GeneDx Holdings Corp. Q4 FY2025 Earnings Call

Good day, and thank you for standing by. Welcome to the GeneDx Holdings Corp. Fourth Quarter 2025 Earnings Conference Call. At this time, all participants are in a listen-only mode. After the speakers' presentation, there will be a question-and-answer session. To ask a question during the session, you will need to press *11 on your telephone. You would then hear an automated message advising your hand is raised. To withdraw your question, please press *11 again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your speaker today, Sabrina Dunbar, Investor Relations. Please go ahead.

Thank you, operator, and thank you to everyone for joining us today. On the call, we have Katherine Stueland, President and Chief Executive Officer, and Kevin Feeley, Chief Financial Officer. Earlier today, GeneDx Holdings Corp. released financial results for the fourth quarter ended 12/31/2025. Before we begin, please take note of our cautionary statement. We may make forward-looking statements on today's call, including about our business plans, guidance and outlook. Forward-looking statements inherently involve risks and uncertainties and only reflect our view as of today, February 23, and we are under no obligation to update. When discussing our results, we refer to non-GAAP measures, which exclude certain items from reported results. Please refer to our Fourth Quarter 2025 earnings release and slides available at ir.gnbx.com for definitions and reconciliations of non-GAAP measures and additional information regarding our results, including a discussion of factors that could cause actual results to materially differ from forward-looking statements. I will now turn the call over to Katherine.

Thank you, Sabrina, and good morning, everyone. The fourth quarter was a strong finish to a transformative year for GeneDx Holdings Corp. We reported quarterly revenues of $121,000,000, bringing full-year revenues to $428,000,000, underpinned by 54% exome and genome revenue growth. We continue to balance high growth and profitability in service of a massive unmet need, delivering accurate genetic diagnoses to the millions of patients and families seeking and waiting for it. Today, we reaffirm our full-year 2026 guidance, and will talk you through the elements of this growth that give us such confidence in our near and long-term targets. 2026 is going to be a breakout year for GeneDx Holdings Corp. We are operating in an enormous and largely untapped market with a twenty-five year head start. We have cemented our position as the clear leader in rare disease, diagnosing more patients with exome and genome than anyone else in the world, and we have the number one genetic test, the largest and most diverse rare disease dataset, and the leading technology and team. Our leadership position was further reinforced by our recent FDA Breakthrough Device Designation, which positions GeneDx Holdings Corp. to become the first FDA-authorized comprehensive genomic solution in this category. A meaningful long-term differentiator, particularly as we enter mainstream medicine. The clinical case, the economic case, and the policy case for exome and genome are converging. And GeneDx Holdings Corp., alongside our patients, is shifting the power of genomics from promise to practice. Patients are the center of everything we do at GeneDx Holdings Corp. Every test, every data point, and every partnership comes together to create a network effect in service of faster answers, deeper understanding, and expanded access to precision care. We are opening new markets like general pediatrics, to reach patients at the earliest moment possible. Rare disease affects one in ten Americans, and it still takes an average of five years for a patient with a rare disease to receive an accurate diagnosis. The current standard of care often allows years of disease progression at a time when we can offer an accurate diagnosis in a matter of hours. There is a huge opportunity here that looks similar to where cancer diagnostics was fifteen years ago. And GeneDx Holdings Corp. is best positioned to serve this massive unmet need. Diagnosing rare diseases is fundamentally a scale problem. In cancer, the key genes are well characterized, but in rare disease, most patients carry genetic changes that have never been seen before. Novel variants are not the exception. They are the norm. To diagnose these patients, you need to find others who share the same genetic change and the same symptoms. That means the size and diversity of your reference dataset is everything. The larger your dataset, the more matches you make, and the more diagnoses you deliver. No one does this at the scale we do, and that is because of GeneDx Infinity. INFINITY is the world's largest and most diverse rare disease dataset composed of more than 2,500,000 rare genetic tests, over 1,000,000 exomes and genomes, and over 8,000,000 phenotypic data points. More than 60% of the exomes and genomes in INFINITY have parental data, which is critical for interpretation. And over 50% are from patients of non-European descent, which improves their diagnostic capabilities across real-world populations. While incredibly vast, INFINITY is also deep, structured, and expertly annotated to enable fast and accurate diagnoses at scale, and across clinical indications. As we test more patients, the power of INFINITY compounds. With over a dozen exome and genome products currently on the market, GeneDx Holdings Corp. is still chosen 80% of the time by the most discerning specialists. And we have held that share through multiple competitive cycles. INFINITY was built specifically for rare disease, patient by patient, year by year in the clinic. It would take decades to replicate what we have today. And by then, we will be decades further ahead.

