Okay, good morning, everybody, and welcome to the Myriad Genetics Investor Event here in New York City. Nice to be back in town.
My name is Matt Scalo. I head up investor relations for the company. And with me today are a number of executives. We're going to talk about current and future growth drivers for the company here. But anytime you talk about the future, I certainly need to call out this slide here. There are risks and uncertainties that are highlighted in our SEC filings. Certainly would point you to the 10-K, 10-Q for a more detailed list on that side. And with that, I've got the pleasure of introducing our President and CEO, Paul Diaz.
Matt?
Good morning, everyone. Thank you for your attendance here. We've got a nice group in person, so we are respectful of your time and do appreciate you coming today. And for those of you participating online equally, we're excited to share with you, as Matt said, the progress that we're making. And really, today is a lot about the future and the exciting things we have going forward. It's funny, I missed to not comment on our offering. And I want to thank the investors here who supported us through that and had the confidence in this management team. Say that we've delivered on those commitments, and we're going to continue to deliver on those commitments because that's what you count on us for, doing what we say we're going to do.
I think coming out today, hopefully, you'll have increased confidence in our ability to continue to deliver on those commitments for both our patients, really all our constituents, and obviously our shareholders. We're quite proud of that, quite frankly, when I think about $17 and where we are today. Got my teammates here today, but we are backed up by 2,700 other people in the company, and we'll talk about their engagement and how they've sort of made this all possible. I'd be remiss to not call out Sam Raha, our new Chief Operating Officer, who really, in only a year, has really taken the company to new levels of operational excellence. Excited for him to share that and how he has really helped continue to drive the culture and the mission of the organization. Similarly, Scott Leffler has been just a great add to our team.
You guys know Dale. He'll speak a little bit later. And I'm going to do my best impression of Mark Verratti because, unfortunately, Mark Verratti has COVID, and he is upstairs in his hotel room. So I'll ask for a great deal of patience in his section as I try to tap dance through his section. Also with us today is Jennifer Fox, our new General Counsel, who just in four or five weeks has just been a great sounding board to me and Sam and Scott, and really excited about her role as a strategic leader, not just a General Counsel, speaking as another reformed lawyer. And some other folks, I think, quickly to call out Dr. George Daneker, who led our Science Day a couple of weeks ago in San Francisco. Crazy, having an oncologist, well-respected, leading our oncology practice seemed like a pretty good idea.
Coming out of ASCO and ESMO and other places, you can just see the increased connectivity with physicians that he has brought to the organization. More team adds coming, but we've got the core team together now, and people have really come together in a great way. Quite proud of that. We're going to talk a lot about growth and innovation today. Certainly going to talk about those things that continue to propel our success in the near term. We do really focus on mission.
We really do focus on the opportunity to advance the incredible science that's happening in our industry, but do it in a way that fits within the rest of the healthcare ecosystem and, quite frankly, the day-to-day lives of our patients and the day-to-day lives of the providers that we help serve, which is difficult and complicated whenever you talk to an OB-GYN or oncologist. We're also quite proud that all of our tests are geared to not just people of Eastern European descent, so part of our mission here is to reach all patients where they live. Coming out of the pandemic, how they receive healthcare has changed, and so you'll hear a lot today about our reach, our mission, and how we're trying to really evolve in so many different ways and keep up with the changes in our healthcare system.
So some of you may be new to the Myriad Genetics story. Some of you may know the Myriad Genetics that was six or seven or ten years ago. And I would hold out to you that the company has changed quite a bit. We're still very much anchored on the great science that goes back 30 years, over 1,000 publications, the IP that we'll talk about today, and the breadth that we have commercially, over 50,000 prescribing practitioners in the market, and the trust that we've continued to gain with our teammates as well as the community. And trust is something we're going to talk about, particularly given dislocation in our industry that we think is paramount to growth and innovation. Quite proud of the 72 Net Promoter Score. For those of you that understand Net Promoter Scores, that is really high. Anything above 50 is a great number.
That's based on providers, payers, patients, and how they view us. And that's also driven by the fact that 84% of our teammates voted us the best place to work. So these are things that underpin so much of what we do and really underpin the 13% growth that we've seen year to date. We'll talk about a little bit this quarter and the coming quarters, but continue to see a sustainable path to continue to grow as we've articulated beyond 12% over the next few years. And hopefully, we'll give you guys more data points to support that. Not unimportant is our industry-leading margins of 70%+ that we're going to continue to build on, a balance sheet with plenty of liquidity to continue to pursue strategic options, but a judicious use of that equity raise from last year.
I hope those investors who came in, some of you are in the crowd, see that. We're going to talk about innovation today. One of the things that I think that we have failed to highlight to a great extent is the innovation that's happening day to day in our current portfolio. We have quite a diverse portfolio of products. Most are hitting and succeeding. Some have required additional investment. We're going to talk about how we get all our products to their full potential in terms of their clinical utility adoption. When you think about the durability and the sustainability of our targeted 12% growth, that has to come from hereditary cancer. That has to come from prenatal. But it also means that we need to keep those products relevant and continue to advance their clinical utility.
So we're going to spend a little bit more time talking about the significant investments we've made in those products today, in addition to the new product launches. Just quickly, again, one of the things that the board charged me with, and we got a few board members here today, thank you guys for coming as well, is that the company was really not centered on how do we exist in the broader healthcare ecosystem, and there are changes happening and new dynamics in healthcare that I think we have to lean into. Certainly that while the change is slow, we are moving to a more patient-centered and value-based arrangement, so increasingly, we're having discussions with payers, not only about clinical utility, but how do we and our diagnostics help solve the total cost of care problem? How do we continue to solve access?
important role that genomics increasingly can play in medicine and advancing care, and we'll talk about that today, and obviously benefiting from the rapid acceleration of automation. We'll talk about AI today. Sam will speak to that and our labs of the future, but also the sequencing platforms that we are investing in, and you'll see a great deal out of that in Sam's presentation. We're really leaning into those things, and lastly a big tailwind for our sector, quite frankly, is that science is advancing new therapies. I was just talking with one of our friends here in the audience today, and that is fueling demand for more diagnostics and more therapy selection products to help guide treatment decisions, and so you're going to see, particularly in oncology, our efforts to elevate and lean into that opportunity, and then lastly there is a lot of disruption in this marketplace.
We see ourselves as beneficiaries of that, given the trust that we have developed with patients and providers. I won't spend a lot of time on the portfolio right now, other than to say that, as I mentioned before, we continue to invest across this portfolio. Sorry, the page stuck. It's a teeny note. But we see continued opportunities here to invest in our oncology, women's health, and our pharmacogenomics business. I'll go into each of those kind of quickly. The thing that I would underscore here, though, before I leave this slide, is this gives us multiple levers to grow in established channels. We are not just a hereditary cancer company. We're the best hereditary cancer company. But we have multiple ways to grow. You're seeing that year to date in our numbers.
You've seen that really emerge over the last couple of years. While, again, we and our industry have advanced quite a bit, there's a lot more work to do to enhance these products, to support adoption, support clinical utility, advance reimbursement, and position us for future growth. Excited, again, we'll talk more about the new pipeline here in a minute. The context for that is a very large and fragmented market. Most of our attention as investors in this room and as providers, we focus on our other immediate competitors. There are 33,000 LDTs out there, part of the reason the FDA is so concerned about regulating them. So a lot of the business is dispersed.
And at a time when health systems and others are looking to standardize processes, increasingly, I think you're going to see more market share consolidation across the larger players who can invest in the kinds of things that Sam is going to talk about. I want to really highlight hereditary cancer, both for affected and unaffected. There's just a misunderstanding about the opportunity here. The use cases for hereditary cancer are growing. Guidelines are expanding. And particularly for unaffected men and women, we'll focus more on women today. Hereditary cancer testing is an important part of the care journey. And so we're going to spend a little bit more time there. But I think you're going to see that in multiple use cases and in multiple settings, this primary driver of our profitability has a lot of runway still. And we're continuing to enhance this product in those different channels.
And so we're going to speak to that. Similarly, in pharmacogenomics, we've got a lot of opportunity here. Our GeneSight product continues to excel. We'll go into the additional share growth that we're getting. And particularly, we're going to highlight the ASP improvement that we see continuing over the next couple of years. And in prenatal, where we probably have our most mature products, you're still going to see a commitment to product enhancements. And there, we really have seen the market dislocation of last year result in market share gains and growth. And things like moving to average risk of expanded guidelines are things that I think and we believe can propel us to future gains in these areas.
So I would just ask you to think about when you're trying to anchor on our goal of 12% growth, this is where the opportunity starts from, an underpenetrated, fractured marketplace in a place where we have the products and the depth and channel to win. So speak specifically to oncology. And again, we're going to cover this in other places. But to enhance MyRisk, which is already our market-leading product, we're going to be expanding the gene panel next year and continuing to build the evidence case. We've already seen guidelines expand for breast cancer, an area of focus for us. One of the things that we're seeing increased demand for is the pairing. So we'll talk about the pairing of our products, and particularly the pairing of Precise Tumor and in the future, Precise Liquid with MyRisk.
Similarly, we see this in the urology channel and oncology channel for pairing Prolaris with MyRisk. This is happening with respect to MyChoice as well. I'll talk about that in a minute. But it is that pairing and the productivity that comes from that that can really not only propel growth, but profitable growth. We'll talk about MyChoice a little bit, our market-leading HRD. It's limited only to ovarian, to a small panel, to a small indication. But we are working quickly to expand that indication to breast and prostate and have a line of sight of doing that in Japan, a very successful market for us, as well as here in the U.S. We'll have more information of that in the future. I won't steal Dale's thunder. He's going to talk about MRD.
I would just underscore that despite a lot of the hype here, we are really in the early days of MRD and quite confident to be a fast follower with a much more sensitive product. And we'll talk about why that matters for patients. But I hear. Sam hears. Dale hears. We just had a group of physicians, our medical affairs board. While a lot of people are ordering MRD tests today, most folks don't know what to do with it. They are not making changes with treatment selection. They are not de-escalating care. And they are not cutting back on the other diagnostics they do to care for patients. So we're not quite over the rainbow here on MRD yet, but believe that the industry has a great opportunity, that MRD has a great opportunity.
But we need to advance the clinical utility, how it's going to work in clinic, and why payers should pay for it. And then lastly, you're going to hear more for us on our emerging biopharma business. We did not have a particularly good year this year after a pretty successful last year. It's a little bit lumpy, that business. But coming out of ASCO and coming out of ESMO, we've got a pretty exciting pipeline of biopharma contracts that really should start benefiting us early next year. And we are soon going to be announcing some new leadership there that we think can help propel and grow this business in a much more material way. In women's health, again, I talked about the market share disruption. So I won't go into this in a lot of detail. We're really starting to see that come through.
I shared with many investors that it takes time. So providers get anxious when they start seeing turnaround times delay, or they start seeing their new provider change billing practices. They get worried. They get nervous about access. They get nervous about affordability to their patients. But it takes time for them to make the switch. And we're really starting to see that happen across our portfolio, particularly in women's health, where we're also exploring new channels, as I mentioned before. You'll hear Dale talk about the expansion of our products. Foresight Universal Plus was already launched. We do expect guidelines expansion either later this year or early next year. That goalpost keeps getting moved. But we are ready. And we are excited. And we're already seeing expansion of coverage. Just last week, Cigna picked up coverage of Foresight Universal Plus.
Already, even ahead of guidelines, we're getting more and more payers to see that they need to expand coverage for expanded carrier screening. And we believe that there's more opportunity for that. And you're going to see that this quarter in our ASP. Similarly, for Prequel, really excited about moving to eight weeks gestational. And we'll talk about that. But in a time where women are really struggling to get the decisions they need around their reproductive rights, being able to have answers at eight weeks versus 10 weeks is really going to matter. Similarly, we've talked about before, but if 22q is included in guidelines, it will be available in the Prequel test immediately after guidelines are issued. And Dale's going to talk about one of the things that we're most excited about, which is the launch of FirstGene, our combined all-in-one.
Remember, 50% of patients are not getting a carrier screening because they can't get dad to come in for a blood draw, and FirstGene solves that problem and has great characteristics for both patients and margins for the company as we think forward, so in pharmacogenomics, just continue to help to solve the crisis that is mental health in America. More than 4,000 new prescribers every quarter. Adoption is getting deeper in terms of getting more docs and nurse practitioners to order multiple GeneSight tests, but I just want to underscore, GeneSight is a tool for addressing mental health. It is not a panacea. What it does is get patients on the right drug faster, and for anybody who's got a family member that struggled with mental health, that makes a difference.
