electroCore (ECOR) Q1 2026 Earnings Transcript

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DATE

Wednesday, May 6, 2026 at 4:30 p.m. ET

CALL PARTICIPANTS

• Interim President — Thomas Errico
• Chief Operating Officer — Michael Fox
• Chief Financial Officer — Joshua S. Lev

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TAKEAWAYS

• Revenue -- electroCore (NASDAQ:ECOR) reported $9.6 million, the highest quarterly revenue in company history and 43% year-over-year growth.
• Gross margin -- 87%, a 200 basis point increase year over year, with gross profit at $8.4 million.
• VA prescription device revenue -- $7.9 million, up 48% year over year, led by prescription gammaCore growth of 26% and Quell surpassing $1 million in first-quarter sales.
• Consumer wellness -- Channel revenue reached $1.6 million, up 44% year over year; TruVega contributed $1.5 million, a 38% increase.
• Return on advertising spend (ROAS) -- Approximately 2.37, a 14% improvement from the previous quarter, attributed to a focus on affiliate and influencer partnerships.
• Adjusted EBITDA loss -- $2.3 million, an improvement of 24% year over year, despite $1.9 million in nonrecurring leadership transition costs.
• Net loss -- GAAP net loss was $5.3 million; net loss per share was $0.59, or $0.37 excluding leadership transition expenses.
• Cash and equivalents -- $8.8 million at quarter-end, down from $11.6 million at year-end, with seasonal and facility-related cash burn expected to extend into the second quarter.
• VA patient penetration -- About 15,000 VA patients have received gammaCore, which management estimates as roughly 2.5% of the addressable VA headache market.
• Quell product line -- Since its May 2025 acquisition, Quell fibromyalgia has generated $2.5 million in revenue, with overall Quell cumulative revenue at approximately $2.7 million.
• 2026 revenue guidance -- Full-year guidance reaffirmed at approximately 30% growth, implying $9 million to $10 million incremental revenue over 2025's $32 million.
• Research and development expense -- $740,000, reflecting increased investment in the Acacia PTSD study.
• Selling, general, and administrative expense -- $12.9 million, including $1.9 million in nonrecurring leadership transition costs and $300,000 in legal expenses tied to IP litigation.
• TACSTIM product -- Management highlighted ongoing research and potential for federal channel contribution, citing increased demand due to military operational tempo.
• PTSD Breakthrough Device Program -- "Additionally, approximately 20 participants have enrolled in the clinical study conducted by Acacia Clinics in collaboration with the Vagus Nerve Society designed to evaluate the safety and effectiveness of electroCore gammaCore nVNS device as an adjunctive treatment for symptoms associated with PTSD," with new evidence under review for label expansion discussions with the FDA.
• International expansion -- TruVega soft-launched in the United Kingdom in January 2026, with future assessment of additional international markets.

SUMMARY

Management emphasized that the company's strategy remains unchanged following recent executive transitions, with operational priorities and financial discipline aligned. Leadership described significant untapped potential in both Veterans Affairs and Department of Defense channels, noting a shift from broad distribution to deeper site-level penetration and increased prescriber uptake. The company identified future growth catalysts, including advancing its clinical data platform, expanding commercial access across VA, Kaiser, TRICARE, and launching next-generation mobile and over-the-counter offerings. Operating leverage was highlighted as revenue, gross margin, and adjusted EBITDA loss all improved concurrently, which management called "the clearest signal yet" of execution toward profitability.

• Michael Fox said, "We have just scratched the surface of penetrating the addressable VA headache market," indicating significant opportunity remains.
• Leadership confirmed that Quell is prescribed in roughly one third the number of VA facilities as gammaCore, implying early-stage distribution for the newer asset.
• The company reported a CDC statistic that "24.3% of U.S. adults experienced chronic pain in 2023," supporting market opportunity for vagus nerve stimulation devices.
• Work is underway on a mobile app for TruVega and Quell, aiming for recurring revenue models and enhanced user engagement in the future.
• Leadership acknowledged that "Q1 is historically our highest cash-burn quarter," and one-time leadership transition costs materially affected reported net loss this period.

INDUSTRY GLOSSARY

• nVNS: Non-invasive vagus nerve stimulation; a therapy using externally applied stimulation to modulate nerve activity for pain and other disorders.
• VA: U.S. Department of Veterans Affairs; a federal agency providing healthcare services to eligible military veterans.
• TACSTIM: A branded device from electroCore for non-invasive neuromodulation to support cognitive performance and fatigue mitigation, especially in military and federal applications.
• VISN: Veterans Integrated Services Network; VA's regional healthcare system structure.
• ROAS: Return on advertising spend; a metric quantifying revenue generated per dollar spent on advertising.
• Quell: Acquired neuromodulation product focused on fibromyalgia and pain management, sold primarily through the VA and planned for over-the-counter relaunch.
• TruVega: A consumer wellness device from electroCore for non-invasive vagus nerve stimulation, targeting chronic pain and wellness applications.

