Insulet Corporation

Good morning and welcome to the Insolent Corporation second quarter 2026 earnings call. As a reminder, this conference call is being recorded. I would now like to turn the conference over to your host, Clare Trachtman, Vice President, Investor Relations.

Good morning and welcome to our second quarter 2026 earnings call. Joining me today are Ashley McEvoy, President and Chief Executive Officer, Flavia Pease, Chief Financial Officer, and Eric Benjamin, Chief Operating Officer. On the call this morning, we will be discussing INFLIP's second quarter results along with our financial outlook for the third quarter and full year 2026. With that, let me start our prepared remarks by reminding everyone that certain statements, including comments regarding our financial outlook, the anticipated impact of our strategic actions, the potential impact of various regulatory and operational matters, and the macroeconomic environment on our results of operation contain forward-looking statements that involve risks and uncertainties. And of course, our actual results could differ materially from our current expectations. Please refer to today's press release and our SEC filings for more detail concerning factors that could cause actual results to differ materially. In addition, on today's call, non-GAAP financial measures will be used to help investors understand Inflit's ongoing business performance, including adjusted operating income, adjusted EPS, adjusted EBITDA, adjusted tax rate, and constant currency revenue, which is revenue growth excluding the effect of foreign exchange. A reconciliation of certain non-GAAP financial measures being discussed today to the comparable GAAP financial measures is included in the accompanying investor presentation and available in our earnings release issued this morning. both of which are available on our website. Additionally, unless otherwise stated, all financial commentary regarding dollar and percentage changes will be on a year-over-year reported basis with the exception of revenue growth rates, which will be on a year-over-year constant currency basis. During the Q&A session this morning, Ashley, Flavia, Eric, and myself will be available to address questions. Now I'd like to turn the call over to Ashley. Ashley?

