Adaptive Biotechnologies CEO Flags MRD Momentum, Lifts 2025 Volume Outlook to 30%+ at TD Cowen Conf.

Key Points

• Adaptive's CEO said MRD testing momentum is strong, citing a five-part playbook and raised 2025 volume guidance from "25%+" to 30%+, and the company expects to meet or beat that target as community adoption increases.
• Key operational tailwinds include EMR integration (repeat‑order compliance ~63–65%), guideline inclusions, and expected payer wins that management says should lift realized price from $1,307 to about $1,400 and broaden coverage by indication.
• Management now targets substantial margin improvement at scale — forecasting 75–80% gross margins and 20–25% operating margins — while pursuing capital‑efficient international expansion and selective partnerships (e.g., Genentech) as upside.

Adaptive Biotechnologies NASDAQ: ADPT CEO Chad Robins told investors at the 46th Annual TD Cowen Healthcare Conference that the company is looking to build on what he described as strong recent performance in minimal residual disease (MRD) testing, while continuing to invest in its immune medicine efforts as a longer-term growth opportunity.

MRD momentum and 2026 priorities

Robins said the company is “super excited” about the trajectory of its MRD business and expects growth to continue, citing what he characterized as rising confidence and engagement from the company’s commercial team and changing conversations with physicians—particularly in the community setting.

He attributed growth to a five-part playbook the company used last year and plans to repeat, consisting of:

• Blood-based testing
• Increasing presence in the community setting
• Guideline inclusion
• Increased data generation
• EMR integration

Robins said these initiatives reinforce each other—for example, EMR integration can make ordering easier, while guideline inclusion can influence community practitioners. He added that the company is allocating more capital to areas it believes are working and pulling back where returns are less attractive.

On volume, Robins said the company previously guided to “25% plus” growth and is now guiding to “30% plus” volume growth, emphasizing that the company “expects to meet or beat it.” He also said the company has come “out of the gate strong” and that sales teams were focused on “doubling down.”

Community vs. academic adoption trends

Robins provided detail on where clonoSEQ testing is occurring. He said the full-year mix last year was about 31% community and 69% academic, ending the year at 33% community and 65% academic medical centers. He said the company expects to end the current year at about 35% community.

He explained that community share is not higher largely because both channels are still growing, with academic growing off a higher base. He cited academic growth of about 8% to 9% and community growth of about 14% in the fourth quarter. Longer term, he said the company expects a more normalized split around 50% community and 50% academic.

EMR integration, guideline lag, and upcoming data readouts

Among the five growth drivers, Robins highlighted EMR integration as a particularly significant tailwind. He said that in Flatiron’s community platform, clinicians can choose repeat-ordering intervals (3, 6, 9, or 12 months) and that about 75% of doctors are clicking one of those options. He said early returns show roughly a 63% to 65% compliance rate in the first cycle, meaning repeat testing occurred after the initial order.

On guidelines, Robins said Adaptive saw five guideline inclusions across indications last year and that guideline changes typically take about six to nine months to meaningfully influence ordering patterns. He described the business as “very low penetrated” across indications and said he sees “many years” of double-digit growth ahead as drivers stack over time.

Discussing data that could influence practice, Robins pointed to interim readouts expected this year from studies including MASTER-2 (discontinuation of maintenance therapy in multiple myeloma after successive MRD-negative tests) and venetoclax stop strategies in CLL. He also referenced PERSEUS (a Janssen-related drug study) and the BOVen study in CLL. Robins also revisited the MIDAS study in multiple myeloma, describing early returns suggesting MRD-negative status may support forgoing transplant decisions, while acknowledging the need for robust evidence when changing a historically standard intervention.

Pricing, reimbursement, and recurrence monitoring

Robins discussed pricing and reimbursement dynamics, stating that realized price increased from $1,117 to $1,307 from 2024 to 2025, which he described as a 17% increase and a “tough comp” due to a gapfill rate increase. For the current year, he said the company expects realized price to rise from $1,307 to $1,400, a 7% increase.

