Detailed Narrative
Record Performance and Strategic Execution
Exagen reported its highest quarterly revenue in company history at $19.9 million, a 16% year-over-year increase. This was driven by record AVISE test volume of nearly 39,000 tests (up 11% YoY) and a trailing 12-month ASP of $446 (up 4% YoY). The company also achieved record pharma services revenue exceeding $1 million for the first time. These achievements reflect disciplined execution against three core objectives: expanding product adoption, increasing ASP through revenue cycle management, and delivering innovation.
AVISE CTD Adoption and Sales Force Productivity
AVISE CTD volume surpassed previous levels from 2023, with a trailing 12-month ASP nearly 40% higher than at that time. Over 2,800 clinicians ordered AVISE CTD in the quarter, up approximately 9% year-over-year. Sales force productivity reached record levels, with trailing 12-month AVISE CTD revenue per territory exceeding $1.4 million, compared to $1.3 million for the full year 2025. Investments in upgrading and training the sales organization are yielding strong returns, with growth seen across the nation, partly due to the refreshed product with new analytes expanding utility into rheumatoid arthritis.
ASP Expansion and Revenue Cycle Management
The trailing 12-month ASP expanded to $446, marking the 13th consecutive quarter of growth. This improvement is attributed to the revenue cycle team's strong collections, including over $1 million from claims older than 360 days in Q2, and $2.3 million in H1 FY26. Total cash collections in the first half of 2026 exceeded first half 2025 levels by $9 million. The company is leveraging analytics and AI to optimize processes, automate appeals, and streamline medical record extraction, with a long-term target ASP of $600-$650 per test.
Pharma Services Growth and AI Investment
Pharma services delivered a record quarter with revenue just over $1 million, representing over 200% growth year-over-year. The contract backlog for pharma services grew by approximately $1 million to over $6 million in Q2. Building on the success of AI in RCM, Exagen is now investing in AI-powered commercial infrastructure to deepen clinical engagement, support AVISE utilization, and embed the company directly in the rheumatology workflow, complementing the commercial team.
Innovation and Pipeline Progress
Exagen published a systematic review validating real-world AVISE Lupus performance, pooling data from over 3,100 patients across 14 medical centers. This study notably showed AVISE Lupus identified approximately 25% of SLE patients missed by conventional markers. The myositis offering, the first new stand-alone product in years, remains on track for commercialization in early 2027, with the company committed to a cadence of approximately one new product every 12 months thereafter.
Path to Profitability and Financial Strength
The company significantly improved its adjusted EBITDA from a $40 million loss in 2022 to near breakeven in Q2 FY26, demonstrating the impact of disciplined execution. Exagen generated $3.1 million in cash in Q2, ending the period with nearly $25 million in cash, cash equivalents, and restricted cash. With $37 million in cash and accounts receivable, the balance sheet provides the runway needed to reach sustainable adjusted positive EBITDA and positive free operating cash flow, targeting breakeven at around $80 million in annual revenue.