Issie Kirby

Issie Kirby questioned the early launch momentum of the Unity Cataract System (CS), specifically placement rates and any training difficulties compared to the VCS. She also asked if there's a 'halo effect' from placing a cataract system that benefits the broader implantables portfolio.

Answer

CEO David Endicott confirmed high visibility to the Unity order book and excellent response to the cataract system, with strong demand. He noted that while product decisions are independent, having an Alcon rep frequently in the OR due to equipment placement provides opportunities for staff and surgeon engagement, but IOL share is primarily driven by product performance like PanOptix Pro.

Issie Kirby asked about Unity's Cataract System placement rates and any training difficulties, as well as whether placing a cataract system provides a halo effect to the broader implantables business.

Answer

David Endicott, CEO, confirmed high visibility to the Unity order book and excellent response to the cataract system, with demand being high. He noted that while being in the OR frequently with equipment provides opportunities for staff and surgeon interaction, the primary driver for IOL share in the U.S. is PanOptix Pro, emphasizing that IOL decisions are mostly discrete choices based on lens performance.

Issie Kirby of Rothschild & Co Redburn asked about contact lens market dynamics, the performance and cannibalization impact of PRECISION7, and how revenue is being recognized for the new Unity system.

Answer

CEO David Endicott reported that the contact lens market saw mid-single-digit growth and that PRECISION7 is performing as expected, taking share and providing a favorable margin mix despite some cannibalization. He clarified that Unity revenue is recognized primarily as a capital purchase, with stable average selling prices and no significant leasing or bundling.

Issie Kirby asked about the prescriber base for Alcon's upcoming dry eye drug, AR-15512, and its contact lens manufacturing capacity and future margins.

Answer

CEO David Endicott explained that Alcon is expanding its sales force to target high-prescribing optometrists for AR-15512, a different audience than for its glaucoma drugs, and will leverage its OTC portfolio. He also stated that manufacturing productivity has improved contact lens capacity, and the flexibility of the production lines to make multiple products enhances capital efficiency, supporting margins.

Issie Kirby asked if the Unity launch ramp should be expected to differ from the previous CENTURION launch and inquired about the financial health of end purchasers. She also questioned if IOL penetration in developed markets like Japan and Europe is approaching a ceiling.

Answer

CEO David Endicott suggested that modeling the Unity ramp similar to CENTURION's is a reasonable approach, with initial enthusiasm followed by a more natural replacement cycle. He expressed confidence that customers will invest in capital that creates value. On penetration, he stated he is unconvinced the U.S. has hit a ceiling and sees significant room for growth internationally, where penetration rates are much lower and Alcon is gaining share.

Issie Kirby of Rothschild & Co Redburn requested more details on the planned restructuring, asking about the specific areas of focus and the timing. She also inquired about the Myopia business, specifically MiSight's performance in Europe versus Asia, and asked for an update on the FDA approval timeline for SightGlass.

Answer

President and CEO Al White explained the restructuring was prompted by the completion of integration activities and IT upgrades, allowing for a fresh look at organizational efficiency, with a focus on G&A expenses. On Myopia, he confirmed MiSight is performing very well in Europe, is doing 'okay' in Asia-Pacific with a key launch in Japan planned for early 2026, and is a bit slower in the Americas. He stated there was no new update on the SightGlass FDA submission.

Issie Kirby inquired about the drivers behind the lowered market growth assumption for Vision Care, asking if it was due to softer pricing, volume, or mix. She also asked for more color on the fertility market softness in Asia and potential cyclical risks in the U.S.

Answer

President & CEO Albert White explained the contact lens market is returning to its historical 4-6% growth range post-COVID, rather than a specific issue with pricing or volume. Regarding fertility, he attributed Asian softness partly to temporary cultural factors in China and noted broader consumer caution and tighter cash management at clinics are impacting the market globally.

Issie Kirby from Redburn Atlantic asked for details on the SightGlass joint venture in China, the financial impact of the JV, the performance of MiSight in China, and the reasons for the decline in Cooper's core business in China.

Answer

CEO Al White described the SightGlass JV with EssilorLuxottica as a long-term investment, noting its financial impact is a loss below the operating line. He reported dramatic increases in SightGlass demand in China and confirmed that both MiSight and ortho-k also grew well there. He clarified that the overall decline in China was specific to Cooper's core contact lens business, which the company is actively working to fix.

Issie Kirby from Redburn Atlantic asked for Cooper's perspective on a competitor's upcoming 7-day wear lens and its potential risk to Cooper's frequent replacement (FRP) portfolio. She also requested more color on the drivers of the strong growth in the fertility business.

Answer

CEO Al White downplayed the risk from the 7-day lens, suggesting it would primarily compete in the 2-week market where Cooper has little presence. On fertility, he highlighted broad strength across consumables (media), genomics, and donor activity, with a particular lift from capital equipment sales in Q4. He also noted that recent political commentary in the U.S. appears to be positive for IVF reimbursement.

Issie Kirby requested a breakdown of new U.S. patient starts from Type 2, asked about the prescriber profile (PCP vs. endocrinologist), and inquired about trends in direct-to-consumer leads.

