Q4 2022 DermTech Inc Earnings Call
Speaker 2: Good day and thank you for standing by. Welcome to Durham Tech's fourth quarter 2022 Financial Results Conference call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question and answer session. To ask a question during the session, you'll need to press star 1 1 on your telephone.
Speaker 2: You will then hear an automated message advising your hand is raised to withdraw your question. Please press star one one again. Please be advised that today's conference is being recorded. I would now like to hand a conference over to your speaker today. Steve Konsebo, Head of Investor Relations.
Speaker 3: Thank you. Welcome to Dermtech's fourth quarter 2022 earnings call. Joining me on today's call are Dr. John Doback, our President and Chief Executive Officer, and Kevin Sun, our Chief Financial Officer. Our call today will include forward-looking statements.
Speaker 3: within the meaning of the Private Securities Litigation Reform Act of 1995. All statements made on this call that do not relate to matters of historical fact are considered forward-looking statements including projections of future performance.
Speaker 3: based on management's expectations as of today, and are subject to various factors, assumptions, risks, and uncertainties which change over time. Actual results could differ materially from those described in such statements.
Speaker 3: Several factors that may contribute to or cause such differences are described in today's press release and our most recent filings with the SEC. We undertake no obligation to update these statements except as required by applicable law. Our fourth quarter 2022 earnings press release and SEC filings are available on our investor relations website.
Speaker 3: a recording and transcript of today's call will be available on our website later today. With that, let me turn things over to John .
Speaker 4: Thank you, Steve, and thank you everybody for joining us. When we were last together in early November , I shared that our capital and energy was focused on two important priorities, expanding coverage of our DermTech Melanoma test or DMT and alleviating payer friction in our commercial channel.
Speaker 4: We've steadily advanced against these objectives and 2023 is off to a great start. In the last few months, we've expanded our coverage footprint from 91 million lives to 124 million lives, a 36 percent increase, and again, that is roughly equivalent to bringing on the second largest national commercial insurance provider.
Speaker 4: Billable sample volume in the fourth quarter grew 48% to approximately 17,460 tests versus last year. Billable sample volume was solid overall, and we expected a modest sequential decline primarily due to seasonal impacts and lingering pressure from commercial payers that it hindered in working conditions, which were significantly Mankind
Speaker 4: increasing usage.
Speaker 4: We believe that payer friction may be starting to ease slightly, and based on the trends we've observed thus far this year, we expect mid-single digit sequential growth in test volumes in the first quarter.
Speaker 4: Overall, the steps we've taken to stabilize our average selling price, or ASP, for current volume, including a greater focus on generating covered billable samples, seem to be showing positive signs. We are pleased to report normalized fourth quarter ASP of $239 for the DMT.
Speaker 4: due to fluctuating payments from non-contracted commercial payers. Nonetheless, all this points to monetizing existing demand in the quarters ahead.
Speaker 4: We continue to believe the most effective step we can take to accelerate top line momentum is to bring on more commercial payers. To grow ASP and to remove barriers that increase customer usage, it is still all about the payers and will be throughout 2023. We achieved our first major goal we set, adding 30 to 40 million covered lives by the end of the first quarter of 2023.
Speaker 4: Specifically, our coverage footprint expanded by 33 million lives in the past three months, and the gains came from a broad mix of regional payers, policies stemming from the second largest lab benefits manager in the U.S. and its relationship with health plans, and two national government payers.
Speaker 4: Importantly, we now have six of the top ten largest blues plans in the country providing access to our test.
Speaker 4: We also have visibility into adding more covered lives from other regional payers.
Speaker 4: Our recent momentum demonstrates that certain payers recognize the DMT test results are clinically meaningful and actionable, improve patient care, and reduce healthcare costs.
Speaker 4: Overall pricing for the coverage we've recently added remains in line with our long-term targets.
Speaker 4: We remain closely engaged with four national payers and are on track for scheduled comprehensive year reviews throughout 2023. We believe these meetings could lead to covers that would ultimately increase ASP and revenue. It's important to remember that in all cases.
Speaker 4: where we are award coverage, the financial benefit could be delayed one to two quarters or more as additional administrative contracting and billing steps need to be taken by both parties.
Speaker 4: Overall, we are pleased with the recent progress we've made to expand coverage for the DMT. We have more work to do and bringing on at least one national payer in 2023 is at the top of our priority list.
Speaker 4: The National Comprehensive Cancer Network, or NCCN, also recognizes that our technology may aid healthcare providers in identifying at-risk lesions for biopsy and surveilling potential melanoma. For the third consecutive year, our technology is included in the guidelines with a 2A recommendation.
Speaker 4: In a recent update to its guidelines, the NCCN strengthened its recommendation for using the DMT in guiding patient care decisions.
Speaker 4: We also recently held our national sales meeting. It's always a great event that reinvigorates the entire commercial organization. This year we emphasized the DMT's clinical value proposition and an enhanced customer service experience, including electronic ordering of our tests, and the
Speaker 4: regional billing, concierge services, and health care provider training programs.
Speaker 4: Importantly, our sales effort is structured to pull through test volumes in geographies where we've recently picked up coverage. In addition, we initiated our Trust 2 study in 2022. This study is prospectively designed to follow a cohort of approximately 3,000 patients
Speaker 4: with negatively tested lesions for up to one year. The study also assesses the histopathologic diagnosis of up to 1000 lesions that tested positive with the DMT and includes analysis of the TERT add-on test.
Speaker 4: We expect to release top-line results in the second half of 2023 to provide additional evidence in support of our payer discussions.
Speaker 4: Finally, we continue to see incremental progress from our targeted programs in primary care.
Speaker 4: Our agreement with Sonora Quest, a reference laboratory partnership between Banner Health, the largest primary care network in Arizona, and Quest Laboratories, continues to ramp up. We received unanimous approval from Banner Health's Medical Review Team to incorporate the DMT into their melanoma care pathway.
Speaker 4: Sonora Quest is now working to complete electronic medical records or EMR integration and is training staff at Banner Clinics throughout Arizona. We expect this work to be completed in the next couple months.
Speaker 4: We are also expanding our pilot with an important payer provider IDN due to the initial success of this arrangement.
Speaker 4: We continue to believe that the primary care segment represents a significant market opportunity for our technology.
Speaker 4: We'll continue to look for ways this year to increase access to this channel through additional distribution and reference lab arrangements. With that, I'll turn the call over to Kevin for a more detailed financial review and then wrap up with a few closing thoughts on my transition that was announced today and why patients are at the heart of everything we do.
Speaker 2: Thanks, John , and good afternoon, everyone. I'll start by recapping key financial and operating metrics for the fourth quarter in full year, then outline how we're thinking about 2023 top-line growth. I'll finish by covering our liquidity profile and cash runway targets. Billable sample volumes were up 48% year over year for the fourth quarter to 17,460.
