Natera (NTRA) 12 Nov 242024 Q3 Earnings call transcript

Welcome to Natera's 2024 Third Quarter Financial Results Conference Call. [Operator Instructions] As a reminder, this conference call is being recorded today, November 12, 2024. I would now like to turn the conference call over to Michael Brophy, Chief Financial Officer. Please go ahead.

Thanks, operator, and good afternoon. Thank you for joining our conference call to discuss the results of our third quarter of 2024.

joined Manager Chapman, Medical of I'm Alex CEO; Officer. line, General Aleshin, Oncology the by our Steve and On and Chief

will broadcast live Solomon here webcast. next Diagnostics, Clinical via conference be but quarter. Today's being Moshkevich, again joining is couldn't call us President, today, be

to also soon be will be Slide our site as posted posted it's a replay available. Starting of X. that has slide to We A presentation the as on to been referring investor.natera.com. call will IR

including conference product judgment the Form suggested identify factors could refer our filed the the recent events press with including or and may the this future Form expected forward-looking X-K reimbursement results, effects outlook, of our Please actual and projections, release. important and Those XX-Q statements dates, opportunities course on we statements. anticipated other our results will differ or from capabilities, materially. by performance, us regarding related strategies the coverage best our today's or During for our markets to and to based those to SEC, and currently statements expected forward-looking call, clinical such and you for we in that studies financial to and from time results file caution events future most products, time operating contained various reflect that make results. We documents partnerships, our actual risks with cause assumptions outlook our on financial that expectations release and factors and by differ operational such future as and XX-K current materially and and documents that known

XX, the any or the this of today, may made disclaims XXXX. forward-looking during not is revise today, current presented or the obligation call as replayed call information. to made accurate Natera any are being during statements. after reviewed If contain or statements information call Forward-looking November update

not forum. a provide updates any during call, unless in but our provide performance quarter, on guidance will the public on or further so will We today's guidance do we

We discuss turn And will Steve. a otherwise reference numeric call now number to like growth over or performance. such noted, financial represents to as each we a Steve? I'd unless the of year-on-year quote changes comparison. And our

Mike. Thanks,

into up get We has transformational record oncology in I XX% fastest year been the sequentially Volumes units in launch. quarter-over-quarter This year-over-year. growth. million the highlights tests up quarter, quarter strong XXX,XXX quarter, quarter XX% growth the slide. is next since clinical Let's QX. versus generated best think of about we already $XXX.X represents yet. posted XXXX which last to from grow year. Signatera Natera, on XX,XXX continue performed up had represents the last a for our rapidly, for revenue, which a year, units is third QX quarter the XX% up another we've and revenue third from

a units best year-on-year XX,XXX growth the we've units. of grew also ever had We record terms quarter in which is

row, Our breaking evolution. a quarter, we of quarters quarter, which our for generated course, on in is, even gross were important again, a record margins million cash milestone in for this a after in us. XX% cash couple another in $XX.X the of And

because the now full a the to XX% guidance decision-making outstanding year, revenue ESMO $X.XX first raise in this with important data time. revenue it for That prospective year billion concurrently this We September position you which and data Medicine Nature survival this. adjuvant we've now our public and the in about recurrence data in puts year. of think in testing, analytical like indication full data physicians and growth overall as our to had significantly implies at expectations to which outcomes studies metrics expect of validation the the colorectal from company, core and is of prospective internal delivered All own Galaxy strongly saw us moved for a the cancer, and for is would see Many $X.XX monitoring. In beginning published year supports billion. growth at presented be groundbreaking for fastest the MRD MRD above expectations beyond clinical have the

with comfort us a also patients clinical which GI from for median a portion These abstract years As the of ASCO follow-up. I'm CRC. XX Phase X Signatera reminder, randomized we January. the took of this of of pleased to announce study over have a a completion CALGB/SWOG results been trial, generate the months in having late-breaking III and X is have study in years as using a good follow-up to XXXXX a accepted

trial As press space as this in randomized of release, one design the indication. our from important most you its see given and we size, the saw

respectively. benefit XXXX. trial Similar another be reminder, As trial is drug to early dependent, to will Signatera whether can will this escalation in and from forward will a survival, adjuvant overall report ALTAIR, that which and we the results looking of at on predict disease-free survival and look is patients sharing therapy

results the Symposium ZEST month. next in Antonio be breast San from trial will the Breast We also expect cancer GSK presented at

still reminder, trial due trend towards survival enrollment, looking disease-free in to treated with underpowered, so this of in patients it's a low placebo. but versus was As XXXX terminated improved see niraparib to April trial MRD-positive we're a

Okay.

the of some business to trends. on get Let's

women's The year. despite growth over the past saw first by volumes scale we be earlier the growth significant In time. Invitae from strong. business, year, to channel And we continues the of the health, direct shows augmented volume QX over very this our our slide added

RHD fetal prenatal the time In community. addition, we in a our of need test at critical launched

medication pregnancies. can seeing prevent for really to which given to negative physicians RHD future demand women assess for help traditionally this complications strong test, the potential in are need We

commitment RHD excited are working as health and get access we differentiated of suite and passion possible help and patients also launch team As this to patients the rallying as was hard The OB/GYNs we've medication. to limited about spoken facing We're of about supplies Nentera women's future a many the were of our previously, in of given launch our having business, an testing. the important need. test of to help example that the timeliness of great is the