Good morning, everyone, and thank you for joining us. We delivered another quarter of strong revenue growth, expanding profitability and solid cash flow generation. Our performance reflected the strength of our differentiated business model and our team's dedication to improving the lives of people with diabetes around the world. Total company revenue grew 23% year over year on a constant currency basis, exceeding our expectations. We saw strong demand for Omnipod across both the U.S. and International Markets, along with a benefit from favorable price mix. Importantly, we delivered growth this quarter while continuing to meaningfully improve profitability. Second quarter adjusted operating margin increased 140 basis points year over year, supported by increased manufacturing productivity and the benefits of scale. Adjusted earnings per share increased approximately 42% driven by our strong revenue growth and disciplined operating performance. Demand remained healthy with new customer starts rebounding from the seasonal slowdown in quarter one. Global new customer starts increased both sequentially and year over year, resulting in our second highest quarter ever and contributing to 23% growth in our global customer base. In the US, we continue to source more than 85% of new customer starts from MDI users and over 40% of new customer starts were people with type 2 diabetes. Internationally, Omnipod 5 became the number one insulin pump for new users in Australia. We also recently launched in Spain, marking our entry into an important new market and further expanding our global reach. We continue to expand our prescriber base with more than 32,000 healthcare providers in the US now prescribing Omnipod up 27% year over year. This growing provider adoption reflects our success in expanding awareness of AID and broadening access to Omnipod across both type 1 and type 2 diabetes. At the same time, this quarter has reinforced that we are still learning how to best serve the Type 2 market. While we have more than 25 years of experience serving people with Type 1 diabetes, we are still in the early stages of bringing Omnipod 5 to the Type 2 community. As we've gained more experience in the Type 2 market, we've developed a deeper understanding of the unique needs and behaviors of these potters. We recognize that we need to adapt our commercial model to better serve this community. Specifically, we are seeing lower rates of utilization and retention among Type 2 customers, and these trends were more pronounced this quarter than we anticipated. As we've gathered additional data and experience, we have a better understanding of these dynamics and are now incorporating learnings into our assumptions and outlook. Over the past nine months, we have driven significant growth in our Type 2 starts. particularly through our DTC activations and sampling program. Both initiatives have proven effective in getting people started. However, getting started is not enough. Customers, particularly type two customers need more support to get fully onboarded and for continuity of therapy. The first 90 days on therapy are critical for helping patients become comfortable and confident with the technology and to establish the habits and practices that then lead them to realize the full benefit of Omnipod. There are a number of key moments when our teams need to provide type two potters with a more personal, higher touch support, like when they're onboarding, their first pod activation, their first pod change, and the first time that they're refilling their prescription. As a result, we're taking a number of actions to enhance our commercial model and customer support. First, We are expanding our customer care team that supports the onboarding experience, including helping customers navigate the insurance process. Second, we're changing our Salesforce compensation structure to prioritize and reward longer term retention, not just new customer starts. Third, we're refining our approach to how we deploy samples to better identify patients who are most likely to benefit from Omnipod and support these customers during the sample process to improve conversion, retention, and long-term success. And finally, we are rolling out new technology platforms like Omnipod Discover, which has shown promising early results during its limited market release. This cloud-based platform helps providers and patients identify trends, personalize therapy, and make more informed treatment decisions. Early data is providing a glimpse into how Discover may positively influence both clinical outcomes and retention, giving us confidence in its ability to support long-term therapy success. Adoption of Omnipod Discover continues to grow with more than 12,000 people with diabetes and over 1,600 healthcare professionals using the platform today. Alongside this progress, we are accelerating the development of a modern customer data and engagement platform. By bringing together the data across our interactions with healthcare professionals and patients, we're building a more complete 360 degree view of each customer. This will enable highly personalized two-way engagement, allowing us to better anticipate needs, tailor support, and improve the overall customer experience. Over time, we expect these capabilities will help to optimize adoption, utilization, Retention and lifetime value while supporting better outcomes for the people we serve. We're confident that over time these actions will help improve long-term success for our Type 2 potters. Importantly, our data show that once Type 2 customers remain on Omnipod for the first 90 days, retention rates stabilize, a trend that we also see in our Type 1 population as patients gain confidence with the technology, and experience the benefits of Omnipod. That's why my conviction in the long-term type two opportunity remains high. While the ADA recommend AID as the standard of care, we've just begun the conversion process. Today, just over 5% of the approximately two and a half million US adult basal bolus insulin users have converted to AID. Additionally, there are approximately 3 million basal-only insulin users who may also benefit from AID therapy. While we're still in the very early stages of type 2 adoption, the opportunity is substantial with significant runway ahead. Interest in Omnipod is strong among both patients and clinicians, which translated into healthy new customer starts, with type 2 representing more than 40% of new customer starts in the second quarter. As we refine our commercial and support model and leverage new technology platforms like Omnipod Discover, we believe we can drive better