Recent Operational Highlights
Cash flow from operations in Q4 2025 was approximately $3.2 million, due to disciplined working capital management and overall increase in gross profit margin
Continued expansion of our capitated footprint, initiating 9 new capitated contracts during 2025 in CA, FL, and NV, representing approximately 260,000 additional lives under management
Further ramped our capitation partnership with Elevance in Florida during the fourth quarter and remains on track to continue expansion across the state in 2026 which would more than double the current partnership
Initiated capitation agreements with Humana and CarePlus in Florida during the fourth quarter, further expanding payor partnerships and representing approximately 22,000 additional MA lives in South Florida
Fourth Quarter 2025 Financial Highlights
All comparisons are to the quarter ended December 31, 2024 unless otherwise noted
Consolidated revenue of $142.0 million, increased 41.6%
Gross profit of $22.7 million, an increase of 55.2%
Net loss of $7.5 million compared to $13.2 million
Basic and diluted loss per share of $(0.06) compared to $(0.14)
Adjusted EBITDA of $147 thousand compared to $(7.8) million
Cash and cash equivalents of $33.6 million as of December 31, 2025
Year Ended 2025 Financial Highlights
All comparisons are to the year ended December 31, 2024 unless otherwise noted
Consolidated revenue of $502.7 million, increased 27.8%
Gross profit of $76.4 million, an increase of 41.6%
Net loss of $60.6 million compared to $64.7 million
Basic and diluted loss per share of $(0.54) and $(0.71)
Adjusted EBITDA of $(12.4) million compared to $(35.7) million
Cash and cash equivalents of $33.6 million as of December 31, 2025
Outlook for Fiscal Year 2026
TOI uses Adjusted EBITDA and Free Cash flow, each a non-GAAP metric, as an additional tool to assess its operational and financial performance. See "Financial Information: Non-GAAP Financial Measures" below. In reliance on the unreasonable efforts exception provided under Regulation S-K, TOI is not reasonably able to provide a quantitative reconciliation for forward-looking information of Adjusted EBITDA and Free Cash flow to net (loss) income and net cash provided by operations, respectively, the most directly comparable GAAP financial measures, without unreasonable efforts due to uncertainties regarding capitated lives, direct costs, taxes, capital expenditures, share-based compensation, change in fair value of liabilities, unrealized (gains) losses on investments, consulting and legal fees, transaction costs and other non-cash items. The variability of these items could have an unpredictable, and potentially significant, impact on TOI's future GAAP financial results.
2026 Guidance
Revenue
$630 to $650 million
Gross Profit
$97 to $107 million
Adjusted EBITDA
$0 to $9 million
Free Cash Flow
$(15) to $5 million
The Company expects approximately $150 million in capitated revenue in 2026. Additionally, the Company anticipates first quarter Adjusted EBITDA to be between $(1) million and $(3) million due to seasonality with patients' deductibles reset and annual drug pricing increases that are not immediately reflected in reimbursement rates, as pharmaceutical reimbursement adjustments operate on a lagged basis from pricing. On the specialty pharmacy side, the Company assumes performance in line with the second-half 2025 revenue run-rate of approximately $27 million per month, plus some modest incremental growth of 3-5% from new capitation lives we are capturing in TOI clinics during 2026.
TOI's achievement of the anticipated results is subject to risks and uncertainties, including those disclosed in its filings with the U.S. Securities and Exchange Commission. The outlook does not take into account the impact of any unanticipated developments in the business or changes in the operating or economic environment, nor does it take into account the impact of TOI's acquisitions, dispositions or financings. TOI's outlook assumes a largely stable global market, which would likely be negatively impacted if recent tariff rate increases and exchange rate changes persist and adversely affect world trade.
Management Commentary
Daniel Virnich, CEO of TOI, commented, "2025 was an incredibly productive year for The Oncology Institute. Our unwavering commitment to delivering high-quality oncology care drove meaningful progress across our business, with continued expansion of our capitated care model through delegated arrangements serving as the primary catalyst. These arrangements allow us to manage the oncology benefit more comprehensively, while aligning incentives with our payor partners and delivering quality clinical outcomes to the patients we serve. Our growing scale, steady working capital management, and clinical pathways, all contributed to the fourth quarter marking a significant milestone on our path to becoming a profitable public company.
