What percentage of the existing Oncotype market is contestable for Prosigna, and what is the expected earliest uptake, particularly in node-positive populations?

Management stated that the entire HER2-negative ER-positive population is addressable by Prosigna's value proposition, not just specific subsegments. While OPTIMA data adds predictive claims for node-positive patients, Prosigna's Level 1A evidence for accurate risk stratification applies broadly. They are optimistic about sustained growth and engagement with large centers considering full switching. “We believe the entirety of the HER2-negative ER-positive population is addressable by our value proposition. The latest data from OPTIMA happens to add predictive claims to the node-positive population, both postmenopausal and premenopausal. But one of the large value proposition here we start with an accurate risk stratification to understand what is the real risk of progression in the 10-year time frame.”

What are Veracyte's plans for EMR integration and other commercial/logistic initiatives to support Prosigna adoption, given it's a mentioned headwind?

Management acknowledged EMR integration is crucial for simplifying logistics and streamlining workflows, especially at volume. They are heavily investing in a team to integrate with practices, leveraging existing efforts for Decipher and Afirma. They agree that EMR integration is a high ROI endeavor. “We believe that at volume, EHR integration goes a long way. not just to simplify the logistical burden on the practice administrators and the physicians, but also in just streamlining and even potentially automating some of the test ordering and automation into the overall workflow.”

How is Veracyte managing patient access for Medicare beneficiaries for Prosigna, and what is the expectation for MolDX timeline and confidence level?

Prosigna already has Medicare coverage via an on-market FDA-approved product. The company is submitting a tech assessment to MolDX for the LDT version, outlining validation and bridging studies. They expect imminent approval and have multiple paths to secure pricing, guiding for the low end around $2,500. “Prosigna has already enjoyed coverage from Medicare via our on-market FDA approved product. Our plan had been to transition away from the FDA distributed product towards a centralized -- so from a coverage perspective, we're covered. The process moving forward is to submit a tech assessment that outlines our lab validation, the analytical validation, our bridging study through the FDA-approved product and platform and to have that reviewed and subsequently approved by Medicare.”

VCYT

Veracyte (VCYT) Q2 FY26 earnings call: guidance and Q&A

Earnings call· Jun 2026 (Q2 FY26)· Health Care· Jul 30, 2026

Source: earnings call transcript

Executive summary

Veracyte Q2 FY26 — Strong Growth and Key Product Launches

Veracyte delivered a strong second quarter, marked by double-digit revenue growth and robust profitability, alongside the significant launches of Prosigna LDT and TrueMRD. The company is strategically investing in these new growth drivers and its core franchises, while navigating NCCN guideline changes impacting low-risk Decipher Prostate volumes. Management remains confident in its long-term growth trajectory, supported by an expanding clinical evidence pipeline and operational efficiencies.

Highlights

Total revenue reached $150.3 million, representing 15% year-over-year growth.
Adjusted EBITDA was $44 million, or 29.2% of revenue, up 23% year-over-year.
Decipher Prostate revenue grew 20% year-over-year, driven by 17% volume growth.
Afirma revenue grew 18% year-over-year, with 10% volume growth and sustained ASP gains.
Successfully launched Prosigna LDT and TrueMRD for muscle invasive bladder cancer, expanding the portfolio into new growth areas.

Concerns

Full-year Decipher Prostate volume guidance lowered by approximately 1,000 tests, primarily in the low-risk setting, due to NCCN guideline changes.
Revenue guidance for Prosigna LDT and TrueMRD excludes contribution due to early launch stages and pending Medicare reimbursement for Prosigna.

Guidance & targets

Category	Target	Timeline	Confidence
Full-year Total Revenue	$590M-$596M high materiality	FY26	High
Full-year Testing Revenue	$576M-$582M high materiality	FY26	High
Full-year Decipher Revenue Growth	~20% medium materiality	FY26	High
Full-year Afirma Revenue Growth	~12%-14% medium materiality	FY26	High
Full-year Adjusted EBITDA	>26% high materiality	FY26	High
Prosigna Medicare Pricing	low end around $2,500 medium materiality	Near-term	Medium
Decipher Low-Risk Studies Readout	as early as 2027 medium materiality	CY27	Medium

