Myomo, Inc. (MYO) Q3 2026 Earnings Report, Transcript and Summary

Good day, and welcome to the Myomo's Third Quarter 2026 Financial Results Conference Call. All participants will be in listen-only mode. Should you need assistance, After today's presentation, there will be an opportunity to ask questions. Please note this event is being recorded. I would now like to turn the conference over to Vivian Cervantes, Investor Relations. Please go ahead.

Thank you, operator, and good afternoon, everyone. This is Vivian Cervantes with Alliance Advisors IR. Welcome to Myomo's third quarter 2026 financial results conference call. With me today are Myomo's Chief Executive Officer, Paul R. Gudonis and Chief Financial Officer, David A. Henry. Before we begin, I would like to caution listeners that statements made during this call by management, other than historical facts are forward looking statements. The words anticipate, believe, estimate, expect, intend, guidance, outlook, confidence, target, project, and other similar expressions are typically used to identify such forward looking statements. These forward looking statements are not guarantees of future performance and may involve and are subject to risks and uncertainties and other factors that may affect Myomo's business financial condition and operating results. These risks, uncertainties and other factors are discussed in Myomo's filings with the SEC, Actual outcomes and results may differ materially from what is expressed in or implied by these forward looking statements. Furthermore, except as required by law, Myomo undertakes no obligation to revise or update any forward looking statements to reflect events or circumstances after the date of this call today, November 9, 2026. Now my pleasure to turn the call over to Myomo's CEO, Paul R. Gudonis. Paul, please go ahead.

Thanks, Vivian, and good afternoon, everyone. Thank you all for joining us today. Myomo's purpose is to help people living with chronic arm and hand paralysis to regain function and independence with our powered arm braces. In the third quarter we made progress in reaching more of these patients we serve, while improving the economics of our business. Revenue reached a quarterly record of $12.3 million up 22% from a year ago Gross margin rose to 71.3%, and we delivered approximately breakeven adjusted EBITDA.

These results reflect continued execution on the 4 success pillars we discussed on our last call including building recurring patient sources, expanding payer access, demonstrating operating leverage and investing in product development and clinical research. Let me walk through the progress on each. The first success pillar relates to increasing revenue from recurring patient sources. Patients referred from rehab hospitals and stroke clinics, orthotics and prosthetics partners and the VA represented 54% of third quarter revenue compared with 33% a year ago. This reflects the success of our MyoConnect program which is now entering its second year. Since its launch healthcare professionals at more than 500 rehabilitation facilities and therapy centers have referred potential MyoPro patients to us which is an increase of over 200 locations in the past quarter. That milestone gives us a broader base of relationships which patients can learn about the device during their care enables us to build a more durable business over time versus relying solely on direct to patient marketing. We see a growing number of physicians and therapists recommending a Myo Pro for their patients and we expect a larger number of referrals per facility as they see the benefits of the MyoPro for their patients. We are already seeing this same store sales growth of over 30%, as our recent referrals came from the existing sites, the therapists and physicians that know our company, the product line, the clinical research that is been published, and their patients' good outcomes with the MyoPro. The increase in referring locations contributed to the record number of orders in the quarter which came in at 258 in the third quarter. Our success pillar number 2 is to increase market access so that more qualified patients can obtain a MyoPro. During the quarter, we have either entered into agreements or in the process of finalizing agreements with payers that covered an additional 35 million lives. For the payers with contracts that have been completed, we are in the process of going live, as an in network provider. These agreements include the payers Medicare Advantage and commercial plans. We also made progress with state Medicaid agencies where we are now enrolled with 7 states such as Pennsylvania, Michigan, and Wisconsin. We have other state Medicaid plans in the queue This will help us with patients that have Medicaid in these states, subject to individual medical coverage policies plus the ability to receive secondary insurance payments for our Medicare patients who may reside in these states. Our plan is to continue to enter into more such contracts given our track record of a higher pre authorization rate from the MyoPro when we are an in network provider. Our third success pillar is generating operating leverage. Our target is to grow revenues at least twice as fast as operating expenses. We achieved that goal again in the third quarter as revenue grew 22% year over year, while operating expenses grew just 6%. In addition, gross margin improved by 750 basis points in the third quarter compared with the prior year. We are continuing our path to profitability and sustainable positive cash flow by working on additional cost savings such as the in sourcing of 3D printing of the custom fabricated shells for each MyoPro, which should go online by the end of this year. Our efficiency efforts in the other functional areas are also making a financial impact with our overall volumes up while our headcount is down over the past 2 years. Our fourth success pillar is continued progress with product development and clinical research. The randomized control trial at the University of Utah continues to make steady progress with 35 of the planned 50 subjects now enrolled up from 25 at the time of our second quarter call Development work also continued on the MyoPro 3 and on the hand only product for the German market. These efforts are a part of our longer term work to expand the evidence base and the applications of our wearable robotics platform. We will provide further updates as milestones are reached. In summary, the quarter showed how executing across our 4 pillars of success reinforce 1 another. More referral relationships and payer access helped drive record orders and revenue, higher volume, and cost reduction supported stronger gross margin and improved operating performance. We are building on our market leading position by investing in the clinical, commercial and product capabilities needed to serve more patients. To continue scaling our commercial operations, last month we announced that Mary-Katherine McClure has joined Myomo as our new Chief Commercial Officer. She has a successful track record of growing revenues establishing strong referral partnerships and leading a sales and field clinical team from our experience at fast growing Inspire Medical and other medical device companies. I am pleased to have her bring this experience to Myomo as we execute our plan to further address this large unmet need of chronic arm paralysis in the country. With that overview, I will turn the call over to David A. Henry to review our financial results in greater detail.

