Sera Prognostics, Inc.

we expect to support our long-term volume and revenue. Adding to our two live programs, we launched our third partnership program during the quarter, further expanding education and access to preterm. This program is expected to reach over 350 providers across three states, expanding our clinical footprint and advancing earlier identification and intervention for at-risk pregnancies. Beyond these established programs, we are contracting with additional partners and expect to provide more detail as these initiatives transition from contracting into live implementation. In parallel, we are now engaged in active discussions with 13 payers across 15 states, reflecting our strategy to deepen relationships with a focused set of target markets. We believe this concentrated approach is more effective in driving meaningful implementation and adoption than pursuing broader but less integrated engagement. Across all of these efforts, our priorities remain execution, reimbursement, physician awareness, clinical integration, and provider adoption. We view these steps as foundational to broader coverage and scale over time. In addition to reimbursement, we are making steady progress in our efforts to drive guideline inclusion while continuing to expand the evidence-based supporting preterms. As discussed in our year-end call, European expert commentary on the prime trial was published in the Journal of Maternal, Fetal, and Neonatal Medicine in March. The authors emphasized that current preterm birth prevention strategies failed to identify the majority of women who ultimately deliver preterm and highlighted the alignment of the preterm approach with existing European healthcare systems. Also in March, results from the PREPARE survey were accepted for publication in the Journal of Women's Health. This survey examined preterm birth awareness and risk perception among women across five European countries and identified a meaningful gap between perceived awareness and actionable understanding, reinforcing the need for earlier and more standardized risk communication. We look forward to the formal publication expected in May. Together, these publications support our stakeholder engagement efforts in Europe and underscore the global relevance of risk-based preterm birth prevention as healthcare systems increasingly emphasize prevention, education, and cost-effective maternal care. Looking ahead, we remain on track to publish several additional prime sub-analyses in 2026, including a highly anticipated health economics study, Medicaid population outcomes of the prime study, and a focused analysis of first-time moms further strengthening the clinical and economic foundation for adoption. During the quarter, we also continued to advance our advocacy strategy. Pre-term birth is not only a clinical challenge, but a public health and policy issue. We're engaging with stakeholders across multiple states to monitor and, where appropriate, support legislative initiatives and policy discussions focused on earlier identification and prevention, particularly in Medicaid and value-based care settings. We also recently launched a targeted letter-writing campaign designed to encourage physicians and patients to engage with state Medicaid programs on reimbursement for the preterm test. The initiative is intended to amplify, at the local level, the existing clinical voice calling for access for its risk populations. To date, we've seen encouraging participation, with multiple letters submitted across several states reflecting growing physician advocacy and awareness. We believe these grassroots efforts will play an important role in advancing broader coverage discussions over time. Through these efforts, we continue to build awareness and alignment well in advance of formal coverage decisions and to help policymakers understand both the clinical and the economic burden of preterm birth. We view advocacy as an important complement to our commercial and scientific strategies. In Europe, we continue to make progress towards commercialization readiness. We remain on track for a mid-year submission of our CE marking dossier and have had constructive discussions with regulators and clinical stakeholders. Engagement with our European advisor group continues to reinforce alignment around clinical utility, evidence requirements, and implementation considerations. On capital deployment, we have completed the next phase of our evolution from a clinical stage company to a commercial organization driven to secure reimbursement and revenue. Following comprehensive business review, We realigned resources, identified significant operational efficiencies, and streamlined R&D and G&A functions. We are prioritizing investments in payer engagement, market access, and clinical adoption of preterm. As part of this realignment, we are intentionally shifting capital away from R&D and clinical operations towards commercial and medical activities that directly support access and adoption. Over time, this results in a meaningfully higher proportion of our operating spend focused on commercialization and medical engagement, with R&D becoming a smaller share of our overall expense base as we move into 2027 and beyond. These actions are expected to reduce our base operating expenses by nearly 10 million annually, while enhancing our ability to focus capital on commercialization efforts. At this new operating level, we expect that our existing cash and cash equivalents will be sufficient to fund our operating expenses and capital expenditure requirements through 2029. By extending our runway by an additional year, we have positioned the company to capitalize on meaningful growth expected over the next 12 months and to achieve key access and commercialization milestones in the years to come. To wrap up, the first quarter was characterized by awareness building and intentional positioning, expanding access points, strengthening referral pathways, advancing advocacy efforts, and continuing to build the scientific foundation necessary for long-term adoption. Everything we've discussed today reflects a consistent strategy focused on establishing the prerequisites for durable, scalable adoption. And while these adoption cycles take time, we remain encouraged by the level of engagement we're seeing and confident that the foundation we're laying will support meaningful long-term pull through. With that, I'll turn the call over to Austin.

