Milestone Pharmaceuticals (MIST) Q2 2026 earnings summary

Executive summary

• CARDAMYST nasal spray launched in the U.S. in Q1 2026 as the first FDA-approved self-administered treatment for PSVT, with rapid prescription growth and positive feedback from patients and providers.

• Over 1,500 prescriptions filled for more than 1,300 patients by June 30, 2026, with over 800 unique prescribers in the first half of 2026.

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

• Initiated pivotal phase III trial 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 expected in H1 2027.

Financial highlights

• Q2 2026 product revenue was $0.6 million; $0.8 million for the first half of 2026, with no revenue in the prior year.

• Net loss for Q2 2026 was $28.6 million ($0.21/share), and $54.7 million for the first half of 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, reflecting launch investments.

• Research and development expense decreased to $3.5 million in Q2 2026 from $3.7 million in Q2 2025; $6.8 million for the first half, down from $8.6 million.

• Cash, cash equivalents, and short-term investments totaled $170.6 million as of June 30, 2026, up from $106.0 million at year-end 2025, sufficient to fund operations into H2 2027.

Outlook and guidance

• Expect continued acceleration in prescription growth and revenue as commercial coverage expands and patient activation initiatives launch.

• Anticipate further payer wins and increased prescriber depth in the second half of 2026.

• EMA decision for European approval expected in H1 2027; China regulatory progress ongoing via partner.

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

• Operating losses and negative cash flows anticipated to continue as commercialization and development efforts expand.