Steven Lichtman

Steven Lichtman asked about the durability of the commercial initiatives, specifically how long intensive efforts are needed and if benefits persist after the team moves on. He also inquired about how the competitive environment for 2026 was factored into guidance and management's qualitative observations.

Answer

President and CEO Dr. Ron Kurtz stated it's too early to comment on durability, noting that practices are dynamic and a 'one and done' approach is unlikely. He emphasized continued close customer engagement due to ongoing technology additions. Regarding competition, Dr. Kurtz mentioned monitoring the environment, recalling the unusual situation in 2025 with three major competitors introducing new multifocal IOLs, and anticipating new premium IOL announcements in 2026, but expects these to be episodic and transient.

Steven Lichtman from William Blair asked Ron Kurtz about the durability of the commercial initiatives put in place, specifically how long the intensive effort needs to be maintained and if benefits persist when the team moves on. He also inquired about how the competitive environment was factored into 2026 guidance and qualitative comments on what RxSight is observing, particularly regarding new premium IOLs.

Answer

Ron Kurtz, President and CEO, stated it's too early to comment on the durability of initiatives, noting that practices are dynamic and a "one and done" approach is unlikely. He emphasized staying close to customers and adapting intensity based on practice needs. Regarding competition, he mentioned monitoring the environment, recalling the unusual situation in 2025 with three major competitors introducing new multifocal IOLs, and anticipating new presbyopia-correcting IOLs in 2026, but expects these to be episodic and transient, eventually returning to baseline.

Steven Lichtman from Oppenheimer asked for more specifics on the company's workflow support initiatives and questioned whether RxSight would consider increasing its sales force ('feet on the street') given its strong balance sheet and the competitive environment.

Answer

President and CEO Dr. Ron Kurtz detailed that the support initiatives involve disseminating clinical and practice management 'pearls' to help customers optimize their use of the technology. CFO Shelley Thunen added that while OpEx is currently rightsized to revenue, any future incremental investment would likely target sales and marketing if a clear benefit is observed.

Steven Lichtman followed up on the new LDD enhancement, asking about the long-term potential for further customization, and also inquired about the primary focus areas for the 2025 operating expense investments in the commercial organization.

Answer

CEO Dr. Ron Kurtz compared the new functionality to the evolution of corneal refractive surgery, suggesting it's a first step toward correcting more than just sphere and cylinder. Regarding OpEx, Dr. Kurtz and CFO Shelley Thunen confirmed investments are broad-based, covering clinical training, field support, and education for the wider eye care community, including optometrists, supported by a commercial team that has grown to over 200 people.

Steven Lichtman from Oppenheimer requested an update on the company's optometrist engagement program, seeking insights on learnings and future opportunities. He also asked for observations on how LAL-adopting practices are gaining market share from regional competitors.

Answer

CEO Dr. Ron Kurtz explained that educating the ~50,000 U.S. optometrists is key, as they are primary eye care providers who refer patients for surgery. He noted that optometrists are also integral to post-operative care due to their expertise in refraction. Regarding market share, Dr. Kurtz stated that while cataract surgery is less driven by external advertising than LASIK, positive word-of-mouth from patients with outstanding LAL results leads to self-referrals to practices offering the technology. CFO Shelley Thunen added this creates a 'halo effect' that benefits the sales team targeting non-adopting practices in the same region.

Steven Lichtman asked about the free cash flow outlook for 2026, including puts and takes, and if Alcon is still expecting incremental spend on Orion, given the R&D leverage discussed.

Answer

Tim Stonesifer, CFO, expects free cash flow to be similar to last year, including restructuring charges, driven by margin expansion and business growth. He confirmed that there's still about 40 basis points of incremental spend for Orion, but R&D leverage is being achieved through efficiency programs like 'create to make,' aiming for a 20% improvement in getting products to market faster.

Steven Lichtman asked for the free cash flow outlook for 2026, including puts and takes. He also inquired about incremental spend on the Orion program, R&D leverage, and the program's current status and costs.

Answer

CFO Tim Stonesifer expects free cash flow to be similar to 2025, including restructuring charges, driven by margin expansion and business growth. He noted that R&D leverage is partly due to efficiency programs, with Orion still accounting for approximately 40 bps of R&D spend, and the company feels it's investing appropriately.

Steven Lichtman asked how Alcon plans to position the upcoming Precision7 contact lens relative to TOTAL30 and what type of patient it will target. He also requested more color on the strategic opportunity with the OcuMension partnership in China.

