Good morning, everyone. This is Jeff Baker. I'm the CFO of Paysign. Thank you for your time today. I've been with the company for a little over three years. I've been in payments my entire career, background in prepaid payments, mostly doing mergers and acquisitions. I was also a sell-side analyst for 10 years prior to moving over to the corporate world. So I'm here to talk about Paysign. We're a publicly traded company. Symbol is P-A-Y-S on the NASDAQ. Just some housekeeping details, maybe making forward-looking statements.
As such, I would encourage you to review the forward-looking statement notice, as well as multiple other disclosures that we have as published under our 10-K from the December 31st, 2023 period. So what is Paysign? Paysign basically is a provider of prepaid card programs, integrated processing services that are designed to reward customers, clients, partners, and employees. What we do is we create customized, innovative payment solutions for businesses across all industries, including pharmaceutical, healthcare, hospitality, and retail.
We have end-to-end technologies that securely enable basically the digital payout of solutions and facilitate the distribution of funds for customers, incentives, employee rewards, travel expenses per diem, as well as reimbursement and rebates. Basically, our solutions lower the administrative costs and streamline operations and drive revenues for our partner companies. We are a B2B2 C type of business. We were incorporated in 1995, headquartered in Henderson, Nevada, right outside of Las Vegas.
We are a leading provider of financial services, uniquely positioned to provide technology solutions tailored mainly to the healthcare industry. As an early innovator in prepaid card programs, comprehensive patient affordability offerings, digital banking services, and integrated payment processing, we've enabled countless exchanges of value for businesses, consumers, and government agencies across all industry types. We're a trusted partner to major pharmaceutical and healthcare companies, as well as multinational corporations.
We offer a suite of solutions for corporate rewards, prepaid gift cards, general purpose reloadable cards, employee incentives, consumer rebates, donor compensation, clinical trials, healthcare reimbursement payments, and copay assistance. I'll talk more about these in some later slides. Through our direct connections for processing and program management, we navigate all aspects of the prepaid card lifecycle completely in-house. This differentiates us from other competitors.
It's very important if we need to make a change in our platform, we don't have to get in a queue with some third party and hope that in 6-9 months down the road, that they're going to implement our changes. We do everything from concept and card design to inventory fulfillment to launch. We have a 365-day, 24/7 in-house bilingual customer service that we facilitate through live agents. A ll this is very important because when a customer has an issue, there's only one throat to choke, so to speak, and that obligation lies on Paysign. Quick financial snapshot of our company.
We're just over $220 million market cap. Trailing 12-month revenues, $50.3 million. At the end of the first quarter, we had $115 million in cash, of which 7 of that was unrestricted. The remaining part of that is restricted cash. That could be from funds that we require our customers to pre-fund account so that we can make payments on their behalf. I'll talk about more of that later, o r just funds that are on cardholders' accounts that are sitting out there ready to be spent, of which we make fees as they use that card.
You will see from our quarterly revenue that first quarter is typically the lowest, and that is because most of our business here to date has been from our plasma business, plasma reimbursement, our distribution business. And in the first quarter, the federal government usually gives out tax rebates, and when the federal government's giving out free business, people aren't going to give plasma to supplement their income. So you'll always see a seasonally slow period in the first quarter.
At the end of the first quarter of 2024, we reported revenues of just under $13.2 million, which you can see is up quite nicely over the first quarter of 2023 of $10.14 million. Our mission and values, basically, these are very important to us. I won't spend a lot of time on them, but we do drive our business by this. We strive each day to adhere to these missions and values, whether it's accountability, as I mentioned, the one throat to choke, or flexibility. We try to help our customers and meet the requests that they have bestowed upon us to help them with their business, whether it's reporting or whatever.
So these are all very important to us and each and every employee at Paysign. Some quick investment highlights. Financials, I'll show you. We have very strong cash flow and no debt. The business continues to grow quite nicely. In the first quarter, our patient affordability business, which is the copay business, we'll talk more about later, grew 350%. It's now 18% of our revenues in the first quarter. Our plasma business continues to grow quite nicely, and the organic growth in that business is around upper single, low double-digit growth. It's a very good cash flow business.
Our technology, I already mentioned, we have a leading proprietary cloud-based platform. We do everything in-house. From products and solutions, we have a large market opportunity in the B2B and B2C prepaid growth business. From a service and delivery perspective, we have superior client retention and quality of service, which keeps our customers coming back month in and month out.
