plasma inventory levels were elevated throughout much of 2025. This led to a reduction in our average monthly revenue per center as compared to the same period in the prior year. We exited the year with 595 centers versus 480 centers at the end of 2024. Other revenue increased by $671,000 or 36.2%, primarily due to the growth in usage in the number of cardholders of our payroll, retail and corporate incentive programs. More importantly, we are beginning to see the benefits of operating leverage across the business. Total operating expenses were $41.4 million, an increase of 32.6%, well below the revenue growth we experienced, which, coupled with our improved gross profit margin to 59.4% versus 55.1% drove our operating margins to 9% versus 1.7% in the prior year. We have reached an important inflection point where our fixed costs can support meaningful scalability without commensurate increased expenses. So we expect further improvements in these metrics throughout 2026. This is consistent with what Mark described earlier as patient affordability becomes a larger part of our business, we expect to see continued improvement in margins and operating leverage. Here are a few other important details to point out for the fourth quarter and full year results. For the fourth quarter, our earnings before taxes increased to $2.5 million versus $1.2 million the same period last year. Fourth quarter net income was impacted by a higher effective tax rate of 45.4%, which reduced earnings per share by $0.02 per fully diluted share versus the prior period. The fourth quarter adjusted EBITDA, which is a non-GAAP measure that adds back stock compensation to EBITDA was $5.4 million or $0.09 per diluted share versus $2.9 million or $0.05 per diluted share for the same period last year. The fully diluted share count for the quarters used in calculating the per share amounts was $61.6 million and $55.5 million, respectively. We exited the year with $21.1 million in cash, almost double from the prior year. This excludes any impact to pass-through receivables and payables we periodically have related to our pharma patient affordability business. We also continue to have zero bank debt, funding operations and our Gamma acquisition through operating cash flow. Turning to our outlook for 2026. We expect revenue of $106.5 million to $110.5 million, representing 30% to 35% year-over-year growth, with plasma and pharma contributing equally and other revenue contributing $2.5 million. Considering the seasonality in both our main health care businesses, we expect plasma revenue to be the lowest in the first quarter with tax refunds going out and ramp up throughout the remainder of the year, while we expect pharma revenues to be the highest in the first quarter and decline throughout the remaining of the year as patient affordability claims ramp down. This outlook reflects continued momentum in our patient affordability business, which we expect to remain the primary driver of growth. Gross profit margins are expected to be between 60% to 62%, reflecting increased revenue contribution from our pharma patient affordability business. Operating expenses are expected to increase 20% over 2025 as we continue to make investments in people and technology. Of this amount, depreciation and amortization expense is expected to be between $9.5 million and $10 million, while stock-based compensation is expected to be approximately $5.5 million. Given our large unrestricted and restricted cash balances and the current interest rate environment, we expect to generate interest income of approximately $3.1 million. Our full year tax rate is estimated to be between 22.5% and 25%. Net income is estimated to nearly double over 2025, reaching a range of $13 million to $16 million or $0.21 to $0.26 per diluted share and adjusted EBITDA to be in the range of $30 million to $33 million or $0.49 to $0.53 per diluted share. The number of fully diluted shares for the year is estimated to be 62.3 million. For the first quarter of 2026, we expect revenue of $27 million to $27.5 million, representing a 45.2% to 47.8% growth over first quarter 2025 and expect to have 137 active patient affordability programs and 589 plasma centers exiting the quarter. Margins are expected to expand across the income statement versus the same period last year, equating to an operating margin between 20% to 22%, net margin between 17% to 19% and adjusted EBITDA margin between 34.5% to 36.5%. Fully diluted earnings per share is estimated to be $0.07 to $0.08, while adjusted EBITDA per share is estimated to be $0.15 to $0.16. Overall, our outlook reflects continued strong growth driven primarily by our patient affordability business, along with further margin expansion as we scale. With that, I would like to turn the call back over to Kevin for questions and answers.

Our first question is coming from Jacob Stephan from Lake Street Capital Markets.

