Myriad Genetics, Inc. (MYGN) Earnings Call Transcript & Summary

Welcome, and thank you for participating in Myriad's 2021 Investor Day. Before we start the event, I wanted to make a few announcements. First, as questions arise during the day, please enter them into the question portal. Please ensure your questions are entered prior to the end of the break period before Q&A, and we will answer as many questions as possible, given time restraints. Secondly, we'll be making forward-looking statements during this event. Please review the forward-looking statements on the current slide. We'll also be using non-GAAP financial measures. A reconciliation of GAAP to non-GAAP financial results can be found on Myriad's website. With that, let's start the event.

Hi. I'm Paul Diaz, President and CEO of Myriad Genetics. Welcome to everyone joining us for our Virtual Investor Day. I'm coming to you from our new Myriad support center in Salt Lake City. I want to thank my 2,700 teammates for the hard work they do every day and their continued efforts to support our patients and their providers as we work through the COVID-19 pandemic. I also want to thank the patients, providers, partners, investors and others who place their trust in us. We will never take it for granted, and we will continue to work to earn your trust every day. Our mission has never been more important than it is today. Since I joined Myriad 9 months ago, we've been executing on a transformation and growth plan. Today, I will share an update on our progress and our plans for the future. I will be joined by several members of our executive team, who will provide details on enterprise initiatives, emerging commercial capabilities, products and technologies to drive long-term growth and profitability. As we transform our business, we are also transforming our brand. And today, for the first time, I'd like to share an expression of that brand. Let's take a look. [Presentation]

A brand is more than a logo. It's a sum of the experiences your customers have with you. It expresses who you are, what you do and why it matters. You'll notice we reintroduced the word genetics back into our name, Myriad Genetics. It's who we are. Our promise is to illuminate the path to better health through genetic insights, which has been our goal from day 1. Our purpose-led mission is clear, to advance health and well-being for all and empower every individual by revealing the answers inside each of us. We do this by providing vital insights that help people take control of their own health and enable health care providers to better detect, treat and prevent disease. Our work matters. It's personal. And together with my Myriad Genetics teammates around the world, I am proud to be part of it. Dramatic changes in our health care system have accelerated during the COVID-19 pandemic. We are embracing these changes to expand our reach and drive future growth. These trends include expanded digital engagement, telehealth and virtual care. Consumer-driven, patient-centered health care with an emphasis on the end-to-end experience and an urgent need to increase access and reduce disparities among underserved populations across racial, social and economic lines, creating new partnership models, driven by the need to improve access, quality and better serve patients and providers. Across all these areas, Myriad Genetics is investing in new capabilities that can drive growth and value for all of our stakeholders. Today, you will see several examples of how we are doing just that. As we update you on our transformation plan, I want to emphasize 4 important themes. First, we need to be best-in-class in quality, service and accessibility to win. Second, we are upgrading our enterprise capabilities to improve our customer experience, revenue cycle management, commercial capabilities and advanced innovation. Third, we have opportunities to expand access to our genetic insights, leverage our data and expand our product offerings. And finally, we are committed to disciplined execution on a focused set of initiatives to drive consistent long-term growth and profitability. Myriad has many advantages. We are in a fast-growing market with tremendous opportunity for growth. We are known and recognized for the quality and accuracy of our products. We have a strong commercial engine with significant size and scale, and our research and tech capabilities are among the best in the industry. We also want to acknowledge areas for improvement. In the past, we have not always prioritized customer experience. We will hear how that's changing today. We've been a siloed company -- that has caused duplication and inefficiencies. We lacked focus in R&D and technology development, and we lacked focus on execution and operational excellence. Our vision for the future and strategy were not well understood. Over the past 9 months, we have developed and launched a comprehensive transformation plan. Phase I started by resetting our base of operations, reducing complexity and costs and streamlining our business unit and product offerings as we continue to focus on COVID volume recovery. We reduced our product, R&D and technology projects by half, focusing on the highest priority areas with the greatest impact. And we have reenergized and restructured our commercial model to drive growth and productivity with new inside sales and technology-enabled tools. Phase I is now substantially completed. Phase II is underway with a focus on elevating our current portfolio to full potential. As part of our cultural transformation, we are linking our mission, vision and values to our behaviors and ways of working. We are deepening our commitment to environmental, social and governance issues and prioritizing diversity, equity and inclusion. We are renewing our brand and marketing strategy, launching our new commercial model, enhancing reimbursement revenue cycle management to support growth and improve financial performance. As we move into Phase III of our transformation plan, we look to accelerate growth. This will include investments in innovation, research and technology. We will also deliver new and enhanced products. Finally, we will continue to build commercial capabilities to support new products and M&A. We are strengthening our team with top talent from outside and inside the company. Numerous new hires with health and technology backgrounds have recently joined us to lead critical functions. At the same time, we are promoting proven leaders into expanded roles. We are now focused on 3 business units where we can be a market leader. We've made hard decisions across the organization to rightsize our cost structure. We believe the divestitures and other identified cost savings will lead to $40 million to $45 million in cost savings in fiscal year 2021 and $55 million to $60 million in run rate savings going into 2022. Make no mistake, however, our focus is on growth, R&D and new commercial capabilities in the coming years. As we enter Phase 2 of the transformation journey, we are highly focused on optimizing our commercial model to drive increased testing more efficiently, building best-in-class revenue cycle capabilities, new state of the art laboratory, automation and technology with the goal of improving financial performance and transparency with investors. We are actively enhancing existing products and launching new offerings across our core businesses. In women's health, we will introduce the option for patients to pay a cash price for key tests. Meeting the pressing need to extend genetic testing to every individual, Myriad is the first and only lab to create a hereditary breast cancer test that improves personalized risk prediction for women of all ancestors. riskScore for all ancestries will launch this year, followed by a direct-to-consumer riskScore offering in 2022. Our next-generation prenatal test combines the Prequel prenatal screen with our Foresight Carrier Screen, combining the key benefits of both. The new test is faster, easier, more accessible to patients and will launch in 2022. We will also launch our next-generation microdeletion technology in 2022, which will improve our market-leading accuracy with AMPLIFY, harness the power of next-generation sequencing to testing. In oncology, our partnership with Intermountain Healthcare, supported by Illumina, provides tumor profiling and companion diagnostic tools in a comprehensive solution that advances precision cancer care. This we will launch by the end of this year. Gene and treatment expansions for our myRisk hereditary cancer test will follow in 2022. As part of our partnership with Illumina, a kit-based version of Myriad's myChoice CDx companion diagnostic test will also launch next year. And in mental health, new evidence and data further supporting the clinical utility of GeneSight is expected in the first half of 2022. Finally, this year, we will expand GeneSight into the ADHD market, helping psychiatrists and general practitioners better treat the growing number of patients with mental health issues. Early results from these changes are promising. As you can see, we have significantly improved our test volumes, stabilized pricing and driven sequential growth over the last several quarters. We have also seen meaningful improvements in gross margins and solid expense control coming out of the pandemic, leading to an improvement in our operating margins. We have had a strong start to 2021 with a 12% sequential growth in the first quarter, returning the company to year-over-year growth despite the continued impact of the pandemic. We also saw strong sequential volume growth and improving average selling price per test, which translated to improved profitability in the quarter. Looking forward, we believe Myriad genetics can achieve a long-term organic growth rate of 8% to 10%, improving gross margins and lowering our operating expenses. Finally, we expect to be profitable in Q4 of 2021 and have the financial flexibility to deploy capital to accelerate growth as we look to 2022 and beyond. As we execute on Phase 2 of our transformation plan, our best-in-class products, superior customer experience and efficiency provide a strong value proposition for patients, providers and payers. Our new platform will support long-term growth and profitability and enable us to become the leading genetics and precision medicine partner in health care. And now I'll turn it over to Eric Santa, our Chief Growth Officer, with a reminder of the human impact of expanding access to genetic testing for all. Let's watch. [Presentation]

