Prepared remarks
Good afternoon. Thank you for joining us today to discuss LifeMD's results for the fourth quarter and full year ended December 31, 2025. Joining the call today are Justin Schreiber, Chairman and Chief Executive Officer; and Marc Benathen, Chief Financial Officer. Following management's prepared remarks, we will open the call for a question-and-answer session. Before we begin, I would like to remind everyone that during this call, the company will make a number of forward-looking statements, which are subject to numerous risks and uncertainties that may cause actual results to differ materially from those projected. These risks and uncertainties are described in the company's 10-K and 10-Q filings and within other filings that LifeMD may make with the SEC from time to time. Forward-looking statements made during this call are based on current information available to the company as of today, March 9, 2026. The company assumes no obligation to update or revise any forward-looking statements after today's call, except as required by law. Also, please note that management will be discussing certain non-GAAP financial measures that the company believes are important in evaluating LifeMD's performance. Details on the relationship between these non-GAAP measures and the most comparable GAAP measures and reconciliations thereof can be found in the press release issued earlier today. Finally, I would like to remind everyone that today's call is being recorded and will be available for replay in the Investor Relations section of the company's website. Now I'd like to turn the call over to LifeMD's CEO, Justin Schreiber. Please go ahead.
Thank you, and good afternoon, everyone. After the market closed, we issued a news release announcing our fourth quarter and full year financial results and posted an updated corporate presentation on our website at ir.lifemd.com. LifeMD delivered a very strong fourth quarter and full year with solid performance across all of our business lines. We entered 2026 with over 322,000 active subscribers, nearly $37 million in cash and no debt, giving us the strongest balance sheet and liquidity position in the company's history. Across our platform, we now onboard approximately 1,200 new patients per day, and we received more than 120,000 unique daily visitors to our websites, a clear reflection of the strength of our brands and the growing demand for our services. Our weight management business alone is seeing record patient acquisition volumes in the first quarter with new sign-ups approaching 700 per day, while customer acquisition costs have declined sequentially, a combination we are very excited about. Weight management remains a significant long-term growth opportunity for us. More than 100 million Americans are clinically eligible for GLP-1 therapy, yet only a fraction have been prescribed treatment. Subsequent to year-end, we successfully launched oral Wegovy through our collaboration with Novo Nordisk, significantly expanding access for patients who prefer an oral option. We are one of the few virtual care providers fully integrated with both Novo Nordisk and Eli Lilly affiliated pharmacies, and we are optimistic these collaborations will continue to evolve and deepen. Beyond our current partnerships, we see significant pipeline opportunities with other large pharmaceutical companies and strategic partners. And we believe LifeMD's infrastructure and patient base make us a highly attractive partner in this space. Our second biggest area of focus after weight management is women's health. We have invested more resources into the launch of this offering than anything we've launched in the history of our company. We started by acquiring Optimal Human Health, a virtual concierge women's health company founded by Dr. Doug Lucas. Dr. Lucas is a former orthopedic surgeon and bone health specialist, who has built a significant social media presence with over 160,000 followers and more than 10 million views across platforms, establishing himself as a recognized authority in women's hormonal and bone health. We also partnered with Dr. Tara Scott, known as the Hormone Guru. Dr. Scott is an internationally recognized physician who is board-certified in OB/GYN, functional medicine and integrative medicine with 26 years of private practice experience and two decades of work in the menopause space. We have more advisers of this caliber joining our Women's Health Advisory Board in the weeks and months to come. As we've shared on prior calls, we are committed to building the highest quality virtual women's health care offering in the country focused on menopause, perimenopause, hormonal health and bone health. The market need is clear. Nearly 50% of U.S. counties lack an OB/GYN and 1.3 million women enter menopause each year, creating massive unmet demand for expert hormonal health care. While still early, we are seeing unit economics move in the right direction and expect women's health to be a meaningful contributor to growth in 2026 and a major driver in the long term. Upcoming catalysts include the launch of insurance and Medicare support for our women's health offerings, pharmacy bundles that combine GLP-1, hormone and other therapies and strategic media and influencer programs in the pipeline for later this year. Turning to men's health. Our RexMD brand, now with approximately 215,000 active patients, returned to growth in the second half of 2025 and continues to perform strongly on a profitable basis. We are focused on expanding RexMD's clinical offering beyond its core sexual health programs into other personalized generic and compounded medication categories. In the last week, we launched the RexMD integration with NovoCare and now offer injectable and oral Wegovy directly to RexMD patients. We are launching five new men's health care offerings and treatments from our pharmacy in the first half of 2026 in areas including insomnia, erectile dysfunction, dermatology and topical pain relief. Further, we are closely following FDA guidance on peptide therapies and are prepared to launch those that are permitted to be compounded and are supported by strong clinical data. A key enabler across all these verticals is our affiliate pharmacy, which is now licensed in all 50 states and processing approximately 20,000 prescriptions per month. With our recently licensed 503-A compounding operation, we have the ability to produce personalized