MYRIAD GENETICS, INC. (Dollars and shares in millions, except per share data) The following Management's Discussion and Analysis of Financial Condition and Results of Operations should be read in conjunction with the unaudited Condensed Consolidated Financial Statements and the related notes thereto included in this Quarterly Report on Form 10-Q and the audited Consolidated Financial Statements and notes thereto and Management's Discussion and Analysis of Financial Condition and Results of Operations for the transition period endedDecember 31, 2020 included in our Transition Report on Form 10-K filed with theSEC onMarch 16, 2021 . "We," "us," "our," "Myriad" and the "Company" as used in this Quarterly Report on Form 10Q refer toMyriad Genetics, Inc. , aDelaware corporation, and its subsidiaries. Cautionary Statement Regarding Forward-Looking Statements TheSEC encourages companies to disclose forward-looking information so that investors can better understand a company's future prospects and make informed investment decisions. This Quarterly Report on Form 10Q contains such "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995. Words such as "may," "anticipate," "estimate," "expects," "projects," "intends," "plans," "believes," "seek," "could," "continue," "likely," "will," "strategy" and "goal" and words and terms of similar substance used in connection with any discussion of future operating or financial performance identify forward-looking statements. All forward-looking statements are management's present expectations of future events and are subject to a number of risks and uncertainties that could cause actual results to differ materially and adversely from those described in the forward-looking statements. These risks include, but are not limited to: •uncertainties associated with COVID-19, including its possible effects on our operations and the demand for our products and services; •risks related to our ability to efficiently and flexibly manage our business amid uncertainties associated with COVID-19; •the risk that sales and profit margins of our existing molecular diagnostic tests may decline or that we may not be able to operate our business on a profitable basis; •risks related to our ability to generate sufficient revenue from our existing product portfolio or in launching and commercializing new tests; •risks related to changes in governmental or private insurers' coverage and reimbursement levels for our tests or our ability to obtain reimbursement for our new tests at comparable levels to our existing tests; •risks related to increased competition and the development of new competing tests and services; •the risk that we may be unable to develop or achieve commercial success for additional molecular diagnostic tests in a timely manner, or at all; •the risk that we may not successfully develop new markets for our molecular diagnostic tests, including our ability to successfully generate revenue outsidethe United States ; •the risk that licenses to the technology underlying our molecular diagnostic tests and any future tests are terminated or cannot be maintained on satisfactory terms; •risks related to delays or other problems with operating our laboratory testing facilities; •risks related to public concern over genetic testing in general or our tests in particular; •risks related to regulatory requirements or enforcement inthe United States and foreign countries and changes in the structure of the healthcare system or healthcare payment systems; •risks related to our ability to obtain new corporate collaborations or licenses and acquire new technologies or businesses on satisfactory terms, if at all; •risks related to our ability to successfully integrate and derive benefits from any technologies or businesses that we license or acquire; •risks related to our projections about the potential market opportunity for our products; •the risk that we or our licensors may be unable to protect or that third parties will infringe the proprietary technologies underlying our tests; 24 -------------------------------------------------------------------------------- Table of Contents •the risk of patent-infringement claims or challenges to the validity of our patents; •risks related to changes in intellectual property laws covering our molecular diagnostic tests, or patents or enforcement, inthe United States and foreign countries; •risks related to security breaches, loss of data and other disruptions, including from cyberattacks; •risks of new, changing and competitive technologies and regulations inthe United States and internationally; •the risk that we may be unable to comply with financial operating covenants under our credit or lending agreements; and •risks related to the material weakness related to our quarterly income tax provision process, including the impact thereof and our remediation plan. In light of these assumptions, risks and uncertainties, the results and events discussed in the forward-looking statements contained in this Quarterly Report, or in any document incorporated by reference might not occur. Stockholders are cautioned not to place undue reliance on the forward-looking statements, which speak only as of the date of this Quarterly Report. We