Inspire Medical Systems posts $24.4M Q3 loss
The revised 2026 revenue range is $850 million to $860 million, and the new single-lead CPT code is set to take effect January 1, 2028.
Sentiment and the balance of points
Rhea-AI Sentiment reads the wording of the document, how positive or negative its language is on a 1 to 5 scale. The balance of points shown with the takes weighs what the document actually discloses, so the two can disagree, for example when a trial that missed its main goal is described in upbeat language.
Form Type
8-K
Rhea-AI Filing Summary
Inspire Medical Systems, Inc. (INSP) reported third-quarter 2026 revenue of $206.7 million, down 7.9% year over year. It recorded a $24.4 million net loss and diluted loss per share of $(0.84), compared with $9.9 million net earnings and diluted EPS of $0.34 a year earlier; adjusted diluted EPS was $0.14.
Gross margin increased 20 basis points to 86.0%, while operating expenses rose 12.8% to $206.6 million, including $24.1 million in restructuring charges and $7.0 million in legal settlement expense. Operating cash flow was $46.4 million, compared with $68.5 million in the prior-year period. Cash, cash equivalents and investments totaled $453.1 million as of September 30, 2026.
For full-year 2026, the company narrowed revenue guidance to $850 million to $860 million from $835 million to $875 million, and expects adjusted operating margin of 4.5% to 5.5%, diluted EPS of $(0.36) to $(0.10), and adjusted diluted EPS of $1.20 to $1.40. The AMA CPT Editorial Panel approved new Category I CPT codes for single-lead hypoglossal nerve stimulation, including Inspire V, set to take effect January 1, 2028.
0 points · 0 major0 major · 3 points
How this balance works
Rhea-AI gives every point it takes from this document a weight. Minor counts 1, Moderate 3 and Major 9, so one Major point outweighs several Minor ones. The bar adds up the weights on each side, and when neither side holds more than 65% of the total the balance reads Mixed.
It reads the document as published, with the same rules for every company, and it does not look at what the market expected or at how the stock traded, so a point can be objectively good on a day the stock falls.
Rhea-AI Sentiment measures something else, the tone of the wording.
Positive
- None.
Negative
- Moderate pointRevenue declined 7.9% to $206.7 million year over year.
- Moderate pointNet loss was $24.4 million, versus $9.9 million net earnings a year earlier.
- Moderate pointOperating cash flow fell to $46.4 million from $68.5 million.
Filing Explained
Inspire says Project Horizon has created
8-K Event Classification
3 items: 2.02, 7.01, 9.01
3 items
Item 2.02
Results of Operations and Financial Condition
Financial
Disclosure of earnings results, typically an earnings press release or preliminary financials.
Item 7.01
Regulation FD Disclosure
Disclosure
Material non-public information disclosed under Regulation Fair Disclosure, often investor presentations or guidance.
Item 9.01
Financial Statements and Exhibits
Exhibits
Financial statements, pro forma financial information, or exhibit attachments filed with this report.
Key Figures
Third-quarter revenue: $206.7 million
Year-over-year revenue change: Decreased 7.9%
Net loss: $24.4 million
+5 more
8 metrics
Third-quarter revenue
$206.7 million
Quarter ended September 30, 2026
Year-over-year revenue change
Decreased 7.9%
Third quarter 2026 compared with third quarter 2025
Net loss
$24.4 million
Third quarter 2026
Diluted EPS
$(0.84) per share
Third quarter 2026
Adjusted diluted EPS
$0.14 per share
Third quarter 2026
Gross margin
86.0%
Third quarter 2026
Operating cash flow
$46.4 million
Three months ended September 30, 2026
Full-year revenue guidance
$850 million to $860 million
Full-year 2026
Key Terms
Category I CPT codes, Adjusted EBITDA, OPPS, Apnea-Hypopnea Index (AHI)
4 terms
Category I CPT codes regulatory
"new Category I CPT codes for single lead hypoglossal nerve stimulation"
Category I CPT codes are standardized numeric labels used by doctors and hospitals to describe common medical procedures and services for billing and insurance purposes. Think of them like a universal price tag and barcode for a medical service: having a Category I code makes it easier for providers to bill insurers and for payers to decide coverage, which directly affects how reliably and quickly a procedure generates revenue and is adopted across the health system.
Adjusted EBITDA financial
"Reconciliation of GAAP Net (Loss) Earnings to Non-GAAP Adjusted EBITDA"
Adjusted EBITDA is a way companies measure how much money they make from their core operations, like running a business, by removing certain costs or income that aren’t part of regular business activities. It helps investors see how well a company is doing without distractions from unusual expenses or gains, making it easier to compare companies or track performance over time.
OPPS regulatory
"Proposed 2027 OPPS Rule Released"
Short for "opportunities," opps are potential ways a company can grow, save money, or improve outcomes — for example new markets, products, partnerships, or efficiency gains. Investors watch opps because they indicate possible future revenue or profit changes; like spotting new routes on a map, the more and clearer the options, the greater the chance of reaching a better financial destination, though not all opps will succeed.
Apnea-Hypopnea Index (AHI) medical
"referred to as the Apnea-Hypopnea Index (AHI)"
AHI is a medical score that counts how many times a person stops breathing (apneas) or takes very shallow breaths (hypopneas) per hour of sleep, and it is used to classify the severity of sleep-disordered breathing. Investors care because AHI is a common, measurable outcome that drives diagnoses, treatment decisions, device sales and regulatory approvals; think of it as a fuel gauge or scoreboard that shows whether a therapy or product is actually improving a patient’s breathing at night.
Earnings Snapshot
Revenue: $206.7 million · Guidance included
Third quarter 2026
Revenue
$206.7 million
Decreased 7.9% year over year
Gross margin
86.0%
Increased 20 basis points year over year
Net loss
$24.4 million
Compared with $9.9 million net earnings in third quarter 2025
Diluted EPS
$(0.84) per share
Compared with $0.34 per share in third quarter 2025
Adjusted diluted EPS
$0.14 per share
Operating cash flow
$46.4 million
Compared with $68.5 million in the prior-year period
Guidance
Full-year 2026 revenue of $850 million to $860 million; adjusted operating margin of 4.5% to 5.5%; diluted EPS of $(0.36) to $(0.10); adjusted diluted EPS of $1.20 to $1.40.
FAQ
AI-generated questions and answers. How Rhea-AI works. Not financial advice.
What were INSP's third-quarter 2026 results?
INSP reported revenue of $206.7 million, down 7.9% year over year, and a net loss of $24.4 million. Diluted EPS was $(0.84), while adjusted diluted EPS was $0.14.
What is INSP's 2026 revenue guidance?
INSP narrowed full-year 2026 revenue guidance to $850 million to $860 million, from $835 million to $875 million. It expects adjusted operating margin of 4.5% to 5.5%, diluted EPS of $(0.36) to $(0.10), and adjusted diluted EPS of $1.20 to $1.40.
What 2027 reimbursement increases did INSP cite?
The presentation described proposed 2027 CMS reimbursement increases of 12% year over year for OPPS and 15% year over year for ASC, subject to the final rule.
What is Project Horizon expected to fund?
Project Horizon created $30 million of incremental annualized growth investment capacity, primarily focused on patient flow, with expected positive impacts beginning in 2027.
AI-generated analysis. How Rhea-AI works. Not financial advice.
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
_________________________
FORM 8-K
_________________________
CURRENT REPORT
Pursuant to Section 13 or 15(d) of
the Securities Exchange Act of 1934
Date of report (Date of earliest event reported): November 2, 2026
_________________________
(Exact name of registrant as specified in its charter)
_________________________
| (State or other jurisdiction of incorporation) | (Commission File Number) | (I.R.S. Employer Identification No.) | ||||||||||||
(Address of principal executive offices) (Zip Code)
(844 ) 672-4357
(Registrant’s telephone number, including area code)
N/A
(Former name or former address, if changed since last report)
Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:
Securities registered pursuant to Section 12(b) of the Act:
| Title of each class | Trading Symbol(s) | Name of each exchange on which registered | ||||||||||||
Indicate by check mark whether the registrant is an emerging growth company as defined in Rule 405 of the Securities Act of 1933 (§230.405 of this chapter) or Rule 12b-2 of the Securities Exchange Act of 1934 (§240.12b-2 of this chapter).
Emerging growth company ☐
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition
period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐
Item 2.02. Results of Operations and Financial Condition.
On November 2, 2026, Inspire Medical Systems, Inc. (the “Company”) issued a press release announcing its financial results for the quarter ended September 30, 2026. The full text of the press release is furnished as Exhibit 99.1 to this Current Report on Form 8-K and is incorporated herein by reference.
Item 7.01. Regulation FD Disclosure.
In November and December of 2026, the Company will be participating in various meetings with investors and analysts, and a copy of the Company’s presentation materials being used at these meetings is furnished as Exhibit 99.2 hereto and is incorporated herein by reference. These presentation materials are also available on the Investor Relations page of the Company’s website at https://investors.inspiresleep.com.
