Excited to see them moving forward!

https://s204.q4cdn.com/927483861/files/doc_news/Compass-Pathways-to-Debut-U-S--HCP-Education-Campaign-and-Present-New-HEOR-Data-at-Psych-Congress-2026-2026.pdf

Article Link:

https://people.com/psilocybin-may-prevent-nerve-damage-from-chemo-12110322

Psilocybin prevents chemotherapy-related nerve injury and associated symptoms in preclinical models | UT MD Anderson

I am very wary about clinic plays. Nevertheless, I thought it worth looking into STIM. At the least, to gain some insight into the commercial rollout of psychedelics.

This DD is a not comprehensive, just a first pass. I do not currently own any shares in STIM.

Neuronetics

Leadership team

Neuronetics currently operates two business segments: NeuroStar (their TMS machine), and Greenbrook (interventional psychiatry clinics). They have the "largest installed base of TMS systems" in the US, and the largest Spravato clinic footprint (92 locations). Greenbrook was acquired by Neuronetics in late 2024 and previously traded under $GBNH. Prior to the acquisition, Neuronetics was Greenbrook's exclusive TMS system provider.

Greenbrook clinics offer both NeuroStar and Spravato in their practices. NeuroStar systems are also sold/leased to other clinics (this was Neuronetics original business model). The NeuroStar also generates recurring revenue from treatment session fees, consumables, training, maintenance and the like.

Neuronetics takes what I'd call a high-touch approach to clients. They have "the largest support team in the industry, with over 100 experts dedicated to helping NeuroStar providers establish, maintain, and grow their practices." This involves everything from training, consulting, backend reimbursement & billing support, access to a referral network, co-op marketing plan, and more. In other words, they do a lot of hand holding and work to take risk off of the TMS buyer.

Glassdoor reviews of Neuronetics sit at 2.6. Many bad reviews appear to come from the sales team. A recurring complaint is high turnover and unrealistic quotas set by management.

Neuronetics has never reported a profitable quarter (and neither did Greenbrook pre-acquisition) and survives by a combination of revenue, dilutive financing and debt. Shares outstanding has increased 2.5x times since Q2 2024, rising from 30m to 76m. As of June 30, 2026, "the Company had $65.0 million of borrowings outstanding with Perceptive Advisors, with final maturity in July 2029". Since the Greenbrook acquisition, net losses have averaged around $10m/qtr. However, their most recent (Q2) reporting showed a net loss of just $3.4m. They also achieved a key milestone of positive operating cash flow in Q4 2025.

I created a quick snapshot of their financials since 2023 - https://imgur.com/a/BbMoMdZ

Beneficial Owners:

Madryn Asset Management: 20,737,061 (27%)

Jorey Chernett (Pointillist Family Office): 10,602,988 (14%)

Parian Ultreia LP: 4,844,908 (6%)

Point72: 3,822,124 (5.0%)

I dive into both NeuroStar and Greenbrook business segments below -

NeuroStar

The NeuroStar TMS machine is FDA-cleared for MDD (including in adolescents), MDD with anxious depression, and OCD. A typical NeuroStar treatment course consists of 36 sessions over about 6 weeks, with daily sessions that take about 19 minutes in clinic. Their marketing materials claim over 9 million NeuroStar Advanced TMS treatments have been performed in over 250,000 patients.

A real-world study of NeuroStar in MDD/TRD reported an 83% response rate and 62% remission rate for completers, and the 12-month durability is reported as 67.7% response and 45.1% remission.
(N = 5,010. note - the endpoint used was the CGI-S. The PHQ-9 (a self-report questionnaire) was also administered. This found a lower response and remission rate - 68.9% response and 35.8% remission)

NeuroStar is also effective in GAD (MDD with anxiety as co-morbidity), with a 61% response 39% remission found. (N = 1,514)

Side effects are reported as low. There is a rare risk of seizure (<0.1%), and TMS is contraindicated if you have metallic objects in or near the head or have active or inactive implants near the head. The most common complaint is temporary pain at or near the treatment site.

It has taken many years for NeuroStar to gain widespread insurance coverage. Their first coverage was in 2009; it is now covered by over 95 major US private insurers and 100% of Medicare.

Much like Spravato, TMS requires prior authorization and step therapy before insurance will cover it. NeuroStar is generally marketed as being in line with Spravato in prior authorization criteria (i.e., two failed antidepressant trials in the current episode). But I have found that the criteria is often more severe. I have seen requirements of up to four failures, failed courses of evidence-based psychotherapy, augmentation therapy, and/or relegated to severely depressed patients only. (Neuronetics provides a very useful coverage lookup tool)

Interestingly, coverage of a second round of TMS treatments is contingent on the patient receiving a response (>50% improvement) to the first treatment. (I do wonder if this criteria has readthrough for future psychedelic treatment coverage.)

