Myriad's Oncology Demand Looks Real-But Reimbursement Is Eating the Upside

Myriad's clinics are busy, but revenue is slipping

Demand is showing up in test volume, not dollars

Myriad's Cancer Care Continuum test volume grew 6% in the second quarter, which suggests clinical demand remains intact. But second quarter 2026 revenue of $190.7 million still decreased 11% year over year, and average revenue per test fell 9%. In other words, more tests are being done, but less revenue is following through.

For investors, that distinction matters. A diagnostics business can stay clinically relevant and still fail to compound as a stock if reimbursement keeps cutting into each order's net value.

Why the recent trend matters

Earlier this year, the backdrop looked healthier. In the first half of 2025, management raised 2025 revenue guidance on positive business momentum. By the fourth quarter of 2025, Myriad reported positive momentum in key areas and another quarter of high single-digit growth in hereditary cancer testing.

That makes the second quarter downgrade more important. The demand side does not look broken, but the revenue side does.

The investor test

Myriad said it is engaging payers and executing revenue-cycle initiatives to improve reimbursement predictability. Until that work shows up more consistently in dollars and cash flow, the business remains easier to admire clinically than to trust financially.

• Good: Demand is still present in the clinic.
• Better: Reimbursement improves enough for revenue to track demand more cleanly.

Reimbursement friction is the real investment question

Test growth is showing up before revenue growth

In the first quarter, Myriad posted 13% test volume growth in Cancer Care Continuum and 7% test volume growth in Mental Health. That is a constructive sign that clinicians still see value in the platform.

But the financial follow-through has been uneven. First-quarter revenue reflected stable test volume and 2% year-over-year growth in average revenue per test, which was an improvement over the softer second-half 2025 trend. Still, first-quarter adjusted EBITDA was $(4.5) million, and gross margin was 68.7%. More activity did not translate into a clean earnings inflection.

Last year's fourth quarter tells a similar story. Reported fourth-quarter revenue was flat year over year at $209.8 million, but excluding a previously discussed headwind of $8.1 million, revenue grew 4% year over year. That reconciliation suggests underlying demand was not the main problem; external pressure on pricing or reimbursement likely was.

The product story still looks intact

This is not a case where Myriad's tools suddenly lost clinical relevance. Myriad received FDA approval of MyChoice CDx as the companion diagnostic for Zejula, launched Precise MRD, launched Prolaris + AI for prostate cancer, and expanded Precise MRD to include colorectal and renal cancers. It also submitted Precise MRD for breast cancer to MolDX for coverage determination.

Those launches matter because they expand use cases and can reinforce Myriad's position with oncologists. If volume stays firm around these products, the science and commercial appeal still look credible.

What to watch over the next few quarters

The key question now is whether payer engagement and revenue-cycle improvements start closing the gap between test activity and realized revenue. If that happens, the business could re-rate because the demand base already exists. If not, Myriad may remain a credible diagnostics company without a fully convincing investment case.

What needs to happen for MYGN to become a stronger stock story

Scorecard: what would improve the thesis

Bull signs - Test volume remains steady or improves, especially in Cancer Care Continuum test volume growth of 6% - Average revenue per test stops declining - Gross margin moves back toward the low-70% range, closer to the 71.2% gross margin reported in the second quarter of 2025 - Revenue-cycle improvements show up more clearly in operating performance, not just in management commentary

Bear signs - Payer pressure continues to suppress revenue per test even when volume holds up - Management keeps emphasizing reimbursement predictability without a sustained recovery in profitability - The company leans more on balance-sheet flexibility than on self-funded operating momentum

What would finally validate the bull case

Myriad does not need a new product mythos. It needs a cleaner conversion from clinical activity to revenue. Stable or growing volume, less pressure on pricing or reimbursement, and better cash conversion would go a long way toward proving that the second-quarter weakness was a trough rather than a new pattern.

The bear case stays alive if revenue adjustments and other earnings pressures keep interrupting the story. For now, this looks more like a waiting game than a clear compounding setup.