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Date

Wednesday, May 6, 2026 at 4:30 p.m. ET

Call participants

  • Chief Executive Officer — Oguzhan Atay
  • Chief Financial Officer — Ross Taylor

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Takeaways

  • Total revenue -- $108.4 million, reflecting 84% year-over-year growth, with $97.7 million from prenatal and $10.7 million from oncology.
  • Test volume -- 188,000 tests delivered, an increase of 44% year over year, including 10% sequential growth in prenatal and 25% sequential growth in oncology tests.
  • Average selling price (ASP) -- Increased 28% year over year to $571 per test, with a $10 sequential increase despite the typical early-year coinsurance/deductible reset.
  • Gross margin -- 73%, up nine percentage points from 64% last year, driven by prenatal ASP expansion and COGS reduction in oncology.
  • COGS per test -- $153, down 5% sequentially and up 1% year over year, despite higher oncology mix and launch-related costs.
  • GAAP operating margin -- 16%, an improvement from 11% in the preceding quarter, with $17.8 million in operating income compared to a $2.3 million loss the prior year.
  • Adjusted EBITDA margin -- 24% in the quarter.
  • Net income -- $18.0 million, or $0.34 per diluted share, reversing a net loss of $4.0 million, or $0.39 per diluted share, from the prior year.
  • Cash and equivalents -- $537.0 million at quarter end, following $11.0 million in operating cash flow minus capital expenditures.
  • Total contracted lives -- Approximately 300 million, representing coverage of over 90% of the U.S. population, following an in-network contract with Anthem.
  • New product launch -- Unity Confirm, described as the "first noninvasive fetal cell-based confirmation assay for high-risk NIPTs," launched May 1 and accessible only after a high-risk Unity Aneuploidy test.
  • Guidance update -- 2026 total revenue guidance raised to $445 million–$465 million, an increase of $20 million at both ends from prior guidance and representing 48%–52% year-over-year growth.
  • True-up revenue -- $9.2 million, compared to $8.4 million previous quarter and $2.9 million last year; guidance excludes further true-up beyond historical Q1 levels.
  • Oncology revenue growth -- Nearly 400% year over year, reaching an annualized run rate of $43 million, with adoption of NorthStar Select and NorthStar Response accelerating market penetration.
  • Response vs. Select ratio -- Approximately two Response tests for every one Select test, with some physician-driven variation.

Summary

Management emphasized that the Unity Confirm product launch positions BillionToOne (BLLN +1.88%) as the first to offer a noninvasive, fetal cell-based confirmation test for high-risk prenatal screening, which is expected to enhance Unity Aneuploidy differentiation and drive provider adoption. The company reached a significant in-network milestone by contracting with Anthem, extending its total covered lives to roughly 300 million and supporting predictable ASP growth. Financially, rapid revenue and margin expansion were reported, with profitability levels noted as unusual for a high-growth diagnostics company, and full-year guidance was raised to reflect both first-quarter performance and higher anticipated ASPs from new payer contracts.

  • Unity Confirm is positioned as a value driver for frontline test adoption rather than as a volume or reimbursement growth lever, since eligibility is limited to roughly 0.5%–1% of tested patients.
  • Management expects gross margins at or above 70% for the full year, citing the impact of payer contracts and ongoing COGS control, with longer-term targets for both business lines above 75% as scale and reimbursement mature.
  • Guidance for true-up revenue includes only historical Q1 levels; no additional true-up revenue is embedded in projections for subsequent quarters.
  • Oncology ASPs are anticipated to increase materially when Medicare coverage for NorthStar Response is secured, with management targeting year-end for this milestone.
  • Operating expenses rose 52%, including strategic investment in commercial expansion and R&D, yet these expenses declined as a percentage of revenue as scale improved.
  • Accounts receivable increased, attributed mainly to timing of new contracts, with expectations for normalization by Q3 as collections occur.
  • The MRD (minimal residual disease) test is on track for launch by year-end, with supporting data to be published concurrently at launch rather than beforehand.
  • Health system-related adoption is not included in current guidance except for standard territory growth, due to variability and unpredictability of health system contracting timelines.