outcomes, improve retention, and expand AID adoption across this large and underpenetrated market. With that context, let me now turn to our updated outlook. We're updating our full year revenue outlook to incorporate the utilization and retention trends we are seeing within our Type 2 customer base and to reflect the time required for the actions we are taking to translate into improved customer success. We now expect 2026 total company revenue growth of 20 to 22% and US Omnipod growth of 17 to 19%. We are raising our international revenue growth outlook to 30 to 32 percent, reflecting the strength of our first half performance and our sustained momentum. As CEO, I take accountability for our reduced U.S. outlook. As we've gained experience in the Type 2 market, we've developed a deeper understanding of certain dynamics that were not fully reflected in our initial planning assumptions. We should have identified the issue sooner and I'm confident in our ability to better serve the Type 2 community and in the long-term opportunity ahead. We're acting decisively to enhance our commercial and customer service model and we will continue to be transparent about what we're learning and how those learnings shape our actions and outlook. As we review our plans for 27 and beyond, We believe it's appropriate to revisit certain assumptions underlying our longer-term revenue outlook given the additional data and experience we've gained, particularly in the Type 2 market. We expect to provide an updated view on our long-range outlook on our fourth quarter call. This will give us time to incorporate additional learnings from the actions that we're taking to improve outcomes for our Type 2 customers. That said, while we're reassessing our specific long range revenue growth expectations, we remain highly confident in the significant long term opportunity ahead and our ability to create value over time. We continue to see a path to delivering top tier revenue growth, meaningful margin expansion, strong earnings growth, and positive free cash flow generation. Importantly, we continue to have strong conviction in the long term opportunity and in our ability to win in this market. That confidence is grounded in five key pillars. First, we're the market leader in one of the fastest growing segments in med tech. AID remains significantly under penetrated across both type one and type two diabetes. And we believe category growth will continue to be driven by conversion from MDI to AID therapy. As new players enter the tubeless AID market, We expect increased awareness to expand the overall category and support broader adoption, further extending our leadership position. Second, we're advancing one of the most robust innovation roadmaps in our 25 year old history to strengthen our competitive position and expand the community we can serve. We expect to deliver annual algorithm enhancements over the next four years, beginning with our latest launch in the second quarter. were encouraged by the early adoption and positive feedback we received from both potters as well as healthcare providers. One example is Darla from New Mexico who lived with type 1 diabetes for more than 40 years. After spending two decades on injections and then another two decades using a traditional tooth pump, she switched to Omnipod 5 two years ago. Darla told us she values the freedom and discretion of Omnipod's tubeless design and smartphone control. And after using our new 100 milligram per deciliter glucose target for the past few weeks, she reports tighter glucose control and more time and range. In her words, I can feel the difference. I would never go back to a tooth pump. Looking ahead, we're advancing the next generation of innovation across our pipeline. At ADA, we presented pivotal STRIVE data supporting Omnipod 6, which delivered improved time and range and time and tight range across people with type 1 and type 2 diabetes while maintaining Omnipod 5's proven safety profile. In the bolus optional phase, users held strong results while requiring significantly less bolusing, shifting the work from the user to the algorithm. Additionally, what we've learned about the type two market further reinforces our conviction in our design of our breakthrough fully closed loop system, which requires no bolusing, no settings, and no manual titration. This directly addresses the unmet need for an AID for type twos that is simpler to start, easier to sustain, and less burdensome for both patients as well as providers. Enrollment in EVOLVE, our pivotal study, is progressing well and we continue to expect a 510K submission in 2027. While the program remains in development, the clinical results to date are encouraging and support its potential to improve utilization and retention over time and broaden access to AID, particularly among the 70% of type 2 patients managed in primary care. The third pillar is expanding our commercial capabilities to accelerate AID adoption and reach new patient populations. We're investing behind our market leading brand, DTC activations, professional education, Salesforce expansion, and initiatives to improve access and affordability. We continue to work closely with payers to expand access to Omnipod and make it easier for patients to start and stay on therapy. During the quarter, we added coverage for an additional six and a half million lives and reduced barriers to therapy by simplifying prior authorization requirements for approximately 10 million lives. Fourth, we have an unmatched manufacturing network. Our scale and operational expertise represent a significant competitive advantage that will take time and substantial investment for others to replicate. Fifth and finally, the strength of our recurring revenue business model generates strong cash flow, giving us significant financial flexibility to continue investing in innovation, our commercial capabilities, and our manufacturing network while maintaining disciplined capital allocation. So let me close with this. This quarter reflects both the progress we've made across our business and the important insights we've gained as we deepen our understanding of our Type 2 customers. We're listening carefully, learning, and acting decisively. Above all, we're committed to improving how we execute to benefit global potters and our business. Looking ahead, we're confident in the future with a differentiated platform, a strong innovation pipeline, and an exceptional team. We're well positioned to improve the lives of more people living with diabetes while creating long-term value for all of our stakeholders. With that, I'll turn it over to Flavia to review the financials.

