ADMA reported roughly flat first-quarter 2026 revenue of $114.5 million as a sharp competitive dislocation in the standard IG market cut BIVIGAM revenue 54%, even as ASCENIV grew 28% to $97.5 million on record utilization. Profitability and cash generation were strong, with gross margin expanding to 71%, adjusted net income up 22%, and about $58 million of operating cash flow, and the company completed the monetization of three plasma centers and secured ASCENIV pediatric label expansion. Citing new IG entrants, plasma oversupply and aggressive discounting, management cut full-year 2026 revenue guidance to $530-$560 million and withdrew its longer-term guidance while characterizing the quarter as a likely trough baseline.
Welcome, everyone, and thank you for joining us this afternoon to discuss ADMA Biologics' financial results for the first quarter of 2026 and recent corporate updates. I'm joined today by Adam Grossman, our President and Chief Executive Officer, Terry Kohler, Chief Financial Officer and Treasurer. During today's call, Adam will provide some introductory comments and provide an update on corporate progress, and Terry will provide an overview of the company's first-quarter 2026 financial results. Finally, Adam will then provide some brief summary remarks before opening the call up for questions. Earlier today, we issued a press release detailing the first quarter 2026 financial results and summarized certain achievements and recent corporate updates. The release is available on our website at www.admabiologics.com.
Before we begin our formal comments, I'll remind you that we will be making forward-looking assertions during today's call that represent the company's intentions, expectations, or beliefs concerning future events, which constitute forward-looking statements for the purposes of the safe harbor provisions under the Private Securities Litigation Reform Act of 1995. All forward-looking statements are subject to factors, risks, and uncertainties, such as those detailed in today's press release announcing this call and in our filings with the SEC, which may cause actual results to differ materially from the results expressed or implied by such statements. In addition, any forward-looking statements represent our views only as of the date of this call and should not be relied upon as representing our views as of any subsequent date. We specifically disclaim any obligations to update such statements except as required by the federal securities laws.
We refer you to the Disclosure Notice section in our earnings release that we issued today and the Risk Factors section in our annual report on Form 10-Q for the quarter ended March 31st, 2026 for a discussion of important factors that could cause actual results to differ materially from these forward-looking statements. Please note that the discussion on today's call includes certain non-GAAP financial measures, including adjusted EBITDA and adjusted net income. A reconciliation of these non-GAAP financial measures to the most directly comparable GAAP metric is available in our earnings release. With that, I would now like to turn the call over to Adam Grossman. Adam.
Thank you. Good afternoon, everyone. We had a strong start to the year with earnings growth and margin expansion, despite total revenue being essentially flat, underscoring the resilience of the business. We grew adjusted net income by 22% year over year, expanded corporate gross margins to 71%, and generated approximately $58 million of operating cash flow during the quarter. This was in spite of top-line pressures primarily impacting BIVIGAM. We believe the first quarter results likely represent the trough revenue baseline from which we would expect to be able to drive growth in the coming quarters. Key drivers of that, in our view, will be enduring ASCENIV demand, expanding margins, and continued strong cash generation. ASCENIV end market demand reached record levels in the first quarter, with revenue growth of approximately 28% year over year.
We saw continued strength in record metrics across new patient starts, prescriber adoption, product pull-through, and patient adherence. As a reminder, our distributors not only have to maintain safety stock levels to ensure the continuity of patient care, but we understand these specialty distributors also typically keep extra stock available for immediate administration and to guard against any potential supply chain, manufacturing, testing, or regulatory disruptions. We see our distributors' inventory and pull-through sales data on a regular basis and believe these levels are consistent with those of our industry peers and are appropriately sized. At the same time, ASCENIV demand is growing. Competitive dynamics in the first quarter, as well as the variability in ordering patterns, created a challenging commercial backdrop, in particular for BIVIGAM. I will discuss these competitive dynamics in a moment.
Operationally, during the period, we completed the monetization of three plasma centers, enhancing liquidity while further diversifying our plasma sourcing by adding a new third-party plasma supplier. We are also actively reducing expenses in a targeted manner to improve profitability without adversely impacting our core operations. Importantly, with a balanced mix of internal and third-party plasma procurement, we believe we have ample supply of high-titer plasma to support both our near- and long-term ASCENIV growth objectives. Our balance sheet remains strong, with pro forma net leverage below 0.5 times, driven by continued cash generation and adjusted EBITDA growth. Which should provide us with the flexibility needed to support growth and activate on our capital allocation priorities. Now, let me take a step back and explain why we believe we are experiencing an extraordinarily unique moment in our industry.
