Billiontoone Stock Earnings Reports

BillionToOne reported a very strong Q1 2026: total revenue of $108.4M (up 84% YoY), ~188k tests (volume +44% YoY), and an annualized revenue run rate of ~$434M. The company achieved gross margin of 73% (+9 pts YoY), GAAP operating margin of 16%, adjusted EBITDA margin of 24%, and ended the quarter with ~$537M in cash. ASPs rose 28% YoY to $571/test while COGS per test remained low at $153. Management highlighted continued commercial momentum (now in-network with Anthem and UnitedHealthcare, ~300M contracted lives), strong underlying prenatal growth, and a rapidly growing oncology business (oncology revenue nearly 5x YoY to $10.7M). Key product catalysts: launch of Unity Confirm (a cell-based noninvasive fetal-cell confirmation assay marketed as a follow-up to high-risk NIPT), ongoing tumor-naive MRD development and planned launch by year-end, and recent oncology product launches (PGx, CH). Management raised 2026 revenue guidance to $445M–$465M (vs prior $425M–$445M), attributing the increase primarily to higher ASPs from new payer contracts rather than increased volume assumptions. They reiterated an operating model focused on sustaining >70% gross margins and profitability while continuing targeted investments in sales, R&D and evidence-generation. Near-term points for investors: Unity Confirm is positioned as a differentiator for prenatal market share (limited direct revenue contribution but potential to drive front-line Unity Aneuploidy adoption); oncology growth is fast but currently lower-margin until Medicare coverage for Response is secured; true-up revenue and AR timing drove some quarter-to-quarter noise; management expects continued sequential volume growth in Q2–Q3 with seasonally slower Q4.