Myriad Genetics, Inc. Stock

Good day, and thank you for standing by. Welcome to the Myriad Genetics Third Quarter 2026 Financial Earnings Conference Call. [Operator Instructions]

Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Matthew Scalo. Go ahead.

Good afternoon, and welcome to the Myriad Genetics Third Quarter 2026 Earnings Call. During the call, we will review financial results we released today, and afterwards, we will host a Q&A session. Our earnings release was issued this afternoon on Form 8-K and can be found on our website at investor.myriad.com.

I'm Matt Scalo, Senior Vice President of Investor Relations. And on the call with me today are Sam Raha, our President and Chief Executive Officer; and Ben Wheeler, our Chief Financial Officer. Joining for Q&A will be Vishal Sikri, Executive Vice President of Commercial; and Mark Verratti, our Chief Operating Officer.

This call can be heard live via webcast at investor.myriad.com, and a recording will be archived in the Investors section of our website, along with the slide presentation. Please note that some of the information presented today contains projections or other forward-looking statements regarding future events or the future financial performance of the company.

These statements are based on management's current expectations, and the actual events or results may differ materially and adversely from these expectations for a variety of reasons. We refer you to the documents the company files from time to time with the SEC, specifically the company's annual report on Form 10-K, its quarterly reports on Form 10-Q and its current reports on Form 8-K. These documents identify important risk factors that could cause the actual results to differ materially from those contained in our projections or forward-looking statements. I'll now turn the call over to Sam.

Thanks, Matt. Good afternoon, everyone, and thank you for joining us. I want to start by welcoming Vishal Sikri to our earnings call. Vishal joined Myriad in 2025 as our SVP of Product and was recently promoted to Executive Vice President of Commercial, where he is now overseeing sales, marketing and product. Vishal has a deep understanding of molecular diagnostics and oncology as well as extensive business and commercial leadership experience. As Matt mentioned, Vishal is here in the room and available to participate in the Q&A portion of our call today, along with Mark Beratti.

Before we discuss third quarter results, I want to start by framing the context for the last few months. We understand the key challenges that we've been facing, continued softness in our Prenatal Health business, reimbursement pressure on HCT and financial stability, and we have been taking decisive actions to address the challenges, and I am pleased by the progress we're making on multiple fronts.

To materially strengthen Myriad going forward, we've been advancing our work on a number of initiatives. First, we've done a rigorous review of our product portfolio to determine how to maximize shareholder value and sharpen Myriad's focus. This led to the definitive agreement to divest our Prenatal Health business, which we recently announced.

Next, we have been working on a set of initiatives to address reimbursement pressures. Our increased revenue per test for the Cancer Care Continuum business in Q3 compared to Q2 reflects our team's ongoing work and early progress with payer engagement and revenue cycle efforts.

Next, we have been working on the Ascend initiative, which we introduced on the second quarter call to modernize how we operate as a company to both better serve customers and increase our ability to win in the market while improving productivity, efficiency and our cost structure. This initiative is about optimized processes and organizational design supported by new tools and technologies. We're working on Ascend with a leading consulting firm. And while this is a multiyear initiative, we've already started taking actions. We will share more about Ascend and its expected impact as we move into 2027.

Finally, we've redoubled our focus on business execution and results to ensure we can demonstrate operational, commercial and financial progress on a consistent quarterly basis.

With that, let me dive into our third quarter performance and highlights.

Third quarter total revenue of $202.7 million was supported by growing demand for our Cancer Care and Mental Health offerings with 4% volume growth of Cancer Care Continuum tests and 3% volume growth of our Mental Health test, offset by an 11% decline in the volume of Prenatal Health tests. For average revenue per test, we reported an increase of 1% year-over-year in Q3 compared to a decrease of 9% year-over-year in Q2. In fact, Q3 revenue for HCT test, while down 6% year-over-year, improved 9% sequentially over Q2 of 2026.

The improvement in total average revenue per test reflects test mix and early progress addressing payer friction through enhanced engagement and revenue cycle management initiatives. We outlined a number of these initiatives on our second quarter call, and Ben will share more about this later. While we are pleased with the results from these activities so far, we know that revenue cycle management requires unrelenting attention and engagement as conditions evolve.

And let me reemphasize that HCT remains a highly profitable business line with attractive margins, strong cash generation and significant long-term volume growth opportunities. In terms of profitability, the sequential improvement of revenue per test flows through the P&L. And our gross margin of 67.9% improved 130 basis points compared to Q2, along with a meaningful quarter-over-quarter improvement in adjusted EBITDA of negative $5.3 million and adjusted EPS of negative $0.11.

On October 20, we announced that Myriad has signed a definitive agreement to sell the Prenatal Health business to Labcorp. This is an all-cash deal for $210 million plus inventory, which values this business at 1.3x trailing 12-month revenue.

We are pleased with the outcome and early investor feedback has been unanimously positive as well. I'll speak further to the benefits of this transaction in a moment.

Looking at the full year of 2026, given the steady volume growth of our Cancer Care Continuum and Mental Health tests, along with improving average revenue per test in Q3 over Q2, we are raising the midpoint of our 2026 revenue guidance modestly. Total revenue guidance moves to a range of $780 million to $790 million.

This update reflects conservative assumptions related to Prenatal Health testing volume. Ben will share more on our guidance later. We expect the sale of the Prenatal Health business to unlock significant value for Myriad and our shareholders, resulting in a new Myriad that has materially strengthened financial profile in terms of revenue growth rate, profitability and liquidity.

Working with Labcorp, when the transaction closes, we expect a smooth transition that preserves uninterrupted patient access to our prenatal tests and a good opportunity for our approximately 500 team members who will move to Labcorp to continue serving Prenatal Health care providers. Importantly, the transaction will enable the new Myriad to be even more focused on the sizable attractive Cancer Care Continuum market opportunity.

Now turning to third quarter performance by business. In Q3, the Cancer Care Continuum business generated revenue of $124 million, up 1% year-over-year, reflecting test volume growth of 4% to 98,000 tests being offset by a 3% decline in average revenue per test. HCT volume grew 6% year-over-year with volume growth in both the unaffected and affected population continuing to be strong.

In fact, unaffected HCT in Q3 marked its highest volume record recorded in the last three years. We continue to drive steady volume growth in HCT enabled by a combination of our clinically relevant content, strong market position and improving commercial execution. It's encouraging to see the continued guideline expansion for HCT, including the updates by NCCN earlier this year, including multi-gene panel testing for all patients with endometrial cancer and also for colorectal cancer and gastric cancers regardless of age and family history.

Guideline expansion is expected to continue to support growth in years to come. For prostate cancer, we continue to receive positive feedback on Prolaris + AI, which we launched midyear. However, we believe our volume has been impacted by the NCCN guideline, which recommends blood-based biomarker testing and imaging in certain situations prior to biopsy.

Turning to Precise MRD. We're pleased to report on the latest positive data using our test. At the ESMO conference a couple of weeks ago, our collaboration partner, the National Cancer Center Hospital East presented data on the clinical significance of ultrasensitive MRD testing using our Precise MRD test in the assessment of colorectal cancer patients enrolled in the MONSTAR-3 study.

While the overall study is still maturing, in this interim analysis, 91% of patients who recurred were MRD-positive and Precise MRD 1 month after surgery, higher than has been reported with other assays and previous analyses. Further, the remaining 9% who recurred were identified as positive via serial testing. Approximately half of the post-surgery ctDNA positive results were detected at an ultrasensitive level and 35% of patients who have recurred so far at their first positive detection at an ultrasensitive level.

In essence, this illustrates the power of Precise MRD for earlier detection to help inform medical management and can benefit patient care. We look forward to strong data readouts and additional presentations and publications in 2027. Regarding commercial availability, we have spoken about how we're engaging new customers at early access sites. In fact, just last week, I had the chance to personally meet with some Precise MRD customers to hear their input directly.

For early access, we continue to closely monitor test utilization, customer experience and our internal operational efficiency. We expect Precise MRD reimbursement for breast cancer to begin in the first half of 2027 to be submitted to MolDX this summer. And consistent with past commentary, we would expect reimbursement for colorectal and renal cancer later in 2027. We intend to continue prudently managing testing demand until reimbursement is established.

Turning now to Mental Health. In the third quarter, GeneSight generated $40 million in revenue, up 2% year-over-year on 3% year-on-year volume growth. We continue to expand the ordering provider base, reaching over 40,000 ordering clinicians in the third quarter, and this steady volume growth reflects positive underlying demand and sales performance. We remain disciplined with a strong focus on capital efficiency while delivering growth to GeneSight.

Now moving to our Prenatal Health business. As I've already discussed the announcement of the sale, I'll be brief. In Q3, the Prenatal Health business generated revenue of $39 million, down 12% year-over-year, reflecting a modest decline of 1% in average revenue per death while volume declined 11%. That being said, First Gene Testing volume showed a nice ramp, and we look forward to working closely with Labcorp to provide continuity prenatal testing for health care providers and patients.

Finally, we've used this slide since the beginning of the year to track progress of key actions and milestones, product launches, publications and submissions. The checkmarks show that as we near the last part of the year, we have successfully completed the majority of these important milestones related to HCT, prostate cancer and Precise MRD. And these actions will support our growth in Cancer Care Continuum as we go forward.

With that, I'll turn it over to our CFO, Ben Wheeler.

Thanks, Sam. Let me start by reviewing our third quarter financial results. We reported revenue of $202.7 million, up 6% sequentially and down 1% year-over-year. Overall, test volumes declined 1% sequentially and 2% compared with the prior year period as continued strength in hereditary cancer testing and Mental Health were offset by Prenatal Health.

Average revenue per test increased 7% sequentially and 1% year-over-year, a meaningful improvement from the 9% year-over-year decline we reported in the second quarter. This improvement reflects product mix, a more normalized year-over-year comparison with prior period change in estimate impact to revenue and early progress from our revenue cycle initiatives.

I'll spend a few minutes on that progress in more detail. While we're encouraged by the improvement in Q3, average revenue per test can fluctuate in any particular quarter or year due to a number of factors. Longer term, we continue to expect modest headwinds to Hereditary Cancer Testing average revenue per test, consistent with our prior commentary.

We generated gross margins of 67.9% in the third quarter, up 130 basis points sequentially, but down 200 basis points year-over-year. Sequential growth reflects the improved average revenue per test. Our laboratory operations continue to perform at a high level, reflecting strong operating discipline and efficiency. Adjusted operating expenses were essentially flat sequentially, but increased $10 million year-over-year.

The year-over-year increase reflects targeted investments made earlier in the year to strengthen commercial capabilities. Our capital allocation philosophy remains unchanged. We will continue to prioritize investments with the highest expected returns while maintaining a disciplined focus on operating efficiency and shareholder value creation. Taking all of that into account, we generated an adjusted EBITDA loss of $5 million and an adjusted EPS loss of $0.11 in the third quarter.

As I mentioned, third quarter average revenue per test increased 1% year-over-year, primarily reflecting test mix. Within hereditary cancer testing, while average revenue per test remains below prior year levels, this slide shows the meaningful sequential improvement we saw in the third quarter. We believe this reflects early progress from our revenue cycle optimization and MyRisk reimbursement initiatives.

As we announced last quarter, we're implementing targeted process improvements, AI-enabled workflow acceleration and other capabilities to reduce reimbursement friction. In parallel, we launched a payer-by-payer market access strategy focused on policy engagement, LBM collaboration and reimbursement optimization to strengthen long-term access and support sustainable reimbursement for hereditary cancer testing.

The key takeaway is that we're seeing encouraging early progress addressing reimbursement friction, but there is more work to do. We continue to expect modest pressure on hereditary cancer testing average revenue per test over time, but we believe that we are building the capabilities and processes necessary to navigate an increasingly complex reimbursement environment more effectively.

Next, I'll speak to Myriad's profitability and liquidity. Third quarter adjusted EBITDA was a loss of $5 million, a significant improvement from the second quarter. This sequential improvement was driven by stronger revenue performance and disciplined operating expense management with adjusted operating expenses remaining flat quarter-over-quarter. We remain in a strong financial position. We ended the quarter with approximately $182 million in available capital. This provides us the financial flexibility to invest in our strategic priorities and fund key growth opportunities while maintaining a disciplined approach to capital allocation.

Next, I'll address the recently announced agreement to divest the Prenatal Health testing business. As Sam discussed, we believe this transaction is transformational for Myriad. In 2025, we refreshed our growth strategy and made a deliberate decision to prioritize the Cancer Care Continuum. Since that time, it has become increasingly clear that our prenatal testing business was unable to generate attractive returns in the near term, particularly given recent dynamics in the prenatal market. We, therefore, moved quickly to find what we believe is the best long-term home for this business. This transaction achieves a number of strategic and financial priorities.

First, it sharpens our focus and allows us to prioritize resources and investment on the Cancer Care Continuum, where we believe Myriad has the strongest opportunities to create long-term value.

Second, we expect the transaction to meaningfully improve the financial profile of the remaining company. Importantly, the combination of a stronger growth profile and higher gross margins should accelerate our path to sustainable profitability.

Third, this $210 million plus inventory all-cash deal will significantly strengthen our balance sheet and enhance our financial flexibility. We are evaluating potential uses of the net proceeds, including debt reduction, internal and external growth investments and other general corporate purposes. It is too early to be more specific on capital allocation, but the transaction meaningfully expands our financial flexibility.

Finally, we recognize this transaction affects many of our colleagues, and we do not take that lightly. At the same time, we believe this is the right strategic decision for both businesses and puts Myriad in a more focused, financially stronger and more competitive position going forward.

Next, I'll speak about guidance. Factoring in our solid Q3 performance and our updated outlook for the remainder of the year, we are raising the midpoint of our full year 2026 revenue guidance to $785 million from $780 million. This increase primarily reflects the improvement in average revenue per test we experienced in the third quarter, partially offset by some potential softness in Prenatal Health given the deal announcement. To provide greater insight into the underlying business, we're also providing separate 2026 revenue guidance for Prenatal Health and the Cancer Care Continuum and Mental Health businesses. Now let me turn the call back to Sam.

Thanks, Ben. I'd like to conclude by summarizing the key points from this call. The combination of the planned divestiture of the Prenatal Health business, the advancement of our ongoing work to mitigate reimbursement pressures, the implementation and benefits from the Ascend initiative over the midterm and improved operational and commercial execution is setting up the new Myriad to have a materially stronger financial profile, increased predictability and increased focus and intentionality on the Cancer Care Continuum to serve more patients and clinicians and win in the market. We recognize the work ahead.

We are energized by it and the opportunities that will unlock. We are pleased with our Q3 results and look forward to building on that in Q4 as we head into 2027. I'll now pass the call back over to Matt for Q&A. Matt?

Thanks, Sam. And as a reminder, during today's call, we use certain non-GAAP financial measures. A reconciliation of the GAAP to non-GAAP financial results and a reconciliation of GAAP to non-GAAP financial guidance can be found in our earnings release and under the Investor Relations section of our website. Now we are ready to begin our Q&A session. Operator?

[Operator Instructions]

Our first question comes from the line of Bill Bonello with Craig-Hallum.

Fun to be on a quarter where things are moving in the right direction. Specifically to that, I was hoping to ask sort of a multipart question on hereditary cancer pricing. Just trying to understand a little bit more the dynamic there. So here's sort of the multipart. Is the decline in ASP a function of not getting paid or is it a function of getting paid at lower rates? And if it's the latter, you're getting paid at lower rates, is that something that's resulting from contracts that you're renegotiating? And then let's assume it's that, maybe you can give us some sense of where you are in that contracting cycle, whether most of the big contracts have been negotiated down, if there's still some big ones ahead of us. And then finally, just when you say you expect modest headwinds going forward, can you put some bookends around that? I know you have in the past, but maybe you can remind us.

Bill, thank you very much for the question. The multipart question. And again, we are pleased by the early progress that we're making on reimbursement and average revenue per test on HCT. But let me turn it over to Ben to provide you some specifics on your questions.

So Bill, when we're thinking about the softness that we've experienced from an HCT average revenue per test standpoint, that softness is really driven by an increase in 0 pay. So more frequently, we're not getting paid or we're experiencing denials. It's not a byproduct or a result of contract changes or a change in medical policy. And so when we experience variability in ASP, it's generally revenue cycle friction as we refer to it, and that's going to be tied to denials.

And so as Sam said, we're pleased with the early progress that we've seen based on our revenue cycle management optimization initiative. And then we also referenced the MyRisk reimbursement initiative, both on our Q2 call and on our call today. There's lots of work still to be done, but we're happy with the early wins, and we feel like that is what we saw drive the improvement in ASP in Q3.

And in terms of what you're expecting for modest headwind going forward?

Yes. So we frame that as 1% to 5%, maybe more like 3% to 5% in some years. And that's from an average standpoint, Bill. So if you think about it, some years, it may be in excess of 5% like this year. In some years, it might be down 1% or we may even be flat. But generally speaking, in the medium to long term, we would say an average decline of 1% to 5%, maybe skewing 3% to 5% most recently.

Okay. And then just one last follow-up to that. I know that the zero pays are supposed to be a function of what the payer is seeing, whether they think it's an appropriate claim or not. But do you think your price position in the market plays into that at all? And if so, how do you kind of deal with that?

Yes. So Bill, I don't think that it is specific to our price position. I think it's more about the amount of money that people spend in specialty diagnostics and maybe in hereditary cancer testing. And so oftentimes, we'll see as payers are managing their P&Ls, they make changes sometimes in their prior authorization requirements or medical record requests, and that's where we see the increase in denials.

One that we had -- sorry, yes, previously, which is what we're seeing is not so different than what the broader industry is seeing. And for example, as ACLA, we collectively are taking some actions to improve on that. But the longer a test is on the market, the more subject it is to various reimbursement pressures. And we have a portfolio which has a number of tests that have been on the market longer. So it's more pronounced perhaps for us at the moment.

Our next question comes from the line of Kyle Boucher with TD Cowen.

I wanted to start with another question or just a question in general on guidance, sort of what's embedded for the fourth quarter. I think the midpoint of the guide sort of reflects maybe just north of $10 million Q-over-Q decline. But I think if we look across hereditary cancer and GeneSight volume looks pretty good across both of those. So I guess what are the puts and takes there on the fourth quarter? And then just second to that, were there any major out-of-period adjustments this quarter?

Kyle, thank you for the question. Ben, these are right up your alley.

So Kyle, when we think about the updated guide, it really is as simple as the two pieces that we called out in the prepared remarks, and that is we were really pleased with the outperformance of, we'll say, about $10 million during Q3. And so if we update the midpoint of our guidance by that Q3 beat and then soften the expectation for prenatal in Q4 as a result of some potential volume softness tied to the deal announcement, that's how we get from a midpoint of $780 million to $785 million off of a $10 million outperform in Q3.

So maybe said differently, maintaining assumptions around Q4 with the exception of softening the volume tied to about half or $5 million worth of prenatal revenue is how it all comes together.

I was just going to answer that second question. As it relates to out-of-period or change in estimate to revenue, insignificant for the quarter.

Got it. Okay. Maybe just one more question. Just obviously, much more focused now, your strategic focus on the Cancer Care Continuum. But I guess can you just talk a little bit more about maybe what some of your key areas of focus are post the divestiture of the prenatal business early next year. You said there's a number of different things you guys could do in terms of use of proceeds. Maybe there's no update on that right now. But I guess just sort of how are you thinking about the different options? And I guess, what does the business really look like from a growth and profitability perspective, excluding the prenatal business?

Kyle, I'd start by saying, as you can understand, we have been completely heads down focused on the strategic review and the resulting transaction, also the initiatives to improve reimbursement and so forth. So we are now getting deep into 2027 planning, and we're going to have more specifics for you coming up. But that being said then, what color might you add?

So Kyle, in the presentation associated with our prepared remarks, we showed that we expect revenue growth to improve over 100 basis points post divestiture. We also showed that we expect gross margins to increase or improve by greater than 500 basis points. We didn't talk about general profitability. We'll get into more details as we get closer to 2027. We don't want to get ahead of guidance there before we formally communicate that.

But we can say that we expect meaningful progress in 2027 as it relates to bottom line profitability. When we think about a more focused organization, we think about the work that we're doing from an Ascend standpoint and then also those revenue ASP initiatives, those are going to layer in during the year at different points in time. We're excited about what it means and what the organization will look like, but it's not the right time to discuss from a quantification standpoint, what that looks like. But I'll reemphasize that we're excited about the work ahead, the work we've done and what we expect the improvement in profitability profile to look like as we progress through 2027.

And then the other question that Kyle had, and I know it was your prepared remarks, but if you can speak to again any thinking we have around the proceeds.

Yes, absolutely. And so we're contemplating use of proceeds across multiple facets or multiple fronts. Part of that will include some level of debt repayment. We're also looking at growth opportunities internally and externally and then naturally just to fund typical operations as we continue to drive for things like MRD and competing in the market in the Cancer Care Continuum in new ways.

[Operator Instructions] This concludes the Q&A-answer session. I would now like to turn the call back over to Matthew Scalo.

Thanks, Grace. This concludes our earnings call. A replay will be available via webcast on our website for one week. Thank you all for joining us this afternoon, and have a good night.

Thank you. Good day, and thank you for standing by. Welcome to MIRIAD Genetics. Second quarter, two thousand and twenty-six financial earnings conference call. At this time, all participants are on a listen-only mode. After the speaker's presentation, there will be a question and answer session. ask a question during the session, you'll need to press star 11 on your telephone. You will then hear an automated message advising your hand is raised. To answer your question, please press star 11 again. Please be advised that today's conference is being recorded.

I would now like to turn the conference over to your speaker for today, Matt Scalio. Please go ahead.

ahead. Good afternoon and welcome to Merit Genetics' second quarter, 2026 earnings call. During the call, we will review financial results we released today. and afterwards we will host a Q&A session. Our earnings release was issued this afternoon on Form 8K and can be found on our website at investor.meria.com. Matt Scalise, Senior Vice President of Investor Relations. On the call with me today are Sam Raha, our President and Chief Executive Officer, Ben Wheeler, our Chief Financial Officer, and Brian Donnelly, our Chief Commercial Officer. The recording for Q&A will be Mark Verratti, our Chief Operating Officer. This call can be heard live via webcast at investor.mary.com, and a recording will be archived in the investor section of our website, along with this slide presentation.

Please note that some of the information presented today contains projections or other forward looking statements regarding future events or the future financial performance of the company. These statements are based on management's current expectations and the actual events or results may differ materially and adversely from these expectations for a variety of reasons. We refer you to the documents the company files from time to time with the SEC, specifically the company's annual report on Form 10-K its quarterly reports on Form 10-2, and its current reports on Form 8-K. These documents identify important risk factors that could cause the actual result to differ materially from those contained in our projections or forward-looking statements.

I'll turn the call over to Sam. Thanks Matt. Good afternoon everyone and thank you for joining us. Let me dive right into our second quarter performance and key actions we're taking to create a more focused business and can drive accelerated growth and profitability as we go forward. The second quarter total revenue of $190.7 million was down 11% year-over-year, as volume decreased 1% and revenue per test decreased 9%. Demand for our cancer care continuum and mental health test portfolios remained solid, with test volume growing 6% and 4% year-over-year, respectively. This growth was offset by continued softness in our prenatal testing volume, which declined 9% over last year's period. Regarding the 9% year-over-year decline in average revenue per test, it is important to call out that this figure included a headwind of approximately $11 million from lower than expected prior period collections, which includes a $4 million write-off of age receivables.

Excluding this headwind, average revenue per test was down 3% year-over-year and reflects elevated payer friction for our prenatal and hereditary cancer tests in 2026. Mitigating the HCT average revenue per test pressure is one of our top priorities. We are executing a focused and comprehensive action plan to address it, which both Ben and I will speak more about. We're also doing a rigorous evaluation of our product portfolio to determine the optimal allocation of capital and enhancement of shareholder value and will keep you updated on our progress and decisions. With regards to our cancer care continuum business, we continue to make meaningful progress on a number of fronts. Q2 MyRisk volume remains... strong with 10% growth year on year. And we achieved a number of pipeline milestones including the launch of our first AI enhanced prostate cancer test, Prolaris plus AI.

We also took important steps forward with our precise MRD test by expanding clinical testing availability to colorectal and renal cancers. and submitting precise MRD for breast cancer to Moldex for coverage determination. These achievements are on track with our stated plans and bolster our confidence in our longer term growth aspirations. As hereditary cancer and other molecular diagnostic testing continues to grow, pressures on reimbursement rates is expected to persist. As a result, we have activated an initiative called ASCEND to increase organizational efficiency, productivity and scalability and are being supported by a leading professional services firm. We anticipate this initiative will produce meaningful measurable benefits to profitability including adjusted EBITDA in 2027 and beyond. Lastly, we are lowering our 2026 revenue and gross margin guidance. Total revenue guidance moves to $770 to $790 million.

