Perfect! Hello, everyone. Good afternoon. This is Rachel Vatnsdal with the Life Science Tools and Diagnostics team here at JP Morgan. I'm joined by Paul Diaz, CEO of Myriad here. And so this will be a 40-minute session, roughly 20, 25 minutes of our presentation, followed by Q&A. And so with that, I will pass it over to you.
Yeah. Thanks, Rachel. Great to be here, and thank you all for attending late in the day. I'm sure it's been a long day for everyone. Really excited to present and give you an update on the progress that we're making at Myriad Genetics. It's been a busy but good year for us, and so we'll dive in, and again, we'll have some time for questions, as I doubt I will take more than 25 minutes. So thanks again for your participation. For those of you participating online, you know, we encourage you to look at the presentation, and at the end, we will give, you know, some reconciliations in terms of our GAAP and GAAP financial measures.
We're also gonna be updating on our progress in the quarter, and we'll be filing an 8-K, so, you know, call your attention to that, and the update that we'll give on guidance and the progress in the quarter later in the presentation. So really a great year, fueled by my teammates. You know, just every day I'm humbled by the lab techs, the genetic counselors, our commercial teams, that every day are serving, you know, thousands of patients and over 45,000 providers. Every day, the promise of genomic testing and precision medicine broadens. It's one of the things that attracted me to Myriad Genetics after 32 years in healthcare and healthcare services.
So really proud of delivering on that mission and very focused on making that information more actionable, being things that providers in the community can really do something with, and empowering patients with that precision medicine as well to guide their own health and well-being. So a great progress this year and really driven by my teammates. For those of you that know Myriad Genetics, we've had a long history and a great history in terms of science. For those of you sort of new to Myriad Genetics, we had a couple of tough years there, you know, 10 years ago, coming out of the Supreme Court case, and some execution issues that we've had.
So over the last three years, we've really embarked on a pretty complete transformation of the company and everything from how we go to market to our processes in the lab, our labs of the future, and particularly really focused on the patient journey and the provider experience, and we'll delve into that. But fundamentally, there's great science in this company that we've built on, and we've built our experiences, whether you're looking at net promoter scores or employee turnover and other measure KPIs that we'll talk about.
In this quarter, for the fifth consecutive quarter, we've grown more than 10% organically on the top line and, you know, continue to maintain our industry-leading 70% gross margins and a much-improved balance sheet, and we'll talk about the steps we took at the end of the year to improve our capital position. So really excited about the progress and the future. Our transformation plan was really built on four pillars. One, we need to constantly be investing in the science of our products and the clinical validation underpinning them. We think about that in the context of FDA regulation and other things, but also in the imperative of always having the best-in-class science, available, you know, for our clinicians, and actionable science. So you'll hear us talk a lot not only about clinical validation, but clinical utility.
How does our science make a difference in clinic? How is it actionable by an oncologist seeing 30 patients a day? How are the reports easy to use? And really excited about additions to the team. Sam Raha is here. He's been with us for 5 weeks now, came to us from Agilent, knows 10 times more about molecular diagnostics than I do, so just a great addition to the team. So the science underpins everything, but we've really been focused on the customer experience, as I mentioned, in commercial execution, and I think with 15% fewer sales force and 24% improvement in productivity, we've been growing. So it is possible to grow more efficiently and productively.
That's been driven by the digital tool investments that we have made across the enterprise, some of which are already coming through, but some of which will roll out over the next year or 20 that really will elevate our position. So across the company, we had a tremendous tech deficit to deal with, and so we standardized processes, we standardized the technology platform, and that's enabling our lab operations, our commercial teams, and really to scale all of our operations in a much more efficient way to support growth, innovation, and new product development. So 3 years ago, we began this transformation journey, first asking ourselves: where do we have a right to exceed and be successful?
And we really determined, after some divestitures that we successfully executed on, to really focus on oncology, which is where we started this journey 30 years ago, and women's health, where we see really where most of healthcare begins and the drivers of the healthcare system. Our pharmacogenomics product might seem like a little bit of an outlier, but in the context of the mental health crisis in America, it has been a really great grower for us. We're really excited of the progress that the team has made and the adoption of GeneSight. So, we operate in many channels in oncology, women's health, and pharmacogenomics, so we have multiple channels to grow, and we're pretty deep in all of these channels in terms of our commercial infrastructure. And so I'll spend a little bit of time, you know, 'cause for some, the...