AI models are only as good as the data they are trained on, and GeneDx Holdings Corp. INFINITY is a rich resource available. Our clinical experts and leading AI tools leverage INFINITY to surface insights hidden within complex clinical and genomic data. We are constantly innovating to amplify this impact. For example, our proprietary AI GeneMaker, Multi analyzes billions of internal and external data points to identify the most likely genes causing a patient's symptoms, improving our scale, efficiency, and turnaround times. AI is an enabler for us, and our team will remain at the forefront of leveraging this technology to improve outcomes for patients. We are currently operating in six massive untapped markets, each of which will contribute to our accelerated growth in 2026. And we are nearly tripling what was already the largest sales force in rare disease to capture the wide open space ahead of us. We have multiple levers for growth, namely one, activating new clinicians in our existing call points, two, driving higher utilization among clinicians already ordering from us, and three, introducing our industry-leading testing to new markets. Even with geneticists, our most established market, we have 80% clinician penetration, but still have room to grow by shifting more testing from single gene and panel approaches to exome and genome. Among pediatric specialists, we have reached about 30% of clinicians and only 15% of eligible patients, giving us two clear ways to grow: establishing more doctors and increasing how often they order.

Good morning, everyone. For the fourth quarter, total revenues were $121,000,000, up 27% year over year. Within that, exome and genome revenues were $104,000,000, an increase of 32% year over year. Excluding a $6,800,000 one-time payer recovery in Q4 last year, our organic growth rate was 42% for exome and genome revenues. Turning to volume, we reported 27,761 exome and genome test results in the fourth quarter, capping a consistent trend of acceleration through the year during 2025 from 24% growth in Q1 to 29% in Q2, 33% in Q3, and now exiting the year at 34%. In the fourth quarter, we saw geneticists increasingly shift towards whole genome, signaling a desire among these experts to generate even more data for their hardest-to-diagnose patients. Our average reimbursement rate, or ARR, for exome and genome was approximately $3,750 in the quarter. As flagged on our last call, the rate fluctuated some in the fourth quarter due to mix dynamics, but the long-term trend is up and durable. Full-year 2023 was $2,500, which went up to $3,000 in 2024, and now $3,750 in 2025. And while any mix towards genome over exome in the outpatient setting may introduce some short-term ARR variability, it is ultimately what is best for both patients and our business. Total company adjusted gross margin for the fourth quarter and full year 2025 was 71%. Genome costs more than exome today, but that is mostly a function of higher reagent costs, which we expect to continue to come down as the adoption curve ramps. Importantly, our dry-side cost advantage applies equally between exome and genome. The annual trend demonstrates our proven ability to drive the cost curve down with scale over time. Full-year 2023 gross margin was 45%, which went up to 65% in 2024 and now 71% in 2025. Moving to the bottom line, adjusted net income for the fourth quarter was $4,400,000 and $4,800,000 for the full year, demonstrating leverage in our business model. Now, Katherine just laid out the strategic layers of our growth. To help you model the business, here is how we expect those layers to contribute to 2026. Let us first look at those foundational markets. First, we have deep penetration with approximately 80% share among clinical geneticists. We are still only ordering for about 30% of the patients, which we believe will grow over time. The goal here is converting single gene and multigene panels into exome and genome, which we view as inevitable. Even within our own business, more than half of all tests are still single gene and multigene panels. Moving those patients to exome or genome materially improves diagnostic yield and reduces time to diagnosis. Conversion is driven by guidelines, education, and sales coverage. Repetition is key, and conversion will continue to be a source of high-volume growth for years to come, and as it occurs, it will provide higher reimbursement and strong contribution margin tailwinds. Moving to those expansion markets, first, the NICU remains a focus, and we are convinced these institutions should be ordering over 200,000 tests a year to address the unmet need and provide better and more efficient patient care. Nearly 25% of the target accounts are existing customers, yet utilization remains in the single digits. As our efforts to push forward the standard of care and ease the implementation burden take hold, we aim to influence that utilization rate up to 60% over time. We are seeing early signs of improved utilization, but we will remain conservative in our modeling assumption for the time being. Second, general pediatricians is a game changer. Following the mid-2026 launch of our custom-designed one-minute ordering workflow, expect volumes to pick up in 2026 