Image source: The Motley Fool.

Date

Tuesday, March 24, 2026 at 8 a.m. ET

Call participants

• Chief Executive Officer — Seth Yon
• Chief Financial Officer — Elizabeth Taylor

Need a quote from a Motley Fool analyst? Email [email protected]

Takeaways

• Net revenue increased 19% year over year in the first quarter of 2026, primarily driven by increased sales of soft tissue repair products, including CellerateRX Surgical and BIASURGE.
• Gross Profit -- $25.9 million, a 20% increase from the prior year, with gross margin rising approximately 100 basis points to 93% of net revenue.
• Operating Income -- $2.6 million, up $1.8 million compared to $0.8 million in the prior year.
• Net Income from Continuing Operations -- $0.4 million, or $0.04 per diluted share, achieving GAAP net profitability versus a loss of $0.6 million ($0.07 per share) in the prior period.
• Adjusted EBITDA -- Adjusted EBITDA was $4.3 million, up 58%, reflecting revenue growth partially offset by increased selling, general, and administrative expenses.
• Sales Team Expansion -- Sales representatives totaled 43 at quarter end, supporting increased hospital and facility penetration.
• Facility and Distribution Network Growth -- Products contracted or approved in over 4,000 hospitals and ambulatory surgery centers, sold in more than 1,400 facilities (up from 1,300+), and distributed by 450+ distributors (versus 400+ last year).
• Operating Expenses -- $23.2 million, or 83.6% of sales, up 12% due to higher SG&A, offset by decreased R&D spending.
• R&D Expense -- $0.8 million, or 2.7% of sales, down from $0.9 million (4.1% of sales), with management expecting full-year R&D spending within the 5%-7% industry standard.
• Other Expense -- $2.2 million, up from $1.4 million, primarily attributed to increased interest expense and fees related to the CRG term loan and losses from equity method investments.
• Cash and Debt -- Cash stood at $13.6 million and long-term debt at $46.2 million as of quarter end; all debt service in the quarter was paid in cash for the first time, marking progress in free cash flow generation.
• Net Cash Used in Operating Activities -- $2.5 million, up from $2 million in the prior year’s period, attributed to seasonal payments of commissions and bonuses.
• Q2 2026 Revenue Guidance -- Management projects net revenue of $28.5 million to $29.5 million, representing 10%-14% growth.
• Full-Year 2026 Guidance -- Maintained at $116 million to $121 million net revenue, signifying growth of approximately 13%-17%.
• OsStic Product Launch Timeline -- The OsStic synthetic bioadhesive bone-void filler remains on track for introduction in the first quarter of 2027 as part of the company's R&D pipeline.

Summary

Sanara MedTech (SMTI 3.01%) achieved company-record sales in March, excluding a prior quarter with hurricane-related disruption, underlining the accelerated uptake of its soft tissue repair portfolio. The company attributes its improved financial performance to a sharpened focus in the surgical market, expanded sales support, and broader facility penetration. Management noted the beneficial impact of the recently added Vizient GPO contract and a growing hospital network. Cash flow strength enabled Sanara to cover its debt service entirely in cash for the first time, which management described as a milestone. The product pipeline was cited as a key to maintaining the competitive moat, notably with OsStic expected to launch in early 2027. Management reaffirmed both its quarterly and full-year revenue guidance, citing continued demand and expectations of further sales team contributions over the calendar year.

• Management said the company is not subject to reimbursement risk, given it is 100% focused on the surgical setting. This may help stabilize revenue streams and reduce exposure to payer-driven volume fluctuations.
• The addition of the Vizient GPO contract is seen as an early driver of new facility exposure, with initial benefits recognized but further upside anticipated as training and education efforts mature.
• R&D spending was intentionally reduced in the quarter but is expected to align with the industry 5%-7% standard on a full-year basis, suggesting future investment pace may increase.
• March marked the strongest sales month in company history apart from a singular event-driven prior month, highlighting momentum into Q2.

