$GRAL A potential 10 bagger (or more) Grail is the leader in multi-cancer early detection (MCED). Their lead product, Galleri, requires only a simple blood draw and can detect up to 50 different cancers types - including deadly ones like pancreatic, ovarian, and liver that currently lack routine screening. Acquired in 20’ for $8 billion by Illumina. Spun-off in June 24’ for ~$500 million. Spinoff occurred due to European anti-trust concerns. Parent company maintains 14.5% ownership. Spin-off included a cash injection of $775 million, enough for a 2.5 year runway - current cap is roughly equal to net cash. Galleri uses machine learning to analyze methylation patterns on cell-free DNA—effectively identifying a cancer “fingerprint” in the bloodstream. It enables early detection across dozens of cancer types before symptoms appear. Has already demonstrated promising results in PATHFINDER study There are 2 large scale trials underway. 140,000 participants in the UK (NHS-Galleri) and 20,000 Medicare participants in the US (PATHFINDER II) With results expected in 2H 2025 and 2026. REFLECTION another ongoing study run by the VA with initial results published in October 2024. Tricare coverage subsequently was approved early this year for members aged 50 and over with increased cancer risk. PATHFINDER II and NHS trials will determine effective outcomes potentially leading to Medicare and NHS approvals. This is where things could get interesting. Valuation Let’s take just Medicare beneficiaries. There’s 65 million of them. Let’s say the trials are a great success and Medicare approves reimbursement for one screen every 2 years. The current cost is about $950 per test. We’ll assume Medicare will reimburse 30-40% of cost so let’s call it an easy $300. Let’s also assume the age cutoff is 80 - that cuts eligibility down to about 50 million members. Assume a 30% adherence rate (adherence should be simple since it is just a blood draw so could be included in an annual physical, far easier than something like a colonoscopy). Okay, we have our variables: ([eligible members] x [reimbursement per test] x [adherence]) / [test frequency] = Sales (50 million x $300 x 30%) / 2 = $2.25 billion Slap an industry norm of 5x sales and we’re looking at an $11 billion+ valuation Or roughly 14x from where it’s trading today and that’s just Medicare - no commercial, no NHS, etc. Flying under the radar as a spinoff (Greenblatt would be salivating)