electroCore, Inc.

Greetings and welcome to the Electric Core second quarter 2026 earnings conference call. At this time, all participants have been placed in listen-only mode. Please make sure to mute yourself. A question and answer session will follow the formal presentation. As a reminder, this conference is being recorded. Earlier today, ElectroCore published results for the second quarter ended June 30, 2026, and the press release is available on the company's website. Before we begin, I would like to remind everyone that members on the call will make forward-looking statements within the meaning of the federal securities laws made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Any statements that are not historical facts should be deemed to be forward looking, including, without limitation, any guidance, the company's outlook on third quarter and full year performance, and its path to profitability. These statements involve material risks and uncertainties that could cause actual results to differ materially from those anticipated. For a list of risk factors, please see the company's filings with the Securities and Exchange Commission. ElectroCore disclaims any obligation to update these statements, except as required by law. This call contains time-sensitive information, accurate only as of today, August 6, 2026. Joining us on today's call from ElectraCore are Dr. Thomas Errico, one of the company's founders, investor, and independent chairman of the board of directors, Joshua Lev, interim president and chief financial officer, and Mike Fox, chief operating officer. It is now my pleasure to turn the call over to Dr. Thomas Errico, ElectraCore's founder and independent chairman, for opening remarks. Dr. Errico?

Thank you, operator. Good afternoon, everyone, and thank you for joining ElectraCore's second quarter 2026 earnings call. It is a pleasure to have the opportunity to speak with you all again about the transformation and momentum underway at Electric Core. As chairman of the board, I have been working closely with Josh Lev, interim president, and Mike Fox, COO, for the entire quarter. Josh has kept the company focused and steady while skillfully managing investor relations while Mike has moved quickly to make important operational changes, including a major transformation of our sales force. Change is never easy and managing change without disruption takes real skill. Today, I am proud to say that Josh and Mike have helped us make meaningful changes while keeping the organization moving forward. You are about to hear the results shortly, but we are entering a new phase of Electric Core, one defined by accelerating revenue growth and improving operating leverage. Today, we are raising our 2026 revenue guidance to greater than 30%. We are doing so while showing improvement in profitability with gap net loss in the quarter improving by 17% to 3.1 million from 3.7 million in the prior year, and adjusted EBITDA improving 26% year-over-year and 25% sequentially. This improvement comes as we deliberately invested roughly $1 million this quarter in initiatives designed to accelerate future growth. We now believe that this trajectory puts us on a path to achieve positive EBITDA in 2027. To me, that is what disciplined execution looks like. investing in durable growth opportunities while staying disciplined and holding the line everywhere on spending. The board is extremely pleased with the competency, discipline, and leadership Josh and Mike have demonstrated in delivering this execution. Our strategy has not changed. What has changed is the pace and precision with which we are executing it. and that reflects the leadership Josh and Mike are providing across the company. With that, Josh will provide opening remarks. Mike will walk you through the operational specifics and then Josh will take you through the quarter and where we go from here. With that, I'd like to turn it over to Josh.