The information in each of Item 2.02 and Item 7.01 of this Current Report on Form 8-K and in the press release attached as Exhibit 99.1 and the presentation attached as Exhibit 99.2 shall not be deemed “filed” for purposes of Section 18 of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), or otherwise subject to the liabilities of that Section, nor shall it be deemed to be incorporated by reference into any filing of the Company under the Securities Act of 1933, as amended, or the Exchange Act, except as expressly set forth by specific reference in such filing.
Item 9.01. Financial Statements and Exhibits.
(d) Exhibits
| Exhibit No. | Description | |||||||
| 99.1 | Press release of Inspire Medical Systems, Inc., dated November 2, 2026. | |||||||
| 99.2 | Inspire Medical Systems, Inc. Presentation, November 2, 2026. | |||||||
| 104 | Cover Page Interactive Data File - the cover page XBRL tags are embedded within the Inline XBRL document. | |||||||
2
SIGNATURE
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.
| INSPIRE MEDICAL SYSTEMS, INC. | |||||||||||
| Date: | November 2, 2026 | By: | /s/ Matthew J. Osberg | ||||||||
| Matthew J. Osberg | |||||||||||
| Chief Financial Officer | |||||||||||
3
Exhibit 99.1
Inspire Medical Systems, Inc. Announces Third Quarter 2026
Financial Results
•Third quarter revenue of $206.7 million
•Third quarter diluted EPS of $(0.84); adjusted diluted EPS of $0.14
•Third quarter operating cash flow of $46.4 million
•AMA CPT® Editorial Panel approved new Category I CPT codes for single lead hypoglossal nerve stimulation, including Inspire V, set to take effect January 1, 2028
MINNEAPOLIS, MN - November 2, 2026 - Inspire Medical Systems, Inc. (NYSE: INSP) (Inspire, or the Company), a medical technology company focused on the development and commercialization of innovative, minimally invasive solutions for patients with obstructive sleep apnea, today reported financial results for the quarter ended September 30, 2026.
“We are pleased to have delivered sequential growth in the third quarter, with U.S. performance coming in ahead of our expectations. Results suggest that, despite some lingering headwinds, there is greater comfort among implanting physicians with the current coding dynamic. We will stay disciplined in our education initiatives and focused on executing our strategic priorities as we finish out 2026 and plan for a return to growth in 2027,” said Tim Herbert, Chairman and CEO of Inspire Medical Systems.
“Looking further ahead, we were also pleased with the AMA Editorial Panel’s September approval of a new CPT® code for single lead HGNS devices, including the Inspire V system. When this takes effect in January 2028, a dedicated code set will give physicians and hospitals enhanced clarity around coding and reimbursement and, in turn, further enable patient access to Inspire therapy. With that progress, and the investment capacity we’re redirecting into high-impact revenue growth initiatives through Project Horizon, we believe we are positioned well for growth in the years ahead.”
Third Quarter 2026 Financial Results (Third Quarter 2026 compared to Third Quarter 2025)
•Revenue decreased 7.9% to $206.7 million, driven primarily by a decline in U.S. revenue. The U.S. revenue decline was primarily driven by the adverse impacts of coding and reimbursement challenges.
•Gross margin increased 20 bps to 86.0%, primarily due to increased sales mix of the Inspire V system, which has a higher gross margin than the Inspire IV system.
•Operating expenses increased $23.5 million, or 12.8%, to $206.6 million, primarily due to $24.1 million of restructuring charges, legal settlement expense of $7.0 million, and higher legal fees, partially offset by lower marketing expenses and lower stock-based compensation expense.
•Operating loss was $28.7 million, and operating margin was (13.9)%. Adjusted operating income was $1.9 million, and adjusted operating margin was 0.9%.
•The effective tax rate was 2.5% compared to 26.7%. The decrease in the effective tax rate was primarily driven by the current period pre-tax loss and discrete tax charges related to restructuring. For the three months ended September 30, 2025, the Company maintained a full valuation allowance against federal and state deferred tax assets, which was subsequently released at December 31, 2025.
•Net loss was $24.4 million and adjusted net earnings was $4.1 million.
•Diluted EPS was $(0.84) and adjusted diluted EPS was $0.14.
Financial Condition
•Net cash provided by operating activities for the three months ended September 30, 2026 was $46.4 million, compared to $68.5 million in the prior year period. The change was primarily driven by lower net earnings and lower collections on receivables due to the third quarter 2025 cash recovery following temporary issues with the implementation of a new invoice portal and delivery process in the second quarter of 2025.
•As of September 30, 2026, cash, cash equivalents, and investments increased $48.5 million to $453.1 million as compared to December 31, 2025.
Full Year 2026 Guidance
The Company is narrowing its previously announced revenue outlook to be in the range of $850 million to $860 million, compared to the previous range of $835 million to $875 million. Additionally, the Company now expects adjusted operating margin to be in the range of 4.5% to 5.5%, diluted EPS to be in the range of $(0.36) to $(0.10) and adjusted diluted EPS to be in the range of $1.20 to $1.40.
The Company’s outlook assumes an effective tax rate of approximately 120% to 175% and an adjusted effective tax rate of 33% to 34%, estimated weighted average diluted shares outstanding of approximately 28.9 million, and capital expenditures between $35 million to $40 million.
Webcast and Conference Call
The Company's management will host a conference call after market close today, Monday, November 2, 2026, at 5:00 p.m. Eastern Time to discuss these results and answer questions.
To access the conference call, please preregister on
https://register-conf.media-server.com/register/BI4b0290b4bb464cecaa0a2b420ca13a02.
Registrants will receive confirmation with dial-in details.
A live webcast of the event can be accessed on https://edge.media-server.com/mmc/p/d84s2zzb/. A replay of the webcast will be available on https://investors.inspiresleep.com starting approximately two hours after the event and archived on the site for two weeks.
About Inspire Medical Systems
Inspire Medical Systems is a medical technology company focused on the development and commercialization of innovative, minimally invasive solutions for patients with obstructive sleep apnea. Inspire’s proprietary Inspire therapy is the first FDA, EU MDR, and PDMA-approved neurostimulation technology that provides a safe and effective treatment for moderate to severe obstructive sleep apnea.
For additional information about Inspire, please visit www.inspiresleep.com.
Use of Non-GAAP Financial Measures
This press release includes non-GAAP financial measures, including without limitation, adjusted operating income, adjusted operating margin, adjusted earnings before income taxes, adjusted income tax expense, adjusted effective tax rate, adjusted net earnings, adjusted net earnings per diluted share ("EPS"), adjusted EBITDA, and adjusted EBITDA margin, which differ from financial measures calculated in accordance with U.S. generally accepted accounting principles (“GAAP”).
We define adjusted operating income as operating income or loss adjusted for items that are not indicative of our ongoing operations. Operating income is the most directly comparable GAAP financial measure to adjusted operating income. We define adjusted operating margin in this release as adjusted operating income divided by revenue. Operating margin is the most directly comparable GAAP financial measure to adjusted operating margin. Adjusted earnings before income taxes is defined as earnings before income taxes, adjusted for items that are not
indicative of our ongoing operations. Earnings before income taxes is the most directly comparable GAAP financial measure. Adjusted income tax expense is defined as income tax expense, adjusted for items that are not indicative of our ongoing operations. Adjusted effective tax rate is adjusted income tax expense divided by adjusted earnings before income taxes. Income tax expense is the most directly comparable GAAP financial measure. Adjusted net earnings is defined as net earnings or loss, adjusted for items that are not indicative of our ongoing operations. Net earnings or loss is the most directly comparable GAAP financial measure to adjusted net earnings. Adjusted net earnings per diluted share is calculated as adjusted net earnings divided by the diluted weighted average shares outstanding. Net earnings or loss per diluted share is the most directly comparable GAAP financial measure to adjusted net earnings per diluted share. We define adjusted EBITDA as net earnings or loss, less interest and dividend income, net, plus income tax expense, plus depreciation and amortization, plus stock-based compensation expense, adjusted for items that are not indicative of our ongoing operations. Net earnings or loss is the most directly comparable GAAP financial measure to adjusted EBITDA. We define adjusted EBITDA margin in this release as adjusted EBITDA divided by revenue. Net earnings or loss margin is the most directly comparable GAAP measure to adjusted EBITDA margin. Reconciliations of these non-GAAP financial measures to their most directly comparable GAAP measures are included in this press release.
These non-GAAP financial measures are presented because we believe they are useful indicators of our operating performance and facilitate a more meaningful trend analysis without the distortion of various adjustment items. Management uses these measures principally as measures of our underlying operating performance, trends, and for planning purposes, including the preparation of our annual operating plan and financial projections. We believe these measures are useful to investors as supplemental information and because they are frequently used by analysts, investors, and other interested parties to evaluate companies in our industry. We also believe these non-GAAP financial measures are useful to our management and investors as a measure of comparative operating performance from period to period.
