Biodesix (NASDAQ:BDSX) outlined its current commercial focus, growth priorities, and financial milestones during a presentation at the 46th annual TD Cowen Healthcare Conference, where Chief Financial Officer Robin Cowie discussed the company’s positioning in lung nodule management and its biopharma services business.
Focus on lung diagnostics and an “underserved” nodule population
Cowie said Biodesix’s mission is “to transform patient care and improve outcomes through personalized diagnostics,” using a multi-omic approach that includes proteomics, genomics, and radiomics. Commercially, the company is currently focused on lung, with “five on-market tests with Medicare coverage,” and is calling on pulmonologists and, more recently, primary care physicians in pulmonology referral networks.
Building adoption through education and real-world evidence
Cowie said one challenge is that adoption is being built “from scratch,” noting pulmonology has not historically ordered diagnostic tests in the same manner as oncologists and pathologists. While the company cited “20%+ growth,” Cowie said broader education and market development take time and could support acceleration as the company scales. Cowie also said the company saw “acceleration of growth” in 2025.
To support evidence generation in real-world practice, Cowie highlighted the company’s Clarify study, which is evaluating 4,000 patients who received Nodify testing in routine care. Cowie said the first Clarify data were presented last fall and that Biodesix is continuing to publish interim studies and subgroup analyses “as fast as we possibly can.” Cowie also emphasized the impact of physicians presenting their own findings and peer-to-peer engagement, describing a shift at the most recent CHEST meeting from “push to pull,” with physicians seeking out the company to learn more.
Primary care expansion targets referral networks rather than the full PCP universe
Responding to feedback from pulmonologists, Biodesix began targeting primary care physicians within pulmonology referral networks to run tests earlier in the patient journey. Cowie described an approach in which primary care can test patients for risk stratification: individuals likely to be benign could stay in primary care with CT surveillance, while higher-risk patients would be referred to pulmonology.
Cowie said Biodesix reviewed claims data indicating that about 50% of patients diagnosed with a lung nodule “never make it to pulmonology” and remain in primary care settings. By engaging primary care in referral networks, Cowie said, the company can access “about 50% of the market,” which Cowie characterized as a meaningful expansion of opportunity.
Biodesix added its first “real class” of primary care representatives in the third quarter, added more in the fourth quarter, and expects to continue adding primary care coverage through 2026 and into 2027. Cowie also stressed that the company is not attempting to call on all primary care physicians nationally. Instead, Biodesix identified roughly 15,000 primary care physicians that “manage over 80% of the nodules” and is focusing on those physicians and their referral networks.
Sales productivity, 2026 growth levers, and margin priorities
Cowie said the company has maintained approximately $1 million in revenue per representative even after expanding the sales force. Cowie said Biodesix began 2025 with about 65 sales reps and ended the year “just under 100,” while maintaining that productivity level, adding that hiring has improved and reps are ramping “really nicely.” On primary care reps specifically, Cowie said productivity has been comparable so far to other reps, while noting territories can differ.
Discussing the company’s 2026 outlook, Cowie referenced three revenue levers:
- Lung diagnostics: volume and average selling prices (ASPs)
- Biopharma and development services: funnel growth and conversion of contracted dollars into revenue
Cowie said the company ended the year with a “very strong uptick in ASP,” attributing improvements to additional coverage policies and revenue cycle management. While Biodesix is “not predicting significant increases,” Cowie said maintaining those ASPs would be supportive. Cowie also said the company’s volume guidance is “fairly conservative,” citing a larger and more tenured sales organization as a potential driver of upside. In biopharma services, Cowie said the company has seen growth in both new customers and additional contracts with existing customers.
On profitability, Cowie noted Biodesix has kept gross margins “around 80%” and said the company sees operating leverage after reaching adjusted EBITDA positivity for the first time in the fourth quarter. Cowie said Biodesix has multiple initiatives underway in 2026 to improve operating margin and potentially gross margin, including lab automation intended to reduce cost per test. Cowie described the company’s goal as reaching cash flow positivity while continuing to invest in pipeline programs.
Balance sheet actions, competition, and reimbursement mix
Cowie said the company strengthened its balance sheet with a $14.7 million raise completed after the quarter closed and through debt refinancing that extended its term loan maturity and interest-only period. Cowie said the combination “help[s] strengthen and de-risk” the balance sheet.
On competition, Cowie said Biodesix is “first to market with nodules and nodule management” and has the “largest commercial organization,” while acknowledging other groups are working on nodules due to the size and clinical importance of the market. Cowie said competitors are likely “several years behind,” but added that additional companies could help educate and build the market.
Regarding multi-cancer early detection (MCED) and single-cancer early detection (SCED) approaches, Cowie said Biodesix views them as complementary. Cowie argued that current lung cancer screening has “very, very poor adoption,” and that false positives remain a concern with some tests—leading physicians to obtain CT scans, where Biodesix believes it can help triage patients with nodules into intervention versus CT surveillance pathways.
On reimbursement mix, Cowie said about 60% of patients are covered by Medicare or Medicare Advantage, with a fairly equal split between Part B and Part C enrollment. Cowie said all five tests have Medicare coverage and that collection rates for Part B and Part C are “very, very strong” and close to each other.
Cowie also addressed policy and guideline dynamics. Cowie said a HEDIS measure related to improving lung cancer screening rates has been under discussion for several years but was put on hold late last year due to systems’ difficulty pulling necessary information, and Cowie did not expect it to be released this year. On guideline updates, Cowie said CHEST has not updated nodule management guidelines in more than 15 years and that timing remains uncertain; guideline inclusion would be upside, particularly for private payers, though Cowie said the impact on ASP may be limited given the company’s Medicare-heavy mix. Cowie estimated payer policy updates could take “two to four quarters” following a major coverage shift.
In discussing pipeline and services, Cowie said Biodesix has partnered with institutions including Memorial Sloan Kettering Cancer Center and life sciences companies including Thermo Fisher and Bio-Rad to advance research with limited cost and, in some cases, associated revenue. Cowie said the company expects this portion of the business to remain around 10% of total revenue, and noted that for tests outside of lung, Biodesix would expect to partner for distribution rather than build a new specialty sales organization.
About Biodesix (NASDAQ:BDSX)
Biodesix, Inc is a commercial-stage molecular diagnostics company headquartered in Boulder, Colorado, that develops and delivers blood-based tests to improve the diagnosis and management of lung diseases, including lung cancer. The company integrates advanced proteomic and, more recently, genomic technologies to offer noninvasive testing solutions designed to guide clinical decision-making. Biodesix operates a CLIA-certified and CAP-accredited laboratory, allowing it to process patient samples at scale and maintain rigorous quality standards.
The company’s flagship product, VeriStrat®, is a proteomic test that stratifies patients with non-small cell lung cancer into groups more likely to benefit from specific therapies.
