previously disclosed contract terms with pharmacy program partners, the net impact of regular contract renewals with our providers, and continued efficiencies in our care management services. Gross margin in the prior year period was also affected by our decision to keep all care management staff in place, despite the pause in treatments caused by COVID-19 at that time.
Net income was $18.7 million, or $0.19 income per diluted share, an increase of $19.8 million as compared to the net loss of $1.1 million reported in the second quarter of 2020. The higher net income was primarily due to operating efficiencies realized on our higher revenues throughout the business in the current period.
Adjusted EBITDA was $18.5 million, a nearly 5-fold increase from the $3.8 million reported in the second quarter of 2020. Adjusted EBITDA margin was 14.4%, an increase of 850 basis points from the 5.9% Adjusted EBITDA margin in the second quarter of 2020. The increase in both Adjusted EBITDA and Adjusted EBITDA margin reflects the same factors that affected net income.
Please refer to Annex A for a reconciliation of Adjusted EBITDA to net income and the calculation of net income and net income per diluted share.
Cash Flow
Net cash used by operating activities for the second quarter of 2021 was $7.5 million, compared to net cash provided by operating activities of $2.2 million in the prior year period. Cash flow in the current period was impacted, as expected, by timing items, which include the impact of the previously disclosed revisions in the agreements with our pharmacy program partners, which changed the timing of the payments we receive. Operating cash flow related to those agreements is expected to normalize in the third quarter.
Balance Sheet and Financial Position
As of June 30, 2021, the company had total working capital of approximately $139.7 million and no debt. This included cash and cash equivalents and marketable securities of $94.0 million.
Key Metrics
The company had 182 clients as of June 30, 2021, as compared to 134 clients as of June 30, 2020.
| | | | | | | | | | | | | |
| | Three Months Ended | | Six Months Ended | |
| | June 30, | | June 30, | |
| | 2021 | | 2020 | | 2021 | | 2020 | |
ART Cycles* | | | 7,340 | | | 3,434 | | | 13,898 | | | 7,877 | |
Utilization – All Members** | | | 0.54 | % | | 0.35% | | | 0.83 | % | | 0.66 | % |
Utilization – Female Only** | | | 0.47 | % | | 0.32% | | | 0.70 | % | | 0.58 | % |
Average Members | | | 2,795,000 | | | 2,137,000 | | | 2,735,000 | | | 2,099,000 | |
* Represents the number of ART cycles performed, including IVF with a fresh embryo transfer, IVF freeze all cycles/embryo banking, frozen embryo transfers, and egg freezing.
** Represents the member utilization rate for all services, including, but not limited to, ART cycles, initial consultations, IUIs, and genetic testing. The utilization rate for all members includes all unique members (female and male) who utilize the benefit during that period, while the utilization rate for female only includes only unique females who utilize the benefit during that period. For purposes of calculating utilization rates in any given period, the results reflect the number of unique members utilizing the benefit for that period. Individual periods cannot be combined as member treatments may span multiple periods.
Financial Outlook
“At this point in our selling season, we are ahead of where we expected to be due, in part, to a higher level of commitments from our “not now” sales prospects than what we have seen in prior years,” said Pete Anevski, Progyny’s President and Chief Operating Officer. “Based on our remaining pipeline, we expect our sales momentum to return to our historic pace of sequential annual increases in new accounts and new covered lives, with the relevant comparison for this year being the 2019 season.
“We are a utilization model and any external factors having an effect on people’s behavior can have an impact on our volumes. As we entered the third quarter, we saw unusual patterns in appointment scheduling, which indicates that July and August utilization could be somewhat lower than expected. While we believe this is a short-term anomaly, and are already seeing indications that member activity is returning to levels that are closer to what we would expect, we are adjusting our expectations slightly for the second half of the year, which will impact our third quarter and full year guidance.”
The company is providing the following financial guidance for both the three-month period ending September 30, 2021 (the “third quarter”) and the year ended December 31, 2021.
| ● | Third Quarter of 2021 Outlook: |
| o | Revenue is projected to be $121.0 million to $130.0 million, reflecting growth of 22% to 31% |