CASTLE BIOSCIENCES INC, 10-Q filed on 11/4/2024
Quarterly Report
v3.24.3
Cover - shares
9 Months Ended
Sep. 30, 2024
Oct. 28, 2024
Cover [Abstract]    
Document Type 10-Q  
Document Quarterly Report true  
Document Period End Date Sep. 30, 2024  
Document Transition Report false  
Entity File Number 001-38984  
Entity Registrant Name CASTLE BIOSCIENCES, INC.  
Entity Incorporation, State or Country Code DE  
Entity Tax Identification Number 77-0701774  
Entity Address, Address Line One 505 S. Friendswood Drive  
Entity Address, Address Line Two Suite 401  
Entity Address, City or Town Friendswood  
Entity Address, State or Province TX  
Entity Address, Postal Zip Code 77546  
City Area Code 866  
Local Phone Number 788-9007  
Title of 12(b) Security Common Stock, $0.001 par value per share  
Trading Symbol CSTL  
Security Exchange Name NASDAQ  
Entity Current Reporting Status Yes  
Entity Interactive Data Current Yes  
Entity Filer Category Accelerated Filer  
Entity Small Business false  
Entity Emerging Growth Company false  
Entity Shell Company false  
Entity Common Stock, Shares Outstanding   28,007,301
Entity Central Index Key 0001447362  
Current Fiscal Year End Date --12-31  
Document Fiscal Year Focus 2024  
Document Fiscal Period Focus Q3  
Amendment Flag false  
v3.24.3
CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($)
$ in Thousands
Sep. 30, 2024
Dec. 31, 2023
Current Assets    
Cash and cash equivalents $ 94,959 $ 98,841
Marketable investment securities 184,826 144,258
Accounts receivable, net 50,261 38,302
Inventory 6,572 7,942
Prepaid expenses and other current assets 8,154 6,292
Total current assets 344,772 295,635
Long-term accounts receivable, net 1,106 1,191
Property and equipment, net 44,383 25,433
Operating lease assets 11,904 12,306
Goodwill and other intangible assets, net 110,569 117,335
Other assets – long-term 1,831 1,440
Total assets 514,565 453,340
Current Liabilities    
Accounts payable 6,810 10,268
Accrued compensation 27,672 28,945
Operating lease liabilities 1,745 1,137
Other accrued and current liabilities 8,068 7,317
Total current liabilities 44,295 47,667
Long-term debt 10,015 0
Noncurrent operating lease liabilities 14,691 14,173
Noncurrent finance lease liabilities 289 25
Deferred tax liability 4,220 206
Total liabilities 73,510 62,071
Commitments and Contingencies (Note 12)
Stockholders’ Equity    
Preferred stock, $0.001 par value per share; 10,000,000 shares authorized as of September 30, 2024 and December 31, 2023; no shares issued and outstanding as of September 30, 2024 and December 31, 2023 0 0
Common stock, $0.001 par value per share; 200,000,000 shares authorized as of September 30, 2024 and December 31, 2023; 27,975,808 and 27,410,532 shares issued and outstanding as of September 30, 2024 and December 31, 2023, respectively 28 27
Additional paid-in capital 650,270 609,477
Accumulated deficit (209,716) (218,371)
Accumulated other comprehensive income 473 136
Total stockholders’ equity 441,055 391,269
Total liabilities and stockholders’ equity $ 514,565 $ 453,340
v3.24.3
CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares
Sep. 30, 2024
Dec. 31, 2023
Statement of Financial Position [Abstract]    
Preferred stock, par value (in dollars per share) $ 0.001 $ 0.001
Preferred stock, shares authorized (in shares) 10,000,000 10,000,000
Preferred stock, shares issued (in shares) 0 0
Preferred stock, shares outstanding (in shares) 0 0
Common stock, par value (in dollars per share) $ 0.001 $ 0.001
Common stock, shares authorized (in shares) 200,000,000 200,000,000
Common stock, shares issued (in shares) 27,975,808 27,410,532
Common stock, shares outstanding (in shares) 27,975,808 27,410,532
v3.24.3
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (UNAUDITED) - USD ($)
shares in Thousands, $ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Income Statement [Abstract]        
NET REVENUES $ 85,782 $ 61,493 $ 245,758 $ 153,668
OPERATING EXPENSES        
Cost of sales (exclusive of amortization of acquired intangible assets) 15,609 11,319 44,022 32,559
Research and development 12,323 12,923 40,268 40,624
Selling, general and administrative 50,499 44,619 150,082 136,062
Amortization of acquired intangible assets 2,272 2,272 6,766 6,742
Total operating expenses, net 80,703 71,133 241,138 215,987
Operating income (loss) 5,079 (9,640) 4,620 (62,319)
Interest income 3,404 2,769 9,544 7,504
Interest expense (201) (2) (485) (9)
Income (loss) before income taxes 8,282 (6,873) 13,679 (54,824)
Income tax expense 6,013 32 5,024 62
Net income (loss) $ 2,269 $ (6,905) $ 8,655 $ (54,886)
Earnings (loss) per share:        
Basic (in dollars per share) $ 0.08 $ (0.26) $ 0.31 $ (2.05)
Diluted (in dollars per share) $ 0.08 $ (0.26) $ 0.30 $ (2.05)
Weighted-average shares outstanding:        
Basic (in shares) 27,840 26,834 27,659 26,725
Diluted (in shares) 29,401 26,834 28,838 26,725
v3.24.3
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) (UNAUDITED) - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Statement of Comprehensive Income [Abstract]        
Net income (loss) $ 2,269 $ (6,905) $ 8,655 $ (54,886)
Other comprehensive income:        
Net unrealized gain on marketable investment securities 645 73 337 310
Comprehensive income (loss) $ 2,914 $ (6,832) $ 8,992 $ (54,576)
v3.24.3
CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY (UNAUDITED) - USD ($)
$ in Thousands
Total
Common Stock
Additional Paid-in Capital
Accumulated Deficit
Accumulated Other Comprehensive (Loss) income
Common stock, shares outstanding, beginning balance (in shares) at Dec. 31, 2022   26,553,681      
Beginning balance at Dec. 31, 2022 $ 399,150 $ 27 $ 560,409 $ (160,905) $ (381)
Increase (Decrease) in Stockholders' Equity [Roll Forward]          
Stock-based compensation expense 13,525   13,525    
Exercise of common stock options (in shares)   30,495      
Exercise of common stock options 95   95    
Issuance of common stock from vested restricted stock units and payment of employees' taxes (in shares)   24,835      
Issuance of common stock from vested restricted stock units and payment of employees’ taxes (314)   (314)    
Issuance of common stock under the employee stock purchase plan (in shares)   77,190      
Issuance of common stock under the employee stock purchase plan 1,652   1,652    
Net unrealized gain (loss) on marketable investment securities 245       245
Net income (loss) (29,204)     (29,204)  
Common stock, shares outstanding, ending balance (in shares) at Mar. 31, 2023   26,686,201      
Ending balance at Mar. 31, 2023 385,149 $ 27 575,367 (190,109) (136)
Common stock, shares outstanding, beginning balance (in shares) at Dec. 31, 2022   26,553,681      
Beginning balance at Dec. 31, 2022 399,150 $ 27 560,409 (160,905) (381)
Increase (Decrease) in Stockholders' Equity [Roll Forward]          
Net unrealized gain (loss) on marketable investment securities 310        
Net income (loss) (54,886)        
Common stock, shares outstanding, ending balance (in shares) at Sep. 30, 2023   26,890,488      
Ending balance at Sep. 30, 2023 385,783 $ 27 601,618 (215,791) (71)
Common stock, shares outstanding, beginning balance (in shares) at Mar. 31, 2023   26,686,201      
Beginning balance at Mar. 31, 2023 385,149 $ 27 575,367 (190,109) (136)
Increase (Decrease) in Stockholders' Equity [Roll Forward]          
Stock-based compensation expense 12,849   12,849    
Exercise of common stock options (in shares)   15,606      
Exercise of common stock options 89   89    
Issuance of common stock from vested restricted stock units and payment of employees' taxes (in shares)   82,201      
Issuance of common stock from vested restricted stock units and payment of employees’ taxes (534)   (534)    
Net unrealized gain (loss) on marketable investment securities (8)       (8)
Net income (loss) (18,777)     (18,777)  
Common stock, shares outstanding, ending balance (in shares) at Jun. 30, 2023   26,784,008      
Ending balance at Jun. 30, 2023 378,768 $ 27 587,771 (208,886) (144)
Increase (Decrease) in Stockholders' Equity [Roll Forward]          
Stock-based compensation expense 13,043   13,043    
Exercise of common stock options (in shares)   3,656      
Exercise of common stock options 13   13    
Issuance of common stock from vested restricted stock units and payment of employees' taxes (in shares)   40,142      
Issuance of common stock from vested restricted stock units and payment of employees’ taxes (271)   (271)    
Issuance of common stock under the employee stock purchase plan (in shares)   62,682      
Issuance of common stock under the employee stock purchase plan 1,062   1,062    
Net unrealized gain (loss) on marketable investment securities 73       73
Net income (loss) (6,905)     (6,905)  
Common stock, shares outstanding, ending balance (in shares) at Sep. 30, 2023   26,890,488      
Ending balance at Sep. 30, 2023 $ 385,783 $ 27 601,618 (215,791) (71)
Common stock, shares outstanding, beginning balance (in shares) at Dec. 31, 2023 27,410,532 27,410,532      
Beginning balance at Dec. 31, 2023 $ 391,269 $ 27 609,477 (218,371) 136
Increase (Decrease) in Stockholders' Equity [Roll Forward]          
Stock-based compensation expense 12,675   12,675    
Exercise of common stock options (in shares)   19,066      
Exercise of common stock options 65   65    
Issuance of common stock from vested restricted stock units and payment of employees' taxes (in shares)   44,830      
Issuance of common stock from vested restricted stock units and payment of employees’ taxes (474)   (474)    
Issuance of common stock under the employee stock purchase plan (in shares)   111,241      
Issuance of common stock under the employee stock purchase plan 1,708 $ 1 1,707    
Net unrealized gain (loss) on marketable investment securities (247)       (247)
Net income (loss) (2,534)     (2,534)  
Common stock, shares outstanding, ending balance (in shares) at Mar. 31, 2024   27,585,669      
Ending balance at Mar. 31, 2024 $ 402,462 $ 28 623,450 (220,905) (111)
Common stock, shares outstanding, beginning balance (in shares) at Dec. 31, 2023 27,410,532 27,410,532      
Beginning balance at Dec. 31, 2023 $ 391,269 $ 27 609,477 (218,371) 136
Increase (Decrease) in Stockholders' Equity [Roll Forward]          
Exercise of common stock options (in shares) 111,223        
Net unrealized gain (loss) on marketable investment securities $ 337        
Net income (loss) $ 8,655        
Common stock, shares outstanding, ending balance (in shares) at Sep. 30, 2024 27,975,808 27,975,808      
Ending balance at Sep. 30, 2024 $ 441,055 $ 28 650,270 (209,716) 473
Common stock, shares outstanding, beginning balance (in shares) at Mar. 31, 2024   27,585,669      
Beginning balance at Mar. 31, 2024 402,462 $ 28 623,450 (220,905) (111)
Increase (Decrease) in Stockholders' Equity [Roll Forward]          
Stock-based compensation expense 13,179   13,179    
Exercise of common stock options (in shares)   1,779      
Exercise of common stock options 8   8    
Issuance of common stock from vested restricted stock units and payment of employees' taxes (in shares)   123,576      
Issuance of common stock from vested restricted stock units and payment of employees’ taxes (615)   (615)    
Net unrealized gain (loss) on marketable investment securities (61)       (61)
Net income (loss) 8,920     8,920  
Common stock, shares outstanding, ending balance (in shares) at Jun. 30, 2024   27,711,024      
Ending balance at Jun. 30, 2024 423,893 $ 28 636,022 (211,985) (172)
Increase (Decrease) in Stockholders' Equity [Roll Forward]          
Stock-based compensation expense 13,027   13,027    
Exercise of common stock options (in shares)   90,378      
Exercise of common stock options 1,571   1,571    
Issuance of common stock from vested restricted stock units and payment of employees' taxes (in shares)   117,959      
Issuance of common stock from vested restricted stock units and payment of employees’ taxes (1,294)   (1,294)    
Issuance of common stock under the employee stock purchase plan (in shares)   56,447      
Issuance of common stock under the employee stock purchase plan 944   944    
Net unrealized gain (loss) on marketable investment securities 645       645
Net income (loss) $ 2,269     2,269  
Common stock, shares outstanding, ending balance (in shares) at Sep. 30, 2024 27,975,808 27,975,808      
Ending balance at Sep. 30, 2024 $ 441,055 $ 28 $ 650,270 $ (209,716) $ 473
v3.24.3
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($)
$ in Thousands
9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
OPERATING ACTIVITIES    
Net income (loss) $ 8,655 $ (54,886)
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:    
Depreciation and amortization 10,229 9,106
Stock-based compensation expense 38,881 39,417
Deferred income taxes 3,708 13
Accretion of discounts on marketable investment securities (5,072) (3,851)
Other 208 284
Change in operating assets and liabilities:    
Accounts receivable (11,874) (13,779)
Prepaid expenses and other current assets (1,679) (892)
Inventory 1,370 (1,789)
Operating lease assets 1,002 (590)
Other assets (35) (455)
Accounts payable (3,802) 2,693
Operating lease liabilities (863) 1,093
Accrued compensation (1,273) (1,953)
Other accrued and current liabilities 1,046 1,376
Net cash provided by (used in) operating activities 40,501 (24,213)
INVESTING ACTIVITIES    
Purchases of property and equipment (20,759) (9,828)
Proceeds from sale of property and equipment 11 10
Purchases of marketable investment securities (158,409) (136,693)
Proceeds from maturities of marketable investment securities 123,250 138,000
Net cash used in investing activities (55,907) (8,511)
FINANCING ACTIVITIES    
Proceeds from exercise of common stock options 1,644 197
Payment of employees’ taxes on vested restricted stock units (2,383) (1,119)
Proceeds from contributions to the employee stock purchase plan 2,334 2,027
Repayment of principal portion of finance lease liabilities (71) (106)
Proceeds from issuance of term debt 10,000 0
Net cash provided by financing activities 11,524 999
NET CHANGE IN CASH AND CASH EQUIVALENTS (3,882) (31,725)
Beginning of period 98,841 122,948
End of period 94,959 91,223
DISCLOSURE OF NON-CASH INVESTING AND FINANCING ACTIVITIES:    
Accrued purchases of property and equipment 1,570 902
Operating lease assets obtained in exchange for lease obligations 607 499
Decrease in operating lease assets with corresponding change in lease liabilities (7) 0
Finance lease assets obtained in exchange for lease obligations 166 0
Property and equipment acquired with tenant improvement allowance $ 1,389 $ 1,281
v3.24.3
Organization and Description of Business
9 Months Ended
Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]  
Organization and Description of Business Organization and Description of Business
Castle Biosciences, Inc. (the ‘‘Company”, “we”, “us” or “our”) was incorporated in the state of Delaware on September 12, 2007. We are a commercial-stage diagnostics company focused on providing clinicians and their patients with personalized, clinically actionable information to inform treatment decisions and improve health outcomes. We are based in Friendswood, Texas (a suburb of Houston, Texas) and our laboratory operations are conducted at our facilities located in Phoenix, Arizona and Pittsburgh, Pennsylvania.
