Executive Summary / Key Takeaways

• Pivotal Product Transition: Inspire Medical Systems is undergoing a critical transition with the full U.S. launch of its next-generation Inspire V system, which promises significant operational and clinical benefits by eliminating the pressure sensing lead.
• Near-Term Headwinds Impacting Growth: The Inspire V rollout has faced unexpected delays in Q2 2025 due to slower center onboarding, Medicare billing complexities, patient warehousing, and inventory destocking, leading to a significant reduction in full-year 2025 revenue and EPS guidance.
• Strong Underlying Demand & Capacity Expansion: Despite near-term challenges, patient demand for Inspire therapy remains robust. The Inspire V system has already demonstrated a 20% reduction in surgical times and over 20% increase in patient implants at early adopter sites, highlighting its potential to unlock significant provider capacity.
• Long-Term Tailwinds & Strategic Investments: Management views the current headwinds as temporary, with corrective actions underway. Strategic investments in direct-to-consumer (DTC) marketing, footprint expansion, and the PREDICTOR study (to streamline patient eligibility) are expected to drive accelerated revenue growth in 2026 and beyond.
• Competitive Differentiation & Profitability: Inspire maintains a unique position as the only FDA-approved neurostimulation technology for OSA. After achieving its first full year of profitability in 2024, the company remains committed to improving operating margins, aiming for 30% long-term, despite the recent EPS reset.

Inspire's Vision: Redefining Sleep Apnea Treatment

Inspire Medical Systems, Inc. (INSP) stands at the forefront of medical technology, dedicated to transforming the lives of patients suffering from obstructive sleep apnea (OSA). The company's core business revolves around its proprietary Inspire system, a minimally invasive neurostimulation technology that offers a safe and effective treatment for moderate to severe OSA. This closed-loop solution continuously monitors a patient's breathing and delivers mild hypoglossal nerve stimulation to maintain an open airway, representing a significant advancement over traditional therapies.

The company's journey began in 2007, culminating in commercial availability in Europe by 2011 and U.S. FDA approval in 2014. This foundational technology established Inspire as a pioneer, addressing a large and underserved market where conventional treatments like CPAP often face adherence challenges. By 2024, Inspire had surpassed 90,000 patients treated, achieving its first full year of profitability, a testament to its growing market penetration and operational maturity. The overarching strategy centers on driving high-quality patient flow and significantly increasing the capacity of its provider partners through medical education, digital tools, and technological innovation.

The Technological Edge: Inspire V and SleepSync

Inspire's competitive moat is deeply rooted in its differentiated technology, which continues to evolve with the introduction of the Inspire V system and the SleepSync programming platform. The Inspire V neurostimulator, fully launched in the U.S. in May 2025, represents a significant leap forward. Its core innovation lies in incorporating respiratory sensing directly into the neurostimulator, thereby eliminating the need to implant a separate pressure sensing lead.

This design enhancement offers several tangible and quantifiable benefits. Early results from a Singapore clinical study demonstrated a 20% reduction in surgical times, a critical factor in expanding treatment capacity. Furthermore, U.S. centers that have successfully transitioned to Inspire V have already experienced a more than 20% increase in patient implants in the first half of 2025 compared to the prior year. From an efficacy standpoint, an accelerometer study indicated significantly improved sensing capability, with an 86% inspiratory overlap with the patient's breathing, crucial for effective airway management. This technological advancement not only reduces surgical complexity and discomfort for ENT surgeons but also provides the foundation for future software-based enhancements, including sleep detection for auto-activation and advanced sleep performance tracking.

Complementing the Inspire V system is the SleepSync programming platform, a cloud-based patient management system. SleepSync is designed to enhance patient programming efficiency, improve access to patient data for healthcare providers, and streamline follow-up care. Its ability to allow providers to use their own laptops or tablets further reduces operational complexities for Inspire. These technological differentiators are vital for investors, as they directly contribute to Inspire's competitive advantage, improve patient and physician experience, and are expected to drive higher adoption rates, ultimately translating into stronger revenue growth and improved gross margins due to reduced production costs.

Competitive Arena: Innovating Against Giants and New Entrants

Inspire operates in a dynamic competitive landscape, positioning itself as a specialized innovator against larger, more diversified medical device companies and emerging indirect threats. Direct competitors like ResMed , Koninklijke Philips , and Medtronic offer a range of OSA treatments, but Inspire's neurostimulation technology provides a unique value proposition.

Compared to ResMed , a leader in CPAP devices, Inspire's minimally invasive implantable solution targets patients who are often non-compliant with or intolerant to CPAP. While ResMed (RMD) boasts a broader market reach and stronger profitability (ResMed's TTM Operating Margin of 33% significantly surpasses Inspire's 4.81%), Inspire's proprietary technology offers a differentiated approach that could foster greater patient comfort and compliance. Similarly, against Koninklijke Philips (PHG), which focuses on integrated health solutions and diversified devices, Inspire's specialized neurostimulation offers a more targeted therapy for severe OSA, potentially leading to superior efficacy in specific patient populations. Medtronic (MDT), another player in neurostimulation, operates at a much larger scale with a broader implantable device portfolio (Medtronic's TTM Operating Margin of 18% is considerably higher than Inspire's). However, Inspire's singular focus on OSA allows for rapid, patient-centric innovation in this niche, as evidenced by the Inspire V system's advancements.

Inspire's competitive advantages, or moats, include its first-to-market regulatory approvals in the U.S., EU, and Japan, and its strong clinical evidence, which has surpassed 300 peer-reviewed publications. The Inspire V system's ability to reduce surgical time and eliminate the pressure sensing lead directly addresses a key pain point for ENT surgeons, potentially increasing adoption and capacity. Furthermore, the proposed 2026 CMS OPPS rules suggest favorable reimbursement increases for CPT code 64568 (used for Inspire V), including a 5% increase for ASCs to $28,000 and an 11% increase for surgeon reimbursement to $660, which could enhance the economic attractiveness for providers.

