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BillionToOne, Inc.: Q1 FY2026 earnings call

What management said about Q1 FY2026, from the documents filed with the SEC on 6 May 2026: press release. Guidance figures: 1 raised. The quarter’s numbers.

Key takeaways

  • Revenue rose 84% year over year: Total revenue was $108.4 million, up from $59.0 million, with prenatal and oncology both growing. Source
  • Operating income turned positive: Income from operations was $17.8 million, compared with a $2.3 million loss a year earlier. Operating margin was 16%. Source
  • Oncology revenue more than quadrupled: Oncology revenue was $10.7 million against $2.2 million a year earlier, a rise of 392%. Source
  • Gross margin widened to 73%: Gross profit was $79.1 million, a 73% margin against 64% a year earlier. Management attributed the improvement to higher Overall ASP. Source
  • Cash flow after capex was $11.0M: Operating cash flow was $15.4 million and capital expenditures $4.5 million, against $2.6 million and $2.3 million a year earlier. Source
  • Unity Confirm assay announced: Unity Confirm is a non-invasive assay that uses isolated circulating fetal cells from a maternal blood draw to confirm high-risk screening results. Source

“Our first quarter performance underscores the continued momentum we are building through our differentiated technology platform, category-defining products, and disciplined execution,”

Dr. Oguzhan Atay, Co-Founder and CEO of BillionToOne

Guidance

AreaPeriodFigureAgainst last quarter
Total revenue SourceFull year 2026$450.0 million to $465.0 millionRaised from $430 million to $445 million

What changed from last quarter

  • Guidance raised: Full-year 2026 revenue guidance was raised to $450 million to $465 million from $430 million to $445 million. Source
  • New: Management announced the launch of Unity Confirm, a circulating fetal cell-based, non-invasive confirmation assay for high-risk screening results. Source
  • New: Management said payor contracts were significantly expanded, with contracted lives in the U.S. reaching $300 million. Source

Revenue and profit growth

  • Revenue rose 84% year over year: Total revenue was $108.4 million, up from $59.0 million, with prenatal and oncology both growing. Source
  • Operating income turned positive: Income from operations was $17.8 million, compared with a $2.3 million loss a year earlier. Operating margin was 16%. Source
  • Net income and diluted EPS: Net income was $18.0 million, or $0.34 per diluted share, against a net loss of $4.0 million, or $(0.39) per diluted share, a year earlier. Source
  • Interest income and term loan charge: Interest income rose to $4.6 million from $1.5 million. The change in fair value of the term loan was a $4.3 million expense. Source

Segment revenue

  • Prenatal revenue rose 72%: Prenatal revenue was $96.5 million, up 72% from $56.1 million a year earlier. Source
  • Oncology revenue more than quadrupled: Oncology revenue was $10.7 million against $2.2 million a year earlier, a rise of 392%. Source
  • Clinical trial support revenue small: Clinical trial support and other services revenue was $1.1 million, up 61% from $0.7 million. Source

“We remain focused on addressing some of healthcare’s most complex challenges.”

Dr. Oguzhan Atay, Co-Founder and CEO of BillionToOne

Test volume and pricing

  • Tests delivered rose 44%: Tests delivered were 188,000, against 131,000 a year earlier, an increase of 44%. Source
  • Overall ASP rose 28%: Overall average selling price rose to $571 from $445. Management named the increase in Overall ASP as a driver of revenue growth. Source
  • Tests accessioned close to deliveries: Tests accessioned were 189,000, up 38% from 137,000, close to the 188,000 tests delivered. Source

Costs and gross margin

  • Gross margin widened to 73%: Gross profit was $79.1 million, a 73% margin against 64% a year earlier. Management attributed the improvement to higher Overall ASP. Source
  • Cost per test held roughly flat: Overall cost-per-test was relatively stable. Per-test cost gains in oncology and prenatal were offset by faster oncology growth, which carries higher cost per test. Source
  • Operating expenses rose 52%: Total operating expenses were $61.3 million, with R&D at $14.7 million and SG&A at $46.6 million, against $10.4 million and $29.9 million a year earlier. Source

“As we move through 2026, we believe we are only beginning to realize the full potential of our platform.”

Dr. Oguzhan Atay, Co-Founder and CEO of BillionToOne

Non-GAAP earnings measures

  • EBITDA swung to a gain: EBITDA was $15.6 million, against a $3.6 million loss a year earlier. Source
  • Adjusted EBITDA rose to $26.0 million: Adjusted EBITDA was $26.0 million against $1.8 million, after adding back stock-based compensation of $6.5 million and a $4.3 million term loan fair value change. Source

Cash flow and balance sheet

  • Cash flow after capex was $11.0M: Operating cash flow was $15.4 million and capital expenditures $4.5 million, against $2.6 million and $2.3 million a year earlier. Source
  • Receivables absorbed operating cash: Accounts receivable rose to $61.3 million from $41.6 million, a $19.7 million use of operating cash in the quarter. Source
  • Debt issuance raised long-term debt: Proceeds from debt issuance were $30.0 million. Long-term debt was $90.0 million, against $57.2 million at year-end. Source
  • Cash balance rose to $537.5M: Cash and cash equivalents were $537.5 million at March 31, 2026, up from $496.0 million at December 31, 2025. Source

Platform and payor reach

  • Payor contracts reached $300 million lives: Management said payor contracts were significantly expanded, with contracted lives in the U.S. reaching $300 million. Source
  • Unity Confirm assay announced: Unity Confirm is a non-invasive assay that uses isolated circulating fetal cells from a maternal blood draw to confirm high-risk screening results. Source
  • Additional prenatal and oncology launches: Management said additional prenatal and oncology offerings were launched in the first quarter of 2026. Source

Figures management reported

FigureReported
Tests delivered Source188,000 vs 131,000 (+44%)
Tests accessioned Source189,000 vs 137,000 (+38%)

Other quarters

Summarised with AI from the documents the company filed with the SEC. Every point is checked against the filing before it is shown: management’s own words word for word, figures against the line or table row they come from. A point that fails the check is left out. Source opens the filing at that line.