Thank you, Paul, and good afternoon, everyone. Our revenue for the third quarter of 2026 was a record $12.3 million up 22% versus the prior year period. The increase was driven by both a higher average selling price or ASP and a higher number of revenue units. ASP for the quarter was approximately $55.5 thousand up about 2% versus the prior year And we recognized revenue on a record 222 MyoPro units, an increase of 19% over the third quarter of 2025. Looking at payer mix, Medicare Part B patients represented 54% of both third quarter revenue and prior year period revenue. Medicare Advantage plans represented 17% of third quarter revenue compared with 18% in the second quarter of 2025. Our transition toward recurring patient sources continued to accelerate during the quarter. Recurring patient sources represented 54% of third quarter revenue compared with 33% in the prior year quarter. Within those recurring channels, 27% of total revenue was generated by direct billing referrals, through our MyoConnect program up from 23% in the second quarter and 20% in the first quarter of 2026. We continue to see strong results from our other recurring channels: international revenue representing 17% of revenue and U. S. O and P revenue representing 8% of revenue, VA patients represented 2% of revenue in the third quarter. Turning to our metrics, we received a record 258 MyoPro orders during the quarter, up 13% year-over-year. We added 600 patients to the pipeline during the quarter, down compared with the second quarter of 2026. MyoConnect referrals represented 18% of pipeline adds in the third quarter. Third quarter MyoConnect pipeline adds were influenced by seasonality in the third quarter from summer vacations among referring sources as well as temporary internal staffing constraints. Staffing constraints have been alleviated entering the fourth quarter. Our direct to patient advertising spending was up 2% year-over-year Advertising driven pipeline ads in the quarter were impacted by an inefficiency in our lead generation, which resulted in fewer workable leads a lower conversion rate among those generated in the quarter. We continually test new methodologies for patient targeting in order to maximize spend effectiveness and optimize customer acquisition cost. With the aforementioned MyoConnect resource constraints alleviated, and the implementation of improvements in direct-to-patient lead generation we generated approximately 30% more direct billing pipeline ads in October than the per month average in the third quarter. We ended the quarter with a backlog of 217 patients, down modestly from the second quarter as the efficiency of our operations turned record orders in the quarter into a record number of revenue units. Turning to our financial results. Gross margin in the second quarter was 71.3%, up from 63.8% in the prior year quarter. The improvement was driven primarily by the higher ASP, material cost reductions and the spreading of fixed costs over a higher number of revenue units, partially offset by somewhat higher clinical costs we classified the cost of goods sold. Operating expenses were 10.5 million representing an increase of 6% compared with the third quarter of 2025. Higher general and administrative expenses and R&D was tempered by lower sales, clinical and marketing spending in the quarter. Operating loss improved significantly to 1.7 million compared with $3.5 million in the prior year quarter. We achieved adjusted EBITDA breakeven in the third quarter, compared with a loss of $2.7 million a year ago. We are keenly focused on operating leverage and minimizing cash burn as we carefully invest in MyoConnect. Note that a portion of the improvement in adjusted EBITDA is due to higher stock based compensation expense, as certain employee incentive payments were paid in stock during the third quarter as part of our cash management initiatives. We expect stock based compensation expense to return to its typical run rate in the fourth quarter. Below operating loss, second quarter results include a noncash charge of approximately $1.8 million related to a market adjustment for the valuation of our derivative liabilities, as well as cash and non cash interest expense associated with the Avenue Capital term loan. Including the aforementioned non cash charge net loss for the third quarter was $4.2 million or $0.10 per share compared with $3.7 million or $0.09 per share in the third quarter of 2025. Turning now to our balance sheet and cash flow. As of September 30, 2026, cash, cash equivalents and short term investments was $11.9 million. Cash used in operating activities during the second quarter was $1.3 million compared with $1.8 million used during the third quarter of 2025. Cash burn or the change in cash in the quarter was $1.5 million an improvement from $2.2 million in the second quarter. Let me conclude with our outlook Last quarter, we raised our full year guidance to a range of $45 million to $47 million We are narrowing that guidance today to $46 million to $47 million at the upper end of that previous range. We expect that the beneficial effect of manufacturing cost reduction initiatives will result in a modest sequential increase in gross margin in the fourth quarter. 1 time costs associated with the transition of our Chief Commercial Officer and higher headcount in support of our MyoConnect program is expected to result in a modest sequential increase in operating expenses in the fourth quarter. Despite this expected increase, are maintaining our previously communicated operating leverage objective of limiting the growth of operating expenses in all of 2026 to half the rate of 2026 revenue growth. We continue to expect total cash burn in the second half of the year to be less than $2 million or less than $500 thousand in the fourth quarter. Overall, we are pleased that we are poised to meet or exceed financial and operating objectives for 2026. And we look forward to continued execution in 2027. With that financial overview, I will turn the call back to Paul.