Segment performance

Segment	Revenue	YoY	QoQ	Margin
Decipher Prostate Delivered strong revenue and volume growth, driven by increased physician adoption and deeper penetration, particularly in higher-risk categories. ASP improvements also contributed to revenue growth. Volume: 29,000 testsVolume growth YoY: 17%ASP: improvedNew ordering positions: strong increaseOrders per physician: new recordOrdering trends: strong in intermediate and high-risk localized diseaseOrdering trends: strong in post-prostatectomy and biochemical recurrence	—	20%	—	—
Afirma Showed strong revenue and volume growth, benefiting from operational efficiencies, ASP gains, and expanded market adoption. The B2 transcriptome workflow improved the no-result rate. Volume: 18,600 testsVolume growth YoY: 10%ASP: sustained gainsUtilization among existing physicians: increasedOrdering physician base: expandedMarket share: ongoing gainsNo result rate benefit: ~400 bps of volume growth	—	18%	—	—
Decipher Bladder Saw encouraging order trends and continued evidence generation, highlighting its growing body of evidence across the bladder cancer continuum. Order trends: encouraging Q2Publications/abstracts: 13 in Q2	—	—	—	—
Prosigna Experienced tremendous enthusiasm and engagement since launch, leading to an accelerated sales force expansion to capture demand. Institutions engaged: >100Sales force expansion: ahead of original plan	—	—	—	—
TrueMRD for MIBC Represents the first commercial application of the MRD platform, leveraging whole genome sequencing for recurrence monitoring in muscle invasive bladder cancer. Commercial application: first on MRD platformTechnology: first and only commercially available MRD test to utilize whole genome sequencing	—	—	—	—

VCYT operating KPIs by quarter

VCYT 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
Tests delivered Afirma	—	~17.2K We delivered approximately 17,200 tests in the first quarter, representing 12% year-over-year volume growth. Source: earnings call transcript	~18.6K We delivered another strong quarter with approximately 18,600 tests, representing 10% year-over-year volume growth and 18% revenue growth. Source: earnings call transcript	—
Tests delivered	~48K We grew total volume to approximately 48,000 tests, a 16% increase over the same period in 2024 and generated $52.6 million of cash from operations to end the quarter with $412.9 million of cash and cash equivalents on hand. Source: earnings call transcript	~47.6K Total volume increased to approximately 47,600 tests, up 17% compared to the same period in 2025, and we generated $35.2 million of cash from operations, ending the quarter with $439.1 million in cash, cash equivalents and short-term investments. Source: earnings call transcript	—	—
Testing volume	~45.5K Total testing volume was approximately 45,500 tests, an increase of 16% over the prior year period. Source: earnings call transcript	~45.2K Total testing volume was approximately 45,200 tests, representing 19% growth year-over-year. Testing ASP was $2,986, up 6% compared to the prior year and inclusive of approximately $4 million of prior period collections or PTCs. Source: earnings call transcript	48.389K Total testing volume was 48,389 tests, representing 14% year-over-year growth. Source: earnings call transcript	—
Testing ASP	~$2,984 Testing ASP was approximately $2,984, an increase of 4% compared to the prior year, driven primarily by the impact of higher prior period collections or PPCs. Source: earnings call transcript	$2,986 Total testing volume was approximately 45,200 tests, representing 19% growth year-over-year. Testing ASP was $2,986, up 6% compared to the prior year and inclusive of approximately $4 million of prior period collections or PTCs. Source: earnings call transcript	$3,010 Testing ASP was $3,010, up 4% to the prior year and inclusive of approximately $4.5 million of prior period collections or PTCs. Source: earnings call transcript	+0.8%
Normalized testing ASP	$2,875 Normalized ASP was also higher at $2,875, a 1% increase compared to the prior year period after adjusting for the approximate impact of $5 million of PPCs in the quarter. Source: earnings call transcript	$2,900 Excluding PTCs, normalized ASP increased 3% to $2,900, driven by continued strong collections. Source: earnings call transcript	~$2,900 Excluding PTCs, normalized ASP increased 3% to approximately $2,900, driven by the benefits of operational efforts put into place over the course of 2025, which have led to sustained pricing gains in the first half of this year. Source: earnings call transcript	—

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	Details
Prosigna LDT	launch	Q2 FY26
TrueMRD for Muscle Invasive Bladder Cancer (MIBC)	launch	June 2026

Risks & headwinds

NCCN guideline changes for low-risk prostate cancer FY26

Decipher volume guidance lowered by ~1,000 tests for FY26

Mitigation:Investing in new clinical evidence generation, with initial readouts expected as early as 2027, to support broader adoption and guideline inclusion.

Lack of Medicare reimbursement for Prosigna LDT Near-term

Revenue guidance excludes contribution from Prosigna

Mitigation:Ongoing constructive discussions with MolDX for Medicare coverage, with an expected pricing around $2,500.

Harder comparative base for Afirma in FY27 FY27

Impact on Afirma's '27 numbers

Mitigation:Anticipated benefit from the NRR in '26 results and strong PTCs will create a harder comp, requiring continued focus on operational efficiencies and market penetration.

