Heron Therapeutics Q1 Earnings Call Highlights

Key Points

• Heron reaffirmed its full-year 2026 outlook despite a weak first quarter, with net product sales of $34.7 million and adjusted EBITDA of negative $727,000. Management said seasonal issues, winter weather, and temporary supplier-related margin pressure were the main drags, and expects conditions to improve through the year.
• Acute care products drove growth, with the portfolio up 32% year over year. ZYNRELEF and APONVIE both posted strong demand gains, helped by improving reimbursement dynamics, expanded account coverage, and the rollout of Heron’s Ignite incentive program.
• CINVANTI held up in a competitive market, maintaining a 25% exit share in the NK1 category while Heron works to expand hospital access through its REIGNITE program. The company also said new account wins could add more than $10 million in annualized net revenue.

Heron Therapeutics NASDAQ: HRTX said first-quarter 2026 results were pressured by seasonal factors and severe winter weather, but management reaffirmed its full-year outlook and pointed to improving momentum exiting the quarter.

Chief Executive Officer Craig Collard said the company entered 2026 with “tremendous momentum” following a strong fourth quarter, but January was affected by co-pay resets, insurance adjustments and two weeks of severe weather that disrupted elective surgeries. Collard described January as “our most difficult month since I joined the company,” while emphasizing that March net sales exceeded $15 million.

“The breadth of this industry-wide impact validates that the headwinds we faced were external and temporary in nature, not reflective of any underlying weakness in our business or markets,” Collard said. He added that Heron expects deferred elective procedures to be rescheduled through the remainder of 2026.

Revenue Falls Below Plan, Guidance Reaffirmed

Chief Financial Officer Ira Duarte said first-quarter net revenue was $34.7 million, modestly below plan. Gross margin was 69%, below Heron’s typical low- to mid-70% range, which Duarte attributed to temporary costs tied to a secondary supplier for CINVANTI.

Duarte said the secondary supplier manufactures smaller batches at roughly three times the cost per batch of Heron’s primary supplier. That inventory is expected to work through the system over the next two quarters, after which Heron expects to return exclusively to its primary supplier and for gross margins to normalize back to the mid-70% range.

Adjusted EBITDA was negative $727,000 in the quarter. Duarte said the result reflected storm-related revenue softness and temporary gross margin pressure, both of which management views as temporary.

Heron reaffirmed its 2026 guidance for net product sales of $173 million to $183 million and adjusted EBITDA of $10 million to $20 million.

Acute Care Portfolio Posts Year-Over-Year Growth

Chief Operating Officer Mark Hensley said total acute care net sales were $13.6 million in the quarter, including $10.2 million from ZYNRELEF and $3.4 million from APONVIE. Collard said Heron’s acute care portfolio grew 32% from the prior-year period, with ZYNRELEF growing 27% and APONVIE growing more than 50%.

Hensley said ZYNRELEF demand units grew 22% year over year, even as the broader local anesthetic market declined sequentially in the first quarter. He cited the product’s permanent J-code, J0668, which has been active since October, and the NOPAIN Act framework as improving the reimbursement environment.

Heron is also expanding its Ignite program, an incentive initiative with orthopedic distribution partners. Hensley said Ignite-targeted accounts grew from about 9,000 ZYNRELEF units in the last pre-Ignite quarter of 2025 to more than 19,000 units by the fourth quarter, a 111% increase. Ignite 2.0 now covers 3,109 accounts for full-year 2026, up 38% from the prior program.

The company plans to expand its ZYNRELEF sales team in the third quarter of 2026, targeting geographies where formulary access, Ignite participation and payer coverage are in place.

APONVIE Gains From Guideline Inclusion

Hensley said APONVIE demand units grew 68% year over year, while average daily units increased 70% compared with the first quarter of 2025. The product exited March with 371 ordering accounts, an all-time high and up 67% from March of last year. APONVIE has received pharmacy and therapeutics approval in 1,903 accounts, representing 5.8 million medium- to high-risk procedures annually, according to Hensley.

Heron said APONVIE’s permanent product-specific J-code became active April 1, which Hensley said removes a layer of reimbursement complexity.

Kevin Warner, Senior Vice President of Medical Affairs, Strategy and Engagement, said APONVIE was specifically named in the fifth consensus guidelines for the management of postoperative nausea and vomiting as the first and only FDA-approved IV push NK1 antagonist for prevention of PONV in adults. Warner said aprepitant-based therapies, including APONVIE, received an A1 evidence rating.

Warner said the guidelines support broader use of multimodal prophylaxis and emphasize post-discharge nausea and vomiting, citing guideline data that approximately 37% of patients may experience symptoms after discharge. He said APONVIE’s 48-hour duration of action aligns with recommendations for long-acting antiemetics in at-risk patients.

CINVANTI Holds Share in Competitive Market

Heron’s oncology net sales were $21.1 million, including $20.5 million from CINVANTI and $0.6 million from SUSTOL, which Hensley said reflects a planned wind down.

Collard said CINVANTI maintained a 25% exit market share in the NK1 category despite increased competitive pressure. Hensley said March ordering accounts totaled 1,188, in line with the product’s 12-month average of about 1,200 accounts, and that the product’s 25% March share matched its 12-month average.

Hensley said Heron’s REIGNITE program is focused on CINVANTI access in major teaching hospitals and has produced formulary wins representing about $10 million in near-term opportunity. Collard said new accounts expected to come on board in the second quarter could add upward of $10 million in annualized net revenue.

Development and Q&A Updates

Heron said the ZYNRELEF prefilled syringe program remains fully funded and on track. The company said registration batches have been manufactured and placed on stability, with 12-month stability data expected in the first quarter of 2027.

During the question-and-answer session, Hensley said Heron’s data showed a high-single-digit decline in surgical volume from the fourth quarter, which he attributed to weather, a record fourth quarter and some surgical partners “taking a deep breath” in the period. He said the company expects volumes to improve and some lost surgeries to be rescheduled.

Asked about the Baxter settlement, Collard said Heron could not discuss details beyond dates that had been published, citing the terms of the settlement.

About Heron Therapeutics NASDAQ: HRTX

Heron Therapeutics, Inc is a commercial-stage biotechnology company focused on developing and commercializing therapies in pain management and supportive care for patients undergoing medical and surgical procedures. The company's research is dedicated to addressing unmet needs in oncology supportive care and post-operative pain management through innovative drug formulations designed to improve patient outcomes and reduce reliance on opioids.

Heron's first approved therapy, SUSTOL (granisetron) extended-release injection, received U.S.

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