Speaker 2: and up 53% year-over-year for 2022 to $68,230. Assay revenue in the fourth quarter decreased 9% to $2.7 million, largely due to $1.5 million in downward revenue adjustment due to changes in collection estimates for samples reported in prior periods.
Speaker 2: Full year 2022 ASA revenue increased 25% to 13.8 million, which included 1.8 million of net downward prior period adjustments.
Speaker 2: Contract revenue was 0.3 million during the fourth quarter, up from 0.2 million in the year-ago period.
Speaker 2: The fourth quarter benefited from the recognition of deferred revenue upon completion of several contracts.
Speaker 2: Total revenue for the fourth quarter fell 5% year over year to 3.0 million, primarily on lower assay revenue.
Speaker 2: Total revenue for the full year 2022 was up 23% year over year to $14.5 million, primarily due to higher assay revenue.
Speaker 2: Looking more closely at our fundamental SA Revenue drivers. First, ASP was $154 per sample in the fourth quarter, down 39% year-over-year, and 19% on a sequential basis.
Speaker 2: Medicare ASPs continued to trend higher due to last year's code-edited update.
Non-contracted commercial payers continue to reduce their payment rates, leading to the downward adjustment for the quarter.
Normalizing for these adjustments in both periods, fourth quarter ASP would have been $239, up approximately 10% sequentially.
Second, we had approximately 2,420 unique ordering clinicians in the fourth quarter, dropped slightly from the prior quarter.
with approximately 4,110 unique ordering clinicians during the last 12 months. We penetrated 46% of our current target market of 9,000 dermatology clinicians.
Third, our average quarterly utilization or average number of tests ordered per unique ordering clinician with 7.2 billable samples in the fourth quarter versus 7.5 in Q3 and 6.5 in the year ago period.
Finally, Medicare samples are represented about 24% of our billable samples in the fourth quarter, which was unchanged as a percentage from the third quarter and up modestly from 23% last year.
We continue to evaluate and implement tactics to bolster penetration of this large market segment, which represents about half of the annual total biopsies from Melanova.
Focusing next on operating expenses. Cost of assay revenue was 3.3 million, a 9% year-over-year increase, yielding an assay gross margin of negative 22%. The increase in cost of assay revenue was primarily due to increased demand. The reduction in assay gross margin from negative 1% in the year-go period.
was primarily the result of lower ASP.
Sales and marketing expenses were 13.6 million during the fourth quarter, a 2% year-over-year increase, largely resulting from higher employer-related costs and marketing expenditures.
Research and development expenses were 5.1 million, a 15% decrease from the year-ago period, primarily due to lower lab and clinical study costs.
General administrative expenses were 9.8 million, 37% higher compared to the fourth quarter of 2021. The increase was driven by higher infrastructure costs for our new building and increased employer-related costs.
As a result of our continued focus on operational efficiency, we expect total cash operating expenses will be slightly down for 2023 despite planned volume growth.
Net loss for the fourth order was 28.2 million, which included 5.3 million and non-cash stock base compensation expense compared to a net loss of 26.1 million for the same period of 2021, which included 3.8 million of non-cash stock base compensation expense.
Moving now to our 2023 outlook.
The commercial headlands we faced during the last several months have improved and we're working our way through payer friction that could continue to express billable sample volumes and ASP in the near term.
We expect to steadily grow DMT volumes during 2023, but ASP is difficult to forecast due to potential delayed positive impact of recent coverage wins and potential reduced non-contracted commercial payments.
As a result, we're not providing revenue guidance until we have better visibility on ASP trends.
And lastly, a review of our liquidity profile and balance sheet. At year end, we had cash, cash equivalents, restricted cash, and marketable securities of $129.8 million.
Based on our fourth quarter expenses and expected additional operating efficiencies, we believe we have sufficient funds, along with the ability to access capital, for cash runway through the third quarter of 2024, or more than 18 months from today.
Now I'll turn the call back to John . Thanks Kevin. As we mentioned today, I am transitioning from my role as Dermtek CEO . After 11 years leading this great company, it's the right time. When I look out nine to 12 months at the leadership needs for Dermtek, I believe a CEO with a strong background in scaling around a large commercial opportunity will be an ideal fit.
We have achieved significant adoption broads hair coverage with a deep pipeline of additional pair opportunities and built out the infrastructure for scale to capture the tremendous opportunity.
in front of us. I remain fully committed to Dermtech until a successor is found that can build on my vision to transform dermatologic care for our non-invasive genomics platform. I am grateful for the dedication and perseverance of my team and all the hard work they put in to build a strong foundation for our long-term success. I'm reminded by patients and physicians almost daily why it's important that we succeed as we are potentially saving lives.
and changing the way melanoma is detected and treated. With that, I'll share an especially powerful patient story that encapsulates why I have led this company for the past 11 years.
One of our patients had a large scar from a previous excisional surgery on a pigmented lesion that ended up being benign, and they therefore refused to abyopsy on a different suspicious pigmented lesion. As a result, she was referred to a different dermatologist office that used our technology.
The new physician administered the DMT, which came back positive and was further confirmed through histopathology as early stage melanoma.
While the patient unfortunately was diagnosed with melanoma, she can be effectively cured with a wide excision because it was caught early. If our technology wasn't available and she neglected to have the lesion assessed, this positive outcome may not have occurred. This is a great example of how our non-invasive tests...
was able to accurately inform physician decision making and improve patient care. With that, I'll turn things back to the operator for Q&A.
Thank you. As a reminder, to ask a question, you will need to press star 1 1 on your telephone and wait for your name to be announced. To withdraw your question, please press star 1 1 again.
Our first question comes from Thomas Fladen with Lake Street Capital Market, Simea Proceed.
Great. Thanks for taking the questions and thanks John for everything and best wishes going forward. Kevin I was just hoping maybe you could provide a little bit of extra help on stretching the cash runway out. It seems that it would need to require a pretty significant gap up in revenues or a significant gap down in expenses to give you the full seven quarters.
you know, from a burn perspective, you're down it, you know, call it 18 million a quarter versus what you've been burning in the past. Any additional guidance you could provide to us there?
Yeah, we're committed to finding additional cost savings throughout the year and monetizing our healthy demand. We do expect the recent pair wins to improve ASPs, and we've demonstrated that we can support higher volumes through improved efficiency and reduced expenses, even with our already highly efficient operation. We may deploy the ATM opportunistically in the future upon catalyst and if market conditions are favored.
to when we might be able to see those monetized in the revenue stream.
expect that the different payers coming on board will help us and provide benefit at different patterns. And if we're going to give the specifics, we believe the Tri-Care Agreement will probably help the most, but we've already know that it'll take a few months for them to update some of their policy manuals before we can get paid on a routine basis.
