Martin Pitkow

$BLLN Q1 2026 earnings: Hyper-Growth Meets Expanding Profitability BillionToOne delivered a flawless Q1 2026, breaking the traditional biotech trade-off between scale and margins. Revenue surged 84% to $108.4 million, fundamentally driven by expanding Average Selling Prices (ASP) and a nearly 5x explosion in Oncology volumes. More importantly, gross margins expanded 900 basis points YoY to 73%, completely erasing earlier concerns that the lower-margin oncology segment would drag down profitability. Operating income flipped from a $2.3M loss a year ago to a $17.8M profit (16% margin). Management raised FY26 guidance, though the implied deceleration in the back half of the year suggests the easiest comps are now in the rearview mirror. Full article with charts - link in bio 🐂 𝐁𝐮𝐥𝐥 𝐂𝐚𝐬𝐞 • 𝐏𝐫𝐢𝐜𝐢𝐧𝐠 𝐏𝐨𝐰𝐞𝐫 𝐢𝐬 𝐒𝐭𝐫𝐮𝐜𝐭𝐮𝐫𝐚𝐥𝐥𝐲 𝐋𝐢𝐟𝐭𝐢𝐧𝐠 𝐌𝐚𝐫𝐠𝐢𝐧𝐬 — Overall ASP expanded 28% YoY to $571, allowing gross margins to hit 73%. The combination of higher prices and a 44% increase in delivered tests creates a compounding effect on the bottom line. • 𝐎𝐧𝐜𝐨𝐥𝐨𝐠𝐲 𝐢𝐬 𝐀𝐜𝐡𝐢𝐞𝐯𝐢𝐧𝐠 𝐄𝐬𝐜𝐚𝐩𝐞 𝐕𝐞𝐥𝐨𝐜𝐢𝐭𝐲 — Oncology revenue grew 392% YoY to $10.7M. As this segment becomes a larger piece of the pie, its absolute dollar contribution to gross profit is accelerating rapidly. 🐻 𝐁𝐞𝐚𝐫 𝐂𝐚𝐬𝐞 • 𝐆𝐫𝐨𝐰𝐭𝐡 𝐑𝐚𝐭𝐞 𝐖𝐢𝐥𝐥 𝐌𝐞𝐜𝐡𝐚𝐧𝐢𝐜𝐚𝐥𝐥𝐲 𝐃𝐞𝐜𝐞𝐥𝐞𝐫𝐚𝐭𝐞 — While Q1 revenue grew 84%, the raised FY26 guidance of $450-$465M implies full-year growth of roughly 50%. This mathematically forces severe deceleration in YoY growth rates in H2 26 due to tougher comps. • 𝐏𝐫𝐨𝐟𝐢𝐭𝐚𝐛𝐢𝐥𝐢𝐭𝐲 𝐌𝐚𝐫𝐠𝐢𝐧 𝐌𝐚𝐲 𝐇𝐚𝐯𝐞 𝐏𝐞𝐚𝐤𝐞𝐝 — Management expects to operate the business to generate profitability 'approaching current levels' for the rest of the year. This specific phrasing suggests Q1's 16% operating margin might be a near-term ceiling as they reinvest in the business. ⚖️ 𝐕𝐞𝐫𝐝𝐢𝐜𝐭: 🟢🟢 Extremely Bullish. Achieving 84% revenue growth alongside a massive positive swing in GAAP operating income demonstrates that the core technology moat translates directly into superior unit economics. 