Exact Sciences Corporation (EXAS) Earnings Call Transcript & Summary

Thanks, everybody, for joining us here at the conference. Happy to have Kevin Conroy and Aaron Bloomer from Exact Sciences with us here today. A bunch to cover. There are some QR codes on the table, and I think online, I have this iPad up here, see if I can figure it out. But I think questions can load on here. If anyone has any from the audience, feel free to submit those. I'll try to get to them. But Kevin, Aaron, again, thanks for being here.

Maybe we can start just with the most recent news. Obviously, got the pricing increase on the CMS side. Maybe just talk about you had the flat initial payment. The final payment came through nicely above in terms of that increase. So that 16% increase higher -- maybe just talk about what volume that hits? I know there's the Medicaid fee-for-service, Medicaid Advantage. Maybe just talk about what that means for you guys and where that came in relative to expectations.

Sure. Well, so the price here is for Cologuard Plus, which is a tremendous new innovation. It's a test that delivers -- detects 95% of cancers at a 94% specificity. That specificity is calculated off the people who have no findings in their colon. So it's a large study, 18,000 patients. And one of the hardest things to do is improve both sensitivity and specificity, and we did both leading to a 40% reduction in the false negative rate, the cancers that you miss and a 40% reduction thereabouts in the false positive rate, leading to fewer people having to go to an unnecessary colonoscopy. So there is a greater economic value to the whole health system because you're sending fewer people to an unneeded colonoscopy, leading to lower costs. We, through the Medicare process or establishing a price, they initially chose the price for the original version of Cologuard and then they changed their mind and issued a price of $592, so that was welcome news. And we think that it is a reflection of -- and a validation of the value of Cologuard. What does that do for us? Number one, it shortens the time of bringing the test to patients -- to all patients because with the ADLT process, the other way where you get to pick your price, there's a benefit that you can pick a higher price if you want, but that price resets every year. With the process that we went through, the price resets every 3 years. It's reset off the median of the commercial rates during a certain measurement period. So we get to bring the test to patients faster now because as of January 1, this is the new price. You don't have to go through any of the complexities of the other process, number one. Number two, it applies first Medicare fee-for-service. So think next year, we will make Cologuard Plus available in, hopefully, the beginning of Q2, the plan is April of Q2. We will then -- those tests will start to roll in. There's a lag between the time a test is ordered and completed, et cetera. So think of the back half of the year and then think Medicare fee-for-service, which is about 1 in 5 people overall in the country that get a Cologuard test. Medicare Advantage, which is another about 1 in 5. It's actually 18% and 22%. And then to the commercial plans. And that overall process will take 18 to 24 months to fully transition from Cologuard to Cologuard Plus. We -- in terms of pricing for commercial, our consistent philosophy on pricing has been -- look, Medicare is the largest payer, and they should -- nobody should get a better price than Medicare. And so we've been very consistent in that approach with Cologuard, and we expect to have the same philosophy with Cologuard Plus.

Yes. Okay. And then, Aaron, maybe just on the financial side, right? As Kevin said, there, 20% Medicare fee-for-service. That will flip over day 1, Medicare Advantage. I think some chunk of that is tied to the pricing day 1, and then it will move over but 16% higher price, the COGS are lower as well. Maybe just talk about what that EBITDA impact could look like for you guys and the profitability of Cologuard Plus versus the old version.

Yes. So we're really excited with the launch of Cologuard Plus that we will now have an increased selling price as well as a lower cost per unit, which will yield over time, several hundred basis points of margin expansion. As Kevin alluded to, we would really expect this to be more back end weighted next year just from a revenue contribution as well as then the benefit on our gross margins and rolling into a full annualized impact as we approach 2026 and into 2027. From a growth acceleration standpoint next year, Cologuard plus -- if you do the math on what Kevin just described, you get to a couple of points worth of growth contribution from Cologuard plus pricing impact in 2025.

