Natera, Inc. (NTRA) Earnings Call Transcript & Summary

All right. Great. Looks like we can get started here. Hi, everybody. Welcome to JPMorgan Healthcare Conference. My name is Casey Woodring from Life Science Tools and Diagnostics team. Pleased to be joined by the management team of Natera. The company will go through their corporate presentation, then we'll do the Q&A session afterwards. So with that, I'll pass it to Steve.

Yes. Great. Thanks for having us. This is the standard safe harbor. So the mission of Natera is transforming the management of disease worldwide. And we do that with a proprietary technology that can detect extremely tiny quantities of DNA that combines molecular techniques with bioinformatics techniques that were developed at Natera. We first applied this technology in cell-free DNA in 2013 with Panorama, which is a cell-free fetal DNA test that looks at chromosomal abnormalities. We were the fourth company to launch in a very competitive market. But today, we are, by far, the market leader with more than 50% market share. We took that same technology, and we applied that in the field of organ health, where we look at donor-derived cell-free DNA in the setting of an organ transplant to identify rejection non-invasively, a product there is called Prospera. And then, of course, in the field of oncology, where we look at circulating tumor DNA in the setting of minimal residual disease or recurrence monitoring and our product there is Signatera. So we've been quite successful over the years, and we follow the same formula for success. Number one, we want to always have leading-edge technology and focus on constant innovation. The second is to be the leader in peer-reviewed published clinical data. The third is to have excellent customer patient experience. And then the fourth is to have broad and talented commercial teams. So 2025 was a great year from us from a volume standpoint. We had a record year in women's health, in organ health and in oncology. We just released our Q4 numbers, and you can see we had 924,000 units in Q4, driven by incredibly strong growth, particularly in Signatera MRD. In Signatera, we were pleased to announce the fastest growth quarter ever in the history of the company. We had 22,800 growth units over the previous quarter for a total of a -- excuse me, 225,000 clinical MRD tests in the quarter. We're super excited about the acceleration that we saw, really pan-cancer across multiple different tumor types, and this is driven by very strong data readouts that we had in the second half of the year and just a continuation of the strategy that we've had throughout the course of the year. Revenues were up 39% in Q4 over 2024 in a similar period with $660 million that was driven by very strong ASPs across the board and outperformance on volume, as I showed on the previous slide. We also had record gross margins and very strong cash generation for the year. In fact, we actually had greater than $100 million in free cash flow generated throughout the course of 2025. So I'm going to shift gears a little bit and talk about some of the innovation that is driving the growth or that may drive growth in the future. So first, in women's health, we recently announced the 21-gene single-gene NIPT test, which we call Fetal Focus. Now historically, with carrier screening for autosomal recessive diseases, you screen the mother. And if the mother is positive, you screen the father. And if the father is positive, then you get an amnio or CVS on the baby to find out the risk of severe genetic diseases. Well, the challenge with that is sometimes the father is not available and you're not able to complete the screening module. So we developed a new test single-gene NIPT test called Fetal Focus that enables us to look at the cell-free fetal DNA directly to look at the severe autosomal recessive and X-linked disorders, things like cystic fibrosis. We think this is filling a major gap in clinical care, and we're seeing a lot of excitement around this product. So product leverages our ultrasensitive LinkedSNP technology. We're doing a broad assessment of over 21 genes. We think -- or of 21 genes, we think this is today the largest panel that's available throughout the industry. We offer the test as a frontline offering, those that just want to order it upfront or as a reflex test where you can screen the mother and then attempt to get the father. If the father is not available, you can order the reflex test. And this is all based on a very robust clinical trial that we did call the EXPAND study. It's still ongoing, where we're collecting about 2,000 samples. And uniquely, we have genetic outcomes on all the positives and all the negatives in the study. We recently reported a readout from the EXPAND trial where we had 96% sensitivity with 98% specificity across approximately 300 samples. And again, we have about 1,800 enrolled to date. We're enrolling 2,000 samples overall roughly. So really excited about this product. There's a very significant amount of interest in this category by physicians, and we've seen a lot of new closed customers in kind of the tail end of Q4 and leading in now into Q1 as a result of having this in the portfolio. In oncology, we've also