Phathom Pharmaceuticals NASDAQ: PHAT reported second-quarter 2026 revenue growth of 88% year over year and said it achieved positive operating profit excluding stock-based compensation for the first time in its history, reaching the milestone one quarter ahead of its prior plan.
The company reported second-quarter net revenue of $74.3 million, up $34.8 million from the prior-year period and up $16 million, or 27%, sequentially from the first quarter of 2026. Cash operating expenses, excluding stock-based compensation, were $56.4 million, down $29.7 million, or 34%, from the second quarter of 2025.
Phathom generated approximately $1.6 million in cash from operations during the quarter and ended the period with $182.5 million in cash and cash equivalents. President and CEO Steven Basta said the results reflected the company’s operational pivot toward a gastroenterologist-focused commercial strategy for VOQUEZNA.
“For the first time in Phathom’s history, and ahead of our guidance, we generated positive operating profit in Q2, excluding stock-based compensation,” Basta said. He contrasted the result with an operating loss of more than $50 million in the second quarter of 2025.
Updated Revenue Outlook Reflects Access Friction
Phathom updated its full-year 2026 revenue outlook to a range of $310 million to $325 million. Management said the revised range still anticipates meaningful growth in the second half, but reflects feedback that physicians can face administrative hurdles when obtaining VOQUEZNA coverage for patients with less severe gastroesophageal reflux disease, or GERD.
Basta said the issue is not a broad loss of payer access, but rather the process around prior authorizations, medical-record documentation and prescription fulfillment. Physicians may be willing to navigate those processes for patients with severe GERD who have not responded to several earlier therapies, he said, while being more reluctant to do so for a broader population of patients.
Management said it is working to improve physician and office-staff education, streamline prior-authorization workflows and encourage greater use of BlinkRx, which can provide support during prescription fulfillment and payer review. Basta said the company’s highest-volume prescribers have generally developed efficient workflows, suggesting the process can be replicated more broadly across gastroenterology practices.
“We need to spend less time talking to physicians about how fabulous our drug is because they already believe it, and more time talking to them about how easy it is to get and how do we streamline that process,” Basta said during the question-and-answer session.
Chief Financial and Business Officer Sanjeev Narula said the company continues to expect gross-to-net discounts of 55% to 59% for 2026 and gross margin of approximately 80%. Phathom updated its forecast for full-year cash operating expenses, excluding stock-based compensation, to $235 million to $245 million.
Narula said expenses are expected to rise modestly in the second half as the company invests in commercial programs, including omnichannel marketing, and clinical development. Still, he said Phathom expects operating profitability, excluding stock-based compensation, to continue in the third quarter and beyond, including for the full year. The company remains on track to achieve durable positive cash flow in 2027, though it expects to use cash during the remainder of 2026 because of anticipated working-capital changes.
Prescription Growth Continues
Since launch through July 17, nearly 1.7 million VOQUEZNA prescriptions had been filled, according to Phathom. Approximately 325,000 prescriptions were filled during the second quarter, including about 209,000 covered prescriptions and roughly 116,000 cash-pay prescriptions.
- Covered prescriptions represented approximately 64% of second-quarter filled prescriptions.
- Covered prescription volume increased 24% sequentially.
- Cash-pay volume increased 16% sequentially.
- Covered prescriptions rose about 79% year over year, while total prescriptions increased about 88%.
Basta said Phathom remains focused primarily on gastroenterologists, which management believes can support $1 billion in annual potential revenue. The company also sees an additional long-term opportunity through greater engagement with primary care prescribers, though management did not provide a specific timeline for broader primary care expansion.
Currently, approximately 60% to 70% of the company’s sales calls are directed to gastroenterologists, with the remaining calls largely focused on high-volume primary care prescribers or doctors who have previously written VOQUEZNA prescriptions.
Pipeline Programs Target EoE and As-Needed GERD Use
Phathom completed enrollment ahead of schedule in its Phase II study of VOQUEZNA for eosinophilic esophagitis, or EoE, in June. Top-line results from the 12-week blinded treatment portion are expected in the fourth quarter of 2026.
Management described the study as the first large placebo-controlled trial of an acid-suppression therapy in EoE. Basta said a favorable result could support discussions with the FDA on a potential Phase III program. The company also said the program could provide a pathway to six months of additional VOQUEZNA exclusivity if the results are favorable, the FDA issues a written request involving pediatric patients, and Phathom completes an agreed pediatric study.
The company also plans to initiate a Phase III trial in the fourth quarter evaluating VOQUEZNA for as-needed treatment of non-erosive GERD. Basta said Phathom’s earlier Phase II study found that VOQUEZNA delivered faster and sustained relief of episodic heartburn compared with placebo, including superiority on complete relief at three hours and sustained relief over 24 hours.
Management said the as-needed program is intended to expand the addressable patient population rather than shift existing daily-use VOQUEZNA patients to intermittent treatment. Basta said current VOQUEZNA users generally have more significant GERD symptoms and need ongoing acid suppression, while the planned as-needed indication would target patients who do not want chronic daily therapy.
Phathom did not provide a specific timeline for Phase III results, but Basta said it could be reasonable to expect data in 2027 or 2028 and a potential label update by 2029, without committing to those dates.
Competition and Capital Structure
Asked about tegoprazan and the broader potassium-competitive acid blocker, or PCAB, category, Basta said the entry of a second product could increase physician awareness of the category and potentially benefit the market leader. He pointed to VOQUEZNA’s 93% healing rate in erosive esophagitis studies, compared with an 84.6% healing rate reported for tegoprazan in data discussed at a recent conference.
Narula said Phathom does not currently expect a major effect on its 2027 growth or expense outlook from competition, though he noted there could be some impact on gross-to-net dynamics. He also said management believes cash on hand and expected operating cash generation will be sufficient to fund operations and meet debt obligations without another debt or equity raise under the company’s current operating plan.
About Phathom Pharmaceuticals (NASDAQ:PHAT)
Phathom Pharmaceuticals is a clinical‐stage biopharmaceutical company focused on developing and commercializing novel treatments for gastrointestinal (GI) diseases. The company's core mission centers on addressing serious GI disorders by leveraging innovative mechanisms of action to improve patient outcomes. Phathom's research and development efforts concentrate on conditions such as Helicobacter pylori infection, erosive esophagitis, gastroparesis and other functional GI disorders where significant unmet medical needs persist.
The company's lead asset is vonoprazan, a potassium‐competitive acid blocker (P-CAB) licensed for use in the United States.
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