And then yes, maybe we can kind of turn our attention to the latest quarter, the guidance, what it all means for '25. I know obviously, you guys came up a little short in terms of the guidance of where you want it to be coming out of 3Q. A big piece of that was just that sales and marketing efficiency, productivity, if you want to call it. Yes, maybe just talk through what happened and where we are today, how you guys are kind of righting the ship on that front and where we stand?

Sure. Let me just start with a little bit about our vision at Exact. Our vision is to help eradicate cancer. Cancer is a disease that in the U.S. will be diagnosed almost 2 million times next year. leading to about 600,000 people dying. It is the #1 killer of people under age 85 by the year 2030. It will be the #1 killer overall overtaking heart disease. So with colon cancer, specifically, there are about 50,000 people a year who die from colon cancer. It is known as the most preventable and least prevented cancer. Until Cologuard launched 10 years ago, really your choices were colonoscopy or a fecal immunochemical test. Colonoscopy has its obvious advantages but also obvious disadvantages and the FIT test is just a -- it's an inexpensive test, but you get what you pay for. It is very poor detecting Stage I cancers and precancerous polyps. So you have these 2 choices, neither of them really met the whole need. Well, Cologuard is filling that need. There are 60 million Americans age 50 to 85 -- or 45 to 85 who are not up to date with their colon cancer screening. So over the last 10 years, we have screened all together 17 million times with Cologuard. And now people are doing their second, third and this next year, even their fourth Cologuard test. We guided in the fourth quarter for the fourth quarter to be down. Part of it was due to some -- about $90 million in total, about 1/3 of that was for onetime reasons and about $60 million of that was because of the performance of Cologuard in especially as we saw a commercial leadership change in the middle of the year, we had a chance to go back and really dig into how we were deploying our sales force, incentivizing our sales force. Historically, we were maniacal about making sure that every single rep at a geography-based territory, we provided them a list of kind of core and super core health care providers to call on to educate. And we could identify those health care providers based on how many patients they saw, a lot of different attributes that you could gain from outside data, but also our own ordering information. So we could see -- for example, when somebody was ordering for the first time and make sure that we called them, we visited them. We provided them with a demo kit, a New England Journal article and education and educate their whole office. And truthfully, we got away from that over the last 3 years. And that's one of the things we learned after these commercial leaders changed. And what we -- so we've identified a problem we're fixing that problem. What were some of those challenges. Number one, we moved away from geographic base territories to just giving them a list of 250 health care providers to call on and then not updating the list. And this is an incredible sales team; incredibly trained and motivated. We weren't giving them the tools, and I'm accountable for that. We're addressing is addressed effective yesterday, everybody has their geographic territories. And they are fired up to do what they always have done, which is get more physicians educated about this amazing new technology in Cologuard and now Cologuard Plus. So that's one thing. The other thing was just how we incentivize our reps that there were some basic changes there that were made for whatever reason, they lowered the attainment for a bonus to 70%. Well, we never ran below 90%. And to any reps who are listening, I want you to understand that we're going back to the old ways. We want you to be successful. We provide incredible upside if you overdeliver, and we're fighting for people to get screened. Most of the people will get a Cologuard test have never been screened. So there's an incredible motivation on our team to be successful for the patients and also for their own families. So some of these changes we're making, some of them are overdue, and we're -- we believe that with these changes, we'll see what we have always seen. If you have a new provider with a high potential and use around them with education, attention, health, they understand our -- what we call our compliance engine or our reminder system to return the kit, all of those digital tools they will order more. And you see them starting now at almost double the rate of Cologuard orders because of the incredible brand awareness relative to 5 or 6 years ago. And then the goal is to move them from 5 or 6 Cologuard tests per quarter to 10 to 12 quarters per quarter in a fairly short period of time. The data show that when we do that, when we call on those newer high potential health care providers, they quickly go up that curve. And that's been true for 10 years. In the last 3 years, we haven't called on them as frequently as we should. Again, I take accountability for that and we are addressing this.

