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Inspire Medical Systems, Inc.: Q2 FY2026 earnings call

What management said about Q2 FY2026, from the documents filed with the SEC on 3 August 2026: press release. Guidance figures: 5 raised, 2 lowered, 1 kept. The quarter’s numbers.

Key takeaways

  • Revenue fell 7.6% to $200.6 million: Q2 2026 revenue declined from $217.1 million in Q2 2025, driven primarily by U.S. market weakness. U.S. decline caused by impacts of evolving coding and reimbursement environment affecting Inspire V procedures. Source
  • Gross margin expanded to 85.5% from prior year: Gross margin increased 150 basis points from 84.0% in Q2 2025, primarily due to increased sales mix of higher-margin Inspire V system compared to Inspire IV. Source
  • Operating loss nearly eliminated to $(0.5) million: Operating loss narrowed significantly from $(3.3) million in Q2 2025 to $(0.5) million in Q2 2026. Adjusted operating income improved to $3.2 million with adjusted operating margin of 1.6%. Source
  • Operating cash flow surged to $23.2 million: Q2 operating cash flow of $23.2 million increased substantially from $2.7 million in Q2 2025. Improvement driven by enhanced working capital management, particularly optimized receivables and inventory levels. Source
  • Restructuring charges of $20-25 million expected: First phase includes $4-5 million of employee-related costs and $16-20 million of non-cash supply chain consolidation expenses. Majority of actions expected to complete in Q3 2026, all substantially complete by year-end. Source
  • Full year revenue guidance raised to $835-875 million: Revenue guidance raised at low end by $10 million. New range reflects improved confidence in ability to navigate reimbursement challenges and stabilize market despite ongoing disruption. Source
  • Adjusted operating margin guidance raised 200 basis points: Adjusted operating margin guidance increased from 2-4% to 4-6%. Reflects operational improvements, disciplined cost management, and Project Horizon strategic initiatives. Source
  • Adjusted diluted EPS raised to $1.05-1.45: Adjusted diluted EPS guidance raised from $0.75-$1.25 to $1.05-$1.45. Reflects operational leverage and cost reduction benefits, partially offset by elevated tax impacts. Source
  • Diluted EPS guidance lowered to $(0.42)-$0.17: Diluted EPS guidance lowered from $0.07-$0.62 to $(0.42)-$0.17. Primary drivers are elevated effective tax rate of 95-100% and $20-25 million restructuring charges. Source

“Our second quarter results reflect the increased discipline and focus we are bringing to the business as we continue to support customers through the evolving coding and reimbursement environment”

Tim Herbert, Chairman and CEO

Guidance

AreaPeriodFigureAgainst last quarter
Revenue SourceFull year 2026$835 million to $875 millionRaised from $825 million to $875 million
Adjusted operating margin SourceFull year 20264% to 6%Raised from 2% to 4%
Diluted EPS SourceFull year 2026$(0.42) to $0.17Lowered from $0.07 to $0.62
Adjusted diluted EPS SourceFull year 2026$1.05 to $1.45Raised from $0.75 to $1.25
Effective tax rate SourceFull year 202695% to 100%Raised from 65% to 70%
Adjusted effective tax rate SourceFull year 202630% to 35%Raised from 27% to 29%
Capital expenditures SourceFull year 2026$35 million to $40 millionLowered from $40 million to $45 million
Weighted average diluted shares SourceFull year 202629.4 millionKept

What changed from last quarter

  • Guidance raised: Full year revenue guidance raised at low end by $10 million to $835-875 million. Reflects improved confidence despite ongoing coding and reimbursement environment disruption persisting through 2026. Source
  • Guidance raised: Adjusted operating margin guidance raised by 200 basis points to 4-6% from prior 2-4%. Reflects operational improvements and cost discipline from Project Horizon execution. Source
  • Guidance raised: Adjusted diluted EPS guidance raised from $0.75-$1.25 to $1.05-$1.45. Reflects operational improvements and strategic cost reduction initiatives from restructuring plan. Source
  • Guidance lowered: Diluted EPS guidance lowered from $0.07-$0.62 to $(0.42)-$0.17. Primarily due to elevated effective tax rates and $20-25 million pre-tax restructuring charges from Project Horizon. Source

Second Quarter Revenue Decline

  • Revenue fell 7.6% to $200.6 million: Q2 2026 revenue declined from $217.1 million in Q2 2025, driven primarily by U.S. market weakness. U.S. decline caused by impacts of evolving coding and reimbursement environment affecting Inspire V procedures. Source
  • Gross margin expanded to 85.5% from prior year: Gross margin increased 150 basis points from 84.0% in Q2 2025, primarily due to increased sales mix of higher-margin Inspire V system compared to Inspire IV. Source
  • International growth partially offset U.S. weakness: International revenue growth provided geographic diversification, partially offsetting U.S. market decline from reimbursement disruption. Source

