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Students, welcome to the electroCore first 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 first quarter ended March 31, 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 to any guidance, the company's outlook on second 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, May 6, 2026. Joining us on today's call from electroCore are Dr. Thomas J. 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 Michael Fox, recently appointed Chief Operating Officer. It is now my pleasure to turn the call over to Dr. Thomas J. Errico, electroCore's Founder and Independent Chairman, for opening remarks. Dr. Errico.

Thank you, Amanda. Good afternoon, everyone, and thank you for joining electroCore's first quarter 2026 earnings call. This is the first earnings call since we announced our leadership transition, and I want to take a moment to share how encouraged I am by the progress we have made executing that transition and by the momentum we continue to see across the organization. Since stepping into the role of Interim President, Josh has provided steady, disciplined leadership while maintaining his focus on financial rigor. The alignment between our operational priorities and our financial strategy has been evident, and the organization has responded with focus and urgency. The strategy has not changed. The execution has not slowed. If anything, the focus across the organization has sharpened.

At the same time, Michael Fox joined us as Chief Operating Officer on April 13th, bringing more than 35 years of commercial leadership experience across complex healthcare markets, including extensive work within the federal systems and the U.S. Department of Veterans Affairs. In just three weeks, his depth of experience has already provided valuable insights to strengthen our execution, particularly as we continue to expand our presence within complex government channels. He will introduce himself shortly. Importantly, this transition has not slowed us down. It has reinforced our foundations. We remain firmly committed to our strategy, driving growth within our covered entities, advancing our clinical and scientific leadership in non-invasive vagus nerve stimulation, and expanding our reach into the consumer wellness market. We are doing so with discipline, managing the cost base, expanding the margin, and projecting our path to profitability.

In our clinical work, we continue to invest in the evidence base that underpins our portfolio. That evidence remains a key differentiator as we engage with providers, payers, and partners globally as well as domestically, and it positions us to expand into new indications over time. In the VA, where we have built a credible commercial presence over many years, we believe we have a meaningful long-term opportunity. Our commercial leadership is leveraging Mike's experience to identify new ways to be more targeted and more effective, particularly within a system where we still have a substantial room to penetrate. On the consumer side, we are building a scalable direct-to-consumer channel with increasing brand visibility, improving unit economics, and a growing network of influencer and affiliate partners that resonate with audiences seeking non-pharmacologic, science-backed wellness solutions.

The early traction we are seeing reinforces our belief in the broader applicability of our technology and its relevance to everyday wellness. What gives me the greatest confidence is not just the program itself, but how it is being achieved with discipline, alignment, and a clear sense of purpose across the organization.

We are building a strong foundation. We are doing so in a way that positions the company for durable long-term growth. While our search for a permanent CEO continues, I am confident that the team we have in place today, Josh, Mike, and the broader leadership group, is the right team to execute against our priorities and carry our strategy forward. I look forward to updating you on our continued progress in the quarters ahead. With that, I would like to introduce our new Chief Operating Officer, Michael Fox. Mike?

Thank you, Tom. Good afternoon, everyone. I joined electroCore for one reason. I saw a science-based platform technology with proven published clinical outcomes data that support a credible commercial foundation and significant room for growth, particularly within the federal channels where I've spent most of my career. Three weeks in, that conviction has only strengthened due to my greater exposure to the existing and future data sets being gathered. I also have the opportunity to meet a vast number of talented colleagues within the company who are dedicated to the mission and the patients we serve. Rather than walk through my background, let me tell you what I've been focused on and where the opportunity exists. The major priority is the VA and Department of Defense markets. We have just scratched the surface of penetrating in the addressable VA headache market.

Though we have patients being treated with our products in VA medical centers across the country, we're not attaining the utilization level that meets the needs of our veterans and the dedicated providers caring for these military heroes. The majority of new patients identified and prescribed our products in Q1 are not spread across the country as expected or needed. That tells me two things. One, we have built real distribution. Two, we are nowhere near saturation. My focus is moving from facility breadth to facility depth. More prescribers per site, more patients per prescriber, and more consistent customer experience across the system. My second priority is the broader federal channel. The VA is our largest entry point, it is not the only one. The Department of Defense, across all service branches, represents an underdeveloped opportunity for both our prescription products and for TAC-STIM.

Given the heightened tempo of U.S. military operations abroad, the demand environment for non-invasive, drug-free, performance-supporting solutions has only intensified. I spent the last three and a half decades building relationships in these channels, and I intend to put them to work for this company. My third priority is operating discipline. Josh and the team have built a high margin business. 87% gross margin in Q1. You're starting to see operating leverage show up in the numbers. My job is to make sure that as we scale, incremental revenue translates to incremental bottom line, not incremental cost. We intend to grow this business efficiently while we establish electroCore as a partner of choice to ensure market stability in the years ahead. I'm three weeks in, but trust that my experience in developing company growth and success is from decades of learnings and proven execution strategies.

I'm truly excited about the opportunity presented to me here at electroCore. There will be much more for me to share over the coming quarters, but I am convinced that what is in front of us is real, and I'm truly grateful to be a part of it. With that, I will turn the call back over to Josh to walk through the quarter. Josh?

Thank you, Mike. Before I get into the details, let me tell you what this quarter represents for electroCore. We just delivered our highest revenue quarter ever, $9.6 million, up 43% year-over-year. Gross margin expanded to 87%. GAAP net loss was $5.3 million, and adjusted EBITDA loss improved by 24% to $2.3 million. That combination, accelerating top line, expanding margin, and improving adjusted EBITDA loss in the same quarter, is demonstrating operating leverage, and it is the clearest signal yet that we are executing on our strategy. We are reaffirming our full year 2026 revenue guidance of approximately 30% growth. As I'll discuss in a moment, the catalysts in front of us for 2026 give us conviction in that outlook. Now to the details.

The VA hospital system remains our largest customer, and growth there continues to accelerate. Prescription device revenue increased 48% year-over-year to $7.9 million. Within that, prescription gammaCore grew 26%, and Quell sales surpassed their first million-dollar quarter. Since we acquired the Quell assets from NeuroMetrix in May 2025, Quell Fibromyalgia has generated $2.5 million in cumulative revenue, and we are still in the early stages of placing that product across the VA system. As of March 31st, approximately 15,000 VA patients have received a gammaCore device, which we estimate represents roughly 2.5% penetration of the addressable VA headache market. The underlying patient population continues to expand.

A 2024 study published in JAMA Network Open of nearly 500,000 U.S. veterans found that 8.2% of male and 30.1% of female veterans report a history of migraine, roughly 3 times the rate observed in the civilian population. That approximately half of veterans with migraine also meet criteria for PTSD. The U.S. Department of Defense has reported more than 485,000 service member traumatic brain injury diagnoses since 2000. Combining the, with the Veterans Health Administration's emphasis on non-opioid first line treatment for chronic pain, we believe the runway for prescription gammaCore adoption inside the VA is long. We are still early. Turning to our consumer wellness channel.

