BillionToOne, Inc. Class A Common Stock Wells Fargo 21st Annual Healthcare Conference

All right. Hi, everyone. We are back here, Life Science Tools and Diagnostics. We have BillionToOne, Oguzhan Atay, CEO and founder. Maybe let us just start, 2Q, revenues grew 64%, volumes 35%, strong gross margins, and you were profitable. What are the most important drivers that you saw in the quarter?

I think we continue to see growth quarter-over-quarter, both in prenatal and oncology, and our ASPs are ticking up in both of those areas as well. I think there are some dynamics with TrOOP that need perhaps more clarification. That was, I think, one of the things that creates a little bit of noise. But in general, we had a, I think, good quarter, both for prenatal and oncology. I think it is also important to understand a little bit of the dynamics around prenatal growth, because it is not a single monolithic market as people tend to think usually. There is health systems and there are independent OBGYN clinics, and the growth that comes from both of those things can be actually different.

Okay. Well, want to go into that then?

Sure. Since you ended on that, maybe discuss the differences between your local OBGYN and health systems, and you seem to imply that that maybe impacted some of the growth you saw maybe in 2Q or, yeah, maybe expand on that, please.

Certainly. Our growth has been actually very consistent and predictable when it comes from a single specialty, independent OBGYN clinics because these are the clinics where typically even each provider can make their own decision to switch to you. We have previously talked about land and expense strategy, where we can have one provider who starts using us, and then we get the second one, third one, fourth one over time in these clinics. The test volume growth that we have seen in these single specialty independent OBGYN clinics has been very consistent in 2025 and 2026. What creates a little bit of the lumpiness in the test volume growth quarter over quarter is the health system additions. Each health system tends to be a lot more binary.

It is the switch-like transition, and it can be anywhere between 3,000 to 5,000 tests that come from a single health system addition. That can make certain quarters, I think, look significant beats, whereas other quarters might look more in line with expectations with test volume growth. As a reminder, we haven't incorporated any big health system wins into our guidance. The majority of the opportunity that is remaining is in health systems. That is why we have been investing in Epic Aura. That is why we have been investing in the launch of the Excel panel. These things are going to be really the big drivers of our long-term growth in this market. If you think about this market, 40% is independent clinics, 60% is health systems.

Vast majority of our current test volume and test volume growth came from independent clinics, and we can continue to grow there at these levels or even potentially a little faster. But if you want to grow 10,000, 15,000 tests per quarter, that will have to come from health systems. We have certainly seen that back in 2025 when we won one or two health systems in Q2 and Q3, which really increased the quarter-over-quarter growth rate in those quarters. Whereas I think in 2026, again, it is going to be a little bit lumpy in when they are going to come in. But now that we have made these investments, we have so many health systems that are actually already on board clinically, that we need to get the EMR and the legal sign-off and the phlebotomy in place to be able to onboard them.

Got you. No, that's super helpful. You said the customer base is 40/60, but you're much more heavily skewed towards local clinics, which is like 90/10. Is that kind of the or Yeah, vast majority.

We have about 20% market share.

The vast majority of it is in the independent clinics.

Okay. Historically, because we didn't invest in Epic Aura and other areas as much, we didn't even have an opportunity to get into the health systems.

That, I think, really opens up a huge market for us now that we have Epic Aura, now we have the Excel panel. I think as we start to onboard some of these health systems, it can significantly accelerate test volume growth, which is, again, what we saw back in 2025.

The single health system in Q2 increased that growth to almost 15,000 tests in Q2 and Q3 last year. That is the difference that we are seeing between 2025 and 2026. It is not really as much the competition. It is really when these health systems can be onboarded.

Got you. No, that's super interesting. Just to kind of recap what you said earlier is that you actually do have health systems that are basically signed up in the pipeline. You just need final sign-off and integration. So the pipeline is there. It's just a function of timing, and it may not slip from 2Q to 3Q, but there's line of sight to them coming on board.