Exact Sciences Corp (EXAS) 2024 Q3 法說會逐字稿

Hello. At this time, I would like to welcome everyone to the Exact Sciences. Third quarter, 2024 earnings conference call. (Operator Instructions)

你好。此時此刻，我歡迎大家來到精確科學。 2024 年第三季財報電話會議。 （操作員說明）

I would now like to turn the call over to Erik Holznecht, Director of Investor Relations. You may begin.

我現在想將電話轉給投資者關係總監 Erik Holznecht。你可以開始了。

Thanks operator. Thank you for joining us for Exact Sciences. Third quarter, 2024 conference call on the call today are Kevin Conroy, the company's Chairman and CEO; and Aaron Bloomer. Our Chief Financial Officer Exact Sciences issued a news release earlier this afternoon detailing our third quarter financial results, this news release and today's presentation are available on our website at exactsciences.com.

感謝運營商。感謝您加入我們的精確科學。今天召開的 2024 年第三季電話會議由公司董事長兼執行長 Kevin Conroy 主持；和亞倫·布盧默。我們的財務長 Exact Sciences 今天下午早些時候發布了一份新聞稿，詳細介紹了我們第三季度的財務業績，本新聞稿和今天的簡報可在我們的網站 exactsciences.com 上取得。

During today's call, we will make forward-looking statements based on current expectations. Our actual results may be materially different from such statements. Discussions of non-GAAP figures and reconciliations to GAAP. Figures are available in our earnings press release and descriptions of the risks and uncertainties associated with exact sciences are included in our CC filings. Both can be accessed through our website.

在今天的電話會議中，我們將根據當前預期做出前瞻性陳述。我們的實際結果可能與此類聲明有重大差異。討論非 GAAP 數據以及與 GAAP 的調整。我們的收益新聞稿中提供了數據，我們的 CC 文件中包含了與精確科學相關的風險和不確定性的描述。兩者都可以透過我們的網站存取。

I'll now turn the call over to Kevin.

我現在將電話轉給凱文。

Thanks Eric. During the third quarter, the exact sciences team made several advancements for patients while strengthening our platform and growing our business efficiently.

謝謝埃里克。在第三季度，精確科學團隊為患者取得了多項進展，同時加強了我們的平台並有效地發展了我們的業務。

Highlights include delivering test results to 1.2 million patients including a record number with Cologuard and Etty DX.

亮點包括向 120 萬名患者提供測試結果，其中使用 Cologuard 和 Etty DX 創下了記錄。

Growing total revenue 13% year over year while holding operating expenses flat, expanding adjusted EBITA by 75% year over year to $99 million generating record free cash flow of $113 million. An improvement of the same amount year over year increasing Cologuard, customer satisfaction and brand awareness to all time highs receiving FDA approval for Cologuard plus our next generation Cologuard test showcasing data at the ESMO Congress for our Liquid biopsy colon cancer screening test and also our multi cancer screening test and securing acceptance from a peer review journal for the first publication of Onco detect our molecular residual disease or MRD test.

總營收年增 13%，同時營運費用保持不變，調整後 EBITA 年增 75%，達到 9,900 萬美元，自由現金流達到創紀錄的 1.13 億美元。同比改善幅度相同，Cologuard、客戶滿意度和品牌知名度達到歷史新高，Cologuard 獲得FDA 批准，加上我們的下一代Cologuard 測試，在ESMO 大會上展示了我們的液體活檢結腸癌篩檢測試以及我們的多樣化本數據癌症篩檢測試並確保 Onco 首次發表的同行評審期刊接受我們的分子殘留疾病或 MRD 測試。

While we've made progress our execution during the third quarter and updated outlook for the full year. Don't reflect our full potential though we're disappointed with the growth in Cologuard testing frequency among our expanding provider base. We remain excited about our ability to continue enhancing value through our impactful industry leading tests and our powerful exact nexus platform. First, we have a large core of nearly 250,000 health care providers who rely on Cologuard as an important screening tool. This number continues to grow every day.

雖然我們在第三季的執行中取得了進展，並更新了全年的展望。儘管我們對不斷擴大的供應商群體中 Cologuard 測試頻率的成長感到失望，但這並沒有反映出我們的全部潛力。我們仍然對透過有影響力的行業領先測試和強大的精確關係平台繼續提升價值的能力感到興奮。首先，我們擁有近 25 萬名醫療保健提供者的龐大核心，他們依賴 Cologuard 作為重要的篩檢工具。這個數字每天都在持續成長。

We are improving the guidance and tools we give to our motivated field force, helping them educate providers with the greatest potential to screen large numbers of their patients with Cologuard cold guard plus will give us even greater access to and more time with our customer base. As we explain, the heightened benefits of our new test access is key especially given how busy primary care providers are today.

我們正在改進為積極進取的現場人員提供的指導和工具，幫助他們教育最有潛力的醫療服務提供者，使用Cologuard Cold Guard 篩選大量患者，此外，這將使我們能夠更好地接觸客戶群，並有更多時間與客戶群相處。正如我們所解釋的，我們的新測試訪問的更大好處是關鍵，特別是考慮到當今初級保健提供者的繁忙程度。

Second Cold Guard plus will launch in the second quarter of 2025 and it sets a new performance standard with 95% cancer sensitivity and 94% specificity.

Second Cold Guard plus 將於 2025 年第二季推出，它設定了新的性能標準，具有 95% 的癌症敏感性和 94% 的特異性。

This will help convince more primary care providers to consider Cologuard plus as at least a co equal standard of care as colonoscopy and even as a first choice due to strong patient preference pricing for cold guard plus will initially apply to Medicare patients followed by commercial patients. This price increase will likely provide a top line growth tailwind for 2025 and beyond. As access grows. Third, the opportunity to re screen patients continues to increase this year. 1.6 million people become due for their next Cologuard test in 2025 that number grows to 2 million and in 2026 2.6 million. This year, we expect to screen about 1 million people in this re screen setting with Cologuard. And next year, we would expect that number to grow to at least 1.3 million.

這將有助於說服更多初級保健提供者將Cologuard plus 視為至少與大腸鏡檢查同等的護理標準，甚至作為首選，因為患者對Cold Guard Plus 的強烈偏好定價將首先適用於醫療保險患者，然後是商業患者。此次價格上漲可能為 2025 年及以後的收入成長提供動力。隨著訪問量的增長。第三，今年重新篩檢患者的機會持續增加。 2025 年，預計將有 160 萬人接受下一次 Cologuard 測試，這一數字將增加至 200 萬人，2026 年將增至 260 萬人。今年，我們預計將使用 Cologuard 在此重新篩檢環境中篩選約 100 萬人。明年，我們預計這個數字將成長到至少 130 萬。

Our re screen success rate continues to steadily improve because of our exact nexus technology and service platform. Over time, our unique data set customer relationships and digital outreach capabilities will fuel even greater growth.

得益於我們精準的Nexus技術和服務平台，我們的重新篩選成功率持續穩定提升。隨著時間的推移，我們獨特的數據集客戶關係和數位推廣能力將推動更大的成長。

We expect re screens will go from about 25% of cold guard volumes today to well over 50% in the future.

我們預計，未來冷櫃中的螢幕佔比將從目前的 25% 左右增加到 50% 以上。

Fourth, our exact nexus platform will continue fueling growth and care. GAAP screening programs. A key growth driver for Cologuard, large payers and health systems are increasingly turning to Cologuard to solve the challenges faced by declining wellness visits and quality measures. This year, we have run nearly 50 programs to help screen a large number of people with Cologuard. We are becoming more adept at driving adherence with our exact nexus digital tools and tailored customer experiences. This will help double the adherence rate from slightly more than one in five today in care GAAP programs. When a test is ordered directly by a patient's health care provider, approximately two and three complete Cologuard growth from care GAAP volume and adherence improvements will provide significant tailwinds over many years.

第四，我們的確切聯繫平台將繼續推動成長和照護。 GAAP 篩檢計畫。作為 Cologuard 成長的關鍵驅動力，大型付款人和衛生系統越來越多地轉向 Cologuard 來解決健康就診和品質措施下降所面臨的挑戰。今年，我們已經運行了近 50 個項目，利用 Cologuard 幫助篩選大量人員。我們越來越善於利用我們精確的關係數位工具和量身定制的客戶體驗來推動人們的遵守。這將有助於將護理 GAAP 計劃的遵守率從目前略高於五分之一的水平提高一倍。當患者的醫療保健提供者直接訂購測試時，護理 GAAP 數量和依從性改進中大約兩到三個完整的 Cologuard 增長將在多年內提供顯著的推動力。

Next, our rich pipelines of new products including ACO Deette, our blood based CRC screening test and our multi cancer screening test will help drive new sources of growth and impact over the long term.

接下來，我們豐富的新產品系列，包括 ACO Deette、基於血液的 CRC 篩檢測試和多種癌症篩檢測試，將有助於推動新的成長來源和長期影響。

Finally, the other important leg of the exact sense is value creation. Story is leverage. Top line growth will be coupled with steady improvement in profitability. The third quarter demonstrates the power of our platform to deliver growth while holding the line on expenses over time, We expect to continue to see leverage across the P&L particularly GN A giving us great flexibility.

最後，精確意義上的另一個重要面向是價值創造。故事就是槓桿。營收成長將伴隨著獲利能力的穩定提高。第三季展示了我們的平台在實現成長的同時保持費用控制的能力。

I'll now turn the call over to Erin to discuss third quarter results and updated guidance in more detail.

我現在將把電話轉給艾琳，更詳細地討論第三季業績和更新的指導。

Thanks Kevin and good afternoon, everyone total revenue grew 13% year over year to $709 million. Growth was led by broad based momentum and Cologuard adoption along with international expansion, Ivana type CX adjusted de margin expanded 500 basis points to 14%. Highlighting another strong quarter of operational execution from the team.

謝謝凱文，下午好，大家總收入年增 13% 至 7.09 億美元。成長是由廣泛的勢頭和 Cologuard 的採用以及國際擴張帶動的，Ivana 型 CX 調整後的利潤率擴大了 500 個基點，達到 14%。凸顯團隊營運執行力又一個強勁的季度。

We generated a record $113 million in free cash flow up nearly 60% sequentially and ended the quarter with cash and security of more than a billion dollars.

