Kestra Medical Technologies Q4 2026 Earnings Report

Kestra Medical Technologies EPS Results

• Actual EPS: -$0.67
• Consensus EPS: -$0.59
• Beat/Miss: Missed by -$0.08
• One Year Ago EPS: N/A

Kestra Medical Technologies Revenue Results

• Actual Revenue: $28.64 million
• Expected Revenue: N/A
• Beat/Miss: N/A
• YoY Revenue Growth: N/A

Kestra Medical Technologies Announcement Details

• Quarter: Q4 2026
• Date: 7/14/2026
• Time: After Market Closes
• Conference Call Date: Tuesday, July 14, 2026
• Conference Call Time: 4:30PM ET

We are a commercial-stage, wearable medical device and digital healthcare company focused on transforming patient outcomes in cardiovascular disease using monitoring and therapeutic intervention technologies that are intuitive, intelligent, and connected. We have developed and are commercializing our Cardiac Recovery System platform, a comprehensive and advanced system that integrates monitoring, therapeutic treatment, digital health, and patient support services into a single, unified solution. The cornerstone of our Cardiac Recovery System platform is the ASSURE WCD, a next generation wearable cardioverter defibrillator (“WCD”) used to protect patients at an elevated risk of sudden cardiac arrest (“SCA”), a major public health problem that accounts for approximately 50% of all cardiovascular deaths in the U.S. The ASSURE WCD automatically monitors elevated risk patients and, if needed, delivers a defibrillation shock to return the patient’s heart to normal rhythm. The ASSURE WCD was purpose-built to enhance patient comfort and compliance and directly address the key barriers to adoption associated with the only other commercially available WCD. We believe the ASSURE WCD offers significant clinical and functional advantages, including greater patient compliance as a result of a major reduction in false alarms and enhanced comfort and wearability. In addition to the ASSURE WCD, our Cardiac Recovery System platform includes a comprehensive suite of fully integrated digital solutions and services that enable enhanced patient and provider engagement and oversight, with the objective of improving patient outcomes. We believe our Cardiac Recovery System platform addresses serious unmet needs in the cardiac patient population and has the potential to disrupt and grow the market which has been limited to a single solution for more than 20 years. As of January 31, 2025, our system is actively being prescribed by more than 550 hospitals across the U.S., representing approximately 20% of WCD prescribing hospitals in the U.S., and has been worn by over 17,000 patients since it was fully commercially launched. In our top 50 hospitals, we believe we have successfully captured approximately 45% of the currently available prescriptions based on company-sourced data on all hospitals that we serve in the U.S. and the percentage of WCD filled prescriptions at those hospitals that are for our ASSURE WCD. SCA is a life-threatening emergency characterized by the abrupt cessation of the heartbeat caused by an electrical malfunction in the heart. This is typically triggered by ventricular arrhythmias, such as ventricular fibrillation (“VF”), and leads to a loss of consciousness and potentially death within minutes if not promptly treated. The American Heart Association (“AHA”) estimates that SCA causes approximately 436,000 deaths per year, making it the third leading cause of death in the U.S. Defibrillation, or an electrical shock, is the only way to restore a fibrillating heart to a normal rhythm. Each minute of delay in restoring the heart to a normal rhythm reduces a patient’s chance of survival by 7% to 10%. The average time for Emergency Medical Services (“EMS”) arrival is 7 minutes from the time of a 911 call, and often longer in rural communities. The most common location of a SCA in adults is at a home or residence, representing approximately 73% of SCAs. In addition, approximately 50% of all SCAs are unwitnessed. A WCD is a wearable, non-invasiveminiaturized automated external defibrillator and is worn underneath regular clothing. The device continuously monitors a patient’s heart rhythm and is capable of delivering a defibrillation shock. Wires connect electrodes inside the garment to the monitor, which is carried in a small pack or shoulder bag. The electrodes continuously acquire a patient’s heart rate and rhythm for evaluation by the automated external defibrillator. If the monitor detects a potentially life-threatening arrhythmia, the WCD first alerts the patient via an audible alarm and then administers a shock, if needed. For over 20 years, WCDs have been used to protect patients at elevated risk of SCA. However, until the ASSURE WCD received Food and Drug Administration (“FDA”) approval in July of 2021, the market was limited to a single solution. Since the approval of the first WCD in 2001, global WCD revenues have grown to $1.3 billion in 2023, with approximately 85% of the revenues generated in the U.S based on our analysis of third-party claims data and estimated average WCD wear prescription lengths and average reimbursement rates in the U.S. and in select international markets derived from industry data and internal estimates. The volume of patients prescribed a WCD in the U.S. grew at roughly 6% annually between 2021 and 2023, and we expect WCD revenues to continue growing. Despite being proven as safe and effective in treating dangerous cardiac rhythms when worn, WCD therapy remains underutilized, reaching just 14% of the eligible U.S. patient population in 2023 based on data on patients indicated for a WCD and WCD prescription data from industry sources. We believe that the low penetration of WCD therapy is largely due to the limitations of the incumbent commercially available device. In feedback we have collected through directly engaging with patients and providers and customer feedback on public platforms, commonly cited reasons for patients or providers failing to use the competitor device include high false alarm frequency, poor wearability and patient discomfort, a unisex-only garment, low utility data and limited connectivity with patients. In the U.S., we estimate that there are approximately 800,000 cardiac patients each year who have experienced a myocardial infarction (“MI”) or are diagnosed with heart failure and have low Left Ventricular Ejection Fraction (“LVEF”), therefore making them eligible for WCD therapy. Additionally, approximately 50,000 patients each year