are not under any obligation, and we expressly disclaim any obligation, to update or alter any forward-looking statements, whether as a result of new information, future events or otherwise. All forward-looking statements in this Quarterly Report attributable to us or to any person acting on our behalf are expressly qualified in their entirety by the cautionary statements contained or referred to in this section. General We discover and commercialize genetic tests that determine the risk of developing disease, assess the risk of disease progression, and guide treatment decisions across medical specialties where critical genetic insights can significantly improve patient care and lower healthcare costs. Since our founding in 1992, we have performed tests for approximately five million patients. Our mission and purpose is to advance health and well-being for all, empower individuals with vital genetic insights and enable healthcare providers to better detect, treat and prevent disease. We are currently developing and executing upon a strategic transformation plan that is focused on the following strategic priorities: (1) put patients and customers first; (2) build new tech-enabled commercial capabilities; (3) elevate core products to their full potential; and (4) create new avenues for growth. In connection with these strategic priorities, we are focusing our efforts on our Hereditary Cancer, Tumor Profiling, Prenatal and Pharmacogenomics products and, as described below, have divested certain non-core assets and businesses. We intend to execute on our transformation plan by prioritizing product innovation, research and technology initiatives, strategic collaborations and investments, and defining and deploying a customer-centric technology-enabled commercial model. We believe that by focusing on these strategic priorities, we will be able to reduce complexity and cost, improve our financial performance, build a more effective and cost-efficient sales model, and enhance our reimbursement and revenue cycle capabilities. In addition, we believe we can accelerate growth as we invest in innovation, research and partnerships, develop capabilities to support our sales team with new digital tools and add more direct-to-consumer engagement, and build commercial capabilities to support new products and acquisitions. Business Updates During the quarter endedSeptember 30, 2021 , we continued to see improvement in business fundamentals for our diagnostic products which have been affected by the COVID-19 pandemic. We have also made the following recent announcements: •OnSeptember 13, 2021 , we completed the sale of select operating assets and intellectual property, including the Vectra® test, from the Myriad Autoimmune business unit (the "Autoimmune Business Transaction") to Laboratory Corporation of America Holdings for cash consideration of$150.0 million .
•On
•OnAugust 2, 2021 , we launched a new version of the myRisk Hereditary Cancer Test which allows women of all ancestries to receive a personalized polygenic breast cancer risk assessment for the first time.
•On
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Results of Operations for the Three Months Ended September 30, 2021 and 2020
The results of operations for the three months ended September 30, 2021 and 2020
are discussed below. See Note 14 "Segment and Related Information" in the notes
to our Condensed Consolidated Financial Statements for information regarding our
operating segments.
Revenue
Three months ended September 30, Change % of total revenue
(in millions) 2021 2020 2021 2021 2020
Molecular diagnostic revenues:
Hereditary Cancer $ 79.4 $ 80.5 $ (1.1) 47% 55%
Tumor Profiling 32.9 17.0 15.9 20% 12%
Prenatal 23.6 16.6 7.0 14% 11%
Pharmacogenomics 24.1 11.9 12.2 14% 8%
Autoimmune 7.3 9.1 (1.8) 4% 6%
Other - 0.6 (0.6) -% -%
Total molecular diagnostic revenue 167.3 135.7 31.6
Pharmaceutical and clinical services
revenue - 9.5 (9.5) -% 7%
Total revenue $ 167.3 $ 145.2 $ 22.1 100% 100%
Molecular diagnostic revenues increased $31.6 million for the three months ended
September 30, 2021 compared to the same period in the prior year. Tumor
profiling revenues increased $15.9 million compared to the same period in the
prior year due to an $8.3 million increase in revenue from myChoice CDx
internationally, including a $4.0 million one-time milestone payment, and a $6.4
million increase in revenue for Prolaris due to expanded coverage. Prenatal
revenues increased $7.0 million compared to the same period in the prior year
due primarily to a change in estimate for prior period revenues, a 13% increase
in average reimbursement per test, and a 7% increase in volumes. Revenues from
Pharmacogenomics increased $12.2 million compared to the same period in the
prior year due primarily to a 71% increase in volume. Hereditary Cancer revenues
decreased $1.1 million compared to the same period in the prior year due to a
slight decrease in reimbursement per test as the market for hereditary cancer
products continues to become commoditized, which decrease was partially offset
by a slight increase in volume. Autoimmune revenues decreased $1.8 million
primarily due to the completion of the Autoimmune Business Transaction on
September 13, 2021 .
