Veracyte

Phase A — Understand the business

Lens 1 · Company Overview

Veracyte is a profitable, commercial-stage molecular diagnostics company — not a pre-revenue biotech. It sells genomic cancer tests that help clinicians make diagnostic, prognostic, and predictive decisions, the explicit value proposition being to help patients avoid unnecessary procedures (e.g. diagnostic thyroid surgery, prostate over-treatment) and accelerate appropriate treatment.

Two go-to-market models:

• US — Laboratory Developed Tests (LDTs) run in its own CLIA-certified labs (South San Francisco + San Diego, CA; cytopathology in Austin, TX). This is the bulk of revenue.
• Ex-US — In Vitro Diagnostic (IVD) kits distributed to local labs/hospitals (currently Prosigna, on the nCounter platform).

Product portfolio:

• Decipher Prostate — whole-transcriptome genomic classifier across the full prostate-cancer continuum; the only gene-expression test in the 2026 NCCN prostate guidelines' risk-stratification table; covered for >215M enrollees. The #1 growth driver.
• Afirma — thyroid genomic sequencing classifier; resolves indeterminate FNA results to avoid unnecessary surgery; covered for >275M enrollees. The #2 driver.
• Decipher Bladder — genomic classifier; first Medicare-covered genomic bladder test (since 2021).
• Prosigna — PAM50 breast-cancer recurrence assay; sold as an IVD ex-US, with a US LDT launch targeted mid-2026.
• Percepta Nasal Swab — non-invasive lung-nodule risk test (in development / clinical-utility trials).
• TrueMRD — whole-genome, AI-powered minimal residual disease (MRD) platform from the 2024 C2i acquisition; first indication = muscle-invasive bladder cancer (MIBC); launch targeted H1/Q2 2026.

Revenue model & payment terms: Recurring per-test billing, mostly to third-party payers. FY2025 testing-revenue payer mix: Medicare Fee-For-Service 34%, Medicare Advantage 18%, Medicaid 1%, private commercial 47%. Reimbursement is the load-bearing variable — coverage decisions (MolDX/Palmetto GBA LCDs), CPT codes, and PAMA rate-setting drive the economics. Not take-or-pay; volume + ASP + collection rate is the engine.

Customers = ordering physicians (urologists, endocrinologists, oncologists) and, ex-US, hospital/lab buyers of IVD kits. Suppliers = sole-source reagent/instrument vendors (notably nCounter, licensed from NanoString — now Bruker). Competitors — see Lens 3.

Lens 2 · Supply Chain

Map: sole-source reagent & instrument suppliers → Veracyte CLIA labs (SSF / San Diego / Austin) → ordering physician → third-party payer reimbursement.

Named stakeholders / dependencies:

• Upstream — sole/single-source suppliers: Veracyte "procure[s] reagents, equipment, and other materials… from sole suppliers" and "purchase[s] components used in our collection kits from sole-source suppliers." It explicitly carries higher-than-normal inventory to mitigate single-source risk. This is a real chokepoint: a reagent interruption stops test processing and report delivery.
• nCounter Analysis System — the instrument Prosigna runs on, licensed from NanoString Technologies, now owned by Bruker Corporation (asset acquisition). Veracyte holds an exclusive worldwide license for clinical IVD use. A platform owned by a third party is a structural dependency for the IVD franchise.
• Illumina — multi-year agreement (announced 2023) to offer some molecular tests as decentralized IVDs on Illumina's NextSeq 550Dx ex-US (Prosigna planned).
• Thyroid Cytopathology Partners (TCP) — partner that performs initial cytopathology for a portion of Afirma order flow. A related-channel dependency for the thyroid franchise.
• Third-party claims transmitters — Veracyte relies on third parties to transmit claims to payers; a flagged risk if delayed.
• Downstream — payer concentration: Medicare (FFS + Advantage) is ~52% of testing revenue; a single MAC (Palmetto GBA, via MolDX) adjudicates most coverage. This is the single most important node in the chain — see Lens 10.