Outside of that one, I'd say the Louisiana contract is the one that will, is already starting to see some benefit. And again, we had some healthy volumes from that territory and it was growing nicely too. So those are the two that will probably have the most immediate impact. And there's one final one. The Medicare percentage of revenue seems to be stubbornly stuck at 24%.
This has always been a challenge, Thomas. We've always talked about it, and we also ask ourselves, why it's been stuck at that. I would just note that as our total volume increases, even though it's at 24%, the absolute number of samples that come from Medicare has been growing nicely. We do provide incentive for sales force to...
It's part of our top priorities driving more Medicare proportion.
And we'll eventually hit on one of these things that really works.
I appreciate it. Thanks, guys.
Thank you. Our next question comes from Max Masuchi with Cowan. You may proceed.
Hi, this is Stephanie on for Max. Thanks for taking my question and congrats John on a long tenure as CEO . So for my first question, I was just curious, so on your Q3 call, you indicated that you have to update Medicare code edit that was implemented at the beginning of October and was backdated to early 2020.
when the Medicare LPD went effective. We're just one of the make sure, have all your Medicare challenges been resolved at this point? Yeah, I'd say many of the Medicare challenges have been resolved with the code edit if there is a code.
coming in the door. In terms of the commercial payers, we still haven't seen a lot of benefit from that code edit in terms of being able to appeal prior claims that had more than the one body site being denied. So it's something that we continue to work on.
Got it. Thanks for that clarification. And then, you know, any update you can provide on your progress and conversations with national commercial payers. So I know you recently secured pair wins with some blue cross the shield plans that are part of the AppLon lab benefit manager, which also has a partnership with Optum. So this is in any way.
They have all committed to giving us a comprehensive review this year. We try to pin them down on exactly when that review is going to occur. They don't really give us the exact date. But we do feel like we're in the best shape ever to try to get a national payer in here. We like the way the conversations have been going, the tone of those conversations.
some success on that front this year. I just don't know the exact timing because they never tell you exactly when they're going to pick it up unfortunately. We try to get it out them but we have submitted them, had very thorough discussion, multiple champions within different payers to try to drive success of those national payers. So.
I feel like we're teed up as best as we could for the year going forward. Got it. Understood. Thanks for that color. And then if I can squeeze in one more quick one. So you now have made that you have cash from the way through Q324. Can you just remind us what are...
from the changes to the operational efficiency that you're making to extend the runway, is there like any specific initiatives that have changed since last quarter that allow you to extend your cash runway? We just continue to look for ways to reduce the discretionary spend categories. We've delayed that.
with broad commercialization activity for any new products until we see improvement in our ISP melanoma test.
until we see improvement in our ISP for melanoma test.
Got it. Understood. Thanks so much for taking all my questions.
Got it, understood. Thanks so much for taking all my questions. Thank you.
Thank you. Our next question comes from Mark Nassaro with BTIG, email proceed.
Hey guys, thanks for taking the questions. John , you'll be missed, but look forward to working with you for the remaining several months that you're at the helm. I'd love to ask about the volumes in the Q4. They were down 3% sequentially.
I know on the Q3 call you guys called out seasonality, holiday impacts, fewer working days. In your opinion, do you think that was probably what...
cause the slight dip sequentially. And then maybe just can you clarify, I think you talked about mid-single digit growth, quarter over quarter and Q1, just confirming that that's on volumes and perhaps revenue. Maybe could you clarify that? Yeah, that's really on volumes. You know, we had some hang- DSM. sandwich. But
positive and we're really working through that. So I think the environment's gotten better so we do see the volumes now starting to pick up and we do expect to grow this quarter. You know, we thought, we knew that fourth quarter was going to be a little bit softer. We've just seen that. Dermatology is a specialty where around holiday periods they take a lot of time off and we have to anticipate that. We still kind of had our maximum sort of...
interference from payers during that time period. So that probably added it to it, but that's just kind of what we see with our business, around the holidays. DERMS will take off the entire last two weeks of the quarter in many cases. And so those are things that we've seen.
We have to, you know, plan for them. That's why we saw it and we anticipated that. So we're actually pretty happy with where we wound up, given the things that we were seeing. And we knew that seasonality that was approaching. Yep, that makes sense. And then Kevin on the guidance, I know for 2022 volumes were pretty solid, up 53% year of a year.
I know for 2023 you're not initiating full year guidance, but you know, is it reasonable to think that you could potentially repeat somewhere in the magnitude of 40 to 50 percent volume growth in 2023? I guess what I'm asking is...
Are there any changes to the underlying environment, whether it's commercial or you know your intention to commit to investing in commercial this year that would impact the volume trajectory in 2023?
As we mentioned, we do expect that mid single-digit sequential growth in volumes for Q1, but given the uncertainty when the pay pressure on the demand fully decreases, fully subsides, we're just not going to provide any additional guidance on future periods beyond that until we have some reliable trends.
Makes sense and then can you guys speak to your R and D pipeline and any changes there? I know. Um, perhaps you may put on pause 1 of the programs, but just give us a sense for an update. Uh, with respect to where where that. Program stands and your commitment to continue to advance that product.
Are you asking about the Luminate product? Yeah, Luminate. In general, as Kevin mentioned, we slowed all the things down. We're continuing to progress those problems, programs, but at a slower pace. Obviously, we saw some improvement in our R&D spend.
The Illuminae product actually works fantastically well. It's been pretty much validated and can demonstrate that it shows a picking up patients that have an increased risk for skin cancer. So we're excited about the product, but we aren't going to do anything major from a product introduction. We will pilot that. We want to get some of the selling metrics around that.
It's already incorporated into our budget and our plans for a reduced spend this year. So we will do some test piling of that in the middle of this year. We're excited about it. I mean, it really works phenomenally well. We exceeded our expectations on how well the product works. And so we're excited to sort of test it out.
progress go ahead
Awesome, awesome. Thank you for that. You know, John , I've received a couple of questions from investors. Really, I know you addressed it in the prepared remarks that perhaps another executive can come in with maybe some more commercial acumen, if you will. But, you know, you've done a pretty good job driving strong volume growth. I guess.
Can you maybe elaborate on why now is the right time after 11 years at Dermtek to move on? Sure. It's never easy. These transitions and the timing always seems difficult, but this is really just about long-term planning. And my job right now is to anticipate the needs of the company looking out and out and
skill set and I think the next phase of growth can be driven by some with a different skill set. That's really it. It's an unselfish move. I just feel like it's in the best interest for Durham Tech and it looks funny the timing maybe now but when you look it's going to take six months. We don't want to be rushed with it six to nine months and we'll give ourselves plenty of time to find the best person.
All right, thanks for taking the question and congrats, John , on the long tangier here. So I think I was just wondering in terms of the national pairs, could you just maybe discuss there's been a lot of wins on the regional side, but what a win this year from one national pair.
with Deerlin and how we detect the business. And then is there any correlation between, you know, it seems like you've already proposed stuff to the parents, but you just discussed maybe trust to and the readout and what they can do for reimbursement.
impact the business and then is there any correlation between you know it seems like you've already proposed stuff to the players but you just discussed maybe trust to and the readout and what that can do for reimbursement.