People view Myriad Genetics as pretty mature, and I would say, yeah, in some ways we are, in some ways we're just starting. Across our product lines, across these channels, we see tremendous growth. And all our peers that have been talking this week have talked about the growth and the increase in adoption that's happening. Genomics is early. Community physicians and nurse practitioners are—it's early days for how they understand how to use this science. So I think there's a tide that's going to lift all the boats here for those companies that can really deliver services in a seamless way. And so big market opportunity across our products, but there is dislocation. There are a lot of small operators that are struggling. We are gaining share.
We expect to gain more market share as people struggle with, you know, the infrastructure investments that are needed to invest in Epic, the infrastructure investments to really have a commercial presence and to deal with the reimbursement and regulatory challenges ahead of us. Nonetheless, we occupy a top three position across six of the seven products that we are in, growing those positions every day. And again, unfortunately, we worry about patient access, but we're seeing people close down their operations and sort of the fragmentation starting to move market share around. And, you know, we're obviously trying to be there for our patients when that opportunity arises. No, you know, part of our portfolio represents that more than MyRisk, oor hereditary cancer product, really the leading product in the space. It has been for years.
When I joined the company, everyone thought it was a melting ice cube, that both volume and rate were collapsing, and volume was collapsing. We had lost market share every year for the preceding 5 years. You'll see in a minute how that has turned around, thanks to the leadership of Mark Verratti and the team. But I would say that across multiple channels, we see a lot of growth in our hereditary cancer franchise. On the unaffected side, in women's health and imaging, there are 25 million women in America that meet guidelines for hereditary cancer test. Very few are getting it, and we're trying to reach those patients through imaging centers, through mammograms when they come in for that, through our partnerships with LifePoint Health and SimonMed. Our women's health, as you saw last quarter, grew MyRisk 19% year-over-year.
So we are delivering on this growth. This isn't sort of aspirational. It is happening. And then on the affected side, where we gave up a lot of share over the years, we've been winning back wallet share and winning back customers that we lost to some of our competitors by not doing stupid things, by you know, really aligning ourselves with genetic counselors and earning back the trust of people that we are really there for the patients first. There, we see guidelines and use cases expanding as we came out of San Antonio Breast, hearing more adoption opportunities. And recently, 4 January , ASCO released new guidelines for breast cancer screening for hereditary cancer. We think NCCN will follow.
So the idea that hereditary cancer is mature and that rates are commoditizing, we have proven otherwise, and we see tremendous growth in this part of our core franchise. So 19% growth in volumes over the last 12 months, and as I said, continue to see opportunities for growth here. Similarly, GeneSight, you know, when I got here, people said, you know, written GeneSight off for dead. This is an incredibly important tool for clinicians and particularly in primary care, people dealing with a mental health crisis, America on the front lines. So we're seeing, like, approximately 4,000 new prescribers a quarter ordering GeneSight. We're continuing to build the body of clinical evidence to support it, and we continue to make progress on the payer coverage side, although, admittedly, that's been, you know, some slow going in some regards.
We'll talk about the United Contract in a little bit. So really excited about the progress in GeneSight. 24% growth in volumes this year after a big year last year as well. Again, you know, this is an underappreciated growth engine for the company, and we see a lot of opportunity to improve payer coverage and improve ASPs here in 2024 for GeneSight. After some coding transitions and some issues with Carelon and some intermediaries that we worked through in Q2 and you saw in Q3, kind of turn around for us. Prolaris, at the point of biopsy, a really important prognostic tool to help guide treatment decisions for patients with prostate cancer. Again, an underappreciated asset in a competitive space for sure, but growing 15%, really high margins.
This is a very high-margin test, and that should improve even more in 2024. We just secured coverage by UnitedHealthcare here beginning 1 January . As we look at the future, we know this is a place where we've underinvested in the, in the body of clinical evidence, so we are on our way to publishing more data to support level one coverage, and we're working towards a post-RP launch of Prolaris, hopefully by 2025. So excited about the prospects for growth for Prolaris. Okay, pause and talk about women's health and prenatal and carrier screening. By far, the most accurate test in the marketplace, I can say that with a great deal of confidence. When you think about-...
