DermTech Inc (DMTK) 2023 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by. Welcome to DermTech's fourth-quarter 2023 financial results call. (Operator Instructions) Please be advised that today's conference is being recorded. I would like now to turn the conference over to Steve Kunszabo. Please go ahead.

女士們先生們，謝謝你們的支持。歡迎參加 DermTech 2023 年第四季財務業績電話會議。（操作員指示）請注意，今天的會議正在錄製中。我現在想把會議交給 Steve Kunszabo。請繼續。

Thank you, operator. Welcome to DermTech's fourth-quarter 2023 earnings call. With me on today's call are Bret Christensen, our President and Chief Executive Officer, and Kevin Sun, our Chief Financial Officer.

謝謝你，接線生。歡迎參加 DermTech 2023 年第四季財報電話會議。與我一起參加今天電話會議的有我們的總裁兼執行長布雷特·克里斯滕森 (Bret Christensen) 和我們的財務長凱文·孫 (Kevin Sun)。

Our call today will include forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. All statements made on this call that do not relate to matters of historical fact are considered forward-looking statements.

我們今天的電話會議將包括 1995 年《私人證券訴訟改革法案》含義內的前瞻性陳述。本次電話會議中所做的所有與歷史事實無關的陳述均被視為前瞻性陳述。

Forward-looking statements made during this call, including statements regarding projections of future performance or financial outlook of DermTech, the performance, patient, benefits, cost effectiveness, commercialization, and adoption of our products, and the market opportunity for our products are based on management's expectations as of today, and are subject to various factors, assumptions, risks and uncertainties, which change over time. Actual results could differ materially from those described in such statements. Several factors that may contribute to or cause such differences are described in today's press release and our most recent filings with the SEC, including our annual report on Form 10-K filed today.

本次電話會議期間所做的前瞻性陳述，包括有關 DermTech 未來業績或財務前景的預測、我們產品的業績、患者、效益、成本效益、商業化和採用以及我們產品的市場機會的陳述截至目前管理層的預期，並受到各種因素、假設、風險和不確定性的影響，這些因素、假設、風險和不確定性會隨著時間的推移而變化。實際結果可能與此類聲明中所述的結果有重大差異。今天的新聞稿和我們最近向 SEC 提交的文件（包括我們今天提交的 10-K 表格年度報告）描述了可能導致或導致此類差異的幾個因素。

We undertake no obligation to update these statements, except as required by applicable law. Our fourth-quarter 2023 earnings press release and SEC filings are available on our Investor Relations website. A recording and transcript of this call will be available on our website later today. With that, let me turn things over to Bret.

除非適用法律要求，否則我們不承擔更新這些聲明的義務。我們的 2023 年第四季收益新聞稿和 SEC 文件可在我們的投資者關係網站上取得。本次通話的錄音和文字記錄將於今天晚些時候在我們的網站上提供。接下來，讓我把事情交給布雷特。

Thank you, Steve, and thank you, everyone, for joining us. We are encouraged by the sustained improvement in many of our key performance indicators as they continued to head in the right direction throughout the second half of last year.

謝謝你，史蒂夫，也謝謝大家加入我們。我們對許多關鍵績效指標的持續改善感到鼓舞，因為它們在去年下半年繼續朝著正確的方向發展。

In the fourth quarter, ASP for the DermTech melanoma test, or DMT, grew 55% year over year. Test revenue increased 38% on the same basis. We also reported another all-time record high in the Medicare proportion of billable samples, which is about half of our addressable market and posted our highest gross margin in six quarters.

第四季度，DermTech 黑色素瘤測試（DMT）的 ASP 年增 55%。測試收入較去年同期成長 38%。我們也報告了醫療保險計費樣本比例再創歷史新高，約占我們潛在市場的一半，並公佈了六個季度以來的最高毛利率。

With the additional restructuring actions we announced last month, we may see a total reduction in annualized operating expenses of approximately $40 million compared to 2022. We will continue to emphasize reimburse test and growing revenue.

透過我們上個月宣布的額外重組行動，與 2022 年相比，我們可能會看到年化營運費用總計減少約 4,000 萬美元。我們將繼續強調報銷測試和增加收入。

Before I take you through a few commercial highlights, let me briefly revisit the key pillars of our story. First, we have a proprietary non-invasive skin genomics technology that has demonstrated it can enhance the standard of care for evaluating lesions suspicious of melanoma. Approximately 4 million surgical biopsies are performed annually to find nearly 190,000 new cases of melanoma.

在向您介紹一些商業亮點之前，讓我先簡單回顧一下我們故事的關鍵支柱。首先，我們擁有專有的非侵入性皮膚基因組技術，該技術已證明它可以提高評估可疑黑色素瘤病變的護理標準。每年大約進行 400 萬次手術活檢，發現近 19 萬個新的黑色素瘤病例。

Dermatologists are working hard to provide great patient care, but their practice can benefit from new tools that supplement existing methods. The DMT rules out melanoma with a 99% or greater negative predictive value or NPV and can support decision-making by clinicians.

皮膚科醫生正在努力為患者提供優質的護理，但他們的實踐可以受益於補充現有方法的新工具。DMT 具有 99% 或更高的陰性預測值或 NPV 排除黑色素瘤，並且可以支持臨床醫生的決策。

Second, we and many leading clinicians believe there's a place for the DMT and every dermatologic practice alongside established protocol. As a starting point with dermatologists, we're aiming to identify the numerous instances in which a health care provider doesn't want to biopsy a clinically suspicious lesion, but still wants to provide patients with peace of mind.

其次，我們和許多領先的臨床醫生相信，DMT 和每項皮膚病學實踐以及既定方案都有其一席之地。作為皮膚科醫生的出發點，我們的目標是識別醫療保健提供者不想對臨床可疑病變進行活檢，但仍希望讓患者安心的眾多情況。

Our customers and patients can trust the results when they use our test and there is room for it to be integrated into the current melanoma care pathway. And third, we can reduce health care costs by providing genomic data to clinicians who can rule out the need for certain surgical procedures while also providing a better patient experience.