我們產生了創紀錄的 1.13 億美元自由現金流，比上一季成長了近 60%，本季末現金和擔保金額超過 10 億美元。

Screening revenue grew 15% to $545 million driven by cold guard volume precision oncology revenue grew 5% to $164 million. Growth was led by oncotype DX which expanded 28% internationally.

在冷衛量的推動下，篩檢收入成長 15% 至 5.45 億美元，精準腫瘤學收入成長 5% 至 1.64 億美元。 Oncotype DX 引領成長，其國際業務成長了 28%。

We generated $99 million in adjusted EBITDA.

我們產生了 9900 萬美元的調整後 EBITDA。

An increase of $42 million year over year adjusted ebita margin expansion was driven by volume and expense controls as a percentage of revenue adjusted G&A improved about 550 basis points year over year.

銷售和費用控制推動了調整後的息稅前利潤率同比增長了 4200 萬美元，調整後的 G&A 佔收入的百分比同比提高了約 550 個基點。

This more than offset a decline in nongaap gross margin of about 85 basis points.

這足以抵銷非公認會計準則毛利率約 85 個基點的下降。

We are making strong progress, expanding profitability and generating free cash flow allowing us to reinvest in growth and innovation.

我們正在取得強勁進展，擴大獲利能力並產生自由現金流，使我們能夠對成長和創新進行再投資。

Turning together we now expect full year revenue between 2.73 and $2.75 billion including full year screening revenue between 2.08 and $2.095 billion and precision oncology revenue between 656 $155 million.

綜合來看，我們現在預計全年收入在 273 至 27.5 億美元之間，其中全年篩檢收入在 2.08 至 20.95 億美元之間，精準腫瘤學收入在 656 至 1.55 億美元之間。

Recall on our earnings call in July, we outlined four key reasons for accelerated cold guard growth in the second half of 2024 typical seasonality care GAAP programs, read screens and recent sales and marketing investments.

回想一下 7 月的財報電話會議，我們概述了 2024 年下半年冷衛衣加速成長的四個關鍵原因，典型的季節性護理 GAAP 計劃、閱讀螢幕以及最近的銷售和行銷投資。

Although we are pleased with progress on rescreens and care GAAP programs which are powered by our exact Nexus platform and capabilities. We fell short of driving demand at faster rate within primary care offices excluding care GAAP programs. Since August Cold Guard orders have grown below the historical rate which our prior guidance assumed this impacted third quarter screening revenue and will have a bigger impact on fourth quarter revenue due to the normal 30 day timing between a Cologuard order and a completed test.

儘管我們對重新篩選和護理 GAAP 計劃方面取得的進展感到高興，但這些計劃由我們確切的 Nexus 平台和功能提供支援。我們未能以更快的速度推動初級保健辦公室內的需求（不包括護理 GAAP 計劃）。自8 月以來，Cold Guard 訂單的成長速度低於我們先前的指導假設的歷史成長率，這影響了第三季的篩檢收入，並且由於Cologuard 訂單和完成的測試之間通常有30 天的時間間隔，因此將對第四季度的收入產生更大的影響。

Second, disruption from hurricane Helene and Milton negatively impacted Cologuard orders and results in September and October.

其次，颶風海倫和米爾頓造成的干擾對 Cologuard 9 月和 10 月的訂單和結果產生了負面影響。

Historically, about 18% of Cologuard tests are from patients who live in affected areas.

從歷史上看，大約 18% 的 Cologuard 測試來自居住在受影響地區的患者。

Our thoughts are with those who suffered from the devastating storms.

我們與那些遭受毀滅性風暴的人們同在。

We continue to monitor these situations closely with expected impacts incorporated into our updated guidance.

我們將繼續密切監控這些情況，並將預期影響納入我們的更新指南中。

Third, we are seeing positive contributions from the new cohort of reps who joined Exact Sciences beginning in May.

第三，我們看到從 5 月開始加入 Exact Sciences 的新一批代表做出了積極貢獻。

This progress has been more gradual than our prior guidance assumed and we expect the return on those investments will increase in the near and long term.

這項進展比我們先前的指導假設更加漸進，我們預期這些投資的回報在短期和長期內都會增加。

Lastly, at the beginning of the third quarter, we moved our Precision Oncology portfolio onto exact nexus. We face transitional challenges that we expect will have a one time negative impact on precision oncology revenue in the second half of 2024.

最後，在第三季初，我們將精準腫瘤學產品組合轉移到精確連接。我們面臨轉型挑戰，我們預計這些挑戰將在 2024 年下半年對精準腫瘤學收入產生一次性負面影響。

These challenges impacted our ability to collect on some of the tests we performed over time. We expect this upgrade will enhance the efficiency of our teams and systems and the challenges we faced have been resolved as a result of our updated revenue outlook, we're revising adjusted bits of guidance to be between 310 and $320 million.

這些挑戰影響了我們收集一段時間內進行的一些測試的能力。我們預計這次升級將提高我們團隊和系統的效率，由於我們更新了收入前景，我們面臨的挑戰已經解決，我們正在將調整後的指導方針修改為 310 至 3.2 億美元之間。

This implies our full year adjusted ebita margin at midpoint expands 270 basis points year over year to 11.5%.

這意味著我們全年調整後的息稅前利潤率中點較去年同期擴大 270 個基點，達到 11.5%。

Although we're facing near term challenges, we expect growth will accelerate in 2025 and margins will continue to expand.

儘管我們面臨短期挑戰，但我們預計 2025 年成長將加速，利潤率將繼續擴大。

We are well on our way to achieving our 2027 financial target of 15% compounded revenue growth and greater than 20% adjusted the margin back to you, Kevin.

我們正在順利實現 2027 年複合收入成長 15% 的財務目標，並將超過 20% 的調整利潤返還給您，凱文。

Thanks, Darin Cologuard is an open ended growth story because it's become synonymous with colon cancer screening.

謝謝，Darin Cologuard 是一個開放式的成長故事，因為它已成為大腸癌篩檢的代名詞。

Our sophisticated exact nexus platform allows us to connect electronically with nearly a quarter of a million providers who've ordered cguard. So far this year, 24 million patients, more than 370 us health systems and over 800 payers over time, the power of our exact nexus platform continues to increase increase both Cologuard order and adherence rates in the primary care and care, GAAP settings.

我們先進的精確連接平台使我們能夠與訂購 cguard 的近 25 萬供應商進行電子連接。今年到目前為止，隨著時間的推移，我們的精確連接平台的力量不斷增強，已有2,400 萬名患者、超過370 個美國醫療系統和超過800 個付款人，從而提高了初級保健和護理、公認會計原則(GAAP) 設定中的Cologuard 訂單率和遵從率。

Our platform will help us address the 60 million people who are not up to date with screenings by sharing data and insights with key stakeholders. It also allows us to build lifelong relationships with patients who are new to screening and those who have previously completed Cologuard.

我們的平台將透過與主要利害關係人分享數據和見解，幫助我們解決 6,000 萬人未能及時了解篩檢的問題。它還使我們能夠與剛開始篩檢的患者和先前完成 Cologuard 的患者建立終生關係。

We expect this will drive Cologuard growth for years to come and expect similar benefits in precision oncology.

我們預計這將推動 Cologuard 在未來幾年的成長，並預計在精準腫瘤學領域也能帶來類似的好處。

Our precision oncology team guides treatment decisions for more than 600 cancer patients every day.

我們的精準腫瘤學團隊每天為 600 多名癌症患者指導治療決策。

Archetype DX helps early stage breast cancer patients determine whether they will benefit from chemotherapy and assess their risk of recurrence. It's globally recognized as standard of care with 90% of us oncologists ordering an adoption, expanding internationally through this same channel oncode can aid in the early detection of residual or recurring cancer and better informed therapy decisions.

Archetype DX 幫助早期乳癌患者確定他們是否會從化療中受益並評估其復發風險。它是全球公認的護理標準，90% 的腫瘤科醫生訂購了採用，透過同一管道在國際上擴展 oncode 可以幫助早期發現殘留或復發的癌症，並做出更明智的治療決策。

We're excited to share clinical validation data. This January in a peer reviewed journal highlighting Onco detects accuracy in detecting residual disease in colon cancer patients.

我們很高興分享臨床驗證數據。今年 1 月，一份同行評審期刊強調 Onco 在檢測結腸癌患者殘留疾病方面的準確性。

We're on track to launch Onco Deette with reimbursement in colon cancer. Next year, we're also conducting clinical studies to expand into multiple other solid tumor types including breast cancer results from these studies will be shared at regular intervals over the next few years supporting our goal to cement this technology as standard of care.

我們正計劃推出 Onco Deette，並可報銷大腸癌的費用。明年，我們還將進行臨床研究，以擴展到包括乳癌在內的多種其他實體瘤類型，這些研究的結果將在未來幾年內定期分享，以支持我們將這項技術鞏固為護理標準的目標。

We achieved another major pipeline milestone by receiving FDA approval for Cologuard plus our next generation Cologuard test.

透過獲得 FDA 批准 Cologuard 和我們的下一代 Cologuard 測試，我們實現了另一個重要的產品線里程碑。

Cologuard plus sets a new performance standard in colorectal cancer screening.

Cologuard plus 為大腸直腸癌篩檢設立了新的性能標準。

Cologuard plus detects 95% of cancers with 94% specificity relative to Cologuard. This represents approximately a 40% improvement in both the false negative and false positive rates per the modeling assumptions that inform us PST F guidelines only Cologuard plus and colonoscopy will be on the efficient frontier which defines the best colon cancer screening strategies.

相較於 Cologuard，Cologuard plus 可檢測 95% 的癌症，特異性為 94%。這意味著根據模型假設，假陰性率和假陽性率均提高了約 40%，這些模型假設僅告知我們 PST F 指南 Cologuard plus 和大腸鏡檢查將處於定義最佳大腸癌篩檢策略的有效前沿。

Next, we plan to establish a higher price through an available Medicare pathway before launching the test with Medicare coverage and guideline inclusion.

接下來，我們計劃在啟動醫療保險覆蓋範圍和指南納入測試之前，透過可用的醫療保險途徑確定更高的價格。

Our blood based colon cancer screening data presented at ESMO in September demonstrated meaningful progress towards another option to screen 16 million Americans who remain on screen.