Answer

CEO David Endicott described Precision7 as a unique weekly replacement lens that will be priced between daily and monthly options, appealing to patients and ECPs who like the intuitive replacement schedule. For the OcuMension deal, he reiterated it was a strategic move for efficiency and capability, leveraging a partner's established local expertise in manufacturing and R&D to maximize the eye drops business in China while Alcon focuses on its larger surgical and vision care opportunities.

Steve Lichtman of Oppenheimer & Co. Inc. asked about the impact of salesforce changes at Inari on its expected revenue contribution. He also inquired about the timing and cadence of the $175 million tariff impact in the second half of the year.

Answer

Chair & CEO Kevin Lobo stated that despite some sales rep turnover from implementing non-competes, Stryker is not calling down its full-year revenue expectation for Inari, which remains around $590 million for the 10-month ownership period. VP & CFO Preston Wells confirmed the tariff impact will be back-end loaded, flowing through inventory onto the P&L more significantly in Q3 and Q4.

Steven Lichtman inquired about the future growth drivers for the Spine business, asking if enabling technologies like Mako would be the primary catalyst, and also asked for direction on below-the-line expenses for 2025.

Answer

CEO Kevin Lobo identified enabling technology, specifically the Mako Spine robot and the CoPilot navigation system, as the main engine for growth in the Spine business in the short term. VP of Finance and IR Jason Beach deferred providing guidance on 2025 below-the-line expenses until the January earnings call.

Steven Lichtman of Oppenheimer & Co. Inc. inquired about the drivers of the strong organic growth in the Cardiac Intervention segment, the potential for further margin benefits from tariff mitigation efforts, and the commercial activities like training and education for Rhapsody during the reimbursement delay.

Answer

CEO Fred Lampropoulos credited the Cardiac Intervention growth to internally developed products and increased lab presence, enhanced by the Cook Medical acquisition. CFO Raul Parra noted the tariff situation remains dynamic but is factored into their guidance range. Regarding Rhapsody, Lampropoulos stated they are maintaining a premium price, focusing on the hospital setting where they have NTAP approval, and using the extra time for physician training and market preparation.

Steven Lichtman asked about the underlying drivers of the strong gross margin performance and the expected quarterly cadence of the tariff impact for the remainder of the year.

Answer

EVP and CFO Raul Parra credited the strong gross margin to a combination of sales execution, favorable product mix, pricing, and operational efficiencies from the CGI program. For the tariff cadence, he stated that approximately 17% of the annual impact is expected in Q2, with the remaining 83% hitting in the second half of the year, reflecting inventory turn cycles.

Steven Lichtman of Oppenheimer highlighted the standout Q4 gross margin and asked about the implied gross margin in the 2025 guidance and its key drivers. He also inquired about the specific investments being made to support the Wrapsody launch this year.

Answer

Executive Raul Parra described the Q4 gross margin as a 'home run' where all factors, including product mix, geographic mix, and operational execution, performed exceptionally well. While not providing specific 2025 gross margin guidance, he confirmed it's a key component of the planned operating margin expansion. Executive Fred Lampropoulos detailed that Wrapsody investments include physician training, reimbursement support activities like NTAP and TPT filings, and the ongoing patient registry to build a strong foundation for the product.

Steven Lichtman of Oppenheimer asked about the Cook Medical acquisition, seeking to identify the largest sales synergy opportunities with Merit's legacy CRM franchise. He also inquired about the business environment in China, including the impact of VBP and confidence in procedure volume growth.

Answer

Executive Joseph Wright highlighted that the Cook assets are global, providing opportunities in the U.S., Europe, and APAC. He noted these assets will help drive adoption of existing Merit products like Worley, SNAP, and transseptal catheters by anchoring a more dedicated sales force. Executive Raul Parra commented on China, stating that strong unit demand has more than offset the pricing headwinds from VBP, leading to better-than-expected results in the region.

Steve Lichtman from Oppenheimer & Co. Inc. asked for more detail on the strong international performance in the quarter and the growth catalysts for the business outside of the U.S.

Answer

EVP & CFO Jereme Sylvain attributed the growth to strong new patient additions, driven by expanded coverage for Dexcom OnePlus in markets like France and new coverage wins in Canada for all insulin users. He highlighted future opportunities in gaining deeper penetration in established markets like Japan and Germany and expanding into emerging markets.

Steven Lichtman of Oppenheimer & Co. asked about the specific forms of the awareness campaigns planned for the non-insulin using population, such as direct-to-patient advertising or physician education.