So as your first question around the impact of the ASP that the national payer would have, is that what you're asking? Yes. Yes.
Yeah, it's going to be a very meaningful impact. We have never quantified that, but it will be a very meaningful impact. I think that's just the best to leave it there. We don't want to get out in front of those things as we said until we see the numbers, but it would have a meaningful impact. And that's why it's very important to us to get those national payers. In terms of the trust to study.
We think it's going to be a great study. We did the Trust One. The Trust One had a component of a perspective element that had about 300 patients that were prospectively followed. This study is going to be much larger. 3000 patients prospectively followed for up to a year. That's really tells you what's going on with a pigmented lesion and if there's melanoma.
and by following it to see if it changes. And so that's what we're doing in that study. It'll be a very robust data set. We'll also have a very big data set on positive cases. And we think it's just a good follow-up study to the TRUST one, much larger, and it's just going to add to our tremendous database of publications and evidence that says this test is very important, does what it's supposed to do.
It's always important to be putting out evidence so to doctors. So we have a few publications that should be coming out here on some smaller studies that we've done in 2022, but this is really the biggest effort we took in 2022 to start which was around this long-term trust-to study.
I just, we always believe it's important to generate data, payers love more data. You know, if there's some that are still on the fence, I think this study is going to do a lot to push them over. And so we just want to get it done and add to that tremendous database that we have.
Okay, great. And then in terms of penetration of the docks, you mentioned 46 percent penetration. Where would you like to end up or what would you think would be reasonable in terms of the peak penetration of the docks? Well, I think if you look at any kind of technology through there...
Once we talk about expanding beyond the 9,000 to the full 11,000 doctors, it's more investment to get the entire reach of it. But I would say we would target whatever a good penetration for typical dermatology or genomics types products are and get an estimate that to be more than half of those doctors.
get out in front when they're sending redirection letters and explain to our customers what that means. And we actually turn the customer into an ally of ours and help us go back to those plans that send those letters. And so we've turned that around and we're out in front of that now and the sales reps know to be on the lookout.
that creates friction is they require medical records, even for the first claim submission. So we've now done some technology integration where instead of us having to go have the doctor pull records and provide them to us, it's just gonna be done seamlessly electronically with our EMR integrations. We've got it.
a tremendous scale up in the EMR integrations with our customers. And we have that functionality that will now be added. And we can just pull those records without having to have put a lot of burden and administrative pain on the customer. I think that's going to be important. And so we're excited about those opportunities to reduce that friction.
Thank you.
Thank you.
Our next question comes from Alex Noak with Craig Hallam Capital Group. You may proceed.
All right, great. Good afternoon, everyone. This is a color on Peralex. Maybe first, John , appreciate the color on what we're looking for in the next liter of DermTech. I'm looking for somebody with a different set of skills. I want to just pull out a little more. What sort of individual is needed to really take DermTech to the next level? I mean, is this primarily...
an external search or has there been an effort to build out an internal bench? So we have not started the process. We're going to be spending in the next few weeks to really kind of scope out what that job description looks like and figure out how we're going to source Canada. So if oneango has started to transfer that, Lee from Canada will have approved a process that works in the next few weeks.
Like I said, we don't want this to be rushed. We're announcing it now, so it gives us the time. And we don't feel like it's rushed sometime in the future. And we'll build out that description for the ideal candidate. But I think we have a huge opportunity with the melanoma test.
and clearly somebody who has brought that kind of scale to a commercial opportunity like we have is going to be important, along with public company experience and things like that. Those are some of the things. So we'll scope that out in the coming weeks, and we'll get started on it and work through it. I'll be here.
I'm not looking to leave until that person is identified and will take as long as it takes to get it done.
Got it, that makes perfect sense. And then maybe, I mean, I understand the cadence of reimbursement timing is hard to predict and I won't ask you to give a specific impact. But, I mean, just from the comments on the call, like, these small regional. Payer wins and then the TRICARE win over the last few weeks, you know, to mention that this kind of
you know, addition to covered lives is similar to adding, you know, the second largest national payer. And then, you know, it was also mentioned that, you know, adding a national payer would have a meaningful impact to ASPs. So, I mean, is it reasonable to think that ASPs can, you know, potentially reverse course and maybe second half, 23 or early in the 24?
I think we're already seeing it. That's why we talk about it. If you look at the Inter-Corder ASP for the up-to-date accruals for the first quarter, it was almost 240. Our peak, I think, in the prior courses around 250, 255.
I think it's already happening. Now we need to see, we need to really confirm that. And we could still see some erosion with the non-contracted payers, but I like what we're seeing now. I think the worst of it's behind us. The low ASP is just because we have all those prior period write downs.
We believe we've fleshed the majority of those through and but we'll have to see. We just got to see what's happening. That's why we don't want to give guidance because we got to see what's happening to make sure things have stabilized. We believe that's happening and we'll know more in the next quarter.
Okay, got it. Thank you for the update. Thank you, and as a reminder, to ask a question, you will need to press star 11 on your telephone.
Our next question goes from Andrew Brackman with William Blair. He may proceed. Thanks for speaking to me. John certainly I go the sentiment here on what you built. A lot of been asked, but John I think you called out in your script the MCCN improvement building throughout 2022. Can you sort of just level set us on that specifically and how that's helping you in the field?
Thanks. Well, I mean, the NCCN has continued to improve that guideline they issued several years ago. What they did this year is they said that our test was useful when in a dermoscopically suspicious lesion. We think that's an important improvement because if you read some policies out there, you'll
where they have a negative or an E&I type policy, they'll say, well, we're not sure how much the Dermtech melanoma test adds over Dermoscopy. But NCSEN now is basically saying that this does help even in a Dermoscopically, Dermoscopically suspicious lesions. So we think that's a good addition.
and a good improvement to the language of our NCCN guidance. It's a 2A recommendation. That means that the unanimous by the 21 members on the panel unanimously are approving that language. There's only one run higher, which is a one. A very few technologies get a one. So we're very pleased with the priorities we've made with the NCCN.
So we look at the run rate that we're exiting Q4 and in Q4 we already demonstrated some cost saving initiatives and being able to reduce op-x. We continue to take that mindset going forward. We do have our plans for 2023 already settled, but we'll continue to look for more savings beyond those plans.
Got it. Thanks, Jess. Thank you. Our next question comes from Mason Carrico with Steven. He may proceed.
Hey guys, this is Jacob on to Remation and thanks for taking our questions. Lots of them covered here, so I'll just ask a couple of quick ones. Fallen up on the improvement to the NCC and recommendation for the DMT. With having discussions with private payers, did it seem like this is something that could be keyed at bringing on more of those payers that are on the fence on board?