Full Conference Call Transcript

Thomas Errico: Good afternoon, everyone, and thank you for joining electroCore, Inc.'s first quarter 2026 earnings call. This is the first earnings call since we announced our leadership transition, and I want to take a moment to share how encouraged I am by the progress we have made executing that transition and by the momentum we continue to see across the organization. Since stepping into the role of interim president, Josh has provided steady, disciplined leadership while maintaining his focus on financial rigor. The alignment between our operational priorities and our financial strategy has been evident, and the organization has responded with focus and urgency. The strategy has not changed. The execution has not slowed.

If anything, the focus across the organization has sharpened. At the same time, Michael Fox joined us as chief operating officer on April 13, bringing more than 35 years of commercial leadership experience across complex healthcare markets, including extensive work within the federal systems and the U.S. Department of Veteran Affairs. In just three weeks, his depth of experience has already provided valuable insights to strengthen our execution, particularly as we continue to expand our presence within complex government channels. He will introduce himself shortly. Importantly, this transition has not slowed us down. It has reinforced our foundations.

We remain firmly committed to our strategy: driving growth within our covered entities, advancing our clinical and scientific leadership in noninvasive vagus nerve stimulation, and expanding our reach into the consumer wellness market. And we are doing so with discipline, managing the cost base, expanding the margin, and protecting our path to profitability. In our clinical work, we continue to invest in the evidence base that underpins our portfolio. That evidence remains a key differentiator as we engage with providers, payers, and partners globally as well as domestically, and it positions us to expand into new indications over time. In the VA, we have built a credible commercial presence over many years. We believe we have a meaningful long-term opportunity.

Our commercial leadership is leveraging Mike's experience to identify new ways to be more targeted and more effective, particularly within a system where we still have substantial room to penetrate. On the consumer side, we are building a scalable, direct-to-consumer channel with increasing brand visibility, improving unit economics, and a growing network of influencer and affiliate partners that resonate with audiences seeking nonpharmacologic, science-backed wellness solutions. The early traction we are seeing reinforces our belief in the broader applicability of our technology and its relevance to everyday wellness. What gives me the greatest confidence is not just the progress itself, but how it is being achieved—with discipline, alignment, and a clear sense of purpose across the organization.

We are building a strong foundation, and we are doing so in a way that positions the company for durable, long-term growth. While our search for a permanent CEO continues, I am confident that the team we have in place today—Josh, Mike, and the broader leadership group—is the right team to execute against our priorities and carry our strategy forward. I look forward to updating you on our continued progress in the quarters ahead. With that, I would like to introduce our new chief operating officer, Mike Fox. Mike, thank you. Good afternoon, everyone. I joined electroCore, Inc. for one reason.

Mike Fox: I saw science-based platform technology with proven, published clinical outcomes data that support a credible commercial foundation and significant room for growth, particularly within the federal channels where I spent most of my career. Three weeks in, my conviction has only strengthened due to my greater exposure to the existing and future datasets being gathered. I have also had the opportunity to meet a vast number of talented colleagues within the company who are dedicated to the mission and the patients we serve. So rather than walk through my background, let me tell you what I have been focused on and where the opportunity exists. My major priority is the VA and Department of Defense markets.

We have just scratched the surface of penetrating the addressable VA headache market. Though we have patients being treated with our products in VA medical centers across the country, we are not attaining the utilization level that meets the needs of our veterans and the dedicated providers caring for these military heroes. The majority of new patients identified and prescribed our products in Q1 are not spread across the country as expected or needed. That tells me two things: we have built real distribution, and we are nowhere near saturation. My focus is moving from facility breadth to facility depth—more prescribers per site, more patients per prescriber, more consistent customer experience across the system.

My second priority is the broader federal channel. The VA is our largest entry point, but it is not the only one. The Department of Defense, across all service branches, represents an underdeveloped opportunity for both our prescription products and for TACSTIM. Given the heightened tempo of U.S. military operations abroad, the demand environment for noninvasive, drug-free, performance-supporting solutions has only intensified. I spent the last three and a half decades building relationships in these channels, and I intend to put them to work for this company. My third priority is operating discipline. Josh and the team have built a high-margin business—87% gross margin in Q1. You are starting to see operating leverage show up in the numbers.