Because as soon as you get a patient on the right drug and the right dosage, without the weight gain, without all the mood swings, then therapy can actually matter. Then the rest of the treatment can actually affect the care of those patients. And we're excited that there's an increased interest in other indications because there are a significant amount of medication administration issues out in America today and in the world. So we are starting to more aggressively explore what are those other medication administration issues where we can extend GeneSight or a GeneSight-like pharmacogenomic product in the future. A lot of what you'll hear from the rest of the team is about how we are anchored to what our customers expect from us. Clinical utility and validity, breadth of offering, turnaround times, ease of use.
These drive our four pillars of science, elevating the customer experience, enabling everything we do with technology, and scaling growth to profitability, an important one that I think that we'll talk about here as I wrap up and hand the mic over. It's been quite a journey for us. Those of you that have been riding along, we appreciate your support. We are a very different company than we were five or six years ago. And we've really done, quite frankly, and I know that there's a lot of progress from our respected peers in the industry, but nobody else has innovated, grown organically, and reached profitability the way that we have. And so to the extent that that matters to the investment community, I would tell you that there's a lot to think about when you think about an investment in Myriad Genetics.
So this is the path that we've been on. But today is really about the future. So I'm going to hand it over to Sam. Thank you. Oh, how could I forget? You can come up anyway. Yeah. This morning, we gave you a little sneak peek, no pun intended, to Q3. So we think we're going to land Q3 at around 210-212. That's despite some soft volumes in July and August. We saw a return to sort of that seasonality again. Great ASP performance as we've continued to work on that. We're reaffirming our 2024 guidance. Obviously, have great confidence in that. And again, hope that was helpful coming into today to help us focus on the future and not wring our hands about Q3 so much. So with that, I'll turn it over to Sam. Thank you, Sam.
Thank you, Paul. Good morning, everyone.
Great to see you all. Thank you very much for making time to join us at our Investor Day. Now, I'm a little bit more of a walker. I try to make eye contact, see if you can look up from your keyboard so don't mind me as I go back and forth across the stage. I joined Myriad to be part of a company that's directly impacting patient lives and 10 months into it, I'm really moved by how palpable the patient-centric mission is across the entire company. I'm also equally excited about the very methodical approach, structured approach we're taking, not only to delivering on our financial and business objectives for 2024.
Paul gave you a sense of Q3 just a moment ago, but as well as the work that we're putting in, which I'll take you through to really lay the foundation for sustained profitable growth the years to come. Now, when you think about Myriad, hereditary cancer testing remains a cornerstone of who we are. Now, without a doubt, MyRisk is gold standard in the industry. But I'd submit to you that we are more than just your mother's Myriad. What I mean by that is we are more than the company that's just about hereditary cancer testing. Paul's already talked a little bit about the portfolio. You hear more about it, and today, everything we do, driving our strategy going forward, every initiative, every work that we do is really guided by a deep understanding of what matters most to our customers.
When I say customers, I'm talking about providers. I'm talking about healthcare systems. I'm talking about patients. Now, Myriad is often associated with quality, with great science. And those things remain important to us. But along with that, in a very deliberate way, we're focusing our efforts on the things that you see here, from the comprehensiveness of having the right menu, the right offerings for our providers, turnaround time, ease of use, affordability. And we have been investing in a very deliberate way to improve these matters. We're starting to see the results, in part helping propel our results for the last several quarters. And also, as evidence you see on the right-hand side, by the perception of Myriad, you can call it a measure of our brand across providers and the market, the positive perception of Myriad.
Now, along with the growing portfolio of clinically relevant and compelling products that you'll hear Dale talk more about in a moment, we are focused on driving profitable growth by strengthening our foundational capabilities and really focusing on operational excellence and scale. And we're doing that to improve how we're able to serve patients, providers, and health systems, be more efficient in processing patient samples, and also improve reimbursement. Over the last three years, we've invested over $75 million along the lines of state-of-the-art labs, standards-based technologies, digital capabilities. And we're starting to see productivity gains in multiple parts of the company. Now, this includes two of them: customer service productivity increased by 28%, and across lab operations, a productivity gain of 18%.
Now, going forward, we're going to continue investing in strengthening our capabilities in a very deliberate and disciplined way to ensure that we can deliver further productivity gains in a predictable way. So let me start by talking about our digital architecture, which is a backbone capability that we've already invested a lot in and will continue to do so in the coming years. And what you see on this slide, you could see the patient-provider journey all the way from how they learn about our products to how they order our products, get that information back in reports, and how we provide them support.
An illustration on this slide of some of the areas where we have invested and worked on our digital improvements and capabilities, all the way from revamping Myriad.com, if you will, the starting point for many to learn about our products, to get educated, to the state-of-the-art digital report for MyRisk, patient support that comes after that, newly designed, easy-to-use portals for both patients and providers to interface with us, once again, all the way from ordering all the way through to report delivery. We've also been working internally to become more efficient. Some of the areas here include improving our CRM to better understand and be able to target and engage our customers, and a multi-year program called Unified Order Management. I'll talk more about that in a moment, but it's going to really enable us to serve customers even better.
On this slide, some of the illustrations of how the work we're doing on digital capability enhancements are already making a difference and adding value for our customers. I've spoken about Myriad.com. If you haven't, please take a look. It's much easier to navigate, understand where to go, learn information, also from the persona of, if you're a patient, a provider, an investor coming in to engage with Myriad, to expert genetic counselors. We have quite a number of genetic counselors with deep expertise that are available at the fingertips for our providers and for our patients, both as they look to learn about which tests are relevant and appropriate for them to the information that comes out.
A major theme that is clear to us, and as evidenced, we were talking to, at Science Day, all the healthcare providers that are there, genetics is still pretty intimidating for a lot of docs. Being able to support them with genetic counselors and digital assets, both before and after they're engaging with a patient, they find to be very valuable. I'll talk more about EMR in a moment. We have a lot of work and a lot of focus that's happening there. I was talking about the Unified Order Management system that we're working on on the prior slide.
The efforts there are going to result in our being able to help a practice, a provider, to really understand in an intuitive way where we are in processing their orders, delivering their results, and really being able to support them across all the portfolio products that they order from us, from oncology to women's health to mental health. Let me double-click on EMR. One of the areas that we have invested a lot in, we'll continue to, I think this really is making a difference for the ease of use, the way we're engaging with our customers, as well as really a huge force for driving additional volume going forward. Now, increasingly, what we're finding is that our customers, what they really want is to integrate genomic and genetic information into the practice and the care of their patients.
To really be able to do that, to make it easy, what's important is that our tests are orderable and the reports are viewable natively in the EMR systems that they're using. Over the last three years, we've more than doubled the investment that we put into this space, all the way from engineering, integration, customer pull-through enablement. We're seeing an eightfold increase in the number of actual sites, provider sites that we're able to bring on board. This year, we're on track to add and integrate, if you will, 4,000 additional sites into the EMRs of choice. Now, we have business relationships with over a dozen of the EMR vendors in this space. We have strategic partnerships with the leading providers. That includes our ability to work with Athena, work with Epic for women's health, with Flatiron for oncology, for Lumea, for urology.
As we look at the first half of next year, of 2025, we're also going to bring on board two other important systems, particularly for oncology, iKnowMed and Elekta. And that's going to enable, for the first time, for our healthcare providers and systems to be able to order the continuum of our oncology products. And again, that's the germline testing, the hereditary testing we're known for, as well as therapy selection and ultimately MRD when we bring that to market. We're also going to bring aboard thousands of more sites in 2025. Let me pivot now and talk about another important program that we've been working on for a number of years and that we're making great progress on called Lab of the Future.
And again, the objective here is to really drive innovation and operational excellence, all with the intention of delivering high-quality results, reducing costs, reducing turnaround time. And we are making great progress. Just to take you through some of the highlights for those of you that have been tracking this program for the last couple of years. All the buildouts related to the new labs in both South San Francisco and Salt Lake City are complete. We're making great progress on now the moves, the revalidation that needs to be done as products are moved across new labs. All the regulatory permitting approvals that are needed are all tracking. And in fact, volume for oncology products that have transferred are starting to ramp in Salt Lake City. Volumes for our products, for prenatal products, excuse me, are ramping in South San Francisco.
We're on track by early 2025 to have completed that phase for prenatal products in South San Francisco and by year-end for everything related to oncology. Let me also point out along the way, as you might recall at the beginning of the year, we acquired assets from Intermountain Precision Genomics. And this is what's given us the exciting ability for Precise Tumor, which allows us to offer a therapy selection product, a test for the market. Happy to say the integration of that into our Salt Lake City site is also progressing on plan. And you can see at the bottom of the slide some of the impact that we're confident in as a result of this phase of work in Lab of the Future, which includes more than 40% reduction in our annual lease costs, as well as taking our capacity.
This year, to give you a sense of it, we're going to process and report on about 1.6 million patients. With the additional capacity Lab of the Future, we're going to be able to process more than 3 million samples annually. Now, operational excellence at scale, all the way from taking orders in to delivering the results, is a competitive differentiator for Myriad. It's something that's key to delivering our objectives or increasing access for patients, as well as for really delivering sustained profitability growth, growing our margins to 70% and being able to do that and beyond. I'll tell you, though, we've already seen productivity gains as a consequence of the work we've done at Lab of the Future.
I see a lot of new opportunity ahead over the years to come, looking very deliberately at every step of this process, all the way from when a sample comes in, accessioning, sample preparation, processing, informatics, all of that, looking at it methodically, all with the eye, again, delivering high-quality results, faster turnarounds, lower costs, and our focus here is in three or four things. One, it's about process optimization for each of the steps and collectively across sites and products. It's about increasing the robotic automation that we have in sample preparation, in sample processing, a number of opportunities there. It's about using AI, which I'll talk a little bit more about in a moment, all the way from in-process QC to curation to variant calling.
And finally, it's also about continuing to be aware of and leveraging new technologies that allow us to push further on what we're able to do. Speaking of which, now, while we use a lot of different technologies, genetic analysis, which is really reading the code, if you will, or reading the nucleic acid of a patient, is the most important technology that we use. We use quantitative PCR. We use mass spectrometry. But without a doubt, the most important technology is next-generation sequencing or NGS. Now, we're confident in the fleet of Illumina instruments that we have. But that being said, we're interested in learning and understanding the innovations and advancements that are happening in the field all around us.
What we do is very deliberate with Dale and his team working across the company to work with Illumina in partnership, also with others, including Ultima and PacBio, to really understand what are the advances to NGS. When I say NGS, it is instruments, it is workflows, it is consumables, informatics, all with the goal, with the aim of really driving, again, those very important parameters for us, driving down costs, reducing turnaround times, and actually even giving us more resolution power to do powerful science. In fact, some of the examples of that you will hear from Dale related to MRD and FirstGene. There is a lot of room to go. An important theme that I want to convey is we do not have to do everything at Myriad.
We have a lot of great things going on, but leveraging partnerships, particularly where there's a lot of investment going in by these companies and using that to our benefit and also bringing value to them because our deep clinical experience and the volume of samples we process, I think, is a mutually beneficial path for us. Let me turn now to talk about artificial intelligence, AI, and this is something that we've already been leveraging within the company for some time. Now, three categories that let me take you through where we're doing work. One, related to our products. Now, along with the deep scientific expertise and experience that we have, we're using our knowledge and understanding of machine learning together with these genetic databases, genetic information databases that we have to really develop differentiated, clinically differentiated products.
Examples of this include RiskScore, which really provides diagnostic testing across many ethnicities, includes the core HRD algorithm that we use in the MyChoice test that Paul talked about that we're excited about expanding applications and indications for. It's also part of truly differentiated high-resolution variant calling as we're applying in MRD. We're also using, moving to the middle column, standard platforms that are state-of-the-art. Once again, technology partnerships, some of the companies mentioned here on the bottom of the slide, to increase workforce productivity. This is all the way from authoring code to being able to develop content for the inside and for customers, as well as being able to better serve our customers through the customer service work that we do.
Now, we're also using AI already extensively related to automation of many steps of our work, all the way from. I was talking about labs of the future. We're using AI related to our LIMS, related to our robotics. We're also seeing a number of opportunities we're working on. I'll go a little deeper on the next slide related to revenue cycle and other internal processes. So let me illustrate. Now, based on the value that we're already seeing of AI and the confidence that we have that it can actually provide value both to our customers and internally, we'll continue to work here and actually increase our focus. Two specific examples. We have developed an AI-driven tool, if you will, called the MyGeneHistory. And this is a system that, AI-aided, enables patients to directly input their information into the system.
