BillionToOne, Inc. Q4 FY2025 earnings call

• Exceptional 2025 performance: Achieved 100% year-over-year revenue growth, adjusted EBITDA margin of 13%, positive GAAP operating margin and cash flow. Test volumes grew 51% and ASP grew 35%. COGS per test decreased by over 10%, gross margins improved by 15 points, and GAAP operating margin improved by 36 points. - Product pillars: Revolutionary technology platform with QCT technology enabling unique prenatal and oncology products. Superior gross margin profile with margins above 70% despite subscale ASPs and underutilized lab capacity. Capital and operational efficiency enabled GAAP profitability while growing at triple-digit rates. - Fourth quarter highlights: Launched multiple products in prenatal (expanded Red Blood Cell Fetal Antigen NIPT, first-and-only Platelet Fetal Antigen NIPT) and oncology (Northstar PGx, Northstar Select CH). Q4 test volume reached ~170,000, up 47% year-over-year. Added record number of new active ordering providers. - 2025 financial highlights: Total revenue $305.1 million, up 100% from 2024. True-up revenue $17.1 million, up from $11.2 million in 2024. Tests delivered grew 51%, ASP grew 35%. Operating income $16.0 million, adjusted EBITDA $38.8 million, 13% margin. Cash flow from operations minus capital expenditures $9 million in Q4 and $16 million for 2025.

In the fourth quarter of 2025, total revenue was $96.1 million, up 113% year-over-year. Prenatal revenue was $86.9 million, up 98% year-over-year, reaching an annualized run rate of $348 million. Oncology revenue was $9.1 million in the fourth quarter, up 736% year-over-year, achieving a $36 million annualized revenue run rate. Overall ASP increased another 12% quarter-over-quarter from $501 to $561. Gross margins were 71.4% in Q4, a 14.3 percentage point year-over-year increase. For full year 2025, total revenue was $305.1 million, up 100% year-over-year. Tests delivered grew 51% to 610,000. Overall ASP grew 35% to $495. Operating income was $16.0 million, versus an operating loss of $47.1 million in 2024. Adjusted EBITDA was $38.8 million, a 13% margin.

• Raised 2026 total revenue outlook to $430 million to $445 million, representing 41% to 46% growth compared to 2025. - Continue to expect positive GAAP operating income for 2026. - New revenue guidance is a $15 million increase at both ends of the range over previous guidance of $415 million to $430 million. - Drivers for 2026 growth: Continued expansion of prenatal portfolio, including clinical guideline changes, new product launches, and Medicaid coverage. Oncology growth from new product launches (Northstar PGx, Northstar Select CH) and Northstar Response MolDX coverage submission. Contracting with UnitedHealthcare as in-network provider.

Q: Andrew Brackmann asked about awareness of UNITY among providers and driving higher awareness in 2026 and beyond.

A: Unaided awareness around 30%, aided around 50%. More than 50% market share if providers know about UNITY. As sales team grows, coverage expands, and products and guidelines improve, awareness will increase.

Q: Daniel Arias asked about new provider number for Northstar and how to think about it.

A: Q4 had record number of new active ordering providers. A high bar for active providers (not just 1-2 tests). Strong signal for Q1 test volume.

Q: Mark Massaro asked about United contract covering which products and impact on ASP.

A: Contract covers prenatal and oncology products. Typically, contracts don't decrease ASPs. Can get reliable reimbursement, higher than blended ASP basis in many cases.

Q: Subbu Nambi asked about what went according to plan, exceeded expectations, and areas for improvement in 2026.

A: Everything has gone according to plan. Some areas like time spent on conferences could be improved. Upside from drivers not in guidance.

Q: David Westenberg asked about details on raising guidance in last 2 months.

A: 2/3 of increase from stronger test volumes in Q4, 1/3 from higher-than-expected true-up revenue. New year guidance didn't incorporate United upside or other recent drivers.

Q: David Westenberg asked about CMS conversations for Northstar Response.

A: MolDX covers treatment monitoring concept. Started conversations, but coverage decision takes time, planned for end of year for Medicare lives.

Q: Casey Woodring asked about therapy selection competitive market, oncology volume growth split, and average test order per month for Northstar Select.

A: Therapy selection competition is overcome by flywheel effect with advocates. Guidance incorporates sales rep growth for oncology volume growth. No specific number for average test order per month for Northstar Select.

Q: Brandon Couillard asked about ASP growth from Q4 baseline and true-up revenue in guide.

A: Revenue guide exclusive of true-up revenue. Overall ASP computation includes true-up revenue, adjustments may be needed.

Q: Brandon Couillard asked about sales force expansion plans for 2026.

A: Prenatal to grow from ~150 to 185 reps, oncology from ~45 to 65 reps by end of year. Systematic growth to maintain service quality and GAAP profitability.

Q: Noah Kava asked about health systems opportunity sizing and timeline, and OpEx phasing.

A: Health system opportunity per system 10,000-30,000 tests per year. Time needed for EMR integration, not incorporated in 2026 guidance. No phasing issues in OpEx, balanced plan.