WGS GeneDx Holdings Corp.

NASDAQ
$78.08

GeneDx Holdings Corp. Q2 F2026 Earnings Call Transcript

Monday, August 3, 2026

AI Conference Call Analysis

Sign in or subscribe to read.
Kevin Cohrs
Chief Financial Officer, GeneDx
Steele, and Jami Biliboaca. Second, on pair coverage, while pair coverage is moving in the right direction, coverage varies significantly between exome and genome, and understanding that gap is important context for the forward-looking ARR outlook. On the commercial side, approximately 98% of commercial lives have some level of exome coverage, up from approximately 90% in the first quarter. Genome is earlier in that journey. Approximately 87% of commercial lives now have some level of genome coverage, up significantly from 47% last quarter, representing a structural shift in reimbursement outlook for genomes. The primary driver of that increase was Caroline. On the Medicaid side, 39 states now cover exome or genome testing, with Mississippi coming online July 1st. The full impact of coverage expansion takes time to flow through our Blended ARR, and revenue based on collections and accrual lags. It's important to acknowledge that across both commercial and Medicaid plans, not all coverage policies are created equal. Even with written policy, genomic testing remains out of reach for too many children as claims are denied by overly restricted eligibility criteria and administrative barriers. In the second quarter, Approximately 67% of our outpatient genome volume was submitted to payers with an active positive coverage policy. Looking at the evolution here, that rate is up from 38% in the second quarter of last year and up from 46% just last quarter. The uptrend has continued in July, giving the role in the advancements of policy coverage. And third, outpatient genome collection rates, which are affected by both coverage and our own operational effectiveness. Our operational underlying outpatient genome collection rate, which is the percentage of claims paid, today stands at approximately 32%, flat with the first quarter and down from 43% in the second quarter of 2025. That decline in collections from last year reflects an investment we made into developing the market by accepting volume ahead of coverage. Importantly, it reflects a tremendous opportunity for us when, in the fullness of time, we get paid more often for these volumes with greater coverage and with better RCM. As Katherine rightly pointed out, we are under-earning versus our full potential. As an illustration of the opportunity, if we were to double that 32% collection rate, what are zeros in our blended ARR today become paid units, driving revenue uplift that falls directly to the bottom line. Now, I focus on Genome here because of the large year-over-year mix shift and its larger place in the future of the business and also the fact that Exome already operates at a gross margin above the total company average. However, outpatient Exome collection rates are comparable to Genome, which means there's a ton of room to improve. Most denials are addressable and the work will put into RCM aims to benefit the entire portfolio. We do not expect improvements to be perfectly linear, but in terms of pacing, Q3 collection rates should remain roughly flat as our payer-specific workflows are still being built out and incrementally implemented. As a reminder, our revenue recognition reflects collection experience over a trailing period, and thus it takes a couple of quarters to fully capture improvements in coverage and the impact of operational actions. We expect to see meaningful improvements in Q4 2026, with the most significant uplift coming in 2027 has both expanded coverage and stronger operational execution compound together. Beyond operational effectiveness, that collection rate, and thus ARR, could always have some underlying variability from the single payer's administrative behaviors, tightening coverage policy, or contracting change. However, we serve a diversified payer base, so the impact of any single payer action is usually moderated. Moving down the income statement, beyond ARR uplift, genome gross margins have room to expand from lower COGs over time. Today, whole genome costs us nearly twice as much to produce than exome. The difference there is almost entirely higher reagent costs, which we expect will come down as utilization for genome grows and manufacturers advance their technology. We expect cost per test to stay relatively flat for the second half of 2026, with step improvements in 2027. Operating expenses were approximately $80 million, which was slightly better than expected. We completed the full $25 million of annual cost actions committed to on our last call. And we've recalibrated our investment pace while continuing to protect core investments in our proven growth channels and operational infrastructure. Onto the balance sheet, subsequent to the close of the quarter, we further fortified our financial position through a $50 million expansion of our existing debt facility and a concurrent equity investment from a valued strategic partner, Blackstone Life Sciences. This brings our pro forma liquidity to approximately $188 million as of June 30th, 2026. This opportunistic capital expansion ensures that GDX is fully capitalized well beyond sustained positive cash flow while maintaining the flexibility to invest in high growth strategic opportunities. Turning to guidance. We're reaffirming our full year guidance range of $475 to $490 million in revenues. We continue to expect exome and genome volume growth of at least 30%, exome and genome revenue growth of at least 20%, gross margin of approximately 70%, and to be profitable for the full year. For the third quarter, we expect revenues between $122 and $124 million, exome and genome revenue of 110 to 112 million, on volume of approximately 33,200 tests. The blended ARR there is approximately $3,300 a test. Expect gross margins of approximately 70% and approximately $2 million in adjusted net income. With that, I'll turn you back to Katherine prior to Q&A.