Congrats on a really nice quarter here. I appreciate all the color on the pharma industry. One thing I kind of wanted to touch on a little bit. So we're hearing some pharma services providers that the drug manufacturers have actually been kind of less active recently with regards to new initiatives. I'm wondering if you're seeing any difference in behavior with your pharma manufacturers over the last few months here.

No. I mean, this is Matt Turner. I would argue that it's just the opposite. If you were at JPMorgan and listening to the conversations there, nobody is slowing down anything. We were sitting there listening to Dave Ricks, the CEO of Lilly, and he was talking about the billions of dollars they're pumping into AI and the fact of doing a deal every 9 days. And almost all the presentations there really pointed to not a slowdown by any means. Everybody's pipelines are really strong right now. Almost every manufacturer has some form of a weight loss or GLP-1 type product in line. FDA calendar for PDUFA this year looks really good. So no, I mean, I don't really see a slowdown. I would say that the push for innovation is growing overall. And I think that's obviously what we've been trying to provide for the last 7 years as we built out this vertical really is the innovation side of things. So no, I don't see a slowdown from our perspective at all, especially not in the patient affordability business.

Okay. You mentioned the GLP-1 opportunity. What does that look like for your team? Do you currently have any GLP-1s on the platform? How do you plan to approach that market moving forward?

We currently do not have any of the two main GLP-1 drugs for weight loss or diabetes products. These are mainly retail-focused, and we are actively working to improve our position in that area. These drugs have been available for some time now and are primarily marketed directly to consumers rather than through traditional co-pay arrangements. While co-pay options exist, they represent a minor portion of the overall volume. Therefore, there is limited potential for GLP-1 products for weight loss, although there is more opportunity on the diabetes side. We do have one client with a GLP-1 product expected to launch, and I believe we are well-positioned to secure that business since we cover a significant portion of their retail and nearly all of their specialty offerings. I think we could potentially gain a GLP-1 product in the next 12 to 18 months. However, I cannot provide a definite commitment about it being ours or what the expected volume will be. We are definitely working on gaining access to more of these opportunities.

Got it. And then maybe just last one for me. Jeff, you made an interesting comment about fixed cost potentially kind of plateauing, minimal additions kind of needed. I'm wondering, from just looking at the math, that looks like around a $22 million to $23 million quarterly kind of cost basis. I'm wondering if you could kind of give me some more color on that.

Yes. The comment regarding fixed costs pertains to the base expenses of our business in 2025. We examined our operating expenses of $41 million. The additional costs required for future growth are significantly lower than historical levels. In 2024, our SG&A growth aligned closely with revenue growth. We anticipate strong improvements in 2025, and in 2026, we expect even greater operating leverage from the business. We're focused on managing our costs effectively, aiming for SG&A growth of only 20%. It's important to note that part of this growth is linked to the acquisition we made in March, which won't fully impact us until 2026 due to the complete year of amortization. Additionally, there will be a stock compensation increase of about $1.5 million year-over-year. If you adjust for those factors, our controllable SG&A looks very manageable.

Our next question today is coming from Gary Prestopino from Barrington Research.

I couldn't write down fast enough. Did you say you were going to exit Q1 with about 137 pharma programs?

Yes, that's correct.

What was the plasma number? Was it 589?

Yes, in the first quarter, we sold 5 centers to a competitor. So they left us, and 1 center closed. So there are 6 centers in total.

Okay. Okay. That's fine. And then just getting back to when you were talking about like the GLP-1s versus your high-cost branded pharmaceuticals. Is there any difference in the revenue per claim processed there if you're doing basically kind of lack of a better word, it's not really a specialty drug, like, say, a cancer and oncology drug?

Each claim type has different potential transactional fees attached to it. Looking at pharmacy or medical claims, the processing fee remains fairly consistent regardless of whether the claim is specialty or pharmacy. However, in the specialty space, additional factors can quickly enhance revenue. For instance, a dynamic business rule claim holds significantly more value than just a single co-pay claim. While retail products like GLP-1s or cardiovascular drugs have substantial volume, historical examples show that the ability to add functionalities that generate greater revenue is limited on the retail side. This is why we focus on the specialty sector, as we can earn more from 1,000 dynamic business rule claims than from 20,000 retail claims. Consequently, the profit potential and bottom line margins are much more favorable in specialty. Nonetheless, we are also working to expand our retail brand offerings to ensure a well-rounded product portfolio.