My job is to make sure that as we scale, incremental revenue translates to incremental bottom line, not incremental cost. I intend to grow this business efficiently while we establish electroCore, Inc. as a partner of choice to ensure market stability in the years ahead. At three weeks in, I trust that my experience in developing company growth and success is from decades of learnings and proven execution strategies. I am truly excited about the opportunity presented to me here at electroCore, Inc. There will be much more for me to share over the coming quarters, but I am convinced what is in front of us is real. I am truly grateful to be a part of this team.

With that, I will turn the call back over to Josh to walk through the quarter. Josh?

Joshua S. Lev: Thank you, Mike. Before I get into the details, let me tell you what this quarter represents for electroCore, Inc. We just delivered our highest revenue quarter ever—$9.6 million, up 43% year over year. Gross margin expanded to 87%. GAAP net loss was $5.3 million, and adjusted EBITDA loss improved by 24% to $2.3 million. That combination—accelerating top line, expanding margin, and improving adjusted EBITDA loss in the same quarter—is demonstrating operating leverage, and it is the clearest signal yet that we are executing on our strategy. We are reaffirming our full-year 2026 revenue guidance of approximately 30% growth. As I will discuss in a moment, the catalysts in front of us for 2026 give us conviction in that outlook.

Now to the details. VA prescription device revenue grew 48% year over year to $7.9 million. Within that, prescription gammaCore grew 26%, and Quell sales surpassed their first $1 million quarter. Since we acquired the Quell assets from NeuroMetrix in May 2025, Quell fibromyalgia has generated $2.5 million in cumulative revenue, and we are still in the early stages of placing that product across the VA system. As of March 31, approximately 15 thousand VA patients have received the gammaCore device, which we estimate represents roughly 2.5% penetration of the addressable VA headache market. The underlying patient population continues to expand.

A 2024 study published in JAMA Network Open of nearly 500 thousand U.S. veterans found that 8.2% of male and 30.1% of female veterans report a history of migraine—roughly three times the rate observed in the civilian population—and that approximately half of veterans with migraine also meet criteria for PTSD. The U.S. Department of Defense has reported more than 485 thousand service member traumatic brain injury diagnoses since 2000. Combining that with the Veterans Health Administration's emphasis on non-opioid first-line treatment for chronic pain, we believe the runway for prescription gammaCore adoption inside the VA is long and we are still early. Turning to our consumer wellness channel.

Revenue reached $1.6 million in the quarter, up 44% year over year, with TruVega contributing $1.5 million, up 38% from Q1 of last year. This quarter, we deliberately tempered top-line growth in favor of efficiency, and the results are showing up in the unit economics. Our return on advertising spend, or ROAS, was approximately 2.37 in the period, a 14% improvement over the prior quarter. In plain English, every dollar we spent on TruVega-related media generated nearly $2.37 of revenue. That improvement was driven by a concentrated shift toward affiliate and influencer partnerships that reach consumers already interested in wellness and in vagus nerve stimulation specifically. Return rates remain in the 12% to 15% range, consistent with prior periods.

We believe the macro environment for our consumer wellness offering is meaningful. The Centers for Disease Control reports that 24.3% of U.S. adults experienced chronic pain in 2023, up from 20.4% in 2019. Independent industry research projects the global noninvasive vagus nerve stimulation segment will expand at a low double-digit CAGR through 2030, supported by aging demographics, the regulatory and clinical pivot towards non-opioid pain management, and rising consumer awareness of the vagus nerve. We believe TruVega is well positioned to capture a meaningful share of that growth. Onto TACSTIM, our human performance product.

While quarterly TACSTIM revenue has historically been variable, the underlying demand environment for cognitive performance and fatigue mitigation in the active-duty military and federal channels is robust and getting more robust. Given the heightened tempo of U.S. military operations abroad—particularly around remotely piloted aircraft, drone defense, and other extended-duration mission profiles—the need for noninvasive, drug-free solutions to support warfighter alertness, focus, and resilience has only grown. TACSTIM is the subject of ongoing research and evaluation across U.S. Air Force Special Operations Command, U.S.

Army Special Operations Command, and the Air Force Research Laboratory, and was previously selected by AFRL for inclusion in the Real-Time Assessing and Augmenting Cognitive Performance in Extreme Environments program, a program designed in part to support multi-day transoceanic operations and long-duration remotely piloted aircraft missions. With Mike now leading our commercial operation, we see a meaningful opportunity in 2026 and beyond to deepen our engagement and to pull TACSTIM through as a more consistent revenue contributor. Now to the financials. Net sales of $9.6 million represented 43% growth over the prior year, driven by gammaCore and Quell within the VA and continued growth in TruVega.

