Inspire Medical Systems (INSP) guides 2026 slowdown after strong 2025
Filing Impact
Filing Sentiment
Form Type
8-K
Rhea-AI Filing Summary
Inspire Medical Systems reported solid growth for 2025 while signaling a slower 2026 and governance changes. Revenue rose 14% to
Fourth quarter 2025 revenue grew 12% to
The filing also outlines a proposal to declassify the board, moving to annual director elections after a phase-in, and bylaw amendments to remove the “for cause only” director removal provision, subject to shareholder approval at the 2026 annual meeting.
Positive
- Strong 2025 financial performance: Revenue grew 14% to
$911.9 million with gross margin of85.4% , net income of$145.4 million , adjusted EBITDA of$200.6 million , and operating cash flow of$117.0 million , supporting$175 million of share repurchases. - Improving profitability metrics: Fourth quarter 2025 operating income rose to
$46.1 million with operating margin of17.1% , and adjusted EBITDA for the quarter increased to$79.3 million , indicating better scale and cost leverage. - Board declassification initiative: The company is proposing to declassify its board and move to annual director elections, alongside bylaw changes on director removal, which can enhance governance transparency and shareholder influence.
Negative
- Material growth deceleration in 2026 outlook: Revenue guidance of
$950 million–$1.0 billion implies only4%–10% growth versus 14% in 2025 and a disclosed five-year revenue CAGR of50% , signaling a significantly slower near-term growth profile. - Reimbursement and coding headwinds: Management notes a recent coding clarification for the Inspire V procedure and expects a transition to CPT code 64582 with a -52 modifier, explicitly flagging disappointment and potential physician fee impact, which contributes to the widened and tempered 2026 guidance.
- Lower projected profitability: Despite strong 2025 margins, 2026 guidance calls for adjusted operating margin of only
6%–8% and adjusted EPS of$1.85–$2.35 , below 2025 adjusted earnings levels, indicating expected pressure from reimbursement and investment dynamics.
Insights
Strong 2025, but sharply slower guided growth and reimbursement risk.
Inspire Medical Systems delivered robust 2025 results: revenue grew
However, management highlights coding clarification for the Inspire V procedure, expecting a transition to CPT code 64582 with a -52 modifier. They explicitly acknowledge disappointment and potential impact on physician fees, and they widened 2026 guidance partly to reflect coding uncertainty and reimbursement outcomes.
For 2026 the company guides revenue to
Board declassification proposal would increase director accountability.
The company plans a charter amendment at the
Contingent on shareholder approval of this charter change, the board has already approved Amended and Restated Bylaws. These bylaws would remove the existing “for cause only” director removal restriction and instead follow Delaware General Corporation Law standards. If approved, this combination would generally make directors more answerable to shareholders on both election and removal.
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): February 5, 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 February 11, 2026, Inspire Medical Systems, Inc. (the “Company”) issued a press release announcing its financial results for the quarter and full year ended December 31, 2025. 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.
The information in this Item 2.02 of this Current Report on Form 8-K (and in the press release attached as Exhibit 99.1 hereto) 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 5.03 Amendments to Articles of Incorporation or Bylaws; Change in Fiscal Year.
The Company intends to put forth a proposal at the Company’s annual meeting of stockholders to be held in 2026 (the “2026 Annual Meeting”) to amend its Seventh Amended and Restated Certificate of Incorporation in order to declassify its Board of Directors (the “Board”) and provide for the annual election of directors following a phase-in period (the “Proposed Charter Amendment”). In connection with the Proposed Charter Amendment, on February 5, 2026, the Board approved the Amended and Restated Bylaws of the Company (the “Amended Bylaws”), subject to and effective upon the approval of the Proposed Charter Amendment by the stockholders at the Company’s 2026 Annual Meeting. The Amended Bylaws would remove the provision providing that directors may be removed only for cause. Instead, removals would be governed by the Proposed Charter Amendment which would follow applicable Delaware General Corporation Law.
The Amended Bylaws, along with a copy marked to show the changes from the Company’s Amended and Restated Bylaws as in effect prior to the Amended Bylaws, are filed herewith as Exhibits 3.1 and 3.2, respectively. The above description of the changes contained in the Amended Bylaws is qualified by reference to the full text of the Amended Bylaws, which are incorporated herein by reference.
Item 7.01. Regulation FD Disclosure.
In February and March 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 this Item 7.01 of this Current Report on Form 8-K (and in the presentation attached as Exhibit 99.2 hereto) shall not be deemed “filed” for purposes of Section 18 of 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 | |||||||
| 3.1 | Amended and Restated Bylaws of Inspire Medical Systems, Inc. | |||||||
| 3.2 | Amended and Restated Bylaws of Inspire Medical Systems, Inc., as marked to show amendments. | |||||||
| 99.1 | Press release of Inspire Medical Systems, Inc., dated February 11, 2026. | |||||||
| 99.2 | Inspire Medical Systems, Inc. Presentation, February 2026. | |||||||
| 104 | Cover Page Interactive Data File - the cover page XBRL tags are embedded within the Inline XBRL document. | |||||||
2
SIGNATURES
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: | February 11, 2026 | By: | /s/ Bryan K. Phillips | ||||||||
| Bryan K. Phillips | |||||||||||
| Sr. Vice President, General Counsel and Secretary | |||||||||||
3
Exhibit 99.1
Inspire Medical Systems, Inc. Announces Fourth Quarter and
Full Year 2025 Financial Results
Launch of Inspire V system complete with strong revenue and profitability performance in the fourth quarter and FDA approval for 3.0T MRI compatibility
•Fourth quarter revenue growth of 12% and full year revenue growth of 14%
•Fourth quarter net income per diluted share of $4.66; adjusted net income per diluted share of $1.65
•Full year net income per diluted share of $4.89; adjusted net income per diluted share of $2.42
•Operating cash flow of $52.5 million in the fourth quarter with full year operating cash flow of $117.0 million
MINNEAPOLIS, Minnesota - February 11, 2026 - Inspire Medical Systems, Inc. (NYSE: INSP) (Inspire), 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 and year ended December 31, 2025.
“We are very excited with the strong finish to 2025. The team made excellent progress with the Inspire V launch, with clinical insights from the early phase of commercial adoption continuing to validate positive patient outcomes and improvements in therapy delivery,” said Tim Herbert, Chairman and CEO of Inspire Medical Systems. “Despite the dynamic reimbursement landscape, our strong fourth quarter execution positions us well as we enter 2026.”
