Q4 2025 Biodesix Inc Earnings Call

February 26, 2026

Operator: Good day. Thank you for standing by. Welcome to the Biodesix Q4 2025 Earnings Conference Call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question-and-answer session. To ask a question during the session, you will need to press star one one on your telephone. You will hear an automated message advising your hand is raised. To withdraw your question, please press star one one again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Chris Brinzey. Please go ahead.

Speaker #1: To ask a question during the session, you will need to press star 1-1 on your telephone; you will then hear an automated message advising your hand is raised.

Speaker #1: To withdraw your question, please press star 11 again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Chris Brinze.

Speaker #1: Please go ahead.

Speaker #2: Thank you, Operator, and good afternoon, everyone. Today, BIODESIX released results from the fourth quarter and fiscal year of 2025. Leading the call today will be Scott Hutton, Chief Executive Officer.

Chris Brinzey: Thank you, operator, and good afternoon, everyone. Today, Biodesix released results from the Q4 and fiscal year of 2025. Leading the call today will be Scott Hutton, Chief Executive Officer. He is joined by Robin Harper Cowie, Chief Financial Officer. An audio recording of today's call and the press release announcement with the quarterly results can be found in the Investor Relations section of the company's website at biodesix.com. As today's call includes forward-looking statements, we encourage you to review the statements contained in today's press release and the risks and uncertainties described in our SEC filings, which identify certain factors that may cause the company's actual events, performance, and results to differ materially from those contained in the forward-looking statements made on today's webcast. In addition, we will discuss non-GAAP financial measures on this call.

Speaker #2: He is joined by Robin Harper Cowie, Chief Financial Officer. An audio recording of today's call and the press release announcement with the quarterly results can be found in the Investor website at biodesics.com.

Speaker #2: As today's call includes forward-looking statements, we encourage you to review the statements contained in today's press release and the risks and uncertainties described in our SEC filings which identify certain factors that may cause the company's actual events performance and results to differ materially from those contained in the forward-looking statements made on today's webcast.

Speaker #2: In addition, we will discuss non-GAAP financial measures on this call. Description of these non-GAAP financial measures and reconciliations of GAAP to non-GAAP financial measures are included in today's press release.

Chris Brinzey: Description of these non-GAAP financial measures and reconciliations of GAAP to non-GAAP financial measures are included in today's press release. I would now like to turn the call over to Scott Hutton, Chief Executive Officer. Scott?

Speaker #2: I would now like to turn the call over to Scott Hutton, Chief Executive Officer. Scott?

Speaker #3: Thank you, Chris, and thank you all for joining today. At BIODESIX, our mission is to transform patient care and improve outcomes through personalized diagnostics that are timely, accessible, and address immediate clinical needs.

Scott Hutton: Thank you, Chris, and thank you all for joining today. At Biodesix, our mission is to transform patient care and improve outcomes through personalized diagnostics that are timely, accessible, and address immediate clinical needs. We leverage a multimodal approach that includes genomics, proteomics, and radiomics, combined with AI to discover, develop, and commercialize innovative diagnostic tests for physicians, biopharmaceutical, life sciences, and diagnostic companies to help improve patient care. In 2025 and 2026, we're focused on three main goals: growing top-line revenue, improving organizational effectiveness and operational leverage, and advancing our pipeline for future commercial growth and expansion. In the Q4, we made progress on all three goals. Our top-line growth accelerated with revenue up 41%. We improved upon already strong gross margins by 400 basis points to 83%.

Speaker #3: We leverage a multimodal approach that includes genomics, proteomics, and radiomics, combined with AI, to discover, develop, and commercialize innovative diagnostic tests for physicians, biopharmaceutical, life sciences, and diagnostic companies to help improve patient care.

Speaker #3: In 2025 and 2026, we're focused on three main goals: growing top-line revenue, improving organizational effectiveness and operational leverage, and advancing our pipeline for future commercial growth and expansion.

Speaker #3: In the fourth quarter, we made progress on all three goals. Our top-line growth accelerated with revenue up 41%. We improved upon already strong gross margins by $400 basis points to $83%.

Speaker #3: We achieved adjusted EBITDA positivity, and we presented real-world clinical data that continues to support the use of our on-market test and demonstrates the potential of our product pipeline.

Scott Hutton: We achieved adjusted EBITDA positivity. We presented real-world clinical data that continues to support the use of our on-market test and demonstrates the potential of our product pipeline. Starting with our clinical offerings in lung diagnostics, our major focus remains on lung nodule management, where nodules are either found during low-dose CT screening for lung cancer or incidentally, when the patient has an image taken for another medical purpose. We've implemented a 3-tiered commercial strategy focused on improving the management of patients with lung nodules through the use of our on-market test. This strategy started at the launch of Nodify Lung testing with interventional pulmonologists, who are typically responsible for diagnosing lung cancer. We expanded into their referral network in general and community pulmonology.

Speaker #3: Starting with our clinical offerings in lung diagnostics, our major focus remains on lung nodule management, where nodules are either found during low-dose CT screening for lung cancer or incidentally when the patient has an image taken for another medical purpose.

Speaker #3: We've implemented a three-tiered commercial strategy focused on improving the management of patients with lung nodules through the use of our on-market test. This strategy started at the launch of Notify Lung Testing with interventional pulmonologists.

Speaker #3: Who are typically responsible for diagnosing lung cancer. We then expanded into their referral network in general and community pulmonology. In 2025, we selectively expanded further into the primary care referral network, allowing us to access the remaining 50% of the available nodule market being managed by those physicians.

Scott Hutton: In 2025, we selectively expanded further into the primary care referral network, allowing us to access the remaining 50% of the available nodule market being managed by those physicians. This approach enhances the value of Nodify Lung testing by first helping general pulmonologists and primary care providers triage patients by risk of malignancy and deciding who should be referred for intervention or managed locally by surveillance, then helping interventionalists prioritize higher-risk patients for prompt diagnostic intervention. We continue to see a positive response from our customers with this expanded sales strategy, resulting in strong growth from both pulmonology and primary care. In Q4, volumes from primary care accounted for 12% of the total Nodify test, growing 67% over Q4 of 2024, and volumes from pulmonology growing 26%.

Speaker #3: This approach enhances the value of Notify Lung Testing, by first helping general pulmonologists and primary care providers triage patients by risk of malignancy, and deciding who should be referred for intervention or managed locally by surveillance.

Speaker #3: Then helping interventionalists prioritize higher-risk patients for prompt diagnostic intervention. We continue to see a positive response from our customers with this expanded sales strategy, resulting in strong growth from both pulmonology and primary care.

Speaker #3: In the fourth quarter, volumes from primary care accounted for 12% of the total Notify tests, growing 67% over the fourth quarter of 2024. Volumes from pulmonology grew 26%.

Speaker #3: In total, for the fourth quarter, we had 97 sales representatives active in the field delivering 18,000 tests or 23% growth. In our last earnings call, we told you about a recent webinar from Dr. Susan Garwood, the National Physician Director for the Pulmonology Service Line at HCA, the largest hospital system in the US.