Answer

Ashley McEvoy, Director, President & CEO, confirmed that new starts from Type 2 patients accounted for approximately one-third of total U.S. new starts. She explained the strategy is to first leverage strong relationships with high-prescribing endocrinologists, using clinical data to build their confidence, and then expand to high-prescribing PCPs.

Issie Kirby from Rothschild & Co Redburn asked for the proportion of new U.S. starts from Type 2 patients, the mix of prescribers between endocrinologists and primary care, and trends in direct-to-consumer leads.

Answer

President and CEO Ashley McEvoy confirmed that new starts from Type 2 patients accounted for approximately one-third of total U.S. new starts. She explained the strategy is to first leverage strong relationships with endocrinologists, using clinical evidence to build their confidence, and then work with them to influence high-prescribing primary care physicians (PCPs).

Issie Kirby asked about the impact of the Malaysia facility ramp on Q1 gross margins and also inquired about the company's strategy for managing tariffs, including the volume sourced from China and any plans to reposition production.

Answer

CFO and Treasurer Ana Maria Chadwick reported that the Malaysia facility is on track to become accretive to gross margin in the third quarter of 2025. Regarding tariffs, she estimated a manageable 50 basis point impact for the year, which she noted was already absorbed within the company's raised full-year gross margin guidance of approximately 71%, underscoring the strength of their operational efficiencies.

Issie Kirby from Redburn Atlantic inquired about the characteristics of early adopters of Omnipod for Type 2 diabetes, both from patient and physician perspectives, and requested more detail on the direct-to-consumer (DTC) marketing strategy.

Answer

President and CEO Jim Hollingshead responded that while it's early to define a clear pattern, reception is strong across the board, likely tilting towards intensive insulin (MDI) users. Regarding DTC, he explained that having the official Type 2 label for Omnipod 5 has significantly improved the yield from marketing efforts, as they can now directly convert interested Type 2 patient leads to the new product, a strategy that is "clearly paying dividends."

Issie Kirby inquired about the strategy for basal-only Type 2 patients, any signs of therapy intensification, and early learnings regarding retention and behavior for the broader Type 2 population.

Answer

President and CEO Jim Hollingshead noted that Omnipod 5 is well-suited for basal-only patients and that the target market is any insulin user not in glycemic control. Regarding retention, he stated that while current rates are strong, they anticipate some Type 2 subsegments may exhibit different usage patterns or lower retention over time. He affirmed that all these patients are incremental to the business and that Insulet is developing customized offerings for them.

Issie Kirby of Rothschild & Co Redburn inquired about the sales force's performance one year after its expansion, focusing on representative productivity and the growth of the prescriber base.

Answer

EVP & CFO Jereme Sylvain stated that the sales team is operating well and becoming increasingly productive. He noted that Dexcom now has 'well over 100,000 prescribers,' and importantly, the average number of scripts per physician has remained stable, indicating that existing prescribers are increasing their volume as new ones are added.

Issie Kirby from Redburn Atlantic asked if new non-insulin Type 2 users were new to CGM or competitive switches, requested an update on Stelo revenue, and inquired about the strategy to upgrade Stelo users to G7.

Answer

CEO Kevin Sayer stated that most new non-insulin users are new to Dexcom CGM, a trend driven by the company's superior PBM coverage. CFO Jereme Sylvain added that Stelo is tracking in line with its full-year guidance to contribute 2-3% of total growth, but quarterly revenue is not being disclosed.

Issie Kirby asked about the potential for accuracy improvements with the G8 sensor and whether DexCom is having discussions with payers about premium pricing for multi-analyte capabilities.

Answer

Executive Jacob Leach confirmed that DexCom is always striving to enhance accuracy and that the G8 platform is being designed with capabilities for further accuracy and reliability improvements. Regarding multi-analyte pricing, he stated that it is still early days and the focus is on developing the technology and use cases, though they will consider the value amplification when discussing pricing later.

Issie Kirby asked for early insights into Stelo's reordering and retention rates, as well as any color on the product's returns and reliability since its launch.

Answer

CEO Kevin Sayer noted that about 50% of customers signed up for a subscription and early reordering rates are good. On reliability, he shared a key learning: consumer market expectations differ from medical users, requiring a different service model. The focus is on creating a 'delightful' experience to drive retention, but it's still too early for definitive metrics.

Issie Kirby inquired about the competitive dynamics, win rates, and expected renewal rates in international (OUS) markets.

Answer

CEO John Sheridan described the OUS market as large and underpenetrated with a stable competitive environment. He expressed confidence in Tandem's position, which he expects to strengthen with a robust pipeline of new technology coming to OUS markets, including Mobi, Libre 3 integration, and mobile bolus.

Issie Kirby inquired about the primary bottlenecks to achieving higher Type 2 market penetration, questioning if it was patient awareness or provider inertia.

Answer

President and CEO John Sheridan responded that it's a combination of both. He emphasized the need to present strong clinical data to physicians while also marketing the benefits of wearability, ease of use, and reduced cognitive burden to patients. He noted that market research showing an increase in "near-term pumpers" is an encouraging sign of growing patient interest.