Industry glossary

  • QCT (Quantitative Counting Template): BillionToOne’s proprietary DNA counting technology enabling single-molecule sensitivity via next-generation sequencing.
  • Unity Confirm: A noninvasive fetal cell-based test for diagnostic confirmation of high-risk prenatal screening results, available only to patients initially screened with Unity Aneuploidy.
  • True-up revenue: Retrospective revenue adjustments, typically from finalized payer settlements or contract updates, recognized after the original billing period.
  • COGS per test: Cost of goods sold associated with delivering each diagnostic test, including labor, materials, and related direct expenses.
  • NorthStar Select/Response: Oncology diagnostics products, with Select identifying mutations in tumor DNA and Response enabling longitudinal monitoring of cancer status using methylation analysis.
  • MRD (minimal residual disease) test: Assay to detect low levels of cancer that remain after treatment, with "tumor-naive" indicating a test not requiring tumor tissue as reference.
  • ASP (average selling price): Company-wide average price received per diagnostic test sold, after contractual adjustments and discounts.

Full Conference Call Transcript

Oguzhan Atay, cofounder and chief executive officer, and Ross Taylor, chief financial officer. Earlier today, BillionToOne, Inc. released financial results for the first quarter ended 03/31/2026. A copy of the press release is available on the company's website. Before we begin, I want to remind you that during this call, we may make forward-looking statements within the meaning of federal securities laws. Such statements about future events may include statements about our financial outlook and performance, market size, our products and services, reimbursement coverage, future clinical performance, and other similar statements. We caution you that such statements reflect our current best judgment and actual results may differ materially from those expressed or implied in any forward-looking statements.

Risk factors that may cause our results to differ are discussed in our filings with the SEC including our previously filed Annual Report on Form 10-K, our Quarterly Report on Form 10-Q, to be filed following this call, and the Current Report on Form 8-K filed today. Any forward-looking statement made during this call is made as of today, 05/06/2026. If this call is replayed or reviewed after today, the information discussed during this call may not contain current or accurate information. BillionToOne, Inc. disclaims any obligation to publicly update any forward-looking statements, whether because of new information, future events, or otherwise, except as required by law. And with that, I will turn the call over to Oguzhan.

Oguzhan Atay: Thank you for joining our first quarter 2026 earnings call. I would like to start by thanking our employees who work with tremendous effort and diligence to build and deliver superior tests to our patients that improve their care and remove the fear of the unknown. Before diving into our quarterly results, I would like to remind you of our four pillars that I believe make us a different category of molecular diagnostics company. First, our revolutionary technology platform, which is enabled by our patented QCT—Quantitative Counting Template—technology, achieves single-molecule level sensitivity and precision with next-generation sequencing. With this technology, we have built unique, category-defining products in both prenatal and oncology.

With our differentiated products, we have grown exponentially in the last six years, even as we reach scale, with a level of compounding that we believe is rare in our industry. But there is still so much room to grow as the opportunity of prenatal and oncology cfDNA markets can exceed $100 billion in U.S. market opportunity over time. In addition to rapid growth, we have achieved a superior gross margin profile, with margins now above 70% with still significant room for expansion through ASP growth and COGS per test reductions.

Lastly, through a culture of fiscal discipline and efficient operations incorporating AI and automation, we achieved GAAP profitability and positive cash flow with less than 10% of the accumulated deficit of our public competitors. In summary, we continue to track towards our long-term goal, which has remained the same: to build a category-defining generational company and become a member of the S&P 500. Our first quarter performance was extremely strong across all four pillars. For the third quarter in a row, we delivered a rule of 100-plus, and this quarter we paired it with a level of profitability that is extremely rare for a high-growth company—yet another quarter of high growth, expanded margins, positive operating income, and positive cash flow.

Looking at our results, pillar by pillar, in addition to expanded fetal antigen NIPT and FNAIT NIPT launches for prenatal, and PGx and CH launches for oncology that were launched in February, after the end of the quarter we launched a category-redefining prenatal test, Unity Confirm. Unity Confirm is the first noninvasive fetal cell-based confirmation assay for high-risk NIPTs. On the oncology side, our product roadmap remains on track. For our Response coverage submission, we responded to all MolDX comments, and our tumor-naive MRD launch is on track to launch by the end of this year.