However, Inspire faces vulnerabilities, including reliance on single-source suppliers for components, which could lead to supply chain disruptions and inventory obsolescence risks, as highlighted by the $2.1 million charge for excess Inspire IV components in Q2 2025. Indirect competition is also emerging, notably from GLP-1 medications like Eli Lilly's (LLY) Zepbound, recently approved for OSA in obese patients. While some patients may delay Inspire therapy to trial GLP-1s, management believes these drugs could be a long-term tailwind by helping patients reduce lateral wall collapse, making them eligible for Inspire's tongue-based collapse treatment. Inspire is also actively defending its intellectual property, having initiated a patent infringement lawsuit against Nyxoah SA (NYXH) in May 2025.

Financial Performance: A Profitable Trajectory Meets Transitionary Headwinds

Inspire's financial narrative in 2025 reflects a company in transition, balancing strong underlying growth with the operational complexities of a major product launch. The company achieved a significant milestone in 2024, reporting its first full year of profitability with diluted net income of $1.75 per share, a stark contrast to the $0.72 loss per share in 2023. Full-year 2024 revenue reached $802.8 million, a robust 28% increase year-over-year, driven by strong U.S. market penetration. Operating income for 2024 was $36.1 million, a substantial turnaround from a $40.3 million operating loss in the prior year, with Adjusted EBITDA reaching $157.8 million, representing a healthy 20% margin.

The first half of 2025, however, presented a mixed picture. For the six months ended June 30, 2025, revenue grew 16.3% year-over-year to $418.4 million. While Q1 2025 saw a strong 23% revenue increase to $201.3 million and a net income of $3.0 million, Q2 2025 experienced a slowdown. Revenue for Q2 2025 was $217.1 million, an 11% increase year-over-year, but the company reported a net loss of $3.6 million, compared to a net income of $9.8 million in Q2 2024. This resulted in a diluted net loss per share of $0.12 for the quarter. Gross margin remained strong at 84.0% in Q2 2025, though slightly down from 84.8% in Q2 2024, primarily due to a $2.1 million charge for excess Inspire IV components.

Operating expenses increased 15% year-over-year in Q2 2025 to $185.7 million, reflecting investments in sales organization expansion and general corporate costs. Notably, this included a one-time $11.2 million accelerated noncash stock-based compensation expense for retirement-eligible employees and $1.7 million in legal fees related to a Department of Justice civil investigative demand and a patent infringement suit.

The company's liquidity remains solid, with $410.7 million in cash, cash equivalents, and available-for-sale debt securities as of June 30, 2025, providing ample flexibility to fund operations and strategic investments.

However, working capital decreased by $62.5 million in the first half of 2025, largely due to share repurchases ($75.0 million) and inventory build-up for Inspire V.

Outlook and Risks: Charting the Path Forward

Inspire's updated outlook for 2025 reflects a recalibration of expectations in light of the Inspire V rollout complexities. Full-year 2025 revenue guidance has been revised to a range of $900 million to $910 million, representing 12% to 13% growth over 2024, a reduction from the previous guidance of $940 million to $955 million. Concurrently, diluted net income per share guidance has been significantly lowered to $0.40 to $0.50, down from $2.20 to $2.30, primarily due to the revised revenue outlook and increased patient marketing investments in the second half of the year. Q3 2025 revenue is projected to increase modestly by 1% to 3% sequentially from Q2.

Management attributes these adjustments to several near-term headwinds impacting the Inspire V transition. These include delays in centers completing necessary training, contracting, and SleepSync implementation (particularly due to IT department approvals), and Medicare billing software updates for the new CPT code 64568 not becoming effective until July 1, 2025. Additionally, some patients opted to delay therapy, waiting for the Inspire V device, and certain customers prioritized using existing Inspire IV inventory. The company also strategically held back on patient marketing and footprint expansion in the first half of 2025 to focus resources on the Inspire V launch.

Despite these challenges, management emphasizes that the headwinds are temporary and corrective actions are actively underway. Technical teams are accelerating SleepSync implementation, with the vast majority of centers expected to be onboarded by the end of Q3 2025. Patient marketing and footprint expansion efforts are significantly ramping up in the second half of 2025 to drive awareness and capacity. The company anticipates Q4 2025 revenue to be stronger than historical levels, driven by these initiatives and expected utilization improvements. Looking ahead to 2026, management expects revenue growth to accelerate beyond the 12-13% projected for 2025, underscoring confidence in the long-term potential of Inspire V and the market.

Conclusion

Inspire Medical Systems is navigating a critical phase defined by the strategic rollout of its advanced Inspire V system. While the company achieved a significant milestone in 2024 with its first full year of profitability and continues to demonstrate strong underlying patient demand, the initial commercialization of Inspire V has encountered operational friction. These near-term challenges, including slower-than-expected center transitions and Medicare billing delays, have necessitated a downward revision of 2025 financial guidance.

However, the core investment thesis remains compelling. Inspire's differentiated neurostimulation technology, particularly the Inspire V system's ability to reduce surgical times and enhance surgeon comfort, is a powerful catalyst for expanding provider capacity and patient access. The demonstrated 20% increase in patient implants at early Inspire V sites underscores its transformative potential. Management's proactive measures to address rollout impediments, coupled with strategic investments in market development and a long-term view of GLP-1s as a complementary tailwind, position Inspire for a reacceleration of growth in 2026. For discerning investors, the current period represents a temporary operational reset, with the company's technological leadership and commitment to profitability poised to unlock substantial long-term value in the vast and underserved OSA market.