Thanks, Paul. It's great to be here. My name is Eric Santa, and I recently joined Myriad Genetics as a Chief Growth Officer. I'm extremely excited to be a part of this team and a part of our future commercial success. My objective is to work across Myriad with our executive and commercial teams to accelerate our immediate organic growth and create a scaled commercial engine for the future. Prior to joining Myriad, I spent the last 12 years of my career at UnitedHealth and Optum. I held a variety of leadership roles, including my time supporting the reboot of healthcare.gov. In my most recent role at UHG, I served as the Chief Revenue Officer of Rally Health. With Rally, I focused on transforming health care through innovative consumer-facing digital technology. I've built and led teams that work with payers, providers and employers to drive consumer engagement and change behavior. I've seen firsthand how the application of data, clinical insights and a well-crafted digital experience can support client objectives. I'm thrilled to draw upon that experience to support Myriad's commercial transformation and growth. With our market-leading products and a strong foundation, it's clear to me in my early days at Myriad that we have the tools and the potential to grow. In my remaining time, I'll take you through our aggressive commercial transformation. Now that said, let's start at the bottom line. Our immediate goal is to drive long-term organic revenue growth of 8% to 10%. Achieving that goal is a central focus of our commercial transformation effort. Our commercial transformation is based on a robust assessment that capitalizes on the insights of hundreds of physicians, payers and patients and Myriad team members. It painted a clear picture about the actions and capabilities required to meet our growth objectives. Specifically, it revealed 4 key areas of focus. First, we need to change the size and structure of our commercial teams currently in the marketplace. Although we will continue to make data-driven improvements, this work is largely complete as a part of Phase I. I'll share those details with you momentarily. Second, we need to achieve a deeper level of precision as it relates to segmenting and prioritizing our customers and prospects. Our efforts will focus on key products like myRisk and GeneSight. Third, we're excited to launch our new brand and expanded enterprise value proposition. Building on a foundation of market-leading products we will focus on creating a unique and effective experience for patients and physicians and set new standards for access and inclusiveness to genetic insights. The Myriad team is excited and motivated to take on this challenge. Lastly, we will create a new enterprise level capability set to bolster the great commercial work already being done within our businesses. Now let's talk about some of the changes we've already made. And let's highlight 2 in particular. First, our assessment showed that we had a clear opportunity to build a more effective and efficient sales model. Historically speaking, we were over reliant on a large outside sales force. As a result, we made a few changes. We reduced the overall number of sales team members from approximately 900 to 750. We relied on sales team member performance as our primary evaluation criteria. We also put measures in place to ensure that our team members pursue the right sales opportunities and brought forward preferred products. We added inside sales and associate sales team members to offer more focused and efficient support to our existing customer base. Secondly, our top sales talent has been targeted by our competition, resulting in higher than desired turnover. Now this turnover directly impacted our top line. To address it, we reinvested some of our savings from our overall commercial team reduction to retain our strongest reps. We increased the base compensation for high performers by an average of $30,000 annually. We believe that these key changes are a good first step towards higher organic growth. Our confidence in these changes is partially rooted in our experience with our GeneSight business. We've been ramping our inside sales model since 2018 with increasing levels of success. We started with 2 inside sales reps in 2018. And based on strong performance, we're ramping up the team to more than 30 inside sales reps. The team in the model performed well. For example, the inside sales team has about a 50% higher close ratio than the overall GeneSight average. With this strong and growing performance as a foundation, we've taken other important steps to improve our results. For example, we created a more detailed segmentation model to identify the customers and prospects that are most likely to produce significant GeneSight revenue. We're also piloting a patient-focused inside sales team to support higher conversion of leads. We anticipate that these changes will continue to drive higher volume and revenue for the GeneSight business. We're also focused on scaling these models across all of Myriad's commercial book. The first phase focused on a baseline commercial reset is essentially complete. Also, many key elements of the second phase are well underway. Now let me highlight one key element of Phase 2 that we believe will support accelerated growth. The first major change will be the rollout of our new brand. Key elements of the rollout, including a rebranding of our digital properties, fresh marketing campaigns and a continued focus on reenergizing our sales force. Our new brand launch, we pair with a reset of our enterprise value proposition. Beyond our reputation for quality science and market-leading products, we'll be making ongoing and meaningful investments in our consumer and physician experiences as well as our commitment to improving access and inclusiveness. These new elements of our value proposition will serve to bolster our growth. However, they're also clearly intended to demonstrate our commitment to putting genetic insights in the hands of all. We have a strong start on Phase 2, and we'll continue to move aggressively. Phase 3 is all about investing for growth, and let me hit on 2 examples. One key initiative will be market-based partnerships. We're targeting partnerships in telehealth across our lines of business. This is an area where I personally have some significant market and technology expertise based on my prior work. We anticipate that telehealth utilization will remain above pre-COVID levels and that service offerings will continue to broaden rapidly. These trends increase the importance of telehealth to our business and our patients. Second initiative is focused on digital demand generation. Expect significant changes to our digital demand-generation capabilities to be launched at scale before the end of 2021. This change will generate additional market demand in support of our excellent field teams. Let's dive deeper here as consumer demand generation is an area where we plan to invest aggressively. We see it as a primary lever for driving volume, one that we haven't fully taken advantage of in the past. In a moment, I'll describe our pilot in women's health and share some early positive results. Prior to the pilot, we sent media traffic to our legacy hereditary cancer quiz to prequalify patients for myRisk. Now on a positive note, we brought in nearly 1 million patients to the funnel. However, converting them to myRisk testing was extremely low. Of these 1 million total leads, we were able to generate nearly 300,000 qualified leads, but were able to convert fewer than 5,000 into tests. That's only a 1.7% qualified lead conversion rate. Early indications demonstrate they'll be able to dramatically improve at all levels of this process, from lead gen through kit submission. To that end, we created 2 long-term goals that will define the success of this program at maturity. First, we'll increase our total lead generation from this channel to at least 2 million total leads annually. Secondly, those leads will result in at least 200,000 consumer-driven orders, inclusive of all of our Myriad products. These are aggressive goals that will challenge us to act with purpose and urgency and the results are impactful to Myriad's overall growth. This new pilot was launched very early this year, focused on a persona, we named Katy, our patient without breast cancer. When Katy clicks on our targeted Google Ad, she enters an experience that qualifies her for hereditary cancer testing according to NCCN criteria. Once Katy is qualified, she's able to easily order myRisk test kit that will be sent directly to her door. One of our inside sales team members will follow-up with Katy to facilitate the testing in partnership with Katy's physician. We made a few key changes in this pilot experience, a more targeted and effective keyword strategy. A more human-centered patient experience, highly credible qualification processes and an easier way to order online or by phone. Even with the limited media investment, we are already seeing conversion rates increase by greater than 4x our baseline results. This pilot is in the early stages of maturity, and our efforts to date have been simple and focused. We intend to aggressively scale the experience and continue to make improvements. At scale, this becomes a significant growth channel for Myriad. Driving long-term organic growth is a central focus of our transformation effort. The hard steps needed to reset our go-to-market model are essentially complete. Our energy and focus is now squarely set on building the new capabilities and experiences that will get Myriad to its organic growth goals. As the new Chief Growth Officer, I'm energized by the focus and dedication of our teams and confident in our ability to deliver on our transformative agenda. Now let me turn it over to Kevin Haas, our Chief Technology Officer, to provide an update on our enterprise technology development.

