Grail is hard to analyze, but the potential upside is staggering.  Due to their regulatory challenges, there is a paucity of information, obfuscated by likely insider dealing and related third-party transactions, and an abundance of lawyers due to regulatory challenges. Icahn waged a proxy fight, and ultimately, the EU forced Illumina to divest Grail.  Analysts are probably waiting until the spin-off is done on June 24th before there will be much commentary, as many banks have been feeding at this trough . But first, here are some quick facts about the spinoff itself.

Grail will only have slightly over 31 million shares outstanding. Based on $15 per share, that is less than a $500 million market cap. They are likely to have close to $1 billion in cash as Illumina has agreed to fund them for two years.


Check out this podcast from the founders of Grail

1 – The Promise of Multi-Cancer Early Detection

But even when analysts opine, they will get hung up on insurance reimbursement. Does it even matter for the initial Grail story that insurance pays for the test? Analysts are too hung up on insurance reimbursement. My concierge doctor offered the test, and I didn’t hesitate to take it, knowing that I wasn’t getting reimbursed by Medicare. Cancer is the 2nd largest killer, and age is the greatest indicator of possible cancer. Early cancer detection is the Holly Grail, hence the name Grail. It is commonly believed that if you can catch cancer early, you have better odds of beating it.  I can afford the test. It’s only $750. I’m pretty sure that’s how a significant amount of the more than 12 million moderately wealthy households with more than 2 Million dollars will feel about it once they learn that it can early detect more than 50 cancers, including the deadly pancreatic, lung, ovarian, and others that there are no early detection tests for.

  • 10% take up in this cohort of moderately wealthy Americans at $750 a pop is a staggering $900,000,000 million yearly on a test that insurance doesn’t even pay for. This is repeatable revenue as the test needs to be retaken annually or every few years.

And this is just the beginning; The tests will get smarter as they are using AI on the largest population genomic testing pool done to date.

Let’s delve into the fascinating history of GRAIL, the cancer detection company, and its relationship with Illumina:

  1. Formation and Spin-Out from Illumina (2016):
  2. Acquisition by Illumina (2020):
  3. Divestment Plan and European Commission Approval (2024):
  4. Recent Spin-Off (June 2024):

In summary, GRAIL’s journey from formation to spin-off has been marked by groundbreaking advancements in cancer detection, and its close ties with Illumina have played a pivotal role in shaping the future of genomics and healthcare.  Undoubtedly, this is the largest, if not one of the world’s largest, machine learning genomic research programs. If enough rich people take the tests from their doctors, it will only be a matter of time before there will be a popular groundswell that Medicare and other private payers offer Galleri.

Analysts on both the bull and bear sides will have their points. No cancer test or screen is perfect, but there is only one question that merits serious analysis at this time: Ask your doctor: If he were over 50, would he take it and pay for it himself? The answer might surprise you, and it might be all you need to form your investment opinion.