F rom a leadership perspective, and I'll comment on this in a later slide, but if you look at our leadership, it's people that have either come out of the payments industry or the banking industry with a great deal of expertise. Some quick company milestones. Some of the things that we look at from a business perspective are the number of plasma centers that we're actually doing business for. So at the end of the first quarter, that was 469. When I joined the company at the end, well, in February of 2021, we had about 340 plasma donation centers. We grew that to 440, excuse me, 366 by the end of 2021.
I n 2022, went to 444, and then 464. And like I said, now we're at 469. So really good growth there on the plasma side. We ended the first quarter with 53 patient affordability programs. That's a business that we De Novo or started from scratch four and a half years ago. So you'll see at the end of 2020, we had four programs. At the end of 2021, that grew to 10 programs. And then the acceleration really started going to 19 programs at the end of 2022 to 43 programs at the end of 2023. And we're very excited about that part of our business and the growth prospects there.
We have 6.5 million cardholders and roughly about 600 card programs that are out there. I mentioned earlier that we serve a large market. This is just the total prepaid market forecast for 2026. And you'll see to the right, and we break it down by market segments where we have programs and solutions for each one of those segments. But like I mentioned earlier, most of our business comes from the healthcare benefits side. But we do have a payroll program and other, we have a gift card program and things of that nature. So as I mentioned earlier, we're a full-service provider.
This is just a screenshot, basically breaking it down to show you where all of our connectivity lies. We're connected to all the card networks: Visa, Mastercard, Discover, Pulse, Allpoint, MoneyPass. Those are ATM networks. We utilize third-party identity services when we're doing KYC. As you can imagine, we're highly regulated in the financial services business. We have to make sure that there's no fraud or anything like that that's occurring. Most of our card production is done at a company called MTL in Nashville, Tennessee. They've been a longstanding partner of ours, and that's for the card production.
That's really the only thing that we outsource other than what we have to outsource from a banking perspective since we're not a bank. We have to utilize a third-party bank for our issuing business. And then from a compliance perspective, I mentioned being in the financial services industry, Level 1 PCI DSS, SOC 1 Type 2, bank audits, bank secrecy audits, HIPAA compliance, you name it. I think there's an auditor in our office pretty much every week. So the main part of our business in the past through 2023, this was plasma donor solutions made up about 90% of our business.
And what that is, is that mostly for low-income individuals, you can give plasma twice a week, up to eight times a month. And you get compensated by going in and donating plasma. Now, plasma is the clear piece or part of your blood when it comes out. So it takes about two hours to hook you up to a machine, and it separates the red blood cells from the white liquid. That plasma is then sent off and used in therapies throughout the world. The United States, believe it or not, provides over 75% of the worldwide plasma. That's because a lot of countries don't allow the compensation of human body parts or fluids.
I believe there's only about four countries in the world that actually do allow compensation for plasma. And like I said, the U.S. is the largest. It's about a $120 million total addressable market and continues to grow in the upper single, low double digits. We differentiate ourselves by technology, our system uptime, our reporting, some of the things like we offer cashback rewards. We also offer pharmacy discount programs to these individuals, again, unbanked and underbanked individuals where these actually make a difference in their lives.
The next part of our business that is quickly growing is our patient affordability solutions business. In the past, you may have heard this as being a copay business for pharmaceutical companies. What happens here is that individuals go to a doctor, they get a script. Let's say you have cancer and you get an oncology drug. You go to the pharmacy and you fulfill that script, and they're going to run your insurance. And let's say you have Cigna Healthcare or UnitedHealthcare, and they're going to pay 80% typically under most programs, and they're going to look to you to pay the other 20%.
Well, a lot of people in this country can't afford a $200 copayment, much less an oncology drug that may be $5,000, $10,000 a month. So what happens is, and you'll see this on commercials out there, Skyrizi is a perfect example. Everybody, I'm sure, has seen that drug because they've been advertising a lot. But at the end of that program or that commercial, it says, "Ask AbbVie how we can help." So typically, that's a voucher that you get from the doctor, or you go onto their website, you print off a voucher, and you take that to the pharmacy along with your script.