Gross margin moves to 66 to 67%. This updated guidance reflects the Q2 performance and lower volume assumptions for prenatal health and lower HCT average revenue per test. However, due to uncertainty regarding the timing and impact SEND initiative, we're suspending our adjusted EBITDA guidance. As I mentioned, we're experiencing elevated reimbursement pressure which is impacting the average revenue per test for our MI-RISC hereditary cancer test. This pressure is coming from changing prior authorization requirements, more medical record requests and higher overall payer denial rates. This type of payer generated revenue cycle friction, while not new, became more aggressive in the quarter and resulted in a step down in realized average revenue per test. Importantly, this reimbursement pressure is not the result of changes in medical policy.

It is payer-initiated revenue cycle friction and we're seeing similar dynamics across the broader healthcare system as payers cite automated denials as a mechanism to manage plan utilization and lower their reimbursement costs. The impact is from a limited number of payers. As we deeply analyzed the situation, we have determined that we should have engaged earlier and more directly with payers as conditions evolved. Earlier intervention could have reduced the downstream impact. Mitigating HCP reimbursement pressure from these limited payers and anticipating other potential pressures is one of our top priorities. To that end, we're taking a number of immediate actions. First, we're optimizing the end-to-end revenue cycle process.

This includes enhancing front-end coverage verification and prior authorization workflows, increasing alignment of services with payer expectations, and integrating third-party medical record repositories into our workflows to automate responses to documentation requests and the associated claim appeals. Next, we're increasing utilization of aid by deploying AI-enabled workflows for reducing manual touches and accelerating claim resolution. Also, we are engaging in a policy-based approach to better align medical policy with clinical practices and utilization of our services. The facts are we have received orders from clinicians for medically necessary tests. We have processed patient samples and returned test results which have been used to inform the care of those patients. The content of of these tests are supported by NCCN and ASCO guidelines, yet we are not receiving payment in a timely manner. We believe that many of these payer practices create unnecessary administrative burden, are inconsistent with the timely reimbursement of medically necessary testing, and ultimately could negatively impact member of patient care.

Individually as a myriad, we're going to do a better job of initiating engagement with our key payer constituencies on a regular basis. Also, we will continue to pursue other pathways to resolve these issues, including working with industry organizations, policymakers, and payers to reduce unnecessary barriers and improve transparency in laboratory benefit management processes. In addition to all of these noted activities, we will continue to advance our work to reduce COGS from high risk and the ASCEND initiative will reduce the OPEX related to revenue cycle management over time. Importantly for our stakeholders, even under scenarios where average revenue per test experiences additional pressure, HCT remains a highly profitable business with attractive margins, strong cash generation, and significant long-term growth opportunities. Lastly, I would call out that our updated 2026 financial guidance assumes no improvement in average revenue per test from the second quarter level. Let me transition now to providing an update on key 2026 milestones. We presented this slide last quarter and you'll notice a number of new checkmarks representing further progress and achievements made since our Q1 call, including key clinical publications, the MOLDEC submission, precise MRD for breast cancer, and recent launches.

These actions strengthen Mary's ability to serve cancer care testing and support our long-term growth profile. We continue to drive solid volume growth in hereditary cancer testing, which is enabled by a combination of our strong market position, commercial execution, and ongoing commitment to clinically relevant innovation. We were encouraged with the feedback on Precise MRD as we transitioned to early access from Alpha Launch. We continue to expand the number of sites and invest in the commercial team and its capabilities ahead of full launch in 2027. Brian will share more on this. In June, we launched our AI-enhanced Prolaris prostate cancer test that combines the power of molecular and AI analysis, and early urologist interest and input has been positive. And last week, we successfully executed the commercial launch of Firstgene.

These milestones and new products, along with the expanding customer reach will enable us to accelerate growth in the quarters ahead. The initiatives and actions we are working on will ensure that we are able to increase focus on our most important near and long-term strategic opportunity, serving the cancer care continuum. expected impact from the combination of implementing the ASCEND organizational initiative to increase efficiency and scalability, mitigating the impact on my risk average revenue per test, and any actions that may stem from the rigorous evaluation of our product portfolio is a stronger company with changes to our structure performance going forward. A company with strengthened growth rate, profitability, and predictability. Now let me turn it over to Brian Donley, our Chief Commercial Officer. Brian.

Thanks, Sam. Good afternoon. Before diving into the quarter, I wanted to begin with a progress update on the sales onboarding activities we discussed last quarter. I'm happy to share that we have now hired, trained, and placed in the field over 100 new account executives, primarily supporting our cancer care continuum product offerings. These new sales team members are expected to begin driving increased volume across the cancer care continuum meaningfully in 2027 and beyond. Now turning to second quarter performance. In Q2, the cancer care continuum product category generated revenue of $114.1 million, down 11% year over year, reflecting test volume growth of 6%, being offset by a 15% decline in average revenue per test. Importantly, hereditary cancer testing volume grew 8% year over year, with MI-RISC test volume growth of 10% year over year. Volume growth in the unaffected population was stronger than the affected segment, which we see as an important indicator for future demand.

In fact, we delivered our strongest quarterly performance in unaffected hereditary cancer testing in Q2, marking the highest volume recorded in the last three years. Now, moving to prostate cancer, we successfully launched our first AI-enabled PROLARIS test at the end of Q2, bringing together AI, biomarker, germline, and genomic insights in a single offering. This combination is differentiated and positions us to compete more effectively in prostate cancer patient care. Early customer feedback has been positive, particularly as a useful tool to support critical decisions in patients in the important active surveillance segment. We have been investing in the commercial channel and other programs in preparation for this launch to improve our overall performance and gain market share. Turning to precise MRD, I wanted to highlight the great progress that our team is making. In June, we announced moving out of early access and into expanded availability of precise MRD, broadening access to patients undergoing treatment and surveillance with breast cancer, colorectal cancer, and renal cancer.

Early access sites and new customers are engaged and continue to provide us actionable feedback. We are closely monitoring testing utilization, customer experience, and our internal operational efficiency. While it's early in the program, let me share some key takeaways. First, we continue to serve more clinicians and a growing number have ordered tests for multiple patients. Next, in terms of customer experience, clinicians have been satisfied with the quality of our test. We continue to work on making test ordering easier and to improve the overall customer experience as we move forward with our expanded launch phases. Finally, in terms of operational efficiency, our MRD assay itself has proven to be robust and has performed extremely well.

Our commercial medical affairs teams are actively ramping and we remain on track for commercial launch in 2027. In addition, we have submitted to Moldex for our breast indication, hitting a major milestone on time with the intent of establishing coverage in 2027. Now moving to our prenatal health business. In Q2, the prenatal health business generated revenue of $40 million, down 16% year over year, reflecting a decline of 8% in average revenue per test, while volume declined 9%. Unfortunately, we have not made as much progress as expected in this business, reflecting a combination of factors, including the timing of Salesforce expansion and competitive dynamics. The good news is that our new dedicated prenatal health sales team is now fully staffed and we anticipate improved prenatal performance will in part be driven by first-team gene, which launched just last week. As a reminder, the first gene screen offers the first and only simultaneous screen of patient carrier status, fetal single gene, fetal chromosome, and fetal RHD status, all delivered collectively in a single, integrated report with the test able to be taken at an industry-leading eight-week gestational age. and with an industry-leading turnaround time with all results delivered within 14 days.

Since our last earnings call, we have made significant strides in Firstgene, including wrapping up our early access period, training our entire sales organization, Just last week, we officially moved into our commercial launch phase. Although we are very early into launch, we have and continue to receive positive feedback on product differentiators, including the value of the combination, particularly the single gene and RHD components. into our turnaround time advantages compared to on-market products, which is a direct result of our assay design and workflow. We are already seeing orders and customers returning to Myriad to trial this new offering. Now turning to mental health. In the second quarter, GeneSight generated $36.8 million in revenue, down 3% year-over-year on 4% volume growth. As Sam mentioned earlier, revenue was impacted by an AR write-off. This write-off obscures the overall improving reimbursement trends in mental health that are due to increased payer coverage and aided by biomarker legislation. We continue to expand the ordering provider base, reaching now over 40,000 ordering clinicians in the second quarter, which is another record high.

The strong second quarter volume growth reflects solid underlying demand and sales performance. We remain disciplined with a strong focus on capital efficiency while delivering growth with Genesight. And with that, I will turn it over to our CFO, Ben Wheeler.

Thanks, Brian. Let me start by reviewing our second quarter financial results. We were reported revenue of $190.7 million, down 11% year over year. Overall test volumes declined slightly with the prior year period as continued strength in hereditary cancer and mental health was offset by prenatal health. It's worth repeating that we generated another quarter of solid test volume growth in MIRIS testing with 10% year-over-year growth in the second quarter. That growth was driven by continued strength in our unaffected market. where demand and execution remain strong. The sustained growth we're seeing in both hereditary cancer volumes and gene site volumes provide evidence that our commercial initiatives are gaining traction and strengthening the underlying business. Average revenue per test decreased 9% year over year, reflecting a challenging comparison with prior period positive change in estimate contributions to revenue and increasing payer friction this quarter, most noticeable in our cancer care continuum.

As Sam mentioned, generally improving reimbursement trends for mental health were offset by a $4 million write-off off of age receivables during the quarter. While average revenue per test can fluctuate in any particular quarter due to a number of variables, we continue to expect modest headwinds to hereditary cancer average revenue per test over the longer term, consistent with our prior commentary. We generated gross margins of 66.6% in the second quarter, down approximately 460 basis points year over year. The decline reflects average revenue per test softness and the unfavorable change in estimate impact to revenue comparison. Gross margins excluding the $11 million impact to revenue from changes in the estimate during the quarter were 68.4%. Our laboratory operations continue to perform at a high level, reflecting strong operational discipline and efficiency. We remain focused on driving additional scale, automation, and productivity across our laboratories to support both our existing portfolio and planned product launches in 2026 and beyond.

Over time, we expect continued cost-per-test improvements to help offset modest reimbursement pressures and support gross margins that remain among the strongest in the industry. Adjusted operating expenses increased by $6.7 million year over year, reflecting targeted investment to strengthen commercial capabilities, execution, and advance key R&D growth initiatives that support our long-term strategy. Our capital allocation philosophy remains unchanged. We will continue to prioritize investments with the highest expected returns while maintaining a strong focus on operational efficiency and shareholder value creation. Taking all of that into account, we generated an adjusted EPS loss of 25 cents for the quarter. We remain comfortable with our liquidity position, ending Q2 with approximately $190 million of available liquidity, providing the financial flexibility to execute our strategic priorities while navigating the current operating environment. As Sam highlighted, we're advancing multiple important initiatives that have the potential to significantly strengthen Myriad's operating model and meaningfully accelerate Myriad's ability to achieve its strategic and financial objectives. were conducting a rigorous portfolio review to ensure capital is deployed to the highest value opportunities and to maximize long-term shareholder value.

We'll provide updates as appropriate. Second and complementary to the first, we've engaged a leading professional services firm to conduct a comprehensive review of Myriad's organizational structure, operating model, and core business processes. This initiative is intended to simplify the business, improve execution, enhance scalability, and better align our resources with our most strategic Third, we've launched initiatives to strengthen reimbursement performance, which I'll speak about in a moment. Together, these initiatives represent important steps in unlocking the value of Myriad's portfolio, improving operational performance, and positioning the company to deliver stronger long-term growth and profitability. At this stage, we're not providing a timeline for these initiatives, as they each involve a number of variables. What we can say is that we are confident the outcome from each initiative can have a material positive impact to Myriad in 2027 and beyond. That said, given the uncertainty surrounding timing and potential financial impact of these initiatives, we believe it prudent to suspend our 2026 adjusted EBITDA guidance at this time. Second quarter average revenue per test declined year over year across the portfolio.

As we've noted in the past, we caution investors against simply extrapolating a single quarter's results. Accordingly, this slide provides the four-year history of quarterly average revenue per test trends for hereditary cancer testing. During 2026, payers continued to introduce new reimbursement requirements and modify existing prior authorization and clinical documentation expectations. In the second quarter, we experienced slower reimbursement from a limited number of payers for our MIRIS panel, contributing to the outsized change in estimate revenue adjustment recognized in the quarter. Importantly, this impact primarily relates to tests performed in Q1 and reflects revenue cycle management friction and administrative complexity, not any change in the underlying clinical value or demand for our testing. In response, we've launched several initiatives to strengthen reimbursement performance and improve long-term predictability. First, our revenue cycle optimization initiative.

In partnership with a leading third party expert, we're implementing targeted process improvements, AI-enabled workflow acceleration, and enhanced denial management capabilities to reduce reimbursement friction, accelerate claim resolution, and improve collection predictability. This includes automation and workflow enhancements across medical record retrieval, document classification, denial triage, appeal prioritization, and payer response management. Importantly, the initiative is focused not only on near-term performance improvement, but also on building scalable processes, analytics, and organizational capabilities that enable Myriad to rapidly adapt to evolving reimbursement requirements and navigate an increasingly dynamic revenue cycle environment. Second, our MI-RISC reimbursement initiative. We've launched a pair-by-pair market access strategy focused on policy engagement, LBM collaboration, and reimbursement optimization to strengthen long-term access and to support sustainable reimbursement for hereditary cancer testing. The initiative is designed to improve predictability and promote greater alignment between rapidly advancing diagnostic technologies, evolving clinical guidelines, and peer medical policies, which often develop on a different timeline than scientific innovation. The key takeaway is that we expect reimbursement friction to remain a headwind through the balance of 2026 and have incorporated that expectation into our revised revenue guidance. While we anticipate continued pressure in the second half, we do not expect the magnitude of the impact experienced in the second quarter to repeat.

Next, I'll speak to Myriad's profitability and liquidity Second quarter adjusted EBITDA with a loss of $16.9 million, reflecting softer revenue performance and relatively stable adjusted operating expenses as we continue to invest in commercial growth initiatives, including new product launches. We remain in a strong financial position. We ended the quarter with approximately $190 million in million in available capital, providing us the flexibility to invest in our strategic priorities and fund key growth opportunities while maintaining appropriate financial discipline. Next, I'll address financial guidance. Factoring in Q2 results and revised assumptions for the second half of 2026, we're lowering our full year 2026 revenue guidance to a range of $770 to $790 million. At the midpoint, this represents a reduction of $90 million from our prior outlook. The revised guidance primarily reflects three factors. vectors, weaker prenatal volume trends relative to our prior expectation, lower than expected hereditary cancer reimbursement levels, and final resolution of the age gene site accounts receivables. Historically, the second half of the year has been stronger than the first half.

Our revised outlook takes a more conservative approach and assumes second half revenue is approximately in line with first half performance. The guidance also assumes no contribution from commercial team expansion initiatives or recent product launches despite the investments we've made in both areas. As a result, We expect third quarter revenue to be flat to slightly higher than the second quarter, with improvement as we move into the fourth quarter. We believe this outlook appropriately reflects the current operating environment, incorporates prudent assumptions around areas of uncertainty, and positions us to reestablish a consistent track record of execution and delivery going forward. Now let me turn the call back to Sam.

Thanks, Ben. Let me conclude our prepared comments by reiterating our confidence in being able to support Myriad's strategic intent to accelerate profitable growth by focusing on the cancer care continuum and in being able to strengthen the company's financial profile by executing the key initiatives that we outlined. In Q2, we continue to make meaningful progress on the cancer care continuum on a number of fronts, including strong volume growth for our MIRIS creditory cancer test, the launch of Prolaris plus AI, the expansion of Precise MRD, along with the submission of Precise MRD breast to Moldex. stated earlier, the expected impact from the combination of implementing the organizational initiative to increase efficiency and scalability, mitigating the impact on my risk average revenue per test, and any actions that may stem from the rigorous evaluation of our product portfolio is our ability to focus more deeply on serving the cancer care continuum and a resulting streamlined company in 2027 and beyond with strengthened growth rate, profitability, and predictability. I will now pass the call over to Matt for Q&A.

Thanks, Sam. And as a reminder, during today's call we use certain non-GAAP financial measures. A reconciliation of the GAAP to non-GAAP financial results and a reconciliation of GAAP to non-GAAP financial guidance can be found in our earnings release and under our investor relations section of our website. Now we're ready to begin our Q&A session. To ensure broad participation, we're asking participants please ask only one question and one follow-up. Operator, we're now ready for the Q&A portion of the call.

Thank you. As a reminder, if you would like to ask a question, please press star 1-1 on your telephone. You'll then hear an automated message advising your hand is raised. To remove yourself from the queue, please press star 1-1 again. We also ask that you wait for your name and company to be announced before proceeding with your question. One moment while we compile the Q&A roster. Our first question today will be coming from the line of Cal voucher of TD Cal and please go ahead.

Hey, good afternoon. Thanks for taking my questions. Just wanted to start here on some some of the updated assumptions in the guidance. I know you walked through it quite a bit, but I guess specifically for the cancer care continuum, hereditary cancer testing business, You know you grew volume overall and the cancer care continuum 6% in the second quarter against the 7% comp and the volume comparisons get a lot tougher in the back half. So I guess just what sort of implied, you know, for growth in the in the second half as it relates to just volume versus price.

Thanks for the question, Kyle. Ben, I'll turn to you. Thanks, Kyle. So maybe I'll just start at the enterprise level and then I'll give you a little bit of insight relative to the different components. So I'll start at revenue for the enterprise, Kyle. The updated guide assumes a 5% decline in revenue. revenue year over year. And the way that we're thinking about that as it relates to the different product categories is that mental health will be modestly up, that the cancer care continuum will be modestly down and then we'll continue to see prenatal health year over year comparisons last.

as we work through building volume through the back half of the year. Got it. And then maybe just one more on the gene site business. Can you sort of discuss the ordering trends between maybe newer clinician ads that you talked about on the call and then, just reorders from existing clinicians. I guess, how should we think about the long-term growth of the gene site business, just given you put up mid-single digits, sort of volume growth over the last few quarters, down from, I think we saw, sort of high single digits last year?.

Yes, thank you for the question, Kyle. Listen, we remain optimistic and excited about the GeneSight opportunity. As you know, as a backdrop, mental health continues to be a very serious matter in this country and beyond. We have the absolute leading test in the market. with great NPS, very high NPS, both with patients and providers. As Brian shared, we again served a very significant number of providers this quarter. We also think that what we have as a positive is that the activities that we put into, you know, action going back a year in terms of how we're targeting, how we're driving marketing and the resulting sales. These things are all working. We have the biomarker. bills that are being enacted in more states, all of these students are positive.

But the volume is actually where we'd expect. We've always said it would be, well, not always, but coming into the year that we'd expect mid-single digits. That's where it is. You know, we are also trying some new approaches as it relates to, you know, individuals at time of billing. So we do anticipate that there's the slight perhaps less volume or growth in volume is going to be offset in revenue as a consequence of some of the new procedures we're putting in place regarding collection of credit card information, for example, at a different time period.

Got it. Thanks, guys. Thank you. One moment for the next question. Our next question will be coming from the line of Davin Wissenberg of Piper Sandler. Please go ahead.

Hi, guys. This is Skye on today. Thanks for taking the question. Maybe just first on the cancer continuum strategy reimbursement headwinds aside, how are the new products changing customer behavior across each of the segments? Are you seeing any meaningful cross-selling into accounts that maybe only used one myriad product previously?.

Thanks. Brian, yes, please take it. Yes, hey, thanks for the question. I can give you an update on that. And first, just as a quick reminder in terms of the new products you brought to the market, we've got the Prolaris Plus AI launch. We've had expansions to MyRisk. And in addition, we've now expanded the availability of Precise MRD. What I would say, one of the components of your question is around portfolio selling. A key piece of the way our organization is structured is when our oncology sales team goes and sees a community-based oncologist, we are making them aware of, as an example, MyRisk and our new Precise MRD offering.

In addition, we have a specialist team around that. We consistently look for opportunities to make sure that our products are known, that for providers who see patients that are relevant, they use the appropriate patients. In the urology setting, for Polaris Plus AI, offering we have for that customer base is of course MyRisk. So we see healthy cross-sell, healthy portfolio adoption from our users, and it's something that we try to continue to lean into to make sure that our products are being used for the appropriate patients.

Okay, great. Very helpful. Thank you. And then specifically on precise MRD, I think last quarter you mentioned you had received feedback on ordering and sample shipment instructions as areas for improvement. Have those changes reduced failed orders or helped turnaround times or sample quality issues and are there any other operational metrics that you're tracking?.

Hey, this is Brian again. Thank you for the question and yes, spot on. As a reminder, we're really focused right now with this expanded availability on breast, renal, and colorectal cancer. The things we discussed last quarter were tracking metrics around test utilization, provider and patient workflows, and customer experience. What we're seeing on test utilization is that we have a growing number of clinics and and precise MRD, many with repeat orders. So on the utilization front, we're early, but we are turning in the right direction. From a provider and patient workflow perspective, the big change in Q3 has to do with some of our digital ordering capabilities, which have come online. So we are actively improving the workflow, expanding these capabilities, and we're taking that feedback to get ready for our fuller commercial launch in 2027.

We did get really useful feedback. We have been incorporating that. And then last but not least is the customer experience. This will be an area that we'll likely talk about for a while. This is a really important part of the product offering, and we'll continue to lean in here to expand as we get more and more customer feedback. you back. Thank you. Thank you.

Thank you. As a reminder, if you would like to ask a question, please press star 11 on your telephone. I'm not seeing any more questions in the queue. I would like to turn the call back over to Matt Scullo. Please go ahead.

Okay, thanks, Lisa. This concludes our earnings call. A replay will be available via webcast on our website for one week. Thank you again for joining us this afternoon. Have a great day.

This concludes today's program. Thank you so much for joining. You may now disconnect.

This live transcript is auto-generated without human intervention or review.

[Call has ended.]

Good day and thank you for standing by. Welcome to the Myriad Genetics First Quarter 2026 Earnings Call. [Operator Instructions] Please be advised that today's conference is being recorded.

Now it's my pleasure to hand the conference over to the Senior Vice President of Investor Relations, Matt Scalo. Please proceed.

Good afternoon, and welcome to the Myriad Genetics First Quarter 2026 Earnings Call. During the call, we will review the financial results we released today. And afterwards, we will host a Q&A session. Our earnings release was issued this afternoon on Form 8-K and can be found on our website at investor.myriad.com.

I'm Matt Scalo, Senior Vice President of Investor Relations. On the call with me today are Sam Raha, our President and Chief Executive Officer; Ben Wheeler, our Chief Financial Officer; and Brian Donnelly, our Chief Commercial Officer. Joining for Q&A will be Mark Verratti, our Chief Operating Officer.

This call can be heard live via webcast at investor.myriad.com, and a recording will be archived in the Investors section of our website, along with this slide presentation.

Please note that some of the information presented today contains projections or other forward-looking statements regarding future events or the future financial performance of the company. These statements are based on management's current expectations, and the actual events or results may differ materially and adversely from these expectations for a variety of reasons. We refer you to the documents the company files from time to time with the SEC, specifically the company's annual report on Form 10-K, its quarterly reports on Form 10-Q and its current reports on Form 8-K. These documents identify important risk factors that could cause the actual results to differ materially from those contained in our projections or forward-looking statements.

I'll now turn the call over to Sam.

Thanks, Matt. Good afternoon, everyone, and thank you for joining us. I want to welcome our Chief Commercial Officer, Brian Donnelly, to the call as he will provide quarterly commercial business updates going forward, and our Chief Operating Officer, Mark Verratti, will join us for the Q&A portion of the call.

Now considering it's been a year that I've been CEO, I thought we'd begin the call by reviewing a number of our key advancements over this time. These include, first, the prioritization of the Cancer Care Continuum. Recall last year, we updated our growth strategy and declared cancer screening and diagnosis as our business of highest importance. Since then, we prioritized our resources, budget and focus with this clear direction. And this year, we're making significant investments in the Cancer Care Continuum, including an expansion of our commercial capabilities and increased R&D spend on product development and clinical studies.

Second, we have strengthened our organization with leaders that have proven experience and a depth of domain knowledge in oncology, genomics and advanced diagnostics. We've added significant expertise in multiple levels of the organization, including Brian Donnelly as CCO; Vishal Sikri as our SVP of Product; Dr. Hosein Kouros-Mehr as our SVP of Oncology R&D, along with other team members to our operations, tech, sales and marketing teams.