and accelerate into 2027. Third, prenatal, adults, and international remain wide open. We expect prenatal to begin to ramp in Q2, and results in the second half of the year. Internationally, we are putting a small number of boots on the ground now to prepare for broader expansion that will become a contributor in late 2026 and beyond. Now in terms of operating expense, we are in a phase of deliberate investment to accelerate growth. Specifically, we are deploying capital to nearly triple our commercial footprint in 2026. We are also investing in the next-generation customer experience—a portal designed by pediatricians for pediatricians—which will launch later this summer. And we are ramping our R&D to support clinical research that underpins commercial strategy. That includes finding the right balance and market fit for things like supplementing short read with long read sequencing and other new technologies to increase diagnostic yield and reduce turnaround times. So with all that in mind, we are reaffirming our guidance to include total revenues in the range of $540 to $555,000,000, exome and genome volume growth of 33% to 35%, with a baseline of 33% growth for Q1. We expect the foundational markets to contribute 25%–27% towards the growth rate. We expect those expansion markets to contribute 7% to 8% towards the growth rate, and we are assuming a very modest second-half contribution from general pediatricians this year. The future markets are about 1%. So to put all that in context another way, 33% volume growth in 2026 would mean 32,000 tests on top of the fiscal 2025 count. In 2025, we were only really active across geneticists, pediatric neurology, and the NICU, and those delivered the 23,000 tests of growth, all accelerating throughout the year. Given current penetration status, there is no reason to think those three markets would slow down. And on top of it, we are now adding 100 new sales reps, approaching new markets, launching a new customer experience, and doubling our marketing efforts. We are confident in our plan to deliver. We are expecting adjusted gross margin at approximately 70%, which takes mix shift dynamics into consideration. Despite a heavy investment cycle, we expect adjusted net income positive for the full year and each individual quarter. The first quarter in particular will be close to breakeven as we deliberately prioritize market capture over near-term margin optimization. As these newly deployed territories activate and ramp towards full productivity, we expect adjusted operating margin to build towards double digits by Q4 as these investments yield revenue. Before I move on, a few notes for your model. At this point in the quarter, volume is matching expectation. That huge storm in January did cost us a full day of volume, and we are experiencing another storm in the Northeast today. We have always built that level of impact into our Q1 projections. In our case, these children are sick, and missed appointments are not typically lost so much as they are rescheduled in the next quarter or maybe even two. Beyond that, this business has a predictable seasonal rhythm. In case clarification is required—and I have been at the company for ten years now—Q1 always steps down due to deductible reset dynamics. All else equal in terms of underlying fundamentals, volume in Q1 is typically lighter by a couple days, and underlying collection rates is typically down about 5% in Q1 compared to Q4, then builds back up because of the impact of deductibles. We factored this rhythm into our guidance. Last point, as a reminder, we wound down the hereditary cancer testing line in Q3 2025. So in terms of comps, that business line generated $2,000,000 in Q1 of last year and $5,000,000 fiscal 2025. Now before we move to Q&A, I do want to hit on something Katherine might be too humble to bring up. Last week, she was named to the 2026 TIME 100 Health list. Katherine has been quick to transfer all credit to the GeneDx team here, but on behalf of our 1,400 employees and countless families we serve, we want to offer our applause. But knowing Katherine, she would want me to point out who else was on that list, because it validates exactly where this industry is going. She was honored alongside pioneers like Dr. Musaad Al-Sudairy, Dr. Aaron’s Nicholas from CHOP, who saved baby KJ with a world-first patient-tailored CRISPR therapy. There were several other honorees this year related to rare disease, and the pioneering work to bring gene therapies forward. This all signals something important: rare disease and genomic medicine are having their moment. We are decades behind oncology, but we are coming fast in terms of diagnosis and eventual therapies.

Now as an investor, here is why you should care about that. The evidence is clear. The science is ready. Our technology is capable. The therapies are coming, and GeneDx Holdings Corp. is the engine that finds the patients who need them.

Thank you. As a reminder, to ask a question, please press *11 on your telephone and wait for your name to be announced. To withdraw your question, please press *11 again. We will now open for questions. Our first question comes from the line of Subhalaxmi T. Nambi with Guggenheim. Your line is now open.