Thank you, Ashley, and good morning, everyone. The Insulet team delivered another strong quarter with $802 million in total revenue, an increase of 23.5% on a reported basis and 22.7% on a constant currency basis. US Omnipod revenue grew 20% during the quarter, driven by continued demand across both Type 1 and Type 2 customers. International Omnipod revenue grew over 35% on a reported basis and 33% on a constant currency basis, driven primarily by volume and continued favorable price mix realization. Second quarter adjusted gross margin with 72.9%, up 320 basis points year over year. Adjusted gross margin performance was driven by continued manufacturing productivity gains across our Acton and Malaysia facilities, positive pricing and increased volumes, turning to operating expenses. Within R&D, we continue to invest in our pipeline in support of the upcoming launch of Omnipod 6 in 2027 and advancing our fully closed loop for type 2 diabetes program, as well as progressing on our next generation technologies and clinical programs. Within SG&A, year-over-year growth was driven primarily by our previously discussed U.S. Salesforce expansion, as well as continued investments in customer support, and Market Development Initiatives. Importantly, we continue to balance these investments with disciplined expense management. Second quarter adjusted operating margin was 19.3%, up 140 basis points year over year, reflecting strong revenue growth, expanding scale across the business and disciplined execution against our investment priorities. Our ability to continue expanding margins while investing behind innovation, commercial capabilities, and future growth opportunities is a key differentiator of Insulet and remains central to our long-term value creation strategy. Second quarter net interest expense was $9.9 million, and our second quarter adjusted tax rate was 19.8%. Second quarter adjusted EPS was $1.66, up 41.5% from $1.17 in the prior year, with adjusted EPS increasing at nearly twice the rate of revenue growth. This performance highlights the earnings leverage inherent in our business model, as revenue growth continues to translate into disproportionately stronger EPS growth. turning to cash and liquidity. We ended the quarter with $535 million in cash and investments and the full $500 million available under our revolving credit facility. Year to date, we have generated $145 million of free cash flow, reflecting investments in working capital, inventory, and manufacturing capacity to support future growth. Turning to our full-year outlook. As Ashley discussed, we are updating our full-year revenue outlook to reflect revised retention and utilization assumptions, primarily within our Type 2 customer population. Given this change, I want to walk you through the key assumptions embedded in our updated guidance. First, our updated outlook assumes current retention and utilization trends continue through the second half of the year. This revised assumption accounts for approximately two thirds of the change to our prior guidance. Second, as highlighted last quarter, NCS started the year slower than anticipated. Additionally, while we continue to expect pricing to be positive, it will be at slightly lower level than previously anticipated. This reflects the timing and mix of commercial investments that support customer access and long-term growth, rather than any change in the competitive pricing dynamics. Together, these factors account for the remaining one-third of our guidance update. Taking these assumptions into account, we now expect full-year constant currency revenue growth of 20% to 22% for total company and 21 to 23% for total Omnipod. Foreign exchange is expected to contribute approximately 100 basis points to both measures. For the US, we now expect Omnipod revenue growth of 17 to 19% for the full year. We are increasing our full year outlook for international Omnipod to 30 to 32% on a constant currency basis. reflecting strong performance here today and continue momentum across our market. Foreign exchange is expected to contribute approximately 300 basis points to international growth. Turning to the third quarter, we expect Omnipod revenue growth of 18 to 20% and total company revenue growth of 17 and a half to 19 and a half percent. On a reported basis, Foreign exchange is expected to be a headwind of approximately 50 basis points to both measures. In the US, we expect Omnipod revenue growth of 14 to 16%. And internationally, we expect Omnipod revenue growth of 28 to 30%. On a reported basis, foreign exchange is expected to be a headwind of approximately 200 basis points to international growth. now turning to operating margin. We remain committed to increasing profitability and continue to expect to drive approximately 100 basis points of operating margin expansion in 2026. Below operating income, we expect approximately $40 billion of net interest expense and a non-GAAP tax rate of 20 to 21%. We continue to expect approximately 70 million shares outstanding and now anticipate adjusted EPS growth of at least 30% for the full year. We expect free cash flow to be down modestly from 2025 levels, which reflects the impact from the medical device corrections, but still healthy, supported by strong earnings growth and margin expansion and offset by increasing capital expenditures associated with our manufacturing expansion plan. While we are reassessing the pace of revenue growth, we remain confident in the substantial opportunity to expand Omnipod globally and deliver top-tier growth. We continue to expect adjusted operating margin to expand by approximately 100 basis points annually and adjusted EPS to grow at a CAGR of more than 25%. while continuing to generate strong free cash flow. We continue to assess the impact of the actions we are taking to improve retention and utilization. It is premature to provide formal 2027 guidance today. However, we believe it is important to share some preliminary thoughts on how to think about 2027. Based on the midpoint of our third quarter and full year guidance ranges, We expect total company constant currency revenue growth to exit 2026 in the mid teens. Our objective in 2027 is to deliver growth consistent with or better than that exit rate, supported by new product launches and the benefits of our Salesforce expansion. I would note that this preliminary view does not assume any benefit from the actions we're taking to improve retention and utilization. We will provide formal 2027 guidance along with our updated views on our long-term growth outlook on our fourth quarter earnings call. To close, we delivered another quarter of strong top-line growth, continued margin expansion, robust earnings growth, and meaningful free cash flow generation. While we are adjusting our revenue assumptions, to reflect the additional insights we have gained in the Type II market, our confidence in the opportunity ahead remains high. We serve a large and under-penetrated global market, continue to take share, and remain committed to investing behind innovation while increasing profitability. We believe this combination positions Insulet to create significant long-term value for shareholders while helping more people with diabetes around the world. With that, operator, please open the call for questions.