v3.24.3
Summary of Significant Accounting Policies
9 Months Ended
Sep. 30, 2024
Accounting Policies [Abstract]  
Summary of Significant Accounting Policies Summary of Significant Accounting Policies
Basis of Presentation
Our unaudited condensed consolidated financial statements include the accounts of Castle Biosciences, Inc. and our wholly owned subsidiaries and have been prepared in conformity with accounting principles generally accepted in the United States of America (‘‘U.S. GAAP’’). All intercompany accounts and transactions have been eliminated in consolidation.
We have a history of recurring net losses and negative cash flows and as of September 30, 2024, we had an accumulated deficit of $209.7 million. We believe our $95.0 million of cash and cash equivalents and $184.8 million of marketable investment securities as of September 30, 2024, and anticipated revenue from our test reports, will be sufficient to meet our cash requirements through at least the 12-month period following the date that these unaudited condensed consolidated financial statements were issued.
Unaudited Interim Financial Information
The accompanying condensed consolidated balance sheet as of September 30, 2024; the condensed consolidated statements of operations, the condensed consolidated statements of comprehensive income (loss) and the condensed consolidated statements of stockholders’ equity, each for the three and nine months ended September 30, 2024 and 2023; and the condensed consolidated statements of cash flows for the nine months ended September 30, 2024 and 2023 are unaudited. The unaudited interim condensed consolidated financial statements have been prepared on the same basis as the audited annual financial statements and, in the opinion of management, reflect all adjustments, which include only normal recurring adjustments, necessary for the fair statement of our consolidated financial position as of September 30, 2024, the results of our consolidated operations for the three and nine months ended September 30, 2024 and 2023 and our consolidated cash flows for the nine months ended September 30, 2024 and 2023. The financial data and other information disclosed in these notes related to the three and nine months ended September 30, 2024 and 2023 are also unaudited. The results for the three and nine months ended September 30, 2024 are not necessarily indicative of results to be expected for the year ending December 31, 2024, any other interim periods, or any future year or period. The balance sheet as of December 31, 2023 included herein was derived from the audited financial statements as of that date. Certain disclosures have been condensed or omitted from the unaudited interim consolidated financial statements. These unaudited condensed consolidated financial statements should be read in conjunction with our audited consolidated financial statements included in our Annual Report on Form 10-K for the year ended December 31, 2023 filed with the Securities and Exchange Commission (“SEC”) on February 28, 2024 (the “2023 10-K”).
Use of Estimates
The preparation of consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities as of the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates include revenue recognition, the valuation of stock-based compensation, assessing future tax exposure and the realizability of deferred tax assets, the useful lives and recoverability of long-lived assets, the goodwill impairment test, the valuation of acquired intangible assets and the valuation of contingent consideration and other contingent liabilities. We base these estimates on historical and anticipated results, trends, and various other assumptions that we believe are reasonable under the circumstances, including assumptions as to future events. These estimates form the basis for making judgments about the carrying values of assets and liabilities and recorded revenues and expenses that are not readily apparent from other sources. Actual results could differ from those estimates and assumptions.
Cash and Cash Equivalents including Concentrations of Credit Risk
Cash equivalents consist of short-term, highly liquid investments with original maturities of three months or less. Our cash equivalents consist of money market funds, which are not insured by the Federal Deposit Insurance Corporation (“FDIC”), that are primarily invested in short-term U.S. government obligations. Cash deposits at financial institutions may exceed the amount of insurance provided by the FDIC. Management believes that we are not exposed to significant credit risk on our cash deposits due to the financial position of the financial institutions in which deposits are held.
Marketable Investment Securities
All debt securities are recognized in accordance with Financial Accounting Standards Board (‘‘FASB’’) Accounting Standards Codification (‘‘ASC’’) Topic 320, Investments-Debt Securities (‘‘ASC 320’’). Management determines the appropriate classification of securities at the time of purchase and re-evaluates such determination at each balance sheet date. All debt securities are classified as available-for-sale and are recorded at fair value in accordance with ASC 320. We recognize the unrealized gains and losses related to changes in fair value as a separate component of accumulated other comprehensive loss within total stockholders’ equity, net of any related deferred income tax effects, on our condensed consolidated balance sheets. Premiums or discounts from par value are amortized to interest income over the life of the underlying investment. Realized gains and losses on available-for-sale securities are calculated at the individual security level and included in interest income in the condensed consolidated statements of operations. Impairments of available-for-sale debt securities, if any, are recorded in our unaudited condensed consolidated statements of operations. See Notes 5 and 11 for further details.
Revenue Recognition
In accordance with ASC Topic 606, Revenue from Contracts with Customers (“ASC 606”), we follow a five-step process to recognize revenues: (1) identify the contract with the customer, (2) identify the performance obligations, (3) determine the transaction price, (4) allocate the transaction price to the performance obligations and (5) recognize revenues when the performance obligations are satisfied. We have determined that we have a contract with the patient when the treating clinician orders the test. Our contracts generally contain a single performance obligation, which is the delivery of the test report, and we satisfy our performance obligation at a point in time upon the delivery of the test report to the treating clinician, at which point we can bill for the report. The amount of revenue recognized reflects the amount of consideration to which we expect to be entitled, or the transaction price, and considers the effects of variable consideration. See Note 3 for further details.
Accounts Receivable and Allowance for Credit Losses
We classify accounts receivable balances that are expected to be paid more than one year from the consolidated balance sheet date as noncurrent assets. The estimated timing of payment utilized as a basis for classification as noncurrent is determined by analyses of historical payor-specific payment experience, adjusted for known factors that are expected to change the timing of future payments.
We accrue an allowance for credit losses against our accounts receivable based on management’s current estimate of amounts that will not be collected. Management’s estimates are typically based on historical loss information adjusted for current conditions. We generally do not perform evaluations of customers’ financial condition and generally do not require collateral. Historically, our credit losses have not been significant given our application of the constraint to variable consideration. The allowance for credit losses was zero as of September 30, 2024 and December 31, 2023. Adjustments for implicit price concessions attributable to variable consideration, as discussed below, are incorporated into the measurement of the accounts receivable balances and are not part of the allowance for credit losses.
Property and Equipment
Property and equipment are stated at cost less accumulated depreciation and amortization. Depreciation is computed using the straight-line method over the estimated useful lives of the assets, generally between five and ten years. Leasehold improvements are amortized using the straight-line method over the shorter of the estimated useful life of the asset or the term of the lease. Our leasehold improvements primarily relate to our office and laboratory facilities in Friendswood, Texas, Phoenix, Arizona and Pittsburgh, Pennsylvania, and are generally being depreciated through the end of the lease terms in 2025 and 2033, respectively. Maintenance and repairs are charged to expense as incurred, and material improvements are capitalized. Interest costs incurred during the construction of major capital projects are capitalized until the underlying asset is ready for its intended use, at which
point the capitalized interest costs are amortized using the straight-line method over the estimated useful life of the underlying asset. When assets are retired or otherwise disposed of, the cost and accumulated depreciation are removed from the consolidated balance sheet and any resulting gain or loss is reflected in the consolidated statements of operations in the period realized.
Goodwill
Goodwill represents the excess of the purchase price over the fair value of the net tangible and intangible assets acquired in a business combination. In accordance with ASC Topic 350, Intangibles—Goodwill and Other, our goodwill is not amortized but is tested for impairment on an annual basis or whenever events or changes in circumstances indicate that it may be impaired. We perform annual impairment reviews of our goodwill balance during the fourth quarter of each fiscal year. We may perform a qualitative assessment to determine if it is necessary to perform a quantitative impairment test. If we determine that a quantitative impairment test is necessary, we apply the guidance in Accounting Standards Update (“ASU”) No. 2017-04, Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment, by comparing the fair value of the reporting unit to its carrying value, including the goodwill. If the carrying value exceeds the fair value, we recognize an impairment loss for the amount by which the carrying value exceeds fair value, up to the total amount of goodwill allocated to the reporting unit. We did not incur any goodwill impairment losses in any of the periods presented.
Factors that could result in a future impairment of goodwill include declines in the price of our common stock, increased competition, changes in macroeconomic developments, unfavorable government or regulatory developments and changes in coverage or reimbursement conditions.
Accrued Compensation
We accrue for liabilities under discretionary employee and executive bonus plans. Our estimated compensation liabilities are based on progress against corporate objectives approved by our board of directors, compensation levels of eligible individuals and target bonus percentage levels. Our board of directors reviews and evaluates the performance against these objectives and ultimately determines the actual achievement levels attained. We also accrue for liabilities under employee sales incentive bonus plans with accruals based on performance achieved to date compared to established targets. As of September 30, 2024 and December 31, 2023, we accrued approximately $17.9 million and $21.7 million, respectively, for liabilities associated with these bonus plans. These amounts are classified as current or noncurrent accrued liabilities in the unaudited condensed consolidated balance sheets based on the expected timing of payment.
Stock-Based Compensation
Stock-based compensation expense for equity instruments issued to employees is measured based on the grant-date fair value of the awards. The fair value of employee stock options and offerings under the 2019 Employee Stock Purchase Plan (the “ESPP”) are estimated on the date of grant using the Black-Scholes option-pricing valuation model. For restricted stock units (“RSUs”) and performance-based restricted stock units (“PSUs”), the fair value is equal to the closing price of our common stock on the date of grant. For awards with graded vesting and only service conditions, we recognize compensation costs on a straight-line basis over the requisite service period of the awards. For options and RSUs, the requisite service period is generally the award’s vesting period (typically four years). PSUs vest upon the achievement of certain performance conditions and the provision of service with us through a specified period. Accruals of compensation cost for PSUs are based on the probable outcome of the performance conditions and are reassessed each reporting period. We recognize compensation cost for PSUs separately for each vesting tranche on a ratable basis over the requisite service period. The requisite service period for PSUs is based on an analysis of vesting requirements and performance conditions for the particular award. Certain employees are entitled to acceleration of vesting of a portion of their awards upon retirement, subject to age, service and notice requirements. In these cases, the requisite service period takes into consideration the employee’s retirement eligibility, and is reassessed at each reporting date. For the ESPP, the requisite service period is generally the period of time from the offering date to the purchase date. Forfeitures are accounted for as they occur.
Comprehensive Income (Loss)
Comprehensive income (loss) is defined as a change in equity during a period from transactions and other events and circumstances from non-owner sources. Comprehensive income (loss) is made up of net income (loss) plus net
unrealized gain (loss) on marketable investment securities, which is our only other item of other comprehensive income (loss).