Women, persons who of non-Eastern European descent, so people of all ancestries, when we think about people with high BMIs, these are tests where many of the other tests in the market fail, and we have a incredibly high accuracy rate. S0 both for Prequel and Foresight, we'll talk about the growth here. We see a lot of runway in these tests, and principally driven by the quality of those tests, our turnaround times, and the changing view in the marketplace of our ability to deliver that value proposition to OB-GYNs. 10% growth, I think you'll see this quarter that we bested this number by a lot. We had a very strong quarter in prenatal, and no, we did not pick up business that Natera cast aside, so that did not happen.
We've been pretty focused qualitatively and qualitatively on the business that we've been getting, and we did not improve ASPs this year in prenatal by taking poor business on. So this is good, organic growth that we've delivered, wallet share, and new customers. And again, there's been a lot of dislocation in the women's health space, and we've been there for those providers, and continue to be. So great excitement about our prenatal offering and the growth that we see here. All of this, I'll shift gears for a second, those are our core products, has been driven by really very disciplined work on our operations and the KPIs that drive them. We started this transformation with 27% turnover of the company. People did not want to work at Myriad Genetics. Their hearts were not in it.
There were a lot of loyal people, but turnover is 9%. You cannot run labs, and you cannot run commercial sales forces when you're turning over people at 27%. Great places to work. 86% of our teammates believe that Myriad Genetics is a place they want to be, where they are comfortable putting their license on the wall. Not surprisingly, that's driven a complete change in perception. We did a lot of perception work with Edelman and Bain when we started this transformation plan, and a net promoter score, for those of you that know net promoter scores, of 69 is really a very strong score. So we've done a great deal of progress in changing the perceptions in the marketplace by even genetic counselors who were really, since that Supreme Court case, were really soured by many of our business practices.
Not surprisingly, good people focused on quality and engaged customers have been driving growth and productivity increases. So we measure turnaround times. We look at our COGS per test, so even in the inflationary environment that we've had, we've reduced our cost per test. And sales productivity, as I think I mentioned before, we've seen, you know, 20% improvement in sales force productivity and the growth that we talked about, the high-teen growth, with 15% fewer salespeople than when we started. And that's because of the digital tools that I mentioned and, and talked about. So a lot of focus on rev cycle. You've probably heard that from some of our peers in the marketplace. This is not new. It's something we, we started focusing on at the beginning of this transformation journey. $08 million of out-of-period collections.
You know, in the quarters, there are some ups and downs with payers and stuff, but overall, this year, year to date, you know, positive $6-$7 million of out-of-period collections, $58 million over the last few years. DSOs are 54 days. I know it's trite, but we think DSOs matter, and, you know, many of our competitors are at 70-80 days in receivables, and I don't know how the auditors think about that, but, you know, to us, we really focus on conversion rates of DSOs. And we have more opportunity here. As I mentioned, we see opportunities in rev cycle prior auth going forward, so a focus of the company. So the next two slides, I'm not going to try to, you know, kill you going through. Please look at them, and we're happy to talk about them offline.
But we wanted to give you a sense of the roadmaps that we've had in terms of the infrastructure investments and the progress that we are making. So whether it's moving to new sequencing technologies, we are now moved into our new labs of the future, both in Salt Lake, our 220,000 sq ft production facility and support center, as well as here in South San Francisco, our innovation center and launchpad, if you will, for new products. We continue to move our products to these new labs, continue to move to new sequencing, and we're also in the process of moving to the automation that was founded here in the South San Francisco lab, so the robots that some of you may have seen in our website.
And so that automation, we've put 2 of those robots on trucks. They are now in South San Francisco being stood up, and we're I mean, in Salt Lake and starting to work through the validation process there. And as I mentioned before, a lot of investment in technology. When you think about the pipes to work with big hospital systems and physician groups, it's Epic, it's Athena, and Flatiron. So we'll do 1,000 EMR integrations this year to get closer to our customers and make it easier to order, to make it easier for us to get prior auth, and make it easier for us to report outcomes on a timely basis. Similarly, we brought a lot of discipline to our product roadmap strategy.
