Earnings Labs

Myriad Genetics, Inc. (MYGN)

Q4 2020 Earnings Call· Thu, Aug 13, 2020

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Transcript

Operator

Operator

Greetings and welcome to the Myriad Genetics Fourth Quarter 2020 Financial Earnings Call. During the presentation, all participants will be in a listen-only mode. Afterwards, we will conduct a question-and-answer session. And as a remainder, this conference is being recorded Thursday, August 13, 2020. I'd now like to turn it to Scott Gleason, VP, Investor Relations. Please go ahead.

Scott Gleason - Myriad Genetics, Inc.

Management

Thanks, Keith. Good afternoon. Welcome to Myriad Genetics fourth quarter 2020 earnings call. During the call, we will review the financial results we released today after which, we will host a question-and-answer session. If you've not had a chance to review our quarterly earnings release, it can be found on our website at myriad.com. I'm Scott Gleason, the Senior Vice President of Investor Relations and Corporate Strategy, and on the call with me today will be Paul Diaz, our newly announced President and Chief Executive Officer and Bryan Riggsbee, our Chief Financial Officer. This call can be heard live via webcast at myriad.com, and a recording will be archived in the Investors section of our website. In addition, there's a slide presentation pertaining to today's call on the Investors section of our website, and which will be filed following the call on Form 8-K. Please note that some of the information presented today may contain projections or other forward-looking statements regarding future events and the future financial performance of the company. These statements are based on management's current expectations and the actual events or results may differ materially and adversely from these expectations for a variety of reasons. We refer you to the documents the company files from time to time with the Securities and Exchange Commission, specifically the company's Annual Report on Form 10-K, its Quarterly Reports on Form 10-Q and its Current Reports on Form 8-K. These documents identify important risk factors that could cause the actual results to differ materially from those contained in our projections or forward-looking statements. With that, I'm pleased to turn the call over to Bryan.

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Thanks, Scott. This quarter, Myriad faced a significant challenge from the global pandemic and its impact on elective testing volume. These times have been challenging but I am extremely proud of our team at Myriad who are the very best in the industry. They have done an incredible job of rising to the challenge and ensuring that we are able to continue to serve patients and providers that depend on us. As the quarter progressed, we saw a significant recovery with volume increasing on average to 75% of pre-pandemic levels by the end of the quarter. Importantly, the biggest recovery was with our core hereditary cancer franchise. Much of our progress was due to new improvements in telemedicine and direct-to-patient sample collection kit shipments. We will look to continue to build upon these capabilities in the coming quarters. Importantly, despite the challenges we faced in fiscal year 2020, we generated positive operating cash flow and our cash balances improved from the fiscal third quarter to the fiscal fourth quarter. This is due to the aggressive cost management initiatives taken by the company to mitigate cash burn at the end of the fiscal third quarter. We were excited to receive a new GeneSight LCD covering all healthcare providers licensed and qualified to diagnose the condition and prescribe relevant medications, either independently or in arrangement. And we have since received new GeneSight pricing. The net impact of these changes is expected to be neutral to slightly positive to our GeneSight average selling price and supports our primary care expansion for GeneSight in fiscal year 2021, which I will discuss in more detail later in the call. Most importantly, I am pleased to have Paul Diaz join us as our new CEO. Paul was previously the CEO of Kindred Healthcare and has broad experiences in healthcare services across many segments. He dramatically expanded the revenue base of Kindred Healthcare during his tenure as CEO and turned the company into a Fortune 500 company prior its acquisition. Myriad is extremely fortunate to have a leader of his calibre and experience, and I look forward to working with him this year on reinvigorating the business strategy executing on pending catalyst and positioning the company to exit the year with increased momentum. With that, I'll turn the call over to Paul.

Paul J. Diaz - Myriad Genetics, Inc.

