← All thesesPAYSNeutralMedium convictionFriday 2 October 2026עברית

Paysign

A small payments company that pays plasma donors on prepaid cards and runs copay-assistance programs for drug makers.

Our viewNeutral Medium conviction
The scores
The profile · 1-4
Growth3/4 ↑

Pharma nearly doubles on 51 net new programs, but plasma grew 4.0% in 2025 and its center count is shrinking.

Business quality3/4 →

Near half of US plasma centers and programs won from incumbents, but centers leave on a sale and McKesson moves $10B to its $1B.

Financial position4/4 ↑

Net cash, no debt, own cash flow covers investment; the only commitment is $6M to Gamma's sellers.

Execution record3/4 →

Beat and raised twice in 2026, but the software deal missed so badly its earn-out was zeroed, and FDA timing slipped.

Per share capture3/4 ↓

Diluted shares up 7.1% in a year with no buyback, and more units promised to Gamma's owner; growth still outruns it.

Potential2/4 →

Plasma is near half the centers already; pharma upside needs program wins nobody has signed and no federal maximizer rule.

Risk profile3/4 →

One drug maker is 36% of receivables and a federal maximizer rule would cut the product's edge; neither resolves in one step.

Valuation2/4 ↓

35.2 times guided earnings needs growth near 30% beyond 2026; the panel expects 16.2%, so little is left if it slows.

Evidence quality3/4 →

Filed figures and outside counts, but the product's value, the savings and the FDA timetable rest on management's word.

The bet · 2-3 years
Priced for success0.8×

If it works 0.8× · if it fails you keep about 44%.

The Verdict

We rate Paysign neutral. It pays plasma donors on prepaid cards and runs the programs drug makers use to cover patients' share of expensive medicines, and the business is solid: the drug-copay side nearly doubled in a year. But plasma centers are leaving, a software purchase failed, and the latest quarter was flattered. The price needs fast growth for several more years, so it is full, not cheap. As a bet it is fragile: even if copay programs keep coming, today's money shrinks a little; if they stall, a little under half is left. We think the growth is real but already paid for.

The long caseInsurers keep finding ways to divert drug makers' copay aid, so drug makers pay administrators like Paysign to protect it, and each new program adds recurring fees.

The evidence under this - 8 claims
C01facthigh confidence
Paysign runs prepaid card programs and claims processing. Revenue comes from paying plasma donors on prepaid cards, from administering drug makers' copay programs, and a small 'other' line; cards are issued by partner banks because it holds no banking licence.
current state · 2026-06-30written 2026-09-27
C03facthigh confidence
Pharma was 51.9% of Q2 2026 revenue, against 41.3% of 2025 revenue; 2025 pharma revenue was $33.89M, up 167.8%, while plasma grew 4.0% to $45.62M.
historical · Q2 2026 and FY2025written 2026-09-27
C05facthigh confidence
Paysign's plasma center count fell from 607 at the end of Q2 2025 to 595 at the end of 2025 and 561 at the end of Q2 2026, as customers closed centers and one sold centers to a company using another payment provider.
current state · 2026-06-30written 2026-09-27
C09facthigh confidence
Paysign bought Gamma Innovation's plasma software in March 2025 for $15.56M, including $10M of cash in five yearly payments and 2.5M shares; by June 2026 it wrote the earn-out to zero because Gamma revenue was materially below the $20M thresholds, cancelled it, and agreed to grant stock units to Gamma's owner if shareholders approve more shares.
current state · 2026-06-30written 2026-09-27
C34estimatemedium confidence
At $12.67 and 61.98M diluted shares, about $785M, the price is 35.2 times the middle of 2026 guided earnings of $0.36 a share, 48.7 times trailing diluted earnings of $0.26, and 30.2 times the 2027 panel's $0.42.
derivedPrice from the pack; diluted shares from the Q2 2026 10-Q (C30); guided EPS from C29; trailing EPS the sum of the last four quarters' filed diluted EPS, $0.04, $0.02, $0.09 and $0.11; 2027 EPS from the two-analyst panel (C35).
against this
  • Guidance has been raised twice this year; if 2026 lands at the Q2 run-rate plus seasonality the multiple is lower than 35.2.
  • Trailing earnings include a 45.4% tax rate in Q4 2025 that depresses the trailing figure.
current state · 2026-09-25written 2026-09-27
C35factmedium confidence
The two analysts in the vendor's estimate panel expect 2026 revenue of $114.65M, inside guidance of $114.0M to $117.0M, and 2027 revenue of $133.22M, growth of 16.2%, with earnings of $0.345 and $0.42 a share.
current state · 2026-09-27written 2026-09-27
C04facthigh confidence
Paysign ran 148 patient affordability programs at the end of Q2 2026, 51 net more than a year earlier, after 55 net added in 2025; it guides 165 to 170 by the end of Q3 2026.
current state · 2026-06-30written 2026-09-27
C41estimatelow confidence
Pharma revenue for 2026 is about $56.5M: the March guide split revenue equally between plasma and pharma after $2.5M of other revenue, applied to the raised $115.5M midpoint.
derivedC29 midpoint $115.5M less $2.5M of other revenue, halved; the March release states the equal split (S04). H1 pharma was $30.33M, so the estimate implies about $26.2M in H2 as claims fade seasonally.
against this

The equal split was stated in March, before the raise; if the raise was mostly pharma, pharma is larger than half.

forwardwritten 2026-09-27
01

The company

Plasma collectors pay donors a fee after each visit. Paysign loads that fee onto a prepaid card, and CSL Plasma, one of the largest collectors, sends its donors to Paysign's app.

Drug makers help insured patients with the part of a drug's price their insurance leaves them to pay. Paysign runs those programs: it checks each claim at the pharmacy, pays the patient's share from the maker's fund and bills the maker back. The alternative is a rival administrator such as McKesson.