either have documented ventricular tachycardia (“VT”) or VF, an inherited genetic condition, or have had their implantable cardioverter defibrillators (“ICD”) temporarily explanted, and are also indicated for WCDs. Based on an average WCD wear prescription length of 3.4 months per patient and an average Medicare reimbursement rate of $3,436 per patient per month, we believe this represents an approximately $10 billion annual addressable market. In select international markets, we estimate based on patient population data collected by various third-party industry sources that there are approximately 3.7 million people each year who experience an MI, are diagnosed with heart failure, have documented VT or VF, have an inherited genetic condition, or have had their ICD temporarily explanted. Among these patients, based on the same third-party industry sources, we estimate that approximately 1.8 million patients meet the indications for WCD therapy. Based on estimated average WCD wear prescription length in these international markets of 2.5 months per patient and estimated average reimbursement rate of $3,000 per patient per month derived from industry data and internal estimates, we believe this represents an approximately $14 billion total annual market opportunity outside the U.S. The ASSURE WCD is the next generation of WCD therapy, delivering a safe and effective solution for patients with a design that enhances patient comfort and compliance. In addition to the ASSURE WCD, the various digital solutions and services of our Cardiac Recovery System platform include the ASSURE patient application, Kestra CareStation remote patient data platform, Heart Alert Services, and ASSURE Assist services. The ASSURE patient application engages patients with real-time mobile updates to promote compliance, while the Kestra CareStation remote patient data platform equips healthcare providers with actionable insights to support timely and informed care decisions. Heart Alert Services and ASSURE Assist services work together to enhance safety and are designed to provide critical alerts to healthcare providers for significant arrhythmias and notify emergency services when therapy is administered. This post-therapy EMS support is critical as a range of injuries, such as head injuries, soft tissue damage and bone fractures, can result from falling down after a SCA. In addition, the ASSURE wearable ECG as part of our Cardiac Recovery System platform provides monitoring and connectivity for patients no longer indicated for a WCD but who still require ongoing support while their heart continues to remodel. We believe we offer the most comprehensive and cohesive platform, with digital solutions and services that are seamlessly integrated with our ASSURE WCD, meaningfully differentiating our Cardiac Recovery System platform from the only other commercially available WCD. We are building a body of clinical evidence supporting the safety, efficacy, and benefits of the ASSURE WCD, with six publications completed to date. This growing portfolio includes our pivotal trials—the ASSURE WCD Clinical Evaluation—Detection and Safety Study (“ACE-DETECT”) and the ASSURE WCD Clinical Evaluation—Conversion Efficacy Study (“ACE-CONVERT”)—which served as the basis for our premarket approval (“PMA”). In addition, we are conducting the ASSURE WCD Clinical Evaluation—Post Approval Study (“ACE-PAS”) as part of a broader ongoing ASSURE Patient Registry. All patients prescribed the ASSURE WCD in the United States after August 5, 2022 are included in the Registry. As of January 31, 2025, our ongoing registry has enrolled over 17,000 patients, and its findings further validate the results of ACE-DETECT and ACE-CONVERT. Our most recent FDA submission from ACE-PAS from July 2024, which includes data from 5,929 patients, reported first shock conversion efficacy of approximately 96%, a low false alarm rate with only 6% of our patients experiencing a false alarm, compared to 46% for the competitor’s device, and a median daily use of 23.2 hours. These results underscore the ASSURE WCD’s competitive advantages in wearability, usability, and patient compliance, providing strong support for continued adoption. We believe this collection of real-world evidence will generate additional publications, continue to increase awareness of WCDs as a proven therapy for elevated risk cardiac patients and further demonstrate the clinical differentiation of our ASSURE WCD. We have made material investments in infrastructure to support rapid growth and scalability, specifically in our commercial organization, distribution and supply chain capabilities, as well as revenue cycle management capabilities. In the U.S., we have built a commercial sales team of approximately 70 direct sales representatives and more than 40 sales and clinical support professionals with deep expertise in cardiac rhythm management and established relationships in the cardiology and electrophysiology fields. This team is responsible for developing sales territory business plans, targeting and opening new accounts, and processing prescriptions of our ASSURE WCD. Our direct sales team is supported by a contracted team of over 250 ASSURE Patient Specialists (“APSs”) who assist patients with fitting and training. At fitting, we deliver our ASSURE WCD from our distribution network to the patient. We utilize a lease business model, and when a patient’s wear time has concluded, the device is returned for reprocessing and reintroduction into the distribution network. To support our growth, we have developed a highly scalable supply chain in collaboration with experienced, top-tier medical technology suppliers. Our substantial investment in a fleet of devices, each with a capacity for approximately three patient wears per year, are reprocessed through efficient reconditioning, which enables the business to scale with an attractive unit economic profile. Finally, our revenue cycle management capabilities streamline reimbursement processes by ensuring claims are accurately prepared and submitted according to individual payor requirements, facilitating timely collections. These capabilities are a critical asset in driving operational efficiency and supporting both patient and prescriber satisfaction. We believe our significant investments in infrastructure create a high barrier to entry that will help us protect and grow our market share. Kestra Medical Technologies (NASDAQ:KMTS) is located in Kirkland, Washington.