Chokepoints: (1) sole-source reagents/kits; (2) the externally-owned nCounter platform; (3) Medicare/MolDX coverage and PAMA rate-setting.

Lens 3 · Competitive Advantages (moats)

Veracyte's moat is evidence + guideline inclusion + payer coverage, compounding through its self-described "Veracyte Diagnostics Platform" flywheel (real-world utilization → data → evidence → guideline inclusion → durable reimbursement).

Durable moat sources:

• Guideline lock-in / evidence depth. Decipher Prostate is the only gene-expression test in the 2026 NCCN prostate risk-stratification table, backed by >115 peer-reviewed studies; Afirma is in NCCN/ATA guidelines with >160 studies and an NEJM validation. Guideline inclusion is the highest barrier to entry in dx — it takes years of prospective + retrospective evidence and is sticky once won.
• Reimbursement breadth — coverage for 215M+ (Decipher) and 275M+ (Afirma) enrollees. A new entrant must re-run the entire evidence-and-coverage gauntlet.
• Specialist commercial channels — entrenched urology (Decipher) and endocrinology (Afirma) sales relationships, which Veracyte intends to leverage to enter the patient journey early and move "down" the continuum into MRD.
• Switching costs / clinician habit — once a test is the standard of care in a specialty's workflow and guideline, displacement is slow.

Bargaining power: weak vs. payers (Medicare sets price administratively via PAMA/CLFS; Veracyte is a price-taker), moderate vs. suppliers (sole-source = supplier leverage), strong vs. individual physicians (guideline + evidence = pull demand). Net: the moat is real on the installed franchises (prostate, thyroid) but does not automatically extend to new categories (MRD, lung, breast LDT), each of which must win its own evidence/coverage battle against incumbents — see Lens 13.

Lens 4 · Segments

segments.csv was empty, so segmentation is taken from the filings' revenue-line and test-volume disclosures.

By revenue line — FY2025 vs FY2024:

Testing revenue — the engine — is ~95% of total. Within testing, FY25 growth was driven by a +$66.7M Decipher increase and +$13.7M Afirma increase. Volume: Decipher ~102,000 tests (+27% YoY), Afirma ~67,700 (+11%). So Decipher is the accelerant; Afirma is the cash cow growing double-digits.

The Biopharma line is shrinking by design — Veracyte deconsolidated its France subsidiary (Veracyte SAS) in restructuring proceedings in August 2025, removing the contract-development/manufacturing services revenue. This is a deliberate focus on the high-margin US testing franchise, not demand loss.

Q1 2026: Testing revenue $135.1M (+26% YoY), total revenue $139.1M (+21%); diagnostic tests reported 45,248 (+19%). Decipher ~28,000 tests (+24%), Afirma ~17,200 (+12%). The biopharma drag (−92% in Q1) is now lapping out.

By geography: Not broken out cleanly in the filing tables; the business is overwhelmingly US (LDT franchise). Ex-US is the Prosigna IVD (Product revenue, ~3% of total) plus the planned Illumina-platform expansion. Geographic concentration in the US is high.

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Phase B — Measure performance

Lens 5 · Earnings Result (latest print — Q1 2026, reported 2026-05-05)

The Q1 2026 print was a decisive beat-and-raise and the single most important recent event for the stock.

• Revenue $139.1M, +21% YoY; beat consensus ~$130.2M.
• Testing revenue $135.1M, +26% — driven by +19% volume plus ASP and prior-period collections.
• Net income $28.7M vs $7.0M PY (+307%); net margin 6% → 21%.
• GAAP EPS ~$0.52 vs consensus ~$0.33 — a ~57% beat.
• Income from operations $22.6M vs $2.9M (+680%) — operating leverage is the story; total opex was nearly flat (+2%) on +21% revenue.
• Adjusted EBITDA $42.8M, ~30.8% of revenue (+73% YoY); non-GAAP gross margin 75.7% (+350bps).
• Margin moves & why: R&D +53% (a $6M reclass of software dev from G&A + the new Chief Development & Technology Officer); G&A −30% (mirror of that reclass + lower legal/audit/contingent-consideration revaluation). So the optics of the opex lines are partly reclass; the real signal is the gross-margin expansion and flat-to-down true G&A.
• Balance-sheet flags: cash + ST investments $439.1M, +$26.2M in the quarter; accumulated deficit narrowed to $348.9M; operating cash flow $35.2M vs $5.4M PY. Clean — no inventory/receivable blowout.
• Guidance raised: FY2026 revenue to $582–592M (~+13.5% at midpoint) and adjusted EBITDA margin to >26%.
• Market reaction: stock +23% on the week — confirming the market rewards testing-volume + margin + guidance, and that profitability inflection is being re-rated.