Industry glossary

• GPO (Group Purchasing Organization): An entity that helps healthcare providers realize savings and efficiencies by aggregating purchasing volume and negotiating discounts with suppliers, such as the Vizient contract referenced in the transcript.
• DRG (Diagnosis-Related Group): A classification system used to determine how much Medicare pays hospitals for each “case,” relevant because SMTI products are included as supply costs within hospital DRG budgets.
• CRG Term Loan: A specific debt facility with CRG, a healthcare investment firm, mentioned as the source of rising interest expense.
• OsStic: A pipeline product, described as a synthetic injectable bioadhesive for treating bone-voids, under development and targeted for a 2027 U.S. market launch.

Full Conference Call Transcript

Seth Yon: Thank you, operator, and welcome, everyone, to our first quarter 2026 earnings conference call. This was a strong quarter for us, which exceeded our expectations. Q1 2026 was the first full quarter in which we were entirely focus on the surgical market. and the results reflect our sharpened focused and enhanced financial model. We delivered 19% revenue growth compared to the first quarter of 2025, margin improvement and broke through to GAAP net profitability with net income from continuing operations of $0.4 million or $0.04 per diluted share. Our first quarter revenue growth was largely supported by increased sales of our soft tissue repair products, including CellerateRX and BIASURGE.

Demand for our products is strong, and we're particularly pleased with our first quarter results given that our first quarter is historically our seasonally slowest sales period of the year. The quarter was also impacted by a 3-day related shutdown in January, which caused us to lose 3 days of shipping during this period. Despite these challenges, we closed out the first quarter with the strongest sales month in company history in March, excluding October of 2024, which benefited from approximately $1.8 million of BIASURGE sales due to the industry disruption caused by Hurricane Helene.

During the end of 2025 and continuing into 2026, we began strengthening our sales team to support enhanced net revenue growth and our heightened focus on the surgical market. At quarter end, we had grown our sales team to a total of 43 reps. In addition to strengthening our sales team, we're also very well positioned with a robust surgeon user network, a growing number of hospitals where our products are contracted or approved to be sold, a growing number of facilities where our products were sold during the quarter and a leading distributor network for our products that continues to expand. Let me dig into that a bit.

As of quarter end, our products were contracted or approved to be sold in over 4,000 hospitals and ambulatory surgery centers throughout the United States. Our products were sold in over 1,400 facilities throughout the United States, up from more than 1,300 in the first quarter of last year. And we had agreements with more than 450 distributors compared to 400 at this time last year. Also, while it's not our practice to disclose specifics related to our active surgeon user base, I'm pleased to share that we saw solid growth in the number of surgeon users on a year-over-year basis in Q1.

While most of you know this, I want to reiterate that Sanara is not subject to reimbursement risk, given we are 100% focused on the surgical setting. This means that we have lower exposure to fluctuation in the cost of volume of patient care which allows us to recognize a predictable and reliable revenue stream with consistently strong margins. Looking ahead, we believe we are well positioned with our strengthened sales team and our more refined pure-play focus on the surgical operating setting to drive growth. In terms of capital allocation, we are focused on further strengthening our home business model.

Our current capital allocation strategy is to drive organic growth judiciously invest in R&D and grow our pipeline of new products that align with our pure-play surgical focus. This includes OsStic, our licensed synthetic injectable structural bioadhesive bone-void filler which remains on track to be introduced to the market in the first quarter of 2027 as well as some longer-term initiatives that we expect to deepen our competitive moat and maintain our position as a leader in bringing innovative surgical products to market. We are encouraged by the strong start to the year and our prospects for the balance of 2026.

For the second quarter, we expect to recognize net revenue in the range of $28.5 million to $29.5 million or growth of 10% to 14% year-over-year. Looking at the full year, we also remain confident in our previously stated guidance of full year 2026 net revenue in the range of $116 million to $121 million, representing growth of approximately 13% to 17%. With that, I will now turn the call over to Elizabeth Taylor, our CFO, for a review of our financial results for the quarter. Please go ahead, Elizabeth.

Elizabeth Taylor: Thanks, Seth. Net revenue in the first quarter of 2026 increased $4.4 million or 19% when compared to the first quarter of 2025, primarily due to increased sales of soft tissue repair products including CellerateRX Surgical and BIASURGE as Seth mentioned before. First quarter gross profit increased $4.3 million or 20% from the prior year period to $25.9 million. Gross margin increased approximately 100 basis points to 93% of net revenue. The increase in gross profit and higher gross margin realized in the quarter was primarily due to increased market penetration and geographic expansion, product mix and the company's strategy to continue expanding and developing its independent distribution network in both new and existing U.S. markets.