𝐊𝐞𝐲 𝐓𝐡𝐞𝐦𝐞𝐬 🟢🟢 𝐀𝐒𝐏 𝐄𝐱𝐩𝐚𝐧𝐬𝐢𝐨𝐧 𝐒𝐡𝐚𝐭𝐭𝐞𝐫𝐬 𝐆𝐫𝐨𝐬𝐬 𝐌𝐚𝐫𝐠𝐢𝐧 𝐇𝐞𝐚𝐝𝐰𝐢𝐧𝐝𝐬 [NEW] In late 2025, management warned of a 'negative mix shift' because the hyper-growth oncology segment carried lower gross margins than prenatal. Q1 2026 data completely invalidated this concern. Driven by better payer coverage and Medicaid code adoptions, the blended Average Selling Price (ASP) jumped 28% YoY to $571. Consequently, Gross Margin expanded from 64% in 25Q1 to 73% in 26Q1, proving they can outgrow the mix-shift headwind via raw pricing power. 🟢 𝐎𝐧𝐜𝐨𝐥𝐨𝐠𝐲 𝐒𝐞𝐠𝐦𝐞𝐧𝐭 𝐇𝐲𝐩𝐞𝐫-𝐆𝐫𝐨𝐰𝐭𝐡 𝐂𝐨𝐧𝐭𝐢𝐧𝐮𝐞𝐬 Oncology clinical testing revenue hit $10.7 million, nearly quintupling (+392%) from $2.2 million a year ago. While Prenatal remains the cash cow ($96.5 million, +72%), Oncology is quickly transitioning from a speculative pipeline project to a primary revenue pillar. 🟢 𝐏𝐫𝐨𝐝𝐮𝐜𝐭 𝐈𝐧𝐧𝐨𝐯𝐚𝐭𝐢𝐨𝐧: 𝐔𝐧𝐢𝐭𝐲 𝐂𝐨𝐧𝐟𝐢𝐫𝐦 𝐋𝐚𝐮𝐧𝐜𝐡 [NEW] The company launched Unity Confirm, utilizing its Fetal Cell Capture technology. By isolating intact circulating fetal cells from a simple blood draw to verify high-risk screening results, they eliminate the need for dangerous invasive procedures like amniocentesis. This significantly expands their addressable market within high-risk pregnancies. 🔴 𝐈𝐦𝐩𝐥𝐢𝐞𝐝 𝐆𝐫𝐨𝐰𝐭𝐡 𝐃𝐞𝐜𝐞𝐥𝐞𝐫𝐚𝐭𝐢𝐨𝐧 𝐌𝐚𝐬𝐤𝐬 𝐐𝟏 𝐁𝐞𝐚𝐭 [NEW] Q1 delivered a staggering 84% YoY revenue increase. However, full-year guidance was raised to $450-$465 million, which represents 48% to 52% growth over 2025. By mathematically subtracting Q1's $108.4 million, the company must average roughly $117 million per quarter for the rest of the year. This implies that while absolute dollar growth is fine, the YoY percentage growth will crater in H2 26 due to the tougher comps created by the late 2025 volume surge. 🔴 𝐎𝐩𝐞𝐫𝐚𝐭𝐢𝐧𝐠 𝐋𝐞𝐯𝐞𝐫𝐚𝐠𝐞 𝐌𝐚𝐲 𝐇𝐚𝐯𝐞 𝐅𝐨𝐫𝐦𝐞𝐝 𝐚 𝐂𝐞𝐢𝐥𝐢𝐧𝐠 [NEW] Operating Income was $17.8 million in Q1 (16.4% margin). In the guidance, management explicitly stated they expect to operate so they 'continue to generate profitability approaching current levels, even with significant continued investments.' The word 'approaching' is a coded warning: margins are unlikely to expand further this year, and may slightly compress, as they ramp up spend on R&D, sales force expansion, and Epic EMR integrations. ⚪ 𝐑𝐞𝐢𝐦𝐛𝐮𝐫𝐬𝐞𝐦𝐞𝐧𝐭 𝐃𝐞𝐩𝐞𝐧𝐝𝐞𝐧𝐜𝐲 𝐚𝐧𝐝 𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐓𝐢𝐦𝐞𝐥𝐢𝐧𝐞𝐬 A massive piece of the company's future valuation rests on securing Medicare MolDX coverage for its Northstar Response oncology test, which management previously slated for late 2026. Any regulatory delays in this macro-reimbursement environment could severely stall the 2:1 recurring revenue ratio they rely on for long-term oncology growth. 