Operational cash generation remains structurally challenged, as demonstrated by a -17.0% free cash flow margin in 2026Q1 and a historical disconnect between net income and actual cash flow.
| Metric | TTM | Dec'25 | Dec'24 | Dec'23 | Dec'22 | Dec'21 | Dec'20 | Dec'19 | Dec'18 | Dec'17 | Dec'16 | Dec'15 | Dec'14 | Dec'13 | Dec'12 | Dec'11 | Dec'10 | Dec'09 | Dec'08 | Dec'07 | Dec'06 | Dec'05 | Dec'04 | Dec'03 | Dec'02 | Dec'01 | Dec'00 | Dec'99 | Dec'98 | Dec'97 | Dec'96 |
|---|
| Cash from Operations | -163.3M | -178.54M | -183.49M | -28.2M | -95.19M | 38.34M | 39.48M | -172.52M | -109.14M | -92.08M | 32.05M | 164.02M | -90.38M | -58.19M | -25.41M | -18.5M | -19.09M | -23.34M | -29.29M | -16.95M | -305K | -897K | -1.59M | -5.84M | -8.84M | -8.01M | -4.99M | -3.23M | -2.4M | -2.9M | -2.5M |
| Operating CF Margin % | - | -29.42% | -25.73% | -3.27% | -9.48% | 2.16% | 2.75% | -19.13% | -11.02% | -9.53% | 2.62% | 33.36% | -99.21% | -60.28% | -54.02% | -66.12% | -67.01% | -177.5% | -310.32% | -2001.06% | - | - | - | -44892.31% | -1572.78% | -600.53% | -576.53% | -234.69% | -200% | -2900% | -2500% |
| Operating CF Growth % | -74.77% | 2.7% | -550.74% | 70.38% | -348.3% | -2.89% | 122.88% | -58.07% | -18.53% | -387.34% | -80.46% | 281.48% | -55.31% | -128.97% | -37.38% | 3.11% | 18.18% | 20.34% | -72.84% | -5457.05% | 66% | 43.58% | 72.76% | 33.97% | -10.42% | -60.52% | -54.54% | -34.46% | 17.24% | -16% | -25% |
| Net Income | -212.96M | -225.68M | -53.22M | -188.86M | -328.4M | -30.14M | 30.59M | -314.93M | -153.04M | -305.25M | -25.08M | -31.43M | -174.64M | -117.35M | -29.65M | -5.18M | 6.25M | -30.11M | -39.83M | -268.4M | -648K | -186K | -1.93M | -5.79M | -10.36M | -8.79M | -7.17M | -3.94M | -2.7M | -3.3M | -2.9M |
| Depreciation & Amortization | 90.34M | 91.63M | 98.18M | 105.3M | 108.66M | 78.72M | 85.36M | 93.81M | 97.34M | 102.09M | 96.58M | 42.25M | 14.93M | 15.22M | 10.16M | 3.83M | 2.21M | 2.36M | 1.82M | 184K | 0 | 3K | 5K | 55K | 472K | 286K | 290K | 200K | 100K | 100K | 100K |
| Stock-Based Compensation | 10.83M | 10.71M | 11.05M | 11.41M | 18.51M | 13.63M | 8.95M | 13.42M | 21.76M | 28.31M | 42.69M | 26.07M | 14.78M | 10.98M | 5.13M | 6.95M | 6.52M | 4.57M | 6.73M | 7.37M | 3K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Deferred Taxes | -15.46M | -15M | 14.74M | 146K | -74.41M | 10.16M | 15.64M | 4.32M | -35.13M | 16.09M | -66.3M | -123.54M | 1.02M | 599K | -9.96M | -19.36M | -1.22M | 1.57M | -6.58M | -6.74M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Other Non-Cash Items | 15.79M | 976K | -286.41M | 22.01M | 137.8M | -13.54M | -3.45M | 99.66M | 18.07M | 18.33M | 27.37M | 70.6M | 57.38M | 31.16M | 3.49M | -3.44M | -19.73M | 2.4M | 8.78M | 251.41M | 3K | -863K | 136K | 190K | 1.04M | 162K | 2.42M | 197K | 100K | 200K | 200K |
| Working Capital Changes | -51.88M | -41.18M | 32.17M | 21.8M | 42.65M | -20.48M | -97.61M | -68.81M | -58.14M | 48.35M | -43.21M | 180.06M | -3.84M | 1.19M | -4.59M | -1.31M | -13.12M | -4.13M | -208K | -770K | 340K | 149K | 195K | -288K | 11K | 332K | -532K | 311K | 100K | 100K | 100K |