Accounting Pronouncements Yet to be Adopted
In December 2023, the FASB issued ASU No. 2023-09, Income Taxes (Topic 740)—Improvements to Income Tax Disclosures (“ASU 2023-09”), which is intended to enhance the transparency and decision usefulness of income tax disclosures. The amendments in ASU 2023-09 provide for enhanced income tax information primarily through changes to the rate reconciliation and income taxes paid information. ASU 2023-09 is effective for the Company prospectively to all annual periods beginning after December 15, 2024. Early adoption is permitted. We are currently evaluating the impact this update will have on our consolidated financial statements and disclosures.
In November 2023, the FASB issued ASU No. 2023-07, Segment Reporting (Topic 280)—Improvements to Reportable Segment Disclosure, which require public companies disclose significant segment expenses and other segment items on an annual and interim basis and to provide in interim periods all disclosures about a reportable segment’s profit or loss and assets that are currently required annually. The guidance is effective for public entities for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The guidance is applied retrospectively to all periods presented in the financial statements, unless it is impracticable. We are currently evaluating the impact this update will have on our consolidated financial statements and disclosures.
We have evaluated all other recently issued, but not yet effective, accounting pronouncements and do not believe that these accounting pronouncements will have any material impact on our consolidated financial statements or disclosures upon adoption.
v3.24.3
Revenue
9 Months Ended
Sep. 30, 2024
Revenue from Contract with Customer [Abstract]  
Revenue Revenue
All of our revenues from contracts with customers are associated with the provision of testing services. Our revenues are primarily attributable to our DecisionDx®-Melanoma test for cutaneous melanoma. We also provide a test for patients with cutaneous squamous cell carcinoma, DecisionDx®-SCC, a test for use in patients with suspicious pigmented lesions, MyPath® Melanoma, a test for uveal melanoma, DecisionDx®-UM, a test for patients diagnosed with Barrett’s esophagus, the TissueCypher® Barrett’s Esophagus Test and a pharmacogenomics testing service focused on mental health, IDgenetix®. We previously offered a second test for patients with suspicious pigmented lesions, DiffDx®-Melanoma, which we suspended in February 2023. Information on the disaggregation of revenues is included below.
Once we satisfy our performance obligations and bill for the service, the timing of the collection of payments may vary based on the payment practices of the third-party payor and the existence of contractually established reimbursement rates. The payments for our services are primarily made by third-party payors, including Medicare and commercial health insurance carriers. Certain contracts contain a contractual commitment of a reimbursement rate that differs from our list prices. However, absent a positive coverage policy, with or without a contractually committed reimbursement rate, with a commercial carrier or governmental program, our diagnostic tests may or may not be paid by these entities. In addition, patients do not enter into direct agreements with us that commit them to pay any portion of the cost of the tests in the event that their insurance provider declines to reimburse us. We may pursue, on a case-by-case basis, reimbursement from such patients in the form of co-payments and co-insurance, in accordance with the contractual obligations that we have with the insurance carrier or health plan. These situations may result in a delay in the collection of payments.
The Medicare claims that are covered by Medicare are generally paid at a rate established on Medicare’s Clinical Laboratory Fee Schedule or by the respective Medicare contractor within 30 days from receipt. Medicare claims that were either submitted to Medicare prior to the local coverage determination or other coverage commencement date or are not covered but meet the definition of being medically reasonable and necessary pursuant to the controlling Section 1862(a)(1)(A) of the Social Security Act are generally appealed and may ultimately be paid at the first (termed ‘‘redetermination’’), second (termed ‘‘reconsideration’’) or third level of appeal (de novo hearing with an Administrative Law Judge). A successful appeal at any of these levels may result in prompt payment.
In the absence of Medicare coverage, contractually established reimbursements rates or other coverage, we have concluded that our contracts include variable consideration because the amounts paid by Medicare or commercial health insurance carriers may be paid at less than our standard rates or not paid at all, with such differences considered implicit price concessions. Variable consideration attributable to these price concessions is measured at
the expected value using the ‘‘most likely amount’’ method under ASC 606. The amounts are estimated using historical average collection rates by test type and payor category taking into consideration the range of possible outcomes, the predictive value of our past experiences, the time period of when uncertainties expect to be resolved and the amount of consideration that is susceptible to factors outside of our influence, such as the judgment and actions of third parties. Such variable consideration is included in the transaction price only to the extent it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainties with respect to the amount are resolved. Variable consideration may be constrained and excluded from the transaction price in situations where there is no contractually agreed upon reimbursement coverage or in the absence of a predictable pattern and history of collectability with a payor. Accordingly, in such situations revenues are recognized on the basis of actual cash collections. Variable consideration for Medicare claims that are not covered by Medicare, including those claims undergoing appeal, is deemed to be fully constrained due to factors outside our influence (e.g., judgment or actions of third parties) and the uncertainty of the amount to be received is not expected to be resolved for a long period of time. Variable consideration is evaluated each reporting period and adjustments are recorded as increases or decreases in revenues. Included in revenues for the three months ended September 30, 2024 and 2023 were $0.6 million of net negative revenue adjustments and $0.9 million of net positive revenue adjustments, respectively, associated with changes in estimated variable consideration. Included in revenues for the nine months ended September 30, 2024 and 2023 were $1.3 million and $3.1 million of net negative revenue adjustments, respectively, associated with changes in estimated variable consideration. These amounts include (i) adjustments for actual collections versus estimated amounts and (ii) cash collections and the related recognition of revenue in current period for tests delivered in prior periods due to the release of the constraint on variable consideration.
Because our contracts with customers have an expected duration of one year or less, we have elected the practical expedient in ASC 606 to not disclose information about our remaining performance obligations. Any incremental costs to obtain contracts are recorded as selling, general and administrative expenses as incurred due to the short duration of our contracts. Contract balances consisted solely of accounts receivable (both current and noncurrent) as of September 30, 2024 and December 31, 2023.
Disaggregation of Revenues
The table below provides the disaggregation of revenue by type (in thousands):
Three Months Ended
September 30,
Nine Months Ended
September 30,
2024202320242023
Dermatologic(1)
$65,060 $51,151 $193,223 $130,097 
Non-Dermatologic(2)
20,722 10,342 52,535 23,571 
Total net revenues$85,782 $61,493 $245,758 $153,668 
(1)Consists of DecisionDx-Melanoma, DecisionDx-SCC and our Diagnostic Gene Expression Profile offering (MyPath Melanoma and DiffDx-Melanoma).
(2)Consists of TissueCypher Barrett’s Esophagus Test, DecisionDx-UM and IDgenetix.
Payor Concentration
We rely upon reimbursements from third-party government payors (primarily Medicare) and private-payor insurance companies to collect accounts receivable related to sales of our tests.
Our significant third-party payors and their related revenues as a percentage of total revenues and accounts receivable balances are as follows:
 Percentage of Revenues
 Nine Months Ended
September 30,
Percentage of
 Accounts Receivable
 (current) as of
Percentage of
 Accounts Receivable
 (noncurrent) as of
 20242023September 30, 2024December 31, 2023September 30, 2024December 31, 2023
Medicare47 %49 %21 %20 %**
Payor A15 %14 %18 %19 %16 %15 %
Payor B**14 %10 %11 %11 %
*    Less than 10%
There were no other third-party payors that individually accounted for more than 10% of our total revenue or accounts receivable for the periods shown in the table above.
v3.24.3
Earnings (Loss) Per Share
9 Months Ended
Sep. 30, 2024
Earnings Per Share [Abstract]  
Earnings (Loss) Per Share Earnings (Loss) Per Share
Basic earnings (loss) per share is computed by dividing net income (loss) for the period by the weighted-average number of common shares outstanding during the period. Diluted earnings (loss) per share reflects the additional dilution from potential issuances of common stock, such as stock issuable pursuant to the exercise of stock options, vesting of RSUs and PSUs or purchases under the ESPP. The treasury stock method is used to calculate the potential dilutive effect of these common stock equivalents. Contingently issuable PSU awards are included in the computation of diluted earnings (loss) per share when the applicable performance criteria would be met and the common shares would be issuable if the end of the reporting period were the end of the contingency period. However, potentially dilutive shares are excluded from the computation of diluted loss per share when their effect is antidilutive.
The following table shows the computation of basic and diluted earnings (loss) per share for the following three and nine months ended September 30, 2024 and 2023 (in thousands, except per share data):
 Three Months Ended
September 30,
Nine Months Ended
September 30,
 2024202320242023
Numerator:
Net income (loss)$2,269 $(6,905)$8,655 $(54,886)
Denominator:
Weighted-average common shares outstanding, basic27,840 26,834 27,659 26,725 
Assumed exercise of stock options457 — 447 — 
Assumed vesting of RSUs1,041 — 663 — 
Assumed vesting of PSUs42 — 55 — 
Assumed issuance of shares under the ESPP21 — 14 — 
Weighted-average common shares outstanding, diluted29,401 26,834 28,838 26,725 
 Earnings (loss) per share:
Basic$0.08 $(0.26)$0.31 $(2.05)
Diluted$0.08 $(0.26)$0.30 $(2.05)
Due to the Company reporting a net loss attributable to common stockholders for the three and nine months ended September 30, 2023, all potentially dilutive securities are antidilutive and are excluded from the computations of diluted loss per share.
The table below provides the weighted-average number of potential common shares associated with outstanding securities not included in our calculation of diluted earnings (loss) per share for the three and nine months ended September 30, 2024 and 2023 because to do so would be antidilutive. With regard to the PSUs, we assume that the associated performance targets will be met at the target level of performance for purposes of calculating diluted net income per common share until such time that it is probable that actual performance will be above or below target (in thousands):
Three Months Ended
September 30,
Nine Months Ended
September 30,
2024202320242023
Stock options2,430 3,302 2,466 3,339 
RSUs and PSUs474 3,422 553 3,403 
ESPP155 371 207 320 
Total3,059 7,095 3,226 7,062 
In addition, in connection with our acquisition of AltheaDx, Inc. (“AltheaDx”) in April 2022, we may be required to issue shares of our common stock to satisfy the contingent consideration obligations, pending the outcome of certain commercial and regulatory milestones, as required by the definitive agreement to acquire AltheaDx. For purposes of calculating diluted earnings (loss) per share, no such shares were assumed to have been issued because none of the applicable conditions have been met to date. See Note 11 for additional information.
v3.24.3
Marketable Investment Securities
9 Months Ended
Sep. 30, 2024
Investments, Debt and Equity Securities [Abstract]  
Marketable Investment Securities Marketable Investment Securities
The following tables present our available-for-sale debt securities (in thousands):
September 30, 2024
Amortized CostUnrealizedEstimated Fair Value
GainsLosses
U.S. government securities$184,353 $473 $— $184,826 
Total$184,353 $473 $— $184,826 

December 31, 2023
Amortized CostUnrealizedEstimated Fair Value
GainsLosses
U.S. government securities$144,122 $143 $(7)$144,258 
Total$144,122 $143 $(7)$144,258 
Although available to be sold to meet operating needs or otherwise, securities are generally held through maturity. We classify all investments as current assets, as these are readily available for use in current operations. The cost of securities sold is determined based on the specific identification method for purposes of recording gains and losses.
There were no realized gains or losses on sales of investments for the three and nine months ended September 30, 2024 and 2023.
We evaluated our investment portfolio under the available-for-sale debt securities impairment model guidance and determined our investment portfolio is comprised of low-risk, investment grade securities. As of September 30, 2024, unrealized losses on our available-for-sale investments are not attributed to credit risk. We believe that an allowance for credit losses is unnecessary because the unrealized losses on certain of our marketable investment securities are due to market factors. No credit-related or noncredit-related impairment losses were recorded for the three and nine months ended September 30, 2024 and 2023. The allowance for credit losses was zero as of September 30, 2024 and December 31, 2023.
As of September 30, 2024, all of our available-for-sale debt securities had contractual maturities of one year or less. Accrued interest receivable is included in prepaid expenses and other current assets in our unaudited condensed consolidated balance sheets. As of September 30, 2024 and December 31, 2023, the accrued interest receivable balance was immaterial.
Additional information relating to the fair value of marketable investment securities can be found in Note 11.
v3.24.3
Property and Equipment, Net
9 Months Ended
Sep. 30, 2024
Property, Plant and Equipment [Abstract]  
Property and Equipment, Net Property and Equipment, Net
Property and equipment, net consisted of the following (in thousands):
 September 30, 2024December 31, 2023
Land(1)
$7,245 $— 
Lab equipment22,201 16,472 
Leasehold improvements14,438 9,990 
Computer equipment5,103 4,060 
Furniture and fixtures3,521 2,385 
Construction-in-progress3,350 637 
Total55,858 33,544 
Less accumulated depreciation(11,475)(8,111)
Property and equipment, net$44,383 $25,433 
(1)On February 9, 2024, we purchased approximately 23 acres of land in Friendswood, Texas for purpose of developing a commercial office building to be used as our future corporate headquarters.