Management

Thank you, Bryan, for that kind introduction. let me begin by first thanking our Chair, Louise Phanstiel, and you, Bryan, who served admirably as our Interim CEO for your leadership and support through this management transition. More importantly for guiding Myriad through a period of unprecedented change and challenge. I'd also like to thank the entire Myriad team and our physicians and payer partners for their extraordinary efforts to continue to serve our patients through the COVID-19 crisis. I've been inspired these many months by the dedication of healthcare professionals across the US and the Myriad Genetics team specifically for the difference they continue to make in our patients' lives and the opportunity we have to make an even bigger impact going forward. I'm excited to join the talented management team and board of directors of Myriad, an organization dedicated to helping patients and physicians identify the risk of developing disease, accurately diagnose disease, assessing disease progression, and aiding in therapy selections. Myriad has a rich history, reputation and powerful genetic tools along with the unique database of clinical and biological information that can empower patients as consumers and stewards of their own health and wellness. Working with physicians and payers, this information can guide treatment decisions, improve clinical outcomes and lower healthcare costs. Our company has a tremendous opportunity to transform its business and strategically position itself for sustained profitable growth. We will look to leverage the company's culture and capabilities of innovation and revitalize our approach to the commercial effectiveness of our products and improve our digital sales and marketing capabilities with the customers in mind. Finally, there are significant opportunities to improve Myriad's financial positions and invest in innovation and R&D to accelerate the launch of new products. Thank you for the opportunity to speak with you today. And I look forward to reporting back to you on our progress and plans for future growth. I'm now pleased to turn it back over to Scott for the financial results.

Scott Gleason - Myriad Genetics, Inc.

Management

Thanks, Paul. I'm pleased to provide more information on our financial trends and outlook for fiscal year 2021, starting with our hereditary cancer business. Hereditary Cancer revenue in the quarter was $39.9 million compared to $119 million in the fiscal fourth quarter of last year. Looking at the components of revenue change, test volumes declined 58% and pricing declined by 20% on a year-over-year basis. Volume declines in the quarter were largely attributable to the global pandemic. We ended the fourth quarter with test volume levels of 72% of pre-COVID-19 baseline from early March and have held relatively steady at these levels through July. From a pricing perspective, we saw year-over-year pricing declines decreased from 28% in the fiscal third quarter to 19% this quarter. We expect another significant reduction in the year-over-year pricing headwind in the first two quarters of fiscal year 2021 as we annualize the CPT code transition impact with the impact of our new long-term contracts. As a reminder, this fiscal year, there will not be a net negative impact on hereditary cancer pricing from PAMA due to provisions in the CARES Act. Moving on to GeneSight, revenue in the quarter was $8.5 million versus $29.8 million in the fiscal fourth quarter of last year. Looking at the components of growth, test volumes declined by 69% year-over-year and pricing declined by 7% year-over-year. From a volume perspective, we saw the significant impact from the global pandemic. However, this quarter, we annualized the impact associated with the discontinuation of our GeneSight ADHD and analgesic tests, which will lead to more favorable comparisons in coming quarters. GeneSight volume increased to approximate 50% of our pre-COVID-19 run rate by the end of June. In the quarter, we had adjustments of $6.3 million related to settlements of payer claims dating…

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Thanks, Scott. Now, I would like to discuss some of the key business highlights in the quarter beginning with our progress on GeneSight. This quarter, Medicare issued a final LCD covering pharmacogenomic testing, which became effective on August 3. There have been some misunderstandings around this LCD, and I would like to highlight a few clarifying points. First GeneSight is covered under the LCD as a multi-gene panel and was one of the listed tests in the coverage articles, which were recently issued. Medicare is not requiring us to make any changes to the test in order to receive coverage. As Scott mentioned, we received a new price for GeneSight for MolDX. We believe that the change in pricing along with the expansion of the market available for reimbursement will be neutral to slightly positive to our overall GeneSight average selling price. Importantly, the new LCD expands coverage with a number of patients who will now be eligible for testing by allowing all licensed health care providers, licensed and qualified to diagnose the condition and prescribe relevant medications either independently or in an arrangement to order the tests. This enables expansion into the primary care setting where approximately 60% of anti-depressant prescriptions are written in the United States. Additionally, the new LCD does not require a prior medication failure. Overall, while we are not aligned with some of the language in the LCD around combinatorial testing where GeneSight is the only pharmacogenomic test that has demonstrated the ability to improve outcomes in a large prospective study, the LCD provides us with a broader market opportunity for the product. Based upon this LCD and coverage from United Healthcare, we are currently implementing our plan to expand GeneSight into the primary care setting. We plan to complete the hiring of an additional…

Scott Gleason - Myriad Genetics, Inc.