Third, we are continuing to strengthen our execution and improve our agility. We have implemented new processes for decision-making and program oversight and have also simplified the organization structure and removed layers to serve customers better. This required making tough decisions that affected a number of our employees, not something we take lightly, but the early progress that we're seeing validates these actions and better positions Myriad to succeed as we go forward.

There is still significant work ahead, but we have clear line of sight to how we will achieve our goals, including accelerated share gain and sustained profitable growth. And that's why I'm very encouraged about Myriad's current position and direction.

Now let's discuss the first quarter results. We reported revenue in the first quarter of just over $200 million, coming within our Q1 revenue guidance range. In terms of testing volume, we delivered 385,000 test results in the first quarter and continue to drive strong volume growth for hereditary cancer testing in both the affected and unaffected populations, where we grew 10% and 16% over the year ago quarter, respectively. These results reflect our deep relationships across community oncology and other provider networks and ongoing efforts to enhance the testing offerings and overall experience.

Brian will provide additional color in his section, but certainly, we see strong demand for our MyRisk hereditary cancer tests, which will continue to be a cornerstone of our accelerated profitable growth journey going ahead.

I'm pleased with the solid growth of our mental health business. First quarter GeneSight test volume grew 7% year-over-year and is the fourth consecutive quarter of mid to high single-digit test volume growth year-over-year. We believe Q1 performance is above market growth, and this is noteworthy considering GeneSight has the leading market share. And we continue to manage this business in a very disciplined fashion to drive growth and improve profitability with a defined set of resources, budget and focus.

Next, as we foreshadowed in our last earnings call, first quarter prenatal volume declined year-over-year. We continue to focus on reactivating accounts, expanding access and driving new customer wins. We expect these actions, along with the launch of FirstGene, to support a return to positive growth in the second half of 2026.

As for the impact of adverse weather during the first quarter, we experienced days of slowdown in the first couple of months of the quarter, largely in the Northeast and certain Midwest territories. We saw strong March test results, so we believe weather had a marginal impact overall.

Taking weather and first quarter business trends into account, we are reaffirming our 2026 financial guidance. We are expecting sequential revenue growth in the low single digits in the second quarter and accelerating through the remaining quarters as our expanded commercial team begins to positively impact second half.

In addition, we reaffirm our positive adjusted EBITDA target range. While Ben will talk through this in more detail, our confidence is grounded in continued strong hereditary cancer testing growth, solid ongoing demand for our GeneSight mental health test and improved prenatal business as well as early contributions from the expansion of our commercial team.

Beyond Q1 revenue, we reported solid gross margin of 69%, in line with our full year range. It's important to have a strong gross margin profile at a time when Myriad is making significant strategic investments, such as the expansion of our commercial organization ahead of a number of major new product launches in 2026. And you can see these investments beginning to run through the adjusted OpEx line.

Ultimately, we reported an adjusted EBITDA loss of $4.5 million and an adjusted EPS loss of $0.09 in Q1. And as Ben will address in his section, we have a solid balance sheet and liquidity position.

Turning to our Cancer Care Continuum strategy. The big news in Q1 was March launch of Precise MRD for breast cancer patients for a select set of customers. While it's early days, we're certainly very encouraged about this product and the impact it can have for patients and clinicians. I'll provide more commentary on the next slide.

Before I get to that, we recently launched a variety of disease-specific MyRisk hereditary cancer panels on our stated timeline and are on track to launch our AI-enhanced Prolaris prostate cancer test in June. And thanks again to Proteomic for their partnership on this. We look forward to providing an update on these new tests as we move through the year.

Now regarding Precise MRD, let me provide an update on our plans and on early feedback from alpha customers. The conversations with customers have reaffirmed our assessment of the MRD market that while greater than 75% of cancer care in the United States happens in the community, we are still in the formative stage for how clinicians are incorporating MRD testing in community oncology.

That's where Myriad has a strong established presence serving nearly 3,500 oncologists today. And as more clinical publications and presentations demonstrate the significant potential benefits of ultrasensitive MRD testing for breast and other cancers, this addressable market expands, and Myriad is well positioned to serve this growing opportunity. For the alpha stage of the commercialization of Precise MRD for breast cancer, we're closely monitoring test utilization, customer experience and internal operational efficiency.

While it's early in the implementation of our program, let me share some key takeaways from the first 6 weeks of the launch. First, in terms of test utilization, we've onboarded and trained nearly a dozen customer sites and onboarded and started engaging even more clinicians. We're happy with the volume of patient samples received to date and some clinicians have already ordered tests for multiple patients based on being satisfied with the results of the first patients tested with Precise MRD.

Next, in terms of customer experience, clinicians have been satisfied with the quality of our test and the turnaround time for getting results from when they place the order. We have received some input on how to make the ordering easier and also learn from early samples received how we can make instructions for sample shipment clear. This another input is already being used to make changes to improve customer experience in the alpha phase and for future expanded launch phases.

Finally, in terms of operational efficiency, our MRD assay itself has proven to be robust and has performed extremely well. We've been pleased with the yield of our assay and also early numbers for turnaround time for the baseline and monitoring assays, all of which are tracking within our pre-established internal targets, which we believe will allow us to be competitive with other on-market tests.

Now let me update you on the overall plan for Precise MRD. First, we're pleased with the growing body of clinical evidence. This data shows that Precise MRD's high sensitivity and an ability to detect disease down to 1 part per million. We believe our MRD platform can help guide clinical decision-making for patients in their journey of cancer care, and has the ability to detect presence and recurrence meaningfully earlier than the standard of care with imaging and therefore, can have positive impact for patient outcomes.

In addition to the multiple presentations and updates already in 2026, including recently at AACR, we look forward to sharing additional updates on clinical studies along with collaborators at the upcoming ASCO conference at the end of May.

In terms of MolDX submissions, our plan remains to submit progress this Q3 and for colorectal and renal by the end of this year. We still plan to expand commercial testing for breast in Q3 beyond our current select set of community practices. However, based on customer input and interest, we're moving up the launch of Precise MRD for colorectal cancer and renal to a select set of customers into Q3. In summary, we're tracking to the plan for Precise MRD that we laid out in Q1 and are looking forward to serving more clinicians and patients over the course of this year while also managing our financials.

Now let me hand it over to our CCO, Brian Donnelly. Brian?

Thanks, Sam. Good afternoon. Before I get into the quarter, I'll briefly introduce myself. I've spent the past 20 years building and scaling businesses across diagnostics, genomics and consumer health at companies, including Ancestry, Amazon, Illumina and GlaxoSmithKline.

I've known Myriad for years and what drew me here is our category-leading assets, serving markets with meaningful unmet needs and having a clear opportunity to unlock growth through commercial innovation and execution. My focus is on driving durable revenue growth, expanding market share and improving return on our commercial investments.

Turning to the first quarter and our Cancer Care Continuum business. As Sam noted previously, we have simplified how we talk about the business externally, aligning around product categories. In Q1, the Cancer Care Continuum product category, which now incorporates both affected and unaffected hereditary cancer testing as well as other genomic testing, which we previously called tumor profiling, generated revenue of $120.2 million, up 4% year-over-year.

Importantly, hereditary cancer testing volume grew 14%, continuing to gain share. Growth in the unaffected population was stronger than the affected segment, and both segments grew above the market growth rates. We were pleased with the unaffected growth rate and view it as an important leading indicator for future demand.

In prostate cancer, Prolaris delivered mid-single-digit growth in both volume and revenue. As mentioned on previous calls, we are actively investing in the commercial channel and other programs to improve performance and regain market share. We're also preparing to launch our first AI-enabled Prolaris test this quarter, bringing together AI, biomarker, germline and genomic insights in a single offering. This combination is differentiated and it positions us to compete more effectively in prostate cancer patient care.

Turning to Precise MRD. Sam covered this well, so I'll just emphasize 3 points. First, clinical evidence continues to build with multiple study presentations at ASCO GU, ASCO GI and AACR. Additional data at the upcoming ASCO meeting is expected to further strengthen Precise MRD's positioning and support broader adoption. Second, early access sites are engaged in providing actionable feedback. And third, we're using this phase to refine workflow, usability and clinical integration ahead of broader commercialization. The commercial and medical affairs teams are actively ramping, and we remain on track for broader commercialization later this year and our full commercial launch in Q1 of 2027.

Now moving to our prenatal health business. As discussed on our fourth quarter call, the prenatal business faced difficult year-over-year comparisons driven by disruption from a new ordering system and the impact that had on several large accounts. First quarter revenue was $41.9 million, down 15% year-over-year.

That said, we are seeing signs of stabilization, including quarter-over-quarter volume growth in Q1. We remain encouraged that our ongoing engagement will win back share and drive overall growth in 2026. And supporting that outlook is our newly deployed prenatal-focused sales team, ongoing engagements to win back key accounts and improving payer dynamics.

To that last point, in April, CIGNA updated its policy to cover expanded carrier screening panels, including Foresight Universal Plus. This is an important step forward for the category.

Moving to FirstGene. We continue early access clinical testing, and we are seeing strong enrollment momentum in the CONNECTOR study. We are encouraged by our assay performance and early customer feedback, highlighting that our clinical value proposition is meaningfully differentiated. The FirstGene screen offers the first and only simultaneous screen of patient carrier status, fetal single gene, fetal chromosome and fetal RHD status, all delivered collectively in a single integrated report with the test able to be taken at an industry-leading 8-week gestational age and with an industry-leading turnaround time with all results delivered within 14 days.

We remain on track for a full commercial launch in the second half of 2026, and we are investing ahead of that launch with confidence in FirstGene's ability to expand clinical insight and to grow the overall prenatal testing market.

Turning now to mental health. In the first quarter, GeneSight generated $38.3 million in revenue, up 24% year-over-year on 7% volume growth. We continue to expand the ordering provider base, reaching over 39,000 ordering clinicians in the first quarter, which is a record high.

This strong first quarter revenue growth reflects improved reimbursement trends and payer coverage aided by biomarker legislation, continued optimization of revenue cycle workflows and solid underlying demand and sales performance. We remain disciplined on this business with a strong focus on capital efficiency while delivering growth.

I want to close with how we are accelerating growth. We're investing $35 million over the next several years to strengthen our commercial capabilities and support multiple upcoming launches. On the commercial capabilities specifically, there are 3 areas to highlight.

First, we expanded our sales team by over 100 account executives compared to last year, adding meaningful field sales capacity, particularly in oncology, to increase our share of voice ahead of new product introductions. Many of these hires bring strong experience in the advanced diagnostics sector.

At the same time, we're focused on improving sales productivity through better onboarding, targeting and performance management. We expect ramping new territories to take several quarters, but this investment is critical to deliver long-term acceleration and profitable growth and our second half plan.

Second, we're enhancing our demand generation capability, particularly in hereditary cancer. This includes new digital patient engagement, risk assessment tools and channel partnerships designed to activate patient-driven demand in the provider channel.

And third, we're preparing for one of the most important launch cycles in the company's history with critical launches across the portfolio, including FirstGene, Prolaris+AI and Precise MRD. To support this, we're strengthening cross-functional launch execution, medical education and KOL engagement, sales targeting and analytics and tools that simplify ordering and integration into clinical workflows. The objective here is faster awareness, faster adoption and stronger return on investment.

So stepping back, our Cancer Care Continuum portfolio continues to show solid growth and share gains. Our prenatal portfolio is stabilizing with a clear catalyst ahead in FirstGene, and mental health is delivering strong performance with improving profitability.

At the same time, we're building the commercial capabilities needed to support sustained growth and upcoming launches across the portfolio. Overall, we're early in the process, but the direction we are heading is towards improved execution, accelerated growth and positioning Myriad for sustained expansion, giving us confidence in delivering against our full year guide.

With that, I will turn it over to our CFO, Ben Wheeler.

Thanks, Brian, and welcome to the earnings call team. I want to reinforce Brian's comments regarding the simplification of our product category messaging. As we discussed on our fourth quarter call, this change better aligns with Myriad's updated growth strategy and how we manage and communicate the business.

Our Cancer Care Continuum category now includes both effective and unaffected hereditary cancer testing, along with other genomic testing previously referred to as tumor profiling. Prenatal health now reflects Prequel noninvasive prenatal screening, Foresight carrier screening and SneakPeek, our early gender DNA test. FirstGene is also included in this category. Our mental health category remains unchanged.

With that context, let me start by reviewing the key drivers of our first quarter performance. We generated another quarter of strong test volume growth in hereditary cancer testing with 14% year-over-year growth in the first quarter, accelerating from the 11% year-over-year growth we delivered in the fourth quarter. This acceleration was driven by continued strength in our unaffected market where demand and execution remains strong.

GeneSight also started the year with strong momentum, delivering 24% year-over-year revenue growth and 7% test volume growth in the first quarter. This performance reflects improving reimbursement dynamics, including the positive impact of recent biomarker legislation as well as continued progress in our revenue cycle management capabilities and overall commercial discipline.

As a reminder, our engagement with health plans and biomarker loss states has been productive, driving sequential improvements in GeneSight average revenue per test for multiple quarters. While no single plan is material on its own, the aggregation of these coverage wins has become a meaningful tailwind for the business. Looking ahead, we're encouraged by additional GeneSight coverage opportunities in biomarker states and plan to extend this reimbursement playbook and payer relationships to our cancer screening portfolio.

Taken together, the sustained strength in both unaffected hereditary cancer volumes and GeneSight volumes is an important proof point that our commercial performance is strengthening. The actions we've taken to sharpen focus, increase accountability and improve execution are translating into tangible momentum.

Moving to our consolidated financial results. For the first quarter, we reported revenue of $200.4 million, within the revenue range we provided during our Q4 call and representing 2% growth year-over-year. Overall test volumes were consistent with the prior year as continued strength in hereditary cancer testing and mental health was offset by prenatal health. Average revenue per test improved 2% year-over-year, driven by growth in hereditary cancer testing revenue and improved reimbursement trends in mental health during the quarter.

While we're pleased with the net positive year-over-year change in average revenue per test this quarter, we continue to expect modest headwinds to ASPs over the longer term, consistent with our prior commentary. We generated gross margins of 68.7% in the first quarter, in line with our full year gross margin guidance and up approximately 20 basis points year-over-year.

The modest improvement reflects a favorable shift in product mix to more margin-accretive revenue. We remain committed to driving efficiency and scale in our laboratory operations for both our existing portfolio and the new product launches in 2026.

Adjusted operating expenses increased by $8 million year-over-year, reflecting targeted investment in commercial execution and R&D growth initiatives. We remain committed to balancing strategic investment to support long-term growth with continued progress toward improving profitability while ensuring capital is allocated to our highest impact priorities.

Taking all of that into account, we generated an adjusted EPS loss of $0.09, within the guidance range we provided.

Next, I'll speak to Myriad's profitability and liquidity. As we've discussed in the past, the first quarter is typically our heaviest cash burn quarter driven by softer overall revenue and elevated expenses, and this year is no exception. First quarter adjusted EBITDA was a loss of $5 million, coming in below the near breakeven commentary we provided due to an acceleration of commercial growth investments.

We're committed to profitable growth and we'll manage our annual operating expenses to grow at a slower rate than our annual revenue. We continue to maintain a solid balance sheet with access to $199 million in capital, providing us the flexibility to invest in our strategy while maintaining appropriate financial discipline.

Next, I'll address financial guidance. We are reaffirming our full year 2026 financial guidance, including revenue of $860 million to $880 million, adjusted gross margin of 68% to 69% and adjusted EBITDA of $37 million to $49 million. During our fourth quarter call on February 23rd, we shared additional commentary on how we expect the year to unfold, including our view that the second half of 2026 will be stronger than the first half, consistent with recent years.

This outlook is supported by current business trends and anticipated improvement in our prenatal portfolio, early contributions from the expansion of our commercial team and recent revenue cycle initiatives. As a result, we expect quarterly revenue to grow sequentially from first quarter and the low single-digit range during the second quarter and accelerate through the remaining quarters of the year as we realize early contribution from the addition of over 100 account executives. We remain confident in our full year outlook and in the team's ability to execute as we progress through 2026.

Now let me turn the call back to Sam.

Thanks, Ben. Let me conclude our prepared comments by highlighting our robust pipeline of new products and enhancements this year. Many of these tests will strengthen Myriad's position across the cancer care testing continuum and support our long-term growth profile.

We continue to drive double-digit growth in hereditary cancer testing, which is enabled by a combination of our strong market position, commercial execution and ongoing commitment to clinically relevant innovation as reflected in the expanded MyRisk test launched this past Q4 and the recent launch of disease-specific panels.

We're encouraged about the early experience and learnings from the alpha launch of our Precise MRD test for breast cancer, and we'll soon be expanding the number of sites on a path to full commercial launch in 2027. We're investing in the commercial team and its capabilities ahead of the full launch, and we'll continue to update investors on our progress.

We're on track to launch our first AI-enhanced Prolaris prostate cancer test that combines the power of molecular and AI analysis next month. And to round out the pipeline, we recently initiated commercial testing with a select number of customers for our FirstGene test and are on track for full commercial launch in the second half of the year. These new products, combined with our operational strength for sample processing and reporting and expanding commercial capabilities and commercial reach give us confidence in accelerating profitable growth in the quarters ahead.

I'll now pass the call back over to Matt for Q&A. Matt?

Thanks, Sam. And as a reminder, during today's call, we use certain non-GAAP financial measures. A reconciliation of the GAAP to non-GAAP financial results and a reconciliation of GAAP to non-GAAP financial guidance can be found in our earnings release and under the Investor Relations section of our website.

Now we're ready to begin our Q&A session. To ensure broad participation we are asking participants to please ask only one question and one follow up. Operator, we're now ready for the Q&A portion of the call.

[Operator Instructions] It comes from Kyle Boucher with TD Cowen.

I wanted to start on just sort of the revenue ramp through the back half of the year. Is there any bridge you can sort of provide for the second half growth rate? I mean I think your guidance implies first half is sort of low single digits. So it's a pretty big step-up in the back half and you reiterated guidance. I guess how should we think about the different moving pieces?

Kyle, thank you for the question. Let me start, and then I'll hand over to Ben to provide some more color. Again, first stating, we are confident in being able to be within our revenue guidance for the year. The elements of confidence, again, we're very pleased with the growth that we've seen in hereditary cancer, really in the Cancer Care Continuum. We're pleased with the ongoing performance of GeneSight, and we're also counting on improvement in our prenatal business, which has been a little bit slower than expected, but within range.

You put that together with the contributions that we're expecting with the sales teammates that we've hired. You heard Brian talk about 100 folks that we've hired. That's a little -- we accelerated that. We're able to get them in. They're going through the process of being trained and prepared. All of those things are what support our confidence in being able to achieve both second quarter and the quarters ahead.

But Ben, what would you add to that?

Yes. So the only thing that I would add is repeating a comment that Brian shared in his prepared remarks as it relates to focused sales forces. And so as we enter Q2 and then proceed through the rest of the year, we have focused our sales forces to make sure that they are spending time in the unaffected market, specifically selling hereditary cancer in a focused way, also in the prenatal side of the business, having a focused sales force calling on doctors and focusing on the prenatal product. We believe that will drive some pull-through on the volume side.

Got it. And then maybe just one more. I think you mentioned during the prepared remarks that you guys are coming up on one of the biggest launch periods for Myriad. Maybe can you just dig in a little bit more on how do you balance that investment that's needed to address those launches and maintaining your adjusted EBITDA profitability?

Yes. Let me start again, and Ben, if you can add on. It starts, Kyle, with a well-crafted year thinking about the timing of investments. We wanted to make sure we're able, for example, on the commercial side, to add sales team members with the right level of experience, which, by the way, we've been very pleased with the talent that we've been able to hire on, particularly to support MRD, the molecular side of cancer care, if you will, that we're building out. It's the timing of that.

It's also the work that we're doing from a market activation, awareness, demand setting standpoint. And for MRD, in particular, it's the number of clinical studies. And I will tell you that we are being mindful to balance the timing of these things to match to stay within what our guidance has been overall for our profitability.

Ben? Color?

Yes. So Kyle, as you know, about 2/3 of our operating expenses are related to people. And so a lot of what drives the successful launches are people investments. And you saw some of that in our Q1 expenses.

In the prepared remarks, I talked about the acceleration of commercial investment, and that is to help us drive success with these launches and also to be able to drive the additional volume and the opportunity to increase revenue as we progress through the year in order to help us manage the timing. It is something that we're focused on, and we are committed to drive profitable growth. So it is something that takes a lot of our time and attention, and we're focused on delivering on that.

Our next question comes from Tycho Peterson with Jefferies.

I wanted to just touch on the hereditary strength. I know you talked about the unaffected market. I'm wondering if you could just maybe delineate how much came from the dedicated sales force versus the expanded MyRisk panel and any lift from the EMR integration as well?

Yes. Appreciate the question, Tycho. Yes, again, just to restate, we were very pleased with the continued strength actually of hereditary cancer business. I think I provided this detail in my prepared remarks, those that have cancer, so the affected market, 10% volume growth, 16% the unaffected. We think that the MyRisk, the new updated panel with 63 genes, it's been a strong point. We are the most relevant current, if you will, panel for hereditary cancer testing. It's definitely helping.

As it relates to dedicated sales force, you know what, here's the good news. That is only going into effect as of April 1st. So I can tell you that really, that that was not within the Q1 numbers, didn't impact it. Now that being said, Tycho, you might have also heard that we just recently launched the various disease-specific panels for breast, prostate, ovarian, colorectal cancer. So we think that will be another good guide for us that will support part of our ongoing growth along with now the dedicated unaffected hereditary cancer sales team that we have in place.

Okay. That's helpful. And then maybe just a follow-up on Precise MRD. You mentioned pulling forward CRC and renal into 3Q. I guess just talk about the thought process there. You obviously have breast as well. So what was the rationale for pulling that forward? And how do we think about, I guess, any sort of additional resourcing?

Yes. I mean the real motivation of this, as you'll recall, again, our original plan that we stated in the last quarter was to launch in the -- around the Q4 timeline for colorectal cancer in renal. And that was to originally be timed ideally with when we submit for MolDX for both of those indications.

Really, what drove our move up of that date is the interest from the community oncologists that we started to work with. And often the case is if you started to serve with breast as we have, they're also interested in other cancer indications where they're seeing those patients come in.

And so we realize that we're -- we think we can still manage it within the controlled way that we're rolling out our commercialization while managing our profitability, but we think that we can actually benefit from understanding how we can serve across multiple indications in the same oncology practices.

Yes, Tycho, the only thing that I would add is we had contemplated the costs around dedicated sales folks as it relates to MRD launches. And so really accelerating CRC and renal is not an acceleration of expense per se as it relates to personnel.

The last thing that I'll mention is, and you know this, hereditary cancer is the profit engine of the organization. And as we drive growth through those channels, it enables us to invest and manage expenses in that way so that we can deliver on profitable growth.

Our next question comes from Puneet Souda with Leerink Partners.

Just wanted to follow up on the commercial side. Could you update us -- you talked about a number of accounts sort of 100 account reps versus last year. Just maybe just give us more updates on do you expect further investments into commercial? How should we think about the overall productivity? To what extent they're carrying different products in the bag? Maybe just walk us through that on the commercial side.

Yes, Puneet, I appreciate the questions. Let me start and Brian, then if you can please add in. First of all, the lens through which we're really running the whole company again is by prioritizing the Cancer Care Continuum. So the vast majority of our investment, be it in these -- the addition of commercial resources or marketing campaigns, market activation, demand generation, other things are -- that's our primary focus. And then also keep in mind, this is through the construct that we're going into place this year, which we've talked about with more dedicated sales teams, particularly for prenatal as well as unaffected. Now there's a lot more to that. So Brian, why don't you take it from there?

Yes, absolutely. Thanks for the question. So I'll just -- I'll hit on the 3 pieces. The first was around the expansion of the sales team and how you think about that in terms of the future, will that continue? What I'd say is we're being really targeted as it relates to who our target providers are and what we think the right level of reach and frequency is to be able to achieve our full year guidance. So as we are looking at the expansion, we're putting it in -- we're basing it on who those providers are who we're going after. So we feel really good about the hiring we've done. We've been able to accelerate some of that hiring in the first quarter, giving us more confidence in the back half of the year.

On the product front and on what the teams are focused on, the big shift that we've made with our sales organization is being very focused on the unique portfolios. As an example, in the past, we've had a Women's Health team that was covering both hereditary cancer screening and prenatal testing. Going forward, the way we've structured our sales teams are they're very focused on the portfolio.

So we have a prenatal team. That team is exclusively selling our prenatal products: Foresight, Prequel and soon to be FirstGene. We have a hereditary cancer screening sales team. They are selling MyRisk exclusively. And so having that focus is not only allowing us to see more customers, but it's allowing us to have more meaningful conversations and support customer adoption of the portfolio.