Revenue reached $1.6 million in the quarter, up 44% year-over-year, with Truvaga contributing $1.5 million, up 38% from Q1 of last year. This quarter, we deliberately tempered top line growth in favor of efficiency. The results are showing up in the unit economics. Our return on advertising spend or ROAS was approximately 2.37 in the period, a 14% improvement over prior quarter. In plain English, every dollar we spent on Truvaga related media generated nearly $2.37 of revenue. That improvement was driven by a concentrated shift toward affiliate and influencer partnerships that reach consumers already interested in wellness and in vagus nerve stimulation specifically. Return rates remain in the 12%-15% range, consistent with prior periods. We believe the macro environment for our consumer wellness offering is meaningful.

The Centers for Disease Control reports that approximately 24.3% of U.S. adults experienced chronic pain in 2023, up from 20.4% in 2019. Independent industry research projects the global non-invasive vagus nerve stimulation segment will expand at a low double-digit CAGR through 2030, supported by aging demographics, the regulatory and clinical pivot towards non-opioid pain management, and rising consumer awareness of the vagus nerve. We believe Truvaga is well-positioned to capture a meaningful share of that growth. On to TAC-STIM, our human performance product. While quarterly TAC-STIM revenue has historically been variable, the underlying demand environment for cognitive performance and fatigue mitigation in the active duty military and federal channels is robust and getting more robust.

Given the heightened tempo of U.S. military operations abroad, particularly around remotely piloted aircrafts, drone defense, and other extended duration mission profiles, the need for non-invasive, drug-free solutions to support warfighter alertness, focus, and resilience has only grown. TAC-STIM is the subject of ongoing research and evaluation across U.S. Air Force Special Operations Command, U.S. Army Special Operations Command, and the Air Force Research Laboratory. Was previously selected by AFRL for inclusion in the real-time Assessing and Augmenting Cognitive Performance in Extreme Environments program. A program designed in part to support multi-day transoceanic operations and long duration remotely piloted aircraft missions. With Mike now leading our commercial operation, we see a meaningful opportunity in 2026 and beyond to deepen our engagement and to pull TAC-STIM through as a more consistent revenue contributor. Now to the financials.

Net sales of $9.6 million represented 43% growth over prior year, driven by gammaCore and Quell within the VA and continued growth in Truvaga. Gross profit was $8.4 million with growth margin expanding to 87%. A 200 basis point improvement year-over-year. Research and development expense was $740,000, up modestly from the prior year, primarily reflecting work on the Acacia PTSD study. Selling, general and administrative expense was $12.9 million. That number includes approximately $1.9 million of non-recurring leadership transition costs and $300,000 of legal expense related to the ongoing IP litigation. Excluding those items, the year-over-year increase was driven by approximately $1.6 million of variable expense, supporting our $2.9 million revenue increase.

A clean illustration of how the cost base scales with the top line. Other expense of $276,000 includes interest associated with the convertible term debt financing we put in place with Avenue Venture Opportunities Fund. GAAP net loss in the first quarter was $5.3 million compared to $3.9 million in the prior year period. This increase was driven primarily by the $1.9 million in non-recurring leadership transition costs. Net loss per share was $0.59 compared to $0.47 per share in the same period last year. Excluding the leadership transition expenses, net loss per share was $0.37. Now I want to draw your attention to the 24% improvement in our adjusted EBITDA loss, which I believe is an important indicator of the operating leverage we are building.

Adjusted EBITDA loss for Q1 was $2.3 million compared to $3.1 million a year ago. That improvement happened in a quarter where we absorbed $1.9 million of non-recurring leadership transition expenses. Strip those out, and the operating leverage in this business is even more evident. Revenue grew 43%. Adjusted EBITDA loss narrowed 24%. As we scale further, that gap is what gets us to profitability. A reconciliation of GAAP net loss to non-GAAP adjusted EBITDA net loss is provided in the financial tables in today's press release. Turning to the balance sheet. Cash, cash equivalents and marketable securities were approximately $8.8 million at March 31, 2026, compared to $11.6 million at December 31, 2025. One important note on cash. Q1 is historically our highest cash burn quarter of the year.

This year, certain working capital items, primarily the timing of inventory and capital improvements to our Rockaway facility, may extend a portion of that burn into the second quarter. We are managing the balance sheet with discipline and remain focused on the operating efficiencies that support our path to profitability, while also evaluating available capital resources, including our existing shelf registration statement and at-the-market facility. Before we open the call for questions, I want to spend a minute on the catalysts ahead of us in 2026, because the runway from here is significant. First, R&D and NVNS as a platform technology. We continue to work towards platform of products that can be sold through our established sales channels. This comes in the form of indications, products, and features. The body of evidence supporting the therapeutic potential of NVNS continues to expand.

A new publication in Frontiers in Neuroscience entitled Adjunctive Non-Invasive Vagus Nerve Stimulation for Chronic Mild Traumatic Brain Injury with Comorbid Post-Traumatic Stress Disorder: A Post-Hoc Analysis, highlighted findings on the potential benefits of adjunctive non-invasive vagus nerve stimulation in patients with mild traumatic brain injury and PTSD. Additionally, approximately 20 participants have enrolled in a clinical study conducted by Acacia Clinics in collaboration with the Vagus Nerve Society, designed to evaluate the safety and effectiveness of electroCore's gammaCore NVNS device as an adjunctive treatment for symptoms associated with PTSD. PTSD is a breakthrough device designation for us. As the data matures, we expect it to become an increasingly important part of the platform story. Work on our next generation Truvaga and Quell mobile platform is underway.

We are developing a mobile application designed to complement our consumer products, deliver more personalized features and user experiences, and, if done right, open the doors to recurring revenue, deeper engagement, and richer real-world data. Second, we remain focused on opening additional commercial channels for our products. Beyond continued VA penetration, Mike's mandate includes expanding our commercial and federal channel presence. This includes areas such as Kaiser, Federal Workers Compensation programs, TRICARE, and broader adoption within active duty military and the Department of Defense. With TAC-STIM already engaged across Air Force Special Operations Command, Army Special Operations Command, and the Air Force Research Laboratory, we see meaningful opportunity for additional federal contract activity. Quell continues gaining adoption through our current sales channel and primarily within the VA.

Sales of the Quell product line surpassed $1 million in quarterly revenue for the first time in Q1 2026, bringing cumulative Quell revenue to approximately $2.7 million since the acquisition from NeuroMetrix in May 2025, including $2.5 million of Quell Fibromyalgia sales in the VA. We have a small cohort of legacy Quell over-the-counter users and expect to relaunch the over-the-counter Quell Relief for lower extremity pain later this year. Earlier this year, in January 2026, we launched Truvaga in the U.K. As that business scales, we expect to evaluate additional markets. Third, perhaps the most important catalyst of all, our path to profitability. The math is straightforward. Mid-80s gross margin, accelerating top line, increasingly disciplined cost base.

