PaySign Q3 2026 Earnings Call Transcript

PaySign (NASDAQ:PAYS) reported third-quarter financial results on Monday. The transcript from the company’s third-quarter earnings call has been provided below.

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Summary

PaySign Inc. reported record revenue of $30.8 million for Q3 2026, marking a 43% year-over-year increase, with net income skyrocketing over 200% to $6.7 million.

The company’s gross margins expanded by 840 basis points to 64.7%, driven by the growth of the patient affordability segment, which doubled in revenue to $16.6 million.

Despite losing a major plasma customer, the company remains positive, expecting to offset the loss with new business, and projects full-year revenue of $114 million to $117 million.

PaySign’s Efferion platform is under regulatory review, with strong interest noted both in the U.S. and EU markets.

Management emphasized the strategic transition towards patient affordability, which offers higher margins and is expected to drive future growth.

Full Transcript

Diego (Conference Operator)

Good afternoon. My name is Diego, and I will be your conference operator today. At this time, I would like to welcome everyone to PaySign Inc.’s third quarter 2026 earnings conference call. After the speakers’ remarks, there will be a question-and-answer session. To ask a question, press star one on your telephone keypad. To remove yourself from the queue, press star two. As a reminder, this conference is being recorded. The comments on today’s call regarding PaySign’s financial results will be on a GAAP basis unless otherwise noted. PaySign’s earnings release was disseminated earlier today and can be found on the Investor Relations section of our website, which includes reconciliations of non-GAAP measures to GAAP reported amounts. Additionally, as set forth in more detail in our earnings release, I would like to remind everyone that today’s call will include forward-looking statements regarding PaySign’s future performance.

Actual performance could differ materially from these forward-looking statements. Information about the factors that could affect future performance is summarized at the end of PaySign’s earnings release and in our recent SEC filings. Lastly, a replay of this call will be available until January 25, 2027. Please see PaySign’s third quarter 2026 earnings call announcement for details on how to access the replay. It is now my pleasure to turn the call over to Mr. Mark Newcomer, President and CEO. Please go ahead.

Mark Newcomer (Chief Executive Officer)

Thank you, Diego, and good afternoon, everyone. Thank you for joining us for PaySign’s third quarter 2026 earnings call. I’m Mark Newcomer, President and Chief Executive Officer. I’m joined today by Jeff Baker, our Chief Financial Officer. Also with us on the call is Matt Turner, our President of Patient Affordability, and Matt Lanford, our Chief Payments Officer, both of whom will be available for Q&A following our prepared remarks. Earlier today, we reported our third quarter results, delivering record revenue, operating income, and adjusted EBITDA. To recap the quarter, revenue grew 43% year over year to $30.8 million. Net income grew over 200% to $6.7 million, or $0.11 per diluted share. Gross margins expanded 840 basis points to 64.7% as patient affordability became a larger share of our revenue mix, growing 110% year over year. We expect gross and operating margins to continue to expand as patient affordability becomes a greater part of our revenue mix.

Before I get into the details, I want to put this quarter in context within the broader strategy we’ve been executing against. As you know, PaySign has historically been known as a payment processor primarily serving the plasma industry. We built a leading position in that business and it remains a good one, but it is a mature market with limited growth, and the nature of payment processing is transactional. We wanted to add business lines with real growth and a more durable value proposition that leverages our existing infrastructure.

Patient affordability was that first complement. Our products and services deliver measurable value to our pharmaceutical clients by helping them increase sales and save money. Importantly, it helps patients start and stay on the treatments they need but might not otherwise be able to afford. That combination of value for the manufacturer and an outcome for the patient is what makes these relationships sticky. It also carries more attractive margins.

Pairing the two gives us a better model with a cash-generative plasma business alongside a fast-growing, higher-margin business with a large and growing market. The strategy is working. You can see it in the growth, the margin expansion, and the operating leverage we delivered this quarter, and we believe it is creating real value for our shareholders. Within that context, I want to cover the plasma customer update in our release. One of our customers has informed us that it will be moving the payment processing for 113 centers to another provider, with the transition expected to be completed in the fourth quarter. As we understand it, the customer is consolidating this business with an existing banking partner with whom it has a broader relationship. The customer has told us that the decision was not related to our service, and we remain the processor for a number of this customer’s other centers.