Kestra Medical Technologies Q4 2026 Earnings Call Transcript

Key Takeaways

• Positive Sentiment: Revenue accelerated sharply in the fourth quarter to $28.6 million, up 66% year over year, and full-year revenue reached $95 million, up 59% from FY2025.
• Positive Sentiment: Gross margin continued to expand to 54.8% in Q4, marking the 10th straight quarter of sequential improvement, and management still sees a path to 70%+ gross margins over the next few years.
• Positive Sentiment: Commercial momentum remained strong with more than 6,300 ASSURE prescriptions in the quarter, 55% growth in new prescribers during FY2026, and sales territories increasing to about 130 from roughly 80 a year earlier.
• Positive Sentiment: FY2027 guidance calls for 44% revenue growth to $137 million, supported by deeper penetration in existing accounts, new account activation, higher in-network mix, and better revenue cycle management.
• Neutral Sentiment: The company emphasized clinical evidence and product innovation, including ACE-PAS recognition in a Heart Rhythm publication, a new enhanced detection algorithm now shipping to all patients, and an expanded product pipeline aimed at further differentiating ASSURE.

[Operator]

Good afternoon, and welcome to Kestra Medical Technologies' fourth quarter fiscal 2026 earnings conference call. This conference call is being recorded for replay purposes. We will be facilitating a question-and-answer session following prepared remarks from management. At this time, all participants are in a listen-only mode. I would now like to turn the call over to Neil Bhalodkar, Vice President of Investor Relations, for introductory comments.

[Speaker 1]

Thank you, Carmen. Good afternoon. Thank you for joining Kestra's fourth quarter fiscal 2026 earnings call. With me today are Brian Webster, President and Chief Executive Officer, and Vaseem Mahboob, Chief Financial Officer. This call includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Statements are made on this call that do not relate to matters of historical fact should be considered forward-looking statements. These statements are based on Kestra's current expectations, forecasts, and assumptions, which are subject to inherent uncertainties, risks, and assumptions that are difficult to predict. Actual outcomes and results could differ materially from any results, performance, or achievements expressed or implied by the forward-looking statements due to various factors. Please review Kestra's most recent filings with the SEC, particularly the risk factors described in our Form 10-K for additional information.

[Speaker 1]

Any forward-looking statements provided during this call, including projections of future performance, are based on management's expectations as of today. Kestra undertakes no obligation to update these statements except as required by applicable law. During today's call, we will also discuss non-GAAP financial measures. These non-GAAP financial measures are in addition to, and are not a substitute for or superior to measures of financial performance prepared in accordance with GAAP. Please refer to our earnings release for a reconciliation of these measures to their most directly comparable GAAP financial measures. With that, I will turn the call over to Brian.

[Speaker 2]

Thanks, Neil. Good afternoon, and thank you for joining us on today's conference call. We are excited to discuss the details of our strong performance in the fourth quarter and the significant progress Kestra made in fiscal 2026. As always, I'd like to begin the call by focusing on what truly differentiates Kestra. That is the lives we protect each day and the patients, families, and clinicians we serve. The reality of cardiac recovery is that risk doesn't always resolve when a patient leaves the hospital. For some patients, the journey to recovery is far more complex than anyone anticipates. Every patient is prescribed ASSURE with the hope that its protection will never be needed. Unfortunately, cardiac recovery doesn't always unfold that way. One patient recently reminded us of that in a very profound way.

[Speaker 2]

The patient was a 43-year-old woman recovering from a recent heart attack and living with advanced heart disease. Like many patients beginning recovery, she was prescribed ASSURE while her care team monitored her progress and evaluated long-term treatment options. 72 days after her initial prescription, the system detected a life-threatening arrhythmia and delivered life-saving therapy. For many patients, that would have marked the end of the event. For her, it was only the beginning. As she was rushed to the hospital, the arrhythmias didn't stop. Through ambulance transport, hospitalization, and every subsequent cardiac episode, ASSURE remained with her, delivering therapy each time it was needed. By the time physicians could provide stabilizing treatment, the system had delivered 12 successful therapies, protecting her through a prolonged and unpredictable period of instability. Every patient's recovery is different, and some emergencies are far more complex than anyone could predict.

[Speaker 2]

In this case, the patient required 12 separate interventions before she could be stabilized. That level of sustained protection isn't simply a feature. It reflects a deliberate design philosophy centered on supporting patients through even the most demanding clinical scenarios. This is just one patient's story. In fiscal 2026, our cardiac recovery system was used to protect 18,000 patients at risk of sudden cardiac arrest. We remain thankful and humbled by this responsibility entrusted to us by prescribers, their patients, and their families. Turning to our financial performance, we concluded fiscal 2026 with another strong quarter. We continue to reach more patients at risk of cardiac arrest, accepting over 6,300 prescriptions written for the ASSURE® system. Revenue was $28.6 million, with growth of 66% compared to the prior year period. For the year, Kestra generated $95 million of revenue, resulting in growth of 59% compared to FY 2025.

[Speaker 2]

Gross margin of 54.8% expanded by over 10 points year-over-year and 200 basis points sequentially, reflecting the attractive unit economics of our rental model. This was our 10th quarter in a row of sequential gross margin expansion. Our full-year gross margin of 51.4% increased by approximately 11 points compared to FY 2025. We remain confident that Kestra is on a path to 70%+ gross margins over the next few years. Although FY 2026 was a year of investment, with the strong revenue growth that Kestra is generating, we continue to see improving operating leverage in our business. This growing leverage supports the investments we are making in the company's key growth drivers to take advantage of the large and attractive market opportunity we see.

[Speaker 2]

The investments that we believe will drive significant near and long-term value for Kestra include expanding our commercial team, enhancing our revenue cycle management capabilities, growing our fleet of devices, innovating to extend our product advantages, and growing the body of clinical evidence supporting the ASSURE® system. One such example was the investment we made at the start of FY 2026 to meaningfully enhance our commercial training and onboarding capability. This has reduced how long it takes a new territory manager to reach a key sales ramp productivity milestone. This accelerated sales force productivity strengthens operating leverage and positions us to more effectively capture the significant growth opportunity in the WCD market. We continue to expand our sales organization with the goal of further penetrating existing accounts as well as calling on new potential ASSURE prescribers.

[Speaker 2]

As we had discussed previously, we are targeting geographies in which a high volume of WCD prescriptions are being written and where we also have strong in-network payer coverage. As planned, we ended FY 2026 with approximately 130 active sales territories, up from about 80 at the end of FY 2025. The impact of this is clear. Our commercial team is winning in the marketplace, with the number of new prescribers for ASSURE growing by 55% in FY 2026, while the number of ordering facilities grew by 65%. It's exciting to see that some of these new ASSURE customers are in fact new prescribers of WCDs as a category.

