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Good afternoon, ladies and gentlemen, and welcome to the Sera Prognostics, Inc. Fourth Quarter 2025 Financial Results Conference Call. At this time, all lines are in a listen-only mode. Following the presentation, we will conduct a question-and-answer session. If at any time during this call you require immediate assistance, please press 0 for the operator. This call is being recorded on Wednesday, 03/18/2026. I would now like to turn the conference over to Jennifer

Thank you, operator. Welcome to Sera Prognostics, Inc.'s Fourth Quarter and Full Fiscal Year 2025 earnings conference call. At the close of market today, Sera Prognostics, Inc. released its financial results for the quarter ended 12/31/2025. Presenting for the company today will be

Thank you, Jennifer, and good afternoon, everyone. I will start with an overview of our 2025 progress, and Lee and Tiffany will speak about our commercial and medical affairs efforts, and Austin will provide a recap of our financial results. As we shared last year, to support Sera Prognostics, Inc.'s next phase of commercialization, we strengthened our leadership team with Lee Anderson joining us as Chief Commercial Officer and Doctor Tiffany Inglis as our Chief Medical Officer, enhancing our commercial and clinical depth, and I wanted to use this opportunity to introduce them to all of you in today's call and have them discuss our progress with you. 2025 was a critical year for Sera Prognostics, Inc., finalizing our PRIME publication to advance our evidence portfolio, setting up for commercial push in 2026, building our organization, ensuring we have capital to deploy in our commercialization efforts, and laying groundwork for potential international expansion. Our goal was simple: to build the evidence, access, and commercial infrastructure required to drive PreTRM adoption at scale. Across all of these dimensions, we made meaningful progress. We began 2025 focused on strengthening the clinical and scientific foundation supporting our commercialization strategy. The presentation of PRIME study at Society for Maternal-Fetal Medicine meeting in Q1 was a major milestone, followed as expected late in the year when our pivotal PRIME study was accepted for publication in December, with a full manuscript published in January 2026. The publication reported important new data showing that the PRIME study resulted in an amazing 56% and 32% fewer babies born before 32 and 35 weeks of gestation, respectively. The full peer-reviewed publication of PRIME in the Pregnancy Journal of Society for Maternal-Fetal Medicine, like studies before it—namely AVERT—reinforces what we have long believed: that biomarker-based identification of women at higher risk of preterm birth paired with a preventive treatment protocol can deliver meaningful reductions in preterm birth rates and drive improved health outcomes for babies. As we move into 2026, we plan to extend this momentum through a thoughtful further analyses, publication, and real-world evidence generation strategy designed to communicate and replicate PRIME outcomes across diverse populations, geographies, and care models. These data will be essential as we engage payers and broaden awareness across the clinical community. I will ask Doctor Inglis to speak more about our scientific and guideline engagement shortly. Post-publication, we are making meaningful strides in advancing coverage and access as our top priority. A central part of the strategy has been launching targeted programs, particularly in Medicaid in high preterm birth burden states, to generate outcomes data that support both clinical adoption and reimbursement expansion. Historically, we referred to these efforts as Medicaid pilot programs. However, with additional real-world experience, it is clear that these programs take many forms, and our discussions involve both Medicaid and commercial payers. As a result, we believe partner programs more accurately reflect the breadth of our commercialization efforts, so we will speak about those. Last year, we set out to engage with our first wave of six target states and to launch partner programs. We exceeded our state engagement goals in 2025, expanding discussions to 13 states, and met our goal of engaging in now two live partner programs. We expect these partner programs to play a critical role in shaping policy, validating economics, and informing future contracting discussion. We are maintaining our disciplined geographic-focused approach, targeting expansion of up to 15 to 17 states by year end, representing 58% to 60% of U.S. births. This strategy allows us to deepen our traction in our existing target states while thoughtfully adding new ones. With this focused growth plan, we are on track to be running five to seven partner programs by the end of 2026. Lee will detail our execution 2026 KPIs for states in active discussion and partner programs, as well as how we expect to convert engagements into coverage pathways. In Europe, we continue to make steady progress towards unlocking a significant, largely unaddressed obstetric care opportunity. Over the last two years, we have advanced our regulatory pathway for the PreTRM Global test and are working towards CE marking approval. We remain on track to submit our European dossiers in the coming months. Importantly, recent European experts' commentary published in the Journal of Maternal-Fetal and Neonatal Medicine reinforces that current prevention strategies miss most women who deliver preterm and highlights our PRIME study approach as well aligned with European health care systems. Alongside ongoing engagement with regulators, clinical leaders, and patient advocacy groups, we are building the foundation needed for successful market entry following regulatory clearance. We continue to expect revenue growth to build gradually as partner programs mature and real-world evidence results are generated and disseminated. We remain disciplined, investing in market access, commercial infrastructure, and state expansion in a measured way. With that, I will hand it over to Lee to discuss our commercial execution.