Yes. And I guess when you guys make some of those changes that you talked about, how long does it take to kind of impact things. I know you guys track things day by day, minute by minute probably. But how do you see that? I know you've talked about -- you've added, I think, 1,000 new providers, one of the more recent weeks. Maybe just talk about how quickly some of those changes can impact?

I think while you were talking, I just got an e-mail showing what our results were yesterday. Yes. So it's -- this is going to take a couple of quarters to have the impact because you have -- it takes a little bit of time to get to those offices. If you have -- every rep should have a list of about 150 health care providers, 25 who are super core to their focus, 50 who are core to their focus and then another 75. And then that gets updated every quarter. By the way, we weren't updating the list every quarter like we always did. In the future, the amazing thing is it gets updated every day because of AI tools that allow you to deploy reps, basically, if a rep wants to be on an automated circuit of office visits, AI tools will do that for them. And so it will take a couple of quarters for us to see the impact. You start to see that impact. We would expect to see that start to see the impact in the first quarter by the end of the second quarter of full deployment here. We think we'll be back to typical impact that we see when we have this hyper focused.

Yes. And I know for 4Q, you talked a little bit about there's that usual seasonality. We're not seeing it this year. Is that -- is that just because of some of that sales and marketing stuff, maybe just talk about the, I guess, the lack of seasonality we're seeing this year and the right way to think about that going forward?

Yes. So if you look back in time, we had some tailwinds over the last 3 years. We saw a bolus of people coming in to get screened 3 years ago after COVID. You saw the lowering of the age 50 to 45. And so you saw a bolus of new people. And I think that obscured some of the lack of tools and incentives that we were providing to the sales force to be successful. And I think coming out of that, you'd typically see in the fall this steep ramp-up. And we saw a ramp-up. It wasn't as steep as we would typically see over the last 10 years. That was the signal we better dig in and see what's going on here. So look, this is -- there are 60 million people who are not up to date with screening; 45 million of them -- and if I ask the question in this room, raise your hand if you're not up to date with screening your half the room would probably raise their hands. It just is -- it has happened at every conference I've ever spoken on it. Are you willing to get screened? Yes, if you're educated, you realize how easy it can be done with Cologuard, how accurate Cologuard is yes, you'll do it in the privacy of your own home. So the response -- there have been a lot of people who have asked the question, do you think we're -- Cologuard is just flattening out? No. This is all about execution. Because those 45 million people are going to get screened.

And I know another thing we talked a lot about during the quarter was the care gap. It was kind of viewed as this 4Q step-up. You guys have said a few times, it's bigger than you think. It's underappreciated -- maybe just talk through maybe first, what care gap is and then what that opportunity looks like as we kind of step forward.

Do you want me to give you a little tidbit?

Sure.

