Perfect. Good afternoon, everyone. Thanks for joining us. I'm Andrew Cooper. I cover diagnostics here for Raymond James. Happy to be joined by the team from Myriad Genetics. I'm going to hand it over to Paul for a presentation, and then we'll go down to Amarante 1 for a breakout immediately after. Thank you. Paul?
Great. Thank you, Andrew. Thank you all for participating, both here in person and online. Excited to update you on the progress that the company continues to make and how we're working through some of the noise in and around, you know, the space right now and around our particular story. We'll refer you to take a look at our website, a lot more information about the company and obviously our financials. You'll find additional information about our non-debt financial measures, et cetera. Please take a look. Really proud of the progress we continue to make at Myriad Genetics in bringing precision medicine into the mainstream in terms of the provision of healthcare. I mean, the opportunities are still enormous.
I've been in the space for five years now, but I'll tell you, I was really drawn by the mission of the company and the opportunity that precision medicine still brings to the healthcare system at large in terms of early detection, enabling providers to better detect, treat, and prevent disease. That mission and the 1.6 million patients that we touched last year really are the core of what drives us. I think the opportunities are still significant for an industry that in many respects is still sort of working through its adolescence and challenges. For those of you not familiar with Myriad , we have been a pioneer in molecular diagnostics and precision medicine for many years, over 30 years of track record in terms of scientific and commercial achievements, over 55,000 providers across the channels that we serve.
Really deep relationships, a 72 Net Promoter Score for those of you that know Net Promoter Scores. That is awfully high in terms of what providers, payers, and our patients think of us. It's a very important part of our brand and that experience that we have. We'll talk about the financials, but a second year in a row of double-digit growth, and really feel like in terms of the balance sheet and our margins, we're well positioned to move forward. We've been on a journey since the pandemic. At Myriad Genetics, like many companies, we strived over the last couple of years to continue to innovate and grow, but also to reach profitability and free cash flow generation.
Quite a turn in terms of our fortunes financially, at the same time as we've rebuilt the company through our lab of the future and other technology investments. We'll talk about our pipeline of new products that we are excited about. We continue to look at, as we think about beyond 2025, double-digit growth and maintaining 70% gross margins, hopefully building on that with some of the automation initiatives that we have. We're just really proud of the team and how much progress we've made over the last few years. As we've worked through a number of different industry and related challenges. For 2024, again, we delivered on our guide, raised mid-year, representing a total 11% revenue growth. That's 15% U.S. domestic.
We did execute on a transaction in the middle of the year to simplify our operations and divest our international EndoPredict business, and you can see almost $600 million of adjusted gross profit, $40 million of adjusted EBITDA, $0.14 of EPS. We carry about $40 million on an ABL. So that's our only debt. We have no converts out there. So our capital structure is really very clean. This year, we'll probably have about a $20 million-$30 million cash burn here in 2025. We have ample liquidity to continue to grow the company, finance our operations, and look strategically at new opportunities. We'll talk about the pipeline more here in a minute, but really excited about the progress that we're making with Precise MRD. Obviously, that is a huge market opportunity for those of you that have been following the space.
We certainly think that we will have a competitive market position, particularly at the more sensitive parts of the indications. We are focused on breast. We expect to go to ASCO this summer with probably six or seven studies. We are running samples for pharma today in MRD and getting really good feedback from our pharma partners. More to talk about that in a minute. We organize in three commercial segments: oncology, women's health, and pharmacogenomics. I'm going to go into those for just a minute and again, leave time for some questions at the end. You know, oncology is probably the area that we're the most excited about in terms of, as I mentioned, Precise MRD and how that fits in.
The core of our strategy, and I would like you to think about it in the context of being a patient or the relative of a patient or a community oncologist, is that people do not want to go to multiple labs for their advanced diagnostics. They want products that are in guidelines, products that have proven clinical utility and ease of use. When we think about the community oncologists that we work with, we are thinking about from early detection through diagnosis and therapy selection to monitoring and, hopefully, remission, trying to have highly differentiated tests at all those different points of the journey. This is where NCCN guidelines are going to, and I'll give you an example of that in prostate, but certainly that is something that we see in breast cancer as well.