Thank you,

Thank you, Lee, and good afternoon. Our medical affairs work in 2026 is focused on ensuring PRIME as a catalyst for consistent evidence-based practice. We are emphasizing three themes. One is identify risk early in the second trimester before symptoms are present. Second, we deploy a standardized test-and-treat pathway consistent with PRIME. And lastly, we support improved neonatal outcomes with the potential to reduce avoidable neonatal hospital utilization. We are partnering closely with clinicians on patient selection, timing, and care pathway deployment while expanding our clinical champion network and peer partnerships. In practical terms, PreTRM is designed to provide early, individualized risk information from a routine blood draw—information that clinicians can act on through a standardized care pathway. The goal is straightforward. Know who is at elevated risk early, before symptoms begin; intervene with measures that are already familiar to providers and safe for patients; and do so in a consistent way that has been proven to support both quality and affordability across populations. To complement PRIME, we are generating real-world evidence results across diverse populations, care settings, and payer environments. This includes outcomes tracking within partner programs, health economic and outcomes research, assessment of budget impact, population-level analyses for state and payer decision-making, and collaborations with academic centers to broaden the evidence base beyond the PRIME cohort. These efforts are foundational to guideline inclusion, payer policy updates, and thoughtful adoption. We continue to partner with Society for Maternal-Fetal Medicine and ACOG and other payer guideline committees, providing evidence-based packages that include clinical outcomes, safety considerations, implementation data, and economic modeling aligned to each group's evaluation framework. Our goal is to demonstrate how incorporating PreTRM into care pathways supports early, proactive identification of need, complements existing risk tools, improves episode-of-care quality metrics, and addresses affordability by leveraging a major driver of maternity cost. In addition to these education initiatives, we have also launched a campaign to assist providers in requesting coverage for the PreTRM test. This campaign is available broadly, with multiple providers confirming submission of requests in four states, and an additional 10-plus providers across all of our states in the process of submitting additional requests. Beyond our efforts, several state Medicaid agencies and state legislatures have begun exploring policy approaches to address the significant clinical and economic burden of preterm birth. This could come in the form of a bill, budget appropriation, or coverage from the Medicaid department mandating that payers cover the PreTRM test. While we have been engaged when asked to provide education and perspective, these discussions have largely been driven by the state's recognition of the unmet need, their focus on health equity, the impact preterm birth has on their communities, and the financial burden it places on Medicaid budgets. I will now hand it to Austin for the financials and our capital allocation approach.