[Speaker 2]

Turning to the WCD market, we have previously noted that despite the overwhelming evidence that an external defibrillation shock is effective at terminating dangerous cardiac rhythms, WCD therapy remains underutilized, with six out of seven patients that are indicated for a WCD not being protected by one. We believe the innovation and clinical evidence we have brought to the category started to change this in FY 2026. Based on our financials and that of the incumbent, we estimate the WCD market grew in the low to mid-teens. We are still in the early innings of market expansion. We see this category growing into a multi-billion dollar market in the years ahead. I wanted to illustrate this last point with a few examples of strategies we are employing across various geographies.

[Speaker 2]

The first case study is a leading academic medical center in the Southwest that demonstrates how our commercial model drives sustained account expansion. When Kestra entered the institution in March 2025, it had never prescribed the ASSURE system. 15 months later, utilization has grown to more than 60 prescriptions, with 40 unique prescribers activated across multiple specialties. That growth has been driven not only by commercial execution, but by repeated clinical validation in our service delivery model. A recent example of this institution highlights that dynamic. A patient experienced ventricular fibrillation while wearing ASSURE. The system delivered a life-saving therapy, and our proprietary ASSURE Assist feature alerted emergency medical services even before the patient's spouse completed a 911 call. Within minutes, the treating physician had been notified, enabling rapid coordination of care as the patient was airlifted for advanced treatment.

[Speaker 2]

The event reinforced the value of the entire ASSURE platform, not just the therapy, but the speed of emergency response, clinical communication, and continuity of care. That experience translated directly into broader physician adoption. Within one week, four additional ASSURE systems were ordered by physicians who had never previously prescribed our platform. Adoption in this system has since expanded beyond the initial heart failure service line, with electrophysiologists beginning to prescribe ASSURE after observing its clinical performance, patient experience, and integrated support. This account reflects a pattern we're seeing repeat across the country. While clinical outcomes accelerate adoption within an institution, physician education creates robust prescribing networks that continue to expand long after the initial engagement. The second case study is a territory in the Midwest that illustrates the long-term impact of that strategy. When the Kestra territory was established, the hospital had previously generated about 20 WCD prescriptions annually.

[Speaker 2]

Through focused engagement with the heart failure program, fellow education, and ongoing clinical support, utilization more than doubled to 50 prescriptions during FY 2026. Growth accelerated through a combination of physician champions and clinical education, expanding ASSURE adoption among both existing and new prescribers. A key driver was the team's investment in fellowship education. Six of the program's eight fellows became active ASSURE prescribers during training. As those physicians entered independent practice, they carried that experience with them, prescribing ASSURE at other hospitals. Rather than expanding a single account, our team is building a growing network of experienced ASSURE prescribers that continue to drive adoption beyond the original institution. Our strategy also extends to enterprise health systems, where we're working to integrate ASSURE directly into standardized care pathways.

[Speaker 2]

The third case study is one of the nation's largest independent cardiovascular organizations in the southeast that is working with our team to integrate ASSURE into standardized heart failure care pathways across its physician network. Working alongside physician leadership, advanced practice providers, and clinical operations teams, we're embedding ASSURE into workflows that support patients from hospital discharge through outpatient recovery. This collaboration began shortly after presentation of the ASSURE post-approval study data at AHA last November. Since that time, prescribing within the organization has increased by approximately 40%, reflecting growing adoption supported by both clinical evidence and operational integration. Today, that organization includes approximately 120 cardiovascular providers, creating an opportunity to expand this care pathway model across multiple affiliated practices and regional markets. This represents another important driver of sustainable long-term growth as we partner to embed ASSURE into standardized clinical workflows.

[Speaker 2]

These examples demonstrate how clinical evidence, physician education, and enterprise partnerships are working together to accelerate market adoption. Turning to clinical evidence. On prior earnings calls, we discussed the results of our ACE-PAS, the largest real-world prospective WCD study to date, with over 21,000 patients enrolled and protected. The study's findings corroborated what patients experience every day with the ASSURE system. Low false alarm rates, comfort that drives higher wear time compliance, and 100% successful conversion of dangerous arrhythmias. I'm pleased to highlight a newly published paper focused on the future of sudden cardiac death prevention that cites the ACE-PAS study as contemporary evidence demonstrating persistent ventricular arrhythmia risk among patients with ischemic and non-ischemic cardiomyopathy. The paper was published in the journal Heart Rhythm, which is a Heart Rhythm Society publication, specifically highlights observed ventricular arrhythmia event rates.

[Speaker 2]

The HRS recommendations state that clinicians should consider WCD use after myocardial infarction or a new heart failure diagnosis while guideline-directed medical therapy is being optimized and better risk stratification tools are being developed. The paper further identifies WCDs as potential strategy to reduce sudden cardiac death in patients not yet eligible for an ICD. From a strategic perspective, this is a meaningful endorsement. The paper was developed through an HRS-led think tank that included many of the field's leading experts. The inclusion of ACE-PAS demonstrates that our data is being incorporated into the broader scientific dialogue around risk stratification, sudden death prevention, and the role of temporary protection for high-risk patients, areas that may ultimately influence guideline development.

[Speaker 2]

Regarding our clinical evidence strategy, we plan to publish multiple abstracts and manuscripts over the next 12 months, highlighting compelling data from ACE-PAS, our new enhanced algorithm, and new innovation in our pipeline. We believe this growing body of evidence will support increased share capture and expanded WCD adoption. On the product development front, we continue to pursue innovation that benefits patients and clinicians. In mid-January, we announced a strategic collaboration with Biobeat Technologies to expand diagnostic insight for hypertensive patients prescribed the ASSURE WCD. That co-development project is progressing as planned. In April, we released an enhanced ASSURE detection algorithm, which we project will further reduce our already low false alarm rate. This new algorithm is now shipping to all patients.