W hat happens is they run that as secondary insurance, and then the pharmaceutical companies end up paying that copay on your behalf. We have some IP that nobody else has that has been helping us win business. We've also gone in with transparent pricing to the pharmaceutical companies where here to date has not been typically a transparent pricing business. We've also gone to partner with hubs. Hubs are like McKesson is the largest hub that most people know about. Hubs provide everything from phase I, phase II, phase III drug trials and marketing of the drug and all of that. We don't do any of that.
We just focus on the payment side of the business. And that's very good because it allows us to work across the entire industry with multiple hubs. We also go direct to pharma, and we've been, like I said, at the end of the first quarter, 53 programs and ramped up nicely. We're in the early days of this business, but it is quite exciting. Some of the other solutions in that are medical benefit copay solutions where you may actually have to go to a hospital or a provider's office to get a drug, like an intravenous drug. That's not done at a pharmacy, a nd then we'll reimburse those providers as well.
The reimbursements can be checks, and believe it or not, checks are still written. It can be virtual debit cards. It can be ACH transfers. It can be regular copay or regular GPR cards. So there's a myriad of different types of payment solutions that are out there. And we are a payments company, and we do them all. So that's one of the things that makes us attractive along with the transparent pricing and the IP that I mentioned to our customers.
Then at the end of the day, we provide pharmaceutical data and analytics back to the healthcare providers, which they haven't really had in the past. That's important because they want to make sure they're getting a return on their investment on these dollars that they're actually providing from a copay perspective. Also, let me say, most of these copay programs are run out of the marketing budgets of these healthcare companies.
That obviously makes sense as they try to get their drug out, try to get people on the drug, and try to recuperate their investments that they have made over the years by people utilizing their drug. Some additional solutions we have, and we have a digital banking solution if people want to treat their card if they're unbanked or underbanked and they want to use their card as a banking solution. They can certainly do that. They can pay their bills with their cards. They can reload the cards.
We do everything that some of our other competitors are out there that are just focused on banking solutions that have a lot more money and a lot more marketing dollars to really kind of go after the B2C world. We have those solutions as well. It's just not the lion's share of our business. Corporate disbursement solutions, we have a company, for example, that does metals recycling. So typically in the past, people would come in and they would pay the individuals with cash. Now they put it on a general purpose reloadable card. We have reward and incentive solutions.
We have a GPR and payroll solution for individuals that want to get paid the same day that they work instead of waiting at the end of the week or every two weeks to get their payroll. It's called same-day wage access. We're just a solution provider behind a party that's out there selling that to quick-service restaurants. Then we have open gift card solutions out there. One of our, I'd say, the main company in that that does that for us is our partner is AAA. So if you go to AAA and you want to give your mom or dad or your son or daughter a birthday gift, you can buy an open gift card for them and gift that to them.
Then they can use it to spend either at AAA for services or any place that Mastercard is offered. So, a bunch of different prepaid solutions back to that big industry slide that I showed you, but we pretty much have solutions for any prepaid opportunity. I mentioned this before, key differentiators, end-to-end solutions, our uptime, unmatched, knock on wood, but we have some very good uptime numbers. We tailor solutions, so we work with our customers. It's not a take it or leave it type of relationship. I mentioned the 24/7/365 in-house bilingual customer service. It's downstairs.
They occupy the first floor of our building. Also, we do chargebacks, fraud, claims processing, adjudication down there. But we do it all in-house. And we have timely solution delivery. We've moved copay programs in a matter of a week. We've stood up new plasma centers in a matter of days. So we are able to react very quickly. And again, that's a key differentiator versus our competition. A little bit more information by the numbers here. I already mentioned the trailing 12-month revenue. Our trailing 12-month Adjusted EBITDA is $7.7 million. I mentioned no debt. We have assets about $173 million.
And as you see in the first quarter, we grew our revenues 30%. Like I mentioned earlier, 350% growth came from our patient affordability business, which on this slide is the yellow line. The light blue line is our plasma business, and you see the seasonality associated with that there. And then the gray line is kind of the other businesses, the other prepaid businesses that I discussed earlier. This green piece here, because when we report numbers to the street, we just mentioned plasma, excuse me, we mentioned pharma in general.