Pharmaceutical and clinical services revenues decreased for the three months
ended September 30, 2021 compared to the same period in the prior year due to
the sale of Myriad RBM, Inc. on July 1, 2021 . As a result of the sale, there
were no Pharmaceutical and clinical services revenues during the current period.
Myriad RBM, Inc. generated $9.3 million in revenues during the prior period.
Cost of Sales
Three months ended September 30,
(in millions) 2021 2020 Change
Cost of molecular diagnostic testing $ 47.8 $ 39.9 $ 7.9
Cost of molecular diagnostic testing as a % of revenue 28.6 % 29.4 %
Cost of pharmaceutical and clinical services $ - $ 4.3 $ (4.3)
Cost of pharmaceutical and clinical services as a % of revenue
- % 45.3 %
The Cost of molecular diagnostic testing as a percentage of revenue decreased
from 29.4% to 28.6% during the three months ended September 30, 2021 compared to
the same period in the prior year.
The Cost of pharmaceutical and clinical services as a percentage of revenue was
45.3% for the three months ended September 30, 2020 . The sale of Myriad RBM,
Inc. was completed on July 1, 2021 , and as a result there were no corresponding
costs during the current period.
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Research and Development Expense
Three months ended September 30,
(in millions) 2021 2020 Change
R&D expense $ 18.8 $ 17.6 $ 1.2
R&D expense as a % of total revenue 11.2 % 12.1 %
Research and development expense for the three months ended September 30, 2021
increased compared to the same period in the prior year primarily due to an
increase in general information technology-related costs, increases in costs
incurred in the current period as part of the Company's strategic transformation
initiatives, and an increase in bonus expense due to improved performance of the
Company, partially offset by a decrease in compensation related costs due to a
lower headcount.
Selling, General and Administrative Expense
Three months ended September 30,
(in millions) 2021 2020 Change
Selling, general and administrative expense $ 180.2 $ 124.1 $ 56.1
Selling, general and administrative expense as a % of total revenue
107.7 % 85.5 %
Selling, general and administrative expense increased for the three months ended
September 30, 2021 compared to the same period in the prior year primarily due
to a $48.0 million legal accrual related to the Crescendo Bioscience, Inc. qui
tam lawsuit, as well as a $2.9 million increase in costs incurred in the current
period as part of the Company's strategic transformation initiatives, a $2.2
million increase in stock-based compensation, a $2.1 million increase in
marketing costs, a $2.1 million increase in legal expenses, and a $1.9 million
increase in consulting fees, partially offset by a $3.7 million decrease in
amortization expense and a $1.7 million decrease in commission expense due to a
decrease in headcount from the prior period.
Change in the Fair Value of Contingent Consideration
Three months ended September 30,
(in millions) 2021 2020 Change
Change in the fair value of contingent consideration $ 0.4
$ (1.1) $ 1.5
Change in the fair value of contingent consideration as a % of total revenue
0.2 % (0.8) %
The fair value of contingent consideration for the three months ended
September 30, 2021 increased compared to the same period in the prior year due
to changes in timing of expected cash payments associated with the contingent
consideration related to the Sividon Diagnostics GmbH acquisition in fiscal year
2016.