compounded medications at scale, supporting our efforts across men's health, women's health and other specialty verticals. We view our pharmacy infrastructure as another growth driver for the company with the potential to meaningfully expand margins and deepen patient engagement across the platform. In March, we beta launched a 30-state virtual cardiology offering. This program allows new and existing LifeMD patients to book a cash pay or insurance covered visit with board-certified cardiologists from the comfort of their home. Our affiliated cardiologists can treat a range of conditions in a virtual environment, prescribe and manage medications and provide diet and lifestyle care plans. Importantly, the diagnostics and care delivered to this program are driven by an AI-supported intake process that pulls in the patient's medical history from a health information exchange and synchronizes it with biomarker data from labs and information provided during patient intake. The result is a significantly more efficient experience for the cardiologist, an enhanced experience for the patient and most importantly, improved clinical outcomes. I am excited to see this program scale, and I believe it will serve as a blueprint for how we triage, diagnose and treat patients across our entire platform in the years to come. Let me now review our infrastructure priorities for 2026. We are focused on three areas that we believe will meaningfully accelerate growth and operating leverage across the business. First and most importantly is artificial intelligence. We have built a dedicated world-class AI and engineering team inside LifeMD that is focused exclusively on deploying advanced agentic AI capabilities across care delivery, diagnostics and patient operations, supported by strong governance controls. This is not something that we are outsourcing or experimenting with on the side. It's central to our strategy and is embedded throughout our platform today. In the first half of this year, we plan to launch our AI clinical decision support tool. As I mentioned with our cardiology offering, this tool connects directly to a patient's medical record, pulls in data from health information exchanges and integrates biomarker data from labs to support diagnosis and personalized treatment recommendations of our affiliated providers. We expect our AI clinical decision support tool to drive new patient acquisition, improve the efficiency of message-based and synchronous consults and enable even more patients to access the industry-leading care provided by our affiliated clinicians. One area where we see particularly high demand is personalized prescribing, especially with compounded medications. Our AI tools will be able to analyze a patient's clinical profile, lab results and treatment history to help providers design highly individualized compound formulations tailored to each patient's specific needs. When you combine that capability with our 503-A compounding pharmacy, you get something that is very difficult to replicate: AI-driven personalized medicine manufactured and fulfilled in-house at scale. We believe this intersection of AI and pharmacy is a major differentiator and will drive both better patient outcomes and improved unit economics across the platform. We believe LifeMD will be a leader, if not the leader, in delivering urgent and specialty health care using AI. The combination of our proprietary technology, our 50-state affiliated medical group, our pharmacy infrastructure and the structured clinical data we have accumulated from over 1.3 million patient consults gives us what we believe is one of the most compelling AI-enabled care platforms in virtual health. Beyond the clinical side, we are embedding AI and automation deeper into our operational workflows, enabling us to handle significantly more volume without proportional increases in overhead. We see a clear path to substantially improving our G&A efficiency throughout 2026 and we expect these investments to be a meaningful contributor to margin expansion as the year progresses. Our second infrastructure priority is benefits. Today, our platform covers over 110 million lives through commercial and government payer contracts. By the end of the second quarter, we expect that number to grow to over 220 million lives through an expanded partnership with a leading third-party benefits partner. This is a critical competitive advantage. When patients are able to use their insurance on our platform, we've seen customer acquisition costs decline by as much as 30% plus we expect meaningful improvements in retention in this population. As we layer insurance enablement across weight management, women's health and primary care, we believe this infrastructure will be a significant long-term differentiator for LifeMD. The third infrastructure priority is our technology platform. We are investing in building a true platform experience for our patients, one that is architected to incorporate emerging AI capabilities and insurance benefits infrastructure in a way that feels invisible to the patient. This means rethinking how our platform is built at a foundational level, modernizing our underlying systems, creating flexible integration layers and designing patient-facing workflows that can seamlessly absorb these technologies without adding complexity. Today, AI tools and benefits verification exist largely as point solutions that sit outside of the core patient journey. Our goal is to enhance the platform so these capabilities are native to the experience woven into how patients access care, communicate with their providers and manage their treatment. Getting the architecture right is what makes a seamless patient experience possible at scale, and it is what will allow us to move quickly as both AI and the insurance landscape continue to evolve. We made meaningful progress on this in 2025, and it remains a top priority in 2026. In summary, LifeMD entered 2026 from a position of strength with record demand in weight management, a diversifying specialty care platform, a scalable pharmacy operation, deepening pharmaceutical collaborations and the financial flexibility to invest aggressively in growth. We are confident in our growth trajectory and excited about the road ahead. With that, I'll now turn the call over to our CFO, Marc Benathen, to provide more detail on our fourth quarter and full year financial results and outlook. Marc?
