GRAIL

Cancer kills 10 million people a year globally. Most of them die because cancer was caught too late — at stage 3 or 4, when treatment is expensive and outcomes are poor.

Grail's founding idea was radical and obvious simultaneously: what if you could find cancer at stage 1 or stage 2, when it is almost always curable, using a routine blood test? The science behind it is cell-free DNA — tumor cells shed fragments of their DNA into the bloodstream long before symptoms appear.

Illumina, the DNA sequencing giant, spun Grail out in 2016 and funded it at the highest levels of ambition. Jeff Huber, who had just lost his wife to cancer, left Google to become CEO.

Grail sells the Galleri blood test — a single blood draw that screens for more than 50 types of cancer, many of which have no standard screening today. The test is sold to healthcare systems and large employers for preventive care programs.

Pricing is around $950 per test out of pocket. The commercial model is direct-to-consumer and employer-sponsored wellness programs, with healthcare system partnerships as the longer-term channel.

Galleri multi-cancer early detection blood test (screens 50+ cancer types), CancerSEEK research program, biobank and clinical data platform

Grail published landmark clinical data from the Pathfinder study proving Galleri's sensitivity and specificity. It then partnered with the NHS in the UK for a 140,000-person screening trial — the largest cancer screening trial in history.

US employer partnerships came next: companies like Walmart began offering Galleri as an employee benefit. Each successful employer adoption is a proof point for the insurance coverage fight.

Getting a $950 blood test covered by insurance is one of the hardest problems in American healthcare. Grail has clinical evidence that Galleri works — it can detect 50+ cancers with a single blood draw.

The challenge is convincing insurers that paying $950 now to potentially catch cancer at stage 1 is cheaper than paying $200,000 for stage 4 chemotherapy later. That math is obviously correct.

Getting insurance companies to act on it is a different problem entirely.

Illumina, Bill Gates, Jeff Bezos, Johnson & Johnson, Bristol-Myers Squibb, Merck, WuXi AppTec