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| All of these programs require significant investment and we are confident that we will see a positive return in the form of improved test turnaround times, lowered operating costs and improved customer experience, which will continue to differentiate us from our competitors |
| So we're quite excited about the study |
| I think the only thing I would add is that, I think you've seen the team just do a really great job in the lab on COGS as well as managing OpEx |
| Our overarching goals are to continue to develop best-in-class molecular diagnostic tests to better detect disease, support treatment decisions, and improve clinical outcomes |
| Second, to improve the clinical utility and ease of use for our patients and provider partners and make our genetic test more accessible and affordable by leveraging technology and scale in our lab and commercial operations |
| And seasonally, the hereditary cancer is pretty strong in Q4 and it was off a pretty big base from the prior year in 2023 and you saw really strong growth in women's health as well |
| So really across the product portfolio, probably less than Prolaris, we saw a really strong ASP year in Prolaris, but both for Hereditary Cancer, Prenatal and especially for GeneSight, we see ASP opportunities here in 2024 and 2025 |
| We are pleased that we continue to deliver on our commitment to shareholders to achieve double-digit profitable growth as total revenue increased more than 11% in 2023 compared to last year |
| And we achieved positive adjusted EPS as well as positive adjusted operating cash flow in the fourth quarter |
| With this strong performance and market share gains in mind, we are raising our full year 2024 revenue guidance and introducing positive adjusted EPS guidance |
| So depending on work in process and lots of different factors but let me just underscore very clearly that we are very excited about both the organic growth of myRisk hereditary cancer test is a highly differentiated product, ASP opportunities there |
| As we look towards 2024 and beyond, we see adoption in use cases for genomic testing and precision medicine growing, providing strong tailwinds for organic profitable growth across our core products, with an increasing ability to sell across the sales channels that we have deep commercial roots in |
| At the same time, we would remind investors that not only is it early days for precision medicine, but it is highly fragmented with less than 20% share concentrated among the top players, providing us with significant opportunity for market share gains |
| Andrew, I mean, again despite those headwinds we had a really good year |
| And we see accelerated market share gains |
| And as you noted, we see significant upside both in terms of volume and ASP as guidelines come out for expanded carrier screening and that will also be supportive of our FirstGene launch hopefully later this year as well |
| We certainly believe it could be a great tailwind Foresight Universal Plus as well as for FirstGene in 2025 |
| We're really pleased about the progress that we're making both in terms of wallet share and new customers |
| And so we've continued to see wallet share gains and more recently an acceleration in new customers Mason |
| So we're very confident when we come to market we're going to have a highly accurate and sensitive MRD assay and that we'll be able to participate in what is a large market and a great opportunity for patients most of all |
| On slide 13, we saw a strong double-digit growth across all of our core products in 2023 |
| So we do see probably upside in the size of the market and we certainly see upside in terms of our ability to win market share gains |
| So we're quite proud that they've chosen our highly accurate MRD assay to follow |
| But it's really too early to talk about readouts but they are incredibly efficient organization and we've had great success in Japan and with MyChoice and other products |
| All of that enables us to do a better job and be a better partner for the payers |
| We've also enhanced our customer targeting, digital marketing, and overall operating model to drive commercial leverage in 2024 and beyond |
| Continued commercial execution led to record-breaking volume growth for our pharmacogenomics business in 2023, as we added approximately 16,000 new providers ordering GeneSight for the first time over the course of the year |
| We're really proud of the progress that we're making in the study |
| We continue to build on GeneSight's strong foundation of clinical data, including a collaboration with Optum to create a multi-phase study design better to understand GeneSight's ability to improve clinical outcomes and reduce overall healthcare costs |
| The momentum that our women's health team carried through 2023 is demonstrated by their strong results |
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| Due to payer issues and transitioning to GeneSight's PLA code, at the start of '23, as well as the transition of multiple Blues health plans and new claims administrative processes that had a negative impact on our collections in ASP in the first half of 2023 |
| For first quarter, gross margins are expected to be lower than fourth quarter levels reflecting typical seasonality and are expected to ramp up throughout the year |
| Also as a reminder, adjusted operating expenses tend to be seasonally higher in Q1 due to timing of certain commercial spend resulting in negative EPS in the first quarter of this year |
| We had some disruptions for hereditary cancer ASP this year because of some payer issues |
| That was a bigger challenge in 2023 quite frankly was not volume with ASP and having addressed those issues with a couple of our payers as we work through some of the coding issues |
| I think some of the levers and we've talked about them I think during our Investor Day and previous, I think one of the challenges with the unaffected market is really the customer journey that patient is on |
| In part as I mentioned earlier we had lost fellowship with genetic counselors and others |
| So, as we mentioned before, we do see a lot of disruption in the marketplace |
| As mentioned earlier, Q1 of 2023 was an unseasonably strong comp |
| And there have been several companies unfortunately that have struggled over the last year and more sort of under the radar smaller companies as I said, this is still a pretty fractured market |
| Not sure if this is right, but I'm calculating a sequential decline in the fourth quarter this year though |
| I think we've stated before it actually is an underpenetrated market, awareness in many cases still seems to be low |
| I think we've proven that now to be an incorrect set of assumptions here |
| And also in academic medical centers that, quite frankly, we've been shut out for many years |
| So the volume more than made up for a tough year on ASP |
| So again quarter-to-quarter I'll just remind everybody the volumes can be choppy |
| Having addressed these issues, we expect improvement in our ASP at or below our pre-stated 3% compression target in 2024 |
| That being the case we expect only mid to high single-digit percentage growth for revenue in Q1 of this year compared to last year |
| These statements are based on management's current expectations and the actual events or results may differ materially and adversely from these expectations for a variety of reasons |
| We really don't see any headwinds in 2024 |
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