Thank you, Tom. Good afternoon, everyone. This quarter marked the beginning of a new era for our company as we implemented significant changes across our commercial organization to better position us for long-term success while also improving reported financial performance. That included expanding our sales regions, adding new representatives, and redesigning our incentive structure to improve accountability and cost efficiency over time. While these actions required investment and focus throughout the quarter, we believe they've strengthened our foundation, improved operating efficiency, and enhanced our ability to accelerate revenue growth. I'll let Mike walk you through the execution in more detail in a moment. Now to our results for the quarter. We reported quarterly revenue of $9.5 million, an increase of approximately 28% year over year, driven by continued growth in the U.S. prescription sales in the VA and in direct-to-consumer TrueVega sales. We restructured this quarter, making the results especially encouraging given the magnitude of the organizational changes. While revenue was flat sequentially, we expect revenue growth to accelerate throughout the year, underpinned by orders already received but not yet impacting revenue, as Mike will explain later on in the call. Importantly, we showed continued operating leverage as illustrated by our continued improvement in adjusted EBITDA of 26% year-over-year and 25% quarter-over-quarter. We view this performance as a meaningful win, demonstrating the resilience of our business and our ability to execute while positioning the company for long-term profitable growth. The changes implemented during the second quarter are already showing promise, and given the momentum we are seeing across the business, we are raising our full year 2026 revenue guidance to greater than 30% growth over full year 2025 revenue. As Dr. Errico mentioned, we believe the operating improvements described today position us to execute our plan of achieving positive adjusted EBITDA in the third quarter of 2027. Turning to the portfolio. The VA continued to be our largest growth driver in the quarter. Prescription Gamma Core revenue grew approximately 11% year over year, and approximately 16,400 VA patients have now received the Gamma Core device, representing approximately 2.7% penetration of the estimated addressable VA headache market. When we acquired NeuroMetrics last year, we added two Class II medical devices to our portfolio. The first, Quell Fibromyalgia, is currently marketed as a prescription therapy through the VA. The second, Quell 2.0, is an FDA-cleared, over-the-counter device for lower extremity pain. It is not currently in production or for sale, and we may rebrand and relaunch it direct to consumer in the future. At the time of the acquisition, we saw the opportunity to bring a different technology than GammaCorp, sold through the same VA relationships, the same reps, the same call points, just a new product to sell. Since making the acquisition, Qwell has become a bright spot in our product portfolio. Sales of the Qwell product line were $1.3 million in the second quarter, growing approximately 700% year over year and roughly 30% over the first quarter of 2026. Cumulative Qwell revenue is approximately $4 million since our acquisition of Neurometrics in May 2025, of which $3.8 million of Quell Fibromyalgia has been sold into the VA. We believe Quell Fibromyalgia continues to be a significant opportunity for the company, where according to an article in Rheumatology Advisor, the prevalence of fibromyalgia among male and female U.S. service members rose from 2.2% and 2% before deployment to 8% and 11.1% after deployment, respectively. The consistency we're seeing, particularly in fibromyalgia, reinforces our thesis of providing non-invasive bioelectronic therapeutics for patients in need of non-pharmaceutical options. True Vega, our over-the-counter wellness brand, grew approximately 27% year-over-year to $1.3 million. Media costs expanded as competition in the health and wellness space increased, driving up the cost to acquire customers and reducing our media efficiency ratio to 1.91. In the first half of 2025, five competitors bid on Truevega's own branded search terms. Through the first half of 2026, that grew to eight, a 60% increase in the number of advertising showing up on the exact terms that should be Truevega's most defensible territory. As a result, The direct cost per click of acquiring a customer increased by roughly 30%. In response to the increased cost of advertising in the space, we reduced our media spend by 2% in the quarter, allowing us to spend less while still driving to achieve year-over-year TrueVega growth. In our first quarter of 2026 10Q, we announced that on May 5, 2026, FDA personnel visited our facility in Rockaway, New Jersey to inspect matters relating to a follow-up 2017 inquiry on our wholly owned subsidiary, Neurometrics. On May 27, 2026, the FDA concluded their inspection and issued the company a preliminary 483 letter citing four observations and two discussion points around how the company addresses and documents patient complaints. Since receiving the letter, we have responded to the preliminary 483 letter with corrective actions to address the observations and discussion points. These corrective actions will delay the potential rebrand and relaunch of QWEL 2.0 direct to consumer in the near term, but ultimately, we believe the changes will result in a stronger product and brand, positioning us to update our claims over time to better reflect the broader benefits of a newly branded product. And now, I'd like to turn the call over to Mike to cover some of the specific changes that were implemented during the quarter. Mike?