Hey, guys. Good morning. Firstly, congratulations, Katherine, on that achievement. Truly remarkable. Second, I have a question on guidance. Let me start with some observations. Your guidance assumes 25,200 or so tests, 200 or so more foundational tests at the midpoint. This is impressive, given that the number of foundational tests last year was 22,700, down from 25,000 in 2024. So your guidance reflects an assumption that a recent trend reverses. What is driving that, and what gives you the confidence to bake this assumption into the guide?

Yeah. I think that, well, there are a lot of factors there, including the point we made on repetition. I think if you look at the overall amount of white space available in terms of penetration rates, there is just so much runway to activate new clinicians, to get them to order more, and, frankly, continue the conversion cycle from single gene and multigene tests. For the past few years now, we have really just focused on a few cohorts of doctors, outpatients, geneticists, and pediatric neurologists, and spent most of the last three years specifically talking just about a few indications, that being epilepsy, intellectual development delay, and autism. There is a far wider range of tests that will be ordered by those physicians over time.

Thank you so much for that, Kevin. Could we also discuss the puts and takes for quarterly cadence this year on both volumes, ASP, and maybe gross margins? Thank you so much.

Yeah. I mean, I think if you look at the cadence of any year here at GeneDx, you would expect Q1 to be the low point in terms of volume and reimbursement rates, in particular driven by those deductible factors I discussed, as well, of course, weather, with Q4 typically being on a per day basis the strongest. There is variability in the number of operating days. Our business tends to follow or draw strength from the school calendar as well as the holiday calendar. And so to the extent you have quarters that are heavy on the inability for families to get into physicians’ offices, it obviously plays a factor, but we typically see Q1 as the low point.

I mean, anything on gross margins, Kevin, as people ramp to newer call points start to order a whole genome extra, and then I will call back in the queue. Thank you so much.

Yeah. I mean, I think overall, where we ended the year around 71% for total company, underlying that, the exome genome portfolio operates significantly stronger than that, combined exome genome portfolio in the eighties in terms of gross margin. Now the reality is, we still have a long way to go to reduce cost per test. The past couple years, we have been optimizing for reimbursement and cost per test on exomes in particular, and now is our time to turn attention towards optimizing genome cost and reimbursement. I think we are well equipped to do that. We have got a proven playbook to do that. We are going to take many of the learnings from exome, and invariably, genome COGS will be coming down as, I mean, we expect them to as the utilization ramp increases.

Thank you. Our next question comes from the line of William Bishop Bonello with Craig-Hallum. Your line is now open.

Hey. Great. I am just going to push a little bit more on the sequential just so we do not have kind of a repeat of last year, if you can help at all. But last year, I think we had cases down, you know, about 114 tests or so. So not a very significant sequential decline, and on the ASP side, we were just a little under $60 down. Given what you talked about with weather, and the, you know, big pop-up that we had in Q4 this year, should we be assuming, you know, a more significant sequential decline than 100 tests or so, I mean, maybe something more in the, you know, 400 to 500 range, or how are you thinking about that?

Yeah. Hi, Bill. In the prepared remarks, I said the baseline expectation for Q1 should be 33%. So if you take the Q1 number at 33%, that would infer a decline of even 300 to 400 tests in Q1 off of Q4 sequentially, would not be unexpected. Like I said, we lost a day of volume due to that storm. We are actually running our first virtual call today given the storm in the Northeast. And so, you know, the guide is anchored in 33% to 35% because of the dynamic of both weather and the deductible reset, typical seasonal plays.

Yep. That makes sense. And just to be clear, the 33% you are talking about, is that for both volume and revenue as a good starting point?

Yes.

Okay. That is great. And then just one follow-up if I could. You talked about nearly tripling the commercial footprint. What is sort of the base there? Is that from where you were before the heads that you were talking about in January that you have added or, you know, triple relative to what?

Yeah. Just call it the average through 2025. But if you look at the full year of 2025, frankly, we did not add a lot to the base. Some reps come and go. But the way I think about it is the full size and scale of the team for the most of 2025 was about 50 sales reps calling on those outpatient markets of geneticists and pediatric neurologists, and then a small team, let us call it 10, focused on the NICU in particular. So 60 reps was really what we went to bat with for the balance of 2025. And we will be adding about 100 on top of that to start the year.

Yep. Okay. Thank you.

Thank you. Our next question comes from the line of Kyle Mikson with Canaccord Genuity. Your line is now open.