Gross profit was $8.4 million, with gross margin expanding to 87%, a 200 basis point improvement year over year. Research and development expense was $740,000, up modestly from the prior year, primarily reflecting work on the Acacia PTSD study. Selling, general, and administrative expense was $12.9 million. That number includes approximately $1.9 million of nonrecurring leadership transition costs and $300,000 of legal expense related to the ongoing IP litigation. Excluding those items, the year-over-year increase was driven by approximately $1.6 million of variable expense supporting our $2.9 million revenue increase—a clean illustration of how the cost base scales with the top line.

Other expense of $276,000 includes interest associated with the convertible term debt financing we put in place with Avenue Venture Opportunities Fund. GAAP net loss in the first quarter was $5.3 million compared to $3.9 million in the prior-year period. This increase was driven primarily by the $1.9 million in nonrecurring leadership transition costs. Net loss per share was $0.59 compared to $0.47 per share in the same period last year. Excluding the leadership transition expenses, net loss per share was $0.37. And now I want to draw your attention to the 24% improvement in our adjusted EBITDA loss, which I believe is an important indicator of the operating leverage we are building.

Adjusted EBITDA loss for Q1 was $2.3 million compared to $3.1 million a year ago. That improvement happened in a quarter where we incurred $1.9 million of nonrecurring leadership transition expenses. Strip those out and the operating leverage in this business is even more evident. Revenue grew 43%, adjusted EBITDA loss narrowed 24%. As we scale further, that gap is what gets us to profitability. A reconciliation of GAAP net loss to non-GAAP adjusted EBITDA net loss is provided in the financial tables in today's press release. Turning to the balance sheet. Cash, cash equivalents, and marketable securities were approximately $8.8 million at 03/31/2026, compared to $11.6 million at 12/31/2025.

One important note on cash: Q1 is historically our highest cash-burn quarter of the year. This year, certain working capital items—primarily the timing of inventory and capital improvements to our Rockwell facility—may extend a portion of that burn into the second quarter. We are managing the balance sheet with discipline and remain focused on the operating efficiencies that support our path to profitability, while also evaluating available capital resources, including our existing shelf registration statement and at-the-market facility. Before we open the call for questions, I want to spend a minute on the catalysts ahead of us in 2026, because the runway from here is significant. First, R&D and nVNS as a platform technology.

We continue to work towards a platform of products that can be sold through our established sales channels. This comes in the form of indications, products, and features. The body of evidence supporting the therapeutic potential of nVNS continues to expand. A new publication in Frontiers in Neuroscience entitled “Adjunctive noninvasive vagus nerve stimulation for chronic mild traumatic brain injury with comorbid post-traumatic stress disorder: a post hoc analysis” highlighted findings on the potential benefits of adjunctive noninvasive vagus nerve stimulation in patients with mild traumatic brain injury and PTSD.

Additionally, approximately 20 participants have enrolled in the clinical study conducted by Acacia Clinics in collaboration with the Vagus Nerve Society designed to evaluate the safety and effectiveness of electroCore, Inc.'s gammaCore nVNS device as an adjunctive treatment for symptoms associated with PTSD. PTSD is a Breakthrough Device designation for us, and as the data matures, we expect it to become an increasingly important part of the platform story. Work on our next-generation TruVega and Quell mobile platform is underway. We are developing a mobile application designed to complement our consumer products, deliver more personalized features and user experiences, and—if done right—open the doors to recurring revenue, deeper engagement, and richer real-world data.

Second, we remain focused on opening additional commercial channels for our products. Beyond continued VA penetration, Mike's mandate includes expanding our commercial and federal channel presence. This includes areas such as Kaiser, federal workers' compensation programs, TRICARE, and broader adoption within active-duty military and the Department of Defense. With TACSTIM already engaged across Air Force Special Operations Command, Army Special Operations Command, and the Air Force Research Laboratory, we see meaningful opportunity for additional federal contract activity. Quell continues gaining adoption through our current sales channel and primarily within the VA.

Sales of the Quell product line surpassed $1 million in quarterly revenue for the first time in Q1 2026, bringing cumulative Quell revenue to approximately $2.7 million since the acquisition from NeuroMetrix in May 2025, including $2.5 million of Quell fibromyalgia sales in the VA. We have a small cohort of legacy Quell over-the-counter users and expect to relaunch the over-the-counter Quell Relief for lower-extremity pain later this year. Earlier this year, in January 2026, we launched TruVega in the United Kingdom, and as that business scales, we expect to evaluate additional markets. And third—perhaps the most important catalyst of all—our path to profitability. The math is straightforward: mid-80s gross margin, accelerating top line, increasingly disciplined cost base.

