Jul 30, 2026 earnings call — FDA approvals and Shield commercial expansion
Q2 revenue was $335 million, up 44% year-over-year.
Revenue $0.3B (est $0.3B) · EPS $-0.90 (est $-0.76) · Next-quarter revenue outlook $1.3B–$1.4B
Key quotes
"This coverage will be effective starting on August 1, which includes Shield as a covered primary colorectal cancer screening option for average risk adults aged 45 and older."
"In May, we received FDA approval for Guardant360 Liquid CDx, the most advanced FDA-approved liquid biopsy panel with 100x more content versus our legacy FDA-approved CDx product."
"Reveal continues to perform at an extremely high level with volume growth accelerating for the third quarter in a row to well above 100% year-over-year."
Analyst Q&A 14
Screening pricing, volume, and USPSTF timing
Q (Kyle Mikson · Canaccord): Analyst asked how UnitedHealth and ACS coverage will affect ASP (price) and volumes now and long-term, and asked whether the late-August USPSTF meeting still implies inclusion in late '27 or early '28.
A: Management said the UnitedHealth win could be a volume tailwind and help build commercial volume among younger patients. On ASP, they said pricing discussions will take time and require conversations and payment history. They are not changing expectations for the USPSTF timing and will monitor the August meeting.
"ASP is going to take some time, though, like ASP in order to see the impact, we need to obviously go through some kind of conversations with them" — AmirAli Talasaz (CEO)
Oncology volume guide and UnitedHealth impact
Q (Subhalaxmi Nambi · Guggenheim): Analyst asked what drove the 50% Oncology volume guide raise, whether Reveal in metastatic stage is the main source, how per-patient testing cadence looks, and how United coverage might influence other payers without USPSTF.
A: Management said volumes were broad-based: G360 grew >30%, tissue accelerated, and Reveal grew >100%, and all products should help reach the 50% guide. They called the UnitedHealth coverage earlier-than-expected but noted multiyear relationships and that the decision is getting other payers' attention; they do not expect major additional wins this year.
"I think all of them are really going to be contributing to sort of continued strong volume for the second half of the year." — Helmy Eltoukhy (CEO)
Product growth S-curve and Shield ramp drivers
Q (Puneet Souda · Leerink): Analyst asked where the products are on the growth S-curve, what drives Shield upside (sales reps, DTC), and whether Q3/Q4 will show sequential Shield ramp.
A: Management said the platform is comprehensive and physicians are still gaining experience, so they think there is more runway for growth. For Shield, Q2 showed a strong sequential step-up (22,000) driven by Quest co-promotion, DTC, and adding field force; they raised the second-half guide modestly and are being thoughtful about expectations.
"The sequential growth of Q2 over Q1 was super strong for us, 22,000 step-up." — AmirAli Talasaz (CEO)
Negotiating price with UnitedHealth and endorsements
Q (Mark Massaro · BTIG): Analyst asked how Guardant is thinking about negotiating ADLT pricing with UnitedHealth, appetite for discounts, and whether ACS/NCCN endorsements derisk USPSTF.
A: Management said they just received coverage and need to go through the pricing negotiation process, noting Medicare pricing is central and their pricing is transparent. They said United acted before USPSTF, the decision is drawing attention, they have managed-care relationships, but they do not expect major wins for the rest of the year and included no additional wins in the guide.
"So in terms of pricing negotiation, like we just got the coverage, so let us go through that process and see what's going to happen." — AmirAli Talasaz (CEO)
ADLT price, ASP pass-through, and reinvestment
Q (Daniel Brennan · TD Cowen): Analyst asked whether $8,500 is the right ADLT price, how MA and commercial realized prices should change, and what drop-through to pre-tax profit versus reinvestment to expect.
A: Management said they expect a price of $8,455 and that it will take 12 to 24 months for Medicare Advantage and commercial payers to change prices to the new Medicare level. They plan to invest incremental gross profit in commercial and innovation while also letting some flow to the bottom line to accelerate cash flow breakeven.
"It will take time for Medicare Advantage and commercial payers to sort of change the price in line with the new Medicare price." — Michael Bell (CFO)
2028 targets, ASP uplift, and profitability impact
Q (Daniel Markowitz · Evercore): Analyst asked how recent developments affect the 2028 revenue target and whether the ADLT/list price implies Guardant360 ASP nearer $5,000 and the resulting profitability impact.
A: Management said they remain on track for the $2.2 billion 2028 target and current 2026 guidance of 36%–38% supports that confidence. They said the $8,455 ADLT rate could lead to a Guardant360 ASP around $5,000 over 12 to 24 months and that incremental gross profit would be partly reinvested and partly used to accelerate breakeven.