Profitability and EPS Results

  • Operating loss nearly eliminated to $(0.5) million: Operating loss narrowed significantly from $(3.3) million in Q2 2025 to $(0.5) million in Q2 2026. Adjusted operating income improved to $3.2 million with adjusted operating margin of 1.6%. Source
  • Diluted EPS of $0.01 despite high tax rate: Net earnings of $0.3 million with diluted EPS of $0.01. Adjusted net earnings of $4.0 million with adjusted diluted EPS of $0.14 after adjusting for legal and restructuring costs. Source
  • Effective tax rate elevated to 89.9% from negative 54%: Effective tax rate increased significantly due to discrete tax impacts from stock-based compensation activity. Prior-year rate reflected valuation allowance maintenance; allowance was released at December 31, 2025. Source

“We are also announcing a strategic growth plan designed to generate approximately $30 million of annualized growth investment capacity, which we intend to redeploy into targeted growth initiatives.”

Tim Herbert, Chairman and CEO

Operating Expense Management

  • Operating expenses declined 7.4% to $172.0 million: Operating expenses decreased $13.8 million, driven by lower stock-based compensation from prior-year acceleration for retirement-eligible employees and lower marketing expenses. Source

Cash Generation and Capital Position

  • Operating cash flow surged to $23.2 million: Q2 operating cash flow of $23.2 million increased substantially from $2.7 million in Q2 2025. Improvement driven by enhanced working capital management, particularly optimized receivables and inventory levels. Source
  • Cash and investments at $415.2 million: Cash, equivalents, and investments increased $10.6 million year-to-date to $415.2 million as of June 30, 2026, reflecting positive operating cash generation and disciplined capital deployment. Source

“We believe these actions will strengthen our operating foundation, sharpen our focus on the highest-return opportunities, and position Inspire for sustainable growth and long-term value creation.”

Tim Herbert, Chairman and CEO

Strategic Growth Plan (Project Horizon)

  • Restructuring charges of $20-25 million expected: First phase includes $4-5 million of employee-related costs and $16-20 million of non-cash supply chain consolidation expenses. Majority of actions expected to complete in Q3 2026, all substantially complete by year-end. Source
  • Strategic plan strengthens operating foundation: Management believes Project Horizon will strengthen operating foundation, sharpen focus on highest-return opportunities, and position company for sustainable long-term growth and value creation. Source

2026 Guidance Raised on Revenue and Margins

  • Full year revenue guidance raised to $835-875 million: Revenue guidance raised at low end by $10 million. New range reflects improved confidence in ability to navigate reimbursement challenges and stabilize market despite ongoing disruption. Source
  • Adjusted operating margin guidance raised 200 basis points: Adjusted operating margin guidance increased from 2-4% to 4-6%. Reflects operational improvements, disciplined cost management, and Project Horizon strategic initiatives. Source
  • Adjusted diluted EPS raised to $1.05-1.45: Adjusted diluted EPS guidance raised from $0.75-$1.25 to $1.05-$1.45. Reflects operational leverage and cost reduction benefits, partially offset by elevated tax impacts. Source
  • Diluted EPS guidance lowered to $(0.42)-$0.17: Diluted EPS guidance lowered from $0.07-$0.62 to $(0.42)-$0.17. Primary drivers are elevated effective tax rate of 95-100% and $20-25 million restructuring charges. Source

Coming up, as management said on 3 August 2026

  • Project Horizon restructuring to complete by year-end: Majority of restructuring actions expected to complete in Q3 2026, with all actions substantially complete by end of 2026. Will generate approximately $30 million annualized growth investment capacity. Source
  • Return to revenue growth expected in 2027: Management expects return to revenue growth in 2027 by leveraging positive clinical outcomes and strength of Inspire V system once reimbursement challenges are resolved.

Earlier plans management reported on

  • Met: Company delivered on discipline commitment with operating expenses down 7.4% in Q2 2026 despite revenue headwinds from reimbursement disruption. Source
  • On track: Company continuing investment in long-term adoption of Inspire therapy, balancing near-term reimbursement challenges with strategic long-term positioning. Source

Other quarters

Summarised with AI from the documents the company filed with the SEC. Every point is checked against the filing before it is shown: management’s own words word for word, figures against the line or table row they come from. A point that fails the check is left out. Source opens the filing at that line.