Katherine Stueland
President and Chief Executive Officer, GeneDx
Thank you, Kevin. GDX is positioned for long-term, sustainable, profitable growth. For 25 years, clinicians have relied on GeneDx to resolve their most challenging cases because our accuracy is proven. Deep clinical loyalty has enabled us to shepherd the market through major shifts before, beginning 15 years ago with the transition from single gene tests and multi-gene panels to exome, and beginning now from exome to genome. Innovation accelerates and we're leading the way. We have the strategy, the team, and the operating plan to capture the significant opportunity ahead. I want to say thank you to our dedicated employees for all of their extraordinary work and to our shareholders for their continued support. Without you, our work and service of the ever-growing number of families needing answers would not be possible. With that, operator, please let's open up the line for questions.
Operator
Conference Operator
Thank you. As a reminder, to ask a question, please press star 11 on your telephone and wait for your name to be announced. To withdraw your question, please press star 11 again. In the interest of time, we ask that you please limit yourself to two questions. Please stand by while we compile the Q&A roster. And our first question comes from Dan Brennan of TD Callen. Your line is open.
Dan Brennan
Analyst, TD Cowen
Great. Thank you. Thanks for the questions. You gave a lot of, obviously a ton of detail on the focus on getting better payment rates. I was hoping maybe you could just, yeah, there's a lot of numbers in there. I was hoping maybe you can just elaborate a little bit on the pacing in 3Q, 4Q. Kevin, I heard you say that it seems like 4Q could see a meaningful uplift just given the timing it takes. Maybe can you just review, I got the numbers in 3Q. So maybe A, like why is the pace a little slower? And then B, what's the kind of upside case you're exiting 4Q at and what could that mean for next year?
Kevin Cohrs
Chief Financial Officer, GeneDx
Thanks, Dan. Look, there's a natural lag between operational improvements and those improvements blending through our accrual rates. We'd expect the collection rates to remain roughly flat with Q3 with meaningful improvements beginning in Q4. And in 2027, the upside is real. It just takes time to flow through. We're placing a premium on getting paid and guiding with that discipline.
Dan Brennan
Analyst, TD Cowen
Okay. And maybe just on the mix, you know, you have the reflex, you're getting the whole genomes down. I know on the last call you talked about, obviously, you want to provide the best service to customers. You don't want to dissuade them from getting what they want. But maybe just speak to a little bit of how you're managing that mix. You've got it down, kind of what you're baking into the back half of the year. And from a competitive standpoint, if a competitor is a pushing whole genome, does that put you at a disadvantage at all that you're trying to favor the exome against that? Thank you.
Katherine Stueland
President and Chief Executive Officer, GeneDx
Certainly. Well, first, we continue to see, as I said in my prepared remarks, the future is indeed genome. We expect that all inherited disease will be diagnosed off of a genome. But in the meantime, we have several services that we're able to provide to give our clinicians, regardless of what channel they're in, the right technology to get the diagnostic yield that they need to get the right answer to their patient. Remember, 80% of the time, patients with genetic disease can be diagnosed with an exome. And so, we see really good uptake with that product. And if they need more information, then we can quickly reflex them beyond that exome to a genome. And because we've been able to drive down our turnaround times, we can do all of that faster than other labs can run a genome. We've been successful in really managing this transition. We saw it in Q2, and we continue to drive, I would say, a really meticulous approach to the sales force to ensure that we are giving customers what they want, utilizing the various tools that we have.
Dan Brennan
Analyst, TD Cowen
If I'm still live, maybe this last one to sneak in. We had modeled, realized price to kind of flattish after 26, because you You were just getting to this level, and I think the street and us probably had similar, maybe low single-digit pricing. I know, Kevin, in the past, you've talked about how you'd be willing to go in contract with payers to secure higher payment rates, even if it meant you give away some of the upside. The tone sounds different now with Mark. It sounds like you feel there's all this upside on getting realized price. Any way for us to think about what this could mean beyond 26 in terms of what the capture could look like? Thanks.