[Speaker 2]

Our team has some other exciting projects in progress intended to further extend our clinical advantage with the performance of the ASSURE system and also bring new first-in-category capabilities to the market. Over time, we believe this will help us accelerate market growth and win additional market share by further differentiating our product from the incumbent. More importantly, by providing additional clinical value and diagnostic insights to physicians, we believe it will result in them prescribing WCDs to more of their patients that heretofore had gone unprotected. In conclusion, the fundamentals of the Kestra story and business remain strong. The clinical evidence of the ASSURE system is compelling. We like our competitive product position in an expanding WCD market. Kestra is delivering premium revenue growth while significantly expanding gross margin, and we have fortified our balance sheet to facilitate investment in that growth.

[Speaker 2]

Our execution has been crisp across all elements of the business, the foundation we have built positions Kestra for strong and durable growth for years to come. I'd like to thank our incredible team in the field and also here at the home office in Kirkland for their passion and commitment to the Kestra mission. Now I'll turn it over to Vaseem, who will discuss fourth quarter financial results in more detail and provide our fiscal year 2027 revenue guidance. Vaseem?

[Speaker 3]

Thank you, Brian, good afternoon, everyone. We had a strong financial performance across the board in the fourth quarter. Total revenue was $28.6 million, an increase of 66% compared to the prior year period. Revenue growth was driven by a 63% year-over-year increase in prescriptions, reflecting market share gains with existing customers, activation of new accounts, and expansion of our field team. We are also continuing to see improvements in all three key drivers of our revenue model, our prescription bill rate, our bill rate, and our collections performance. As we continue to bring more payers in-network and enhance our revenue cycle management capabilities, we expect to see benefits in revenue growth, gross margin, and our profitability profile. We are investing in revenue cycle AI tools and other automation projects that will drive operating leverage as we scale the business.

[Speaker 3]

Turning to gross margin, our margins increased to 54.8% in the fourth quarter versus 44.3% in the prior year period. As Brian mentioned, we have now expanded our gross margin sequentially 10 quarters in a row. This continued expansion in gross margin was driven by the attractive unit economics inherent in Kestra's business model, an increase in our revenue per fit from more in-network patients, and a decline in our cost per fit driven by volume leverage and cost improvement projects. In the quarters ahead, you should expect to see steady and consistent increases in our gross margin as our rental model benefits from the volume leverage. We remain confident in our ability to achieve 70% plus gross margins in the next few years. GAAP operating expenses were $55 million in the fourth quarter, compared to $55.8 million in the prior year period.

[Speaker 3]

Excluding non-recurring costs and stock-based compensation, operating expenses were $44.7 million in the fourth quarter of fiscal year 2026, compared to $29.7 million in the prior year period. The increase was primarily attributable to investments in our commercial organization, including support resources and revenue cycle management capabilities to capitalize on the large and expanding WCD market opportunity. GAAP net loss was $38.8 million in the fourth quarter, compared to a GAAP net loss of $51.1 million in the prior year period. Adjusted EBITDA loss was $26.7 million in the fourth quarter, compared to an adjusted EBITDA loss of $20.3 million in the prior year period. Cash, cash equivalents, and investments totaled $262 million as of April 30. It is important to highlight that our operating cash burn in the fourth quarter declined on a year-over-year basis.

[Speaker 3]

Specifically, net cash use in operating activities was $18.7 million, a reduction from $24.1 million in the prior year period. We expect this trend to continue each year going forward. This afternoon, we also issued a press release about our new $200 million term loan facility that we have entered into with Pharmakon. This non-dilutive financing was a great outcome for Kestra. It fortifies our balance sheet, reduces our cost of capital, and provides the significant financial flexibility to invest in our commercial strategies and expand our fleet to drive durable, best-in-class growth for years to come. Only $75 million of the facility has been funded at closing, a large portion of which was used to retire our existing term loan. Including unused availability under the new term loan agreement and excluding the uncommitted M&A tranche, Kestra has a total liquidity of approximately $357 million.

[Speaker 3]

In summary, 2026 was a foundational year for Kestra. We delivered top-tier revenue growth, significant expansion in our gross margin, and fortified our balance sheet with a follow-on offering in December and today's non-dilutive financing. Our investments in the field team and RCM capabilities position Kestra to drive durable revenue growth with meaningful operating leverage for years to come. I will now go over our fiscal year 2027 guidance. We expect revenue of $137 million, an increase of 44% compared to fiscal year 2026. We expect prescription growth to be driven by deeper penetration within existing accounts and the activation of new accounts as we invest in regional coverage. We expect higher revenue per fit to be driven by a higher mix of in-network patients and continued improvements in our revenue cycle management capabilities.

[Speaker 3]

We expect Kestra to generate significant operating leverage over the next several years, even as we continue to invest in our business to capitalize on the large, growing, and under-penetrated WCD market opportunity. With that, operator, we have concluded our prepared remarks and are ready to proceed to the Q&A portion of the call.

[Operator]

Thank you so much. To ask a question, please press star one one on your telephone and wait for your name to be announced. To remove yourself, press star one one again. We ask that you please keep your questions to one and one related follow-up. One moment for our first question, please. It comes from Marie Thibault with BTIG. Please proceed.

[Speaker 4]

Hi. Good afternoon. Thanks for taking the questions, and congrats on a really strong finish to the fiscal year. Apologies in advance if there's any background noise. I'm in an airport. I wanted to start here by asking for a little more detail, Vaseem, on sort of what the assumptions are behind the fiscal year 2027 guidance. Certainly, your prescription growth has been tremendous. Sounds like you're seeing a lot of nice momentum following ACE-PAS. The conversion rate has continued to move higher with all the revenue cycle management improvements. If there's any details you can give us on how you're thinking about that $137 million, the assumptions behind it, that would be very helpful.