The AI enables more prompted prompts to the patients to be more comprehensive in what they're entering. It also allows providers who are connected through their EMRs to better understand and accelerate how quickly they can qualify a patient to be eligible for screening and diagnostic testing. I was in Texas last week visiting with a number of leading healthcare systems and providers, and they are truly excited about the possibility of leveraging the MyGeneHistory enabled by AI to accelerate bringing more patients into testing and thereby remembering in cancer every day matters. Being able to get them into the programs earlier, detect, and put them on the right course of treatment is really going to make an impact. Another area where AI is already making a difference, you'll hear Scott talk more about it in a little bit, is related to our revenue cycle.
All the way from using information we have in various places in our system, assisted by AI to, in a more timely and complete way, be able to submit prior authorization forms to really taking some of the very mundane, repetitive tasks that are done as part of submissions of claims to payers. These are ways that we are seeing efficiency gains and benefits by using AI. So let me conclude by, again, reaffirming our excitement and our commitment to strengthening our core capabilities, leveraging operational excellence to really deliver sustained profitable growth. Once again, this is based on maintaining a real understanding of what's most important to our customers, all the way from developing our products, enhancing our portfolio to improving the experience. Along the way, we're using our capabilities to support margin expansion in a very deliberate way. Something that I didn't talk about, I'll take a moment here.
One of the things we've started to do and we're already seeing good return from is taking a strategic approach to managing our supply chain of all the procurement spend that we have over $200 million. There's a methodical approach both in how we do that and how we structure that, working with our leading suppliers to manage costs more effectively. Again, going back to the narrative here, we see the opportunity increase operational efficiency by leveraging technology partners, and EMR is an example of that. Sequencing platform providers is another example of that. Now, along with all of this work related to strengthening our capabilities, the enhancements that we have, the portfolio that we're expanding, you're going to hear more about. I am absolutely confident in our ability to grow in the coming years, 12%+ on the revenue side.
It also gives me great confidence to be able to retain our gross margins in 70% and beyond in support of expanding our earnings per share, our EPS. And equally importantly, it gives me the confidence based on the portfolio, again, and the work that we're doing to be able to deliver sustained profitable growth in a predictable and durable way. So thank you for your time. And with that, let me turn it back to Paul playing the part of Mark, talk about our product portfolio, as well as our commercial strategy.
Thanks, Sam.
Yeah, thank you. So I'll be around a little bit here since I'm not Mark Verratti, but I'll do my best. First, a shout-out to Mark. I hope you're feeling better. I'm sure he's in bed upstairs listening online and probably will send me text messages of how I screwed up here.
But Mark and the team have just done an incredible job, and so we'll talk about some of that. One of the things I want to encourage you to do, there's a lot of content in our materials today. That was purposeful. We have heard from many of you the importance of having something to go back and reference to. So if your schedule's permitted, time permitted, go back because we're not going to hit everything. But we did work pretty hard to give you, and particularly those new to Myriad Genetics or those coming back to Myriad Genetics, a fuller view of really how much is going on in the enterprise. A lot of progress in our commercial group. Those of you that might remember, we had 37% turnover in the sales force. It's down to nine. Pretty hard to grow without the engagement of the team.
That's in the context, quite frankly, of physicians and health systems, really, the consolidation trend continues. That consolidation trend will continue to have those folks look for more reliable partners for advanced diagnostics at scale. Those partners that can invest in the EMR, invest in all the capabilities that Sam talked about. Our growth right now and the big contracts that we've signed, and we talked about this at our last earnings calls, three systems are really fundamentally based on trust and reputation. Now that we have the capabilities to reach them with those 4,000 EMR integrations. The other thing that we hear more and more about, and again, I want to underscore, one of the big leverages for us in prenatal and oncology is the comprehensive set of offerings. Because these docs do not want to send tissue samples to two different labs.
They do not want to wait and get one report on Tuesday and another report on Friday. They want an ease of use, and they want any discordance in the studies resolved for them, and that is something we've been able to do with GeneSight and MyRisk that we're bringing to the rest of the portfolio, so again, a great deal of work on this customer experience that is really driving the commercial team. In addition, we've brought a lot more science to how we go to market commercially. We're leveraging Salesforce like we never have before, using market intelligence data to really target customers, using inside sales for smaller customers, and you can see the leverage that we're getting out of this commercial team. We have almost 14% decrease in headcount while we've achieved a 68% increase in revenue per commercial team member.
And this is because of the digital tools that we've invested in, the discipline around measurement and reporting, and that's benefiting average sales price. I said on the last earnings call, we are giving up some volume of no pay to drive revenue and being much more thoughtful, protecting access to patients for sure across any payers, but making sure that our commercial teams are fully aligned and their commissions are fully aligned with revenue, not just how many tests we run. So a great deal of progress in Mark and his team. Going forward, there are really sort of four drivers accelerating the integrations that we talked about, driving deeper depth in these accounts. So the pair testing, we call it doubles and triples. But every time that we're in an OB/GYN office and can sell Prequel, Foresight, and MyRisk, that's a tremendous amount of leverage.
Increasingly, I'll talk about, I mentioned this before, increasingly, oncologists want to pair MyRisk with Precise Tumor. So we see Precise Tumor as being, it's small right now, but it's going to be a mighty part of growing our tumor-informed business. And increasingly, we're focused on large accounts, right? So while we have a lot of community oncologists we work with, distributed, the real opportunity for acceleration of growth is this national accounts team and how we're going to market with that team. And lastly, again, we've talked about this across the product channels, guideline expansion, more adoption, and better reimbursement coverage we are seeing across almost all of our products right now. So this idea of commoditization, particularly in hereditary cancer, declining ASP, it's just wrong. And we've shown that over the last three years.
Yeah, we've talked about pharmacogenomics, a $2 billion market opportunity, continued double-digit growth of 16% for GeneSight, and again, as I said before, it solves a very unique problem. How do we get patients on the right drugs faster, and again, lots of other drug issues out there that we're going to be talking about, so just really proud of the GeneSight team that is now a profitable business unit. Our pharmacogenomics business makes money. It was not making money four years ago. In women's health, again, I've touched upon this, but you can come back and look at some of these slides. This is where we really have seen the most acceleration of growth, 28% year-over-year revenue growth, combination of reaching more customers, more wallet share, and yes, beginning to sign new customer business, and we think that's going to accelerate.
I remind you that when dislocation happens in the marketplace, it takes time for customers to look at new competitors. And certainly in the case of Labcorp and Invitae and other market disruptions, Sema4, etc., we are really starting to land some new customers. And I think you'll see that over the next couple of quarters as well. Prenatal care, growing adoption we saw over the last two years because of the move to average risk. I've talked about the enhancements to Foresight, the enhancements to prenatal, already market-leading tests in terms of accuracy and low failure rates, and even more powerful tests when we talk about expanded carrier screening, the opportunities there not only for more adoption and volume growth, but also reimbursement growth.
And again, some near-term expansion of coverage even today as some reluctant payers who have not wanted to cover expanded carrier screen are starting to cover expanded carrier screen, and we've had some recent wins there. And as I mentioned, 22q, eight weeks gestational, these are big. These are big reasons for our sales force to go into physician offices and talk about the differentiating nature of our prenatal products. I'm not sure we're going to be able to continue to grow at 37%, but that's certainly what we're striving for. I think we're out of order a little bit here. So we've talked about women's health, we've talked about prenatal care. Oh, here we go. So other big opportunity in the women's health channel and in other channels.
The increasing adoption and association of preventative screening, particularly for breast cancer that I'll talk about in a minute, but also for men and their risk for hereditary cancers, so MyRisk is the gold standard today. It is widely respected with everybody, as Sam mentioned, we talked to, but even there, we are adding additional genes to the panel. We're adding more flexibility to the panel. We've had tough conversations with some folks who want 37 different flavors of our hereditary cancer product. We can't do that. We won't do that because that's not the actionable genes that people need, but we are trying to increase flexibility as we enhance our infrastructure as well. MyRisk with RiskScore. RiskScore is a differentiated add to MyRisk. If you order a MyRisk test, you can get RiskScore, and interesting, nine posters at NSGC, the National Society of Genetic Counselors this year on RiskScore.
And just even over the course of the year, a greater interest and adoption in MyRisk and PRS testing that we've seen. So great growth in the women's health channel of MyRisk across a number of different channels. But where is the bigger opportunity? And it's great that we're sitting here today during Breast Cancer Awareness Month because we have launched a pretty aggressive program to partner with health systems and other outpatient providers and integrated delivery systems on our breast cancer risk assessment program. And again, the key here is MyRisk combined with RiskScore gives women a comprehensive risk assessment and a five-year lifetime risk. So this combines what the FDA recently talked about of the risk around women with breast density, our risk model and RiskScore, and the fact that MyRisk will identify 11 different cancer risks for patients.
So more than 50% of the time, our patients that do MyRisk with RiskScore will require medical management change. And sadly, I have a friend whose daughter has stage four breast cancer. That should never have happened. Fortunately, given what we do, we were able to get her into the City of Hope and get her on a treatment program. But this is a young woman with two toddlers that should absolutely have had this identified earlier. So there are real-world examples and a lot of discussion today, just even in the last few weeks around the need to do much more breast cancer screening. And for those with a family history, MyRisk with RiskScore is an important tool in terms of that. So this is just a little bit about the program.
Again, this is another way that we think we're going to propel the 12% growth we've committed to: is expanding in this unaffected channel for men and women. It's only 10% penetrated, and quite frankly, it's the only place. We're the only ones really playing here in an aggressive way, so we see a lot of white space for growth. All right, I'm going to just talk about oncology pretty quickly. Again, our focus that Dr. Daneker and the team have brought to our growth in oncology, we've got more work to do here. Again, MyRisk is our anchor product, but we see a lot of opportunity in other areas as we roll out our new tests. Understanding the community and oncologists is critical. 83% of patients are diagnosed in the community.
Now, sometimes they may go into an NCCN institution, but even when they do that, 50% of the care they receive is happening in the community. That's the playing field that we are in. That's where our MyRisk, and as I'll talk about in a minute, our treatment selection diagnostics are going to play a bigger and bigger role for our growth. And yes, we're aspiring to 12% growth, but that's not really our long-term aspiration. We think our new products and the leverage we have about bringing these comprehensive offerings can grow us beyond 12% when you think about 2027, 2028, and beyond. So this is a complicated slide, but one worth staring at later.
What this helps illustrate is that early in terms of screening, the role that MyRisk with RiskScore can play, the role that MyRisk plays for affected patients in terms of treatment selection, and the other products that we're bringing to market, including Precise Tumor and in the future, Precise MRD, and the role they play from early detection to treatment and even post-surgery, what happens in terms of monitoring, progression, and surveillance. And Dale will do a much better job talking about that. But this is where we're going in oncology. Understanding is the first thing I asked Dr. Daneker to do. Let's develop an oncology strategy that is grounded on where patients are in their journey and how physicians treat them along that journey. So we can have the three or four diagnostic tools to help those patients in that process.
Accelerating winning back share in hereditary cancer in oncology, this is where we lived for many years and where we gave up share. And so we are starting to win back this customer group, genetic counselors, oncologists, as we continue to differentiate the experience that oncologists have with us. So we believe we can continue to grow on this 15% number. Okay, this is where we've underperformed this year. All right? So portfolio theory is about how it all works together. But let us come clean here. MyChoice has underperformed as we had a lot of disruptions in Europe and as AstraZeneca decentralized the product and they were asking us to do satellite labs all over Europe. Imagine having to do a lab in Belgium, France, Germany. That just made no sense. Where MyChoice continues to do great is in Japan. And it's only with the indication of ovarian.
So as I mentioned before, MyChoice is a gold standard. We're going to build that product for tumor, for excuse me, for prostate and breast. And we're going to expand MyChoice for prostate and breast in the near future for Japan, a huge market where we've been very successful. Prolaris, kind of growth there has been flat. It's very profitable, but we are doing a lot to increase the guidance, the guidelines there to NCCN 1, to level one. We're doing a lot in the experience. We're working on some AI opportunities in pathology. So we've got work to do here to reposition and reset the opportunity. But the big driver of future growth here is Precise Tumor and the pairing of Precise Tumor with our other products. So more to come here. But again, despite our success this quarter and despite our success here today, we've underperformed here.
Again, as I mentioned, our biopharma business has been a little lumpy. We think that will pick up next year, again, given the contracts we've signed here recently. Again, what we see in the commercial team that Mark has led is a highly energized team, a much more focused team, and with a more enhanced core set of products to go out and grow, and the ability to get those doubles and triples that we talked about, and we pay them for that, as well as removing the friction that Sam talked about with our customers and the rest of their experience. A lot of great stuff happening in the commercial team and a lot of reasons for you to have confidence in that 12% growth number that we've put out there for you and profitable growth to boot.