Depreciation expense was recorded in the unaudited condensed consolidated statements of operations as follows (in thousands):
Three Months Ended
September 30,
Nine Months Ended
September 30,
 2024202320242023
Cost of sales (exclusive of amortization of acquired intangible assets)$766 $505 $2,058 $1,205 
Research and development89 84 258 246 
Selling, general and administrative414 313 1,147 913 
Total$1,269 $902 $3,463 $2,364 
v3.24.3
Goodwill and Other Intangible Assets, Net
9 Months Ended
Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill and Other Intangible Assets, Net Goodwill and Other Intangible Assets, Net
Goodwill
The balance of our goodwill was $10.7 million as of September 30, 2024 and December 31, 2023. There were no accumulated impairments of goodwill as of September 30, 2024 or December 31, 2023.
Other Intangible Assets, Net
Our other intangible assets, net consist of the following (in thousands):
September 30, 2024
 Gross carrying valueAccumulated amortizationNetWeighted-Average Remaining Life (in years)
Developed technology$125,317 $(25,684)$99,633 11.5
Assembled workforce563 (319)244 2.2
Total other intangible assets, net$125,880 $(26,003)$99,877 
December 31, 2023
 Gross carrying valueAccumulated amortizationNetWeighted-Average Remaining Life (in years)
Developed technology$125,317 $(19,003)$106,314 12.2
Assembled workforce563 (234)329 2.9
Total other intangible assets, net$125,880 $(19,237)$106,643 
Amortization expense of intangible assets was $2.3 million and $6.8 million for the three and nine months ended September 30, 2024, respectively, and $2.3 million and $6.7 million for the three and nine months ended September 30, 2023, respectively.
v3.24.3
Other Accrued and Current Liabilities
9 Months Ended
Sep. 30, 2024
Payables and Accruals [Abstract]  
Other Accrued and Current Liabilities Other Accrued and Current Liabilities
Other accrued and current liabilities consisted of the following (in thousands):
 September 30, 2024December 31, 2023
Clinical studies$3,023 $3,475 
Accrued service fees3,410 2,097 
ESPP contributions577 896 
Accrued benefits418 199 
Other640 650 
Total$8,068 $7,317 
v3.24.3
Long-Term Debt
9 Months Ended
Sep. 30, 2024
Debt Disclosure [Abstract]  
Long-Term Debt Long-Term Debt
We had no debt as of December 31, 2023. Our long-term debt as of September 30, 2024 is presented in the table below (in thousands):
 September 30, 2024
Term debt$10,200 
Unamortized discount(185)
Total long-term debt10,015 
Less: Current portion of long-term debt— 
Total$10,015 
Borrowings under our 2024 LSA approximate their fair value as the interest rate is variable and reflects market rates (Level 2 instrument). As of September 30, 2024, the carrying amount of borrowings under our 2024 LSA, exclusive of unamortized discount, and their estimated fair value were $10.2 million.
Future maturities of principal amounts on long-term debt as of September 30, 2024 are as follows (in thousands):
Years Ending December 31,
2024$— 
2025278 
20263,333 
20273,333 
20283,056 
Total$10,000 
2024 Loan and Security Agreement
On March 26, 2024 (the ‘‘Closing Date’’), we entered into a Loan and Security Agreement (the ‘‘2024 LSA”), by and between us, our wholly owned subsidiary, Castle Narnia Real Estate Holding 1, LLC and Silicon Valley Bank, a division of First-Citizens Bank & Trust Company (the “Lender’’). The 2024 LSA provides for (i) on the Closing Date, $10.0 million aggregate principal amount of term loans (discussed in the ‘‘2024 Term Loan’’ section below), and (ii) from the Closing Date until March 31, 2025, an additional line of credit of $25.0 million with the same interest rate and maturity as the term debt available (discussed in the ‘‘2024 Credit Line’’ section below) at our option.
The obligations under the 2024 LSA are secured by substantially all of our assets, excluding intellectual property, the real property held by us, and are subject to certain other exceptions and limitations. We have the right to prepay the 2024 LSA in whole, subject to a prepayment fee of approximately 1.50% if prepaid prior to March 26, 2026. Amounts repaid under the 2024 LSA may not be reborrowed.
In addition, the 2024 LSA contains customary conditions of borrowing, events of default and covenants, including covenants that restrict our ability to dispose of assets, merge with or acquire other entities, incur indebtedness and make distributions to holders of our capital stock. Should an event of default occur, including the occurrence of a
material adverse change, we could be liable for immediate repayment of all obligations under the 2024 LSA. Should we seek to amend the terms of the 2024 LSA, the consent of the Lender would be required. As of September 30, 2024, we were in compliance with all of the covenants.
The 2024 LSA bears interest at a floating rate equal to the greater of (a) the WSJ Prime Rate plus 0.25% or (b) 6.00% per annum. The Term Loans are interest only from the Closing Date through November 30, 2025, which may be extended at our option through November 30, 2026 as long as no event of default under the 2024 LSA has occurred. After the end of the interest only period, we are required to pay equal monthly installments of principal through the maturity date of November 1, 2028.
We are also obligated to make an additional final payment of 2.00% of the aggregate original principal amounts of Term Loans advanced by the Lender, due at the earlier of the maturity date or date the Term Loans are repaid in full.
2024 Term Loan
On March 26, 2024, we drew $10.0 million in Term Loans under the terms and provisions of the 2024 LSA. We are obligated to make a final payment of $0.2 million under the terms of the 2024 LSA final payment provisions. A discount on debt equal to this obligation was recorded on the draw date and is being amortized as additional interest expense using the effective interest method over the term of the debt. As of September 30, 2024, no payment on principal has been made. As of September 30, 2024, the weighted average effective interest rate for all outstanding debt under the 2024 Term Loan was 8.60%.
2024 Credit Line
We have a $25.0 million line of credit under the terms and provisions of the 2024 LSA available from the Closing Date until March 31, 2025. Amounts repaid under the 2024 Credit Line may not be reborrowed. As of September 30, 2024, no draws had been made on the line of credit.
Interest Expense on Long-Term Debt
The table below shows the components of interest expense for the three and nine months ended September 30, 2024 (in thousands):
 Three Months Ended September 30, 2024Nine Months Ended September 30, 2024
Interest expense on long term debt$229 $470 
Less: Capitalized interest(37)(49)
Total$192 $421 
There was no interest expense on long term debt or capitalized interest for the three and nine months ended September 30, 2023.
v3.24.3
Leases
9 Months Ended
Sep. 30, 2024
Leases [Abstract]  
Leases Leases
Lease Amendment
On August 1, 2024 (“the Modification Date”) we amended our lease agreement for our Pittsburgh facilities to take early possession of additional square footage under an expansion provision in the original contract at an earlier date than provided for under the original agreement. The expansion option provided us with 23,821 additional square feet, most of which will be dedicated laboratory space, in exchange for an incremental increase in our fixed monthly payments. The amendment did not change the end date under the original lease term, or provide any additional options not already provided for under the original agreement. We evaluated the amendment under ASC Topic 842, Leases, and determined that it constituted a modification to an existing contract and assessed the classification remained an operating lease. Following the modification, our obligations for the remaining lease term increased and we used $1.3 million of lease incentives for leasehold improvements. As of September 30, 2024, we had no remaining credits for leasehold improvements under this contract. In our remeasurement, we recognized an additional $0.6 million in operating lease assets in exchange for an equal amount of additional lease liabilities.
Discount Rate
We remeasured our lease obligations using our incremental borrowing rate as of the Modification Date. The incremental borrowing rate is the rate of interest we would have to pay to borrow on a collateralized basis over a similar term an amount equal to the lease payments in a similar economic environment. As of the Modification Date, we had outstanding borrowings under the “2024 LSA” and referred to the interest rate of such debt for use as our incremental borrowing rate.
v3.24.3
Fair Value Measurements
9 Months Ended
Sep. 30, 2024
Fair Value Disclosures [Abstract]  
Fair Value Measurements Fair Value Measurements
Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market in an orderly transaction between market participants at the measurement date. The fair value hierarchy prioritizes the inputs to valuation techniques used in measuring fair value. There are three levels to the fair value hierarchy based on the reliability of inputs, as follows:
Level 1 – Observable inputs that reflect quoted prices (unadjusted) for identical assets or liabilities in active markets.
Level 2 – Inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly.
Level 3 – Unobservable inputs in which little or no market data exists, therefore requiring us to develop our own assumptions.
Financial instruments measured at fair value are classified in their entirety based on the lowest level of input that is significant to the fair value measurement. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires management to make judgments and consider factors specific to the asset or liability. The use of different assumptions and/or estimation methodologies may have a material effect on estimated fair values. Accordingly, the fair value estimates disclosed, or amounts recorded, may not be indicative of the amount that we or holders of the instruments could realize in a current market exchange.
The tables below provide information, by level within the fair value hierarchy, of our financial assets and liabilities that are accounted for at fair value on a recurring basis as of September 30, 2024 and December 31, 2023 (in thousands):
As of September 30, 2024
 Quoted Prices in Active Markets for Identical Items (Level 1)Significant Other Observable Inputs
(Level 2)
Significant Unobservable Inputs
(Level 3)
Total
Assets
Money market funds(1)
$89,571 $— $— $89,571 
U.S. government securities(2)
$184,826 $— $— $184,826 
Liabilities
Contingent consideration(3)
$— $— $— $— 
As of December 31, 2023
 Quoted Prices in Active Markets for Identical Items (Level 1)Significant Other Observable Inputs
(Level 2)
Significant Unobservable Inputs
(Level 3)
Total
Assets
Money market funds(1)
$89,308 $— $— $89,308 
U.S. government securities(2)
$144,258 $— $— $144,258 
Liabilities
Contingent consideration(3)
$— $— $— $— 
(1)Classified as “Cash and cash equivalents” in the unaudited condensed consolidated balance sheets.
(2)Classified as “Marketable investment securities” in the unaudited condensed consolidated balance sheets.
(3)Current portion, if any, classified as “Other accrued and current liabilities” in the unaudited condensed consolidated balance sheets.
Contingent Consideration
In connection with our acquisition of AltheaDx, we agreed to pay contingent consideration of up to $75.0 million of commercial milestone payments based on the achievement of certain net revenue targets relating to the years ending December 31, 2022, 2023 and 2024 (“AltheaDx Earnout Payments”). The portion of the AltheaDx Earnout Payments associated with the commercial milestones for the year ended December 31, 2023 was $37.5 million and was not paid since the applicable commercial milestones were not met. The AltheaDx Earnout Payments included a 2022 catch-up provision for additional payment of up to $17.5 million that expired in 2023. Therefore, as of September 30, 2024, we have a potential payment obligation of up to $20.0 million with respect to the remaining commercial milestones for 2024. If the settlement of the remaining portion of the AltheaDx Earnout Payments would have occurred on September 30, 2024, no amounts would have been due because no commercial milestones had been achieved as of such date.
The contingent consideration was classified as a Level 3 fair value measurement due to the use of significant unobservable inputs and a Monte Carlo simulation to determine its fair value. The Monte Carlo simulation uses projections of the commercial milestones for the applicable period as well as the corresponding targets and approximate timing of payment based on the terms of the arrangement. The valuation of the AltheaDx contingent consideration was zero as of September 30, 2024 and December 31, 2023, and no gains or losses were recorded associated with changes in fair value during the three and nine months ended September 30, 2024 and 2023.
The contingent consideration liability is remeasured at fair value at each reporting period taking into account any updated assumptions or changes in circumstances. Any changes in the fair value are recorded as gains or losses in our unaudited condensed consolidated statement of operations.
v3.24.3
Commitments and Contingencies
9 Months Ended
Sep. 30, 2024
Commitments and Contingencies Disclosure [Abstract]  
Commitments and Contingencies Commitments and Contingencies
From time to time, we may be involved in legal proceedings arising in the ordinary course of business. We believe there is no threatened litigation or litigation pending that could have, individually or in the aggregate, a material adverse effect on our financial position, results of operations or cash flows. On February 1, 2024, we received a Subpoena from the Department of Health and Human Services, Office of Inspector General, seeking documents and information concerning claims submitted for payment under federal healthcare programs. The Subpoena requested that we produce documents relating primarily to interactions with medical providers and billing to government-funded healthcare programs for our tests. The time period covered by the Subpoena is January 1, 2015 through February 1, 2024. We are continuing to cooperate with the government’s request and are in the process of responding to the Subpoena. We are unable to predict what action, if any, might be taken in the future by the Department of Health and Human Services, Office of Inspector General, or any other governmental authority as a result of the matters related to this Subpoena. No claims have been made against us at this time. Any potential claims could subject us to significant liability for damages and harm our reputation. Our insurance and indemnities may not cover all claims that may be asserted against us. We are unable to predict the outcome and are unable to make a meaningful estimate of the amount or range of loss, if any, that could result from any unfavorable outcome.
v3.24.3
Stock Incentive Plans and Stock-Based Compensation
9 Months Ended
Sep. 30, 2024
Share-Based Payment Arrangement [Abstract]  
Stock Incentive Plans and Stock-Based Compensation Stock Incentive Plans and Stock-Based Compensation
Stock Incentive Plans
Effective January 1, 2024, an additional 1,370,526 shares became available under our 2019 Equity Incentive Plan (the “2019 Plan”) pursuant to an automatic annual increase. The 2019 Plan provides for automatic annual increases to the number of shares authorized for issuance, equal to 5% of our common shares outstanding as of the immediately preceding year end, through January 1, 2029. As of September 30, 2024, 556,925 shares remained available for grant under the 2019 Plan.