Our next question is coming from Jon Hickman from Ladenburg Thalmann.

Could you provide some insight into your position in the pharmaceutical market? What is the total addressable market, and at what stage of growth are you currently?

Yes. This is Matt. We usually refrain from providing a total addressable market estimate because it's challenging to pinpoint the actual dollars associated with marketing expenses and various factors, and vendors do not disclose their payment details. We estimate the total addressable market is between $500 million and $850 million at any time. With some of our offerings, particularly the dynamic business rules we are promoting, we believe this total addressable market is increasing as we generate revenue from these unique products. Additionally, as we continue to expand and introduce more features and products, we expect the total addressable market could grow to $1 billion. Regarding our growth stage, I would say we are still in the first inning, with significant growth potential ahead. We do not anticipate any slowdown in acquiring new programs. If you analyze our year-over-year growth, it is not just in terms of dollars but also in terms of the number of programs we are adding. Last year, we launched a new program approximately every 6 days. We hope to achieve similar results this year. We are far from reaching a midpoint; in fact, we are very much at the beginning. I believe we will continue to see robust growth in this sector for many years ahead.

So a follow-up. So are you inviting competition here? Are people starting to pay attention to what you're doing?

There's always really been competition.

I mean yes.

I mean we've come into the market and really gone up against the competition. And by bringing new functionality, new features to the market, that's part of the reason why we're winning the business.

This was a very stale business that had become almost commoditized. It was treated like just picking something off the shelf, which made it easy for some manufacturers, and they enjoyed that when things like maximizers and accumulators didn't pose a real threat to their bottom line. As that threat has grown, the need for innovation became apparent. Unfortunately, the established players in the industry did not respond. There are some new players emerging, which is typical in an industry that is ready for disruption. The good news for us is that we were ahead of this trend and contributed significantly to the disruption. We have truly changed the game in how we sell into this industry, prompting manufacturers to reconsider how co-pay programs should operate and how they should fund them. The open book pricing we introduced, where we don't profit in ways that we can't explain, significantly disrupted the marketplace. Looking back at our growth trajectory, we can trace a pivotal moment to June or July of 2023 when we hosted a webinar on pricing transparency, which really helped us gain traction. We demonstrated to the industry that there’s a better way to operate, allowing for profit without the deceptive practices many competitors employed.

And another thing, when we look at our competitive advantage, that's certainly one very important factor. Another advantage is that, as a payments company, we have insights into our pharma customers' programs that our competitors lack. We provide our customers with a web portal where they can view bank balances, transaction data, and other information that helps them evaluate the success of their programs. We consider this standard practice as a payments company, but our competitors, who are not payments companies, do not offer this. Additionally, I want to highlight the dynamic business rules. The efficacy rate of 97% on first fills is impressive and is completely independent of the consumer receiving their medication. We can determine if a transaction is linked to a maximizer program, which is significant. This technology is unique to our market and is not available from anyone else.

Okay. One more question. So Matt, what are you most worried about here on this side of the business?

That's a tough question. Right now, we don't have many concerns. Our outlook is quite positive. Looking back three years, we concentrated on our personnel and how to scale with our team. It was about sourcing talent who could help the organization grow. We’ve dedicated significant time and effort to bringing in the right individuals and creating opportunities for them to advance within the company. Now that we have established that framework, with over 55 programs introduced last year, we’ve eliminated growth issues related to people since we've already developed the necessary systems. We can easily integrate new hires into their roles. Our training programs are in place, making the process much more manageable for us. So, at the moment, I don't have any concerns. Everything looks positive, and we are eager for continued growth and expanding our current partnerships.

Nice results.

Thank you.

Our next question is coming from Gary Prestopino of Barrington Research.

Yes. I just have a follow-up. Did you give any indication of your pipeline on the patient affordability side? I mean, at times you have said that you feel pretty confident you're going to exit the year at a certain number of programs. Could you maybe just comment on that?