[Speaker 3]

Sure, Marie. Thank you for the question. Our revenue growth has historically been driven by prescription and volume growth, in-network mix, revenue cycle management improvements, and quite frankly, the growth of our field team. These KPIs are all tracking in the right direction and give us confidence in guiding to 44% growth in fiscal year 2027. Higher prescriptions will be driven by winning new accounts, going deeper in existing accounts, and quite frankly, as Brian mentioned, expanding the market. We expect to continue the in-network mix to be in the low mid-eighties as we continue to make progress on the payer side, and also the significant improvements that we'll make and have made on the revenue cycle management process. We are starting the fiscal year with 137 sales territories, which is up 80 from the start of fiscal year 2026.

[Speaker 3]

We're really confident in the guide that we are putting out, and we'll continue to give you updates as we go through the year.

[Speaker 4]

Okay. That's very helpful. I guess as a follow-up question here, certainly encouraging to see the Heart Rhythm publication, the recognition of ACE-PAS. What are your latest thoughts on guideline recommendations, stronger support from societies? Is that something we could start to see more of this fiscal year? Thanks for the question.

[Speaker 2]

Yeah. Thanks, Marie. This is Brian. I think it's going to be a journey. The papers like this are the start of that journey. We'll be publishing our manuscript for ACE-PAS soon. That'll be the next milestone, and then we'll continue to work with our clinical advisors to get on the docket for this conversation about guidelines. I do think that what's also meaningful about that recent paper is the insight they had into not just the typical WCD patient who's a post-MI patient, but also the heart failure patient population. Really good news in that, and really good news in that that was a parallel activity that a body of really high-caliber physicians took on to step back away from the evidence and look and say, "Hey, what should we be doing to improve sudden cardiac death rates?" I think that's really positive for us.

[Operator]

One moment for our next question. It comes from Travis Steed with Bank of America Securities. Please proceed.

[Speaker 5]

Hey, thanks for the question, and congrats on a good quarter. I guess maybe I'd ask a question about just kind of the share gains that you've been getting. I think you're taking about four points a share in the market over the last year. Is that kind of the steady state that we should think about going forward, or are there ways you can accelerate the share gain capture in 2027 as you expand territories and build up coverage?

[Speaker 2]

Yeah, thanks for the question, Travis. I think that the share gain we saw in 2026, it doesn't fully get the benefit of a lot of the hiring we did in 2026. I would expect that we'll see even more share gain, in particular in those territories where we were not in before adding new reps. As those reps come up the curve, I think we'll see that share gain start to grow. Now, of course, the other good news is it's not just about share capture, it's about market growth. We're seeing pretty exciting market growth occurring, and we'll continue to push for that as we do our market development of the WCD category.

[Speaker 5]

Okay. That's helpful. I did want to follow up on the financing. Why raise money, either the equity offering last year? Why more money now, why the structure of this? Still a little unique with different tranches available, and one of the tranches mentioned availability for acquisitions. Is this a sign that potentially you're going to be a little more acquisitive going forward?

[Speaker 3]

Yeah. Let me start, Travis, and maybe Brian can also provide some color. When we started the refinancing conversation, it was purely to go out and seek lower cost of capital. If you remember that the term loan that we had in Perceptive was three years ago when we were a private company. Quite frankly, what we were able to achieve in our cost of capital was a 24% reduction from what we were paying Perceptive. That was the impetus for going out and looking into the market. As we went through that conversation, we decided that we should have and retain the financial flexibility that continues to allow us to invest in our business and gives us the optionality to do different things. I'd say we didn't need more cash.

[Speaker 3]

Like I said, we finished the quarter at $262 million of cash on the balance sheet. This was just purely being opportunistic, working with a great partner now, and having the flexibility to do buy or be type tuck-in deals to do more M&A. That's really from a structure and a deal perspective. Brian, I don't know if you want to comment on that.

[Speaker 2]

Yeah, I would just add that the M&A tranche is a prospective one. There's not something right in front of us there, we do continue to be very interested. We're building a first-class direct-to-cardiology sales force, we want to take advantage of that channel. If there's new technologies that we can bring to the table that can be additive for our clinical partners then we're going to be very interested in that. I think the other thing it should demonstrate is we're pretty bullish on our story. We want to make sure we've got financial flexibility to be able to invest in the assets to continue to grow the market. With the market growth showing the way it is, we're leaning in to the Kestra story and the WCD category. This just provides us a little bit more financial flexibility as we look forward.

[Speaker 5]

Great. Makes sense. Thanks a lot.

[Operator]

Thank you.

[Speaker 3]

Thank you.

[Operator]

Our next question is from Matthew O'Brien with Piper Sandler. Please proceed.

[Speaker 6]

Afternoon. Thanks for taking the questions. Maybe to follow up a little bit on Travis and Marie's question on guidance. When I do the math on the growth rate in the market that you guys are accelerating, plus your share taking, which, Travis is right, it's 400 basis points last year, but if it's up to 500 this year, whatever it may be, I'm getting script numbers that are at least 10% and more like 12%-13% higher than where you're guiding, roughly. What is it that we're missing, especially with all these new reps, and all this momentum that you're seeing that would put the guide into the $137 range versus something higher? Is there something competitively, something else just in terms of adding all these reps at once, something else like that we should really be considering? Then I do have a follow-up.

[Speaker 2]

Well, I would say very clearly that there's not a competitive dynamic to that's driving that. I think it's us just being a rational management team. It's the start of the year. We want to make sure that as we get the year kicked off and we do absorb a lot of these new sales reps, that we set ourselves up for success. I think 44% growth as an initial guide is pretty darn fantastic. We're excited about the year ahead.

[Speaker 6]

Fair enough, Brian. 44% is great. Vaseem, on the profitability side, I know you said the operating cash burn came down by about $5 and a half million year-over-year, the revenue number was up about $11 million. When I look at the SG&A per new script, it's the highest amount of SG&A per script that we've seen in several quarters. How do we think about the profitability on the EBITDA side trending or maybe even on the operating cash burn trending throughout fiscal 2027? From a revenue perspective, it seems like you're about a year ahead. From a profitability perspective, you seem like you're on track or maybe a little bit behind. You think this is a year we see a bigger catch-up as far as profitability goes? Thanks so much.