On December 22, 2022, our board of directors approved the 2022 Inducement Plan (the “Inducement Plan”). Our Inducement Plan provides for the grant of RSU awards and other stock awards made as an inducement material to the grantee’s entering into employment with us to the extent such grantee was not previously an employee of ours or is entering into employment following a bona fide period of non-employment with us. As of September 30, 2024, there were 348,917 shares available for grant under the Inducement Plan.
Stock Options
Stock option activity under our stock plans for the nine months ended September 30, 2024 is set forth below:
  Weighted-Average 
 Stock Options
Outstanding
Exercise
Price
Remaining
Contractual
Term (Years)
Aggregate
Intrinsic
Value
(in thousands)
Balance as of December 31, 20233,208,979 $35.38 
Granted3,379 $71.22 
Exercised(111,223)$14.78 
Forfeited/Cancelled(61,197)$39.96 
Balance as of September 30, 20243,039,938 $36.09 5.8$13,365 
Exercisable at September 30, 2024
2,789,681 $35.29 5.7$13,310 
Restricted Stock Units
RSUs represent the right to receive shares of our common stock at a specified future date, subject to vesting. Our RSUs generally vest annually from the grant date in four equal installments subject to the holder’s continued service with us. We issue new shares of common stock upon the vesting of RSUs.
The following table summarizes our RSU activity for the nine months ended September 30, 2024:
Restricted Stock Units OutstandingWeighted-Average Grant Date Fair Value
Balance as of December 31, 2023
2,805,075 $25.48 
Granted1,515,966 $21.52 
Vested(1)
(290,337)$25.60 
Forfeited/Cancelled(299,980)$21.78 
Balance as of September 30, 2024
3,730,724$24.16 
(1)The aggregate number of shares withheld upon vesting for employee tax obligations was 71,944 for the nine months ended September 30, 2024.
Performance-Based Restricted Stock Units
PSUs represent the right to receive shares of our common stock contingent upon the achievement of certain financial performance measures. We issue new shares of common stock upon the vesting of PSUs.
On August 9, 2024 (the “Initial Vesting Date”), the Board certified that the revenue goal for the PSUs granted on December 23, 2022 (“2022 PSUs”) was achieved. Therefore, 50% of the 2022 PSUs were vested and we immediately recognized $0.1 million of stock-based compensation related to this performance metric. The remaining 50% of the 2022 PSUs are all subject to time-based vesting and will vest in full on the one-year anniversary of the Initial Vesting Date.
The following table summarizes our PSU activity for the nine months ended September 30, 2024:
Performance-Based Restricted Stock Units OutstandingWeighted-Average Grant Date Fair Value
Balance as of December 31, 2023
196,033 $23.23 
Granted177,513 $21.23 
Vested(1)
(98,018)$23.23 
Forfeited/Cancelled— $— 
Balance as of September 30, 2024
275,528$21.94 
(1)The aggregate number of shares withheld upon vesting for employee tax obligations was 30,046 for the nine months ended September 30, 2024.
Retirement Policy
In January 2023, our board of directors approved a retirement policy (the “Retirement Policy”) that provides for acceleration of a portion of unvested awards that were granted to certain eligible employees upon meeting age, service and notice requirements. We considered the adoption of the Retirement Policy to be a modification of existing awards under ASC Topic 718, Compensation – Stock Compensation. The modification did not result in any incremental compensation cost. However, the adoption of the policy resulted in a new estimate of the requisite service period for certain awards, which we reassess at each balance sheet date. In connection with the Retirement Policy, we accelerated the recognition of compensation expense of $0.4 million and $0.5 million during the three months ended September 30, 2024 and 2023, respectively, and accelerated the recognition of compensation expense of $0.8 million and $1.6 million for the nine months ended September 30, 2024 and 2023, respectively.
Employee Stock Purchase Plan
The ESPP provides for certain automatic increases in the number of shares of common stock reserved for issuance, which resulted in an additional 274,105 shares becoming available under the ESPP effective January 1, 2024. During the nine months ended September 30, 2024, we issued 167,688 shares of common stock pursuant to scheduled purchases under the ESPP. As of September 30, 2024, 1,046,680 shares remained available for issuance under the ESPP.
Determining Fair Value - Summary of Assumptions
We use the Black-Scholes option pricing model to estimate the fair value of each option grant on the date of grant or any other measurement date. The following table sets forth the assumptions used to determine the fair value of stock options:
 Nine Months Ended
September 30,
20242023
Average expected term (years)5.05.0
Expected stock price volatility
80.20% - 80.20%
75.57% - 76.01%
Risk-free interest rate
4.39% - 4.39%
3.57% - 3.57%
Dividend yield—%—%
The following table sets forth assumptions used to determine the fair value of the purchase rights issued under the ESPP:
 Nine Months Ended
September 30,
20242023
Average expected term (years)1.21.3
Expected stock price volatility
59.85% - 130.95%
93.17% - 130.95%
Risk-free interest rate
3.82% - 5.33%
4.74% - 5.33%
Dividend yield—%—%
We use the closing price of our common stock on the date of grant to determine the fair value of RSUs and PSUs.
Stock-Based Compensation Expense
Stock-based compensation expense is included in the unaudited condensed consolidated statements of operations as follows (in thousands):
 Three Months Ended
September 30,
Nine Months Ended
September 30,
 2024202320242023
Cost of sales (exclusive of amortization of acquired intangible assets)$1,464 $1,245 $4,179 $3,719 
Research and development2,345 2,682 7,611 7,755 
Selling, general and administrative9,218 9,116 27,091 27,943 
Total stock-based compensation expense$13,027 $13,043 $38,881 $39,417 
For the nine months ended September 30, 2024 and 2023 the weighted-average grant date fair value of stock options granted was $9.23 and $15.99 per option, respectively. For the nine months ended September 30, 2024 and 2023, the weighted-average grant date fair value of the purchase rights granted under the ESPP was $12.28 and $11.51 per share, respectively. As of September 30, 2024, the total unrecognized stock-based compensation cost related to outstanding awards was $77.6 million, which is expected to be recognized over a weighted-average period of 2.2 years. The total unrecognized compensation cost will be adjusted for forfeitures in future periods as they occur.
v3.24.3
Income Taxes
9 Months Ended
Sep. 30, 2024
Income Tax Disclosure [Abstract]  
Income Taxes Income Taxes
For the three and nine months ended September 30, 2024, our effective income tax rate was 72.6% and 36.7%, respectively.
For the three months ended September 30, 2024, differences in our effective rate and the federal statutory rate of 21% was due to revisions in estimated pre-tax income, reflecting uncertainty in continued Medicare coverage for our DecisionDx-SCC test and updated information, as well as stock-based compensation, permanent differences, changes in valuation allowance, research and development tax credit and state income taxes. For the nine months ended September 30, 2024, differences in our effective rate and the federal statutory rate of 21% was due to stock-based compensation, permanent differences, changes in valuation allowance, research and development tax credit and state income taxes.
For the three and nine months ended September 30, 2023, our effective income tax rate was immaterial.
v3.24.3
Pay vs Performance Disclosure - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2024
Jun. 30, 2024
Mar. 31, 2024
Sep. 30, 2023
Jun. 30, 2023
Mar. 31, 2023
Sep. 30, 2024
Sep. 30, 2023
Pay vs Performance Disclosure                
Net income (loss) $ 2,269 $ 8,920 $ (2,534) $ (6,905) $ (18,777) $ (29,204) $ 8,655 $ (54,886)
v3.24.3
Insider Trading Arrangements
3 Months Ended 9 Months Ended
Sep. 30, 2024
shares
Sep. 30, 2024
shares
Trading Arrangements, by Individual    
Non-Rule 10b5-1 Arrangement Adopted false  
Rule 10b5-1 Arrangement Terminated false  
Non-Rule 10b5-1 Arrangement Terminated false  
Frank Stokes [Member]    
Trading Arrangements, by Individual    
Material Terms of Trading Arrangement  
On August 13, 2024, Frank Stokes, Chief Financial Officer, adopted a Rule 10b5-1 trading arrangement providing for the sale from time to time of an aggregate of up to 6,923 shares of our common stock plus any additional shares that remain unsold under his previous arrangement. The new trading arrangement is intended to satisfy the affirmative defense in Rule 10b5-1(c). The duration of the trading arrangement is estimated to be from November 15, 2024 until the earlier of all transaction under the trading arrangement being completed or the termination of the plan.
Name Frank Stokes  
Title Chief Financial Officer,  
Rule 10b5-1 Arrangement Adopted true  
Adoption Date August 13, 2024  
Aggregate Available 6,923 6,923
Tobin Juvenal [Member]    
Trading Arrangements, by Individual    
Material Terms of Trading Arrangement  
On September 11, 2024, Tobin Juvenal, our Chief Commercial Officer, adopted a Rule 10b5-1 trading arrangement providing for the sale from time to time of an aggregate of up to 2,230 shares of our common stock plus any additional shares that remain unsold under his previous arrangement. The trading arrangement is intended to satisfy the affirmative defense in Rule 10b5-1(c). The duration of the trading arrangement will be from January 2, 2025 through December 31, 2025.
Name Tobin Juvenal  
Title Chief Commercial Officer  
Rule 10b5-1 Arrangement Adopted true  
Adoption Date September 11, 2024,  
Expiration Date December 31, 2025  
Arrangement Duration 363 days  
Aggregate Available 2,230 2,230
v3.24.3
Summary of Significant Accounting Policies (Policies)
9 Months Ended
Sep. 30, 2024
Accounting Policies [Abstract]  
Basis of Presentation Our unaudited condensed consolidated financial statements include the accounts of Castle Biosciences, Inc. and our wholly owned subsidiaries and have been prepared in conformity with accounting principles generally accepted in the United States of America (‘‘U.S. GAAP’’).
Consolidation All intercompany accounts and transactions have been eliminated in consolidation.
Use of Estimates The preparation of consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities as of the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates include revenue recognition, the valuation of stock-based compensation, assessing future tax exposure and the realizability of deferred tax assets, the useful lives and recoverability of long-lived assets, the goodwill impairment test, the valuation of acquired intangible assets and the valuation of contingent consideration and other contingent liabilities. We base these estimates on historical and anticipated results, trends, and various other assumptions that we believe are reasonable under the circumstances, including assumptions as to future events. These estimates form the basis for making judgments about the carrying values of assets and liabilities and recorded revenues and expenses that are not readily apparent from other sources. Actual results could differ from those estimates and assumptions.
Cash and Cash Equivalents Cash equivalents consist of short-term, highly liquid investments with original maturities of three months or less. Our cash equivalents consist of money market funds, which are not insured by the Federal Deposit Insurance Corporation (“FDIC”), that are primarily invested in short-term U.S. government obligations.
Concentration of Credit Risk Cash deposits at financial institutions may exceed the amount of insurance provided by the FDIC. Management believes that we are not exposed to significant credit risk on our cash deposits due to the financial position of the financial institutions in which deposits are held.
Marketable Investment Securities All debt securities are recognized in accordance with Financial Accounting Standards Board (‘‘FASB’’) Accounting Standards Codification (‘‘ASC’’) Topic 320, Investments-Debt Securities (‘‘ASC 320’’). Management determines the appropriate classification of securities at the time of purchase and re-evaluates such determination at each balance sheet date. All debt securities are classified as available-for-sale and are recorded at fair value in accordance with ASC 320. We recognize the unrealized gains and losses related to changes in fair value as a separate component of accumulated other comprehensive loss within total stockholders’ equity, net of any related deferred income tax effects, on our condensed consolidated balance sheets. Premiums or discounts from par value are amortized to interest income over the life of the underlying investment. Realized gains and losses on available-for-sale securities are calculated at the individual security level and included in interest income in the condensed consolidated statements of operations. Impairments of available-for-sale debt securities, if any, are recorded in our unaudited condensed consolidated statements of operations.
Revenue Recognition In accordance with ASC Topic 606, Revenue from Contracts with Customers (“ASC 606”), we follow a five-step process to recognize revenues: (1) identify the contract with the customer, (2) identify the performance obligations, (3) determine the transaction price, (4) allocate the transaction price to the performance obligations and (5) recognize revenues when the performance obligations are satisfied. We have determined that we have a contract with the patient when the treating clinician orders the test. Our contracts generally contain a single performance obligation, which is the delivery of the test report, and we satisfy our performance obligation at a point in time upon the delivery of the test report to the treating clinician, at which point we can bill for the report. The amount of revenue recognized reflects the amount of consideration to which we expect to be entitled, or the transaction price, and considers the effects of variable consideration.