As we continue to launch new products, our business continues to grow, delivering consistent test volume growth of 44% year over year and total revenue growth of 84% year over year. In our third pillar, we have continued our progress with our in-network contracts. Most importantly, with a contract with Anthem, bringing our total contracted lives to 300 million in the United States. As our ASPs increased 28% year over year to $571 per test, and as we maintained our COGS at $153 per test, despite a higher proportion of oncology tests that have a higher COGS, we expanded our gross margins to 73% in Q1, a strong nine percentage point increase year over year.

And finally, in our fourth pillar, as our gross margins expanded and as we operated with higher efficiency, we delivered a remarkable profitability profile in the first quarter with a 16% GAAP operating margin and 24% adjusted EBITDA margin, increasing our cash position to $537.5 million at the end of the quarter. Delving into each pillar one by one: For our first pillar, on May 1, just five days ago, at the ACOG Annual Meeting, we moved the field forward once again by launching what we believe is going to be seen as the innovation of the decade in prenatal genetics. Unity Confirm is the first and only noninvasive confirmation assay for high-risk pregnancies.

It represents what many in our field have long considered the holy grail of noninvasive prenatal testing. Unity Confirm captures and sequences intact circulating fetal cells from a maternal blood sample, providing 100% fetal fraction. To put that in perspective, conventional cell-free DNA tests rely on small fractions of fetal DNA in maternal plasma. By isolating and sequencing whole fetal cells directly, Unity Confirm is in a fundamentally different category. We have launched Unity Confirm as a specialized offering, as a follow-up for high-risk pregnancies identified on our Unity Aneuploidy screen.

Today, if an NIPT returns a high-risk result, the next step is invasive diagnostic testing, which is increasingly inaccessible in maternity care deserts and also carries a small miscarriage risk. The majority of patients cannot or choose not to proceed to invasive diagnostic confirmation. Unity Confirm addresses this critical clinical gap. It gives these patients and their physicians a noninvasive option. Our initial results have shown 100% concordance compared to invasive diagnostics, and we are now enrolling patients in what we believe is the largest prospective circulating fetal cell-based study ever conducted with concordance to invasive diagnostics. We also built a comprehensive launch campaign around Unity Confirm. More than 500 providers attended the launch or watched on the live stream.

We believe Unity Confirm will further increase the differentiation of our Unity product offerings. Turning to our second pillar, scalable rapid growth: Our leadership in product innovation and our growing commercial team continued to drive strong test volume in the quarter. In Q1, we delivered approximately 188 thousand tests, representing 44% year-over-year growth, and strong sequential growth across both product lines, with prenatal volumes growing approximately 10% quarter over quarter and oncology volumes growing approximately 25% quarter over quarter. Importantly, on the oncology side, approximately 60% of NorthStar Select orders now opt in to CH, reflecting growing physician awareness of the importance of distinguishing tumor-derived from non–tumor-derived variants in liquid biopsy.

Our total revenues in the first quarter grew even faster, achieving 84% year-over-year growth. This was driven by 44% year-over-year growth in test volume and 28% year-over-year growth in ASP. Looking at the segment detail, both prenatal and oncology contributed meaningfully to our growth. Prenatal revenue in the first quarter was $97.7 million, up 72% year over year, driven by strong volume growth, commercial execution, and additional traction driven by our fetal antigen test products launched at SMFM in February. This continues to underscore the depth of Unity’s differentiation and the durability of our prenatal growth.

Oncology revenue was nearly five times over last year, reaching $10.7 million in the first quarter and an annualized revenue run rate of $43 million. The oncology ramp is being driven by increasing adoption of both NorthStar Select and NorthStar Response, the recent launches of PGx and CH, and strong execution of our oncology commercial team. We continue to see substantial opportunity ahead in oncology as we continue to grow our sales team, build clinical evidence, and pursue Medicare coverage for NorthStar Response. Before discussing ASPs and COGS, I want to highlight a major step forward this quarter.

I am pleased to announce that BillionToOne, Inc. is now in network with Anthem, one of the largest health insurers in the United States. This brings our total contracted lives to approximately 300 million in the U.S., representing more than 90% of patients. Following the in-network agreement we announced last quarter with UnitedHealthcare, the addition of Anthem further strengthens our market access position. As I have noted previously, an in-network contract removes friction for both physicians and patients, increases access, and over time, results in higher and more predictable ASPs. Turning to ASPs, we continue to see growth in the first quarter, with overall ASP increasing to $571 per test, a 28% year-over-year increase and a $10 per-test sequential increase.

