Personalis reported a fourth‑quarter net loss of $23.8 million on revenue of $17.3 million, with earnings per share of –$0.26, beating the consensus estimate of –$0.30. The company’s gross margin fell to 11% in the quarter, down from 22.7% for the full year, while its cash balance remained at $240 million, giving it a runway of roughly two years to reach cash‑flow breakeven.
The quarter’s results were driven by a 400% year‑over‑year increase in clinical test volume, reaching 16,233 tests for 2025. CEO Chris Hall said, "Our performance in 2025 was transformative, demonstrated by 400% year‑over‑year clinical volume growth and pivotal Medicare coverage for breast and lung cancer." Medicare coverage for these indications is a key milestone that validates the NeXT Personal MRD assay and expands the company’s addressable market.
Margin compression was intentional, CFO Aaron Tachibana explained, "Gross margin was 11% in the fourth quarter and 22.7% for the full year. It is vital to understand that this margin compression is intentional but temporary." The company is subsidizing testing to build evidence for reimbursement, accepting lower margins in the short term to capture market share in the high‑growth MRD space.
For 2026, Personalis guided full‑year sales to $78 million–$80 million and annual test volume to 43,000–45,000, a 170% increase year‑over‑year. Hall added, "Looking ahead to 2026, we expect total revenue to be in the range of $78 million to $80 million. We’re setting our initial 2026 annual volume guidance at 43,000 to 45,000 tests, which would be about 170% growth year‑over‑year." The guidance reflects a cautious outlook amid ongoing Medicare negotiations and the need to balance volume growth with cash conservation.
Investors responded with mixed sentiment, weighing the EPS beat and volume growth against the lower guidance and projected cash burn. The company’s strong cash position and Medicare wins are viewed as positive long‑term drivers, while the intentional margin compression and lower revenue outlook raise short‑term concerns.
The results underscore Personalis’s strategic pivot from legacy pharma and population sequencing revenue toward high‑value clinical MRD testing. The company’s ability to secure Medicare coverage, coupled with a robust cash runway, positions it to capture a growing MRD market, though it must navigate headwinds from reimbursement negotiations and short‑term margin pressure.
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