Scott Hutton: In total, for Q4, we had 97 sales representatives active in the field, delivering 18,000 tests or 23% growth. In our last earnings call, we told you about a recent webinar from Dr. Susan Garwood, the National Physician Director for the Pulmonary Service Line at HCA, the largest hospital system in the US. Dr. Garwood detailed her experience and successes with implementing Nodify Testing in her referring primary care network. This experience is replicating across the country, with Nodify testing being utilized to help health systems identify cancers earlier and manage the sheer volume of patients with lung nodules through better triaging to either intervention or monitoring. In addition to growth in testing volumes, we continued to see improvements in average revenue per test that started to pick up in Q3.

Speaker #3: Dr. Garwood detailed her experience and successes with implementing Notify Testing in her referring, primary care network. This experience is replicating across the country, with Notify Testing being utilized to help health systems identify cancers earlier and manage the sheer volume of patients with lung nodules through better triaging to either intervention or monitoring.

Speaker #3: In addition to growth in testing volumes, we continue to see improvements in average revenue per test that started to pick up in the third quarter.

Speaker #3: This is a result of our market access and revenue cycle management teams delivering additional coverage policies and improved claims collection, particularly for Notify XL2 and CDT.

Scott Hutton: This is a result of our market access and revenue cycle management teams delivering additional coverage policies and improved claims collection, particularly for Nodify XL2 and Nodify CDT. On the development services front, we continue to see increasing interest in our distinctive offerings, where we leverage our multi-omic approach and R&D expertise to help deliver insights that our biopharma, life science tools, and diagnostic partners use to personalize patient care and help improve disease detection and treatment decisions across various disease types. We announced two major partnerships to develop and validate tests as a center of excellence for Thermo Fisher Scientific and separately with Bio-Rad Laboratories. These partnerships are an important recognition of the strength and breadth of capabilities in our team to deliver high quality and rapid results for our partners.

Speaker #3: On the development services front, we continue to see increasing interest in our distinctive offerings where we leverage our multi-omic approach and R&D expertise to help deliver insights that our biopharma, life science tools, and diagnostic partners use to personalize patient care and help improve disease detection, and treatment decisions across various disease types.

Speaker #3: We announced two major partnerships to develop and validate tests as a center of excellence for thermal fissure scientific and separately with BIORED laboratories. These partnerships are an important recognition of the strength and breadth of capabilities in our team to deliver high-quality, and rapid results for our partners.

Scott Hutton: In December, at the Association for Molecular Pathology, or AMP, annual meeting, we were joined by collaborators from Memorial Sloan Kettering Cancer Center, Thermo Fisher, and Bio-Rad to present on these key partnerships and provide insights into portions of our product development pipeline. Today, our development pipeline consists of a unique MRD test that combines the proteomic information from our proprietary Risk of Recurrence test that provides insights into a patient's immune profile, along with tumor-informed genomics that leverages the high sensitivity and specificity of multiplex droplet digital PCR for disease monitoring. It also includes expansion of the VeriStrat test into immunotherapy selection in several new tumor types, including colorectal cancer, as well as another expansion of the VeriStrat test for prostate cancer, predicting the likelihood of response to standard of care hormone therapy.

Speaker #3: In December, at the Association for Molecular Pathology, or AMP, annual meeting, we were joined by collaborators from Memorial Sloan Kettering Cancer Center, Thermo Fisher, and BIORED to present on these key partnerships and provide insights into portions of our product development pipeline.

Speaker #3: Today, our development pipeline consists of a unique MRD test that combines the proteomic information from our proprietary risk-of-recurrence test, which provides insights into a patient's immune profile.

Speaker #3: Along with tumor-informed genomics that leverages the high sensitivity and specificity of multiplex droplet digital PCR for disease monitoring. It also includes expansion of the Veristrat test into immunotherapy selection in several new tumor types, including colorectal cancer.

Speaker #3: As well as another expansion of the Veristrat test for prostate cancer, predicting the likelihood of response to standard of care hormone therapy. We also have a new ESR-1 genomic test, which is available to help guide treatment in breast cancer.

Scott Hutton: We also have a new ESR1 genomic test, which is available to help guide treatment in breast cancer. Lastly, AI-based digital diagnostics that will initially supplement our current on-market tests in lung disease. You'll hear more about the new AI-based digital diagnostic test offering in the coming quarters. Throughout the course of 2025, we continued to generate, present, and publish real-world clinical and health economics data for our on-market and pipeline products. In order to help drive the adoption of our tests by healthcare systems, healthcare providers, and payers, we published new clinical data and had multiple data presentations at a variety of physician society meetings. Our efforts were supplemented by data presentations from our partners and by a number of independent clinicians publishing on their own data on the real-world use of our test.

Speaker #3: And lastly, AI-based digital diagnostics that will initially supplement our current on-market tests in lung disease. You'll hear more about the new AI-based digital diagnostic test offering in the coming quarters.

Speaker #3: Throughout the course of 2025, we continued to generate, present, and publish real-world clinical and health economics data for our on-market and pipeline products. In order to help drive the adoption of our tests by healthcare systems, healthcare providers, and payers, we publish new clinical data and had multiple data presentations at a variety of physician society meetings.

Speaker #3: Our efforts were supplemented by data presentations from our partners and by a number of independent clinicians publishing on their own data on the real-world use of our test.

Speaker #3: To summarize, we finished 2025 strong with excellent fourth-quarter performance, including accelerated revenue growth to 41%, delivered 83% gross margins—which are the strongest in advanced diagnostics—recognized significant improvements in reimbursement, achieved adjusted EBITDA positivity, generated strong clinical and real-world evidence for our on-market and pipeline products, announced additional key development partnerships, and increased the number of services contracts and customers utilizing our offering.

Scott Hutton: To summarize, we finished 2025 strong, with excellent Q4 performance, including accelerated revenue growth to 41%, delivered 83% gross margins, which are the strongest in advanced diagnostics, recognized significant improvements in reimbursement, achieved adjusted EBITDA positivity, generated strong clinical and real-world evidence for our on-market and pipeline products, announced additional key development partnerships, and increased the number of services, contracts, and customers utilizing our offering. With that, let me turn it over to Robin to review our financial performance and provide initial 2026 guidance. Robin?

Speaker #3: With that, let me turn it over to Robin to review our financial performance and provide initial 2026 guidance. Robin?

Speaker #4: Thanks, Scott. And good afternoon, everyone. Total revenue was $28.8 million, and $88.5 million for the fourth quarter and fiscal 2025, an increase of 41% and 24% over the respective prior year periods.

Robin Harper Cowie: Thanks, Scott. Good afternoon, everyone. Total revenue was $28.8 million and $88.5 million for Q4 and fiscal 2025, an increase of 41% and 24% over the respective prior year periods. Lung diagnostics revenue of $25.1 million and $79.2 million for Q4 and fiscal 2025, was an increase of 46% and 22% over the respective prior year periods. Lung diagnostics revenue, excluding claims older than one year, was $24.1 million, representing core organic growth of 40% over the prior year comparable period. The overall increase in lung diagnostics revenue was driven by growth in test volumes and an increase in average revenue per test. Test volumes were 18,000 and 62,600, growth of 23% and 15%, respectively.

Speaker #4: Lung diagnostics revenue of $25.1 million and $79.2 million for the fourth quarter and fiscal 2025 was an increase of 46% and 22% over the respective prior year periods.