Answer

CEO Kevin Sayer explained the strategy is 'across the board,' involving both more focused direct-to-consumer advertising and a significant educational effort for physicians. A key goal is to inform physicians that their non-insulin patients now have strong coverage and can get a Dexcom with a much better and more affordable experience than in the past.

Steven Lichtman asked how DexCom's messaging for Stelo will evolve as reimbursed coverage for the G-Series expands into the non-insulin Type 2 population.

Answer

CEO Kevin Sayer explained that the product strategies will bifurcate and converge. Features developed in Stelo for Type 2 users will be migrated into the reimbursed G-Series app to serve that covered population. Concurrently, Stelo will add more features tailored to the health, wellness, and pre-diabetes cash-pay markets. Executive Jacob Leach reiterated that Stelo's broad indication was purposeful to serve users beyond diabetes.

Following the positive turn in Japan, Steven Lichtman asked about the biggest international growth drivers Dexcom sees heading into 2025.

Answer

CEO Kevin Sayer identified expanded access as the single biggest driver for 2025. He cited major recent wins, including reimbursement in France for 600,000 people and access to 1 million individuals in Japan. He also pointed to new basal coverage in mature EU markets and growing access for Type 2 intensive insulin users as key opportunities.

Steve Lichtman of Oppenheimer & Co. Inc. asked for a breakdown of growth expectations for FY26 within the MedTech segment, specifically for Mechanical Thrombectomy, Auryon, and NanoKnife. He also inquired about the expected contribution from Auryon outside the U.S. and sought details on the FY26 gross margin guidance, including tariff offsets and the timing of benefits from outsourcing initiatives.

Answer

EVP and CFO Steve Trowbridge projected Auryon growth in the mid-teens, with Mechanical Thrombectomy expected to be the strongest growth driver. He noted NanoKnife will see continued disposable adoption but a potential step back in capital sales. Regarding gross margins, Trowbridge confirmed the guidance includes known tariff impacts and mitigation efforts, and that benefits from the manufacturing transfer plan, which began in FY25, will ramp up in the back half of FY26 with the full impact realized in FY27.

Steven Lichtman of Oppenheimer & Co. inquired about the commercial strategy for the mechanical thrombectomy portfolio, including plans for sales force expansion, and asked for an update on the progress of Auryon's European launch.

Answer

CEO James Clemmer stated that the initial sales force deployment for mechanical thrombectomy was successful and the company plans to expand the combined AlphaVac and AngioVac sales team over the calendar year. Regarding Europe, Clemmer highlighted successful physician training efforts and expects Auryon to begin contributing revenue in Q4 with sequential growth. EVP & CFO Stephen Trowbridge clarified that while the EU is a smaller market than the U.S., the company is pleased with the early traction.

Steven Lichtman of Oppenheimer & Co. Inc. asked for the growth outlook for the combined mechanical thrombectomy portfolio for the remainder of the fiscal year. He also sought a longer-term update on potential indication expansions for Auryon into iliofemoral DVT and coronary applications. Finally, he questioned the full-year gross margin guidance, given the strong performance in the first half.

Answer

CFO Stephen Trowbridge stated that the mechanical thrombectomy portfolio is expected to continue delivering double-digit growth in the second half of the year. Executive James Clemmer addressed Auryon's future, noting that while DVT and coronary applications are promising, the company is still evaluating the resource allocation for these complex pathways. Trowbridge explained the gross margin guidance reflects a balance between the positive mix shift to Med Tech and temporary overhead costs from the ongoing manufacturing transition.

Steven Lichtman questioned the rationale for instituting a free trial program for MiSight if the annual price is not a barrier. He also asked for the geographic scope of the capital purchasing delays in the fertility market.

Answer

President & CEO Albert White clarified that the barrier to MiSight adoption is the initial upfront cost and parental hesitation, not the long-term annual cost. The free trial is designed to overcome this initial hurdle. He noted that capital equipment delays in the fertility business are being seen in Europe, India, and the Americas.

Steven Lichtman from Oppenheimer asked about pricing expectations in the contact lens business amid consumer sentiment shifts and inquired about the expense mix, particularly regarding investments in MiSight.

Answer

CEO Al White stated there has been no change in pricing strategy, with the market seeing 2-3% price increases and Cooper at the mid- to upper-end of that range, without significant consumer pushback. CFO Brian Andrews explained that strong gross margins allow for balanced investments, and while the company is gaining leverage in G&A, OpEx will ebb and flow to support growth initiatives like MiSight.