Hi. I'm Kevin Haas, Chief Technology Officer at Myriad Genetics. And I'm here at our campus in South San Francisco, where we are developing tech-enabled capabilities to better serve patients and our customers and finally make us easier to work with overall. Today, I'll demonstrate new online portals and technology tools designed to do just that. I'll also give you a glimpse of our state-of-the-art testing lab, we are using the latest in robotics and automation to improve the quality, efficiency and turnaround time for our products. But first, let's start off with Myriad Complete. It's a suite of services that offers comprehensive digital experience, supporting patients and providers through the entirety of the genetic testing journey. Once an order has been placed, patients will receive a personalized estimate within 48 hours. The patient can then make an informed decision as to whether or not to go ahead with testing. Finally, we offer on-demand post-test consults. This approach allows them to get answers to the most critical questions directly from a health care professional. And with that, I'd like to give you a demo of our new unified provider portal. So let's log in. From here, you get a dashboard of all of the testing activity within the clinic, both those that need attention, those that are in flight, those that have already been resulted and those that are still in processing. We can also go towards seeing what it looks like to place an order. From here, we can order both Foresight, Prequel, myRisk and soon to be additional oncology products in the later half of the year. So let's see what it's like to order a test through the Myriad provider portal. If I click on order a test, I can actually order through a unique tool called myGeneHistory, myGeneHistory is a tool we use to screen patients before they even come into the doctor's office, collect their family history and see if they actually qualify under NCCN criteria for genetic hereditary cancer testing. From here, we can seamlessly go to order a test for them and present it with a simple eTRF. We can fill out information like name, data of birth, but importantly, also their home address, so that we can ship them a kit directly, making it easier to address and care for patients remotely. Today, we do about 3,000 myGeneHistory screens per week and we have seen that those clinics, which use myGeneHistory, are seeing about a 10% increase in volume before and after leveraging this tool to improve their care and get testing to those who truly need it and qualify. Finally, I want to showcase the cost estimate tool. This is a way to be able to assess a patient's typical out-of-pocket responsibility using their name, data of birth, information about their insurance so we can actually integrate with their insurers, see what their deductibles are, see what their coverages are and provide a very highly accurate estimate for their out-of-pocket responsibility. So that's the unified provider portal for Myriad. At Myriad, we've done over 700 EMR integrations to date in 2020 and are planning for about 225 integrations in 2021. And each one of those integrations results in a 20% increase in ordering volume before and after the integration and entrenches our position within that particular clinic. This EMR's footprint extends across all of our major businesses. For prenatal with Foresight and Prequel, for myRisk in oncology and for our mental health, it also increases our adoption of GeneSight. Now I'd like to highlight, though, our patient portal. So here we have a patient whose results are ready on the Foresight carrier screen, and they can dive in to see the really detailed information that this product offers. We try to highlight at the top, the most impactful information. Importantly, they're obviously going to want to know more about this report and what it means for them and their families. And so we've embedded customized tailored videos where we display what this type of carrier status means for them, what it means for their status, for their family, what the risk could be for their pregnancy. And finally, follows up with a call to action, things that they need to take in order to be able to complete this Myriad Complete experience. We now get the ability to leverage our genetic consults capabilities. This is the way in which they can only have the conversation, learn more about the results, but also the results of that genetic consult go back to the physician so they can follow-up and continue that care, while Myriad takes on the brunt of the workflows and simplifies and make it seamless and frictionless for those patients and their ordering providers. Now that we've seen the technology advancements that power our digital engagement, both in how we serve our providers and a frictionless clinical workflow and how we empower patients to take charge of their health, let's move onto our state-of-the-art genetic testing lab for a quick tour. We'll show how we are applying the best in genetic technology to quickly deliver highly accurate results for our patients and providers. We call it the Lab of the Future. Welcome to the Lab of the Future here in South San Francisco, this 13,000 square foot facility, which processes our clinical samples, is one of the most advanced revolutionary genome centers in the world. It is the culmination of over 8 years of research, engineering, construction and optimization, which brings us to this point today. We are now taking the efficiencies and best practices from this lab and incorporating them as a model to replicate in other facilities across Myriad. The end goal is better, faster and more accurate results for the patients and providers who rely on us. Now let me show you how we do that. Our process begins here in [ pre-samp ], where we get the samples from accessioning and load them into one of these racks. We take both blood and saliva. We can extract them on this instrument over here. We're able to place it into the instrument and start extraction without even having to take off the caps. What that means is, we have a chain of custody from when the sample arrives at our door to when it's picked up by the robots, all the way to when it processes and makes it into a patient report. That reduces the chances of contamination, minimizes human error and ensures overall process quality. This instrument is highly customized by innovations developed here at Myriad. We're able to run over 12 batches simultaneous within just this 1 machine, and we have 3 of them. That means we can run over 2,500 samples a day in just this facility. The robot also benefits from having on deck, liquid handling and also waste treatment. That waste treatment means we can reduce our reliance on plastic waste, overall making the lab more environmentally sustainable. This is possible because at Myriad, we have full system integration from the lowest level actuators and valves that do the actual chemical processing for next-generation sequencing, to the applications, which run each particular instrument, to the real-time imperative scheduling of every little motion of a robot or a piece of apparatus in the work cell. It's a whole lab orchestration like we see here. It gives a bird's eye view for both lab supervisors and scientists to make sure everything is working appropriately and immediately address any issues. This workcell that we have here is comprised of over 300 instruments and over 500 software applications to keep that all well-functioning. It's built that way so we have automated failover and redundancy. Anything that goes wrong, it can immediately switch over to another backup instrument without any delays in sample processing. So before we saw our extraction instrument. After extraction the DNA is normalized and placed in one of these microcuvette. These microcuvettes each have a 2D barcode on the bottom. That allows us to continue to track the sample from beginning to end in the processing, reducing the risks of contamination. This also allows us to dispatch that sample to whatever product, assay or downstream processing step we're trying to run. At Myriad, when we say automation, we really meet it. The real heart of the operation is the suite of 6-axis robotic arms and the slide that serve as a material bus for the entire integrated lab. We're able to assemble every essential liquid handling instrument, every plate spinner, centrifuge, labeler, refrigerator, all in one place. And what that means is our vertically integrated software stack is able to dynamically schedule multiple different product lines and dispatch samples to exactly where they need to go in the lab. All of this is done to improve turnaround time, reduce cost, and the net benefit to the patient is better access to testing. It also means that this lab is just more efficient. We only require 1/4 of the floor space of a typical competing lab, and only half of the scientists. So now we've talked about these real innovations and automation, the technology that powers the heart of Myriad Genetics labs. Let's walk over to [ post-samp ] to see the last step in sequencing where we extract out these genetic insights from the wealth of data and talk about the future of our labs at Myriad. Myriad built the first laboratory able to deliver clinical hereditary cancer results to patients scale. We're bringing this next-generation of capability to Salt Lake city with a major investment for myRisk and flexibility for future product innovation, with even more advanced chemistry and robots, with modularity to accommodate advances in next-generation sequencing and scalability to support multimillion samples per year in one facility and one lab technology backbone, all for the benefit of the patients and providers we serve. Thank you for joining me virtually here today in South San Francisco. And now I'll turn it over to Jerry Lanchbury, back at the Myriad support center in Salt Lake City.

