Guardant Health is a very inefficient business.

Founded at the beginning of the easy-money era in 2012, the business has focused on revenue growth at the expense of the quality of revenue. The company reported record annual operating cash outflow of $325 million in 2023 as a result. At that rate, Guardant Health has just three years of cash left. That might not be enough to survive a negative U.S. Food and Drug Administration (FDA) approval decision or unfavorable Centers for Medicare & Medicaid Services (CMS) coverage decision for its blood-based colon cancer screening tool Shield. Although regulatory approval seems nearly certain, a favorable level of Medicare coverage is anything but.