Electrocore’s 2025 Earnings Call: Quell Sales Channels, VA Contract Status, and Fibromyalgia Launch Timelines Clash

Date of Call: Mar 19, 2026

Financials Results

• Revenue: Q4: $9.2M, up 31% YOY; Full Year: $32M, up 27% YOY
• EPS: Net loss of $1.65 per share in 2025, compared to net loss of $1.59 per share in 2024
• Gross Margin: 87% for full year 2025, compared to 85% for full year 2024

Guidance:

• Full year 2026 revenue has the potential to continue growing at approximately 30% year-over-year.
• No detailed formal guidance issued due to leadership transition; expectation to revisit when appropriate.

Business Commentary:

Leadership Transition and Strategic Focus:

• Dan Goldberger announced his retirement as CEO of electroCore effective April 1, 2026, following his tenure since late 2019.
• Joshua Lev was appointed as interim president, and Michael Fox will join as Chief Operating Officer in April 2026.
• The transition aims to ensure continuity and focus as electroCore moves into its next phase of growth.

Revenue Growth and Channel Expansion:

• electroCore reported record revenue of $9.2 million in Q4 2025, up 31% year-over-year, contributing to a full-year revenue of $32 million, a 27% increase over 2024.
• The growth was primarily driven by increased sales in the VA hospital system and strong performance in the general wellness channel, particularly Truvaga sales, which grew 93% in 2025.

VA System and Product Adoption:

• The VA hospital system remains the largest customer, with 200 VA facilities purchasing gammaCore products by the end of 2025, up from 170 a year ago.
• The company estimates this represents approximately 2% penetration of the addressable VA headache market, indicating significant growth potential.

General Wellness Channel Performance:

• General wellness revenue for the full year 2025 totaled $5.5 million, an increase of 97% compared to 2024, driven by Truvaga sales.
• The increase was supported by a shift in advertising focus to direct-to-consumer platforms and increased affiliate partnerships.

Financial Metrics and Operating Efficiency:

• Gross margin for 2025 improved to 87% from 85% in 2024, indicating enhanced operating efficiency.
• The company reported a net loss of $14 million for 2025, compared to a net loss of $11.9 million in 2024, primarily due to increased operating expenses.

Sentiment Analysis:

Overall Tone: Positive

• "electroCore delivered another year of strong top-line revenue growth, extending our growth trend and exceeding both revenue and EPS analyst consensus estimates." "We believe the company is well-positioned to continue driving growth, to reach expanded adoption in the VA system, scale our wellness platform..."

Q&A:

• Question from Jeffrey Cohen (Ladenburg Thalmann): Could you talk about the channels, talk about the VA and talk about DTC for both gammaCore as well as for Quell, where you anticipate in 2026? Also, thoughts about DTC business for both Truvaga as well as Quell?
  Response: VA growth will be accelerated by new COO Michael Fox's federal channel expertise; DTC efficiency is improved by focusing on own website and expanding affiliate partnerships for Truvaga.

• Question from Jeffrey Cohen (Ladenburg Thalmann): Can you talk about OUS channels and any expectation into 2026, OUS and any specific geographies worth calling out today?
  Response: NHS England is the main OUS revenue driver; other international markets are developing infrastructure for reimbursement and cash-based distribution.

• Question from Charles Wallace (HCW): With the changes with management and the new hiring of Michael Fox and increased responsibilities for Joshua, I wanted to better understand these new leadership dynamics. Will Michael focus primarily on kind of the VA business while Joshua handles the wellness and ex-VA?
  Response: Yes, Michael Fox will focus on commercial/VA operations, while Joshua Lev will handle day-to-day operations and Truvaga DTC.

• Question from Charles Wallace (HCW): For my final question. You know, Dan’s kind of been the architect on kinda TAC-STIM in the military channel. With him leaving, does that mean that there might be a de-emphasis on the TAC-STIM product?
  Response: No de-emphasis; TAC-STIM pipeline remains robust, and new COO Michael Fox's federal experience could help accelerate opportunities.

• Question from Jeremy Pearlman (Analyst): First related, you mentioned earlier on the call the Quell Relief. Is that gonna be sold into the VA/DOD channels? Is that gonna be in general wellness? Also, is that a first half or second half 2026 event? And is revenue from that gonna be baked into the guidance, or you think anything from any revenue generated would just be, you know, icing on the cake?
  Response: Quell Relief (OTC) is planned for a soft launch in first half 2026; revenue will be incremental to the existing ~30% growth guidance.

