2025 Guidance Confidence
Q: Do you view 2025 consensus as reasonable?
A: Management believes the current 2025 consensus is not unreasonable and expects continued growth driven by ongoing footprint expansion, targeted DTC investments, international contributions from France, the launch of Inspire V, and expanded payer indications for BMI and AHI. They plan to provide more color as they finalize their annual operating plan.

Margin Outlook and Expense Leverage
Q: Can margins continue improving as sales grow?
A: Management aims to maintain profitability by leveraging efficiencies across DTC spending, R&D, and sales team performance through increased utilization. R&D expenses reduced to about 13% of Q3 revenue, down from higher teens historically, due to less prelaunch inventory expense. They expect R&D to be in the mid- to high teens going forward but anticipate continued profitability year-over-year.

Inspire V Launch Impact
Q: What is the impact of Inspire V launch on margins and pricing?
A: With Inspire V, they will maintain system-level pricing consistent with current contracts, minimizing burden on renegotiations. Eliminating the pressure sensing lead will reduce COGS, leading to a slight increase in gross margin over time. They are preparing for a full launch in early 2025 after ensuring proper inventory and training.

Impact of GLP-1s on Business
Q: How might GLP-1s affect your business in 2025?
A: Management views GLP-1s as complementary to Inspire therapy. While GLP-1s help patients lose weight, they believe this will increase the pool of suitable candidates for Inspire therapy. They are confident that GLP-1s will be a positive tailwind but await FDA indications and timing.

Q4 Headwinds from Hurricanes and Shortages
Q: How will hurricanes and IV shortages affect Q4?
A: The company anticipates revenue headwinds in Q4 due to hurricanes causing center closures and national saline shortages impacting all procedures. While difficult to quantify, they are monitoring the situation closely and assisting affected staff and regions, expecting some regional impact but working hard to overcome challenges.

Utilization Trends and Capacity
Q: What are the trends in utilization and capacity constraints?
A: Utilization was flat from Q2 to Q3 but up year-over-year. Management aspires to continue growing utilization, which remains a focus. In Q4, they run up against capacity constraints due to high demand, making it challenging to compensate for regional impacts like hurricanes.

International Expansion Plans
Q: What are your international growth prospects?
A: The company expects positive impact from markets like France and the UK. With country-wide reimbursement in France, they plan to open more centers and help patients receive therapy. They anticipate consistent international growth as seen in the past, including progress in Germany, Austria, Switzerland, Belgium, the Netherlands, and Asian markets.

Physician Training and Capacity Expansion
Q: Will Inspire V simplify physician training and expand capacity?
A: Eliminating the sensing lead with Inspire V simplifies the procedure, potentially attracting more ENT surgeons and increasing capacity. Management plans to focus on training additional surgeons at existing sites in 2025 to help meet patient demand.

Coding Strategy for Inspire V
Q: How will you address coding for Inspire V?
A: They are working with payers and MACs to finalize coding strategies, ensuring Medicare and payers are informed. While the Inspire V procedure is shorter, enabling physicians to perform more procedures, they expect reimbursement to be neutral to positive for physicians, emphasizing overall efficiency gains.

Payer Receptivity to PREDICTOR Data
Q: How are payers responding to PREDICTOR data?
A: Payers are receptive to using the PREDICTOR algorithm, which may allow some patients to proceed directly to implant without a drug-induced sleep endoscopy, saving costs without reducing quality of care. This is particularly relevant for patients with BMI less than 32.