electroCore NASDAQ: ECOR executives highlighted record quarterly revenue, expanding margins, and continued progress toward profitability during the company’s first-quarter 2026 earnings call, while also discussing a leadership transition and commercial priorities across federal and consumer channels.
Leadership transition and operating focus
Dr. Thomas J. Errico, the company’s founder and independent chairman, said the first-quarter call was the first since electroCore announced a leadership transition. Errico said Interim President and Chief Financial Officer Joshua Lev has provided “steady, disciplined leadership” and that “the strategy has not changed” and “the execution has not slowed.”
Errico also noted that Michael Fox joined as chief operating officer on April 13, bringing more than 35 years of commercial experience, including work with federal systems and the U.S. Department of Veterans Affairs. Errico said Fox’s experience has already provided insights to strengthen execution, “particularly as we continue to expand our presence within complex government channels.”
Fox told investors he joined electroCore because he saw a “science-based platform technology with proven published clinical outcomes data” and said his initial conviction has strengthened after reviewing company data and meeting employees. He outlined three priorities: deeper penetration in the VA and Department of Defense markets, broader federal channel expansion beyond the VA, and operating discipline to ensure incremental revenue drives incremental profit.
Q1 results: record revenue, higher gross margin, and improved adjusted EBITDA loss
Lev said electroCore delivered its “highest revenue quarter ever,” reporting revenue of $9.6 million, up 43% year-over-year. Gross margin expanded to 87%, and the company posted a GAAP net loss of $5.3 million. Lev said adjusted EBITDA loss improved 24% to $2.3 million, calling the combination of accelerating revenue, expanding margin, and improving adjusted EBITDA loss “the clearest signal yet that we are executing on our strategy.”
Lev said 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, including approximately $1.9 million of “non-recurring leadership transition costs” and $300,000 of legal expense tied to ongoing intellectual property litigation. Other expense of $276,000 included interest associated with a convertible term debt financing with Avenue Venture Opportunities Fund.
Cash, cash equivalents, and marketable securities were approximately $8.8 million as of March 31, 2026, down from $11.6 million at December 31, 2025. Lev noted the first quarter is “historically our highest cash burn quarter,” and said some working capital timing items, including inventory timing and capital improvements at the Rockaway facility, “may extend a portion of that burn into the second quarter.” He said the company remains focused on operating efficiencies and is evaluating available capital resources, including its existing shelf registration and at-the-market facility.
VA prescription business: growth and deeper penetration strategy
Lev said the VA hospital system remains electroCore’s largest customer, with prescription device revenue increasing 48% year-over-year to $7.9 million. Within that category, prescription gammaCore grew 26%, while Quell sales surpassed their first million-dollar quarter. Lev said that since electroCore acquired the Quell assets from NeuroMetrix in May 2025, Quell Fibromyalgia generated $2.5 million in cumulative revenue, and the company remains in the “early stages” of placing the product across the VA system.
As of March 31, Lev said approximately 15,000 VA patients have received a gammaCore device, which the company estimates represents about 2.5% penetration of the addressable VA headache market. Lev cited published and government data points he said support a long runway for adoption inside the VA, including migraine prevalence among veterans and Department of Defense reporting of traumatic brain injury diagnoses since 2000.
Fox emphasized a shift from “facility breadth to facility depth,” describing a goal of more prescribers per site, more patients per prescriber, and a more consistent customer experience. In response to an analyst question about sales force structure, Fox said he supports both 1099 and W-2 models and framed the near-term opportunity as internal alignment and accountability rather than a major structural change. Asked about penetration targets across VA medical centers, Fox said he did not provide an exact number but said the company needs “consistent utilization” in “at least 75%” of facilities on a monthly basis.
Fox also discussed Department of Defense opportunities, pointing to major facilities such as Walter Reed, SAMMC, Portsmouth Naval, and Balboa as potential focus areas. Lev and Fox described the DoD channel as distinct from the VA, including the TRICARE component, and Fox said the company is early in evaluating where to start, with an initial focus on key opinion leaders in headache and migraine.