We being as with pipeline XX The to also strong excellent Oregon prospective Health, in very including evidence continuing forward We product year-on-year. peer-reviewed more papers received physicians the than is forward. we Health look volume and growth differentiated of in strength another well peer-reviewed had Oregon and quarter have published our by move now in the field date. to study We to serve patients largest physicians.

volume Signatera which X double-clicking our units clinical of best Signatera XX,XXX we're volumes. the between slide, We units include ever. processed represents growth was XX,XXX clinical the This quarter, of of average next quarters XXX,XXX the our well units. volumes. XXX,XXX in about on and of growth in On QX, X,XXX The above

of be at of Given year, company. and also last a the compared to look sequential very to variability QX quarters QX for record off great continuing XX,XXX despite useful days, trend trends tend hurricane clinical have in number to to receiving We're positive. the impact are terms to start were a units and of the QX year it's year-on-year. this the some of holidays the in higher

revenues total year-on-year Okay. slide next trend. shows and sequential The quarter a

would that revenue revenue Mike We more million expected, pleased later a XX% the $XX.X quarters true-ups years. rate the very is out We and despite has growth few base of are stripping yielded with had the post in gotten favorably as that those have much our past XX% call. compares growth talk of to year-on-year. in about will which Even which last lower true-ups very the fact quarter fastest-growing revenue than larger

health services important strong that a our to for any the are the across toward health volumes this growth, revenue to ASP Signatera and for We've contribute the recall providing level the without continues covered to to continues clearly improve. board ASP women's to seen improvement in guidelines. base tailwinds worked we've While women's as improve we growth. progress getting reached reimbursement It's to

remain guidelines without pleased to successful [ at both and with happening. we be see screening optimistic guidelines, that While or plan on to for we're ]we XXQ carrier

to over The Signatera step as COGS expectations. wins to towards expansion exceeded and down $XX as delivered our company in pleased see QX That once fueling evolution the here up quarter moderated product million total half mix QX. gross true-ups in evolving shown is growth a cash also mix a ASP we excellent we're function the ASPs our of gross in and shift is in margins QX. margin execution of QX year. products, on This quarter. slightly to strong Signatera. past expectations our represents Our modestly across receipts margin ASPs at gross this held all the beginning next very again is our of well once slide. of us were above just first for the steady the record our again significant [ from and major The product compared a the the under ]

expanded in by ASPs, XX% business shift considerably roughly Excluding is gross XX% Signatera. in QX. over execution true driven ups, from underlying gross COGS continuing margins that the mix QX on margins and strong gross Again, in the projects towards to margins

ramp. feel quarter-to-quarter, and Signatera continuing While margins tariff higher, by to reimbursement well we like volumes led we to can fluctuate very positioned continue ASPs from drive are to

XXXX accelerating a meaningful demonstrates QX and reality The us followed. of is burned leading access strategies coupled The and cash deliver and that reimbursement time in throughout of our generation. investments remain revenues frame the the to expectations the the required collections first our we flow quite where well care million from this big chart. So prior margins, quarter gross a $XXX single are in of cash made We to with chart for depicted patients quarter. same volumes on journey excellent

here been cuts we've the business. gotten future cost jeopardize very with our efficient of we've big resources, While that without

guide, and Mike meaningful we've our investments teams. to in as to adding commercial in In will fact, by the R&D invest growth cover future continued

best customer oncology. the for As we to think to me that, We over flow we're to Alex? managing XXXX, service the breakeven. in. With that continue look will for doctors update and Alex business it for of that's the given let markets and an provide hand while innovation into patients, approach prioritize size to cash the we on

pleased to I'm the in well from Steve. particularly were overall to adjuvant which believe predict across some the board, study CRC. results Signatera's as we of cancer, recent universally benefit on survival the with Thanks, ability colorectal patients chemotherapy GALAXY as in share excellent

circulate the GALAXY As platform of part study. many is know, you of

far, since We thus have data survival sets mature. to presented overall few which on longer are survival focused takes a disease-free

published for in Signatera the overall first an At show concurrently the Medicine, study. in ESMO with a associated time prospective survival signal Nature we conference September and in

Given metric main I points and an want for for the we survival standard for the today. you major such view a highlight a clinical to this important oncologists few trials, milestone that as is are overall gold field. There for

positive all Signatera overall worse tested that Signatera prognosis when months. a recurrence as is patients, had of overall predictor first survival. who Furthermore, around The most predictive significant known survival at negative compared the as was to well XXx Signatera pathological much was factors. clinical risk XX worse Patients of than Signatera

an tested receive treatment. benefit Signatera-positive The patient The show of predicted study The second with versus also that had demonstrated benefit survival and point superior tested that had XX% received overall from death is who patients patients that a chemo. significant no lower who GALAXY overall results Signatera a a they risk from not chemotherapy. if negative survival chemotherapy, did

achieve deescalation DNA showed of had we Signatera-negative Signatera therapy. of with hope survival who the change how CT clearance XX-month for of for a comparison, terms colorectal at and overall recurrent In of can adjuvant In allow outcomes being just large of portion an These adjuvant that of XX treatment highlighting cleared superior not months OS cancer looked managed. for We patients therapy we who after personalization is potential and remains had clearance finally, may CTN findings fundamentally sponsoring that patients. And OS, did patients XXX%. XX%.

