Specialist
Former VP at Senseonics Holdings Inc
Agenda
- Recent trends and developments in the CGM (continuous glucose monitoring) device market and strategies to penetrate type 1 and type 2 diabetes populations
- Competitive landscape and product differentiation – Dexcom’s (NASDAQ: DXCM) G7, Medtronic’s (NYSE: MDT) MiniMed and Abott’s (NYSE: ABT) Freestyle Libre 3, including compatibility with pumps, usability and other features to meet changing patient demands
- Quality control outlook for Medtronic's MiniMed device and expectations for a new sensor in 2024
- Potential threats for CGM market disruption, including emerging players and increase of weight loss drug use for the type 2 population
- Global CGM global market opportunity and successful go-to-market dynamics
Questions
1.
Could you lay out the current operating environment for diabetes device players, perhaps highlighting a few key trends and developments to better inform our Interview on CGMs [continuous glucose monitors]?
2.
Could you do a granular deep dive of the competitive landscape including the relative positioning of the big three, or even big two, Dexcom, Abbott and then Medtronic? How would you juxtapose the business models, relative product innovation and market share of these leading players?
3.
We see that Abbott is strong in type 2s as well ex-US, Dexcom has made some serious inroads with the type 1 population and in the US market, and Medtronic playing with its closed-loop system. In light of that context, how should investors be thinking about breaking out the TAM for CGMs in the US and globally? Could you stratify this by type 1, type 2 and insulin-intensive/non-intensive, and even without insulin when appropriate? I’m trying to get a sense of whether it’s a zero-sum game or if there is enough growth to go around.
4.
You obviously highlighted that the way to go after patients in type 2 markedly differs between MDI [multiple daily injection] insulin, non-intensive, etc. What are the keys to penetrating the higher-growth type 2 population for CGMs? How are players such as Dexcom and Abbott approaching building awareness campaigns and brand recognition in these demographics who may not be aware or willing to pay for premium CGM standard-of-care products? You also highlighted the endo vs PCP [primary care physician] dynamics for some of those patients in type 2.
5.
How do you assess Dexcom’s ability to make up the gap in type 2s? We did see the CMS coverage benefit to basal populations, but how are you viewing its efforts both on the consumer or patient awareness front as well as trying to get in with more PCPs to help reach parity with Abbott in type 2s?
6.
We talked about the CMS coverage benefit for type 2 basal. Could you lay out the broader reimbursement environment for CGMs in the US and how it’s trending for Dexcom and Abbott as they look to build clinical efficacy stories for the G7 and FreeStyle Libre 3? What are the important differences and developments to note from both CMS and commercial payers relating to type 1 and type 2 populations currently on CGMs?
7.
What’s the approximate appetite for consumers to pay out of pocket for CGMs, and how does profitability within the cash pay channel differ vs the payer channel?
8.
Where do you think reimbursement coverage may plateau for Dexcom’s G7 as it becomes more widely adopted, given it’s just been launched? What are you monitoring in terms of their market access initiatives that could give us a better understanding of future reimbursement trends?
9.
Could you expound on some of the new features of the upgraded Medtronic Guardian 4 sensor likely coming to market at the end of 2023 or early 2024? What improvements should we expect for this offering?
10.
How much of a differentiator is sensor wear time from a patient experience standpoint? You noted Abbott at 14 days, Dexcom at 10 and Medtronic at seven currently. How do you assess the efforts from Dexcom and Medtronic to close the gap there?
11.
How would you juxtapose the longer wear time of the Senseonics sensor vs the burden of going to a clinician to implant or remove the device, from the overall patient experience standpoint?
12.
What are your thoughts around some of the quality issues Medtronic had suffered historically, resulting in an FDA warning letter? It appears that Medtronic has ameliorated some of these challenges. What are your expectations of the company’s outlook post lift of the warning letter?
13.
Could you discuss Dexcom and Abbott’s relationships with the leading insulin pump manufacturers, Insulet and Tandem? How do you juxtapose their pump relationships and relative interconnectivity with the T:slim and Omnipod 5 offerings?
14.
In January 2023, Tandem completed its acquisition Sigi, a company currently trying to develop a patch pump for bolus insulin populations. Embecta is also hastily working on a patch pump. What might be the major implications for CGMs if and when a patch pump inevitably comes to market? What could be the trickle-down impact on the major manufacturers in light of our discussion on pump partnerships?
15.
What else are you excited about on the innovation front, aside from increased sensor wear time? What does the broader product innovation strategy look like, industry-wide, to unlock the next frontier of revenue growth for diabetes care?
16.
What are your thoughts on the broader opportunity in the health system end market for the wider applicability for CGMs, and what does the penetration strategy look like for Dexcom, Abbott and others?
17.
What are your thoughts on Dexcom and Abbott’s ability to drive operating leverage through automated manufacturing? What does the greater effort look like there, and what kind of margin expansion is possible from these initiatives?
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