Thank you, Kevin. I think we've seen tomorrow's world with the Lab of the Future. I'm Jerry Lanchbury, Chief Scientific Officer at Myriad Genetics. My starting point is that Myriad's products are the best-in-class. Our tests are based on the highest scientific standards, and we ensure the information provided is clinically actionable. Part of what I want you to leave with today is why the science that we do matters. Somehow, over the last few years, the power of Myriad science and the clinical value and differentiation of our products got lost in the minds of many physicians and patients. As we strive to make our products relevant to even more patients, we are also mindful of addressing social, economic and ethnicity differences in access to health care. First, we go all out to make sure our products work scientifically for all groups. And second, we work to ensure that all groups have access to our products. This focus is married to a commitment to continually developing each product with additional functionality and capability. The myRisk test focuses on the most important genes underpinning hereditary cancer. It is backed by an industry-leading classification database, which minimizes the reporting of uncertain variants. This could be a particular problem in less studied minorities. For the 95% of patients with a worrying family history of breast cancer, but who test negative for high and intermediate risk mutations, we offer riskScore. This feature evaluates common risk sites across the genome, along with clinical and biological factors. Around 35% of women who take riskScore receive an actionable result, which puts them into the category for enhanced surveillance going forward. This is transformational and a major differentiator. In addition, we are the first commercial testing lab to show that riskScore can meaningfully modify risk for carriers of mutations in moderate risk genes. So results no longer have uncertainty around them. We are able to give true personalized risks based on genomic, clinical and biological information. In the second half of this year, we will launch riskScore for all ancestries, and we intend to launch a consumer version suitable for 100 million women next year. We will follow with additional gene content from myRisk, cementing the leading edge quality of Myriad's hereditary cancer offerings. Our companion diagnostics business is starting to shine with accelerating momentum. We have 2 leading CDx products, BRACAnalysis CDx and myChoice CDx. And both match patients to particular PARP inhibitors in breast, ovarian, prostate and pancreatic cancer, depending on the precise indication. Building on our history of genetic testing and through extensive collaboration with pharma companies, we have emerged with industry-leading germline and tumor CDx products that provide life-saving choices for patients with cancer. We see significant volumes for both these products in U.S., European and Japanese markets. We remain excited that the reach of myChoice CDx will be extended to patients in need in many other countries through our partnership with Illumina. We are currently conducting clinical trials of myChoice CDx in all solid tumor cohorts, which may turn into a significant market expansion opportunity. Our soon to be released combined germline and tumor offering provides valuable opportunity for expansion of lucrative pharma trials. The quality that we bring to our cancer diagnostics is reflected in our women's health products, which are also best-in-class, and there is more to come. First, Prequel, our noninvasive prenatal screen for chromosome abnormalities is the only product of its kind that has the ability to AMPLIFY fetal fraction. This is important because AMPLIFY massively reduces test failure rates compared to competitors. This ensures women receive a timely result, thereby avoiding the anxiety that a delay causes during this critical period in their lives. AMPLIFY also means that providers don't have to be worried that the test will fail in patients that are more likely to have a low fetal fraction, like those with a high BMI, for example. They can count on a highly confident result the first time for all patients. I also want to add that Prequel is run on a whole genome sequencing platform. Outcomes are collected for a large proportion of cases. Given our production volume, this leads to a robust and extensive database of genetic information, matched with associated outcomes, giving opportunity for deep research, improvement of existing products and development of novel products. Foresight is the best studied recessive carrier screen available. It is backed by more than 25 peer-reviewed scientific articles, giving confidence to our patients and providers. The disorders included in Foresight are serious and prevalent. And our genomic technology maximizes both at-risk couple detection and clinical utility. Foresight has also been optimized to have superior sensitivity for conditions that are technically challenging to screen, such as congenital adrenal hyperplasia and alpha thalassemia. In fact, an improved software tool for alpha thalassemia was released just a few months ago. It increases the ability to detect novel pathogenic variants that are more prevalent in minority ethnicities, supporting our commitment to delivering equitable care across ancestries. The technological capabilities that support Prequel and Foresight enable the development of new products to add to our prenatal portfolio. For example, fetal fraction amplification allows for finer resolution analysis of cell-free fetal DNA, so that we can detect even smaller copy number variants than currently detected by our competitors. We are even developing the ability to detect single-gene disease like cystic fibrosis in the fetus. Let's turn to Prolaris and GeneSight. Prolaris provides clinically actionable prostate tumor information that aids management of this common cancer all the way across the risk spectrum. After testing, men with low-risk can keep their prostates and be managed by active surveillance. Men with mid-range risk can be managed with a single therapy, while those above the risk threshold can be offered multimodal therapy. In two of our peer-reviewed utility studies, Prolaris led to treatment changes in 65% of patients: outstanding clinical utility. Now to GeneSight. GeneSight, our proprietary pharmacogenetic test aids physicians managing treatment-resistant depression, and it's backed by the most robust clinical studies in the field. Meta-analysis on over 1,500 patients and 4 independent studies demonstrates improved outcomes for remission, response and symptom improvement. In the immediate future, we will be making adjustments to GeneSight to accommodate therapies frequently used to treat ADHD, extending the utility of this key product. Myriad Genetics has delivered test results to over 6 million patients. The longevity and popularity of Myriad's family of tests has created a data ecosystem, which continues to deliver significant advantages in the improvement of existing versions of tests and in the discovery of new ones. RiskScore, our industry-leading test for breast cancer risk in non-carriers, was developed and validated using genomic data from around 200,000 patients with a family history of breast cancer. Development of riskScore for all ancestries was based on large numbers of minority subjects, helping us to develop novel algorithms for translation into the clinic. Over the past several years, we have invested significant resources in running genome scans on African-American subjects at risk. This commitment to excellence, coupled with massively powered data sets, gives rights to a continual pipeline of opportunities to advance patient care. And it's a differentiator that no other company appears to have matched. Currently, we are generating over 100 terabytes of sequence data per week. And we only see the power of this resource accelerating as we move forward. So while we are guardians of our patient's privacy, our commitment to them and to our providers is that we will squeeze every iota of product improvement out of the data that they trust us with. Myriad curates a very large body of high-quality organized data. Data is a key currency now and a property we need to exploit to supercharge the utility and acceptance of our products to patients, providers and payers. We have learned from past partnerships that we can't do it all ourselves. And we believe leading partnerships position us for success and growth in precision medicine. We never forget that DNA is the complex chemical that runs through our families. The lives of many of us at Myriad have been positively changed by the products we've worked so hard to develop, whether it be myRisk, riskScore, GeneSight, Prequel, Foresight, Prolaris, or myChoice, we take our personalized medicine personally. And now I'd like to turn it over to Nicole Lambert. But first, let's listen to noted radiologists, Dr. Danna Grear for insights on the importance of planning and prevention in breast cancer.

Women tend to come in about 40 for their screening mammograms, and in patients that have strong family history and may have a genetic mutation, that may be too late. So what we want is to find women at an earlier time in their life when we can determine if they are at increased risk for developing breast cancer and then make a plan for their screening, prevention to help prevent breast cancer in those women, or if not, to diagnose it at an earlier, more treatable stage, and it really allows us to personalize their screening going forward.