我們的客戶和患者在使用我們的測試時可以信任結果，並且有空間將其整合到當前的黑色素瘤護理途徑中。第三，我們可以透過向臨床醫生提供基因組數據來降低醫療成本，臨床醫生可以排除某些外科手術的需要，同時還可以提供更好的患者體驗。

On the payer front, all the insurance providers we brought on in 2023, which represent approximately 42 million new covered lives have started paying some claims for the DMT. We're determined to continuously improve the onboarding and reimbursement process with payers to speed up the revenue benefit. Finally, the Blues plan of Rhode Island and a Blues plan in the mid-Atlantic recently issued favorable coverage decisions for the DMT.

在付款人方面，我們在 2023 年引入的所有保險提供者（代表約 4,200 萬新的受保人）已開始為 DMT 支付一些索賠。我們決心不斷改善付款人的入職和報銷流程，以加快收入效益。最後，羅德島州的藍調計劃和大西洋中部的藍調計劃最近發布了對 DMT 有利的承保決定。

In January, we were incredibly pleased to announce positive top line data for the Trust 2 study. With a large cohort of more than 20,000 patients, the results reaffirm the DMT's real-world clinical utility with an NPV of 99.7% to rule out melanoma, which is meaningfully higher than other currently available methods.

一月份，我們非常高興地宣布 Trust 2 研究的積極頂線數據。透過超過 20,000 名患者的大型隊列研究，結果再次證實了 DMT 的實際臨床實用性，其排除黑色素瘤的 NPV 為 99.7%，明顯高於目前其他可用的方法。

For clinicians and patients, a high NPV delivers assurance that a suspicious pigmented lesion, which tested negative is unlikely to be melanoma. The study is an important way to continue to build trust with our customers, and we're actively showcasing the clinical value of DMT in the field.

對於臨床醫生和患者來說，高 NPV 可以確保檢測呈陰性的可疑色素病變不太可能是黑色素瘤。這項研究是繼續與客戶建立信任的重要途徑，我們正在積極展示 DMT 在該領域的臨床價值。

The outstanding Trust 2 study results will also allow us to reengage with insurance providers that don't cover our test. We're working to make the full study available at a peer-reviewed medical journal and expect to have an article published in the next several months. We will continue to reinforce our message around the clinical and health economic benefits of DMT with all stakeholders.

出色的 Trust 2 研究結果也將使我們能夠與不承保我們測試的保險公司重新合作。我們正在努力在同行評審的醫學期刊上提供完整的研究，並預計在未來幾個月內發表一篇文章。我們將繼續向所有利害關係人傳達有關 DMT 的臨床和健康經濟效益的訊息。

Our visibility with payers also improves through state legislative efforts. Bills mandating insurance coverage of genomic testing or biomarker bills are gaining traction across the US as lawmakers advocate for improving access to potentially life-saving genomic tests. Legislation has now been enacted in 14 states and 8 additional states introduced biomarker bills in 2023 that are making their way through the legislative process.

透過州立法努力，我們在付款人中的知名度也提高了。隨著立法者倡導改善獲得可能挽救生命的基因組測試的機會，強制對基因組測試或生物標記物進行保險的法案正在美國各地受到關注。目前已有 14 個州頒布了立法，另有 8 個州將於 2023 年推出生物標記法案，目前正在進入立法程序。

Moving now on to our commercial business, where we continue to dedicate substantially all of our resources to growing reimbursed tests and boosting revenue. We now have two quarters behind us since we changed our approach. We believe it is evident these changes have had a positive impact on our top line, but we're still refining our tactics as we learn more.

現在轉向我們的商業業務，我們繼續將所有資源用於增加報銷測試和增加收入。自從我們改變了方法以來，我們現在已經落後了兩個季度。我們相信，這些變化顯然對我們的營收產生了積極影響，但隨著我們了解更多，我們仍在完善我們的策略。

First incentive compensation for our sales team continues to be linked to reimburse test and revenue over volume growth. We're also arming the field with robust analytics reporting to support these goals. More recently, we reduced the target list for our sales managers. This change also allows us to foster stronger relationships with our customers and increases touch frequency in the field.

我們銷售團隊的第一激勵薪酬繼續與報銷測試和收入與銷售成長掛鉤。我們也為該領域提供強大的分析報告來支持這些目標。最近，我們減少了銷售經理的目標清單。這項變更也使我們能夠與客戶建立更牢固的關係，並增加現場接觸頻率。

Second, as a result of additional restructuring actions we undertook in January, we dissolved certain sales territories and merged others to further optimize our footprint and focus on the highest-value regions. As a result, we reduced our sales territories from approximately 60 to roughly 55. We are intentionally pursuing a strategy that prioritizes ASP and revenue growth over volume growth in the short term.

其次，由於我們在一月份採取了額外的重組行動，我們解散了某些銷售區域並合併了其他銷售區域，以進一步優化我們的足跡並專注於價值最高的區域。因此，我們將銷售區域從大約 60 個減少到大約 55 個。我們有意推行一項策略，在短期內將平均售價和收入成長置於銷售成長之上。

In closing, we've significantly improved many of our key operating and financial indicators for two consecutive quarters. We believe this approach is the best way to reach a meaningful revenue inflection point. With that, let me turn the call over to Kevin for a more detailed financial review.

最後，我們連續兩個季度顯著改善了許多關鍵營運和財務指標。我們相信這種方法是實現有意義的收入轉折點的最佳方式。接下來，讓我將電話轉給凱文，以進行更詳細的財務審查。

Thanks, Bret, and good afternoon, everyone. I'll outline our key financial and operating metrics for the fourth quarter, then summarize how we're thinking about 2024. I'll wrap up by recapping our liquidity profile and cash runway estimates. All comparisons are to the prior year period, unless otherwise noted.