Speaker #4: Lung diagnostics revenue, excluding claims older than one year, was $24.1 million, representing core organic growth of 40% over the prior year comparable period. The overall increase in lung diagnostics revenue was driven by growth in test volumes and an increase in average revenue per test.

Speaker #4: Test volumes were $18,000 and $62,600, growth of 23% and 15% respectively. The increase in average revenue per test was driven by the advancements in reimbursement that began in the third quarter from improvements in payer coverage and revenue cycle management, and approximately $1 million in collections from claims older than one year.

Robin Harper Cowie: The increase in average revenue per test was driven by the advancements in reimbursement that began in Q3 from improvements in payer coverage and revenue cycle management, and approximately $1 million in collections from claims older than one year. Development services revenue of $3.6 million and $9.3 million for Q4 in fiscal 2025, was an increase of 12% and 41%, respectively, and was a result of both delivering against our book of contracted business and securing new agreements. Following a strong finish and the highest revenue of any quarter in 2025, we finished the year with $11.8 million of contracted business going into 2026.

Speaker #4: Development services revenue of $3.6 million and $9.3 million for the fourth quarter and fiscal 2025 was an increase of 12% and 41% respectively, and was a result of both delivering against our book of contracted business and securing new agreements.

Speaker #4: Following a strong finish and the highest revenue of any quarter in 2025, we finished the year with $11.8 million of contracted business going into 2026.

Speaker #4: Our gross margin percentage was 83% for the fourth quarter and 81% for fiscal 2025, a 400 basis point and 300 basis point improvement, respectively.

Robin Harper Cowie: Our gross margin percentage was 83% for Q4 and 81% for fiscal 2025, a 400 basis point and 300 basis point improvement, respectively. The ongoing improvement was driven by growth in lung diagnostic testing, improvements in average revenue per test, and optimization of testing workflows that resulted in decreases in average cost per test. Gross margins continue to be a hallmark of Biodesix' performance and operational excellence, and we expect them to remain near 80% throughout 2026. Overall operating expense, excluding direct costs and expenses, were $25.8 million and $99.7 million for Q4 and fiscal 2025, an increase of 14% and 10%, respectively. Sales and marketing investment increased 14% to support the 40% core organic lung diagnostic revenue growth in the quarter.

Speaker #4: The ongoing improvement was driven by growth in lung diagnostic testing, improvements in average revenue per test, and optimization of testing workflows that resulted in decreases in average cost per test.

Speaker #4: Gross margins continue to be a hallmark of Biodesix performance and operational excellence, and we expect them to remain near 80% throughout 2026. Overall operating expense, excluding direct costs and expenses, was $25.8 million and $99.7 million for the fourth quarter and fiscal 2025, an increase of 14% and 10%, respectively.

Speaker #4: Sales and marketing investment increased 14% to support the 40% core organic lung diagnostic revenue growth in the quarter. Total SGNA was $23 million and $87.5 million for the fourth quarter and fiscal 2025, a 14% and 9% increase respectively.

Robin Harper Cowie: Total SG&A was $23 million and $87.5 million for Q4 in fiscal 2025, a 14% and 9% increase, respectively. Growth in SG&A was primarily driven by the expansion of our sales organization from an average of 65 reps in the field in Q1 to an average of 97 active in the field in Q4. In 2026, we plan to add approximately 6 reps per quarter as we continue to build out our commercial structure to drive growth through increased market penetration. We expect continued operating leverage as the recently expanded sales team gains tenure and experience selling the Biodesix tests. R&D expense was $2.9 million and $12 million, a 19% and 26% increase over the prior year.

Speaker #4: Growth in SG&A was primarily driven by the expansion of our sales organization from an average of 65 reps in the field in the first quarter to an average of 97 active in the field in the fourth quarter.

Speaker #4: In 2026, we plan to add approximately six reps per quarter as we continue to build out our commercial structure to drive growth through increased market penetration.

Speaker #4: We expect continued operating leverage as the recently expanded sales team gains tenure and experience selling the BIODESIX X tests. R&D expense was $2.9 million and $12 million, and 19% in 26% increase over the prior year.

Speaker #4: R&D reflects the investments in clinical studies to help advance adoption of our lung diagnostic tests, as well as advancement of our pipeline. Net loss was $4 million, a $35.3 million improvement, or 52% and 18% over the prior year period.

Robin Harper Cowie: R&D reflects the investments in clinical studies to help advance adoption of our lung diagnostic tests, as well as advancement of our pipeline. Net loss was $4 million and $35.3 million for Q4 and fiscal year, an improvement of 52% and 18% over the prior year period. Adjusted EBITDA, which excludes non-cash and other one-time items, was a positive $530,000 for the quarter, which was an improvement of 113% over Q4 of 2024, and is the company's first-ever positive adjusted EBITDA quarter. This milestone reflects strong revenue flow-through and operating leverage across the organization. Adjusted EBITDA for the year was a loss of $17.5 million and improved 21% over 2024.

Speaker #4: Adjusted EBITDA, which excludes non-cash and other one-time items, was a positive $530,000 for the quarter, which was an improvement of 113% over the fourth quarter of '24, and is the company's first-ever positive adjusted EBITDA quarter.

Speaker #4: This milestone reflects strong revenue flow-through and operating leverage across the organization. Adjusted EBITDA for the year was a loss of $17.5 million and improved 21% over 2024.

Speaker #4: Pro forma cash and cash equivalents is $33.7 million, including subsequent at-the-market proceeds, supported by our first quarter of adjusted EBITDA positivity, which positions us to reduce quarterly cash consumption as revenue scales.

Robin Harper Cowie: Pro forma cash and cash equivalents is $33.7 million, including subsequent at-the-market proceeds, supported by our Q1 of adjusted EBITDA positivity, which positions us to reduce quarterly cash consumption as revenue scales. We ended Q4 with $19.0 million in unrestricted cash and cash equivalents, which was an increase of 14% over Q3, including $2.3 million in at-the-market proceeds. Subsequent to the end of Q4, an additional $14.7 million in at-the-market proceeds were raised, and we amended our senior secured term loan with Perceptive Advisors to extend the maturity date and interest-only period to November 2028. The extension and additional cash strengthens the balance sheet and provides increased flexibility for the organization.

Speaker #4: We ended the quarter with $19.0 million in unrestricted cash and cash equivalents, which was an increase of 14% over the third quarter, including $2.3 million in at-the-market proceeds.

Speaker #4: Subsequent to the end of the quarter, an additional $14.7 million in at-the-market proceeds were raised, and we amended our senior secured term loan with perceptive advisors, to extend the maturity date.

Speaker #4: An interest-only period to November 2028. The extension and additional cash strengthens the balance sheet and provides increased flexibility for the organization. Turning to guidance for 2026, we expect to deliver $106 to $112 million in annual revenue, the midpoint of which represents 23% annual growth over 2025, and expect continued improvement towards sustained adjusted EBITDA positivity.

Robin Harper Cowie: Turning to guidance for 2026, we expect to deliver $106 to $112 million in annual revenue, the midpoint of which represents 23% annual growth over 2025, and expect continued improvement towards sustained adjusted EBITDA positivity. The revenue growth and improvement on the path to profitability is expected to be driven by increased tenure and experience of the recently expanded sales force, increases in average revenue per test demonstrated in the second half of 2025, additional clinical data on the Nodify Lung test to help drive adoption from healthcare providers and payers, increases in the development services pipeline, and the demonstrated operational leverage. We do want to acknowledge the recent weather events and seasonality historically seen in Q1, which has been considered in the guidance range provided today.

