# Inspire Medical Systems (INSP.US)

Canonical: https://gigainvestors.com/s/INSP

Analysis as of: 2026-10-16T07:29:21.547Z. Financial observations: FY2017–FY2026.

Listing currency: USD. Reporting currency: USD.

## Verdict

Not a wonderful business

Quality tests for Buy: not passed (profit record: fail; earnings resilience is evidence only). Published buy qualification: no.

Share price: $70.12 per share; close as of 2026-10-15.

## Checklist

### understandable: fail

- 1 revenue decline in the last 10 years (informational)

- more than 2 net loss years

- negative average operating margin

- operating margin variation exceeds 0.35

- Financial history: 10 years

- Years with declining revenue: 1

- Years with a net loss: 7

- Operating margin variation: 1.11×

Chart: Operating margin; fiscal year observations.

- FY2017: -0.56×

- FY2018: -0.40×

- FY2019: -0.43×

- FY2020: -0.49×

- FY2021: -0.17×

- FY2022: -0.12×

- FY2023: -0.06×

- FY2024: 0.04×

- FY2025: 0.06×

- LTM to Jun 2026: 0.06×

### moat: fail

- ROIC median below threshold

- ROIC worst years below threshold (more than 1 bad year allowed)

- ROIC, median of available years: -64.7%

- ROIC, second-lowest year: -769.0%

- Typical minus recent gross margin: -0.1 pp

- Typical gross margin (annual median): 84.5%

- Recent gross margin (lower of latest and 3-year median): 84.7%

- Years with nonpositive capital: 0

- Capital spending / revenue: 2.2%

- ROIC including acquisitions, ten-year median: -78.8%

Chart: ROIC excluding acquisitions; fiscal year observations.

- FY2017: -769.0%

- FY2018: -2251.6%

- FY2019: -175.4%

- FY2020: -170.7%

- FY2021: -64.7%

- FY2022: -61.6%

- FY2023: -23.2%

- FY2024: 12.0%

- FY2025: 10.1%

### economics: fail

- owner earnings cash conversion below threshold

- Owner earnings / net income, 5-yr: 0.61×

- Cash conversion uses consolidated totals: No

- Owner earnings, five-year total: $56M

- Net income, five-year total: $91M

- Return on incremental invested capital: 20.2%

- Working capital / revenue, annual change: 0.5 pp

Chart: Annual owner cash / profit; fiscal year observations.

- FY2021: 1.00×

- FY2022: 1.00×

- FY2023: 1.21×

- FY2024: 0.69×

- FY2025: 0.90×

### management: pass

- Historical market-dollar context (not the management verdict): 2018 to 2025 (7 years)

- potential debt-funded buybacks (informational)

- buybacks leaned toward cheaper years (informational)

- ROIC first 3 years vs last 3 years: -769.0% vs 10.1%

- Per-share earnings: -1.41 to 1.75 (three-year endpoint medians)

- Management verdict uses per-share economic progress: Yes

- Ordinary dilution, 5-year annual growth: 2.7%

- Market cap gain: $1.6B

- Cumulative retained earnings: $421K

- Diluted shares, 5-year annual growth: 2.7%

- $1 test, starting fiscal year: FY2018

- $1 test, ending fiscal year: FY2025

- Per-share value change: $3.16

- Per-share value, starting three-year median: -$1.41

- Per-share value, ending three-year median: $1.75

- Buybacks concentrated in cheaper years (correlation): 1.00

- Average buyback yield: 2.1%

- Buyback history: 4 years

- Debt-funded buybacks: Yes

- ROIC, first three-year median: -769.0%

- ROIC, last three-year median: 10.1%

Chart: Earnings per share; fiscal year observations.