謝謝布雷特，大家下午好。我將概述我們第四季度的主要財務和營運指標，然後總結我們對 2024 年的看法。最後，我將回顧我們的流動性狀況和現金跑道估計。除非另有說明，所有比較均與上一年期間進行比較。

Test revenue was up 38% to $3.7 million, largely due to a higher ASP for the DMT. Test revenue was flat sequentially. Billable sample volume declined 11% to approximately 15,580 and was down less than 1% sequentially. Year-over-year and sequential decrease was partly due to prioritizing reimbursed tests ahead of total volume and the overall reduction in the size of our sales force.

測試收入成長了 38%，達到 370 萬美元，這主要是由於 DMT 的平均售價較高。測試收入環比持平。可計費樣本量下降 11% 至約 15,580 個，較上季下降不到 1%。年比和環比下降的部分原因是優先考慮報銷測試而不是總量以及我們銷售隊伍規模的整體縮減。

As previously noted, we also stopped testing samples from pediatric patients and certain Fitzpatrick skin types in early 2023 based on guidance from our lab accrediting organization, which also affected the year-over-year comparison. The sequential decrease was also partly due to seasonality we have previously seen during the year-end holiday season.

如前所述，我們也根據實驗室認證組織的指導，於 2023 年初停止了對兒科患者和某些 Fitzpatrick 皮膚類型的樣本進行測試，這也影響了同比比較。環比下降的部分原因是我們之前在年終假期期間看到的季節性因素。

Contract revenue was $0.2 million compared to $0.3 million. The decrease is from the timing of activity related to clinical trial progress of our biopharma customers. Total revenue increased 31% to $3.9 million, primarily on higher test revenue.

合約收入為 20 萬美元，而去年同期為 30 萬美元。減少的原因是與我們的生物製藥客戶的臨床試驗進展相關的活動時間。總收入成長 31% 至 390 萬美元，主要得益於測試收入的增加。

Drilling into our test revenue drivers, first, ASP was up 55% to $238 per sample and up 1% sequentially. The Medicare proportion of billable sample volume hit another all-time record high, increasing sequentially from 27% to 28%. In the last three quarters, this proportion has increased by five percentage points and has contributed to the ASP improvement.

深入研究我們的測試收入驅動因素，首先，平均售價上漲 55%，達到每個樣本 238 美元，比上一季上漲 1%。醫療保險佔計費樣本量的比例再創歷史新高，從 27% 連續增加至 28%。過去三個季度，這一比例增加了五個百分點，為平均售價的提高做出了貢獻。

We're beginning to see consistent payment from TRICARE at the VA, as well as improving payment from certain other Blues plans we signed on last year. The revenue benefit is ramping from the big increase in covered lives we've achieved, but we still need to clear administrative and billing obstacles in some cases before improved payment behavior from certain insurance providers.

我們開始看到 VA 的 TRICARE 持續支付，以及我們去年簽署的某些其他 Blues 計劃的支付有所改善。我們所實現的核保人壽大幅增加所帶來的收入效益正在增加，但在某些情況下，我們仍需要清除某些情況下的管理和計費障礙，然後才能改善某些保險公司的支付行為。

Net positive prior-period adjustments had a negligible impact on test revenue during the fourth quarter. ASP may fluctuate in the future as payers update their administrative procedures or other requirements for payment, even those payers with consistent reimbursement history.

前期淨調整對第四季測試收入的影響可以忽略不計。隨著付款人更新其管理程序或其他付款要求，即使是那些具有一致報銷歷史的付款人，平均售價未來可能會波動。

Second, we had approximately 2,200 unique ordering clinicians in the fourth quarter, down 2% sequentially. Because we're currently focused on building deeper relationships with clinicians rather than creating broad awareness for the DMT, the level of unique ordering clinicians may continue to be flat or even modestly down in the short term. Third, our average quarterly utilization or average number of tests ordered per unique ordering clinician was 7.1 billable samples in the fourth quarter, up from 7.0 in the third quarter and versus 7.2 in the year-ago period.

其次，第四季我們大約有 2,200 名獨特的訂購臨床醫生，比上一季下降 2%。由於我們目前的重點是與臨床醫生建立更深的關係，而不是建立對 DMT 的廣泛認識，因此短期內獨特的訂購臨床醫生的水平可能會繼續持平，甚至略有下降。第三，第四季度我們的平均季度利用率或每位獨立訂購臨床醫生訂購的平均測試數量為 7.1 個可計費樣本，高於第三季度的 7.0 個，去年同期為 7.2 個。

Turning now to operating expenses, cost of test revenue was $3.4 million, an increase of 4%, yielding a test gross margin of 7%. Our quarterly test gross margin was the highest it's been in six quarters. The increase in cost of test revenue was primarily due to higher infrastructure costs related to our new lab.

現在轉向營運費用，測試收入成本為 340 萬美元，成長 4%，測試毛利率為 7%。我們的季度測試毛利率是六個季度以來的最高水準。測試收入成本的增加主要是由於與我們的新實驗室相關的基礎設施成本較高。

Sales and marketing expenses were $8.4 million, a 38%-decrease, largely due to lower employee-related and marketing expenditures. Research and development expenses were $3.3 million, a 34%-decrease, primarily due to lower employee-related and lab supplies costs. General and administrative expenses were $8.4 million, a 14%-decrease driven by lower employee-related costs, offset by higher infrastructure costs related to our new facility.

銷售和行銷費用為 840 萬美元，下降 38%，主要是由於員工相關費用和行銷費用減少。研發費用為 330 萬美元，下降 34%，主要是因為員工相關成本和實驗室用品成本降低。一般和管理費用為 840 萬美元，下降了 14%，原因是員工相關成本下降，但被新設施相關基礎設施成本上升所抵消。

On a full-year basis, including the impact from our comprehensive restructuring actions and other efforts to identify cost reductions, we expect an approximately $40 million annualized reduction in total operating expenses versus 2022. Total operating expenses for 2024 are currently estimated to be approximately $80 million.