| Change in Receivables | 16.81M | 30.21M | -220K | 3.41M | 128.6M | 5.23M | -150.44M | 7.38M | 20.4M | 58.01M | -25.64M | -29.39M | -3.92M | 754K | 763K | -1.72M | -2.89M | -1.27M | 590K | -554K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Change in Inventory | 1.51M | -4.12M | 4.22M | 15.2M | 13.66M | 30.68M | -77.64M | -12.13M | 4.59M | -3.54M | -6.61M | -5.88M | -1.75M | 1.89M | -5.81M | 2.17M | -8.16M | -928K | -2.1M | -317K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Change in Payables | -22.2M | -14.22M | -20.66M | 2.83M | -9.39M | -10.85M | 37.16M | 15.64M | -26.08M | 20.17M | -19.82M | -18.12M | -3.85M | 1.83M | 1.25M | -1.78M | 1.5M | -1.02M | -1.23M | -607K | 397K | 38K | -201K | -337K | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Cash from Investing | 187.97M | 230.3M | 352.21M | -18.2M | 91.04M | 35.95M | -18.33M | -13.27M | -26.12M | -46.67M | -20.7M | -99.22M | -5.67M | 30.32M | -24.77M | -14.84M | -2.78M | -22.6M | -330K | -2.74M | 0 | 1.06M | 10.03M | 10.03M | 115K | -10.55M | -611K | -324K | -100K | 0 | -100K |
| Capital Expenditures | -10.92M | -12.28M | -25.01M | -16.27M | -24.58M | -32.16M | -33.68M | -12.74M | -27.86M | -46.52M | -23.55M | -15.85M | -4.73M | -3.96M | -1.47M | -1.95M | -774K | -172K | -378K | -489K | 0 | 0 | 0 | 0 | 0 | -498K | -407K | -250K | -100K | 0 | -100K |
| CapEx % of Revenue | 1.88% | 2.02% | 3.51% | 1.88% | 2.45% | 1.81% | 2.35% | 1.41% | 2.81% | 4.82% | 1.93% | 3.22% | 5.2% | 4.1% | 3.13% | 6.98% | 2.72% | 1.31% | 4% | 57.73% | - | - | - | - | - | 37.36% | 47.05% | 18.18% | 8.33% | - | 100% |
| Acquisitions | 197.77M | 0 | 0 | -5M | -1.76M | -6M | 0 | -1.2M | -1M | -9.63M | 1.45M | -83.38M | -2.27M | 3.09M | -22.49M | -28.19M | -1.32M | -17.63M | 48K | 2.75M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Investments | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| Other Investing | 588K | 190.39M | 210.62M | 2.71M | 1.95M | 66.03M | 245K | 671K | -26.64M | -39.25M | 1.4M | -9.38M | -4.73M | 636K | -23.3M | 17.32M | -33K | -6.8M | 0 | -5M | 0 | 1.06M | 28K | 28K | 115K | -10.05M | -204K | -74K | 0 | 0 | 0 |
| Cash from Financing | -119.19M | -118.06M | 184.17M | -11.3M | 22.97M | -10.35M | -35.08M | 175.25M | 140.91M | 61.04M | -35.2M | 33.01M | 7.26M | 186.17M | 6.03M | 86.92M | -2.77M | 81.92M | 12.93M | 42.94M | 0 | 0 | 192K | -198K | -83K | -1.86M | 37.79M | -62K | 7.4M | 1.9M | 0 |
| Debt Issued (Net) | -66.65M | -70.76M | 287.98M | -11.03M | 23.75M | -11.24M | -35.83M | 106.95M | 47.24M | 58.91M | -43.77M | 6.98M | -1.93M | 165.76M | 3.75M | -4.83M | -2.84M | 212K | -2.45M | 6.54M | 0 | 0 | 0 | -202K | -83K | 0 | -135K | 0 | 0 | 0 | 0 |
| Equity Issued (Net) | -47.38M | -47.3M | -90.22M | 0 | 0 | 0 | 0 | 76.06M | 92.5M | 0 | 0 | 0 | 0 | 23.43M | 0 | 95.2M | 0 | 80.99M | 15M | 36.41M | 0 | 0 | 192K | 4K | 0 | -1.31M | 37.93M | 84K | 2.6M | 1.9M | 0 |