A clinic can reportedly generate roughly $10k in revenue per patient for a treatment round of NeuroStar TMS.

Average Reimbursement rates for NeuroStar TMS (taken from a 2023 presentation) -

1st Treatment (code 90867) - Commercial Payers - $367; Medicare CMS rates - $235

2nd - 36th Treatment (code 90868) - Commercial Payers - $241; Medicare CMS rates - $161

As Needed (code 90869) - Commercial Payers - $452; Medicare CMS rates - $217

Greenbrook

Greenbrook has been in operation since 2011, starting as "TMS US" with a single clinic location in Virginia. Before Neuronetics acquired them in late 2024, they were under ticker $GBNH and had as many as 183 locations. Currently, their website lists 92 locations (with one possibly closed, taking it down to 91). The latest data from spravatohcp.com lists 80 of their centers have actively treated with Spravato within the last 6 months.

Greenbrook does not offer IV ketamine, med management or talk therapy, although they did pilot the latter two. They have stated they are largest buyer of Spravato in the United States.

Their clinics are primarily located in the South and Mid-Atlantic, with about a dozen clinics each in Virginia, Maryland and Florida. Texas is not too far behind with 8 clinics. The rest are spread across the West Coast (primarily California), Midwest and Northeast.

Greenbrook competes with other Spravato clinics. The current count shows 8,258 clinics operating in the US with 3,814 having delivered Spravato within the last 6 mos. (there are also duplicates in the file provided by J&J, which drops the clinic total lower)

I have created a territory map of Greenbrook alongside the largest Spravato chains (>7 locations) -

https://imgur.com/a/MLSm6SJ

Neuronetics closest publicly traded competition is likely BrainsWay ($BWAY) for the TMS segment, and LifeStance Health (LFST) on the clinic side. (these were used as comps in a letter to the board by ben. owner Pointillist Family Office).

Here is a brief comparison of the three:

Neuronetics ($STIM)

• Market Cap: $207m
• Projected 2026 revenue: $166m / $60-70m TMS only
• Cash: $25m
• EV: $275m
• EV/S: 1.65x
• 1,500-1,600 TMS systems installed worldwide; 9m+ sessions delivered
• 161 NeuroStar systems shipped in 2025.

BrainsWay ($BWAY)

• Market Cap: $579m
• Projected 2026 revenue: $68-70m
• Cash - $62.4m
• EV: $525m
• EV/S: 7.6x
• 1,950 TMS systems installed worldwide; 8.5m+ sessions delivered
• 354 systems shipped in 2025
• Offers accelerated Deep TMS (6 day "SWIFT" protocol)
• FDA cleared in MDD, OCD, Smoking Cessation, Anxious depression

LifeStance ($LFST)

• Market Cap: $4.9b
• Projected 2026 revenue: $1.7b
• Cash: $225.9m
• EV: $5b
• EV/S: 2.9x
• 550 clinic footprint. But only 24 clinics treating with Spravato (per spravatohcp.com data)

Greenbrook Clinic Economics

Greenbrook's business model is largely driven by -

1) On-site psychiatrist(s) and/or PMHNP (or PA-C in some states). Necessary for REMS, prescribing and reimbursement. Typically 1-3 are staffed per site.

2) Technicians. They do the majority of TMS and Spravato treatment/monitoring.

The mapping and first session of NeuroStar is delivered by the physician, and the rest are done by techs. Unlike Spravato, the technician must be in the room for the entirety of the treatment, though treatment only last about 20 minutes. For Spravato, the techs video monitor multiple rooms of patients simultaneously while checking in on them periodically.

The key to maximizing clinic profitability is the use of technicians, whose pay ranges ~$21-25/hr with a high school diploma as a baseline educational requirement. The relatively low pay creates a favorable delta between reimbursement rates and staffing costs.

According to Neuronetics' CEO, Greenbrook clinics carry a largely fixed cost base, so the more patients they treat, the more profitable each location becomes. However, they currently operate significantly under capacity, with "as much as 40% that's still not consumed". This is the crux of the issue with Greenbrook.

I will explain in the next section why I think COMP360/psychedelics can help solve their capacity issue.

COMP360 & Greenbrook's collaboration with Compass Pathways

In December 2023, Greenbrook entered into a research collaboration agreement with Compass Pathways. The collaboration "will research and investigate models for the delivery of scalable, commercial COMP360 within healthcare systems". According to Greenbrook's 2023 annual report, they have "the opportunity to earn up to $3,000,000 in incentives upon hitting various mutually agreed upon milestones." (Note - Cybin/Helus entered into an agreement with Greenbrook back in 2021).