And then on the productivity front, the third part of the question, what you should expect and what we're expecting is it's going to -- as with any of our -- anyone in our position, as we onboard these sales reps, they're going through training. They're getting introduced to their accounts. And so you should expect it to take several quarters for them to be able to reach peak productivity. But we have a really good eye on our data, and we know what we're going after here. So we'll be making sure to continue to optimize.

And Brian, maybe I'll just add to that. Based on the time when we've been able to get them aboard and the very number of quarters you talked about, this is why we believe we're going to start seeing some productivity in the back end of the year.

Got it. That's helpful. And then, Sam, just wanted to get a high-level view from you in terms of the overall portfolio today, either in terms of additions or potential trimming that puts you both in terms of higher growth and potentially higher profitability. Thoughts there?

Yes. Thank you, Puneet. Listen, again, I'll start by saying the part of the business that is at the core, the part of the business that we are most focused on is the Cancer Care Continuum. We believe that based on the reputation we have in the market, the reach that we have, the quality of our testing and the portfolio that we have that we have a real opportunity to expand and be more than the hereditary cancer testing company. And I think we're well on our way with that. Clearly, the alpha launch of MRD is an important milestone to that. The AI-enabled Prolaris for prostate cancer is going to be another important milestone coming up next month. It won't be -- it will be the first of multiple AI-enabled products we'll bring to market over the coming years.

Again, we are managing with an extreme level of discipline in focusing first and foremost on the Cancer Care Continuum. And over time, we are interested in adding other parts to the Cancer Care Continuum where we aren't as strong through partnerships and at the right time for the right set of circumstances in a more direct way into Myriad. And we'll continue to use extreme business rigor on a regular basis as we are looking at every part of the company to say, hey, does this part provide us the expected financial return, the ability to win in the market? Is this best fit for us at Myriad? But our focus again is the Cancer Care Continuum.

Our next question comes from David Westenberg with Piper Sandler.

This is [ Skya ] on for Dave. Maybe just to touch on what you were just speaking about there. On the upcoming launch of the AI-enabled prostate cancer test, how are you positioning this commercially alongside Prolaris? Is there anything we should be looking at specifically with this launch?

Maybe just to start, Brian, I'll hand it over to you. We are very excited about the AI-enabled Prolaris prostate cancer launch. As a -- I think we've mentioned this before, but once we launch this test, this will become our Prolaris test. We believe it's going to provide a step-up in value to our current Prolaris test. And also, just as a reminder, we -- in terms of reimbursement, we're not in our guidance. There is no incremental reimbursement that we're expecting at this phase.

Brian, maybe you can talk a little bit about the teams and how they're getting ready.

Yes, absolutely. Yes. Our teams are actually together this week going through sales training and working through all the positioning and how we're preparing for the market launch. I would say the thing that we are excited about with regard to Prolaris+AI is really the value proposition it has in that active surveillance setting. It's a really important aspect of Prolaris by itself and the AI enhancements certainly augment the clinical value proposition there. So that's a component of how we're thinking about the product offering. And we're, as we've mentioned earlier in the prepared remarks, excited to get this offering out. We've got really positive feedback from clinicians who have seen the product offering, and we're looking forward to get it in the hands of many.

Maybe, Brian, just to add to what you said, and I know this wasn't exactly the question, but I think it is an important part of our overall commitment to prostate cancer testing. Again, we are pleased with the number of collaborators who are now working with us to give us the access to the samples that we've needed to do the clinical studies, which we believe when we're able to publish those will improve our position as it relates to the standings. So we are -- so we're excited about that as well.

Okay. Great. And maybe just secondly, on the GeneSight revenue. Is there anything to call out there on payer dynamics? And are they sustainable for you for the remainder of the year?

Ben, do you want to take this one?

Yes, happy to. So we were really pleased with the performance of GeneSight in Q1. As a reminder, we've seen improvement in GeneSight ASP for several quarters. And as we've been successful in leveraging policy changes or plans updating their coverage position relative to GeneSight in states where they've passed biomarker laws, we continue to focus on that and see opportunities ahead.

I will mention, it's important for folks to recall that when you look at 2025, Q1 was the softest ASP quarter for GeneSight. And so we were pleased with the growth that we saw this quarter. We expect this quarter to be viewed as a baseline for ASP and something that we can continue to focus on building on.

One moment for our next question, comes from Brandon Couillard with Wells Fargo.

Sam or Brian, on the prenatal business, I mean, on one hand, test volumes were up a smidge sequentially, but at the same time, the year-over-year trend is still decelerating. And historically, 1Q kind of tends to be the high watermark for the year. So is it really reasonable to expect that prenatal volumes grow for the year? And how confident are you that kind of the internal issues are mostly behind you at this point?

Yes. No, I'll start here and then Brian, if you can add and Ben, you're welcome to is the internal ChatGPT and the historian of all things Myriad.

Yes, first, Brandon, let me acknowledge that the prenatal volumes were a bit softer than we expected for the quarter. That is a fact. That being said, we have been pleased that with the level of interest and the ability that Brian's sales team has been able to, particularly with new customers, to be able to start driving new business there. Again, part of what gives us confidence in being able to return to growth is 2 other things, right? And sorry, Brian, I'm sure I'm taking all your time here.

It's okay.

Is, one, again, the dedicated sales channel. I think in business and sales, what you focus on and how you prioritize it, how little you distract the sales team makes a huge difference. And having absolute focus on prenatal, I think, is going to pay dividends, and that's part of our thesis of why we're confident.

Number two, FirstGene. I can't tell you about how excited we are about FirstGene. You might have heard Brian talk about it in his prepared remarks, right? When it comes to market fully commercially here early in the second half, it will be the first and at that time, probably the only screen that simultaneously screens for the patient carrier, the fetal single gene, fetal chromosome, fetal RHD all delivered in a single integrated report. There is nothing out there that does that and the ability to do that as early as 8 weeks gestational age. So I emphasize this because there is differentiation in terms of value that it provides, and that is, again, part of what gives us the confidence to be able to return to a level of growth.

Brian?

Yes, thanks. I'll just add a couple of pieces on this, but very well covered. So prior year first quarter was a really strong year for us as well. So when you're looking at the year-on-year comparison, it's important to remember that we were building real momentum in the prenatal business prior to that order management issue, which we saw in Q2. And so as we're passing that comp, delivering the consecutive quarter-over-quarter volume growth, standing up our dedicated sales team and launching FirstGene, we think we have the pieces together here to be able to return to growth and again, execute on our full year guide.

We're watching it very carefully. We're being very thoughtful as it relates to our account engagement and as it relates to the launch of FirstGene and how we educate providers about the product offering, but we've got the pieces together here to deliver on our plan.

And one final thing to add, Brandon, because you asked that, and I should have started with that. We haven't had any internal [indiscernible] or operational issues related to the prenatal being able to take the orders all the way through analyzing the samples and returning the reports. We have no issues there at all. And in fact, we haven't had for several quarters. So really, it's about commercial execution and FirstGene being a truly differentiated assay that we think we can start to return to growth with.

Got you. That's helpful. And then, Ben, how should we think about OpEx over the next few quarters? It seems to imply that maybe that line item is flat to down as you move through the balance of the year. Just trying to back into the OpEx line based off the EBITDA guide would be helpful.

Yes, Brandon, I appreciate the question. And so you're spot on. We will manage our operating expenses as we see volume and revenue grow. And so we're committed to profitable growth. When you look at Q1 and you multiply it by 4, essentially will require some phasing of expense in the back half of the year in order to drive that level of adjusted EBITDA that we've guided to, but we're committed to doing that. So I would just repeat, yes, your -- the phasing that you talked about essentially phasing into the year is the way that you should think about it.

Our next question comes from the line of Subbu Nambi with Guggenheim.

As we get closer to FirstGene launch, where do you stand in terms of reimbursement? Have you started to get this contracted? Will the full commercial rollout be a headwind or a tailwind to prenatal ASPs in second half '26?

Thanks for the question, Subbu. And we've definitely been engaging closely as we've been doing the, if you will, the early access on FirstGene. So Ben, why don't you take your specific question of how we think about ASP and we'll be better or different?

Sure. Yes. So as we think about ASP as it relates to FirstGene, Subbu, we will build using existing codes. And so ultimately, as time moves forward, we may move to a specific or an individual code for FirstGene, but that's not where things will start. And our expectation based on experience is that FirstGene ASP will be a boon to overall prenatal ASP.

Yes. I'll just add that as you might be aware, we have a study, the CONNECTOR study, that we're doing and we're continuing to enroll and process samples there. So we had a publication -- sorry, we presented some data at a conference in the first quarter, which showed just really robust performance and also just the value of the assay. And we're pleased with the ongoing number of samples now that we have been able to process as part of the CONNECTOR study.

So when you take the long horizon view, though exactly as Ben said, today, we're using codes we already have. We're also building the optionality of potentially being able to make a case for reimbursement that would be better over time.

And then in the ACOG workshop that you guys hosted, it was clear that FirstGene involves deep sequencing and that you do not complete fetal recessive testing as a reflex, but instead you do it on every patient. Could you speak to the expected gross margin profile of FirstGene? And this is not like anything in the short term, but just overall, is it accretive or dilutive to Women's Health segment on the gross margin level?

Yes. Maybe I'll start here and then Mark, you can jump in, too, and Ben, you can jump in. Yes, you're right again, Subbu, that's what I was answering a prior question that we are taking an approach which we think will provide more value to clinicians that we are providing -- we're doing the analysis at the same time for all the various indications that FirstGene provides. But that being said, I'm really pleased by what Mark and his team have done in terms of operational capabilities. The yield has been -- I'm going to knock on wood here -- extremely pleasing for where we want it to be.

And in terms of gross margin overall, maybe Ben, I'll let you take that part.

Yes. So as I mentioned, from an ASP standpoint, it is accretive to the portfolio. Due to the lab process, it's essentially costs associated with processing the sample will be a little bit higher than our existing portfolio, but we have an efficient and effective process that enables us to have a very short turnaround time. So I would think about that as a singular lab process or processes as opposed to sequential multiple lab processes. And so ultimately, where that lands you is margin accretive to the portfolio. You've got stronger ASP, you've got marginally higher COGS. Ultimately, you've got stronger gross margins.

And our last question comes from Mason Carrico with Stephens.

I think I may have heard you say you expanded your sales team by over 100 reps compared to last year. Are you willing to provide, I guess, a bit more insight into the split of those reps across MRD, prenatal, Prolaris, really just your commercial teams more broadly?

Thanks for the question, Mason. Yes, we are excited again by the expansion, 100 individuals that we've added so far this year. While I won't get as granular as perhaps as you just asked, again the guidance is -- or to help answer your question, the vast majority is related to the Cancer Care Continuum.

So there are individuals who are further helping us grow with reach and frequency for hereditary cancer testing. We believe that continues to be a $7 billion market that is less than 50% penetrated. We are the pioneers in that. So we believe there's a lot of room opportunity to continue growing for some of the resources that have been applied there.

MRD, clearly, an incredibly important area for us, and you've heard us talk about that. So yes, we've added a meaningful number of individuals who have background in molecular to that space. Prolaris as well prostate cancer, that is an area that, along with AI, along with the other things that we've done working on the NCCN guidelines I was talking about, we've added there too.

So I'm sorry, it's probably not the granularity that you're looking for. But we -- what I would leave you with is, yes, we have been very deliberate, Brian is a very deliberate guy, but the primary focus is on the Cancer Care Continuum.

Got it. Okay. And in terms of the back half ramp in prenatal, how dependent, I guess, is that reacceleration on a successful launch and positive reception to FirstGene maybe versus your broader operational initiatives to improve performance of this segment? I think I've heard you guys mention a number of times that that launch is a key opportunity to reengage with some of the accounts where you lost volumes.

Yes. Now, great question. I appreciate it. And maybe I'll start here and Brian, you can build on this. We believe these things come together, right? They are collectively going to allow us to resume growth. The thing is, numerically, we know we have a formula that we can use based on our experience of how much value each sales rep should bring, particularly as they ramp. We have that. That's a formula thing.

We also believe that FirstGene is not only an opportunity -- it's an opportunity to both to regain some share that we've lost, particularly based on some of the challenges we had with our own order management system. And that's based on a number of customers saying to us if you have this product, then we love to work with Myriad because it is differentiated.

I think just -- I answered some of how it's differentiated on a prior question, plus we also have, I think, the industry-leading support for genetic counselors, all those things that are needed on the front and the back end, that's a real differentiator. And we also believe FirstGene is an opportunity to expand the market. Remember, 2/3 of the fathers -- male partners are just not available for one or another reason. So this is a market expansion opportunity.

Brian, is there anything else you'd add to this?

So just to reemphasize, I think, some of the points you made. It is not a one or the other piece, right? And everything you said is spot on, which is FirstGene will be really great for us to be able to reengage with customers. We have expectations in terms of our core business growing, and we have some expectations in terms of FirstGene being adopted.

And based on your question, it felt like you were asking like do we have heroics planned as it relates to FirstGene. The answer to that is no. We have very -- what we think is reasonable growth assumptions in the back half of the year for the launch and for our base business.

And this will conclude the Q&A session. I will pass it back to Matt Scalo for closing comments.

Okay. Thanks, Carmen. And this concludes our earnings call. A replay will be available via webcast on our website for one week. Thanks again for joining us this afternoon, and have a good night.

And this will conclude our conference. Thank you for participating, and you may now disconnect.

Good day and thank you for standing by. Welcome to the Myriad Genetics Fourth Quarter and Full Year 2025 Earnings Call. [Operator Instructions] Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Matt Scalo, Senior Vice President of Investor Relations. Please go ahead.

Good afternoon, and welcome to Myriad Genetics Fourth Quarter and Full Year 2025 Earnings Call. During the call, we will review the financial results we released today, and afterwards, we will host a Q&A session. Our earnings release was issued this afternoon on Form 8-K and can be found on our website at investor.myriad.com. I'm Matt Scalo, Senior Vice President of Investor Relations.

On the call with me today are Sam Raha, our President and Chief Executive Officer; Ben Wheeler, our Chief Financial Officer; and Mark Verratti, our Chief Operating Officer. Also joining us for Q&A will be Brian Donnelly, our Chief Commercial Officer. This call can be heard live via webcast at investor.myriad.com, and a recording will be archived in the Investors section of our website, along with this slide presentation.

Please note that some of the information presented today contains projections or other forward-looking statements regarding future events or the future financial performance of the company. These statements are based on management's current expectations, and the actual events or results may differ materially and adversely from these expectations for a variety of reasons.

We refer you to the documents the company files from time to time with the SEC, specifically the company's annual report on Form 10-K, its quarterly reports on Form 10-Q and its current reports on Form 8-K. These documents identify important risk factors that could cause actual results to differ materially from those contained in our projections or forward-looking statements. I will now turn the call over to Sam.

Thanks, Matt. Good afternoon, everyone, and thank you for joining us. As we head into the new year, I'm pleased with the progress we're making as the new Myriad to live up to our significant potential by focusing on high-growth market segments, advancing our plans for multiple timely product launches, including leveraging strategic partnerships and by executing with stepped-up urgency and strengthened execution rigor.

I'm happy with how we ended 2025 with fourth quarter revenue of $210 million, coming in above the high end of the preannounced range we provided in January. When you exclude the headwind from UnitedHealthcare's decision on GeneSight, our business grew approximately 4% over Q4 of 2024. In terms of testing volume, we delivered 382,000 test results in the fourth quarter.

Our financial results were supported by continued strong volume growth for MyRisk in oncology at 14% over the year ago quarter and MyRisk for unaffected at 11% over the year ago quarter. These results reflect our ongoing efforts to enhance the customer workflow, including EMR functionality. Mark will provide additional color in his section, but certainly, we continue to see positive demand for our MyRisk hereditary cancer test, and this supports our accelerated profitable growth journey ahead.

I'm also pleased to call out the acceleration in Prolaris test volume growth in the fourth quarter, where the combination of actions over the last 2 quarters, including incremental investments in the commercial team focused on urologists have helped drive 12% test volume growth year-over-year. Fourth quarter prenatal volume declined year-over-year, primarily stemming from Q2 order management disruption.

With this issue resolved, we are now in an active rebuild phase, reactivating accounts, expanding access and driving new customer wins. We expect these actions to support a return to positive growth in 2026. Moving to our mental health business. GeneSight volume grew 9% year-over-year and continued to accelerate from the first half of 2025 as our commercial organization maintained strong execution with new and existing customers.

For the full year 2025, revenue was $824.5 million, and we delivered over 1.5 million test reports by serving over 55,000 health care providers. Turning now to profitability. In the fourth quarter, we reported strong adjusted gross margin of 70% and closely managed our discretionary spend as reflected in our adjusted OpEx line. Ultimately, we reported a healthy adjusted EBITDA of $14.3 million and adjusted EPS of $0.04.

We're also making great progress on our cancer care continuum strategy to maintain leadership hereditary cancer testing while expanding into other attractive cancer testing applications. This includes launching the expanded MyRisk panel in Q4, which has been well received in the market. We're also sharing results from an increasing number of studies in Precise MRD with positive clinical data presented at major clinical conferences.

And we're in final preparation mode to start commercial testing of Precise MRD for breast cancer for a select set of customers in what we call an Alpha launch starting next week. Overall, we're making good progress towards our goal of expanding our portfolio of differentiated testing solutions that provide actionable insights across the cancer care continuum. From a new product pipeline perspective, 2026 is shaping up to be a banner year.

Throughout the year, there are a number of important catalysts that we will be tracking that supports this year's growth. But even more, these are leading indicators of key growth drivers for 2027 and beyond. We're making significant progress on a number of catalysts outlined in this slide. Our strong fourth quarter test volume growth for MyRisk reflects ongoing traction of our breast cancer risk assessment programs and the launch of our expanded MyRisk test.

We plan to launch disease-specific panels for MyRisk in Q2 and expect our market activation programs and product extensions to support increased MyRisk growth. Building on Prolaris' strong fourth quarter performance, we're on track to launch our first AI-enhanced Prolaris prostate cancer test in Q2 that combines the power of molecular and AI analysis, and this is based on our partnership with PATHOMIQ.

On Precise MRD, as I noted earlier, we're on track to commence commercial testing for select set of customers next week, and I'll provide additional color on the next slide. At JPMorgan Healthcare Conference in January, we reconfirmed that our first Precise MRD test will be for breast cancer and announced additional indications that will follow. We plan to submit for MolDX and expand commercial testing for early access customers for both renal and colorectal cancer in the second half of the year with commercial launch of breast, renal and colorectal planned for 2027.

All of these Precise MRD tests have a growing body of clinical validation, some of which has been shared recently in venues, including presentations at the San Antonio Breast Cancer Symposium in December, ASCO GI Symposium in January, where a first look at Precise MRD data related to colorectal cancer was presented by collaborators from National Cancer Center Hospital East in Japan, showing how the ultrasensitive detection of Precise MRD can have additional benefits compared to first-gen MRD tests.

And to round out the robust 2026 pipeline, we're on track to launch first gene multiple prenatal screen tests in the second half of this year. The timing of this launch dovetails nicely the deployment of a focused prenatal health sales team next quarter and the expected early results of the CONNECTOR study in the next few months. As we prepare to achieve the important milestone of commencing commercial testing for select set of customers with Precise MRD for breast cancer patients next week, I want to help frame expectations at this stage.

This slide highlights our three objectives. First, we're looking to further showcase Precise MRD's clinical performance while continuing to build the body of real-world evidence. To date, data shows Precise MRD's high sensitivity and ability to detect disease down to 1 part per million. We believe our MRD platform can help guide clinical decision-making for patients in their journey in cancer care and has the ability to detect presence and recurrence meaningfully earlier than the standard of care with imaging and therefore, can positively impact patient outcomes.

Second, nearly 85% of cancer care in the U.S. happens in the community. That's where Myriad has a strong established presence where we serve nearly 3,500 oncologists in 2025. We've seen strong interest from our community oncologist base to participate in the Alpha and early access stages of our commercial rollout. Clearly, this is an encouraging sign.

But we also remain disciplined regarding the overall number of participating centers in these early stages of launch to ensure good customer experience and manage our profitability. We will look to expand the number of centers as we move through 2026. And the third objective is to track and learn from specific metrics appropriate for this early stage. After all, you get what you measure, and we'll look to provide an appropriate level of visibility into these metrics moving forward, starting with the Q1 earnings call.

While we're excited and busy preparing for multiple launches this year, I want to reiterate that there is little to no contribution from these MRD tests in our 2026 revenue guidance. Going into 2026, we're taking a number of actions to accelerate growth. This includes our plan to invest over $35 million over the next few years to support a number of initiatives to accelerate organizational efficiency, agility and growth.

These initiatives include strengthening our commercial capabilities, particularly in the cancer care continuum. Specifically, we're adding a meaningful number of sales and medical headcount ahead of multiple new product launches this year. Many of these new additions come from advanced diagnostics sector and bring strong domain knowledge and experience in molecular profiling and cancer diagnostics, along with relationships across the oncology health care community.

In addition, we're strengthening the tools critical to our sales team while implementing a comprehensive plan to drive awareness, excitement and demand for our products. I attended our commercial kickoff meeting last month hosted by Brian Donnelly, our Chief Commercial Officer, and I can say our teams are energized and highly motivated to win in the market. Now let me hand it over to our COO, Mark Verratti. Mark?

Thanks, Sam. Turning to fourth quarter oncology. Total oncology revenue was $84.7 million, growth of 2% over the fourth quarter of 2024. I would like to highlight our MyRisk test continues to gain share with fourth quarter 2025 year-over-year volume growth of 14% in the affected market and 11% in the unaffected market. Shifting to prostate cancer. Prolaris revenue growth in the fourth quarter accelerated to 16% year-over-year, up from 3% year-over-year revenue growth in our third quarter.

Fourth quarter Prolaris revenue growth was driven by 12% volume growth, reflecting a continued improvement year-to-date. As mentioned on previous calls, we are investing in the commercial channel and other programs to grow and regain share in this market. Adding to what Sam mentioned in previous calls, Myriad is on track to be the only company that will offer AI, biomarker, germline and tumor profile testing when we launch our first AI-enabled Prolaris test in the second quarter of 2026.

In January, we issued a press release outlining our MRD commercialization time lines and clinical evidence presented at recent clinical conferences. Our ultrasensitive Precise MRD test continues to demonstrate strong clinical value in these studies, which now includes data on colorectal cancer patients, where we saw 100% baseline ctDNA detection across all patients. Approximately 20% of samples were detected at levels in the ultrasensitive range that may have gone undetected on first-generation assays.

This supports strong performance of Precise MRD. As Sam mentioned, we're excited to begin offering our ultrasensitive Precise MRD test next week. Initially, this launch will be limited to a number of oncology centers, ones we believe best reflect a variety of needs across the community oncology setting and breast cancer patient. This early launch provides the opportunity to engage these providers and incorporate their feedback about a host of topics, including the ease of use and overall utility and actionability of the test.

As we move ahead, we'll plan to expand the number of centers in a controlled manner until full commercial launch. Now moving to our Women's Health business. In the fourth quarter, Women's Health delivered revenue of $88.5 million, an increase of 2% over prior year period. We're pleased to see another consecutive quarter of incremental growth in hereditary cancer testing in the unaffected market with revenue growth of 3% and volume growth of 11% year-over-year.

This improving volume growth trend is particularly important as it reflects EMR-related workflow improvements put in place, such as the September integration of our MyGeneHistory assessment into Epic as a way to better identify patients that qualify for hereditary testing and improve the provider experience. So we continue to be optimistic about the potential for continued momentum.

We also remain confident about our ongoing progress from breast cancer risk assessment programs that enable providers to rapidly identify patients who qualify for additional screening. We continue to see positive momentum at these sites and expect to make further investments in our commercial capabilities to accelerate this program through 2026 to fuel growth in MyRisk volume.

As for prenatal testing in the fourth quarter, we saw a modest pullback in volume growth from previous quarters as we continue to work with accounts affected by friction created by the second quarter implementation of a new test ordering system. While we are optimistic on our ongoing engagement will win back share and drive overall growth in 2026, prenatal volume growth in the first quarter of 2026 will face a difficult year-over-year comparison, likely leading to a decline in year-over-year volume growth.

As for our new multiple prenatal screen, FirstGene, last week, we published the analytical validation of FirstGene in clinical chemistry. FirstGene is an integrated solution for multiple pillars of prenatal testing, and our paper shows excellent accuracy and reliability for each pillar. We continue early access clinical testing with our CONNECTOR study seeing positive enrollment momentum, and we are pleased with our turnaround times, assay performance and early customer feedback.