"Looking ahead to 2026, we are acutely focused on execution, enhancing our scale, and delivering profitable growth. Key initiatives include continuing to expand our delegated capitated model, launching a proprietary network provider portal to strengthen engagement with our affiliated partners, and adding expertise to our board with recent appointments like Mark Stolper and Kim Tzoumakas. Based on the momentum from our fourth quarter, we are reaffirming our expectation to achieve full-year positive Adjusted EBITDA in 2026. We remain well-positioned to expand payor partnerships and deliver sustainable growth as we execute on our strategic goals," Dr. Virnich concluded.
Webcast and Conference Call
TOI will host a conference call on Thursday, March 12, 2026 at 5:00 p.m. (Eastern Time) to discuss fourth quarter and full year results and management's outlook for future financial and operational performance.
The conference call can be accessed live over the phone by dialing 1-877-407-0789, or for international callers, 1-201-689-8562. A replay will be available two hours after the call and can be accessed by dialing 1-844-512-2921, or for international callers, 1-412-317-6671. The passcode for the live call and the replay is 13758646. The replay will be available until Thursday, March 19, 2026.
Interested investors and other parties may also listen to a simultaneous webcast of the conference call by logging onto the Investor Relations section of TOI's website at https://investors.theoncologyinstitute.com.
About The Oncology Institute, Inc.
Founded in 2007, The Oncology Institute, Inc. (NASDAQ:TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI offers cutting-edge, evidence-based cancer care to a population of approximately 2.0 million patients including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With over 300 employed and affiliate clinicians and over 100 clinics and affiliate locations of care across five states and growing, TOI is changing oncology for the better. For more information visit www.theoncologyinstitute.com.
Forward-Looking Statements
This press release includes certain statements that are not historical facts but are forward-looking statements for purposes of the safe harbor provisions under the United States Private Securities Litigation Reform Act of 1995. Forward-looking statements generally are accompanied by words such as "preliminary," "believe," "may," "will," "estimate," "continue," "anticipate," "intend," "expect," "should," "would," "plan," "project," "predict," "potential," "guidance," "approximately," "seem," "seek," "future," "outlook," and similar expressions that predict or indicate future events or trends or that are not statements of historical matters. These forward-looking statements include, but are not limited to, statements regarding projections, anticipated financial results, estimates and forecasts of revenue and other financial and performance metrics and projections of market opportunity and expectations. These statements are based on various assumptions and on the current expectations of TOI and are not predictions of actual performance. These forward-looking statements are provided for illustrative purposes only and are not intended to serve as, and must not be relied on by anyone as, a guarantee, an assurance, a prediction or a definitive statement of fact or probability. Actual events and circumstances are difficult or impossible to predict and will differ from assumptions. Many actual events and circumstances are beyond the control of TOI. These forward-looking statements are subject to a number of risks and uncertainties, including the accuracy of the assumptions underlying the 2026 full fiscal year outlook, the outcome of judicial and administrative proceedings to which TOI may become a party or investigations to which TOI may become or is subject that could interrupt or limit TOI's operations, result in adverse judgments, settlements or fines and create negative publicity; changes in TOI's patient or payors' preferences, prospects and the competitive conditions prevailing in the healthcare sector; failure to continue to meet stock exchange listing standards; the impact of a cybersecurity incident affecting a software provider on TOI's business; the impact of the war in Iran; those factors discussed in the documents of TOI filed, or to be filed, with the SEC, including the Item 1A. "Risk Factors" section of TOI's Annual Report on Form 10-K for the year ended December 31, 2024 filed with the SEC on March 26, 2025 and any subsequent Quarterly Reports on Form 10-Q or Current Reports on Form 8-K. If the risks materialize or assumptions prove incorrect, actual results could differ materially from the results implied by these forward-looking statements. There may be additional risks that TOI currently is evaluating or does not presently know or that TOI currently believes are immaterial that could also cause actual results to differ from those contained in the forward-looking statements. In addition, forward-looking statements reflect TOI's plans or forecasts of future events and views as of the date of this press release. TOI anticipates that subsequent events and developments will cause TOI's assessments to change. TOI does not undertake any obligation to update any of these forward-looking statements. These forward-looking statements should not be relied upon as representing TOI's assessments as of any date subsequent to the date of this press release. Accordingly, undue reliance should not be placed upon the forward-looking statements.
