The Oncology Institute (TOI) Q4 2025 earnings summary

Executive summary

• Achieved first profitable quarter as a public company on an adjusted EBITDA basis in Q4 2025, with full-year positive adjusted EBITDA expected in 2026.

• Revenue grew 41.6% year-over-year in Q4 2025, with full-year revenue up 27.8% to $502.7 million.

• Net loss narrowed to $7.5 million in Q4 2025 from $13.2 million in Q4 2024; full-year net loss improved to $60.6 million from $64.7 million.

• Expanded capitated care model, adding 9 new contracts and 260,000 patient lives in 2025, with new partnerships in Florida.

• Strengthened leadership and board with key hires and new appointments to support growth and scalability.

Financial highlights

• Full-year 2025 revenue increased 27.8% year-over-year to $502.7 million; Q4 revenue was $142 million, up 41.6% year-over-year.

• Q4 2025 gross profit was $22.7 million (16% margin), up from $14.6 million (14.6% margin) in Q4 2024; full-year gross profit was $76.4 million, up 41.6%.

• Adjusted EBITDA for Q4 was $147,000, up from -$7.8 million in Q4 2024; full-year Adjusted EBITDA improved to $(12.4) million from $(35.7) million.

• Ended 2025 with $33.6 million in cash and positive free cash flow in Q4.

• Pharmacy revenue rose 49.6% to $269.2 million, driven by higher prescription attachment and reduced leakage.

Outlook and guidance

• 2026 revenue guidance: $630–$650 million; gross profit: $97–$107 million; adjusted EBITDA $0–$9 million; free cash flow -$15 million to $5 million.

• Capitated revenue expected to reach ~$150 million in 2026.

• Q1 2026 expected to be seasonally lowest for adjusted EBITDA due to deductible resets and drug price lags.

• Gross margins projected to improve by 100–200 basis points in 2026.

• Specialty pharmacy revenue projected to maintain $27 million/month run-rate with 3–5% incremental growth.