T here was a pharma prepaid business that was a legacy business that we exited at the end of 2022. So now all the numbers, as you see it now, are very clean between our plasma business, our patient affordability business, and other. And you can see the growth associated with those. We make our money a number of ways. Our revenue drivers, we get cardholder fees on the plasma side. That can be a fee for an ATM withdrawal or a purchase at a point of sale, purchase at a retailer, inactivity fees from cardholders that no longer use their cards. We also get interchange when they go spend money.
We're getting paid interchange. And then on our patient affordability business, we get program management fees. So X dollars a month to run a program. And then we get claims fees. So whether I'm getting $3 for a pharmacy claim or I'm getting $80 for a check that I process or whatever, that's how we make our money and a number of other fees. But it's all fee-based. There's no one concentration, like I mentioned, from the plasma side of the business. All of the individual customers who have those 6.5 million customers out there that we have that we get paid based on the usage of their cards.
Some quick revenue reconciliation of net income to Adjusted EBITDA. You will see here, again, focusing on the first quarter, $13.2 million in revenue, Adjusted EBITDA of $1.7 million. That compares to the first quarter of 2023, where we had $10.1 million in revenues and $720,000 of Adjusted EBITDA. So the business continues to perform nicely and grow nicely. One thing to pull out or alert you to, in the fourth quarter of 2023, we did have an income tax benefit of $4.3 million, but you can adjust that out. There's no impact on the Adjusted EBITDA there for that. It would just be at the net income line item.
If you wanted to apples to apples with everything else, you just back out that out of the net income. But we had, basically, due to accounting rules, we had this money sitting on our balance sheet from historical losses that we had, and we were able to pull that in and get that benefit on our P&L. But most of the people, the analysts that follow us, they look at us and value us based on our revenue and our Adjusted EBITDA.
The only adjustment, the only add-back on that to EBITDA is stock-based compensation, which is very important to shareholders and employees and is used as a retention tool to keep management engaged in the business. If you're interested in learning more about the company, I would highly encourage you to go to our website. It's Paysign.com. Under the investors tab, you can pull up this very presentation. These are hyperlinks that will give you more information about the plasma industry. What's plasma used for? Where can you donate? Companies that are in that business, etc.
Then under the patient affordability, we didn't talk a lot about it because it's pretty complex, but maximizers and accumulator programs that are out there that are trying to push more liability back to individuals like you and me versus insurance companies to pay those copay payments. There's a lot of information here. If you click over these links, it'll take you to that information. I mentioned earlier the leadership team. Here's a smattering, but Matt Lanford was at InComm with me. He came from Mastercard.
Robert Strobo, our GC, and Brad Cunningham, our CTO, they were all at Republic Bank & Trust. So they came out of the banking industry. Our Chief Compliance Officer comes out of the banking industry. So you'll see a lot of talent here that's either in payments or banking, which is very important for our company and what we do. With that, there's a list of our independent directors. You can read that on your own. With that, I will turn it over to Brendan for Q&A.
Great. Thank you both, Jeff. We really appreciate the overview. We have a couple of minutes here for Q&A. I'd like to start off with one. It seems like a really interesting diversified business model. What do you think your total addressable market is here?
I mentioned on the plasma side, it's about $120 million. We have just under 40% market share. And we did $40-ish million in revenues in that last year. This is about a $120 million market, TAM. And there's only about four players in that market. So it's big enough to be meaningful for us. It's not big enough to really attract a lot of other people that are trying to start at De Novo, that business. And then the patient affordability business, just on the payment side, we believe it is about $500 million TAM. We have 53 programs. At the end of Q, at the end of 2023, we had 43 programs and $4 million in revenue there.
So I know there's thousands of drugs that are in the market that have copay programs. So we're on a very early or leading stages of that business opportunity. But we think that's about $500 million. And then, I mean, if you want to throw in the other prepaid, which I'm very skeptical when people say, "Hey, we have a $728 billion TAM."
I'm realistic to say that, yeah, we have solutions there, but realistically, we're not going to go compete against InComm or Blackhawk in the retail distribution of GPR cards. We don't have a balance sheet for that. But if you wanted to say it was what this open loop prepaid market forecast is, then technically, I guess that would be accurate.
Got it. Well, Jeff, we really appreciate the overview. Thank you very much for your time. This concludes our conference. I know there may have been some questions we didn't get to. Feel free to reach out to Paysign directly, or you could contact Sidoti, and we could get those questions answered. Thanks again, Jeff.
Thank you, Brendan. I appreciate it.
Take care, everybody.