The Oncology Institute (TOI) Q1 2026 earnings summary

Executive summary

• Achieved 41.2% year-over-year revenue growth to $147.4 million for Q1 2026, driven by value-based contracts, strong capitated revenue, and record specialty pharmacy performance.

• Net loss narrowed significantly to $2.5 million from $19.6 million year-over-year, with adjusted EBITDA loss improving to $2.4 million from $5.1 million.

• Florida operations reached profitability, reflecting maturation of capitated relationships and record pharmacy revenue.

• Operates 65 community-based oncology practices across five states, managing 2.0 million patients under value-based contracts as of March 31, 2026.

• Focuses on integrated oncology care, specialty pharmacy, and clinical trials in community settings.

Financial highlights

• Total Q1 2026 revenue was $147.4 million, up 41.2% year-over-year; specialty pharmacy revenue grew 77.6% to $87.5 million.

• Patient services revenue was $59.1 million, up 11.3% year-over-year; capitation revenue rose 54% to $26.9 million.

• Gross profit was $23.3 million (15.8% margin), up from $17.2 million last year; specialty pharmacy gross margin held at 19.2%.

• Net loss for Q1 2026 was $2.5 million, improved from $19.6 million loss; adjusted EBITDA was $(2.4) million, improved from $(5.1) million.

• Ended Q1 with $30.3 million in cash and $85.9 million in senior secured convertible notes outstanding.

Outlook and guidance

• Full-year 2026 revenue expected at $630–650 million, with $150 million from capitation.

• Gross profit guidance of $97–107 million; adjusted EBITDA of $0 to $9 million; free cash flow outlook raised to $5–15 million.

• Q2 adjusted EBITDA expected between -$1 million and $1 million, with momentum building through the year.

• Management expects sufficient liquidity to fund operations for at least one year from the reporting date.

• Ongoing focus on scaling specialty pharmacy, leveraging AI for operational efficiency, and expanding value-based care contracts.