William Ruby

William Ruby asked about the company's cash position after achieving adjusted EBITDA positivity and utilizing ATM proceeds, and whether additional cash cushion would be needed in 2026. He also inquired about potential upside levers to the 2026 guidance and any additional evidence of stage shift from primary care referrals, including interest in real-world studies.

Answer

Robin Harper Cowie (CFO) expressed confidence in the company's cash position, attributing it to operational improvements, strong gross margins, and the strategic use of ATM proceeds for balance sheet flexibility. She identified increased sales rep productivity, stable/growing average revenue per test, and an expanding development services portfolio as key upside levers for the 2026 guidance. Scott Hutton (CEO) confirmed that physicians are observing and sharing evidence of stage shift, encouraging them to publish their data, and mentioned investigating options through the CLARIFY study to demonstrate this effect.

William Ruby asked if Biodesix feels well-positioned from a cash perspective after achieving Adjusted EBITDA positivity and utilizing ATM proceeds, and if additional cushion is needed in 2026. He also inquired about the most likely upside levers to the 2026 guidance. Lastly, Ruby questioned if Biodesix has seen additional evidence of stage shifting due to primary care referrals and if real-world studies are planned to demonstrate this effect.

Answer

CFO Robin Harper Cowie expressed strong confidence in the cash position, attributing it to operational improvements, gross margin growth, and opportunistic ATM proceeds. Cowie identified upside levers for 2026 guidance as increased sales force tenure and experience, potential for higher rep productivity, continued ASP stability and growth, and increased interest in the development services portfolio. CEO Scott Hutton confirmed observing evidence of stage shift and encouraged physicians to publish their data, mentioning exploration of real-world studies, possibly through CLARIFY, to demonstrate the impact of earlier detection in lung cancer.

William Ruby, on behalf of Dan from TD Cowen, asked about the company's capital needs for the next 18 months and its runway to breakeven. He also questioned the confidence level in new primary care reps achieving the $1 million per-rep productivity target.

Answer

CFO Robin Harper Cowie affirmed the company's focus on reaching both adjusted EBITDA and cash flow breakeven with its current growth plans and expense management. President, CEO & Director Scott Hutton expressed confidence in the primary care reps' productivity, citing positive results from the pilot program and early performance of new hires, and noted potential for upside.

William Ruby, on behalf of Dan Brennan at TD Cowen, asked about the potential impact of the ALTITUDE study publication on test usage and market awareness. He also questioned whether the study could influence future updates to the CHEST guidelines for lung nodule management.

Answer

CEO Scott Hutton emphasized that ALTITUDE is the first prospective controlled trial in lung nodule management, involving top institutions, which he believes will give it a significant market impact upon publication. Regarding guidelines, Hutton noted that CHEST leadership publicly acknowledged in late 2024 that the decade-old guidelines were prioritized for an update in 2025. He expressed confidence that strong data from ALTITUDE and other studies will be compelling for both physicians and payers, and will be helpful for inclusion in updated guidelines.

William Ruby from TD Cowen asked about the rationale for European expansion, the current number of sales reps and hiring plans tied to Medicaid coverage, and any recent feedback related to the ACOG 234 bulletin.

Answer

President and CEO Zhenya Lindgardt stated that the EU expansion was driven by demand from European opinion leaders and will be executed through commercial partnerships to minimize direct costs. She noted the sales force is currently small but will expand in a 'waved' rollout as reimbursement is secured in targeted states. Regarding ACOG, Lindgardt highlighted a broader, positive shift in the organization's philosophy towards tailored care for all pregnancies, which creates a favorable environment for risk stratification tools like the PreTRM test, rather than feedback on a specific bulletin.

Asked about the sustainability of recent volume growth, its primary drivers, and the progress towards the company's average selling price (ASP) target.

Answer

The company stated that volume growth is sustainable, driven by strong team execution and new marker adoption, not yet by the recent sales force expansion. They remain confident in their long-term ASP target but made a conservative accrual adjustment in Q2 to align with cash collections, which moderated the short-term pace of ASP increases.

William Ruby of TD Cowen questioned the sustainability of Exagen's recent volume growth, its primary drivers, and the progress toward the previously guided $90 ASP increase from new markers.

Answer

CEO John Aballi affirmed the volume growth is sustainable, attributing it to a high-caliber, stable sales team and the new markers acting as a catalyst for clinical conversations. Regarding ASP, Aballi explained that the company prudently adjusted its accrual rate for new markers to better align with real-time cash collections, which tempered the short-term TTM ASP increase, but he remains confident in achieving the $90+ target over time.

William Ruby from TD Cowen asked for details on demand trends in the EMEA region and inquired about the key drivers for achieving positive free cash flow by the end of 2027.

Answer

Christian Henry, President and CEO, stated that EMEA is expected to be the fastest-growing region, driven by strong Revio uptake in the rare disease market. To reach cash flow positive by the end of 2027, Henry outlined three pillars: top-line revenue growth from existing and new products, gross margin expansion, and disciplined expense management, citing the recent restructuring as a key step.

William Ruby from TD Cowen questioned whether Personalis anticipates needing to access the capital markets in 2025, given the guided cash usage of $75 million to $80 million.

Answer

CFO Aaron Tachibana stated that the company has sufficient capital on its balance sheet to reach cash flow breakeven and has no specific need to raise additional capital. He added that they would evaluate opportunities if further investment were needed for strategic areas like clinical evidence generation.