Accounts Receivable
We classify accounts receivable balances that are expected to be paid more than one year from the consolidated balance sheet date as noncurrent assets. The estimated timing of payment utilized as a basis for classification as noncurrent is determined by analyses of historical payor-specific payment experience, adjusted for known factors that are expected to change the timing of future payments.
Allowance for Credit Losses
We accrue an allowance for credit losses against our accounts receivable based on management’s current estimate of amounts that will not be collected. Management’s estimates are typically based on historical loss information adjusted for current conditions. We generally do not perform evaluations of customers’ financial condition and generally do not require collateral. Historically, our credit losses have not been significant given our application of the constraint to variable consideration. The allowance for credit losses was zero as of September 30, 2024 and December 31, 2023. Adjustments for implicit price concessions attributable to variable consideration, as discussed below, are incorporated into the measurement of the accounts receivable balances and are not part of the allowance for credit losses.
Property and Equipment
Property and equipment are stated at cost less accumulated depreciation and amortization. Depreciation is computed using the straight-line method over the estimated useful lives of the assets, generally between five and ten years. Leasehold improvements are amortized using the straight-line method over the shorter of the estimated useful life of the asset or the term of the lease. Our leasehold improvements primarily relate to our office and laboratory facilities in Friendswood, Texas, Phoenix, Arizona and Pittsburgh, Pennsylvania, and are generally being depreciated through the end of the lease terms in 2025 and 2033, respectively. Maintenance and repairs are charged to expense as incurred, and material improvements are capitalized. Interest costs incurred during the construction of major capital projects are capitalized until the underlying asset is ready for its intended use, at which
point the capitalized interest costs are amortized using the straight-line method over the estimated useful life of the underlying asset. When assets are retired or otherwise disposed of, the cost and accumulated depreciation are removed from the consolidated balance sheet and any resulting gain or loss is reflected in the consolidated statements of operations in the period realized.
Goodwill
Goodwill represents the excess of the purchase price over the fair value of the net tangible and intangible assets acquired in a business combination. In accordance with ASC Topic 350, Intangibles—Goodwill and Other, our goodwill is not amortized but is tested for impairment on an annual basis or whenever events or changes in circumstances indicate that it may be impaired. We perform annual impairment reviews of our goodwill balance during the fourth quarter of each fiscal year. We may perform a qualitative assessment to determine if it is necessary to perform a quantitative impairment test. If we determine that a quantitative impairment test is necessary, we apply the guidance in Accounting Standards Update (“ASU”) No. 2017-04, Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment, by comparing the fair value of the reporting unit to its carrying value, including the goodwill. If the carrying value exceeds the fair value, we recognize an impairment loss for the amount by which the carrying value exceeds fair value, up to the total amount of goodwill allocated to the reporting unit. We did not incur any goodwill impairment losses in any of the periods presented.
Factors that could result in a future impairment of goodwill include declines in the price of our common stock, increased competition, changes in macroeconomic developments, unfavorable government or regulatory developments and changes in coverage or reimbursement conditions.
Accrued Compensation
We accrue for liabilities under discretionary employee and executive bonus plans. Our estimated compensation liabilities are based on progress against corporate objectives approved by our board of directors, compensation levels of eligible individuals and target bonus percentage levels. Our board of directors reviews and evaluates the performance against these objectives and ultimately determines the actual achievement levels attained. We also accrue for liabilities under employee sales incentive bonus plans with accruals based on performance achieved to date compared to established targets. As of September 30, 2024 and December 31, 2023, we accrued approximately $17.9 million and $21.7 million, respectively, for liabilities associated with these bonus plans. These amounts are classified as current or noncurrent accrued liabilities in the unaudited condensed consolidated balance sheets based on the expected timing of payment.
Stock-Based Compensation
Stock-based compensation expense for equity instruments issued to employees is measured based on the grant-date fair value of the awards. The fair value of employee stock options and offerings under the 2019 Employee Stock Purchase Plan (the “ESPP”) are estimated on the date of grant using the Black-Scholes option-pricing valuation model. For restricted stock units (“RSUs”) and performance-based restricted stock units (“PSUs”), the fair value is equal to the closing price of our common stock on the date of grant. For awards with graded vesting and only service conditions, we recognize compensation costs on a straight-line basis over the requisite service period of the awards. For options and RSUs, the requisite service period is generally the award’s vesting period (typically four years). PSUs vest upon the achievement of certain performance conditions and the provision of service with us through a specified period. Accruals of compensation cost for PSUs are based on the probable outcome of the performance conditions and are reassessed each reporting period. We recognize compensation cost for PSUs separately for each vesting tranche on a ratable basis over the requisite service period. The requisite service period for PSUs is based on an analysis of vesting requirements and performance conditions for the particular award. Certain employees are entitled to acceleration of vesting of a portion of their awards upon retirement, subject to age, service and notice requirements. In these cases, the requisite service period takes into consideration the employee’s retirement eligibility, and is reassessed at each reporting date. For the ESPP, the requisite service period is generally the period of time from the offering date to the purchase date. Forfeitures are accounted for as they occur.
Comprehensive Income (Loss)
Comprehensive income (loss) is defined as a change in equity during a period from transactions and other events and circumstances from non-owner sources. Comprehensive income (loss) is made up of net income (loss) plus net
unrealized gain (loss) on marketable investment securities, which is our only other item of other comprehensive income (loss).
Accounting Pronouncements Yet to be Adopted
In December 2023, the FASB issued ASU No. 2023-09, Income Taxes (Topic 740)—Improvements to Income Tax Disclosures (“ASU 2023-09”), which is intended to enhance the transparency and decision usefulness of income tax disclosures. The amendments in ASU 2023-09 provide for enhanced income tax information primarily through changes to the rate reconciliation and income taxes paid information. ASU 2023-09 is effective for the Company prospectively to all annual periods beginning after December 15, 2024. Early adoption is permitted. We are currently evaluating the impact this update will have on our consolidated financial statements and disclosures.
In November 2023, the FASB issued ASU No. 2023-07, Segment Reporting (Topic 280)—Improvements to Reportable Segment Disclosure, which require public companies disclose significant segment expenses and other segment items on an annual and interim basis and to provide in interim periods all disclosures about a reportable segment’s profit or loss and assets that are currently required annually. The guidance is effective for public entities for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The guidance is applied retrospectively to all periods presented in the financial statements, unless it is impracticable. We are currently evaluating the impact this update will have on our consolidated financial statements and disclosures.
We have evaluated all other recently issued, but not yet effective, accounting pronouncements and do not believe that these accounting pronouncements will have any material impact on our consolidated financial statements or disclosures upon adoption.
v3.24.3
Revenue (Tables)
9 Months Ended
Sep. 30, 2024
Revenue from Contract with Customer [Abstract]  
Schedule of Disaggregation of Revenue
The table below provides the disaggregation of revenue by type (in thousands):
Three Months Ended
September 30,
Nine Months Ended
September 30,
2024202320242023
Dermatologic(1)
$65,060 $51,151 $193,223 $130,097 
Non-Dermatologic(2)
20,722 10,342 52,535 23,571 
Total net revenues$85,782 $61,493 $245,758 $153,668 
(1)Consists of DecisionDx-Melanoma, DecisionDx-SCC and our Diagnostic Gene Expression Profile offering (MyPath Melanoma and DiffDx-Melanoma).
(2)Consists of TissueCypher Barrett’s Esophagus Test, DecisionDx-UM and IDgenetix.
Schedule of Concentration of Risk, by Risk Factor
Our significant third-party payors and their related revenues as a percentage of total revenues and accounts receivable balances are as follows:
 Percentage of Revenues
 Nine Months Ended
September 30,
Percentage of
 Accounts Receivable
 (current) as of
Percentage of
 Accounts Receivable
 (noncurrent) as of
 20242023September 30, 2024December 31, 2023September 30, 2024December 31, 2023
Medicare47 %49 %21 %20 %**
Payor A15 %14 %18 %19 %16 %15 %
Payor B**14 %10 %11 %11 %
*    Less than 10%
v3.24.3
Earnings (Loss) Per Share (Tables)
9 Months Ended
Sep. 30, 2024
Earnings Per Share [Abstract]  
Schedule of Computation of Basic and Diluted Earnings (Loss) Per Share
The following table shows the computation of basic and diluted earnings (loss) per share for the following three and nine months ended September 30, 2024 and 2023 (in thousands, except per share data):
 Three Months Ended
September 30,
Nine Months Ended
September 30,
 2024202320242023
Numerator:
Net income (loss)$2,269 $(6,905)$8,655 $(54,886)
Denominator:
Weighted-average common shares outstanding, basic27,840 26,834 27,659 26,725 
Assumed exercise of stock options457 — 447 — 
Assumed vesting of RSUs1,041 — 663 — 
Assumed vesting of PSUs42 — 55 — 
Assumed issuance of shares under the ESPP21 — 14 — 
Weighted-average common shares outstanding, diluted29,401 26,834 28,838 26,725 
 Earnings (loss) per share:
Basic$0.08 $(0.26)$0.31 $(2.05)
Diluted$0.08 $(0.26)$0.30 $(2.05)
Schedule of Antidilutive Securities Excluded from Computation of Earnings (Loss) Per Share
The table below provides the weighted-average number of potential common shares associated with outstanding securities not included in our calculation of diluted earnings (loss) per share for the three and nine months ended September 30, 2024 and 2023 because to do so would be antidilutive. With regard to the PSUs, we assume that the associated performance targets will be met at the target level of performance for purposes of calculating diluted net income per common share until such time that it is probable that actual performance will be above or below target (in thousands):
Three Months Ended
September 30,
Nine Months Ended
September 30,
2024202320242023
Stock options2,430 3,302 2,466 3,339 
RSUs and PSUs474 3,422 553 3,403 
ESPP155 371 207 320 
Total3,059 7,095 3,226 7,062 
v3.24.3
Marketable Investment Securities (Tables)
9 Months Ended
Sep. 30, 2024
Investments, Debt and Equity Securities [Abstract]  
Schedule of Debt Securities, Available-for-Sale
The following tables present our available-for-sale debt securities (in thousands):
September 30, 2024
Amortized CostUnrealizedEstimated Fair Value
GainsLosses
U.S. government securities$184,353 $473 $— $184,826 
Total$184,353 $473 $— $184,826 

December 31, 2023
Amortized CostUnrealizedEstimated Fair Value
GainsLosses
U.S. government securities$144,122 $143 $(7)$144,258 
Total$144,122 $143 $(7)$144,258 
v3.24.3
Property and Equipment, Net (Tables)
9 Months Ended
Sep. 30, 2024
Property, Plant and Equipment [Abstract]  
Schedule of Property and Equipment, Net
Property and equipment, net consisted of the following (in thousands):
 September 30, 2024December 31, 2023
Land(1)
$7,245 $— 
Lab equipment22,201 16,472 
Leasehold improvements14,438 9,990 
Computer equipment5,103 4,060 
Furniture and fixtures3,521 2,385 
Construction-in-progress3,350 637 
Total55,858 33,544 
Less accumulated depreciation(11,475)(8,111)
Property and equipment, net$44,383 $25,433 
(1)On February 9, 2024, we purchased approximately 23 acres of land in Friendswood, Texas for purpose of developing a commercial office building to be used as our future corporate headquarters.