我們 9 月在 ESMO 上公佈的基於血液的大腸癌篩檢數據表明，在篩檢 1,600 萬仍在接受篩檢的美國人的另一種選擇方面取得了有意義的進展。

Results of a large well defined study showed our test achieved 88% overall cancer sensitivity and 31% sensitivity for advanced precancerous lesions. At 90% specificity. These data reinforce the power of our unique scientific approach which delivers an unrivaled cost profile and extends beyond colon cancer. We expect to have the best stool and blood based screening options available with the technology and commercial platforms necessary to engage patients.

一項大型明確研究的結果表明，我們的測試對癌症的整體敏感性達到 88%，對晚期癌前病變的敏感性達到 31%。特異性為 90%。這些數據增強了我們獨特的科學方法的力量，該方法提供了無與倫比的成本概況，並擴展到結腸癌之外。我們希望透過吸引患者所需的技術和商業平台，提供基於糞便和血液的最佳篩檢方案。

We see a clear path to accelerating growth and expanding profitability. In 2025 the progress we're making with commercial execution, our exact Nexus platform, re screens care, GAAP programs and new product launches reinforces our positive outlook.

我們看到了一條加速成長和擴大獲利能力的明確道路。 2025 年，我們在商業執行、精確的 Nexus 平台、重新篩選護理、GAAP 計劃和新產品發布方面取得的進展強化了我們的積極前景。

This positions us to continue making a positive impact on the lives of millions of patients around the world with our portfolio of innovative cancer diagnostics. We're now happy to take your questions.

這使我們能夠透過我們的創新癌症診斷產品組合繼續對世界各地數百萬患者的生活產生積極影響。我們現在很樂意回答您的問題。

Thank you. And as a reminder to ask a question, simply press star followed by the number one and again, please limit yourself to one question. Our first question comes from the line of

謝謝。作為提問問題的提醒，只需按星號，然後按數字 1，然後再按一次，請將自己限制在一個問題上。我們的第一個問題來自

Brandon Collier from Wells Fargo. Please go ahead.

富國銀行的布蘭登·科利爾。請繼續。

Hey, thanks, good afternoon. Kevin or Aaron. Do you just kind of walk through? What changed in the second half outlook relative to where you stood 90 days ago would be helpful if you could maybe unpack some of the moving parts and contribution be it between care? GAAP. The hurricane disruptions slow ramp from from new reps and have you seen any bounce and orders following the hurricane in those effective areas? Thank you.

嘿，謝謝，下午好。凱文或亞倫。你只是走過去嗎？如果您能在護理期間解開一些活動部分和貢獻，那麼下半年前景相對於您 90 天前的情況發生了哪些變化，這將會很有幫助？公認會計準則。颶風造成的破壞減緩了新代表的成長速度，您是否在這些有效區域看到颶風過後的任何反彈和訂單？謝謝。

Sure. Why don't I take this at a high level and then hand it over to Erin. First of all, I'd say that a long term trend for Cologuard remain intact. With that said, I take accountability. Our management team takes accountability for the, the lesson performance and guidance for Q3 and Q4 respectively. We can do better.

當然。為什麼我不從高層次考慮這個問題，然後將其交給艾琳呢？首先，我想說 Cologuard 的長期趨勢保持不變。話雖如此，我承擔責任。我們的管理團隊分別對第三季和第四季的課程表現和指導負責。我們可以做得更好。

And we have our arms around these execution issues and we have clear plans in place to address them. We'll talk more about that on the call. Let me say that Cologuard is and remains promotionally responsive.

我們全力解決這些執行問題，並制定了明確的計劃來解決這些問題。我們將在電話中詳細討論這一點。我要說的是，Cologuard 一直致力於促銷回應。

It's responsive the most and the newer health care providers that have begun ordering Cologuard since the pandemic, we are calling on those that cohort of positions the least and that is an opportunity for us to execute much better as we have in the past.

它反應最快，自大流行以來已經開始訂購 Cologuard 的新醫療保健提供者，我們正在呼籲那些立場最少的人，這對我們來說是一個機會，可以像過去一樣更好地執行。

We're disappointed, but at the same time, we see a very clear path to improvement.

我們很失望，但同時，我們看到了一條非常明確的改進之路。

The size of the opportunity remains unchanged. There are 60 million Americans who are not up to date with screening.

機會的大小保持不變。有 6000 萬美國人沒有及時進行篩檢。

We are seeing a change in the way that patients are consuming health care with a decrease over time in face to face office visits in the primary care setting that has changed and it has changed most significantly since COVID that provides on one hand, a challenge. Another a real opportunity because of the exact nexus platform and our ability to reach people as we are with care. GAAP programs initiated by our customers where health systems and payers, we'll, we'll talk about that more. And then I just want to keep everybody to keep in mind that 2025 tails and why we believe that growth in 2025 and beyond will continue starting with re screens, which continues to grow. We'll unpack that a little bit and we believe over time that'll grow from 25% to 50%. The Care GAAP programs which are becoming a larger part of our overall Cologuard volumes, Cologuard plus the introduction of it and the price increase that we will seek in 2025 and then finally, stronger commercial execution than you saw in Q3 and we expect to see in Q4 Erin.

我們看到患者消費醫療保健的方式發生了變化，初級保健機構中面對面就診的次數隨著時間的推移而減少，這種情況已經發生了變化，而且自新冠疫情以來，這種變化最為顯著，這一方面帶來了挑戰。這是另一個真正的機會，因為我們有確切的聯繫平台，我們有能力小心地接觸人們。由我們的客戶發起的 GAAP 計劃，其中衛生系統和付款人，我們將更多地討論這一點。然後我想讓大家記住 2025 年的尾巴，以及為什麼我們相信 2025 年及以後的成長將繼續從重新篩選開始，並繼續成長。我們將對此進行一些分析，我們相信隨著時間的推移，這一數字將從 25% 增長到 50%。 Care GAAP 計劃正在成為我們整體Cologuard 銷售的重要組成部分，Cologuard 加上它的推出以及我們將在2025 年尋求的價格上漲，最後，比您在第三季度看到的更強大的商業執行力，我們預計在Q4 艾琳。

Yeah. Hey Brandon. So as we laid out on the, on the last call, you know, there were really four key reasons for why we expected growth to accelerate into the back half of the year, typical seasonality, re screens, care gaps. And then the recent sales and marketing investments that we've made really proud of what's what's going on in the team execution around re screens and care GAAP, driving significant growth for us in the back half of the year. If you look at kind of what's driving the shortfall, you know, first, as we laid out, we typically see the highest volume of Cologuard order growth really from that kind of early August through late October, that's the steepest part of our growth curve. And while we have seen increases over this period of time, it's not been at the levels that we expect or that we've seen historically, the second key reason would be we've seen a positive signal on recent sales and market investments that we've made. But that signal is, is a bit more gradual than the prior guidance. Assumed.

是的。嘿布蘭登。因此，正如我們在上次電話會議上所闡述的那樣，您知道，我們預計今年下半年成長將加速的原因實際上有四個關鍵原因：典型的季節性、重新篩檢、護理差距。然後，我們最近對銷售和行銷投資感到非常自豪，我們對圍繞重新篩選和護理 GAAP 的團隊執行感到非常自豪，這推動了我們在今年下半年的顯著成長。如果你看看是什麼導致了短缺，你就會知道，首先，正如我們所指出的，我們通常會看到Cologuard 訂單增長量最高的時期是從8 月初到10 月底，這是我們增長曲線中最陡峭的部分。雖然我們在這段時間看到了成長，但並未達到我們預期或歷史上看到的水平，第二個關鍵原因是我們看到了近期銷售和市場投資的正面訊號，我們認為，已經做了。但這個訊號比之前的指導要漸進一些。假定。

The third key driver really comes down to, to hurricanes and as outlined on the call, the those that live in the affected areas of the two hurricanes that hit, that represents roughly 18% of co guard volumes historically. And that has had an impact on orders and results in September and October and obviously given the 30 day time lag between, you know, when, when we see an order and a result, this has a bigger impact on the fourth quarter.

第三個關鍵驅動因素實際上歸結為颶風，正如電話會議中概述的那樣，那些生活在兩次颶風襲擊影響地區的人，約佔歷史上共同警戒量的 18%。這對 9 月和 10 月的訂單和結果產生了影響，顯然考慮到我們看到訂單和結果之間有 30 天的時間間隔，這對第四季度的影響更大。

Tycho Peterson, Jefferies.

第谷·彼得森，杰弗里斯。

Hey, thanks. I'm I'm I'm going to pick up right there. So you're, you're not willing to quantify each of the impacts. And then how long do you expect care GAAP and rep productivity issues to linger and then fourth quarter guidance, you're down sequentially. I'm just curious, you know, as to why that, that would be the case. And then lastly anything you're willing to say about 25 at this point. Thanks.

嘿，謝謝。我我我我要去那裡接。所以你不願意量化每一個影響。然後，您預計公認會計原則和代表生產力問題會持續多久，然後在第四季度指導，您將連續下降。我只是很好奇，你知道，為什麼會這樣。最後是關於 25 點你願意說的任何事情。謝謝。

Hey, Tyco. Yeah. So as we look at and you know, in, in the fourth quarter, it is down sequentially, we're not going to size each one of the kind of four key, three, key reasons that we outlined. The single biggest reason for why revenue would be down sequentially from Q3 to Q4 is the hurricanes. Again, as we look at patients who in affected areas and we closely monitor on a week to week basis. What's been happening both with orders and results. We know that this is going to have an outsized impact on Q4 relative to Q3. Again, those that live in affected areas make up roughly 18% of co guard volumes as it relates to care gaps. You know, care GAAP continues to be a strong growth driver for us into the back half of the year. The pacing between Q3 and Q4, we actually saw some of the payer programs pull forward from Q4 into Q3 and some of the care GAAP programs we had contemplated in Q4 are happening a little bit later in the quarter. So some of that revenue will be recognized in 2025 as we result those orders, you know, turning to to 2025 just reiterate what Kevin said before. We've got four key reasons to be excited about growth heading into next year. First is re screens. Second is Care GAAP programs. Third is the launch of Cologuard Plus and the pricing increase that we expect to see. And then fourth would be commercial execution.