This increase was despite the largely temporary effect of resetting of coinsurance and deductibles at the beginning of the year. We continue to expect substantial room for ASP expansion ahead, driven by additional Medicaid adoptions of our carrier panel PLA code, the continued mix shift to higher ASP oncology tests, and, in time, Medicare coverage of our NorthStar Response test. In addition to driving ASP growth, we have remained committed to our operating model of continuous improvement to reduce COGS per test. Our overall COGS per test was $153 in the first quarter, down 5% sequentially and only 1% higher year over year.

This was a particularly significant achievement given two factors: first, the continued mix shift toward a higher proportion of oncology tests, which have higher COGS per test; and second, the COGS impact from recent product launches and enhancements, such as CH. While we expect to continue to see COGS per test reductions, especially in oncology, over the long term we expect overall COGS per test to increase gradually over time as our oncology business continues to grow faster. As our overall ASPs continue to increase, and our overall COGS per test remained approximately stable, our gross margin profile expanded further in the first quarter.

Gross margins were 73% in Q1, representing a nine percentage point year-over-year increase from 64% in 2025 and a two percentage point sequential increase from 71% in Q4 2025. The increase was primarily driven by continued increase in prenatal ASP and significant COGS reductions in oncology. We are encouraged by the margin trajectory in both segments. While the faster growth of our oncology business can influence margins—as oncology currently has lower margins due to lower volume scale and prior to Medicare coverage of Response—we expect to maintain strong overall gross margins above 70%. Finally, our first quarter performance allowed us to continue making important strides toward our long-term goals.

We delivered a 16% GAAP operating margin and a 24% adjusted EBITDA margin in Q1 while continuing to invest meaningfully in our sales force, in new product launches, and in clinical evidence generation. I would like to note again that we have achieved this profitability at a much smaller scale than our competitors while growing faster and with less than 10% of their accumulated deficits. This combination of growth and profitability speaks to the uniqueness of our technology, the differentiation of our product portfolio, and our operational discipline. With that, I will turn the call over to Ross to review our financial results and updated 2026 guidance before I conclude.

Ross Taylor: Thank you, Oguzhan. As Oguzhan mentioned, in Q1 2026 we had a strong performance that combined 84% year-over-year revenue growth with a 16% operating margin and 24% adjusted EBITDA margin. Total revenue in Q1 2026 was $108.4 million compared to $59.0 million in Q1 2025, representing an increase of 84%. Both our prenatal and oncology product lines demonstrated strong growth in the quarter. Prenatal revenues, consisting of clinical testing revenues and revenues from clinical trial support and other services, increased 72% to $97.7 million in Q1. Oncology revenues increased almost 400% to $10.7 million in Q1 2026 versus Q1 of last year.

Our total revenue growth was driven primarily by test volume growth across both prenatal and oncology as well as continued expansion of both our prenatal and oncology ASPs. True-up revenue was $9.2 million in Q1 2026, compared to $8.4 million in Q4 2025 and $2.9 million in Q1 2025. Excluding true-up revenue, total revenue growth in Q1 was 77% compared to the same period last year. Gross profit in Q1 2026 was $79.1 million compared to $38.0 million in Q1 2025, resulting in a gross margin of 73% in Q1 2026 versus 64% in Q1 2025. The increase in gross margins was primarily attributable to continued increases in our overall ASP.

Total operating expenses were $61.2 million in Q1 2026 compared to $40.3 million in the comparable prior-year quarter, representing an increase of 52%. Within total operating expenses, R&D expense was $14.7 million in Q1 2026 compared to $10.4 million in the comparable prior-year quarter. SG&A expense was $46.6 million in Q1 2026 compared to $29.9 million in the comparable prior-year quarter. We continue to invest in our commercial team, R&D, and clinical evidence generation, yet operating expenses as a percentage of revenue declined materially. Operating income was $17.8 million in Q1 2026 compared to an operating loss of $2.3 million in Q1 2025.

Our Q1 operating profit margin was 16%, representing a meaningful step up from the 11% operating margin we delivered in Q4 2025. Adjusted EBITDA in the quarter represented a 24% margin. Net income available to common shareholders was $18.0 million, or $0.34 per diluted share, in Q1 2026 compared to a net loss of $4.0 million, or $0.39 per diluted share, for the same period of 2025. Cash flow from operations minus capital expenditures was $11.0 million in Q1 2026. We are well capitalized with a very healthy balance sheet. We ended the first quarter with $537.0 million in cash and equivalents.