| Dividends Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -3.02M | 0 | -4.7M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Share Repurchases | -47.04M | -47.04M | -90.22M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -9.62M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -1.33M | -2.02M | 0 | 0 | 0 | 0 |
| Other Financing | -5.16M | 0 | -13.59M | -272K | -774K | 893K | 756K | -7.76M | 1.17M | 2.13M | 8.58M | 26.02M | 9.19M | 0 | 2.28M | 1.24M | 74K | 718K | 383K | 0 | 0 | 0 | -390K | 0 | 0 | -550K | 0 | -146K | 4.8M | 0 | 0 |
| Net Change in Cash | -94.11M | -62.87M | 349.73M | -57.31M | 18.48M | 62.5M | -13.24M | -11.02M | 4.97M | -77.23M | -24.86M | 96.69M | -88.89M | 158.44M | -44.16M | 53.5M | -24.64M | 35.98M | -16.7M | 23.26M | -305K | 167K | -1.4M | 3.99M | -8.81M | -20.41M | 32.2M | -3.61M | 7.4M | -1M | -2.6M |
| Free Cash Flow | -174.22M | -190.82M | -208.5M | -44.47M | -119.77M | 6.18M | 5.79M | -185.26M | -137M | -138.6M | 8.5M | 148.18M | -95.11M | -62.15M | -26.89M | -20.45M | -19.87M | -23.51M | -29.67M | -17.44M | -305K | -897K | -1.59M | -5.84M | -8.84M | -8.5M | -5.39M | -3.48M | -2.5M | -2.9M | -2.6M |
| FCF Margin % | -29.98% | -31.44% | -29.24% | -5.15% | -11.93% | 0.35% | 0.4% | -20.54% | -13.83% | -14.35% | 0.7% | 30.14% | -104.4% | -64.39% | -57.15% | -73.1% | -69.73% | -178.81% | -314.32% | -2058.8% | - | - | - | -44892.31% | -1572.78% | -637.88% | -623.58% | -252.87% | -208.33% | -2900% | -2600% |
| FCF Growth % | 15.53% | 8.48% | -368.83% | 62.87% | -2037.66% | 6.68% | 103.13% | -35.23% | 1.16% | -1730.83% | -94.26% | 255.79% | -53.03% | -131.17% | -31.46% | -2.94% | 15.48% | 20.77% | -70.16% | -5617.38% | 66% | 43.58% | 72.76% | 33.97% | -3.95% | -57.64% | -55.13% | -39.08% | 13.79% | -11.54% | -30% |
| FCF per Share | -0.23 | -0.25 | -0.30 | -0.06 | -0.17 | 0.01 | 0.01 | -0.31 | -0.24 | -0.25 | 0.02 | 0.30 | -0.23 | -0.18 | -0.09 | -0.07 | -0.08 | -0.10 | -0.16 | -0.14 | -0.02 | -0.06 | -0.10 | -0.37 | -0.56 | -0.54 | -0.37 | -0.34 | -0.26 | -0.35 | -0.38 |
| FCF Conversion (FCF/Net Income) | 0.82x | 0.79x | 3.45x | 0.15x | 0.29x | -1.27x | 1.29x | 0.55x | 0.71x | 0.30x | -0.66x | -5.46x | 0.53x | 0.51x | 0.87x | 14.42x | 1.01x | 0.77x | 0.74x | 0.06x | 0.47x | 4.82x | 0.83x | 1.01x | 0.85x | 0.91x | 0.70x | 0.74x | 0.89x | 0.88x | 0.86x |
| Interest Paid | 16.44M | 0 | 20.88M | 8.13M | 7.42M | 8.52M | 10.91M | 11.87M | 0 | 1.31M | 2.89M | 4.57M | 6.28M | 3.41M | 945K | 726K | 4.39M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Taxes Paid | 18.57M | 0 | 10.01M | 3.71M | 8.04M | 5.97M | 903K | 2.67M | 0 | 5.42M | 27.12M | 4.88M | 954K | 1.32M | 575K | 338K | 235K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Persistent Negative Operating Cash
As reported in recent financial filings, OPK consistently records negative operating cash flow despite occasional net income spikes, with the OCF/NI ratio frequently falling into negative territory, indicating that reported earnings are often driven by non-cash accounting adjustments rather than actual cash generation from core operations.
