Inspire Medical Systems, Inc.
INSP · Surgical & Medical Instruments & Apparatus · 28.8M shares · +5%/yr ↑ shares · EDGAR filings ↗
Reference price $43.28 · est. market cap ~$1.2B — last insider sale, 2026-05-15 (estimated from the dated SEC Form 4 price × shares outstanding — not a live quote)
Grade
B81Profitable, cash-generative best-in-class OSA neurostimulation franchise with a durable moat, tempered by a DOJ probe and reimbursement/coding uncertainty.
Strengths
- Top-tier returns and margins: ROA 16% (95.9 pct), ROE 18.6% (79 pct), gross margin 85.4% (92 pct), positive FCF $78M (86 pct)
- Durable edge: only FDA-PMA hypoglossal-nerve-stim device for OSA, broad payor coverage (>300M lives), positive STAR pivotal foundation
Risks
- DOJ Civil Investigative Demand/False Claims Act inquiry into marketing and reimbursement practices
- Inspire V coding confusion and a potential -52 modifier (10–50% professional-fee cut) plus decelerating revenue growth (13.6%, 43.9 pct)
Notable findings
- Fund exitedNotable fund(s) exited this quarter: VANGUARD GROUP INC
- Customer concentration~96% of revenue from one customer/distributor — For the year ended December 31, 2025, 95
- Exec changeRecent 8-K item 5.02 8-K ↗
- Strong balance sheetStrong balance sheet — $405M cash & investments
- Trial readout soonUpcoming trial readout ~2027-02-28 — PHASE3 · Down Syndrome
- Revenue declineRevenue -24.0% YoY
- Notable holderHeld by 6 notable fund(s): STATE STREET CORP, GOLDMAN SACHS GROUP INC, CITADEL ADVISORS LLC +3 more (as of 2026-03-31)
- Insider sellingInsider selling — 4 open-market sale(s) by 2 insider(s) (cluster of 2 insiders, last 6mo) Form 4 ↗
Quarterly revenue
Last 4 quarters · from SEC filings.
Key metrics
Gross margin
85.4%
Operating margin
5.6%
Net margin
15.9%
Return on equity
18.6%
Return on assets
16.0%
Revenue growth (QoQ)
-24.0%
Net-income growth
171.8%
Current ratio
6.1×
Free cash flow
$78M
EBITDA
$65M
Tangible book value
$781M
Cash & investments
$405M
Stock comp / revenue
14.3%
Insider transactions · last 18 months
| Date | Insider | Type | Shares | Price |
|---|---|---|---|---|
| 2026-05-15 | Rondoni John | Sell | 2.6K | $43.28 |
| 2026-05-14 | Rondoni John | Sell | 700 | $43.01 |
| 2026-05-08 | mcCormick Shawn | Sell | 696 | $45.31 |
| 2026-05-01 | Melenikiotou Georgia | Tax withheld | 50 | $56.70 |
| 2026-04-30 | Curet Myriam | Grant | 3.6K | — |
| 2026-04-30 | Burks Cynthia | Grant | 3.6K | — |
| 2026-04-30 | mcCormick Shawn | Grant | 3.6K | — |
| 2026-04-30 | Melenikiotou Georgia | Grant | 3.6K | — |
| 2026-04-30 | Broader Shelley G | Grant | 3.6K | — |
| 2026-04-30 | Ellis Gary Lee | Grant | 3.6K | — |
| 2026-04-30 | Mead Dana G Jr. | Grant | 3.6K | — |
| 2026-04-30 | Tansey Casey M | Grant | 3.6K | — |
| 2026-04-15 | Broader Shelley G | Grant | 342 | $52.07 |
| 2026-04-15 | Melenikiotou Georgia | Grant | 307 | $52.07 |
| 2026-04-15 | Ellis Gary Lee | Grant | 518 | $52.07 |
| 2026-04-15 | Tansey Casey M | Grant | 308 | $52.07 |
| 2026-02-20 | Phillips Bryan K | Grant | 2.4K | — |
| 2026-02-20 | Herbert Timothy P. | Grant | 9.0K | — |
| 2026-02-20 | Herbert Timothy P. | Tax withheld | 4.0K | $59.53 |
| 2026-02-20 | Herbert Timothy P. | Grant | 62K | — |
| 2026-02-20 | Phillips Bryan K | Tax withheld | 735 | $59.53 |
