Inspire Medical Systems’ first quarter results were met with a significant negative response from the market, as management pointed to persistent challenges in reimbursement coding and operational disruptions related to the WISER program. CEO Timothy Herbert described the period as one of uncertainty, highlighting that both the ongoing reimbursement confusion and new prior authorization requirements in six WISER pilot states materially impacted the company’s revenue pipeline. These factors led to a cautious stance on short-term performance, with Herbert acknowledging that many treatment centers put on the brakes to understand new billing protocols before proceeding with patient authorizations. Additionally, management revised its full-year revenue guidance to a range of $825 million to $875 million, down from its prior range, reflecting anticipated challenges for the remainder of the year. The full-year adjusted diluted EPS guidance was also revised to a range of $0.75 to $1.25.
Is now the time to buy INSP? Find out in our full research report (it’s free for active Edge members).
Inspire Medical Systems (INSP) Q1 CY2026 Highlights:
- Revenue: $204.6 million vs analyst estimates of $200.7 million (1.6% year-on-year growth, 1.9% beat)
- Adjusted EPS: $0.10 vs analyst estimates of -$0.26 (significant beat)
- Adjusted EBITDA: $35.89 million vs analyst estimates of $19.86 million (17.5% margin, 80.7% beat)
- The company dropped its revenue guidance for the full year to $850 million at the midpoint from $975 million, a 12.8% decrease
- Management lowered its full-year Adjusted EPS guidance to $1 at the midpoint, a 52.4% decrease
- Operating Margin: 0.2%, in line with the same quarter last year
- Market Capitalization: $1.28 billion
While we enjoy listening to the management's commentary, our favorite part of earnings calls are the analyst questions. Those are unscripted and can often highlight topics that management teams would rather avoid or topics where the answer is complicated. Here is what has caught our attention.
Our Top 5 Analyst Questions From Inspire Medical Systems’s Q1 Earnings Call
- Lily (J.P. Morgan) asked about the assumptions behind the revised guidance and how confident management is that the outlook is appropriately de-risked. CEO Timothy Herbert explained that improvement relies on building centers’ confidence in coding and prior authorizations as the year progresses.
- Jonathan Block (Stifel) inquired whether the $120–$150 million revenue headwind from reimbursement issues could lead to pent-up demand or lost opportunities, and if there were early signs of improvement. Herbert responded that tracking and supporting patients in the pipeline remains a focus, with some progress noted in Medicare billing practices.
- Adam Maeder (Piper Sandler) questioned whether the guidance cut stems entirely from reimbursement issues or if GLP-1 medications and competition are also factored in. CFO Matthew Osberg said the primary driver is reimbursement headwinds, with other factors like GLP-1s being harder to quantify.
- Christopher Pasquale (Nephron Research) asked about the rationale and impact of recent salesforce realignment. Herbert stated that territory consolidation and hiring of clinical reps were intentional to better support centers through ongoing reimbursement uncertainty.
- Anthony Petrone (Mizuho) sought clarity on WISER state procedural backlogs and the coding ambiguity between Medicare and commercial payers. Herbert explained that WISER delays are likely temporary, and coding for procedures varies by payer but is being addressed with targeted education.
Catalysts in Upcoming Quarters
In upcoming quarters, key areas to monitor include (1) the pace at which treatment centers become comfortable with new coding and reimbursement protocols, (2) the company’s success in reducing WISER program–related procedural delays, and (3) the outcome and industry reception of new clinical data presented at the SLEEP conference. Continued monitoring of territory management effectiveness and the competitive landscape will also be crucial.
Inspire Medical Systems currently trades at $44.26, down from $54.84 just before the earnings. Is the company at an inflection point that warrants a buy or sell? The answer lies in our full research report (it’s free).
The Best Stocks for High-Quality Investors
ONE MORE THING: Top 5 Growth Stocks. The biggest stock winners almost always had one thing in common before they ran. Revenue growing like crazy. Meta. CrowdStrike. Broadcom. Our AI flagged all three. They returned 315%, 314%, and 455%, respectively.
Find out which 5 stocks it's flagging for this month - FREE. Get Our Top 5 Growth Stocks for Free HERE.
Stocks that have made our list include now familiar names such as Nvidia (+1,326% between June 2020 and June 2025) as well as under-the-radar businesses like the once-micro-cap company Kadant (+351% five-year return). Find your next big winner with StockStory today.