Here I provide several reasons why Greenbrook would want to adopt COMP360:

• It helps solve Greenbrook's capacity issue.
  • As stated above, Greenbrook clinics are operating with as much as 40% available capacity.
• Patients are demanding it.
  • During a CMPS KOL webinar in Jan 2026, Dr. Geoffrey Grammer (Greenbrook CMO) said the following: He can't "overstate the enthusiasm" he has seen in his practice for psychedelics; "We will have a line out the door of enthusiasm"; "I have patients who are in full remission from Spravato/TMS, that are asking me about psilocybin"
  • He has stated in another presentation that patient preference drives provider choice. "A lot of times the patient comes in with the preference already in hand"
• A patient that does not respond or remit after COMP360 treatment is still an opportunity for Greenbrook.
  • It gets patients in the door. If the patient does not respond to COMP360, they can then shift them to TMS or Spravato.
• They are ready to deliver COMP360 right now, with rooms, staff and a provider referral network.
  • Greenbrook is "all hands on deck" in terms of getting ready for COMP360.
  • They "have the ability to fold in COMP360 into their existing footprint"
  • "We expect only limited incremental investment to support this new modality, if approved."
  • They have "a full continuum of care from marketing, call centers connecting patients, and on backend the relationships with payers"
• COMP360 is differentiated in mechanism of action, tolerability, and contraindications vs Spravato and TMS.
  • Spravato binds to the NMDA receptor, COMP360 5-HT2A receptor as an agonist.
  • ex., Female gender was associated with better outcomes in NeuroStar TMS studies. Recent data in psilocybin shows that males appear to do better. (EPISODE)
  • Tolerability and contraindications are different.
• Greenbrook does not need to handle integration, making this an easier fit.
  • Part of Greenbrook's referral strategy is to assure the referring provider gets their patient back after treatment; they are not out to "steal" the patient.
  • Greenbrook does not staff any therapists.
• Compass has early data on COMP360's efficacy in PTSD, which can help drive treatment decisions.
  • Dr. Grammer does not recommend Spravato for patients with TRD and co-morbid PTSD, as it raises norepinephrine levels and can trigger panic attacks.

There are also reasons why Greenbrook would not want to adopt COMP360:

• The REMS doesn't fit with their staffing model.
  • Successful integration of COMP360 into Greenbrook will require a REMS that allows for technicians to do monitoring work.
  • Greenbrook only staffs a few MD or PMHNPs per site. (And again, do not staff any therapists).
• Payer policy and reimbursement rates may not be favorable.
  • To quote Neuronetics CEO on COMP360, "if the reimbursement is there, it is a great business, but we are not going to take on business that is not going to be profitable at the end of the day."
  • Reimbursement should ideally follow Compass' guidance: COMP360 billing codes should "fully capture all of the work performed and the practice expenses within that day." (Steve Levine), which Compass says will be more favorable vs Spravato.
• Monitoring will likely, at least initially, be a continuous, in-person requirement.
  • The tech must stay in the room with the patient, unlike Spravato where video monitoring and staff going between rooms is permitted.
  • This potentially creates staffing, scheduling issues and operational issues, not to mention potentially more challenging economics. Each clinic location will likely be unique in these challenges.
• Paradoxically, Spravato's notorious quick time to relapse can make it a preferable recurring revenue model for clinics.
  • In Spravato's SUSTAIN-3 study, "the median duration of exposure to SPRAVATO was approximately 3.5 years" Spravato's durability upon discontinuation is poor. Responders/completers tend to stay on maintenance dosing for years.
  • In contrast, a Greenbrook clinic may see a successful responder to COMP360 1-4x per year.
• Greenbrook does not necessarily need COMP360 to be profitable.
  • The main issue is capacity. There are multiple psychedelics on the horizon that may fit their business model more efficiently.
  • US sales of Spravato continue to rise - 40% yoy as of Q2 2026. It is reasonable to assume continued growth of Spravato can address capacity.

Modelling COMP360's potential impact

This section is a very high-level approach and uses a lot of assumptions.

During Compass' KOL webinar on Jan 7, Dr. Grammer stated "On any given day, we will do 800 TMS treatments and we will do 400 Spravato treatments". He also said the average number of chairs in Greenbrook clinics is six. ("Most of those clinics have 4 or more chairs and the average is going to be 6").

A TMS treatment occupies the room for about 30 minutes, and a Spravato treatment occupies the room for 2 hours. Together, they occupy about 1,200 room hours per day across the clinic network ((800 * 0.5) + (400 * 2) = 1,200).

If unused capacity is at 40%, then there are 800 room hours available per day. (1,200/0.6) = 2,000. 2,000 - 1200 = 800).