Dale, our featured speaker, because you don't want to hear from me anymore.
Thank you, Paul. Thanks, everyone, for being with us here this morning. So I want to talk about what really gets us out of bed in the morning at Myriad and R&D and our guiding light. And it really is the problems that our patients face and what our providers face. So our patients very often are not treated by specialists. They receive care that is often not up to guideline standards, and many of them come from diverse populations. What those individuals need is really accessible, excellent testing that is equitable and meets guidelines. Again, most of them are not getting that today. That is something we solve too. Our providers often are seeing more than 20 patients in a day. They don't have hours to have a deep genetic conversation with their patients.
They have to get through the patients quickly. They need to often administer not just one test, but multiple genetic tests to those patients. And to boot, they're often not experts in genetics. So that makes this all really, really hard. And what they need is an aggregated, simplified delivery of genetic insights. And so what we do in R&D is really bring ingenuity and practicality to addressing these problems. Sometimes it's more one than the other, and I'll talk about that on a subsequent slide, but really by merging together innovation and being practical, that allows us to deliver tests that have high utility, that are simple, accessible, and equitable. So I'm going to sort of thread this through the other content that I'm going to cover. So you'll see that here. I'm going to focus on our Precise Oncology Solutions and some of our women's health products.
So in Precise Oncology Solutions, starting with the Precise Tumor solid test itself, this is a great example of practicality. From ingenuity in the past with MyRisk that makes it the gold standard of hereditary cancer testing, we needed to couple that with a leading somatic test offering. That's what Precise Tumor is. We've in-house that into our laboratories and are seeing increased uptake. We are similarly pursuing our Precise Liquid offering that will be very comparable to the tumor offering. It can be used in a reflex capacity, and then ultimately, we expect as a first-line test as well. Where we are really dedicating a lot of our ingenuity, however, is in the Precise MRD direction. I'll talk more about that on subsequent slides, but the RUO version of that test is operating right now in the new facility in Salt Lake City that Sam mentioned.
On the women's health side, ingenuity at Myriad more than a decade ago really brought expanded carrier screening to the world. We are now in that sort of more practical stage of making sure that it is meeting guidelines. And so we recently added genes to the test. It is now 60% bigger than it was, and it is very well positioned for what we expect will be favorable guidelines from ACOG to be announced soon. I'll talk a little bit more about Prequel on a subsequent slide. As Paul mentioned, we're moving that to earlier gestational age, and that has high impact. Where, again, we focus a lot of our ingenuity, however, in the women's health space is on FirstGene, which I will cover as well in a subsequent slide. So first on those two prenatal existing products for Foresight, as I said, we just grew the panel.
We have seen increased utilization and good reception of that larger panel, and again, should help us when guidelines expand, excuse me, to have higher ASP for that offering. Let me talk for a minute about the earlier gestational age testing and Prequel. You can think about non-invasive prenatal screening as a liquid biopsy of the placenta. So you're looking for genetic anomalies that are present in placental tissue, and the size of the placenta matters. The bigger it is, sort of the easier the test is to do, the smaller it is, the harder the test is to do. When you move earlier in gestation, the placenta is smaller. When you go from 10 weeks, where nearly everyone is today, that's where almost every laboratory offers non-invasive prenatal screening, the placenta is a certain size. When you go from 10- 8, it's about half as big.
That makes it about twice as hard. Prequel, and here at Myriad, we have this Amplify technology as part of Prequel, where we are the only lab to do this, where we are able to increase the fetal fraction of DNA. So of the DNA we look at, we can basically double with a proprietary technology the amount of DNA. And so that means that when we go from 10 down to eight and the placenta is smaller, our Amplify technology effectively doubles it back up again. So Prequel at eight weeks will be as good as other laboratories at 10 weeks, but also those laboratories will not be able to move down to eight and match us in performance. So it is a differentiated offering. It is important for patients because it gets them those results more quickly.
It helps them get to the point where they can schedule and pursue diagnostic testing earlier to confirm their non-invasive prenatal screening results, and that has huge impact in the world we are today. I want to move now to FirstGene, so this test addresses multiple pretty big challenges in the prenatal space. Some of those are, as I said on the first slide, providers don't have enough time to be talking about prenatal genetics, and as a result, a lot of patients don't get genetic offerings, so about 50% of women today do not get carrier screening at all, not even just expanded carrier screening, but literally any carrier screening. Similarly, and this one keeps me up at night, when mothers are identified as being carriers for disease, 30% of the time fathers get screened, 70% of the time they don't.
There's an enormous amount of risk that is basically not captured by current testing modalities. Next, these tests are also, as you all know, as well as I do, generally lower margin tests. Our solution to this set of challenges is the FirstGene test. It merges together into a single molecular assay, non-invasive prenatal screening, carrier screening on the mother. It then can also, and this is really novel, look at the fetal recessive status without screening the father. It also looks at blood compatibility between the mother and the fetus. This makes it far easier for providers to administer. Again, you do not need the father as part of this testing. Because it is a single one run through the lab with multiple insights that we are delivering, it ultimately we expect has a higher gross margin than the existing products.
In terms of its performance, it's really excellent. So this is a summary of data from a nearly 600-sample validation study that is complete. As you can see, it is basically in line with leading non-invasive prenatal screening and carrier screening. The performance on recessive status has not been seen before for this type of test. That is fantastic performance. And it also performs, as we've seen so far, perfectly on detecting blood compatibility between the mother and the fetus. Some key highlights, though. This test is built. We were recently at NSGC, where we presented four analytical validation posters. We have submitted the manuscript about this to peer review. We have submitted our New York State validation of this test.
We are moving toward a first half next year pre-launch of the test into a study where we will be gathering clinical validity and clinical utility data on more than 4,000 patients who will be getting this testing, getting results. We'll be talking to their providers. This evidence generation really is what will help propel the product forward even more strongly. I want to pivot now to MRD. As a sort of entree into that, I want to share a quote from one of our collaborators, Memorial Sloan Kettering down the road here. He said that we anticipate the MRD test from Myriad will be more sensitive and specific than many other ctDNA offerings. It may more accurately identify the patients who will or will not benefit from certain therapies. Some of these patients may go undetected on a less sensitive test.
I happen to agree with him, and I want to talk you through why. Our test, for those who are not familiar with it yet, it is a tumor-informed MRD. We start by profiling with whole genome sequencing the tumor and normal tissues. We then identify somatic variants, off of which we create a custom panel. That custom panel has 1,000 sites in it. Because we are looking at the genome and literally the totality of DNA, we can identify well more than 1,000 sites, and we pick the best 1,000 to track. This is in contrast to most of the existing MRD offerings, which look at the exome. The exome is 1% of the genome. Therefore, they have far fewer sites to select from, and they select far fewer of them.
They typically track about 16 sites, whereas, again, we'll be looking at 1,000. The way to think about this is that just gives us much, much more cell-free DNA to be looking at and many, many more opportunities to identify tumor-derived pieces of DNA. The number of sites matters. We see 60-fold more of them because we are looking at so much more genomic territory. That ultimately gives you a more sensitive test. Really, a key thing that we've optimized in our laboratory is the ability to do this sustainably with good margin. Part of this is that we're building upon core competencies that we already have. We have been running, I'll describe, our MyChoice test for many, many years in Salt Lake City. We're very, very good at pathology and tissue processing. We've been doing whole genome sequencing for years.
That's the core part of the first part of the assay. The second part that's more plasma-based off of the liquid biopsy sample, it's very, very similar to the FirstGene product that I talked about. We have a lot of expertise with cell-free DNA. So we put these things together, and we can run it affordably at scale. I want to now take you through some of the performance. So we have characterized this test very deeply. We are running this on samples today in our laboratory. In a validation study, we characterize the limit of detection of the assay. So this looks at if you had a million cell-free DNA molecules, how many of them are tumor-derived? How low can you go, basically? And what you can see here is we can literally go below five parts per million and still have high sensitivity with the assay.
That is in line with one other laboratory in the space that runs, takes a similar approach, but it is far lower, and remember, lower is good than many, many of the other laboratories in MRD today that are looking at the exome with fewer sites and just have a less sensitive offering, and so let's just take a minute to look more deeply at why does this sensitivity matter? Not just why, but where, so what you're seeing in the plot on the right are a bunch of squiggles. Let's unpack the squiggles. Each black dot there is a patient with cancer who got profiled, and you can see the different cancer types. Let's focus just on the colorectal sort of vertical third from the right. Each black dot in that squiggle is a patient.
You can see on the y-axis the number of sites that are tumor-specific mutations. So in colorectal cancer, some patients have up to 25,000 or 30,000 variants in just their exome. They've got an enormous number of mutations across their DNA. Whereas at the low end of that colorectal distribution, like about the lowest patient still has about 30 sites that differ in the tumor genome versus the normal genome. So if you're building a test with 16 sites, you can do really well in colorectal cancer by looking at the exome. Similarly, in lung cancer and bladder cancer. Note that these are the areas where you typically have seen these first-generation MRD assays perform. But now let's move to the left side of the plot. This is now ovarian cancer, prostate cancer, breast cancer, pancreatic cancer. There are many that I don't have shown here as well.
These cancers have far fewer variants in the genome. Let's focus on breast cancer. Even the top parts of the dots only have 300 variants in the exome. The average breast cancer sample has about 30 in the exome, and that means that 50% of people with breast cancer in the exome have far fewer than 30 sites. What this means is that those first-generation assays will have a much higher failure rate. They'll be much less performant in a really critical cancer. However, those exact same samples, if you now look at the number of sites in the genome, in breast cancer, the average person has 3,000 variants in the genome. For our test, we're looking at 1,000. We get to select the best ones from that and make a far more sensitive assay in a very, very challenging cancer.
So ultimately, what this does is gives patients a lower failure rate and the providers a lower failure rate, more confident results, and more tissues and more sort of space available to us in the market. So some of the progress that we've made, and I think we've shared a lot of this, but I want to reinforce it here. We've strengthened our intellectual property portfolio in MRD. So we have announced this year three patents that have filing dates back to 2016, but were recently granted. We entered a cross-license agreement with Personalis related to this tumor-informed method of MRD. We have established research collaborations with some of the leading centers in the world, including MD Anderson, Memorial Sloan Kettering, and excellent collaborators at National Cancer Center Hospital East in Japan.
We are expanding, as I'll get to in a second, the studies that we are doing for this test, and we are in final contracting stages with a major cancer center that we will announce soon for a strategic alliance to drive development in MRD. Here's a quick overview of the studies that we are pursuing. Mainly, I just want to stress is that the study types are variable. We are looking at, we're doing prospective studies, retrospective studies, investigator-initiated, Myriad-sponsored. There's some diversity here. Key highlights. This is just things already contracted. We have more than 4,000 patients who are getting this test from Precise MRD. This is across more than 30,000 time points. Again, each patient will often have multiple draws. So 4,000 patients, 30,000 time points across more than seven indications, and this list grows every day as we aim to increase the evidence of our test.
Some of the milestones that I want to draw your attention to in 2024, like just there's almost things we've already accomplished. It is available for research use currently today in partnership with typically academic collaborators. We continue to strengthen our IP portfolio. We are already partnering on retrospective clinical validity studies. We have begun several prospective clinical validity studies. We are scaling our lab operations in Salt Lake City to be able to run this at scale. Next year, a key area of focus for us is to make Precise MRD available to biopharma partners. We will submit validity studies that are going to read out here shortly. We will submit those published data to CMS for reimbursement, commence clinical utility studies. Paul talked a lot about that.
Again, this is early days for MRD, but we want to be at the forefront of characterizing its clinical utility, and we want to continue to scale our lab operations, so the target is a commercial launch in 2026 with breast cancer as the first indication, and again, we really expect to have, as I showed you on the previous slide, excellent performance in breast cancer. This is a low-shedding tumor. It does not have a lot of variants. It is ideally suited to our assay. And when you're thinking about a patient who might be undergoing a care where they are going to de-escalate off of chemotherapy, you want an extremely sensitive assay to be able to say that it is okay to stop taking chemo.
The reverse of that, you want a very sensitive assay to be able to tell you when you need to restart taking chemo or other systemic therapies. So that is underlying our aim there. To finish up here, we have a lot of evidence generation going on at Myriad, not just in MRD. So we have more than 40 active studies right now across the portfolio. Year to date, we have published more than 25 journal articles and had more than 50 conference presentations. Some of the highlights are at the right there. And finally, one thing that I think is also important, we really are increasing our engagement with the provider and academic community such that it is not just Myriad driving a lot of these studies, but it's really the broader community. So we have created to that end the Myriad Collaborative Research Registry.
