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    DEXCOM (DXCM)

    Q3 2024 Earnings Summary

    Reported on Feb 7, 2025 (After Market Close)
    Pre-Earnings Price$74.85Last close (Oct 24, 2024)
    Post-Earnings Price$73.40Open (Oct 25, 2024)
    Price Change
    $-1.45(-1.94%)
    • Dexcom achieved record new patient additions in the third quarter, excluding Stelo, indicating strong underlying demand for its core insulin products. With 35,000 new prescribers added during the quarter, expanding the prescriber base significantly, the company expects this to drive deeper market penetration.
    • The company is confident in reiterating its long-range plan of $4.6 billion revenue in 2025, with margin targets, driven by new product launches like Stelo and the upcoming 15-day G7 sensor, which is expected to be a significant revenue enhancer. Dexcom believes these products will contribute to revenue growth and improve gross margins due to longer sensor wear periods.
    • Significant international growth opportunities are emerging due to expanded access and reimbursement in key markets, such as France, where reimbursement now provides access to more than 600,000 people , and Japan, with access to over 1 million potential customers. These developments are expected to drive international revenue growth in 2025.
    • Declining U.S. Revenue and Growth Rates: The company reported a 2% decline in U.S. revenue for the third quarter of 2024 compared to the same period in 2023, driven by slower new customer starts and a decline in revenue per customer due to shifting channel dynamics and higher rebate eligibility. This eligibility factor alone negatively impacted U.S. growth by approximately 6 percentage points.
    • Concerns Over Market Slowdown: Analysts noted that the U.S. CGM market growth appears to have slowed to about 10%, down from over 20% in previous periods, raising concerns about a market slowdown. While the company remains optimistic about future growth, attributing current figures to execution issues, the potential for sustained slower growth may impact future performance.
    • Increasing Competition in Core Segments: Questions were raised about how the company plans to defend its position in the type 1 pump-integrated segment amid anticipated increased competition in the coming year. The entry of new sensor options may challenge the company's market share and growth in this critical segment.
    MetricPeriodPrevious GuidanceCurrent GuidanceChange

    Revenue

    FY 2024

    $4.00B to $4.05B (11%-13% organic)

    $4.00B to $4.05B (11%-13% organic)

    no change

    Non-GAAP Gross Margin

    FY 2024

    63%

    63%

    no change

    Non-GAAP Operating Margin

    FY 2024

    20%

    20%

    no change

    Adjusted EBITDA Margin

    FY 2024

    29%

    29%

    no change

    Revenue

    FY 2025

    no prior guidance

    $4.6B

    no prior guidance

    TopicPrevious MentionsCurrent PeriodTrend

    Long-range revenue guidance for 2025

    In Q2 2024, management stated the LRP remains valid but would likely be at the lower end. In Q4 2023, they referenced growth expectations but did not explicitly restate 2025 guidance. No specific guidance mentioned in Q1 2024.

    Dexcom reaffirmed its $4.6B guidance for 2025, citing strong business performance, record new patient starts, and upcoming product launches.

    Consistently reiterated, more positive Q3 stance

    Extended-wear CGM products (15-day G7)

    Q2 2024: Committed to a 2025 launch. Q1 2024: Focused R&D efforts; favorable margin implications. Q4 2023: Ongoing development and testing.

    Submission to FDA with strong confidence in durability and manufacturability; seen as a 2025 growth driver.

    Ongoing focus with increasing optimism

    Stelo launch and type 2 non-insulin market

    Q2 2024: Planned August launch, 1% of revenue contribution in 2024. Q1 2024: Summer 2024 launch timing; targeting 25M T2 non-insulin patients. Q4 2023: Cash-pay launch in summer 2024, significant long-term opportunity.

    Stelo launched in the U.S. with positive early feedback; 70,000 users; viewed as gateway to type 2 non-insulin and prediabetes opportunities.

    Continued expansion and growing commitment

    Record new prescribers in Q3 2024

    No mention of Q3 2024 prescriber records in Q2, Q1, or Q4 2023.

    Added 35,000 new prescribers, boosting prescriber base and aligning with field expansion strategy.

    New topic introduced in Q3 2024

    DME channel market share dynamics

    Q2 2024: Notable share loss in DME, shift to pharmacy channel, $100M revenue impact. Q1 2024: DME base stable but heavier pharmacy tilt. No specific update in Q4 2023.

    Experienced some share loss but stabilized late in Q3; improving relationships with DME partners.

