Kamada in the first quarter: San Antonio is approved, but the cash test is still ahead
Kamada opened 2026 with $45.2 million of revenue and FDA approval for San Antonio, but the quarter also showed lower gross margin, slightly negative operating cash flow, and a higher run-rate needed for the rest of the year. After the April dividend, the question is not whether there is cash, but how much is truly free for growth.
Kamada did not report a weak quarter, but it also did not yet provide the proof that was missing after 2025. Revenue rose 3% to $45.2 million, adjusted EBITDA was essentially unchanged at $11.6 million, and net income edged up to $4.1 million. Still, under that headline, gross profit declined, operating income declined, and operating cash flow remained slightly negative. FDA approval for the San Antonio center closes an important checkpoint raised in the previous annual analysis, but it moves the test from regulation to commercialization: NSP sales are expected to begin in the second half of 2026, and the market still needs to see customers, collection pace, and price. Full-year guidance stayed at $200 million to $205 million of revenue and $50 million to $53 million of adjusted EBITDA, but after the first quarter it now requires the next three quarters to run stronger than the opening quarter. The cash position is still meaningful, with $73.1 million of cash and short-term investments, but that was before the $14.4 million dividend paid in April, and the company’s own presentation already shows net cash after contingent and lease liabilities at zero. The first quarter therefore keeps the story moderately positive, but less clean: 2026 has to show that the plasma centers, distribution, and core-product demand are producing cash that remains inside the company.
The company is already judged as a commercial business, and the segment split explains the quarter
The company is a commercial biopharmaceutical company in specialty plasma therapies, not only a development-stage biotech name. Its reported activity rests on two segments: proprietary products, including plasma-derived therapeutics and normal source plasma, and distribution of third-party medicines in Israel and the MENA region. Around those segments sit four growth drivers: expansion of the commercial product portfolio, distribution and biosimilars, three plasma collection centers in Texas, and potential M&A or business-development transactions.
The economic machine here combines growth, margin, and working capital. Growth is needed to replace weaker drivers, mainly CYTOGAM and lower-rate GLASSIA royalties. Margin depends on how much of the revenue comes from proprietary products rather than distribution. Working capital and legacy acquisition liabilities determine how much of the improvement actually reaches shareholders. The local market capitalization is around NIS 1.4 billion and short interest is negligible at 0.04% of float, so the market does not signal extreme stress. The possible disappointment in the next reports would not come from a heavy skeptical position, but from the gap between guidance and the actual execution pace.
Distribution more than doubled, but it does not replace proprietary margins
The positive headline number in the first quarter is total revenue growth, but the segment split changes the read. Proprietary-product revenue fell 9.5% to $36.2 million, while distribution revenue jumped to $9.0 million from $4.0 million. That is how the company produced 3% total growth, but gross profit declined to $19.1 million from $20.7 million, and gross margin fell to 42% from 47%.
The implication is straightforward: distribution is an important growth engine, but at this stage it does not carry the same profit weight as proprietary products. Distribution gross margin was about 12%, almost unchanged from the comparable quarter, while proprietary products generated about 50%. Growth through distribution can protect the top line, but it also dilutes overall margin if proprietary products do not return to growth.
This is why the single delayed order that was delivered in April should not be the whole explanation. The delay reduces the severity of the first quarter and may help the second quarter. But it does not remove the mix issue: if 2026 growth comes mainly from distribution and biosimilar launches, the market will need to see gross profit dollars rise, not only revenue.
Guidance stayed intact, and the math now requires a higher pace
Management kept 2026 guidance unchanged: revenue of $200 million to $205 million and adjusted EBITDA of $50 million to $53 million. At the midpoint, after $45.2 million of first-quarter revenue, the next three quarters need to generate about $157.3 million combined, or roughly $52.4 million per quarter on average. Adjusted EBITDA also needs a step-up: after $11.6 million in the first quarter, the company needs about $13.3 million per quarter on average to reach the midpoint of guidance.
That gap is not unreasonable. The company points to increasing demand for KEDRAB in the U.S. and for KAMRAB and VARIZIG outside the U.S., the delayed shipment was delivered in April, and San Antonio received FDA approval and is cleared to begin commercial sales of normal source plasma. Distribution should also benefit from additional biosimilar launches and expansion into the MENA region.
But this is now a proof year, not an automatic continuation of 2025. San Antonio approval is an important operating achievement, especially after it was one of the key checkpoints in the analysis of the plasma collection platform. From here, the test becomes sharper: whether Houston and San Antonio begin generating NSP sales in the second half of the year, whether those sales come at prices that justify donor and collection costs, and whether they also reduce external plasma procurement dependence in the relevant products. Regulatory approval opens the gate, but it is not yet proof of profitability.
The full cash picture narrows the room for error
When assessing financial flexibility, the right frame here is all-in cash flexibility: how much cash remains after actual cash uses, not only whether the company is profitable on the income statement. In the first quarter, operating cash flow was negative by $0.3 million, after a $9.8 million increase in trade receivables, a small inventory increase, and a reduction in trade payables. This is not a distress signal, but it reminds investors that growth still needs balance-sheet funding.
| Cash layer | Q1 2026 | Meaning |
|---|---|---|
| Operating cash flow | $(0.3) million | Profit did not yet convert into cash in the quarter |
| CAPEX and intangible assets | $(1.0) million | Low quarterly investment, but the plasma centers are still ramping |
| Lease repayments | $(0.4) million | Part of the fixed operating base |
| Repayment of other long-term liabilities | $(0.5) million | Continued slow runoff of acquisition-related liabilities |
| All-in cash picture before the dividend | About $(2.1) million | The quarter did not generate free surplus cash |
| Dividend paid in April | $(14.4) million | The payment came after the balance-sheet date, so reported cash did not yet reflect it |
The more important figure sits on the balance sheet. At the end of March, the company had $73.1 million of cash and short-term investments, compared with $75.5 million at the end of 2025. But this amount still came before the April dividend. In addition, the company’s presentation shows net cash debt of zero after contingent and lease liabilities, even before the dividend payment. That is not financial distress, but it is also not a picture of large and fully free excess cash.
This brings back the question left open at the end of 2025. The company can generate profit and it has a meaningful cash balance, but part of the value is still absorbed by receivables, inventory, acquisition liabilities, leases, and distributions to shareholders. If the next quarters show higher revenue without better cash flow, the market will focus less on San Antonio approval and more on the cash cost of growth.
Conclusions
The first quarter strengthens the mixed read on the company: the business direction remains positive, but the cash proof has moved to the next few quarters. San Antonio is no longer a regulatory bottleneck, management kept guidance, and demand for key products still supports the growth story. Against that, gross profitability declined, operating income weakened, and the April dividend reduces the flexibility that appeared in the March balance sheet.
Investors should not look at the second quarter only for a technical catch-up from the delayed shipment. The more important proof points are the revenue pace relative to the roughly $52 million per quarter needed on average through year-end, improvement in gross profit dollars, early NSP sales signals from San Antonio and Houston, and whether receivables and inventory stop absorbing most of the operating improvement. If those pieces connect, 2026 can become a real proof year. If they do not, the first quarter will look in hindsight less like a slow start and more like an early sign that guidance depends on a commercial ramp that still has not proven itself.
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