Speaker #4: The revenue growth and improvement on the path to profitability is expected to be driven by increased tenure and experience of the recently expanded sales force, increases in average revenue per test demonstrated in the second half of 2025, additional clinical data on the Notify Lung test to help drive adoption from healthcare providers and payers, increases in the development services pipeline, and the demonstrated operational leverage.

Speaker #4: We do want to acknowledge the recent weather events and seasonality historically seen in the first quarter, which has been considered in the guidance range provided today.

Speaker #4: Now I'll turn it back to Scott for some closing thoughts before the Q&A.

Robin Harper Cowie: Now I'll turn it back to Scott for some closing thoughts before the Q&A.

Speaker #1: Thank you, Robin. In closing, I want to thank every member of the Biodesix team for your unwavering commitment to our mission, the healthcare professionals we serve, and the patients they treat.

Scott Hutton: Thank you, Robin. In closing, I want to thank every member of the Biodesix team for your unwavering commitment to our mission, the healthcare professionals we serve, and the patients they treat. Our culture is not just aspirational, it is operational. It shows up in disciplined execution, in how we serve healthcare providers, and in how we build trusted industry partnerships. 2025 demonstrated the strength of our strategy and the resilience of our model. As adoption expands and awareness grows, we continue to deliver clinical value, strengthen customer relationships, and drive scalable, durable growth. We remain focused on operational discipline, capital efficiency, and expanding our impact in lung cancer care.... The opportunity in front of us is significant. Our team, culture, differentiated test portfolio, and disciplined execution create sustainable long-term value for healthcare professionals, patients, and shareholders alike.

Speaker #1: Our culture is not just aspirational; it is operational. It shows up in disciplined execution in how we serve healthcare providers, and in how we build trusted industry partnerships.

Speaker #1: 2025 demonstrated the strength of our strategy and the resilience of our model. As adoption expands and awareness grows, we continue to deliver clinical value, strengthen customer relationships, and drive scalable, durable growth.

Speaker #1: We remain focused on operational discipline, capital efficiency, and expanding our impact in lung cancer care. The opportunity in front of us is significant. Our team, culture, differentiated test portfolio, and disciplined execution create sustainable, long-term value for healthcare professionals, patients, and shareholders alike.

Speaker #1: We are operating from a position of increasing strength and remain confident in our ability to execute against a significant long-term opportunity. Thank you to our team, our customers, our partners, and our investors for your continued trust.

Scott Hutton: We are operating from a position of increasing strength and remain confident in our ability to execute against a significant long-term opportunity. Thank you to our team, our customers, our partners, and our investors for your continued trust. We are building a high-performance organization designed to deliver meaningful impact and sustained value quarter after quarter, year after year. Let's now move to questions. Operator, let's start with the Q&A session.

Speaker #1: We are building a high-performance organization designed to deliver meaningful impact, and sustained value, quarter after quarter, year after year. Let's now move to questions.

Speaker #1: Operator, let's start with the Q&A session.

Speaker #3: Thank you. As a reminder to ask a question, please press star 11 on your telephone and wait for your name to be announced. To withdraw your question, please press star 11 again.

Operator: Thank you. As a reminder, to ask a question, please press star one one on your telephone and wait for your name to be announced. To withdraw your question, please press star one one again. Please stand by while we compile the Q&A roster. Our first question comes from Kyle Mikson of Canaccord Genuity. Your line is open.

Speaker #3: Please stand by while we compile the Q&A roster. And our first question comes from Kyle Mixon of Canaccord Genuity. Your line is open.

Speaker #4: Hey, guys. Thanks for the questions. Congrats on a great year. I want to go back to the first quarter comments and just try to understand how much of a step-down we should expect with revenue and volume, with respect to—I guess it's relative to the fourth quarter—because there seemed like there was a little bit of a flush, maybe some revenue that was from prior periods or pulled forward in the fourth.

Kyle Mikson: Hey, guys. Thanks for the questions. Congrats on a great year. I want to go back to the Q1 comments and just trying to understand how much of a step down we should expect with the revenue and volume as, you know, with respect to the, I guess, it's relative to Q4, because, you know, there seemed like there was a little bit of a flush, maybe some revenue that was from prior periods or pulled forward in Q4. If you could talk about, you know, how we should think about the step down for volume and then pricing, and especially given the deductible dynamics and then the weather, too.

Speaker #4: So if you could talk about how we should think about the step-down for volume and then pricing, and especially given that deductible dynamics have been the weather too.

Speaker #4: I mean, I know you referenced that, but there's obviously been some storms and stuff in the northeast and other places. So it would be helpful to understand that.

Kyle Mikson: I mean, I know you referenced that, but there's obviously been some, you know, some storms and stuff in the Northeast and other places, so it'd be helpful to understand that. Thanks.

Speaker #4: Thanks.

Speaker #3: Thanks, Kyle. It's a great question. Yes, there's a lot of dynamics at play here. And the weather disruption across the country and most recently in the northeast absolutely is a consideration for us.

Robin Harper Cowie: Thanks, Kyle. It's a great question. There's a lot of dynamics at play here, and the weather disruption across the country and most recently in the Northeast absolutely is a consideration for us. You're right, we did have some increased collections in Q4, about $1 million of collections from claims over 1 year. When we're looking at Q1 versus Q4, would encourage everyone to compare it to the revenues excluding that $1 million. In Q1, we usually always see a step down in ASP, and we expect that similar step down that we've seen in prior years, same with the volumes. We're anticipating that the volume dynamics and the ASP dynamics are consistent with our historic seasonality.

Speaker #3: And you're right. We did have some increased collections in the fourth quarter. About a million dollars of collections from claims over one year. So when we're looking at the first quarter versus fourth quarter, I would encourage everyone to compare it to the revenues excluding that million dollars.

Speaker #3: In the first quarter, we usually always see a step-down in ASP, and we expect that similar step-down that we've seen in prior years. Same with the volumes.

Speaker #3: So we're anticipating that the volume dynamics and the ASP dynamics are consistent with our historic seasonality.

Speaker #4: All right. Great. Thanks for that. And maybe just one on the pipeline as well. I think I heard, Scott, you were mentioning—going into some detail about the other tests.

Kyle Mikson: All right, great. Thanks for that. Maybe just one on the pipeline as well. I think I heard, Scott, you were mentioning, going into some detail about some other tests. Could you know, maybe just something you have not already shared on the call, could you talk a little bit more and elaborate on those new tests, what you're developing, what you aim to launch in the next, you know, 12 to 18 months, let's say? Ultimately, like, what are you the most excited about in the, you know, kind of future portfolio for the company?

Speaker #4: Could you maybe just to the extent that you have not already shared on the call, could you talk a little bit more and elaborate on those new tests, what you're developing, what you aim to launch in the next 12 to 18 months, let's say?

Speaker #4: And ultimately, what are you the most excited about in the kind of future portfolio for the company?