We are not yet ready to provide a specific quarter for breakeven, but that trajectory is clear, and Q1 is the strongest evidence yet that we are on it. Taking together, these catalysts underpin our reaffirmed full year 2026 revenue guidance of approximately 30% growth, which translates to roughly $9 million-$10 million of incremental revenue versus our $32 million in 2025. We expect the majority of that growth to come from continued VA prescription growth, where Q1 alone delivered prescription device revenue of 48% year-over-year. Truvaga, growing in the high 30% range and improving in efficiency, is our next meaningful contributor. Quell Relief and our international launch represents newer contributions that we hope to scale through the back half of the year. TAC-STIM, while historically variable, represents potential upside as Mike deepens our federal engagement.

Our next generation mobile platform is a 2027 contributor that opens the doors to recurring revenue over time. In short, 3 catalysts, a clear 30% growth bridge from 2026 and a longer runway into 2027 and beyond. With that, I would like to open the call for questions. Operator?

Thank you, Josh. We will now open the call for Q&A session. For those joining via Zoom, there are two ways to participate. First, you may raise the 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. Okay. Our first question comes from Jeff Cohen at Ladenburg.

Hi.

Destiny.

Can you hear me okay?

Oh, is this Destiny?

Yes. Hi, this is Destiny on for Jeff. Thank you for taking our questions. I just wanted to touch on the VA channel a little bit, and this is gonna be a multi-part question, but I'm wondering, as you move away from breadth and more towards depth in this channel, could that and does that change the structure of your sales force in terms of W-2 versus 1099? How are you balancing expanding into new sites versus additional patient treatment, or additional patients treated, I should say?

Hey, Destiny. Thanks so much for the question. Really appreciate it and appreciate you being on the call today. You know, I think the best person to answer that question would be Mike. Mike, why don't you jump in and let everyone know what your strategy is?

Yeah. Thanks, Josh. I think the question is a really good one because I don't believe it's an either/or. In my experience, we definitely want to expand breadth. We do have VA utilization across the country, but the depth in various specialties and within various patient segment groups is not where it needs to be. I'm a fan of the 1099 model. I'm a fan of the W-2 model. In my history, as long as we have strong performers that are aligned to the strong mission to help our veterans, we can build a really strong opportunity around that.

I don't see this being a big change as much as just an internal alignment focus and opportunity for us to ensure that we're setting appropriate expectations and really holding people accountable to exceeding those expectations for both our gammaCore and the Quell. Destiny, does that answer your question?

It does. I think I would also just be curious, what is your target for number of clinics for the end of 2026? Perhaps a range from that 200 number.

That depends on When you say clinics.

Medical centers. Sorry.

Yeah, the VA medical centers, depends on what number you wanna utilize. I've always been in the belief that we're not helping at least 75% of the facilities across the country help the vets, we're not doing our job. I don't know about an exact number, but we need to get really active and have consistent utilization of our products in treating veterans in at least 75% of those counts on a monthly basis.

Got it. As you go into these other DoD channels, how does that process compare to the VA centers? Is it similar in terms of timing?

It probably will be a different story altogether because, as you know, they're both under FSS, but the Department of Defense accounts, like the military health centers, that also include the TRICARE component. There's different segments, but from a timeline perspective, the VA usually takes a long time to get things established due to FSS and working with our customers, like Global Government Services for some things. On the Department of Defense side, I would expect by sometime 2023, 2024, with our plan in place that we'll start seeing additional revenue.

Okay, that's really helpful. Thank you. I guess transitioning over to wellness and Truvaga, you have really strong ROAS this quarter, which I think is fantastic. I'm just wondering if there were any changes to the marketing channels that played into that stronger ROAS.

Yeah, I'd say that's a great question. It's not so much a change in the marketing channels, it's more a function of where we're deploying and investing our resources. We made a more concerted effort to work on affiliate programs and influencers. You may have seen that Miranda Kerr posted about us earlier. That's a co-marketing opportunity that we have. Those are opportunities where what we can do is utilize and leverage the marketing budgets of other people so that they're actually the ones that are putting out there the marketing messaging, and really what we're doing is using that halo effect to help lift our efficiency. It's not so much a change per se. I wouldn't say that we cut out any of the other channels or media that we've done before. We're just reallocating the resources and looking at it slightly differently.

Okay. Have you noticed any differences in repeat purchase behavior or anything of that nature compared to last year?

Not yet, but we also haven't given any, you know, formal guidance on that either. I would say not yet for the, for the time being. Everything seems to be, you know, business as usual.

Got it. All right. That does it for me. Thank you for taking the questions and great quarter.

Thanks, Destiny.

Thank you.

Okay, our next question comes from Fozia Ahmed from Brookline.

Fozia, we're trying to unmute you.

Hi. Can you hear me?

Yes.

Hey, Fozia.

Perfect. Give me one second. All right. First, Mike, thank you for joining the call and coming on board. We look forward to engaging with you. My question is on the Frontier study on PTSD patients, which was very compelling. I was wondering if you can just remind us how this study is aligned with the ongoing Acacia trial. Is it set up the same, whether the outcomes are actually designed to capture the same kind of outcomes that were published in Frontier or something different?

It's something slightly different. Both of them are there to capture patients with PTSD and the effects of utilizing non-invasive vagus nerve stimulation on patients with PTSD. The actual protocols themselves are slightly different. You can look those up on the IRBs if you'd like. In essence, the idea here is how do you aggregate different data points that have PTSD as being tested to a patient population, but the populations themselves may be slightly different.

Okay. Then I have a follow-up question. You know, there's a breakthrough designation attached with PTSD. Are there any ongoing discussions with the FDA at this point?

You know, in previous quarters, we've given information and spoken about how we've gone back and forth with the FDA in terms of the best way to approach expanding the breakthrough designation to what would be a formal PTSD label. What we're doing with a lot of the work now for primarily with the Acacia study, and what you just referenced a moment ago, is really aggregating more data points and information that we can bring to the FDA to have a full rollout of what would be a PTSD indication and a full label. We're doing that sort of in conjunction with them in that they've identified or articulated to us what they're looking for.

Based off of that information, we're looking to take that and aggregate the data set to provide to them to ultimately, you know, apply for the full form, PTSD label.

Thank you.

Great. Thanks, Fozia.

Of course.

Okay, our next question comes from Swayampakula Ramakanth at H.C. Wainwright & Co.

Good afternoon, Joshua. Welcome aboard Michael Fox. Hopefully, you guys are able to hear me.

Yeah, you're great, RK.

I have two or three questions. Josh, just starting off, you know, thanks for reiterating the 30%, you know, growth for 2026. You know, during the first quarter, you, there was a gain of 43%. What is it that's kind of keeping you know, being more careful than needed? Do you see something that makes you, I'm not gonna use the word concerned, but makes you think that I need to wait for at least one more quarter to change that guidance?

