Exagen (E08A) Q3 2026 Earnings Report

The call was strongly positive, with record quarterly revenue, double-digit year-to-date revenue growth, improving adjusted EBITDA, rising ASP, expanding commercial productivity, strong Pharma Services growth, balance sheet strengthening and meaningful progress toward the myositis launch. The principal challenges were modest third-quarter volume growth, normal seasonal effects, continued adjusted EBITDA losses, uncertain PAMA implementation and no update on the AVISE CTD LCD. Highlights significantly outweighed lowlights.

Exagen reiterated 2026 full year revenue guidance of $72 million to $75 million, assuming high single-digit volume growth and mid-single-digit full year ASP growth compared to the fourth quarter 2025 exit rate, with typical second half volume seasonality and a growing contribution from Pharma Services; management also expects high single digits volume growth, low to mid-single digits ASP growth and revenue growth in the double digits on an annual basis, targets an ASP of at least 50% of Medicare reimbursement or approximately $600 to $650 per test over time, expects gross margin to progress to the mid-60s over time, and believes that at $80 million and around a 60% gross margin it should be right at breakeven on an adjusted EBITDA basis; the myositis offering is on track for launch in early '27, with the validation package expected by the end of January, while potential PAMA impact is expected to be low single-digit impact if it were to be realized fully.