𝐎𝐭𝐡𝐞𝐫 𝐊𝐏𝐈𝐬 𝐅𝐫𝐞𝐞 𝐂𝐚𝐬𝐡 𝐅𝐥𝐨𝐰 (𝐎𝐩𝐞𝐫𝐚𝐭𝐢𝐧𝐠 𝐂𝐚𝐬𝐡 𝐅𝐥𝐨𝐰 𝐦𝐢𝐧𝐮𝐬 𝐂𝐚𝐩𝐄𝐱): $11.0 million Accelerating. Generating strong positive free cash flow proves the company is now fully self-sustaining. With over $537 million in cash and equivalents on the balance sheet following the late-2025 IPO, dilution risk is practically zero. 𝐓𝐨𝐭𝐚𝐥 𝐓𝐞𝐬𝐭𝐬 𝐃𝐞𝐥𝐢𝐯𝐞𝐫𝐞𝐝: 188,000 Accelerating. Up 44% YoY compared to 131,000 in Q1 2025. Volume growth is healthy across both primary business lines, ensuring revenue isn't entirely dependent on favorable pricing actions. 𝐎𝐩𝐞𝐫𝐚𝐭𝐢𝐧𝐠 𝐄𝐱𝐩𝐞𝐧𝐬𝐞𝐬: $61.3 million Accelerating, but at a controlled pace. OPEX grew 52% YoY, which is significantly slower than the 84% revenue growth, resulting in massive positive operating leverage. 𝐆𝐮𝐢𝐝𝐚𝐧𝐜𝐞 𝐅𝐘𝟐𝟔 𝐓𝐨𝐭𝐚𝐥 𝐑𝐞𝐯𝐞𝐧𝐮𝐞: $450.0 - $465.0 million Decelerating mathematically, but an absolute raise. Increased from the prior range of $430M-$445M. The midpoint implies 50% YoY growth. Because Q1 grew at 84%, the rest of the year implies heavy deceleration in growth rates (likely dropping toward 30-40% YoY in Q4) as they lap the massive Q3/Q4 2025 quarters. 𝐊𝐞𝐲 𝐐𝐮𝐞𝐬𝐭𝐢𝐨𝐧𝐬 𝐀𝐒𝐏 𝐂𝐞𝐢𝐥𝐢𝐧𝐠 Overall ASP grew to $571 this quarter. How much of this was a one-time catch-up in Medicaid coding versus a structural, repeatable baseline? Where does ASP plateau? 𝐄𝐩𝐢𝐜 𝐈𝐧𝐭𝐞𝐠𝐫𝐚𝐭𝐢𝐨𝐧 𝐔𝐩𝐝𝐚𝐭𝐞 In Q3 2025, you announced a major Epic EMR integration expected to take 9 months to go live. Are those implementations complete, and is that volume factored into the H2 2026 guidance raise? 𝐌𝐚𝐫𝐠𝐢𝐧 𝐏𝐡𝐢𝐥𝐨𝐬𝐨𝐩𝐡𝐲 Guidance points to profitability 'approaching' Q1 levels for the rest of the year. Are you intentionally capping operating margins in the mid-teens to fund specific R&D initiatives, like the Tumor-naive MRD pipeline? 𝐎𝐧𝐜𝐨𝐥𝐨𝐠𝐲 𝐒𝐚𝐥𝐞𝐬 𝐅𝐨𝐫𝐜𝐞 𝐏𝐫𝐨𝐝𝐮𝐜𝐭𝐢𝐯𝐢𝐭𝐲 Oncology grew 392% YoY. Are you still hiring 4-7 oncology reps per quarter, and are the newer cohorts reaching productivity faster than historical averages?