• Question from Jeremy Pearlman (Analyst): Then maybe if we could jump to, you know, your return on advertising spend. You said it was 2.1x this quarter, and you did mention on one of the earlier questions you are trying to identify more partnerships to help growth. Is there a goal for 2026? You know, how much can you really increase that return? Is it you can get into the 3x range even more, or is it an incremental gain?
  Response: Goal is to maintain ROAS above 2.0, typically hovering between 2.0 and 2.5 on average for the year.

• Question from Jeremy Pearlman (Analyst): Just last question. You know, in the past, any updates on your insurance reimbursement coverage, and maybe what do you think the biggest barriers to broader reimbursement adoptions are you’re facing?
  Response: Biggest opportunity is Kaiser Permanente; on contract now, with success hoped for in 2026, potentially expanding to other insurers in 2027/2028.

Contradiction Point 1

Quell Product Sales Channels

Contradiction on whether Quell is sold via VA hospitals or as an off-contract product.

What were Jeffrey Cohen's key insights from Ladenburg Thalmann's earnings call? - Jeffrey Cohen (Ladenburg Thalmann)

2025Q4: The primary international revenue driver remains the NHS England channel... The focus for 2026 will remain on NHS England... - Joshua Lev(CFO)

Can you discuss OUS channel expectations for 2026 and any specific geographies to highlight? - Jeffrey Cohen (Ladenburg)

20251106-2025 Q3: Prior to the acquisition, prescription Quell for fibromyalgia was sold in 4 or 5 VA hospitals off-contract through open market access... - Daniel Goldberger(CEO)

Contradiction Point 2

VA Contract Status and Growth Strategy

Contradiction on the status of VA contracts and the primary driver of VA growth.

Charles Wallace (HCW) - Charles Wallace (HCW)

2025Q4: The existing VA contract already lists electroCore products. A change in leadership does not automatically change the contract. - Joshua Lev(CFO)

What are the details of the prior VA contracts, and will there be any adjustments to them following Michael's onboarding? - Swayampakula Ramakanth (H.C. Wainwright)

20251106-2025 Q3: The product was added to the VA hospital contract in June/July 2025 after production moved. Uptake has been much faster than expected... - Daniel Goldberger(CEO)

Contradiction Point 3

Prescription Quell Fibromyalgia Product Launch Timeline

Contradiction on when material revenue from prescription Quell is expected.

Jeffrey Cohen (Ladenburg Thalmann) - Jeffrey Cohen (Ladenburg Thalmann)

2025Q4: The focus for 2026 will remain on NHS England... The infrastructure for patient reimbursement... is still being developed. - Joshua Lev(CFO)

Can you discuss expectations for OUS channels in 2026 and highlight any specific geographies of importance today? - Jeffrey Scott Cohen (Ladenburg Thalmann & Co. Inc., Research Division)

2025Q2: The launch of prescription Quell Fibromyalgia is underway... This product is expected to start generating material revenue in the second half of 2025. - Daniel S. Goldberger(CEO)

Contradiction Point 4

Revenue Guidance and Incrementality of New Products

Contradiction on whether new product revenue is additive to growth guidance.

Jeremy Pearlman (Unknown Firm) - Jeremy Pearlman (Unknown Firm)

2025Q4: Any revenue from Quell Relief will be incremental to the company's existing ~30% year-over-year growth guidance for 2026. - Joshua Lev(CFO)

Will Quell Relief be sold through VA/DOD channels or general wellness, when is its launch expected (first half or second half of 2026), and will its revenue be included in guidance or considered incremental? - Submitted Question (via chat)

2025Q2: The investments are intended to accelerate revenue growth. The company aims to increase quarterly revenue from the current $7.5 million level to a range of $11.5 million to $12 million... to achieve cash positivity. - Daniel S. Goldberger(CEO)

Contradiction Point 5

Strategic Outlook for VA Channel Growth

Contradiction on near-term revenue growth expectations from the VA channel.

Jeffrey Cohen (Ladenburg Thalmann) - Jeffrey Cohen (Ladenburg Thalmann)

2025Q4: Focus is on NHS England... updates provided as other distribution and reimbursement opportunities mature. - Joshua Lev(CFO)

Can you discuss OUS channel expectations for 2026 and highlight any specific geographies today? - RK (HCW, Unidentified Analyst)

2025Q1: VA channel returned to sequential growth in Q1, with mid-to-high single-digit growth expected in Q2. With Quell and Sparrow added, growth is expected to accelerate into the teens/mid-teens. - Dan Goldberger(CEO)