OptimizeRx (NASDAQ:OPRX) reported fourth-quarter and full-year fiscal 2025 results that management said exceeded both internal expectations and consensus estimates, driven by growth across established customers and a rising contribution from mid-tier and “long-tail” life sciences companies. The company also updated its 2026 outlook to reflect what it described as early-year softness in contracted revenue tied to shifting customer spending patterns.
Fourth-quarter and full-year results
For the fourth quarter, OptimizeRx reported revenue of $32.2 million and adjusted EBITDA of $12.0 million. For fiscal 2025, revenue totaled $109.4 million and adjusted EBITDA was $24.3 million, with management attributing performance to a combination of top-line execution and operating leverage.
Chief Financial and Strategic Officer Ed Stelmakh said fourth-quarter revenue was “largely in line” with prior expectations as the company continued converting more DAAP agreements into subscription revenue that is recognized more evenly over the year, while “buy-ups came in at a more moderate level than in 2024.”
Margin expansion, profitability, and cash flow
OptimizeRx posted a fourth-quarter gross margin of 74.8%, up from 68.1% in the year-ago quarter. Stelmakh said the year-over-year expansion was driven by favorable solution and channel partner mix. He cautioned, however, that the company does not expect gross margins to remain at that level in 2026 and continues to expect margins in the mid-60% range, noting the fourth quarter included “an unusually high amount of specialty messaging in higher margin channels.”
Operating expenses in the quarter ended December 31, 2025 decreased by $2.9 million year-over-year, which Stelmakh attributed primarily to lower cash operating expenses from post-acquisition cost reduction measures implemented in 2024.
Net income in the fourth quarter was $5.0 million, or $0.26 per fully diluted share, compared to a net loss of $0.1 million in the fourth quarter of 2024. On a non-GAAP basis, fourth-quarter net income was $9.9 million, or $0.51 per diluted share, versus $5.5 million, or $0.30 per diluted share, a year earlier.
OptimizeRx ended 2025 with $23.4 million in cash and short-term investments, up from $13.4 million at the end of 2024. Operating cash flow was $18.7 million in 2025 versus $4.9 million in 2024. Stelmakh said the company increased its cash balance despite paying off $8.0 million of principal during 2025, including $6.0 million ahead of its prepayment schedule, leaving a current debt balance of $26.3 million.
Updated 2026 outlook and contracting headwinds
Management updated guidance for 2026, citing “softness in our year-to-date contracted revenue numbers as compared to last year.” Silvestro attributed the change primarily to a previously discussed market shift away from managed services, which contributed “a material portion” of contracted revenue in the first half of 2025, and to a more conservative spending tone among clients early in 2026 as they adjust portfolios to Most-Favored-Nation (MFN) pricing.
For 2026, OptimizeRx now expects:
- Revenue: $109 million to $114 million
- Adjusted EBITDA: $21 million to $25 million
Stelmakh added that managed services contributed approximately $9 million in the first half of 2025, and the company does not expect a similar mix in 2026. As a result, management expects revenue phasing to align with a historical 40%/60% split between the first and second halves of the year.
During Q&A, Silvestro said the spending pause appears broader than only companies directly involved in MFN negotiations, with clients shortening contracting duration from six-to-12-month terms toward quarterly or half-year “pulses.” He said the cautious tone is similar across direct-to-consumer (DTC) and healthcare-professional (HCP) marketing spend.
Management also disclosed that, excluding managed services, contracted revenue is running roughly 15% to 20% behind where it normally would be at this point, largely due to shorter contract duration and timing. Executives said they expect conditions to normalize as customers digest MFN impacts.
Share repurchase authorization, customer mix, and AI commentary
OptimizeRx’s board authorized a $10 million share repurchase program, which the company intends to finance using available cash and cash equivalents through open market or privately negotiated transactions. Stelmakh said the company will continue to prioritize paying down debt with excess cash flow while also weighing opportunities to repurchase shares, depending on circumstances.
Silvestro highlighted growth among mid-tier and long-tail manufacturers, saying OptimizeRx can serve as a commercialization partner for companies that lack large internal infrastructure and budgets. He described performance in that segment as exceeding expectations and noted that specialty pharmaceutical volume continues to come from the mid-tier and biotech sector.
On key performance indicators, Stelmakh said average revenue per top 20 pharmaceutical manufacturer was $2.8 million, down slightly from $3.0 million in 2024, tied to lower buy-ups and data-related revenue. Net revenue retention remained 116%, and revenue per FTE increased to $839,000 from $701,000 in 2024.
Management also addressed questions about artificial intelligence, with Silvestro saying the business has experienced minimal disruption from AI and does not expect future disruption. He characterized AI as a potential tailwind, citing customer feedback that content creation has historically consumed a large portion of marketing budgets and could become more efficient with AI, potentially freeing spend for “commercial execution,” where OptimizeRx is positioned. In the Q&A, executives also discussed how AI could support more efficient channel partner distribution, message distribution, and physician identification.
Separately, Silvestro discussed ongoing efforts to expand point-of-prescribe connectivity alongside EHR integrations, emphasizing deeper workflow embedding rather than simply adding new platforms. He said the company has also brought in certain channel partners that had previously worked with competitors, though he declined to name them and said additional announcements may come later.
About OptimizeRx (NASDAQ:OPRX)
OptimizeRx, Inc is a healthcare technology company that operates a digital health network designed to facilitate communication between pharmaceutical manufacturers, payers and healthcare providers. Through its cloud-based platform, OptimizeRx delivers targeted digital interventions—such as patient savings messages, clinical content and product information—directly into electronic health record (EHR) workflows at the point of care. By integrating with leading EHR systems, the company helps life sciences organizations optimize brand engagement, improve patient adherence and support informed prescribing decisions.
The company’s core offerings include digital prescription benefit notifications, co-pay assistance alerts and real-time clinical messaging tailored to specific patient populations.