We are not yet ready to provide a specific quarter for breakeven, but the trajectory is clear, and Q1 is the strongest evidence yet that we are on it. Taken together, these catalysts underpin our reaffirmed full-year 2026 revenue guidance of approximately 30% growth, which translates to roughly $9 million to $10 million of incremental revenue versus our $32 million in 2025. We expect the majority of that growth to come from continued VA prescription growth, where Q1 alone delivered prescription device revenue growth of 48% year over year. TruVega, growing in the high-30% range and improving in efficiency, is our next meaningful contributor.

Quell Relief and our international launch represent newer contributions that we hope to scale through the back half of the year. TACSTIM, while historically variable, represents potential upside as Mike deepens our federal engagement. And our next-generation mobile platform is a 2027 contributor that opens the doors to recurring revenue over time. In short, three catalysts, a clear 30% growth bridge for 2026, and a longer runway into 2027 and beyond. With that, we will now open the call for questions. Operator?

Operator: Thank you, Josh. We will now open the call for questions. For those joining via Zoom, there are two ways to participate. First, you may raise the hand icon located at the bottom of your screen. Selecting this will alert the operator that you would like to ask a live question, and you will be placed in the queue. Please note that you will remain muted until your question is called. Second, you may submit a question using the Q&A widget, which allows you to type your question directly. We will monitor and take questions submitted there as well.

If time does not permit us to address all questions during today's call, a member of the Investor Relations team will follow up directly. With that, we will pause briefly to allow the queue to form. Our first question comes from Jeff Cohen at Ladenburg. Jeff, can you hear me okay? Oh, is this Destiny? Yes. Hi. This is Destiny on for Jeff. Thank you for taking our questions.

Analyst: I just wanted to touch on the VA channel a little bit. And this is going to be a multipart question. But I am wondering, as you move away from breadth and more towards depth in this channel, could that—and does that—change the structure of your sales in terms of W-2 versus 1099? And then how are you balancing expanding into new sites versus additional patients treated, I should say?

Joshua S. Lev: Hey, Destiny. Thanks so much for the question. Really appreciate it, and appreciate you being on the call today. I think the best person to answer that question will be Mike. Mike, why do you not jump in and let everyone know what your strategy is?

Mike Fox: I think the question is a really good one because I do not believe it is an either-or. In my experience, we definitely want to expand breadth. We do have VA utilization across the country, but the depth in various specialties and within various patient-segment groups is not where it needs to be. I am a fan of the 1099 model. I am a fan of the W-2 model. In my history, as long as we have strong performers that are aligned to the strong mission to help our veterans, we can build a really strong opportunity around that.

So I do not see this being a big change as much as just an internal alignment and opportunity for us to ensure that we are setting appropriate expectations and really holding people accountable to exceeding those expectations for both our gammaCore line and the Quell line. Destiny, does that answer your question?

Analyst: It does. I think I would also just be curious, what is your target for number of clinics for 2026? Perhaps a range from that 200 number?

Mike Fox: That depends as of right now when you say clinics—really like centers. Sorry. Yeah. The VA medical centers. It depends on what number you want to utilize. I have always been of the belief that if we are not helping at least 75% of the facilities across the country help the vets, we are not doing our job. I do not know about an exact number, but we need to get really active and have consistent utilization of our products in treating veterans in at least 75% of those accounts on a monthly basis.

Analyst: Got it. And then as you go into these other DoD channels, how does that process compare to the VA centers? Is it similar in terms of timing?

Mike Fox: It probably will be a different story altogether because, as you know, they are both under FSS, but the Department of Defense accounts, like the military health centers that also include the TRICARE component—so there are different segments. From a timeline perspective, the VA usually takes a long time to get things established due to FSS and working with our customers like Level Government Services for some things. On the Department of Defense side, I would expect by sometime Q3, Q4, with our plan in place, that we will start seeing additional revenue.

Analyst: Okay. That is really helpful. Thank you. And then I guess transitioning over to wellness and TruVega, you had really strong ROAS this quarter, which I think is fantastic. I am just wondering if there were any changes to the marketing channels that played into that stronger ROAS.

Joshua S. Lev: That is a great question. It is not so much a change in the marketing channels. It is more a function of where we are deploying and investing our resources. We made a more concerted effort to work on affiliate programs and influencers. You may have seen that Miranda Kerr posted about us earlier. That is a co-marketing opportunity that we have. Those are opportunities where we can utilize and leverage the marketing budget of other people so that they are actually the ones that are putting out the marketing messaging, and really what we are doing is using that halo effect to help lift our efficiency. So it is not so much a change per se.

I would not say that we cut out any of the other channels or media that we have done before—just reallocating the resources and looking at it slightly differently.

Analyst: Okay. And have you noticed any differences in repeat purchase behavior or anything of that nature compared to last year?