[Speaker 3]

That's a great question, Matt. I think, fiscal year 2026 was a foundational year as we have talked about from an investment perspective, right? We hired the 130 TN goal. We got there sooner. We invested in regional leadership with commercial support resources like clinical specialists to really help form those accounts and see the prescription trend that you saw. Our prescriptions grew 17% in the fourth quarter, 1,000 higher than the previous quarter, and quite frankly, it even beat our own internal expectation in the fourth quarter. We have invested in our Revenue Cycle Management capability. This really positions us to drive durable growth in fiscal year 2027 and beyond. Having said that, even this level of investment, our operating cash burn declined by $5 million. You should look at that, right? Our operating burn was down $5 million.

[Speaker 3]

We'll continue to invest in 2027, but maybe not at the same pace in 2026. Really, you should start to see some good operating leverage in 2027 and 2028, as we continue to drive the top line higher based on the investments that we made in 2026.

[Operator]

One moment for our next question. It's from Rick Wise with Stifel. Please proceed.

[Speaker 7]

Good afternoon. I'll add my congratulations on the excellent finish to the year, Brian. I thought maybe you could expand on your comments a little bit about your sales territory goals. Obviously, 130 to finish the year up from 80, that's a big expansion, and you've always been very clear about the metrics that you want to see related to reimbursement, et cetera. How many more ideal or optimal opportunities are there? Do we see similar expansion in numbers for the year ahead? Is that the right way to think about it?

[Speaker 2]

Yeah, Rick, thank you for the question. I think that as we're sitting here today looking at FY 2027, we're probably thinking that we'll add another 40 or so reps in the fiscal year. Maybe a little bit slower than FY 2026, but not a lot more. We still have uncovered territories in the U.S., and even more importantly, we have territories where we have a rep who's assigned to certain accounts, but that rep might have 15 or 18 accounts and we need to go deeper and split some of those territories. We will be adding additional horsepower here in a pretty balanced way throughout the year. I don't think we're going to front-load it because we're still kind of absorbing the big income adds that we added at the back half of FY 2026. It'll be another year of expanding the commercial footprint.

[Speaker 2]

With that, not only territory managers, but also clinical account specialists.

[Speaker 7]

Got you. I wanted to touch on both some of your innovation commentary and the competitive dynamics. Obviously, you're taking share, obviously, you're growing faster than the market. I was hoping you would update us on just whatever your incremental thinking perspectives are on the competitive dynamics generally, but how innovation is tying into those dynamics. The shipping of the new algorithm clearly differentiates your product from the competitors. Maybe talk about how that manifests itself in the P&L in terms of volume or margin. Are there any implications beyond just that broad statement about differentiation, which is meaningful, obviously? Thank you.

[Speaker 2]

Yeah. Thank you for that question as well. I love talking about innovation. They won't always let me talk about innovation, but I love to talk about it. I think our goal with the new algorithm update was to just really make that algorithm bulletproof and give us that just really clear differentiation of the market. We've accomplished that. That product is now every product is going out with the new algorithm. We continue to invest in new innovation that you will see over the next 12 months. We're excited about that. On the other hand, the question always comes, well, what is your competitor doing when it comes to answering that? We feel like the competitor has shown their cards. They've launched a product last year that they are starting to roll out. Remember, in this business, it's a fleet, right?

[Speaker 2]

You don't have the opportunity to replace your entire fleet all at the same time. They will be rolling out their new product that we view as being incremental and not transformative. We view that they will be rolling that out over the next 3 to 5 years, 3 at the most aggressive, more likely 5 years. We kind of know what we're playing against. We love our positioning from a product competitiveness. We love the pipeline that we have. We're really excited about where we're going with future innovation at Kestra.

[Speaker 7]

Thank you very much.

[Operator]

Thank you. Our next question comes from the line of Michael Polark with Wolfe Research. Please proceed.

[Speaker 8]

Hey, good afternoon. Thank you for taking the questions. I have a question on your primary competitor. There was news of a warning letter that that firm received public in June, dated late April. I don't see any specific mentions related to the wearable defibrillator product, but there were focus items on the AEDs, electrode components, and other similar inputs. My question for you, Brian and Vaseem is there something going on here with your competitor that might strengthen your position, or do you view that letter as primarily noise as it relates to your business?

[Speaker 2]

Yeah. Mike, thanks for the question. I think anytime that there's regulatory actions in the industry, you would be wise to pay attention, and we're certainly paying attention. My understanding of that particular situation is it was directed at a different part of their business. Having said that, most med tech companies try and standardize their quality systems across divisions. I'm sure that our competitor is evaluating, even in their LifeVest business, evaluating their quality system to make sure that, let's say, that contagion doesn't spread. I'm sure they're looking at that, but my understanding right now is that was not directed at that particular division. It was directed at their AED and ventilator business.

[Speaker 8]

Very helpful. Maybe for the follow-up, a short-term modeling question, perhaps for Vaseem, just the current July quarter, it's almost the end of July, so you're about to finish the first quarter. Should we take the full year revenue growth vision 44% and just have that as the year-on-year growth rate throughout the 4 quarters or should we consider something different about phasing? Can you help level set models for the current July quarter? Thank you.

[Speaker 3]

Sure. Yeah, obviously, we can't comment on the first quarter, Mike. Nice try. I think, based on our guidance, the 44% reflects the total year. Same thing as we said last year, if you remember, we were hiring reps and as you know, there's a 6-month ramp period for those reps, so you should start to see some accelerating growth, from the first half to the second half. As Brian said, we brought in those 130 PMs sooner, and they're all in the journey of their ramp-up, and we should start to see some really exciting growth here in the second half versus the first half. Regardless, we feel really optimistic and comfortable with the guide that we have provided out there.