This thing is actually quite awesome in literally all meanings of the word. There are more than 1.1 million patient results that are de-identified, all compliant, posted into the registry. These have all of the intake, all of the materials reported, and it's across multiple different tests. We've had multiple people from academia, now like many, many of them, register to look at the registry. We are getting abstracts now that are coming from these investigators. And really, the people who are logging in, it's kind of a mind-blowing amount of data, like aggregated across decades at Myriad Genetics. So it's a wonderful resource. So excellent. Well, with that, I'm going to pass it to Scott.
Thanks, Dale. And good morning, everybody.
I'd like to start out by echoing some of the comments that Paul made leading things off here, which is that as excited as we all are to be presenting here today and conveying our optimism and excitement over the company's long-term prospects, it is equally exciting to see the engagement and interest that we have from the investor community, and looking out over the number of faces that we have in this room and knowing how many we have online, it is truly an exciting prospect to be able to deliver all of this information, including our outlook from a financial standpoint, and to know that this is a launching point here today for continued engagement with investors who intend to accompany our story and hopefully invest with the company.
With that, I'm going to jump into a look at the financial outcome from so many of the business drivers that you've been hearing about this morning. Of course, you heard from Paul and Dale and Sam about the many investments that have been going on in terms of our operational infrastructure, our commercial capabilities, and our product development. These are investments that have been going on and that are ongoing. We're at a very special inflection point right now as a company where many of those investments are actually yielding increasing levels of traction that you see in the overall performance of the company, whether it's our top-line momentum or our bottom-line performance, as we'll get into during the coming slides.
We wanted to start out before we talk about the long-term targets, just to make sure that we are anchored in terms of the momentum of the company as we see it today, and when you hear about so many of those investments that Sam and Dale and Paul were detailing earlier, it's important, I think, to take a step back and recognize how those investments translate to improvements in the provider and patient experience that then drive the type of volume growth and revenue growth that we're seeing today, and a great example of that is the operational investments that Sam and his team have made in improved turnaround times, where this is a clearly identified sensitive point for our stakeholders in terms of the providers and patients that they serve.
And the improvements that we have yielded in turnaround time improve the provider and patient experience and have a direct impact on order flow from those impacted stakeholders. So that example, or the many other investments and initiatives that you've heard about today, contribute to what you see on the screen here right now, which is that our trailing 12-month revenue growth has improved materially since the beginning of last year from low to mid-single-digit trailing 12-month revenue growth at the beginning of 2024 to where we are today, which is on a trailing 12-month basis as of Q2, delivering 15% trailing 12-month year-over-year revenue growth.
And there is obviously a lot that goes into that in terms of individual product performance, but we're seeing it across the portfolio led by revenue growth in terms of GeneSight and hereditary cancer testing performance and overall with a bullish outlook that helps to feed the longer-term projections that we're going to be talking about more right now. Against the backdrop, of course, of an evolving competitive landscape where increasingly there is pressure on the irrational players in the marketplace, creating more and more opportunity for companies like Myriad that have based their business model on sustainable business practices that providers now are increasingly sensitive to, knowing that their provider will be here tomorrow or that their service provider will be here tomorrow and the next day and the day after that.
And clearly, we are in that category based on the sustainability of the business practices that we have employed. Taking that momentum that we have on the revenue front and doing a slightly deeper dive, we announced recently an international restructuring that included the divestiture of our European EndoPredict business. That's important, I think, in terms of not just the overall accomplishment as far as continuing to optimize and reposition our portfolio to focus our efforts on the areas where we see the most opportunity for profitable growth, but in particular in terms of appreciating the strength of our starting point as we look at our long-term projections and long-term targets.
When you take our 15% revenue growth, which is the consolidated revenue growth that we reported for Q2, and parse it out between our domestic revenue compared to our international revenue performance, you see that our revenue on a domestic basis was even stronger than that 15%. We delivered 20% year-over-year revenue growth for the second quarter, and that growth in our core market was diluted by a weaker performance, 21% decline in revenue growth for the rest of the world, which gives us even more comfort regarding the strength of our core portfolio where we are here in the year and what it means as a jumping-off point for what we can do going forward.
Now, you've been hearing from us all year, not just about the overall strength in our revenue trajectory, but in terms of the drivers of that strength, the increasingly optimistic view we have around the ASP or average revenue per test environment, and this is an area that historically has been one, especially for those that have followed the company over a multi-year period. You would recall that in the past, we have expressed that we viewed ASP trends as a headwind for the company that we would overcome with elevated levels of volume growth. We have even specifically cited in the past that we expected in any given year a revenue headwind of 3%-5% from downward pressure on things like contracting rates and other challenges in the revenue cycle environment.
What we have seen this year, the fruits of a number of years of investment now that are finally gaining traction against the backdrop of an improving and evolving competitive landscape, is that we now are increasingly comfortable that we can actually hold the line in terms of our overall ASP or average revenue per test performance. And that view totally changes the model for us in terms of what we think we can deliver in terms of long-term revenue growth and is an important part of the increasing level of conviction that we have around being able to deliver on 12% plus long-term revenue growth. And when we think about the drivers of the improvement in our average revenue per test environment, we can divide it into two broad buckets. One bucket would be internal to Myriad, and the second bucket would be external to Myriad.
When you think about internal to Myriad, there are so many different initiatives that have been underway that continue to gain traction. Sam mentioned a couple of them earlier, but for example, we've talked about enterprise-wide initiatives around unified order management and EMR integration, which have far-reaching implications for us as a company in terms of enabling our commercial success, but they also have important ramifications in terms of our revenue cycle process. It is streamlining the revenue cycle process with more dividends to come in the future as we ramp up those investments, remove risk of human error, and accelerate our ability to monetize billings. Similarly, we have continued to make investments in our revenue cycle team, and that includes, for example, focusing on our prior authorization capabilities where we have staffed up where it was appropriate to do so in terms of frontline prior auth teams.
But we've also invested in cutting-edge technology, including robotic process automation that helps to automate repetitive tasks to streamline the prior auth process and, again, make sure that we're removing or mitigating risk of human error in that process. Those are just a few examples of a large bucket of investments that we're making in terms of frontline tactical revenue cycle improvements. That is complemented by investments that we've made internally on a more strategic level where we have invested in our payer markets team and their capabilities, and they are engaging now at a higher level than they've ever engaged before with payers on matters relating to contracting and coverage. We have been speaking all year long about win after win after win in terms of obtaining coverage determinations with different payers relating to different products. I'll get into a few examples of that on the subsequent slide.
No one of those is going to transform the P&L, but every single one of those, the singles, doubles, and triples is accumulating now and adding an increasing level of momentum and, for us, an increasing level of comfort and confidence that we can hold the line overall and perhaps even add to our revenue growth based on the opportunity that we see out there from a rough cycle standpoint, and I'm sure you all recall that both a pain point and an opportunity for us is our 44% no-pay rate. We've already seen an improvement so far this year of a couple of percentage points in that no-pay rate, but that is a tremendous market opportunity for us to continue to drive the P&L forward. It will not happen overnight, but the accumulation of these various singles, doubles, and triples continues to give us positive momentum.
And again, I'll get into a few examples of those when we get into the subsequent slide. But these internal drivers then are complemented by what we see as a maturing landscape from an ASP standpoint. And some of this is just based on the maturation of our space. Overall, we are still in relation to the rest of the healthcare ecosystem in a relatively immature part of the ecosystem. Every year it matures, and there is no place where that maturation is more obvious than hereditary cancer testing, which is our most storied product. And as Paul referenced earlier, the market is wrong about the overall trajectory in our view for hereditary cancer testing because we see on the front lines that after many years of pressure on pricing for hereditary cancer testing, we see now that it appears that that pricing has reached an equilibrium level.
We see that the tide is turning in terms of coverage determinations, our own ability to work through any challenges that might exist in terms of the frontline logistics of the revenue cycle opportunity. And we see that as more upside opportunity than downside opportunity, not just for hereditary cancer testing, but of course, across the broader portfolio. Just to illustrate that on this slide, first, we look at the most recent pricing trends for both hereditary cancer testing, which falls into the more mature bucket in terms of the maturation level of our product portfolio. And you compare that to the trends for GeneSight, which is in the least mature part of our portfolio in terms of maturation.
What you can see is that even with some amount of noise, sometimes influenced by a little bit of out of period, we have achieved a level of stability that gives us incredible optimism about what's to come. We've been talking again about a number of different wins impacting not just these products, but other products across the portfolio. One thing that's so important to acknowledge is that the wins that we are conveying to our stakeholders and to the investing community, these are prospective in nature. We've talked about the examples of Blue Shield of California that was a recent coverage win for GeneSight and Centene's Peach State plan also for GeneSight. Those are examples where we have talked about the wins recently, but there is little to no benefit from that yet in our P&L, but we know it's coming.
We also have a number of high-probability opportunities that are in the hopper where our team, again, the payer markets team that has achieved a level of sophistication beyond what they had in the past, now has much better understanding in terms of what is coming as far as future coverage determinations that we know can serve to offset any kind of downward pressure that we might feel on contracted rates or potentially even serve as an upside opportunity as well. So I just gave a couple of the examples in terms of new coverage that we won recently. Other examples that we've talked about already in the past include UHC expanding coverage to include Prolaris and MyRisk and other determinations that have benefited us more recently as well.
We also are really excited about, obviously, the stability that comes from the four-year contract that we signed recently with United, which is paying dividends for us already and we believe will continue to make for a more sustained environment for us going forward. I've talked a lot about the different investments in revenue cycle management and the momentum that that creates.
But overall, you bring it all together, and I just want to emphasize again when you take a step back and think about the drivers of long-term revenue growth as we see it today relative to how it may have been viewed in the past, the increasing level of comfort that we have around the ability to at least hold the line where any kind of downward pressure on contracted rates. We have a 44% opportunity in terms of potential no-pay reduction that we continue to chip away at. And as we are more and more successful in that, it creates more and more opportunity to at least ensure that we hold the line on overall ASPs and optimally contribute to incremental revenue growth as well.
So obviously, revenue is a huge part of our story in terms of growth trajectory, but the rest of the P&L is benefiting in so many ways, not just from the revenue growth contribution, but also from the fruits of so much of the other labor that you heard about, particularly the investments in the operating environment that Sam discussed. And as Sam mentioned when he was talking about the Labs of the Future initiative, we have yet to see many of the benefits from many of the investments that have been done so far.
And so our ability, as you see here, to have delivered 15% revenue growth in the most recent quarter while doing it, maintaining industry-leading margin profile, which is overall we've maintained around a 70% margin profile at the gross margin level and increasingly demonstrating the operating leverage that we have at the OpEx level where our OpEx as a percentage of sales in the most recent quarter has declined from what was 73% in Q2 of last year to what is now 67% in Q2 of this year. Just another indication of the power of the model and the scalability of the business that we've brought. And of course, we feel very proud to have achieved profitability now on an adjusted EBITDA basis, as well as profitability on an adjusted EPS basis with opportunity for more to come.
Also, in terms of setting the stage for future growth coming out of 2024, in addition to the announcement that we made this morning with an indication of our expected Q3 revenue, we also reaffirmed our guidance for full year 2024, which serves as another reference point for the conviction that we have in our jump-off point here in 2024 as we think about our longer-term trajectory. As a reminder, our guidance that we reiterated this morning is for revenue of $835 million-$845 million, representing year-over-year growth of 11%-12%. Doing it again on the chassis of 70% + gross margin profile, industry-leading margins, and an increasing amount of scale in our OpEx infrastructure, contributing to $25million-$35 million of adjusted EBITDA and a very positive trajectory on our adjusted EPS as well.
So against the backdrop of this very solid jump-off point from 2024, just a reiteration of the fact that when we have talked recently about the expectation of a 12% + top-line revenue trajectory, the drivers are there. You have seen them clearly in all of whether it's the content that you just saw from Paul and Sam and Dale, or in general, the various communications that we've had all year. The momentum is real in all of the different parts of the business that matter for us, in particular the women's health side where we just see an extraordinary market opportunity in order to accomplish more commercial penetration. Pharmacogenomics, as Paul said, over $150 million revenue business benefiting from continued positive feedback and interest from the new providers that has driven it to the scale that it is and that we expect to continue to drive it to grow.
Hereditary cancer testing, again, on the chassis, on the basic platform of a stable or improving ASP environment with an extraordinary market opportunity, including the unaffected space that Paul emphasized earlier. Overall, these different parts of our business, the levers that we have in the broader portfolio position us very well to achieve the 12% long-term, 12% + long-term growth target that we have in our mind. So I'm going to wrap up also just by thinking about the way that cascades through the rest of the P&L over this long-term period. Spoken extensively about the revenue growth opportunity and our increasing levels of conviction around delivering that.