Thank you. We will now begin the question and answer session. I would like to remind participants that this call is being recorded and a digital replay will be available on the Intuit website. We ask that you please help us respect time by limiting to one question and one follow-up. Thank you. Our first question comes from Robbie Marcus from JP Morgan. Please go ahead. Your line is open.

Thank you and good morning and thanks for taking the question. Really wanted to focus on current trends and 27 update here. It sounds like type two is the big issue. So maybe Ashley and Flavia, you can kind of walk us through Exactly what's changed since ADA? At ADA, the comments were pretty positive. What happened since then in your learnings? When did you really start to see type 2 fall off in terms of attrition? And on 27, it sounds like you still feel like you can accelerate a bit off of exit trends. There's a big view out there and investors are worried hitting the share price about oncoming patch pump competition and potentially pricing in the pharmacy channel. So within the comments on 27, maybe you could walk us through what you're assuming for competition and pricing. And with an exit rate in the US around 10%, what gives you confidence that you could accelerate and why not take the opportunity to and perhaps lower the bar here with 27. Thanks.

Yeah, good morning, Ravi. And listen, thank you for the question. I'm going to handle that first part and then I'll turn it over to Flavia to talk about 27. And let me kind of first start, which is I appreciate that this new outlook comes as a change from the past comments and what I was speaking about. And I just need to acknowledge up front that we should have understood some of these type two trends sooner. and done a better job of adapting our commercial and customer service model to the needs of this really important customer base of us, which is the Type 2. And as CEO, I take accountability for that. You know, as I mentioned in my opening remarks, we've been serving the Type 1 community for 25 years and we're about 20 months in to serving the Type 2 community. So let me get specific on some of the timing and the context. So in quarter two is you know the quarter started to progress we did see some emerging trends in retention and utilization specifically among the type 2 community and so we dug into the data and this is what we uncovered demand for type 2 is really strong as evidence in quarter 2 on the customer base as well as NCS we then looked at retention data and what we identified is past 90 days They start to get more comfortable, they get more confident and start to realize the benefit of AID therapy and retention stabilizes. Our opportunity is to get much better at the first 90 days of onboarding. We've identified these issues and as I shared in my opening remarks, we are taking decisive actions in quarter three to get people to have better success. But I'll tell you, it's going to take a little bit of time for these actions to translate into improve customer success. So that's why we've updated our guidance to reflect that the trends that we saw in quarter two, specifically related to the type two community on utilization and retention, that they continue in the back half of the year until we have sustained evidence that these are really going to have improved outcomes. and I would just kind of wrap, you know, Robbie, before we get to 27 is listen, I've got absolute conviction in the long-term health of this business. I think that this is an execution challenge. I don't see anything structurally different in the marketplace. Again, this is not due to pricing. This isn't due to competition. This isn't due to GLP-1s. This is due to our execution in serving the Type 2 community in the first 90 days. So on that, let me turn this to Flavia who will talk a bit about 27s.

Thank you, Ashley, and good morning, Robbie. As we mentioned, it would be premature at this point to provide guidance for 2027, but we did want to provide some color. To your specific question, our outlook does contemplate competitive entrance in 2027. However, we remain highly confident on our competitive position. Omnipod's very differentiated form factor is only getting better with the algorithm innovations that we continue to launch, starting this year with the enhancements to Omnipod 5, next year with Omnipod 6, and then in 2028 with fully closed loop for Type 2. The outlook also assumes stable price, and that is consistent with what we've seen in the marketplace. You asked a question around the philosophy on the guidance. We believe that it does reflect what we're seeing in the marketplace today. It does not contemplate improvements from the actions that Ashley described. And we believe that that's a prudent way for us to establish this preliminary view for 2027.

Our next question comes from Travis Steed from Bank of America. Please go ahead. Your line is open.

Hey, everybody. I think maybe I'd kind of follow up on the first question. First of all, what gives you the confidence things can stabilize and re-accelerate in 2027, just given you're still kind of working through some of the Type 2 stuff today? Why go ahead and assume that re-accelerates in 2027? And it seems like the exit rate for the U.S. Omnipod growth is is around 9% in the guidance. Is that how you'd also think about the 27 view for U.S.? I mean, you commented on global, but just curious if that applies to the U.S. Omnipod growth and what you're assuming on the competition piece for 27, given you're still kind of above the market.

Thank you, Travis. Let me start, and then I'll turn it to Flavia. To your question on stabilization, Again, the focus for today's conversation is around type two and the learning that we've gleaned on type two and what we're doing about it. We have not assumed that all of the actions that we're taking right now in quarter three are going to be baked into the guidance going forward. So we've assumed that the run rates on utilization and retention that we experienced in type two remain constant in the balance to go. Now, we have confidence that those actions are going to have an impact and we're going to be keeping a keen eye. Again, the several things that are very new and different of changing Salesforce compensation, going from new customer starts to retention, improving our data platform. As I mentioned, we launched our Omnipod Discover. We've got about 12,000 people with Type 2 using that. We've got early data back on that in the limited market release. It's showing not just really strong customer satisfaction, but also very improved retention rates. And then clearly making sure that we have a strengthened customer experience and we've refined our sampling program. And as Flavia mentioned that we've got, you know, we're preparing for innovation as we go. So that's what gives us confidence that we're going to end this year, albeit off of our original guidance by a point. but really healthy, strong MedTech revenue growth, expanding operating margins, and very strong cash flow generation. So I'm going to turn it to Flavia to talk about exit rates for next year.

Sure. Travis, just a couple of things. One, the range we provided is relatively wide. And the 9% is the bottom of the range, but the top of that range is 14. So the midpoint is 12. And it does contemplate and the impact of the new product launches, as well as the full benefit of our Salesforce expansion, which will accrue into 2027. So we believe, again, it's a prudent approach, as Ashley said, and will provide additional insights in our fourth quarter earnings call.

Our next question comes from Larry Bijelson from Wells Fargo. Please go ahead. Your line is open.

Good morning. Thanks for taking the question. I guess, Ashley, I'll just ask one on the type 2. Maybe if you could share some of the metrics on utilization and retention with us, and why are you confident the actions will have an impact? I mean, is it plausible that just type 2 patients are different from type 1? Thanks for taking the questions.