Thanks, Josh. Good afternoon, everyone. At the time of our last earnings call, I was three weeks into my new position. With nearly four months under my belt, I have never been more confident that Electric Core is positioned to drive accelerating revenue growth with greater predictability and enhanced profitability. My belief is underpinned by progress on three core priorities, which I shared in my first earnings call. Expanding VA medical center breadth, increased depth of product utilization within each VA, building out the broader federal channel, and driving operating principle as we scale. I want to walk you through where each of those stands as of today. First, within our sales organization, we evaluated how our team was structured against the size of the opportunity in front of us, and the conclusion was very clear. We needed to execute a clear plan to expand coverage and assign clear accountability within the sales team. We doubled the number of sales regions and realigned our regional sales directors against that new structure, providing enhanced focus and stronger leadership over smaller geographical areas, allowing our RSDs to coach lead, and expand advocacy within their assigned regions. This improved focus provides an immense opportunity for us for increased customer value, stronger patient advocacy, and higher return on investment for the efforts of our sales team. Alongside that, we recruited, contracted, and trained 17 new 1099 sales representatives who are now covering 29 VA medical centers. This is approximately 20% of the national VAMC network. Let me stress. This group of new 1099s are not new to the VA market or new to medical device sales. These are some of the most talented and high-performing sales professionals available within the US market. I personally work with every one of these new colleagues and can assure you they have all built legacies within their accounts and with their customers due to the many years of dedicated top-level customer service resulting in top-tier performance. Their addition reflects the highest number of sales colleagues added to our team in any given quarter and illustrates that not only that we are dedicated to adding strength to every position and process within Electric Core, but it showcases that the best are wanting to join in on our mission. In a short amount of time, with these newly added 1099s, we have opened new VA accounts and expanded the number of new prescribers, representing tangible expansion of our footprint within the VA and Department of Defense accounts. The exact federal channel where we said the opportunity is largest and requires greater penetration. These additions will help diversify our revenue across more facilities where currently our top 15 accounts produce 54% of our Q2 VA revenue. This diversification is important in mitigating concentration risks where a few, albeit large, facilities drive a significant portion of revenue. To that end, in Q2 2026, one of our facilities had a staffing issue in their prosthetics department, creating a backlog of approximately 30 orders from being fulfilled. These orders, while prescribed in second quarter 2026, were filled and fulfilled in July, pushing roughly $145,000 in revenue to Q3 2026. The backlog did not eliminate the revenue. We booked it in the current quarter, but it does illustrate the need to expand the breadth of our facilities selling and fulfilling our prescription products so that no one facility can drastically affect our metrics. We're also being disciplined to how we measure and impact that expansion. We've updated our KPIs to focus on performance dashboards so we can see new patients and refill rates at the individual VA account level, allowing us to build a pipeline of future scripts and focus on increasing our refill rate by 30% in every region by the end of 2026. To make sure this newly expanded team performs, we also revised our sales incentive compensation plan to raise the bar on expectations and accountability. We brought on a new dedicated recruiter whose sole job is filling vacant or underperforming VA territories with proven sales talent. This, in combination with those talented sales professionals who are contacting us directly, requesting to join our team, will continue to strengthen our team and results. These changes are also structured to improve our cost efficiency over time. Redesigning our incentive plan around sustained account-level growth rather than end-of-quarter volume is intended to reduce the sales and marketing expense associated with each dollar of revenue as it takes hold. And the realignment of territories is aimed at eliminating overlapping, inefficient coverage that added costs without building sustainable accounts. Based on the elimination of paying commission to overlapping sales colleagues, we expect to see a reduction in incentive compensation variable expense from approximately 35% of prescription revenue to approximately 27% by the end of 2027 and reduction of overall sales and marketing expense to approximately 54% by the end of 2027 under the new cost structure and territory alignment. Beyond the VA, we made two targeted federal hires this quarter as well. We contracted a 1099 representative with a specific mandate to grow our presence within Kaiser outside of California market, and we hired a W-2 employee to bring dedicated focus and expertise to Department of Defense and federal workers' compensation, two channels we've talked about in the past as underdeveloped relative to their potential. One of the more structurally important moves this quarter was on the contracting side. Moving forward, Lovell Government Services will be the sole federal supply schedule contract holder across all Electric Core products in both the VA and Department of Defense markets. That simplifies how our products move through the federal procurement process and positions us to scale federal growth more efficiently. It will also cut roughly 3% of our general and administrative expenses and transaction fees associated with direct sales. This transition for all federal orders, process through level, will be completed before the end of this month, August 2026. We also have consultants identified with contracts being finalized to build advocacy and revenue specifically within opportunities identified within first responders, Department of Defense, and Departments of Women Health within the VA. One of our own board members has been directly engaged in the Women's Health Initiative and we're encouraged by the early alignment there. On TACSTEM, we're working on adoption outside of active duty military and broadening our pipeline of potential customers. We're engaged in a study evaluating TACSTEM during annual SWAT training academy scheduled in November of this year. We have also engaged another state police department for SWAT team evaluation and other opportunities to help our first responders in their daily roles. Additionally, we have seen expanded utilization as shown by units purchased and distributed by various domestic law enforcement and U.S. intelligence agencies. Finally, on marketing and enablement, we hired a marketing director with vast VA training and marketing experience, and we're developing a new training and onboarding curriculum for our existing and expanded sales colleagues that will roll out this quarter in 2026. In parallel, marketing is expanding provider-facing access to the substantial number of our published clinical trials and data sets, while updating our materials so they more directly meet the needs of our customers and patients we focus on. Ultimately, this quarter was about building and growing the infrastructure, people, contracts, data, and process. That turns stated strategy of market and specific facility depth into something measurable. We're seeing early signs of success, and we believe this impact to grow over time as business progress translates into greater financial impact. I'm confident in the foundation that has been established and actions we implemented in the last 90 days. We as a company are stronger and have set the blueprint for consistent and sustainable growth. I look forward to sharing more results and KPI metrics as the data develops in the months ahead. With that, I'll turn it back to Josh to walk through the financials. Josh?