been innovating. So last year, we talked about launching tumor-naive MRD, and we also talked about launching a genome backbone for our Signatera tumor-informed MRD test. And we did both of those. So we launched the LATITUDE tumor-naive MRD product in colorectal. That's actually results have just been accepted in a major publication, which should be out in the next couple of months, and then we'll be submitting for reimbursement there. We're also now expanding that to other tumor types as well. And with our genome test, we had a successful launch. We can get down to 1 part per million LOD, so extremely ultrasensitive and that had a great reception in the field. We've seen uptick there exactly as we thought we would. But we're not done innovating. And we were excited with the recently announced acquisition of Foresight Diagnostics because this adds to the ultrasensitive strategy that we have in MRD. So Foresight has a unique technology that they call phased variants where there's 2 variants that are traveling on the same [ homolog ]. And this allows you to get really exquisite levels of sensitivity and limit of detection down to 1 part per 10 million. So I just announced previously with the standard genome testing and traditionally ultrasensitive tests, they're talking about 1 part per million, maybe 3 parts per million. Here, we're talking about 1 part per 10 million and an LOD95 that's been shown to be 3 parts per 10 million. So we're now in the process of incorporating this proprietary phase variant technology into the Signatera test. And in short order, probably late spring, early summer, we're going to be launching a new version of Signatera that incorporates phased variants and structural variants and increases the number of variants that we're tracking. Now we're still going to be taking our same tried and true multiplex PCR NGS method that does extremely deep sequencing, like roughly about 150,000x coverage at each of the variants that we detect because we think that, that's the best approach rather than doing thousands of different variants. But by incorporating phased and structural variants plus slightly increasing the number that we're tracking, we think we really have now a gold-plated MRD test that is really incredible. And I'm excited to be in a position to roll that out. In addition, we also are able to now move into the lymphoma and hematologic cancer space with Foresight, and that's an exciting area where they've generated incredible data. They have Phase III clinical trials going, and we're excited to be partnered with them to move into that space. So in addition, we think the next wave of innovation beyond ultrasensitivity will come from enhanced MRD. And we're excited this morning to announce an enhancement that we've been able to develop, which is based on AI and a foundation model that we built that looks at digital pathology that looks at the entire genome and exome sequence and transcriptome, where available, combines that with over 1 million longitudinal ctDNA time points and clinical records longitudinally collected all of these -- about 300 patients. We've taken all that together. We built a foundation model where now when we get a ctDNA sample, we can take the digital image, the MRD result, plug it into the model and get an augmented MRD score that actually can improve the overall precision of the risk score that's given. Now we've generated statistically significant data that shows that this augmented model using AI and using our foundational model, can improve upon ctDNA alone, and we're in the process of submitting that to ASCO. So we think in the future, when you order MRD, we'll get all of this other information, digital pathology, we get your genome sequence from the tissue and from your germline. We plugged that into our model, and we can give you not just the ctDNA score back but also this unique AI-driven score that comes out of our foundation model. So we should be rolling that out roughly mid-year. And this is really unique to Natera because to generate this type of model, you saw the partnership we announced with NVIDIA. To generate this type of data, you have to have -- or this type of power with the foundation model, you have to have millions of data points to input. And we have more early stage and adjuvant stage, tumor genome and exome sequencing and more longitudinal ctDNA time points and clinical data than any other company has ever generated. So we're uniquely able to do this to improve upon and augment traditional MRD testing. Now we're also working on AI enablement in other areas. So one is to just use these foundation models to identify new prognostic and predictive signatures or in partnership with pharma companies to develop new actionable drug targets that they can go after. Another area that pharma is interested is real-time patient matching. As I said, we have all this early-stage data that nobody else has. It's a very different set than what other companies have. And since we announced our AI initiatives, we've seen really significant number of pharma companies that are interested in partnering with us and getting access to our unique data set and our unique capabilities. Another area where we've built a moat and we're continuing