Earnings call transcript: Organogenesis Q3 2025 revenue beats forecasts, stock dips

Organogenesis Holdings Inc. (NASDAQ:ORGO) reported a robust third quarter, with revenue surpassing forecasts, yet its stock experienced a slight dip in aftermarket trading. The company achieved a net product revenue of $150.5 million, significantly exceeding the forecasted $134.1 million, marking a 31% increase year-over-year. Despite this strong financial performance, the stock closed at $3.97, down 2.02%, reflecting investor concerns over regulatory changes and product trial outcomes.

Key Takeaways

• Q3 2025 revenue outperformed expectations, reaching $150.5 million.
• Advanced wound care revenue surged by 31%.
• Stock declined by 2.02% post-earnings, closing at $3.97.
• Regulatory changes by CMS may impact future market conditions.
• The Renew program's trial did not achieve statistical significance.

Company Performance

Organogenesis demonstrated strong financial growth in Q3 2025, driven by significant increases in both advanced wound care and surgical product revenues. The company's operating income rose to $20.7 million from $6.2 million the previous year, indicating improved operational efficiency. However, the market's reaction was tempered by external factors, including regulatory changes and mixed results from the Renew program's trials.

Financial Highlights

• Revenue: $150.5 million, up 31% year-over-year.
• Advanced wound care revenue: $141.5 million, up 31%.
• Surgical and sports medicine products revenue: $9 million, up 25%.
• Gross profit: $114.2 million, representing 76% of net product revenue.
• Operating income: $20.7 million, compared to $6.2 million last year.
• Cash and equivalents: $64.4 million as of September 30, 2025.

Earnings vs. Forecast

Organogenesis exceeded its revenue forecast of $134.1 million with actual revenue of $150.5 million, marking a considerable beat. The lack of specific EPS data prevents a detailed analysis of earnings per share against forecasts.

Market Reaction

Despite the revenue beat, Organogenesis' stock fell by 2.02% to $3.97. This decline positions the stock in the lower half of its 52-week range, which spans from $2.61 to $6.71. The aftermarket session showed stability, with no further price changes, indicating a cautious investor sentiment.

Outlook & Guidance

Looking ahead, Organogenesis anticipates 2025 net revenue between $500 and $525 million, with gross margins expected to remain strong at 74-76%. The company projects advanced wound care revenue between $470 and $490 million and surgical and sports medicine revenue of $30 to $35 million. Adjusted EBITDA is forecasted to range from $45.5 to $68.3 million.

Executive Commentary

CEO Gary Gillheeney emphasized the company's strategic advantages, stating, "We have substantial advantages, including strong brand equity, deep customer relationships." He also noted the company's unique position with Apligraf, the only PMA-approved product for DFUs and VLUs, which is expected to aid in regaining market share.

Risks and Challenges

• Regulatory changes: CMS's new fee schedule for 2026 could reduce coverage for over 200 products, impacting market dynamics.
• Product development: The Renew program's trial results may delay approval timelines.
• Market competition: Maintaining competitive advantage in a contracting skin substitute market.
• Economic pressures: Potential impacts from macroeconomic conditions on healthcare spending.
• Operational costs: Expected increases in operating expenses could affect margins.

Q&A

During the earnings call, analysts inquired about potential changes in physician behavior due to the new fee schedule and the margin implications of Medicare changes in 2026. The company confirmed a slight delay in the Renew approval timeline, approximately two months, due to trial results.

Full transcript - Organogenesis Holdings Inc (ORGO) Q3 2025:

Conference Call Operator/Moderator: Welcome, ladies and gentlemen, to the third quarter 2025 earnings conference call of Organogenesis Holdings. At this time, all participants have been placed in listen-only mode. Please note that this conference call is being recorded and that the recording will be available on the company's website for replay shortly. Before we begin, I would like to remind everyone that our remarks today may contain forward-looking statements that are based on the current expectations of management and involve inherent risks and uncertainties that could cause actual results to differ materially from those indicated, including the risks and uncertainties described in the company's filings with the Securities and Exchange Commission, including item 1A, risk factors of the company's most recent annual report and its subsequently filed quarterly reports. You are cautioned not to place undue reliance upon any forward-looking statements, which speak only as of the date made.