That's a great question, RK, and very astute. The answer is no. You know, more than anything, we have internal projections, as you know, the guidance that we provided to the street is really based off of what we believe, you know, organic growth could look like based off of, I would say an outdated model, if you will. What I mean by outdated is, you know, Mike, with all of his experience of coming to the organization, has utilized strategy and tactics which has helped grow his former businesses 3 to 4x in terms of top line revenue.

Mike's only been here since April 13th. You know, it's not really necessarily, quote, fair, unquote, to expect any more sort of direction or tactics as it relates to how it's gonna be able to expand or accelerate that growth, what the timing of that growth is gonna look like and the resources required. Which is the reason why we keep on going back to, we are gonna provide more detailed guidance when it becomes available and more appropriate. It just hasn't been enough time for Mike to get his feet wet fully to be able to map out and say, "Okay, I think that we can grow by X, but it's gonna take this amount of time.

Okay, thanks for that. Michael Fox, as I said, welcome aboard. I have a quick question for you. As you were doing your due diligence, and trying to get on board, gammaCore has been marketed to the VA facilities for quite a while now. We have about 200 centers, actually not only acquiring but also stocking the product. From your experience and from what you have done in the past, what is the easy pickings in the VA market to a larger number of centers? Also, outside of the VA, can you name 1 or 2 additional federal centers where you think this can be an easy sell?

RK, that's a really good question. I would say from what I've seen in my experience in the VA, the best way to adjust within the VA is to work with them. The VA's got a lot of standardizations. They've got a lot of requests for algorithms and treatment protocols, medical necessity. I find a lot of companies do a lot of great things one at a time. They're not working with the leadership at the vision level or national level to really place where this product fits and get support from top down. I believe this company's done a phenomenal job of generating support from the bottom up.

What I can do is continue to work with that information, that data, the patient-provided outcomes and the information gathered by our providers in the VA to generate more opportunity for us to standardize treatment and put a really strong position for gammaCore within the federal space. On the second part of your question with outside of the VA, I know there's a large federal workers comp opportunity with a number of headaches and migraines within that space. Within the Department of Defense, whenever you say Department of Defense, you got to think of places like Walter Reed, SAMMC, Portsmouth Naval, Balboa. There's so many medical facilities that treat patients post-deployment that come back with various things that we can definitely assist them with.

It's early in my evaluation of where we will be able to start, but I promise, for the Department of Defense, it will be with key opinion leaders within the headache space on those active military bases with a focus on the larger centers first, probably closer to the East Coast, more base. Does that answer your question, RK?

Yes, yes, if I can, one more question for you, Michael Fox. In terms of Kaiser Permanente, you know, this is one of those entities where you really need to generate internal KOLs that can drive the growth of the product. I'm not sure, in terms of your experience, do you see that as a real way to do it? Or is there any other levers that need to be pulled? Because I believe once you can get that going, you know, it can be a good draw of the product.

RK, that's a phenomenal question. I think a lot of companies ask the same thing about Kaiser because everyone knows the importance of a place like that for business. I can't say of all the details of our propositions to date with Kaiser. I've been on numerous calls. I'm very excited about what we have going on in the key opinion leader support within Kaiser. It is a phenomenally well-organized and standardized group. Within the foundation, I know there's a lot of support. The work is definitely being done in the California market, and we're gonna address some other outside of market opportunities. I don't want to get too deep into the Kaiser description of what's gonna happen.

We have a very favorable position now that we need to really just understand what's holding us back so we can generate that necessity from the customers. You are right, we need internal providers requesting it. I can tell you from my early meetings, we have national headache and migraine experts already doing that. We're in a good spot. We just gotta, I would say, try and bowl a little bit and figure out what's missing, we are, we're gaining a lot of momentum there.

Perfect. On the Quell Fibromyalgia, you know, you have $2.5 million cumulative in the VA market. How big is the market, you know, and how big is the opportunity within the VA for Quell? Is there any opportunity outside of the VA? You know, because it looks like it does not sell much on the over-the-counter sort of product. You know, you have quite a bit of experience now with Truvaga, and I'm just trying to understand, you know, how can that be translated into Quell OTC, if I can call it that.

Well, that's a great question, RK, 'cause within the VA, obviously we're treating some of the multidisciplinary types of patients with multifactorial disorders, and fibromyalgia as a percentage is a large population in the VA. I think there's some recent statistics just on even active military. It's very low before they go on deployment, but upon return from deployment, it's about 11% just on active duty. The veterans as a whole are always exposed to greater and bigger issues. It is a market by itself, which is very, very scalable, as a product like Quell. Outside of the VA, I think we all have family members and friends that have been dealing with fibromyalgia. It is a big opportunity outside there. I would say we talked about Kaiser a little bit earlier.

I think those are the markets that would be the first ones to address as we continue to explore maybe some opportunities to talk with TriWest and Optum for some of the active military. That's been the plan for at least for the immediate future, but we still have to verify what's the best spot.

Look, RK, it's also definitely worth noting as we look at the number of facilities that are out there prescribing our products. The fibromyalgia product, Quell, is being prescribed in roughly a third of the number of facilities that are being that gammaCore is being prescribed in.

Huh.

If you think about that in the context of overall runway, you know, we acquired the company a year ago. We've been able to grow that to about $2.5 million within the VA system. Of that VA system, it's kind of concentrated on the in one area of the region.

Yeah.

You know, we just need to spend more time in being out there and selling. It's, you know, there's a lot of opportunity, I think.

I don't mean to hog the call, but one last question, on Truvaga. You know, what learnings can you take from the U.S. to the U.K. part of it?

You know, that's a great question. Right now, we've only launched in the U.K. with our Truvaga 350. We've had a lot of inbound interest that are coming from the U.K. and people that are expressing the need or the desire to get more access to vagus nerve, non-invasive vagus nerve stimulation for the wellness space. You know, it's early days there. We really just launched it in January. It's a soft launch, and what I mean by that is we're not actively putting any media $ behind it right now.

Really what we're trying to get a better understanding of is what is that uptake for that Truvaga 350 unit, and does it make sense, and what is the business opportunity more broadly, not in just the U.K., but also in other areas outside of the U.S., but also outside of the U.K. to go ahead and launch our next generation product, a Truvaga Plus.

Okay, perfect. Thank you, gentlemen. Thanks for taking all my questions.

Thanks, RK.

Okay. Josh, our next questioner comes from Jeremy Bauman from Maxim. His first question is actually for Mike. He says, "Where does Mike see the easiest wins, lowest hanging fruit, and what are his longer term plans to drive increased utilization?

Thanks for the question, Jeremy. In my vast 4 weeks of experience, the low-hanging fruit opportunity is, as we discussed, the federal space. I think that the VA and the unmet needs with our veterans is a key focus for us. We know we have a really strong opportunity there and other federal channels, like we discussed, the Department of Defense. I think long-term plans, it's a good starting spot, but we all know that it's a good place to help our veterans, but we have to go beyond. That's where I think the longer term plan will be continue to work on the commercial segments and figure that system out as a way for us to expand beyond the FSS and VA opportunity.