Other Income (Expense), Net
Three months ended September 30,
(in millions) 2021 2020 Change
Other income (expense), net $ 119.7 $ (4.1) $ 123.8
Other income (expense), net increased for the three months ended September 30,
2021 compared to the same period in the prior year due primarily to the $121.0
million net gain recognized on the sale of Myriad RBM, Inc. in the current
period, partially offset by expenses in the current period, including a $0.6
million loss recognized on the sale of the Myriad Autoimmune business unit. The
prior year expense primarily relates to foreign exchange losses partially offset
by interest income in the prior period.
Income Tax Expense (Benefit)
Three months ended September 30,
(in millions) 2021 2020 Change
Income tax expense (benefit) $ 15.2 $ (28.5) $ 43.7
Effective tax rate 38.2 % 65.2 %
Our tax rate is the product of a blended U.S. federal effective rate of 21.0%
and a blended state income tax rate of approximately 3.4%. Certain significant
or unusual items are separately recognized during the period in which they occur
and can be a source of variability in the effective tax rates from period to
period.
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Income tax expense (benefit) for the three months ended September 30, 2021 was
$15.2 million , and our effective tax rate was 38.2%. The change in the effective
tax rate for the three months ended September 30, 2021 as compared to the same
period in the prior year is primarily due to the tax benefit recorded in the
prior year related to the CARES Act, tax expenses recorded in the current year
related to the differences between the book and tax basis of assets divested,
disallowed executive compensation expenses, and stock compensation expenses.
Results of Operations for the Nine Months Ended September 30, 2021 and 2020
The results of operations for the nine months ended September 30, 2021 and 2020
are discussed below. See Note 14 "Segment and Related Information" in the notes
to our Condensed Consolidated Financial Statements for information regarding our
operating segments.
Revenue
Nine months ended September 30, Change % of total revenue
(in millions) 2021 2020 2021 2021 2020
Molecular diagnostic revenues:
Hereditary Cancer $ 241.5 $ 205.6 $ 35.9 46% 51%
Tumor Profiling 94.4 41.2 53.2 18% 10%
Prenatal 76.7 53.5 23.2 14% 13%
Pharmacogenomics 64.3 40.8 23.5 12% 10%
Autoimmune 28.2 26.8 1.4 5% 7%
Other 0.5 1.6 (1.1) -% -%
Total molecular diagnostic revenue 505.6 369.5 136.1
Pharmaceutical and clinical services revenue 24.2 32.9 (8.7) 5% 8% Total revenue$ 529.8 $ 402.4 $ 127.4 100% 100% Molecular diagnostic revenues for the nine months endedSeptember 30, 2021 increased$136.1 million compared to the same period in the prior year. Revenue for the nine months endedSeptember 30, 2020 was negatively impacted by the pandemic as patients faced significant obstacles to accessing health care professionals. Tumor Profiling revenues increased$53.2 million compared to the same period in the prior year due to a$27.4 million increase in revenue for Prolaris due to expanded coverage and the submission of claims for previously performed tests that were pending clarification of the coverage policy and a$21.1 million increase in revenues from myChoice CDx due to expansion inJapan and other areas. Hereditary Cancer revenues increased$35.9 million compared to the same period in the prior year due primarily to a 21% increase in volume. Revenues from Pharmacogenomics increased$23.5 million compared to the same period in the prior year due primarily to a 56% increase in volume. Prenatal revenues increased$23.2 million compared to the same period in the prior year due primarily to an increase of 15% in volume and an over 10% increase in the average reimbursement per test, as well as a change in estimate related to revenues from prior periods. Pharmaceutical and clinical services revenues decreased for the nine months endedSeptember 30, 2021 compared to the same period in the prior year due to decreased revenue attributable to the sale ofMyriad RBM, Inc. onJuly 1, 2021 , which generated$28.9 million in revenue during the prior period and the sale of the Clinic, an internal medicine emergency hospital, which was sold inFebruary 2020 and generated$3.9 million in revenue during the prior period. The decrease was partially offset by$2.9 million generated from processing COVID-19 tests in the current period. Cost of Sales Nine months ended September 30, (in millions) 2021 2020 Change Cost of molecular diagnostic testing$ 139.9 $ 115.2 $ 24.7 Cost of molecular diagnostic testing as a % of revenue 27.7 % 31.2 % Cost of pharmaceutical and clinical services $ 11.9$ 15.8 $ (3.9) Cost of pharmaceutical and clinical services as a % of revenue 49.2 % 48.0 % 28