These non-GAAP financial measures should not be considered as an alternative to, or superior to, the most directly comparable GAAP financial measures, as measures of financial performance or cash flows from operations, as a measure of liquidity, or any other performance measure derived in accordance with GAAP, and they should not be construed to imply that our future results will be unaffected by unusual or non-recurring items. In addition, Adjusted EBITDA is not intended to be a measure of cash flow for management’s discretionary use, as it does not reflect certain cash requirements such as tax payments, capital expenditures, and certain other cash costs that may recur in the future. Adjusted EBITDA contains certain other limitations, including the failure to reflect our cash expenditures, cash requirements for working capital needs, and cash costs to replace assets being depreciated and amortized. In evaluating our non-GAAP financial measures, you should be aware that in the future we may incur expenses that are the same as or similar to some of the adjustments in this presentation. Our presentation of non-GAAP financial measures should not be construed to imply that our future results will be unaffected by any such adjustments. Management compensates for these limitations by primarily relying on our GAAP results in addition to using non-GAAP financial measures on a supplemental basis. These measures and their definitions are discussed in more detail below and our definition of these non-GAAP financial measures is not necessarily comparable to other similarly titled captions of other companies due to different methods of calculation.
Forward Looking Statements
This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. All statements other than statements of historical facts are forward-looking statements, including, without limitation, statements regarding estimated financial and non-financial impacts from our strategic growth plan (including without limitation , the extent and manner of the use of investments in revenue growth initiatives as well as the time to complete the strategic growth plan) and potential impacts to our business (including potential actions and solutions, such as the new Category I CPT code for Inspire V set to take effect January 1, 2028 and final 2027 Medicare reimbursement payments, as well as timing of these impacts and any related clarity) associated with coding and reimbursement, and our expectations regarding our future growth prospects and full year 2026 financial outlook (including without limitation expectations for the impacts of coding and reimbursement, revenue, expected growth, adjusted operating margin, net earnings or loss per diluted share, adjusted net earnings per diluted share, effective tax rate, adjusted effective tax rate, weighted average diluted shares outstanding and capital expenditures). In some cases, you can identify forward-looking statements by terms such as ‘‘may,’’ ‘‘will,’’ ‘‘should,’’ ‘‘expect,’’ ‘‘plan,’’ ‘‘anticipate,’’ ‘‘could,’’ “future,” “outlook,” “guidance,” ‘‘intend,’’ ‘‘target,’’ ‘‘project,’’ ‘‘contemplate,’’ ‘‘believe,’’ ‘‘estimate,’’ ‘‘predict,’’ ‘‘potential,’’ ‘‘continue,’’ or the negative of these terms or other similar expressions, although not all forward-looking statements contain these words.
These forward-looking statements are based on management’s current expectations and involve known and unknown risks and uncertainties that may cause our actual results, performance, or achievements to be materially different from any future results, performance, or achievements expressed or implied by the forward-looking statements. Such risks and uncertainties include, among others: our dependency on our Inspire system for revenues; fluctuations in our financial results and the market price of our common stock; our ability to sustain or increase our profitability and our history of operating losses; commercial success and market acceptance of our Inspire therapy; our ability to achieve and maintain adequate and clear levels of coverage or reimbursement for our Inspire system or any future products we may seek to commercialize; competitive companies, technologies, and pharmaceuticals in our industry; our ability to expand our indications and develop and commercialize additional products and enhancements to our Inspire system; our ability to forecast demand and manage our inventory; our dependence on third-parties; risks related to consolidation in the healthcare industry; our ability to expand, manage, and maintain our direct sales and marketing organization, and to market and sell our Inspire system in markets outside of the United States; our ability to manage our growth; risks related to product liability claims and warranty claims; our ability to address quality issues that may arise with our Inspire system; any failure of key information technology systems, processes, or sites or damage to or inability to access our physical facilities; any violations of anti-bribery, anti-corruption, and anti-money laundering laws; future needs for additional financing; risks related to our tax assets and changes in tax laws; our ability to timely commercialize or obtain regulatory approvals or certifications for our Inspire therapy and system; U.S. Food and Drug Administration (FDA) or other United States or foreign regulatory actions affecting us or the healthcare industry generally; our ability to establish and maintain intellectual property protection for our Inspire therapy and system or avoid claims of infringement; and our strategic growth plan may not achieve our intended outcome.
Other important factors that could cause actual results, performance or achievements to differ materially from those contemplated in this press release can be found under the captions “Risk Factors” and "Management's Discussion and Analysis of Financial Condition and Results of Operations“ in our Annual Report on Form 10-K for the fiscal year ended December 31, 2025, our Quarterly Report on Form 10-Q for the quarter ended June 30, 2026, and as such factors may be updated from time to time in our other filings with the SEC, which are accessible on the SEC’s website at www.sec.gov and the Investors page of our website at www.inspiresleep.com. These and other important factors could cause actual results to differ materially from those indicated by the forward-looking statements made in this press release. Any such forward-looking statements represent management’s estimates as of the date of this press release. While we may elect to update such forward-looking statements at some point in the future, unless required by applicable law, we disclaim any obligation to do so, even if subsequent events cause our views to change. Thus, one should not assume that our silence over time means that actual events are bearing out as expressed or implied in such forward-looking statements. These forward-looking statements should not be relied upon as representing our views as of any date after the date of this press release.
Investor and Media Contact
Brian Johnston or Louisa Smith
Gilmartin Group
IR@inspiresleep.com
Inspire Medical Systems, Inc.
Consolidated Statements of Operations (unaudited)
(in thousands, except share and per share amounts)
| Three Months Ended | Nine Months Ended | |||||||||||||||||||||||||
| September 30, | September 30, | |||||||||||||||||||||||||
| 2026 | 2025 | 2026 | 2025 | |||||||||||||||||||||||
| Revenue | $ | 206,695 | $ | 224,501 | $ | 611,859 | $ | 642,904 | ||||||||||||||||||
| Cost of goods sold | 28,837 | 31,773 | 85,630 | 97,154 | ||||||||||||||||||||||
| Gross profit | 177,858 | 192,728 | 526,229 | 545,750 | ||||||||||||||||||||||
| Operating expenses: | ||||||||||||||||||||||||||
| Research and development | 22,176 | 24,211 | 72,700 | 78,223 | ||||||||||||||||||||||
| Selling, general and administrative | 184,398 | 158,873 | 483,877 | 462,684 | ||||||||||||||||||||||
| Total operating expenses | 206,574 | 183,084 | 556,577 | 540,907 | ||||||||||||||||||||||
| Operating (loss) income | (28,716) | 9,644 | (30,348) | 4,843 | ||||||||||||||||||||||
| Interest and dividend (income), net | (3,897) | (3,973) | (11,377) | (13,521) | ||||||||||||||||||||||
| Other expense, net | 191 | 66 | 527 | 2,986 | ||||||||||||||||||||||
| (Loss) earnings before income taxes | (25,010) | 13,551 | (19,498) | 15,378 | ||||||||||||||||||||||
| Income tax (benefit) expense | (616) | 3,619 | 15,876 | 6,046 | ||||||||||||||||||||||
| Net (loss) earnings | $ | (24,394) | $ | 9,932 | $ | (35,374) | $ | 9,332 | ||||||||||||||||||
| Basic (loss) earnings per share | $ | (0.84) | $ | 0.34 | $ | (1.23) | $ | 0.32 | ||||||||||||||||||
| Diluted (loss) earnings per share | $ | (0.84) | $ | 0.34 | $ | (1.23) | $ | 0.31 | ||||||||||||||||||
| Weighted average shares outstanding: | ||||||||||||||||||||||||||
| Basic | 28,929,352 | 29,332,376 | 28,822,985 | 29,512,495 | ||||||||||||||||||||||
| Diluted | 28,929,352 | 29,600,223 | 28,822,985 | 29,938,246 | ||||||||||||||||||||||
Inspire Medical Systems, Inc.
Consolidated Balance Sheets (unaudited)
(in thousands, except share and per share amounts)
| September 30, 2026 | December 31, 2025 | |||||||||||||
| Assets | ||||||||||||||
| Current assets: | ||||||||||||||
| Cash and cash equivalents | $ | 190,803 | $ | 104,813 | ||||||||||
| Investments, short-term | 137,168 | 203,455 | ||||||||||||
| Accounts receivable, net of allowance for credit losses of $787 and $1,080, respectively | 104,706 | 119,692 | ||||||||||||
| Inventories, net | 178,960 | 145,293 | ||||||||||||
| Prepaid expenses and other current assets | 15,988 | 10,399 | ||||||||||||
| Total current assets | 627,625 | 583,652 | ||||||||||||
| Investments, long-term | 125,125 | 96,330 | ||||||||||||
| Property and equipment, net | 85,635 | 97,872 | ||||||||||||
| Operating lease right-of-use assets | 22,125 | 23,532 | ||||||||||||
| Deferred tax assets | 74,196 | 88,667 | ||||||||||||
| Other non-current assets | 18,327 | 17,264 | ||||||||||||
| Total assets | $ | 953,033 | $ | 907,317 | ||||||||||
| Liabilities and stockholders' equity | ||||||||||||||
| Current liabilities: | ||||||||||||||
| Accounts payable | $ | 38,073 | $ | 36,565 | ||||||||||
| Accrued expenses | 59,265 | 59,490 | ||||||||||||
| Total current liabilities | 97,338 | 96,055 | ||||||||||||
| Operating lease liabilities, non-current portion | 28,611 | 29,998 | ||||||||||||
| Other non-current liabilities | 135 | 104 | ||||||||||||
| Total liabilities | 126,084 | 126,157 | ||||||||||||
| Stockholders' equity: | ||||||||||||||
| Preferred Stock, $0.001 par value; 10,000,000 shares authorized; no shares issued and outstanding | — | — | ||||||||||||
| Common Stock, $0.001 par value; 200,000,000 shares authorized; 28,941,555 and 28,579,015 issued and outstanding at September 30, 2026 and December 31, 2025, respectively | 29 | 29 | ||||||||||||
| Additional paid-in capital | 1,010,235 | 927,159 | ||||||||||||
| Accumulated other comprehensive (loss) income | (1,449) | 464 | ||||||||||||
| Accumulated deficit | (181,866) | (146,492) | ||||||||||||
| Total stockholders' equity | 826,949 | 781,160 | ||||||||||||
| Total liabilities and stockholders' equity | $ | 953,033 | $ | 907,317 | ||||||||||
Inspire Medical Systems, Inc.