We believe our balance sheet positions us for strong growth moving forward, particularly given our intent to continue to manage the business for profitability and positive cash flow. Finally, I will provide an update on our full-year guidance for 2026. We are raising our 2026 total revenue outlook to a range of $445 million to $465 million, representing growth of 48% to 52% compared to full-year 2025. Our new revenue guidance is a $20 million increase at both ends of the range over our previous guidance of $425 million to $445 million that we provided in early March.

We are raising our guidance to reflect the strength of our business in Q1, as well as our expectation that new payer contracts will benefit our ASPs over the remainder of the year. Also, we expect to operate the business such that we will continue to generate profitability approaching current levels even with significant continued investments. I will now turn the call back to Oguzhan to conclude.

Oguzhan Atay: Thank you, Ross. In summary, we are transforming health care one molecule at a time, one patient at a time. Looking ahead, my confidence is rooted in the durability and scalability of the foundation we have built. This is not a story dependent on one catalyst. It is a story of multiple reinforcing drivers working together over time. Each product that we launch makes our platform more powerful. Each study that we publish further validates the clinical utility of our technology. Each payer contract, including our landmark agreements with UnitedHealthcare and now Anthem, strengthens access and reinforces the value of our offerings. In Q1, we launched Unity Confirm, a first-of-its-kind offering that further differentiates our prenatal product portfolio.

And we made important strides towards keeping our oncology product roadmap on track. We continued our strong revenue growth—84% year over year—leading to a $434 million annualized revenue run rate. We have combined this revenue growth with impressive gross margins of 73%, a nine percentage point year-over-year increase even with subscale COGS and ASPs, especially in oncology. Last but not least, we have shown that rapid growth does not have to come at the expense of profitability, achieving an impressive 16% GAAP operating margin and 24% adjusted EBITDA margin. We are powered by a team of highly motivated, mission-driven individuals who show up every day with a shared purpose to make a meaningful difference in patients' lives.

That dedication is reflected in the strength of our results and continues to drive our momentum. Looking ahead, our ambition remains clear: to build a category-defining company, earn a place in the S&P 500, transform molecular diagnostics, and help reshape health care. We are pleased with our progress to start the year and look forward to updating you as the year progresses. We will now open the call for questions. Over to the operator.

Operator: Our first question comes from the line of Daniel Arias from Stifel. Your question, please.

Daniel Arias: Ross, maybe just to start on the guidance raise on revenues. Is there a higher volume component embedded there, or is that really just a function of ASPs? And then can you maybe just talk a little bit to volume cadence over the course of the rest of the year here?

Ross Taylor: Sure, Dan. As I made some reference to in my prepared remarks, the guidance increase came from the strength we had in Q1, factoring that into the guidance, as well as an ASP lift we expect to see from several additional payer contracts we entered into since the start of 2026. So not really assuming any increase in volume compared to our prior expectations other than the good results we saw in Q1, but primarily driven by lift in ASPs and again strong performance in Q1.

Just in terms of cadence for volumes in the year, I think the only real remark I would make there is we typically have a slower Q4 due to seasonality around the holidays and other factors. Other than that, I would expect a little bit of sequential growth in Q2 and Q3, but Q4 is a seasonally slower quarter for us.

Daniel Arias: Okay. And then maybe on the gross margins, the step up there was pretty notable. We do not really have a mid-70s number at all in our out-year forecast. So how sustainable is that as new products come into the portfolio? At the very least, it feels like the 68%–69% assumption for this year seems low unless something is about to step down in the back half. So can you just maybe help us with that?

Ross Taylor: Sure. As mentioned during our remarks, we expect 70% or better gross margin over the course of the year. There could be a little bit of quarterly volatility in that, but I would expect 70% or better gross margin is something we can sustain for this calendar year.

Oguzhan Atay: I can add a little bit of commentary around that. With these contracts, especially including Anthem and UnitedHealthcare, and other contracts as well—we are signing roughly five to 10 contracts almost every month now—they are all incrementally helping our ASPs. Our prenatal, I think, is one of the most remarkable molecular diagnostics businesses in terms of gross margin. As you know, without Response Medicare coverage, oncology has lower margins, and it is growing extremely fast—25% quarter over quarter. So in the short term, there is this dynamic between faster growth of oncology and gross margins of prenatal. That is going to keep further expansion in check, but we still expect it to be above 70%.