The recurring divergence between net income and operating cash flow suggests that the company's profitability metrics are not reflective of its underlying cash-generating capacity. Investors should monitor this gap closely, as it implies that the diagnostic business requires significant cash infusions to sustain operations, regardless of accounting-based earnings results.
Based on the company's quarterly cash flow statements, free cash flow margins have remained consistently negative, reaching a low of -55.3% in 2025Q2, which highlights the structural difficulty of funding R&D and laboratory overhead through current operational revenue streams without relying on external capital.
The persistent negative FCF trajectory suggests that the company is currently in a cash-burning phase that may not be sustainable in the long term. This trend warrants further investigation into whether the pharmaceutical royalty streams can eventually offset the diagnostic segment's cash requirements before the current liquidity runway is exhausted.
According to the provided financial data, working capital changes have been highly erratic, including a significant $37.9 million outflow in 2025Q2, suggesting that the company faces substantial challenges in managing its cash conversion cycle and optimizing the timing of its laboratory-related receivables and payables.
The volatility in working capital appears to be a primary driver of the unpredictable quarterly cash flow swings. This instability may indicate underlying inefficiencies in the diagnostic billing process, which could be exacerbating the company's overall cash burn during periods of declining revenue.
As evidenced by recent financial statements, OPK has continued to utilize cash for share repurchases, such as the $18.3 million spent in 2025Q2, even while the core business continues to report negative operating cash flow and significant net losses, raising questions about the current capital allocation strategy.
The decision to prioritize share repurchases while the company is burning cash suggests a management focus on supporting the stock price rather than reinvesting in operational efficiency. This approach appears counterintuitive given the persistent negative operating margins and the ongoing need for capital to fund the pharmaceutical pipeline.
Quick answers to the most common questions about buying OPK stock.
OPKO Health, Inc. (OPK) generated $-178.5M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
OPKO Health, Inc. (OPK) reported negative free cash flow of $190.8M in 2025, indicating capital requirements exceeded cash from operations.
OPKO Health, Inc. (OPK) spent $12.3M on capital expenditures in 2025. CapEx represents the cash invested in physical assets like property, plant, and equipment to maintain or grow the business.
In 2025, OPKO Health, Inc. (OPK) spent $47.0M on share repurchases. This shows the company's commitment to returning capital to its equity investors.