Myriad Genetics (MYGN) Q4 2025: Oncology Test Volumes Climb 14% as Cancer Pipeline Expands
Myriad Genetics closed 2025 with robust oncology test volume growth and a disciplined approach to new product launches, signaling a pivotal year ahead for its cancer care continuum strategy. Operational execution and targeted investments are setting the stage for multiple launches in 2026, though payer dynamics and prenatal headwinds temper near-term visibility. Investors should track the ramp of MRD and AI-enabled tests as key catalysts for 2027 and beyond.
Summary
- Oncology Volume Acceleration: MI-RISC and Prolaris tests delivered double-digit volume growth, underpinning the cancer care focus.
- Disciplined Launches: MRD and AI-driven products will roll out in controlled phases, balancing innovation with reimbursement realities.
- 2027 Growth Levers: Execution on new pipeline launches and prenatal recovery will define the path to sustained double-digit growth.
Performance Analysis
Myriad Genetics ended 2025 with a strong operational finish, as fourth quarter revenue reached $210 million, exceeding the high end of its pre-announced range. Test volumes grew 2% year-over-year, with oncology and mental health segments standing out. Oncology test volumes, led by MI-RISC, surged 14% in affected patients and 11% in unaffected, reflecting both market share gains and successful workflow enhancements such as EMR integration.
Prolaris prostate cancer test volumes rose 12% year-over-year, following incremental commercial investments and targeted urologist outreach. Mental health’s GeneSight test volumes grew 9% despite revenue pressure from UnitedHealthcare’s coverage change, demonstrating underlying demand and commercial resilience. Prenatal testing volumes declined, a byproduct of Q2 order management disruptions, but leadership is focused on account reactivation and expects a return to growth in 2026. Gross margin remained solid at 70%, though average revenue per test was pressured by payer mix and policy changes.
- Oncology Outperformance: MI-RISC and Prolaris drove double-digit volume growth, offsetting prenatal softness.
- Payer Mix Headwind: Lower average revenue per test, especially in mental health, muted top-line gains.
- Cost Discipline: Operating expenses declined $7 million YoY as resources shifted to commercial and R&D priorities.
Overall, Myriad’s test portfolio showed resilience, with operational leverage supporting positive adjusted EBITDA and cash flow, even as segment-level dynamics diverged.
Executive Commentary
"We are at an inflection point where we have the absolute clarity and conviction for our go-forward strategy with a particular focus on the cancer care continuum. We have a robust pipeline of new products and enhancements for attractive market opportunities mostly developed internally but also complemented with ones enabled through strategic partnerships."
Sam Raha, President and Chief Executive Officer
"We generated $14.3 million of adjusted EBITDA and $17.9 million in adjusted operating cash flow in the fourth quarter. These results reflect the strength of our gross profit base, the operating leverage inherent in our business model, and the meaningful earnings and cash flow potential of the business as we continue to execute."
Ben Wheeler, Chief Financial Officer
Strategic Positioning
1. Cancer Care Continuum Expansion
Myriad is doubling down on its core strength in oncology diagnostics, with MI-RISC and Prolaris volume momentum validating its focus. The company’s near-term strategy is to leverage its deep provider network (serving 3,500 oncologists in 2025) and expand into new cancer testing modalities, including AI-enhanced and MRD (Minimal Residual Disease) solutions.
2. Disciplined Pipeline Execution
Multiple launches are slated for 2026, including the expanded MI-RISC panel, AI-enabled Prolaris, and the ultra-sensitive Precise MRD test for breast cancer. Notably, leadership is deliberately throttling the MRD rollout, targeting select oncology centers in an “alpha” launch to ensure operational quality and data collection ahead of broader commercialization and reimbursement (Moldex) milestones.
3. Commercial Investment and Talent Upgrade
Organizational agility is being enhanced through over $35 million in planned investments, focused on sales force expansion and specialized hiring from the advanced diagnostics sector. New hires bring molecular profiling expertise and established relationships, positioning Myriad to accelerate post-launch adoption.