Joshua S. Lev: Not yet, but we also have not given any formal guidance on that either. But I would say not yet for the time being. Everything seems to be business as usual.

Analyst: Got it. Alright. That does it for me. Thank you for taking the questions and great quarter.

Joshua S. Lev: Thanks.

Operator: Okay. Our next question comes from Brookline.

Analyst: Hi. Can you hear me?

Joshua S. Lev: Yes. Perfect. Well, give me one second. Alright. First, Mike, thank you for joining the call and coming on board. We look forward to engaging with you. My question is on the Frontiers study on PTSD patients, which was very compelling. I was wondering if you can just remind us how this study is aligned with the ongoing Acacia trial. Is it set up the same, whether the outcomes are actually designed to capture the same kind of endpoints that were published in Frontiers, or something different?

Joshua S. Lev: It is something slightly different. Both of them are there to capture patients with PTSD and the effects of utilizing noninvasive vagal nerve stimulation on patients with PTSD. The actual protocols themselves are slightly different, and you can look those up on the IRBs if you would like. But in essence, the idea here is how do you aggregate different data points that have PTSD being tested through a patient population. But the populations themselves may be slightly different.

Analyst: Okay. And then I have a follow-up question. You know, there is a Breakthrough designation attached with PTSD. Are there any ongoing discussions with the FDA at this point?

Joshua S. Lev: In previous quarters, we have given information and spoken about how we have gone back and forth with the FDA in terms of the best way to approach expanding the Breakthrough designation to what would be a formal PTSD label. What we are doing with a lot of the work now—primarily with the Acacia study and what you just referenced a moment ago—is really aggregating more data points and information that we can bring to the FDA to have a full rollout of what would be a PTSD indication and a full label. And we are doing that in conjunction with them in that they have identified, or articulated to us, what they are looking for.

Based off that information, we are looking to take that and aggregate the dataset to provide to them to ultimately apply for the full-form PTSD label with them.

Analyst: Thank you.

Joshua S. Lev: Great. Thanks.

Operator: Okay. Our next question comes from RK Ramakanth at H.C. Wainwright.

Swayampakula Ramakanth: Good afternoon, Joshua. Welcome aboard. Michael Fox, hopefully, you guys are able to hear me.

Joshua S. Lev: Yeah. You are great, RK.

Swayampakula Ramakanth: I have two or three questions. So, Josh, just starting off—thanks for reiterating the 30% growth for 2026. But during the first quarter, there was a gain of 43%. What is it that is keeping you being more careful than needed? Do you see something that makes you—I am not going to use the word concerned—but makes you think that you need to wait for at least one more quarter to change that guidance?

Joshua S. Lev: That is a great question, RK, and very astute. The answer is no. More than anything, we have internal projections, as you know, and the guidance that we provide to The Street is really based off what we believe organic growth could look like based off of, I would say, an outdated model, if you will. And what I mean by outdated is Mike, with all of his experience coming to the organization, has utilized strategy and tactics which have helped grow his former businesses three to four times in terms of top-line revenue. Mike has only been here since April 13.

So it is not really necessarily “fair” to expect any more sort of direction or tactics as it relates to how he is going to be able to expand or accelerate that growth, what the timing of that growth is going to look like, and the resources required—which is the reason why we keep on going back to: we are going to provide more detailed guidance when it becomes available and more appropriate. It just has not been enough time for Mike to get his feet wet fully to be able to map out and say, okay, I think that we can grow by X, but it is going to take this amount of time.

Swayampakula Ramakanth: Okay. Thanks for that. And Michael Fox, as I said, welcome aboard. I have a quick question for you. As you were doing your due diligence and trying to get on board, gammaCore has been marketed to the VA facilities for quite a while now, and we have about 200 centers actually not only acquiring but also stocking the product. From what you have done in the past, what are the easy pickings in the VA market to move that to a larger number of centers? And also, outside of the VA, can you name one or two additional federal centers where you think this can be an easy sell?

Mike Fox: RK, that is a really good question. I would say from what I have seen in my experience in the VA, the best way to adjust within the VA is to work with them. The VA has a lot of standardizations. They have a lot of requests for algorithms and treatment protocols, medical necessity. I find a lot of companies do a lot of great things one account at a time, but they are not working with the leadership at the VISN level or national level to really place where this product fits and get support from the top down. I believe this company has done a phenomenal job of generating support from the bottom up.

What I can do is continue to work with that information, that data, the patient-provided outcomes, and the information gathered by our providers in the VA to generate more opportunity for us to standardize treatment and put a really strong position for gammaCore within the federal space. On the second part of your question—outside of the VA—I know there is a large federal workers' comp opportunity with the number of headaches and migraines within that space. Within the Department of Defense, whenever you say Department of Defense, you have to think of places like Walter Reed, Sampson, Portsmouth Naval, and Balboa.