Unusual vs. own history: this is the company's clearest profitability inflection — Veracyte only turned GAAP-profitable in 2024 ($24.1M net income after a −$74.4M loss in 2023) and Q1 2026 shows the model scaling.

Lens 6 · Earnings Calls (sentiment trend)

No transcripts on the shelf (transcripts/ empty); this lens is ``.

Management's consistent focus across recent calls: (1) Decipher + Afirma volume outperformance, (2) the three-pillar growth pipeline — TrueMRD (MIBC, Q2 launch), Prosigna LDT (mid-2026), and longer-term lung/Percepta, and (3) profitability/adjusted-EBITDA discipline. Tone has shifted over the last ~4 quarters from "approaching sustainable profitability" (2024) to confidently profitable + reinvesting (2026), with management now guiding EBITDA margin up while funding R&D for MRD. Recurring phrases: "durable growth," "multiple growth catalysts," "exceeded profitability targets." What they've stopped emphasizing: the France/biopharma services business (now deconsolidated) and cash-runway anxiety (the company self-funds). The narrative is credible and matches the printed numbers — a positive sentiment trend.

Lens 7 · Comps

Peer set = US molecular-diagnostics / precision-oncology names.

Read: VCYT is the rare profitable, FCF-positive, debt-free name in a peer group where Natera, Guardant, and Exact are larger but still GAAP-loss-making. It trades at ~6.5x forward sales `` — a premium to the slower-growers but a discount to Natera's growth multiple. The honest framing: you pay a profitability premium for a slower grower (+13–14% guided) vs. Natera (+38% Q1). The multiple is defensible only if the MRD/lung optionality converts; on the installed base alone, ~6.5x sales / ~30x FCF is full. (Forward P/E and most peer multiples were not cleanly sourced — flagged rather than fabricated.)

Lens 8 · Stock-Price Catalysts

`` throughout. The 52-week range is $22.61 → $54.72, and the stock sits ~$53.21 (2026-06-22) — i.e. it has roughly doubled off its low and trades within ~3% of its 52-week high.

Pattern of >5% moves:

• +23% week of 2026-05-05 — Q1 2026 beat-and-raise (revenue +21%, EPS +57% vs consensus, FY guide raised).
• "More than doubled since early August 2024" — Q3 2024 beat + FY24 guidance raise kicked off the re-rating.
• Historically the stock reacts to (1) earnings beats/guidance raises and (2) volume + reimbursement/coverage news (e.g. Decipher metastatic expansion, Decipher Bladder final Medicare coverage), far more than to macro.

What the market reacts to for VCYT: testing-volume growth, margin/EBITDA inflection, guidance changes, and Medicare-coverage milestones. Conversely, the bear catalysts to watch are reimbursement/PAMA resets and competitive data — neither of which has hit the stock yet, which is precisely the asymmetry.

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Phase C — Judge people & books

Lens 9 · Management

`` (Part III is incorporated by reference to the proxy, not in the 10-K).