Consumer wellness and performance products: Truvaga efficiency gains and TAC-STIM pipeline
On the consumer wellness side, Lev said revenue reached $1.6 million, up 44% year-over-year, with Truvaga contributing $1.5 million, up 38% from the prior year quarter. Lev said the company “deliberately tempered top line growth in favor of efficiency,” with return on advertising spend (ROAS) of approximately 2.37, a 14% improvement from the prior quarter. He said the improvement was driven by a “concentrated shift toward affiliate and influencer partnerships,” and added that return rates remained in the 12% to 15% range.
During Q&A, Lev said the ROAS improvement was primarily a reallocation of resources rather than a pullback in existing channels, and cited influencer and affiliate efforts, including what he described as a co-marketing opportunity following a social media post from Miranda Kerr. When asked about repeat purchase behavior, Lev said, “Not yet,” and added that the company has not provided formal guidance on that metric.
For TAC-STIM, electroCore’s human performance product, Lev said revenue has historically been variable but described the “underlying demand environment” as robust. He said TAC-STIM is undergoing research and evaluation across U.S. Air Force Special Operations Command, U.S. Army Special Operations Command, and the Air Force Research Laboratory, and noted it was previously selected by AFRL for inclusion in the Assessing and Augmenting Cognitive Performance in Extreme Environments program. Lev said the company sees an opportunity to make TAC-STIM a more consistent revenue contributor as Fox deepens federal engagement.
Guidance and 2026 catalysts: platform expansion, new channels, and profitability trajectory
Lev reaffirmed full-year 2026 revenue guidance of approximately 30% growth. In response to a question about why the company was not raising guidance after 43% first-quarter growth, Lev said the guidance reflects the company’s current model and that Fox has only been in the role since mid-April, making it premature to assume the timing and resource requirements for additional acceleration.
Lev outlined several catalysts for 2026, including expanding evidence for non-invasive vagus nerve stimulation (NVNS), product and feature development, and new commercial channels. He referenced a publication in Frontiers in Neuroscience involving a post-hoc analysis on adjunctive NVNS for chronic mild traumatic brain injury with comorbid PTSD. He also said approximately 20 participants have enrolled in a clinical study conducted by Acacia Clinics in collaboration with the Vagus Nerve Society evaluating gammaCore as an adjunctive treatment for PTSD symptoms. During Q&A, management said the Frontiers analysis and the Acacia study are “slightly different” protocols but both aim to capture effects of NVNS in PTSD populations. Executives also said they are aggregating data to support discussions with the FDA regarding a potential formal PTSD label, noting the company has a breakthrough device designation for PTSD.
On product development, Lev said work is underway on a next-generation Truvaga and Quell mobile platform, including an application intended to complement consumer products and potentially enable recurring revenue and deeper engagement over time.
Commercially, Lev and Fox discussed efforts to expand beyond the VA into areas including Kaiser, federal workers’ compensation programs, TRICARE, and broader DoD adoption. Regarding Quell, Lev said the company expects to relaunch the over-the-counter Quell Relief product for lower extremity pain later in 2026, describing a plan to proceed “slow” and “deliberate” while addressing concerns tied to NeuroMetrix’s earlier Federal Trade Commission issue. Lev also noted electroCore launched Truvaga in the U.K. in January 2026 as a “soft launch” without active media spending, and said the company is assessing uptake and broader international opportunity.
While Lev said electroCore is not yet ready to provide a specific quarter for breakeven, he described the direction as clear, citing “mid-80s gross margin, accelerating top line, [and an] increasingly disciplined cost base” as supporting the company’s stated path to profitability.
About electroCore NASDAQ: ECOR
electroCore, Inc is a commercial-stage bioelectronic medicine company headquartered in Rockaway, New Jersey. The company specializes in the development and commercialization of non-invasive vagus nerve stimulation (nVNS) therapies designed to address a variety of neurological and inflammatory conditions. Established in 2006, electroCore has focused its efforts on translating neuromodulation science into a compact, patient-administered treatment device.
The company's lead product, gammaCore®, is a handheld, battery-powered device that delivers nVNS through the skin to the cervical branch of the vagus nerve.
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