嘿，泰科。是的。因此，正如我們所看到的，你知道，在第四季度，它是連續下降的，我們不會逐一衡量我們概述的四個關鍵原因，三個關鍵原因。收入從第三季到第四季連續下降的最大原因是颶風。同樣，當我們觀察受影響地區的患者時，我們每週都會密切監測。訂單和結果都發生了什麼。我們知道，相對於第三季度，這將對第四季產生巨大影響。同樣，居住在受影響地區的人約佔共同監護人的 18%，因為這與護理缺口有關。您知道，護理 GAAP 仍然是我們今年下半年強勁的成長動力。從第三季和第四季的節奏來看，我們實際上看到一些付款人計劃從第四季度提前到第三季度，而我們在第四季度考慮的一些護理GAAP 計劃將在本季度晚些時候發生。因此，當我們完成這些訂單時，部分收入將在 2025 年得到確認，你知道，轉向 2025 年只是重申 Kevin 之前所說的。我們有四個關鍵理由對明年的成長感到興奮。首先是重新篩選。其次是 Care GAAP 計劃。第三是 Cologuard Plus 的推出以及我們預計會看到的價格上漲。第四是商業執行。

Yeah, and adding on to that new products with our launch of MRD occurring next year too in the first half.

是的，明年上半年我們也會推出 MRD，補充這些新產品。

Andrew Brackmann, William Blair.

安德魯·布拉克曼，威廉·布萊爾。

Hi, good afternoon.

嗨，下午好。

Thanks for taking the question. You know, I think one of the things folks are going to want some comfort around is just your ability to forecast the business, especially in the context of how things sort of played out this quarter. But can you maybe just sort of talk about the signs that you saw in inter quarter that this was sort of playing out against your favor? And I guess specifically how those changed or evolved over the last couple of years and I guess bigger picture here, the number of variables in the model. How are those sort of moving in and out of your control as we look forward? Thanks.

感謝您提出問題。你知道，我認為人們想要安慰的事情之一就是你預測業務的能力，特別是在本季情況如何發展的背景下。但你能否談談你在季間比賽中看到的跡象，這些跡象表明這對你不利？我具體猜測這些在過去幾年中是如何變化或演變的，我想這裡有更大的圖景，模型中變數的數量。當我們展望未來時，這些是如何進入或脫離你的控制的？謝謝。

Hey, Andrew. Yeah, the, the biggest thing that I would say from an intra quarter perspective is just obviously, again, reiterating that, that growth that we expect to see and have seen over time from August through October and that's been a very reliable period of growth in the past. We did see growth in orders during that time period, just not at the levels as we have historically and to reiterate some of the points Kevin made, you know, this comes down to commercial execution and we're taking actions to address that heading into 2025. The second thing that we saw play out intra quarter was obviously the the two large hurricanes which kind of hit back to back and we monitor those effective areas very, very closely and are able to predict what's happening both in terms of orders as well as results heading into the fourth quarter.

嘿，安德魯。是的，從季度內的角度來看，我想說的最重要的事情顯然是，再次重申，我們預計會看到並已經看到從8 月到10 月的增長，這是一個非常可靠的增長時期在過去。我們確實看到了這段時間內訂單的增長，只是沒有達到我們歷史上的水平，並重申凱文提出的一些觀點，你知道，這取決於商業執行，我們正在採取行動解決這一問題2025 年。我們在季度內看到的第二件事顯然是兩場大型颶風，它們連續襲擊，我們非常非常密切地監控這些有效區域，並且能夠預測訂單方面發生的情況作為進入第四季度的結果。

Doug Schenkel, Wolfe Research.

道格‧申克爾，沃爾夫研究中心。

Hey, good. Good afternoon. So question on the guidance and then just thinking ahead from here for the next couple of years. So Aaron is doing some quick math, if we assume 18% of your revenue went to zero for one month, I think that would equate to 35 to $40 million in revenue, you cut guidance for the year by more than half that. So just just want to make sure I'm in the right neighborhood. I want to be, you know, crystal clear that even if it were not for the hurricanes, you would be cutting guidance here because of your lack of visibility. And, and just not executing to, to plan. So that's my first question. My second is, you know, your, your guidance implies that Cologuard fourth quarter volume growth is going to moderate, I think to around 10%. And, you know, this is in a period where you talked about again, material care, GAAP benefits coming in. The reps you hired, you know, that were completed in May, but we're hired earlier than that in some cases starting to become more efficient as they're supposed to be. And then the opportunity to convert reorders from three years years ago, you know, as we look at the second half of this year, that's as big as ever. So if that's what's going on with Cologuard, your other major product line oncotype, great product, but it's mature. That's a mid single digit growth franchise, pulling those things together, you know, and acknowledging the tailwinds that you talked about in your prepared remarks, you know, let's just cut to it. Recognizing a key part of the buy thesis for exact is your ability to grow revenue double digits. Can you do that over the next 1 to 2 years? Unless you get the ASP increases or get help from other products like MRD or Cologuard Plus? Thank you.

嘿，很好。午安.因此，請對指導意見提出質疑，然後從現在開始思考未來幾年的情況。因此，亞倫正在快速計算一下，如果我們假設您 18% 的收入在一個月內為零，我認為這將相當於 35 至 4000 萬美元的收入，您將今年的指導削減了一半以上。所以只是想確保我在正確的社區。我想非常清楚地表明，即使沒有颶風，你們也會因為缺乏能見度而切斷這裡的指導。而且，只是不執行計劃。這是我的第一個問題。我的第二點是，你知道，你的指導意味著 Cologuard 第四季銷售成長將放緩，我認為在 10% 左右。而且，你知道，這是你再次談到的時期，物質關懷，GAAP 福利即將到來。更早變得更有效率，正如他們應該的那樣。然後，從三年前開始轉換再訂單的機會，你知道，當我們看到今年下半年時，這與以往一樣大。因此，如果這就是 Cologuard 的情況，您的另一個主要產品線 oncotype，很棒的產品，但它已經成熟了。這是一個中等個位數的成長特許經營權，將這些因素結合在一起，你知道，並承認你在準備好的講話中談到的順風車，你知道，讓我們切入正題。準確地認識到購買論點的關鍵部分是您使收入增長兩位數的能力。你能在接下來的1到2年內做到這一點嗎？除非您獲得 ASP 成長或獲得 MRD 或 Cologuard Plus 等其他產品的協助？謝謝。

Doug. Thanks for that. Let me take the first part and then hand it over to Erin. You know, when you zero in on the biggest impact in terms of the fourth quarter, it is on the responsiveness to in our core customer base, the the customers who are, are seeing patients and there is a change that is ongoing in the way that Americans are consuming health care with a decrease in primary care visits. That's, that's a fact. There's also a transition going on in the way that Cologuard is being delivered through these care GAAP programs. Well, let's let's come back to our ability to grow our customer base. The reason that we're confident that we'll continue to grow at that in the primary care setting is because we have seen tremendous growth in new users and new health care providers. And we haven't called on them very frequently, but we're calling on the cohorts of new ordering physicians from 2020 beyond at half the rate that we're calling on the more tenured. So there's an opportunity for us to execute. And one thing that we see and we can see this from our data is when you call on those health care providers, you see a response in terms of how frequently they order klog.

道格.謝謝你。讓我先完成第一部分，然後交給艾琳。你知道，當你把第四季度的最大影響歸零時，那就是我們核心客戶群的響應能力，那些正在看病人的客戶，並且正在發生變化。卻在減少。這就是，這就是事實。透過這些護理 GAAP 計劃提供 Cologuard 的方式也正在轉變。好吧，讓我們回到我們擴大客戶群的能力。我們之所以有信心在初級保健領域繼續成長，是因為我們看到新用戶和新醫療保健提供者的巨大成長。我們並沒有非常頻繁地拜訪他們，但從 2020 年開始，我們拜訪新開診醫生的比例超過了我們拜訪更多終身醫生的一半。所以我們有一個執行的機會。我們看到的一件事是，我們可以從我們的數據中看到這一點，當您致電這些醫療保健提供者時，您會看到他們訂購 klog 的頻率的回應。

And so refocusing our efforts there. We have done the math and we know what that we have confidence that that will lead to growth. But there are other growth drivers that provide kind of a minimum floor of double digit growth next year. Maybe Erin you can touch upon those.

因此，我們將努力重新集中在那裡。我們已經做了計算，我們知道我們有信心這將帶來成長。但還有其他成長動力可以提供明年兩位數成長的最低下限。也許艾琳你可以談談這些。

Yeah. So the the floor it really comes down to, to re screen those care GAAP programs. And then Cologuard plus pricing sets a solid base for double digit plus growth in our screening business. And as we turn around on the commercial execution side, that obviously provides upside to that coming back to kind of the the fourth quarter deceleration Doug, you, you had decent math on on the hurricanes. You know, still a we'd still be cutting the guide, right. The the larger impact for us is ultimately on not accelerating growth during that critical time period from August through October. There is a smaller but maybe less of an impact on the recent sales and marketing investments. We have seen a positive signal from those and look forward to a greater contribution impact from those heading into to 2025 on the Q3 to Q4. Sequential. The the biggest impact there, Doug is the hurricane absent the hurricane, you, you would see a sequential growth from Q3 to Q4 and as I called out earlier to a lesser extent, you know, if you just look at care GAAP from a year over year perspective, we saw higher growth year over year in Q3 than we would in in Q4.

是的。因此，真正歸結為重新篩選那些護理 GAAP 計劃。然後，Cologuard plus 定價為我們篩選業務的兩位數以上成長奠定了堅實的基礎。當我們轉向商業執行方面時，這顯然為第四季度的減速提供了好處，道格，你對颶風有很好的數學計算。你知道，我們仍然會削減指南，對吧。對我們來說更大的影響最終是在八月到十月這個關鍵時期沒有加速成長。對最近的銷售和行銷投資的影響較小但可能較小。我們已經看到了這些積極的信號，並期待進入 2025 年的那些對第三季至第四季產生更大的貢獻影響。順序的。那裡最大的影響，道格是沒有颶風的颶風，你會看到從第三季度到第四季度的連續增長，正如我早些時候所指出的，在較小程度上，你知道，如果你只看一年中的護理公認會計原則從年比角度來看，我們第三季的年增率高於第四季。

Dan Brennan, TD Cowen.