Thank you, Jerry. I'm Nicole Lambert, President of Myriad Genetic Laboratories. As Dr. Grear said, early detection is critical in hereditary cancer and women's health, that has been the case for me and my family. Myriad Genetics has always been known for quality. In my personal experience and during my years as a genetic counselor, I never doubted the accuracy of a test result that came from Myriad. Of the 122 million adult women in the United States, 29 million have a family history of cancer and meet criteria for genetic testing. Less than 3 million asymptomatic women have undergone testing. Most of these tests have been performed by Myriad. But still, after 2 decades, more than 90% of at-risk women have not been tested, and that needs to change. In oncology, nearly 700,000 patients per year are diagnosed with cancers that make them eligible for genetic testing. In 2019, the American Society of Breast Surgeons issued a guideline stating that all patients with breast cancer qualify for testing. A majority of prostate cancer patients are now also eligible for our companion diagnostic test to determine if they will benefit from PARP inhibitors. Aside from a onetime coding change in 2019, average selling prices for hereditary cancer testing have stabilized over the last 4 years. We expect pricing pressure to continue in the low single digits. I want to be direct about our hereditary cancer performance. It's not yet where we want it to be. Like other areas in health care, our hereditary cancer business experienced a downturn at the height of COVID. Fewer women were returning to clinics for their well women exams, and mammograms were down by about 80%. During this time, we also had a leadership transition in our women's health business unit. I've stepped in as interim President, and we've uncovered some gaps in execution, including understanding our biggest opportunities, effective sales messaging and coaching of our sales professionals. Historically, we've had a lot of perching in our customer experience. Health care providers often told us that it was just easier to use other labs. Our technology tools did not always fit into their practices. Since June of 2020, we have seen greater than 50% increase in myRisk volume. We are focusing our sales teams on these opportunities. We currently have 2,000 customers who utilize our prenatal genetic testing but have not yet started to order myRisk in their practice. This is an opportunity to partner with them for more comprehensive genetic services. Finally, I'm happy to report that we have found a new leader for this business unit. In the coming weeks, we will announce a new President of Myriad Women's Health. This individual has over 20 years of experience in the women's health marketplace, including leadership of a multimillion-dollar global business. She has built multiple high performing teams. Over the last 2.5 years, we've taken tangible steps to make ordering tests simpler -- for example, integrating with an electronic medical record. That gives our physicians the opportunity to get the right answers, plan the right treatments, and ensure that their patients have access to high-quality testing. myGeneHistory is another tool to help physicians streamline testing in their practice. It identifies appropriate patients, offers them pre-test education, and links to a physician order. We see about a 10% increase in testing from customers who use myGeneHistory history in their practice, and we anticipate this to be a key driver of growth. We are proud of the innovative science behind riskScore. The vast majority of women who undergo genetic testing for breast cancer will receive a negative result. As part of myRisk, this additional testing gives those patients a personalized 5-year and lifetime risk to develop breast cancer. Myriad has worked hard to close the gap to provide an accurate tailored breast cancer risk assessment for women of all ancestries. I'm pleased to announce that this data will be presented at the American Society of Clinical Oncology meeting in just a few weeks. We are the first and only lab that can deliver a polygenic riskScore to women of all ancestries. 25% more myRisk patients will receive an answer, making it the most inclusive test in the market today. But this still leaves 93 million women who don't qualify for hereditary cancer testing without an answer, and these women deserve answers as well. So we are developing a stand-alone version of riskScore that can be accessed by all women. We expect this to be available in 2022. We see the future of genetic testing services as accessible to patients through multiple avenues. Traditionally, health care providers identified patients and initiated testing, and that channel remains critical to our strategy. At the same time, we are investing in direct-to-consumer outreach to empower patients to initiate testing with their doctor. Additionally, new partnerships with other health care leaders will create even more opportunities to expand our reach. I couldn't be more excited to see the transformation at Myriad Genetics and to enter this next phase of growth. Now let's move on to the prenatal market, where we have the same 3 goals that we do for all of our products to deliver the most accurate genetic testing, access for the most patients and the most user-friendly experience for our physicians. Despite COVID, we've seen tremendous growth in our NIPS, or noninvasive prenatal screening market. This growth is driven mainly by increased uptake in the high-risk population. We expect further growth to accelerate over the next 5 years as guidelines, like those from ACOG, the American College of Obstetrics and Gynecology, now recommend that all patients be offered screening regardless of their age or baseline risk. These recommendations also influence payer decisions, making testing accessible to more patients. We also expect the carrier screening market to accelerate over the next 5 years. Previous guidelines recommended screenings for only a few common conditions. In the coming months, we expect that recommendation to change to screening for over 100 conditions. As payers and providers embrace this new recommendation, we expect both demand and coverage to increase significantly. Keep in mind, the total addressable market shown here is only for patients that are currently pregnant. More than 20 million couples a year are planning a pregnancy and are also eligible for carrier screening. 60% of our current Prequel noninvasive prenatal screening volume comes from average risk patients. Increased coverage will lead to meaningful revenue increases. As major payers adopt expanded carrier screening guidelines, more patients will have coverage for a wider panel of diseases. As we listen to feedback from our physicians and patients, we find that cost uncertainty is their top concern. Myriad was the first company to launch a cost estimator. We also offer financial assistance for patients who qualify. We are incredibly proud of the AMPLIFY technology that supports Prequel. Having been a prenatal genetic counselor earlier in my career, I know how stressful it can be for couples awaiting the results of a prenatal screen. When noninvasive prenatal screening is unable to provide an answer, these couples face invasive procedures that carry the risk of miscarriage of a perfectly healthy pregnancy. A number of conditions, including high body mass index, can affect the results of prenatal screening. In the U.S., 50% of pregnant patients are considered to have high body mass index. But this is not distributed evenly across all ethnicities, causing disparities of care. When a physician orders Prequel from Myriad, they will get a confident result, 99.9% of the time on the first round of screening. This means fewer invasive procedures, more time to make decisions and fewer unexpected diagnoses in the delivery room. We are also working on 2 new product enhancements available in 2022. The first one will increase our ability to detect microdeletions and duplications, which affects 6% of pregnancies. Our second product enhancement combines the power of Prequel with our Foresight Carrier Screen into 1 test. Currently, only 1/3 of pregnant women are receiving the benefits of both tests. Right now, NIPS and carrier screening require a complex workflow involving 3 samples from 2 parents, which often take several weeks to coordinate. We are developing a solution that requires just 1 sample from the mother. This will allow more patients to get answers faster. Myriad has a strong commitment to quality science in everything we develop for patients. We are especially proud of our scientific excellence in prenatal testing, where we have built not only best-in-class products, but also an underlying platform that will support future innovation. I'm excited for what we will discover, what we will build and how many more patients we can serve in the future. And now I want to turn it over to Faith Zaslavsky to talk about Myriad Oncology. But first, let's hear from Dr. Sharyn Lewin discussing the importance of companion diagnostics in the care of ovarian cancer.

All women with ovarian cancer and fallopian tube and primary peritoneal have just been lumping them into the same group. We have germline testing with Myriad's myRisk panel right when they're diagnosed. So if someone has a germline BRCA mutation following chemotherapy, she now goes on a PARP inhibitor. Based on data form SOLO-1 we will actually be curing -- curing -- many of these women who have stage 3 and 4 disease, that's pretty incredible, who are on PARP inhibitor therapy.

Thank you, Nicole. And as I reflect on Dr. Lewin's comments, I see the power of companion diagnostics and comprehensive solutions to improve cancer care. I'm Faith Zaslavsky, President of Myriad Oncology. It's an exciting time at Myriad and in our industry. We are in the midst of a strategic transformation. And today, I'll provide an update with where we are on that journey. Treating cancer is becoming more complex. Health care providers need simpler, more comprehensive solutions at the very start. Myriad is committed to bring these solutions to the providers we serve by creating a combined offering of our myRisk Hereditary Cancer test, myChoice CDx HRD and now tumor profiling. Time and accuracy of information are essential when making treatment decisions for patients with cancer. The ability to receive answers from a single source in a timely manner reduces complexity and speeds the ability to make the right decisions for patients facing cancer. Precision medicine has shifted from germline alone, this is where we've historically created the space, to germline and tumor testing as a critical source of information to guide treatment. Over a 10-year time frame, you can see the shift accelerate, along with the need for more data on therapies and clinical trials. This is what the vast majority of oncologists are seeking. The space is where Myriad has historically focused, ovarian, endometrial, breast, prostate and pancreatic cancers, create a unique opportunity for us to offer multiple solutions to health care providers and their patients. Germline testing is critical to understanding tumor biology and treatment, and we will continue leading in this space. At the same time, we learned through experience with ovarian cancer that while myChoice CDx, which is our tumor test in HRD, provides a differentiating biomarker, it alone doesn't provide all the information that providers are seeking. 46% of medical oncologists order both tumor and germline testing on their patients. 84% of medical oncologists want data on therapies and clinical trials. With the new combined offering that integrates tumor and germline testing, we can serve the growing need for ovarian cancer care. We can also compete in spaces where we historically have been strong in germline testing, while adding new capabilities and improving our total value to the provider and patient. Recent new partnerships position Myriad to secure our foothold in the oncology space globally. Working with Intermountain Healthcare creates opportunities to increase engagement with more than 5,000 physicians and nearly 1 million more patients. Working with other industry leaders, we can capture a competitive position in the somatic market even faster. We have increased domestic opportunities to provide patients and providers with actionable solutions to address their cancers. This also allows us to approach outcome focused research together. Outside the U.S., our collaboration with Illumina offers the best-in-class combined HRD TSO 500 kit, which expands our global reach and focus on entering mature markets that have reimbursement. While the oncology space is competitive, these partnerships position us to be a global leader. Our new combined and comprehensive offering aligns with the current standard of care outlined by NCCN. It offers the best-in-class germline and HRD testing. This further differentiates us with a test that identifies 34% more tumors with HRD than with the percent of LOH alone. It's also worth noting that ASCO guidelines recommend myChoice CDx as the only version of an HRD test for patients with ovarian cancer. Individual patients facing a cancer diagnosis will have access to Myriad germline, tumor and myChoice CDx. This illuminates all possibilities and options to give patients the best outcomes. These offerings provide the most thorough set of answers to treatment decisions and clinical trial matching through 1 report. Providers can stay focused on the patient with confidence that they have the best, most comprehensive collection of solutions delivered through an easy, frictionless experience. And now for more insight on how we are merging companion diagnostics, tumor sequencing and testing services to raise the standard of care in precision oncology, let's hear from Dr. Nadauld, Executive Director of Intermountain Healthcare's Precision Genomics Program.