| 2026-02-20 | Phillips Bryan K | Grant | 16K | — |
| 2026-02-20 | Phillips Bryan K | Grant | 8.4K | — |
| 2026-02-20 | Kelly Jason P | Grant | 16K | — |
| 2026-02-20 | Mann Melissa | Grant | 16K | — |
| 2026-02-20 | Weatherby Carlton | Grant | 2.2K | — |
| 2026-02-20 | Weatherby Carlton | Tax withheld | 672 | $59.53 |
| 2026-02-20 | Weatherby Carlton | Grant | 21K | — |
| 2026-02-20 | Weatherby Carlton | Grant | 13K | — |
| 2026-02-20 | Rondoni John | Grant | 2.4K | — |
| 2026-02-20 | Rondoni John | Tax withheld | 735 | $59.53 |
| 2026-02-20 | Rondoni John | Grant | 16K | — |
| 2026-02-13 | Buchholz Richard | Tax withheld | 579 | $59.76 |
| 2026-02-13 | Herbert Timothy P. | Tax withheld | 1.6K | $59.76 |
| 2026-02-13 | Mann Melissa | Tax withheld | 615 | $59.76 |
| 2026-02-13 | Rondoni John | Tax withheld | 587 | $59.76 |
| 2026-02-13 | Kelly Jason P | Tax withheld | 551 | $59.76 |
| 2026-02-13 | Weatherby Carlton | Tax withheld | 570 | $59.76 |
| 2026-02-13 | Phillips Bryan K | Tax withheld | 579 | $59.76 |
| 2026-02-09 | Rondoni John | Tax withheld | 327 | $66.33 |
| 2026-02-09 | Weatherby Carlton | Tax withheld | 327 | $66.33 |
| 2026-02-09 | Phillips Bryan K | Tax withheld | 327 | $66.33 |
| 2026-02-09 | Herbert Timothy P. | Tax withheld | 968 | $66.33 |
| 2026-02-09 | Buchholz Richard | Tax withheld | 327 | $66.33 |
| 2026-01-15 | Ellis Gary Lee | Grant | 304 | $96.47 |
| 2026-01-15 | Melenikiotou Georgia | Grant | 180 | $96.47 |
| 2026-01-15 | Broader Shelley G | Grant | 200 | $96.47 |
| 2026-01-15 | Tansey Casey M | Grant | 181 | $96.47 |
| 2026-01-09 | Rondoni John | Sell | 109 | $100.00 |
| 2025-12-02 | mcCormick Shawn | Sell | 1.2K | $139.00 |
| 2025-11-28 | mcCormick Shawn | Sell | 2.0K | $127.48 |
| 2025-10-14 | Melenikiotou Georgia | Grant | 229 | $78.84 |
| 2025-10-14 | Tansey Casey M | Grant | 221 | $78.84 |
| 2025-10-14 | Broader Shelley G | Grant | 245 | $78.84 |
| 2025-10-14 | Ellis Gary Lee | Grant | 372 | $78.84 |
| 2025-08-29 | Buchholz Richard | Sell | 11K | $93.39 |
| 2025-08-19 | Buchholz Richard | Tax withheld | 276 | $90.28 |
| 2025-08-19 | Buchholz Richard | Option exercise | 18K | $71.00 |
| 2025-08-19 | Buchholz Richard | Option exercise | 7.2K | $42.15 |
| 2025-08-19 | Buchholz Richard | Tax withheld | 2.6K | $90.24 |
| 2025-08-19 | Buchholz Richard | Tax withheld | 2.5K | $90.21 |
| 2025-08-08 | Curet Myriam | Sell | 4 | $77.28 |
| 2025-07-15 | Broader Shelley G | Grant | 148 | $128.00 |
| 2025-07-15 | Melenikiotou Georgia | Grant | 131 | $128.00 |
| 2025-07-15 | Ellis Gary Lee | Grant | 221 | $128.00 |
| 2025-07-15 | Tansey Casey M | Grant | 133 | $128.00 |
| 2025-06-04 | mcCormick Shawn | Option exercise | 4.0K | $16.00 |
| 2025-05-19 | Rondoni John | Sell | 1.7K | $149.38 |
| 2025-05-08 | Curet Myriam | Sell | 2 | $153.22 |
| 2025-05-02 | mcCormick Shawn | Sell | 360 | $160.00 |
| 2025-05-02 | Melenikiotou Georgia | Tax withheld | 35 | — |
| 2025-05-01 | Burks Cynthia | Grant | 1.3K | — |
| 2025-05-01 | Ellis Gary Lee | Grant | 1.3K | — |
| 2025-05-01 | Broader Shelley G | Grant | 1.3K | — |
| 2025-05-01 | mcCormick Shawn | Grant | 1.3K | — |
| 2025-05-01 | Curet Myriam | Grant | 1.3K | — |
| 2025-05-01 | Melenikiotou Georgia | Grant | 1.3K | — |