Yeah, we believe so. We think it's important and when you follow the three-year history of that improving recommendation, we think that's very impactful and we make sure that that's in front of the payer. So we're going to use that.
You know, you can't get a better endorsement from that than from the NCCN. So it's got a hold of water. I know it does and we think it's going to be helpful for sure. Okay, got it. And then could you just update us on your relation trends for clinicians utilizing your test? Have you seen the building in your...
saw a little bit of a decrease in the average utilization as we mentioned in the fourth quarter sequentially. And again, we think that's also due to the payer friction, right? So a physician has difficulty scaling up and an increasing usage. One, there's more and more requests for medical records for each test that they're running. So as we implement those EMR integrations and as we've...
figured out the right appropriate way to respond to the redirection letters, we think that friction will go down and will lead to pre-civilization in coming quarters. Thank you. This concludes today's conference call. Thank you for participating. You may now disconnect. This concludes today's conference call.
The conference will begin shortly. To raise and lower your hand during Q&A, you can dial star 1-1.
The conference will begin shortly. To raise and lower your hand during Q&A, you can dial star 111.
And.
I.
The.
And.
Good day, and thank you for standing by. Welcome to Durham Tech's fourth quarter 2022 financial results conference call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question and answer session. Thank you.
to ask a question during the session, you'll need to press star one one on your telephone. You will then hear an automated message advising your hand is raised to withdraw your question. Please press star one one again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your speaker today. Steve Konsebo, head of investor relations. Thank you. Welcome to DermTex Force Quarter 2022.
or consider forward-looking statements, including projections of future performance based on management's expectations as of today and are subject to various factors, assumptions, risks, and uncertainties which change over time. Actually results could differ materially from those described in some statements. Several factors that may contribute to recall such differences are described in today's press release and are most recent filings with the SEC.
job.
Thank you, Steve, and thank you everybody for joining us. When we were last together in early November , I shared that our capital and energy was focused on two important priorities, expanding coverage of our DermTech Melanoma test or DMT and alleviating payer friction in our commercial channel.
We've steadily advanced against these objectives and 2023 is off to a great start. In the last few months, we've expanded our coverage footprint from 91 million lives to 124 million lives, a 36 percent increase, and again, that is roughly equivalent to bringing on the second largest national commercial insurance provider.
Billable sample volume in the fourth quarter grew 48% to approximately 70,460 tests versus last year. Billable sample volume was solid overall and we expected a modest sequential decline primarily due to seasonal impacts and lingering pressure from commercial payers that it hindered increasing usage. We believe that pair friction may be starting to ease slightly and base...
showing positive signs. We are pleased to report normalized fourth quarter ASP of $239 for the DMT, which is sequentially higher. But we still expect variability going forward primarily due to fluctuating payments from non-contradict commercial payers.
Nonetheless, all this points to monetizing existing demand in the quarters ahead. We continue to believe the most effective step we can take to accelerate top-line momentum is to bring on more commercial payers. To grow ASP and to remove barriers that increase customer usage,
It is still all about the payers and will be throughout 2023. We achieved our first major goal. We set adding 30 to 40 million covered lies by the end of the first quarter of 2023. Specifically, our coverage footprint expanded by 33 million lies in the past through months. And the gains came from a broad mix of regional payers.
policy stemming from the second largest lab benefits manager in the US and its relationship with health plans and two national government payers. Importantly, we now have six of the top ten largest blues plans in the country providing access to our test.
We also have visibility into adding more covered lives from other regional payers. Our recent momentum demonstrates that certain payers recognize the DMT test results are clinically meaningful and actionable, improve patient care, and reduce healthcare costs. Overall pricing for the coverage we've recently added remains in line with our long-term targets.
We remain closely engaged with four national payers and are on track for scheduled comprehensive year reviews throughout 2023. We believe these meetings could lead to coverage that would ultimately increase ASP and revenue. It's important to remember that in all cases where we are award coverage, the financial benefit could be delayed one to two quarters or more.
the top of our priority list. The National Comprehensive Cancer Network, or NCCN, also recognizes that our technology may aid healthcare providers in identifying at-risk lesions for biopsy and surveilling potential melanoma. For the third consecutive year, our technology is included in the guidelines with a 2A recommendation.
In a recent update to its guidelines, the NCCN strengthened its recommendation for using the DMT in guiding patient care decisions. We also recently held our national sales meeting. It's always a great event that reinvigorates the entire commercial organization. This year we emphasized the DMT's clinical value proposition and an enhanced customer service experience.
including electronic ordering of our tests, regional billing, concierge services, and health care provider training programs. Importantly, our sales effort is structured to pull through test volumes in geographies where we've recently picked up coverage. In addition, fast-emerge standards are recommended in order to Bits Saying phrases per hour while they are not required.
We initiated our Trust 2 study in 2022. This study is prospectively designed to follow a cohort of approximately 3,000 patients with negatively tested lesions for up to one year. This study also assesses the histopathologic diagnosis of up to 1,000 lesions that tested positive with the DMT and includes analysis of the TERT add-on test.
We expect to release top-line results in the second half of 2023 to provide additional evidence in support of our payer discussions.
Finally, we continue to see incremental progress from our targeted programs in primary care.
Our agreement with Sonora Quest, a reference laboratory partnership between Banner Health, the largest primary care network in Arizona, and Quest Laboratories, continues to ramp up. We received unanimous approval from Banner Health's Medical Review Team to incorporate the DMT into their melanoma care pathway.
Sonora Quest is now working to complete electronic medical records or EMR integration and is training staff at Banner Clinics throughout Arizona. We expect this work to be completed in the next couple months. We are also expanding our pilot with an important payer provider IDN due to the initial success of this arrangement. We continue to believe that the primary care segment represents a significant market opportunity for our children.
everything we do. Thanks John and good afternoon everyone. I'll start by recapping key financial and operating metrics for the fourth quarter in full year than outline how we're thinking about 2023 top line growth. I'll finish by covering our liquidity profile and cash runway targets. The global sample volumes were up 48% year over year for the fourth quarter to 17,460.
and up 53% year over year for 2022 to 68,230. Asset revenue in the fourth quarter decreased 9% to 2.7 million, largely due to 1.5 million a downward revenue adjustment due to changes in collection estimates for samples reported in prior periods. Full year 2022 Asset revenue increased 25% to 13.8 million, which included 1.8 million of net downward prior periods adjustments.
Contract revenue was $0.3 million during the fourth quarter, up from $0.2 million in the year-ago period. The fourth quarter benefited from the recognition of deferred revenue upon completion of several contracts. Total revenue for the fourth quarter fell 5% year over year to $3.0 million, primarily on lower assay revenue.
Total revenue for the full year 2022 was up 23% year over year to 14.5 million prior, merely due to higher assay revenue. Looking more closely at our fundamental assay revenue drivers.