GAAP to Non-GAAP Reconciliations (unaudited)
(in thousands, except per share amounts)
| Three Months Ended September 30, 2026 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Gross Profit | Operating Expenses | Operating (Loss) Income | Operating Margin | Other (Income) | (Loss) Earnings Before Income Taxes | Income Tax (Benefit) Expense | Effective Tax Rate | Net (Loss) Earnings | Diluted EPS | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Reported | $ | 177,858 | $ | 206,574 | $ | (28,716) | (13.9) | % | $ | (3,706) | $ | (25,010) | $ | (616) | 2.5 | % | $ | (24,394) | $ | (0.84) | ||||||||||||||||||||||||||||||||||||||||||
| Non-GAAP adjustments: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Legal fees1 | — | (3,567) | 3,567 | 1.7 | % | — | 3,567 | 935 | 2,632 | 0.09 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Legal settlement2 | — | (7,000) | 7,000 | 3.4 | % | — | 7,000 | 2,361 | 4,639 | 0.15 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Restructuring charges3 | — | (24,138) | 24,138 | 11.7 | % | — | 24,138 | 1,851 | 22,287 | 0.77 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Share forfeitures4 | — | 4,128 | (4,128) | (2.0) | % | — | (4,128) | (1,392) | (2,736) | (0.09) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Tax impact of stock-based compensation5 | — | — | — | — | % | — | — | (1,636) | 1,636 | 0.06 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Adjusted | $ | 177,858 | $ | 175,997 | $ | 1,861 | 0.9 | % | $ | (3,706) | $ | 5,567 | $ | 1,503 | 27.0 | % | $ | 4,064 | $ | 0.14 | ||||||||||||||||||||||||||||||||||||||||||
| Three Months Ended September 30, 2025 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Gross Profit | Operating Expenses | Operating Income | Operating Margin | Other (Income) | Earnings Before Income Taxes | Income Tax Expense | Effective Tax Rate | Net Earnings | Diluted EPS | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Reported | $ | 192,728 | $ | 183,084 | $ | 9,644 | 4.3 | % | $ | (3,907) | $ | 13,551 | $ | 3,619 | 26.7 | % | $ | 9,932 | $ | 0.34 | ||||||||||||||||||||||||||||||||||||||||||
| Non-GAAP adjustments: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Legal fees1 | — | (1,289) | 1,289 | 0.6 | % | — | 1,289 | 320 | 969 | 0.03 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Adjusted | $ | 192,728 | $ | 181,795 | $ | 10,933 | 4.9 | % | $ | (3,907) | $ | 14,840 | $ | 3,939 | 26.5 | % | $ | 10,901 | $ | 0.37 | ||||||||||||||||||||||||||||||||||||||||||
1 These costs represent legal-related expenses related to (a) a civil investigative demand from the Department of Justice, (b) a patent infringement suit that we filed against Nyxoah S.A. and its wholly-owned subsidiary, Nyxoah, Inc. ("Nyxoah"), and (c) a patent infringement suit brought against us by Nyxoah.
2 Legal settlement expense associated with the proposed settlement of a pixel-tracking class action.
3 Restructuring charges related to Project Horizon.
4 Stock-based compensation expense benefit due to share forfeitures related to actions of Project Horizon.
5 The accounting standards codification guidance governing employee stock-based compensation requires that any excess or deficient tax deduction for stock-based compensation be immediately recorded within income tax expense. Employee stock-based compensation activity, including the exercise of stock options, can be unpredictable and can significantly impact our net earnings, net earnings per diluted share, and effective tax rate. These amounts represent the discrete tax expense recorded as excess tax expense for stock-based compensation.
Inspire Medical Systems, Inc.
GAAP to Non-GAAP Reconciliations (unaudited)
(in thousands, except per share amounts)
| Nine Months Ended September 30, 2026 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Gross Profit | Operating Expenses | Operating (Loss) Income | Operating Margin | Other (Income) | (Loss) Earnings Before Income Taxes | Income Tax Expense | Effective Tax Rate | Net (Loss) Earnings | Diluted EPS | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Reported | $ | 526,229 | $ | 556,577 | $ | (30,348) | (5.0) | % | $ | (10,850) | $ | (19,498) | $ | 15,876 | (81.4) | % | $ | (35,374) | $ | (1.23) | ||||||||||||||||||||||||||||||||||||||||||
| Non-GAAP adjustments: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Legal fees1 | — | (8,700) | 8,700 | 1.5 | % | — | 8,700 | 2,611 | 6,089 | 0.21 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Legal settlement2 | — | (7,000) | 7,000 | 1.1 | % | — | 7,000 | 2,361 | 4,639 | 0.16 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Restructuring charges3 | — | (24,138) | 24,138 | 4.0 | % | — | 24,138 | 1,851 | 22,287 | 0.77 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Share forfeitures4 | — | 4,128 | (4,128) | (0.7) | % | — | (4,128) | (1,392) | (2,736) | (0.09) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Tax impact of stock-based compensation5 | — | — | — | — | % | — | — | (16,011) | 16,011 | 0.56 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Adjusted | $ | 526,229 | $ | 520,867 | $ | 5,362 | 0.9 | % | $ | (10,850) | $ | 16,212 | $ | 5,296 | 32.7 | % | $ | 10,916 | $ | 0.38 | ||||||||||||||||||||||||||||||||||||||||||
| Nine Months Ended September 30, 2025 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Gross Profit | Operating Expenses | Operating Income | Operating Margin | Other (Income) | Earnings Before Income Taxes | Income Tax Expense | Effective Tax Rate | Net Earnings | Diluted EPS | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Reported | $ | 545,750 | $ | 540,907 | $ | 4,843 | 0.8 | % | $ | (10,535) | $ | 15,378 | $ | 6,046 | 39.3 | % | $ | 9,332 | $ | 0.31 | ||||||||||||||||||||||||||||||||||||||||||
| Non-GAAP adjustments: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Stock-based compensation expense6 | — | (11,155) | 11,155 | 1.7 | % | — | 11,155 | 2,770 | 8,385 | 0.27 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Legal fees1 | — | (3,025) | 3,025 | 0.5 | % | — | 3,025 | 751 | 2,274 | 0.08 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Asset impairment charge7 | — | — | — | — | % | (4,046) | 4,046 | — | 4,046 | 0.14 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Adjusted | $ | 545,750 | $ | 526,727 | $ | 19,023 | 3.0 | % | $ | (14,581) | $ | 33,604 | $ | 9,567 | 28.5 | % | $ | 24,037 | $ | 0.80 | ||||||||||||||||||||||||||||||||||||||||||
1 These costs represent legal-related expenses related to (a) a civil investigative demand from the Department of Justice, (b) a patent infringement suit that we filed against Nyxoah S.A. and its wholly-owned subsidiary, Nyxoah, Inc. ("Nyxoah"), and (c) a patent infringement suit brought against us by Nyxoah.
2 Legal settlement expense associated with the proposed settlement of a pixel-tracking class action.
3 Restructuring charges related to Project Horizon.
4 Stock-based compensation expense benefit due to share forfeitures related to actions of Project Horizon.
5 The accounting standards codification guidance governing employee stock-based compensation requires that any excess or deficient tax deduction for stock-based compensation be immediately recorded within income tax expense. Employee stock-based compensation activity, including the exercise of stock options, can be
unpredictable and can significantly impact our net earnings, net earnings per diluted share, and effective tax rate. These amounts represent the discrete tax expense recorded as excess tax expense for stock-based compensation.
6 Represents accelerated stock-based compensation expense for certain employees who were retirement eligible in accordance with the implementation of changes to the treatment of equity awards under the Inspire Medical Systems, Inc. 2018 Incentive Award Plan upon the holder's death, disability, or retirement.