    Continued challenge, showing signs of stabilization

    International market expansion (France, Japan, Germany)

    Q2 2024: Coverage in France for T2 on basal insulin, direct sales in Japan. Q1 2024: Basal coverage progress in France and Germany; direct sales model in Japan. Q4 2023: Minimal Japan contribution due to transition; ongoing growth in Germany.

    France launch with basal coverage; Japan sales team showed renewed growth momentum; broader EU access expansions mentioned.

    Ongoing expansion with incremental milestones

    Sales force expansion and realignment

    Q2 2024: Disruption caused lower-than-expected new starts, especially in DME. Q1 2024: Completed hiring, targeting PCPs. Q4 2023: Planned expansion to support new launches.

    Improved productivity and record new customer starts; U.S. sales force expansion seems to be paying off.

    Recovery from prior disruption, showing progress

    Gross margin and operating margin trends

    Q2 2024: Gross margin 63.5%, operating margin 19.5%. Q1 2024: Gross margin 61.8%, operating margin 15.2%. Q4 2023: Gross margin 64.2%, operating margin 23.5%.

    Non-GAAP gross profit margin at 63% with a non-cash charge excluded; operating margin around 21.3%.

    Stable to slightly improved, on track for targets

    Competition and potential new entrants

    Q2 2024: Similar competition environment as past expansions. Q1 2024: Confident in superior product features, strategic pricing. Q4 2023: Highlighted technology, software, and scale advantages.

    Maintains confidence in market position; competitor CGM shortages not a major factor; sees strong brand loyalty.

    Consistent approach, focusing on product strengths

    Shifts in U.S. revenue growth

    Q2 2024: Grew 19% but below expectations, partly due to sales force issues. Q1 2024: Up 24%, driven by G7 coverage. Q4 2023: Up 27%, fastest growth since 2021.

    U.S. revenue down 2% YoY to $702M; heavily impacted by rebate eligibility and DME share shift.

    Slowed growth in Q3 after strong prior quarters

    1. 2025 Guidance and Long-Range Plan
      Q: Do you still expect to hit your 2025 guidance of $4.6 billion revenues and margin targets?
      A: Yes, we are on track to hit our long-term guidance of $4.6 billion in revenues with the same margin targets we gave. Based on what we're seeing today—record new patients this quarter, stability in the DME channel, increased productivity in the sales force, and international acceleration—we feel good about where we're going. We haven't even really talked about Stelo, which is going to be a real interesting opportunity for us going forward.

    2. U.S. Sales and New Patient Growth
      Q: Did the record new patient starts include Stelo, and how does patient growth compare to revenue growth?
      A: The record new patient adds exclude Stelo; this is for our G-Series insulin products. Our U.S. patient base is growing in the mid-20% range, but revenue growth is affected by factors like rebates and channel shifts. We expect the gap between patient growth and revenue growth to close over time as these factors stabilize.

    3. CGM Market Growth
      Q: Is the CGM market growth slowing, given it appeared to slow to about 10% in Q3?
      A: We believe the market can grow faster than that going forward. Our numbers were lower based on execution issues we needed to improve, but we're still very bullish on the category. Basal coverage is still early on, and there are many people on intensive insulin who still don't use CGM.

    4. 15-Day G7 Sensor Approval and Impact
      Q: What's the status of the 15-day G7 sensor approval and expected financial impact in 2025?
      A: We've submitted it and, while we won't speculate on approval timing, we would love a fast approval. The financial impact will depend on launch timing and how long it takes to roll through the customer base. There's an interesting lever here, and we're really excited about it.

    5. DME Channel Stabilization
      Q: How are you stabilizing your position in the DME channel, and can you regain previous standing?
      A: We've met with leadership, listened to them, and heard what they had to say. We've encouraged our team to be more channel agnostic and send patients to DME when appropriate. While this will take time to build back up, we believe we've taken very good steps to shift in the other direction.

    6. Competition in Type 1 Pump Segment
      Q: How will you defend your position in the type 1 pump-integrated segment with more competition next year?
      A: Every study in these AID systems has been done with the Dexcom sensor, and the results with our partners have been incredibly good. We work closely with them to enhance the experiences of their customers, and the accuracy of Dexcom is tried and true and proven to these patients.

    7. Stelo Launch and Impact
      Q: What are your plans for accelerating the Stelo launch in 2025, and how has it performed so far?
      A: We have scheduled enhancements to the Stelo app and will expand distribution channels. We've had positive feedback, and with over 70,000 users, it's a huge success for us. We'll continue to enhance the experience and create a more delightful experience for users.