丹布倫南，TD·考恩。

Great, thanks. Since there's been a lot of questions on the quarter and care, maybe I could focus on 2.0 Kevin, you talked about you know, the upside driver a couple of times for 2025. Can you just kind of remind us of the pricing strategy for 2.0 sounds like ad LT will be the focus given the clinical fee schedule. You know, I think the interim update didn't go your way. So can you let us know kind of what price you you know, you look to seek with ad LT status you talked about? It'll apply to Medicare. Just remind us what percent of volumes it'll apply to. And then how do you deal with the commercial payers? Like any, any, any kind of thoughts about what commercial payers will sign up for it and won't. And then if that's the case, then how do you deal with maybe running two tests in terms of the margin profile of that? Thank you.

太好了，謝謝。由於有關本季和關心的問題很多，也許我可以專注於 2.0 凱文，您多次談到 2025 年的上行驅動因素。成為焦點。你知道，我認為臨時更新並不符合你的意願。那麼您能否告訴我們您所知道的、您希望以您談到的廣告 LT 狀態尋求的價格是多少？它將適用於醫療保險。請提醒我們它將適用於多少百分比的捲。那麼你如何與商業付款人打交道呢？就像任何、任何、任何關於商業付款人會簽署和不會簽署的想法一樣。如果是這種情況，那麼您如何處理可能針對其利潤概況進行兩次測試？謝謝。

Thanks Dan. So first, I'll start with Cold Guard plus, it's a major advancement. We got the final safety and effectiveness data and the, the final label for Cold Guard plus. And this sensitivity ended up at 95% and 94% specificity. When you adjust to the census by age which the agency allowed us to do and look at what's called category six specificity, the true normals, those patients without any poly polyps in their colon. And so that 95% sensitivity, 94% specificity is unmatched by any non invasive approach. In terms of how we intend to price that we are still before Medicare with the clinical fee schedule process that plays out before the end of the year. And we remain, we continue to engage with C MS on getting a clinical the, the CD LT process to seek a price increase. But if not, then we will go the AD LT path and the AD LT path, it's just a slightly longer path we get. There's a benefit that you probably start with a higher price than the CD LT path. The process then takes a couple of years to transition from Cologuard to Cologuard plus the patients who have access to Cologuard plus, we get Cologuard plus and over time, we will, well, we will start with the Medicare patients and then move into the commercial and then Medicaid patients. That process probably takes 12 to 24 months to, to play out. Obviously, there are a lot of benefits for payers and their members to have access to Cologuard plus including the, the performance and, and also the price of the, the cost make up of Coldu plus is lower and you know, it will take some time, but we're confident about what that process will look like. We will create value and increase price because of the innovation that we're delivering.

謝謝丹。首先，我將從 Cold Guard plus 開始，這是一個重大進步。我們獲得了最終的安全性和有效性數據以及 Cold Guard plus 的最終標籤。該敏感性最終達到 95% 和 94% 特異性。當你根據該機構允許我們進行的年齡普查進行調整時，看看所謂的六類特異性，即真正的正常值，即那些結腸中沒有任何息肉的患者。因此 95% 的敏感性、94% 的特異性是任何非侵入性方法都無法比擬的。就我們打算如何定價而言，我們仍在醫療保險之前，臨床費用表流程將於年底前完成。我們仍然繼續與 C MS 接觸 CD LT 臨床流程，以尋求價格上漲。但如果沒有，那麼我們將採取 AD LT 路徑和 AD LT 路徑，這只是我們得到的稍長的路徑。有一個好處是您可能會以比 CD LT 路徑更高的價格開始。然後，這個過程需要幾年時間才能從 Cologuard 過渡到 Cologuard plus，對於能夠使用 Cologuard plus 的患者，我們會獲得 Cologuard plus，隨著時間的推移，我們將從 Medicare 患者開始，然後進入商業領域然後是醫療補助患者。這個過程可能需要 12 到 24 個月才能完成。顯然，對於付款人及其會員來說，使用 Cologuard plus 有很多好處，包括性能和價格，Coldu plus 的成本構成較低，而且您知道，這需要一些時間時間，但我們對這個過程會是什麼樣子充滿信心。由於我們提供的創新，我們將創造價值並提高價格。

Mat Sykes, Goldman Sachs.

馬特·賽克斯，高盛。

Yeah, thanks for taking my questions. Maybe just to dig a little bit deeper on the commercial side. Kevin, you talked about the response you see from some of those newer, newer doctors and, and systems that you brought on post COVID. But clearly the, the calls weren't going into them and you've been dealing with sort of the lack of in office visits for some time now. So, could you maybe just talk a little bit about sort of what the breakdown was? I know you've had some turnover in sales management. Was it a sales management issue? Was it turnover of reps? Was it just new reps ramping up? Just it seems like something that you had focused on previously where the focus was lost. So I'm just wondering, you know, kind of what the breakdown was there. Thanks.

是的，謝謝你回答我的問題。也許只是為了在商業方面更深入地挖掘。凱文，您談到了您從一些較新的醫生和您在新冠疫情後引入的系統中看到的反應。但顯然，電話並沒有打給他們，而且你已經有一段時間沒有去辦公室拜訪了。那麼，您能否簡單談談故障是什麼？我知道您在銷售管理方面有一些人員流動。是銷售管理問題嗎？是代表的更替嗎？只是新代表的增加嗎？只是它看起來像是你之前關注的事情，但現在卻失去了焦點。所以我只是想知道，你知道，那裡出了什麼問題。謝謝。

You know, I don't want to look backwards. I want to look forwards because there are just, there's a whole list of things that we can do to execute better. We have an incredible sales team, they're trained, they're hungry, they're motivated, they have integrity and we are giving them better tools to be able to be more successful in what they do. Remember, there are two almost 200,000 health care providers that order Cold Guard during the quarter and we know they are responsive to to visits by our field force, but that our base of customer continues to grow. So you have a dilution effect in terms of our ability to focus we are going to provide, we are providing tools to our field force to allow them to really focus on the physicians and nurses and pas that are most responsive to their calls. We owe that to them. We can deliver that we take accountability here at headquarters to help them achieve that success. And remember there's a significant stickiness to the providers that order coga I'll give you one example for a reason that we believe that we will continue to grow in this core part of our business.

你知道，我不想回頭看。我想展望未來，因為我們可以做一整套事情來更好地執行。我們擁有一支令人難以置信的銷售團隊，他們接受過培訓，他們充滿渴望，他們充滿動力，他們正直，我們為他們提供更好的工具，以便他們能夠在工作中取得更大的成功。請記住，本季度有兩家近 20 萬家醫療保健提供者訂購了 Cold Guard，我們知道他們對我們現場人員的訪問做出了回應，但我們的客戶群仍在不斷增長。因此，就我們將要提供的專注能力而言，我們會產生稀釋效應，我們正在為我們的現場人員提供工具，使他們能夠真正專注於對他們的呼叫最敏感的醫生、護士和護理人員。這是我們欠他們的。我們可以表明，我們在總部承擔責任，並幫助他們取得成功。請記住，訂購古加的供應商具有很大的黏性，我將給您一個例子，因為我們相信我們將在我們業務的這一核心部分繼續成長。

If you take a look at providers who ordered for the first time, let's say before 2020 compare them to health care providers who ordered 2020 or beyond there in their initial couple of quarters of ordering, these newer providers are ordering at a 50% rate, more than 50% higher rate when they first start ordering.

如果你看一下首次訂購的供應商，假設在2020 年之前將他們與2020 年或之後訂購的醫療保健提供者在最初幾個季度的訂購中進行比較，這些新的提供者的訂購率為50% ，當他們第一次開始訂購時，比率高出 50% 以上。

So they want to use Cologuard. They know about Cologuard. Patients are asking for Cologuard. We can do a better job of giving them the tools that they need to be successful so that they're even more sticky than, than older co cohorts. So, this is about execution and this starts with me and it extends to the whole team and everybody is confident about our ability to address this.

所以他們想使用 Cologuard。他們了解 Cologuard。患者正在尋求 Cologuard。我們可以更好地為他們提供成功所需的工具，使他們比老同事更具黏性。所以，這是關於執行的，這從我開始，延伸到整個團隊，每個人都對我們解決這個問題的能力充滿信心。

Vijay Kumar, Evercore ISI.

維傑·庫馬爾，Evercore ISI。

Hey guys. Thanks for taking my question, Kevin, maybe back of those comments you made. You know, when you look at the, how, how third quarter played out and you look at the guidance for Q4, is the change here between the 45 to 49 age group or is this the about 50 you know, first time screening screen patients? Was there any regional variant? I guess, what were the learnings? And when you say commercial execution will improve? What, what is going to change here? That, that, that, you know, resolves I guess or fixes the execution issues. Thank you.

嘿夥計們。感謝您提出我的問題，凱文，也許是對您發表的評論的回應。你知道，當你看看第三季度的表現以及第四季度的指導時，你會發現 45 歲至 49 歲年齡組之間的變化，或者是你知道的大約 50 名首次篩檢患者？有地區差異嗎？我想，學到了什麼？當你說商業執行力會提升？什麼，這裡會發生什麼變化？那，那，那，你知道，我猜解決或解決了執行問題。謝謝。

Yeah, we're not going to go into all the details about what we're doing from a commercial execution standpoint. I'll just keep going back to the ability for us to access offices and to drive re screens care gaps. Cologuard plus is significant. Let me zero in on Cologuard for an example. Cologuard plus is such a step up in terms of performance as we have done research and focus groups on Coldu Plus, there's a clear excitement among our, our customers to be able to have access to the data and and they need, and we need to get out there and do that with our field force. The new data will provide us greater access and time with the health care providers. And that is something that will we believe will help us help drive greater volumes with both Cologuard and Cologuard plus. But there are a whole range of areas where we can improve. Not going to, again, not going to go into them. Now, we, we know that this is disappointing to you, to investors. We're confident in our ability to grow and achieve or exceed our long range plan as we've laid out.