Myriad Genetics has been an expert in the field of genetic testing for decades. Partnering with Myriad allows Intermountain Precision Genomics to offer their test in combination in a way that neither could do on their own. It's this comprehensive combined analysis of both the germline and the somatic state that allow a physician to provide the best possible treatment plan for that individual. This personalized medicine approach, where we combine targeted therapies, based on an individual's specific DNA makeup is yielding outcomes that we've never thought were never possible. We've seen examples where patients' tumors have been refractory to a variety of treatments. And now when they get a precision medicine approach, finally they get a response. Their tumor shrinks, they feel better. And they do well for a long time. We've even in some rare cases seen a complete response where on a subsequent CT scan, for example, we don't see any evidence of disease. Imagine taking a patient's DNA and identifying which treatment would be predicted to be best for them and giving them just that single targeted therapy. That's what we all want: the right medicine, for the right patient, at the right time. That's the essence of precision oncology. It is such an exciting partnership. It's good news for medicine. It's good news for patients. It's good news for physicians. And I'm excited to be a part of it.

Thank you, Dr. Nadauld. Working with other health care leaders like Intermountain Precision Genomics is just one example of our drive to improve health outcomes for patients with cancer and expand innovative treatment options for the health care providers that care for them. We have mapped key milestones to set the stage for a successful launch. To date, we have secured 18 clinical leaders to head our Scientific Advisory Board. We've received commitment from over 10 sites to launch our research registry that will enroll 18,000 patients with plans to add many more sites. Together with our partners, our team has developed rigorous training to prepare our strategic accounts and medical affairs teams to properly seed the market. We see a bright future in our oncology suite of products. Our goal is to provide comprehensive solutions to guide surgical and medical treatment selection at every step of the patient's journey. We are committed to putting customers first, building new commercial capabilities and elevating our products as we open up a $70 billion market for Myriad. We are confident in the value that this combined offering delivers. As a result, we will see accelerated and sustainable financial growth. This combined offering is differentiated based on our myChoice CDx and BRCA expertise. We are now positioned as a best-in-class competitor in the fast-growing tumor profiling market that has a total opportunity of $5 billion. By providing multiple offerings, we can better serve patients and nearly triple and simultaneously expand our revenue opportunities. And now I'd like to turn it over to Mark Verratti to talk about how we are serving the growing need for mental health with GeneSight.

Hello. I'm Mark Verratti, President of Mental Health at Myriad Genetics. It's great to share the progress our mental health team has made over the past year, and I'm excited about what's next. The GeneSight test is backed by the most extensive research of any pharmacogenomic test of its kind. As the pandemic changed our market, we've learned and adapted. As a result, we are even better positioned for future growth. These are 3 points I'll share with you today. First, we have a large and growing market for GeneSight and an increased demand among patients and providers. Second, our test and our science are unmatched in the industry. Building on this base, I will share exciting news about how we are expanding the opportunities for GeneSight. And third, we have adjusted our go-to-market model to accelerate growth and expand our reach. Our market base has expanded significantly in the past year. Historically, we had focused on approximately 16,000 psychiatrists for GeneSight. Now both UnitedHealthcare and Medicare allow reimbursement regardless of the type of prescribing provider. As a result, we are expanding our focus to more than 100,000 high potential providers, including primary care physicians and nurse practitioners, who prescribe nearly 80% of antidepressant medications. These providers offer treatment for mental health conditions like depression, anxiety and ADHD. More than 17 million people have a depressive episode each year, but only 40% of the patients have success with their first medication that the doctor prescribes. Nearly 15 million Americans are diagnosed with anxiety, and more than 12 million children and adults have ADHD. Among the 3 diagnoses, we estimate there are approximately 5 million new patients each year who may benefit from their clinicians ordering the GeneSight test. There's no doubt the past 14 months have been rough on all of us. The pandemic, long-term isolation and a constant strain of uncertainty has impacted many Americans, young and old. This has led to a 60% increase in doctor visits for mental health issues. A new study from the Centers for Disease Control shows mental health prescriptions rose 6.5% nationally in the last 8 months alone. Last week, we released the latest GeneSight Mental Health Monitor survey. It showed more than half of those diagnosed with depression started a new treatment since the beginning of the pandemic. Unfortunately, just receiving a prescription for mental health medications doesn't necessarily translate into success. Our research shows 1 in 2 of those diagnosed with depression said they have tried 4 or more depression medications in their lifetime. Nearly 1 in 4 respondents reported they have tried 6 or more medications to find relief. Helping reduce trial and error is what we do. GeneSight is the only pharmacogenomic test backed by extensive research, including 2 important studies published in the past few months. First, in February, we announced the peer review journal, Psychiatric Research, published a new analysis showing GeneSight better predicted variation in patient outcomes. It more accurately predicts blood drug levels and identifies more patients with significant gene-drug interactions, who would be missed by single gene testing. Second, we shared a meta-analysis of 4 randomized trials that demonstrated the GeneSight test improved patient outcomes on all study endpoints. Outcomes improved significantly for patients with major depressive disorder, whose care was informed by GeneSight compared with treatment as usual. The U.S. Department of Veterans Affairs selected GeneSight to conduct an extensive study of 2,000 veterans across 17 states. The study is investigating the implementation of GeneSight compared to current treatment options within the VA system. Enrollment for the study is completed, and the results are anticipated in the first half of 2022. All of this research further validates the utility of the GeneSight test. Our proven results advances beyond our competitors and demonstrate the added value our test brings to patients, physicians and payers. In terms of financial results, we have significant momentum with sequential quarters of double-digit volume growth. This is accelerating. We saw a 13% increase in Q3 to Q4 last year and a 17% increase in volume in Q1 of this year. Not only are more people seeking mental health treatment, but the pandemic has also helped people become more comfortable talking about it. Our targeted go-to-market approach has resulted in new providers ordering the GeneSight test, and the number is growing. This has led us to an important milestone. More than 1.5 million patients have now taken the GeneSight test to date. We are continuing to build on our momentum in the back half of the year with an expanded GeneSight test and a rapidly growing tool in GeneSight at Home. Today, we are announcing that we are expanding our GeneSight test to include additional genes and medications, including those related to the treatment of ADHD. As shared earlier, the ADHD population is large and the pandemic is putting a further strain on this population. We are broadening our comprehensive panel because we are confident in our supporting evidence, including in-vitro experiments and a thorough scientific literature review of genes and medications tied to ADHD. We are meeting a critical need. Adults with ADHD are 3x more likely to be diagnosed with major depressive disorder. We already have market support for the expanded test, as Medicare includes ADHD as a covered diagnosis. I'm happy to announce that on May 10, providers can start ordering the expanded GeneSight test through our secure portal. You heard earlier from Paul and Eric about our enhanced go-to-market strategy and commercial transformation. An important piece of our approach has been GeneSight at Home. It allows providers to order GeneSight for their virtual patients through a secure portal. More than 60% of mental health appointments are now being done through telehealth. We have adapted quickly by introducing the GeneSight at Home collection kit. Clinicians still need to order the GeneSight test, but instead of administering it in their office, they can have it shipped directly to the patients' homes. Already, we have had more than 60,000 kits shipped to patient homes through March 2021. In fact, in Q1, 35% of orders requested the direct to patient kit. To continue to build on the growing demand for virtual solutions, we are initiating telehealth partnerships. We know that genetic testing can provide critical insights that clinicians might not be able to see, hear or know during a patient evaluation. This information is only available through pharmacogenomic testing. For more than 1.5 million patients, GeneSight has provided this genetic insight to their clinicians. By providing genetic information with more genes and more medications, we can help clinicians better treat patients with depression, anxiety, ADHD and other psychiatric conditions. With expanded Medicare coverage beyond depression, our ability for fair reimbursement is better than ever. With a focused team and a proven commercial model, we are well equipped to serve the expanded health care provider and patient populations. All of this will help us build on our strong momentum as we continue to accelerate our growth. We are excited for 2021. And now I want to turn it over to our CFO, Bryan Riggsbee, to talk about delivering long-term growth and profitability for Myriad Genetics. But first, a quick snapshot of what the external market is saying about our opportunity with GeneSight. [Presentation]