Thanks, David. Well, to summarize over the past year, we have executed on all 4 of our success pillars to grow Myomo at volume and revenues while improving key financial metrics including gross margin, adjusted EBITDA and cash usage. In September, I attended the American Orthotics and Prosthetics Association National Conference where we met with new and existing O&P partners to establish a deeper engagement with this channel so that they can have another product included in their treatment plans for their stroke patients. As an example of how these relationships are working, 1 of the national providers recently brought our MyoConnect clinicians into 1 of their possible referral sources which resulted in several patients added to their candidate pipeline and delivery of their first MyoPro to a patient who is now able to use their arm and hand again for the first time in years. We look forward to replicating these successes in our markets in the US and Germany, as we have a very large opportunity in front of us to improve the lives of many individuals with our proprietary technology. We have established Myomo as the market leader with over 4 thousand devices provided to patients with paralysis And yet this is only about 1% penetration of the addressable market. Over 3 million individuals in the US suffer from chronic arm paralysis and another 250 thousand cases that result from the 800 thousand strokes that occur annually in the US. We have already laid the foundation for executing our strategy of continued market penetration and revenue growth by hiring additional field clinical staff across the US and Germany to develop more referral relationships with the physicians and therapists that treat these patients And this evolution of our go to market strategy will lead to a growing, durable business serving this patient population for years to come. Now Dave and I are ready to take your questions. Operator.

While we are waiting for the first question, I would like to mention that next week, we will be in the Craig-Hallum's 17th Annual Alpha Select Conference in New York on November 17. David and I along with our new Chief Commercial Officer Mary-Katherine McClure will attend in person at this conference and will be available for 1-on-1 meetings. Operator, let's go with the first question whenever you are ready. The first question comes from Chase Richard Knickerbocker with Craig Hallum. Please go ahead.

Good afternoon. Thanks for taking the questions. Couple for me, maybe just first on pipeline adds. We have not seen the seasonality in Q3 before. Do you kind of expect this going forward now that MyoConnect is a bigger piece of the pipeline strategy? And then second to that, guidance implies most of the change was kind of in Q3 here. Appreciate your thoughts on October. Kind of pipeline activity. Now that MyoConnect brings a higher percentage of ads that are filled, is there some potential conservatism in Q4? Or how to think about some of the positive indicators that you gave around October?