and these body believe So significant supporting expand the we in of evidence CRC. incredibly further Signatera summary, results in are

patients the clinical results in a the of study I'll plus or start, to chemotherapy forward summarize the morning. is as update first addition adjuvant the colon Moving celecoxib. The provide key CRC as we release in to to earlier XXXX celecoxib show slide. points per in to either study, study evaluated that study press happy refer III the main randomized chemotherapy an stage adjuvant a the To going in not and a cancer. of believe celecoxib the or CALGB/SWOG placebo were Individuals this the with management benefit chemotherapy which colorectal next study original cancer also trial an III why I'm plus this from that of adding receive cancer. our published will patients improve active important significantly on with did is postoperative drawn XXX in disease-free the in survival and randomized study Phase such trial. XXXXX colorectal

However, Signatera. who can samples from to benefit therapy with X,XXX without than that addition status more from a included be study study investigate may you celecoxib. to patients analyses it whether Signatera readout. Signatera escalation of of the CTA was analysis the The post sizable surgery, initially prespecified adjuvant run new so patients of subgroup utilized XXX identify This will with be a

to report will We benefit the predict the GI, as celecoxib. of with ASCO addition The from Signatera's results on have for study. a been and of along ability DSS results the OS late-breaking abstract accepted ALTAIR

being you I is which, likely subpopulations NSAIDs to provide certain NSAID, both in of pain, bit down sharing look cost. NSAIDs Celecoxib used and as like more generally CRC. aware, more non-toxic and promise nonsteroidal These on and details also a is available, drug investigated have in also the are in next as as celecoxib, drug that benefiting Celebrex January. On class aspirin fevers. are can are anti-inflammatory we to a forward low trial. late on slide, of widely So relatively in context mentioned, reduce shown we this many bring be this known inflammation relieve drugs medicines or

XX drug space that For a clear colon will of the for not the developing treatment over colorectal cancer in for polyps. studies additional precancerous There suggest there a NSAIDs as is example, years. adjuvant with patients need several has risk options for new been approval reduce

hopeful door it will the Mike. be the study unmet to first who turn are Signatera we analysis help to to patients address open cancer, options the most over in those are with this personalize need. help that, randomized that likely effect And can Our Mike? to I'll benefit. And treatment colorectal

more which compared ago, grown the comp. slide progress. to litigation the on revenue days in that tempo XX although to of up to think the cash steady the the result. R&D, work and a I mention spiked lot for very year quarterly working relief see We note Signatera is to the slide. the P&L our related covered are The coverage completely really positive range health place a we wouldn't the other to staffed days was SG&A step-up of seeing business you even play of above Despite notes were based previously. posted significant bounce a to efficient around we DSOs and the hovering women's continues the conversion Steve bottom slide. which consistent loss clearly key much QX retire to a investments, happen. One on typical the launches this the in we've during services a the after At be Great. significantly margins after cash year-over-year this payers years to through all after for of trends dramatically and are of growth. gross hard pleased those XXX I surprised in the our a and of approximately but here are operations noncash feature given on make $XX, with you'll cleans was the share time we see our margins, cash this new notes then. good is share see of capital additional a to first terms early with pleased strategy cash and as a at we dynamics narrowed year, XXXX, actually of made that in tremendous Thanks, via quarters where flow time very I to of few the very of and able we've mid-XXs other relative opportunistic quarters team in is players in that next chunk per beginning delivered a expenses and mature convert And several had commercial the issued charges space to outstanding to a dropped event flow convertible of related course, to as actually on pandemic an the is the were the the summary revenues we meaningfully, price policy at make next set but our in year. note in This we've has available were the since sales stock-based to had have again insurance the might few up balance when quarter years sheet Alex. clinical performance many just out. That's as whatever the QX we that generation gross shutting down. course in are stark we've The their at different sales purely the market maturities to that Signatera the was caps. generation, We, to roughly just Invitae trials. sure slide. to that was product convertible we world over don't massive until the stepped notes accelerate also added cash our see up to move survive shares happen soft you the Related call days when scale we retire subsequent investments as

closed XX-K UBS books the and same earnings We are wiped line own now convert this the is in be transaction will so effectively the of our debt print the the cost of We the year. secured the credit when we roughly this by as October, free as is cash capital. off

Good. Okay.

the get page. the on guide next Let's to

our the up growth is in its covered, had and growth the roughly past $X.XX ASP kind gross we've margins, revenue strong guide year, especially the this expect of billion pricing full revenues as transforming year QX. mature to also is we the but XX% We've expect year. million now Note gross That's of of on organic seen range growth which volume performance accelerated XX%. strong QX. $XXX Steve has as true-ups. has this in we $X.X before $X,XXX year internally. These really continued number drivers to that to this products in year very Signatera that in and margins compared the this realized the are moving seen As of now repeatable major and anchor same roughly initial XXXs billion, from $X,XXX number implies we the between all now

We bumping for elevated expenses in account that continue keep our future and addition to on gas are the for year we OpEx litigation fact the comp stock-based growth. to for to the foot

to expecting Finally, guide I'm about year to year million. the generation we very $XX $XX of pleased started to to $XX million the million this cash update where burn