Thank you, Justin, and good afternoon, everyone. Our fourth quarter results were very strong and ahead of our previous guidance, driven by outperformance in all areas of the company. During the quarter, we added over 13,000 net new subscribers to our patient subscriber count. This was the largest net gain of any quarter in 2025 and is reflective of the strong business momentum as a result of LifeMD making significant inroads with the penetration of branded therapy within our weight management subscriber base and a consistent multi-quarter return to sequential growth in our men's health business. To date, in the first quarter, we have seen this momentum continue and even accelerate in the first quarter of 2026 with GLP-1 patient new sign-ups at record levels and over 80% of new patient sign-ups going on branded therapy. We are leveraging our pristine balance sheet to invest in accelerating the acquisition and onboarding of patients to best position us for long-term growth and significant momentum in the back half of 2026. Now turning to the fourth quarter numbers. Revenue grew 4% versus the year-ago period to $46.9 million. Telehealth subscriber growth remains strong with the number of active subscribers increasing 16% year-over-year to nearly 323,000 at quarter end. Gross margin for the fourth quarter was 87.1%, an expansion of 570 basis points versus the prior year due to revenue mix and increasing operational efficiency as we scale. Gross profit was $40.8 million, an increase of 11% from the year-ago period. Our GAAP net income attributable to common stockholders for the fourth quarter of 2025 was $19 million or $0.41 per share. This figure includes the one-time benefit from the sale of WorkSimpli last November. Excluding this one-time gain, our GAAP net loss from continuing operations was $1.9 million or $0.04 per share. This compares with a GAAP net loss from continuing operations for the fourth quarter of 2024 of $6.8 million or a loss of $0.16 per share. Adjusted EBITDA is a non-GAAP measure we define as income or loss attributable to common shareholders before various items as outlined in today's news release. Adjusted EBITDA totaled $4.8 million for the fourth quarter of 2025, up from $1.1 million in the year-ago period. Now turning to the full year numbers. Revenue grew 25% versus the year-ago period to $194.1 million. Gross margin for 2025 was 85.7%, a slight decrease of 50 basis points versus the prior year due to mix. Gross profit was $166.3 million, an increase of 25% versus 2024. Our GAAP net income attributable to common stockholders for 2025 was $11.2 million or $0.25 per share. This figure includes the one-time benefit from the sale of WorkSimpli. Excluding this one-time gain, our GAAP net loss from continuing operations was $13.3 million or $0.30 per share. This compares with a GAAP net loss from continuing operations for the full year 2024 of $26.3 million or a loss of $0.64 per share. Adjusted EBITDA totaled $15.3 million for the full year 2025 as compared with $3.7 million in the year-ago period. We exited the fourth quarter and full year 2025 with $36.8 million in cash and no debt. Turning to financial guidance. We expect first quarter 2026 revenue in the range of $48 million to $49 million with adjusted EBITDA loss in the range of $4 million to $5 million. This expected loss is purely being driven by record volumes of approximately 700 new patient sign-ups a day in our GLP-1 weight loss business amidst significant demand for our branded and oral therapy business. We see this discretionary investment as a major driver for potential growth in the coming quarters. At the same time, we have achieved this record demand with a 4% sequential decline in CACs within this business line. Our very strong balance sheet allows us to easily finance this investment. LifeMD plans to return to adjusted EBITDA profitability in the second quarter following this investment. For the full year 2026, we expect revenue of between $220 million and $230 million and adjusted EBITDA between $12 million and $17 million. By the fourth quarter of 2026, we expect our annualized run rate for revenue to exceed $250 million and for adjusted EBITDA, our annualized run rate to exceed $25 million.
Thanks, everybody. I think now we'll open up to questions.
Questions and answers
Please proceed with your questions.
