Biodesix NASDAQ: BDSX reported first-quarter 2026 results that company leadership said reflected accelerating revenue growth, expanding margins, and continued operating leverage as it works toward profitability.
First-quarter results and updated outlook
Chief Executive Officer Scott Hutton said Biodesix delivered “an exceptional start to 2026,” citing progress against three stated objectives for the year: driving top-line growth, improving operational efficiency and leverage, and advancing its pipeline. Total revenue in the quarter was $25.6 million, up 42% year-over-year, which Hutton attributed to momentum in both diagnostic testing and development services.
Chief Financial Officer Robin Harper Cowie said Biodesix is raising its full-year 2026 revenue guidance to $108 million to $114 million. She said the higher outlook reflects “strong first quarter performance and improved visibility into demand and execution,” while remaining “consistent with our full year planning assumptions.”
Diagnostic testing growth driven by volume and payer-related ASP improvement
Diagnostic testing revenue was $22.3 million, up 37% from the prior-year period. Hutton said the growth was driven by accelerating test volumes and improved average selling prices compared with the first quarter of 2025.
Total test volumes were approximately 17,800, up 29% year-over-year. Hutton said adoption increased among both pulmonology and primary care providers, and noted that primary care test volumes represented 15% of total tests delivered in the quarter.
Cowie said average revenue per test improved primarily due to additional payer coverage and stronger revenue cycle management, continuing a trend that began in the third quarter of 2025. She added that the company views the improvements as “durable changes” rather than one-time benefits.
Asked about growth in primary care, Hutton said the company has been building on learnings from roughly three quarters of experience with a sales cohort focused on primary care physicians. He said a key approach has been “starting with the pulmonologist” and using those relationships to gain introductions into referral networks. Hutton said the company initially concentrated those efforts in the Northeast and has been expanding westward, adding that the approach has been “transferable.”
Hutton also framed the primary care channel as an expansion of Biodesix’s addressable market, saying the company believes about 49% of patients with incidentally found nodules are in primary care. He said the company expects that reaching those patients earlier can support earlier detection and diagnosis.
Clinical evidence and use in smaller nodules
Hutton highlighted ongoing publication and presentation of clinical data to support provider and payer adoption of Nodify Lung Testing, which he described as helping triage patients by risk of lung cancer to guide intervention versus surveillance. In February, Biodesix announced publication of what Hutton called the largest lung nodule biomarker clinical validation study, including more than 1,100 patients, using its real-world evidence study, CLARIFY.
According to Hutton, the study showed consistently strong Nodify CDT performance with high specificity—low false positive rates—regardless of nodule size or other patient risk factors. He also pointed to other data, saying that among patients without biomarker testing, 40% of malignant nodules had progressed in tumor size between first detection and the start of definitive treatment, which he said underscores a need to expedite diagnosis.
In response to a question about whether the data is driving use in smaller nodules, Hutton said the company is seeing an increase in smaller nodules. He linked that trend in part to the “advent of robotic bronchoscopies,” which he said has increased confidence among interventional pulmonologists in reaching smaller nodules than in prior years.
On lung cancer screening more broadly, Hutton said screening compliance has historically been low and remains a challenge, citing reports that place it at less than 15% to 20% of the screen-eligible population. He said Nodify Testing can be used in both incidentally found nodules and screen-detected nodules, and added that increased screening compliance would expand the opportunity. Hutton also said he expects blood-based screening tests in lung cancer to help and believes it would benefit Nodify Testing and Biodesix.
Development services nearly doubled; management cites steady demand
Development services revenue was $3.3 million, up 99% year-over-year. Hutton said the increase reflected execution on contracted programs and continued success in securing new agreements. Cowie said the company ended the quarter with about $10.4 million in contracted business following “accelerated revenue conversion velocity” during the quarter and added that Biodesix continues to see strong demand and visibility in its development services pipeline.
When asked about the revenue outlook mix, Cowie said full-year expectations for development services remained consistent with prior assumptions, with some revenue pulled forward into the first quarter. She said “the majority of the increase” in the higher revenue guidance is embedded in lung diagnostics.
Asked about biopharma-related revenue timing, Hutton said the quarter benefited from a “cadence or timing scenario” in which retrospective samples arrived earlier than forecast, allowing some contract work to be pulled forward. He reiterated that development services has historically represented about 8% to 10% of annual revenue and said the company has maintained contracted dollars above the $10 million level for “quite some time,” supporting confidence in the outlook. He said interest from biopharma partners has been driven by Biodesix’s genomic and proteomic capabilities and its focus on “multi-omics solutions.”
Margins, operating leverage, and cash
Gross margin was 84% on a GAAP basis, including a $0.4 million one-time recovery related to previously paid sales and use taxes. Excluding that recovery, gross margin was 82%, a 300-basis-point improvement year-over-year. Both Hutton and Cowie attributed margin expansion to scale in diagnostic testing, improved pricing realization, workflow optimization, and reductions in cost per test.
Operating expenses (excluding direct costs and expenses) were $27.6 million, up 18% year-over-year. Cowie said the increase was driven by a 19% rise in sales, marketing, and general administrative expenses tied to planned commercial expansion. She said the company expects operating leverage as sales cohorts gain experience and improve productivity. Biodesix supported an average of 100 sales representatives in the field during the quarter and expects to continue commercial expansion at a cadence of about six representatives per quarter through 2026.
Research and development expense was $3.3 million, up 14% year-over-year, reflecting clinical studies supporting adoption of lung diagnostic tests and pipeline work, according to Cowie.
Net loss was $7.8 million, a 30% improvement from the prior-year period. Adjusted EBITDA was a loss of $4.1 million, improving 35% year-over-year.
Biodesix ended the quarter with $25.6 million in unrestricted cash and cash equivalents, which Cowie said was a 35% increase from the fourth quarter. She said the change included $15.8 million in at-the-market net proceeds, partially offset by planned first-quarter annual cash outflows.
In the Q&A, Cowie said the company intends to reinvest the benefits of margin improvement primarily into commercial expansion, with the goal of reaching “sustained adjusted EBITDA positivity and cash flow positivity.” Hutton said the company expects to provide more updates on research and development and development services in the second half of the year and will share partnership and collaboration developments as they occur.
Cowie also noted that the company experienced “a pretty significant impact” from storms in late January and early February that disrupted FedEx hubs, but she said the team responded and “finished the quarter strong.”
About Biodesix NASDAQ: BDSX
Biodesix, Inc is a commercial-stage molecular diagnostics company headquartered in Boulder, Colorado, that develops and delivers blood-based tests to improve the diagnosis and management of lung diseases, including lung cancer. The company integrates advanced proteomic and, more recently, genomic technologies to offer noninvasive testing solutions designed to guide clinical decision-making. Biodesix operates a CLIA-certified and CAP-accredited laboratory, allowing it to process patient samples at scale and maintain rigorous quality standards.
The company's flagship product, VeriStrat®, is a proteomic test that stratifies patients with non-small cell lung cancer into groups more likely to benefit from specific therapies.
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