Kevin Cohrs
Chief Financial Officer, GeneDx
Yeah, look, in terms of 27, I think to keep flat in 27 and beyond misses a core central opportunity for us. Today, at 32%, genome collection rates reflect where we are in the coverage maturity, not where we think we're going. We've brought in that volume to deliberately build the clinical evidence to expand payer policies. That's worked, as represented by that Thank you for joining us. Thank you. And our next question comes from Mark Massaro of BTIG. Your line is open.
Mark Massaro
Analyst, BTIG
Hey guys, thank you for taking the questions. I was hoping that maybe you could double click on the Carillon opportunity, recognizing that that is a very, very significant lift that you talked about, but I was just wondering if you could maybe frame what needs to happen next. Is this just getting in front of commercial payers? And I think I heard you say this is a big lift in 2027, but can you just walk me through why it It wouldn't be a lift in Q3 and Q4 and any potential for that?
Katherine Stueland
President and Chief Executive Officer, GeneDx
Yeah, so Mark, thank you for that. It is indeed in a single quarter just a massive opening up of possible patients and revenue for us moving forward. So it's a really positive development as Kevin had shared in his comments. Coverage leads and payment lags. So there's just a massive opportunity ahead to raise our collection rates and revenue based on Carolon and extended coverage to about 56 million lives. But payers don't always operationalize everything immediately. So it takes some time. Kevin, anything you want to add?
Kevin Cohrs
Chief Financial Officer, GeneDx
Yeah, I would just add that certainly we're not counting on anything in that regard for the third quarter here, but some contribution beginning in the fourth quarter of 2026, but then more fully in 2027 to account for that natural act.
Mark Massaro
Analyst, BTIG
Okay, perfect. And then if you don't mind, I want to ask the same question on Medi-Cal. You know, obviously these are different payers, but can you just walk us through the same The same thought process as to when you expect a benefit and if there could be anything in Q3 versus Q4.
Kevin Cohrs
Chief Financial Officer, GeneDx
Yep, monitoring it closely. But California pricing for their genome within Medi-Cal fee-for-service, they published a rate a couple months ago and that became effective just July 1st and so it's pretty early but monitoring adjudication experience closely to see that they're paying often and at that price. I think some of the larger work to do is to make sure that MCOs in the state of California are following Medi-Cal policies and guidelines, which they're required to do under regulatory frameworks. But we want to see some data further accumulated that the MCOs, which is the largest proportion of volume, are going to follow policy. We have counted on some uplift based on recent trends that we can see, but I continue to view it as a massive long-term win that Medi-Cal has put out policy, but still monitoring it closely and expect greater uplift in 2027.
Mark Massaro
Analyst, BTIG
Fantastic. Last one for me. It was encouraging to hear the progress with rising engagement with the general pediatrician market. with orders coming in. Is there any way to quantify what those orders are? When do you think it might be material enough to quantify them? And then are there any lessons learned? I know it's early, but perhaps, you know, can you talk about ways that maybe you've optimized the early launch and how you can attack that in a bigger way in 2027?
Katherine Stueland
President and Chief Executive Officer, GeneDx
Certainly. Well, as a reminder, it's been just over a year since the guidelines published. We're still in the early stages of commercial activity post guidelines. We're pleased that we are investing in this channel. We're seeing clinicians in the Gen Peds channel ordering exome testing predominantly, and we're seeing some good interest there. It's a different call point, though. I'll let Mark comment a little bit more on this.
Mark [Last Name Unknown]
Chief Commercial Officer, GeneDx
Obviously, this is one where depending on the specifics of each of the practices, some of those practices are more attractive than others. There's obviously a greater emphasis amongst prevailed mental and behavioral specialists to order more exomes than you might see amongst the rest of the general peds call point. So we're definitely seeing that there are differences even within the overall general pediatrics channel. The other thing I would note is that we think that this is an area where as more and more general practitioners are becoming corporatized or part of larger groups, that that's actually an opportunity to aggregate demand and to set policy for the larger corporate entity. So we think that by being really focused on higher productivity physicians and by concentrating on how we win corporate accounts, we think that that's a way to expand the market. So far, the evidence is that it has a very high return on investment.