to invest is in clinical data. So obviously, we had a very significant amount of clinical trials readout in 2025. Most notably, I think, was the IMvigor011 trial that was featured in the New England Journal of Medicine, focusing on muscle-invasive bladder cancer. But we have many other readouts as well. PALLAS, DARE, I-SPY, all in breast cancer, an area that we previously said, we've invested over $100 million in evidence generation in breast cancer. We had the 702 study in colorectal cancer and a series of other trials that we just had so many readout. We can't list them all here. But we're not done. We're continuing to invest heavily into data generation and into new prospective clinical trials, both with consortium groups and pharma partners but also directly ourselves. We've recently announced big trials in breast cancer, MiRaDoR, HEROES and the TEODOR study. And in fact, we have another major de-escalation trial in breast cancer that is to be announced. So we're upping our focus on breast cancer. We're investing another $100 million into clinical trial evidence development, specifically in breast cancer because we think that there's an important clinical unmet need there. So very significant investment. And then, of course, we just announced the STELLAR study in partnership with Exelixis in colorectal cancer. Now we think this is a very exciting trial. It's a Phase III pivotal trial that's going to start in mid-2026, looking at their drug, zanza and resected Stage II and III colorectal cancer in patients that have completed their initial course of adjuvant chemotherapy but are still MRD positive. So we think this is a great opportunity to take a set of patients that are highly likely to recur and have an actionable therapeutic for them should the trial work out. But what's exciting about this as well beyond just this particular study is that all the patients that are getting enrolled are clinical commercial Signatera patients. So because, I think, now pharma companies are realizing and they're saying MRD-positive patients is a great cohort for us to go after and to try to build new drugs to target into new clinical trials. We have all the MRD-positive patients at Natera. We know where they are. We generate them as part of our clinical testing business. So pharma companies are now coming to us saying, "Okay, we want to partner with you based on your clinical testing that you're doing to go after these MRD-positive patients and build clinical trials on top of that." So this is really just the beginning of this trend to come to Natera and do trials off of the commercial business. And we think this is a great opportunity. This treatment on molecular recurrence concept of patients that are either still MRD positive or are in remission and then become MRD positive is a very significant trend and area that we're seeing a lot of interest. And then last, I'll just touch on our early cancer detection screening initiative. So we are excited to generate very strong colorectal cancer screening data in 2025 and then also solid data in advanced adenoma from the prospective PROCEED trial that we announced at the end of 2025. In 2026, our goal is to complete enrollment in the FDA-enabling FIND study. So we are well underway now enrolling. In fact, our run rate for enrollment right now is already 20,000 patients, and that's before we turn on a bunch of new sites and a bunch of new recruitment channels. So we're super excited about the trajectory that we're on, actually ahead of schedule. And we think we're going to be able to collect 35,000-plus patients this year, complete the enrollment and be in a position to submit to the FDA in mid-2027, which is our goal. We think this is a big driver of growth for Natera in the future, and we're excited about this opportunity. So last, I want to finish with a series of milestones for 2026. First, we have mentioned we have submitted for expanded MolDX coverage. About 30% of the tests that we run today are in a category where they're not necessarily covered under Medicare. We said in December, we had submitted 7 additional MolDX submissions, and we think there's an opportunity to expand upon that as well. So that could be a big driver for us this year. We're also working intensely to integrate the Foresight business. As I mentioned, we're going to be launching Signatera genome with phased variants and structural variants in mid-2026. We're well underway working with Japan. We think we're going to have regulatory approval this year and be in a position to launch. We're expanding our tumor-naive LATITUDE test into other tumor types. In women's health, we've launched the Fetal Focus test now with 21 genes. So we're seeing extreme interest there. We think that's going to be a great opportunity. We plan on completing the enrollment for the FIND study in early cancer detection. And then in AI and partnerships, we announced our partnership with NVIDIA, which we think is great. We also are in a significant partnership with Ultima Genomics for launching new CLIA products and using their sequencing platforms. And we expect continued growth in ASPs and volume as one of the main drivers. So with that, I think we'll conclude the presentation and open it up for Q&A.