So a there. swing meaningful

As organic expectations year's revenue well the gross for this do for above Those margins to and guide to our XXXX, into baked that our of $X.XX in that growth for mind $XXX next to about about you into underlying range QX year. true-ups actuals QX million initial billion billion how still year, are in form think next keep and revenue include not this solid $X.XX XX% results would we XX%. into through now baseline continues in translates there's so a

grow XXXX baseline past, next number should the be same in year as we the have units As XXXX. in goal of to

ASP new same bolus influx of Signatera units repeat the health base got Invitae continue plus hold QX, presume our consideration those to course, made receive think the we've typically next won't year. think and the cancer on a So women's continue to continue units XXXX. to steady with monitoring progress then orders users we expect that it's this we as of recurrence fact into erosion to we and of But there, that I from we'll I women's to And take pricing. into plausible their ASPs some in need year, side, given on health patients in would journey. We grow,

biomarker of additional commercial it's see improvement that OpEx best term Signature the second particularly menu clinical the Steve start Signatera is as see of from everything contributions optimistic coverage use to laws around for in within flow need the have more some cautiously year, are trials we recognize state where Signatera in cash offerings. out priority the patients. laid immediate still and We to from more possibly important continue to to we that We are volumes to we do to and and in commercial growth. for of serve half business, is better operations, and remain place. On cash to that room positive. Medicare plans generation, modest enhancing the support Advantage turn reinvest our of cash do clearly ASPs it could But in our

Okay. for questions. With that, let's open it up Operator?

Puneet comes [Operator from of . Partners. question Instructions] first Souda with the Our Leerink line

the in elaborate I ASP generation. can that quarter the this. to It's that -- know with that scrutiny the come strong other the Steve, Really you ASP attention Mike, some product? seeing outline can I Signatera. you ASPs. you pickup of and or bit Can grow. continue I commercial first congrats stability congrats mean, paying here, you has cash a for the because And ASP strong a you're how Maybe, across on of see payers coverage to great across closer products to Signatera think the highlighted

oncology. on then questions I can So elaborate that, on you a have wondering if bit

you Mike, to do take that? want

question. Thanks Yes. the sure. for Yes,

had to from for puts to and here, there's But there's payers an on here, that basis. really more run additional terms maybe volatility Advantage second then ASPs. start grind, in room path you Medicare talk you kind Signatera execution to movement Advantage of prepared those rapid chance I tailwind potential a some biomarker covered be year, the from mentioned from to and of discussed continue of with cautiously have in track for with online optimistic, it's them as organic to upward remarks, services and mature getting the always ASPs, terms of interact these it's going we're as to quarter-to-quarter feel next The a we've allowed So think at chance half kind in about Signatera a I I Signatera really laws just previously. see $X,XXX increase with mean we've of in could into always effect services the payers. And to well. $XXXs state on I payers person like the go coverage had Medicare we're with same of but ASPs now, got there's with as and in ASP we takes, think the kind covering

So or it like ASPs. trajectory for months looks a XX good so Signatera

On actually always having for mature there the the think seen more strong just the really I in diagnostics I'd yes. always kind I for products, rest been product well, business you're health portfolio, about, women's some improvement, of hear is you. in we've of both I erosion usually, particularly Panorama. there's these in major And products? kind the in chance enough, say, thinking Horizon mean long And of

instrined of I are just without of the more that of the just fact on and prenatal just us offerings on visibility as and kind actuals we're -- there. a and think standard kind that more kind seeing more given the confidence care time of and more maybe the these has bit ASPs for the in task our health

me let to don't if anything So know Steve, else there, pause have you I add.

on those things. tests course, XQ expanding records just really today the getting medical of not we've example, additional I'll then there's we're getting I improving couple look mean when still a I women's in testing appeals, opportunity we're where upside like just executing the at performing of sector indications think requested. like in of that add, benefit of good. some RH medical the paid, invested And to oncology. or or health some seeing over of we that's And for lot you're last the No, into years, when the things

upside think ahead. it's I opportunity positive So

it. but much That's or tier great. growth, academic growth you -- parse maybe the quarter. of ASCO you that community strong you're volume obviously is the in where conferences, And in the then setting, sustainability lift lift and the present ESMO, growth from you at elaborate data how the others, seeing setting mostly these I the the seeing [indiscernible] get the very to is, just including Sigmetera, are community can the in Got when trying on in the from of you and this out assume,

Yes, good question.

both we really it's uplift mix. community in in I the So a academic see and setting. mean here

we've As said, oncologists Signatera using today. think of are we about XX%

that And Every that in what of the to to penetration. we exactly And there's talking of so market time The very when people generated sort go. data, data long type low just see kind we think single-digit GALAXY, you're the into with more that's generate especially bring overall that way excited is helps longer-term the this data readouts. you're still we're in survival of threshold that I a fray. course, of about to want for. And underpenetrated future physicians is where meeting to of the hitting going been about follow-up upcoming of we're now that some randomized level really have where waiting been that kind getting of data that have the kind we're mark doctors of that then, the you're have holding out

from long think community. go, way but I to it there's a both So academic seeing and we're

it is that for further study? the most insights you maybe, give NCCN or expect would helpful? And helpful maybe Got And elaborate one, Paper, any at Alex, Medicine of out deeper just is where And the most study that Is just driving into practices? clinical Nature actually last the then what the you ESMO? that it. XXX Alex, study into IMvigorXXX

first all, the a Puneet. lot Sure. been I across say, much the would would I for waiting study, of of say, say Medicine for Thanks helpful, it's would pretty I the have Nature OS board. doctors question, for data.

to for longer, of I the waiting assays I kind patients of think living a DFS field think is one the but actually predicted out. that been read has seeing whole well-powered thing, study

the that market. for part the second I is study pharmaceutical think

show first think DTA the is we've a new really end that predictive overall ] step cert been validate really able [ survival. I to point. And dynamics of that's kind to of

So of additional readouts lot confident, awaiting. some makes I I we've that right, think that we're seeing a been very those And us results. about interest in think

commenting on defer X,XXX XXX It until the design over the I again, is kind embargo a was listed study, of think I ASCO study. well patients. But GI. it's outcome the randomized of that think, for perspective will

I to able on to. And for results IMvigorXXX, then So share that's excited think when we're those we're track.