Speaker #1: Yeah. Thanks, Kyle. Great question. You may recall at AMP Dr. Gary Pistano led an R&D day representing BIODESIX where we had other participants from Biorad, Thermo Fisher, and Memorial Sloan Kettering.

Scott Hutton: Yeah. Thanks, Kyle Mikson. Great question. You may recall, at AMP, Dr. Gary Pestano led an R&D day representing Biodesix, where we had other participants from Bio-Rad, Thermo Fisher, and Memorial Sloan Kettering. We are planning on providing another R&D update this year, where Gary and that team will have an ability to highlight the progress that's been made since that last meeting. In your question, you know, we are not planning on commercializing any of those within the next 12 months. We're very mindful. You know, we have laser focus on our march towards profitability, and we don't want to launch any no-pay tests. We want to be very mindful of reimbursement timing, and the appropriate studies that will help put us in a positive reimbursement position.

Speaker #1: We are planning on providing another R&D update this year where Gary and that team will have an ability to highlight the progress that's been made since that last meeting.

Speaker #1: In your question, we are not planning on commercializing any of those within the next 12 months. We're very mindful. We have laser focus on our march towards profitability.

Speaker #1: And we don't want to launch any no-pay tests. We want to be very mindful of reimbursement, reimbursement timing. And the appropriate studies that'll help put us in a positive reimbursement position.

Speaker #1: We'll continue to give other updates as to what the opportunities look like for those tests. And when you ask the question of what excites me most, I think it's really about highlighting what our development team is capable of, has done in the past, and will do in the future.

Scott Hutton: We'll continue to give other updates as to what the opportunities look like for those tests. When you ask the question of what excites me most, I think it's really about highlighting what our development team is capable of, has done in the past and will do in the future. We think the world of our team, and it's about time that others start to see what they're able to deliver. We're eager to give Gary and team an opportunity to do so.

Speaker #1: We think the world of our team and it's about time that others start to see what they're able to deliver and so we're eager to give Gary and team an opportunity to do so.

Speaker #4: All right. And finally, on the primary care kind of rep cohort that you've been building, I think now that are almost all of them are probably up to speed and mature and kind of full productivity at this point, given they've had this time to ramp, what is the approximate volume that is accounted for by that rep base, by the primary care rep base?

Kyle Mikson: Perfect. Finally, on the primary care, kind of rep cohort that you've been building, I think now that are almost all of them are probably up to speed and mature and, you know, kind of full productivity at this point. Given they've had this time to ramp, what is the approximate volume that is accounted for by that rep base, by the primary care rep base? Is it, you know, above the 11% that you saw in Q3? You know, how do you feel about that mix, I guess, as you sort of look to the, you know, throughout 2026 as a year. You had the proving ground in 2025 and now 2026 is the year to kind of, you know, that will pay dividends, I guess.

Speaker #4: Is it above the 11% that you saw in the third quarter? And how do you feel about that mix, I guess, as you sort of look to the throughout '26 as the year you've had the proven ground in '25 and now '26 is the year to kind of that will pay dividends, I guess?

Speaker #1: Yeah, it's a great question. We continue to see the primary care focus perform and deliver. It grew over the 11% that you referenced, up to 12% of total Notify orders coming out of primary care.

Scott Hutton: Yeah, it's a great question. We continue to see the primary care focus perform and deliver. It grew over the 11% that you referenced, up to 12% of total Nodify orders coming out of primary care. We expect that to continue to grow as we scale. You referenced some of our sales professionals. I was honored to be in San Antonio, Texas, this week with our sales team as we kicked off our 2026 national sales meeting. I can tell you, sitting both with our pulmonology-focused and primary care-focused sales teams, they both feel strongly and feel confident about their ability to continue to grow, and they're eager to do so. We'll continue to provide highlights there. As we look at adding.

Speaker #1: We expect that to continue to grow as we scale. You referenced some of our sales professionals. I was honored to be in San Antonio, Texas, this week with our sales team as we kicked off our 2026 national sales meeting.

Speaker #1: And I can tell you, sitting with both our pulmonology-focused and primary care-focused sales teams, they both feel strongly and feel confident about their ability to continue to grow.

Speaker #1: And they're eager to do so. And so we'll continue to provide highlights there. But as we look at adding approximately 24 sales reps again this year in 2026, we think we can continue to grow and scale across the board.

Scott Hutton: approximately 24 sales reps again this year in 2026. You know, we think we can continue to grow and scale across the board. We'll give updates on a quarterly basis, but we see both teams thriving right now. We're proud of them, but we also think it speaks volumes about the opportunity and our ability to address more of that market by going into PCP. Just as a reminder, again, this is not about us calling on every primary care physician. This is about us building relationships within pulmonology, better understanding their referral network and patterns, and working through them to reach those primary care physicians so that we can increase the opportunity to diagnose and detect cancers earlier. We feel confident in doing so, we'll see a stage shift over time.

Speaker #1: So we'll give updates on a quarterly basis but we see both teams thriving right now. We're proud of them. But we also think it speaks volumes about the opportunity and our ability to address more of that market by going into PCP.

Speaker #1: And just as a reminder, again, this is not about us calling on every primary care physician. This is about us building relationships within pulmonology, better understanding their referral network and patterns, and working through them to reach those primary care physicians so that we can increase the opportunity to diagnose and detect cancers earlier. And we feel confident that, in doing so, we'll see a state shift over time.

Speaker #4: Awesome. Okay. Thanks, Scott. Thanks, Robin. Appreciate it.

Andrew Brackmann: Awesome. Okay. Thanks, Scott. Thanks, Robin. Appreciate it.

Kyle Mikson: Awesome. Okay. Thanks, Scott. Thanks, Robin. Appreciate it.

Speaker #1: Thanks, Kyle.

Scott Hutton: Thanks, Kyle.

Speaker #3: Thank you. And our next question comes from William Ruby of TD Cowen. Your line is open.

Operator: Thank you. Our next question comes from William Ruby of TD Cowen. Your line is open.

Speaker #5: Hi. Thanks for the questions. First question is just you reached adjusted EBITDA positivity in the quarter. And you tapped into your ATM and you're sitting in a pro forma with 33.7 million in cash.

William Ruby: Hi, thanks for the questions. First question is just, you reached adjusted EBITDA positivity in the quarter, and you tapped into your ATM, and you're sitting in pro forma with $33.7 million in cash. Just wondering if you feel well-positioned now from a cash perspective, and if you see any need to add additional cushion in 2060. I'll follow up as well.

Speaker #5: Just wondering if you feel well

Speaker #1: Opposition now from a cash perspective . And if you see any need to add additional cushion in 2016 , I will follow up as well .

Speaker #2: Thanks , William . Appreciate the questions . Yeah , we feel very good about the cash position . We not only showed the operational improvement strong gross margin improvement that helped contribute to our operating leverage for the quarter , but then also adding the extra cash opportunistically through the ATM .

Robin Harper Cowie: Thanks, William. Appreciate the questions. Yeah, we feel very good about the cash position. We not only showed the operational improvement, strong growth margin improvement, that helped contribute to our operating leverage for the quarter, also adding the extra cash opportunistically through the ATM, really strengthened the balance sheet, and gives us flexibility going forward. Yes, we feel very good about where we are from a cash perspective.