From MyRisk, our hereditary cancer product, to Precise Tumor that we acquired through the acquisition of Intermountain Precision Genomics last year, to the launch of Precise Liquid and Precise MRD in 2026, we think we'll have a much fuller continuum, and through the EMR integrations and other commercial things that we've invested in, a really easy-to-go, reliable place to get your diagnostics for cancer care. Again, bringing more clarity to genomics and genetics in oncology is really what we're all about. Part of that MRD journey is certainly getting the clinical evidence. Again, we should have a number of different studies. One of the things that we're excited about in order to accelerate our clinical evidence generation and do it efficiently is our five-year alliance with MD Anderson Cancer Center. A lot of great progress with that partner.
As I mentioned, NCCN guidelines have expanded for our core products, including hereditary cancer for breast cancer and for prostate cancer. I'll dip into prostate cancer in a minute. I am really proud of the progress that we've made in oncology in 2024 and excited about the future here. One of the things that we are terribly excited about that's going to improve our competitive position in prostate cancer is the partnership and collaboration and licensing agreement that we entered into with PATHOMIQ. PATHOMIQ is a company we have been following and doing pilots with for over a year. We are really impressed with the technology that they have developed and really impressed that they are prostate cancer folks by development. These are not AI folks who just decided to get into oncology.
They have deep relationships with KOLs and they have many years of experience in prostate cancer. We are excited to come to market with this clinically validated test, and reimbursement hopefully by the end of the year. The strategic collaboration affords us a number of other opportunities that I just want to highlight for you for a second. First, it really complements Prolaris. As you will see on the next slide in terms of the patient journey, you know, we have clinically superior data at the time of biopsy, but we have not had a test post-RP after surgery or after radiation. That is part of what this collaboration gives us. It allows us to expand into that post-RP market where Prolaris does not live today.
Importantly, one of the points that one of our competitors has done a really good job with in terms of competitive differentiation is Simon Level evidence. Simon Level evidence is something that is unique to prostate cancer. NCCN has not adopted that for other cancers. They created, quite frankly, a lot of confusion in the marketplace here recently. We are in advanced diagnostics. We are in guidelines for prostate cancer. What PATHOMIQ is going to allow us to do is get access to the samples that have been part of our challenge to get to Simon Level 1 evidence. When you think about the journey for prostate cancer, 300,000 men get diagnosed with prostate cancer at the time of biopsy. That is the biggest part of the market.
That's where we have lost some share, but we think that some new commercial efforts that we're making and this PATHOMIQ deal allows us to re-energize our ability to win and regain share that we've lost at the time of biopsy. As I mentioned, what it also gives us is post-surgery, post-radiation, the ability to compete that we haven't been able to do before, and importantly, move us to Simon Level 1 evidence for both PRAD, which is the PATHOMIQ product, as well as, excuse me, as well as Prolaris at the time of biopsy. One thing that we have tried to communicate that has lost in some of the noise around Simon Level evidence is the fact that importantly, the new NCCN guidelines also talked about the importance of germline testing for metastatic patients and tumor or somatic testing.
We are the only company today that can offer all these products in terms of a prostate journey. We've got another competitor that is working on this, but certainly our main competitor in prostate cancer cannot offer this comprehensive set of offerings for radiologists, oncologists, or urologists treating prostate cancer patients. We are excited about the overall messaging in terms of NCCN guidelines here. We'll talk about women's health in a moment as well. Very competitive area where we've seen some dislocation and some market consolidation. We are certainly participating in that. We've seen some nice growth in our prenatal products. As I'll talk about in a minute, we've launched some enhancements in next generation to both our carrier screening and our prenatal product.
We're very excited about our FirstGene launch that I'll talk about in a minute that brings together a number of different assays in terms of carrier screening and prenatal testing. I'm going to hit this in a minute, but really nice growth this past year in prenatal. We think there are still market share gains as the market continues to consolidate and continue to advance our clinical evidence generation in prenatal testing as well. Continued improvement in rev cycle and improving ASPs for prenatal products. Our 2024 results, a big part of our gains in 2024, and we imagine that continuing in 2025, is the improvement in average revenue per test that we are seeing and we continue to see coming into the year through our rev cycle efforts and our payer markets efforts.