We read first expect in our partner half Genentech of to the XXXX. out results probably probably those

the question Cowen. TD of next Dan line from Brennan with Our comes

in bit Maybe know prior nice here one just the drivers Congrats biomarker, color constructive $X,XXX on to on Can seen been we've improvement on from prepared felt on you little I -- than quarters. in have some price quarter. opportunity I the I you remarks, Signatera first modest of some but the just what this you speak speak gave the fairly in particular, what to be. -- just of of Mike, like price, could the a know kind guys more

You've X year. for had, a over states I live think,

had the the in country biggest of month the You in go states last or X live so.

your been upside there? So kind that what whether or and of not maybe in more has driver services wondering experience good could and an be I'm just making you're some of

been and payer at natural so with denied. of you human, you it's this I for And been senior person the door, you between been them It about a been you've and that so more get actually. claim any then our with And to just takes where of interact to cases far. interactions submitted some denials mean you It's just mass the that got online [indiscernible] has a constructive online. collaborative time in year of denials, the kind really comes the have workflow. No, coverage really coverage Yes. been the work appeal on the No, comes like the critical positive, have appeals that you then those time thanks just it's thousands far. quite back has question. experience get correctly

I but it. that, So reflective get it about logistics and optimistic feel have said way But things right. long you to I can for that's Hopefully, of we'll as I the just faster see. really come to just the timeline how the gave takes work

maturity to of mean, the an pace forever. tried of I increase, launch. of mean, the that increase no kind we as for point. ASP kind like into that's us a year I terms we've of In there's think gotten get $XXX important a to I way mean just the Signatera there's the here to I

Having said a quite are So margins that's strong. gross the in just products realistic that, I mean, consideration. the

I can get to stronger. they think continue

strong with that coupled today, feeling data we're franchise. really about Alex Signatera that, So on call highlighted the the the

see just maybe I the on gross you Maybe on kind you gross Mike, a the remarks, kind about just bit margin know initiatives. in of talked trajectory side, some turn calendar we of Can Got about as we ex into say I'll basis think 'XX, XXX the driver margins, little cost about Steve remarks do some just only the true-ups. we the prepared the starting we more adjuvant updated -- it. I the financial as I the the starting nice you and one you leverage to surveillance margin points but of the know a but think on gross benefit margins mix 'XX. gross And come -- of follow-up. to is how color year which shift through, Are really full guide, there? prepared in to about talked nice expansion the give the talked of

the Yes. I move mean shift, has mean remained of steady. in I favor think I seen some the mix mix. within the that we've recurrence on monitoring relatively

gross between important kind I our is thinking franchises. if mix about of you're think what's the for more corporate margins, mix

meaningfully long and our is are for but away, now was now and product. it's And where quarter, time, Signatera far higher first Panorama first revenue really quarter our biggest revenues this than last the Panorama biggest -- quarter really now So product. a

on margins, kind that improvement. margin of margins Signatera gross gross driving of itself seeing So accreted given kind is this the corporate that now the corporate we're

our to of like can be far gross the in as reflected have would as in the go said margins year. Having to be moderate, steady to of I prior of gross margin kind move question, which more kind right? corporate think next ASPs in that they of corporate into kind increase have as the kind expect first that I they year and trend have you trajectory that, favor well. to -- and I go it's next improvements, to mean for So understanding what's I Steve's worth as the mean, of rate just -- continue I think is they

comes next from of Stanley. Tejas Morgan line question Our with Savant the

trends on start cleanups framework of business, the the even terms you're Steve. recent to Just in in a perhaps of or seeing couple guidance what just

across that these are business, bit know half of weather back risk grab of might a rollout just the was portfolio. I of on But some guide? the the that So or clean more feet the of really, private in at light uptick you little on in biomarker of Medicare required And the factor their what to bit First quantify payers mentioned book implementation of up then, revised some the starting the in impacts offsetting a all, last help of to oncology in to documentation seen here you guide any ops Mike, in there extent the through the in the just year. pain few going middle and is have all? payers the private you little ] any months prior can next [ an

Yes.

bureaucratic down protocols not having make then question payers. mean various all to a appeal for follow sort obstacles of for on news just that's with sort with this and procedures. processes something medical in think developed requests get outright good and to us good the prior I records is just whether of kind like we've order of payers, we to systems, sorts that is denials that, insurance I sure we've by of respect dealing these can been and bogged and through authorization, years the

So we've invested there. heavily

But better really think to the seen getting couple I things. that historically. we've different we've Natera noticed anything responding of we is Over types what recently those than just are is seeing last tons of we've years, improvements. And what of don't had