| 2025-05-01 | Tansey Casey M | Grant | 1.3K | — |
| 2025-05-01 | Mead Dana G Jr. | Grant | 1.3K | — |
| 2025-04-14 | Tansey Casey M | Grant | 103 | $149.70 |
| 2025-04-14 | Melenikiotou Georgia | Grant | 102 | $149.70 |
| 2025-04-14 | Ellis Gary Lee | Grant | 169 | $149.70 |
| 2025-04-14 | Broader Shelley G | Grant | 116 | $149.70 |
| 2025-04-07 | Curet Myriam | Buy | 1 | $148.26 |
| 2025-03-20 | Curet Myriam | Buy | 4 | $163.84 |
| 2025-03-03 | Ban Randy | Sell | 1.2K | $186.20 |
| 2025-03-03 | Ban Randy | Sell | 478 | $187.08 |
| 2025-03-03 | Rondoni John | Sell | 2.3K | $185.60 |
| 2025-03-03 | Ban Randy | Sell | 2.2K | $185.37 |
| 2025-02-24 | Phillips Bryan K | Tax withheld | 2.2K | $186.45 |
| 2025-02-24 | Rondoni John | Grant | 3.3K | — |
| 2025-02-24 | Rondoni John | Tax withheld | 1.0K | $186.45 |
| 2025-02-24 | Ban Randy | Tax withheld | 2.2K | $186.45 |
| 2025-02-24 | Herbert Timothy P. | Grant | 18K | — |
| 2025-02-24 | Herbert Timothy P. | Tax withheld | 8.3K | $186.45 |
| 2025-02-24 | Phillips Bryan K | Grant | 6.2K | — |
| 2025-02-24 | Buchholz Richard | Grant | 6.2K | — |
| 2025-02-24 | Buchholz Richard | Tax withheld | 2.2K | $186.45 |
| 2025-02-24 | Ban Randy | Grant | 6.2K | — |
| 2025-02-21 | Buchholz Richard | Gift | 125 | — |
| 2025-02-21 | Buchholz Richard | Gift | 500 | — |
| 2025-02-21 | Buchholz Richard | Gift | 125 | — |
| 2025-02-21 | Buchholz Richard | Gift | 125 | — |
| 2025-02-21 | Buchholz Richard | Gift | 125 | — |
| 2025-02-13 | Kelly Jason P | Grant | 4.5K | — |
| 2025-02-13 | Ban Randy | Sell | 2.5K | $178.54 |
| 2025-02-13 | Ban Randy | Sell | 1.0K | $179.41 |
| 2025-02-13 | Ban Randy | Sell | 1.3K | $180.79 |
| 2025-02-13 | Ban Randy | Sell | 3.8K | $181.90 |
| 2025-02-13 | Ban Randy | Sell | 3.2K | $182.90 |
| 2025-02-13 | Ban Randy | Sell | 2.5K | $183.79 |
| 2025-02-13 | Ban Randy | Sell | 3.5K | $184.81 |
| 2025-02-13 | Ban Randy | Sell | 3.8K | $185.84 |
| 2025-02-13 | Ban Randy | Sell | 3.3K | $186.96 |
| 2025-02-13 | Ban Randy | Sell | 584 | $187.66 |
| 2025-02-13 | Mann Melissa | Grant | 5.1K | — |
| 2025-02-13 | Rondoni John | Grant | 5.1K | — |
| 2025-02-13 | Herbert Timothy P. | Grant | 16K | — |
| 2025-02-13 | Weatherby Carlton | Grant | 5.1K | — |
| 2025-02-13 | Buchholz Richard | Grant | 5.1K | — |
| 2025-02-13 | Phillips Bryan K | Grant | 5.1K | — |
| 2025-02-13 | Ban Randy | Grant | 5.1K | — |
| 2025-02-13 | Ban Randy | Option exercise | 25K | $67.63 |
| 2025-02-11 | Rondoni John | Sell | 583 | $170.49 |
| 2025-02-09 | Buchholz Richard | Tax withheld | 314 | $182.15 |
| 2025-02-09 | Herbert Timothy P. | Tax withheld | 896 | $182.15 |
| 2025-02-09 | Rondoni John | Tax withheld | 315 | $182.15 |
| 2025-02-09 | Ban Randy | Tax withheld | 314 | $182.15 |
| 2025-02-09 | Phillips Bryan K | Tax withheld | 282 | $182.15 |
| 2025-02-09 | Weatherby Carlton | Tax withheld | 313 | $182.15 |
| 2025-01-29 | Phillips Bryan K | Tax withheld | 204 | $189.99 |
| 2025-01-15 | Melenikiotou Georgia | Grant | 80 | $176.33 |
| 2025-01-15 | Tansey Casey M | Grant | 81 | $176.33 |
| 2025-01-15 | Ellis Gary Lee | Grant | 137 | $176.33 |
| 2025-01-15 | Broader Shelley G. | Grant | 92 | $176.33 |
| 2025-01-07 | Rondoni John | Sell | 58 | $215.00 |
All non-derivative Form 4 activity (SEC), newest first.
