I cover life science tools and diagnostics here at Leerink Partners, and it's my pleasure to be hosting the NeoGenomics team. Thanks for making the time and coming here. Tony Zook as CEO. Abhishek Jain CFO, and Warren Stone joining as COO, and Kendra is in the audience.
Hi, Puneet
to have you guys here.
Thank you for having us.
Not too far from the home. Yeah.
Yeah.
Not too far from the home base.
This is close to home for us.
Maybe just to, you know, kick off, you know, I would love to, Tony, first, I would love to hear from you. First year as a CEO, number of learnings, but really, you know, obviously you knew the company from board level. Maybe just give us, you know, top one or two underappreciated learnings that you didn't see before and now you have. Maybe what are you proud of? Maybe what you would have done differently, you know, in the early days?
Yeah, yeah. Great question. I think I guess if I were to step back and say, you know, what would you have loved to have been able to turn the clock back a bit?
Mm-hmm.
I would probably say, Puneet, if we could have turned the clock back a few years, and I would say even from the Board Chair and then migrating into the role, the whole profitability balance.
Mm-hmm
I think at times has potentially hamstrung Neo just a bit, right? Because we were almost equally focused on revenue and profitability.
Mm-hmm.
I think there are opportunities that we could have invested in maybe just a little bit sooner, that could have driven additional growth. I say that because I'm even more confident now that I'm seeing the results. For example, in the past, I would say that there was not a tremendous alignment between the commercial and the R&D groups relative to product ideation, product development, having consistency across the enterprise. That has taken drastic steps forward in the last, you know, 12-18 months. The teams are working extremely well, and you're starting to see the proof of the pudding beginning to work its way through the system, right? You saw, you know, PanTracer, you know, PanTracer HRD, PanTracer Tissue, now PanTracer Pro, you know, liquid biopsy, RaDaR ST beginning to flow.
There's more of a cadence now, excuse me, and a rhythm to what's starting to work its way through the R&D pipeline as an organization. I think there is an opportunity that something that we are doing even better than I envisioned we would be doing it at these early days.
Mm-hmm.
Had we invested even a bit earlier, we may have had the advantage of some of these products even sooner. I think the second area that I'm very proud to see, our operations team have done some amazing things, and I respected it. I don't think I truly appreciated it, because so much of it is done on just pure horsepower, right? We've seen these ever-increasing volumes, and yet the people in Warren's shop have improved turnaround time profiles and all the other key metrics within ops look extremely promising, right? I again see there's untapped potential there if we aren't just effective, but efficient.
Mm-hmm.
I think that's an underappreciated asset that we have as an organization. Then the final piece I would say is we have actually a very good and growing talent base. Some of the new talent that's been coming on board over the last 12-18 months has been really strong, embracing new ideas, bringing new ways of thinking into the company. Those would probably be the areas that I would highlight.
Got it.
Yeah.
Abhishek, I know it's been just a couple of weeks for you. I'd love to hear your philosophy, as you were thinking about this role.
No, absolutely, Puneet. First of all, great to meet with you, and I look forward to working with you, Puneet. It's been week six with NeoGenomics, and if I talk about my philosophy starting from the guidance, I think I always would want to have a very high degree of confidence to be able to meet the numbers that we are putting up there, and if things were to pan out the way we are anticipating, then hopefully beat the expectations. So a high degree of confidence as far as the guidance is concerned. But I don't like to be too conservative, and be in that like, okay, that you'll be beating every single time with a long shot.
Okay.
The second piece is profitable growth. In my mind, growth stays the most important value driver for a company right now. Then I say profitable because this is the balance between, okay, of the incremental dollars, how much money do you really need to invest back into the business to continue to kind of drive the growth in the further years, and then how much of that incremental dollars you need to drop to the bottom line to expand your margins. Profitable growth becomes extremely important to me. Third and final piece is around the capital allocation and the cost management. How do we stay prudent in terms of managing our expenses, especially around the G&A side of the house?
How do we drive the leverage, and how do we kind of use the benefits of the automation to be able to drive the efficiencies within the organization? I think those are the three things that I would call out on the philosophy.