First, ASP was $154 per sample in the fourth quarter, down 39% year-over-year and 19% on a sequential basis. Medicare ASPs continue to trend higher due to last year's code edit update.
Non-contraded commercial payers continue to reduce their payment rates leading to the downward adjustment for the quarter. Normalizing for these adjustments in both periods, fourth quarter ASP would have been $239 up approximately 10% sequentially. Second, we had approximately 2,420 unique ordering clinicians in the fourth quarter.
up slightly from the prior quarter. With approximately 4,110 unique-ordering clinicians during the last 12 months, we penetrated 46% of our current target market of 9,000 dermatology clinicians. Third, our average quarterly utilization or average number of tests ordered per unique-ordering clinician was 7.2 billable samples in the fourth quarter.
versus 7.5 in Q3 and 6.5 in the year-ago period. Finally, Medicare samples are represented about 24% of our billable samples in the fourth quarter, which was unchanged as a percentage from the third quarter and up modestly from 23% last year.
We continue to evaluate and implement tactics to bolster penetration of this large market segment, which represents about half of the annual total biopsies for melanoma. Focusing next on operating expenses. Cost of assay revenue was 3.3 million, a 9% year-over-year increase, yielding an assay gross margin of negative 22%.
The increase in cost of assay revenue was primarily due to increased demand. The reduction in assay gross margin from negative 1% in the year-ago period was primarily the result of lower ASP. Sales and marketing expenses were 13.6 million during the fourth quarter, a 2% year-over-year increase, largely resulting from higher employer-related costs and market expenditures.
Research and development expenses were $5.1 million, a 15% decrease from the year-ago period, primarily due to lower lab and clinical study costs. General administrative expenses were $9.8 million, 37% higher compared to the fourth quarter of 2021.
The increase was driven by higher infrastructure costs for our new building and increased employer-related costs. As a result of our continued focus on operational efficiency, we expect total cash operating expenses will be slightly down for 2023 despite planned volume growth. Net loss for the fourth quarter was 28.2 million, which included 5.3 million and non-cash stock income.
sample volumes and ASP in the near term. We expect to steadily grow DMT volumes during 2023, but ASP is difficult to forecast due to potential delayed positive impact of recent cover duens and potential reduced non-contracted commercial payment payments. As a result, we're not providing revenue guidance until we have better visibility.
additional operating efficiencies. We believe we have sufficient funds, along with the ability to access capital, for cash runway through the third quarter of 2024, or more than 18 months from today.
We believe we have sufficient funds along with the ability to access capital for cash runway through the third quarter of 2024 or more than 18 months from today. Now I'll turn the call back to John .
Thanks, Kevin. As we mentioned today, I am transitioning from my role as Dermtech CEO . After 11 years leading this great company, it's the right time. When I look out nine to 12 months at the leadership needs for Dermtech, I believe a CEO with a strong background in scaling around a large commercial opportunity will be an ideal fit. We have achieved significant adoption, broad payer coverage with a deep pipeline of additional payer opportunities andChef Bob!
and built out the infrastructure for scale to capture the tremendous opportunity. In front of us, I remain fully committed to Dermtek until a successor is found that can build on my vision to transform dermatologic care for our non-invasive genomics platform. I am grateful for the dedication and perseverance of my team and all the hard work they put into building a strong foundation for our long-term success.
I'm reminded by patients and physicians almost daily why it's important that we succeed as we are potentially saving lives and changing the way melanoma is detected and treated. With that, I'll share an especially powerful patient story that encapsulates why I have led this company for the past 11 years.
One of our patients had a large scar from a previous excisional surgery on a pigmented lesion that ended up being benign, and they therefore refused a biopsy on a different suspicious pigmented lesion.
As a result, she was referred to a different dermatologist office that used our technology. The new physician administered the DMT, which came back positive and was further confirmed through histopathology as early stage melanoma.
to a different dermatologist's office that used our technology. The new physician administered the DMT, which came back positive, and was further confirmed through histopathology as early stage melanoma. [...]
Unfortunately, with diagnosed with melanoma, she can be effectively cured with a wide excision because it was caught early. If our technology wasn't available and she neglected to have the lesion assessed, this positive outcome may not have occurred. This is a great example of how our non-invasive test was able to accurately inform physician decision-making and improve patient care. With that, I'll turn things back to the operator for Q&A.
best wishes going forward. Kevin, I was just hoping maybe you could provide a little bit of extra help on stretching the cash runway out. It seems that it would need to require a pretty significant gap up in revenues or a significant gap down in expenses to give you the full seven quarters. You know from a burn perspective, you're down at you know call it 18 million a quarter versus what you've been burning in the past. Any additional guidance you could provide to us there?
Yeah, we're committed to finding additional cost savings throughout the year and monetizing our healthy demand. We do expect the recent pair of lins to improve ASPs and we've demonstrated that we can support higher volumes through improved efficiency and reduced expenses, even with our already highly efficient operation. We may deploy the ATM opportunistically in the future upon catalysts and if market conditions are favorable while being mindful of the cost of capital in this environment. And I know it's only been a couple months since you guys had the early January announcements above New
specifics, we believe the tricare agreement will probably help the most, but we already know that it will take a few months for them to update some of their policy manuals before we can get paid on a routine basis. Outside of that one, I'd say the Louisiana contract is the one that will, is already starting to see some benefit, and again, we had some healthy volumes from that territory, and it was growing nicely too. So those are the two that will probably have.
level to increase that penetration. Yeah, you know, this has always been a challenge, Tom, as we've always talked about, and we also ask ourselves why it's been stuck at that. I would just note that, you know, as our total volume increases, even though it's at 24% the absolute number of samples that come from Medicare has been growing nicely. We do provide incentive for sales force to...
and we'll eventually hit on one of these things that really works.
Appreciate it. Thanks, guys. Thank you.
Our next question comes from Max Masuchi with Cowan. You may proceed. Hi, this is Stephanie Ahn for Max. Thanks for taking my question and congrats, John , on a long tenure at CEO . So for my first question, I was just curious, so on your Q3 call, you indicated that.
You had the updated Medicare code edit that was implemented at the beginning of October and was backdated to early 2020 when the Medicare LPD went effective. So, I just wanted to make sure, have all your Medicare challenges been resolved at this point, and were you able to appeal and recapture any of the commercial payer revenues that were also affected by the code edits?