7 Represents a non-cash impairment of a strategic investment.
Reconciliation of GAAP Net (Loss) Earnings to Non-GAAP Adjusted EBITDA
| Three Months Ended | Nine Months Ended | |||||||||||||||||||||||||
| September 30, | September 30, | |||||||||||||||||||||||||
| 2026 | 2025 | 2026 | 2025 | |||||||||||||||||||||||
| Net (loss) earnings | $ | (24,394) | $ | 9,932 | $ | (35,374) | $ | 9,332 | ||||||||||||||||||
| Interest and dividend income, net | (3,897) | (3,973) | (11,377) | (13,521) | ||||||||||||||||||||||
| Income tax expense | (616) | 3,619 | 15,876 | 6,046 | ||||||||||||||||||||||
| Depreciation and amortization | 5,140 | 3,677 | 14,847 | 10,135 | ||||||||||||||||||||||
| EBITDA | (23,767) | 13,255 | (16,028) | 11,992 | ||||||||||||||||||||||
Stock-based compensation expense1 | 26,917 | 29,468 | 88,832 | 102,247 | ||||||||||||||||||||||
Legal fees2 | 3,567 | 1,289 | 8,700 | 3,025 | ||||||||||||||||||||||
Legal settlement3 | 7,000 | — | 7,000 | — | ||||||||||||||||||||||
Restructuring charges4 | 24,138 | — | 24,138 | — | ||||||||||||||||||||||
Asset impairment charge5 | — | — | — | 4,046 | ||||||||||||||||||||||
| Adjusted EBITDA | $ | 37,855 | $ | 44,012 | $ | 112,642 | $ | 121,310 | ||||||||||||||||||
1 Total stock-based compensation expense.
2 These costs represent legal-related expenses related to (a) a civil investigative demand from the Department of Justice, (b) a patent infringement suit that we filed against Nyxoah S.A. and its wholly-owned subsidiary, Nyxoah, Inc. ("Nyxoah"), and (c) a patent infringement suit brought against us by Nyxoah.
3 Legal settlement expense associated with the proposed settlement of a pixel-tracking class action.
4 Restructuring charges related to Project Horizon.
5 Represents a non-cash impairment of a strategic investment.
Reconciliation of GAAP Net (Loss) Earnings Margin and Non-GAAP Adjusted EBITDA Margin
| Three Months Ended | Nine Months Ended | |||||||||||||||||||||||||
| September 30, | September 30, | |||||||||||||||||||||||||
| 2026 | 2025 | 2026 | 2025 | |||||||||||||||||||||||
Net (loss) earnings margin1 | (11.8) | % | 4.5 | % | (5.8) | % | 1.5 | % | ||||||||||||||||||
| Interest and dividend income, net | (1.9) | % | (1.8) | % | (1.9) | % | (2.1) | % | ||||||||||||||||||
| Income tax expense | (0.3) | % | 1.6 | % | 2.6 | % | 0.9 | % | ||||||||||||||||||
| Depreciation and amortization | 2.5 | % | 1.6 | % | 2.4 | % | 1.6 | % | ||||||||||||||||||
Stock-based compensation expense2 | 13.0 | % | 13.1 | % | 14.7 | % | 15.9 | % | ||||||||||||||||||
Legal fees3 | 1.7 | % | 0.6 | % | 1.4 | % | 0.5 | % | ||||||||||||||||||
Legal settlement4 | 3.4 | % | — | % | 1.1 | % | — | % | ||||||||||||||||||
Restructuring charges5 | 11.7 | % | — | % | 3.9 | % | — | % | ||||||||||||||||||
Asset impairment charge6 | — | % | — | % | — | % | 0.6 | % | ||||||||||||||||||
Adjusted EBITDA margin7 | 18.3 | % | 19.6 | % | 18.4 | % | 18.9 | % | ||||||||||||||||||
1 Net (loss) earnings margin is calculated as net (loss) earnings divided by total revenue.
2 Total stock-based compensation expense.
3 These costs represent legal-related expenses related to (a) a civil investigative demand from the Department of Justice, (b) a patent infringement suit that we filed against Nyxoah S.A. and its wholly-owned subsidiary, Nyxoah, Inc. ("Nyxoah"), and (c) a patent infringement suit brought against us by Nyxoah.
4 Legal settlement expense associated with the proposed settlement of a pixel-tracking class action.
5 Restructuring charges related to Project Horizon.
6 Represents a non-cash impairment of a strategic investment.
7 Adjusted EBITDA margin is calculated as Adjusted EBITDA divided by total revenue.
Full Year 2026 Outlook
Reconciliation of Full Year 2026 Outlook of Estimated Net (Loss) Earnings per Diluted Share
to Adjusted Net Earnings per Diluted Share
| Outlook Full Year 2026 | Tax Rate Outlook Full Year 2026 | |||||||||||||||||||||||||
| Low Range | High Range | Low Range | High Range | |||||||||||||||||||||||
| Net (loss) per diluted share | $(0.36) | $(0.10) | 175.0% | 120.0% | ||||||||||||||||||||||
Legal fees1 | 0.31 | 0.29 | ||||||||||||||||||||||||
Legal settlement2 | 0.18 | 0.18 | ||||||||||||||||||||||||
Restructuring charges3 | 0.64 | 0.64 | ||||||||||||||||||||||||
Share forfeitures4 | (0.16) | (0.16) | ||||||||||||||||||||||||
Tax impact of stock-based compensation5 | 0.59 | 0.55 | ||||||||||||||||||||||||
| Adjusted net earnings per diluted share | $1.20 | $1.40 | 34.0% | 33.0% | ||||||||||||||||||||||
1 These costs represent legal-related expenses related to (a) a civil investigative demand from the Department of Justice, (b) a patent infringement suit that we filed against Nyxoah S.A. and its wholly-owned subsidiary, Nyxoah, Inc. ("Nyxoah"), and (c) a patent infringement suit brought against us by Nyxoah.
2 Legal settlement expense associated with the proposed settlement of a pixel-tracking class action.
3 Restructuring charges related to Project Horizon.
4 Stock-based compensation expense benefit due to share forfeitures related to actions of Project Horizon.
5 The accounting standards codification guidance governing employee stock-based compensation requires that any excess or deficient tax deduction for stock-based compensation be immediately recorded within income tax expense. Employee stock-based compensation activity, including the exercise of stock options, can be unpredictable and can significantly impact our net earnings, net earnings per diluted share, and effective tax rate. These amounts represent the discrete tax expense recorded as excess tax expense for stock-based compensation.
Inspire Medical Systems, Inc. November 2026 NYSE: INSP
© Inspire Medical Systems, Inc. All Rights Reserved. Disclaimer This presentation contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. All statements other than statements of historical facts are forward- looking statements, including, without limitation, statements regarding estimated financial and non-financial impacts from our strategic growth plan (including without limitation , the extent and manner of the use of investments in revenue growth initiatives as well as the time to complete the strategic growth plan) and potential impacts to our business (including potential actions and solutions, such as the new Category I CPT code for Inspire V set to take effect January 1, 2028 and final 2027 Medicare reimbursement payments, as well as timing of these impacts and any related clarity) associated with coding and reimbursement, and our expectations regarding our future growth prospects and full year 2026 financial outlook (including without limitation expectations for the impacts of coding and reimbursement, revenue, expected growth, adjusted operating margin, net earnings or loss per diluted share, adjusted net earnings per diluted share, effective tax rate, adjusted effective tax rate, weighted average diluted shares outstanding and capital expenditures). In some cases, you can identify forward-looking statements by terms such as ‘‘may,’’ ‘‘will,’’ ‘‘should,’’ ‘‘expect,’’ ‘‘plan,’’ ‘‘anticipate,’’ ‘‘could,’’ “future,” “outlook,” “guidance,” ‘‘intend,’’ ‘‘target,’’ ‘‘project,’’ ‘‘contemplate,’’ ‘‘believe,’’ ‘‘estimate,’’ ‘‘predict,’’ ‘‘potential,’’ ‘‘continue,’’ or the negative of these terms or other similar expressions, although not all forward-looking statements contain these words. These forward-looking statements are based on management’s current expectations and involve known and unknown risks and uncertainties that may cause our actual results, performance, or achievements to be materially different from any future results, performance, or achievements expressed or implied by the forward-looking statements. Such risks and uncertainties include, among others: our dependency on our Inspire system for revenues; fluctuations in our financial results and the market price of our common stock; our ability to sustain or increase our profitability and our history of operating losses; commercial success and market acceptance of our Inspire therapy; our ability to achieve and maintain adequate and clear levels of coverage or reimbursement for our Inspire system or any future products we may seek to commercialize; competitive companies, technologies, and pharmaceuticals in our industry; our ability to expand our indications and develop and commercialize additional products and enhancements to our Inspire system; our ability to forecast demand and manage our inventory; our dependence on third-parties; risks related to consolidation in the healthcare industry; our ability to expand, manage, and maintain our direct sales and marketing organization, and to market and sell our Inspire system in markets outside of the United States; our ability to manage our growth; risks related to product liability claims and warranty claims; our ability to address quality issues that may arise with our Inspire system; any failure of key information technology systems, processes, or sites or damage to or inability to access our physical facilities; any violations of anti-bribery, anti-corruption, and anti-money laundering laws; future needs for additional financing; risks related to our tax assets and changes in tax laws; our ability to timely commercialize or obtain regulatory approvals or certifications for our Inspire therapy and system; U.S. Food and Drug Administration (FDA) or other United States or foreign regulatory actions affecting us or the healthcare industry generally; our ability to establish and maintain intellectual property protection for our Inspire therapy and system or avoid claims of infringement; and our strategic growth plan may not achieve our intended outcome. Other important factors that could cause actual results, performance or achievements to differ materially from those contemplated in this presentation can be found under the captions “Risk Factors” and "Management's Discussion and Analysis of Financial Condition and Results of Operations“ in our Annual Report on Form 10-K for the fiscal year ended December 31, 2025, our Quarterly Report on Form 10-Q for the quarter ended June 30, 2026, and as such factors may be updated from time to time in our other filings with the SEC, which are accessible on the SEC’s website at www.sec.gov and the Investors page of our website at www.inspiresleep.com. These and other important factors could cause actual results to differ materially from those indicated by the forward-looking statements made in this presentation. Any such forward-looking statements represent management’s estimates as of the date of this presentation. While we may elect to update such forward-looking statements at some point in the future, unless required by applicable law, we disclaim any obligation to do so, even if subsequent events cause our views to change. Thus, one should not assume that our silence over time means that actual events are bearing out as expressed or implied in such forward-looking statements. These forward-looking statements should not be relied upon as representing our views as of any date after the date of this presentation. This presentation contains trademarks, trade names and service marks of other companies, which are the property of their respective owners. We do not intend our use or display of other parties' trademarks, trade names or service marks to imply, and such use or display should not be construed to imply, a relationship with, or endorsement or sponsorship of us by, these other parties. 22