We are reaffirming our full commercial launch in the second half of 2026 and are investing appropriately ahead of this launch as FirstGene provides added insight and has the potential to expand the overall addressable prenatal testing market. Turning now to mental health. In the fourth quarter, the team generated GeneSight revenues of $36.6 million on volume growth of 9% year-over-year.

We continue to drive expansion of the ordering provider base, achieving a record number of ordering clinicians to over 38,000 in the fourth quarter. This strong fourth quarter volume performance is worth highlighting as Myriad remains disciplined and focused on capital efficiency in this group.

While quarterly revenue continues to be impacted by UnitedHealthcare's coverage policy change in January of 2025, we are proud of our clinical development and payer market teams for securing positive coverage policies across 12 payers for GeneSight in 2025 related to biomarker laws, including the California Medicaid program, Medi-Cal. In addition, we are seeing benefit from optimizing revenue cycle workflows to maximize reimbursement. I will now turn the call over to our CFO, Ben Wheeler.

Thanks, Mark. As Sam and Mark highlighted, we're seeing clear momentum from the operational and commercial progress made throughout 2025. Let me start with a recap of our fourth quarter growth drivers. We generated another quarter of strong test volume growth in hereditary cancer testing, achieving 9% year-over-year growth in the fourth quarter and 7% year-over-year growth for the full year 2025. This acceleration in the fourth quarter reflects continued double-digit growth in our unaffected market.

Likewise, GeneSight finished the year with strong momentum, generating test volume growth of 9% year-over-year in the fourth quarter and 6% for the full year 2025. This progress reflects commercial discipline and effectiveness of the actions taken in early 2025 in response to UnitedHealthcare's coverage decision.

The reacceleration in both unaffected hereditary cancer volumes and GeneSight volumes is a clear proof point that our commercial performance is strengthening and that the actions that we've taken to enhance focus, accountability and effectiveness are translating into tangible momentum. Moving to the consolidated financial results. For the fourth quarter, we reported revenue of $209.8 million, above the high end of the range pre-announced on January 12 and consistent with the year ago period.

Overall, test volumes grew 2% year-over-year, while average revenue per test declined 2% year-over-year. The headwind in fourth quarter average revenue per test reflects the impact from UnitedHealthcare's policy change with respect to GeneSight coverage. Despite the average revenue per test headwind, underlying demand continues to be strong. Excluding UnitedHealthcare's net impact on GeneSight of $8.1 million, our underlying fourth quarter 2025 revenue growth rate was 4% year-over-year.

We generated 70% gross margins in fourth quarter, in line with our third quarter, but down approximately 190 basis points year-over-year. This decline was driven by the revenue headwind I just mentioned that affected GeneSight average revenue per test. Fourth quarter adjusted operating expenses decreased by $7 million year-over-year, reflecting disciplined cost management and the timing of investment as resources were deliberately redirected towards commercial and R&D initiatives that will ramp and be reflected in first quarter spending.

We remain committed to balancing strategic investment to support our long-term growth with continued progress toward improving profitability while ensuring capital is allocated to our highest impact priorities. Taking all of that into account, we generated adjusted EPS of $0.04 or $0.01 above the year ago period. Next, I'll speak to Myriad's profitability and liquidity. We generated $14.3 million of adjusted EBITDA and $17.9 million in adjusted operating cash flow in the fourth quarter.

These results reflect the strength of our gross profit base, the operating leverage inherent in our business model and the meaningful earnings and cash flow potential of the business as we continue to execute. We also maintain a solid balance sheet with access to $225 million in capital. As a note, we intend to file a universal shelf registration to replace our existing shelf. We view maintaining an effective shelf registration as a prudent corporate housekeeping measure.

Next, I'll address financial guidance. We're reaffirming our full year 2026 financial guidance, which we issued on January 12, including a revenue range of $860 million to $880 million, and adjusted gross margin range of between 68% and 69% as well as an adjusted EBITDA guidance range of between $37 million and $49 million. In order to support investor modeling for 2026 by quarter, we provided additional commentary in the earnings release, and I would like to highlight a few key points.

First quarter revenue is expected to be between $200 million and $203 million, representing 2% to 4% growth over the year ago period. As happens in most years, first quarter average revenue per test tends to be lower than fourth quarter due to items such as the resetting of insurance deductibles. In addition, as Mark mentioned, prenatal volume and revenue are expected to face unfavorable year-over-year comparisons in the first quarter, leading to a year-over-year decline in this portfolio.

We anticipate prenatal to demonstrate year-over-year progress likely beginning in Q2. Also consistent with recent years, revenue in the second half of the year is typically stronger than the first half. We expect this pattern to repeat to a similar degree in 2026. This outlook is supported by current business trends and anticipated improvement in prenatal portfolio and early contributions from recent commercial investments.

As a result, we expect quarterly revenue to grow sequentially from first quarter through the remaining quarters of the year. I also want to make investors aware that beginning in first quarter, we plan to simplify how we present and discuss our business to better align with our refreshed strategy and how we're operating the company. Going forward, we'll organize our reporting around our strategic areas of focus with the first group being the cancer care continuum.

This group will incorporate all hereditary cancer testing, including both affected and unaffected populations and all tumor profile testing. This will be followed by prenatal health, which will include our NIPS and Carrier Screen lines as well as SneakPeek. And lastly, we'll continue to report mental health as a distinct category.

We are making these changes because it provides clear visibility into the core drivers of the business and better aligns our external reporting with how we operate and allocate resources to our strategic priorities. We're confident in our full year outlook and the team's execution as we enter 2026. Now let me turn the call back to Sam.

Thanks, Ben. Let me conclude by saying this is an energizing time for the new Myriad. We are at an inflection point where we have the absolute clarity and conviction for our go-forward strategy with a particular focus on the cancer care continuum. We have a robust pipeline of new products and enhancements for attractive market opportunities, mostly developed internally but also complemented with ones enabled through strategic partnerships. Yes, we are the hereditary cancer company, but we are more than that.

And many of these new products will strengthen our position across cancer care testing. Along with that, we're going to leverage our operational strengths for sample processing and reporting while expanding our commercial capabilities and customer reach. We have a stronger leadership team now, both from my direct staff and the next level with a needed blend of diagnostics, cancer and genomics domain knowledge combined with proven experience for delivering results.

Along with all this, we're taking steps programmatically and culturally to strengthen execution excellence. Put it all together, we have the substance and confidence to positively impact an increasing number of patient lives and to accelerate profitable growth. I now pass the call over to Matt for Q&A. Matt?

Thanks, Sam. As a reminder, during today's call, we use certain non-GAAP financial measures. A reconciliation of the GAAP to non-GAAP financial results and a reconciliation of GAAP to non-GAAP financial guidance can be found in our earnings release and under the Investor Relations section of our website. Now we're ready to begin the Q&A session. [Operator Instructions] Operator, we're now ready for the Q&A portion of the call.

And our first question comes from Puneet Souda of Leerink Partners.

First one, maybe, Sam, just given the momentum or the recovery that you're focused on for the full year, do you -- I was trying to understand what gives you confidence that we can continue with this sort of high single-digit long-term growth rate that you had before and what you're projecting for the year, is that how should we think about sort of 2027? Can we -- or can we return back to that high single-digit growth rate? Let me just pause there, and I'll come back with another question follow-up.

Yes, Puneet, thanks for the question. Well, first, let me start with 2026. And the drivers of our growth this year, again, it's a number of products that we have already launched coming into the year, be it the expanded MyRisk panel in Q4 of last year. It's improvement that we're seeing across the board, both in commercial and other parts of our organization and execution. So we're getting better at that.

We are also -- as we get along the year, we're adding headcount to go along with new products that we're launching and so forth. So based on what we have, the recovery of the prenatal business that we anticipate that we've spoken to happening over the next several months and quarters, we feel confident being right there in our guidance range, right? That's what we feel for this year.

Listen, when you look at 2027 and beyond, as I've said recently at the JPM conference in January, we believe that we have a number of levers in place. I'll again point you to the catalyst slide, which talks about a number of new products, right? We have 3 major launches this year, starting with Precise MRD for breast and other indications as well, AI-enabled Prolaris for prostate cancer as well as FirstGene, right?

All of these things, I think, will be important that we're timely in our launch. But truly, these become even more growth drivers for 2027 and beyond. So I would summarize second part of your question and that we have confidence that as we exit this year going into '27, '28 that we will be on path for high single-digit to low double-digit sustained profitable growth.

Got it. That's helpful. And then on the MRD launch, I appreciate the details you provided, but just wanted to get sort of how do you plan on holding back? I mean, is it certain indications just given the sort of the competitiveness of the market and competition in the market and also the fact that currently, the products are not reimbursed, but you're on a path towards that.

So maybe just talk to us as to sort of how you plan to throttle it back and then accelerate sort of into the second half of the year and beyond? And then on prenatal, if I could just squeeze in, how should we think about the growth rate in the first quarter? I know it's down but just wanted to make sure if there's a finer point on that and then the recovery through the rest of the year.

Yes. Let me take the MRD question, and then Ben, if you can answer the prenatal question here. Yes, from an MRD standpoint, we are excited again. As I said, it's next week, we're going live. We're going to start commercial testing, and it is for what we're calling our Alpha phase of the launch, select number. So we are being selective, Puneet. It is a little bit challenging in a good way that we've seen a lot of interest to have access to precise MRD, but I believe we can do it in a balanced way.

I mean, again, in this phase, what we're looking for is input on the user experience all the way from ordering to the reporting, the number of repeat orders, the operational efficiency that we have and ultimately, the order volume that we have. And as we noted, our MolDX submission is planned for early H2, so you can call it Q3 for breast and then later in '26 for renal and colorectal cancer.

So until we have submitted for MolDX, we're going to be a little bit more careful on the volume we take on. But we have a path. And listen, it will be something we will carefully consider as the year goes by of are there merits to increase the volume? What do we think on the timing of MolDX? So as we sit right now, we're pleased, particularly with the start of Alpha for Precise MRD and breast next week. Ben, over to you on prenatal.

Thanks, Sam. So as it relates to prenatal, Puneet, as a policy, we don't generally offer product level revenue guidance. But we did call out the prenatal Q1 growth and the unfavorable year-over-year comparison because we had noticed that the Street revenue models had a pretty wide range as it related to our prenatal product.

And so we thought it was important to be able to make sure that folks understood that appropriately reflecting our expectation as it relates to the recovery in 2026 is really the only major change needed to get Q1 revenue in line with our updated revenue range of $200 million to $203 million.

Our next question comes from Subbu Nambi of Guggenheim.

At JPM, you laid out an ambitious MRD launch road map, which you reiterated today. As you think about the puts and takes in that road map, where is there the most risk or the most factors out of your control that could delay your road map? And conversely, are there things that would go faster than what you planned?

Yes. Thank you, Subbu, for the question. In fact, when we think about this year, one of the biggest challenges, if you will, and I think it could be a positive thing is exactly how many samples in advance of MolDX approval that -- for Precise MRD that we run. Some of the things that are, as you're asking, out of our complete control are just how long and how many cycles it might take MolDX to do the review, provide us input and ultimately for us to get approval.

What we can control, and I think we've been doing a really nice job of is preparing the data and for the submission for the publication. I think I've shared before, we have more than 15 active studies in MRD underway. The MONITOR study is the one, which will inform and provide the publication for breast cancer MRD. And that is on track for us to be able to do that in Q3.

Now the -- for the colorectal cancer submission to MolDX, that's tied. That's part of the pan-cancer study as part of the MONSTAR study that we're doing with our collaborators in Japan. We believe that's on track for the second half, which will be the submission to colorectal.

Now in renal, the good news is we -- in September of last year, we already had a publication in Lancet for renal cell carcinoma. So those things on submissions, that's just to speak to kind of our level of confidence. We have, I think, a decent level of control. It's really about the MolDX timing. And as you know, Subbu, we'll kind of walk that road together, and we'll see how that goes.

One follow-up. Last week, you published a paper of performance data for FirstGene in a prospectively collected set of patient samples. You reiterated the timing for CONNECTOR study in second half of this year, which will be based on real-world samples. Is there any reason to expect the real-world data set to have meaningful difference in performance of the test and the prospectively collected samples?

Thank you. Thank you for the great question. So first, yes, we were very pleased with the results, both on selectivity and sensitivity from about 500 samples that we noted in the press release last week. And we -- until the data is fully there from a broader set of CONNECTOR -- individuals who are enrolled in CONNECTOR, we can't conclusively say, but there is -- we see no reason to believe that the data shouldn't be as robust and compelling in terms of the performance for FirstGene.

And our next question comes from Tycho Peterson of Jefferies.

A couple on margins. So if we look at HCT volumes in oncology, you grew 9%, revenue obviously only increased 3%. Maybe just talk about what specific ASP or payer mix dynamics are driving this gap? And how do we think about this kind of dynamic in '26 as you launch disease-specific panels?

So Tycho, this is Ben. Thanks for the question. Yes, as we talked about ASP in Q3, we talked about that kind of the launching point for Q4 and then moving forward into 2026, I think it's important for folks to take into account that we anticipate a modest headwind relative to ASP when we look at the portfolio in 2026 when you're thinking about what the year will look like.

As you mentioned, from a payer mix standpoint, as we focus on selling the expanded panel and then also the MyRisk more broadly across our sales channels, we've talked about this before where we have about a 10% lighter ASP in the unaffected channel relative to the affected channel.

And I think that we saw that headwind across the portfolio from an ASP standpoint when you look at 2025, really driven by the different mix of payers. Part of it was biopharma revenue that we talked about in -- excuse me, in Q3 with the new baseline moving forward. And then another part of it is you just see a shift in the different payer mix from one payer group from a Blue Cross Blue Shield group to another group or something along those lines.

Okay. And then on Precise, I appreciate the color on kind of the Alpha rollout. Maybe just talk a little bit about how you think about scaling up on the sales and commercial channel there. Obviously, more of a '27 driver overall. But just talk a little bit about how you're thinking about hiring for the various indications.

Yes, sure. Maybe I'll start and then I'll allow Brian Donnelly, who's here with us to join in. I'll just say that the scale-up and the preparation for the launch has been underway for some time, and it includes training the existing team, making sure we're hiring people with the right profile, meaning understanding of molecular. And beyond just the sales team, it's also our medical folks, MSLs and a lot of that's already happening. But Brian, please?

Yes. Thanks, Sam. This is Brian. So just building on what Sam said, we're really focused on making sure we have the right level of reach and frequency to priority targets, which you won't be surprised to hear us say. So we're just taking a consistent view at the market, making sure that we are hiring the right level of folks in the right territories, and we're training them, which is a really important piece of the puzzle. We want to get them ready to go as quickly as possible to make an impact.

And Tycho, I'll just add to that. We've mentioned -- I mentioned again earlier in my prepared remarks that we're spending over $35 million over the next couple of years. And a very big part of that is to augment our sales team. And those additions are underway as we speak. In fact, we had our commercial meeting kickoff just a couple of months ago, and there's a lot of new faces in the room. They're coming from places where they've done this already. So they're not just going to be learning on the job.

Okay. That's helpful. And then maybe just along those lines and lastly, just on the Alpha launch, can you just provide any more color? You talked a little bit about how you're thinking about number of tests you need to run, but maybe the customer profiles you're going to target.

Sorry, I didn't know if you got cut off. Did you just say can I provide any more color? Is that what you said?

Yes. On the Alpha launch, I mean, you talked about a number of tests you may target, but in terms of...

I'm going to go with that. Listen, we are...

Ladies and gentlemen, please remain on the line, your conference will resume shortly.

Yes. Apologies, Tycho. I got cut off. So I think what I was answering your question about Alpha is we're excited about the launch. We're starting off with a handful of community oncology centers. And by the end of the year, as we move into early access, we're going to broaden that into dozens of actual accounts. We have already done the training to prepare these sites. We have sample collection kits in their hands. So we're looking forward starting next week to activate fully and start receiving samples and can't share enough the excitement that we have to start.

And our next question comes from Doug Schenkel of Wolfe.

My first one is on Prolaris, where ostensibly, you picked up some momentum into year-end. As you noted in your prepared remarks, the recent volume was up low double digits was because of the favorable comparison. Can you delineate between how much of it was the comp versus improved rep productivity or any other dynamics that you think are worth calling out? That's my first question.

On an unrelated topic, my other question is on prenatal momentum into year-end. Units were actually down, I think, 5,000 or so sequentially in the fourth quarter. I just want to see if there were any remaining order management dynamics. And if so, how is that contemplated into 2026 guidance? And beyond that, are there other things that are worth talking through like competitive dynamics, for example, that may have affected trends into year-end?

Yes. Thank you, Doug, for the questions. Let me start with a question on Prolaris, and then I'll hand it off to the combination of Ben and Brian to talk about prenatal. Listen, there have been a number of activities that we've been working on over the last few quarters actually related to Prolaris. It includes the engagement we've had with KOLs; it includes the various programs we've been driving. It includes the expansion of our sales team into more -- serving more urologists.

So all of those things are things that we think will endure. Now yes, did we potentially get a little bit of a compare benefit in Q4? That's possible. But as we look into 2027, we expect maybe not the 12% growth that we had within the quarter, but much stronger and actual growth throughout the year in 2026 than what we saw in 2025. So moving on to the prenatal question, Ben, let me hand it to you and Brian to answer that.

Sure. Thanks, Sam. And I was just going to make one comment relative to Prolaris urology, Doug. So as Sam mentioned, we've focused on that channel executing with the sales force, and that gives us confidence as we look at 2026. So like Sam said, we don't expect, or we didn't model out a 12% year-over-year growth going into '26.

The guide did reflect some traction relative to the total annual growth rate that we saw in '25 moving into '26, and we're bullish about the opportunity ahead as we see the performance that we saw in Q4. Now transitioning over to prenatal. You're accurate in the view that volume declined in Q4. Typically, Q4 is often a challenging volume quarter period, all else equal, not simply saying that, that is the year that we had for prenatal in 2025.

But when you look at the seasonal or the quarterly volumes from a prenatal standpoint, oftentimes, you'll see a softening in Q4. We did see softening in Q4. And as we mentioned in the prepared remarks and then also, as I briefly shared with Puneet, our expectation is that we'll see a decline in prenatal year-over-year in Q1 with recovery in Q2 and beyond.

And there are several things that give us that confidence. Part of it is having a focused sales force as they focus on our prenatal bag and Brian can speak more to that. The early traction that we're seeing in conversations with GeneSight and FirstGene, excuse me, as providers will be interested and open to conversations as we work to win back share as well.

So I do want to emphasize the fact that the guide does not include a sizable benefit from FirstGene, but we do believe that as we launch that product commercially, we'll have an opportunity to have conversations with docs that will give us some traction or leverage across the portfolio.

It's Brian. Just a couple of adds for that. So [Technical Difficulty] order management issue that we have been working to resolve throughout the year. What we have seen underneath that is accounts who are not impacted by our order management issue are growing at or above market, which is a good signal for the underlying health of the base. In the same period of time, we've been focused on adding new customers. Our sales team has been really focused on restoring the accounts where we lost volume.

And if you go forward into this year, Sam mentioned earlier, we have our prenatal sales team that we're going to be expanding going into the second quarter, and we have the FirstGene launch. So I would just align fully with what Ben said, we do -- Q1 is going to be the beginning of this year for us. We're excited to get out into Q2 and into the back half of the year when we got our new -- our expanded team and our new product.

And our next question comes from Andrew Cooper of Raymond James.

Maybe just a follow-up on that. I do want to drill in a little bit more on just how many customers are left that kind of are affected by this -- by the change at this point? Is it a few important ones? Is it kind of more widespread? I just would love a little bit of kind of color there. And then what other parts of the portfolio maybe need some updates to some of your systems? And at this point, how are you balancing those risks and thinking about it differently than you were before sort of this hiccup in prenatal?

Maybe I take the second question first. Thank you for the questions, Andrew. And then Ben if you and Brian, if there's anything you want to say with the first question. We take it incredibly seriously, Andrew, and we took the opportunity when it happened in Q2 of last year to look through every ordering that we have and to really ensure that everything was intact, that we had no issues, no friction either in the test ordering system or in the reporting system.

And what we really learned is as part of improving execution excellence, it's about a different level of rigor and testing that we'll do before we go live with something, right? This was a self-induced error that we had, which we shouldn't have, and we did, and we've taken care of it. But we have gone through all our other testing -- all of our -- excuse me, ordering systems, and we feel good about all of those continuing to work as they are without any issues.

So building on that, as Sam mentioned, we [Technical Difficulty] to win back the customers that encountered that challenge, we see some progress there, and I'll have Brian speak to that in just a moment. But I think it's important to recognize that as we have the opportunity to go back in there and reengage in conversations, being able to speak about a new product is an opportunity that opens that conversation or opens the door that we have not necessarily had the opportunity to leverage or open over the last couple of quarters.

And so again, not to be too repetitious here, but that's one of the things that really gives us excitement about the ability to move forward and see year-over-year growth as we move in Q2 and beyond.

Yes. This is Brian. I don't have a lot to add to that other than as it relates to where we're at now, we have a really good handle on our current accounts. We understand their needs. They are adopting our portfolio. We feel really good about our current customers and our relationships with them. So we feel like we are stabilizing there.

Okay. Great. And then maybe if I can just sneak one more in. Just on GeneSight, you talked about the 12 payers and the biomarker bills that you added in '25. How should we think about the trend in ASP there for '26, knowing that you're past sort of the big headwind here that you've been facing for the last year or so?

Yes. So we've been really pleased to see the traction that's come as we've engaged in states with biomarker bills and the wins that we had in 2025. Those wins came across the year. And so there's going to be an annualized benefit to some of those that we didn't see in '25, but none of them in isolation are a sizable win. And so when we think about '26 from an ASP standpoint, again, across the portfolio, we're expecting a modest headwind. As it relates to GeneSight, we just think about it as being stable.

Ben, let me just add to what you said. Sorry, Andrew, is that the good thing, well, if you will, we have a much more balanced portfolio, if you will, of payers now. Unlike what had happened with United, even if we were to lose another payer unless they were to be Medicare and there's no sign of that. We feel that's completely stable. We're in a much better place than we were [Technical Difficulty].

Our next question comes from Dan Brennan of TD Cowen.

Maybe just on hereditary cancer. Can you just walk through a little bit kind of what's assumed this year for volume growth? You had some nice growth this quarter. I think comps are a little easier. Just wondering how we might think about the volume growth in hereditary cancer going forward.

Yes. So Dan, when we think about '26, we think about high single-digit growth from a hereditary cancer portfolio perspective, and that's across both unaffected and affected. Obviously, exiting the year with the momentum that we had continues to add how bullish we are about that, but that's how we're thinking about it in '26.

Okay. Maybe just on pricing. I think you said you have a headwind on the whole portfolio. Can you just give a little bit more color on that? Like is there a specific dynamic in '26? Or just how do we think about that?

Yes, Dan, I wouldn't think about it as a specific dynamic per se for the portfolio. I would just think about it just generally as we experience price pressure in hereditary cancer, you think about the dynamics for GeneSight, net-net, we expect the portfolio to have a very modest decline, 1% to 2%.

And so obviously, there's individual dynamics for different [Technical Difficulty] there in '25. We'll continue to engage with payers, and we're excited about the ASP that FirstGene can bring to the portfolio as a modest improvement for our existing prenatal portfolio. But just generally, when you think about the enterprise ASP, that's how we think about the modest headwind of 1% to 2%.

And maybe just one more, sneak one in. Just on MolDX and MRD, like -- so do you assume you get the coverage in the back half of the year and then you have some revenue contribution from that coverage in the model? Sorry if I missed that.

No, Dan, we did not. We're not assuming that we would get coverage until sometime in 2027. So we're assuming really no revenue from MRD in our 2026 numbers.

And our next question comes from Mason Carrico of Stephens.

A lot has been asked. But on FirstGene, I guess, what do you view as the largest practical barrier to scaling adoption and revenue for that assay in 2027? I mean, is it clinical confidence? Is it workflow integrations, payer coverage, sales execution? I guess, which barrier do you feel the most confident that you can clear early, which do you think takes more time?

Yes. Thank you for the question. I'm going to let Brian, if you don't mind.

Yes, sure. Thanks for the question. So with regard to FirstGene, for us, as you know, this is a new product. So it is really about getting the product in front of our providers, both our existing base as well as new customers we're interested in doing business with.