Thank you, Mike. For the three months ended June 30th, 2026, Electric Core reported net sales of $9.5 million compared to $7.4 million during the same period in 2025, an increase of approximately 28% over the prior year. The increase of $2.1 million was primarily driven by growth in net sales of Quell Fibromyalgia products acquired from Neuro in May 2025 and prescription GammaCore, which are sold to the VA, and continued growth in net sales of the company's non-prescription general wellness Truvega product. The company expects that the majority of the fiscal year 2026 revenue will come from the VA. Gross profit increased $1.7 million to $8.2 million for the three months end of June 30th, 2026 compared to the three months end of June 30th, 2025. The increase in gross profit is attributed to the increase in net sales. Gross margin decreased from 87.3% to 86.5% for the three months ended June 30th, 2026 compared to the three months ended June 30th, 2025. The slight decrease in gross margin was primarily due to an increase in our inventory reserve. Research and development expense was $800,000 in the second quarter of 2026 compared to $500,000 in the second quarter of 2025. The increase was primarily due to increased studies and grants, higher stock-based compensation, and initial cost-developed enhancements to our TrueVega mobile application. Selling, general, and administrative expense was $10.1 million for the three months ended June 30, 2026, compared to $9.4 million in the prior year period. Sales and marketing increased $1.4 million from the prior year. The increase in sales and marketing expense was primarily driven by approximately $900,000 of variable expenses that supported the $2.1 million increase in net sales, reflecting the operating leverage embedded in the company's platform as it scales. General and administrative expense decreased $700,000 from the prior year. The decrease was primarily driven by $500,000 in bad debt expense associated with a taxed and receivable recorded in the three months ended June 30th, 2025 that did not repeat in 2026 and a reduction in professional fees in the three months ended June 30th, 2026. Total operating expenses in the three months ended June 30th, 2026 were $10.9 million compared to $9.9 million in the three months ended June 30th, 2025. Gap net loss in the second quarter of 2026 was $3.1 million compared to $3.7 million in the second quarter of 2025. A decrease in gap net loss was primarily attributed to higher gross profit associated with the increase in net sales partially offset by variable sales and marketing expenses associated with the increase in those net sales. Net loss per share for the second quarter of 2026 was $0.33 compared to a net loss of $0.44 per share in the second quarter of 2025. Adjusted EBITDA net loss in the second quarter of 2026 was $1.8 million compared to an adjusted EBITDA net loss of $2.4 million in the second quarter of 2025, an improvement of approximately $600,000 or 26% year-over-year. Total cash, cash equivalents, and marketable securities at June 30th, 2026 was approximately $10 million compared to approximately $11.6 million at December 31st, 2025. This quarter realized the early infrastructure changes that Mike walked through, including expanded sales regions, growth in sales personnel, and focus on new KPIs driving sustained growth giving us confidence to raise our previous guidance to greater than 30% annual growth over full year 2025. Based on our current model, we are targeting positive adjusted EBITDA by Q3 of 2027, and we believe we can reach that milestone using our existing capital resources without the need for a dilutive capital raise or additional equity issuances if we can realize the operating leverage described above. I want to spend a moment on strategy because it is essential to how we think about the business. We are changing the narrative from Electric Core being a single product, single customer story into Electric Core as a multi-catalyst platform in bioelectronic medicine. There are three catalysts we will manage and communicate against every quarter. Let me touch briefly on the catalysts ahead for the second half of the year. First, research and development. Pursuing new prescription indications supported by more than 30 investigator initiated trials currently underway across a range of therapeutic areas at no direct cost to the company and building the clinical evidence base for vagus nerve stimulation. Number one, We are working towards an FDA submission for CIPN or chemotherapy-induced peripheral neuropathy using our Quell device and are targeting completion by year-end subject to ongoing analysis. Number two, we have begun working with the Dorn VA Research Institute on real-world studies with the VA to help us aggregate additional information in a post-use environment of our veterans utilizing GammaCore and its possible effects on PTSD. The Dorn VA Institute is one of the many VA research institutes located across the country with a primary focus on enhancing veteran clinical outcomes and quality of life. We believe this data will help us create an outline for an expanded label in mild traumatic brain injury and PTSD, expanding GammaCore from a headache therapeutic to a neurological health therapeutic. The real world PTSD data gathering work is now underway at the VA site we selected and feeds directly into our Acacia effort. We'll keep you updated as that program develops. And three, on the product side, we have begun outlining the framework for our next generation clinical device, which looks to incorporate a form factor that will allow us to capture biometrics as well as provide vagal nerve stimulation. While we are just at the beginning of this process, we are working to develop a form factor that does not require being held by the user and gives real-time feedback in a closed-loop system, which could be valuable in understanding and addressing the specific needs of individual users or patients. The second catalyst, we are looking to diversify our commercial customer base outside of acceleration efforts within the VA. That includes, one, push into new markets like TACSTM with first responders, such as a study utilizing TACSTM during annual SWAT training and other opportunities to help our first responders in their daily roles or progress with other various domestic law and U.S. intelligence agencies. Two, expanding our Kaiser Permanente efforts outside of California and federal channels such as DOD and federal workers' compensation through our newly dedicated 1099, and W2 Employee, respectively. And three, new focus on advocacy within the VA's Department of Women's Health, assisted by members of our board. Third, the last catalyst will be our operating results. Accelerating revenue, lowering our cost of sales as a percentage of revenue to roughly 54% by the end of 2027, cutting out 3% of general and administrative expenses associated with transaction fees on sales made off of our FSS contract and progressing towards positive adjusted EBITDA. We continue to expect operating leverage to improve as our expanded sales infrastructure matures and VA revenue scales against a largely fixed cost base. Before I hand the call over, a word on capital. Our approach is disciplined. Our intent is to invest capital behind growth, new indications, and new products, not simply to fund operating burn. In the second quarter of 2026, approximately $1 million of the cash used was towards investment and growth, such as inventory purchases to meet our future sales expectations, capital improvements in our Rockaway facility so that our infrastructure can scale with our growth expectations, and commercial team reorganization to accelerate revenue. That discipline, combined with the momentum across the portfolio and $10 million of cash on the balance sheet, positions us well for accelerating revenue growth and moderating operating losses through the second half of 2026 and gives us confidence in achieving positive adjusted EBITDA by the third quarter 2027. With that, I'd like to turn the call over for questions. Operator.