This is Matt. So I don't know that we've ever given that guidance this early in the year. And I'll also kind of point back to our selling cycle is for most of our opportunities is in the 90-day area. We know what the pipeline looks like right now for a number of opportunities. I think we would probably comment on that as we got a little more further down the year, exited the Asembia conference, things like that. That's really where we kind of start to narrow down what we think the pipeline will look like between now and the end of the year. Plus it gives us a chance to do a better evaluation of the FDA PDUFA calendar and what opportunities out of that, we believe are truly winnable for us. So yes, I don't think we can give a number of programs this early in the year. But hopefully, we can do that in the next quarter if everything lines up right.

All right. And you guys are doing really well. And obviously, the stock market has been a miniature disaster in the last couple of months here. Doesn't look like, obviously, the fundamentals of the business are reflected in the stock price. And I'm just wondering, as you go around and talk to investors, is it that they don't understand what's going on with your company? Is there, say, a fear that artificial intelligence is going to serve maybe your ability with your dynamic business rules? What can you pinpoint as to what is some of the hesitation among investors to grasp the story?

Yes, Gary. When we engage with investors, everyone clearly recognizes the plasma business, which resembles retail same-store sales. The market has been in a cautious phase regarding the operating leverage from the patient affordability side. There's always a lot of noise surrounding direct-to-consumer initiatives. Remember when Donald Trump proposed to address pricing issues and launched his own pharmacy and direct-to-consumer program? They announced a list of drugs, of which we had two. The pricing for those cash-paying customers was actually cheaper with insurance than paying directly. It's important to note that there are around 160 million people on private insurance, which is why co-pay programs exist; they are not meant for cash-paying customers. Many people don't fully understand co-pay, and I am certain that they lack clarity on it. We plan to focus on this in 2026 to ensure that the understanding of co-pay is clearer. There is a real market for co-pay, and we have an effective solution that no one else offers, which is reflected in our financials. This year in 2025, you definitely noticed the potential for operating leverage. Our operating margin has increased from 1.7% to 9%, which is significant. Based on the guidance I've provided, we anticipate further substantial growth in 2026 and beyond. While I can't influence the stock price or investor sentiments, I believe the numbers are telling, and over time, the market will reflect that efficiency.

If you compare us to our competitors in the market, like Cencora and McKesson, they both have co-pay offerings, but those make up a minor part of their balance sheets and are rarely mentioned during earnings calls. We're essentially the first publicly traded company addressing this in a way that analysts are trying to grasp because, unlike them, this is significant for us. For McKesson and Cencora, it barely affects their overall portfolio. This has given the market an opportunity to recognize it as a new offering. We hope that analysts will start to support us and gain a better understanding of it. The private equity market appears to recognize this potential well, with several funds acquiring similar assets privately. In the private markets, there's considerable M&A activity occurring, not just in the co-pay sector but in patient services overall. It's a continuously evolving market. We had the opportunity to attend the Cantor HCIT conference where we engaged with many people and heard their insights. There's significant activity in this sector; it's just not reflected in the public market. Therefore, one of our challenges is to convey that there's a much larger financial opportunity here than it may seem at first glance. I often joke with clients that AI can do anything they can imagine; it's just uncertain when that will happen. We don't see AI as a threat. We're actively developing our own AI-based systems to enhance our algorithms, making it easier to identify maximizers and accumulators. Additionally, a change in a client's actions doesn't mean we won't adapt to continue identifying them. For example, once I identify a patient impacted by a maximizer, it doesn't matter what changes occur; I can still trace that patient because they were a maximizer in the past and likely still are. Therefore, we don't view this as a threat to our business model. Rather, we see AI as an asset, and we plan to incorporate more of it into our patient affordability initiatives to create a stronger, more comprehensive product across our sector.

We reached the end of our question-and-answer session. I'd like to turn the floor back over for any further or closing comments.

Thank you, Kevin. In closing, we delivered strong results in 2025. We remain confident in our long-term strategy. I want to thank you all for joining us today, and we look forward to speaking with you again in Q1.

Thank you. That does conclude today's teleconference webcast. You may disconnect your line at this time, and have a wonderful day. We thank you for your participation today.