Although if made voluntarily do so from time to time, the company undertakes no commitment to update or revise the forward-looking statements, whether as a result of new information, future events, or otherwise, except as required by applicable securities laws. This call will also include references to certain financial measures that are not calculated in accordance with the generally accepted accounting principles or GAAP. We generally refer to these as non-GAAP financial measures. Reconciliations of these non-GAAP financial measures to the most comparable measures calculated and presented in accordance with GAAP are available in the earnings press release on the investor relations portion of our website. I would now like to turn the call over to Mr. Gary Gillheeney, Sr., Organogenesis Holdings President, Chief Executive Officer, and Chair of the Board. Please go ahead, Sir.

Gary Gillheeney, Sr., President, Chief Executive Officer, and Chair of the Board, Organogenesis Holdings: Thank you, Operator, and welcome everyone to Organogenesis Holdings' third quarter 2025 earnings conference call. I'm joined on the call today by Dave Francisco, our Chief Financial Officer. Let me start with a brief agenda of what we'll cover during our prepared remarks. I'll begin with an overview of our third quarter revenue results and provide an update on key operating and strategic developments in recent months. Dave will then provide you with an in-depth review of our third quarter financial results, our balance sheet and financial condition at quarter end, as well as our financial guidance for 2025, which we updated in our press release this afternoon. We will open up the call for questions. Let me begin with a review of our revenue results for Q3. We delivered sales results which exceeded the high end of our guidance range outlined in our second quarter call.

Driven primarily by better than expected growth in sales of our advanced wound care products, which increased 31% year over year. Sales of our surgical and sports medicine products also performed well, increasing 25% year over year in the third quarter. The record revenue performance we delivered in the third quarter reflects our team's strong execution and commitment to our strategy to build upon our deep customer relationships and promoting access to existing and recently launched products, despite continued aggressive pricing strategies from our competitors. On October 31, CMS announced the final Medicare physician fee schedule for the calendar year 2026. As mentioned in our last quarter's earnings call, this is a watershed moment for the industry and the most impactful development in more than a decade. We congratulate CMS on taking this significant step in payment reform.

We are pleased CMS finalized skin substitute classifications based on FDA regulatory status and a per square centimeter payment methodology in both the physician office and hospital outpatient settings. We are pleased that CMS has recognized the clinical differentiation of PMA products and has taken steps toward higher payment and expanded access for PMA products. We remain committed to working with CMS and other stakeholders to further expand access to these lifesaving technologies, as well as incentivize investment and innovation in the space and achieve long-term market stability. We believe this new policy will address abuse under the current system and the resulting rapid escalation in Medicare spending, while ensuring a much-needed consistent payment approach across sites of care.

With more than 40 years in regenerative medicine and a diverse evidence-based portfolio with technologies in each FDA category, we believe we are best positioned in the skin substitute market for 2026 and beyond, and will continue to be a leader in the space with highly innovative, highly efficacious products that deliver on our mission of advancing healing and recovery beyond our customers' expectations. Before turning the call over to David, I wanted to provide some updates on key clinical and regulatory developments in recent months. Beginning with an update on our Renew program. On September 25th, we announced that the second phase three trial of Renew did not achieve statistical significance for its primary endpoint, despite demonstrating a numerical improvement in baseline pain reduction that exceeded the results of the first phase three trial.

Baseline pain reduction at six months for Renew was negative 6.9 for the second phase three study compared to negative 6.0 in the first phase three study. Additionally, Renew results from the second phase three study continued to demonstrate a favorable safety profile. Given the first phase three trial achieved statistically significant reduction in pain compared to saline, and the second phase three trial demonstrated a numerical improvement in baseline pain reduction that exceeded the results of the first phase three trial, we believe these combined results support the potential approval of Renew for pain symptoms associated with knee osteoarthritis, included in those patients classified as the most severe. Renew has been studied in three large RCTs of more than 1,300 patients combined. Organogenesis believes the totality of this data is compelling evidence for the FDA to review in a biologic license application.

Additionally, FDA granted Renew regenerative medicine advanced therapy, or RMAT designation, based on Renew demonstrating the potential to treat an unmet need in symptomatic knee osteoarthritis, a serious condition affecting more than 30 million Americans. We have a meeting scheduled for December 12th with the FDA to discuss our submission, including using the combined efficacy analysis from both phase three studies to support a BLA approval. We believe gathering robust and comprehensive clinical and real-world evidence is an essential component of developing a competitive product portfolio and driving further penetration in the markets where we compete. While we did not meet the November 1st submission deadline for new data for LCD coverage consideration in 2026 for PurePly AM, for DFU, and Affinity for VLU, these studies and analyses continue, and we intend to submit for coverage once they're published.