I mentioned two new product launches that just got going here at the end of 2024 that we think will continue to help us grow in our prenatal market, Foresight Universal Plus, which is an expanded carrier screening panel. Despite ACOG, you know, not moving to these new guidelines, we've seen a number of commercial payers start to move in this direction. You know, that should provide a little, some tailwinds for us. Obviously, ACOG's expansion of guidelines too should, would be a really big catalyst for us if you, if you're thinking about, you know, what are the upsides in our guidance. Similarly, at the end of the year, we launched very exciting Prequel at eight weeks. Eight weeks is where most women do their prenatal care.
If they, most of the time now, they have to come back at 10 or 12 weeks to get a blood draw. The ability to give a woman, and particularly given reproductive rights challenges that we have in many parts of the country, the ability to give those answers with a clinically validated test, high accuracy, we have the lowest failure rate of anybody in terms of NIPS testing at eight weeks is something that we've gotten a lot of energy around and should be a good catalyst for growth here in 2025. Pharmacogenomics, we had a really successful year with GeneSight in 2025. Those of you who've been following the company know that we had a setback with UnitedHealthcare and their medical policy team. That was a decision broadly across pharmacogenomics.
We continue to make the case that GeneSight is differentiated in terms of clinical evidence. We have the randomized trials that we have, and we're going to continue to work with the medical policy team and others at UnitedHealthcare to try to reverse this decision or more likely get a carve-out for GeneSight because it really doesn't belong in the same universe as the other PGx testing. We've put a number of mitigation strategies in place. We still believe we have a path, having achieved profitability in GeneSight, to get back to profitability here over the next couple of years. You know, again, despite the UHC reimbursement cut, we expect probably 9% or 10% growth in GeneSight in 2025 as we mitigate that reimbursement cut by United. I'll just touch upon the pipeline, you know, really quickly.
Again, I've mentioned Prequel at eight weeks, FirstGene, which we will launch, soft launch later this year, a full commercial launch at the beginning of 2026. Really excited about the answer that that gives to families in terms of carrier screening as well as NIPS testing. I mean, you know, access to these answers happens with FirstGene just on a maternal blood draw. That we think is highly differentiated in terms of access for patients, that we're excited to launch. We're also going to be expanding MyRisk in terms of the gene panel to continue its competitive differentiation, and have a number of enterprise initiatives. Worth calling out, we did probably 4,500 EMR integrations in the fourth quarter.
That created a little noise in terms of our volumes and the transitions. Those of you that saw our fourth quarter results, we, while we made guidance, we were disappointed a little bit in the volume. That was in part because of a lot of these EMR integrations. We are really excited about the traction that we are getting on our breast cancer risk assessment program. Later this year, we are going to be launching our unified order management system. Think about EMR as the front end of a provider engagement and unified order management as our backend, which will really make us more efficient on everything from sample collection to reporting inside the house at Myriad Genetics.
We continue to look at partnerships as a really good way to deploy, you know, our capital, if you will, when I consider capital in our OpEx as well. Again, we're in a great position in the balance sheet, but we don't need to use it because the opportunities that we see to enter into partnerships like we've done with Intermountain and the acquisition of Intermountain Precision Genomics last year that gave us Precise Tumor and will be followed with Precise Liquid and the partnership with PATHOMIQ that I referenced earlier allows us to do what we do well, add to our portfolio without, you know, a significant capital deployment. We are excited about these kinds of partnerships. I think you can expect Sam and the team to do more in the year and years to come.
I've mentioned most of these, but these are the catalysts for growth for us in 2025 and 2026. The expansion of MyRisk, our market-leading hereditary cancer product. We are running samples for several pharma partners for MRD with really good results right now. That will continue to grow in the back half of the year. We expect to, you know, some nice MRD ROU volume, to start coming in the door. We're already running samples for a couple, as I said, but we've got a nice pipeline of contracts, you know, with our biopharma team. Precise Liquid we will be submitting for MolDX and hopefully launching commercially in 2026. Liquid is going to be really important, you know, 15% of the time we can't get enough tumor for Precise Tumor. That solves that sample collection issue.