是的，我們不會從商業執行的角度詳細討論我們正在做的事情。我將繼續回到我們進入辦公室並縮小螢幕護理差距的能力。 Cologuard plus 意義重大。讓我以 Cologuard 為例。 Cologuard plus 在性能方面取得了巨大進步，因為我們對 Coldu Plus 進行了研究和焦點小組研究，我們的客戶對能夠訪問他們需要的數據感到非常興奮，我們需要走出去，與我們的現場人員一起做到這一點。新數據將為我們提供更多與醫療保健提供者接觸的機會和時間。我們相信，這將有助於我們透過 Cologuard 和 Cologuard plus 提高銷售量。但我們還有很多方面可以改進。不會再一次，不會深入其中。現在，我們知道這讓你們、投資者感到失望。我們對成長、實現或超越我們所製定的長期計劃的能力充滿信心。

And BJ just maybe a little bit of additional color on on the breakdown, both in Q3 and expectations for, for Q4. We did see growth obviously across care gaps as well as re screens and new ordering providers. The biggest contribution and growth coming from care gaps and re screen, you know, double clicking on on re screens. This is a really great source of revenue for us. It's obviously highly predictable, recurring high margin revenue last year, we disclosed that represented roughly 20% of screening revenue in 2023. We're at 25% now here in the back half of the year and thinking about, you know, new providers, new users. This is an area as Kevin alluded to. This is an area we know we can grow faster, particularly amongst the 45 to 49 cohort, which remains a very large unpenetrated cohort. Many of whom are still unaware of, of CRC screening and, and one of the things that we've been seeing is with the Care GAAP program is it represents an opportunity to get at this 45 to 4,545 to 49 age cohort.

BJ 可能只是對第三季的細分和第四季度的預期進行了一些額外的說明。我們確實看到了護理差距以及重新篩選和新訂購提供者的顯著增長。最大的貢獻和成長來自護理差距和重新篩選，你知道，雙擊重新篩選。這對我們來說確實是一個巨大的收入來源。這顯然是高度可預測的，去年的經常性高利潤收入，我們透露，這約佔2023 年放映收入的20%。商，新用戶。這是凱文提到的一個領域。我們知道，這是一個可以成長得更快的領域，特別是在 45 歲至 49 歲的人群中，他們仍然是一個非常大的未滲透人群。他們中的許多人仍然不知道 CRC 篩檢，而且我們所看到的一件事是 Care GAAP 計劃，它代表了接觸 45 歲至 4,545 歲至 49 歲年齡層的機會。

Dan Arias, Stifel.

丹·阿里亞斯，斯蒂菲爾。

Hey guys. Thanks for the questions, Kevin or Aaron. I'm, I'm sure you don't want to give exact numbers on total number of reps in the field. But I'm hoping you can sort of provide us with a four Q snapshot if you will on commercial, just when it comes to how many more reps you'll have in the field come mid four Q when everybody should sort of be up and running versus four Q of last year, it would just be helpful to try to understand the productivity difference year over year as you're finishing the year this year versus finishing the year last year.

嘿夥計們。謝謝凱文或亞倫的提問。我確信您不想給出現場代表總數的確切數字。但我希望你能給我們一個四季度快照，如果你願意在商業上，只是當談到你在現場還有多少代表時，四季度中期，每個人都應該站起來，與去年的四個季度相比，嘗試了解同比生產力差異會很有幫助，因為今年即將結束的這一年與去年即將結束的一年相比。

Yeah, we're not going to get into the number of reps that we have in the field. It won't be appreciably different in Q4 than it was in Q3.

是的，我們不會透露我們在現場的代表人數。第四季與第三季不會有明顯不同。

It's, as you know, we talked in on our Q1 call about our, our step up in that field force where we added about 100 reps. That group of reps has shown the ability to have an impact on the physicians, health care providers that they call on. Maybe not quite at the rate that we expected, but we see that positive impact that continues to grow month over month. And that clearly is going to be have been a good investment to make. You know, that's where we are in terms of the sizing of the field force.

如您所知，我們在第一季電話會議中談到了我們在現場部隊中的進步，我們增加了大約 100 名代表。這群代表已經展現了對他們所要求的醫生和醫療保健提供者產生影響的能力。也許與我們預期的速度不太一樣，但我們看到這種正面影響逐月持續成長。這顯然是一項很好的投資。你知道，這就是我們在現場人員規模的現況。

And.

和。

If you, and if you look at, if you look at productivity, you know, we saw leverage again, not only in Q2, but also in Q on the sales and marketing line. So we got operating leverage on sales and marketing expenses. And obviously, we'll continue to expect that moving forward.

如果你看看，如果你看看生產力，你知道，我們再次看到了槓桿，不僅在第二季度，而且在銷售和行銷線上的 Q。因此，我們透過銷售和行銷費用獲得了營運槓桿。顯然，我們將繼續期待這種情況的發展。

Jack Meehan, Nephron Research.

傑克·米漢，腎單位研究。

Thank you. Good evening. Wanted to ask more about care GAAP. Kevin just more directly has the recent Medicare star situation led to increased engagement with large payers. Is it possible to talk about your hit rate and then use of Cologuard relative to fit and for Erin? Not sure if I heard this wrong, but just wanted to be clear. Are the care GAAP sales expected to be lower in four Q sequentially? If you could just talk about why some programs were pulled forward versus pushed out, that would be great.

謝謝。晚安.想詢問更多有關護理 GAAP 的資訊。凱文更直接地表示，最近醫療保險明星的情況導致了與大額付款人的接觸增加。是否可以談談您的命中率以及相對於適合和 Erin 而言的 Cologuard 的使用情況？不確定我是否聽錯了，但只是想澄清一下。護理 GAAP 銷售額預計將在第四季度連續下降嗎？如果你能談談為什麼有些項目提前而不是被推遲，那就太好了。

Yeah, let me first give background on care, GAAP programs, care back care. GAAP programs are initiated by payers and health systems, probably three parts payers, one part health systems. But I think over time that changes driven by quality measures, both payers and health systems care about their quality measures. And historically have used the fit test to reach those patients who are under screened or who've never been screened. And typically the fit test seats about they ship out 10 fit tests for every one they get back at 10% compliance rate. Now note that last year with our care GAAP programs, we saw about a 18% compliance rate, that has grown to about 22% this year, but 24% in the third quarter. So we keep getting better at that compliance rate. And just imagine is that double? So today, the Care GAAP program I think is bigger than people appreciate. And over time, we think this is going to be a major avenue for how people get screened for colon cancer and probably other services too that we're able to provide over time. But the, the doubling, let's assume that we go from 22% to 44% which is still 22% less than we're at with our with our core base of customers and, and their compliance rate.

是的，讓我先介紹一下護理、公認會計準則計劃、護理背部護理的背景。 GAAP 計劃由付款人和衛生系統發起，可能有三個部分是付款人，一部分是衛生系統。但我認為，隨著時間的推移，由品質措施驅動的變化，付款人和衛生系統都會關心他們的品質措施。歷史上曾使用適合性測試來接觸那些未接受篩檢或從未接受過篩檢的患者。通常，貼合度測試座椅大約會為每返回一個座椅進行 10 次貼合度測試，符合率達 10%。現在請注意，去年我們的護理 GAAP 計劃的合規率約為 18%，今年已增長至 22% 左右，但第三季為 24%。因此，我們的合規率不斷提高。想像一下那是雙重的嗎？所以今天，我認為 Care GAAP 計劃比人們想像的要大。隨著時間的推移，我們認為這將成為人們篩檢大腸癌的主要途徑，也可能成為我們隨著時間的推移所能提供的其他服務的主要途徑。但是，如果翻倍，我們假設我們從 22% 增加到 44%，這仍然比我們的核心客戶群及其合規率低 22%。

So as if we were to double that, you know, we wouldn't be talking about the challenge in the quarter today. It would be a a it would be just another leg of large growth. And we know that the tools that we provide through the exact nexus platform, our service capabilities will drive that improvement in the K return rate over time.

因此，如果我們將其加倍，您知道，我們今天不會談論本季的挑戰。這將是一個巨大成長的另一個階段。我們知道，我們透過 Nexus 平台提供的工具、我們的服務能力將隨著時間的推移推動 K 回報率的提高。

Yeah. And so just speaking Q3 to Q4, we would expect roughly similar revenue sizes Q4 versus Q3 maybe up slightly. Jack, I think the other thing just to reinforce what Kevin was talking about this being larger than I think most people appreciate our thing. We've talked a lot about how significant of a growth driver for us. This is in 2024 but maybe just to size this a little bit. You know, historically, you know, there's been about 3 million fit tests completed through care GAAP programs run by Med Advantage plans each year. And if you zoom out beyond Med Advantage plans, you know, we, we we would estimate that the addressable opportunity is between four and 5 million completed fit tests per year. And keep in mind, those are at about roughly, you know, a 10 ish percent compliance rate as Kevin just talked about, we've already demonstrated the ability to double that compliance rate and we'd obviously look to double from the roughly 22% we're at today. And so if you kind of get this even to the 40 to 50% level, Kevin talked about you adjust for interval and apply our Cologuard average sale price. You know, this is a multi billion dollar opportunity for us over time and we're really, really excited to go after it.

是的。因此，僅就第三季到第四季而言，我們預期第四季與第三季的營收規模大致相似，可能會略有上升。傑克，我認為另一件事只是為了強化凱文所說的，這比我認為大多數人欣賞我們的東西更大。我們已經多次討論了成長動力對我們的重要性。這是 2024 年的事，但也許只是為了稍微調整規模。您知道，從歷史上看，每年透過 Med Advantage 計劃運行的護理 GAAP 計劃完成了大約 300 萬次適合性測試。如果你把目光放遠到 Med Advantage 計劃之外，你知道，我們，我們估計，可解決的機會是每年完成 400 到 500 萬次適合性測試。請記住，正如 Kevin 剛才談到的，這些大約是 10% 左右的合規率，我們已經展示了將合規率翻倍的能力，並且我們顯然希望將大約 22% 的合規率翻倍。 % 我們今天到了。因此，如果您達到 40% 到 50% 的水平，Kevin 談到您需要調整間隔並應用我們的 Cologuard 平均銷售價格。你知道，隨著時間的推移，這對我們來說是一個價值數十億美元的機會，我們真的非常非常高興能抓住它。

Patrick Donnelly, Citi.