Speaker #2: Really strengthened the balance sheet and gives us flexibility going forward . So yes , we feel very good about about where we are from .

Speaker #2: A cash perspective

Speaker #1: Gotcha. And then also, just on the guide—came in above the Street—I’m just wondering, what do you see as some of the most likely upside levers this year to guidance?

William Ruby: Gotcha. Then also just on the guide, came in above the street. Just wondering, what do you see as some of the most likely upside levers this year to guidance?

Speaker #2: Yeah , we think we have a couple upside levers . We've got a sales organization that is gaining in tenure and experience out in the field .

Robin Harper Cowie: Yeah, we think we have a couple upside levers. We've got a sales organization that is gaining in tenure and experience out in the field. We hired quite a few sales team members in, really, in the last part of the year, and so they're really just getting their feet under them. For most of the org, or a larger portion of the organization, this will be their first full year in the field. We think we've got opportunity for increased rep productivity from a test perspective, continuing the ASP stability that, and growth that we saw in the second half of last year. Not to mention the increased excitement about our development services portfolio and what we're able to offer to partners.

Speaker #2: We we hired quite a few sales team members in really in the last part of the year . And so they're really just getting their feet under them .

Speaker #2: And for , for most of the or a large portion of the organization , this will be their first full year in the field .

Speaker #2: So we think we've got opportunity for increased rep productivity from a test perspective , continuing the ASP stability , that and growth that we saw in the second half of last year , not to mention the increased excitement about our development services portfolio and what we're able to offer to to partners .

Speaker #2: So we think, really, we've got opportunities to grow both portions of the business. And really, it's volumes, ASP, and Development Services funnel.

Robin Harper Cowie: we think really we've got opportunities to grow both portions of the business, and really it's volume, ASP, and development services funnel.

Speaker #1: Gotcha . If if I could just ask one more . Actually , I think you mentioned on the on the Q1 call , and I think Scott mentioned earlier talking and Susan Garrett's presentation mentioned as well , that she seemed to see some stage shifts by referring through primary care .

William Ruby: Gotcha. If I can just ask one more, actually. I think you mentioned on the Q1 call, and I think Scott mentioned earlier, and Dr. Susan Garwood's presentation mentioned as well, that she seemed to see some stage shift by referring through primary care. I'm just wondering if you've seen any additional evidence of, like, shifting stage, and if you'd even potentially want to do real-world studies to demonstrate this effect for your shifting stage earlier.

Speaker #1: I'm just wondering if you've seen any additional evidence of shifting stage, and if you'd even potentially want to do real-world studies to demonstrate this effect, where you're shifting stage earlier?

Speaker #3: Yeah . Thanks , William . It's a great question . We have the way it usually transpires is , is physicians will share with us what they're seeing .

Scott Hutton: Yeah. Thanks, William. It's a great question. We have. The way it usually transpires is, physicians will share with us what they're seeing, some of their performance. We've encouraged those individual physicians and sites to publish that data. It's a little bit out of our control, but we encourage them to do that because we think that that'll speak, or at least send a very powerful message, because it's not company-sponsored. We are talking about that. Whether we're able to achieve that through CLARIFY or not, we'll continue to investigate and explore options to do so. Most importantly, you know, we want to encourage those physicians that are seeing the positive impact of utilizing Nodify testing. We want to see them share that data.

Speaker #3: Some of their performance . We've encouraged those individual physicians and sites to publish that data . So it's a little bit out of our control .

Speaker #3: But we encourage them to do that because we think that that'll speak , or at least send a very powerful message because its not company sponsored .

Speaker #3: We are talking about that whether we're able to achieve that through clarify or not , we'll continue to investigate and explore options to do so .

Speaker #3: But most importantly , you know , we want to encourage those physicians that are seeing the positive impact of utilizing notify testing . We want to see them them share that data .

Scott Hutton: It's not really about promotion, it's about awareness. If we can increase more awareness, we think we'll have greater compliance. We think patients will be interested in receiving the testing, and so will physicians, and they'll allow that to guide them. As we know, we're in lung cancer, we're dealing with the deadliest cancer, so any material impact in, you know, shifting stage of diagnosis is gonna be meaningful in overall long-term survival.

Speaker #3: And it's not really about promotion . It's about awareness . And if we can increase more awareness , we think we'll have greater compliance .

Speaker #3: We think patients will be interested in receiving the testing and so will physicians . And they'll allow that to guide them . But as we know , we're in lung cancer .

Speaker #3: We're dealing with the deadliest cancer . So any material impact in , you know , shifting stage of diagnosis is going to be meaningful in overall long term survival .

Speaker #1: Thank you very much

William Ruby: Thank you very much.

Speaker #3: Thanks , William .

Scott Hutton: Thanks, William.

Speaker #4: Thank you And our next question comes from Andrew Brackman of William Blair . Your line is open .

Operator: Thank you. Our next question comes from Andrew Brackmann of William Blair. Your line is open.

Speaker #1: Hey , Scott . Hey , Robin .

Andrew Brackmann: Hey, Scott. Hey, Robin. Good afternoon. Thanks for taking the questions. Maybe I'll pick up on that last question there, sort of around the data readouts that you expect. I think, you know, you've been making some good progress on Clarify over the last couple of quarters. Anything new to share there on when we should maybe expect some of that data to read out? On Altitude, just an update on potential readout for that study as well. Thanks.

Speaker #5: Good afternoon . Thanks for taking the questions . Maybe I'll pick up on that last question there . Sort of around the data readouts that you expect .

Speaker #5: I think , you know , you've been making some good progress on clarify over the last couple of quarters . So anything new , new to share there on when we should maybe expect some of that data to read out .

Speaker #5: And then on altitude , just an update on potential readout study as well . Thanks

Speaker #3: Yeah . Thanks , Andrew . Great questions . With clarify . We're going to continue to to look at different interim analysis and kind of subgroups , if you will , with clarify , we're not going to wait for chest .

Scott Hutton: Yeah. Thanks, Andrew. Great questions. With CLARIFY, we're gonna continue to look at different interim analysis, and kind of subgroups, if you will. With CLARIFY, we're not gonna wait for CHEST, we'll continue to submit those abstracts and papers to different journals. We don't feel the need to wait. We think it's more important to get that data out there. We have submitted some here recently, we'll keep you updated as we receive word back on their acceptance and then publication timing.... But that's gonna be, again, that's real-world data. It's very exciting for us to get that out there and demonstrate how physicians are utilizing the test, how it's performing, and the impact it's making.

Speaker #3: So we'll continue to to submit those abstracts and papers to to different journals . We don't feel the need to wait . We think it's more important to get that data out there .

Speaker #3: We have submitted some here recently and so we'll keep you updated as we receive word back on there acceptance . And then publication timing .

Speaker #3: But but that's going to be again that's real world data . It's very exciting for us to get that out there . And demonstrate how physicians are utilizing the test , how it's performing and the impact it's making in regards to altitude , you may recall that we stopped enrolling altitude , and now we just have to monitor those patients for a minimum of a year .

Scott Hutton: In regards to ALTITUDE, you may recall, that we stopped enrolling ALTITUDE, and now we just have to monitor those patients for a minimum of 1 year, and then up to 2 years. For 2026, we won't hit the 1-year endpoint until Q3. What that means is we will miss the CHEST submission timing for 2026. At the earliest that we'll see any data out of ALTITUDE is gonna be at some point in time in 2027.