-------------------------------------------------------------------------------- Table of Contents The Cost of molecular diagnostic testing as a percentage of revenue decreased from 31.2% to 27.7% during the nine months endedSeptember 30, 2021 compared to the same period in the prior year. The decrease was primarily driven by the increase in revenue from higher test volumes during the period as the same period from the prior year was impacted by COVID-19; thus, costs decreased as a percentage of revenue as revenue from increases in test volumes outpaced personnel and materials costs to perform the tests. The cost of pharmaceutical and clinical services decreased compared to the same period in the prior year due to the sale ofMyriad RBM, Inc. that was completed onJuly 1, 2021 . Research and Development Expense Nine months ended September 30, (in millions) 2021 2020 Change R&D expense $ 61.4$ 54.7 $ 6.7 R&D expense as a % of total revenue 11.6 % 13.6 % Research and development expense for the nine months endedSeptember 30, 2021 increased compared to the same period in the prior year primarily due to increases in costs incurred in the current period as part of the Company's strategic transformation initiatives, increases in lab expenses, and increases in compensation costs as a result of employee bonus reductions in the prior period stemming from the significant impact of COVID-19 on the Company's financial results. Selling, General and Administrative Expense Nine months ended September 30, (in millions) 2021 2020 Change Selling, general and administrative expense$ 460.5 $ 364.4 $ 96.1
Selling, general and administrative expense as a % of total revenue
86.9 % 90.6 %
Selling, general and administrative expense increased for the nine months ended
September 30, 2021 compared to the same period in the prior year primarily due
to a $48.0 million legal accrual related to the Crescendo Bioscience, Inc. qui
tam lawsuit, a $14.4 million increase in costs incurred in the current period as
part of the Company's strategic transformation initiative, and a $10.5 million
increase in stock-based compensation due to lower stock-based compensation in
the prior period as a result of adjustments to stock-based compensation related
to the departure of our former Chief Executive Officer, as well as an $8.5
million increase in bonus expense as a result of employee bonus reductions in
the prior year stemming from the significant impact of COVID-19 on the Company's
financial results, a $5.6 million increase in legal expenses, a $3.4 million
increase in commissions due to increases in sales, and a $2.9 million increase
in consulting fees. Increases were partially offset by a $5.1 million decrease
in amortization expense and a decrease in sales and marketing expenses of $2.6
million due primarily to fewer in-person sales and marketing events and
travel-related expenses.
Change in the Fair Value of Contingent Consideration
Nine months ended September 30,
(in millions) 2021 2020 Change
Change in the fair value of contingent consideration $ 1.7
$ (4.5) $ 6.2
Change in the fair value of contingent consideration as a % of total revenue
0.3 % (1.1) %
The fair value of contingent consideration for the nine months ended
September 30, 2021 increased compared to the same period in the prior year due
to changes in timing of expected cash payments associated with the contingent
consideration related to the Sividon Diagnostics GmbH acquisition in fiscal year
2016.
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Goodwill and long-lived asset impairment charges
Nine months ended September 30,
(in millions) 2021 2020 Change
$ 98.4 $ (96.6)
0.3 % 24.5 %
Goodwill and long-lived asset impairment charges decreased for the nine months
ended September 30, 2021 compared to the same period in the prior year primarily
due to the Company recognizing goodwill impairment charges in the prior period
related to the Myriad Autoimmune reporting unit, as well as additional charges
related to the abandonment of an in-process research and development intangible
asset during the prior period.