Yeah. So regarding the pipeline adds, there were a couple of things. The seasonality that I mentioned was more of it. More around MyoConnect and trying to schedule screening days and things like that at these referring locations, we found as a bit harder to do so. During the summer months. The other part on the advertising side, and we did, I did mention that there were inefficiencies in the quarter. So that contributed to the 600 pipeline adds and what I mentioned was with the combination of you know, the staffing constraints that we also had on the MyoConnect side during the, third quarter combined with what we think is fixing some of these inefficiencies on the DTC side resulted in the 30% increase in pipeline ads in October. Remember though that pipeline ads, you know, advertising is seasonally lower in the fourth quarter compared with the third. it is something that we always do So keep that in mind as you look at you know, any projections for pipeline ads in third quarter and fourth quarter. And in terms of the conservatism or in our forecast, I would just say that we believe we try to give guidance that we believe is achievable.

Understood. Maybe just on commercial organization. Under Mary-Katherine's new leadership, what should we expect to change around commercial strategy and go to market?

Thanks, Chase. So she's been on board for a month, been out in the field meeting with our team. She is looking at how we are organized, where we ought to be staffing. We have already added several more clinicians in the field in the last 30 days. Because we have got this tremendous opportunity. She's looking at how to organize, where should we add more clinical staff, compensation plans, and the like. Stay tuned. She's only been here 30 days, but she brings a wealth of experience from a tremendous track record of growing Inspire Medical's business over the 8 years that she was there.

Understood. Just last for me. Appreciate that you are certainly not giving guidance here. But just would appreciate some early thoughts on 2027? I guess, do you think your guided range in 2026 from a revenue growth perspective is sustainable into 2027 and a decent way for us to think about potential growth. And then secondly, on 2027, do you expect the same leverage target that you have given in 2026 growing revenue twice as much as operating expenses? Thank you.

Yes, sure. I guess I will take the second 1 first. I think we are in the process now of doing our planning for 2027. So I will defer my answer on the leverage target until we finalize those plans. But then in terms of the revenue, we are trying to we are making this transition. We are in the midst of it now. And I think done a pretty good job in 2026. Trying to bring more of our revenues, have them come from recurring patient sources. Want to continue to build on that into 2027 and to continue with the progress that we have made While I am not giving any revenue guidance today, we are focused on trying to grow revenue at a rate as quickly as we can grow it while at the same time making sure that we maximize that operating leverage and minimizing the burn. Understood. Thank you.

The next question comes from Jeremy Pearlman with Maxim Group. Please go ahead.

Firstly, of the 500 plus MyoConnect locations, maybe how should we look at the how many. What percentage of them are actually you know, submitting and generating orders for you? Is it. should we look at, like, the 80/20 rule, you know, 20%, the top 20% are generating 80% of the referrals? And if that is the case, are your plans to maybe bridge that divide between the top performers, maybe the lower performers?

Thanks, Jeremy. The MyoConnect program is really just a little over a year old now. So most of these referring facilities, we went in, we met with the physicians and therapists, conducted the services and education and received an initial referral Typically the process would be refer 1 patient to us They want to make sure that the patient is medically qualified that their insurance will pay for the device. And then after they get the device, these referring facilities will then treat the patient. there is a 12-week myomo therapy training protocol. And after that, as they see these good outcomes, they will then refer a second and third patients. So we are seeing that So the ones that first came on a year ago are already starting to refer the second, third or more patients. But a lot of them, as I mentioned, we had over 200 new ones in this third quarter, typically just on their first patients. So I expect that over time we will see the same store sales growth as they see the good outcomes from their patients that are referred and about 30% of the referrals in the quarter came from these referring facilities that already had experience with MyoPro. Understood.

And do you have-- is there a better conversion rate, a higher conversion rate from the MyoConnect Versus historically, what you would like the DTC, let's say?

Yes, in a couple of respects. 1, we find that these are better qualified patients medically. Because unlike the direct to consumer marketing where anybody sees an ad that will contact us and we do an evaluation of that patient. Because our clinicians do such a good job explaining what makes for a good MyoPro candidate in terms of their inclusion criteria. We find that, more of these patient referrals actually enter the pipeline and then because we outline what are the typical payers in an area, whether it is Medicare Part D, certain Blue Cross or other plans covering the device, we see a higher authorization rate as well. I look at the quality of the pipeline coming from these referrals as much higher both from medical qualification, as well as a reimbursement qualification. Understood.