The transition has had no effect on third quarter results, and Jeff will walk you through the expected fourth quarter financial impact. The plasma business continues to grow. We expect to offset the loss of these centers over the next couple of quarters with new centers from existing clients, and we are in active discussions with a couple of prospective new plasma clients. That being said, the quarter’s strength was primarily driven by better-than-expected results from our patient affordability business, where revenue more than doubled year over year to $16.6 million and claim volume increased approximately 55%. That reflects the continued maturation of existing programs, new program launches, strong utilization within those programs, and our largest pharmaceutical relationships continuing to scale. We also increased the revenue per program by about 32% year over year to $99,524, a sign that the programs we are adding are deepening over time and not just increasing the number.

In the third quarter, we launched 19 new programs, a mix of both new programs and transitions from other providers, bringing total active programs on the platform to 167. We expect to end the year with 190 to 195 programs, adding anywhere from 59 to 64 programs to the portfolio in 2026, compared with 55 programs last year. That growth reflects the confidence pharmaceutical companies are placing in our solutions and the savings we deliver for the patients that rely on their therapies.

During the third quarter, our platform delivered approximately $367 million in financial assistance to patients. Through the first nine months of 2026, we have now delivered more than $1.4 billion in patient benefit, and since the launch of this platform, we have supported more than $3.2 billion in financial assistance across the programs we administer. Behind those numbers are patients who can start and stay on treatments—often lifesaving treatments—they need.

Our Dynamic Business Rules technology is where the value we deliver to pharmaceutical clients is easiest to measure. In the third quarter alone, it insulated our clients from approximately $82.5 million in costs that copay maximizers and accumulator programs would otherwise have absorbed. Year to date this figure is over $553 million, and since the launch of DBR, cumulative savings have surpassed $923 million. Those savings are a large part of why clients keep expanding their relationships with us.

On industry engagement, Matt Turner served on an executive panel at the Association for Value-Based Cancer Care Summit, an oncology event attended by pharmaceutical companies, prescribers, and other patient-facing professionals. The conversation around copay maximizers and accumulators reinforced what we hear from clients: the value we deliver is resonating at senior levels in the industry. In November, our team will attend the Informa Copay Congress, an important forum for manufacturers, hub partners, and policy leaders in patient affordability, where Brian Denison, our SVP of Sales and Product, will discuss product updates and new service offerings we will bring to market in 2027. In summary, patient affordability is the engine of our growth, and the pipeline remains robust and supports our outlook for the rest of the year and into 2027.

Turning to plasma, revenue was $13.8 million, up 7.5% from $12.9 million a year ago, as our centers delivered higher average monthly revenue per center of $8,187, up from $7,122, reflecting stronger per-center utilization. We finished the quarter serving 562 centers and expect to end the year servicing between 445 and 450 centers, reflecting the transition we discussed. We continue to pursue new plasma business from collection companies that do not use PaySign today.

Despite the financial impact that the transition has had on the fourth quarter, the continued strength of patient affordability is giving us the confidence to raise our projections on some key metrics for the year-end, and Jeff will go over those in his prepared remarks. Now, turning to Efferion. Efferion draws on what we have learned as a leading processor for plasma centers. We understand the pain points these centers face, and the software available to them is largely generic rather than built for their industry. Efferion was designed to address those needs, and we believe it can give the plasma industry—from the plasma collection process to the manufacturing of the end products—a better way to streamline and operate their business.

The donor management system remains under regulatory review. We recently completed in-center testing and submitted the results as part of that process, and we will update you as it progresses. Interest in the suite remains strong in both the U.S. and the EU. We are building our European base in Dublin through our wholly owned subsidiary, Efferion Technologies Ltd., to support European demand. We also see Efferion fitting the same model that has worked for us in patient affordability, with the potential for higher margins and deeper customer relationships.