The evidence under this - 5 claims
C01facthigh confidence
Paysign runs prepaid card programs and claims processing. Revenue comes from paying plasma donors on prepaid cards, from administering drug makers' copay programs, and a small 'other' line; cards are issued by partner banks because it holds no banking licence.
current state · 2026-06-30written 2026-09-27
C12facthigh confidence
CSL Plasma, one of the five large collectors that run about 90% of US centers, sends its donors to Paysign customer service and the Paysign app for their donor cards.
current state · 2026-09-27written 2026-09-27
C13factmedium confidence
Onbe, a private payments company, sells instant payouts to plasma donors and clinical trial participants, the same product Paysign's plasma business sells.
current state · 2026-09-27written 2026-09-27
C20management claimmedium confidence
Management says it has programs with 6 of the 10 largest US drug makers, that its wins mix programs moved from incumbent administrators with new drug launches, and that about half its pipeline is new clients.
against this

Winning programs moved from incumbents proves programs can move, which means Paysign's can too; no count of programs lost is disclosed.

current state · 2026-05-12written 2026-09-27
C42inferencemedium confidence
Paysign is paid per program and per claim, not on the dollars it moves: its $33.89M of 2025 pharma revenue was about 3.4% of the roughly $1B of assistance it says it delivered.
derivedThe 10-Q lists pharma revenue as management, setup, claim processing and other fees (S02); C03 and C19 give the ratio.
historical · FY2025written 2026-09-27

How it makes money

From plasma, it earns a fee each time a donor spends from the card: about $7,699 a month per center in Q2 2026. From drug makers, it earns set-up, monthly and per-claim fees, not a share of the money it pays out. More programs and more claims bring more fees. Nothing is paid on a percentage of the aid itself.

The evidence under this - 4 claims
C42inferencemedium confidence
Paysign is paid per program and per claim, not on the dollars it moves: its $33.89M of 2025 pharma revenue was about 3.4% of the roughly $1B of assistance it says it delivered.
derivedThe 10-Q lists pharma revenue as management, setup, claim processing and other fees (S02); C03 and C19 give the ratio.
historical · FY2025written 2026-09-27
C06facthigh confidence
Average monthly plasma revenue per center rose to $7,699 in Q2 2026 from $7,098 a year earlier, after 2025 plasma revenue grew only 4.0% while plasma inventories were high across the industry.
historical · Q2 2026written 2026-09-27
C04facthigh confidence
Paysign ran 148 patient affordability programs at the end of Q2 2026, 51 net more than a year earlier, after 55 net added in 2025; it guides 165 to 170 by the end of Q3 2026.
current state · 2026-06-30written 2026-09-27
C01facthigh confidence
Paysign runs prepaid card programs and claims processing. Revenue comes from paying plasma donors on prepaid cards, from administering drug makers' copay programs, and a small 'other' line; cards are issued by partner banks because it holds no banking licence.
current state · 2026-06-30written 2026-09-27
Where the money comes from, stream by stream
StreamShare of sales (Q2 2026)How it earns it
Pharma (patient affordability)51.9%Fees per program and per claim from drug makers for running copay assistance cards and catching insurers' maximizer claims.
Plasma46.2%Card program, cardholder and interchange fees on prepaid cards plasma centers use to pay donors.
Other2.0%Corporate incentive, payroll, disbursement and gift card programs, earning card fees, interchange, breakage and settlement income.

Who runs it

Mark Newcomer co-founded the business and has run it since 2006; he owns about a sixth of the company, and officers and directors together about a quarter, so management gains or loses with shareholders. Pay is loosely tied to results: bonuses are set by the board at its discretion, and most share awards vest simply by staying, with some tied to profit targets the company does not publish.

The evidence under this - 3 claims
C46facthigh confidence
Mark Newcomer co-founded the company's predecessor in 2001 and has been chairman, chief executive and president since March 2006; Jeffery Baker has been chief financial officer since February 2021, after ten years running acquisitions at InComm Payments; Matthew Lanford, a director, has been chief payments officer since January 2024 after serving as chief operating officer and president from 2021.
current state · 2026-03-27written 2026-10-04
C47facthigh confidence
At March 19, 2026 Mark Newcomer beneficially owned 9,025,728 shares, 16.3% of the 55,185,394 outstanding; the 11 officers and directors as a group owned 24.5%, including 2,175,001 options and shares vesting within 60 days; Topline Capital Partners at 9.7% was the only outside holder above 5%; there is one class of common stock.
current state · 2026-03-19written 2026-10-04
C48facthigh confidence
Paysign's 2025 cash bonuses were discretionary, set by the board on no formula or target; the long-term awards are restricted stock vesting over three to five years on continued employment, and two-thirds of the chief executive's May 2025 grant of 600,000 shares also vests on unspecified earnings targets, which the proxy says were met by December 31, 2025. The board uses no compensation consultant.
against this
  • The earnings targets are not disclosed, so how hard they were to reach cannot be judged, and they were met in the first year of a three-year grant.
  • The proxy says the company has not looked to net income or shareholder return to measure executive performance.
historical · FY2025written 2026-10-04
02

Why it wins, and who could beat it

Why customers come back

Switching is a nuisance. A collector that leaves must give every donor a new card, and a drug maker that moves a program risks patients' claims failing at the counter. Paysign holds 47.7% of US plasma centers by an outside count.

Its pitch to drug makers is catching insurers' plans that drain copay funds; those plans took $2.7B in 2023. Paysign says its rules saved clients $325M in 2025, but only Paysign measured that. And when collectors sell centers, the cards leave with them.

The evidence under this - 5 claims
C11facthigh confidence
Paysign's 595 plasma centers at the end of 2025 were 47.7% of the 1,247 US plasma collection centers an outside count found on the same date; its 10-K says it serves about 48% of US and Puerto Rico centers.
current state · 2025-12-31written 2026-09-27
C12facthigh confidence
CSL Plasma, one of the five large collectors that run about 90% of US centers, sends its donors to Paysign customer service and the Paysign app for their donor cards.
current state · 2026-09-27written 2026-09-27
C43inferencemedium confidence
Plasma revenue is not locked in beyond the collector: when a collector sells or closes centers, the donors' cards move to whatever provider the new owner uses.
derivedC05 and the Q1 2026 call: centers were 'sold to collectors that do not utilize our services'; C13 shows a rival ready to take them.
against this

Management says closures cost little because donors move to nearby Paysign centers, and revenue per center rose 8.5% while centers fell.

current state · 2026-06-30written 2026-09-27
C17facthigh confidence
IQVIA estimated that insurers' maximizer plans took $2.7B and accumulator plans $2.1B of drug makers' US patient support spend in 2023, and that state bans slowed accumulators without removing them.
historical · 2023written 2026-09-27
C19management claimlow confidence
Management says Paysign delivered nearly $1B of copay assistance to more than 840,000 patients in 2025, and that its maximizer-detection rules saved clients over $325M that year.
against this
  • No client or third party has published the savings; the $325M is the seller's own count of money it says it kept from insurers.
  • The 97% first-fill detection rate management cites is also unaudited.
historical · FY2025written 2026-09-27

The threat

McKesson runs the same copay service at a far larger scale, saving patients about $10B a year against Paysign's $1B. Onbe, a private company, sells the same donor cards. For plasma software, Haemonetics already sells a cleared system linked to its own collection machines; Paysign's has no clearance.

