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    GH
    Earnings call· Jun 2026(Q2 FY26)

    Guardant Health Q2 FY26 earnings call GH

    Jul 30, 2026 Source

    Executive summary

    Guardant Health Q2 FY26 — Strong Growth Across Segments, Key Shield Milestones, and FDA Approvals

    Guardant Health delivered a landmark quarter with broad-based revenue growth driven by strong performance in Oncology, Biopharma & Data, and Screening segments. Key milestones included FDA approvals for Guardant360 Liquid CDx and a lower-COGS Shield workflow, alongside significant Shield adoption catalysts like ACS guideline inclusion and UnitedHealth Group coverage, positioning the company for accelerated future growth while managing increased investments.

    Highlights

    5

    • Total revenue grew 44% year-over-year to $335 million, driven by broad-based strength across all business lines.

    • Oncology revenue increased 38% year-over-year to $219 million, with test volumes rising 63% to approximately 104,000 tests.

    • Reveal volume growth accelerated to more than 100% year-over-year for the third consecutive quarter, reflecting strong MRD adoption and therapy monitoring use.

    • Shield testing revenue reached $53 million, up from $15 million in Q2 FY25, with volumes increasing to 66,000 tests from 16,000.

    • Shield achieved inclusion in American Cancer Society guidelines and secured coverage from UnitedHealth Group, expanding access to approximately 70 million lives (60% of the market).

    Concerns

    3

    • Adjusted EBITDA loss was $56 million in Q2 FY26, compared to a loss of $52 million in Q2 FY25.

    • Free cash flow burn in Q2 FY26 was $70 million, an increase from $66 million in Q2 FY25, due to additional CapEx investments.

    • Full year FY26 free cash flow burn guidance was raised by $10 million to a range of $195 million to $205 million, reflecting accelerated investments in Shield lab capacity.

    Guidance & targets

    15
    CategoryTargetConfidence
    Full year 2026 revenue
    $1.34 billion to $1.36 billion
    high materiality
    High
    Full year 2026 Oncology revenue growth
    approximately 30%
    medium materiality
    High
    Full year 2026 Oncology volume growth
    approximately 50%
    medium materiality
    High
    Full year 2026 Biopharma & Data growth
    low double-digit growth
    medium materiality
    High
    Full year 2026 Screening revenue
    $218 million to $230 million
    high materiality
    High
    Full year 2026 Shield tests
    270,000 to 285,000
    high materiality
    High
    Full year 2026 non-GAAP gross margin
    64% to 65%
    medium materiality
    High
    Full year 2026 non-GAAP operating expenses
    $1.08 billion to $1.1 billion
    medium materiality
    High
    Full year 2026 free cash flow burn
    $195 million to $205 million
    high materiality
    High
    Shield cost per test reduction
    roughly 15%
    medium materiality
    High
    Shield cost per test target
    $200
    medium materiality
    Medium
    Company-wide cash flow breakeven
    by the end of 2027
    high materiality
    High
    Guardant360 Liquid CDx ADLT designation
    in the first half of 2027
    medium materiality
    High
    Reveal Ultra launch
    later this year
    medium materiality
    High
    MolDX coverage for Reveal (breast cancer surveillance, immuno-oncology monitoring)
    at least one or both by end of this year
    medium materiality
    Medium

    Segment performance

    3
    SegmentRevenueYoYQoQMargin
    Oncology
    Strong and broad-based growth across therapy selection and MRD products, with Reveal leading the portfolio.
    Test volumes: 104,000Test volume growth: 63% YoYGuardant360 Liquid volume growth: >30% YoYGuardant360 Tissue volume growth: accelerated (second fastest-growing)Reveal volume growth: >100% YoY (fastest-growing)
    		$219 million38%——
    Biopharma & Data
    Record quarterly revenue, reflecting increasing strategic value of Smart Platform and InfinityAI offerings.
    		$61 million9%——
    Screening
    Exceptional volume growth driven by commercial scale, DTC momentum, and Quest collaboration. ASP remained strong across Medicare fee-for-service and Medicare Advantage.
    Test volumes: 66,000Test volume growth: from 16,000 in Q2 FY25ASP: ~$800 per test
    		$53 millionfrom $15 million——

    Operational metrics

    13
    Cash and investments balance
    $1.2 billion
    Q2 FY26 end

    As of quarter end.