To close, this quarter is a strong example of us executing successfully on our growth strategy. We built a leading position in plasma, and we recognized the need for additional growth opportunities. Patient affordability was the first of those businesses and is now driving our results, with growth, expanding margins, and operating leverage. Our Dynamic Business Rules technology protects our pharmaceutical partners from the cost of copay maximizers and accumulators, and behind the numbers are patients who can start and stay on the treatments they need.

Plasma remains a dependable source of cash flow, and our experience servicing those customers is the foundation on which Efferion was built. The strength of our underlying business and our belief that we are well positioned to capitalize on the opportunities that lie ahead give us confidence that we will continue to deliver strong, meaningful year-over-year top- and bottom-line growth for the foreseeable future. With that, I’ll turn it over to Jeff for additional details on our third quarter results.

Jeffery Baker (Chief Financial Officer)

Thank you, Mark. Good afternoon, everyone. We delivered another strong quarter. Patient Affordability’s momentum carried through the third quarter and it shows in the results. Revenue, operating margin and net income all finished above the high end of our guidance, and operating margin more than tripled to 23.8% for the third quarter. Total revenues increased 42.6% year over year to $30.8 million. Pharma industry revenue led the way, increasing 109.8% year over year to $16.6 million.

That growth was driven by continued program expansion over the past 12 months. We launched 62 net pharma patient affordability programs. We exited the quarter with 167 active programs. Processed claims increased approximately 55% compared to the third quarter of 2025. Average quarterly revenue per program was $99,524 in the third quarter versus $75,435 during the same period last year. The revenue increase reflected higher monthly management fees, setup fees and claims processing fees.

It also reflected customer service, contact center support and other billable services such as dynamic business rules. Plasma revenue increased 7.5% year over year to $13.8 million. Average monthly revenue per center increased 14.9% to $8,187, up from $7,122 in the third quarter of 2025. The improvement was driven primarily by stronger per center utilization. As Mark noted, we exited the quarter with 562 centers, in line with the expectations we communicated on our second quarter earnings call. Gross profit margin expanded to 64.7% from 56.3% a year ago. Two factors supported that expansion: a greater mix of pharma revenue, which carries higher gross margins than our plasma business, and slower growth in aggregate costs.

Call center support, implementation, processing and commission costs collectively grew well below our 42.6% revenue growth. Total operating expenses were $12.6 million, an increase of 19.2% from $10.6 million in the third quarter of 2025, also well below our 42.6% revenue growth. Selling, general and administrative expenses were $10.3 million, up 22.8%, including $1.4 million in stock-based compensation. Operating leverage is one of the highlights of the quarter.

Operating margin expanded to 23.8% from 7.3% in the third quarter of 2025, an improvement of 1,650 basis points. As a separate indicator of operating leverage, we converted over $0.60 of each incremental revenue dollar into adjusted operating income. Here are a few other important details for the third quarter. Income before taxes increased to $8.2 million from $2.2 million in the third quarter of 2025. The company reported an income tax provision of $1.5 million. The effective tax rate was 17.8% compared to 1.4% in the third quarter of 2025. The higher rate reflects discrete item adjustments, primarily related to the increase in our stock price at September 30, 2026 compared to the same period last year.

GAAP net income for the quarter totaled $6.7 million, or $0.11 per fully diluted share, an increase from $2.2 million, or $0.04 per fully diluted share, in the third quarter of 2025. Adjusted EBITDA increased 118% to $11 million. That compares to $5 million in the third quarter of 2025. Adjusted EBITDA margin expanded to 35.7% from 23.3% a year ago. We use adjusted EBITDA to evaluate core operating performance. The measure excludes stock-based compensation and change in fair value of contingent consideration.

The fully diluted share count used in calculating per share amounts was 62.7 million shares versus 61.8 million shares in the prior year period. We exited the quarter with $34.5 million in unrestricted cash and zero bank debt. Separately, restricted cash totaled $201.8 million, an increase of $57.9 million from the year-end December 31, 2025. That increase was driven primarily by customer program deposits for plasma and pharma programs as well as higher funds on card.