Yeah, Larry, let me, you know, thank you for type two. Let me kind of share what we've been learning and some areas that obviously, you know, the whole pod community, what inspires us to better serve these folks, and also some of the challenging aspects of in our learning curve. And then really importantly, what are we doing about it? And what KPIs are we going to be looking at to make sure that we're making progress? I would I would first start with why we're so encouraged and inspired to serve this community. It's a large under-penetrated TAM. There's significant unmet need in this community. We have really strong science and ADA guidelines are on our side. We do have synergy and learning from 25 years serving the Type 1 community. And as we stand here in August, we have tens of thousands of Type 2-ers who are using POD and getting fantastic results. You know, just last week I was in the field at one of the largest safety net hospitals in Boston. And they serve over 40,000 people with diabetes. And 90% of their cohort are people with type 2 diabetes. And what I heard loud and clear is if they have a CGM, if they have phone control, if they're somewhat engaged in their diabetes and they have medical coverage, all of them can benefit from AID therapy. So that's what drives us. Now listen, some of the challenges in the type 2 community are as following. a different kind of emotional burden. You know, our Type 1 community often refers at their point of diagnosis like a tidal wave. It happens to them. The Type 2 community says, you know what, it's more like a rising flood. It's slow and progressive, and I did this. There are higher comorbidity rates. There's a different payer mix. 60% in Type 2s are on Medicare or Medicaid, whereas Type 1 is around 60% commercial. And listen, the slower path to insulin, and predominantly it's the PCP that is really writing for them. And with that in mind, that's what led us to the actions I spoke about in my opening remarks. That coupled with our innovation coming within two years, which really unlocks the Type 2 community. It's specifically designed, it's CGM-like, you put it on, there's no bulleting, there's no settings, there's no manual titration. This is really going to unlock the 70% of Type 2s who are seen in primary care. So that's what gives us confidence and makes us resolute to go deliver masterful customer service the first 90 days, just like we do with the Type 1 community.

Our next question comes from Jeff Johnson from Baird. Please go ahead, your line is open.

Yeah, thank you. Good morning, everyone. Maybe two questions here, if I could squeeze them together. But just one, Ashley, as you talk about those T2s that are tougher to stay adherent, any early evidence that you can go back to some of those patients, address those needs, and you've brought them back into the fold? I guess what has worked, if anything, so far in trying to reverse some of that adherence issue, number one. Number two, you talked about pricing maybe a little bit Thank you for joining us. with this change we saw from one of the big blue payers here recently. Thanks.

Yeah, thank you for the two questions, Jeff. Let me address your last question first, and then I'll have Eric address a little bit of what we've been doing to smooth out some of the pain points in the Type 2 community. You know, as Flavia mentioned, our price realization in the United States has been able to slightly up. and we've been, again, very disciplined in our pricing. We've been continuing to, because we think that wins for the category, as new contenders have entered into the pharmacy, our pricing strategy is extremely disciplined. And we, as I mentioned in my opening remarks, we continue to experience coverage wins on access, as well as really reducing the barriers of prior authorizations. As I shared, we had 10 million reductions of prior authorization. So I would tell you our strategy is working. It's good for insulin, it's good for patients, and it's good for the category. So on the type twos, I would just open with demand, again, is very strong. We're getting a lot of demand, a lot of people interested and a lot of people on pod. And we're keeping them retention rates stabilized for type two, our opportunity and all of our learning has been around those early pain points, the first 90 days. So Eric is going to elaborate a little bit on that. Thank you, Jeff.

Hi Jeff, just a couple of bills in terms of what we've seen and our ability to keep folks who live with type 2 engaged and why the actions that we're taking we believe will be effective there. The first, we've had success re-engaging with customers and we are scaling some things that we've had at pilot scale to provide proactive support and help our type 2 customers through those early moments of truth. A first pod change or a first refill or a first service and and many more. We've also seen that we can adjust some of how we go to market in the field to make sure that the support that we provide with prior authorization and benefits checks is as easy and as seamless as folks need it to be because we know that that's really important to the type 2 customer as well. And finally, Ashley mentioned that we've seen really encouraging early data from Omni on outcome satisfaction and retention. And it puts success metrics right in the palm of the hands of the people who are using Omnipod 5 to help them see the benefits of therapy and stay engaged. So we do have some strong early proof points that give us confidence in the actions that we're taking to have an impact on the important metrics that we need to drive. I'll just hand to Flavia for a quick bill.

Yeah, and just specifically to address your question about the Blues, we are not taking any positions that would result in exclusionary positions in access. So that was not something that that was initiated by us. And we don't believe in that. So I just want to specifically address your question.

Thank you.

Our next question comes from Matt Taylor from Jefferies. Please go ahead. Your line is open. Matt Taylor Hi.

Thanks for taking the question. I just wanted to double-click on some of the questions that were asked about the specific metrics, the retention rates. Could you characterize that at all, the difference that you're seeing in the early 90-day retention between Type 1 and Type 2? In the changes that you're making, what kind of early success have you had in changing those rates, just so we can understand the quantum of the deltas there?