That's still in development, still being identified, but that's the long-term plan so we can develop the revenue for long term.

Okay. Jeremy's next question is, "What does the Quell Relief commercialization rollout look like? Target markets and users.

Great question. First and foremost, Jeremy, there is a small cohort of users of the Quell over-the-counter product that we inherited when we acquired the NeuroMetrix business. You may recall that when NeuroMetrix was at its peak, it was doing somewhere to the tune of $12 million-$15 million of Quell over-the-counter relief business. A lot of that went away after the company decided to do a strategic pivot, had the FTC issue and moved to a medical device, Quell Fibromyalgia product. From our point of view, what we're really focused on making sure, number 1, that we can still go ahead and service those legacy consumers that have been using the product or that may want to have continued using the product, but it's no longer available. That's number 1.

Number two is we need to do it in a way that makes sure that we have addressed all of the concerns that NeuroMetrix had addressed regarding the FTC. In terms of overall rollout and commercial strategy, the answer is gonna be, it's gonna be slow and it's gonna be well-defined, but it's gonna be deliberate in that we're purposely going to make sure that we've addressed the concerns that NeuroMetrix had earlier in their iteration as an over-the-counter product, so that we can go ahead and do it in a way that's balanced between offering a Quell Fibromyalgia FDA-cleared product or FDA-approved product, and then also a consumer product as well.

Okay. Our last question from Jeremy, "What are your leading indicators, pipeline, reorder rates, device utilization that give confidence in continued acceleration and guidance?

Again, Jeremy, great question. You know, I tried to really focus on it at the end of, at the end of my remarks, there's really, if you look at this in terms of 3 main categories of catalysts. The first is R&D related, that could be additional indications, right? PTSD, putting out additional information about how the studies are going. If you look and follow our IR page, you'll note that we put out recent press releases noting the Acacia study, noting some other publications where data is coming out to help support what could be the makings of a PTSD label. That would be an R&D effort. Products or features, you know, we had mentioned as it relates to Truvaga and Quell, we are investing in our 2nd generation or our next generation mobile application.

Those features will allow us to hopefully get to a point where if done correctly, we'll be in a situation that we can have a recurring revenue model. That would be the first catalyst. The second catalyst would be commercial. By being able to go ahead and announce items such as launching Truvaga outside the United States, as we recently done in January. The opportunity or the probability of ultimately launching the Quell Relief or the Quell over-the-counter product as its own standalone consumer product. Hopefully Mike coming to the table and being able to announce either further traction within places like Kaiser, new orders within the federal marketplace, like Federal Workers Comp, perhaps TRICARE. Opening up different commercial avenues. Lastly, which is the third catalyst, this will ultimately be the operating results.

You know, we believe that we can be in a situation where these other catalysts will help drive increased total addressable market and adoption of non-invasive vagal nerve stimulation products or devices. We believe that acceleration will yield higher revenue growth and be able to do it in a way that we're managing our costs and expenses. Ultimately speaking, can we accelerate our revenue while also reducing our overall cost to do that?

Whether that's a percentage of sales and marketing, as a percentage of revenue, as an indicator, so on and so forth. Those are really the 3 main catalysts that we're here focused on, and we're gonna be very mindful about as we go into the remainder of 2026 and beyond, that we can give very specific milestone updates as to these different areas that we are strategically, you know, focused on. Mike, I don't know if you've got anything else you wanna add.

Jeremy, I'd just like to add, in my opening comments, I talked about what I knew about the company before I got here as far as how clinically in-depth this location is and what they're doing to continue to enhance the strength of the clinical platform. Since joining the company and seeing Dr. Staats and his team and all the investigator-initiated research and the resources the company's putting behind the products to prove more and to do more is one of the reasons I'm extremely excited about the future. When you talk about acceleration, it's not just always using the same product or the same and just trying to get momentum.

It's building the platform that Josh has talked about, and that's what I believe is a really exciting factor of this company is what you will see in the future that we really can't discuss today. The economics and the efforts are being placed here at this point, at electroCore to make it happen.

Okay. We have now concluded the live Q&A portion of the call. With that, I will turn the call back over to Josh for closing remarks.

Thank you, Amanda. I wanted to take the opportunity to thank our shareholders for your patience and your continued support. To our patients, our providers, and our partners, thank you for trusting us with your care and your time. Most importantly to our team, thank you for showing up every day with the discipline and the ambition this opportunity demands. I really appreciate everyone's participation in today's call. We look forward to speaking with you again at our next quarter, and I wish you all a happy afternoon.

That concludes today's call. Thank you for your participation.

Greetings, and welcome to the electroCore Fourth Quarter and Full Year 2025 Earnings Conference Call. [Operator Instructions] Reminder, this con call is being recorded. Earlier today, electroCore published results for the fourth quarter and full year ended December 31, 2025. A copy of the press release is available on the company's website. I'd like to remind you that members on the call will make statements during the call that include forward-looking statements within the meaning of the federal securities law, which are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Any statements contained in this call that are not statements of historical fact should be deemed to be forward looking. All forward looking statements, including, without limitation, any guidance, outlook or future financial expectations, our operational activity and performance, including any statements regarding first quarter 2026 and full year performance and the path to profitability are based upon the company's current estimates and various assumptions. These statements involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements. Accordingly, you should not place undue reliance on these statements. For a list of these risks and uncertainties associated with the company's business, please see the company's filings with the Securities and Exchange Commission. ElectroCore disclaims any intention or obligation, except as required by law, to update or revise any financial projections, forward-looking statements whether because of new information, future events or otherwise. This conference call contains time-sensitive information that is accurate only as of the live broadcast today, March 19, 2026. It's now my pleasure to introduce Dan Goldberger, electroCore's Chief Executive Officer.

[indiscernible] participating in today's electroCore earnings call. Joining me today are Dr. Thomas Errico, one of our founders and investor and Chairman of the electroCore Board of Directors; and Joshua Lev, our Chief Financial Officer. Before we begin, I want to express the privilege it is to address so many colleagues, partners, investors and their friends who have supported electroCore since I took the CEO position in late 2019. For the years, we've taken meaningful steps in building a great company. I'm Deeply proud of what we accomplished and truly thankful for your support as well as the support and hard work of all the employees worked tirelessly in making our noninvasive pain therapeutics available to patients who need them. With that in mind, I'd like to share an important personal decision about the next chapter for myself and for this organization. After a thoughtful discussion with the Board about the company's next phase of growth I have made a decision to retire as CEO of electroCore effective April 1, 2026. When I joined in late 2019, [indiscernible] was strengthening the company's financial position and establishing a focused commercial strategy. For the past several years, we've made substantial progress on those objectives, including building momentum in the VA channel, expanding our product portfolio and putting the company on a stronger financial footing. With that foundation now in place, the Board and I believe this is the right time to begin a leadership transition as electroCore moves into its next stage of growth. To ensure a seamless transition, the Board of Directors has appointed Joshua Lev as Interim President, electroCore is also hiring a new Chief Operating Officer. These steps will provide stability and operational momentum while the Board conducts a thorough search for my permanent successor. I look forward to continuing to support the company during the transition and to exploring new opportunities where my experience may be helpful. I step away knowing that electroCore is in excellent hands and well positioned for continued success. I'm confident the leadership team will continue building on the progress we've made and drive the company forward in the next phase of growth. It's been an honor to lead this organization and serve you, our shareholders. Thank you for your unwavering support. I look forward to watching electroCore thrive [indiscernible] Now the Chairman, Dr. Errico like to share a few thoughts on strategy and [indiscernible]