Management

Thanks, Bryan. As a reminder, during today's call, we use certain non-GAAP financial measures. A reconciliation of the GAAP financial results to non-GAAP financial results and reconciliation of GAAP to non-GAAP financial guidance can be found under the Investor Relations section of our website. Now, we're ready to begin our Q&A session. In order to ensure broad participation in today's Q&A session, we're asking participants to please ask only one question and one follow-up. Operator, we're now ready for the Q&A portion of the call.

Operator

Operator

And the first question is from the line of Sung-Ji Nam from BTIG. Please go ahead.

Sung-Ji Nam - BTIG LLC

Analyst

Hi, thanks for taking the questions and welcome aboard, Paul. So, my first question is on your telemedicine direct-to-patient sampling strategy, just kind of curious where you are with that in terms of what percentage of your patients are currently taking advantage of that. What your capabilities and – or the infrastructure, if you have the capability and infrastructure to meaningfully expand from where you are today as well?

Scott Gleason - Myriad Genetics, Inc.

Management

Yeah, Sung-Ji, I don't know off the top of my head what the actual percentage of patients, but it actually got relatively high this quarter in terms of the patients that were taking advantage of kind of the telemedicine approach and not going to actually receive a test kit from the physician. We've been working – I think when we think from a strategy standpoint of where medicine is going, that's obviously going to play an increasingly important role in the future. When you look at areas like psychiatry, where telemedicine lends itself exceptionally well to patient care, there's big opportunities for telemedicine. And so, we are currently looking at a number of strategies. It's probably too early to talk about some of those, but we definitely are evaluating a number of things in that area.

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

And, Sung-Ji, I would just add, I think to Scott's point when we first started, obviously GeneSight was that one of the first that we deployed and I believe we had said we were around 60% at the time. That number's trailed off to some extent as physicians have returned to the office. But in answer to your final question there, it's certainly something that it is scalable, and we would be looking to scale that broadly going forward.

Sung-Ji Nam - BTIG LLC

Analyst

Great. Thank you so much. And then my follow-up is just would love to hear any update on the private payer side for GeneSight, if you're making any progress there or has the pandemic made it more challenging to make any progress there?

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Sure. Thanks for the question. Yeah, I think that the pandemic has made a lot of things more challenging. Everyone is focused at this point I think really across the healthcare system on doing what's necessary for patients in order to expand COVID testing and to get patients into the physician office and get them the treatment that they need. We're certainly continuing to engage with payers, but not only payers, we've talked about PBM partnerships and other collaborations as well to look for ways that we can further deploy GeneSight and get patients that are experiencing major depression, which is terrible, to get them well. So, nothing to report at this time, but certainly I think the team is well engaged and we've certainly made progress through the year.

Sung-Ji Nam - BTIG LLC

Analyst

Great. Thank you so much.

Operator

Operator

The next question is from the line of Doug Schenkel from Cowen. Please go ahead.

Doug Schenkel - Cowen and Company, LLC

Analyst

Hey, guys. Good afternoon. Maybe to – with a welcome to Paul. And I wanted to – it may be too early to ask this question, but I wanted to get your take on whether the combination of your addition to the team and what we've seen as the start of kind of a changeover or evolution at the board level. If your addition and that trend in combination is likely to lead to some change in incentive structure and target metrics for the company? Maybe it's too early to answer that question, but would love to hear do you think there are changes that need to be made in that sense?

Paul J. Diaz - Myriad Genetics, Inc.

Management

Yeah. Thank you. Look, it's a little too early to get into specifics, but I would say that the board and I and the time I've spent with the management team thus far are committed to really a bottom up total review of our businesses, our products, and that would include looking at new KPIs and just following up the discussion on telemedicine and digital marketing opportunities, I think there's a tremendous opportunity there to reach more consumers, reach more physicians. And we need to build metrics around those new initiatives as well. So, I think in the months to come, we'll complete our strategic review, and I'm sure that out of that strategic review will come new performance indicators that we'll be talking with you about. As Bryan said, telemedicine is a good example. These are opportunities for us to partner with people on the telemedicine business. And one of the things I know that the new board members and I are excited about and the entire board is excited about are, having more of a partnership orientation to the broader healthcare ecosystem, something I've done a lot in my career and I'm excited to move the team in that direction.