And so it is going to be the traditional issue of getting folks aware of the product, making them ensuring they understand the product to a degree where they're willing to clinically adopt it and then pulling it through. There isn't like a particular issue here other than just really good execution, getting the product in front of customers and being there for them when they're ready to start using it with their patients.

Brian, if I can just add to that, I think that we've been pleased with the early access period that we've had so far, both in terms of input we've received from customers that have been using it, from our own operational efficiency that we've seen in a very high yield and also though it's still relatively early from the reimbursement that we've gotten. So all those things you mentioned, we're not going in blind.

We have a pretty good sense of it. The other thing is we want to have higher market share, and we intend to in the coming quarters and years. But from where we are, we see FirstGene, particularly this combined screen as an opportunity to expand the market, at least for us and to go gain new share, and that's something that is really, I think, important to our future.

Got it. And then could you talk about the progress you've made in terms of cross-selling multiple assays across customers or really just growing wallet share. Are there any metrics you can provide to highlight how maybe an increasing percentage of your customers are ordering more than one test from the Myriad portfolio or any update there?

We will likely share something along the lines as we get deeper into this year. But what I can say, we -- again, we have intentionally gone to focus sales organizations. Again, as we've mentioned, for prenatal health, we are kicking that off in Q2. So that's going to be even more of a focus now with Prequel, Foresight and FirstGene that will be coming.

In oncology, I can give you an example on the urology channel, we are pleased that along with Prolaris, there are a number of customers, increasing number of customers who are also using MyRisk our hereditary cancer test because that is written into the ASCO guidelines for those who are in the course of being treated for prostate cancer.

So fundamental, the great question to [Technical Difficulty] differentiated, and we really believe [Technical Difficulty] is our strong established relationships in community medicine as it relates to what we call the cancer care continuum because there, what we are finding we [Technical Difficulty] relevant tests in the course of treatment.

So we fully expect, and the numbers are things we're going to track here between hereditary cancer, between our comprehensive genomic profiling tests, between MRD, there should be a growing connectivity and a benefit by being in an account serving it. So great question, and we'll look to share more of that in the coming quarters.

And our next question comes from Bill Bonello of Craig-Hallum.

I just want to circle back to your response to Tycho's question on the hereditary cancer ASP, and then I do have a follow-up to that. But -- so I totally understand the price differential between affected and unaffected. But obviously, the ASP was down in both of those groups this quarter.

And so -- and then later, you made some comments about the pricing headwinds and pressure. I guess I'm trying to understand, is that really simply payer mix difference? Or are you seeing your contracted rates for MyRisk going down from where they had been?

Yes, Bill, I appreciate the question. So the short answer is no. We are not seeing contracted rates going down. We're not experiencing pressure in that regard as we have conversations with payers. Really, as we think about ASP, as I mentioned, Q3 is a reflection of the mix that we expected going forward.

We saw that be consistent in Q4, and that's the way that I would think about it into '26, use Q3, Q4 as the ASP baseline, recognizing that in Q1 with deductible resets, there's going to be ASP pressure across the portfolio that will then generally recover through the remaining 3 quarters of the year.

Okay. And when you say mix, not necessarily mix between affected and unaffected but mix like payer mix.

That's correct. When you think about volumes coming from a particular payer versus a different payer versus patient portion.

Yes. Are you guys still there?

We're here. Yes. Can you hear us, Bill?

Yes, you've been kind of breaking up, might -- probably just my phone. So the follow-up is just you talked about a change in the way that you're going to show the numbers, which sounds like it will maybe make it easier for all of us. I'm just curious if that change is reflecting any underlying change in your go-to-market strategy for the various businesses.

I mean you've talked about the focused prenatal team. Will there be changes in who is actually selling for instance, MyRisk into the unaffected market? Or will current salespeople have essentially the same bag they've had all along?

It's a great question, Bill. Yes, we are making changes. So again, a quick summary. In October, we shared that we made a number of changes organizationally. We went away from what we used to call the business unit structure with women's health, oncology and so forth.

And to cut to the chase, yes, now we have determined through our strategy focused channels, meaning now those folks that are in prenatal that we're going live with this coming quarter, they're selling prenatal products. Again, that's Prequel, Foresight and FirstGene, and they will not be carrying the unaffected -- excuse me, they will not be carrying MyRisk, if you will, to serve the unaffected population.

Likewise, we have said that there can be more, we believe, more traction by having a team that is really focused on serving hereditary cancer [Technical Difficulty] that supported a number of marketing initiatives to drive awareness, drive market activation, both directly what we're doing and through partners and through other channels we're driving. So it is a very intentional way [Technical Difficulty] more efficiency and growth and eligibility through the reach and frequency that we intend to execute on.

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And our next question comes from Lu Li of UBS.

I guess my first question on the MRD. I think you mentioned that you're planning to kind of like disclose some of like early-stage metrics. I wonder if you guys have like internal targets for like, for example, like per center utilization, like how do you measure success for those metrics?

Yes. No, great question, Lu. Appreciate it. Yes. So among other things, the 4 things that we will be looking at is user experience for those that are part of the Alpha. And when we say user experience, it's all the way from how their perception on ordering, on the turnaround time, on the quality of the results, the reporting, how easy it is to interpret and take action from it. So that's one category.

Repeat orders, I think that one is pretty obvious. It's important that we see oncologists, health care systems, the same ones continuing to order for multiple patients. and order volume, though we're not disclosing that, we are looking to see that we are able to achieve a certain number of volume of orders here within our Alpha time period, if you will.

And then operational efficiency, that's -- those are the other things that will ensure that we're able to scale and prepare to scale more that includes our internal yield turnaround time, our targeted COGS and other elements. So those are the metrics that we'll be tracking.

Got it. One question for Ben. I think the guide talking about the EBITDA margin going to be like near breakeven in Q1. I wonder, can you comment on the pacing of that? And anything else that you wanted to flag just in terms of like the Q1? Is it just like the prenatal volume headwinds or anything else that you want to flag?

Sure. So yes, we've touched base on the expectation that that's going to be down year-over-year. Also, when we look at historical operating expenses from Q4 to Q1, Q1, we have some outflows just because of the regular cadence of meetings and compensation adjustments and the like.

And so the combination of deductible resets at the start of the year, the impact of prenatal year-over-year decline and then a modest step-up in OpEx starting in Q1 and persisting through the year is what impacts the profitability in Q1. Now I will say when we think about the full year, it's important to remember that we look back across the last couple of years [Technical Difficulty] stronger than H1 revenue.

I just talked about the impact of a step-up in operating expenses that we will titrate as we see some traction with some of our commercial initiatives. But we issued guidance on January 12 as it relates to adjusted EBITDA, and we're still very confident in that level.

This concludes our question-and-answer session. I'd now like to turn it back to Matt Scalo for closing remarks.

Thanks, [ Didi ]. This concludes our earnings call. A replay will be available [Technical Difficulty] for 1 week. Thanks again, everyone, for joining us this afternoon, and have a good day.

This concludes today's conference call. Thank you for participating, and you may now disconnect.

Good evening, ladies and gentlemen. I'm [ Nischal Kapadia ]. I'm an associate with the Healthcare Investment Banking Group at JPMorgan. It's my pleasure to welcome you to the company presentation for Myriad Genetics. Today, we are joined by Sam Raha, who is the President and CEO at Myriad, who will be taking us through the presentation. And Sam is also joined by Ben Wheeler, who will be joining us for the Q&A. Ben serves as the Chief Financial Officer at Myriad.

Thank you very much. Good afternoon, everyone. It's a pleasure to be here and have an opportunity to provide you an update of Myriad what lies ahead. First, forward-looking statements for your pleasure.

So I've been with the company for 2 years now. And from the beginning, I've been inspired by the noble purpose, which is to advance the health and well-being for all. The noble purpose is palpable throughout our organization and a reminder every day how we are making an impact.

A little bit about Myriad. We are a leader in precision medicine and diagnostic testing. We have been a pioneer for over 30 years now since we originally bought BRCA1 testing to make breast cancer, we have over 1,000 publications and counting. We're deeply rooted in science and medicine and in 2025 we served over 55,000 health care providers and delivered over 1.5 million tests, test reports.

Now that being said, we are at a very important inflection point for the company. As we move forward, we're going to build on the strengths that we have, which you can see on this slide, but we're also making a number of changes as we go forward as the new Myriad. Now those changes include having rigor and discipline of where we invest our resources, our time, our energy and of course, our dollars. Our priority, as you'll hear me talk about in a moment, is the cancer care continuum and beyond hereditary cancer we will build a portfolio to serve the full continuum of care.

We also believe in the new Myriad along with the organic capabilities we have for product development, that partnerships can help us serve the market quicker in a number of cases by complementing our capabilities. I also believe that having the right team, which has the combination of the right domain knowledge and experience with the right experiences and capabilities will allow us to move forward. Now hung with that, I get very excited about execution excellence. And this is a step-up level of rigor and discipline in everything we do from product development to commercialization and launch.

We've been using AI for some time within the company, but this is also as a go forward, the opportunity all the way from operations, how we're processing samples, variant analysis to revenue cycle management into customer experience and beyond, you will see that we will increase the adoption of AI, including for our products.

As we move forward, we have absolute clarity on our strategic intent, which is to accelerate growth and profitability. We're going to do so by focusing on 3 strategic pillars. First, the cancer care continuum. Again, this is going to be the heart and the focus of the company and beyond hereditary cancer, we are going to add products for other high-growth applications. Second, for prenatal health and mental health here under health care screening, we will execute strategies to grow at or above market. Now under the moniker here of execution excellence, this is really our commitment to not only to increase the growth for the company, but at the same time to maintain profitability. And we will maintain industry-leading margins. We are going to continue reducing our costs. We're going to use our revenue cycle team, and we also have a mantra going forward that we will grow revenue faster than we grow expenses.

Now on this slide, you see the markets that we serve. They are sizable and most of them are growing in the double digits. And you should also know the majority of these have less than 50% market penetration. For us, as Myriad, we have a top 3 market position in the majority of these important markets. As well, when you look at the new products we'll be launching in the coming 18 months, this together with our position and the incremental adds that we're having to strengthen our commercial capabilities, will allow us to accelerate our growth in this overall $40 billion market opportunity.

Over the next slides, I'll be talking about the cancer care continuum and our expanding of our menu. What you see here is a snapshot of the tests that we currently have as well as the number of tests that we will introduce in the coming couple of years. More important perhaps than any single test on the slide is the comprehensiveness of the overall portfolio because what's important to health care providers, health care systems is to have the tests that serve their need once again across the care of cancer patients. Now that together with the trust that they have in Myriad for the quality of our products, the science, the clinical utility, the turnaround time, the support that we're able to provide clinicians and patients, genetic counselors and beyond are part of the differentiation that we bring forward into the market.

In the next set of slides, I'm going to be providing an update on some specific activities on our product portfolio in cancer. Let me start here by talking about hereditary cancer testing. Hereditary cancer continues to be a sizable important market for us. Between the unaffected, meaning those individuals who don't have cancer but have a familiar reason for being tested between that market and the market for those who actually have cancer and it's part of therapy selection, this total market opportunity is $7 billion. We have the gold standard test for hereditary cancer with MyRisk. And just last quarter, we provided an update, we introduced an update to the market. And now our MyRisk test has more than 63 genes together represent all the strongly recommended genes in the NCCN and ASCO guidelines.

Now coming up within this half of 20 we'll be launching what we call Disease Specific Panels. And these are bespoke predefined panels that are tailored for certain types of oncologists, breast cancer surgeons and others to really help define what they're looking for in a more convenient way without having information perhaps that's distracted.

Now along with that, particularly for the unaffected side, which is a $5 billion part of the overall $7 billion market opportunity, we are the leaders in that space, and we provide something called RiskScore to go along with MyRisk, which really helps determine the level of risk over a lifetime that an individual have for developing breast cancer. We'll be expanding the number of SNPs there for the polygenic RiskScore to 365 in the second half of this year.

Now that, along with the number of programs that we're driving to activate the market. This includes the breast cancer risk assessment program we're enabling health care systems and providers to better identify and pull through patients that are eligible, includes partnerships that we've announced with JScreen, more recently with Clairity Health, with MagView are ways to get into places where breast cancer and other sort of cancers are being tested. We are also going to start activating more of the unaffected market, including consumers through a number of pilots going to do. Put it all together, the takeaway here is that MyRisk is and will continue to be a very important cornerstone for us for both growth and profitability for the years to come.

Moving to therapy selection. This is also a very important part of cancer care with an increasing number of oncology drugs now tied to biomarkers. We are the leader in the HRD with our MyChoice test and in the coming years, we will be expanding the number of indications that we have here. Now for tissue comprehensive genomic profiling, or CGP, we'll be expanding our offering to support precise tumor with IHC stains, starting with PD-L1 later this year.

Now in terms of liquid CGP towards the end of last year, we introduced a partnership with SOPHiA Genetics, along with MSK. And this partnership enables us to leverage the power of a very well-established liquid CGP test, which is the MSK-ACCESS test, together with SOPHiA genetics analysis interpretation capabilities enabled by AI with Myriad's capabilities for lab operations for quality assurance, for regulatory affairs and registration to provide pharma partners as a start the ability to do biomarker selection, biomarker development, companion diagnostic development and ultimately registration and having test as a companion diagnostic available for clinical use. We also have the opportunity down the line to start offering the MSK-ACCESS and SOPHiA package together with Myriad as a quid biopsy test.

Moving to prostate cancer. There are over 300,000 new incidents of prostate cancer in 2025. And there are over 3 million then that live with prostate cancer. We're excited that leader this year, and you can see in the first half of this year, we'll be launching our first-ever AI-enabled Prolaris test. And this is done in partnership with PATHOMIQ. This test will be able to provide a higher level of confidence to urologists and oncologists on the course of treatment of a patient at the time of biopsy to determine what to do in terms of active surveillance or a different treatment path. I will say part of what we've seen really in the market, a lot of energy and excitement for is the ability to offer a test which brings together the power of molecular as well as the power of AI, and that's what this test is.

Now this will be the first of multiple tests that bring the power of AI to market for prostate cancer, our next test will be in 2027. Let me also note that we have clinical studies that are underway now, and the reports and results from those as we share those, we believe, will improve our position as it relates to the NCCN guidelines. Now the takeaway here for prostate cancer and Brad as we are uniquely positioned through our tests of Prolaris AI precise tumor and my risk to bring together the combination of tests, again, for molecular and AI, CGP and germ line testing to really provide a unique answer and support for patient care for prostate cancer. And by the way, we've already started to see in 2025 the, I'll say, the halo effect or an increasing number of patients -- excuse me, providers who are ordering our prostate cancer tests are also starting to order the MyRisk test.

Okay. I want to talk about MRD. MRD clearly is one of the most important market opportunities for our industry and for serving patients. At the heart of our differentiation for MRD is this ultrasensitive precise MRD test. It's a tissue-informed whole-genome sequencing-based test that allows sensitivity for the circulating tumor DNA down to 1 part per million. This is particularly important for low shedding tumors such as breast, such as prostate, renal and other cancers. And it really increases the confidence that providers have on the course of treatment.

Now working with a number of collaborators, including MD Anderson MSK, we have over 20 clinical studies that are underway across multiple cancer types. Now for us, the opportunity to really differentiate and the confidence that we have that over the coming years, we will build a leading MRD business comes from not only the sensitivity and the performance of our assay. But that, combined with the fact that we have a number of other leading tests that are used in conjunction with MRD, again, our hereditary cancer test, HRD test, the growing portfolio of our CGP tests, all that together with the fact that we have leadership presence in the community.

And you might be aware that more than 70% of oncology care in this country happens in the community. We already have relationships with over 3,500 oncologists that we served even last year. So the combination of these things, we believe will allow us to build a meaningful business in the coming years.

Let me share now the high-level plan for MRD. We're starting with breast cancer for a number of reasons. It's a $7 billion TAM. It's a cancer type that is low shedding that really is amenable. Again, that could benefit from the sensitivity that we have. In many ways, we are known as the breast cancer company, given our long legacy starting with BRCA1, BRCA2 as I noted earlier, almost 30 years ago. Our plan here is to start offering select testing for a number of customers actually within this quarter.

We will then submit to MolDX for approval and at the same time, expand the set of customers that we're offering our test to through a regulated early access period. And we're expecting to do that in Q3 of this year. Now giving time for MolDX review and approval, we are planning to launch or expecting to launch commercially sometime in the first half of 2027.

Now in this year, as we go beyond a select set of customers and expand in a regulated way to additional set and early access, we'll be paying particular attention to the overall experience that our customers have. What is their experience with ordering, what's their experience with the clinical utility, the value and equally important, what's the number of orders relative to what we're targeting? What's the number of repeat orders? Are they coming back? What's the input that we have?

Now beyond breast cancer, there's a number of other important things we're doing in 2026. We will be submitting for MolDX for renal cancer. In fact, that paper that will support that something we published last year that you might have seen, but we will launch and also start early access for that in the second half of this year. Now along with that, we will be submitting for colorectal cancer second half of this year as well as doing early access.

Let me pause for a moment and talk about colorectal cancer. You may say, well, colorectal cancer, is that a low shedding tumor? It's not. It's actually high shedding. And so it's been one of the cancers that many companies have put assays out there for already. However, for us, the play is when we're serving community medicine, we need to have a portfolio of tests, when they're working with Myriad, and we're supporting them that over time, we're able to cover as many of the prevalent cancers as possible.

Furthermore, for your reference, this past weekend at ASCO GI, along with our collaborators from the hospital East, it's part of the MONSTAR study. We shared results from over 160 patients that showed the sensitivity level, a very high degree of sensitivity for colorectal cancer. There is a number of publications now starting to show that, that level of sensitivity could have benefit in being able to detect can't colorectal cancer even earlier and that can make a difference in patient care. Now looking ahead to 2027, now building on the MolDX emissions that we'll have this year, we expect to do a commercial launch of both renal cancer and colorectal cancer broadly. We will also be submitting in 2027 from MolDX for both endometrial cancer and ovarian cancer.

Let me move to some quick updates on prenatal health and mental health. This year, we're looking forward to doing the full commercial launch of first sheet. Now FirstGene is a combined test that brings together NIPT or NIPS testing, carrier screening, both for the mother and the fetus, fetal recessive status, as you can see along with blood compatibility. One of the differentiators for our test FirstGene compared to others that may be available in the market, the fact that our test can be done at 8 week gestational age compared to the most tests on the market being done at 10 weeks.

This is important because 8 weeks is the time when a mother usually comes in to do a battery of other blood tests. So this adds convenience both for the mother as well as for the health care system. Now we have had early access for FirstGene in the market for a number of months now, and the early returns on it are good. Those providers that are using it are happy with the ordering process. They're happy with the results.

On the inside, we have seen very high yield as well in terms of our operational capabilities. The results from this early set of samples that we've been running are part of a CONNECTOR Study, which will also help provide us a path to how we may be able to have reimbursement down the line. And the first set of results from that, we expect to share later on this year. The full commercial launch is set for the second half of this year.

Now along with that, part of the changes we're making going into the year and our commercial organization is to drive absolute focus on the areas to drive the results that we expect to see. So different than what we had been doing before, our sales organization will now have a team that is explicitly focused on prenatal health. So the combination of the launch of FirstGene together with the changes we're making and focus on our sales team, we believe will be a growth catalyst going forward for prenatal health.

Moving to mental health. Now mental health continues to be a very important matter and a growing crisis in this country and beyond. Our GeneSight test is the market-leading product. And now we have provided test results for over 3 million patients. And our test that allows health care providers to select better, the most effective and efficacious drugs that will help individuals who are experiencing anxiety, depression, ADHD and other mental disorders. We started the year with a number of challenges in this area, but I'm very pleased with the progress we've made. More on that when we share our fourth quarter results in a number of weeks.

But I will tell you that going forward, we'll continue to focus on those opportunities, those accounts that we believe have high growth, high reimbursement. We now have 26 states that have biomarker laws that have been passed and our collective teams between sales between legal, between rev cycle and payer markets together are doing a really good job. We have a plan of how to pull through once a biomarker law passes, how we can get reimbursement from that. Now together with that, we've already started to do and see some returns, and we will continue to really leverage the digital capabilities to make it easier to understand what our products is to order it as well as to get support. We are also optimizing a direct payment option.

Now put it together, we expect to grow mid-single digits. We are the leader in this market. That, along with ASPs being stable along with the planned improvements in COGS that we have will make this a profitable business within the next few years.

Let me move now to the financial update. Happy to share our preliminary results. For the fourth quarter, revenue is going to be between $207 million and $209 million. For the full year 2025, we're projecting revenue between $822 million and $824 million. Now in terms of volume for the overall year across all of our products, we had 1% growth. Now just to give you some important elements of the overall volume, Hereditary Cancer had growth of 7% for the year. And as we exited the year, we continued to grow strength in volume and that momentum carried through. Mental Health, again, starting from the place where we had almost no growth in the first quarter. We've done better every quarter and fourth quarter was no different than that.

And Prenatal Health, here, as some of you might be aware, we had a challenge that was based on implementing an order management system, which we've completely resolved now, but it takes some time to get back to the growth level that we want to be at, at or above market. So collectively, for the year, we had a 4% decline in Prenatal Health.

Now as we look forward, as we go into 2026, we're doing a number of things to start accelerating growth, including spending over $35 million over the next few years of particular focus on strengthening our commercial capabilities related to the cancer care continuum. Specifically, we're adding a number of headcount, a meaningful number of head count to our sales teams tied to the launch of our new products. talked about Precise MRD, Prolaris AI and some of the other cancer care products that we're launching. We're also strengthening other tools that are critical to our sales team to make them more effective, make them more efficient along with a very well thought out and funded plan to drive the awareness excitement and demand for our new products as they come to market.

Now in terms of guidance for the full year, let me share the following: revenue of $860 million to $880 million. If you look at the midpoint of that compared to the midpoint, or $823 million that I just mentioned about 2025, that's a 6% growth for revenue. In terms of gross margin, we take pride and put a lot of work into maintaining industry-leading gross margins. The 68% to 69% when that takes into account, that we will continue to have that strength in our core established products, but this includes the launch of new products, including MRD which, at first, we're deliberately going in understanding that there won't be reimbursement.

Now looking at adjusted EBITDA, it's between $37 million and $49 million and at the midpoint compared to our latest guidance on 2025, that's more than a 40% improvement over the year. We spent a lot of time over the last several months looking deeply and analyzing all the way from our existing products, market trends, our specific activities, new product launches, the things that we're doing to improve how we execute to define our long-range plan. And we can share with the conviction that over the next 5 years, starting in 2025 that we will grow our revenue between high single digit to low double digit.

Now we're starting that growth in 2026, improving from what we had in 2025. There are a number of catalysts this year that we're closely tracking. And these are as much about supporting growth in 2026 as they are about indicators, leading indicators of things that will be very important to our growth and acceleration going into '27 and '28. You can see here a number of important product launches. I already talked about disease-specific panels for MyRisk, our core product for Hereditary Cancer. You can see the prostate cancer Prenatal Health with FirstGene.

Along with that, you can see here this is an incredibly important year for us, not for revenue, but for establishing our presence in MRD. And you can see here that there are catalysts both related to submissions and publications that will happen throughout the year. I'll also call out in terms of the overall cancer care continuum, we expect to introduce and share news on one or a small number of important strategic partnerships that will allow us to, again, more comprehensively serve the cancer care opportunity.

Okay. Let me conclude with this slide. This is an energizing time for the new Myriad. We're at an inflection point. We have absolute clarity on our new strategy on the areas of focus, again, cancer care being the most important part of that. Together with that, we have a robust pipeline more robust than we've had in 5 years of new products that we're bringing to market, and that includes not only ones that we've developed internally along with the ones that we're bringing through partnerships to serve high-growth market opportunities. Yes, we are BRCA1, BRCA2, we are hereditary cancer company, but we are more than that, and these products will help solidify our position across cancer care.

Along with that, we're going to leverage the strengths that we build in operational capabilities sample processing, reporting together with the commercial expansion that we have. We're also strengthening our leadership team now, and I believe that we have now an improving combination not just at my CEO staff level, but across many parts of the organization where there's the right combination of domain knowledge and genomics and diagnostics and cancer together with experience.

Now you put that together with this deliberate efforts, programmatically and culturally strengthen execution excellence, roll that all together, we have absolute substance and confidence to grow revenue going forward, high single digit to low double digit. Thank you for listening, and I look forward to your questions.

Can we please invite Ben Wheeler, the CFO, on the stage, please? If you have questions, please raise your hand. Sam, in the meanwhile, maybe I can get the ball rolling with a few questions that do not let me speak.

Please.

Firstly, it's been a couple of years that you joined the company and a month less than a year since you became the CEO. What do you think has changed in the meanwhile?