I the have take that We've so ahead payer still And from biomarker time. coverage biomarker upside good this good said, And to of Signatera. in with historically have that was a opportunity things really regards that we us. investment Mike commercial and commercial we well that it's think definitely as opportunities, done and these bills bill implementation and

highlight there we or additional for there's that interacting with The just other could where getting of Medicare submitting published Medicare didn't opportunity areas of is coverages lots Mike indications. process some additional in that we were in coverage earlier, to Signatera. upside be the get And area

And both for then, of So in we you getting health, where when particularly have back think opportunity. course, don't and there's look at Oregon women's that's opportunities indications Health today or coverage currently coverage. then we test an where for -- ASP improvement, around

these precision. QX. think far always think hurricanes on to a And We with We that weather just weather the impact in we saw then, hard hitting measure it's weather like week modest Tejas the the the things question. to really with last

to get their We try a their that QX had of to kind impact people as probably people positions -- and approach and remains that of October taken there we as themselves think results. into weather kind just homes saw guide itself, to not rebuild of a I But that the work it and try the and would of quarter. only a take for seen get be impact that to cautious seeing around such? that what kind that an kind So on back was impact in account. And kind modest the we've of into be full

it. Got

a we study results framing the terms thinking in on or standard promising And be adjuvant Signatera the should obviously, How -- results of approach on top meaningful XXX DFS will clinically OS around is bit physicians. chemo a studies and populations? prior can provide for about then Okay. the also, drug in one on what's dependent And and little that guys. context certain showed evaluated, and those of be given that of color Celebrex you

you that? do to Alex, want take Yes.

to absolutely. I there's think Yes, Well, X parts question. the

And kind clinically tolerated. outcome from the tolerated, an of terms of the the be is well study. is what drug first in how The class meaningful could then of drugs

good the toxicities, adjuvant risk a think has significant I chemotherapy, is of unlike death. sometimes traditional that news which

think one a which obviously pretty of millions side class of folks them, It's I but class taken of this indications. drugs, relatively, are thousands the well completely, of are effects and drugs, without for NSAID not of Celebrex other is is tolerated.

DFS, on terms look in like, looks good of of obviously, prior OS, going things. what studies. How think, I a think readout depend terms the does does that's to and in I compare it how few to

and we've for to MOSAIC benefit past think new and I kind hazard had approval agent a study, last in study DSS OS. kind was range a of said a very an ratio with that of the X.XX, and led for the small the X.XX

about. number a think of So we good do kind to think that's

range, or think XXX was of I of, OS, hazard think, in a was I around it selection, depending obviously I think Celebrex significant. X.X DFS itself statistically if the and it any X.X, initial for showed without study not ratio kind

answer, and/or but of short significant well below think of So for the I X.X long we drugs it of class the is, maybe significant, and hazard kind that's pretty anything that's do be especially DFS OS think with ratio tolerated.

And you'd sophisticated that of than a We've expectations, talked more bit to decision. Okay. your I September, relatively sharing That's going Steve, that really bit. help also me been about the called question was out screening. getting on in you that and inform to to which little And little data. one you helpful. actually expect fulsome Back close last go/no-go you for think a initial proof sort initial of be being concept

are year-end little where evolved one we as a in in right on of in the data lines your of peers? And Is still that So adenoma time mind on the to post have there. just curious process? bit advanced benchmark your of terms light ESMO from the

Yes, it's question. a good

screening where initial plan now. cancer going yes, as We're of to and big out very reading conferences XXXX, we So say, just would in data reading actually early tuned. medical conferences early couple very investor the out we we're CRC be on detection a stay in and I that said, close there's

Our comes next line Vatnsdal from question Rachel the with of JPMorgan.

XQ us Can what quarter-over-quarter you have for walk I Signatera within growth. you volume through on Signatera just first volume. are assuming guys So

talked past few historically about rate the quarters. You've this XX,XXX X,XXX for to

been as beating obviously You've well. that

trend what expect should beating a we to continue? of XXXX? So head And into kind into then that volume we XQ level sequential that assumption when of

Yes.

I So strong -- was we mean, well, on like quarter. this as I think a obviously, first really QX,

differences sort kind fastest something we've like X,XXX because of of of third think, just because samples, the could really can of in We be had kind Sunday sequentially. well that. receiving the in comparisons number to above it access additional a or maybe right, holiday ever differences to the maybe X you along there's holidays, of this was was, XX,XXX. that X,XXX we into I XX,XXX you you get day I all quarter-over-quarter or just of did can't I weren't said think the mean average the number able days, sequential a was that it and just That

either just that's XX,XXX of the we've what sort of estimate in. to of sort of roughly But sticking look, quarters. we're and for outperformance We've several conservative the or that way able the kind of come and plugged we're that X,XXX average, kind been with beat to course, to is so always days that trying the of for So in above last forth. saying, just fell

exactly like our strong in in QX, New bag landed is have just the Year's the we Christmas in I ended whole obviously, number, mean, it number Last like and have made enough point, to And with think Steve's our tell particular, take QX QXs really off. this seasonality on you're we don't having weekends [indiscernible] opposing going but product that I that you yet? to up very on in we holidays. what week a more QX, like

we that lot in first in X a landed I have would of weeks of think, the December. up, kind retrospect, January got ended normally in So units

here. So more a land hence, a taking specific around there just of a quarter the holidays. caution because bit lot for little are around a trying to But QX number caution

the fast think a we despite, of -- I we hurricane were off start to mean prepared this hit in we the October, I beginning said But Yes. remarks, think, as in I QX. also

on Got it. then SG&A. just by And

for guide accelerating the talked raised about year. SG&A you've the And for growth your investments. of You some

down on single high just is where digits business. growth you digits about But it obviously, this of into time. OpEx can spend for us to So mid-single break towards? you've driving over annual going sense to increased then makes XXXX, that talked And like invest historically the

should be that lower think for range? is the what right or the to to higher relative factors us Or other number considering about way we So XXXX? move would that that

