0001799191-26-000007
SEC filingThe Oncology Institute, Inc. (TOI) reported total operating revenue of $502.7 million for FY 2025, representing a 27.8% increase from the prior year. This growth was driven by a 49.6% increase in specialty pharmacy revenue to $269.2 million and an 11.8% increase in patient services revenue to $229.0 million. However, the company incurred a net loss of $60.6 million, an improvement from a $64.7 million loss in FY 2024. The loss from operations was $36.1 million. The company ended the year with $33.6 million in cash and cash equivalents, a decrease of $16.1 million from the prior year, and had total assets of $164.7 million against total liabilities of $180.4 million, resulting in a stockholders' equity deficit of $15.7 million. More than 46% of revenue was generated from value-based contracts.
For the fiscal year ended December 31, 2025, The Oncology Institute, Inc. reported total operating revenue of $502.7 million, a significant increase of 27.8% from $393.4 million in FY 2024. Despite this revenue growth, the company continued to operate at a loss. The net loss for the year was $60.6 million, an improvement from a net loss of $64.7 million in the prior year. The loss from operations was $36.1 million. Key drivers of revenue growth were the specialty pharmacy segment, which saw a 49.6% increase, and the patient services segment, which grew 11.8%. The company's cash position decreased by $16.1 million during the year, ending with $33.6 million in cash and cash equivalents.
Revenue is derived from three primary segments: Patient Services, Specialty Pharmacy, and Clinical Trials & Other. Patient Services revenue, comprising capitation and fee-for-service arrangements, increased 11.8% to $229.0 million. This growth was driven by a 9.0% increase in fee-for-service revenue and a 17.2% increase in capitated revenue, attributed to steady patient volumes in mature markets, momentum in new markets, and investments in referral relationship management. Specialty Pharmacy revenue grew 49.6% to $269.2 million, driven by a 66.6% increase in the number of prescription fills, partially offset by a 10.2% decrease in average revenue per fill. The company attributes this growth to higher underlying patient volumes and efforts to direct prescriptions to its internal pharmacy. Clinical Trials & Other revenue decreased 47.0% to $4.6 million due to a profit-sharing agreement entered into with Helios Clinical Research in 2025.
The company's gross margin was 15.3% for FY 2025, calculated as (Total Operating Revenue - Direct Costs) / Total Operating Revenue, where direct costs totaled $426.3 million. This margin is consistent with the prior year. The operating margin was -7.2%. Direct costs for patient services increased 10.0% to $205.5 million, primarily due to a 13.1% increase in intravenous drug costs driven by patient mix and volume, partially offset by a 4.1% decrease in clinical payroll costs. Direct costs for specialty pharmacy increased 45.8% to $220.6 million, in line with the revenue increase. Selling, general, and administrative expenses decreased 2.1% to $105.6 million, driven by a 59.2% decrease in share-based compensation expense and a 9.4% decrease in non-clinical payroll, partially offset by increases in professional fees and support services.
Net cash used in operating activities was $24.6 million for FY 2025, an improvement from $26.5 million used in the prior year. Key adjustments to reconcile net loss included depreciation and amortization of $6.9 million, share-based compensation of $4.6 million, and a $12.2 million change in the fair value of conversion option derivative liabilities. Net cash used in investing activities was $3.1 million, primarily for purchases of property and equipment. Net cash provided by financing activities was $11.6 million, driven by proceeds from a private placement ($15.4 million net) and an at-the-market offering ($13.8 million net), partially offset by principal payments on long-term debt ($20.0 million). The company ended the period with $33.6 million in cash and cash equivalents. Total assets were $164.7 million, including $112.7 million in current assets. Total liabilities were $180.4 million, including $71.0 million in current liabilities and $77.4 million in long-term debt, net. This resulted in a stockholders' equity deficit of $15.7 million.
The company's growth strategy focuses on expanding its network of oncology care clinics through acquisitions, de novo clinic builds, and network provider contracts. It aims to drive covered lives growth in existing markets and enter new markets with attractive dynamics, such as high Medicare Advantage penetration and value-based primary care groups. The company acknowledges several risk factors, including its history of net losses, dependence on third-party payor reimbursement, concentration in certain geographic areas, and challenges related to rapid growth and organizational change. It also notes regulatory risks, such as California's AB 1415, which could delay strategic transactions. The company believes its value-based care model and hybrid network approach position it for future growth, but there is no assurance of achieving or maintaining profitability.