Mark Massaro
Analyst, BTIG
Great. Thank you.
Operator
Conference Operator
Thank you. And our next question comes from William Bonello of Craig Hallam. Your line is open.
William Bonello
Analyst, Craig-Hallum
Hey, guys. Thanks a lot. I'll ask my two questions. One, I'm trying to understand. So, you know, it sounded like you said a pretty Significant improvement in mix, actually, in Q2 versus Q1. But we actually saw the ASP or ARR go down not a ton, but slightly. And with the improvement in mix, we might have thought it would move the other direction. So is something else getting worse? Are you seeing an uptick in the rate of denials? Are you seeing pricing pressure? I mean, why wouldn't it flow through to higher ARR rather than lower ARR?
Kevin Cohrs
Chief Financial Officer, GeneDx
It's a great question, Bill, and hi. Look, the mix improvement is real, moving from 40% to 32%. with the differential there flowing back into the Reflex product, an important bridge that allows us more time to mature collection processes for genome. But the reality is exome collection rates roughly flat underlying from quarter to quarter. There was some slight variation in payer mix that led to about that $50 variation that's within 1%. of Q1. I think the way we would read that is the blended ARR has stabilized. It's flat. It now represents a new base for us to work off of. The building blocks that we described in terms of operational improvements is being deployed now. That will take some time. We're not happy with the 32% collection rate on genome, and exome collection rates are comparable to that. We have work to do, and frankly, we think that represents the largest opportunity the company has to meaningfully increase our earnings power over time.
William Bonello
Analyst, Craig-Hallum
Hey, if you'll indulge me and let me sneak in a third, I don't have to, but just I want to follow up on that. When you're saying exome collection is roughly the same, I thought in the past we had gotten all the way up to like 55%. Collection rates or something on Exome. And so if we're down at sort of 32-ish or something, maybe I'm just not understanding what you're saying.
Kevin Cohrs
Chief Financial Officer, GeneDx
No, you're tracking well, Bill. The nuance there is those collection rates we cited are for the outpatient insurance-based volume only. And so what I mean by that is excluding the NICU. The NICU is collected at 100% and what buoys that rate back up towards the 50% range in total. What we'll be tracking and calling out specifically so you can all track along with us is the improvements in the underlying outpatient insurance-based rate, which is where we see the largest opportunity at.
William Bonello
Analyst, Craig-Hallum
Okay, that makes a ton of sense. If I can ask what was going to be my second question, I'm just trying to wrap my head around the guidance and I may be remembering, you know, commentary a little bit wrong from last quarter, but I thought we were kind of expecting some, you know, steady improvement in ARR over the course of the year and, you know, I appreciate all the reasons not to necessarily expect that, and that seems really prudent. But you held your volume growth rate flat and your revenue guidance flat, or your volume guidance and your revenue guidance flat. I'm just sort of wondering how we reconcile maybe ARR not improving at the same rate, but revenue and volume being still where you expected.
Kevin Cohrs
Chief Financial Officer, GeneDx
Yeah. Look, the guide reflects July trends that we had the benefit of seeing, which showed mix continuing to move in the right direction and core channel demand really healthy at this point and reflex volume for the first time on a single month basis since we launched that product, reflex volumes exceeding T-notes in the month of July. We took stock of the totality of what we see as really positive trends that played out throughout the second quarter and into July and incorporated all that into the new guide that we just provided here. Perfect. I really appreciate that.
William Bonello
Analyst, Craig-Hallum
Thanks a lot.
Operator
Conference Operator
Thank you. And our next question comes from David Westenberg of Piper Sandler. Your line is open.
David Westenberg
Analyst, Piper Sandler
Okay, I'm going to truly ask just one in one follow-up here. So can you just, I'm going to get into the H2 guidance. How much visibility do you have on collection rates in Q4? Secondly, on kind of like the Salesforce ramp and their productivity, how much productivity are you seeing right now and how much of productivity gains are in the Q4 guidance I'm thinking about specifically? Last one follow-up.