Okay, great. And then just last question from us. You said that you are having some of the marketing, the DTC was having some headwinds this quarter. Is it I know we have heard from other companies that it is related to the, you know, Google, the AI overview, it is really preventing some of, like, the click throughs that you would usually get. Is that how should we look at that? You know, what the issues were, and then how. What did you do to. What steps did you take to rectify them? Thanks.

Yeah. I do not think Most of our. When we look at you know, social media and lead generation, most of it comes from meta. So, I am not sure if Google and whatever issues that they had, I am not actually aware of them. Actually had much of an impact with respect to our pipeline adds in third quarter. Okay.

The next question comes from Scott Henry with AGP. Please go ahead.

Thank you, and good afternoon. I guess, for starters, David, I do not did you give us a cumulative reimbursement pipeline number?

I did not, but it was. it is around a little over 1.4 thousand at the end of the of the third quarter.

Okay, great. And as we look at the metrics and kind of the model, which, you know, most people use to get down to product placements. Top of the funnel was always pipeline ads, which was always the key number. To try to gauge growth. Now with over 50% now coming from recurrent patient sources, I guess, first of all, do all of those people make it through the top of the funnel? And you know, the second thing is it should we be looking at it a little different now given that half the patients are coming from recurring sources?

We, I mean, we still -- for pipeline ads, we still gather information for O&P providers to the extent that they provide it to us. We also gather it from our operations in Germany and obviously as well as direct to patient marketing. So regardless of like. Now speaking of direct billing specifically, regardless of whether the patient comes from a referral or it comes through advertising, we still track pipeline ads. And so, you know, I think, you know, for your for your modeling, I would say that, you know, the pipeline adds is still the key metric to look at. But I will say, and I think Paul just mentioned it, to a -- in response to a previous question, that the conversion rate as the pipeline has become more weighted in the future toward MyoConnect. We would expect better conversion of those pipeline adds into revenue as compared to direct to patient. I think I gave a stat, I think last quarter was still holds true that about, you know, 10x MyoConnect pipeline adds turn into revenue at a rate 10x better than direct to patient advertising. So I still think that pipeline ads is still a good metric to model off of going forward.

Okay. And as the hit rate goes up, because the quality of the ads is higher, Do you think the total pipeline adds will still drift up And, you know, might they drift up at a lower rate because the hit rate's higher, Just trying to get in sync because it looked like we were on our way to, you know, 800, you know, consistently in the 8 hundreds and you know, perhaps eventually getting to 4 digits. But maybe that may take longer now if the hit rates higher, which, you know, is not a bad thing. But I just wanna get your sense of how we should think about that top of the funnel.

Oh, we would like to see that top of the funnel be, you know, obviously, as high as we can. But that hit rate, as you say, will have an effect because it is more about in terms of growing revenue, it is more about the quality of those pipeline ads. As opposed to the sheer volume of them. Because that is ultimately what will drive revenue going forward. Okay. Okay, great. So the other way to say it, you know, 800 pipeline ads yesterday is not the same as 800 pipeline adds in the future going forward because of this transition we are making toward recurring patient sources. Okay.

And you know, anything different on the Medicare front that you are seeing in kind of Q4 versus Q3? Or even Q3 versus Q2 How is that evolving? Or should maybe we think more about beginning of next year for where we may see some changes?

Well, we continue to get reimbursement under our HCPCS code for the Medicare Part B patients. So that was the proper medical documentation, all those patients are getting reimbursed for their device. And where we are in networks with a payer's contract, those contracts often include Medicare Advantage or commercial plans. And we have a higher authorization rate in those instances compared to being out of network providers. So that is why we continue to invest in getting more payer contracts because we do get more Medicare Advantage authorizations that way.

Okay. Great. Final question for me. I know you were asked on prior questions about your outlook in 2027 for revenue growth. Perhaps even, you know, drilling it down a little bit how do you think about the pricing environment? Going forward? Should we expect incremental gains? Or perhaps as you come out with new models, maybe even larger pricing gains? Or just wanted to get your thoughts on the topic.