Depreciation expense was recorded in the unaudited condensed consolidated statements of operations as follows (in thousands):
Three Months Ended
September 30,
Nine Months Ended
September 30,
 2024202320242023
Cost of sales (exclusive of amortization of acquired intangible assets)$766 $505 $2,058 $1,205 
Research and development89 84 258 246 
Selling, general and administrative414 313 1,147 913 
Total$1,269 $902 $3,463 $2,364 
v3.24.3
Goodwill and Other Intangible Assets, Net (Tables)
9 Months Ended
Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]  
Schedule of Finite-Lived Intangible Assets
Our other intangible assets, net consist of the following (in thousands):
September 30, 2024
 Gross carrying valueAccumulated amortizationNetWeighted-Average Remaining Life (in years)
Developed technology$125,317 $(25,684)$99,633 11.5
Assembled workforce563 (319)244 2.2
Total other intangible assets, net$125,880 $(26,003)$99,877 
December 31, 2023
 Gross carrying valueAccumulated amortizationNetWeighted-Average Remaining Life (in years)
Developed technology$125,317 $(19,003)$106,314 12.2
Assembled workforce563 (234)329 2.9
Total other intangible assets, net$125,880 $(19,237)$106,643 
v3.24.3
Other Accrued and Current Liabilities (Tables)
9 Months Ended
Sep. 30, 2024
Payables and Accruals [Abstract]  
Schedule of Accrued And Current Liabilities
Other accrued and current liabilities consisted of the following (in thousands):
 September 30, 2024December 31, 2023
Clinical studies$3,023 $3,475 
Accrued service fees3,410 2,097 
ESPP contributions577 896 
Accrued benefits418 199 
Other640 650 
Total$8,068 $7,317 
v3.24.3
Long-Term Debt (Tables)
9 Months Ended
Sep. 30, 2024
Debt Disclosure [Abstract]  
Schedule of Long-term Debt Instruments Our long-term debt as of September 30, 2024 is presented in the table below (in thousands):
 September 30, 2024
Term debt$10,200 
Unamortized discount(185)
Total long-term debt10,015 
Less: Current portion of long-term debt— 
Total$10,015 
Schedule of Maturities of Long-Term Debt
Future maturities of principal amounts on long-term debt as of September 30, 2024 are as follows (in thousands):
Years Ending December 31,
2024$— 
2025278 
20263,333 
20273,333 
20283,056 
Total$10,000 
Schedule of Components of Interest Expense
The table below shows the components of interest expense for the three and nine months ended September 30, 2024 (in thousands):
 Three Months Ended September 30, 2024Nine Months Ended September 30, 2024
Interest expense on long term debt$229 $470 
Less: Capitalized interest(37)(49)
Total$192 $421 
v3.24.3
Fair Value Measurements (Tables)
9 Months Ended
Sep. 30, 2024
Fair Value Disclosures [Abstract]  
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis
The tables below provide information, by level within the fair value hierarchy, of our financial assets and liabilities that are accounted for at fair value on a recurring basis as of September 30, 2024 and December 31, 2023 (in thousands):
As of September 30, 2024
 Quoted Prices in Active Markets for Identical Items (Level 1)Significant Other Observable Inputs
(Level 2)
Significant Unobservable Inputs
(Level 3)
Total
Assets
Money market funds(1)
$89,571 $— $— $89,571 
U.S. government securities(2)
$184,826 $— $— $184,826 
Liabilities
Contingent consideration(3)
$— $— $— $— 
As of December 31, 2023
 Quoted Prices in Active Markets for Identical Items (Level 1)Significant Other Observable Inputs
(Level 2)
Significant Unobservable Inputs
(Level 3)
Total
Assets
Money market funds(1)
$89,308 $— $— $89,308 
U.S. government securities(2)
$144,258 $— $— $144,258 
Liabilities
Contingent consideration(3)
$— $— $— $— 
(1)Classified as “Cash and cash equivalents” in the unaudited condensed consolidated balance sheets.
(2)Classified as “Marketable investment securities” in the unaudited condensed consolidated balance sheets.
(3)Current portion, if any, classified as “Other accrued and current liabilities” in the unaudited condensed consolidated balance sheets.
v3.24.3
Stock Incentive Plans and Stock-Based Compensation (Tables)
9 Months Ended
Sep. 30, 2024
Share-Based Payment Arrangement [Abstract]  
Schedule of Share-based Payment Arrangement on Stock Option Activity
Stock option activity under our stock plans for the nine months ended September 30, 2024 is set forth below:
  Weighted-Average 
 Stock Options
Outstanding
Exercise
Price
Remaining
Contractual
Term (Years)
Aggregate
Intrinsic
Value
(in thousands)
Balance as of December 31, 20233,208,979 $35.38 
Granted3,379 $71.22 
Exercised(111,223)$14.78 
Forfeited/Cancelled(61,197)$39.96 
Balance as of September 30, 20243,039,938 $36.09 5.8$13,365 
Exercisable at September 30, 2024
2,789,681 $35.29 5.7$13,310 
Schedule of Share-based Payment Arrangement on Restricted Stock Units
The following table summarizes our RSU activity for the nine months ended September 30, 2024:
Restricted Stock Units OutstandingWeighted-Average Grant Date Fair Value
Balance as of December 31, 2023
2,805,075 $25.48 
Granted1,515,966 $21.52 
Vested(1)
(290,337)$25.60 
Forfeited/Cancelled(299,980)$21.78 
Balance as of September 30, 2024
3,730,724$24.16 
(1)The aggregate number of shares withheld upon vesting for employee tax obligations was 71,944 for the nine months ended September 30, 2024.
Schedule of Share-Based Payment Arrangement, Performance Shares, Activity
The following table summarizes our PSU activity for the nine months ended September 30, 2024:
Performance-Based Restricted Stock Units OutstandingWeighted-Average Grant Date Fair Value
Balance as of December 31, 2023
196,033 $23.23 
Granted177,513 $21.23 
Vested(1)
(98,018)$23.23 
Forfeited/Cancelled— $— 
Balance as of September 30, 2024
275,528$21.94 
(1)The aggregate number of shares withheld upon vesting for employee tax obligations was 30,046 for the nine months ended September 30, 2024.
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions The following table sets forth the assumptions used to determine the fair value of stock options:
 Nine Months Ended
September 30,
20242023
Average expected term (years)5.05.0
Expected stock price volatility
80.20% - 80.20%
75.57% - 76.01%
Risk-free interest rate
4.39% - 4.39%
3.57% - 3.57%
Dividend yield—%—%
Schedule of Share-based Payment Award, ESPP, Valuation Assumptions
The following table sets forth assumptions used to determine the fair value of the purchase rights issued under the ESPP:
 Nine Months Ended
September 30,
20242023
Average expected term (years)1.21.3
Expected stock price volatility
59.85% - 130.95%
93.17% - 130.95%
Risk-free interest rate
3.82% - 5.33%
4.74% - 5.33%
Dividend yield—%—%
Schedule of Share-based Payment Arrangement, Expensed and Capitalized, Amount
Stock-based compensation expense is included in the unaudited condensed consolidated statements of operations as follows (in thousands):
 Three Months Ended
September 30,
Nine Months Ended
September 30,
 2024202320242023
Cost of sales (exclusive of amortization of acquired intangible assets)$1,464 $1,245 $4,179 $3,719 
Research and development2,345 2,682 7,611 7,755 
Selling, general and administrative9,218 9,116 27,091 27,943 
Total stock-based compensation expense$13,027 $13,043 $38,881 $39,417 
v3.24.3
Summary of Significant Accounting Policies (Details) - USD ($)
3 Months Ended 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Dec. 31, 2023
Class of Stock [Line Items]          
Accumulated deficit $ 209,716,000   $ 209,716,000   $ 218,371,000
Cash and cash equivalents 94,959,000   94,959,000   98,841,000
Marketable investment securities 184,826,000   184,826,000   144,258,000
Allowance for credit losses 0   0   0
Goodwill impairment loss 0 $ 0 0 $ 0  
Accrued bonuses $ 17,900,000   $ 17,900,000   $ 21,700,000
Stock options          
Class of Stock [Line Items]          
Service period     4 years    
Restricted Stock Units (RSUs)          
Class of Stock [Line Items]          
Service period     4 years    
Minimum          
Class of Stock [Line Items]          
Property and equipment, useful life (in years) 5 years   5 years    
Maximum          
Class of Stock [Line Items]          
Property and equipment, useful life (in years) 10 years   10 years    
v3.24.3
Revenue - Narrative (Details) - USD ($)
$ in Millions
3 Months Ended 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Revenue from Contract with Customer [Abstract]        
Number of days contract with customer is generally paid     30 days  
Variable consideration adjustments included in revenue $ (0.6) $ 0.9 $ (1.3) $ (3.1)
v3.24.3
Revenue - Schedule of Disaggregation of Revenue (Details) - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Disaggregation of Revenue [Line Items]        
Total net revenues $ 85,782 $ 61,493 $ 245,758 $ 153,668
Dermatologic        
Disaggregation of Revenue [Line Items]        
Total net revenues 65,060 51,151 193,223 130,097
Non-Dermatologic        
Disaggregation of Revenue [Line Items]        
Total net revenues $ 20,722 $ 10,342 $ 52,535 $ 23,571
v3.24.3
Revenue - Schedule of Concentration of Risk, by Risk Factor (Details) - Third-Party Payor Concentration Risk
9 Months Ended 12 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Dec. 31, 2023
Medicare | Percentage of Revenues      
Concentration Risk [Line Items]      
Concentration risk percentage 47.00% 49.00%  
Medicare | Percentage of Accounts Receivable (current)      
Concentration Risk [Line Items]      
Concentration risk percentage 21.00%   20.00%
Payor A | Percentage of Revenues      
Concentration Risk [Line Items]      
Concentration risk percentage 15.00% 14.00%  
Payor A | Percentage of Accounts Receivable (current)      
Concentration Risk [Line Items]      
Concentration risk percentage 18.00%   19.00%
Payor A | Percentage of Accounts Receivable (noncurrent)      
Concentration Risk [Line Items]      
Concentration risk percentage 16.00%   15.00%
Payor B | Percentage of Accounts Receivable (current)      
Concentration Risk [Line Items]      
Concentration risk percentage 14.00%   10.00%
Payor B | Percentage of Accounts Receivable (noncurrent)      
Concentration Risk [Line Items]      
Concentration risk percentage 11.00%   11.00%
v3.24.3
Earnings (Loss) Per Share - Schedule of Basic and Diluted (Loss) Earnings Per Share (Details) - USD ($)
$ / shares in Units, shares in Thousands, $ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2024
Jun. 30, 2024
Mar. 31, 2024
Sep. 30, 2023
Jun. 30, 2023
Mar. 31, 2023
Sep. 30, 2024
Sep. 30, 2023
Numerator:                
Net income (loss) $ 2,269 $ 8,920 $ (2,534) $ (6,905) $ (18,777) $ (29,204) $ 8,655 $ (54,886)
Denominator:                
Weighted-average common shares outstanding, basic (in shares) 27,840     26,834     27,659 26,725
Assumed exercise of stock options (in shares) 457     0     447 0
Assumed vesting of RSUs (in shares) 1,041     0     663 0
Assumed vesting of PSUs (in shares) 42     0     55 0
Assumed issuance of shares under the ESPP (in shares) 21     0     14 0
Weighted-average common shares outstanding, diluted (in shares) 29,401     26,834     28,838 26,725
Earnings (loss) per share:                
Basic (in dollars per share) $ 0.08     $ (0.26)     $ 0.31 $ (2.05)
Diluted (in dollars per share) $ 0.08     $ (0.26)     $ 0.30 $ (2.05)
v3.24.3
Earnings (Loss) Per Share - Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share (Details) - shares
shares in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]        
Antidilutive securities excluded from computation of earnings per share, amount (in shares) 3,059 7,095 3,226 7,062
Stock options        
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]        
Antidilutive securities excluded from computation of earnings per share, amount (in shares) 2,430 3,302 2,466 3,339
RSUs and PSUs        
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]        
Antidilutive securities excluded from computation of earnings per share, amount (in shares) 474 3,422 553 3,403
ESPP        
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]        
Antidilutive securities excluded from computation of earnings per share, amount (in shares) 155 371 207 320
v3.24.3
Marketable Investment Securities - Schedule of Available-for-Sale Debt Securities (Details) - USD ($)
$ in Thousands
Sep. 30, 2024
Dec. 31, 2023
Debt Securities, Available-for-Sale [Line Items]    
Amortized Cost $ 184,353 $ 144,122
Unrealized gains 473 143
Unrealized losses 0 (7)
Estimated Fair Value 184,826 144,258
U.S. government securities    
Debt Securities, Available-for-Sale [Line Items]    
Amortized Cost 184,353 144,122
Unrealized gains 473 143
Unrealized losses 0 (7)
Estimated Fair Value $ 184,826 $ 144,258
v3.24.3
Marketable Investment Securities - Narrative (Details) - USD ($)
3 Months Ended 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Dec. 31, 2023
Investments, Debt and Equity Securities [Abstract]          
Realized gain (loss) on sale of investment $ 0 $ 0 $ 0 $ 0  
Impairment loss 0 $ 0 0 $ 0  
Allowance for credit loss $ 0   $ 0   $ 0
v3.24.3
Property and Equipment, Net - Schedule of Property and Equipment (Details)
$ in Thousands
Feb. 09, 2024
a
Sep. 30, 2024
USD ($)
Dec. 31, 2023
USD ($)
Property, Plant and Equipment [Line Items]      
Total   $ 55,858 $ 33,544
Less accumulated depreciation   (11,475) (8,111)
Property and equipment, net   44,383 25,433
Acquisition of land (acres) | a 23    
Land      
Property, Plant and Equipment [Line Items]      
Total   7,245 0
Lab equipment      
Property, Plant and Equipment [Line Items]      
Total   22,201 16,472
Leasehold improvements      
Property, Plant and Equipment [Line Items]      
Total   14,438 9,990
Computer equipment      
Property, Plant and Equipment [Line Items]      
Total   5,103 4,060
Furniture and fixtures      
Property, Plant and Equipment [Line Items]      
Total   3,521 2,385
Construction-in-progress      
Property, Plant and Equipment [Line Items]      
Total   $ 3,350 $ 637
v3.24.3