Operating expenses for the first quarter of 2026 were $23.2 million or 83.6% of sales compared to $20.8 million or 88.6% of sales for the first quarter of 2025, an increase of $2.5 million or 12% year-over-year. The increase in operating expenses was primarily due to higher selling, general and administrative expenses, offset by a decrease in research and development expenses for the first quarter of 2026. R&D for the first quarter of 2026 decreased to $0.8 million or 2.7% of sales compared to R&D of $0.9 million or 4.1% of sales for the first quarter of 2025.

While R&D will fluctuate from quarter-to-quarter based on timing of projects, the company expects R&D on an annual basis to be within industry standards of 5% to 7% of sales. Operating income for the first quarter increased $1.8 million to $2.6 million compared to $0.8 million for the first quarter of 2025. Other expense for the first quarter of 2026 was $2.2 million compared to $1.4 million for the first quarter of 2025. The increase in other expense was primarily due to higher interest expense and fees related to our CRG term loan and share of losses from equity method investments.

Net income from continuing operations for the first quarter was $0.4 million or $0.04 per diluted share compared to net loss from continuing operations of $0.6 million or $0.07 per diluted share in the first quarter of 2025. Moving to our non-GAAP results. Adjusted EBITDA for the first quarter of 2026 increased $1.6 million or 58% to $4.3 million. The increase in adjusted EBITDA was primarily related to net revenue growth offset by increases in SG&A. Turning to the balance sheet. As of March 31, 2026, we had $13.6 million of cash and $46.2 million in long-term debt. This compares to $16.6 million of cash and $46 million of long-term debt as of December 31, 2025.

Net cash used in operating activities as of March 31, 2026, was $2.5 million compared to $2 million in the 3 months ended March 31, 2025. Notably, we paid our debt service in the quarter entirely in cash as opposed to a combination of cash and payment in kind as we have done in prior quarters. We view this as a milestone and a reflection of our improving free cash flow generation. We are particularly pleased with our working capital in the quarter and ability to pay our debt service in cash, given our first quarter historically requires a higher use of cash related to the payment of employee commissions and annual bonuses.

So this is encouraging as we progress through the year. As Seth stated, our capital allocation priorities have evolved alongside our strategic shift and focus to target and invest in opportunities in the pure-play surgical setting. Looking ahead, we believe that our strengthened free cash flow will allow us to more efficiently invest in our organic growth, which includes expanding our sales team to address more underserved geographies. With that, I will now turn it back to Seth for closing remarks.

Seth Yon: Thanks, Elizabeth. We are very pleased with our first quarter results. which serves as an encouraging early validation of our strategic shift in focus to our pure-play surgical setting. We believe that we are well positioned with a strengthened sales team and growing market presence among hospitals, facilities and distributors, a robust product pipeline and improving free cash flow generation to strategically and efficiently allocate capital to drive long-term growth and value for our shareholders. With that, operator, you may now open the call for questions.

Operator: [Operator Instructions] Your first question for today is from Frank Takkinen with Lake Street Capital Markets.

Seth Yon: Operator?

Elizabeth Taylor: Operator, can you hear us?

Operator: Yes, I can hear you. One moment, please.

Seth Yon: Yes, we lost Frank. So we only heard his intro.

Operator: Frank, your line is live.

Frank Takkinen: Can you hear me now?

Elizabeth Taylor: Yes.

Frank Takkinen: I was hoping to ask one follow-up on the first quarter. Could you maybe just break out what was the strongest contributor to outperformance, maybe was it core Cellerate execution, BIASURGE within the Vizient GPO, I'm guessing that the new reps haven't started to contribute yet, but I don't know if that's also a piece that's contributing as well. It's just great to have a little more color on Q1.

Seth Yon: Let's start with the reps, the new hires, those 3 that were mentioned in the call. So they're still kind of going through training that's both in-house and then also out into the field as well. So their impact typically takes about -- from the time of training completion about 6 months to start to realize some impact from those individuals. They've done a great job of coming in, getting educated and getting comfortable with our technologies, and we fully anticipate that group plus some others that we'll bring in before the end of the year, we'll be able to touch this business before the end of this calendar year.