Yes.

and can innovation, investing. a I into like sense experience, of customer areas certain maybe, to patient 'XX. of then expanding, kind we're of clinical expansions. add Mike, Let handful makes portals, connectivity, significant new heavily or sort think, certain areas investing where me lot obviously Look, investment here trials, we've -- what you expanding service, there's a comment in looks it user comment of of on on maybe salespeople just marketing areas EMR where it there, And more

So to to about we're early And this we're on said, able with patients stages order in doing of serve possible as talk we're be our in very you like plan want as 'XX. all things. tests, do Mike, investments. we opportunity. many the investing to those And making and we those

really of -- mean think 'XX. good I mentioned to to to we're remarks. plus framework on and our cash. grow cash and of to in say, ledger and to that's -- our come right We focus beyond on I next we does terms to our are focus we an you that, serving really guys of back side the burn year, going we're some going prepared really need the have kind opportunity. primary appetite we of But still don't No, amount in the be understand going to the that remain the patients continuing

line of next Our Doug Schenkel question the with Research. comes Wolfe from

Okay.

First, growth. on volume

I right? should heard Mike, mean the I growth incremental year. year? get does You're a expect tracking tests right, $XXX,XXX, so, I think if of next think, Did if similar at said portfolio $XXX,XXX. you call, point I that maybe growth volume on year-on-year some And we number of, similar next across that the you volume the about

rather growth Yes. that goal units always do this growth and that's to our kind than as baseline quantify I mean, of on this, think focus a rates. I try as to is absolute

becomes challenging I rates growth think business because base so the become bigger. much the

]. previously as Similar comments the relates though, going the with different different goal. drivers be that's it So as context Steve to gave [ what to

Okay.

QX be. model of taken you that should normalizing true-ups I collections said, out we base That business out and as next did of of Obviously, as true-ups. we are we year-to-date, know argument are the what You -- have to about right. $XXX think Hopefully, math true-ups improvements? we going true-ups don't year, in actually about of be these kind is the sustainable that ASP Or there an better indicative space? million

by as think from the it's ahead that Well, defined year. our our reality accruals in last both. of come collections I I the mean have is expectations

to are should can of so true-ups, is and driving an a ASPs we And to attempt as this us that based much. happen respond time is available which the have of only ASP to at to kind up on up the queue. of going that's lot But going the best when just information we kind match the the revenue put what's kind

for it's into kind expectation go to guide about continue true-ups cash when kind a of get of So just of and that's to second an it's model the way that our trials kind you're the because no of in, still get guide you see for the timing with the cash it's to next going units we're moderate. And the as that kind to appeal of that year operational impossible we guide, I business. bunch think appropriate finally to you of on

you've is closer from again, had that these is getting for we're makes to just you my I'm presumably everything in. like quarter What ago, with sense. they're Mike, the worth presumably at true-ups, And aren't And I'm periods closer years you. whatever and Yes. opinion said consistent

true-ups you're from but these indicative periods, So collections actually frequently it's past their more tests. actually like on these if getting obviously, of, as almost are paid

model. Is So like, true-ups going you wouldn't see sustainable. sign expect being could and this that the a guide I to this that into higher, is -- ASPs actually the our I are logical? model yes, But

we're mean, know commentary way have specific are right? we themselves [ Medicare zone that ] are the a So that can we now. the which that Yes, [indiscernible] that where we think bills. And we typically fact drivers in the are that when we And then you can those ASPs that seeing, can that's to for time some I long Advantage biomarker us, for and potentially the some us follows we of Signatera erosion. of about followed some ASP going there be gives I -- we confidence guide state think definitely. I comes who've what pretty some are ahead guide, we think, to

I terms the -- are we're your actually like the where getting collections do confidence mean, improvement every is, term. ASPs think what higher that one, reduction that's the the longer kind getting gets in of of can I in of DSOs, So of in over terms do our and And the that what reflected reflected in also reporting I think the in we the quarter.

the we and business, have Diagnostics way you ups [indiscernible] but that there. that good just feel remaining we're With ASPs and it will downs spot it's goes, a with the in

[indiscernible] Mike, Okay. monitoring. mix Last one, what recurrence was the first-time of versus

give could there if anything us a quarter. get I you was to a mix think that shift tried specific Obviously, I'm but it curious margin at kick gross kind to in, material to that as I like improvement. have leg suggest gross the call really may because Dan earlier, just period but good in driver margin this was to didn't another starts on to the of that's anything that that, margin, hear

of just window, to a about That are Signatera then treatment recurrent healthy the through we're continue one think than like there And that for to are into fill in to split getting adjuvant have patients, channel. the patients example, a is monitoring a there we we adjuvant and X. remission. continue has talk balanced journey treatment tweak continue that what's the between pretty their going window, between first-time as trend And in tests. their go us very -- you I have the stayed retention reimburse top with what be typically and to volume they on is there's rather then like that happening Yes. bundle, get this patients patients who And of

We to door. the new in get continue patients

the continued to far. the has that between that window. we've that increase petitions patients been in adjuvant pretty here monitoring is window, and And of treatment balanced recurrence net so And adjuvant all our so

move to and kind of margins, -- just some just itself for is I this the not move the trend in has contribution is not kind implications So described the quarter. that huge that revenue gross terms though bigger by as ported of mix different franchises in The total that of there's of in [indiscernible].

