BillionToOne (NasdaqGS:BLLN) Q4 2025 Earnings call March 04, 2026 04:30 PM ET Company ParticipantsBrandon Couillard - Managing DirectorCasey Woodring - VP of Equity ResearchDan Arias - Managing DirectorDavid Deichler - Head of Investor RelationsDavid Westenberg - Managing Director of Equity ResearchOzan Atay - Co-founder and CEORoss Taylor - CFOConference Call ParticipantsAndrew Brackmann - Equity Research AnalystMark Massaro - Managing Director and Senior Equity Research AnalystSubbu Nambi - Managing Direc ...

Financial Data and Key Metrics Changes - For the full year 2025, the company achieved 100% year-over-year growth with an adjusted EBITDA margin of 13%, a positive GAAP operating margin, and positive cash flow [5][34] - Total revenue in Q4 2025 was $96.1 million, representing an increase of 113% compared to $45.1 million in Q4 2024 [29][30] - Gross profit in Q4 2025 was $68.6 million, resulting in a gross margin of 71.4%, up from 57% in Q4 2024 [31][34] - The overall ASP increased from $368 in 2024 to $495 in 2025, a 35% year-over-year increase [33][24] Business Line Data and Key Metrics Changes - Prenatal revenue in Q4 was $86.9 million, up 98% year-over-year, reaching an annualized run rate of $348 million [21][29] - Oncology revenue reached $9.1 million in Q4, achieving a 736% year-over-year increase, with an annualized revenue run rate of $36 million [23][29] - Test volumes grew by 51% year-over-year, with approximately 170,000 tests delivered in Q4 [20][33] Market Data and Key Metrics Changes - The company signed 44 payer contracts, adding more than 25 million lives, reaching a total of 250 million contracted lives in the U.S. [6] - The company achieved a gross margin profile above 70%, despite subscale ASPs, particularly in oncology [10] Company Strategy and Development Direction - The long-term goal remains to build a category-defining business and enter the S&P 500 [10] - The company is focused on expanding its prenatal and oncology product lines, with recent launches aimed at solidifying its competitive advantage [11][18] - The company aims to leverage its revolutionary technology platform to address a market opportunity exceeding $100 billion in the U.S. [9] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the company's growth trajectory, citing strong performance across all teams and the potential for further market penetration [4][7] - The company anticipates continued momentum in both prenatal and oncology segments, driven by new product launches and increased awareness among healthcare providers [37][41] - Management highlighted the importance of the recent in-network contract with UnitedHealthcare, which is expected to enhance ASPs and reduce friction in patient access to tests [41][60] Other Important Information - The company ended the year with approximately $496 million in cash and equivalents and only $50 million in term debt, positioning it for strong growth moving forward [34][35] - The company achieved GAAP profitability in both Q4 2025 and the full year 2025, with significant improvements in net and operating margins [27][34] Q&A Session Summary Question: Awareness of UNITY among providers - Management noted that around 50% of providers are unaware of UNITY, indicating significant growth potential as awareness increases [47][48] Question: Conversations with MFMs regarding test uptake - Management emphasized the influence of MFMs on test selection and the importance of building relationships with them to drive adoption [50][51] Question: New provider metrics for Northstar - Management reported a record increase in active ordering providers, indicating strong growth potential for Q1 2026 [54][55] Question: Gross margin expectations - Management expects gross margins to remain stable in the high 60% range, with no aggressive expectations for expansion [56] Question: Impact of UnitedHealthcare contract - Management anticipates higher ASPs from the in-network contract with UnitedHealthcare, which is expected to streamline reimbursement processes [60][61] Question: Coverage discussions with CMS - Management is in discussions with CMS regarding coverage for Northstar Response, with expectations for a decision by the end of the year [78]