“In the last week, we received clarification regarding the coding that should be used for the Inspire V procedure. Currently, healthcare centers and physicians should bill the most recent healthcare policies, be it a Medicare Administrative Contractor (MACs) or a commercial payor, and based on this clarification, we believe the code will transition to CPT code 64582 for the Inspire V procedure, including the use of a -52 modifier,” continued Mr. Herbert. “While we are disappointed with this result, this clarification provides direction for us going forward, and we will work with payers, including the MACs, government agencies, commercial payers and physician societies to attempt to minimize the impact to the physician fee from this change. Additionally, we are seeking a long-term solution, namely the creation of a separate CPT code that would support appropriate reimbursement for the Inspire V procedure. We remain focused on our commitment to put the patient first and deliver strong patient outcomes. We believe we have a differentiated product, a strong team and that we can drive long-term profitable growth and shareholder value.”
Fourth Quarter 2025 Financial Results (Fourth Quarter 2025 compared to Fourth Quarter 2024)
•Revenue increased 12% to $269.1 million primarily driven by growth at existing centers and new center additions.
•Gross margin increased 160 bps to 86.6% primarily due to increased sales volume as well as increased sales mix of the Inspire V system.
•Operating expenses increased 9%, or $15.0 million, to $186.9 million primarily driven by higher investments in patient marketing and education expenses, partially offset by lower R&D expenses.
•Operating income increased $14.2 million to $46.1 million, and operating margin was 17.1%. Adjusted operating income was $47.1 million, and adjusted operating margin was 17.5%.
•Income tax was a benefit of $85.8 million, primarily driven by the release of the valuation allowance against net deferred tax assets.
•Net income was $136.1 million and adjusted net income was $48.1 million.
•Net income per diluted share was $4.66 and adjusted net income per diluted share was $1.65.
•Adjusted EBITDA increased $16.6 million to $79.3 million.
Full Year 2025 Financial Results (Full Year 2025 compared to Full Year 2024)
•Revenue increased 14% to $912.0 million primarily driven by growth at existing centers and new center additions.
•Gross margin increased 70 bps to 85.4% primarily driven by increased sales volume as well as increased sales mix of the Inspire V system.
•Operating expenses increased $84.1 million to $727.8 million primarily driven by investments to build our commercial infrastructure, increased patient marketing and medical education expenses.
•Operating income increased $14.9 million to $51.0 million, and operating margin was 5.6%. Adjusted operating income was $66.2 million, and adjusted operating margin was 7.3%.
•Income tax was a benefit of $79.7 million, primarily driven by the release of the valuation allowance against net deferred tax assets allowance in the fourth quarter of 2025.
•Net income was $145.4 million and adjusted net income was $72.1 million.
•Net income per diluted share was $4.89 and adjusted net income per diluted share was $2.42.
•Adjusted EBITDA increased $42.8 million to $200.6 million.
Financial Condition
•Fourth quarter operating cash flow of $52.5 million and full year operating cash flow of $117.0 million.
•Share repurchases of $50 million in the fourth quarter, bringing the full year total to $175 million.
•As of December 31, 2025, cash, cash equivalents, and investments decreased $111.9 million to $404.6 million as compared to December 31, 2024.
Full Year 2026 Outlook
The Company is revising its previously announced revenue outlook to be in the range of $950 million to $1.0 billion, which represents expected annual growth of 4% to 10%. This widened and revised range reflects the estimated impact on the first quarter for coding uncertainty as well as the range of outcomes that exist by moving to CPT code 64582 with the –52 modifier and related physician reimbursement rates.
Additionally, the Company expects annual adjusted operating margin in the range of 6% to 8%, net income per diluted share in the range of $1.23 to $1.81 and adjusted net income per diluted share in the range of $1.85 to $2.35.
The Company’s outlook assumes an effective tax rate of approximately 44% to 49% and an adjusted effective tax rate of 26% to 28%, estimated weighted average diluted shares outstanding of approximately 29.4 million and capital expenditures between $45 million to $50 million.
Webcast and Conference Call
The Company will host a conference call after market close today, Wednesday, February 11, 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.vevent.com/register/BI7cf46340089b42e6982e8a18b19d4126. 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/m3be3sbt/. 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 income before income taxes, adjusted income tax expense, adjusted effective tax rate, adjusted net income, adjusted net income 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 income before income taxes is defined as income before income taxes, adjusted for items that are not indicative of our ongoing operations. Income 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 income before income taxes. Income tax expense is the most directly comparable GAAP financial measure. Adjusted net income is defined as net income or loss, adjusted for items that are not indicative of our ongoing operations. Net income is the most directly comparable GAAP financial measure to adjusted net income. Adjusted net income per diluted share is calculated as adjusted net income divided by the dilutive weighted average shares outstanding. Net income per diluted share is the most directly comparable GAAP financial measure to adjusted net income per diluted share. We define adjusted EBITDA as net income or loss, less interest income, plus interest expense, plus income tax expense, plus depreciation and amortization, plus stock-based compensation expense, less non-operating income, adjusted for items that are not indicative of our ongoing operations. Net income 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 income 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 potential impacts to our business associated with Inspire V reimbursement, our plans to obtain a long-term solution that would support appropriate reimbursement for Inspire V, and our expectations regarding our full year 2026 financial outlook (including without limitation expectations for the impacts of coding uncertainty and the range of outcomes from applying a CPT code 64582 with a modifier and other aspects to reimbursement, revenue, expected growth, adjusted operating margin, net income per diluted share, adjusted net income 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: there may be uncertainty in, or changes to, billing codes to be used for our Inspire therapy, which could impact reimbursement rates and physician usage; our financial results may fluctuate significantly and may not fully reflect the underlying performance of our business; our history of operating losses and dependency on our Inspire therapy for revenues; 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 therapy or any future products we may seek to commercialize; competitive companies, technologies and pharmaceuticals in our industry; our involvement in current or future legal disputes or regulatory proceedings; our ability to expand our indications and develop and commercialize additional products and enhancements to our Inspire therapy; future results of operations, financial position, research and development costs, capital requirements and our needs for additional financing; our ability to accurately forecast customer demand for our Inspire therapy and manage our inventory; our dependence on third-party suppliers, vendors, and contract manufacturers; 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 therapy in markets outside of the U.S.; our ability to manage our growth; our ability to hire and retain our senior management and other highly qualified personnel; risk related to product liability claims and warranty claims; our ability to address quality issues that may arise with our Inspire therapy; our ability to successfully integrate any acquired business, products, or technologies; changes in global macroeconomic trends; our business model and strategic plans for products, technologies and business, including our implementation thereof; the impact of glucagon-like peptide 1 class of drugs on demand for our Inspire therapy; risks related to information technology and cybersecurity; our ability to commercialize or obtain regulatory approvals for our Inspire therapy, or the effect of delays in commercializing or obtaining regulatory approvals; and FDA or other U.S. or foreign regulatory actions affecting us or the healthcare industry generally.
