BillionToOne (BLLN) Q1 2026 earnings summary

Executive summary

• Achieved 84% year-over-year revenue growth in Q1 2026, reaching $108.4 million, with strong performance in both prenatal and oncology segments and an annualized run-rate of $434 million.

• Net income reached $18.0 million, reversing a net loss of $4.0 million in Q1 2025.

• Delivered approximately 188,000 tests in Q1 2026, up 44% year-over-year.

• Launched UNITY Confirm, a first-of-its-kind non-invasive prenatal confirmation assay, and expanded payor contracts to 300 million contracted lives in the U.S.

• Achieved GAAP profitability and positive cash flow, with a 16% operating margin and 24% adjusted EBITDA margin.

Financial highlights

• Q1 2026 revenue was $108.4 million, up from $59.0 million in Q1 2025 (84% growth).

• Prenatal revenue grew 72% year-over-year to $97.7 million; oncology revenue increased nearly 400% to $10.7 million.

• Gross profit was $79.1 million, with gross margin expanding to 73% from 64% a year ago.

• Operating income reached $17.8 million, reversing a $2.3 million loss in Q1 2025.

• Adjusted EBITDA was $26.0 million, up from $1.8 million in Q1 2025.

Outlook and guidance

• Raised 2026 revenue guidance to $450–$465 million, representing 48–52% growth over 2025.

• Guidance increase driven primarily by higher ASPs from new payer contracts, not by increased volume assumptions.

• Expect gross margins to remain at or above 70% for the year, with some quarterly volatility.

• Continued profitability expected, even with ongoing investments in sales, R&D, and clinical evidence.

• Current liquidity is expected to fund operations for at least the next 12 months.