4. Prenatal and Mental Health Portfolio Management
Prenatal testing is in recovery mode, with a new ordering system and account reactivation underway. The Firstgene multi-panel prenatal test is on track for a second-half 2026 launch, supported by positive early validation data. In mental health, payer wins and workflow optimization are partially offsetting UnitedHealthcare’s negative coverage decision for GeneSight.
Key Considerations
The quarter underscores Myriad’s pivot toward high-growth oncology diagnostics, with operational rigor and selective risk-taking in new launches. Investors should weigh the following:
Key Considerations:
- Oncology Momentum: MI-RISC and Prolaris are delivering sustained double-digit volume growth, anchoring the growth thesis.
- Pipeline Execution Risk: The deliberate pace of MRD and AI test launches reflects a focus on quality and reimbursement, but also means revenue contributions will lag initial clinical adoption.
- Payer and ASP Pressure: Changes in payer policy, especially in mental health and the unaffected hereditary cancer channel, are compressing average revenue per test and require ongoing payer engagement.
- Operational Investment: The $35 million earmarked for commercial and R&D expansion is a necessary bet, but success hinges on rapid ramp and ROI from new hires and tools.
- Prenatal Rebuild: Recovery in prenatal testing is critical for 2026 growth, with Q1 headwinds expected before a return to positive momentum later in the year.
Risks
Reimbursement uncertainty remains a central risk, particularly for new launches like MRD where Moldex timing is outside management’s control. Payer mix shifts and ASP compression in both oncology and mental health could further pressure margins. Prenatal recovery is not guaranteed, and any delays in account reactivation or new product uptake could weigh on growth. Execution risk on multiple simultaneous launches is elevated, especially as commercial headcount ramps and operational complexity increases.
Forward Outlook
For Q1 2026, Myriad guided to:
- Revenue of $200 to $203 million, representing 2% to 4% growth YoY
- Lower average revenue per test due to insurance deductible resets and prenatal headwinds
For full-year 2026, management reaffirmed guidance:
- Revenue of $860 to $880 million
- Adjusted gross margin of 68% to 69%
- Adjusted EBITDA of $37 to $49 million
Management expects:
- Prenatal volumes to return to growth beginning in Q2
- Sequential revenue acceleration through the year, with stronger performance in the second half as new launches scale
Takeaways
Myriad’s quarter validates its cancer care continuum strategy, with oncology volumes and a robust launch pipeline supporting the long-term growth profile.
- Oncology Drives Growth: MI-RISC and Prolaris volume growth offset segment headwinds, confirming the focus on cancer diagnostics is yielding results.
- Pipeline Catalysts Ahead: Controlled launches of MRD and AI-enabled tests are set to drive future growth, but revenue impact will be back-weighted and dependent on payer adoption.
- Watch Execution and Payer Trends: Investors should monitor the pace of new product adoption, prenatal recovery, and any evolution in payer policy, as these will determine the trajectory toward high single-digit or low double-digit growth in 2027 and beyond.
Conclusion
Myriad Genetics exits 2025 with clear operational momentum in its oncology franchise and a disciplined approach to pipeline execution. The next 12 to 24 months will be defined by the company’s ability to convert commercial investments and new product launches into sustainable, high-margin growth against a backdrop of evolving payer dynamics and segment-level volatility.
Industry Read-Through
Myriad’s experience highlights several sector-wide dynamics: The need for payer alignment and reimbursement certainty is as critical as clinical innovation in diagnostics. Disciplined, phased launches of complex tests like MRD are becoming the industry norm, reflecting the operational and regulatory hurdles to scaling advanced molecular diagnostics. Talent migration from established diagnostics players is accelerating as companies seek to build domain expertise ahead of major launches. Finally, prenatal and mental health testing remain volatile segments, with workflow and coverage disruptions creating both risk and opportunity for nimble players.