The evidence under this - 4 claims
C21factmedium confidence
McKesson's affordability business says it helped patients save about $10B on brand and specialty drugs in its latest year and has supported more than 650 drug brands, about ten times Paysign's 2025 assistance dollars.
current state · 2026-03-31written 2026-09-27
C13factmedium confidence
Onbe, a private payments company, sells instant payouts to plasma donors and clinical trial participants, the same product Paysign's plasma business sells.
current state · 2026-09-27written 2026-09-27
C15facthigh confidence
Haemonetics, which makes plasma collection machines, already sells NexLynk, an FDA-cleared donor management system wired to its NexSys collection device.
current state · 2026-03-28written 2026-09-27
C10management claimmedium confidence
Paysign's donor management system for plasma centers is still awaiting FDA 510(k) clearance and earned no revenue as of May 2026; in November 2025 management expected clearance around the end of 2025 or early 2026.
against this
  • The timetable has already slipped at least twice, from Q4 2025 to 'first quarter, second quarter' of 2026, and the Q1 2026 call would say nothing beyond 'discussions back and forth'.
  • The FDA's 510(k) database shows no clearance for Paysign, Gamma or Apherion as of 2026-09-27.
current state · 2026-09-27written 2026-09-27

The rivals: MCK, HAE, and 1 more that is private, in-house or listed abroad.

Who else does this, rival by rival
TickerRivalWhere it competesHow far alongPriced against it
MCKMcKesson Prescription Technology SolutionsPriced against it: One segment onlyPharma industryOn saleOne segment only
PrivateOnbePriced against it: PrivatePlasma industryOn salePrivate
HAEHaemonetics NexLynk DMSPriced against it: One segment onlyApherion softwareOn saleOne segment only
03

How big it could get

How big this could get

If all 1,247 US plasma centers paid Paysign's current rate, plasma cards would bring in about $115.2M a year, against $45.62M in 2025. Paysign already has nearly half of them, so that business can grow mainly by taking more per center.

Drug makers spent $23B on copay aid in 2023; Paysign handled nearly $1B in 2025. Nobody publishes what administrators earn on that pool, so its size in fees is unknown.

The evidence under this - 4 claims
C11facthigh confidence
Paysign's 595 plasma centers at the end of 2025 were 47.7% of the 1,247 US plasma collection centers an outside count found on the same date; its 10-K says it serves about 48% of US and Puerto Rico centers.
current state · 2025-12-31written 2026-09-27
C06facthigh confidence
Average monthly plasma revenue per center rose to $7,699 in Q2 2026 from $7,098 a year earlier, after 2025 plasma revenue grew only 4.0% while plasma inventories were high across the industry.
historical · Q2 2026written 2026-09-27
C16facthigh confidence
Drug makers' copay assistance offset $23B of US patients' costs in 2023, by IQVIA's count.
historical · 2023written 2026-09-27
C19management claimlow confidence
Management says Paysign delivered nearly $1B of copay assistance to more than 840,000 patients in 2025, and that its maximizer-detection rules saved clients over $325M that year.
against this
  • No client or third party has published the savings; the $325M is the seller's own count of money it says it kept from insurers.
  • The 97% first-fill detection rate management cites is also unaudited.
historical · FY2025written 2026-09-27
Where the growth is coming from, business by business

Where the growth is coming from

BusinessShare of revenueGrowth: last quarterLast half-yearLast yearShare in 3 years at its half-year rate
Pharma industry52%+88.9%+85.2%+106.1%79%
Plasma industry46%+21.4%+23.0%+12.9%21%
Rest of the company2%-3.1%+2.0%+23.8%1%
Whole company100%+48.1%+49.4%+44.2%100%

On the filed split through 2026-06-30, if each business keeps its last half-year's growth, the company grows about 55% next year and 67% in year 3, against 46.8% over the last twelve months. Pharma industry carries the case: it grows 85% against 22% for the rest, and would be 79% of revenue by then. A scenario, not a forecast: no business holds its rate.

How we read it: The business carrying the case: pharma's 85% half-year rise is organic, 51 net new programs, nothing bought (Gamma is plasma software, C09). It laps a weak base and the guide implies a slower second half: 3, not 4.

04

The results

The numbers

Is it growing?Fast

Sales grew 47% over the twelve months to Jun 2026, faster than the 40% in the year to Dec 2025.

Dec 2021: $29.5MDec 2022: $38.0MDec 2023: $47.3MDec 2024: $58.4MDec 2025: $82.0M12 mo to Jun 2026: $101M$29.5M$101M
Is it profitable?Healthy

Operating margin is 17%, up from −0.4% in the year to Dec 2023.

Dec 2021: −9.3%Dec 2022: 0.9%Dec 2023: −0.4%Dec 2024: 1.7%Dec 2025: 9.0%12 mo to Jun 2026: 17%−9.3%17%
Does growth pay off?Pays off

Running costs take 44¢ of each sales dollar, down from 59¢ in the year to Dec 2021.

Dec 2021: 59¢Dec 2022: 54¢Dec 2023: 51¢Dec 2024: 53¢Dec 2025: 50¢12 mo to Jun 2026: 44¢59¢44¢
Does it earn good returns?Strong

Each dollar put into the business earns 23% a year after tax, up from 2.1% in the year to Dec 2022.

Dec 2022: 2.1%Dec 2023: −0.8%Dec 2024: 3.4%Dec 2025: 13%12 mo to Jun 2026: 23%2.1%23%
Is it making cash?Strong

It turned 73% of sales into free cash, $73.5M over the last twelve months.