Doug Schenkel - Cowen and Company, LLC

Analyst

Okay. Super helpful. Thank you for that, Paul. And I guess it's a – I'll admit it completely unrelated follow-up, just thinking about the Counsyl business, thinking about reproductive, there's a little bit of false precision here, but the reality is when we look at least some of the public competitors out there that you overlap with, it does seem like you're continuing to lose a little bit of share. This deal relative to original target certainly hasn't gone as planned thus far. You talked about some exciting new data and product characteristics that you think will potentially change that position. I just want to make sure that's right. Do you think what you discussed on the call today in terms of the attributes of your reproductive products are going to be enough in combination with your existing commercial team to kind of turn things around for Counsyl?

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Yeah, Doug, I'll take the question. Yeah, certainly, I think that we've experienced some challenges with the reproductive business over time as we've brought that business into the fold of our women's health infrastructure and we've invested in new tools ease of use and in some of the studies and the readouts on those that we've talked about here today. I believe the net of all that is that we believe going forward in that business is part of the women's health offering. And I believe that the team is perfectly capable of playing and winning in that space, because we have great products and we have great science behind it.

Doug Schenkel - Cowen and Company, LLC

Analyst

Okay, that's great. Thank you, guys. I appreciate it.

Operator

Operator

The next question is from line of Tycho Peterson with JPMorgan. Please go ahead.

Tycho W. Peterson - JPMorgan Securities LLC

Analyst

Hey thanks. I'll start with on GeneSight, volumes are covered to 50% of pre-pandemic levels, everything else was 75%. So why is their volume recovery lagging? And then can you just help us think through the map a little bit more on why a reset on pricing with MolDX ends up being a neutral as you're trying to push in the PCP channels, it is just that you have better line of sight on higher private payer ASP or why would it be neutral. Thanks.

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Yeah, thanks Tycho. And I think the actual recovery for GeneSight was more in that 57% range. I think that was mis-stated, it was 57%. So, still, it's lagged where we've seen some of the others, I think part of that is just we've historically focused on the psychiatry channel. And so, I think that it's just more channels driven than anything the nature of that interaction, just it does not allow for as much in – potentially as much in-person, person-to-person contact. And so, I think that's probably why you're seeing some lagging there. Also, there's somewhat a – I mean it's not is – there is somewhat of an elective nature to that in terms of having that interaction. With respect to the GeneSight pricing, I think the reason why we made the commentary that we believe it'll be neutral to slightly positive on balance is really driven by a couple of things. First of all, we're running a significant number of tests today are not insignificant number of tests today for Medicare beneficiaries in the primary care channel. They're not paid for and when you couple the expansion of the market covered by Medicare along with a price change that is not so significant as to bring the overall number average down, that's how we get to a place where we believe it'll be neutral to slightly positive.

Scott Gleason - Myriad Genetics, Inc.

Management

Tycho, so not a larger number of Medicare patients will get paid for now. And so, you have a higher percentage of claims paid at a slightly lower price.

Tycho W. Peterson - JPMorgan Securities LLC

Analyst

Got it. And then for a follow up, just going back to Paul and the announcement tonight, I'm just curious, Paul, your background at Kindred, not necessarily in the diagnostic space, so how do you think that kind of translates over into the diagnostic world? And it would be helpful if we could just hear from you a little bit more about where you see the opportunities? You mentioned telemedicine, you mentioned more partnerships. I'm just curious as you think about the business today, do you see opportunity for more M&A, portfolio reshaping? How do you think about your first year in job or some...? Thanks.

Paul J. Diaz - Myriad Genetics, Inc.

Management

Yeah. Thank you. Well, first I think it's a tremendous opportunity for growth here and I was attracted to that growth opportunity through both discovery and innovation, but specifically, I think Myriad is an incredible platform to create a market leader in precision medicine. My experience in building adjacent businesses and cross-selling and doing M&A, which you refer to as well, it's pretty varied. I would say that my private equity experience coupled with two public companies, where I've both bought, spun off, merged successfully through a hospital-acquired Gentiva would give you a sense of sort of my historic ambitions for growth and expansion. And again, I think that that platform here lends itself to that growth opportunity. The other thing I would just say from a personal investment thesis that the underlying market for what Myriad does and a great reputation for its product is large and growing that it is a trusted partner as I did my due diligence. And I like the economics of the business model and this I believe there are multiple levers for growth and margin expansion. So, pretty excited to be here. My experience at Kindred and in multiple other segments, I think gives me a pretty good background and wide field of vision to help this team think more aggressively about where we can succeed, but also to be more focused, and I think that's one of the things we're going to examine through the strategic review, make sure that we're focused on those areas that we can win and be a leader in.