What to watch in Q3 FY26

Prosigna Medicare Reimbursement

Next quarter / Near-term

Current Discussions ongoing with MolDX

Target Approval of tech assessment and pricing agreement

Why it matters

Securing Medicare reimbursement is critical for Prosigna's commercial ramp-up and revenue contribution.

We are making progress on reimbursement and continue to have constructive discussions with MolDX regarding Medicare coverage. We are encouraged by the engagement to date and look forward to providing updates as those discussions progress.

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

Q&A highlights

Is the reduction in Decipher low-risk volume due to AI-based testing, and how do molecular and AI approaches coexist in the future?

Management clarified that the reduction in low-risk Decipher volume is due to NCCN guideline changes impacting all genomic tests in that setting, not a threat from AI. They emphasized that molecular and AI are complementary, measuring different biological aspects, and can coexist, with physicians generally preferring more information.

“The reduction in our internal expectations for Decipher for the year is only in the low category where we took it down by about 1,000 tests, some of which -- most of which is actually behind us in the second quarter. And the real -- the rationale for that and what we're seeing there is the guideline change that happened at the end of last year where effectively for every test, whether molecular or AI-based for active surveillance, it was taken out of guidelines.”

asked by Unknown Analyst · answered by Marc Stapley

3 min read 5 chapters

Detailed narrative

Prosigna Launch and OPTIMA Trial Impact

Veracyte successfully launched Prosigna LDT in the U.S. following the presentation of practice-changing OPTIMA trial results at ASCO. The OPTIMA trial, an independent prospective Phase III study, demonstrated that over two-thirds of clinically high-risk early-stage breast cancer patients, including premenopausal women and those with up to 9 positive lymph nodes, may safely avoid chemotherapy.

This Level 1A evidence significantly expands Prosigna's clinical utility beyond node-negative patients. The company is seeing tremendous physician enthusiasm and is expanding its sales force to meet demand, with over 100 institutions evaluating broad adoption. Discussions with MolDX for Medicare coverage are ongoing, with an expected price around $2,500.

TrueMRD Platform and Bladder Cancer Entry

Veracyte entered the rapidly growing MRD market with the launch of TrueMRD for muscle invasive bladder cancer (MIBC) recurrence monitoring. This test is the first commercial application of its TrueMRD platform, which utilizes whole genome sequencing for both landmark and subsequent liquid biopsy surveillance tests, offering a broader view of tumor biology and tracking tumor evolution.

The company secured Medicare reimbursement for this initial indication and plans to leverage its Decipher Bladder brand and relationships in urology to accelerate adoption. The TrueMRD platform is designed to be extensible to multiple tumor types and clinical applications over time, positioning it as a long-term growth driver.

Decipher Prostate Performance and Evidence Generation

Decipher Prostate delivered a strong quarter with 20% year-over-year revenue growth and 17% volume growth, totaling nearly 30,000 tests. This growth was driven by increased ordering positions and deeper penetration among existing physicians, particularly in intermediate and high-risk localized disease, post-prostatectomy, and biochemical recurrence.

While low-risk volume guidance was slightly reduced due to NCCN guideline changes, the company is investing in new evidence generation, with initial readouts expected as early as 2027, to support broader adoption in this segment. Decipher Prostate was featured in over 35 publications and abstracts, including Level 1b evidence from the EZAMET trial, further solidifying its clinical utility.

Afirma Growth and Operational Improvements

Afirma continued its strong performance with 18% year-over-year revenue growth and 10% volume growth, totaling approximately 18,600 tests. This was driven by increased utilization, expansion of the ordering physician base, and ongoing market share gains. Revenue also benefited from sustained ASP gains and favorable commercial payer reimbursement.

Operational efficiencies from the B2 transcriptome workflow significantly improved the no-result rate, contributing approximately 400 basis points to volume growth. Evidence generation remains robust, with Afirma featured in 10 conference abstracts and multiple peer-reviewed manuscripts, and growing academic and industry collaborations through Afirma Grid.

Strategic Investments and Capital Deployment

Veracyte generated $45.8 million in cash from operations, ending the quarter with $485.2 million in cash, cash equivalents, and short-term investments. The company is maintaining its full-year adjusted EBITDA guidance of greater than 26%, reflecting strategic investments in its growth initiatives, including the expansion of the Prosigna sales force and R&D for pipeline development.

Management prioritizes investing in the business for continued growth, evaluating M&A opportunities for the right assets, and regularly discusses returning capital to investors, though current focus remains on internal opportunities.

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