就全年而言，包括我們全面重組行動和其他降低成本努力的影響，我們預計總營運費用與 2022 年相比每年將減少約 4,000 萬美元。目前估計 2024 年的總營運費用約為 8,000 萬美元。

Net loss was $19.1 million, which included $3.2 million of non-cash, stock-based compensation expense compared to a net loss of $28.2 million, which included $5.3 million of non-cash, stock-based compensation expense. Net loss decreased 32%, while test revenue increased 38%.

淨虧損為 1,910 萬美元，其中包括 320 萬美元的非現金股票補償費用，而淨虧損為 2,820 萬美元，其中包括 530 萬美元的非現金股票補償費用。淨虧損減少 32%，而測試收入增加 38%。

Moving now to how we're thinking about 2024, we believe DMT volumes could be flat to modestly down for the first half of 2024 compared to the same period last year, primarily due to our focused, unreimbursed test and the impact in the field from our restructuring actions and the change in tactics. We'll continue to emphasize ASP and revenue growth.

現在談談我們對 2024 年的看法，我們認為，與去年同期相比，2024 年上半年 DMT 銷量可能持平或略有下降，這主要是由於我們重點關注的無償測試以及該領域的影響我們的重組行動和策略的改變。我們將繼續強調平均售價和收入成長。

And lastly, a review of our liquidity profile and balance sheet, at year end, we had cash, cash equivalents, restricted cash, and marketable securities of $59.3 million. Cash burn is estimated to decline to $55 million to $60 million annually based on the fourth quarter of 2023 run rate, a roughly 40%-decrease from our net cash burn in 2022. We believe we have cash runway into the first quarter of 2025, not to exceed 12 months from today's 10-K filing.

最後，回顧我們的流動性狀況和資產負債表，截至年底，我們擁有 5,930 萬美元的現金、現金等價物、限制性現金和有價證券。根據 2023 年第四季的運行率，現金消耗預計將下降至每年 5,500 萬至 6,000 萬美元，比 2022 年的淨現金消耗減少約 40%。我們相信我們有足夠的現金儲備持續到 2025 年第一季度，從今天的 10-K 備案算起，不超過 12 個月。

In summary, our plan demonstrated sustained results in growing revenue during the second half of 2023 while operating with a leaner organization. Now I'll turn the call back to Bret.

總而言之，我們的計劃展示了 2023 年下半年收入持續成長的成果，同時以更精簡的組織運作。現在我將把電話轉回布雷特。

Thanks, Kevin. Before we wrap up and move to Q&A, I'll share a compelling patient story that inspires us as we forge ahead. A patient will see in her dermatologists on a monthly basis for severe acne treatment without any other concerns. During her last visit, she mentioned a mole on her arm that she hadn't noticed before. The clinician evaluated the mole and wasn't concerned, but because the patient was worried, a DMT was ordered.

謝謝，凱文。在我們結束並進行問答之前，我將分享一個引人入勝的患者故事，它激勵我們繼續前進。患者每月都會去看皮膚科醫生，接受嚴重痤瘡的治療，而無需擔心其他問題。在上次訪問期間，她提到手臂上有一顆她以前沒有註意到的痣。臨床醫生對痣進行了評估，並不擔心，但由於患者擔心，所以要求進行 DMT。

The test came back positive, indicating the correlation with melanoma. A biopsy of the lesion was then sent to a pathologist who confirmed it was melanoma and the patient was referred to a surgical oncologist. The health care provider is still in shock that this patient may have otherwise walked out of the office.

檢測結果呈陽性，顯示與黑色素瘤相關。然後將病變的活檢送到病理學家那裡，病理學家確認這是黑色素瘤，並將患者轉診給外科腫瘤學家。醫療保健提供者仍然對這名患者可能走出辦公室感到震驚。

This story, much like others we hear on a regular basis, highlights the critical need for precision genomics as cancer is a disease of the genome and the current visual assessment standard is challenging even for an expertly trained medical professional. The DMT helps clinicians evaluate higher risk lesions alongside other traditional tools. With that, I'll turn the call back to the operator for Q&A.

這個故事，就像我們經常聽到的其他故事一樣，強調了對精密基因組學的迫切需求，因為癌症是一種基因組疾病，而當前的視覺評估標準即使對於經過專業培訓的醫療專業人員來說也具有挑戰性。DMT 與其他​​傳統工具一起幫助臨床醫生評估高風險病變。這樣，我會將電話轉回接線生進行問答。

(Operator Instructions) Thomas Flaten, Lake Street Capital Markets.

（操作員說明）Thomas Flaten，湖街資本市場。

Hey, guys, appreciate you taking the questions. Just out of curiosity -- I just wanted to clarify, Kevin, you said that you expect volumes in the first half of 2024 to be down relative to the first half of 2023, did I hear that right?

嘿，夥計們，感謝您提出問題。只是出於好奇 - 我只是想澄清一下，Kevin，你說你預計 2024 年上半年的銷量將比 2023 年上半年有所下降，我沒聽錯嗎？

That's correct.

這是正確的。

Okay, so closer to where we were in 3Q and 4Q or a lesser reduction from 17 -- the mid to high 17s?

好的，那麼接近我們在第三季和第四季的水平，或者從 17 的中到高 17 的減少幅度較小？

Yeah, we're not providing specific guidance right now. We're happy with the performance in Q4 and again, where our updated strategy to prioritize reimburse volume, drove a 55% year over year ASP growth and a 38% year-over-year test revenue growth.

是的，我們現在不提供具體指導。我們對第四季度的表現再次感到滿意，我們更新了優先考慮報銷量的策略，推動了 ASP 同比增長 55% 和測試收入同比增長 38%。

Q4 was that second quarter of where we've achieved sequential growth in these top line metrics. So as we said, we believe the volumes could be down for the first half because of the impact in the field from the restructuring and the change in tactics.

