Natera's Scale Limits BillionToOne Growth

Natera’s advantage is not just a better known test, it is a distribution machine already embedded in how large OB practices order prenatal genetics. BillionToOne has grown fast by winning clinics open to a new workflow, but moving from early adopters to the next layer of established practices means displacing bundled ordering habits, payer contracts, and sales relationships that Natera built around Panorama and adjacent women’s health tests.1 2 3 4

• In practice, prenatal testing share is won at the clinic level, not one patient at a time. BillionToOne sells UNITY into OB GYNs, hospitals, and fertility clinics and bills insurers per test. Natera serves the same doctors with a broader women’s health menu that includes Panorama, Vistara, Fetal Focus, Anora, and Empower, which makes it easier to stay the default vendor across multiple ordering moments.2 3 4
• Scale matters because it funds reach and reinforces payer leverage. BillionToOne was estimated at $153M of 2024 revenue and about 500,000 total prenatal tests processed, while Natera reported $2.31B of 2025 revenue and about 3.34M total tests reported across its business, with most revenue coming from insurers and 96% tied to its U.S. direct sales force in 2025. That supports a much larger field team and contracting base.2 4 5 6
• The hardest accounts are likely the biggest practices. BillionToOne’s land and expand motion works best when a clinic will trial a new blood draw based screen and then broaden use. Once a practice has long standing Natera workflows, staff training, billing routines, and rep relationships in place, switching costs rise even if a challenger has a differentiated test.1 2 3 4

The next phase of competition will be less about proving the science and more about owning the prenatal ordering seat inside the clinic. BillionToOne can keep gaining by turning UNITY into a broader menu and using oncology revenue to fund commercial expansion, but Natera’s incumbent position means each additional point of prenatal share will get more expensive to win.1 2 4 5