That's great. Let me switch gears and I wanted to talk a little bit about the guidance and unpack that a bit. I mean.
Mm-hmm
You're expecting 9%-10% growth. You've talked about ASP benefits through the year as you retire some of the, you know, low-value maybe Pathline tests. There was a contract, and a low-value contract. Maybe we'll touch on that as well.
Mm-hmm.
I think AUP was a significant discussion in the quarter, and I just wanted to maybe if you could take a minute and help clarify as to, you know, the puts and takes there, for the AUP through the year, especially in the first half.
Mm-hmm.
How do we. You know, this is. There's a large jump from 1 Q to 2 Q there. Maybe just walk us through what's happening there.
Absolutely.
Would you like me to kick it off on the volume piece?
Yeah
you can finish it off with AUP and then the resulting impact?
Absolutely. Please. Yeah.
Is that fair? If you step back, Puneet, as you had mentioned, we had talked last year about two contracts.
Mm-hmm
That were relatively high volume but low in value. If you remember, that caused that first sequential decline in AUP that caused some concern that we then had to monitor closely through the course of the year.
Mm-hmm.
It's one of those contracts, right? It was with a reference lab. Just to put it in context, it was high volume, so it was almost 3%-4% of our volume, right? But the AUP that we were generating from this one test was just about $200.
Mm-hmm.
You know, when you enter these types of contracts, it's always with the belief that, okay, you know, we're gonna show what we can do, but we wanna move up the value chain and be able to secure some higher value business as well, and we just couldn't get to that same point with this customer, right? You're looking at a world where you have, yes, high volume, but this low AUP that inevitably is just going to be a downward price spiral. When you looked at the resource that we were using internally for this, it just didn't make good business sense for us. We had made the conscious decision that, well, no, we had to exit this, right? When you then ripple that through, there was an impact, a sequential decline in volume in Q4.
We would anticipate the remainder or the bulk of the remainder of that contract coming through again in Q1, so a sequential decline in volume in Q1.
Mm-hmm.
we would get back to sequential growth starting in Q2. In fact, Q2 volume should be flat year-over-year, sequentially up from Q1, and then up again in Q3 and Q4. it's working through one contract with one reference lab, with one modality. It wasn't across modalities or across a broad customer base.
Mm-hmm.
That'll just give you context for how does that affect AUP and how did that affect the guide.
Yeah.
That's helpful.
No, absolutely.
I'll let you take over now.
No, thanks, Tony, for setting the context here from the strategy standpoint. Now from the guidance standpoint, what happened, Puneet, last year in 2025, we basically drove the clinical revenue by 15%. 12% came from volumes, and 3% came from AUP. Now, in that result, the breakdown between the volume and the AUP, we had two factors going on. The first factor was Pathline, and the second factor was this one contract, right?
Mm-hmm.
This time, actually, what we did just before this fireside chat, we have updated our presentation on our investor relations website, and we have added one slide there that basically provides more color on this dynamic. The point there is that, okay, if we were to kind of remove the impact of the Pathline and this one contract-
Mm-hmm
Our volume growth for the overall business is going to be in the mid-single-digit. It has not changed year-over-year. It has been very similar to what we have seen in the prior years and is going to be very similar in 2026. Exactly the same on the AUP as well. If we were to take out the dynamic of this high-volume, low-value contract and Pathline, we would be growing our AUP in the mid-single-digit. That's what we did in 2025, and that's exactly what we're anticipating in 2026. Now, maybe if you were to see it from a slightly different angle, Q4 2025, our AUP growth was 5% year-over-year. Now, if you look at Q1, Q2, and Q3 of 2025, we have been growing about two to three points.
We increased it to 5% AUP growth in Q4 because we started to flush out the high volume, low value contract. That basically gave us two points.
Mm-hmm.
We have not completely done with that contract because we are gonna further flesh out in Q1 the remaining portions of that contract. That 5% can easily become the high single digit from that standpoint, right?
Mm-hmm.