Thank you, Josh. We will now open the call for the Q&A session. For those joining via Zoom, there are two ways to participate. First, you may use the raise hand icon located at the bottom of your screen. Selecting this will alert the operator that you would like to ask a live question and you will be placed in the queue. Please note that you will remain muted until your question is called. Second, you may submit a question using the Q&A widget, which allows you to type your question directly. We will monitor and take questions submitted there as well. If time does not permit us to address all questions during today's call, a member of the investor relations team will follow up directly. With that, we will pause briefly to allow the queue to form. Our first question comes from Jeffrey Cohen from Ladenburg-Thalman. Jeffrey.

Hello.

Hi. Josh and Mike. So two questions. So firstly, can you give us a better sense of back half sales and marketing expense as far as the ads? Walk us through the ads again as far as the sales force. You talked about 72 ads that are 1099s. Are there any ads that are W2s? And maybe how that relates to back half spend versus front half, please.

Sure, Mike. Mike, you want to take that? You want to talk about the changes you're making in the commercial organization?

Yeah, that sounds great. Sorry, I'm getting a little back. I don't know if you can hear any back talk, but we'll see if we can clear that up for you. Yeah, Jeffrey, great question. As you know, 1099s, we pay a percent commission based on revenue. So the additive cost of those 1099s that I said in the discussion points were some of the best in the country. There's no economic additions to that. That's truly just a percent of revenue enhancement to our bottom line. The increase in our regional directors from three to six was an additive cost. However, a few of those were promotions internally because we have a very strong bench internally at the company. So there's very little additional cost to that leadership change. In my opinion, it was a very smart investment and will be easily taken up by the increased revenue based on the focus. And what was your other question, Jeffrey?

Sorry, Jeffrey, you need to unmute.

Sorry about that. And then as follow up, could you talk about peripheral neuropathy, please? And what is the study that you anticipate to finish by the end of the year? And then how do you plan time-wise and pathway to get to a expanded label, I believe?

Yeah, so great question, Jeff. Thanks so much, and always thanks for the support. So our CIPN work is actually already done. When we acquired Neurometrics in 2025, a study was already completed around the chemotherapy-induced peripheral neuropathy. When we took a look at the marketplace, we saw a really big unmet need. I think one of the statistics that I saw was roughly 70% of patients that go through chemotherapy have some form of chemotherapy-induced peripheral neuropathy. From our point of view, there's no real additional work per se that needs to happen on a clinical study point of view. Where we are now is really just organizing the data and presenting it in a way that we can go ahead and submit to the FDA before the end of the year. So from a just overall workload perspective, we don't actually anticipate the need right now for any additional data points. It's really more about packaging the information and working with our FDA consultants to go ahead and put it in front of the FDA as an expanded label for the Quell product line.

Okay, I think Jeffrey has asked all his questions. And we're going to go to our next caller. R.K. Ramakant from H.C. Wainwright.

Good afternoon, Josh and Mike. Thank you for doing this. A few questions from me. The first one, the prescription gamma core revenue certainly grew 11% year-over-year this quarter. However, if my math is correct, sequentially it is down 4%. So how much of that deceleration is commercial reorg that you just have completed or undergoing versus underlying demand for the product itself at that current level? And if I... Again, think about the guidance which says greater than 30%, which means you've got to reach somewhere close to 23 million in the second half. What needs to get done from here to get to that point?

Well, so RK, that was a great question. Thanks so much. And again, thanks so much for participating today. I think from our point of view, if you go ahead and take a look at the Gamma Core deceleration, a lot of it has to do, yes, with the change in... The new era or the restructuring that we were doing. But I think it's less so about the actual changes that were made or the demand rather than we're changing the KPIs in the way that we're addressing the growth of the business moving forward. What I mean by that is, historically speaking, we've had a very robust pipeline of refills. and our renewed focus and the way that we're starting to look at the world moving forward is not only necessarily on the refills, but building up that pipeline of future new patient starts as well. So I think what we saw in this quarter was number one, a change in philosophy where we have our team that's going ahead and starting to shift a little bit of their focus away from what they were doing before to what we're looking forward to them doing in the future. and then the other thing that I think is important to note is we did have that one hiccup in a particular location in Phoenix with the prosthetics department there. So typically speaking, that hiccup Michael Fox, Andy Brown, But going back to it, I think it's, you know, you're asking about the deceleration. I'm not so sure that while on paper it was decelerated, but I think it's really more of a philosophy and how we worry about the acceleration moving forward. Which also then sort of leads into your second question, which is where do we think that acceleration is going to come from? And I think part and parcel of what you saw is the work being done in this particular quarter to help with the acceleration moving forward. We believe, based off of the changes that have been made to the commercial organization, and that's a function of not only just the territory reorganization, but also the addition of new 1099s, changing the incentive compensation plan, focused on many of the KPIs or new KPIs that we're going to look for as leading indicators to the growth of our revenue moving forward. We believe that that will start kicking in in this quarter, meaning in the third quarter of 2023. And then on top of that, when you think about that greater than 30% growth, the other areas where we've had more That started towards the back half of the second quarter, now moving into the third quarter in the areas such as Taxton, where Mike had mentioned that we're increasing our work and our efforts primarily around different forms of federal agencies, both in terms of governmental statewide police organizations, as well as different intelligence agencies. Mike, as part of his expansion, has not only hired 17 new 1099s that he's worked with in the past, but some of those people actually have Rolodexes and experience selling primarily into new channels, which we really didn't have before. Mike, is there anything else you want to add to that?