第四季是我們在這些營收指標上實現連續成長的第二季。正如我們所說，我們認為由於重組和策略變化對該領域的影響，上半年的銷售可能會下降。

We have about 15 fewer sales territories now than we did in Q1 of 2023. We do plan to continue to emphasize throughout the organization our focus on driving ASP improvements but providing any specific guidance right now remains difficult without having a trend for several quarters in payer reimbursement behavior and the sustained effectiveness of our updated commercial tactics.

與 2023 年第一季相比，我們現在的銷售區域減少了約 15 個。我們確實計劃繼續在整個組織中強調我們對推動 ASP 改進的關注，但如果沒有幾個季度付款人報銷行為的趨勢以及我們更新的商業策略的持續有效性，目前提供任何具體指導仍然很困難。

Got it. And with respect to the $40-million reduction in OpEx relative to 2022, could you help us maybe spread those savings around? Is it kind of a pro rata cut across the three OpEx lines or how should we think about that?

知道了。相對於 2022 年，營運支出將減少 4,000 萬美元，您能否協助我們將這些節省的資金分散到各處？這是否是按比例削減這三個營運支出線，或者我們應該如何考慮這一點？

It would be fairly, I think, consistently spread as we saw within the fourth quarter results. So it is all in the up and down the organization where we've made cost-saving and efficiency efforts. And so I think, as we said previously, looking at the fourth quarter of 2023 is kind of a benchmark going forward. That's a good kind of jumping off point for where we think expenses and costs will be in the future.

我認為，正如我們在第四季度業績中看到的那樣，這將是相當公平的。因此，我們在組織上下都做出了節省成本和提高效率的努力。因此，我認為，正如我們之前所說，2023 年第四季是未來的一個基準。這是我們認為未來費用和成本的一個很好的起點。

And then one final one, if I may, speaking to the Medicare penetration, was there anything specific that you did tactically to drive that number up or was this just kind of a natural evolution of the business where that's starting to get closer to where it should be in the kind of around about 50%?

最後一個問題，如果可以的話，就醫療保險滲透率而言，您是否在戰術上採取了任何具體措施來推動這一數字的上升，或者這只是業務的一種自然演變，開始接近它的水平應該是50%左右吧？

Yeah, hey, Thomas. This is Bret. I'll take that one. If you remember, there's quite a few tactics that we deployed starting in the middle of last year and they evolved throughout the year, but many of those were around the focus for the mix that comes in the door reimbursed tests, and certainly a big portion of that is Medicare.

是的，嘿，湯瑪斯。這是布雷特。我會接受那個。如果您還記得的話，我們從去年年中開始部署了相當多的策略，並且它們在全年中不斷發展，但其中許多策略都是圍繞著報銷測試中的組合的重點，當然還有很大一部分其中包括醫療保險。

If you remember, we changed comp plans for our field sales personnel to focus on revenue and reimbursed tests versus strictly volume, which was historically how comp was laid out for them. We also provided them with the analytics and targeting tools to help them understand where most of their reimbursement was coming from. And on top of that, we reduced the number of targets that each rep was calling on, so they can go deeper into each practice and all that has sort of paid dividends in the form of Medicare reimbursement but also just overall ASP.

如果你還記得的話，我們改變了現場銷售人員的薪酬計劃，將重點放在收入和報銷測試上，而不是嚴格的數量上，這就是歷史上為他們制定薪酬的方式。我們也為他們提供了分析和定位工具，幫助他們了解大部分報銷的來源。最重要的是，我們減少了每個銷售代表要求的目標數量，這樣他們就可以更深入地了解每項業務，並且所有這些都以醫療保險報銷的形式獲得了紅利，但也只是整體平均售價。

Fantastic. Appreciate you taking the questions. Thank you.

極好的。感謝您提出問題。謝謝。

Andrew Brackmann, William Blair.

安德魯·布拉克曼，威廉·布萊爾。

Hey, guys. Good afternoon. Thanks for taking the question. Maybe just one on the major commercial payers, in the 10-K, I think you called out you believe there's possibility to secure some sort of contract from them over the next 12 to 24 months. Can you maybe just sort of talk about some of the confidence behind sort of putting that timeframe out there or anything which has sort of changed over the last handful of months here? Thanks.

大家好。午安.感謝您提出問題。也許只是關於主要商業付款人的一個問題，在 10-K 中，我認為您認為您相信在未來 12 到 24 個月內有可能從他們那裡獲得某種合約。您能否談談制定時間表背後的一些信心，或過去幾個月發生的任何變化？謝謝。

Yeah, hi, Andrew, it's Bret. We continue to have really good conversations with the national payers. We're happy with where reimbursement ended this past year, adding 42 million covered lives and finishing about 45% of all covered lives for DMT.

是的，嗨，安德魯，我是布雷特。我們繼續與國家付款人進行良好的對話。我們對去年報銷結束的情況感到滿意，增加了 4,200 萬人的承保生命，並完成了 DMT 承保生命的約 45%。

We did get, if you remember, three negative policy decisions last year from three of the nationals. We are having good conversations with one but Trust 2 is an opportunity for us, when that's published in the next several months, to go back to all the national payers and continue those conversations. And as we've said in the past, we're just optimistic because the economics of DMT are so strong for payers that we know they'll eventually draft favorable policy and cover the test.

如果你還記得的話，去年我們確實從三名國民那裡得到了三個負面的政策決定。我們正在與其中一個進行良好的對話，但 Trust 2 對我們來說是一個機會，當它在未來幾個月內發佈時，我們可以回到所有國家付款人並繼續這些對話。正如我們過去所說，我們只是樂觀，因為 DMT 的經濟效益對於付款人來說是如此強勁，以至於我們知道他們最終會起草有利的政策並涵蓋測試。

Great. And then, Bret, you sort of talked about reducing the target lifts for your commercial team. Anything analytically that you can share which sort of shows that the greater frequency and greater touch here leads to either greater utilization of the test or even movements towards more reimbursed tests for those providers? Thanks.