So we now, and kind of crazy that we were a products company that didn't have product management capabilities, but we now look at every product, we look at the market intelligence. We look at reimbursement, we look at what our customers are asking for and needing, and so each of our products has a path to get to full potential. And that means the user experience, the clinical validation, the clinical utility, as well as the tools to do that. And so really excited about the progress we're making, getting all of our products to full potential. And I'll talk about the new products here in a second. And here we go. So pretty active pipeline. We talked about the growth in our core, but in women's health, we are excited to launch FirstGene later this year.
That'll be after the launch of Foresight Universal Plus here in this quarter. That is essentially a bigger panel, 234 genes in advance of ACOG guideline expansion, which we think will happen this spring. I'll just mention that 22q is in our model. It's an opt-in if a provider wants it, so if it becomes part of guidelines, that's an easy switch to flip. We have a different view than others about whether it'll be included in guidelines, but if it is, we're, we will be there. So Foresight Universal Plus is a big product enhancement that we're going to be going to market with here in this quarter, and that will be followed by FirstGene, hopefully in a soft launch in Q3 and a full commercial launch in Q4.
We'll talk about the oncology offerings here in a minute, but really, it's Precise Tumor that we launched last year in partnership with Intermountain. That partnership and the form of that partnership continues to advance as we improve that product offering, and we expect to launch Precise Liquid later this year as well. Obviously, a lot of discussion around MRD, and I got a couple of slides and updates for you in terms of MRD. So FirstGene, you know, really what the problem we're trying to solve with FirstGene is access, ease of use, and the power of FirstGene and it won't be for everybody. There'll still be genetic counselors that want Foresight.
But for most OBGYN and offices where you can get a solution to NIPS and carrier screening with just a maternal blood draw, we are not trying to get dad to come in to do a blood draw. That's going to be an ease of use thing that we think will be differentiated. It'll also come with better reimbursement and a higher margin profile. So we think this is going to be a really great add to our women's health portfolio and really improve access and care for many populations that aren't getting carrier screening today, where utilization is pretty low because of the friction in the process. In oncology, we really are working to build out a portfolio from MyRisk in terms of high-risk screening to MRD. So I've mentioned Prolaris and expansion of Prolaris.
We're also working on expanding myChoice CDx, our FDA-approved companion diagnostic for ovarian to other indications like breast and prostate. The work is ongoing for that. We expect to hopefully be able to do that in 2025 and 2026. More near term, as I said, adding Precise Liquid to the Precise Tumor portfolio. MRD, which there's a lot of excitement about, a great patient opportunity and, obviously, a great opportunity for our business as well. We'll talk about that. A couple of points of differentiation here. Our MRD assay is being built on our proprietary franchise. These are up and running in our labs, not sourced out, technologies that have been built over many, many years.
So the IP related to this and, and the chemistry and, and the proprietary workflows on this whole genome assay are differentiated from some of the other assays that are in controversy in the marketplace. So we are quite confident in our freedom to operate, our ability to continue to move MRD forward, and we believe when we come to market, and we'll be doing research samples, we'll talk about the studies here in a minute, but we'll be doing research samples for pharma later this year. We think when we come to market, we're going to have a highly sensitive test, and sensitivity is going to matter. Sensitivity is going to matter if you want to withhold treatment or increase treatment. And so it's not going to matter for all cancers, but for many cancers, it's going to matter.
The other thing that we are quite confident in is we have the commercial franchise to go to market with this. We do not have to build a commercial franchise to do this. Just a footnote, we're not adding one salesperson in the company in 2024. We believe we can keep growing with the teams that we have. And you see, you know, a first cut of the margin profile that we see. So we believe we can run this very sensitive test, this deeper test with 1,000 sites, in a cost-effective way and in a way that we see the path to reimbursement, like we've been able to be successfully done in across our portfolio. So a little bit of validation. Memorial Sloan Kettering, MD Anderson are helping lead our studies.