- FY2017: -$1.41

- FY2018: -$1.50

- FY2019: -$1.40

- FY2020: -$2.19

- FY2021: -$1.54

- FY2022: -$1.60

- FY2023: -$0.72

- FY2024: $1.75

- FY2025: $4.89

### accounting: pass

- stock compensation exceeds 15% of operating cash flow

- Sloan accruals: 3.1%

- Receivables to sales index (DSRI): 1.13×

- Restructuring years, last five: 0

- Stock compensation / operating cash flow: 111.4%

- Earnings backed by cash: Yes

- Operating cash / earnings: 0.80×

- Accounting red flags: 1

- Goodwill and intangibles / equity: 0.00×

Chart: Sloan accruals; fiscal year observations.

- FY2017: -6.9%

- FY2018: -1.6%

- FY2019: 0.1%

- FY2020: -1.5%

- FY2021: -7.4%

- FY2022: -10.0%

- FY2023: -6.8%

- FY2024: -9.5%

- FY2025: 3.1%

## Holders

## Price story

Down 78% since Jun 2023 · "Why Inspire Medical Systems (INSP) Is Down 30.6% After Medicare Coding Shift And Lawsuits" (finance.yahoo.com, Dec 2025) · sales -1.5%

Story as of 2026-10-16T09:58:57.305Z; price observation 2026-10-15.

- 2025-08-05: Inspire Medical Systems cuts 2025 revenue guidance to $900M-$910M amid Inspire V rollout delays ([seekingalpha.com](https://seekingalpha.com/news/4478060-inspire-medical-systems-cuts-2025-revenue-guidance-to-900m-910m-amid-inspire-v-rollout-delays?utm_source=feed_news_all&utm_medium=referral&feed_item_type=news))

- 2025-11-04: INSP Q3 Deep Dive: Inspire V Launch Drives Adoption, Margin Pressures Persist ([finance.yahoo.com](https://finance.yahoo.com/news/insp-q3-deep-dive-inspire-134108237.html))

- 2025-12-19: Why Inspire Medical Systems (INSP) Is Down 30.6% After Medicare Coding Shift And Lawsuits ([finance.yahoo.com](https://finance.yahoo.com/news/why-inspire-medical-systems-insp-042425417.html))

- 2026-02-12: Inspire Medical Systems Lowers FY2026 Revenue Guidance After CMS Coding Clarification, Oppenheimer Says ([finance.yahoo.com](https://finance.yahoo.com/news/inspire-medical-systems-lowers-fy2026-164602727.html))

- 2026-05-04: Inspire Medical Systems Swings To Loss In Q1, Updates FY26 Outlook ([nasdaq.com](https://www.nasdaq.com/articles/inspire-medical-systems-swings-loss-q1-updates-fy26-outlook))

- 2026-08-05: INSP Raises 2026 Outlook as Reimbursement Headwinds Start to Ease ([finance.yahoo.com](https://finance.yahoo.com/healthcare/articles/insp-raises-2026-outlook-reimbursement-180000465.html))

### Sales · FY2025–2026

sales -1.5%; source https://www.sec.gov/Archives/edgar/data/1609550/000160955026000016/insp-20251231.htm; observed 2026-02-13.

- FY2017: $29M 

- FY2018: $51M 

- FY2019: $82M 

- FY2020: $115M 

- FY2021: $233M 

- FY2022: $408M 

- FY2023: $625M 

- FY2024: $803M 

- FY2025: $912M 

- FY2026: $899M 

### Gross margin · FY2025

gross margin 85.4%; source https://www.sec.gov/Archives/edgar/data/1609550/000160955026000016/insp-20251231.htm; observed 2026-02-13.

- FY2017: 78.9% 

- FY2018: 80.1% 

- FY2019: 83.4% 

- FY2020: 84.7% 

- FY2021: 85.7% 

- FY2022: 83.8% 

- FY2023: 84.5% 

- FY2024: 84.7% 

- FY2025: 85.4% 

## Owner memo

Memo as of 2026-10-16T08:06:05.509Z.

### How it makes money

Operates in medical devices; annual sales are USD 912 million.