So this year, we expect to screen nearly 300,000 not quite. Over 200,000 people with our -- if I'm going to give you information to better be accurate. Over 200,000 people with their care gap initiative. What is the care gap initiative? Well, there are these things in the U.S. called quality measures, and they're a powerful force in American health care. They're about incentivizing a suite of about 30 different types of testing, screening in the primary care setting. For example, making sure that people have their blood pressure under control. What percentage of people in your health system and your health plan, so both health systems and plans are motivated? And they do this across a range of different measures. One of them is colon cancer screening. And it's always one of the worst-performing measures. It is -- so Cologuard because it's in the main guidelines, it then also got into the quality measures. So it gives a health system or a health plan like a Medicare Advantage plan. Three years of credit for every patient who gets a Cologuard test. So it boosts their quality measure, not only for this year but for the next couple of years. And that's a big deal. Why is that a big deal? Because they are dying, they are just -- they really want to make sure that their members get updated with colon cancer screening. So we -- last year, we had over 50 programs mostly with payers, health plans, mostly with Medicare Advantage, but some commercial and some Medicaid. And then also about 25% of those were with health systems. So I think big hospital networks, group practices that are also incentivized to boost their screening rates. This just started. So a year -- this has grown at triple digits. It's more than doubled over last year. So we had fewer than 100,000 last year, and now it's more than that. And we expect it to grow again in a major way. One of the reasons that we can do this is because of what we call our Exact Nexus platform. So are we a cancer diagnostic company or are we a technology company? You can have that debate. Our cancer diagnostic tests are powered by this Exact Nexus platform, which allows us to do electronic ordering, electronic resulting, electronic messaging, to and from a patient, automated prior authorization or preauthorization, automated billing on the back end. It's this powerful technology platform that nobody in our space has. Nobody has that full suite of capabilities. This allows us then to deliver for these payers if they give us a list of 90,000 patients, we're able to send them Cologuard kits. Over -- right now, the return rate in these programs is low. It's, let's say, it's 22% for the year, 24% in the last quarter. Cologuard, typically, when it's ordered in a physician's office that has about a 2/3, 67% kit return rate. Imagine what happens to the size of this opportunity to get people screened as we double or in some day, triple that kit return rate in this care gap setting. Are we going to be able to do that? Yes. As we unlock the full suite of our capabilities for these customers. We saw one program coming in at over 50% kit return rate. And that's all powered by this Exact Nexus platform. If we're going to screen 60 million people, we're not going to do it all by people going into their doc and getting screened. What we're seeing is fewer people are going in for a conventional wellness visit, especially younger people. When was last time you -- I get to ask the question. When was the last time you went to a primary care offices? I just picked up upon and said it's time for a health checkup?

Probably like 2 years.

Yes. So that's -- we are not going to get people screened through that conventional approach, and now we have a capability that we've just -- this program is 18 months old. And it was the inspiration of innovators within Exact. And I think one of the things that we should be held accountable to is, can we remain an innovative company as we grow in size and scale. And this is proof. The leaders that came forward and said, we want to create this capability internally and banged down the table for resources, they got the resources and then they massively over delivered. We think at some point in time, this is going to be over -- you're going to be screening over 1 million people a year just in this -- through this approach in the next several years.

Just to build on that, back to the point, Patrick, on sort of the growth acceleration in the back half of the year, the team that leads these care gap programs, as Kevin said, has consistently outperformed expectations. And so when we talked about a reason for growth acceleration, one of the key drivers was care gap programs. It has exceeded expectations in the back half of the year. Roughly 2/3 of the patients will have screened through care gap is in the back half of the year and building on that into 2025.

Yes. Maybe that's a good time, Aaron to talk a little bit about 2025. I know you guys have talked about a reacceleration, double-digit growth, care gap, rescreen, obviously, big pieces. I guess when you think about the bridge or the drivers into next year, obviously you talked a little bit about care gap there. What are the big opportunities and just the confidence in that reacceleration into next year?

Yes, it starts with rescreens. And so rescreens, the great thing about this as a CFO is it's highly predictable, recurring highly profitable form of revenue. And the number of patients eligible for a rescreen is going to continue to grow. It was 1.2 million patients last year, 1.6 million patients this year, 2 million next year, 2.6 million the year after that. And I think one thing that's not often understood is it's not just when you're eligible for your second rescreen, this is a compounding effect because then it's people that are eligible for their third are screen and eventually their fourth screen, fifth rescreen. And so this is going to provide a recurring form of growth acceleration for Exact in the screening business for years to come. And so if you look at growth contribution from rescreens next year, that gets our screening business to mid- to high single-digit growth just from rescreens alone. With some of the things we just built on from a care gap perspective, those 2 things combined gets you to something north of 10% growth in 2025. And then as we talked about earlier, our Cologuard Plus launch, which we would expect to add a couple of points of growth. Obviously, there's things we're doing and we talked about at length from a commercial execution perspective. We would expect that to take several quarters to contribute and just too early to tell in terms of impact on 2025.

No, that's helpful. And then I guess, yes, maybe in terms of the EBITDA piece, obviously, a big focus as well. You guys have some long-term guide out there. Maybe just talk about the execution on the EBITDA front so far. And then, again, the right way to think about the expectations going forward as we talked about Cologuard Plus should be a nice boost on that front as well.