偉大的。然後，布雷特，您談到了減少商業團隊的目標提升。您可以分享哪些分析表明，這裡更高的頻率和更大的接觸會導致測試的更大利用率，甚至會導致這些提供者獲得更多報銷測試？謝謝。

Yeah, thanks, Andrew. We're still learning a lot from the revised tactics last year but one thing we know is that selling DMT in dermatology requires time and frequency in the field, and we revised the messaging with the salespeople to start with the clinical argument for DMT, making sure that dermatologists understand the clinical utility, the 99.7% negative predictive value that we showed in Trust 2, then we figure out where we can integrate it into the practice.

是的，謝謝，安德魯。我們仍然從去年修改後的策略中學到了很多東西，但我們知道的一件事是，在皮膚科銷售DMT 需要在現場投入時間和頻率，我們修改了與銷售人員的信息，從DMT 的臨床論證開始，使得確保皮膚科醫生了解臨床效用，即我們在 Trust 2 中展示的 99.7% 陰性預測值，然後我們找出可以將其整合到實踐中的位置。

So it's a non-threatening message that gets them to say, look, there's some times I don't want to do a biopsy, and when I don't want to do a biopsy, yes, I would use DMT. And whatever that percent of biopsies is 20%, 25%, 30%, we work on integrating that into their practice so it becomes habit and just part of what they normally do. And that takes some time. It takes frequency. It takes a number of sales calls. And so that's why we think fewer targets allows for that to happen quicker.

所以這是一個非威脅性的信息，讓他們說，看，有時我不想做活檢，當我不想做活檢時，是的，我會使用 DMT。無論活檢的百分比是 20%、25%、30%，我們都會努力將其融入他們的實踐中，使其成為習慣，成為他們通常所做的一部分。這需要一些時間。這需要頻率。這需要多次銷售拜訪。這就是為什麼我們認為更少的目標可以讓這種情況更快發生。

I'll leave it there. Thanks, guys.

我會把它留在那裡。多謝你們。

(Operator Instructions) Mark Massaro, BTIG.

（操作員說明）Mark Massaro，BTIG。

Hey, guys. This is Vivian on for Mark. Thanks for taking the question. So I guess on the ASP front, are there any health plan wins that haven't turned on yet? I think you alluded to some administrative and billing obstacles preventing payments where you do have coverage, so just any more granularity you could give there on what's preventing the payments. Thanks.

大家好。這是薇薇安為馬克代言的。感謝您提出問題。所以我想在 ASP 方面，是否還有尚未啟動的健康計畫勝利？我認為您提到了一些管理和計費障礙，在您確實有保險的情況下阻止了付款，因此您可以更詳細地說明阻止付款的原因。謝謝。

Yeah, I believe for the most part, most of all of the wins that we had last year have started paying something, but there are certainly still upside potential in improving the payment rate. Because again, sometimes it's documentation, sometimes it's specific processes we have to follow to allow for better payment with them. So they are improving, but there is still more room for improvement (technical difficulty) to focus on those efforts to improve it as much as we can.

是的，我相信在很大程度上，我們去年取得的所有勝利都已經開始支付一些費用，但在提高支付率方面肯定仍然存在上行潛力。因為，有時是文件，有時是我們必須遵循的特定流程，以便更好地付款。所以他們正在改進，但是還有更大的改進空間（技術難度），我們要集中精力盡可能地改進它。

Okay, perfect. Thanks, Kevin. And then just any trends in utilization per ordering clinician to call out? I think we've chatted in the past that it takes a certain number of tests that clinicians need to get through to get their first positive results and really understand the value proposition. So just anything else to call out there?

好的，完美。謝謝，凱文。然後，每位臨床醫師的利用率有什麼趨勢需要指出嗎？我想我們過去曾討論過，臨床醫生需要通過一定數量的測試才能獲得第一個積極的結果並真正理解價值主張。那還有什麼需要注意的嗎？

Yeah, no, I think as we said before, because we're trying to go deeper right now, the number of unique ordering clinicians in any quarter could be flat or even modestly down. But with that same rationale, we would expect the utilization to increase. Because again, if we're going deeper and making sure it's integrated in the practice as Bret mentioned, making sure that the clinicians understand the clinical value and the best places to use the technology and how to give comfort to their patients with it, we do believe that that should drive increases in utilization on a per doctor basis.

是的，不，我認為正如我們之前所說，因為我們現在正在嘗試更深入，所以任何季度的獨特訂購臨床醫生的數量都可能持平甚至略有下降。但出於同樣的理由，我們預期利用率會增加。因為，如果我們更深入並確保將其融入布雷特提到的實踐中，確保臨床醫生了解臨床價值和使用該技術的最佳場所以及如何用它來給患者帶來安慰，我們我相信這應該會推動每位醫師的利用率增加。

And that's where we're focused right now. Instead of broad marketing and awareness, it's really going deep and trying to get advocates and trying to get them to understand where to use it and integrate it into their practice.

這就是我們現在關注的重點。它不是廣泛的營銷和意識，而是真正深入並試圖獲得倡導者，並試圖讓他們了解在哪裡使用它並將其融入他們的實踐中。

Awesome, thanks for taking the question.

太棒了，感謝您提出問題。

Mason Carrico, Stephens.

梅森·卡里科，史蒂芬斯。

Hey, guys. Thanks for the questions, two quick ones upfront from me here if that's all right. Maybe on the news of discontinuing the TERT optional add-on assay, could you kind of talk about the cost benefit there from a COGS perspective? And second, you guys had previously talked about some ongoing projects to drive down COGS. I think some of those depended more on volumes and scale, others were more project-related. So could you just walk through where you stand on some of those today?