Thanks, Jenya, and good afternoon, everyone. Revenue for the quarter was $14,000 compared to $38,000 in the first quarter of 2025. As expected, revenue in the quarter remained modest, reflecting the timing and nature of our geographically targeted commercialization strategy and our ongoing effort to build advocacy and awareness following the prime publication. Operating expenses for the quarter were $9.4 million, up slightly from $9.3 million in the prior year period, consistent with our expectations and reflecting disciplined cost management alongside continued investment in evidence generation, regulatory preparation, and advocacy activities. As discussed following our business review, we expect to reduce our operating expense base by nearly $10 million on an annualized basis. The benefit in 2026 will be limited due to the phasing of activities and related charges, with the majority of the savings expected to be realized in 2027 and beyond. Research and development expenses were $3.0 million compared to $3.3 million in 2025. With the prime study now published, R&D expenses will continue to decrease as we focus resources on activities that more directly drive commercialization and awareness building. Selling general and administrative expenses were $6.3 million versus $5.9 million in the prior year, reflecting our transition from clinical stage investments toward targeted commercial initiatives and strategic headcount. Net loss for the quarter was $8.4 million compared to a net loss of $8.2 million in the first quarter of 2025. We ended March 31, 2026 with $86.8 million in cash, cash equivalents, and available for sale securities. Based on our measured commercialization strategy and a more sustainable cost base resulting from the activities discussed earlier, we believe our capital resources will be sufficient to fund the company across significant adoption and commercial milestones through 2029. As Jenny outlined, our strategy prioritizes building durable prerequisites for adoption. From a financial perspective, that means revenue in 2026 could remain modest and uneven as we continue pushing reimbursement, awareness and advocacy campaigns, and as programs move from setup to implementation, with increasing pull-through anticipated later in the year and into 2027. In summary, the first quarter reflects continued financial discipline alongside steady progress in laying the groundwork for broader adoption. We remain focused on execution as these initiatives mature. With that, let's open the line for questions. Operator?

Thank you, ladies and gentlemen. We will now begin the question and answer session. Should you have a question, please press the star followed by the number one on your touchtone phone. You will hear a prompt that your hand has been raised. Should you wish to decline from the polling process, please press the star followed by the number two. If you are using a speakerphone, please lift the handset before pressing any keys. Please be advised to ask one question and one follow-up. Your question comes from Tycho Peterson from Jefferies. Please go ahead.

Hey, team. This is Lauren on for Tycho. A few from me. First on the partner program, so could we get maybe a little bit of color on the kind of profile of the third partner and kind of how it compares to the first two? And then in terms of kind of the required cadence throughout the rest of the year to hit the goal of five to seven partner programs, what that's going to look like for the next couple quarters. And then second, for the new reps, I think you've talked about before how it could take a couple quarters to kind of see density of adoption and increased productivity. Are you measuring anything in terms of tests per rep per month or other KPIs that you're targeting for the second half of the year for these reps? Thanks.

Lauren, thank you so much for the questions. On the programs, indeed, very exciting. The way we planned our pipeline of the potential programs is to launch roughly one a quarter to make sure that we swarm the organization and stand them up well. Each program typically is a combination of a payer and provider group. to ensure that the pull-through can happen on the ground in the offices quickly. We've learned over the last couple of years that it takes a few months to iron out how the patients who test for higher risk of preterm birth get cared for by the physician offices with the intervention bundle. So we make it as seamlessly integrated into the workflow of those offices as possible. So for us, each of these programs, that's why one a quarter roughly, and we're right on track with that with another launch this quarter, we first select how will the test get paid for, engage on reimbursement, then with the payers figure out what is the the set of providers that are going to partner with us to adopt the test and get them ready for seamless integration to their workflow and delivery of the intervention bundle. So that is critical for fast recruitment and delivery of the test to the participant, which of course in turn gives the results to both payers and providers faster. So it's in all of the partners' interests in these programs to prepare well to get to, you know, for us to revenue, for them to impact faster. For many programs, we are engaged deeply with the state as well. So on a quarterly basis, we report out the progress of the programs to the state Medicaid agencies. And these are usually public forums where other payers are present. And another reason why one-quarter is because there's a fair bit of follow-up with other payers in the state that have the Medicaid plans who are starting to also reach out and want to participate. So we're excited to report that our pipeline of payers that we're engaged with is growing steadily from 10 payers in 13 states, which we reported last quarter, 13 payers in 15 states. We're still sticking to our target states, but what we're seeing happen is the payers that we're running the program with now for six to nine months are introducing us to other parts of their organization that cover plans in other states, which is exactly what we were hoping for. and expanding with these payers into other regions. So that's why we're pacing it one a quarter roughly, and you can certainly anticipate us announcing one per quarter. Of course, we'll go faster if we can go faster, but I describe the activities so that you get a feel for what an undertaking it is. to stand up these pretty substantial provider institutions who partner with us. Obviously, of course, because we, with the payers, select large volume institutions so that we could get the density of test ordering after we get reimbursement to go faster and to pull through to be clear for about once a quarter to give us three months to execute on the launch of the program. Does that answer the first part of your question?

Yeah, that's helpful, Culler. Thank you.