• CEO — Marc Stapley (since June 2021; ~5-yr tenure). Track record: prior CEO of Helix (2019–21, built a leading COVID surveillance lab), and CFO/CAO/EVP at Illumina (2012–19) — i.e. a finance-and-genomics operator, not a scientist-founder. On his watch Veracyte went from a −$74.4M loss (2023) to GAAP profit ($24.1M 2024, $66.4M 2025) and FCF-positive — a credible, quantified turnaround to profitability.
• Executive Chairman — Bonnie Anderson — the long-time founder/former CEO, providing continuity. Founder-on-the-board + professional-operator-CEO is a healthy archetype for this commercial-scaling stage.
• Skin in the game / ownership: Insider ownership is ~2.5%; institutions own >94% (BlackRock ~15.4%, Vanguard ~10.2%, ARK ~6.8%). Stapley directly owns ~440,494 shares after recent sales.
• RED FLAG to weight — persistent insider selling: Stapley sold 138,051 shares at $50.12 ($6.9M) on 2026-06-04 and has a pattern of 10b5-1 sales (another ~$6.9M sale flagged separately). Sales are 10b5-1-planned and partly tax-withholding on RSU/PSU vesting, but the net direction is selling into strength near all-time highs with low absolute insider ownership. Not disqualifying, but it tempers the "management is all-in at these prices" narrative.
• Capital allocation: The signature move is the 2024 C2i acquisition (whole-genome MRD → TrueMRD) — the entire MRD growth thesis rests on it; jury still out on ROI. Otherwise disciplined: no dividend, no buyback, self-funding growth from FCF, and a value-additive deconsolidation of the loss-making France/biopharma unit (2025). ROE is turning positive only now (post-2024 profitability), so a clean multi-year ROIC trend isn't yet established.
• Founder vs professional: professional-operator CEO + founder chairman — appropriate for a scale-and-execute phase.

Lens 10 · Forensic Red Flags

Grounded in the filings; figures `` unless noted.

• Revenue recognition / collections: Testing revenue is recognized net of expected payer adjustments — inherently estimate-heavy in dx. Watch the gap between billed and collected. Q1 2026 explicitly benefited from "prior period collections" — a tailwind that can flatter a quarter and shouldn't be extrapolated. AR was roughly flat ($44.7M vs $46.5M YoY) against +16% revenue — clean, no receivables blowout. Cash flow corroborates earnings (OCF $136.3M FY25 > net income $66.4M) — a positive forensic sign, not a divergence.
• Goodwill / intangibles — the biggest balance-sheet item to watch. Goodwill is $767.2M and intangibles $89.1M against total assets of $1.41B — i.e. goodwill is >54% of assets, largely from the C2i and earlier (Decipher/Castle, NanoString IVD) acquisitions. The company took a $20.5M impairment in FY2025 (vs $3.4M in 2024, +509%) and $68.3M of impairment in 2023. So impairment is a recurring feature, and a TrueMRD/C2i stumble could trigger another goodwill write-down. This is the #1 accounting risk.
• Stock-based comp: $43.6M FY25 (+20%), ~8.4% of revenue; $12.8M in Q1 2026. SBC flatters the adjusted-EBITDA margin the bulls quote (30.8%) vs GAAP. Material but not extreme for the sector; dilution is real (shares 77.8M → 79.4M YoY).
• Contingent consideration: A −$15.3M revaluation gain on acquisition contingent consideration helped FY25 — a non-operating, non-cash earnings contributor to watch for quality-of-earnings.
• Deferred-tax valuation allowance: Management flagged it may release a portion of the valuation allowance within 12 months — would create a one-time tax benefit that inflates a future GAAP quarter. Forewarned.
• Foreign-currency / deconsolidation noise: FY25 included a $6.7M non-cash loss on the France deconsolidation and an $8.3M release of accumulated translation adjustment — non-recurring; normalize them out.

Regulatory findings (required):

• SEC: No Litigation Releases and no AAERs naming Veracyte (2021-06-23 → 2026-06-23), per SEC EDGAR EFTS.
• 10-K Item 3 (Legal Proceedings): Veracyte states it is "currently not a party to any material legal proceedings".
• Non-SEC (FDA/FTC/DOJ): No material enforcement actions surfaced in web search. The relevant regulatory risk (not an action) is the LDT oversight regime: the FDA's May-2024 final rule to phase out LDT enforcement discretion was vacated by a federal court on 2025-03-31 and not appealed, so Veracyte's LDTs currently face no incremental FDA premarket burden — but the landscape "remains uncertain" and could change via new legislation (e.g. a future VALID Act).
• Conclusion: No material regulatory or legal findings — verified via SEC EDGAR EFTS (LR, AAER), web search, and 10-K Item 3 as of 2026-06-23.