All right. Great. Thank you. Thanks for that, Steve. So maybe to start, you guys preannounced a solid top line beat. Maybe walk us through the performance in the quarter across each segment relative to your initial expectations. And then digging into it, Signatera had another record quarter of sequential growth units. Maybe walk us through the drivers there. And is it fair to flow the strong performance into the 2026 outlook and assume quarterly growth units for Signatera are at the high end or slightly above that kind of 18,000-ish quarter-on-quarter average that you've seen in the last 4 quarters?

Yes. So we really saw 2025 as a whole was a record across all of the different areas that we do business. Women's health, we saw significant growth. Organ health, we saw significant growth. And then, of course, in oncology, we saw significant growth. So I think there was a time not too long ago where if we had grown 15,000 units quarter-over-quarter, everyone would have been going crazy. But I think now we've reset the bar for ourselves with a record Q3 where I think we grew like 21,000 units or something in that range. And now, again, in Q4, a new record in Signatera quarter-on-quarter growth. We're seeing significant interest. I think the beginning part of December ahead of the holiday, we saw like just very strong weeks coming in both new patients and recurring patients. I think the start of the year here, we're off to a great start as well. I just kind of been watching the numbers come in. So everything is setting up for an incredible growth trend as we go forward. We invested a lot in 2025 in adding salespeople, increasing histology-specific medical directors and teams. And I think as we look into 2026, we're going to start to see some of that investment directly impact the unit growth. So we've got a lot going on. We also had some great data readouts, getting good feedback coming out of ASCO GI as well, which is always good. I think it's going to be another good year.

And you called out share gains in women's health as well as strong growth and significant interest in Fetal Focus. So maybe just walk us through the competitive dynamics seen in the quarter and how Fetal Focus contributed to growth from a volume perspective in 4Q?

Yes. So I think in women's health, we have been in a great position where we've had more than 50% market share. We've been innovating. But one of the areas where I think there's an opportunity for us is in this field of single-gene NIPT. Now for a period of time, there's been maybe 1 company that was the only company that had a single gene NIPT test, and I think that helped them grow and take share. We still grew our share and had a great year, but of course, other companies that have this single-gene NIPT product also did well. But now we're in a position where we have single gene NIPT. And that helps us both to defend from share losses from competitors that come in and try to take our business, but also to grow business from competitors that don't have a single-gene NIPT offering. And we're excited about our product. It's the largest panel that's available. We've done a thorough validation. The EXPAND trial, I think, is a very good clinical trial. We've got this unique LinkedSNP technology, and we're seeing record growth on a weekly basis coming in significant interest in the product line. I think it's going to be an opportunity for us to continue to grow and continue to take share.

You gave a lot of color on Foresight, but just walk us through Natera strategy in the lymphoma market, including which specific indications you're interested in targeting, how that Foresight technology will enable this? And what call points that Natera has in this part of the market already and then the competitive landscape there? And then lastly, beyond lymphoma, what is Natera's interest in the broader heme MRD market such as multiple myeloma?