Yes. So as a reminder, our long-term guidance for adjusted EBITDA or profitability at Exact Sciences is to be to 20% plus by 2027. We did just south of 9% profitability last year. Really pleased with the progress we've made this year. We will have expanded margins by nearly 300 basis points. This year, we'll be approaching 12%. So tracking well ahead of our expectations to get to that 20% plus and we'd look for consistent margin expansion kind of marching from the 12%, where we're finishing this year to get to that 20% plus. And if you look at what are some of the key drivers, behind that, I'll start with some of the progress we've made this year in G&A. And so in the last 2 quarters, we've seen more than 500 basis points of margin expansion coming from G&A leverage. And that's something that we would expect to be able to build upon between now and 2027 as we continue to take a look at our enabling functions and how do we operate them more efficiently and effectively. Obviously, we'd also get productivity on sales and marketing. We've talked about roughly for every $100 million of sales growth. We look to reinvest back in sales and marketing, it is our highest form of ROI investment that we have today and will continue to be, but we will get leverage from that. And then gross margins. We've seen some headwinds here in 2024, primarily due to the care gap kit return rate, that Kevin talked about earlier. We would expect to improve that over time as well as then with the launch of Cologuard Plus, where we'll get the benefit not only from margin accretion from the added price, but also a lower cost per test as well. So there's several building blocks that we have that are going to enable us to expand margins and importantly, allow us to continue to reinvest back in our business.

Yes. Okay. That's helpful. And then maybe just kind of circling back on the rescreen piece, big opportunity getting bigger every year. I know you guys have refined the strategy of capturing those rescreens, whether it was text or doctor reminders, I know the folks don't come back 3 years of one day and reorder. Where are we in terms of that recapture rate? And again, what's the right way to think about when these on average, people are indeed reordering to your point, people tend to slip a little bit off of the time line for pretty much everything on the health side. But where are you guys these days? And what's the right way to think about that going forward?

So the rescreen opportunity is incredible. Let's start with people who get a Cologuard test should get a Cologuard test every 3 years. Why? Because when you model how to have the biggest impact on reducing both the incidence and mortality of disease, you have to figure out how frequently to be tested with colonoscopy, it's every 10 years with the fecal immunochemical test. It's every year because it's not a very good test. You better do it every single year without fail. And Cologuard, it's every 3 years, and that's in the guideline. So what it provides an opportunity is to get people tested every 3 years. And the question is how efficient your question is how efficient are we at getting that done? Over time, we are getting much more efficient, leveraging our technology platform, digital reminders, e-mails, post cards, just -- I think it was about 3 million post cards went out to people that are due for -- to return a Cologuard kit. And we are getting better at this over time. If you take a look at this. If you get a kit ordered when you're due for a second Cologuard test, 80% of people return the kit and the return pretty quickly. If they're due for their third Cologuard test and they get a kit, they return at 90% of the time. But it's just -- but not everybody gets a kit. Why? Because people move, and so their health care provider isn't there, they don't go back in to the office, maybe every 2 or 3 years. And so they're not there at the time that they're due for our Cologuard test. So we're now employing programs that allow us to get more of those people screened. Today, it's north of between 50% and 60% of people overall that are due for their next test get it within a 2-year window frame. Our goal, obviously, is to move that to everybody. So that's how we think about this opportunity. As Aaron said, this has grown from just over 1 million potential to 1.6 million this year to 2 million to 2.6 million, and then it grows quadratically because you keep adding additional increments of people that were doing it layers on in a way that you get tremendous growth. And at some point in time, our recurring revenue portion of our screening business will be north of 50%. And that gives us the ability to plan and think for the long term and invest for the long term.

Yes. No, it's nice, as Aaron said, nice predictable revenue as well and profitable. And then the care gaps...