Dec 2021: $14.9MDec 2022: $25.2MDec 2023: $27.4MDec 2024: $22.5MDec 2025: $51.2M12 mo to Jun 2026: $73.5M$14.9M$73.5M
How steady is it?Uneven

Yearly sales growth has ranged from +22% to +40% over the last 5 years.

Dec 2021: +22%Dec 2022: +29%Dec 2023: +24%Dec 2024: +24%Dec 2025: +40%+22%+40%
Are shares being diluted?Diluting

The share count rose 22% in 4.5 years, and pay in shares costs 5.1% of sales.

Dec 2021: 51.0MDec 2022: 52.9MDec 2023: 54.2MDec 2024: 55.6MDec 2025: 59.6M12 mo to Jun 2026: 62.0M51.0M62.0M
All the numbers

Filed figures from the company's 10-K and 10-Q, read 2026-10-04. Fiscal years end in December.

Dec 2021Dec 2022Dec 2023Dec 2024Dec 202512 mo to Jun 2026
Size and growth
Sales$29.5M$38.0M$47.3M$58.4M$82.0M$101M
Sales growth+22%+29%+24%+24%+40%+47%
Profit
Gross margin50%55%51%55%59%61%
Operating margin−9.3%0.9%−0.4%1.7%9.0%17%
Net margin−9.2%2.7%14%6.5%9.2%16%
What growth costs, per sales dollar
Selling, general and admin51%47%43%43%40%35%
Pay in shares7.7%6.0%6.0%4.5%5.2%5.1%
Capital spending1.1%0.3%0.6%0.7%1.5%1.4%
Cash
Cash from operations$15.2M$25.3M$27.6M$22.9M$52.5M$74.9M
Free cash flow$14.9M$25.2M$27.4M$22.5M$51.2M$73.5M
Balance sheet
Cash and short-term investments$7.39M-----
Debt---$0$8.00M$5.25M
Returns and shares
Return on capital-2.1%−0.8%3.4%13%23%
Shares (diluted)51.0M52.9M54.2M55.6M59.6M62.0M

What growth costs

Growth has made Paysign steadily more profitable. Office, sales and admin costs rise much more slowly than sales, so each new dollar of revenue keeps more profit. It reports no research spending; it builds its software and spreads that cost over later years instead.

The evidence under this - 2 claims
C50facthigh confidence
Selling, general and administrative costs fell from 62.6% of revenue in 2020 to 40.3% in 2025 and 34.7% in the year to June 2026, stock pay from 12.3% to 5.2%, while depreciation and amortisation stayed near a tenth of revenue; operating margin went from a 34.6% loss to 9.0% and 17.0%. Paysign tags no research and development expense; it capitalises software development instead (C49).
against this

Gross margin rose from 38.6% to 61.0% over the same span, so much of the widening came from the shift toward pharma rather than from fixed costs alone (C03).

historical · FY2020 to the year to June 2026written 2026-10-04
C49facthigh confidence
From 2023 to 2025 Paysign repurchased about $2.0M of shares under a $5M program, 100,000 shares in 2025 and 136,700 in 2024, while diluted weighted shares rose from 54.16M to 59.65M; it paid no dividend, carries no bank debt, issued 2.5M shares in the Gamma purchase, and spent $6.80M in 2025 and $8.93M in 2024 capitalising internally developed software.
historical · FY2023 to FY2025written 2026-10-04

The last report (5 Aug)

Quarter ended June 2026, filed figures.

48%
Sales growth
against the same quarter a year earlier
0.8%
Growth from the quarter before
against 23.2% the quarter before that
25¢
Operating profit
per dollar of sales

Q2 2026 was the best quarter Paysign has reported. Revenue rose 48.1%, copay programs grew 88.9%, and the company raised its forecast for the year a second time.

Two things flattered it. A $990,000 gain came from cancelling a payment the company no longer owed on a failed purchase, and the tax rate was unusually low. Without them, earnings were about $0.085 a share rather than $0.11. Plasma centers kept falling, to 561 from 607 a year earlier.

What it did to the thesisIt confirmed the drug-copay business is growing fast and the beat was real even without one-offs. It also showed plasma centers still leaving and earnings flattered by a gain and a low tax rate. The view stays Neutral because the price already assumes years of fast growth.

The quarter in detail

Sales growth from the previous quarter, filed figures.

Earnings per share $0.11 against $0.06 expected; $0.11 as filed, with no adjustments.

The evidence under this - 5 claims
C02facthigh confidence
In Q2 2026 revenue was $28.25M, up 48.1% on Q2 2025: pharma $14.65M, up 88.9%; plasma $13.04M, up 21.4%; other $0.56M, down 3.1%.
historical · Q2 2026written 2026-09-27
C05facthigh confidence
Paysign's plasma center count fell from 607 at the end of Q2 2025 to 595 at the end of 2025 and 561 at the end of Q2 2026, as customers closed centers and one sold centers to a company using another payment provider.
current state · 2026-06-30written 2026-09-27
C07facthigh confidence
Q2 2026 operating margin was 24.8%, or 21.3% without a one-off $990,000 gain from writing the Gamma earn-out to zero, and the effective tax rate was 14.5% against a full-year guide of 22.5% to 25.0%.
historical · Q2 2026written 2026-09-27
C08estimatemedium confidence
Without the earn-out gain and at a 23.75% tax rate, the middle of the full-year guide, Q2 2026 diluted earnings were about $0.085 a share, against $0.11 reported and a $0.06 estimate.
derivedPretax income $7,905,119 less the $990,000 gain is $6,915,119; at 23.75% tax that is $5,272,778 over 61,975,531 diluted shares, $0.085. Reported $0.11 and the vendor's $0.06 estimate are from the release and the pack.
against this
  • The $0.085 still beats the $0.06 estimate by 42%, so the beat was real without the one-offs.
  • Stock-pay tax benefits recur whenever the share price rises, so a low tax rate is not purely one-off while the price keeps climbing.
historical · Q2 2026written 2026-09-27
C29management claimmedium confidence
Paysign guides 2026 revenue of $114.0M to $117.0M, net income of $21.5M to $23.0M and $0.35 to $0.37 of diluted earnings a share, raised from $106.5M to $110.5M and $0.21 to $0.26 in March; Q3 2026 revenue $28.5M to $30.0M.
against this
  • Guidance was raised twice in 2026 and beaten at every line in Q1, so the risk runs to under-guiding as much as over.
  • The H2 guide rests on plasma rising and pharma falling seasonally, and the Q2 net income used a 14.5% tax rate the guide does not repeat.
forwardwritten 2026-09-27
What management did with the money

Insiders in 2026Q2: 8 purchases and 21 sales, from their Form 4 filings.