We believe that historically, the plasma fractionation industry has been in a dislocated state where IG utilization demand has outpaced the industry's ability to supply. Over the back half of 2025 and the first quarter of 2026, new IG products have entered the U.S. market. During the first quarter, the industry also saw a surplus of raw material plasma supply, increased PDT and IG finished goods inventory across the distribution network, and aggressive pricing tactics, including discounting and rebating from newer entrants. This drove greater than expected competitive intensity and distribution recalibration. We believe there was and continues to be a rapid shift in the ordering patterns occurring at the wholesaler and distributor level, which adversely impacted reported first quarter revenue and created additional variability in ordering patterns for ADMA's products within the quarter. We believe these dynamics were timing related and are transitory in nature.
Although it's still early, we are observing signs of reversion in the second quarter. We see these as industry-wide dynamics, not only specific to ADMA Biologics, and again, we believe they primarily impacted distributor behavior rather than end market demand. While these dynamics impacted near-term ordering patterns, there was no deterioration in underlying demand for ASCENIV, where fundamentals remain strong and continue to improve with record utilization growth throughout the quarter. We are particularly encouraged that the second quarter run rate based on April demand is in line with the level of first quarter direct sales. This reinforces a key point. Record ASCENIV demand and utilization, which is a forward-looking indicator, is robust and growing despite the broader standard IG and plasma products market competitive pressures.
In our view, this is clear evidence that the first quarter variability was driven by distribution and inventory dynamics primarily affecting BIVIGAM, not by any change in demand or forward-looking growth outlook for ASCENIV. We continue to believe ASCENIV remains early in its penetration curve and that we have multiple durable growth drivers. We believe we still benefit from record new patient adds, a growing prescriber base, expanding distribution network, strong payer access, and increasing physician confidence driven by ASCENIV's differentiated clinical profile and favorable real-world outcomes. In review of the reported ASP declines from certain competitor IG products, we know that the market is seeing elevated levels of aggressive discounting and rebating across standard IG. We remain disciplined in our pricing strategy and are committed to building a durable and sustainable growth model.
These near-term competitive and pricing dynamics do not change our conviction in the forecast of long-term growth and durability of the U.S. IG market or ASCENIV's differentiated position in the later line setting for refractory immunodeficient patients. Looking ahead, we believe we have several important catalysts, including our recent approval for ASCENIV's pediatric label expansion and the associated commercial opportunity, and upcoming preclinical data publication for our lead pipeline program, SG-001, which will be presented at the International Symposium on Pneumococci and Pneumococcal Diseases conference. We expect this SG-001 preclinical data presentation, including oral and poster sessions, to further illuminate the product's novel profile and market as we advance our capital-efficient development pathway.
ADMA is a unique company in the plasma-derived therapies complex in that we have a specialized, innovative, and forward-thinking R&D engine, which translates into growth opportunities and expanded product margins. Our yield enhancement manufacturing process allows us to maximize the high titer RSV plasma we collect required to meet ASCENIV's increasing demand. Yield improvement was designed to enhance our R&D pipeline programs, including SG-001, so that in the same way we are able to maximize value on the hyperimmune plasma used to produce SG-001. We have identified a proprietary way of blending the highest titer plasma containing Streptococcus pneumoniae antibodies from donors and will rely on the yield enhancement IG production methods for future clinical trials and potential future commercialization.
To design the most effective methods for SG-001 production, we have developed and designed proprietary blends of plasma that are already showing strong proof of concept in preclinical studies for TWO virulent and prevalent serotypes of pneumonia. As data becomes available, we will keep the market apprised of our R&D developments. ADMA remains on track to submit its Pre-IND package for SG-001 to the FDA later this year. We believe if approved, SG-001 represents an approximately $300 million-$500 million in annual market opportunity at peak that can be ramped to in short order, leveraging our existing platform, infrastructure, and commercial footprint.
All told, our confidence in ASCENIV's growth trajectory and our mission to meet unmet medical needs for immune-compromised patients remains unchanged. ASCENIV demand is strong, fundamentals are intact, and the IG markets growth outlook remains robust. We believe we are well-positioned to drive sustained growth, expand margins, and increase cash generation moving forward. Before I turn the call over, I want to recognize and thank our entire ADMA team for their continued dedication and execution during what has been a dynamic and evolving market environment. Their focus on patients, operational discipline, and commitment to excellence continues to drive our performance and position the company for expected long-term success. We are grateful for your contributions and proud of the progress we are making together. With that, I'll turn the call over to Terry.