Here's where we'd love to move. We'd love to move to the point where people just automatically get their Cologuard test on their third year anniversary. And that's to really impact public health. That's where we've got to move to. And so is that a public policy question to enable that to happen automatically? Is it working with the FDA, CMS, et cetera. We have an incredible government affairs team if you're listening in, this is one of your challenges is to get Cologuard, automate it so that everybody is always up to date with the colon cancer screening, and you can think about other aspects of your health.

Yes. It also enables efficiency for the physicians as well, right? They've got many other things they're worried about right now. And if we can help hit the easy button for them and automate that reorder process, we'll get the patients rescreened for you.

And how realistic is that? I guess, what would be the hurdles to getting that move from needing a script or whatever it may be to just being able to at least on a reorder basis, just have it show up on your front porch 3 years and a day?

We'll hold that one and keep this conversation going. But the team is working on thinking through the ways that we -- they're dreaming how do we keep people screened and we'll come back to you and talk about our view of a time line to make that happen.

Yes, fair enough.

But it confers a huge advantage because of the investments we've made. A lot of people said, as you guys are investing like crazy in sales and marketing and technology, your G&A is high. Why is your G&A high? Well, it's because we're building this technology platform that enables growth 5 years and 10 years down the road and it also creates a defensible position and the opportunity for us to keep adding new tests into this big commercial organization. For example, we just move Oncotype DX to the Exact Nexus platform, enabling among other things, prior authorization and automated billing -- electronic billing. That will bring down the days that a bill is outstanding. It was a faster collection from payers. But it will also over time, help us increase the yield of what we collect.

Yes. And then the care gap piece, helpful nugget there in terms of being over 200,000 this year. I think you mentioned it has a path to $1 million had doubled this year. I guess what's a realistic time line to think about in terms of getting to that number? And what's -- how do you guys frame up 1 million tests as an opportunity on the care gas side?

We're not quite ready to give you the time frame for that. Let's see how this evolves. Again, it's only been around for 18 months, and it's -- it's been an important driver of getting people screened. I think it's -- it's in the not-too-distant future where you can imagine it becomes a major way that you're getting those -- you're reaching those 60 million people.

Yes. I wanted to spend some time on the pipeline, I know we've chatted , maybe it's a little underappreciated at times. It's starting to get a little more spotlight these days. But maybe we could start with MRD and then we'll move to the blood side. But MRD, I know the time line has shifted around a little bit there. Maybe just talk through when we should expect to see some data out of you guys, and then you have maybe some that you've already seen? And what the right expectation is on the MRD side? Obviously a big market, you have some large players out there. How do you think about your approach and when we should be thinking about that catalyst out there?

So we have 4 major products in the pipeline, Cologuard Plus, our MRD test, which is molecular residual disease for detecting cancer recurrence, guiding cancer treatment. We have our Cologuard or colon cancer screening blood test and our multi-cancer early detection test, a test that will detect a wide range of cancers from a single blood draw. When you think about the opportunity in our MRD test, we expect to submit data in the first quarter of next year to MolDX. We will share data from 3 different studies altogether likely in late January. That's the time frame. There's one publication that is pending. So we know -- we would expect that to be in late January. We want to announce a multiple -- these 3 studies, all at once. One is an internal validation study into our clinical studies in the colon cancer space. That would give us the ability to start to introduce our technology into this growing field. That's one. Cologuard Plus would launch. The goal is beginning in Q2. Huge opportunity there, as we've discussed. CRC blood, we expect data next year. The goal is the middle of the year. The goal is also to have the best test possible. And we believe, based on the data that we've seen, we can deliver best-in-class performance with the blood test at a much lower cost of goods and a better value to payers and to patients. So that is an opportunity for data next year and then submission to the FDA. We don't have an estimation of when that would be approved. And we haven't seen the data yet there from the pivotal study. We'll share that next year. And then our multi-cancer early detection test. We recently shared data, and with a combination of DNA methylation mutations and protein. The performance there in -- if you take a look at the 6 deadliest cancers, including esophageal cancer and the pancreatic cancer, and cancers that today aren't screened for. And today, 86% of all patients diagnosed with cancers discovered them symptomatically not through screening. So the opportunity here is huge, but the 6 deadliest cancers performance was 66% in a case-control study. Performance won't be that good in a longitudinal study, but the test is designed to detect at least 21 different types -- detect 21 different types of cancer. I don't think investors are paying any attention to multi-cancer early detection any. There's one company with the field force that can deliver this to patients. There is one test that has this kind of performance at a cost of goods that allows us to deliver a test at a price of below $700 a test. Maybe more below that. And we know that patients are willing to pay out of pocket for a blood test that they would get every couple of years that may not detect all cancers, but on a population level may detect 30%, 40%, 50% of cancers. If you can do that, that is how -- if you really want to move towards disease eradication screen a whole person in addition to their individual organ screening, screen a whole person and screen a whole population. That is how you shift stage detection from Stage 3 or 4 symptomatic hard to treat really hard to cure, to earlier detection when you have a much better chance to treat successfully. And that we have an enormous capability to reach payers to reach health systems, and back to this amazing motivated, hungry commercial organization that we reach virtually, all the important health systems and health care providers in the primary care setting. And we are going to get those people screened with this amazing new technology. We'd rather kind of keep this expectations low for this pipeline of these 4 remarkable tests. There are other tests in the pipeline, too, but these are the 4 big ones. And because we just have a lot of work to do, and the team would -- is improve it mode.