Yes. So there was really two reasons why we were interested in partnering with Foresight. And the first was the phased variant technology and the intellectual property around phased variant technology. We did a ton of research and we ran a lot of different experiments. We looked at 5,000 variant panels. We looked at all these different opportunities, and we determined that phased variants is the path to get the most sensitive assay in MRD. And after that, we began our discussions with Foresight, and we were able to acquiring the company and get access to the full set of intellectual property plus the proprietary technology. And now we're in the process of incorporating that into Signatera along with structural variants, and that's going to be rolled out pan-cancer across every tumor type. Now another reason why we pursued the company was for the lymphoma clinical opportunity and pharma opportunity. Foresight has developed a significant leadership position in DLBCL, non-Hodgkin's lymphoma, follicular lymphoma, and we thought that, that was an area where Natera, although we've had a small presence, could be helped significantly by the acquisition. Now that's not a small market. There's something like 70,000 new patients per year, which is maybe just slightly smaller than what we see with Stage II and III colorectal cancer and to be able to just jump ahead and leapfrog several years by acquiring Foresight and partnering with them, we thought it was a great opportunity. Now there's an opportunity to expand upon the list of indications that I just listed off. But so far, I think we're really excited about the DLBCL in non-Hodgkin's lymphoma opportunity and the work that they've done, and we're going to secure that and then go from there.

That's helpful. Maybe one on Signatera genome. You had some new data presented at San Antonio Breast from the international randomized Phase III PALLAS study. It looked like look, PALLAS looked at the use of MRD in post-surgical Stage 2 and HR+ and HER2-breast cancer. Walk us through the main takeaways and early feedback from physicians there. How do you see this readout potentially translating to impact on volumes?

Yes, it's good. You guys do you want to take that, Alex? Actually, it could be a good one for you or Sol.

Yes, absolutely. Yes. So I think that was very large, probably one of the largest adjuvant studies that were run looking at palbociclib or IBRANCE would improve outcomes in early-stage breast cancer patients. Unfortunately, the study was negative in all comers. So a very similar story with the IMvigor010 study that we analyzed a few years ago. And this is the first of, I think, probably 2 or 3 presentations I will have on this data that looked at just the prognostic question. Can Signatera at the post-treatment postsurgical post-treatment time point on treatment and an end of treatment time point, predict which patients are at very, very high risk of recurrence? There's always been a question about any MRD technology this type of low-shedding breast cancer. Is it sensitive enough, especially from a single time point to identify, and we usually say at least, I think around 50%, if not higher, of all the recurrences. And I think for the first time, we have shown definitively that the answer is yes. So I think that really helps kind of move the field forward. And we're also looking forward now to the predictive data where we're going to actually ask the next logical question, well, in ctDNA-positive patients, do these individuals actually derive benefit from palbociclib while the ctDNA-negative patients do not. And if that turns out also to be a positive finding, I think that's going to be another kind of big advancement in the field where we basically replicate the whole IMvigor010 story, but now in this much bigger market of HER-positive breast cancer.

And in terms of reimbursement, what's the process to get coverage with this new Foresight technology integrated into Signatera genome? Do you need to generate new data to submit some LDX for coverage?

Yes. So I think anytime you kind of work on a new assay, it's always important to be interacting with MolDx and kind of make sure that there's there, and we do that. And I think the relationship there has been positive when we have the data. The key is generating the data. And we're in a position to be able to generate data, send it to them because we have so many studies that we've done, so many biobanks that we've done, and that's kind of the plan here.

Okay. Maybe moving to the STELLAR trial for treatment on molecular occurrence with Exelixis that you highlighted during the presentation. Maybe just talk a little bit about how the drug is being used in this trial and the potential pathway to read this out and submit to NCCN. Could this trial read out ahead of the other escalation trials like MODERN and CIRCULATE U.S.? And could it be the next potential guideline submission?

Yes, it's a good question. Solomon, do you want to take that or.

Yes. I think, first of all, it's the trial is sponsored by Exelixis. So it's Natera's partnering on the trial, but it's not ours. We're not running it. I think what's important and exciting about this announcement is it signals where the field is going when Signatera becomes standard of care in clinical practice. So Exelixis rather than setting up a whole expensive screening arm to test 20 patients to find 1 positive to randomize into their trial, they're able to come to us, as Steve said, and pre-identify patients who already meet inclusion and exclusion criteria just based on their commercial MRD testing. And that's a big deal because it accelerates the operation of the trial, and it increases the probability of success for trial enrollment. On the flip side of that, it's -- this addresses a significant need for physicians and patients who have completed definitive chemotherapy in Stage II and III colorectal cancer. They're positive on Signatera. They do a scan to look for some evidence of disease on a CT scan or a PET or an MRI. Hopefully, they found it and they can intervene. But if not, the doctor and the patient are saying, "Okay, what do we do next?" Now they can go on to this STELLAR-316 trial, which is awesome for the patient. So it -- since Signatera is the only MRD assay that is allowed as part of the enrollment for the trial, we think that also makes physicians more comfortable to come in off the sidelines if they haven't been using Signatera in this way and to adapt it clinically. So there's a really strong network effect here, and we expect more trials like this in the future.