Tycho W. Peterson - JPMorgan Securities LLC

Analyst

Great. Thank you very much.

Paul J. Diaz - Myriad Genetics, Inc.

Management

Thank you.

Operator

Operator

The next question is from the line of Steve Unger with Needham. Please go ahead. Stephen Unger - Needham & Co. LLC: Hi. Just, one quick question on, I realized that volumes may be difficult to forecast over the next couple of quarters. But I wanted to understand clearly what your expected pricing negative impacts are for hereditary cancer and prenatal, let's say, over the next two quarters.

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Yes. Steve. I think that obviously we didn't, we weren't in a position to provide guidance either for the upcoming quarters or for the year. I think what I would point you to is a qualitative assessment that we provided relative to both of those products and that, as we come to the back half of the calendar year and into next – the first part of next calendar year, we'll lap some of the comps that really made for negative comparisons in previous quarters, namely the Hereditary Cancer code switch and then the changes that we made in the Prenatal billing area. So I think that those would be the biggest drivers of Hereditary Cancer pricing change as we look to the back half of the year – calendar year. And then also the other factor that's out there is the payment delay that was part of the CARES Act. Those will be the things I think would be relevant as you think about Hereditary Cancer and Prenatal pricing. Stephen Unger - Needham & Co. LLC: Okay. And then I noticed that you have roughly $33 million of deferred revenue on the balance sheet this quarter. Could you discuss what's that related to and is it the CARES Act. And did you receive grant money from the CARES Act...

Paul J. Diaz - Myriad Genetics, Inc.

Management

Yeah, we had said on the – during the prepared remarks that we had received advance payments from Medicare as part of the CARES Act. So that's what that dollar figure relates to.

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

It was prepayment on future claims, Steve. Stephen Unger - Needham & Co. LLC: Got it, okay. Thanks, I appreciate it. Thanks.

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Sure.

Operator

Operator

The next question is from the line of Puneet Souda from SVB Leerink. Please go ahead.

Puneet Souda - SVB Leerink LLC

Analyst

Thanks. So Paul, first of all, great to you have onboard. Welcome into the seat. I appreciate your thoughts on industry and diagnostics overall, and I know it's totally early in these times. But maybe I'm wondering, if you can just share some thoughts on opportunities that you see having looked at things here from a fresh perspective and sort of looking in. I mean, you mentioned focus is an important aspect here and you mentioned growth as well, could you just help us understand looking at the sort of the broader portfolio – broader diagnostic space. Are there anything – is there anything that gets you more excited versus others?

Paul J. Diaz - Myriad Genetics, Inc.

Management

Yeah. Again, look, I think the company has just great tradition; great reputation and most of my observations are outside looking in. But pretty thorough in terms of my diligence and my preliminary discussions with the management team reinforced my view that we have the opportunity to execute a lot better, whether it's in our customer service and on our ease-of-use and solving to both physicians and in a more consumer-centric way. We've got more opportunities to partner with payers and change some of the historical dynamics around that and sort of pricing strategies. And we've begun to talk about the digital marketing and telemedicine, and really re-energizing how we approach the marketplace from a sales and marketing standpoint. So I think there's a lot of opportunity there and the management team and I are excited to take a fresh look top to bottom of the organization of where we can perform better, and how we can manage costs better. And reprioritize both OpEx and capital to new growth opportunities, and one of my favorite people said strategy is about choices so that's where the focus will come in as we go through that examination figuring out which of those products and which of those markets we think we really can lead in and doubling down on those efforts.

Puneet Souda - SVB Leerink LLC

Analyst

That's great. Thanks for that. Bryan, if I could just get a bit of clarification on COVID testing. Could you maybe just – I appreciate you could get to 3,000 samples here per day, but could you elaborate pricing on that? I'm wondering if you are accessioning these samples yourselves or you're getting these samples from another reference lab and actually running them or turning the results?