He said drivers include potential addition of two large payer contracts in the second half, broader policy and coverage expansion (including what he said was the company’s first coverage policy expansion in DLBCL), and rev cycle management efforts using AI for prior authorizations, letters of medical necessity, and appeals to reduce time to cash and improve collections. He also cited progress on Medicaid policy on a state-by-state basis and said there may be upside to the $1,400 figure, though he wanted to remain prudent early in the year.

On commercial coverage, Robins said coverage varies significantly by indication, citing multiple myeloma at “close to 80%” and DLBCL at roughly 5%.

Robins also addressed recurrence monitoring and broader payment mechanisms. He said Adaptive is focused on policy efforts, including revising NGS 90.2 to cover repeat testing and exploring whether Medicare’s bundle of four tests could be expanded as evidence and guidelines evolve. For recurrence monitoring, he said the company has been told it must proceed “one by one” by indication, noting mantle cell lymphoma (MCL) as the first, with a CLL submission expected in the second half of this year and evidence generation underway for DLBCL and multiple myeloma. He said decisions can take around six months depending on the evidence package.

International expansion, competition, and profitability targets

Internationally, Robins described a capital-efficient technology transfer model in which Adaptive packages reagents and works with qualified sites. He said the company has transferred to Italy, France, Germany, Spain, the U.K., Japan, and Australia, and is moving into Canada. He highlighted a reimbursement win with Bupa in the U.K. and said the company intends to be measured in capital deployment outside the U.S., avoiding acquisitions or building labs. He framed international efforts as supporting global pharma trials and said deeper MRD sensitivity is driving demand versus next-generation flow approaches.

Robins said a lab-to-lab partnership with Genentech is not incorporated into volume guidance because the company is still assessing the opportunity following a pilot, including return on capital considerations and logistical complexity. He said any contribution would be upside to the 30% volume growth outlook and that Adaptive expects to have more to say later.

On competition, Robins addressed Natera’s acquisition of Foresight, emphasizing what he sees as a technology distinction between clonoSEQ’s VDJ recombination approach and mutation-based methods. He argued clonoSEQ’s specificity and sensitivity reduce false positives and said the company’s competitive strengths include publications, covered lives under contract, EMR integration, intellectual property, turnaround times, and clinical consult services. He also said he views PET scans—not other MRD tests—as the primary competition in DLBCL given what he cited as approximately 3% penetration.

Regarding next-generation flow cytometry, Robins argued it is less sensitive than NGS-based MRD and gave a sensitivity comparison: he cited Quest’s assay as 1 in 200,000 using 10 milliliters of blood versus clonoSEQ’s FDA-approved 1 in 1 million and analytical validation at 1 in 1.5 million on 2 milliliters of blood.

Finally, Robins outlined profitability targets, saying the company previously discussed reaching 70% gross margins at scale and now expects 75% to 80% gross margins at scale, citing cost improvements from transitioning sequencing to NovaSeq X and operational enhancements. He also said Adaptive is targeting 20% to 25% operating margins over time.

In closing, Robins said the MRD business has a “very significant” growth trajectory and described immune medicine as a “huge call option,” noting the company is spending about $20 million to develop a large immunology dataset and expects to pursue pharma deals that could offset burn while developing additional products.

About Adaptive Biotechnologies NASDAQ: ADPT

Adaptive Biotechnologies is a clinical-stage biotechnology company that focuses on harnessing the adaptive immune system to transform the diagnosis and treatment of disease. Through proprietary immune receptor sequencing and analysis, the company decodes the genetic information of T-cell and B-cell receptors to identify signatures of immune response. Its core technology platform provides insights into immune-driven conditions, enabling more precise monitoring and targeted therapeutic development.

The company's flagship product, immunoSEQ, offers high-throughput immune repertoire profiling for researchers and pharmaceutical partners.

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