That gives us the confidence that, okay, the way we have provided the guidance on the AUP, we will be able to kind of meet the expectations because, number one, the underlying business is exactly the same, excluding this one contract, and number two, the Q4 2025 results are the proof point as to that higher AUP as we kind of exit from this one contract.
Got it. That's very helpful context because I think that's. It's raising a number of questions just looking at the cadence, so thanks for clarifying. Maybe-
Just one comment.
Yeah, please.
You said the Q1 to Q2.
Yeah.
That is the Pathline washing out.
Yeah
Pathline annualizes at the end of this quarter.
That's right. Yeah.
Going to Q2, there was a headwind on AUP.
Mm-hmm.
That headwind washes out into Q2, so that's why you sort of see this spike again as well.
Okay
It's another dynamic to just keep in mind from an AUP point of view.
Just on the AUP front, obviously historically that was driven more by NGS addition, more higher value tests coming in, and that's lifting the AUP line. Now, with this elevated number, I just wanna make sure how should we think about this longer term? Is this something that you expect will remain stable or, you know, should we expect an uptick from this?
I would definitely feel that we will continue to see the impact as we kind of launch our RaDaR ST testing.
Mm-hmm
... number one, because we may not be getting all the coverage from the private payer, so that could be a little bit of a headwind on the AUP.
Mm-hmm.
For the outer years, I would definitely feel the AUP will be a tailwind for multiple years to come.
Got it. Yeah.
The reason for that is that two-thirds of our portfolio is our direct client base.
Mm-hmm.
On that particular portion of our business, we're able to kind of implement the price increases every year. That is a pure play pricing increase that you can actually get the benefit. The second piece on the AUP growth is the mix, as you were calling out. At the same time, as we kind of get these private payers to pay us, as we start to look into 2027, 2028, that will be all accretion to not only the growth margin expansion, but this will be all accretive to the bottom line. I see the pricing increase to be a multiyear kind of a process where our RCM initiatives and our pricing increases and then move to the higher value tests, they will be actually driving the AUP growth.
I think the other aspect and which is why we wanted to create more visibility into it, Puneet, was around the NGS growth rates.
Yes.
You know, when you look at it in totality, right? Our NGS volume represents, you know, 9%-10% of our volume. It's about a third of our revenue, right? It has been growing at, you know, 22%-23%, and we don't anticipate seeing that slow down in 2026. That's also going to be a contributor to this ongoing growth.
Yeah.
A number of questions there. I mean, on the NGS front, maybe this is for you, Warren.
Yeah.
In terms of, you look at the market space today in tumor profiling, you know, a company like Foundation's been there for a long time, then Caris and others have come in, obviously reference labs. Other reference labs are also
Mm-hmm
providing tissue testing. There's a leading CGP liquid provider as well. Just given the nature of the competitive landscape of the market, you know, how should we think about the NGS growth that just Tony referenced to? How is that something that you believe is sustained? I recognize you guys are really strong in the community setting-
Yeah
is that sustainable? Because obviously these competitors have larger sales forces today than ever before.
Yeah. That's a great question, and I think, a few points I'll touch on. First of all, exclusively focused in the community.
Yeah
That's our target space. Even within that community, we focus heavily on prioritizing customers and deciling physicians. Really trying to be more surgical in terms of where we invest the time of our salespeople, because as you said, we've got a smaller sales team, but let's use them as productive as we can. Those are sort of the philosophies that we drive. I think two additional points I'd like to make is there is NGS on the heme side of things is one of the areas where we're differentiated. A number of the companies you just mentioned don't have an offering there, and four out of 10 patients walking into a community practice are going to have heme cancer. These physicians have a need on the NGS side of things from the heme perspective.
We're in the door. We've got a seat at that table already, not just with NGS Heme, but other products at Heme that they may find valuable, like COMPASS, as an example. We use that position in the community then to expand.
Mm-hmm.
You remember our commercial strategy, protect, expand, acquire, so protect existing customers, but expand within existing customers. This is exactly the expansion. Provide a great experience around our Heme NGS and other portfolio, and use that as a mechanism to expand into other areas. This is where the PanTracer Tissue comes into play, PanTracer liquid comes into play. We find through the good experience and the benefits of having a holistic portfolio, which is often supported through an integrated bi-directional interface, actually pulls through additional volume. You know, a great use case we showcased this before is we launched PanTracer Tissue in March of 2023, so we're actually pretty much three years ago.