Long term, as both of these product lines mature, we expect both product portfolios to be easily above 75%.

Operator: Thank you. And our next question comes from the line of Mark Massaro from BTIG. Your question, please.

Mark Massaro: Congrats on the strong quarter. I wanted to ask about Unity Confirm. It seems like a pretty interesting novel product offering. Oguzhan, how do you size this market? So even starting with, I think, 3.6 million births in the U.S. roughly, how many of them do you think would be eligible to go on to Confirm? And I think you are launching this later this month. Is this something that you expect to get expanded reimbursement coverage for as an add-on? And related to that, can you speak about the clinical trial that you are enrolling? How long do you think it will take to enroll the patients in the study?

Oguzhan Atay: Thank you, Mark, for the question. In terms of reimbursement or revenue additions for Unity Confirm, we expect that to be actually quite minimal, if any. The reason is that this is only going to be about 0.5% of the patients, maybe up to 1% of the patients, who would test positive on a cell-free DNA test and be eligible for this. I think the important part about Unity Confirm is that the patient is only able to get this test if they use Unity Aneuploidy.

We believe that this is going to make our Aneuploidy offering strongly differentiated, and there will be an increased interest in using our Unity Aneuploidy platform over all others so that if there is a positive high-risk result, the patient only then will be eligible to get tested with Unity Confirm. Having this exclusive offering—noninvasive confirmation for these high-risk pregnancies—we believe that this is going to be another driver of volume, not in terms of the Unity Confirm volume alone, but because patients are only eligible for this if they used our Aneuploidy screening as a frontline screen to begin with.

The timing for the clinical trial: it is a very large clinical trial, and invasive testing in the United States has significantly declined over time. There are not as many patients as there used to be getting invasive confirmation, which speaks to how critical this offering is and the clinical utility that it provides. But that also means that the timing of a very large clinical trial like this can easily take anywhere between one to three years.

Mark Massaro: And just to confirm, will these patients be measured against both amnio and CVS?

Oguzhan Atay: The clinical trial as it is designed includes both CVS and amniocentesis, but the primary endpoint, the primary utility, is against CVS because it matches with the cell type that we are measuring as well as the timeframe of the CVS that we are measuring.

Mark Massaro: Perfect. And then last question for me. Nice to see Anthem come online. I think United started on April 1, if you could confirm that. And what is the go-live date of Anthem?

Oguzhan Atay: United effective date was April 1. Anthem is already effective.

Operator: Thank you. And our next question comes from the line of Andrew Brackmann from William Blair. Your question, please.

Andrew Brackmann: I also wanted to ask on Unity Confirm. Can you maybe just sort of talk about the cell capture technology broadly? What does this technology mean to the entire prenatal genetics platform? And what are some of the future applications that this unlocks for you as you think years in advance?

Oguzhan Atay: Thank you, Andrew. This has been the holy grail of prenatal testing, something that people have been working on for the last 20 years. Capturing these cells is extremely difficult. When we think about cell-free DNA testing, about 5%–10% of the DNA is of fetal origin. When we think about these trophoblasts—these fetal cells—it is truly a one-in-a-billion type of cell type. It is a more labor-intensive and more difficult process, and that is why this is positioned for confirmation of high-risk cases rather than frontline testing. But as you can imagine, one of the really big limitations of cell-free DNA testing, especially as you go into rarer conditions, was the concern around PPVs.

Having a noninvasive confirmation assay actually removes that concern. From a long-term perspective, I do not see cell-based methodology as a replacement of cell-free DNA methodology—both due to cost and the labor-intensive nature of Unity Confirm or any other cell-based methodology—but it can really solve the fundamental problem with cell-free DNA testing, which is this gap between screening and diagnostics that has been increasing over time. That can really enable cell-free DNA testing to be more comprehensive and more widely adopted as well.

Andrew Brackmann: Then I just wanted to ask on capital allocation priorities. I think you called out maintaining profitability while still investing pretty heavily. So I assume cash should continue to grow from here. How should we think about you using cash and capital allocation from here?