"Our current guidance now for the full year of '26 is 36% to 38%." — Michael Bell (CFO)
Therapy monitoring (Reveal) volumes and FDA approval impact
Q (Casey Woodring · JPMorgan): Analyst asked how therapy monitoring volumes are tracking and contributing to Reveal's >100% growth, how to think about revenue once IO and chemo reimbursement turn on, and whether the FDA approval has materially moved doctor adoption.
A: Management said therapy monitoring (MRD) traction is strong and may be an underappreciated, large opportunity given ~1 million late-stage patients who could be monitored multiple times. On FDA approval, it was late in the quarter and too early to quantify impact, though reception is positive and they will lean into it.
"We're seeing very, very good uptake from our G360 orders who really want to sort of move into the future of precision medicine here." — Helmy Eltoukhy (CEO)
Reveal Ultra roadmap and Shield MCD opt-ins
Q (Kallum Titchmarsh · Morgan Stanley): Analyst asked for more detail on Reveal Ultra's indication roadmap and commercial strategy, and for AmirAli to describe Shield multi-cancer opt-in rates and how the test data are being used.
A: Management said Reveal Ultra development has gone very well with limits of detection below 1 parts per million, and they will be thoughtful about launch timing, indications, reimbursement, and clinical validation. On Shield multi-cancer, management said data collection is going well and the majority of physicians ordering Shield opt in to receive the MCD results report.
"data collection is going very well, powered really by the attachment rate that remains very strong." — AmirAli Talasaz (CEO)
Addressing patient copays and rebates with United
Q (Dan Leonard · RBC): Analyst asked whether Guardant can address price sensitivity in United's member base via copay assistance, and whether USPSTF is needed to eliminate patient cost-sharing.
A: Management said they need to see the United conversation on copays and patient responsibility; they noted that post-USPSTF any copay would go away. On rebates, management declined to comment.
"So actually, we have to see what the United conversation would be around, like the co-pay and the patient responsibility." — AmirAli Talasaz (CEO)
Cross-selling between therapy selection and monitoring
Q (Elizabeth Koslosky · Goldman Sachs): Analyst asked about cross-selling benefits between therapy monitoring and therapy selection and any sales force productivity color.
A: Management said the same oncologists order both tests and the products fit as a one-two punch: test to select therapy and then monitor response, creating a longitudinal data stream for each patient. They framed this as advancing platformization but did not provide specific productivity numbers.
"it's a nice one-two punch in terms of how the products fit together." — Helmy Eltoukhy (CEO)
G360 Tissue volumes after liquid approval
Q (Paige Chamberlain · Wolfe): Analyst asked whether G360 Tissue volumes might accelerate after the liquid test NCD and phased FDA rollout, and whether any volume upside is baked into guidance ahead of ADLT pricing.
A: Management said they have not baked much in given the phased rollout, but are excited for potential after ADLT. They said Guardant360 Tissue is the second fastest-growing Oncology product, can process more challenging samples, and that its performance advantage is driving stand-alone volume gains.
"We're really able to process much more challenging samples than a lot of the other tests out there." — Helmy Eltoukhy (CEO)
Profitability timeline and drivers
Q (Bradley Bowers · Mizuho): Analyst asked about profit modeling, whether an EBITDA or cash flow inflection could happen in the next 12 months, and what might pull profitability forward.
A: Management said the business excluding Screening is adjusted EBITDA positive and generating cash flow, and Screening investments will continue while they ramp commercial scale. They expect Screening to start reducing cash burn in 2027, the Screening business to reach breakeven in 2028, and that ADLT pricing for Guardant360 could accelerate the path to cash flow breakeven.
"We're well on track to get to cash flow breakeven by the end of 2027." — Michael Bell (CFO)
Why Guardant360 Tissue is gaining share
Q (Noah Kava · Jefferies): Analyst asked whether Tissue share gains are from concurrent testing trends or a true shift in provider preference, and what the growth assumption is for this market going forward.
A: Management said much of the growth is Tissue standing on its own: it can use smaller samples and offers a comprehensive panel plus recent apps ported from Liquid. They said the product benefits from their InfinityAI platform and should perform well as concurrent testing becomes more prevalent.
"I think right now, I think a lot of the growth is really sort of Tissue standing on its own 2 feet." — Helmy Eltoukhy (CEO)
Reveal MolDX timing and Shield low-COGS change
Q (Catherine Ramsey · Baird): Analyst asked when they might hear back from MolDX on Reveal submissions and about the PMA supplement that appears to simplify Shield to a methylation-only, lower-COGS workflow and how that development proceeded.
A: Management said IO and breast are closest and they are hopeful to get at least one or both by the end of this year, with chemo progress as well and additional submissions in preparation. They said Shield was focused on a methylation-only workflow using information already in Shield V1 and that algorithm updates and multimodal Shield work are generating pipeline activities.
"I think we're hopeful that we can get at least one or both of them by end of this year." — Helmy Eltoukhy (CEO)