Thanks, Tiffany, and good afternoon, everyone. I will start with our financial results and then discuss our cash runway and capital allocation. Starting with the fourth quarter, revenue for the quarter was $10,000 compared to $24,000 in 2024. As a reminder, revenue remains modest and can fluctuate from period to period in this early commercial stage. We continue to expect revenue expansion as we move towards broader commercialization following the PRIME publication. Operating expenses for the quarter were $9,000,000, down from $9,400,000 for the prior-year period, reflecting our continued disciplined expense management. Research and development expenses were $3,200,000 compared to $3,100,000 in 2024. With the completion of the PRIME study, R&D expenses will likely decrease as we focus resources on activities that support commercialization and awareness building. Selling, general, and administrative expenses were $5,700,000 versus $6,300,000 in the prior year, reflecting our prudent allocation to targeted commercial initiatives and strategic headcount. Net loss for the quarter was $7,900,000 compared to a net loss of $8,600,000 in 2024. Turning to the full year, total revenue for 2025 was $81,000, up slightly from $77,000 in 2024. Total expenses were $36,600,000 compared to $36,700,000 last year as we began our strategy of capital reallocation from R&D to commercial activities and advanced PRIME publication. Research and development expenses for the full year were $13,200,000, down from $14,700,000 in 2024 and driven by lower clinical study costs following PRIME completion. Selling, general, and administrative expenses were $23,300,000 compared to $21,900,000 last year due to targeted commercial readiness investment. Net loss for the year was $31,900,000 compared to $32,900,000 in 2024, again demonstrating our disciplined approach to capital deployment. We ended 12/31/2025 with $95,800,000 in cash, cash equivalents, and available-for-sale securities. Based on our current operating plan and commercialization strategy, we believe this capital will fund the company across significant adoption and commercial milestones through 2028. In summary, 2025 was a year of important financial and operational progress. We maintained tight expense controls, strengthened the balance sheet, and positioned the company to execute effectively as we move into a transformative year with the publication of PRIME and our expected commercial extension. Before we open the call for questions, I will provide a brief overview of our capital allocation philosophy for the near term. Our approach is anchored in disciplined deployment toward milestones that derisk the commercial model while maintaining the strength of our balance sheet. One, we will prioritize market access, making investments that accelerate coverage decisions, such as partner programs that include quality-of-care and health economic outcomes research. Two, focus on commercial scale-up, concentrating resources where we see the greatest adoption potential, like regions with payer engagement, clinical champions, and health system readiness. Three, fund additional evidence-generating programs, such as RWE and targeted clinical collaboration that could support guideline inclusion and payer policy updates. And four, maintain financial discipline and flexibility, pacing spending in line with key milestones and emerging adoption or reimbursement tailwinds. As sales volumes build following payer decisions and broader access, we will sequence certain commercial and infrastructure investments when appropriate. This ensures our ability to preserve runway while supporting a healthy, sustainable ramp from early adoption to repeat ordering. Regarding this last point, concurrent with today's 10-K filing, we reestablished our at-the-market, or ATM, facility. While we have no immediate plans to issue shares, maintaining an ATM is the best practice in corporate hygiene for companies at our stage. It provides the optionality of an efficient and low-cost tool to maintain financial flexibility and provide sustainable ramp as we advance payer coverage, commercial adoption, and key milestones for PreTRM. With our current cash position providing runway through 2028, this does not reflect any change in the capital allocation priorities I discussed or any near-term funding needs. It simply renews our access to our existing shelf registration and maintains financial preparedness. With that, let's open the line for questions.

Thank you. Ladies and gentlemen, we will now begin the question-and-answer session. You will hear a prompt that your hand has been raised. Should you wish to cancel your request, please press the star followed by the two. I would like to advise everyone to have a limit of one question and one follow-up. If you are using a speakerphone, please lift up the handset before pressing any keys. Your first question comes from the line of Andrew Brockman with William Blair. Please go ahead.

Hi. Afternoon. Thanks for taking the questions. I want to go back to something Lee said in his remarks, sort of converting payer discussions and partner programs by using outcomes and some economic data. Can you maybe just expand on that a little bit, just in practical terms? How does that work with each of these partners? And then, typically, what do you expect that these partners will look for in those results to move forward with some of those contracts that you might have sketched out?

Thank you for the question. I am also going to enlist Tiffany on this as well. But by this partner program approach, you take an entity that is interested, and they look at the clinical outcomes. They are also going to look at their books and their numbers and their patient population and equate that to the fact that if they adopted PreTRM and the treatment regimen as standard of care, what could that do for their patient base, so to speak? So as we have these discussions, we are not only highlighting the clinical outcome improvement, but also the health economic outcome improvement. And that is, as you can imagine, very important for state Medicaid agencies or providers throughout the country.

Yes, I will make that add—agree completely. As we look at the results of 20% reduction in NICU admissions, NICU utilization is a huge driver of spend and trend for those who are paying the bill on the backside, whether that is our government, or whether that is employer groups, or whether that is payers. So as we think about our partnerships with each of those entities, they have really struggled with how to control that spend and trend, and this is really an avenue for them to have a significant impact on something that drives a cost driver for many of them, as well as something that drives things like high-cost claimants and things like that on their books. So as we continue to do sub-analyses and evidence generation post-PRIME, the health economic model and the impact to what that looks like will be something that we will be able to speak even more deeply about from a publication perspective, but we are able to share with our partners now what that 20% NICU reduction really looks like.

Perfect. That is really, really helpful. And then I want to go back to the comment made around SMFM was earlier in the year. It has been a couple months now. Can you maybe just talk about some of the feedback that you received at the conference? And then since then, how the conversations may be changed now that PRIME is published? You have gone through that conference, and sort of where we are at today. Thank you.