05

The price, and where we disagree

In short. Full. The price already pays for Paysign's drug-copay business to keep growing fast for several more years, and leaves little if growth slows to what analysts expect.

Share price
$14.36
close,
Price for each $1 of yearly profit
44.4
its 6-year normal 30.1

The shares more than doubled in a year, and most of the rise came from buyers paying more for each dollar of sales rather than from sales themselves. They jumped 29.3% the day after the Q2 2026 results.

The next test is close. On 2026-11-11 Paysign reports Q3 2026 against a promise of $28.5M to $30.0M of revenue and 165 to 170 copay programs.

The evidence under this - 4 claims
C33facthigh confidence
Over 252 sessions to 2026-09-25 the shares rose 124.7% to $12.67 while trailing revenue per share rose 37.1%, so the price paid for each dollar of sales rose 63.8%.
historical · 2025-09-24 to 2026-09-25written 2026-09-27
C39facthigh confidence
The shares rose 29.3% on 2026-08-06, from $9.59 to $12.40, the day after the Q2 2026 results and guidance raise.
historical · 2026-08written 2026-09-27
C29management claimmedium confidence
Paysign guides 2026 revenue of $114.0M to $117.0M, net income of $21.5M to $23.0M and $0.35 to $0.37 of diluted earnings a share, raised from $106.5M to $110.5M and $0.21 to $0.26 in March; Q3 2026 revenue $28.5M to $30.0M.
against this
  • Guidance was raised twice in 2026 and beaten at every line in Q1, so the risk runs to under-guiding as much as over.
  • The H2 guide rests on plasma rising and pharma falling seasonally, and the Q2 net income used a 14.5% tax rate the guide does not repeat.
forwardwritten 2026-09-27
C04facthigh confidence
Paysign ran 148 patient affordability programs at the end of Q2 2026, 51 net more than a year earlier, after 55 net added in 2025; it guides 165 to 170 by the end of Q3 2026.
current state · 2026-06-30written 2026-09-27
The betPriced for success
If it works
0.8×
from today's value, at the stated multiple
If it fails
keep 44%
of today's market value: the rest of the company and Pharma industry stalled at its lowest case, less debt
How we read the multiple

Buyers pay about 44 times last year's profit, against its usual 30. On the company's own forecast for this year it is 35 times, and about 30 times what its two analysts expect for 2027.

Those analysts see sales growth slowing to 16% next year. If they are right, the shares are still dear in 2028. The price makes sense only if growth stays near 30% for several more years.

Against its own history. Buyers now pay far more for each dollar of sales than they have in recent years, so the rise is enthusiasm as much as progress.

The evidence under this - 3 claims
C34estimatemedium confidence
At $12.67 and 61.98M diluted shares, about $785M, the price is 35.2 times the middle of 2026 guided earnings of $0.36 a share, 48.7 times trailing diluted earnings of $0.26, and 30.2 times the 2027 panel's $0.42.
derivedPrice from the pack; diluted shares from the Q2 2026 10-Q (C30); guided EPS from C29; trailing EPS the sum of the last four quarters' filed diluted EPS, $0.04, $0.02, $0.09 and $0.11; 2027 EPS from the two-analyst panel (C35).
against this
  • Guidance has been raised twice this year; if 2026 lands at the Q2 run-rate plus seasonality the multiple is lower than 35.2.
  • Trailing earnings include a 45.4% tax rate in Q4 2025 that depresses the trailing figure.
current state · 2026-09-25written 2026-09-27
C35factmedium confidence
The two analysts in the vendor's estimate panel expect 2026 revenue of $114.65M, inside guidance of $114.0M to $117.0M, and 2027 revenue of $133.22M, growth of 16.2%, with earnings of $0.345 and $0.42 a share.
current state · 2026-09-27written 2026-09-27
C29management claimmedium confidence
Paysign guides 2026 revenue of $114.0M to $117.0M, net income of $21.5M to $23.0M and $0.35 to $0.37 of diluted earnings a share, raised from $106.5M to $110.5M and $0.21 to $0.26 in March; Q3 2026 revenue $28.5M to $30.0M.
against this
  • Guidance was raised twice in 2026 and beaten at every line in Q1, so the risk runs to under-guiding as much as over.
  • The H2 guide rests on plasma rising and pharma falling seasonally, and the Q2 net income used a 14.5% tax rate the guide does not repeat.
forwardwritten 2026-09-27
Priced against its rivals

None of the listed rivals above sells the same thing to the same buyers as a large part of what it does. A price comparison needs at least two, so the price is judged against its own history instead.

Private or foreign rivals that cannot be priced: Onbe, Cencora (copay offering).

The bet: what it pays if it works

This bet is on one business only: the drug-copay programs, which grow far faster than the rest. Paying plasma donors, the older half, is counted separately at the price the market paid for the company when it was mostly plasma.

If copay programs keep being added at their recent pace for two more years, the stock is worth less than today, so this is an expensive bet. If the copay business stalls, the plasma half and the stalled copay business cover a little under half of today's price.

Pharma industry revenue in two to three yearsPrograms at 2026's average revenue neededAt the stated multiple
$47.85Mabout 131 at 100% kept0.5×
$95.50M (the big win)about 262 at 100% kept0.8×
$127.00Mabout 348 at 100% kept1.0×

To pay 2× (a Fair bet) it would need about $282.18M of Pharma industry revenue (about 773 programs at 2026's average revenue); to pay 5× (a Cheap bet), about $763.87M of Pharma industry revenue (about 2.1K programs at 2026's average revenue), at the same multiple.

Each row is Pharma industry alone, plus the rest of the company (Plasma industry and other cards) counted at about $194.70M.