Hey, guys. Thanks for the questions. Congrats, Katherine, as well, and I hope you are doing well this storm in the Northeast. So just on the guidance, thanks for the 1Q framing, Kevin. But for the full year, helpful that you have this expansion and future market and the kind of the current, you know, stable base, assumptions and stuff. But as you think about upside and, you know, what you are not baking in and things like reimbursement that was not exactly called out, how could you just, like, help contextualize that for us in terms of, you know, the excitement levels and what is actually possible to penetrate maybe in these newer areas? Thanks.

Obviously, we have got greater ambitions than what is baked into the guide for the year. I think areas where we have stayed appropriately conservative but offer potential upside, you know, we have consistently said on general pediatricians, expect eighteen to twenty-four months from guidelines to see volumes ramp. All interactions with pediatricians to date, including focus groups, extensive market research, we are out in the field, extremely positive. I think we have immense confidence these physicians will order. The acumen and willingness to order will be there. But it has also told us we have to deliver the front-end and back-end experience that they said they would need in order to get comfortable ordering, and we launch that customer experience later this summer, Q2 into Q3. And so we built some time for volumes to ramp following that launch.

The only one I would add to that, Kyle, is the NICU setting. We have been, you know, I would say, out of sight on NICU. Just given our experience in 2025, we did just bring on a new Chief Medical Officer, Dr. Linda Gannon, who is a neonatologist. She is also been in the business of practice management for the NICU. We have new commercial leadership, including a neonatal nurse leading the strategy and the go-to-market there that is driving more of a protocol approach in the NICU.

Alright. Perfect. And then just a quick follow-up on test performance, something that has been called out recently in our conversations. So if you maybe talk about, like, a snapshot regarding how performance compares to some of the up-and-coming tests in your view? And could you maintain or accelerate market share if you do not really invest in or lean into, like, integrating long read or these other technologies to increase diagnostic yield?

Yeah. So I think as we look at the strength of our test, we deliver two times the accuracy of another exome or genome out on the market today, and that is because of INFINITY and that reference data that I spoke at length about in the prepared comments because I think as new entrants start to enter the market, they are going to realize how important it is to have the breadth and depth of both the genotypic and phenotypic data for your expert geneticist to be able to tap into. So, I would say at a baseline, we are absolutely confident in the importance of the accuracy of our testing. Not to mention the fact that we also have the scale. The turnaround times for other competitors in our space are far longer. We have our turnaround times down to about two weeks for an exome and a genome. So we are turning these around and that matters to customers. And we are doing it cost effectively, and we have the payer contracts, which, of course, is beneficial from the customer and from the patient standpoint. So we stand in a confident position in terms of our ability to continue to keep the competitive moat extraordinarily strong.

Perfect. Appreciate you guys.

Thank you. Our next question comes from the line of David Michael Westenberg with Piper Sandler. Your line is now open.

Hi. Thanks for the question, and I echo everybody's congratulations on all the work done and prenatal outside rare disease health. So I just wanted to talk about the general pediatric. You have noted an eighteen to twenty-four month adoption curve following the AAP guidelines and deployed a 50-person sales force to target this. What specific indicators—I do not know if that would be, like, repeat testing, number of new physicians ordering per quarter, utilization of one-minute workflow—what are you tracking to gauge success in that market that that sales force expansion is working? At what point in 2026 or 2027 do you believe this translates into a material inflection in revenue?

Yeah. So you are hitting on all the right key metrics, Dave. So thank you. We want to see number of new clinicians, and then we want to see time to ramp. So, you know, we are tracking: are they going to do one or two at a time just to kind of get some experience without the one-minute ordering? Then how much faster can we actually see the one-minute ordering start to accelerate utilization? So those are the key metrics. We are obviously going to be tracking average reimbursement rates, so we want to make sure that we have our revenue cycle management team revved up and continuing to make sure that we are getting paid for those tests. Again, in the one-minute ordering, we are building in the opportunity for a parent to be able to upload their child's symptoms, so all the phenotypes information. We think that is going to be really powerful also in the appeals/denial process.

Perfect. Thank you. And just one follow-up. Here on the NICU in Q4, you mentioned a 5% tenor rate. You know, how do you grow on that penetration rate? And, you know, what is within your control in terms of growing that? And then just, again, a reminder of how key how it went in Q4 and their opportunities to try to ramp that throughout this year. Thank you very much.