    Non-GAAP gross margin
    67%compared with 66% a year ago
    Q2 FY26

    Improvement reflects lab efficiency, disciplined execution, and tight cost control.

    Non-GAAP operating expenses
    $288 millionup 34%
    Q2 FY26

    Increase concentrated in commercial investment.

    Sales and marketing expense
    $172 millioncompared with $108 million a year ago
    Q2 FY26

    Continued expansion of Screening sales infrastructure, advanced Shield HCP and DTC programs, and supported Oncology growth.

    Guardant360 Liquid cost per test reduction
    $200
    Q2 FY26

    Due to NovaSeq X transition completed in May.

    Shield cost per test
    $410
    current

    Current level, expected to reduce by ~15% by end of 2026.

    Field organization professionals
    over 400
    Q2 FY26

    Commercial reach continues to expand rapidly.

    Dedicated health system team
    more than 30
    Q2 FY26

    Built and expanded, encouraged by engagement within large accounts.

    U.S. addressable screening market
    $50 billion
    current

    For colorectal cancer screening.

    Eligible average-risk individuals for CRC screening
    approximately 120 million
    current

    In the U.S. eligible for colorectal cancer screening.

    Companion diagnostic approvals
    284 added in H1 FY26
    Q2 FY26

    Reflects the strategic value of the Smart Platform to biopharma companies.

    Patient tests in data repository
    more than 1.3 million
    Q2 FY26

    Proprietary data asset powering InfinityAI.

    Epigenetic profiles in data repository
    over 700,000
    Q2 FY26

    Across more than 100 tumor types, powering InfinityAI.

    Industry KPIs

    2
    MetricValueDetails
    Membership covered lives by lineapproximately 70 millionlives
    Adjusted EPS EBITDA leverage guidance$56 millionUSD

    Deals & partnerships

    3
    NuvalentCollaboration to develop companion diagnostics

    Initial focus on Guardant360 Tissue.

    Quest DiagnosticsCo-promotion and EMR connectivity for Shield

    Collaboration went live in the field in Q1 FY26, contributing to strong Shield volume growth.

    UnitedHealth GroupCoverage for Shield for colorectal cancer screening

    UnitedHealth Group is the largest commercial insurer in the U.S. and the first major insurer to cover Shield for average risk adults aged 45 and older.

    Risks & headwinds

    3
    Increased CapEx for Shield lab capacityFY26

    Full year FY26 free cash flow burn guidance raised by $10 million to $195 million-$205 million.

    Mitigation: Accelerating investments to support anticipated growth and higher test volumes, greater processing efficiency, and improved turnaround times.

    Delay in MolDX reimbursement for RevealBeyond end of 2026 for some indications

    Not quantified, but noted as 'taking a little bit longer than we would have liked'.

    Mitigation: Submissions are progressing, with confidence in getting them over the finish line for breast and IO by end of 2026.

    ASP realization for commercial payers for Guardant360 ADLT12-24 months

    Expected ADLT price of $8,455, but it will take 12 to 24 months for Medicare Advantage and commercial payers to align their pricing to the new Medicare rate, impacting realized ASP.

    Mitigation: Ongoing conversations with payers; UnitedHealth coverage is a positive step that may influence other payers.

    What to watch in Q3 FY26

    5

    Shield volume growth

    Q3 FY26
    Current66,000 tests in Q2 FY26 (22,000 sequential step-up from Q1)
    TargetSequential growth of 12,000 Q-over-Q (midpoint of guide)

    Why it matters

    Verifying if the strong Q2 momentum from Quest co-promotion, DTC, and field force expansion can be sustained, especially with UnitedHealth coverage becoming effective.