Thanks, Mark. Hi. I'm Bryan Riggsbee, Chief Financial Officer of Myriad Genetics, and I'm pleased to discuss our focus on delivering long-term growth and profitability. I would like to start with an update on our first quarter earnings, which we released yesterday. We are extremely pleased with the strong start to the fiscal year. I will touch on a few of the highlights. Coming off of an extremely challenging year in 2020, we were pleased to return to year-over-year growth with revenue increasing 5%. More importantly, we saw sequential revenue growth of 12% in a seasonally weak quarter. Our total test volume increased 5% sequentially with notable strength in GeneSight and our prenatal products, and our per test ASP improved sequentially by 2%. Adjusted earnings per share improved to a loss of $0.06. Importantly, as we look ahead, we expect to generate approximately $375 million in gross proceeds from the asset divestitures that we have previously announced. This will provide capital that we can deploy to grow the business. We're providing long-term guidance for Myriad to grow revenue organically at 8% to 10% in fiscal year '22 and fiscal year '23, with higher growth in fiscal year '21 as we come out of the pandemic. In terms of our cost structure, we are focusing on becoming more efficient and expect to achieve run rate savings of $55 million to $60 million by fiscal year '22. While focusing on our cost structure, we will also be making important investments that will improve our gross margins and profitability over the next 3 years. Finally, we expect to return to profitability by the fourth quarter of this calendar year. From a financial standpoint, we are focused on 3 areas to drive improved financial performance. The first of these is returning the business to consistent growth. We really feel we have reached a point in the market evolution where we can grow consistently organically from this point forward. Additionally, we believe that a consistent growth profile, along with a focus on our cost structure, will allow us to be the most cost-effective provider, which we believe is a strategic core competency. When combined, we believe this will translate to profitable growth and free cash flow generation. This will provide a competitive advantage in a market where capital returns are valued. We are also building a strong best-in-class revenue cycle management capability focused on improving cash collections. Some of the key components to this process are a physician portal redesign to ensure correct data capture for prior authorizations, AI-powered automated appeal filing, better contracting to reduce road blocks and an overhaul of our claims processing system. We believe by the end of next calendar year, these upgrades could reduce no pay tests by 10%, which would have a significant top and bottom line impact. Beyond operating expenses, you have heard today that we are focused on our lab efficiency. In the short term, projects such as the conversion to new sequencing technology will drive savings and add up to 150 basis points to our gross margin over the next several years. In addition, over the longer term, we believe our lab of the future, which Kevin discussed, will support continued improvement beyond that time frame. We're also addressing our operating expense cost structure. We are guiding to $40 million to $45 million in operating expense savings this fiscal year off of our $130 million January 1, 2021, quarterly expense starting point. The impact of these savings will grow to $55 million to $60 million in run rate savings in 2022. These savings will come from the announced divestitures and other identified savings. Let me be clear, we are focused on growth, and we'll continue to invest for growth going forward. This waterfall shows the bridge to where we are today from an expense standpoint and where we expect to be for fiscal year 2021, given our planned divestitures and expense reductions. For this year, we believe we will have total adjusted operating expenses of approximately $477 million, which reflects the impact of our expense reduction initiatives and divestitures. This slide maps out the relative size of our planned divestitures on an annual basis using calendar year 2020 full year results. When we exclude the allocated corporate overhead for these businesses, the divestitures will be accretive to the bottom line before capital deployment. Importantly, we believe the remaining company, following the divestitures, will grow faster, have higher gross margins and be more profitable. In addition, the divestitures will provide us with approximately $375 million in gross proceeds, which can be allocated as growth capital going forward. While we are not providing specific guidance, we wanted to provide some thoughts on our ability to grow the core business over the long term. When we look out to fiscal year '22 and fiscal year '23, we believe we can grow test volume at 10% to 12%, and we'll see a 3% to 5% average annual impact on ASP. This translates to 8% to 10% revenue growth, assuming a fiscal year '21 baseline, which excludes the announced divestitures. For fiscal year '21, we will grow at a higher organic rate compared to 2020 when we saw the primary impact of the pandemic. In addition, the 2021 organic growth rate will be negatively impacted by the divestitures, which we expect to occur around midyear. This long-term growth, along with our focus on cost efficiency, will support gross margin improvement. Moving beyond 2023, programs such as lab of the future could provide additional benefits. Our focus on growth and efficiency has us on the path to return to profitability in the fourth quarter of 2021. Longer term, we could potentially grow even faster as we look to deploy capital and take on leverage. In terms of capital deployment, we will focus on strategically sound acquisitions and partnerships to drive growth. Some of the major themes could include deals that bring new product content in our core businesses, new enterprise capabilities to drive growth and technologies that broaden our market reach and access. In summary, we are focused on driving growth and reinvigorating our position as a leader and innovator in the genetic testing market. With that, I am pleased to turn it back over to Paul for closing remarks. Thank you.

Thank you, Bryan. As we transition to the Q&A, I want to thank everyone who has joined us. I also want to thank Eric, Kevin, Jerry, Nicole, Faith and Mark for their insightful presentations. Our transformation is taking hold. We are now organized and energized to better serve customers and support growth. As I wrap up, I want to reinforce these key takeaways. Building on the early success in our transformation journey, we have reorganized and reenergized our team, culture and business processes to better serve customers and support growth. We reduced complexity, lowered costs and redesigned our commercial model to improve our operating and financial results. We've launched several initiatives to improve our competitive position, elevate our products to their full potential and accelerate growth. We are passionate about our purpose of improving health and well-being for all, and we are excited about our future. After a 5-minute break, Bryan and I will be back with Maggie Ancona, Senior Vice President of Enterprise Transformation, who will moderate our Q&A. Please stay logged into the webcast, and we'll see you back in 5 minutes. [Break]

[Audio Gap] from Jack Meehan from Nephron Research. Some of your peers, you -- some of your peers price hereditary cancer tests at less than $1,000. How far away is Myriad's HCT pricing from this level?

So we'll not get into the pricing discussion today, Jack. But just know that we are committed to having a price point and a cash out-of-pocket for our patients to make our products as accessible, not more accessible than others.

Our next question, also from Jack. How much of the sales force reduction to 750 representatives was related to the recent divestitures?

So very few -- it's a good question. We actually feel really good about the changes that we've made, as Eric spoke to today earlier in the presentation. We continue to have momentum in each of the sales channels. We have our highest producers more aligned and engaged than ever. So we really feel like we're going to continue to get more throughput and higher levels of productivity at lower cost. And so the vast majority of the reductions happened in our primary channels.

Thank you. Our next question from Sung Ji Nam of BTIG. Just a clarification, is the test combining germline with somatic mutation testing with Intermountain Health, just for the PARP inhibitors or for all oncology therapeutics?

Do you want to take this, Bryan?

Yes. Sung Ji, this test, we plan to make broadly available across the oncology population. So combo tumor and germline has become standard of care in that market. And so our offering now supports that.

Thank you, Bryan. Now the questions are coming in fast and furious. Our next one [Audio Gap]

Thanks, Tycho. We are very excited, as I know our entire industry is, about the ability to make our products more accessible in terms of the expanded coverage. And so we are excited about the significant growth opportunity and the opportunity to serve many more patients in that regard.

Thank you. Our next question coming in from Puneet Souda from SVB Leerink. EMR, great to see the EMR integration is improving. What is the penetration of EMR integration today? And where would you like that to be in the long term?