    8. 2025 U.S. Recovery and Rebate Impact
      Q: How do you see U.S. recovery in 2025, and will rebate eligibility impact your results?
      A: It assumes a stable market moving into 2025, with stable trends in the DME channel. Stelo has been considered in our modeling, and we feel good about the $4.6 billion number. We have 100% rebates assumed, so you won't necessarily have that headwind.

    9. International Growth Drivers
      Q: What do you see as the biggest drivers internationally in 2025?
      A: We've opened up a tremendous amount of access across the world over the past several months. For example, we just launched Dexcom in France in October, accessing 600,000 more individuals, and in Japan, there's access to 1 million individuals. Access will be a big driver in the markets that we serve.

    10. Rebate Impact on Growth
      Q: What is the rebate impact on growth in Q3, and what's being assumed in the Q4 guide?
      A: The rebate impact was about 6 points of headwind in Q3. It's less than that in Q4; it won't be 6 points. We have ASPs pretty consistent moving from Q3 to Q4 because we do have them at 100% rebate rate.

    11. Stelo as a Gateway Product
      Q: Have you seen any Stelo users transfer to the G7 product, and what are your expectations?
      A: We haven't necessarily seen a lot, but we've heard some anecdotal stories. What we have seen is our reps going into primary care offices with the Stelo message, which leads to positive conversations and G7 prescriptions.

    12. U.S. Commercial Strategy and Leadership Transition
      Q: Given the leadership transition in the U.S., can you talk about your confidence in the commercial strategy getting into 2025?
      A: We'll miss Teri, but we have a lot of good leaders in this organization. I'm not concerned about the leadership of my U.S. team; they are very good and very strong. We will work hard not to disappoint.

    13. New Patient Start Dynamics
      Q: Can you give any qualitative commentary between type 1 and type 2 in your record new starts?
      A: The record new patient starts exclude Stelo. We're continuing to see robust adoption in all categories, with intensive insulin continuing to lead the way across type 1 and type 2. Basal continues to be relatively strong, and we're seeing more uptake as we dive deeper with these physicians.

    14. 15-Day Sensor Survival and Cost
      Q: Will the 15-day sensor have incremental COGS, and will survival to full wear time be similar?
      A: The standard cost doesn't change at all. We expect the durability of the 15-day to be solid, and survivability is going to be very well received by the community.

    15. Competitor CGM Shortages Impact
      Q: Did you benefit from competitor CGM shortages towards the end of the quarter in the U.S.?
      A: We heard about some disruptions, but we didn't see anything necessarily change. What we saw was our sales force getting out there and getting more interest in Dexcom.

    16. Risk of Channel Mix Shift Due to Competition
      Q: Is there risk of persistent channel mix shift from DME to pharmacy with competitors accessing the pharmacy channel?
      A: We've seen a major shift of our volumes to the pharmacy channel, particularly on the commercial side. As others seek reimbursement and distribution in the pharmacy channel, we're well-positioned to serve that. Medicare fee-for-service is reimbursed via Part B, so it won't necessarily shift to pharmacy anytime soon.

    17. Early Insights on Stelo Retention and Reliability
      Q: Any early insights around Stelo reordering retention rate and product reliability?
      A: At least 50% of individuals signed up on the subscription model, and reordering has just begun. We're happy with the ordering rates right now. We've learned that a consumer market has different expectations, and we're working to create a proper experience.

    18. DME Channel Strategies
      Q: What specific strategies are you employing to improve relationships with DMEs?
      A: We've met with leadership, heard their concerns, and are focusing on volume rather than price. We've encouraged our team to be channel agnostic and consider DME when appropriate. We're offering DMEs Stelo as an opportunity to market and sell to their large patient bases.

    19. Attrition Rates
      Q: Have you seen any notable change in attrition?
      A: We haven't seen many changes in attrition by category. Intensive insulin users have traditionally stayed in a band, basal users are close, and non-insulin users tend to be in a band of its own; these continue to remain very similar categorically.

    20. Financial Impact of Stelo in 2025
      Q: How are you considering Stelo's financial impact for 2025?
      A: We've considered multiple ranges and opportunities. We felt good about the $4.6 billion number, which includes all of that. We'll give more clarity as we start to roll out commercial plans.

    Research analysts covering DEXCOM.