Kevin Cohrs
Chief Financial Officer, GeneDx
Yeah, look, in terms of visibility, it was a commitment of ours to improve that following the first quarter call. And we think we've done that. I've had the benefit of adding a number of folks to my financial leadership team. We brought in some exciting revenue cycle leaders with experience doing this at very large scale at companies you all know very well, in addition to Mark. So beyond Mark joining us, a whole host of new talent really with the goal of upping experience levels operating at much larger scale than we have. And we've accumulated data trends like I said through July and those data points throughout the second quarter and into July inform what we see as the outlook that we provide. And on the sales productivity.
Mark [Last Name Unknown]
Chief Commercial Officer, GeneDx
With regard to the sales report I would just say that What we've seen is that while our traditional call points continue to deliver at a very high rate per rep, if you actually look at the incremental number of new physicians, the incremental number of new orders, we think that these emerging markets actually represent a significant amount of our future growth. They by now actually represent a meaningful and impactful amount of our overall volume growth for the quarter. and, you know, frankly, a lot of those folks we just hired in the first part of this year. So, you know, traditionally they would have a learning curve and they would get more productive as the year goes on. So we see that accelerating in the back half of the year.
David Westenberg
Analyst, Piper Sandler
Thank you so much. Kevin, just going to stick with the question on you and, you know, congrats on the return to profitability in Q2. The operating cash flow was one of the high points we've seen in quite a while. I think investors are also kind of seeing the Blackstone facility and that happening in the quarter. So we just want to think about how you're thinking about cash flow expenses from here out for the rest of the quarter and what GDX needs to do to become a sustainably cash flow positive company over the next couple of years. Thank you.
Katherine Stueland
President and Chief Executive Officer, GeneDx
Sir, and Dave, thanks for the question. I'll kick it off and then hand it over to Kevin. Just to say, as we committed on the last call, we have succeeded in that $25 million OpEx cut. And we've organized the company around the three biggest levers, which is improving unit economics, driving utilization of XM and genome, and delivering best-in-class products. And we have organized everyone around and all of our capital deployment around those three efforts. Anything that doesn't fall into that is opportunity to continue to make sure that we've got the right capital management strategy. So we feel like we've got the right focus in place.
Kevin Cohrs
Chief Financial Officer, GeneDx
Yeah, and as you pointed out, Dave, Q2 certainly will be the high point of the year. Q2 reflecting the lag from the first quarter operating loss. which in large part was driven by the heavy commercial investment into expanding the sales team as well as some other investments. The second quarter was a heavier capex cycle than what we might expect moving forward as we've significantly increased the sequencing fleet to keep pace with the increase in genome volume that we've seen over the past year. We think that has now reached a point of leveling out and Q2 did have some certain one-time payments as well as the lag between the fact that earning a dollar today takes some more time to collect it in cash. Three things kind of improve that picture moving forward. First, as I mentioned, we've completed the execution at a net $25 million in cost from our plan. That work is behind us and in current run rates. Second, the RCM improvements we've talked about will begin to increase our earnings power. More so in the fourth quarter as collection rates rise. And then third, as volumes continue to grow, we do get some compounding COGS leverage that improves operating margins over time. So we'd expect about $10 million approximately in the third quarter. But the fourth quarter returning to cash flow generation, and that Blackstone financing gives us ample runway to get there without any sort of compromise. And by 2027, we expect all of those factors to converge in strong, sustained cash generation.
Operator
Conference Operator
Thank you. And our next question comes from Kyle Mixon of Canaccord Genuity. Your line is open.
Kyle Mixon
Analyst, Canaccord Genuity
Hey guys, thanks for the question. It's good to see a clean quarter. I wanted to ask about the reflex testing. So that volume mix continues to expand at a pretty rapid clip like you saw recently. And the reflex mix is much higher in 4Q than you would have expected. How does that impact the guidance, especially ARR?
Kevin Cohrs
Chief Financial Officer, GeneDx
What's in the guide is our expectation of how those mix would evolve over time. And look, think about All right, great.
Kyle Mixon
Analyst, Canaccord Genuity
If the outpatient genome mix, you know, decreased by so much here, what other end markets kind of benefited the most? Was it the emerging, like the NICU and the GenP or the established kind of end markets? Which volume, which area did volume increase the most?
Kevin Cohrs
Chief Financial Officer, GeneDx
Yeah, look, the Reflex product, like I said, is in large part meant to be a bridge offering. Where we're seeing the greatest interest is in the geneticist forum. As Mark said, the secular shift to genome and its interest has not slowed down. But what we have seen is many of those genome orders moving to reflex, taking advantage of the exome to reflex structure that we've put up. The product is operating better than initial expectations when we first launched it in February.