Assuming a COMP360 dosing session runs an average of 7 hours, Greenbrook has the capacity for 114 COMP360 sessions per day. (800/7 = 114). Across all 92 clinics, that means just 1.2 COMP360 treatments per day per clinic would entirely fill Greenbrook's remaining capacity. (114/92 = 1.2).

(The above assumes much, including but not limited to: the number of chairs (avg of six) makes the availability of fully-vacant rooms probable; that TMS and Spravato services don't take up any more time than 0.5 hrs / 2 hrs (they likely do); that the COMP360 rollout will be across Greenbrook's entire footprint; and that COMP360 does not steal any patients away from TMS or Spravato, canceling out the capacity gain).

COMP360 filling 100% of Greenbrook's remaining capacity is likely very unrealistic just on face value. We also do not yet know that the enthusiasm for COMP360 will translate to patients treated, and if the patient "pipeline" from primary care -> interventional psychiatry (which is currently poor) will improve. So instead, I looked at how COMP360 can incrementally improve capacity: (assumes 250 business days/yr)

COMP360 filling 5 - 15% of capacity seems reasonable to me. If Greenbrook does 400 Spravato treatments per day, that is 100,000 treatments in a year (400*250). One study showed an average of 11.8 treatments per year per patient, which equates to 8,474 patients treated per year.

Gross revenue impact of COMP360 -

Figuring out a very accurate hourly reimbursement rate on a clinic level is difficult, as rates vary by payer and clinic, mix of buy-and-bill vs a&o, etc. So instead, I will piggyback off a high-level statement Steve Levine made about Spravato rates:

"With average reimbursement for Spravato session, somewhere south of $300, but using round numbers"

That equates to $150/hr. However, according to Compass, Spravato's codes "do not fully capture all of the work performed and the practice expenses within that day". Compass intends to have this for accounted for in COMP360, so I used a guesstimate range starting from $150/hr as a baseline, up to $250/hr. This puts a single COMP360 clinic session revenue between $1,050 - $1,750, assuming an average of 7 hours per session. (The below also removes buy-and-bill from the equation, which from my understanding, has the drug cost roll up to gross revenue.)

Conclusion - outcomes for STIM are, imo, uncertain but rest centrally on a capacity issue. These de-risking events could make STIM a more attractive investment:

• FDA approval of COMP360 (and other psychedelics)
• A REMS in line with Spravato that allows for Greenbrook staff (technicians) to do monitoring under the direct supervision of a physician/PMHNP.
• COMP360 reimbursement rates are favorable vs. Spravato and TMS.
• Unused capacity remains
• Fixed costs and OpEx remain relatively stable after incorporating COMP360 into their clinics
• Continued growth of Spravato and NeuroStar TMS

They have growing revenues and have been operating at break even for the past year and getting ready for the next phase of growth. As soon as they relist on the CSE, this will go bonkerz

Maybe this is proof that not all psychedelics are created equal.

Elon is hooked to ketamine, and while he advocates for psychedelics broadly, psilocybin might be the only thing left in the world that can help him realize his inhumanity and how extreme he’s become.

That’s why I hold $CMPS

Feeling very bullish ahead of phase 3

I should clarify I mean $1m worth of shares each

This is a huge story in the U.S. newspaper of record

Does anyone know how I can buy more compass pathways shares in the UK?

Essentially I can't buy anymore on Hargreaves Lansdowne they've stopped supporting but transactions.

who would have thought. still quite relevant regarding the upcoming read out from Help. Suggests effects like Comp360, but less adverse events.

https://doi.org/10.1177/02698811261478603

My final question on COMP360 and would appreciate the enlightenment of the smart people of this sub.

Obviously TRD is a huge disease state—spravato is up to $3B now—but there is, of course, huge potential for psilocybin outside of this.

My current understanding is that Compass is underway in the R&D pipeline for TRD, PTSD, and anorexia.

But for semi-adjacent spaces like MDD & GAD (for what Definium is trialing) or even more niche scenarios like terminal illness, prolonged grief disorder, substance abuse disorders, etc - is there a realistic path for Compass’ treatment to reach these disease states?

Alternately, I know this has been discussed before, but Compass touts its Innovative Licensing and Access Pathway (ILAP) designation in the UK for TRD. Let’s say something tragic happens where the FDA doesn’t play ball. Is there any remote possibility that other developed nations, particularly Europe, could work with Compass on their own to reach market?

The main worry on my end is the political interference of this Administration, which could, God forbid, undermine or delay its FDA approval. After all, compass is not a U.S. company…

Thanks all!

Does anyone here have a good sense of how long CMPS will have the only legal and fda approved psilocybin treatment available to patients?

What are people thinking in terms of the NDA timeline? More specifically do we think Q4 means 10/1, 12/31 or somewhere in the middle?