Yeah, thanks, Josh. And exactly what you said. I would say the one thing to remember, RK, is that we try to do our best in some of these federal channels to have stability. But I would say it depends on the stability of the market you're in. The VA has always been one of those. It's hard to consistently expect stability. Quarter over quarter stability from them. But I am extremely proud of that 11 percent you talked about, because in our transition, if you understand our price points of some of our products we offer to the VA, for example, we have a 90 day for a trial run on the product to make sure things work for GammaCore. Then we have a one year and a three year. Through this quarter, our new patient starts have been very strong during the transition. The difference is we've had some accounts in some areas that have gone instead of to a three-year prescription have decided to use the one-year prescription to better align with their fiscal year budgets and then also make sure the patients are doing well and are able to maintain therapy before they give them longer-term therapy. So it's not a loss. It's really a reformation of the processes in place for treating patients with migraines and cholesterol headaches. But when we see more patients being treated by more providers and more accounts behind that number, which is the part I see that you haven't been able to see at RK, I'm extremely happy what I saw. Would we love that number to be higher? Of course. to see it at 11%. It's very easy to explain. The second part is why do we have the excitement for moving forward is because of the ability to get into these new accounts and have breadth and depth. In so many different accounts, we can do better. But more importantly, we have a lot of providers in various departments beyond neurology and beyond the headache clinics that that treat patients that need our help. And we've hired and are coaching our people up to attain a higher level of expectations. And just like Josh said, there's things outside of the VA within Department of Defense that are extremely of interest. I was just at a Department of Defense meeting yesterday in D.C., and all I can say is the active military need us as much as the VA does. So that is a focus point. Hopefully that gives you a little clarity.

Perfect. But if I may, asked another set of questions. You know, we have been used to certain metrics that ElectroCore has been giving us over the years. So this is a question on that. So you certainly disclosed 16,400 cumulative VA patients. I'm also trying to understand in terms of the facility count or the utilization, and reorder metrics. Is there some of that information that you can provide on this call? And also, Mike, one of your mandates was trying to get 75% consistent monthly utilization. Where does that sit and how far have you been able to get some of the folks really focus on that sort of metric?

Josh, I can take the second one for you first. Yeah, RK, great question. It probably is a better answer I could give you territory by territory or account by account. Stabilization a lot of times is have we had the right people with the right message? I truly believe in the three Ps, people, process, and product. We've got extremely strong clinical data. Sometimes with 1099s, they were not putting us high enough in their order of products that they were selling, so we weren't first or second in their bag. We were not getting priority time. with the priority customers. So that is what we've been focusing on. So sustainability of getting more patients and more excitement is really to drive the advocacy with the individual providers in the VA. So that's where I'm seeing the greatest results. We have examples of a few of the 1099s that have come into accounts just in the last six to eight weeks have gone from zero new patient starts to 12 new patient starts in six weeks. Just because we have somebody who understands the VA and understands access and how to get to the key advocates. And we have definitely enough patients to take care of in the VA. They need us there. So hopefully that gives you a little bit more. But it's hard to say nationally what's the one thing because I would say the biggest part is the people and the expectations of performance that we're providing. Does that sound good?

Yeah. And then just, RK, in terms of where are we in total number of facilities? You know, our goal this quarter really was not to go ahead and start to open up new facilities. It was to reorganize the team so that we have a plan moving forward for the third quarter. The number of new facilities that we ordered was flat from quarter to quarter. However, the other initiative that we really did start focusing in on is we've had roughly, or we've sold, we've said publicly, roughly 200 different VA facilities that have purchased our products over the course of, over the last few years. However, the last quarter when we were going through this process and this exercise, we noted that only about a third of those facilities were really focused primarily on selling the Quell product. So one of the things that was a big focus of ours in this particular quarter, in the second quarter, was how do we go ahead and expand that adoption of Quell within the existing accounts that have already purchased from us a product, whether that was GammaCore or something else. and what we've done is change the training and the philosophy as well as the focus, I would say, on some of the sales executives that we have within our organization, whereby some of them now only sell Quell versus selling both. But the broader point here is Our focus this quarter was not to increase the number of facilities purchasing. Really what it was is to set the stage for the third quarter, identify the new targets within different territories. And again, we have 17 new 1099s that are going to go ahead and canvass different areas, different facilities that we don't already have, as well as increasing adoption of QWEL within existing accounts.

Thanks, Josh. I have a quick question on QWEL. Actually, I appreciate you mentioning Quell and how you're managing and trying to grow that sales. In that vein, you grew over 30% sequentially on Quell sales. How are you assuring yourselves that that sort of growth will continue? I know it's a 1.3 million base. It's not a big base, but still. How are you thinking about growth there? as you deepen your relationship within each of the VA facilities.