Speaker #3: And then up to to two years . So for 2026 , we won't hit the one year endpoint until third quarter . So that what that means is we will miss the chest submission timing for 2026 .

Speaker #3: So at the earliest that we'll see any data out of altitude is going to be at some point in time in 2027 .

Speaker #5: Perfect . Thanks . Thanks for all that color . And then I want to go back to sort of the different channels here .

Andrew Brackmann: Perfect. Thanks for all that color. Then I wanna go back to the sort of the different channels here, primary care, sort of being one of them. Thanks for all that color that you gave on sort of the mix and growth within the different channels. Can you maybe just sort of talk about what you're seeing in the field in terms of these efforts being complementary to each other as opposed to maybe cannibalistic? Thanks.

Speaker #5: Primary care sort of being one of them . And thanks for all that color that you gave on sort of the mix and growth within the different channels .

Speaker #5: Can you maybe just sort of talk about what you're seeing in the field in terms of these efforts being complementary to each other , as opposed to maybe cannibalistic ?

Speaker #5: Thanks .

Speaker #3: Yeah , it's a great question . It's one of the reasons why we highlight that . We start by building a strong relationship within pulmonology .

Scott Hutton: Yeah, it's a great question. It's one of the reasons why we highlight that we start by building a strong relationship within pulmonology. You know, we know that pulmonologists are responsible for diagnosing lung cancer. We also know that they're stressed. There's significant burden there. There's lengthy wait times in their clinics. Their practices are filling up more and more. If you take kind of that needle in the haystack approach, anything that we can do to help them enrich the patients that they're seeing, increasing the likelihood that they're spending time with the highest-risk patients, those with the highest likelihood of lung cancer, then we know that they'll have a greater impact. That in and of itself is what this is about. Those pulmonologists, and we referenced Dr.

Speaker #3: You know , we know that pulmonologists are responsible for lung cancer . We also know that that they're stressed . There's a significant burden there .

Speaker #3: There's lengthy wait times in their clinics . There . Practices are filling up more and more . And so if you take kind of that needle in the haystack approach , anything that we can do to help them enrich the patients that they're seeing , increasing the likelihood that they're spending time with the highest risk patients , those with the highest likelihood of lung cancer , then we know that they'll have a greater impact that that in and of itself is what this is about .

Speaker #3: Those pulmonologists . And we referenced Doctor Susan Garwood using her as an example . It's one of the reasons why they really see the value in promoting and pushing notify testing out into their referral network .

Scott Hutton: Susan Garwood, using her as an example, it's one of the reasons why they really see the value in promoting and pushing Nodify testing out into their referral network so that a positive CDT is referred on quickly and pulled to the front of the line. On the other extreme, somebody that's positive for Nodify XL2, meaning that they can sit back and take a wait-and-watch approach, supported with CT surveillance on an annual basis. Those patients aren't referred in to a pulmonologist because they just block or take up an available slot for a high-risk patient. We continue to see a number of those on a weekly and monthly basis. Those positive stories really reinforce that not only was it the right strategic decision, but that we continue to have success.

Speaker #3: So that a positive seat is referred on quickly and pulled to the front of the line . And on the other extreme , somebody that's positive for notify Xl2 , meaning that they can sit back and take a wait and watch approach supported with CT surveillance on an annual basis .

Speaker #3: Those patients aren't referred in to a pulmonologist because they just block or take up an available slot for a high risk patient . So we continue to see a number of those on a on a weekly and monthly basis .

Speaker #3: Those positive stories really reinforce that not only was it the right strategic decision , but that we continue to have success and then internally , we've talked a lot about having 50 sales territories and having a squad or team approach within the field , and I referenced being at our national sales meeting .

Scott Hutton: Internally, we've talked a lot about having 50 sales territories and having a squad or team approach within the field. I referenced being at our national sales meeting. What I saw was a team that is heavily motivated and focused on the team. There's lots of collaboration, there's sharing of best practices, and they're excited to positively impact patients, first and foremost. We are seeing it work exceptionally well, and we continue to anticipate broader adoption as we progress through 2026.

Speaker #3: What I saw was a team that is heavily motivated and focused on the team . There's lots of collaboration , there's sharing of best practices , and they're excited to positively impact patients .

Speaker #3: First and foremost. And so, we are seeing it work exceptionally well, and we continue to anticipate broader adoption as we progress through 2026.

Speaker #5: Very helpful . Appreciate all the color .

Andrew Brackmann: Very helpful. Appreciate all the color.

Speaker #3: Thanks , Andrew .

Scott Hutton: Thanks, Andrew.

Speaker #4: Thank you And our next question comes from Thomas Flaten of Lake Street Capital Markets . Your line is open .

Operator: Thank you. Our next question comes from Thomas Flatten of Lake Street Capital Markets. Your line is open.

Speaker #6: Great . Good afternoon guys . Thanks for taking the questions . Just kind of teeing off the last question there . So when you think about the additions you're making to the sales force in 2026 , can you just help us understand what that allocation is going to be between PCP and pulmonology ?

Thomas Flatten: Great. Good afternoon, guys. Thanks for taking the questions. Just, kind of teeing off the last question there. When you think about the additions you're making to the sales force in 2026, can you just help us understand what that allocation is gonna be between PCP and pulmonology?

Thomas Flaten: Great. Good afternoon, guys. Thanks for taking the questions. Just, kind of teeing off the last question there. When you think about the additions you're making to the sales force in 2026, can you just help us understand what that allocation is gonna be between PCP and pulmonology?

Speaker #3: Yeah . Thanks , Thomas . You know we haven't disclosed that . And one of the things that we pride ourselves on is being agile and being able to adapt .

Scott Hutton: Yeah. Thanks, Thomas. You know, we haven't disclosed that, and one of the things that we pride ourselves on is being agile and being able to adapt. What really will lead us to hiring one or the other is current performance today. As we continue to grow and scale, we wanna take a need-based approach. We don't wanna be too prescriptive. We've got some territories that are very mature. We've had great success in penetrating that market for a lengthy period of time. Those are gonna be the teams or squads where you've got great representation of the different specialization and call point focus.

Speaker #3: And so what really will lead us to hiring one or the other is current performance today , as we continue to grow and scale , we want to take a need based approach .

Speaker #3: We don't want to be too prescriptive . We've got some territories that are that are very mature . We've had great success in penetrating that market for a lengthy period of time .

Speaker #3: Those are going to be the teams or squads where you've got great representation of the different specialization and call point focus . You know , we still have some territories that that are newer or earlier in that , that maturation .

Scott Hutton: You know, we still have some territories that are newer or earlier in that maturation, and so, that mix, based upon performance, will guide us, and we'll give you guys updates as we make those hires. Right now, we're really focused on... the majority of it will be a blend of associate sales professionals and primary care-focused sales professionals.

Speaker #3: And so that mix based upon performance will guide us . And we'll give you guys updates as we make those hires . But right now we're really focused on it's going to be the majority of will be a blend of associate sales professionals and primary care focused sales professionals .