Yeah, I'd say many of the Medicare challenges have been resolved with decode edit if there is a claim that comes in with three or more samples on the same data service. The entire claim is still denied. We do have to appeal that claim and we do still have a very good track record of overturning those appeals when we get medical records. It just extends our own way of the cash coming in the door.
in terms of the commercial payers, we still haven't seen a lot of benefits from that code edit in terms of being able to appeal prior claims that had more than the one body side being denied. So it's something that we continue to work on. Got it, thanks for that clarification. And then any update you can provide on your progress in conversations with national commercial payers. So I know you recently secured a pair when to some blue cross blue shield plans that are part of the app line.
lab benefit manager, which also has a partnership with Optum. Does this in any way help your conversations with national commercial payers? Yes, look, we've had very comprehensive meetings and submitted full dossiers to all the national payers in the last three to four months. They've all committed to giving us a comprehensive review this year. We try to pin them down on exactly when that review is going to occur. They don't really give us the exact
on that front this year. We just don't know the exact timing because they never tell you exactly when they're going to pick it up, unfortunately. We try to get it out then, but we have submitted them, had very thorough discussions, multiple champions within different pairs to try to drive success of those national pairs. So I feel like we're teed up as best as we could for the year going forward.
Thanks for that color. And then if I can squeeze in one more quick one. So you now estimate that you have cash runways through Q3-24. Can you just remind us what are some of the changes to the operational efficiencies that you're making to extend the runway? Is there any specific initiatives that have changed since last quarter that have changed
allows you to extend your cash runway? We just continue to look for ways to reduce discretionary spend categories. We've delayed many planned hires and we are working to sublease extra space in our new headquarters buildings since we haven't grown as quickly as originally thought two years ago when we first were identifying the building. And we also continue to only make limited targeted investments in our pipeline.
We don't expect to move forward with broad commercialization activity for any new products until we see improvement in our ISP melanoma test. Got it. Understood. Thanks so much for taking all my questions. Thank you. Thank you. Our next question comes from Mark Casaro with BTIG. You may proceed. Hey, guys. Thanks for taking the questions. John , you'll be missed, but look forward to working with you for the remaining several months that you're at the helm.
I guess, yeah, I'd love to ask about the volumes in the Q4. They were down 3% sequentially. I know on the Q3 call you guys called out seasonality, holiday impacts, fewer working days. In your opinion, do you think that was probably what caused the slight dip sequentially? And then maybe just can you clarify, I think you talked about mid single digit growth.
quarter over quarter in Q1, just confirming that that's on volumes and perhaps revenue. Maybe could you clarify that? Yeah, that's really on volumes. You know, we had some hangover from the payer friction early in the year, but I would say now we have a very healthy selling environment now. We've really figured out how to address all the sort of...
I refer to it as payer hazing, but sort of the redirection notices that the payers tend to send our customers. We figured out how to address that, turn it into a positive, and we're really working through that. So I think the environment's gotten better. So we do see the volumes now starting to pick up, and we do expect to grow this quarter. We thought we knew that fourth quarter was going to be a little bit softer. We'd just seen that. Dermatology is a specialty where around holiday periods they take a lot of time off, and we have to anticipate that. We still kind of had our maximum sort of...
interference from payers during that time period. So that probably added it to it, but that's just kind of what we see with our business, around the holidays. Durham's will take off the entire last two weeks of the quarter in many cases. And so those are things that we have to plan for, and that's why we saw it and we anticipated that. So we're actually pretty happy with where we wound up.
given the things that we were seeing, and we knew that seasonality that was approaching. Yep, that makes sense. And then, Kevin, on the guidance, I know for 2022, volumes were pretty solid, up 53% year over year. I know for 2023, you're not initiating full-year guidance. But, you know, is it reasonable to think that you could potentially repeat
Somewhere in the magnitude of 40 to 50 percent volume growth in 2023, I guess what I'm asking is, are there any changes to the underlying environment, whether it's commercial or you're intention to commit to investing in commercial this year that would impact the volume trajectory in 2023? As we mentioned, we do expect that in mid-single-
I know perhaps you may put on pause one of the programs, but just give us a sense for an update with respect to where that program stands and your commitment to continue to advance that product.
Are you asking about the Luminate product? Yeah, Luminate. Yeah, so that product, in general, as Kevin mentioned, we slowed all the things down. We're continuing to progress those programs but at a slower pace. Obviously, we saw some improvement in our R&D spend. The Luminate product actually works fantastically well.
It's been pretty much validated and can demonstrate that it shows a picking up patients that have an increased risk for skin cancer. So we're excited about the product, but we aren't going to do anything major from a product introduction. We will pilot that. We want to get some of the selling metrics around that. It's already incorporated into our budget and our plans for a reduced spend this year. So we will do some test piloting of that in the middle of this year. We're excited about it. I mean, it really works phenomenally well. We were...
exceeded our expectations on how well the product works. And so we're excited to sort of test it out, but we're not, we're going to, you know, it's going to be controlled. Until the environment improves, we've got to be very cost-conscious. We can't be excessive with a big product launch. We're going to just test it out, get some of the metrics, and then inform our planning going forward with that product.
We're making progress. Go ahead. Awesome, awesome. Thank you for that. John , I've received a couple of questions from investors. I know you addressed it in the prepared remarks that perhaps another executive can come in with maybe some more commercial acumen, if you will. But you've done a pretty good job driving strong volume growth. I guess.
Can you maybe elaborate as to why now is the right time to, you know, after 11 years at Durham Tech to move on? Sure. You know, it's never easy. These transitions and the timing is always, always seems difficult. But this is really just about long term planning. And my job right now is to anticipate the needs of the company looking out nine to 12 months. And if I look at where we are going to be with payers, with the commercial progress, with the infrastructure that we have.
it's going to be the perfect time to find someone who's got that leader that's adept at scaling around a very large commercial opportunity. I've always said I'm a company creator and a builder. That's my skill set. And I think the next phase of growth can be driven by someone with a different skill set. It's really an unselfish move. I just feel like it's in the best interest for Dermtech.
And it looks funny the time you may be now, but when you look, it's going to take six months. We don't want to be rushed with it six to nine months and we'll give ourselves plenty of time to find the best person at that point where we are in our growth phase is going to make sense to everybody. Thank you. Our next question comes from Francois Walsh with Oppenheimer. You may proceed. All right. Thanks for taking the question and congrats, John , on the long 10 year here.
So I think just – I was just wondering in terms of the national payers, can you just maybe discuss – there's been a lot of wins on the regional side, but what a win this year from one national payer would do and how it would impact the business. And then is there any correlation between – No hunt, no Taylor campaign.
it seems like you've already proposed stuff to the payers, but can you just discuss maybe trust too, and the readout and what that can do for reimbursement. So as your first question around the impact of the ASP that the national payer would have, is that what you're asking? Yes. Yeah, it's gonna be a very meaningful impact. You know, we can't...
We think this is going to be a great study. You know, we did the TRUST-1. The TRUST-1 had a component of a prospective element that had about 300 patients that were prospectively followed. But this study is going to be much larger, 3,000 patients prospectively followed for up to a year. That really tells you what's going on with a pigmented lesion and if there's melanoma.
and by following it to see if it changes. And so that's what we're doing in that study. It'll be a very robust data set. We'll also have a very big data set on positive cases. And we think it's just a good follow-up study to the TRUST one, much larger, and it's just going to add to our tremendous database of publications and evidence that says this test is very important, does what it's supposed to do. We're excited to get it done and announce the top-line results in the back half of the year.
