Heron Therapeutics (NASDAQ:HRTX) reported fourth-quarter and full-year 2025 results while outlining plans to increase commercial investment in 2026 to build on what management described as an inflection in acute care demand that emerged earlier than expected.
2025 financial results and profitability
For the full year 2025, Heron generated approximately $155 million in total net revenues and delivered adjusted EBITDA of $14.7 million, exceeding the company’s prior guidance range of $9 million to $13 million, Chief Executive Officer Craig Collard said. Gross margin for the year was approximately 73%, which management attributed to continued cost discipline and product mix.
Collard also highlighted the company’s refinancing as a key 2025 accomplishment, calling it a meaningful de-risking event that removed a capital structure “overhang” and provided flexibility for the next phase of commercial execution.
Acute care growth accelerates in Q4
Management pointed to sharp fourth-quarter growth in the acute care portfolio, citing multiple commercial initiatives launched during 2025. Collard said the company had previously expected an inflection in late third quarter or early fourth quarter, and that the shift “materialized ahead of our internal expectations.”
In the fourth quarter, Chief Operating Officer Mark Hensley said acute care net sales were $16.3 million, up from $12.3 million in the third quarter, a roughly 33% sequential increase. ZYNRELEF net sales rose to $12.5 million from $9.3 million in the prior quarter, while APONVIE net sales increased to $3.8 million from $3.0 million.
On a year-over-year basis, Hensley reiterated that ZYNRELEF net revenue increased 48% and APONVIE grew 97% in the quarter. Collard said the acute care franchise overall increased more than 57% year-over-year in Q4.
Management attributed momentum to steps taken during 2025, including:
- CrossLink Ignite, an incentive-based program intended to enhance distributor engagement (launched in July 2025 and set to continue into 2026).
- Introduction and rollout of the Vial Access Needle (VAN) to simplify preparation and handling.
- Implementation of permanent J-codes to improve reimbursement clarity, including J0668 for ZYNRELEF and, as announced on the call, J8502 for APONVIE.
- Creation of a dedicated hospital sales team (the IBM team) focused on APONVIE and CINVANTI in the hospital setting.
- APONVIE inclusion in the newly released fifth consensus guidelines for management of post-operative nausea and vomiting (PONV).
Hensley said the company continues to see reimbursement becoming more straightforward as hospitals and ambulatory surgery centers become more familiar with coding and the evolving post-operative pain reimbursement environment, including the NOPAIN Act.
Development update: ZYNRELEF prefilled syringe timeline
On product expansion, Collard and Hensley provided an update on the prefilled syringe (PFS) presentation for ZYNRELEF. Registration batches were placed on stability in the fourth quarter of 2024, and the company needs to complete 12 months of stability testing before filing. Assuming a typical four-to-six-month regulatory review, management said it anticipates potential approval in mid to late 2027.
During Q&A, management said the VAN rollout went “remarkably well,” describing the transition primarily as winding down prior supply and moving to the new accessory, and added that it did not expect major strategic changes for a potential PFS rollout beyond inventory management ahead of approval.
Oncology supportive care: CINVANTI resilience, SUSTOL wind-down
In oncology supportive care, management said the franchise continued to produce a stable base despite competitive dynamics. Collard said the oncology franchise generated just over $105 million in net revenue for full-year 2025, representing a 7.8% decline versus 2024. He attributed most of the decline to SUSTOL as the company continues a planned wind-down throughout 2026, while describing CINVANTI as resilient with strong customer loyalty.
Hensley said oncology supportive care net sales were $24.2 million in the fourth quarter, and added that the company is focused on driving hospital demand for CINVANTI while “managing expected pricing dynamics on the clinic side.” He also noted that APONVIE and CINVANTI increasingly benefit from shared hospital relationships as Heron deepens engagement with anesthesia and pharmacy stakeholders.
2026 outlook: higher investment, continued EBITDA positivity
Looking ahead, Collard said Heron plans to accelerate expansion of its commercial team in priority geographies beginning in 2026, focusing on markets where the company already sees favorable access, reimbursement dynamics, and distributor traction. He cautioned that increased commercial investments may temporarily moderate EBITDA growth, but said management believes the long-term return warrants the spending.
Duarte said the company intends to remain EBITDA positive in 2026 while making targeted commercial investments designed to accelerate sustained revenue growth and free cash flow generation in 2027.
Heron’s 2026 guidance calls for:
- Net product sales: $173 million to $183 million
- Adjusted EBITDA: $10 million to $20 million
In response to an analyst question, management said it expects unit volume growth in the CINV franchise (now largely CINVANTI) driven by hospital promotion, offset by price erosion, resulting in sales that should stay “relatively flat” for the year. Management also said it continues to view the NOPAIN Act as a tailwind for ZYNRELEF, with 2025 focused heavily on provider education and expectations that awareness and reimbursement understanding will continue to improve.
Regarding APONVIE’s guideline inclusion, executives said adoption impact is likely to be gradual, with a more material effect expected in the back half of the year as hospitals incorporate guidelines into Pharmacy & Therapeutics (P&T) decisions, order sets, and protocols—processes they characterized as taking roughly six to nine months.
About Heron Therapeutics (NASDAQ:HRTX)
Heron Therapeutics, Inc is a commercial-stage biotechnology company focused on developing and commercializing therapies in pain management and supportive care for patients undergoing medical and surgical procedures. The company’s research is dedicated to addressing unmet needs in oncology supportive care and post-operative pain management through innovative drug formulations designed to improve patient outcomes and reduce reliance on opioids.
Heron’s first approved therapy, SUSTOL (granisetron) extended-release injection, received U.S.