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, 2024, as updated in our Quarterly Report on Form 10-Q for the quarter ended September 30, 2025 and as will be further updated in our Annual Report on Form 10-K for the fiscal year ended December 31, 2025, 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 & Media Contact
Ezgi Yagci
Vice President, Investor Relations
ezgiyagci@inspiresleep.com
617-549-2443
Inspire Medical Systems, Inc.
Consolidated Statements of Operations and Comprehensive Income (unaudited)
(in thousands, except share and per share amounts)
| Three Months Ended December 31, | Year Ended December 31, | |||||||||||||||||||||||||
| 2025 | 2024 | 2025 | 2024 | |||||||||||||||||||||||
| Revenue | $ | 269,077 | $ | 239,718 | $ | 911,981 | $ | 802,804 | ||||||||||||||||||
| Cost of goods sold | 36,071 | 35,988 | 133,225 | 122,986 | ||||||||||||||||||||||
| Gross profit | 233,006 | 203,730 | 778,756 | 679,818 | ||||||||||||||||||||||
| Operating expenses: | ||||||||||||||||||||||||||
| Research and development | 24,942 | 30,336 | 103,165 | 114,128 | ||||||||||||||||||||||
| Selling, general and administrative | 161,953 | 141,510 | 624,637 | 529,607 | ||||||||||||||||||||||
| Total operating expenses | 186,895 | 171,846 | 727,802 | 643,735 | ||||||||||||||||||||||
| Operating income | 46,111 | 31,884 | 50,954 | 36,083 | ||||||||||||||||||||||
| Other (income) expense: | ||||||||||||||||||||||||||
| Interest and dividend income | (4,000) | (5,552) | (17,536) | (23,247) | ||||||||||||||||||||||
| Interest expense | 122 | 22 | 137 | 22 | ||||||||||||||||||||||
| Other expense (income), net | (330) | 778 | 2,656 | 855 | ||||||||||||||||||||||
| Total other income | (4,208) | (4,752) | (14,743) | (22,370) | ||||||||||||||||||||||
| Income before income taxes | 50,319 | 36,636 | 65,697 | 58,453 | ||||||||||||||||||||||
| Income tax (benefit) expense | (85,771) | 1,412 | (79,725) | 4,944 | ||||||||||||||||||||||
| Net income | 136,090 | 35,224 | 145,422 | 53,509 | ||||||||||||||||||||||
| Other comprehensive income (loss): | ||||||||||||||||||||||||||
| Foreign currency translation loss | (128) | (151) | (296) | (65) | ||||||||||||||||||||||
| Unrealized (loss) gain on investments | (47) | (1,013) | 224 | (199) | ||||||||||||||||||||||
| Total comprehensive income | $ | 135,915 | $ | 34,060 | $ | 145,350 | $ | 53,245 | ||||||||||||||||||
| Basic net income per share | $ | 4.70 | $ | 1.18 | $ | 4.95 | $ | 1.80 | ||||||||||||||||||
| Diluted net income per share | $ | 4.66 | $ | 1.15 | $ | 4.89 | $ | 1.75 | ||||||||||||||||||
| Basic weighted average shares outstanding | 28,942,778 | 29,827,947 | 29,368,892 | 29,763,395 | ||||||||||||||||||||||
| Diluted weighted average shares outstanding | 29,218,099 | 30,751,338 | 29,757,036 | 30,543,274 | ||||||||||||||||||||||
Inspire Medical Systems, Inc.
Consolidated Balance Sheets (unaudited)
(in thousands, except share and per share amounts)
| December 31, | |||||||||||
| 2025 | 2024 | ||||||||||
| Assets | |||||||||||
| Current assets: | |||||||||||
| Cash and cash equivalents | $ | 104,813 | $ | 150,150 | |||||||
| Investments, short-term | 203,455 | 295,396 | |||||||||
| Accounts receivable, net of allowance for credit losses of $1,080 and $880, respectively | 119,692 | 93,068 | |||||||||
| Inventories, net | 145,293 | 80,118 | |||||||||
| Prepaid expenses and other current assets | 10,399 | 12,074 | |||||||||
| Total current assets | 583,652 | 630,806 | |||||||||
| Investments, long-term | 96,330 | 70,995 | |||||||||
| Property and equipment, net | 97,872 | 71,925 | |||||||||
| Operating lease right-of-use assets | 23,532 | 23,314 | |||||||||
| Deferred tax assets | 88,667 | 13 | |||||||||
| Other non-current assets | 17,264 | 11,330 | |||||||||
| Total assets | $ | 907,317 | $ | 808,383 | |||||||
| Liabilities and stockholders' equity | |||||||||||
| Current liabilities: | |||||||||||
| Accounts payable | $ | 36,565 | $ | 38,687 | |||||||
| Accrued expenses | 59,490 | 49,814 | |||||||||
| Total current liabilities | 96,055 | 88,501 | |||||||||
| Operating lease liabilities, non-current portion | 29,998 | 30,039 | |||||||||
| Other non-current liabilities | 104 | 148 | |||||||||
| Total liabilities | 126,157 | 118,688 | |||||||||
| 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; 28,579,015 and 29,740,176 shares issued and outstanding at December 31, 2025 and 2024, respectively | 29 | 30 | |||||||||
| Additional paid-in capital | 927,159 | 981,043 | |||||||||
| Accumulated other comprehensive income | 464 | 536 | |||||||||
| Accumulated deficit | (146,492) | (291,914) | |||||||||
| Total stockholders' equity | 781,160 | 689,695 | |||||||||
| Total liabilities and stockholders' equity | $ | 907,317 | $ | 808,383 | |||||||
Inspire Medical Systems, Inc.