We remain confident in our strong competitive position in the skin substitute market heading into next year. We have substantial advantages, including strong brand equity, deep customer relationships, and importantly, three highly innovative, highly efficacious commercialized products on the covered list if the LCDs take effect as scheduled on January 1, 2026. Specifically, our Apligraf product for DFU and VLU, and our Affinity and NuShield products for DFU. We have strongly advocated for CMS to implement an integrated coverage and payment policy for the skin substitute market. We believe they have taken the right steps to address rapidly escalating Medicare costs while ensuring patient access to the most appropriate clinically effective technologies. We believe these changes present an enormous opportunity for Organogenesis to serve more patients, and importantly, will be positive for the long-term health of the wound care market.

Beyond 2026, we expect to advance our competitive position as we leverage our development engine, fueling new innovation, capacity to launch and reintroduce products, including our Dermagraft product, which is already covered for DFU and VLU under the LCDs. Strategic investments in expanding the body of clinical evidence supporting our technologies and a transformational opportunity with Renew. With that, I'd like to turn the call over to Dave.

Dave Francisco, Chief Financial Officer, Organogenesis Holdings: Thanks, Gary. I'll begin with a review of our third quarter financial results. Unless otherwise specified, all growth rates referenced during my prepared remarks are on a year-over-year basis. Net product revenue for the third quarter was $150.5 million, up 31% year-over-year and up 49% sequentially. As Gary mentioned, these results came in above the high end of our expectations we provided on our Q2 call, which called for total revenue in the range of $130 million-$145 million. Our advanced wound care net product revenue for the third quarter was $141.5 million, up 31%. As Gary mentioned, the commercial team executed well in the period, building upon the momentum that we experienced towards the end of Q2 that we discussed on our last earnings call.

Net product revenue from surgical and sports medicine products for the third quarter was $9 million, up 25%, primarily due to an increase across the PurePly family of products. Our total revenue results for the third quarter included $0.4 million of grant income related to the grant issued from the Rhode Island Life Sciences Hub, offsetting our employee-related costs in our Smithfield facility. This compares to no impact in the prior year period, and we continue to expect grant income to be immaterial in 2025. Gross profit for the third quarter was $114.2 million, or 76% of net product revenue, compared to 77% last year. The change in gross profit was due primarily to a shift in product mix. Operating expenses for the third quarter were $130.1 million, compared to $108.9 million last year, an increase of $21.2 million, or 19%.

Excluding cost of goods sold of $36.3 million for the third quarter and $26.8 million last year, our non-GAAP operating expenses for the third quarter were $93.9 million, compared to $82.1 million last year, an increase of $11.7 million, or 14%. The year-over-year change in operating expenses, excluding cost of goods sold, was driven by a $7.9 million, or 11% increase in SG&A expenses, a $2.9 million, or 28% increase in research and development expenses, and a $0.9 million write-down of certain non-recurring expenses. Operating income for the third quarter was $20.7 million, compared to an operating income of $6.2 million last year, an increase of $14.5 million. Excluding non-cash amortization and certain non-recurring costs in both periods, our non-GAAP operating income was $23 million, compared to $7.1 million income last year.

GAAP net income for the third quarter was $21.6 million, compared to a net income of $12.3 million last year, an increase of $9.2 million. Net income to common for the third quarter was $14.5 million, compared to a net income of $12.3 million last year. As a reminder, net income to common includes the impacts of the cumulative dividend, the non-cash equation to redemption value on our convertible preferred stock, and undistributed earnings allocated to participating redeemable convertible preferred stock. Adjusted EBITDA for the third quarter was $30.1 million, compared to adjusted EBITDA of $13.4 million last year. Now, turning to the balance sheet, as of September 30, 2025, the company had $64.4 million in cash equivalents and restricted cash with no outstanding debt obligations, compared to $136.2 million in cash equivalents and restricted cash with no outstanding debt obligations as of December 31, 2024.

On October 31st, 2025, we amended our credit agreement to better align with the underlying fundamentals of our business. The amended credit agreement now provides access to up to $75 million of future borrowings. We believe we are well capitalized with our cash on hand and other components of working capital as of September 30th, 2025, and available under our revolving credit facility and net cash flows from product sales. Now, turning to a review of our 2025 revenue guidance, which we updated in this afternoon's press release, for the 12 months ended December 31st, 2025, the company now expects net revenue of between $500 million and $525 million, representing a year-over-year increase in the range of 4% to 9%.