Yes, there's been a number of changes. I'd offer you the following. We've redefined the focus of the company and the strategy. And we've defined the focus on the cancer care continuum. That's one. We've also had a number of changes in leadership. If you look at the CEO staff, more than half of us are in new positions. So I think we have the right combination of leaders that can take the company forward. We've also started building a new level of rigor and discipline in how we plan and how we exit. You put that together with a robust pipeline. I think these are the most important changes that have happened in the last 12 months.

Okay. And you've put forward a multiyear plan to increase your revenue growth to high single digits or low double digits. What do you think are maybe 2 or 3 pillars that the investors should focus on during this?

Yes. It's tied to the answer to the first one. Again, we believe a very important part of our growth will be the foundational products that and continuing to see performance there. Proprietary cancer continues to be a cornerstone that will continue to do well. Equally importantly, it is about the new products. And this is as much about the promise for the future years and how we're going to accelerate growth. But the effective timely launches of these products will be a very important thing to keep an eye on. And then thirdly, again, doing what we say we're going to do consistently. So every quarter being able to meet the expectations we've set for ourselves, not only in terms of financials, but in terms of the product launches and other important catalysts that I laid out. These are the things that will be important to our success this year.

Okay. Moving on to the cancer care side of things. On the hereditary cancer testing is still a very big piece of the Media story, and we see that from the Q4 as it has been one of the biggest driver of revenue. So with the strong oncology and the unaffected volume growth, where do you think this trend is leading you into 2026 at that we see in testing?

Hereditary cancer, again, as I said, it's a $7 billion market opportunity. The $5 billion part of the market is less than 20% penetrated. We believe the combination of the new product, the updated MyRisk panel that we launched in Q4, the new disease-specific panels that we will be launching coming up in the next half that I talked about, along with, by the way, NCCN guidelines continue to expand where hereditary cancer can be used. And the other market activating things that I talked about, we did. This gives us a dance to grow this continued growing in a very healthy way and delivering a significant amount of profit which is important for hereditary cancer in patients, but it's also a very important way for us to fund our intentions as we expand in cancer care.

And on Prolaris, can you throw some light on the AI enabled version of Prolaris? How does it change things from Myriad? And how does Myriad win back the share?

Yes, great question. Listen, the fact is that over the last couple of years, we've been just holding steady. And that means that we have been losing share. We are very excited, and we're really energized to see the market reception even with the announcement that we would be bringing an AI-based test to market. That, together with the KOL engagement that we've had the expansion that we've already put in place, and we'll be continuing to do on the Prolaris or the urology sales team, I think, gives us an opportunity to return to growth for our prostate cancer, arisen test in 2026. And then again, I said this is our first AI-enabled launch, they'll be more in the coming years. So now this is the opportunity to accelerate growth in prostate cancer.

So, are there any questions in the room? Okay. I have a few more questions, if I can pick your brain, please. On MRD, you mentioned that we'll be having a controlled launch the reimbursements. So what does success in 2026 look like for MRD?

Yes, there's a number of things. This was such an important year for us in MRD. It is first market related to this is starting clinical testing for a select number of customers. It is the submission for MolDx for a number of tests that I mentioned, breast, colorectal, renal. And it also means for those in a controlled way, the customers that we're doing testing for that we are closely working with them to understand their experience, understanding their ordering patterns and see what's the level of repeating testing. These are important for MRD success this year.

Okay. Great. And you mentioned about the collaboration with SOPHiA Genetics or MSK? How would you define success in this collaboration?

Yes. So again, where we're starting off with the collaboration is really focused to be able to serve pharma partners in the biomarker selection, development and CDx development registration. So signing up one or multiple agreements to start leveraging this, we're in various conversations already, but actually initiating that work will be an important milestone and measure of success for that partnership.

And could we perhaps be seeing more partnerships or collaborations in 2026 or even near term?

Yes. Yes, as I mentioned, and in fact, that's a catalyst. Now listen, it's less about an extensive number of partnerships. It is more about strategic partnerships that we really think can have deep impact. So yes, we would expect to announce one or a small number of other strategic partnerships throughout the course of this year.

Okay. And you mentioned a number of new product launches that the team is planning in 2026. I'm sure these come along with a reasonable number of expenses or the resources that are required to make these expenses. So should an investor expect expenses to jump near term of launches?

Well, I'll start, and Ben, you can always jump in here, too, please. The short answer is this is all contemplated within our plan for 2026. Yes, we will be doing the things, as I mentioned, to drive awareness, understanding and demand for our products, working with KOLs and other things to really activate. But the funding for that in part is paid for, if you will, by some strategic moves we made restructuring and other cost management things that we did in October of last year. And the other spend is part of our plan. So in terms of a bolus of spend, I believe that was the question. That is not something that an investor should expect.

Yes. I think the only thing that I would add is Sam spoke to the $35 million multiyear investment that is contemplated to those new product introductions are contemplated in that multiyear investment. And again, just to reiterate that, that investment is contemplated in the guide. So we would expect a modest increase in OpEx year-over-year, again, contemplated in the 2026 guide.

Okay. And what would you say are the top 3 priority catalysts out of the number of things that we are looking out for in 2026?

Yes. First, I would give you the category called MRD. So we've already talked about that. There's a lot of sub catalysts in there, again, starting the testing, getting the MolDX submissions and so forth. Next, I think Prolaris with AI is the important catalyst. Again, that is one of our -- it's a very profitable test for us. It's an important market. And beyond the volume directly for prostate cancer testing, it also has the opportunity to pull through my risk and other tests. And third, I would say it is really about the announcement and being able to initiate a strategic partnership that allows us to further tap into serving the cancer care continuum.

And talking about these new launches, how much of your 2026 revenue that we are guiding do you expect to be arriving from the new launch products versus the existing products?

Ben, do you want to take this one?

Absolutely. So yes, we're excited about 2026 for lots of reasons. Sam's spoken to all of those. The guide, however, is centered on our core products. And so the revenue guide of $860 million to $880 million is focused on our core portfolio. There's an immaterial implication or impact considered from new product introductions in that guide.

Okay. And with your long-term goal, like we have discussed already, what do you think are the key levers that support this growth acceleration? And how do you think ASP plays a trend in those factors?

Yes. So when we think about the long-range plan and the acceleration of Again, Sam spoke very well to the focus on the cancer care continuum. We need to build on our leadership position in hereditary cancer and HRD. We need to expand into offerings in MRD and in CGP. And then when we think about how ASP plays into that, our view regarding ASP as it relates to the hereditary cancer franchise is that there's going to be modest pressure downwards looking forward down 1% to 2% downward. And then Sam spoke to this as well when we think about prenatal and mental health, we expect some stability in ASP there when we look forward across the LRP period.

Okay. And probably one last question in the interest of time. We also spoke about investing to set up the growth inflection coming up in 2027. What do you think are the biggest swing factors in achieving both revenue and margin?

Do you want to start?

Sure. Happy to. Yes. So again, as Sam mentioned, we took some reorganization efforts in Q3 in order to be able to reallocate $35 million in order to accelerate growth. I think that's key in order to enable that acceleration in '26 to set us up in '27 and beyond.

Yes, well answered. I mean the other 2 factors is, listen, we're being very deliberate in a controlled way to increase funding for commercial capabilities. And that will have an impact in the second half of the year and going into next year. And of course, again, it's the new portfolio of products, the pipeline that will set us for not just a good year, but really for 2027.

Perfect. That brings us to the end of the presentation and the Q&A. Thank you, team.

Thank you.

Thank you.

Good day, and thank you for standing by. Welcome to the Myriad Genetics' Third Quarter 2025 Earnings Conference Call. [Operator Instructions] Please be advised that today's conference is being recorded.

I would now like to hand the conference over to your first speaker today, Matt Scalo. Please go ahead.

Good afternoon, and welcome to the Myriad Genetics Third Quarter 2025 Earnings Call. During the call, we will review the financial results we released today. And afterwards, we will host a Q&A session. Our quarterly earnings release was issued this afternoon on Form 8-K and can be found on our website at investor.myriad.com.

I'm Matt Scalo, Senior Vice President of Investor Relations. On the call with me today are Sam Raha, our President and Chief Executive Officer; Ben Wheeler, our Chief Financial Officer; and Mark Verratti, our Chief Operating Officer. This call can be heard live via webcast at investor.myriad.com, and a recording will be archived in our Investors section of our website, along with this slide presentation.

Please note that some of the information presented today contains projections or other forward-looking statements regarding future events or the future financial performance of the company. These statements are based on management's current expectations, and the actual events or results may differ materially and adversely from these expectations for a variety of reasons. We refer you to the documents the company files from time to time with the Securities and Exchange Commission, specifically the company's annual report on Form 10-K, its quarterly reports on Form 10-Q and its current reports on Form 8-K. These documents identify important risk factors that could cause the actual results to differ materially from those contained in our projections or forward-looking statements.

I will now turn the call over to Sam.

Thanks, Matt. Good afternoon, everyone, and thank you for joining us today. I'm pleased with our results, the actions we're taking to execute against our updated strategy, the stepped-up urgency and rigor in how we operate, leading to growing momentum as we head into Q4 and 2026.

Let me start with our results. We generated revenue of $206 million, which decreased 4% year-over-year. When you exclude previously discussed headwinds, including UnitedHealthcare's decision on GeneSight and the divested European EndoPredict business, our business was stable with Q3 of 2024. In addition, there was a material $8.6 million prior period contribution in the third quarter of 2024 that did not repeat. Factoring in these previously discussed headwinds in the prior period change of estimates, year-over-year growth was 5%. In terms of testing volume, our solid results were supported by continued strong volume growth for MyRisk in oncology at 16% over the year ago quarter. We also saw volume growth for MyRisk for unaffected at 11%. This is a meaningful improvement from past quarters and reflects our ongoing efforts to enhance the customer workflow, including EMR functionality. Mark will provide additional color in his section, but certainly, MyRisk continues to see positive demand in the market and supports our profitable growth journey.

GeneSight volume grew 8% year-over-year, accelerating from the first half of the 2025, as our commercial organization continued to focus on medium and higher volume accounts. Prolaris demand continues to be stable, and test volume growth up modestly year-over-year. As expected, volume growth for our legacy prenatal products, Prequel and Foresight, while flat year-over-year, showed improvement from second quarter, as we continue to increase the volume of testing customers affected in Q2 challenges and add new customers.

Turning now to profitability. We generated strong adjusted gross margin of 70.1% in the third quarter and closely manage our discretionary spend as reflected in our adjusted OpEx line. Ultimately, we reported a healthy adjusted EBITDA of $10.3 million. I'll talk about our growth strategy in a moment, and Ben will talk later about our reiteration of the 2025 financial guidance.

Moving to the next slide. I want to spend a few minutes reviewing our updated strategy and why we believe we will be able to deliver accelerated profitable growth in the years to come. Our first strategic pillar is to focus on the cancer care continuum to accelerate growth. We will achieve this by leveraging and growing volume of our leading hereditary cancer test, MyRisk, and also by expanding our portfolio to include other cancer screening, diagnostic and monitoring tests.

Our second strategic pillar reflects our recognition of the opportunity to meaningfully grow prenatal health and mental health revenues at or above market growth. We believe, we can achieve this by leveraging recently launched products and strengthening our commercial execution, while maintaining a disciplined level of investment and resources in these areas. Our third strategic pillar is about our focus and commitment to delivering sustained profitable growth by continuing to leverage our industry-leading gross margin profile and maintaining financial discipline.

Now one can say, what's different about this strategy from before? Well, there are 5 primary differences. First, it's about intentional focus and prioritization of funding and resources on the cancer care continuum opportunity. Second, for our cancer care portfolio, it's about going beyond our strong hereditary cancer and HRD positions and also offering tests for other relevant high-growth applications, including therapy selection and MRD. Third, it's about strategic partnerships. Unlike before, we see an increasing opportunity to serve attractive market applications in a timely manner by complementing Myriad's differentiated capabilities by leveraging select partnerships.

Next, it's about having the right team with deep domain knowledge and proven experience in cancer, diagnostics, genomics and commercial execution to win in a dynamic market. And with the leaders that have joined Myriad like Lou Welebob for Biopharma and CDx Services, Hosein Kouros-Mehr for Oncology R&D, Vishal Sikri for Product, and Brian Donnelly as our Chief Commercial Officer, I'm confident in the strength of our overall team. Finally, it's about strengthening execution excellence, thinking and acting with elevated urgency, leveraging industry best practices for key processes and executing with rigor and discipline.

On the next slide, let me provide updates on the progress we're making on the cancer care continuum strategy, many of which will be important catalysts for accelerating growth in 2026 and beyond. We're on track to launch our updated MyRisk test this month in November, and we expect this to support strong MyRisk growth in 2026 and beyond. In terms of offerings for other attractive high-growth cancer care applications, in September, we entered into a collaboration with SOPHiA GENETICS that enables us to provide pharma customers with biomarker validation and CDx development services using a leading liquid biopsy-based therapy selection assay.

We're making steady progress on our ultrasensitive tumor-informed Precise MRD test and are on track to start offering the test for clinical use in the first half of 2026. First indication will be Stage II, Stage III breast cancer in the neoadjuvant setting. In addition, Myriad will present three MRD studies at the San Antonio Breast Cancer Symposium next month, two of which were just accepted this past week as late-breaking abstracts.

We'll also be presenting six additional abstracts and other oncology-related studies for a total of nine abstracts at SABCS. We're also on track to launch our first Prolaris prostate cancer test that combines the power of molecular and AI, based on our partnership with PATHOMIQ in the first half of 2026. I expect to have more exciting news regarding strategic partnerships to share with you over the coming months. Also, I want to take a moment to share that we are making changes in our organizational design and investments to help improve customer experience, gain market share, and reduce operating expenses as a percentage of revenue going forward.

The actions we are taking will in part result in the reallocation of headcount and funding to support growth in the cancer care continuum. This will include the meaningful expansion of our commercial team and increased funding for commercial launch and market activation programs to support the exciting new products that I just updated you on as well as increased funding for MRD R&D.

On the next slide, let me provide brief updates on our second and third strategic pillars. In June, we commenced early access for our FirstGene multiple prenatal screen that we believe will support growth in our prenatal portfolio volume profitability and has significant potential to expand the prenatal market over time. Mark will provide more details on our experience during our early access and how this supports our optimism for strong commercial launch in 2026. Regarding mental health, we expect to continue growing revenue for our market-leading GeneSight test by concentrating high-value accounts, leveraging state biomarker laws, and building on the success, we've seen over the past few quarters.

In alignment with our overall strategy, we will achieve this growth for both of these businesses while maintaining disciplined capital deployment. The third strategic pillar is about our focus and commitment to delivering sustained profitable growth. The organizational redesign and efficiency actions that I shared with you earlier will support our ability to accelerate top line growth while ensuring we grow operating expenses less than revenue. Before I turn the call over to Mark, I want to welcome our new CFO, Ben Wheeler. Ben certainly isn't new to many of you. And with 14 years of experience at Myriad, he has the knowledge, skills, and demeanor that make him our ideal CFO. Personally, I'm thrilled to partner with Ben in this important time for the company.

Now let me hand it over to our COO, Mark Verratti. Mark?

Thanks, Sam. Turning to oncology. In the third quarter, total oncology revenue was $81.8 million, a decline of 1% over the third quarter of 2024. I would call out that our MyRisk test continues to gain share with volume growth in the affected market of 16% and 11% volume growth in the unaffected market in the third quarter year-over-year.

Shifting to prostate cancer. Prolaris revenue in the third quarter grew 3% year-over-year on positive volume growth and a continued improvement year-to-date. As mentioned on previous calls, we are investing in the commercial channel and other programs to grow and regain share in this market. As an example, Myriad is on track to be the only company that will offer AI, biomarker, germline and tumor profiling testing when we launch our first AI-enabled Prolaris test in the first half of 2026.

I'm also excited to call out a strategic collaboration we recently announced with SOPHiA GENETICS. We expect this collaboration to support the development and global commercialization of comprehensive companion diagnostic solutions for our biopharma partners with the potential to add an important product offering to the Myriad menu and support the growth of our companion diagnostic programs. We look forward to providing an update on our progress going forward.

Lastly, I want to call attention to our September press release regarding our latest MRD publication in Lancet Oncology. Our tumor-informed ultrasensitive Precise MRD test showed clinical value in patients with oligometastatic clear cell renal cell carcinoma, which is a very low-shedding tumor and requires an MRD test in the ultrasensitive range.

Importantly, the study showed that in patients who were Precise MRD negative and maintained on metastasis-directed therapy, and not on systemic therapy, had an overall survival rates of 94% at 2 years and 87% at 3 years. The data is extremely promising because it highlights that using an ultrasensitive test like Precise MRD can potentially identify specific patients on MDT, who can delay systemic therapy and all of its associated side effects based off of their ctDNA status without sacrificing overall survival rates. As Sam mentioned, we are excited and expect to start offering our ultrasensitive Precise MRD test for clinical use in the first half of 2026.

Expanding on MyRisk. With our current momentum in the hereditary cancer testing, now is a perfect time to launch Myriad's expanded MyRisk with RiskScore panel. The team is excited to get this new test in the hands of our customers and drive further growth and build on our leadership in the $6 billion market. This new panel adds 15 actionable gene targets and is the only panel to meet both NCCN high-risk assessment and ASCO strongly recommended guidelines. I can't overemphasize that point enough as guidelines impact provider decisions.

In fact, many of our medical oncologists and genetic counselors, those that work with pan-cancer test populations, have been very interested in our expanded panel in order to not miss any patient who may have a hereditary cancer syndrome that may impact treatment.

Now moving to our women's health business. In the third quarter, Women's Health delivered revenue of $85.2 million, an increase of 3% over prior year period. We're pleased to see incremental positive momentum in hereditary cancer testing in the unaffected market with revenue growth of 4% and volume growth of 11% year-over-year. This improving volume growth trend is particularly important as it reflects EMR-related workflow improvements put in place earlier in the year. And in September, we've completed the integration of our myGeneHistory assessment into EPIC as a way to better identify patients that qualifies for hereditary cancer testing and improve the provider experience, so we are optimistic about the potential for continued momentum. We also remain confident about the ongoing progress from breast cancer risk assessment programs that enable providers to rapidly identify patients who qualify for additional screening.

We continue to see positive momentum at these sites and expect to make further investments in our commercial capabilities to accelerate this program through Q4 and into 2026 to fuel growth in MyRisk volume. As for prenatal testing, in the third quarter, we saw a modest rebound in volume growth from the second quarter and expect this trend to continue. As Sam mentioned, we introduced our multiple prenatal screening test, FirstGene and expect the commercial launch in 2026. This test provides added insights to providers and has the potential to expand the overall addressable prenatal testing market. We are pleased with our turnaround times, assay performance and early customer feedback.

Now turning to mental health. In the second quarter, the team generated GeneSight revenues of $38.7 million on volume growth of 8% year-over-year. We continue to drive expansion of the ordering provider base by achieving a record number of ordering clinicians over 37,000 in the third quarter.

While quarterly revenue continues to be impacted by UnitedHealthcare's coverage policy change in January, we submitted additional data in Q3 and expect to review this quarter as part of their typical review cycle. While we continue to work with United to achieve a successful outcome for both parties, we continue to make forward-looking decisions assuming the status quo.

We are excited and proud of our payer markets team for securing positive coverage policies across 9 states for GeneSight year-to-date related to biomarker laws. Most recently, the California Medicaid program, Medi-Cal, added GeneSight with a September 2025 effective date. In addition, we are seeing benefit from optimizing revenue cycle workflows to maximize reimbursement.

I will now turn the call over to our new CFO, Ben Wheeler.

Thanks, Mark. I'm especially pleased to join you today as Myriad's Chief Financial Officer. Myriad is a company whose mission I've been fully committed to for the last 14 years, and it's an honor to now represent our team in this role. While this is my first earnings call as CFO, I've had the opportunity to contribute to many of them over the years. Let me start with a recap of our third quarter consolidated financial results.

For the third quarter, we reported revenue of $205.7 million, a decline of 4% year-over-year with test volumes up 3%, but average revenue per test down 7%. The growth in third quarter test volume reflects improved execution across our portfolio. As Mark pointed out, the hereditary cancer testing portfolio saw strong volume growth in the third quarter, increasing 11% year-over-year.

Our mental health business saw volume growth of 8% year-over-year as the team continues to hit its stride following organizational adjustments made earlier in the year. The reacceleration in both unaffected hereditary cancer volumes and GeneSight volumes represent important proof points in our improving commercial execution.

The year-over-year headwind in average revenue per test this quarter primarily reflects three factors, two of which we've discussed previously. First, we're lapping a difficult comparison against third quarter of 2024, which included an $8.6 million positive prior period change in estimate versus an immaterial amount this quarter. Second, we continue to see the impact from UnitedHealthcare's policy change with respect to GeneSight coverage, which took effect in January 2025.

The third factor reflects modest shifts in payer mix within our hereditary cancer portfolio that had a larger-than-expected impact on average revenue per test in the third quarter. As you know, payer mix can be quite fluid, and it's something we actively work to manage through our commercial targeting and revenue cycle and payer markets teams. Our fourth quarter assumptions for average revenue per test take these third quarter dynamics into account. This quarter, these 3 factors have masked our strong ongoing work by our revenue cycle, payer markets and clinical development teams as well as the generally stable reimbursement landscape. As we mentioned last quarter, we're encouraged by the progressive stance some payers are taking towards ECS coverage, even in the absence of updated ACOG guidelines, and the ongoing traction we're experiencing with health plans that have implemented medical policies that conform to state biomarker legislation. We expect these positive trends to continue supporting prenatal and GeneSight reimbursement in the quarters ahead.

My last comment on third quarter revenue. Sam referenced an underlying third quarter 2025 revenue growth rate of 5% after taking into account the impact of certain items on our Q3 2024 baseline, namely UnitedHealthcare's net impact on GeneSight of $7 million, the divestiture of our EndoPredict European business of approximately $1 million and the $8.6 million impact from prior period change in estimate in the third quarter of 2024 that did not repeat this quarter.

By calling out these items, we're able to show what we consider to be a clear view as to Myriad's underlying performance trends. Even with these headwinds to third quarter revenue growth, we maintained adjusted gross margins of approximately 70%. This reflects a favorable test mix, continued operational efficiencies in our labs and underscores the strength and scalability of our business model. Third quarter adjusted operating expenses decreased by $1 million year-over-year, reflecting continued cost discipline across SG&A. We remain focused on maintaining the right balance between investing for future growth and driving profitability with a deliberate effort to allocate resources to our highest strategic priorities.

Next, I'll speak to Myriad's profitability and liquidity. We generated $10.3 million of adjusted EBITDA and $18.6 million in adjusted free cash flow in the third quarter. Our strong adjusted free cash flow in the third quarter reflects the timing of collections from certain payers, as we noted on our second quarter call, and we don't expect this level of free cash flow generation to repeat in the fourth quarter. That said, the combination of our strong gross profit base and positive adjusted EBITDA demonstrates the leverage inherent in our operating structure and the profit and cash-generating potential of the business.

Lastly, we have a solid balance sheet and access to $220 million in capital. Next, I'll talk about additional steps we are taking to drive business results. As part of our strategy to drive sustained profitable growth, we have launched a multiyear program to invest more than $35 million in strengthening our commercial capabilities with a focus on the cancer care continuum. This investment will be primarily funded through the company's streamlined structure, continued emphasis on organizational efficiency and disciplined capital deployment. Three core areas of future investment include: one, the expansion of our commercial organization, this includes meaningful growth in our field sales team and optimizing the structure and management of target territories; two, the enhancement of commercial capabilities and tools to support new product introductions and commercial excellence; and three, increased funding for strategic R&D programs, which includes current and future clinical studies for MRD as well as other areas.

Part of our organizational redesign is to move to being organized functionally going forward. With this, we're reducing management layers and eliminating other roles. We believe these important actions will accelerate revenue growth and generate long-term value.

Before I conclude, I'll cover our full year 2025 financial guidance. Based on our Q3 performance and our expectations for the remainder of 2025, we're reaffirming our full year financial guidance, which includes a revenue range of $818 million to $828 million, a gross margin range of between 69.5% and 70%, and adjusted OpEx range of between $562 million and $568 million as well as an adjusted EBITDA and adjusted EPS guidance ranges of between $27 million and $33 million and a loss of $0.02 and a gain of $0.02 for the full year 2025, respectively.

Now let me turn the call back to Sam.

