Heron Therapeutics (HRTX) Q3 2025: Acute Care Net Sales Jump 49% as Zynrelef Momentum Accelerates
Heron Therapeutics delivered a pivotal Q3, marked by an inflection in acute care product adoption and operational focus after resolving long-standing financing constraints. The company’s acute care franchise, led by Zynrelef and Aponvie, posted outsized growth, while oncology supportive care remained stable outside of Sustol’s ongoing decline. New reimbursement clarity and streamlined commercial execution are setting the stage for continued growth into 2026, with management reaffirming guidance and signaling targeted commercial expansion.
Summary
- Acute Care Inflection: Zynrelef and Aponvie posted breakout sales and unit growth, signaling a structural demand shift.
- Commercial Execution Reset: Dedicated sales teams, new incentive programs, and streamlined reimbursement improved market access and protocol adoption.
- Oncology Franchise Stability: Sinvanti held steady despite competitive pressure, while Sustol is being wound down ahead of a potential 2027 relaunch.
Performance Analysis
Heron’s Q3 2025 results reflect a decisive pivot toward acute care growth, with net revenues of $38.2 million and year-to-date revenues of $114.3 million. The acute care franchise—driven by Zynrelef, a non-opioid post-surgical pain treatment, and Aponvie, an antiemetic for postoperative nausea—delivered $12.3 million in net sales for the quarter, up from $10.7 million in Q2. Zynrelef net sales grew 49% year-over-year, and Aponvie surged 173% year-over-year, both outpacing the company’s legacy oncology care franchise. Weekly unit demand for Zynrelef in late September and October reached all-time highs, signaling a possible inflection point in adoption.
The oncology supportive care segment contributed $25.9 million in net sales, with Sinvanti, an antiemetic for chemotherapy-induced nausea, generating $24 million—up 6% year-over-year and stable sequentially. Sustol, another antiemetic, declined 32% year-over-year as Heron prepares to wind down commercialization. Gross margin slipped to 68.8% due to a one-time Sustol inventory write-off, but adjusted gross margin remains in the mid-70% range excluding this charge. Operating leverage improved, with adjusted EBITDA positive at $1.5 million for the quarter, despite a reported net loss driven by a non-recurring $11.3 million debt extinguishment charge.
- Acute Franchise Surge: Zynrelef and Aponvie’s combined growth outpaced legacy oncology, reflecting successful commercial initiatives.
- Margin Dynamics: Gross margin temporarily impacted by inventory write-offs; underlying margin remains consistent with prior quarters.
- Profitability Inflection: Adjusted EBITDA turned positive, reflecting operational discipline and sales momentum.
Heron’s acute care business is now the primary growth engine, while the oncology segment provides stability and cash flow, aside from Sustol’s planned wind-down.
Executive Commentary
"One of the most significant milestones was the successful completion of our financing. This has been an overhang on the company since I joined, and we're glad to have it behind us. With this resolved, management can now fully focus on commercial execution and product growth."
Craig Collard, Chief Executive Officer
"Our product gross profit for the three months ended September 30, 2025, was $26.3 million, or 68.8%, which decreased from 71.2% for the same period in 2024. This decrease is due to an increase of $1.4 million of inventory reserves and write-offs recorded and an increase of $1.3 million in the cost of units sold, primarily due to supplier mix."
Ira Duarte, Chief Financial Officer
Strategic Positioning
1. Acute Care Commercial Model: Dedicated Teams and Friction Removal
Heron’s acute care strategy centers on dedicated sales teams for Zynrelef and Aponvie, supported by new programs like Crosslink Ignite, which incentivizes distributors to target high-potential accounts. Operational improvements, such as the introduction of the VAN (vial access needle), have streamlined product use in the operating room, reducing adoption barriers. The company’s focus on “friction removal and focus” is translating into durable protocol adoption and expanding hospital relationships.
2. Reimbursement and Market Access: J-Code and No Pain Act Tailwinds
The permanent J-code for Zynrelef, effective October 1, is a major catalyst, simplifying billing and accelerating uptake among providers. The No Pain Act, which allows for separate reimbursement of non-opioid pain alternatives, is gaining traction with both Medicare and commercial payers, broadening coverage for Heron’s acute portfolio. About 75% of target Zynrelef procedures now have some form of reimbursement, with further upside as value-based care models expand.