Yes, I'll give you just my two cents, then I'll pass it to Mike to add anything that he feels. But I'd say there's a few things. Number one is we're really changing the way that we're thinking about our sales organization and how they're selling different products and who gets to sell well and who does not get to sell well. That's number one. Number two is, you know, I had mentioned earlier on the call The total market, according to rheumatology advisors, I think it was roughly 2% of active duty military had some form of fibromyalgia before deployment that came back to roughly 8% to 11% after deployment. This notion of attracting or going after active duty military, I think, is a really, really large opportunity for the organization. We've historically really focused on the VA, but the Quell product line as its own right, when you think about it, doesn't really have so many natural competitors within the market space of bioelectronic therapeutics specifically for different forms of fibromyalgia or fibromyalgia in general. So the reason why that's important to us is we've changed our training around the way that we go ahead and train for the Quell product line. Historically, we've had one call it a product expert. That product expert is now working on, in conjunction with the rest of the new marketing team that was brought in that Mike mentioned, on the resources and the training so that everyone has the ability to sell Quell, as well as what I had said before, opening up a new real target market for us, which is active duty military, not something that we focused on in the past. Mike, you want to add anything to that?

Yeah. Hey, Arke, I was just going to say one other quick, a couple of quick things. You can never get me to say one thing. First off, on the fibromyalgia side, I think the excitement that we have is, if you really look back when we acquired that company, remember, a company was established to stand alone on Quell. Thank you for joining us. Thank you for joining us. Women have a very high rate of fibromyalgia versus their male counterparts within the VA and active military. Same is true for migraines. But there's a large business within the VA that is focused on these type of ailments that we have not aligned with as a company as much as we should have prior to my entrance to the company. So we're focused on the right providers with the right therapy for the right patient. We do that. We're excited about the future with Qualp.

Perfect. Thank you very much both for taking all my questions and I appreciate the deep color that you provided. Thanks.

Thank you, sir.

Thanks, RK.

Fazia, why don't we go to you? It looks like you've got a question as well.

Yes. Hi, Mike and Josh. Thank you for taking my question. I just was wondering if you can elaborate on how this transitioning to level government services as your primary federal supply schedule contract holder will improve the process for VA and DOD customers, and if you can expand on what specific advantages will come with this partnership.

Yeah, Josh, you want me to take that and I'll turn it back over to you for some of the contracting side of that?

Yeah, absolutely.

Yeah. So, yeah, Fozzie, a great question, because if there's not a lot of knowledge about what the difference between some of the opportunities in the FSS, one of them is to contract and have your products through small disabled veteran owned groups. The advantage is very simple. The VA is requested a certain percent of their business go through those entities. So we're aligning with what the VA and Department of Defense wants. But most importantly for our business, they're the experts in basically processing orders and maintaining harmony within the ordering systems within the federal space. Not that we weren't doing a good job, but these are the experts at that job. So we're really lucky to have them take in us as a sole source, but also they offer things that we don't have the ability on our own FSS. They have what's called DAPA. They have ECAT. They also have a web store. They have a lot of other opportunities to help us with active military, such as military treatment facilities and the VAs. And they have a strong relationship in DC. They have their own lobbyist firm. It's a really strong. It's not just a distribution network. It is a partnership. And I've worked with level government services in the past with other companies, and they are the best in the country at helping to identify needs of veterans and taking care of those people that need help. So we chose this because economically it makes sense. No question. But we did it also because it makes our business stronger and it helps us do our job of taking care of the VA. So, Josh, I'll turn over to you if you would like to add anything to that.

Yeah, I think, look, on the contracting side, on just the overall economic point of view, switching over to Level is something that we think can really help improve our margins. First and foremost, the way that Level gets paid is typically they have a markup to our overall price that we provide to the government. And the reason why that's important to note is when we sell direct from our own FSS contract, There are rebates that come off of that that we were required to go ahead and pay back to the customer. It's called an IFF. But that being said, those rebates, that all comes out of Lovell's economics, so we don't have to pay that. It comes out of their fee. So incrementally speaking, there's no incremental cost to us because we net the same amount that we would have netted beforehand if we were selling The second piece, which I think is even more substantial, if you will, is whenever we charge a government, and as I'm sure you're familiar with this, the government's prosthetics department typically provides us their credit card. Every time we have a transaction that we swipe a credit card, it's roughly a 3% fee on all direct sales. Again, when we talk about a level's fee, their fee, which is incremental, It captures that 3%. So typically what will happen is on an order that we have from direct, when we go direct from our own contract, we'll have to pay back the rebate and we'll have to pay the transaction fee. When we go directly with level, all of that we keep, right? We keep that. So I think that that's an economic benefit. The only, I would say, quote, detriment, if you'll call it that, is when you think about our cash-on-cash cycle and our accounts receivable, historically speaking, our accounts receivable have been very, very good. And the reason why is because typically we swipe the credit card and then we ship. In this particular instance with Lovell or with all Lovell orders, what happens is we get the order from Lovell, we ship the product, the VA pays Lovell, and then Lovell goes ahead and pays us. That extra one or two days is going to change our accounts, days receivable, outstanding. But Lovell has been very, very consistent in paying us well, well, well ahead of what they're supposed to be paying us in terms of what's current and not current. And we don't think it's actually going to be a material change overall in terms of our AR balance is increasing. But it is the only real change, I'd say, on the side of the contracting that I wouldn't consider, quote, favorable. Everything else is part of this is a favorable transaction. So moving to level, just from an overall economics point of view, is going to be more favorable than it would be if we were going direct through our own FSS contract.