Mm-hmm.
In the first year, we generated some volume. We doubled that volume the next year, and we just about doubled it again the year thereafter. That's a demonstration of our ability to pull through volume in the community, and we think it's a great proxy as people start to think about PanTracer liquid as another product that we're bringing to market.
All right.
I think the only add to that is. You're right, you know, the other competitors do have larger sales forces, so we are still under-indexed there. The value that our incremental investments have been giving us in sales force have become more and more evident, right? I think this is one of the areas where behind the scenes, we've put a lot of work into place on launch excellence and sales force excellence initiatives. You know, we are seeing now, we saw this 14% growth in the number of physicians using five or more Neo tests. You know, we're now up to about 40% of practicing physicians and oncologists using five or more Neo tests. It almost mirrors the growth with these investments that we have continued to make.
Mm-hmm
with the field force. I agree that our competitors are strong and we may be under indexed, but it's creating real value for us. If anything, there's probably opportunity for us to further penetrate and go after the remaining 60%. Because once people start getting accustomed to working with Neo, they seem to enjoy the experience, and they're staying with us.
Can I actually just put one more plug in there?
Yeah.
One of the things that I'm particularly proud of, which I think is a proof statement as well, is we measure NPS score every year. We do it twice a year, typically first half of the year, second half of the year. I'll be the first one to acknowledge that three years ago, our NPS scores were good, but they were actually poor in the oncology setting in the community. We've actively taken that feedback and looked to improve. In December of 2025, so three months ago, we did our NPS survey. It's run independently by a third-party company. About 1,400 people responded to that. About 50% of those 1,400 were-
Mm
Community oncologists, identifying as community oncologists. For the first time ever in my history, and it's only three years, so the first time since I've been at Neo, the NPS score of oncologist outstripped the NPS score of a pathologist. An oncologist came in at 80.1 or 80.2. An incredibly high score, and it's a demonstration of the things we've been doing behind the scenes to create a better experience for these community oncologists across the continuum of care. That's why we believe that we've managed to get a 14% growth rate in new physicians dealing with Neo with five tests or more in 2025.
That's great. Just on that point, I mean, where do you stand with the overall sales force on the oncology side, and the plans for expansion and how are you thinking about the overall, you know, OPEX spend on that too?
Yeah. I come back to this, probably one of the things maybe Tony was alluding to at the beginning. This is one of the areas where I think trying to balance profitability as well as and growth is being maybe at odds with each other in certain places, 'cause I personally, I'm also in charge of sales, would have loved a bigger sales team. We have also taken a very methodical approach around investing in our sales team, and we've always done it ahead of the launch of new products or the new indications. We invested in new sales people towards the very end of 2024 into 2025. We had a PanTracer liquid coming out. And that took us to roughly 140 people.
The breakdown there is about. It's not quite 50-50, it's 60-40. 60% are what we call territory business managers. They're targeting hospitals and the pathology business. The OSSs is the 40% today, targeting community oncology. As we've rolled into 2026 and launched RaDaR ST, head and neck HPV negative cancers has a new core point to us, which is the ENT, and we've invested in a small sales team there, roughly 10 people, dedicated towards the ENT and for RaDaR ST head and neck HPV negative. That's an additional OSS team. Then in anticipation of approval of two additional indications for RaDaR ST that we've submitted, we anticipate those approvals to take place in the latter part of the year.
We're gonna be investing in another sort of 25 or so oncology sales specialists in the third quarter. Again, ahead of those approvals, so that we're up and running when they are approved. That again will take us to roughly 165, and for the first time you'll see a higher index towards the Oncology Sales Specialists versus our Territory Business Managers.
Interesting. Abhishek, anything on the OPEX side, I mean, as you think about this ramp?