These are obviously really great institutions and excited about the readouts that we anticipate there. So far, all the work's been progressing really well, and as you can see from the note, a highly sensitive test is something that many clinicians are looking for when they think about MRD, and when they think about clinical utility, not just clinical validation in these tests. Okay, I'll take a quick breath. We'll get through the financials, and then we'll, I think we'll still have plenty of time for Q&A. So, a good update for you guys in terms of the progress, and for those listening online, again, please take a look at the 8-K that we'll file.
But we believe, we expect to report earnings at the high end of our guidance in terms of revenue, approximately $196 million-$197 million of revenue, and we will be profitable this quarter. We expect EPS to be $0.02-$0.03. That's where we, we expect to land the quarter, and, you know, pretty confident that that's, you know, the results that we will have. I think the fact that we are profitable-- Again, this is on an adjusted EPS basis, just to be 100% clear. But still, our path to profitability is not, you know, is clear. We are here, and we're gonna build on this in the year. Be mindful that Q1 is always an expensive quarter. 70% of our costs are people.
You've got HSA, health insurance costs, you've got a number of different things, and volume gets affected by co-pays and deductibles and physician behaviors in offices in terms of patients going in. So Q1 is definitely a softer quarter, will not be profitable, but we expect 2024 to be a profitable year for us. We lost $0.19 in Q1 last year. We are not gonna lose $0.19 in Q1 of this year. So we'll be giving full guidance probably, and when we release earnings at the end of February, and we'll probably give quarterly guidance as well. But we're off to a great start for the year and pretty proud of the finish. We've given long-term guidance, if you will, long-term targets. Last five quarters, we've achieved the revenue target.
We've maintained the 70% gross margins target. We continue to run OpEx growth at around 5%-6%, so we believe these are achievable targets over the next few years, and they do not include any of the new product launches. We are quite confident, and Rachel asked a question about, "Is 10% sort of the baseline?" The answer is yes, we are aspiring for 12 or more. Our preliminary midpoint of our guidance is $825 million for next year for the revenue, and you know, we certainly are targeting to do better than that. All of the pieces in terms of our P&L are in place to continue to perform at that level. We've also cleaned up the balance sheet, gotten a lot of externalities, legacy litigation out of the way.
In this, in this prior quarter, we had a very successful equity offering. We raised about $117 million. We've got an ABL facility that will continue to expand. It's about $115 million today. It'll expand further as the year progresses under the covenants. So quite confident for a company that is making money and will, will, generate free cash flow in 2025 and essentially cover most of our CapEx needs this year, that we're in a great position in terms of liquidity and, and our balance sheet. So again, a lot of work this year from the team and everyone to position the company going into 2024, and a very different company for those of you that may have been following the company before.
So, again, just to wrap up and to get into Q&A, Rachel, we're just excited about our ability to make the plus sign bigger on the revenue side, and we have a clear path to do that. We're really excited about the pipeline of new products accelerating growth beyond 2024 into 2025, and really kinda love where the P&L is and the balance sheet is going into the year. So...
Perfect. Awesome. That was helpful. Thank you, Paul. So first up, I just wanted to dig into the guidance that you reiterated for the year of 10%-11%. So can you maybe walk through the fourth quarter, and how did that play out relative to your expectations in terms of volume growth, ASP trends? And then, were there any other variables that would have influenced those four Q results?
Yeah. I'm not gonna break out the different pieces, but the volume, you know, is essentially coming in as we have seen through the year. Prenatal was a little bit stronger, hereditary was a little bit softer, but ASP was a little stronger across the portfolio as we continue to make progress there. So, you know, with all the different pieces, we're quite confident with the different levers that we can land at the 10%+, that we can land at 10% or 12%, quite frankly, as we're targeting. And we've got a lot of opportunities to continue to improve gross margins. You know, Sam is leading an effort in terms of supply chain. He obviously brings a lot of experience from Illumina and Allergan in that regard.
So I would say that, you know, the 10% number is a high confidence number, and we hope to do better.
Got it. That's helpful. Then how should we think about some of those trends kind of playing out into 2024 in the context of some of your long-term targets as well?
So, you know, the way I think about it is if you look at all of our volume, if we are growing volume at 15%, you know, across the portfolio, and we've always talked about a 3%-5% ASP compression because of... You know, ASP is a function of contracted pricing, but a bigger function of rev cycle prior auth than those pieces. We've talked a little bit about that. So this year, in 2023, we were on sort of the tougher end of that, closer to 5%-6% pricing compression because of the Carelon changes and some of the coding changes. But as we think about 2024, we hope to work our way to the 3%.