From there, we've done a really nice job in bringing that clarity to the organization on just being surgically pure play. And we knew that was an important thing for us to do, and our team has responded extremely well. And even the distributor network, I think, has responded extremely well to it as well. So I mean that, coupled with strong support around Cellerate and BIASURGE -- you had mentioned, Frank, the Vizient contract. That was new to us in the first quarter. It's similar to a new hire, right? You have to go out and do ongoing training and education at the facility level, and our team is doing that.

And so we're starting to see some uptick from that, and that's really encouraging. And at the same time, Cellerate continues to be a real anchor product for us. and our team continues to: one, get wider into facilities that they've been working in for some time; and two, reaching into new facilities as well. And they did an overall really sound job of all 3 of those things in the first quarter of 2026.

Frank Takkinen: Got it. That's very helpful. And then I was hoping to ask a follow-up on guidance. I heard the comments of Q1 seasonally slowest, three-day weather shutdown, also strongest month in company history, Vizient is coming this year as well as new reps. Maybe talk through how you contemplated leaving the guide unchanged versus maybe taking it up a little bit, just given some of the tailwinds and strong execution you've had year-to-date.

Seth Yon: Yes, great question. I mean the goal is always to try to replicate Q4, right? I mean we know Q4 is just higher volume of procedures. And if you can do that in the first quarter, you stand in good ground. One of the things that we were very well aware of going into during this calendar year is in the start of 2025, we went through some reorg for the sales team in a really healthy way. to set us up for long-term success as well. And as a result of that, we probably saw a little bit of a slowdown in Q1 of 2025.

So we had a ton of confidence going into this calendar year in Q1 and to obviously go above our number in Q1 and hit 19% growth was a great achievement for our group. And then you start to look into Q2 at 10% to 14%. Again, some of that is just we knew we were going to have a really successful Q1 and Q2, kind of that blended results from Q1 and Q2 guidance really puts us right kind of at that midpoint for our overall guidance on the year.

Operator: Your next question is from Yi Chen with H.C. Wainwright.

Unknown Analyst: This is Katie on for Yi. I was wondering if you could elaborate a little bit more. You spoke of some initiatives for deepening your competitive moat. Could you give us an idea of what that looks like?

Seth Yon: There's a number of things, Katie. Thanks for the question that we continue to work on. One, we want to surround ourselves with clinical evidence on our core products, and we continue to do that at a really great rate. Two, the economic story that continued to come out and was published in the first quarter was really meaningful as well. I think hospitals have done a great job over the last many years to do a solid evaluation of their spend and the meaningfulness of the products that get brought into the OR.

And so there's 3 things that we want to make sure that we're very well aware of the clinical evidence that supports those technologies, the economic evidence as well and then to be well positioned with our ASP. We feel like we've done all 3 of those things. And then in addition to that, we're looking at things from an R&D perspective as well on product enhancements and next-gen products as well, along with IP, additional IP to support our technology. So there's a lot going on right now in way of that competitive moat space, and we feel really confident in the work that we're doing.

Operator: Your next question is from [ Christopher Viselli ] with [ Viselli ] Capital Partners.

Unknown Analyst: Just a quick one for me here. Is there any evidence that macroeconomic pressure is pressuring hospital budgets generally or the pockets of spending that covers Sanara products?

Seth Yon: Yes. Chris, listen, I think that's a great question. Like I said a couple of minutes ago, I think hospitals are doing a great job of really assessing their spend inside the OR, and we're obviously a supply cost into the DRG. But again, the things that kind of let us stand out in those moments is the evidence that supports the technologies, both clinically and economic. And we feel that we're very well positioned with our selling price as well as the hospitals. So will that work continue by the hospitals? Of course. Will we continue to build more and more of our story around that evidence? Absolutely.

And again, we think that we're very well situated given those 3 things.

Operator: We have reached the end of the question-and-answer session, and I will now hand the call back to Seth for closing remarks.

Seth Yon: Well, again, thank you so much for the questions. I just want to again thank our team, thank our distributor network, the facilities that trust us and obviously, the investor community as well. We're grateful for the opportunity, and we look forward to connecting with everybody after our second quarter's performance. Thank you.

Operator: This does conclude today -- our conference call for today. Thank you for your participation.