Reconciliation of Non-GAAP Financial Measures (unaudited)
(in thousands, except share and per share amounts)
Reconciliation of GAAP Net Income (Loss) to Non-GAAP Adjusted Net Income
| Three Months Ended | Year Ended | |||||||||||||||||||||||||||||||
| March 31, | June 30, | September 30, | December 31, | December 31, | ||||||||||||||||||||||||||||
| 2025 | 2025 | 2025 | 2025 | 2025 | ||||||||||||||||||||||||||||
| Net income (loss) | $ | 2,992 | $ | (3,592) | $ | 9,932 | $ | 136,090 | $ | 145,422 | ||||||||||||||||||||||
Stock-based compensation expense(1) | — | 8,385 | — | — | 8,385 | |||||||||||||||||||||||||||
Legal fees(2) | — | 1,305 | 969 | 770 | 3,044 | |||||||||||||||||||||||||||
Asset impairment charge(3) | — | 4,046 | — | — | 4,046 | |||||||||||||||||||||||||||
Release of valuation allowance(4) | — | — | — | (88,751) | (88,751) | |||||||||||||||||||||||||||
| Adjusted net income | $ | 2,992 | $ | 10,144 | $ | 10,901 | $ | 48,109 | $ | 72,146 | ||||||||||||||||||||||
(1) Represents accelerated stock-based compensation expense for certain employees who are 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.
(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. These costs do not reflect costs associated with our normal ongoing operations.
(3) Represents a non-cash impairment of a strategic investment, which does not reflect costs associated with our ongoing operations, and was recorded in other expense (income), net in the consolidated statements of operations and comprehensive income (loss).
(4) Non-recurring income tax benefit of the release of the valuation allowance against net deferred tax assets.
Reconciliation of GAAP Net Income (Loss) per Diluted Share to Non-GAAP Adjusted Net Income Per Diluted Share
| Three Months Ended | Year Ended | |||||||||||||||||||||||||||||||
| March 31, | June 30, | September 30, | December 31, | December 31, | ||||||||||||||||||||||||||||
| 2025 | 2025 | 2025 | 2025 | 2025 | ||||||||||||||||||||||||||||
| Net income (loss) per diluted share | $ | 0.10 | $ | (0.12) | $ | 0.34 | $ | 4.66 | $ | 4.89 | ||||||||||||||||||||||
Stock-based compensation expense(1) | — | 0.28 | — | — | 0.28 | |||||||||||||||||||||||||||
Legal fees(2) | — | 0.04 | 0.03 | 0.03 | 0.10 | |||||||||||||||||||||||||||
Asset impairment charge(3) | — | 0.14 | — | — | 0.14 | |||||||||||||||||||||||||||
Release of valuation allowance(4) | — | — | — | (3.04) | (2.99) | |||||||||||||||||||||||||||
| Adjusted net income per diluted share | $ | 0.10 | $ | 0.34 | $ | 0.37 | $ | 1.65 | $ | 2.42 | ||||||||||||||||||||||
(1) Represents accelerated stock-based compensation expense for certain employees who are 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.
(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. These costs do not reflect costs associated with our normal ongoing operations.
(3) Represents a non-cash impairment of a strategic investment, which does not reflect costs associated with our ongoing operations, and was recorded in other expense (income), net in the consolidated statements of operations and comprehensive income (loss).
(4) Non-recurring income tax benefit of the release of the valuation allowance against net deferred tax assets.
Reconciliation of GAAP Net Income (Loss) to Non-GAAP Adjusted EBITDA
| Three Months Ended | Year Ended | |||||||||||||||||||||||||||||||
| March 31, | June 30, | September 30, | December 31, | December 31, | ||||||||||||||||||||||||||||
| 2025 | 2025 | 2025 | 2025 | 2025 | ||||||||||||||||||||||||||||
| Net income (loss) | $ | 2,992 | $ | (3,592) | $ | 9,932 | $ | 136,090 | $ | 145,422 | ||||||||||||||||||||||
| Interest and dividend income | (5,066) | (4,486) | (3,984) | (4,000) | (17,536) | |||||||||||||||||||||||||||
| Interest expense | — | 4 | 11 | 122 | 137 | |||||||||||||||||||||||||||
| Income tax expense (benefit) | 1,167 | 1,260 | 3,619 | (85,771) | (79,725) | |||||||||||||||||||||||||||
| Depreciation and amortization | 3,044 | 3,414 | 3,677 | 3,822 | 13,957 | |||||||||||||||||||||||||||
| EBITDA | 2,137 | (3,400) | 13,255 | 50,263 | 62,255 | |||||||||||||||||||||||||||
Stock-based compensation expense(1) | 31,056 | 41,724 | 29,468 | 28,011 | 130,259 | |||||||||||||||||||||||||||
Legal fees(2) | — | 1,736 | 1,289 | 1,025 | 4,050 | |||||||||||||||||||||||||||
Asset impairment charge(3) | — | 4,046 | — | — | 4,046 | |||||||||||||||||||||||||||
| Adjusted EBITDA | $ | 33,193 | $ | 44,106 | $ | 44,012 | $ | 79,299 | $ | 200,610 | ||||||||||||||||||||||
(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. These costs do not reflect costs associated with our normal ongoing operations.
(3) Represents a non-cash impairment of a strategic investment, which does not reflect costs associated with our ongoing operations, and was recorded in other expense (income), net in the consolidated statements of operations and comprehensive income (loss).
Reconciliation of GAAP Net Income (Loss) Margin to Non-GAAP Adjusted EBITDA Margin
| Three Months Ended | Year Ended | |||||||||||||||||||||||||||||||
| March 31, | June 30, | September 30, | December 31, | December 31, | ||||||||||||||||||||||||||||
| 2025 | 2025 | 2025 | 2025 | 2025 | ||||||||||||||||||||||||||||
Net income (loss) margin(1) | 1.5 | % | (1.7) | % | 4.5 | % | 50.7 | % | 16.0 | % | ||||||||||||||||||||||
| Interest and dividend income | (2.5) | % | (2.1) | % | (1.8) | % | (1.5) | % | (1.9) | % | ||||||||||||||||||||||
| Interest expense | — | % | — | % | — | % | — | % | — | % | ||||||||||||||||||||||
| Income tax expense (benefit) | 0.6 | % | 0.6 | % | 1.6 | % | (31.9) | % | (8.7) | % | ||||||||||||||||||||||
| Depreciation and amortization | 1.5 | % | 1.6 | % | 1.6 | % | 1.4 | % | 1.5 | % | ||||||||||||||||||||||
Stock-based compensation expense(2) | 15.4 | % | 19.2 | % | 13.1 | % | 10.4 | % | 14.3 | % | ||||||||||||||||||||||
Legal fees(3) | — | % | 0.8 | % | 0.6 | % | 0.4 | % | 0.4 | % | ||||||||||||||||||||||
Asset impairment charge(4) | — | % | 1.9 | % | — | % | — | % | 0.4 | % | ||||||||||||||||||||||
Adjusted EBITDA margin(5) | 16.5 | % | 20.3 | % | 19.6 | % | 29.5 | % | 22.0 | % | ||||||||||||||||||||||
(1) Net income margin is calculated as net income 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. These costs do not reflect costs associated with our normal ongoing operations.
