Personalis, Inc.

Personalis reported first-quarter 2026 revenue of $15.5 million, down 25% year over year. Clinical test volume was more than 7,800 tests, up 26% sequentially and 258% year over year. Total strategic revenue was $4.5 million, with $3.1 million of biopharma MRD revenue and $1.4 million of clinical revenue. Gross margin was 1.8%, versus 35% in the prior-year quarter, and net loss was $30.0 million versus $15.8 million a year ago. The company ended the quarter with $233.2 million of cash and short-term investments and no debt other than small equipment loans, and used about $28 million of cash in the quarter. Full-year 2026 guidance was unchanged: revenue of $78 million to $80 million, gross margin of 15% to 20%, net loss of about $105 million, and cash usage of about $100 million. Within that outlook, clinical revenue from Medicare-covered breast and lung surveillance is expected to be $10 million to $11 million, biopharma and other pharma/customer revenue $55 million to $56 million, MRD revenue from those customers $20 million to $21 million, and population sequencing plus enterprise revenue about $13 million.

Chris Hall framed the quarter as proof that Personalis is “disrupt[ing] the market” with NeXT Personal and is now scaling after validating its MRD strategy in 2025. He emphasized accelerating clinical adoption, saying the company surpassed 1,000 ordering physicians in the quarter, retention has been over 98%, and annual clinical volume remains targeted at 43,000 to 45,000 tests. He also highlighted positive evidence updates from AACR, including colorectal, real-world, and immunotherapy data, and said the company feels confident about reimbursement submissions and the long-term opportunity.

Aaron Tachibana stressed that the revenue mix shift is intentional, moving away from lower-margin legacy enterprise business toward higher-growth strategic clinical and biopharma MRD revenue. He said Q1 gross margin of 1.8% was compressed by unreimbursed test costs, that the first two quarters should be the low point of the year, and that margins should improve as reimbursed volumes and biopharma revenue scale. He also cited Q1 operating expenses of $32.4 million, with R&D at $14.5 million and SG&A at $17.9 million, and pointed to strong liquidity with $233.2 million of cash and short-term investments, no meaningful debt, and expected 2026 cash usage of about $100 million.

Analysts pressed on whether the volume ramp reflected real competitive share gains, and management said the 26% sequential growth, 7,800 tests, and 1,000-plus ordering physicians showed the strategy was working. Questions also focused on how quickly new physicians ramp, the mix of breast and lung volumes, and the timing of IO reimbursement; management said breast was roughly 20% of volume, lung about 15% to 20%, and that IO coverage is still under review but they are optimistic. On Tempus and internal selling, management said the channel partnership is working as designed, with Tempus handling a little over 80% of volume in Q1 and the internal team flat sequentially, while both channels work together rather than compete.