No. Thank you. We learned a lot in the NICU. And we are, with our now 10 reps out there, really having them focus on selling directly to the neonatologist. Dr. Gannon has been with us for about a month, but already has made an incredible impact. As I mentioned, we have a neonatal nurse who has helped us kind of refocus the go-to-market strategy. So, you know, we are eager to let that play out a little bit, but early signs, I would say, are good in terms of this new strategy in place, and we will keep you posted on what momentum looks like.

Thank you. Our next question comes from the line of Daniel Gregory Brennan with TD Cowen. Your line is now open.

Great. Thanks. Congrats on the quarter. Good close to the year. I had one on the growth drivers and one on pricing. Maybe I will just start with pricing, Kevin. Implied in the guide, right, is flat pricing for exome/genomes, but obviously, you are talking about conservatism on some of the new markets. In your prepared remarks, you talked about continued upside on pricing. So I guess the first question is, just kind of, you know, do we see really pricing going? Like, kind of what is the headroom we look out even beyond 2026? And I know you had some comments in the prepared remarks on genomes and exomes. I am wondering how those influence pricing. And is there anything baked in for Medi-Cal on pricing?

Yeah. There is nothing baked in yet with respect to Medi-Cal. In fact, although policy went effective November 1, we still have a published price, which makes it hard to accrue and forecast. That is just working through the mechanics of the powers at Medi-Cal. And so continue to leave Medi-Cal out of the guide for now. And consistent with what has always been our approach, what we have left out of the guide, of course, is any new Medicaid state coming online as well. A lot of work to influence more Medicaid coverage expansion, but there are just so many factors out of our control. So the guide does, effectively, assume zero new Medicaid states this year. Do I think that that is reasonable to expect zero? I do not. But we will always leave new Medicaid coverage out until proven otherwise.

Great. And then maybe just on the 7%–8% contribution from the new growth drivers, could you share a little bit of color between the p-neuro and prenatal since I am assuming no—excuse me—the p-neuro and, yeah, prenatal and/or NICU, just any relative contribution you can share with us and kind of what informed that. Thanks a lot.

Yeah. If you had to rank order those, NICU is at the top of the pack there. And I guess as we talked about on this call, we are seeing great early signs to start the year in the NICU in terms of increased utilization rate. And if you look back at 2025, we actually activated more NICU accounts than what was in our original plan. Now what offset that was we did not see the quick ramp-up that we expected in terms of ordering patterns. But if you look at where that utilization rate has gone in the past couple months, I think we are seeing great signs to start off the year, but like I said, we will take a fairly modest approach in terms of modeling at this point until that really takes hold.

Great. Thanks a lot, Kevin.

Thank you. Our next question comes from the line of Tycho W. Peterson with Jefferies. Your line is now open.

Hey, can you guys hear me?

Mhmm.

Kevin, can you maybe, I appreciate all the color on ASPs. I mean, obviously, in the background here, you have got, you know, H.R. 7118, you know, Genomic Answers for Children Act and Florida Sunshine Genetics Act. Can you maybe just talk about how you are thinking about these opportunities? Obviously more of a 2027 driver than 2026 drivers, you know, if it does go through for H.R. 7118. But how are you kind of handicapping this over the next, you know, couple of years?

Yeah. Clearly, nothing in 2026 in terms of uplift expected from any national legislation. Look. It is exciting, and we are part of a group of about 30 influencing that bill to make its way through the process. Now, introducing a bill and getting it signed and across the President’s desk is two very different things. I think what we are seeing is great reception across policymakers, and it could be a big deal for us, but, obviously, it is something that we would not build into our short-term expectation until we get much clearer line of sight. So I would love to take anything off of that pending legislation out of the outlook. For now, we will continue to do that until we get some more clarity.

And then, that is helpful. Thanks. Katherine, can you maybe touch on—I know you are talking about doubling the business this year. I guess, any color on just kind of what sort of contracts these are? Does the recent Komodo Health partnership help pull through incremental demand there? Or is that too early? I know you have, you know, hired a bit. You hired Lucia Guri in September. So maybe just talk a little bit about, you know, where you are from scaling on the pharma side. And is that mostly, you know, patient matching and longitudinal data for FDA submissions, or are you kind of expanding the scope of what you are doing with pharma too?