There are so many medical facilities that treat patients post-deployment that come back with various things that we can definitely assist them with. It is early in my evaluation of where we will be able to start, but I promise for the Department of Defense it will be with key opinion leaders within the headache space on those active military bases, with a focus on the larger centers first—probably closer to the East Coast where we are based. Fantastic. Does that answer your question okay?

Swayampakula Ramakanth: Yes. Yes. So if I can, one more question for you, Mike. In terms of Kaiser Permanente, this is one of those entities where you really need to generate internal KOLs that can drive the growth of the product. In terms of your experience, do you see that as a real way to do it, or are there any other levers that need to be pulled? Because I believe once you can get that going, it can be a good draw of the product.

Mike Fox: That is a phenomenal question. I think a lot of companies ask the same thing about Kaiser because everyone knows the importance of a place like that for business. I cannot say all the details of our proposition to date with Kaiser. I have been on numerous calls. I am very excited about what we have going on in the key opinion leader support within Kaiser. It is a phenomenally well-organized and standardized group. So within the foundation, I know there is a lot of support. The work is definitely being done in the California market. We are going to address some other outside-of-California market opportunities.

I do not want to get too deep into the Kaiser description of what is going to happen, but we have a very favorable position now that we need to really understand what is holding us back so we can generate that necessity from the customers. But you are right—we need internal providers requesting it. I can tell you from my early meetings, we have national headache and migraine experts already doing that. So we are in a good spot. We just need to tie a bow a little bit and figure out what is missing, but we have a lot of momentum there.

Swayampakula Ramakanth: Perfect. Perfect. On the Quell fibromyalgia—you have $2.5 million cumulative in the VA market. How big is the opportunity within the VA for Quell, and is there any opportunity outside of the VA? Because it looks like it does not sell much on the over-the-counter sort of product. You have quite a bit of experience now with TruVega, and I am just trying to understand how that can be translated into Quell OTC, if I can call it that.

Mike Fox: That is a great question, RK. Within the VA, obviously, we are treating some of the multidisciplinary types of patients with multifactorial disorders. Fibromyalgia, as a percentage, is a large population in the VA. I think there are some recent statistics—just on even active military, it is very low before they go on deployment, but upon return from deployment, it is about 11% just on active duty. So the veterans as a whole are always exposed to greater and bigger issues. It is a market by itself which is very scalable for a product like Quell. Outside of the VA, I think we all have family members and friends that have been dealing with fibromyalgia.

It is a big opportunity outside there. But I would say—we talked about Kaiser a little bit earlier—I think those are the markets that would be the first ones to address as we continue to explore maybe some opportunities to talk with TriWest and Optum for some of the active military. That would be the plan at least for the immediate future, but we still have to verify what is the best spot.

Joshua S. Lev: And look, RK, it is also definitely worth noting as we look at the number of facilities that are out there prescribing our products: the fibromyalgia product, Quell, is being prescribed in roughly a third of the number of facilities that are prescribing gammaCore. If you think about that in the context of overall runway—yes, we acquired the company a year ago. We have been able to grow that to about $2.5 million within the VA system. But within that VA system, it is kind of concentrated in one area of the region. We just need to spend more time being out there and selling. So there is a lot of opportunity, I think.

Swayampakula Ramakanth: I do not mean to hog the call, but one last question. On TruVega, what learnings can you take from the U.S. to the U.K.?

Joshua S. Lev: That is a great question. Right now, we have only launched in the U.K. with our TruVega 350. We have had a lot of inbound interest coming from the U.K., and people are expressing the need or the desire to get more access to noninvasive vagal nerve stimulation for the wellness space. It is early days there. We really just launched it in January, a soft launch, and what I mean by that is we are not actively putting any media dollars behind it right now. Really, what we are trying to get a better understanding of is what is the uptake for that TruVega 350 unit, and does it make sense?

What is the business opportunity more broadly not just in the U.K., but also in other areas outside of the U.S., to go ahead and launch next-generation products like the TruVega Plus. Thanks, RK.

Operator: Okay. Josh, our next questioner comes from Jeremy Perlman from Maxim. His first question is actually for Mike. He says, where does Mike see the easiest wins, lowest hanging fruit, and what are his longer-term plans to drive increased utilization?

Mike Fox: Thanks for the question, Jeremy. In my vast four weeks of experience, the low-hanging-fruit opportunity is, as we discussed, the federal space. I think the VA and the unmet needs with our veterans is a key focus for us. We know we have a really strong opportunity there, and other federal channels like we discussed with the Department of Defense. I think long-term plans—it is a good starting spot, but we all know that it is a good place to help our veterans, and we have to go beyond.