Financial Information; Non-GAAP Financial Measures
Some of the financial information and data contained in this press release, such as Adjusted EBITDA and Free Cash Flow, have not been prepared in accordance with United States generally accepted accounting principles ("GAAP"). TOI's non-GAAP financial measures may be different from non-GAAP financial measures used by other companies. The presentation of non-GAAP financial measures is not intended to be considered in isolation or as a substitute for, or superior to, financial measures determined in accordance with GAAP. Because of the limitations of non-GAAP financial measures, you should consider the non-GAAP financial measures presented in this press release in conjunction with TOI's financial statements and the related notes thereto.
TOI believes that the use of Free Cash Flow provides an additional tool to assess the Company's financial performance, evaluate its ability to generate cash from operations, and plan for future investments and obligations. Free Cash Flow is useful in understanding the cash available for strategic initiatives. It also helps in comparing TOI's financial performance with other similar companies, many of which use similar non-GAAP financial measures to provide insights into their cash generation capabilities. However, the principal limitation of Free Cash Flow is that it does not account for certain cash outflows or inflows that are required by GAAP to be recorded in TOI's financial statements. TOI defines Free Cash Flow as net cash flow provided by (used in) operations plus cash paid for interest, less capital expenditures.
TOI believes that the use of Adjusted EBITDA provides an additional tool to assess our operations and results of our performance, to plan and forecast future periods, and factors and trends in, and in comparing our financial measures with, other similar companies, many of which present similar non-GAAP financial measures to investors. The principal limitation of Adjusted EBITDA is that it excludes significant expenses and income that are required by GAAP to be recorded in TOI's financial statements.
TOI defines Adjusted EBITDA as net (loss) income plus depreciation, amortization, interest, taxes, non-cash items, share-based compensation, goodwill impairment charges, change in fair value of liabilities, unrealized gains or losses on investments and other adjustments to add-back the following: consulting and legal fees related to acquisitions, one-time consulting and legal fees related to certain advisory projects, software implementations and debt or equity financings, severance expense and temporary labor and recruiting charges to build out our corporate infrastructure.
A reconciliation of net cash flow used in operating activities to Free Cash Flow and net loss to Adjusted EBITDA, the most comparable GAAP metric, is set forth below.
Free Cash Flow Reconciliation
Years ended December 31,
Change
(dollars in thousands)
2025
2024
$
%
Net cash and cash equivalents used in operating activities
$
(24,587
)
$
(26,538
)
$
1,951
7.4
%
Cash paid for interest
3,914
4,498
(584
)
13.0
%
Purchases of property and equipment
(3,200
)
(3,789
)
589
15.5
%
Free Cash Flow
$
(23,873
)
$
(25,829
)
$
1,956
7.6
%
Adjusted EBITDA Reconciliation
Three Months Ended December 31,
Change
(dollars in thousands)
2025
2024
$
%
Net loss
$
(7,508
)
$
(13,182
)
$
5,674
(43.0
)%
Depreciation and amortization
1,632
1,707
(75
)
(4.4
)%
Interest expense, net
1,917
1,168
749
64.1
%
Tax payments and penalties
36
—
36
—
%
Non-cash addbacks
2,419
71
2,348
3,307.0
%
Share-based compensation
1,317
1,289
28
2.2
%
Change in fair value of liabilities
(1,066
)
(176
)
(890
)
505.7
%
Unrealized (gains) losses on investments
—
(4
)
4
—
%
Post-combination compensation expense
7
13
(6
)
(46.2
)%
Consulting and legal fees
409
69
340
492.8
%
Infrastructure and workforce costs
984
1,217
(233
)
(19.1
)%
Adjusted EBITDA
$
147
$
(7,828
)
$
7,975
(101.9
)%
Adjusted EBITDA Reconciliation
Year Ended December 31,
Change
(dollars in thousands)
2025
2024
$
%
Net loss
$
(60,606
)
$
(64,663
)
$
4,057
(6.3
)%
Depreciation and amortization
6,944
6,287
657
10.5
%
Interest expense, net
11,276
7,497
3,779
50.4
%
Tax payments and penalties
12
(32
)
44
(137.5
)%
Non-cash addbacks
4,642
(139
)
4,781
(3,439.6
)%
Share-based compensation
4,551
11,151
(6,600
)
(59.2
)%
Change in fair value of liabilities
12,453
(3,316
)
15,769
(475.5
)%
Unrealized (gains) losses on investments
6
(133
)
139
(104.5
)%
Post-combination compensation expense
46
374
(328
)
(87.7
)%
Consulting and legal fees
2,030
841
1,189
141.4
%
Infrastructure and workforce costs
6,236
6,427
(191
)
(3.0
)%
Transaction costs
1
18