(4) Represents a non-cash impairment of a strategic investment, which does not reflect costs associated with our ongoing operations, and was recorded in other expense (income), net in the consolidated statements of operations and comprehensive income (loss).
(5) Adjusted EBITDA margin is calculated as Adjusted EBITDA divided by total revenue.
Reconciliation of GAAP Operating Income (Loss) to Non-GAAP Adjusted Operating Income (Loss)
| Three Months Ended | Year Ended | |||||||||||||||||||||||||||||||
| March 31, | June 30, | September 30, | December 31, | December 31, | ||||||||||||||||||||||||||||
| 2025 | 2025 | 2025 | 2025 | 2025 | ||||||||||||||||||||||||||||
| Operating (loss) income | $ | (1,485) | $ | (3,316) | $ | 9,644 | $ | 46,111 | $ | 50,954 | ||||||||||||||||||||||
Stock-based compensation expense(1) | — | 11,155 | — | — | 11,155 | |||||||||||||||||||||||||||
Legal fees(2) | — | 1,736 | 1,289 | 1,025 | 4,050 | |||||||||||||||||||||||||||
| Adjusted operating (loss) income | $ | (1,485) | $ | 9,575 | $ | 10,933 | $ | 47,136 | $ | 66,159 | ||||||||||||||||||||||
(1) Represents accelerated stock-based compensation expense for certain employees who are 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.
(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. These costs do not reflect costs associated with our normal ongoing operations.
Reconciliation of GAAP Operating Margin to Non-GAAP Adjusted Operating Margin
| Three Months Ended | Year Ended | |||||||||||||||||||||||||||||||
| March 31, | June 30, | September 30, | December 31, | December 31, | ||||||||||||||||||||||||||||
| 2025 | 2025 | 2025 | 2025 | 2025 | ||||||||||||||||||||||||||||
Operating margin(1) | (0.7) | % | (1.5) | % | 4.3 | % | 17.1 | % | 5.6 | % | ||||||||||||||||||||||
Stock-based compensation expense(2) | — | % | 5.1 | % | — | % | — | % | 1.3 | % | ||||||||||||||||||||||
Legal fees(3) | — | % | 0.8 | % | 0.6 | % | 0.4 | % | 0.4 | % | ||||||||||||||||||||||
Adjusted operating margin(4) | (0.7) | % | 4.4 | % | 4.9 | % | 17.5 | % | 7.3 | % | ||||||||||||||||||||||
(1) Operating margin is calculated as operating income (loss) divided by total revenue.
(2) Represents accelerated stock-based compensation expense for certain employees who are 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.
(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. These costs do not reflect costs associated with our normal ongoing operations.
(4) Adjusted operating margin is calculated as adjusted operating margin divided by total revenue.
Reconciliation of GAAP Income Before Income Taxes to Non-GAAP Adjusted Income Before Income Taxes
| Three Months Ended | Year Ended | |||||||||||||||||||||||||||||||
| March 31, | June 30, | September 30, | December 31, | December 31, | ||||||||||||||||||||||||||||
| 2025 | 2025 | 2025 | 2025 | 2025 | ||||||||||||||||||||||||||||
| Income (loss) before income taxes | $ | 4,159 | $ | (2,332) | $ | 13,551 | $ | 50,319 | $ | 65,697 | ||||||||||||||||||||||
Stock-based compensation expense(1) | — | 11,155 | — | — | 11,155 | |||||||||||||||||||||||||||
Legal fees(2) | — | 1,736 | 1,289 | 1,025 | 4,050 | |||||||||||||||||||||||||||
Asset impairment charge(3) | — | 4,046 | — | — | 4,046 | |||||||||||||||||||||||||||
| Adjusted income before income taxes | 4,159 | $ | 14,605 | $ | 14,840 | $ | 51,344 | $ | 84,948 | |||||||||||||||||||||||
(1) Represents accelerated stock-based compensation expense for certain employees who are 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.
(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. These costs do not reflect costs associated with our normal ongoing operations.
(3) Represents a non-cash impairment of a strategic investment, which does not reflect costs associated with our ongoing operations, and was recorded in other expense (income), net in the consolidated statements of operations and comprehensive income (loss).
Reconciliation of GAAP Income Tax Expense (Benefit) to Non-GAAP Adjusted Income Tax Expense
| Three Months Ended | Year Ended | |||||||||||||||||||||||||||||||
| March 31, | June 30, | September 30, | December 31, | December 31, | ||||||||||||||||||||||||||||
| 2025 | 2025 | 2025 | 2025 | 2025 | ||||||||||||||||||||||||||||
| Income tax expense (benefit) | $ | 1,167 | $ | 1,260 | $ | 3,619 | $ | (85,771) | $ | (79,725) | ||||||||||||||||||||||
| Stock-based compensation expense | — | 2,770 | — | — | 2,770 | |||||||||||||||||||||||||||
| Legal fees | — | 431 | 320 | 255 | 1,006 | |||||||||||||||||||||||||||
Release of valuation allowance(1) | — | — | — | 88,751 | 88,751 | |||||||||||||||||||||||||||
| Adjusted income tax expense | $ | 1,167 | $ | 4,461 | $ | 3,939 | $ | 3,235 | $ | 12,802 | ||||||||||||||||||||||
(1) Non-recurring income tax benefit of the release of the valuation allowance against net deferred tax assets.