Steven Lichtman of Oppenheimer & Co. Inc. inquired about the outlook for free cash flow and capital expenditures in fiscal 2025. He also asked for more detail on the impact of foreign exchange (FX) headwinds on the P&L.

Answer

CFO Brian Andrews projected FY25 CapEx to be around 11% of revenue (approx. $450 million) and guided for free cash flow to improve to the $350-$400 million range, driven by revenue growth and operational improvements. Regarding FX, he stated the headwind would be relatively even throughout the year, impacting revenues by about 1.5% and EPS by about 4%, with a notable impact on reported revenues.

Steven Lichtman asked for the long-term underlying growth outlook for PARAGARD, separate from recent stocking dynamics. He also questioned how the company could moderate CapEx when product demand is still outstripping supply.

Answer

CEO Al White characterized the PARAGARD market as having declining unit volumes, with growth coming from price, and noted it is not a major growth driver. CFO Brian Andrews clarified that CapEx will remain significant next year to meet demand, and that his comment on moderation was a longer-term opportunity for efficiency gains, not an immediate plan to reduce spending.

Steven Lichtman requested more detail on the company's direct-to-consumer (DTC) marketing efforts, particularly how deep they are into this strategy and what kind of returns or conversion improvements they have seen.

Answer

President and CEO Ashley McEvoy conveyed strong excitement about the DTC initiatives. She explained that existing advertising is now more efficient as they can directly serve type 2 patients who express interest. She highlighted positive results, including an increase in both the quantity of leads and the rate at which those leads are converted into new customers, confirming that this investment is factored into their financial plan.

Steven Lichtman asked about the deployment of the expanded salesforce and how it will support the commercial expansion into the Type 2 diabetes market.

Answer

CEO John Sheridan explained that a salesforce pilot program for the Type 2 market is now live in a meaningful number of territories. While declining to provide specific deployment details, he stated the company feels confident in its current salesforce size to support both Type 1 and Type 2 populations.

Steven Lichtman of Oppenheimer & Co. Inc. inquired about the progress and next steps for Tandem's pharmacy channel initiative, including any 2025 coverage goals and how the current 20% coverage will impact the business.

Answer

Mark Novara, Executive Vice President and Chief Commercial Officer, stated that Tandem is pleased with its progress, now having patients receiving products through the pharmacy channel. He highlighted that contracts covering roughly 20% of U.S. lives are signed and co-pay assistance is being activated, with a top priority of driving scale and efficiency in this channel for 2025.

Steven Lichtman asked for an update on Tandem's broader pharmacy channel strategy following the announcement of its first pharmacy contract.

Answer

EVP and CFO Leigh Vosseller described the signed contract as a "very important first step" in their multiyear strategy. She stated the immediate focus is on executing the "pull-through" for this contract to position the company for 2025. Further details on potential volume and economic benefits will be shared once sustainable trends can be assessed.

Steven Lichtman asked for an update on the private label component supply issue and Integra Skin supply, seeking confidence that customer demand for both product lines will be retained during the disruption.

Answer

CFO Lea Knight expects the private label component issue to be resolved by H2 2025. CEO Mojdeh Poul expressed high confidence in retaining Integra Skin demand, citing direct surgeon feedback on the product's critical and unique nature for complex wound procedures.

Steven Lichtman inquired about customer stability amid ongoing supply challenges and asked for an updated outlook on 2025, considering the new CEO and the compliance master plan.

Answer

CEO Jan De Witte stated that product holds are typically short-term and that differentiated products and strong sales relationships help retain customers. CFO Lea Knight confirmed the 2025 outlook for mid-single-digit organic growth remains unchanged, as recent quality holds fall within the scope of disruptions already anticipated in their forecast.

Ryan, on behalf of Steven Lichtman, asked about iDose uptake in different settings, questioning if there was a difference in adoption between larger hospital systems and smaller facilities due to inventory costs. He also asked about plans to facilitate inventory carrying for these centers.

Answer

President and COO Joe Gilliam explained that Glaukos mitigates inventory cost concerns for facilities by offering longer-dated payment terms, a standard practice in the pharmaceutical industry. He acknowledged a difference in adoption speed, with nimble ASCs moving faster than larger, more bureaucratic hospital systems. While the launch has been more indexed towards ASCs so far, he expects progress on the hospital side to continue throughout 2025.