Longer term, I think we're all excited about the energy around liquid and the success that, you know, many companies have had out there like Guardant, et cetera. We'll be in a position to compete, you know, more directly in terms of liquid in the years to come. I mentioned Foresight, I've mentioned Prequel and FirstGene. Really excited about the expansion of our product offerings in women's health as well. A few minutes on financial results for Q4 and 2024. Again, 11% top line growth for the second year in a row driven by hereditary cancer, prenatal 17% growth, and GeneSight, 23% growth. We expect the portfolio in terms of the core to continue to grow at double-digit rates. That's sort of implied in our guide, that we'll talk about in a minute.
As I said, we had a little bit of a softer Q4 because of some of the interruptions, but still made our annual guide, excited about the continued growth in our gross margins at 72%. Q1 will be a little softer because of mix, but those are really healthy trends for us in terms of gross margins. We certainly expect to continue to build on that now that we've completed our lab of the future integrations or nearly completed that. There will be more automation that happens later this year in terms of the robots and what we call project arches. We continue to be pretty disciplined managers of operating expense. I would call your attention to the adjusted operating expense and EPS. We spent more to accelerate our studies for FirstGene and MRD.
That's why you saw a little bit of a pop of operating expense in Q4. That was purposeful. Now that we have crossed that line, we've realized that we need to drive growth. We need to drive more clinical evidence generation, but we remain profitable at $0.03 . You can draw a line between that bar chart would have been profitable if we had not made those strategic investments, and they were purposely made. I've mentioned this again, the adjusted gross profit growth, adjusted EBITDA of $40 million. Not a lot of folks in our space can talk about EBITDA, quite frankly, at this point in their journey. A great position in terms of the balance sheet, nearly $160 million of liquidity. Expect around a $20-$30 million cash burn this year.
Ample liquidity to run the business and, and to continue to grow. Guidance, we reaffirmed guidance, when we announced earnings, the week before last, and at $840-$860, again, maintaining gross margins, even as we change the product mix, you know, expect as you launch new products, you're going to have lower gross margins, you know, so as we start launching new products, that will, you know, that, that will put some pressure on margins as, as we advance the studies and even in terms of billing and collection. You know, that growth does come with a price and, and part of that price is the investment on OpEx and, and the investment in gross margin and, and the labs, but still profitable.
In order to help investors understand kind of where we are, in terms of leadership transition, everything else, we gave guidance for Q1 just to make sure everybody was level set, you know, for the start of the year. Real feeling good about the year momentum we have in the business, despite the UnitedHealthcare cut and some of the noise around NCCN guidelines around prostate. As we sit here today, GeneSight is still growing. I just want to underscore that. And Prolaris, our prostate test, is still growing. You know, low single digits, but still growing. The bottom has not fallen out on GeneSight or Prolaris, which is implied in the stock price right now.
I just want to reassure our current investors and any new investors that we have our hands fully on the wheel and expect to be able to deliver as we have the last five years on our operational commitments to our patients and providers, as well as to our financial commitments to you all. Longer term, as we get through 2025 and think about 2026 and 2027, we absolutely expect to get back to double-digit growth. That is not new. That is something we talked about at the JPMorgan conference. GeneSight was obviously a big part of our growth. We did come off our 12% growth to say double-digit. It does not mean we have given up on 12%+ growth here over the longer term. That has been a little confusion maybe that we created in the marketplace.
But again, I would think about us continuing to grow double digits top line, maintaining gross margins of 70%, and all the while while maintaining OpEx investments, including R&D at around 5% or 6%. That creates tremendous leverage in this P&L in terms of free cash flow generation and adjusted EBITDA. We have done that and we will continue to do that. I commit to you over the next couple of years and Sam and the rest of the team does as well. Andrew, I may have finished early or maybe right on time, but we can start with some questions here if you would like.
[audio distortion] Yeah.
First, if one thing that sort of caught my attention in one comment you made is, you know, around the carve-out in PGx and that GeneSight is different than some of what else is out there in the market. Maybe dive a little bit deeper there and lay out kind of what you've done to make sure you do have that distinction.
Yeah. I mean, there's a lot of things happening at UnitedHealthcare right now. I mean, they've got no lack of things going on. At different levels of the organization, we are working to try to engage them. The context again for this, this was a decision made by the medical policy team, which kind of stands apart theoretically independently from everything.