© Inspire Medical Systems, Inc. All Rights Reserved. Use of non-GAAP measures This presentation includes non-GAAP financial measures. Reconciliations of such non-GAAP financial measures to the most directly comparable GAAP financial measure have been provided along with the presentation. These non-GAAP financial measures are presented because we believe they are useful indicators of our operating performance and facilitate a more meaningful trend analysis without the distortion of various adjustment items. Management uses these measures principally as measures of our underlying operating performance, trends and for planning purposes, including the preparation of our annual operating plan and financial projections. We believe these measures are useful to investors as supplemental information and because they are frequently used by analysts, investors and other interested parties to evaluate companies in our industry. We also believe these non-GAAP financial measures are useful to our management and investors as a measure of comparative operating performance from period to period. These non-GAAP financial measures should not be considered as an alternative to, or superior to, the most directly comparable GAAP financial measures, as measures of financial performance or cash flows from operations, as a measure of liquidity, or any other performance measure derived in accordance with GAAP, and they should not be construed to imply that our future results will be unaffected by unusual or non-recurring items. In evaluating our non-GAAP financial measures, you should be aware that in the future we may incur expenses that are the same as or similar to some of the adjustments in this presentation. Our presentation of non-GAAP financial measures should not be construed to imply that our future results will be unaffected by any such adjustments. Management compensates for these limitations by primarily relying on our GAAP results in addition to using non-GAAP financial measures on a supplemental basis. These measures and their definitions are discussed in more detail in the presentation, and our definition of these non-GAAP financial measures is not necessarily comparable to other similarly titled captions of other companies due to different methods of calculating. 33
enhancing patient lives through sleep innovation We are a medical technology company committed to 4 It all starts and ends with our mission
© Inspire Medical Systems, Inc. All Rights Reserved. Company overview The first and only… >400 PUBLICATIONS Compelling body of evidence >300 MILLION U.S. COVERED LIVES Established reimbursement in all 50 states ~1,300 EMPLOYEES Led by a proven management team >$900 MILLION REVENUE IN 2025 With 50% five-year CAGR >150,000 INSPIRE PATIENTS Significant first-mover advantage >$10 BILLION Underpenetrated U.S. market Innovative, closed-loop, neurostimulation technology for Obstructive Sleep Apnea (OSA) 5
4,000 Patients receiving Inspire $50M Revenue 200 Implanters With new innovations on the horizon and a big blue ocean of opportunity in front of us! … and we are still just getting started 6 From our entrepreneurial beginnings, and with a focus on delivering life-changing outcomes, we’ve been enhancing the lives of patients for nearly 20 years… Founded 2007 IPO 2018 >150K Patients receiving Inspire >$900M 2025 Revenue >1,500 Implanters TODAY 2026
>150K PATIENTS WITH INSPIRE Proving out our care pathways and therapy optimization CLINICAL EVIDENCE >400 publications portraying a compelling body of evidence >$900M REVENUE IN 2025 With 50% five-year CAGR, continuing our strong performance NEXT-GEN NEUROSTIMULATOR ~20 years in pursuing perfection of our technology BROAD PAYOR COVERAGE Reimbursement in all 50 states with >300 million US covered lives >$10B DOMESTIC MARKET With less than 5% penetration we have plenty of room for growth 7 First mover. Market disruptor. Innovation leader.
Obstructive sleep apnea is caused by blockage that prevents airflow to the lungs 8 Results in repeated arousals and oxygen desaturations Severity of sleep apnea is measured by frequency of apnea or hypopnea events per hour, which is referred to as the Apnea-Hypopnea Index (AHI) Normal Mild Moderate Severe 5 15 30 APNEA-HYPOPNEA INDEX 8 Airway obstruction during breathing Typical OSA event
OSA is a chronic disease that is often untreated and proven to be linked to serious health risks 9 2x The risk for stroke1 2x The risk for sudden cardiac death2 57% Increased risk for recurrence of Atrial Fibrillation after ablation4 5x The risk for cardiovascular mortality3 Years of Follow-up % S ur vi vi ng Increased Risk of Mortality 5 9 1. Redline et al, The Sleep Heart Health Study. Am J Res and Crit Care Med 2010. 2. Gami et al, J Am Coll Cardiol 2013. 3. Young et al, J Sleep 2008. 4. Li et al, Europace 2014. 5. Prospective Study of Obstructive Sleep Apnea and Incident Coronary Heart Disease and Heart Failure from SHHS and Wisconsin Sleep Cohort Study. High risk patients: obese, male or of advanced age Common first indicator: heavy snoring Other indicators: → Lack of energy → Headaches → Depression → Nighttime gasping → Dry mouth → Memory or concentration problems → Excessive daytime sleepiness TYPICAL PATIENT PROFILE EXACERBATED HEALTH RISKS
Current treatment options, such as CPAP and invasive surgeries, have significant limitations 10 Uvulopalatopharyngoplasty (UPPP) Maxillomandibular Advancement (MMA) • Several variations of sleep surgery • Success rates vary widely (30% - 60%)1 • Irreversible anatomy alteration • Inpatient surgery with extended recovery DRIVERS OF NON-COMPLIANCE • Demonstrated improvements in disease severity and long-term gold standard therapy • Major limitation as a therapeutic option is primarily due to low patient compliance (~35%–65%) • Mask Discomfort • Mask Leakage • Pressure Intolerance • Skin Irritation • Nasal Congestion • Nasal Drying • Nosebleeds • Claustrophobia • Lack of Intimacy 10 1. Shah, Janki, et al; American Journal of Otolaryngology (2018). Uvulopalatopharyngoplasty vs. CN XII stimulation for treatment of obstructive sleep apnea: A single institution experience. CPAP IS THE FIRST-LINE THERAPY… …WITH SURGICAL ALTERNATIVES FOR TREATMENT
CPAP prescriptions annually ~2,000,000 CPAP non-compliant ~700,000 Inspire eligible ~500,000 Adults with moderate to severe OSA ~23,000,000 The domestic OSA market is huge… 11 Internal estimates >$10B o p p o r t u n i t y
Closed-loop, or Synchronized Stimulation, is delivered when airway is most vulnerable to collapse (inspiratory phase) Sensing with Inspire V is SUPERIOR to Inspire IV2 Inspire V Patient Remote Stimulation Lead Neurostimulator 1. Inclusive of previous Inspire generations (data collected during the Wear Study) 2. Inspire V was found to be non-inferior to Inspire IV (retrospective control from Wear study); superiority was subsequently tested. No device setting changes were made during the Inspire V IPOP measurement PSGs 3.Total of n=43; early exit: n=1 (refused further study visits) 4. Assumes early exit was a non-responder; compared to 66% at 12M in STAR 5. 6M PSGs were conducted at 1 therapeutic amplitude throughout the entire night; no changes were made to device settings All-night AHI5 3 1 Proprietary Closed-Loop Sensing Algorithm to Modulate Therapy Delivery Singapore Clinical Study • SHER Responder Rate of 80%4 • 100% of implants completed successfully • Therapy Adherence of 5.9±1.2 hours/night Inspire Therapy is an Innovative and Proven Solution for Patients with OSA 12
Quality Patient Flow Care Pathway Capacity Strong Clinical Outcomes Sleep Test (in-lab or home) Activation Procedure DISE & Insurance Strong Patient Outcomes Patient Awareness, Referral or Appointment Request Screening Appointment Efficacy Check Monitoring & Clinic Adjustments 1 2 3 13 The Inspire patient journey is a multi-specialty care continuum
Continuous data collection & outcomes monitoring 14 Real World Data BELGIUM, GERMANY, NETHERLANDS, SWITZERLAND • Collection of real-world, international outcomes data • Eligibility – ALL patients receiving Inspire therapy • Registry - 5,000 enrollments at 61 medical centers • Transition to 2.0 as part of Inspire SleepSync in the U.S. 14 AHI = Apnea Hypopnea Index ESS = Epworth Sleepiness Scale POST MARKET SURVEILLANCE DATA Proactive Data Reactive Data DATA ANALYSIS FOR SIGNALS US CENTERS EU CENTERS
15 89% 90% 91% 92% 93% 94% 95% 96% 97% 98% 99% 100% 0 6 12 18 24 30 36 42 48 54 60 66 72 78 84 90 96 Cu m ul at iv e Su rv iv al P er ce nt ag e Months After Implant 2018 2020 2019 2021 2022 2023 2024 2025 93% 94% 95% 96% 97% 98% 99% 100% 0 6 12 18 24 30 36 42 48 54 60 66 72 78 84 90 96 Cu m ul at iv e Su rv iv al P er ce nt ag e Months After Implant 2018 2020 2019 2021 2023 2024 2025 2022 15 Continued improvement in system safety and reliability Inspire Patient Experience Report, 2025 INSPIRE GLOBAL SYSTEM SURVIVABILITY TO REVISION BY IMPLANT YEAR INSPIRE GLOBAL SYSTEM SURVIVABILITY TO EXPLANT BY IMPLANT YEAR