    So we don't expect multiple new things all hitting at once in Q3. Having said that, we are very excited of what we can do in the second half, like we increased our guide by 40,000 samples, which translates at the midpoint, the guide that we put out there, like sequential growth of 12,000 Q-over-Q.

    Q&A highlights

    7

    How will UnitedHealth Group coverage and ACS guidelines impact Shield's near-term volume and long-term ASP? What are the expectations for USPSTF's August meeting?

    UnitedHealth coverage is expected to be a volume tailwind, helping to build commercial volume for younger patients. However, ASP realization will take time as negotiations and collection history are established. The company's expectations for USPSTF timing remain unchanged, despite some payers engaging in conversations earlier.

    “This UHG win could actually give us some interesting benefits, like we are excited to see how the rest of the year would play out. It could be a tailwind for the volume. It would help us to strategically step-by-step build our commercial side of the volume, so not just 65 and above, but actually younger patients, make sure they get actually access to this breakthrough technology.”

    asked by Kyle Mikson · answered by AmirAli Talasaz

    2 min read6 chapters

    Detailed Narrative

    01

    Strategic Platform Vision and Market Opportunity

    Guardant's Smart Platform is designed to address four major opportunities in precision medicine: therapy selection, recurrence monitoring, cancer screening, and multi-disease screening, collectively representing a nearly $400 billion potential market. This integrated platform leverages compounding technology, data, and clinical insights across the disease continuum, as evidenced by recent FDA approvals and guideline inclusions that advance this vision into clinical impact and durable growth.

    02

    Oncology Business Momentum and Product Acceleration

    The Oncology segment delivered strong, broad-based growth, with revenue up 38% year-over-year and test volumes increasing 63%. Guardant360 Liquid saw over 30% volume growth, Guardant360 Tissue accelerated, and Reveal continued its rapid expansion with over 100% year-over-year volume growth for the third consecutive quarter. Reveal's performance is driven by growing MRD adoption and its unique suitability for therapy monitoring in late-stage cancer, representing a multi-million test annual opportunity.

    03

    Shield Screening Breakthroughs and Market Expansion

    The Shield screening business achieved significant milestones, including its inclusion in the American Cancer Society's colorectal cancer screening guidelines and a major coverage decision from UnitedHealth Group. These developments are expected to broaden patient access, with approximately 70 million lives (60% of the U.S. addressable market) now covered for Shield blood tests, driving strong demand and commercial execution.

    04

    Technological Advancements and Cost Efficiency

    Guardant received FDA approval for Guardant360 Liquid CDx, enhancing its therapy selection portfolio with 100x more content and integrating genomic and epigenomic data. Additionally, FDA approval for a higher-throughput, lower-COGS Shield workflow is expected to reduce Shield's cost per test by approximately 15% by the end of 2026 from $410, with a long-term target of $200 per test by 2028, improving scalability and profitability.

    05

    Data and AI as Strategic Assets

    The company highlighted its proprietary data asset, comprising over 1.3 million patient tests and 700,000 epigenetic profiles across more than 100 tumor types. This repository fuels the InfinityAI platform, enabling the discovery of novel biological signatures, development of clinically actionable Smart apps, and acceleration of drug discovery for biopharma partners, showcasing a strong positive response at ASCO.

    06

    Financial Performance and Outlook

    Guardant raised its full-year 2026 revenue guidance to $1.34 billion to $1.36 billion, reflecting strong first-half results and increased confidence in Shield's trajectory. While accelerated investments in Screening lab capacity led to a revised free cash flow burn outlook of $195 million to $205 million, the company remains committed to achieving company-wide cash flow breakeven by the end of 2027, with the non-Screening business already adjusted EBITDA positive.

    AI-generated summary of the company’s earnings call. Not investment advice.