Reconciliation of GAAP Effective Tax Rate to Non-GAAP Adjusted Effective Tax Rate
| Three Months Ended | Year Ended | |||||||||||||||||||||||||||||||
| March 31, | June 30, | September 30, | December 31, | December 31, | ||||||||||||||||||||||||||||
| 2025 | 2025 | 2025 | 2025 | 2025 | ||||||||||||||||||||||||||||
Effective tax rate(1) | 28.1 | % | (54.0) | % | 26.7 | % | (170.5) | % | (121.4) | % | ||||||||||||||||||||||
| Stock-based compensation expense | — | % | 73.1 | % | — | % | — | % | 4.2 | % | ||||||||||||||||||||||
| Legal fees | — | % | 11.4 | % | (0.2) | % | 0.5 | % | 1.5 | % | ||||||||||||||||||||||
Release of valuation allowance(2) | — | % | — | % | — | % | 176.3 | % | 130.8 | % | ||||||||||||||||||||||
Adjusted effective tax rate(3) | 28.1 | % | 30.5 | % | 26.5 | % | 6.3 | % | 15.1 | % | ||||||||||||||||||||||
(1) Effective tax rate is calculated by dividing income tax expense (benefit) by income before income taxes.
(2) Non-recurring income tax benefit of the release of the valuation allowance against net deferred tax assets.
(3) Adjusted effective tax rate is calculated by dividing adjusted income tax expense by adjusted income before income taxes.
Full Year 2026 Outlook
Reconciliation of Full Year 2026 Outlook of Estimated Net Income per Diluted Share
to Adjusted Net Income per Diluted Share
| Outlook Full Year 2026 | Tax Rate Outlook Full Year 2026 | |||||||||||||||||||||||||
| Low Range | High Range | Low Range | High Range | |||||||||||||||||||||||
| Net income per diluted share | $1.23 | – | $1.81 | 49.0% | – | 44.0% | ||||||||||||||||||||
Legal fees(1) | 0.12 | – | 0.08 | (1.0)% | – | (1.0)% | ||||||||||||||||||||
Tax impact of stock-based compensation(2) | 0.50 | – | 0.46 | (20.0)% | – | (17.0)% | ||||||||||||||||||||
| Adjusted net income per diluted share | $1.85 | – | $2.35 | 28.0% | – | 26.0% | ||||||||||||||||||||
(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. These costs do not reflect costs associated with our normal ongoing operations.
(2) Represents the estimated tax impact of permanent differences that arise between the expense recognized for financial reporting of stock-based compensation awards and the tax deduction the Company receives (tax windfall or shortfall). Accounting standards codification guidance requires that any excess or deficient tax deduction for stock-based compensation be immediately recorded within income tax expense. These amounts represent the estimated discrete tax impact for stock-based compensation during the period presented.
Inspire Medical Systems, Inc. February 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 potential impacts to our business associated with Inspire V reimbursement, our plans to obtain a long-term solution that would support appropriate reimbursement for Inspire V, and our expectations regarding our full year 2026 financial outlook (including without limitation expectations for the impacts of coding uncertainty and the range of outcomes from applying a CPT code 64582 with a modifier and other aspects to reimbursement, revenue, expected growth, adjusted operating margin, net income per diluted share, adjusted net income 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: there may be uncertainty in, or changes to, billing codes to be used for our Inspire therapy, which could impact reimbursement rates and physician usage; our financial results may fluctuate significantly and may not fully reflect the underlying performance of our business; our history of operating losses and dependency on our Inspire therapy for revenues; 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 therapy or any future products we may seek to commercialize; competitive companies, technologies and pharmaceuticals in our industry; our involvement in current or future legal disputes or regulatory proceedings; our ability to expand our indications and develop and commercialize additional products and enhancements to our Inspire therapy; future results of operations, financial position, research and development costs, capital requirements and our needs for additional financing; our ability to accurately forecast customer demand for our Inspire therapy and manage our inventory; our dependence on third-party suppliers, vendors, and contract manufacturers; 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 therapy in markets outside of the U.S.; our ability to manage our growth; our ability to hire and retain our senior management and other highly qualified personnel; risk related to product liability claims and warranty claims; our ability to address quality issues that may arise with our Inspire therapy; our ability to successfully integrate any acquired business, products, or technologies; changes in global macroeconomic trends; our business model and strategic plans for products, technologies and business, including our implementation thereof; the impact of glucagon-like peptide 1 class of drugs on demand for our Inspire therapy; risks related to information technology and cybersecurity; our ability to commercialize or obtain regulatory approvals for our Inspire therapy, or the effect of delays in commercializing or obtaining regulatory approvals; and FDA or other U.S. or foreign regulatory actions affecting us or the healthcare industry generally. 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, 2024, as updated in our Quarterly Report on Form 10-Q for the quarter ended September 30, 2025 and as will be further updated in our Annual Report on Form 10-K for the fiscal year ended December 31, 2025, 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. 2
© 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. 3
enhancing patient lives through sleep innovation I t a l l s tarts and ends wi th our mission We are a medical technology company committed to
© Inspire Medical Systems, Inc. All Rights Reserved. Company Overview The first and only … 5 >385 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 >125,000 INSPIRE PATIENTS Significant first-mover advantage >$10 BILLION Underpenetrated U.S. market Innovative, closed-loop, neurostimulation technology for Obstructive Sleep Apnea (OSA)
From our entrepreneurial beginnings, and with a focus on delivering life-changing outcomes, we’ve been enhancing the lives of patients for over 18 years… >125,000 Patients receiving Inspire >$900M Revenue >1,500 Implanters Founded 2007 IPO 2018 Today 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
First Mover. Market Disruptor. Innovation Leader. 125K pat ient s w i th Insp i re Proving out our care pathways and therapy optimization Cl in ica l ev idence >350 publications portraying a compelling body of evidence >$900M revenue in 2025 With 50% five-year CAGR, continuing our strong performance Next -gen neuros t imu lator >20 years in pursuing perfection of our technology Broad payor coverage Reimbursement in all 50 states with >300 million US covered lives >$10B domest ic market With less than 5% penetration we have plenty of room for growth
Obstructive Sleep Apnea is caused by blockage that prevents airf low to the lungs 8 Airway obstruction during breathing Typical OSA event • 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
OSA is a chronic disease that is often untreated and proven to be l inked to ser ious health r isks 9 Exacerbated Health Risks • 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 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 Typical Patient Profile 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.
