What Guardant Health (GH) Said on Its Q3 Earnings Call

Key Points

• Guardant raised its 2026 revenue outlook after third-quarter revenue grew 36% to $361 million, driven by oncology testing and Shield. It now expects full-year revenue of $1.36 billion to $1.37 billion, or approximately 38% to 40% growth.
• Shield screening grew rapidly: screening revenue rose 180% to $68 million and test volume increased 246% to 83,000. Guardant lifted its 2026 screening forecast and said more than 80% of the eligible U.S. population is expected to have Shield coverage entering 2027.
• Cash-flow burn guidance increased to $205 million–$220 million for 2026, as delayed Medicare claim processing is expected to shift $10 million–$15 million of payments into 2027. The company still targets companywide free cash flow breakeven by the end of 2027.

Guardant Health NASDAQ: GH raised its full-year 2026 revenue forecast after third-quarter sales increased 36%, driven by growth in its oncology testing business and demand for its Shield blood-based cancer screening test.

The company reported revenue of $361 million for the quarter ended Sept. 30, up from $265 million a year earlier. It now expects full-year revenue of $1.36 billion to $1.37 billion, representing growth of approximately 38% to 40%. Its prior outlook called for growth of 36% to 38%.

Guardant also raised its projected 2026 free cash flow burn, citing a delay in Medicare claims processing that it expects to shift $10 million to $15 million in payments into the first half of 2027. Chief Financial Officer Mike Bell said the company remains confident it will reach companywide free cash flow breakeven by the end of 2027.

Shield Growth and Coverage Expansion

Screening revenue rose 180% to $68 million, while Shield test volume increased 246% to 83,000. Guardant raised its full-year screening revenue forecast to $233 million to $238 million and now expects 285,000 to 290,000 Shield tests.

Co-CEO AmirAli Talasaz said third-quarter Shield volume exceeded the company’s expectations, helped by sales representative productivity, direct-to-consumer marketing and its collaboration with Quest. He also cited the inclusion of blood-based screening in American Cancer Society guidelines and expanding insurance coverage.

UnitedHealthcare coverage took effect in August, and Guardant reported favorable policy updates from Carelon, eviCore and several regional payers. Talasaz estimated that, entering 2027, approximately 100 million people, or more than 80% of the eligible U.S. screening population, will have coverage for Shield.

Talasaz said discussions with UnitedHealthcare on contracting had begun but had not yet produced material progress on pricing. Bell said Shield’s average selling price was above $800 in the third quarter. He expects it to decline somewhat in the short term as the share of commercially insured patients under age 65 increases, before potentially rising as the company establishes payment histories with commercial payers.

Guardant is also offering patients who opt in additional multi-cancer detection results from the same blood draw used for Shield colorectal cancer screening. Talasaz said participation in the data initiative is growing, but did not provide a timeline for seeking FDA clearance of the multi-cancer test.

Oncology Volume Climbs

Oncology revenue increased 25% to $231 million, while test volume rose 58% to 117,000. Co-CEO Helmy Eltoukhy said Guardant360 Liquid volume grew nearly 30%, Guardant360 Tissue was the company’s second-fastest-growing oncology product, and Reveal volume more than doubled.

Guardant maintained its outlook for approximately 30% oncology revenue growth in 2026 and now expects oncology volume growth of more than 50%. Biopharma and data revenue rose 8% to $59 million; the company maintained its forecast for low-double-digit growth in that business.

Eltoukhy highlighted the September FDA approval of Guardant360 CDx as a companion diagnostic for AstraZeneca’s ETCAMAH. The test identifies emerging ESR1 mutations in patients with advanced breast cancer before disease progression is visible on imaging, potentially informing an earlier treatment change.

Asked about reimbursement for quarterly testing under the protocol, Eltoukhy said Guardant has discussed updating the relevant national coverage determination with the Centers for Medicare & Medicaid Services. He said a partnership with pharmaceutical companies provides a stopgap to help patients access testing while Guardant pursues that change.

Guardant also submitted a premarket approval application for Guardant360 Tissue. Eltoukhy said the review typically takes about 12 months and that approval could create an opportunity for improved reimbursement. The company expects to launch Reveal Ultra, its newer residual disease test, to clinical customers before year-end; it has already launched the assay for biopharma partners.

Costs and Cash Flow

Guardant’s third-quarter non-GAAP gross margin improved to 67% from 66% a year earlier. Its adjusted EBITDA loss narrowed to $37 million from $46 million, while free cash flow burn was $37 million, down from $46 million. Cash and investments totaled $1.1 billion at quarter-end.

Bell said a lower-cost Shield workflow brought the cost per test down to $330 in the third quarter from $410 in the second, surpassing the company’s $350 year-end target. Guardant continues to target a Shield cost per test of $200 by the end of 2028.

For 2026, the company now expects free cash flow burn of $205 million to $220 million, compared with its previous forecast of $195 million to $205 million. Bell attributed the change to a temporary delay in CMS processing claims for Guardant360 Liquid CDx, whose new billing code is expected to be added to the agency’s system in January 2027.

Guardant plans to continue reinvesting incremental gross profit in Shield’s commercial expansion. Bell said the company expects screening spending growth to slow at an inflection point in 2027 and is targeting standalone screening cash flow breakeven by the end of 2028.

About Guardant Health (NASDAQ:GH)

Guardant Health, Inc NASDAQ: GH is a precision oncology company that develops blood-based tests and data solutions designed to help detect cancer, guide treatment decisions and monitor patients over time. Its technologies analyze circulating tumor DNA and other molecular information from blood samples, supporting more accessible and less invasive alternatives to some tissue-based testing approaches.

The company's products include Guardant360, which helps identify genomic alterations in advanced cancers and may inform targeted treatment selection; Guardant360 Response, designed to assess a patient's response to therapy; and Guardant Reveal, which is used to detect minimal residual disease and recurrence risk in certain cancers.

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