Other Income (Expense), Net
Nine months ended September 30,
(in millions) 2021 2020 Change
Other income (expense), net $ 133.8 $ 8.3 $ 125.5
Other income (expense), net increased for the nine months ended September 30,
2021 compared to the same period in the prior year due primarily to the combined
$152.2 million net gain recognized on the sales of Myriad RBM, Inc. and the
Myriad myPath, LLC laboratory in the current period, partially offset by
expenses or losses in the current period, including the $0.6 million net loss
recognized on the sale of the Myriad Autoimmune business unit and losses of $5.2
million and $6.5 million for a non-cancelable purchase commitment and inventory,
respectively, recognized in connection with the divestiture transactions.
Increases were also partially offset by the receipt of $14.6 million in stimulus
funds from the CARES Act in the prior period.
Income Tax Expense (Benefit)
Nine months ended September 30,
(in millions) 2021 2020 Change
Income tax benefit $ 6.0 $ (47.4) $ 53.4
Effective tax rate (44.1) % 20.3 %
Our tax rate is the product of a blended U.S. federal effective rate of 21.0%
and a blended state income tax rate of approximately 3.4%. Certain significant
or unusual items are separately recognized during the period in which they occur
and can be a source of variability in the effective tax rates from period to
period.
Income tax expense for the nine months ended September 30, 2021 was $6.0
million , and our effective tax rate was (44.1)%. The change in the effective tax
rate for the nine months ended September 30, 2021 as compared to the same period
in the prior year is primarily due to the tax benefit recorded in the prior year
related to the CARES Act, tax expense recorded in the prior year related to
asset impairments, tax expense recorded in the current year related to the
differences between the book and tax basis of assets divested, disallowed
executive compensation expenses, the release of a valuation allowance, and stock
compensation expense.
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Liquidity and Capital Resources Our primary sources of liquidity are our cash, cash equivalents and marketable investment securities, our cash flows from operations, our cash flows from investing activities, and, in certain circumstances as discussed below, amounts available for borrowing under our Amended Facility. Our capital deployment strategy focuses on use of resources in the key areas of research and development and acquisitions. We believe that investing organically through research and development and acquisitively to support business strategy provides the best return on invested capital. During the three months endedSeptember 30, 2021 , our liquidity increased$346.6 million from the combined proceeds from the sales ofMyriad RBM, Inc. and the Myriad Autoimmune business. The cash generated from these divestitures provides us with additional liquidity as we seek out strategic opportunities for capital deployment. We believe that our existing capital resources will be sufficient to meet our current and projected operating requirements for the foreseeable future. In addition, our capital resources and cash on hand may be used for acquisitions or other strategic investments. All remaining borrowings under our Amended Facility, which matures onJuly 31, 2023 , were repaid onJuly 30, 2021 using cash generated from our recent divestitures. Our available capital resources, however, may be consumed more rapidly than currently expected, and we may need or want to raise additional financing. We may not be able to secure such financing in a timely manner or on favorable terms, if at all. In addition, we are subject to financial covenants as part of our Amended Facility that could limit our ability to incur additional indebtedness. Without additional funds, we may be forced to delay, scale back or eliminate some of our sales and marketing efforts, research and development activities, or other operations, and potentially delay development of our diagnostic tests in an effort to provide sufficient funds to continue our operations. If any of these events occurs, our ability to achieve our development and commercialization goals could be adversely affected. The Amended Facility restricts our ability to make future borrowings if unrestricted cash, cash equivalents and marketable securities exceed$150.0 million , unless such borrowings are used in connection with certain permitted acquisitions. Unrestricted cash, cash equivalents and marketable securities totaled$413.6 million as ofSeptember 30, 2021 . Our revolving commitment amount is$250.0 million as ofSeptember 30, 2021 . As the Company's total unrestricted cash, cash equivalents, and marketable securities exceeded$150.0 million