Milestone Pharmaceuticals (MIST) Q2 2026 earnings summary

Executive summary

• CARDAMYST nasal spray launched in the U.S. as the first FDA-approved self-administered PSVT treatment, with rapid adoption: over 1,200 prescriptions and more than 1,000 patients treated in Q2 2026, and over 800 unique prescribers in H1 2026.

• Commercial insurance coverage for CARDAMYST expanded from 25% to over 50% of commercially insured lives post-Q2, driven by major PBM and insurer wins.

• Initiated pivotal phase III trial (ReVeRA-301) for etripamil in AFib-RVR, with several clinical sites activated and enrollment on track for H2 2026.

• Regulatory reviews ongoing in Europe and China, with EMA decision for PSVT indication expected in H1 2027.

• CARDAMYST nominated for the 2026 Prix Galien USA Awards for Best Pharmaceutical Product.

Financial highlights

• Cash, cash equivalents, and short-term investments totaled $170.6 million as of June 30, 2026, up from $106 million at year-end 2025.

• Product revenue was $0.6 million for Q2 and $0.8 million for H1 2026, with no product revenue in prior-year periods.

• Net loss for Q2 2026 was $28.6 million ($0.21/share), and $54.7 million for H1 2026, reflecting higher commercial and development expenses.

• Selling, general, and administrative expense rose to $22.6 million in Q2 2026 from $8.9 million in Q2 2025, driven by launch investments.

• Research and development expense for Q2 2026 was $3.5 million, down from $3.7 million in Q2 2025.

Outlook and guidance

• Cash position expected to fund operations into the second half of 2027.

• Anticipates acceleration in prescription growth and revenue as commercial coverage expands and patient activation campaigns launch in H2 2026.

• EMA decision for European approval of etripamil in PSVT expected in H1 2027; Medicare coverage anticipated to begin in 2027.