Inspire Medical Systems (INSP) Q4 2025 earnings summary

Executive summary

• Q4 2025 revenue grew 12% to $269.1M; full year revenue rose 14% to $912M, driven by growth at existing and new centers and strong Inspire V adoption.

• Net income for Q4 was $136.1M, with diluted EPS of $4.66; full year net income was $145.4M, with diluted EPS of $4.89, aided by a tax valuation allowance release.

• Completed $175M in share repurchases in 2025.

• Over 125,000 patients have received Inspire therapy, with significant first-mover advantage in a >$10B underpenetrated U.S. market.

• FDA approval for 3.0T MRI compatibility and launch of Inspire VI development with sleep detection and auto activation.

Financial highlights

• Gross margin reached 86.6% in Q4 and 85.4% for FY2025.

• Q4 net income per diluted share: $4.66; adjusted: $1.65. Full year net income per diluted share: $4.89; adjusted: $2.42.

• Q4 operating cash flow was $52M–$53M; full year $117M.

• Q4 adjusted EBITDA: $79.3M; full year adjusted EBITDA: $200.6M.

• Ended 2025 with $404.6M in cash and investments.

Outlook and guidance

• 2026 revenue outlook: $950M–$1.0B, representing 4%–10% growth.

• Adjusted operating margin expected at 6%–8%; net income per diluted share $1.23–$1.81; adjusted net income per diluted share $1.85–$2.35.

• Effective tax rate projected at 44%–49%; adjusted rate 26%–28%.

• Capital expenditures for 2026 expected between $45M–$50M.

• Q1 2026 revenue expected to be flat year-over-year, with a net loss anticipated; sequential improvement expected through the year.