Katherine Stueland
President and Chief Executive Officer, GeneDx
And I would just add in the We're seeing good utilization of our Exome products, so it's predominantly Exome, and so there's a healthy mix. Again, as we're on each channel, we learn more about what product works, what services work, and what the sales force needs to do to make sure we've got the right mix.
Kyle Mixon
Analyst, Canaccord Genuity
Thanks, guys.
Operator
Conference Operator
Thank you. and our next question comes from Tycho Peterson of Jefferies. Your line is open.
Tycho Peterson
Analyst, Jefferies
Hey, thanks and welcome, Mark. I'm curious how you characterize the competitive landscape now. I mean, I think you called out at some of the conferences competitive forces as a factor of that whole genome shift. Any comments you'd make on kind of just the shifting competitive landscape?
Katherine Stueland
President and Chief Executive Officer, GeneDx
Sure, I'll kick it off and then would love Mark to share his fresh perspective on it. One, I would say we're still the dominant We still have 80% market share amongst geneticists. We're now at 50% for pediatric specialists. So we're continuing to be the market leader. And we're evolving and developing new markets in Gen Peds, mainly because of the quality and accuracy of our products, the customer experience, the underlying data that ensures that people have confidence in our answers. But yeah, we keep our eyes on competition. We've made it clear this is a really attractive and it's a very large market that will require more than GDX. Having more voices out there really opens up markets faster. It helps shape payer policy faster, helps shape policy in general faster. You know, we're going to continue to be the leader and we also welcome competition for those reasons. Mark?
Mark [Last Name Unknown]
Chief Commercial Officer, GeneDx
Trico, it's great to hear your voice again. And I would just say that, you know, what really characterizes a lot of our competition right now is who's able to both measure variation and match variation the best. And, you know, there are a lot of different ways to measure genomic variation. but at the end of the day, the Infinity Database is a unique asset for matching that variation to drive discovery. And so what we find is that our customers are loyal to that because it produces a higher diagnostic yield and it gets better answers for the patient. So we feel like we can maintain our leadership through continuing to invest in that data asset and continue to drive discovery in the market.
Tycho Peterson
Analyst, Jefferies
Okay, that's helpful. And then the one-minute genome, where are you in rolling that out and, you know, how critical is that to the ramp in the back half of the year?
Katherine Stueland
President and Chief Executive Officer, GeneDx
Certainly. So, we've made some really good progress with one-minute ordering, which in the past we've talked about as an unlock predominantly for general pediatricians. It was designed by them, for them, we think as the potential to unlock more volume across all the channels. So it will be later this summer with, I would say, a rolling set of features. We're going to continue, put out kind of an MVP and continue to iterate on it. But all is on track there.
Mark [Last Name Unknown]
Chief Commercial Officer, GeneDx
Kevin, I would just add that, you know, obviously that one of the things about these emerging markets is that, you know, the customer service expectations are different. And so we're obviously learning from that and we're adjusting our approach, you know, commensurate with and the maturity of those markets. And so I feel really proud of the work of the team on that. And I think we're really going to be able to accelerate growth with people who are frankly not that used to ordering exome and genome testing.
Tycho Peterson
Analyst, Jefferies
I'll do it at that. Thank you.
Operator
Conference Operator
Thank you. And our next question comes from Sabu Nambi of Guggenheim. Your line is open.
Sabu Nambi
Analyst, Guggenheim
Hey guys, thank you for taking my question. Kevin, last quarter you were really helpful in telling us the exome genome mix and it would be really helpful if you could tell us what your assumptions are for exome genome mix in 3Q and then in 4Q. And where do you see yourself exiting this year? This is all acknowledging that payer coverage is improving at a rapid rate for genome.
Kevin Cohrs
Chief Financial Officer, GeneDx
Yeah, in terms of mix, we would expect Thank you for that. And then I want to probe a bit on the operational pillars and focus in the prepared remarks.
Sabu Nambi
Analyst, Guggenheim
Mark, can you expand a bit on what's different about this approach compared to what was being done before? Just trying to understand how this new approach will materially change things in the near term. Thank you so much.