Funds on card represent balances loaded to cards but not yet spent by cardholders. As Mark described, one of our plasma customers is moving 113 centers to another provider by year-end. We remain the processor for a number of their other centers under existing agreements. For the fourth quarter, we expect the transition to reduce revenue by $1.5 million and gross profit by $700,000. These centers represented approximately $11.3 million in revenue and $5.15 million in gross profit over the previous 12 months ending September 2026.

Moving to our updated full year 2026 outlook: revenue, gross profit margin, net income, and adjusted EBITDA all finished well above the high end of our third quarter guidance. That strength, combined with the visibility into additional patient affordability program launches for the remainder of this year, gives us confidence we’ll land within our full year 2026 revenue outlook of $114 million to $117 million, but exceed our prior full year margin and profitability outlook even after accounting for the 113 centers that we anticipate transitioning to another provider during the fourth quarter.

We expect full year gross profit margins of 63.5% to 64.5%. Supported by increasing patient affordability revenues, we expect GAAP net income of $23 million to $24 million, or $0.37 to $0.38 per diluted share. We expect adjusted EBITDA of $38.5 million to $40 million. Our full year tax rate is expected to be approximately 21.3%. Turning to our year-end operating expectations, we expect to exit the year with 190 to 195 active patient affordability programs and 445 to 450 plasma centers. In short, our full year outlook and confidence in the long-term earnings power of the platform are supported by continued strong patient affordability program momentum, higher year-over-year operating margins and a clean balance sheet as we move into the fourth quarter. That concludes my prepared remarks.

With that, I would like to turn the call back over to the operator to begin the question and answer session.

OPERATOR

Thank you. And at this time we will conduct the Q and A session. To ask a question, press star one on your telephone keypad. A confirmation tone will indicate that your line is in the question queue. You may press star two if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment, please, while we poll for questions. Your first question comes from Gary Prescopino with Barrington Research.

Please state your question.

Gary Prescopino (Analyst at Barrington Research)

Hey, good afternoon, everyone. On this plasma business, Mark, you did mention that you’re looking at, you know, possibly adding business in next year. And I’m just wondering, is there enough business out there that—I don’t know if you do this via RFP or whatever—that you can, you know, replace what the loss of these centers were in terms of the revenue and profitability on a run-rate basis. I would assume most of these centers have somebody processing for them.

So you have to really do some competitive takeaways here.

Mark Newcomer (Chief Executive Officer)

Yeah. To answer your question, Gary, there absolutely is enough centers out there for us to replace what we’re losing. It’s just a matter of timing and making it through transitions. But we are in discussions with several different organizations currently.

Gary Prescopino (Analyst at Barrington Research)

Okay, so there was nothing in the loss of this business that had to do with price. It was all that they needed some kind of a banking relationship to support their business, and the processor who took it over had that ability to offer that.

Mark Newcomer (Chief Executive Officer)

Yeah, correct. You know, we have basically, you know, customers—they’ve left. We’ve had customers leave in the past that have gone to other banks. It’s kind of something that’s been happening over the historical servicing of these accounts. We’ve had banks enter, we’ve had banks exit. I don’t expect that we’ll see much of a change there. A lot of times when these banks come on, they’ll come on and they will only support for a certain period of time before they end up exiting again.

So, you know, it’s hard to say what the future looks like. I don’t have a crystal ball for that, but that’s kind of historically the way it’s happened.

Gary Prescopino (Analyst at Barrington Research)

Okay, and then just the last question on that. I know you had staffed up and you built support for the pharma business overall, but did you have to staff up as well to support the plasma business? I mean, I guess the question I would have is that, is there expense reductions that can come along with the fact that this business has been lost?

Jeffery Baker (Chief Financial Officer)

Hey, Gary. Yeah. Remember last year when we won all the centers? You know, we said we did that without any additional SG&A dollars. And now we’re losing centers. And keep in mind the business model is a highly variable business model. In other words, you know, our costs are aligned with the revenues to the tune of basically gross margin. There is, you know, 40% to 45% depending on the quarter. So there’s not a lot of cost to take out, you know, maybe some call center if we, you know, as we see volumes go back off.