Thank you, Dan. On behalf of the Board of Directors, I want to take a moment to recognize Dan Goldberger, for his outstanding leadership. We're grateful for the strong foundation he has built and for the momentum the company carries forward today. As we look ahead, I'm pleased to share an update on our leadership transition, which is designed to ensure continuity and focus as we enter our next phase of growth. Effective April 1, Joshua Lev, our Chief Financial Officer, will assume the role of Interim President, overseeing day-to-day operations while continuing to serve as CFO. Josh has more than 15 years of experience in finance and operations and has played a central role in guiding the company through several key milestones. He is well positioned to lead during this transition as we conduct a search for a permanent successor. In April, we will welcome Michael Fox as our new Chief Operating Officer. Michael joins us from Pro Medtech, where he served as Chief Revenue Officer. He brings more than 3 decades of experience across pharmaceuticals, biotechnology and medical devices with deep expertise in complex federal markets, including the VA system. His operational leadership will be instrumental as we continue to scale across the organization. With this transition in place, the Board and management team remains fully focused on executing our strategy of increasing sales within covered entities such as the VA system and driving long-term value through market expansion into general wellness with our Truvaga product offering. Being now to the business. We remain encouraged by the continued momentum of our noninvasive vagal nerve stimulation or MVNS platform. Before Josh Lev reviews the financials, I'd like to briefly highlight the clinical foundation supporting our portfolio. Our flagship gammaCore device is supported by a substantial body of scientific evidence, including more than 20 peer-reviewed publications and multiple randomized controlled trials, such as AT1, AT2, Presto and premium. These studies have demonstrated statistically significant reductions in migraine and cluster headache frequency, intensity and duration, gammaCore is FDA cleared for both acute and preventive treatments in adult and adolescents and real-world adoption continues to build. For example, U.K. audit data shows that a meaningful portion of cluster headache patients achieved clinically significant response rates alongside measurable cost savings compared to standard care. Beyond gammaCore, exploratory studies plus additional indications, including Schorn syndrome, gastroparesis, traumatic brain injury, and inflammatory conditions related to COVID-19 highlighted the potential for broader anti-inflammatory potential of nVNS. These studies have shown encouraging signals across fatigue, quality of life measures and anti-inflammatory biomarkers. At the same time, ongoing trials in areas such as PTSD, long COVID, substance abuse disorder, muscularskeletal pain and concussions, supported by partnerships, including the NFL and NFLPA funded research support our long-term strategy for indication expansion. In addition, our Quell device is supported by a growing body of peer-reviewed research. -- including randomized controlled trials published in well-regarded journals. These studies demonstrate efficacy across multiple pain-related conditions, including difficult-to-treat fibromyalgia, further strengthening the clinical foundation of our portfolio. On the consumer side, Truvaga continues to gain traction as a wellness product, focused on stress reduction, sleep quality and emotional well-being through parasypthetic nervous system activation. Truvaga has recently received recognition from major lifestyle publications and engagement across social and digital channels continues to grow. For example, national media outlets like women's health and men's health have been driving website traffic. Miranda Kerr mentioned Truvaga on the skinny confidential podcast, [indiscernible] like true met, Ben Greenfield and Luke story have been promoting Truvaga, and Truvaga is now available through online retail outlets like Best Buy and Rehab. Independent in-home studies indicate high levels of user reported commonness and sleep improvement after consistent use. Importantly, this momentum supports diversification of our revenue mix and highlights the scalability of our nVNS technology in direct-to-consumer channels. First, the expanding clinical validation across our product lines continues to support prescription growth, payer engagement and international expansion. We believe this positions the company well for sustained revenue acceleration and long-term value creation as we bolster our commercial team with VA governmental specialists to further execute against our pipeline and strategic priorities while maintaining our attention on operating efficiency to progress towards profitability over time. And now I will turn the call over to our Interim President and CFO, Joshua Lev to walk through the financial results.

