Inspire Medical: Coding overhang; move to Underperform

Research evidence excerpt

Inspire Medical: Coding overhang; move to Underperform

ion to behave more

like a reimbursement and market access team, with reps spending time on coding

education, administrator engagement, and prior auth workflows rather than recruiting

new surgeons and driving new centers. INSP has added reimbursement specialists and

prior auth resources (increasing SG&A spend) because it could not rely on territory

managers to become reimbursement experts. While INSP has said it is willing to be

flexible with the sales force to maintain morale/prevent attrition, if confusion persists,

productivity risk and morale risk could become harder to ignore, especially when growth

is slowing and variability across centers/territories remains high. Our view is that these

steps are necessary to educate centers but also signal the INSP’s is still in stabilization

mode, not acceleration mode, and will likely need to continue to invest to educate

centers and prevent rep attrition.

INSP still has moat, but competition changes the math

INSP still has an advantage in terms of patients treated (easier for docs to trust product

that has 1000s of patients treated), cardiovascular outcome data, and a pipeline of

innovation (INSP VI, automated sleep detection.) However, INSP has acknowledged

competitors were coming (Nyxoah and LivaNova), and that some accounts would trial

alternatives as the category evolves from one credible option to 2-3. We think that shift

creates another question for INSP, because early competitive activity tends to focus on

influential high-volume accounts (another risk to near-term #s.) Competitors also benefit

from a clean slate in how they educate centers on reimbursement and process, while

INSP is still having to re-educate a large installed base account-by-account (lengthy and