Perfect. Thank you so much. I appreciate the color.

Great. Thank you. Operator, are there any additional questions coming from members of the call? Okay, it looks like we're getting a question here from Jeremy Perlman. Jeremy asks, you increased your full-year revenue outlook from approximately 30% growth to greater than 30%. Can you break down what's driving the increased confidence? Is the upside primarily coming from GammaCore and the VA, Quell, Truvega, or all three? Mike, you want to handle that one?

Yeah, sounds great, Josh. So great question, Jeremy. I know there's a lot of excitement here. So where is it coming from? I would say all the above that you mentioned. But to put a little color on that, the VA has always been a focus, always will be, for both GammaCore and the growth of Quell. We are excited about the trajectories that we're going to see with both. But The Department of Defense, when we're talking about that downrange, we're talking about the military treatment facilities. We're talking first responders, the effects and the efforts we're putting at Kaiser and some new entries. People were discussing some potentials of TRICARE. I think the big excitement is because we're not just considering things. We're considering a lot of different points as critical access discussions for the quarter that have started to have actual metrics and results. So as discussed before, we have had first responder orders from various SWAT teams. We have intelligence AGs ordering product. We do have military treatment facilities make their first order here in the last eight weeks. So we are seeing fruits of our labor. So that's why the excitement is here. It's not because we have good thoughts. We're starting to see results from our actions. So that's what I would say right now. That's where the excitement is coming from.

Thanks, Mike. Jeremy continues, the VA continues to be your largest prescription channel. Are you seeing increased utilization at existing VA facilities, expansion into new VA sites, or growth in patients per site? Which of those will be your biggest contributor over the next several quarters?

Yeah, Josh, I... That's a great question, and that's probably the one I love to answer most is, Jeremy, the answer is yes. I would say we have the team, we have the focus, we've got the products. So we have touched many VAs over the years since GammaCore has been here and also recently since the Quell edition. but we need to continue to have consistent utilization and advocacy in more accounts at more depth. And we have seen that during the next phase of which we incorporated here over the last 90 days. So yes, we are going to continue to focus on that, which is going to have the biggest impact I would say when a vast majority of VAs, the majority nationally, are utilizing and we have a significant number of providers utilizing the technology, I may be somewhat happy at that point, but there's always room to grow. But it's a combination of both. We have to delineate the risk by having a few accounts carry large volume. We need to have more accounts with sustainable, consistent volume, and that's the focus right now that's going to continue to pay the biggest dividends.

Back to you, Josh. Thanks, Mike. All right. Last question from Jeremy. Should investors expect incremental gross profit to increasingly fall to the bottom line, or do you expect to continue investing aggressively in commercial expansion? So, Jeremy, again, another great question. I would say we do expect gross profit to increasingly fall to the bottom line. As revenues continue to expand, we expect that gross profit to continue to drop. We are seeing that we are getting operating margin out of our P&L. and the higher the net sales that we're able to generate, the more we believe is going to drop down to the bottom line. In terms of gross margin, however, we continue to guide both analysts and investors to model around that 85% gross profit margin. We believe that that number is sustainable, definitely in the short to midterm. And that is what we would guide in order to the analysts, right? So we keep that pretty much fixed. And then in terms of investing aggressively in commercial expansion, I think Mike has done a lot of explaining of that over the course of the last hour or so on the call. We have taken a lot of steps over the course of this quarter to shepherd us into this new era. And there's a lot of commercial expansion going on, both in terms of our existing customer accounts, but also in terms of the different areas by which we believe that we can show that expansion. That includes things from federal marketplaces, federal workers comp, you know, the tax team examples that Mike had given earlier in different state police departments, SWAT, different intelligence, federal intelligence agencies. And then last but not least, of course, utilizing the knowledge, the data and the product success that we've been having in Quell and bringing that as well as GammaCore to our active duty military. So with that, that concludes the question and answer section of the earnings call. I appreciate everyone's time today. Thank you all to our shareholders for your patience and the continued support. And then, of course, most importantly to our team, thank you for showing up every day with discipline and the ambition to help us execute on the strategy and really do the things that are required that will help us achieve our goals and the ambition that the opportunity that is in front of us demands. So with that, we appreciate everyone's participation in today's call, and we look forward to speaking with you again next quarter. With that, that concludes our earnings call. Thank you everyone and have a great day.