Well, thanks, Scott. I mean, most of the pricing really is established here in the US By the CMS allowable fees it is now $68.8 thousand for the flagship MyoPro G. We have seen price increases from Medicare based on the cost of living increases over the last couple of years of around 2% to 2.5%. I do not know if those will continue, but that pricing is really set by CMS and then that becomes sort of the benchmark for all these commercial contracts that we enter into. And then our O and P pricing, is more of a wholesale pricing because then they have to do all the clinical work and the reimbursement work to provide the device to the patients in Germany. The pricing is really set again by the payers, the statutory health insurers such as TK and others basically take our pricing and work with the OMP who actually gets reimbursed for the device. So, we do not plan to make any changes to that. it is really dependent on, what CMS does. Okay, great. Thank you for taking the questions.

The next question comes from Sean Lee with H. C. Wainwright. Please go ahead.

Hey, good afternoon, Paul and David, and congrats on a great quarter. Just have a couple of questions. First on the gross margin, we see that it is up quite a bit year over year, but down a little bit sequentially. I was wondering what are some of the pushes and pulls on that number? And also with things like the 3D printing, you could bring in-house and also the hand-only device in Germany. Thinking about those, how do we expect the margins to move, going forward?

Yes. Thanks for the question. Sort of the components of that 750-basis point increase in gross margin year over year about 90 basis points was related to the 2% year over year ASP increase about 190 basis points was related to the material cost reductions that we have put in place, And while there are still others coming down the road, like, for example as you mentioned the 3D printing, and then the rest of it was just primarily due to higher volume and the spreading of fixed costs over that higher volume, you know, the Paul mentioned the headcount is that we have been holding down the headcount to the extent that we are able to and that is translating into benefits on the gross margin line And then, as you look at gross margins going forward, I would still say sort of a low 70s gross margin is something that you should think of modeling and there will be incremental improvements, and we would expect as I mentioned, fourth-quarter gross margin is expected to be modestly higher as we have some of these improvements take effect And then, like I said, I would continue in that low-70s vein as you move into 2027. Got it.

that is very helpful. And my last question is on the reimbursement side. So as you mentioned, you tend to get better authorization rates with your in-network approved from these payers. I was wondering can you provide some color on what is the increasing authorization rate you are seeing once you are in network and also where do how many patients I guess or payers do you expect to expand over the next year or so? In terms of new coverage?

Well, without going through this on a plan by plan basis, I would tell you that certain payers have a much higher authorization rate They are not at 100% like we have with the Medicare Part B, patients. But they are certainly up higher than when we do not have a contract that is why we are going to continue to get more of these contracts. And then where we get enrolled in-network with state Medicaid plans, those plans will often pay for the secondary co-pay For Medicare part B patients. So that helps, raise our ASP by collecting that secondary insurance payment from the state Medicaid plan for certain patients. Got it. that is all I have and thanks again for taking my questions. Great. Well, thanks, Sean. It was good to see you at the H. C. Wainwright conference back in September.

The next question comes from Edward Wu with Ascendiant Capital. Please go ahead.

Yes, congratulations on the quarter. My question is on Germany. You guys have done very well. Is it time to expand your focus beyond Germany into other EU countries? Thank you.

Yes, thanks. Yes, Germany is doing very well. Another year of record revenues, year over year growth, and so on. So we are going to continue to double down in Germany. it is a big market. Again, just like the US, very small market penetration so far. We have already added a couple more clinical staff, business development staff to keep growing that business for us. When I look at the best return on a euro, do I invest to try and open up a new market? or just doing more in Germany because that converts to revenue much more quickly. So for right now, even though there are certainly other market opportunities across Europe, we are doubling down and just doing more in Germany, and the new hand product that is been developed for Germany that gets released in 2027. That will even further open up the market because right now some patients are not medically qualified for the MyoPro because they may have elbow movement, but they do not have hand function. So that will address a need and further expand the market potential for us in Germany and then we will bring that here to the US. Great. Thanks for answering my questions, and I wish you guys good luck. Thank you. Great. Thank you, Edward.

This concludes our question and answer session. I would like to turn the conference back over to Paul R. Gudonis for any closing remarks.

Well, thank you, operator, and thanks to all of you for joining us today and for your questions. We look forward to seeing and hearing from you in the coming months. So please have a good evening and thanks again. Goodbye.

The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.