Current treatment options, such as CPAP and invasive surgeries, have s ignif icant l imitations 10 InaUvulopalatopharyngoplasty (UPPP) Maxillomandibular Advancement (MMA) • Several variations of sleep surgery • Success rates vary widely (30% - 60%)1 • Irreversible anatomy alteration • Inpatient surgery with extended recovery …with surgical alternatives for treatmentCPAP is the first-line therapy… 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 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 prescriptions annually ~2,000,000 CPAP non-compliant ~700,000 Inspire eligible ~500,000 Adults with moderate to severe OSA ~23,000,000 >$10B opportuni ty The domestic OSA market is huge… Internal estimates
Inspire Therapy is an Innovative and Proven Solution for Patients with OSA Inspire Therapy Utilizes a Proprietary closed-loop Sensing Algorithm to Modulate Therapy Delivery Inspire V Solution 2 Typically a 30-45 minute outpatient procedure Requires only two small incisions Patients usually recover quickly and resume normal activities within a few days 31 Neurostimulator houses the electronics, sensing and battery power for the device Patient Remote facilitates patient control of therapy Stimulation lead delivers electrical stimulation to the hypoglossal nerve Stimulation Lead Neurostimulator Inspire V Neurostimulator Patient Remote
The Inspire Patient Journey is a mult i-specialty care continuum 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
- 20,000 40,000 60,000 80,000 100,000 120,000 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Total implants New implants Minutes between implants Our global impact continues to cl imb >125K Patients receiving Inspire therapy to date A patient receives Inspire therapy on average every ~15 minutes ≈100 hours ≈5 hours ≈15 mins
Continuous Data Collection & Outcomes Monitor ing 15 AHI = Apnea Hypopnea Index ESS = Epworth Sleepiness Scale Post Market Surveillance Data Real World Data Proactive Data Reactive Data Data Analysis for Signals US Centers EU Centers (Belgium, Germany, Netherlands, Switzerland • Collection of real-world, international outcomes data • Eligibility – ALL patients receiving Inspire therapy • ADHERE Registry - 5,000 enrollments at 61 medical centers • Transition to ADHERE 2.0 as part of Inspire SleepSync in the U.S.
16Inspire Patient Experience Report and Internal Data 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 Cu m ul at iv e Su rv iv al P er ce nt ag e Months After Implant Inspire Global System Survivability to Revision by Implant Year 2018 2020 2019 20212022 2023 2024 2025 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 Cu m ul at iv e Su rv iv al P er ce nt ag e Months After Implant Inspire Global System Survivability to Explant by Implant Year 2018 2020 2019 2021 2022 2023 2024 2025 2025 data is partial year 2025 data is partial year Continued Improvement in System Safety and Rel iabi l i ty
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) Inspire patients report less sleepiness and demonstrate increased therapy adherence 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 Inspire patients report having a positive patient experience and enhanced quality of life Strong Patient Outcomes Inspire Patient Experience Report, 2024
Compared to CPAP, Inspi re has been Demonstrated to be Better at Improving OSA Symptoms, Potent ia l ly wi th Greater Therapy Adherence 18 Therapy Adherence1 4.0 5.0 Usage/Night (hours) Sleepiness Reduction1 3.9 8.0 ESS reduction (points) 2 p = 0.042 p = 0.087 CPAP CPAP UAS (Inspire) UAS (Inspire) 1. Heiser, Sleep & Breathing 2022 Comparison between baseline and 12-month follow-up between matched cohorts 2. Epsworth Sleepiness Scale
Current Sensor Inspire V Sensor Performance Therapy Evolution Built-in • Multiple electrodes capability • Enables new stim targets and sensing features Flexible Software Platform • Downloadable features for clinical studies and field upgrades • Future features could include posture-responsive therapy, auto start/pause, AHI detection State of the Art Technology • Allows stim of multiple targets • Multiple Sensing Modes Proven Cybersecurity Consistent Long Battery Life of 11 Years on Average SleepSync Connectivity • Support for future remote programming • Remote software updates for all components Inspire V: Reduced implant time, improved therapy performance, fewer revisions & future innovation
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 Continuing to evolve with future innovation in mind
• 100% of implants completed successfully • 20% reduction in surgical time • Therapy Adherence of 5.9±1.2 hours/night • No serious device or intraoperative adverse events • Wound dehiscence (resolved) in two patients post-op are only serious adverse events and patients provided antibiotics and events resolved within two weeks Inspire V Clinical Study conducted in Singapore with 44 patients *Inclusive of previous Inspire generations (data collected during the Wear Study) **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 *Total of n=43; One patient was early exit (refused further study visits) and scored as a non-responder; compared to 66% at 12M in STAR **6M PSGs were conducted at 1 therapeutic amplitude throughout the entire night; no changes were made to device settings** All-night AHI** Stimulation delivered when the airway is most vulnerable to collapse which is during the inspiratory phase Response Rate (Sher20): 79.5%1 Sensing with Inspire V is SUPERIOR to Inspire IV**
Inspire V Limited Market Release conducted with 101 patients at 11 U.S. Centers Tracking data and currently 49 patients with AHI data collected to date at 6-months • 100% successful implants for all 101 patients • 100% of patients continue on therapy • No serious adverse events • 5 non-serious adverse events • Neuropraxia – resolved before activation(2) • Mild marginal mandibular weakness(1) • Mild ear pain(1) • Incision swelling/tenderness(1) • Average amplitude 1.5v • Average adherence @ 6 months • 6.3 Hours per night • 80% nights used • Patients utilizing new features • Small Step Size – 26% • Start Impulse – 17% • Ramp – 26%
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 Patient Inspire App Clinician 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
© Inspire Medical Systems, Inc. All Rights Reserved. $82 $115 $233 $408 $625 $803 $912 0.0 100.0 200.0 300.0 400.0 500.0 600.0 700.0 800.0 900.0 1,000.0 2019 2020 2021 2022 2023 2024 2025 24 Annual Revenue and Gross Margin ($ in Mil l ions) Annual Gross Margin 83.4% 84.7% 85.7% 83.8% 84.5% 84.7% 85.4% 2026 Guidance: • FY2026 revenue range of $950M-$1.0B, representing 4%-10% growth over FY2025 • FY2026 Adjusted operating income margin between 6%-8% • FY2026 Adjusted EPS $1.85-$2.35
© Inspire Medical Systems, Inc. All Rights Reserved.25 Recent Business Highlights • Made steady progress on the full launch of the Inspire V system in the U.S. • Presented Inspire V safety and efficacy data at AAO-HNS / ISSS meetings Continued Commercial Expansion Financial Performance • Generated $269.1 million of revenue in the fourth quarter, a 12% increase over the same quarter last year • Achieved gross margin of 86.6% in the fourth quarter • Reported net income per diluted share of $4.66 in the fourth quarter or $1.65 adjusted • Generated $53 million in operating cash flow for the fourth quarter; $117 million full year • Completed $175 million in share repurchase in 2025
© Inspire Medical Systems, Inc. All Rights Reserved. Our Growth Strategy 26 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
Inspire Way We are a medical technology company committed to enhancing patient lives through sleep innovation “Put the patient first and you will never lose your way.” Demonstrate Operational Excellence Drive Therapy Adoption Strengthen Organizational Culture Focused on Outcomes. Fueled by Innovation. Grounded in Integrity. Committed to Compliance. Leading with Respect. Positively Persistent.