Matt comes Our the Sachs. with next line from of Goldman question Sykes

on one Congrats just the maybe the first you. quarter. for Mike,

and OpEx. how of towards you make assumption the next sure on following going we but sales on I'm sales think investment up Rachel's be the move about are business, sort Just of marketing Signatera. the women's steady across of as and sort most there's just at to just to side, want of where my about on about the to that health certainly spend the marketing. just going product you think relates Are allocation we trying portfolio? the maintained question some marketing kind the thinking is you're I'm a Signatera OpEx year? is on into into as And curious, beneficiary the it maintenance think 'XX, state of made, as sales to the there you and

have that? go? you Steve, do on do a to Or you take want me

standpoint did yes, we add over built new and and to say health, and I'll is commercial a things I a you patients, we launch look, or on presence have an clinical we you [indiscernible] spending I ] with it's see helping we're additional additional we last at years presence stages, of we're think, so. very a a spending of that impact science Yes. big the a that's that is Yes, [ early mean, and at commercial very is going, that maybe able already of do was look trials, of or sort help we big really both making where research do -- you look clinical to lot that's then counselors, kind and extra. innovative medical medical the care, yes, think, in you there, development, I genetic but of focusing and we directors, women's already that have have, the at But going. where lot like there's innovation, sometimes of test right. do look the and the pretty Obviously, a we're comment and oncology Signatera trials rounding of at time I that you at largely, at an able that's sort a you RECIST about patients. But would XX from seeing out, look some when lot look

there pretty Got I and shift it. Have breast And then ones, you of to Signatera. sort sort of might have towards indication but on Meaning, follow-up, up is lower this CRC differences in just consistent with? have been my know for any the noticeable been just it growth. main that it different that ramping are begin any whole Or time? volumes that seen significantly indications been any has

Yes.

generate able what peer-reviewed certainly, broadly which a of. utilization I but we're where data, lot think we've it's And been done consistent, drives evidence. pretty to is

the tends of more And than to use that the publications evidence-based kind we're decision-making. physicians generate makes able sense, be right? where supporting you where have the data, using of have I You think Signatera product. technology that we XX see to now the want to

Alex some think, of data I very IMvigorXXX strong that's itself reading mentioned, XXXX, a So think about, about with that a we're bladder, IMvigorXXX now we great the as that areas out talked opportunity. the in muscle invasive being, excited study with I and

Of where generated see IO of bit we there. monitoring good is another a area utilization we data some do course, quite

a we one the from decent is coverage from of of have on currently getting indications reasons Medicare of do mix. some covered there's that's that still opportunity yes, the think outside It's utilization So a why upside indications. chunk even it's additional I

with line of Peterson Our next the Jefferies. comes from Tycho question

A been lot asked has already.

couple by numbers that? term. Just And the raise the you more by million in was Vita a here What did what's then be, more on on delta the to near $XX in than contribution the quarter? the than

just we've at the seen. But nonetheless, you is also to the back continued the Yes. as just book true-up. kind The -- well. the true-ups is would back of encourage up growth even across really what delta I

the contribution, million the think guide year, been kind full $XX so say, the we of up on of that move year than So kind you terms more the call to we far kind comments substantially we've increased than guidance -- than I contributor in is. Invitae it just beginning of in the $XX that's specifically for in B, that's we the the terms added million, more a all to the of that the other zone made broken and have of and we and for of guide, year. it's business like where the and to contribution, haven't where

And the year, And penetration tests, think sounds additional do then for you XXX,XXX at about it to community kind year? next next in about the don't I you framework where goes? this feel like think like reps add thinking to place guess the point you've XXX,XXX then you of need put we as

we're of I type setting about bigger sort comment you're broadly the single or prevalent slightly looking talking I the incident in adjuvant mean, then patients. look, Yes. it's opportunity, digits. or patients obviously, just tumor whether But still and the by low different of penetration. we pool I'll think the new mean, at on

a there's members a is investment. more sales ahead and opportunity additional And trials, academic clinical in big we part team are and adding in members doing ton settings. which So community team of to of our medical

know And breast lines kidney, about but then bladder the lastly, and I and for indications, expect kidney on on some the I of breast and readouts covered should time time next guess, other those just we Okay. we CRC and lines? do year still the I think we've as mean, how well?

reading very data solid out. map going Yes. We've a think, to road I be got, of that's

which broad data those I think of sets just span indications, got of a across not big reading indications. but we're sort So We've pretty out, excited about.

underway going think there's are various right are points. So that trials reading the out I over XXX time now, probably be that to

from Medicare about generating about excited evidence So drive We're drive additional that we're additional can that that. coverage can excited utilization. and

call. conference our that, for with This participation. we session. today's will conclude conclude your Q&A you all Thank will And

disconnect. now may You