Exagen Inc. Q4 FY2025 earnings call

• Continuing to expand ASP, executing revenue cycle optimizations and market access initiatives, engaging with payers. - New biomarkers launched in early 2025 are earning traction, combined T cell and RA33 ASP approaching $80 per test by year end, Pad 4 biomarkers expected to contribute at least $10 to ASP over time. - Revenue cycle initiatives in 2025 generated over $1.5 million in cash collected on claims older than 360 days. - Pharma services offering momentum robust with $1.7 million revenue in 2025, over $4 million backlog. - Aggressively managing COGS by streamlining lab workflows and reducing supply chain costs. - Exercising strong expense discipline, directing incremental spend to commercial and R&D while holding G&A line. - Prioritizing inflection to positive EBITDA and managing expenses through that lens without compromising new product pipeline.

Pharma services offering: 2025 revenue was $1.7 million (up from $100,000 in 2024), backlog value over $4 million expected to be realized in next 2 - 3 years. Gross margin: 2025 was just over 58% vs about 60% in 2024, reflecting ASP pressure in second half of 2025. COGS for CTD tests tracked well below internal target in 2025. Expenses: 2025 operating expenses $53 million, up about 13% vs 2024. SG&A $47 million, increase of 13% due to commercial talent investment and territory expansion. R&D $6 million, up 16% to support new markers launch and pipeline development. Adjusted EBITDA loss $9.8 million in 2025, moderate improvement over 2024. Cash: Ended 2025 with cash, cash equivalents and restricted cash just over $32 million.

• Expect total revenue for 2026 to be $70 million to $73 million with volume and ASP growth contributing. Midpoint assumes high single - digit volume growth and low single - digit ASP growth from Q4 2025 in - period ASP rate. - Believe the business will reach break - even adjusted EBITDA and begin to generate cash at roughly an $80 million revenue run rate, revenue threshold up moderately due to increased investment in long - term growth drivers. - Confident in achieving positive adjusted EBITDA as thresholds are crossed.

• Uncertainty in projecting ASP trajectory in terms of timing and magnitude. - One - time setback related to Northwell volume which was a short - term impact but needed to be transparent about. - Dependence on successful commercialization and payer engagement for new biomarkers and other products.

Q: Dan Brennan from TD Cowan asked about the appropriateness of making investments and reaching profitability target, and about myositis commercialization target.

A: Jeff and John responded discussing reasons for making investments for durable cash flow positivity, R&D pay - off, balance sheet strength, and myositis development with goal of having offering ready for clinic in 2027.

Q: Kyle Mixon with Canaccord Genuity asked about volume and revenue mix from direct bill accounts, Northwell volume, and ACR support.

A: The response framed volume from direct bill accounts was 2% of overall volume, revenue impact about $25 contributor to ASP, Northwell volume transitioning well, and ACR support through education campaign and advocacy into commercial insurers.

Q: Bill Vanilla with Craig Helm asked about Q4 ASP, gross margin pressure, etc.

A: Response discussed not disclosing in - period ASP but reset to about 430, gross margin pressure due to added new biomarkers with increased COGS per test despite better than expected cost.

Q: Mark Massaro with BTIG asked about new biomarkers payment traction and LCD for rheumatologic disease.

A: Response talked about new biomarkers ASP approaching $80 range and expected to reach $90 range by 2027, Pad 4 biomarkers expected to contribute at least $10, and LCD in progress with regular contact with Moldex and waiting for draft.

Q: Matthew Parisi with KeyBank Capital Markets asked about Salesforce ramp and full year test volume.

A: Response said 45 sales territories in US, 5 additions to team, full year test volume 137,004 advised CTD tests.

Q: Andrew Brackman with William Blair asked about volume growth drivers and halo effect of new markers.

A: Response said growth in number of ordering physicians and orders per physician, and halo effect still early innings in terms of growth related to new markers.