The 2025 net revenue guidance range now assumes net revenue from advanced wound care products of between $470 million and $490 million, representing a year-over-year increase in the range of 4% to 8%. Net revenue from surgical and sports medicine products between $30 million and $35 million, representing a year-over-year increase in the range of 6% to 23%. With respect to our profitability and EBITDA guidance, the company now expects GAAP net income in the range of $8.6 million to net income of $25.4 million, compared to a range of a net loss of $6.4 million to net income of $16.4 million previously. EBITDA in the range of $19.1 million to $41.9 million, compared to $6.2 million to $37 million previously. Non-GAAP adjusted net income in the range of $21.5 million to $38.4 million, compared to $5.5 million to $28.3 million previously.

Adjusted EBITDA in the range of $45.5 million-$68.3 million, compared to $31.1 million-$61.9 million previously. In addition to our formal financial guidance for 2025, we're providing some considerations for our modeling purposes. Our profitability guidance for 2025 now assumes gross margins in the range of approximately 74%-76%. GAAP operating expenses, excluding cost of goods sold, up 1%-2% year-over-year. Excluding non-cash intangible amortization of approximately $3.4 million, the non-recurring FDA payment related to our Renew BLA filing of $4.6 million, and the $9.8 million write-down of assets and restructuring activities in the first nine months of 2025, our total non-GAAP operating expenses will increase in the range of 3%-5% year-over-year. With that, I'll turn the call over to the operator to open up the call for your questions.

Gary Gillheeney, Sr., President, Chief Executive Officer, and Chair of the Board, Organogenesis Holdings: Thank you. If you'd like to ask a question, please press Star and the number one on your telephone keypad. If you'd like to withdraw your question or your question has been answered, simply press Star one again. Thank you. We will take our first question from Ross Osborne from Cantor Fitzgerald. Please go ahead.

Ross Osborne, Analyst, Cantor Fitzgerald: Hey, guys. Congrats on this strong quarter, and thanks for taking our questions tonight.

Gary Gillheeney, Sr., President, Chief Executive Officer, and Chair of the Board, Organogenesis Holdings: Hello.

Ross Osborne, Analyst, Cantor Fitzgerald: Starting off, we'd be curious to hear how your conversations are going with the clinical community in terms of when you're expecting physician behavior to change following the PFS. Is that December this year, earlier? Any thoughts there?

Gary Gillheeney, Sr., President, Chief Executive Officer, and Chair of the Board, Organogenesis Holdings: Yeah. This is Gary, Ross. We're starting to see some of that behavior change now, where clinicians are moving to products that are on the approved LCD list. We're seeing some contracts starting to get processed to get those products on and apparently get the other products off. We're starting to see some of the administrative behaviors starting now. I don't think we've seen any sales behavior at this point in time, but we're certainly seeing the pieces being put in place where there'll be a change in utilization going forward, based on the physician fee schedule.

Ross Osborne, Analyst, Cantor Fitzgerald: Okay. Got it. Then looking to next year, what can you do from a company's standpoint to help generate awareness regarding your products as incremental volume opens up, as many players that were selling higher ASG products won't be able to operate in the market?

Gary Gillheeney, Sr., President, Chief Executive Officer, and Chair of the Board, Organogenesis Holdings: Fortunately, we have strong brand equity for our products, and we focus on the clinical efficacy of what our portfolio contains. We will continue to message that. I think that plays extremely well in today's or into next year's world. We think with Wiser as well, getting products that are appropriate for use and will get reimbursed, I think will carry a lot of weight. The clinical evidence of those products will support utilizing those products and will carry a lot of weight. Those are the messages that we'll continue to beat and to make sure the market is aware of what we have, the clinical evidence, the likelihood of reimbursement as a result of being on the LCD and being appropriate with appropriate data, if challenged.

Ross Osborne, Analyst, Cantor Fitzgerald: Thanks for taking our questions. Congrats again.

Gary Gillheeney, Sr., President, Chief Executive Officer, and Chair of the Board, Organogenesis Holdings: Thank you.

Conference Call Operator/Moderator: Thank you. Again, if you'd like to ask a question, please signal by pressing Star one on your telephone keypad. If you're using a speakerphone, please make sure that your mute function is turned off to allow your signal to reach your equipment. Our next question comes from the line of Ryan Zimmerman from BTIG. Please go ahead.