It's, you know, as simple as just sort of saying, I know the models are more complicated, but the way I would suggest you check yourself, people think about it is, if we're going volume across the enterprise 15% and you've got 3% pricing compression, you're landing at the 12% that we hope to get to.
So that's helpful. Then maybe just stepping back, I wanted to ask, you know, you've been the CEO now since August of 2020. Myriad, as you mentioned-
It seems like a decade.
I know, right? Myriad has been really viewed as a turnaround story. So can you kind of walk us through how has that transformation of the company gone relative to your expectations? And then what inning are we in on the turnaround process? Is there still more work to do on that front?
Look, the work is never done, right? But the turnaround is done. You know, we've got 5 quarters under our belt of growth, where people thought, you know, we were written off for dead. We've re-energized our innovation. We've got new products. The commercial team is humming. We've made a lot of the investments in lab and technology that we need to make. You know, now we need to take the car out for a spin and really see what it can do. But there's always more work to be done. There's 1,000 EMRs that we need to do with Athena and Epic to really, you know, grease the wheels and stuff. And we've got a lot of work still to do in playing catch-up on clinical validation. You know, we've been transparent about that.
But, we had a really good base, and we kind of stopped investing in that, and now, you know, we're replenishing that, that part of it. But really excited about MRD and FirstGene accelerating growth beyond 2024. I mean, those are really great opportunities for us.
Got it. That's helpful. Then maybe just shifting to that long-term target that you have laid out at your recent Analyst Day. You talked a bit about the top line already, so I want to focus on the gross margin profile. That long-term gross margin target is 70%+ in 2026. You're already pretty close to that right now. So, you know, how should we think about gross margin? Is there a point where you kind of hit a ceiling on the gross margin profile, and then what levers are there still really left to pull on gross margins?
Yeah. Well, I think our job is to set reasonable expectations and exceed them. So, you know, the plus, hopefully, the plus sign gets better on the revenue and the gross margin side. There's a lot of levers here. You know, as we're moving into the new labs and revisiting workflows and redundancies and process, I mean, we've been so focused on quality and making sure that we're really accurate with our tests, but sometimes we're rerunning tests unnecessarily. And automation and process improvement help with that. Look, maintaining 70% gross margins in the inflationary environment that we've had the last couple of years has not been easy. You know, wage rates went up a lot, you know, 10%, 12%, and so we've done that through a number of different efficiencies.
But we're pretty excited about the opportunities to do better than that 70%. But that's not nothing. You know, wage rates will go up 4%. Health insurance is going to go up 7% this year. Supply chain costs will come down because we're gonna, you know, we're gonna squeeze them down. But, yeah, I think we're, I think we're going to work hard to beat that 70%, and I'd, I'd say we have 150-200 basis points of opportunity there.
Okay, got it. That's really helpful. Then maybe shifting over to oncology and that portfolio on that side of things, can you just walk us through where do you think your market share is for hereditary cancer testing right now, just given some, you know, competitor exits and things like that from smaller players? And where do you think that market share could really go?
Yeah. So I think there's a couple of things playing out there. One is I think the market is growing more than people think, that adoption is growing, coming out of the pandemic and as people become more aware of the use cases. And as I've talked about, the unaffected side is really a lot of white space, and we don't have a lot of competition there at all in terms of the unaffected side. In imaging and hospital systems, you know, in that piece, even in urology and stuff. On the affected side, we lost a lot of share when we broke, you know, faith with people, and we've been earning that back. We've been earning wallet share back from some of our competitors that have had some issues.
I think it's not just the names that everybody kind of knows top of mind. A lot of the small players are struggling. A lot of people that brought community-based hospitals and, you know, physician groups that brought hereditary cancer and other products in-house, they can't do the variant interpretation on the back end. They can't bill and collect. And so we are seeing people kind of throw in the towel on that, and so we believe we'll continue to see market share gains both on the unaffected and affected side.
