Medexus Pharmaceuticals (MDP) Q3 2026 earnings summary

Executive summary

• Strong commercial progress for GRAFAPEX, exceeding pre-launch expectations, with record patient demand in January 2026 and expanding utilization in adult hospitals.

• GRAFAPEX adoption is robust, with 32% of 180 U.S. transplant centers ordering and a 77% reorder rate among those institutions.

• Net revenue and adjusted EBITDA declined year-over-year due to generic competition and loss of exclusivity for key products, partially offset by GRAFAPEX and Rasuvo growth.

• Operational focus remains on scaling GRAFAPEX and stabilizing the broader product portfolio in the US and Canada.

• Portfolio approach continues to drive performance, with ongoing investments in IXINITY and strategic responses to competitive changes in Rasuvo and Rupall.

Financial highlights

• Fiscal Q3 2026 net revenue was $25.3 million, down from $30 million year-over-year, mainly due to Rupall generic competition and the return of Gleolan.

• Adjusted EBITDA for Q3 2026 was $4.5 million, down from $5.8 million year-over-year, but marked the third consecutive quarter of adjusted EBITDA growth since GRAFAPEX launch.

• Operating income was $1.7 million for Q3 and $3.9 million for the nine months, both down year-over-year.

• Gross margin improved to 53.6% for Q3 2026 and 55.1% for the nine months; adjusted gross margin rose to 62.9% and 64.5% respectively.

• Operating cash flow reached $7.8 million in Q3 2026, up from $6.7 million in Q3 2025; cash from operating activities was $15.1 million for the nine months.

Outlook and guidance

• GRAFAPEX expected to be accretive to operating cash flows starting fiscal Q4 2026, with projected FY26 product-level net revenue of $11–$12 million.

• Fiscal Q4 2026 GRAFAPEX patient demand forecasted at $3–$4 million, up from $2.6 million in Q3 2026.

• Continued focus on expanding GRAFAPEX formulary access, especially in adult hospitals, with significant uptake expected over the next 12–18 months.

• Management expects further improvement in operating cash flow as GRAFAPEX scales.

• Stable base business expected, with GRAFAPEX growth driving future revenue increases.