TOI · CIK 0001799191
What The Oncology Institute, Inc. told the SEC could break it.
The Oncology Institute's sharpest exposure is its drug supply: cancer drugs make up about 84% of its medical groups' total costs, and it buys substantially all of them from a single source — one vendor accounted for 98% of direct costs — leaving it unable to pivot if that supplier disrupts delivery, raises prices or changes terms. On the revenue side it leans on a limited number of payors, with its largest about 14% of 2025 patient-services revenue, and it is closely tied to Medicare and Medicare Advantage rates, since roughly 14% of revenue comes directly from Medicare and many private payors peg their rates to it. All of this sits on a strained balance sheet: a $60.6 million net loss in 2025 and secured convertible notes backed by a first-priority lien on substantially all of its property, including its intellectual property and subsidiary equity.
4 self-disclosed vulnerabilities, pulled from its own filings, each in the company’s words, with the source. This is the risk register almost nobody reads.
In its own words
What could break it.
Sole-source dependency
- single-source drug supplier (Vendor A = 98% of direct costs; drugs ~84% of TOI PC costs)high
TOI is substantially dependent on a single source for its oral/IV/injectable chemotherapy drug supply — one vendor was 98% of direct costs and drug purchases are ~84% of TOI PC total costs — leaving it unable to shift to alternatives if that supplier disrupts, raises prices or changes terms.
“We are substantially dependent on a single source of drug supplies, which is critical to the services the TOI PCs provide, or to which we have committed obligations to make purchases, sometimes at particular prices. Approximately 84% of the TOI PCs' total costs are related to drug purchases, including both oral and chemotherapy drugs,”
SEC filing →As of 2026
Customer concentration
- reliance on a limited number of payors (largest ~14% of patient-services revenue)medium
TOI relies on a limited number of payors for much of TOI PC revenue (its largest customer was ~14% of patient-services revenue in 2025); fee reductions, scope changes or payor creditworthiness issues could hurt revenue.
“our largest customer by revenue in 2025 represented approximately 14% of our patient services revenue.”
SEC filing →As of 2026
Liquidity & debt
- net losses and secured convertible-note debt (assets pledged)medium
TOI posted a $60.6M net loss in 2025 and its Facility Agreement obligations (and senior secured convertible notes) are secured by a first-priority lien on substantially all personal property, including IP and subsidiary equity, constraining liquidity despite cash-burn-reduction efforts.
“our obligations under the Facility Agreement are guaranteed by a perfected, first-priority security interest in substantially all of our personal property, including our intellectual property and the equity ownership interests directly and indirectly held by us in our wholly-owned subsidiaries.”
SEC filing →As of 2026
Regulatory & policy
- Medicare / Medicare Advantage reimbursement-rate dependencemedium
TOI receives ~14% of patient-services revenue directly from Medicare and many private payors peg rates to Medicare or are themselves Medicare-Advantage funded, so Medicare/MA rate changes (CMS announced ~3.26% MA increase for 2026) materially affect results.
“The TOI PCs receive a significant portion of revenue directly from Medicare, which accounted for approximately 14% of our Patient Services revenue in 2025.”
SEC filing →As of 2026
The hidden graph
Who it depends on, and who depends on it.
Relationships surfaced from filings, including ones disclosed by the other side, which is how the non-obvious ones come to light.
Its customers
Anthem (Elevance Health) affiliates
“We and our affiliated providers have contractual relationships with payors serving a variety of patients, including Medicare Advantage ("MA"), Medicaid, and commercial patients. These payors include affiliates of Anthem”
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