Dr. Errico. Before reviewing the financial results, I want to briefly acknowledge the leadership transition announced earlier. [indiscernible] played an important role in shaping the company over the past several years and the strategy we have in place today reflects that work. On a personal note, I've learned a great deal from working with Dan, and he has been a strong leader for the organization. Our focus remains on executing the [indiscernible] strategy expanding adoption across the VA system and continuing to scale our wellness platform. [indiscernible] details of our fourth quarter and full year 2025 operating performance. electroCore delivered another year of strong top line revenue growth, extending our growth trend and exceeding both revenue and EPS analyst consensus [indiscernible] The VA hospital system remains our largest customer, continues to grow. We expect adoption of our noninvasive same therapeutics. Truvaga sales also showed great strong driven primarily by our e-commerce store at www.truvaga.com and an expanding network of affiliates to actively promote Truvaga to their [indiscernible] Revenue in the fourth quarter of 2025 was our highest ever, reaching a record of $9.2 million, up 31% year-over-year and bringing our full year 2025 revenue to $32 million or 27% over full year 2024. [indiscernible] revenue increased 23% year-over-year to $26 million by continued growth gammaCore and Quell within the VA hospital system. Acquiring the Quell assets in May 2025, [indiscernible] generated $1.5 million in revenue. As of December 31, 2025, [indiscernible] facilities [indiscernible] products, up from 170 a year ago. Approximately 13,400 VA patients [indiscernible] gammaCore device and [indiscernible] we estimate this represents roughly 2% penetration of the addressable VA headache market. Given the scale of the VA system and the number of patients experiencing headaches, related to PTSD and mild traumatic brain injury, we believe there may be a significant opportunity for continued growth. For this opportunity we expanded our VA sales presence during 2025 by adding both internal team members and contracted representatives. In 2026, we will also welcome Michael Fox as Chief Operating Officer. We [indiscernible] experience commercializing products within federal health care systems to help accelerate [indiscernible] and expand our commercial reach. Turning to our general wellness channel Fourth quarter revenue reached $1.4 million, representing 31% year-over-year growth. Full year general wellness revenue totaled $5.5 million, an increase of 97% compared to 2024. [indiscernible] primarily driven by $5.4 million in Truvaga sales, up 93% from 2024. While Truvaga revenue was flat sequentially [indiscernible] quarter included a onetime $500,000 order associated with a third-party clinical trial. Excluding that order, Truvaga revenue grew approximately 40% sequentially. Return on advertising spend or ROAS for the [indiscernible] period was approximately $2.10, meaning for every dollar spent on media, we generated nearly $2.10 [indiscernible] $1.80 in Q3 2025 was primarily driven by a seasonal increase in sales during the holiday season. [indiscernible] across our e-commerce platforms have increased slightly but remain at approximately 12% to 15% with prior periods. We believe that ROAS as a result of the shift away from Amazon and the teams increased [indiscernible] driving sales through other direct-to-consumer platforms. As we look forward to 2025, we expect to expand the potential applications for our NDNS platform while introducing additional wellness offerings, including Quell relief for lower extremity pain. We are also developing our next-generation mobile application signed to complement an [indiscernible] differing more personalized and data-driven user experience, which could support recurring revenue opportunities. Based on the opportunities ahead, we are investing in people, marketing and product development to accelerate growth in 2026 to 2027 while maintaining discipline around operating [indiscernible]. Turning briefly to the full year 2025 financial results. Net sales in 2025 increased 27% to $32 million, driven by growth of prescription gammaCore and Quell fiber biologic products in the VA system as well as increased sales of our nonprescription group data general wellness products. We expect the majority of 2026 revenues continue coming from the U.S. Department of [indiscernible] Net profit increased to $27.8 million for the year ended December 31, 2025. Margin was 87% compared to 5% full year 2024. Research and development expense of $2.7 million decreased by approximately $375,000 compared to the prior year, [indiscernible] primarily related to the development work on our gammaCore Emerald and our next-generation [indiscernible]. Selling, general and administrative expense, $38.2 million year ended December 31, 2025, increased by $7 million compared to $31.2 million in the [indiscernible] marketing increased by $4.3 million from the prior period. The increase in sales and marketing was primarily driven by a $3.8 million increase in burial expenses, which contributed [indiscernible] increase in sales. General and administrative expense increased by $2.7 million from the prior year. This increase was primarily driven by a $800,000 increase in legal fees and early associated development activity, $500,000 [indiscernible] with 1 customer, $300,000 investment [indiscernible] systems and $200,000 of increased transaction fees [indiscernible] Total operating expenses for the full year 2025 were approximately $40.9 million as compared to $33.6 million in the full year of 2024. Other expense of $800,000 for the year ended December 31, 2025, increased by $1 million versus the prior year period. The increase is primarily attributed to nonrecurring expenses, including $0.5 million change in the estimated liability payable pre-closing shareholders of [indiscernible] metrics pursuing to with CDR equipment and interest expense associated with our term debt financing with [indiscernible] other income for the year ended December 31, 2024, which is primarily of interest. Net loss for 2025 was $14 million or $1.65 per share compared to a net loss of $11.9 million or $1.59 per share in 2024. Net loss is primarily attributed to an increase in operating expense and other expense [indiscernible]. Adjusted EBITDA net loss this full year 2025 was $8.7 million compared to $9 million in the prior year. [indiscernible] and adjusted EBITDA primarily reflects a GAAP net loss, offset by adjusting for Neurometrix acquisition-related items [indiscernible] for reserve bad debt expense and IP litigate [indiscernible]. A reconciliation of GAAP net loss to non-GAAP adjusted EBITDA net loss has been provided in the financial statement table concluded [indiscernible] and marketable securities at December [indiscernible] 2025, or approximately $11.6 million approximately $12.2 million as of September 30, 2024. Looking ahead, we remain focused on accelerating growth in our high-margin [indiscernible] particularly within the VA by adding leaders, Michael Fox spent a career successfully commercializing products in the federal channel, while also continuing to build durable inefficient general wellness channel. We believe our full year 2026 revenue has the potential to continue growing at approximately 30%. [indiscernible] However, in light of the leadership transition, you're not issuing detailed guidance at this time and expect to revisit formal guidance when appropriate. We believe the company is well positioned in driving growth and adoption in the [indiscernible] how our wellness platform and maintain discipline on operating efficiency drive long-term shareholder value and profit. I would now like to turn the call over to the operator for Q&A.

[Operator Instructions] Our first question comes from Jeffrey Cohen of Ladenburg. Jeffrey, can you please unmute?

Congrats on all the accomplishments and we wish you well. I guess, firstly, could you talk about the channels? Talk about the VA and talk about DTC for both gammaCore as well as Quell where you anticipate in '26. I know that you've done a great job in adding centers of excellence PAs. How might the outlook into 2026 and steps and thoughts about the DTC business for both Truvaga as well as Quell.

Jeff, thanks so much. Appreciate you joining the call and always appreciate your great questions. From the VA channel, we've had a lot of acceleration over the course of the last year in 2025. And we've been pretty adamant that we believe the way for us to go ahead and grow that is to increase the number of boots on the ground, either through W-2 employees or through a 1099 network. And we've done a really nice job over the course of the 2025 of increasing those 1099s, which is a variable expense as it relates to the overall sales and marketing, right? It doesn't add any headcount. But we're really enthusiastic that we have a new commercial leader joining and Michael Fox, who's joining mid-April. Michael comes to us with a background in selling primarily into the federal channels. He has years of experience and actually decades of experience in building out commercial-related teams, primarily focused in accelerating growth within those federal channels, particularly in the VA. So as we think about how we think the VA is going to grow over the course of 2026, while we haven't given any specific guidance to that. Our thought is that we have an existing team, which has been proven successful to go ahead and grow within those channels. And then we've got Michael who's going to come in and bring his know-how, his knowledge and hopefully, some of his relationships to help accelerate growth within the VA. When it comes to the direct-to-consumer channel, I think what we realized earlier on this year is we're much more effective in terms of our efficiency of media spend. when we're focused primarily in driving traffic to our own website at www.truvaga.com. And the way that we've been able to go ahead and grow that most efficiently is by increasing the number of affiliates and influencers that we have that are out there that are talking about electroCore and our Truvaga product. So as we look into 2026, our goal is to focus on identifying more partnerships such as the Miranda Kerr relationship that we talked about earlier, we have Mark, Best Buy, things of that nature that will help us with the growth in the channel that will help grow around the truvaga.com traffic.

Okay. That's perfect. And then one more as a follow-up. Could you talk about OUS channels and any expectation into '26 of US or any specific geographies worth calling out today?

Yes. From our perspective, NHS England is still a channel that's much -- that's worthwhile in terms of mentioning as it just relates to our overall revenue. We have the most adoption within the NHS in England. But the NHS does have a bit of a bottleneck because of the way that the rules are written as it relates to who specifically has to write the prescription in order to get prescriptions adjudicated and ultimately fulfilled through the program. While we have interest in other countries outside of England, we've got distributors in locations such as Belgium, where we have some reimbursement -- we're still developing the infrastructure, if you will, or the adjudication infrastructure more than anything to make sure that there is a pathway for which patients can go ahead and actually either get this covered or pay through cash providers. And we're doing that through third-party distributors. So right now, I'd say NHS England is really going to be our focus as it relates to the main driver of OUS revenue. But as additional distribution partners come available and reimbursement opens up, we'll be sure to update the Street on that.

