The firm exhibits a persistent cash burn, with free cash flow reaching a negative $16.1 million in 2026Q1, highlighting the capital-intensive nature of its current development phase.
| Cash from Operations | -51.21M | -49.04M | -28.85M | -46.42M | -52.47M | -33.22M | -50.73M | -51.15M | -21.05M | -8.05M |
| Operating CF Margin % | - | -3172.12% | - | -4642.4% | -1049.38% | -221.49% | - | - | - | - |
| Operating CF Growth % | -249.21% | -70% | 37.86% | 11.52% | -57.93% | 34.51% | 0.82% | -143.05% | -161.38% | - |
| Net Income | -68.36M | -63.06M | -41.52M | -59.69M | -58.39M | -42.85M | -49.97M | -55.23M | -23.18M | -8.09M |
| Depreciation & Amortization | 143K | 114K | 105K | 92K | 89K | 93K | 97K | 38K | 10K | 8K |
| Stock-Based Compensation | 6.14M | 7.46M | 5.78M | 9.53M | 9.05M | 7.28M | 4.95M | 1.19M | 633K | 190K |
| Deferred Taxes | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -1.63M | 0 | 0 |
| Other Non-Cash Items | 8.26M | 3.76M | 3.13M | 2.39M | 44K | 0 | 0 | 1.63M | 787K | 59K |
| Working Capital Changes | 2.6M | 2.68M | 3.66M | 1.24M | -3.26M | 2.26M | -5.81M | 2.85M | 1.5M | -164K |
| Change in Receivables | -2.85M | -1.12M | 1.46M | -2.64M | -730K | 465K | -112K | -169K | -134K | 147K |
| Change in Inventory | -1.18M | -648K | 0 | 0 | 0 | 0 | 0 | 169K | 0 | 0 |
| Change in Payables | 7.58M | 4.43M | 0 | 0 | 0 | 0 | -2.08M | 3.52M | 2.88M | -222K |
| Cash from Investing | -103.03M | 11.25M | 8.28M | 4.76M | -57.12M | 70M | -70M | -384K | 16M | -16.02M |
| Capital Expenditures | -74.98K | -302K | -33K | -112K | -272K | 0 | 0 | -413K | -5K | -36K |
| CapEx % of Revenue | 4.2% | 19.53% | - | 11.2% | 5.44% | - | - | - | - | - |
| Acquisitions | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 35.41M | 0 | 0 |
| Investments | - | - | - | - | - | - | - | - | - | - |
| Other Investing | -46.36M | 0 | 0 | 0 | 0 | 0 | 0 | -35.41M | 16M | -15.99M |
| Cash from Financing | 180.48M | 85.53M | 32.12M | 47.79M | 3.09M | 5.05M | 73.22M | 85.41M | 80.11M | 30.72M |
| Debt Issued (Net) | 75M | 0 | 0 | 50M | 0 | 0 | 0 | 0 | 0 | 0 |
| Equity Issued (Net) | 104.89M | 85.53M | 27.26M | 0 | 2.63M | 0 | 24.92M | 85.36M | 79.65M | 31M |
| Dividends Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Share Repurchases | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Other Financing | 599.2K | 0 | 4.86M | -2.21M | 458K | 5.05M | 48.31M | 44K | 461K | -278K |
| Net Change in Cash | 26.23M | 47.73M | 11.55M | 6.12M | -106.5M | 41.83M | -47.51M | 33.87M | 75.07M | 6.65M |
| Free Cash Flow | -51.23M | -49.34M | -28.88M | -46.54M | -52.74M | -33.22M | -50.73M | -51.56M | -21.05M | -8.09M |
| FCF Margin % | -2871.85% | -3191.66% | - | -4653.6% | -1054.82% | -221.49% | - | - | - | - |
| FCF Growth % | -51.11% | -70.85% | 37.94% | 11.77% | -58.74% | 34.51% | 1.62% | -144.95% | -160.27% | - |
| FCF per Share | -0.39 | -0.59 | -0.46 | -1.08 | -1.24 | -0.79 | -1.73 | -3.27 | -0.89 | -0.34 |
| FCF Conversion (FCF/Net Income) | 0.75x | 0.78x | 0.69x | 0.78x | 0.90x | 0.78x | 1.02x | 0.93x | 0.91x | 1.00x |
| Interest Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Taxes Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Binary regulatory and liquidity risk
As reported in financial statements, MIST consistently exhibits a significant gap between net income and operating cash flow, with OCF/NI ratios fluctuating between 0.55 and 0.97, indicating that accounting losses are consistently exacerbated by the ongoing cash requirements of clinical-stage development and regulatory compliance.
The persistent negative operating cash flow suggests that the company remains in a deep pre-commercial phase where cash burn is the primary operational metric. Investors should monitor the OCF/NI ratio closely, as the inability to bridge this gap without external financing highlights the structural reliance on capital markets to fund R&D activities.
Based on recent SEC filings, the company's free cash flow remains deeply negative, with quarterly outflows reaching $16.1 million in 2026Q1, underscoring a trajectory defined by aggressive capital consumption rather than self-sustaining operational generation as the firm pursues its primary regulatory milestones.
The lack of positive free cash flow is typical for a single-asset biotech firm, yet the magnitude of these outflows relative to the cash balance warrants caution. This trend suggests that the company is effectively trading equity value for the time required to reach commercialization, leaving little room for operational missteps.
According to the provided data, capital expenditures remain negligible, peaking at only $45,000 in 2026Q1, which confirms that the firm's cash burn is driven almost entirely by operational R&D and clinical trial expenses rather than investments in physical infrastructure or manufacturing capacity.
The low capital intensity suggests that the company has not yet committed to significant fixed-asset investment, which may be a strategic choice to preserve liquidity. However, this also implies that a future commercial launch will likely necessitate a sudden and substantial increase in capital spending to establish distribution and supply chain capabilities.
As evidenced by quarterly data, working capital changes have been erratic, swinging from a $4.5 million inflow in 2026Q1 to an $899,000 outflow in 2024Q1, reflecting the lumpy nature of milestone-based revenue recognition and the timing of clinical trial-related payables.
These fluctuations appear to be a byproduct of the company's reliance on licensing agreements rather than a reflection of efficient operational cycle management. Investors should interpret these swings as noise inherent to the pre-commercial business model rather than indicators of underlying improvements in cash conversion efficiency.
Based on reported figures, stock-based compensation consistently adds back to the cash flow statement, with $1.3 million recorded in 2026Q1, which effectively obscures the true economic cost of talent retention during the company's high-risk clinical development phase.
While non-cash in nature, the reliance on equity-based incentives suggests that the company is managing its cash runway by shifting compensation burdens to shareholders. This practice warrants further investigation to determine if the dilution resulting from these grants is adequately offset by the progress of the etripamil clinical program.
Quick answers to the most common questions about buying MIST stock.
Milestone Pharmaceuticals Inc. (MIST) generated $-49.0M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
Milestone Pharmaceuticals Inc. (MIST) reported negative free cash flow of $49.3M in 2025, indicating capital requirements exceeded cash from operations.
Milestone Pharmaceuticals Inc. (MIST) spent $0.3M on capital expenditures in 2025. CapEx represents the cash invested in physical assets like property, plant, and equipment to maintain or grow the business.