Congratulations on the good quarter and the good year. Can you talk a little bit about the demand you're seeing for the Wegovy pill and the brand products? How does that compare to, say, 3Q and 4Q of 2025 heading into 1Q of 2026?
Dave, this is Justin Schreiber. I'll take that one. The demand, as we mentioned on the call, has been very strong since this product launched in early January. If you compare it, we nearly doubled new patient acquisition in the weight loss business, and a lot of that was driven by the Wegovy pill. We also saw really encouraging unit economics, which is why we decided to spend more on new patient acquisition in this area.
Okay. And then when you say patient or unit economics, can you expand a little bit on that? What is the revenue model for the Wegovy pill? Is it being priced at like $150 a month, which I think is the cash-pay price that Novo charges? Any additional color like gross margins on that product would be very helpful.
Yes. So David, it will depend upon dosage. But typically, it's at a $249 a month price all in as a bundle and can move up from there. The gross margins are healthy. We're in approximately $100 an order or so in margin, which is pretty healthy. We treat it from an accounting and financial statement standpoint similar to how we've treated other bundled relationships and recognize the net amount into the P&L, which is driven by the margin since essentially the product today is a pass-through. The margin that we make is on the additional services that we provide to our patients. So it's very similar economics to what we've seen on branded injectables, which are strong economics that have multifold returns on a three-year basis.
Okay. That's great. And then any more color on the investments you're going to be making in Q1 of 2026 that are going to create that sort of EBITDA margin phenomenon?
Yes. The big increase is going to be in the sales and marketing line. In 2025, we were typically around $20 million to $22 million in sales and marketing within the telehealth business. We're going to be in the $30 million to low $30s in the first quarter, but that's with CAC reducing sequentially about 4% to 5% and volumes doubling, which is impressive that we're able to drive that much more volume with reduced CAC. Because of the volume, it's going to drive incremental dollars. Those dollars will pay back to us in the coming quarters, particularly in the back half of 2026. Given the demand out there and where LifeMD is positioned in the market, our insurance capabilities, we collectively believe it makes a lot of sense to capitalize upon that.
Okay. And just one last quick one before I hop back in the queue. The ramp in revenue — I think you're talking about maybe $63 million in revenue in the fourth quarter — it's a pretty good ramp from Q1. What will be the drivers of that increase as we progress through the year, please?
Predominantly subscriber count growth. It's mostly going to take place in the GLP-1 weight business, growth in the women's health business, which is at its infancy, and the Rx business, which is back to sequential growth and will continue to be a consistent grower. Those will be the three areas, and you'll see it in subscriber count growth as we move throughout the year.
We'll move now to Sarah James with Cantor Fitzgerald.
Congrats on a great quarter and exciting outlook. There's a lot of growth levers here to unpack. I want to stick on the topic of the run-rate revenue and earnings. Can you help frame up when you're getting to that $25 million annualized EBITDA by exiting 2026? How much of that growth is coming from women's health versus weight management versus cross-care pharmacy? What are the main drivers there in 2026?
Sarah, first, when we launch a new offering like women's health, we generally breakeven on unit economics around the six- to seven-month mark, sometimes sooner or a bit later. As you scale into that business, it won't be EBITDA positive on a consolidated basis in the first year. It will add revenue, likely around $10 million on a full year basis with run-rate being higher by the fourth quarter, but you won't see EBITDA positivity for that offering in the first year. Where the EBITDA accretion comes this year is from our more mature men's health and weight management businesses, continuing to scale subscriber count across highly leverageable fixed costs. We are making a discretionary marketing investment now, particularly in weight management and to a lesser degree in men's health. That is where a lot of the accretion will happen this year. Women's health will be in a great position at the end of the year, probably slightly accretive on a run-rate basis and then significantly accretive in 2027.
Great. That's helpful. On women's health, when you think about early performance versus your entrance into weight management or Rex, how is women's health comparing on CAC, conversion to care plans, early retention? What does the ramp look like versus other markets you've entered?
Sarah, it's Justin. From a CPC basis, we've seen higher intent for these offerings than anything we've ever launched, which is encouraging on the marketing side. We've struggled a bit on conversion and have put enormous energy into improving that. We've invested heavily in our brand, assets and advisers for the women's health program. We're starting to see the benefits: we've cut the CPA by approximately half over the last 30 days, and there's still room for improvement. There's an enormous amount of demand. Our pharmacy products, including compounded hormone therapies, are priced very competitively given the quality of our offering. Early therapy and retention rates are strong — initial on-therapy and retention rates are north of 80%, which is very promising. It's early, but the initial numbers are really good and the team is excited.