Hi everyone. This is Izzy on for Ryan. Thank you for taking the questions. I wanted to start, or continue, I guess, on the physician fee schedules for 2026. I was curious how you think the new rates might impact margins as we start to think about our models for next year.

Dave Francisco, Chief Financial Officer, Organogenesis Holdings: Yeah, sure. I mean, obviously, yeah, it's a little bit early to be talking about 2026, but we'll maybe connect on a couple of things around the revenue profile and the margin one as well. Again, we're not providing financial guidance today, but I'm glad you asked the question because I think there are several key changes in the marketplace for 2026 that I think people should be cognizant of. First off, with the LCD going into place, there's well over 200 products that will no longer be covered for DFUs and VLUs under that LCD that's scheduled right now to go and be enacted on January 1, 2026. As Gary mentioned in his preparatory remarks, we have three commercialized products that are covered by the LCD, with an additional one in Dermagraft coming back online in the back half of 2027.

Those products are NuShield, which is a dehydrated amnion that is covered for DFUs, Affinity, which is a living amnion which is covered for DFUs, and then our Apligraf product, which is a bioengineered cellular product. It is the only PMA-approved product for both DFUs and VLUs. We are excited about having those on the covered list. In addition to that, the financial incentives will be dramatically reduced in the marketplace, leveling the playing field, which is what we have been advocating for for quite some time. Overall, as Gary mentioned too, we have the brand equity, efficacy, and service, which puts us in a very nice position, which is the attributes that we will be competing against. In 2026 once the field is leveled, as I mentioned. Of course, we have got a broad portfolio across many different FDA classifications that are addressing multiple indications.

The last piece I'd say is that the commercial team has done a nice job of pivoting in a dynamic market environment, and I think that's indicated over the last couple of years, and certainly in this last quarter. All those things coming together, I think there's obviously no implication to the surgical business next year. That's one element that you think about. I think the other components around wound care would be that our dominant position in the hospital outpatient setting can drive into incremental growth, given that the reimbursement there has been unbundled. In addition to that, I think obviously there's been several new entrants into the market over the last couple of years, and we expect that share that's been lost over the last couple of years to be regained. We expect to participate in that.

The offset to that is, of course, the market has expanded to some extent, and we expect that to contract based on overuse. The last piece I'd say is overall, on the market standpoint, ASPs across the entire market will decline. From that perspective, ours will as well, but there's a couple of other components there. Obviously, with Apligraf on the market, and again, the only PMA-approved product for both DFUs and VLUs, very, very strong product, particularly in HOPD, will now be reimbursed at a much higher rate than it has been in years past. From our perspective, we see a lot of growth drivers next year, and we also see improvements in margin and cash flow as well.

That's really helpful. Thank you. To your point about ASPs coming down, I was curious if you were surprised at all by the final rate ending up in that $127 range, or is that kind of where you were expecting?

Yeah, I think we were public and thought that it was going to come out finalized at the rate that it was proposed in the proposed rule. We didn't think that at this point in time, CMS was going to change that rate, though they have indicated that they recognize PMAs have a clinical differentiation and resource costs associated with them and value, and expect that. That reimbursement will be higher over time than the 510(k)s and the 361 HCT/Ps. I think over time, we're going to see a change. I think one of those will be the PMAs will be separated. Perhaps once the market absorbs this change, CMS will take a look and see if that rate of $127 for the 361 HCT/Ps and 510(k)s is appropriate or not, or has it really in some way contained care in any way, shape, or form.

I think they want to see if that's what's going to happen. That's why we think they left everything at what's $127. Now the proposal was $125. That's why we felt it would come out at the $125 or something close to it.

Got it. That's helpful. Just shifting focus over to Renew. I know you're meeting with the FDA in December, but I was curious if the initial approval timelines that you had called out before, I believe it was late 2026 or early 2027, are still on the table given the recent data readout. Thanks for taking the questions.

Sure. We still think there is an opportunity to still file, and we'll be filing in a modular form. In December if we have a successful meeting with the FDA. I would guide to a two-month delay is probably safe. It's possible we could stay on our current timeline, but two months I think is reasonable based on where we are today in preparing for that December 12th meeting.

Conference Call Operator/Moderator: Thank you. Again, if you'd like to ask a question, please press Star and the number one on your telephone keypad. We are currently showing no remaining questions in the queue at this time. That does conclude our conference for today. Thank you for your participation. You may now disconnect.

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