Mark [Last Name Unknown]
Chief Commercial Officer, GeneDx
Yeah, I would say that with regard to developing payer-specific processes, that's something where historically we've frankly not invested enough in the systems and process muscle to really execute against that. The team had already brought on a number of key personnel to help lead that. So I'm just sort of shepherding that further along. But I think with some of the people that we brought in from the industry who really have sort of been there and done that before, you really have a playbook that's relatively straightforward. It just comes down to complying with exactly what the payers need you to comply with in order to get paid. And it's a very and many more. So it's not a tension of detail-oriented process, but it's something where I think that we're seeing dramatic improvement in that.
Sabu Nambi
Analyst, Guggenheim
Thank you for that, Mark. And Tim, you hired a bunch of sales reps. How is the productivity going on with the new reps? Are we seeing returns from that investment already? Should we expect that group to still be ramping to full productivity throughout the end of the year?
Mark [Last Name Unknown]
Chief Commercial Officer, GeneDx
we already see what we would say is a positive return on investment so far and absolutely we think that those scenes will continue to accelerate in their productivity and you know things like one minute ordering actually just complement that you know it's not just about adding reps it's also about adding processes and and market specific customer service elements to to really drive adoption so you know we feel like That should continue to accelerate the time.
Sabu Nambi
Analyst, Guggenheim
Okay. Thank you so much, guys. Thank you.
Operator
Conference Operator
And the next question comes from Keith Hinton of Freedom Capital Markets. Your line is open.
Keith Hinton
Analyst, Freedom Capital Markets
Great. Thank you. I have one on volumes and then a follow-up on gross margin. For volumes in the quarter and the back half of the year, can you just talk a little bit about the contributions from the foundational markets versus how much of the growth came from the various expansion markets? So sort of any granularity you can give there for the quarter and kind of what's baked into the guide. And then I'll follow up on the gross margin.
Kevin Cohrs
Chief Financial Officer, GeneDx
Yeah. Yeah. We've seen broad-based contribution. The majority of growth in terms of units, of course, coming from geneticists, Pete Neuro, and the NICU, maybe in that ranked order, just given the much larger base. If you were to double-click into those newer markets of general pediatricians and prenatal Lower unit contribution, but significant year-over-year growth rates or even quarter-over-quarter growth rates just off of a much smaller base. And we would expect through the second half of the year to see contribution from all those channels. I think signals through July continues to show we're in the right markets and they're growing in the direction that we'd expect them to. I think, frankly, if you look at contribution, we still have significant headroom to penetrate and grow in those core foundational markets of geneticists, Pneuro and the NICU alike, notwithstanding early contributions received from the new markets.
Keith Hinton
Analyst, Freedom Capital Markets
Great, that's helpful. And then on gross margin, I believe, based on the numbers I'm looking at, that you guys were able to improve gross margin almost 200 bps quarter over quarter, even though the ex-gen ASP was slightly down. So can you just talk a little bit about sort of what drove that quarter over quarter efficiency gains and how we should think about the sustainability going forward as hopefully ASP starts to come up?
Kevin Cohrs
Chief Financial Officer, GeneDx
Yeah, maybe I'll start and then see if Mark has some additional color to layer in. Thanks for pointing that out. I think the team here continues to focus really on two fronts. How do we continue to improve wet lab efficiency? Certainly see reductions in input costs as utilization for genome grows, but also we are still in the early innings of deploying advanced technology across the dry side stack, having made Thank you. Thank you.
Mark [Last Name Unknown]
Chief Commercial Officer, GeneDx
opportunities that we actually have as a company is leveraging the power of machine learning and AI and other tools like that, coupled with our data, coupled with the talented variant scientists that we have on the team to really drive productivity on that. And I would say that we had very significant improvements in dry lab productivity in Q2, and we're obviously trying to continue to drive that for several years to come. By now, in a lot of ways, the amount of productivity that comes from the dry lab in some cases actually is larger than that that you'd see from the web lab. So exciting stuff. Great. Thank you.
Operator
Conference Operator
Thank you. This concludes our question and answer session. I'd like to turn it back to Katherine Stueland for closing remarks.
Katherine Stueland
President and Chief Executive Officer, GeneDx
Excellent. Well, we appreciate everyone's time tonight. We look forward to talking to you soon over the coming days and have a good evening. Thank you.
Operator
Conference Operator
This concludes today's conference call. Thank you for participating and you may now disconnect.