Our next question comes from Carl Wallace of HCW.

This is Charles on for RK. And Dan, congrats on on all you've done for electroCore, and it was great working with you.

Thank you.

So for my first question, with the changes with management, the new hiring of Michael Fox and increased responsibilities for Joshua. I wanted to better understand these new leadership dynamics. And so will Michael focus primarily on kind of the VA business. Will Joshua handles the wellness in ex-VA.

Charles, great question. Yes. So the short answer to your question is yes. But Charles -- I'm sorry, Michael has really -- has a strong background and history in driving and building commercial organizations. So our expectation is going to be that Michael is going to need to come in here, get his feet wet a little bit and get a firm understanding as to how our sales operations currently work. But we believe that Michael's background primarily around commercial and whether that's not just VA, but it could be other federal systems as well. It could also be other commercial systems, perhaps such as Kaiser or commercial insurers is really going to fall under Michael's purview. As it relates to the day-to-day activities as well as Truvaga, right now, the plan is for that to fall in my court.

Perfect. And then can you remind us of the prior VA contracts? And with the onboarding of Michael, is there going to be any adjustment to this contract?

Great question. At the moment, the answer is I don't know, but I don't think so. Our VA contract already has our products listed on it. The name and who's the at the helm of an organization doesn't really necessarily change the nature of the contract in its own right. That said, Michael is coming to us with years and decades of experience in selling to these different channels. So if there are opportunities for us to make that contract more efficient for both electroCore or for the VA for that matter for the customer then what's absolutely on the table that we would consider it.

And then for my final question. So Dan has kind of been the architect on kind of TAC-STIM in the military channel. So with him leaving, does that mean that there might be a deemphasis on the TAC-STIM product?

No, I don't think so. TAC-STIM has always been a lumpy business for the company, and we still have a robust pipeline of different military groups and military organizations that are of interest. If anything, I think that there could be an opportunity here to maybe pull through some of that or accelerate, as mentioned before, Michael Fox's experience isn't just necessarily in the VA, it's all federal systems. So I do think that there could be -- it doesn't mean that there will be, but there could be an operation to maybe pull forward some of those revenue opportunities. Because we have someone that's been in depth in working with those with the Hill and different military organizations.

Our next question comes from Charles Wallace. Okay. Let's go to Jeremy Pearlman, Jeremy, do you want to unmute?

First related, you mentioned earlier on the call the Quell relief -- is that going to be sold into the VA DoD channels? Is that going to be in general wellness also is that a first half or second half '26 event? And is revenue from that going to be baked into the guidance? Or do you think anything from any revenue generated would just be icing on the cake.

Jeremy, thanks so much for the question. So our Quell Relief product, which is also internally, we know as Quell over-the-counter is it's technically an over-the-counter product. So it's not technically a general wellness product. Our plan is to launch that product in the first half of 2026. Our expectations for that product are similar to how when we originally launched Truvaga. I'm not sure if you recall, but -- we did a very soft launch early on just to see what kind of access and traction we got. The Quell brand itself has legacy users and legacy demand. And we're hoping that by doing a soft launch of the program, we could start getting a sense as to where to best spend our media dollars. Which will then give us a more robust plan as to how we go ahead and grow that into its own product category. But to answer your question, right now, when we look at our 30% guidance that we've given year-over-year, anything that would come out of the Quell OTC or the Quell relief product would be incremental to that.

Okay. Understood. Great. And then maybe if we could jump to your return on advertising spend. You said it was $2.1 million ex this quarter. And you did mention on one of the earlier questions, you are trying to identify more partnerships to help growth. Is that -- is there a goal for 2026? And how much can you really increase that return? Is it -- you can get into the 3x range even more? Or is it an incremental gain?

That's a fantastic question. The true answer is it really depends right? We have a team of dedicated people that look at our -- look at our return on advertising spend on a daily basis, and they move our media dollars around based off of where we're getting the highest efficiency or the highest return on our investment. From what we've seen in the category, we think industry would be somewhere between the 2 to 2.5 range. If we -- there have been times within Truvaga's lifespan that we have actually achieved greater than 3% return on media spend. But typically, what happens is the more efficient you get over time in a particular channel, that efficiency then hits its it's peak and then starts coming down and you have to find different avenues. So to answer your question, I think that our goal for the year is going to try to have that above 2, having that above 2 or $2 of revenue for every dollar of media is a good place as a sort of conservative number. And then our expectation would be is that we try to hover around that, call it, between 2 and 2.5 on an average basis for the year.

Okay. Understood. And then just last question. in the past, you -- maybe you could any updates on your insurance reimbursement coverage? And maybe what do you think the biggest barriers to broader reimbursement adoptions are you're facing? It's always been -- it seems like it's been a struggle over time.

Yes. Thank you. So just from an update point of view, I think the biggest opportunity we have in front of us is the work that we've been doing with Kaiser. We've spent some time talking about it in the past. Earlier on in this year, we finally got on contract with Kaiser. So not only are we on formulary, but we're also on contract. That allows us to give us a license to sell, if you will, within the organization and gives prescribers an easier opportunity to actually prescribe the product itself, but it's not necessarily the end all be all. We spent a better part of the last quarter. And within 2026, what we plan to do is spend more time trying to develop the right KOLs and subject matter experts advocates for the product within the system. I think Kaiser will remain to be our largest sort of opportunity, if you will, as it relates to from an insurance point of view, where can we get coverage. And the reason why I say that is Kaiser is the largest of these managed care systems. Typically, they're kind of like a beachhead strategy. If you can get Kaiser and show other managed care systems that it works. Other managed care systems will follow suit. So right now, we've guided in the past that we've got dedicated resources focused primarily on trying to get Kaiser up and running. If we do, our plan would be to leverage that success and turn it into additional adoption throughout other managed care insurers.

Okay. And you think that, that could be a 2026 event?

No, I would think that Kaiser, some Kaiser success the plan is or the hope is for it to be in 2026. I think other additional insurers would be after that. It would be 2027 and 2028.

And Josh, I'm going to turn the call back over to you for a closing statement that has exhausted our questions from live callers.

Well, great, Rob. Thank you so much. Just wanted to thank everyone for the opportunity and for joining us today. I want to recognize the team for their continued hard work and their commitment to our patients to the health care providers and to our customers, especially as we go through this transition. I also want to thank our shareholders for their continued support. Before we conclude, I'd like to extend our sincerest appreciation to Dan for all of his leadership and the foundation that he's leaving behind. We're excited about the opportunities ahead and remain focused on execution, disciplined investment and long-term value creation for our shareholders. On behalf of myself, the employees of electroCore and everyone who has benefited from your leadership. Dan, thank you for your dedication, your vision and the lasting impact you've made on the organization. We wish you the very best in your retirement and in the next chapter ahead.

That concludes today's call. Thank you for your participation.