- Source: https://www.sec.gov/Archives/edgar/data/1609550/000160955026000016/insp-20251231.htm (filed 2026-02-13); FY2025: revenue 911981000; grossProfit 778756000; margin = grossProfit / revenue.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-10-15); INSP.US: Inspire Medical Systems, Inc., a medical technology company, focuses on the development and commercialization of minimally invasive solutions for patients with obstructive sleep apnea (OSA) in the United States and internationally. The company offers Inspire system, a neurostimulation technology that provides a safe and effective treatment for patients with moderate to severe OSA. It also develops a novel, closed-loop solution that continuously monitors a patient's breathing and delivers mild hypoglossal nerve stimulation to maintain an open airway. The company was incorporated in 2007 and is headquartered in Golden Valley, Minnesota.

### Why customers stay

Margins ranged from 84.5% to 85.4% during 2023–25; it lost 64.7% on its capital.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-13); FY2023: grossProfit / revenue = 84.5%.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-13); FY2024: grossProfit / revenue = 84.7%.

- Source: https://www.sec.gov/Archives/edgar/data/1609550/000160955026000016/insp-20251231.htm (filed 2026-02-13); FY2025: grossProfit / revenue = 85.4%.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-13); 9-year return on capital observations [[2017,-7.690006082725061],[2018,-22.515552447552448],[2019,-1.7537296437659033],[2020,-1.7067425145097437],[2021,-0.646756101569562],[2022,-0.6163250987656345],[2023,-0.23224506332810163],[2024,0.11970295178345657],[2025,0.10088962017396401]]; median -0.646756101569562. ROIC follows the displayed moat series; financial companies use return on tangible equity.

### Can it raise prices

Kept about a 84% gross margin through 2022 cost inflation.

- Source: https://www.sec.gov/Archives/edgar/data/1609550/000160955026000016/insp-20251231.htm (filed 2026-02-13); Gross margin observations: [[2021,0.8574127869611043],[2022,0.837896218273116],[2023,0.8454286898666611]]; range within 2 percentage points.

### Where the cash goes

Spends 8% of cash earnings on expansion; earns 20.2% on new investment.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-13); FY2024: growth capex 15831690.964027107; upkeep 23291309.035972893; owner earnings 36767690.96402711. Growth capex / owner earnings = 0.43058703304258533.

- Source: https://www.sec.gov/Archives/edgar/data/1609550/000160955026000016/insp-20251231.htm (filed 2026-02-13); FY2025: growth capex 10513252.44667064; upkeep 27985747.55332936; owner earnings 131393252.44667064. Growth capex / owner earnings = 0.08001364035750402.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-13); Incremental return on capital 0.20170881860394307, from the economics test's unchanged annual inputs.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-13); Dividend observations: [[2017,0],[2018,0],[2019,0],[2020,0],[2021,0],[2022,0],[2023,0],[2024,0],[2025,0]]. Zero only counted when supported by a complete cash-flow statement.

- Source: https://www.sec.gov/Archives/edgar/data/1609550/000160955026000016/insp-20251231.htm (filed 2026-02-13); FY2025: cash repurchases 175019000 USD.

### Are managers owners

Insiders own 1.2% of the company.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-10-15); INSP.US SharesStats.PercentInsiders = 1.1769999999999998 percentage points; cache date 2026-10-15.

### What the price says

The price is 2.3 times annual sales.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-13); Closing price 70.12 USD; reporting-to-trading FX 1; FY2025 annual sales per share 30.64757524909403; price multiple 2.287946091333043. FY2025 cash earnings/share 4.41553562144666. Closing-price date 2026-10-15.

