Myriad Genetics (MYGN) Q4 2025 earnings review
Stabilizing Revenue and Improved Cost Discipline Set the Stage for 2026 Product Cycle
Myriad Genetics closed out FY25 by weathering severe reimbursement headwinds to deliver flat YoY Q4 revenue ($209.8M) and an underlying growth rate of 4% when excluding UnitedHealthcare (UHC) and divestiture impacts. The real story is the Reversing trajectory of profitability: strict operating expense controls drove Adjusted EBITDA to $14.3M in Q4, up from near-breakeven at the start of the year. While GeneSight pricing and Prenatal volumes remain notable drags, strong Hereditary Cancer test volumes (+9%) and a pipeline of major 2026 product launches (Precise MRD, AI-Prolaris) provide a credible bridge to accelerated growth. FY26 guidance targets $860-$880M in revenue, implying a return to mid-single-digit top-line expansion.
🐂 Bull Case
Hereditary Cancer testing—the core of the business—is Accelerating, with Q4 volume up 9% (and unaffected volume growing sequentially throughout the year). It proves Myriad's EMR integration efforts are finally yielding commercial results.
FY26 is a catalyst-rich year. The launch of Precise MRD (March 2026), AI-enabled Prolaris (Q2 2026), and FirstGene prenatal screen (H2 2026) will transition the company from defending legacy turf to attacking high-growth adjacent markets.
🐻 Bear Case
GeneSight volumes grew 9% in Q4, but revenue fell 10%. The UHC coverage discontinuation has structurally degraded the Average Selling Price (ASP) of this segment, forcing the company to run faster just to stand still.
Prenatal volumes remain Decelerating, dropping 6% in Q4 to 150k. The lingering friction from a Q2 order management system implementation has resulted in multi-quarter market share loss that FirstGene must now attempt to win back.
⚖️ Verdict: ⚪
Neutral/Cautiously Bullish. Management has successfully stopped the bleeding on profitability and reset the cost base. However, execution on the 2026 product launches must be flawless to offset the structural ASP damage in Pharmacogenomics and volume loss in Prenatal.
Key Themes
The GeneSight Volume vs. Revenue Disconnect
Management touted 'improving volume growth' for GeneSight (+9% in Q4). However, this directly contradicts the financial reality: Mental Health revenue shrank 10% YoY to $36.6M. The UHC coverage discontinuation has severely impaired unit economics. While Myriad secured coverage in 9 states via biomarker laws (including Medi-Cal), it is not yet enough to offset the UHC commercial and Medicaid gap. This trend of volume growth yielding revenue contraction is Reversing only very slowly.
Prenatal Segment Continues to Lag
Prenatal volumes are Decelerating and lagging the company average. Q4 volumes fell 6% YoY to 150,000. Management attributes this to 'transition dynamics' following a Q2 implementation of a new order management system. This persistent operational friction has led to market share loss to competitors, placing immense pressure on the upcoming FirstGene launch to rescue the segment's trajectory.
Hereditary Cancer Stabilizes the Core
Hereditary Cancer testing serves as the critical anchor for Myriad, generating $96.8M in Q4 (+3% YoY) with volumes Accelerating to 9% growth (82k tests). EMR workflow integrations (like myGeneHistory into Epic) have successfully revitalized growth in the unaffected patient population, proving the commercial infrastructure is functioning well outside of the UHC crosshairs.
Innovation Pipeline: Precise MRD and AI-Prolaris
2026 marks a structural shift in Myriad's portfolio. The company is launching Precise MRD (targeted alpha launch in March 2026) targeting breast and colorectal cancers, backed by 100% baseline sensitivity data from the MONSTAR-SCREEN-3 study. Concurrently, an AI-enabled Prolaris prostate cancer test (partnered with PATHOMIQ) will fully launch in Q2 2026. These represent high-ASP, high-margin drivers that transition Myriad into the lucrative minimal residual disease and AI-diagnostic spaces.
Strict Cost Management Expands EBITDA
Management delivered on its promise of financial discipline. Q4 adjusted operating expenses fell by $7.0M YoY to $139.0M, resulting in a Q4 Adjusted EBITDA of $14.3M (an impressive jump from Q1's -$0.1M). By streamlining management layers and reallocating capital toward the cancer care continuum, Myriad has proven it can fund its 2026 product launches without degrading its balance sheet.
Gross Margin Guidance Implies Mild Compression
Despite achieving a strong 70.0% gross margin in Q4, FY26 Adjusted Gross Margin guidance is set at 68% - 69%. This suggests management anticipates margin pressure, likely driven by lower-margin introductory pricing on new product launches (FirstGene, Precise MRD) and continued payer mix shifts. Investors should watch if new tests dilute the overall profitability profile during their ramp phase.
Other KPIs
Reversing. Cash generation improved significantly, driven by $17.9M in adjusted operating cash flow. Capital expenditures were contained at $6.0M. The company ends FY25 with a healthy $149.6M in cash and equivalents, providing ample runway for the 2026 commercial launches without immediate need for dilutive financing.
While Adjusted EBITDA was positive ($38.9M) for the year, the massive GAAP net loss was heavily skewed by a $319.4M non-cash impairment charge recorded earlier in the year against the Pharmacogenomics and Women's Health reporting units, reflecting the structural degradation of the UHC coverage loss.
Guidance
Accelerating. The midpoint of $870M implies a 5.5% YoY growth rate over FY25's $824.5M. This shows management's confidence that the UHC headwind has fully annualized and new products will contribute meaningfully in the second half of the year.
Stable. Represents 2% to 4% growth over 25Q1. Management explicitly noted this reflects current business trends offset by an 'unfavorable YOY comparison for Prenatal testing,' confirming that Prenatal struggles will persist into early 2026.
Accelerating. Midpoint of $43M represents roughly 10% growth over FY25's $38.9M. However, Q1 26 is guided to 'near breakeven,' indicating heavy commercial investments and launch costs front-loaded in the first half of the year, requiring a steep ramp in H2 to hit the annual target.
Key Questions
Prenatal Volume Floor
Prenatal volumes fell 6% this quarter. At what point does the 'friction' from the Q2 order management system fully burn off, and how much permanent market share loss are you modeling into the Q1 guidance?
Precise MRD Commercialization Strategy
With the targeted alpha launch of Precise MRD in March, how should we think about the timeline for securing MolDX coverage and when this will transition from an R&D investment to a material revenue contributor?
GeneSight ASP Stabilization
GeneSight volumes are up 9% but revenue is down 10%. With UHC coverage now in the rearview mirror, when do you project the ASP will establish a hard floor so volume growth can finally translate to top-line growth?
Gross Margin Dynamics
You exited Q4 with a 70% gross margin but are guiding FY26 to 68-69%. Is this compression entirely a function of introductory costs for new product launches, or are there further pricing pressures expected in the base business?