Inspire patients report having a positive patient experience and enhanced quality of life How does Inspire compare against your previous experience with CPAP? 91% Say Inspire is better I would recommend Inspire to a friend or family member. 93% Agree or strongly agree Overall, how satisfied are you with Inspire? 90% Satisfied or very satisfied Given the chance, I would choose to receive Inspire again. 92% Agree or strongly agree Inspire patients experience a significant reduction in the severity of their OSA 33.0 10.2 Baseline (n=1,963) 12-mo All Night Study (n=890) Median AHI (events/hr) 11.0 6.0 Baseline (n=1,712) 12-mo Visit (n=994) Median ESS Hours of nightly use at 12-months (n=913)5.7 hours 16 Strong patient outcomes Inspire Patient Experience Report, 2025 Inspire patients report less sleepiness and demonstrate increased therapy adherence
1717 Compared to CPAP, Inspire has demonstrated to be better at improving OSA symptoms, potentially with greater therapy adherence 1. Heiser, Sleep & Breathing 2022 Comparison between baseline and 12-month follow-up between matched cohorts 2. Epsworth Sleepiness Scale SLEEPINESS REDUCTION1 THERAPY ADHERENCE1 3.9 8.0 ESS reduction (points) 2 4.0 5.0 Usage/Night (hours)
Current Sensor Inspire V Sensor Performance • Multiple electrodes capability • Enables new stim targets and sensing features • Downloadable features for clinical studies and field upgrades • Future features could include posture-responsive therapy, auto start/pause, AHI detection • Allows stim of multiple targets • Multiple sensing modes Proven cybersecurity • Support for future remote programming • Remote software updates for all components 18 Inspire V: reduced implant time, improved therapy performance, fewer revisions & future innovation THERAPY EVOLUTION BUILT-IN FLEXIBLE SOFTWARE PLATFORM STATE OF THE ART TECHNOLOGY CONSISTENT LONG BATTERY LIFE OF 11 YEARS ON AVERAGE SLEEPSYNC CONNECTIVITY
Therapy Evolution Built In • Multiple electrodes capability • Enables new stimulation targets and sensing features Flexible Software Platform • Downloadable features for clinical studies and field upgrades • Future features include posture-responsive therapy, auto start/pause, AHI detection State of the Art Technology • Allows stimulation of multiple targets • Multiple sensing modes 19 Continuing to evolve with future innovation in mind
Dynamic patient engagement + Efficient care coordination Expanding sleep clinician confidence & capacity enabling more patients to benefit from Inspire therapy In 2025, broadly adopted at Inspire centers in the U.S. Remote patient management Inspire App SleepSync Web Portal • Find a doctor • Customized education • Track therapy & sleep quality • Virtual check-ins • Ease Prior Authorization process • Access therapy quality measures • Manage patients by exception • Grow confidence & productivity • Support sleep practice efficiency • Symptom relief • adherence • Disease burden (future) • Remote adjustments (future) SleepSync digital health platform 20 PATIENT CLINICIAN
© Inspire Medical Systems, Inc. All Rights Reserved.2121 Reimbursement: Upcoming milestones for 2027 (CPT® 64582) and 2028 (New CPT® for single-lead system) Jan. 2028 New CPT Code for single - lead system takes effect Sept. 2026 Initial application for new CPT code for single-lead system reviewed • declined by AMA CPT Editorial Panel July 2026 Nov. 2026 Final 2027 OPPS Rule Expected Release AMA CPT Editorial Panel Approved application for new CPT code for single-lead system Proposed 2027 OPPS Rule Released • + 12% increase for OP • + 15% increase for ASC May 2026 Revised application for new CPT code for single-lead system submitted including • Joint industry stakeholders • Replacement procedure subcoding clarification • Additional clinical evidence June 2026 Jan. 2027 Final 2027 OPPS rates take effect AMA RUC Valuation of New CPT Code Mid-2027
© Inspire Medical Systems, Inc. All Rights Reserved.2222 Reimbursement: Improved clarity in 64582 coding for Inspire V C-Codes in place for 64582 and coding uncertainty from 1H26 reduced Hospital & ASC reimbursement rates are unchanged Correct C-Code adopted in all 6 WISeR states Continued focus on customer education Only 2 MACs have surgeon fee impact with -52 modifier
© Inspire Medical Systems, Inc. All Rights Reserved.2323 Key catalysts and updates Reimbursement 1 Near term: Improved clarity regarding coding pathway, and effective customer education Medium term: Proposed 2027 CMS reimbursement increases: OPPS +12% Y/Y, and ASC +15% Y/Y (subject to final rule) Long term: New Category 1 CPT Code in January 2028 Inspire V & Clinical Data 2 5th Gen system: Improved patient outcomes and physician experience Positive trial data: Presented at recent ENT conferences, AAO and ISSS; multiple studies demonstrating potential for systemic health benefits Project Horizon 3 Created $30M of incremental growth investment capacity: Expected positive impacts beginning in 2027; focus on accelerating patient flow Restructuring charges: Expected ~$25M of pre-tax charges,~95% recognized in Q3
© Inspire Medical Systems, Inc. All Rights Reserved.24 1 Through planned and controlled market expansion and robust physician training Ensure Strong Clinical Outcomes 2 By enhancing interconnectivity, simplifying the care pathway, and closely tracking outcomes Improve the Customer Experience 3 Amongst patients, ENT/Sleep physicians, and general practitioners Promote Widespread Consumer Awareness 4 Commensurate with new center additions and leveraging consumer outreach programs Drive Continued Commercial Scale 5 Driving breakthrough technology innovation and expanded indications Invest in Research & Development 6 Further penetrating existing markets and entering into new geographical locations Facilitate International Market Expansion 24 Our growth strategy
© Inspire Medical Systems, Inc. All Rights Reserved.2525 3Q26 highlights $206.7M Revenue (7.9%) Y/Y, +3.0% Q/Q 86.0% Gross Margin $46.4M Operating Cash Flow ($0.84) Diluted EPS $0.14 Adj. Diluted EPS Results Ahead of Expectations: 3.0% sequential revenue growth with strength in U.S. business, coding and reimbursement disruption primary driver of Y/Y revenue decline of 7.9% New CPT® Code for 2028: AMA Editorial panel approved new single-lead HGNS CPT Code, to take effect January 1, 2028. Customers have increased clarity and familiarity for 2027 coding Margin Expansion: Gross margin of 86.0%, up 20 bps Y/Y Narrowed Full-Year 2026 Outlook: Narrowing top and bottom ends of guidance for revenue, adjusted operating margin, and adjusted EPS Project Horizon: Optimizing organizational structure and supply chain to reallocate $30 million of annualized operating expense to drive future revenue growth
© Inspire Medical Systems, Inc. All Rights Reserved.2626 Financial outlook as of November 2, 2026 $803 $912 2024 2025 2026E 2027E $850-$860 Annual Revenue ($M) Anticipating low-single digit growth in 20271 FY26 revenue range of $850M-$860M Vs Prior range of $835M-$875M FY26 adj. operating income margin of 4.5%-5.5% Vs Prior range of 4%-6% FY26 adjusted diluted EPS of $1.20-$1.40 Vs Prior range of $1.05-$1.45 1. As of 3Q26 earnings call (Nov. 2nd, 2026)
© Inspire Medical Systems, Inc. All Rights Reserved.2727 Strategic growth plan: Project Horizon Optimizing Organizational Structure to Align Resources to Support Revenue Growth Created incremental annualized growth investment capacity; prioritizing investments in patient flow Expanding patient access to care Support in navigating treatment journey $30M Improving patient education and engagement
© Inspire Medical Systems, Inc. All Rights Reserved.2828 Summary Enhanced coding clarity in 2026 and 2027, new Category 1 CPT Code in 2028 Inspire V data shows improved patient outcomes and physician experience Recent studies expand the evidence supporting patient outcomes, cardiovascular health, and treatment pathway optimization Project Horizon creates $30M of incremental annualized capacity to invest in growth initiatives; primarily focused on patient flow
No mask. No hose. Just sleep. INSPIRE CONFIDENTIAL. Inspire is a public company and has an Insider Trading Policy. The content in this deck is not to be shared with anybody outside of Inspire Medical Systems, Inc. It is for internal review and discussion only www.inspiresleep.com ® 29
© Inspire Medical Systems, Inc. All Rights Reserved. Appendix 30
© Inspire Medical Systems, Inc. All Rights Reserved.31 Consolidated statements of operations (Unaudited)(In thousands, except share and per share amounts)
© Inspire Medical Systems, Inc. All Rights Reserved.32 Condensed consolidated balance sheets (Unaudited)(In thousands)
© Inspire Medical Systems, Inc. All Rights Reserved.33 GAAP to non-GAAP reconciliations (Unaudited) (In thousands, except per share amounts) 1 These costs represent legal-related expenses related to (a) a civil investigative demand from the Department of Justice, (b) a patent infringement suit that we filed against Nyxoah S.A. and its wholly-owned subsidiary, Nyxoah, Inc. ("Nyxoah"), and (c) a patent infringement suit brought against us by Nyxoah. 2 Legal settlement expense associated with the proposed settlement of a pixel-tracking class action. 3 Restructuring charges related to Project Horizon. 4 Stock-based compensation expense benefit due to share forfeitures related to actions of Project Horizon. 5 The accounting standards codification guidance governing employee stock-based compensation requires that any excess or deficient tax deduction for stock-based compensation be immediately recorded within income tax expense. Employee stock-based compensation activity, including the exercise of stock options, can be unpredictable and can significantly impact our net earnings, net earnings per diluted share, and effective tax rate. These amounts represent the discrete tax expense recorded as excess tax expense for stock-based compensation.