大家好。感謝您提出問題，如果可以的話，我先快速提出兩個問題。也許關於終止 TERT 可選附加檢測的消息，您能從 COGS 的角度談談那裡的成本效益嗎？其次，你們之前討論過一些正在進行的項目來降低銷售成本。我認為其中一些更多地取決於數量和規模，而另一些則更多地與項目相關。那麼您能簡單介紹一下您今天在其中一些方面的立場嗎？

Yeah, hey, Mason. So with TERT itself, again, what we assessed as part of the Trust 2 dataset is that there was limited improvement in some of the key statistical measures or performance metrics of the test when TERT was included. And we also have determined through getting feedback from clinicians who use our TERT test that TERT didn't really impact clinical decision-making too much. So the reason that we decided to simplify the DMT and stop testing TERT was just that to simplify it, and based on the patient need, and how it's being used in clinical practice.

是的，嘿，梅森。因此，對於 TERT 本身，我們作為 Trust 2 資料集的一部分進行的評估是，當包含 TERT 時，測試的一些關鍵統計指標或效能指標的改進有限。透過使用我們的 TERT 測試的臨床醫生的回饋，我們還確定 TERT 並沒有真正影響臨床決策太多。因此，我們決定簡化 DMT 並停止測試 TERT 的原因只是為了簡化它，並基於患者的需求以及它在臨床實踐中的使用方式。

As a benefit to that decision though, we should get some improvement in COGS. TERT was a DNA mutation that was run on a separate piece of equipment, and so that was the only use for that equipment, and there was also additional processing time and people needed to process those things. And again, part of the reason we also discontinued it is that we were only able to report out a test result in about a third of the time that was ordered or less.

不過，作為該決定的一個好處，我們的銷貨成本應該會得到一些改善。TERT 是一種 DNA 突變，在一台單獨的設備上運行，因此這是該設備的唯一用途，而且還需要額外的處理時間和人員來處理這些事情。再說一次，我們也停止使用它的部分原因是我們只能在訂購時間的大約三分之一或更少的時間內報告測試結果。

So we haven't quantified yet exactly what that will be because there will certainly be some direct cost savings from not having to use supplies and the labor, but as we're still working through what to do with the equipment, and now we also have fixed costs that are spread to other parts of the processing -- so it should provide some savings, but we haven't provided definitive detail on that yet.

因此，我們還沒有確切地量化這將是什麼，因為不必使用供應品和勞動力肯定會節省一些直接成本，但由於我們仍在研究如何處理設備，現在我們也固定成本會分攤到處理的其他部分— —因此它應該可以節省一些成本，但我們尚未提供這方面的明確細節。

And then as -- relates to the other cost-saving measures, so we'll continue to focus on all sorts of things, whether it's systems improvements, whether it's material cost related to the configurations or different things within the kits, labor, efficiency, automation, these are all things that we'll continue to work on as well as technology improvements. Some of them can go a little bit sooner than others. Some of them take some more work to validate and ensure that it doesn't affect how the test works, but we're committed to continue to improve the COGS profile.

然後，與其他節省成本的措施相關，因此我們將繼續關注各種事情，無論是系統改進，無論是與配置相關的材料成本，還是套件中的不同事物、勞動力、效率、自動化，這些都是我們將繼續致力於的事情以及技術改進。他們中的一些人可以比其他人早一點。其中一些需要更多的工作來驗證並確保它不會影響測試的工作方式，但我們致力於繼續改進 COGS 配置文件。

And as we saw just in Q4, we had just slightly lower volume, then Q3, which meant that the fixed portion of the costs were spread over again a slightly lower base than in Q3, but we're also able to reduce the COGS on a per test basis about 6% in Q4 sequentially. And that's the lowest cost per test that we've had since actually moving into the new laboratory. So we're committed to improving it, and we've already demonstrated some improvements to it, and we'll have some more information around TERT specifically once we get the change fully implemented.

正如我們在第四季度看到的那樣，我們的銷售量略低於第三季度，這意味著成本的固定部分再次分攤到略低於第三季度的基數，但我們也能夠降低銷售成本每個測試基礎上，第四季連續成長約6%。這是自搬入新實驗室以來每次測試的最低成本。因此，我們致力於改進它，並且我們已經展示了對其的一些改進，一旦我們完全實施了更改，我們將獲得有關 TERT 的更多資訊。

Got it. Thanks, Kevin.

知道了。謝謝，凱文。

(Operator Instructions) Dan Brennan, Cowen.

（操作員說明）Dan Brennan，Cowen。

Great, thanks. Thanks for taking the question. Sorry, I joined a few minutes late, and I just wanted to understand a little bit and you've probably already addressed this, but in terms of the outlook for '24, I don't think you're giving much, but I'm just wondering if there's any framework to at least consider from a price volume standpoint, how we might think about it?

萬分感謝。感謝您提出問題。抱歉，我遲到了幾分鐘，我只是想了解一點，你可能已經解決了這個問題，但就 24 的前景而言，我認為你並沒有付出太多，但我我只是想知道是否有任何框架至少可以從價格數量的角度來考慮，我們可以如何考慮？

Yeah, we're going to continue to emphasize throughout the organization our focus on driving ASP improvements, but providing the specific guidance right now remains difficult without having a trend for several quarters in payer reimbursement behavior and whether or not there's the sustained effectiveness of our updated commercial tactics. So we're not providing any additional detailed guidance at this point.

是的，我們將繼續在整個組織中強調我們對推動 ASP 改進的關注，但如果沒有幾個季度付款人報銷行為的趨勢，以及我們的服務是否具有持續有效性，現在提供具體指導仍然很困難。更新的商業策略。因此，我們目前不提供任何額外的詳細指導。

Is it fair to think the street's got $20 million in revenue for '24 versus, they call it, $15 million this year? Like rather than be completely all sides, I mean, is there any framework at all to think about magnitude or it's just impossible at this point?