Investors appreciate the size of the MRD market and how early it is in terms of penetration with Natera currently running the vast majority of tests as of now. Maybe just walk us through how you see Natera's market share evolving over time. In therapy selection, for example, there isn't just 1 player with 90% share, but maybe MRD is different. So where should or shouldn't we draw parallels to therapy selection maybe as a proxy for the evolution of market share in MRD?

Yes. I think that's a good question. I mean we are focusing now on penetrating the market as deeply as possible and then making our tests and our offering unique. And I think that's the right approach. And you do that by constantly innovating. So you saw 2 years ago, we had exome 16. Now we have exome 16. We have genome. We just announced phased and structural variants. We launched tumor-naive MRD. We're expanding tumor-naive MRD. So we're innovating. We're spending a lot on R&D. You also do that by generating a lot of peer-reviewed evidence where we now have, I think, over 100-something peer-reviewed publications and interventional trials, FDA enabling trials. And that really sets you apart. And so there's other areas where you can look like, for example, with RNA expression profiling where there's been 1 player that got 95% market share, and they've been able to maintain 95% market share by doing the big clinical trials by generating the data and by having their first-mover advantage. And I think we're hoping to follow that path, and we're trying to do all the right things and make all the right investments to maintain significant share down the road. And so far, I mean, we launched in 2019. Here we are 7 years later, and I think we're still in an excellent position.

That's helpful. Maybe shifting to early cancer detection. Natera has made meaningful strides here in 2025, including releasing multiple data sets and initiating enrollment for the FDA-enabling FIND-CRC trial. With so much going right for Signatera and MRD, maybe walk us through why early cancer detection is worth pursuing, including running a large outcomes trial, which requires meaningful investment?

Yes, it's a good question. So MRD is extremely underpenetrated right now. We think it's low single-digit penetration, and we're investing heavily there. But we've also built capabilities to develop technology that we think can solve some of the biggest problems like, for example, early cancer detection. And our technology is working incredibly well in our initial studies and in the PROCEED prospective trial. And so us to be able to run the FIND study and bring this to market, I think, is well within the scope of what Natera is capable of doing, and we think it can have a big impact on patients. We think it's a huge TAM, some, say, maybe $50 billion or $30 billion. So it's definitely worth pursuing both for the impact we can have on patients but also for the overall financial impact on the company. And the FIND trial is already well within our budget. It's already built into our budget for 2026. And we generated $100 million in cash last year. We're -- on our balance sheet, we're in a great position. So we think it's worth us pursuing.

Maybe as a follow-up, Natera released encouraging data on advanced adenoma sensitivity for your test as shown in the PROCEED-CRC trial. Historically, we've seen some degradation in test performance when moving from case-control smaller scale studies to full FDA trials. Maybe walk us through your view on why this degradation, particularly in AA sensitivity has occurred historically? And what is Natera doing to mitigate this in the fine CRC study?

Alex, why don't you take that?