Yeah. Thank you for that. So we are encouraged, I would say, by the types of conversations we are having with pharma companies. I think one of the notable shifts in our go-to-market strategy is focusing on some of the adult-onset conditions. And we feel like in focusing on adult-onset conditions, if it is sponsored testing or patient matching, that gives us the opportunity to work really strategically with these companies as we have seen happen in the pediatric side of things to accelerate adoption of these technologies, generate a body of evidence to be able to go to payers. We are thinking across both pediatric and adult as well as many of these bespoke. We talked about CHOP and baby KJ. There are more organizing happening amongst these parents who are becoming biotech CEOs. So how do we really work in partnership with them to put our data to work for their families and for their businesses. So, encouraged by, I think, the shift in thinking and the more expansive nature. It is everything from clinical trial matching to sponsored testing, just getting different types of docs using testing. And what is also really—I know we have talked about this in the past, Tycho, but it is true across every condition. The more you test, the higher the prevalence is of these diseases. And so, you know, we were sitting with a pharma company that was looking for 400 patients. We happen to have 2,300 of them in our database, and really challenge the understanding of the prior limited prevalence.

Great. And then maybe just one last one on competition. I mean, we have not really, you know, touched on it on the call, but—and you have always said competition validates the market size. It does not really threaten your leadership, and, you know, new entrants can help educate payers and governments. But anything you can kind of flag here—is that, you know, how your thinking here has evolved? I mean, has it—are you going to have to counter-detail more? Are you pulling forward any hiring? Just maybe just talk a little bit about the competitive environment because we are obviously all getting more questions on that too.

Yeah. No. And you are right. I think competition is a good thing. I think that more—it validates, as you said, but it also helps put more and different types of clinicians to start using this testing. So, you know, the sheer size of our sales force—I think our sales team is six times the next largest sales team. I think we have more reps in California than one company has for their entire sales team. So we have got a massive footprint for rare disease. We are always going to be looking to pull forward hiring. We talked about some encouraging signs in the NICU, that might be an area where we could pull forward some more hiring. We pulled forward hiring into our specialty sales team. So, you know, as a commercial person, I, of course, am always eager to see how do we continue to accelerate our growth. So I would say we are seeing positive signs across the board, but even if we were to not hire another person—which I feel confident we will continue to strengthen that team—we have a monster-sized team compared to the next one out there. And, you know, I think more education on this is a good thing. There is plenty of wide-open space. INFINITY, as the reference dataset, is going to continue to ensure that GeneDx Holdings Corp. is delivering the most accurate information, which is, of course, what is most important to these clinicians and these families. But also the turnaround times. I said we are now at two weeks for exome and genome. Just being able to do it better, faster, more cost effectively. All of that means we can move faster and keep adding more clinicians along the way.

Thank you. Our next question comes from the line of Keith Hinton with Freedom Capital Markets. Your line is now open.

Great. Thank you. Can you hear me okay?

We can.

Okay. Great. Just one question then a quick follow-up. Just in terms of the foundational market growth, obviously, as we have talked about, looking for a little bit of an acceleration here versus last year. So I just want to clarify. Are there any sort of major new indications or disease areas you are launching in 2026 that fall into that foundational bucket, or is this just a natural reacceleration?

No. We have got a multiyear roadmap for expansion of indication targets that we kicked off early 2025. As I said, we went the previous three years really just talking three of what ultimately is a span of thousands of rare diseases that our technology can diagnose. We have been taking a fairly disciplined approach to only target pulling through volumes where underlying guidelines and reimbursement policy would be secured to get paid. And the aperture of that continues to increase, in large part because of our work, but also other evidence provided by many others.

Got it. Okay. And then just on the follow-up, I am looking at Slide 22 of the deck here and looking at the 300,000 annual patients among geneticists, penetration a little bit above thirty percent. You know, kind of two ways to look at that—on the positive side, you know, a lot of room for growth. On the negative side, you could say you guys have been at this a long time, and it is only at thirty percent. So my question is more geared towards that more bearish look, which is, you know, obviously, some portion of those patients may not have a best fit for getting an exome/genome versus a single or multi-gene panel. I am thinking about a patient that has kind of strong suspicion for a particular rare disease based either on pheno or family history. So do you have any sort of insight based on your market research into what percent of that 300,000 patients, you know, maybe the best clinical practice would not be a next-gen—would be to start with something like a single or multi-gene panel, and then reflex to a next-gen if needed?