Oguzhan Atay: As of right now, we do not have any specific plans about how to use the cash. We expect to maintain our profitability while investing in various different areas.

Operator: Thank you. And our next question comes from the line of Subhalaxmi Nambi from Guggenheim. Your question, please.

Subhalaxmi Nambi: You mentioned the MRD launch is on track. What is the next tangible catalyst we should look out for? And if it is data, do you know the forum you would share it on—either publication or conference?

Oguzhan Atay: We will launch MRD with data at the time of the launch. It is not going to be ahead of the launch; it is going to be at the time of launch. I do not know whether it is going to be at a specific conference. It might be essentially a manuscript that we release.

Subhalaxmi Nambi: Thank you for that. And just remind us, what is the Response versus Select ratio this quarter? And separately, ACOG guidelines were updated last week. In light of that, how has prenatal reimbursement contracting progressed so far this year, especially for expanded carrier screening and 22q? Depending on that, what are you expecting exiting 2026, and how might this shape your view for next year ASPs?

Oguzhan Atay: We did not see any specific changes around coverage policies. We were able to get in network with more and more payers in Q1, and that is the primary contribution to our ASP growth right now. The Response versus Select ratio is similar; it is around two Response to one Select. Each physician uses differently. Some physicians are repeating Select and Response, so it is a one-to-one ratio. Other physicians are doing one Select and one Response to begin with, and then following up with two or three or four Response tests until they see progression, and at that point they are using a Select test.

The blended average is staying at two Response to one Select, which really speaks to the value of Medicare coverage of a Response test for us. That is why we have been working diligently on that front.

Operator: Thank you. And our next question comes from the line of Casey Woodring from JPMorgan. Your question, please.

Casey Woodring: Hi. This is Sebastian Sandler on for Casey. Thanks for taking the question. My first question is on the sales rep ramp. Can you share the fully ramped rep count as of Q1? Then your latest expectations for fully productive reps exiting the year? And if you have this by prenatal and oncology, that would be super helpful. And then just any other color on how the process of getting these reps fully ramped is progressing—taking more or less time compared to your initial expectations?

Oguzhan Atay: Thank you, Casey. The numbers that we shared in the March earnings call—we are approximately on track to those numbers. We are not going to share every quarter how many exactly ramped-up reps we have, but their productivity is staying within the expectations that we had from the past quarter.

Casey Woodring: And then on oncology ASPs, it looked like those stepped down a touch sequentially. I am assuming this might have been on the NorthStar Select side, maybe from true-ups rolling off. So if you could give us more color on that. And then just ASP progression for the rest of the year—should this be pretty stable, or do you expect it to be more back-half weighted as some of these new contracts start kicking in?

Oguzhan Atay: I believe the oncology ASPs, primarily excluding true-up, were very similar. True-up numbers change from quarter to quarter, and it can impact exactly what is being recognized. But there are no material changes in how our oncology tests are being paid. NorthStar Select has broad coverage and reimbursement, and NorthStar Response does not. We expect NorthStar Response ASP to be significantly higher once we have Medicare coverage of NorthStar Response, which we anticipate around the end of the year.

Operator: Thank you. And our next question comes from the line of David Westenberg from Piper Sandler. Your question, please.

David Westenberg: Hi. This is Skye on for Dave. Thanks for taking the question. Maybe just on the health system pipeline, where does that stand today? Are health system-related adoptions still not embedded in the guide?

Oguzhan Atay: The health system adoption is something that we work on, but the timeline for health system adoptions can be very variable. So it is not directly embedded in the guide except for sales team territory growth expectations that are embedded as a standard in our projections.

David Westenberg: Got it. Okay. Thanks. And then next, just a little bit more color on how you see cancer monitoring over the next few years and timing on that?

Oguzhan Atay: Can you repeat the question?

David Westenberg: Yes. How do you see cancer monitoring adoption over the next few years and the timing around that?

Oguzhan Atay: You mean NorthStar Response–related adoption when you say cancer monitoring, or are you referring to more surveillance with respect to MRD?

David Westenberg: More surveillance with respect to MRD would be great.