Yeah, Matt, thank you for the question. I would, what Eric really alluded to, so we are seeing differences in retention and modest differences in utilization in our Type 2 community relative to the Type 1. I would then First kind of need to underscore that we're in a reoccurring revenue business model and so it's really worth the investment to go and the time to get them successfully through this 90-day onboarding period because of the lifetime value of these people being on insulin. And so again I come back to there's we've proven that there's healthy demand it really is those first 90 days and as Eric mentioned it's number one making sure as we get them on a sample it's making sure that we do the right kind of adjudication on medical coverage so that's really seamless it's holding their hand for many of what we call their firsts it could be their first pod change it could be the first time they actually have to go pick up their prescription it could be the first time that they're going to take a vacation you know we've identified let's say 10 of these pain points that we need to offer very strong encouragement to keep them on pod. And as Eric mentioned, we just completed our limited market release of a very modern new customer data platform that will have several new modules that we're pulling forward on our roadmap. It's called Omnipod Discover. And again, we have 1,600 clinicians who are using Discover and 12,000 patients and basically what Discover is it gives real lifetime data to patients. It shows them the insulin trends that they're getting. It initiates a really clear conversation they can have with their clinician. Caregivers can have access to that which is very beneficial and ultimately not only does it give them more confidence and more control, it results in better satisfaction and we've seen early data of meaningfully improved retention rates in this community. Secondly, it's just Salesforce compensation. Our biggest investment in our P&L is our field. We have the largest field force in the industry, and we are evolving in addition to new customer starts to hold them accountable, but also retention. This is, I think, for the first 45 days. That's going to have a meaningful result, and again, really managing those first 90 days.

Our next question comes from Marie Thibault from BTIG. Please go ahead. Your line is open.

Good morning. I just wanted to try to understand a little bit more what you're building in for potential competition coming, I think, late in the year, and a little more detail on sort of the timeline for when some of these efforts in the Type 2 population might start to show up. I know there's obviously a 90-day kind of cycle before they're coming back, so I want to understand both what's being built into the guidance for competition and any timelines on when we'll see updates on this.

Yeah, thank you, Marie. Let me take your second one on T2 and then I'll speak also about competition and turn it to Flavia. You know, for T2, as I shared, we, again, 20 months into this, we've identified some trends in quarter two that accelerated. We're taking action right now. We thought it was prudent to not bake those actions into the updated guidance that we're providing today. So the updated guidance assumes that the trends that we solve related to attrition and utilization specifically in the type two community in quarter two do not improve and in the balance to go. And we just thought that that was a prudent approach. It gives the team time to really see the cause and effect of these interventions. monitoring this monthly and we'll make any kind of adaptations again as we learn how to master this community and customer service the first 90 days. As it relates to competition, I'll turn it to Flavia.

Sure, and just again to summarize in terms of our preliminary views for next year, just to reinforce, it does not assume any acceleration of the market exit rate. It does not assume any improvement from the actions as Ashley just mentioned. it does assume competition based on what we know so far. And it also assumes a stable pricing environment. And again, what we will benefit from is the impact of the new product launches as well as the Salesforce expansion that we just completed.

Our next question comes from Richard Newiter from Truist Securities. Please go ahead, your line is open.

Hi, thanks for taking the question. Apologies that this is a little repetitive and may have been answered. But so I just want to get a better understanding. You guys have initiatives to try to improve retention and utilization. And a lot of that you feel can be very impactful and crucial during the first 90 day period of onboarding. So should we be thinking that you know within the next uh three months you'll see whether or not those initiatives that had their intended impact and and that is going to be what leads you to believe whether there's something more structural about this patient population versus type one and that's going to inform kind of your go forward view i guess i'm just trying to make sure i understand how much of a handle you think you'll have on the underlying market dynamics because this is Thank you, Rich.

I mean, again, I want to first start with we view the Type 2 community as a very attractive customer base. Again, we have a recurring revenue model. It's worth the investment upfront, specifically the first 90 days to deliver the right kind of onboarding experience so they stay on therapy. It's good for the category. It's good for patient care. It's good for outcomes. Again, we are getting a lot of success. I have to mention that we have tens of thousands of people using POD right now with very strong clinical outcomes and very strong satisfaction. So I would characterize what we're experiencing as an execution challenge, which not anything structurally related to the market. Again, demand we've seen 20 months into the launch is very healthy and very strong. I mentioned my field experience that clinicians and patients are waiting to go benefit from AID therapy because we do have strong science and we do have strong utilization. And so I think really it has to do with just the timing. I'm going to come and give specificity. We're implementing these programs right now. Eric mentioned we've had a customer experience support team since the launch. We've added more resources. We've strengthened a lot of their engagement to address the pain points, specifically around insurance and reducing that barrier. Interestingly enough, we're doing this because we have efficiencies in the business, so this is not a net incremental cost to our business. And I'm just allowing some time to see the impact of those. And that's why we were very prudent with guidance to not assume that these are going to have an immediate impact and we the guidance assumes that the utilization and retention trends that we experienced in quarter two continue on for the balance half of the year. Clearly we aim to beat that and do better but this is an emerging customer base and we're very committed to serving them just as well as we're serving our type one community.