© Inspire Medical Systems, Inc. All Rights Reserved. • Inspire is founded after being spun out of Medtronic • Initiated Phase III pivotal STAR trial • STAR results published in the New England Journal of Medicine; received PMA approval from the FDA • 1,000th implant milestone • Launched Inspire IV neurostimulator in U.S.; 2,000th implant • Inspire IV CE mark; 5-year STAR results publication; IPO on NYSE • Medicare coverage in all 50 states; Inspire Sleep app released; 10,000th implant • FDA approved 2-incision approach and Bluetooth® remote; 20,000th implant • First implants in Japan, Singapore, and the U.K.; FDA approved full-body MRI compatibility • Expanded AHI, BMI, and pediatric Down syndrome indications; 60,000th implant; revenues of $625M 2007 2011 2014 2016 • Inspire II CE mark received in Europe 2010 2017 2018 2020 2021 20232022 • Inspire V approval from the FDA; EU MDR approval; French reimbursement; 90,000th implant 2024 2025 • 100,000th implant; Inspire V U.S. launch 34 Company overview Our history and key milestones 2026 • 150,000th implant
Bryan Phillips SVP, General Counsel & Chief Compliance Officer Joined 2021 Tim Herbert Chair, President & Chief Executive Officer Joined 2007 Matt Osberg Chief Financial Officer Joined 2026 Carlton Weatherby Chief Strategy & Growth Officer Joined 2023 Jason Kelly Chief Operations and Innovation Officer Joined 2025 Melissa Mann Chief People Officer Joined 2024 35 Proven management team grounded in integrity, fueled by innovation, and devoted to delivering the promise of our mission
© Inspire Medical Systems, Inc. All Rights Reserved. Implant Fine- tune ActivationInspire Advisor Care Program (ACP) DISE/ Prior Authorization Patient education using the InspireSleep.com website Community health talks Physician Consultations Awareness with direct-to- consumer outreach programs Life with Inspire – Patient management with SleepSync Time from ACP contact to implant can be as much as six months 36 Supporting patients on their path to Inspire
© Inspire Medical Systems, Inc. All Rights Reserved. Awareness Education Consultation Implant Life w/ Inspire Confirm Sleep Study Fine- tuneActivationImplantPrior AuthDISE Conduct Online Search Attend Appt. Schedule an Appt. with IS Dr. Obtain Updated Sleep Study Request an Appt. Do I Qualify Lead Register for CHT Visit IS.com Ask their Dr. about Inspire See an Inspire Ad Challenges What is the biggest pain point for patients? SUPPORT What key investments and programs is Inspire investing in to support patients? • Patients need sufficient information to feel prepared to take the next step with Inspire • There are limited ways to engage with Inspire for support and education • It is difficult to schedule an appointment • Sleep Studies can take months for patients to get • Time for scheduling DISE • Time for scheduling implant • Patients need support through the therapy optimization process • Lead capture + scoring • Lead nurturing via email, text, phone • Request a call for nights/weekends • Updated website content for patients • Chatbot improvements with two-way text messaging • Digital scheduling through ACP • Ognomy, Lofta, EnsoData, Rest Assured • Increase ENT capacity to grow number of Inspire procedures • Expect Inspire V to reduce OR time • Expect PREDICTOR to replace DISE for many patients • SleepSync Digital Health Platform to support patient from contact to post-implant sleep management 37 The patient journey
© Inspire Medical Systems, Inc. All Rights Reserved. Improving Patient Engagement Conversion Initiatives Increasing ENT Capacity to Further Grow Utilization SleepSync Digital Health Platform Increases Utility • Digital scheduling has shown significant improvements with initial sites • Patient education using chat guide bot • Patient nurturing with auto-email system • Improved patient tracking with SleepSync • Work with ENTs to optimize time by ensuring support team (sleep physicians) engages and conducts longitudinal patient management • Train additional ENTs in the practice • Continue to add new centers with ability to quickly grow utilization (complete teams) • Longitudinal patient engagement from first contact to long after Inspire implant • Fully incorporate both objective data (utilization, sleep performance) and subjective data (e-visit, questionnaires) to support strong patient outcomes • Future enhancements including remote patient programming and physician notifications Improving Patient Experience and Reducing Time-to-Implant • Inspire V neurostimulator with internal sensor expected to reduce OR time and improve patient experience • PREDICTOR study intended to replace DISE with office airway measurement for vast majority of patients • Continued development of Inspire VI and VII for auto- activation and future auto-titration 38 Patient engagement conversion initiatives
• Untreated OSA patients had ~$20,000 higher total annual Medicare costs • CPAP intolerant patients had higher Medicare utilization than PAP tolerant ALASKA-Study – non-adherent patients have greater chance of mortality (n>176,000)2 PAP non- adherent PAP adherent96% 98% 100% Su rv iv al Pr ob ab ili ty Conclusions: • Prioritize PAP intolerant to therapy, especially those with CV disease • Addressing PAP intolerance improves mortality Growing evidence that CPAP intolerance is linked to higher healthcare costs1 94% 39 Health economics: untreated OSA cost burden 1. Wickwire JCSM 2020; Wickwire Sleep Breathing 2022 2. Pepin, ERS 2021 Conference
Committed to improving the economic, social, and environmental impacts that our business has on the communities in which we operate, as well as our customers, business partners, suppliers, employees, and stockholders. E N V I R O N M E N T A L We work to operate our business responsibly and reduce our impact on the environment wherever feasible. • Our Board and executive officers are responsible for oversight, identification, and communication of climate-related risks and opportunities. • We are focused on building out foundational programmatic elements and oversight that enable meaningful future reductions in our environmental impact. S O C I A L Product safety and quality are of the utmost importance at Inspire. We also pride ourselves on our innovative and collaborative work environment, which we believe has driven our success and which we seek to uphold through an inclusive workforce, generous compensation and benefits, open communication, a focus on employee health, well- being and engagement, and robust training and development programs. • Our company’s success is built on our enduring commitment to product quality and patient outcomes. • InspireGives is our community outreach program and the foundation of our charitable giving and volunteer efforts. • We aim to foster a culture of continuous learning with significant investments in our people through programs focused on leadership and professional development. G O V E R N A N C E We strive to maintain strong governance practices and high standards of ethics, compliance, and accountability designed to provide long-term value creation opportunities. • Our governance practices include regular consideration and assessment of our governance structure, board and committee function, and board and management succession. • Our strong and diverse Board collectively possesses a range of qualifications, skills, and experiences that align with our long-term strategy and business needs. • Sustainability matters are overseen by our Board, executive leadership, and cross-functional team. 40 Sustainability at Inspire
© Inspire Medical Systems, Inc. All Rights Reserved. Covers aspects of our current Inspire system and future product concepts • 119 issued U.S. patents (expiring between 2029 and 2043) and 73 pending U.S. patent applications • 83 issued foreign patents and 73 pending foreign patent applications 178 pending and registered trademark filings worldwide Competitive position enhanced by trade secrets, proprietary know-how and continuing technological innovation Entered into an agreement with Medtronic in 2007 to make, use, import, and sell products and practice methods in the field of electrical stimulation of the upper airway for the treatment of OSA • Royalty-free license agreement • Perpetual license (no right of termination) 41 Our intellectual property portfolio (as of December 31, 2025)