We do expect to be able to deliver that on a consistent margin profile, maintaining or perhaps growing that gross margin profile, which is already an industry-leading gross margin profile, giving us the room to continue to invest at least modestly in the parts of the business that will continue to pay dividends for us, particularly in the areas like Dale's R&D and technology that will continue to improve the comprehensiveness of our product portfolio and the customer, the patient, and provider experience, allowing us the opportunity over time to leverage the scalability of our model and in the longer term achieve double-digit adjusted EBITDA margins. With that, I will hand it over to Paul to wrap things up.
Thanks, Scott. Thank you all. We'll have some time for Q&A. So I'll just wrap quickly.
You heard a lot today about our focus on patients and everything we're doing from Dale to Sam. The innovation that is happening today within our P&L, a lot more investment I wanted you all to come away with in our core business across many different functional areas, all of which with the intent of reaching more patients with more actionable science, sustaining profitable growth, and delivering on the longer-term financial opportunity that Scott spoke to. You know, one thing that I failed to kind of call out that I just want to make sure that the folks are clear both from a legal notice perspective and otherwise, we have three patents in MRD.
We have the freedom to operate, and we are also advancing a strategy to turn that into a business of driving royalty licensing revenues because there are a lot of folks out there who are infringing, we believe, on our IP, and we don't want to limit anybody's right to advance MRD and reach patients. That's not who we are and how we think about the world. But if you're infringing on our patents, we want you to know that we're going to be knocking on your door and we're going to be expecting you to pay for it. So that is something we're going to hear more about in the coming year, in addition to more about our biopharma business and the prospects there. So thank you, and I'll ask my partners to come on up and join me in Q&A. We're actually miraculously on time.
Let's open it up for some questions. Matt, you got the.
Yeah, thanks, Paul. Due to the size of the group here, we're going to ask you to limit yourself to two questions and a follow-up, and then we can circle back around if there's additional time.
All right, great. Puneet Souda, Leerink Partners. Paul, thanks for the presentations and the details today. I appreciate the disclosures. Maybe just on the quarter, quick clarification, just in terms of volume versus ASP, can you elaborate a little bit more? It seems like there's more ASP left. Just maybe that. And then I didn't see a change in the full year guide despite the beat that we saw here.
It's got to hold you back, buddy. It's got to hold you back. Look, we haven't closed the quarter yet.
We're really pleased about kind of where the preliminary revenue number is penciling out. That should flow to the bottom line. There's nothing changing in the rest. You know, as Scott elaborated, you know, the leverage in our operating model, so you'll see another profitable quarter. And this is a seasonally weak quarter. And I think what we saw in July and August is a little bit more return. I mean, everybody seemed to be on vacation in July and August, and sort of that impacted. A little concerned about the weather, and our hearts go out to all the people displaced in Florida and North Carolina and likely displaced here over the next couple of days. We have 200 teammates that have been affected by the prior storm and more probably going to be affected here.
And so, you know, just not prudent to get out there and raise our guidance given all the things swirling in the world. And the quarter did benefit from continued ASP growth and helped mitigate some soft volume in July and August, but that's about as much color as we're going to be able to give you today. We'll talk more about it in four weeks when we release earnings. But you should come away with confidence in our guidance incrementally and certainly confidence that we're going to deliver our guidance for that guidance and that Q3 pan out to be a strong quarter. So that's what I think you can take home today. Great.
And then a little bit on the longer term, I mean, 12% growth, just given the level of growth that you were seeing this year, comps do get harder, you know, in next year.
But as you presented, 20% growth that you're seeing in the U.S. market versus the international market. Maybe just elaborate, how do you think about the U.S. market growth going forward and the contribution from international? And again, it comes back to the point of, you know, historically, the prior Myriad, that consistency of 12% or commitment to that just wasn't there. And so just help us elaborate, you know, just clarify.
It's there now, and we just spent two hours talking about the component pieces. So look, there's no question that, you know, delivering compounded growth in a competitive environment is difficult. That is, but that notwithstanding, what we tried to articulate today, and if you go through the materials and we have follow-up conversations, we have multiple levers to get there, and we're delivering 13% year to date.
That is with biopharma underperforming, MyChoice underperforming, Prolaris not performing to the level of expectation. So, you know, the strength of the portfolio and the market disruptions and the new customers that we expect and our onboarding here in Q4, guideline expansion, depth of customers. I mean, there's just a lot of different reasons why that stack that Scott provided, we believe, can sustain, you know, this growth that you're seeing the last year and profitable growth going into the next few years. So we'll obviously have more to talk about, you know, when we release the quarter, but I think we gave you a lot to think about and hopefully more confidence in that we can get to, we are delivering 12% and we can deliver 12%.
And quite frankly, the new products are hopefully going to move us further, you know, but they'll be slightly lower margin new products for the first couple of years out the gate, although FirstGene should be a higher margin product, quite frankly, as Dale described. So we ask you to be with us, patient on our delivery, breaking out all the products by volume and ASP, which I know you guys would love to put in your models. We're not going to do that. It just creates much more work for you and for us that, quite frankly, I'm not sure is constructive. I'm going to let Matt pass the mic.
Hi, Paul.
Sorry, hey. Sorry.
This is Subbu Nambi from Guggenheim. Paul and team, you're pretty close to having a full menu of cancer solutions.
Is the lab and infrastructure where you want it to be to start capitalizing on the menu? Are you seeing instances where you'll capture share by providing enterprise solution instead of individual testing? And additionally, how important is it as a component for your long-term growth target?
I'm going to start and then hand it over to Sam quickly. We have an emerging portfolio of oncology products, you know, but we're just getting Precise Tumor up in the lab in Q4. But the commercial team is set. We'll probably add some more medical affairs people. We had an incredible Science Day with our medical affairs committee.
So again, as we think about growing, you know, we've got everything we need to deliver in 2025, but this expansion of our portfolio and the increase in content to the rest of our existing portfolio, those are the things that we think can sustain that 12%. But Sam, why don't you speak to where we are in the labs?
Yeah, absolutely. We're ready. I mean, we're making great progress. And today already, I can tell you with confidence, you know, of course, MyRisk is in great shape. We're ready for the indication expansion related to MyChoice that Dale talked about, MRD, right? I mean, we are actually doing work that Dale talked about and RUO, and we're already building it to scale, right? We're going to do a lot of work with biopharma that Paul alluded to that we see, you know, promising opportunity for.
So, and then Precise, I talked about, we're already doing the integration. That's moving on track. So I think we're prepared.
Yeah, by the end of 2025, everything is going to be up and running in our labs. We're not outsourcing a darn thing, you know, and that gives us control over the science, control over accuracy, the ability to add content, not be dependent on third parties, the ability to reduce turnaround times with improved workflow and, you know, our partners with different sequencing technologies and, you know, having them help us in the labs. So those machines are right next to each other. So we're going to really understand where the workflows, where the accuracy is. That's what Lab of the Future is all about. And, you know, we've been doing all this stuff this year while we're moving labs and getting through validations, guys.
I mean, it's been three-dimensional chess, but by the end of 2025, going into 2026, we should be in really good shape.
Yeah, just one more thing to add related to your second part of your question. I got to tell you, I've been in this space for a long time. The last three weeks have been really revealing and encouraging for me, specifically in the following way. I think Paul mentioned that we had the first-ever Science Day where we had more than 15 different healthcare providers, systems administrators, patient advocates that were there.
The message that came from them, as we dug in, as well as last week, I was in Texas with a number of leading healthcare providers, is it makes a difference for them in terms of efficiency to be able to work with a single provider diagnostic testing lab to really go all the way from germline testing to do therapy selection, treatment selection. We could see it, and that's where the enablement functions we were talking about, the EMR, because it's one thing to want to do it, but to be able to get all the results that are concordant in a system that's easy to use. These are part, by the way, Puneet, these are part of the things, the EMR work that I think is going to give for a long time in volume growth for us as well.
Thank you.
Matt Sykes at Goldman Sachs.
Thanks for doing this today. Appreciate it. Appreciate you coming to New York. First question for Dale. You had mentioned you talked about Prequel at eight weeks, which seems like a pretty critical development given the sort of regulatory environment we're in. But you also mentioned the competitors you don't think can get to eight weeks. Why is that? Is that a sensitivity issue? Is it something else? And do you think eventually they could? Is it just a time issue?
Yeah, thanks, Matt, for the question. So the main, and I didn't necessarily have time to go into it fully today, so I'm glad you asked. So our Prequel test today, and actually for the last four years, has included what we call the Amplify technology.
What this means is in our laboratory, and we've published on this, we preferentially sequence shorter fragments, and these shorter fragments tend to be more fetal-enriched than maternally-enriched. By doing that, we effectively, in our test, boost the fetal fraction to a higher level, and it is fetal fraction that you're looking at to assess aneuploidy, trisomy 21, things like that. No other lab is doing that today. It is actually quite operationally challenging to do. It's something that took us a while to develop and really optimize and get right, but it's because we do that and basically significantly increase the fetal fraction of every sample that comes into the laboratory that allows us uniquely to go earlier in gestation where fetal fractions are lower kind of for everyone. So you kind of have these offsetting effects.
Fetal fraction's lower because you went earlier, but then we have Amplify to bring it back up to the level where the test is still highly performing. Everyone would suffer by going down to lower time, but not everyone has Amplify to bring it back up.
So Matt, we can't comment on what others can do. We just don't think they can get there quickly. This Amplify technology, as Dale talked about, is how we built MRD for circulating DNA too. Maybe they'll have to pay us a royalty to do that too. I mean, we'll see. You know, we're doing a 360 on all of our patent pools, and the Amplify technology is one of the great differentiators for our company. It's up, it's running, it's built. Look, we hope everybody gets to eight weeks. You know, women, families deserve answers sooner.
We just are going to be able to do this beginning in January, and others hopefully will be able to do it too to improve access, you know, because there's a lot of maternity deserts out there. And if they're infringing on our IP to get there, then they're going to hear from Jennifer.
Great. And then just my follow-up for Scott. You talked about the no pay rate at 44%. You also said that you've improved that by a few percentage points, I think you said this year. Could you talk about how we should think about the cadence of improvement in no pay rate over the course of a given year? Like how much should we be thinking about that improvement? And what are some of the key drivers of that?
I'm sure it's partly not chasing volume at maybe some unprofitable customers, but also just blocking and tackling revenue cycle management. Is there any big drivers of that reduction of no pay rate? That'd be great to know as well as the cadence.
Sure. Thanks for that question, Matt. And you know, I think if you were to turn back the clock, we had made comments coming into 2024 referencing a no pay rate that was around 46%. So really we're talking about a 2% improvement so far this year. But as I mentioned earlier in my comments, there are a lot of victories that we know are in the books in terms of documentation that just haven't flowed into the P&L yet.
So, for example, when we had a number of coverage determinations that came through in the last couple of months, that we do not have a full quarter or a full year of benefit from that. And so there's a certain amount of the progress that we see coming that honestly is based on either wins that we've already delivered or in some cases just based on the visibility that our payer markets team has based on wins that we are anticipating with higher levels of conviction than we've been able to in the past. And that's in terms of the more kind of strategic side of the opportunity. With a 44% no pay bucket, there is a vast number of root causes that go into that, and most of those have a unique solution in one way or another.
And so we've given some of the, you know, kind of directional indications of where the largest problem opportunities are. Will that no pay rate ever get to zero? No. Can we move the needle materially? Yes. The question is just how quickly we can move it. And so we're certainly not going to commit to 3, 4, 5%, but it's certainly reasonable to think that we could deliver at least as much as the 2% that we've seen so far this year. And given the amount of visibility that we have into either recent actual wins or wins that are coming, I think it's reasonable to think that in any given year, we could deliver something in the 3%-4% range and maybe more if we really knock it out of the park.
But it's, as you said, though, 3%-4%, $8 million per percentage point over the next three to five years, that's real money. And all goes to the bottom line, but there's countervailing, you know, winds. I mean, there will be contract negotiations and pricing pressure, although we didn't mention the, you know, the hereditary cancer win and what maybe was in the slide, but you know, that $1,313, I believe, was the rate.
Yeah, that's right. It was in the slide and I didn't call it out, but there was a great example where CLFS pricing, preliminary pricing came out for 2025. And for BRCA analysis with MyRisk, the pricing, preliminary pricing is up more than 10%. And so just another example of singles, doubles, and triples that are really adding up for us and giving us.