3. Oncology Care: Sinvanti Stability, Sustol Wind-Down
Sinvanti remains a stable anchor within oncology supportive care, with consistent sales and account retention despite ongoing competitive pricing pressure. The company is leveraging cross-selling opportunities through its acute care sales force. Sustol’s continued decline has prompted a planned wind-down, with a potential relaunch targeted for late 2027 pending product improvements.
4. Pipeline and Product Simplification: Pre-Filled Syringe Program
The pre-filled syringe (PFS) initiative for Zynrelef is on track for a potential 2027 approval, following successful registration batch manufacturing and stability testing. Management expects the PFS to further simplify hospital onboarding and accelerate conversion of accounts, building on the success of the VAN in reducing operational hurdles.
Key Considerations
This quarter marks a strategic turning point for Heron, as acute care growth and operational discipline offset legacy product headwinds. Investors should weigh the following factors:
Key Considerations:
- Acute Care Growth Sustainability: Recent momentum in Zynrelef and Aponvie is underpinned by both operational improvements and market access wins, but continued execution is required to maintain this trajectory.
- Reimbursement Expansion: The J-code and No Pain Act are expanding coverage, but variability in commercial payer adoption and state-by-state differences introduce uncertainty.
- Oncology Franchise Transition: Sinvanti’s stability is offset by Sustol’s wind-down, requiring management to manage both cash flow and customer relationships during the transition period.
- Commercial Investment Discipline: Management is adopting a targeted approach to adding sales resources, focusing on high-potential regional “pockets” and maintaining profitability thresholds.
Risks
Heron faces competitive pressure in both acute and oncology care, with the risk of account losses or required price concessions, especially for Sinvanti. Reimbursement expansion is not uniform across commercial payers, and the impact of new value-based care models remains emergent. The wind-down of Sustol poses a near-term revenue headwind, and pipeline execution (notably for the pre-filled syringe) is subject to regulatory and operational risk. One-time charges and inventory write-offs may recur if market conditions shift unexpectedly.
Forward Outlook
For Q4 2025, Heron guided to:
- Net revenue in the range of $153 million to $163 million for the full year
- Adjusted EBITDA between $9 million and $30 million for the full year
Management highlighted several factors that will influence the outlook:
- Continued acute care adoption, driven by expanded sales teams and market access improvements
- Stable Sinvanti sales, with ongoing monitoring of competitive dynamics
- Careful management of Sustol wind-down and product transition plans
Takeaways
Heron’s acute care business is now the core growth engine, with structural improvements in commercial execution and market access driving outsized performance. Oncology supportive care provides a stable base, though the winding down of Sustol will require careful management. Reimbursement clarity and operational focus are likely to sustain momentum into 2026, but investors should monitor for competitive and reimbursement risks.
- Acute Care Traction: Zynrelef and Aponvie are now the primary growth drivers, with strong signals of sustained demand and protocol adoption.
- Margin and Profitability Improvement: Underlying gross margin remains healthy, and adjusted EBITDA turned positive despite one-time charges.
- Execution Watchpoint: Sustained acute care growth and stable Sinvanti performance are essential to offsetting oncology franchise headwinds and delivering on guidance.
Conclusion
Heron Therapeutics exited Q3 2025 with acute care products inflecting, operational discipline in place, and legacy oncology headwinds managed through strategic wind-downs. With new reimbursement wins and a pipeline simplification strategy, the company is positioned for continued growth, but must maintain execution focus amid competitive and payer uncertainties.
Industry Read-Through
Heron’s experience highlights the critical importance of streamlined reimbursement and targeted commercial execution in specialty pharma. The acute care inflection demonstrates that removing operational friction (via dedicated teams and product simplification) can drive protocol adoption in hospital settings. Broader industry participants should note the accelerating impact of legislative reimbursement changes (such as the No Pain Act) and the need to proactively manage product transitions in legacy franchises. Companies with similar acute care or hospital-based products can look to Heron’s model of focused execution and payer engagement as a template for driving durable adoption and offsetting competitive pressures.