as ofSeptember 30, 2021 , we will be unable to make future borrowings unless related to a permitted acquisition. In addition, following the expiration of the waiver of the leverage ratio and interest coverage ratio covenants, which waiver is effective untilMarch 31, 2022 , our ability to borrow under the Amended Facility will be limited if we are unable to comply with those financial covenants. From time to time, we enter into purchase commitments or other agreements that may materially impact our liquidity position in future periods. InApril 2021 , a non-cancelable operating lease for our new corporate headquarters inSalt Lake City, Utah , commenced with a lease term of 15 years and total future lease payments of approximately$67.0 million as ofSeptember 30, 2021 . In addition, we have accrued$48.0 million for a potential settlement of the qui tam lawsuit againstCrescendo Bioscience, Inc. and the Company, which is included in accrued liabilities in our Condensed Consolidated Balance Sheet. 31 -------------------------------------------------------------------------------- Table of Contents Due to the continuing evolving global situation from the COVID-19 pandemic, including the emergence of the more highly transmissible Delta coronavirus variant and its impact on the ongoing recovery from the COVID-19 pandemic, it is not possible to predict whether unanticipated consequences of the pandemic are reasonably likely to materially affect our liquidity and capital resources in the future. Because of the specialized scientific nature of our business, we are highly dependent upon our ability to attract and retain qualified management, scientific, and technical personnel. Competition and compensation for such personnel and other qualified personnel rose as employment vacancies surged during the nine months endedSeptember 30, 2021 , and job applicants are often seeking a more flexible work arrangement over the long term as a condition of employment.President Biden's administration is in the process of implementing a mandate requiring companies with 100 or more employees to require full COVID-19 vaccination or regular testing for COVID-19 as a condition of employment. The mandate could increase already elevated employment vacancies. In addition, any future federal or state regulations that could require us to mandate full COVID-19 vaccinations for our employees, or any future decision on our part to voluntarily require our employees to receive a COVID-19 vaccine, could impact our ability to hire and retain employees. Loss of the services of or failure to recruit additional key management, scientific and technical personnel and other qualified personnel who are necessary to operate our business would adversely affect our research and development programs and molecular diagnostic business. Additionally, disruptions to our supply chain as a result of COVID-19 could cause shortages of critical materials required to conduct our business, which may have a material adverse effect on our business as a whole. In addition, inflation, led by supply constraints, federal stimulus funding, increases to household savings, and the sudden macroeconomic shift in activity levels arising from the loosening or removal of many government restrictions and the broader availability of COVID-19 vaccines, has had, and may continue to have, an impact on the labor costs we incur to attract and retain qualified personnel, costs to generate sales and produce diagnostic testing results, and costs of lab supplies. The following table represents the balances of cash, cash equivalents and marketable investment securities: September 30, December 31, (in millions) 2021 2020 Change Cash and cash equivalents$ 295.2 $ 117.0 $ 178.2 Marketable investment securities 70.9 33.7 37.2 Long-term marketable investment securities 47.5 21.0 26.5 Cash, cash equivalents and marketable investment securities$ 413.6
The increase in cash, cash equivalents, and marketable investment securities was primarily driven by$379.1 million in total cash consideration from the sale ofMyriad RBM, Inc. , select assets of the Myriad Autoimmune business unit, and the Myriad myPath, LLC laboratory, the receipt of an$89.6 million U.S. federal tax refund in the quarter endedMarch 31, 2021 , and proceeds of$90.0 million from the exercise of stock options, partially offset by$226.4 million in repayments of the Company's revolving credit facility during the nine months endedSeptember 30, 2021 and$10.5 million in transaction expenses related to the foregoing divestitures, as well as by cash used in operating activities as part of our normal course of business. The following table represents the Condensed Consolidated Cash Flow Statement:
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