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Yeah. Thanks, Puneet. As we said earlier, we hope to get to about a 3,000 capacity because there's obviously significant demand in the market and you've read some of the struggles for some folks in the market in terms of keeping up with demand for the testing which we think will continue to grow. Relative to where we are today in the sample flow that we have, obviously, we don't have the type of logistics network built out for sample collection that many of the large reference labs and some others would have. So at this point samples are coming in from other – via reference lab for other laboratories and are also marketing it to other providers that would send us samples and we would bill client bill effectively. And so that's the way the process is working at this point. Did that answer your question?

Puneet Souda - SVB Leerink LLC

Analyst

Yeah. And I just wanted to make sure that you are able to extract that complete price, if it's a $100 test rather than have it being a portion of that?

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Yeah. It would come into a laboratory. They would have accession it and send it to us for testing. We would return the result to them. They would do the billing et cetera. So in that scenario you would not get the full billed price, you would get some smaller amount that you had negotiated just for the process of running the test.

Puneet Souda - SVB Leerink LLC

Analyst

Got it. Okay. All right. Thank you.

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

You're welcome.

Operator

Operator

The next question is from the line of Derik de Bruin with Bank of America. Please go ahead.

Derik de Bruin - Bank of America Merrill Lynch

Analyst

Hi. Good afternoon. Paul, welcome. A couple of questions. So the first one is the MolDX pricing coming down, how does that impact your potential for any of your commercial agreements? How does this tie to – does this potentially impact what you're going to get paid from United or your other commercial contracts you're negotiating?

Paul J. Diaz - Myriad Genetics, Inc.

Management

Yeah. So thanks, Derik. I guess, what I would say is it doesn't impact other commercial agreements. Obviously we just re-signed the United agreement back in January. There's no impact to that contract and we don't have broad payer coverage outside of that. So I would say at this point there's not really a lot to talk about there.

Derik de Bruin - Bank of America Merrill Lynch

Analyst

Got it. And also on United, are you seeing increases in pre-authorizations for GeneSight. I'm just sort of wondering is – have those ticked up, just you haven't sort of talked about sort of what some of the – how the uptick has been, sort of what the pre-authorization process has been?

Paul J. Diaz - Myriad Genetics, Inc.

Management

Sure. Thanks, Derik. I would say in general for all genetic testing in our space, as you know, the use of prior authorization is key for payers and it's a process we have to follow for most all of our products, and so there's really no change from what we've had to deal with historically there. We have – as you know any time you go through something for a period of time you adapt and you improve and your yields get better. And so I would characterize it as we continue to look for areas of opportunity to improve. But there's no change or additional prior authorizations that have been put in place.

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

And Derik, I would just highlight, we've been making progress on our prior authorization program in terms of getting physicians trained. We did mention outside of the settlements of payer claims that we saw positive net cash flows for GeneSight in the quarter. And so I think that's an important data point.

Derik de Bruin - Bank of America Merrill Lynch

Analyst

Great. Thank you.

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Thanks, Derik.

Operator

Operator

The next question is from the line of Brandon Couillard from Jefferies. Please go ahead.

Brandon Couillard - Jefferies LLC

Analyst

Hey, Thanks. Good afternoon. Bryan, just curious if you could speak to the added cost of the at home collection kit for GeneSight and if the unit economics are materially different using that sample collection approach?

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Yeah. Thank you for the question. It's relatively straightforward. It's just a cheek swab and it doesn't impact the cost of the test significantly. I wouldn't consider it to be material.

Paul J. Diaz - Myriad Genetics, Inc.

Management

Brandon, from a kit fulfilment standpoint we still send a kit to the physician's office as well. So it's just a different format of that kit, so the cost isn't – difference is negligible.

Brandon Couillard - Jefferies LLC

Analyst

Got you. And as far as the GeneSight sales force expansion, will you remind us how many reps you have today and do you ultimately envision needing a partner to scale into that GP market, and how do you think about future growth of that sales force beyond the initial 65 reps?

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Yeah, thanks. I think the number was 165.

Paul J. Diaz - Myriad Genetics, Inc.

Management

The psychiatry sales team is about 160 reps, 165 reps, Brandon.