Okay, great. And is there maybe a clear impact correlation here on the impact it would have on the reimbursement or? Well, I think payers always love more evidence, right? And it's always important to be putting out evidence so to doctors. So we have a few publications that should be coming out here on some smaller studies that we've done in 2022. But this is really the biggest effort we took in 2022 to start, which was around this.
this long-term trust to study. I just, we always believe it's important to generate data, payers love more data. You know, if there's some that are still on the fence, I think this study is going to do a lot to push them over. And so we just want to get it done and add to that tremendous database that we have.
And then in terms of penetration of the docks, you mentioned 46 percent penetration. Where would you like to end up or what would you think would be reasonable in terms of the peak penetration of the docks? Well, I think if you look at any kind of technology through there, getting heavy levels of penetration, more than half would be ideal. As we noted, we've only targeted the first 9,000 doctors based on efficiency of scaling.
easing, can you just maybe give us a little color as to what you base that statement on? Well, so, you know, one, we've been able to get out in front when they're sending redirectional letters and explain to our customers what that means, and we actually turn the customer into an ally of ours and help us go back to those plans that send those...
And so we've turned that around and we're out in front of that now and the sales reps know to be on the lookout for any of those things. And so we've seen that dropping off. We haven't seen as much of that in this quarter. We've been able to get some of the folks that got those letters and kind of shut down. We've got them back on track. The other thing we've done is EMR integration. So one of the challenges the payers are doing that creates friction is they require medical records even for the first claim submission. So
We've now done some technology integration where instead of us having to go have the doctor pull records and provide them to us, it's just going to be done seamlessly, electronically with our EMR integrations. We've got a tremendous scale up in the EMR integrations with our customers and we have that functionality that will now be added and we can just pull those records without having to put a lot of burden and administrative pain on the customer. We think that's going to be important and so we're excited about those opportunities to reduce that friction. Thank you. Thank you. Our next question comes from Alex Nowak with Craig Hallam Capital Group. You may proceed.
All right, great. Good afternoon, everyone. This is Connor for Alex. Maybe first, John , appreciate the color on what we're looking for in the next leader of DermTech, kind of looking for somebody with a different set of skills. I wanted to just pull on that a little more. I mean, what sort of individual is needed to really take DermTech to the next level? I mean, is this primarily an external search or has there been an effort to build out an internal bench? So we have not started the process. We're going to try to do it on people fromAmro anymore to just check my Snapshot of where you're going to start.
opportunity with the melanoma test and clearly somebody who has brought that kind of scale to a commercial opportunity like we have is going to be important along with public company experience and things like that. Those are some of the things, but we'll scope that out in the coming...
weeks and we'll get started on it and work through it. I'll be here. I'm not looking to leave until that person is identified and we'll take as long as it takes to get it done. Got it. That makes perfect sense. And then maybe, I mean, I understand the cadence of reimbursement timing is hard to predict, and I won't ask you to.
to give a specific impact, but I mean just from the comments on the call like these small regional payer wins and then and the TRICARE win over the last few weeks you know it was mentioned that this kind of you know addition to covered lives is similar to adding you know the second largest national payer and then you know it was also mentioned that you know adding a national payer would have a meaningful impact to ASPs so I mean is it reasonable to think that ASPs can you know potentially reverse course and maybe second half 23 or early in the 24.
I think we're already seeing it. That's why we talk about if you look at the interquarter ASP for the up-to-date accruals for the fourth quarter it was almost 240 and that's you know our peak I think in the prior course is around 250-255 so I think it's already happening. Now we need to see we need to really confirm that and we could still see some erosion with the non-contracted payers but
But I like what we're seeing now. I think the worst of it's behind us. The low ASP is just because we have all those prior period write downs. We believe we flushed the majority of those through. And, but we'll have to see. We just got to see what's happening. That's why we don't want to give guidance because we got to see what's happening to make sure things have stabilized. We believe that's happening.
and we'll know more in the next quarter. Okay, got it. Thank you for the update. Thank you, and as a reminder, to ask a question, you will need to press star 11 on your telephone.
Our next question comes from Andrew Brackman with William Blair. You may proceed. Hey guys, thanks for sneaking me in. John , certainly echoed the sentiment here on what you built. A lot's been asked, but John , I think you called out in your script the MCCN improvement building throughout 2022. Can you sort of level set us on that specifically and how that's helping you in the field? Thanks.
Well, I mean the NCCN has continued to improve that guideline they issued several years ago. What they did this year is they said that our test was useful when in a dermoscopically suspicious lesion. We think that's an important improvement because if you read some policies out there...
where they have a negative or an ENI type policy, they'll say, well, we're not sure how much the DermTech melanoma test adds over dermoscopy. But NCCN now is basically saying that this does help even in a dermoscopically suspicious lesion. So we think that's a good addition and a good improvement to the language of our NCCN guidance. It's a 2A recommendation. That means it's unanimous by the 21 members on the panel and unanimously are approving that language. There's only one.
rung higher, which is a one. Very few technologies get a one. So we're very pleased with the progress we've made with the NCCN and their continued endorsement of the test.
Okay, thanks for that. And then Kevin, maybe one for you. I think I got the comments on spending for the year, but I may have missed any comments around pacing of that spend. Anything we should consider there for on the off-ex line. Thanks. No, no, I think, you know, we look at the run rate that we're exiting Q4 and in Q4, we already demonstrated some cost-saving initiatives and being able to reduce op-x.
We continue to take that mindset going forward. We do have our plans for 2023 already settled, but we'll continue to look for more savings beyond those plans. Got it. Thanks, Josh. Thank you. Our next question comes from Mason Carico with Stevens. You may proceed.
Hey guys, this is Jacob on information. Thanks for taking our questions. Lots of things covered here, so I'll just ask a couple quick ones. Following up on the improvement to the NCC and recommendation for the DMT. With having discussions with private payers, did it seem like this is something that could be key to bringing on more of those payers that are on the fence on board? Yeah, we believe so. We think it's important and when you follow the three year history of that improving recommendation, we think that's
relation trends for clinicians utilizing your tests. Have you seen stability in your mix for three or more tests per patient, did it, or has that turned it high recently? Thanks. Yeah, we've seen stabilization in that. And so the pressure that come with that is subsiding. And then when we look at the broader buckets, that's, you know, M wanna apologize, No.
we saw a little bit of a decrease in the average utilization, as we mentioned in the fourth quarter, sequentially. And again, we think that's also due to the payer friction. So a physician has difficulty scaling up and increasing usage when there's more and more requests for medical records for each test that they're running. So as we implement those EMR integrations and as we've figured out the right appropriate way to respond to the redirection letters, we think that friction will go down and will lead to increased