But, and you know, those folks determined, quite frankly, appropriately that for the broader PGx universe, there's just not a lot of clinical evidence generation. What we have continued to engage with both the medical policy team as well as other people within UHG broadly is that GeneSight is clinically differentiated, in terms of the studies. And quite frankly, they did not take into account their own Optum Genomics study, which is now being published in the next couple of weeks. We have a meta-analysis, that again proves the clinical validity of GeneSight that'll come out in the next six to eight weeks. And we have some additional data around the PRIME study, that randomized control trial from the VA that goes to one of the, a couple of the criticisms there. Is there persistence after 24 weeks in the benefit?
We've got data that we're going to be going back to the investigator around that. We also have data to support the fact, like the other studies have supported, that GeneSight really does make a difference in terms of the medical management of patients with depression. Anyone here and one out of five Americans are going to struggle with depression and anxiety in their lifetime. It makes a real big difference getting on the right medications faster. That is what the Optum Genomics Healthcare Utility study showed, almost a 30% reduction in spend. I would think that would matter to United when you see lower emergency room visits and lower hospitalizations.
Over the course of this year and certainly going into their policymaking schedule in the fall, Andrew, I think we'll continue to engage and continue to post additional clinical evidence, both to the medical policy team and throughout the United organization, make the case for GeneSight that we think it should be carved out of that policy.
Perfect. Maybe just since we don't have a ton of time up here, you know, hit the other sort of hot, hot button topic of late in terms of Prolaris and NCCN. I think you covered some of it there, but maybe to take it in another direction, you're going to be unique in having that AI capability and the genomic, you know, piece of it together. Maybe talk a little bit about why that's unique and how that sets you apart.
In guidelines, germline, and somatic testing.
True. Fair.
You know, unique. You know, my two favorite slides for all of you in the audience, and you go to our previous deck too on breast cancer. Our goal is across that patient journey for that community oncologist, and that patient to know that they have a reliable partner with trusted brand and science, clinically validated in NCCN guidelines across that entire journey. For investors, that means higher returns on invested capital, more efficiency in our labs. One report. Imagine if you're a community oncologist and you're sending a tissue sample to Foundation Medicine and then you're sending blood work to Myriad or you're sending, you know, that's just not the way our healthcare system is moving.
The 4,500 EMR integrations that we did, that's where we're going to grow share by selling multiple products to large healthcare systems through their EMRs where they can get the data. We're not the only ones. Exact Sciences has done a nice job here in this area as well. You know, that's where I came from and that's where this industry is going to need to go. We're going to have to live in the ecosystem of healthcare systems and large community oncology practices. That means trying to have the key advanced diagnostics they need. There was a lot of noise around the NCCN guidelines, as I've mentioned. We are in guidelines. We are an advanced tool.
We are, honestly, it was a wake-up call for me, and I own this, that with all the other things going on, we did not invest enough in that Prolaris commercial team, and they have now been folded in the oncology team. We're not going to double the size of the Salesforce, but we're making significant investments in the Salesforce, in our KOL strategy, as well as our medical affairs team. You know, we're back in the ring and we're going to compete in prostate cancer in a way that we haven't over the last year or two. That's something that's built into our plan.
Perfect. Maybe, you know, this is going to be a broad question that maybe lets you get into details if you want, but we think about the pipeline. There's a lot of things there. Can you help us sequence when do we start feeling impacts from FirstGene, from Foresight Universal Plus, from Precise Liquid, and MRD in more meaningful ways? Just help us think about the timelines coming together.
Yeah. I think you'll start seeing more Precise Tumor volume this year. You know, we went to ASCO this past June, got a lot of receptivity from that, from people who want to pair Precise Tumor with MyRisk, our hereditary cancer test. Liquid will follow in 2026. You know, strategy's about choices. We did have to sort of prioritize our, we were going to stay profitable, our investments. Again, MRD, we're really excited about going to ASCO this summer with six or seven publications, hopefully, continuing to grow and, you know, essentially launch this in our labs. We're not outsourcing any of this.
We're operationalizing Precise MRD, Precise Tumor in our labs. We think they'll start contributing in 2026 for sure, and we think Precise Tumor will contribute this year. Foresight Universal Plus is already contributing. Prequel at eight weeks is already contributing. When people ask, how do you maintain sort of double-digit organic growth in your core products? It's these kinds of product enhancements that will do that.
Great. We're at the end of time. Again, we'll head down to Amarante 1 for the breakout. Thank you both.
Thank you all.