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Yeah. So I think in terms of how we think about that going forward obviously, I think one thing that's important, we talked about a mix of outside and inside sales people. We talked about our digital initiatives and our direct-to-consumer initiatives. So I think that one of the things that you'll see and as we start to evolve our thinking some on the sales side is just how we interact with the consumer and our physician customers. So I think over time we'll just continue to evaluate our sales force and how we're positioned in the market and how we go to market.

Brandon Couillard - Jefferies LLC

Analyst

Thanks.

Operator

Operator

The next question is from the line of Jack Meehan from Nephron Research. Please go ahead.

Jack Meehan - Nephron Research

Analyst

Thank you and Paul, congratulations on your role. I'm looking forward to working with you again here.

Paul J. Diaz - Myriad Genetics, Inc.

Management

Yeah. Thank you.

Jack Meehan - Nephron Research

Analyst

Wanted to go back to GeneSight. So previously your pricing was around $2,200 per test. What do you expect your average collection per patient will be under the new policy?

Paul J. Diaz - Myriad Genetics, Inc.

Management

Yeah, Jack, we're not providing that level of detail. The price is actually a little bit different than what you stated there for the actual Medicare rate as well. And so we're not getting into the detail around pricing and how we're coding for the test.

Jack Meehan - Nephron Research

Analyst

Okay. The language in the LCD documents suggests that there's going to be additional documentation required for physicians to justify the genes that they're ordering and you've heard of some feedback that that could cause some challenges in order to order the test. I was curious what you're doing with the sales team around that to make sure that doesn't become a burden. And what's your plan, are you going to stack multiple codes for each test, for each of the genes that are required?

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Yeah. Thanks, Jack, for the question and welcome back. Glad to have you back covering Myriad.

Jack Meehan - Nephron Research

Analyst

Yeah. Thank you.

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Yeah. The – what I would say with respect to the sales team and – excuse me, with respect to how we're billing for the product is we have agreed with Medicare on the price and so I think at this point just to follow-up on your last question. We've been given clear instruction in terms of how we'll bill, so with respect to stacking codes are billing for a single test et cetera. We have clear direction and pricing for Medicare, so really no change there. I think that relative to the other point, there is any time you see a change in the requirements for the physician, there does tend to be disruption and training that – some training that has to happen to educate physicians on exactly how they should be complying with the requirements and following the requirements of the LCD. So that's pretty normal, but it's also something that I think the team has become pretty adept at navigating that process. And so, it's not surprising that you would have heard about some disruption as this is relatively new, it was on August 3 effective date, but it would be something that I would expect the team would be able to work through.

Paul J. Diaz - Myriad Genetics, Inc.

Management

And Jack from a pre-authorization standpoint, it's really the requirements have just changed, right. Previously, we had to really show that the patient had failed medication previously and that they had treatment-resistant depression, and provide documentation around that. That the new documentation requirements are more around showing that the physicians considering medications that and follow multiple gene drug interaction pathways. And so we're just providing really a different level, or a different type of documentations.

Jack Meehan - Nephron Research

Analyst

Got it. If I can squeeze in one follow-up. You mentioned a combination of these factors, should be neutral to positive. Just to make sure we're thinking about it right. What's the baseline you're using, is that relative to the $74 million of revenue in 2020. Or are you referring more to the relative size of the market with PCPs versus the price decline and that combination. Just what were you referring to with neutral to positive?

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Yeah. I think when we said neutral to positive, we were talking about that with respect to how the market will look going forward. That's a combination of the updated pricing from MolDX along with the expansion of the LCD in the primary care segment. As we mentioned on the call earlier, there's a population of tests there that we've run historically and gotten zeros for that will now be covered. So there's a number of things that sort of go into that. But our expectation is that the net of all that is neutral to slightly positive on the overall GeneSight ASP.

Jack Meehan - Nephron Research

Analyst

Thanks, Bryan.

R. Bryan Riggsbee - Myriad Genetics, Inc.

Management

Thanks, Jack.

Operator

Operator

There is no other questions at this time, I'll turn it back for any closing remarks.

Scott Gleason - Myriad Genetics, Inc.

Management

And this concludes our earnings call. A replay will be available via webcast on our website for one week. Thank you again for joining us this afternoon.