On the OpEx, the way I'm kind of thinking, Puneet, is that, okay, we need to provide sufficient investments within our sales organization, which as Tony was saying, is that under-indexed as compared to some of our competition. We need to make sure that we have enough boots on the ground to be able to kind of gain the market share. At the same time, we're gonna stay extremely prudent as to how do we ramp that sales force. That will definitely be a kind of. We will be watchful there. Overall, on the operating expense, I think from the philosophy standpoint, like making some rightful investments to be able to drive the growth, that will be the priority.
Number two, a little bit in the R&D so that we can drive the payer reimbursement of the coverage, so that can again assist our top line growth. The third area of investment would be the LIMS or some of the IT infrastructure, because we have not spent or invested the amount that we should have, like, a few years ago, so that we could actually start to use the benefit of the automation, not only in our lab, but across the organization. Those will be the three areas of investments, and everything else is going to be flattish or lower as we kind of look forward from here.
Any thoughts on Adjusted EBITDA in terms of?
Mm-hmm.
Adjusted EBITDA margins were, I believe, flat in 2024, 2025. Though I think they were still at 6%. You know, how should we think, investors think about Adjusted EBITDA improvement given the context of the amount? You know, I mean, obviously a number of things that you wanna push on with the investments and on the sales force side. Yeah.
Yeah. No. It's going to be a balance, Puneet, because in 2026, our guidance basically assumes about 100 basis points expansion in the Adjusted EBITDA from 6%- 7%.
Mm-hmm.
We are actually growing Adjusted EBITDA by about, like, 29% at the midpoint of our guide. We have been very thoughtful in terms of making sure that we stay prudent in terms of making the investment in the rightful areas, and then dropping the part of the incremental dollar to the bottom line. Having said that, my sense is 2026 is still a year where we are making more investments. As we kind of look into 2027, 2028, once these newer products basically start to become a little bit more mature, you will start to see a lot more expansion on the Adjusted EBITDA line.
Just given the, you know, knowing the cadence of, you know, getting the reps and expanding on new products.
Mm-hmm.
getting the penetration, can you maybe just sort of give us a glimpse into when you start to see maybe potentially a significant ramp in volumes as a result of these investments?
We've done these sort of serial increases in sales team members sort of every-
Mm-hmm.
I don't know, eight to 12 months, we've really focused on onboarding and time to productivity and trying to get better and better. It's not. It does depend a little on the profile of the person we recruit. Is this the prior territory of theirs, and do they have relationships? Are they coming directly out of community oncology setting or they may be a pharma rep? You know, there's different dynamics, but we typically see it somewhere between the six to eight month range. It's in that sort of range. Some of the growth that we're obviously seeing in the first half of this year can be contributed towards the sales reps we hired in back end of 2024, early 2025 that are now in stride.
We're definitely gonna benefit from that, and as I said, we'll have some additional sales reps coming on board early in Q3 as well.
I wanna touch briefly on PanTracer liquid and as well as RaDaR. On the PanTracer, you now have a full suite of PanTracer, both liquid, solid and liquid. Maybe just remind us conversations on MolDX side and then, you know, in terms of what's the traction for the liquid side?
Yeah.
Yeah. On the conversations with MolDX, and then Warren can take on the traction side. They've been ongoing. They've been good conversations in my opinion. What we have seen across the landscape, it's taken about 12 months for new products, so about four cycles through MolDX. We're not quite at that point yet. We would be at that point in early April. What I would tell you is that through the cycles, the number of questions that have come back to us have become fewer and fewer. We've not been asked to do any kind of additional wet work or anything like that. It's provide additional information or data around a specific point or two, which we have happily provided.
We still are fairly confident and optimistic that right around that 12-month window, we should be hearing something. The guidance was a different story. You know,
Mm-hmm.
We just wanted to exercise prudence. That's why we only put it in the second half with limited revenue because then it would represent-
Yeah
opportunity for us. We're still relatively confident. Again, no additional wet work, nothing out of the ordinary from our perspective.
I think in terms of uptake, we've been very pleased with the uptake. Uptake across two elements for me. The first one is how much absolute PanTracer liquid is being requisitioned. We've seen a healthy uptick sort of month-over-month or quarter-over-quarter since we launched right at the end of July of 2025. We're obviously incurring those costs to result those tests right now, but we're not actually receiving reimbursement based on what Tony had said.