We'll take our next question from Steve Dechert with KeyBanc.
Congrats on a solid quarter. Just wondering the level of stickiness you're seeing with people on the Wegovy pill versus the injectable? And if that is a higher stickiness level, given it is early, how much is that factored into your 2026 guidance?
It's a little early, as you said, to understand long-term retention. We have taken a conservative stance on this. We've seen strong on-therapy rates, likely driven by patients who come knowing they want the Wegovy pill, qualify for therapy and are willing to pay cash. The interim price for the drug is $149, which is an attractive price point. Initial retention rates are better than the injectable, but long-term retention is still to be determined.
Okay. And then just on your weight management platform compared to competitors. We've had Lilly announce a weight management offering and Amazon announce a direct-to-consumer offering. How does your platform compare to some of these competitors?
There are a couple of big differentiators. We operate our own 50-state provider group staffed mostly with full-time providers who are highly trained and specialize in their practice areas, such as women's health and weight management. That's a significant differentiator versus companies that rely on third-party provider networks. We're a platform for care with multiple specialty offerings: women's health, weight management, hormone therapy, behavioral health and psychiatry. Patients can access synchronous care — video or audio visits — with providers who work for LifeMD's affiliated medical group, not 1099 providers from a third-party staffing business. Those factors, along with our pharmacy products and integrations, are core differentiators. It's a big market and different customers will use different providers, but we're seeing strong demand for LifeMD services and pharmacy products, and recent competitive launches haven't materially impacted our business so far.
We'll take our next question from Ryan Meyers with Lake Street Capital Markets.
First, thinking about the patient acquisition channels you're investing in for Q1, are you going after any different marketing channels? Is the marketing strategy any different here, or similar to what you've done in the past?
It's mostly similar to what we've done historically. We do have some new media partnerships that have performed very well and delivered thousands of new patients. We also piloted programs with several smaller employers in the last 30 days, and feedback has been excellent. We're working on other significant partnerships with very large companies that could be transformational if finalized. We have a very active pipeline of opportunities that could drive patient acquisition in the next 60 to 90 days.
When you think about the benefits infrastructure covering over 220 million lives by the end of Q2, how does the potential lifetime value of a covered patient compare to a cash-pay patient? Is there a big difference?
It's a great question. I don't have a precise answer yet because the insurance business for us is still new. I believe retention will be stronger for patients who use insurance or Medicare on the LifeMD platform and pay a co-pay or lower membership fee versus cash-pay patients. We expect better LTVs and better retention, but we still need to prove that out. We were surprised by the demand for insurance when we turned it on in a limited capacity recently; it had a meaningful impact on CPA. We need to work out billing kinks and gather more data to clarify long-term value, but the early signals are promising. We expect the business to shift more toward commercial and government insurance patients over coming quarters, and we'll report more detail on this in future periods.
We'll move now to Yi Chen with H.C. Wainwright.
This is Eduardo on for Yi. Could you reiterate total number of subscribers and detail how many of them came on specifically for the Wegovy pill? I'm curious if you're seeing migration from patients who were on the injectables to the pill, or is it primarily new customers signing up for the oral drug?
We have 322,000 overall subscribers. Approximately 80,000-plus are weight management subscribers, as indicated in the updated presentation posted on our Investor Relations website today. We haven't released the exact count for oral Wegovy pill subscribers; demand has been very strong but the product only started selling in January. We're seeing some migration, but oral Wegovy is driving a lot of new patient demand for us. We will include more detail in future updates.
Going to the pharmacy: now that you're 50-state licensed, what percentage of RexMD and Shapiro MD fulfillment is handled in-house, and what's the incremental margin lift with in-house fulfillment?
We are approaching the 70% mark with in-house fulfillment. The margin lift is in the range of 150 to 200 basis points from internal fulfillment. Beyond margin improvement, the long-term benefit is flexibility, especially for personalized and 503-A compounded products that we can now produce in-house to support lifestyle and specialty conditions.
Would you detail any additional drugs you are considering compounding and bringing into your offering that you think would be key growth drivers for the pharmacy?
We have a strong internal roadmap for additional products, but we're not at liberty to detail that at this moment.
At this time, there are no further questions in queue. I will now turn the meeting back to Justin Schreiber for closing remarks.
Thank you, everyone, for your questions and for your interest in LifeMD. We look forward to speaking with you once again when we report our first quarter results. Have a great evening.
Thank you. This brings us to the end of today's meeting. We appreciate your time and participation. You may now disconnect.