Thanks, Ben. Considering breast cancer awareness month in October that just passed, I want to take a moment to reiterate Myriad's long-standing commitment to supporting patients and health care providers with breast cancer risk assessment and medical management tools. We will continue investing in tests that help improve breast cancer care. As we noted earlier, our MyRisk with RiskScore test is considered an industry gold standard, and we're looking forward to launching the expanded panel later this month. And then in the first half of 2026 to launching our first Precise MRD test for breast cancer.

As for the third quarter, we demonstrated good progress across our commercial operations and development teams. Strong volume growth for a number of our tests supported this quarter's performance, while our overall gross margin remained resilient and among the industry's best. This, combined with our ongoing focus on operational leverage, allowed Myriad to drive another quarter of positive adjusted EBITDA while investing for future growth. With clear actions now being implemented to support the execution of our updated growth strategy, the Myriad team is energized to deliver on our mission to advance the health and well-being for all, positively impacting an increasing number of patients while driving accelerated profitable growth.

I'll now pass the call over to Matt for Q&A. Matt?

Thanks, Sam. And as a reminder, during today's call, we used certain non-GAAP financial measures. A reconciliation of the GAAP to non-GAAP financial results and a reconciliation of the GAAP to non-GAAP financial guidance can be found in our earnings release and under the Investor Relations section of our website.

Now we're ready to begin our Q&A session. [Operator Instructions] Operator, we're now ready for the Q&A portion of the call.

[Operator Instructions] And our first question will be coming from Puneet Souda of Leerink Partners.

Maybe, Sam, a higher-level question here. With the commercial focus and the investment you're talking about, can you talk a little bit about what are some of the offsets and the savings that you're able to manage as you go into 2026? How should we think about growth as a result of these investments? And obviously, profitability has been, as you pointed out, an important piece of the story. So how should we think about adjusted EBITDA in 2026, just given the focus in pushing for growth? I just want to understand a little bit in terms of the growth versus profitability focus that you have emerging on this call.

Yes, Puneet, thank you very much for the question. And let me start and then Ben, I'll turn to you to add more color. So first, let me reaffirm embedded in your question, we are committed to profitable growth going forward and being able to accelerate that, as you know, we've talked about, by focusing in on the cancer care continuum.

So the actions that we took related to the organizational redesign and changes in our investment focus, those actions, including, and Ben spoke to this already, reorganizing in a way where we believe we're going to be able to serve customers, be able to increase our win rate. This includes, in some instances where we've taken out multiple layers of management, we've made other choices on positions that we've deemed to be less critical than other ones that are related to having more feet on the street, if you will, to compete, and particularly timed with new upcoming product launches that we have that you heard me talk about. So between that and reallocation of investments, we are committed to growing revenue faster than we grow operating expenses. So that part of the profitability along with growth remains intact. I said a lot there, Ben. What would you add?

Yes. I would just say that the actions and the focus is absolutely consistent with the strategy as we focus on the cancer care continuum, and we want to grow revenue at an accelerated rate, and we want to do it profitably. We felt like we could rebalance the organization and focus on growth in the cancer care continuum by expanding the sales footprint and focusing on tools and also R&D to support that, and we believe that we can do that.

Okay. And then a question on the NIPT side. Just wanted to get a sense of -- it does look like you came in softer versus us and consensus as well, just wondering if there was any share shift that you're seeing in the market. I know you talked about that you grew sequentially, but -- just wondering, given new entrants in the marketplace, mother-only blood draws with a competitor, others that are pushing it more aggressively into market, maybe just help us understand what you're seeing on the market end versus Myriad's position, and if you're seeing any share loss?

Yes. So, Puneet, thank you for this question, too. And you might recall, we had some challenges that were related to our operational execution matters that were in Q2, which we've fully addressed. And we had predicted that it would take us multiple quarters to gain back to the level of growth that we'd expect, right, to be able to grow at or above market, which means at least in the single digit for volume, if not higher, because we do have the new products, which we've seen good traction from, be it Prequel at 8-week gestational age, Foresight with the expanded carrier screening. And most recently, we've also added F8 and FXN.

So we're actually -- we have seen improvement where we actually decreased in volume, I think, 7 percentage points last quarter, and we talked about volume being flat. Now are we happy with flat? Heck no. We want to gain -- go back to being able to grow at or above market, but we're pacing actually exactly as we had anticipated and we had kind of shared with you.

Now are there others that are growing and that are coming to market? Yes, that's a fact. I'm not commenting on that, but we are, by the way, excited about the opportunity to accelerate our own growth with FirstGene, which Mark talked about in his comments, which will be the combined 2-in-1 screen for NIPS together with carrier screening.

And our next question will be coming from David Westenberg of Piper Sandler.

I'm going to actually follow on Puneet's question on NIPT business. Can you give us some color on the friction on the new ordering management system, why that is lasting into this quarter and why that wouldn't maybe necessarily end in the second quarter? And then just in terms of that market dynamics that he kind of discussed here, can you talk about how single-gene NIPT would play a role in kind of maybe some of the growth that you'd receive next -- or see next year? Do you expect any data differences, particularly after you complete the CONNECTOR study? And maybe can talk about some of those long-term differences you might see versus some of those long -- versus some of those competitors? And I'll have one quick NIPT follow-up.

Yes. Thank you, Dave. Appreciate the question. Let me start, and then I'll invite Mark in answering with me here. Again, we wish we can just snap our fingers and gain back all the customers in the volume. I think we had described this previously. The matter is that many of the high-volume customers that we have, they are working with a -- us and a couple of other often -- other providers for these prenatal tests. And when we work through our -- when we have the challenges, which again, have been completely addressed, that led to some shifts in volume away from us. So we are improving on that. That's why we've gone again from 7% volume decline back to flat in terms of our volume. Again, that's not where we want to be.

We're right on track to being able to now show volume growth in the coming quarters. It just takes time to regain and also to add new customers, and we have done that. It's just -- it's something that you just can't make happen much quicker than that. Second part of your question is related to FirstGene, again, our screen that combines NITS together with expanded carrier screening. And we are excited about that, Mark. Maybe you can talk a little bit about both what we've seen so far as well as why we think it's going to help us expand the market.

Yes, sure. Thanks, Sam. Look, I think we knew when we started developing FirstGene that there were a couple of challenges within the carrier screening space. Number one is providers just didn't have enough time to really talk about all of the benefits, and there was a little bit of complexity in terms of ordering the products. Number two, we knew that only 30% of the time, fathers were also getting screened. And so we knew that there would be an advantage of having a single test where you only need to test the mother and then have the ability to look at the fetal recessive status.

So since then, obviously, some competitors have entered the space, and they've had success. So if anything, that's just validated, what we already knew and has given us some greater conviction around the product that we're going to be bringing to market, we know that our product is going to be competitive from a scientific clinical perspective. Based on the footprint that we currently have, we're excited to be able to bring it to our providers. And so we think we will have a very, very competitive test that will have lower gross margins moving forward than our current product. So we are excited to be launching that next year.

And Dave, you had asked a part of that. Yes, we believe this will help expand the market, the market opportunity for us and accelerate our growth, not relative to the 0% volume growth, but relative to being at or above market. So beyond what we really were previously, we should be getting back, it's growing faster than that.

Got it. I just want to maybe ask one more on just kind of the revenue opportunity growth from an ASP perspective in the coming years. Do you think that there's -- or can you remind us if you're getting paid for RDH (sic) [ RHD ]? When do you think you could get that -- see that happen? Any update on ACOG, microdeletions or expanded carrier screening? And then lastly, on that single-gene NIPT offering, as I understand, you would be not, no longer receiving the father -- or no longer running a father sample. Is there a chance to go back to reimbursement in the future for an additional reimbursement for that given the fact that you are saving the system money by not getting the father or testing the father?

Yes. Thank you, Dave. I think you had quite a number of important questions built into. First, let me just provide some facts on that. what we provide today does not have RHD. So we're excited that when we actually launch this product that RHD will be included in our FirstGene offering. In terms of ACOG, we remain intrigued and interested and fully ready to catch the wave when ACOG guidelines are introduced. Important point related to ASP there, we have seen a number of payers in advance of that starting to see the value of the fuller expanded carrier screening and starting to reimburse for that. So that's good news. We expect that to continue as it is. Mark, do you want to speak to maybe the third question is related to opportunity father reimbursement related.

Yes. Look, I think, we will -- as we continue to generate clinical evidence, and as you know, some payers will require us to get a very specific code for our FirstGene products, I think we are excited to have those conversations, but if you think about the time that it took to get expanded carrier screening, we're not necessarily going to rely on anything happening quickly within the reimbursement market. But for sure, any time, innovation comes out, if we can get it quickly adopted into guidelines, we'll be sure to be talking to payers about trying to get increased reimbursement because you are right, it is a win-win for both patients as well as those that are reimbursing it.

Our next question will be coming from Dan Brennan of TD Cowen.

This is Kyle on for Dan. I wanted to shift over to the hereditary cancer side of the business. Volume grew 11% year-over-year off a pretty strong number Q3 last year. Just digging in a little bit, with any of the 3Q volume growth, sort of, any catch-up from the EMR issues you experienced in the last few quarters? And then maybe on that, I know some peers have really put up some pretty strong numbers in the hereditary cancer testing side. Is there anything going on in the market that's really accelerated over the last 11 months?

Thank you for the question, Kyle. Yes, and we are pleased with the performance we had for our overall hereditary cancer portfolio, particularly for MyRisk, which will play an even bigger role going forward, as you heard us talk about with the launch of the updated expanded panel that we have later this month. I think you also asked, like is there anything specific going on? Is there a catch-up? I don't think so. The testing that has to happen as it relates to the oncology patient that happens in a very timely manner, we've continued to be strong there.

What we have done, as you heard Mark talk about in his section, is we have continued to make improvements to the workflow for the actual customers. Some of the challenges that we weren't as easy to work with, we've improved on. We've had some improvements on the EMRs, the EMR part of the ordering and reporting journey. So those things, I think, have -- are starting to show fruit along with what Brian and his team have been doing have really been starting to drive. And I think we're still early days of our programs like the breast cancer risk assessment program and other things to really help those in the unaffected providers and health care systems better identify and bring patients forward. And I think that there's a lot more to come there.

And the overall market, again, as a reminder, that market is closer to $5 billion, less than 50% penetrated, and it's a great market development opportunity for us and perhaps other competitors in the space. So I don't know, Mark, if you or Brian have anything to add about anything in the market, but what it does reaffirm for us, our results, and maybe the broader dynamics is a great foundation for Myriad with our gold standard tests to continue really growing profitably in '26 and beyond.

Got it. And then maybe on the partnership side, you announced the PATHOMIQ partnership earlier this year, you just announced the SOPHiA partnership. Where in the portfolio might you be looking to add more of these partnerships in the near term?

Yes, great question. Our primary focus is, first and foremost, related to the cancer care continuum. And we are excited, by the way, by both of those partnerships. And for the Prolaris partnership with PATHOMIQ, as I said, it's -- and now that Brian is here, we're also -- him and his team are working in partnership with Mark and others to think about excellence in commercial launch, and that's why we're thinking about exactly how to sequence that into the first half of the year.

In terms of next, where to look, what I would tell you is we are particularly interested in partnerships that allow us to expand into these high-growth attractive market segments of the cancer care continuum. SOPHiA is a great example of that. We knew that we needed an offering starting with -- for pharma partners in liquid biopsy for therapy selection using a comprehensive genomic panel.

We're starting by leveraging the work that both SOPHiA have done in partnership with MSK. MSK-ACCESS is their liquid biopsy assay. So we're excited to start there with the option to provide that liquid biopsy assay down the line for clinical use for clinical testing. And if you think about the other exciting areas, important high-growth areas, that include other elements of therapy selection. It includes areas such as IO therapy response monitoring, other things we might be able to do to go even faster in MRD.

Now, I'm not saying we're going to do all these, but these are illustrations of some of the things that we're deeply thinking about that we think would add value to the customers that we serve with a more comprehensive portfolio, but help us, also in a profitable way, accelerate growth.

And our next question will be coming from Lauren Timmins of Jefferies.

This is Lauren on for Tycho. Just to kind of level set the volume growth and top line performance for HTT, in particular, revenue was down still 4% year-over-year, even though you had 11% volume growth. So maybe just kind of what were some of the biggest mix and ASP effects and how that is going to evolve, especially with the cancer tests targeted November 2025 launch? And then the second kind of follow-up question there in terms of the cancer care continuum. What are some of the specific, I guess, KPIs, whether that's integration pathways with oncology networks, EMR-triggered orders that you're going to be looking for, for targets for 2026?

Thank you, Lauren. Appreciate the question. Why don't we start with you, Ben, to help with the first part, and then you can start with the second question? Mark, you can help with that one, too.

Sure. Yes. Thanks for the question. So we touched on the primary drivers that resulted in 4% decrease in revenue year-over-year. ASP was the driver of that. And the biggest pieces of that change year-over-year, naturally, we're still feeling the impacts of the medical policy change from UnitedHealthcare as it relates to GeneSight. Sam also referenced the $1 million impact for the divestiture of our EndoPredict business. So the combination of those 2 things were an $8 million headwind in the quarter year-over-year, and that resulted in flat revenue when we compare this year's Q3 relative to last year's Q3.

And then Sam also referenced the change in estimate to revenue that benefited last year's Q3 of nearly $9 million that did not recur this year. So the combination of those 2 headwinds, when you adjust for those, we're looking at about 5% revenue growth year-over-year. And then in my prepared remarks, I talked about a couple of additional items that impacted ASP during the quarter. So as it relates to the enterprise, we had product mix that impacted our ASP, and then when we think about hereditary cancer specifically, we had some payer mix that impacted ASP.

So we've been really pleased with the progress that we have made with our biopharma business, really strong ASPs in connection with that revenue, but that revenue is also lumpy. And because it is lumpy, we had some adverse effect to our hereditary cancer ASP as a result of the lumpiness of that biopharma hereditary cancer revenue in the quarter. And then we also had some impact to ASP for hereditary cancer as it relates to some out-of-period revenue, although it was not material to the organization during the quarter, it did have a little bit of an impact on ASP for hereditary cancer.

Mark, do you want to take a little bit of the first question?

Yes, Lauren, related to the KPIs, and we'll provide more of this as we get into 2026, probably at JPMorgan sort of beyond. But I think in addition to the standard KPIs, when you think of volume as well as revenue, I think as we think about the cancer care continuum, we'll be looking a little bit more into the providers that are actually ordering our test and thinking about how are we expanding that provider base as well as providers that are using multiple of our products.

So we have several of our top customers today that we've heard from who want to just use a single lab like Myriad. And so I think our ability to be able to sell into that channel for both hereditary cancer, HRD, MRD, and our full continuum will be something that we'll be sharing in the future, but that's just a glimpse, but we'll share more at JPMorgan.

And our next question will be coming from Subu Nambi of Guggenheim.

This is Ricki on for Subu. I wanted to ask another on women's health. I know a lot has already been asked, but you're quite differentiated in offering Prequel at 8 weeks. That's a week earlier than the blood draw for most of your competitors. And that time line advantage, though, is only really clinically meaningful if the patient and the physician are receiving their results sooner than the competing tests that are offered for a 9-week blood draw.

So if your results take a 2-week turnaround, then the competitor takes a week after drawing the sample at 9 weeks, both of you are delivering results in the 10th week of gestation. So with that context, what is your current average turnaround time for your Prequel results today?

Yes. I mean, I'll let Mark take this in more detail, but I believe our turnaround times for almost all of our products are industry standard or industry best. So there's not like an extended period. Mark, you know offhand.

Yes, let me add to that because -- and I don't disagree with what you articulated other than I think the turnaround time of when they get the result isn't as important as when the patient is showing up. So for our providers who like to see the patient at that 8-week time frame, when the provider is showing up, they're able to use our test at that time. So it's more about patient convenience, and it's more about workflow as opposed to when they're getting the result on the back end.

That said, as Sam mentioned, we have very, very competitive turnaround times. So often, they will be getting the answers, maybe 1 week sooner. But again, it's probably less about getting the result 1 week sooner as opposed to meeting the patient when they're coming into that OB/GYN office at that 8-week time period. And again, maybe that's not important to all of the providers, but to those that really care about it, that's where Myriad shows up best.

I see. That's really helpful context. And then maybe just as a follow-up for FirstGene, do you expect to have a similar turnaround time given that it's more of a combined assay, and then FirstGene is launching with the 9-week blood draw? I'm just curious if you're working in R&D on moving that up to 8 weeks as well.

Mark, do you want to take this one?

Yes. So we do expect to, when we launch fully commercially to move it to 8 weeks as well to answer that question. And we also expect a very similar around -- similar turnaround times as well. So yes, I would not expect any major delays related to the FirstGene test.

And just to add, Mark, you had said in your prepared remarks, we've been pleased so far with the sample we've been running, the efficiency, the yield internally, all of that has been working really well. So there's no reason to believe as we ramp into full commercial launch that we shouldn't continue to have really, really tight turnaround times.

And our next question will be coming from Lu Li of UBS.

Great. I think the first one on GeneSight. You're expecting the volume to be mid-single digit to high single digit. And then you also highlight some of the reimbursement win from like California Medicaid. So how should we think about the ASP assumption for 2026?

Yes. I'll start, then Mark and Ben, I'll look at to both of you to answer it. So, Lu, first, I will say very pleased with the team, both our commercial team as well as our payer team, if you will, on our rev cycle and payer market teams, both for being able to really be targeted and engaging customers. And you saw in Mark's slide, we had a record number of new prescribing physicians that also ordered GeneSight within the quarter.

So the results -- remember, we're saying we should be growing at about the mid-single digit. We performed a little bit better than that this quarter. We're pleased by that. And I think in one of your prepared remarks, you also talked about the number of payers we've continued to add on for GeneSight, 9 new states beginning of the year, right, related to biomarker laws. But as it relates to ASP and what to expect next year, either you guys know we're not providing guidance for 2026. Is there any color that either of you would want to offer?

Yes, sure. I'll just maybe repeat that both Mark and I touched on the fact that we've been really pleased to see health plans implementing medical policies in compliance with the biomarker laws. And none of those medical policies have a significant impact in isolation, but we continue to work towards having wins everywhere that we can get those, and we'll continue to do that going forward. And so our expectation is that we will continue to have support with ASP for GeneSight. And like Sam said, we'll talk more about 2026 at a future date.

Got it. And then second question. So I think you touched on some of the organizational structure change. And you also mentioned there's -- and then you're going to shift some of the resources to kind of funding your key programs, but I guess, I wanted to get a bigger picture. Are you expecting any kind of like lower OpEx, like any sizing of that? Like any other areas that you expect to have more lower OpEx in addition to reallocation of the R&D, if that makes sense?

Yes. No, let me start, and then you can add here, too. Listen, again, this is a very deliberate set of actions we've taken, all with the intention of being able to serve our customers better, show up, cover more accounts and improve the overall customer experience and win more. And specifically, some of the things I can tell you maybe answers your question is we will be adding a very meaningful number of additional sales-related positions. That's part of where the savings, if you will, related to our other actions are going to be applied as well as other programs really related to activating the new product launches that are coming up, right, be it the PATHOMIQ, Prolaris launch that we have the, of course, MRD being the most important one. And on MRD, it's both the programs on the marketing activation side, but it's also further on R&D for MRD R&D that we're going to be adding. So that's a high-level answer. I don't know if, Ben, if there's anything you would add to that.

Maybe the only thing I'll add is we'll focus on investment to support our account executives with tools to enable them to be effective in the work that they do.

And our next question comes from Mason Carrico of Stephens.

This is Ben on for Mason. Just on the PATHOMIQ, Prolaris combination test, could you give us some insight into the cadence of clinical data releases on this assay? What should we expect to see, call it, over the next 12 months?

Well, thank you for the question, Ben. We are going to be launching the test, our first combined test in the first half 2026. And again, this will combine our leading molecular test with the AI capabilities, looking at morphology and sting slides and really being able to draw conclusions on that. And the combination of which we believe will drive an increased level of clarity and to help physicians on what they do in treatment. So this is our first test, and it's at the time of biopsy.

What we have planned then for some time in 2027 is another -- the next follow-on offering, if you will, which will allow us also to start addressing parts of the overall prostate cancer segment, which includes what happens post radiation or post radical prostatectomy. So that's a future product to come. But right now, our focus and what we've seen a lot of interest from customers in anticipation is for our first combined product launch in the first half.

Great. And you've highlighted the progress you've made reducing no-pay rates and tightening your RCM initiatives. Would you be able to quantify how much of the 2025 ASP benefit has come from some of these operational factors versus really the new coverage wins? And how much runway remains on the operational side?

Ben?

Sure. Yes. So we've talked about the fact that about 1% decrease in no-pay rate is worth about $8 million or so in revenue. Now it's important to remember that with the change in UnitedHealthcare medical policy, it really muddies the water in changes in no-pay rate year-over-year. We had talked about being at about 42% in 2024, and from a comparison standpoint, it's an apples-to-oranges. And so we're not in a position to quantify the benefit of the impact that we have had this year, but I'll say that we continue to focus on improving no-pay rates and optimizing revenue cycle management.

And then just maybe one more thing for context, as we think about where no-pay rates can go, if you think about across the portfolio, our most mature products in the hereditary cancer space, we're still looking at about a 30% no-pay rate. And so we'll continue to focus on reducing and improving no pays, but that just gives you an idea that the best case scenario from a no-pay rate standpoint, you're still looking at 30% plus with a really, really mature product portfolio. And then I would just add summary of that is we think that there are many years of opportunity and goodness from continued improving -- or focusing on rev cycle improvements to the ASP.

And our next question will be coming from John Wilkin of Craig-Hallum.

So it looks like your MyRisk volume in the unaffected segment ticked up pretty meaningfully versus the last 2 quarters this quarter. And I know you guys have talked about some headwinds that you had seen in Q4 and going into Q1 just with delays in EMR integrations and such. But could you just parse out what you're seeing now that's driving that acceleration and how you see that continuing into the future? And also if you think the expanded MyRisk panel is going to drive any incremental acceleration on top of that?

Yes. Thank you for the question. And, I think, as I might have mentioned, we are pleased with the continued improvement in the performance of the unaffected part of the market with MyRisk. And yes, it is the results and the meaningful impact or the pickup in the volume growth is a combination of really working on the pain points or the areas we can improve on the customer workflow includes the work that's being done by our teams related to EMR abilities, also just thinking -- working with the customers on what does it really take from day 1. It's not just about turning on the EMR, but what is the real experience like, what's happening in the office when orders are being placed, what are the questions that they have?

So all of those things through customer success managers and other positions we've instituted, I think, are starting to make a difference. I think, again, also, we've done certain things related to our programs. We've learned ourselves as we're implementing these breast cancer risk assessment programs to continue to iterate and make those even more fine-tuned to drive value for our customers. So again, trying to identify and be able to identify, and then engage with patients for testing. So all of those activities, I think, have started to show some real promise and real impact already.

There's no reason, by the way, to think that, that's not going to continue staying strong and get stronger as we implement more programs. And yes, we absolutely believe now having an updated expanded MyRisk panel, which, again, will launch this month, will only help support the growth at where we've been or even further. And Mark, I think you had in your prepared comments, this will be -- this panel will be the only one related to -- can you just state those words, the NCCN?

Yes. It's the only panel when you look at the NCCN guidelines as well as the ASCO guidelines, they actually parse out sort of different levels. And so for NCCN, it will be the only panel that includes all the high-risk genes that they recommend as well as on the ASCO side, the ones that are strongly recommended.

So the takeaway is we believe that this will be a very important catalyst for growth going into '26.

Got it. That's helpful. And then just on GeneSight, it sounds like you alluded to that your investments in that business going forward are kind of assuming that there is no change in UnitedHealth coverage, which seems prudent. But does that imply that, that business is going to be maybe less of a priority within the commercial organization? And just how do you balance that with the fact that -- I mean, it seems like that business has seen, excluding the UnitedHealth impact, a lot of momentum this year with added payer coverage decisions and more clinician adoption.

Yes. Listen, I mean, we are pleased with the performance of GeneSight, and we really appreciate the hard work and efforts in a very focused way that our teams have been taking, again, both on the commercial side as well as on the payer market side and so forth. So we think it continues to be an important part of our portfolio. But what we have said very explicitly is in this new phase of Myriad, this new time of Myriad, we are incredibly deliberate, focused and disciplined on what we prioritize, particularly related to development and other growth. And that's really the point on GeneSight.

And I would now like to turn the call back to Matt for closing remarks.

Thanks, Latanya. This concludes our earnings call. A replay will be available via webcast on our website for 1 week. Thank you again for joining us this afternoon, and have a good night.

And this concludes today's program. Thank you for participating. You may now disconnect.