## Monthly share-price history (USD per share)

- 2018-05: $30.00 per share

- 2018-06: $35.66 per share

- 2018-07: $44.80 per share

- 2018-08: $54.99 per share

- 2018-09: $42.08 per share

- 2018-10: $40.08 per share

- 2018-11: $45.94 per share

- 2018-12: $42.25 per share

- 2019-01: $53.63 per share

- 2019-02: $62.00 per share

- 2019-03: $56.78 per share

- 2019-04: $51.69 per share

- 2019-05: $56.47 per share

- 2019-06: $60.65 per share

- 2019-07: $67.63 per share

- 2019-08: $69.51 per share

- 2019-09: $61.02 per share

- 2019-10: $60.98 per share

- 2019-11: $70.96 per share

- 2019-12: $74.21 per share

- 2020-01: $74.80 per share

- 2020-02: $85.87 per share

- 2020-03: $60.28 per share

- 2020-04: $71.66 per share

- 2020-05: $81.54 per share

- 2020-06: $87.02 per share

- 2020-07: $99.36 per share

- 2020-08: $119.45 per share

- 2020-09: $129.05 per share

- 2020-10: $119.43 per share

- 2020-11: $185.74 per share

- 2020-12: $188.09 per share

- 2021-01: $201.51 per share

- 2021-02: $232.79 per share

- 2021-03: $206.99 per share

- 2021-04: $236.82 per share

- 2021-05: $194.30 per share

- 2021-06: $193.26 per share

- 2021-07: $183.16 per share

- 2021-08: $223.56 per share

- 2021-09: $232.88 per share

- 2021-10: $269.58 per share

- 2021-11: $223.27 per share

- 2021-12: $230.06 per share

- 2022-01: $221.29 per share

- 2022-02: $244.06 per share

- 2022-03: $256.69 per share

- 2022-04: $205.76 per share

- 2022-05: $176.83 per share

- 2022-06: $182.67 per share

- 2022-07: $208.99 per share

- 2022-08: $191.49 per share

- 2022-09: $177.37 per share

- 2022-10: $194.95 per share

- 2022-11: $241.57 per share

- 2022-12: $251.88 per share

- 2023-01: $253.06 per share

- 2023-02: $259.93 per share

- 2023-03: $234.07 per share

- 2023-04: $267.63 per share

- 2023-05: $292.49 per share

- 2023-06: $324.64 per share

- 2023-07: $287.81 per share

- 2023-08: $226.88 per share

- 2023-09: $198.44 per share

- 2023-10: $147.16 per share

- 2023-11: $145.31 per share

- 2023-12: $203.43 per share

- 2024-01: $210.87 per share

- 2024-02: $179.04 per share

- 2024-03: $214.79 per share

- 2024-04: $241.66 per share

- 2024-05: $158.79 per share

- 2024-06: $133.83 per share

- 2024-07: $141.05 per share

- 2024-08: $179.82 per share

- 2024-09: $211.05 per share

- 2024-10: $195.04 per share

- 2024-11: $192.76 per share

- 2024-12: $185.38 per share

- 2025-01: $193.50 per share

- 2025-02: $185.59 per share

- 2025-03: $159.28 per share

- 2025-04: $158.38 per share

- 2025-05: $138.20 per share

- 2025-06: $129.77 per share

- 2025-07: $124.54 per share

- 2025-08: $93.69 per share

- 2025-09: $74.20 per share

- 2025-10: $72.08 per share

- 2025-11: $124.41 per share

- 2025-12: $92.23 per share

- 2026-01: $75.78 per share

- 2026-02: $64.51 per share

- 2026-03: $51.58 per share

- 2026-04: $56.14 per share

- 2026-05: $41.36 per share

- 2026-06: $44.61 per share

- 2026-07: $50.21 per share

- 2026-08: $62.99 per share

- 2026-09: $69.36 per share

- 2026-10: $70.12 per share

## Annual estimated value (USD per share)

Historical values use today's bond yield for every fiscal year

Historical values use today's FX rate into trading currency for every fiscal year

Historical values use current restated fundamentals and current commodity classification; they are not point-in-time estimates

## Sources

[Original 10-K filing](https://www.sec.gov/Archives/edgar/data/1609550/000160955026000016/insp-20251231.htm); period 2025-12-31, filed 2026-02-13.

Estimates depend on assumptions and are not guarantees or investment advice. Underlying data remains subject to its source licenses; public reading does not grant bulk redistribution rights.