Yeah. Look. I think our position has always been and remains that ultimately there will be one test for all hereditary disease diagnosis, and it will be a whole genome. I think if you look to say, well, we have activated eight out of ten clinical geneticists who have been ordering from GeneDx Holdings Corp., and we have held that share for at least the ten years I have been with the company, I think proves the power of our service offering. You say, well, why are they only ordering for 30% of their patients? Like I said, we have not been attempting to pull through all volume types. In the fourth quarter and all periods prior, there is volume we have left on the table. There would be demand out there for offering physicians a far better answer than multigene panels if we were just willing to take all the volume and not get paid for it. We have been taking a fairly disciplined approach to step up those conversion rates over time in a way that is both good for patients and healthy for our business.

The only thing I would add to that is by continuing to utilize single gene or multigene panels, we are just contributing to the diagnostic odyssey. So we have gotten the industrial strength of exome and genome to the point where multigene panels really should, for the most part, be retired. But their use in the settings that we are in are just continuing to proliferate the delayed diagnosis.

Thank you. Our next question comes from the line of Brandon Couillard with Wells Fargo. Your line is now open.

Hey. Thanks. Good morning. Thanks for squeezing me in. Kevin, just one for you. Given it sounds like you have front-end loaded this sales rep build for the year, I think you talked about a double-digit operating margin by the fourth quarter. Should we expect a modest loss to start the year here on the operating line? And just how we think about OpEx ramp moving through the year?

Yeah. Not a loss, but as we said, expect Q1 to be right near breakeven. So it will push the boundary there, but we expect to be able to hold it positive and then build up throughout the year as those reps in particular and some other factors start to earn their keep.

Thank you. Our next question comes from the line of Mark Anthony Massaro with BTIG. Your line is now open.

Hey, guys. Thank you for taking the questions, and congrats on a strong 2025, and congratulations, Katherine, for the award. I wanted to ask about, you know, I did not hear a lot about EMRs or Epic Aura. Can you just speak about your EMR strategy in 2026? Should we expect that to lift, and how do we think about EMRs going into the pediatrician market?

Yeah. And thank you, Mark. I am glad you are asking this. So last year, we, you know, for better or for worse, I think we tied EMRs very much to the NICU. And we learned a lot. What we learned is that clinicians who have been ordering testing from us like our portal. So that is great. We continue to improve it. And so they like that workflow. And so, we spent a lot of time with the team at Epic just to really understand where the opportunities are from their perspective. They obviously see a lot of this business. So we really want to focus our Epic strategy on new customers. So general pediatricians would be a great example of a new customer where Epic can be helpful. So we are thinking about Epic as a driver for both outpatient and inpatient. So really going in with health systems, we have been kind of reprioritizing which health systems we are going into. So looking at it less as a current customer unlock and more as a future customer unlock. So that has been, I think, a really healthy shift for us and very much in line with what Epic sees as kind of best in class moving forward. So more to come on that and how it plays a part in unlocking new customer types.

That is really helpful. And then last question for me. It looks like the NICU is going to likely be the largest source from that 7% to 8% growth from the expansion markets. Understand that you are adding 10 reps into the NICU, and, you know, you have talked about onboarding a neonatal nurse. You have talked about, you know, a lot of lessons learned last year. So it seems like this is an important initiative for 2026.

Is there anything else you could just speak to that gives you confidence about maybe some of the, you know, encouraging early performance you have seen here in Q1, but how you are thinking about this building throughout the year with respect to the lessons you learned from last year. Yeah. So we are happy with what we are seeing from an ordering perspective year-to-date. So I think that is point one, and that is a great message to be able to deliver. So much so that we are, you know, we are taking a look at do we want to add more reps and at what point in time. The new leadership that we brought on, our Chief Medical Officer, Dr. Gannon, she is super eager to be spending time in the field and to start a real peer-to-peer KOL strategy because her view is neonatologists are going to listen to other neonatologists. So we need to kind of break the pattern of the neonatologists constantly deferring to the geneticist. And so I think the peer-to-peer work that we are going to be deploying this year we feel like is going to be powerful. She has been making calls already, sharing great feedback on GeneDx Holdings Corp. from those who are ordering. And then, you know, just in her network, being able to unlock some good opportunity for us to go get. And so with that and then also with the SEQuence First protocol being a really important tool for us, I think it is really just trying to simplify the selling strategy. So we are going right to those neonatologists and activating them more directly versus having to tackle it in a more systemic way.

Thank you. And I am currently showing no further questions at this time. This does conclude today's call. Thank you all for your participation. You may now disconnect.