認為這條街在 24 世紀獲得了 2000 萬美元的收入，而今年他們稱之為 1500 萬美元，這公平嗎？就像而不是完全全面，我的意思是，是否有任何框架來考慮規模，或者在這一點上這是不可能的？

It's very challenging and difficult at this point based on the factors we've just said. But as we said, we'll continue to focus the team on driving those ASP improvements to drive revenue improvements, which we are able to demonstrate in Q3 and Q4 with the change in tactics to be able to get some improvements there. So that's where the focus will continue to be, but yeah, we're just not providing detailed guidance right now.

根據我們剛才所說的因素，目前這是非常具有挑戰性和困難的。但正如我們所說，我們將繼續讓團隊專注於推動ASP 的改進，以推動收入的提高，我們可以在第三季和第四季透過策略的改變來證明這一點，以便能夠在那裡取得一些改進。所以這就是焦點將繼續存在的地方，但是，是的，我們現在只是不提供詳細的指導。

And on the Trust 2 study, I think you talked about it's really important to engage with payers. What kind of payers are you specifically looking to engage with and any potential timeline of reviewing decision?

在 Trust 2 研究中，我認為您談到了與付款人互動非常重要。您特別希望與哪些類型的付款人合作以及審查決定的任何潛在時間表？

Yeah, hi, Dan, it's Bret. Yes, Trust is going to help us with all outstanding payers that don't have a policy, a positive policy yet for DMT. Specifically the nationals, we think it's a large cohort, 20,000 patients. Our highest negative predictive value that we have to date of 99.7%, but all of our publications show over 99%, so it will help with the majority payers and the discussions that we're having to date. And we expect that publication probably in the next several months, so it's a really good opportunity for us to put that in front of payers and restart any negative policy decisions, but also continue the ones we're having today.

是的，嗨，丹，我是布雷特。是的，Trust 將幫助我們解決所有尚未制定 DMT 政策的未清付款人的問題。特別是國民，我們認為這是一個很大的群體，有 20,000 名患者。到目前為止，我們的最高陰性預測值為 99.7%，但我們所有的出版物都顯示超過 99%，因此這將有助於大多數付款人和我們迄今為止的討論。我們預計該出版物可能會在接下來的幾個月內發布，因此這對我們來說是一個非常好的機會，可以將其擺在付款人面前並重新啟動任何負面政策決定，但也可以繼續我們今天的決定。

And just maybe one final one on that, so is NPV definitely the most important metric to consider? What else do the payers look at in the study?

也許只是最後一個，那麼 NPV 絕對是需要考慮的最重要的指標嗎？付款人在研究中還看什麼？

Yeah, since it's a rule-out test and what clinicians are looking to do is just rule out the need for biopsy and further procedures, the negative predictive value is really by far the most important factor for us. It's what they point to as a rule-out test and we're pleased with that result.

是的，由於這是一項排除測試，臨床醫生想要做的只是排除活檢和進一步手術的需要，因此陰性預測值實際上對我們來說是迄今為止最重要的因素。這就是他們所說的排除測試，我們對此結果感到滿意。

Okay, great. Thank you.

好的，太好了。謝謝。

(Operator Instructions) Connor Chamberlain, Craig-Hallum.

（操作員說明）Connor Chamberlain，Craig-Hallum。

Hey, good afternoon. This is Connor on for Alex. Thanks for taking my questions. So you've been working on getting these commercial payers online for years now. Can you maybe talk about how DermTech has evolved their approach in talking with these payers over time? Thanks.

嘿，下午好。這是亞歷克斯的康納。感謝您回答我的問題。因此，多年來您一直致力於讓這些商業付款人在線化。您能否談談 DermTech 隨著時間的推移如何改進與這些付款人交談的方法？謝謝。

Hey, Connor. Yeah, we've been working awhile to get payers on board. But if you remember, we went public in 2019, had a bit of a blackout with COVID, but quickly got back on track with payers adding 42 million covered lives last year, 7 of the top 10 Blues. So we're having really good progress. These discussions just take time and they take more time with the nationals who tend to drag their feet and do a little bit more analysis.

嘿，康納。是的，我們一直在努力讓付款人參與其中。但如果你還記得的話，我們在2019 年上市，曾因新冠疫情而受到一些影響，但很快就回到了正軌，去年，付款人增加了4200 萬人的承保生命，佔前10 名藍調中的7 名。所以我們取得了非常好的進展。這些討論只是需要時間，而且需要更多時間與那些往往拖拖拉拉、做更多分析的國民在一起。

So the discussions are going well. It's impossible to predict when they'll come through, but Trust 2, again, is a really good opportunity for us to put some strong data in front of these payers, and we're optimistic that we will continue to progress throughout the year.

所以討論進展順利。無法預測他們何時會通過，但 Trust 2 再次對我們來說是一個很好的機會，可以向這些付款人提供一些強有力的數據，我們樂觀地認為我們將在全年繼續取得進展。

Great, and then just one more here, with current OpEx pushing about $80 million run rate for '24, and we're still getting minimal gross profit, just how do we make this math work?

太棒了，然後這裡還有一個，目前的營運支出在 24 年推動了約 8000 萬美元的運行率，而我們仍然獲得了最低的毛利潤，那麼我們如何使這一數學運算發揮作用呢？

So we believe we have cash runway into the first quarter of 2025, not exceeding 12 months from today's 10-K filing date based on our cash on hand, our most recent cash usage, and our future operating projections. We're going to continue to focus on driving ASP improvements to improve revenue, and we'll continue to focus on trying to find cost-saving measures and efficiencies wherever we can.

因此，根據我們的手頭現金、最近的現金使用情況以及我們未來的營運預測，我們相信，我們的現金跑道可以持續到2025 年第一季度，即從今天的10-K 申報日期起不超過12 個月。我們將繼續致力於推動 ASP 改善以提高收入，並將繼續致力於盡可能尋找節省成本的措施和提高效率。

Great. Thanks for the update.

偉大的。感謝更新。

I show no further questions at this time. This will conclude today's conference call. Thank you for your participation. You may now disconnect.

我目前沒有提出任何進一步的問題。今天的電話會議到此結束。感謝您的參與。您現在可以斷開連線。