Well, as Kevin spoke to this, we have several hundred EMR integrations that are currently live and up and running. We've got a ways to go in oncology and some other opportunities. But we are heavily investing in all parts of the patient and physician experience, including making the data more transferable through enhanced EMR capabilities. So that's a big part of the tech investments we continue to make.

Thank you. Also from Tycho Peterson, how meaningful could the carrier screening expansion be?

Significant, Tycho. As you know, we think that the expansion provides just -- opens up a large market of opportunities for women, and we're really excited about our innovations and our expanded offerings in terms of meeting that market demand. So we're pretty excited about it.

And our next question, I believe, comes in from Doug Schenkel from Cowen. I believe there are 2 questions potentially here. First question, can you share multiyear assumptions for pricing and volume by major product category?

Thanks, Maggie, and thanks, Doug, for the question. We didn't share in our presentation. We really talk about it in terms of our total portfolio growing 8% to 10% over the '22 and '23 years and pricing was a component of that, along with significant volume growth -- we didn't break that out by product category.

Second question from Douglas as well. Subsequent to pruning the portfolio, are you positioning to potentially add to the portfolio? And if so, on what time frame?

Absolutely. We're excited to have this first phase of our transformation behind us. And quite frankly, we're excited about how much progress we've made moving into the second phase of our growth and getting our -- all of our current products to their full potential, including additional recovery in hereditary cancer, which Nicole spoke to. And as we think about deploying capital, both human and financial, going forward, we see great opportunities in women's health, emerging opportunities in mental health as well as oncology. And so we're going to be excited going into next year and beginning to look more aggressively at opportunities in the back half of this year.

Bryan, the next one is for you from Bill Dezellem from Tieton Capital Management. Is the Q4 profit forecast GAAP or adjusted? And if adjusted, what is it adjusted for?

Yes. Thanks, Bill. The Q4 profit forecast would be an adjusted measure, and it would be consistent with the adjustments that we've seen in the first quarter of this year.

Thank you. And back to another question from Puneet Souda from SVB Leerink. Sales force. What are the key changes in the sales force messaging now versus before in the hereditary channel? Health care providers have a view of Myriad based on prior experience. So what are the strategies to turn that around?

Well, I think the impression of most health providers are that we are among the best in terms of reputation and quality. And -- but as we've talked about earlier in the day, we weren't -- haven't always been the easiest to work with, and we need to change that focus on both the patient and the physician experience. I think like all organizations, this is an opportunity for us to refresh our messaging to really deliver the differentiating quality of our products to exceed expectations in terms of service and to really work to make our products more accessible, including pricing for more patients. And so I think along those 3 dynamics, we've got a great opportunity here in the context of our new commercial strategy to accelerate growth in the back half of this year and really going into next year. So we're quite excited about the progress we've made. And again, this opportunity to refresh our brand, our value proposition in the minds of both patients and physicians.

So picking up on a conversation we had with our new growth officer this morning, a question from Steve Mah from Piper Sandler. On the direct-to-consumer riskScore test versus physician-directed testing, will the DTC end users still have to get a physician prescription?

So we're still working through the details of what a direct-to-consumer launch would look like. And again, we're quite excited about that offering. And we'll be piloting different versions of that later this year and going into next year. So we'll be coming back to you with those details soon.

Thank you. Our next question back to Sung Ji Nam from BTIG, with the cash pay for patients, what is the pricing strategy?

Well, again, the strategy generally is we know that we have not led the market in terms of accessibility and pricing. And so we are looking across all of our different product lines of how we can better partner with payers, but also deal with the challenges of the out-of-pocket cash price that many of our patients face. And we certainly don't want that to be a barrier between our physician partners and their patients. So we're looking out across all our channels, again, with the goal of being more accessible. We've got the best products. We've got a great sales team. We're arming them with a reenergized value proposition. And now we got to make sure that our tests are accessible from a price standpoint as well.

Another good question from Sung Ji Nam of BTIG. For the combined NIPT carrier screen test, do you need to show clinical utility of combining the tests? Would you be billing separately for these tests?

We'll be coming back on the details of the combined offering. Again, we're quite excited, as Nicole spoke to. Right now, you've got to jump through lots of hoops and hurdles and multiple samples when the science is really here for us to deliver on 1 sample, the full benefits of both Foresight and Prequel. So in terms of the details of what that rollout will look like, we'll hopefully be able to speak to you about that early next year.

Our next question is from Steven Mah from Piper Sandler. Can you comment on the GeneSight ASPs versus Q4 and Q1 2021? Seems like volumes went from -- went up from -- to 17 -- went up 17%, but revenues declined.

Yes. Thanks, Steven. A couple of comments on that. First of all, very excited about the continued recovery and growth in GeneSight volumes in the first quarter. What I would say relative to ASP is there was some onetime adjustments in Q4 that you have to account for. But also, given our expansion a couple of years ago with UnitedHealthcare and coverage for our tests, we typically see a greater level of seasonality in Q1 as patient co-pay and deductibles reset -- that's versus what we might have seen historically.

Thank you. Another question, as we look at the competitive landscape, what do you believe is Myriad's greatest competitive advantage?

Well, I think our people, I think our history and the science and the data underlying our quality of our products. Jerry, I think, spoke really well today to the differentiating nature of the quality and accuracy of our test and how across a broader set of populations, we can deliver those genetic insights. So we now need to couple that science and that -- those capabilities from the quality of our products with an unmatched service capability and broader access to our patients. And I think that's the winning combination for us in oncology, women's health and mental health.

Our next question from Puneet Souda at SVB Leerink. Paul, it's clear that your focus is realigning the core, and congratulations on the divestitures. It's also clear that you're aligning to the patient, consumer and health care provider, but could you talk a bit more about the overall longer-term portfolio that you envision at Myriad? And is that contemplated in that 8% to 10% growth portfolio?

No. I would say that we're quite confident in those organic growth rates, and that really is meant to put the stake in the ground about all of our different transformation initiatives and where we think we can get the core business to on an organic basis. And as Bryan spoke to, we've got opportunities on the top line. We've got opportunities through low-cost sequencing and our lab of the future and just productivity enhancements on gross margins. And we're obviously looking at reprioritizing our OpEx and getting the full pull-through there. We are equally excited about the opportunity to deploy capital. And again, as I mentioned earlier, financial and human, because as we move our R&D team and our tech teams to start thinking about new product innovations as well as continued enhancements to our current products, we see more growth opportunities there. But we have the balance sheet and the financial liquidity and access to capital that will allow us to take this commercial engine and this stronger company, quite frankly, and look to acquire new products that are emerging in the marketplace and grow above those 8% to 10% growth rates.

I think we have time for one last question. Paul, I think this one is for you. Can you talk about the key elements of your direct patient offering? When will the core capabilities be in place from a tech standpoint?

So today and over the last few months, our tech teams have just worked tirelessly to improve the patient experience and improve our portals. What we've not done has done that across all of our products and we haven't had an enterprise approach to making sure that all of that technology is available across all our products. So Kevin and his team are working hard. We've invested a lot more in expanding the team to make these experiences available across all of our products. So I think over the course of the next 12 to 18 months, I think you'll see that harmony coming together in terms of our products. And that, again, should really power our organic growth and improve our capabilities in terms of regaining market share and growing in a fast-growing market.

And before we close today, Paul, any final thoughts?

Just thank you all for participating today, and thank the team that helped pull this event together. Again, we are excited to have completed the first phase of our transformation plan. We are launching aggressively into the second phase of organic growth and making sure all our products can reach their full potential and beginning to turn our attention to longer-term growth opportunities that we see in our focus areas. So thank you again for your participation today, and we look forward to talking to you again soon.

And thanks to all of you who attended today's Investor Day at Myriad Genetics. Note that all of the materials that we shared with you today are posted on our new investor website at myriad.com. It's a terrific portal that just launched today with all of our new brand materials as well as all the presentations from today. We'll continue to update that portal. So please come back to visit for more news from Myriad Genetics. Thank you very much.