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 ®
© Inspire Medical Systems, Inc. All Rights Reserved. Appendix 29
© Inspire Medical Systems, Inc. All Rights Reserved. Consolidated Statements of Operations & Comprehensive Income (Unaudited)(In thousands, except share and per share amounts) 30
© Inspire Medical Systems, Inc. All Rights Reserved. Condensed Consolidated Balance Sheets (Unaudited)(In thousands) 31
© Inspire Medical Systems, Inc. All Rights Reserved. Reconciliation of GAAP Net Income (Loss) to Non-GAAP Adjusted Net Income (Unaudited)(In thousands) 32
© Inspire Medical Systems, Inc. All Rights Reserved. Reconciliation of GAAP Net Income (Loss) per Diluted Share to Non-GAAP Adjusted Net Income per Diluted Share (Unaudited) 33
© Inspire Medical Systems, Inc. All Rights Reserved. Reconciliation of GAAP Operating Income (Loss) to Non- GAAP Adjusted Operating Income (Loss) (Unaudited)(In thousands) 34
© Inspire Medical Systems, Inc. All Rights Reserved. Reconciliation of GAAP Operating Margin to Non-GAAP Adjusted Operating Margin (Unaudited) 35
$40 $53 $62 $78 $69 $91 $109 $138 $128 $151 $153 $193 $164 $196 $203 $240 $201 $217 $225 $269 1Q21 2Q21 3Q21 4Q21 1Q22 2Q22 3Q22 4Q22 1Q23 2Q23 3Q23 4Q23 1Q24 2Q24 Q324 Q424 Q125 Q225 Q325 Q425 36 Quarterly Revenue ($ in Millions) %YoY Revenue Growth 72% 73% 77% 76% 84% 65% 40% 40% 28% 30% 33% 25% 23% 11% 10% 12%
© Inspire Medical Systems, Inc. All Rights Reserved. Company Overview Our History and Key Milestones 37 20222016 20202007 2014 2018 20232017 20212011 • 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 2010 • Inspire II CE mark received in Europe 2024 • Inspire V approval from the FDA; EU MDR approval; French reimbursement; 90,000th implant 2025 • 100,000th implant; Inspire V U.S. launch
Proven management team that is grounded in integrity, fueled by innovation, and devoted to delivering on the promise of our mission Randy Ban Executive Vice President, Patient Access & Therapy Development Joined 2009 Bryan Phillips SVP, General Counsel & Chief Compliance Officer Joined 2021 Tim Herbert Chair, President & Chief Executive Officer Joined 2007 Ezgi Yagci Vice President, Investor Relations Joined 2022 Matt Osberg Chief Financial Officer Joined 2026 John Rondoni Chief Product & Innovation Officer Joined 2008 Carlton Weatherby Chief Strategy & Growth Officer Joined 2023 Jason Kelly Chief Manufacturing & Quality Officer Joined 2025 Melissa Mann Chief People Officer Joined 2024
© Inspire Medical Systems, Inc. All Rights Reserved. Supporting Patients on their Path to Inspire 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 39
© Inspire Medical Systems, Inc. All Rights Reserved. Inspire Patient THE PATIENT JOURNEY 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 C h a l l e n g e s What is the biggest pain point for patients? S U P P O R T 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 40
© Inspire Medical Systems, Inc. All Rights Reserved. Patient Engagement Conversion Initiatives 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 41
Health Economics: Untreated OSA Cost Burden • 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 mortality1. Wickwire JCSM 2020; Wickwire Sleep Breathing 2022 2. Pepin, ERS 2021 Conference Growing evidence that CPAP intolerance is linked to higher healthcare costs1 94% 42
Sustainability at Inspire 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 TA 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.
© Inspire Medical Systems, Inc. All Rights Reserved. Our Intellectual Property Portfolio (as of December 31, 2025) 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) 44
FAQ
How did Inspire Medical Systems (INSP) perform financially in 2025?
In 2025, Inspire Medical Systems delivered solid growth and profits. Revenue rose 14% to $911.9 million , with gross margin of 85.4% . Net income reached $145.4 million , adjusted EBITDA was $200.6 million , and operating cash flow totaled $117.0 million for the year.
What were Inspire Medical Systems’ Q4 2025 results?
Fourth quarter 2025 showed continued expansion for Inspire. Revenue grew 12% year over year to $269.1 million . Operating income was $46.1 million with a 17.1% operating margin, while net income reached $136.1 million , or $4.66 per diluted share, aided by a large tax benefit.
What 2026 financial guidance did Inspire Medical Systems (INSP) provide?
For 2026, Inspire expects slower but positive growth. Revenue is guided to $950 million–$1.0 billion , implying 4%–10% annual growth. The company targets adjusted operating margin of 6%–8% and adjusted net income per diluted share between $1.85 and $2.35 .
How are reimbursement and coding changes affecting Inspire’s outlook?
Management links a softer 2026 outlook to coding and reimbursement factors. They recently received coding clarification for the Inspire V procedure and expect a shift to CPT code 64582 with a -52 modifier, which they describe as disappointing and a driver of wider, more cautious 2026 guidance ranges.
What capital allocation actions did Inspire Medical Systems take in 2025?
In 2025, Inspire combined growth investment with buybacks. Operating cash flow was $117.0 million , and the company repurchased $175 million of stock, including $50 million in the fourth quarter. Year-end cash, cash equivalents, and investments stood at $404.6 million .
What corporate governance changes is Inspire Medical Systems proposing?
The company plans to modernize its board structure. At the 2026 annual meeting, it will seek shareholder approval to declassify the board and move to annual director elections, alongside bylaw amendments that remove the “for cause only” director removal limit in favor of Delaware law standards.
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Inspire Medical
NYSE:INSP
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1.71B
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Medical Devices
Surgical & Medical Instruments & Apparatus
United States
GOLDEN VALLEY