Oguzhan Atay: Today, we do not have an MRD test, but we are working on building a tumor-naive MRD test. Our belief is that today most of the usage of MRD is in academic centers, and it is primarily in colorectal cancer. That is one area where access to tissue is much easier than other cancer types. We believe that the adoption of a tumor-naive test that is as sensitive, if not more sensitive, than many of the tumor-informed tests will be much more easily adopted by community oncologists who care for upwards of 80%+ of oncology lives in the United States.

So, even though most of the adoption today is in colorectal and most is in academic centers, eventually the bigger adoption of MRD is going to be by community oncologists using tumor-naive tests, and that is why we spend a lot of our efforts around the tumor-naive aspect of our test, even though it is much easier to build a tumor-informed test. In fact, internally, we built a tumor-informed test that is ultra-sensitive just so that we can benchmark our tumor-naive test against it.

Operator: Thank you. And our next question comes from the line of Brandon Couillard from Wells Fargo. Your question, please.

Brandon Couillard: Hey, thanks. Good afternoon. Just two questions for you, Ross. Just want to confirm to what extent, other than the first quarter true-ups, have you embedded any additional true-ups over the balance of the year in the new guide? And then could you speak to the spike in accounts receivable in the first quarter?

Ross Taylor: Sure. With regard to the true-ups, we do not include true-up revenue in the guide other than the historical Q1 numbers we have already seen. So for the out quarters, no, there is no true-up revenue embedded in that guide. The change in AR: we entered into a number of contracts in Q1, some of which came in late Q1 as well. We are not going to get reimbursement for those until several months from now, and some of that new contracting drove about half of the increase in our AR this quarter—or almost half of the increase in the AR. I would expect that will come down, if not by Q2, certainly by Q3.

It just depends on how rapid these activities proceed.

Operator: Thank you. And our next question comes from the line of Tycho Peterson from Jefferies. Your question, please.

Tycho Peterson: Hey, I would love to dig into the Q1 volumes a bit. You called out an increase in active ordering providers last quarter. Could you maybe touch on how much of the volume contribution this quarter came from new providers versus repeat orders from previously integrated providers?

Oguzhan Atay: Thank you, Tycho, for the question. We have seen a very similar number of newly active ordering providers that we added in this quarter compared to previous quarters. We have not seen any difference. Really, the difference between test volume increases between quarters is primarily due to the number of accessioning days in the quarter and when those providers become active throughout the quarter. Q4 tends to be seasonally slow for us; any difference between Q4 and Q1 is due to the number of accessioning days and the holidays in the quarter, which artificially decreases the test volume.

Tycho Peterson: And then, on Unity Confirm, I am just wondering how you are thinking about share dynamics in the market today. There have been competitive launches as well. What is your view of share dynamics today?

Oguzhan Atay: We are not seeing significant impact in the way that we are acquiring new providers and new accounts. Unity Confirm, granted, does create some noise, but the fact we have added a similar number of newly active ordering providers in Q1 as well as Q4—similar to previous quarters—really shows that our products are resonating with providers and we are executing well. Unity Confirm is another driver, another reason for providers to use our test.

As opposed to some of our previous launches, this particular offering is only accessible if a provider has ordered Unity Aneuploidy as a frontline screen, which we believe is going to position our test much more as a frontline usage in certain cases where they may have relied on our test as a second line in the past. Sometimes, with our fetal antigen testing, we would receive another aneuploidy order even though frontline testing was another competitor's test, or we receive tests where our aneuploidy is being ordered because other tests were no-calls or were incorrect results.

In this case, we are only enabling Unity Confirm if our test has been used as a frontline test, which means it will be an important driver of test volume.

Tycho Peterson: And then last one: understanding the timelines for MolDX on NorthStar Response. We hear a lot about potential delays with MolDX and longer times to turn new applicants. What is the risk it gets pushed into next year?

Oguzhan Atay: We are not seeing any issues with MolDX. They are responding within their stated timelines, which is 60 days, and it was a very productive back and forth with MolDX. We do not see potential for delay. It might even potentially be slightly earlier than we originally anticipated.

Operator: Thank you. This does conclude the question-and-answer session of today's program. I would like to hand the program back to Oguzhan for any further remarks.

Oguzhan Atay: Thank you, operator. And thank you all for joining today's conference call. We look forward to speaking with you on our next conference call in a few months. Have a good day.

Operator: Thank you, ladies and gentlemen, for your participation in today's conference. This does conclude the program. You may now disconnect. Good day.