Yes. No, it is a great question. So, the SMFM conference, the national conference, was in February, and it was shortly after we obviously had our publication go live in the Pregnancy Journal, which is the SMFM journal. And it was a great conference, a ton of engagement with providers, but also with the leadership at SMFM and really understanding next steps and how we work together and how we make this test more accessible to women. And so we are continuing on those next steps with our partners there, many of whom are investigators on our study and have been integrally working tightly with SMFM from day one, including the company itself as well. So really looking at all the steps—what does that look like—and then opportunities for rapid response or other things like that with those partners so that we can understand what those guidelines and what the changes would look like and how we get to that endpoint, which, again, is just about access for patients for this test and for providers for this test to be able to change those outcomes for moms and babies.

And I will add, Andrew, that the team has seen a marked improvement in engagement across providers, payers, state legislators, key opinion leaders, societies, employers. The study really proved and gave us credibility. We have long believed PreTRM can be supported by an RCT level evidence and, indeed, it is coming to fruition. It has been only about 10 weeks since the publication took place, but we are incredibly excited about the signal we are seeing from all of these audiences. And we will keep reporting on engagement specifically with the guideline-setting bodies and the signals that we can send to the market about where the standards of care are evolving to.

Again, if you would like to ask a question. Your next question comes from the line of Tycho Peterson with Jefferies. Please go ahead.

This is Lauren on for Tycho. My first question, I guess, is around the cash runway into 2028. How are you guys planning to balance investments in successful U.S. states versus the capital requirements of the global EU launch? And do you expect to accelerate SG&A spend into this year? Thanks.

Yes. Hi, Lauren. Thanks for the question. Yes, I think we said this in the last quarter, but I will reiterate some of the basics, and then I will get into the question. So last year, OpEx—cash OpEx—was in the low thirties. We have budgeted roughly the same cash OpEx this year, and that is with reallocating a significant amount of our spending from our clinical and R&D activities more towards our commercial activities, which does include the work we are doing in the EU, a pretty significant spend that we are doing in the EU to explore the opportunities there as well. Certainly, as the commercial opportunities—domestic or EU—continue to develop, we will continue to shift, reallocate more capital from other areas to the commercial side of the business.

Great. Thank you. And I guess one more going back to the second active partnership program. Could you elaborate a bit more on the profile of this new partner, whether it is a regional health system, national commercial carrier? And whether or not and how their model differs from your first partnership? Thanks.

Great question. Multiple partners, multiple partnerships. All of them a little similar, but all of them different. You hit the nail on the head. Yes. We have large health systems, IDNs that we are negotiating with. We have provider-payers we are negotiating with. We have large, large group practices. And then we cannot forget the PRIME sites themselves. You know, how do you take the study site from a great study site with PRIME and now input this into their clinical workflow for their entire organization so that it is truly standard of care for any woman that comes in and appears to be low risk preterm birth—they get a PreTRM test. So there are very similar aspects of the model, but each payer partner or each partner is going to be a bit different. Our goal is to fill the needs of that partner: what works best for them, and what are they looking to achieve?

And I will just add that the second partner is an example of an employer collaborative that is multistate, and we are entering with them in the first state, and there is a great path for expansion. As Lee said, there are a lot of flavors here. We are partnering far and wide from the legislative bodies at the state level to midwife associations to innovative providers of telehealth services in pregnancy. We want to make sure that we capture all of those adopters that are ready to go.

There are no further questions. I will hand the call back over to

Sounds great. Thanks, Vincent. Before we close, I wanted to leave you with how we see the year ahead. With PRIME now published, a growing base of peer and state-level engagement, and an expanded leadership team in place, we are entering 2026 with strong momentum. This year is about disciplined execution, advancing all of the partner programs we have talked about, expanding real-world data, and supporting clinicians as they integrate PreTRM into their workflows. While adoption will be gradual, the foundation we have built gives us confidence in the path forward. We believe the combination of compelling clinical evidence, increasing payer engagement, and thoughtful commercial scale-up positions us to unlock meaningful value in a large underserved market. Thank all of you so much for your continued support as we work to improve outcomes for mothers and babies and deliver long-term value for our shareholders. Over to you, operator, to close the call.