Mm.
We're building a really good funnel of business at this particular point and quite a nice geographical dispersion as well in terms of where this business is coming from around the country.
Mm.
The other area which I've been particularly pleased with is just the overall increase in the category, our PanTracer family portfolio. Again, PanTracer Tissue, PanTracer Tissue + HRD, PanTracer Liquid , and our PanTracer Pro. You know, as we launched liquid, we saw an inflection point in terms of the growth of the category overall, driven by liquid and solid tumor. We've just, we've also now recently launched PanTracer Pro, and we've seen exactly the same thing again. We see these inflection points. Both the individual test, but the actual category both doing really nicely.
Got it. Okay. On the RaDaR side, if I could switch to that in the few minutes we have here. Maybe just remind us, I mean, maybe how many oncologists were or oncologists that were using RaDaR 1.0 or before, are those the ones that are suitable funnel for ordering this test? Maybe just, I know it's been a couple of weeks since the launch, so, wondering if you can give a sense of what kind of traction are you getting from oncologists.
Certainly. Go ahead.
Go ahead. I'm sorry. Certainly prior users of RaDaR were, and is a subset of our targeting because when we launched RaDaR in 2023, it was more we're in sort of an EAP program and it was very much a PanTracer pan-cancer type approach.
Mm.
We've taken those users who are still sending us time points today for many of their patients, that they're still sending us time points. We have relationships. Those that are in indication have absolutely been targets for us. They head and neck HPV negative and the subset of breast. We've gone after them and we've had one of the prior physicians actually already requisition a new RaDaR ST. In terms of uptake, it's been a little over a week. We have had multiple orders coming in already. I'll give one example in a moment, but what has been incredibly helpful for us is access to the community oncologists has significantly increased, 'cause we've got something new to talk about, something that's relevant.
Again, it adds to our solution from a continuum of care perspective. Access is up. We've seen dinner programs, lunch and learns. These are all sort of pre-indications of what's likely to come. First tests already in the lab, which is really encouraging. One thing I want to call out in two of the tests that have already arrived in the lab, the requisition wasn't only for RaDaR ST, it was for RaDaR ST, PanTracer Tissue, and some auxiliary tests. These were. I've actually reached out to one of the physicians myself to find out like, "Tell me why you did that," just for my own insight. It's really around this particular physician, A, appreciates the value of our portfolio, but was very concerned about tissue preservation and recognized that they wanted to do multiple testing, not just MRD.
They wanted to get the CGP insights as well as some particular auxiliary insights. They were concerned that they would exhaust the tissue. By sending it to one lab that could do everything was their solution here. That's why this particular physician sent that to us. We have two such examples already. Demonstration of the value of a breadth of portfolio.
Yeah, sort of the one-stop shop that
Yeah
-you always talked about. On the just maybe last one, on the competition front, on the MRD side, obviously a number of companies are talking about their scale, the presence in the market. Obviously, you have a strong presence in the community setting.
Yeah.
Is there any reason why you can't, you know, do with MRD what you did with NGS in that market? You came later in the market with NGS. You're similar, in a similar way you're coming in a bit later, but again, not as late as even NGS, you know?
Yeah.
Yeah, how do you know, how should one think about the penetration of RaDaR or the uptake, growth overall?
I think we're thinking about it in exactly the same way. I think your comment that we actually, with RaDaR ST, we're nowhere near as late as maybe what we were with
Yeah
...with our PanTracer Tissue, if you think to Foundation Medicine as an example.
Yeah.
We've done a lot of work since then around improving our experience that I touched on, a lot of the tools we need to be successful. We certainly believe that what we've done with PanTracer Tissue is a great proxy to think about how we can penetrate the market with RaDaR ST, and we'd like to do better than that as well.
Yeah. Well, that's all the time we have. Fabulous. Thanks for your comments, guys.
Thanks for having us.
Okay. Thank you.
Yeah.
Many thanks.
Thank you very much.
We appreciate it.
Yeah.