BillionToOne’s IPO
- 3 days ago
- 4 min read
By Kush Mahawar, Lexi Xiao, Sean Yeow and Joe Colton (University of Oxford); Cooper Thompson, Charlie Mercuri, Daniel Blitenthall and Aikie Davoren (University of Melbourne)
Photo: Ashraful Islam (Unsplash)
Summary of IPO
BillionToOne, a molecular diagnostics company, raised $314 million on November 6, 2025, in an upsized initial public offering that stands as one of the largest MedTech IPOs of the year by capital raised. Despite the headwinds of a U.S. government shutdown and a year defined by geopolitical volatility, the offering was heavily oversubscribed, with approximately 66% of institutional orders not allocated shares.
The IPO follows a period of aggressive scaling, as the company saw its top-line revenue more than double in 2024, approaching operating breakeven. While BillionToOne currently holds a 15% market share in the non-invasive prenatal testing sector, which is projected to exceed a market value of $8 billion by 2030, the capital raise is partly a strategic catalyst for diversification into other technologies.
The company is pivoting toward the highly competitive oncology diagnostics landscape and expanding into early cancer detection. By leveraging its molecular counting platform and developing AI-driven predictive technologies, BillionToOne aims to expand its Total Addressable Market to over $100 billion. According to SEC filings, the primary objectives of the offering are enhanced financial flexibility and increased market visibility as the firm prepares to challenge large incumbents and continue its mission to democratise access to precision diagnostics.
“Early detection of cancer is where a lot of the excitement for our company lies.” - Oguzhan Atay, Co-Founder and CEO
Company and IPO Profile
Sector: Molecular Diagnostics
Exchange floated: Nasdaq Global Select Market
Amount raised: $314 million (including over-allotment)
Offered price and number of shares: $60.00 per share and 4,551,100 Class A shares.
Over-allotment option: 682,665 additional shares
Equity offered: 11.3%
Valuation and relevant multiples at IPO:
- Market Capitalization: $4.4 billion
- EV: $4.5 billion
- EV/Revenue: 17.6x
- EV/EBITDA: NM (not meaningful due to minimal EBITDA)
Coordinators/Advisors
- Joint bookrunners and coordinators : J.P. Morgan, Piper Sandler, Jefferies, William Blair, Stifel, Wells Fargo Securities, BTIG
- Notable investors: Hummingbird Ventures, Libertus Capital, Neotribe Ventures, Pamir Gelenbe
Strategic Rationale
BillionToOne focuses on precision molecular diagnostics, particularly in non-invasive prenatal screening and oncology testing. The company holds approximately a 15% share of the US market. In 2024, BillionToOne reported $153 million in revenue, implying around 113% year-on-year growth from $72 million in 2023.
Strategically, the IPO provides the company with capital to fund further investment. The IPO raised approximately $314 million in gross proceeds, with shares priced above the initial range following strong investor demand. Access to capital would allow it to invest in R&D pipelines and geographic expansion, which could accelerate its long-term revenue and enhance the competitive positioning when facing competitors such as Natera and Guardant Health.
From an economies of scale perspective, the IPO is likely to contribute to cost reductions. Management commentary at major healthcare investor conferences indicates the test volume of BillionToOne has soared by 51% year-to-year as of Q3 2025. Higher test volume post-IPO improves equipment utilization, thereby reducing the cost per test. This is expected to enhance its bargaining power with suppliers of reagents and lab equipment, expanding the gross margin and manufacturing.
The company’s technology-driven diagnostics platform represents a key competitive strength. Its proprietary testing platform enables large-scale genomic data collection and analysis. This data advantage is expected to enhance product performance and contribute to increased client credibility and commercial opportunities over time.
Market Reaction
Build Up
BillionToOne reported 2024 revenue of $153 million, up 113% year-on-year, while margins improved significantly from 24% to 53%, boosting investor confidence ahead of its IPO. Broader market conditions, including falling interest rates and heightened interest in AI and innovative healthcare companies, also made for a resurgence in the IPO market, in particular the healthcare sector. Responding to strong institutional demand, BillionToOne upsized its initial public offering 18% to 5,233,765 shares of Class A common stock, including the full exercise of the underwriters’ option to purchase an additional 682,665 shares, at a public offering price of $60 per share. The IPO raised approximately $314 million in gross proceeds before underwriting discounts, commissions, and estimated offering expenses.
Launch
Investor response to BillionToOne’s IPO was notably positive. The stock debuted on the Nasdaq Global Select Market at $100 per share, well above the $60 IPO price, and quickly surged to an intraday high of $123.45. It closed the session up 81.6% at $108.94, giving the company a market valuation of approximately $4.4 billion on its first day of trading, reflecting robust investor demand for high-growth biotech and healthcare companies. Analysts providing coverage have set price targets above current trading levels, signaling confidence in the company’s future potential. Since its big jump on debut, BLLN has generally remained elevated well above the $60 IPO price, continuing to trade strongly in the weeks afterward. While it has traded with volatility, such fluctuations are typical in innovative healthcare stocks.
Potential Risks and Downsides
There are several risks and downsides present in this volatile healthcare growth stock. First is that continued revenue growth relies on clinicians switching from incumbent providers to BillionToOne’s prenatal and oncology molecular diagnostic tests. Established competitors have the benefit of long-standing commercial relationships, broader test menus and greater scale, which may impede BillionToOne’s growth. BillionToOne is also vulnerable to significant third-party payor reimbursement risk, with over 90% of BillionToOne’s revenue reimbursed by third-party payors, including government programmes such as Medicare and Medicaid as well as commercial insurers. As payors prioritise cost containment, realised pricing and cash collection may come under pressure. This could increase revenue volatility and compress operating margins.
There is also a degree of long-term regulatory uncertainty around the treatment of laboratory-developed tests. BillionToOne currently markets its clinical tests as LDTs. The FDA’s 2024 attempt to impose device-style regulation on LDTs was vacated by a federal court and then formally withdrawn. As such, while significant near-term regulatory changes appear unlikely, longer-term uncertainty remains a material risk.
Finally, the dual-class share structure concentrates voting power with founders, reducing minority shareholder influence and potentially limiting institutional demand, which may weigh on valuation and post-IPO share price performance. While these risks are material, they are broadly characteristic of high-growth diagnostics companies at a similar stage of commercialization.