The steps it has to take

  • Done 55 net copay programs added in 2025 and 51 in the twelve months to June 2026
  • Done 2025 pharma revenue up 167.8% to $33.89M
  • In progress Q3 2026: 165 to 170 programs and revenue of $28.5M to $30.0M due 2026-11
  • In progress 2026 pharma revenue of about $56.5M inside the raised full-year guide due 2027-03
  • Not started 2027 revenue guidance at or above $150M, about 30% growth due 2027-03
  • Not started 2028 pharma revenue near $95.5M on 40 or more net programs a year due 2029-03
The detail behind the label
Rating
Expensive
the big win's payoff against the 2× and 5× lines
Cheap bet at about
$2.40
83% below the price (close, )
The option
0.8×
what Pharma industry is worth if it works, against what the price pays for it
The evidence under this - 5 claims
C04facthigh confidence
Paysign ran 148 patient affordability programs at the end of Q2 2026, 51 net more than a year earlier, after 55 net added in 2025; it guides 165 to 170 by the end of Q3 2026.
current state · 2026-06-30written 2026-09-27
C41estimatelow confidence
Pharma revenue for 2026 is about $56.5M: the March guide split revenue equally between plasma and pharma after $2.5M of other revenue, applied to the raised $115.5M midpoint.
derivedC29 midpoint $115.5M less $2.5M of other revenue, halved; the March release states the equal split (S04). H1 pharma was $30.33M, so the estimate implies about $26.2M in H2 as claims fade seasonally.
against this

The equal split was stated in March, before the raise; if the raise was mostly pharma, pharma is larger than half.

forwardwritten 2026-09-27
C03facthigh confidence
Pharma was 51.9% of Q2 2026 revenue, against 41.3% of 2025 revenue; 2025 pharma revenue was $33.89M, up 167.8%, while plasma grew 4.0% to $45.62M.
historical · Q2 2026 and FY2025written 2026-09-27
C45factmedium confidence
Paysign's trailing price-to-sales was 7.04 at 2026-09-27 against a median of 3.26 over the six prior years, years in which plasma was most of revenue: 75.2% in 2024 and 55.6% in 2025.
against this

The vendor's ratio series is advisory, and the six-year median includes years of losses and a smaller pharma line, so it prices plasma only roughly.

current state · 2026-09-27written 2026-10-02
C35factmedium confidence
The two analysts in the vendor's estimate panel expect 2026 revenue of $114.65M, inside guidance of $114.0M to $117.0M, and 2027 revenue of $133.22M, growth of 16.2%, with earnings of $0.345 and $0.42 a share.
current state · 2026-09-27written 2026-09-27

Where we disagree with the market

The market believes

Paysign is a fast-growing healthcare payments company, and the plasma worries and drug-policy fears are behind it.

We believe

The copay growth is real, but plasma centers are leaving, the software purchase failed, and the latest quarter was flattered.

The market reads the headline figures. The center losses, the cancelled payment on the failed purchase and the one-off gain sit in the notes to the accounts, not in the release's opening lines.

The case against us: the company has beaten and raised its forecast twice this year, and if copay programs keep compounding, today's price will look cheap.

What analysts say, and the evidence
Analysts positive
100%
of 5, 1 Sep
Four months earlier
100%
of 5, 1 May
The evidence under this - 6 claims
C33facthigh confidence
Over 252 sessions to 2026-09-25 the shares rose 124.7% to $12.67 while trailing revenue per share rose 37.1%, so the price paid for each dollar of sales rose 63.8%.
historical · 2025-09-24 to 2026-09-25written 2026-09-27
C39facthigh confidence
The shares rose 29.3% on 2026-08-06, from $9.59 to $12.40, the day after the Q2 2026 results and guidance raise.
historical · 2026-08written 2026-09-27
C05facthigh confidence
Paysign's plasma center count fell from 607 at the end of Q2 2025 to 595 at the end of 2025 and 561 at the end of Q2 2026, as customers closed centers and one sold centers to a company using another payment provider.
current state · 2026-06-30written 2026-09-27
C09facthigh confidence
Paysign bought Gamma Innovation's plasma software in March 2025 for $15.56M, including $10M of cash in five yearly payments and 2.5M shares; by June 2026 it wrote the earn-out to zero because Gamma revenue was materially below the $20M thresholds, cancelled it, and agreed to grant stock units to Gamma's owner if shareholders approve more shares.
current state · 2026-06-30written 2026-09-27
C08estimatemedium confidence
Without the earn-out gain and at a 23.75% tax rate, the middle of the full-year guide, Q2 2026 diluted earnings were about $0.085 a share, against $0.11 reported and a $0.06 estimate.
derivedPretax income $7,905,119 less the $990,000 gain is $6,915,119; at 23.75% tax that is $5,272,778 over 61,975,531 diluted shares, $0.085. Reported $0.11 and the vendor's $0.06 estimate are from the release and the pack.
against this
  • The $0.085 still beats the $0.06 estimate by 42%, so the beat was real without the one-offs.
  • Stock-pay tax benefits recur whenever the share price rises, so a low tax rate is not purely one-off while the price keeps climbing.
historical · Q2 2026written 2026-09-27
C04facthigh confidence
Paysign ran 148 patient affordability programs at the end of Q2 2026, 51 net more than a year earlier, after 55 net added in 2025; it guides 165 to 170 by the end of Q3 2026.
current state · 2026-06-30written 2026-09-27
06

What could go wrong, and how we would know

The risks

  • A rule against copay-draining plans. Paysign's selling point is blocking insurers' maximizer plans. A federal ban would shrink the problem it is paid to solve.
  • One drug maker looms large. A single client is 36% of the money Paysign is owed, up from 31% at the end of 2025.
  • Plasma centers walking away. When collectors sell centers, the new owner can bring its own card provider; 46 net centers went in a year.
  • A far larger rival. McKesson's copay service saves patients about $10B a year to Paysign's $1B, and programs Paysign wins from others can be won back.
  • Insiders are selling. Twenty open-market sales and no purchases in a year; share count up 7.1%.
The evidence under this - 8 claims
C23inferencemedium confidence
Paysign's edge in pharma is catching insurers' maximizer claims; a federal ban on maximizers in employer plans would shrink the problem it is paid to solve, though drug makers would still need someone to run copay programs.
derivedC17 and C18 size the diversion; C19 and C20 are management's account of why clients pick Paysign; C24 is management's view that no federal action is coming.
against this
  • State bans did not remove accumulators and did not touch maximizers, and most employer plans fall under federal ERISA law that states cannot reach (IQVIA, management).
  • A ban would also stop insurers draining programs mid-year, which could raise claim volume Paysign is paid on.
forwardwritten 2026-09-27
C24management claimmedium confidence
Management says most action against accumulators and maximizers is state law, which does not reach employer plans governed by ERISA, and it expects no federal action in the foreseeable future.
against this