[Speaker 3]

As Brian said, our credibility is our biggest asset, and we continue to have a repeat of fiscal year 2026 and 2027.

[Speaker 8]

Thank you.

[Operator]

One moment for our next question. It comes from Larry Biegelsen with Wells Fargo. Please proceed.

[Speaker 9]

Good afternoon. Thanks for taking the question and congrats on the strong finish here. Vaseem, maybe just two modeling questions for me. One, on gross margin. I think it was up 1,100 basis points year-over-year in 2026. Any color on the cadence to expect for 2027? The conversion rate, it looks like it was relatively flat year-over-year in fiscal 2026. Why is that, and how do we think about that going forward?

[Speaker 3]

Sure. Larry, on the conversion rate, as we have said in the past, we will continue to see acceleration on an annual basis. We finished the year, about 46%, which was up actually, slightly over two points, compared to fiscal year 2025 to 2026. We did well on our conversion rate journey. We continue to see all of our KPIs, the fill rate, our in-network mix, our collections performance, they're all trending in the right direction. Quite frankly, in the fourth quarter, the conversion rate was slightly lower, but that was because of the massive prescription intake that we had. Our prescriptions were up 17%, as I mentioned earlier, and a lot of that came in month three. As you guys know, that month three will translate into revenue here in the first quarter. We feel really good about that.

[Speaker 3]

On the gross margin, again, we are really, really excited about our gross margin trending. As I said, 10 quarters in a row of gross margin expansion, we continue to expect to see that gross margin progression through the year, and that's really a testament to the model as we have now demonstrated multiple quarters in a row. You should expect to see sequential improvement on our gross margins all through this year. We think that for the full year, it's going to be in the 700 basis point range increase year-over-year.

[Speaker 9]

That's helpful. If I could, Brian, I just want to ask one on the revenue growth. We've seen an acceleration, I think now four quarters in a row. Could you put a finer point on what you think is really driving the acceleration? If there's a couple things you would point to? Thanks.

[Speaker 2]

Thanks, Larry. Appreciate the question. I think it's a combination, as we have said, that we have a higher mix of in-network patients because of our insurance contracting success, that leads to higher revenue per fit. We have more sales territories opening up, that's just salesforce math. I think we have, as we've gotten experience with some of our existing sales territories, you put really great clinical data into the field, that just gives them the ability to further penetrate those accounts. We're seeing nice account penetration and expanding the existing accounts. It's a combination of all three of those things. The top tier in our vernacular last year was platinum sales territories, we continue to have people moving up into the platinum sales territories as they drive significant volume.

[Speaker 9]

Thank you very much.

[Speaker 2]

Okay.

[Operator]

Thank you. Our last question comes from David Roman with Goldman Sachs. Please proceed.

[Speaker 10]

Thank you. Good afternoon, everyone. I want to just follow on some of the commercial comments that were made earlier in the call. I think, Brian, in response to one of the questions, you talked about building out a general cardiology sales force. Can you maybe talk about just at which customer the sales force expansion has targeted cardiologists versus EP, and where you see the opportunity? Is it in the upstream referral channel? Is it in market share capture on downstream prescribing? I had one follow-up.

[Speaker 2]

Sure. Thanks, David. Appreciate the question. Yeah. When I say we're building a direct to cardiology, I'm using that in a fairly general term because in reality, our reps are calling on EPs. An EP generally will not do a lot of the writing of the prescriptions, but they will sort of give us a license to hunt in terms of the technology. Our reps end up spending a lot of their time all the way back into the cath lab as the patient is revascularized and moving up to general cardiology and also heart failure. When we're looking at reps that we're putting in the field, we're not just going after those reps who have one specialty and relationships there. We're really looking across the whole board when it comes to the cardiology suite.

[Speaker 10]

Okay. Maybe just a related follow-up on the commercial side. You talked about having territories that aren't covered at this point in time. Can you give us any framework to think about what % of relevant territories you have covered? Is the right way to look at it as prevalence of heart failure patients by territory or some other metric to help us think about what you have covered today versus where the remaining gaps are and how long it takes for you to get to whatever your definition is of full coverage?

[Speaker 2]

Yeah. When we talk about full coverage, what we're talking about is what % of the WCD prescribing universe, if you will, does a Kestra rep have assigned to them. You might have, as an example, you might have a rep who's in. You put your first rep in the city of Chicago. Well, in the city of Chicago, that one rep might have 20 accounts, which they can't possibly service. Although we count that as coverage, we've got a rep in Chicago, so they're covered. When we're talking about coverage, we think that with the 130 that we landed on at the end of the year, we think that gets us somewhere around 70% of that geographic coverage.

[Speaker 2]

Don't mistake that for full penetration coverage, where in that Chicago example, we might end up with five or six reps as we get to a more manageable level of accounts. I think it's reasonable to think that over the next two years, we probably would get to a pretty good level of what we would call full coverage in the market. We'll pace that according to how well we're doing when it comes to ramping up reps and how well we continue to progress against our plans.

[Speaker 10]

Great. Thanks for taking the questions.

[Speaker 2]

You bet. Thanks, David.

[Operator]

This will conclude our Q&A session, and I will pass it back to Brian Webster for closing comments.

[Speaker 2]

Thank you very much. Thanks again, everybody, for joining us. Again, very proud to announce our results today. FY 2026 was indeed a year of investment for Kestra. We think FY 2027 affords us new opportunities for investment as we see the opportunity to win. We see the market growing. We've got a really great product, and most importantly, we've got a team of incredibly committed people. We couldn't be more excited about the future of the category and the future of Kestra, and we're looking forward to a really strong FY 2027. Thank you all for joining the call today.

[Operator]

This concludes our conference. Thank you for participating, and you may now disconnect.