There is not a melting ice cube in hereditary cancer, which was what I was told four years ago when we got here. In fact, the rates are going up, the use cases are expanding, guidelines are expanding, and I hear from oncologists all the time that MyRisk is core to their treatment selection for patients. So more to follow.
Good morning. This is Doug Schenkel from Wolfe Research.
There you go, Wolfe.
Hey, guys. I actually, I'm going to break the rules. I got three topics I just want to rattle through real quick. I think the first is for Scott or Paul. Listen, specialty diagnostics historically has been an industry where companies can grow, but they can't drive EBITDA or free cash flow. We haven't seen many examples of companies that do both. You're starting to do that. You've guided to expectations for pretty robust growth.
I think my question is, if for some reason you were to come up light of that target, you know, whether it's Myriad specific or something happens in the industry, do you now have the toggles, the flexibility in place to basically still hit your EBITDA targets? Can you get there even if growth, you know, comes up a little bit light in a certain period? So that's the first one. Why don't I pop that? I'll pop that.
[crosstalk]I'm going to, let's take them one at a time.
I'm going to take this one. There's a strategic question for our board. There's a strategic question for everybody here. How much of our EBITDA do we reinvest in growth and innovation? Technology, you know, clinical studies. That's the challenge we have every day. That's a challenge everybody in biotech or technology has.
My sort of rule is you ought to be putting back a third of your winnings back to drive growth in years five, six, seven, eight, and nine. But there is a toggle there, Doug, and we're not going backwards on profitability or free cash flow generation. That's not happening. So, but we may not grow as fast if things don't go our way and we have to, you know, throttle back the R&D. I mean, we're expecting to increase Dale's budget by $15 million next year to accelerate MRD, accelerate our other studies. Believe me, Sam's got a great wish list of technology he wants to. I mean, we're going to the budgets next week with all that arm wrestling. So, so there are great opportunities, but strategies about choices and we'll have to make, and the board will have to help us make those decisions and those choices.
Okay. Thank you.
Well, I would just add to that as well that when you think about some of the investments that you heard about so far this morning that are still in the ramp-up phase, particularly the Lab of the Future initiative, so much of the financial benefit, as Sam conveyed, is still to come from that, and it gives us a fair amount of cushion in terms of levers of the P&L to ensure we can deliver bottom line value.
Okay, thank you for that. And maybe I'll stay on kind of the financial and strategic side. You know, Paul, as we've got to know each other over the last several years, I've really valued your perspective because you're not, you're now a diagnostic person, but you grew up, you know, more broadly outside of diagnostics.
So just kind of thinking about your broader experience, your broader perspective, you know, as you think about the diagnostic industry, is there too much lab and commercial infrastructure? Should there be consolidation? And if so, you know, how does Myriad play into this?
Absolutely. You know, we need to regulate, you know, LDTs. We didn't agree with using the medical device framework. We'll see where that lawsuit goes. But so much innovation came out of the pandemic, but some bad use cases came out of the pandemic too. And so we do need regulation that supports high-quality testing. I mean, there are things that we can all be behind, like making sure that CLIA and the quality standards are there in the labs, making sure that labeling and messaging is appropriate to the use cases.
So look, I've gained, you know, really respect for Kevin at Exact and Marc Stapley and a number of others. Our industry has a lot of really good people doing some really good things. And I think many of us have gotten religion. Obviously, Labcorp and Quest are playing a bigger role. I think this is a tougher market, advanced diagnostics with the high touch we need to provide than those guys maybe have signed up for, but we will see. But consolidation is tricky, Doug, in that we're not going to do consolidation. And we've been at the table with all the deals of broken business models, of poor revenue cycle reimbursement with the risk of recoupments.
I think the broader answer is, you know, there's been a lot of hubris in our industry, and we need to figure out how we participate in the broader healthcare ecosystem to partner with Epic, to partner with Optum. It is hubris to think that we should be the center of data and information for hospital systems and payers and patients. It's crazy, you know? And so, but how we fit into that, how we participate in that, and how we become, you know, a part of the broader healthcare ecosystem, that's our future to contribute to patient care and adoption of our science.
Okay, thank you for that. And last one, Dale, it seems like you're really focused on low-shedding tumors, you know, with some of the first indications you're going after. Is that right?
And if so, is it really the limit of detection that makes you feel more comfortable in going after those cancers relative to some of the incumbents? And, you know, low abundance means it's harder. So, you know, how should we think about the risk of those studies from here? Thank you.
Yeah, no, happy to talk about that, Doug. So I think the main thing we want to communicate again, yes, breast cancer is a low-shedding tumor with low tumor mutation burden. Our tests should perform very, very well there. And it obviously is a very natural fit for Myriad Genetics. So that is our key area of focus.
As for the performance of the assay, I think a thing worth stressing is that it is tumor-informed, but the way it operates could work in just about, I mean, there's really no limit to, like, if it's a solid tumor, it has variants in the genome and you can run MRD on it. But, yeah, breast is our main area of focus. The detection at very, very low levels would be helpful really kind of almost anywhere. I think what's also important is that in indications that have higher levels of tumor, not only do we detect it at a low level, but we're extremely quantitative across the whole spectrum. And that is something where we're still doing the studies to determine like the value of that.
But like, yeah, the test would work in high-shedding tumors with lots of variants, and it would just be more quantitative than the first-generation assays.
I mean, Doug, it's going to depend on the clinical utility and the price of all of this too, right? So our view is let's deliver a highly sensitive test, building it in-house so we can deliver it at a compelling price for payers. There's plenty of space here potentially for tumor-agnostic for low-shedding tumors. There might, you know, and some of the incumbents today, I just don't buy into 35 years in healthcare that anybody's going to control all of this.
And if it's a $20 billion market and our Precise MRD solves to a unique subset of prostate and breast and pancreatic patients, and we can do a good job there and do it profitably, we're going to be very happy having 10%, 15% of the market.
Hey, Doug, just one thing to add, just to kind of put an exclamation mark, a little bit of the new Myriad in our focus. Everything Dale said, and to highlight this point, I think it's incredibly important for us to think about not only the great science, and there is no substitute for that, but really how do you take it to market and win in the market and serve. So really the channels, you know, where are we in the community? You saw Paul talk about that, the breast franchise that we have, right?
These are things that we think can give us a differentiation as well because of our reputation of our access already. So as you think about, and that's one example, but everything that we do, we want to be incredibly thoughtful of where we, you know, where we shoot our arrows to give us the best return.
No recreational science, right?
Yeah, we do not do recreational. We love genomics here, but we don't make, right? We don't recreationally do genomics. We want to be very practical.
My favorite thing. There we go. No recreational science here.
Hey, Paul, over here. Paul and team, hey, Dan Brennan from TD Cowen. I guess the first question just on hereditary cancer, it's nearly 50% of revenues. You gave a lot of detail here in the deck. I guess 44 by our numbers, but I rounded up.
So can you just break down a little bit how we're thinking about the volume and price outlook across the unaffected and the affected? You gave the TAMs, you gave like the market growth, but be interested to see how you're thinking about that going forward. And then within that, are we thinking price is flat? It sounds like maybe that's the right assumption or maybe positive. It sounds like you're leaving some room there. And I know you talked about share gains. I'm just wondering price and volume. And on the volume side, like what are you seeing on share gains since you're really talking about it more here today?
Okay. So we're going to take cancer in oncology. We're winning back business that we gave up because we did not put patients first.
A lot of dislocation in the market, a great level of excitement about expanding our gene panel and make it more competitive, ease of use, EMR. You know, as Sam said, MyRisk germline test is where we have a physician group where 80 doctors stood up in this 400 group and said, we want to pair MyRisk with Precise Tumor. Those are the validation points I look for. Okay. And they're doing 30,000 somatic tumor tests a year. I don't know how much of that we're going to get next year, but we're going after that. So the 15% growth in hereditary cancer revenue will continue to be hopefully double-digit volume and continued ASP progress. The reason we just talked about, you know, the rate issue. We see that stabilizing as use cases broaden and guidelines broaden.
That doesn't mean that certain commercial payers aren't going to come back and say, you know, as the market consolidates, we expect you to, you know, to pay less. But, you know, we had United, we had Aetna improve reimbursement rates for MyRisk. I mean, increase because of expanded use cases. There'll be pushes and pulls there, Dan. The bigger opportunity is unaffected. And also for men and pairing that with Prolaris. So we got three or four multiple different ways. And we're looking at standalone RiskScore and other things that might be really novel and interesting as people really get after breast cancer screening earlier and stuff.
So, you know, I think there's just a lot of ways for us to continue to grow that 44% and sustain that as our profitable anchor, even as we add more therapy selection products, even as we grow GeneSight, add more indications to MyChoice, grow in Japan. And then prenatal is where we're really like gaining share and momentum right now, and ASP as well. So again, the main thing we want to leave you all with, multiple levers to grow. Can't get into all your models today. I know that's part of the effort, but I think we've given you a lot to think about and certainly hopefully a lot to have confidence in our ability to sustain growth profitably. Great.
Thank you for that. And then maybe just one on GeneSight.
I think you talked about in the presentation, you're seeing, you know, increased frequency of number of tests per doctor. Maybe could you break it down a little bit or just help us think conceptually about the, you know, the levers of this low teens GeneSight growth in terms of same-store sale growth per doctor? Because there's a huge number of doctors that are still yet to be penetrated. So I think it's helpful to think about like the new doctor ads versus the existing continuing tests that you're seeing for doctors and any update on where coverage stands today will be.
We got our friends from AWS here with One Medical, and we believe GeneSight should be available with a cheek swab to all the One Medical patients. Same thing with CVS, same thing with Walgreens.
You're going to find a SneakPeek on the shelf in those folks. So, you know, I've spent a lot of time in risk-based primary care. We are developing tools like RiskScore, like GeneSight, expanding how we do sample collection, you know, to more cheek swabs across our product lines. We acquired this, you know, right to the SneakPeek Snap device with SneakPeek. So looking at harder how we can do NIPS testing at home so people get to the office and the results are there. So there's just a lot of innovation happening here to improve access and find our way more broadly into imaging centers, integrated delivery networks, primary care physicians that are organizing across the country. Lots of different ways, but it doesn't work if you can't plug into their workflows, if you can't plug into their EMRs. And that's why these partnerships are so important.
So a lot of running room still for GeneSight because our mental health crisis is not abating. And I'm not sure if the election in a couple of weeks is going to help, but maybe once we get past that.
Hey, I'm over here. It's Tycho Peterson from Jefferies. Maybe Paul just following up on that. You know, you had, I think, Blue Shield of California go effective on GeneSight September 1st. I know you don't want to talk about 3Q, but, you know, it'd be helpful to know, are you getting paid on that? Is that adding anything now? And I think they said coverage is dependent on clinical utility, but they've also kind of said, you know, tests like GeneSight do not have clinical utility. So can you maybe just talk about that dynamic?
Yeah, honestly, I don't know.
We just haven't even closed the book, so we haven't, you know, gone through all the details and, you know, Scott will yank me back. But it is early days for all these biomarker laws. Many of them are just going into effect in July. Many of them don't go into effect in January. We are seeing contract wins with Centene. We're seeing contract wins with Blue Shield of California. But from medical policy changes to contract to actually getting through prior auth and collecting money, that's a year. I mean, you know, so that's what Scott's point is that we're not seeing the benefit of some of this yet. We've got a lot of momentum on coverage across the product portfolio that will hopefully sustain the ASP growth that you're seeing year to date. And I think you'll see some in Q3.
Yeah, I would add that while certainly Paul's right in terms of this long tail on the rev cycle, there are elements. There are early indications that you do get. Based on everything that we see so far, we have no reason to doubt that our excitement over the expansion of coverage by Blue Shield of California. We have no reason to doubt that that's going to ultimately result in the improved ASP that we anticipated from it.
So more to follow on that. Sorry, I can't give you more detail today.
Then just follow up, you know, kind of along the lines of Doug's question just on leverage. You know, if I look at kind of what the SHRE's modeling for SG&A, it's I think a 2.5% step up in 2025 and 5% in 2026.
Just considering the MRD launch, just talk a little bit about channel investments you need to make in the channel. And then, you know, you're a lawyer. You mentioned, you know, the patent issue. Is this NIPT part two? Everybody's going to kind of sue each other and have to kind of settle the IP. How do you think this plays out? I think some of the people in your patents went to [crosstalk].
We're going, you know, again, I have great respect for this industry and the people in this industry. So we're going to really try to work with people to help them bring their products to market and compete on the merits. We are not afraid to compete on the merits. But one of the things I have learned that this industry thrives on is IP revenue.