Congress has repeatedly seen bills to count copay aid toward deductibles; management is the party most exposed if one passes, so its forecast is interested.

forwardwritten 2026-09-27
C25facthigh confidence
One pharma client was 36% of Paysign's receivables at the end of Q2 2026, up from 31% at the end of 2025; these receivables are copay claims Paysign paid on clients' behalf and bills back.
current state · 2026-06-30written 2026-09-27
C05facthigh confidence
Paysign's plasma center count fell from 607 at the end of Q2 2025 to 595 at the end of 2025 and 561 at the end of Q2 2026, as customers closed centers and one sold centers to a company using another payment provider.
current state · 2026-06-30written 2026-09-27
C43inferencemedium confidence
Plasma revenue is not locked in beyond the collector: when a collector sells or closes centers, the donors' cards move to whatever provider the new owner uses.
derivedC05 and the Q1 2026 call: centers were 'sold to collectors that do not utilize our services'; C13 shows a rival ready to take them.
against this

Management says closures cost little because donors move to nearby Paysign centers, and revenue per center rose 8.5% while centers fell.

current state · 2026-06-30written 2026-09-27
C21factmedium confidence
McKesson's affordability business says it helped patients save about $10B on brand and specialty drugs in its latest year and has supported more than 650 drug brands, about ten times Paysign's 2025 assistance dollars.
current state · 2026-03-31written 2026-09-27
C32facthigh confidence
Insiders made 20 open-market sales and no purchases in the year to September 2026; nine were not under a trading plan, including 150,000 shares by Gamma's founder at $12.74 to $12.85 on 2026-09-08 and 2026-09-09.
historical · 2025-11 to 2026-09written 2026-09-27
C30facthigh confidence
Diluted shares were 61,975,531 in Q2 2026, up 7.1% from 57,872,318 a year earlier; basic shares rose 3.0% to 55,864,262, with 4.83M unvested restricted shares in the diluted count.
historical · Q2 2026written 2026-09-27
What we still do not know
  • How many copay programs Paysign loses to rivals. It reports only the net count.
  • What it charges per program and per claim, against McKesson and private rivals. Nobody publishes it.
  • Which collector sold centers to a rival card provider, and which provider won them.
  • When, if ever, the FDA clears its plasma software.
The evidence under this - 4 claims
C04facthigh confidence
Paysign ran 148 patient affordability programs at the end of Q2 2026, 51 net more than a year earlier, after 55 net added in 2025; it guides 165 to 170 by the end of Q3 2026.
current state · 2026-06-30written 2026-09-27
C42inferencemedium confidence
Paysign is paid per program and per claim, not on the dollars it moves: its $33.89M of 2025 pharma revenue was about 3.4% of the roughly $1B of assistance it says it delivered.
derivedThe 10-Q lists pharma revenue as management, setup, claim processing and other fees (S02); C03 and C19 give the ratio.
historical · FY2025written 2026-09-27
C05facthigh confidence
Paysign's plasma center count fell from 607 at the end of Q2 2025 to 595 at the end of 2025 and 561 at the end of Q2 2026, as customers closed centers and one sold centers to a company using another payment provider.
current state · 2026-06-30written 2026-09-27
C10management claimmedium confidence
Paysign's donor management system for plasma centers is still awaiting FDA 510(k) clearance and earned no revenue as of May 2026; in November 2025 management expected clearance around the end of 2025 or early 2026.
against this
  • The timetable has already slipped at least twice, from Q4 2025 to 'first quarter, second quarter' of 2026, and the Q1 2026 call would say nothing beyond 'discussions back and forth'.
  • The FDA's 510(k) database shows no clearance for Paysign, Gamma or Apherion as of 2026-09-27.
current state · 2026-09-27written 2026-09-27

What would change our view

  1. Neutral→AttractiveGrowth holds well above the panel into 2027

    It needs all of:

    • ○Paysign guides 2027 revenue of $150M or more, about 30% growth.checked at the next results, due by 11 Nov
    • ○Its plasma center count holds at 561 or more at the end of 2026.checked at the next results, due by 11 Nov
  2. Neutral→AttractiveA cheaper price on unchanged execution

    It needs all of:

    • ○The shares fall to 25 times this year's guided profit.about $10.11 today, 30% below the last close
    • ○Q3 2026 revenue reaches at least $28.5M, the bottom of the promise.checked at the next results, due by 11 Nov
  3. Neutral→UnattractiveThe growth engine stalls

    It needs any of:

    • ○Fewer than 30 net copay programs are added over twelve months.checked at the next results, due by 11 Nov
    • ○Paysign's plasma center count falls below 520.checked at the next results, due by 11 Nov
We would also be wrong if
  • A federal rule bars insurers' maximizer plans in employer health plans.
  • One drug maker's bills pass half of what Paysign is owed, or a top-ten maker leaves.

What is coming

  • 11 November 2026 Q3 2026 results: Revenue against the $28.5M to $30.0M guide, programs against 165 to 170, plasma centers against 561, and operating margin without one-off gains.
Every dated event ahead
  • 11 November 2026 Q3 2026 results: Revenue against the $28.5M to $30.0M guide, programs against 165 to 170, plasma centers against 561, and operating margin without one-off gains.
  • March 2027 Q4 and full-year 2026 results with 2027 guidance: Whether 2027 revenue guidance reaches about $150M, the growth near 30% the price needs, against the panel's 16%; and the next Gamma payment.
  • 30 June 2027 2027 annual meeting vote on more equity-plan shares: How many new shares the board asks for, including the units promised to Gamma's owner, and so how fast the diluted count keeps rising.
Since we wrote this
Written
27 Sep
Price the thesis read
$12.67
25 Sep
Latest close
$14.36
close, · +13.3% since
  • 5 OctThesis reviewThe bet now names what it ridesThe owner asked that every bet name the macro trend behind it, after BWXT's bet was missing its chief executive's case for nuclear over gas.
  • 4 OctThesis reviewOwner's checklist: revenue streams, cost of growth, management, catalystsThe owner's checklist found the method silent on who runs the company, what growth costs, where the money comes from and what is dated ahead; this pass fills those four blocks from the proxy and filings.
  • 27 SepThesis writtenNeutral, medium convictionWritten six weeks before Q3 2026 results, after the shares more than doubled on two guidance raises.

