BillionToOne (BLLN) Q2 FY26 earnings call: guidance and Q&A

Earnings call· Jun 2026 (Q2 FY26)· Health Care· Aug 5, 2026

Source: earnings call transcript

Executive summary

BillionToOne Q2 FY26 — Strong Growth and Profitability Driven by Product Innovation and Commercial Expansion

BillionToOne delivered a strong quarter, showcasing robust revenue and volume growth alongside impressive profitability and margin expansion, driven by its innovative QCT technology platform. The company continues to invest strategically in product development and commercial expansion, including new prenatal and oncology offerings and EMR integration, positioning for accelerated growth in the coming quarters. Despite some short-term impacts from true-up timing and held claims, management remains confident in its long-term trajectory and ability to maintain profitability.

Highlights

Total revenue grew 64% year-over-year to $109.4 million.
Total test volume increased 35% year-over-year to approximately 196,000 tests.
Gross margin expanded to 70.5%, up 5 percentage points year-over-year.
Achieved GAAP operating income of $5.5 million, representing a 5% operating margin and 15% adjusted EBITDA margin.
Cash and equivalents increased to $549 million at quarter-end.

Concerns

Overall ASP declined $20 sequentially due to true-up timing, though ex-true-up ASP increased $15 quarter-over-quarter.
Over $10 million in claims were held awaiting in-network implementation, temporarily impacting cash collections and realized ASPs.
Accelerated hiring of 70 sales representatives in H1 FY26 had some impact on short-term sales productivity.

Guidance & targets

Category	Target	Timeline	Confidence
Full-year 2026 total revenue	$450 million to $465 million high materiality	FY26	High
Full-year 2026 profitability	Similar to current levels high materiality	FY26	High
MolDX Medicare coverage for Northstar Response	Expected by the end of this year high materiality	FY26	High
Highly sensitive tumor-naive MRD launch	By the end of the year high materiality	FY26	High
Oncology production lab production start	By the end of 2027 medium materiality	CY27	High
Gross margin	At or above 70% high materiality	Ongoing	High

Segment performance

Segment	Revenue	YoY	QoQ	Margin
Prenatal Revenue driven by strong commercial execution and rising ASPs. Ex-true-up revenue increased by approximately $4.5 million sequentially, representing 5% growth.	$95.8 million	56%	—	—
Oncology Revenue grew nearly 3x year-over-year, exceeding expectations. All sequential growth was attributed to test volume increases, as ASPs remained stable. Annualized revenue run rate: ~$55 million	$13.7 million	176%	—	—

BLLN operating KPIs by quarter

BLLN operating KPIs stated on its earnings calls, by fiscal quarter
KPI	Dec 2025 Q4 FY25	Mar 2026 Q1 FY26	This call Jun 2026 Q2 FY26	Change vs prior quarter
Procedures	~170K Our leadership in product innovation and our growing commercial team continue to drive our test volume with Q4 reaching approximately 170,000 tests, a 47% year-over-year increase. Source: earnings call transcript	~188K In Q1, we delivered approximately 188,000 tests, representing 44% year-over-year growth and strong sequential growth across both product lines, with prenatal volumes growing approximately 10% quarter-over-quarter and oncology volumes growing approximately 25% quarter-over-quarter. Source: earnings call transcript	—	—
Average selling price	$561 Overall ASP increased another 12% quarter-over-quarter from $501 to $561, a significant $60 per test increase in a single quarter. Source: earnings call transcript	$571 As our ASPs increased 28% year-over-year to $571 per test and as we maintained our COGS at $153 per test despite the higher proportion of oncology tests that have a higher COGS, we expanded our gross margins to 73% in Q1, a strong 9 percentage point increase year-over-year. Source: earnings call transcript	$551 Overall ASP increased 21% year-over-year to $551 per test. Source: earnings call transcript	-3.5%

Operating figures the company stated on at least two of the calls shown, checked against each call's transcript. Click a figure to read the sentence. A dash means it was not stated that quarter.

Product announcements

Product	Type	Timeline
Unity Confirm	launch	May 28
Unity fetal risk screen	expansion	August 17
Northstar Select	expansion	September 1
Northstar Origin	launch	September 1

Risks & headwinds

Short-term sales productivity impact from new hiring Short-term

Not quantified, but noted as 'some impact'

Mitigation:Expect hiring to translate into faster growth exiting the year and into early next year as representatives become fully productive and penetrate health systems.