Yes, absolutely. So I think this is something we've been kind of paying attention to now for a few years. And again, I can't speculate for other studies, but I think there's been concern that certain case control studies, selected advanced adenomas from a different set than normal controls, advanced adenomas might have been symptomatic. And all of that can create some bias where it's a little bit easier to detect those lesions. I think when we set out to kind of really develop and validate our assets, first of all, we said, "hey, we have some time, what can we do to really optimize the technology upfront?" So we did extensive discovery. I think we also have the ability test samples that had gold standard Signatera results. So if you're detecting a signal, you can verify it's correct because you do have that match Signatera. And then also, I think we were able to optimize the technology. And when we went to actually start clinically validate the assay's performance, we said, "Well, let's make sure we use samples that as closely represent the FDA-enabling study as possible." So PROCEED is really actually the same exact study. It's the same centers. It's using the same enrollment criteria using the same vendors for sample storage and processing. And I think because of that, we are really confident that we are really testing an average risk population that is as representative of the FIND study as possible, and I think that's when we see those results. I think that we are encouraged that at least we're taking all the right steps to minimize the risk of degradation. Obviously, we can't predict the future, but at least that's been our kind of strategy from the very beginning.

Helpful. Maybe just one on the model, maybe you can loop in mic here. 2025 was a significant investment year for Natera with commercial team expansion, new product launches, meaningful data generation. You pointed to a preliminary framework of 10% year-on-year OpEx growth in 2026 weighted towards R&D. Maybe walk us through the long-term framework for operating margins and how investors should think about operating leverage in the business.

Yes. No, thanks for the question. I mean I think the general framework is that we're just going to grow into profitability as the top line matures. So in order to grow that top line, you've got to have the infrastructure in place just a little bit ahead of time. That's exactly the process that we undertook to go from being a cash-burning enterprise and now one that consistently generates cash. So I'll just remind you, going back to 2022, we got to a point where we were burning about $100 million per quarter, and we set out a target to get to cash flow breakeven within a couple of years, and we hit that target exactly. If you look at our operating expenses back then as compared to now, in absolute dollars, the OpEx is much bigger now than it was when we were burning cash. The difference is that the top line, the revenue line is just more mature. We're further along in the commercialization and reimbursement for Signatera. And we still have miles to go on that front. While the OpEx line in terms of the operations are getting much more mature, we've got a fully mature revenue cycle operation team now that can actually get leaner going into the future. Same to be said for kind of more broadly on Signatera operations and just clinical, commercial kind of operations in general. On the commercial front, just in terms of our sales rep accounts, we had to make a very meaningful investment in getting -- just getting our sales our commercial operation to scale with other players over the last year, where previously we've been subscale. And from here, there's not really an obvious need to kind of double that team again, right? Meanwhile, the revenues absolutely can do that kind of doubling. So I think we'll just kind of naturally kind of grow into, first, EBITDA, profitability and then EPS profitability.

Okay. Maybe we have 1 more minute here. Just on the Signatera ASP front, you pointed the Signatera ASP stepping up $50 in '26 to maybe exit the year somewhere in the $1,250 range. There are a few moving pieces to that. You have a headwind from the ADLT rate resetting, offset by biomarker bills and closing the gap for Medicare Advantage and covered tumor types. So can you just walk through the puts and takes and the drivers to get to that net $50 increase?

Yes. I mean, sinter ASPs were again positive in Q4. And I'll just note, just on the presentation, all the results for Q4 were preliminary, and we'll have final numbers when we file the 10-K. But I expect ASPs to be positive in Q4, growth in Q4 over Q3. I expect to have growth in Signatera ASPs in 2026 over 2025. You mentioned some of the puts and takes. You have some ADLT modest headwind, but you've got a lot of positive drivers as well. I mean Steve made reference to the huge amount of effort we've put into getting Medicare reimbursement for a much broader swath of tumor types. So that's kind of #1 on my list. You've got the biomarker state laws, which will continue to be a tailwind. And then the other piece I'd say is we still have just kind of generalized execution where we can just get -- just actually get reimbursed for covered test kind of across the portfolio. So I think Q4 is indicative of what we can see through '26, and I expect that to be a modest improvement in ASPs from here.

All right. Well, looks like we're at time. We'll have to leave it at that. Thank you to the Natera management team for joining us. Thank you for everybody for joining us here. Enjoy the rest of the conference.

Great. Thank you.

Thank you.