Perfect. And then the second question, of course, rep productivity is critical. Actually, our chief commercial officer and our head of sales, that's exactly how they engage with Austin and me on our forecasting on the number of reps and a number of tests per month per rep that is anticipated so that we can goal the reps and drive towards steady progress. And, of course, we're cautiously optimistic, but we want to watch it for another few quarters. We are seeing these metrics move. The question behind the question probably is, when are you guys going to report on some of these metrics? Let us see the steady progress on them internally first, and as soon as we see the steady up and up, we will start reporting on those.

That's great. Thank you.

Your next question comes from Dan Brennan from TD Cohen. Please go ahead.

Great. Thank you. Thanks for the questions. Maybe first one just on the, you both talked about the shift to a more direct commercial effort, maybe pulling back some resources on the R&D side, extend the cash runway. Just I guess what prompted the shift? It kind of makes sense logically, but I'm just wondering kind of is there any feedback in the market about timing, how long it's going to take, or was this in discussion with the board? Just maybe a little color behind that.

Dan, thank you for the question. It's a very logical one. There's actually two root causes that drove that happening now. First, of course, as you know, the R&D and clinical operations efforts, both of these groups, were incredibly focused on PRIME, And that was a seven-year effort, if you can believe it, with very, very heavy resourcing devoted to that. As we're shifting towards now publishing as much as possible with a couple of dozen publications in a pipeline from our data, we realized that we need less capacity specifically for our preterm birth product R&D and Klonoff's capacity. Of course, we have a pipeline of other products that we're working on, but we had inbound interest from partners to collaborate on R&D and clinical operations efforts in developing new tests. So what you're really seeing as the first impetus is the less demand on R&D and ClinOps capacity internally, and the second one is the demand externally. to continue developing the tests. And as soon as we lock in these partnerships, of course, we'll communicate all of those to you. And you can imagine our R&D proteomics platform is a great asset with a biobank of thousands and perhaps a couple of tens of thousands of samples, which will allow us to support other diagnostic and screening tests in pregnancy perhaps also support therapeutics of screening in for eligibility for drug interventions in pregnancy. You can imagine it's a strategic move, as well as just simply less demand internally for now until we pick up in this collaborative model on other assets. So that's the answer on the R&D side. Does that help?

Yep, yeah, that helps. Very logical. Maybe just a couple other quick ones. Just on the, I think previously you talked about low single-digit thousand volumes this year. Is that still on track, or just maybe kind of how should we think about that?

Dan, I didn't hear you quite well. A low single-digit thousand volumes?

I was talking about volumes for 26. I think in the past maybe. I got you.

Yeah, that's not unreasonable. That's not unreasonable. As you know, we don't report the volume of orders, but it's certainly not an unreasonable number to be thinking about. And given your question, Dan, in our conversations, of course, as soon as we see steadiness, we'll start reporting on it. But yes, that assumption is not unreasonable.

Got it. And then maybe just on the first Medicaid program that began, I think, a little over a year ago, when can you see that program potentially turn into a positive coverage decision, do you think?

Great question. And I think when we announced it, I believe I even talked through the timeline for that particular program. We believe it took us about six months to stand it up with EMR integration and all of the provider setup to provide care management for the patients. And actually that set of collaborators are now piloting a digital tool with us that allows the providers to deliver care management a lot more efficiently with weekly symptom check and And we're looking forward to reporting on how that goes, because that is something that will remove a significant barrier in terms of taking the OB-GYN nursing capacity from the office for that care management. So it took us six months to do that. It will take us about nine to 12 months to fully recruit the program, about four to five months for the patients to deliver, obviously on a rolling basis. Then a couple of months to collect data on the outcomes, NICU admissions, health of the baby, weight of the baby, all of the other outcomes we typically would monitor in these implementation studies. And then, of course, take it to the state. I will tell you the state is not waiting for it. The state already engaged with us for that particular program. on what would coverage mean, why is it needed. We're mobilizing our clinical advocates in that state and that's what I meant when I said our letter writing campaign. We're asking every provider to write to the state Medicaid and advocate why this test needs to be paid for in the state for all of the pregnant moms there. The tactical timeline I laid out nets out to be about two years to decision timeline for the state. I think that probably has plus or minus a quarter or two on each side of that two-year estimate. It could go faster. It could go a little bit slower if data is messy, for example, because in some states they assign the baby into a different Medicaid plan at birth. Don't ask me why that gets done, but that's the case. And it requires us to do some data chasing to combine the mom and baby outcomes. So for that program, we expect probably beginning of 2027 to bring the decision and the results of the program to us. And of course, we'll report on that. Does that help?

Yep. Yeah, that helps a lot. Terrific. All right. Well, thanks a lot.

There are no further questions. Oh, sorry. There are no further questions at this time. I will now turn the call over to Xenia Lingard, President and CEO. Please continue.

Thank you so much, operator. In summary, we're building the medical reimbursement and advocacy foundations necessary for commercialization and guideline inclusion efforts. and the engagement we're seeing across stakeholders reinforces our confidence in the opportunity ahead. Thank you so much, everyone, for your time today, and we look forward to continuing to share our progress steadily each quarter.

Ladies and gentlemen, this concludes today's conference call. Thank you for participation. You may now disconnect.