Delayed claims processing and cash collections Second half of the year

More than $10 million of claims held

Mitigation:Expects resolution through the second half of the year as claims are processed and paid. Maintaining conservative guidance until clearer.

Health system EMR integration timeline Next 2-4 quarters

2 to 4 quarters

Mitigation:Company has record-speed integration with Epic Aura, but individual health systems' IT roadmaps delay full conversion. Actively working to convince health systems to prioritize integrations.

Overall COGS per test increase due to mix shift Gradually over time

Overall COGS per test was $161, up from $152 in Q1 and $156 a year ago

Mitigation:Underlying operational discipline is intact (prenatal COGS flat, oncology COGS down >10% QoQ). Expects to maintain strong gross margins at or above 70% by continuing to drive ASP increases and reduce oncology COGS.

What to watch in Q3 FY26

MolDX Medicare coverage for Northstar Response

By end of year

Current Publication of supporting clinical data

Target Coverage decision

Why it matters

This coverage is a significant catalyst, as Northstar Response accounts for almost two-thirds of oncology test volume.

This publication is designed to support our pursuit of MolDX Medicare coverage for Northstar Response response in the IO and [ IO ] combination therapy settings. Since response accounts for almost 2/3 of our oncology test volume, this coverage remains one of our most meaningful catalysts and is still expected by the end of this year.

Find out whether BLLN delivers this. Inve re-checks your case every morning.

Q&A highlights

Did prenatal test revenue increase sequentially when excluding true-ups, given the drop in true-up numbers?

Yes, prenatal revenue, excluding true-ups, increased sequentially by about $4.5 million, representing approximately 5% growth. Both test volumes and ASPs for prenatal ex-true-up increased significantly.

“I think quarter-to-quarter, we did see about a $4.5 million increase in prenatal revenues. If you exclude the true-up, it's about 5% growth sequentially.”

asked by Mark Massaro · answered by Ross Taylor

2 min read 5 chapters

Detailed narrative

Revolutionary Technology Platform and Market Opportunity

BillionToOne leverages its patented Quantitative Counting Template (QCT) technology, enabling single-molecule sensitivity with next-generation sequencing. This platform has allowed the company to rapidly scale to a $438 million annualized revenue run rate in six years, addressing an estimated $100 billion market in the United States for prenatal and oncology cell-free DNA testing. The technology underpins unique, category-defining products in both segments.

Strong Financial Performance and Fiscal Discipline

The company achieved a 70.5% gross margin in Q2 FY26, an expansion of 5 percentage points year-over-year, despite a mix shift towards higher-COGS oncology tests. This superior margin, combined with a culture of fiscal discipline and AI-driven efficient operations, led to $5.5 million in GAAP operating income (5% operating margin) and a 15% adjusted EBITDA margin. The company's accumulated deficit is approximately 10% of its public competitors, demonstrating efficient capital use.

Prenatal Product Innovation and Adoption

Unity Confirm, launched May 28, is the first noninvasive confirmation assay for high-risk pregnancies, capturing intact circulating fetal cells. It has seen exceptional early reception, with providers ordering it for over 50% of eligible high-risk patients. Additionally, the Unity fetal risk screen will expand to 130 genes on August 17, becoming the largest panel on the market and significantly increasing the serviceable market, especially for providers preferring large panels.

Oncology Product Development and Clinical Validation

New clinical evidence was published on June 24, validating Northstar Response for monitoring immunotherapy, supporting pursuit of MolDX Medicare coverage expected by year-end. The company is also on track to launch a highly sensitive tumor-naive MRD test by year-end. Northstar Select will expand to 102 genes on September 1, and Northstar Origin, a tissue of origin add-on with 91% top 3 accuracy, will launch simultaneously, addressing a critical need in community oncology settings.

Commercial Expansion and EMR Integration

BillionToOne added approximately 70 sales representatives in H1 FY26, ahead of plan, to drive future growth. The company launched on Epic's Aura platform in under five months, a record speed, and completed its first health system integration in just two weeks. While health system adoption will take time (2-4 quarters for full integration), Epic Aura removes a critical barrier. A new 62,000 sq ft oncology production lab is under construction, expected to support 5,000 tests per day by end of 2027.

Summary of the company's earnings call; see how call summaries are prepared. Not investment advice.