Our next question comes from John Block from Stiefel. Please go ahead your line is open.

Hey everyone, Joe Federico on for John. Thanks for taking the question. Maybe just like almost follow up on that last point. I wanted to just ask how you're viewing the returns from the type two spending at this point and, you know, balancing top line growth goals versus just profitability. The T2 returns have arguably changed, you know, a lot with these somewhat new retention dynamics and the market taking longer to cultivate. So I'm just curious how you're viewing that spend going forward.

Yeah, thank you, Joe, for the question. Again, I'm going to come back to that. I think the Type 2 customer base is strategically very important to us and very attractive to us. We've been 20 months since our Type 2 indication. You can look at our performance this quarter in aggregate. We deliver 23% revenue growth. We have expanding operating margins. Our EPS was nearly 2x what revenue growth is. That's all while supporting the Type 2 community. and again we have very strong demand with the type twos and once we get them on pod post the 90 days retention rates stabilize we have a very attractive recurring revenue model and they're on insulin unfortunately for a lifetime and so our key focus is around the 90 days we think we can do so in a capital efficient manner we always look at our cost to acquire we look at our cost to serve clearly some of the lifetime value measures right now aren't as attractive as what we anticipate they will be. And I would just say some of the short-term trends are absolutely not reflective of what the long-term opportunity is.

Yeah, let me build. Ashley talked about the customer lifetime value. When we think also about the cost to acquire and cost to serve the Type 2 population, the good news is the actions that we are implementing and that Ashley described, they're not going to have a negative impact on these metrics. our cost to acquire is stable even as we expand our sales force and we continue to drive efficiencies in our cost to serve even as we redeploy and add some additional customer care support. The actions we are taking, whether it is the updated incentives for the sales force that Ashley described or optimizing our sampling program, and leveraging obviously our really recently launched Discover platform. These are already embedded in our baseline, so they're really not going to have a, not going to create a headwind on the service cost for the Type 2 population. And maybe just to close, in the medium term, we have high conviction that the fully closed loop for Type 2 will actually meaningfully change both the customer lifetime value as well as the cost to serve that population. Our fully closed loop has been uniquely designed to address some of these challenges that we have been discussing. So feel really good about the outlook.

Our last question comes from Kieran Ryan from Deutsche Bank. Please go ahead. Your line is open.

Hi there. Thanks for taking the question. I was wondering if you could maybe just clarify, I think there's the words retention and utilization have both been used here, but it sounds like this is much more of a retention dynamic than necessarily your type two users who are staying on pod, just using it less than you originally expected. Is that fair to say? And then maybe just any commentary you might have on how this retention looks between patients that are getting treated by endos versus PCPs and anything we should be thinking about as far as how the type of prescriber might play in here. Thanks a lot.

Yeah, thank you. Thank you, Karen. Let me first talk about, you're correct, retention is one that we're seeing a little bit more variability than we had expected. Utilization is slightly down, but it's really retention that we're talking about. And you know I would tell you obviously endos are the most comfortable with AID therapy in the type 2 community so early on we're getting most of our scripts from endos we've seen that evolve over the past couple months as we've expanded our field force on their called on universe as well as activated DTC so our mission is to really get PCPs comfortable and confident with the benefits of AID therapy I will tell you though the onboarding experience really is similar regardless of what clinician is recommending them. And so that's why tools that Eric mentioned around a customer data platform like Omnipod Discover that is available to both endos as well as primary care. I'll tell you endos and PCPs love it. They get to see the insulin trends. It lets them show them exactly how our algorithm is working. So we've gotten really good feedback with that. It gets them both more confident and comfortable in engaging with the community and then from a patient perspective, we start to see that they again can see their own data and get a lot more confident and comfortable and also willingness to engage with us to get encouragement and ask for any kind of clarifying questions. So I'm going to pause there because I know Eric wants to add another comment.

Karen, just a quick build. The other thing, as you observed, the prescribers who are the most comfortable prescribing AID do have better retention in their offices. And so the Salesforce expansion that we've just done, which helps us call on and serve another several thousand healthcare providers, also gives us a way to keep better serving this community. And so that is a key part of the strategy going forward.

Thank you that concludes our call today. Thank you.

Ladies and gentlemen, this concludes today's conference. Thank you for your participation and have a wonderful day. You may all disconnect.