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Phase D — Project & stress-test

Lens 11 · Forward Projection

Built bottom-up from FY25 actuals + FY26 guidance. No forecast.ts create (watchlist/unattended). Output ``.

Anchors: FY25 revenue $517.1M, net income $66.4M; FY26 guided revenue $582–592M (mid $587M, +13.5%), adj-EBITDA margin >26%. Testing revenue is growing ~26% but the biopharma runoff masks ~12pts of it at the total line in FY26 (last lap of the deconsolidation drag).

EPS arithmetic ``: base FY26 net income ~$95–105M on ~80M shares ≈ $1.20–1.30 GAAP EPS; growing to ~$1.55 by FY28 on operating leverage net of SBC dilution and a normalizing tax rate (valuation-allowance release is a one-time wildcard). Brier forecast I would log (not logged here): "VCYT FY2026 revenue ≥ $585M, p≈0.75, resolves 2026-12-31" and "VCYT FY2026 GAAP net income ≥ $90M, p≈0.65."

The number that matters: at ~$53 / ~$4.25B cap, the market is paying ~30x FCF / ~6.5x forward sales for a 13–14% top-line grower. That only works if FY27–28 reaccelerates on MRD/lung. The base case does not clear today's price; the bull case roughly justifies it; the bear case implies meaningful downside.

Lens 12 · Bull vs Bear

Bull case. A profitable, debt-free, FCF-generative ($126M FY25) genomic-dx leader with guideline-locked, deeply-reimbursed franchises (Decipher = only NCCN prostate gene-expression test; Afirma covered for 275M lives). The flywheel — evidence → guidelines → coverage → volume → more evidence — is genuinely durable on the installed base, and Decipher is still compounding +27%. On top sits three free options: TrueMRD (a shot at the ~$20B MRD TAM that's only ~6% penetrated), Prosigna US LDT (a new breast revenue line mid-2026), and Percepta lung (a large screening-adjacent market). Management has proven it can turn losses into profit and operating leverage. Few dx names combine this growth, this profitability, and a fortress balance sheet ($439M net cash).

Bear case (permanent-impairment risks).

1. MRD is already lost at the beachhead. Natera's Signatera CDx won FDA approval as the first MRD companion diagnostic in MIBC (the exact TrueMRD launch indication), on the landmark Phase III IMvigor011 NEJM data (Oct 2025). Veracyte is launching an LDT into a category where the dominant ~$28B competitor has an FDA-approved CDx + NEJM evidence + a near-monopoly. The single biggest reason to own the stock (MRD optionality) may be the weakest part of the thesis.
2. Reimbursement reset risk. The PAMA data-reporting cycle for Afirma (81546), Decipher (81542) and Decipher Bladder (0016U) runs May–July 2026, with new rates possibly effective Jan 2027. A weighted-median private-payer reset could cut ASP on ~95% of revenue. This is a 2027 cliff the market isn't pricing.
3. Valuation/expectations. ~6.5x forward sales / ~30x FCF for +13–14% growth, near all-time highs, with analyst targets ($46–48) below the ~$53 spot.

Pre-mortem (18 months out, thesis broke): TrueMRD's MIBC launch undershoots because urologists/payers default to FDA-approved Signatera; PAMA cuts Decipher/Afirma rates in 2027; a C2i/goodwill impairment hits; growth decelerates to high-single-digits and the ~6.5x-sales multiple compresses toward the loss-making peers' — a 30–45% drawdown without any fraud or operational disaster, just expectations meeting reality.

Contrarian view — what the market is refusing to see: The bull crowd is buying the MRD/lung story and the profitability re-rating simultaneously, but those partly conflict — funding the MRD land-grab against Natera's FDA-approved product will pressure the very margins being celebrated. The market is treating MRD as a free call option when Natera has already collected the prize at the first indication.