That is where I think the longer-term plan will be to continue to work on the commercial side and figure that system out as a way for us to expand beyond the FSS and GSA opportunity. So that is still in development, still being identified, but that is the long-term plan. We can develop the revenue for the long term.

Operator: Okay. Jeremy's next question is: what does the Quell Relief commercialization rollout look like—target markets and users?

Joshua S. Lev: Yeah, so great question. First and foremost, there is a small cohort of users of the Quell over-the-counter product that we inherited when we acquired the NeuroMetrix business. You may recall that when NeuroMetrix was at its peak, it was doing somewhere to the tune of $12 million of over-the-counter related business. A lot of that went away after the company decided to do a strategic pivot, had the FTC issue, and moved to a medical device called the fibromyalgia product.

From our point of view, we are really focused on, number one, making sure that we can still service those legacy consumers that have been using the product or that may want to have continued using the product but it is no longer available. That is number one. And then number two is we need to do it in a way that makes sure that we have addressed all of the concerns that NeuroMetrix had regarding the FTC. In terms of overall rollout and commercial strategy, the answer is that it is going to be slow.

It is going to be well defined, but it is going to be deliberate in that we are purposely going to make sure that we have addressed the concerns that NeuroMetrix had earlier in their iteration as an over-the-counter product so that we can go ahead and do it in a way that is balanced between offering Quell fibromyalgia—an FDA-cleared product—and then also a consumer product as well.

Operator: Okay. And our last question from Jeremy: what are your leading indicators—pipeline, reorder rates, device utilization—that give confidence in continued acceleration and guidance?

Joshua S. Lev: Again, Jeremy, great question. I tried to really focus on it at the end of my remarks, but we look at this in terms of three main categories of catalysts. The first is R&D-related—so that could be additional indications, right? PTSD, putting out additional information about how the studies are going. If you look and you follow our IR page, you will note that we put out recent press releases noting the Acacia study, noting some other publications where data is coming out to help support what could be the makings of a PTSD label. That would be an R&D effort.

Products or features—we had mentioned, as it relates to TruVega and Quell, we are investing in our next-generation mobile application. Those features will allow us to hopefully get to a point where, if done correctly, we will be in a situation that we can have a recurring revenue model. So that would be the first catalyst.

The second catalyst would be commercial—being able to go ahead and announce items such as launching TruVega outside the United States, as we recently did in January; the opportunity or the probability of ultimately launching the Quell Relief, or the Quell over-the-counter product, as its own standalone consumer product; hopefully Mike coming to the table and being able to announce either further traction within places like Kaiser or new orders within the federal marketplace like federal workers' comp, perhaps TRICARE—so opening up different commercial avenues. And then lastly, which is the third catalyst, would be the operating results.

We believe that we can be in a situation where these other catalysts will help drive increased total addressable market and adoption of noninvasive vagal nerve stimulation devices, and we believe that acceleration will yield higher revenue growth and be done in a way where we are managing our costs and expenses. Ultimately, can we accelerate our revenue while also reducing our overall cost to do that—whether that is sales and marketing as a percentage of revenue as an indicator, and so on.

Those are really the three main catalysts that we are focused on, and we will be very mindful as we go into the remainder of 2026 and beyond to give very specific milestone updates in these different areas that we are strategically focused on. Mike, I do not know if you have anything else you want to add.

Mike Fox: And, Jeremy, I would just like to add—in my opening comments I talked about what I knew about the company before I got here as far as how clinically in-depth this organization is and what they are doing to continue to enhance the strength of the clinical platform. Since joining the company and seeing Doctor Stotts and his team and all the investigator-initiated research and the resources the company is putting behind the products to prove more and to do more is one of the reasons I am extremely excited about the future. So when you talk about it, it is not just always using the same product and just trying to get momentum.

It is building the platform that Josh has talked about, and that is what I believe is a really exciting factor for this company—what you will see in the future that we really cannot discuss today, but the economics and the efforts are being placed here at electroCore, Inc. to make it happen.

Operator: We have now concluded the live Q&A portion of the call. With that, I will turn the call back over to Josh for closing remarks.

Joshua S. Lev: Thank you. I want to take the opportunity to thank our shareholders for your patience and your continued support. To our patients, our providers, and our partners, thank you for trusting us with your care and your time. And most importantly, to our team, thank you for showing up every day with the discipline and the ambition this opportunity demands. I really appreciate everyone's participation in today's call. We look forward to speaking with you again next quarter, and I wish you all a happy afternoon.

Operator: That concludes today's call. Thank you for your participation.

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