Specialist
Former senior executive at Becton Dickinson & Co.
Agenda
- Diabetes device market overview, focusing on trends and themes within insulin management systems and pumps
- Competitive positioning of major players and comparative product analysis – Medtronic (NYSE: MDT), Becton Dickinson (NYSE: BDX), Insulet (NASDAQ: PODD) and Tandem (NASDAQ: TNDM)
- Technological developments and innovative capabilities to improve insulin delivery and management
- Outlook – type 2 diabetes penetration, US regulatory landscape and international opportunities
Questions
1.
What major trends and developments have you been following in the diabetes and insulin delivery space over the past 12 months or so?
2.
President Biden has expressed interest in capping out-of-pocket insulin payments at USD 35 per month. In addition, the House of Representatives is currently debating the Affordable Insulin Now Act in Congress. How should we distinguish between rhetoric vs actual policy outcomes from the executive and legislative branch for something like insulin price ceilings?
3.
The FDA flagged several product safety problems in a December 2021 warning letter to Medtronic’s diabetes group, citing the medical device maker for not appropriately classifying patient risk for faulty MiniMed insulin pump devices and for not initiating a recall, despite tens of thousands of reports made to the agency over three years. How detrimental is this development to the company’s pump positioning? What are your thoughts on its ability to recover reputationally?
4.
How are manufacturers improving the affordability and accessibility of insulin delivery systems? How might these efforts increase these devices’ penetration and adoption in type 1 and 2 markets? Is the PBM [pharmacy benefit manager] piece the main barrier to cost reduction, or are there other levers to improve affordability and accessibility?
5.
What are your thoughts on the rise of generic device offerings, whether it be CGMs [continuous glucose monitors], insulin pumps or other generic products as a lever to combat pricing? How far away are we from widespread availability of generic alternatives and what hit could there be to larger diabetes players’ ASPs?
6.
How are you viewing adoption and demand for open-looped vs hybrid closed-looping insulin pumps? How much could we see a shift towards hybrid pumps over the next 2-3 years, particularly in the more lucrative type 2 population?
7.
How far are we away from completely closed-loop pump systems which will not need user input? What’s the innovative potential of a closed-loop system to displace leading offerings, even hybrids?
8.
What’s important to understand about the commercial cycle and go-to-market efforts for products such as insulin pumps? How do you assess Insulet, Tandem and Medtronic’s sales forces on their respective execution and go-to-market efforts?
9.
What are your thoughts on strategic partnerships with CGM manufacturers such as Dexcom and Abbott? How do these improve the connectivity of pumps and sensors in addition to any other commercial advantages?
10.
Why do you think Becton Dickinson has struggled so much getting a patch pump offering to market for the type 2 diabetes population? What are some pain points with developing patch pumps?
11.
How much revenue opportunity do you see in the US type 2 market for a patch pump offering?
12.
How much would a patch pump overlap with legacy products from Insulet, Medtronic and Tandem in terms of pump sales? Could you expound on a patch pump’s competitive threat to the incumbents’ share?
13.
What are your thoughts on the general shift to oral therapies away from injectables for type 2 patients? How might this affect R&D focus and strategy for players such as Beckton Dickinson, Insulet and Tandem?
14.
How do you assess the relative positioning of Tandem’s t:slim X2, Insulet’s Omnipod Dash system and Medtronic’s MiniMed offering in the US market? How are they differentiated in terms of innovation, pricing and market share?
15.
What are your thoughts on Becton Dickinson spinning off its diabetes business to ‘enhance focus on innovation and priority growth markets’? What do you believe was the strategic rationale behind the divestiture and how do you assess Embecta’s prospects as a standalone company in the pen market?
16.
What are the implications in the competitive landscape for other names such as Insulet and Tandem from the Medtronic recall? How much opportunity do they have to capitalise on Medtronic’s lack of market presence and who stands the most to gain?
17.
How do you assess the insulin delivery system market opportunity and landscape internationally? Roche discontinued its US insulin pump business a few years ago. Who’s best-suited to drive performance and capture market share internationally, and why?
18.
Might the international dynamics you mentioned, especially in APAC, translate to downward pricing pressure on pump sales? How exposed are incumbent players to pricing headwinds in Asia?
19.
How are you viewing diabetes market growth globally? To what extent could the increasing prevalence of obesity and perhaps any long-term effects from the pandemic lead to a higher portion of diabetic patients and expanded TAM opportunity over the next 7-10 years?
20.
Is there anything we haven’t discussed that might be important to highlight around the insulin delivery systems and pump market?