Lens 13 · Devil's Advocate (short-seller)

Dismantling the bull case.

• Where revenue is concentrated: ~95% testing, and within that Decipher + Afirma are the substantial majority — and ~52% of testing revenue is Medicare, administratively priced. Two products + one payer system = the whole company. A PAMA rate cut or a single adverse MolDX/Palmetto coverage change hits the core directly.
• Why the moat is weaker than bulls think: Guideline inclusion protects prostate and thyroid. It does nothing for MRD, lung, or breast-LDT, each of which is a fresh, contested evidence-and-coverage war. The moat is franchise-specific, not company-wide — and bulls are paying a platform multiple for a two-franchise reality.
• Most dangerous competitor bulls underestimate: Natera. It has the FDA-approved MIBC CDx, NEJM data, ~$28B cap, ~38% growth, and a near-monopoly in MRD. Veracyte's "strong urology channel" advantage may not overcome an FDA-approved companion diagnostic that guides immunotherapy. Guardant (Reveal) and Roche/SAGA are also circling MRD.
• Worst capital-allocation question: Was the C2i acquisition (now $767M of goodwill on the books, source of recurring impairments) a bet that's already been out-competed before the product even launched?
• Assumptions that must hold for today's price: (1) MRD/lung convert into real revenue by 2027–28; (2) PAMA does not cut core rates; (3) margins keep expanding while funding the MRD fight. If growth disappoints by 20–30% (i.e. high-single-digit rather than mid-teens), a ~6.5x-sales multiple has no support — fair value compresses toward 3–4x sales, i.e. a stock in the low-$30s.
• Single scenario that permanently impairs the business: A 2027 PAMA cut to Decipher/Afirma combined with TrueMRD failing to gain MIBC share — simultaneously hitting the cash-cow economics and killing the growth narrative. Plausibility: moderate, and crucially not in the price.

Lens 14 · Management Questions (ordered by information value)

1. With Natera's Signatera CDx already FDA-approved in MIBC on IMvigor011 NEJM data, what is TrueMRD's specific, evidence-backed path to win urologist and payer adoption as an LDT in that same indication — and why won't you be the #2 in a category you're paying $767M of goodwill to enter?
2. Walk through your PAMA exposure: how much of FY2027 revenue is at risk if the May–July 2026 data-reporting cycle resets Afirma/Decipher/Decipher-Bladder rates, and what is your downside ASP scenario?
3. Can you sustain >26% adjusted-EBITDA margins while funding the MRD and lung launches, or does the MRD land-grab require a margin step-down the Street isn't modeling?
4. What is the FY2027–28 revenue reacceleration path that justifies the current multiple, and how much of it depends on products not yet commercial (TrueMRD, Prosigna LDT, Percepta)?
5. Decipher is the growth engine at +27% — what is the realistic ceiling on prostate penetration, and when does it decelerate?
6. After the $20.5M FY25 and $68.3M FY23 impairments, how confident are you in the carrying value of C2i-related goodwill given the competitive MRD landscape?
7. How exposed is the IVD franchise to the nCounter platform now owned by Bruker, and what is the contingency if that license or supply is disrupted?
8. What inning is the Prosigna US LDT launch, and what peak US breast revenue do you underwrite?
9. On sole-source reagents/kits: what's your worst realistic supply-interruption scenario and mitigation beyond carrying excess inventory?
10. Percepta lung: what's the gating milestone (guideline? coverage? a pivotal readout) before it's a revenue line, and the realistic timeline?
11. Capital allocation: with $439M net cash and growing FCF, why no buyback at a moment when analyst targets sit below your share price — and would you consider M&A to bolster MRD competitiveness?
12. Insider selling has been steady near all-time highs — how should investors read management's conviction at these levels?
13. What share of testing revenue is collected vs. billed, and how much did "prior-period collections" flatter Q1 2026?
14. If the LDT regulatory regime tightens via future legislation (a revived VALID Act), what's the cost and timeline to bring your core LDTs through FDA?
15. International is ~3% of revenue — is ex-US a real growth pillar or a distraction from the US franchise?

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