But like Mark alluded to, you know, we feel pretty good about our opportunities that are out there. There’s still providers that are processing with our competitors, and we feel that the PaySign software platform is actually going to help hopefully bring more centers over to us over time. So obviously don’t have a crystal ball, but we feel good about the long-term outlook.

Gary Prescopino (Analyst at Barrington Research)

Okay, thank you.

OPERATOR

Your next question comes from Jacob Stephan with Lake Street Capital Markets. Please state your question.

Jacob Stephan (Analyst at Lake Street Capital Markets)

Hey guys, appreciate you taking the questions. Maybe just first for me on the patient affordability side, you know, your guidance is coming in well ahead of kind of what we had anticipated at the start of the year. I’m just curious how you’re thinking about, you know, kind of future planned or future program wins as it relates to, you know, maybe the first half of 2027. And maybe just a follow-up on that as well: is there any other kind of products or solutions that you can cross-sell your 200-program base?

Mark Newcomer (Chief Executive Officer)

I’ll take the first part and then I’ll turn it over to Matt to take that last question. So keep in mind—and this has been constant, 2025, 2023, even before—you don’t see a lot of programs move in the first half of the year. Quite the opposite. You see the programs move in the second half of the year, and definitely seeing that again this year. Why? Because January 1st, when most insurance plans reset, everybody wants to be ready to go, and they want to make sure that the program’s working on January 1st. They don’t have time to transition programs in the most active period of the lifecycle. So, you know, last year, 2026, this year I think we added four programs in the first quarter. You know, sometimes those are related to PDUFA dates, new drug launch, but for the most part it’s really back-end loaded and going into the beginning of the year.

Right, we don’t—you know, we even said this—you know, our big conference is Asembia, and Asembia is in April every year. So, you know, in Asembia we start, you know, getting a better idea of what our pharmaceutical customers’ plans are for the remainder of the year. Some of them are under contract through certain dates throughout the year, and as those roll off, then we obviously transition those programs over. So a lot of moving parts associated with that.

But that’s why you see a lot of the migration in the third and fourth quarter. With that, I’ll turn it over to Matt. Yeah, and hi, Jacob. So I think as you look at the product stack and IT being usable across different clients, we break the business really into three core verticals where we say we’ve got medical benefit, and then we look at specialty pharmaceutical drugs, then retail pharmaceutical drugs. Those are kind of our three key verticals there. There’s many things that are used across all three, and then there’s some things that are kind of highly specific to one place or another.

But anytime we look at building a product, we try to make it as available to all of our clients as possible. If you look at the IT infrastructure, that’s a shared asset, right? That’s used across all of those different, you know, all those different business types. So, you know, portals, websites, reporting platforms, BI tools, things like that, that’s all shared because there’s not a huge difference. We might have a different report inside of a system or something, but for the most part a lot of the tech stack that’s on the back end is used across all three verticals.

And then anywhere that we can, we develop a product, we want to try to make it, you know, obviously as profitable as possible. That means making it as available to as many clients as we can.

Jacob Stephan (Analyst at Lake Street Capital Markets)

Got it. And maybe just on the Ethereum software platform. Sorry if the last question covered this, but any update from the FDA? Just curious on if you have a timeline or anything for us.

Mark Newcomer (Chief Executive Officer)

We don’t have a timeline at this point. We’re waiting to hear back from the regulators on that, and as soon as we do, we’ll give you guys an update.

Jacob Stephan (Analyst at Lake Street Capital Markets)

Okay, got it. I appreciate you guys. Thanks.

Mark Newcomer (Chief Executive Officer)

Thank you.

OPERATOR

Your next question comes from John Hickman with Ladenburg Thalmann. Please state your question.

John Hickman (Analyst at Ladenburg Thalmann)

Hello? Hi. Could you—I’m a little confused. Has the seasonality in your pharma business, is it changing a little bit? It’s kind of unusual for you to report such a big third quarter versus Q2.

