BONESUPPORT Hits a Temporary Speed Bump While the Reimbursement Tailwind Builds
Q2 2026: Strong 30% CER growth, a rare 'go-stop-go' dynamic, and a guidance trim to 33-36% — all set against a potentially game-changing CMS proposal.
BONEX.ST · Earnings Call · 2026-07-16
A New Friction in the U.S. Growth Engine
BONESUPPORT's Q2 2026 results delivered the headline metrics investors have come to expect: net sales of SEK 356 million, up 30% at constant exchange rates, an adjusted operating margin of 29%, and operating cash flow of SEK 67 million. But the real story this quarter is a newly visible friction in the U.S. — a phenomenon management calls "go-stop-go." A handful of top-50 accounts, while continuing to use CERAMENT G, have imposed temporary usage restrictions as hospital administration reacts to rising spend. As CEO Torbjörn Sköld explained, “Yeah. What we can see is that it's a handful number of accounts. All the accounts are among the, let's say, the top 50 accounts that we have. We don't see anything related to that they are in a special niche or only in one of the three categories.” — Torbjörn Sköld, CEO · 2026-07-16 This is not a demand problem — clinicians remain enthusiastic — but a cost-containment response, and it shaved a few points off what would otherwise have been on-plan growth.
This dynamic is not entirely new, but its visibility in Q2 marks a shift in the company's risk profile. Historically, management has framed temporary restrictions as a natural part of scaling with large hospital systems, and they have a track record of reversing them. When asked about the success rate, Sköld noted, “We've been pretty successful with this historically. Not 100%, but definitely more than 50%.” — Torbjörn Sköld, CEO · 2026-07-16 The company is investing in medical education and health economics teams to preempt these bottlenecks, yet the episode underscores how the U.S. growth engine now depends on navigating hospital budget committees as much as winning over surgeons.
It's simply nature of the business that we're in. We're growing 30%, 30%-40% in the U.S. That means that the hospitals spend a lot more money on CERAMENT. We keep our pricing very, very stable, and we want to be disciplined around that.
Guidance Reset — and the Catalysts That Could Reaccelerate
Perhaps more notable than the go-stop-go itself is the company's decision to trim full-year growth guidance. Management now expects 33-36% CER growth, down from the prior "at least 35%" framework. The reasoning is transparent: “It is more a reflection that we have now two quarters in the books. We grew 31% in the first half year compared to first half year in 2025, where we grew 40%.” — Torbjörn Sköld, CEO · 2026-07-16 This updated guidance incorporates the go-stop-go friction and reflects a more conservative view of near-term hospital behavior. Yet the company is quick to point to the upside triggers embedded in the guidance — none of which are yet in the numbers.
The most significant of these is the CMS ruling. In the quarter, CMS proposed improved reimbursement for CERAMENT G in complex orthopedic infections, along with more specific identification codes, and the final decision is expected in late summer with implementation on October 1. Management sees this as a potential game-changer for the go-stop-go dynamic. As Sköld described, “The proposed changes to DRG codes announced by CMS during the quarter, with expected implementation in the fourth quarter, add further strength to these dialogues.” — Torbjörn Sköld, CEO · 2026-07-16 The company is preparing a rollout plan to educate both administrators and coders, explicitly targeting the hospital cost barrier.
Another catalyst is CERAMENT V, which remains in the De Novo process with responses due at the end of August. A positive approval would open an entirely new product category, but management has deliberately kept CERAMENT V sales out of 2026 guidance. In the Q2 call, they reiterated that the submission is on track, though the timeline for approval remains outside their control. The company also awaits the SOLARIO study publication, which could provide the health-economic evidence needed to overcome resistance.
Why This Matters
BONESUPPORT is at an inflection point. The 30% CER growth is still exceptional, and the company's long-term thesis — that CERAMENT G is in early, multi-year penetration across trauma, revision arthroplasty, and now spine — remains intact. But the go-stop-go dynamic introduces a new variable that investors must weigh: as the company scales, hospital administration costs become a gating factor. The CMS ruling is the key test. If it delivers the promised reimbursement improvements, it could not only offset the friction but accelerate adoption.
For now, the guidance reset is a prudent acknowledgment of near-term realities, not a strategic reversal. The company's cash position remains strong, and the continued investment in commercial resources suggests confidence in the multi-year runway. The market's focus will now shift to the CMS final decision, the SOLARIO study, and the FDA's response to the CERAMENT V submission — any of which could change the growth trajectory for the second half of 2026 and beyond.