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- **Revenue Surge**: Q3 revenue up 23% to $137M, driven by 42% Pharmacy growth and 13% fee-for-service expansion.
- **AI Cost Savings**: Prior auth automation saves $2M annually, freeing 100+ staff hours/week.
- **Profitability Path**: Q4 adjusted EBITDA breakeven, targeting 2026 free cash flow positivity.
- ** Pharmacy Dominance**: Dispensing revenue +57% YoY, Part B pharmacy opening adds incremental growth.
- **Risk Management**: Cybersecurity incident caused billing delay, but minimal patient impact; ample cash to manage Q4 collections.

**【CEO Opening Remarks】**
- **Revenue Growth**: Q3 revenue of $137 million (+23% YoY), driven by 42% Pharmacy growth and 13% fee-for-service expansion.
- **Profitability Milestones**: Adjusted EBITDA loss of $3.5 million (vs. $8.2M prior year), targeting Q4 breakeven and 2026 free cash flow positivity.
- **Florida Expansion**: Added 40k capitated lives with Elevance Health, opening a specialty pharmacy for Part B drugs.
- **AI Efficiency**: Prior auth automation reduces processing time from 18min to 5sec, saving $2M in OpEx annually.
- **Cybersecurity Impact**: Billing delay caused by vendor incident, but minimal patient disruption; expects Q4 collections catch-up.

**【CFO Financial Review】**
- **Top Line**: Total revenue $136.6M (+36.7% YoY), Pharmacy ($75.9M, +57.4%) and Patient Services ($60.2M, +21%) lead growth.
- **Profitability**: Gross profit $18.9M (-$1.8M fee-for-service reserve), adjusted EBITDA loss $3.5M (vs. $8.2M prior year).
- **Balance Sheet**: $27.7M cash, $86M convertible debt; Q3 cash flow negative $27.8M due to drug inventory build.
- **Guidance Update**: Full year revenue raised to $495-505M, EBITDA loss narrowed to -$13M to -$11M.

**【Q&A Highlights】**
- **Reserve Impact**: $1.8M fee-for-service reserve one-time adjustment, no Q4 impact.
- **MLR Performance**: Delegated model MLR mid-80s, stable despite 38% capitated revenue growth.
- **Payer Changes**: IRA-driven drug cost reductions benefit TOI's community-based care model.
- **2026 Outlook**: 20%+ top-line growth, margin expansion, and flat SG&A as % of revenue.
- **Pluvicto Adoption**: Community-based certification achieved, limited but growing use cases.

The Oncology Institute, Inc. (TOI) Q3 2025 Earnings Call Transcript

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