Exagen Inc. Common Stock 2026 Q2 Earnings Call

Thanks, operator. Good morning, thank you for joining us to discuss Exagen's financial results for the quarter ended June 30th, 2026. Today, I'm joined by John Aballi, our President and Chief Executive Officer, and Jeff Black, our Chief Financial Officer. The recording of this call, the press release announcing our financial results, and a slide presentation can be accessed on our website at www.exagen.com. Today's call will include forward-looking statements. We encourage you to review the statements contained in today's press release and the risk and uncertainties described in our SEC filings, which identify certain factors that may cause the company's actual events, performance, and results to differ materially from those contained in the forward-looking statements made on today's call. We also will discuss non-GAAP financial measures on this call.

Descriptions of these non-GAAP financial measures and the reconciliations of GAAP to non-GAAP financial measures are included in today's press release. Now I will turn the call over to John Aballi.

John? Good morning, everyone, thank you for joining us today.

The second quarter was an outstanding one at Exagen, there's a lot to be excited about, I'll get right into the details. This morning, we reported revenue of $19.9 million, up 16% year-over-year and the highest quarterly revenue in company history. While total revenue was a record, we also achieved several other records in the quarter, including quarterly AVISE test volume, trailing 12-month ASP, and Pharma Services revenue. We delivered those top-line achievements while narrowing adjusted EBITDA loss to $0.1 million, essentially break even, and a significant improvement compared to the $1.7 million loss in the second quarter of last year. Based on the strength of the first half of 2026, we are increasing full-year revenue guidance to $72 million-$75 million. Results like these don't happen by accident.

They reflect execution against the same three core objectives we've prioritized for the last several years. First, expanding adoption of our products. Second, increasing ASP through disciplined revenue cycle management. And third, delivering a steady cadence of innovation to address the unmet needs of our clinicians. In our business, individual quarters will always have some variability, but the structural changes we've made are clearly improving our long-term trajectory of both volume and ASP. Q2 was the strongest demonstration yet that our strategy is working and our business can scale. As always, we anchor to our mission. Autoimmune disease is diagnosed too late and too inconsistently, and it's the patients that suffer. Exagen exists to bring clarity to that complexity. We have now surpassed 1.2 million AVISE CTD results delivered to clinicians and their patients since product inception. That's a meaningful milestone, but we're just getting started.

With just over 3% share of an autoimmune testing market, we estimate at more than $2.2 billion and growing about 5% annually. The opportunity ahead of us is significant. We intend to continue to earn share the same way we've built trust in this underserved channel, through the best science, more timely answers, and world-class service. Let me start with clinical adoption. AVISE CTD volume reached nearly 39,000 tests in the second quarter, up 11% year over year and the highest quarterly volume in Exagen's history. I also want to put that volume record in context. In 2023, we deliberately reset our ASP strategy and rebuilt our commercial approach, accepting that volume would contract as a consequence. This quarter, volume exceeded those previous levels, and we crossed that threshold with a trailing 12-month ASP nearly 40% higher than it was back then.

We established the right strategy, executed with discipline, and have now rebuilt the volume base on a dramatically stronger economic foundation. The quality of that growth is exactly what we want to see. Over 2,800 clinicians ordered AVISE CTD in the quarter, up approximately 9% year over year, which speaks to the value our testing has established within the rheumatology community. Salesforce productivity reached record levels with trailing 12-month AVISE CTD revenue per territory of over $1.4 million in the second quarter. This is compared to roughly $1.3 million for the full year 2025. The investments we've made to upgrade, expand, and enhance the training of our sales organization are delivering. We continue to advance the clinical aptitude of the team, and the momentum is carried into the current quarter. Turning to ASP. Trailing 12-month ASP is the metric we use as operators to assess the performance of our business because it smooths the variability associated with accrual accounting and the timing of collections.

We believe it's the most reliable indicator of progress in what is a highly critical area of our business. In the second quarter, trailing 12-month ASP expanded to $446, up $18 per test or 4% versus last year and marking our 13th consecutive quarter of growth. Our revenue cycle team deserves recognition for another quarter of strong collections, including meaningful recoveries on older claims. The performance reflects years of disciplined work to structurally improve how this team operates. This year, our revenue cycle strategy has shifted more towards optimization of our processes.

We're leveraging analytics and AI to prioritize where the highest value opportunities lie, to automate appeals and to streamline medical record extraction. Together, these initiatives have driven trailing 12-month ASP from $284 at the end of 2022 to $446 today, and I'm confident there's more ground to gain. Pharma Services also delivered a record quarter, with quarterly revenue crossing the million-dollar point for the first time. This is a business we've built deliberately over the past couple of years, and the strong results are early proof that the unique data, biobank, and scientific capabilities we've assembled serve not only clinicians, but also partners developing the next generation of autoimmune therapies. During the quarter, we began to build on the success we've achieved in incorporating AI across RCM processes by investing in the development of customer-facing applications.

This AI-powered commercial infrastructure is designed to deepen clinical engagement, support AVISE utilization, and embed Exagen directly in the rheumatology workflow. It's early, and we'll share more as development progresses, but over time, we believe the investment will complement our commercial team and reinforce Exagen's leadership within autoimmune diagnostics. On the evidence front, we published a systematic review validating real-world AVISE Lupus performance. This manuscript is one of the most extensive evidence-generation efforts behind any novel lupus diagnostic, pooling years of data representing 3,100-plus patients across 14 medical centers into the most diverse analysis of the AVISE test to date. Most notably, AVISE Lupus identified approximately 25% of SLE patients who were missed by conventional markers, and this was noted by the authors, including some of the most prominent lupus physicians in the space. AVISE meaningfully influences diagnosis, physician confidence, and patient management.

This is the kind of clinical impact we strive to deliver across our portfolio, and this manuscript helps make the impact clear. On that note, our innovation engine remains on track. Our myositis offering, the first new standalone product for Exagen in many years, continues to progress towards commercialization in early 2027, and we remain committed to a cadence of approximately one new product every 12 or so months thereafter. We've deliberately built an R&D to commercial machine that can deliver on that cadence, and our channel is eager for what's to come. Before I hand it over, I want to take a second to highlight the immense progress we've made. In 2022, our full-year adjusted EBITDA loss was around $40 million and worsening.

This quarter, we approached break-even adjusted EBITDA while setting records across the business, and we did it before our next wave of products has even launched. This is what disciplined execution compounds into: a business that grows, innovates, and generates cash. Sustained profitability is within reach, and we intend to cross that threshold through the same disciplined execution that brought us here, delivering on our commitments and building a durable long-term organization. With that, I'll turn it over to Jeff for additional comments on the financials.

Thank you, John, and good morning, everybody. As John just highlighted, our second quarter results reflect another strong quarter of execution across the business. We achieved record top-line performance driven by record testing volume and trailing 12-month ASP, and a record contribution from our Pharma Services offering. Starting with revenue, we generated $19.9 million in the second quarter, an increase of 16% year-over-year and 15% sequentially. AVISE CTD test volume grew 11% year-over-year, reflecting continued strength in clinician adoption and utilization, as well as the impact of last year's investment in commercial expansion. Our commercial investments are delivering solid returns. Even with several sales territories under one year old, productivity continued to ramp. Trailing 12-month CTD revenue per territory grew about 6% year-over-year, and ordering clinicians increased approximately 9%.