Got it. That's helpful. Then maybe shifting over to MRD. Just from a competitive standpoint, during the Analyst Day, you had called out that Precise uses whole genome sequencing versus whole exome, like many peers do. So is this something that customers are asking for, and why should the market be excited about this? And then does this increase in sensitivity outweigh the increased cost, theoretically, in MRD as well?
I think that's the right question, but as we've tried to point to today, our path to having a sensitive test that is also cost-effective... You know, we're standing this up in our labs. We're standing this up in, you know, on an X Plus machine. We are building the systems and processes. It's built on the, you know, the companion diagnostic CDx technology of myChoice, FDA approved. It's built on the circulating DNA technology that is Precise. So from workflows to... We just think we have an eye towards bringing this in at a COGS that we can deliver a higher sensitive test and still be cost-effective.
Now, it won't be necessary for all cancer types to have that sensitivity, but from what we hear from pharma, what we hear from MD Anderson and Memorial Sloan Kettering, you know, people would like to have that higher sensitivity test.
Got it.
We're going to want it if it's somebody we care and love about before we withhold treatment, right? So-
Perfect. Maybe shifting over to the women's health franchise then, can you just spend a minute talking about what are your expectations on ACOG guidelines, expansions for carrier screening, 22q testing? And then, as an aside, how are you thinking about your market share in the NIPT sector, just given, again, the amount of exits that we've seen across competitors?
Yeah. I mean, I think, I think you will see very strong growth this quarter in prenatal, you know, and that's, that's continued to build. That's market share gains as well as, you know, the market's expanded, moving, you know, to average risk. We see similar dynamics playing out. We, we are excited and hopeful that the ACOG's expands guidelines in the spring. It's not in our model for 2024, by the way, so none of this, you know, stuff is, is we're banking on. But those guideline expansions will improve ASP and, and broader adoption. So we do think that's an opportunity. And as I mentioned, 22q, if that makes it into guidelines, it's an easy to flip the switch to make that part of the, the panel.
Got it. Okay, that's helpful. Then maybe shifting over to GeneSight. You've been one of the players that have been a bit more bullish on some of these state biomarker bills than others in this space. So should we think of, you know, could these bills have an impact on GeneSight? And then can maybe you walk us through those expectations and what contribution that could have to Myriad?
Yeah, this is part of a long-term, you know, revenue cycle payer coverage game, right? It is a long term, but you have to be excited when the American Cancer Institute has driven, you know, 15 states, including New York, I think yesterday, to adopt these biomarker laws, California, even Texas. And so what that does is it enables our payer markets team and our government relations team to work with state insurance commissioners, put more pressures on the GCs of the plans. And in 11 of those 14... well, 12 of those 14 states, 'cause I think New York State, you know, I think there's a strong case that GeneSight should be included.
We've already seen in a couple of states, you know, $2 million of rev for GeneSight, where that adoption is translated into a commercial contract. Blue Cross Blue Shield of Rhode Island, for example, not a big state, but we're, you know, we're on our way in Ohio, we're on our way in Arizona and a couple other places, so.
Got it. That's helpful. Then maybe in the last minute or so here, just on closing remarks, Paul, could you kind of share with us, what do you think investors are misunderstanding about the Myriad story?
You know, someone described it to me yesterday that and that's why I've tried to, you know, tailor my remarks a little bit about the old Myriad and the new Myriad. I think there's some PTSD with investors, you know, and I think that, you know, rightly, people wanted more consistency and clarity. And again, I think the last five quarters points to that. I think this year points to that. I think when you look at the overhangs this year, we were very deliberate on getting Ravgen behind us, the shareholder derivative action, the capital structure. I've gone through the list of my favorite shareholders and, you know, knocked them out one by one. And what you saw in our equity offer is some really high-quality people come in and double down, and we're excited about that.
And so it is hard for me to see the discount, quite frankly, it's kind of frustrating.
Mm-hmm.
But, you know, I've been doing this for a long time and play long ball, so we're quite confident that the market's going to see, hopefully you will see, right, the opportunity here that we have to grow and expand multiple and create shareholder and patient value, so.
Perfect. With that, unfortunately, we are out of time.
Yeah.
Thank you so much.
No, it's been great.
... for joining us today.
No, thank you. Appreciate it.
Thank you, everyone in the room os well.
Thoughtful question. Thanks, everyone.