Speaker #6: And maybe just playing that out and you probably won't be able to share anything qualitative , or anything quantitative . Maybe qualitative . How do you see the differential growth rates through 2026 between the two channels

Thomas Flatten: Maybe just playing that out, you probably won't be able to share anything quantitative, but maybe qualitative. How do you see the differential growth rates through 2026 between the two channels?

Thomas Flaten: Maybe just playing that out, you probably won't be able to share anything quantitative, but maybe qualitative. How do you see the differential growth rates through 2026 between the two channels?

Speaker #3: Yeah , not again . Can't really be that . You know prescriptive because we don't know exactly where we'll be focused on hiring .

Scott Hutton: Yeah, again, can't really be that, you know, prescriptive because we don't know exactly where we'll be focused on hiring and when. We just know there's a massive opportunity ahead. We're barely scratching the surface in this addressable market on both the primary care and the pulmonology front. We see growth opportunities across the board in both. Reminding everybody, reimbursement is the same, right? In this patient population, we're still focused on patients that are of Medicare age, predominantly. We've got a pretty well-defined reimbursement path and trajectory. For us, it doesn't really matter where it's coming out of. It just matters that we're getting to more and more patients on a quarterly basis.

Speaker #3: And when . We just know there's a massive opportunity ahead , we're barely scratching the surface in this this addressable market . On both the primary care and the pulmonology front .

Speaker #3: So we see growth opportunities across the board in both . But reminding everybody same . Right . And this patient population , we're still focused on patients that are of Medicare age predominantly .

Speaker #3: So we've got a pretty well defined reimbursement path . And trajectory for us . It doesn't really matter where it's coming out of .

Speaker #3: It just matters that we're getting to more and more patients on a quarterly basis.

Speaker #6: And then just a quick one , any any insight to share on the guidelines

Thomas Flatten: Just a quick one. Any insight to share on the HEDIS guidelines?

Thomas Flaten: Just a quick one. Any insight to share on the HEDIS guidelines?

Speaker #3: Oh yeah . Nothing new on on on hiatus . I think it was September time frame of last year that they stated that they wouldn't provide the update for 2025 .

Scott Hutton: Oh, yeah, nothing new on HEDIS. I think it was September timeframe of last year that they stated that they wouldn't provide the update for 2025. We're eager to see what they say here in 2026. We know that the problem isn't going away. The challenge still will remain. We know that once they make those statements, it will create a different change than we're able to facilitate ourselves. We've referenced the example in breast cancer historically. You know, we're eager and supportive of this. It will benefit us and help, but most importantly, it'll impact those patients that need to get screening earlier and get into this queue so that we can see earlier detection and diagnosis.

Speaker #3: We're eager to see what they say here in 2026 . We know that the problem isn't going away . The challenge is still will remain and we know that once they make those statements , it will create a different change that then we're able to facilitate ourselves .

Speaker #3: And so we've referenced the example in breast cancer historically . You know , we're eager and supportive of this . It will it will benefit us and help .

Speaker #3: But most importantly it will impact those patients that need to get screening earlier and get into this queue so that we can see earlier detection and diagnosis .

Speaker #3: But when it comes to us guidelines , no material updates , parties just continue to state that they will continue to prioritize it and provide updates in 2026 .

Scott Hutton: When it comes to HEDIS and guidelines, no material updates, both parties just continue to state that they will continue to prioritize it and provide updates in 2026.

Speaker #6: That's great . Thank you .

Thomas Flatten: That's great. Thank you.

Thomas Flaten: That's great. Thank you.

Speaker #3: Thank you Thomas .

Scott Hutton: Thank you, Thomas.

Speaker #4: Thank you And our next question comes from John Wilkin of Craig-hallum . Your line is open

Operator: Thank you. Our next question comes from John Wilkin of Craig-Hallum. Your line is open.

Speaker #6: Hi , Congrats on on hitting .

John Wilkin: Hi, guys. Congrats on hitting the EBITDA milestone in Q4. Wanted to touch a little bit more on sales rep productivity. Are you able to parse out at all... You added around 8,000 tests for the year. Are you able to parse out how much of that growth came from the new reps you hired within the year versus your existing sales force?

Speaker #7: The EBITDA milestone in Q4 . I wanted to I wanted to touch a little bit more on sales rep productivity . I are you able to parse out all ?

Speaker #7: So you added around 8000 tests for the year . Are you able to parse out how much of that growth came from the new reps you hired within the year versus your existing sales force ?

Speaker #2: Yeah , absolutely . We we we track everything very , very closely . The the important thing to remember is the , the majority of the new reps were hired later in the year .

Robin Harper Cowie: Yeah, absolutely. We track everything very, very closely. The important thing to remember is the majority of the new reps were hired later in the year. A lot of the growth that we saw came from our existing reps. We, of course, saw growth from the new reps, and so it was pretty balanced. Where we really expect to see growth from the new reps is in 2026, as they have a full year in the field and more time and more experience selling the test.

Speaker #2: So a lot of the growth that we saw came from our existing reps . We of course saw growth from the new reps .

Speaker #2: And so it was—it was pretty balanced. But where we really expect to see growth from the new reps is in 2026, as they have a full year in the field and more time and more experience selling, selling the test.

Speaker #7: Got it . And then for the I don't know if to the extent that you're able to quantify . So I mean , thinking about reps that are maybe hired like earlier in 2025 , are you able to give us any sense of how productive those reps were by year end ?

John Wilkin: Got it. Then for the, I don't know if, to the extent that you're able to quantify. I mean, thinking about reps that are maybe hired, like, earlier in 2025, are you able to give us any sense of how productive those reps were by year-end? Just to give us a sense of how long it has been taking recently for newly added reps to ramp.

Speaker #7: Just just to give us a sense of how long it has been taking recently for for newly added reps to ramp ?

Speaker #2: Yeah , we've been very , very pleased with the caliber of reps that have been hired and brought in . We historically have seen that it takes 2 to 3 months for a rep to to pay for themselves , and that has continued with the the new batch of reps .

Robin Harper Cowie: Yeah, we've been very, very pleased with the caliber of reps that have been hired and brought in. We historically have seen that it takes two to three months for a rep to pay for themselves, and that has continued with the new batch of reps. We've been very consistent there. That's important to note, that's not the end of the ramp. That's really just the beginning. We see reps continue to ramp, not just in their first year, but ongoing. As I stated, we continue to see growth from existing reps and some who have been here for a couple of years. The growth trajectory is there, we're seeing it, and there is huge opportunity for every rep in our field.

Speaker #2: So we've been very consistent there . But that's it's important to note that's not the end of the ramp . That's really just the beginning .

Speaker #2: And so we see reps continue to ramp up, not just in their first year but ongoing. As I stated, we continue to see growth from existing reps and some who have been here for a couple of years.

Speaker #2: So the growth trajectory is there. We're seeing it, and there is huge opportunity for every rep in our field.

Speaker #7: Perfect . Thank you so much .

John Wilkin: Perfect. Thank you so much.

Speaker #3: Thanks , John .

Scott Hutton: Thanks, John.

Operator: Thank you. This concludes our question and answer session and today's conference call. Thank you for participating, and you may now disconnect.

Q4 2025 Biodesix Inc Earnings Call

Request a DemoDemo

BDSX

Biodesix

Earnings