派崔克唐納利，花旗銀行。

Hey, guys, thanks for taking the questions. Kevin, maybe the first one just in terms of the headwinds you, I'd be curious how they developed as the quarter went. I mean, was this something, you know, you guys picked up steadily as the quarter progressed? Was it a little later? Obviously, the hurricanes, you know, when those happen, but just curious in terms of when you guys realized, you know, the shortfall is going to happen and the headwinds were there. And then secondly, just on the Ebida guide down, you know, how you guys are thinking about the cost structure going forward. You know, it sounds like you reiterated the confidence in that EBITA target a few years out, but just how to think about the trajectory near term here and launching off into the 25 on the EBITA piece would be helpful. Thank you guys.

嘿，夥計們，感謝您提出問題。凱文，也許第一個只是就逆風而言，我很好奇他們在本季的發展情況如何。我的意思是，隨著本季的進展，你們知道，這是穩定上升的嗎？是不是有點晚了？顯然，颶風，你知道，當這些發生時，但只是好奇你們什麼時候意識到，你知道，短缺將會發生，逆風也在那裡。其次，就在 Ebida 指南中，你們知道，你們是如何考慮未來的成本結構的。你知道，聽起來你重申了對幾年後 EBITA 目標的信心，但如何思考近期的軌跡並在 EBITA 部分上進入 25 將會有所幫助。謝謝你們。

Right? So the number that we look at, most intently is that daily and weekly number of orders and what we saw in the first half of the year was the typical seasonal growth that you see in the spring where you see typically week, over week improvement in or increase in the number of orders driven by that by office visits. And by our, what we would call our point of care delivery.

正確的？因此，我們最關注的數字是每日和每週的訂單數量，我們在上半年看到的是春季典型的季節性增長，通常會看到每週訂單量的改善。數量增加。透過我們所謂的護理點交付。

And over starting in August and going into October, we saw an increase, we just didn't see the increases. Erin mentioned that we typically would see at that time of year. So when, did we know that there was going to be a challenge that, you know, really, it starting in September and into October, we realized that there was a greater challenge there than we had seen in past, falls during that time period of the year which we have described as typically the steepest increase.

從八月開始到十月，我們看到了成長，但我們只是沒有看到成長。艾琳提到我們通常會在一年中的那個時候看到。那麼，我們什麼時候知道將會有一個挑戰，你知道，真的，從 9 月開始到 10 月，我們意識到在那個時期出現了比我們過去看到的更大的挑戰我們將其描述為通常成長最快的一年。

Yeah. And Patrick just turning to, to EBITA, right. So we're very confident in our ability to achieve our 20% plus adjusted to guide, you know, we've made meaningful progress on profitability ahead of expectations. If you turn to the full year, it's, it's up at midpoint roughly 270 basis points unpacking that, you know, it starts with growth. Obviously, double digit revenue growth is an important part of our value creation story and drives a lot of meaningful leverage. And we're seeing that play out here in 2024 Kevin alluded to, we have reasons to be confident that that's going to accelerate even more as we head into 2025. Really driven by again, re screens care, GAAP new product launches as well as pricing.

是的。派崔克剛剛轉向息稅折舊攤提前利潤（EBITA），對吧。因此，我們對實現 20% 以上的調整目標非常有信心，因為我們在獲利能力方面取得了超出預期的有意義的進展。如果你看全年，它的中位數上漲了大約 270 個基點，你知道，它是從成長開始的。顯然，兩位數的收入成長是我們價值創造故事的重要組成部分，並推動了許多有意義的槓桿作用。我們看到凱文提到的 2024 年會出現這種情況，我們有理由相信，隨著我們進入 2025 年，這種情況將會進一步加速。

But if you look at it, you know, we're driving leverage across the P&L right now. So whether that's sales and marketing efficiency on the investments that we're making, we've seen a slight decline in gross margins in the near term, largely driven by some of the one time ASP benefits we've talked about as well as a temporary headwind from care GAAP due to the lower adherence that should flip to a tailwind for us in 2025 with the launch of Cologuard Pro Plus, which will give us added ASP as well as a lower cost of goods.

但如果你看看它，你就會知道，我們現在正在推動損益表上的槓桿作用。因此，無論是我們正在進行的投資的銷售和營銷效率，我們都看到短期內毛利率略有下降，這主要是由我們討論過的一些一次性平均售價收益以及由於遵守率較低，護理GAAP 帶來了暫時的逆風，但隨著Cologuard Pro Plus 的推出，到2025 年，這對我們來說應該會是順風，這將為我們帶來更高的平均售價和更低的商品成本。

And then looking at G&A just so proud of the efforts from the team thus far this year, you know, we saw more than 500 basis points of operating leverage on G&A. But there's a lot more that we can and will do to address GN A. It's come down on an adjusted basis from, you know, roughly 35% to, to a roughly 30% where we were in the quarter. And we know, and we take plans to make sure that we address that to continue to bring that down moving forward.

然後看看 G&A，我們對團隊今年迄今為止所做的努力感到非常自豪，你知道，我們看到 G&A 的營運槓桿超過 500 個基點。但我們可以而且將會採取更多措施來解決 GN A 問題。我們知道，我們採取計劃來確保我們解決這個問題，並繼續向前邁進。

Dan Leonard, UBS.

丹‧倫納德，瑞銀集團。

Thank you. Just a couple of questions on the Cologuard plus mechanics. I think Kevin, you mentioned the launch would be in, in Q2 for some reason, I thought it might be Q1. So, so could you educate me on, on why Q2? And then secondly, on the ad LT pricing mechanics, I I just like to better understand the way that mechanism works. If you want the AD LT route, you get paid list price by nine months or for nine months by Medicare. But, but your list price for Cologuard is actually quite a bit higher than your ASP. So are you going to get an increase from that list price and then get paid at a far, far higher rate from Medicare for a period of time? But I'd just like to understand that better. Thank you.

謝謝。關於 Cologuard plus 機械裝置的幾個問題。我想凱文，你提到發布將在第二季度，出於某種原因，我認為可能是第一季。那麼，您能告訴我為什麼是 Q2 嗎？其次，關於廣告 LT 定價機制，我只是想更了解機制的工作方式。如果您想要 AD LT 路線，您將在九個月內獲得標價或由 Medicare 支付九個月的費用。但是，但你們的 Cologuard 標價實際上比你們的 ASP 高很多。那麼，您是否會在標價的基礎上提高價格，然後在一段時間內以高得多的費率從醫療保險中獲得報酬？但我只是想更好地理解這一點。謝謝。

Yeah. So first the launch timing is kind of the end of Q1, beginning of Q2 is what we're shooting for. You know, is that going to adjust one way or the other by a little bit? It couldn't, but that's what we're shooting for in terms of the mechanics. Yeah, you have that essentially right that you have a list price, you pick that list price, you get paid by Medicare for that list price. And then, at the end of a period, it reverts to the median of the commercial rate if there's commercial rates that are, where there are claims that have been processed. And, you know, you can dig into how the mechanics of the ad LT process works. That's the essence of it. And then you get that price for two years and then it readjust and every year after that, so you do have the ability to control that price. And you get paid on the Medicare claims initially, be the Medicare fee for service claims over time as you get, commercial contracts or your commercial contracts that exist cover Cold Guard plus, you would start to have those patients access Coldu Plus and then with the commercial deals and that just takes time to work through all of that.

是的。因此，首先，發佈時間是第一季末，第二季開始是我們的目標。你知道，這會以某種方式進行調整嗎？它不可能，但這就是我們在機制上所追求的目標。是的，您本質上有權利，您有一個標價，您選擇該標價，醫療保險以該標價向您支付費用。然後，在一個時期結束時，如果有商業費率，並且有已處理的索賠，則它會恢復到商業費率的中位數。而且，您知道，您可以深入了解廣告 LT 流程的運作原理。這就是它的本質。然後你得到這個價格兩年，然後每年都會重新調整，所以你確實有能力控制這個價格。您最初會獲得 Medicare 索賠的付款，隨著時間的推移，您將獲得服務索賠的 Medicare 費用，商業合同或現有的商業合同涵蓋 Cold Guard plus，您將開始讓這些患者訪問 Coldu Plus，然後使用商業交易，而這只是需要時間來完成所有這些。

Puneet Souda, Leerink Partners.

Puneet Souda，Leerink 合夥人。

Yeah, hi, thanks, Kevin. Thanks for taking the question. So, just a clarification. Is there any air pocket that you saw from switching, you know, due to the nexus or due to the care GAAP switching of the patients. And just a quick follow up on there was a launch of a product in early August in blood just wondering if you're seeing that in any of the accounts. I'll just leave it at that. Thank you.

是的，嗨，謝謝，凱文。感謝您提出問題。所以，只是澄清一下。您是否在轉換中看到了任何氣穴，您知道，由於聯繫或由於患者的護理 GAAP 轉換。快速跟進一下，八月初在血液中推出了一款產品，只是想知道您是否在任何帳戶中看到了這一點。我就這樣吧。謝謝。

Yeah. In terms of, I think you referenced an air bubble, we saw an impact as we moved on to type DX onto the exact Nexus platform. Because some of the claims of the test that we processed, we do believe we will not get paid for it. I won't go into all of those details, but that was a component of the the, the really what's going on in the fourth quarter in terms of an impact in the quarter by a blood based colon cancer screening tests. No, we've stayed close to that and we anecdotally and also based on research, we we have seen no impact on our business based on that competitive dynamic.

是的。就而言，我認為您提到了氣泡，當我們繼續在確切的 Nexus 平台上鍵入 DX 時，我們看到了影響。因為我們處理的一些測試索賠，我們確實相信我們不會因此獲得報酬。我不會詳細討論所有這些細節，但這是第四季度真正發生的事情的一部分，即基於血液的結腸癌篩檢測試對該季度的影響。不，我們一直在接近這一點，根據研究，我們沒有看到這種競爭動態對我們的業務產生任何影響。

Subu Nambi, Guggenheim Securities.

Subu Nambi，古根漢證券。

Hey guys. Thank you for taking my question. Regarding 2025 revenue growth, your comments suggest that you're confident in the outlook for high single digit or even double digit screening revenue growth and continued low to mid single digit onco type growth. Is that right? If so, are you confident you can do this while growing operating spend at mid single digit levels? And finally, is your 2027 20% ebida target still intact?