And we're certainly not going to not take advantage of that given the decades' worth of investment that we've made in some of this IP going back to 2016. So, you know, we're not going to be, you know, suing people and getting injunctions. We're going on a friendly basis to go to people and say, hey, we know you're working on a tumor-informed MRD. We think we may have a problem here. Let's work it out. Let's just figure out how we can keep you on track. And yeah, you know, if it's as good as everybody thinks and, you know, cutting us a check to help you get there faster with freedom to operate would seem to me, which is why we entered into the cross-licensing agreement with Personalis, a smarter long-term business view.
The hubris that this company has worked its way out of goes back 10 years to the Supreme Court case trying to patent the gene. We are not going to do those kinds of things again. But we are going to be pragmatic stewards of your capital and go get those returns when we can get them and when we have a right to be paid for. Yes.
Sung Ji Nam with Scotiabank. So question for Scott and one for Dale. So Scott, just I think it was alluded to earlier, but for your operating expense target, the longer-term target for your operating expense growth, does that assume investments needed to get MRD, Precise Liquid, and FirstGene off the ground? Because given that's not included in your top-line guidance. And then are there scenarios where you may have to accelerate your OpEx in order to get those off the ground?
Sure. Well, certainly, you know, the range that we gave is a little bit higher than what we had communicated last year. And so it does contemplate in general, not just MRD, but in general, the desire and expectation to reinvest as we become increasingly profitable, to reinvest more in the areas that are true differentiators for us, including Dale's area and the tech area in general. You know, could you have a need for some accelerated spend beyond that? Certainly you could, but as we have been talking about all year, we've been talking all year about the fact that we anticipated some ramp in OpEx relating to onboarding new customers and so on. And we've characterized that as being good money to spend. That's the money you want to spend.
And so what I would say is that certainly if there is an opportunity as we get into the MRD ramp to accelerate the project and the commercialization, then sure, that's good money to spend.
So I'm sorry, that was the other part of your question as well. No, R&D, tech investment. By the way, everything you heard about today came at the cost of millions of millions of dollars over the last four years. Millions and millions of dollars. And we've made it ourselves more productive and kept OpEx growth to around 5% or 6%. The 6%-7% absolutely incorporates more R&D, more tech build, where we need to add more on the commercial side, which is not a lot. And the other things we need to do to launch Precise Tumor, to launch MRD, launch FirstGene.
So that, just to be clear, that 6%-7%, you can take to the bank. That ain't moving. Just like it hasn't moved over the last four years.
And then just a quick follow-up for Dale. For Precise MRD, can appreciate obviously the differentiated technology and how that plays into maybe the low-shedding tumors and things like that. But could you maybe give us kind of an example of a low-hanging fruit in MRD in terms of where we could start to see clinical utility? I know you talked about that as well. So, you know, an example is that earlier stage, stage two breast cancer. I know breast cancer is different types as well. Kind of where can we see that clinical utility really, you know, what's the time frame? Is it three years? Do you think five years from a prospective trial standpoint?
I'm going to give a pretty high-level answer to that. There are multiple, we expect MRD, and this isn't just our expectation, but I think it's an expectation of the field that MRD will play a role across the whole spectrum of care. So it's brought up a lot as a recurrence monitoring, you know, after you've undergone treatment just to see if the cancers come back and that sort of surveillance period. It clearly has a life there. But it has also shown like really promising early indications in the prior to surgery neoadjuvant treatment setting. So monitoring response to therapy like even before surgery. So between diagnosis and surgery.
That's what we've been hearing from our biopharma partners. Yeah, that's why we're going to be doing a lot of MRD for biopharma because of those early-stage therapeutics.
And like utility as well in the immediate post-surgery period when you're, again, you can think about it as a way of monitoring how well treatment is going. And like really those will be sort of the shorter-term time. Like it will show its utility on a tighter time period in those settings most likely. But because it'll take time for like that longer-term recurrence monitoring studies to read out. Yeah, so there are really multiple places that we expect it to show utility.
Hey guys, Tejas Savant from Morgan Stanley. Thanks for the time.
Maybe just following up on that MRD question, Dale, can you just put a finer point on the differentiation in terms of your approach to MRD versus some of the other players who are also taking a whole genome sequencing approach, you know, Personalis you mentioned, but also Veracyte, you know, potentially NeoGenomics goes down that route as well. And then I think on that MRD slide you talked about, you know, a gross margin sort of profile. I think it was mid-30s for the first draw and then approaching 70%-ish for subsequent blood draws. Just any color you can share on the pricing and volume assumptions underpinning that graphic?
Sure. Let me start with your first question about, I think, a way that we think about the tumor-informed type of testing, and I've kind of reinforced it with that plot, is that there are only so many molecules in the entire tube of blood. There are only so many sites that you can look at that have information like where the tumor and the normal genome are different. And we are looking at nearly the whole set of them. So we're, we and really everyone else is really that like are trying to develop those ultra-sensitive tests are more or less converging in a somewhat similar place on sensitivity. That said, I think that clearly differentiates us, and you've heard this all day long. We have a whole portfolio of offerings where this really dovetails nicely, and that is not generally true across the field.
And I'm sorry, could you please r
repeat yourself? That was just on the gross margin.
Oh, yeah, yeah, on the margin. So yeah, this is one of the things where we all really differentiate. So like again, the expertise and scale that we have operating in like solid tissue handling, genome sequencing, short-read DNA-based analysis, laboratory automation, all of that run in-house, that is also a key differentiator that we have. So like, yes, the first test costs some money to run. The bulk of that is sequencing already at positive attractive margin, and those costs we expect to diminish greatly. After we've done that initial whole genome sequencing, the thing that differentiates our test from some of the other ones you mentioned, we do whole genome upfront when we profile a tumor. Thereafter, it is a targeted test with a customized 1,000-site panel.
That test is very cheap to run and much cheaper than whole genome, and so that's why for those subsequent rounds of testing, our margins are very, very attractive,
And Tej, just to remind, I talked about technology partnerships, right, and the brilliance about the way markets work is the very presence of Ultima and actually having not just smoke and mirrors, but a legitimate offering, particularly with the sensitivity I think that they're going to be able to provide. I mean, if nothing else, it gives Illumina incentive to collaborate perhaps more deeply with us, right, so to enable the market, we have many opportunities and these levers that we absolutely intend to pull as well.
And we have a tremendous amount of respect for Illumina. We do a lot with them. We've got the X Plus up and running, six of them at this point.
And so we're just going to stand them up right next to each other and see how they perform. But this is happening today. This is happening in our labs today. This is not recreational genomics. This is, we are operationalizing this. We have a commercial reach. And increasingly, this is really important. The oncologists that we talk to, they want all this and they want MRD to be part of what they're doing. Our friends at Florida Cancer, our friends at Texas Oncology, MD Anderson, I mean, the clinical utility is going to be, how does this get put into practice in clinic? How often am I going to do it? Who's going to pay for it? These are questions as an industry we have to solve because look, this is the biggest opportunity for patients and growth this industry has.
I just think we all have a lot more work to do, but it's going to be a huge opportunity for all of those that have the staying power and the ability to see all of these different components come through.
Got it. And one quick follow-up on your earlier comments and just, you know, industry structure and inevitable consolidation there. Do you think some of these larger reference labs, you know, given that reimbursement eventually gets easier and more uniform, you know, some of the high-touch stuff that takes up time now, which they're not sort of best equipped to lean into, becomes less and less of a factor? Do you see the larger reference labs sort of acquiring their way into this space? Or do they, you know, essentially have a shot at building this out on their own?
Look, I have a tremendous amount of respect for Adam and Jim, and those are really good companies, and they are investing. They are acquiring. They're going to be formidable competitors. We have differentiated products, differentiated experience, and you know, that's our strength and that's what we have to play to. I think it's going to be hard for them to recreate all of this given the way, and I've been in the reference lab business, given the way reference labs work, given the way they build, you know, culturally, it's just very different, but I do think Labcorp and Quest will be among the players here when we're back here five years from now talking about precision medicine and genomics. They're going to be here and they're going to have a bigger presence.
I think some of the smaller undercapitalized companies that can't build a commercial infrastructure can invest in FDA, you know, compliant labs. Those are the folks where the market share is going to go to us, some of our main competitors, you know, and as well as Labcorp and Quest. And we're not sticking our heads in the sand around that. You know, we're going to have to figure out how to compete with those models. And at least most of the hospital systems and stuff that we're engaged with right now understand the difference, you know, between what a historical reference lab loves and the commoditization there and what they need from us, both on the women's health side and on the oncology side. And that's, you know, but that's still something we got to keep, you know, work
ing on. Hey guys, Mason Carrico at Stephens.
One, could you talk about the benefits you're seeing post-EMR integration in terms of customers ordering a broader variety of tests? And then second, when it comes to ACOG guidelines and we're thinking about the upside of the prenatal business, could you talk about the evolution of carrier mix, larger versus smaller panels? And really how you see that playing out over the next three years versus maybe what you're seeing today?
I mean, you've seen the Foresight volume growth last year here. You know, even in advance of the launch of Foresight Universal Plus. We do think that if ACOG expands guidelines, there will be more providers that go to expanded carrier screening guidelines. And similarly, more payers will need to go there as well. So we're there. We're launched. We're ready to go. With a higher reimbursement rate as well for the expanded panels. Right.
And so we just want to assure you guys that we're going to be able to maintain, you know, that growth there. Sorry, the other part of your question?
EMR integrations.
Yeah, so EMR integrations, it depends, but sometimes we're getting as much as a 25% lift. And you know, the unified, this is the way to think about it. The front end of EMR, the front end of the Myriad portals together with unified order management makes it that much easier to do doubles and triples of our tests. To order Foresight in the future, FirstGene, to order MyRisk with Precise Tumor. I mean, that's what one of the big oncology practices said to us at ASCO. Absolutely.
And basically said, look, if you can build the IT link here so that because we're already doing MyRisk with you, where they're a predominant provider, if you can build this IT link so that we can order the somatic offering Precise Tumor, at the same time we order MyRisk and you can send us one report, the business is yours. So we went and gave PwC $4 million to go do it because that's what we're spending money on. So this is going to take time, you know, orders, years, but over the next couple of years, we are building, we are building something pretty special here and something that is, you know, sustainable and that we think is going to create a lot of patient value and a lot of value for shareholders. And with that, I think we should move on to lunch, right?
Absolutely.
One more question.
Hi, Nelson Tong, I'm asking a question for my team, Brandon Couillard from Wells Fargo. So we noticed that regarding your actionable market opportunity that you presented in your slide this year, they are a little bit different from the market size opportunity you presented last year. For example, for the affected hereditary cancer test, I think you have $1.7 billion for this year and last year were $1.2 billion. And then for unaffected was $4.63 billion. And for the pharmacogenomic test, it was $2 billion this year and last year was $5 billion.
Time out. Time out. We're not marking to market on what we think the size of the markets are from one year to the next. What we do, we have a whole team of market intelligence people that are trying to get the best data about where the market is.
The market's moving fast. I don't even think the data's right, quite frankly. I think it underestimates that adoption is still low in most physician offices. They don't, as Dale talked about, they don't understand genomics. And so a function of consolidation, us continuing to advance, you know, differentiated tests, we just think there are large markets out there. I'm happy to go through with you on the side, but we're not going to try to reconcile to last year's market intelligence. We've just updated that to what the best information we have today. Okay.
And a follow-up is that for the GeneSight pharmacogenetic test, do you have an update in terms of your clinical utility, economic studies?
No, we're disappointed. We were disappointed by the end of this year. Well, first of all, we're going to publish phase I.
We're going to publish phase one, which showed significant differences in those patients that took the GeneSight test in terms of hospitalization and utilization. We were not able to get the data, and Dale can explain this more eloquently, to appropriately figure out how much of those savings were attributable to GeneSight. Okay? So it doesn't mean logic would tell you, given the magnitude of those savings, that GeneSight had a causal relationship to better medically managing these patients. So we're still working with Optum to try to figure this out. But I will tell you that what people should anchor on is that the mental health crisis in America continues to be a problem. Nurse practitioners and primary care officers are on the front line of this.
They are desperate to get patients on the right drug faster so they can start dealing with the rest of the patient's conditions. And that's what GeneSight does. And we're going to continue to develop the science to support that. But that's the value proposition, and that's why it's growing, and that's why more payers are paying for it. So happy to follow up in more detail. All right. Well, listen, thank you all very much. Thanks for my partners here. Mark, get better. Probably didn't do as good a job as he would have done, but really appreciate everyone's support. Again, it's been a big year since our equity offering on $17 last year. So thank you, and please join us for lunch, and we can continue the conversations there.