If you think about long-term value creation for exact, I mean, it's these 4 tests, and it's leveraging the platform, like Kevin talked about. We're going to be -- we've invested in innovation to bring these 4 tests to market we're now reaching the point in 2025, where 3 of these tests could launch. And we're going to drop them not only into the platform of our existing commercial organization but also our technology platform. And so you're now taking all of the infrastructure that we've invested over the last decade building out and you're able to get leverage then as we launch these tests, not only in the commercial organization, but also with our Exact Nexus platform.

Yes. And maybe on the MRD side, since it's maybe coming the soonest, how do you think about both the commercial side, is there a build-out necessary there? And then again, there's one very large player in there. How do you think the market just develops as we look forward a few years?

Yes. Look, Natera has done a wonderful job of building this market that addresses a real need. So patients been diagnosed with cancer and you want to determine do they have circulating tumor DNA in their blood after treatment? This approach is a really good approach. But there's a lot of patients that need to be tested. There's a lot of segments of this market. Our commercial organization through the through our Oncotype DX product reaches 90% of oncologists in the U.S. So 90% of oncologists in the U.S. use Oncotype DX. And so we have a relationship with them. They trust us with tissue, et cetera. We know the health systems in this field. So we have the ability to have the conversations. But look, the test has to outperform. Data is the final data expected in early January. Internally, we'll share that maybe it's mid-January internally, and we'll share that shortly thereafter. So it's a huge opportunity. This market is growing at an incredible pace, and we expect to be able to have an impact in the areas that make sense for the test that we've developed.

Yes. And maybe in the last minute, I know there's been times over the last couple of years, you need 30 minutes to talk about the blood market. But maybe just quickly on the blood side for colorectal. How are you thinking about the pricing? I know you guys take a different approach maybe some others that have kind of hinted at what their price could be on a blood-based test? What's your guys' view of how that market develops on the blood side and what role it could play?

Yes. Look, a blood test the performance is nowhere near as close as Cologuard which means you're going to -- it's like a FIT test. You're going to have to test every year if you want it to model out as being impactful. And therefore, can it be at the same price as Cologuard Plus and really be utilized and add not only to health outcomes but also to cost, and overall health care cost because you need to deliver both. And so our view of the world is that, that pricing has to be in the low hundreds, not in the over $1,000. That's our view. Other people have different views that's up to them. But we've been doing this for a long time, and we know that value matters when you're having a conversation with the individual health care provider, they care. When they're getting paid $17 for a Medicaid visit, they care about what you're charging. It's important.

Absolutely. All right, Kevin, and Aaron, thank you so much. Really appreciate it.