Property and Equipment, Net - Schedule of Depreciation Expense (Details) - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Property, Plant and Equipment [Line Items]        
Depreciation $ 1,269 $ 902 $ 3,463 $ 2,364
Cost of sales (exclusive of amortization of acquired intangible assets)        
Property, Plant and Equipment [Line Items]        
Depreciation 766 505 2,058 1,205
Research and development        
Property, Plant and Equipment [Line Items]        
Depreciation 89 84 258 246
Selling, general and administrative        
Property, Plant and Equipment [Line Items]        
Depreciation $ 414 $ 313 $ 1,147 $ 913
v3.24.3
Goodwill and Other Intangible Assets, Net - Narrative (Details) - USD ($)
3 Months Ended 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]          
Goodwill $ 10,700,000   $ 10,700,000   $ 10,700,000
Goodwill accumulated impairment 0   0   $ 0
Amortization expense of intangible assets $ 2,272,000 $ 2,272,000 $ 6,766,000 $ 6,742,000  
v3.24.3
Goodwill and Other Intangible Assets, Net - Schedule of Finite-Lived Intangible Assets (Details) - USD ($)
$ in Thousands
Sep. 30, 2024
Dec. 31, 2023
Finite-Lived Intangible Assets [Line Items]    
Gross carrying value $ 125,880 $ 125,880
Accumulated amortization (26,003) (19,237)
Net 99,877 106,643
Developed technology    
Finite-Lived Intangible Assets [Line Items]    
Gross carrying value 125,317 125,317
Accumulated amortization (25,684) (19,003)
Net $ 99,633 $ 106,314
Weighted-Average Remaining Life (in years) 11 years 6 months 12 years 2 months 12 days
Assembled workforce    
Finite-Lived Intangible Assets [Line Items]    
Gross carrying value $ 563 $ 563
Accumulated amortization (319) (234)
Net $ 244 $ 329
Weighted-Average Remaining Life (in years) 2 years 2 months 12 days 2 years 10 months 24 days
v3.24.3
Other Accrued and Current Liabilities (Details) - USD ($)
$ in Thousands
Sep. 30, 2024
Dec. 31, 2023
Payables and Accruals [Abstract]    
Clinical studies $ 3,023 $ 3,475
Accrued service fees 3,410 2,097
ESPP contributions 577 896
Accrued benefits 418 199
Other 640 650
Total $ 8,068 $ 7,317
v3.24.3
Long-Term Debt - Schedule of Long-term Debt Instruments (Details) - USD ($)
Sep. 30, 2024
Dec. 31, 2023
Debt Disclosure [Abstract]    
Term debt $ 10,200,000  
Unamortized discount (185,000)  
Total long-term debt 10,015,000 $ 0
Less: Current portion of long-term debt 0  
Total $ 10,015,000 $ 0
v3.24.3
Long-Term Debt - Schedule of Maturities of Long-Term Debt (Details)
$ in Thousands
Sep. 30, 2024
USD ($)
Debt Disclosure [Abstract]  
2024 $ 0
2025 278
2026 3,333
2027 3,333
2028 3,056
Total $ 10,000
v3.24.3
Long-Term Debt - Narrative (Details) - USD ($)
3 Months Ended 9 Months Ended
Mar. 26, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Debt Instrument [Line Items]        
Carrying amount of borrowings     $ 10,200,000  
Proceeds from term loan draw     $ 10,000,000 $ 0
Interest expense   $ 0   $ 0
2024 Loan and Security Agreement | Secured Debt        
Debt Instrument [Line Items]        
Aggregate principal amount $ 10,000,000      
Basis spread on variable rate 0.25%      
Debt instrument, interest rate, stated percentage 6.00%      
Final payment, percentage of principal 2.00%      
Proceeds from term loan draw $ 10,000,000      
Final payment $ 200,000      
Effective interest rate     8.60%  
2024 Loan and Security Agreement | Secured Debt | Prior to March 26, 2026        
Debt Instrument [Line Items]        
Prepayment fee percentage 1.50%      
2024 Loan and Security Agreement | Secured Debt | Line of Credit        
Debt Instrument [Line Items]        
Maximum borrowing capacity $ 25,000,000      
Proceeds from line of credit draw     $ 0  
v3.24.3
Long-Term Debt - Schedule of Components of Interest Expense (Details) - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2024
Sep. 30, 2024
Debt Disclosure [Abstract]    
Interest expense on long term debt $ 229 $ 470
Less: Capitalized interest (37) (49)
Total $ 192 $ 421
v3.24.3
Leases - Narrative (Details)
$ in Thousands
9 Months Ended
Aug. 01, 2024
USD ($)
ft²
Sep. 30, 2024
USD ($)
Sep. 30, 2023
USD ($)
Leases [Abstract]      
Operating lease, expansion option, additional area | ft² 23,821    
Lessee, operating lease, recognition of lease incentives $ 1,300    
Operating lease assets obtained in exchange for lease obligations $ 600 $ 607 $ 499
v3.24.3
Fair Value Measurements - Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis (Details) - USD ($)
$ in Thousands
Sep. 30, 2024
Dec. 31, 2023
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Available-for-sale debt securities $ 184,826 $ 144,258
U.S. government securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Available-for-sale debt securities 184,826 144,258
Fair Value, Recurring    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Money market funds 89,571 89,308
Contingent consideration 0 0
Fair Value, Recurring | U.S. government securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Available-for-sale debt securities 184,826 144,258
Fair Value, Recurring | Quoted Prices in Active Markets for Identical Items (Level 1)    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Money market funds 89,571 89,308
Contingent consideration 0 0
Fair Value, Recurring | Quoted Prices in Active Markets for Identical Items (Level 1) | U.S. government securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Available-for-sale debt securities 184,826 144,258
Fair Value, Recurring | Significant Other Observable Inputs (Level 2)    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Money market funds 0 0
Contingent consideration 0 0
Fair Value, Recurring | Significant Other Observable Inputs (Level 2) | U.S. government securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Available-for-sale debt securities 0 0
Fair Value, Recurring | Significant Unobservable Inputs (Level 3)    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Money market funds 0 0
Contingent consideration 0 0
Fair Value, Recurring | Significant Unobservable Inputs (Level 3) | U.S. government securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Available-for-sale debt securities $ 0 $ 0
v3.24.3
Fair Value Measurements - Narrative (Details) - AltheaDx, Inc - USD ($)
3 Months Ended 9 Months Ended 12 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Dec. 31, 2023
Fair Value Measurement Inputs and Valuation Techniques [Line Items]          
Additional consideration payable based on achievement of certain commercial milestones $ 75,000,000.0   $ 75,000,000.0    
Contingent consideration, portion not paid         $ 37,500,000
Contingent consideration, catch up payment not paid         17,500,000
Potential payment obligation 20,000,000   20,000,000    
Earnout payment, amount due 0   0    
Value of contingent consideration 0   0   $ 0
Recognized (gain) loss of contingent consideration $ 0 $ 0 $ 0 $ 0  
v3.24.3
Stock Incentive Plans and Stock-Based Compensation - Narrative (Details)
$ / shares in Units, $ in Thousands
3 Months Ended 9 Months Ended
Aug. 09, 2024
USD ($)
Jan. 01, 2024
shares
Sep. 30, 2024
USD ($)
shares
Sep. 30, 2023
USD ($)
Sep. 30, 2024
USD ($)
vesting_period
$ / shares
shares
Sep. 30, 2023
USD ($)
$ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]            
Total stock-based compensation expense | $     $ 13,027 $ 13,043 $ 38,881 $ 39,417
Accelerated recognition of compensation expense | $     400 $ 500 800 $ 1,600
Unrecognized compensation costs | $     $ 77,600   $ 77,600  
Unrecognized compensation expense, period for recognition         2 years 2 months 12 days  
Restricted Stock Units (RSUs)            
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]            
Grant date vesting in period | vesting_period         4  
Performance-Based Restricted Stock Units            
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]            
Total stock-based compensation expense | $ $ 100          
Performance-Based Restricted Stock Units | First Year of Vesting            
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]            
Vesting percentage 50.00%          
Performance-Based Restricted Stock Units | Second Year of Vesting            
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]            
Vesting percentage 50.00%          
Vesting period 1 year          
Stock options            
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]            
Options granted, weighted average grant date fair value (in dollars per share) | $ / shares         $ 9.23 $ 15.99
2019 Plan            
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]            
Increase in number of shares authorized for issuance (in shares)   1,370,526        
Percentage of common shares outstanding         5.00%  
Number of shares available for grant (in shares)     556,925   556,925  
2022 Inducement Plan            
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]            
Number of shares available for grant (in shares)     348,917   348,917  
Employee Stock Purchase Plan | ESPP            
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]            
Increase in number of shares authorized for issuance (in shares)   274,105        
Number of shares available for grant (in shares)     1,046,680   1,046,680  
Shares issued during period (in shares)         167,688  
Options granted, weighted average grant date fair value (in dollars per share) | $ / shares         $ 12.28 $ 11.51
v3.24.3
Stock Incentive Plans and Stock-Based Compensation - Schedule of Activity Under Stock Incentive Plan (Details) - USD ($)
$ / shares in Units, $ in Thousands
9 Months Ended
Sep. 30, 2024
Stock Options Outstanding  
Beginning balance (in shares) 3,208,979
Granted (in shares) 3,379
Exercised (in shares) (111,223)
Forfeited/Cancelled (in shares) (61,197)
Ending balance (in shares) 3,039,938
Options exercisable, number of options (in shares) 2,789,681
Exercise Price  
Beginning balance (in dollars per share) $ 35.38
Granted (in dollars per share) 71.22
Exercised (in dollars per share) 14.78
Forfeited/Cancelled (in dollars per share) 39.96
Ending balance (in dollars per share) 36.09
Options exercisable, weighted average exercise price (in dollars per share) $ 35.29
Stock Option Activity, Additional Disclosures  
Options outstanding, weighted average remaining contractual term 5 years 9 months 18 days
Options exercisable, weighted average remaining contractual term 5 years 8 months 12 days
Options outstanding, aggregate intrinsic value $ 13,365
Options exercisable, aggregate intrinsic value $ 13,310
v3.24.3
Stock Incentive Plans and Stock Based Compensation - Schedule of Restricted Stock Units and Performance Stock Units (Details)
9 Months Ended
Sep. 30, 2024
$ / shares
shares
Restricted Stock Units (RSUs)  
Restricted Stock Units Outstanding  
Beginning Balance (in shares) 2,805,075
Granted (in shares) 1,515,966
Vested (in shares) (290,337)
Forfeited/Cancelled (in shares) (299,980)
Ending Balance (in shares) 3,730,724
Weighted-Average Grant Date Fair Value  
Weighted average grant date fair value at beginning balance (in dollars per share) | $ / shares $ 25.48
Granted (in dollars per share) | $ / shares 21.52
Vested (in dollars per share) | $ / shares 25.60
Forfeited / Cancelled (in dollars per share) | $ / shares 21.78
Weighted average grant date fair value at ending balance (in dollars per share) | $ / shares $ 24.16
Withheld upon vesting for employee tax obligations (in shares) 71,944
Performance-Based Restricted Stock Units  
Restricted Stock Units Outstanding  
Beginning Balance (in shares) 196,033
Granted (in shares) 177,513
Vested (in shares) (98,018)
Forfeited/Cancelled (in shares) 0
Ending Balance (in shares) 275,528
Weighted-Average Grant Date Fair Value  
Weighted average grant date fair value at beginning balance (in dollars per share) | $ / shares $ 23.23
Granted (in dollars per share) | $ / shares 21.23
Vested (in dollars per share) | $ / shares 23.23
Forfeited / Cancelled (in dollars per share) | $ / shares 0
Weighted average grant date fair value at ending balance (in dollars per share) | $ / shares $ 21.94
Withheld upon vesting for employee tax obligations (in shares) 30,046
v3.24.3
Stock Incentive Plans and Stock-Based Compensation - Schedule of Assumptions Used in Fair Value of Stock Options and ESPP (Details)
9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Stock options    
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]    
Average expected term (years) 5 years 5 years
Expected stock price volatility, minimum 80.20% 75.57%
Expected stock price volatility, maximum 80.20% 76.01%
Risk-free interest rate, minimum 4.39% 3.57%
Risk-free interest rate, maximum 4.39% 3.57%
Dividend yield 0.00% 0.00%
ESPP | Employee Stock Purchase Plan    
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]    
Average expected term (years) 1 year 2 months 12 days 1 year 3 months 18 days
Expected stock price volatility, minimum 59.85% 93.17%
Expected stock price volatility, maximum 130.95% 130.95%
Risk-free interest rate, minimum 3.82% 4.74%
Risk-free interest rate, maximum 5.33% 5.33%
Dividend yield 0.00% 0.00%
v3.24.3
Stock Incentive Plans and Stock-Based Compensation - Schedule of Stock-based Compensation Expense (Details) - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Total stock-based compensation expense $ 13,027 $ 13,043 $ 38,881 $ 39,417
Cost of sales (exclusive of amortization of acquired intangible assets)        
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Total stock-based compensation expense 1,464 1,245 4,179 3,719
Research and development        
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Total stock-based compensation expense 2,345 2,682 7,611 7,755
Selling, general and administrative        
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Total stock-based compensation expense $ 9,218 $ 9,116 $ 27,091 $ 27,943
v3.24.3
Income Taxes (Details)
3 Months Ended 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Income Tax Disclosure [Abstract]        
Effective income tax rate 72.60% 0.00% 36.70% 0.00%