Mark Newcomer (Chief Executive Officer)

Yeah, so, no, I mean, I think we’ve talked about this in the past a little bit. You know, as we keep onboarding more and more programs, it does hide the seasonality. You know, like if we didn’t grow at all this year—right, let’s say we started the year with 100 programs or we’re going to end the year with 100 programs—well, you’d see the seasonality. But as you know, Q1 and Q2 are strong for claims, since especially Q1, because everybody’s benefits have reset.

And so as you move into Q3 and Q4, there’s a ramp down in claims, but we’re ramping up in business. So where you would normally say, oh, hey, it looks like your claim volume is dropping off, yeah, that would be true. But because we’re continuously adding more programs in Q3 and Q4, we’re driving up the utilization of the platform, therefore adding more claims. So it hides the seasonality of the business. And, you know, hopefully that continues.

John Hickman (Analyst at Ladenburg Thalmann)

Okay, then, one more question. I know you just got a question about this, but the FDA approval, is there something they’re concerned about? I mean, I think if we would have talked last year, you would have expected approval by now.

Mark Newcomer (Chief Executive Officer)

You know, I mean, it’s something we really don’t have control over. It’s a question-and-answer period. So they’ll ask a set of questions. We’ll go back with a response. They have a certain amount of time to review that, and if they have additional questions, they will bring additional questions. So, you know, we’ve submitted and we wait right now.

John Hickman (Analyst at Ladenburg Thalmann)

Okay, is this like your second or third round of questions?

Mark Newcomer (Chief Executive Officer)

I really can’t speak to that at this point.

John Hickman (Analyst at Ladenburg Thalmann)

Okay, thank you.

Mark Newcomer (Chief Executive Officer)

Thank you.

OPERATOR

And a reminder to the audience: to ask a question, press star one on your phone now. We’ll pause for a moment to see if there are any questions. Once again, to ask a question, press star one. We’ll pause for another moment. We have another question from Gary Prescopino with Barrington Research. Please state your question.

Gary Prescopino (Analyst at Barrington Research)

Yeah, I just wanted to ask. On this Ethereum platform, I would assume you’re actually out there talking with potential clients right now. You may have mentioned this, but the level of interest I would assume is pretty high.

Mark Newcomer (Chief Executive Officer)

There is a lot of interest. There’s a lot of interest both in the US and the European Union market, and continues to be.

Gary Prescopino (Analyst at Barrington Research)

So once this is approved, would it be kind of a safe assumption to say that building a book of business would happen rather rapidly, or do you think this is something where you’re still going to have to get one or two of the leading plasma centers in—wherever, the US or Europe—to start beta testing this product before you can launch it out into the market?

Mark Newcomer (Chief Executive Officer)

I think this is something, obviously, as we’ve spent time going through the review process, we’ve been continuing to talk with clients, and so therefore I think that will take away some of the time that you would expect to take, and I think that we will have a quicker ramp than expected.

Gary Prescopino (Analyst at Barrington Research)

Okay. Thank you, Mark.

Mark Newcomer (Chief Executive Officer)

You’re very welcome.

OPERATOR

Thank you. And there are no further questions at this time. So I’ll hand the floor back to Mark Newcomer for closing remarks. Thank you.

Mark Newcomer (Chief Executive Officer)

Thank you. And thanks, everyone, for joining us today. I want to thank our employees for their commitment, our customers and partners for their trust, and our shareholders for their continued support. We remain focused on strengthening our business, delivering reliable service, and investing thoughtfully for the future. We look forward to updating you when we report our fourth quarter and full-year results. Thank you again, and have a great afternoon.

OPERATOR

This concludes today’s conference. All parties may disconnect. Have a good day.

Disclaimer: This transcript is provided for informational purposes only. While we strive for accuracy, there may be errors or omissions in this automated transcription. For official company statements and financial information, please refer to the company’s SEC filings and official press releases. Corporate participants’ and analysts’ statements reflect their views as of the date of this call and are subject to change without notice.