Steven Lichtman asked about plans to expand the sales force to support both iStent infinite and iDose, and for an outlook on the timing for establishing iDose professional fees across all MACs.

Answer

President and COO Joseph Gilliam stated that sales force expansion will continue to be organic and commensurate with territory growth. Regarding professional fees, he explained it is a 'volume game' and expects payments to become more predictable and consistent across MACs as 2025 progresses, driven by increased procedure volumes in regions with normalized J-code payment.

Steven Lichtman of Oppenheimer asked what level of end-market growth in China would be necessary in the first half of 2025 to successfully reduce inventory and enable revenue recognition to resume in the third quarter. He also questioned the wide guidance range for G&A expenses, which would seem to be more within the company's control.

Answer

CFO Patrick Williams clarified that the wide G&A range is primarily driven by variable components, such as stock-based compensation and performance-based bonuses, which fluctuate depending on whether high-end or low-end targets are met. On the inventory question, he explained that hitting the low end of the China sales guidance would be the result of a -10% market decline, but a faster market rebound could allow for incremental revenue recognition sooner than Q3, though the primary focus remains on normalizing inventory levels.

Steven Lichtman of Oppenheimer & Co. requested more detail on the expected cadence of sales growth and margin progression throughout 2025, excluding the Paragon 28 acquisition.

Answer

CFO and EVP Suketu Upadhyay provided a detailed outlook for 2025. He projected Q1 to have the lowest ex-FX growth at around 2% due to a selling day headwind, with Q2 being similar after adjusting for days. The second half is expected to be stronger due to easier comps and new product ramps. For margins, the first half will be lower than the prior year due to inventory costs and strategic investments, with Q1 operating margin down approximately 250 bps YoY, followed by a stronger second half.

Steven Lichtman from Oppenheimer & Co. Inc. asked about meaningful product pipeline drivers in the medium term, beyond the well-known near-term launches.

Answer

CEO Ivan Tornos detailed a robust mid-to-long-term pipeline, highlighting the Oxford Partial cementless knee for mid-2025, future ROSA Shoulder enhancements, three new ROSA indications, and a first-to-market launch of coated hip implants expected in late 2025 or early 2026 to address infection.

Steven Lichtman of Oppenheimer inquired about the impact and progress of converting legacy NuVasive distributors to a direct sales model and the strategy for competing in orthopedics with a less comprehensive product portfolio.

Answer

President & CEO Dan Scavilla explained that converting distributors to a direct model allows for better investment and more rapid growth in those markets, a process that is ongoing. He also stated that while the orthopedics portfolio is still being built out with products like a revision knee and hip systems in progress, the company is making inroads and expects 2025 to be a meaningful year of impact as surgeons see the investment and are willing to partner.

Steven Lichtman from Oppenheimer asked if the commercialization strategy would initially focus on one indication (DFU or VLU) over the other, and sought clarification on whether the previously discussed treatment cost advantages apply equally to the VLU indication.

Answer

President & CEO Nissim Mashiach responded that the company plans to focus equally on both DFU and VLU markets upon launch to fully leverage the expected broad label for 'all wounds below the knee.' He confirmed that the cost-benefit assumptions and attractive price proposition apply to both VLU and DFU, highlighting an estimated $6,000 cost for a full course of treatment as highly competitive for closing chronic wounds in either indication.

An analyst representing Steve Lichtman of Oppenheimer inquired which data points from the MOA study were most positively surprising to physicians. They also asked if the accelerated VLU timeline could move up the BLA submission, and requested updates on reimbursement strategy and the timing for building the new manufacturing facility.

Answer

CMO Mike Molyneaux stated that physicians were most excited by CureXcell's potent angiogenic capabilities and its ability to produce robust granulation tissue and collagen, mimicking normal healing. President & CEO Nissim Mashiach confirmed the BLA submission target remains H2 2016. He noted that reimbursement discussions with CMS will begin after the DFU data is available in October, and that construction of the new manufacturing facility is planned to start in 2015 for completion in early 2016.

Steve Lichtman from Oppenheimer and Company questioned if the DFU study could be submitted to the FDA on a rolling basis ahead of the VLU study and asked about the timeline for establishing commercial manufacturing capabilities.

Answer

President and CEO Nissim Mashiach stated that based on prior FDA discussions, both the DFU and VLU studies must be complete to file the BLA. Regarding manufacturing, he noted that the company is scouting locations on the East Coast and expects the facility to be operational in time for the BLA submission in the second half of 2016.