Also checked 5 times with nothing new to act on.

Sources 20

Where this came from

Sources - 20

Every claim above cites one of these, or states the reasoning that derived it. The quote is frozen at the date it was read: a link can rot, and an agent fetch returns a reading of a page rather than the page. Backs counts the whole claim ledger, so it can name a claim this page does not surface.

  1. S01primarycompany filing2026-03-25
    Item 1 business, the plasma center share, the competition section (classes, no names), risk factors on issuing banks, the cash flow statement, receivable concentration, the buyback authorisation
    backsC01C11C25C27C28C31C45C49C50
  2. S02primarycompany filing2026-08-06
    the MD&A, the Gamma acquisition note and earn-out write-off, receivable concentration, the cash flow statement, share counts and dilution, interest income
    backsC01C02C05C07C09C25C26C27C30C31C33C40C49C50C51
  3. S03primarycompany release2026-08-05
    revenue by industry, program and center counts, revenue per center, the one-off earn-out gain, the balance sheet, the raised 2026 guidance and the Q3 2026 guide
    backsC02C03C04C05C06C07C26C29C31C35C39
  4. S04primarycompany release2026-03-24
    2025 revenue by industry, centers and programs at year end, the first 2026 guidance, the plasma inventory explanation, the Gamma closing and BECS status
    backsC03C04C05C06C07C11C29C31C40
  5. S05primarycompany release2025-08-05
    the quarter plasma revenue fell 4.7% on industry plasma oversupply, 123 centers added on 2025-06-16, 97 programs
    backsC37
  6. S06primarytranscript2026-05-12
    Paysign Q1 2026 earnings call transcript (FMP), held 2026-05-12
    management's remarks on programs, claims, the $540M of Q1 assistance and plasma closures; three analysts' questions, including whether Apherion earns revenue (it does not) and the $6M left to pay Gamma's sellers
    Currently, we're having discussions back and forth with the FDA, and that's really all I can say right now.
    backsC10C20C27C44
  7. S07primarytranscript2026-03-24
    Paysign Q4 2025 earnings call transcript (FMP), held 2026-03-24
    the $1B of 2025 assistance and $325M of claimed savings, the transitions-versus-launches mix, the named rivals McKesson and Cencora, and the argument that federal action on maximizers is not expected
    In 2025, our platform helped deliver nearly $1 billion in financial assistance to patients, supporting access to high-cost therapies for more than 840,000 individuals. At the same time, we help manufacturers better control how those dollars are spent, which is one of the key value propositions we provide. A key differentiator of our platform is our dynamic business rules technology, which helps pharmaceutical manufacturers avoid unnecessary costs associated with co-pay maximizer programs. In 2025 alone, this solution saved our clients over $325 million.
    backsC19C20C21C24C38
  8. S08primarytranscript2025-11-12
    Paysign Q3 2025 earnings call transcript (FMP), held 2025-11-12
    the BECS clearance timetable as management stated it in November 2025
    we were to get through the FDA approval sometime in fourth quarter. Going into first quarter.
    backsC10
  9. S09primarycompany filing2026-09-27
    20 open-market sales and no purchases; the Rule 10b5-1 flag on each sale
    backsC32
  10. S10secondaryvendor data2026-09-27
    Research pack, PAYS, 2026-09-27 (FMP market data, FINRA short interest)
    price, the 252-session decomposition, daily closes around each print, the two-analyst estimate panel, the ratings series and short interest
    backsC33C35C36C37C38C39C45
  11. S11primaryindustry data2024-05-07
    the size of manufacturers' copay assistance, measured outside the industry's sellers
    This amount is after $23Bn in copay assistance programs provided by manufacturers, with patients using copay cards for nearly one-third of brand commercial prescriptions in the top 10 therapy areas and 63% of obesity prescriptions.
    backsC16
  12. S12primaryindustry data2024-03
    what maximizers and accumulators take from manufacturers' support budgets, and that state bans slowed but did not stop them
    Nevertheless, in 2023, maximizers accounted for an estimated $2.7B (23%) of total patient support spend in the U.S.
    backsC17
  13. S13secondaryindustry data2026-02
    how many commercial lives sit in plans that divert copay aid, measured by a benefits-data firm
    For 2025, we estimate that only 39% of covered lives are enrolled in plans with accumulators and a comparable number are in plans with maximizers.
    backsC18
  14. S14secondaryother2026-01
    an outside count of US plasma centers and collections, and the device-driven yield gain
    As of December 31, there are 1,247 plasma collection centers in the United States (including four centers in Puerto Rico). Centers may not have grown by 8%, but plasma collections grew by 8.41% from 57.6 to 62.5 million liters.
    backsC11C12C14
  15. S15primaryother2026-09-27
    that CSL Plasma pays its donors on Paysign cards, said by the customer
    Donors with questions can call Paysign Customer Service at 888-522-4853 for assistance.
    backsC12
  16. S16primaryother2026-09-27
    a private rival selling the same donor payout product
    Pay donors and trial participants instantly with payment choices that offer convenient, secure access to funds.
    backsC13
  17. S17primarycompany filing2026-05-20
    the incumbent donor management system NexLynk DMS, wired to its own collection device, and the device yield gains
    backsC12C14C15
  18. S18primarycompany filing2026-05-08
    the scale of McKesson's affordability business and a Justice Department demand about its copay coupon administration
    backsC21C22
  19. S19primaryregulator2026-09-27
    no 510(k) clearance on record for Paysign's donor management system
    error code NOT_FOUND, message: No matches found!
    backsC10
  20. S20primarycompany filing2026-03-26
    directors and executive officers with tenure, the summary compensation table and its footnotes on bonus and stock awards, pay versus performance, and beneficial ownership at March 19, 2026
    backsC46C47C48
Rendered from content/PAYS/thesis.json · thesis reviewed 2026-10-02. This page explains a company; it does not say what to pay, when to buy or how much.