Clinical trials
| Trial | Title | Phase | Status | Primary completion |
|---|---|---|---|---|
| NCT06971796 ↗ | EURO-STIM Registry Obstructive Sleep Apnea, Obstructive Sleep Apnea (OSA) | — | Recruiting | 2035-04-01 |
| NCT07113288 ↗ | Inspire UAS High Apnea Hypopnea Index (AHI)/High Body Mass Index (BMI) Post-Approval Study Obstructive Sleep Apnea (OSA) | — | Recruiting | 2032-01-01 |
| NCT06851338 ↗ | Pediatric Down Syndrome Post-Approval Study Pediatric Obstructive Sleep Apnea, Down Syndrome (DS) | NA | Recruiting | 2030-05-01 |
| NCT04457154 ↗ | Pediatric Post-Approval Registry Obstructive Sleep Apnea | — | Recruiting | 2027-12-01 |
| NCT04801771 ↗ | Effects of Hypoglossal Nerve Stimulation on Cognition and Language in Down Syndrome and Obstructive Sleep Apnea Down Syndrome, Obstructive Sleep Apnea | PHASE3 | Active Not Recruiting | 2027-02-28 |
| NCT02907398 ↗ | Adherence and Outcome of Upper Airway Stimulation (UAS) for OSA International Registry Obstructive Sleep Apnea | — | Unknown | 2025-09-01 |
| NCT06540716 ↗ | Inspire Singapore Study Obstructive Sleep Apnea, OSA | NA | Completed | 2025-07-17 |
| NCT02413970 ↗ | Inspire® Post-Approval Study / Protocol Number 2014-001 Obstructive Sleep Apnea | NA | Unknown | 2025-03-01 |
| NCT05428839 ↗ | The PREDICTOR Study: Assessing Diagnostic Predictors of Airway Collapse in Patients With Obstructive Sleep Apnea Sleep Apnea, Obstructive | NA | Unknown | 2024-01-11 |
| NCT04416542 ↗ | Inspire Home Study: Utilization of Home Monitoring During Therapy Optimization in Patients With an Inspire Upper Airway Stimulation System (Comparison of Home Sleep Testing vs. In-lab Polysomnography Testing) Obstructive Sleep Apnea | NA | Completed | 2022-06-10 |
| NCT02293746 ↗ | Inspire® Upper Airway Stimulation (UAS) System German Post-Market Study Obstructive Sleep Apnea | PHASE4 | Completed | 2016-12-11 |
| NCT02675816 ↗ | Inspire® Upper Airway Stimulation System Obstructive Sleep Apnea | PHASE4 | Terminated | 2016-07-01 |
| NCT01161420 ↗ | Stimulation Therapy for Apnea Reduction (Www.theSTARtrial.Com) Obstructive Sleep Apnea | PHASE3 | Completed | 2013-03-01 |
Source: ClinicalTrials.gov (U.S. NIH) · active studies first.
Notable events (8-K)
| Date | Items | |
|---|---|---|
| 2026-06-26 | Reg FDExhibits | filing ↗ |
| 2026-05-05 | Exec/director change5.03Shareholder voteExhibits | filing ↗ |
| 2026-05-04 | ResultsReg FDExhibits | filing ↗ |
| 2026-02-11 | Results5.03Reg FDExhibits | filing ↗ |
| 2026-01-12 | ResultsExec/director changeReg FDExhibits | filing ↗ |
| 2025-11-17 | Other | filing ↗ |
| 2025-11-03 | ResultsReg FDExhibits | filing ↗ |
| 2025-10-10 | Reg FDExhibits | filing ↗ |
Recent filings
| Form | Filed | Period | Accession |
|---|---|---|---|
| 8-K | 2026-06-26 | 2026-06-26 | 0001609550-26-000035 ↗ |
| 8-K | 2026-05-05 | 2026-04-30 | 0001609550-26-000026 ↗ |
| 10-Q | 2026-05-04 | 2026-03-31 | 0001609550-26-000023 ↗ |
| 8-K | 2026-05-04 | 2026-05-04 | 0001609550-26-000021 ↗ |
| 10-K | 2026-02-13 | 2025-12-31 | 0001609550-26-000016 ↗ |
| 8-K | 2026-02-11 | 2026-02-05 | 0001609550-26-000012 ↗ |
| 8-K | 2026-01-12 | 2026-01-09 | 0001609550-26-000006 ↗ |
| 8-K | 2025-11-17 | 2025-11-17 | 0001609550-25-000055 ↗ |
| 8-K | 2025-11-03 | 2025-11-03 | 0001609550-25-000052 ↗ |
| 10-Q | 2025-11-03 | 2025-09-30 | 0001609550-25-000053 ↗ |
| 8-K | 2025-10-10 | 2025-10-10 | 0001609550-25-000046 ↗ |
| 8-K | 2025-08-26 | 2025-08-22 | 0001609550-25-000040 ↗ |