嘿夥計們。感謝您回答我的問題。關於 2025 年收入成長，您的評論表明您對高個位數甚至兩位數篩檢收入增長和持續低至中個位數腫瘤類型增長的前景充滿信心。是這樣嗎？如果是這樣，您是否有信心能夠做到這一點，同時以中等個位數水準成長營運支出？最後，您的 2027 年 20% EBDA 目標是否仍然完好無損？

Yes, to the last question. To the first question we expect next year to you are not giving guidance now for next year, but the 15% growth target over the next three years is intact and again, the re screens care gaps, Cologuard plus commercial execution can deliver mid double digit increase or greater. So we and we'll spend more time talking through this, but there's a, there's a floor and the floor is at a very attractive level.

是的，到最後一個問題。對於我們預計明年向您提出的第一個問題，現在並未給出明年的指導，但未來三年15% 的增長目標完好無損，並且重新篩選護理差距、Cologuard 加上商業執行可以實現中兩位數增加或更大。因此，我們將花更多時間討論這個問題，但有一個底線，而且這個底線處於非常有吸引力的水平。

Yeah, just to reiterate screening growth this year while we're disappointed is is that 12% at midpoint. And as Kevin alluded to earlier for those four key reasons, we actually expect growth will accelerate in screening in 2025 turning to adjusted EBITA, it is absolutely still intact. I want to reiterate, we are very confident in our ability to get to 20% plus adjusted EBITA by 2027. You know, we will have expanded from just under 9% profitability last year to approaching 12% profitability in 2024. You could expect meaningful margin expansion again in 2025. Both coming from a double digit screening growth, but importantly, also coming from addressing our cost base particularly in G&A.

是的，重申今年的放映成長，雖然我們感到失望的是中間值 12%。正如 Kevin 早些時候提到的這四個關鍵原因，我們實際上預計 2025 年放映業務的成長將加速，轉向調整後的 EBITA，它絕對仍然完好無損。我想重申，我們對到2027 年達到20% 加上調整後EBITA 的能力非常有信心。能力。

Andrew Cooper, Raymond James.

安德魯庫珀，雷蒙德詹姆斯。

Hey, everybody. Thanks for the question. A lot already asked. So maybe just one more on sort of the comments that you've reiterated in, in response to a couple of questions on the dot Being promotionally responsive, but at the same time saying it's taking longer to ramp these new reps and kind of some of the comments there. Like, can you help us adjudicate those two things? And what gives you the confidence that doctors are truly as responsive as they are receptive as they always have been versus potentially a change in their behavior, not as much directly tied to your execution as we think about three Q and four Q.

嘿，大家。謝謝你的提問。已經問了很多了。因此，也許只是再補充一下您重申的評論，以回應有關促銷響應的幾個問題，但同時表示需要更長的時間來提升這些新代表以及一些那裡的評論。例如，你能幫我們裁決這兩件事嗎？是什麼讓你相信醫生確實像他們一直以來那樣反應迅速、樂於接受，而不是他們的行為可能發生改變，而不是像我們認為的三個問題和四個問題那樣與你的執行力直接相關。

And.

和。

So tying those together as we move into the fourth quarter. And next year, we're able to, to provide tools and deployment of our field force in a way that focuses their efforts on those hcps who are the most responsive.

因此，當我們進入第四季度時，將這些聯繫起來。明年，我們能夠提供工具並部署我們的現場部隊，將他們的工作重點放在那些反應最快的 HCP 上。

And we have a plan to do that in terms of knowing that that responsiveness exists. We're fortunate to have a ton of data and our data allows us to look at hcps that we call on versus hcps that we don't and the frequency of calling on them. And then what the responsiveness is. And based on that data, we're confident that with a greater amount of analytics and focus, we will expect to see stronger growth in in that core part of the Cold Guard business.

我們有一個計劃來做到這一點，因為我們知道這種回應能力的存在。我們很幸運擁有大量數據，我們的數據使我們能夠查看我們拜訪的 hcp 與我們不拜訪的 hcp 以及拜訪他們的頻率。然後是響應能力。基於這些數據，我們相信，透過更多的分析和關注，我們預期冷衛士業務的核心部分將出現更強勁的成長。

Mark Massaro, BTIG.

馬克·馬薩羅，BTIG。

Hey guys. Thank you for taking the questions. The first one is Kevin, did you make any changes in the field to people's territories? And if you did are those folks sort of in their new territories at this time? And then the second part is on the transition to Cold Guard plus next year. So I'm just curious if, if it, if an indi if a clinician orders a Cologuard for someone with a commercial health plan, you know, let's just call it in Q3. If there's no contract there, what happens? Do they automatically default to Cologuard one point? Oh, I'm just really asking how you can prevent potential zeros or no pays?

嘿夥計們。感謝您提出問題。第一個是凱文，你對人們的領地領域做了什麼改變嗎？如果你這樣做了，那些人此時是否已經進入了他們的新領域？第二部分是關於明年向 Cold Guard plus 的過渡。所以我只是好奇如果臨床醫生為有商業健康計劃的人訂購 Cologuard，你知道，讓我們在第三季度稱之為。如果那裡沒有合同，會發生什麼事？他們會自動預設為 Cologuard 一分嗎？哦，我只是想問一下如何防止潛在的零薪或無薪？

Yeah, sure. So as you know, we have about 800 payers with contracts around Cologuard plus or with Cologuard and we see north of 96%. I don't know, Eric, what is the, the latest 96% to 98% recovery on every dollar bill? So, we're proud of that. We're also proud of, you know, the depth of our relationships with, with those payers. So when we start to make this transition to Cold Guard, plus we'll be able to deliver the test, whether it's Cold Guard or Cold Guard. Plus that the patient has access to and our system has the ability to look that up and deliver the right test to the patient. It's very important that we do that in a thoughtful way and and not deliver those what you call zeros. We haven't seen zeros in many, many years and we don't plan to see zeros as we look into 2025 and beyond because it's very important that people get screened. And remember Coldu Cologuard is a great test with 92% sensitivity and 90% specificity so that patients will get one of those tests, whichever they have access for. We have the ability to deliver in terms of territory changes and that level of commercial execution.

是的，當然。如您所知，我們有大約 800 個付款人簽訂了 Cologuard plus 或 Cologuard 合同，我們看到超過 96%。我不知道，Eric，每張鈔票最新的 96% 到 98% 回收率是什麼？所以，我們為此感到自豪。你知道，我們也為我們與這些付款人的深厚關係感到自豪。因此，當我們開始向 Cold Guard 過渡時，我們將能夠提供測試，無論是 Cold Guard 還是 Cold Guard。另外，患者可以訪問，我們的系統也有能力找到並為患者提供正確的測試。非常重要的是，我們要以深思熟慮的方式做到這一點，而不是交付那些你們所謂的「零」。我們已經很多很多年沒有看到零了，我們也不打算在 2025 年及以後看到零，因為人們接受篩檢非常重要。請記住，Coldu Cologuard 是一項出色的測試，具有 92% 的敏感性和 90% 的特異性，因此患者將獲得其中一項測試，無論他們可以進行哪一項測試。我們有能力在地域變化和商業執行水準方面提供服務。

We we have total confidence in our sales and marketing leadership. We're excited about some of the changes we're making. The team is fired up. I've been out. And I've talked to many of those teams and the energy is high. The engagement is very high. I, I want to make one other point as you look into 2025 and beyond. And I want to really drive home this point around re screens, care gaps, Cologuard plus commercial execution and new products like oncode detect. But, but let's talk about re screens for a minute. This year, there were 1.6 million people who are eligible for re screen next year. It's 2 million people the year after that, it's 2.6 million people.

我們對我們的銷售和行銷領導充滿信心。我們對我們正在做出的一些改變感到興奮。團隊充滿了鬥志。我已經出去了。我已經與許多這樣的團隊進行了交談，他們的能量很高。參與度非常高。當您展望 2025 年及以後時，我想再提出一點。我想真正圍繞重新篩選、護理差距、Cologuard 加上商業執行和 oncode 檢測等新產品來真正闡述這一點。但是，讓我們談談重新篩選。今年，有 160 萬人符合明年重新篩檢的資格。之後的一年是 200 萬人，是 260 萬人。

They get delivered the new orders for Cologuard through the exact Nexus platform largely.

他們主要透過 Nexus 平台交付 Cologuard 的新訂單。

And we get a ton of leverage because we built that exact Nexus platform. And we know what the adherence rate is today. And we also know very discrete things that we're doing and there dozens of them to improve the adherence rate of that population.

因為我們建立了確切的 Nexus 平台，所以我們獲得了巨大的影響力。我們知道今天的遵守率是多少。我們也知道我們正在做的非常離散的事情，其中​​有許多事情是為了提高該群體的依從率。

So we're confident about the base level of growth that we expected to see next year. But I also want to come back to where we started. We as a management team are accountable for this.

因此，我們對明年預期的基本成長水準充滿信心。但我也想回到我們開始的地方。我們作為管理團隊對此負有責任。

We've never been more focused in doing our job to make sure that this doesn't happen in the future. There is a big transition that is occurring and we are in a unique and competitively unique position to be able to deliver for these health systems and payers who are facing the same challenges of getting people screened. That's through the Care GAAP program. We're excited about that and we're truly excited about Cologuard plus and the improved performance. They're setting a new standard of care. We look forward to completing this year heading into 2025 and talking with you in the near term. Thank you.

我們從未像現在這樣專注於工作，以確保未來不會發生這種情況。正在發生一場重大轉變，我們處於獨特且具有獨特競爭優勢的地位，能夠為面臨同樣挑戰的醫療系統和付款人提供服務。這是透過 Care GAAP 計劃實現的。我們對此感到非常興奮，並且對 Cologuard plus 和改進的性能感到非常興奮。他們正在製定新的護理標準。我們期待在 2025 年完成這一年，並在短期內與您交談。謝謝。

Thank you. And that is all the time we have for our questions. Thank you so much for joining the exact sciences. Third quarter, 2024 earnings conference call. Have a pleasant evening.

謝謝。這就是我們提問的全部時間。非常感謝您加入精確科學。 2024 年第三季財報電話會議。祝您有個愉快的夜晚。