I will begin our first quarter financial performance and then provide an update on our balance sheet, cash generation, and the outlook for the remainder of 2026. Total revenue for the first quarter was $114.5 million, compared to $114.8 million in the prior year period, representing flat trends year-over-year. ASCENIV revenue was $97.5 million, representing 28% growth year-over-year, while BIVIGAM revenue was $15.4 million, down 54% and disproportionately impacted by the competitive market dynamics discussed. Revenue from the sale of intermediates and other products also declined year-over-year by $3 million. Gross profit for the quarter was $80.8 million, resulting in gross margin of 71% compared to 53% in the prior year period.
Adjusted EBITDA was $59.7 million, representing 24% year-over-year growth, and adjusted net income was $40.7 million. GAAP net income for the quarter was $45.3 million. Turning to the balance sheet, we exited the quarter with substantial flexibility. Pro forma net leverage remains below 0.5 times, even following the revolving credit facility draw and accelerated stock repurchase deployment, and we retain approximately $100 million of additional borrowing capacity to support future growth initiatives and return capital to stockholders. Additionally, the company has been actively executing share repurchases, which we will continue deploying opportunistically, and through March 31st, resulted in ADMA converting approximately 3.6% of the outstanding share count into treasury stock.
ADMA generated $58 million in cash from operations during the quarter and received an additional $5 million in proceeds from the sale of three plasma centers in the period. The accounts receivable decline during the quarter was driven by the change in revenue quarter-over-quarter. All of our accounts receivable from the year-end 2025 balance sheet have now been collected, and we ended the quarter with $138 million cash and cash equivalents. As has been the case historically, the quality of our accounts receivable remains strong. DSOs, which represents accounts receivable as of the balance sheet date, divided by net sales per day in the quarter, increased in Q1 2026 to approximately 107 days. As we have referenced in the past, working capital remains a focus for the company and we believe DSOs stabilized during Q1.
Going forward, we believe the appropriate level of DSOs for ADMA is between 90 and 105 days, and we will target that range with expected improvement from current levels over the back half of the year as ordering patterns normalize and as the McKesson specialty distribution agreement continues to ramp up. For full year 2026, we now expect total revenue in the range of $530 million-$560 million. This outlook reflects continued ASCENIV growth, partially offset by the expectation of sustained competitive pressure in the standard IG space over the course of 2026. Full year 2026 expectations for adjusted EBITDA are now $265 million-$300 million, and adjusted net income is expected to be between $170 million and $200 million.
These expectations reflect not only the reduced revenue expectations in the year, but also an expected step-up in operating expense, primarily driven by R&D spend related to our SG-001 program, but also a step-up in SG&A as we continue to invest in our commercial operations. Given the uncertainty in the competitive landscape, which Adam described earlier, we are withdrawing longer-term guidance at this time. To be clear, this updated outlook does not reflect any change in our confidence regarding the underlying demand fundamentals for ASCENIV as a later line therapy for refractive and complex immune-compromised patients, which remains strong. However, from where we sit today, we simply do not have the longer-term visibility that we had when the IG landscape was less competitive and in a period of undersupply. Overall, we believe ADMA remains exceptionally well-positioned.
The company has a differentiated growth asset in ASCENIV, a strong balance sheet, and a continued commitment to return capital stockholders, expanding margins, positive free cash flow, and multiple levers to drive long-term value creation. With that, I'll turn the call back to Adam for closing remarks.
Thank you, Terry. In summary, we believe the most important takeaway from this quarter is that underlying ASCENIV growth trends continue to strengthen even as the distributors of plasma-derived therapies, including standard IG, work through a temporary period of dislocation, reinforcing the durability of ADMA's franchise.
We remain focused on what matters, ASCENIV patient outcomes, product pull-through, patient adherence, prescriber expansion, and long-term margin expansion and earnings power. Across each of those dimensions, we continue to see encouraging trends even beyond the first quarter. Additionally, we see meaningful long-term opportunity in SG-001 and in the broader platform we have built. We remain focused on disciplined execution in creating long-term stockholder value. Our confidence in SG-001's market potential remains unwavering as we continue to see a potentially rapid path to commercially scaling the SG-001 product to $300 million-$500 million on an annual basis if approved. Despite recent competitive challenges, we believe we are operating from a position of relative strength. Our business is highly differentiated and specialized. Yield-enhanced production remains embedded in our commercial model. Our plasma sourcing strategy has become more capital efficient and more diversified.
Our balance sheet remains flexible, and we are generating robust cash while continuing to invest behind the franchise and our capital-efficient pipeline. We believe that combination positions us well to navigate the current and rapidly evolving U.S. immunoglobulin environment, and we are confident ADMA and ASCENIV will emerge even stronger as market conditions normalize. Thank you for your time today, and thank you for your continued support of ADMA Biologics. With that, operator, please open up the call for questions.